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This work was aimed at evaluating the role of teleradiology in a diagnostic emergency room. Over a 6-month period (September 1991-February 1992), 2,000 films made in the emergency room were transmitted to a resident radiologist 1 kilometer away: each examination included patient's data (sex, age, site of trauma, etc.) which were sent by the admitting physician. A teleradiology system (Lumiscan 100 AT&T and Philips) was used. Films were digitized on a 1024 x 1024 x 8-bit image matrix and then transmitted over a dedicated standard phone line to the Department of Radiology. The autograph report was sent by fax to the emergency room. Four radiologists, of varying experience, independently reviewed a sample of 179 digitized radiographs and, 30 days later, the original films on a conventional light-box. The results appear to be encouraging because no significant differences were observed in the performance of any of the radiologists. Good video/films agreement was obtained, together with high sensitivity and specificity. A good result was the relatively small number (0.4% of all examined cases) of false negatives diagnosed on faxed films relative to the actual clinical diagnosis.
Bone metabolism in humans and several animal species can be monitored in vivo by measuring enzymes and other protein products released by osteoblasts and osteoclasts, respectively. Bone mineral density (BMD) and content (BMC) can be determined by peripheral quantitative computer tomography (pQCT). Another approach is to measure histomorphometric indices of bone biopsies. The biochemical markers of bone formation currently in use include bone isoenzyme of alkaline phosphatase, osteocalcin and propeptides derived from the N or C terminal ends of the type I procollagen molecule. The longest established method for the measurement of bone resorption is hydroxyproline in urine. However, it is not specific for bone, since it is found in all collagen types and it can also derive from the diet. The most useful markers of bone resorption are breakdown products of type I collagen. The measurement of collagen crosslinks, deoxypyridinoline and pyridinoline, is comparatively more specific to monitor bone resorption. Deoxypyridinoline and pyridinoline are of use in human medicine in the diagnosis and evaluation of bone diseases and in the prediction of the occurrence of fractures and the rates of bone loss. The carboxyterminal telopeptide of type I collagen, which has been used in several animal species, is also a promising bone resorption marker. This overview gives a general idea about the use of different bone markers and measurements of other bone parameters in ruminants during growth, gestation and lactation in relation to calcium metabolism.
This project was to develop a web based wireless system to be used by community care nurses. Wound care constitutes approximately one half of home health care nursing visits. The system was implemented with a digital camera and a handheld computer with a wireless connection to a web based server. A database was used to control access to the clinical cases and to serve as a data repository. When new images were uploaded to the server a wound expert was notified via pager. The images and data could be viewed from any computer with an internet connection.
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We evaluated bone adaptation of the tibia to mechanical stresses in male marathon runners and in sedentary controls in function of the ground impact measured by accelerometry and of the bone mineral density assessed by peripheral quantitative computed tomography (QCT). Sixty-three subjects (51 runners and 12 controls) were enrolled. All had measurements of bone mineral density of the proximal tibia and of acceleration at the same site during a jogging at 9 km/hour. The results show a significant higher cortical BMD in runners with the higher value of late accelerations (at 50 ms after the contact with the ground). The late acceleration might be related to muscle contraction.
Bone densitometric data often are difficult to interpret in children and adolescents because of large inter- and intraindividual variations in bone size. Here, we propose a functional approach to bone densitometry that addresses two questions: Is bone strength normally adapted to the largest physiological loads, that is, muscle force? Is muscle force adequate for body size? To implement this approach, forearm muscle cross-sectional area (CSA) and bone mineral content (BMC) of the radial diaphysis were measured in 349 healthy subjects from 6 to 19 years of age (183 girls), using peripheral quantitative computed tomography (pQCT). This functional approach to pediatric bone densitometric data should be adaptable to a variety of densitometric techniques.
We investigated the effects of grape seed proanthocyanidins extract (GSPE) on bone formation by examining total and cortical bone mass, density, architecture, and strength non-invasively using mandibular condyles of Ca-restricted rats. Forty Wistar male rats, each 5 weeks old, were divided into control (C), low-Ca diet (LCaD), low-Ca diet-standard diet (LcaD x SD), and low-Ca diet x Estandard diet with supplementary GSPE (LcaD x SD+GSPE) groups. In LCaD x SD group, after the bone debility was induced by low-Ca diet, a standard diet therapy was given. In LCaD x SD+GSPE group, after the bone debility was induced by low-Ca diet, a standard diet therapy with supplementary GSPE was given. Each mandibular condyle was examined using peripheral quantitative computed tomography (pQCT). There were no significant inter-group differences in body weight seen throughout the experimental period. In LcaD x SD+GSPE, cortical bone cross-sectional area and mineral content were not significantly different from C, while bone mineral content was significantly higher in LcaD x SD+GSPE than in LcaD x SD. Cortical bone density of LcaD x SD+GSPE was not significantly different from that of C, however, that value in LCaD and LcaD x SD was significantly lower than that. The cross-sectional (bending) moment of inertia values in LcaD x SD+GSPE were the highest among all groups, though they did not differ significantly from those in C. Further, the cross-sectional (bending) Stress/Strain Index (SSI) values in LcaD x SD+GSPE were statistically similar to those in C, however, not significant higher than in LcaD x SD. These results suggest that GSPE treatment would increase both bone mass and bone strength on the rat mandibular condyles.
Changes in the organ of vision as well as dependence of the changes on load intervals were studied during sessions of using the computer. Some functional changes in the eye, which are within the norm limits, can be pointed out in monitor users. The functional changes in the eye in 2-hour computer session are comparable to those observed in 1-hour session, however, they are more pronounced in the former case--there is trend towards an enhanced refraction and exophoria (in near) at a reduced volume of accommodation due to a higher volume of relative accommodation and of its reserve. A reliably shorter interval of the lachrymal-film rupture was registered in declining tear production. Reliably intensifying changes in the functional parameters between 2 above time loads could denote a negative effect from more time spent at monitor on the eye.
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Our study was designed to examine the validity of dual energy X-ray absorptiometry (DXA) and peripheral quantitative computed tomography (pQCT) measurements as predictors of whole bone breaking strength in beagle femora. DXA was used to determine the bone mineral content, bone area, and 'areal' bone mineral density. PQCT was used to determine the cross-sectional moments of inertia, volumetric densities of the bone, and to calculate bone strength indices based on bone geometry and density. A three-point bending mechanical test was used to determine maximal load. Three variables from the pQCT data set explained 88% of the variance in maximal load, with the volumetric bone mineral density explaining 32% of the variance. The addition of the volumetric cortical density increased the adjusted r(2) to 0.601 (p=0.001) and the addition of an index created by multiplying volumetric cortical bone density by the maximum cross-sectional moment of inertia made further significant (p<0.001) improvements to an adjusted r(2) of 0.877. In comparison, when only the DXA variables were considered in a multiple regression model, areal bone mineral density was the only variable entered and explained only 51% (p<0.001) of the variance in maximal load. These results suggest that pQCT can better predict maximal load in whole beagle femora since pQCT provides information on the bone's architecture in addition to its volumetric density.
The densities and cross-sectional areas (CSAs) of the femur in 40- and 60-week-old senescence-accelerated mice prone 6 (SAMP6) were determined using peripheral quantitative computed tomography (pQCT) and compared with those in age-matched control mice (ICR). In addition, the effects of 20 weeks of voluntary running exercise with increasing loads on femur density and CSA were examined in SAMP6. There were no differences in the cortical and trabecular densities or CSAs between the 40- and 60-week-old ICR. The cortical and trabecular densities of the 60-week-old control SAMP6 were lower than those of the 40-week-old control SAMP6. There was no difference in the cortical CSA between the 40- and 60-week-old control SAMP6, while the trabecular CSA of the 60-week-old control SAMP6 was higher than that of the 40-week-old control SAMP6. It was concluded that an age-related decline in femur cortical and trabecular densities occurs at an earlier age in control SAMP6, indicating that SAMP6 show accelerated progression of age-associated osteoporosis. There were no differences in the cortical density between the 40-week-old control and 60-week-old exercised SAMP6. These data indicate that running exercise with increasing loads prevents age-associated osteoporosis in this senescence-accelerated mouse strain.
BACKGROUND: Maximal bone acquisition in adolescent girls through dietary and lifestyle practices is advocated to prevent or minimize the development of osteoporosis and its associated complications in later life. Longitudinal investigations of bone acquisition in children and adolescents have utilized areal bone mineral density (BMD, mg/cm(2)) as a measure of bone mass and strength. Peripheral quantitative computed tomography (pQCT), which provides a three-dimensional display of data, separate analyses of bone compartments, and bone mass in terms of volumetric BMD (vBMD, mg/cm(3)), has recently been introduced for clinical use. OBJECTIVE: To assess the impact of a 12-month daily calcium supplement on total and trabecular bone acquisition as measured by pQCT in preadolescent girls. DESIGN: Early adolescent Caucasian girls (aged 12 years, Tanner Stage 2) were enrolled in a randomized trial of daily calcium supplement (TX, 800 mg calcium carbonate and 400 IU vitamin D) or placebo (C). Body weight, height, and distal tibia measurements by pQCT were obtained at enrollment, 6 and 12 months. Pubertal status and physical activity records were assessed at baseline and 12 months. Three-day food intake records were completed every three months. RESULTS: Seventy-one girls completed the 12-month trial (TX=35, C=36). No differences were found for age, weight, height, body mass index, pubertal maturation, or reported physical activity at enrollment or during the study. Average intakes during the study were 1524 mg calcium and 496 IU vitamin D (TX) versus 865 mg calcium and 160 IU vitamin D (C) per day. Baseline total bone values were similar, however, trabecular values were greater in TX girls despite randomization. Percent changes were calculated to adjust for baseline differences. Because of the small cortical thickness at the 10% site (mean values < 1.6 mm), cortical mass and density were not analyzed. The percent changes for trabecular bone mineral content (BMC, mg) and vBMD were significantly greater in TX girls (+4.1% BMC and +1.0% vBMD TX versus -1.6% BMC and -2.0% vBMD C, p<0.006; ANCOVA) after 12 months of supplement. Trabecular bone area (BA, cm(2)) and total bone change, however, did not differ between groups. CONCLUSIONS: Daily calcium and vitamin D supplementation promotes greater trabecular BMC and vBMD acquisition in preadolescent girls. The single site selected for pQCT evaluation in this study did not allow evaluation of the cortical bone compartment. Future studies that utilize the pQCT technique need to incorporate multiple measurement sites to better assess total, cortical, and trabecular bone.
Animal models are suitable to study many aspects of bone structure and strength. This article reviews some general principles of current bone biomechanics and describes the scope of the available methodology for biomechanical studies of the musculoskeletal system employing those models. The analysis comprises bone and muscle "mass" indicators provided by standard densitometry (DEXA); bone 'mass', 'apparent density', geometry or architectural design and strength and muscle strength indicators that can be determined by peripheral quantitative computed tomography (pQCT), and bone material and structural (whole-bone) properties than can be directly assessed by destructive mechanical tests. Some novel interrelationships that can be investigated that way are discussed, namely, 1. the pathogenetic analysis of the effects on whole-bone strength, 2. the discrimination between mineralization and microstructural factors as determinants of changes in the bone material or structural properties, 3. the evaluation of the interaction of a treatment with the ability of bone 'mechanostat' to optimize the bone architectural design by 'distribution / mass' and 'distribution / quality' curves, and 4. the analysis of effects on the musclebone interactions for a differential diagnosis between 'physiological' or 'disuse' and 'true' osteopenias and osteoporoses.
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We studied the effects of grape seed proanthocyanidins extract (GSPE) given as a ratio of 3 mg in 100 g in a standard diet, on the tibial bone diaphysis in low-calcium fed rats. Measurements of bone density, mineral content, geometry, and bone strength using peripheral quantitative computed tomography (pQCT). Further, the whole tibia bones were tested for mechanical resistance using a material-testing machine, and mineral elements were also determined. Forty male Wistar rats, 5 weeks old, were divided into control (Co), low-calcium diet (LC), low-calcium diet . standard diet (LCS), and low-calcium diet . standard diet with supplementary GSPE (LCSG) groups. We found no significant differences in body weight among the 4 groups, whereas all of the bone parameters in LC were significantly lower than those in Co (p<0.01, except in periosteal perimeter (Peri) p<0.05). The cortical bone mineral content (CtBMC), cortical bone density (CtvBMD) and Peri in LCSG were significantly higher than those in LCS (p<0.01; p<0.01; p<0.05, respectively). All bone parameters in LCSG were significantly higher than those in LC (p<0.01, except in Peri, and stress strain index to reference axis x (xSSI) p<0.05)). In addition, Ca, P, and Zn contents in LCSG were significantly higher than those in LCS (p<0.01; p<0.01; p<0.05, respectively). Our results suggest that GSPE included in a diet mixture with calcium has a beneficial effect on bone formation and bone strength for the treatment of bone debility caused by a low level of calcium.
OBJECTIVE: Compared with 17beta-estradiol, to evaluate the effects of estradiol valerate on osteopenia in ovariectomized rats. METHODS: Forty two six months old female Wistar rats were randomly divided into 5 groups performed ovariectomy (OVX) or sham-operation. (1) 6 weeks after OVX (Ovxb, n = 8): sacrificed at 6 weeks after OVX; (2) Sham ovariectomized (n = 8); (3) 14 weeks after OVX (Ovxe, n = 8); (4) 17beta-estradoil treated group (O + E, n = 9, with 17beta-estradiol 20 microg x kg(-1) x d(-1) Sc.); (5) Estradoil valerate treated group (O + EV, n = 9, with estradiol valerate 800 microg x kg(-1) x d(-1) po). Treatment started 6 weeks after OVX and lasted for 8 weeks. Histomorphometry analysis of tibia, peripheral quantitative computed tomography (pQCT) scanning of femur, bone biomechanical test in femur were performed. RESULTS: OVX induced osteopenia and increase of bone turnover. Compared with Ovxe, O + E and O + EV caused an evident reduction of urinary deoxypyridinoline/creatinine, a bone resorption marker, by 54.6% and 77.4% respectively (all P < 0.01). Both O + E and O + EV lowered the high level of eroded surface, mineral surface and bone formation rate induced by OVX. An increase of 122.3% and 119.7% in trabecular bone volume respectively in O + E and O + EV group, compared with Ovxe group. Microarchitecture of trabeculea also improved in those two groups. The trabeculae bone mineral density determined by pQCT were significantly increased in O + E and O + EV compared with Ovxe group (99.5% and 128.4% P < 0.01). Similarly, significant increases were found in cancellouse maximal load and canceallous stiffness of distal femur in O + E, but not O + EV. There was no significant difference in these changes between the group O + E and O + EV. CONCLUSION: Oral estradiol valerate performed effects similar to those of 17beta-estradiol Sc. in inhibiting bone turnover, protecting bone loss and increasing bone mineral density of trabecular bone.
Digital radiography is gaining in popularity and many dentists are considering changing from a film-based system to this new technology. Dentists must clearly define their objectives for adopting digital radiography and be aware of the problems that may be encountered with this equipment, so that they can make an informed purchasing decision. This article provides an overview of digital radiographic equipment, experiences users have had with this technology and factors to consider when deciding to purchase a DR system.