Forensic Science Medicine and Pathology, Jul 17, 2023
Farid et al., described how 8 of 11 cases of Bone Marrow Embolism were found to be non-traumatic.... more Farid et al., described how 8 of 11 cases of Bone Marrow Embolism were found to be non-traumatic. In our research group we found several shortcomings in the methodology, and within our own Institute we could not replicate the results.
To cite: Hartlev lB, Klose-Jensen r, thomsen JS, et al. thickness of the bonecartilage unit in re... more To cite: Hartlev lB, Klose-Jensen r, thomsen JS, et al. thickness of the bonecartilage unit in relation to osteoarthritis severity in the human hip joint. RMD Open 2018;4:e000747.
Calcified cartilage is suggested to be involved in the pathogenesis of osteoarthritis (OA) by fac... more Calcified cartilage is suggested to be involved in the pathogenesis of osteoarthritis (OA) by facilitating endochondral ossification at the bone-cartilage unit. Therefore, the objective was to quantify the volume and surface area of the calcified cartilage in the femoral head in OA patients and healthy subjects. Materials and methods: We used design-based stereological principles, i.e., systematic uniform random sampling and vertical uniform random sections of the entire femoral head. We investigated the articular and calcified cartilage and femoral head surface area and volume, excluding fovea capitis and marginal osteophytes, in 20 patients with OA and 15 healthy subjects. Results: The volume of the calcified cartilage was significantly larger for the patients with OA compared with the healthy subjects (mean difference [95% CI]) (284 [110,457] mm 3 , p = 0.002). The upper and lower surface area of the calcified cartilage, i.e. the tidemark and cement line, were both significantly larger for OA patients compared with the healthy subjects (17.8 [8.4,27.3] cm 2 , p < 0.001) and (38.7 [20.8,56.7] cm 2 , p = 0.002), respectively. The volume of the calcified cartilage and the volume of the femoral head were significantly correlated for the patients with OA (Spearman's ρ = 0.51, p = 0.021), but not for the healthy subjects (ρ = 0.41, p = 0.123). Conclusions: Patients with OA had a larger femoral head surface area and more calcified cartilage compared to healthy subjects. The volume of the calcified cartilage correlated positively with the volume of the femoral head for patients with OA, but not for healthy subjects. This strongly supports the existing view that bone growth in OA is associated with endochondral ossification.
Journal of forensic radiology and imaging, Jun 1, 2017
In this case report, we introduced post-mortem computed tomography angiography (PMCTA) in three c... more In this case report, we introduced post-mortem computed tomography angiography (PMCTA) in three cases suffering from vascular lesions in the upper extremities. In each subject, the third part of the axillary arteries and veins were used to catheterize the arms. The vessels were filled with a barium sulfate based contrast agent using a syringe. A CT scan was performed before and after filling of the vessels. Partial PMCTA provided information about the exact location and the severity of lesions. In one subject, partial PMCTA was essential to identify the cause of death. The substantial benefit of partial PMCTA is that the procedure is easily performed using standard clinically available CT systems without the use of pumps or other advanced equipment. These findings demonstrated the feasibility of PMCTA for identification of vascular lesions in the upper extremities. We expect that partial PMCTA can be of great value in cases where the subjects are suspected to have lesions in the extremities.
Journal of forensic radiology and imaging, Dec 1, 2016
We investigated the use of computer tomography angiography (CTA) to visualize microvascular struc... more We investigated the use of computer tomography angiography (CTA) to visualize microvascular structures in a vessel-mimicking phantom and post-mortem (PM) bodies. A contrast agent was used based on 22% barium sulfate, 20% polyethylene glycol and 58% distilled water. A vessel-mimicking phantom identified small vessels. Intercostal arteries and veins were visualized in four males and one female without known vascular lesions. Histology confirmed the filling of vascular structures down to 8 µm without extravasation.
and inhibited the expression of Sp1. Knockdown and overexpression experiments confirmed that XT-1... more and inhibited the expression of Sp1. Knockdown and overexpression experiments confirmed that XT-1 expression was modulated by Sp3 and Sp1, which are ubiquitous transcriptional proteins and compete for the same DNA binding site. Conclusions: These results demonstrated that 29-kDa FN-f plays a detrimental role in the regulation of cartilage extracellular matrix formation including XT-1 expression.
While standard magnetic resonance imaging (MRI) sequences are increasingly employed in post-morte... more While standard magnetic resonance imaging (MRI) sequences are increasingly employed in post-mortem (PM) examinations, more advanced techniques such as diffusion tensor imaging (DTI) remain unexplored in forensic sciences. Therefore, we studied the temporal stability and reproducibility of DTI and fiber tractography (FT) in non-fixed PM subjects. In addition, we investigated the lumbosacral nerves with PMDTI and compared their tissue characteristics to in vivo findings. MRI data were acquired on a 1.5T MRI scanner in seven PM subjects, consisting of six non-trauma deaths and one chronic trauma death, and in six living subjects. Inter-scan (within one session) and inter-session (between days) reproducibility of diffusion parameters, fractional anisotropy (FA), and mean diffusivity (MD), were evaluated for the lumbosacral nerves using Bland-Altman and Jones plots. Diffusion parameters in nerves L3-S2 were compared to living subjects using the non-parametric Mann-Whitney U test. Reproducibility of diffusion values of inter-scan 95% limits of agreement ranged from -0.058 to 0.062 for FA, and (-0.037 to 0.052)×10(-3)mm(2)/s for MD. For the inter-session this was -0.0423 to 0.0423, and (-0.0442 to 0.0442)×10(-3)mm(2)/s for FA, and MD, respectively. Although PM subjects showed approximately four-fold lower diffusivity values compared to living subjects, FT results were comparable. The chronic trauma case showed disorganization and asymmetry of the nerves. We demonstrated that DTI was reproducible in characterizing nervous tissue properties and FT in reconstructing the architecture of lumbosacral nerves in PM subjects. We showed differences in diffusion values between PM and in vivo and showed the ability of PMDTI and FT to reconstruct nerve lesions in a chronic trauma case. We expect that PMDTI and FT may become valuable in identification and documentation of PM nerve trauma or pathologies in forensic sciences.
Journal of forensic radiology and imaging, Mar 1, 2018
The aim of this work is to examine the architectural configuration and the microstructural substr... more The aim of this work is to examine the architectural configuration and the microstructural substrate of the cervical spine and its nerve roots with post-mortem (PM) diffusion tensor imaging (DTI) in non-fixed subjects and to compare these findings with histology. Methods: Magnetic resonance imaging (MRI) data were acquired on a 1.5 T MRI scanner in five non-fixed nontrauma deaths. Two different areas were evaluated: 1) the cervical spinal cord and ventral and dorsal nerve roots with a "high in-plane" DTI and a multi-echo fast field echo protocol, and 2) the cervical peripheral nerves with an "isotropic" DTI and a 3D turbo spin echo protocol. Histology samples were obtained matching the anatomical level of the slices of the 'high in-plane' DTI protocol. Results: We were able to show detailed reconstructions of the dorsal and ventral nerve roots with the 'high inplane' protocol and identified a low fractional anisotropy (FA = 0.30 ± 0.08) in the grey matter and a high FA (0.51 ± 0.13) in the white matter. Both grey and white matter configurations correlated with the anatomical MRI, the diffusion MRI, and with the histological sections. Using the 'isotropic' DTI protocol, it was feasible to reconstruct the spinal cord, cervical nerves, and nerve roots in all PM subjects. Conclusion: We were able to generate detailed architectural configurations of the ventral and dorsal nerve roots. Anatomical and diffusion MR scans showed good qualitative agreement with histology. We believe that PMDTI will be helpful in the assessment of head and neck injuries in a forensic setting.
Background: In biomedical sciences, ex vivo angiography is a practical mean to elucidate vascular... more Background: In biomedical sciences, ex vivo angiography is a practical mean to elucidate vascular structures three-dimensionally with simultaneous estimation of intravascular volume. The objectives of this study were to develop a magnetic resonance (MR) method for ex vivo angiography and to compare the findings with computed tomography (CT). To demonstrate the usefulness of this method, examples are provided from four different tissues and species: the human placenta, a rice field eel, a porcine heart and a turtle. Results: The optimal solution for ex vivo MR angiography (MRA) was a compound containing gelatine (0.05 g/mL), the CT contrast agent barium sulphate (0.43 mol/L) and the MR contrast agent gadoteric acid (2.5 mmol/L). It was possible to perform angiography on all specimens. We found that ex vivo MRA could only be performed on fresh tissue because formalin fixation makes the blood vessels permeable to the MR contrast agent. Conclusions: Ex vivo MRA provides high-resolution images of fresh tissue and delineates fine structures that we were unable to visualise by CT. We found that MRA provided detailed information similar to or better than conventional CTA in its ability to visualize vessel configuration while avoiding interfering signals from adjacent bones. Interestingly, we found that vascular tissue becomes leaky when formalin-fixed, leading to increased permeability and extravascular leakage of MR contrast agent.
Injuries to the upper cervical spine (UCS) are common in traumatic deaths and postmortem computed... more Injuries to the upper cervical spine (UCS) are common in traumatic deaths and postmortem computed tomography (PMCT) may contribute to the forensic investigation. This study presents PMCT in comparison with autopsy in the examination of UCS injury. Thirteen consecutive cases with UCS fracture and ⁄ or cranio-cervical dislocation were examined with PMCT and autopsy, and the findings were correlated. Neither of the techniques identified all UCS injuries. Fractures of atlas and axis were best visualized with PMCT whereas cranio-cervical dislocation was better identified during autopsy. Serious injuries were present after both high-and low-energy trauma. Medico-legal autopsy in combination with PMCT produced a thorough evaluation of UCS injuries. By combining these procedures detailed investigations, including accident reconstruction and injury pattern analysis, can be performed. This study supports the routine application of PMCT, as a supplement to the medico-legal autopsy of deaths with UCS injuries.
AMG tolerability was good. 15-25% patients had mild dyspepsia. Discontinuation of therapy due to ... more AMG tolerability was good. 15-25% patients had mild dyspepsia. Discontinuation of therapy due to side effects was only in 6 patients (0.93%). The development or worsening of arterial hypertension, as well as other cardiovascular complications, was not observed. Conclusion: AMG is an effective, well-tolerated NSAID, which is appropriate for long-term treatment of OA, RA and AS.
Background: Osteoarthritis (OA) is a common joint disease, but the pathology is not fully underst... more Background: Osteoarthritis (OA) is a common joint disease, but the pathology is not fully understood. It has been suggested that bone changes are important for the pathogenesis of OA. However, only few histological studies have examined bone remodelling, and results are conflicting. Objectives: The aim of this study was to quantify bone remodelling and bone volume in human hip OA in relation to overlying cartilage lesions using design-based stereological estimators. Methods: Femoral heads, from 25 OA patients (64.0±7.3 yrs) and 24 controls (CTRL) (61.5±7.9 yrs), were cut systematic uniform randomly in accordance with the principles of Cavalieri and vertical sectioning. The bone slaps was then cut into two halves, and embedded in methylmethacrylate. Each section was stained with Masson-Goldner trichrome. Design-based quantitative histology were used to estimate absolute values of the femoral head's tissue volume (TV), bone volume (BV), bone surfaces (BS), osteoid surfaces (OS), and eroded surfaces (ES). The fractional bone volume (BV/TV), osteoid surface (OS/BS), and eroded surface (ES/BS) were calculated for the subchondral bone and the central region of the femoral head. Subchondral bone was further subdivided according to the histological osteoarthritis score (OARSI-grade) into three groups OARSI-grade 0-2 (normal-mild), 3-4 (moderate), and 5-6 (severe). The OA patients and the CTRL group were compared with Mann-Whitney U-test, and correlation between bone changes, and cartilage lesions was calculated for OA patients using spearman's rank correlation coefficient (ρ). Results: In the subchondral bone, BV/TV was higher in OA (30.4±6.1%) than in CTRL (25.9±4.2%) (p<0.01) as were ES/BS (4.6±2.0% vs. 3.0±1.3%, p<0.001) and OS/BS (8.8±5.4% vs. 2.6±3.7%, p<0.001). In the centre of the femoral head, ES/BS (7.8±3.1% vs. 4.3±1.6%, p<0.001) and OS/BS (8.8±5.4% vs. 4.4±6.3%, p<0.001) were also higher in OA than in CTRL, whereas BV/TV did not differ between OA and CTRL (21.4±4.1% vs. 20.5±3.0%, p=0.87). The subchondral regions with normal-mild cartilage lesions, showed higher ES/BS (9.8±3.9% vs. 4.3±1.6%, p<0.001) and higher OS/BS (15.9±6.7% vs. 4.3±6.2%, p<0.001) in OA compared to CTRL, but no difference in BV/TV (25.3±5.5% vs. 25.9±4.2%, p=0.44). In OA patients, subchondral BV/TV was correlated to the severity of the overlying cartilage lesions (ρ=0.686, p<0.001). The same was seen for ES/BS and OS/BS which showed a correlation of ρ=0.524, p<0.001, and ρ=0.637, p<0.001, respectively. Conclusions: In this cross-sectional study of human hip OA using designbased stereological estimators on entire femoral heads, OA was associated with increased bone mass and increased bone remodelling in the subchondral region. Furthermore, in OA patients, changes in bone volume and remodelling were correlated with the degree of the osteoarthritic lesions. In the subchondral region with normal or mildly affected cartilage and in the centre of the femoral head, bone remodelling was higher in OA patients than in controls, although the bone mass did not differ. Therefore, we suggest, that subchondral bone remodelling is affected already at an early stage of OA, where changes in bone mass are not present.
Journal of Magnetic Resonance Imaging, Feb 9, 2018
Background: Diffusion tensor imaging (DTI) has been applied in the lumbar and sacral nerves in vi... more Background: Diffusion tensor imaging (DTI) has been applied in the lumbar and sacral nerves in vivo, but information about the reproducibility of this method is needed before DTI can be used reliably in clinical practice across centers. Purpose: In this multicenter study the reproducibility of DTI of the lumbosacral nerves in healthy volunteers was investigated. Study Type: Prospective control series. Subjects: Twenty healthy subjects. Field Strength/Sequence: 3T MRI. 3D turbo spin echo, and 3.0 mm isotropic DTI scan. Assessment: The DTI scan was performed three times (twice in the same session, intrascan reproducibility, and once after an hour, interscan reproducibility). At site 2, 1 week later, the protocol was repeated (interweek reproducibility). Fiber tractography (FT) of the lumbar and sacral nerves (L3-S2) was performed to obtain values for fractional anisotropy, mean, axial, and radial diffusivity. Statistical Tests: Reproducibility was determined using the intraclass correlation coefficient (ICC), and power calculations were performed. Results: FT was successful and reproducible in all datasets. ICCs for all diffusion parameters were high for intrascan (ranging from 0.70-0.85), intermediate for interscan (ranging from 0.61-0.73), and interweek reliability (ranging from 0.58-0.62). There were small but significant differences between the interweek diffusivity values (P < 0.0005). Depending on the effect size, nerve location, and parameter of interest, power calculations showed that sample sizes between 10 and 232 subjects are needed for cross-sectional studies. Data Conclusion: We found that DTI and FT of the lumbosacral nerves have intermediate to high reproducibility within and between scans. Based on these results, 10-58 subjects are needed to find a 10% change in parameters in crosssectional studies of the lumbar and sacral nerves. The small significant differences of the interweek comparison suggest that results from longitudinal studies need to be interpreted carefully, since small differences may also be caused by factors other than disease progression or therapeutic effects. Level of Evidence: 1 Technical Efficacy: Stage 2
Forensic Science Medicine and Pathology, Jul 17, 2023
Farid et al., described how 8 of 11 cases of Bone Marrow Embolism were found to be non-traumatic.... more Farid et al., described how 8 of 11 cases of Bone Marrow Embolism were found to be non-traumatic. In our research group we found several shortcomings in the methodology, and within our own Institute we could not replicate the results.
To cite: Hartlev lB, Klose-Jensen r, thomsen JS, et al. thickness of the bonecartilage unit in re... more To cite: Hartlev lB, Klose-Jensen r, thomsen JS, et al. thickness of the bonecartilage unit in relation to osteoarthritis severity in the human hip joint. RMD Open 2018;4:e000747.
Calcified cartilage is suggested to be involved in the pathogenesis of osteoarthritis (OA) by fac... more Calcified cartilage is suggested to be involved in the pathogenesis of osteoarthritis (OA) by facilitating endochondral ossification at the bone-cartilage unit. Therefore, the objective was to quantify the volume and surface area of the calcified cartilage in the femoral head in OA patients and healthy subjects. Materials and methods: We used design-based stereological principles, i.e., systematic uniform random sampling and vertical uniform random sections of the entire femoral head. We investigated the articular and calcified cartilage and femoral head surface area and volume, excluding fovea capitis and marginal osteophytes, in 20 patients with OA and 15 healthy subjects. Results: The volume of the calcified cartilage was significantly larger for the patients with OA compared with the healthy subjects (mean difference [95% CI]) (284 [110,457] mm 3 , p = 0.002). The upper and lower surface area of the calcified cartilage, i.e. the tidemark and cement line, were both significantly larger for OA patients compared with the healthy subjects (17.8 [8.4,27.3] cm 2 , p < 0.001) and (38.7 [20.8,56.7] cm 2 , p = 0.002), respectively. The volume of the calcified cartilage and the volume of the femoral head were significantly correlated for the patients with OA (Spearman's ρ = 0.51, p = 0.021), but not for the healthy subjects (ρ = 0.41, p = 0.123). Conclusions: Patients with OA had a larger femoral head surface area and more calcified cartilage compared to healthy subjects. The volume of the calcified cartilage correlated positively with the volume of the femoral head for patients with OA, but not for healthy subjects. This strongly supports the existing view that bone growth in OA is associated with endochondral ossification.
Journal of forensic radiology and imaging, Jun 1, 2017
In this case report, we introduced post-mortem computed tomography angiography (PMCTA) in three c... more In this case report, we introduced post-mortem computed tomography angiography (PMCTA) in three cases suffering from vascular lesions in the upper extremities. In each subject, the third part of the axillary arteries and veins were used to catheterize the arms. The vessels were filled with a barium sulfate based contrast agent using a syringe. A CT scan was performed before and after filling of the vessels. Partial PMCTA provided information about the exact location and the severity of lesions. In one subject, partial PMCTA was essential to identify the cause of death. The substantial benefit of partial PMCTA is that the procedure is easily performed using standard clinically available CT systems without the use of pumps or other advanced equipment. These findings demonstrated the feasibility of PMCTA for identification of vascular lesions in the upper extremities. We expect that partial PMCTA can be of great value in cases where the subjects are suspected to have lesions in the extremities.
Journal of forensic radiology and imaging, Dec 1, 2016
We investigated the use of computer tomography angiography (CTA) to visualize microvascular struc... more We investigated the use of computer tomography angiography (CTA) to visualize microvascular structures in a vessel-mimicking phantom and post-mortem (PM) bodies. A contrast agent was used based on 22% barium sulfate, 20% polyethylene glycol and 58% distilled water. A vessel-mimicking phantom identified small vessels. Intercostal arteries and veins were visualized in four males and one female without known vascular lesions. Histology confirmed the filling of vascular structures down to 8 µm without extravasation.
and inhibited the expression of Sp1. Knockdown and overexpression experiments confirmed that XT-1... more and inhibited the expression of Sp1. Knockdown and overexpression experiments confirmed that XT-1 expression was modulated by Sp3 and Sp1, which are ubiquitous transcriptional proteins and compete for the same DNA binding site. Conclusions: These results demonstrated that 29-kDa FN-f plays a detrimental role in the regulation of cartilage extracellular matrix formation including XT-1 expression.
While standard magnetic resonance imaging (MRI) sequences are increasingly employed in post-morte... more While standard magnetic resonance imaging (MRI) sequences are increasingly employed in post-mortem (PM) examinations, more advanced techniques such as diffusion tensor imaging (DTI) remain unexplored in forensic sciences. Therefore, we studied the temporal stability and reproducibility of DTI and fiber tractography (FT) in non-fixed PM subjects. In addition, we investigated the lumbosacral nerves with PMDTI and compared their tissue characteristics to in vivo findings. MRI data were acquired on a 1.5T MRI scanner in seven PM subjects, consisting of six non-trauma deaths and one chronic trauma death, and in six living subjects. Inter-scan (within one session) and inter-session (between days) reproducibility of diffusion parameters, fractional anisotropy (FA), and mean diffusivity (MD), were evaluated for the lumbosacral nerves using Bland-Altman and Jones plots. Diffusion parameters in nerves L3-S2 were compared to living subjects using the non-parametric Mann-Whitney U test. Reproducibility of diffusion values of inter-scan 95% limits of agreement ranged from -0.058 to 0.062 for FA, and (-0.037 to 0.052)×10(-3)mm(2)/s for MD. For the inter-session this was -0.0423 to 0.0423, and (-0.0442 to 0.0442)×10(-3)mm(2)/s for FA, and MD, respectively. Although PM subjects showed approximately four-fold lower diffusivity values compared to living subjects, FT results were comparable. The chronic trauma case showed disorganization and asymmetry of the nerves. We demonstrated that DTI was reproducible in characterizing nervous tissue properties and FT in reconstructing the architecture of lumbosacral nerves in PM subjects. We showed differences in diffusion values between PM and in vivo and showed the ability of PMDTI and FT to reconstruct nerve lesions in a chronic trauma case. We expect that PMDTI and FT may become valuable in identification and documentation of PM nerve trauma or pathologies in forensic sciences.
Journal of forensic radiology and imaging, Mar 1, 2018
The aim of this work is to examine the architectural configuration and the microstructural substr... more The aim of this work is to examine the architectural configuration and the microstructural substrate of the cervical spine and its nerve roots with post-mortem (PM) diffusion tensor imaging (DTI) in non-fixed subjects and to compare these findings with histology. Methods: Magnetic resonance imaging (MRI) data were acquired on a 1.5 T MRI scanner in five non-fixed nontrauma deaths. Two different areas were evaluated: 1) the cervical spinal cord and ventral and dorsal nerve roots with a "high in-plane" DTI and a multi-echo fast field echo protocol, and 2) the cervical peripheral nerves with an "isotropic" DTI and a 3D turbo spin echo protocol. Histology samples were obtained matching the anatomical level of the slices of the 'high in-plane' DTI protocol. Results: We were able to show detailed reconstructions of the dorsal and ventral nerve roots with the 'high inplane' protocol and identified a low fractional anisotropy (FA = 0.30 ± 0.08) in the grey matter and a high FA (0.51 ± 0.13) in the white matter. Both grey and white matter configurations correlated with the anatomical MRI, the diffusion MRI, and with the histological sections. Using the 'isotropic' DTI protocol, it was feasible to reconstruct the spinal cord, cervical nerves, and nerve roots in all PM subjects. Conclusion: We were able to generate detailed architectural configurations of the ventral and dorsal nerve roots. Anatomical and diffusion MR scans showed good qualitative agreement with histology. We believe that PMDTI will be helpful in the assessment of head and neck injuries in a forensic setting.
Background: In biomedical sciences, ex vivo angiography is a practical mean to elucidate vascular... more Background: In biomedical sciences, ex vivo angiography is a practical mean to elucidate vascular structures three-dimensionally with simultaneous estimation of intravascular volume. The objectives of this study were to develop a magnetic resonance (MR) method for ex vivo angiography and to compare the findings with computed tomography (CT). To demonstrate the usefulness of this method, examples are provided from four different tissues and species: the human placenta, a rice field eel, a porcine heart and a turtle. Results: The optimal solution for ex vivo MR angiography (MRA) was a compound containing gelatine (0.05 g/mL), the CT contrast agent barium sulphate (0.43 mol/L) and the MR contrast agent gadoteric acid (2.5 mmol/L). It was possible to perform angiography on all specimens. We found that ex vivo MRA could only be performed on fresh tissue because formalin fixation makes the blood vessels permeable to the MR contrast agent. Conclusions: Ex vivo MRA provides high-resolution images of fresh tissue and delineates fine structures that we were unable to visualise by CT. We found that MRA provided detailed information similar to or better than conventional CTA in its ability to visualize vessel configuration while avoiding interfering signals from adjacent bones. Interestingly, we found that vascular tissue becomes leaky when formalin-fixed, leading to increased permeability and extravascular leakage of MR contrast agent.
Injuries to the upper cervical spine (UCS) are common in traumatic deaths and postmortem computed... more Injuries to the upper cervical spine (UCS) are common in traumatic deaths and postmortem computed tomography (PMCT) may contribute to the forensic investigation. This study presents PMCT in comparison with autopsy in the examination of UCS injury. Thirteen consecutive cases with UCS fracture and ⁄ or cranio-cervical dislocation were examined with PMCT and autopsy, and the findings were correlated. Neither of the techniques identified all UCS injuries. Fractures of atlas and axis were best visualized with PMCT whereas cranio-cervical dislocation was better identified during autopsy. Serious injuries were present after both high-and low-energy trauma. Medico-legal autopsy in combination with PMCT produced a thorough evaluation of UCS injuries. By combining these procedures detailed investigations, including accident reconstruction and injury pattern analysis, can be performed. This study supports the routine application of PMCT, as a supplement to the medico-legal autopsy of deaths with UCS injuries.
AMG tolerability was good. 15-25% patients had mild dyspepsia. Discontinuation of therapy due to ... more AMG tolerability was good. 15-25% patients had mild dyspepsia. Discontinuation of therapy due to side effects was only in 6 patients (0.93%). The development or worsening of arterial hypertension, as well as other cardiovascular complications, was not observed. Conclusion: AMG is an effective, well-tolerated NSAID, which is appropriate for long-term treatment of OA, RA and AS.
Background: Osteoarthritis (OA) is a common joint disease, but the pathology is not fully underst... more Background: Osteoarthritis (OA) is a common joint disease, but the pathology is not fully understood. It has been suggested that bone changes are important for the pathogenesis of OA. However, only few histological studies have examined bone remodelling, and results are conflicting. Objectives: The aim of this study was to quantify bone remodelling and bone volume in human hip OA in relation to overlying cartilage lesions using design-based stereological estimators. Methods: Femoral heads, from 25 OA patients (64.0±7.3 yrs) and 24 controls (CTRL) (61.5±7.9 yrs), were cut systematic uniform randomly in accordance with the principles of Cavalieri and vertical sectioning. The bone slaps was then cut into two halves, and embedded in methylmethacrylate. Each section was stained with Masson-Goldner trichrome. Design-based quantitative histology were used to estimate absolute values of the femoral head's tissue volume (TV), bone volume (BV), bone surfaces (BS), osteoid surfaces (OS), and eroded surfaces (ES). The fractional bone volume (BV/TV), osteoid surface (OS/BS), and eroded surface (ES/BS) were calculated for the subchondral bone and the central region of the femoral head. Subchondral bone was further subdivided according to the histological osteoarthritis score (OARSI-grade) into three groups OARSI-grade 0-2 (normal-mild), 3-4 (moderate), and 5-6 (severe). The OA patients and the CTRL group were compared with Mann-Whitney U-test, and correlation between bone changes, and cartilage lesions was calculated for OA patients using spearman's rank correlation coefficient (ρ). Results: In the subchondral bone, BV/TV was higher in OA (30.4±6.1%) than in CTRL (25.9±4.2%) (p<0.01) as were ES/BS (4.6±2.0% vs. 3.0±1.3%, p<0.001) and OS/BS (8.8±5.4% vs. 2.6±3.7%, p<0.001). In the centre of the femoral head, ES/BS (7.8±3.1% vs. 4.3±1.6%, p<0.001) and OS/BS (8.8±5.4% vs. 4.4±6.3%, p<0.001) were also higher in OA than in CTRL, whereas BV/TV did not differ between OA and CTRL (21.4±4.1% vs. 20.5±3.0%, p=0.87). The subchondral regions with normal-mild cartilage lesions, showed higher ES/BS (9.8±3.9% vs. 4.3±1.6%, p<0.001) and higher OS/BS (15.9±6.7% vs. 4.3±6.2%, p<0.001) in OA compared to CTRL, but no difference in BV/TV (25.3±5.5% vs. 25.9±4.2%, p=0.44). In OA patients, subchondral BV/TV was correlated to the severity of the overlying cartilage lesions (ρ=0.686, p<0.001). The same was seen for ES/BS and OS/BS which showed a correlation of ρ=0.524, p<0.001, and ρ=0.637, p<0.001, respectively. Conclusions: In this cross-sectional study of human hip OA using designbased stereological estimators on entire femoral heads, OA was associated with increased bone mass and increased bone remodelling in the subchondral region. Furthermore, in OA patients, changes in bone volume and remodelling were correlated with the degree of the osteoarthritic lesions. In the subchondral region with normal or mildly affected cartilage and in the centre of the femoral head, bone remodelling was higher in OA patients than in controls, although the bone mass did not differ. Therefore, we suggest, that subchondral bone remodelling is affected already at an early stage of OA, where changes in bone mass are not present.
Journal of Magnetic Resonance Imaging, Feb 9, 2018
Background: Diffusion tensor imaging (DTI) has been applied in the lumbar and sacral nerves in vi... more Background: Diffusion tensor imaging (DTI) has been applied in the lumbar and sacral nerves in vivo, but information about the reproducibility of this method is needed before DTI can be used reliably in clinical practice across centers. Purpose: In this multicenter study the reproducibility of DTI of the lumbosacral nerves in healthy volunteers was investigated. Study Type: Prospective control series. Subjects: Twenty healthy subjects. Field Strength/Sequence: 3T MRI. 3D turbo spin echo, and 3.0 mm isotropic DTI scan. Assessment: The DTI scan was performed three times (twice in the same session, intrascan reproducibility, and once after an hour, interscan reproducibility). At site 2, 1 week later, the protocol was repeated (interweek reproducibility). Fiber tractography (FT) of the lumbar and sacral nerves (L3-S2) was performed to obtain values for fractional anisotropy, mean, axial, and radial diffusivity. Statistical Tests: Reproducibility was determined using the intraclass correlation coefficient (ICC), and power calculations were performed. Results: FT was successful and reproducible in all datasets. ICCs for all diffusion parameters were high for intrascan (ranging from 0.70-0.85), intermediate for interscan (ranging from 0.61-0.73), and interweek reliability (ranging from 0.58-0.62). There were small but significant differences between the interweek diffusivity values (P < 0.0005). Depending on the effect size, nerve location, and parameter of interest, power calculations showed that sample sizes between 10 and 232 subjects are needed for cross-sectional studies. Data Conclusion: We found that DTI and FT of the lumbosacral nerves have intermediate to high reproducibility within and between scans. Based on these results, 10-58 subjects are needed to find a 10% change in parameters in crosssectional studies of the lumbar and sacral nerves. The small significant differences of the interweek comparison suggest that results from longitudinal studies need to be interpreted carefully, since small differences may also be caused by factors other than disease progression or therapeutic effects. Level of Evidence: 1 Technical Efficacy: Stage 2
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