Effects of dapagliflozin compared with glimepiride on body composition in Asian patients with type 2 diabetes inadequately controlled with metformin: The BEYOND study.

AIMS: To evaluate the effect of dapagliflozin on body composition such as total body fat (BF) mass, abdominal visceral adipose tissue (VAT), and subcutaneous adipose tissue (SAT) areas compared with glimepiride in Korean patients with type 2 diabetes. MATERIALS AND METHODS: This was a 52-week, multicentre, randomized, parallel-group, open-label, Phase IV (NCT02564926) study. Patients with inadequate glycaemic control (glycated haemoglobin ≥7.0% and <10.0%) on metformin monotherapy (≥1000 mg/day) were randomized 1:1 to receive dapagliflozin 10 mg/day or glimepiride 1-2 mg/day for 12 months as an add-on to metformin. Baseline and end of study body composition evaluations included dual-energy X-ray absorptiometry and abdominal computed tomography scans. RESULTS: Of 124 enrolled patients from 14 centres, 121 received study treatment (dapagliflozin: 60; glimepiride: 61) and 106 (85.5%) completed the study. Over 52 weeks, the dapagliflozin group showed the following differences versus the glimepiride group: -2.59 kg BF mass, -1.94% BF%, -17.55 cm2 VAT area, -18.39 cm2 SAT area, -0.46% glycated haemoglobin, -18.25 mg/dl fasting blood glucose, -3.7 kg weight, -2.21 cm waist circumference, -1.37 kg/m2 body mass index, -6.81 mmHg systolic blood pressure and +657.71 ng/ml in adiponectin; all were statistically significant. Both groups had similar incidences of adverse events; however, hypoglycaemic events were mainly (12 of 15) reported in the glimepiride group. CONCLUSION: Dapagliflozin reduced total BF mass, abdominal VAT and SAT areas, and showed better glycaemic control than glimepiride. Being safe and well-tolerated, dapagliflozin appears to be a more favourable alternative to sulphonylureas as add-on therapy after metformin monotherapy failure in Korean patients with type 2 diabetes.

PET/CT in benign and malignant musculoskeletal tumors and tumor-like conditions.

This article briefly reviews malignant bone tumors, diffuse marrow infiltrating diseases, and other benign bone diseases with fluorodeoxyglucose (FDG) uptake on positron emission tomography/computed tomography (PET/CT) that should be differentiated from malignant tumors. Clinical use of FDG PET/CT in (1) primary malignant bone tumors including osteosarcoma, malignant fibrous histiocytoma, and primary bone lymphoma, (2) hematopoietic tumors with bone marrow involvement, such as plasmacytoma, multiple myeloma, lymphoma and leukemia, and (3) benign tumors and tumor-like lesions including hemangioma, neurogenic tumor, fibrous dysplasia, and nodular fasciitis are presented, with an emphasis on various imaging findings on FDG PET/CT. Benign tumors and tumor-like conditions are often incidentally detected on FDG PET/CT in serial follow-up studies of cancer patients and should be differentiated from metastasis.

Musculoskeletal applications of PET/MR.

To overcome each limitation of morphological and functional imaging procedures, hybrid imaging systems have been developed and introduced into clinical routine. It has been increasingly discussed whether magnetic resonance imaging (MRI) might be an appropriate alternative for computed tomography (CT). The major advantage of positron emission tomography (PET)/MR consists of combined metabolic and anatomical information in a single imaging session that provides superior soft tissue characterization of MRI over CT. Until now, fusion image has been effectively utilized in oncologic indications. Because biopsy cannot be replaced by images for definite diagnosis, fusion imaging may be more efficient for staging based on nodal spread or metastases rather than the diagnosis of primary tumor, and it can be proficient for treatment response or postoperative assessment. This review describes mainly oncologic and nontumorous conditions among the musculoskeletal applications of PET/MR.

The prevalence and risk factors of vertebral fractures in Korean patients with type 2 diabetes.

Although type 2 diabetes mellitus (T2DM) has been associated with an increase in fracture risk, there is no data regarding the prevalence of vertebral fractures or its risk factors for patients with T2DM in Korea. In this cross-sectional study, we recruited postmenopausal women with T2DM from 24 tertiary hospital diabetes clinics in Korea. Prevalent vertebral fractures were identified on lateral spinal radiographs of thoracolumbar vertebrae by vertebral morphometry. Demographic and biochemical characteristics related to diabetes were obtained, and bone mineral density of the lumbar spine and femoral neck, which was available in 752 (33.6 %) and 675 (30.1 %) patients, respectively, was also analyzed. Of the 2239 subjects recruited (mean age 63.9 years), a total of 970 (43.3 %) subjects had vertebral fractures. In the bivariate analysis, history of fragility fractures after 50 years of age, microalbuminuria, presence of cardiovascular disease (myocardial infarction, angina, cerebrovascular complications of cardiovascular disease), and presence of osteoporosis at the total hip were significantly associated with the presence of vertebral fractures, after adjusting for age. In the multivariate analysis, the presence of cardiovascular diseases in addition to advancing age and history of fragility fractures was significantly associated with increased odds of vertebral fractures. Vertebral fractures were highly prevalent in postmenopausal women with T2DM in this study conducted in Korea, and the presence of cardiovascular disease, in addition to older age and history of fragility fractures, was significantly associated with the presence of vertebral fractures.

Artificial intelligence for predicting five-year survival in stage IV metastatic breast cancer patients: A focus on sarcopenia and other host factors.

We developed an artificial intelligence (AI) model that can predict five-year survival in patients with stage IV metastatic breast cancer, mainly based on host factors and sarcopenia. From a prospectively built breast cancer registry, a total of 210 metastatic breast cancer patients were selected in a consecutive manner using inclusion/exclusion criteria. The patients' data were divided into two categories: a group that survived for more than 5 years and a group that did not survive for 5 years. For the AI model input, 11 features were considered, including age, body mass index, skeletal muscle area (SMA), height-relative SMA (H-SMI), height square-relative SMA (H2-SMA), weight-relative SMA (W-SMA), muscle mass, anticancer chemotherapy, radiation therapy, and comorbid diseases such as hypertension and mellitus. For the feature importance analysis, we compared classifiers using six different machine learning algorithms and found that extreme gradient boosting (XGBoost) provided the best accuracy. Subsequently, we performed the feature importance analysis based on XGBoost and proposed a 4-layer deep neural network, which considered the top 10 ranked features. Our proposed 4-layer deep neural network provided high sensitivity (75.00%), specificity (78.94%), accuracy (78.57%), balanced accuracy (76.97%), and an area under receiver operating characteristics of 0.90. We generated a web application for anyone to easily access and use this AI model to predict five-year survival. We expect this web application to be helpful for patients to understand the importance of host factors and sarcopenia and achieve survival gain.

Consensus survey on pre-procedural safety practices in radiological examinations: a multicenter study in seven Asian regions.

OBJECTIVE: To understand the status of pre-procedural safety practices in radiological examinations at radiology residency training institutions in various Asian regions. METHODS: A questionnaire based on the Joint Commission International Accreditation Standards was electronically sent to 3 institutions each in 10 geographical regions across 9 Asian countries. Questions addressing 45 practices were divided into 3 categories. A five-tier scale with numerical scores was used to evaluate safety practices in each institution. Responses obtained from three institutions in the United States were used to validate the execution rate of each surveyed safety practice. RESULTS: The institutional response rate was 70.0% (7 Asian regions, 21 institutions). 44 practices (all those surveyed except for the application of wrist tags for identifying patients with fall risks) were validated using the US participants. Overall, the Asian participants reached a consensus on 89% of the safety practices. Comparatively, most Asian participants did not routinely perform three pre-procedural practices in the examination appropriateness topic. CONCLUSION: Based on the responses from 21 participating Asian institutions, most routinely perform standard practices during radiological examinations except when it comes to examination appropriateness. This study can provide direction for safety policymakers scrutinizing and improving regional standards of care. ADVANCES IN KNOWLEDGE: This is the first multicenter survey study to elucidate pre-procedural safety practices in radiological examinations in seven Asian regions.

Nonpalpable supraclavicular lymph nodes in lung cancer patients: preoperative characterization with 18F-FDG PET/CT.

OBJECTIVE: Our purpose was to evaluate the usefulness of integrated 18F-FDG PET/CT in the detection and characterization of nonpalpable supraclavicular lymph node metastasis in patients with the initial diagnosis of lung cancer. SUBJECTS AND METHODS: This study was conducted from May 2005 to May 2006 and included 32 consecutively registered lung cancer patients in whom supraclavicular lymph nodes were not palpable but were identified on contrast-enhanced CT or exhibited increased FDG uptake on integrated PET/CT. Three patients had bilateral nodes, for a total of 35 nodes in the 32 patients. Results of cytologic analysis of a specimen obtained with sonographically guided fine-needle aspiration (n = 27), normal initial and follow-up sonographic findings (n = 3), and no change in the size of supraclavicular lymph nodes on follow-up sonography (n = 2) were the reference standards. The presence of supraclavicular lymph node metastasis was determined with integrated PET/CT (uptake greater than that of surrounding tissue) and contrast-enhanced CT (node short-axis diameter of 5 mm or more). The diagnostic efficacies of these methods in the detection of supraclavicular lymph node metastasis were compared. RESULTS: Supraclavicular lymph node metastasis was diagnosed cytologically in 12 (34%) of 35 lesions. The diagnostic accuracies of integrated PET/CT and contrast-enhanced CT in the detection of supraclavicular lymph node metastasis were 71% and 66%, respectively; the difference was not statistically significant. Although the difference was not statistically significant, the sensitivity (92%) and negative predictive value (93%) of integrated PET/CT were higher than those of contrast-enhanced CT. CONCLUSION: Because of its high sensitivity and negative predictive value, integrated PET/CT is useful in the detection and characterization of nonpalpable supraclavicular lymph nodes in lung cancer patients.

Recovery from welding-fume-exposure-induced MRI T1 signal intensities after cessation of welding-fume exposure in brains of cynomolgus monkeys.

The shortening of the MRI T1 relaxation time, indicative of a high signal intensity in a T1-weighted MRI, is known as a useful biomarker for Mn exposure after short-term welding-fume exposure. A previous monkey experimental study found that the T1 relaxation times decreased time-dependently after exposure, and a visually detectable high signal intensity appeared after 150 days of exposure. The nadir for the shortening of the T1 relaxation time was also previously found to correspond well with the blood Mn concentration in welders, suggesting a correlation between a prolonged high blood Mn concentration and shortened T1 relaxation time. Accordingly, to clarify the clearance of the brain Mn concentration after the cessation of welding-fume exposure, cynomolgus monkeys were assigned to 3 groups-unexposed, low dose (31 mg/m(3) total suspended particulate (TSP), 0.9 mg Mn/m(3)), and high dose (62 mg/m(3) TSP, 1.95 mg Mn/m(3))-and exposed to manual metal-arc stainless steel (MMA-SS) welding fumes for 2 h per day for 8 mo in an inhalation chamber system equipped with an automatic fume generator. After reaching the peak MRI T1 signal intensity (shortest T1 relaxation time), the monkeys were allowed to recover by ceasing the welding-fume exposure. Within 2 mo, the MRI T1 signal intensities for the exposed monkeys returned to nearly the same level as those for the unexposed monkeys, indicating the potential for recovery from a high MRI T1 signal intensity induced by welding-fume exposure, even after prolonged exposure. Clearance of the Mn tissue concentration was also demonstrated in the globus pallidus, plus other tissues from the brain, liver, spleen, and blood. In contrast, there was no clearance of the lung concentrations of Mn, indicating that a soluble form of Mn was transported to the blood and brain. Therefore, the solubility of Mn in welding fumes would appear to be an important determinant as regards the retention of blood Mn levels and brain tissue Mn concentrations in welders.

Bone mineral density assessment for research purpose using dual energy X-ray absorptiometry.

Dual energy X-ray absorptiometry (DXA) has become the most common method for measuring bone mineral density (BMD) of small animals in metabolic bone disease research, and errors should be minimized in all procedures involved in research studies in order to increase the accuracy of the study results. DXA is simpler and rapid compared to micro-computed tomography for quantitative analysis of change in trabecular bone of test subject. In human research, measuring BMD is widely used; postoperative evaluation on orthopedic surgery, evaluation of osteoporosis medication in menopause and many other areas of study. For the study, the inspector should be trained by the equipment manufacturer regarding the utilization and analysis of the equipment and regular phantom testing should be conducted to ensure the stability of the equipment, and precision tests should be conducted to analyze the positioning and data analysis. They should also be familiar with the clinical trials and conduct studies based on the approval of the Institutional Review Board. In the absolute BMD measurement of the human body, it is necessary to apply and compare the position and condition, rotation degree, region of interest, and area of the scan in the follow-up test. In the case of small animals, animal selection, measurement and equipment should be modeled to match the research. Therefore, we would like to provide information for researchers to minimize the errors, effective data management and accurate data presentation. This article reviews the process of DXA measurement for research purpose including plan for DXA examination, BMD measurement in a human body study and small animal studies.

Changes in blood manganese concentration and MRI t1 relaxation time during 180 days of stainless steel welding-fume exposure in cynomolgus monkeys.

Welders are at risk of being exposed to high concentrations of welding fumes and developing pneumoconiosis or other welding-fume exposure-related diseases. Among such diseases, manganism resulting from welding-fume exposure remains a controversial issue, as although the movement of manganese into specific brain regions has been established, the similar movement of manganese presented with other metals, such as welding fumes, has not been clearly demonstrated as being similar to that of manganese alone. Meanwhile, the competition between Mn and iron for iron transporters, such as transferrin and DMT-1, to the brain has also been implicated in the welding-fume exposure. Thus, the increased signal intensities in the basal ganglia, including the globus pallidus and subcortical frontal white matter, based on T1-weighted magnetic resonances in welders, require further examination as regards the correspondence with an increased manganese concentration. Accordingly, to investigate the movement of manganese after welding-fume exposure, 6 cynomolgus monkeys were acclimated for 1 mo and assigned to 3 dose groups: unexposed, low dose of (total suspended particulate [TSP] 31 mg/m3, 0.9 mg/m3 of Mn), and high dose of total suspended particulate (62 mg/m3 TSP, 1.95 mg/m3 of Mn). The primates were exposed to manual metal-arc stainless steel (MMA-SS) welding fumes for 2 h/day in an inhalation chamber system equipped with an automatic fume generator for 6 mo. Magnetic resonance imaging (MRI) studies of the basal ganglia were conducted before the initiation of exposure and thereafter every month. During the exposure, the blood chemistry was monitored every 2 wk and the concentrations of metal components in the blood were measured every 2 wk and compared with ambient manganese concentrations. The manganese concentrations in the blood did not show any significant increase until after 2 mo of exposure, and then reached a plateau after 90 days of exposure, showing that an exposure period of at least 60 days was required to build up the blood Mn concentration. Furthermore, as the blood Mn concentration continued to build, a continued decrease in the MRI T1 relaxation time in the basal ganglia was also detected. These data suggested that prolonged inhalation of welding fumes induces a high MRI T1 signal intensity with an elevation of the blood manganese level. The presence of a certain amount of iron or other metals, such as Cr and Ni, in the inhaled welding fumes via inhalation was not found to have a significant effect on the uptake of Mn into the brain or the induction of a high MRI T1 signal intensity.

Comparison of high MRI T1 signals with manganese concentration in brains of cynomolgus monkeys after 8 months of stainless steel welding-fume exposure.

Several pharmacokinetic studies on inhalation exposure to manganese (Mn) have already demonstrated that Mn readily accumulates in the olfactory and brain regions. However, a shortening of the magnetic resonance imaging (MRI) T1 relaxation time or high T1 signal intensity in specific sites of the brain, including the globus pallidus and subcortical frontal white matter, as indicative of tissue manganese accumulation has not yet been clearly established for certain durations of known doses of welding-fume exposure in experimental animals. Accordingly, to investigate the movement of manganese after welding-fume exposure, six cynomolgus monkeys were acclimated and assigned to three dose groups: unexposed, low dose (31 mg/m(3) total suspended particulate [TSP], 0.9 mg/m(3) of Mn), and high dose (62 mg/m(3) TSP, 1.95 mg/m(3) of Mn) of total suspended particulate. The primates were exposed to manual metal arc stainless steel (MMA-SS) welding fumes for 2 h per day in an inhalation chamber system equipped with an automatic fume generator. Magnetic resonance imaging (MRI) studies were conducted before the initiation of exposure and thereafter every month. The tissue Mn concentrations were then measured after a plateau was reached regarding the shortening of the MRI T1 relaxation time. A dose-dependent increase in the Mn concentration was found in the lungs, while noticeable increases in the Mn concentrations were found in certain tissues, such as the liver, kidneys, and testes. Slight increases in the Mn concentrations were found in the caudate, putamen, frontal lobe, and substantia nigra, while a dose-dependent noticeable increase was only found in the globus pallidus. Therefore, the present results indicated that a shortening of the MRI T1 relaxation time corresponded well with the Mn concentration in the globus pallidus after prolonged welding-fume exposure.

Synovial sarcoma of the head and neck: a case of predominantly cystic mass.

We report a case of predominantly cystic synovial sarcoma partly adherent to the hyoid bone in the submental area. The mass demonstrated posterior acoustic enhancement at sonography and a complex cystic mass with mural nodules and solid septa at CT.

Genistein may prevent cadmium-induced bone loss in ovariectomized rats.

This study compared the ability of genistein, a soy isoflavone, with that of 17 beta-estradiol to prevent bone loss in cadmium (Cd)-exposed ovariectomized (OVX) rats during growth. Female Wistar rats (4 weeks old) were either sham-operated (SH; n = 9/group) or OVX and placed on experimental diets (n = 9/group): OVX; OVX rats fed 50 ppm of CdCl(2) (OVX-Cd); OVX fed 50 ppm of CdCl(2) and 10 microg/kg of body weight genistein (OVX-Cd-G); and OVX fed 50 ppm of CdCl(2) and 10 microg/kg of body weight estrogen (OVX-Cd-E). All rats were given free access to AIN-76 modified diet and drinking water, with or without Cd, for 8 weeks. The OVX groups gained more body weight than the SH group. Femoral weight was increased by feeding genistein and estradiol, whereas femoral length among groups was not significantly different. Femoral Cd content was significantly higher in the OVX-Cd group than in the other groups. Both serum osteocalcin and calcium (Ca) concentrations, as well as urinary Ca, were significantly higher in the OVX-Cd group than in the other groups. Urinary excretion of Cd was significantly increased in Cd-OVX-G rats, and fecal Cd excretion was increased by feeding both genistein and estradiol. Femoral histomorpological changes in proliferative cartilage and hypertrophic cells in the OVX-Cd group showed that both cell types were decreased by feeding Cd, and irregular arrangements were observed in proliferative cells. However, both cells types exhibited normal distribution in OVX-Cd-G and OVX-Cd-E groups. These findings suggest that Cd/OVXinduced osteopenia or osteoporosis probably results from an increase in bone turnover. Genistein may be involved in stimulating Cd excretion and inhibiting Ca excretion from bone.

Quantitative assessment of bone marrow cellularity by magnetic resonance imaging in workers with long-term exposure to solvents.

This study was conducted to develop a noninvasive method of bone marrow cellularity evaluation in solvent-exposed painters. Six painters with hypocellular marrow and 132 referents were examined using magnetic resonance imaging (MRI). Full examination of the peripheral blood and bone marrow biopsy was done on each patient. Signal indices were calculated from the signal intensities measured at the vertebral bodies from T12 to S1 and on the paraspinal muscles on both the T1- and the T2-weighted image (T1WI and T2WI). Bone marrow cellularities of the painters were between 20.3% and 33.6%. Signal indices at T1WI were greater in the hypocellular marrow cases compared to those of the referents (p<0.05, p<0.01) and were significantly higher in older women compared with men (p<0.05). After adjusting for age and gender, the signal index of cases at S1 of T1WI was higher than that of the referents by 0.364. Five of the six cases had signal index at S1 of T1WI higher than the mean +1 standard deviation for the same age group and gender. MRI signal indices can be used as a useful indicator of bone marrow cellularity in a high-risk population after adequate adjustment.

Quality Control of DXA System and Precision Test of Radio-technologists.

The image quality management of bone mineral density (BMD) is the responsibility and duty of radio-technologists who carry out examinations. However, inaccurate conclusions due to the lack of understanding and ignorance regarding the methodology of image quality management can be a fatal error to patients. The accuracy and precision of BMD measurement must be maintained at the highest level so that actual biological changes can be detected with even slight changes in BMD. Accuracy and precision should be continuously preserved for image quality of machines. Those factors will contribute to ensure the reliability of BMD examination. The enforcement of proper quality control of radiologists performing BMD inspections which brings about the durability extensions of equipment and accurate results of calculations will help the assurance of reliable inspections.

Assessment of exposure to heavy metals and health risks among residents near abandoned metal mines in Goseong, Korea.

Metal contamination from mining activity is of great concern because of potential health risks to the local inhabitants. In the present study, we investigated the levels of Cd, Cu, As, Pb, and Zn in environmental samples and foodstuffs grown in the vicinity of the mines in Goseong, Korea, and evaluated potential health risks among local residents. Soils near the mines exceeded the soil quality standard values of Cu, As, and Zn contamination. The concentrations of Cd, Cu, Pb, and Zn in crop samples collected from the study area were significantly higher than those of the reference area. Some rice samples collected from the study area exceeded the maximum permissible level of 0.2 mg Cd/kg. The intake of rice was identified as a major contributor (≥75%) to the estimated daily intake among the residents. The average estimated daily intakes of metals were, however, below the provisional tolerable daily intake.

Imaging of synovitis in osteoarthritis: current status and outlook.

OBJECTIVES: This review article provides an overview of the current state of imaging of synovitis in osteoarthritis (OA), looking at recent advances and controversies and focusing particularly on the application of ultrasound and magnetic resonance imaging (MRI) in the assessment of the hand and knee joint. Computed tomography and nuclear medicine including positron emission tomography are also briefly discussed. METHODS: PubMed and MEDLINE search for articles published up to 2010, using the keywords synovitis, osteoarthritis, rheumatoid arthritis, pathogenesis, imaging, radiography, computed tomography, nuclear medicine, magnetic resonance imaging, ultrasound, and pain. RESULTS: Synovitis is defined as inflammation of the synovial membrane. Modern imaging techniques have demonstrated that synovial pathology is common in the early and late stages of OA and may be associated with pain. The current standard for OA imaging in clinical practice is conventional radiography but it does not allow direct visualization of synovitis. MRI without contrast administration, although widely used in clinical studies, cannot assess synovitis directly. Contrast-enhanced MRI and ultrasound, however, both allow direct visualization of synovitis including early inflammatory changes. They are regularly used to image synovitis in rheumatoid arthritis and increasingly in OA. CONCLUSIONS: Synovitis is increasingly recognized as an important feature of the pathophysiology of OA, although there is conflicting evidence with respect to its association with disease severity and clinical parameters. Contrast-enhanced MRI and ultrasound are the most important methods for assessing synovitis associated with OA.

Small Cell Carcinoma of the Gallbladder: (18)F-FDG PET/CT Imaging Features-A Case Report.

The diagnostic role of (18)F-fluorodeoxyglucose ((18)F-FDG) positron emission tomography (PET)/computed tomography (CT) for gallbladder small cell carcinoma has not been reported. A knowledge of the imaging characteristic features of this malignancy can be useful. Here we report a rare case of a patient who had various diagnostic imaging modalities, including (18)F-FDG PET/CT.

Investigation on health effects of an abandoned metal mine.

To investigate potential health risks associated with exposure to metals from an abandoned metal mine, the authors studied people living near an abandoned mine (n=102) and control groups (n=149). Levels of cadmium, copper, arsenic, lead, and zinc were measured in the air, soil, drinking water, and agricultural products. To assess individual exposure, biomarkers of each metal in blood and urine were measured. beta2-microglobulin, alpha1-microglobulin, and N-acetyl-beta-glucosaminidase and bone mineral density were measured. Surface soil in the study area showed 2-10 times higher levels of metals compared to that of the control area. Metal concentrations in the groundwater and air did not show any notable differences between groups. Mean concentrations of cadmium and copper in rice and barley from the study area were significantly higher than those of the control area (p<0.05). Geometric means of blood and urine cadmium in the study area were 2.9 microg/L and 1.5 microg/g Cr, respectively, significantly higher than those in the control area (p<0.05). There were no differences in the levels of urinary markers of early kidney dysfunction and bone mineral density. The authors conclude that the residents near the abandoned mine were exposed to higher levels of metals through various routes.