Reliability and Validity of Digital Images to Assess Child Dietary Intake in a Quick-Service Restaurant Setting.

BACKGROUND: Development of methods to accurately measure dietary intake in free-living situations-restaurants or otherwise-is critically needed to understand overall dietary patterns. OBJECTIVE: This study aimed to develop and test reliability and validity of digital images (DI) for measuring children's dietary intake in quick-service restaurants (QSRs), validating against weighed plate waste (PW) and bomb calorimetry (BC). DESIGN: In 2016, cross-sectional data were collected at two time points within a randomized controlled trial assessing children's leftovers in QSRs from parents of 4- to 12-year-old children. PARTICIPANTS/SETTING: Parents (n = 640; mean age = 35.9 y; 70.8% female) consented and agreed to provide their child's PW for digital imaging, across 11 QSRs in Massachusetts in areas with low socioeconomic status and ethnically diverse populations. OUTCOME MEASURES: Outcome measures were interrater reliability for DIs, correspondence between methods for energy consumed and left over, and correspondence between methods across varying quantities of PW. ANALYSES PERFORMED: Intraclass correlations, percent agreement, Spearman correlations, Wilcoxon signed rank tests, and Bland-Altman plots were used. RESULTS: Interrater reliability ratings for DIs had substantial intraclass correlations (ICC = 0.94) but not acceptable exact percent agreement (80.2%); DI and PW energy consumed were significantly correlated (r = 0.96, P < 0.001); DI slightly underestimated energy consumed compared with PW (Mdiff = -1.61 kcals, P < 0.001). Bland-Altman plots showed high DI-PW correspondence across various energy amounts and revealed few outliers. Energy left over by BC was highly correlated with DI (r = 0.87, P < 0.001) and PW (r = 0.90, P < 0.001); and mean differences were not significantly different from DI (Mdiff = 9.77 kcal, P = 0.06) or PW (Mdiff = -2.84 kcal, P = 0.20). CONCLUSIONS: Correspondence was high between PW and DI assessments of energy consumed, and high with BC energy left over. Results demonstrate reliability and practical validity of digital images for assessing child meal consumption in QSR settings.

The Body Adiposity Index is not applicable to the Brazilian adult population.

Background: Obesity is a serious disease that burdens public health systems around the world. It is a risk factor for the development of several non-communicable chronic diseases that are related to the amount and distribution of body fat. Body composition assessment using simple and low-cost techniques can help in the early detection of excess fat, allowing for the prevention and treatment of both obesity and associated diseases. Thus, identifying and proposing valid anthropometric indices for this purpose can be a great ally of health programs. Objective: To verify the validity of the Body Adiposity Index (BAI) in relation to Dual Energy X-Ray Absorptiometry (DXA) for estimating body fat percentage in Brazilian adults, as well as to propose a new mathematical model to estimate the fat-free mass of this population. Methods: In a cross-sectional study, 424 subjects (of which 220 were women), aged between 20 and 59 years, were evaluated by BAI and DXA, then randomly divided into two groups stratified by sex: the development group (n = 283) and the cross-validation group (n = 141). Statistical analyses to test the validity of BAI as a predictor of fat mass, in addition to proposing a new mathematical model for estimating fat-free mass, using DXA as a reference method. The analysis included paired t-test, stepwise multiple regression, coefficient of concordance correlation, and Bland-Altman plots. Results: The BAI validity analysis showed a low correlation coefficient of agreement [CCC = 0.626; ρ (precision) = 0.795; Cb(accuracy) = 0.787]; in addition, the mean difference in the Bland-Altman plot was different from zero in the cross-validation group (p < 0.01) and limits of agreement (LOA) ranged between-8.0 and 14.4 kg, indicating a poor agreement between the BAI and the reference method. The new mathematical model for estimating FFM showed a high correlation coefficient of agreement (CCC = 0.952; ρ = 0.953; Cb = 0.999), in addition to acceptable LOA in the Bland-Altman plot (-6.7 and 6.7). Conclusion: In the studied sample, the BAI showed low validity for estimating body fat, while the new proposed model was found to be a good option to assess the body composition of Brazilian adults.

Association of Vitamin D Supplementation in Cardiorespiratory Fitness and Muscle Strength in Adult Twins: A Randomized Controlled Trial.

Although vitamin D is related to cardiorespiratory fitness and muscle strength, there is no evidence in the literature about the genetic influence of the response to vitamin D supplementation and improvements in these parameters. Therefore, we evaluate the effect of longitudinal supplementation of vitamin D on parameters of physical fitness in monozygotic twins. In total, 74 participants were included, with a mean age of 25 years, divided into two groups, one group received supplementation with cholecalciferol for 60 days and the other group did not. Cardiorespiratory fitness and muscle strength were measured before and after supplementation through maximal treadmill tests and dynamometry, respectively. Wilcoxon tests were used to compare intragroup results and the Mann-Whitney test to examine intergroup differences. There was an increase in the serum concentration of vitamin D in participants who ingested the supplementation. Cardiorespiratory fitness improved after supplementation through increases in the values of maximum oxygen consumption of 28% (p < .001). Muscle strength in left hand grip increased 18% in participants who received the supplement (p = .007). Sixty days of cholecalciferol supplementation improved cardiorespiratory fitness and upper limb muscle strength.

Genotypic and phenotypic diversity among Lactobacillus plantarum and Lactobacillus pentosus isolated from industrial scale cucumber fermentations.

The Lactobacillus plantarum and Lactobacillus pentosus genotypes existing in industrial-scale cucumber fermentations were defined using rep-PCR-(GTG)5. The ability of each genotype to ferment cucumbers under various conditions was evaluated. Rep-PCR-(GTG)5 was the technique capable of illustrating the most intraspecies discrimination compared to the sequencing of housekeeping genes (recA, dnaK, pheS and rpoA), MLST and RAPD with primers LP1, OPL5, M14 and COC. Ten genotypic clusters were defined for the 199 L. pentosus tested and three for the 17 L. plantarum clones. The ability of the 216 clones genotyped and 37 additional cucumber fermentation isolates, of the same species, to rapidly decrease the pH of cucumber juice medium under various combinations of sodium chloride (0 or 6%), initial pH (4.0 or 5.2) and temperatures (15 or 30 °C) was determined using a fractional factorial screening design. A reduced fermentation ability was observed for the L. plantarum strains as compared to L. pentosus, except for clone 3.2.8, which had a ropy phenotype and aligned to genotypic cluster A. L. pentosus strains belonging to three genotypic clusters (B, D and J) were more efficient in cucumber juice fermentation as compared to most L. plantarum strains. This research identified three genetically diverse L. pentosus strains and one L. plantarum as candidates for starter cultures for commercial cucumber fermentations.

The impact of vitamin D supplementation on VDR gene expression and body composition in monozygotic twins: randomized controlled trial.

Vitamin D supplementation is widely used. However, there is no consensus on the use and dosage of this supplement and the existing recommendations arise from studies based on the benefits that this nutrient can facilitate in bones. In addition, individual genetics can influence the response to supplementation, therefore, research involving monozygotic twins aims to reduce these differences in phenotypic responses. The objective of this randomised controlled study is to examine the effect of vitamin D supplementation on body composition and the expression of the vitamin D receptor (VDR) mRNA. An intervention was performed through supplementation with cholecalciferol at the concentration of 2000 IU in 90 healthy adult monozygotic twins (male or female pairs) for 2 months. The findings showed that serum vitamin D concentration increased by 65% and VDR gene expression sixty times (p = 0.001). Changes in body composition parameters were observed regarding body fat and lean mass. Our results indicate that an increase in serum vitamin D concentration may have potential therapeutic implications.

Metabolic Profile and Body Composition in Twins Concordant and Discordant for Physical Exercise.

The aim of this study was to evaluate the differences in the metabolic profile and body composition of monozygotic (MZ) twins concordant and discordant for the practice of physical exercise. The sample consisted of 92 MZ twins (72.5% female and 27.5% male, mean age 25.4 ± 5.69 years), registered with the Brazilian Registry of Twins, residing in Natal, Brazil. Data collection was carried out between the years 2016 and 2018. On day 1, subjects underwent a whole-body fitness evaluation, including measures of weight, height, body composition by Dual-Energy X-ray Absorptiometry and the Cardiorespiratory Exercise Test. On day 2, 10 ml blood samples were collected (overnight fasting) to determine the lipid profile and fasting glucose. The sample was separated into three groups: Active Concordant twins (Concordant A, n = 44 subjects), Inactive Concordant twins (Concordant I, n = 22 subjects) and Discordant pairs for Physical Exercise (Discordant PE, n = 26 subjects). The results demonstrated a difference between the discordant twins for exercise and also between the active versus sedentary groups, indicating a causal effect of exercise on the fat percentage, maximum oxygen consumption (VO2max) and second ventilatory threshold variables. Between groups, a difference was also observed between the groups in ventilatory threshold, very low-density lipoprotein and triglycerides. We concluded that, regardless of genetics, the practice of physical exercise was sufficient to generate alterations in body composition and VO2max in MZ twins, but not in the lipid profile or fasting glucose.

Distúrbio de movimento por conta de estado hiperosmolar não cetótico em idosa: relato de caso / Movement disorder caused by hyperosmolar hyperglycemic state in an older adult: a case report

O diabetes e suas complicações constituem as principais causas de mortalidade precoce na maioria dos países. O envelhecimento da população e a crescente prevalência da obesidade e do sedentarismo, além dos processos de urbanização, são considerados os principais fatores responsáveis pelo aumento da incidência e da prevalência do diabetes mellitus (DM) em todo o mundo. Este relato de caso objetiva descrever a presença de distúrbio do movimento em idoso por conta do estado hiperosmolar não cetótico. A combinação de hemicoreia-hemibalismo, hiperglicemia não cetótica e envolvimento dos gânglios da base em exames de imagem é considerada uma síndrome única. Os distúrbios do movimento em estado hiperosmolar não cetótico apresentam resposta terapêutica satisfatória com o uso de neurolépticos e controle glicêmico adequado. A escassez de trabalhos publicados proporciona subdiagnósticos clínico e laboratorial, interferindo no prognóstico e no acompanhamento dos pacientes.

Diabetes mellitus (DM) and its complications constitute the leading causes of early mortality in most countries. Population aging and the growing prevalence of obesity and sedentary lifestyles, in addition to spreading urbanization, are considered the main drivers of the increasing incidence and prevalence of DM worldwide. This case report describes the acute onset of movement disorder in an older woman secondary to hyperosmolar hyperglycemic state (HHS). The combination of hemichorea­hemiballismus, HHS, and evidence of basal ganglia involvement on neuroimaging is considered a unique syndrome. Movement disorders secondary to HHS respond satisfactorily to administration of neuroleptic agents and proper glycemic control. The lack of published studies on this pathologic entity may lead to clinical and laboratory underdiagnosis, with negative impacts on patient prognosis and follow-up.

Risk of Malignancy in Thyroid Nodules Using the American College of Radiology Thyroid Imaging Reporting and Data System in the NIFTP Era.

Recently, the American College of Radiology (ACR) proposed a Thyroid Imaging Reporting and Data System (TI-RADS) for thyroid nodules based on ultrasonographic features. It is important to validate this classification in different centres. The present study evaluated the risk of malignancy in solid nodules>1 cm using ACR TI-RADS. The risk of malignancy was defined including noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) and after its exclusion from malignant tumours. For the present study, the original images were revised, and each nodule was assigned to one of the TI-RADS levels proposed for solid nodules: TR3, TR4, or TR5. This risk of malignancy was significantly different for the three levels: 1.7%, 11.2%, and 60.6% for TR3, TR4, and TR5, respectively, when NIFTP was included, and 0.6%, 7.9%, and 60.2% for TR3, TR4, and TR5, respectively, when NIFTP was excluded from malignant tumours. The nodules corresponding to NIFTP were classified according to ACR as TR3 in 28.5% of cases, TR4 in 67.8%, and TR5 in only 3.5%. The nodules corresponding to cancer were classified according to ACR as TR3 in only 2.3% of cases, TR4 in 27%, and TR5 in 70.5%. In conclusion, this study shows the validity of the ACR TI-RADS for solid thyroid nodules, even after the exclusion of NIFTP from malignant tumours.

Relação da idade óssea com antropometria e aptidão física em jovens praticantes de voleibol / Relationship of age with bone and fitness anthropometry practitioners in youth volleyball / Relación de edad ósea con antropometría y condición física en jugadores jóvenes de vóleibol

Resumo O estudo teve como objetivo correlacionar a idade óssea, os componentes antropométricos e a aptidão física em 149 crianças de 8 a 14 anos. Foram aferidos estatura, massa corporal, perímetros de braço e de perna, perímetros de braço e de perna corrigidos, diâmetros bicristailíaco e biacromial, dobras cutâneas tricipital e perna, teste motores de agilidade, velocidade de membros superiores e força explosiva de membros inferiores e superiores e o exame de raios X de mão e punho para verificar maturação. Nos resultados, encontramos correlação positiva entre a idade óssea e as demais variáveis, com exceção das dobras cutâneas tricipital, de perna e teste de agilidade. Dessa forma, verificamos a influência da maturação sobre componentes antropométricos e motores. Assim, possibilitamos uma melhor forma de controle dos processos de detecção, seleção e orientação esportiva.

Abstract The study aimed to correlate bone age, anthropometric measurements and physical fitness in 149 young volleyball players between ages 8 and 14. Height, weight, arm and leg circumferences, adjusted arm and leg circumferences, bi-iliac and biacromial breadths, tricipital and leg skin fold thicknesses, physical fitness tests, coordination and explosive strength of the upper and lower limbs were measured, in addition to x-rays of hand and wrist to check for maturation. Results showed positive correlation between bone age and all other variables, except tricipital skinfold, leg skinfold and agility. We concluded that maturation has influence on anthropometric and motor components, leading to a better control in the process of selecting and promoting young athletes.

Resumen El estudio tuvo como objetivo observar la correlación entre edad ósea, variables antropométricas y condición física en 149 niños de 8 a 14 años. Se midieron la estatura, la masa corporal, la circunferencia del brazo y de la pierna, la circunferencia corregida del brazo y de la pierna, el diámetro bi-cresta ilíaca y biacromial, y el pliegue cutáneo del tríceps. Se hicieron pruebas motoras de agilidad de las piernas, de velocidad de los miembros superiores y de fuerza explosiva de los miembros superiores e inferiores, y se hicieron radiografías de la mano y el puño para verificar la maduración. En los resultados se encontró una correlación positiva entre la edad ósea y otras variables, con la excepción del pliegue cutáneo del tríceps y la prueba de agilidad de las piernas. Por tanto, se observa la influencia de la maduración de las variables antropométricas y motoras, lo que permite una mejor manera de controlar los procesos de detección, selección y orientación deportiva.

Is Doppler ultrasound of additional value to gray-scale ultrasound in differentiating malignant and benign thyroid nodules?

The objective of this study was to evaluate whether Doppler ultrasound (DUS) is of additional value to gray-scale ultrasound (GSUS) in predicting the benign or malignant nature of thyroid nodules. A total of 1,502 solid thyroid nodules ≥ 10 mm were evaluated. Suspicious vascularity (predominantly or exclusively central blood flow) was observed in only 5% of the nodules. This finding showed 96% specificity, but only 15% sensitivity. GSUS alone showed sensitivity and specificity of 88.7% and 68.2%, respectively, which did not improve with the addition of DUS (sensitivity of 89.4% and specificity of 66.4%). In non-suspicious nodules on GSUS, the type of vascularity on DUS did not modify the risk of malignancy, which was low. In suspicious nodules on GSUS, suspicious vascularity on DUS increased the risk of malignancy, but non-suspicious vascularity did not reduce this risk. DUS provided no additional value to GSUS in predicting the benign or malignant nature of thyroid nodules.

Is Doppler ultrasound of additional value to gray-scale ultrasound in differentiating malignant and benign thyroid nodules?

The objective of this study was to evaluate whether Doppler ultrasound (DUS) is of additional value to gray-scale ultrasound (GSUS) in predicting the benign or malignant nature of thyroid nodules. A total of 1,502 solid thyroid nodules ≥ 10 mm were evaluated. Suspicious vascularity (predominantly or exclusively central blood flow) was observed in only 5% of the nodules. This finding showed 96% specificity, but only 15% sensitivity. GSUS alone showed sensitivity and specificity of 88.7% and 68.2%, respectively, which did not improve with the addition of DUS (sensitivity of 89.4% and specificity of 66.4%). In non-suspicious nodules on GSUS, the type of vascularity on DUS did not modify the risk of malignancy, which was low. In suspicious nodules on GSUS, suspicious vascularity on DUS increased the risk of malignancy, but non-suspicious vascularity did not reduce this risk. DUS provided no additional value to GSUS in predicting the benign or malignant nature of thyroid nodules. Arch Endocrinol Metab. 2015;59(1):79-83.

Prevalência de Síndrome metabólica em mulheres climatéricas / Prevalence of metabolic Syndrome in menopausal women

Fundamentos: Apesar da importância da síndrome metabólica no contexto das doenças metabólicas e cardiovasculares, tanto a sua prevalência como demais características epidemiológicas ainda são pouco conhecidas no climatério. Objetivos: Identificar a presença de síndrome metabólica em mulheres no climatério e correlacionar com os fatores sociodemográficos, clínicos e antropométricos. Métodos: Estudo transversal e descritivo com 85 mulheres climatéricas, realizado no período de maio a junho 2013 no Núcleo de Atenção à Saúde e de Práticas Profissionalizantes (NASPP) das Faculdades Integradas Pitágoras (FIPMoc). Foi avaliada a presença de síndrome metabólica (SM) segundo os critérios da International Diabetes Federation (IDF) e análise sanguínea laboratorial. Para a avaliação dos dados sociodemográficos e clínicos aplicou-se um questionário. Os dados antropométricos foram avaliados pelo índice de massa corpórea (IMC) e pela circunferência abdominal (CA). Realizada análise descritiva dos dados, expressos em médias e porcentagens; utilizados os testes binominal e de Spearman para a correlação das variáveis, considerando-se o nível de significância de 5 %. Resultados: SM foi encontrada em 50,6 % das mulheres. Os componentes mais frequentes foram: HDL-colesterol baixo (61,2 %) e circunferência abdominal elevada (85,9 %). Os outros fatores determinantes da síndrome, isoladamente, não foram significativos, porém a SM apresentou correlação moderada com os fatores determinantes.

Background: Despite the importance of metabolic syndrome in the context of metabolic and cardiovascular diseases, its prevalence during the climacteric and other epidemiological characteristics are still little known.Objectives: To identify the presence of metabolic syndrome in menopausal women, correlated with socio-demographic, clinical and anthropometric factors.Methods: Cross-sectional descriptive study of 85 menopausal women conducted in May-June 2013 at the Center for Health Care and Vocational Practice (NASPP), Faculdades Integradas Pitágoras college (FIPMoc). The presence of metabolic syndrome (MS) was assessed in compliance with the criteria established by the International Diabetes Federation (IDF) and laboratory blood analyses, using a questionnaire to assess socio-demographic and clinical data. Anthropometric data were assessed by Body Mass Index (BMI) and Waist Circumference (WC). A descriptive analysis of the data was performed, expressed as means and percentages, using the binomial and Spearman tests to correlate the variables, with a significance level of 5%.Results: MS was found in 50.6% of the women, with the most common components being low HDL cholesterol (61.2%) and large waist circumference (85.9%). The other syndrome determinants were not significant individually, although MS showed moderate correlation with the determinants.

Evaluation of a pictorial method to assess liking of familiar fruits and vegetables among preschool children.

Research suggests fruit and vegetable (FV) preferences greatly influence on FV intake. Methods for assessing children's FV preference in a reliable and valid manner are needed. The purpose of this study was to develop a practical, reliable, and valid method for evaluating FV liking among preschool-aged children using photographs. Authors formatively assessed a series of digital FV photographs and hedonic scales to develop content for the liking measure. The measure for assessment included 20 high-quality, digital photographs presenting 13 FVs. A non-gendered 5-point face scale (super yummy to super yucky) was chosen to determine level of liking. We used this measure to establish reliability (i.e., test re-test) and concurrent validity (i.e., photograph versus tasting experience) of the pictorial method. Data were analyzed using Spearman's Rho Correlation Coefficients and Wilcoxon signed-rank tests. The measure demonstrated varying levels of reliability/validity for individual FV items and the fruit scale; however, the vegetable scale and collapsed FV scale were determined to be valid measures. Authors recommended the removal of one weak pictorial fruit item (halved peach) from the fruit and FV scales to improve validity. The final recommended measure included 19 high-quality, digital photographs presenting 12 FVs. The pictorial FV measure and subscales may be useful for assessing FV liking among groups of preschool-aged children within the studied population. Additional research is needed to further validate the use of the pictorial FV measures in a larger, more generalizable sample.

Ultrasonographic differentiation of cervical lymph nodes in patients with papillary thyroid carcinoma after thyroidectomy and radioiodine ablation: a prospective study.

OBJECTIVE: The objective of the present study was to validate an ultrasound (US) classification of cervical lymph nodes (LNs) in patients with papillary thyroid cancer (PTC) after thyroidectomy and radioactive iodine (131I) ablation. METHODS: We performed a prospective study in which the patients were submitted to thyroidectomy and 131I ablation and then followed until neck US revealed LN(s) ≥5 mm. A total of 288 LNs from 112 patients with PTC were evaluated. Patient management was based on LN characteristics grouped according to the classification system studied here. RESULTS: The presence of microcalcifications and/or cystic degeneration of cervical LNs were highly suggestive of a metastatic etiology (specificity of 99.4%). In contrast, the most sensitive finding for LNs affected by PTC was the absence of an echogenic hilum (sensitivity of 100%). In the absence of these findings (microcalcifications, cystic degeneration, echogenic hilum), a metastatic etiology was the most likely in the case of a round LN (specificity of 89%). The differentiation of a spindle-shaped LN without a visible hilum by Doppler analysis permitted us to dichotomize an initial probability of metastases of 13% in 25% (with peripheral vascularization) versus 3.3% (without peripheral vascularization). CONCLUSIONS: Our results confirm that the classification proposed for cervical LNs in patients with PTC is valid for determining patient management following initial therapy.

Elevated plasma factor VIII and von Willebrand factor in women with type 2 diabetes: inflammatory reaction, endothelial perturbation or else?

The association between type 2 diabetes and cardiovascular disease is long recognized. Although perturbations of haemostatic markers have been shown to be associated with macrovascular disease in patients with type 2 diabetes, it is unclear whether these are primarily due to endothelial dysfunction or a result of inflammation. The present study was undertaken to elucidate whether elevated levels of factor VIII (FVIII) and von Willebrand factor (vWF) in women with type 2 diabetes represent endothelial dysfunction, inflammation or an alternate mechanism. Sixty-four women with type 2 diabetes were evaluated using ultrasonography Doppler for carotid intima-media thickness (IMT) and were classified as group A--having no (<1  mm), group B - mild (≥1  mm and no plaque) and group C--moderate (≥1 mm and presence of plaque and stenosis) macrovascular disease. Several haemostatic markers including, FVIII, vWF and fibrinogen were assessed. In addition, thrombomodulin, a marker for endothelial damage, and high-sensitivity C-reactive protein (hsCRP), an inflammatory marker, were also measured. A significant association of elevated FVIII was found in group B and C patients (i.e. patients with IMT ≥1 mm and with plaque). Elevated fibrinogen and vWF levels were also found but confined to group C patients. No significant difference among subgroups was found for any other variable evaluated (hsCRP, thrombomodulin and FVII). In conclusion, plasma FVIII levels are elevated in women with type 2 diabetes and macrovascular disease. It also appears that this is not mediated by inflammation or endothelial injury and is likely to be due to an alternate mechanism.

O processo de viver e de ser cuidado de idosos e a percepção dos cuidadores / The process of living and being cared for in the elderly and the perception of their carers

Estudo exploratório descritivo com abordagem qualitativa objetivou conhecer como o idoso percebe o cuidado em saúde e a significação deste em sua vida, e identificar a percepção dos cuidadores leigos e trabalhadores de saúde acerca do cuidado oferecido. Para a coleta de dados utilizou-se entrevista e questionário. A amostra foi constituída de dez idosos institucionalizados e sete domiciliados; seis cuidadores e quatorze trabalhadores. Os dados, analisados pelo referencial da análise de conteúdo, resultaram em quatro categorias centrais e identificou-se que o processo de viver e de ser cuidado é percebido de diferentes maneiras e tem relação com a história de vida, individual e familiar de cada ser. Cuidar do idoso requer preparo e valorização cultural em função das peculiaridades que envolvem o processo de envelhecimento humano.

PAI-1 and D-dimer in type 2 diabetic women with asymptomatic macrovascular disease assessed by carotid Doppler.

Asymptomatic diabetic patients with different degrees of macrovascular complications can present different hemostatic changes. At this study, plasminogen activator inhibitor-1 (PAI-1) and D-dimer were evaluated in 12 women without diabetes and 64 type 2 diabetic women. All patients were classified into 3 different categories according to the carotid intima-media thickness (IMT) assessed by Doppler: 25 with <1 mm (normal), 15 with >1 mm and without plaque (intermediate), and 24 with stenosis lower than 50% of the vessel lumen (plaque). The results showed increased plasma D-dimer in type 2 diabetic women with carotid plaque when compared to the other groups. High levels of PAI-1 were observed in all the 3 groups of diabetic women when compared to women without diabetes. Our results suggest that high levels of PAI-1 in type 2 diabetic women are only associated with diabetes and are not associated with macrovascular progression; however, it seems that D-dimer plasma levels are associated with carotid plaque.

Frequência do polimorfismo da glicoproteína IIIa de plaquetas (PlA2) em mulheres com diabetes mellitus tipo 2 / Platelet glycoprotein IIIa polymorphism (PlA2) frequency in Type 2 diabetic women

O polimorfismo da glicoproteína IIIa de plaquetas está associado a um aumento no risco de doenças arteriais coronarianas. Mulheres com diabetes mellitus tipo 2 apresentam um aumento de cinco vezes no risco para doenças arteriais coronarianas quando comparadas com mulheres não-diabéticas. O objetivo do presente estudo foi verificar a frequência do polimorfismo da glicoproteína IIIa (PlA2) em mulheres com diabetes mellitus tipo 2 e comparar com a frequência descrita na literatura. A análise do polimorfismo PlA2 foi realizada para 62 mulheres com diabetes mellitus tipo 2 através da reação em cadeia da polimerase seguida de análise do polimorfismo de tamanho de fragmento de restrição (PCR-RFLP). As frequências observadas foram 81 por cento para PlA1A1, 18 por cento para PlA1A2 e 1 por cento para PlA2A2. Não houve diferença significativa entre as frequências observadas e as frequências descritas na literatura. Nossos resultados sugerem que a frequência do polimorfismo PlA2 em mulheres com diabetes mellitus tipo 2 é a mesma observada na população em geral.

The platelet glycoprotein IIIa polymorphism is associated to an increased risk of coronary heart disease. Type 2 diabetic women present a fivefold higher risk of coronary heart disease compared to non-diabetic women. The aim of this study was to verify the frequency of the glycoprotein IIIa polymorphism (PlA2) in type 2 diabetic women and compare this result with the frequency reported for the general population. The PlA polymorphisms of 62 type 2 diabetic women were determined by polymerase chain reaction and restriction fragment length polymorphism (PCR-RFLP). The resulting frequencies were 81 percent for PlA1A1, 18 percent for PlA1A2 and 1 percent for PlA2A2. There was no significant difference between observed frequencies and the frequencies described in the literature. Our results suggest that the frequency of the glycoprotein IIIa polymorphism, PlA2, in type 2 diabetic women is similar to that observed in general population

Preparation with recombinant human thyroid-stimulating hormone for thyroid remnant ablation with 131I is associated with lowered radiotoxicity.

UNLABELLED: Preparation with recombinant human thyroid-stimulating hormone (rhTSH) for thyroid remnant ablation results in lower extrathyroidal radiation than does hypothyroidism. The objective of this prospective study was to compare the damage caused by 131I (3.7 GBq) when these 2 preparations are used. METHODS: Ninety-four consecutive patients who underwent total thyroidectomy and remnant ablation with 3.7 GBq of 131I were studied. Thirty patients (group A) received rhTSH, and 64 (group B) were prepared by levothyroxine withdrawal. Damage to salivary glands, ovaries, and testes; hematologic damage; and oxidative injury were evaluated by measurement of serum amylase, follicle-stimulating hormone (FSH), complete blood count, and plasma 8-epi-PGF2alpha before and after radioiodine. The 2 groups were similar in sex, age, and the results of baseline assessment. RESULTS: The rate of successful ablation (stimulated thyroglobulin level < 1 ng/mL and negative findings on neck ultrasonography) was 90% in group A and 80% in group B. Considering only patients with a preablation thyroglobulin level greater than 1 ng/mL, these rates were 80% and 70.6%, respectively. Only 1 patient (3.3%) reported transient headaches with rhTSH. Elevated FSH levels after therapy were observed in 4 of 9 (44%) men in group A versus 16 of 18 (89%) in group B (P < 0.03), with a mean increase of 105% versus 236% (P < 0.001), respectively. In women, elevated FSH was observed in 1 of 13 (7.7%) patients in group A versus 6 of 30 (20%) in group B (P = 0.4), with a mean increase of 65% versus 125% (P < 0.001). Thrombocytopenia or neutropenia occurred in 2 of 28 (7%) patients in group A versus 12 of 56 (21.4%) in group B (P = 0.1), with a mean decrease of 20% versus 45% and 25% versus 52% (P < 0.01) for neutrophils and platelets, respectively. Hyperamylasemia and symptoms of acute sialoadenitis occurred in 11 of 30 (36.6%) versus 48 of 60 (80%) (P < 0.001) and in 9 of 30 (30%) versus 35 of 60 (58.3%) (P = 0.01), respectively. 8-Epi-PGF2alpha was found to be elevated after 131I in 14 of 25 (56%) patients in group A versus 45 of 45 (100%) in group B (P < 0.001), with a mean increase of 60% versus 125% (P < 0.001). CONCLUSION: The lower radiotoxicity with rhTSH, suggested in dosimetry studies, was confirmed in the present prospective investigation, and this advantage occurred without compromising the efficacy of treatment.