The diagnosis of primary central nervous system lymphoma (PCNSL) depends on histopathology of brain biopsies, because disease markers in the cerebrospinal fluid (CSF) with sufficient diagnostic accuracy are not available yet. MicroRNAs (miRNAs) are regulatory RNA molecules that are deregulated in many disease types, including cancer. Recently, miRNAs have shown promise as markers for cancer diagnosis. In this study, we demonstrate that miRNAs are present in the CSF of patients with PCNSL. With a candidate approach and miRNA quantification by reverse transcription polymerase chain reaction, miRNAs with significant levels in the CSF of patients with PCNSL were identified. MiR-21, miR-19, and miR-92a levels in CSF collected from patients with PCNSL and from controls with inflammatory CNS disorders and other neurologic disorders indicated a significant diagnostic value of this method. Receiveroperating characteristic analyses showed area under the curves of 0.94, 0.98, and 0.97, respectively, for miR-21, miR-19, and miR-92a CSF levels in discriminating PCNSL from controls. More importantly, combined miRNA analyses resulted in an increased diagnostic accuracy with 95.7% sensitivity and 96.7% specificity. We also demonstrated a remarkable stability of miRNAs in the CSF. In conclusion, CSF miRNAs are potentially useful tools as novel noninvasive biomarker for the diagnosis of PCNSL. (Blood. 2011;117(11):3140-3146) IntroductionUnraveling the cause of focal brain lesions in patients with unexplained neurologic symptoms remains a clinical challenge. Especially in patients with primary central nervous system lymphoma (PCNSL), definitive diagnosis often is not possible on the basis of radiographic features and responsiveness to corticosteroids, which both do not specifically distinguish between lymphoma and inflammatory central nervous system (CNS) disease. 1,2 In most patients with suspected CNS lymphoma who present with rapidly deteriorating neurologic symptoms, stereotactic brain biopsy remains the diagnostic procedure of choice. However, CNS biopsies are associated with the risk of hemorrhage and neurologic damage, and a definitive histopathologic diagnosis cannot always be achieved. 1 Because PCNSLs represent highly aggressive tumors, early diagnosis is essential for successful treatment and improvement of disease prognosis. 1,[3][4][5] Although evaluation of the cerebrospinal fluid (CSF) is less invasive than brain biopsy, cytopathologic, immunophenotypic, and genetic analyses of CSF cells are much less sensitive. [6][7][8] Protein markers within the CSF include antithrombin, 9 soluble CD27, 10 and free immunoglobulin light chains. 11 They have been shown to be helpful with improved diagnostic sensitivities; however, their utility in accurate diagnosis of PCNSL from the CSF has not finally been established. 1 MicroRNAs (miRNAs) are small regulatory RNA molecules that bind the 3Ј-untranslated regions of mRNA transcripts and inhibit gene expression at a posttranscriptional level by interference with translational initia...

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Firstly, bilateral post-operative low-dose -similar radiation exposure as plain chest radiographs- CT assessment of tibial rotational alignment is a reliable diagnostic imaging modality to assess rotational malalignment in patients following IMN of tibial shaft fractures and it allows for early revision surgery. Secondly, it may contribute to our understanding of the incidence-, predictors- and clinical relevance of post-operative tibial rotational malalignment in patients treated with IMN for a tibial shaft fracture, and facilitates future studies on this topic.

Purpose: To examine the results of isolated arthroscopic posterior labral repair of the shoulder in an active military population, looking specifically at the reoperation rate and rate of return to previous military activity with a minimum follow-up period of 2 years. Methods: A retrospective case series was performed in active-duty military service members who underwent isolated, primary arthroscopic posterior labral repair at a single academic military treatment facility between 2009 and 2015 and had at least 2 years of follow-up. Patients were excluded if they were of noneactive-duty status, had insufficient follow-up (<2 years), or had undergone a concurrent procedure. Injury presentation, demographic data, and surgical data (i.e., surgical positioning, number of anchors, and anchor placement location) were compiled manually. Outcomes including the rate of return to active duty, recurrence of symptoms, and need for revision surgery were evaluated. Results: Sixty-five patients were included. After arthroscopic repair, a high rate of return to previous military duties (83%) was noted at short-to mid-term follow-up (mean AE standard deviation, 3.04 AE 1.30 years), with 1 patient (1.5%) requiring revision arthroscopic repair and 10 patients (15.5%) showing activity-limiting shoulder pain preventing a return to active duty. Intraoperative positioning (P ¼ .17), a low anchor position (P ¼ .27), and the number of anchors used (P ¼ .62) were not found to be significant contributors to continued postoperative pain or recurrent instability. Conclusions: Arthroscopic intervention resulted in a reliable rate of glenohumeral stability with a low rate of surgical revision and a high rate of return to military duty at short-to mid-term follow-up. However, 1 in 6 military service members showed significant, activity-limiting shoulder pain postoperatively that did not permit a return to previous military activities after surgical intervention. Level of Evidence: Level IV, therapeutic case series.