Doctor of Philosophy / Department of Horticulture, Forestry, and Recreation Resources / Candice A. Shoemaker / The objectives of this study were to determine exercise intensity of common gardening tasks in older adults and to investigate if older gardeners meet the physical activity (PA) recommendations (intensity and time) through their daily gardening. Kinds of gardening tasks, body postures, and bodily pain while gardening of older gardeners were investigated and the possibility of gardening as a predictor for a physically active lifestyle and life satisfaction in older adults was determined. Older participants were randomly recruited from the community of Manhattan, KS. To determine the exercise intensity of gardening, the heart rates of older adults were measured by radiotelemetry during gardening or garden tasks, and then oxygen uptake and energy expenditure were measured via indirect calorimetry using a submaximal graded exercise test. Overall health conditions by the Short Form 36 Health Survey (SF-36), hand functions by hydraulic hand dynamometer and pinch gauge, and bone mineral density (BMD) by dual-energy x-ray absorptiometry were measured. An observational study and weekly logs were conducted to study kinds of gardening, postures, and bodily pain of older gardeners. The Community Healthy Activities Model Program for Senior (CHAMPS) questionnaire was used to measure leisure-time PAs (frequency per week of all PAs and calories expended per week in all PAs). In conclusion, the nine gardening tasks were found to be low to moderate intensity PA in healthy older adults (1.6 ± 3.6 METs). Gardening observed was moderate intensity (3.8 ± 1.4 METs) PA in older adults and the subjects met the PA recommendation, which is at least 30 minutes of moderate intensity PA on most days of the week through their daily gardening (moderate intensity; average 33 hrs/wk in May and 15 hrs/wk in June and July). The older gardeners showed higher values for hand function and some SF-36 domains (physical function, bodily pain, and physical summary) than older non-gardeners. Gripping, stooping, lifting, stretching, walking, standing, kneeling, sitting, and squatting were observed while older adults gardened and lower back pain was the main bodily pain reported. Furthermore, gardening was found to be a predictor for leading a physically active lifestyle and high life satisfaction in older adults.

The GH/IGF-I axis is important for bone growth, but its effects on joint function are not completely understood. Adult onset GH deficient (GHD) individuals have often reduced bone mineral density (BMD). However, there are limited data on BMD in adult patients with untreated congenital isolated GHD (IGHD). We have shown that adult IGHD individuals from the Itabaianinha, homozygous for the c.57+1G>A GHRHR mutation, have reduced bone stiffness, but BMD and joint status in this cohort are unknown. The objective is to study BMD, joint function, and osteoarthritis score in IGHD adults harboring c.57+1G > A GHRHR mutation, previously untreated. It was performed a cross-sectional study. Areal BMD by dual-energy X-ray absorptiometry was measured in 25 IGHD and 23 controls. Volumetric BMD (vBMD) was calculated at the lumbar spine and total hip. Joint function was assessed by goniometry of elbow, hips and knees. X rays were used to measure the anatomic axis of knee and the severity of osteoarthritis, using a classification for osteophytes (OP) and joint space narrowing (JSN). Genu valgum was more prevalent in IGHD than controls. The osteoarthritis knees OP score was similar in both groups, and knees JSN score showed a trend to be higher in IGHD. The hips OP score, and JSN score were higher in IGHD. Areal BMD was lower in IGHD than controls, but vBMD was similar in the two groups. Range of motion was similar in elbow, knee and hip in IGHD and controls. Untreated congenital IGHD due inactivating GHRHR mutation causes hip joint osteoarthritis problems and genu valgum, without apparent clinical significance, reduces bone size but does not reduce vBMD of the lumbar spine and hip. / O eixo GH/IGF-I é importante para o crescimento e desenvolvimento ósseo, mas seus efeitos na densidade mineral óssea (DMO) e na função articular não são completamente conhecidos. Indivíduos com deficiência de GH (DGH) no início da vida adulta tem frequentemente redução da DMO. Entretanto, existem dados limitados em indivíduos com deficiência isolada e congênita do hormônio do crescimento (DIGH). Mostramos que indivíduos adultos com DIGH, decorrente de uma mutação no GHRHR tipo c.57+1G>A, provenientes da coorte de Itabaianinha, não tratados, apresentam uma redução da rigidez óssea, mas a DMO e a função articular dessa coorte são desconhecidas. O objetivo desse trabalho é estudar a DMO, a severidade da osteoartrite, a função e a anatomia articular em uma população de indivíduos com DIGH de ambos os sexos, portando a mutação c.57+1G > A GHRHR, provenientes de Itabaianinha. Foi realizado um estudo transversal, através da realização da densitometria óssea com cálculo da DMO areal e volumétrica (DMOv) em coluna lombar, quadril total e corpo inteiro, em 25 indivíduos com DIGH e 23 controles. A função articular foi avaliada pela goniometria dos cotovelos, quadris e joelhos. Radiografias foram feitas para mensurar o eixo anatômico do joelho e a severidade da osteoartrite, baseada numa adaptação da classificação da Sociedade Internacional de pesquisa da OA a partir dos osteófitos (OF) e estreitamento do espaço articular (EEA). Os resultados mostraram que DMO areal foi menor que nos controles, mas a DMOv foi similar em ambos os grupos. A amplitude de movimentos dos cotovelos, quadris e joelhos foram semelhantes em ambos os grupos. Geno valgo foi mais prevalente nos indivíduos com DIGH que nos controles. No joelho, o escore de osteoartrite para OF foi similar em ambos os grupos e o escore para EEA mostrou uma tendência a ser mais elevado na DIGH. No quadril, os escores de OF e do EEA foram maiores no DIGH. Em conclusão, DIGH congênita não tratada causa osteoartrite no quadril e geno valgo, sem aparente importância clínica, reduz o tamanho do osso, mas não reduz a DMOv da coluna lombar e quadril.

Abstract Background: Childhood brain tumors (CBTs) are the most common solid tumors in childhood. CBT survivors have a high risk of several late-effects, including cerebrovascular disease (CVD), neurocognitive impairment, secondary neoplasms, and low bone mineral density; however, only a few studies have clinically investigated the late-sequelae in young-adult CBT survivors. Aim: To determine the prevalence of CVD, neurocognitive impairment, secondary neoplasms, and bone mineral density in a national cohort of radiotherapy-treated long-term survivors of CBT. Subjects and Methods: Radiotherapy-treated CBT survivors diagnosed between 1970–2008 were selected based on the following inclusion criteria: follow-up ≥5 years since the cessation of therapy and age of ≥16 years at the time of the study. Survivors were clinically and neuropsychologically examined, and investigated by magnetic resonance imaging (MRI), bone mineral densitometry, and laboratory analysis. Results: We included 74 survivors after a mean follow-up time of 18.9 ± 6.1 years. The mean age at follow-up was 28.4 ± 6.8 years and at diagnosis 8.3 ± 4.3 years. At the 20-year follow-up, the cumulative prevalence of CVD, along with small- and large-vessel disease was 52%, 38%, and 16%, respectively. Ischemic infarcts or transient ischemic attacks were diagnosed in 11% of the survivors, lacunar infarcts in 10%, and cerebral hemorrhage in 3%. White matter lesions (WMLs) were noted in 49% of the survivors. Higher blood pressure was associated with CVD, large-vessel disease, WMLs, and lacunar infarcts. Survivors had lower cognitive performance in all neuropsychological domains than controls. Mean verbal intelligence quotient was 89 ± 14 and mean performance intelligence quotient 87 ± 19. Executive functions (Z-score -5.0 ± 5.3 SD) and processing speed (Z-score -4.3 ± 5.4 SD) were extensively impaired. Executive functions and processing speed were associated with everyday life skills. Cumulative incidence of secondary meningiomas was 10.2% at the 25-year follow-up using the clinical data, and that of secondary neoplasms was 2.4% using the Finnish Cancer Registry data. We observed low bone mineral density in 23.6% of the survivors, which was associated with fractures in long bones. Conclusions: Young adult CBT survivors experienced late-consequences typically associated with ageing. / Tiivistelmä Taustaa: Suomessa sairastuu vuosittain 46-60 lasta aivokasvaimeen, joka on lapsuusiän yleisin, kiinteä kasvain. Selviytyneillä on todettu lisääntynyt hoitojen myöhäisvaikutuksien riski. Kuitenkin nuorten aikuisten haittavaikutuksia on toistaiseksi tutkittu melko vähän. Tutkimuksen tarkoitus: Tarkoituksena oli selvittää sädehoidon jälkihaittoina esiintyvien sairauksien, kuten aivoverisuonisairauksien, älyllisten ongelmien, sekundaaristen kasvainten ja luustonhaurastumisen yleisyyttä ja riskitekijöitä suomalaisessa, kansallisessa kohortissa. Aineisto ja Menetelmät: Tutkimukseen kutsuttiin kaikki Suomessa lapsuusiällä aivokasvaimen sairastaneet aikuiset, jotka oli hoidettu sädehoidolla vuosina 1970-2008. Tutkittavat olivat yli 16-vuotiaita ja hoitojen päättymisestä oli yli 5 vuotta. Osallistuneille tehtiin kliininen ja neuropsykologinen tutkimus, pään magneettikuvaus, luustontiheysmittaus ja laboratoriotutkimuksia. Tulokset: Tutkimukseemme osallistui 74 nuorta aikuista 18,9 ± 6,1 vuotta hoitojen päättymisen jälkeen. Tutkittavat olivat iältään 28,4 ± 6,8 -vuotiaita osallistuessaan, ja 8,3 ± 4,3 -vuotiaita diagnoosihetkellä. Aivoverisuonisairaus todettiin 52% tutkimukseen osallistuneella 20 vuoden seurannan jälkeen, pienten suonten tauti oli 38 %:lla ja suurten suonten tauti 16 %:lla. Aivoinfarktin oli sairastanut 9 % tutkituista, lakuunainfarktin 10 % ja aivoverenvuodon 3 % tutkituista. Valkean aivoaineen muutoksia todettiin 49 %:lla magneettikuvauksessa. Korkea verenpaine lisäsi aivoverisuonisairauden, suurten suonten taudin, valkoisen aivoaineen muutoksien sekä lakuunainfarktien riskiä. Selviytyjien keskimääräinen kielellinen älykkyysosamäärä oli 89 ± 14 ja ei-kielellinen 87 ± 19. Suurimmat vaikeudet todettiin toiminnanohjauksessa (Z-luku -5,0 ± 5,3 SD) ja prosessointinopeudessa (Z-luku -4,3 ± 5,4 SD). Toiminnanohjauksen ja prosessointinopeuden vaikeudet olivat yhteydessä arkielämän haasteisiin. Sekundaaristen aivokalvokasvainten kumulatiivinen esiintyvyys oli 25 vuoden seuranta-aikana 10,2 % kliinisessä tutkimuksessa ja sekundaaristen kasvainten 2,4 % Syöpärekisteriaineistossa. Matala luustontiheys todettiin 23,6%:lla selviytyneistä. Johtopäätökset: Nuorilla aikuisilla, jotka ovat lapsena aivokasvaimen vuoksi saaneet sädehoitoa, esiintyy useita sellaisia jälkihaittoja, jotka yleensä liittyvät ikääntymiseen.

The goal of this thesis is to get acquainted with methods of determining bone mineral density from appropriate tissue types in diagnostic CT data and possibly modifying or extending them in order to make the bone quality diagnosis more reliable. The thesis begins by introducing the issue of determining bone quality. Next, a method that takes cortical bone deformations into account as well as bone mineral density is introduced. Accuracy assessment based on opinion of a medical expert suggests positive outcome of future objective accuracy assessment utilizing so far unavailable base of calibrated CT data, that is needed before deployment into clinical practice. If the accuracy of the suggested method is confirmed this way, this work provides a so far absent tool for fully automatic preventive diagnostics of osteoporosis.

This thesis deals with the segmentation and classification of paraspinal muscle and subcutaneous adipose tissue in 3D CT image data in order to use them subsequently as internal calibration phantoms to measure bone mineral density of a vertebrae. Chosen methods were tested and afterwards evaluated in terms of correctness of the classification and total functionality for subsequent BMD value calculation. Algorithms were tested in programming environment Matlab® on created patient database which contains lumbar spines of twelve patients. Following sections of this thesis contain theoretical research of the issue of measuring bone mineral density, segmentation and classification methods and description of practical part of this work.

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