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Balachandran A, Pei H, Beard J, Caspi A, Cohen A, Domingue BW, Eckstein Indik C, Ferrucci L, Furuya A, Kothari M, Moffitt TE, Ryan C, Skirbekk V, Zhang Y, Belsky DW. Pace of Aging in older adults matters for healthspan and lifespan. medRxiv 2024:2024.04.25.24306359. [PMID: 38712264 PMCID: PMC11071564 DOI: 10.1101/2024.04.25.24306359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
As societies age, policy makers need tools to understand how demographic aging will affect population health and to develop programs to increase healthspan. The current metrics used for policy analysis do not distinguish differences caused by early-life factors, such as prenatal care and nutrition, from those caused by ongoing changes in people's bodies due to aging. Here we introduce an adapted Pace of Aging method designed to quantify differences between individuals and populations in the speed of aging-related health declines. The adapted Pace of Aging method, implemented in data from N=13,626 older adults in the US Health and Retirement Study, integrates longitudinal data on blood biomarkers, physical measurements, and functional tests. It reveals stark differences in rates of aging between population subgroups and demonstrates strong and consistent prospective associations with incident morbidity, disability, and mortality. Pace of Aging can advance the population science of healthy longevity.
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Affiliation(s)
- A Balachandran
- Robert N Butler Columbia Aging Center, Columbia University Mailman School of Public Health, New York, NY, USA
| | - H Pei
- Robert N Butler Columbia Aging Center, Columbia University Mailman School of Public Health, New York, NY, USA
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - J Beard
- Robert N Butler Columbia Aging Center, Columbia University Mailman School of Public Health, New York, NY, USA
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
- Department of Health Policy & Management, Columbia University Mailman School of Public Health, New York, NY, USA
| | - A Caspi
- Department of Psychology & Neuroscience, Duke University, Durham, NC, USA
- Social, Genetic, and Developmental Psychiatry Unit, Institute of Psychiatry, Kings College, University of London, London, UK
| | - A Cohen
- Robert N Butler Columbia Aging Center, Columbia University Mailman School of Public Health, New York, NY, USA
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY, USA
| | - BW Domingue
- Graduate School of Education, Stanford University, Palo Alto, CA, USA
| | - C Eckstein Indik
- Robert N Butler Columbia Aging Center, Columbia University Mailman School of Public Health, New York, NY, USA
| | - L Ferrucci
- National Institute on Aging, Bethesda, MD, USA
| | - A Furuya
- Robert N Butler Columbia Aging Center, Columbia University Mailman School of Public Health, New York, NY, USA
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - M Kothari
- Robert N Butler Columbia Aging Center, Columbia University Mailman School of Public Health, New York, NY, USA
| | - TE Moffitt
- Social, Genetic, and Developmental Psychiatry Unit, Institute of Psychiatry, Kings College, University of London, London, UK
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY, USA
| | - C Ryan
- Robert N Butler Columbia Aging Center, Columbia University Mailman School of Public Health, New York, NY, USA
| | - V Skirbekk
- Norwegian Institute for Public Health, Oslo, Norway
| | - Y Zhang
- Robert N Butler Columbia Aging Center, Columbia University Mailman School of Public Health, New York, NY, USA
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, USA
| | - DW Belsky
- Robert N Butler Columbia Aging Center, Columbia University Mailman School of Public Health, New York, NY, USA
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
- Department of Health Policy & Management, Columbia University Mailman School of Public Health, New York, NY, USA
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2
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Jenkins V, Starkings R, Teoh M, May S, Bloomfield D, Zammit C, Elwell-Sutton D, Betal D, Finlay J, Nicholson K, Kothari M, Santos R, Stewart E, Bell S, McKinna F, Matthews L. Patients' views and experiences on the supported self-management/patient-initiated follow up pathway for breast cancer. Support Care Cancer 2023; 31:658. [PMID: 37889343 PMCID: PMC10611591 DOI: 10.1007/s00520-023-08115-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 10/11/2023] [Indexed: 10/28/2023]
Abstract
PURPOSE To explore patients' expectations and experience of Supportive Self-Management (SSM)/ Patient Initiated Follow Up (PIFU) following breast cancer treatments over a 12-month period. METHODS In total, 32/110 (29%) patient participants in the PRAGMATIC (Patients' experiences of a suppoRted self-manAGeMent pAThway In breast Cancer) study were interviewed at baseline, 3, 6, 9 and 12 months. Interviews in this sub-study used a mix-methods approach to explore understanding of the pathway, confidence in self-management, triggers to seek help and/or re-engage with the clinical breast team and impact of the COVID-19 pandemic. Responses to pre-assigned categories were summarised as counts/ percentages and collated in tabular or graphic format. Free responses were recorded verbatim and reviewed using framework analysis. RESULTS Participants regarded the SSM/PIFU pathway as a way to save time and money for them and the National Health Service (NHS) (14/32; 44%) and as a means of assuming responsibility for their own follow-up (18/32; 56%). Most maintained (very/somewhat) confidence in managing their BC follow-up care (baseline 31/32, 97%; 12 months 29/31, 93%). During the year, 19% (5/26) stopped endocrine therapy altogether because of side effects. Qualitative analysis revealed general satisfaction with SSM/PIFU and described the breast care nurses as reassuring and empathic. However, there was a lingering anxiety about identifying signs and symptoms correctly, particularly for those with screen-detected cancers. There was also uncertainty about who to contact for psychological support. The COVID-19 pandemic discouraged some participants from contacting the helpline as they did not want to overburden the NHS. CONCLUSIONS The results show that during the first year on the SSM/PIFU pathway, most patients felt confident managing their own care. Clinical teams should benefit from understanding patients' expectations and experiences and potentially modify the service for men with BC and/or those with screen-detected breast cancers.
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Affiliation(s)
- Valerie Jenkins
- Sussex Health Outcomes Research & Education in Cancer (SHORE-C), Brighton & Sussex Medical School, University of Sussex, Falmer, East Sussex, England, UK.
| | - Rachel Starkings
- Sussex Health Outcomes Research & Education in Cancer (SHORE-C), Brighton & Sussex Medical School, University of Sussex, Falmer, East Sussex, England, UK
| | - May Teoh
- Ashford & St Peter's NHS Foundation Trust, London Road, Ashford, Surrey, England, UK
| | - Shirley May
- Sussex Health Outcomes Research & Education in Cancer (SHORE-C), Brighton & Sussex Medical School, University of Sussex, Falmer, East Sussex, England, UK
| | - David Bloomfield
- University Hospitals Sussex NHS Foundation Trust, Brighton, East Sussex, England, UK
| | - Charles Zammit
- University Hospitals Sussex NHS Foundation Trust, Brighton, East Sussex, England, UK
| | - Debbie Elwell-Sutton
- University Hospitals Sussex NHS Foundation Trust, Brighton, East Sussex, England, UK
| | - Dibendu Betal
- University Hospitals Sussex NHS Foundation Trust, Worthing, West Sussex, England, UK
| | - Judith Finlay
- University Hospitals Sussex NHS Foundation Trust, Worthing, West Sussex, England, UK
| | - Kay Nicholson
- University Hospitals Sussex NHS Foundation Trust, Worthing, West Sussex, England, UK
| | - Manish Kothari
- Ashford & St Peter's NHS Foundation Trust, London Road, Ashford, Surrey, England, UK
| | - Regina Santos
- Ashford & St Peter's NHS Foundation Trust, London Road, Ashford, Surrey, England, UK
| | - Elaine Stewart
- Ashford & St Peter's NHS Foundation Trust, London Road, Ashford, Surrey, England, UK
| | - Stephanie Bell
- Surrey & Sussex Cancer Alliance, Royal Surrey County Hospital NHS Foundation Trust, Guildford, Surrey, England, UK
| | - Fiona McKinna
- Surrey & Sussex Cancer Alliance, Royal Surrey County Hospital NHS Foundation Trust, Guildford, Surrey, England, UK
| | - Lucy Matthews
- Sussex Health Outcomes Research & Education in Cancer (SHORE-C), Brighton & Sussex Medical School, University of Sussex, Falmer, East Sussex, England, UK
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Jenkins V, Matthews L, Solis-Trapala I, Gage H, May S, Williams P, Bloomfield D, Zammit C, Elwell-Sutton D, Betal D, Finlay J, Nicholson K, Kothari M, Santos R, Stewart E, Bell S, McKinna F, Teoh M. Patients' experiences of a suppoRted self-manAGeMent pAThway In breast Cancer (PRAGMATIC): quality of life and service use results. Support Care Cancer 2023; 31:570. [PMID: 37698629 PMCID: PMC10497681 DOI: 10.1007/s00520-023-08002-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 08/16/2023] [Indexed: 09/13/2023]
Abstract
PURPOSE To describe trends and explore factors associated with quality of life (QoL) and psychological morbidity and assess breast cancer (BC) health service use over a 12-month period for patients joining the supported self-management (SSM)/patient-initiated follow-up (PIFU) pathway. METHODS Participants completed questionnaires at baseline, 3, 6, 9 and 12 months that measured QoL (FACT-B, EQ 5D-5L), self-efficacy (GSE), psychological morbidity (GHQ-12), roles and responsibilities (PRRS) and service use (cost diary). RESULTS 99/110 patients completed all timepoints; 32% (35/110) had received chemotherapy. The chemotherapy group had poorer QoL; FACT-B total score mean differences were 8.53 (95% CI: 3.42 to 13.64), 5.38 (95% CI: 0.17 to 10.58) and 8.00 (95% CI: 2.76 to 13.24) at 6, 9 and 12 months, respectively. The odds of psychological morbidity (GHQ12 >4) were 5.5-fold greater for those treated with chemotherapy. Financial and caring burdens (PRRS) were worse for this group (mean difference in change at 9 months 3.25 (95% CI: 0.42 to 6.07)). GSE and GHQ-12 scores impacted FACT-B total scores, indicating QoL decline for those with high baseline psychological morbidity. Chemotherapy patients or those with high psychological morbidity or were unable to carry out normal activities had the highest service costs. Over the 12 months, 68.2% participants phoned/emailed breast care nurses, and 53.3% visited a hospital breast clinician. CONCLUSION The data suggest that chemotherapy patients and/or those with heightened psychological morbidity might benefit from closer monitoring and/or supportive interventions whilst on the SSM/PIFU pathway. Reduced access due to COVID-19 could have affected service use.
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Affiliation(s)
- V Jenkins
- Sussex Health Outcomes Research & Education in Cancer (SHORE-C), Brighton & Sussex Medical School, University of Sussex, Falmer, East Sussex, England, UK.
| | - L Matthews
- Sussex Health Outcomes Research & Education in Cancer (SHORE-C), Brighton & Sussex Medical School, University of Sussex, Falmer, East Sussex, England, UK
| | - I Solis-Trapala
- School of Medicine, Keele University, University Road, Staffordshire, England, UK
| | - H Gage
- Surrey Health Economics Centre/Department of Clinical and Experimental Medicine, Leggett Building, University of Surrey, Guildford, Surrey, England, UK
| | - S May
- Sussex Health Outcomes Research & Education in Cancer (SHORE-C), Brighton & Sussex Medical School, University of Sussex, Falmer, East Sussex, England, UK
| | - P Williams
- Department of Mathematics, University of Surrey, Guildford, Surrey, England, UK
| | - D Bloomfield
- Royal Sussex County Hospital, University Hospitals Sussex NHS Foundation Trust, Brighton, East Sussex, England, UK
- Surrey & Sussex Cancer Alliance, Royal Surrey County Hospital NHS Foundation Trust, Guildford, Surrey, England, UK
| | - C Zammit
- Royal Sussex County Hospital, University Hospitals Sussex NHS Foundation Trust, Brighton, East Sussex, England, UK
- Surrey & Sussex Cancer Alliance, Royal Surrey County Hospital NHS Foundation Trust, Guildford, Surrey, England, UK
| | - D Elwell-Sutton
- Royal Sussex County Hospital, University Hospitals Sussex NHS Foundation Trust, Brighton, East Sussex, England, UK
| | - D Betal
- Worthing Hospital, University Hospitals Sussex NHS Foundation Trust, Worthing, West Sussex, England, UK
| | - J Finlay
- Worthing Hospital, University Hospitals Sussex NHS Foundation Trust, Worthing, West Sussex, England, UK
| | - K Nicholson
- Worthing Hospital, University Hospitals Sussex NHS Foundation Trust, Worthing, West Sussex, England, UK
| | - M Kothari
- Ashford & St Peter's NHS Foundation Trust, London Road, Ashford, Surrey, England, UK
| | - R Santos
- Ashford & St Peter's NHS Foundation Trust, London Road, Ashford, Surrey, England, UK
| | - E Stewart
- Ashford & St Peter's NHS Foundation Trust, London Road, Ashford, Surrey, England, UK
| | - S Bell
- Surrey & Sussex Cancer Alliance, Royal Surrey County Hospital NHS Foundation Trust, Guildford, Surrey, England, UK
| | - F McKinna
- Surrey & Sussex Cancer Alliance, Royal Surrey County Hospital NHS Foundation Trust, Guildford, Surrey, England, UK
| | - M Teoh
- Surrey & Sussex Cancer Alliance, Royal Surrey County Hospital NHS Foundation Trust, Guildford, Surrey, England, UK
- Ashford & St Peter's NHS Foundation Trust, London Road, Ashford, Surrey, England, UK
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Waziry R, Ryan CP, Corcoran DL, Huffman KM, Kobor MS, Kothari M, Graf GH, Kraus VB, Kraus WE, Lin DTS, Pieper CF, Ramaker ME, Bhapkar M, Das SK, Ferrucci L, Hastings WJ, Kebbe M, Parker DC, Racette SB, Shalev I, Schilling B, Belsky DW. Author Correction: Effect of long-term caloric restriction on DNA methylation measures of biological aging in healthy adults from the CALERIE trial. Nat Aging 2023:10.1038/s43587-023-00432-y. [PMID: 37161091 DOI: 10.1038/s43587-023-00432-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Affiliation(s)
- R Waziry
- Butler Columbia Aging Center, Columbia University Mailman School of Public Health, New York, NY, USA
| | - C P Ryan
- Butler Columbia Aging Center, Columbia University Mailman School of Public Health, New York, NY, USA
| | - D L Corcoran
- Department of Genetics, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - K M Huffman
- Duke Molecular Physiology Institute and Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - M S Kobor
- Department of Medical Genetics, Edwin S.H. Leong Healthy Aging Program, Centre for Molecular Medicine and Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada
| | - M Kothari
- Butler Columbia Aging Center, Columbia University Mailman School of Public Health, New York, NY, USA
| | - G H Graf
- Butler Columbia Aging Center, Columbia University Mailman School of Public Health, New York, NY, USA
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - V B Kraus
- Duke Molecular Physiology Institute and Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - W E Kraus
- Duke Molecular Physiology Institute and Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - D T S Lin
- Department of Medical Genetics, Edwin S.H. Leong Healthy Aging Program, Centre for Molecular Medicine and Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada
| | - C F Pieper
- Center on Aging and Development, Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | - M E Ramaker
- Duke Molecular Physiology Institute and Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - M Bhapkar
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - S K Das
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA
| | - L Ferrucci
- Translational Gerontology Branch, National Institute on Aging, National Institutes of Health, Baltimore, MD, USA
| | - W J Hastings
- Department of Biobehavioral Health, Pennsylvania State University, State College, PA, USA
| | - M Kebbe
- Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - D C Parker
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - S B Racette
- Program in Physical Therapy and Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
- College of Health Solutions, Arizona State University, Phoenix, AZ, USA
| | - I Shalev
- Department of Biobehavioral Health, Pennsylvania State University, State College, PA, USA
| | - B Schilling
- Buck Institute for Research on Aging, Novato, CA, USA
| | - D W Belsky
- Butler Columbia Aging Center, Columbia University Mailman School of Public Health, New York, NY, USA.
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA.
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Waziry R, Ryan CP, Corcoran DL, Huffman KM, Kobor MS, Kothari M, Graf GH, Kraus VB, Kraus WE, Lin DTS, Pieper CF, Ramaker ME, Bhapkar M, Das SK, Ferrucci L, Hastings WJ, Kebbe M, Parker DC, Racette SB, Shalev I, Schilling B, Belsky DW. Effect of long-term caloric restriction on DNA methylation measures of biological aging in healthy adults from the CALERIE trial. Nat Aging 2023; 3:248-257. [PMID: 37118425 PMCID: PMC10148951 DOI: 10.1038/s43587-022-00357-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 12/22/2022] [Indexed: 04/30/2023]
Abstract
The geroscience hypothesis proposes that therapy to slow or reverse molecular changes that occur with aging can delay or prevent multiple chronic diseases and extend healthy lifespan1-3. Caloric restriction (CR), defined as lessening caloric intake without depriving essential nutrients4, results in changes in molecular processes that have been associated with aging, including DNA methylation (DNAm)5-7, and is established to increase healthy lifespan in multiple species8,9. Here we report the results of a post hoc analysis of the influence of CR on DNAm measures of aging in blood samples from the Comprehensive Assessment of Long-term Effects of Reducing Intake of Energy (CALERIE) trial, a randomized controlled trial in which n = 220 adults without obesity were randomized to 25% CR or ad libitum control diet for 2 yr (ref. 10). We found that CALERIE intervention slowed the pace of aging, as measured by the DunedinPACE DNAm algorithm, but did not lead to significant changes in biological age estimates measured by various DNAm clocks including PhenoAge and GrimAge. Treatment effect sizes were small. Nevertheless, modest slowing of the pace of aging can have profound effects on population health11-13. The finding that CR modified DunedinPACE in a randomized controlled trial supports the geroscience hypothesis, building on evidence from small and uncontrolled studies14-16 and contrasting with reports that biological aging may not be modifiable17. Ultimately, a conclusive test of the geroscience hypothesis will require trials with long-term follow-up to establish effects of intervention on primary healthy-aging endpoints, including incidence of chronic disease and mortality18-20.
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Affiliation(s)
- R Waziry
- Butler Columbia Aging Center, Columbia University Mailman School of Public Health, New York, NY, USA
| | - C P Ryan
- Butler Columbia Aging Center, Columbia University Mailman School of Public Health, New York, NY, USA
| | - D L Corcoran
- Department of Genetics, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - K M Huffman
- Duke Molecular Physiology Institute and Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - M S Kobor
- Department of Medical Genetics, Edwin S.H. Leong Healthy Aging Program, Centre for Molecular Medicine and Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada
| | - M Kothari
- Butler Columbia Aging Center, Columbia University Mailman School of Public Health, New York, NY, USA
| | - G H Graf
- Butler Columbia Aging Center, Columbia University Mailman School of Public Health, New York, NY, USA
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - V B Kraus
- Duke Molecular Physiology Institute and Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - W E Kraus
- Duke Molecular Physiology Institute and Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - D T S Lin
- Department of Medical Genetics, Edwin S.H. Leong Healthy Aging Program, Centre for Molecular Medicine and Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada
| | - C F Pieper
- Center on Aging and Development, Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | - M E Ramaker
- Duke Molecular Physiology Institute and Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - M Bhapkar
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - S K Das
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA
| | - L Ferrucci
- Translational Gerontology Branch, National Institute on Aging, National Institutes of Health, Baltimore, MD, USA
| | - W J Hastings
- Department of Biobehavioral Health, Pennsylvania State University, State College, PA, USA
| | - M Kebbe
- Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - D C Parker
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - S B Racette
- Program in Physical Therapy and Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
- College of Health Solutions, Arizona State University, Phoenix, AZ, USA
| | - I Shalev
- Department of Biobehavioral Health, Pennsylvania State University, State College, PA, USA
| | - B Schilling
- Buck Institute for Research on Aging, Novato, CA, USA
| | - D W Belsky
- Butler Columbia Aging Center, Columbia University Mailman School of Public Health, New York, NY, USA.
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA.
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Kaneria MV, Kothari M, Vishwanath J, Jain R, Raut I, Mashru P, Gohel T, Bhabhor A, Nagral A, Wadia P, Savardekar A, Pispati A, Palekar G, Goleria D, Ladkat K, Tandon S, Bhandare S, Narula S, Shah S, Bhat G, Afzal F. 972. Bone and Joint Infections : Looking Beyond Gram Positive Bugs, A Case Series from Mumbai, India. Open Forum Infect Dis 2022. [DOI: 10.1093/ofid/ofac492.814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Abstract
Background
Bone and joint infection (BJI) is a dreadful complication of arthroplasties and orthopaedic trauma. Infection with non traditional organisms is a trade off for medical advances such as newer immunosuppressants and implants.
Complex BJIs, may be complicated by longer hospitalizations and higher costs due to the virulence of organisms, growing resistance to antibiotics and patient comorbidities, especially immunocompromised status. The purpose of this study was to analyse the various characteristics of BJIs with emphasis on the organisms cultured.
Methods
21 consecutive patients of BJIs were prospectively included from June 2021 to March 2022. Demographic features, comorbidities, anatomic site involved, previous surgical intervention, presence of implant, infecting organism, their susceptibility patterns, inflammatory markers, surgical procedure performed, antibiotics given , their route, duration and the outcome were noted.
Results
12/21 (57.14 %) had spondylodiscitis ; 4/21 (19.04 %) knee joint involvement ; 3/21 (14.29 %) orthopaedic trauma ; 3/21 (14.29 %) hip involvement ; 1 ankle joint involvement (diabetic foot) and 1 sternal osteomyelitis. 17/21 (80.95 %) had comorbidities. 7/21 (33.33 %) were immunosuppressed . 14/21 (66.67 %) had undergone recent surgery.
11 gram positive, 8 gram negative organisms and 3 fungi were isolated . 2 were culture negative and 4 had mycobacterial infection. Histopathology revealed pyogenic inflammation in bacterial and granulomatous inflammation in fungal and mycobacterial infections. CRP and ESR were elevated in all bacterial infections and were used to guide antibiotic route switchover. All bacterial infections were treated with 6 weeks of antibiotics .14/21 (66.67 %) underwent surgery, whereas the rest underwent diagnostic aspiration and biopsy only. 3/21 (14.29 %) had relapse on stopping antibiotics and responded after restarting.
Conclusion
Though staphylococcus is thought to be the culprit in most cases of BJIs, gram negative organisms, mycobacteria and fungi are gaining centrestage. Histopathology can give important clues in the absence of positive cultures. Surgical interventions, implant presence and immunosuppressed states are implicated in a majority of the infections. CRP guided therapy is a valuable strategy.
Disclosures
All Authors: No reported disclosures.
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Affiliation(s)
- Mala V Kaneria
- Topiwala National Medical College and BYL Nair Ch. Hospital , Mumbai, Maharashtra , India
| | - Manish Kothari
- Jaslok Hospital and Research Centre , Mumbai, Maharashtra , India
| | | | - Reetu Jain
- Jaslok Hospital and Research Centre , Mumbai, Maharashtra , India
| | - Indraneel Raut
- Jaslok Hospital and Research Centre , Mumbai, Maharashtra , India
| | - Puneet Mashru
- Jaslok Hospital and Research Centre , Mumbai, Maharashtra , India
| | - Tejash Gohel
- Jaslok Hospital and Research Centre , Mumbai, Maharashtra , India
| | - Anand Bhabhor
- Jaslok Hospital and Research Centre , Mumbai, Maharashtra , India
| | - Aabha Nagral
- Jaslok Hospital and Research Centre , Mumbai, Maharashtra , India
| | - Pettarusp Wadia
- Jaslok Hospital and Research Centre , Mumbai, Maharashtra , India
| | | | - Ameet Pispati
- Jaslok Hospital and Research Centre , Mumbai, Maharashtra , India
| | - Gaurav Palekar
- Jaslok Hospital and Research Centre , Mumbai, Maharashtra , India
| | - Dhimant Goleria
- Jaslok Hospital and Research Centre , Mumbai, Maharashtra , India
| | - Kiran Ladkat
- Jaslok Hospital and Research Centre , Mumbai, Maharashtra , India
| | - Shruti Tandon
- Jaslok Hospital and Research Centre , Mumbai, Maharashtra , India
| | - Sonal Bhandare
- Jaslok Hospital and Research Centre , Mumbai, Maharashtra , India
| | - Sonar Narula
- Jaslok Hospital and Research Centre , Mumbai, Maharashtra , India
| | - Samir Shah
- Jaslok Hospital and Research Centre , Mumbai, Maharashtra , India
| | - Ganapathi Bhat
- Jaslok Hospital and Research Centre , Mumbai, Maharashtra , India
| | - Fahad Afzal
- Jaslok Hospital and Research Centre , Mumbai, Maharashtra , India
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Matthews L, Teoh M, May S, Zammit C, Bloomfield D, Kothari M, Betal D, Santos R, Stewart E, Finlay J, Nicholson K, Elwell-Sutton D, McKinna F, Gage H, Bell S, Jenkins V. CN61 Patients’ experiences of a suppoRted self-manAGeMent pAThway In breast Cancer (PRAGMATIC): Interview results. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Kumar V, Kothari M, Gandhi S, Vastardi M. P050 PROFILE OF URTICARIA AND ANGIOEDEMA CASES IN AN INNER-CITY PEDIATRIC E.D. OVER 12 MONTHS. Ann Allergy Asthma Immunol 2021. [DOI: 10.1016/j.anai.2021.08.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Kothari M, Huang J, Hancock U, Beydoun S, Seth D, Poowuttikul P, Secord E. A203 VISUAL RECOGNITION OF ASTHMA MEDICATIONS IN INNER CITY ASTHMA CHILDREN AND CAREGIVERS. Ann Allergy Asthma Immunol 2019. [DOI: 10.1016/j.anai.2019.08.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
STUDY DESIGN Retrospective study. OBJECTIVES Treatment of spinal tuberculosis in the elderly involves consideration of compromised physiology, which often poses a clinical challenge to the surgeons to balance surgical safety versus deteriorating function. Frailty scoring has been reported as an effective tool to predict mortality and morbidity in cardiovascular surgery and recently in hip fractures. Its use in spinal surgery is scarcely reported. METHODS We included elderly patients operated for spinal tuberculosis. Demographic, clinical and radiological profile with operative details of instrumentation, blood loss, surgical duration and mortality were noted. Modified frailty score (MFS) was calculated for each patient. There were 26 patients (males 9, females 17) with a mean age of 73.2 years. The patients were divided into those with 30-day postoperative mortality (M) and those who survived (S). The null hypothesis was that the MFS was comparable in both the groups. RESULTS The M group had 5 patients (19.2%) and the S group consisted of 21 patients. There was no statistical difference between the groups with regard to mean age, sex, number of medical comorbidities, ASA (American Society of Anesthesiologists) grade, Frankel grade C or worse, blood loss, and operative time. The mean MFS in M group was 5 and in S group was 1.8, which was statistically significant (P < .001). CONCLUSIONS Higher MFS is associated with postoperative 30-day mortality in the elderly patients with spinal tuberculosis undergoing surgery. It can be used as a guide to predict 30-day postoperative mortality in these patients.
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Affiliation(s)
- Kunal Shah
- We Are Spine Centre, Maharastra, India,Kunal Shah, “We Are Spine” Centre, Aarav
Polyclinic, 101 Excel Arcade, Opposite Telephone Exchange, LBS Road, Ghatkopar
West, Mumbai 400086, Maharastra, India.
| | | | - Abhay Nene
- Wockhardt Hospital, Mumbai, Maharashtra, India
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11
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Cook L, Bennett P, Kothari M, Nordblad M, Clayton E, Conway A, Luck J, Odedra A, Sharp E, Pronisceva V, Amajuoyi A, Cook W, Betal D. Decision-making and management of elderly patients with early stage breast cancer in the Kent, Surrey and Sussex region: A multi-centre audit. Eur J Surg Oncol 2018. [DOI: 10.1016/j.ejso.2018.02.170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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12
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Kumar A, Kothari M, Grigoriadis A, Trulsson M, Svensson P. Bite or brain: Implication of sensorimotor regulation and neuroplasticity in oral rehabilitation procedures. J Oral Rehabil 2018; 45:323-333. [DOI: 10.1111/joor.12603] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2017] [Indexed: 02/04/2023]
Affiliation(s)
- A. Kumar
- Division of Oral Diagnostics and Rehabilitation; Department of Dental Medicine; Karolinska Institutet; Huddinge Sweden
- Scandinavian Center for Orofacial Neurosciences (SCON); Huddinge Sweden
| | - M. Kothari
- Hammel Neurorehabilitation Centre and University Research Clinic; Aarhus University; Hammel Denmark
| | - A. Grigoriadis
- Division of Oral Diagnostics and Rehabilitation; Department of Dental Medicine; Karolinska Institutet; Huddinge Sweden
- Scandinavian Center for Orofacial Neurosciences (SCON); Huddinge Sweden
| | - M. Trulsson
- Division of Oral Diagnostics and Rehabilitation; Department of Dental Medicine; Karolinska Institutet; Huddinge Sweden
- Scandinavian Center for Orofacial Neurosciences (SCON); Huddinge Sweden
| | - P. Svensson
- Division of Oral Diagnostics and Rehabilitation; Department of Dental Medicine; Karolinska Institutet; Huddinge Sweden
- Scandinavian Center for Orofacial Neurosciences (SCON); Huddinge Sweden
- Section of Orofacial Pain and Jaw Function; Institute for Odontology and Oral Health; Aarhus University; Aarhus Denmark
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Affiliation(s)
- Hossein Mehdian
- Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Derby Road, Nottingham, NG7 2UH, UK.
| | - Manish Kothari
- Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Derby Road, Nottingham, NG7 2UH, UK
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Kothari M, Stubbs PW, Pedersen AR, Jensen J, Nielsen JF. Reliability of surface electromyography measurements from the suprahyoid muscle complex. J Oral Rehabil 2017. [PMID: 28644567 DOI: 10.1111/joor.12537] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Assessment of swallowing musculature using motor evoked potentials (MEPs) can be used to evaluate neural pathways. However, recording of the swallowing musculature is often invasive, uncomfortable and unrealistic in normal clinical practice. To investigate the possibility of using the suprahyoid muscle complex (SMC) using surface electromyography (sEMG) to assess changes to neural pathways by determining the reliability of measurements in healthy participants over days. Seventeen healthy participants were recruited. Measurements were performed twice with one week between sessions. Single-pulse (at 120% and 140% of the resting motor threshold (rMT)) and paired-pulse (2 ms and 15 ms paired pulse) transcranial magnetic stimulation (TMS) were used to elicit MEPs in the SMC which were recorded using sEMG. ≈50% of participants (range: 42-58%; depending on stimulus type/intensity) had significantly different MEP values between day 1 and day 2 for single-pulse and paired-pulse TMS. A large stimulus artefact resulted in MEP responses that could not be assessed in four participants. The assessment of the SMC using sEMG following TMS was poorly reliable for ≈50% of participants. Although using sEMG to assess swallowing musculature function is easier to perform clinically and more comfortable to patients than invasive measures, as the measurement of muscle activity using TMS is unreliable, the use of sEMG for this muscle group is not recommended and requires further research and development.
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Affiliation(s)
- M Kothari
- Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus University, Hammel, Denmark
| | - P W Stubbs
- Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus University, Hammel, Denmark
| | - A R Pedersen
- Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus University, Hammel, Denmark
| | - J Jensen
- Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus University, Hammel, Denmark
| | - J F Nielsen
- Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus University, Hammel, Denmark
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15
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Kothari M, Stubbs PW, Figlewski K, Pedersen AR, Jensen J, Baad-Hansen L, Svensson P, Nielsen JF. Effect of transcranial direct current stimulation on neuroplasticity in corticomotor pathways of the tongue muscles. J Oral Rehabil 2017; 44:691-701. [DOI: 10.1111/joor.12529] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2017] [Indexed: 11/29/2022]
Affiliation(s)
- M. Kothari
- Hammel Neurorehabilitation Centre and University Research Clinic; Aarhus University; Hammel Denmark
| | - P. W. Stubbs
- Hammel Neurorehabilitation Centre and University Research Clinic; Aarhus University; Hammel Denmark
| | - K. Figlewski
- Hammel Neurorehabilitation Centre and University Research Clinic; Aarhus University; Hammel Denmark
| | - A. R. Pedersen
- Hammel Neurorehabilitation Centre and University Research Clinic; Aarhus University; Hammel Denmark
| | - J. Jensen
- Hammel Neurorehabilitation Centre and University Research Clinic; Aarhus University; Hammel Denmark
| | - L. Baad-Hansen
- Section of Orofacial Pain and Jaw Function, Department of Odontology and Oral Health; Aarhus University; Hammel
- Scandinavian Center for Orofacial Neurosciences (SCON); Aarhus Denmark
| | - P. Svensson
- Section of Orofacial Pain and Jaw Function, Department of Odontology and Oral Health; Aarhus University; Hammel
- Scandinavian Center for Orofacial Neurosciences (SCON); Aarhus Denmark
- Department of Dental Medicine; Karolinska Institutet; Huddinge Sweden
| | - J. F. Nielsen
- Hammel Neurorehabilitation Centre and University Research Clinic; Aarhus University; Hammel Denmark
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Kothari M, Baad-Hansen L, Svensson P. Bilateral sensory deprivation of trigeminal afferent fibres on corticomotor control of human tongue musculature: a preliminary study. J Oral Rehabil 2016; 43:656-61. [PMID: 27265155 DOI: 10.1111/joor.12414] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2016] [Indexed: 12/01/2022]
Abstract
Transcranial magnetic stimulation (TMS) has demonstrated changes in motor evoked potentials (MEPs) in human limb muscles following modulation of sensory afferent inputs. The aim of this study was to determine whether bilateral local anaesthesia (LA) of the lingual nerve affects the excitability of the tongue motor cortex (MI) as measured by TMS. The effect on MEPs after bilateral LA of the lingual nerve was studied, while the first dorsal interosseous (FDI) muscle served as a control in ten healthy participants. MEPs were measured on the right side of the tongue dorsum in four different conditions: (i) immediately prior to anaesthesia (baseline), (ii) during bilateral LA block of the lingual nerve, (iii) after anaesthesia had subjectively subsided (recovery) and (iv) 3 h after bilateral lingual block injection. MEPs were assessed using stimulus-response curves in steps of 10% of motor threshold (T). Eight stimuli were given at each stimulus level. The amplitudes of the tongue MEPs were significantly influenced by the stimulus intensity (P < 0·001) but not by condition (P = 0·186). However, post hoc tests showed that MEPS were statistically significantly higher during bilateral LA block condition compared with baseline at T + 40%, T + 50% and T + 60% (P < 0·028) and also compared with recovery at T + 60% (P = 0·010) as well as at 3 h after injection at T + 50% and T + 60% (P < 0·029). Bilateral LA block of the lingual nerve seems to be associated with a facilitation of the corticomotor pathways related to the tongue musculature.
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Affiliation(s)
- M Kothari
- Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus University, Hammel, Denmark
| | - L Baad-Hansen
- Section of Orofacial Pain and Jaw Function, Institute of Odontology and Oral Health, Aarhus University, Aarhus, Denmark.,Scandinavian Center for Orofacial Neurosciences (SCON), Aarhus, Denmark
| | - P Svensson
- Section of Orofacial Pain and Jaw Function, Institute of Odontology and Oral Health, Aarhus University, Aarhus, Denmark.,Scandinavian Center for Orofacial Neurosciences (SCON), Aarhus, Denmark
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Gimzewska M, Allen S, Tambling M, Johnson O, Kothari M. Sentinel Lymph Node Analysis Pre and Post-Introduction of One Step Nucleic Acid Amplification (OSNA): Cost evaluation. Eur J Surg Oncol 2016. [DOI: 10.1016/j.ejso.2016.02.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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18
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Wang T, Fielding LC, Parikh A, Kothari M, Alamin T. Sacral spinous processes: a morphologic classification and biomechanical characterization of strength. Spine J 2015; 15:2544-51. [PMID: 26343242 DOI: 10.1016/j.spinee.2015.08.058] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Revised: 07/31/2015] [Accepted: 08/25/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND There has been increasing interest in using the lumbosacral spinous processes for fixation as a less invasive alternative to transpedicular instrumentation. Alhough prior studies have described the appearance and biomechanics of lumbar spinous processes, few have evaluated the dimensions, morphology, or strength of the sacral spinous processes. PURPOSE The goals of this study were to characterize the morphology of the S1 spinous process and biomechanical strength of the S1 spinous process when loaded in a cranial direction. STUDY DESIGN This study was performed as both an analysis of radiographic data and biomechanical testing of cadaveric specimens. METHODS Lumbosacral spine radiographs and computed tomography scans of 20 patients were evaluated for visibility and morphology of the S1 spinous process. S1 spinous process length, height, and size of the L5-S1 segment were measured. Additionally, 13 cadaveric lumbosacral spinal segments were obtained for biomechanical testing and morphologic analysis. Specimens were loaded at the S1 spinous process in a cranial direction via a strap, simulating resistance to a flexion moment applied across the L5-S1 segment. Peak load to failure, displacement, and mode of failure were recorded. RESULTS The S1 spinous process was clearly visible on lateral radiographs in only 10% of patients. Mean spinous process length (anterior-posterior) was 11.6 mm while mean spinous process height (cranial-caudal) was 23.1 mm. We identified six different morphologic subtypes of the S1 spinous process: fin, lumbar type, fenestrated, fused, tubercle, and spina bifida occulta. During tension loading of the S1 spinous process in the cephalad direction, mean peak load to failure was 439N, with 92% of specimens failing by fracture through the spinous process. CONCLUSIONS This is the first study evaluating sacral spinous process morphology, visibility, and biomechanical strength for potential instrumentation. Compared with lumbar spinous processes, sacral spinous processes are smaller with more variable morphology but have similar peak load to failure. For ideal visualization of morphology and suitability for interspinous fixation,preoperative three-dimensional imaging may be a valuable tool over plain radiographs.
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Affiliation(s)
- Tim Wang
- Stanford Orthopaedic Surgery, 450 Broadway St Pavilion C 4th Floor, Redwood City, CA 94063, USA.
| | | | - Anand Parikh
- Simpirica Spine, 1680 Bayport Ave, San Carlos, CA 94070, USA
| | - Manish Kothari
- Simpirica Spine, 1680 Bayport Ave, San Carlos, CA 94070, USA
| | - Todd Alamin
- Stanford Orthopaedic Surgery, 450 Broadway St Pavilion C 4th Floor, Redwood City, CA 94063, USA; Simpirica Spine, 1680 Bayport Ave, San Carlos, CA 94070, USA
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Sutherland SM, Byrnes JJ, Kothari M, Longhurst CA, Dutta S, Garcia P, Goldstein SL. AKI in hospitalized children: comparing the pRIFLE, AKIN, and KDIGO definitions. Clin J Am Soc Nephrol 2015; 10:554-61. [PMID: 25649155 DOI: 10.2215/cjn.01900214] [Citation(s) in RCA: 292] [Impact Index Per Article: 32.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Accepted: 01/08/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Although several standardized definitions for AKI have been developed, no consensus exists regarding which to use in children. This study applied the Pediatric RIFLE (pRIFLE), AKI Network (AKIN), and Kidney Disease Improving Global Outcomes (KDIGO) criteria to an anonymized cohort of hospitalizations extracted from the electronic medical record to compare AKI incidence and outcomes in intensive care unit (ICU) and non-ICU pediatric populations. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Observational, electronic medical record-enabled study of 14,795 hospitalizations at the Lucile Packard Children's Hospital between 2006 and 2010. AKI and AKI severity stage were defined by the pRIFLE, AKIN, and KDIGO definitions according to creatinine change criteria; urine output criteria were not used. The incidences of AKI and each AKI stage were calculated for each classification system. All-cause, in-hospital mortality and total hospital length of stay (LOS) were compared at each subsequent AKI stage by Fisher exact and Kolmogorov-Smirnov tests, respectively. RESULTS AKI incidences across the cohort according to pRIFLE, AKIN, and KDIGO were 51.1%, 37.3%, and 40.3%. Mortality was higher among patients with AKI across all definitions (pRIFLE, 2.3%; AKIN, 2.7%; KDIGO, 2.5%; P<0.001 versus no AKI [0.8%-1.0%]). Within the ICU, pRIFLE, AKIN, and KDIGO demonstrated progressively higher mortality at each AKI severity stage; AKI was not associated with mortality outside the ICU by any definition. Both in and outside the ICU, AKI was associated with significantly higher LOS at each AKI severity stage across all three definitions (P<0.001). Definitions resulted in differences in diagnosis and staging of AKI; staging agreement ranged from 76.7% to 92.5%. CONCLUSIONS Application of the three definitions led to differences in AKI incidence and staging. AKI was associated with greater mortality and LOS in the ICU and greater LOS outside the ICU. All three definitions demonstrated excellent interstage discrimination. While each definition offers advantages, these results underscore the need to adopt a single, universal AKI definition.
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Affiliation(s)
| | | | | | | | - Sanjeev Dutta
- Department of Pediatrics, Stanford University, Stanford, California
| | | | - Stuart L Goldstein
- Center for Acute Care Nephrology, Cincinnati Children's Hospital, Cincinnati, Ohio
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Lawn A, Johnson T, Kothari M. Introducing an oncoplastic MDT to facilitate teaching and training in the breast unit. Eur J Surg Oncol 2014. [DOI: 10.1016/j.ejso.2014.02.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Lawn A, Akhtar Z, Husain N, Shrotria S, Johnson T, Kothari M. Symptomatic U3 lesions: An audit of 400 patients. Eur J Surg Oncol 2014. [DOI: 10.1016/j.ejso.2014.02.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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22
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Jog S, Sable S, Patel D, Kapadnis N, Rajhans P, Akole P, Pawar B, Bhurke B, Kothari M, Gururaj S. Comparison of HFOV and conventional ventilation in H1N1 influenza ARDS. Crit Care 2014. [PMCID: PMC4069430 DOI: 10.1186/cc13483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Kothari M, Svensson P, Jensen J, Kjærsgaard A, Jeonghee K, Nielsen J, Ghovanloo M, Baad-Hansen L. Training-induced cortical plasticity compared between three tongue-training paradigms. Neuroscience 2013; 246:1-12. [DOI: 10.1016/j.neuroscience.2013.04.040] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Revised: 04/18/2013] [Accepted: 04/18/2013] [Indexed: 02/08/2023]
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Kothari M, Mehta L. Scope and limitations of therapies: a neomillennial epistemological evaluation for helping medical practices. J Postgrad Med 2013; 58:309-13. [PMID: 23298934 DOI: 10.4103/0022-3859.105465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Medical practice is in crisis - the sophistications are enormous and expensive, and the outcomes leave much to be desired. An epistemologic evaluation that weighs the scope and limitations of any -pathy or any procedure seems to be the need of the day. As an example, described herein is the logic of such an exercise; and a sample of the exercise itself, taking cancer as an example.
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Affiliation(s)
- M Kothari
- Seth GS Medical College, Parel, Mumbai, India
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Valecha N, Krudsood S, Tangpukdee N, Mohanty S, Sharma SK, Tyagi PK, Anvikar A, Mohanty R, Rao BS, Jha AC, Shahi B, Singh JPN, Roy A, Kaur P, Kothari M, Mehta S, Gautam A, Paliwal JK, Arora S, Saha N. Arterolane Maleate Plus Piperaquine Phosphate for Treatment of Uncomplicated Plasmodium falciparum Malaria: A Comparative, Multicenter, Randomized Clinical Trial. Clin Infect Dis 2012; 55:663-71. [DOI: 10.1093/cid/cis475] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Kothari M, Svensson P, Basic A, Christiansen B, Vigsø M, Truc L, Baad-Hansen L. Influence of the ability to roll the tongue and tongue-training parameters on oral motor performance and learning. Arch Oral Biol 2011; 56:1419-23. [DOI: 10.1016/j.archoralbio.2011.04.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2011] [Revised: 04/01/2011] [Accepted: 04/28/2011] [Indexed: 10/18/2022]
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Abstract
The aims of this study were to compare test-retest variability and accuracy measures between (1) manual palpation and a novel palpometer and (2) different force levels. Sixteen clinicians were instructed to target 0.5, 1.0, and 2.0 kg on a force meter using manual palpation and the new palpometer (adjustable spring-coil with a small pin touching the examiner’s hand when the correct pressure is reached). In all experiments, 10 consecutive measures of the force levels were recorded. The coefficient of variation (CV), actual force levels, and relative differences between target level and actual force level were compared between experiments and target levels. All outcome parameters had significantly lower values for the new palpometer than for manual palpation in a force-dependent manner (p < 0.004). CVs and actual force levels were significantly different between all target levels (p < 0.004). The new palpometer had low test-retest variability and provides a more accurate pressure stimulus than manual palpation.
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Affiliation(s)
- S. Futarmal
- Department of Clinical Oral Physiology, School of Dentistry, Aarhus University, Denmark
| | - M. Kothari
- Department of Clinical Oral Physiology, School of Dentistry, Aarhus University, Denmark
| | - E. Ayesh
- Department of Clinical Oral Physiology, School of Dentistry, Aarhus University, Denmark
| | - L. Baad-Hansen
- Department of Clinical Oral Physiology, School of Dentistry, Aarhus University, Denmark
| | - P. Svensson
- Department of Clinical Oral Physiology, School of Dentistry, Aarhus University, Denmark, Center for Functionally Integrative Neuroscience (CFIN), MindLab, Aarhus University Hospital, Denmark
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Aboutaleb E, Kothari M, Damrah O, Canelo R. c-KIT positive Gastrointestinal Stromal Tumor presenting with acute bleeding in a patient with neurofibromatosis type 1: a case report. Int Semin Surg Oncol 2009; 6:17. [PMID: 19852778 PMCID: PMC2776011 DOI: 10.1186/1477-7800-6-17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2009] [Accepted: 10/23/2009] [Indexed: 01/09/2023]
Abstract
Background Gastrointestinal stromal tumours are rare (GIST). However, the incidence of GIST among neurofibromatosis type 1 (NF-1) patients is approximately 3.9-25%. GIST can present clinically in different ways such as abdominal pain, gastrointestinal bleeding and obstruction. Case report We present 51 year female patient admitted with Background of neurofibromatosis type 1 admitted with melena. OGD has been done and showed duodenitis with large volume fresh blood in distal duodenum but no obvious bleeding point. Exploratory laparotomy revealed smooth nodular masses on the serosal surface of jejunum. Small bowel resection and side-to-side anastomosis were performed. Histopathoogical examination revealed small bowel gasrointestinal stromal tumour with low risk malignant potential. Conclusion The incidence of GIST among neurofibromatosis type 1 (NF-1) patients is not uncommon and we should pay attention to gastrointestinal manifestation in such patients.
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Affiliation(s)
- Esam Aboutaleb
- Imperial College Healthcare Trust, Hammersmith Hospital, Department of Hepatopancreatic and Biliary Surgery, Du Cane Road, London, W12 0HS, UK.
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Somyreddy K, Kothari M. Nitrous oxide induced sub-acute combined degeneration of spinal cord: a case report. Electromyogr Clin Neurophysiol 2008; 48:225-228. [PMID: 18754532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
We report a patient who developed signs and symptoms of a myelopathy after exposure to nitrous oxide. Magnetic Resonance Imaging of the cervical spinal cord disclosed hyperintensities of the dorsal columns on T2 weighted images suggesting sub-acute combined degeneration.
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Affiliation(s)
- K Somyreddy
- Department of Neurology, Penn State College of Medicine, Hershey, PA 17033, USA
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Bruyere O, Genant H, Kothari M, Zaim S, White D, Peterfy C, Burlet N, Richy F, Ethgen D, Montague T, Dabrowski C, Reginster JY. Longitudinal study of magnetic resonance imaging and standard X-rays to assess disease progression in osteoarthritis. Osteoarthritis Cartilage 2007; 15:98-103. [PMID: 16890461 DOI: 10.1016/j.joca.2006.06.018] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2005] [Accepted: 06/13/2006] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To investigate, over 1-year, the relationship between X-ray and magnetic resonance imaging (MRI) findings in patients with knee osteoarthritis (OA). METHODS Sixty-two osteoarthritic patients (46 women) were followed for 1 year. At baseline and after 1 year, volume and thickness of cartilage of the medial tibia, the lateral tibia and the femur were assessed by MRI. A global score from the multi-feature whole-organ MRI scoring system (WORMS) was calculated for each patient at baseline and after 1 year. This score combined individual scores for articular cartilage, osteophytes, bone marrow abnormality, subchondral cysts and bone attrition in 14 locations. It also incorporated scores for the medial and lateral menisci, anterior and posterior cruciate ligaments, medial and lateral collateral ligaments and synovial distension. Lateral and medial femoro-tibial joint space width (JSW) measurements, performed by digital image analysis, were assessed from fixed-flexion, postero-anterior knee radiographs. RESULTS One-year changes in medial femoro-tibial JSW reach 6.7 (20.5) % and changes in medial cartilage volume and thickness reach 0.4 (16.7) % and 2.1 (11.3) %, respectively. Medial femoro-tibial joint space narrowing (JSN) after 1 year, assessed by radiography, was significantly correlated with a loss of medial tibial cartilage volume (r=0.25, P=0.046) and medial tibial cartilage thickness (r=0.28, P=0.025), over the same period. We found also a significant correlation between the progression of the WORMS and radiographic medial JSN over 1 year (r=-0.35, P=0.006). All these results remained statistically significant after adjusting for age, sex and body mass index. CONCLUSION This study shows a moderate but significant association between changes in JSW and changes in cartilage volume or thickness in knee joint of osteoarthritic patients.
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Affiliation(s)
- O Bruyere
- WHO Collaborating Center for Public Health Aspects of Osteoarticular Disorders, University of Liège, Liège, Belgium.
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Abstract
Until recently, imaging evaluation of osteoarthritis has relied primarily on conventional radiography. Using radiography in clinical practice or clinical research, however, has been fraught with difficulty. Techniques for reproducibly acquiring serial radiographs of joints have improved considerably over the past several years. However, the greatest promise for advancing knowledge about osteoarthritis and its treatment lies in MRI and its unique ability to examine the joint as a whole organ. In contrast to conventional radiography, MRI can directly visualize the articular cartilage, synovium, menisci, and other intra-articular structures important to the functional integrity of joints. There have been considerable advances in MRI of articular cartilage in particular over the past several years. However, much of this has come from small cross-sectional studies. Larger, longitudinal studies are ongoing, and publications are just emerging. This paper reviews the current status of x-ray and MRI in osteoarthritis and points to where changes might be anticipated in the future.
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Affiliation(s)
- Charles Peterfy
- Scientific Client Services, Synarc San Francisco, 575 Market Street, 17th Floor, San Francisco, CA 94105, USA
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Bruyere O, Collette J, Kothari M, Zaim S, White D, Genant H, Peterfy C, Burlet N, Ethgen D, Montague T, Dabrowski C, Reginster JY. Osteoarthritis, magnetic resonance imaging, and biochemical markers: a one year prospective study. Ann Rheum Dis 2006; 65:1050-4. [PMID: 16396978 PMCID: PMC1798262 DOI: 10.1136/ard.2005.045914] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To investigate the relation between biochemical markers of bone, cartilage, and synovial remodelling and the structural progression of knee osteoarthritis. METHODS 62 patients of both sexes with knee osteoarthritis were followed prospectively for one year. From magnetic resonance imaging (MRI), done at baseline and after one year, the volume and thickness of cartilage of the femur, the medial tibia, and the lateral tibia were assessed. A whole organ magnetic resonance imaging score (WORMS) of the knee was calculated for each patient at baseline and at the one year visits. This score consists in a validated, semiquantitative scoring system for whole organ assessment of the knee in osteoarthritis using MRI. Biochemical markers (serum hyaluronic acid, osteocalcin, cartilage glycoprotein 39 (YKL-40), cartilage oligomeric matrix protein (COMP), and C-telopeptide of type I collagen (CTX-I), and urine C-telopeptide of type II collagen (CTX-II)) were measured at baseline and after three months. RESULTS Baseline markers were not correlated with one year changes observed in cartilage volume and thickness. However, an increase in CTX-II after three months was significantly correlated with a one year decrease in mean thickness of medial tibial and lateral tibial cartilage. Patients in the highest quartile of three month changes in CTX-II experienced a mean loss of 0.07 (0.08) mm of their medial thickness, compared with a mean increase of 0.05 (0.19) mm for patients in the lowest quartile (p = 0.04) Multiple regression analysis showed that high baseline levels of hyaluronic acid are predictive of a worsening in WORMS (p = 0.004). CONCLUSIONS These results suggest that a single measurement of serum hyaluronic acid or short term changes in urine CTX-II could identify patients at greatest risk of progression of osteoarthritis.
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Affiliation(s)
- O Bruyere
- University of Liège, Department of Public Health, Epidemiology and Health Economics, CHU Sart-Tilman, 4000 Liège, Belgium.
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Abstract
Giant exomphalos containing liver as its major component and with visceroabdominal disproportion presents difficult management options to a paediatric surgeon. At Starship Children's Hospital, we deal with these with primary skin closure, if possible, followed by staged repair of the ventral hernia beginning in the 2nd year of life. During the closure of a ventral hernia, we encountered major hepatic venous bleeding resulting from the inadvertent injury to the right hepatic vein, resulting in the death of the child. An autopsy report showed the position of the hepatic veins superficially just beneath the skin. Subsequently, we performed magnetic resonance imaging (MRI) of the abdomen to look at the hepatic venous and caval anatomy in two children before closure of the ventral hernia. This was of immense help in limiting the dissection in the area and thus avoiding catastrophe. We recommend routine imaging with MRI before closure of a ventral hernia in children with giant exomphalos.
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Affiliation(s)
- M Kothari
- Department of Paediatric Surgery, Starship Children's Hospital, Auckland, New Zealand
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Keskek M, Kothari M, Ardehali B, Betambeau N, Nasiri N, Gui GPH. Factors predisposing to cavity margin positivity following conservation surgery for breast cancer. Eur J Surg Oncol 2004; 30:1058-64. [PMID: 15522551 DOI: 10.1016/j.ejso.2004.07.019] [Citation(s) in RCA: 90] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2004] [Indexed: 11/29/2022] Open
Abstract
AIMS Incomplete excision leads to local recurrence following breast conservation therapy (BCT). The aim of this study was to examine factors associated with cavity margin (CM) positivity and return to theatre rates. METHODS Breast conservation surgery with entire CM excision was the initial procedure in 301 patients with 303 breast cancers. Of these, 258 patients were treated successfully with breast conservation surgery and 43 patients subsequently required a mastectomy for persistent involved margins. The mean and median follow-up was 38 and 42 (range 6-78) months, respectively. RESULTS Positive CMs were found in 73 out of 303 tumours. Large tumour size (p<0.001) and tumour type (invasive lobular cancer and ductal carcinoma in-situ) (p=0.043) were significant predictors of CM positivity both by univariate and multivariate analysis. As a result of CM status in relation to initial margin (IM) status, 60 cancers treated that were IM positive but CM negative avoided return for further excision at a second operative procedure. CONCLUSION Complete CM excision should avoid the need for further re-excision surgery in most patients where initial specimen margin was positive.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Breast/pathology
- Breast Neoplasms/pathology
- Breast Neoplasms/surgery
- Carcinoma in Situ/pathology
- Carcinoma in Situ/surgery
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/surgery
- Carcinoma, Lobular/pathology
- Carcinoma, Lobular/surgery
- Female
- Follow-Up Studies
- Forecasting
- Humans
- Logistic Models
- Mastectomy
- Mastectomy, Segmental
- Middle Aged
- Neoplasm, Residual
- Reoperation
- Risk Factors
- Statistics, Nonparametric
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Affiliation(s)
- M Keskek
- Academic Breast Surgery, Royal Marsden Hospital, 203 Fulham Road, London SW3 6JJ, UK
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Kothari M, Guermazi A, von Ingersleben G, Miaux Y, Sieffert M, Block JE, Stevens R, Peterfy CG. Fixed-flexion radiography of the knee provides reproducible joint space width measurements in osteoarthritis. Eur Radiol 2004; 14:1568-73. [PMID: 15150666 DOI: 10.1007/s00330-004-2312-6] [Citation(s) in RCA: 180] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2003] [Revised: 02/03/2004] [Accepted: 03/05/2004] [Indexed: 10/26/2022]
Abstract
The validity of a non-fluoroscopic fixed-flexion radiographic acquisition and analysis protocol for measurement of joint space width (JSW) in knee osteoarthritis is determined. A cross-sectional study of 165 patients with documented knee osteoarthritis participating in a multicenter, prospective study of chondroprotective agents was performed. All patients had posteroanterior, weight-bearing, fixed-flexion radiography with 10 degrees caudal beam angulation. A specially designed frame (SynaFlexer) was used to standardize the positioning. Minimum medial and lateral JSW were measured manually and twice by an automated analysis system to determine inter-technique and intra-reader concordance and reliability. A random subsample of 30 patients had repeat knee radiographs 2 weeks apart to estimate short-term reproducibility using automated analysis. Concordance between manual and automated medial JSW measurements was high (ICC=0.90); lateral compartment measurements showed somewhat less concordance (ICC=0.72). There was excellent concordance between repeated automated JSW measurements performed 6 months apart for the medial (ICC=0.94) and lateral (ICC=0.86) compartments. Short-term reproducibility for the subsample of 30 cases with repeat acquisitions demonstrated an average SD of 0.14 mm for medial JSW (CV=4.3%) and 0.23 mm for lateral JSW (CV=4.0%). Fixed-flexion radiography of the knee using a positioning device provides consistent, reliable and reproducible measurement of minimum JSW in knee osteoarthritis without the need for concurrent fluoroscopic guidance.
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Affiliation(s)
- Manish Kothari
- Department of Scientific Client Services, Synarc, Inc., 575 Market Street, 17th Floor, San Francisco, CA 94105, USA
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36
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Peterfy CG, Guermazi A, Zaim S, Tirman PFJ, Miaux Y, White D, Kothari M, Lu Y, Fye K, Zhao S, Genant HK. Whole-Organ Magnetic Resonance Imaging Score (WORMS) of the knee in osteoarthritis. Osteoarthritis Cartilage 2004; 12:177-90. [PMID: 14972335 DOI: 10.1016/j.joca.2003.11.003] [Citation(s) in RCA: 1056] [Impact Index Per Article: 52.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2003] [Accepted: 11/02/2003] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To describe a semi-quantitative scoring method for multi-feature, whole-organ evaluation of the knee in osteoarthritis (OA) based on magnetic resonance imaging (MRI) findings. To determine the inter-observer agreement of this scoring method. To examine associations among the features included in the scoring method. METHODS Nineteen knees of 19 patients with knee OA were imaged with MRI using conventional pulse sequences and a clinical 1.5 T MRI system. Images were independently analyzed by two musculoskeletal radiologists using a whole-organ MRI scoring method (WORMS) that incorporated 14 features: articular cartilage integrity, subarticular bone marrow abnormality, subarticular cysts, subarticular bone attrition, marginal osteophytes, medial and lateral meniscal integrity, anterior and posterior cruciate ligament integrity, medial and lateral collateral ligament integrity, synovitis/effusion, intraarticular loose bodies, and periarticular cysts/bursitis. Intraclass correlation coefficients (ICC) were determined for each feature as a measure of inter-observer agreement. Associations among the scores for different features were expressed as Spearman Rho. RESULTS All knees showed structural abnormalities with MRI. Cartilage loss and osteophytes were the most prevalent features (98% and 92%, respectively). One of the least common features was ligament abnormality (8%). Inter-observer agreement for WORMS scores was high (most ICC values were >0.80). The individual features showed strong inter-associations. CONCLUSION The WORMS method described in this report provides multi-feature, whole-organ assessment of the knee in OA using conventional MR images, and shows high inter-observer agreement among trained readers. This method may be useful in epidemiological studies and clinical trials of OA.
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Abstract
Traditional approaches for treating cancer have largely focused on the ability of chemotherapy, and to a lesser extent radiation therapy, to destroy tumour cells. Recent developments in antiangiogenesis treatments require a fundamental shift in the radiological and imaging paradigms associated with evaluating response. Proper design and execution of any clinical trial involving imaging angiogenesis requires satisfactory consideration of a number of strategies and an in-depth understanding of different imaging techniques such as dynamic contrast enhanced MRI and CT, contrast-enhanced ultrasound and positron emission tomography. In particular, for imaging, the strategies can be divided into issues that need to be addressed during the protocol planning phase, and strategies that need to be addressed during the execution phase. Furthermore, clinical trials are usually subject to stringent regulations surrounding traceability and reproducibility that need to be followed before the regulatory authorities will accept the integrity of the data. This paper elaborates on the above strategies and outlines certain aspects, or tactics, that need to be considered while preparing for a multicentre clinical trial that involves imaging angiogenesis.
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Affiliation(s)
- M Kothari
- Synarc Inc., 575 Market St Suite 1700, San Francisco CA 94117, USA
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Singh A, Debella M, Kothari M, Smith C, Foxwell B, Ali S, Coombes R. Patey Prize 07. Br J Surg 2002. [DOI: 10.1046/j.1365-2168.89.s.1.23_7.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Kothari M, Chaudhary BL. Allelopathic effects of Lantana camara Linn. on spore germination of Asterella angusta Steph.--a liverwort. Indian J Exp Biol 2001; 39:1194-8. [PMID: 11906121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
Extract from root, stem and leaf of L. camara proved inhibitory for germination of the spores of A. angusta. Leaf extract was found to exhibit maximum allelopathic potentiality followed by stem and root extract and may be interpreted to be the result of phytotoxic substances which are possibly synthesized in the leaf and translocated to other organs.
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Affiliation(s)
- M Kothari
- Department of Botany, College of Science, M.L. Sukhadia University, Udaipur, India
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40
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Upadhyay V, Kothari M, Manoharan M. The referral pattern for undescended testes in Auckland. N Z Med J 2001; 114:310-1. [PMID: 11556444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
AIM To accurately audit the age at orchiopexy at our institution and then to analyse the referral pattern specially related to the age of the patient. METHODS A retrospective review of hospital records was performed. Data were obtained from the hospital database based on the procedure code of orchiopexy. Mean and median values were calculated for age at referral, time between clinic visit and referral (T1) and between clinic visit and operation (T2). RESULTS The mean age at referral was 42.6 months (median 23, range 0 - 179.1 months). The mean time T1 was 2.6 months (median 1.7, range 0 - 16.9 months). The mean time T2 was 7.0 months (median 3.3 months). CONCLUSION There is a need to increase awareness about undescended testes amongst all parties involved in the health care of children.
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Kothari M, Mehta L. Trust her inner voice. Issues Med Ethics 2001; 9:27. [PMID: 16334456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Affiliation(s)
- M Kothari
- Department of anatomy, Seth GS Medical College and KEM Hospital, Parel, Mumbai 400 012, India.
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Parentis MA, Rumi MN, Deol GS, Kothari M, Parrish WM, Pellegrini VD. A comparison of the vastus splitting and median parapatellar approaches in total knee arthroplasty. Clin Orthop Relat Res 1999:107-16. [PMID: 10546604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
This prospective randomized study was undertaken to evaluate the vastus splitting approach as an alternative to the median parapatellar approach in primary total knee arthroplasty. Fifty-one knees in 42 patients were randomized preoperatively. Clinical parameters were evaluated preoperatively and at regular postoperative intervals. Electromyography was performed preoperatively and postoperatively to evaluate each approach relative to its effect on the innervation of the quadriceps mechanism. There were no significant preoperative differences. Postoperatively, there were no significant differences regarding strength, range of motion, knee scores, tourniquet time, proprioception, or patellar replacement. There were significantly more lateral releases performed and greater blood loss in the patients in the parapatellar group. The results of all preoperative electromyograms were normal, as were all of the results of postoperative electromyograms in the patients in the parapatellar group. However, the results of nine of 21 (43%) of the electromyograms performed postoperatively on patients who had the vastus splitting approach were abnormal. Significantly fewer lateral releases were performed and there was less blood loss in the patients in the vastus group. However, the postoperative electromyographic results revealed neurologic injuries in the vastus medialis muscle that only were present after the vastus splitting approach. The clinical significance of denervation of the vastus medialis muscle by the vastus approach remains to be determined by longer term clinical and electromyographic studies.
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Affiliation(s)
- M A Parentis
- Department of Orthopaedics and Rehabilitation, Pennsylvania State University, College of Medicine, Milton S. Hershey Medical Center, Hershey 17033, USA
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Abstract
A three-dimensional technique was developed for the quantification of the number and cross-sectional geometry of individual trabeculae oriented along a given direction. As an example application, the number of vertical and horizontal trabeculae and their respective cross-sectional geometry were determined for a set of six vertebral cancellous bone specimens (L3-L4 female vertebral bodies; age range 39-63 years). Three-dimensional optical images at a spatial resolution of 20 microm were obtained using an automated serial milling technique. The thickness distributions were generally right skewed. The mean true thickness for both the vertically and horizontally oriented trabeculae showed a strong relationship with volume fraction (vertical: r2 = 0.86; p < 0.05; horizontal: r2 = 0.80; p < 0.05), and mean trabecular thickness (Tb.Th.) (vertical: r2 = 0.81; p < 0.05; horizontal: r2 = 0.72; p < 0.05). The horizontal trabeculae were greater in number and were thinner than the vertical trabeculae. The coefficient of variation of the intraspecimen vertical trabecular thicknesses ranged from 25% to 42%, and showed a weak, albeit insignificant, positive correlation with volume fraction (r2 = 0.46). The findings demonstrated substantial intraspecimen variations exist in trabecular thickness that are not related to volume fraction. Further studies are recommended to determine the potential role of such intraspecimen variations in architecture on biomechanical properties.
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Affiliation(s)
- M Kothari
- Magnetic Resonance Science Center, Department of Radiology, University of California, San Francisco, California USA
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Majumdar S, Lin J, Link T, Millard J, Augat P, Ouyang X, Newitt D, Gould R, Kothari M, Genant H. Fractal analysis of radiographs: assessment of trabecular bone structure and prediction of elastic modulus and strength. Med Phys 1999; 26:1330-40. [PMID: 10435535 DOI: 10.1118/1.598628] [Citation(s) in RCA: 84] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
The purpose of this study was to determine whether fractal dimension of radiographs provide measures of trabecular bone structure which correlate with bone mineral density (BMD) and bone biomechanics, and whether these relationships depend on the technique used to calculate the fractal dimension. Eighty seven cubic specimen of human trabecular bone were obtained from the vertebrae and femur. The cubes were radiographed along all three orientations--superior-inferior (SI), medial-lateral (ML), and anterior-posterior (AP), digitized, corrected for background variations, and fractal based techniques were applied to quantify trabecular structure. Three different techniques namely, semivariance, surface area, and power spectral methods were used. The specimens were tested in compression along three orientations and the Young's modulus (YM) was determined. Compressive strength was measured along the SI direction. Quantitative computed tomography was used to measure trabecular BMD. High-resolution magnetic-resonance images were used to obtain three-dimensional measures of trabecular architecture such as the apparent bone volume fraction, trabecular thickness, spacing, and number. The measures of trabecular structure computed in the different directions showed significant differences (p<0.05). The correlation between BMD, YM, strength, and the fractal dimension were direction and technique dependent. The trends of variation of the fractal dimension with BMD and biomechanical properties also depended on the technique and the range of resolutions over which the data was analyzed. The fractal dimension showed varying trends with bone mineral density changes, and these trends also depended on the range of frequencies over which the fractal dimension was measured. For example, using the power spectral method the fractal dimension increased with BMD when computed over a lower range of spatial frequencies and decreased for higher ranges. However, for the surface area technique the fractal dimension increased with increasing BMD. Fractal measures showed better correlation with trabecular spacing and number, compared to trabecular thickness. In a multivariate regression model inclusion of some of the fractal measures in addition to BMD improved the prediction of strength and elastic modulus. Thus, fractal based texture analysis of radiographs are technique dependent, but may be used to quantify trabecular structure and have a potentially valuable impact in the study of osteoporosis.
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Affiliation(s)
- S Majumdar
- Magnetic Resonance Science Center, Department of Radiology, University of California, San Francisco 94143, USA.
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Lin JC, Grampp S, Link T, Kothari M, Newitt DC, Felsenberg D, Majumdar S. Fractal analysis of proximal femur radiographs: correlation with biomechanical properties and bone mineral density. Osteoporos Int 1999; 9:516-24. [PMID: 10624459 DOI: 10.1007/s001980050179] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Conventional radiography and fractal analysis were used to quantify trabecular texture patterns in human femur specimens and these measures were used in conjunction with bone mineral density (BMD) to predict bone strength. Radiographs were obtained from 51 human femur specimens (25 male, 26 female). The radiographs were analyzed using three different fractal geometry based techniques, namely semi-variance, surface area and Fourier analysis. Maximum compressive strength (MCS) and shear stress (MSS) were determined with a material testing machine: BMD was measured using quantitative computed tomography (QCT). MCS and MSS both correlated significantly with BMD (MCS: R = 0.49-0.54; MSS: R = 0.69-0.72). Fractal dimension also correlated significantly with both biomechanical properties (MCS: R = 0.49-0.56; MSS: R = 0.47-0.54). Using multivariate regression analysis, the fractal dimension in addition to BMD improved correlations versus biomechanical properties. Both BMD and fractal dimension showed statistically significant correlation with bone strength. The fractal dimension provided additional information beyond BMD in correlating with biomechanical properties.
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Affiliation(s)
- J C Lin
- Department of Radiology, University of California San Francisco 94143-1290, USA
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van Rietbergen B, Majumdar S, Pistoia W, Newitt D, Kothari M, Laib A, Rüegsegger P. Assessment of cancellous bone mechanical properties from micro-FE models based on micro-CT, pQCT and MR images. Technol Health Care 1998. [DOI: 10.3233/thc-1998-65-613] [Citation(s) in RCA: 70] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- B. van Rietbergen
- Institute for Biomedical Engineering, University of Zürich and Swiss Federal Institute of Technology (ETH), Zürich, Switzerland
| | - S. Majumdar
- Department of Radiology, Magnetic Resonance Science Center, University of California, San Francisco, CA 94143, USA
| | - W. Pistoia
- Institute for Biomedical Engineering, University of Zürich and Swiss Federal Institute of Technology (ETH), Zürich, Switzerland
| | - D.C. Newitt
- Department of Radiology, Magnetic Resonance Science Center, University of California, San Francisco, CA 94143, USA
| | - M. Kothari
- Department of Radiology, Magnetic Resonance Science Center, University of California, San Francisco, CA 94143, USA
| | - A. Laib
- Institute for Biomedical Engineering, University of Zürich and Swiss Federal Institute of Technology (ETH), Zürich, Switzerland
| | - P. Rüegsegger
- Institute for Biomedical Engineering, University of Zürich and Swiss Federal Institute of Technology (ETH), Zürich, Switzerland
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47
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Millard J, Augat P, Link TM, Kothari M, Newitt DC, Genant HK, Majumdar S. Power spectral analysis of vertebral trabecular bone structure from radiographs: orientation dependence and correlation with bone mineral density and mechanical properties. Calcif Tissue Int 1998; 63:482-9. [PMID: 9817942 DOI: 10.1007/s002239900562] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Trabecular bone structure and bone density contribute to the strength of bone and are potentially important in the study of osteoporosis. Fourier transforms of the textural patterns in radiographs of trabecular bone have previously been used for the measurement of trabecular bone structure in subjects, however, the relationship between these measures and biomechanical properties of bone have not previously been established. In this study radiographs were acquired of 28 cubic specimens of spinal trabecular bone along each of the three anatomic axes: cranio-caudal or superior-inferior (SI), medial-lateral (ML), and anterior-posterior (AP). The radiographs were digitized, background corrected, and uniformly aligned. The Fast Fourier transform (FFT) was performed on a region comprised solely of trabecular bone for each image. The zero (DC), first (FMO), and second moments (SMO) of the Fourier power spectrum and the fractal dimension (FD) as determined from the Fourier power spectrum were correlated with stereology measures, with bone mineral density (BMD) as well as with measured biomechanical properties [Young's elastic modulus (YM) and ultimate strength] of the cubes. The results show that the power spectra-based measures, when compared with structural parameters determined using 3D stereology, show good correlations with bone volume fraction, trabecular spacing, thickness, and number. These power spectral measures showed fair to good correlations with BMD and the biomechanical properties. Moreover, the correlations between the power spectral measures of trabecular structure and the BMD, YM, and stereology measures of structure depend on the orientation of the radiographic image. Specifically, these were significant differences in the measured biomechanical properties and the power spectral measures of the trabecular structure between the SI and ML and the SI and AP directions. In addition, depending on the spatial frequency range for analysis, the fractal dimension showed opposite trends with changes in BMD and biomechanical properties. Multivariate regression models showed the correlation coefficients increasing with the inclusion of some of the power spectral measures, suggesting that FFT-based texture analysis may play a potential role in studies of osteoporosis.
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Affiliation(s)
- J Millard
- Box 1290 Magnetic Resonance Science Center, Department of Radiology, 1 Irving Street, AC109, University of California, San Francisco, California 94143, USA
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48
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van Rietbergen B, Majumdar S, Pistoia W, Newitt DC, Kothari M, Laib A, Rüegsegger P. Assessment of cancellous bone mechanical properties from micro-FE models based on micro-CT, pQCT and MR images. Technol Health Care 1998; 6:413-20. [PMID: 10100943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Recently, new micro-finite element (micro-FE) techniques have been introduced to calculate cancellous bone mechanical properties directly from high-resolution images of its internal architecture. Also recently, new peripheral quantitative computed tomography (pQCT) and magnetic resonance (MR) imaging techniques have been developed that can create images of whole bones in vivo with enough detail to visualize the internal cancellous bone architecture. In this study we aim to investigate if the calculation of cancellous bone mechanical properties from micro-FE models based on such new pQCT and MR images is feasible. Three bone specimens were imaged with the pQCT scanning system and the MR-imaging system. The specimens were scanned a second time using a micro-CT scanner with a much higher resolution. Digitized reconstructions were made based on each set of images and converted to micro-FE models from which the bone elastic properties were calculated. It was found that the results of both the pQCT and the MR-based FE-models compared well to those of the more accurate micro-CT based models in a qualitative sense, but correction factors will be needed to get accurate values.
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Affiliation(s)
- B van Rietbergen
- Institute for Biomedical Engineering, University of Zürich and Swiss Federal Institute of Technology (ETH).
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Majumdar S, Kothari M, Augat P, Newitt DC, Link TM, Lin JC, Lang T, Lu Y, Genant HK. High-resolution magnetic resonance imaging: three-dimensional trabecular bone architecture and biomechanical properties. Bone 1998; 22:445-54. [PMID: 9600777 DOI: 10.1016/s8756-3282(98)00030-1] [Citation(s) in RCA: 186] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The purpose of this study was to use high-resolution magnetic resonance (MR) imaging combined with image analysis to investigate the three-dimensional (3D) trabecular structure, anisotropy, and connectivity of human vertebral, femoral, and calcaneal specimens. The goal was to determine whether: (a) MR-derived measures depict known skeletal-site-specific differences in architecture and orientation of trabeculae; (b) 3D architectural parameters combined with bone mineral density (BMD) improve the prediction of the elastic modulus using a fabric tensor formulation; (c) MR-derived 3D architectural parameters combined with BMD improve the prediction of strength using a multiple regression model, and whether these results corresponded to the results obtained using higher resolution depictions of trabecular architecture. A total of 94 specimens (12 x 12 x 12 mm cubes) consisting of trabecular bone only were obtained, of which there were 7 from the calcaneus, 15 from distal femur, 47 from the proximal femur, and 25 from the vertebral bodies. MR images were obtained using a 1.5 Tesla MR scanner at a spatial resolution of 117 x 117 x 300 microm. Additionally, BMD was determined using quantitative computed tomography (QCT), and the specimens were nondestructively tested and the elastic modulus (YM) was measured along three orthogonal axes corresponding to the anatomic superior-inferior (axial), medial-lateral (sagittal), and anterior-posterior (coronal) directions. A subset of the specimens (n=67) was then destructively tested in the superior-inferior (axial) direction to measure the ultimate compressive strength. The MR images were segmented into bone and marrow phases and then analyzed in 3D. Ellipsoids were fitted to the mean intercept lengths, using single value decomposition and the primary orientation of the trabeculae and used to calculate the anisotropy of trabecular architecture. Stereological measures were derived using a previously developed model and measures such as mean trabecular width, spacing, and number were derived. Because the spatial resolution of MR images is comparable to trabecular bone dimensions, these measures may be subject to partial volume effects and were thus treated as apparent measures, such as BV/TV, Tb.Sp, Tb.N, and Tb.Th rather than absolute measures, as would be derived from histomorphometry. In addition, in a subset of specimens, the Euler number per unit volume was determined to characterize the connectivity of the trabecular network. There were significant differences in the BMD, trabecular architectural measures, elastic modulus, and strength at the different skeletal sites. The primary orientation axes for most of the specimens was the anatomic superior-inferior (axial) direction. Using the fabric tensor formulation, in addition to BMD, improved the prediction of YM (SI), while including some of the architectural parameters significantly improved the prediction of strength. In comparing MR-derived 3D measures with those obtained from 20 microm optical images (n=18; 9 vertebrae, 9 femur specimens), good correlations were found for the apparent Tb.Sp and Tb.N, moderate correlation was seen for the apparent BV/TV, and poor correlation was found for the apparent Tb.Th. Using these higher resolution images, the fabric tensor formulation for predicting the elastic modulus also showed improved correlation between the measured and calculated modulus in the axial (SI) direction. In summary, high-resolution MR images may be used to assess 3D architecture of trabecular bone, and the inclusion of some of the 3D architectural measures provides an improved assessment of biomechanical properties. Further studies are clearly warranted to establish the role of architecture in predicting overall bone quality, and the role of trabecular architecture measures in clinical practice. (ABSTRACT TRUNCATED)
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Affiliation(s)
- S Majumdar
- Magnetic Resonance Science Center, Department of Radiology, University of California, San Francisco 94143-1290, USA.
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50
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Abstract
Although the efficacy of various measures for the assessment of trabecular bone architecture has been widely studied, the impact of spatial resolution on the estimation of these measures has remained relatively unexplored. In this study, ten cubes each of human trabecular bone from the femur and vertebral bodies were obtained from nine cadavers (four males and five females), aged 23-67 years (mean 42.3 years). These specimens were serially milled and imaged at a resolution of 40 microm to produce three-dimensional digitizations from which traditional morphometric and structural anisotropy measures could be computed based on a three-dimensional approach. The cubes were then artificially degraded to an in-plane resolution of 100 microm and an out-of-plane (slice) resolution of 100-1000 microm. These resolutions mimicked in vivo resolutions as seen using magnetic resonance (MR) imaging. All images, original and degraded, were individually segmented using a thresholding algorithm, and both the traditional morphometric and structural anisotropy measures were recomputed. The choice of slice direction was varied along the superior-inferior (axial), anterior-posterior (coronal), and medial-lateral (sagittal) directions to minimize the impact of the lower slice resolution on the architectural measures. It was found that traditional morphometric measures such as trabecular spacing and trabecular number showed weak resolution dependency; measures such as trabecular thickness, however, showed strong resolution dependency and required very high resolutions for precise measurement. In the case of the femur specimens, both structural anisotropy as well as the preferred orientation showed a strong resolution dependency. The resolution dependency of these parameters could be minimized for the femur and the vertebral body specimens if the slice direction was taken along the superior-inferior direction.
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Affiliation(s)
- M Kothari
- Magnetic Resonance Science Center & Osteoporosis and Arthritis Research Group, Department of Radiology, University of California, San Francisco 94143, USA
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