Identification and characterization of a new pathologic mutation in a large Leber hereditary optic neuropathy pedigree.

BACKGROUND: Most patients suffering from Leber hereditary optic neuropathy carry one of the three classic pathologic mutations, but not all individuals with these genetic alterations develop the disease. There are different risk factors that modify the penetrance of these mutations. The remaining patients carry one of a set of very rare genetic variants and, it appears that, some of the risk factors that modify the penetrance of the classical pathologic mutations may also affect the phenotype of these other rare mutations. RESULTS: We describe a large family including 95 maternally related individuals, showing 30 patients with Leber hereditary optic neuropathy. The mutation responsible for the phenotype is a novel transition, m.3734A > G, in the mitochondrial gene encoding the ND1 subunit of respiratory complex I. Molecular-genetic, biochemical and cellular studies corroborate the pathogenicity of this genetic change. CONCLUSIONS: With the study of this family, we confirm that, also for this very rare mutation, sex and age are important factors modifying penetrance. Moreover, this pedigree offers an excellent opportunity to search for other genetic or environmental factors that additionally contribute to modify penetrance.

Maximal Respiratory Pressure Reference Equations in Healthy Adults and Cut-off Points for Defining Respiratory Muscle Weakness.

INTRODUCTION: Maximal inspiratory and expiratory pressures (PImax/PEmax) reference equations obtained in healthy people are needed to correctly interpret respiratory muscle strength. Currently, no clear cut-off points defining respiratory muscle weakness are available. We aimed to establish sex-specific reference equations for PImax/PEmax in a large sample of healthy adults and to objectively determine cut-off points for respiratory muscle weakness. METHODS: A multicentre cross-sectional study was conducted across 14 Spanish centres. Healthy non-smoking volunteers aged 18-80 years stratified by sex and age were recruited. PImax/PEmax were assessed using uniform methodology according to international standards. Multiple linear regressions were used to obtain reference equations. Cut-off points for respiratory muscle weakness were established by using T-scores. RESULTS: The final sample consisted of 610 subjects (314 females; 48 [standard deviation, SD: 17] years). Reference equations for PImax/PEmax included body mass index and a squared term of the age as independent variables for both sexes (p<0.01). Cut-off points for respiratory muscle weakness based on T-scores ≥2.5 SD below the peak mean value achieved at a young age were: 62 and 83cmH2O for PImax and 81 and 109cmH2O for PEmax in females and males, respectively. CONCLUSION: These reference values, based on the largest dataset collected in a European population to date using uniform methodology, help identify cut-off points for respiratory muscle weakness in females and males. These data will help to better identify the presence of respiratory muscle weakness and to determine indications for interventions to improve respiratory muscle function.

[Developing a questionnaire about violence(s) suffered by professionals in the field of Physiotherapy.] / Elaboración de un cuestionario sobre violencia(s) sufrida(s) por profesionales del ámbito de la Fisioterapia.

OBJECTIVE: Violence in the health sector is a big problem and it has serious consequences. The prevalence of clinical violence suffered by Spanish physiotherapists is unknown. The objective of this paper was to create and validate a tool in order to detect cases of sexual, physical and psychological and/or verbal violence in the Spanish physiotherapists. METHODS: A questionnaire was elaborated according to the available bibliography. It was analyzed by a group of six physiotherapists in charge of the Union observation and management of violence or from Me-Too Fisio movement. Finally, a pilot test was carried out on a convenience sample of fourteen physiotherapists. RESULTS: The questionnaire obtained includes questions about the facts suffered by the professionals in this discipline, as well as the main data on the profile of the aggressor (sex, age, mental condition…), the contexts where violence is more prevalent (clinical field, size of the population where the center is located…), and the main characteristics of the professional who suffers it (sex, age, professional experience…). Moreover, information about formal and informal strategies used to deal with violence and perception of its impact, will be assessed. CONCLUSIONS: The annual use of this tool will allow the exposure of this group of professionals to be assessed specifically and, also, to assess the evolution over time of each violence separately for providing direction for successful policies and training.

OBJETIVO: La violencia en el sector sanitario es un problema importante y con graves consecuencias. Se desconoce la prevalencia de la violencia en el ámbito clínico sobre los fisioterapeutas en España. El objetivo de este trabajo fue crear y validar una herramienta para detectar casos de violencia sexual, física y psicológica y/o verbal ejercida por pacientes/acompañantes/familiares sobre la población de fisioterapeutas de España. METODOS: A partir de la bibliografía disponible, se elaboró un cuestionario que fue analizado por un grupo de seis fisioterapeutas del Consejo a cargo de la gestión y observación de la violencia sufrida por fisioterapeutas o profesionales destacadas en el movimiento Me Too Fisio. Finalmente, se realizó una prueba piloto en una muestra de conveniencia de catorce fisioterapeutas. RESULTADOS: El cuestionario obtenido incluye preguntas sobre los hechos sufridos por los/las profesionales de esta disciplina, así como los principales datos del perfil de persona agresora (sexo, edad, condición mental, etc.), el contexto en el que la violencia es más prevalente (campo laboral, tamaño del municipio, etc.) y las principales características del/de la profesional que sufre la violencia (sexo, edad, experiencia profesional, etc.). Además se recoge información sobre estrategias formales e informales utilizadas para enfrentar la violencia y la percepción de su impacto. CONCLUSIONES: Una utilización anual de esta herramienta ayudará a valorar la exposición de este grupo de profesionales de forma específica y, también, la evolución en el tiempo de cada violencia por separado, con la finalidad de establecer políticas y programas formativos exitosos.

Adaptations of the Walking Corsi Test (WalCT) for 2- and 3-year-old preterm and term-born toddlers: A preliminary study.

Introduction: Topographical memory is crucial for navigation and environmental representation. The Walking Corsi Test (WalCT) has been used to evaluate topographical memory in children from 4 years upward. The present study aims to determine whether adapted versions of the WalCT- by simplifying instructions and increasing motivation- can be adopted to test topographical memory in 2- and 3-year-old toddlers born at term and preterm. Assessing this skill in such young children is important in light of recent studies that have shown how spatial cognition underlies the development of skills in other cognitive domains as well. Methods: For this purpose, 47 toddlers (27.39 ± 4.34 months, 38.3% females), 20 born at term and 27 preterm, performed two aimed-designed versions of WalCT. Results: The results showed better performance of the term groups with increasing age and for both versions. On the other hand, performance was better in 2-year-old term toddlers vs. preterm. When rising motivation, 2-year-old preterm toddlers improve their performance but differences between both groups were still significant. The preterm group showed lower performance related to lower levels of attention. Discussion: This study provides preliminary data on the suitability of the adapted versions of WalCT in early ages and prematurity conditions.

Mapping the field of physical therapy and identification of the leading active producers. A bibliometric analysis of the period 2000- 2018.

OBJECTIVES: The objectives of the study were: 1) Describe the thematic structure and evolution of the field of physical therapy; 2) identify the main research producers (i.e. countries and institutions); and 3) compare their research output and citation impact. METHODS: Papers related to physical therapy indexed in Web of Science (2000-2018) were identified to delineate the field, using keywords, journals, and citation networks. VOSviewer software, advanced bibliometric text mining, and visualization techniques were used to evaluate the thematic structure. We collected data about the country and institutional affiliation of all the authors and calculated production and citation impact indicators. RESULTS: 85,697 papers were analyzed. Eleven thematic clusters were identified: 1) "health care and education"; 2) "biomechanics"; 3) "psychosocial, chronic pain and quality of life outcomes"; 4) "evidence-based physical therapy research methods"; 5) "traumatology and orthopedics"; 6) "neurological rehabilitation"; 7) "psychometrics and cross-cultural adaptation"; 8) "gait-balance analysis and Parkinson's disease"; 9) "exercise"; 10) "respiratory physical therapy"; and 11) "back pain." The United States, the United Kingdom, and Australia were the most productive countries. Netherlands, Norway, and Sweden had the highest citation impact. CONCLUSIONS: Our bibliometric visualization approach makes it possible to comprehensively study the thematic structure of physical therapy. The ranking of producers has evolved and now includes China and Brazil. High research production does not imply a high citation impact.

Evolution of the thematic structure and main producers of physical therapy interventions research: A bibliometric analysis (1986 to 2017).

BACKGROUND: Bibliometric studies are used to analyse and map scientific areas, and study the scientific output and impact of institutes and countries. OBJECTIVES: Describe the thematic structure and evolution of the field of physical therapy interventions using articles indexed in Physiotherapy Evidence Database (PEDro). Also, identify and compare the main producers (countries, institutions) over time (research output, citation impact). METHODS: Eligible articles were those indexed in PEDro (1986-2017) and matched to Web of Science. VOSviewer software, bibliometric text mining, and visualisation techniques were used to evaluate the thematic structure of the included articles. We collected data about authors' country and institutional affiliation, and calculated bibliometric indicators (production, citation impact). RESULTS: A total of 29 090 articles were analysed. Eight topics were identified: "neurological rehabilitation"; "methods"; "exercise for prevention and rehabilitation of lifestyle diseases"; "assessment and treatment of musculoskeletal pain"; "physical activity", "health promotion and behaviour change"; "respiratory physical therapy"; "hospital, primary care and health economics"; "cancer and complementary therapies". The most productive countries were United States, United Kingdom, Australia, and Canada. The most impactful countries were United States, France, Finland, and Canada. The most productive institutions were University of Sydney, VU University of Amsterdam, University of Queensland, and University of Toronto. CONCLUSIONS: The thematic structure of physical therapy interventions has evolved over time with "neurological rehabilitation", "methods", "exercise related to lifestyle diseases", and "physical activity" becoming increasingly important. Main producers of this research were traditionally located in North America and Europe but now include countries like China and Brazil.

Thirty Minutes Identified as the Threshold for Development of Pain in Low Back and Feet Regions, and Predictors of Intensity of Pain during 1-h Laboratory-Based Standing in Office Workers.

This study with 40 office workers investigated (a) the effect of time spent standing on low- back and lower limb pain during a 1-h laboratory-based task; (b) the standing time after which a significant increase in pain is likely; and (c) the individual, physical and psychosocial factors that predict pain. The primary outcome was bodily location of pain and pain intensity on a 100-mm Visual Analogue Scale recorded at baseline and every 15 min. Physical measures included trunk and hip motor control and endurance. Self-report history of pain, physical activity, psychosocial job characteristics, pain catastrophizing and general health status were collected. Univariate analysis and regression models were included. The prevalence of low-back pain increased from 15% to 40% after 30 min while feet pain increased to 25% from 0 at baseline. The intensity of low-back and lower limb pain also increased over time. A thirty-minute interval was identified as the threshold for the development and increase in low-back and feet pain. Modifiable factors were associated with low-back pain intensity-lower hip abductor muscle endurance and poorer physical health, and with feet symptoms-greater body mass index and less core stability.

Mode of Delivery and Maternal Sensitivity: Effects on the Socioemotional Development of Children at One Year of Age / Tipo de parto y sensibilidad materna: Efectos en el desarrollo socioemocional de niños y niñas al año de edad

Abstract Early childhood is a period of high relevance in children's socioemotional development, establishing the basis for future development. Acquisitions during the first year of life are significant predictors of future social and emotional skills. During this period, maternal sensitivity is also essential, and there is evidence regarding its effects on the socioemotional development of the child. Considering the relevance of this competence, together with the global and national increase in cesarean rates and the possible risks associated with the type of delivery experienced, the influence of the type of delivery and the maternal sensitivity in child's socioemotional development at one year of age was analyzed. For this, an intentional non-probabilistic sample of 91 mothers with their respective children of different socioeconomic levels, who attended public or private nurseries in the city of Santiago, Chile, was studied. The instruments used were the Adult Sensitivity Scale (ESA) and the Functional Emotional Assessment Scale (FEAS). The results showed no differences in the children's socioemotional development according to the type of delivery. However, it was possible to observe an association between a higher maternal sensitivity and a more significant socioemotional development on children at one year of age. The implications of promoting maternal sensitivity are discussed to support optimal socioemotional development in infants.

Resumen La infancia temprana es un periodo de gran relevancia en el desarrollo socioemocional infantil; de hecho, es donde se sientan las bases del desarrollo futuro. En este sentido, las adquisiciones durante el primer año de vida son predictores importantes de las habilidades sociales y emocionales futuras, de modo que la sensibilidad materna, según evidencia respecto a sus efectos en el desarrollo socioemocional del niño, ha demostrado ser un aspecto fundamental durante este periodo. Teniendo esto en cuenta, y considerando la relevancia de dicha competencia, así como el alza mundial y nacional en las tasas de cesárea y los posibles riesgos asociados al tipo de parto vivenciado, el presente estudio tuvo como objetivo analizar la influencia de la sensibilidad materna y del tipo de parto en el desarrollo socioemocional infantil al año de edad. Para ello, se estudió una muestra no probabilística intencionada de 91 madres con sus respectivos hijos o hijas -de distinto nivel socioeconómico- que asistían a salas cuna públicas o privadas en la ciudad de Santiago, Chile, por medio de dos instrumentos: la escala de sensibilidad del adulto (ESA) y la functional emotional assessment scale (FEAS). En general, los resultados no mostraron diferencias en el desarrollo socioemocional de los niños según el tipo de parto, aunque sí se pudo apreciar una relación entre una mayor sensibilidad materna y un mayor desarrollo socioemocional de los niños al año de edad. Al final se discuten las implicaciones de promover la sensibilidad materna con el fin de apoyar un óptimo desarrollo socioemocional en los infantes.

What Psychosocial and Physical Characteristics Differentiate Office Workers Who Develop Standing-Induced Low Back Pain? A Cross-Sectional Study.

This study examines demographic, physical and psychosocial factors associated with an increase in low back pain (LBP) during a one-hour standing task. A cross-sectional survey with 40 office workers was conducted. The primary outcome was pain severity during a one-hour standing task recorded every 15 min using a 100 mm Visual Analogue Scale (VAS). Participants were defined as pain developers (PD), if they reported a change in pain of ≥10 mm from baseline, or non-pain developers (NPD). Physical outcomes included participant-rated and examiner-rated trunk and hip motor control and endurance. Self-report history of LBP, physical activity, psychosocial job characteristics, general health and pain catastrophising were collected. Fourteen participants were PD. Hip abduction, abdominal and spinal muscle endurance was lower for PD (p ≤ 0.05). PD had greater self-reported difficulty performing active hip abduction and active straight leg raise tests (p ≤ 0.04). Those reporting a lifetime, 12 month or 7-day history of LBP (p < 0.05) and lower self-reported physical function (p = 0.01) were more likely to develop LBP during the standing task. In conclusion, a history of LBP, reduced trunk and hip muscle endurance and deficits in lumbopelvic/hip motor control may be important to consider in office workers experiencing standing-induced LBP.

Bayesian Methods in the Field of Rehabilitation.

Bayesian techniques, as an alternative method of statistical analysis in rehabilitation studies, have some advantages such as handling small sample sizes, allowing incorporation of previous experience of the researchers or clinicians, being suitable for different kinds of studies, and managing highly complex models. These characteristics are important in rehabilitation research. In the present article, the Bayesian approach is displayed through three examples in previously analyzed data with traditional or frequentist methods. The studies used as examples have small sample sizes and show that the Bayesian procedures enhance the statistical information of the results. The Bayesian credibility interval includes the true value of the corresponding parameter diminishing uncertainty about the treatment effect. In addition, the Bayes factor value quantifies the evidence provided by the data in favor of the alternative hypothesis as opposed to the null hypothesis. Bayesian inference could be an interesting and adaptable alternative statistical method for physical medicine and rehabilitation applications.

Bone Mineral Density T-Scores Derived from CT Attenuation Numbers (Hounsfield Units): Clinical Utility and Correlation with Dual-energy X-ray Absorptiometry.

Background: Clinical computed tomography (CT) studies performed for other indications can be used to opportunistically assess vertebral bone without additional radiation or cost. Reference values for young women are needed to evaluate diagnostic accuracy and track changes in CT bone mineral density values across the lifespan. The purpose of this study was to determine reference values for lumbar trabecular CT attenuation (Hounsfield units [HU]) and determine the diagnostic accuracy of HU T-scores (T-scoreHU) for identifying individuals with osteoporosis. Methods: We performed a retrospective single-center cohort study of patients undergoing CT of the lumbar spine. Reference values for lumbar spine Hounsfield units were determined from a reference sample of 190 young women aged 20-30 years undergoing CT scan of the lumbar spine. A separate sample of 252 older subjects undergoing CT and dual-energy X-ray absorptiometry (DXA) within a 6-month period that served as a validation cohort. Osteoporosis was defined by T-scoreDXA ≤ -2.5. Reference values were determined for lumbar HU from L1 to L4 from the reference cohort (24.0 ± 2.9 years). T-scoreHU was calculated in the validation cohort (58.9 ± 7.5 yrs). Receiver operating characteristic (ROC) curves were used to assess sensitivity and specificity of T-scoreHU for this task. Results: Reference group HU ranged from 227 ± 42 at L3 to 236 ± 42 at L1 (P < 0.001). Validation group T-scoreDXA was -0.7 ± 1.5 and -0.9 ± 1.2 at lumbar and femoral sites respectively. Mean T-scoreHU was -2.3. T-scoreHU of -3.0, corresponding to 110 HU, was 48% sensitive and 91% specific for osteoporosis in the validation group. ROC area under the curve ranged from 0.825 to 0.853 depending on lumbar level assessed. Conclusions: Although lumbar trabecular HU T-scores are lower than DXA T-scores, thresholds can be selected to achieve high sensitivity and specificity when screening for osteoporosis. Patients with a lumbar T-scoreHU ≤ -3.0 should be referred for additional evaluation. Further research into HU T-scores and clinical correlates may also provide a tool to assess changes in vertebral bone and the relationship to fracture risk across the lifespan.

Incidence and outcomes of incidental breast lesions detected on cross-sectional imaging examinations.

The aim of this study was to determine the frequency and outcomes of incidental breast lesions detected on nonbreast specific cross-sectional imaging examinations. A retrospective review of the medical records was performed to identify all patients without a known history of breast cancer, who had an incidentally discovered breast lesion detected on a nonbreast imaging examination performed at our institution between September 2008 and August 2012 for this IRB-approved, HIPAA compliant study. Outcomes of the incidental lesions were determined by follow-up with dedicated breast imaging (mammography, breast ultrasound, and/or breast MRI) or results of biopsy, if performed. Imaging modality of detection, imaging features, patient age, patient location at the time of the nonbreast imaging examination, type of follow-up, and final outcome were recorded. Rates of malignancy were also calculated, and comparison was made across the different cross-sectional imaging modalities. Kruskal-Wallis and Fisher's exact tests were used to identify factors associated with an increased rate of malignancy. Logistic regression was used to model the risk of malignancy as a function of continuous predictors (such as patient age or lesion size); odds ratios and 95% confidence intervals were obtained. A total of 292 patients with incidental breast lesions were identified, 242 of whom had incidental lesions were noted on computed tomography (CT) studies, 25 on magnetic resonance imaging (MRI), and 25 on positron emission tomography (PET). Although most of the incidental breast lesions were detected on CT examinations, PET studies had the highest rate of detection of incidental breast lesions per number of studies performed (rate of incidental breast lesion detection on PET studies was 0.29%, compared to 0.10% for CT and 0.01% for MRI). Of the 121 of 292 (41%) patients who received dedicated breast imaging work-up at our institution, 40 of 121 (33%) underwent biopsy and 25 of 121 (21%) had malignancy. There was a significantly increased rate of malignancy in older patients (odds ratio: 1.05, 95% CI: 1.02-1.093; P = .006). Additionally, patients with PET-detected incidental breast lesions had a significantly higher rate of malignancy (55%), compared to patients with CT-detected (35%) and MRI-detected (8%) incidental breast lesions (P = .038). The rate of malignancy upon follow-up of incidental breast lesions detected on nonbreast imaging examinations in this retrospective study was 21%, supporting the importance of emphasizing further work-up of all incidentally detected breast lesions with dedicated breast imaging. Additionally, we found that PET examinations had the highest rate of detection of incidental breast lesions and the highest rate of malignancy, which suggests that PET examinations may be more specific for predicting the likelihood of malignancy of incidental breast lesions, compared to CT and MRI.

Percutaneous liver biopsy and revised coagulation guidelines: a 9-year experience.

PURPOSE: To retrospectively review revised pre-procedural coagulation guidelines for percutaneous liver biopsy to determine whether their implementation is associated with increased hemorrhagic complications on a departmental scale. Secondary endpoints were to determine the effect of this change on pre-procedural blood product (FFP and platelet) utilization, to evaluate the impact of administered blood products on hemorrhagic complications, and to determine whether bleeding complications were related to INR and platelet levels. MATERIALS AND METHODS: This IRB-approved, HIPAA-compliant, retrospective study reviewed 1846 percutaneous liver biopsies in 1740 patients, comparing biopsies performed, while SIR consensus pre-procedural coagulation guidelines were in place (INR ≤ 1.5, platelets ≥50,000 µL) to those performed after departmental implementation of revised, less stringent guidelines (INR ≤ 2.0, platelets ≥25,000 µL). RESULTS: On a departmental scale, there were significantly fewer hemorrhagic complications in the population of patients treated after adoption of less stringent guidelines as compared to those treated under the SIR guidelines (1.6% vs. 3.4%, p = 0.0192) despite a significant decrease in pre-procedural FFP (0.8% vs. 3.9%, p < 0.001) and platelet transfusions (0.3% vs. 1.2%, p = 0.021). Individual patient hemorrhagic complication rates significantly increased as INR increased (p = 0.006) and platelet counts decreased (p = 0.004), but pre-procedural FFP (p = 0.64) and/or platelet transfusion (p = 0.5) did not have a significant impact on hemorrhagic complication rates. CONCLUSION: Implementation of less stringent pre-procedural coagulation parameter guidelines for percutaneous liver biopsy (INR ≤ 2.0, platelets ≥25,000 µL) did not result in an increase in departmental hemorrhagic complication rates but did significantly decrease pre-procedural FFP/platelet administration. An individual patient's bleeding risk does increase as INR increases and platelets decrease, but pre-procedural FFP and/or platelet transfusion did not mitigate that increased risk.

Volumetric Versus Unidimensional Measures of Metastatic Colorectal Cancer in Assessing Disease Response.

INTRODUCTION: The purpose of this study was to compare unidimensional (1D/linear) and volumetric (3D) measures of metastatic colorectal cancer (mCRC) at computed tomography (CT) for predicting clinical outcome. PATIENTS AND METHODS: Analysis of CT images in 105 patients (mean age, 59 years; range, 25-81 years; 45 women, 60 men) receiving treatment for mCRC was performed. Both unidimensional and volumetric measures were obtained on index lesions at 3 time points (baseline/midpoint/post-therapy; mean interval, 4.1 months; median, 3.7 months) by 3 readers using a semi-automated technique. Measurements were summed and compared using best overall response across the 3 time points. Patient response was categorized based on Response Evaluation Criteria In Solid Tumors (RECIST) 1.1 thresholds for unidimensional and volume measures (CR, complete response; PR, partial response; SD, stable disease; PD, progressive disease). Survival data was correlated (mean follow-up, 19.9 ± 17.1 months; median, 14.7 months). Intra/interobserver variability and reproducibility of 1D and 3D measures was assessed. Cox survival and Kaplan-Meier models were constructed and compared. RESULTS: Cox models and Kaplan-Meier curves for unidimensional versus volumetric assessment were very similar in appearance. Both 1D and 3D measurements effectively separated PD from the SD/PR groups, but neither separated SD from PR well. Volumetric measures showed comparable intra/interobserver variability on Bland-Altman analysis to unidimensional measures across readers using a semi-automated measurement technique. Metastatic site (lung, liver, node, other) did not seem to impact measurement reproducibility. CONCLUSIONS: Although CT volumetric assessment of metastatic colorectal cancer is fairly reproducible by reader and site using a semi-automated technique, the ability to stratify progressive disease from other disease response categories in terms of survival was similar to unidimensional measurement.

Stratification of Fat-Free Mass Index Percentiles for Body Composition Based on National Health and Nutrition Examination Survey III Bioelectric Impedance Data.

BACKGROUND: Loss of protein mass and lower fat-free mass index (FFMI) are associated with longer length of stay, postsurgical complications, and other poor outcomes in hospitalized patients. Normative data for FFMI of U.S. populations do not exist. This work aims to create a stratified FFMI percentile table for the U.S. population using the large bioelectric impedance analysis data obtained from National Health and Nutrition Examination Surveys (NHANES). METHODS: Fat-free mass (FFM) was calculated from the NHANES III bioelectric impedance analysis and anthropometric data for males and females ages 12 to >90 years for 3 race/ethnicities (non-Hispanic white, non-Hispanic black, and Mexican American). FFM was normalized by subject height to create an FFMI distribution table for the U.S. POPULATION: Selected percentiles were obtained by age, sex, and race/ethnicity. Data were collapsed by race/ethnicity before and after removing obese and underweight participants to create an FFMI decile table for males and females 12 years and older for the healthy-weight U.S. RESULTS: FFMI increased during adolescent growth but stabilized in the early 20s. The FFMI deciles were similar by race/ethnicity, with age group remaining relatively stable between ages 25 and 80 years. The FFMI deciles for males and females were significantly different. CONCLUSIONS: After eliminating the obese and extremely thin, FFMI percentiles remain stable during adult years allowing creation of age- and race/ethnicity-independent decile tables for males and females. These tables allow stratification of individuals for nutrition intervention trials to depict changing nutrition status during medical, surgical, and nutrition interventions.

Combined gadoxetic acid and gadofosveset enhanced liver MRI for detection and characterization of liver metastases.

PURPOSE: To compare gadoxetic acid alone and combined gadoxetic acid/gadofosveset trisodium-enhanced liver MRI for detection of metastases and differentiation of metastases from haemangiomas. METHODS: Ninety-one patients underwent gadoxetic acid-enhanced liver MRI before and after additional injection of gadofosveset. First, two readers retrospectively identified metastases on gadoxetic acid alone enhanced delayed hepatobiliary phase T1-weighted images together with all other MR images (dynamic images, T2-weighted images, diffusion-weighted images). Second, readers assessed additional T1-weighted images obtained after administration of gadofosveset trisodium. For both interpretations, readers rated lesion conspicuity and confidence in differentiating metastases from haemangiomas. Results were compared using alternative free-response receiver-operating characteristic (AFROC) and conventional ROC methods. Histology and follow-up served as reference standard. RESULTS: There were 145 metastases and 16 haemangiomas. Both readers detected more metastases using combined gadoxetic acid/gadofosveset (reader 1 = 130; reader 2 = 124) compared to gadoxetic acid alone (reader 1 = 104; reader 2 = 103). Sensitivity of combined gadoxetic acid/gadofosveset (reader 1 = 90 %; reader 2 = 86 %) was higher than that of gadoxetic acid alone (reader 1 = 72 %; reader 2 = 71 %, both P < 0.01). AFROC-AUC was higher for the combined technique (0.92 vs. 0.86, P < 0.001). Sensitivity for correct differentiation of metastases from haemangiomas was higher for the combined technique (reader 1 = 98 %; reader 2 = 99 % vs. reader 1 = 86 %; reader 2 = 91 %, both P < 0.01). ROC-AUC was significantly higher for the combined technique (reader 1 = 1.00; reader 2 = 1.00 vs. reader 1 = 0.87; reader 2 = 0.92, both P < 0.01). CONCLUSION: Combined gadoxetic acid/gadofosveset-enhanced MRI improves detection and characterization of liver metastases compared to gadoxetic acid alone. KEY POINTS: • Combined gadoxetic acid and gadofosveset-enhanced liver MRI significantly improves detection of metastases. • The combined enhancement technique improves the accuracy to differentiate metastases from haemangiomas. • Prospective studies need to determine the clinical impact of the combined technique.

Correlation Between Hip Arthroscopy Outcomes and Preoperative Anesthetic Hip Joint Injections, MR Arthrogram Imaging Findings, and Patient Demographic Characteristics.

OBJECTIVE: The purpose of this study is to determine whether the preoperative response to intraarticular hip anesthetic injection correlates with the outcome of hip arthroscopy. A secondary aim is to determine whether the outcome of arthroscopy correlates with intraarticular pathologic findings or patient demographic characteristics. MATERIALS AND METHODS: Ninety-three patients who underwent MR arthrography (MRA), preoperative injections of anesthetic into the hip joint (with pain scores documented), and subsequent hip arthroscopy (with a modified Harris Hip Score [mHHS] determined at 1 year after arthroscopy) were included in the study. MRA images and surgery reports were retrospectively reviewed to identify information about labral tear type and size and cartilage damage grade. The correlation between the response to hip anesthetic injection (defined as poor [0-30% improvement], moderate [31-60% improvement], or good [61-100% improvement]) and the surgical outcome (poor, fair, or good, as determined on the basis of the mHHS or the need for repeat surgery) was evaluated using the Fisher exact test. Univariate analysis (performed using the Fisher exact test) and multivariate analysis (performed using ANOVA) of correlations with age, sex, body mass index (BMI [weight in kilograms divided by the square of height in meters]), the interval between injection and surgery, labral tear type and size, and cartilage damage grade were also performed. RESULTS: Comparison of the response to preoperative hip anesthetic injection with the outcome of arthroscopy at 1 year indicated no statistically significant association (p = 0.59). The BMI of the patient, however, was statistically significantly associated with surgical outcome (p = 0.03), with a BMI of less than 25 denoting a higher likelihood of a good surgical outcome. No statistically significant correlations were noted in analyses of surgical outcomes and patient age (p = 0.31) and sex (p = 0.83); the interval between injection and surgery (p = 0.28); labral tear type, as determined by MRA (p = 0.34) and arthroscopy (p = 0.47); labral tear size, as determined by MRA (p = 0.34); and cartilage grade, as determined by MRA (p = 0.58) and arthroscopy (p = 0.26). CONCLUSION: No positive or negative correlation was noted between the response to preoperative hip anesthetic injection and the outcome at 1 year after hip arthroscopy. Only BMI was shown to correlate with the surgical outcome.

CT Textural Analysis of Large Primary Renal Cell Carcinomas: Pretreatment Tumor Heterogeneity Correlates With Histologic Findings and Clinical Outcomes.

OBJECTIVE: The purpose of the present study is to determine whether CT texture features of newly diagnosed primary renal cell carcinomas (RCCs) correlate with pathologic features and oncologic outcomes. MATERIALS AND METHODS: CT texture analysis was performed on large (> 7 cm; mean size, 9.9 cm) untreated RCCs in 157 patients (52 women and 105 men; mean age, 60.3 years). Measures of tumor heterogeneity, including entropy, kurtosis, skewness, mean, mean of positive pixels, and SD of pixel distribution histogram were derived from multiphasic CT using various filter settings: unfiltered (spatial scaling factor, 0), fine (spatial scaling factor, 2), medium (spatial scaling factor, 3-4), or coarse (spatial scaling factor, 5-6). Texture values were correlated with histologic subtype, nuclear grade, pathologic stage, and clinical outcome. RESULTS: When a coarse filter setting (spatial scaling factor, 6) was used, entropy on portal venous phase CT images was positively associated with clear cell histologic findings (odds ratio [OR], 134; 95% CI, 16-1110; p < 0.001) and was negatively associated with non-clear cell subtype findings (papillary spatial scale factor, 6; OR, 0.016; 95% CI, 0.002-0.132; p < 0.001). ROC curve analysis for entropy (on portal venous phase images obtained with a spatial scaling factor of 6) revealed an AUC of 0.943 (95% CI, 0.892-0.993) for clear cell histologic findings, with similar values noted for non-clear cell histologic findings. The mean of positive pixels and the SD of the pixel distribution histogram were statistically significantly associated with histologic cell type in a similar fashion. Entropy, the SD of the pixel distribution histogram, and the mean of positive pixels were associated with nuclear grade, most prominently when fine or medium texture filters were used (p < 0.05). There was a statistically significant association of texture features noted on unenhanced CT, including the SD of the pixel distribution histogram, the mean of positive pixels, and entropy, with the time to disease recurrence and death due to disease (e.g., for entropy noted on unenhanced CT images obtained with a spatial scaling factor of 6, the hazard ratio was 3.49 [95% CI, 1.55-7.84]; p = 0.002). CONCLUSION: CT texture features (in particular, entropy, the mean of positive pixels, and the SD of the pixel distribution histogram) are associated with tumor histologic findings, nuclear grade, and outcome measures. The contrast phase does seem to affect heterogeneity measures.

The Liver Segmental Volume Ratio for Noninvasive Detection of Cirrhosis: Comparison With Established Linear and Volumetric Measures.

OBJECTIVE: The aim of this study was to compare the liver segmental volume ratio (LSVR), a novel volumetric computed tomography measurement, with established linear measurements for differentiating normal from cirrhotic livers. METHODS: Hepatic volumes were measured using semiautomated software (Liver Analysis Application, Philips IntelliSpace Portal) on contrast-enhanced abdominal computed tomography scans in 312 adults, including 108 patients with end-stage liver disease (mean age, 55 years; 63 men/45 women) and 204 healthy controls (potential renal donors; mean age, 46 years; 82 men/122 women). The LSVR was defined as the volume ratio of Couinaud segments I to III to segments IV to VIII. Linear measures included the caudate-to-right lobe ratio and maximal splenic dimension. RESULTS: Differences in LSVR between cirrhotics and controls were highly significant (P < 0.0001; mean, 0.55 ± 0.29 versus 0.27 ± 0.07; receiver operating characteristic [ROC] area under the curve [AUC], 0.916). Linear caudate-to-right lobe ratio differences were not statistically significant between the 2 cohorts (P = 0.051; ROC AUC, 0.567). Total liver volume was ineffective for discrimination (ROC AUC, 0.598). An LSVR threshold of 0.35 or greater had a sensitivity and specificity for cirrhosis of 81.5% and 88.7%, respectively. CONCLUSIONS: Regional hepatic volume changes, as reflected by the LSVR, are more effective than standard linear measures or total liver volume for differentiating cirrhotic from normal livers.

Comparing Simultaneous and Pointwise Confidence Intervals for Hydrological Processes.

Distribution function estimation of the random variable of river flow is an important problem in hydrology. This issue is directly related to quantile estimation, and consequently to return level prediction. The estimation process can be complemented with the construction of confidence intervals (CIs) to perform a probabilistic assessment of the different variables and/or estimated functions. In this work, several methods for constructing CIs using bootstrap techniques, and parametric and nonparametric procedures in the estimation process are studied and compared. In the case that the target is the joint estimation of a vector of values, some new corrections to obtain joint coverage probabilities closer to the corresponding nominal values are also presented. A comprehensive simulation study compares the different approaches, and the application of the different procedures to real data sets from four rivers in the United States and one in Spain complete the paper.