The normal ischiofemoral distance and its variations.

The aim of this study is to measure the ischiofemoral distance (IFD) in the normal hip with healthy surrounding soft tissues and describe its variations caused by gender, age and proximal femoral anatomy so that this could serve as a reference for future studies on this subject. This is a retrospective study in which we reviewed the CT scans of 149 patients (298 hips) who had a CT of their pelvis for non-orthopaedic (abdomino-pelvic) pathology. The images were reviewed by two independent observers and the IFD (the smallest distance between the lateral cortex of the ischial tuberosity and the posteromedial cortex of the lesser trochanter), offset (the perpendicular distance from the centre of the femoral head to a line running down the middle of the shaft of the femur) and the neck-shaft angle (the angle between the lines in the middle of the neck to the line forming the axis of the femoral shaft) were measured. The CT scans belonged to 71 males and 78 females (M: 48%, F: 52%), with an average age of 51  ± 19 years (range 18-92). The mean IFD was 18.6  ±  8 mm in the females and 23  ± 7 mm in the males and this difference was statistically significant (P <  0.001). The IFD increased by 1.06 mm for each 1 mm of offset and dropped by 0.09 mm with each year of age. However, the neck-shaft angle did not show any significant correlation with the IFD.This is the final version of the article. It first appeared from Oxford University Press via http://dx.doi.org/10.1093/jhps/hnw00

A Comprehensive Single Institutional Review of 2 Years in a Designated Fast-Track Sarcoma Diagnostic Clinic Linked with a Sarcoma Specialist Advisory Group: Meeting the Target but Failing the Task?

Background. National guidelines prompted the implementation of a designated two-week wait referral pathway to facilitate the early diagnosis of sarcomas, to improve treatment outcomes. Methods. Patients referred to the Cambridge Sarcoma Diagnostic Clinic between January 2013 and December 2014 were identified through the electronic appointments system. Information was retrospectively retrieved about patient characteristics and details of the diagnostic pathway. Results. 17.3% of patients referred (69/397) were diagnosed with a malignancy. Of these, 59.3% (41/69) had primary sarcomas, 17.4% (12/69) had metastatic cancer, and 23.2% (16/69) had a different primary malignancy. 15% of the 41 sarcomas were 10 cm. Sarcomas diagnosed through this clinic represented 13% (41/315) of sarcomas managed at the centre during the same 2 years. Conclusion. While we achieved the target of 10% (41/397) sarcoma diagnosis rate in the rapid access clinic, only 15% of these were <5 cm better prognosis lesions. This calls into question the "real world" impact of such diagnostic clinics on early diagnosis of sarcomas. In order to enhance generic cancer diagnostic skills, training in these diagnostic clinics could be usefully integrated into national training curricula for both surgical and nonsurgical oncologists.This is the final version of the article. It first appeared from the Hindawi Publishing Corporation via http://dx.doi.org/10.1155/2016/603260

5-hydroxytryptamine (5-HT) cellular sequestration during chronic exposure delays 5-HT₃ receptor resensitization due to Its subsequent release

The serotonergic synapse is dynamically regulated by serotonin (5-hydroxytryptamine (5-HT)) with elevated levels leading to the down-regulation of the serotonin transporter and a variety of 5-HT receptors, including the 5-HT type-3 (5-HT(3)) receptors. We report that recombinantly expressed 5-HT(3) receptor binding sites are reduced by chronic exposure to 5-HT (IC(50) of 154.0 ± 45.7 μm, t(½) = 28.6 min). This is confirmed for 5-HT(3) receptor-induced contractions in the guinea pig ileum, which are down-regulated after chronic, but not acute, exposure to 5-HT. The loss of receptor function does not involve endocytosis, and surface receptor levels are unaltered. The rate and extent of down-regulation is potentiated by serotonin transporter function (IC(50) of 2.3 ± 1.0 μm, t(½) = 3.4 min). Interestingly, the level of 5-HT uptake correlates with the extent of down-regulation. Using TX-114 extraction, we find that accumulated 5-HT remains soluble and not membrane-bound. This cytoplasmically sequestered 5-HT is readily releasable from both COS-7 cells and the guinea pig ileum. Moreover, the 5-HT level released is sufficient to prevent recovery from receptor desensitization in the guinea pig ileum. Together, these findings suggest the existence of a novel mechanism of down-regulation where the chronic release of sequestered 5-HT prolongs receptor desensitization

Patient characteristics and clinical management of patients with shoulder pain in U.S. primary care settings: Secondary data analysis of the National Ambulatory Medical Care Survey

BACKGROUND: Although shoulder pain is a commonly encountered problem in primary care, there are few studies examining its presenting characteristics and clinical management in this setting. METHODS: We performed secondary data analysis of 692 office visits for shoulder pain collected through the National Ambulatory Medical Care Survey (Survey years 1993–2000). Information on demographic characteristics, history and place of injury, and clinical management (physician order of imaging, physiotherapy, and steroid intraarticular injection) were examined. RESULTS: Shoulder pain was associated with an injury in one third (33.2% (230/692)) of office visits in this population of US primary care physicians. Males, and younger adults (age ≤ 52) more often associated their shoulder pain with previous injury, but there were no racial differences in injury status. Injury-related shoulder pain was related to work in over one-fifth (21.3% (43/202)) of visits. An x-ray was performed in 29.0% (164/566) of office visits, a finding that did not differ by gender, race, or by age status. Other imaging (CT scan, MRI, or ultrasound) was infrequently performed (6.5%, 37/566). Physiotherapy was ordered in 23.9% (135/566) of visits for shoulder pain. Younger adults and patients with a history of injury more often had physiotherapy ordered, but there was no significant difference in the ordering of physiotherapy by gender or race. Examination of the use of intraarticular injection was not possible with this data set. CONCLUSION: These data from the largest sample of patients with shoulder pain presenting to primary care settings offer insights into the presenting characteristics and clinical management of shoulder pain at the primary care level. The National Ambulatory Medical Care Survey is a useful resource for examining the clinical management of specific symptoms in U.S. primary care offices

Altered 5-hydroxytryptamine signaling in patients with constipation- and diarrhea-predominant irritable bowel syndrome

Background &amp; Aims: Evidence suggests that postprandial platelet-depleted plasma 5-hydroxytryptamine (5-HT) concentrations may be abnormal in irritable bowel syndrome (IBS). However, interpretation of the data has been hampered by the variable methodology and rather small numbers used in previous studies. Therefore, the aim of this study was to measure concentrations of platelet-depleted plasma 5-HT and its metabolite 5-HIAA under fasting and fed conditions in a large group of patients with diarrhea-predominant (d-) and constipation-predominant (c-) IBS, compared with controls. The ratio of plasma 5-HIAA:5-HT and platelet stores was also assessed. Methods: Twenty-nine c-IBS patients (aged, 19-53 years), 55 d-IBS patients (aged, 19-52 years), and 35 healthy volunteers (aged, 18-46 years) had platelet-depleted plasma 5-HT/5-HIAA concentrations measured using reverse-phase, high-performance liquid chromatography with fluorimetric detection before and after a standard meal. Results: d-IBS patients had raised platelet-depleted plasma 5-HT concentrations under fasting and fed conditions (P &lt;.05). However, the postprandial relative to fasting concentration was similar to controls. In contrast, c-IBS patients failed to show an increase in platelet-depleted plasma 5-HT concentration with meal ingestion compared with controls (P &lt;.01). c-IBS was associated with decreased 5-HIAA (P &lt;.01) but normal 5-HIAA:5-HT ratio and d-IBS with normal 5-HIAA concentrations but reduced 5-HIAA:5-HT ratio (P &lt;.005). C-IBS but not d-IBS patients had increased platelet 5-HT. Conclusions: These results support the concept that d-IBS is characterized by reduced 5-HT reuptake, whereas impaired release may be a feature of c-IBS. These results also provide a rational basis for current pharmacologic approaches involving modulation of different 5-HT receptors in c- and d-IBS. © 2006 by the American Gastroenterological Association

ITER materials irradiation within the D-T neutron environment at JET: post-irradiation radioactivity analysis following the DTE2 experimental campaign

This work presents the results following the first irradiation of ITER materials samples in a tokamak D-T plasma environment operating at significant fusion power. The materials exposed to this nuclear environment at the Joint European Torus during the DTE2 experimental campaign that took place in 2021 include representative ITER samples from various components such as poloidal field coil jacket samples, toroidal field coil radial closure plate steels, EUROFER 97 steel, W and CuCrZr materials from the divertor, Inconel-718 and 316L stainless steel for blanket modules, as well as vacuum vessel forging samples. The experimental results discussed include high-resolution gamma spectrometry measurements and analysis conducted with the post-irradiated samples, of which there were 68 in total. These samples were exposed through different experimental campaigns, including deuterium, deuterium-tritium and tritium phases. Diagnostics that supported the analysis included 25 dosimetry foil-based neutron diagnostics and two ‘VERDI’ neutron spectrometry diagnostics. A further 12 samples for positron annihilation spectroscopy were also irradiated. The irradiation of all these samples took place in a long-term irradiation assembly located near the JET vacuum vessel. The post-irradiation analysis of the ITER material samples has yielded valuable insights into their material activation levels and radiation fields. Comparative assessments between experimental measurements and comprehensive neutronics simulations have demonstrated a significant level of agreement in this work, while also revealing some discrepancies in specific material instances. The data and interpretation from this work not only serve as a robust experimental foundation for enhancing the precision and predictability of neutronics simulation approaches for ITER and next-step devices but also present some opportunities for the refinement of simulation methodologies. In light of these findings, a series of recommendations have been proposed, aimed at improving confidence in nuclear predictions associated with materials that have been exposed to fusion nuclear environments and advancing understanding in this important domain