Visceral obesity in predicting oncologic outcomes of localized renal cell carcinoma.

PURPOSE: We investigate the clinicopathological features and prognostic significance of visceral obesity in patients with localized renal cell carcinoma. MATERIALS AND METHODS: This study included 706 patients with localized renal cell carcinoma who had undergone curative surgery between January 2003 and April 2012. Visceral, subcutaneous and total adipose tissue were measured based on preoperative computerized tomography of the umbilical region. Visceral adipose tissue percent was calculated using the formula, VAT% = [visceral adipose tissue/total adipose tissue] × 100. The association between clinicopathological factors and visceral obesity was examined. RESULTS: A higher VAT% at diagnosis was associated with older age at diagnosis, higher prevalence of diabetes and higher prevalence of former or current smoking status. The distribution of histological subtypes differed significantly among VAT% quartiles. The proportion of high grade tumors increased as VAT% increased (OR 1.023, 95% CI 1.000-1.126, p = 0.037). A U-shaped association between VAT% quartiles and the risk of disease recurrence was observed for all patients. Disease recurrence was significantly increased in the lowest (HR 3.198, 95% CI 1.765-10.040, p = 0.036) and highest (HR 4.760, 95% CI 2.937-13.210, p = 0.010) VAT% quartiles. CONCLUSIONS: Relative visceral obesity as assessed by VAT% was associated with clinicopathological characteristics of localized renal cell carcinoma. A U-shaped association between VAT% quartiles and risk of disease recurrence was observed among patients with localized renal cell carcinoma.

How to assess scapular dyskinesis precisely: 3-dimensional wing computer tomography--a new diagnostic modality.

BACKGROUND: Aberrations in scapular motion are believed to be associated with the presence of shoulder or elbow pathologies. There are many methods to evaluate scapular kinematics, but they have certain limitations. Nevertheless, it is believed that appropriate rehabilitation for each type of scapular dyskinesis is important. METHODS: Eighty-nine athletes were videotaped and seven blinded observers categorized scapular dyskinesis into 4 types, which was followed by 3-dimensional (3D) wing computer tomography (CT). Four blinded examiners evaluated 5 angles [upward rotation (UR), internal rotation (IR), anterior tilting (AT), superior translation (ST), and protraction (PRO)] on the 3D wing CT. Inter-rater reliability (IRR) was calculated for both the methods. CT scan measurements were compared with the 4 observational types to establish the validity. RESULTS: The IRR with observational assessment of scapular dyskinesis into 4 types was good, 0.780. The 3D wing CT analysis had a very high IRR, 0.972. There was a statistically significant correlation between observational assessment and 3D wing CT analysis. The UR angle, ST angle in type 3 scapular dyskinesis, and AT angle in type 1 scapular dyskinesis were increased as compared with those in the other types of scapular dyskinesis. All these measurements were made in the resting position of the scapula. CONCLUSION: The 3D wing CT analysis allows precise quantification of a position associated with scapular dyskinesis. Therefore, 3D wing CT can be considered as an alternative method for assessing scapular dyskinesis.