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Ariyaratne S, Whittaker P, James SL, Botchu R. Comparison of patterns and rates of cement leakage in percutaneous sacroplasty for sacral insufficiency fractures versus neoplasia. Skeletal Radiol 2024; 53:93-98. [PMID: 37301797 DOI: 10.1007/s00256-023-04386-5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 06/04/2023] [Accepted: 06/04/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Percutaneous sacroplasty is a minimally invasive procedure which utilises injection of bone cement into the sacrum for stabilisation of osteoporotic sacral insufficiency fractures (SIF) and neoplastic lesions to relieve pain and improve function. While effective, cement leakage is an important complication associated with the procedure. This study aims to compare the incidence and patterns of the cement leakages following sacroplasty for SIF versus neoplasia and discuss the various patterns of cement leakage and their implications. MATERIALS AND METHODS This retrospective study analysed 57 patients who underwent percutaneous sacroplasty at a tertiary orthopaedic hospital. Patients were divided into 2 groups of SIF (n=46) and neoplastic lesions (n=11) based on their indication for sacroplasty. Pre- and post-procedural CT fluoroscopy was used to assess for cement leakage. The incidence and patterns of cement leakage were both compared among the two groups. A Fisher's exact test was used for statistical analysis. RESULTS Eleven (19%) patients had cement leakage on post-procedural imaging. The most common sites of cement leakage were into the presacral region (6), followed by sacroiliac joints (4), sacral foramina (3) and posterior sacral (1). There was a statistically significant higher incidence of leakage in the neoplastic group in comparison to SIF group (P-value <0.05). The incidence of cement leakage in the neoplastic group was 45% (n = 5/11) versus SIF 13% (n=6/46). CONCLUSION There was a statistically significant higher incidence of cement leak in sacroplasties conducted for the treatment of neoplastic lesions compared to those with sacral insufficiency fracture.
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Affiliation(s)
- S Ariyaratne
- Department of Musculoskeletal Radiology, Royal Orthopedic Hospital, Birmingham, UK
| | - P Whittaker
- Department of Musculoskeletal Radiology, Royal Orthopedic Hospital, Birmingham, UK
| | - S L James
- Department of Musculoskeletal Radiology, Royal Orthopedic Hospital, Birmingham, UK
| | - R Botchu
- Department of Musculoskeletal Radiology, Royal Orthopedic Hospital, Birmingham, UK.
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2
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Daniels LJ, Macindoe C, Koutsifeli P, Annandale M, James SL, Watson LE, Coffey S, Raaijmakers AJA, Weeks KL, Bell JR, Janssens JV, Curl CL, Delbridge LMD, Mellor KM. Myocardial deformation imaging by 2D speckle tracking echocardiography for assessment of diastolic dysfunction in murine cardiopathology. Sci Rep 2023; 13:12344. [PMID: 37524893 PMCID: PMC10390581 DOI: 10.1038/s41598-023-39499-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 07/26/2023] [Indexed: 08/02/2023] Open
Abstract
Diastolic dysfunction is increasingly identified as a key, early onset subclinical condition characterizing cardiopathologies of rising prevalence, including diabetic heart disease and heart failure with preserved ejection fraction (HFpEF). Diastolic dysfunction characterization has important prognostic value in management of disease outcomes. Validated tools for in vivo monitoring of diastolic function in rodent models of diabetes are required for progress in pre-clinical cardiology studies. 2D speckle tracking echocardiography has emerged as a powerful tool for evaluating cardiac wall deformation throughout the cardiac cycle. The aim of this study was to examine the applicability of 2D speckle tracking echocardiography for comprehensive global and regional assessment of diastolic function in a pre-clinical murine model of cardio-metabolic disease. Type 2 diabetes (T2D) was induced in C57Bl/6 male mice using a high fat high sugar dietary intervention for 20 weeks. Significant impairment in left ventricle peak diastolic strain rate was evident in longitudinal, radial and circumferential planes in T2D mice. Peak diastolic velocity was similarly impaired in the longitudinal and radial planes. Regional analysis of longitudinal peak diastolic strain rate revealed that the anterior free left ventricular wall is particularly susceptible to T2D-induced diastolic dysfunction. These findings provide a significant advance on characterization of diastolic dysfunction in a pre-clinical mouse model of cardiopathology and offer a comprehensive suite of benchmark values for future pre-clinical cardiology studies.
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Affiliation(s)
- L J Daniels
- Cellular and Molecular Cardiology Laboratory, Department of Physiology, University of Auckland, Auckland, New Zealand
- Radcliffe Department of Medicine, OCDEM, University of Oxford, Oxford, UK
| | - C Macindoe
- Cellular and Molecular Cardiology Laboratory, Department of Physiology, University of Auckland, Auckland, New Zealand
| | - P Koutsifeli
- Cellular and Molecular Cardiology Laboratory, Department of Physiology, University of Auckland, Auckland, New Zealand
| | - M Annandale
- Cellular and Molecular Cardiology Laboratory, Department of Physiology, University of Auckland, Auckland, New Zealand
| | - S L James
- Cellular and Molecular Cardiology Laboratory, Department of Physiology, University of Auckland, Auckland, New Zealand
| | - L E Watson
- Cellular and Molecular Cardiology Laboratory, Department of Physiology, University of Auckland, Auckland, New Zealand
| | - S Coffey
- Department of Medicine, University of Otago, Dunedin, New Zealand
| | - A J A Raaijmakers
- Department of Anatomy and Physiology, University of Melbourne, Melbourne, Australia
| | - K L Weeks
- Department of Anatomy and Physiology, University of Melbourne, Melbourne, Australia
- Baker Department of Cardiometabolic Health, University of Melbourne, Melbourne, Australia
| | - J R Bell
- Department of Anatomy and Physiology, University of Melbourne, Melbourne, Australia
- Department of Microbiology, Anatomy, Physiology and Pharmacology, La Trobe University, Melbourne, Australia
| | - J V Janssens
- Department of Anatomy and Physiology, University of Melbourne, Melbourne, Australia
| | - C L Curl
- Department of Anatomy and Physiology, University of Melbourne, Melbourne, Australia
| | - L M D Delbridge
- Department of Anatomy and Physiology, University of Melbourne, Melbourne, Australia
| | - Kimberley M Mellor
- Cellular and Molecular Cardiology Laboratory, Department of Physiology, University of Auckland, Auckland, New Zealand.
- Department of Anatomy and Physiology, University of Melbourne, Melbourne, Australia.
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand.
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3
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James SL, Quemada H, Benedict MQ, Dass B. Requirements for market entry of gene drive-modified mosquitoes for control of vector-borne diseases: analogies to other biologic and biotechnology products. Front Bioeng Biotechnol 2023; 11:1205865. [PMID: 37362219 PMCID: PMC10285705 DOI: 10.3389/fbioe.2023.1205865] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 05/25/2023] [Indexed: 06/28/2023] Open
Abstract
Gene drive-modified mosquitoes (GDMMs) are proposed as new tools for control and elimination of malaria and other mosquito-borne diseases, and promising results have been observed from testing conducted in containment. Although still at an early stage of development, it is important to begin now to consider approval procedures and market entry strategies for the eventual implementation of GDMMs in the context of disease control programs, as these could impact future research plans. It is expected that, as for other types of new products, those seeking to bring GDMMs to market will be required to provide sufficient information to allow the regulator(s) to determine whether the product is safe and effective for its proposed use. There already has been much emphasis on developing requirements for the biosafety components of the "safe and effective" benchmark, largely concerned with their regulation as genetically modified organisms. Other potential approval requirements have received little attention, however. Although GDMMs are expected to be implemented primarily in the context of public health programs, any regulatory analogies to other public health products, such as pharmaceuticals, vaccines, or chemical pesticides, must take into account the characteristics of live mosquito products. Typical manufacturing standards related to product identity, potency or quality will need to be adapted to GDMMs. Valuable lessons can be drawn from the regulatory approval processes for other whole organism and genetically modified (GM) organism products. Supply chain requirements, such as scale of production, location and design of production facilities, and methods of distribution and delivery, will be dependent upon the characteristics of the particular GDMM product, the conditions of use, and the region to be served. Plans for fulfilling supply chain needs can build upon experience in the development of other live insect products for use in public health and agriculture. Implementation of GDMMs would benefit from additional research on enabling technologies for long-term storage of mosquito life stages, efficient mass production, and area-wide delivery of GDMMs. Early consideration of these practical requirements for market entry will help to mitigate downstream delays in the development of these promising new technologies.
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Affiliation(s)
- Stephanie L. James
- GeneConvene Global Collaborative, Foundation for the NIH, Bethesda, MD, United States
| | | | | | - Brinda Dass
- GeneConvene Global Collaborative, Foundation for the NIH, Bethesda, MD, United States
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4
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James SL, O'Brochta DA, Randazzo F, Akbari OS. A gene drive is a gene drive: the debate over lumping or splitting definitions. Nat Commun 2023; 14:1749. [PMID: 36991021 PMCID: PMC10060380 DOI: 10.1038/s41467-023-37483-z] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 03/20/2023] [Indexed: 03/31/2023] Open
Affiliation(s)
- Stephanie L James
- Foundation for the National Institutes of Health, North Bethesda, MD, 20852, USA
| | - David A O'Brochta
- Foundation for the National Institutes of Health, North Bethesda, MD, 20852, USA
| | | | - Omar S Akbari
- University of California San Diego, La Jolla, CA, 92093, USA.
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5
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Davies AM, Patel A, Azzopardi C, James SL, Botchu R. Prevalence of Enchondromas of the Proximal Femur in Adults as an Incidental Finding on MRI of the Pelvis. Indian J Radiol Imaging 2021; 31:582-585. [PMID: 34790301 PMCID: PMC8590542 DOI: 10.1055/s-0041-1735915] [Citation(s) in RCA: 1] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Objective To determine the prevalence of enchondroma in adults as an incidental finding in the proximal femur on magnetic resonance imaging (MRI). Materials and Methods A retrospective review of the MRI scans of the pelvis in a series of adult patients was conducted. All presented with nononcological musculoskeletal complaints. The site, size, and appearances of the enchondromas were identified according to criteria from previous studies. Results A total of 1,209 proximal femora in 610 patients were reviewed and a total of 9 enchondromas were identified. These ranged from 0.6 to 2.5 cm in length (mean 1.3 cm). None showed aggressive features suggestive of malignancy. Three cases (33%) underwent follow-up MRI scans which showed no change in size or morphology. Conclusion The prevalence on MRI of incidental enchondromas arising in the proximal femur is 0.7%. This is three to four times less common than seen in the proximal humerus and around the knee.
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Affiliation(s)
- A M Davies
- Department of Musculoskeletal Radiology, The Royal Orthopaedic Hospital, Birmingham, United Kingdom
| | - A Patel
- Department of Musculoskeletal Radiology, The Royal Orthopaedic Hospital, Birmingham, United Kingdom
| | - C Azzopardi
- Department of Musculoskeletal Radiology, The Royal Orthopaedic Hospital, Birmingham, United Kingdom
| | - S L James
- Department of Musculoskeletal Radiology, The Royal Orthopaedic Hospital, Birmingham, United Kingdom
| | - R Botchu
- Department of Musculoskeletal Radiology, The Royal Orthopaedic Hospital, Birmingham, United Kingdom
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6
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Rajakulasingam R, Kho J, Almeer G, Azzopardi C, James SL, Botchu R. Birmingham Intervention Tent Technique (BITT): A Technical Note. Indian J Radiol Imaging 2021; 31:521-523. [PMID: 34556944 PMCID: PMC8448233 DOI: 10.1055/s-0041-1733467] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Objective
We describe a novel and safe CT biopsy technique that we have termed the “Birmingham intervention tent technique (BITT).” This technique is ideal for biopsying osseous lesions where a direct approach is not possible due to difficult positioning.
Methods
The BITT uses a plastic surgical forceps clamp attached at an angle to the biopsy needle, creating a tent shape. The finger rings of the forceps is stabilized on the table.
Results
In our institution, we have already used the BITT successfully in over 10 cases.
Conclusion
The BITT is an inexpensive and reproducible technique.
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Affiliation(s)
- R Rajakulasingam
- Department of Musculoskeletal Imaging, Royal Orthopaedic Hospital, Birmingham, UK
| | - J Kho
- Department of Musculoskeletal Imaging, Royal Orthopaedic Hospital, Birmingham, UK
| | - G Almeer
- Department of Musculoskeletal Imaging, Royal Orthopaedic Hospital, Birmingham, UK
| | - C Azzopardi
- Department of Musculoskeletal Imaging, Royal Orthopaedic Hospital, Birmingham, UK
| | - S L James
- Department of Musculoskeletal Imaging, Royal Orthopaedic Hospital, Birmingham, UK
| | - R Botchu
- Department of Musculoskeletal Imaging, Royal Orthopaedic Hospital, Birmingham, UK
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7
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Annandale M, Daniels LJ, Li X, Neale JPH, Chau AHL, Ambalawanar HA, James SL, Koutsifeli P, Delbridge LMD, Mellor KM. Fructose Metabolism and Cardiac Metabolic Stress. Front Pharmacol 2021; 12:695486. [PMID: 34267663 PMCID: PMC8277231 DOI: 10.3389/fphar.2021.695486] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 06/07/2021] [Indexed: 11/13/2022] Open
Abstract
Cardiovascular disease is one of the leading causes of mortality in diabetes. High fructose consumption has been linked with the development of diabetes and cardiovascular disease. Serum and cardiac tissue fructose levels are elevated in diabetic patients, and cardiac production of fructose via the intracellular polyol pathway is upregulated. The question of whether direct myocardial fructose exposure and upregulated fructose metabolism have potential to induce cardiac fructose toxicity in metabolic stress settings arises. Unlike tightly-regulated glucose metabolism, fructose bypasses the rate-limiting glycolytic enzyme, phosphofructokinase, and proceeds through glycolysis in an unregulated manner. In vivo rodent studies have shown that high dietary fructose induces cardiac metabolic stress and functional disturbance. In vitro, studies have demonstrated that cardiomyocytes cultured in high fructose exhibit lipid accumulation, inflammation, hypertrophy and low viability. Intracellular fructose mediates post-translational modification of proteins, and this activity provides an important mechanistic pathway for fructose-related cardiomyocyte signaling and functional effect. Additionally, fructose has been shown to provide a fuel source for the stressed myocardium. Elucidating the mechanisms of fructose toxicity in the heart may have important implications for understanding cardiac pathology in metabolic stress settings.
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Affiliation(s)
- M Annandale
- Department of Physiology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - L J Daniels
- Department of Physiology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.,Oxford Centre for Diabetes, Endocrinology and Metabolism, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - X Li
- Department of Physiology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - J P H Neale
- Department of Physiology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - A H L Chau
- Department of Physiology, School of Biomedical Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - H A Ambalawanar
- Department of Physiology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - S L James
- Department of Physiology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - P Koutsifeli
- Department of Physiology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - L M D Delbridge
- Department of Physiology, School of Biomedical Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - K M Mellor
- Department of Physiology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.,Department of Physiology, School of Biomedical Sciences, University of Melbourne, Melbourne, VIC, Australia
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8
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Smith E, Rajakulasingam R, Davies AM, James SL, Botchu R. Answer To Test Yourself Question: Right medial hip pain. Skeletal Radiol 2021; 50:1271-1272. [PMID: 33241439 DOI: 10.1007/s00256-020-03679-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 10/23/2020] [Accepted: 11/15/2020] [Indexed: 02/02/2023]
Affiliation(s)
- E Smith
- Department of Musculoskeletal Imaging, Royal Orthopaedic Hospital, Birmingham, UK
| | - R Rajakulasingam
- Department of Musculoskeletal Imaging, Royal National Orthopaedic Hospital, Stanmore, UK
| | - A M Davies
- Department of Musculoskeletal Imaging, Royal Orthopaedic Hospital, Birmingham, UK
| | - S L James
- Department of Musculoskeletal Imaging, Royal Orthopaedic Hospital, Birmingham, UK
| | - R Botchu
- Department of Musculoskeletal Imaging, Royal Orthopaedic Hospital, Birmingham, UK.
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9
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Smith E, Rajakulasingam R, Davies AM, James SL, Botchu R. Test yourself question: right medial hip pain. Skeletal Radiol 2021; 50:1237-1239. [PMID: 33231716 DOI: 10.1007/s00256-020-03678-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 10/23/2020] [Accepted: 11/15/2020] [Indexed: 02/02/2023]
Affiliation(s)
- E Smith
- Department of Musculoskeletal Imaging, Royal Orthopaedic Hospital, Birmingham, UK
| | - R Rajakulasingam
- Department of Musculoskeletal Imaging, Royal National Orthopaedic Hospital, Stanmore, UK
| | - A M Davies
- Department of Musculoskeletal Imaging, Royal Orthopaedic Hospital, Birmingham, UK
| | - S L James
- Department of Musculoskeletal Imaging, Royal Orthopaedic Hospital, Birmingham, UK
| | - R Botchu
- Department of Musculoskeletal Imaging, Royal Orthopaedic Hospital, Birmingham, UK.
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10
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Hegde G, Subramanian A, Azzopardi C, Patel A, James SL, Botchu R. Iliotibial band enthesopathy: an unusual cause of lateral knee pain post total knee replacement. J Ultrasound 2021; 25:83-87. [PMID: 33591565 PMCID: PMC8964855 DOI: 10.1007/s40477-021-00565-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 11/13/2020] [Accepted: 01/25/2021] [Indexed: 11/26/2022] Open
Abstract
Iliotibial band (ITB) pathology is one of the main causes of lateral knee pain. The enthesopathy of the ITB at its insertion post total knee replacement (TKR) is a rare cause of lateral knee pain. We describe a series of cases of ITB enthesopathy with sonographic findings and management.
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Affiliation(s)
- G Hegde
- Department of Musculoskeletal Imaging, Department of Musculoskeletal Radiology, The Royal Orthopaedic Hospital, Bristol Road South, Northfield, Birmingham, UK
| | - A Subramanian
- Department of Musculoskeletal Imaging, Department of Musculoskeletal Radiology, The Royal Orthopaedic Hospital, Bristol Road South, Northfield, Birmingham, UK
| | - C Azzopardi
- Department of Musculoskeletal Imaging, Department of Musculoskeletal Radiology, The Royal Orthopaedic Hospital, Bristol Road South, Northfield, Birmingham, UK
| | - A Patel
- Department of Musculoskeletal Imaging, Department of Musculoskeletal Radiology, The Royal Orthopaedic Hospital, Bristol Road South, Northfield, Birmingham, UK
| | - S L James
- Department of Musculoskeletal Imaging, Department of Musculoskeletal Radiology, The Royal Orthopaedic Hospital, Bristol Road South, Northfield, Birmingham, UK
| | - Rajesh Botchu
- Department of Musculoskeletal Imaging, Department of Musculoskeletal Radiology, The Royal Orthopaedic Hospital, Bristol Road South, Northfield, Birmingham, UK.
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Rajakulasingam R, Attard V, Botchu R, James SL, Saifuddin A. The value of chest and skeletal staging in parosteal osteosarcoma: two-centre experience and literature review. Skeletal Radiol 2021; 50:301-309. [PMID: 32705301 DOI: 10.1007/s00256-020-03557-y] [Citation(s) in RCA: 1] [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: 06/01/2020] [Revised: 07/14/2020] [Accepted: 07/14/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine the value of chest and skeletal staging in patients with parosteal osteosarcoma (POS), and the incidence of late local and chest recurrence. MATERIALS AND METHODS Retrospective review of patients across two institutions with histological confirmation of POS diagnosed between January 2007 and March 2020. Data collected included age, sex, skeletal location, results of chest CT and whole-body bone scintigraphy (WB-BSc) or whole-body MRI (WB-MRI) obtained at initial diagnosis. The histological tumour grade based on surgical resection specimens was classified as low-grade POS (LG-POS) and dedifferentiated POS (DD-POS). Findings of chest CT and skeletal staging were correlated with tumour grade. Follow-up chest CT and MRI studies were reviewed to determine the rate of late lung metastases and local recurrence. RESULTS There were 27 males and 44 females, mean age 33 years (range 12-79 years). The femur (n = 43) and tibia (n = 14) were the most commonly involved bones. From surgical resection histology, 42 (59.2%) were LG-POS and 29 (40.8%) were DD-POS. WB-BSc/WB-MRI showed no skeletal metastases, while 1 case of DD-POS presented with bilateral calcified lung metastases. At follow-up, 7 patients (9.9%) developed lung metastases (mean of 18.9 months, range 10-48 months) from initial presentation, of which all were DD-POS. All but 1 patient who developed subsequent lung metastases had a local recurrence. CONCLUSIONS Skeletal staging is unlikely to be of value in POS. Staging chest CT is very unlikely to demonstrate lung metastases in LG-POS and could be limited to DD-POS, particularly at the time of local recurrence.
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Affiliation(s)
- R Rajakulasingam
- Department of Medical Imaging, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK.
| | - V Attard
- Department of Medical Imaging, Mater Dei Hospital, Msida, MSD, 2090, Malta
| | - R Botchu
- Department of Medical Imaging, Royal Orthopaedic Hospital, The Woodlands, Bristol Road South, Birmingham, B31 2AP, UK
| | - S L James
- Department of Medical Imaging, Royal Orthopaedic Hospital, The Woodlands, Bristol Road South, Birmingham, B31 2AP, UK
| | - A Saifuddin
- Department of Medical Imaging, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK
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12
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Mak D, Chisholm C, Davies AM, Botchu R, James SL. Psoas muscle atrophy following unilateral hip arthroplasty. Skeletal Radiol 2020; 49:1539-1545. [PMID: 32361852 DOI: 10.1007/s00256-020-03447-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 03/28/2020] [Accepted: 04/06/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Studies have demonstrated the presence of muscle atrophy around the hip in patients with hip osteoarthritis. Few studies have examined the psoas muscle or assessed it at a paraspinal level in patients post-total hip arthroplasty. The aim of this study was to determine if there is significant psoas muscle atrophy as indicated by muscle cross-sectional area and high degree of fat infiltration post-unilateral hip arthroplasty. METHODS Retrospective analysis of 341 patients with unilateral hip implant and subsequent lumbar spine MRI over a 8-year period was performed. Fat infiltration and cross-sectional area of the psoas muscle at L3/4 level were measured by two musculoskeletal fellows (1 year experience in musculoskeletal radiology), and comparison made between the implant and non-operative sides was made. Fat infiltration was measured using the modified Goutallier grading. The degree of hip osteoarthritis in the non-operative side was measured using the Kellgren-Lawrence grading. The data was analysed using paired t test, ANOVA, unpaired t test, Pearson correlation and Jonckheere-Terpstra test. RESULTS The cross-sectional area of the psoas muscle on the implant side was significantly less than the non-operative side. There was significance between the cross-sectional area difference and the fat grade of the implant side. CONCLUSION Our results demonstrate psoas atrophy on the implant side compared to the non-operative side in post-unilateral implant patients. Post-operative hip implant rehabilitation may benefit from more focused psoas strengthening exercises to improve functional outcome.
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Affiliation(s)
- D Mak
- Department of Musculoskeletal Radiology, Guy's & St. Thomas' NHS Foundation Trust, London, UK
| | - C Chisholm
- Department of Musculoskeletal Radiology, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - A M Davies
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Northfield, Birmingham, UK
| | - R Botchu
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Northfield, Birmingham, UK.
| | - S L James
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Northfield, Birmingham, UK
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13
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Kho J, Azzopardi C, Davies AM, James SL, Botchu R. MRI assessment of anatomy and pathology of the iliofemoral ligament. Clin Radiol 2020; 75:960.e17-960.e22. [PMID: 32718743 DOI: 10.1016/j.crad.2020.06.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 06/04/2020] [Indexed: 10/23/2022]
Abstract
The iliofemoral ligament is strongest ligament of the body. We review the magnetic resonance imaging (MRI) appearances of the iliofemoral ligament, and discuss the disease entities that may affect this region.
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Affiliation(s)
- J Kho
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK
| | - C Azzopardi
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK
| | - A M Davies
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK
| | - S L James
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK
| | - R Botchu
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK.
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14
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Davies AM, Patel A, James SL, Azzopardi C, Botchu R. An imaging protocol for the management of central cartilage tumours of the proximal fibula. Clin Radiol 2020; 75:714.e1-714.e6. [PMID: 32665062 DOI: 10.1016/j.crad.2020.03.040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 03/19/2020] [Indexed: 10/23/2022]
Abstract
AIM To retrospectively review a series of solitary central cartilage tumours (CCTs) of the proximal fibula and propose an imaging protocol for their management. MATERIALS AND METHODS Over 11 years, 48 patients were identified with a CCT of the proximal fibula. The initial magnetic resonance imaging (MRI) and follow-up imaging were assessed for tumour length, endosteal scalloping, or aggressive/malignant features. Each case was categorised according to the Birmingham Atypical Cartilage Tumour Imaging Protocol (BACTIP). The final diagnosis and outcome were reviewed to establish an appropriate imaging protocol for the management of similar cases in the future. RESULTS The final diagnosis based on imaging alone or imaging and histopathology was enchondroma in 46 cases (96%) and atypical cartilage tumour (ACT)/low-grade chondrosarcoma in two (4%). Using the BACTIP classification, the majority were type IC (48%) with type IA the second commonest (24%). Of 19 that underwent follow-up MRI, only two revealed any increase in length, neither of which was shown to be malignant. No cases re-presented later with evidence of malignant transformation. CONCLUSION There has been a significant increase in the number of CCTs of the proximal fibula referred to Royal Orthopaedic Hospital, Birmingham, over the past decade. This can largely be attributed to the increased use of MRI. The majority were benign with only 4% classified as an ACT. A modified BACTIP, the Fibular Atypical Cartilage Tumour Imaging Protocol (FACTIP) is presented, indicating which cases would benefit from follow-up imaging and which require referral to a specialist orthopaedic oncology service.
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Affiliation(s)
- A M Davies
- Department of Diagnostic Imaging, The Royal Orthopaedic Hospital, Birmingham, B31 2AP, UK
| | - A Patel
- Department of Diagnostic Imaging, The Royal Orthopaedic Hospital, Birmingham, B31 2AP, UK.
| | - S L James
- Department of Diagnostic Imaging, The Royal Orthopaedic Hospital, Birmingham, B31 2AP, UK
| | - C Azzopardi
- Department of Diagnostic Imaging, The Royal Orthopaedic Hospital, Birmingham, B31 2AP, UK
| | - R Botchu
- Department of Diagnostic Imaging, The Royal Orthopaedic Hospital, Birmingham, B31 2AP, UK
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15
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Kurisunkal V, Botchu R, Davies AM, James SL, Jeys L. Computer assisted tumour surgery - An insight. J Orthop 2020; 22:268-273. [PMID: 32467658 DOI: 10.1016/j.jor.2020.04.013] [Citation(s) in RCA: 1] [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: 03/25/2020] [Revised: 04/06/2020] [Accepted: 04/26/2020] [Indexed: 11/30/2022] Open
Abstract
Success in the management of bone sarcomas entails being able to achieve wide margins, which helps decrease the risk of local recurrence and provide an improvement in overall survival. The role of computer-assisted surgery has been investigated across various areas of orthopaedics, including joint replacement, cruciate ligament reconstruction, and pedicle screw placements which has led to increased interested in computer assisted tumour surgery (CATS). CATS can be used in a wide array of tumour surgeries, however its role in pelvic and sacral tumours is unparalled. Its importance lies in being able to provide radiological information to guide the surgeon at the time of surgery i.e. the distance from the tumour to the resection margin can be determined precisely based on preoperative planning and intra-operative image guidance. This minimises unnecessary bone resection, aiming to achieve good oncological and functional results which can be challenging in pelvic surgery. Most published articles on CATS have concentrated on the surgical aspects of navigation surgery. Although advanced imaging techniques such as magnetic resonance imaging (MRI) and computed tomography (CT) scans can provide anatomic detail about the primary tumour, the successful transfer of that information from a viewing screen to the intraoperative field can be difficult. The role of the radiologist lies in being able to provide appropriate imaging (CT, MRI) to facilitate surgical planning. This article aims at providing the radiologist a surgical insight on CATS and to facilitate optimal imaging in a patient tentatively being planned for CATS.
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Affiliation(s)
- V Kurisunkal
- Department of Orthopaedic Oncology Royal Orthopaedic Hospital, Birmingham, UK
| | - R Botchu
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK
| | - A M Davies
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK
| | - S L James
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK
| | - L Jeys
- Department of Orthopaedic Oncology Royal Orthopaedic Hospital, Birmingham, UK
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16
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Iqbal A, McLoughlin E, Patel A, James SL, Botchu R, Davies AM. Osteochondroma-induced pseudoaneurysms of the extremities mimicking sarcoma: a report of seven contemporary and one historical case. Clin Radiol 2020; 75:642.e9-642.e13. [PMID: 32317165 DOI: 10.1016/j.crad.2020.02.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 02/20/2020] [Indexed: 11/28/2022]
Abstract
AIM To provide a diagnostic approach to distinguish osteochondroma-induced pseudoaneurysm from sarcoma on imaging and prevent biopsy which may be fatal. MATERIALS AND METHODS A retrospective study of the orthopaedic oncology database was performed to identify all patients referred to specialist orthopaedic oncology service with a final diagnosis of osteochondroma-induced pseudoaneurysm. The demographics of the cohort, the anatomical location of the osteochondromas and pseudoaneurysms, and the imaging appearances were assessed. RESULTS Seven contemporary and one historical case of osteochondroma-induced-pseudoaneurysm were identified. There were five patients with solitary osteochondroma and three cases of hereditary multiple exostosis. Five cases underwent magnetic resonance imaging (MRI) of which pulsation artefact was present in 40%. On MRI, all the present cases demonstrated a small central pseudoaneurysm surrounded by multiple eccentric layers of thrombus and haemorrhage, which was termed the "eccentric-whorl sign". CONCLUSION Osteochondroma-induced pseudoaneurysms are often misdiagnosed as malignant transformation of an osteochondroma or a soft-tissue sarcoma and referred for urgent biopsy. This study presents the largest case series, which includes the first documented case diagnosed in 1934. Differentiating and characterising pseudoaneurysms from sarcomas is imperative in order to prevent a biopsy, which could be fatal.
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Affiliation(s)
- A Iqbal
- Department of Musculoskeletal Radiology, Royal Orthopedic Hospital NHS Foundation Trust, Birmingham, UK
| | - E McLoughlin
- Department of Musculoskeletal Radiology, Royal Orthopedic Hospital NHS Foundation Trust, Birmingham, UK
| | - A Patel
- Department of Musculoskeletal Radiology, Royal Orthopedic Hospital NHS Foundation Trust, Birmingham, UK
| | - S L James
- Department of Musculoskeletal Radiology, Royal Orthopedic Hospital NHS Foundation Trust, Birmingham, UK
| | - R Botchu
- Department of Musculoskeletal Radiology, Royal Orthopedic Hospital NHS Foundation Trust, Birmingham, UK.
| | - A M Davies
- Department of Musculoskeletal Radiology, Royal Orthopedic Hospital NHS Foundation Trust, Birmingham, UK
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17
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Abstract
Facet joints are the only synovial joints in the spine and can be involved in a large number of pathological processes including arthropathy, infection, inflammation, trauma and tumour. In this review article, we present a spectrum of pathologies that arise from or involve facet joints that we have encountered in our tertiary orthopaedic and spinal centre. The objective of this review is to create an aide memoire for the general radiologist who may encounter facet joint pathology, which they may not be familiar with.
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Affiliation(s)
- G Almeer
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK
| | - C Azzopardi
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK
| | - J Kho
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK
| | - H Gupta
- Department of Musculoskeletal Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - S L James
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK
| | - R Botchu
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK
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18
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Davies AM, Shah A, Shah R, Patel A, James SL, Botchu R. Are the tubular bones of the hand really the commonest site for an enchondroma? Clin Radiol 2020; 75:533-537. [PMID: 32183998 DOI: 10.1016/j.crad.2020.02.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 02/13/2020] [Indexed: 12/19/2022]
Abstract
AIM To investigate whether the long-held view that the hand is the commonest site for an enchondroma is actually correct in light of more sensitive imaging techniques that are able to demonstrate small enchondromas at other skeletal sites. MATERIALS AND METHODS A two-part retrospective study was undertaken. Part 1 comprised a review of the hand radiographs obtained in two major teaching hospitals over a 10-year period to establish the incidence of enchondroma in the hand. Part 2 was a review of a series of enchondromas of the proximal humerus, distal femur, and proximal tibia <4 cm in length on magnetic resonance imaging (MRI) to see which cases were visible or not on corresponding radiographs. RESULTS Part 1: 84 enchondromas were identified on 116,354 trauma radiographs to give an incidence of 0.07%. Part 2: 157 patients with an enchondroma on MRI <4 cm were reviewed. Only 17% of lesions <2 cm in length were visible on the contemporaneous radiographs. In lesions that were 2-2.9 and 3-3.9 cm the percentage visible on the radiographs increased to 58 and 77%, respectively. CONCLUSION It is well recognised from existing studies that incidental enchondromas can be seen in approximately 2.5% of routine shoulder and knee MRI scans. This figure is 35 times higher than the incidence found in the series of hand trauma radiographs. This infers that the hand should no longer be considered as the commonest site for an enchondroma. This is because radiographs are relatively insensitive to the detection of small lesions in larger bones, such as the proximal humerus and around the knee, when compared with MRI.
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Affiliation(s)
- A M Davies
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK
| | - A Shah
- Department of Radiology, Leicester Royal Infirmary, Leicester, UK
| | - R Shah
- Department of Radiology, University Hospitals Coventry & Warwick, Coventry, UK
| | - A Patel
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK
| | - S L James
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK
| | - R Botchu
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK.
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19
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James SL, Marshall JM, Christophides GK, Okumu FO, Nolan T. Toward the Definition of Efficacy and Safety Criteria for Advancing Gene Drive-Modified Mosquitoes to Field Testing. Vector Borne Zoonotic Dis 2020; 20:237-251. [PMID: 32155390 PMCID: PMC7153640 DOI: 10.1089/vbz.2019.2606] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Mosquitoes containing gene drive systems are being developed as complementary tools to prevent transmission of malaria and other mosquito-borne diseases. As with any new tool, decision makers and other stakeholders will need to balance risks (safety) and benefits (efficacy) when considering the rationale for testing and deploying gene drive-modified mosquito products. Developers will benefit from standards for judging whether an investigational gene drive product meets acceptability criteria for advancing to field trials. Such standards may be formalized as preferred product characteristics and target product profiles, which describe the desired attributes of the product category and of a particular product, respectively. This report summarizes discussions from two scientific workshops aimed at identifying efficacy and safety characteristics that must be minimally met for an investigational gene drive-modified mosquito product to be deemed viable to move from contained testing to field release and the data that will be needed to support an application for first field release.
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Affiliation(s)
- Stephanie L James
- Foundation for the National Institutes of Health, North Bethesda, Maryland
| | | | | | | | - Tony Nolan
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
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20
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Iqbal A, McLoughlin E, Botchu R, James SL. The ring-shaped meniscus: a case series demonstrating the variation of imaging appearances on MRI. Skeletal Radiol 2020; 49:281-289. [PMID: 31363822 DOI: 10.1007/s00256-019-03277-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 03/29/2019] [Revised: 06/05/2019] [Accepted: 07/04/2019] [Indexed: 02/02/2023]
Abstract
The ring-shaped meniscus (RSM) is a rare meniscal variant in which there is an intermeniscal bridge between the anterior and posterior horns of the meniscus, thus forming a complete ring. The lateral meniscus is more commonly involved than the medial meniscus. Distinguishing an RSM from a bucket handle tear (BHT) with a displaced fragment in the intercondylar notch is challenging and there are reports of negative arthroscopies for suspected BHTs. There are many reports of symptomatic and asymptomatic lateral RSMs diagnosed on MRI in the literature. We report a series of RSMs in six patients, which includes MRI descriptions of two cases of medial RSM and a case of bilateral lateral RSM, which were diagnosed on MRI and have never previously been reported. This study will also describe the various imaging features of a RSM that distinguish it from a displaced BHT. We will also discuss associated rare malformations encountered in our study, such as hypoplastic anterior cruciate ligament and the anomalous insertion of the popliteus tendon onto the posterior horn of a lateral RSM.
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Affiliation(s)
- A Iqbal
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Northfield, Birmingham, UK
| | - E McLoughlin
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Northfield, Birmingham, UK
| | - Rajesh Botchu
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Northfield, Birmingham, UK.
| | - S L James
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Northfield, Birmingham, UK
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21
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Boo SL, Botchu R, McLoughlin E, Patel A, James SL, Gregory J, Davies AM. Sarcoma multidisciplinary team meeting: past, present, and future. Clin Radiol 2020; 75:316-318. [PMID: 31973939 DOI: 10.1016/j.crad.2019.12.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 12/18/2019] [Indexed: 10/25/2022]
Affiliation(s)
- S L Boo
- Department of Orthopaedic Oncology, Royal Orthopaedic Hospital, Birmingham, UK
| | - R Botchu
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK.
| | - E McLoughlin
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK
| | - A Patel
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK
| | - S L James
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK
| | - J Gregory
- Department of Orthopaedic Oncology, Royal Orthopaedic Hospital, Birmingham, UK
| | - A M Davies
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK
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22
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McLoughlin E, Davies AM, Iqbal A, James SL, Botchu R. The diagnostic significance of pulmonary nodules on CT thorax in chondrosarcoma of bone. Clin Radiol 2019; 75:395.e7-395.e16. [PMID: 31898960 DOI: 10.1016/j.crad.2019.11.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 11/13/2019] [Indexed: 10/25/2022]
Abstract
AIM To provide a diagnostic approach to pulmonary nodules in patients with chondrosarcoma. MATERIALS AND METHODS A search of the oncology database at a specialist orthopaedic oncology referral centre was performed to identify all patients who were treated surgically for chondrosarcoma between January 2007 and December 2018. Reports from the computed tomography (CT) examinations of the thorax of these patients were reviewed. In patients who had pulmonary nodules/metastases identified on CT, data on the primary chondrosarcoma and pulmonary nodule characteristics were collected. RESULTS Twenty point two percent of patients had a pulmonary nodule identified on either initial or follow-up staging CT of the thorax, of which 8.1% were pulmonary metastases. Patients with grade 3 and dedifferentiated chondrosarcoma were more likely to have pulmonary metastases than patients with grade 1/2 chondrosarcoma. The time interval to developing metastases was shorter in patients with grade 2/3 and dedifferentiated chondrosarcoma versus patients with grade 1 chondrosarcoma. A low proportion of patients with grade 1 chondrosarcoma developed metastases (12.5%), all of which were identified at the time of a local recurrence. Nodules ≥10mm, nodules with lobulate margins, nodules containing irregular or subtle calcification, and nodules seen bilaterally or both centrally and peripherally were more likely to represent pulmonary metastases than benign nodules. CONCLUSION The diagnostic significance of pulmonary nodules (i.e., whether they represent pulmonary metastases or not) can be predicted by taking into account a number of factors, in particular, the histological grade of the patient's chondrosarcoma, the size and margins of the nodules, and the presence of subtle/irregular calcification.
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Affiliation(s)
- E McLoughlin
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - A M Davies
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - A Iqbal
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - S L James
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - R Botchu
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK.
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23
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Affiliation(s)
- A Iqbal
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South Northfield, Birmingham, UK.
| | - E McLoughlin
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South Northfield, Birmingham, UK
| | - R Botchu
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South Northfield, Birmingham, UK
| | - S L James
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South Northfield, Birmingham, UK
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24
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McLoughlin E, Iqbal A, Patel A, James SL, Botchu R. Dual steristrip technique: a novel use of steristrips to reduce operator radiation dose during CT-guided intervention. Skeletal Radiol 2019; 48:1617-1620. [PMID: 30927033 DOI: 10.1007/s00256-019-03211-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 02/03/2019] [Revised: 03/13/2019] [Accepted: 03/14/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE We describe a novel and safe needle-holding method that we have termed the 'dual steristrip technique'. This technique can be used to stabilize the bone biopsy needle without the need for the radiologist's hand to be in close proximity to the X-ray beam during CT-guided intervention. MATERIALS AND METHODS The dual steristrip technique uses steristrips to stabilize the bone biopsy needle and allows for accurate assessment of needle position and trajectory. This involves affixing one end of a steristrip to the skin 2 cm from the needle skin entry point, wrapping the mid-section of the steristrip around the biopsy needle and affixing the other end of the steristrip to the skin at the opposite side of the needle 2 cm from the needle skin entry point. A second steristrip is then applied in a similar fashion at 90° to the first steristrip. RESULTS In our institution, we have used the dual steristrip technique to stabilize the biopsy needle in certain cases where assessment of needle position/trajectory can be more challenging. This includes cases where there is a paucity of soft tissues overlying the bone or if the bone lesion is located in the superficial cortex. We have found it to be successful in 80% of cases. CONCLUSIONS The dual steristrip technique is a safe and effective needle stabilization method that should be considered by the interventional radiologist in challenging CT-guided bone biopsy cases.
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Affiliation(s)
- E McLoughlin
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Northfield, Birmingham, UK
| | - A Iqbal
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Northfield, Birmingham, UK
| | - A Patel
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Northfield, Birmingham, UK
| | - S L James
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Northfield, Birmingham, UK
| | - Rajesh Botchu
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Northfield, Birmingham, UK.
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25
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Affiliation(s)
- A Iqbal
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Birmingham, Northfield, UK.
| | - E McLoughlin
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Birmingham, Northfield, UK
| | - R Botchu
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Birmingham, Northfield, UK
| | - S L James
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Birmingham, Northfield, UK
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26
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Rajakulasingam R, Murphy J, Panchal H, James SL, Botchu R. Master knot of Henry revisited: a radiologist's perspective on MRI. Clin Radiol 2019; 74:972.e1-972.e8. [PMID: 31563291 DOI: 10.1016/j.crad.2019.08.011] [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] [Received: 02/23/2019] [Accepted: 08/20/2019] [Indexed: 10/26/2022]
Abstract
The master knot of Henry refers to a narrow space located between the anatomical crossover of the flexor hallucis longus and flexor digitorum longus tendons. This small space is prone to "intersection syndrome," as a result of tendinosis, tenosynovitis, and tears of the aforementioned tendons at the knot of Henry. The aim of this educational review is to detail the anatomy of the knot of Henry, including common variations in the tendon position and orientation. These complex interconnections can affect the outcome of surgical intervention if not appreciated at the time of treatment. We will also provide an overview of the common and rarer pathologies related to the knot of Henry. The aim of the present review is to make radiologists more aware of pathologies in this region, which are not routinely seen in daily practice.
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Affiliation(s)
- R Rajakulasingam
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham B31 2AP, UK.
| | - J Murphy
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham B31 2AP, UK
| | - H Panchal
- Sanya Pixel Diagnostics, Ahmedabad, Gujarat, India
| | - S L James
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham B31 2AP, UK
| | - R Botchu
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham B31 2AP, UK
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27
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McLoughlin E, Iqbal A, Tillman RM, James SL, Botchu R. Calcific tendinopathy of the direct head of rectus femoris: a rare cause of groin pain treated with ultrasound guided percutaneous irrigation. J Ultrasound 2019; 23:425-430. [PMID: 31372946 DOI: 10.1007/s40477-019-00402-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 05/10/2019] [Accepted: 07/18/2019] [Indexed: 12/14/2022] Open
Abstract
Groin pain can be caused by a myriad of pathologies. Abnormalities of the rectus femoris are a very rare cause of groin pain; calcific tendinopathy of the direct head is particularly so, with only two case reports in the literature. We report the first case of calcific tendinopathy of the direct head of the rectus femoris that was treated effectively with ultrasound-guided percutaneous irrigation of calcific tendinopathy (USPICT). The anatomy of the rectus femoris and the technique for US-PICT of the rectus femoris are also described.
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Affiliation(s)
- E McLoughlin
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - A Iqbal
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - R M Tillman
- Department of Orthopedic Oncology, Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - S L James
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - R Botchu
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK.
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28
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Vidoni A, McLoughlin E, James SL, Botchu R. Intra-neural ganglion cyst of the lateral dorsal cutaneous nerve: an uncommon cause of lateral ankle pain. J Ultrasound 2019; 23:81-86. [PMID: 31161399 DOI: 10.1007/s40477-019-00387-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 05/22/2019] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION An intra-neural ganglion cyst of the lateral dorsal cutaneous branch of the sural nerve is rare, with only a few cases reported in the literature. MATERIALS AND METHODS We carried out a retrospective investigation of patients with an intraneural ganglion cyst of the lateral dorsal cutaneous nerve. RESULTS We present a case series of four patients with intra-neural ganglion cysts of the lateral dorsal cutaneous nerve, the distal continuation of the sural nerve at the lateral aspect of the foot. CONCLUSION Intra-neural ganglion cysts of the lateral dorsal cutaneous nerve are rare. They represent a relatively uncommon source of lateral ankle pain, which can easily be diagnosed with ultrasound (US) and magnetic resonance imaging and managed effectively with US-guided aspiration or surgical excision.
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Affiliation(s)
- A Vidoni
- Department of Musculoskeletal Radiology, The Royal Orthopedic Hospital, Bristol Road South, Northfield, Birmingham, UK.,Royal National Orthopedic Hospital, Stanmore, UK
| | - E McLoughlin
- Department of Musculoskeletal Radiology, The Royal Orthopedic Hospital, Bristol Road South, Northfield, Birmingham, UK
| | - S L James
- Department of Musculoskeletal Radiology, The Royal Orthopedic Hospital, Bristol Road South, Northfield, Birmingham, UK
| | - R Botchu
- Department of Musculoskeletal Radiology, The Royal Orthopedic Hospital, Bristol Road South, Northfield, Birmingham, UK.
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29
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McLoughlin E, Iqbal A, Shamji R, James SL, Botchu R. Brachialis tendinopathy: a rare cause of antecubital pain and ultrasound-guided injection technique. J Ultrasound 2019; 24:355-358. [PMID: 31006087 DOI: 10.1007/s40477-019-00378-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Accepted: 04/10/2019] [Indexed: 11/24/2022] Open
Abstract
Antecubital pain can be caused by a myriad of pathologies. Abnormalities of the brachialis, in particular, tendinopathy at its insertion, are extremely rare, with no case report in the literature. We report the first case of tendinopathy of the brachialis tendon at its insertion in a 42-year-old male who presented with a year-long history of antecubital pain. The anatomy of the brachialis and the technique for ultrasound-guided steroid injection of the brachialis will also be described.
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Affiliation(s)
- E McLoughlin
- Department of Musculoskeletal Radiology, The Royal Orthopedic Hospital, Bristol Road South, Northfield, Birmingham, UK
| | - A Iqbal
- Department of Musculoskeletal Radiology, The Royal Orthopedic Hospital, Bristol Road South, Northfield, Birmingham, UK
| | - R Shamji
- Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - S L James
- Department of Musculoskeletal Radiology, The Royal Orthopedic Hospital, Bristol Road South, Northfield, Birmingham, UK
| | - R Botchu
- Department of Musculoskeletal Radiology, The Royal Orthopedic Hospital, Bristol Road South, Northfield, Birmingham, UK.
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Murphy J, Patel A, James SL, Botchu R, Davies AM. "Flow-void" sign in osseous metastatic renal cell carcinoma. Clin Radiol 2018; 74:111-115. [PMID: 30220594 DOI: 10.1016/j.crad.2018.08.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 08/09/2018] [Indexed: 11/16/2022]
Abstract
AIM To evaluate the frequency of the "flow-void" sign in a large series of pathologically proven renal cell carcinoma (RCC) bone metastases referred to a specialist unit and to evaluate its correlation with both lesion size and imaging sequence. A further aim was to describe a proposed grading system for the description of the "flow-void" sign. MATERIALS AND METHODS A retrospective review of patients with magnetic resonance imaging (MRI) of pathologically proven RCC bone metastases between September 2007 and December 2017 was performed. MRI images were reviewed for the presence of the "flow-void" sign and a proposed grading system for this sign was applied. Statistical analysis was performed to determine the association between the presence of the "flow-void" sign and lesion size and MRI sequence. RESULTS One hundred and forty bone lesions in 123 patients with histologically proven metastatic RCC were reviewed. One hundred and thirty-two (94.3%) lesions demonstrated the "flow-void" sign on at least one sequence in each study. A statistically significant difference was demonstrated between lesion size and the presence and type of "flow-void" sign. Lesions demonstrating type 3 "flow-void" sign had mean dimensions of 82.2 mm compared to 47.3 mm for lesions that did not demonstrate the "flow-void" sign (χ2(2) =11.4; p=0.01). T2-weighted, proton density and fat-saturated imaging also demonstrated the "flow-void" sign more frequently. CONCLUSION The "flow-void" sign is a common imaging feature within RCC bone metastases. When observed, the "flow-void" sign can be a useful imaging feature in the diagnosis of RCC bone metastases.
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Affiliation(s)
- J Murphy
- Royal Orthopaedic Hospital, Bristol Road South, Birmingham B31 2AP, UK.
| | - A Patel
- Royal Orthopaedic Hospital, Bristol Road South, Birmingham B31 2AP, UK
| | - S L James
- Royal Orthopaedic Hospital, Bristol Road South, Birmingham B31 2AP, UK
| | - R Botchu
- Royal Orthopaedic Hospital, Bristol Road South, Birmingham B31 2AP, UK
| | - A M Davies
- Royal Orthopaedic Hospital, Bristol Road South, Birmingham B31 2AP, UK
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Botchu R, Bharath A, Davies AM, Butt S, James SL. Correction to: Current concept in upright spinal MRI. Eur Spine J 2018; 27:994. [PMID: 29480408 DOI: 10.1007/s00586-018-5532-1] [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] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Unfortunately, the legend of Fig. 5 was incorrectly published in original publication. The corrected legend is given below.
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Affiliation(s)
- R Botchu
- Department of Musculoskeletal Radiology, The Royal Orthopedic Hospital, Bristol Road South, Northfield, Birmingham, B31 2AP, UK.
| | - A Bharath
- Department of Musculoskeletal Radiology, The Royal Orthopedic Hospital, Bristol Road South, Northfield, Birmingham, B31 2AP, UK
| | - A M Davies
- Department of Musculoskeletal Radiology, The Royal Orthopedic Hospital, Bristol Road South, Northfield, Birmingham, B31 2AP, UK
| | - S Butt
- Department of Musculoskeletal Radiology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK
| | - S L James
- Department of Musculoskeletal Radiology, The Royal Orthopedic Hospital, Bristol Road South, Northfield, Birmingham, B31 2AP, UK
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Crawford DE, Miskimmin CK, Cahir J, James SL. Continuous multi-step synthesis by extrusion - telescoping solvent-free reactions for greater efficiency. Chem Commun (Camb) 2018; 53:13067-13070. [PMID: 29165442 DOI: 10.1039/c7cc06010f] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Chemical manufacturing typically requires more than one step, involving multiple batch processes, which makes synthesis at scale laborious and wasteful. Herein, we demonstrate that several reactions can be telescoped into a single continuous process and/or be carried out as a continuous multi-component reaction (MCR), by twin screw extrusion (TSE), in the complete absence of solvent.
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Affiliation(s)
- Deborah E Crawford
- Queen's University Belfast, School of Chemistry and Chemical Engineering, David Keir Building, 39-123 Stranmillis Road, Belfast BT9 5AG, UK.
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Shah A, James SL, Davies AM, Botchu R. A diagnostic approach to popliteal fossa masses. Clin Radiol 2016; 72:323-337. [PMID: 28007292 DOI: 10.1016/j.crad.2016.11.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 11/10/2016] [Accepted: 11/21/2016] [Indexed: 02/07/2023]
Abstract
There is a myriad of potential mass lesions that occur in the popliteal fossa, which present as palpable masses or are found incidentally on imaging. With a thorough knowledge and understanding of the appearances and locations of these different entities, one can narrow the differential diagnoses in the majority of cases. This will eliminate unnecessary additional investigations and enable a more rapid management. We present a review of frequently encountered and less common entities using an anatomical sieve, with the aim of providing a diagnostic approach to popliteal fossa masses.
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Affiliation(s)
- A Shah
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK.
| | - S L James
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK
| | - A M Davies
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK
| | - R Botchu
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK
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Shatzel J, Dulai PS, Harbin D, Cheung H, Reid TN, Kim J, James SL, Khine H, Batman S, Whyman J, Dickson RC, Ornstein DL. Safety and efficacy of pharmacological thromboprophylaxis for hospitalized patients with cirrhosis: a single-center retrospective cohort study. J Thromb Haemost 2015; 13:1245-53. [PMID: 25955079 PMCID: PMC6658183 DOI: 10.1111/jth.13000] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [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] [Received: 09/19/2014] [Accepted: 04/23/2015] [Indexed: 12/20/2022]
Abstract
BACKGROUND Hospitalized patients with cirrhosis are at increased risk for venous thromboembolism (VTE). The benefits and risks of pharmacological thromboprohylaxis in these patients have not been well studied. OBJECTIVES To examine the safety and efficacy of pharmacological VTE prophylaxis in hospitalized cirrhotic patients. PATIENTS/METHODS Retrospective cohort study of patients with cirrhosis hospitalized at an academic tertiary care referral center over a 5-year period. RESULTS Six hundred hospital admissions accounting for 402 patients were included. VTE prophylaxis was administered during 296 (49%) admissions. Patients receiving VTE prophylaxis were older (59 years vs. 55 years, P < 0.001), had longer lengths of stay (9.6 days vs. 6.8 days, P = 0.002), and lower Model for End-Stage Liver Disease scores (13.2 vs. 16.1, P < 0.001). In-hospital bleeding events (8.1% vs. 5.5%, P = 0.258), gastrointestinal bleeding events (3.0% vs. 3.2% P = 0.52), new VTE events (2.37% vs. 1.65%, P = 0.537), and mortality (8.4% vs. 7.3%, P = 0.599) were similar in the two groups. VTE prophylaxis did not reduce the risk of VTE (odds ratio 0.94, 95% confidence interval 0.23-3.71), and patients receiving unfractionated heparin, but not low molecular weight heparin, were at increased risk for in-hospital bleeding events (odds ratio 2.38, 95% confidence interval 1.15-4.94 vs. 0.87, 0.37-2.05, respectively). CONCLUSION The rate of VTE in this cohort of hospitalized cirrhotic patients was low and was unaffected by pharmacological thromboprophylaxis. Unfractionated heparin was associated with an increased risk for in-hospital bleeding, suggesting that if thromboprophylaxis is indicated, low molecular weight heparin may be favored.
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Affiliation(s)
- J Shatzel
- Department of Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
| | - P S Dulai
- Department of Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
| | - D Harbin
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - H Cheung
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - T N Reid
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - J Kim
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - S L James
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - H Khine
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - S Batman
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - J Whyman
- Department of Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
| | - R C Dickson
- Department of Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - D L Ornstein
- Department of Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA
- Department of Pathology, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
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Abstract
Soft tissue sarcomas are rare tumours which can be clinically difficult to differentiate from more common benign lesions. Imaging plays a fundamental role in diagnosis, but in some cases it can be difficult to differentiate benign from malignant conditions. This article reviews potential pitfalls in soft tissue sarcoma imaging.
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Affiliation(s)
| | | | - S L James
- Consultant Radiologist in the Department of Radiology, Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham B31 2AP
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36
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Fonville JM, Wilks SH, James SL, Fox A, Ventresca M, Aban M, Xue L, Jones TC, Le NMH, Pham QT, Tran ND, Wong Y, Mosterin A, Katzelnick LC, Labonte D, Le TT, van der Net G, Skepner E, Russell CA, Kaplan TD, Rimmelzwaan GF, Masurel N, de Jong JC, Palache A, Beyer WEP, Le QM, Nguyen TH, Wertheim HFL, Hurt AC, Osterhaus ADME, Barr IG, Fouchier RAM, Horby PW, Smith DJ. Antibody landscapes after influenza virus infection or vaccination. Science 2014; 346:996-1000. [PMID: 25414313 DOI: 10.1126/science.1256427] [Citation(s) in RCA: 313] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
We introduce the antibody landscape, a method for the quantitative analysis of antibody-mediated immunity to antigenically variable pathogens, achieved by accounting for antigenic variation among pathogen strains. We generated antibody landscapes to study immune profiles covering 43 years of influenza A/H3N2 virus evolution for 69 individuals monitored for infection over 6 years and for 225 individuals pre- and postvaccination. Upon infection and vaccination, titers increased broadly, including previously encountered viruses far beyond the extent of cross-reactivity observed after a primary infection. We explored implications for vaccination and found that the use of an antigenically advanced virus had the dual benefit of inducing antibodies against both advanced and previous antigenic clusters. These results indicate that preemptive vaccine updates may improve influenza vaccine efficacy in previously exposed individuals.
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Affiliation(s)
- J M Fonville
- Center for Pathogen Evolution, Department of Zoology, University of Cambridge, Cambridge CB2 3EJ, UK.,WHO Collaborating Center for Modeling, Evolution, and Control of Emerging Infectious Diseases, Cambridge CB2 3EJ, UK.,Department of Viroscience, Erasmus Medical Center, Rotterdam 3015 CE, the Netherlands
| | - S H Wilks
- Center for Pathogen Evolution, Department of Zoology, University of Cambridge, Cambridge CB2 3EJ, UK.,WHO Collaborating Center for Modeling, Evolution, and Control of Emerging Infectious Diseases, Cambridge CB2 3EJ, UK
| | - S L James
- Center for Pathogen Evolution, Department of Zoology, University of Cambridge, Cambridge CB2 3EJ, UK.,WHO Collaborating Center for Modeling, Evolution, and Control of Emerging Infectious Diseases, Cambridge CB2 3EJ, UK
| | - A Fox
- Oxford University Clinical Research Unit and Wellcome Trust Major Overseas Programme, Hanoi, Vietnam
| | - M Ventresca
- Center for Pathogen Evolution, Department of Zoology, University of Cambridge, Cambridge CB2 3EJ, UK
| | - M Aban
- WHO Collaborating Centre for Reference and Research on Influenza, VIDRL at the Peter Doherty Institute for Infection and Immunity, Melbourne VIC 3000, Australia
| | - L Xue
- WHO Collaborating Centre for Reference and Research on Influenza, VIDRL at the Peter Doherty Institute for Infection and Immunity, Melbourne VIC 3000, Australia
| | - T C Jones
- Center for Pathogen Evolution, Department of Zoology, University of Cambridge, Cambridge CB2 3EJ, UK.,WHO Collaborating Center for Modeling, Evolution, and Control of Emerging Infectious Diseases, Cambridge CB2 3EJ, UK
| | - N M H Le
- Oxford University Clinical Research Unit and Wellcome Trust Major Overseas Programme, Hanoi, Vietnam
| | - Q T Pham
- National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - N D Tran
- National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Y Wong
- Oxford University Museum of Natural History, Oxford OX1 3PW, UK
| | - A Mosterin
- Center for Pathogen Evolution, Department of Zoology, University of Cambridge, Cambridge CB2 3EJ, UK.,WHO Collaborating Center for Modeling, Evolution, and Control of Emerging Infectious Diseases, Cambridge CB2 3EJ, UK
| | - L C Katzelnick
- Center for Pathogen Evolution, Department of Zoology, University of Cambridge, Cambridge CB2 3EJ, UK.,WHO Collaborating Center for Modeling, Evolution, and Control of Emerging Infectious Diseases, Cambridge CB2 3EJ, UK
| | - D Labonte
- Insect Biomechanics Group, Department of Zoology, University of Cambridge, Cambridge CB2 3EJ, UK
| | - T T Le
- National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - G van der Net
- Department of Viroscience, Erasmus Medical Center, Rotterdam 3015 CE, the Netherlands
| | - E Skepner
- Center for Pathogen Evolution, Department of Zoology, University of Cambridge, Cambridge CB2 3EJ, UK.,WHO Collaborating Center for Modeling, Evolution, and Control of Emerging Infectious Diseases, Cambridge CB2 3EJ, UK
| | - C A Russell
- WHO Collaborating Center for Modeling, Evolution, and Control of Emerging Infectious Diseases, Cambridge CB2 3EJ, UK.,Department of Veterinary Medicine, University of Cambridge, Cambridge CB3 0ES, UK
| | - T D Kaplan
- bobblewire.com, Saint Louis, MO 63112, US
| | - G F Rimmelzwaan
- Department of Viroscience, Erasmus Medical Center, Rotterdam 3015 CE, the Netherlands
| | - N Masurel
- Department of Viroscience, Erasmus Medical Center, Rotterdam 3015 CE, the Netherlands
| | - J C de Jong
- Department of Viroscience, Erasmus Medical Center, Rotterdam 3015 CE, the Netherlands
| | - A Palache
- Abbott Laboratories, Weesp 1380 DA, the Netherlands
| | - W E P Beyer
- Department of Viroscience, Erasmus Medical Center, Rotterdam 3015 CE, the Netherlands
| | - Q M Le
- National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - T H Nguyen
- National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - H F L Wertheim
- Oxford University Clinical Research Unit and Wellcome Trust Major Overseas Programme, Hanoi, Vietnam.,Nuffield Department of Clinical Medicine, Centre for Tropical Medicine, University of Oxford, Oxford OX3 7BN, UK
| | - A C Hurt
- WHO Collaborating Centre for Reference and Research on Influenza, VIDRL at the Peter Doherty Institute for Infection and Immunity, Melbourne VIC 3000, Australia.,Melbourne School of Population and Global Health, University of Melbourne, Parkville VIC 3010, Australia
| | - A D M E Osterhaus
- Department of Viroscience, Erasmus Medical Center, Rotterdam 3015 CE, the Netherlands
| | - I G Barr
- WHO Collaborating Centre for Reference and Research on Influenza, VIDRL at the Peter Doherty Institute for Infection and Immunity, Melbourne VIC 3000, Australia
| | - R A M Fouchier
- Department of Viroscience, Erasmus Medical Center, Rotterdam 3015 CE, the Netherlands
| | - P W Horby
- Oxford University Clinical Research Unit and Wellcome Trust Major Overseas Programme, Hanoi, Vietnam.,Nuffield Department of Clinical Medicine, Centre for Tropical Medicine, University of Oxford, Oxford OX3 7BN, UK
| | - D J Smith
- Center for Pathogen Evolution, Department of Zoology, University of Cambridge, Cambridge CB2 3EJ, UK.,WHO Collaborating Center for Modeling, Evolution, and Control of Emerging Infectious Diseases, Cambridge CB2 3EJ, UK.,Department of Viroscience, Erasmus Medical Center, Rotterdam 3015 CE, the Netherlands
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Botchu R, Douis H, Davies AM, James SL, Puls F, Grimer R. Post-traumatic heterotopic ossification of distal tibiofibular syndesmosis mimicking a surface osteosarcoma. Clin Radiol 2013; 68:e676-9. [PMID: 24034551 DOI: 10.1016/j.crad.2013.07.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2012] [Revised: 07/16/2013] [Accepted: 07/22/2013] [Indexed: 01/19/2023]
Abstract
AIM To present the imaging features of post-traumatic heterotopic ossification (HO) of the distal tibiofibular syndesmosis initially suspected to be a surface osteosarcoma. MATERIALS AND METHODS A retrospective review was conducted of the presenting complaint and imaging features of patients with a final diagnosis of HO referred over an 8 year period to a specialist orthopaedic oncology centre. RESULTS Five patients with HO were identified. All were adult males with an age range of 19-41 years. There was a history of prior ankle trauma in all cases but the significance was not recognized at the time of referral to the specialist centre. There was radiographic evidence of HO arising from the inner aspects of the distal tibia and fibula approximately 3 cm proximal to the ankle joint. The HO was "kissing" in two cases and partially fused (synostosis) in two. The HO in the fifth case was arising on the inner fibular cortex alone. Magnetic resonance imaging (MRI), available in four cases, showed predominantly low signal intensity due to the dense bone formation. CONCLUSION The history of prior ankle trauma with ossification arising from the inner aspects of both the distal tibia and fibula is typical of post-traumatic HO and distinguish this benign condition from the rare surface osteosarcoma at this site.
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Affiliation(s)
- R Botchu
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK
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Abstract
Effects of fatigue were assessed on 12 female subjects who were filmed at two stages of a maximal-effort, gross physical performance task (running). Comparisons were then made between selected temporal and kinematic parameters describing the activity: The results appear to support the concept that fatigue does not simply produce a uniform reduction in the components of a movement pattern but, rather, changes their relationship completely.
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Affiliation(s)
- B T Bates
- a Department of Physical Education , University of Oregon
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39
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Douis H, Davies AM, James SL, Kindblom LG, Grimer RJ, Johnson KJ. Can MR imaging challenge the commonly accepted theory of the pathogenesis of solitary enchondroma of long bone? Skeletal Radiol 2012; 41:1537-42. [PMID: 22422023 DOI: 10.1007/s00256-012-1387-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2011] [Revised: 12/06/2011] [Accepted: 02/26/2012] [Indexed: 02/02/2023]
Abstract
OBJECTIVE It has been widely postulated that enchondromas arise from cartilage remnants that have been displaced from the growth plate into the metaphysis. However, this theory remains unproven. Based on the common occurrence of enchondromas on routine knee MR imaging (2.9 %), one would expect to find displaced cartilage in the metaphysis of skeletally immature individuals on routine knee MR examinations if the above theory was to be supported. MATERIALS AND METHODS The electronic databases of a specialist orthopedic hospital and children's hospital were searched for skeletally immature patients who underwent MR imaging of the knee for a variety of indications. Individuals with Ollier disease or hereditary multiple exostoses were excluded. The MR images were subsequently reviewed by a musculoskeletal radiologist for evidence of displaced cartilage into the metaphysis. RESULTS We reviewed 240 MR examinations of the knee that were performed in 209 patients. There were 125 MR studies in male and 115 MR examinations in female patients (age range: 5 months-16 years; median age: 13 years). In 97.1 %, the growth plates around the knee demonstrated a regular appearance. Seven cases (2.9 %) in six patients showed cartilage extension from the growth plate into the metaphysis, which remained in continuity with the growth plate. There were no cases of displaced cartilage into the metaphysis on MRI. CONCLUSIONS Our study challenges the widely believed theory that enchondromas arise from displaced growth plate remnants.
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Affiliation(s)
- H Douis
- Department of Radiology, Royal Orthopaedic Hospital, Birmingham, B31 2AP, UK.
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Abstract
by Jill Lincoln, Charles H.V. Hoyle and Geoffrey Burnstock, Cambridge University Press, 1997. pound24.95 (pbk)/ pound70.00 (hbk) (xiv +363 pages) ISBN 0 521 55977 4/0 521 55038 6.
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Affiliation(s)
- S L James
- Parasitology and International Health Branch NIAID, National Institutes of Health Solar Building Room 3A-02 Bethesda MD 20892, USA
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41
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Affiliation(s)
- Z B Shafi
- Pharmaceutical Sciences Research Group, Brighton Polytechnic, Brighton BN2 4GJ UK
| | - GP Martin
- Pharmaceutical Sciences Research Group, Brighton Polytechnic, Brighton BN2 4GJ UK
| | - SL James
- Pharmaceutical Sciences Research Group, Brighton Polytechnic, Brighton BN2 4GJ UK
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42
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Phillips GJ, Lethem MI, Paget TA, James SL. The Effect of Mono and Divalent Cations on the In-Vitro Hydration Kinetics of Purified Porcine Gastric Mucus Gel. J Pharm Pharmacol 2011. [DOI: 10.1111/j.2042-7158.1990.tb14535.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- GJ Phillips
- Pharmaceutical Sciences Research Group, Dept. of Pharmacy, Brighton Polytechnic, Brighton, BN2 4GJ
| | - MI Lethem
- Pharmaceutical Sciences Research Group, Dept. of Pharmacy, Brighton Polytechnic, Brighton, BN2 4GJ
| | - TA Paget
- Pharmaceutical Sciences Research Group, Dept. of Pharmacy, Brighton Polytechnic, Brighton, BN2 4GJ
| | - SL James
- Pharmaceutical Sciences Research Group, Dept. of Pharmacy, Brighton Polytechnic, Brighton, BN2 4GJ
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43
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Smedley YM, Marriott C, Hodges N, James SL. Rheological Interactions of Cystic Fibrosis Tracheal Mucin and Pseudomonas Aeruginosa Extracellular Alginate. J Pharm Pharmacol 2011. [DOI: 10.1111/j.2042-7158.1986.tb14283.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Y M Smedley
- Department of Pharmacy, Brighton Polytechnic, Moulsecoomb, Brighton BN2 4GJ
| | - C Marriott
- Department of Pharmacy, Brighton Polytechnic, Moulsecoomb, Brighton BN2 4GJ
| | - N Hodges
- Department of Pharmacy, Brighton Polytechnic, Moulsecoomb, Brighton BN2 4GJ
| | - S L James
- Department of Pharmacy, Brighton Polytechnic, Moulsecoomb, Brighton BN2 4GJ
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44
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Simpfendorfer CS, Ilaslan H, Davies AM, James SL, Obuchowski NA, Sundaram M. Does the presence of focal normal marrow fat signal within a tumor on MRI exclude malignancy? An analysis of 184 histologically proven tumors of the pelvic and appendicular skeleton. Skeletal Radiol 2008; 37:797-804. [PMID: 18551289 DOI: 10.1007/s00256-008-0523-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2008] [Revised: 04/25/2008] [Accepted: 05/13/2008] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The aim of this study was to determine if the presence of focal normal bone marrow fat signal within a tumor on magnetic resonance imaging excludes malignancy. MATERIALS AND METHODS One hundred eighty-four histologically proven tumors with available magnetic resonance imaging (MRI) of the appendicular skeleton and pelvis from 184 patients were collected and reviewed at two separate institutions. There were 111 malignant and 73 benign tumors. Two radiologists at each institution, blinded to the diagnosis, reviewed the MRIs independently and reported the presence or absence of normal marrow fat signal within the tumor based upon T1-weighted imaging without fat suppression and T2-weighted imaging with fat suppression and/or short inversion-time inversion recovery (STIR). Discrepancies were then reviewed in consensus to determine the presence or absence of focal normal marrow signal. For each institution, a Fisher's exact test was used to compare the frequency of focal normal marrow fat signal in benign and malignant tumors. This comparison was performed for each reader, as well as for the consensus reading at each site. Positive and negative predictive values were also calculated for each reader, as well as the consensus reading at each site. Fisher's exact test was also used to compare the frequency of intratumoral fat in benign and malignant lesions for the pooled sample. Bayes theorem was used to calculate the positive and negative predictive values for the pooled consensus data. Ninety-five percent confidence intervals were constructed for the pooled estimates using a bootstrapping algorithm. RESULTS There was good interobserver reliability of 95.3% and 96.7% at sites 1 and 2, respectively. There were three discrepancies (one malignant and two benign) at site 1 and four discrepancies (two malignant and two benign) at site 2. Reader consensus at site 1 identified normal marrow fat signal within 1 of 50 (2.0%) malignant and three of 14 (21.4%) benign tumors. Findings were statistically significant with a p value of 0.030. The positive predictive value (PPV) and negative predictive value (NPV) at site 1 was 81.7% and 75.0%, respectively. Reader consensus at site 2 identified normal marrow fat signal within three of 61 (4.9%) malignant and 14 of 59 (23.7%) benign tumors. Findings were statistically significant with a calculated p value of 0.004. The PPV and NPV at site 1 was 56.3% and 82.4%, respectively. For the pooled consensus, the frequency of intratumoral fat in benign lesions (17/73, 23.3%) is significantly greater than the frequency in malignant lesions (4/111, 3.6%), p < 0.001. CONCLUSION The presence of focal normal marrow signal within a tumor is highly suggestive of a benign tumor.
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Affiliation(s)
- C S Simpfendorfer
- Department of Radiology, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
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Newnham E, Hawkes E, Surender A, James SL, Gearry R, Gibson PR. Quantifying exposure to diagnostic medical radiation in patients with inflammatory bowel disease: are we contributing to malignancy? Aliment Pharmacol Ther 2007; 26:1019-24. [PMID: 17877508 DOI: 10.1111/j.1365-2036.2007.03449.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [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] [Indexed: 12/16/2022]
Abstract
BACKGROUND While potential risks of diagnostic medical radiation are acknowledged, actual exposure of patients in routine clinical practice is poorly documented. AIM To quantify such exposure to vulnerable abdominal organs in patients with inflammatory bowel disease who are already at risk of intestinal cancer. METHODS All incidences of exposure to diagnostic medical radiation were documented in a consecutive series of 100 patients with inflammatory bowel disease (62 Crohn's disease, 37 ulcerative colitis, 1 indeterminate colitis) attending a hospital-based clinic. Total effective dose (mSv) was calculated using published tables. Predictors of high or no irradiation were evaluated by multivariate logistic regression analysis. RESULTS Thirteen patients had no documented diagnostic irradiation. Twenty-three patients received an effective dose greater than 25 mSv. An at-risk effective dose >50 mSv was received by 11 patients. Dosage was higher in patients with Crohn's disease than ulcerative colitis (P = 0.02) and in patients undergoing surgery (P = 0.004). However, no predictive factors for high radiation dosage or for no exposure were identified. CONCLUSIONS At-risk irradiation from diagnostic medical radiation is common in patients with inflammatory bowel disease, and might potentially contribute to the elevated risk of intra-abdominal and other cancers. The level of irradiation should be considered in clinical decisions regarding abdominal imaging.
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Affiliation(s)
- E Newnham
- Department of Gastroenterology and Monash University Department of Medicine, Box Hill Hospital, Victoria, Australia
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Alyas F, James SL, Davies AM, Saifuddin A. The role of MR imaging in the diagnostic characterisation of appendicular bone tumours and tumour-like conditions. Eur Radiol 2007; 17:2675-86. [PMID: 17342487 DOI: 10.1007/s00330-007-0597-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2006] [Revised: 12/02/2006] [Accepted: 01/15/2007] [Indexed: 12/14/2022]
Abstract
MRI has an established role in the local staging of primary bone tumours. However, as the majority of tumours have non-specific appearances on MRI, the diagnosis is usually established on the basis of clinical history, plain film findings and biopsy. This article reviews the value of MRI in the further characterisation of appendicular bone tumours and tumour-like lesions, with particular reference to peri-lesional oedema, fluid-fluid levels, flow voids, fat signal, cartilage signal and dedifferentiation. These features are a useful adjunct for distinguishing between benign and malignant disease, pointing towards a more specific diagnosis, and guiding biopsy.
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Affiliation(s)
- F Alyas
- Department of Radiology, The Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK
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Evans KC, Evans RG, Royal R, Esterman AJ, James SL. Effect of caesarean section on breast milk transfer to the normal term newborn over the first week of life. Arch Dis Child Fetal Neonatal Ed 2003; 88:F380-2. [PMID: 12937041 PMCID: PMC1721616 DOI: 10.1136/fn.88.5.f380] [Citation(s) in RCA: 105] [Impact Index Per Article: 5.0] [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: 11/04/2022]
Abstract
OBJECTIVE To determine the effect of caesarean section on breast milk transfer (BMT) to the normal term infant over the first week of life. METHOD A sample of 88 healthy nursing mothers who had a normal vaginal delivery, and 97 mothers who had a caesarean section were recruited from a teaching hospital. Mothers and midwives were instructed to weigh the infants before and after each feed throughout the study period using calibrated portable electronic scales. RESULTS The volume of milk transferred to infants born by caesarean section was significantly less than that transferred to infants born by normal vaginal delivery on days 2 to 5 (p < 0.05), but by day 6 there was no difference between the two groups (p = 0.08). The difference could not be explained by any of the maternal and infant variables measured. Birth weight was regained by day 6 in 40% of infants born vaginally compared with 20% in those born by caesarean section. CONCLUSION There is a lag in the profile of the daily volume of breast milk transferred to infants delivered by caesarean section compared with those born by normal vaginal delivery. This study also challenges the widely followed schedules of milk volumes considered to be suitable for the term infant, which appear to be excessive, at least for the first four to five days post partum.
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Affiliation(s)
- K C Evans
- Women and Children at Flinders, Flinders Medical Centre, Bedford Park, South Australia 5042
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Abstract
The concept of dietary fibre is a complex one that incorporates the physical and physiological functions of fibre and its effects both systemically and local to the gastro-intestinal tract. Dietary fibre can be usefully classified according to its solubility and fermentability, which allows rational clinical application. Fibres may act in several ways including by gel-forming effects in the stomach and small intestine, by its fermentation by colonic bacteria, by a 'mop and sponge' effect, and via concomitant changes in other aspects of the diet. These actions lead to potentially beneficial effects in the gastro-intestinal tract and systemically, such as lowering serum cholesterol and improving glycaemic control. Dietary fibre has been implicated in multiple clinical situations but, although an extensive literature on putative actions and proposed physiological bases is available, high-level evidence of efficacy is limited. Nevertheless, encouraging the intake of a high-fibre diet is likely to have a range of health benefits and physicians are encouraged to follow simple practical guidelines in their everyday practice.
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Affiliation(s)
- S L James
- Department of Gastroenterology, Box Hill Hospital, Box Hill, Victoria, Australia
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James SL. Support for Parasitology Research at the National Institute of Allergy and Infectious Diseases. COMP PARASITOL 2002. [DOI: 10.1654/1525-2647(2002)069[0120:sfprat]2.0.co;2] [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: 11/11/2022]
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