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PubMed1986

Evaluating bizarre-idiosyncratic thinking: a comprehensive index of positive thought disorder.

A summary of our method of assessing positive thought disorder, or bizarre-idiosyncratic thinking, from two short verbal tests is presented. This measure provides for standardized thought disorder assessments of: the overall presence and severity of thought disorder, and the type of disordered thinking shown. A definition and examples of bizarre-idiosyncratic thinking are provided, along with information on the reliability and validity of the scoring system. A method of establishing subject groups based on the severity of positive thought disorder also is presented--ranging from no thought disorder, to abnormal thinking, to severe formal thought disorder. This measure has been used to assess longitudinal changes in thought disorder symptoms over time and to evaluate relationships between thought disorder, other aspects of psychopathology (such as delusions), and adjustment in other areas of functioning across diagnostic groups.

Humans↗
PubMed2004

GB virus C during the natural course of HIV-1 infection: viremia at diagnosis does not predict mortality.

OBJECTIVE: To investigate whether GBV-C viremia at diagnosis of HIV-1 infection predicts disease outcome in patients not receiving combination antiretroviral therapy (ART), and whether longitudinal changes in GBV-C viremia are associated with disease progression. DESIGN: Prospective cohort study. METHODS: 230 patients with a serum sample available for testing obtained within 2 years of HIV-1 diagnosis were followed until either initiation of ART, death, or their last visit to our clinic (median follow-up 4.3 years). Baseline and follow-up serum samples (available from 163 patients) were tested for GBV-C RNA and antibodies against GBV-C envelope E2 protein (anti-E2; signifying resolved GBV-C viremia). RESULTS: At inclusion, 62 patients (27%) had GBV-C viremia and 69 (30%) had anti-E2. Baseline GBV-C status was not associated with all-cause mortality (P = 0.12), HIV-related mortality (P = 0.18), or development of AIDS (P = 0.84). However, GBV-C RNA was less prevalent in patients with AIDS at inclusion (P = 0.008). Eleven of 44 patients with baseline GBV-C viremia lost GBV-C RNA during follow-up without showing anti-E2 seroconversion. In comparison with anti-E2-negative patients with either persistent absence, persistent presence, or acquisition of GBV-C viremia, these subjects had significantly increased all-cause mortality (P = 0.018), HIV-related mortality (P = 0.007), and AIDS incidence (P < 0.001). CONCLUSIONS: GBV-C status at diagnosis did not predict disease outcome in this HIV cohort. GBV-C viremia was rare in patients with AIDS, and tended to disappear without occurrence of anti-E2 in patients with progressive disease. This suggests that the GBV-C status of HIV-1-infected patients could be a phenomenon secondary to HIV progression, rather than an independent prognostic factor.

Adult↗
PubMed1999

Baylor profound mental status examination: a brief staging measure for profoundly demented Alzheimer disease patients.

There is no brief patient-derived rating scale for staging and following profoundly demented Alzheimer disease (AD) patients. We developed the Baylor Profound Mental Status Examination (BPMSE) modeled after the Mini-Mental State Examination (MMSE) to meet this need. The BPMSE consists of 25 cognitive questions that assess orientation, language, attention, and motor functioning; 10 examiner ratings of presence or absence of problem behaviors; and 2 qualitative observations of language and social interaction. Two hundred eight probable or possible AD patients (MMSE scores of 20 or less) received the BPMSE. Some were also rated on the clinical dementia rating (CDR) and Lawton activities of daily living (ADL). A ceiling effect occurred at MMSE scores above 11. BPMSE cognitive scores and MMSE scores correlated significantly (r = 0.76, p < 0.0001). Subareas of the BPMSE also intercorrelated significantly. The BPMSE correlated with both CDR and ADL scores (p < 0.001). Internal consistency, interrater reliability, and test-retest stability were excellent. There was no floor effect, and BPMSE scores continued to decline after the MMSE reached 0. The BPMSE is a quick and easy staging tool with excellent validity and test-retest stability that measures cognitive function successfully in patients with MMSE scores below 12. The scale is sensitive to longitudinal change and continues to assess decline when performance has reached the lowest levels on conventional measures.

Aged↗
PubMed1996

Loss of elbow and wrist motion in hemophilia.

The longitudinal changes in elbow and wrist motion for 48 patients with hemophilia were reviewed to determine the effect of recurrent hemarthroses. The average age of the patients at the time of followup was 23 years 9 months. The average duration of followup was 10.8 years. The patients were divided into 3 age groups: younger than age 15 years (14 patients), age 15 to 25 years (11 patients), and older than age 25 years (23 patients). For patients older than age 25 years, pronation, supination, elbow flexion and extension, wrist flexion and extension, and ulnar deviation were significantly decreased relative to patients younger than age 15 years. Pronation was the first motion to show a significant change, decreasing by 19% in patients age 15 to 25 years and by 31% in patients older than age 25 years. Loss of elbow extension showed the greatest change. In cases of severe hemophilic arthropathy of the elbow, synovectomy and radial head excision decreased elbow pain and bleeding episodes and improved supination and pronation.

Adolescent↗
PubMed2002

Bone mineral density in patients with stroke.

The objectives of this study were to investigate the development and pathogenesis of osteoporosis in stroke in-patients, to compare the bone mineral density (BMD) of the paretic and non-paretic sides, to study longitudinal changes during the period on the rehabilitation ward and to relate BMD to demographic, impairment and disability variables. Participants were 32 first-stroke in-patients (19 men), with an average age of 62.4 +/- 8.1 years. Demographic and clinical characteristics were documented. The BMD of lumbar spine, bilateral distal radius and femoral neck were measured and compared at admission and discharge. The associations between bone loss and age, sex, time since stroke, Brunnstrom motor recovery scores and functional independence measure motor (mFIM) scores were assessed. The mean percentage differences in BMD between paretic and non-paretic arms at discharge were 12% (P < 0.001) and 3.5% (P < 0.05), respectively, and between paretic and non-paretic legs were 5% (P < 0.01) and 2% (P < 0.05), respectively. There was a statistically significant correlation between BMD loss and Brunnstrom stage (r = -0.41) and mFIM score at admission (r = -0.42). In conclusion, patients with hemiparesis due to stroke are at increased risk of developing osteoporosis on the paretic side. Higher motor impairment and functional dependency at admission increases the risk. New strategies are needed for stroke patients to prevent further decreases in BMD and reduce the risk of fractures.

Activities of Daily Living↗
PubMed2002

Repeated blood pressure measurements in a sample of Swedish twins: heritabilities and associations with polymorphisms in the renin-angiotensin-aldosterone system.

BACKGROUND: Twin and family studies have shown that genetic effects explain a relatively high amount of the phenotypic variation in blood pressure. However, many studies have not been able to replicate findings of association between specific polymorphisms and diastolic and systolic blood pressure. METHODS: In a structural equation-modelling framework the authors investigated longitudinal changes in repeated measures of blood pressures in a sample of 298 like-sexed twin pairs from the population-based Swedish Twin Registry. Also examined was the association between blood pressure and polymorphisms in the angiotensin-I converting enzyme and the angiotensin II receptor type 1 with the 'Fulker' test. Both linkage and association were tested simultaneously revealing whether the polymorphism is a Quantitative Trait Locus (QTL) or in linkage disequilibrium with the QTL. RESULTS: Genetic influences explained up to 46% of the phenotypic variance in diastolic and 63% of the phenotypic variance in systolic blood pressure. Genetic influences were stable over time and contributed up to 78% of the phenotypic correlation in both diastolic and systolic blood pressure. Non-shared environmental effects were characterised by time specific influences and little transmission from one time point to the next. There was no significant linkage and association between the polymorphisms and blood pressure. CONCLUSIONS: There is a considerable genetic stability in both diastolic and systolic blood pressure for a 6-year period of time in adult life. Non-shared environmental influences have a small long-term effect. Although associations with the polymorphisms could not be replicated, results should be interpreted with caution due to power considerations.

Aged↗
PubMedDate not supplied

Variation in zinc, calcium, and magnesium concentrations of human milk within a 24-hour period from 1 to 6 months of lactation.

Longitudinal changes in nutrient levels of human milk have been observed with the progression of lactation, but less is known about changes at different feedings during a 24-h period. In this study, calcium, magnesium, and zinc levels were examined in milk obtained from 49 women at every breast feeding during one 24-h period each month for the first 6 months of lactation. Magnesium and zinc concentrations showed significant diurnal variation at each stage of lactation examined, whereas calcium levels were relatively constant. Maximum variations of 7.5, 17, and 48% were observed within a 24-h period in mean levels of calcium, magnesium, and zinc, respectively. Irrespective of variability, zinc and magnesium concentrations in a single milk sample obtained between 10:00 a.m. and 2:00 p.m. were highly correlated with the mean value of samples collected at each feeding during a 24-h period.

Adult↗
PubMed1998

Whey protein/casein ratio and nonprotein nitrogen in preterm human milk during the first 10 days postpartum.

BACKGROUND: This study was designed to describe the longitudinal changes in the casein and whey fractions and the total and nonprotein nitrogen contents of preterm human milk for the first 10 days postpartum. METHODS: Eleven mothers delivering at 30 to 34 weeks of gestation were studied, six throughout the first 10 days and five on the first postpartum day. Four milk samples were collected every day by expression of one breast with an electric breast pump. Casein and whey protein were separated from the defatted milk by isoelectric precipitation in calcium chloride and by subsequent ultracentrifugation. The milk nitrogen content was determined before and after acid precipitation. Whey protein and casein were characterized by electrophoresis in polyacrylamide gel. RESULTS: Total and protein nitrogen showed a sharp decrease during the first 3 postpartum days, whereas the nonprotein nitrogen did not change markedly (mean concentration, 0.58 mg.ml-1). Casein content expressed as nitrogen in preterm human milk was 0.35 mg.ml-1 between days 3 and 5 and 0.60 mg.ml-1 between days 6 and 10. The whey protein-casein ratio before day 2, was 100:0, at day 3, 86:14, at day 5, 76:24, and at day 10, 70:30. Three days after delivery, casein levels rose progressively, increasing markedly after day 6. CONCLUSIONS: These findings suggest that delivering before term affects neither casein production nor its chemical characteristics.

Caseins↗
PubMed1996

Longitudinal evaluation of vocal function after thyroplasty type I in the treatment of unilateral vocal paralysis.

This study investigated longitudinal changes of vocal efficiency and stability after primary thyroplasty type 1. Fifty-three patients with unilateral vocal-fold paralysis underwent vocal-function evaluation preoperatively and at periodic intervals of 1, 3, and 6 months postoperatively. Vocal-function assessment included videostrobolaryngoscopic examination, acoustical and aerodynamic analysis, and perceptual judgment of voice characteristics. Parameters that included glottic-gap size, maximum phonation time, glottic-flow rate, jitter, harmonic/noise ratio, breathiness, hoarseness, loudness, and phrasing showed significant improvement after thyroplasty and remained stable as early as 1 month postoperatively, with only slight fluctuations over a 6-month period. Postoperative voice outcome was not affected by age, sex, duration of vocal symptoms, cause of paralysis, or preoperative pulmonary function.

Adolescent↗
PubMed1976

21. The National Center for Health Statistics; long-term care surveys.

The NCHS has been conducting ad hoc surveys of nursing homes and other long-stay institutions since 1963. Growing public concern about the quality of care in nursing homes has provided the support to expand these data collection activities and establish a biennial program, commencing with the 1973-74 Nursing Home Survey. Based on a national probability sample, the new program collects a wide range of data about the health status and demographic characteristics of residents, availability of personnel and services, facility characteristics, costs, charges, and sources of payment. Among the problems common to these surveys are the difficulties of measuring quality of care, assessing the actual cost of services or episodes of illness, classifying long-term care establishments, and adapting survey methods to measure longitudinal changes in health status of residents and the corresponding provision of services.

Costs and Cost Analysis↗
PubMed2004

Refractive astigmatism and the toricity of ocular components in human infants.

PURPOSE: Many studies have characterized astigmatism in infancy, but few have been longitudinal or contained ocular component data. This study characterized the frequency, orientation, and longitudinal change with age of infant astigmatism. Additional factors investigated were the influence of early astigmatism on emmetropization and its relation to corneal and lenticular toricity. METHODS: Three hundred two infants were enrolled in the study. Of these, 298 provided data for at least one visit at 3 +/- 1 months, 9 +/- 1 months, 18 +/- 2 months, and 36 +/- 3 months. Testing included cycloplegic retinoscopy (cyclopentolate 1%), video-based keratophakometry, and ultrasonography over the closed eyelid. RESULTS: Astigmatism > or =1.00 DC was common at 3 months of age (41.6%) but decreased in prevalence to 4.1% by 36 months (p < 0.0001). The most common orientation was with-the-rule at 3 months (37.0% compared with 2.7% for against-the-rule) but against-the-rule at 36 months (3.2% compared with 0.9% for with-the-rule). Most of the change in the average value of the horizontal/vertical component of astigmatism (J0) occurred between 3 and 9 months (-0.26 +/- 0.36 D; p < 0.0001) with no significant change between 9 and 36 months (-0.05 +/- 0.36 D; p=0.09). Spherical equivalent refractive error was not correlated with J0 at 3 and 9 months (R=0.002, p=0.48 and R=0.001, p=0.56, respectively). The two were only weakly correlated at 18 and 36 months (R=0.06 for each age, p <0.0001, p=0.0002, respectively). Changes in spherical equivalent between 3 and 9 months were unrelated to either the initial value of J0 (partial R for J0=0.0001; p=0.85) or the change in J0 (partial R for change in J0=0.0031; p=0.31). Across all the ages, corneal toricity was with-the-rule, and lenticular toricity was against-the-rule (produced by the toricity of the posterior lens surface). The cornea and anterior lens surface became more spherical with age, contributing to the shift away from with-the-rule refractive astigmatism. Toricity of all the refractive surfaces became less variable with age. CONCLUSIONS: Consistent with many reports, astigmatism was common in early infancy but decreased in prevalence with age, particularly when with-the-rule in orientation. The reduction in percentage of infants with astigmatism appeared to be caused by decreases in the toricity of the cornea and the anterior lens combined with decreases in the variability of corneal and lenticular surfaces. Astigmatism in infancy appeared to be unrelated to emmetropization of spherical equivalent refractive error.

Age Distribution↗
PubMed1999

Identification of kidneys subjected to preretrieval warm ischemic injury by simultaneous monitoring of glomerular filtration and perfusate flow during hypothermic perfusion preservation.

BACKGROUND: Historically, ex vivo physiological evaluation of cadaveric renal allografts has been limited to assessing perfusate flow (PF) during hypothermic perfusion preservation (HPP). Using a small animal model, we have previously described a method for continuous monitoring of glomerular filtration rate (GFR) during HPP. Our study was undertaken to determine if monitoring GFR and PF during HPP distinguished kidneys subjected to preretrieval warm ischemic (WI) injury more reliably than PF alone. METHODS: In situ WI was induced in Lewis rats (n=10) by extrinsic occlusion of the suprarenal aorta for 30 min. After in situ cold perfusion and retrieval, the left kidney underwent 16 hr of HPP. Nonischemic (NI) control kidneys (n=10) were retrieved in the absence of suprarenal aortic occlusion. Longitudinal changes in PF, GFR, and filtration fraction (FF) during HPP were compared in WI versus NI kidneys (FF=GFR/PF x 100%). RESULTS: PF remained the same in both cohorts throughout HPP. GFR, however, increased to a significantly greater degree in WI versus NI kidneys during the first 4 hr of HPP (713+/-401 vs. 26+/-23%, respectively) (P<0.05). The increase in FF at 4 hr was 1203+/-696% in the WI kidneys versus 83+/-46% in the NI controls (P<0.05). CONCLUSIONS: In contrast to PF alone, measurement of both PF and GFR distinguished kidneys subjected to pre-WI from NI controls. The data provide a means to determine if monitoring of both GFR and PF during HPP will predict short- and long-term renal allograft function more reliably than PF alone.

Animals↗
PubMed2002

Medical surveillance of clandestine drug laboratory investigators.

Law enforcement officers investigating clandestine drug laboratories may be exposed to a wide range of hazardous chemicals. This study was conducted to determine the extent of persistent health effects seen in California drug laboratory investigators after occupational exposure. Study participants with a minimum of 1 year of laboratory investigations completed a questionnaire evaluating occupational and personal health history and consented to review of their medical surveillance examinations and administrative records. The 40 participating investigators averaged 6.1 +/- 2.5 annual medical evaluations for the period 1991 to 1998. Average annual decline in forced expiratory volume in 1 second (FEV1) was 64.0 +/- 138.0 mL/year (median, 40.0 mL/year). For 34 subjects with valid exposure data, longer duration use of respiratory protection was associated with a less rapid decline in FEV1, whereas lack of respiratory protection during the processing phase of laboratory investigation was associated with a more rapid annual decline. There were no significant longitudinal changes in serum alanine aminotransferase, serum aspartate aminotransferase, hemoglobin, and white blood cell count, although platelets declined slightly. Law enforcement personnel investigating clandestine drug laboratories may have long-term respiratory effects from chemical exposure, for which more assiduous use of respiratory protection is recommended.

Adult↗
PubMed2004

Is chronic airway obstruction from cotton dust exposure reversible?

BACKGROUND: Exposure to cotton dust is known to cause chronic airway obstruction, but there is little information on whether the obstructive impairment is reversible after the exposure stops. METHODS: Longitudinal changes in lung function were evaluated among 429 cotton textile workers and 449 silk workers in Shanghai, China, beginning in 1981. Both active and retired workers were tested every 4 to 6 years for 15 years. RESULTS: Overall, cotton workers had greater annual declines in forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC). Compared with active workers, retired cotton workers had lower annual loss of FEV1, although the retired workers had a greater loss during their active employment than the currently active workers. No such trends were detected in silk workers. Annual declines in FEV1 in retired cotton workers were smaller with increasing time since retirement. Multivariate analysis showed that retirement was a substantial contributing factor for improved FEV1 and FVC in the cotton workers, especially among those who did not smoke. Correspondingly, remission of airflow obstruction, defined as a ratio of FEV1 and FVC of less than 70%, was more common in retirees than in the active workers, and more common in nonsmokers than in smokers. CONCLUSION: Chronic airway obstruction related to long-term exposure to cotton dust may be partially reversible after the exposure ceases, although lung function does not return to the level found in unexposed workers.

Adult↗
PubMed2005

Postmenopausal oral estrogen therapy and blood pressure in normotensive and hypertensive subjects: the Estrogen in the Prevention of Atherosclerosis Trial.

OBJECTIVE: To determine if 17beta-estradiol increases blood pressure in postmenopausal women. DESIGN: A total of 222 healthy postmenopausal women were randomly assigned to either 1 mg micronized 17beta-estradiol daily or placebo for 2 years. Blood pressure measurements were obtained every other month and common carotid artery intima-media thickness measured every 6 months. Statistical analyses comparing longitudinal changes in systolic and diastolic blood pressure between treatment groups used a mixed general linear model including interaction terms to evaluate variations by age or estradiol level. RESULTS: Both placebo and estradiol groups showed small declines in systolic and diastolic blood pressure during the trial among the normotensive subjects and subjects on antihypertensive medications. However, the decline did not differ significantly between the groups. Treatment effects on systolic blood pressure differed significantly by the age of the subject (interaction P value = 0.04) with younger women on estradiol showing on average a rise in systolic blood pressure, and older women a decline. The association between serum estradiol level and systolic blood pressure showed a similar modification with age (P = 0.03). Changes in systolic blood pressure in women on estradiol were positively correlated with intima-media thickness progression (P = 0.03). CONCLUSIONS: Overall, 17beta-estradiol did not influence changes in blood pressure in normotensive or hypertensive women. The effect of 17beta-estradiol treatment on systolic blood pressure may be influenced by a woman's age. Estradiol may increase systolic blood pressure in younger postmenopausal women, while having the opposite effect in older postmenopausal women.

Age Factors↗
PubMed2003

Heterogeneity of 5 alpha-reductase gene expression in benign prostatic hyperplasia.

PURPOSE: The search for molecular markers of benign prostatic hyperplasia in general is based on an analysis of a limited number of biopsy samples. Little is known about the homogeneity of the expression of key genes in different zones of the prostate. We studied the intraprostatic (that is within the same gland) and inter-prostatic (that is between glands) variability of 5 alpha-reductase 2 (5aR2) gene expression. MATERIALS AND METHODS: Ten tissue samples removed by open prostatectomy were the source of tissue specimens. Two frozen sections were generated from each of several random biopsies taken from each adenoma immediately after enucleation, 1 of which was used for 5aR2 gene expression analysis and 1 for morphometric analysis. Results among biopsies were compared using the 5 alpha-reductase index (ratio of 5 alpha-reductase expression to an internal standard measured as electrophoretic band intensity). Morphometric composition was determined for smooth muscle, collagen, epithelium and glandular lumens. Statistical comparisons were performed with ANOVA by pairwise multiple comparison (Dunn) and Spearman's rank correlation procedure. RESULTS: For the 71 biopsies analyzed mean 5 alpha-reductase index was 0.23 +/- 0.16 and overall tissue distribution was smooth muscle 34%, collagen 35%, epithelium 14% and glandular lumens 17%. Inter-prostate and intraprostate variability in 5 alpha-reductase index was statistically significant (p = 0.004) as was the variability in stromal-to-epithelial ratio (p = 0.012). The 5 alpha-reductase index showed strong correlation with stroma (%) and negative correlation with epithelium (%). CONCLUSIONS: Benign prostatic hyperplasia is heterogeneous in terms of tissue morphometry and expression of single important genes. This finding limits the use of single biopsy based markers to predict biological behavior, and has significant impact on the ability of distinguishing longitudinal changes in tissue composition from sampling artifacts.

3-Oxo-5-alpha-Steroid 4-Dehydrogenase↗
PubMed2004

What is the fate of the refluxing contralateral kidney in children with multicystic dysplastic kidney?

PURPOSE: We clarify the natural history of contralateral vesicoureteral reflux (VUR) in children with multicystic dysplastic kidney (MCDK), including its impact on long-term renal growth. MATERIALS AND METHODS: We performed a retrospective cohort study of 75 patients with MCDK. The primary outcomes were resolution of contralateral VUR and long-term renal growth. The Kaplan-Meier method was used to compare time to spontaneous resolution based on VUR grade. Mixed regression models were used to compare longitudinal changes in sonographic renal length. RESULTS: Contralateral VUR was present in 19 of the 75 cases (26.4%) and was low grade (I-II) in 9. After a median followup of 4.4 years spontaneous resolution was more common in patients with grades I and II (89%) versus grades III and IV VUR (50%) (p = 0.14). Median time to resolution did not differ by grade (20.1 vs 31.3 months, p = 0.3). One child underwent ureteral reimplantation and no patients had hypertension or renal insufficiency. Mixed regression analysis demonstrated no significant difference in the annual increase in renal length based on VUR status (p >0.20). CONCLUSIONS: In the largest series to date of patients with MCDK and contralateral VUR we found that spontaneous resolution in a relatively short period can be anticipated for most children. Furthermore, VUR is not a significant threat to the growth of the solitary renal unit in the first few years of life.

Cohort Studies↗
PubMed2004

Health-related quality of life among patients with breast cancer receiving zoledronic acid or pamidronate disodium for metastatic bone lesions.

BACKGROUND: Research on individual differences in health-related quality of life (HRQOL) can identify intervention targets and important covariates in analyses of treatment outcomes. OBJECTIVES: The objectives of this study were to describe HRQOL trajectories for women with metastatic breast cancer in a randomized trial of bisphosphonates and to identify characteristics associated with variations in HRQOL. RESEARCH DESIGN: We conducted a prospective quality-of-life study within a randomized, controlled trial. SUBJECTS: We studied women with metastatic breast cancer receiving zoledronic acid or pamidronate disodium to reduce the incidence of skeletal-related events (SREs). MAIN OUTCOME MEASURES: HRQOL was measured at fixed time points during the trial. Individual growth-curve modeling was used to describe longitudinal trajectories and to identify predictors of trajectories. RESULTS: For most domains of HRQOL, the mean trajectory reflected a mild increase, which leveled off later in the trial. Older age and full-time employment were associated with higher baseline HRQOL. Longer time from cancer diagnosis to randomization, lower Eastern Cooperative Oncology Group (ECOG) status (score of 2 ["inactive"]), and a history of SREs were associated with lower baseline HRQOL. Significant differences across geographic regions were observed for all domains. Active ECOG status (score of 0-1) at baseline was predictive of greater increases in all domains of HRQOL except Social/Family Well-Being. Age, geographic region, and time from first bone metastases to randomization were associated with longitudinal changes in some domains. CONCLUSIONS: Women with metastatic breast cancer receiving bisphosphonates for prevention of SREs experienced an overall increase in HRQOL. Variations among women's experiences are explained partly by such characteristics as a history of SREs.

Bone Neoplasms↗