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PubMed1982

Evaluation of a maximal predictive cycle ergometer test of aerobic power.

A maximal predictive cycle ergometer (CE) test for estimating maximal oxygen uptake (VO2 max) was evaluated in 15 male and 12 female subjects. The test consisted of pedalling a cycle ergometer (Monark) at 75 rev X min-1, beginning at an intensity of 37.5 watts and increasing by this amount each min until the subject could no longer maintain pedal rate. The highest work rate achieved was recorded as the endpoint of the test and used to construct regression equations to predict VO2 max. This was compared with two direct measures of VO2 max [an interrupted treadmill (TM) run and an interrupted CE procedure at 60 rev X min-1] and with the submaximal predictive test of Astrand-Rhyming. When compared to TM VO2 max, VO2 measured during the final 30 s of the maximal predictive CE test was 16.0% and 16.2% lower for males and females respectively; compared to VO2 max determined by the direct CE test, it was lower by 2.9% for males and 5.2% for females. Correlation coefficients for VO2 max predicted from the maximal predictive CE test and VO2 max measured directly by CE and TM were 0.89 and 0.87 for males and 0.88 and 0.83 for females (p less than 0.01), respectively. The VO2 max predicted from the Astrand-Rhyming test correlated significantly with VO2 max measured by CE and TM only in the male group. Test-retest reliability coefficients for intensity (watts) on the maximal predictive CE test were 0.95 and 0.81 for males and females respectively (p less than 0.01). The data suggest that this CE test gives a reliable and valid estimate of VO2 max.

Adult↗
PubMed1995

Monte Carlo simulation studies on the prediction of protein folding types from amino acid composition. II. Correlative effect.

A number of methods to predicting the folding type of a protein based on its amino acid composition have been developed during the past few years. In order to perform an objective and fair comparison of different prediction methods, a Monte Carlo simulation method was proposed to calculate the asymptotic limit of the prediction accuracy [Zhang and Chou (1992), Biophys. J. 63, 1523-1529, referred to as simulation method I]. However, simulation method I was based on an oversimplified assumption, i.e., there are no correlations between the compositions of different amino acids. By taking into account such correlations, a new method, referred to as simulation method II, has been proposed to recalculate the objective accuracy of prediction for the least Euclidean distance method [Nakashima et al. (1986), J. Bochem. 99, 152-162] and the least Minkowski distance method [Chou (1989), Prediction in Protein Structure and the Principles of Protein Conformation, Plenum Press, New York, pp. 549-586], respectively. The results show that the prediction accuracy of the former is still better than that of the latter, as found by simulation method I; however, after incorporating the correlative effect, the objective prediction accuracies become lower for both methods. The reason for this phenomenon is discussed in detail. The simulation method and the idea developed in this paper can be applied to examine any other statistical prediction method, including the computer-simulated neural network method.

Amino Acids↗
PubMed2004

Experimental evaluation of lesion prediction modelling in the presence of cavitation bubbles: intended for high-intensity focused ultrasound prostate treatment.

The accuracy of high-intensity focused ultrasound (HIFU) lesion prediction modelling was evaluated for a truncated spherical transducer designed for prostate cancer treatment The modelling adapted the bio heat transfer equation (BHTE) to take into account the activity of cavitation bubbles generated during HIFU exposure. This modelling was used to predict the lesions produced by three different transducer geometries: fixed-focus, concentric-ring and 1.5D phased-array. Lesions were predicted for different ultrasound exposure conditions close to those used in prostate cancer treatment. Twenty-one in vitro and nine in vitro experiments were performed on pig liver to validate the accuracy of the predictions. A good match was found between the predicted and experimental lesion shapes. Lesion dimensions (maximum depth and length, area at the centre of the lesion or central surface area) were measured on experimental and predicted lesions. The central surface area was predicted by the model with a range of error of 0.15-6.5% for in vitro tests and 0.97-9% in vivo. For comparison, BHTE without bubbles had a range of error of 0.4-55.5% (in vitro) and 9-25.5% (in vivo). The model should be accurate enough to predict HIFU lesions under ultrasound exposure conditions used in prostate cancer treatment.

Acoustics↗
PubMed1994

Physician response to a prediction rule for the triage of emergency department patients with chest pain.

OBJECTIVE: To determine the response of physicians to a noncoercive prediction rule for the triage of emergency department patients with chest pain. DESIGN: Prospective time-series intervention study. SETTING: A university hospital emergency department. PARTICIPANTS/PATIENTS: 68 physicians, all of whom were responsible for the triage of at least one of 252 patients presenting to the emergency department with a chief complaint of acute chest pain. INTERVENTION: A previously validated algorithmic prediction rule that was attached to the back of patient data forms in the emergency department. MEASUREMENTS: Patients' clinical data were recorded by the examining physician in the emergency department or by a research nurse blinded to patient outcome. The physicians recorded their own estimates of the risk of acute myocardial infarction and their reactions to the prediction rule in a self-administered questionnaire completed at the time of triage. MAIN RESULTS AND CONCLUSIONS: The physicians reported that they looked at the prediction rule during the triage of 115 (46%) of the 252 patients. The likelihood of using the prediction rule decreased significantly with increasing level of physician training. The most common reasons given for disregarding the prediction rule were confidence in unaided decision making and lack of time. The physicians reported that of the 115 cases for which the prediction rule was used, only one triage decision (1%) was changed by it. Future research should explore how prediction rules can be designed and implemented to surmount the barriers highlighted by these data.

Algorithms↗
PubMedDate not supplied

Prediction and control as determinants of behavioural uncertainty: effects on task performance and heart rate reactivity.

Control or control-belief is often viewed as being directly instrumental in facilitating coping mechanisms in aversive situations, and yet the empirical evidence for the beneficial effects of control is inconclusive. In this study we investigated the role of predictability in determining the effects of perceived control during an aversive reaction time task. Fifty-six subjects were allocated to one of four groups; predictable-control, predictable-no control, unpredictable-control, unpredictable-no control. In the predictable conditions, subjects could temporally predict the occurrence of an aversive noise. In the perceived control conditions, duration of the aversive tone was contingent on subject's performance. All subjects were matched in terms of the nature of the task and in the number and time of receipt of both the warning signal and noise. Heart rate reactivity and two performance parameters were measured, reaction time and performance increase. Both predictability and control-belief led to a reduction in heart rate reactivity, although they appeared to function independently and at different points in the sequence of events. That is, predictability or perceived control was sufficient to mitigate the effects of an aversive situation. Neither perception of control or predictability led to better task performance. These results are discussed in terms of behavioural uncertainty explanations.

Acoustic Stimulation↗
PubMed2000

Generation of deviation parameters for amino acid singlets, doublets and triplets from three-dimentional structures of proteins and its implications for secondary structure prediction from amino acid sequences.

We present a new method, secondary structure prediction by deviation parameter (SSPDP) for predicting the secondary structure of proteins from amino acid sequence. Deviation parameters (DP) for amino acid singlets, doublets and triplets were computed with respect to secondary structural elements of proteins based on the dictionary of secondary structure prediction (DSSP)-generated secondary structure for 408 selected non-homologous proteins. To the amino acid triplets which are not found in the selected dataset, a DP value of zero is assigned with respect to the secondary structural elements of proteins. The total number of parameters generated is 15,432, in the possible parameters of 25,260. Deviation parameter is complete with respect to amino acid singlets, doublets, and partially complete with respect to amino acid triplets. These generated parameters were used to predict secondary structural elements from amino acid sequence. The secondary structure predicted by our method (SSPDP) was compared with that of single sequence (NNPREDICT) and multiple sequence (PHD) methods. The average value of the percentage of prediction accuracy for a helix by SSPDP, NNPREDICT and PHD methods was found to be 57%, 44% and 69% respectively for the proteins in the selected dataset. For b-strand the prediction accuracy is found to be 69%, 21% and 53% respectively by SSPDP, NNPREDICT and PHD methods. This clearly indicates that the secondary structure prediction by our method is as good as PHD method but much better than NNPREDICT method.

Amino Acid Sequence↗
PubMed1993

Lung perfusion SPECT in predicting postoperative pulmonary function in lung cancer.

The aim of this prospective study is to evaluate the availability of preoperative perfusion SPECT in predicting postoperative pulmonary function following resection. Twenty-three patients with lung cancer who were candidates for lobectomy were investigated preoperatively with spirometry, x-ray computed tomography and 99mTc macroaggregated albumin SPECT. Their postoperative pulmonary functions were predicted with these examinations. The forced vital capacity and the forced expiratory volume in one second were selected as parameters for overall pulmonary function. The postoperative pulmonary function was predicted by the following formula: Predicted postoperative value = observed preoperative value x percent perfusion of the lung not to be resected. The patients were reinvestigated with spirometry at 3 months and 6 months after lobectomy, and the values obtained were statistically compared with the predicted values. Close relationships were found between predicted and observed forced vital capacity (r = 0.87, p < 0.001), and predicted and observed forced expiratory volume in one second (r = 0.90, p < 0.001). The accurate prediction pulmonary function after lobectomy could be achieved by means of lung perfusion SPECT.

Adenocarcinoma↗
PubMed2004

Prediction of protein function and pathways in the genome era.

The growing number of completely sequenced genomes adds new dimensions to the use of sequence analysis to predict protein function. Compared with the classical knowledge transfer from one protein to a similar sequence (homology-based function prediction), knowledge about the corresponding genes in other genomes (orthology-based function prediction) provides more specific information about the protein's function, while the analysis of the sequence in its genomic context (context-based function prediction) provides information about its functional context. Whereas homology-based methods predict the molecular function of a protein, genomic context methods predict the biological process in which it plays a role. These complementary approaches can be combined to elucidate complete functional networks and biochemical pathways from the genome sequence of an organism. Here we review recent advances in the field of genomic-context based methods of protein function prediction. Techniques are highlighted with examples, including an analysis that combines information from genomic-context with homology to predict a role of the RNase L inhibitor in the maturation of ribosomal RNA.

ATP-Binding Cassette Transporters↗
PubMed2007

Sensory versus motor information in the control of predictive saccade timing.

Humans readily make predictive saccades to periodic alternating targets. This predictive behavior depends on internal monitoring of timing error of past saccades in order to determine the time of initiation of future saccades; our earlier studies have confirmed this by finding correlations between latencies of consecutive predictive saccades. It is natural to consider that timing error is determined by visual detection of the difference between the time the target appears and the time the eyes arrive at the target; this in turn implies that saccades must actually be produced in order for their timing errors to be determined and predictive saccade timing to be established. We tested this hypothesis by having subjects view alternating visual targets while fixating a central target in order to eliminate saccade production. After six alternating target presentations, subjects began tracking the alternating targets. Tracking performance was assessed with an error measure that compared saccade latency and inter-saccade interval with desired values (zero and inter-stimulus interval, respectively). Errors in this Prior Viewing paradigm were compared to those from a conventional De Novo paradigm in which saccades began as soon as the alternating targets were presented. Saccades under Prior Viewing reached a low-error steady predictive state more rapidly than under De Novo tracking. The initial saccade under Prior Viewing had a higher latency than the others, suggesting that this saccade was reactive even though the paradigm is predictable; other reasons for this higher latency include time to disengage from the fixation target and time required to pre-program the initial set of saccades. The results show that visual detection of timing error from an actual motor act (saccades) is not necessary to establish predictive saccadic pacing: sensory-only information from viewing the moving targets can help to establish this predictive state.

Brain↗
PubMed1998

Prediction of carboplatin clearance calculated by patient characteristics or 24-hour creatinine clearance: a comparison of the performance of three formulae.

PURPOSE: Carboplatin doses can be individualized using the formula of Calvert et al. (Calvert formula) dose (mg) = area under the plasma concentration versus time curve (AUC) x [glomerular filtration rate (GFR) + 25]. Creatinine clearance (Ccr), either measured by the 24-h method or calculated by the formula of Cockcroft and Gault [Cockcroft-Gault (CG) formula], is often substituted for the GFR. The CG formula is based on patient weight, age and sex, and the serum creatinine (Cr) concentration. Another method for predicting carboplatin clearance (CL) using patient characteristics has also been proposed by Chatelut et al. (Chatelut formula). This study was undertaken to evaluate the performance of the three formulae in predicting standard- and low-dose carboplatin pharmacokinetics. METHODS: A total of 52 patients with advanced lung cancer were enrolled in this pharmacokinetic study; 37 received standard-dose carboplatin and 25 received low-dose carboplatin. The Cr concentration was measured using an enzymatic assay. The three formulae were used to predict carboplatin CL. The median absolute percent error (MAPE) for each formula was evaluated by comparing the calculated and observed CL. For comparison of AUCs, free platinum plasma concentrations were measured at intervals up to 24 h after carboplatin administration. AUCs were determined and compared with predicted values. RESULTS: In the standard-dose carboplatin group, the MAPEs for the prediction of carboplatin CL from the 24-h Calvert, CG-Calvert and Chatelut formulae were 13%, 12% and 23%, respectively. In the low-dose carboplatin group, the corresponding MAPEs were 27%, 18% and 44%, respectively. Observed standard-dose carboplatin AUCs after aiming for target AUCs of 5 and 6 mg x min/ml using the Calvert formula based upon the 24-h Ccr were 5.3+/-0.8 and 5.9+/-0.8, respectively, indicating a small and acceptable bias compared with that predicted from the dosing formula. CONCLUSIONS: The pharmacokinetics of standard-dose carboplatin were accurately predicted by the Calvert formula based upon either 24-h or CG-calculated Ccr, but not by the Chatelut formula. Either CG-calculated or 24-h Ccr can be substituted for the GFR in the Calvert formula for the determination of individual doses. The poor predictability of the Chatelut formula found in this study might be the result of a differences in either the Cr assay or the patient population. Therefore, formulae which attempt to estimate GFR are not necessarily valid if either the Cr assay or the patient population is changed.

Age Factors↗
PubMed2003

Ultrasonographic prediction of clinical pulmonary hypoplasia: measurement of the chest/trunk-length ratio in fetuses.

Pulmonary hypoplasia is involved in patients with various surgical diseases. The aim of this study was to evaluate the clinical usefulness of measurement of the chest/trunk-length ratio (C/T) for predicting pulmonary hypoplasia in patients with congenital anomalies, with the exception of mass-like lesions in the thorax such as diaphragmatic hernia and cystic lung diseases. For measurement of C/T on fetal ultrasound, the sagittal section of the body trunk, including the spine, was analyzed. C/T was calculated as the chest length, defined from the top of the thorax to the top of the diaphragm, divided by the trunk length, defined from the top of the thorax to the bottom of the urinary bladder. From 1986 to 2000, measurements of C/T were undertaken in 49 healthy fetuses from 17 to 37 weeks of gestation and 98 fetuses with congenital anomalies, with the exception of intra-thoracic mass lesions, omphalocele, and fetal hydrops. Pulmonary hypoplasia was clinically assessed by the following criteria: (1) a lung-to-birth-weight ratio of 0.012 or less; (2) patients who required high-frequency oscillatory ventilation with mean airway pressure of 15 cmH(2)O or more with pure oxygen and/or who died presenting respiratory failure without evidences of meconium aspiration, congenital pneumonia, sepsis or hyaline membrane disease. For a predicting value for pulmonary hypoplasia to be obtained, sensitivity, specificity, positive predictive value and negative predictive value were quoted between C/T in patients with pulmonary hypoplasia and those without pulmonary hypoplasia. Healthy fetuses revealed the mean value as 0.38+/-0.03, with no significant change after 20 weeks of gestation. Pulmonary hypoplasia was assessed in 25 fetuses with urethral atresia and stenosis, renal agenesis, polycystic kidney, cloacal anomalies, diaphragmatic eventration, bronchopulmonary foregut malformation, chest deformity, meconium peritonitis and sacrococcygeal teratoma. As a predicting value for pulmonary hypoplasia, 0.32 or less of the maximum value of C/T indicated good accuracy, with a sensitivity of 92.0%, specificity of 95.9%, positive predictive value of 88.5% and negative predictive value of 97.2%. Ultrasonic measurement of C/T is useful in predicting postnatal respiratory conditions with regard to pulmonary hypoplasia.

Abnormalities, Multiple↗
PubMed2005

Validation of an equation for predicting energy cost of arm ergometry in women.

Few studies have examined the validity of metabolic equations for the prediction of energy cost (VO(2)) of arm ergometry in women. Therefore, the purpose of this study was (a) to compare directly measured and predicted VO(2) values using the American College of Sports Medicine (ACSM) equation and (b) to develop and validate a prediction equation for women. A sample of 60 female subjects with mean (+/-SD) age, weight and height 26.5 +/- 14.4 years, 61.5 +/- 7.6 kg, 163.3 +/- 6.0 cm, respectively, was randomly assigned to an equation group (N = 40) and a cross validation group (N = 20). All subjects performed an incremental arm ergometry test (10 W increases every 2 min), until termination criteria were met. Repeated measures ANOVA indicated significant differences between the measured VO(2) and ACSM predicted VO(2) during all the incremental test work rate. Multiple linear regression analysis was used to develop the following upper body exercise VO(2) prediction equation: VO(2)(ml . kg(-1) . min(-1) = 23.461 - (0.272 x Body Weight) + (0.403 x watts) [R(2) = 0.82, SEE = 2.79] Cross validation indicated lower variability using the current prediction equation. An additional independent sample of 13 subjects performed a 30-min steady-state test at 40% of their pre-determined maximal work rate. VO(2) measured during the 30 min steady-state test (was significantly different P < 0.05) from the ACSM prediction at all time intervals. There were no significant differences using the above equation following the 5 min time interval. Therefore, a new equation is proposed as a means of providing a gender-specific energy cost prediction equation.

Adolescent↗
PubMed2001

Inferences about predictable events: eye movements during reading.

Eye fixations were recorded to assess whether, how, and when readers draw inferences about predictable events. Predicting context sentences, or non-predicting control sentences, were presented, followed by continuation sentences in which a target word referred to a predictable event (inferential word) or an unlikely event (non-predictable word). There were no effects on initial target word processing measures, such as launch and landing sites, fixation probability, first-fixation duration, or first-pass reading time. However, relative to the control condition, the predicting context (1) speeded up reanalysis of the inferential word, as revealed by a reduction in second-pass reading time and regressions, and (2) interfered with processing of the non-predictable word, as shown by an increase in regressions. These results indicate that predictive inferences are active at late text integration processes, rather than at early lexical-access processes. The pattern of findings suggests that these inferences involve initial activation of rather general concepts following the inducing context, and that they are completed or refined with delay, after the inferential target word is read.

Eye Movements↗
PubMed2000

Intracranial pressure processing with artificial neural networks: prediction of ICP trends.

It is well known that intracranial pressure (ICP) is influenced by an array of predictable and unpredictable factors, which gives rise to a signal heavily loaded with stochastic, i.e. random components. Hence, statistical modelling of this signal has proved to be of limited utility, in spite of the very sophisticated mathematical methods applied. In recent years, neural network algorithms (ANN), which are an alternative to statistical methods, have proved their effectiveness in the prediction of trends, as applied in a variety of medical and non-medical tasks. We therefore attempted to test the efficiency of neural models in the on-line prediction of ICP values, compare their effectiveness to statistically oriented algorithms and combine ANN methods with some newer signal processing algorithms, like wavelet decomposition. Prediction horizons of up to 5 minutes have been tested with various architectures of the neural predictor. For a 3 minute prediction horizon, a satisfactory accuracy of forecasting has been achieved with "plain" ANN, as expressed by the "average relative variance coefficient". This was measured by the ratio of the prediction error obtained, in relation to the error which would occur if a current value were taken as the forecasted one. The prediction quality with statistical autoregressive models has proved unsatisfactory, whilst the result obtained using the ANN model with the wavelet transform incorporated, performed significantly better than the ANN models alone. The prediction quality obtained with the ANN methodology seems to be satisfactory over a short time horizon, though no conclusion can be derived at this stage of the study, as to the clinical utility of this method. In particular, even with this methodology, it is not possible to forecast any sudden dehiscencies of the ICP signal with any practical reliability. From the point of view of modelling theory, such sharp deviations of the signal may be regarded as a "catastrophe". This implies the necessity for a different approach to the ICP signal analysis with the artificial intelligence methodology; one, that is more oriented towards the global properties of the signal.

Cerebral Hemorrhage↗
PubMed2006

Prediction of adipose tissue composition using Raman spectroscopy: average properties and individual fatty acids.

Raman spectroscopy has been used for the first time to predict the FA composition of unextracted adipose tissue of pork, beef, lamb, and chicken. It was found that the bulk unsaturation parameters could be predicted successfully [R2 = 0.97, root mean square error of prediction (RMSEP) = 4.6% of 4 sigma], with cis unsaturation, which accounted for the majority of the unsaturation, giving similar correlations. The combined abundance of all measured PUFA (> or = 2 double bonds per chain) was also well predicted with R2 = 0.97 and RMSEP = 4.0% of 4 sigma. Trans unsaturation was not as well modeled (R2 = 0.52, RMSEP = 18% of 4 sigma); this reduced prediction ability can be attributed to the low levels of trans FA found in adipose tissue (0.035 times the cis unsaturation level). For the individual FA, the average partial least squares (PLS) regression coefficient of the 18 most abundant FA (relative abundances ranging from 0.1 to 38.6% of the total FA content) was R2 = 0.73; the average RMSEP = 11.9% of 4 sigma. Regression coefficients and prediction errors for the five most abundant FA were all better than the average value (in some cases as low as RMSEP = 4.7% of 4 sigma). Cross-correlation between the abundances of the minor FA and more abundant acids could be determined by principal component analysis methods, and the resulting groups of correlated compounds were also well-predicted using PLS. The accuracy of the prediction of individual FA was at least as good as other spectroscopic methods, and the extremely straightforward sampling method meant that very rapid analysis of samples at ambient temperature was easily achieved. This work shows that Raman profiling of hundreds of samples per day is easily achievable with an automated sampling system.

Adipose Tissue↗
PubMed1995

Fetal macrosomia: does antenatal prediction affect delivery route and birth outcome?

OBJECTIVE: Our purpose was to determine whether clinical or ultrasonographic prediction of fetal macrosomia influences subsequent delivery route and birth outcome in a clinical setting where macrosomia is not considered an indication for cesarean delivery. STUDY DESIGN: The hospital records of 504 patients delivered of infants weighing > or = 4200 gm between October 1989 and March 1994 were reviewed. Statistical comparisons were made between patients in whom fetal macrosomia was predicted before delivery (n = 102) and those in whom it was not (n = 402). Cesarean delivery, shoulder dystocia, and birth trauma rates were the variables of interest. RESULTS: Cesarean sections were performed in 52% of the "predicted" group deliveries and in 30% of the "not predicted" group (p < 0.01). The increased cesarean delivery rate in the predicted group appeared to be related to an increased incidence of labor inductions (42.5% vs 26.6%, p = 0.005) and a greater proportion of failed inductions. The proportion of patients delivered by cesarean section without a trial of labor was similar in the predicted and not predicted groups (14.7% vs 10.2%, p = 0.21). There was no significant differences in the incidence of shoulder dystocia or the occurrence of birth trauma. CONCLUSIONS: The antenatal prediction of fetal macrosomia is associated with a marked increase in cesarean deliveries without a significant reduction in the incidence of shoulder dystocia or fetal injury. Ultrasonography and labor induction for patients at risk for fetal macrosomia should be discouraged.

Birth Injuries↗
PubMed1990

CSF 5-HIAA, serum cortisol, and age differentially predict vegetative and cognitive symptoms in depression.

Prior studies have shown that both cerebrospinal fluid (CSF) concentrations of 5-hydroxyindolacetic acid (5-HIAA) and serum cortisol levels are related to overall symptom severity in depression. In the present study, 30 unmedicated inpatients meeting Research Diagnostic Criteria (RDC) criteria for depression participated in serum cortisol collection and a lumbar puncture for CSF. A multiple regression evaluated the ability of CSF 5-HIAA, serum cortisol, and age to predict cognitive and vegetative symptom clusters of the Hamilton Rating Scale for Depression. The multiple regression to predict the vegetative symptom cluster was highly significant overall (p = 0.002) and found that age and cortisol but not 5-HIAA predicted vegetative symptoms. The regression to predict the cognitive cluster narrowly missed overall significance (p = 0.06). Both CSF 5-HIAA and serum cortisol predicted cognitive symptoms and 5-HIAA predicted the cognitive cluster more strongly than cortisol. Age did not predict cognitive symptoms. The results suggest a dissociation between serum cortisol levels and CSF 5-HIAA in predicting vegetative and cognitive symptom clusters in depression.

Adult↗
PubMed1993

Evaluation of finite element analysis for prediction of the strength reduction due to metastatic lesions in the femoral neck.

Between 30 and 70% of almost one million new cancer patients diagnosed each year will develop osseous metastases. Clinicians are faced with the difficult task of determining which patients require prophylactic stabilization to prevent pathologic fracture. The objective of this study was to test the ability of macroscopic finite element models to predict the fracture strength of the proximal femur with a lesion in the femoral neck. Drill hole defects in human cadaver femora were used to simulate lesions that penetrate one cortex of the femoral neck. Based on the first of two series of in vitro experiments, the fracture strength of a femur with a lesion that penetrates either the inferior-medial or superior-lateral cortex of the neck is approximately 45% less than the fracture strength of the paired intact femur; based on the second series, the fracture strength with the inferior-medial lesion is approximately 20% less than the fracture strength with the superior-lateral lesion. A series of three-dimensional finite element models were used to predict the fracture strength for anterior and posterior lesions, as well as the inferior-medial and posterior-lateral lesions tested in vitro. Based on a direct comparison of the strengths predicted by the finite element models to the measured in vitro fracture strengths, the finite element models performed poorly. In particular, the application of an anisotropic strength criterion to the stresses predicted by the models resulted in a considerable underestimation of the percentage reduction in the in vitro fracture strength. This may reflect a fundamental inability of a linear, macroscopic continuum-based analysis to predict accurately the fracture strength of a bone structure as complex as the proximal femur. However, despite this lack of agreement in absolute fracture strength, the general trends for gait and stair ascent loading for the inferior-medial and superior-lateral lesions were consistent with the in vitro data. The greatest reduction in strength was predicted for the inferior-medial lesion, followed by the anterior lesion and then the superior-lateral lesion, and the least reduction in strength was predicted for the posterior lesion. Most importantly, the predicted strength ratio varied considerably as a function of the applied loads. Any metastatic lesions of the femoral neck may be especially sensitive to some particular activity, making it difficult to determine precisely the risk of fracture.

Aged↗