Increased femoral anteversion in females with anterior knee pain relates to both the neck and the shaft of the femur.

INTRODUCTION: Increased femoral anteversion (FAV) can have many clinical manifestations, including anterior knee pain (AKP). To our knowledge, no studies have measured the location of FAV in a cohort of female AKP patients. The objective of this research is to determine whether the increased FAV in AKP females originates above the lesser trochanter, below the lesser trochanter or at both levels. MATERIALS AND METHODS: Thrity-seven consecutive AKP female patients (n = 66 femurs) were recruited prospectively. There were 17 patients (n = 26 femurs; mean age of 28 years) in whom the suspicion for the increased FAV of the femur was based on the clinical examination (pathological group-PG). The control group (CG) consisted of 20 patients (n = 40 femurs; mean age of 29 years) in whom there was no increased FAV from the clinical standpoint. All of them underwent a torsional computed tomography of the lower limbs. FAV was measured according to Murphy´s method. A segmental analysis of FAV was performed using the lesser trochanter as a landmark. RESULTS: Significant differences in the total FAV (18.7 ± 5.52 vs. 42.46 ± 6.33; p < 0.001), the neck version (54.88 ± 9.64 vs. 64.27 ± 11.25; p = 0.0006) and the diaphysis version (- 36.17 ± 8.93 vs. - 21.81 ± 11.73; p < 0.001) were observed between the CG and the PG. The difference in the diaphyseal angle between CG and PG accounts for 60% of the total difference between healthy and pathological groups, while the difference between both groups in the angle of the neck accounts for 40%. CONCLUSION: In chronic AKP female patients with increased FAV, the two segments of the femur contribute to the total FAV, with a different pattern among patients and controls, being the compensation mechanism of the diaphysis much lower in the pathological femurs than in the controls.

Central sensitization negatively influences the level of disability in female patients with anterior knee pain.

PURPOSE: To define the prevalence of Central Sensitization (CS) in patients with Anterior Knee Pain (AKP) and determine whether there is an association between CS and the magnitude of pain, disability, quality-of-life and psychological impairment. METHODS: The data of a total of 44 AKP female patients with a mean age of 27.7 years (15-50) recruited consecutively from hospital outpatient knee clinics were prospectively included in this study. The patients had no antecedents of knee trauma or surgery and no history of injury or disease of the nervous system. There were also 50 healthy female controls with a mean age of 26.1 years (16-46). CS was evaluated using the Central Sensitization Inventory (CSI). Quality-of-life was evaluated using the EuroQoL-5D questionnaire. Self-reporting of clinical pain intensity was obtained using the Visual Analogue Scale. The Kujala Knee Scale and IKDC form were used to evaluate disability. Anxiety and depression were evaluated using the Hospital Anxiety and Depression Subscale (HAD). Kinesiophobia was measured with the Tampa Scale for Kinesiophobia (TSK-11) and catastrophizing by means of the Pain Catastrophizing Scale (PCS). RESULTS: Sixteen AKP patients (36%), and 2 (4%) of the healthy controls presented with central sensitization (p < 0.01). AKP patients with CS have a greater degree of disability based on the Kujala Scale and higher levels of anxiety and depression than AKP patients without CS. The score of AKP patients in the CSI correlated weakly with disability and quality of life and moderately with anxiety and depression. However, no association was seen between CSI score and pain intensity, nor with catastrophizing and kinesiophobia. A multivariate logistic regression analysis showed that only depression was statistically significant in the prediction of the presence of CS (odds ratio 1.45; 95% CI 1.07 to 1.96). CONCLUSIONS: AKP patients have a significantly higher prevalence of CS in comparison with what has been reported for the general population. This finding suggests the presence of altered pain modulation in a subgroup of AKP patients. LEVEL OF EVIDENCE: Level III.

Gray matter volume differences in intimate partner violence perpetrators and its role in explaining dropout and recidivism.

AIM: Psychological instruments that are employed to adequately explain treatment compliance and recidivism of intimate partner violence (IPV) perpetrators present a limited ability and certain biases. Therefore, it becomes necessary to incorporate new techniques, such as magnetic resonance imaging (MRI), to be able to surpass those limitations and measure central nervous system characteristics to explain dropout (premature abandonment of intervention) and recidivism. METHOD: The main objectives of this study were: 1) to assess whether IPV perpetrators (n = 60) showed differences in terms of their brain's regional gray matter volume (GMV) when compared to a control group of non-violent men (n = 57); 2) to analyze whether the regional GMV of IPV perpetrators before starting a tailored intervention program explain treatment compliance (dropout) and recidivism rate. RESULTS: IPV perpetrators presented increased GMV in the cerebellum and the occipital, temporal, and subcortical brain regions compared to controls. There were also bilateral differences in the occipital pole and subcortical structures (thalamus, and putamen), with IPV perpetrators presenting reduced GMV in the above-mentioned brain regions compared to controls. Moreover, while a reduced GMV of the left pallidum explained dropout, a considerable number of frontal, temporal, parietal, occipital, subcortical and limbic regions added to dropout to explain recidivism. CONCLUSIONS: Our study found that certain brain structures not only distinguished IPV perpetrators from controls but also played a role in explaining dropout and recidivism. Given the multifactorial nature of IPV perpetration, it is crucial to combine neuroimaging techniques with other psychological instruments to effectively create risk profiles of IPV perpetrators.

The contribution of brain volume to explain autonomous imbalance during recovery from acute stress in batterers.

AIM: Many authors have suggested that intimate partner violence (IPV) perpetrators present an imbalance between both branches of the autonomous nervous system when coping with acute stress. Concretely, there is a predominance of the sympathetic branches over the parasympathetic ones when recovering from stress. This imbalance can be explained by their tendency toward anger rumination, and more concretely, by their focus on thoughts of revenge during this period. Unfortunately, there is a gap in the scientific literature in terms of using magnetic resonance imaging (MRI) techniques to assess which brain structures would explain this tendency of IPV perpetrators when coping with acute stress. METHOD: The main objective of this study was to assess whether the gray matter volume (GMV) of relevant brain structures, signaled in previous scientific literature, moderates the association between thoughts of revenge and sympathetic activation during the recovery period, based on skin conductance levels (SCL) after being exposed to stress, in a group of IPV perpetrators (n = 58) and non-violent men (n = 61). RESULTS: This study highlighted that the GMV of the left nucleus accumbens, right lobules of the cerebellum, and inferior temporal gyrus in IPV perpetrators moderated the association between thoughts of revenge and SCL during the recovery period. Accordingly, the higher the thoughts of revenge, the higher the sympathetic predominance (or higher SCL levels), especially among IPV perpetrators with the lowest GMV of these brain structures. Nonetheless, those variables were unrelated in the control group. CONCLUSIONS: Our study highlights the involvement of certain brain structures and how they explain the tendency of some IPV perpetrators to ruminate anger or, more precisely, to focus on thoughts of revenge when they recover from acute stress. These results reinforce the need to incorporate neuroimaging techniques during screening processes to properly understand how IPV perpetrators deal with stress, which in turn helps target their needs and design concrete intervention modules.

Executive dysfunction and cortical variations among intimate partner violence perpetrators and the association with sexism.

Malfunctioning in executive functioning has been proposed as a risk factor for intimate partner violence (IPV). This is not only due to its effects on behavioral regulation but also because of its association with other variables such as sexism. Executive dysfunctions have been associated with frontal and prefrontal cortical thickness. Therefore, our first aim was to assess differences in cortical thickness in frontal and prefrontal regions, as well as levels of sexism, between two groups of IPV perpetrators (with and without executive dysfunctions) and a control group of non-violent men. Second, we analyzed whether the cortical thickness in the frontal and prefrontal regions would explain sexism scores. Our results indicate that IPV perpetrators classified as dysexecutive exhibited a lower cortical thickness in the right rostral anterior cingulate superior frontal bilaterally, caudal middle frontal bilaterally, right medial orbitofrontal, right paracentral, and precentral bilaterally when compared with controls. Furthermore, they exhibited higher levels of sexism than the rest of the groups. Most importantly, in the brain structures that distinguished between groups, lower thickness was associated with higher sexism scores. This research emphasizes the need to incorporate neuroimaging techniques to develop accurate IPV profiles or subtypes based on neuropsychological functioning.

Deep learning automatic semantic segmentation of glioblastoma multiforme regions on multimodal magnetic resonance images.

OBJECTIVES: In patients having naïve glioblastoma multiforme (GBM), this study aims to assess the efficacy of Deep Learning algorithms in automating the segmentation of brain magnetic resonance (MR) images to accurately determine 3D masks for 4 distinct regions: enhanced tumor, peritumoral edema, non-enhanced/necrotic tumor, and total tumor. MATERIAL AND METHODS: A 3D U-Net neural network algorithm was developed for semantic segmentation of GBM. The training dataset was manually delineated by a group of expert neuroradiologists on MR images from the Brain Tumor Segmentation Challenge 2021 (BraTS2021) image repository, as ground truth labels for diverse glioma (GBM and low-grade glioma) subregions across four MR sequences (T1w, T1w-contrast enhanced, T2w, and FLAIR) in 1251 patients. The in-house test was performed on 50 GBM patients from our cohort (PerProGlio project). By exploring various hyperparameters, the network's performance was optimized, and the most optimal parameter configuration was identified. The assessment of the optimized network's performance utilized Dice scores, precision, and sensitivity metrics. RESULTS: Our adaptation of the 3D U-net with additional residual blocks demonstrated reliable performance on both the BraTS2021 dataset and the in-house PerProGlio cohort, employing only T1w-ce sequences for enhancement and non-enhanced/necrotic tumor models and T1w-ce + T2w + FLAIR for peritumoral edema and total tumor. The mean Dice scores (training and test) were 0.89 and 0.75; 0.75 and 0.64; 0.79 and 0.71; and 0.60 and 0.55, for total tumor, edema, enhanced tumor, and non-enhanced/necrotic tumor, respectively. CONCLUSIONS: The results underscore the high precision with which our network can effectively segment GBM tumors and their distinct subregions. The level of accuracy achieved agrees with the coefficients recorded in previous GBM studies. In particular, our approach allows model specialization for each of the different tumor subregions employing only those MR sequences that provide value for segmentation.

Brain network functional connectivity changes in patients with anterior knee pain: a resting-state fMRI exploratory study.

BACKGROUND: This study investigates the functional brain connectivity in patients with anterior knee pain (AKP). While biomechanical models are frequently employed to investigate AKP, it is important to recognize that pain can manifest even in the absence of structural abnormalities. Leveraging the capabilities of functional magnetic resonance imaging (fMRI), this research aims to investigate the brain mechanisms present in AKP patients. METHODS: Forty-five female subjects (24 AKP patients, 21 controls) underwent resting-state fMRI and T1-weighted structural MRI. Functional brain connectivity patterns were analyzed, focusing on pain network areas, and the influence of catastrophizing thoughts was evaluated. RESULTS: Comparing patients and controls, several findings emerged. First, patients with AKP exhibited increased correlation between the right supplementary motor area and cerebellum I, as well as decreased correlation between the right insula and the left rostral prefrontal cortex and superior frontal gyrus. Second, in AKP patients with catastrophizing thoughts, there was increased correlation of the left lateral parietal cortex with two regions of the right cerebellum (II and VII) and the right pallidum, and decreased correlation between the left medial frontal gyrus and the right thalamus. Furthermore, the correlation between these regions showed promising results for discriminating AKP patients from controls, achieving a cross-validation accuracy of 80.5%. CONCLUSIONS: Resting-state fMRI revealed correlation differences in AKP patients compared to controls and based on catastrophizing thoughts levels. These findings shed light on neural correlates of chronic pain in AKP, suggesting that functional brain connectivity alterations may be linked to pain experience in this population. RELEVANCE STATEMENT: Etiopathogenesis of pain in anterior knee pain patients might not be limited to the knee, but also to underlying alterations in the central nervous system: cortical changes might lead a perpetuation of pain. KEY POINTS: • Anterior knee pain patients exhibit distinct functional brain connectivity compared to controls, and among catastrophizing subgroups. • Resting-state fMRI reveals potential for discriminating anterior knee pain patients with 80.5% accuracy. • Functional brain connectivity differences improve understanding of pain pathogenesis and objective anterior knee pain identification.