Ping C. Leung

Osteoporosis is associated with increased marrow fat content and decreased marrow fat unsaturation: A proton MR spectroscopy study

To use proton magnetic resonance spectroscopy (1H‐MRS) to evaluate vertebral marrow fat, and to determine whether bone density correlates with fat content and fat unsaturation levels in postmenopausal women.

Compromised Bone Marrow Perfusion in Osteoporosis

A link between bone blood flow and osteoporosis may exist. Outside of the spine, the proximal femur is the most common site of osteoporotic fracture and is also an area prone to avascular necrosis and fracture nonunion. This study of the proximal femur investigates the relationship between BMD, bone marrow fat content, bone perfusion, and muscle perfusion. One hundred twenty healthy female subjects (mean age, 74 yr; age range, 67–89 yr) underwent DXA examination of the hip, proton MR spectroscopy, and dynamic contrast‐enhanced MR imaging of the right proximal femur, acetabulum, and adductor thigh muscle. In all bone areas examined (femoral head, femoral neck, femoral shaft, acetabulum), perfusion indices (maximum enhancement, enhancement slope) were significantly reduced in subjects with osteoporosis compared with subjects with osteopenia or normal BMD. Adductor muscle perfusion was not affected by change in BMD. As marrow perfusion decreased in the proximal femur, marrow fat increased (r = 0.827). This increase in fat content seemed to account for the decrease in marrow perfusion more than a reduction in BMD. For normal BMD subjects, perfusion parameters in the femoral head were one third of those in the femoral neck or shaft and one fifth of those in the acetabulum. Perfusion throughout the proximal femur is reduced in osteoporotic subjects compared with osteopenic and normal subjects. This reduction in perfusion only affects bone and not those tissues outside of bone with the same blood supply. As bone perfusion decreased, there was a corresponding increase in marrow fat.

Ligamentotaxis and bone grafting for comminuted fractures of the distal radius

The conventional treatment of comminuted fractures in the distal radius has been unsatisfactory. We therefore made a prospective study using the principle of ligamentotoxis and primary cancellous bone grafting as the uniform method of treatment. Ligamentotaxis was maintained by using an external fixator for three weeks only, after which a carefully monitored programme of rehabilitation was given. We have reviewed 72 consecutive distal radial fractures after a follow-up of 7 to 40 months (average 11 months). Reduction had been maintained during healing and over 80% of patients regained full range of movement in hands, wrists and forearms with strong and pain-free wrist function. Complications were infrequent and gave no real problems. We conclude that distraction, external fixation and bone grafting appears to be an excellent method of treating comminuted fractures of the distal radius.

A study of bone marrow and subcutaneous fatty acid composition in subjects of varying bone mineral density

Osteoporosis is associated with an increase in marrow fat. Fats, particularly polyunsaturated fats, either in co-cultures or diet, have been shown to significantly influence bone remodeling. Whether the increase in marrow fat seen in osteoporosis is also associated with a change in fatty acid composition is not known. This study was undertaken to investigate the fatty acid composition in subjects of varying bone mineral density (BMD). Samples of marrow fat and subcutaneous fat from 126 subjects (98 females, 34 males, mean age 69.7+/-10.5 years) undergoing orthopedic surgery were analyzed for fatty acid composition by gas chromatography. These results were correlated with BMD assessed by DXA. A total of 22 fatty acids were identified in marrow and subcutaneous fat. Significant differences in fatty acid composition existed between marrow and subcutaneous fat as well as between marrow fat samples obtained from the proximal femur and proximal tibia. Other than cis-7-hexadecenoic acid [C16:1 (n=9)] and docosanoic acid [C22:0], no difference in marrow fatty acid composition was evident between subject groups of varying BMD (normal, low bone mass, and osteoporosis). In conclusion, there exists a wide range of individual fatty acids in marrow fat. Marrow fatty acid composition differs from that of subcutaneous fat and varies between predominantly erythropoetic and fatty marrow sites. Other than cis-7-hexadecenoic acid [C16:1 (n=9)] and docosanoic acid [C22:0], no difference in marrow fatty acid composition was evident between subjects of varying BMD.

Depressive symptoms and lifestyle factors as risk factors of lower urinary tract symptoms in Southern Chinese men: a prospective study

Background.u2003Few prospective studies have been conducted to identify risk factors associated with lower urinary tract symptoms (LUTS). Our objective is to evaluate the dietary, lifestyle and medical risk factors of LUTS. Methods.u2003Data were collected from a large prospective cohort of elderly Chinese men in Hong Kong. Eight hundred seventy-one subjects provided response to a structured interviewer-administered questionnaire and physical examination at baseline and at 4-year follow-up. LUTS and depressive symptoms were assessed using International Prostate Symptom Score (IPSS) and Geriatric Depressive Symptom Scale (GDS). Results.u2003The GDS score was independently associated with increased risk of having moderate to severe LUTS (odd ratios (OR)u2009=u20092.08; confidence interval (CI)u2009=u20091.28–3.40; Wald chi-square testu2009=u20099.52 and pu2009=u20090.023). A history of coronary heart disease was independently associated with increased risk of moderate to severe LUTS (ORu2009=u20091.65, CI: 1.05–2.59; Wald chi-square testu2009=u20094.74 and pu2009=u20090.029). Alcohol consumption of seven drinks or more per week was independently associated with increased risk of moderate to severe LUTS (ORu2009=u20092.51; CI: 1.32–4.79; Wald chi-square testu2009=u20098.01 and pu2009=u20090.018). Limitations.u2003We have studied LUTS but not surgical BPH. Conclusions.u2003The results showed that medical and lifestyle factors may increase the risk of LUTS in Chinese elderly men.

Chronic recurrent multifocal osteomyelitis: a great clinical and radiologic mimic in need of recognition by the pathologist.

The spectrum of histopathologic changes in four cases of chronic recurrent multifocal osteomyelitis encountered in our orthopedic outpatient clinic in the past 3 years was studied in conjunction with clinical and radiologic findings. All presented with pain with or without swelling in the affected region. Radiographically, the appearance of the lesions varied from a mixed picture of bone lysis and sclerosis with expansion to sclerosis alone to bone collapse. Bone scintigraphy demonstrated asymptomatic and separate foci of activity in all cases. Prior to biopsy, the clinical and radiologic differential diagnoses included Ewings sarcoma, metastatic neuroblastoma, hematolymphoid malignancy, Langerhans cell histiocytosis and chronic infection, notably tuberculosis. The spectrum of histopathologic changes ranged from acute (acute inflammatory infiltration, active bone resorption and necrosis, reactive bone formation) to subacute (predominantly lymphocytic and plasma cell infiltration) to chronic inflammation (fibroblastic organization and bony sclerosis). Histologic changes correlated poorly with clinical features, but relatively well with radiologic findings. Lesional excision was performed in one case, cortical saucerization in another, while the final two cases received supportive treatment. All remained well 18–21 months post‐therapy. Chronic recurrent multifocal osteomyelitis is a great clinical and radiologic mimic, which merits recognition by the pathologist. Awareness of the spectrum of histologic features encountered enables a correct diagnosis to be made in the appropriate clinical setting. The patient can thus be reassured of a favorable prognosis.

Prediction of bone loss in elderly female subjects by MR perfusion imaging and spectroscopy

ObjectiveTo determine whether MR perfusion indices or marrow fat content at baseline can predict areal bone mineral density (BMDa) loss.MethodsRepeat dual x-ray absorptiometry (DXA) of the hip was performed in female subjects at 2xa0years (nu2009=u200952) and 4xa0years (nu2009=u200945) following baseline MR perfusion imaging and spectroscopy of the hip.ResultsPercentage reduction in femoral neck BMDa at 4xa0years post-baseline was greater in subjects with below median acetabulum enhancement slope (Eslope) (−5.6u2009±u20091.2 Vs −1.1u2009±u20091.2 (mean ± standard error) pu2009=u20090.014) or muscle maximum enhancement (Emax) (−5.7u2009±u20091.2 Vs −0.23u2009±u20091.2, pu2009=u20090.009) after adjusting for baseline co-variables. Baseline MR parameters correlated with reduction in BMDa at 4xa0years (acetabulum Esloperu2009=u20090.517, pu2009=u20090.0003; muscle Emaxru2009=u20090.306, pu2009=u20090.043) as well as traditionally applied clinical risk factors. Acetabulum Eslope, femoral neck Emax and marrow fat content at baseline had sensitivities of 89%, 81% and 72% respectively at distinguishing between fast (>1%/annum) (nu2009=u200918) and slow (<1%/annum) (nu2009=u200927) BMD losers.ConclusionElderly female subjects with reduced perfusion indices at baseline had increased femoral neck bone loss at 4xa0years. Selected perfusion indices and marrow fat content have a moderate to high sensitivity in discriminating between fast and slow bone losers.

Acupuncture for Stroke Rehabilitation

BACKGROUNDnStroke is the third leading cause of death in Western society; in China it is the second most common cause of death in cities and the third in rural areas. It is also a main cause of adult disability and dependency. Acupuncture for stroke has been used in China for hundreds of years and is increasingly practiced in some Western countries.nnnOBJECTIVESnTo assess the efficacy and safety of acupuncture for patients with stroke in the subacute or chronic stage.nnnSEARCH STRATEGYnWe searched the Cochrane Stroke Group Trials Register (November 2005), the Cochrane Complementary Medicine Field Trials Register (November 2005), the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 3, 2005), MEDLINE (1966 to November 2005), EMBASE (1980 to November 2005), CINAHL (1982 to November 2005), AMED (1985 to November 2005), the Chinese Stroke Trials Register (November 2005), the Chinese Acupuncture Trials Register (November 2005), the Chinese Biological Medicine Database (1977 to November 2005), the National Center for Complementary and Alternative Medicine Register (November 2005), and the National Institute of Health Clinical Trials Database (November 2005). We handsearched four Chinese journals and checked reference lists of all papers identified for further trials.nnnSELECTION CRITERIAnTruly randomised unconfounded clinical trials among patients with ischemic or hemorrhagic stroke, in the subacute or chronic stage, which compared acupuncture involving needling with either placebo acupuncture, sham acupuncture or no acupuncture.nnnDATA COLLECTION AND ANALYSISnTwo review authors independently selected trials for inclusion, assessed quality, extracted and cross-checked the data.nnnMAIN RESULTSnFive trials (368 patients) met the inclusion criteria. Methodological quality was considered inadequate in all trials. Although the overall estimate from four trials suggested the odds of improvement in global neurological deficit was higher in the acupuncture group compared with the control group (odds ratio (OR) 6.55, 95% confidence interval (CI) 1.89 to 22.76), this estimate may not be reliable since there was substantial heterogeneity (I(2 )= 68%). One trial showed no significant improvement of motor function between the real acupuncture group and the sham acupuncture group (OR 9.00, 95% CI 0.40 to 203.30), but the confidence interval was wide and included clinically significant effects in both directions. No data on death, dependency, institutional care, change of neurological deficit score, quality of life or adverse events were available.nnnAUTHORS CONCLUSIONSnCurrently there is no clear evidence on the effects of acupuncture on subacute or chronic stroke. Large, methodologically-sound trials are required.

Does Acupuncture Therapy Alter Activation of Neural Pathway for Pain Perception in Irritable Bowel Syndrome?: A Comparative Study of True and Sham Acupuncture Using Functional Magnetic Resonance Imaging

Background/Aims Patients with irritable bowel syndrome (IBS) are characterized by abnormal central processing with altered brain activation in response to visceral nociceptive signals. The effect of electroacupuncture (EA) on IBS patients is unclear. The study is set to study the effect of EA on brain activation during noxious rectal distension in IBS patients using a randomized sham-controlled model. Methods Thirty IBS-diarrhea patients were randomized to true electroacupuncture or sham acupuncture. Functional MRI was performed to evaluate cerebral activation at the following time points: (1) baseline when there was rectal distension only, (2) rectal distension during application of EA, (3) rectal distension after cessation of EA and (4) EA alone with no rectal distension. Group comparison was made under each condition using SPM5 program. Results Rectal distension induced significant activation of the anterior cingulated cortex, prefrontal cortex, thalamus, temporal regions and cerebellum at baseline. During and immediately after EA, increased cerebral activation from baseline was observed in the anterior cingulated cortex, bilateral prefrontal cortex, thalamus, temporal regions and right insula in both groups. However, true electroacupuncture led to significantly higher activation at right insula, as well as pulvinar and medial nucleus of the thalamus when compared to sham acupuncture. Conclusions We postulate that acupuncture might have the potential effect of pain modulation in IBS by 2 actions: (1) modulation of serotonin pathway at insula and (2) modulation of mood and affection in higher cortical center via ascending pathway at the pulvinar and medial nucleus of the thalamus.

Depressive Symptoms and Change in Abdominal Obesity in the Elderly: Positive or Negative Association?

OBJECTIVESnRecent evidence suggests that depression can result in abdominal obesity in the elderly. Few longitudinal studies are available and none has been conducted outside the United States.nnnMETHODSnTo examine the relationship between depressive symptoms and abdominal obesity, data from 3,998 community-dwelling Chinese elderly men and women age 65 years and older with 4-year follow-up were analyzed. Depression was defined by a Geriatric Depression Scale score of 8 or higher. At baseline and after 4 years, overall obesity measures included body mass index, percentage of body fat, and general adiposity or body fat index (expressed by total body fat mass measured by DEXA (dual-energy x-ray absorptiometry) in kilograms divided by the square of stature in meters). Abdominal obesity measures included waist circumference, waist to hip ratio, and relative truncal fat (ratio of truncal fat mass to total fat mass measured by DEXA).nnnRESULTSnAfter adjustment for sociodemographics, lifestyle, and medical factors, the presence of clinically relevant depressive symptoms at baseline was associated with significant decrease in waist circumference at follow-up after adjusting for sociodemographic factors, baseline obesity, lifestyle, and medical factors (β = -1.801, t = -2.93, df = 1564, p = 0.0034), although this relationship disappeared in older age women in further age-stratified analysis.nnnCONCLUSIONSnThis study shows that depressive symptoms may result in a decrease in abdominal obesity, suggesting that more research is needed to further explore this relationship. Similar studies conducted in different cultural groups may help to explain these conflicting findings.