Bone marrow lesions of the femoral head : can radiomics distinguish whether it is reversible?

Purpose: Contrary to the self-limiting nature of reversible bone marrow lesions, irreversible bone marrow lesions require early surgical intervention to prevent further morbidity. Thus, early discrimination of irreversible pathology is necessitated. The purpose of this study is to evaluate the efficacy of radiomics and machine learning regarding this topic. Material and methods: A database was scanned for patients who had undergone MRI of the hip for differential diagnosis of bone marrow lesions and had had follow-up images acquired within 8 weeks after the first imaging. Images that showed resolution of oedema were included in the reversible group. The remainders that showed progression into characteristic signs of osteonecrosis were included in the irreversible group. Radiomics was performed on the first MR images, calculating first- and second-order parameters. Support vector machine and random forest classifiers were performed using these parameters. Results: Thirty-seven patients (seventeen osteonecrosis) were included. A total of 185 ROIs were segmented. Fortyseven parameters were accepted as classifiers with an area under the curve value ranging from 0.586 to 0.718. Support vector machine yielded a sensitivity of 91.3% and a specificity of 85.1%. Random forest classifier yielded a sensitivity of 84.8% and a specificity of 76.7%. Area under curves were 0.921 for support vector machine and 0.892 for random forest classifier. Conclusions: Radiomics analysis could prove useful for discrimination of reversible and irreversible bone marrow lesions before the irreversible changes occur, which could prevent morbidities of osteonecrosis by guiding the decisionmaking process for management

Medial Meniscus Scaffold Implantation in Combination with Concentrated Bone Marrow Aspirate Injection: Minimum 3-Year Follow-up

The objective of this study is to show the short-term clinical and radiological outcomes of concentrated bone marrow aspirate (CBMA) injection administered in combination with medial meniscus scaffold implantation. Twenty-three patients who received intra-articular CBMA injection in combination with polyurethane-based medial meniscus scaffold implantation were evaluated within the scope of this study. The International Knee Documentation Committee (IKDC) questionnaire and the Knee injury and Osteoarthritis Outcome Score (KOOS) were used to evaluate the results, and the visual analog scale was used to assess the pain scores. Magnetic resonance imaging (MRI) scans were obtained in the preoperative period and at postoperative months 1, 12, 24, and 36 to assess the scaffold position as well as chondral degeneration/damage in a comparative manner. MRI assessment was performed by using the modified Outerbridge scale for cartilage and the Genovese scoring system for the meniscal implant. Twenty-three patients who were included in the study were evaluated for a mean follow-up period of 38.3 months. Patients exhibited statistically significant improvement according to all scoring data from the preoperative period until the follow-up period. The mean postoperative extrusion at year 3 was 2.39 mm (distribution 2.30-2.56 mm). There was no significant difference in the distribution of the degree of chondral damage between the preoperative and 3-year follow-up periods. Four patients did not show any improvement nor had lower scores according to the assessment. Medial meniscus scaffold implantation combined with intra-articular CBMA injection resulted in a significant improvement in all functions and pain scores as well as a statistically significant clinical improvement in IKDC and KOOS values in the short-term follow-up. The Level of evidence for this study is IV

Undifferentiated spondyloarthritis is more frequently seen in women than in men

Introduction Spondyloarthritis (SpA) are a group of inflammatory rheumatic diseases that share some common clinical and genetic features such as inflammatory back pain, peripheral arthritis, enthesitis, anterior uveitis, sacroiliitis, and HLA-B27 positivity. The aim of the present study was to describe the clinical, radiologic, and genetic features of patients with undifferentiated spondyloarthritis (uSpA) and ankylosing spondylitis (AS). Patients and methods This study included 225 SpA patients (134 uSpA and 91 AS) attending our Rheumatology Outpatient Clinic consecutively. Patients underwent peripheral and axial joint and enthesitis assessment, erythrocyte sedimentation rate or C-reactive protein determination, HLA-B27 tissue typing, radiographic evaluation, and sacroiliac MRI. Results In total, 26 of 91 AS patients and 115 of 134 uSpA patients were women (28.6 vs. 85.8%) and 65 of AS and 19 of uSpA were men (71.4 vs. 14.2%). The time for diagnosis was 15.82 ± 20.7 months for AS patients and 5.91 ± 3.63 months for uSpA patients. Diagnostic delay was 102.46 ± 88.99 (median 83, range 8-377) months for AS and 74.23 ± 60.7 (median 55.5, range 0-238) months for uSpA patients. HLA-B27 positivity was present in 51.6% of AS and 14.9% of uSpA patients. The mean BASDAI level of patients with AS was 6.4 ± 1.1 and that of uSpA patients was 4.8 ± 2.1. Conclusion SpA are frequent diseases and physicians other than rheumatologists should also be aware of them. uSpA is more frequent in women than men. Early diagnosis of SpA is important because early treatment with new biological therapies may lead to much better Results than applying them in the advanced stages

Is coracoacromial arch angle a predisposing factor for rotator cuff tears?

PURPOS

Impact of fibular torsion and rotation on chronic ankle instability

Background: The fibula is known not to involve in transmission of weight but known simply as an ankle stabilizer. However, its main function in stabilizing the ankle remains obscure. Since the fibula has an impact on torsion and rotation of the ankle, its effect on lateral ankle instability should be investigated

Zmniejszona aktywność paraoksonazy w surowicy u chorych ze zwapnieniem tętnic wieńcowych

Background: Previous studies have shown an association between paraoxonase (PON) activity and the presence and severity of coronary atherosclerosis.Aim: To demonstrate any association between serum PON activity and the presence and severity of coronary artery calcification (CAC).Methods: A total of 156 consecutive patients having the suspicion of coronary atherosclerosis or needing risk stratification for cardiovascular events were included in the present study. Peripheral venous blood samples of all participants to measure serum PON activity were collected before undergoing multidetector computed tomography, which was used to determine the presence and quantity of CAC.Results: Serum PON-1 levels were lower in the CAC group compared to the no CAC group (60 [35–96] U/L vs. 291 [230–371] U/L, respectively, p < 0.001). There was a significant negative correlation between total CAC score and PON (r2 = 0.335, p < 0.001). In multivariate analysis, the significant and independent predictors of the presence of CAC were male sex, high-sensitive C-reactive protein, and PON. Similarly, increased PON was significantly and independently associated with freedom from CAC. In receiver operating characteristics analysis, PON level < 197 U/L had 87% sensitivity, 91% specificity, 93% positive predictive value, and 85% negative predictive value in predicting CAC.Conclusions: Diminished serum PON activity is significantly and independently associated with the presence and severity of CAC, and vice versa.Wstęp: Wcześniejsze badania wykazały związek między aktywnością paraoksonazy (PON) a występowaniem i nasileniem zwapnień w tętnicach wieńcowych (CAC).Cel: Celem badania było wykazanie zależności między aktywnością PON w surowicy a występowaniem i nasileniem CAC.Metody: Do badania włączono 156 kolejnych pacjentów z podejrzeniem miażdżycy tętnic wieńcowych lub wymagających stratyfikacji ryzyka zdarzeń sercowo-naczyniowych. Od wszystkich uczestników badania pobrano próbki obwodowej krwi żylnej w celu wykonania pomiaru aktywności PON w surowicy przed badaniem metodą multidetektorowej tomografii komputerowej, które zastosowano do wykrycia obecności zwapnień i ich oceny ilościowej.Wyniki: Stężenia PON-1 w surowicy były niższe w grupie z CAC niż u osób, u których nie stwierdzono CAC (odpowiednio 60 [35–96] j./l i 291 [230–371] j./l; p < 0,001). Wykazano istotną ujemną korelację między całkowitą punktacją w skali oceny CAC oraz PON (r2 = 0,335; p < 0,001). W analizie wieloczynnikowej silnymi i niezależnymi czynnikami predykcyjnymi występowania CAC były: płeć męska, stężenia PON i białka C-reaktywnego mierzonego metodą wysokoczułą. Zwiększona aktywność PON była istotnie i niezależnie związana z brakiem zmian typu CAC. W analizie krzywych ROC stężenie PON wynoszące poniżej 197 j./l pozwalało prognozować wystąpienie CAC, przy czym oznaczenie tego parametru cechowało się 87-procentową czułością, 91-procentową swoistością, wartością predykcyjną dodatnią — 93% i wartością predykcyjną ujemną — 85%.Wnioski: Zmniejszona aktywność PON w surowicy była istotnie i niezależnie związana z obecnością oraz nasileniem CAC i odwrotnie — mała aktywność CAC korelowała z brakiem CAC