Hip Bone Research Articles

Atypical Presentation of Metastatic Castrate-resistant Prostate Cancer in a Middle Aged African Male with Good Response to Radioligand Therapy.

Prostate cancer typically follows a characteristic pattern of metastatic spread to the pelvic lymph nodes and bone. Atypical patterns of metastasis are rare but have been documented. In African men, this disease tends to follow a more aggressive course, with the possibility of an atypical site of metastatic spread. We present a case of a 58-year- old African male with metastatic castrate-resistant prostate cancer who presented with both typical and atypical patterns of metastatic disease detected by a fluorine 18 prostate-specific membrane antigen positron emission tomography/computed tomography scan. This patient also had a good response to radioligand therapy.

Upaya Pemberdayaan Kader dan Ibu Hamil tentang Senam Hamil untuk Mengatasi Ketidaknyamanan Kehamilan pada Ibu Hamil di Posyandu Kinasih Banjarsari Surakarta

Pregnancy exercise is a form of structured exercise or exercise. Exercising on a regular basis will improve blood circulation, strengthen muscles and flex joints and can reduce common disorders during pregnancy such as aches, back pain, muscle stiffness, constipation, and reduce leg swelling. Doing pregnancy exercise regularly can reduce lower back pain, one of which is by kneeling, rotating the pelvic bones, bending the buttocks, bending the knees, chest. The purpose of this community service is that after receiving counseling it is hoped that pregnant women and Health Cadres members of Posyandu Kinasih, Banjarsari Subdistrict, Surakarta can apply and be able to provide education to pregnant women to carry out pregnancy exercise to overcome discomfort in pregnant women. The target of counseling activities about pregnancy exercise is all Health Cadres and pregnant women in the Banjarsari Village, Surakarta. The expected output of pregnancy exercise counseling activities for cadres and members of the Balita Kinasih Posyandu in Banjarsari Surakarta Village is an increase in knowledge and skills about pregnancy exercise for mothers and cadres. The results of community service are that after counseling cadres and pregnant women become more knowledgeable, understand about pregnancy exercise as evidenced in the results of the evaluation through the distribution of questionnaires, the average value of the level of knowledge is from 70% to 90%. Based on the implementation of community service, it can be concluded that there is an increase.

Nonalcoholic Fatty Liver Disease, Bone and Muscle Quality in Prolactinoma: A Pilot Study

Objective: Hyperprolactinemia has negative impacts on metabolism and musculoskeletal health. In this study, individuals with active prolactinoma were evaluated for nonalcoholic fatty liver disease (NAFLD) and musculoskeletal health, which are underemphasized in the literature.Methods: Twelve active prolactinoma patients and twelve healthy controls matched by age, gender, and BMI were included. Magnetic resonance imaging-proton density fat fraction (MRI-PDFF) was used to evaluate hepatic steatosis and magnetic resonance elastography (MRE) to evaluate liver stiffness measurement (LSM). Abdominal muscle mass, and vertebral MRI-PDFF was also evaluated with MRI. Body compositions were evaluated by dual energy X-ray absorptiometry (DXA). The skeletal muscle quality (SMQ) was classified as normal, low and weak by using “handgrip strength/appendicular skeletal muscle mass (HGS/ASM)” ratio based on the cut-off values previously stated in the literature.Results: Prolactin, HbA1c and CRP levels were higher in prolactinoma patients (p<0.001, p=0.033 and p=0.035, respectively). The median MRI-PDFF and MRE-LSM were 3.0% (2.01-15.20) and 2.22 kPa (2.0-2.5) in the prolactinoma group and 2.5% (1.65-10.00) and 2.19 kPa (1.92-2.54) in the control group, respectively and similiar between groups. In prolactinoma patients, liver MRI-PDFF showed a positive and strong correlation with the duration of disease and traditional risk factors for NAFLD. Total, vertebral and pelvic bone mineral density was similar between groups, while vertebral MRI-PDFF tended to be higher in prolactinoma patients (p=0.075). Muscle mass and strength parameters were similar between groups, but HGS/ASM tended to be higher in prolactinoma patients (p=0.057). Muscle mass was low in 33.3% of prolactinoma patients and 66.6 of controls. According to SMQ, all prolactinoma patients had normal SMQ, whereas 66.6% of the controls had normal SMQ.Conclusion: Prolactinoma patients demonstrated similar liver MRI-PDFF and MRE-LSM to controls despite their impaired metabolic profile and lower gonadal hormone levels. Hyperprolactinemia may improve muscle quality in prolactinoma patients despite hypogonadism.

Radiological Anatomy of the Pelvis and Pelvic Limb of the Greater Cane Rat (Thryonomys swinderianus).

Greater cane rats (Thryonomys swinderianus) are now being captive reared and domesticated in the sub-Saharan Africa because of increase in their demand for biomedical research and traditional medicine and as a source of meat. This research was performed to provide the normal radiological anatomy of the pelvis and pelvic limb in greater cane rats for a reference in biomedical research, in anatomical studies, and in clinical use. Radiological examination of the pelvis and right pelvic limb was done in five greater cane rats. Radiological results were correlated with bones of the pelvis and right pelvic limb. The pelvic bone had a prominent caudoventral iliac spine. The pelvic symphysis was long and obturator foramina appeared teardrop-shaped elongated craniocaudally. The prominent major trochanter extended proximally higher than the femoral head. The middle third of the body of the tibia presented a very prominent tuberosity. In all specimens, the tarsal sesamoid bone was visualised. Mineralised popliteal sesamoid bone was not visualised. In male greater cane rats, the os penis was visualised. The lateral and medial menisci of the stifle joint were seen with ossicles. The first metatarsal bone was rudimentary with greater plantar divergence. Despite of the pelvic limb and pelvis of greater cane rats sharing anatomical structures with other rodents, it retains some exceptional anatomical features. Findings of this study will serve as a reference for anatomical studies, clinical veterinary practice, and in biomedical research.

3D-modeling from hip DXA shows improved bone structure with romosozumab followed by denosumab or alendronate.

Romosozumab treatment in women with postmenopausal osteoporosis increases bone formation while decreasing bone resorption, resulting in large BMD gains to reduce fracture risk within 1yr. DXA-based 3D modeling of the hip was used to assess estimated changes in cortical and trabecular bone parameters and map the distribution of 3D changes in bone parameters over time in patients from 2 randomized controlled clinical trials: FRAME (romosozumab vs placebo followed by denosumab) and ARCH (romosozumab vs alendronate followed by alendronate). For each study, data from a subset of ~200 women per treatment group who had TH DXA scans at baseline and months 12 and 24 and had provided consent for future research were analyzed post hoc. 3D-SHAPER software v2.11 (3D-SHAPER Medical) was used to generate patient-specific 3D models from TH DXA scans. Percentage changes from baseline to months 12 and 24 in areal BMD (aBMD), integral volumetric BMD (vBMD), cortical thickness, cortical vBMD, cortical surface BMD (sBMD), and trabecular vBMD were evaluated. Data from 377 women from FRAME (placebo, 190; romosozumab, 187) and 368 women from ARCH (alendronate, 185; romosozumab, 183) with evaluable 3D assessments at baseline and months 12 and 24 were analyzed. At month 12, treatment with romosozumab vs placebo in FRAME and romosozumab vs alendronate in ARCH resulted in greater increases in aBMD, integral vBMD, cortical thickness, cortical vBMD, cortical sBMD, and trabecular vBMD (P < .05 for all). At month 24, cumulative gains in all parameters were greater in the romosozumab-to-denosumab vs placebo-to-denosumab sequence and romosozumab-to-alendronate vs alendronate-to-alendronate sequence (P < .05 for all). 3D-SHAPER analysis provides a novel technique for estimating changes in cortical and trabecular parameters from standard hip DXA images. These data add to the accumulating evidence that romosozumab improves hip bone density and structure, thereby contributing to the antifracture efficacy of the drug.

Cochrane in CORR ®: Pharmacological Interventions for the Prevention of Bleeding in People Undergoing Definitive Fixation or Joint Replacement for Hip, Pelvic and Long Bone Fractures.

Cochrane in CORR ®: Pharmacological Interventions for the Prevention of Bleeding in People Undergoing Definitive Fixation or Joint Replacement for Hip, Pelvic and Long Bone Fractures.

How Does Customized Cutting Guide Design Affect Accuracy and Ergonomics in Pelvic Tumor Resection? A Study in Cadavers.

Customized cutting guides are technical aids that make primary pelvic bone tumor resection safer and more reliable. Although the effectiveness of such devices appears to be widely accepted, their conception and design remain varied. Two main designs have been reported: the heavier block-type customized cutting guides and the lighter patch-type customized cutting guides. As recent tools, there must be more evidence regarding the impact of design on their accuracy and ergonomics. Thus, an evaluation of their respective performances appears warranted. In a cadaver model, we assessed whether (1) a thinner, patch-type customized cutting guide design results in resections that are closer to the planned resections than the heavier block-type customized cutting guides, and (2) the patch-type customized cutting guide design is more ergonomic than the block-type customized cutting guide with improved usability in surgery (in terms of bulkiness, ease of placement, primary and secondary stability, and stability during cutting). We conducted an experimental study involving five fresh whole-body anatomic specimens (three women and two men with a median age of 79 years and median weight of 66 kg) by simulating six virtual tumors in three areas according to the Enneking classification (Zones I: iliac wing, II: periacetabular area, and I and IV: sacroiliac joint area). We compared the impact of the customized cutting guide's design on performance in terms of the resection margin accuracy using CT scan analysis (deviation from the planned margin at the closest point and the maximum deviation from the planned margin) and the intraoperative ergonomic score under conditions simulating those of an oncologic resection of a bone tumor (with a range of 0 to 100, with 100 being best). The patch customized cutting guides performed slightly better than the block customized cutting guides regarding deviation from the planned margin at the closest point, with median values of 1 mm versus 2 mm (difference of medians 1 mm; p = 0.02) and maximum deviation from the planned margin of 3 versus 4 mm (difference of medians 1 mm; p = 0.002). In addition, the patch design was perceived to be slightly more ergonomic than the block design, with a 92% median score versus 84% for the block design (difference of medians 8%; p = 0.03). We observed an equivalence in performance regarding accuracy and ergonomics, with slight advantages for patch customized cutting guides, especially in complex zones (Zone I and IV). Owing to a small cohort in a cadaver study, these results need independent replication. The patch-type customized cutting guide with thinner contact spots to the bone in specific areas and less soft tissue dissection might offer an advantage over a larger block design for achieving negative oncologic bony margins, but it does not address issues of soft tissue margins.

New Neogene fossil phocid postcranial material from the Atlantic (USA)

ABSTRACT To date, the phocid fossil record from the Western Atlantic includes representatives of the subfamilies Monachinae and Phocinae. New partial postcranial bones (humerus, innominate) of true seals from the Meherrin River, Murfreesboro, Hertford County, North Carolina, U.S.A. are morphologically examined in detail. The newly discovered postcranial bones are compared to representatives of other pinnipeds (Phocidae, Otariidae, and Odobenidae) and to representatives from other phocid subfamilies (Cystophorinae, Devinophocinae, Monachinae, and Phocinae). Detailed morphological analyses demonstrate characteristics that are known to be phocid-specific, such as: the humeral deltoid crest extending to half its length, becoming thinner towards the distal portion; short and flattened femur, with a diaphysis that is broader at its distal end; and absence of femoral lesser trochanter. Taxonomic assessment identified the humerus as Phocanella pumila (Subfamily Phocinae), and the three innominate bones (Subfamily Monachinae): Homiphoca capensis, Sarcodectes magnus, and a newly discovered genus and species Seronectes meherrinensis. In the same collection, a fossil femur from the Chesapeake Group, St. Marys Formation, Maryland-Virginia is identified as Homiphoca capensis (Subfamily Phocinae). This study further confirms the likely presence of adaptively diverse phocids from either the subfamily Monachinae or Phocinae in the same locality during the Miocene time.

Drying irreversibly affects the elastic behavior of pelvic cortical bone

Various studies have shown that the water content affects the elastic behavior of cortical bone. However, there is disagreement regarding the reversibility of the elastic behavior with rewetting. This study investigates this issue using an intrinsic approach, i.e., moisture manipulation and material testing were always carried out on the same specimen. The test results were then evaluated separately for each of several specimens.In total, 24 specimens of human cortical bone from the ischiopubic ramus were examined. The water content was varied in 11 steps, and the corresponding elastic moduli were determined using three-point bending tests within the elastic range. Moisture adjustment was achieved mainly using desiccators, accelerated by forced convection. Reference samples stored in the same manner were evaluated microscopically.The experiments confirmed the known correlation between water content reduction and stiffness increase of cortical bone. Complete drying increased the elastic modulus by about 83 %. By rewetting, the stiffness was significantly reduced again, though not only to the initial state, but even about 24 % below this. Thus, an irreversible alteration of the elastic behavior was observed. Decay of the reference samples was not observed. Therefore, decay is not the main reason for the significant loss of stiffness. In terms of the storage conditions for cortical bone specimens, an environment with 100 % relative humidity yielded the best match with the initial state. This storage method can therefore be recommended for biomechanical specimens used to determine in-vivo-like material parameters.

Pathology of the pelvic bones and its correction in bladder exstrophy

There are many studies regarding treatment methods for bladder exstrophy, but it is impossible to single out the only correct one. When treating bladder exstrophy, all defects can be eliminated separately, but the effect of such interventions will be incomplete. When analyzing the anatomy of patients with this pathology, pronounced splitting and divergence of the pelvic muscles is noted due to dysplasia and the wide position of the iliac and pubic bones. Due to the inferiority of the pelvic bones, the functions of all its organs are disrupted. Modern methods of radiation research have made it possible to better understand the main causes of such changes: outwardly rotated iliac bones, retroversion of the acetabulum and femur, shortened branches of the pubic bones, a backward curved acetabulum and flabby sacroiliac joint, increased distance between the triradial cartilages. Such changes are difficult to eliminate with soft tissue plastic surgery, so specialists who use osteotomy of the pelvic bones in the treatment of this pathology have more positive results. Since 1958, in the treatment of children with exstrophy of the bladder, osteotomy has been used in various versions, which makes it possible to restore the pelvic ring, improve the results of soft tissue plastic surgery and urinary continence. The authors noted a high rate of continence success in patients who underwent primary bladder closure without complications such as wound infection, dehiscence, or any degree of bladder prolapse. Thus, correction of the skeletal system serves as a basic element in the correction of bladder exstrophy.

Targeting TRPV1 for Cancer Pain Relief: Can It Work?

Chronic intractable pain affects a large proportion of cancer patients, especially those with metastatic bone disease. Blocking sensory afferents for cancer pain relief represents an attractive alternative to opioids and other drugs acting in the CNS in that sensory nerve blockers are not addictive and do not affect the mental state of the patient. A distinct subpopulation of sensory afferents expresses the capsaicin receptor TRPV1. Intrathecal resiniferatoxin, an ultrapotent capsaicin analog, ablates TRPV1-expressing nerve endings exposed to the cerebrospinal fluid, resulting in permanent analgesia in women with cervical cancer metastasis to the pelvic bone. High-dose capsaicin patches are effective pain killers in patients with chemotherapy-induced peripheral neuropathic pain. However, large gaps remain in our knowledge since the mechanisms by which cancer activates TRPV1 are essentially unknown. Most important, it is not clear whether or not sensory denervation mediated by TRPV1 agonists affects cancer progression. In a murine model of breast cancer, capsaicin desensitization was reported to accelerate progression. By contrast, desensitization mediated by resiniferatoxin was found to block melanoma growth. These observations imply that TRPV1 blockade for pain relief may be indicated for some cancers and contraindicated for others. In this review, we explore the current state of this field and compare the analgesic potential of TRPV1 antagonism and sensory afferent desensitization in cancer patients.

Reconstruction after Pelvic Bone Massive Resection: Evolution and Actuality of 3D-Printing Technology.

Pelvic reconstructions after massive bone resections are among the most challenging practices in orthopedic surgery. Whether the bone gap results after a trauma, a tumor resection, or it is due to a prosthetic revision, it is mandatory to reconstruct pelvic bone continuity and rebuild the functional thread that connects spine and hip joint. Several different approaches have been described in literature through the decades to achieve those goals. To this date, 3D-printed implants represent one of the most promising surgical technologies in orthopedic oncology and complex reconstructive surgery. We present our experience with 3D-printed custom-made pelvic prostheses to fulfi ll bone gaps resulting from massive bone loss due to tumor resections. We retrospectively evaluated 17 cases treated with pelvic bone reconstruction using 3D-printed prostheses. Cases were evaluated in terms of both oncological and functional outcomes. At the last follow-up, local complications were found in 6 cases (36%): in 4 (23.5%) of them the cause was a local recurrence of the disease, whereas only 2 (12.5%) had non-oncologic issues. The mean MSTS score in our population increased from 8.2 before surgery to 22.3 at the latest clinical control after surgery. 3D-printing technology, used to produce cutting jigs and prosthetic implants, can lead to good clinical and functional outcomes. These encouraging results are comparable with the ones obtained with other more frequently used reconstructive approaches and support custom-made implants as a promising reconstructive approach. Our data confi rm 3D-printing and custom-made implants as promising technologies that could shape the next future of orthopedic oncology and reconstructive surgery. custom made prosthesis, pelvic reconstruction, orthopedic oncology, cutting jigs, 3D-printing.

A Prospective Study of the IlluminOss Photodynamic Nail System for Pelvic Stabilization: Treatment of Impending and Actual Fractures from Metastatic Bone Disease, Multiple Myeloma, and Primary Bone Lymphoma.

The stabilization of metastatic lesions in the periacetabular region can be successfully performed using percutaneous techniques. Photodynamic nails (PDNs) are among the available tools for stabilization. Data on postoperative complications and functional outcomes are, however, scarce. Patients undergoing percutaneous stabilization using PDNs (IlluminOss Medical) for impending or actual minimally displaced pathological fractures of the pelvis from metastatic bone disease, multiple myeloma, or primary bone lymphoma were enrolled prospectively. Outcomes were assessed preoperatively and postoperatively at the 2-day, 2-week, 6-week, 3-month, 6-month, and 1-year time points. Functional outcomes assessed included the Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function, PROMIS Pain Interference, Combined Pain and Ambulatory Function (CPAF), EuroQol-Visual Analogue Scale (EQ-VAS), and Musculoskeletal Tumor Society (MSTS) scores. Pain was assessed using a VAS. A total of 30 patients treated with PDNs were included. The median VAS pain score dropped from 60 points preoperatively to 30 at 6 weeks postoperatively (p = 0.004). The median CPAF score improved from 6 preoperatively to 7 postoperatively at the 6-week mark. The median EQ-VAS score showed significant improvement at 6 weeks (70 versus 50; p = 0.006). The median 2-week PROMIS Pain Interference score was significantly lower than preoperatively (64.1 versus 66.9; p = 0.03). An improvement in the median PROMIS Physical Function score was seen at 6 weeks following surgery compared with preoperatively (37 versus 30.1; p = 0.001). A significant improvement in the MSTS score was seen as soon as 2 days after surgery (77% versus 40%; p < 0.0001). Among patients with pelvic bone metastases, multiple myeloma, or primary bone lymphoma, we found that treatment using PDNs resulted in immediate return to ambulation and rapid functional outcome improvement, with low complication rates. In this population, this technique represents a safe alternative to open surgery. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

The Use of the "System Method of Leech Therapy" in Severe Transport Trauma, Pelvic Bone Fractures and Subarochnoid Hemorrhage (Clinical Case)

The article describes the treatment of an 83-year-old woman who received a severe craniocerebral injury, with multiple bone fractures, as a result of a traffic accident (RTA) - she was hit by a car while crossing the street. Considering the severity of the victim's disease and the pessimistic prognosis, after 8 days in the hospital - the Central District Hospital (CDH), the patient was discharged for home treatment at the insistence of her daughter. As a result of the complex treatment, in which the leading role was played by the "System Method of Leech Therapy", after 11 months of treatment from the date of the accident, the patient was able to walk and take care of herself independently.

Manufacturing evaluation of seven medical device companies during the production of a 3D-printed titanium pelvic implant

Powder bed fusion (PBF) technology has become a popular manufacturing method to fabricate custom metallic implants. This trend has generated some regulatory concerns because traditional developing guidelines are not suitable for three-dimensional (3D)-printed implants. This is due to the layered microstructure of additive manufactured parts that produces mechanical properties different than those of traditionally manufactured parts. The inappropriate choice of the process parameters and postprocessing methods can lead to fabrication errors that could negatively affect mechanical properties and dimensional accuracy. The objective of the study was to perform a preliminary evaluation of the quality of manufacturing provided by the medical device industry and identify the best 3D printing practices. We designed a pelvic bone reconstructing implant and asked seven companies to manufacture it in Ti6Al4V with PBF technology. We inspected some important aspects of the manufacturing quality of the prototypes received by evaluating geometrical precision and microstructural integrity in the surface and in the matrix, including a qualitative assessment of voids and grain morphology. Results demonstrated a great difference among the implant prototypes. Two companies proved to be superior and provided defect-free implants. The other five produced evidence of some defects including: geometrical deviations (maximum values of up to 5 mm); heterogeneous acicular grain morphologies; broken sections of lattice structures; and internal and superficial voids and cracks that could potentially compromise functional and clinical performance. To our knowledge, this is the first study analyzing the production of several custom implant additive manufacturers based on a geometrical and microstructural evaluation of the same pelvic implant fabrication. The imperfections found in some prototypes produced by companies certified to commercialize personalized implants highlight the urgent need for technical standards that regulate the safe development of 3D-printed implants. Further analyses are required to determine the actual clinical and mechanical consequences of such imperfections. The results also show that when additive manufacturing is adequately managed, it can be a valid manufacturing method to fabricate defect-free implants.

MANAJEMEN PENDEKATAN FISIOTERAPI DENGAN TERAPI LATIHAN DAN POSTURAL CORRECTION TERHADAP NYERI MUSKULOSKELETAL LOW BACK PAIN SELAMA KEHAMILAN

Low back pain (LBP) is a common musculoskeletal problem during pregnancy with an estimated prevalence of 30% -78% of pregnant women experiencing complaints in the form of low back pain at some point in their pregnancy. This type of LBP can occur in the pelvic bones between the posterior iliac crest, gluteal folds or in the lumbar spine area. In this case the pain usually spreads to the buttocks, legs and feet. This is due to hormonal changes, blood circulation and biomechanical changes. low back pain usually increases with increasing gestational age, interfering with work, every activity and sleep so that it has an impact on the quality of life of pregnant women. This research aims to determine the effect of providing exercise and postural correction on the condition of low back pain during pregnancy. Method: this research uses quasie experimental with a pre and post test research design without control group design, the population in this study were all pregnant women who were experiencing low back pain who received physiotherapy services in the form of providing exercise and postural correction totaling 15 clients. Results: based on paired sample tests in the group treatment obtained a value of P = 0.001 (P&lt;0.05) with a mean value of 5.27 ± 2.07, meaning that there were significant differences in results before and after the intervention of providing exercise and postural correction. Conclusion: there was a decrease in the VDS (verbal descriptive scale) value in low back pain conditions by providing exercise and postural correction interventions. This can be seen from the difference between the results before and after the intervention, which means that the exercise and postural correction interventions significantly have a very good effect in reducing pain scores in low back pain conditions during pregnancy

Response rates for lumbar spine, total hip, and femoral neck bone mineral density in men treated with abaloparatide: results from the ATOM study.

Osteoporosis in men is an underappreciated public health issue, accounting for approximately 30% of the societal burden of osteoporosis. Although the prevalence of osteoporosis in men is lower, fracture-related morbidity and mortality rates exceed those of women. Abaloparatide is a synthetic, 34-amino acid peptide with homology to human parathyroid hormone-related protein (PTHrP), which favors bone formation by selective activation of PTH receptor type 1. In the Abaloparatide for the Treatment of Men With Osteoporosis (ATOM; NCT03512262) trial, 228 men with primary or hypogonadism-associated osteoporosis were randomized to receive subcutaneous injections of abaloparatide 80μg or placebo. Abaloparatide significantly improved LS, TH, and FN BMD when compared with placebo. In this prespecified analysis, the proportion of men with a percent change from baseline of >0%, >3%, and > 6% in BMD at the LS, TH, and FN at 3, 6, and 12mo and/or a shift in T-score category (based on LS and TH T-scores) at 12mo was compared between the abaloparatide and placebo groups in ATOM. There were significantly more men with a BMD gain of >3% at all 3 anatomical sites in the abaloparatide than placebo group at month 6 (18/122 [14.8%] vs 1/70 [1.4%], P = .002) and at month 12 (38/119 [31.9%] vs 1/66 [1.5%], P < .0001). At month 3, more men treated with abaloparatide than placebo had a > 3% BMD increase at the LS (82/134 [61.2%] vs 21/68 [30.9%], P < .0001). A greater proportion of men treated with abaloparatide had an improvement in T-score category from osteoporosis to low BMD or normal when compared with placebo. In conclusion, use of abaloparatide compared with placebo for 12mo resulted in significant and rapid improvements in BMD in men with osteoporosis from the ATOM study.

Evaluating AI-generated CBCT-based synthetic CT images for target delineation in palliative treatments of pelvic bone metastasis at conventional C-arm linacs

PurposeOne-table treatments with treatment imaging, preparation and delivery occurring at one treatment couch, could increase patients’ comfort and throughput for palliative treatments. On regular C-arm linacs, however, cone-beam CT (CBCT) imaging quality is currently insufficient. Therefore, our goal was to assess the suitability of AI-generated CBCT based synthetic CT (sCT) images for target delineation and treatment planning for palliative radiotherapy. Materials and methodsCBCTs and planning CT-scans of 22 female patients with pelvic bone metastasis were included. For each CBCT, a corresponding sCT image was generated by a deep learning model in ADMIRE 3.38.0. Radiation oncologists delineated 23 target volumes (TV) on the sCTs (TVsCT) and scored their delineation confidence. The delineations were transferred to planning CTs and manually adjusted if needed to yield gold standard target volumes (TVclin). TVsCT were geometrically compared to TVclin using Dice coefficient (DC) and Hausdorff Distance (HD). The dosimetric impact of TVsCT inaccuracies was evaluated for VMAT plans with different PTV margins. ResultsRadiation oncologists scored the sCT quality as sufficient for 13/23 TVsCT (median: DC = 0.9, HD = 11 mm) and insufficient for 10/23 TVsCT (median: DC = 0.7, HD = 34 mm). For the sufficient category, remaining inaccuracies could be compensated by +1 to +4 mm additional margin to achieve coverage of V95% > 95% and V95% > 98%, respectively in 12/13 TVsCT. ConclusionThe evaluated sCT quality allowed for accurate delineation for most targets. sCTs with insufficient quality could be identified accurately upfront. A moderate PTV margin expansion could address remaining delineation inaccuracies. Therefore, these findings support further exploration of CBCT based one-table treatments on C-arm linacs.

Increasing Burden of Lower-Extremity Fractures in the Middle East and North Africa (MENA): A 30-Year Epidemiological Analysis.

Lower-extremity fractures (LEFs) account for >30% of all skeletal injuries, contributing to the global health and economic burden. Fracture epidemiology in the Middle East and North Africa (MENA) region has been studied little. Health factors and disease epidemiology differ greatly among populations in MENA despite cultural, political, and economic similarities among the region's countries. This study examined the epidemiology of LEFs and the need for rehabilitation in MENA from 1990 to 2019. We examined the epidemiology of fractures of the pelvis, hip, femur, patella, tibia, fibula, ankle, and foot bones using Global Burden of Disease (GBD) data. Fracture incidence, counts, and rates were measured for males and females across age groups in the 21 MENA countries as identified by the GBD data set. Associations between years of healthy life lost due to disability (YLD) resulting from fracture and the Socio-demographic Index (SDI) were analyzed. In contrast to the global trend, the age-standardized incidence rate (ASIR) of LEFs in the MENA region increased by 4.57% from 1990 to 2019. In 2019, the highest ASIR among fractures was attributed to fractures of the patella, fibula, tibia, or ankle (434.36 per 100,000), most frequently occurring among those 20 to 24 years of age. In 2019, the highest ASIR of all fractures was noted in Saudi Arabia (2,010.56 per 100,000) and the lowest, in Sudan (523.29 per 100,000). The greatest increases from 1990 to 2019 in the ASIR of LEFs were noted in Yemen (132.39%), Syria (107.27%), and Afghanistan (94.47%), while the largest decreases were found in Kuwait (-62.72%), Sudan (-48.72%), and Iran (-45.37%). In 2019, the YLD rate of LEFs had increased to 277.65 per 100,000, up from 235.55 per 100,000 in 1990. Between 1990 and 2019, LEFs increased in the MENA region. Violence, war, and road traffic accidents increased, leading to a high rate of fractures, especially among youth. Low bone-mineral density related to vitamin D deficiency has also been reported as a risk factor for fracture in the region. Regional health authorities should be informed of fracture patterns by this study. Prognostic Level III . See Instructions for Authors for a complete description of levels of evidence.

Age Estimation among 12-18 Years Children by Studying the Ossification Centers of Hip Joint and Pelvis

Background: Bone age is an indicator of the skeletal and biological maturity of an individual. Skeletal ossification progression studies are one of them and are admissible in court as unparalleled scientific evidence for age estimation. Age group of juveniles between 12 - 18 years is dealt with special laws for medico- legal cases.Aims &amp; Objective: To observe age of appearance and fusion of ossification centers of hip joint and pelvic bone in adolescent population of Jaipur.Material &amp; Methodology: An observational prospective study that used inclusion and exclusion criteria wasconducted. Healthy Adolescents of 12-18 years of age group from Jaipur were taken in the study. The presentstudy had been conducted in the Department of Forensic Medicine &amp; Toxicology, SMS Hospital, Jaipur withDepartment of Radiology, SMS Medical College and Attached Hospitals, Jaipur during the period from June 2021to May 2022.Result &amp; Observation: Appearance of triradiate cartilage was found earliest at the age of 12 – 13 years in bothsexes, complete fusion was found earliest at the age 13 - 14 years in females and 14 – 15 years in males. Appearance of ossification centre of Ischial Tuberosity was found earliest at the age of 12 – 13 years in males and females; old fusion is earliest found at the age of 17 - 18 years in females and was not found in males. Appearance of ossification centre of Iliac Crest was found earliest at the age of 12 – 13 years in males and females; old fusion is earliest found at the age of 17 - 18 years in both male &amp; females. Appearance of ossification centre of Pubis was found earliest at the age of 12 – 13 years in males and females; old fusion is earliest found at the age of 17 - 18 years in females and was not found in males.Conclusion: Appearance and fusion of ossification centers for hip joint &amp; pelvis joint can be implemented inroutine forensic practice for 12 – 18 years age group to opine about age of subjects with lesser age range.