Shih-Chang Wang

Prevalence and clinical features of lumbar zygapophysial joint pain: a study in an Australian population with chronic low back pain.

OBJECTIVES--To determine the prevalence of pain arising from the zygapophysial joint in patients with chronic low back pain and to determine whether any clinical features could distinguish patients with and without such pain. METHODS--Sixty three patients with chronic low back pain were studied prospectively. All patients underwent a detailed history and physical examination as well as a series of intra-articular zygapophysial joint injections of 0.5% bupivacaine starting at the symptomatic level to a maximum of three levels or until the pain was abolished. They also received injections of normal saline into paraspinal muscles to act as controls. RESULTS--All patients proceeded with the injections. Twenty (32%; 95% confidence interval (CI) 20 to 44%) obtained greater than 50% relief of their pain following the administration of saline. Fifty seven patients completed the study; 23 of them (40%; 95% CI 27 to 53%) failed to obtain relief following the injection of saline but obtained relief following one or more intra-articular injections of local anaesthetic. None of the historical features or clinical tests could discriminate those patients with and those without zygapophysial joint pain. CONCLUSION--Pain originating from the zygapophysial joint is not uncommon, but this study failed to find any clinical predictors in patients with such pain.

The ability of computed tomography to identify a painful zygapophysial joint in patients with chronic low back pain

Study design A prospective cross-sectional analytic study. Objectives To assess in patients with chronic low back pain whether the presence or absence of pain originating from the lumbar zygapophysial joints correlates with changes seen on computed tomography. Summary of Background Data Results of studies have been divided as to whether or not radiologic imaging is able to predict those patients with pain originating from the zygapophysical joints. Methods Sixty-three patients with low back pain lasting for longer than 3 months underwent computed tomography and blocks of the zygapophysial joints at L5-S1,L4-L5, and L3-L4. The zygapophysical joints of all images were scored by three independent, masked radiologists. Results Interobserver agreement was poor with intraclass correlation coefficients of 0.34–0.66 using total joint scores for all three assessors. Using the results of a repeat assessment with two radiologists there was no statistically significant difference in joint scores between those with and those without pain originating from the zygapophysial joint. Conclusions Computed tomography has no place in the diagnosis of lumbar zygapophysial joint pain.

Patient selection and activity planning guide for selective internal radiotherapy with yttrium-90 resin microspheres.

PURPOSE Selective internal radiotherapy (SIRT) with yttrium-90 ((90)Y) resin microspheres can improve the clinical outcomes for selected patients with inoperable liver cancer. This technique involves intra-arterial delivery of β-emitting microspheres into hepatocellular carcinomas or liver metastases while sparing uninvolved structures. Its unique mode of action, including both (90)Y brachytherapy and embolization of neoplastic microvasculature, necessitates activity planning methods specific to SIRT. METHODS AND MATERIALS A panel of clinicians experienced in (90)Y resin microsphere SIRT was convened to integrate clinical experience with the published data to propose an activity planning pathway for radioembolization. RESULTS Accurate planning is essential to minimize potentially fatal sequelae such as radiation-induced liver disease while delivering tumoricidal (90)Y activity. Planning methods have included empiric dosing according to degree of tumor involvement, empiric dosing adjusted for the body surface area, and partition model calculations using Medical Internal Radiation Dose principles. It has been recommended that at least two of these methods be compared when calculating the microsphere activity for each patient. CONCLUSIONS Many factors inform (90)Y resin microsphere SIRT activity planning, including the therapeutic intent, tissue and vasculature imaging, tumor and uninvolved liver characteristics, previous therapies, and localization of the microsphere infusion. The influence of each of these factors has been discussed.

Biodegradable magnetic-fluorescent magnetite/poly(dl-lactic acid-co-α,β-malic acid) composite nanoparticles for stem cell labeling

Bifunctional superparamagnetic magnetite/poly(dl-lactic acid-co-alpha,beta-malic acid) composite nanoparticles (PLMA-MNPs) detectable by both magnetic resonance imaging (MRI) and fluorescence microscopy were synthesized by coating Fe(3)O(4) nanoparticles with biodegradable poly(dl-lactic acid-co-alpha,beta-malic acid) copolymer (PLMA) with covalently bound fluorescein isothiocyanate (FITC). The FITC modified PLMA-MNPs (FITC-PLMA-MNPs) have a hydrodynamic diameter of 100nm and an anionic surface. MTT assays of mouse macrophages, 3T3 fibroblasts and human mesenchymal stem cells (hMSCs) incubated with these nanoparticles indicated that these nanoparticles did not possess significant cytotoxicity. Furthermore, the osteogenic and adipogenic differentiations of the hMSCs were not influenced by the labeling process. As a result of the high R(2) (164.8mm(-1)s(-1)) and R(2)/R(1) ratio (32) of the FITC-PLMA-MNPs, the labeled hMSCs can be detected by a clinical 3T MRI scanner at an in vitro detection threshold of about 1200 cells. The green fluorescence associated with the FITC can be readily observed. Such nanoparticles can potentially be used as a T(2)-weighted contrast agent and fluorescent agent for stem cell labeling.

(Carboxymethyl)chitosan-Modified Superparamagnetic Iron Oxide Nanoparticles for Magnetic Resonance Imaging of Stem Cells

Magnetic resonance imaging (MRI) is emerging as a powerful tool for in vivo noninvasive tracking of magnetically labeled stem cells. In this work, we present an efficient cell-labeling approach using (carboxymethyl)chitosan-modified superparamagnetic iron oxide nanoparticles (CMCS-SPIONs) as contrast agent in MRI. The CMCS-SPIONs were prepared by conjugating (carboxymethyl)chitosan to (3-aminopropyl)trimethoxysilane-treated SPIONs. These nanoparticles were internalized into human mesenchymal stem cells (hMSCs) via endocytosis as confirmed by Prussian Blue staining and electron microscopy investigation and quantified by inductively coupled plasma mass spectrometry. A MTT assay of the labeled cells showed that CMCS-SPIONs did not possess significant cytotoxicity. In addition, the osteogenic and adipogenic differentiations of the hMSCs were not influenced by the labeling process. The in vitro detection threshold of cells after incubation with 0.05 mg/mL of CMCS-SPIONs for 24 h was estimated to be about 40 cells. The results from this study indicate that the biocompatible CMCS-SPIONs show promise for use with MRI in visualizing hMSCs.

Microgel Iron Oxide Nanoparticles for Tracking Human Fetal Mesenchymal Stem Cells Through Magnetic Resonance Imaging

Stem cell transplantation for regenerative medicine has made significant progress in various injury models, with the development of modalities to track stem cell fate and migration post‐transplantation being currently pursued rigorously. Magnetic resonance imaging (MRI) allows serial high‐resolution in vivo detection of transplanted stem cells labeled with iron oxide particles, but has been hampered by low labeling efficiencies. Here, we describe the use of microgel iron oxide (MGIO) particles of diameters spanning 100‐750 nm for labeling human fetal mesenchymal stem cells (hfMSCs) for MRI tracking. We found that MGIO particle uptake by hfMSCs was size dependent, with 600‐nm MGIO (M600) particles demonstrating three‐ to sixfold higher iron loading than the clinical particle ferucarbotran (33‐263 versus 9.6‐42.0 pg iron/hfMSC; p < .001). Cell labeling with either M600 particles or ferucarbotran did not affect either cellular proliferation or trilineage differentiation into osteoblasts, adipocytes, and chondrocytes, despite differences in gene expression on a genome‐wide microarray analysis. Cell tracking in a rat photothrombotic stroke model using a clinical 1.5‐T MRI scanner demonstrated the migration of labeled hfMSCs from the contralateral cortex to the stroke injury, with M600 particles achieving a five‐ to sevenfold higher sensitivity for MRI detection than ferucarbotran (p < .05). However, model‐related cellular necrosis and acute inflammation limited the survival of hfMSCs beyond 5‐12 days. The use of M600 particles allowed high detection sensitivity with low cellular toxicity to be achieved through a simple incubation protocol, and may thus be useful for cellular tracking using standard clinical MRI scanners. STEM CELLS 2009;27:1921–1931

Cranioplasty After Trephination Using a Novel Biodegradable Burr Hole Cover:Technical Case Report

OBJECTIVE AND IMPORTANCE: We have developed novel biodegradable polymer implants by using the rapid prototyping technology fused deposition modeling. Early results of a clinical pilot study for cranioplasty are presented. CLINICAL PRESENTATION: Five patients with the diagnosis of chronic subdural hematoma were included in the study. After trephination and evacuation of the subdural hematoma, burr holes (diameter, 14 mm) were closed using a biodegradable implant made of polycaprolactone. Implants were computer designed with an upper rim diameter of 16 mm and a 14 mm body diameter with a fully interconnected, honeycomb-like architecture of 400 to 600 &mgr;m in pore size. INTERVENTION: Postoperative computed tomographic scans indicated that the plugs were stably anchored in the osseous host environment with no fluid collection detectable. The postoperative course was uneventful, and patients were discharged after 5 days. Follow-up scans after 3, 6, and 12 months showed that the implants were well integrated in the surrounding calvarial bone with new bone filling the porous space. CONCLUSION: These novel polymer scaffolds made of the slow-degrading material polycaprolactone represent a suitable implant for closure of post-trephination defects.

THE RELAXIVITY OF Gd-EOB-DTPA AND Gd-DTPA IN LIVER AND KIDNEY OF THE WISTAR RAT

The NMR relaxivities of Gd-EOB-DTPA and Gd-DTPA were determined in the kidney and liver of intact male Wistar rats immediately following sacrifice and in vitro in solutions and gels, at 1.5 T using a clinical MR scanner, T1 and T2 values of tissue samples were derived from spin-echo image sequences. Tissue gadolinium concentrations were determined by radioassay of Gd153, Gd-EOB-DTPA T1 and T2 relaxivities, R1 and R2 (s-1 mmole-1 kg), were found to be 10.7 +/- 0.5 and 22.5 +/- 3.2 respectively, for liver, 2.4 +/- 0.2 and 12.1 +/- 1.7 for kidney cortex, 2.7 +/- 0.2 and 14.5 +/- 1.9 for kidney outer medulla, 2.0 +/- 0.2 and 11.4 +/- 2.1 for kidney inner medulla. Gd-DTPA R1 and R2 were found to be 4.8 +/- 0.4 and 14.5 +/- 3.7 for liver, 1.2 +/- 0.1 and 7.9 +/- 0.8 for kidney cortex, 1.6 +/- 0.1 and 10.2 +/- 1.4 for kidney outer medulla, 1.3 +/- 0.1 and 10.2 +/- 1.2 for kidney inner medulla. Gd-EOB-DTPA and Gd-DTPA R1 was increased in liver compared to agarose gets at 38 degrees C (4.49 +/- 0.03 and 3.47 +/- 0.06), but reduced in kidney tissues. All R2 were elevated compared to agarose gels at 38 degrees C (5.72 +/- 0.12 and 4.12 +/- 0.03). Elevated R2 and R1 (expressed in terms of the concentration of gadolinium per kg of tissue) can be accounted for in part by the lower water content of tissues compared with gels or solutions increased microviscosity and binding to macromolecules. In addition, susceptibility effects may give rise to further increases in R2. By contrast, the reduced R1 observed in kidney may be the result of compartmentalization of the magnetopharmaceuticals. Statistically improved fits were obtained for T1 recovery curves for liver in the presence of Gd-EOB-DTPA when a dual exponential model was used. Assuming in vitro values for the relaxivities of these artificial contrast agents will lead to inaccuracies when relating observed signal enhancement factors to tissue gadolinium concentration.

Vascular Mapping using Albumin-(Gd-DTPA), an Intravascular MR Contrast Agent, and Projection MR Imaging

An intravascular magnetic resonance (MR) contrast agent is valuable for vascular mapping of tissues when used in combination with projection spin-echo MR imaging. The primary advantage of using projection imaging lies in its global depiction of anatomy. Also, relatively short echo time values can be readily achieved, reducing flow dephasing signal losses from blood and increasing overall signal-to-noise. These advantages, coupled with the reduction of blood pool T1 values due to the presence of the intravascular contrast agent, allow for detailed spatial mapping of slow-flow vascular structures using MR.

Pulse Design for Time Reversal Method as Applied to Ultrawideband Microwave Breast Cancer Detection: A Two-Dimensional Analysis

We conduct a two-dimensional study of pulse design for electromagnetic time-reversal (TR) imaging as applied to ultrawideband (UWB) breast cancer detection. We consider the situation when a tumor located in the human breast is surrounded by a large number of small tissue inhomogeneities that create strong signal clutter. When applying the TR algorithm, the excitation pulse should be properly designed such that there are distinguishable differences between the tumor and clutter responses. In this paper, we propose four pulse design criteria for the TR-based tumor detection. The modulated and modified Hermite polynomials (MMHPs) that fit well into the real pulse shapes are used as a general waveform template for the design process. Finally, numerical examples are used to demonstrate the usefulness of the proposed analytical framework. This paper can be a guide in the selection of suitable waveforms for which the tumor response can be enhanced and/or the clutter interference can be suppressed. The investigation is also well suited for applications to surface-penetrating radar using UWB signals