RESUMO
INTRODUCTION: Body composition has been associated with disease outcome in several cancer types. Results for localized and metastatic renal cell cancer (RCC) are limited and inconsistent. Our aim was to examine the association between body composition and survival in RCC. METHODS: We conducted a population-based historical cohort study including patients diagnosed with RCC from 2008 to 2012. Diagnostic Computed Tomography images at the third lumbar vertebra (L3) were assessed for skeletal muscle index (SMI), skeletal muscle density (SMD), visceral adipose tissue index (VATI) and subcutaneous adipose tissue index (SATI). Clinical data was retrieved from medical records. Multivariable Cox regressions with restricted cubic splines were used to determine hazard ratios (HRs) and 95% confidence intervals (95%CIs) for 10-unit increases in body composition features with overall survival (OS) and recurrence-free survival (RFS). RESULTS: We included 719 stage I-III (of whom 254 (35.3%) died and 148 (21.9%) experienced recurrence) and 320 stage IV RCC patients (of whom 298 (93.1%) died). Median follow-up was 6.35 years (interquartile range; 1.41-8.23). For stage I-III, higher SMD was associated with better OS (men: HR 0.86; 95% CI 0.68-1.08; women: HR 0.69; 95% CI 0.50-0.95). Lower compared to median VATI was associated with worse OS for both men (HR 1.38; 95%CI 1.05-1.83 for VATI = 25) and women (HR 1.67; 95%CI 1.01-2.78 for VATI = 20). For stage IV, higher SMD and higher VATI were associated with better OS among men (HR 0.74; 95% CI 0.59-0.94 and HR 0.93; 95% CI 0.88-0.99, respectively). Results for women were similar but non-significant. No statistically significant associations were found for SMI or SATI. CONCLUSION: Higher SMD and higher VATI were marginally associated with better survival in RCC patients and might be useful for better prognostication. However, the added value to current prognostic scores needs to be investigated.
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Carcinoma de Células Renais/diagnóstico por imagem , Densitometria/estatística & dados numéricos , Indicadores Básicos de Saúde , Gordura Intra-Abdominal/diagnóstico por imagem , Neoplasias Renais/diagnóstico por imagem , Idoso , Composição Corporal , Carcinoma de Células Renais/mortalidade , Carcinoma de Células Renais/patologia , Estudos de Coortes , Feminino , Humanos , Gordura Intra-Abdominal/patologia , Neoplasias Renais/mortalidade , Neoplasias Renais/patologia , Vértebras Lombares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Músculo Esquelético/diagnóstico por imagem , Músculo Esquelético/patologia , Valor Preditivo dos Testes , Prognóstico , Modelos de Riscos Proporcionais , Gordura Subcutânea/diagnóstico por imagem , Gordura Subcutânea/patologia , Tomografia Computadorizada por Raios XRESUMO
PURPOSE: We investigated corneal endothelial morphology and corneal densitometry in smokers and compared our results with findings observed in non-smokers. MATERIALS AND METHODS: This cross-sectional observational study included 100 participants (50 smokers, 50 non-smokers) aged 18-80 years in whom corneal endothelial morphology was analysed using a non-contact Tomey EM-4000 specular microscope (Tomey Corporation, Japan). The Pentacam HR system was used to measure corneal densitometry spatially in three concentric zones (from the centre to the periphery) and at three different corneal depths (from the anterior to the posterior aspects). Endothelial morphology findings and corneal densitometry values were recorded in all participants, and these results were compared between smokers and non-smokers. RESULTS: Endothelial morphology and corneal densitometry analysis showed significantly lower endothelial cell counts (Num) in smokers (228 cells/mm2 vs. 246 cells/mm2, p = 0.02) in addition to increased maximum cell area (Max) values (986.5 µm2 vs. 935 µm2, p = 0.04). We observed no statistically significant intergroup difference in corneal densitometry values (p > 0.05 for each zone); however, we observed a moderately positive correlation between densitometry values in the 6-10 mm concentric zone and between the all total corneal zones and number of pack-years in smokers. CONCLUSIONS: Our study highlights that among the morphometric corneal endothelial variables analysed in this study, only the Num value was significantly correlated with smoking. We observed no statistically significant intergroup difference in corneal densitometry values in this study; however, a positive correlation was observed between the number of pack-years and corneal densitometry findings. Therefore, as the pack-years increase, the increase in corneal densitometry values may indicate a decrease in corneal clarity, considering the possible contribution of secondary factors such as age.
Assuntos
Doenças da Córnea/diagnóstico , Densitometria/estatística & dados numéricos , Endotélio Corneano/diagnóstico por imagem , Fumar/efeitos adversos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Contagem de Células , Doenças da Córnea/etiologia , Topografia da Córnea/estatística & dados numéricos , Estudos Transversais , Células Endoteliais , Endotélio Corneano/citologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , não Fumantes , Fotografação , Fumantes/estatística & dados numéricos , Adulto JovemRESUMO
BACKGROUND: This study will aim to evaluate the diagnostic accuracy of digital X-ray radiogrammetry (DXR) on hand bone loss (HBL) for rheumatoid arthritis (RA). METHODS: In this study, we will search the literature from PubMed, EMBASE, Cochrane Library, PsycINFO, Web of Science, Google Scholar, Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine Database, Chinese Biomedical Literature Database, China National Knowledge Infrastructure, and WANFANG from the inception to June 1, 2019 without language restrictions. All case-controlled studies on assessing diagnostic accuracy of DXR on HBL for diagnosis of RA will be included. Quality Assessment of Diagnostic Accuracy Studies tool will be used for eligible studies. We will apply RevMan V.5.3 software and Stata V.12.0 software for statistical analysis. RESULTS: We will evaluate diagnostic accuracy of DXR on HBL in patients with RA by assessing the sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio. CONCLUSION: This study will detect the diagnostic accuracy of DXR evaluation on HBL in patients with RA. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42019139489.
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Artrite Reumatoide/diagnóstico por imagem , Doenças Ósseas Metabólicas/diagnóstico por imagem , Densitometria/estatística & dados numéricos , Intensificação de Imagem Radiográfica/métodos , Radiografia/estatística & dados numéricos , Revisões Sistemáticas como Assunto , Artrite Reumatoide/complicações , Doenças Ósseas Metabólicas/etiologia , Estudos de Casos e Controles , Densitometria/métodos , Progressão da Doença , Feminino , Ossos da Mão/diagnóstico por imagem , Humanos , Masculino , Radiografia/métodos , Projetos de Pesquisa , Índice de Gravidade de DoençaRESUMO
Bone health evaluation in children requires an appropriate reference database. We have shown higher curves for spine aBMD in Iranian subjects than Americans, but lower curves for femoral neck and total body. These results can be used as reference values to assist Iranian clinicians in interpreting and monitoring bone densitometry results. PURPOSE: Bone health evaluation requires an appropriate reference database that can identify the bone deficit according to age, sex, puberty, and race. The aim of this study was to determine bone mineral density Z-scores in Iranian children and adolescents and their comparability with other reference data. METHODS: A sample of 476 healthy children and adolescents, aged 9-18 years, from Kawar (an urban community, 50 km east of Shiraz, Iran) was selected and bone mineral measurements of the lumbar spine, femoral neck, and total body (less head) were done. Sex-specific height-for-age, weight-for-age, and BMI-for-age Z-scores, as well as bone mineral density Z-scores, were calculated. RESULTS: Extended reference curves for bone mineral content (BMC) and areal bone mineral density (aBMD) of the total body less head, lumbar spine, and femoral neck, for ages 9-18 years were constructed relative to sex and age. We found that median, - 2SD, and + 2SD curves for the lumbar spine aBMD were higher in Iranian subjects than in the American participants, but the curves of the femoral neck and total body were lower. Also, we showed that subjects with a lower height-for-age Z-score had a lower BMC and aBMD Z-score in the lumbar spine, femoral neck, and total body (p < 0.001). CONCLUSIONS: Relevant differences in bone mineral density and its curves exist between Iranian children and adolescents and other databases, revealing a significant potential for misdiagnosis. However, our results can be used to provide reference databases to assist clinicians in interpreting, assessing, and monitoring bone densitometry.
Assuntos
Fatores Etários , Densitometria/estatística & dados numéricos , Colo do Fêmur/diagnóstico por imagem , Vértebras Lombares/diagnóstico por imagem , Fatores Sexuais , Adolescente , Densidade Óssea , Criança , Feminino , Humanos , Irã (Geográfico) , Masculino , Valores de Referência , Reprodutibilidade dos TestesRESUMO
BACKGROUND AND OBJECTIVES: Cutaneous squamous cell carcinoma (SCC) is known for its capacity to metastasize via lymphatic vessels. In recent studies, the level of lymphangiogenesis has been reported as a potential prognostic factor for several skin tumors. The aim of this study was to quantify lymphangiogenesis in SCC using either computer-assisted image analysis or the Chalkley count technique. Vascular parameters were evaluated and compared with respect to their predictive power for tumor metastasis. PATIENT AND METHODS: In this case-control study, clinical and histological data of 15 metastatic and 15 nonmetastatic SCC patients were retrospectively analyzed. SCC samples were immunostained for the lymphatic endothelial marker D2-40 and the panvascular marker CD31, and analyzed using computer-assisted morphometric image analyses within hot spots as well as the digitalized Chalkley counting method. RESULTS: Lymphatic vessel density, relative lymphatic vessel area, and lymphatic Chalkley count were significantly elevated in metastatic SCC. Tumor thickness was significantly higher in metastatic SCC, and had the highest predictive power for metastatic disease. Tumor thickness was a significant predictor of lymphangiogenic parameters. CONCLUSIONS: Lymphangiogenesis is elevated in metastatic SCC but its extent is influenced by tumor thickness. Tumor thickness remains the most reliable predictive factor for metastatic disease.
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Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/secundário , Densitometria/métodos , Linfangiogênese , Metástase Linfática/patologia , Vasos Linfáticos/patologia , Neoplasias Cutâneas/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Densitometria/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão , Prognóstico , Reprodutibilidade dos Testes , Fatores de Risco , Sensibilidade e EspecificidadeRESUMO
PURPOSE: The aim of this study was to evaluate the accuracy of visual mammographic breast density assessment and determine if training can improve this assessment, to compare the accuracy of qualitative density assessment before and after training with a quantitative assessment tool, and to evaluate agreement between qualitative and quantitative density assessment methods. METHODS: Consecutive screening mammograms performed over a 4-month period were visually assessed by two study breast radiologists (the leads), who selected 200 cases equally distributed among the four BI-RADS density categories. These 200 cases were shown to 20 other breast radiologists (the readers) before and after viewing a training module on visual density assessment. Agreement between reader assessment and lead radiologist assessment was calculated for both reading sessions. Quantitative volumetric density of the 200 mammograms, determined using a commercially available tool, was compared with both sets of reader assessment and with lead radiologist assessment. RESULTS: Compared with lead radiologist assessment, reader accuracy of breast density assessment increased from 65% before training to 72% after training (odds ratio, 1.41; P < .0001). Training specifically improved assignment to BI-RADS categories 1 (P < .0001) and 4 (P < .10). Compared with quantitative assessment, reader accuracy showed statistically nonsignificant improvement with training (odds ratio, 1.1; P = .26). Substantial agreement between qualitative and quantitative breast density assessment was demonstrated (κ = 0.78). CONCLUSIONS: Training may improve the accuracy of mammographic breast density assessment. Substantial agreement between qualitative and quantitative breast density assessment exists.
Assuntos
Neoplasias da Mama/diagnóstico por imagem , Instrução por Computador/estatística & dados numéricos , Densitometria/estatística & dados numéricos , Mamografia/estatística & dados numéricos , Competência Profissional/estatística & dados numéricos , Radiologia/educação , Adulto , Boston , Educação Médica Continuada/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Melhoria de Qualidade/estatística & dados numéricos , Reprodutibilidade dos Testes , Sensibilidade e EspecificidadeRESUMO
Existe discrepancia en la elección de las áreas esqueléticas a evaluar para determinar la prevalencia de osteoporosis (OP). La International Society for Clinical Densitometry sugiere evaluar la columna lumbar (CL) y el fémur proximal (FT), mientras que la International Osteoporosis Foundation (IOF) sugiere medir solo el cuello femoral (CF). La estimación de la prevalencia de OP evaluada solo por CF en mujeres mayores de 50 años de Buenos Aires mostró un sub-diagnóstico del 53%. Objetivo: analizar la discrepancia en la prevalencia de OP, según el área esquelética evaluada por DXA, en los estudios internacionales disponibles. Materiales y Métodos: Se incluyeron los trabajos publicados en la literatura internacional, en idioma inglés que contenían: 1. Medición simultánea de CL y CF. 2. Análisis por décadas a partir de los 50 años y hasta por lo menos la década 70-79. 3. Diagnóstico densitométrico de osteoporosis con el criterio de la OMS: T-score ≤-2.5. Resultados: fueron incluidos doce estudios. La evaluación de estos estudios arrojó un sub-diagnóstico global del 52 % si la prevalencia de OP fuera estimada solo por la densidad mineral ósea (DMO) de CF. Cuando analizamos por décadas la sub-estimación fue del 75% en la 6a década, 58% en la 7a década y del 22% en 8a década, mostrando claramente que el subdiagnóstico disminuye a medida que aumenta la edad y desaparece después de los 80 años. Conclusión: Estos resultados señalan que la prevalencia de OP debe ser determinada a través de la evaluación de la DMO de ambas áreas esqueléticas: CL y CF. (AU)
There is discrepancy in the election of skeletal areas to be measured to determine the prevalence of osteoporosis.The International Society for Clinical Densitometry suggests evaluating the lumbar spine and proximal femur, while the International Osteoporosis Foundation (IOF) suggests measuring only the femoral neck.The estimate of the prevalence of osteoporosis (OP) evaluated only for femoral neck (FN) in women over 50 years of Buenos Aires showed underdiagnosis of 53%. Objective: To analyze the discrepancy on the prevalence of OP, according to the skeletal area evaluated by DXA, in international studies. Material and Methods: We included the works published in the international English literature that contained: 1- Simultaneous measurement of lumbar spine (LS) and femoral neck (FN). 2- Analysis for decades from 50 years and up to at least the decade 70-79. 3- Densitometric diagnosis of osteoporosis according to WHO: T-score ≤-2.5. Results: Twelve studies were included. The evaluation of these studies showed an overall underdiagnosis of 52% if the prevalence of OP was estimated only for bone mineral density of the femoral neck.When we analyzed for decades the underestimation was 75% in the sixth decade, 58% in the seventh and 22% in the eighth decade, clearly showing that the underdiagnosis decreases as age increases and disappears after 80 years. Conclusion: This over-all review of 12 studies indicates that lumbar spine as well as femoral neck should be assessed by DXA to determine the prevalence of osteoporosis. (AU)
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Humanos , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Osteoporose/diagnóstico , Osteoporose/epidemiologia , Densidade Óssea , Densitometria/estatística & dados numéricos , Prevalência , Fêmur , Colo do Fêmur , Região LombossacralRESUMO
Now that New Jersey has become the 14th state in the United States to enact legislation regarding dense breast screening, its patients are eligible to receive screening breast sonography coverage from their insurance carriers. This law is intended to improve breast cancer detection in patients with dense breasts and create awareness of unique issues that come with dense breast tissue, while reinforcing already present efforts to reduce the incidence of and morbidity related to the diagnosis of breast cancer. The aim of this study was to examine data from months preceding the effective date of this legislation in a community hospital setting and compare these data with data from months immediately after, and 6 months after, its enactment to present patient participation data and estimate the legislation's direct financial ramifications. Detractors of this type of legislation worry about overburdening the health care system with an influx of patients. Although there is a lack of present studies confirming this suspicion in other states with dense breast legislation, this study confirms a large increase in patient utilization after enactment, showing a minimum relative increase of 176.90% and a maximum relative increase of 335.56% in patient utilization of screening breast sonography. The investigators further include an estimation of an increased direct cost for insurers of $4,910,899.18 to $9,848,897.96 for a given month.
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Neoplasias da Mama/diagnóstico , Neoplasias da Mama/economia , Cobertura do Seguro/economia , Cobertura do Seguro/legislação & jurisprudência , Mamografia/economia , Mamografia/estatística & dados numéricos , Densitometria/economia , Densitometria/estatística & dados numéricos , Detecção Precoce de Câncer/economia , Detecção Precoce de Câncer/estatística & dados numéricos , Feminino , Custos de Cuidados de Saúde/legislação & jurisprudência , Custos de Cuidados de Saúde/estatística & dados numéricos , Humanos , New Jersey/epidemiologia , Revisão da Utilização de Recursos de SaúdeRESUMO
AIM: This study aims to examine the referral practices for the Royal Children's Hospital (RCH) bone density service over the past 13 years and to demonstrate referral patterns and possible limitations to accessing paediatric bone densitometry. METHODS: All patients attending the RCH Healthy Bones Unit for bone densitometry from 1 July 1999 to 30 June 2012, aged under 18 years of age, were included. Densitometry results were downloaded directly from the Hologic scanner into an Excel document. However, the referring unit and indication for referral were collected manually from either the referral card or the hospital's scanned medical records system. RESULTS: A total of 5767 bone densitometry scans were performed over the study period on 3004 patients. The majority of referrals were made by the Endocrinology department, followed by Adolescent Medicine, Gastroenterology and Neurology. Relatively few referrals were made by general paediatrics. The most common indication for bone density test overall was eating disorders, followed by steroid use, osteogenesis imperfecta and other collagen disorders and inflammatory bowel disease. The lowest lumbar spine z-scores by indication were for cerebral palsy and other causes of immobility. CONCLUSIONS: Multiple childhood diseases predispose to low bone density; however, paediatric bone densitometry is still underutilised and not appropriately supported by subsidies.
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Densidade Óssea , Densitometria/estatística & dados numéricos , Osteoporose/diagnóstico , Encaminhamento e Consulta/estatística & dados numéricos , Adolescente , Austrália , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Osteoporose/epidemiologia , Centros de Atenção TerciáriaRESUMO
PURPOSE: The aim of this study was to explore how women respond to the wording of dense breast tissue notifications, which are increasingly required by state law after mammography. The specific aims were to (1) determine whether perceived lifetime risk for breast cancer and intentions to undergo mammography increase after reviewing a sample notification, (2) explore individual difference variables (eg, minority status, insurance coverage) that may influence intentions for additional ultrasound screening, and (3) assess whether anxiety mediates the relationship between perceived risk and screening intentions. METHODS: A total of 184 women aged >40 years in the United States were recruited from Amazon Mechanical Turk to respond to a dense breast tissue notification as if they had personally received it. RESULTS: After reviewing a notification, women reported greater perceived risk (d = 0.67) and intentions to undergo mammography (d = 0.25) than before. Most women intended to undergo additional ultrasound screening, although to a lesser extent when ultrasound was covered by insurance than when it was not (d = 1.03). All screening intentions were lower in women with ambiguity aversion, a tendency to avoid tests without medical consensus, and those who preferred an active decision-making role. Anxiety mediated the relationship between perceived breast cancer risk and all screening intentions. CONCLUSIONS: Women who receive dense breast tissue notifications may generally increase their breast cancer screening intentions; however, intention strength varies depending on internal (eg, ambiguity aversion) and external (eg, insurance for ultrasound) factors. Although perceived risk increases after notification, it is anxiety that drives women's intentions for future screening.
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Ansiedade/psicologia , Atitude Frente a Saúde , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/psicologia , Consentimento Livre e Esclarecido/psicologia , Participação do Paciente/psicologia , Ansiedade/epidemiologia , Comorbidade , Densitometria/estatística & dados numéricos , Detecção Precoce de Câncer/psicologia , Detecção Precoce de Câncer/estatística & dados numéricos , Feminino , Previsões , Pesquisas sobre Atenção à Saúde , Humanos , Pessoa de Meia-Idade , Participação do Paciente/estatística & dados numéricos , Estados Unidos , Saúde da Mulher/estatística & dados numéricosRESUMO
Current software applications for densitometric analysis, such as ImageJ, QuantityOne (BioRad) and the Intelligent or Advanced Quantifier (Bio Image) do not allow to take the non-linearity of autoradiographic films into account during calibration. As a consequence, quantification of autoradiographs is often regarded as problematic, and phosphorimaging is the preferred alternative. However, the non-linear behaviour of autoradiographs can be described mathematically, so it can be accounted for. Therefore, the 'Densitometric Image Analysis Software' has been developed, which allows to quantify electrophoretic bands in autoradiographs, as well as in gels and phosphorimages, while providing optimized band selection support to the user. Moreover, the program can determine protein-DNA binding constants from Electrophoretic Mobility Shift Assays (EMSAs). For this purpose, the software calculates a chosen stepwise equilibrium constant for each migration lane within the EMSA, and estimates the errors due to non-uniformity of the background noise, smear caused by complex dissociation or denaturation of double-stranded DNA, and technical errors such as pipetting inaccuracies. Thereby, the program helps the user to optimize experimental parameters and to choose the best lanes for estimating an average equilibrium constant. This process can reduce the inaccuracy of equilibrium constants from the usual factor of 2 to about 20%, which is particularly useful when determining position weight matrices and cooperative binding constants to predict genomic binding sites. The MATLAB source code, platform-dependent software and installation instructions are available via the website http://micr.vub.ac.be.
Assuntos
Proteínas Arqueais/química , DNA de Cadeia Simples/química , Proteínas de Ligação a DNA/química , DNA/química , Densitometria/normas , Software , Archaea/química , Sítios de Ligação , Calibragem , Densitometria/estatística & dados numéricos , Ensaio de Desvio de Mobilidade Eletroforética , Cinética , Ligação Proteica , Multimerização ProteicaRESUMO
Contexto: Latinoamérica se encuentra en una transición demográfica y epidemiológica, proceso que representa un aumento de las enfermedades crónico-degenerativas. La osteoporosis y las fracturas por fragilidad se perfilan como una de las causas de carga por enfermedad de mayor impacto en el sector salud. Objetivo: ofrecer un panorama actualizado sobre las tendencias de la epidemiología de la osteoporosis y las fracturas por fragilidad, su impacto económico y los recursos con que actualmente cuenta nuestra región para el diagnóstico, tratamiento oportuno y prevención. Método: panel de expertos. Conclusión: se observó que la información epidemiológica y económica en nuestra región es escasa y fragmentada. Por lo tanto es deseable recolectar datos sobre la calidad de vida en la osteoporosis y fracturas por fragilidad, además de enfatizar la prevención como herramienta para disminuir estas lesiones.
Background. The Latin American region is undergoing a demographic and epidemiological transition, which is leading to an increase in chronic and degenerative diseases. Osteoporosis (OP) and fragility fractures (FF) are emerging as main causes of disease burden with great impact on health institutions. Purpose. This review article provides an updated overview of trends in the epidemiology and economic impact of OP and FF, as well as in diagnosis and available treatments in Latin America, including calcium, vitamin D and prevention programs. Methods. Expert panel. Conclusions. According to this review, there is a lack of epidemiological and economic information in the region. It is desirable to obtain information regarding quality of life in OP and FF as well as to highlight prevention as a tool to reduce FF.
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Feminino , Fraturas Ósseas/epidemiologia , Osteoporose/epidemiologia , Dinâmica Populacional , Densitometria/estatística & dados numéricos , Equipamentos para Diagnóstico/provisão & distribuição , Equipamentos e Provisões/provisão & distribuição , Fraturas do Quadril/epidemiologia , Fraturas da Coluna Vertebral/epidemiologia , Osteoporose/prevenção & controle , Insumos Farmacêuticos , Política de Saúde , Recursos em Saúde/provisão & distribuiçãoRESUMO
OBJECTIVE: Abnormalities in retinal vessels are frequent, but its association with findings in other vascular sites has been scarcely investigated. This study aimed to examine the association between ultrasound-measured carotid intima-media thickness (IMT) and retinal arteriolar and venular diameters, in hypertensive patients. METHODS: In this cross-section study, 173 hypertensive patients had both retinography taken and digitized to determine vessel diameters by an edge-detecting computerized method and carotid ultrasound for semi-automated carotid IMT measurement. The association between the mean common carotid IMT and retinal arterioles and venules diameters was assessed by using multiple linear regression models. RESULTS: The mean (±SD) arteriolar and venular diameters were 102. 8 (±11.6) µm and 128.9 (±15.5) µm, respectively, and common carotid IMT was 0.87 (±0.19) mm. A significant and independent association was demonstrated for carotid IMT and retinal arteriolar caliber (adjusted ß -0.245, p = 0.001) and for carotid IMT and retinal venular caliber (adjusted ß 0.191, p = 0.009) after controlling for age, gender, systolic blood pressure, total cholesterol and HDL (high-density lipoprotein) cholesterol, prior cardiovascular disease, carotid plaque and the retinal fellow vessel. CONCLUSION: In patients with hypertension, carotid intima-media thickness, a marker of macrovascular damage, is significantly and independently associated with microvascular damage, determined by retinal arteriolar and venular calibers.
Assuntos
Artéria Carótida Primitiva/diagnóstico por imagem , Espessura Intima-Media Carotídea , Hipertensão/diagnóstico por imagem , Vasos Retinianos/diagnóstico por imagem , Idoso , Arteríolas/diagnóstico por imagem , Estudos Transversais , Densitometria/métodos , Densitometria/normas , Densitometria/estatística & dados numéricos , Feminino , Humanos , Hipertensão/epidemiologia , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Radiografia , Reprodutibilidade dos Testes , Fatores de Risco , Vênulas/diagnóstico por imagemRESUMO
BACKGROUND/PURPOSE: A number of studies of the internal structure of Japanese woman's skin are now performed by means of optical coherence tomography (OCT) as a technique capable of visualizing the internal structure in a non-invasive manner. METHODS: We measured the epidermal and corneous thicknesses at 11 sites in 116 healthy female volunteers aged from teens to sixties to examine possible positional differences and aging changes. RESULTS: The epidermal thickness determined at the 11 sites averaged 68.6 ± 23.0 µm (mean ± SD) and the corneous thickness averaged 14.1 ± 1.80 µm, the values of which were thinner than those presented in conventional textbooks on the subject. It was also revealed that, with advancing age, the epidermal thickness becomes less at some sites but showed no change at other sites, and the comparison between age groups suggested that a thinning trend is generally observed up to the thirties with no continuous changes thereafter. CONCLUSION: Aging changes in the epidermis appeared to occur in the granular to basal layers, and the results obtained by OCT, which can viably determine the skin thickness, seemed to be very important for understanding the skin more accurately.
Assuntos
Densitometria/estatística & dados numéricos , Dermoscopia/estatística & dados numéricos , Células Epidérmicas , Epiderme/fisiologia , Envelhecimento da Pele/fisiologia , Tomografia de Coerência Óptica/estatística & dados numéricos , Adolescente , Adulto , Distribuição por Idade , Idoso , Feminino , Voluntários Saudáveis , Humanos , Japão/epidemiologia , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Adulto JovemRESUMO
OBJETIVO: Analisar a acurácia da detecção de calcificação da aorta abdominal por meio de densitometria em comparação com a radiografia lateral de coluna. MATERIAIS E MÉTODOS: Casuística de 80 indivíduos, sendo 50 com diagnóstico de calcificação de aorta abdominal e 30 sem calcificação. Densitometria realizada uma única vez em cada participante, com o paciente em decúbito lateral direito. RESULTADOS: Em relação à idade e ao índice de massa corporal tivemos grupos semelhantes, com idade média de 74,56 ± 10,55 anos e 68,40 ± 10,80 anos e índice de massa corporal de 28,94 ± 6,06 kg/m2 e 26,84 ± 4,11 kg/m2 nos grupos com calcificação de aorta abdominal e sem calcificação de aorta abdominal, respectivamente. A comparação estatística da densitometria com a radiografia mostra que são semelhantes na detecção da calcificação de aorta abdominal, com valores de 100% na especificidade e valor preditivo positivo; sensibilidade de 94%, valor preditivo negativo de 90,9% e acurácia de 96,3%. Equivalência qualitativa no diagnóstico foi demonstrada pelo índice de correlação de kappa de 0,922. CONCLUSÃO: Os resultados da radiografia e da densitometria são estatisticamente equivalentes, o que permite sugerir a investigação de calcificação de aorta abdominal pela densitometria para a detecção de calcificação da aorta abdominal.
OBJECTIVE: To evaluate the accuracy in the detection of abdominal aortic calcification by densitometry as compared with lateral spine radiography. MATERIALS AND METHODS: Study comprising 80 individuals, 50 of them with abdominal aortic calcification and 30 without calcification. Densitometry was performed once for each participant, with the patient in right lateral decubitus position. RESULTS: Both groups were similar in terms of age range and body mass index - mean age of 74.56 ± 10.55 years and 68.40 ± 10.80 years and mean body mass index of 28.94 ± 6.06 kg/m2, and 26.84 ± 4.11 kg/m2, respectively for the individuals with abdominal aortic calcification and for the individuals without calcification. A statistical comparison between densitometry and radiography demonstrates similar performances of the two methods in the detection of abdominal aortic calcification, with 100% specificity and positive predictive value, 94% sensitivity, 90.9% negative predictive value, and 96.3% accuracy. Qualitative equivalence in diagnosis was demonstrated by kappa correlation index of 0.922. CONCLUSION: The results obtained by radiography and densitometry were statistically equivalent, which endorses the indication of densitometry for investigating abdominal aortic calcification.
Assuntos
Humanos , Masculino , Feminino , Aorta Abdominal , Arteriosclerose/diagnóstico , Calcinose , Densitometria/estatística & dados numéricos , Radiografia , Coluna Vertebral , DensitometriaRESUMO
Automated breast ultrasound (ABUS)was performed in 3418 asymptomatic women with mammographically dense breasts. The addition of ABUS to mammography in women with greater than 50% breast density resulted in the detection of 12.3 per 1,000 breast cancers, compared to 4.6 per 1,000 by mammography alone. The mean tumor size was 14.3 mm and overall attributable risk of breast cancer was 19.92 (95% confidence level, 16.75 - 23.61) in our screened population. These preliminary results may justify the cost-benefit of implementing the judicious us of ABUS in conjunction with mammography in the dense breast screening population.
Assuntos
Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/epidemiologia , Densitometria/estatística & dados numéricos , Interpretação de Imagem Assistida por Computador/métodos , Imageamento Tridimensional/métodos , Reconhecimento Automatizado de Padrão/métodos , Ultrassonografia Mamária/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Inteligência Artificial , Feminino , Florida/epidemiologia , Humanos , Aumento da Imagem/métodos , Pessoa de Meia-Idade , Prevalência , Reprodutibilidade dos Testes , Medição de Risco , Sensibilidade e Especificidade , Adulto JovemRESUMO
UNLABELLED: This survey investigated osteoporosis management practices in the Asia-Pacific region. While access to anti-osteoporotic medication is reasonable, screening for secondary contributors is performed insufficiently. FRAX® is well-known, but not used by many physicians. High costs of medication and unawareness about the disease are the biggest barriers to osteoporosis care. PURPOSE: Osteoporosis is an increasing burden amongst countries of the Asia-Pacific. The fracture risk assessment tool FRAX® has recently been introduced in some Asian countries. This study aimed to identify attitudes about osteoporosis management in general and the utilization of FRAX® in particular amongst physicians in the Asia-Pacific region. METHODS: A 26-item questionnaire was distributed to the participants of the first Asian regional osteoporosis meeting of the IOF in 2010. In total, 247 valid questionnaires representing 17 countries from the Asia-Pacific region were analyzed. RESULTS: Most physicians make use of bone densitometry devices (94 %) and have access to at least one type of anti-osteoporotic medication (100 %). Central dual-energy X-ray absorptiometry was the most accessible device (87 %). Oral bisphosphonates were the only medication that was available to health care professionals in all surveyed Asia-Pacific countries. Seventy-six percent were aware of FRAX®; however, among these only 62 % used it. The main reason for not using FRAX® was the lack of country-specific models (46 %). Screening for secondary osteoporosis was performed by 36 % of the respondents. The high costs of medication and lack of awareness amongst physicians and patients about the disease were perceived as the most important barriers to osteoporosis care. CONCLUSION: More FRAX® models should be established and implemented into the local guidelines. The necessity of screening for secondary contributors to osteoporosis should be emphasized, as easily treatable causes might be identified. To further improve osteoporosis diagnosis and treatment, the awareness of osteoporosis among doctors as well as patients needs to be raised.
Assuntos
Conservadores da Densidade Óssea/uso terapêutico , Densitometria/estatística & dados numéricos , Pesquisas sobre Atenção à Saúde , Osteoporose , Padrões de Prática Médica/estatística & dados numéricos , Adulto , Idoso , Ásia , Feminino , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Humanos , Masculino , Programas de Rastreamento/estatística & dados numéricos , Pessoa de Meia-Idade , Osteoporose/diagnóstico por imagem , Osteoporose/tratamento farmacológico , Osteoporose/epidemiologia , Ilhas do Pacífico , Radiografia , Fatores de Risco , Inquéritos e Questionários , Adulto JovemRESUMO
INTRODUCTION: With the development of country-specific FRAX® tools to estimate fracture probability, guidance is required on the fracture probability at which treatment can be recommended. OBJECTIVES: The aim of the present study was to determine FRAX-based intervention thresholds in men and women from Turkey and determine their population impact. PATIENTS AND METHODS: Intervention thresholds for treatment and assessment thresholds for measuring BMD were devised using the strategy adopted by the National Osteoporosis Guideline Group of the UK but applied to the fracture probabilities in Turkey. The number of men and women potentially eligible for treatment was determined from the distribution of FRAX-based probabilities of a major fracture (Turkish model, version 3.6) in a representative sample of 26,394 men and women aged 50 years or more. RESULTS: Intervention thresholds, set at the probability equivalents of a woman with a prior fragility fracture rose with age from 7.0 % at the age of 50 years to 31 % at the age of 90 years. Approximately 8.6 % of the female Turkish population aged 50 years or more had a prior fragility fracture and would be eligible for treatment. A further 13.6 % without a prior fracture would be eligible for treatment. In contrast, the number of men aged 50 years or more eligible for treatment was 3.1 %. CONCLUSIONS: FRAX-based guidelines can be developed and are expected to avoid unnecessary treatment of individuals at low fracture risk and direct treatments to those at high risk. The adoption of FRAX-based intervention thresholds will demand a reappraisal of the criteria for reimbursement of interventions and health economic assessment.