Study of secondary dentine deposition in central incisors as an age estimation method for adults.

This work aimed to assess the pulp/tooth area ratio's utility in the upper central incisors using orthopantomograms. A convenience sample of 801 adult patient orthopantomograms was studied. Image J® software was used to measure the pulp/tooth area ratio, and a regression model was developed. Our results conclude that the methodology assessing upper incisors' pulp/tooth area ratio using orthopantomograms can lead to age overestimation and statistically significant differences between chronological and estimated age. For those over 50, no correlation between pulp/tooth area ratio and chronological age was found, suggesting that this may be the upper limit of this technique in this population. This methodology may not be suitable for age estimation, particularly in older adults.

The challenge of estimating kelp production in a turbid marine environment.

Coastal kelp forests produce substantial marine carbon due to high annual net primary production (NPP) rates, but upscaling of NPP estimates over time and space remains difficult. We investigated the impact of variable underwater photosynthetically active radiation (PAR) and photosynthetic parameters on photosynthetic oxygen production of Laminaria hyperborea, the dominant NE-Atlantic kelp species, throughout summer 2014. Collection depth of kelp had no effect on chlorophyll a content, pointing to a high photoacclimation potential of L. hyperborea towards incident light. However, chlorophyll a and photosynthesis versus irradiance parameters differed significantly along the blade gradient when normalized to fresh mass, potentially introducing large uncertainties in NPP upscaling to whole thalli. Therefore, we recommend a normalization to kelp tissue area, which is stable over the blade gradient. Continuous PAR measurements revealed a highly variable underwater light climate at our study site (Helgoland, North Sea) in summer 2014, reflected by PAR attenuation coefficients (Kd ) between 0.28 and 0.87 m-1 . Our data highlight the importance of continuous underwater light measurements or representative average values using a weighted Kd to account for large PAR variability in NPP calculations. Strong winds in August increased turbidity, resulting in a negative carbon balance at depths >3-4 m over several weeks, considerably impacting kelp productivity. Estimated daily summer NPP over all four depths was 1.48 ± 0.97 g C · m-2 seafloor · d-1 for the Helgolandic kelp forest, which is in the range of other kelp forests along European coastlines.

Sex and race/ethnicity specific reference predictive equations for abdominal adiposity indices using anthropometry in US adults.

BACKGROUND AND AIMS: Abdominal adiposity indices have stronger associations with cardiometabolic risk factors compared to anthropometric measures but are rarely used in large scale studies due to the cost and efficiency. The aim of this study is to establish sex and race/ethnicity specific reference equations using anthropometric measures. METHODS AND RESULTS: A secondary data analysis (n = 6589) of healthy adults was conducted using data from National Health and Nutrition Examination Survey 2011-2018. Variables included in the analyses were anthropometric measures (height; weight; waist circumference, WC) and abdominal adiposity indices (android percent fat; android to gynoid ratio, A/G ratio; visceral adipose tissue area, VATA; visceral to subcutaneous adipose area ratio, VSR). Multivariable prediction models were developed using quantile regression. Bland-Altman was used for external validation of prediction models. Reference equations to estimate android percent fat, A/G ratio, VATA and VSR from anthropometric measurements were developed using a randomly selected subsample of 4613. These reference equations for four abdominal adiposity indices were then cross-validated in the remaining subsample of 1976. The measured and predicted android percent fat, A/G ratio, VATA and VSR were not statistically different (p > 0.05) except for the A/G ratio in Asian males and VSR in White females. The results of Bland-Altman further revealed that ≥93% of predicted abdominal adiposity indices fell within the limits of agreement (±1.96 standard deviation). CONCLUSION: The sex and race/ethnicity specific reference equations for abdominal adiposity indices established using anthropometrics in the present study have strong predictive ability in US healthy adults.

Correlation between surgical timing and postoperative ocular motility in orbital blowout fractures.

PURPOSE: The study reports the correlation between surgical timing and postoperative ocular motility in orbital blowout fractures. METHODS: This was a retrospective study of 191 patients that underwent surgical repair for unilateral orbital fractures. All patients included in the study had symptomatic diplopia from the fracture. Patients were classified into one of three groups according to the time of surgery after injury: (1) Early (within 14 days of surgery), (2) intermediate (between 15 and 30 days), and (3) late (greater than 30 days). Ocular motility was measured presurgery and at 3 and 6 months postsurgery by Hess chart with calculation of the Hess area ratio (HAR%). RESULTS: Surgery was conducted at a mean of 24.7 ± 45.0 days (range: 1-283 days) postinjury. There were 120 patients in the early surgery group (surgery at 6.8 ± 3.8 days), 38 in the intermediate surgery group (20.7 ± 4.1 days), and 33 in the late surgery group (95.1 ± 75.0 days). Overall the HAR% improved significantly from a mean of 74.2% preoperatively to 90.8% at 6 months postoperatively (p < 0.01). In the early and intermediate groups, the postoperative HAR% improved significantly with all fracture regions (orbital floor, medial wall, and combined orbital medial wall and floor) (p < 0.05). However, in the late groups, the postoperative HAR% only improved significantly with orbital floor fractures. CONCLUSION: Pre- and postoperative the HAR% give objective evidence of ocular motility improvement with early orbital floor fracture repair surgery. However, observation can be deployed, as a significant improvement in ocular motility can also be achieved with reconstructive surgery conducted 30 days or more after depressed floor-fragment fractures. Early intervention should be prioritized for symptomatic medial wall fractures, as late surgery does not improve motility.

High visceral to subcutaneous fat area ratio predicts early postoperative small bowel obstruction after surgery for colorectal cancer.

PURPOSE: Risks for postoperative small bowel obstruction have been demonstrated in several reports, most of which indicated male sex was a risk factor, but with the reason remaining unknown. We tested the hypothesis that it could be because males have more visceral fat than females. This prospective observational study aims to examine risks of early postoperative small bowel obstruction (EPSBO) after colorectal cancer surgery and the association between visceral to subcutaneous fat area ratio (V/S ratio) and EPSBO. METHODS: Four hundred and seventy-four patients who underwent colectomy for colorectal cancer in our hospital were enrolled in this study. The influence of several factors including V/S ratio on the development of EPSBO was analyzed. RESULTS: Thirty-one of the 474 patients (6.5%) developed EPSBO. EPSBO occurred more frequently in males (p = 0.03) and cases who developed postoperative anastomotic leakage (p < 0.001) or wound infection (p = 0.02). Higher V/S ratio was strongly related to male sex (p < 0.001). Multivariate analysis revealed higher V/S ratio (OR 2.25; p = 0.049) and anastomotic leakage (OR 5.86; p < 0.001) were independent risk factors for EPSBO. CONCLUSION: Higher V/S ratio was significantly related to EPSBO, suggesting that one of the reasons EPSBO was more likely to occur in males because they have more visceral fat than females. Preoperative identification of this risk factor could help us watch out for this potential complication.

Prenatal predictors of mortality in fetuses with congenital diaphragmatic hernia: a systematic review and meta-analysis.

PURPOSE: This study aimed to evaluate prenatal predictors of mortality in fetuses with congenital diaphragmatic hernia (CDH). METHODS: A systematic literature search was performed to identify relevant observational studies that evaluated the ability of lung-to-head ratio (LHR), observed-to-expected LHR (o/e-LHR), observed-to-expected total fetal lung volume (o/e-TFLV), lung-to-thorax transverse area ratio (L/T ratio), intrathoracic herniation of the liver and the stomach, and side of diaphragmatic hernia, using a threshold for the prediction of mortality in fetuses with CDH. Study quality was assessed using the QUADAS-2 tool. Hierarchical summary receiver operating characteristic curves were constructed. RESULTS: A total of 50 articles were included in this meta-analysis. The QUADAS-2 tool identified a high risk of bias in more than one domain scored in all parameters. Among those parameters, the diagnostic odds ratio of mortality with o/e-LHR < 25%, o/e-TFLV < 25%, and L/T ratio < 0.08 were 11.98 [95% confidence interval (CI) 4.65-30.89], 11.14 (95% CI 5.19-23.89), and 10.28 (95% CI 3.38-31.31), respectively. The predictive values for mortality were similar between the presence of liver herniation and retrocardiac fetal stomach position. CONCLUSIONS: This systematic review suggests that o/e-LHR, o/e-TFLV, and L/T ratio are equally good predictors of neonatal mortality in fetuses with isolated CDH.

Ground-Reaction-Force-Based Gait Analysis and Its Application to Gait Disorder Assessment: New Indices for Quantifying Walking Behavior.

Gait assessment is an important tool for determining whether a person has a gait disorder. Existing gait analysis studies have a high error rate due to the heel-contact-event-based technique. Our goals were to overcome the shortcomings of existing gait analysis techniques and to develop more objective indices for assessing gait disorders. This paper proposes a method for assessing gait disorders via the observation of changes in the center of pressure (COP) in the medial-lateral direction, i.e., COPx, during the gait cycle. The data for the COPx were used to design a gait cycle estimation method applicable to patients with gait disorders. A polar gaitogram was drawn using the gait cycle and COPx data. The difference between the areas inside the two closed curves in the polar gaitogram, area ratio index (ARI), and the slope of the tangential line common to the two closed curves were proposed as gait analysis indices. An experimental study was conducted to verify that these two indices can be used to differentiate between stroke patients and healthy adults. The findings indicated the potential of using the proposed polar gaitogram and indices to develop and apply wearable devices to assess gait disorders.

Mass balance estimation of Mulkila glacier, Western Himalayas, using glacier melt model.

One of the main water supplies in Asia is known to be melting water from Himalayan glaciers. One of the most important metrics to analyze and evaluate potential shifts in freshwater supplies from glacier storage is the estimate of mass balance. The present study aims at estimating the glacier mass balance with the help of remote sensing and in situ data for the Mulkila, a benchmark glacier situated in the Bhaga basin of Western Himalayas. The inter-annual difference in the run-off of glaciers is associated with the annual change in glacier mass. To estimate the mass balance of the Mulkila glacier, the current study uses the transient snowline, accumulation area ratio (AAR), and glacier melt model. For 10 consecutive hydrological years from 2009 to 2018, the analysis was conducted using 40 cloud-free Landsat 5/7/8 and Sentinel-2 datasets. Additionally, in situ meteorological weather data for calculating precipitation and changes in temperature were also used. For the period of study, a cumulative mass balance of - 6.66 m.w.e. for 10 years and a mean mass balance of - 0.66 ± 0.27 m.w.e./year were obtained. A negative mass balance obtained for many consecutive hydrological years indicates the effect of climate change and global warming on the glacier ice thinning. This directly affects the regional or local environment and, in the long run, alters water supply. The findings of the present study help in preparing an immediate commitment to curb future warming both at the local and regional scale.

Glacier mass balance estimation in Garhwal Himalaya using improved accumulation area ratio method.

Water requirements of the mountain communities living in the Himalaya are supported by snow and glacier melt. The availability of water from the source depends on numerous climatic and glacier parameters. One key parameter is mass balance, which helps to assess the glacier health and future water availability. We have used the improved accumulation area ratio (IAAR) method to estimate mass balance in Alaknanda and Bhagirathi basins, constituting 1055 glaciers covering ~1609 km2. The mean Equilibrium Line Altitude (ELA) of the Alaknanda and Bhagirathi basins are estimated as 6147 ± 130 and 5985 ± 130 m.a.s.l, respectively. The mass balance is estimated using the accumulation area ratio (AAR)-mass balance relationship. The mean specific mass balance of the Alaknanda and Bhagirathi for 2001-2013 is estimated as -1.1 ± 0.03 m.w.e.a-1 and -1.01 ± 0.07 m.w.e.a-1, respectively. Total mass loss from the study area is calculated as ~21.4 ± 1.1Gt during this period. The loss of glaciers in the mountain area will increase the vulnerability of communities living in the region. It suggests a need for better adaptation strategies to improve the resilience of high mountain communities.

Evaluation of Acoustic Radiation Force Impulse Imaging in Differentiating Benign and Malignant Cervical Lymphadenopathy.

Background: The aim of this study was to assess the diagnostic role of acoustic radiation force impulse imaging (ARFI) in differentiating benign and malignant cervical nodes. Methods: This was a diagnostic accuracy cross-sectional study. All patients who underwent ultrasound-guided fine-needle aspiration cytology (FNAC) of cervical nodes were included. Patients without FNAC/biopsy and patients in whom cervical nodes were cystic or completely necrotic were excluded. FNAC was used as reference investigation to predict the diagnostic accuracy. In all cases, FNAC was carried out after the B-mode, color Doppler and the ARFI imaging. In patients with multiple cervical lymph nodes, the most suspicious node based on grayscale findings was chosen for ARFI. ARFI included Virtual Touch imaging (VTI), area ratio (AR), and shear wave velocity (SWV) for each node, and the results were compared with FNAC/biopsy. Results: The final analysis included 166 patients. Dark VTI elastograms had sensitivity and specificity of 86.2% and 72.1%, respectively, in identifying malignant nodes. Sensitivity and specificity of AR were 71.3% and 82.3%, respectively, for a cutoff of 1.155. Median SWV of benign and malignant nodes was 1.9 [95% confidence interval (CI), 1.56-2.55] m/s and 6.7 (95% CI, 2.87-9.10) m/s, respectively. SWV >2.68 m/s helped in identifying malignant nodes with 81% specificity, 81.6% sensitivity, and 81.3% accuracy. ARFI was found to be inaccurate in tuberculous and lymphomatous nodes. Conclusion: Malignant nodes had significantly darker elastograms, higher AR and SWV compared to benign nodes, and SWV was the most accurate parameter. ARFI accurately identifies malignant nodes, hence could potentially avoid unwarranted biopsy.

The correlation between the change of Hounsfield units value and Modic changes in the lumbar vertebral endplate.

OBJECTIVES: To evaluate the changes of Hounsfield units (HU) value in different types of Modic changes (MCs) and to analyze the correlation between the change of HU value and area ratio of MCs region, bone mineral density (BMD), and degree of intervertebral disc degeneration. METHODS: One hundred fifty-eight endplates with MCs were included and analyzed. HU values of MCs regions and adjacent vertebral corresponding regions without MCs were measured. The area ratio of MCs region was defined as the area of MCs divided by the area of endplate or the vertebral sagittal plane. BMD was measured by Dual-energy x-ray absorptiometry (DXA). Degree of intervertebral disc degeneration was evaluated based on Pfirrmann classification. According to the types of variables, descriptive statistics, Kolmogorove-Smirnov test, paired t-test, Wilcoxon signed-rank test, Independent-Samples T Test, and Pearson correlation analysis were used. RESULTS: The HU values in any types of MCs are significantly higher than that of adjacent vertebral corresponding regions without MCs (P < 0.001). The HU value of the type III MCs is higher than that of the type I and type II MCs. HU value was positively correlated with BMD. In the levels with Grade V disc degeneration, the area ratio of MCs region was significant increased. CONCLUSIONS: HU values of the vertebral endplate and bone marrow were increased in most MCs regions with all types of MCs. HU value of endplates had a significantly positive correlation with BMD. Higher area ratio of MCs region is associated with more severe intervertebral disc degeneration.

The role of cerebrospinal fluid cross-section area ratio in the prediction of dural ossification and clinical outcomes in patients with thoracic ossification of ligamentum flavum.

BACKGROUND: It is imperative to preoperatively distinguish dural ossification (DO) and thus anticipate the risks and outcome of the surgery for patients with ossification of ligamentum flavum (OLF). However, studies have disagreed as to the efficacy of the radiographic signs or factors to predict DO and surgical outcome. In additon, the association between the cerebrospinal fluid cross-section area ratio (CCAR) and DO or clinical outcome had not been reported. The purpose of this study was to analyse CCAR and its role in prediction of DO and neurological function recovery rate in patients with OLF. METHODS: Fifty-two consecutive patients with OLF, who underwent posterior thoracic decompression and fusion between September 2012 and March 2019 at a single institution, were retrospectively reviewed. Demographic data, radiographic signs of DO, CCAR, pre- and postoperative modified Japanese Orthopedic Association (mJOA) score were recorded. RESULTS: There were 27 patients in the DO group and 25 patients in the non-DO group, with a mean age at surgery of 57.4 years and 53.9 years, respectively. No significant differences were found in sex, age, segment of maximum compression and preoperative mJOA score between the two groups. The receiver operating characteristic curve showed that the value of CCAR had a relatively high value for diagnosis of DO and prediction of neurological function recovery rate (P = .000). According to the value of CCAR, three zones were defined as DO zone (≤14.3%), non-DO zone (≥44.5%), and gray zone (14.3 to 44.5%). When the value of CCAR≤14.3%, the recovery rate was poor or fair, while it had good or excellent recovery when CCAR≥45.2%. CONCLUSION: The value of CCAR had a high diagnostic value for prediction of DO and neurological function recovery rate in patients with OLF.

Impact of the preoperative body composition indexes on intraoperative blood loss in patients undergoing pancreatoduodenectomy.

PURPOSES: This study sought to identify any significant predictors of blood loss during pancreatoduodenectomy (PD) among preoperative variables, including the body composition indexes. METHODS: The preoperative data of patients undergoing PD were retrospectively reviewed. The objective variable was the percentage of blood loss during PD to the estimated circulating blood volume (proportional blood loss: PBL). The circulating blood volume was estimated using Nadler's formula. The total psoas area, average Hounsfield units of psoas area (psoas muscle density: PMD), and visceral to subcutaneous adipose tissue area ratio (VSR) were measured at the third vertebra using preoperative plain computed tomography images. A univariate analysis and multiple linear regression analysis for PBL were conducted using the preoperative variables. RESULTS: A total of 415 patients were analyzed. The median PBL was 24.5%. The PMD (coefficient - 0.267; 95% CI - 0.518, - 0.015), VSR (coefficient 2.719; 95% CI 0.238, 5.201), serum albumin level (coefficient - 8.458; 95% CI - 13.02, - 3.898), neoadjuvant therapy (coefficient 9.605; 95% CI 1.722, 17.49), and prothrombin time-international normalized ratio (PT-INR, coefficient 38.63; 95% CI 10.94, 66.31) were independently associated with PBL. CONCLUSIONS: The preoperative PMD, VSR, serum albumin level, neoadjuvant therapy, and PT-INR independently affected PBL. These factors could therefore be potential targets to reduce blood loss during PD.

A Novel Method to Determine Basic Probability Assignment Based on Adaboost and Its Application in Classification.

In the framework of evidence theory, one of the open and crucial issues is how to determine the basic probability assignment (BPA), which is directly related to whether the decision result is correct. This paper proposes a novel method for obtaining BPA based on Adaboost. The method uses training data to generate multiple strong classifiers for each attribute model, which is used to determine the BPA of the singleton proposition since the weights of classification provide necessary information for fundamental hypotheses. The BPA of the composite proposition is quantified by calculating the area ratio of the singleton proposition's intersection region. The recursive formula of the area ratio of the intersection region is proposed, which is very useful for computer calculation. Finally, BPAs are combined by Dempster's rule of combination. Using the proposed method to classify the Iris dataset, the experiment concludes that the total recognition rate is 96.53% and the classification accuracy is 90% when the training percentage is 10%. For the other datasets, the experiment results also show that the proposed method is reasonable and effective, and the proposed method performs well in the case of insufficient samples.

A Digital Radiographic Study of Age Estimation Using Area-specific Formula in Odisha Population.

AIM: The aim of the article was to evaluate the feasibility of pulp/tooth area ratio in three mandibular teeth, namely left canine, left first premolar, and left second premolar (33, 34, and 35), as an indicator of age using digital panoramic radiograph and Kvaal's parameters. The study also aimed at computing an area-specific formula for age estimation in Odisha population. MATERIALS AND METHODS: Observation and analysis of 50 digital orthopantomographs (OPGs) and clinical data of patients were made. These images were saved as high-resolution JPEG files. Using the Adobe Photoshop CS3 (extended) image editing software program (Adobe Systems Inc, San Jose, California, United States), the pulp/tooth area ratio of 33, 34, and 35 was analyzed. These ratios were substituted in Odisha population-specific formula, derived using principal component regression analysis. RESULTS: The mean chronological age was 33.24 years. Principal component regression analysis was used to derive multiple regression formulae for individual teeth as well as a combined formula. R2 (coefficient of determination) for combined three mandibular teeth was highest (0.7769) with a standard error of 4.5969 years and thus was a better predictor of age in the population of Odisha. In terms of an individual tooth, comparison between chronological and predicted age revealed that left second mandibular premolar (35) had highest correlation to actual age. Karl Pearson's correlation coefficient showed correlation between age and the mean of ratios from combined three mandibular teeth was stronger than that of single tooth. CONCLUSION: In the present study, second left mandibular premolar showed highest correlation to actual age when used alone. The use of three teeth in combination increased the correlation. This Odisha-specific formula showed promising results and can be used for forensic applications in this population. CLINICAL SIGNIFICANCE: Using three different teeth for age estimation proved to be a better predictor of age in the Odisha population. Moreover, the obtained formula can act as a standard and be used for anthropological or forensic investigations in the said population.

[Evaluation of Astragali Radix quality grade based on appearance characteristics and internal ingredients].

This study is to provide the basis of establishing a quality evaluation system, based on the differences in appearance and internal components of Astragali Radix from different sources. The diameter of 18 batches of Astragali Radix, the content of alcohol(water) extract and 7 kinds of flavonoids were determined. The peak area ratio of flavonoid aglycon to aglycone was calculated. PCA and CA were carried out by synthesizing various indexes. The results of PCA and CA showed that Astragali Radix was obviously clustered into three types. Alcohol extract, formononetin/formosan glycosides,(pilose isoflavones+astragalus flavonoid A)/pilose isoflavone glucoside are the most significant differences in the variable importance projection index(VIP) of Astragali Radix. Combining the diameter, alcohol(water) extract, flavonoid aglycon to aglycone peak area ratio can provide an analysis method for the establishment of the grade evaluation system of Astragali Radix.

Midbrain/pons area ratio and clinical features predict the prognosis of progressive Supranuclear palsy.

BACKGROUND: Progressive supranuclear palsy (PSP) is a rare movement disorder with poor prognosis. This retrospective study aimed to characterize the natural history of PSP and to find predictors of shorter survival and faster decline of activity of daily living. METHOD: All patients recruited fulfilled the movement disorder society (MDS) clinical diagnostic criteria for PSP (MDS-PSP criteria) for probable and possible PSP with median 12 years. Data were obtained including age, sex, date of onset, age at onset (AAO), symptoms reported at first visit and follow-up, date of death and date of institutionalization. Magnetic resonance imaging was collected at the first visit. Endpoints were death and institutionalization. Kaplan-Meier method and Cox proportional hazard model were used to explore factors associated with early death and institutionalization. RESULTS: Fifty-nine patients fulfilling MDS-PSP criteria were enrolled in our study. Nineteen patients (32.2%) had died and 31 patients (52.5%) were institutionalized by the end of the follow-up. Predictors associated with poorer survival were late-onset PSP and decreased M/P area ratio. Predictors associated with earlier institutionalization were older AAO and decreased M/P area ratio. CONCLUSION: Older AAO and decreased M/P area ratio were predictors for earlier dearth and institutionalization in PSP. The neuroimaging biomarker M/P area ratio was a predictor for prognosis in PSP.

Refining initial diagnosis of Parkinson's disease after follow-up: A 4-year prospective clinical and magnetic resonance imaging study.

BACKGROUND: No prospective study of patients with Parkinson's disease (PD) has investigated the appearance of vertical gaze abnormalities, a feature suggestive of progressive supranuclear palsy (PSP). OBJECTIVE: To identify, within a cohort of patients with an initial diagnosis of PD, those who developed vertical gaze abnormalities during a 4-year follow-up, and to investigate the performance of new imaging biomarkers in predicting vertical gaze abnormalities. METHODS: A total of 110 patients initially classified as PD and 74 controls were enrolled. All patients underwent clinical assessment at baseline and every year up to the end of the follow-up. The pons/midbrain area ratio 2.0 and the Magnetic Resonance Parkinsonism Index 2.0 were calculated. RESULTS: After 4-year follow-up, 100 of 110 patients maintained the diagnosis of PD, whereas 10 PD patients (9.1%) developed vertical gaze abnormalities, suggesting an alternative diagnosis of PSP-parkinsonism. At baseline, the Magnetic Resonance Parkinsonism Index 2.0 was the most accurate biomarker in differentiating PD patients who developed vertical gaze abnormalities from those who maintained an initial diagnosis of PD. At the end of follow-up, both of these biomarkers accurately distinguished PSP-parkinsonism from PD. CONCLUSIONS: Our results demonstrate that a number of patients with an initial diagnosis of PD developed vertical gaze abnormalities during a 4-year follow-up, and the diagnosis was changed from PD to PSP-parkinsonism. In PD patients, baseline Magnetic Resonance Parkinsonism Index 2.0 showed the best performance in predicting the clinical evolution toward a PSP-parkinsonism phenotype, enabling PSP-parkinsonism patients to be identified at the earliest stage of the disease for promising disease-modifying therapies. © 2019 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.

The relationship between non-alcoholic fatty liver and skeletal muscle mass to visceral fat area ratio in women with type 2 diabetes.

BACKGROUND: Sarcopenic obesity, central obesity combined with decreased skeletal muscle mass, is identified to be associated with metabolic syndrome and cardiovascular diseases; however, its role in the occurrence of non-alcoholic fatty liver disease (NAFLD) among patients with type 2 diabetes mellitus (T2DM) remains unclear. Therefore, this study aimed to investigate the value of the skeletal-to-visceral ratio (SVR) in the prediction of NAFLD in T2DM. METHODS: T2DM patients (n = 445) were recruited into the current study. Hepatic steatosis was diagnosed based on ultrasonic results, while skeletal muscle mass as well as visceral fat area (VFA) was estimated based on bioimpedance analysis measurements. RESULTS: NAFLD prevalence increased with the decreased SVR tertiles: statistically significant differences were observed in the highest tertiles (21.5% in men, and 30.4% in women) and the lowest tertiles (53.9% in men and 60.0% in women) (both P < 0.01). The decreased SVR tertiles were independently associated with the presence of NAFLD in female T2DM patients, with the odds ratio (OR) of 3.43 and 2.31 in the lowest and middle tertiles, respectively. Besides, the areas under the curve (AUC) for identifying NAFLD were 0.675 and 0.63 in men and women, respectively (P < 0.05). CONCLUSIONS: T2DM patients who have lower SVR levels are associated with higher risks of developing the NAFLD-related complications. Besides, SVR shows independent correlation with NAFLD in female T2DM patients, suggesting that SVR may be a useful index to predict the high risk of hepatic steatosis in T2DM.

The dynamics of endothelial changes in vivo following standardized skin injury.

BACKGROUND: Vascular changes, that is, functional and cellular endothelial changes, are of essential importance in healing. Alongside these vascular changes, inflammatory factors and hypoxia may play an important role in recovery. OBJECTIVES: To investigate the dynamics of functional and cellular endothelial changes and hypoxia in vivo following standardized skin damage caused by tape stripping. METHODS: Vascular changes (endothelial cell proliferation, vascular network size, vessel diameter) and hypoxia-inducible factor-1α were examined immunohistochemically using a CD31/Ki67 double staining and HIF-1α single staining. Cutaneous perfusion was evaluated using the Twente Optical Perfusion Camera (TOPCam). RESULTS: The initial phase is seen to be dominated by endothelial cell proliferation, HIF-1α expression, and vasodilatation. Cutaneous perfusion intensity is particularly increased in the first 16 hours. The late phase of recovery (after 72 hours) is characterized by a peak of expansion of the vascular network and a second peak of endothelial cell proliferation and HIF-1α expression. CONCLUSION: Endothelial cell proliferation and HIF-1α expression appear to be (strongly) related, having maximum levels at 16 hours and 72 hours. Angiogenesis and HIF-1α expression are not continuous processes, but rather occur intermittently.