Repeat Prostatic Artery Embolization for Patients with Benign Prostatic Hyperplasia.

PURPOSE: To evaluate the safety and efficacy of repeat prostatic artery (PA) embolization (PAE) for benign prostatic hyperplasia (BPH). MATERIALS AND METHODS: A single-center retrospective study was conducted from 2009 to 2018 in 108 patients with symptomatic BPH treated with repeat PAE: group A (n = 39; 36.1%) were patients who never showed a response to PAE, and group B (n = 69; 63.9%) were patients who had clinical improvement in the first 6 months following PAE but relapsing symptoms afterward. The main patterns of revascularization were 75% from the previously embolized PA and 25% from collateral vessels (superior vesical, posterior-lateral PA, penile branches). Technical outcomes and adverse events were registered. International Prostate Symptom Score (IPSS), quality of life (QOL), and clinical success were compared between groups. RESULTS: Median follow-up was 18 months (range, 1-36 mo); median interval between PAE and repeat PAE was 420 days (range, 77-2,240 d). Mean procedural time was significantly longer for repeat PAE vs initial PAE (81.1 min vs 67.4 min; P = .0007). There were no major complications and no urinary incontinence. Mean IPSS/QOL improvements were greater in group B vs group A: 9.51 vs 6.13 and 1.30 vs 0.56, respectively (P < .001). The cumulative probability of clinical success after repeat PAE was higher in group B than in group A (P = .0001): 84.1% vs 46.2% at 1 month, 56.7% vs 28.2% at 12 months, and 51.9% vs 16.9% at 24-36 months. CONCLUSIONS: Repeat PAE is safe and effective for recurrence of lower urinary tract symptoms caused by BPH but has limited impact in patients who did not show a response to initial PAE.

Design and clinical validation of a software program for automated measurement of mammographic breast density.

BACKGROUND: Mammographic breast density is an important predictor of breast cancer, but its measurement has limitations related to subjectivity of visual evaluation or to difficult access for automatic volumetric measurement methods. Herein, we describe the design and clinical validation of Aguida, a software program for automated quantification of breast density from flat mammography images. MATERIALS AND METHODS: The software program was developed in MatLab. After image segmentation separating the background from the breast image, the operator positions a cursor defining a region of interest on the pectoralis major muscle from the mediolateral oblique view. Then, in the craniocaudal view, the threshold for separation of the dense tissue is based on the optical density of the pectoral muscle, and the proportion of dense tissue is calculated by the program. Mammograms obtained from 2 different occasions in 291 women were used for clinical evaluation. RESULTS: The intraclass correlation coefficient (ICC) between breast density measurements by the software and by a radiologist was 0.96, with a bias of only 0.67 percentage points and a 95% limit of agreement of 13.5 percentage points; the ICC was 0.94 in the interobserver reliability assessment by two radiologists with different experience; and the ICC was 0.98 in the intraobserver reliability assessment. The distribution among the density classes was close to the values obtained with the volumetric software. CONCLUSIONS: Measurement of breast density with the Aguida program from flat mammography images showed high agreement with the visual determination by radiologists, and high inter- and intra-observer reliability.

Randomized Clinical Trial of Balloon Occlusion versus Conventional Microcatheter Prostatic Artery Embolization for Benign Prostatic Hyperplasia.

PURPOSE: To compare balloon occlusion prostatic artery embolization (bPAE) with conventional microcatheter PAE (cPAE). MATERIALS AND METHODS: In this single-center trial, between November 2017 and November 2018, 89 patients with symptomatic benign prostatic hyperplasia were randomly assigned to cPAE (n = 43) or bPAE (n = 46). All patients received embolization with 300-500 µm Embosphere microspheres and were evaluated before and 1 and 6 months after PAE. Primary outcome measure was change from baseline in International Prostate Symptom Score (IPSS). Student t test was used for between-group comparisons of change from baseline, and paired t test was used for within-group comparisons. RESULTS: At baseline, groups were identical (P > .05). Unilateral PAE was performed in 4 patients receiving cPAE and 3 patients receiving bPAE (9.30% and 6.52%, P = .708). Procedural and fluoroscopy times, dose area product, air kerma, embolic volume, and mean prostate-specific antigen (PSA) 24 hours after PAE did not differ between groups (P > .05). Coils were used in 6 patients receiving cPAE and 4 patients receiving bPAE (14.0% and 8.70%, P = .51). Assessments at 6 months after PAE showed mean IPSS reduction was 7.58 ± 6.88 after cPAE and 8.30 ± 8.12 after bPAE (P = .65); mean prostate volume reduction was 21.9 cm3 ± 51.6 (18.2%) after cPAE and 6.15 cm3 ± 14.6 (7.3%) after bPAE (P = .05); mean PSA reduction was 0.9 ng/mL ± 2.22 after cPAE and 0.22 ng/mL ± 1.65 after bPAE (P = .10). Penile skin lesions (n = 3) and rectal bleeding (n = 2) were documented only in patients receiving cPAE (11.9%, P = .01). No major adverse events occurred. CONCLUSIONS: bPAE is as effective as cPAE in treating benign prostatic hyperplasia with a potential to reduce nontarget embolization.

Prostatic Artery Embolization for Benign Prostatic Hyperplasia: Prospective Randomized Trial of 100-300 µm versus 300-500 µm versus 100- to 300-µm + 300- to 500-µm Embospheres.

PURPOSE: This study compared the safety and efficacy of prostatic arterial embolization (PAE) with that of trisacryl gelatin microspheres of different sizes for treatment of benign prostatic hyperplasia (BPH). MATERIALS AND METHODS: This study consisted of a single-center, randomized controlled clinical trial in 138 patients who underwent PAE for BPH between July 2015 and December 2016. Patients were randomized to PAE using microspheres of different sizes: group A patients were treated with microspheres 100-300 µm, group B with 300-500 µm, and group C with 100-300 µm followed by 300-500 µm. All patients were evaluated before and at 1, 3, 6, 12, and 18 months after PAE. Baseline data were comparable across the 3 groups, using the following mean International Prostate Symptom Score/quality of life (IPSS/QoL); prostate volume (PV) scores, respectively: 23.0/4.14; 87.9 cm3 (group A); 23.0/4.09; 89.0 cm3 (group B); and 24.2/4.29; 81.0 cm3 (group C) (P > 0.05). RESULTS: Mean IPSS/QoL scores; PV after PAE were: 9.98/2.49; 65.1 cm3 (group A); 8.24/2.26; 63.1 cm3 (group B); and 10.1/2.69; 53.1 cm3 (group C) (P = 0.23; P = 0.39; P = 0.24). There were 26 clinical failures. The cumulative probabilities of clinical success at 18 months were 76.7% in group A, 82.6% in group B, and 83.3% in group C (P = 0.68). Nontarget embolization was prevented in 6 patients by coil embolization. All adverse events were mild and self-limited with rates of 86.0% in group A (37 of 43); 41.3% in group B (19 of 46); and 58.3% in group C (28 of 48) (P < 0.001). Dysuria was the most frequent adverse event (28 of 137 [20.4%]). CONCLUSIONS: PAE outcomes were not significantly different among microspheres of different sizes. The use of 100- to 300-µm microspheres was associated with an increased risk of minor adverse events.

Safety and Efficacy of Prostatic Artery Chemoembolization for Prostate Cancer-Initial Experience.

PURPOSE: To evaluate outcome of prostatic artery chemoembolization for patients with prostate cancer (PCa). MATERIALS AND METHODS: This single-center prospective cohort study was conducted between August 2013 and July 2016 in 20 patients with PCa who underwent chemoembolization. Mean patient age was 67.5 years ± 6.4. Gleason score was 6-10, and staging was T2N0M0. Fifteen patients refused prostatectomy and 5 wanted to stop hormonal therapy because of side effects. For chemoembolization, Chelidonium majus mother tincture 1 mL was slowly injected into the prostatic arteries. Docetaxel 1 mL and 150-300 µm Embosphere (Merit Medical Systems, Inc, South Jordan, Utah) microspheres 0.5 mL were thoroughly mixed, and the mixture was slowly injected by the same route. Embolization of prostatic arteries was finished with 150-300 µm Embosphere microspheres. Technical success was defined as bilateral prostatic artery embolization. Biochemical failure was defined as prostate specific antigen (PSA) decrease to < 2 ng/mL followed by recurrence when PSA increased to > 2 ng/mL within 1 month after success. RESULTS: Technical success was 80.0% (16/20 patients). Biochemical failure was 18.7% (3/16 patients). There was 1 short-term biochemical recurrence at 4 months and 2 midterm recurrences (12-18 months). Biochemical success at 12-18 months was 62.5% (10/16 patients). Adverse events (31.3%) included a small area (2 cm2) of bladder wall ischemia, which was removed by surgery (n = 1); transient acute urinary retention (n = 1) and urinary urgency (n = 1) for 1 week; sexual dysfunction (n = 2), which completely recovered after 10 and 12 months, respectively. CONCLUSIONS: Prostatic artery chemoembolization allowed a biochemical response in patients with localized PCa and is a promising treatment.

Spontaneous Pregnancy with a Live Birth after Conventional and Partial Uterine Fibroid Embolization.

Purpose To determine pregnancy rates after conventional and partial uterine fibroid embolization (UFE). Materials and Methods The study received institutional review board approval and all patients gave written informed consent. A retrospective analysis of data collected prospectively was performed between June 2004 and June 2014 in a cohort of 359 women (mean age, 35.9 years ± 4.8) with uterine fibroids and/or adenomyosis who were unable to conceive. The median follow-up period was 69 months (range, 6-126 months). Under local anesthesia, both uterine arteries were embolized. In 160 patients, partial embolization was intentionally performed to preserve fertility, which may be decreased after conventional UFE. In partial UFE, only the small arterial vessels to the fibroids were embolized, leaving the large vessels of the fibroids patent. The Kaplan-Meier method and Cox regression were used for the statistical analysis. Results During follow-up, 149 women became pregnant, 131 women had live births, and 16 women had several pregnancies, resulting in a total of 150 live newborns. It was the first pregnancy for 85.5% (112 of 131) of women. Spontaneous pregnancy rates at 1 year and 2 years after UFE were 29.5% and 40.1%, respectively. The probability of successful pregnancy with live birth at 1 year and 2 years was 24.4% and 36.7%, respectively. Clinical success for fibroid-related symptoms was 78.6% (282 of 359). A dominant submucosal fibroid and ischemia greater than or equal to 90% had greater likelihood of spontaneous pregnancy. Complication rates in patients treated with partial UFE (14.6%) were not greater than rates in patients treated with conventional UFE (23.1%, P = .04). Conclusion Conventional and partial UFE may be safe and effective outpatient procedures for women with uterine fibroids who want to conceive. © RSNA, 2017.

Predictors of Clinical Outcome after Prostate Artery Embolization with Spherical and Nonspherical Polyvinyl Alcohol Particles in Patients with Benign Prostatic Hyperplasia.

Purpose To assess predictors of outcome after prostate artery embolization (PAE) for benign prostatic hyperplasia with spherical particle polyvinyl alcohol (sPVA) and compare outcomes with the use of nonspherical particle polyvinyl alcohol (nsPVA). Materials and Methods This was a single-center retrospective institutional review board-approved study conducted from 2009 to 2015 in patients undergoing PAE with sPVA (n = 186; mean age ± standard deviation, 65.5 years ± 7.7) and nsPVA (n = 300; mean age, 65.3 years ± 7.6). The two cohorts were compared and analyzed for predictors of outcome with a Cox proportional hazards model and linear regression. Post-PAE prostate ischemia was measured with contrast material-enhanced magnetic resonance (MR) imaging in 23 patients with nsPVA and 25 patients with sPVA. The 24-hour post-PAE prostate-specific antigen (PSA) level was registered in 133 patients with sPVA. Prognostic values of MR imaging and PSA levels 24 hours after PAE were assessed with Cox and random-effects regressions. Results Predictors of clinical failure were older age (age over 65 years, P = .002), unilateral procedure (P = .002), and higher baseline International Prostate Symptom Score (IPSS, P = .033). Adjusted hazard ratio for clinical failure of sPVA was 1.273 (P = .16). Acute urinary retention was a predictor of lower IPSS after PAE (P = .002). The mean proportion of prostate ischemia was 11% with sPVA and 10% with nsPVA (P = .65). Lower IPSS after PAE was associated with a higher proportion of prostate ischemia (P = .009). Patients with a PSA level of at least 75 ng/mL (75 µg/L) 24 hours after PAE had a greater decrease in IPSS (P = .01). Prostate ischemic volume and PSA level 24 hours after PAE were correlated (Pearson r = 0.64, P = .014). Conclusion Clinical outcome was similar after PAE with sPVA and nsPVA. Younger age (up to 65 years), bilateral PAE, lower baseline IPSS, and acute urinary retention were predictors of better clinical outcome. The PSA level 24 hours after PAE correlated with prostate ischemia, and both correlated with clinical outcome. (©) RSNA, 2016.

The impact of cognitive symptoms on migraine attack-related disability.

BACKGROUND: The socio-economic impact of migraine is mostly related to work loss either by absenteeism or decreased work performance. Migraine-associated cognitive dysfunction during an attack may contribute to these difficulties. OBJECTIVE: The objective of this article is to analyze the presence and relevance of cognitive symptoms during migraine attacks and to relate their intensity and symptom-related disability with other migraine-defining symptoms. METHODS: Consecutive migraine patients of a headache clinic completed diaries scoring each migraine symptom (including cognitive symptoms) intensity and symptom-related disability. RESULTS: Of 100 consecutive patients included in this study, 34 (all females, age average 31.8 ± 8.8 years) returned information on 229 attacks, on average 6.7 per participant. Every symptom's intensity was always rated slightly higher than the disability it caused. Pain was the symptom scored with the highest intensity and disability, followed by cognitive symptoms (difficulty in thinking and worsening with mental effort) and photo- and phonophobia. Scoring was independent of any of the clinical variables. Attack intensity and disability scores correlated with intensity and disability from pain and from worsening with mental effort. CONCLUSIONS: Attack-related cognitive symptoms are intense and disabling. Some attack-related cognitive symptoms correlate to intensity and disability subjectively attributed to the migraine attack. Cognitive performance should be addressed as a valuable secondary endpoint in trials of acute migraine treatment.

Medium- and Long-Term Outcome of Prostate Artery Embolization for Patients with Benign Prostatic Hyperplasia: Results in 630 Patients.

PURPOSE: To confirm that prostatic artery embolization (PAE) has a positive medium- and long-term effect in symptomatic benign prostatic hyperplasia (BPH). MATERIALS AND METHODS: Between March 2009 and October 2014, 630 consecutive patients with BPH and moderate-to-severe lower urinary tract symptoms refractory to medical therapy for at least 6 months or who refused any medical therapy underwent PAE. Outcome parameters were evaluated at baseline; 1, 3, and 6 months; every 6 months between 1 and 3 years; and yearly thereafter up to 6.5 years. RESULTS: Mean patient age was 65.1 years ± 8.0 (range, 40-89 y). There were 12 (1.9%) technical failures. Bilateral PAE was performed in 572 (92.6%) patients and unilateral PAE was performed in 46 (7.4%) patients. The cumulative clinical success rates at medium- and long-term follow-up were 81.9% (95% confidence interval [CI], 78.3%-84.9%) and 76.3% (95% CI, 68.6%-82.4%). There was a statistically significant (P < .0001) change from baseline to last observed value in all clinical parameters: International Prostate Symptom Score (IPSS), quality-of-life (QOL), prostate volume, prostate-specific antigen, urinary maximal flow rate, postvoid residual, and International Index of Erectile Function. There were 2 major complications without sequelae. CONCLUSIONS: PAE had a positive effect on IPSS, QOL, and all objective outcomes in symptomatic BPH. The medium- (1-3 y) and long-term (> 3-6.5 y) clinical success rates were 81.9% and 76.3%, with no urinary incontinence or sexual dysfunction reported.

Prostate Embolization as an Alternative to Open Surgery in Patients with Large Prostate and Moderate to Severe Lower Urinary Tract Symptoms.

PURPOSE: To evaluate efficacy of prostate artery embolization (PAE) in patients with benign prostatic hyperplasia (BPH), prostate volume (PV) > 100 cm(3). MATERIALS AND METHODS: This was a single-center retrospective cohort study. Between March 2009 and September 2014, PAE was performed in patients with a diagnosis of BPH, PV > 100 cm(3), and moderate to severe lower urinary tract symptoms (LUTS) refractory to medical treatment for at least 6 months or who had acute urinary retention. Success was defined as improved symptoms (International Prostate Symptom Score ≤ 15 and decrease of ≥ 25% from baseline score), improved quality of life (measured as score of ≤ 3 points or decrease of ≥ 1 point from baseline), and no need for additional treatment. RESULTS: PAE was performed in 152 patients 48-87 years old (mean ± SD 67.4 y ± 7.5) with mean PV of 134.2 cm(3) ± 41.8 (range, 101-383 cm(3)). PAE was technically successful in 149 patients (98.0%). Symptomatic control was achieved for a median of 18 months ± 15.5 (range, 3-66 mo). There were 33 clinical failures (23.6%); 23 occurred in the short-term (≤ 6 mo), and 10 occurred in the medium-term (6-24 mo); there were no long-term failures (> 36 mo). Cumulative clinical success rates were 90%, 87.9%, 83.5%, 81.1%, and 77.8% at 1, 3, 6, 12, and 18 months and 72.4% thereafter to 66 months (5.5 y). CONCLUSIONS: PAE provides sustained short-, medium-, and long-term control for LUTS in patients with BPH and PV > 100 cm(3).

Clinical Utility of the Mig-SCog.

BACKGROUND: Mig-SCog is a 9-item questionnaire developed to quantify attack-related cognitive complaints in migraine (M). The items relate to executive function and language, and the total Mig-SCog score is the sum of those scales. OBJECTIVE: To evaluate the Mig-SCog scores regarding cognitive symptoms during a variety of conditions. METHODS: We conducted a prospective comparative study of the Mig-SCog scores (1) between migraine and tension-type headache (TTH) patients during a headache; (2) in migraine patients between migraine attacks, non-headache pain and pain-free status; (3) in migraine patients during and outside a migraine attack. RESULTS: One hundred forty-nine patients (98 M and 51 TTHA). Total Mig-SCog score was higher in migraine patients than TTH (8.0 ± 4.1 vs 3.4 ± 3.2, P < .0001). Sixty-three patients took part in the next part of the study. Migraine patients rated the Mig-SCog higher for migraine (7.9 ± 4.6) than for non-headache pain (2.3 ± 2.9, P < .0006) or pain-free (1.6 ± 2.4, P < .0006). In the final phase of the study, 38 patients Mig-SCog scores were not significantly different whether obtained during or outside an M attack (P = .26). CONCLUSIONS: Attack-related subjective cognitive symptoms, assessed by Mig-SCog scores, differed between migraine and TTH patients. The Mig-SCog scores from migraine patients were found to be higher during migraine than during non-headache pain or pain-free conditions. Patient scoring from memory for usual attacks was not significantly different to scoring within attacks, We believe this demonstrates negligible recall bias.

Cognitive dysfunction during migraine attacks: a study on migraine without aura.

BACKGROUND: Cognitive difficulties contribute to patients' disability during migraine attacks and have been overlooked in migraine research. Neuropsychological studies performed during attacks have produced inconsistent findings due to design differences and limitations. OBJECTIVE: Our objective is to document changes in cognitive performance of migraine patients during migraine attacks with a comprehensive battery of cognitive/behavioral tests, while controlling for potential confounders. METHOD: A prospective two-period, randomized, cross-over study compared within-subject neuropsychological evaluation in two conditions-during a naturally occurring untreated migraine attack and a headache-free period. RESULTS: Thirty-nine patients with episodic migraine (37 females, average 38 years old) were included and 24 completed the study. Participants performed worse during the attack in the majority of cognitive tests, compared to the headache-free status, and significantly so in word reading speed (p = 0.013), verbal learning (p = 0.01), short-term verbal recall with (p = 0.01) and without (p = 0.013) semantic cueing and delayed recall with (p = 0.003) and without (p = 0.05) semantic cues. Differences found were unrelated to age, gender, literacy, condition order, interval between evaluations, anxiety, pain intensity or duration of the attack. DISCUSSION: Cognitive performance decreases during migraine attacks, especially in reading and processing speed, verbal memory and learning, supporting patients' subjective complaints. These findings suggest the existence of a reversible brain dysfunction during attacks of migraine without aura, which can relate specifically to migraine or be a consequence of acute pain processing by the brain.

Embolisation of prostatic arteries as treatment of moderate to severe lower urinary symptoms (LUTS) secondary to benign hyperplasia: results of short- and mid-term follow-up.

OBJECTIVES: To evaluate the short- and medium-term results of prostatic arterial embolisation (PAE) for benign prostatic hyperplasia (BPH). METHODS: This was a prospective non-randomised study including 255 patients diagnosed with BPH and moderate to severe lower urinary tract symptoms after failure of medical treatment for at least 6 months. The patients underwent PAE between March 2009 and April 2012. Technical success is when selective prostatic arterial embolisation is completed in at least one pelvic side. Clinical success was defined as improving symptoms and quality of life. Evaluation was performed before PAE and at 1, 3, 6 and every 6 months thereafter with the International Prostate Symptom Score (IPSS), quality of life (QoL), International Index of Erectile Function (IIEF), uroflowmetry, prostatic specific antigen (PSA) and volume. Non-spherical polyvinyl alcohol particles were used. RESULTS: PAE was technically successful in 250 patients (97.9 %). Mean follow-up, in 238 patients, was 10 months (range 1-36). Cumulative rates of clinical success were 81.9 %, 80.7 %, 77.9 %, 75.2 %, 72.0 %, 72.0 %, 72.0 % and 72.0 % at 1, 3, 6, 12, 18, 24, 30 and 36 months, respectively. There was one major complication. CONCLUSIONS: PAE is a procedure with good results for BPH patients with moderate to severe LUTS after failure of medical therapy. KEY POINTS: • Prostatic artery embolisation offers minimally invasive therapy for benign prostatic hyperplasia. • Prostatic artery embolisation is a challenging procedure because of vascular anatomical variations. • PAE is a promising new technique that has shown good results.

Does polyvinyl alcohol particle size change the outcome of prostatic arterial embolization for benign prostatic hyperplasia? Results from a single-center randomized prospective study.

PURPOSE: To evaluate whether different polyvinyl alcohol (PVA) particle sizes change the outcome of prostatic arterial embolization (PAE) for benign prostatic hyperplasia (BPH). MATERIALS AND METHODS: A randomized prospective study was undertaken in 80 patients (mean age, 63.9 y; range, 48-81 y) with symptomatic BPH undergoing PAE between May and December 2011. Forty patients underwent PAE with 100-µm (group A) and 200-µm PVA particles (group B). Visual analog scales were used to measure pain, and rates of adverse events were recorded. PAE outcomes were evaluated based on International Prostate Symptom Score (IPSS) and quality-of-life (QoL) questionnaires, prostate volume (PV), prostate-specific antigen (PSA) levels, and peak flow rate measurements at baseline and 6 months. RESULTS: No differences between groups regarding baseline data, procedural details, or adverse events were noted. Mean pain scores were as follows: during embolization, 3.2 ± 2.97 (group A) versus 2.93 ± 3.28 (group B); after embolization, 0.10 ± 0.50 (group A) versus 0 (group B; P = .20); and the week after PAE, 0.85 ± 1.65 (group A) versus 0.87 ± 1.35 (group B; P = .96). Patients in group B had greater decreases in IPSS (3.64 points; P = .052) and QoL (0.57 points; P = .07). Patients in group A had a greater decrease in PV (8.75 cm(3); P = .13) and PSA level (2.09 ng/mL; P < .001). CONCLUSIONS: No significant differences were found in pain scores and adverse events between groups. Whereas PSA level and PV showed greater reductions after PAE with 100-µm PVA particles, clinical outcome was better with 200-µm particles.

Quantitative and Qualitative Changes in Diet Associated with the Consumption of Ultra-Processed Foods: A Survey on a Representative Sample of Manufacturing Workers in Brazil.

The increasing intake of ultra-processed (UP) foods is causing changes in the profile of food and nutrient consumption, negatively influencing consumer behavior. The present study aimed to evaluate the influence of UP foods on the diet of Brazilian adults, verifying the association between its increasing contribution to total energy and trends in the consumption of other NOVA groups, food subgroups, energy consumption, and macro- and micronutrients. We conducted an observational, cross-sectional study of a probability sample of 921 manufacturing workers in the state of Rio Grande do Norte, Brazil, from a combined stratified and two-stage survey. Trends in consumption across quintiles of UP food contribution to the total energy intake were tested with linear regression. The results showed that higher UP food consumption is associated with a higher intake of energy, carbohydrates and total-, mono- and polyunsaturated fats, saturated fats and trans fats, and the micronutrients calcium, iron and thiamine; and higher consumption of ready-to-eat foods, accompanied by lower consumption of foods that require preparation, such as beans, tubers and roots, vegetables and fruits, which may represent a risk for the development of non-transmissible chronic diseases in this population.

Prostatic arterial supply: anatomic and imaging findings relevant for selective arterial embolization.

PURPOSE: To describe the anatomy and imaging findings of the prostatic arteries (PAs) on multirow-detector pelvic computed tomographic (CT) angiography and digital subtraction angiography (DSA) before embolization for symptomatic benign prostatic hyperplasia (BPH). MATERIALS AND METHODS: In a retrospective study from May 2010 to June 2011, 75 men (150 pelvic sides) underwent pelvic CT angiography and selective pelvic DSA before PA embolization for BPH. Each pelvic side was evaluated regarding the number of independent PAs and their origin, trajectory, termination, and anastomoses with adjacent arteries. RESULTS: A total of 57% of pelvic sides (n = 86) had only one PA, and 43% (n = 64) had two independent PAs identified (mean PA diameter, 1.6 mm ± 0.3). PAs originated from the internal pudendal artery in 34.1% of pelvic sides (n = 73), from a common trunk with the superior vesical artery in 20.1% (n = 43), from the anterior common gluteal-pudendal trunk in 17.8% (n = 38), from the obturator artery in 12.6% (n = 27), and from a common trunk with rectal branches in 8.4% (n = 18). In 57% of pelvic sides (n = 86), anastomoses to adjacent arteries were documented. There were 30 pelvic sides (20%) with accessory pudendal arteries in close relationship with the PAs. No correlations were found between PA diameter and patient age, prostate volume, or prostate-specific antigen values on multivariate analysis with logistic regression. CONCLUSIONS: PAs have highly variable origins between the left and right sides and between patients, and most frequently arise from the internal pudendal artery.

A subjective cognitive impairment scale for migraine attacks. The MIG-SCOG: development and validation.

BACKGROUND: The burden of migraine is determined by impairment during attacks due to pain or non-painful symptoms such as cognitive symptoms. OBJECTIVE: Development of a questionnaire to measure self-reported subjective cognitive symptoms during migraine attacks. METHODS: Item generation was accomplished through structured patient interviews analysed by a panel of experts. A set of 43 candidate items was applied to consecutive migraine patients. Test construction with factor analysis retained nine items. Internal consistency was assessed with Cronbach's alpha and Spearman's rho, and convergent and construct validity by correlation to spontaneous cognitive complaints, and the 43-item and the Cognitive Failures Questionnaires. RESULTS: The nine-item Mig-SCog covers two domains, executive functions and language. Cronbach's alpha was 0.82. It correlates with spontaneous cognitive complaints (p < 0.001), the 43-item (rho = 0.69) and the Cognitive Failures Questionnaires (rho = 0.61). Test-retest reliability (Cohen's kappa) was 0.55. CONCLUSIONS: Mig-SCog is a valid, reliable, consistent working instrument of fast self-administration that quantifies subjective cognitive symptoms during migraine attacks.

Polyvinyl alcohol particle size for uterine artery embolization: a prospective randomized study of initial use of 350-500 µm particles versus initial use of 500-700 µm particles.

PURPOSE: To evaluate whether different polyvinyl alcohol (PVA) particle sizes change the outcome of uterine artery embolization (UAE). MATERIALS AND METHODS: This randomized prospective study comprised 160 patients with symptomatic leiomyomas undergoing UAE with PVA particles from January to August 2008. In 80 patients in group A, UAE was started with 350-500 µm particles; in 80 patients in group B, UAE was started with 500-700 µm particles. UAE was finished with larger particles when necessary (500-700 µm and 700-900 µm for group A; 700-900 µm for group B). Visual analogue scales were used to measure pain during and in the 4-8 hours after embolization. The outcome of UAE was evaluated at 6 months by pelvic magnetic resonance (MR) imaging, clinical observation, and response to questionnaires. RESULTS: In group A, PVA particle sizes were as follows: 350-500 µm in 45 patients; 350-500 µm and 500-700 µm in 24 patients; and 350-500 µm, 500-700 µm, and 700-900 µm in 11 patients. In group B, PVA particle sizes were as follows: 500-700 µm in 66 patients and 500-700 µm and 700-900 µm in 14 patients. Mean pain scores during embolization were 1.44 (group A) and 0.97 (group B); after embolization, mean pain scores were 4.71 (group A) and 3.42 (group B) (P < .0001). At 6 months, there were no statistically significant differences in decrease in size of uterus and dominant leiomyoma, in dominant leiomyoma ischemia (P = .31; P = .32), or in the clinical outcome between the two groups. CONCLUSIONS: The initial use of PVA particle sizes 350-500 µm was associated with a higher mean pain score during and after UAE, although the outcome at 6 months was similar compared with the initial use of particle sizes 500-700 µm.

Prostatic arterial embolization to treat benign prostatic hyperplasia.

PURPOSE: To evaluate whether prostatic arterial embolization (PAE) might be a feasible procedure to treat lower urinary tract symptoms associated with benign prostatic hyperplasia (BPH). MATERIALS AND METHODS: Fifteen patients (age range, 62-82 years; mean age, 74.1 y) with symptomatic BPH after failure of medical treatment were selected for PAE with nonspherical 200-µm polyvinyl alcohol particles. The procedure was performed by a single femoral approach. Technical success was considered when selective prostatic arterial catheterization and embolization was achieved on at least one pelvic side. RESULTS: PAE was technically successful in 14 of the 15 patients (93.3%). There was a mean follow-up of 7.9 months (range, 3-12 months). International Prostate Symptom Score decreased a mean of 6.5 points (P = .005), quality of life improved 1.14 points (P = .065), International Index of Erectile Function increased 1.7 points (P = .063), and peak urinary flow increased 3.85 mL/sec (P = .015). There was a mean prostate-specific antigen reduction of 2.27 ng/mL (P = .072) and a mean prostate volume decrease of 26.5 mL (P = .0001) by ultrasound and 28.9 mL (P = .008) by magnetic resonance imaging. There was one major complication (a 1.5-cm(2) ischemic area of the bladder wall) and four clinical failures (28.6%). CONCLUSIONS: In this small group of patients, PAE was a feasible procedure, with preliminary results and short-term follow-up suggesting good symptom control without sexual dysfunction in suitable candidates, associated with a reduction in prostate volume.

Hepatic steatosis in hepatitis B virus infected patients: meta-analysis of risk factors and comparison with hepatitis C infected patients.

BACKGROUND AND AIMS: Although hepatic steatosis (HS) has an association with hepatitis C virus (HCV) infection, an association with hepatitis B virus (HBV) is controversial. We performed a meta-analysis to evaluate HS prevalence and risk factors, in HBV infection. METHODS: Standard guidelines for performance of meta-analyses were followed. Studies with HS assessed by histology were included. Pooled odd ratios (OR) and standardized mean differences (SMD) were obtained with the random-effects model and DerSimonian-Laid method. RESULTS: Seventeen out of 21 studies were included, comprising 4100 HBV infected patients. Overall HS prevalence was 29.6%. Eight studies also included 945 HCV infected patients, showing decreased risk of HS in HBV versus HCV patients (OR 0.55, 95%CI [0.45-0.67], P < 0.001). In HBV, HS positively associated with male gender (OR 1.74, 95%CI [1.28-2.38], P < 0.001), body mass index (SMD 2.17, 95%CI [1.23, 3.11], P < 0.001), obesity (OR 6.59, 95%CI [3.51-12.257], P = 0.003), diabetes (OR 2.62, 95%CI [1.37-4.00], P = 0.004), glycemia (SMD 0.84, 95%CI [0.00, 1.67], P = 0.049), triglycerides (SMD 1.18, 95%CI [0.48, 1.89], P = 0.001), cholesterol (SMD 0.88, 95%CI [0.31, 1.45], P = 0.003), moderate alcohol consumption (OR 1.54, 95%CI [1.10-2.15], P = 0.011) and negatively with HBV DNA (SMD -74.12, 95%CI [-82.93, -65.31], P < 0.001). HS had no association with aminotransferases, HBeAg, genotype or hepatic histology, necroinflammation or fibrosis. CONCLUSION: HS in HBV seems to be as frequent as in the general population, and lower than in HCV infected patients, relating to metabolic factors but not with hepatic histology severity. A puzzling strong negative association between viral load and HS, may even suggest a protective effect of the virus on HS.