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2. Low back pain of disc, sacroiliac joint, or facet joint origin: a diagnostic accuracy systematic review

Author

Christopher S. Han, Mark J. Hancock, Sweekriti Sharma, Saurab Sharma, Ian A. Harris, Steven P. Cohen, John Magnussen, Chris G. Maher, and Adrian C. Traeger

Subjects
Articles, General Medicine
Abstract

BACKGROUND: The accuracy of diagnostic tests available in primary care to identify the disc, sacroiliac joint, and facet joint as the source of low back pain is uncertain. METHODS: Systematic review of diagnostic tests available in primary care. MEDLINE, CINAHL, and EMBASE were searched between March 2006 and 25th January 2023. Pairs of reviewers independently screened all studies, extracted data, and assessed risk of bias using QUADAS-2. Pooling was performed for homogenous studies. Positive likelihood ratios (+LR) ≥2 and negative likelihood ratios (−LR) ≤0.5 were considered informative. This review is registered with PROSPERO (CRD42020169828). FINDINGS: We included 62 studies: 35 investigated the disc, 14 the facet joint, 11 the sacroiliac joint, and 2 investigated all three structures in patients with persistent low back pain. For risk of bias, the domain ‘reference standard’ scored worst, however approximately half the studies were of low risk of bias for every other domain. For the disc, pooling demonstrated MRI findings of disc degeneration and annular fissure resulted in informative +LRs: 2.53 (95% CI: 1.57–4.07) and 2.88 (95% CI: 2.02–4.10) and −LRs: 0.15 (95% CI: 0.09–0.24) and 0.24 (95% CI: 0.10–0.55) respectively. Pooled results for Modic type 1, Modic type 2, and HIZ on MRI, and centralisation phenomenon yielded informative +LRs: 10.00 (95% CI: 4.20–23.82), 8.03 (95% CI: 3.23–19.97), 3.10 (95% CI: 2.27–4.25), and 3.06 (95% CI: 1.44–6.50) respectively, but uninformative −LRs: 0.84 (95% CI: 0.74–0.96), 0.88 (95% CI: 0.80–0.96), 0.61 (95% CI: 0.48–0.77), and 0.66 (95% CI: 0.52–0.84) respectively. For the facet joint, pooling demonstrated facet joint uptake on SPECT resulted in informative +LRs: 2.80 (95% CI: 1.82–4.31) and −LRs: 0.44 (95% CI: 0.25–0.77). For the sacroiliac joint, a combination of pain provocation tests and absence of midline low back pain resulted in informative +LRs of 2.41 (95% CI: 1.89–3.07) and 2.44 (95% CI: 1.50–3.98) and −LRs of 0.35 (95% CI: 0.12–1.01) and 0.31 (95% CI: 0.21–0.47) respectively. Radionuclide imaging yielded an informative +LR 7.33 (95% CI: 1.42–37.80) but an uninformative −LR 0.74 (95% CI: 0.41–1.34). INTERPRETATION: There are informative diagnostic tests for the disc, sacroiliac joint, and facet joint (only one test). The evidence suggests a diagnosis may be possible for some patients with low back pain, potentially guiding targeted and specific treatment approaches. FUNDING: There was no funding for this study.

Published
2023
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3. International Impact of COVID-19 on the Diagnosis of Heart Disease

Author

Einstein, A. J., Shaw, L. J., Hirschfeld, C., Williams, M. C., Villines, T. C., Better, N., Vitola, J. V., Cerci, R., Dorbala, S., Raggi, P., Choi, A. D., Lu, B., Sinitsyn, V., Sergienko, V., Kudo, T., Norgaard, B. L., Maurovich-Horvat, P., Campisi, R., Milan, E., Louw, L., Allam, A. H., Bhatia, M., Malkovskiy, E., Goebel, B., Cohen, Y., Randazzo, M., Narula, J., Pascual, T. N. B., Pynda, Y., Dondi, M., Gerd Hinterleitner, Paez D., Yao, Lu, Olga, Morozova, Zhuoran, Xu, Juan, Lopez-Mattei, Purvi, Parwani, Mohammad Nawaz Nasery, Artan, Goda, Ervina, Shirka, Rabie, Benlabgaa, Salah, Bouyoucef, Abdelkader, Medjahedi, Qais, Nailli, Mariela, Agolti, Roberto Nicolas Aguero, Maria Del Carmen Alak, Lucia Graciela Alberguina, Guillermo, Arroñada, Andrea, Astesiano, Alfredo, Astesiano, Carolina Bas Norton, Pablo, Benteo, Juan, Blanco, Juan Manuel Bonelli, Jose Javier Bustos, Raul, Cabrejas, Jorge, Cachero, Alejandro, Canderoli, Silvia, Carames, Patrícia, Carrascosa, Ricardo, Castro, Oscar, Cendoya, Luciano Martin Cognigni, Carlos, Collaud, Claudia, Cortes, Javier, Courtis, Daniel, Cragnolino, Mariana, Daicz, Alejandro De La Vega, Silvia Teresa De Maria, Horacio Del Riego, Fernando, Dettori, Alejandro, Deviggiano, Laura, Dragonetti, Mario, Embon, Ruben Emilio Enriquez, Jorge, Ensinas, Fernando, Faccio, Adolfo, Facello, Diego, Garofalo, Ricardo, Geronazzo, Natalia, Gonza, Lucas, Gutierrez, Miguel Angel Guzzo, Victor, Hasbani, Melina, Huerin, Victor, Jäger, Julio Manuel Lewkowicz, Maria Nieves, A López De Munaín, Jose Maria Lotti, Alejandra, Marquez, Osvaldo, Masoli, Edgardo, Mastrovito, Matias, Mayoraz, Graciela Eva Melado, Anibal, Mele, Maria Fernanda Merani, Alejandro Horacio Meretta, Susana, Molteni, Marcos, Montecinos, Eduardo, Noguera, Carlos, Novoa, Claudio Pereyra Sueldo, Sebastian Perez Ascani, Pablo, Pollono, Maria Paula Pujol, Alejandro, Radzinschi, Gustavo, Raimondi, Marcela, Redruello, Marina, Rodríguez, Matías, Rodríguez, Romina Lorena Romero, Arturo Romero Acuña, Federico, Rovaletti, Lucas San Miguel, Lucrecia, Solari, Bruno, Strada, Sonia, Traverso, Sonia Simona Traverzo, Maria Del Huerto Velazquez Espeche, Juan Sebastian Weihmuller, Juan, Wolcan, Susana, Zeffiro, Mari, Sakanyan, Scott, Beuzeville, Raef, Boktor, Patrick, Butler, Jennifer, Calcott, Loretta, Carr, Virgil, Chan, Charles, Chao, Woon, Chong, Mark, Dobson, D'Arne, Downie, Girish, Dwivedi, Barry, Elison, Jean, Engela, Roslyn, Francis, Anand, Gaikwad, Ashok Gangasandra Basavaraj, Bruce, Goodwin, Robert, Greenough, Christian, Hamilton-Craig, Victar, Hsieh, Subodh, Joshi, Karin, Lederer, Kenneth, Lee, Joseph, Lee, John, Magnussen, Nghi, Mai, Gordon, Mander, Fiona, Murton, Dee, Nandurkar, Johanne, Neill, Edward, O'Rourke, Patricia, O'Sullivan, George, Pandos, Kunthi, Pathmaraj, Alexander, Pitman, Rohan, Poulter, Manuja, Premaratne, David, Prior, Lloyd, Ridley, Natalie, Rutherford, Hamid, Salehi, Connor, Saunders, Luke, Scarlett, Sujith, Seneviratne, Deepa, Shetty, Ganesh, Shrestha, Jonathan, Shulman, Vijay, Solanki, Tony, Stanton, Murch, Stuart, Michael, Stubbs, Ian, Swainson, Kim, Taubman, Andrew, Taylor, Paul, Thomas, Steven, Unger, Anthony, Upton, Shankar, Vamadevan, William Van Gaal, Johan, Verjans, Demetrius, Voutnis, Victor, Wayne, Peter, Wilson, David, Wong, Kirby, Wong, John, Younger, Gudrun, Feuchtner, Siroos, Mirzaei, Konrad, Weiss, Natallia, Maroz-Vadalazhskaya, Olivier, Gheysens, Filip, Homans, Rodrigo, Moreno-Reyes, Agnès, Pasquet, Veronique, Roelants, Caroline, M Van De Heyning, Raúl Araujo Ríos, Valentina, Soldat-Stankovic, Sinisa, Stankovic, Maria Helena Albernaz Siqueira, Augusto, Almeida, Paulo Henrique Alves Togni, Jose Henrique Andrade, Luciana, Andrade, Carlos, Anselmi, Roberta, Araújo, Guilherme, Azevedo, Sabbrina, Bezerra, Rodrigo, Biancardi, Gabriel Blacher Grossman, Simone, Brandão, Diego Bromfman Pianta, Lara, Carreira, Bruno, Castro, Tien, Chang, Fernando Cunali Jr, Roberto, Cury, Roberto, Dantas, Fernando de Amorim Fernandes, Andrea De Lorenzo, Robson De Macedo Filho, Fernanda, Erthal, Fabio, Fernandes, Juliano, Fernandes, Thiago Ferreira De Souza, Wilson Furlan Alves, Bruno, Ghini, Luiz, Goncalves, Ilan, Gottlieb, Marcelo, Hadlich, Vinícius, Kameoka, Ronaldo, Lima, Adna, Lima, Rafael Willain Lopes, Ricardo Machado, E Silva, Tiago, Magalhães, Fábio Martins Silva, Luiz Eduardo Mastrocola, Fábio, Medeiros, José Claudio Meneghetti, Vania, Naue, Danilo, Naves, Roberto, Nolasco, Cesar, Nomura, Joao Bruno Oliveira, Eduardo, Paixao, Filipe Penna De Carvalho, Ibraim, Pinto, Priscila, Possetti, Mayra, Quinta, Rodrigo Rizzo Nogueira Ramos, Ricardo, Rocha, Alfredo, Rodrigues, Carlos, Rodrigues, Leila, Romantini, Adelina, Sanches, Sara, Santana, Leonardo Sara da Silva, Paulo, Schvartzman, Cristina Sebastião Matushita, Tiago, Senra, Afonso, Shiozaki, Maria Eduarda Menezes de Siqueira, Cristiano, Siqueira, Paola, Smanio, Carlos Eduardo Soares, José Soares Junior, Marcio Sommer Bittencourt, Bernardo, Spiro, Cláudio Tinoco Mesquita, Jorge, Torreao, Rafael, Torres, Marly, Uellendahl, Guilherme Urpia Monte, Otávia, Veríssimo, Estevan Vieira Cabeda, Felipe Villela Pedras, Roberto, Waltrick, Marcello, Zapparoli, Hamid, Naseer, Marina, Garcheva-Tsacheva, Irena, Kostadinova, Youdaline, Theng, Gad, Abikhzer, Rene, Barette, Benjamin, Chow, Dominique, Dabreo, Matthias, Friedrich, Ria, Garg, Mohammed Nassoh Hafez, Chris, Johnson, Marla, Kiess, Jonathon, Leipsic, Eugene, Leung, Robert, Miller, Anastasia, Oikonomou, Stephan, Probst, Idan, Roifman, Gary, Small, Vikas, Tandon, Adwait, Trivedi, James, White, Katherine, Zukotynski, Jose, Canessa, Gabriel Castro Muñoz, Carmen, Concha, Pablo, Hidalgo, Cesar, Lovera, Teresa, Massardo, Luis Salazar Vargas, Pedro, Abad, Harold, Arturo, Sandra, Ayala, Luis, Benitez, Alberto, Cadena, Carlos, Caicedo, Antonio Calderón Moncayo, Sharon, Gomez, Claudia, T Gutierrez Villamil, Claudia, Jaimes, Juan Luis Londoño Blair, Luz, Pabon, Mauricio, Pineda, Juan Carlos Rojas, Diego, Ruiz, Manuel Valencia Escobar, Andres, Vasquez, Damiana, Vergel, Alejandro, Zuluaga, Isabel Berrocal Gamboa, Gabriel, Castro, Ulises, González, Ana, Baric, Tonci, Batinic, Maja, Franceschi, Maja Hrabak Paar, Mladen, Jukic, Petar, Medakovic, Viktor, Persic, Marina, Prpic, Ante, Punda, Juan Felipe Batista, Juan Manuel Gómez Lauchy, Yamile Marcos Gutierrez, Rayner, Menéndez, Amalia, Peix, Luis, Rochela, Christoforos, Panagidis, Ioannis, Petrou, Vaclav, Engelmann, Milan, Kaminek, Vladimír, Kincl, Otto, Lang, Milan, Simanek, Jawdat, Abdulla, Morten, Bøttcher, Mette, Christensen, Lars Christian Gormsen, Philip, Hasbak, Søren, Hess, Paw, Holdgaard, Allan, Johansen, Kasper, Kyhl, Kristian Altern Øvrehus, Niels Peter Rønnow Sand, Rolf, Steffensen, Anders, Thomassen, Zerahn, Bo, Alfredo, Perez, Giovanni Alejandro Escorza Velez, Mayra Sanchez Velez, Islam Shawky Abdel Aziz, Mahasen, Abougabal, Taghreed, Ahmed, Ahmed, Asfour, Mona, Hassan, Alia, Hassan, Ahmed, Ibrahim, Sameh, Kaffas, Ahmed, Kandeel, Mohamed Mandour Ali, Ahmad, Mansy, Hany, Maurice, Sherif, Nabil, Mahmoud, Shaaban, Ana Camila Flores, Anne, Poksi, Juhani, Knuuti, Velipekka, Kokkonen, Martti, Larikka, Valtteri, Uusitalo, Matthieu, Bailly, Samuel, Burg, Jean-François, Deux, Vincent, Habouzit, Fabien, Hyafil, Olivier, Lairez, Franck, Proffit, Hamza, Regaieg, Laure, Sarda-Mantel, Vania, Tacher, Roman, P Schneider, Harold, Ayetey, George, Angelidis, Aikaterini, Archontaki, Sofia, Chatziioannou, Ioannis, Datseris, Christina, Fragkaki, Panagiotis, Georgoulias, Sophia, Koukouraki, Maria, Koutelou, Eleni, Kyrozi, Evangelos, Repasos, Petros, Stavrou, Pipitsa, Valsamaki, Carla, Gonzalez, Goleat, Gutierrez, Alejandro, Maldonado, Klara, Buga, Ildiko, Garai, Erzsébet, Schmidt, Balint, Szilveszter, Edit, Várady, Nilesh, Banthia, Jinendra Kumar Bhagat, Rishi, Bhargava, Vivek, Bhat, Partha, Choudhury, Vijay Sai Chowdekar, Aparna, Irodi, Shashank, Jain, Elizabeth, Joseph, Sukriti, Kumar, Girijanandan, Mahapatra, Deepanjan, Mitra, Bhagwant Rai Mittal, Ahmad, Ozair, Chetan, Patel, Tapan, Patel, Ravi, Patel, Shivani, Patel, Sudhir, Saxena, Shantanu, Sengupta, Santosh, Singh, Bhanupriya, Singh, Ashwani, Sood, Atul, Verma, Erwin, Affandi, Padma Savenadia Alam, Edison, Edison, Gani, Gunawan, Habusari, Hapkido, Basuki, Hidayat, Aulia, Huda, Anggoro Praja Mukti, Djoko, Prawiro, Erwin Affandi Soeriadi, Hilman, Syawaluddin, Amjed, Albadr, Majid, Assadi, Farshad, Emami, Golnaz, Houshmand, Majid, Maleki, Maryam Tajik Rostami, Seyed Rasoul Zakavi, Eed Abu Zaid, Svetlana, Agranovich, Yoav, Arnson, Rachel, Bar-Shalom, Alex, Frenkel, Galit, Knafo, Rachel, Lugassi, Israel Shlomo Maor Moalem, Maya, Mor, Noam, Muskal, Sara, Ranser, Aryeh, Shalev, Domenico, Albano, Pierpaolo, Alongi, Gaspare, Arnone, Elisa, Bagatin, Sergio, Baldari, Matteo, Bauckneht, Paolo, Bertelli, Francesco, Bianco, Rachele, Bonfiglioli, Roberto, Boni, Andrea, Bruno, Isabella, Bruno, Elena, Busnardo, Elena, Califaretti, Luca, Camoni, Aldo, Carnevale, Roberta, Casoni, Armando Ugo Cavallo, Giorgio, Cavenaghi, Franca, Chierichetti, Marcello, Chiocchi, Corrado, Cittanti, Mauro, Colletta, Umberto, Conti, Alberto, Cossu, Alberto, Cuocolo, Marco, Cuzzocrea, Maria Luisa De Rimini, Giuseppe De Vincentis, Eleonora Del Giudice, Alberico Del Torto, DELLA TOMMASINA, Veronica, Rexhep, Durmo, Erba, PAOLA ANNA, Laura, Evangelista, Riccardo, Faletti, Evelina, Faragasso, Mohsen, Farsad, Paola, Ferro, Luigia, Florimonte, Viviana, Frantellizzi, Fabio Massimo Fringuelli, Marco, Gatti, Angela, Gaudiano, Alessia, Gimelli, Raffaele, Giubbini, Francesca, Giuffrida, Salvatore, Ialuna, Riccardo, Laudicella, Lucia, Leccisotti, Lucia, Leva, Liga, Riccardo, Carlo, Liguori, Giampiero, Longo, Margherita, Maffione, Maria Elisabetta Mancini, Claudio, Marcassa, Barbara, Nardi, Sara, Pacella, Giovanna, Pepe, Gianluca, Pontone, Sabina, Pulizzi, Natale, Quartuccio, Lucia, Rampin, Fabrizio, Ricci, Pierluigi, Rossini, Giuseppe, Rubini, Vincenzo, Russo, Gian Mauro Sacchetti, Gianmario, Sambuceti, Massimo, Scarano, Roberto, Sciagrà, Massimiliano, Sperandio, Antonella, Stefanelli, Guido, Ventroni, Stefania, Zoboli, Dainia, Baugh, Duane, Chambers, Ernest, Madu, Felix, Nunura, Hiroshi, Asano, Chimura Misato Chimura, Shinichiro, Fujimoto, Koichiro, Fujisue, Tomohisa, Fukunaga, Yoshimitsu, Fukushima, Kae, Fukuyama, Jun, Hashimoto, Yasutaka, Ichikawa, Nobuo, Iguchi, Masamichi, Imai, Anri, Inaki, Hayato, Ishimura, Satoshi, Isobe, Toshiaki, Kadokami, Takao, Kato, Shinichiro, Kumita, Hirotaka, Maruno, Hiroyuki, Mataki, Masao, Miyagawa, Ryota, Morimoto, Masao, Moroi, Shigeki, Nagamachi, Kenichi, Nakajima, Tomoaki, Nakata, Ryo, Nakazato, Mamoru, Nanasato, Masanao, Naya, Takashi, Norikane, Yasutoshi, Ohta, Satoshi, Okayama, Atsutaka, Okizaki, Yoichi, Otomi, Hideki, Otsuka, Masaki, Saito, Sakata Yasushi Sakata, Masayoshi, Sarai, Daisuke, Sato, Shinya, Shiraishi, Yoshinobu, Suwa, Kentaro, Takanami, Kazuya, Takehana, Junichi, Taki, Nagara, Tamaki, Yasuyo, Taniguchi, Hiroki, Teragawa, Nobuo, Tomizawa, Kenichi, Tsujita, Kyoko, Umeji, Yasushi, Wakabayashi, Shinichiro, Yamada, Shinya, Yamazaki, Tatsuya, Yoneyama, Mohammad, Rawashdeh, Daultai, Batyrkhanov, Tairkhan, Dautov, Khalid, Makhdomi, Kevin, Ombati, Faridah, Alkandari, Masoud, Garashi, Tchoyoson Lim Coie, Sonexay, Rajvong, Artem, Kalinin, Marika, Kalnina, Mohamad, Haidar, Renata, Komiagiene, Giedre, Kviecinskiene, Mindaugas, Mataciunas, Donatas, Vajauskas, Christian, Picard, Noor Khairiah, A Karim, Luise, Reichmuth, Anthony, Samuel, Mohammad Aaftaab Allarakha, Ambedhkar Shantaram Naojee, Erick, Alexanderson-Rosas, Erika, Barragan, Alejandro Becerril González-Montecinos, Manuel, Cabada, Daniel Calderon Rodriguez, Isabel, Carvajal-Juarez, Violeta, Cortés, Filiberto, Cortés, Erasmo De La Peña, Manlio, Gama-Moreno, Luis, González, Nelsy Gonzalez Ramírez, Moisés, Jiménez-Santos, Luis, Matos, Edgar, Monroy, Martha, Morelos, Mario, Ornelas, Jose Alberto Ortga Ramirez, Andrés, Preciado-Anaya, Óscar Ulises Preciado-Gutiérrez, Adriana Puente Barragan, Sandra Graciela Rosales Uvera, Sigelinda, Sandoval, Miguel Santaularia Tomas, Lilia, M Sierra-Galan, Silvia, Siu, Enrique, Vallejo, Mario, Valles, Marc, Faraggi, Erdenechimeg, Sereegotov, Srdja, Ilic, Nozha, Ben-Rais, Nadia Ismaili Alaoui, Sara, Taleb, Khin Pa Pa Myo, Phyo Si Thu, Ram Kumar Ghimire, Bijoy, Rajbanshi, Peter, Barneveld, Andor, Glaudemans, Jesse, Habets, Klaas Pieter Koopmans, Jeroen, Manders, Stefan, Pool, Arthur, Scholte, Asbjørn, Scholtens, Riemer, Slart, Paul, Thimister, Erik-Jan Van Asperen, Niels, Veltman, Derk, Verschure, Nils, Wagenaar, John, Edmond, Chris, Ellis, Kerryanne, Johnson, Ross, Keenan, Shaw Hua Anthony Kueh, Christopher, Occleshaw, Alexander, Sasse, Andrew, To, Niels Van Pelt, Calum, Young, Teresa, Cuadra, Hector Bladimir Roque Vanegas, Idrissa Adamou Soli, Djibrillou Moussa Issoufou, Tolulope, Ayodele, Chibuzo, Madu, Yetunde, Onimode, Elen, Efros-Monsen, Signe Helene Forsdahl, Jenni-Mari Hildre Dimmen, Arve, Jørgensen, Isabel, Krohn, Pål, Løvhaugen, Anders Tjellaug Bråten, Humoud Al Dhuhli, Faiza Al Kindi, Naeema, Al-Bulushi, Zabah, Jawa, Naima, Tag, Muhammad Shehzad Afzal, Shazia, Fatima, Muhammad Numair Younis, Musab, Riaz, Mohammad, Saadullah, Yariela, Herrera, Dora, Lenturut-Katal, Manuel Castillo Vázquez, José, Ortellado, Afroza, Akhter, Dianbo, Cao, Stephen, Cheung, Dai, Xu, Lianggeng, Gong, Dan, Han, Yang, Hou, Caiying, Li, Tao, Li, Dong, Li, Sijin, Li, Jinkang, Liu, Hui, Liu, Ming Yen Ng, Kai, Sun, Gongshun, Tang, Jian, Wang, Ximing, Wang, Zhao-Qian, Wang, Yining, Wang, Yifan, Wang, Jiang, Wu, Zhifang, Wu, Liming, Xia, Jiangxi, Xiao, Lei, Xu, Youyou, Yang, Yin, Wu, Jianqun, Yu, Yuan, Li, Tong, Zhang, Longjiang, Zhang, Yong-Gao, Zhang, Xiaoli, Zhang, Zhu, Li, Ana, Alfaro, Paz, Abrihan, Asela, Barroso, Eric, Cruz, Marie Rhiamar Gomez, Vincent Peter Magboo, John Michael Medina, Jerry, Obaldo, Davidson, Pastrana, Christian Michael Pawhay, Alvin, Quinon, Jeanelle Margareth Tang, Bettina, Tecson, Kristine Joy Uson, Mila, Uy, Magdalena, Kostkiewicz, Jolanta, Kunikowska, Nuno, Bettencourt, Guilhermina, Cantinho, Antonio, Ferreira, Ghulam, Syed, Samer, Arnous, Said, Atyani, Angela, Byrne, Tadhg, Gleeson, David, Kerins, Conor, Meehan, David, Murphy, Mark, Murphy, John, Murray, Julie, O'Brien, Ji-In, Bang, Henry, Bom, Sang-Geon, Cho, Chae Moon Hong, Su Jin Jang, Yong Hyu Jeong, Won Jun Kang, Ji-Young, Kim, Jaetae, Lee, Chang Kyeong Namgung, Young, So, Kyoung Sook Won, Venjamin, Majstorov, Marija, Vavlukis, Barbara Gužic Salobir, Monika, Štalc, Theodora, Benedek, Imre, Benedek, Raluca, Mititelu, Claudiu Adrian Stan, Alexey, Ansheles, Olga, Dariy, Olga, Drozdova, Nina, Gagarina, Vsevolod Milyevich Gulyaev, Irina, Itskovich, Anatoly, Karalkin, Alexander, Kokov, Ekaterina, Migunova, Viktor, Pospelov, Daria, Ryzhkova, Guzaliya, Saifullina, Svetlana, Sazonova, Irina, Shurupova, Tatjana, Trifonova, Wladimir Yurievich Ussov, Margarita, Vakhromeeva, Nailya, Valiullina, Konstantin, Zavadovsky, Kirill, Zhuravlev, Mirvat, Alasnag, Subhani, Okarvi, Dragana Sobic Saranovic, Felix, Keng, Jia Hao Jason See, Ramkumar, Sekar, Min Sen Yew, Andrej, Vondrak, Shereen, Bejai, George, Bennie, Ria, Bester, Gerrit, Engelbrecht, Osayande, Evbuomwan, Harlem, Gongxeka, Magritha Jv Vuuren, Mitchell, Kaplan, Purbhoo, Khushica, Hoosen, Lakhi, Nico, Malan, Katarina, Milos, Moshe, Modiselle, Stuart, More, Mathava, Naidoo, Leonie, Scholtz, Mboyo, Vangu, Santiago, Aguadé-Bruix, Isabel, Blanco, Antonio, Cabrera, Alicia, Camarero, Irene, Casáns-Tormo, Hug, Cuellar-Calabria, Albert, Flotats, Maria Eugenia Fuentes Cañamero, María Elia García, Amelia, Jimenez-Heffernan, Rubén, Leta, Javier Lopez Diaz, Luis, Lumbreras, Juan Javier Marquez-Cabeza, Francisco, Martin, Anxo Martinez de Alegria, Francisco, Medina, Maria Pedrera Canal, Virginia, Peiro, Virginia, Pubul-Nuñez, Juan Ignacio Rayo Madrid, Cristina Rodríguez Rey, Ricardo Ruano Perez, Joaquín, Ruiz, Gertrudis Sabatel Hernández, Ana, Sevilla, Nahla, Zeidán, Damayanthi, Nanayakkara, Chandraguptha, Udugama, Magnus, Simonsson, Hatem, Alkadhi, Ronny Ralf Buechel, Peter, Burger, Luca, Ceriani, Bart De Boeck, Christoph, Gräni, Alix Juillet de Saint Lager Lucas, Christel, H Kamani, Nadine, Kawel-Boehm, Robert, Manka, John, O Prior, Axel, Rominger, Jean-Paul, Vallée, Benjapa, Khiewvan, Teerapon, Premprabha, Tanyaluck, Thientunyakit, Ali, Sellem, Kemal Metin Kir, Haluk, Sayman, Mugisha Julius Sebikali, Zerida, Muyinda, Yaroslav, Kmetyuk, Pavlo, Korol, Olena, Mykhalchenko, Volodymyr, Pliatsek, Maryna, Satyr, Batool, Albalooshi, Mohamed Ismail Ahmed Hassan, Jill, Anderson, Punit, Bedi, Thomas, Biggans, Anda, Bularga, Russell, Bull, Rajesh, Burgul, John-Paul, Carpenter, Duncan, Coles, David, Cusack, Aparna, Deshpande, John, Dougan, Timothy, Fairbairn, Alexia, Farrugia, Deepa, Gopalan, Alistair, Gummow, Prasad Guntur Ramkumar, Mark, Hamilton, Mark, Harbinson, Thomas, Hartley, Benjamin, Hudson, Nikhil, Joshi, Michael, Kay, Andrew, Kelion, Azhar, Khokhar, Jamie, Kitt, Ken, Lee, Chen, Low, Sze Mun Mak, Ntouskou, Marousa, Jon, Martin, Elisa, Mcalindon, Leon, Menezes, Gareth, Morgan-Hughes, Alastair, Moss, Anthony, Murray, Edward, Nicol, Dilip, Patel, Charles, Peebles, Francesca, Pugliese, Jonathan Carl Luis Rodrigues, Christopher, Rofe, Nikant, Sabharwal, Rebecca, Schofield, Thomas, Semple, Naveen, Sharma, Peter, Strouhal, Deepak, Subedi, William, Topping, Katharine, Tweed, Jonathan, Weir-Mccall, Suhny, Abbara, Taimur, Abbasi, Brian, Abbott, Shady, Abohashem, Sandra, Abramson, Tarek, Al-Abboud, Mouaz, Al-Mallah, Omar, Almousalli, Karthikeyan, Ananthasubramaniam, Mohan Ashok Kumar, Jeffrey, Askew, Lea, Attanasio, Mallory, Balmer-Swain, Richard, R Bayer, Adam, Bernheim, Sabha, Bhatti, Erik, Bieging, Ron, Blankstein, Stephen, Bloom, Sean, Blue, David, Bluemke, Andressa, Borges, Kelley, Branch, Paco, Bravo, Jessica, Brothers, Matthew, Budoff, Renée, Bullock-Palmer, Angela, Burandt, Floyd, W Burke, Kelvin, Bush, Candace, Candela, Elizabeth, Capasso, Joao, Cavalcante, Donald, Chang, Saurav, Chatterjee, Yiannis, Chatzizisis, Michael, Cheezum, Tiffany, Chen, Jennifer, Chen, Marcus, Chen, Andrew, Choi, James, Clarcq, Ayreen, Cordero, Matthew, Crim, Sorin, Danciu, Bruce, Decter, Nimish, Dhruva, Neil, Doherty, Rami, Doukky, Anjori, Dunbar, William, Duvall, Rachael, Edwards, Kerry, Esquitin, Husam, Farah, Emilio, Fentanes, Maros, Ferencik, Daniel, Fisher, Daniel, Fitzpatrick, Cameron, Foster, Tony, Fuisz, Michael, Gannon, Lori, Gastner, Myron, Gerson, Brian, Ghoshhajra, Alan, Goldberg, Brian, Goldner, Jorge, Gonzalez, Rosco, Gore, Sandra, Gracia-López, Fadi, Hage, Agha, Haider, Sofia, Haider, Yasmin, Hamirani, Karen, Hassen, Mallory, Hatfield, Carolyn, Hawkins, Katie, Hawthorne, Nicholas, Heath, Robert, Hendel, Phillip, Hernandez, Gregory, Hill, Stephen, Horgan, Jeff, Huffman, Lynne, Hurwitz, Ami, Iskandrian, Rajesh, Janardhanan, Christine, Jellis, Scott, Jerome, Dinesh, Kalra, Summanther, Kaviratne, Fernando, Kay, Faith, Kelly, Omar, Khalique, Mona, Kinkhabwala, George Kinzfogl Iii, Jacqueline, Kircher, Rachael, Kirkbride, Michael, Kontos, Anupama, Kottam, Joseph, Krepp, Jay, Layer, Steven, H Lee, Jeffrey, Leppo, John, Lesser, Steve, Leung, Howard, Lewin, Diana, Litmanovich, Yiyan, Liu, Kathleen, Magurany, Jeremy, Markowitz, Amanda, Marn, Stephen, E Matis, Michael, Mckenna, Tony, Mcrae, Fernando, Mendoza, Michael, Merhige, David, Min, Chanan, Moffitt, Karen, Moncher, Warren, Moore, Shamil, Morayati, Michael, Morris, Mahmud, Mossa-Basha, Zorana, Mrsic, Venkatesh, Murthy, Prashant, Nagpal, Kyle, Napier, Katarina, Nelson, Prabhjot, Nijjar, Medhat, Osman, Edward, Passen, Amit, Patel, Pravin, Patil, Ryan, Paul, Lawrence, Phillips, Venkateshwar, Polsani, Rajaram, Poludasu, Brian, Pomerantz, Thomas, Porter, Ryan, Prentice, Amit, Pursnani, Mark, Rabbat, Suresh, Ramamurti, Florence, Rich, Hiram Rivera Luna, Austin, Robinson, Kim, Robles, Cesar, Rodríguez, Mark, Rorie, John, Rumberger, Raymond, Russell, Philip, Sabra, Diego, Sadler, Mary, Schemmer, U Joseph Schoepf, Samir, Shah, Nishant, Shah, Sujata, Shanbhag, Gaurav, Sharma, Steven, Shayani, Jamshid, Shirani, Pushpa, Shivaram, Steven, Sigman, Mitch, Simon, Ahmad, Slim, David, Smith, Alexandra, Smith, Prem, Soman, Aditya, Sood, Monvadi Barbara Srichai-Parsia, James, Streeter, Albert, T Ahmed Tawakol, Dustin, Thomas, Randall, Thompson, Tara, Torbet, Desiree, Trinidad, Shawn, Ullery, Samuel, Unzek, Seth, Uretsky, Srikanth, Vallurupalli, Vikas, Verma, Alfonso, Waller, Ellen, Wang, Parker, Ward, Gaby, Weissman, George, Wesbey, Kelly, White, David, Winchester, David, Wolinsky, Sandra, Yost, Michael, Zgaljardic, Omar, Alonso, Mario, Beretta, Rodolfo, Ferrando, Miguel, Kapitan, Fernando, Mut, Omoa, Djuraev, Gulnora, Rozikhodjaeva, Ha Le Ngoc, Son Hong Mai, Xuan Canh Nguyen, Einstein, A. J., Shaw, L. J., Hirschfeld, C., Williams, M. C., Villines, T. C., Better, N., Vitola, J. V., Cerci, R., Dorbala, S., Raggi, P., Choi, A. D., Lu, B., Sinitsyn, V., Sergienko, V., Kudo, T., Norgaard, B. L., Maurovich-Horvat, P., Campisi, R., Milan, E., Louw, L., Allam, A. H., Bhatia, M., Malkovskiy, E., Goebel, B., Cohen, Y., Randazzo, M., Narula, J., Pascual, T. N. B., Pynda, Y., Dondi, M., Paez, D., Cuocolo, A., Einstein, A, Shaw, L, Hirschfeld, C, Williams, M, Villines, T, Better, N, Vitola, J, Cerci, R, Dorbala, S, Raggi, P, Choi, A, Lu, B, Sinitsyn, V, Sergienko, V, Kudo, T, Norgaard, B, Maurovich-Horvat, P, Campisi, R, Milan, E, Louw, L, Allam, A, Bhatia, M, Malkovskiy, E, Goebel, B, Cohen, Y, Randazzo, M, Narula, J, Pascual, T, Pynda, Y, Dondi, M, Paez, D, Pacella, S, and Erba, P

Subjects
INCAPS COVID Investigators Group, Heart disease, Vascular damage Radboud Institute for Health Sciences [Radboudumc 16], Diagnostic Techniques, Cardiovascular, coronavirus, global health, IAEA, Disease, Telehealth, Cardiorespiratory Medicine and Haematology, 030204 cardiovascular system & hematology, Cardiovascular, 0302 clinical medicine, cardiovascular disease, cardiac testing, COVID-19, diagnostic techniques, cardiovascular, health care surveys, heart diseases, humans, international agencies, Pandemic, Global health, 030212 general & internal medicine, COVID-19 Heart Disease, Cause of death, STATEMENT, Heart Disease, International Agencie, Public Health and Health Services, Biomedical Imaging, Cardiology and Cardiovascular Medicine, Human, medicine.medical_specialty, Heart Diseases, 03 medical and health sciences, Clinical Research, medicine, Humans, Personal protective equipment, Heart Disease - Coronary Heart Disease, business.industry, International Agencies, medicine.disease, the, coronaviru, Diagnostic Techniques, Good Health and Well Being, Clinical research, Cardiovascular System & Hematology, Health Care Survey, Health Care Surveys, Emergency medicine, Global Health, business
Abstract

BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has adversely affected diagnosis and treatment of noncommunicable diseases. Its effects on delivery of diagnostic care for cardiovascular disease, which remains the leading cause of death worldwide, have not been quantified. OBJECTIVES The study sought to assess COVID-19`s impact on global cardiovascular diagnostic procedural volumes and safety practices. METHODS The International Atomic Energy Agency conducted a worldwide survey assessing alterations in cardiovascular procedure volumes and safety practices resulting from COVID-19. Noninvasive and invasive cardiac testing volumes were obtained from participating sites for March and April 2020 and compared with those from March 2019. Availability of personal protective equipment and pandemic-related testing practice changes were ascertained. RESULTS Surveys were submitted from 909 inpatient and outpatient centers performing cardiac diagnostic procedures, in 108 countries. Procedure volumes decreased 42% from March 2019 to March 2020, and 64% from March 2019 to April 2020. Transthoradc echocardiography decreased by 59%, transesophageat echocardiography 76%, and stress tests 78%, which varied between stress modalities. Coronary angiography (invasive or computed tomography) decreased 55% (p < 0.001 for each procedure). hi multivariable regression, significantly greater reduction in procedures occurred for centers in countries with lower gross domestic product. Location in a low-income and lower-middle-income country was associated with an additional 22% reduction in cardiac procedures and less availability of personal protective equipment and teteheatth. CONCLUSIONS COVID-19 was associated with a significant and abrupt reduction in cardiovascular diagnostic testing across the globe, especially affecting the world's economically challenged. Further study of cardiovascular outcomes and COVID-19-related changes in care delivery is warranted. (C) 2021 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation.

Published
2021
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4. Magnetic Resonance Spectroscopic Assessment of Isocitrate Dehydrogenase Status in Gliomas: The New Frontiers of Spectrobiopsy in Neurodiagnostics

Author

John Magnussen, Jeffery McIntosh, Margery C. Pardey, Antonio Di Ieva, Michael J. Mulcahy, and Changho Choi

Subjects
Adult, Male, Oncology, medicine.medical_specialty, Magnetic Resonance Spectroscopy, IDH1, DNA Mutational Analysis, Neuroimaging, Pilot Projects, Sensitivity and Specificity, IDH2, Young Adult, 03 medical and health sciences, Diffuse Glioma, 0302 clinical medicine, Internal medicine, Glioma, Biomarkers, Tumor, medicine, Humans, Survival rate, Brain Neoplasms, business.industry, Middle Aged, medicine.disease, Magnetic Resonance Imaging, Isocitrate Dehydrogenase, Neoplasm Proteins, Isocitrate dehydrogenase, Tumor progression, 030220 oncology & carcinogenesis, Mutation, Female, Surgery, Neurology (clinical), business, 030217 neurology & neurosurgery, Forecasting
Abstract

Background In the era of integrated genomic-histologic analysis of brain tumors, new biomarkers have been introduced as diagnostic, prognostic, and therapeutic indicators. The analysis of the mutation in the isocitrate dehydrogenase (IDH) genes IDH1 and IDH2 has provided important diagnostic and prognostic information for patients affected by diffuse glioma (i.e., the presence of the mutation has been related to an increased survival rate). The reference standard of IDH mutation detection has been its assessment in surgical specimens, immunohistochemistry, and/or genetic sequencing. Knowing the IDH status information preoperatively would be of great importance, because it has been related to tumor progression and the response to treatment. The oncometabolite 2-hydroxyglutarate (2HG), accumulated in gliomas with IDH mutation status, can be detected in vivo using magnetic resonance spectroscopy (MRS). Methods The 2HG-MRS technique remains technically challenging. We have summarized the results of the first pilot study in Australia, which included 10 patients affected by glioma. The data recorded from May 2017 to November 2018 were analyzed. Results In our exploratory study, we reached a sensitivity and specificity of 100%, confirming the strong predictive role of 2HG, as detected using MRS, in the diagnosis of glioma. Conclusion In the present study, we have focused on methodological tips and future perspectives of the technique in the neuroimaging and neuro-oncological scenario. We would advocate the integration of 2HG-MRS into standard clinical practice.

Published
2020
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5. Cerebellar Tissue Strain in Chiari Malformation with Headache

Author

Lynne E. Bilston, Marcus A. Stoodley, Bryden H. Dawes, Jeffrey Rogers, John Magnussen, and Robert A. Lloyd

Subjects
Adult, Male, medicine.medical_specialty, Strain (injury), Pathogenesis, 03 medical and health sciences, 0302 clinical medicine, Cerebellum, medicine, Humans, Displacement (orthopedic surgery), Respiratory system, Retrospective Studies, Chiari malformation, Cardiac cycle, medicine.diagnostic_test, business.industry, Headache, Magnetic resonance imaging, medicine.disease, Magnetic Resonance Imaging, Arnold-Chiari Malformation, medicine.anatomical_structure, 030220 oncology & carcinogenesis, Cerebellar tonsil, Female, Surgery, Neurology (clinical), Radiology, business, 030217 neurology & neurosurgery
Abstract

Objective The pathogenesis of Chiari malformation type 1 (CM-1)—associated Valsalva headache is unknown, but it may be caused by abnormal cerebellar tonsil tissue strain. Advances in cardiac-gated magnetic resonance imaging (MRI) techniques such as balanced fast-field echo (bFFE) allow quantification of the motion of anatomic structures and can be used to measure tissue strain. The current study investigated the relationship between Valsalva heachache and tonsillar motion in patients with CM-1. Methods A retrospective review of patients with CM-1 who had undergone cardiac-gated bFFE MRI was performed. Headache symptoms were retrieved from the medical records. Anatomic landmarks were manually selected on the cine bFFE, and a validated motion-tracking software was used to assess motion over the cardiac cycle in patients at rest. For each patient, displacement, strain, and strain rate were calculated for 3 anatomic segments. Patients undergoing surgery were examined before and after surgery. Results From 88 patients, a total of 108 bFFE sequences were analyzed. Valsalva headache was present in 50% of patients. Cerebellar tonsil displacement (P = 0.003), strain (P = 0.012), and maximum strain rate (P = 0.04) were reduced after surgery (n = 20). There was no statistically significant association between tissue motion and headache symptoms. Conclusion The results of this study do not support a relationship between cardiac cycle cerebellar strain and Valsalva headache in patients with CM-1. It is possible that cerebellar strain related to respiratory maneuvers is associated with headache in Chiari patients. Further investigation of tissue strain is warranted because it represents a potential biomarker for outcomes after surgery.

Published
2019
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6. The integration of pharmacology and pathophysiology into locoregional chemotherapy delivery via mass fluid transfer

Author

John Magnussen, Stephen Clarke, Nick Pavlakis, Nyan Y. Khin, Thomas J. Hugh, Kevin Ho-Shon, Rodney J. Lane, and Chris Rogan

Subjects
business.industry, Hemodynamics, Vascular access, Pharmaceutical Science, Antineoplastic Agents, Bioinformatics, 030218 nuclear medicine & medical imaging, Locoregional chemotherapy, 03 medical and health sciences, Drug Delivery Systems, 0302 clinical medicine, Regional Blood Flow, Neoplasms, 030220 oncology & carcinogenesis, Isolation techniques, Humans, Medicine, business
Abstract

The prevailing paradigm of locoregional chemotherapy has been centred around delivering chemotherapy as close to the tumour as possible and in some cases incorporating vascular isolation techniques. Strategically, the development of these techniques has been rudimentary without consideration for the interdependencies between macrovascular manipulation and the microvascular effects. This review focuses on how new capabilities offered by recent advances in vascular access technology could be exploited to facilitate the mass fluid transfer (MFT) of anticancer agents to solid tumours. A haemodynamic model of MFT is proposed using the physical laws of fluid flow, flux, and diffusion that describe the microvascular effects anticancer agents may have upon tumours through the manipulation of macrovascular blood flow control. Finally, the possible applications of this technique for several organs are discussed.

Published
2018
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7. Imaging for low back pain: is clinical use consistent with guidelines? A systematic review and meta-analysis

Author

John Magnussen, Hazel Jenkins, Mark J. Hancock, Christopher G. Maher, Aron Downie, and Niamh Moloney

Subjects
medicine.medical_specialty, MEDLINE, Context (language use), CINAHL, 03 medical and health sciences, 0302 clinical medicine, Lumbar, Internal medicine, Medical imaging, Humans, Medicine, Orthopedics and Sports Medicine, 030212 general & internal medicine, Referral and Consultation, Lumbar Vertebrae, Primary Health Care, business.industry, Low back pain, Confidence interval, Outcome and Process Assessment, Health Care, Meta-analysis, Spinal Diseases, Surgery, Guideline Adherence, Neurology (clinical), medicine.symptom, business, Low Back Pain, 030217 neurology & neurosurgery
Abstract

Background Context The problem of imaging patients with low back pain (LBP) when it is not indicated is well recognized. The converse is also possible, although rarely considered. The extent of these two problems is presently unclear. Purpose This study aimed to estimate how commonly overuse, and also underuse, of imaging occurs in the management of LBP, and how appropriate use of imaging is assessed. Design This is a systematic review and meta-analysis. Patient Sample The sample comprised patients with LBP presenting to primary care. Outcome Measures Proportions of inappropriate referral, and inappropriate non-referral, for diagnostic imaging for LBP were the outcome measures. Methods MEDLINE, EMBASE, and CINAHL were searched from January 1, 1995 to December 17, 2017. Two authors independently assessed study quality and extracted data. Meta-analyses were performed where appropriate, and strength of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation system. Results Thirty-three studies were included. In patients referred for lumbar imaging, 34.8% (95% confidence interval [CI]: 27.1, 43.3) were judged inappropriate by the absence of red flags for serious pathology and 31.6% (95% CI: 28.3, 35.1) were judged inappropriate by the criteria of no clinical suspicion of pathology. In patients presenting for care, imaging was inappropriately performed in 27.7% of cases (95% CI: 21.3, 35.1) when judged by duration of episode, 9.0% of cases (95% CI: 7.4, 11.0) when judged by absence of red flags, and 7.0% (95% CI: 1.8, 23.3) when judged by no clinical suspicion of pathology. In patients presenting for care, imaging was not performed where appropriately indicated in 65.6% (95% CI: 51.8, 77.2) of patients who presented with red flags, and 60.8% (95% CI: 42.0, 76.8) with clinical suspicion of serious pathology. Conclusions Inappropriate imaging is common in LBP management, including both overuse in those where imaging is not indicated and underuse of imaging when it is indicated. Appreciating that both underuse and overuse can occur is fundamental to efforts to improve imaging practice to align with current guidelines and best evidence.

Published
2018
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8. The analysis of Italian Sigillata potters' stamps using Dual Energy Computed Tomography (DECT) and X-ray imaging

Author

John Magnussen and Jaye McKenzie-Clark

Subjects
010506 paleontology, Archeology, 060102 archaeology, Mineralogy, Digital Enhanced Cordless Telecommunications, Dual-Energy Computed Tomography, 06 humanities and the arts, 01 natural sciences, Northern italy, visual_art, Non destructive, visual_art.visual_art_medium, 0601 history and archaeology, Ceramic, Geology, 0105 earth and related environmental sciences
Abstract

Dual Energy Computed Tomography (DECT) and conventional X-ray imaging are employed in this study to investigate stamped Italian Sigillata vessels excavated at the Roman site of Carsulae in Umbria, Italy. DECT and conventional X-ray imaging were chosen for this investigation because they are non-destructive techniques, and permission to examine the material was given only on the condition that the ceramics were not physically altered. The study aims to define the composition of the ceramic fabrics and seeks to identify the manufacturing practices employed by Italian Sigillata workshops. The results indicate that although the clays used by Italian Sigillata producers in northern Italy were similar in composition overall, the preparation of clay varied considerably between manufacturing centres and individual potters. Importantly, the investigation also reveals that the composition of the ceramic fabric is not always uniform throughout each vessel. This result holds significant implications for traditional ceramic studies, where samples are routinely removed from specific areas of vessels for conventional compositional analyses.

Published
2018
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9. Risk factors for a recurrence of low back pain

Author

Chris M. Maher, Chung-Wei Christine Lin, Alejandro Luque-Suarez, Daniel Steffens, John Magnussen, Peter Petocz, and Mark J. Hancock

Subjects
Adult, Male, medicine.medical_specialty, Intervertebral Disc Degeneration, Lumbar, Recurrence, Risk Factors, Internal medicine, medicine, Humans, Orthopedics and Sports Medicine, Risk factor, Aged, medicine.diagnostic_test, Proportional hazards model, business.industry, Hazard ratio, Magnetic resonance imaging, Modic changes, Middle Aged, Magnetic Resonance Imaging, Low back pain, Surgery, Female, Neurology (clinical), medicine.symptom, business, Low Back Pain, Cohort study
Abstract

Background context The clinical importance of lumbar pathology identified on magnetic resonance imaging (MRI) remains unclear. It is plausible that pathology seen on MRI is a risk factor for a recurrence of low back pain (LBP); however, to our knowledge, this has not been investigated by previous studies. Purpose The aim was to investigate whether lumbar pathology, identifiable on MRI, increases the risk of a recurrence of LBP. Study design This was a prospective inception cohort study with 1-year follow-up. Patient sample Seventy-six people who had recovered from an episode of LBP within the previous 3 months were included. Outcome measures The primary outcome was time to recurrence of LBP, which was determined by contacting participants at 2-month intervals for 12 months. Methods All participants underwent a baseline assessment including MRI scan and completion of a questionnaire, which assessed a range of potential risk factors for recurrence. Magnetic resonance imaging scans were reported for the presence of a range of MRI findings. The primary analysis investigated the predictive value of two clinical features (age and number of previous episodes) and six MRI findings (disc degeneration, high intensity zone, Modic changes, disc herniation, facet joint arthrosis, and spondylolisthesis) in a multivariate Cox regression model. We decided a priori that dichotomous predictors with hazard ratios (HRs) of greater than 1.5 or less than 0.67 would be considered potentially clinically important and justify further investigation. Results Of the eight predictors entered into the primary multivariate model, three (disc degeneration, high intensity zone, and number of previous episodes) met our a priori threshold for potential importance. Participants with disc degeneration score greater than or equal to 3 (Pfirrmann scale) had a HR of 1.89 (95% confidence interval [CI] 0.42–8.53) compared with those without. Patients with high intensity zone had an HR of 1.84 (95% CI 0.94–3.59) compared with those without. For every additional previous episode, participants had an HR of 1.04 (95% CI 1.02–1.07). Conclusions We identified promising risk factors for a recurrence of LBP, which should be further investigated in larger trials. The findings suggest that pathology seen on MRI plays a potentially important role in recurrence of LBP.

Published
2015
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11. Clinical Audit of Contemporary Radiation Doses in a University Hospital Coronary Computed Tomography Angiography Practice

Author

Z. Wang, Lloyd J Ridley, S. Bird, W. Chan, Kevin Ho-Shon, Christopher Naoum, Christopher Yu, and John Magnussen

Subjects
Pulmonary and Respiratory Medicine, Clinical audit, medicine.medical_specialty, business.industry, Coronary computed tomography angiography, Medicine, Radiology, Cardiology and Cardiovascular Medicine, business, University hospital
Published
2018
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13. Liposuction for advanced lymphoedema – Impact of liposuction on limb volumes. Surgical treatment results from Australia

Author

Kerry A. Sherman, Asha Heydon-White, Caleb J. Winch, John Boyages, Thomas Lam, Louise Koelmeyer, John Magnussen, Quan Ngo, Katrina Kastanias, Lisa M. Sedger, Alex Munnoch, and Helen Mackie

Subjects
medicine.medical_specialty, business.industry, Gold coast, Liposuction, medicine.medical_treatment, medicine, Surgery, General Medicine, Creative commons, Surgical treatment, business
Abstract

presented at the Australian Breast Congress, 9-11 October 2014, Gold Coast, Australia. Abstract published online at 10.1016/j.breast.2015.02.005published online at 10.1016/j.breast.2015.02.005 © 2015, Elsevier. Licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 Internationalhttp://creativecommons.org/licenses/by-nc-nd/4.0/

Published
2015
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14. A 93 year old man with an unusual kyphosis: Question

Author

G. Michael Halmagyi, Matthew J. Thurtell, John Magnussen, and Gülden Akdal

Subjects
Weakness, medicine.medical_specialty, business.industry, Kyphosis, General Medicine, medicine.disease, Pyramidal signs, Trunk, Clinical neurology, Upper thoracic spine, Neurology, Physiology (medical), medicine, Physical therapy, Surgery, Neurology (clinical), medicine.symptom, business, human activities
Abstract

An independently living 93-year-old man was sent by his family doctor for an opinion concerning a kyphosis, progressive over several years, thought to be due to Parkinson’s disease. The kyphosis had not prevented him from touring India as well as Australia, by himself. On examination, there were no neurological abnormalities apart from the marked forward flexion of his trunk as he stood or walked (Fig. 1A). There was no bradykinesia, rigidity or tremor, no wasting, weakness, fasciculations or pyramidal signs. When asked to stand up straight with his hands behind his back, he could do so (Fig. 1B) and he could also lie flat on his back (Fig. 1C). Even while stooped, his head was in line with his cervical and upper thoracic spine.

Published
2008
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15. A 93 year old man with an unusual kyphosis: Answer

Author

Guelden Akdal, G. Michael Halmagyi, John Magnussen, and Matthew J. Thurtell

Subjects
medicine.medical_specialty, Neuromuscular disease, business.industry, Kyphosis, General Medicine, Disease, Action dystonia, medicine.disease, Multisystem atrophy, Surgery, Camptocormia, Atrophy, Neurology, Physiology (medical), Medicine, Neurology (clinical), business, Paraspinal Muscle
Abstract

MRI (Fig. 2) showed near-total atrophy of the paraspinal muscles with replacement by fat. Camptocormia is a kyphosis in the upright position due to neurological rather than vertebral disease. One can show this clinically: the kyphosis disappears when the patient lies down (Fig. 1C). Camptocormia can occur in extrapyramidal or in neuromuscular disease. Remarkably some patients appear to have both. In Parkinson’s disease it has been attributed to paraspinal action dystonia, but recent observations suggest that in at least in some Parkinson’s or multisystem atrophy patients it is actually due to

Published
2008
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