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Jerban S, Jang H, Chang EY, Bukata S, Du J, Chung CB. Bone Biomarkers Based on Magnetic Resonance Imaging. Semin Musculoskelet Radiol 2024; 28:62-77. [PMID: 38330971 DOI: 10.1055/s-0043-1776431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
Magnetic resonance imaging (MRI) is increasingly used to evaluate the microstructural and compositional properties of bone. MRI-based biomarkers can characterize all major compartments of bone: organic, water, fat, and mineral components. However, with a short apparent spin-spin relaxation time (T2*), bone is invisible to conventional MRI sequences that use long echo times. To address this shortcoming, ultrashort echo time MRI sequences have been developed to provide direct imaging of bone and establish a set of MRI-based biomarkers sensitive to the structural and compositional changes of bone. This review article describes the MRI-based bone biomarkers representing total water, pore water, bound water, fat fraction, macromolecular fraction in the organic matrix, and surrogates for mineral density. MRI-based morphological bone imaging techniques are also briefly described.
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Affiliation(s)
- Saeed Jerban
- Department of Radiology, University of California, San Diego, La Jolla, California
| | - Hyungseok Jang
- Department of Radiology, University of California, San Diego, La Jolla, California
| | - Eric Y Chang
- Department of Radiology, University of California, San Diego, La Jolla, California
- Research Service, Veterans Affairs San Diego Healthcare System, San Diego, California
| | - Susan Bukata
- Department of Orthopaedic Surgery, University of California, San Diego, La Jolla, California
| | - Jiang Du
- Department of Radiology, University of California, San Diego, La Jolla, California
- Research Service, Veterans Affairs San Diego Healthcare System, San Diego, California
- Department of Bioengineering, University of California, San Diego, La Jolla, California
| | - Christine B Chung
- Department of Radiology, University of California, San Diego, La Jolla, California
- Research Service, Veterans Affairs San Diego Healthcare System, San Diego, California
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2
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Pham C, Ross HE, Vijayan T, Bukata S, Mekheal M, Markovic D, Silakar S. 243. Analysis of Risk Factors Associated with Adverse Outcomes Following Calcium Sulfate Bead Use in Periprosthetic Joint Infections. Open Forum Infect Dis 2021. [PMCID: PMC8643852 DOI: 10.1093/ofid/ofab466.445] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Calcium sulfate (CS) beads are increasingly utilized in orthopedic surgeries as a delivery vehicle to administer local antimicrobials intraoperatively. Hypercalcemia, AKI, and elevated serum antimicrobial levels have been reported as potential complications, especially with higher bead volumes. We analyzed the risk factors associated with adverse outcomes among patients with PJIs who received intraoperative CS beads loaded with tobramycin and vancomycin. Methods We conducted a retrospective review of adult patients with PJIs who received CS beads from October 2019 to October 2020. Primary outcomes included the incidence of AKI (defined using RIFLE criteria) and hypercalcemia (≥ 11 mg/dL). Logistic regression with forward entry selection of independent variables based on a liberal probability significance of α < 0.25 was used to model the relationships between our variables. Independent variables with clinical relevance that did not meet the conditional selection were also included in the model. Results A total of 171 adult patients were included for the analysis. Postoperative AKI occurred in 42 patients (24.6%) who received a mean bead volume of 32 cc. Hypercalcemia occurred in 16 patients (9.4%) who had a mean bead volume of 40 cc. In a univariate analysis, the odds of having AKI and hypercalcemia increased significantly per 10 cc of bead volume with ORs of 1.39 (95%CI, 1.06, 1.82) and 1.65 (95%CI, 1.20, 2.29), respectively. In a multivariate analysis, significant predictors of AKI included: increased bead volume (aOR 1.52; 95%CI, 1.10-2.10), female sex (aOR 2.77; 95%CI, 1.00-7.71), CHF (aOR 3.48; 95%CI, 1.08-11.28), and CAD (aOR 3.90; 95%CI, 1.25-12.18). In the adjusted model, serum tobramycin levels increased (OR 2.67; 95%CI, 1.83-3.90), calcium levels increased with a mean of 0.2 mg/dL (95%CI, 0.12, 0.28), and GFR decreased with a mean of 5.6% (95%CI, 2.8, 8.7) per 10 cc bead volume. In a subset analysis, individuals more likely to experience AKI were patients aged 65 and older (OR 1.9; P=0.039) and had CAD (OR 15.26; P=0.028). Conclusion Higher volume of CS beads loaded with vancomycin and tobramycin is associated with adverse outcomes. Older patients with heart disease may be at higher risk for adverse outcomes. Disclosures All Authors: No reported disclosures
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Affiliation(s)
- Christine Pham
- University of California, Los Angeles; David School of Medicine/University of California, Los Angeles, Los Angeles, California
| | | | - Tara Vijayan
- UCLA David Geffen School of Medicine, Los Angeles, California
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3
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Gao Y, Ghodrati V, Kalbasi A, Fu J, Ruan D, Cao M, Wang C, Eilber FC, Bernthal N, Bukata S, Dry SM, Nelson SD, Kamrava M, Lewis J, Low DA, Steinberg M, Hu P, Yang Y. Prediction of soft tissue sarcoma response to radiotherapy using longitudinal diffusion MRI and a deep neural network with generative adversarial network-based data augmentation. Med Phys 2021; 48:3262-3372. [PMID: 33908045 DOI: 10.1002/mp.14897] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 05/19/2020] [Revised: 02/18/2021] [Accepted: 04/12/2021] [Indexed: 11/10/2022] Open
Abstract
PURPOSE The goal of this study was to predict soft tissue sarcoma response to radiotherapy (RT) using longitudinal diffusion-weighted MRI (DWI). A novel deep-learning prediction framework along with generative adversarial network (GAN)-based data augmentation was investigated for the response prediction. METHODS Thirty soft tissue sarcoma patients who were treated with five-fraction hypofractionated radiation therapy (RT, 6Gy×5) underwent diffusion-weighted MRI three times throughout the RT course using an MR-guided radiotherapy system. Pathologic treatment effect (TE) scores, ranging from 0-100%, were obtained from the post-RT surgical specimen as a surrogate of patient treatment response. Patients were divided into three classes based on the TE score (TE ≤ 20%, 20% < TE < 90%, TE ≥ 90%). Apparent diffusion coefficient (ADC) maps of the tumor from the three time points were combined as 3-channel images. An auxiliary classifier generative adversarial network (ACGAN) was trained on 20 patients to augment the data size. A total of 15,000 synthetic images were generated for each class. A prediction model based on a previously described VGG-19 network was trained using the synthesized data, validated on five unseen validation patients, and tested on the remaining five test patients. The entire process was repeated seven times, each time shuffling the training, validation, and testing datasets such that each patient was tested at least once during the independent test stage. Prediction performance for slice-based prediction and patient-based prediction was evaluated. RESULTS The average training and validation accuracies were 86.5% ± 1.6% and 84.8% ± 1.8%, respectively, indicating that the generated samples were good representations of the original patient data. Among the seven rounds of testing, slice by slice prediction accuracy ranged from 81.6% to 86.8%. The overall accuracy of the independent test sets was 83.3%. For patient-based prediction, 80% was achieved in one round and 100% was achieved in the remaining six rounds. The mean accuracy was 97.1%. CONCLUSION This study demonstrated the potential to use deep learning to predict the pathologic treatment effect from longitudinal DWI. Accuracies of 83.3% and 97.1% were achieved on independent test sets for slice-based and patient-based prediction respectively.
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Affiliation(s)
- Yu Gao
- Department of Radiological Sciences, University of California, Los Angeles, CA, USA.,Physics and Biology in Medicine IDP, University of California, Los Angeles, CA, USA
| | - Vahid Ghodrati
- Department of Radiological Sciences, University of California, Los Angeles, CA, USA.,Physics and Biology in Medicine IDP, University of California, Los Angeles, CA, USA
| | - Anusha Kalbasi
- Department of Radiation Oncology, University of California, Los Angeles, CA, USA
| | - Jie Fu
- Physics and Biology in Medicine IDP, University of California, Los Angeles, CA, USA.,Department of Radiation Oncology, University of California, Los Angeles, CA, USA
| | - Dan Ruan
- Physics and Biology in Medicine IDP, University of California, Los Angeles, CA, USA.,Department of Radiation Oncology, University of California, Los Angeles, CA, USA
| | - Minsong Cao
- Physics and Biology in Medicine IDP, University of California, Los Angeles, CA, USA.,Department of Radiation Oncology, University of California, Los Angeles, CA, USA
| | - Chenyang Wang
- Department of Radiation Oncology, University of California, Los Angeles, CA, USA
| | - Fritz C Eilber
- Division of Surgical Oncology, Department of Surgery, University of California, Los Angeles, CA, USA
| | - Nicholas Bernthal
- Department of Orthopaedic Surgery, University of California, Los Angeles, CA, USA
| | - Susan Bukata
- Department of Orthopaedic Surgery, University of California, Los Angeles, CA, USA
| | - Sarah M Dry
- Department of Pathology, University of California, Los Angeles, CA, USA
| | - Scott D Nelson
- Department of Pathology, University of California, Los Angeles, CA, USA
| | - Mitchell Kamrava
- Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - John Lewis
- Physics and Biology in Medicine IDP, University of California, Los Angeles, CA, USA.,Department of Radiation Oncology, University of California, Los Angeles, CA, USA
| | - Daniel A Low
- Physics and Biology in Medicine IDP, University of California, Los Angeles, CA, USA.,Department of Radiation Oncology, University of California, Los Angeles, CA, USA
| | - Michael Steinberg
- Department of Radiation Oncology, University of California, Los Angeles, CA, USA
| | - Peng Hu
- Department of Radiological Sciences, University of California, Los Angeles, CA, USA.,Physics and Biology in Medicine IDP, University of California, Los Angeles, CA, USA
| | - Yingli Yang
- Physics and Biology in Medicine IDP, University of California, Los Angeles, CA, USA.,Department of Radiation Oncology, University of California, Los Angeles, CA, USA
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4
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Palmerini E, Seeger LL, Gambarotti M, Righi A, Reichardt P, Bukata S, Blay JY, Dai T, Jandial D, Picci P. Malignancy in giant cell tumor of bone: analysis of an open-label phase 2 study of denosumab. BMC Cancer 2021; 21:89. [PMID: 33482769 PMCID: PMC7824947 DOI: 10.1186/s12885-020-07739-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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: 10/01/2020] [Accepted: 12/15/2020] [Indexed: 01/17/2023] Open
Abstract
Background Giant cell tumor of bone (GCTB) is a rare osteoclastogenic stromal tumor. GCTB can rarely undergo malignant transformation. This post hoc analysis evaluated and classified malignancies in patients with GCTB who received denosumab. Methods This analysis was conducted on patients with pathologically confirmed GCTB and measurable active disease treated with denosumab 120 mg subcutaneously once every 4 weeks, with loading doses on study days 8 and 15, as part of a phase 2, open-label, multicenter study. We identified potential cases of malignancy related to GCTB through an independent multidisciplinary review or medical history, associated imaging or histopathologic reports, and disease course. The findings were summarized and no statistical analysis was performed. Results Twenty of five hundred twenty-six patients (3.8%) who received at least one dose of denosumab were misdiagnosed with GCTB that was later discovered to be malignancies: five primary malignant GCTB, five secondary malignant GCTB, four sarcomatous transformations, and six patients with other malignancies (giant cell-rich osteosarcoma, undifferentiated pleomorphic sarcoma, spindle cell sarcoma, osteogenic sarcoma, phosphaturic mesenchymal tumor of mixed connective tissue type, and fibrosarcoma/malignant fibrous histiocytoma). Many malignancies were present before denosumab was initiated (8 definitive cases, 7 likely cases), excluding potential involvement of denosumab in these cases. Signs associated with potential misdiagnoses of GCTB included poor mineralization with denosumab treatment, rapid relapse in pain, or a failure of the typical dramatic improvement in pain normally observed with denosumab. Conclusions Although rare, GCTB can undergo malignant transformation, and rates in this study were consistent with previous reports. Signs of poor mineralization or lack of response to denosumab treatment may warrant close monitoring. Trial registration clinicaltrials.gov, (NCT00680992). Registered May 20, 2008. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-020-07739-8.
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Affiliation(s)
- Emanuela Palmerini
- Chemotherapy Unit, IRCCS Istituto Ortopedico Rizzoli, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Bologna University, 40136, Bologna, Italy.
| | - Leanne L Seeger
- David Geffen School of Medicine, UCLA Health System, 200 UCLA Medical Plaza Suite 165-57, Los Angeles, CA, 90095, USA
| | - Marco Gambarotti
- Department of Pathology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Alberto Righi
- Department of Pathology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Peter Reichardt
- Department of Interdisciplinary Oncology, Sarcoma Center Berlin-Brandenburg; HELIOS Klinikum Berlin-Buch, Schwanebecker Chaussee 50, 13125, Berlin, Germany
| | - Susan Bukata
- David Geffen School of Medicine, UCLA Health System, 200 UCLA Medical Plaza Suite 165-57, Los Angeles, CA, 90095, USA
| | - Jean-Yves Blay
- Department of Medical Oncology, Leon Berard Center, 28, rue Laennec 2 69373 Lyon Cedex 08, Lyon, France
| | - Tian Dai
- Global Development (Oncology), Amgen Inc., One Amgen Center Drive, MS 38-2-B, Thousand Oaks, CA, 91320-1799, USA
| | - Danielle Jandial
- Global Development (Oncology), Amgen Inc., One Amgen Center Drive, MS 38-2-B, Thousand Oaks, CA, 91320-1799, USA
| | - Piero Picci
- Chemotherapy Unit, IRCCS Istituto Ortopedico Rizzoli, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Bologna University, 40136, Bologna, Italy
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5
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Gao Y, Kalbasi A, Hsu W, Ruan D, Fu J, Shao J, Cao M, Wang C, Eilber FC, Bernthal N, Bukata S, Dry SM, Nelson SD, Kamrava M, Lewis J, Low DA, Steinberg M, Hu P, Yang Y. Treatment effect prediction for sarcoma patients treated with preoperative radiotherapy using radiomics features from longitudinal diffusion-weighted MRIs. Phys Med Biol 2020; 65:175006. [PMID: 32554891 DOI: 10.1088/1361-6560/ab9e58] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The objective of this study was to explore radiomics features from longitudinal diffusion-weighted MRIs (DWIs) for pathologic treatment effect prediction in patients with localized soft tissue sarcoma (STS) undergoing hypofractionated preoperative radiotherapy (RT). Thirty patients with localized STS treated with preoperative hypofractionated RT were recruited to this longitudinal imaging study. DWIs were acquired at three time points using a 0.35 T MRI-guided radiotherapy system. Treatment effect score (TES) was obtained from the post-surgery pathology as a surrogate of treatment outcome. Patients were divided into two groups based on TES. Response prediction was first performed using a support vector machine (SVM) with only mean apparent diffusion coefficient (ADC) or delta ADC to serve as the benchmark. Radiomics features were then extracted from tumor ADC maps at each of the three time points. Logistic regression and SVM were constructed to predict the TES group using features selected by univariate analysis and sequential forward selection. Classification performance using SVM with features from different time points and with or without delta radiomics were evaluated. Prediction performance using only mean ADC or delta ADC was poor (area under the curve (AUC) < 0.7). For the radiomics study using features from all time points and corresponding delta radiomics, SVM significantly outperformed logistic regression (AUC of 0.91 ± 0.05 v.s. 0.85 ± 0.06). Prediction AUC values using single or multiple time points without delta radiomics were all below 0.74. Including delta radiomics of mid- or post-treatment relative to the baseline drastically boosted the prediction. In this work, an SVM model was built to predict the TES using radiomics features from longitudinal DWI. Based on this study, we found that use of mean ADC, delta ADC, or radiomics features alone was not sufficient for response prediction, and including delta radiomics features of mid- or post-treatment relative to the baseline can optimize the prediction of TES, a pathologic and clinical endpoint.
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Affiliation(s)
- Yu Gao
- Department of Radiological Sciences, University of California, Los Angeles, CA, United States of America. Physics and Biology in Medicine IDP, University of California, Los Angeles, CA, United States of America
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6
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Abstract
Atypical femoral fracture is a rare but serious complication of long-term bisphosphonate therapy. Although the benefit of preventing osteoporotic fractures greatly outweighs the risk of atypical fracture in bisphosphonate users, concern about atypical fracture risk has led to a decrease in bisphosphonate use. What are the risks, and how do we treat atypical femoral fracture?
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Affiliation(s)
- Stuart Silverman
- Cedars-Sinai Medical Center, Los Angeles, CA, USA.,Medical Director, OMC Clinical Research Center, Beverly Hills, CA, USA. .,David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Eli Kupperman
- Department of Orthopaedic Surgery, University of California, Los Angeles, CA, USA
| | - Susan Bukata
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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7
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Upfill-Brown A, Bukata S, Bernthal NM, Felsenfeld AL, Nelson SD, Singh A, Wesseling-Perry K, Eilber FC, Federman NC. Use of Denosumab in Children With Osteoclast Bone Dysplasias: Report of Three Cases. JBMR Plus 2019; 3:e10210. [PMID: 31687646 PMCID: PMC6820455 DOI: 10.1002/jbm4.10210] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 05/24/2019] [Accepted: 06/04/2019] [Indexed: 12/29/2022] Open
Abstract
Denosumab has been used successfully to treat disease‐associated osteoclast overactivity, including giant cell tumor of bone. Given its mechanism of action, denosumab is a potent potential treatment of other osteoclast bone dysplasias including central giant cell granuloma (CGCG), aneurysmal bone cyst (ABC), and cherubism. Relatively little is known about the safety and efficacy of denosumab in patients with these conditions, especially in children. We report on 3 pediatric patients treated with denosumab over a 3‐year period at UCLA Medical Center (Los Angeles and Santa Monica, CA, USA): a 12‐year‐old with recurrent ABC of the pelvis, a 14‐year‐old with CGCG of the mandible, and a 12‐year‐old with cherubism. All were started on a 1‐year course of 15 doses 120 mg s.c., given monthly with two loading doses on day 8 and 15. All patients demonstrated rapid and pronounced clinical improvement while on denosumab, including a significant reduction in pain and sclerosis of lytic lesions on radiographs. Within 1 month of initiating therapy, 2 patients experienced hypocalcemia (Common Terminology Criteria for Adverse Events [CTCAE] grade 2) and hypophosphatemia, with 1 patient experiencing symptoms. One patient went on to experience symptomatic rebound hypercalcemia (CTCAE grade 4) 5 months after completing therapy, requiring bisphosphonates and calcitonin. For the second patient, we developed a schedule to wean denosumab involving the progressive lengthening of time between doses from 1 to 4 months in 1‐month increments before cessation. We found that denosumab therapy results in significant clinical and radiographic improvement for pediatric patients with nonresectable ABC, CGCG, and cherubism. Problems with serum calcium may be more common in younger patients, with symptomatic and protracted rebound hypercalcemia after cessation of therapy the most significant. We present a potential solution to this problem with progressive spacing of doses. Potential serious adverse events from alterations in calcium homeostasis should be explored in prospective clinical trials. © 2019 The Authors. JBMR Plus published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Alexander Upfill-Brown
- Department of Orthopaedic Surgery University of California Los Angeles Los Angeles CA USA
| | - Susan Bukata
- Department of Orthopaedic Surgery University of California Los Angeles Los Angeles CA USA
| | - Nicholas M Bernthal
- Department of Orthopaedic Surgery University of California Los Angeles Los Angeles CA USA
| | - Alan L Felsenfeld
- Department of Oral & Maxillofacial Surgery University of California Los Angeles Los Angeles CA USA
| | - Scott D Nelson
- Department of Orthopaedic Surgery University of California Los Angeles Los Angeles CA USA.,Department of Pathology University of California Los Angeles Los Angeles CA USA
| | - Arun Singh
- Division of Hematology & Oncology, Department of Medicine University of California Los Angeles Los Angeles CA USA
| | - Katherine Wesseling-Perry
- Division of Nephrology, Department of Pediatrics University of California Los Angeles Los Angeles CA USA
| | - Fritz C Eilber
- Division of Surgical Oncology, Department of Surgery University of California Los Angeles Los Angeles CA USA
| | - Noah C Federman
- Department of Orthopaedic Surgery University of California Los Angeles Los Angeles CA USA
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8
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Sheth NP, Bukata S. The 2018 Austrian-Swiss-German Traveling Fellowship. J Bone Joint Surg Am 2018; 100:e147. [PMID: 30516634 DOI: 10.2106/jbjs.18.00751] [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] [Indexed: 02/01/2023]
Affiliation(s)
- Neil P Sheth
- University of Pennsylvania, Philadelphia, Pennsylvania
| | - Susan Bukata
- University of California, Los Angeles, Los Angeles, California
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9
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Kiyuna T, Murakami T, Tome Y, Igarashi K, Kawaguchi K, Russell T, Eckardt MA, Crompton J, Singh A, Bernthal N, Bukata S, Federman N, Kanaya F, Eilber FC, Hoffman RM. Labeling the Stroma of a Patient-Derived Orthotopic Xenograft (PDOX) Mouse Model of Undifferentiated Pleomorphic Soft-Tissue Sarcoma With Red Fluorescent Protein for Rapid Non-Invasive Imaging for Drug Screening. J Cell Biochem 2017; 118:361-365. [PMID: 27357060 DOI: 10.1002/jcb.25643] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [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: 06/28/2016] [Accepted: 06/29/2016] [Indexed: 01/11/2023]
Abstract
Our laboratory pioneered patient-derived orthotopic xenograft (PDOX) mouse models using surgical orthotopic implantation (SOI). PDOX models are patient-like, in contrast to the ectopic subcutaneous-transplant cancer models. In the present study, we demonstrate that an undifferentiated pleomorphic soft-tissue sarcoma (UPS-STS) PDOX model acquired bright RFP-expressing stroma through one passage in red fluorescent protein (RFP) transgenic mice, which upon passage to non-colored nude mice was non-invasively imageable. A PDOX nude mouse model of UPS-STS was established in the biceps femoris of nude mice. After the tumors grew to a diameter of 10 mm, the tumors were subsequently passaged to RFP transgenic mice, and after tumor growth were then passaged to non-transgenic nude mice. Tumors were divided into small fragments and transplanted in the biceps femoris at each passage. The OV100 Small Animal Fluorescence Imaging System and FV1000 laser scanning confocal microscope were used to image RFP fluorescence in the UPS-STS PDOX models. UPS-STS PDOX tumors, previously grown in RFP transgenic nude mice for only one passage, had very bright fluorescence and after passage to non-transgenic nude mice maintained the bright fluorescence and were non-invasively imageable. FV1000 confocal imaging revealed diffusely distributed bright RFP stromal cells in the PDOX tumor, both in RFP transgenic mice and after passage to non-transgenic mice. These results demonstrate a powerful method to make the PDOX UPS-STS model brightly fluorescent for non-invasive imaging, as well as for confocal microscopy of individual stromal cells associated with the tumor. The RFP-labeled UPS PDOX has the potential to rapidly screen for novel effective agents for individual patients, including stroma-targeting drugs, whereby the stromal cells are a visual target. J. Cell. Biochem. 118: 361-365, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Tasuku Kiyuna
- AntiCancer Inc., San Diego, California
- Department of Surgery, University of California, San Diego, California
- Department of Orthopedic Surgery, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Takashi Murakami
- AntiCancer Inc., San Diego, California
- Department of Surgery, University of California, San Diego, California
| | - Yasunori Tome
- Department of Orthopedic Surgery, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Kentaro Igarashi
- AntiCancer Inc., San Diego, California
- Department of Surgery, University of California, San Diego, California
| | - Kei Kawaguchi
- AntiCancer Inc., San Diego, California
- Department of Surgery, University of California, San Diego, California
| | - Tara Russell
- Division of Surgical Oncology, University of California, Los Angeles, California
- Veterans Affairs Los Angeles Health Services Research and Development Center of Innovation, Los Angeles, California
| | - Mark A Eckardt
- Division of Surgical Oncology, University of California, Los Angeles, California
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Joseph Crompton
- Division of Surgical Oncology, University of California, Los Angeles, California
| | - Arun Singh
- Division of Hematology-Oncology, University of California, Los Angeles, California
| | - Nicholas Bernthal
- Department of Orthopedic Surgery, University of California, Los Angeles, California
| | - Susan Bukata
- Department of Orthopedic Surgery, University of California, Los Angeles, California
| | - Noah Federman
- Department of Pediatrics, University of California, Los Angeles, California
| | - Fuminori Kanaya
- Department of Orthopedic Surgery, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Fritz C Eilber
- Division of Surgical Oncology, University of California, Los Angeles, California
| | - Robert M Hoffman
- AntiCancer Inc., San Diego, California
- Department of Surgery, University of California, San Diego, California
- PDOX Inc., San Diego, California
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10
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Gomes A, Monteleone P, Vasan A, Bukata S, Sayre J. Ethylene vinyl alcohol copolymer in the treatment of high flow arteriovenous vascular malformations: long term results and histology. J Vasc Interv Radiol 2016. [DOI: 10.1016/j.jvir.2015.12.391] [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: 11/27/2022] Open
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11
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Abstract
Atypical femur fractures were first reported in 2007 and are now recognized as a unique clinical entity. They occur along the shaft of the femur extending from the subtrochanteric region proximally to the distal femoral metaphysis. These fractures have an increased incidence in patients taking bisphosphonates for osteoporosis and develop as stress reactions in the lateral cortex of the femoral shaft. The fractures often have a distinct radiographic appearance with thickening or beaking of the lateral cortex. Treatment should be initiated immediately. There is a higher incidence of complications with atypical fractures. Early detection of these fractures can greatly reduce morbidity.
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Affiliation(s)
- Wakenda Tyler
- Department of Orthopaedic Surgery, University of Rochester, 601 Elmwood Avenue, Box 665, Rochester, NY 14642, USA.
| | - Susan Bukata
- Department of Orthopaedic Surgery, University of California, Los Angeles, Los Angeles, California, USA
| | - Regis O'Keefe
- Department of Orthopaedic Surgery, University of Rochester, 601 Elmwood Avenue, Box 665, Rochester, NY 14642, USA
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12
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Jacobson JA, Yanoso-Scholl L, Reynolds DG, Dadali T, Bradica G, Bukata S, Puzas EJ, Zuscik MJ, Rosier R, O'Keefe RJ, Schwarz EM, Awad HA. Teriparatide therapy and beta-tricalcium phosphate enhance scaffold reconstruction of mouse femoral defects. Tissue Eng Part A 2010; 17:389-98. [PMID: 20807012 DOI: 10.1089/ten.tea.2010.0115] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
To investigate the efficacy of endocrine parathyroid hormone treatment on tissue-engineered bone regeneration, massive femoral defects in C57Bl/6 mice were reconstructed with either 100:0 or 85:15 poly-lactic acid (PLA)/beta-tricalcium phosphate (β-TCP) scaffolds (hereafter PLA or PLA/βTCP, respectively), which were fabricated with low porosity (<30%) to improve their structural rigidity. Experimental mice were treated starting at 1 week postop with daily subcutaneous injections of 40 μg/kg teriparatide until sacrifice at 9 weeks, whereas control mice underwent the same procedure but were injected with sterile saline. Bone regeneration was assessed longitudinally using planar X-ray and quantitative microcomputed tomography, and the reconstructed femurs were evaluated at 9 weeks either histologically or biomechanically to determine their torsional strength and rigidity. Teriparatide treatment increased bone volume and bone mineral content significantly at 6 weeks and led to enhanced trabeculated bone callus formation that appeared to surround and integrate with the scaffold, thereby establishing union by bridging bone regeneration across the segmental defect in 30% of the reconstructed femurs, regardless of the scaffold type. However, the bone volume and mineral content in the PLA reconstructed femurs treated with teriparatide was reduced at 9 weeks to control levels, but remained significantly increased in the PLA/βTCP scaffolds. Further, bridged teriparatide-treated femurs demonstrated a prototypical brittle bone torsion behavior, and were significantly stronger and stiffer than control specimens or treated specimens that failed to form bridging bone union. Taken together, these observations suggest that intermittent, systemic parathyroid hormone treatment can enhance bone regeneration in scaffold-reconstructed femoral defects, which can be further enhanced by mineralized (βTCP) particles within the scaffold.
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Affiliation(s)
- Justin A Jacobson
- The Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, New York, USA
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Shindle MK, Gardner MJ, Koob J, Bukata S, Cabin JA, Lane JM. Vertebral height restoration in osteoporotic compression fractures: kyphoplasty balloon tamp is superior to postural correction alone. Osteoporos Int 2006; 17:1815-9. [PMID: 16983458 DOI: 10.1007/s00198-006-0195-x] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2006] [Accepted: 06/20/2006] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Kyphoplasty has been shown to restore vertebral height and sagittal alignment. Proponents of vertebroplasty have recently demonstrated that many vertebral compression fractures (VCFs) are mobile and positional correction can lead to clinically significant height restoration. The current investigation tested the hypothesis that positional maneuvers do not achieve the same degree of vertebral height correction as kyphoplasty balloon tamps for the reduction of low-energy VCFs. METHODS Twenty-five consecutive patients with a total of 43 osteoporotic VCFs were entered into a prospective analysis. Each patient was sequentially evaluated for postural and balloon vertebral fracture reduction. Preoperative standing and lateral radiographs of the fractured vertebrae were compared with prone cross-table lateral radiographs with the patient in a hyper-extension position and on pelvic and sternal rolls. Following positional manipulation, patients underwent a unilateral balloon kyphoplasty. Postoperative standing radiographs were evaluated for the percentage of height restoration related to positioning and balloon kyphoplasty. RESULTS In the middle portion of the vertebrae, the percentage available for restoration restored with extension positioning was 10.4% (median 11.1%) and after balloon kyphoplasty was 57.0% (median 62.2%). This difference was statistically significant (p<0.001). Thus, kyphoplasty provided an additional 46.6% of the height available for restoration from the positioning alone. With operative positioning, 51.2% of VCFs had >10% restoration of the central portion of the vertebral body, whereas 90.7% of fractures improved at least 10% following balloon kyphoplasty (p<0.002). CONCLUSION Although this study supports the concept that many VCFs can be moved with positioning, balloon kyphoplasty enhanced the height reduction >4.5-fold over the positioning maneuver alone and accounted for over 80% of the ultimate reduction. If height restoration is the goal, kyphoplasty is clearly superior in most cases to the positioning maneuver alone.
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Affiliation(s)
- M K Shindle
- Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA.
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Nathan SS, Gorlick R, Bukata S, Chou A, Morris CD, Boland PJ, Huvos AG, Meyers PA, Healey JH. Treatment algorithm for locally recurrent osteosarcoma based on local disease-free interval and the presence of lung metastasis. Cancer 2006; 107:1607-16. [PMID: 16933325 DOI: 10.1002/cncr.22197] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Local recurrence in osteosarcoma is clinically distinct from metastasis, although associated with a similar reduction in survival. The prognostic factors in locally recurrent osteosarcoma were investigated and these factors were translated into a management strategy. METHODS In all, 407 consecutive patients with skeletal osteosarcoma between 1977 and 2002 were analyzed. Twenty-three patients with resectable local recurrence were analyzed. Clinical and tumor-related factors were assessed for significance in relation to survival and a management strategy was formulated based on factors found to be independently significant for survival. RESULTS Seventeen of the 23 patients underwent primary resections and initial treatment, yielding an overall local recurrence rate of 4.2% for resectable cancer. Median time to local recurrence was 13 months (95% confidence interval, 9-16 months). The 5-year and 10-year survival rates in the recurrent cases were 29% and 10%, respectively. All patients received chemotherapy both for their primary and recurrent disease. Increased risk of local recurrence (P < .0001) was strongly correlated with positive margins of resection. The rate of local recurrence was not related to chemotherapy-associated necrosis in the primary tumor. Nevertheless, neoadjuvant therapy halved the risk of local recurrence (odds ratio, 1.92; P = .3, power 10%). The strongest correlate with poor survival was local recurrence within the first year after primary resection (P = .001), followed by metastasis at the time of first local recurrence (P = .04) and failure to achieve clinical remission after disease recurrence (P = .04). Chemotherapy-associated necrosis and margins of resection of the primary tumor were not significant prognostic variables for survival. Survival differed significantly among patients defined by local disease-free interval and lung metastasis (P = .0001). They required an individualized approach as captured in the management algorithm. CONCLUSION There is a residual risk of local recurrence in patients despite favorable chemotherapy-associated necrosis and negative margins of resection. A treatment strategy emphasizing clinical remission at all identifiable sites offers the highest likelihood of survival in this patient population.
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Affiliation(s)
- Saminathan S Nathan
- Department of Orthopaedics, Faculty of Medicine, National University of Singapore, Singapore, USA
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Pollice PF, Hsu J, Hicks DG, Bukata S, Rosier RN, Reynolds PR, Puzas JE, O'Keefe RJ. Interleukin-10 inhibits cytokine synthesis in monocytes stimulated by titanium particles: evidence of an anti-inflammatory regulatory pathway. J Orthop Res 1998; 16:697-704. [PMID: 9877394 DOI: 10.1002/jor.1100160611] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The anti-inflammatory mediator interleukin-10 was investigated as a potential inhibitor of proinflammatory cytokine release in human peripheral blood monocytes activated with titanium particles. It inhibited the secretion of both tumor necrosis factor-alpha and interleukin-6 in a dose-dependent manner, with complete inhibition observed at 2 ng/ml. Co-culture experiments were performed to determine whether this cytokine may have functional importance as an inhibitor of the inflammatory response. When unstimulated lymphocytes and monocytes were co-cultured with titanium-stimulated monocytes, they significantly suppressed the secretion of both interleukin-6 and tumor necrosis factor-alpha. The inhibitory effect of these co-cultured cells could be partially blocked with the addition of an interleukin-10 neutralizing antibody. Interleukin-10 levels were measured in monocyte cultures treated with titanium particles as well as in fresh monocyte cultures treated with conditioned medium from titanium-stimulated monocytes. The latter experiments demonstrated marked stimulation of interleukin-10 secretion in conditioned medium-treated cultures, an effect that was related to the presence of tumor necrosis factor-alpha in the conditioned medium. The addition of titanium to conditioned medium-treated cultures markedly reduced the secretion of interleukin-10, suggesting that the most responsive cells are unstimulated monocytes exposed to agents released from activated monocytes. Altogether, the expression and responsiveness to interleukin-10 suggest a potential role for anti-inflammatory cytokines in regulation of the inflammatory response to wear debris.
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Affiliation(s)
- P F Pollice
- Department of Orthopaedics, University of Rochester School of Medicine and Dentistry, New York 14642, USA
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