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INTRODUCTION: It is unclear whether kidney/pancreas (KP) transplantation will prevent the progression of peripheral arterial disease (PAD) in patients with insulin dependent diabetes (IDDM) and end-stage renal disease. We sought to determine the pre- and posttransplant prevalence of symptomatic PAD and changes in carotid artery intima-media thickness (IMT) in KP recipients. METHODS: In this single center study, outcomes were compared between KP recipients with and without a history of PAD. A subset of recipients underwent pre- and posttransplant IMT measurements. RESULTS: Among the study group (N = 107), 18 (17%) recipients admitted to a pretransplant history of symptomatic PAD, comprised 11 foot infections and 7 amputations (5 minor and 2 major). Baseline characteristics of age, gender, race, years of diabetes, dialysis history, smoking history, years of hypertension, and history of coronary artery disease (CAD) were equivalent between PAD and non-PAD cohorts. At a median follow-up of 60 months (IQR: 28, 110), 16 (15%) KP recipients had suffered a PAD event. In multivariate analysis, a pretransplant history of PAD (hazard ratio [HR] 9.66, p < 0.001) and CAD (HR 3.33, p = 0.04) were independent predictors of posttransplant PAD events. Among a subset of 20 recipients (3 with PAD), mean IMT measurements pretransplant and at a median of 24 (range 18-24) months posttransplant, showed no evidence of disease progression. CONCLUSION: Based on IMT measurements and clinical results, KP transplantation stabilized PAD in most patients, but did not alter outcomes of symptomatic PAD recipients. A pretransplant history of PAD and CAD was an independent predictor of posttransplant PAD events.
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Espessura Intima-Media Carotídea , Falência Renal Crônica , Transplante de Rim , Transplante de Pâncreas , Doença Arterial Periférica , Humanos , Feminino , Masculino , Transplante de Pâncreas/efeitos adversos , Doença Arterial Periférica/cirurgia , Doença Arterial Periférica/etiologia , Pessoa de Meia-Idade , Seguimentos , Transplante de Rim/efeitos adversos , Falência Renal Crônica/cirurgia , Fatores de Risco , Prognóstico , Diabetes Mellitus Tipo 1/cirurgia , Diabetes Mellitus Tipo 1/complicações , Adulto , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Taxa de Filtração Glomerular , Testes de Função RenalRESUMO
Background: This study aimed to assess intraoperative cerebral hemodynamic responses and embolic events during transcarotid artery revascularization via transcranial Doppler, near-infrared spectroscopy, and bispectral index monitoring. Methods: Twelve patients (7 males, 5 females; mean age: 72.8±9.0 years; range, 63 to 91 years) undergoing transcarotid artery revascularization with simultaneous transcranial Doppler, near-infrared spectroscopy, and bispectral index monitoring were analyzed in this retrospective study between September 2017 and December 2019. The mean flow velocity and pulsatility index of the middle cerebral artery, alongside near-infrared spectroscopy and bispectral index values, before flow reversal, during flow reversal, and after flow reversal phases were investigated. The presence and frequency of high-intensity transient signals were recorded to evaluate embolic incidents. Results: Significant reductions in middle cerebral artery mean flow velocity were noted during flow reversal (40.58±10.57 cm/sec to 20.58±14.34 cm/sec, p=0.0004), which subsequently returned to and exceeded baseline values after flow reversal cessation (53.33±17.69 cm/sec, p=0.0005). Near-infrared spectroscopy (71±4.4% to 66±6.2%) and bispectral index (45.71±8.5 to 40.14±8.1) values mirrored these hemodynamic changes, with notable decreases during flow reversal, and recoveries after flow reversal. The highest concentration of high-intensity transient signals was observed during stent deployment, signifying a critical embolic phase. No perioperative neurological complications or other significant adverse events were documented. Conclusion: Transcranial Doppler, near-infrared spectroscopy, and bispectral index effectively monitor cerebral hemodynamics and embolic potential during transcarotid artery revascularization, providing real-time data crucial for optimizing perioperative management. These findings underscore the clinical value of multimodal monitoring in improving patient outcomes in transcarotid artery revascularization procedures.
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We describe a 78-year-old woman with a large ascending aortic pseudoaneurysm who underwent thoracic endovascular aortic repair under intraoperative image fusion guidance and real-time transcranial Doppler (TCD) monitoring. TCD monitoring revealed a total of 419 microembolic signals throughout the procedure, with the majority occurring as the first stent graft crossed the ascending aorta. Two days later, she underwent endovascular repair of a graft type IA endoleak. We highlight the role of image fusion guidance and TCD monitoring in enabling successful thoracic endovascular aortic repair in an elderly woman and in identifying procedural areas of improvement to minimize stroke risk.
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PURPOSE: Better time-resolved imaging of stent grafts in the ascending aorta and arch accounting for cardiac motion is necessary to understand device-related complications and endoleaks. This report describes dynamic time-resolved computed tomographic angiography (d-CTA) and its combination with electrocardiography gating (d-gated CTA) to image stent grafts in the ascending aorta and to characterize endoleaks more clearly. DESCRIPTION: d-CTA involves multiple scans acquired at different time points along the contrast enhancement curve. d-Gated CTA involves concomitant electrocardiography gating in a predefined cardiac phase minimizing motion-induced artifacts. EVALUATION: This report illustrates the utility of d-CTA and d-gated CTA in 2 clinical cases. d-CTA demonstrated a type 1A endoleak in a patient with an aortic arch aneurysm treated with total arch debranching and a thoracic stent graft. d-gated CTA demonstrated a type 1A endoleak in a patient with an ascending aortic pseudoaneurysm treated with aortic cuff placement. CONCLUSIONS: Dynamic, cardiac-gated CTA enables time-resolved angiographic imaging of the ascending aorta and arch without any cardiac motion-related artifacts. Such advanced imaging techniques help with better characterization of endoleaks after stent graft deployment in the ascending aorta and arch.
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Aneurisma da Aorta Torácica , Implante de Prótese Vascular , Procedimentos Endovasculares , Aorta/cirurgia , Aneurisma da Aorta Torácica/complicações , Aneurisma da Aorta Torácica/cirurgia , Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/métodos , Angiografia por Tomografia Computadorizada , Endoleak/diagnóstico por imagem , Endoleak/etiologia , Endoleak/cirurgia , Procedimentos Endovasculares/métodos , Humanos , Estudos Retrospectivos , Stents/efeitos adversosRESUMO
Positional occlusion of the internal carotid artery is an unusual phenomenon. Reports are scarce in the literature and generally related to compression by external agents when the head is rotated. Cases with no extrinsic etiology are even more uncommon and require high suspicion to avoid misdiagnosis. We present a case of a patient with intermittent internal carotid occlusion depending on the position of the head with no external agent identified. Due to the dynamic characteristics of this presentation, diagnostic tests yielded contradictory results. Carotid ultrasound during neck rotation revealed the positional occlusion. Ultrasound is a versatile technique to explore the carotid arteries in different angles of the neck, useful if positional pathology is suspected.
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Artéria Carótida Interna , Pescoço , Artérias Carótidas/diagnóstico por imagem , Artéria Carótida Interna/diagnóstico por imagem , Humanos , Pescoço/diagnóstico por imagem , Rotação , UltrassonografiaRESUMO
AIM: To investigate whether vertebrobasilar geometry contributes to the presence, severity, and laterality of white matter hyperintensities (WMH). METHODS: We retrospectively reviewed 290 cerebral scans of patients who underwent time-of-flight and fluid-attenuated inversion recovery (FLAIR) magnetic resonance imaging (MRI) between 2017 and 2018. WMH were counted, localized, and grouped according to laterality on the FLAIR sequence. A 3D mesh of the posterior circulation was reconstructed (with ITK SNAP software) and the morphology of the vertebrobasilar system analyzed with an in-house software written in Python. RESULTS: Patients were assigned into a group with WMH (n=204) and a group without WMH (n=86). The severity of WMH burden was mainly affected by age and hypertension, while the localization of the WMH (or laterality) was mainly affected by the vertebrobasilar system morphology. Basilar artery morphology only affected the parieto-occipital region significantly if both posterior communicating arteries were hypoplastic or absent. The dominant vertebral artery and basilar artery curve had an opposite directional relationship. CONCLUSIONS: An unequal vertebral artery flow is an important hemodynamic contributor to basilar bending. Increased basilar artery curvature and increased infratentorial WMH burden may signal inadequate blood flow and predict cerebrovascular events.
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Artéria Basilar , Substância Branca , Artéria Basilar/diagnóstico por imagem , Humanos , Imageamento por Ressonância Magnética , Estudos Retrospectivos , Artéria Vertebral/diagnóstico por imagem , Substância Branca/diagnóstico por imagemRESUMO
BACKGROUND: Time-of-flight (TOF) magnetic resonance angiography (MRA) of the head and transcranial Doppler (TCD) are used to diagnose intracranial stenosis, an important cause of ischemic stroke. We aimed to compare TCD findings with TOF-MRA results in a population of patients with symptoms of cerebrovascular disease in whom both tests were done within a short intervening period of each other. METHODS: This is a retrospective, single-center study. Among adult patients referred for symptoms of cerebrovascular disease in both outpatient and inpatient settings, those who received a TCD with adequate insonation of all intracranial arteries and underwent MRA within 3 months intervals of TCD were included in this study. We evaluated the agreement between the results of these two modalities, and also assessed sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of TCD through receiver-operating characteristic (ROC) curve analysis, while MRA considered as a comparator. RESULTS: Among eighty included patients, 720 arteries were examined. An overall significant agreement of 96.5% was observed between TCD and MRA (Kappa = 0.377, P < 0.001). Compared to MRA, TCD had sensitivity of 42.1%, specificity of 99.6%, PPV of 72.7%, and NPV of 98.4% (ROC area: 0.708 [0.594-0.822]). TCD is specifically accurate in evaluating middle cerebral artery (MCA) (ROC area = 0.83). CONCLUSIONS: The high NPV of TCD in our study indicates the utility of TCD as a diagnostic test to exclude the presence of intracranial stenosis. This study supports TCD as a convenient, safe, and reproducible imaging modality applicable in the screening of intracranial stenosis, especially to evaluate MCA.
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Transcranial Doppler ultrasonography (TCD) is a noninvasive, bedside, portable tool for assessment of cerebral hemodynamics. Modern TCD head frames allow continuous hands-free emboli detection for risk stratification and assessment of treatment efficacy in several cardiovascular diseases. Identifying a focal stenosis, arterial occlusion, and monitoring the treatment effect of intravenous tissue plasminogen activator can easily be accomplished by assessing TCD waveforms and determining prestenotic and poststenotic mean flow velocities. TCD is an excellent screening tool for vasospasm in aneurysmal subarachnoid hemorrhage. The use of intraoperative TCD during carotid endarterectomy and stenting allows optimal intraoperative hemodynamic management. Other applications are also discussed.
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Embolia Intracraniana/diagnóstico por imagem , Hemorragia Subaracnóidea/diagnóstico por imagem , Ultrassonografia Doppler Transcraniana/métodos , Vasoespasmo Intracraniano/diagnóstico por imagem , Humanos , Embolia Intracraniana/tratamento farmacológico , Embolia Intracraniana/fisiopatologia , Hemorragia Subaracnóidea/tratamento farmacológico , Hemorragia Subaracnóidea/fisiopatologia , Ativador de Plasminogênio Tecidual/administração & dosagem , Vasoespasmo Intracraniano/tratamento farmacológico , Vasoespasmo Intracraniano/fisiopatologiaRESUMO
BACKGROUND: The vascular contributions to neurodegeneration and neuroinflammation may be assessed by magnetic resonance imaging (MRI) and ultrasonography (US). This review summarises the methodology for these widely available, safe and relatively low cost tools and analyses recent work highlighting their potential utility as biomarkers for differentiating subtypes of cognitive impairment and dementia, tracking disease progression and evaluating response to treatment in various neurocognitive disorders. METHODS: At the 9th International Congress on Vascular Dementia (Ljubljana, Slovenia, October 2015) a writing group of experts was formed to review the evidence on the utility of US and arterial spin labelling (ASL) as neurophysiological markers of normal ageing, vascular cognitive impairment (VCI) and Alzheimer's disease (AD). Original articles, systematic literature reviews, guidelines and expert opinions published until September 2016 were critically analysed to summarise existing evidence, indicate gaps in current knowledge and, when appropriate, suggest standards of use for the most widely used US and ASL applications. RESULTS: Cerebral hypoperfusion has been linked to cognitive decline either as a risk or an aggravating factor. Hypoperfusion as a consequence of microangiopathy, macroangiopathy or cardiac dysfunction can promote or accelerate neurodegeneration, blood-brain barrier disruption and neuroinflammation. US can evaluate the cerebrovascular tree for pathological structure and functional changes contributing to cerebral hypoperfusion. Microvascular pathology and hypoperfusion at the level of capillaries and small arterioles can also be assessed by ASL, an MRI signal. Despite increasing evidence supporting the utility of these methods in detection of microvascular pathology, cerebral hypoperfusion, neurovascular unit dysfunction and, most importantly, disease progression, incomplete standardisation and missing validated cut-off values limit their use in daily routine. CONCLUSIONS: US and ASL are promising tools with excellent temporal resolution, which will have a significant impact on our understanding of the vascular contributions to VCI and AD and may also be relevant for assessing future prevention and therapeutic strategies for these conditions. Our work provides recommendations regarding the use of non-invasive imaging techniques to investigate the functional consequences of vascular burden in dementia.
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Doença de Alzheimer/diagnóstico por imagem , Disfunção Cognitiva/diagnóstico por imagem , Doença de Alzheimer/patologia , HumanosRESUMO
Dissection of the internal carotid artery (ICA) accounts for 5% to 25% of ischemic strokes in young adults. We report a case of spontaneous recanalization of a traumatic ICA dissection in which carotid duplex (CDU) and transcranial color-coded duplex ultrasound (TCCD) were used. A 47-year-old male presented with intermittent episodes of headache, blurry vision, anisocoria, and loss of taste sensation following a whiplash injury while body surfing. Magnetic resonance angiogram (MRA) of the neck revealed absent flow in the cavernous ICA and a clot at the skull base. Carotid duplex, used to further evaluate flow, demonstrated reverberating color Doppler and spectrum signal. A TCCD showed ICA occlusion and smaller-caliber intracranial ICA. The patient reported for follow-up after 1 month on anticoagulation therapy. Upon his return, CDU and TCCD were normal and the ICA showed normal color and spectrum signals. Computed tomography angiogram confirmed ultrasound findings of a dramatic improvement of ICA patency. Additionally, the patient reported that his headaches had resolved. Extracranial CDU and TCCD are useful for monitoring patient progress in cases of spontaneous recanalization following carotid artery dissection. These inexpensive and noninvasive imaging modalities proved to be critical in the initial and follow-up evaluations of the extracranial and intracranial vascular system, providing a strong alternative to expensive magnetic resonance imaging and invasive angiograms and offering more hemodynamic information than "static" MRA.
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Dissecação da Artéria Carótida Interna/diagnóstico por imagem , Artéria Carótida Interna/diagnóstico por imagem , Ultrassonografia Doppler em Cores , Ultrassonografia Doppler Transcraniana/métodos , Esportes Aquáticos/lesões , Traumatismos em Chicotada/diagnóstico por imagem , Anticoagulantes/uso terapêutico , Velocidade do Fluxo Sanguíneo , Artéria Carótida Interna/fisiopatologia , Dissecação da Artéria Carótida Interna/tratamento farmacológico , Dissecação da Artéria Carótida Interna/etiologia , Dissecação da Artéria Carótida Interna/fisiopatologia , Circulação Cerebrovascular , Angiografia por Tomografia Computadorizada , Hemodinâmica , Humanos , Angiografia por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Fluxo Sanguíneo Regional , Remissão Espontânea , Fatores de Tempo , Traumatismos em Chicotada/tratamento farmacológico , Traumatismos em Chicotada/etiologia , Traumatismos em Chicotada/fisiopatologiaAssuntos
Artéria Carótida Primitiva/fisiopatologia , Circulação Cerebrovascular , Insuficiência Cardíaca/terapia , Balão Intra-Aórtico/métodos , Choque Cardiogênico/terapia , Velocidade do Fluxo Sanguíneo , Artéria Carótida Primitiva/diagnóstico por imagem , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/fisiopatologia , Humanos , Balão Intra-Aórtico/efeitos adversos , Masculino , Pessoa de Meia-Idade , Fluxo Sanguíneo Regional , Choque Cardiogênico/diagnóstico , Choque Cardiogênico/fisiopatologia , Volume Sistólico , Fatores de Tempo , Resultado do Tratamento , Ultrassonografia Doppler , Função Ventricular EsquerdaRESUMO
Doppler interrogation studies of the liver blood flow indicate altered hepatic vein waveforms in association with impaired hepatocellular function. However, little is known about the mechanisms responsible for variations of these parameters in the absence of disease. We aimed to investigate the contribution of heritable and environmental factors to the physiological variability of hepatic vein flow in a twin cohort. Two hundred twenty-eight healthy adult Hungarian twins (69 monozygotic, 45 same-sex dizygotic pairs) underwent Doppler sonography of the hepatic vein. Age- and sex-adjusted heritability of the highest velocity (amplitude of S wave) of hepatic vein flow was negligible. Shared environment contributed to 33% (95% CI, 16%-51%), and unshared environment was responsible for the largest portion (67%; 95% CI, 49%-84%) of the variance. Duration of sports activities was significantly (P < 0.05) related to the magnitude of hepatic vein flow, while other risk factors and lifestyle characteristics had no significant influence. The data suggest that genetic factors have little impact on the parameters of hepatic venous blood flow. The variability observed in healthy twins by the Doppler interrogation can be explained by the effect of unshared environmental components primarily related to regular physical activity. These findings underscore the importance of unique environments in physiological variations of hepatic venous blood flow.
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Veias Hepáticas/fisiologia , Adulto , Meio Ambiente , Exercício Físico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fluxo Sanguíneo Regional , Gêmeos Dizigóticos , Gêmeos MonozigóticosRESUMO
Abstract Background: Configuration of the abdominal aorta is related to healthy aging and a variety of disorders. Objectives: We aimed to assess heritable and environmental effects on the abdominal aortic diameter. Methods: 114 adult (69 monozygotic, 45 same-sex dizygotic) twin pairs (mean age 43.6 ± 16.3 years) underwent abdominal ultrasound with Esaote MyLab 70X ultrasound machine to visualize the abdominal aorta below the level of the origin of the renal arteries and 1-3 cm above the bifurcation. Results: Age- and sex-adjusted heritability of the abdominal aortic diameter below the level of the origin of the renal arteries was 40% [95% confidence interval (CI), 14 to 67%] and 55% above the aortic bifurcation (95% CI, 45 to 70%). None of the aortic diameters showed common environmental effects, but unshared environmental effects were responsible for 60% and 45% of the traits, respectively. Conclusions: Our analysis documents the moderate heritability and its segment-specific difference of the abdominal aortic diameter. The moderate part of variance was explained by unshared environmental components, emphasizing the importance of lifestyle factors in primary prevention. Further studies in this field may guide future gene-mapping efforts and investigate specific lifestyle factors to prevent abdominal aortic dilatation and its complications.
Resumo Fundamento: A configuração da aorta abdominal relaciona-se com o envelhecimento saudável e uma série de distúrbios. Objetivos: Avaliar efeitos herdáveis e ambientais no diâmetro da aorta abdominal. Métodos: 114 pares de gêmeos adultos (69 monozigóticos e 45 dizigóticos do mesmo sexo), com idade média de 43,6 ± 16,3 anos, foram submetidos a ultrassonografia abdominal com o aparelho Esaote MyLab 70X para visualização da aorta abdominal abaixo da origem das artérias renais e 1-3 cm acima da bifurcação aórtica. Resultados: A herdabilidade ajustada para idade e sexo do diâmetro da aorta abdominal abaixo da origem das artérias renais foi 40% [intervalo de confiança (IC) 95%, 14 – 67%] e acima da bifurcação, 55% (IC 95%, 45 – 70%). Nenhum dos diâmetros aórticos apresentou efeitos ambientais comuns, mas os efeitos ambientais não compartilhados foram responsáveis por 60% e 45% dos traços, respectivamente. Conclusões: Nossa análise mostrou herdabilidade moderada e diferença do diâmetro da aorta abdominal com especificidade de segmento. A parte moderada da variância foi explicada pelo componente ambiental não compartilhado, enfatizando a importância do estilo de vida na prevenção primária. Estudos adicionais nesse campo poderão guiar futuros esforços de mapeamento genético e investigar fatores específicos de estilo de vida para prevenir dilatação da aorta abdominal e suas complicações.
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Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Aorta Abdominal/anatomia & histologia , Interação Gene-Ambiente , Aorta Abdominal , Doenças da Aorta/genética , Aterosclerose/genética , Predisposição Genética para Doença , Estilo de Vida , Tamanho do Órgão/genética , Valores de Referência , Fatores de Risco , Gêmeos Dizigóticos/genética , Gêmeos Monozigóticos/genéticaRESUMO
BACKGROUND: Configuration of the abdominal aorta is related to healthy aging and a variety of disorders. OBJECTIVES: We aimed to assess heritable and environmental effects on the abdominal aortic diameter. METHODS: 114 adult (69 monozygotic, 45 same-sex dizygotic) twin pairs (mean age 43.6 ± 16.3 years) underwent abdominal ultrasound with Esaote MyLab 70X ultrasound machine to visualize the abdominal aorta below the level of the origin of the renal arteries and 1-3 cm above the bifurcation. RESULTS: Age- and sex-adjusted heritability of the abdominal aortic diameter below the level of the origin of the renal arteries was 40% [95% confidence interval (CI), 14 to 67%] and 55% above the aortic bifurcation (95% CI, 45 to 70%). None of the aortic diameters showed common environmental effects, but unshared environmental effects were responsible for 60% and 45% of the traits, respectively. CONCLUSIONS: Our analysis documents the moderate heritability and its segment-specific difference of the abdominal aortic diameter. The moderate part of variance was explained by unshared environmental components, emphasizing the importance of lifestyle factors in primary prevention. Further studies in this field may guide future gene-mapping efforts and investigate specific lifestyle factors to prevent abdominal aortic dilatation and its complications.
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Aorta Abdominal/anatomia & histologia , Interação Gene-Ambiente , Adulto , Aorta Abdominal/diagnóstico por imagem , Doenças da Aorta/genética , Aterosclerose/genética , Feminino , Predisposição Genética para Doença , Humanos , Estilo de Vida , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão/genética , Valores de Referência , Fatores de Risco , Gêmeos Dizigóticos/genética , Gêmeos Monozigóticos/genética , UltrassonografiaAssuntos
Doenças das Artérias Carótidas/diagnóstico por imagem , Artéria Carótida Interna/diagnóstico por imagem , Interpretação de Imagem Assistida por Computador , Imageamento Tridimensional , Placa Aterosclerótica , Ultrassonografia/métodos , Doenças das Artérias Carótidas/patologia , Doenças das Artérias Carótidas/cirurgia , Artéria Carótida Interna/patologia , Artéria Carótida Interna/cirurgia , Endarterectomia das Carótidas , Humanos , Imageamento por Ressonância Magnética , Valor Preditivo dos Testes , Reprodutibilidade dos TestesRESUMO
Objectives Decreased thyroid volume has been related to increased prevalence of thyroid cancer. Subjects and methods One hundred and fourteen Hungarian adult twin pairs (69 monozygotic, 45 dizygotic) with or without known thyroid disorders underwent thyroid ultrasound. Thickness of the thyroid isthmus was measured at the thickest portion of the gland in the midline using electronic calipers at the time of scanning. Volume of the thyroid lobe was computed according to the following formula: thyroid height*width*depth*correction factor (0.63). Results Age-, sex-, body mass index- and smoking-adjusted heritability of the thickness of thyroid isthmus was 50% (95% confidence interval [CI], 35 to 66%). Neither left nor right thyroid volume showed additive genetic effects, but shared environments were 68% (95% CI, 48 to 80%) and 79% (95% CI, 72 to 87%), respectively. Magnitudes of monozygotic and dizygotic co-twin correlations were not substantially impacted by the correction of covariates of body mass index and smoking. Unshared environmental effects showed a moderate influence on dependent parameters (24-50%). Conclusions Our analysis support that familial factors are important for thyroid measures in a general twin population. A larger sample size is needed to show whether this is because of common environmental (e.g. intrauterine effects, regional nutrition habits, iodine supply) or genetic effects.
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Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Interação Gene-Ambiente , Glândula Tireoide , Estudos Transversais , Predisposição Genética para Doença/epidemiologia , Hungria/epidemiologia , Tamanho do Órgão/genética , Prevalência , Medição de Risco , Glândula Tireoide/anatomia & histologia , Gêmeos Dizigóticos/genética , Gêmeos Monozigóticos/genéticaRESUMO
OBJECTIVES: Decreased thyroid volume has been related to increased prevalence of thyroid cancer. SUBJECTS AND METHODS: One hundred and fourteen Hungarian adult twin pairs (69 monozygotic, 45 dizygotic) with or without known thyroid disorders underwent thyroid ultrasound. Thickness of the thyroid isthmus was measured at the thickest portion of the gland in the midline using electronic calipers at the time of scanning. Volume of the thyroid lobe was computed according to the following formula: thyroid height*width*depth*correction factor (0.63). RESULTS: Age-, sex-, body mass index- and smoking-adjusted heritability of the thickness of thyroid isthmus was 50% (95% confidence interval [CI], 35 to 66%). Neither left nor right thyroid volume showed additive genetic effects, but shared environments were 68% (95% CI, 48 to 80%) and 79% (95% CI, 72 to 87%), respectively. Magnitudes of monozygotic and dizygotic co-twin correlations were not substantially impacted by the correction of covariates of body mass index and smoking. Unshared environmental effects showed a moderate influence on dependent parameters (24-50%). CONCLUSIONS: Our analysis support that familial factors are important for thyroid measures in a general twin population. A larger sample size is needed to show whether this is because of common environmental (e.g. intrauterine effects, regional nutrition habits, iodine supply) or genetic effects.
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Interação Gene-Ambiente , Glândula Tireoide/diagnóstico por imagem , Adulto , Estudos Transversais , Feminino , Predisposição Genética para Doença/epidemiologia , Humanos , Hungria/epidemiologia , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão/genética , Prevalência , Medição de Risco , Glândula Tireoide/anatomia & histologia , Gêmeos Dizigóticos/genética , Gêmeos Monozigóticos/genética , UltrassonografiaRESUMO
AIM: To determine the reasons for large standard deviation of bronchodilator response (BDR) and establish whether there is a potential heritable component in healthy subjects. METHODS: 67 monozygotic and 42 dizygotic adult twin pairs were assessed for bronchodilator response (% change in FEV1 after inhaling 400 µg salbutamol). Univariate quantitative genetic modeling was performed. RESULTS: Multiple regression modeling showed a significant association between BDR and sex and baseline FEV1 (P<0.05), while no association was found with smoking habits, body mass index, or age. Within pair correlation in monozygotic twins was modest (0.332), but higher than in dizygotic twins (0.258). Age-, sex-, and baseline FEV1-adjusted genetic effect accounted for 14.9% (95% confidence interval, CI 0%-53.1%) of the variance of BDR, shared environmental effect for 18.4% (95% CI 0%-46.8%), and unshared environmental effect for 66.8% (95% CI 46.8%-88.7%). CONCLUSION: Our twin study showed that individual differences in BDR can be mostly explained by unshared environmental effects. In addition, it is the first study to show low, insignificant hereditary influences, independently from sex, age, and baseline FEV1.
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Albuterol/administração & dosagem , Broncodilatadores/administração & dosagem , Volume Expiratório Forçado/genética , Interação Gene-Ambiente , Gêmeos Dizigóticos/genética , Gêmeos Monozigóticos/genética , Adulto , Índice de Massa Corporal , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
The purpose of this study was to provide further data on the relationships between positive psychology constructs and cardiorespiratory parameters including arterial stiffness indicators. Hypotheses were tested cross-sectionally on a sample of patients with cardiovascular disease and on a healthy sample. Life satisfaction, psychological well-being, optimism, meaning in life, and sense of coherence were included as psychological indicators, while peripheral and central blood pressure, arterial stiffness, and heart cycle and respiratory function parameters were used as physiological variables. Most of the associations examined were not significant in either sample, with some notable exceptions (the direction of these linear relationships was in accordance with our expectations). Satisfaction with life was related to lower peripheral systolic and mean arterial blood pressure in the clinical sample. Further, sense of coherence was positively associated with forced expiratory volume. In the healthy sample, the augmentation indexes and aortic systolic blood pressure were negatively associated with optimism. However, none of the linear and non-linear relationships proved to be significant in either of the samples when using the Bonferroni correction. Further research should determine whether the present findings derive from the cultural characteristics of our samples or whether the mediators between flourishing and cardiorespiratory health should be sought among other variables than the ones included in the present investigation
Introducción: Muchos estudios han demostrado que las características psicológicas positivas son factores de protección contra las enfermedades cardiovasculares. El objetivo de este estudio es ampliar los datos conocidos acerca de las relaciones entre las cualidades positivas y los parámetros cardiorrespiratorios, incluida la rigidez arterial. Método: Las hipótesis fueron contrastadas transversalmente en una muestra clínica de pacientes con enfermedades cardiovasculares y otra muestra de pacientes sanos. La satisfacción en la vida, el bienestar psicológico, el optimismo, el sentido de la vida y el sentimiento de coherencia fueron considerados indicadores psicológicos, mientras que las variables fisiológicas tenidas en cuenta fueron la presión arterial periférica y central, la rigidez arterial, el ciclo cardiaco y la función respiratoria. La relación entre las variables dependientes e independientes, ajustadas por sexo, edad y nivel educativo se analizó mediante un modelo lineal. También se examinaron las relaciones no lineales entre las variables dependientes e independientes. Resultados: La mayoría de las asociaciones estudiadas no fueron significativas para ninguna de las dos muestras, aunque con algunas excepciones notables: la satisfacción en la vida se relacionó con una tensión arterial sistólica periférica menor, así como con una presión arterial media más baja en la muestra clínica. El sentido de la coherencia se asoció positivamente al volumen respiratorio forzado. En la muestra sana, el índice aórtico y la presión arterial sistólica presentaron una asociación negativa con el optimismo; sin embargo, utilizando la corrección de Bonferroni, ninguna de las relaciones lineales o no lineales resultaron significativas en las muestras. Conclusiones: estudios futuros deberán determinar si estos hallazgos derivan de las características culturales de estas muestras en concreto, o si los mediadores entre la salud psicológica y la salud cardiorrespiratoria deberían ser buscados más allá de las variables incluidas en este estudio