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Background Clinical assessment of hindfoot alignment (HA) in adult acquired flatfoot deformity (AAFD) can be challenging and weightbearing (WB) cone beam CT (CBCT) may potentially better demonstrate this three-dimensional (3D) deformity. Therefore, we compared clinical and WB CBCT assessment of HA in patients with AAFD. Methods In this prospective study, we included 12 men and 8 women (mean age: 52.2, range: 20–88) with flexible AAFD. All subjects also underwent WB CBCT and clinical assessment of hindfoot alignment. Three fellowship-trained foot and ankle surgeons performed six hindfoot alignment measurements on the CT images. Intra- and Inter-observer reliabilities were calculated using intra-class correlation (ICC). Measurements were compared by paired T-tests, and p-values of less than 0.05 were considered significant. Results The mean of clinically measured hindfoot valgus was 15.2 (95% confidence interval [CI]: 11.5–18.8) degrees. It was significantly different from the mean values of all WB CBCT measurements: Clinical Hindfoot Alignment Angle, 9.9 (CI: 8.9–11.1) degrees; Achilles tendon/Calcaneal Tuberosity Angle, 3.2 (CI: 1.3–5.0) degrees; Tibial axis/Calcaneal Tuberosity Angle, 6.1 (CI: 4.3–7.8) degrees; Tibial axis/Subtalar Joint Angle 7.0 (CI: 5.3–8.8) degrees, and Hindfoot Alignment Angle 22.8 (CI: 20.4–25.3) degrees. We found overall substantial to almost perfect intra- (ICC range: 0.87–0.97) and inter-observer agreements (ICC range: 0.51–0.88) for all WB CBCT measurements. Conclusions Using 3D WB CBCT can help characterize the valgus hindfoot alignment in patients with AAFD. We found the different CT measurements to be reliable and repeatable, and to significantly differ from the clinical evaluation of hindfoot valgus alignment. Level of evidence: Level II—prospective comparative study.

Background To investigate the reliability and reproducibility of syndesmosis measurements on weightbearing (WB) cone-beam computed tomography (CBCT) images and compare them with measurements obtained using non-weightbearing (NWB) images. Methods In this IRB-approved, retrospective study of 5 men and 9 women with prior ankle injuries, simultaneous WB and NWB CBCT scans were taken. A set of 21 syndesmosis measurements using WB and NWB images were performed by 3 independent observers. Pearson/Spearman correlation and intra-class correlation (ICC) were used to assess intra- and inter-observer reliability, respectively. Results We observed substantial to perfect intra-observer reliability (ICC = 0.72–0.99) in 20 measurements. Moderate to perfect agreement (ICC = 0.45–0.97) between observers was noted in 19 measurements. Conclusion Measurements evaluating the distance between tibia and fibula in the axial plane 10 mm above the plafond had high intra- and inter-observer reliability. Mean posterior tibio-fibular distance, diastasis, and angular measurement were significantly different between WB and NWB images.

Our objective was to describe a measurement to assess sagittal tibial tuberosity (TT)-trochlear groove (TG) distance and to compare this between asymptomatic (control) patients and patients with symptomatic patellar instability.We compared static CT images of 22 fully extended knees of patients with symptomatic patellar instability with images of 22 asymptomatic knees. TT-TG distance was measured to quantify lateralization of the TT, and anteroposterior TT-TG distance was used to quantify the sagittal distance between these two points. Lateral trochlear inclination, sulcus angle, and trochlear depth were measured. Groups were compared using paired t tests (alpha = 0.05). Correlations of anteroposterior TT-TG distance with lateral trochlear inclination, sulcus angle, and trochlear depth were assessed using linear and multivariate regression.Mean TT-TG distances were 19.9 ± 4.4 mm (symptomatic) and 16.8 ± 5.5 mm (control) (mean ± std deviation) (P = 0.002). Mean anteroposterior TT-TG distances were 8.3 ± 7.8 mm (symptomatic) and -0.5 ± 4.6 mm (control) (P 0.0001). The symptomatic group had greater measurements of trochlear dysplasia, with lower lateral trochlear inclination, greater sulcus angle, and lower trochlear depth (all P 0.0001). Anteroposterior TT-TG distance and trochlear depth were strongly negatively correlated (r = 0.62, RIn asymptomatic patients, the anteroposterior TT-TG distance was -0.5 mm, indicating that the TG and TT were nearly in the same coronal plane. In patients with symptomatic patellar instability, the TG was almost nine millimeters anterior, and this distance correlated with measurements of trochlear dysplasia.III, case control study.

Aim was to describe three definitions for an MRI-defined cartilage-meniscus phenotype and to report phenotypic progression in Kellgren-Lawrence (KL) 2 and 3 knees over 48 months.The study sample was a nested case-control study with knees showing either 1) radiographic and pain progression ("composite" case), 2) radiographic progression only, 3) pain progression only, and 4) no progression. MRI was performed on 3T systems. MRIs were read according to the MOAKS system. Knees were classified as having the cartilage-meniscus phenotype according to three modified ROAMES (Rapid OsteoArthritis MRI Eligibility Score) definitions (D): 1) ​≤ ​2.2 (10-75% of the region of cartilage surface area with 10-75% affected by full thickness loss), i.e. 'D1' 2) ≤ 2.1 (10-75% of the region of cartilage surface area with10% affected by full thickness loss), i.e. 'D2' and 3) ≤ 2.0 (10-75% of the region of cartilage surface area without full thickness loss), i.e. 'D3'. The odds of being a composite case for those with vs. without each definition was determined using logistic regression.485 knees were included. For KL2 knees 191 (64%) knees fulfilled D1 criteria, 183 (62%) D2 and 167 (56%) D3. For KL3 these numbers were 164 (87%), 103 (55%) and 77 (41%). Odds for being a composite case for KL2 knees were 2.52 (95% CI 1.40,4.54) for D1, 1.93 (95% CI 1.11,3.35) for D2 and 1.92 (95% CI 1.13,3.28) for D3. For KL3 knees odds were 0.32 (95% CI 0.13,0.78) for D1, 0.56 (95% CI 0.31,1.01) for D2 and 0.49 (95% CI 0.26,0.91) for D3.Increased odds for progression are seen for KL2 knees for all definitions, while this was not observed for KL3 knees. KL3 knees exceeding the maximum damage thresholds and not fulfilling the phenotypic definitions are still likely to experience further progression.

Summary Objective To determine the association between bisphosphonate treatment with the change of periarticular bone area and three-dimensional (3D) shape in participants of the Osteoarthritis Initiative (OAI) study. Design Using propensity score (PS) matching method in females, 48 bisphosphonate users and 105 non-users, who were matched for osteoarthritis (OA) and osteoporosis (OP) related factors were included. Baseline and 24-month magnetic resonance imaging (MRI)-based periarticular bone area and 3D shape measurements were used. The association between bisphosphonate intake and 24-month interval changes of the periarticular bone area and 3D shape were evaluated using paired Wilcoxon signed rank test. We used conditional logistic regression models for determining the association between bisphosphonate intake and periarticular bone change, defined using the standard deviation of difference (SDD) and reliable change index (RCI) methods. P -values have been adjusted for multiple comparisons using Benjamini & Hochberg procedure and false discovery rate (FDR)-adjusted P -values were reported. Results The 24-month interval increases in the periarticular bone area in medial side of tibia were significantly greater in non-users than users ( FDR-adjusted P-value: 0.002 ). There was an approaching significance trend for lower medial tibial periarticular bone area expansion in bisphosphonate users in comparison with non-users (For 1SDD change, odds ratio 95% confidence interval (OR (95% CI)): 0.514 (0.271–0.975), FDR-adjusted P-value : 0.085 ) (For 1.96RCI change, OR (95% CI): 0.552 (0.309–0.986), FDR-adjusted P-value: 0.085 ). Conclusions Bisphosphonate intake was associated with a reduction in the odds (approaching but not achieving significance) of expansion periarticular bone area, specifically in the medial tibial sub-region.

Summary Objective This narrative review covers original research publications related to imaging advancements in osteoarthritis (OA) published in the English language between 1 st April 2016 and 30 th April 2017. Methods Relevant human studies (excluding pre-clinical and in vitro studies), were searched and selected from PubMed database using the search terms of "osteoarthritis (OA)" in combination with "radiography", "magnetic resonance imaging (MRI)", "computed tomography (CT)", "ultrasound", "positron emission tomography (PET)," "single-photon emission computed tomography (SPECT)," and "scintigraphy". The included studies were sorted according to their relevance, novelty, and impact. Original research articles with both imaging advancements and novel clinical information were discussed in this review. Results A large portion of the published studies were focused on MRI-based semi-quantitative and quantitative (morphological and structural) metrics of the knee joint to assess OA-related structural damages. New imaging technologies, such as PET, have been investigated for OA diagnosis and characterization, the delineation of predictive factors for OA progression, and to monitor the treatment responses. Conclusion Advanced imaging modalities play a pivotal role in OA research, and make a significant contribution to our understanding of OA diagnosis, pathogenesis, risk stratification, and prognosis.

We present the case of a man with oligometastatic prostate cancer who underwent a PSMA-targeted 18F-DCFPyL PET/CT scan in order to illustrate how the PSMA-RADS grading sytem can be successfully used to support clinical decision-making and treatment planning. Notably, the presented patient was found to have an equivocal bone lesion (PSMA-RADS-3B) which was further worked up with a tumor protocol MRI and found to be definitively benign (PSMA-RADS-1B) and thus removed from the oligometastatic treatment plan. Remaining avid lesions were incorporated into the treatment plan or deferred for later work-up or monitoring, as indicated within the PSMA-RADS framework. Keywords: PSMA, DCFPyL, Prostate cancer, Oligometastatic

Osteoarthritis (OA) is a major chronic and global health care problem. Recent technological advances in imaging and postprocessing techniques have enhanced the understanding and characterization of the pathophysiology of this chronic and prevalent disease. Although plain radiograph remains the modality of choice for initial assessment of OA, recent studies have shown that advanced cross-sectional imaging can improve the early detection, grading, structural damage quantification, and risk stratification of OA. This article discusses the currently available evidence regarding both the conventional and novel imaging modalities that can be used for evaluation of patients with OA and its longitudinal assessment.

Summary Objective To assess the association between physical activity and cartilage damage progression in medial tibiofemoral compartment (MTFC) using 2-year follow-up magnetic resonance imaging (MRI) in subjects with denuded areas of subchondral bone (dABs) at the central weight-bearing medial femur (cMF) at baseline MRI examination. Methods One hundred subjects from the Osteoarthritis Initiative (OAI) progression cohort with dABs at the cMF at 3T MRI at baseline (51% men; mean age 62.2 years, range 45–79) were included. Sagittal 3D dual-echo steady-state with water excitation images were used to assess 2-year MTFC cartilage change. Associations between 2-year average Physical Activity Scale for the Elderly (PASE) and 2-year MTFC cartilage change were assessed by linear regression analysis. Subgroup analyses were performed. Results No associations between PASE and 2-year MTFC cartilage change were observed in the entire cohort. Similarly, in the subgroup with cartilage loss during the 2 years, the non-refuted confidence intervals for the regression coefficients were tightly clustered around the null value (regression coefficients for: mean cMF.ThCtAB = −0.00059; 98.75% CI: −0.00130 to 0.00012), cMF.dAB% = 0.02176; 98.75% CI: −0.02514 to 0.06865, Mean MT.ThCtAB = −0.00013; 98.75% CI: −0.00064 to 0.00038, MT.dAB% = 0.02543; 98.75% CI: −0.01485 to 0.06571. Conclusion In the entire group of subjects with dABs at the cMF at baseline, no association between physical activity and 2-year MTFC cartilage change was detected. Due to the limited sample size of our study, small-sized effects may not have been detected in our study.

Rationale and Objectives The study aimed to perform a systematic review and meta-analysis for evaluating the diagnostic accuracy of 1.5 Tesla and 3.0 Tesla magnetic resonance imaging (MRI), and magnetic resonance arthrography (MRA), in the detection of scapholunate interosseous ligament (SLIL) injury. Materials and Methods A literature search was performed (until July 2015) using the PubMed (MEDLINE), Embase, ISI Web of Science, Scopus, and conference proceedings. Original studies evaluating the diagnostic accuracy of MRI or MRA in the detection of SLIL injuries using arthroscopy or open surgery as the reference standard were included. Results Of the initial 930 published records and 103 conference proceedings, 24 studies (1902 MRI examinations) were included (median SLIL injury prevalence: 33% [interquartile range: 25–42]). Heterogeneity was detected for 1.5 T MRI (chi-square: 47.93, P P value: 0.09) and MRA (chi-square: 14.54, P value: 0.34) studies. The sensitivities of 1.5 T MRI, 3.0 T MRI, and MRA for detection of SLIL injury were 45.7% (95% confidence interval: 40.1–51.4), 75.7% (66.8–83.2), and 82.1% (76.1–87.2), respectively. The specificities of 1.5 T MRI, 3.0 T MRI, and MRA for detection of SLIL injury were 80.5% (77.3–83.4), 97.1% (89.8–99.6), and 92.8% (90.2–94.9), respectively. The diagnostic odds ratios of 1.5 T MRI, 3.0 T MRI, and MRA for detection of SLIL injury were 5.56 (2.71–11.39), 23.23 (3.16–171.00), and 65.04 (32.89–128.62) ( P value Conclusions MRA is superior to 3.0 T MRI, and 3.0 T MRI is superior to 1.5 T MRI in terms of diagnostic performance. 3.0 T MRI has the highest specificity for the detection of SLIL injuries.

Summary Objectives To determine the association between the long-term use of analgesics and progression of osteoarthritis (OA) as evidenced by up to 3-years follow-up worsening of radiographic Kellgren–Lawrence (KL) grade and incidence of knee replacement (KR). Design Using nearest neighbor matching of the propensity scores with caliper in the Osteoarthritis Initiative (OAI) cohort, 173 index (Analgesic +) and 173 referent (Analgesic −) subjects were included. Analgesic + and − subjects had analgesics in all and none of their visits, respectively. Analgesic + and − subjects were balanced in their demographics, baseline, first, second and third year body mass index (BMI), Western Ontario and McMaster (WOMAC) total score, Physical and Mental health summary scales (SF-12), Physical Activity Scale for the Elderly (PASE) and Charleston Comorbidity Scale. Analgesic + and − subjects were also matched for baseline radiographic KL grade. Interval increase in the KL grade and incidence of KR were defined as the outcome. Results Included subjects had average 6.5 years of follow-up. By the third year, 44 subjects had an interval increase in the KL grade; 29 in Analgesic + and 15 among Analgesic − subjects ( P = 0.024). By the eighth-year, 41 subjects had their first KR; 29 in Analgesic + and 12 among Analgesic − subjects ( P = 0.005). Hazard Ratio (HR) of OA progression and KR for Analgesic + subjects was 1.91 (1.02–3.57) and 2.57 (1.31–5.04), respectively. Conclusions Long-term use of analgesics may be associated with radiographic progression of knee OA and increased risk of future KR.

Objectives To investigate the effects of morphine on reperfusion injury due to testicular torsion-detorsion (T/D). Methods We divided 36 adult male Sprague-Dawley rats into six groups. Testicular ischemia was achieved by twisting the right testis 720° counterclockwise for 1 hour, and reperfusion was allowed for 4 hours after detorsion. The baseline group was for basal normal values. The sham-operated group served as the control group. The T/D group underwent 1 hour of testicular torsion and 4 hours of detorsion. The morphine group received pretreatment with intravenous morphine sulfate (10 mg/kg) just before detorsion. The naltrexone group received an intravenous injection of naltrexone HCl (20 mg/kg) 15 minutes before detorsion. The naltrexone/morphine group received intravenous administration of naltrexone HCl (20 mg/kg) 15 minutes before detorsion and morphine sulfate (10 mg/kg) just before detorsion. Results The ipsilateral malondialdehyde levels in the T/D group were significantly greater than in the control and baseline groups. Moreover, the ipsilateral testicular malondialdehyde values in the morphine group were significantly lower than in the T/D and naltrexone/morphine groups. Also, significant decreases occurred in catalase and superoxide dismutase activities in the T/D group compared with the control and baseline groups. These values were significantly greater in the morphine group than in the T/D and naltrexone/morphine groups. The ipsilateral testes of all groups that underwent testicular torsion showed similar histopathologic changes. Conclusions Morphine increased the ipsilateral intratesticular antioxidant markers during the reperfusion phase after unilateral testicular torsion, which was eventually reflected in lower testicular malondialdehyde levels. Furthermore, this effect was mediated through the opioid receptors.

Opioid receptors have been implicated in protecting several organ systems from ischaemic events. The authors have studied the effects of opioid receptors on random-pattern skin flap survival. Sixty-nine male Sprague-Dawley rats were used. Bipedicled dorsal skin flaps (2 x 8 cm) were elevated at the midline. Different doses of morphine (0.01, 0.1, 1 and 5 mg/flap) were administered locally in the cranial half of the flap and systemically through intraperitoneal injections (5 and 10 mg/kg). In another experiment, 0.4 mg/flap of naloxone was injected followed by 5 mg/flap injection of morphine to determine whether the effect of morphine is receptor mediated. The role of the opioid receptors in the ischaemic preconditioning (IPC) phenomenon was investigated by administration of naloxone (0.4 mg/flap) 1 h before clamping the cranial pedicle for 20 min followed by 40 min of reperfusion. Appropriate control groups were included. The cranial pedicle was cut 2 h after saline or drug administration in all groups and flap survival area was evaluated on the seventh postoperative day. Local administration of morphine in higher doses (1 and 5 mg/flap) significantly reduced the amount of flap necrosis when compared to that of the control cohort (P < 0.05). Naloxone abolished this protective effect of morphine. Furthermore naloxone significantly decreased the anti-ischaemic effect of the IPC. Systemic administrations of morphine had no significant effect on flap survival area in compare with the control group.

Lithium has been reported to inhibit opioid-induced properties. The present study examined the effect of acute and chronic administration of lithium chloride (LiCl) on morphine's biphasic modulation of susceptibility to pentylenetetrazole (PTZ)-induced clonic seizure in mice. We also examined the possible involvement of nitric oxide (NO) pathway in lithium effect. Both acute (0.1 and 1 mg/kg) and chronic (same doses, 21 consecutive days) administration of LiCl completely inhibited the anticonvulsant and proconvulsant effects of morphine (at doses 1 and 30 mg/kg, respectively). A very low and per se noneffective dose of LiCl (0.05 mg/kg) significantly inhibited both phases of morphine effect when administered concomitant with a noneffective low dose of naloxone (0.1 mg/kg). The NO synthase inhibitor NG-nitro- l -arginine methyl ester (L-NAME) at a per se noneffective dose of 0.3 mg/kg potentiated the inhibitory effects of low doses of LiCl (0.01 and 0.05 mg/kg) on both phases of morphine effect. l -arginine, a NO synthase substrate, at a per se noneffective dose of 30 mg/kg reversed the inhibitory effects of lithium (1 mg/kg). Lithium is capable of antagonizing both modulatory effects of morphine on seizure susceptibility even at relatively low doses. These inhibitory effects of lithium may also involve NO synthesis.

The effect of agmatine, an endogenous polyamine metabolite, on seizure susceptibility was investigated in mice. Acute intraperitoneal administration of agmatine (5, 10, 20, 40 mg/kg) had a significant and dose-dependent inhibitory effect on pentylenetetrazole (PTZ)-induced seizures. The peak of this anticonvulsant effect was 45 min after agmatine administration. We further investigated the possible involvement of the α2-adrenoceptors and l -arginine/NO pathway in this effect of agmatine. The α2-adrenoceptor antagonist, yohimbine (0.5–2 mg/kg), induced a dose-dependent blockade of the anticonvulsant effect of agmatine. The nitric oxide synthase (NOS) substrate, l -arginine (60 mg/kg), inhibited the anticonvulsant property of agmatine and this effect was significantly reversed by NOS inhibitor NG-nitro- l -arginine ( l -NAME, 30 mg/kg), implying an NO-dependent mechanism for l -arginine effect. We further examined a possible additive effect between agmatine (1 or 5 mg/kg) and l -NAME (10 mg/kg). The combination of l -NAME (10 mg/kg) with agmatine (5 but not 1 mg/kg) induced a significantly higher level of seizure protection as compared with each drug alone. Moreover, a combination of lower doses of yohimbine (0.5 mg/kg) and l -arginine (30 mg/kg) also significantly decreased the anticonvulsant effect of agmatine. In conclusion, the present data suggest that agmatine may be of potential use in seizure treatment.