Researchers using functional magnetic resonance imaging (fMRI) to study brain activation have found that men and women respond differently to positive and negative stimuli, according to a study presented at the annual meeting of the Radiological Society of North America (RSNA).

“Men may direct more attention to sensory aspects of emotional stimuli and tend to process them in terms of implications for required action, whereas women direct more attention to the feelings engendered by emotional stimuli,” said Andrzej Urbanik, M.D., Ph.D., chair of Radiology at Jagiellonian University Hospital in Krakow, Poland.

For the study, Dr. Urbanik and colleagues recruited 40 right-handed volunteers, 21 men and 19 women, between the ages of 18 and 36. The volunteers underwent fMRI while viewing pictures from the International Affective Picture System (IAPS), a widely used, standardized testing system comprised of several thousand slides of various objects and images from ordinary life designed to evoke defined emotional states. The images were displayed in two runs. For the first run, only negative pictures were shown. For the second run, only positive pictures were shown.

While viewing the negative images, women showed decidedly stronger and more extensive activation in the left thalamus, which relays sensory information to and from the cerebral cortex, including the pain and pleasure centers. Men exhibited more activation in the left insula, which gauges the physiological state of the entire body and then generates subjective feelings that can bring about actions. Information from the insula is relayed to other brain structures involved in decision making.

“The brain activation seen in the women might indicate stronger involvement of the neural circuit, which is associated with identification of emotional stimuli,” Dr. Urbanik said. “The more pronounced activation of the insular cortex in the men might be related to the autonomic components, such as elevated heart rate or increased sweating, that accompany watching emotional material.”

The autonomic nervous system controls involuntary functions, including respiration, heart rate and digestion, and helps to adjust certain functions in response to stress or other environmental stimuli. It is responsible for the body’s “fight or flight” response to threatening situations.

“In men, the negative images on the slides were more potent in driving their autonomic system,” Dr. Urbanik said. “This might signal that when confronted with dangerous situations, men are more likely than women to take action.”

While viewing positive images, women showed stronger and more extensive activation in the right superior temporal gyrus, which is involved in auditory processing and memory. Men exhibited stronger activation in the bilateral occipital lobes, which are associated with visual processing.

Dr. Urbanik believes these differences indicate that women may analyze positive stimuli in a broader social context and associate the positive images with a particular memory. Viewing a picture of a smiling toddler might evoke memories of a woman’s own child at this age. Conversely, male responses are more perceptual.

“Positive images are devoured by mens’ visual and motivational systems,” Dr. Urbanik said.

Today hundreds of people with mental health problems will attend Mind’s annual conference in Brighton to help the charity launch a fresh debate around ‘wellbeing’ and discuss how we can improve the mental health of the nation.

As public awareness grows for the idea that everyone can do something to improve their mental health, conference delegates will be challenging the experts on how the wellbeing agenda will shape our lives and change the face of mental health care in the future.

Over the last decade the government’s plan for mental health care has been set out in the National Service Framework, and this winter the 10-year strategy has come to a close leaving the door open for a rethink on mental health care.

Wellbeing will be at the heart of the Government’s New Horizons strategy, due to be published shortly, and will look not just at mental health services but at how wellbeing can be made a priority in other areas of our lives. At this pivotal moment, the Mind conference is calling on delegates to air their views and concerns on how mental health services will be affected, and to help inform Mind’s work.

Expert speakers will include Dr Liz Miller, mental health specialist and author whose new book Mood Mapping on managing mood and mental health is quickly becoming a bestseller. Dr Miller’s expertise on wellbeing helps her to manage bipolar disorder medication-free. Other speakers include wellbeing advocate and headmaster of Wellington College Dr Anthony Seldon, along with some of his students who will talk about how the school instils young people with wellbeing skills and positive psychology, and author Dr Richard Bentall who is renowned for his work on clinical psychology.

Mind’s Chief Executive Paul Farmer will be speaking and chairing at the conference, he said:

Wellbeing is a popular term at the moment that is cropping up in all kinds of places, and we’re looking to dig beneath the buzzword and discuss what it means for people with mental distress, and how wellbeing should be integrated into the future mental health agenda.

Mental health issues cost £77 billion a year and investing in mental wellbeing has the potential to not only transform the experiences of millions of people with mental health problems, but to bring wide-ranging benefits to the economy and society as a whole.

We hope to see a shift in focus towards the promotion of wellbeing as a way of preventing mental distress and these conferences will be a great way to inform Mind’s future work in this area.

Radiologists can accurately diagnose acute appendicitis from a remote location with the use of a handheld device or mobile phone equipped with special software, according to a study presented at the annual meeting of the Radiological Society of North America (RSNA).

“The goal is to improve the speed and accuracy of medical diagnoses, as well as to improve communications among different consulting physicians,” said the study’s lead author, Asim F. Choudhri, M.D., fellow physician in the Division of Neuroradiology at Johns Hopkins University in Baltimore. “When we can make these determinations earlier, the appropriate surgical teams and equipment can be assembled before the surgeon even has the chance to examine the patient.”

Appendicitis, or inflammation and infection of the appendix, is a medical emergency requiring surgical removal of the organ. Undiagnosed or left untreated, the inflamed appendix will rupture, causing toxins to spill into the abdominal cavity and potentially causing a life-threatening infection. Appendicitis can occur at any age but is most common in people between the ages of 10 and 30, according to the National Institutes of Health.

Typically, a patient arriving at the emergency room with suspected appendicitis will undergo computed tomography (CT) and a physical examination. If a radiologist is not immediately available to interpret the CT images or if consultation with a specialist is needed, diagnosis is delayed, increasing the risk of rupture. Transmitting the images over a mobile device allows for instant consultation and diagnosis from a remote location. It can also aid in surgical planning.

“This new technology can expedite diagnosis and, therefore, treatment,” Dr. Choudhri said.

For the study performed at the University of Virginia in Charlottesville, CT examinations of the abdomen and pelvis of 25 patients with pain in the right lower abdomen were reviewed over an encrypted wireless network by five radiologists using an iPhone G3 equipped with OsiriX Mobile medical image viewing software. All of the patients had surgical confirmation or follow-up evaluations to confirm whether or not they had appendicitis.

“The scans can be read in full resolution with very little panning, and the software allows the reader to zoom and adjust the contrast and brightness of the image,” Dr. Choudhri said. “The radiologist is evaluating actual raw image data, not snapshots.”

Fifteen of the 25 patients were correctly identified as having acute appendicitis on 74 (99 percent) of 75 interpretations, with one false negative. There were no false positive readings. In eight of the 15 patients who had appendicitis, calcified deposits within the appendix were correctly identified in 88 percent of the interpretations. All 15 patients had signs of inflammation near the appendix that were correctly identified in 96 percent of interpretations, and 10 of the 15 had fluid near the appendix, which was correctly identified in 94 percent of the interpretations. Three abscesses were correctly identified by all five readers.

“The iPhone interpretations of the CT scans were as accurate as the interpretations viewed on dedicated picture archiving and communication system (PACS) workstations,” Dr. Choudhri said.

Dr. Choudhri pointed out that patient privacy concerns would have to be addressed before any handheld mobile device could be considered practical for clinical use, but noted that this technique has great potential for improving emergency room care.

“We hope that this will result in improved patient outcomes, as evidenced by decreased rates of ruptured appendicitis, shorter hospital stays and fewer complications,” he said.

Elastography is an effective, convenient technique that, when added to breast ultrasound, helps distinguish cancerous breast lesions from benign results, according to an ongoing study presented at the annual meeting of the Radiological Society of North America (RSNA).

When mammography yields suspicious findings, physicians often use ultrasound to obtain additional information. However, ultrasound has the potential to result in more biopsies because of its relatively low specificity, or inability to accurately distinguish cancerous lesions from benign ones. Approximately 80 percent of breast lesions biopsied turn out to be benign, according to the American Cancer Society.

“There’s a lot of room to improve specificity with ultrasound, and elastography can help us do that,” said the study’s lead author, Stamatia V. Destounis, M.D., a diagnostic radiologist at Elizabeth Wende Breast Care, a large, community-based breast imaging center in Rochester, N.Y. “It’s an easy way to eliminate needle biopsy for something that’s probably benign.”

Elastography improves ultrasound’s specificity by utilizing conventional ultrasound imaging to measure the compressibility and mechanical properties of a lesion. Since cancerous tumors tend to be stiffer than surrounding healthy tissue or cysts, a more compressible lesion on elastography is less likely to be malignant.

“You can perform elastography at the same time as handheld ultrasound and view the images on a split screen, with the two-dimensional ultrasound image on the left and the elastography image on the right,” Dr. Destounis said.

As part of the ongoing study, 179 patients underwent breast ultrasound and elastography. The research team obtained 184 elastograms and performed biopsies on all solid lesions. Of 134 biopsies, 56 revealed cancer. Elastography properly identified 98 percent of lesions that had malignant findings on biopsy, and 82 percent of lesions that turned out to be benign. Elastography was also more accurate than ultrasound in gauging the size of the lesions.

“Ultrasound can underestimate the true size of lesions, as it only sees the actual mass and not the surrounding changes the mass may cause,” Dr. Destounis said.

In 2009, there will be an estimated 192,370 new cases of invasive breast cancer among women in the United States, according to the American Cancer Society, along with about 62,280 new cases of ductal carcinoma in situ, a noninvasive, early form of breast cancer.

A large proportion of patients who undergo abdominal/pelvic computed tomography (CT) receive unindicated and unnecessary additional image acquisition resulting in excess, avoidable radiation exposure, according to a study presented at the annual meeting of the Radiological Society of North America (RSNA).

“It is the responsibility of all physicians who work with ionizing radiation to ensure that the dosage is as low as reasonably achievable without compromising the patient’s well being,” said Kristie Guite, M.D., radiology resident at the University of Wisconsin (UW) in Madison. “Our study found that this principle is not being followed in many practices.”

A CT examination consists of imaging the patient using a CT scanner and sometimes involves the injection of an intravenous contrast agent. Imaging can be performed at multiple time points before and/or after the injection of the contrast material. Each image acquisition is referred to as a “series.” Although having multiple series can be helpful for some conditions, they are not generally necessary.

Because it provides valuable diagnostic information, CT use has risen rapidly. In recent years, a number of reports have highlighted the increasing radiation exposure to patients through the use of medical imaging, particularly CT. While these reports have often focused on general and screening uses, little attention has been paid to radiation from additional series, including routine non-contrast or delayed-phase CT, which may or may not be indicated by the patient’s condition but are sometimes performed so that nothing is overlooked.

To determine the frequency of unindicated additional scanning and the resultant excess radiation exposure to patients, the researchers reviewed the appropriateness and radiation dose of abdomen and pelvis CT exams for 500 patients performed at outside institutions and submitted to UW – Madison for interpretation. The patients ranged in age from nine months to 91 years, with most between 30 and 50 years old.

There were a total of 978 series for the 500 patients. Using the American College of Radiology (ACR) Appropriateness Criteria®, 35.3 percent (345/978) of the CT series in 52.2 percent (261/500) of the patients were determined to be unindicated. The most common unnecessary exam was delayed-phase imaging, accounting for 268 (77.7 percent) of the 345 unnecessary series. In delayed-phase imaging, several images of the same region are obtained a short period of time after contrast injection to detect changes. Among the 500 patients, the mean excess radiation dose per patient from unnecessary scans was 11.3 millisieverts (mSv), equivalent to the dose received from 113 chest x-rays or three years of naturally occurring background radiation.

“We suspect that at many institutions there is a lack of focus on selecting CT protocols tailored specifically to answer the clinical question,” said coauthor J. Louis Hinshaw, M.D., assistant professor of radiology at UW – Madison. “It is certainly easier to select an ‘every size fits all’ approach.”

The researchers also noted a possible connection in some cases between additional scanning and increased payment, such as performing both non-contrast and contrast-enhanced scans when only one series was indicated.

Efforts are ongoing to protect patients from unnecessary radiation exposure from medical imaging procedures, including the Image Gently initiative for safety in pediatric radiology and an ACR-RSNA task force for adult radiation protection. In addition to following strict appropriate imaging utilization standards, radiologists and medical physicists stress the importance of minimizing dose without sacrificing diagnostic ability. Advances in CT technology over recent years have markedly decreased dose while maintaining optimal image quality.

Dr. Guite advises patients not to be unduly alarmed when their physician orders a CT exam.

“The use of CT has been a huge benefit to human health,” she said. “When used appropriately, the benefits of the diagnostic information obtained with CT far outweigh the potential risks.”

Dr. Hinshaw suggests that patients ask their physicians about the risks and benefits of the proposed exam and inquire at the CT facility as to the number of series that will be performed, and if a smaller number of series would be sufficient.

Three decades ago, a study revealed that beverage can pull-tabs were being swallowed by children, prompting a switch by U.S. manufacturers to stay-tabs. But a study presented at the annual meeting of the Radiological Society of North America (RSNA) found that the new tabs are still potentially unsafe.

“One of the driving factors leading the change in beverage can construction in the U.S. was to eliminate inadvertent swallowing of the pull-tab and potential related injury to the gastrointestinal tract,” said the study’s lead author, Lane F. Donnelly, M.D., radiologist-in-chief and director of biodiagnostics at Cincinnati Children’s Hospital Medical Center. “Our findings raise the possibility that the redesign of beverage cans may not have reduced the number of ingestions.”

In 1975, amid already growing concerns that removable beverage can pull-tabs posed a litter problem, as well as a potential injury hazard if stepped on, a study in the Journal of the American Medical Association revealed two cases of accidental ingestion and one case of aspiration of pull-tabs that had been dropped back into the cans. As a result, U.S. beverage can manufacturers refitted cans with stay-tabs that remained attached to the can after opening. However, these tabs could still be removed with little effort.

Dr. Donnelly identified 19 cases of inadvertent stay-tab ingestion at Cincinnati Children’s Hospital Medical Center over a 16-year period from 1993 to 2009. The mean age of the children who had swallowed the tabs was 8.5. Only 4 of the children were younger than age 5. Most of the cases were teenagers.

“It is unusual that the majority cases occurred among teenagers, since foreign body ingestion typically occurs in infants and toddlers,” Dr. Donnelly said.

While most of the 19 cases in the study were resolved without surgery, ingestion of foreign bodies, particularly those with sharp edges, can lead to injury of the gastrointestinal tract. Some cases do require surgery.

Confounding the problem is that stay-tabs are difficult to see on x-rays. While 19 ingestions were witnessed or self-reported, only four (21 percent) of the 19 ingested stay-tabs were visible on x-rays. In each visible case, the tab was located in the stomach.

“Clinicians and radiologists should be aware that this does occur,” Dr. Donnelly said. “Not seeing the tab on the x-ray does not mean it was not swallowed.”

The findings of the study question the current construction of beverage cans in the U.S. and indicate that the tabs still pose a potential danger to children and adolescents.

“The identification of 19 ingested stay-tabs at a single children’s hospital suggests that such occurrences are not uncommon,” Dr. Donnelly said.

New connections begin to form between brain cells almost immediately as animals learn a new task, according to a study published this week in Nature. Led by researchers at the University of California, Santa Cruz, the study involved detailed observations of the rewiring processes that take place in the brain during motor learning.

The researchers studied mice as they were trained to reach through a slot to get a seed. They observed rapid growth of structures that form connections (called synapses) between nerve cells in the motor cortex, the brain layer that controls muscle movements.

“We found very quick and robust synapse formation almost immediately, within one hour of the start of training,” said Yi Zuo, assistant professor of molecular, cell and developmental biology at UCSC.

Zuo’s team observed the formation of structures called “dendritic spines” that grow on pyramidal neurons in the motor cortex. The dendritic spines form synapses with other nerve cells. At those synapses, the pyramidal neurons receive input from other brain regions involved in motor memories and muscle movements. The researchers found that growth of new dendritic spines was followed by selective elimination of pre-existing spines, so that the overall density of spines returned to the original level.

“It’s a remodeling process in which the synapses that form during learning become consolidated, while other synapses are lost,” Zuo said. “Motor learning makes a permanent mark in the brain. When you learn to ride a bicycle, once the motor memory is formed, you don’t forget. The same is true when a mouse learns a new motor skill; the animal learns how to do it and never forgets.”

Understanding the basis for such long-lasting memories is an important goal for neuroscientists, with implications for efforts to help patients recover abilities lost due to stroke or other injuries.

“We initiated the motor learning studies to understand the process that takes place after a stroke, when patients have to relearn how to do certain things. We want to find out if there are things we can do to speed up the recovery process,” Zuo said.

The lead authors of the Nature paper, Tonghui Xu and Xinzhu Yu, are a postdoctoral researcher and doctoral student, respectively, in Zuo’s lab at UCSC. Coauthors include Andrew Perlik, Willie Tobin, and Jonathan Zweig of UCSC and Kelly Tennant and Theresa Jones of the University of Texas, Austin.

The study used mice that had been genetically altered to make a fluorescent protein within certain neurons in the brain. The researchers were then able to use a special microscopy technique (two-photon microscopy) to obtain clear images of those neurons near the surface of the brain. The noninvasive imaging technique enabled them to view changes in individual brain cells of the mice before, during, and after the mice were trained in the seed-reaching task.

“We were able to follow the same synapses over time, which had not been done before in a motor learning study,” Zuo said. “We showed that structural changes occur in the brain at a much earlier stage than people had believed.”

Results from the study suggested that the newly formed dendritic spines are initially unstable and undergo a prolonged selection process during the course of training before being converted into stable synapses.

When previously trained mice were reintroduced to the reaching task four months later, their skill at the task remained high, and images of their brains did not show increased spine formation. When previously trained mice were taught a new skill, however, they showed enhanced spine formation and elimination similar to that seen during the initial training. Furthermore, spines that had formed during the initial training persisted after the remodeling process that accompanied the learning of a new task.

These findings suggest that different motor behaviors are stored using different sets of synapses in the brain, Zuo said. One of the questions she would like to explore in future studies is how these findings apply to different types of learning.

“In China, where I grew up, we memorize a lot in school. What are the changes that take place in the brain during learning and memorizing, and what are the best ways to consolidate those memories? We don’t really know the best way to learn and memorize,” she said.

New results from a survey of 1,122 post-menopausal women in Asia found that nearly half (48.5 percent) were not aware whether or not they had osteoporosis despite being hospitalized with a fragility fracture. A fragility fracture is one potential indicator of osteoporosis, along with BMD measurements, family history and other factors, according to International Osteoporosis Foundation (IOF). Of the women who were told that they have osteoporosis (51.5 percent), 40.5 percent did not receive any treatment. The results of this survey, which was conducted in Hong Kong SAR, Thailand, South Korea, mainland China, Singapore, Malaysia and Taiwan region, were presented at the 1st Scientific Meeting of the Asian Federation of Osteoporosis Societies. The survey was conducted by MSD, also known in the United States and Canada as Merck.

A fragility fracture occurs in a non-traumatic situation where bones would not break under normal force; these fractures are often considered a strong clinical indicator in the diagnosis of osteoporosis in post-menopausal women, along with other factors considered. According to the IOF, the incidence of hip fracture has risen two-to-three-fold in most Asian countries in the past 30 years and IOF estimates that more than 50 percent of all osteoporotic hip fractures will occur in Asia by the year 2050. Guidelines from the IOF recommend that postmenopausal women with a previous hip or vertebral fracture can be considered for osteoporosis treatment along with other factors.

“This study involves data from seven Asian countries/regions to document the treatment gap of fracture patients,” said Professor Annie Kung, lead investigator. “It reminds us of the urgency we have to address this important disease in Asia.”

Among the patients who were diagnosed as having osteoporosis (n=576), 8.1 percent received only an osteoporosis medication, 26.5 percent received vitamin supplementations, 24.9 percent were treated with both medications and supplements and 40.5 percent did not receive any medication or vitamin supplementation. Patients aged 65-79 years were significantly more likely to receive osteoporosis medications than patients in other age groups.

Patients who received a bone mineral density (BMD) screening were more likely to receive an osteoporosis diagnosis (10.1 odds ratio) than patients who reported a prior history of fracture only (0.8 odds ratio). Similarly, patients who had a BMD test were more likely to be on osteoporosis medication (1.79 odds ratio) than those with a prior history of fracture only (1.05 odds ratio). Fracture history is one important indicator for osteoporosis screening and diagnosis.

US researchers report finding that ghrelin, a hormone produced in the stomach that regulates appetite and how the body deposits fat, may be used to boost resistance to or slow the development of Parkinson’s disease.

The study is the work of Dr Tamas Horvath, chair and professor of comparative medicine and professor of neurobiology and obstetrics and gynecology at the Yale University School of Medicine, New Haven, Connecticut, and colleagues and was published earlier this month in The Journal of Neuroscience.

Parkinson’s disease is a neurodegenerative disorder where dopamine neurons in an area of the midbrain known as the substantia nigra, which is responsible for dopamine production, start to die off.

As less dopamine is produced, the symptoms become more severe, so that eventually people with the disease have difficulty walking, have restricted and delayed movements, get tremors in their head and limbs, lose their appetite, can’t eat properly, and have periods of immobility or “freezing”.

We already know that ghrelin targets the hypothalamus and affects appetite, food intake and how the body deposits fat. The authors wrote that ghrelin receptors at sites outside of the hypothalamus also “promote circuit activity associated with learning and memory, and reward seeking behavior”. And recent human studies have shown that body mass index (BMI), stored fat and diabetes are linked to Parkinson’s disease.

In this study, Horvath and colleagues discovered that ghrelin also protects the neurons that make dopamine.

“We also found that, in addition to its influence on appetite, ghrelin is responsible for direct activation of the brain’s dopamine cells,” said Horvath. He explained that because the hormone is made in the stomach, it circulates normally in the bloodstream, “so it could easily be used to boost resistance to Parkinson’s or it could be used to slow the development of the disease”.

For the study, which was supported by the Michael J Fox Foundation for Parkinson’s Research, Horvath and colleagues gave one group of mice extra ghrelin, and while another group were genetically engineered to lack the hormone and its receptor.

When compared to a group of control mice, the mice that had impaired ghrelin action in the brain had more dopamine loss.

The authors explained that the mice that were given extra ghrelin lost fewer substantia nigra pars compacta dopamine cells and showed “restricted striatal dopamine loss”, while the mice that were genetically engineered to lack the hormone and its receptors lost more substantia nigra pars compacta dopamine cells and showed “lowered striatal dopamine levels”. The effect in the genetically engineered mice was reversed when they switched the ghrelin receptor on.

They concluded that their study supports the idea that ghrelin could be a new therapeutic strategy to fight neurodegeneration, loss of appetite and body weight linked with Parkinson’s disease.

Horvath said they could see these results being applicable to humans because the ghrelin system is preserved through various species.

The researchers are now planning to find out how ghrelin levels differ between healthy people and people with Parkinsons disease, and whether changes in ghrelin levels might serve as a biomarker of disease susceptibility and development.

“Ghrelin Promotes and Protects Nigrostriatal Dopamine Function via a UCP2-Dependent Mitochondrial Mechanism.

A new study by radiologists found that middle-aged men and women who do lots of exercise, and particularly high impact activities like running and jumping, may be unknowingly causing damage to their knees and putting themselves at greater risk of developing osteoarthritis. By implication, low impact activities like swimming and cycling may protect damaged and healthy joints they said, although further research is needed to confirm this.

The study was the work of Christoph Stehling and colleagues, and is being presented Monday at the 95th Scientific Assembly and Annual Meeting of the Radiological Society of North America (RSNA), taking place from Nov 29 to Dec 4, in Chicago.

Stehling is a research fellow in the Department of Radiology and Biomedical Imaging at the University of California, San Francisco (UCSF) and a resident in radiology with the Department of Clinical Radiology at the University of Muenster in Germany.

Osteoarthritis, the most common form of arthritis, affects some 27 million American adults, estimates the US Centers for Disease Control and Prevention (CDC). The disease is degenerative and affects the joints, causing pain, swelling and stiffness.

Osteoarthritis has three features: damaged cartilage (the strong, smooth lining that allows joints to move easily without friction), bony growths around the edge of joints, and mild inflammation (synovitis) of the tissue surrounding the affected joint.

Stehling told the media that:

“Our data suggest that people with higher physical activity levels may be at greater risk for developing knee abnormalities and, thus, at higher risk for developing osteoarthritis.”

For the study, Stehling and colleagues analysed data of 100 men and 136 women aged 45 to 55 taking part in the National Institutes of Health Osteoarthritis Initiative (which they referred to as the “OAI incidence cohort”).

None of the participants reported experiencing knee pain before enrollment and their weight was in the healthy range.

The researchers categorized the participants into low, middle and high activity, depending on their responses to a questionnaire that assessed their physical activity according to the Physical Activity Scale for the Elderly (PASE). PASE yields a score based on activity type and time spent doing it.

The participants were thus put in one of three groups: low activity (PASE score 27 to 155), middle activity level (PASE 156 to 230) and high activity (PASE 231 to 409).

A middle-aged person who spends several hours a week walking, doing sport and other exercises, plus yard work, heavy gardening and household chores would have a high PASE score.

Two of the researchers, who are experts in musculoskeletal radiology, analyzed MRI images of the participants to assess severity of any cartilage, meniscal and ligament damage, or other abnormalities, in the right knee.

The results showed that:

* 47 per cent of the participants had meniscal lesions.

* 74.6 per cent had cartilage lesions.

* 40.3 per cent had bone marrow edema.

* 17 per cent had ligament lesions.

* Incidence of abnormalities went up in line with PASE activity level (low, medium, high).

* Grade of cartilage lesions also went up with PASE activity level.

* Presence of other knee abnormalities was also significantly linked to presence of cartilage defects.

* Abnormalities were linked solely with activity levels and were not age or gender specific.

The researchers concluded that:

“Middle-aged non-symptomatic individuals from the OAI incidence cohort had a high prevalence of knee abnormalities including cartilage and meniscus lesions. Individuals with higher PASE showed a significantly higher number and grade of knee abnormalities.”

“These results suggest that subjects with higher physical activity levels may be at greater risk for cartilage and meniscal abnormalities and thus higher risk for developing Osteoarthritis (OA),” they added.

Stehling said that knee abnormalities went up in line with level of physical activity, and “in addition, cartilage defects diagnosed in active people were more severe”.

He said the findings also showed that some activities carry a greater risk of knee damage over time.

“This study and previous studies by our group suggest that high-impact, weight-bearing physical activity, such as running and jumping, may be worse for cartilage health”, said Stehling.

“Conversely, low-impact activities, such as swimming and cycling, may protect diseased cartilage and prevent healthy cartilage from developing disease,” he added, suggesting more studies were now needed to compare the effect of low and high impact activity on disease progression.

“Subjects with Higher Physical Activity Levels Have More Severe Focal Knee Lesions Diagnosed with 3T MRI: Analysis of the Non Symptomatic Incidence Cohort of the Osteoarthritis Initiative.”