Comparison of severity of aortic regurgitation by cardiovascular magnetic resonance versus transthoracic echocardiography.

Transthoracic echocardiography is the current standard for assessing aortic regurgitation (AR). AR severity can also be evaluated by flow measurement in the ascending aorta using cardiac magnetic resonance (CMR); however, the optimal site for flow measurement and the regurgitant fraction (RF) severity grading criteria that best compares with the transthoracic echocardiographic assessment of AR are not clear. The present study aimed to determine the optimal site and RF grading criteria for AR severity using phase-contrast flow measurements and CMR. A prospective observational study was performed of 107 consecutive patients who were undergoing CMR of the thoracic aorta. Using CMR, the AR severity and aortic dimensions were measured at 3 levels in the aorta (the sinotubular junction, mid-ascending aorta, and distal ascending aorta). The results were compared to the transthoracic echocardiographic grade of AR severity using multiple qualitative and quantitative criteria (grade 0, none; I+, mild; II+, mild to moderate; III+, moderate to severe; and IV+, severe). The mean RF values were significantly greater at the sinotubular junction than at the distal ascending aorta (13 ± 13.3% vs 9.4 ± 12.6%, respectively; p <0.001). The RF values that best defined AR severity using phase-contrast CMR were as follows: grade 0 to I+, <8%; grade II+, 8% to 19%; grade III+, 20 to 29%; and grade IV+, 30%) at the sinotubular or mid-ascending aorta. In conclusion, the quantitative RF values of AR severity using phase-contrast flow are best assessed in the proximal ascending aorta and differ from recognized quantitative echocardiographic criteria.

Assessing the violent offending and violent victimization overlap among discharged psychiatric patients.

Prior studies have documented linkages between mental disorder and both offending and victimization. However, few studies have examined the violent offending-violent victimization overlap among mentally disordered individuals and none have examined the factors that are jointly related to their covariation. Here, we assess this overlap during the first ten weeks following hospital discharge among a large sample of psychiatric patients from three large cities. Findings indicate that: (1) violent offending and violent victimization show substantial covariation; (2) although each of the two outcomes were predicted by a few unique risk factors, several risk factors were similarly predictive of both outcomes; and (3) even after adjusting for demographic, clinical, and social risk factors, the correlation between violent offending and violent victimization remained robust. Implications for theory, research, and policy are highlighted.

Angiomyolipoma with minimal fat on MDCT: can counts of negative-attenuation pixels aid diagnosis?

OBJECTIVE: The purpose of this study was to determine whether counts of pixels with subzero attenuation on CT scans can aid in the diagnosis of renal angiomyolipoma with minimal fat. MATERIALS AND METHODS: Of 33 angiomyolipomas identified among 719 renal masses resected from 702 patients over 4 years, 15 masses in 15 patients were prospectively diagnosed on the basis of the presence of fat at MDCT. The 18 patients with minimal-fat angiomyolipoma and a matched (age, sex, tumor size) cohort of patients with renal cell carcinoma were included in this study. Three radiologists independently counted the number of pixels with attenuation less than -10, -20, and -30 HU. Receiver operating characteristic analysis of the number of pixels at each cutoff was used to calculate sensitivity, specificity, and positive predictive value with the following criteria: 1, more than 10 pixels less than -20 HU; 2, more than 20 pixels less than -20 HU; 3, more than 5 pixels less than -30 HU. RESULTS: Using criterion 1, reader A identified six angiomyolipomas; reader B, five; and reader C, two. The combined sensitivity was 24%; specificity, 98%; and positive predictive value, 69%. Using criterion 2, reader A identified three angiomyolipomas; reader B, four; and reader C, two. The combined sensitivity was 17%; specificity, 100%; and positive predictive value, 100%. Using criterion 3, reader A identified four angiomyolipomas; reader B, four; and reader C, two. The combined sensitivity was 18%; specificity, 100%; and positive predictive value, 100%. CONCLUSION: CT findings of more than 20 pixels with attenuation less than -20 HU and more than 5 pixels with attenuation less than -30 HU have a positive predictive value of 100% in detection of angiomyolipoma, but most angiomyolipomas with minimal fat cannot be reliably identified on the basis of an absolute pixel count.

The RIN: an RNA integrity number for assigning integrity values to RNA measurements.

BACKGROUND: The integrity of RNA molecules is of paramount importance for experiments that try to reflect the snapshot of gene expression at the moment of RNA extraction. Until recently, there has been no reliable standard for estimating the integrity of RNA samples and the ratio of 28S:18S ribosomal RNA, the common measure for this purpose, has been shown to be inconsistent. The advent of microcapillary electrophoretic RNA separation provides the basis for an automated high-throughput approach, in order to estimate the integrity of RNA samples in an unambiguous way. METHODS: A method is introduced that automatically selects features from signal measurements and constructs regression models based on a Bayesian learning technique. Feature spaces of different dimensionality are compared in the Bayesian framework, which allows selecting a final feature combination corresponding to models with high posterior probability. RESULTS: This approach is applied to a large collection of electrophoretic RNA measurements recorded with an Agilent 2100 bioanalyzer to extract an algorithm that describes RNA integrity. The resulting algorithm is a user-independent, automated and reliable procedure for standardization of RNA quality control that allows the calculation of an RNA integrity number (RIN). CONCLUSION: Our results show the importance of taking characteristics of several regions of the recorded electropherogram into account in order to get a robust and reliable prediction of RNA integrity, especially if compared to traditional methods.

Serum sex hormones and measures of benign prostatic hyperplasia.

BACKGROUND: Despite biologic plausibility, the associations between sex hormones and measures of benign prostatic hyperplasia (BPH) have not been consistently reported. METHODS: Subjects were randomly selected from the Olmsted County, MN population (n, 320; median age, 60.9 years) and followed biennially since 1990. In 2002, surrogate measures of BPH were assessed from an approximation of the American Urological Association Symptom Index (AUASI), Peak urinary flow rates (Q(max)), and a transrectal ultrasound assessment of prostate volume. Serum levels of prostate specific antigen (PSA), testosterone, bioavailable testosterone, and estradiol were also measured. RESULTS: Bioavailable testosterone levels declined with increasing cross-sectional age from 53.8, 50.2, to 41.2 ng/dl (P = 0.001) in men aged <60, 60-69, and >69 years, respectively, and the estradiol/bioavailable testosterone ratio increased from 0.042, 0.044, to 0.050 (P = 0.04). Among men with bioavailable testosterone above the median, estradiol levels had a dose response relationship with prostate size. Among men with bioavailable testosterone level