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Journal of Orthopaedic Surgery and... Apr 2024The goal of this study is to propose a classification system with a common nomenclature for radiographic observations of periprosthetic bone changes following cTDR.
BACKGROUND
The goal of this study is to propose a classification system with a common nomenclature for radiographic observations of periprosthetic bone changes following cTDR.
METHODS
Aided by serial plain radiographs from recent cTDR cases (34 patients; 44 devices), a panel of experts assembled for the purpose of creating a classification system to aid in reproducibly and accurately identifying bony changes and assessing cTDR radiographic appearance. Subdividing the superior and inferior vertebral bodies into 3 equal sections, observed bone loss such as endplate rounding, cystic erosion adjacent to the endplate, and cystic erosion not adjacent to the endplate, is recorded. Determining if bone loss is progressive, based on serial radiographs, and estimating severity of bone loss (measured by the percentage of end plate involved) is recorded. Additional relevant bony changes and device observations include radiolucent lines, heterotopic ossification, vertebral body olisthesis, loss of core implant height, and presence of device migration, and subsidence.
RESULTS
Serial radiographs from 19 patients (25 devices) implanted with a variety of cTDR designs were assessed by 6 investigators including clinicians and scientists experienced in cTDR or appendicular skeleton joint replacement. The overall agreement of assessments ranged from 49.9% (95% bootstrap confidence interval 45.1-73.1%) to 94.7% (95% CI 86.9-100.0%). There was reasonable agreement on the presence or absence of bone loss or radiolucencies (range: 58.4% (95% CI 51.5-82.7%) to 94.7% (95% CI 86.9-100.0%), as well as in the progression of radiolucent lines (82.9% (95% CI 74.4-96.5%)).
CONCLUSIONS
The novel classification system proposed demonstrated good concordance among experienced investigators in this field and represents a useful advancement for improving reporting in cTDR studies.
Topics: Humans; Treatment Outcome; Diskectomy; Total Disc Replacement; Cervical Vertebrae; Neck; Intervertebral Disc Degeneration
PubMed: 38566203
DOI: 10.1186/s13018-024-04679-y -
The American Journal of Case Reports Mar 2024BACKGROUND Erdheim-Chester disease (ECD) is a rare neoplasm of histiocytes that is characterized by prominent involvement of the long bones. Approximately 1500 cases...
BACKGROUND Erdheim-Chester disease (ECD) is a rare neoplasm of histiocytes that is characterized by prominent involvement of the long bones. Approximately 1500 cases have been reported since the disease was first described in 1930. The imaging appearance of ECD can be highly variable given the numerous systems it can affect. In this case report we discuss a patient whose ECD was occult on multiple imaging modalities. CASE REPORT We report the case of a 60-year-old woman who presented with sub-acute left knee and calf pain that led to an MRI. She was found to have innumerable marrow-replacing lesions in the axial and appendicular skeleton visualized on the initial MRI, as well as on an ¹⁸F-FDG PET/CT scan. The patient did not have extraosseous abnormal uptake on the PET/CT. Subsequently, a lesion from the left iliac bone was histologically confirmed as ECD on the basis of positive staining for CD68 and CD163 and negative staining for CD1a. Osseous lesions in ECD have a distinct imaging appearance and are typically detected by radiography and bone scintigraphy, among other modalities; however, the lesions in this case were unexpectedly absent from those studies. CONCLUSIONS If there is a high degree of suspicion for ECD, 18F-FDG PET/CT and/or MRI may be necessary for adequate visualization of bone lesions, given that those lesions can have an infiltrative nature that may be difficult to image with other anatomic imaging modalities. Use of 18F-FDG PET/CT and/or MRI may also lead to adequate guidance of confirmatory biopsy.
Topics: Female; Humans; Middle Aged; Positron Emission Tomography Computed Tomography; Fluorodeoxyglucose F18; Erdheim-Chester Disease; Magnetic Resonance Imaging; Tomography, X-Ray Computed
PubMed: 38553814
DOI: 10.12659/AJCR.941169 -
JBMR Plus Apr 2024Achondroplasia (ACH) is a skeletal dysplasia characterized by short-limbed short stature caused by the gain-of-function mutations in the fibroblast growth factor...
Achondroplasia (ACH) is a skeletal dysplasia characterized by short-limbed short stature caused by the gain-of-function mutations in the fibroblast growth factor receptor 3 (FGFR3) gene. Activated FGFR3, which is a negative regulator of bone elongation, impairs the growth of long bones and the spinal arch by inhibiting chondrocyte proliferation and differentiation. Most patients with ACH have spinal canal stenosis in addition to short stature. Meclozine has been found to inhibit FGFR3 via drug repurposing. A 10-d treatment with meclozine promoted long-bone growth in a mouse model of ACH ( mice). This study aimed to evaluate the effects of long-term meclozine administration on promoting bone growth and the spinal canal in mice. Meclozine (2 mg/kg/d) was orally administered to mice for 5 d per wk from the age of 7 d to 56 d. Meclozine (2 mg/kg/d) significantly reduced the rate of death or paralysis and improved the length of the body, cranium, and long bones in male and female mice. Micro-computed tomography analysis revealed that meclozine ameliorated kyphotic deformities and trabecular parameters, including BMD, bone volume/tissue volume, trabecular thickness, and trabecular number at distal femur of mice in both sexes. Histological analyses revealed that the hypertrophic zone in the growth plate was restored in mice following meclozine treatment, suggesting upregulation of endochondral ossification. Skeletal preparations demonstrated that meclozine restored the spinal canal diameter in mice in addition to improving the length of each bone. The 2 mg/kg/d dose of meclozine reduced the rate of spinal paralysis caused by spinal canal stenosis, maintained the growth plate structure, and recovered the bone quality and growth of axial and appendicular skeletons of mice in both sexes. Long-term meclozine administration has the potential to ameliorate spinal paralysis and bone growth in patients with ACH.
PubMed: 38544920
DOI: 10.1093/jbmrpl/ziae018 -
Journal of Human Evolution Apr 2024Biased skeletal part representation is a key element for making inferences about transport decisions, carcass procurement, and use patterns in anthropogenic...
Biased skeletal part representation is a key element for making inferences about transport decisions, carcass procurement, and use patterns in anthropogenic accumulations. In the absence of destructive taphonomic processes, it is often assumed that the abundance of different anatomical portions represents selective transport and discard patterns of human groups. Because body parts may be transported for specific products such as meat, marrow or grease, a pattern that usually attracts attention in many archaeological sites is the low proportions of appendicular epiphyses. Here we present the case of faunal assemblages from the lower stratigraphic sequence of Qesem Cave, Israel, dated to ca. 430 to 300 ka. All bone accumulations are characterized by a biased skeletal profile including mainly long-limb bones and a virtual absence of epiphyses. The assemblages also show density-mediated attrition not linked to fossil-diagenetic processes, a targeted specific destruction to the most greasy articular ends and an almost total absence of carnivore intervention. Our goal here is to explore the processes that entail the destruction of appendicular epiphyses at Qesem Cave, as well as propose viable hypotheses to explain their underrepresentation on-site. Our results shed light on the domestic activities linked to the processing of bones at the site and support the importance of animal grease in the caloric intake of Middle Pleistocene humans.
Topics: Animals; Humans; Israel; Hominidae; Bone and Bones; Fossils; Caves; Archaeology
PubMed: 38518437
DOI: 10.1016/j.jhevol.2024.103509 -
Bone & Joint Open Mar 2024The aim of this study is to determine the predictors of overall survival (OS) and predictive factors of poor prognosis of conventional high-grade osteosarcoma of the...
AIMS
The aim of this study is to determine the predictors of overall survival (OS) and predictive factors of poor prognosis of conventional high-grade osteosarcoma of the limbs in a single-centre in South Africa.
METHODS
We performed a retrospective cross-sectional analysis to identify the prognostic factors that predict the OS of patients with histologically confirmed high-grade conventional osteosarcoma of the limbs over ten years. We employed the Cox proportional regression model and the Kaplan-Meier method for statistical analysis.
RESULTS
This study comprised 77 patients at a three-year minimum follow-up. The predictors of poor OS were: the median age of ≤ 19 years (hazard ratio (HR) 0.96; 95% confidence interval (CI) 0.92 to 0.99; p = 0.021); median duration of symptoms ≥ five months (HR 0.91; 95% CI 0.83 to 0.99; p < 0.037); metastasis at diagnosis (i.e. Enneking stage III) (HR 3.33; 95% CI 1.81 to 6.00; p < 0.001); increased alkaline phosphatase (HR 3.28; 95% CI 1.33 to 8.11; p < 0.010); palliative treatment (HR 7.27; 95% CI 2.69 to 19.70); p < 0.001); and amputation (HR 3.71; 95% CI 1.12 to 12.25; p < 0.032). In contrast, definitive surgery (HR 0.11; 95% CI 0.03 to 0.38; p < 0.001) and curative treatment (HR 0.18; 95% CI 0.10 to 0.33; p < 0.001) were a protective factor. The Kaplan-Meier median survival time was 24 months, with OS of 57.1% at the three years. The projected five-year event-free survival was 10.3% and OS of 29.8% (HR 0.76; 95% CI 0.52 to 1.12; p = 0.128).
CONCLUSION
In this series of high-grade conventional osteosarcoma of the appendicular skeleton from South Africa, 58.4% (n = 45) had detectable metastases at presentation; hence, an impoverished OS of five years was 29.8%. Large-scale future research is needed to validate our results.
PubMed: 38471520
DOI: 10.1302/2633-1462.53.BJO-2023-0159.R1 -
Academic Radiology Mar 2024Aiming to offset image quality limitations in radiographs due to superimposition, this study investigates the diagnostic potential of appendicular skeleton tomosynthesis.
RATIONALE AND OBJECTIVES
Aiming to offset image quality limitations in radiographs due to superimposition, this study investigates the diagnostic potential of appendicular skeleton tomosynthesis.
MATERIALS AND METHODS
Eight cadaveric extremities (four hands and feet) were examined employing the prototypical tomosynthesis mode of a twin robotic X-ray scanner. 12 protocols with varying sweep angles (10, 20 vs. 40°), frame rates (13 vs. 26 fps), and tube voltages (60 vs. 80 kV) were compared to radiographs. Four radiologists separately evaluated cortical and trabecular bone visualization and fracture patterns. Interreader reliability was assessed based on the intraclass correlation coefficient (ICC).
RESULTS
Radiation dose in radiography was 0.59 ± 0.20 dGy * cm versus 0.11 ± 0.00 to 2.46 ± 0.17 dGy * cm for tomosynthesis. Cortical bone display was inferior for radiographs compared to 40° and 20° tomosynthesis. Best results were ascertained for the 80 kV/40°/26 fps protocol. Trabecular bone depiction was also superior in tomosynthesis (p ≤ 0.009) and best with the 80 kV/10°/26 fps setting. Interreader reliability was moderate for cortical bone display (ICC 0.521, 95% confidence interval 0.356-0.641) and good for trabecular bone (0.759, 0.697-0.810). Diagnostic accuracy for articular involvement and multifragment situations was higher in tomosynthesis (93.8-100%/92.2-100%) vs. radiography (85.9%/82.8%.). Diagnostic confidence was also better in tomosynthesis (p ≤ 0.003).
CONCLUSION
Compared to radiography, tomosynthesis allows for superior assessability of cortical and trabecular bone and fracture morphology, especially at high framerates. Operating on a multipurpose X-ray system, tomosynthesis of the appendicular skeleton can be performed without additional scanner hardware.
PubMed: 38448327
DOI: 10.1016/j.acra.2024.02.020 -
Radiography (London, England : 1995) Mar 2024New Zealand has seen an increase in the X-ray examinations in the emergency departments (ED), and the radiology report is generally unavailable immediately. This...
The impact of intensive training in preliminary image evaluation (PIE) for radiographers in the emergency department of a regional hospital in New Zealand - A pilot study.
INTRODUCTION
New Zealand has seen an increase in the X-ray examinations in the emergency departments (ED), and the radiology report is generally unavailable immediately. This requires practitioners managing the patient to take the responsibility of detecting any abnormalities in the images and using such information for the management of the patient. There is, therefore, a need for consideration of the contribution that radiographers could make in the accurate management of the patients in ED in New Zealand. The aim of this study was to assess if an intensive preliminary image evaluation (PIE) training course improved radiographer accuracy, sensitivity, and specificity on extremity X-ray examinations in a regional ED in New Zealand.
METHOD
A pre-post-intervention design was employed for this study. Seven radiographers working at a regional base hospital in New Zealand undertook image evaluation tests to evaluate their ability to detect and describe abnormalities prior to and following a 2-day intensive PIE training course. The training concentrated on acute extremity abnormalities. Tests were then scored to determine sensitivity, specificity, and accuracy.
RESULTS
Following an intensive PIE training course, the post-intervention test mean demonstrated an improved sensitivity by an average of 3.99% (89.01-93.0), specificity improved by an average of 6.13% (79.77-85.90%), and accuracy improved by an average of 3.33% (77.55-80.87%).
CONCLUSION
This study demonstrated that an intensive training course in PIE improved the participants' sensitivity, specificity, and accuracy when evaluating acute extremity X-ray examinations in ED at the study site, however further research is required to see if these results also represent clinical ability.
IMPLICATION FOR PRACTICE
The NZ healthcare system could benefit by the introduction of a radiographers' PIE system. It is therefore recommended that when introducing PIE into an ED in New Zealand, radiographers should undertake additional training to improve image evaluation sensitivity, specificity, and accuracy prior to participation.
Topics: Humans; Radiology; Pilot Projects; New Zealand; Clinical Competence; Emergency Service, Hospital
PubMed: 38394826
DOI: 10.1016/j.radi.2024.02.008 -
Molecular Imaging and Radionuclide... Feb 2024A biopsy-proven patient with prostate carcinoma aged 70 years was referred to the department of nuclear medicine for radionuclide-based therapy. His prostate-specific...
A biopsy-proven patient with prostate carcinoma aged 70 years was referred to the department of nuclear medicine for radionuclide-based therapy. His prostate-specific antigen levels were >1000 ng/mL, and prostatic magnetic resonance imaging showed an enlarged prostate with a heterogeneous signal and size 3.8x3.7x3.5 cm with few small heterogeneous nodular signals in the transition zone. He was scheduled for F prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) scan before therapy. F PSMA PET/CT revealed PSMA-expressing prostate lesions (maximum standardized uptake value ~10.2) with extension into the urinary bladder along with bilateral supraclavicular, mediastinal, retrocrural, retroperitoneal, and pelvic lymph nodes and sclerotic lesions in the entire axial and appendicular skeleton.
PubMed: 38390777
DOI: 10.4274/mirt.galenos.2023.68815 -
Biology Open Feb 2024Limb regeneration in salamanders is achieved by a complex coordination of various biological processes and requires the proper integration of new tissue with old. Among... (Review)
Review
Limb regeneration in salamanders is achieved by a complex coordination of various biological processes and requires the proper integration of new tissue with old. Among the tissues found inside the limb, the skeleton is the most prominent component, which serves as a scaffold and provides support for locomotion in the animal. Throughout the years, researchers have studied the regeneration of the appendicular skeleton in salamanders both after limb amputation and as a result of fracture healing. The final outcome has been widely seen as a faithful re-establishment of the skeletal elements, characterised by a seamless integration into the mature tissue. The process of skeletal integration, however, is not well understood, and several works have recently provided evidence of commonly occurring flawed regenerates. In this Review, we take the reader on a journey through the course of bone formation and regeneration in salamanders, laying down a foundation for critically examining the mechanisms behind skeletal integration. Integration is a phenomenon that could be influenced at various steps of regeneration, and hence, we assess the current knowledge in the field and discuss how early events, such as tissue histolysis and patterning, influence the faithful regeneration of the appendicular skeleton.
Topics: Animals; Humans; Locomotion; Osteogenesis; Research Personnel; Urodela
PubMed: 38319134
DOI: 10.1242/bio.060152