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The advantage of the high passive cooling effect of traditional extensive green roofs during daytime is always offset against their disadvantage of the high thermal insulation effect during nighttime in summer in subtropical regions. The purpose of this study was to develop types of green roofs that can not only improve the passive cooling effect of extensive green roofs during daytime but also mitigate the thermal insulation effect of extensive green roofs during nighttime in summer in humid subtropical regions to reduce the cooling energy load over 24 h compared with that of traditional extensive roofs. The following factors were considered to obtain such an ideal extensive green roof—the depth of growth medium, the proportion and placement of lightweight expanded clay aggregate (LECA), and the presence and absence of a non-CAM edible plant. The results indicated that, compared with the 0% LECA (traditional garden soil) roof without plants in the second stage and under a slightly different air temperature (0.26 °C during daytime and 0.57 °C during nighttime), the introduction of Ipomoea batatas and 10%–40% LECA can significantly increase the passive cooling effect by approximately 1.5 times (5.51–6.21 °C) during daytime and significantly mitigate the thermal insulation effect by approximately half (2.05–3.20 °C) during nighttime. In summary, the introduction of Ipomoea batatas (non-CAM edible plant) and LECA into the traditional extensive roofs can effectively reverse the higher-cooling-and-stronger-warming effects to higher-cooling-and-weaker-warming effects.

Background Neurenteric cyst (NEC) is a rare intradural spinal tumor, but a correct preoperative diagnosis remains challenging. A misdiagnosis of arachnoid cyst (AC) often leads to conflicting surgical management and significantly higher recurrence. Case Description We report the case of a 26-year-old woman who presented with progressive spastic quadriparesis with myelopathy below the C4 level, which was caused by a ventral intradural extramedullary cystic tumor at the C3-4 level. Magnetic resonance images showed the cystic content as identical to cerebrospinal fluid, which prompted the tentative diagnosis of spinal AC. Surgical fenestration was scheduled. However, intraoperative findings of a thick-walled cyst and severe adhesion to the neural structure without a history of trauma and inflammation were more compatible with the pathogenesis of an NEC. Because of the high recurrence rate after an incomplete resection of an NEC, we did a complete resection of the cyst with adhesive rootlets instead. Pathology analysis and immunohistochemical staining confirmed the diagnosis of an endodermal-derived NEC. Conclusions NECs must be differentiated from ACs because they are different diseases and require different surgical management. In cases with clear cystic content, however, the diagnosis is likely to be AC, but a thick cystic wall and structural adhesions should suggest the differential diagnosis of NEC. Gross total removal of NECs should be attempted to reduce NEC recurrence.

We compared the accuracy of the fluoroscopic dorsal tangential view (DTV) and an ultrasound (US) examination in detecting dorsal screw penetration during volar distal radius plating. In six fresh cadaveric distal radii, seven periarticular locking screws in two rows for each plate were inserted according to the measured length using a depth gauge and then replaced with another that was 1 and 2 mm longer, respectively. The actual protruded length of each screw was determined using computed tomography (CT) images. The accuracy of US and DTV measurements was determined using the intraclass correlation coefficient (ICC), as both measurements were compared with CT measurements. The ICC of US and DTV was 0.96 and 0.75, respectively, for all screws. After excluding the data for proximal-row screws, the ICC of US remained unchanged at 0.96, and that of DTV improved to 0.86. The ICC of US was significantly higher than that of DTV (p 0.01). US had a 100% detection rate for screw protrusion of more than 1.0 mm. US examination showed excellent consistency with CT measurements and its accuracy was not affected by screw location. US might thus be a practical tool for detecting dorsal cortex screw penetration during volar distal radius plating.

OBJECTIVES This study aimed to evaluate the feasibility of automatic Stanford classification of classic aortic dissection (AD) using a 2-step hierarchical neural network. METHODS Between 2015 and 2019, 130 arterial phase series (57 type A, 43 type B, and 30 negative cases) in aortic CTA were collected for the training and validation. A 2-step hierarchical model was built including the first step detecting AD and the second step predicting the probability (0-1) of Stanford types. The model's performance was evaluated with an off-line prospective test in 2020. The sensitivity and specificity for Stanford type A, type B, and no AD (Sens A, B, N and Spec A, B, N, respectively) and Cohen's kappa were reported. RESULTS Of 298 cases (22 with type A, 29 with type B, and 247 without AD) in the off-line prospective test, the Sens A, Sens B, and Sens N were 95.45% (95% confidence interval [CI], 77.16-99.88%), 79.31% (95% CI, 60.28-92.01%), and 93.52% (95% CI, 89.69-96.25%), respectively. The Spec A, Spec B, and Spec N were 98.55% (95% CI, 96.33-99.60%), 94.05% (95% CI, 90.52-96.56%), and 94.12% (95% CI, 83.76-98.77%), respectively. The classification rate achieved 92.28% (95% CI, 88.64-95.04%). The Cohen's kappa was 0.766 (95% CI, 0.68-0.85; p

An aortic dissection has been reported a mortality of 50% within the first 48 hours and an increase of 1-2% per hour. Therefore, rapid diagnosis of intimal flap would be very important for the emergency treatment of patients. In order to accurately present the affected part of AD and reduce the time for doctors to diagnose, image segmentation is the most effective way of presentation. We used the U-Net model in this study and focus on AD (including ascending, arch, and descending part) in the detection process. Furthermore, we design the site and area regression (SAR) module. With this help of accurate prediction, we achieved slice-level sensitivity and specificity of 99.1 % and 93.2%, respectively.

The aim of the study was to use a previously proposed mask region–based convolutional neural network (Mask R-CNN) for automatic abnormal liver density detection and segmentation based on hepatocellular carcinoma (HCC) computed tomography (CT) datasets from a radiological perspective. Training and testing datasets were acquired retrospectively from two hospitals of Taiwan. The training dataset contained 10,130 images of liver tumor densities of 11,258 regions of interest (ROIs). The positive testing dataset contained 1,833 images of liver tumor densities with 1,874 ROIs, and negative testing data comprised 20,283 images without abnormal densities in liver parenchyma. The Mask R-CNN was used to generate a medical model, and areas under the curve, true positive rates, false positive rates, and Dice coefficients were evaluated. For abnormal liver CT density detection, in each image, we identified the mean area under the curve, true positive rate, and false positive rate, which were 0.9490, 91.99%, and 13.68%, respectively. For segmentation ability, the highest mean Dice coefficient obtained was 0.8041. This study trained a Mask R-CNN on various HCC images to construct a medical model that serves as an auxiliary tool for alerting radiologists to abnormal CT density in liver scans; this model can simultaneously detect liver lesions and perform automatic instance segmentation.

Prospective electrocardiography (ECG)-gated cardiac computed tomography angiography (CTA) is widely used for pediatric patients with congenital heart disease (CHD) due to the lower radiation dose compared with the ECG-gated technique. However, functional parameters acquired using ECG-gated cardiac CT to predict pulmonary hypertension (PH) in children with CHD have not yet been reported. This study aimed to investigate the potential of diastolic and systolic right ventricular diameters (RVD) on prospective ECG-gated cardiac CTA to predict PH in children with CHD. A total of 44 children with CHD were divided into two groups: CHD with PH (n = 22) and CHD without PH (n = 22). The association between ECG-gated CTA parameters and PH was evaluated by logistic regression. The receiver operating characteristic curve (ROC) was used to find the best cut-off point for the parameters measured by Youden's index. Patients with higher RVD-BSA [aOR (95% CI) diastolic: 2.76 (1.23–6.23); systolic: 6.15 (1.72–22.06)] had higher risk of PH after adjusting for age and patent ductus arteriosus. The area under the curve (AUC) of D-RVD-BSA was 0.907 and the AUC of S-RVD-BSA was 0.917. Logistic regression showed that patients with D-RVD-BSA over 6.86 or S-RVD-BSA over 5.87 had significantly higher risk of PH after adjustments (aOR = 23.52, 95% CI = 2.89–191.03; aOR = 31.14, 95% CI = 2.75–352.85). In conclusion, in children with CHD, measurements of diastolic or systolic BSA-modified RVDs on prospective ECG-gated CTA are non-invasive markers of PH. BSA-modified D-RVD of 6.86 or BSA-modified S-RVD of 5.87 may be used to identify PH in children with CHD.

A simple and rapid method for direct quantitation of drugs in human urine samples was developed using a system composed of an automatic column switch and two home-made capillary immunoaffinity columns (CIACs, 100 μm × 15 cm). Before being injected by an autosampler into the system, the urine sample was filtered through a 0.22 μm membrane. The alternating column regeneration was achieved by using two identical CIACs. One column underwent analyte elution while the other column underwent column regeneration simultaneously. 6-Acetylmorphine (6AM) and oxycodone (OCOD) were studied as examples of opiates in urine. Linear calibration curves were obtained in the concentration ranges of 40–200 ng mL−1 and 50–400 ng mL−1, with a limit of quantitation of 22 ng mL−1 and 47 ng mL−1 for 6AM and OCOD, respectively. The results of this method exhibited good inter-day accuracy and precision. Furthermore, the present method was successfully applied to the determination of 6AM in urine samples of drug abusers.

Few studies have described extents of subluxation, applied stresses, and assessing postures during trapeziometacarpal stress-view radiography, which probably has led to unsatisfactory reliability of the Eaton classification for determining arthritis. To address this problem, this study examined the effects of applied forces and thumb position on levels of trapeziometacarpal subluxation during stress-view radiography. Thirty-two volunteers allowed our team to quantify their trapeziometacarpal subluxation ratio (TSR) via fluoroscopic images while stress was applied to their thumbs under 3 different positions (Stress_IP, Stress_MP, and Stress_KP). The results were recorded synchronously using a force transducer embedded in a custom stress-view evaluation system (SvES). The differences in TSR under different stress levels and thumb positions and the relationships between TSRs and applied stresses on the joint were analyzed. The findings show acceptable reliability and validity with use of the SvES for trapeziometacarpal stress-view tests. There were significant correlations between applied stresses and TSRs (r = 0.8 − 0.989, P

Although dual EGFR/HER2 tyrosine kinase inhibitor lapatinib has provided effective clinical benefits for HER2-positive breast cancer patients, acquired resistance to this drug remains a major concern. Thus, the development of alternative therapeutic strategies is urgently needed for patients who failed lapatinib treatment. Proteasome inhibitors have been reported to possess high anti-tumor activity to breast cancer cells. Therefore, this study aims to examine whether and how proteasome inhibitor bortezomib can overcome lapatinib resistance. Treatments with several proteasome inhibitors, including Bortezomib, MG132, and proteasome inhibitor I (PSI), as well as the viabilities of both HER2-positive breast cancer cell lines and their lapatinib-resistant clones, were inhibited. Importantly, the expressions of ErbB family were downregulated at both transcriptional and translational levels. Also, our results further indicated that proteasome inhibitors decreased ErbB family expression through lysosomal degradation pathway in a heat shock protein 90 (HSP90)-dependent manner. In this study, our data supported a potential approach to overcome the acquired resistance of HER2-overexpressing breast cancer patients to lapatinib using proteasome inhibitors.

Background/Aims: The purpose of this study is to report our results using a computed tomography (CT)-guided fat transversing coaxial biopsy technique for pancreatic lesion biopsy that avoids major organs and vessels. We retrospectively reviewed the records of patients referred to our department for pancreatic mass biopsy. Patients and Methods: The records of patients (from June 2008 to August 2014) in whom biopsy was performed under CT guidance with a coaxial needle using a fat transversing technique were reviewed. Patient demographic data and biopsy outcomes were collected. We aimed to compare differences between lesion size and biopsy outcome, the independent two-samples t-test was used. Results: A total of 122 patients who underwent 17-G coaxial needle biopsy were included. The mean pancreatic lesion size was 3.2 cm, and in 30 patients it was more than 4 cm. The majority of lesions were located in the head of the pancreas (44.3%). No transorgan biopsies were performed. In most patients, the biopsy was performed via a fat traversing detour route (93.4%), and a successful diagnosis was made based on the biopsy outcome in 96.7% patients. Complications occurred in five patients (4.1%); three of the patients developed a fever, and two developed pancreatitis. All patients recovered with symptomatic treatment. Conclusion: CT-guided coaxial core biopsy of pancreatic lesions using a fat detour route appears to be a safe and effective method for obtaining pancreatic lesion biopsies with a high success rate and low complication rate.

BACKGROUND Kinesio tape (KT) is an elastic therapeutic tape used for treating sports-related injuries and a number of other disorders. To date, the objective evidence to link pathophysiological effects and actual reactions triggered by KT is limited. PURPOSE To explore the effect of KT on the lumbar paraspinal muscles by magnetic resonance (MR) elastography. STUDY TYPE Prospective observational study. POPULATION Sixty-six asymptomatic volunteers with 31 women and 35 men. FIELD STRENGTH/SEQUENCE 3.0T MRI and elastography with vibration frequency of 120 Hz. ASSESSMENT The 5-cm-width KT with full tension was placed on a single side of the lumbar paraspinal muscle. The taping side and adhering direction were randomly decided. Two rectangular regions of interest (ROIs) of 5- and 2.5-cm-width were positioned at the bilateral paraspinal regions from the L2 to L4 level on the confidence map of MR elastography before and after KT taping. The mean shear stiffness values of the ROIs at the superficial, middle, and deep depths were recorded; then the differences between the taping and reference sides were calculated. STATISTICAL TESTS Paired t-test and Pearson correlations were used to evaluate the stiffness changes after KT application and intraoperator errors of the stiffness measures on the reference side, respectively. RESULTS A significant decrease in the muscle stiffness value between taping and reference sides (-0.71 kPa ± 0.60 with KT and -0.25 kPa ± 0.78 without KT, P

Ponticulus posticus (PP) is the bony bridge that can completely or partially embrace the vertebral artery and the suboccipital nerve root at the atlas posterior arch. The PP can be a possible cause of vertigo, vertebrobasilar insufficiency, neck pain, shoulder pain, and cervicogenic headache. Moreover, the vertebral artery injury may happen during atlas lateral mass screw insertion in the presence of PP.The purpose of this study was to determine the prevalence of PP in a population of patients undergoing dental cone-beam computed tomography (CBCT) and the association between PP and atlas superior articular facet (SAF).This is a retrospective study.Five hundred consecutive patients who had undergone dental CBCT scans were included.Outcome measures were age, sex, and radiologic measures.The maximum anteroposterior and transverse dimensions of atlas SAF were measured on the axial image, and then the area was calculated by using the formula for an elliptical area. The left-right differential ratios of the SAF in patients with unilateral PP were compared with those in age- and gender-matched patients without PP. The relationships among imaging findings, age, and sex were assessed with the two-tailed paired t test, χ(2) test, and logistic regression model, as appropriate.The overall prevalence of PP was 7% (35 of 500 patients). There were no significant differences in the prevalence of PP with gender and age. The anteroposterior dimension, transverse dimension, and area of atlas SAF on the PP side were significantly larger than those on the non-PP side in the 18 unilateral complete PP patients (p.001, p.001, and p.001, respectively) and in the 11 unilateral partial PP patients (p=.001, p=.007, and p.001, respectively). The SAF area differential ratios in patients with unilateral PP were greater than those in the patients without PP (29.8% vs. 2.9%, p=.002 for 18 complete lesions, and 23.5% vs. 1.8%, p.001 for 11 partial lesions).The prevalence of PP and the measurement of SAF can be assessed by CBCT. The imaging findings show the larger SAF on the PP side and greater left-right difference of SAF area in the patients with unilateral PP.

Summary Background Addition of nitroglycerine (NTG) to transcatheter arterial embolization/transarterial chemoembolization (TAE/TACE) has been shown to increase deposition of Lipiodol emulsion in hepatocellular carcinoma (HCC) tumors. The aim of this retrospective study was to evaluate if the addition of nitroglycerin (NTG) to TAE/TACE improved treatment response in HCC. Methods Patients with HCC either received (n = 42) or did not receive (non-NTG) (n = 111) NTG and an emulsion of Lipiodol with or without doxorubicin, followed by embolization with Gelfoam pledgets. Treatment response was monitored using dual-energy computer tomography (CT). Disease progression and overall survival (OS) were monitored. Results The rate of disease progression in the NTG group was 86.5% and in the non-NTG group was 88.6%. Median time to disease progression was 12 months (95% CI; 9.0, 15.0) for the NTG group and 12 months (95% CI; 10.4, 13.6) for the non-NTG groups (P = 0.040). No difference was observed in OS between the NTG (60 months) and the non-NTG groups (41 months) (P = 0.117). Multivariate analysis found that in the NTG group, OS was associated with Cancer of the Liver Italian Program (CLIP) stage I and Barcelona Clinic Liver Cancer (BCLC) stage B. Conclusions Addition of NTG to TAE/TACE did not result in improved OS or disease progression.

Background The investigation of the joint arthrokinematics of the trapeziometacarpal joint is critical to comprehend the causative mechanism underlying this common form of osteoarthritis. Therefore, the purpose of this study is to evaluate the arthrokinematics of the trapeziometacarpal joint during thumb postures in vivo. Methods Fifteen healthy participants were enrolled in this study. Static computed tomography images of the 1st metacarpal bone and trapezium were taken at specific thumb postures during thumb flexion–extension, abduction–adduction, and circumduction motions. Images were analyzed to examine the joint gliding, expressed as displacement of the centroid of the articular surface of the 1st metacarpal bone, relative to the trapezium. The gliding ratio, defined as joint gliding in each direction normalized to the dimension of the trapezium joint surface in the given direction, was computed and compared between different thumb motions. Findings The results indicate that thumb motions influenced joint gliding. The centroids of the articular surface of the 1st metacarpal bone were primarily located at the central and dorsal–radial regions while executing these motions. The maximum joint gliding of the 1st metacarpal bone occurred in the radial–ulnar direction when performing abduction–adduction, and in the dorsal–volar direction while performing flexion–extension and circumduction, with the gliding ratio values of 42.35%, 51.65%, and 51.85%, respectively. Interpretation Activities that involved abduction–adduction in the trapeziometacarpal joint caused greater joint gliding in the ulnar–radial direction, while flexion–extension resulted in greater joint gliding in the dorsal–volar and distal–proximal directions. Understanding normal joint kinematics in vivo may provide insights into the possible mechanism leading to osteoarthritis of the trapeziometacarpal joint, and help to improve the design of implants.

Patients with developmental dysplasia of the hip (DDH) generally undergo multiple x-ray examinations of both hip joints. During these examinations, the gonads are completely exposed to radiation, unless shielded. Although many types and sizes of gonad shields exist, they often do not provide adequate protection because of size and placement issues; additionally, these shields are frequently omitted for female patients. Our aim was to assess gonad protection during x-ray examination that is provided by gonad shields designed for individual female patients with DDH.We retrospectively retrieved data from the Picture Archiving and Communication System database; pelvic plain x-ray films from 766 females, 18 years old or younger, were included in our analysis. Based on x-ray measurements of the anterior superior iliac spine, we developed a system of gonad shield design that depended on the distance between anterior superior iliac spine markers. We custom-made shields and then examined shielding rates and shielding accuracy before and after these new shields became available. Standard (general-purpose) shields were used before our custom design project was implemented. The shielding rate and shielding accuracy were, respectively, 14.5% and 8.4% before the project was implemented and 72.7% and 32.2% after it was implemented. A shield that is more anatomically correct and available in several different sizes may increase the likelihood of gonad protection during pelvic x-ray examinations.

Comprehending knee motion is an essential requirement for studying the causes of knee disorders. In this paper, we propose a new 2-D-3-D registration system based on joint-constraint model for reconstructing total knee motion. The proposed model that contains bone geometries and an articulated joint mechanism is first constructed from multipostural magnetic resonance volumetric images. Then, the bone segments of the model are hierarchically registered to each frame of the given single-plane fluoroscopic video that records the knee activity. The bone posture is iteratively optimized using a modified chamfer matching algorithm to yield the simulated radiograph which is the best fit to the underlying fluoroscopic image. Unlike conventional registration methods computing posture parameters for each bone independently, the proposed femorotibial and patellofemoral joint models properly maintain the articulations between femur, tibia, and patella during the registration processes. As a result, we can obtain a sequence of registered knee postures showing smooth and reasonable physiologic patterns of motion. The proposed system also provides joint-space interpolation to densely generate intermediate postures for motion animation. The effectiveness of the proposed method was validated by computer simulation, animal cadaver, and in vivo knee testing. The mean target registration errors for femur, tibia, and patella were less than 1.5 mm. In particular, small out-of-plane registration errors [less than 1 mm (translation) and 2° (rotation)] were achieved in animal cadaver assessments.

To assess the use of the dual-energy computed tomographic (CT) virtual noncalcium technique in the evaluation of bone marrow edema in vertebral compression fractures.This prospective study was approved by the institutional review board; informed consent was obtained from all patients. Sixty-three consecutive patients with 112 thoracic and/or lumbar vertebral compression fractures were studied between January 2011 and April 2012. All patients underwent both dual-energy CT (100 kV and Sn140 kV, where Sn indicates the use of a 0.4-mm tin filter) and magnetic resonance (MR) imaging. Dual-energy CT data were postprocessed by using a three-material decomposition algorithm for generating noncalcium images of the collapsed bodies. Two radiologists evaluated for the presence of abnormal attenuation alterations in the bone marrow by using color-coded maps and measured CT numbers on noncalcium grayscale images. Bone sclerosis and intravertebral air were evaluated with CT scans. MR images served as the reference standard. CT numbers were subjected to receiver operating characteristic curve analysis.MR imaging depicted 46 edematous and 66 nonedematous vertebral compression fractures. Eighty-two bodies were classified as having less than 50% sclerosis and/or air. Significant differences in noncalcium CT numbers between edematous and nonedematous vertebral compression fractures were found for both readers (P.0001). CT numbers for the diagnosis of bone marrow edema on the basis of MR imaging revealed areas under the receiver operating characteristic curve of 0.799 and 0.841 for readers 1 and 2, respectively (P = .56). Use of a cutoff value of -80 to differentiate edematous vertebral bodies resulted in a sensitivity of 96.3%, specificity of 98.2%, and accuracy of 97.6% in the group of vertebral bodies with less than 50% sclerosis and/or air.Dual-energy CT virtual noncalcium images were able to depict bone marrow in the collapsed vertebral bodies, especially in those with less than 50% sclerosis and/or air.

Objectives The aim of this study was to retrospectively compare the frequency, distribution, and radiographic features of osteosclerosis of the jaws between Taiwanese and American cohorts using cone-beam computed tomography.

In vivo 1 H MRS is a noninvasive imaging technique for the identification of malignancy. Musculoskeletal lesions vary in their composition, causing field inhomogeneity and magnetic susceptibility effects which may be technical and diagnostic challenges for MRS. This study investigated the factors that affect diagnostic accuracy in the use of MRS for the characterization of musculoskeletal neoplasms. During a 7-year period, 210 consecutive patients with musculoskeletal lesions larger than 1.5cm in diameter were examined. MRS of a single-voxel point-resolved spectroscopy sequence with TE=135ms was undertaken using a 1.5-T scanner. Lesions with a choline signal-to-noise ratio larger than 3.0 were considered to be malignant tumors. The diagnostic accuracy was calculated for all lesions and for subgroups on the basis of lesion type (bone and soft tissue), lesion composition (mixed and solid nonsclerotic), lesion size (≤4, >4–10 and >10cm), MR scanner (MR scanner 1 and 2) and selected voxel size (≤3, >3– 8a nd>8cm 3 ). Multivariate logistic regressions were performed to estimate the associations between each factor and diagnostic accuracy. The diagnostic accuracy was 73.3% for all lesions. The accuracy was 54.4% for mixed lesions and 80.4% for solid nonsclerotic lesions (p 4–10cm (p=0.04) and 63.6% for lesions of >10cm (p=0.007)]. There was no difference in diagnostic accuracy for bone versus soft-tissue lesions or as a function of MR scanner or voxel size. By the use of multivariate logistic regression, a solid nonsclerotic lesion was 3.15 times (95% confidence interval, 1.59–6.27) more likely than a mixed lesion to have a diagnosis (p=0.001). MRS can be used to characterize musculoskeletal lesions, particularly solid nonsclerotic lesions. Copyright # 2011 John Wiley & Sons, Ltd.

The Insall-Salvati ratio (ISR) is important for detecting two common clinical signs of knee disease: patella alta and patella baja. Furthermore, large inter-operator differences in ISR measurement make an objective measurement system necessary for better clinical evaluation. In this paper, we define three specific bony landmarks for determining the ISR and then propose an x-ray image analysis system to localize these landmarks and measure the ISR. Due to inherent artifacts in x-ray images, such as unevenly distributed intensities, which make landmark localization difficult, we hence propose a registration-assisted active-shape model (RAASM) to localize these landmarks. We first construct a statistical model from a set of training images based on x-ray image intensity and patella shape. Since a knee x-ray image contains specific anatomical structures, we then design an algorithm, based on edge tracing, for patella feature extraction in order to automatically align the model to the patella image. We can estimate the landmark locations as well as the ISR after registration-assisted model fitting. Our proposed method successfully overcomes drawbacks caused by x-ray image artifacts. Experimental results show great agreement between the ISRs measured by the proposed method and by orthopedic clinicians.

Purpose: The quantitative measurements of hand bones, including volume, surface, orientation, and position are essential in investigating hand kinematics. Moreover, within the measurement stage, bone segmentation is the most important step due to its certain influences on measuring accuracy. Since hand bones are small and tubular in shape, magnetic resonance(MR)imaging is prone to artifacts such as nonuniform intensity and fuzzy boundaries. Thus, greater detail is required for improving segmentation accuracy. The authors then propose using a novel registration-based method on an articulated hand model to segment hand bones from multipostural MRimages. Methods: The proposed method consists of the model construction and registration-based segmentation stages. Given a reference postural image, the first stage requires construction of a drivable reference model characterized by hand bone shapes, intensity patterns, and articulated joint mechanism. By applying the reference model to the second stage, the authors initially design a model-based registration pursuant to intensity distribution similarity, MR bone intensity properties, and constraints of model geometry to align the reference model to target bone regions of the given postural image. The authors then refine the resulting surface to improve the superimposition between the registered reference model and target bone boundaries. Results: For each subject, given a reference postural image, the proposed method can automatically segment all hand bones from all other postural images. Compared to the ground truth from two experts, the resulting surface image had an average margin of error within 1 mm (mm) only. In addition, the proposed method showed good agreement on the overlap of bone segmentations by dice similarity coefficient and also demonstrated better segmentation results than conventional methods. Conclusions: The proposed registration-based segmentation method can successfully overcome drawbacks caused by inherent artifacts in MRimages and obtain more accurate segmentation results automatically. Moreover, realistic hand motion animations can be generated based on the bone segmentation results. The proposed method is found helpful for understanding hand bone geometries in dynamic postures that can be used in simulating 3D hand motion through multipostural MRimages.

Solanum lyratum Thunberg (Solanaceae) has been used as a folk medicine for treating liver, lung and esophagus in the Chinese population. Our previous studies have shown that the crude extract of S. lyratum Thunberg (SLE) induced apoptosis in colo 205 human colon adenocarcinoma cells; however, there is no report to show SLE affect immune responses in vivo. In this study, the in vivo effects of SLE on leukemia WEHI-3 cells and immune responses such as phagocytosis and natural killer (NK) cell activity in normal and leukemia mice were investigated. The SLE treatment decreases surface markers of CD3 and Mac-3 in normal and leukemia mice but promoted the cell markers of CD19 and CD11b in normal mice and CD11b in leukemia mice indicating that the precursors of T cells was inhibited and B cells and macrophage were promoted. The SLE treatment promoted the activity of macrophage phagocytosis in the peripheral blood mononuclear cells (PBMC) and peritoneal cells from normal and leukemia mice. The results also showed that NK cells from the normal and leukemia mice after treatment with SLE can kill the YAC-1 target cells. Therefore, the SLE treatment increased macrophage and NK cell activities. These consistent results indicate SLE could be a potent immune responses agent.

Kaposiform haemangioendothelioma is a rare soft-tissue tumour of infants and children, and presents as a moderately aggressive malignancy. We present the MRI findings of a histologically proven case of Kaposiform haemangioendothelioma without Kasabach-Merritt phenomenon or typical skin changes. Our case also reveals that the multiple foci of the cutaneous tumour have different MRI morphologies. These findings have not been reported in the literature to date.

PURPOSE: To investigate the value of in vivo proton (H) magnetic resonance spectroscopy (MRS) in longitudinally monitoring the treatment response of malignant musculoskeletal tumors under chemotherapy. MATERIALS AND METHODS: Twenty-three studies in 3 patients with bone and soft-tissue tumors (2 lymphomas and 1 alveolar soft part sarcoma) were included in the study. The dynamic contrast-enhanced magnetic resonance (MR) imaging and single-voxel proton MRS with 135 milliseconds of echo time were carried out using a whole-body 1.5-T scanner and a surface coil. The volume of interest within the lesion was positioned on the area of early enhancement according to the finding of the first dynamic contrast-enhanced MR imaging with subtraction. The choline and water intensities were measured at the peak areas at 3.2 and 4.5 ppm. The choline-water ratios were calculated as well. Statistical analysis was performed by using Kruskal-Wallis 1-way analysis of variance test ().(Table is included in full-text article.) RESULTS: The changes observed on the dynamic contrast-enhanced MR images and tumor size after chemotherapy fell into 2 clearly distinct patterns: subsequent partial response (patients 1 and 2) and progressive disease (patient 3). The choline concentration, choline-volume ratio, and choline-water ratio in the first 2 patients were reduced substantially to zero in the follow-up MRS. In the remaining patient, the choline, choline-volume ratio, and choline-water ratio remained high in the follow-up MRS. The water concentration and water-volume ratio between the 3 patients showed significant statistical differences (Kruskal-Wallis test, P = 0.004 and 0.039). CONCLUSION: In vivo proton MRS is technically feasible for the evaluation of musculoskeletal tumors. Choline can be detected in malignant bone and soft-tissue tumors, and the early metabolite changes after chemotherapy can also be identified in the in vivo proton MRS by using a standard clinical-use 1.5-T MR scanner and a surface coil. The decline of choline after treatment in malignant bone and soft-tissue tumors correlates with the response of the dynamic contrast MR images and the tumor size. The information provided with MR imaging and proton MRS may improve the diagnostic specificity of MR examination in the follow-up of tumor treatment.