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Background: Angular measurements are commonly used in orthopaedic surgery. No study has addressed measurement variability due to the measurement device itself. It was the purpose of this study to assess measurement variability of articulated versus fixed devices., Methods: Three articulated and 4 fixed goniometers were randomly selected. Thirty-two different angles, ranging from a few degrees to nearly 180 degrees, were drawn with a standard soft-lead marking pencil. The angles were measured by 5 different observers with 7 different goniometers on 2 separate occasions separated by a minimum of 3 weeks. We wished to determine whether the variability of any goniometer was within a +/-1-degree range., Results: There were 1023 (91.3%) absolute differences of 1 degree or less and 97 (8.7%) of more than 1 degree. Intraobserver agreement was 92.0%; 96.9% for fixed and 84.0% for hinged goniometers. Interobserver agreement was of 90.7%; 96.2% for the fixed and 83.4% for the hinged goniometers. Intragoniometer agreement was 91.3%; 96.9% for fixed and 84.0% for hinged goniometers. Intergoniometer agreement was 87.0% with fixed goniometers demonstrating better agreement than hinged goniometers. The overall intraobserver and interobserver measurement variability was +/-2.33 and +/-2.26 degrees, respectively; the overall intragoniometer and intergoniometer measurement variability was +/-2.26 and +/-2.30 degrees, respectively. For fixed goniometers, the intergoniometer measurement variability is +/-2.0 degrees, for hinged goniometers, +/-2.9 degrees, and when using both fixed and hinged goniometers, +/-2.4 degrees. Thus, the fixed goniometers are the ideal type with overall better agreement and measurement variability., Conclusion: Any one orthopaedic surgeon should use the same goniometer at all times, preferably a fixed type, so that measurement variability can be reduced by +/-2.0 degrees. If a physician uses a particular published measurement variability from the literature in which different goniometers were used, then the intraobserver measurement variability will be less than the published value by approximately +/-2 degrees. This is important when faced with the question of a change in an angular measurement being a true change or simply a reflection of measurement error.

Here we show that an affinity proteomics strategy using affinity-purified antibodies raised against recombinant human protein fragments can be used for chromosome-wide protein profiling. The approach is based on affinity reagents raised toward bioinformatics-designed protein epitope signature tags corresponding to unique regions of individual gene loci. The genes of human chromosome 21 identified by the genome efforts were investigated, and the success rates for de novo cloning, protein production, and antibody generation were 85, 76, and 56%, respectively. Using human tissue arrays, a systematic profiling of protein expression and subcellular localization was undertaken for the putative gene products. The results suggest that this affinity proteomics strategy can be used to produce a proteome atlas, describing distribution and expression of proteins in normal tissues as well as in common cancers and other forms of diseased tissues.

The cases of 78 patients with osseous metastases from kidney cancer were reviewed to determine the rate of local progression after operative resection as compared with more traditional intralesional procedures. Group I consisted of 41 (53%) patients who were treated with intralesional procedures involving internal fixation with or without curettage or polymethylmethacrylate. Of the 41 patients, additional operations were recommended for 17 (41%) of the patients who had local osseous progression. Fourteen additional procedures including nine wide resections with reconstruction, three amputations, and two mass excisions were done. Group II consisted of 37 (47%) patients who were treated with marginal or wide resection with or without reconstruction. In this group, only one patient required additional operative intervention for local osseous progression. Median survival of patients in Group I was 20 months compared with 35 months for patients in Group IL This study shows that despite shorter average survival, patients who undergo intralesional surgery are at high risk of reoperation for local progression. Resectional surgery should be considered in patients with skeletal metastases from kidney cancer to lessen the risk of reoperation for local progression.