Effects of Bariatric Surgery on Knee Articular Cartilage and Osteoarthritis Symptoms-A 12-Month Follow-Up Using T2 Relaxation Time and WOMAC Osteoarthritis Index.

BACKGROUND: Obesity is a significant risk factor for osteoarthritis (OA). The most effective treatment for morbid obesity is bariatric surgery. PURPOSE: To study the effects of potential surgically induced weight loss on knee articular cartilage and OA symptoms of obese patients over a 12-month follow-up. STUDY TYPE: Prospective longitudinal cohort study. SUBJECTS: 45 obese patients (38 female, BMI = 42.3 ± 6.5 kg/m2) who underwent gastric bypass (intervention group), and 46 age-matched conservative-care controls (37 female, BMI = 39.8 ± 4.6 kg/m2). FIELD STRENGTH/SEQUENCE: Multiecho spin echo sequence at 3 T. ASSESSMENT: Knee cartilage T2 measurements and WOMAC Indices were measured presurgery and after 12 months. The intervention group was split into successful (≥20% total weight loss (TWL)) and unsuccessful (<20% TWL) weight loss groups. T2 and WOMAC indices were also measured in controls at baseline and after 12 months. Changes among the three groups were analyzed. STATISTICAL TESTS: Analysis of variance (significance level 0.05). RESULTS: Twenty-six (58%) intervention patients achieved ≥20% TWL. The <20% TWL group demonstrated significantly more T2 reduction in the deep lateral femur over 12 months compared with the ≥20% TWL group (-3.83 ± 8.18 msec vs. 2.47 ± 6.54 msec, respectively), whereas no significant differences were observed on the medial femoral compartment (P = 0.385, P = 0.551, and P = 0.511 for bulk, superficial and deep regions, respectively). Changes in WOMAC indices over 12 months were significantly greater in the ≥20% TWL group compared with controls. In the <20% TWL group, pain significantly improved over 12 months compared with controls, while stiffness and function changes were not statistically significant (P = 0.063 and P = 0.051, respectively). DATA CONCLUSION: Cartilage matrix, measured by T2, showed improvement on lateral femoral cartilage with <20% TWL compared with ≥20% TWL. Bariatric surgery provided significant improvements in knee symptoms with ≥20% TWL compared with conservative WL. This effect is also seen to some extent with <20% TWL compared with conservative WL. LEVEL OF EVIDENCE: 2 TECHNICAL EFFICACY: Stage 4.

Functioning, psychiatric symptoms and quality of life of individuals with severe mental disorders after psychiatric rehabilitation.

PURPOSE: Psychiatric disorders may have a negative effect on individuals' living, forming intimate relationships, education, and employment. The aim of psychiatric rehabilitation is to promote recovery - finding ways to cope with mental disorders despite debilitating symptoms. This study aimed to explore the outcomes of accommodation, social inclusion, psychiatric symptoms, substance and service use, quality of life and subjective recovery of young adults with severe mental illness after psychiatric rehabilitation. MATERIALS AND METHODS: The study population consisted of individuals who had been in residential psychiatric rehabilitation between the ages of 18-29 years. Data on outcomes were collected using a questionnaire after a flexible follow-up period (mean 29 months). The questionnaire was answered by 32 eligible persons. We analysed multiple outcomes and compared the proportion of persons living independently at the start, after psychiatric rehabilitation, and at the follow-up point. RESULTS: At the start of the rehabilitation, 33%, at the end, 69%, and at follow-up, 78% lived independently. However, most had not reached competitive employment nor were studying. Cognitive symptoms were the most common psychiatric symptoms, followed by depressive symptoms. More than 80% of the sample felt that they had partly recovered from their severe mental illness. CONCLUSION: According to the results of this study residential psychiatric rehabilitation may have positive effects on functioning and independent living at follow-up. Reaching competitive employment is difficult for persons with severe mental disorders and effective rehabilitation interventions need to be implemented. However, this study had limitations, and these results should be considered preliminary.

Thrombolysis treatment protected impairment of functional ability, quality of life and fatigue seven years after stroke.

OBJECTIVES: We studied quality of life, functional outcome, depression, and fatigue of ischemic stroke patients treated with or without thrombolysis seven years post-stroke. MATERIALS AND METHODS: A total of 204 ischemic stroke patients treated with or without thrombolysis during 2013-2015. After seven years the 136 survivors were assessed with telephone interview, which included questions about subjective quality of life (European Quality of Life-5 Dimensions), depression, fatigue with Fatigue Severity Scale, functional ability assessed with Barthel Index and Modified Rankin Scale, living conditions, need of care, and medical aids. RESULTS: At admission patients with thrombolysis had higher National Institutes of Health Stroke Scale scores compared with those not treated with thrombolysis. At seven years post-stroke, 99% of alive patients answered the questionnaires. There were no group differences concerning functional outcome, quality of life, depression, fatigue, or insomnia. The Barthel Index was normal in both groups. The quality of life was good in both groups without group differences in any domains. Of all patients, 68% reported no problems in usual activities, and 61% were without pain. Anxiety or depression were experienced by 19% of all stroke patients, while fatigue was present in 32% of cases. CONCLUSIONS: Seven years post-stroke the quality of life was good and functional outcome remained in good level in both study groups. One third experienced fatigue, while every fifth experienced depression. The thrombolysis treatment seems to protect from decreased quality of life, fatigue, and decreased mobility, self-care, and usual activities despite more severe stroke.

Employment trajectories until midlife in schizophrenia and other psychoses: the Northern Finland Birth Cohort 1966.

PURPOSE: Psychoses are associated with poor labour market attachment, but few studies have compared schizophrenia (SZ) and other psychoses (OP). Moreover, studies on long-term employment trajectories over individuals' working life courses are lacking. We compared 30 year employment trajectory patterns in a general population sample among individuals with SZ, OP, and those with no psychosis (NP). METHODS: Utilising the Northern Finland Birth Cohort 1966, we collected survey data on employment from ages 16 to 45 and detected individuals with register-based history of SZ (n = 62), OP (n = 87), or NP (n = 6464) until age 46. Through gender-specific latent class analyses on annual employment roles, we identified traditional, highly educated, self-employed, delayed and floundering employment trajectories with distinct socioeconomic characteristics. We addressed attrition by conducting weighted analyses. RESULTS: Floundering trajectories were common among individuals with SZ (79% of men, 73% of women) and OP (52% of men, 51% of women). In NP, a traditional employee trajectory was most common in men (31%), and a highly educated trajectory in women (28%). A history of psychosis was associated with heightened odds ratios (ORs; 95% confidence intervals (CIs)) for floundering trajectories in both men (SZ: 32.9 (13.3-81.4); OP: 7.4 (4.0-13.9)) and women (SZ: 9.9 (4.6-21.5); OP: 3.9 (2.1-7.1)) compared to NP. Weighted analyses produced similar results. CONCLUSION: Most individuals with SZ or OP have floundering employee trajectories reflecting an elevated risk of unemployment and part-time work until midlife. These results indicate the importance of improving labour market attachment during the early phases of psychoses.

Effectiveness of a Mobile App Intervention for Preparing Preschool Children and Parents for Day Surgery: Randomized Controlled Trial.

BACKGROUND: Day surgery allows families to return home quickly. Only a few approaches to preparing for day surgery have demonstrated how digital solutions can support families and children. OBJECTIVE: This study aims to evaluate the effectiveness of a mobile app intervention on preschool children's fear and pain and parents' anxiety and stress in preparing children for day surgery. METHODS: This study was conducted at the Pediatric Day Surgical Department of a university hospital in Finland between 2018 and 2020. Parents of children (aged 2-6 y) who were in a queue for elective day surgery were randomized into the intervention group (IG; n=36) and control group (CG; n=34). The CG received routine preparations, whereas the IG was prepared using a mobile app. Parents' and children's outcomes were measured using validated scales at 4 different points: at home (T1 and T4) and at the hospital (T2 and T3) before and after surgery. Group differences were analyzed using statistical methods suitable for the material. RESULTS: Before surgery, parents in both groups experienced mild anxiety, which decreased after surgery. Parental anxiety did not differ between groups preoperatively (P=.78) or postoperatively (P=.63). Both groups had less anxiety at home after surgery compared with before. The IG showed a significant decrease (P=.003); the CG also improved (P=.002). Preoperatively at home, most parents in both groups experienced no stress or mild stress (P=.61). Preoperatively at the hospital, parents in both groups experienced mild stress; however, parents in the IG experienced more stress during this phase (P=.02). Parents in the IG experienced significantly less stress postoperatively than those in the CG (P=.05). Both groups showed decreased stress levels from before to after surgery (IG: P=.003; CG: P=.004) within each group. There were no significant differences in children's pain levels between the groups and measurement points. This was observed before surgery at home (P=.25), before surgery at the hospital (P=.98), and after surgery at the hospital (P=.72). Children's fear decreased more in the IG (P=.006) than in the CG (P=.44) comparing the phases before and after surgery at home. Fear did not differ between the IG and CG preoperatively at home (P=.20) or at the hospital (P=.59) or postoperatively at the hospital (P=.62) or at home (P=.81). CONCLUSIONS: The mobile app intervention did not reduce anxiety or pain. However, it was observed that parents in the IG experienced substantially heightened stress levels before surgery at the hospital, which decreased significantly after surgery at home. In addition, fear levels in children in the IG decreased over time, whereas no significant change was observed in the CG. These results are important for developing health care service chains and providing families with innovative and customer-oriented preparation methods. TRIAL REGISTRATION: ClinicalTrials.gov NCT03774303; https://classic.clinicaltrials.gov/ct2/show/NCT03774303.

Effect of onset age on the long-term outcome of early-onset psychoses and other mental disorders: a register-based Northern Finland Birth Cohort 1986 study.

Psychiatric illnesses can affect the social transitions of adolescence and young adulthood, such as completing education and entering working life and relationships. However, associations between earlier onset age and long-term outcomes among those with early-onset psychoses (EOP) are unclear, as are the long-term outcomes of EOP compared to non-psychotic disorders. We used national register data of the Northern Finland Birth Cohort 1986 to detect persons with EOP and other early-onset psychiatric disorders. The long-term clinical and work-family outcomes of persons with onset age before 18 years (n = 41 psychoses, n = 495 non-psychoses) or between 18-22 years (n = 61 psychoses, n = 377 non-psychoses) were compared. Individuals with the onset of psychosis between 18-22 years had significantly more unfavourable long-term outcomes when compared to those with psychosis onset before 18 years. Persons with psychosis onset before the age of 18 years had similar outcomes to those with non-psychotic psychiatric disorder onset before 18 years regarding educational level, marital status, having children, and substance use disorders. Individuals with EOP were more often on a disability pension compared to those with other early-onset mental disorders. Adjusting for sex, educational level and substance use only slightly diluted these results. Unexpectedly, later onset age of EOP was associated with worse outcomes. Those with psychosis onset between 18-22 years of age are in a critical period, which underlines the importance of investing on interventions in this age group. Further studies on the effect of the onset age on later outcomes in EOP are needed.

Prevalence and characteristics of psychiatric morbidity treated in specialized health care in a nationwide cohort of people with newly diagnosed Alzheimer's disease.

OBJECTIVE: Psychiatric disorders have been implied as both risk factors and prodromal symptoms of Alzheimer's disease (AD). A better understanding of the history of psychiatric morbidity in people with AD may aid with understanding this relationship and highlight challenges in diagnosing AD in people with concomitant psychiatric disorders. METHODS: Medication use and Alzheimer's disease (MEDALZ) study is a nationwide register-based cohort of people (n = 70,718) who received a clinically verified AD diagnosis in Finland in 2005-2011 and were community-dwelling at the time of diagnosis. The study population was divided into four groups based on psychiatric morbidity treated in specialized health care. We characterized the groups using data of psychiatric and somatic illnesses, psychotropic drug use, and socioeconomic factors and investigated factors associated with prodromal AD. RESULTS: Altogether, 4.3% of cohort members had a psychiatric diagnosis at least five years before AD diagnosis, 3.1% had a psychiatric diagnosis only up to five years before AD diagnosis, and 1.1% had a psychiatric diagnosis both less and more than 5 years before AD. Belonging to the Prodromal group (psychiatric diagnosis within 5 years before AD diagnosis) was most strongly associated with substance abuse (RR 65.06, 95%CI 55.54-76.22). Other associated factors with the Prodromal group were female gender, use of psychotropics, stroke, and asthma/COPD. CONCLUSION: Substance abuse and psychotropic drug use are common five years before AD diagnosis. These can be potential markers of possible prodromal symptoms of AD and should be acknowledged in clinical work.

Characteristics and predictors of off-label use of antipsychotics in general population sample.

OBJECTIVE: Increasing number of people have been prescribed antipsychotics (APs) off-label in recent decades. This study aimed to identify the characteristics and predictors of receiving prescription of antipsychotics off-label. METHODS: The study sample was part of the Northern Finland Birth Cohort 1966 (n = 7071). Data included questionnaires and national register data. Information on prescribed medications was extracted from the national register. The sample was divided into three groups: Persons who had been prescribed APs off-label (n = 137), individuals with non-psychotic mental disorders without APs off label (n = 1478) and individuals who had been diagnosed with psychosis or bipolar disorder and who had been prescribed APs (n = 151). We compared sociodemographic, lifestyle and clinical characteristics between the off-label and the comparison groups using logistic regression. RESULTS: The most common diagnoses in the off-label group were depression (n = 96, 70.1%) and anxiety (n = 55, 40.1%). Compared with individuals with non-psychotic mental disorders who were not prescribed APs off-label, individuals with prescribed off-label APs had a lower level of education, lower socioeconomic status, were less often married, had a higher level of somatic and psychiatric morbidity, were more often smokers and more often had a substance abuse disorder and heavy alcohol consumption. When comparing the off-label group to individuals with psychosis or bipolar disorder who used APs, there were less differences, though individuals with psychosis or bipolar disorder had more markers of morbidity and a lower level of education. CONCLUSION: Individuals who had been prescribed APs off label had a higher level of mental and somatic morbidity and poorer socioeconomic status than individuals with non-psychotic mental disorders who did not use APs.

Parental death due to natural death causes during childhood abbreviates the time to a diagnosis of a psychiatric disorder in the offspring: A follow-up study.

Parental death before adulthood has been shown to increase offspring's risk of poor health and adverse social consequences. In a sample of 422 subjects with parental death (334 (79.1%) due to natural causes), and 6172 matched controls, those with parental death were given a diagnosis of a psychiatric disorder up to 28 years of age earlier than their controls (10-year survival proportions: 88.6% vs. 93.1%, p = 0.001). Our findings indicate that psychosocial support must be provided as early as when a parent falls ill, especially with those illnesses that are the most common causes of death in the population.

Return to the labour market in schizophrenia and other psychoses: a register-based Northern Finland Birth Cohort 1966 study.

PURPOSE: The prospects and predictors of returning to the labour market after long-term work disability in psychoses are unclear. Our aim was to study the proportion and characteristics of persons with schizophrenia and other psychoses who return to the labour market after receiving a disability pension. METHODS: In this 50-year follow-up study in the Northern Finland Birth Cohort 1966 (NFBC1966), national registers on demographics, care, and disability pensions were used to detect and characterize individuals who had been on a disability pension for psychiatric reasons. We compared individuals with schizophrenia (SZ, n = 223) or other psychoses (OP, n = 200) to those with non-psychotic psychiatric disorders (NP, n = 1815) regarding demographics and end of pension by cross-tabulations and logistic regression. RESULTS: Of the 170 (74%) persons with SZ who had been on disability pension for a psychiatric reason, 15 (9%) returned to the labour market. Corresponding percentages were 19% for OP and 28% for NP. In SZ, being married, a later onset age of psychosis, and better school performance, and in OP and NP, having children predicted returning to the labour market. In all groups, a shorter length of the latest disability pension associated with returning to the labour market. CONCLUSION: Although rare, it is possible to return to the labour market after a disability pension due to psychosis. Factors predicting a return to the labour market could be taken into account when planning rehabilitation.

Serum biomarkers for Modic changes in patients with chronic low back pain.

PURPOSE: Lumbar Modic change (MC) can serve as a diagnostic marker as well as an independent source of chronic low back pain (CLBP). This study aimed to test for the existence of serum biomarkers in CLBP patients with MC. METHODS: Age- and sex-matched CLBP patients with confirmed MC on lumbar MRI (n = 40) and pain-free controls (n = 40) were assessed. MC was classified into M1, predominating M1, predominating M2 and M2. MC volumes were calculated. Fasting blood samples were assessed for inflammatory mediators, signalling molecules, growth factors and bone turnover markers. Serum concentrations of 46 biomarkers were measured. RESULTS: Median concentrations of interleukin (IL)-15 (p < 0.001), IL-8 (p < 0.001), tumour necrosis factor (TNF)-alpha (p < 0.001), Eotaxin-1 (p < 0.05), Eotaxin-3 (p < 0.001), monocyte chemotactic protein (MCP)-1 (p < 0.05), macrophage inflammatory protein (MIP)-1alpha (p < 0.01), TEK receptor tyrosine kinase (Tie)-2 (p < 0.001), vascular cell adhesion molecule (VCAM)-1 (p < 0.001), RANTES (p < 0.001), C telopeptide of type I collagen (CTX)-1 (p < 0.001), vascular endothelial growth factor (VEGF)-C (p < 0.001), VEGF-D (p < 0.05), fms-related tyrosine kinase (Flt)-1 (p < 0.01) and intercellular adhesion molecule (ICAM)-1 (p < 0.01) were significantly higher among controls. IL-1sRII (23.2 vs. 15.5 ng/ml, p < 0.001) and hepatocyte growth factor (HGF)-1 (169 vs. 105 pg/ml, p < 0.01) concentrations were significantly higher among patients. Type or volume of MC was not associated with biomarker concentrations. CONCLUSIONS: This is the first study to assess the blood serum biomarker profile in individuals with CLBP with MC. Several biomarkers were suppressed, while two markers (IL-1sRII and HGF) were elevated among MC patients, irrespective of MC type or size, with CLBP compared with asymptomatic controls.

Association between chronic diseases and falls among a sample of older people in Finland.

BACKGROUND: Falls are a major problem for older people and recurrent fallers are especially prone to severe consequences due to falls. This study investigated the association between chronic conditions and falls. METHODS: Responses from 872 older persons (age 65-98) to a health questionnaire were used in the analyses. Characteristics and disease prevalence between recurrent fallers, one-time fallers and non-fallers were compared. A hierarchical clustering method was applied to find combinations of chronic conditions that were associated with recent recurrent falling. RESULTS: The results showed that recurrent fallers had a higher number of diseases (median 4, interquartile range, IQR = 2.0-5.0) compared to non-fallers (median 2, IQR = 1.0-3.0). Eight clusters were formed based on the data. The participants in the low chronic disease cluster were younger, more physically active, not frail, and had fewer geriatric conditions. Multiple chronic disease cluster participants were older, less physically active, overweight (body mass index, BMI > 30), at risk of malnutrition, and had more geriatric conditions. Significantly increased risk of recurrent falls relative to the low chronic cluster was found for respondents in the osteoporosis cluster and multiple chronic disease cluster (OR = 5.65, 95% confidence interval CI: 1.23-25.85, p = 0.026, and OR = 13.42, 95% CI: 2.47-72.96, p = 0.002, respectively). None of the clusters were associated with increased risk of one-time falling. CONCLUSIONS: The results implicate that the number of chronic diseases is related with risk of recurrent falling. Furthermore, the results implicate the potential of identifying certain combinations of chronic diseases that increase fall risk by analyzing health record data, although further studies are needed with a larger population sample.

Association between grayscale sonographic and clinical findings in severe knee osteoarthritis.

PURPOSE: To assess whether ultrasonographic (US) findings associate with clinical findings in severe knee osteoarthritis (OA). Association of US findings with side-of-knee pain and inter-reader agreement of knee US were also evaluated. METHODS: One-hundred-two patients (in total 123 knees) with severe knee OA were recruited for this cross-sectional study. US was performed by a single observer, and on 53 knees by two independent observers to assess inter-reader reliability. Preoperative clinical data was available for 69 knees. Cutoff values were applied to dichotomize US and clinical findings. The Chi-square test, Mann-Whitney test, and prevalence- and bias-adjusted kappa (PABAK) were applied for statistical analyses. RESULTS: Seven of 99 associations tested were statistically significant. Associations were observed between range of flexion and lateral femoral (P = .009) and tibial (P = .001) osteophytes, mediolateral instability and damage to the lateral femoral cartilage (P = .014) and damage to the lateral meniscus (P = .031), and alignment and damage to the lateral femoral cartilage (P < .001), lateral tibial osteophytes (P = .037), and damage to the lateral meniscus (P < .001). A strong association was observed between medial-sided pain and same-sided cartilage damage and osteophytes (P < .001). That inter-reader agreement was excellent on the medial side of the knee joint (PABAK = 0.811-0.887). CONCLUSIONS: US findings show a rather poor association with clinical OA findings. Inter-reader agreement of knee US is excellent on the medial side.

Variable angle gray level co-occurrence matrix analysis of T2 relaxation time maps reveals degenerative changes of cartilage in knee osteoarthritis: Oulu knee osteoarthritis study.

BACKGROUND: Texture analysis methods based on gray level co-occurrence matrices (GLCM) can be optimized to probe the spatial correspondence information from knee MRI T2 maps and the changes caused by osteoarthritis, and thus possibly leading to a more sensitive characterization of osteoarthritic cartilage. Curvature of the cartilage surfaces combined with the low image resolution in relation to cartilage thickness set special requirements for an effective texture analysis tool. PURPOSE/HYPOTHESIS: To introduce a novel implementation of GLCM algorithm optimized for cartilage texture analysis; to evaluate the performance of the designed algorithm against mean T2 relaxation time analysis; and to identify the most suitable texture features for discerning osteoarthritic subjects and asymptomatic controls. STUDY TYPE: Case control. POPULATION/SUBJECTS/PHANTOM/SPECIMEN/ANIMAL MODEL: Eighty symptomatic osteoarthritis patients and 64 asymptomatic controls. FIELD STRENGTH/SEQUENCE: Multislice multiecho spin echo sequence on a 3T MRI system. ASSESSMENT: The T2 relaxation time maps were manually segmented by an operator trained for the task. Texture analysis was performed using an in-house algorithm developed in MATLAB. STATISTICAL TESTS: Symptomatic and asymptomatic subjects were compared using Mann-Whitney U-test. Repeatability of different features was addressed using the concordance correlation coefficient (CCC). Spearman's correlations between the features were determined. RESULTS: The algorithm displayed excellent performance in discerning symptomatic and asymptomatic subjects. Fifteen features provided a significant difference between the groups (P ≤ 0.05) and 12 of those had P values smaller than the mean T2 differences. Most of the studied texture features were highly repeatable with CCC over 90%. For the features with significant differences, correlation with mean T2 was low or moderate (|r| ≤ 0.5). DATA CONCLUSION: With careful parameter and feature selection and algorithm optimization, texture analysis provides a powerful tool for assessing knee osteoarthritis with more sensitive detection of cartilage degeneration compared to the mean value of the T2 relaxation times in an identical region of interest. LEVEL OF EVIDENCE: 2 Technical Efficacy Stage 2 J. Magn. Reson. Imaging 2018;47:1316-1327.

Elevated adiabatic T1ρ and T2ρ in articular cartilage are associated with cartilage and bone lesions in early osteoarthritis: A preliminary study.

PURPOSE: To evaluate adiabatic T1ρ and T2ρ of articular cartilage in symptomatic osteoarthritis (OA) patients and asymptomatic volunteers, and to determine their association with magnetic resonance imaging (MRI)-based structural abnormalities in cartilage and bone. MATERIALS AND METHODS: A total of 24 subjects (age range: 50-68 years; 12 female) were enrolled, including 12 early OA patients and 12 volunteers with normal joint function. Patients and volunteers underwent 3T MRI. T2 , adiabatic T1ρ , and T2ρ relaxation times of knee articular cartilage were measured. Proton density (PD)- and T1 -weighted MR image series were also obtained and separately evaluated for morphological changes using the MRI OA Knee Scoring (MOAKS) system. Comparisons using the Mann-Whitney nonparametric test were performed after dividing the study participants according to physical symptoms as determined by Western Ontario and McMaster Universities (WOMAC) score or presence of cartilage lesions, bone marrow lesions, or osteophytes. RESULTS: Elevated adiabatic T1ρ and T2ρ relaxation times of articular cartilage were associated with cartilage loss (P = 0.024-0.047), physical symptoms (0.0068-0.035), and osteophytes (0.0039-0.027). Elevated adiabatic T1ρ was also associated with bone marrow lesions (0.033). CONCLUSION: Preliminary data suggest that elevated adiabatic T1ρ and T2ρ of cartilage are associated with morphological abnormalities of cartilage and bone, and thus may be applicable for in vivo OA research and diagnostics. LEVEL OF EVIDENCE: 2 Technical Efficacy: Stage 2 J. MAGN. RESON. IMAGING 2017;46:678-689.

The effect of zoledronic acid on type and volume of Modic changes among patients with low back pain.

BACKGROUND: Modic changes (MC) are associated with low back pain (LBP). In this study, we compared changes in size and type of MC, after a single intravenous infusion of 5 mg zoledronic acid (ZA) or placebo, among chronic LBP patients with MC on magnetic resonance imaging (MRI), and evaluated whether the MRI changes correlate with symptoms. METHODS: All patients (N = 19 in ZA, 20 in placebo) had MRI at baseline (0.23-1.5 T) and at one year (1.5-3 T). We evaluated the level, type and volume of all the MC. The MC were classified into M1 (M1 (100%)), predominating M1 (M1/2 (65:35%)) or predominating M2 (M1/2 (35:65%)), and M2 (M2 (100%)). The first two were considered M1-dominant, and the latter two M2-dominant. Volumes of M1 and M2 were calculated separately for the primary MC, which was assumed to cause the symptoms, and the other MC. We analysed the one-year treatment differences in M1 and M2 volumes using analysis of covariance with adjustments for age, sex, body mass index, and smoking. The correlations between the MRI changes and the changes in LBP symptoms were analysed using Pearson correlations. RESULTS: In the ZA group, 84.2% of patients had M1-dominant primary MC at baseline, compared to 50% in the placebo group (p = 0.041). The primary MC in the ZA group converted more likely to M2-dominant (42.1% ZA, 15% placebo; p = 0.0119). The other MC (15 ZA, 8 placebo) were on average 42% smaller and remained largely M2-dominant. The M1 volume of the primary MC decreased in the ZA group, but increased in the placebo group (-0.83 cm3 vs 0.91 cm3; p = 0.21). The adjusted treatment difference for M1 volume was -1.9 cm3 (95% CI -5.0 to 1.2; p = 0.22) and for M2 volume 0.23 cm3 (p = 0.86). In the MC that remained M1-dominant, volume change correlated positively with increased symptoms in the placebo group, whereas the correlations were negative and weak in the ZA group. CONCLUSIONS: Zoledronic acid tended to speed up the conversion of M1-dominant into M2-dominant MC and decrease the volume of M1-dominant MC, although statistical significance was not demonstrated. TRIAL REGISTRATION: The registration number in ClinicalTrials.gov is NCT01330238 and the date of registration February 11, 2011.

Information about radiation dose and risks in connection with radiological examinations: what patients would like to know.

OBJECTIVES: To find out patients' wishes for the content and sources of the information concerning radiological procedures. METHODS: A questionnaire providing quantitative and qualitative data was prepared. It comprised general information, dose and risks of radiation, and source of information. Two tables demonstrating different options to indicate the dose or risks were also provided. Patients could give one or many votes. Altogether, 147 patients (18-85 years) were interviewed after different radiological examinations using these devices. RESULTS: 95% (139/147) of the patients wished for dose and risk information. Symbols (78/182 votes) and verbal scale (56/182) were preferred to reveal the dose, while verbal (83/164) and numerical scale (55/164) on the risk of fatal cancer were preferred to indicate the risks. Wishes concerning the course, options and purpose of the examination were also expressed. Prescriber (3.9 on a scale 1-5), information letter (3.8) and radiographer (3.3) were the preferred sources. Patients aged 66-85 years were reluctant to choose electronic channels. CONCLUSIONS: Apart from general information, patients wish for dose and risk information in connection with radiological examinations. The majority preferred symbols to indicate dose and verbal scales to indicate risks, and the preferred source of information was the prescriber or information letter. KEY POINTS: • 95% of patients expect information on the dose and risks of radiation. • Symbols and verbal scale are preferred to indicate the dose. • Verbal and numerical scales are preferred to indicate fatal cancer risk. • Patients expect information on course, options and purpose of examination. • Prescriber, information letter and radiographer are popular sources of the overall information.

Effect of display type and room illuminance in chest radiographs.

OBJECTIVES: To compare diagnostic accuracy in the detection of subtle chest lesions on digital chest radiographs using medical-grade displays, consumer-grade displays, and tablet devices under bright and dim ambient light. METHODS: Five experienced radiologists independently assessed 50 chest radiographs (32 with subtle pulmonary findings and 18 without apparent findings) under bright (510 lx) and dim (16 lx) ambient lighting. Computed tomography was used as the reference standard for interstitial and nodular lesions and follow-up chest radiograph for pneumothorax. Diagnostic accuracy and sensitivity were calculated for assessments carried out in all displays and compared using the McNemar test. The level of significance was set to p < 0.05. RESULTS: Significant differences in sensitivity between the assessments under bright and dim lighting were found among consumer-grade displays in interstitial opacities with, and in pneumothorax without, Digital Imaging and Communication in Medicine-Grayscale Standard Display Function (DICOM-GSDF) calibration. Compared to 6 megapixel (MP) display under bright lighting, sensitivity in pneumothorax was lower in the tablet device and the consumer-grade display. Sensitivity in interstitial opacities was lower in the DICOM-GSDF calibrated consumer-grade display. CONCLUSIONS: A consumer-grade display with or without DICOM-GSDF calibration or a tablet device is not suitable for reading digital chest radiographs in bright lighting. No significant differences were observed between five displays in dim light. KEY POINTS: • Ambient lighting affects performance of consumer-grade displays (with or without DICOM-GSDF calibration). • Bright light decreases detection of pneumothorax on non-medical displays. • Bright light decreases detection of interstitial opacities on DICOM-GSDF-calibrated, consumer-grade displays. • Dim light is sufficient to detect subtle chest lesions from all displays.

Bone healing in rabbit calvarial critical-sized defects filled with stem cells and growth factors combined with granular or solid scaffolds.

PURPOSE: In pediatric neurosurgery, decompressive craniectomy and correction of congenital cranial anomalies can result in major cranial defects. Corrective cranioplasty for the repair of these critical-sized defects is not only a cosmetic issue. The limited availability of suitable autogenous bone and the morbidity of donor site harvesting have driven the search for new approaches with biodegradable and bioactive materials. This study aimed to assess the healing of rabbit calvarial critical-sized defects filled with osteogenic material, either with bioactive glass scaffolds or tricalcium phosphate granules in various combinations with adipose stem cells or bone marrow stem cells, BMP-2, BMP-7, or VEGF to enhance osteogenesis. METHODS: Eighty-two bicortical full thickness critical-sized calvarial defects were operated. Five defects were left empty as negative control defects. The remaining 77 defects were filled with solid bioactive glass scaffolds or tricalcium phosphate granules seeded with adipose or bone marrow derived stem cells in combination with BMP-2, BMP-7, or VEGF. The defects were allowed to heal for 6 weeks before histologic and micro-CT analyses. RESULTS: Micro-CT examination at the 6-week post-operative time point revealed that defects filled with stem cell-seeded tricalcium phosphate granules resulted in new bone formation of 6.0 %, whereas defects with bioactive glass scaffolds with stem cells showed new bone formation of 0.5 to 1.7 %, depending on the growth factor used. CONCLUSIONS: This study suggests that tricalcium phosphate granules combined with stem cells have osteogenic potential superior to solid bioactive glass scaffolds with stem cells and growth factors.

Transcultural adaption and psychometric properties of the STarT Back Screening Tool among Finnish low back pain patients.

PURPOSE: The STarT Back Screening Tool (SBST) is a 9-item questionnaire designed for screening low back pain (LBP) patients into three prognostic groups for stratified care. The stratified care approach has proven to be clinically more beneficial and cost-effective than the current best physiotherapy practice. The objective of this study was to translate, culturally adapt and study psychometric properties of the SBST among Finnish LBP patients. METHODS: The SBST was translated into Finnish using appropriate translation guidelines. A total of 116 patients were recruited from outpatient clinics. They were asked to fill out two questionnaires within 1-7 days. The first questionnaire set included the SBST, Oswestry Disability Index (ODI), Beck Depression Inventory (BDI), Örebro Musculoskeletal Pain Screening Questionnaire (ÖMPSQ) and intensities of back and leg pain (10-cm Visual Analogue Scale). The second questionnaire form included the SBST and a question about persistence of symptoms. RESULTS: Some linguistic and cultural differences emerged during the translation process with item 1 ("spread down my legs"), item 2 ("neck and shoulder pain"), item 6 ("worrying thoughts") and item 9 ("bothersome"). The test-retest reliability of the SBST total score was excellent (intraclass correlation coefficient 0.78) and of the psychosocial subscale good (0.68). Cronbach's alpha for the psychosocial subscale was 0.55. Spearman's correlation coefficient between SBST total score and BDI was 0.38, ODI 0.39, ÖMPSQ 0.45, intensity of leg pain 0.45 and LBP 0.31. Based on analysis of variance, the SBST discriminated low- and medium-risk groups better than medium- and high-risk groups. CONCLUSIONS: The Finnish translation of the SBST is linguistically accurate and has been adapted to the Finnish-speaking population. It showed to be a valid and reliable instrument and comparable with the original English version. Therefore, it may be used in clinical work with Finnish LBP patients.