We have previously demonstrated the expression of GATA-DNA-binding protein (GATA)-3, a transcription factor, in osteoblasts and have verified its function in transducing cell survival signaling. This ...translational study was further designed to evaluate the roles of GATA-3 in regulating bone healing and to explore its possible mechanisms. A metaphyseal bone defect was created in the left femurs of male ICR mice. Analysis by micro-computed topography showed that the bone volume, trabecular bone number and trabecular thickness were augmented and that the trabecular pattern factor decreased. Interestingly, immunohistological analyses showed specific expression of GATA-3 in the defect area. In addition, colocalized expression of GATA-3 and alkaline phosphatase was observed at the wound site. As the fracture healed, the amounts of phosphorylated and non-phosphorylated GATA-3 concurrently increased. Separately, GATA-3 mRNA was induced during bone healing, and, levels of Runx2 mRNA and protein were also increased. The results of confocal microscopy and co-immunoprecipitation showed an association between nuclear GATA-3 and Runx2 in the area of insult. In parallel with fracture healing, Bcl-XL mRNA was significantly triggered. A bioinformatic search revealed the existence of a GATA-3-specific DNA-binding element in the promoter region of the bcl-xL gene. Analysis by chromatin immunoprecipitation assays further demonstrated transactivation activity by which GATA-3 regulated bcl-xL gene expression. Therefore, this study shows that GATA-3 participates in the healing of bone fractures via regulating bcl-xL gene expression, owing to its association with Runx2. In the clinic, GATA-3 may be used as a biomarker for diagnoses/prognoses or as a therapeutic target for bone diseases, such as bone fractures.
Paired associative nerve stimulation (PANS) was proposed as a potential nerve rehabilitation treatment strategy. However, few relevant documents are available regarding the strategy, and only a few ...clinical studies have involved healthy people. To determine the feasibility of the neurorehabilitation treatment and to estimate the effect of PANS on nerve plasticity for individuals with incomplete spinal cord injury (iSCI), a design combining repetitive transcranial magnetic stimulation (rTMS) with trans-spinal electrical stimulation was developed for treating individuals with iSCI in this pilot case study. First, a novel PANS system with multiple stimulation modes was designed and verified with resistors and a metal coil as load. Then, the system was applied to three individuals with iSCI, and five types of paired associative stimulation was performed to confirm the feasibility of the system and determine the most effective treatment strategy. The preliminary result showed that 20-Hz rTMS combined with cathodal trans-spinal direct current stimulation (tsDCS) had the greatest effect on corticospinal excitability. Next, stimulations of 20-Hz rTMS (brain) and sham (spine) as well as sham (brain) and cathode tsDCS (spine) were administered to individuals with iSCI, and the results revealed that paired associative stimulation of brain and spine was more effective than only 20-Hz rTMS brain stimulation or cathodal tsDCS stimulation for corticospinal plasticity.
In this study, we assessed the radiation dose to the lens and the impacts of various eye shields using either a fixed or modulated tube current.
Patients undergoing head computed tomography (CT) ...examinations were recruited, and each was randomly assigned to one of five imaging groups, either without a CT eye shield or with one of two types of shielding and topogram-based tube current modulation (TCM). The radiation dose at the eye lens was estimated using Gafchromic films. All CT images were analyzed for quality in the orbit and brain areas. Two radiologists also qualitatively assessed image artifacts and their impacts on image quality using three-point Likert scales.
Both barium sulfate and bismuth-antimony shields significantly reduced radiation dose to the lens (by 28.60%-31.92% and 43.87%-47.00%, respectively) while significantly inducing image artifacts. The image quality of the intraocular structure, but not the intracranial structure, was significantly degraded by shielding. In addition, discriminating the periocular tissues was improved using a bismuth-antimony shield and topogram-based TCM. Compared to fixed tube current, topogram-based TCM provided better signal-to-noise and contrast-to-noise ratios in the intracranial structures when the bismuth-antimony and barium sulfate shields were applied, respectively.
Artifacts resulting from the application of eye shields during head CT examinations can be reduced by using topogram-based TCM instead of a fixed tube current. This could be an alternative approach for maintaining image quality in CT scans that do not encompass organ-based TCM.
Dual-energy X-ray absorptiometry is the gold standard for evaluating Bone Mineral Density (BMD); however, a typical BMD report is generated in a time-inefficient manner and is prone to error. We ...developed a rule-based automated reporting system, BatchBMD, that accelerates DXA reporting while improving its accuracy over current systems. BatchBMD generates a structured report, customized to the specific clinical purpose. To compare BatchBMD to a Web-based Reporting (WBR) system for efficiency and accuracy, 500 examinations were randomly chosen from those performed at the Taipei Municipal Wanfang Hospital from January to March 2021. The final assessment included all 2326 examinations conducted from September 2020 to March 2021. The average reporting times were 6.7 and 10.8 min for BatchBMD and the WBR system, respectively, while accuracy was 99.4% and 98.2%, respectively. Most of the errors made by BatchBMD were digit errors in the appendicular skeletal muscle index. After correcting this, 100% accuracy across all 2326 examinations was validated. This automated and accurate BMD reporting system significantly reduces report production workload for radiologists and technicians while increasing productivity and quality. Additionally, the portable software, which employs a simple framework, can reduce deployment costs in clinical practice.
Objectives: Hypersensitivity reactions (HSRs) are uncommon but serious adverse events following the administration of iodinated contrast media (ICM) prior to CT imaging. While premedication is almost ...universally given in high-risk patients, there is a lack of evidence regarding the efficacy of such premedication. This study aims to determine the efficacy of premedication with corticosteroids prior to ICM administration in the prevention of HSRs through meta-analysis. Materials and Methods: An extensive review of the literature yielded 404 potentially relevant studies. Of these, five studies met the inclusion criteria of this meta-analysis. Pooled HSR event rates were obtained from each of the studies for both patients who had and who had not received premedication with corticosteroids. Heterogeneity between studies was also determined. Results: A total of 736 patients across all five studies were included in the analysis. Patients who did not receive premedication had initial pooled HSR rates of 0.16 (95% CI, 0.07−0.35) across all studies. Following premedication, pooled HSR rates dropped to 0.02 (95% CI, 0.01−0.06). Patients who had prior HSRs were significantly less likely to experience HSRs (OR = 0.09; 95% CI, 0.03−0.25; p < 0.00001) after treatment with premedication. Conclusions: This meta-analysis offers evidence for the reduction in the recurrence of moderate and severe HSRs in patients who have a history of such reactions. Premedication with corticosteroids prior to ICM administration is thus highly recommended in high-risk patients.
Objectives
Our aim was to retrospectively investigate the frequency and outcome of large-volume iodinated contrast medium (CM) extravasation in our institution and to compare our management protocol ...to current practice.
Methods
Institutional review board approval was obtained, and informed consent was waived because the study was retrospective. From January 2008 to September 2016, radiological examinations with intravenous non-ionic iodinated CM administration were performed in 67,129 patients. Contrast medium extravasation events on CT scans and intravenous pyelograms but not on angiograms were included. All data were collected prospectively and stratified according to age, injection method (manual vs auto-injection), prevention of extravasation by various means (including intercom alarm), management of extravasation (routine application of silver sulfadiazine ointment, clobetasol propionate cream, and damp gauze at room temperature), etc.
Results
The incidence of large-volume CM extravasation was very low (0.04% 27/67,129 overall; 0.03% related to manual injection age range, 59-92 years; mean, 75.4 years, and 0.045% related to auto-injection age range, 36-86 years; mean, 65.8 years). The CM extravasation volume in majority of patients was 20–40 ml in 5 of 9 patients (55.6%) in the manual injection group and 14 of 18 (77.8%) in the auto-injection group. Swelling and pain were the most common symptoms. No patient developed severe signs or needed surgical intervention.
Conclusions
Results show a very low incidence of large-volume CM extravasation without severe complications or sequelae. The casual effect between our protocols and good outcome cannot be scrutinised thoroughly because the study lacks a control group and is retrospective.
Key Points
• The incidence of large-volume contrast medium extravasation (≥20 ml) was 0.04%.
• No patient needed surgical intervention, and most recovered within 7 days.
• Each element of our management protocol contributed to good outcome.
Purpose: We aimed to develop a novel interpretable artificial intelligence (AI) model algorithm focusing on automatic detection and classification of various patterns of calcification distribution in ...mammographic images using a unique graph convolution approach. Materials and methods: Images from 292 patients, which showed calcifications according to the mammographic reports and diagnosed breast cancers, were collected. The calcification distributions were classified as diffuse, segmental, regional, grouped, or linear. Excluded were mammograms with (1) breast cancer with multiple lexicons such as mass, asymmetry, or architectural distortion without calcifications; (2) hidden calcifications that were difficult to mark; or (3) incomplete medical records. Results: A graph-convolutional-network-based model was developed. A total of 581 mammographic images from 292 cases of breast cancer were divided based on the calcification distribution pattern: diffuse (n = 67), regional (n = 115), group (n = 337), linear (n = 8), or segmental (n = 54). The classification performances were measured using metrics including precision, recall, F1 score, accuracy, and multi-class area under the receiver operating characteristic curve. The proposed model achieved a precision of 0.522 ± 0.028, sensitivity of 0.643 ± 0.017, specificity of 0.847 ± 0.009, F1 score of 0.559 ± 0.018, accuracy of 64.325 ± 1.694%, and area under the curve of 0.745 ± 0.030; thus, the method was found to be superior compared to all baseline models. The predicted linear and diffuse classifications were highly similar to the ground truth, and the predicted grouped and regional classifications were also superior compared to baseline models. The prediction results are interpretable using visualization methods to highlight the important calcification nodes in graphs. Conclusions: The proposed deep neural network framework is an AI solution that automatically detects and classifies calcification distribution patterns on mammographic images highly suspected of showing breast cancers. Further study of the AI model in an actual clinical setting and additional data collection will improve its performance.
Background
Adipose tissue is closely related to bone mass, bone quality, and bone fractures, but the connection between fat and bone is complex and gender‐related. Fat–water magnetic resonance ...imaging (MRI) and MR spectroscopy (MRS) are very useful tools for identifying tissue fat.
Purpose
To assess gender interactions between bone mineral density (BMD), bone marrow fat, and body mass index (BMI) in the elderly using fat–water MRI and MRS.
Study Type
Prospective/cohort.
Population
Sixty‐six women and 38 men (mean age, 62.3 years; range, 50–75 years), Asian.
Field Strength
A 1.5T MR equipped with a body and spine array coil. STEAM MRS and T2* Dixon were performed.
Assessment
Vertebral bone marrow fat ratio (MFR), BMI, and BMD were measured. Correlations between these variables and differences in bone density in MFR were assessed between participants, divided into three groups based on bone density.
Statistical Tests
Multiple regression; Pearson tests; analysis of covariance; analysis of variance.
Results
Multiple regression analysis identified gender, vertebral bone MFR, and BMI as significant predictors of vertebral BMD (P < 0.001). Among the women, vertebral BMD was negatively correlated with vertebral MFR (P = 0.011), but among the men, it was positively correlated with BMI (P = 0.048), although this relationship was confounded by age and MFR. Moreover, vertebral bone marrow fat and BMI were indeed statistically uncorrelated in the elderly (P = 0.357 in women; P = 0.961 in men).
Data Conclusion
We found gender interactions between fat and bone in the elderly. Higher bone marrow fat was correlated with lower trabecular BMD in older women but not in men. On the other hand, the positive correlation between BMI and BMD was more pronounced in men than in women.
Level of Evidence: 2
Technical Efficacy Stage: 2
J. Magn. Reson. Imaging 2020;51:1382–1389.
A Nonsurgical Solution: Jefferson (Burst) Fracture Tay, Shee Yen; Li, Chia-Wei; Ko, Chih-Hsiang ...
The American journal of medicine,
September 2018, 2018-09-00, 20180901, Letnik:
131, Številka:
9
Journal Article
PDF
