Early diagnosis of osteoporosis using radiogrammetry and texture analysis from hand and wrist radiographs in Indian population.

We propose an automated low cost tool for early diagnosis of onset of osteoporosis using cortical radiogrammetry and cancellous texture analysis from hand and wrist radiographs. The trained classifier model gives a good performance accuracy in classifying between healthy and low bone mass subjects. INTRODUCTION: We propose a low cost automated diagnostic tool for early diagnosis of reduction in bone mass using cortical radiogrammetry and cancellous texture analysis of hand and wrist radiographs. Reduction in bone mass could lead to osteoporosis, a disease observed to be increasingly occurring at a younger age in recent times. Dual X-ray absorptiometry (DXA), currently used in clinical practice, is expensive and available only in urban areas in India. Therefore, there is a need to develop a low cost diagnostic tool in order to facilitate large-scale screening of people for early diagnosis of osteoporosis at primary health centers. METHODS: Cortical radiogrammetry from third metacarpal bone shaft and cancellous texture analysis from distal radius are used to detect low bone mass. Cortical bone indices and cancellous features using Gray Level Run Length Matrices and Laws' masks are extracted. A neural network classifier is trained using these features to classify healthy subjects and subjects having low bone mass. RESULTS: In our pilot study, the proposed segmentation method shows 89.9 and 93.5% accuracy in detecting third metacarpal bone shaft and distal radius ROI, respectively. The trained classifier shows training accuracy of 94.3% and test accuracy of 88.5%. CONCLUSION: An automated diagnostic technique for early diagnosis of onset of osteoporosis is developed using cortical radiogrammetric measurements and cancellous texture analysis of hand and wrist radiographs. The work shows that a combination of cortical and cancellous features improves the diagnostic ability and is a promising low cost tool for early diagnosis of increased risk of osteoporosis.

Long-term HIV infection and antiretroviral therapy are associated with bone microstructure alterations in premenopausal women.

UNLABELLED: We evaluated the influence of long-term HIV infection and its treatment on distal tibia and radius microstructure. Premenopausal eumenorrheic HIV-positive women displayed trabecular and cortical microstructure alterations, which could contribute to increased bone fragility in those patients. INTRODUCTION: Bone fragility is an emerging issue in HIV-infected patients. Dual-energy X-ray absorptiometry (DXA) quantified areal bone mineral density (BMD) predicts fracture risk, but a significant proportion of fracture risk results from microstructural alterations. METHODS: We studied the influence of long-term HIV infection on bone microstructure as evaluated by high-resolution peripheral quantitative computed tomography (HR-pQCT) in 22 HIV-positive (+ve) premenopausal eumenorrheic women and 44 age- and body mass index (BMI)-matched HIV-negative (-ve) controls. All subjects completed questionnaires regarding calcium/protein intakes and physical activity, and underwent DXA and HR-pQCT examinations for BMD and peripheral skeleton microstructure, respectively. A risk factor analysis of tibia trabecular density using linear mixed models was conducted. RESULTS: In HIV+ve women on successful antiretroviral therapy (undetectable HIV-RNA, median CD4 cell count, 626), infection duration was 16.5 ± 3.5 (mean ± SD) years; median BMI was 22 (IQR, 21-26) kg/m². More HIV+ve women were smokers (82 versus 50 %, p = 0.013). Compared to controls, HIV+ve women had lower lumbar spine (spine T-score -0.70 vs -0.03, p = 0.014), but similar proximal femur BMD. At distal tibia, HIV+ve women had a 14.1 % lower trabecular density and a 13.2 % reduction in trabecular number compared to HIV-ve women (p = 0.013 and 0.029, respectively). HR-pQCT differences in distal radius were significant for cortical density (-3.0 %; p = 0.029). CONCLUSIONS: Compared with HIV-ve subjects, premenopausal HIV+ve treated women had trabecular and cortical bone alterations. Adjusted analysis revealed that HIV status was the only determinant of between group tibia trabecular density differences. The latter could contribute to increased bone fragility in HIV+ve patients.

Is time since hip fracture influencing the discrimination between fractured and nonfractured subjects as assessed at the calcaneum by three technologically different quantitative ultrasound devices?

Because quantitative ultrasound (QUS) instruments from different manufacturers have significant technical differences, it is difficult to assess whether all of them can discriminate similarly between osteoporotic fractures and age-matched controls. Thus, to avoid any bias, reliable comparative assessment of the QUS devices should be carried out on the same population. Few studies have fulfilled this condition. Another source of variability in cross-sectional studies in which fractured and nonfractured subjects are compared is the time since osteoporotic fracture. Our study evaluated the ability of three calcaneal QUS devices to discriminate patients with osteoporotic hip fracture from control subjects, using the same population. In addition, a subset of patients was re-measured about 9 months after the hip replacement surgery to check how the time since fracture affects the discriminatory ability of the different QUS devices. Fifty postmenopausal hip-fractured patients and 46 postmenopausal age-matched controls were included in this study and measured on three QUS devices, as well as 50 young healthy controls to calculate the T-score. Odds ratio results showed that a decrease in UBIS trade mark BUA of 1 SD was associated with a significant increase in fracture risk (odds ratio adjusted = 2.30) comparable with Sahara broadband ultrasound attenuation (BUA) (OR adj. = 2.30), and Achilles BUA (OR adj. = 3.5). However, given the large overlap between the 95% intervals of each OR and for the areas under ROC curves, no significant difference was found between them. In the subset of 15 hip-fractured subjects, no significant differences were found between ultrasound parameters of the first visit and 9 months after except for the heel width (soft tissue variation). Odds ratio and areas under the curve (AUC) tend to increase from visit 1 to 2 for the BUA and decrease substantially for the SOS for all but the Lunar Achilles+. Nonsignificant correlation was found between the absolute difference of the ultrasound parameters measured at the two visits and the time since fracture, except for the Sahara SOS (r = 0.45; P < 0.04). In conclusion, no significant differences between QUS technologies were observed in their positive and significant ability to discriminate hip-fractured patient from controls. However, this statement is shadowed when taking into account the time since fracture which seems to negatively influence results obtained on dry versus wet QUS systems. As a result, it is advisable that such parameters would be taken into account when designing a study aimed to demonstrate the discriminatory ability of heel ultrasound between normal and hip-fractured patients.

[Value of the Pediatric Trauma Score in routine hospital practice--apropos of a prospective one-year trial]. / Utilité du Pediatric Trauma Score dans la pratique hospitalière quotidienne--à propos d'une série prospective d'un an.

AIM: To test the usefulness of the Pediatric Trauma Score (PTS) in a university hospital setting. METHODS: All injured children who were admitted to our emergency room during a one year period were prospectively studies. The study was performed at the Pediatric University Hospital of Geneva. Patients were divided into two groups: group one included severely injured children with a PTS equal or lower 8 and group two included patients with a PTS greater than 8. RESULTS: A total of 6804 injured children were admitted to our emergency room and 927 (14%) were hospitalized. In group one (104 children, 1.5%), six patients died whereas in group two (823 children, 12%), all patients survived. In addition, children in group one demonstrated a significant higher number of general anesthesia, a longer stay in the ICU and a longer stay, and an increased number of sequelae 3 months after trauma. DISCUSSION: Our result confirm the usefulness of the PTS and the cutoff value of 8 in pediatric trauma. In addition, the study underlines the important morbidity and the residual sequelae after severe trauma in children. CONCLUSION: The PTS should be used in all injured children in order to identify patients at risk. This would allow to begin an appropriate treatment or, if necessary, initiate a transfer to a surgical pediatric center without delay.

The frequency of pretransplant donor cytotoxic T cell precursors with anti-host specificity predicts survival of patients transplanted with bone marrow from donors other than HLA-identical siblings.

Transplantation with bone marrow from other than genotypically HLA-identical donors is associated with an increased incidence and severity of graft-versus-host disease (GvHD). The precise influence of HLA incompatibilities is not easy to analyze as even perfectly matched, HLA-identical unrelated donors might still express HLA differences that remain undetected by conventional typing. To measure T cell activity against serologically detectable and nondetectable HLA antigens, we analyzed the frequencies of CTL precursors (CTLp) between 11 unrelated HLA-matched and five related haploidentical donor/recipient pairs in graft-versus-host direction. Our results show that whenever HLA class I disparities could be identified by serology, high precursor frequencies (1/28,000-1/94,000) were measured. In contrast, in donor/recipient pairs that differed for class II only, no precursors were detected. CTLp were elevated in two out of eight fully matched donor/recipient combinations. These combinations displayed activities as high (1/21,000; 1/52,000) as the combinations that were serologically HLA class I disparate. The incompatibilities detected by the cellular assay were highly significant for the clinical results after transplantation. High CTLp frequencies before transplantation correlated with unfavorable clinical results independent of the incidence of detected HLA differences. Five out of the six patients with high (> 1/100,000) CTLp frequencies died within 120 days after transplantation. GvHD IV was the cause of death for all (3/5) patients who had received an unmanipulated bone marrow. In the group with intermediate or undetectable CTLp frequencies, eight out of 10 patients are alive, seven (CTLp frequency undetectable) without GvHD more severe than grade II, while one patient (CTLp frequency = 1/180,000) suffered from GvHD grade III. One patient rejected the graft and was rescued by an autologous BMT.