Genicular Artery embolisation in Patients with Osteoarthritis of the Knee (GENESIS) Using Permanent Microspheres: Long-Term Results.

PURPOSE: To report the 2-year follow-up of patients with mild-to-moderate knee osteoarthritis (OA) treated with genicular artery embolisation (GAE) as part of the GENESIS study. MATERIALS AND METHODS: Forty-six patients, median age = 60 (45-83) underwent GAE using permanent microspheres (100-300 µm). Technical success was defined as embolisation of the targeted genicular arteries. Knee Injury and Osteoarthritis Outcome Score (KOOS) and Visual Analogue Scale (VAS) (0-100 mm) were recorded at baseline, 6 weeks, 3 months, 1, 2 years. Contrast-enhanced MRI knee scans were acquired at baseline and 1 year, and evaluated with the Whole-Organ Magnetic Resonance Imaging Score (WORMS). Functional MRI brain imaging and psychometric assessments were undertaken to investigate correlation between neuropsychological phenotypes and clinical outcome. Adverse events were recorded prospectively. RESULTS: Technical success was achieved in forty patients (87%). Mean VAS improved from 58.63 (SD = 20.57, 95% CI 52.7-65.5) at baselines to 37.7 at 2-years (SD = 26.3, 95% CI 27.0-47.5). Whole and subgroup KOOS were significantly improved at each timepoint with associated reductions in analgesia usage. WORMS analysis demonstrated significant reduction in synovitis (p < 0.05) with no cases of osteonecrosis. Self-limiting skin discolouration occurred in four patients. A self-limiting groin haematoma and single case of deep-vein thrombosis due to immobilisation were also recorded. Nine patients subsequently underwent knee arthroplasty with no additional operational complexities identified. Neuropsychometric assessment elucidated a correlation between baseline catastrophising and greater reduction in pain post GAE. CONCLUSION: GAE is a safe intervention for mild-moderate knee osteoarthritis, with sustained efficacy at 2 years. These results are promising and justify ongoing controlled trials.

Genicular artEry embolizatioN in patiEnts with oSteoarthrItiS of the Knee (GENESIS) Using Permanent Microspheres: Interim Analysis.

PURPOSE: Planned interim analysis of GENESIS; a prospective pilot study investigating the role of genicular artery embolization (GAE) in patients with mild to moderate osteoarthritis of the knee using permanent microspheres. METHODS: Thirty-eight patients, median age = 60 (45-83), attended for GAE using 100-300 µm permanent microspheres. All patients had mild to moderate knee OA, resistant to conservative treatments over 6 months. Knee MRI was performed at baseline, and 12 months, enabling semi-quantitative analysis using Whole-Organ Magnetic Resonance Imaging Score (WORMS). Knee Injury and Osteoarthritis Outcome Score (KOOS) and visual analogue scale (VAS) (0-100 mm) were completed at baseline, 6 weeks, 3 months (n = 32), and 1-year (n = 16). Adverse events were recorded prospectively. RESULTS: Technical success of accessing and embolizing the target genicular arteries was 84%. Six patients were not embolized: four due to a presumed risk of non-target embolization, and two due to a lack of hyperaemic target. Mean VAS improved from 60 (SD = 20, 95% CI 53-66) at baseline to 36 (SD = 24, 95% CI 28-44) at 3 months (p < 0.001) and 45 (SD = 30, 95% CI 30-60) at 1-year (p < 0.05). All KOOS subscales showed a significant improvement at 6-weeks, 3-months, and 1-year follow-up, except function in daily living, which reached borderline significance (p = 0.06) at 1-year. Four patients experienced mild self-limiting skin discoloration over the embolized territory. One patient experienced a small self-limiting groin haematoma. WORMS scores at 1-year follow-up showed significant improvement in synovitis (p < 0.05). There were no cases of osteonecrosis. CONCLUSION: GAE using permanent microspheres in patients with mild to moderate knee OA is safe, with potential efficacy at early follow-up.

The popliteal fibular ligament in acute knee trauma: patterns of injury on MR imaging.

OBJECTIVE: To describe the patterns of injury associated with injury to the popliteofibular ligament injury. MATERIALS AND METHODS: A retrospective review was performed of 180 MRI scans undertaken for acute knee trauma. Scans were excluded if the time of injury was over 4 weeks from the time of the scan, or if there was a history of septic arthritis, inflammatory arthropathy, previous knee surgery, or significant artefact. An agreed criterion for assessing the structures of the posterolateral ligamentous complex was defined and in each scan, the popliteofibular ligament (PFL) was scored as normal or injured. The menisci, ligaments, and tendons of each knee were also assessed. RESULTS: The mean age was 25.7 years (range, 9-65 years) and 72.2% (n = 130) patients were male. The PFL was injured in 36 cases (20%). There is a significant association between PFL injury and ACL rupture (p = 0.0001), ITB injury (p = 0.0001), PCL injury (p = 0.0373), in addition to associations with injury to other posterolateral corner structures including the lateral collateral ligament (p = 0.0001), biceps femoris tendon (p = 0.0014), and popliteus tendon (p = 0.0014). Of our series of PFL injuries, nine cases (25%) were associated with further injuries of posterolateral corner structures and in 27 cases (75%) the PFL was the only posterolateral corner structure torn. CONCLUSIONS: PFL injury is not uncommon in acute knee trauma and is associated with significant internal derangement of the knee, especially anterior cruciate ligament rupture, ITB sprain, and injury to other structures within the posterolateral corner.

Normal anatomical variants of the menisci and cruciate ligaments that may mimic disease.

There are many normal anatomical variants of the knee joint. Some are common and others are rare. With continuing improvements in the spatial resolution of MRI, smaller variants are more clearly demonstrated and can be mistaken for disease. They can all be differentiated from pathological conditions by understanding their anatomy and key differentiating features. This review compares normal variants of the menisci and cruciate ligaments with the pathological disorders that can mimic them.

Regional inequality in radiology research output in the UK: a 5-year bibliometric study.

The objective of this study was to describe the patterns of peer-reviewed general radiology publication rates with reference to deaneries in the UK. This was a retrospective bibliometric analysis of publications in the six highest cited general radiology journals. Publications were identified using a manual search in PubMed between 2005 and 2009. Publications originating from UK radiology departments were identified and subcategorised into primary institution of origin, deanery and publication type. The total number of radiology trainees in each deanery was obtained from the General Medical Council. 913 publications were included in the study. Original papers constituted 48.7% (n=445), review articles 30.3% (n=277) and case reports 17.4% (n=159). The median number of publications in each deanery was 27 [interquartile range (IQR) 11-60], and the median number of publications per trainee was 0.49 (IQR 0.31-0.88). The largest proportion of publications came from the London deanery (n=354, 38.8%), followed by Eastern 86 (9.4%), Oxford and Yorkshire 70 (7.7% each). Relative to the number of trainees within each deanery, Oxford had the highest number of publications per trainee (1.78), followed by East Midlands (1.5), London (1.25) and Eastern (0.99). There was a significantly higher publication rate for those deaneries with academic radiologists (p<0.0001). There is a marked difference in the volume of published work in the general radiology literature among UK deaneries, even accounting for differences in the number of trainees. This probably means that opportunities for training in research are similarly non-uniform.

Phalangeal fractures of the hand.

The present review systematically describes common fractures of the phalanges with reference to the anatomy and the pertinent radiological classifications; in particular, the role of radiology in indicating prognosis, guiding treatment, and revealing subtle injuries, which may cause permanent loss of function.

An accurate and robust gyroscope-gased pedometer.

Pedometers are known to have steps estimation issues. This is mainly attributed to their innate acceleration based measuring sensory. A micro-machined gyroscope (better immunity to acceleration) based pedometer is proposed. Through syntactic data recognition of apriori knowledge of human shank's dynamics and temporally précised detection of heel strikes permitted by Wavelet decomposition, an accurate and robust pedometer is acquired.

Ulnar nerve palsy after open carpal tunnel decompression: Case report and review of the literature.

Open carpal tunnel release is the commonest surgical treatment of median nerve compression at the wrist. Although successful in most cases, there are well described complications. We report a case of laceration of the deep motor branch of the ulnar nerve at the level of the hook of hamate following a complicated carpal tunnel decompression. Good surgical technique and knowledge of wrist anatomy are essential for performing this apparently simple procedure safely.

Wireless On-Body-Network breathing rate and depth measurement during activity.

This paper describes a method of detecting and analyzing breathing rate and approximate depth during physical activity in a Bluetooth Wireless On-Body-Network (OBN) in the context of a Spinal Cord Injured patient. Conventional signal processing techniques and sensor fusion through a Linear Kalman Filter will be used to fuse signals from a piezoelectric breathing band and two tri-axis accelerometers. Results will show that the proposed method provides very accurate measurements of breathing rate and depth at rest and during physical activity.

Thymic carcinoma - an unusual cause for unilateral breast oedema.

An 83-year-old lady presented with oedema of the right breast with no focal masses and was found to have a tumour of thymic origin in the anterior mediastinum. We describe this interesting case along with a review of the causes of unilateral breast oedema.

Evolution of a molecular switch: universal bacterial GTPases regulate ribosome function.

The GTPases comprise a protein superfamily of highly conserved molecular switches adapted to many diverse functions. These proteins are found in all domains of life and often perform essential roles in fundamental cellular processes. Analysis of data from genome sequencing projects demonstrates that bacteria possess a core of 11 universally conserved GTPases (elongation factor G and Tu, initiation factor 2, LepA, Era, Obg, ThdF/TrmE, Ffh, FtsY, EngA and YchF). Investigations aimed at understanding the function of GTPases indicate that a second conserved feature of these proteins is that they elicit their function through interaction with RNA and/or ribosomes. An emerging concept suggests that the 11 universal GTPases are either necessary for ribosome function or transmitting information from the ribosome to downstream targets for the purpose of generating specific cellular responses. Furthermore, it is suggested that progenitor GTPases were early regulators of RNA function and may have existed in precursors of cellular systems driven by catalytic RNA. If this is the case, then a corollary of this hypothesis is that GTPases that do not bind RNA arose at a later time from an RNA-binding progenitor that lost the capability to bind RNA.

Familial idiopathic megaduodenum.

Familial idiopathic megaduodenum is an uncommon condition which may be associated with other visceral abnormalities. Antineuronal antibody directed against guinea-pig skeletal muscle was found in one member of the family suffering from megaduodenum, in whom degeneration of the Auerbach's and Meissner's plexuses was documented. The significance of this finding is unclear. Management of the complaint is problematic. Despite shortcomings of surgical treatment, surgery nevertheless has an important role to play when medical treatments fail.