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Radioactive contamination of the Pacific Ocean following the Fukushima nuclear accident has raised public concern about seafood safety, particularly in coastal Indigenous communities. To address this, Health Canada and partners have collected and analyzed a total of 621 samples of commonly consumed salmon, ground fish, and shellfish from the Canadian west coast from 2011 to 2018. While the vast majority of the 137Cs and 134Cs levels were below the Minimum Detectable Concentration (MDC, typically 0.7-1.0 Bq kg-1 fw for a 6 h counting), further examination of 19 fish samples revealed 137Cs concentrations of 0.17-0.53 Bq kg-1 fw with an average value and uncertainty (k = 1) of 0.29 ± 0.02 Bq kg-1 fw. Of these, only two samples were found to have trace levels of 134Cs likely derived from the Fukushima accident. The global fallout contribution from atmospheric nuclear weapons testing to the observed 137Cs in these two samples was determined to be 0.26 ± 0.08 Bq kg-1 fw (49 ± 14%) and 0.12 ± 0.02 Bq kg-1 fw (24 ± 4%) for collection years 2015 and 2016, respectively. The annual average level of 137Cs in fish and shellfish was also determined by spectral summation for collection years 2014-2018. In fish, 137Cs levels determined through spectral summation were relatively constant (0.18-0.25 Bq kg-1 fw) with an average value and uncertainty of 0.21 ± 0.02 Bq kg-1 fw. By contrast, 38 shellfish samples (bivalves) were measured and revealed no radiocesium or other anomalies in either tissue or shell. In all, measurements over eight years showed that the radioactivity in fish and shellfish was dominated by natural radionuclides and that the level of anthropogenic radionuclides, as indicated by the radioactive cesium content, remained small. An upper bound for ingested dose from 137Cs was determined to be approximately 0.26 µSv per year, far below the worldwide average annual effective dose of 2400 µSv from exposure to natural background radiation. We can therefore conclude that fish, such as salmon, ground fish, and shellfish from the Canadian west coast are of no radiological health concern despite the Fukushima Dai-ichi nuclear accident of 2011.
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Accidente Nuclear de Fukushima , Monitoreo de Radiación , Radiactividad , Contaminantes Radiactivos del Agua , Animales , Canadá , Radioisótopos de Cesio/análisis , Peces/metabolismo , Japón , Alimentos Marinos , Mariscos , Contaminantes Radiactivos del Agua/análisisRESUMEN
OBJECTIVES: To assess telemedicine readiness of gynecologic oncology patients, particularly those at risk for care access disparities (increased distance to care, rural populations.). METHODS: Patients at all disease/treatment stages completed an anonymous survey during in-person outpatient appointments at an academic comprehensive cancer center from 1/6/2020 to 2/28/2020, conducted prior to the COVID-19 pandemic, before the introduction of telemedicine in this practice. RESULTS: Of 180 patients approached, 170 completed the survey (94.4%). Mean age was 59.6 years; 73.4% identified as White, 23.7% Black, and 2.9% other race. Ovarian cancer was most common (41.2%), followed by endometrial (27.1%), cervical (20.6%), and vaginal/vulvar (7.1%). Most patients traveled > 50 miles for appointments (63.8%); they were more likely from rural counties with significantly higher travel costs/visit ($60.77 vs $37.98, p = 0.026.) The majority expressed interest in using telemedicine (75.7%) or a smartphone app (87.5%) in their care. The majority of patients with difficulty attending appointments (88.9 vs 70.2%, p = 0.02) or from rural counties (88.7% vs 69.6%, p = 0.03) were interested in telemedicine; those with both characteristics reported 100% interest. The majority in both urban and rural counties had home internet access, and reported similarly high rates of daily use (79% vs 75%). Race and age were not associated with differences in internet access or use or telemedicine interest. CONCLUSIONS: Telemedicine is attractive to the majority of patients and may offer financial/logistical advantages. Patients have high internet use rates and comfort with using technology for healthcare. Telemedicine should be incorporated into standard practice beyond the COVID-19 pandemic to reduce healthcare access disparities.
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Dissolved organic matter (DOM) in freshwater environments is an important source of organic carbon, supporting bacterial respiration. Frozen environments cover vast expanses of our planet, with glaciers and ice-sheets storing upwards of six petagrams of organic carbon. It is generally believed that DOM liberated from ice stimulates downstream environments. If true, glacial DOM is an important component of global carbon cycling. However, coupling the release of DOM to microbial activity is challenging due to the molecular complexity of DOM and the metabolic connectivity within microbial communities. Using a single environmentally relevant organism, we demonstrate that processing of compositionally diverse DOM occurs, but, even though glacially derived DOM is chemically labile, it is unable to support sustained respiration. In view of projected changes in glacier DOM export, these findings imply that biogeochemical impacts on downstream environments will depend on the reactivity and heterogeneity of liberated DOM, as well as the timescale.
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Subsurface environments contain a large proportion of planetary microbial biomass and harbor diverse communities responsible for mediating biogeochemical cycles important to groundwater used by human society for consumption, irrigation, agriculture and industry. Within the saturated zone, capillary fringe and vadose zones, microorganisms can reside in two distinct phases (planktonic or biofilm), and significant differences in community composition, structure and activity between free-living and attached communities are commonly accepted. However, largely due to sampling constraints and the challenges of working with solid substrata, the contribution of each phase to subsurface processes is largely unresolved. Here, we synthesize current information on the diversity and activity of shallow freshwater subsurface habitats, discuss the challenges associated with sampling planktonic and biofilm communities across spatial, temporal and geological gradients, and discuss how biofilms may be constrained within shallow terrestrial subsurface aquifers. We suggest that merging traditional activity measurements and sequencing/-omics technologies with hydrological parameters important to sediment biofilm assembly and stability will help delineate key system parameters. Ultimately, integration will enhance our understanding of shallow subsurface ecophysiology in terms of bulk-flow through porous media and distinguish the respective activities of sessile microbial communities from more transient planktonic communities to ecosystem service and maintenance.
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Bacterias/crecimiento & desarrollo , Biopelículas/crecimiento & desarrollo , Agua Dulce/microbiología , Sedimentos Geológicos/microbiología , Agua Subterránea/microbiología , Plancton/crecimiento & desarrollo , Bacterias/clasificación , Humanos , Hidrología , Microbiota , Plancton/clasificaciónRESUMEN
Vast expanses of Earth's surface are covered by ice, with microorganisms in these systems affecting local and global biogeochemical cycles. We examined microbial assemblages from habitats fed by glacial meltwater within the McMurdo Dry Valleys, Antarctica and on the west Greenland Ice Sheet (GrIS), evaluating potential physicochemical factors explaining trends in community structure. Microbial assemblages present in the different Antarctic dry valley habitats were dominated by Sphingobacteria andFlavobacteria, while Gammaproteobacteria and Sphingobacteria prevailed in west GrIS supraglacial environments. Microbial assemblages clustered by location (Canada Glacier, Cotton Glacier and west GrIS) and were separated by habitat type (i.e. ice, cryoconite holes, supraglacial lakes, sediment and stream water). Community dissimilarities were strongly correlated with dissolved organic matter (DOM) quality. Microbial meltwater assemblages were most closely associated with different protein-like components of the DOM pool. Microbes in environments with mineral particles (i.e. stream sediments and cryoconite holes) were linked to DOM containing more humic-like fluorescence. Our results demonstrate the establishment of distinct microbial communities within ephemeral glacial meltwater habitats, with DOM-microbe interactions playing an integral role in shaping communities on local and polar spatial scales.
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Flavobacteriaceae/aislamiento & purificación , Gammaproteobacteria/aislamiento & purificación , Cubierta de Hielo/microbiología , Sphingobacterium/aislamiento & purificación , Regiones Antárticas , Biodiversidad , Canadá , ADN Bacteriano/genética , Flavobacteriaceae/clasificación , Flavobacteriaceae/genética , Gammaproteobacteria/clasificación , Gammaproteobacteria/genética , Groenlandia , Lagos/microbiología , Microbiota/genética , Sphingobacterium/clasificación , Sphingobacterium/genética , AguaRESUMEN
Spirometry is a simple test and considered the gold standard in lung function. An obstructive ventilatory defect is a disproportionate reduction of maximal airflow from the lung in relation to the maximal volume that can be displaced from the lung. It implies airway narrowing and is defined by a reduced FEV1/FVC ratio below the 5th percentile of the predicted value (lower limit of normal, LLN). A restrictive disorder may be suspected when vital capacity (FVC) is reduced and FEV1/FVC is normal. It is definitely proven, however, only by a decrease in TLC below the 5th percentile of predicted value (LLN). The measurement of TLC by body plethysmography is necessary to confirm or exclude a restrictive defect or hyperinflation of the lung when FVC is below the LLN. 2012 a task force of the ERS published new reference values based on 74,187 records from healthy non-smoking males and females from 26 countries. The new reference equations for the 3-95 age range are now available that include appropriate age-dependent mean values and lower limits of normal (LLN). This presentation aims at providing the reader with recommendations dealing with standardization and interpretation of spirometry.
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Diagnóstico por Computador/normas , Medicina Ambiental/normas , Medicina del Trabajo/normas , Guías de Práctica Clínica como Asunto , Neumología/normas , Espirometría/normas , AlemaniaRESUMEN
The aim of the present study was to assess the contribution of clinical data to the variability of impulse oscillometric test results observed previously by Püllen et al. (2014). Fifty-eight German hybrid pigs from 29 different herds with unknown respiratory status were examined in the context of routine diagnostics as part of herd health service. Routine clinical examination was extended to a total set of 29 parameters, representing detailed clinical signs of the respiratory system, and to lung function testing applying the impulse oscillometry system (IOS). The resulting linear relationship between clinical data and variables of pulmonary mechanics had a mean r(2) of 0.52. Clinical parameters predominantly representing the lower respiratory tract closely correlated with established impulse oscillometric indices reflecting peripheral airways. Because of a restricted relationship between pulmonary functional disorders and clinical data, additional diagnostic methods are required to reveal the proportion of variance undefined by clinical examination.
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Oscilometría/veterinaria , Enfermedades Respiratorias/veterinaria , Enfermedades de los Porcinos/fisiopatología , Animales , Reproducibilidad de los Resultados , Pruebas de Función Respiratoria/veterinaria , Enfermedades Respiratorias/diagnóstico , Enfermedades Respiratorias/fisiopatología , Porcinos , Enfermedades de los Porcinos/diagnósticoRESUMEN
The aim of this study was to assess impulse oscillometry as a method to characterise lung function in 58 German hybrid pigs from 29 different herds of unknown respiratory status. The variability of repeated lung function measurements increased significantly after the sixth run and therefore the average of the first six runs was used for analysis. The presence of peripheral respiratory alterations in some pigs was indicated by the negative frequency dependence of the 95th percentile of respiratory resistance (Rrs), with highest values at 3 Hz and the sharp drop of respiratory reactance (Xrs) across the whole frequency range (3-15 Hz). Respiratory resistance and reactance were negatively correlated. Reactance area was correlated with (1) Rrs at 3, 5 and 10 Hz; (2) Xrs at 3, 5, 10 and 15 Hz; (3) the frequency dependence of resistance compared between 3 and 5 Hz (R3-R5), 5 and 10 Hz (R5-R10), and 5 and 15 Hz (R5-R15); and (4) tidal volume. High repeatability and low intra-individual variability of impulse oscillometry indicate that this method is a promising tool for advanced characterisation of the pulmonary system of pigs and has potential for use for herd health monitoring.
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Oscilometría/veterinaria , Pruebas de Función Respiratoria/veterinaria , Porcinos/fisiología , Animales , Oscilometría/normas , Reproducibilidad de los Resultados , Pruebas de Función Respiratoria/normasRESUMEN
While methacholine (MCH) testing is commonly used in the clinical diagnosis of asthma, the detection of airway narrowing often relies on either spirometry or body plethysmography, however comparative studies are rare. In this study we performed MCH testing in 37 patients with variable shortness of breath at work and in 37 patients with no history of airway disease. The inclusion criteria were: no acute respiratory infection within 6 weeks, no severe diseases, normal baseline specific airway resistance (sR(aw)), normal baseline forced expiratory volume in 1 s (FEV(1)), Tiffeneau index >70%, no previous treatment with steroids within 14 days and no short acting bronchodilators within 24 h. Cumulative doses of 0.003, 0.014, 0.059, 0.239 and 0.959 mg MCH were inhaled by a dosimeter method. A FEV(1) decrease of ≥20% from baseline and a 100% increase of sR(aw) to ≥2.0 kPa/s was defined as end-of-test-criterion. Provocation doses were calculated by interpolation. Performance of lung function parameters was compared using receiver-operating-characteristic (ROC) analysis. ROC analysis resulted in an area under the ROC curve (AUC) of 0.74 for FEV(1) vs. 0.82 for sR(aw). The corresponding Youden Indices (J) were 0.46 for FEV(1) and 0.57 for sR(aw). The Youden Index of sR(aw) was higher and sensitivity and specificity (73%/84%) were rather well-balanced, in contrast to FEV(1) (54%/92%). In conclusion, in cumulative MCH challenges sR(aw) was found to be the overall most useful parameter for the detection of bronchial hyperresponsiveness. Body plethysmography yielded a balanced sensitivity-specificity ratio with higher sensitivity than spirometry, but comparable specificity.
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Hiperreactividad Bronquial/diagnóstico , Cloruro de Metacolina , Pletismografía Total , Espirometría , Adulto , Estudios de Casos y Controles , Femenino , Volumen Espiratorio Forzado , Humanos , Masculino , Persona de Mediana Edad , Curva ROCRESUMEN
The anthropometrical data of the Caucasian population have significantly changed within the last five decades. The European Community for Coal and Steel (ECCS) assumes a plateau phase and recommends the entry of 25 years old for calculation of reference values in this age range. The question arises if the commonly used reference recommendations for lung function of the ECCS can still be accepted. In the present study standardized spirometric lung function tests were performed by pneumotachography, recording lung volumes and flows (MasterScreen Pneumo, CareFusion, Höchberg) in asymptomatic nonsmoking subjects (202 females, 201 males), aged between 18 and 26, according to the ATS/ERS criteria. The results were compared with the reference recommendations of ECCS, SAPALDIA, LuftiBus, and Bochum (only males). All absolute lung function values showed a correlation (p< 0.05) with height. With respect to FVC and FEV(1), SAPALDIA and Bochum reference values were comparable and close to a 100 (range 97.6-101.4) %pred, whereas both ECCS and LuftiBus showed higher values (range 103.6-109.9%pred). The FEV(1)/FVC ratio was close to a 100 (range 97.6-101.7) %pred in all reference systems, whereas flows showed a wide variability between the reference systems (77.1-114.6%pred), single flows (e.g., 96.9-114.2%pred for MEF(50)) and males/females (males: 93.6-114.6%pred; females: 77.1-107.9%pred). We conclude that SAPALDIA reference values for FVC and FEV(1) should be used, as they better represent lung function in the age group. ECCS and LuftiBus reference values are appreciably (4-10%) lower. Differences between reference systems were less important for the FEV(1)/FVC ratio and lung flows.
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Pulmón/fisiología , Adolescente , Adulto , Factores de Edad , Estatura , Femenino , Volumen Espiratorio Forzado , Humanos , Masculino , Estudios Multicéntricos como Asunto , Valores de Referencia , Capacidad Vital , Adulto JovenRESUMEN
The hypothalamic-pituitary-adrenal (HPA) axis underlies both adaptive and maladaptive responses to stress and may be an important marker of childhood vulnerability to psychopathology, although little is known about genetic variants that influence cortisol reactivity. We therefore examined associations between corticotrophin-releasing hormone (CRH) system gene (CRH, CRHR1 and CRHBP) variants and cortisol reactivity in preschoolers. A community sample of 409 three-year-old children completed a standardized stress task to elicit HPA axis activation. Salivary samples were obtained at the baseline and at 10-min intervals post-stress for a total of six samples. Salivary cortisol was measured using standard ELISA (enzyme-linked immunosorbent assay) protocols and cortisol reactivity was operationalized by calculating cortisol change scores ([baseline]-[peak cortisol post-stressor]). A single nucleotide polymorphism (SNP) marker panel containing 18 SNPs was used to tag the full-length CRH (4 SNPs), CRHR1 (7 SNPs) and CRHBP (7 SNPs) genes. Significant main effects on children's cortisol reactivity (all ps<0.05) were found for loci on CRHR1 and CRHBP. Haplotypes of the CRHR1 linkage region were also associated with cortisol reactivity (all ps<0.01). Additionally, we found multiple interactions between tag-SNPs in all three gene-coding regions predicting cortisol reactivity (all ps<0.05). Individual differences in children's cortisol reactivity are related to genetic variation in CRH system gene-coding regions. Our results have important implications for future research on the role of HPA axis function in the development of disorders such as anxiety and depression.
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Proteínas Portadoras/genética , Hormona Liberadora de Corticotropina/genética , Hidrocortisona/sangre , Sistema Hipotálamo-Hipofisario/metabolismo , Sistema Hipófiso-Suprarrenal/metabolismo , Receptores de Hormona Liberadora de Corticotropina/genética , Preescolar , Femenino , Estudios de Asociación Genética , Genotipo , Haplotipos , Humanos , Desequilibrio de Ligamiento , Masculino , Polimorfismo de Nucleótido SimpleRESUMEN
UNLABELLED: AIMS OF INVESTIGATION: The chronological age of the Caucasian population and their anthropometrical data have significantly changed within the last five decades. Therefore the question arises whether or not the commonly used reference values of the European Community (ECCS) for lung function may still be accepted today. Since these values were obtained in the 1960s from subjects in a limited age range. For the elderly, the measured values are deduced by extrapolation beyond the range of reference equations which had been obtained in a different population. Therefore decisions concerning elderly and smaller subjects concerning remuneration due to impaired lung function after industrial exposure on the basis of EGKS values are questionable. METHODS: Lung function tests were performed by pneumotachography, recording static lung volumes and flow-volume-curves in 262 asymptomatic non smoking males, aged 20 to 90 years. Measurements were performed with the MasterLab, or PneumoScreen systems (CareFusion, Höchberg). RESULTS were compared to the reference values of ECCS, SAPALDIA and LuftiBus. - RESULTS: For simplicity analysis of age and height dependence of investigated respiratory parameters (VC, FVC, FEVâ1, FEVâ1%FVC, PEF, MEFâ75,50,25) can be described by linear functions (y = a * height ? b * age + c). The forced expiratory vital capacity, FVC, was calculated by FVC = 0.0615*H - 0.0308*A - 4.673; r = 0.78. Mean FVC for younger subjects was found to be 104.7 ± 10.7% of the ECCS reference values and 96.5 ± 11.8 % in older subjects. For most parameters investigated linear regressions on age were steeper than described by the ECCS reference values. The regression of lung function to height largely follows the ECCS prescriptions. SUMMARY: Bochum lung function values of younger healthy subjects were higher compared to the reference values of the ECCS and showed a steeper age descent. The alternatively discussed reference values of the SAPALDIA-, or LuftiBus-Study are higher, but do not cover all necessary parameters and/or the age range. A multi centre study for contemporary reference values is recommended.
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Envejecimiento/fisiología , Pulmón/fisiología , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Valores de Referencia , Pruebas de Función RespiratoriaRESUMEN
Body plethysmography allows to assess functional residual capacity (FRC(pleth)) and specific airway resistance (sRaw) as primary measures. In combination with deep expirations and inspirations, total lung capacity (TLC) and residual volume (RV) can be determined. Airway resistance (Raw) is calculated as the ratio of sRaw to FRC(pleth). Raw is a measure of airway obstruction and indicates the alveolar pressure needed to establish a flow rate of 1 L s(-1). In contrast, sRaw can be interpreted as the work to be performed by volume displacement to establish this flow rate. These measures represent different functional aspects and should both be considered. The measurement relies on the fact that generation of airflow needs generation of pressure. Pressure generation means that a mass of air is compressed or decompressed relative to its equilibrium volume. This difference is called "shift volume". As the body box is sealed and has rigid walls, its free volume experiences the same, mirror image-like shift volume as the lung. This shift volume can be measured via the variation of box pressure. The relationship between shift volume and alveolar pressure is assessed in a shutter maneuver, by identifying mouth and alveolar pressure under zero-flow conditions. These variables are combined to obtain FRC(pleth), sRaw and Raw. This presentation aims at providing the reader with a thorough and precise but non-technical understanding of the working principle of body plethysmography. It also aims at showing that this method yields significant additional information compared to spirometry and even bears a potential for further development.
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Obstrucción de las Vías Aéreas/fisiopatología , Resistencia de las Vías Respiratorias/fisiología , Capacidad Residual Funcional/fisiología , Pletismografía Total/instrumentación , Capacidad Pulmonar Total/fisiología , Humanos , Espirometría/instrumentaciónRESUMEN
OBJECTIVE: To explore the predictive value of MRI parameters and tumour characteristics before neoadjuvant chemotherapy (NAC) and to compare changes in tumour size and tumour apparent diffusion coefficient (ADC) during treatment, between patients who achieved pathological complete response (pCR) and those who did not. METHODS: Approval by the Regional Ethics Committee and written informed consent were obtained. Thirty-one patients with invasive breast carcinoma scheduled for NAC were enrolled (mean age, 50.7; range, 37-72). Study design included MRI before treatment (Tp0), after four cycles of NAC (Tp1) and before surgery (Tp2). Data in pCR versus non-pCR groups were compared and cut-off values for pCR prediction were evaluated. RESULTS: Before NAC, HER2 overexpression was the single significant predictor of pCR (p = 0.006). At Tp1 ADC, tumour size and changes in tumour size were all significantly different in the pCR and non-pCR groups. Using 1.42 × 10(-3) mm(2)/s as the cut-off value for ADC, pCR was predicted with sensitivity and specificity of 88% and 80%, respectively. Using a cut-off value of 83% for tumour volume reduction, sensitivity and specificity for pCR were 91% and 80%. CONCLUSION: ADC, tumour size and tumour size reduction at Tp1 were strong independent predictors of pCR.
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Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias de la Mama/diagnóstico , Neoplasias de la Mama/tratamiento farmacológico , Imagen de Difusión por Resonancia Magnética/métodos , Gadolinio DTPA , Adulto , Anciano , Medios de Contraste , Femenino , Humanos , Persona de Mediana Edad , Terapia Neoadyuvante/métodos , Pronóstico , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Resultado del TratamientoRESUMEN
Nasal airflow resistance in brachycephalic dogs is significantly elevated compared to normal dogs. LaserAssisted TurbinEctomy (LATE)-surgery as well as xylometazolin were shown to reduce pathologically increased intranasal airway resistance in brachycephalic dogs by approximately 50 %. Impulse oscillometry provides a reliable and sensitive method to examine intranasal stenoses in the canine nose. Acoustic rhinometry allows assessment of changes in cross sectional area and volume of the canine nasal cavity.
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Resistencia de las Vías Respiratorias/fisiología , Craneosinostosis/fisiopatología , Craneosinostosis/veterinaria , Enfermedades de los Perros/fisiopatología , Obstrucción Nasal/fisiopatología , Obstrucción Nasal/veterinaria , Nariz/anomalías , Nariz/fisiopatología , Animales , Craneosinostosis/cirugía , Enfermedades de los Perros/cirugía , Perros , Terapia por Láser/veterinaria , Obstrucción Nasal/cirugía , Nariz/cirugía , Oscilometría/veterinaria , Rinometría Acústica/veterinaria , Cornetes Nasales/cirugíaRESUMEN
OBJECTIVES: To assess the long-term outcome of craniofacial morphology related to disease variables and temporomandibular joint (TMJ) involvement as demonstrated with computed tomography (CT) and magnetic resonance imaging (MRI) in adult patients with juvenile idiopathic arthritis (JIA). METHODS: Sixty of 103 patients participated in a re-examination on average 27 years after baseline. Craniofacial morphology, with emphasis on size and position of the mandible, was assessed in lateral cephalographic images and related to disease variables and TMJ involvement by CT and MRI. Definitions of craniofacial growth disturbances were based on measurements outside 2 SD from the mean of healthy adult controls. RESULTS: Sagittal craniofacial growth disturbances were found in 57% and micrognathia in 27% of the 60 patients. Of those with JIA TMJ involvement, 70% had some form of growth disturbance. Micrognathia occurred only in patients with bilateral TMJ involvement. The bilateral TMJ group had significantly different craniofacial morphology than healthy controls and patients without TMJ involvement. Growth disturbances and TMJ involvement were present in all subtypes of JIA, except for one subtype comprising one patient. Patients with growth disturbances had more severe disease than patients with normal craniofacial growth, regarding both present and previous disease activity. Unexpectedly, half of the patients without craniofacial growth disturbances also had TMJ involvement, many from before the age of 12. CONCLUSIONS: Craniofacial growth disturbances were found to be frequent in adult JIA patients, especially in those with bilateral TMJ involvement. However, growth disturbances did not always follow TMJ involvement, not even when affected early.
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Artritis Juvenil/complicaciones , Anomalías Craneofaciales/diagnóstico , Anomalías Craneofaciales/etiología , Huesos Faciales/crecimiento & desarrollo , Cráneo/crecimiento & desarrollo , Articulación Temporomandibular/crecimiento & desarrollo , Adolescente , Adulto , Artritis Juvenil/patología , Estudios de Casos y Controles , Niño , Preescolar , Anomalías Craneofaciales/epidemiología , Huesos Faciales/anomalías , Huesos Faciales/diagnóstico por imagen , Femenino , Estudios de Seguimiento , Humanos , Imagen por Resonancia Magnética , Masculino , Micrognatismo/epidemiología , Prevalencia , Pronóstico , Índice de Severidad de la Enfermedad , Cráneo/anomalías , Cráneo/diagnóstico por imagen , Articulación Temporomandibular/anomalías , Articulación Temporomandibular/diagnóstico por imagen , Tomografía Computarizada por Rayos XRESUMEN
OBJECTIVE: To investigate the relationship between radiographic JIA disease course in the TMJs and mandibular growth rotation, compared with growth in healthy individuals. METHODS: From a larger series of JIA patients followed from childhood to adulthood, 26 were included; 11 without and 15 with bilateral radiographic TMJ involvement. Joint morphology and function were assessed at baseline, 2-, 4-, 6- and 27 years follow-up. Mandibular growth rotation (anterior, posterior or none) was assessed from cephalometric evaluations at childhood and adulthood, with observations from 16 healthy individuals as controls. TMJ disease course and mandibular growth rotation were assessed independently and their relationship analysed. Non-parametric statistical methods were applied to test differences between groups. RESULTS: In the normal TMJ group of JIA patients the joint morphology was similar at the follow-ups and all patients had good function both in childhood and in adulthood. The mandibular growth rotation was similar to that of healthy controls, i.e. predominantly in anterior direction. In the abnormal TMJ group different JIA TMJ disease courses were observed and associated with changes in the mandibular growth rotation (p = 0.007).Progressing JIA TMJ disease course was related to posterior mandibular growth rotation and improving disease course to anterior mandibular growth rotation. CONCLUSION: A relationship was found between JIA disease course in the TMJs and mandibular growth rotation, suggesting that a favourable growth could be regained in patients with improvement in TMJ morphology and/or TMJ function. To confirm this, further research on larger patient series is needed.
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In order to compare the outcome from surgical repair and physiotherapy, 103 patients with symptomatic small and medium-sized tears of the rotator cuff were randomly allocated to one of the two approaches. The primary outcome measure was the Constant score, and secondary outcome measures included the self-report section of the American Shoulder and Elbow Surgeons score, the Short Form 36 Health Survey and subscores for shoulder movement, pain, strength and patient satisfaction. Scores were taken at baseline and after six and 12 months by a blinded assessor. Nine patients (18%) with insufficient benefit from physiotherapy after at least 15 treatment sessions underwent secondary surgical treatment. Analysis of between-group differences showed better results for the surgery group on the Constant scale (difference 13.0 points, p - 0.002), on the American Shoulder and Elbow surgeons scale (difference 16.1 points, p < 0.0005), for pain-free abduction (difference 28.8 degrees , p = 0.003) and for reduction in pain (difference on a visual analogue scale -1.7 cm, p < 0.0005).
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Artroscopía/normas , Modalidades de Fisioterapia/normas , Lesiones del Manguito de los Rotadores , Manguito de los Rotadores/cirugía , Adulto , Anciano , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Satisfacción del Paciente , Rango del Movimiento Articular , Índice de Severidad de la Enfermedad , Resultado del TratamientoRESUMEN
BACKGROUND AND PURPOSE: Dural ectasia (DE) is one of the major criteria of Marfan syndrome (MFS). Our aim was to establish the prevalence of DE in an adult population fulfilling the Ghent criteria for MFS and to assess definitions of DE. MATERIALS AND METHODS: One hundred five adults with suspected MFS were included. MR imaging at 1.5T was performed unless contraindicated; then CT was obtained. Lumbosacral anteroposterior vertebral body diameters (VBD) and dural sac diameters (DSD) were measured. Dural sac ratios (DSR = DSD/VBD) at levels L3 through S1 were calculated. Anterior meningoceles, herniations of nerve root sleeves, and scalloping were characterized. One hundred one sex- and age-matched patients were included as controls. RESULTS: We identified 3 patient groups: 1) fulfilling Ghent criteria independent of DE (n = 73), 2); fulfilling Ghent criteria dependent on DE (n = 14), and 3); and suspected MFS, not fulfilling Ghent criteria (n = 18). DE was found in 86% of group 1. At levels L4-S1, mean DSRs were significantly higher in group 1 than in group 3 and controls (P < .001). Herniations of the nerve root sleeves were present in 73% in group 1 versus 1% in controls. Anterior meningoceles were found in 37% and 14% in groups 1 and 2, respectively, but not in group 3 or controls. CONCLUSIONS: The diagnosis of DE on MR imaging or CT should be based on the presence of at least 1 of the following criteria: anterior meningoceles or nerve root sleeve herniation, DSD at S1 or below larger than DSD at L4, and DSR at S1 >0.59.