A multi-task convolutional neural network for classification and segmentation of chronic venous disorders.

Chronic Venous Disorders (CVD) of the lower limbs are one of the most prevalent medical conditions, affecting 35% of adults in Europe and North America. Due to the exponential growth of the aging population and the worsening of CVD with age, it is expected that the healthcare costs and the resources needed for the treatment of CVD will increase in the coming years. The early diagnosis of CVD is fundamental in treatment planning, while the monitoring of its treatment is fundamental to assess a patient's condition and quantify the evolution of CVD. However, correct diagnosis relies on a qualitative approach through visual recognition of the various venous disorders, being time-consuming and highly dependent on the physician's expertise. In this paper, we propose a novel automatic strategy for the joint segmentation and classification of CVDs. The strategy relies on a multi-task deep learning network, denominated VENet, that simultaneously solves segmentation and classification tasks, exploiting the information of both tasks to increase learning efficiency, ultimately improving their performance. The proposed method was compared against state-of-the-art strategies in a dataset of 1376 CVD images. Experiments showed that the VENet achieved a classification performance of 96.4%, 96.4%, and 97.2% for accuracy, precision, and recall, respectively, and a segmentation performance of 75.4%, 76.7.0%, 76.7% for the Dice coefficient, precision, and recall, respectively. The joint formulation increased the robustness of both tasks when compared to the conventional classification or segmentation strategies, proving its added value, mainly for the segmentation of small lesions.

StressMatic: A Novel Automated System to Induce Depressive- and Anxiety-like Phenotype in Rats.

Major depressive disorder (MDD) is a multidimensional psychiatric disorder that is estimated to affect around 350 million people worldwide. Generating valid and effective animal models of depression is critical and has been challenging for neuroscience researchers. For preclinical studies, models based on stress exposure, such as unpredictable chronic mild stress (uCMS), are amongst the most reliable and used, despite presenting concerns related to the standardization of protocols and time consumption for operators. To overcome these issues, we developed an automated system to expose rodents to a standard uCMS protocol. Here, we compared manual (uCMS) and automated (auCMS) stress-exposure protocols. The data shows that the impact of the uCMS exposure by both methods was similar in terms of behavioral (cognition, mood, and anxiety) and physiological (cell proliferation and endocrine variations) measurements. Given the advantages of time and standardization, this automated method represents a step forward in this field of preclinical research.

Study of the compression behavior of functionally graded lattice for customized cranial remodeling orthosis.

Deformational plagiocephaly is a head deformity that occurs in newborns, treated in severe cases with helmets named cranial remodeling orthoses (CRO). Current CROs can fail to adapt to head growth, causing excessive pressure sores and other complications, and may lead to poor clinical results. In this work, we experimentally and numerically study the compressive behavior of a functionally graded lattice that may be used in future work as a potential inner lining for a CRO with a customized density distribution. This work is divided into five stages. First, we describe the design of all lattices involved in the study. Second, we measure the mechanical properties of the bulk material used in the manufacturing of the lattices. Third, we study the effect of unit cell size variation, testing three homogenous body-centered cubic (BCC) lattices, and creating a numerical model for the prediction of the compressive behavior of various lattices with different unit cell sizes. Fourth, we study the effects of truss diameter variation, designing and testing three homogenous lattices with different truss diameters. Finally, we design a BCC lattice with a truss diameter gradient and analyze compressive deformations in numerical and experimental compression studies. The numerical simulations of the compression of the homogenous and graded lattices agree with the experimental measurements, both in unit cell variation and in truss diameter variation. In the graded lattice, the compression displacements observed in each region are proportional to their density and agree with the numerical simulation. Truss diameter variation was found to have a wider range of compressive responses than unit cell size variation without major changes in the overall geometry of the lattice and found more suitable for the intended application. The studies showed the potential of the functionally graded lattice for use in the CRO.

3D Facial Landmark Localization for cephalometric analysis.

Cephalometric analysis is an important and routine task in the medical field to assess craniofacial development and to diagnose cranial deformities and midline facial abnormalities. The advance of 3D digital techniques potentiated the development of 3D cephalometry, which includes the localization of cephalometric landmarks in the 3D models. However, manual labeling is still applied, being a tedious and time-consuming task, highly prone to intra/inter-observer variability. In this paper, a framework to automatically locate cephalometric landmarks in 3D facial models is presented. The landmark detector is divided into two stages: (i) creation of 2D maps representative of the 3D model; and (ii) landmarks' detection through a regression convolutional neural network (CNN). In the first step, the 3D facial model is transformed to 2D maps retrieved from 3D shape descriptors. In the second stage, a CNN is used to estimate a probability map for each landmark using the 2D representations as input. The detection method was evaluated in three different datasets of 3D facial models, namely the Texas 3DFR, the BU3DFE, and the Bosphorus databases. An average distance error of 2.3, 3.0, and 3.2 mm were obtained for the landmarks evaluated on each dataset. The obtained results demonstrated the accuracy of the method in different 3D facial datasets with a performance competitive to the state-of-the-art methods, allowing to prove its versability to different 3D models. Clinical Relevance- Overall, the performance of the landmark detector demonstrated its potential to be used for 3D cephalometric analysis.

Anthropometric Landmarking for Diagnosis of Cranial Deformities: Validation of an Automatic Approach and Comparison with Intra- and Interobserver Variability.

Shape analysis of infant's heads is crucial to diagnose cranial deformities and evaluate head growth. Currently available 3D imaging systems can be used to create 3D head models, promoting the clinical practice for head evaluation. However, manual analysis of 3D shapes is difficult and operator-dependent, causing inaccuracies in the analysis. This study aims to validate an automatic landmark detection method for head shape analysis. The detection results were compared with manual analysis in three levels: (1) distance error of landmarks; (2) accuracy of standard cranial measurements, namely cephalic ratio (CR), cranial vault asymmetry index (CVAI), and overall symmetry ratio (OSR); and (3) accuracy of the final diagnosis of cranial deformities. For each level, the intra- and interobserver variability was also studied by comparing manual landmark settings. High landmark detection accuracy was achieved by the method in 166 head models. A very strong agreement with manual analysis for the cranial measurements was also obtained, with intraclass correlation coefficients of 0.997, 0.961, and 0.771 for the CR, CVAI, and OSR. 91% agreement with manual analysis was achieved in the diagnosis of cranial deformities. Considering its high accuracy and reliability in different evaluation levels, the method showed to be feasible for use in clinical practice for head shape analysis.

Anthropometric Landmark Detection in 3D Head Surfaces Using a Deep Learning Approach.

Landmark labeling in 3D head surfaces is an important and routine task in clinical practice to evaluate head shape, namely to analyze cranial deformities or growth evolution. However, manual labeling is still applied, being a tedious and time-consuming task, highly prone to intra-/inter-observer variability, and can mislead the diagnose. Thus, automatic methods for anthropometric landmark detection in 3D models have a high interest in clinical practice. In this paper, a novel framework is proposed to accurately detect landmarks in 3D infant's head surfaces. The proposed method is divided into two stages: (i) 2D representation of the 3D head surface; and (ii) landmark detection through a deep learning strategy. Moreover, a 3D data augmentation method to create shape models based on the expected head variability is proposed. The proposed framework was evaluated in synthetic and real datasets, achieving accurate detection results. Furthermore, the data augmentation strategy proved its added value, increasing the method's performance. Overall, the obtained results demonstrated the robustness of the proposed method and its potential to be used in clinical practice for head shape analysis.

Technical Note: Assessment of electromagnetic tracking systems in a surgical environment using ultrasonography and ureteroscopy instruments for percutaneous renal access.

PURPOSE: Electromagnetic tracking systems (EMTSs) have been proposed to assist the percutaneous renal access (PRA) during minimally invasive interventions to the renal system. However, the influence of other surgical instruments widely used during PRA (like ureteroscopy and ultrasound equipment) in the EMTS performance is not completely known. This work performs this assessment for two EMTSs [Aurora® Planar Field Generator (PFG); Aurora® Tabletop Field Generator (TTFG)]. METHODS: An assessment platform, composed by a scaffold with specific supports to attach the surgical instruments and a plate phantom with multiple levels to precisely translate or rotate the surgical instruments, was developed. The median accuracy and precision in terms of position and orientation were estimated for the PFG and TTFG in a surgical environment using this platform. Then, the influence of different surgical instruments (alone or together), namely analogic flexible ureterorenoscope (AUR), digital flexible ureterorenoscope (DUR), two-dimensional (2D) ultrasound (US) probe, and four-dimensional (4D) mechanical US probe, was assessed for both EMTSs by coupling the instruments to 5-DOF and 6-DOF sensors. RESULTS: Overall, the median positional and orientation accuracies in the surgical environment were 0.85 mm and 0.42° for PFG, and 0.72 mm and 0.39° for TTFG, while precisions were 0.10 mm and 0.03° for PFG, and 0.20 mm and 0.12° for TTFG, respectively. No significant differences were found for accuracy between EMTSs. However, PFG showed a tendency for higher precision than TTFG. AUR, DUR, and 2D US probe did not influence the accuracy and precision of both EMTSs. In opposition, the 4D probe distorted the signal near the attached sensor, making readings unreliable. CONCLUSIONS: Ureteroscopy- and ultrasonography-assisted PRA based on EMTS guidance are feasible with the tested AUR or DUR together with the 2D probe. More studies must be performed to evaluate the probes and ureterorenoscopes' influence before their use in PRA based on EMTS guidance.

High-density lipoprotein-cholesterol functionality and metabolic syndrome: Protocol for review and meta-analysis.

INTRODUCTION: The prevalence of metabolic syndrome (MetS) and MetS-related stroke is set to increase dramatically in coming decades. MetS is a complex disease that includes endothelial dysfunction, insulin resistance, diabetes, hypertension, ectopic obesity, and dyslipidaemia and an increased risk of cardiovascular events. One function of high-density lipoprotein (HDL) cholesterol (HDL-C) is the cholesterol-efflux pathway, which is the pathway where cholesterol is removed from macrophages within the arterial walls back into the bloodstream and out to the liver. As one of the key functions of HDL, their hypothesis was that if they could measure HDL-C-efflux capacity, they would have a better handle on the role of HDL in atherosclerosis. However, there are no systematic analyses or well-conducted meta-analyses to evaluate the relationship between HDL-C functionality and MetS. The aim of this study is to examine this association of HDL-C functionality with MetS in different ages and sex. METHODS AND ANALYSIS: The update systematic review and meta-analysis will be conducted using published studies that will be identified from electronic databases (i.e., PubMed, EMBASE, Web of Science, and Google Scholar). Studies that examined the association between HDL-C functionality and MetS; focused on cohort, case-control, and cross-sectional studies; were conducted among in adults aged 40 to 70 years; provided sufficient data for calculating odds ratio or relative risk with a 95% confidence interval; were published as original articles written in English or other languages; and have been published until January 2018 will be included. Study selection, data collection, quality assessment, and statistical syntheses will be conducted based on discussions among investigators. ETHICS AND DISSEMINATION: Ethics approval was not required for this study because it was based on published studies. The results and findings of this study will be submitted and published in a scientific peer-reviewed journal. TRIAL REGISTRATION NUMBER: PROSPERO (CRD42018083465).

Epicardial adipose tissue and carotid artery disease: Protocol for systematic review and meta-analysis.

BACKGROUND: Atherosclerosis is now widely recognized as a multifactorial disease with outcomes that arise from complex factors such as plaque components, blood flow, and inflammation. Epicardial adipose tissue (EAT) is a metabolically active fat depot, abundant in proinflammatory cytokines, and has been correlated with the extent and severity of carotid artery disease (CD). The locations most frequently affected by carotid atherosclerosis are the proximal internal carotid artery (ie, the origin) and the common carotid artery bifurcation. Progression of atheromatous plaque at the carotid bifurcation results in luminal narrowing, often accompanied by ulceration. However, there are no systematic analyses or well-conducted meta-analyses to evaluate the relationship between EAT and CD. The aim of this study is to examine this association of EAT with CD in different ages and sex. METHODS: This systematic review and meta-analysis will be conducted using published studies that will be identified from electronic databases (ie, PubMed, EMBASE, Web of Science, and Google Scholar. Studies that (1) examined the association between EAT and CD, (2) focus on cohort, case-control and cross-sectional studies, (3) will conducted among in adults aged 40 to 70 years, (4) provided sufficient data for calculating ORs or relative risk with a 95% CI, (5) will published as original articles written in English or other languages, and (6) have been published until January 2018 will be included. Study selection, data collection, quality assessment and statistical syntheses will be conducted based on discussions among investigators. RESULTS: We propose the current protocol to evaluate the evaluation of EAT with ED. CONCLUSION: This systematic review will not need ethical approval, because it does not involve human beings. The results and findings of this study will be submitted and published in a scientific peer-reviewed journal. ETHICS AND DISSEMINATION: Ethics approval was not required for this study because it was based on published studies. The results and findings of this study will be submitted and published in a scientific peer-reviewed journal. TRIAL REGISTRATION NUMBER: PROSPERO (CRD42018083458).

Statins in adult patients with HIV: Protocol for a systematic review and network meta-analysis.

BACKGROUND: Patients with HIV have been found to suffer from lipid abnormalities, including elevated levels of total and LDL-cholesterol as well as triglyceride levels. Abnormal lipid levels are associated with an increased risk of developing cardiovascular diseases, which are significant causes of mortality among the general population. Therefore, the objective of the current study is to conduct a systematic review with network meta-analysis to compare the effects of statins classes on HIV patients. METHODS: Randomized clinical trials (RCTs) and observational studies published in English up to 31 December 2017, and which include direct and/or indirect evidence, will be included. Studies will be retrieved by searching four electronic databases and cross-referencing. Dual selection and abstraction of data will occur. The primary outcome will all-cause mortality, new event of acute myocardial infarction, stroke (hemorrhagic and ischemic), hospitalization for acute coronary syndrome and urgent revascularization procedures and cardiovascular mortality. Secondary outcomes will be assessment of the differences in change of total cholesterol (TC), low-density lipoprotein (LDL-C), apolipoprotein B (ApoB), high density lipoprotein (HDL-C). Risk of bias will be assessed using the Cochrane Risk of Bias assessment instrument for RCTs and the Strengthening the Reporting of Observational Studies in Epidemiology instrument for observational studies. Network meta-analysis will be performed using multivariate random-effects meta-regression models. The surface under the cumulative ranking curve will be used to provide a hierarchy of statins that reduce cardiovascular mortality in HIV patients. A revised version of the Cochrane Risk of Bias tool (RoB 2.0) will be used to assess the risk of bias in eligible RCTs. Results will be synthesized and analyzed using network meta-analysis (NMA). Overall strength of the evidence and publication bias will be evaluated. Subgroup and sensitivity analysis will also be performed. RESULTS AND CONCLUSION: Ethics approval was not required for this study because it was based on published studies. The results and findings of this study will be submitted and published in a scientific peer-reviewed journal. The evidence will determine which combination of interventions are most promising for current practice and further investigation. TRIAL REGISTRATION NUMBER: PROSPERO (CRD42017072996).

Epicardial adipose tissue and metabolic syndrome: An update protocol for systematic review and meta-analysis.

BACKGROUND: The prevalence of metabolic syndrome (MetS) and MetS-related stroke is set to increase dramatically in coming decades. MetS is a complex disease that includes endothelial dysfunction, insulin resistance, diabetes, hypertension, ectopic obesity, and dyslipidaemia, and an increased risk of cardiovascular events. However, there are no systematic analyses, or well-conducted meta-analyses to evaluate the relationship between epicardial adipose tissue (EAT) and (MetS). The aim of this study is to examine this association of EAT with MetS in different ages and sex. METHODS: The update systematic review, and meta-analysis will be conducted using published studies that will be identified from electronic databases (ie, PubMed, EMBASE, Web of Science, and Google Scholar. Studies that firstly, examined the association between EAT and MetS, secondly, focus on cohort, case-control, and cross-sectional studies, thirdly, were conducted among in adults aged between 40 and 70 years, fourth, provided sufficient data for calculating ORs or relative risk with a 95% CI, fifth, were published as original articles written in English or other languages, and sixth, have been published until January year 2018 will be included. Study selection, data collection, quality assessment, and statistical syntheses will be conducted based on discussions among investigators. RESULTS: Ethics approval was not required for this study because it was based on published studies. The results and findings of this study will be submitted and published in a scientific peer-reviewed journal. This study will provide a high quality synthesis on the association of EAT and MetS. CONCLUSION: This systematic review will provide evidence to assess whether there is a strong association of EAT and MetS, and its components.

Metabolic syndrome and risk of stroke: Protocol for an update systematic review and meta-analysis.

INTRODUCTION: The metabolic syndrome is composed of several cardiovascular risk factors and has a high prevalence throughout the world. However, there are no systematic analyses or well-conducted meta-analyses to evaluate the relationship between metabolic syndrome and stroke. The aim of this study is to examine this association of metabolic syndrome with stroke in different ages and sex. METHODS AND ANALYSIS: The update systematic review and meta-analysis will be conducted using published studies that will be identified from electronic databases (i.e., PubMed, EMBASE, Web of Science, and Google Scholar. Studies that examined the association between metabolic syndrome and stroke, had a longitudinal or prospective cohort design, were conducted among in adults aged 40 to 70 years, provided sufficient data for calculating ORs or relative risk with a 95% CI, were published as original articles written in English or other languages, and have been published until December 2017 will be included. Study selection, data collection, quality assessment, and statistical syntheses will be conducted based on discussions among investigators. ETHICS AND DISSEMINATION: Ethics approval was not required for this study because it was based on published studies. The results and findings of this study will be submitted and published in a scientific peer-reviewed journal. The findings from this study could be useful for assessing metabolic syndrome risk factors in stroke, and determining approaches for prevention of stroke in the future.

Development of a patient-specific atrial phantom model for planning and training of inter-atrial interventions.

BACKGROUND: Several authors have presented cardiac phantoms to mimic the particularities of the heart, making it suitable for medical training and surgical planning. Although the initial models were mainly focused on the ventricles, personalized phantoms of the atria were recently presented. However, such models are typically rigid, the atrial wall is not realistic and they are not compatible with ultrasound (US), being sub-optimal for planning/training of several interventions. METHODS: In this work, we propose a strategy to construct a patient-specific atrial model. Specifically, the target anatomy is generated using a computed tomography (CT) dataset and then constructed using a mold-cast approach. An accurate representation of the inter-atrial wall (IAS) was ensured during the model generation, allowing its application for IAS interventions. Two phantoms were constructed using different flexible materials (silicone and polyvinyl alcohol cryogel, PVA-C), which were then compared to assess their appropriateness for US acquisition and for the generation of complex anatomies. RESULTS: Two experiments were set up to validate the proposed methodology. First, the accuracy of the manufacturing approach was assessed through the comparison between a post-production CT and the virtual references. The results proved that the silicone-based model was more accurate than the PVA-C-based one, with an error of 1.68 ± 0.79, 1.36 ± 0.94, 1.45 ± 0.77 mm for the left (LA) and right atria (RA) and IAS, respectively. Second, an US acquisition of each model was performed and the obtained images quantitatively and qualitatively assessed. Both models showed a similar performance in terms of visual evaluation, with an easy detection of the LA, RA, and the IAS. Furthermore, a moderate accuracy was obtained between the atrial surfaces extracted from the US and the ideal reference, and again a superior performance of the silicone-based model against the PVA-C phantom was observed. CONCLUSIONS: The proposed strategy proved to be accurate and feasible for the correct generation of complex personalized atrial models.

Clinical predictors of Crohn's disease course.

A modern approach to Crohn's disease (CD) should be influenced by the patient's underlying prognosis. Here, I analyse the clinical factors predicting CD course on the basis of information obtained at diagnosis and in the year following diagnosis. Perianal disease at diagnosis appears to be a strong predictor of unfavourable outcome and has been associated with a more frequent use of immunosuppressive treatment. Early age at diagnosis, ileocolonic disease and extraintestinal manifestations are characteristics of patients at risk for more complicated disease. Otherwise, patients subjected to surgery at diagnosis or during the first year of follow-up appear to have a relatively benign outcome. Disease activity in the year after diagnosis appears to be a good predictor of future disease activity as about two-third of the patients who remain in remission tend to remain unchanged thereafter, whereas those patients treated with steroids have, manifestly, an unfavourable subsequent clinical course. Moreover, there is consistent evidence that active smoking is associated with a complicated disease course. The results of the studies reviewed suggest that the combination of 'phenotype at diagnosis' and 'comportment follow-up classification' in the year following diagnosis can be potentially useful prognostic factors in clinical practice. With the development of newer therapies in CD, there is a growing need to predict disease outcome, despite the difficult challenge in anticipating the future clinical course in a given patient.

Abdominal Obesity and Association With Atherosclerosis Risk Factors: The Uberlândia Heart Study.

Ectopic visceral fat (VF) and subcutaneous fat (SCF) are associated with cardiovascular risk factors. Gender differences in the correlations of cardiovascular disease risk factors and ectopic fat in the Brazilian population still lacking. Cross-sectional study with 101 volunteers (50.49% men; mean age 56.5 ±â€Š18, range 19-74 years) drawn from the Uberlândia Heart Study underwent ultrasonography assessment of abdominal visceral adipose tissue with convex transducer of 3.5 MHz of frequency. The thickness of VF was ultrasonographically measured by the distance between the inner face of the abdominal muscle and the posterior face of abdominal aorta, 1 cm above the umbilicus. The SCF thickness was measured with a 7.5 MHz linear transducer transversely positioned 1 cm above the umbilical scar. The exams were always performed by the same examiner. Ectopic fat volumes were examined in relation to waist circumference, blood pressure, and metabolic risk factors. The VF was significantly associated with the levels of triglycerides (P < 0.01, r = 0.10), HDL cholesterol (P < 0.005, r = 0.15), total cholesterol (P < 0.01, r = 0.10), waist circumference (P < 0.0001, r = 0.43), systolic blood pressure (P < 0.001, r = 0.41), and diastolic blood pressure (P < 0.001, r = 0.32) in women, and with the levels of triglycerides (P < 0.002, r = 0,14), HDL cholesterol (P < 0.032, r = 0.07), glucose (P < 0.001, r = 0.15), alanine aminotransferase (ALT) (P < 0.008, r = 0.12), gamma-GT (P < 0.001, r = 0.30), waist circumference (P < 0.001, r = 0.52), systolic blood pressure (P < 0.001, r = 0.32), and diastolic blood pressure (P < 0.001, r = 0.26) in men. SCF was significantly associated with the levels of triglycerides (P < 0.01, r = 0.34), LDL cholesterol (P < 0.001, r = 0.36), total cholesterol (P < 0.05, r = 0.36), waist circumference (P < 0.0001, r = 0.62), systolic and diastolic blood pressure (P < 0.05, r = 0.34) in women, and with the waist circumference (P < 0.001, r = 0.065)), and MetS (P < 0.05, r = 0.11) in men. The VF and SCF were correlated with most cardiovascular risk factors in both genders but our findings support the idea that there are gender differences in the correlations between ectopic fat deposition and the cardiovascular risk factors.

NOD2/CARD15 and TNFA, but not IL1B and IL1RN, are associated with Crohn's disease.

BACKGROUND: NOD2/CARD15 was described as the first susceptibility gene to Crohn's disease (CD). Polymorphisms in the TNFA gene and in the IL1 gene cluster, which are associated with an enhanced chronic inflammatory response, may also play a role in the development of CD. The aim of this study was to determine the association of polymorphisms in the CARD15, TNFA, IL1B, and IL1RN genes with risk of development of CD and with the clinicopathological profile of CD patients. METHODS: In a case-control study including 235 CD patients and 312 controls (929 controls for TNFA genotyping), the CARD15 (R702W, G908R, and 1007fs), TNFA (-308G/A and -857C/T), IL1B (-511C/T), and IL1RN (intron 2 variable number of tandem repeats) polymorphisms were genotyped. RESULTS: We observed a significant association between CD and the CARD15 polymorphisms, with an odds ratio (OR) of 2.9 [95% confidence interval (CI), 1.9 to 4.6] for carriers of 1 variant allele and an OR of 11.8 (95% CI, 3.5 to 40.4) for carriers of 2 variant alleles. Patients with CARD15 polymorphisms had more frequently ileal or ileocolonic disease location, stricturing phenotype, abdominal surgery, and no extraintestinal manifestations. The TNFA-308A/A genotype was associated with susceptibility to CD with an OR of 3.0 (95% CI, 1.2 to 7.2). TNFA-308A/A homozygotes showed a higher frequency of erythema nodosum and arthritis, colonic disease location, and absence of abdominal surgery. No associations were found with the TNFA-857, IL1B-511, and the IL1RN VNTR polymorphisms. CONCLUSIONS: These findings suggest that CARD15 and TNFA-308 genetic polymorphisms are associated with increased risk of CD displaying distinct clinicopathological profiles.

Perirenal Fat and Association With Metabolic Risk Factors: The Uberlândia Heart Study.

Perirenal fat (PRF) is associated with cardiovascular risk factors. Gender differences in the correlations of cardiovascular disease risk factors and PRF in the Brazilian population are lacking.Cross-sectional study with 101 (50.49% men; mean age 56.5 ±â€Š18, range 19-74 years) drawn from the Uberlândia Heart Study underwent ultrasonography assessment of abdominal adipose. For the PRF, a 3.5 MHz transducer was measured in the middle third of the right kidney, with the transducer positioned at the axillary midline. The examinations were always performed by the same examiner. The PRF thickness was examined in relation to waist circumference, blood pressure, and metabolic risk factors. The PRF was significantly associated with the levels of gamma-glutamyl transferase (P < 0.05, r = 0.08), fasting plasma glucose (P < 0.05, r = 0.07), waist circumference (P < 0.05, r = 0.10), and metabolic syndrome (P < 0.001, r = 0.38) in men, and with the levels of fasting plasma glucose (P < 0.05) in women.The PRF was correlated with most cardiovascular risk factors in men and only in glucose at the women.

Extraintestinal manifestations of inflammatory bowel disease: do they influence treatment and outcome?

Crohn's disease and ulcerative colitis are chronic inflammatory bowel diseases that often involve organs other than those of the gastrointestinal tract. Immune-related extraintestinal manifestations (EIMs) are usually related to disease activity, but sometimes may take an independent course. Globally, about one third of patients develop these systemic manifestations. Phenotypic classification shows that certain subsets of patients are more susceptible to developing EIMs, which frequently occur simultaneously in the same patient overlapping joints, skin, mouth, and eyes. The clinical spectrum of these manifestations varies from mild transitory to very severe lesions, sometimes more incapacitating than the intestinal disease itself. The great majority of these EIMs accompany the activity of intestinal disease and patients run a higher risk of a severe clinical course. For most of the inflammatory EIMs, the primary therapeutic target remains the bowel. Early aggressive therapy can minimize severe complications and maintenance treatment has the potential to prevent some devastating consequences.