Hypoalbuminemia and Osteoporosis: Reappraisal of a Controversy.

CONTEXT: Human studies have reported conflicting results on the association of hypoalbuminemia with osteoporosis. OBJECTIVE: The aim of the study is to test the independent association between hypoalbuminemia and osteoporosis. DESIGN: This is a cross-sectional observation. SETTING AND PARTICIPANTS: Patients are the outpatient consecutive individuals with available clinical, laboratory, and densitometry data from 2001 to 2013 in our tertiary care academic medical center. EXPOSURE: Exposure is hypoalbuminemia defined as serum albumin less than 3.5 g/dL. MAIN OUTCOME MEASURE: Osteoporosis is defined as bone mineral density of 2.5 SD or less below the mean peak bone mass of young, healthy adults. RESULTS: Overall, 21 121 patients were included. Mean of age was 61 years (SD 14). There were 4244 males (20.1%) and 1614 patients of African-American ethnicity (7.6%). There was a graded decrease in rate of osteoporosis from 28.0% (n = 33) at albumin of 3 g/dL or less to 9.3% (n = 1548) at albumin greater than 4 g/dL (P < .001) at the femoral neck and from 20.3% (n = 24) to 6.1% (n = 1011) at the total hip (P < .001). In a fully adjusted model, the odds of osteoporosis at albumin of 3 g/dL or less was 3.31-fold (95% confidence interval [CI] 2.08-5.28, P < .001) at the femoral neck, 2.98-fold (95% CI 1.76-5.01, P < .001) at the total hip, and 2.18-fold (95% CI 1.43-3.31, P < .001) at the lumbar spine as compared with albumin greater than 4 mg/dL. A similar independent association was identified with a longer-observed duration of hypoalbuminemia. CONCLUSION: In a large population, we report an independent association of osteoporosis with lower levels of serum albumin and a longer-observed duration of hypoalbuminemia.

Friction in total hip joint prosthesis measured in vivo during walking.

Friction-induced moments and subsequent cup loosening can be the reason for total hip joint replacement failure. The aim of this study was to measure the in vivo contact forces and friction moments during walking. Instrumented hip implants with Al2O3 ceramic head and an XPE inlay were used. In vivo measurements were taken 3 months post operatively in 8 subjects. The coefficient of friction was calculated in 3D throughout the whole gait cycle, and average values of the friction-induced power dissipation in the joint were determined. On average, peak contact forces of 248% of the bodyweight and peak friction moments of 0.26% bodyweight times meter were determined. However, contact forces and friction moments varied greatly between individuals. The friction moment increased during the extension phase of the joint. The average coefficient of friction also increased during this period, from 0.04 (0.03 to 0.06) at contralateral toe off to 0.06 (0.04 to 0.08) at contralateral heel strike. During the flexion phase, the coefficient of friction increased further to 0.14 (0.09 to 0.23) at toe off. The average friction-induced power throughout the whole gait cycle was 2.3 W (1.4 W to 3.8 W). Although more parameters than only the synovia determine the friction, the wide ranges of friction coefficients and power dissipation indicate that the lubricating properties of synovia are individually very different. However, such differences may also exist in natural joints and may influence the progression of arthrosis. Furthermore, subjects with very high power dissipation may be at risk of thermally induced implant loosening. The large increase of the friction coefficient during each step could be caused by the synovia being squeezed out under load.

SPECT/CT characterization of oral activity on radioiodine scintigraphy.

CONTEXT: Oral activity on radioiodine scintigraphy is commonly seen and may cause diagnostic dilemma. Determining the precise mechanism of oral uptake on radioiodine scintigraphy will increase the accuracy and confidence of interpretation and avoid possible misinterpretation. OBJECTIVE: To determine the etiology of focal persistent radioiodine oral uptake seen on radioiodine scans. DESIGN: Retrospective sequential series at a university clinic and a phantom study experiment. METHODS: Preablation iodine-131 planar and single photon emission computed tomography/computed tomography (SPECT/CT) scans of 216 patients after total thyroidectomy were reviewed. Planar images were inspected for the presence of oral activity above the salivary gland background and SPECT/CT was reviewed to determine the location and nature of oral activity. A post-hoc phantom study was designed using typodont stone models fitted with various dental materials, immersed in a diluted iodine-131 solution, and imaged with SPECT/CT to characterize radioiodine uptake by high-attenuation dental materials. RESULTS: Oral activity was seen on planar images in 123 of 216 (57%) patients; 12 patients were excluded from analysis because the SPECT/CT field of view did not cover the entire oral cavity. In the remainding 111 patients SPECT/CT images demonstrated focal uptake localizing to high-attenuation dental material on the CT in 95 of 111 (86%) patients. All cases of oral activity on planar imaging were interpreted as benign etiology on SPECT/CT. The phantom study confirmed focal in vitro uptake within high-attenuation dental materials representing a range of commonly used metal alloys. CONCLUSION: Focal oral activity on diagnostic radioiodine scans frequently localizes to high-attenuation dental material on SPECT/CT. We postulate that an affinity between negatively charged iodide ions (I(-)) in saliva and positively charged metal ions (eg, Ag(+), Hg(+), Au(2+), Pd(2+)) within the dental materials is at the basis of persistent focal radioiodine uptake in the oral cavity. This represents a new mechanism underlying benign radioiodine activity not previously described in the medical literature.

Comparison of single time-point [111-In] pentetreotide SPECT/CT with dual time-point imaging of neuroendocrine tumors.

PURPOSE: to determine whether single time-point single-photon emission computed tomography-computed tomography (SPECT/CT) somatostatin receptor imaging can replace traditional dual time-point planar and SPECT somatostatin receptor scintigraphy for evaluation of neuroendocrine tumors. MATERIALS AND METHODS: twenty-four patients (9 males, 15 females; mean age: 56 years; range: 14-82 years) underwent [111-In] pentetreotide scintigraphy, with planar whole-body images acquired at 24 and 48 hours after injection and abdominal SPECT/CT at 24 hours postinjection. Two blinded readers independently interpreted each study, using single time-point (24 hours planar and SPECT/CT) and separately using dual time-point (24- and 48-hours planar, and 24-hour SPECT without CT) image information. Consensus interpretations were compared with surgical pathology, or clinical and radiologic follow-up for at least 12 months. RESULTS: Interobserver agreement was excellent (κ = 0.86) for single time-point imaging, and good (κ = 0.56) with dual time-point imaging. After consensus review, single time-point imaging identified pathologic lesions in 11 of 12 subjects with diagnosis of NET at follow-up, and in 0 of 12 subjects without NET (sensitivity 92%; specificity 100%). Dual time-point imaging performed similarly, but missed an additional NET case (sensitivity 83%; specificity 100%). After review of SPECT/CT, the readers considered that additional 48 hours imaging was not necessary in the majority of cases, indicating high degree of confidence with the single time-point imaging. CONCLUSION: [111-In] pentetreotide SPECT/CT imaging at 24 hours identifies pathologic disease sites and distinguishes physiologic activity equally well compared to traditional strategies using 2 imaging days. Routine use of SPECT/CT will allow single time-point imaging without loss of diagnostic accuracy, enhancing patient convenience, and clinical throughput.

Making MRI quieter.

We have mitigated acoustic noise in a 1.5 T cylindrical MRI scanner equipped with epoxy-potted, shielded gradients. It has been widely assumed that MRI acoustic noise comes overwhelmingly from vibrations of the gradient assembly. However, with vibration-isolated gradients contained in an airtight enclosure, we found the primary sources of acoustic noise to be eddy-current-induced vibrations of metal structures such as the cryostat inner bore and the rf body coil. We have elucidated the relative strengths of source-pathways of acoustic noise and assembled a reduced-acoustic-noise demonstration MRI system. This scanner employed a number of acoustic noise reduction measures including a vacuum enclosure of a vibrationally isolated gradient assembly, a low-eddy-current rf coil and a non-conducting inner bore cryostat. The demonstration scanner reduced, by about 20 dBA, the acoustic noise levels in the patient bore to 85 dBA and below for several typical noisy pulse sequences. The noise level standing near the patient bore is 71 dBA and below. We have applied Statistical Energy Analysis to develop a vibroacoustic model of the MR system. Our model includes vibrational sources and acoustic pathways to predict acoustic noise and provides a good spectral match above 400 Hz to experimentally measured sound levels. This tool enables us to factor acoustics into the design parameters of new MRI systems.

Differential metabolic activity in the striosome and matrix compartments of the rat striatum during natural behaviors.

The striosome and matrix compartments of the striatum are clearly identified by their neurochemical expression patterns and anatomical connections. To determine whether these compartments are distinguishable functionally, we used [14C]deoxyglucose metabolic mapping in the rat and tested whether neutral behavioral states (free movement, gentle restraint, and focal tactile stimulation under gentle restraint) were associated with regions of high metabolic activity in the matrix, in striosomes, or in both. We identified metabolic peaks in the striatum by means of image analysis, striosome-matrix boundaries by [3H]naloxone binding, and primary somatosensory corticostriatal input clusters by injections of anterograde tracer into electrophysiologically identified sites in SI. Peak metabolic activity was primarily confined to the matrix compartment under each behavioral condition. These findings show that during relatively neutral behavioral conditions the balance of activity between the two compartments favors the matrix and suggest that this balance is present in the striatum as part of normal behavior and processing of afferent activity.