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This study aimed to compare the accuracy of PET/CT parameters with CT parameters for directing bone biopsies. The study was an IRB-approved retrospective study of 388 patients who underwent both 2-[18F] FDG PET/CT and CT within 6 weeks before a bone biopsy. Age, sex, cancer type, lesion length, SUVmax, tumor to liver (T/L) ratio, CT attenuation, difference in CT attenuation between the lesion and normal bone (delta CT attenuation), and the absolute delta CT attenuation were used as predictors. T tests and chi-squared tests were used to compare variables. DeLong’s test was used to compare receiver operator characteristic (ROC) curves. We reviewed the data from 388 patients. Of these, 295 patients had bone lesion biopsies, and 93 patients had bone marrow aspirations/biopsies. Biopsies of larger bone lesions (p = 0.033) and bone lesions with higher SUVmax (p = 0.005) were more likely to show malignancy. For bone lesions, the ROC curve for the SUVmax (AUC = 0.6827) was better than the ROC curves for delta CT attenuation (AUC = 0.5766, p = 0.032) and absolute delta CT attenuation (AUC = 0.5491, p = 0.006), but not significantly better than the ROC curves for CT attenuation (AUC = 0.5894, p = 0.061) and T/L ratio (AUC = 0.6778, p = 0.774). A threshold SUVmax of 5.25 had an accuracy of 0.713, sensitivity of 0.766, and specificity of 0.549 to predict malignancy in bone lesion biopsies. None of these variables predicted malignancy in bone marrow biopsies (p > 0.05 for all). Metabolic 2-[18F]FDG PET/CT parameters have more clinical impact for planning bone biopsies as compared to CT parameters. • The 2-[ 18 F]FDG PET/CT measurement (SUVmax) has more clinical impact for planning bone biopsies as compared to CT measurements. • Neither the change in CT attenuation of the lesion relative to normal bone nor the absolute value of this change was a significant predictor of malignancy. • 2-[ 18 F]FDG PET/CT may have clinical benefit and an additional role in directing bone biopsies.

PURPOSE: We aimed to evaluate whether tears of the posterior horn of the medial meniscus root ligament (PHMM RL) are associated with osteoarthritis of the far posterior femoral condyles (FPFC). METHODS: Retrospective review of 1158 patients who underwent arthroscopy identified 49 patients with confirmed tears of the medial meniscus posterior root ligament attachment. Preoperative magnetic resonance imaging (MRI) studies were reviewed to identify advanced osteoarthritis involving the medial and lateral FPFC. Control patients (n=48) had no meniscal tears confirmed by arthroscopy. Cases and controls were age- and sex-matched exactly 1:1. One case patient was excluded since there was no age- and sex-matched control available. The International Cartilage Research Society (ICRS) MRI cartilage grade was recorded for the medial and lateral FPFC. Associations were evaluated using univariate and multivariable conditional logistic regression analyses. RESULTS: There were 48 case and 48 control patients (10 men in each group, 20.8%) with median age 53 years (range, 21–67). Medial FPFC ICRS Grade 2 or higher lesions were present in 34 (70.8%) of case patients and 16 (33.3%) of control patients. Lateral FPFC ICRS Grade 2 or higher lesions were present in 24 (50%) of case patients and 14 (28.2%) of control patients. Increased body mass index (BMI) was associated with PHMM RL tears (OR=1.11, 95% CI [1.01, 1.22], P = 0.020). MRI was 81.2% (39/48) sensitive and 91.2% (44/48) specific for detection of PHMM RL tears. PHMM RL tears were associated with Grade 2 or higher medial FPFC osteoarthritis (OR=10.00, 95% CI (2.34, 42.78), P < 0.001). This association remained after adjusting for BMI (OR=11.79, 95% CI [2.46, 56.53], P = 0.002). There was also an association between PHMM RL tears and lateral FPFC osteoarthritis, which persisted after adjusting for BMI (OR =3.00, 95% CI [1.07, 8.37], P = 0.036). CONCLUSION: PHMM RL tears are associated with advanced osteoarthritis of the FPFC. Radiologists identifying FPFC osteoarthritis should look carefully for PHMM RL tears.

Osteoporosis and osteopenia are diagnosed most commonly by evaluating the lowest T‐score of BMD measurements, typically taken at three sites: the L1‐L4 lumbar spine, femoral neck, and total hip. This study aimed to evaluate the effect of using all three BMD measurements and multivariate statistical theory to evaluate how the diagnoses of osteoporosis and osteopenia change in simulation studies and in real data. First, it was found that the T‐scores from these three BMD measurements rarely give concordant diagnoses using the same World Health Organization (WHO) and International Society for Clinical Densitometry (ISCD) guidelines, so that the diagnosis strongly depends on the BMD sites measured. Next, strong correlations were found between the BMD measurements at different sites within the same person, which resulted in increased congruence/concordance between the diagnoses obtained from the BMD T‐scores. Multivariate statistical theory was used to show that the joint distribution of the BMD T‐scores at different sites follows a multivariate t distribution and found that the marginal distribution of any BMD T‐score follows a univariate t distribution. Confidence ellipsoids were derived that are equivalent to the univariate WHO/ISCD thresholds for osteoporosis (T‐score ≤−2.5) and osteopenia (−2.5

Introduction Bone lesions are sometimes detected on computed tomography studies, and biopsies are performed to evaluate whether these are malignant. The aim of the study is to evaluate whether chemical‐shift imaging (CSI) and diffusion‐weighted imaging (DWI) magnetic resonance imaging (MRI) are more informative than the CT attenuation for predicting malignancy. Methods Retrospective analysis of 86 patients who underwent both diagnostic CT, CSI MRI and DWI MRI within 6 weeks prior to bone biopsy at a tertiary care academic institution between 01/01/2010 and 03/01/2020. The CT attenuation, signal intensity on in‐phase sequences (SIIP), signal intensity on out‐of‐phase sequences (SIOP), signal intensity ratio (SIR = SIOP/SIIP) and the apparent diffusion coefficient (ADC) of the lesions over the region of the biopsy tract were measured. Results A threshold CT attenuation of 157 Hounsfield Units (HU) had a sensitivity of 47.7%, specificity of 83.3% and area under the curve (AUC) of 0.59. A threshold ADC of 793 × 10−6 mm2/s had a sensitivity of 75.8%, specificity of 85.7% and AUC of 0.83 to predict whether a bone biopsy would detect malignancy. A threshold SIR of 0.949 had a sensitivity of 77.8%, specificity of 77.8% and AUC of 0.81 to predict whether a bone biopsy would detect malignancy. ADC (P = 0.029) and SIR (P = 0.009) were significantly better than CT attenuation. There was no predictive difference between SIR and ADC (P = 0.742). Conclusions The CT attenuation of a lesion is a poor predictor of malignancy in bone lesions. CSI and DWI are significantly better for predicting malignancy., Diffusion‐weighted imaging (DWI) and Chemical‐shift imaging (CSI) from MRI are superior to CT attenuation for determining whether a bone lesion is malignant or benign. MRI may play a role in the evaluation of whether a bone lesion should be biopsied. Although CT attenuation may differ between benign and malignant sclerotic bone lesions, CT attenuation has limited ability to predict whether a bone lesion that is biopsied (suspicious for malignancy) is benign or malignant.

Remote Ischemic Preconditioning and Cardiac Arrhythmias. Introduction: The effect of remote ischemic preconditioning (RIPC) on arrhythmias in in vivo models is unknown. Our purpose was to determine effects of both acute and delayed RIPC on arrhythmias. Methods and Results: In the acute protocol anesthetized open chest rats were exposed to 5 minutes of proximal left coronary artery occlusion (CAO) and 10 minutes of reperfusion. Rats were either untreated (ischemia/reperfusion, IR group, n = 17) or received RIPC (n = 14) with 5 minutes bilateral femoral occlusions followed by 5 minutes of reperfusion times 3, started 30 minutes before CAO. At reperfusion, onset of ventricular tachycardia (VT) was delayed in RIPC group (25.7 seconds) versus IR (8.8 seconds; P = 0.04). Number of episodes of VT was 17.0 in IR versus 3.0 in the RIPC group (P = 0.01) and duration of VT was 54.1 seconds in IR versus 4.9 seconds in RIPC (P = 0.019). Number of ventricular premature complexes (VPC) was 26.0 in IR and 10.0 in RIPC rats (P = 0.04). Levels of reperfusion injury salvage kinases (RISK), that is, phospho-Akt and phospho-p70S6 in the risk area of IR and RIPC hearts were similarly higher compared to the nonischemic areas both at 1 and 10 minutes into reperfusion. Delayed RIPC was induced on day 1 and on day 2, myocardial IR was induced. Delayed RIPC did not affect VT or VPC. Conclusion: Acute RIPC of the lower limbs induced a powerful delay in/and reduction in IR induced ventricular arrhythmias, but without evoking the RISK pathway; a late protective phase of RIPC on arrhythmias did not occur. (J Cardiovasc Electrophysiol, Vol. 23, pp. 1374-1383, December 2012)

Objective(s): (1) To compare the effectiveness of customized exercises with that of standard exercises for the treatment of patients with shoulder disorders. (2) To determine whether four weeks or eight weeks would be needed to see improvement in outcome measures. Design: A single-blinded randomized clinical trial. Setting: An outpatient physical therapy clinic affiliated with an academic institution. Subjects: Thirty patients with shoulder disorders were tested and treated between February 2003 and December 2004. Interventions: Patients were randomized to a customized or standard exercise group. Each patient first underwent a standardized physical therapy assessment. Based on the results of the assessment, a classification was determined and a classification-specific exercise programme was instructed to the patients in the customized exercise group. The standard exercise group, regardless of classification, received preselected standard exercises. Both groups were followed for eight weeks. Main measures: Shoulder range of motion, strength, pain intensity and function were assessed three times (weeks 0, 4 and 8). Results: There were no significant differences between the customized and standard exercise groups in measures of shoulder range of motion, strength, pain intensity and function after four or eight weeks of exercise. Patients in both groups had significant improvements in shoulder strength, pain intensity and function. Significant improvements occurred at week 8, but not at week 4. Conclusion: The customized shoulder exercises did not provide additional benefit to our shoulder patients than the standard exercises.

The purposes of this study were to determine inter-tester reliability, one-week test-retest reliability and smallest detectable difference (SDD) of serratus anterior muscle strength and endurance tests. Asymptomatic subjects were tested on an apparatus designed by the investigators. During strength testing, subjects performed isometric contractions recorded by a hand-held dynamometer. For endurance testing, subjects held a dumbbell of 15% of their body weight and performed repetitions until they became fatigued. Intraclass correlation coefficients (ICC) for the strength test revealed good inter-tester reliability (ICC2,3 = .90-.93) and good one-week test-retest reliability (ICC2,3 = .83-.89). For the endurance test, ICCs showed good inter-tester reliability (ICC2,1 = .71-.76) but moderate one-week test-retest reliability (ICC2,1 = .59-.62). The SDDs at 68% confidence level ranged from 22.7 to 39.2 newtons for the strength test, and 11 to 20 repetitions for the endurance test. In summary, the technique used in the study is reliable for quantifying the SA muscle strength.

Muscle tightness is often considered to be a predisposing factor in muscle injuries. The purpose of this study was to assess the muscle flexibility of the hamstrings, rectus femoris, iliopsoas, gastrocnemius, and soleus muscles in long distance runners. Range of motion measurements of five movements, including hip flexion with knee extended, hip extension with knee flexed, hip extension with knee extended, ankle dorsiflexion with knee extended, and ankle dorsiflexion with knee flexed, were evaluated to determine muscle tightness. Twenty runners and 20 nonrunners volunteered for the study. Each group consisted of 10 males and 10 females. The observed means were compared between runners and nonrunners, males and females, plus the dominant and nondominant leg using a three-way analysis of variance. The runners were found to have tighter hamstrings (p < .05), and soleus (p < .05) muscles than nonrunners. There was no significant difference in rectus femoris and iliopsoas muscle tightness in runners compared with nonrunners. In addition, the males had tighter hamstring muscles than the females in both runners and nonrunners (p < .05). The hamstring muscles of the dominant leg were tighter than the hamstrings of the nondominant leg in all subjects (p < .05). In conclusion, long distance runners appear to have posterior muscle tightness in the lower extremity.

Bowen's disease (BD), or cutaneous squamous cell carcinoma (SCC) in situ, is rare in children. BD usually occurs in Caucasian adults on sun-exposed areas and may progress to invasive cutaneous SCC. Most cases of periungual BD have been linked to human papillomavirus infection. We report an immunocompetent child with periungual BD.

The excretion levels of urinary amino acids obtained from acid hydrolysates were studied by gas chromatographic analysis in 29 normal individuals and 118 patients with bladder carcinoma. Leucine and isoleucine excretion were elevated in patients with bladder carcinoma as compared with normal subjects under the same experimental condition. Mathematical computer-assisted programs developed to aid in determining clusters of amino acid variables suggested that excretion of glycine, leucine, proline, and glutamic acid in men and concentrations of valine, serine, aspartic acid, phenylalanine, and lysine in women vary according to the invasiveness of the disease. These findings suggest that measurements of urinary amino acids may provide a useful parameter for the detection and aid in the staging of bladder carcinoma.

Summary 1.Following intravenous injection of Bromsulfalein in man, 45 to 60 per cent of dye is recovered from the urine and stool. Following its oral administration, 25 to 35 per cent of dye is recovered. Recovery is significantly reduced if stool output is delayed. 2.When Bromsulfalein is incubated with stool suspensions, dye destruction occurs at about the same rate as in the intestinal tract. 3.The bacteria of the stool from patients with acute and chronic hepatitis destroy B SP at a normal rate. The intestinal bacteria from three patients with portal cirrhosis, however, appear unable to do so in trypticase soy broth. 4.Incubation of BSP with individual intestinal organisms reveals that the diphtheroids and B. subt' 's are responsible for the major part of the destruction of dye.

A study of hematopoiesis in Sabra mice was carried out soon after hydroxyurea (HU) administration. Three hours after administration of a single intra-peritoneal injection of HU (1000 mg/kg), 50% of the nucleated bone marrow cells per femur were killed. HU-treated bone marrow was inoculated into peritoneal DC in non-irradiated mice. In additional experiments in which the double diffusion chamber (DDC) technique was used, HU-treated bone marrow was inoculated into the regulator compartment (RC) and normal bone marrow into the test compartment (TC). The DDC were implanted in irradiated hosts and cultured for 7 days. In control experiments, normal bone marrow was inoculated into both RC and TC. The results obtained with DC and DDC demonstrate the presence of stimulating factors of diffusion chamber progenitor cells (DCPC) in the bone marrow of mice 3 h following HU administration. The occurrence of a stimulating factor(s) of granulopoiesis was manifested by (1) a higher granulocyte/macrophage (G/M) ratio in single DC containing HU-treated bone marrow than in control cultures and (2) a higher G/M ratio in both compartments of the DDC in experimental groups than in controls. The stimulating factor of granulopoiesis present in HU-treated bone marrow crossed the Millipore filter (0.2 μm pore size) separating the compartments of the DDC as manifested by a high G/M ratio in both RC and TC.

SummaryIn dogs and rats with complete biliary obstruction, the retention of BSP in the serum wras of much shorter duration than that previously observed in man. Conclusions concerning mechanisms of BSP removal in man based on observations made in the dog must be questioned in the light of these data.