Adipokine genes and radiographic hand osteoarthritis in Finnish women: a cross-sectional study.

OBJECTIVES: Available evidence suggests that genetic factors and overweight play major roles in the aetiology of osteoarthritis (OA). We analysed the association of 18 single-nucleotide polymorphisms (SNPs) from nine adipokine and adipokine receptor genes (LEP, LEPR, ADIPOQ, RETN, NAMPT, SERPINA12, ITLN1, RARRES2, and APLN) with radiographic hand OA. METHOD: The study design was cross-sectional. Bilateral hand radiographs of 542 occupationally active Finnish female dentists and teachers aged 45-63 years were examined and classified for the presence of hand OA using reference images. Hand OA was defined as at least three finger joints with radiographic OA of grade 2-4. The genotypes were determined using polymerase chain reaction-based methods. Body mass index (BMI) was calculated based on self-reported height and measured weight. Associations of the individual SNPs and their haplotypes with hand OA were tested using logistic regression analysis. RESULTS: The minor allele of RETN rs10401670 was associated with a decreased [odds ratio (OR) = 0.73, 95% confidence interval (CI) 0.55-0.97, p = 0.03] and RARRES2 rs4721 with an increased (OR 1.41, 95% CI 1.07-1.87, p = 0.01) prevalence of hand OA. Also, LEPR AC (OR 1.54, 95% CI 1.01-2.35, p = 0.05) and RETN GGTT (OR 0.58, 95% CI 0.37-0.93, p = 0.02) haplotypes were associated with hand OA. These associations were modified by BMI when comparing normal and overweight women. However, the associations lost their statistical significance after adjusting for multiple testing. CONCLUSION: Our results suggest weak associations between the studied variations in LEPR, RARRES2, and RETN genes and hand OA in Finnish women, and that the associations are modified by BMI. However, these associations could not be verified in the current study.

Lung and pleural fibrosis in asbestos-exposed workers: a risk factor for pneumonia mortality.

Lungs exposed to occupational dust may be especially vulnerable to fatal infections. We followed up asbestos-exposed workers (n=590) originally screened for lung cancer with computed tomography and scored for pleuropulmonary fibrosis. We checked these workers' influenza and pneumonia mortality data (ICD-10 codes J10-J18) in the national register. In total, 191 deaths, including 43 deaths from infectious pneumonia, occurred in 6158 person-years of follow-up (mean follow-up time 10·44 years). 'Some interstitial fibrosis' [hazard ratio (HR) 2·26, 95% confidence interval (CI) 0·98-5·19, P=0·06] and 'definite interstitial fibrosis' (HR 3·70, 95% CI 1·22-11·23, P=0·02) were associated with an increased risk of death from pneumonia compared to no fibrosis. Asbestosis patients, i.e. those with both asbestos exposure and lung fibrosis, therefore appear to be particularly at risk for death from pneumonia. These patients should be vaccinated against influenza and Pneumococcus.

Genetic susceptibility to asbestos-related fibrotic pleuropulmonary changes.

The objective of this study was to determine whether genetic polymorphisms in enzymes that metabolise oxidative agents modify the individual susceptibility to developing asbestos and smoking-related pleuropulmonary changes. Nine polymorphisms of six genes (EPHX1, GSTM1, GSTM3, GSTP1, GSTT1 and NAT2) were genotyped from 1,008 Finnish asbestos-exposed workers. The genotype data were compared to signs of lung fibrosis and pleural thickenings, as well as with total lung capacity, single-breath diffusing capacity of the lung for carbon monoxide (D(L,CO)) and specific diffusing capacity (expressed as D(L,CO) per unit of alveolar volume (V(A))). The GSTT1 deletion polymorphism was associated with fibrotic changes (p=0.003), and decreased D(L,CO) (p=0.02) and D(L,CO)/V(A) (p=0.002), and the GSTM1 deletion polymorphism was associated with the greatest thickness of pleural plaques (p=0.009). On further analysis, the GSTT1 null genotype was found to pose over a three-fold risk for severe fibrotic changes (OR 3.12, 95% CI 1.51-6.43), and around two-fold risks for decreased D(L,CO) (OR 1.77, 95% CI 1.06-2.95) and D(L,CO)/V(A) (OR 2.37, 95% CI 1.33-4.23). In addition, the GSTM1 null genotype showed an elevated risk (OR 1.36, 95% CI 1.03-1.80) for thicker pleural plaques. Our data suggest that inherited detoxification capacity may affect the development and severity of asbestos and smoking-related nonmalignant pulmonary changes.

Hand osteoarthritis and pinch grip strength among middle-aged female dentists and teachers.

OBJECTIVES: Among female dentists and teachers, we investigated the relationship of pinch grip strength with radiographic hand osteoarthritis (OA) and hand joint pain. MATERIALS AND METHODS: We studied 295 female dentists and 248 female teachers aged 45-63 years for pinch grip strength using the Martin Vigorimeter. Hand radiographs were examined for the presence of OA in the wrist and each joint of the first, second, and third fingers. Joint pain and tasks with high hand loading during leisure were assessed by questionnaire. Glove size was used as proxy for hand size. RESULTS: Symptomatic hand OA (jointwise co-occurrence of radiological findings and pain) increased the risk of low pinch grip strength in both hands, with an odds ratio (OR) of 3.3 (95% CI 1.8-6.2) for the right and 2.0 (95% CI 1.1-3.8) for the left hand, allowing for age, occupation, body mass index (BMI), hand size, and hand-loading leisure-time activity. The occurrence of findings and pain in non-corresponding joints was also associated with pinch grip strength in the right hand, but not in the left. Having only radiographic findings or pain was not associated with pinch grip strength. CONCLUSIONS: Our findings support the view that hand function is related to the severity of hand OA.

COL2A1 gene polymorphisms and susceptibility to osteoarthritis of the hand in Finnish women.

OBJECTIVES: To study the role of two COL2A1 single nucleotide polymorphisms (rs3737548 and rs2276455) and their haplotypes in individual susceptibility to osteoarthritis (OA) of the hand in Finnish women. METHODS: Bilateral hand radiographs of 543 Finnish female dentists and teachers aged 45-63 years were examined and classified for the presence of OA by using reference images. The COL2A1 genotypes were determined by PCR-based methods. Data regarding other risk factors were collected by questionnaire. The haplotypes were statistically reconstructed from the genotype data by the PHASE program. Associations between the genotypes/diplotypes and hand OA were studied by logistic regression. RESULTS: Allowing for age and occupation, the carriage of at least one COL2A1 intron 33 minor allele was associated with an increased risk of hand OA (odds ratio (OR) 1.58, 95% CI 1.05 to 2.36) and the number of affected joints. When stratified by occupation, the increased risk associated with the intron 33 minor allele carriage appeared to be mainly attributable to the dentists (OR 2.18, 95% CI 1.18 to 4.06). The 2-1 haplotype (exon 5B minor allele-intron 33 major allele) posed a significantly higher risk of hand OA (OR 3.21, 95% CI 1.08 to 9.55) compared with non-carriers. Moreover, an interaction was observed between intron 33 minor allele carriage and low task variation history in dental work (OR 2.87, 95% CI 1.05 to 7.89 for their joint effect). CONCLUSIONS: The results suggest that the studied COL2A1 gene polymorphisms may play a role in the aetiology of hand OA and that this effect may be enhanced by repetitive loading work tasks.

Visual scoring of atherosclerosis in chest computed tomography: findings among male construction workers.

BACKGROUND: Standard chest computed tomography (CT) examinations may contain valuable and underused information on atherosclerosis. PURPOSE: To study the retrospective scoring of chest atherosclerosis in CT studies performed for reasons other than cardiovascular. MATERIAL AND METHODS: Unenhanced CT images originally used for lung cancer screening of 505 male construction workers were retrospectively analyzed for chest atherosclerotic calcifications (coronary, aortic, and precervical artery origins). Findings were compared between those with a prediagnosed cardiovascular disease or diabetes (n = 180) and disease-free subjects (n = 325). RESULTS: Arterial calcifications (all) occurred among 96.6% of the subjects and coronary calcifications among 91.7%. The average total calcium score of the diseased subjects was 8.34 vs. 5.13 in the disease-free group (P<0.001). All calcification scores increased with age. In multivariable analyses, systolic blood pressure, erythrocyte sedimentation rate, and smoking were generally associated with high scores, while high stature and high diastolic blood pressure were mainly associated with low scores. Nonsignificant positive associations between asbestos exposure and coronary calcifications were found. CONCLUSION: Our scoring method agreed well with preknown cardiovascular risk factors, indicating the method's usability. Chest CT examinations contain valuable information concerning atherosclerosis. This can be used epidemiologically or to reveal occult atherosclerotic disease.

Accuracy of linear measurements using dental cone beam and conventional multislice computed tomography.

OBJECTIVES: The aim of this study was to evaluate the accuracy of linear measurements obtained with dental cone beam CT (CBCT) and multislice CT (MSCT) by altering radiation doses using pre-operative planning of the placement of oral implants as a model. METHODS: A human cadaver mandible was examined in two edentulous areas and one dentate area using CBCT and MSCT. The mandible was examined both dry and immersed in sucrose solution isointense with soft tissue. Two readers measured four linear distances twice from each section. The mandible was cut into 4 mm thick slices at three marked places. These slices were microradiographed and used as the gold standard for measurements from each section. RESULTS: The intraclass correlations between the intra- and interobserver readings obtained with the different methods showed almost perfect matches. The measurement error (ME) showed significant differences between the methods studied (P = 0.022): the mean ME was 4.7% for CBCT and 8.8% for MSCT of the dry mandible, 2.3% and 6.6%, respectively, for the mandible immersed in sucrose solution and 5.4% for low-dose MSCT. Lowering the MSCT radiation dose to less than a quarter of its conventional original value did not significantly affect the ME. CONCLUSIONS: CBCT is a reliable tool for implant-planning measurements when compared with MSCT. In this study, a considerable radiation dose reduction could be achieved with low-dose MSCT examinations without a major loss of measurement accuracy.

Association between overweight and dip osteoarthritis among middle-aged Finnish female dentists and teachers.

SUMMARY: The objective of this study was to examine associations between body mass index (BMI) and symptomatic and non-symptomatic radiographic osteoarthritis in the distal interphalangeal joints (DIP ROA). The subjects were 295 female dentists and 248 female teachers aged 45-63 years randomly selected from the registers of the Finnish Dental Association and the Finnish Teachers' Trade Union of the Helsinki metropolitan region. Radiographs of both hands were examined for the presence of osteoarthritis in each DIP joint. Information on the occurrence of pain in each DIP joint during the past 30 days and hand laterality was obtained by questionnaire. Current BMI was based on self-reported height and measured weight. BMI at the age of 25 years was based on self-reported height and weight. Overweight was defined as BMI ≥ 25.0 kg/m(2). Allowing for age, occupation, hand-loading leisure-time physical activity and smoking history, the risk of symptomatic DIP ROA was increased in currently overweight women (OR 1.98, 95% CI 1.18-3.34) and in women with overweight both currently and at the age of 25 (7.55; 1.33-42.83). The OR for an increase of one standard deviation in BMI at the age of 25 was 1.20 (1.05-1.38) and that for a similar increase in current BMI 1.08 (1.01-1.16), adjusted as above. No relationship of BMI with non-symptomatic DIP ROA or joint pain only was found. The study provides evidence that the risk of symptomatic DIP ROA is increased among overweight middle-aged women. Consideration even of BMI at young adulthood further underlines the association.:

Finger joint pain in relation to radiographic osteoarthritis and joint location--a study of middle-aged female dentists and teachers.

OBJECTIVES: To investigate the associations of radiographic finger joint osteoarthritis (ROA), hand laterality (right/left) and anatomical location within the hand, with finger joint pain. METHODS: Radiographs of both hands of 295 female dentists and 248 female teachers were examined for the presence of osteoarthritis in each finger joint, using grades 0 = no OA, 1 = doubtful OA, 2 = mild OA, 3 = moderate OA, 4 = severe OA. Information on the occurrence of pain in each finger joint during the past 30 days and hand laterality was obtained by questionnaire. RESULTS: Compared with subjects with no ROA, the prevalence ratio (PR) of finger joint pain was 1.92 [95% confidence interval (CI) 1.61-2.34] among those with mild ROA and 5.34 (4.51-6.54) among those with at least moderate ROA, based on a multivariate log-binomial regression model. Pain was slightly more common in the right than in the left hand (1.27; 1.15-1.40). Compared with the little finger, more pain occurred in the thumb (2.67; 2.25-3.16), the index finger (1.76; 1.50-2.07) and the middle finger (1.47; 1.24-1.74). Further, pain was more common in the proximal interphalangeal (1.77; 1.56-2.00) and the distal interphalangeal (1.51; 1.29-1.76) joints than in the metacarpophalangeal joints. The strength of the association between ROA and finger joint pain increased with the severity of pain. CONCLUSIONS: Our findings suggest that ROA, anatomic localization within the hand, and hand laterality have independent effects on finger joint pain.

Toxinogenic Bacillus pumilus and Bacillus licheniformis from mastitic milk.

To elucidate the occurrence of heat-stable toxin-producing strains among mastitic Bacillus isolates, 100 milk samples of mastitic cows from different parts of Finland were screened. Bacillus was identified as the major organism in 23 samples. Toxinogenic Bacillus isolates identified by sperm cell motility inhibition assay were isolated from six samples. Four isolates belonged to the species Bacillus pumilus and two to Bacillus licheniformis. The toxic substances were heat-stable and soluble to methanol thus being of non-protein nature. The methanol extracted substances disrupted the sperm cell plasma membrane permeability barrier at exposure concentrations of 1-15 microg ml(-1) (B. pumilus) or 20-30 microg ml(-1) (B. licheniformis). The toxic properties of the two mastitic B. licheniformis strains were similar to those of B. licheniformis strains known to produce the lipopeptide lichenysin A and the synthetase genes lchAA, lchAB and lchAC for lichenysin were found in the mastitic strains by PCR. Toxin synthetase genes for the syntheses of lichenysin or surfactin were searched but not found in the toxic B. pumilus strains. The ribopatterns of the mastitic B. pumilus and B. licheniformis isolates were similar to those of the toxinogenic strains described earlier from food poisoning incidents and contaminated indoor air. B. licheniformis and B. pumilus survive pasteurization and other heat treatments as spores. Toxin-producing strains of these species in the dairy production chain may thus be of food safety concern.

High genetic relatedness among Mycobacterium avium strains isolated from pigs and humans revealed by comparative IS1245 RFLP analysis.

Members of the Mycobacterium avium complex cause pig mycobacteriosis and opportunistic human infections. Infections due to environmental mycobacteria are increasing in both industrial and developing countries. Mycobacterium-infected pig carcasses can pass for human consumption due to the poor specificity of meat control by visual detection at the slaughter houses. The genetic relatedness of porcine and human MAC isolates in Finland has been unknown. M. avium isolates isolated from pig organs (n=16) and clinical samples (n=13) were compared by IS1245 RFLP analysis to evaluate the similarity of the isolates obtained from human and porcine samples. Nearly identical multicopy M. avium subsp. hominissuis IS1245 RFLP fingerprints were obtained for isolates of porcine and human origin. IS1245 RFLP patterns of 38% of the porcine and human M. a. hominissuis isolates were >90% similar. The RFLP patterns of two porcine and two human isolates showed >95% similarity. The high similarity of the IS1245 RFLP patterns of the human and porcine M. a. hominissuis isolates indicates close genetic relatedness, suggesting that M. a. hominissuis is transmitted between pigs and humans, or that pigs and humans share common environmental sources of infection. Porcine and human isolates with RFLP patterns differing by only one or two bands were found, which shows that the same M. a. hominissuis strains may infect both humans and pigs.

E-learning is a well-accepted tool in supplementary training among medical doctors: an experience of obligatory radiation protection training in healthcare.

PURPOSE: To evaluate the possibilities of Internet-based radiation protection training among referring physicians. MATERIAL AND METHODS: 324 referring physicians underwent an Internet-based radiation protection training course (www.prewise.com/radiationsafetytraining). Two hundred ten of them (96 female, 114 male, aged 25-64 years) filled out the questionnaire, which included questions regarding their expectations for the course, its scope and schedule, and the benefit they derived from the course. In addition, we asked whether it was difficult to learn using the Internet, whether e-learning saved time, and whether they learned more or less effectively in comparison to conventional lectures. RESULTS: 75% found e-learning to be an easy way to study. Nineteen percent had previous experience in e-learning. Sixty-one percent found that it saved time, and 57% stated that they learned more effectively using e-learning in comparison to conventional lectures (22% chose "could not say"). Ninety-one percent found that the course fulfilled their expectations, and the scope and schedule were found convenient by 91% and 55% of subjects, respectively. Eighty-four percent stated that they benefited from the course, and 94% were willing to study using the Internet in the future. No sex or age differences were found. Subjects working in the open ward (P = 0.028) and hospital (P = 0.004) found the course to be more timesaving than subjects working elsewhere. CONCLUSION: Finnish medical doctors are very positive about Internet-based learning. E-learning seems to be a well-accepted and practical learning method in healthcare.

Chest CT screening of asbestos-exposed workers: lung lesions and incidental findings.

The objective of the present study is to determine the feasibility of chest computed tomography (CT) in screening for lung cancer among asbestos-exposed workers. In total, 633 workers were included in the present study and were examined with chest radiography and high-resolution CT (HRCT). A total of 180 current and ex-smokers (cessation within the previous 10 yrs) were also screened with spiral CT. Noncalcified lung nodules were considered positive findings. The incidental CT findings not related to asbestos exposure were registered and further examined when needed. Noncalcified lung nodules were detected in 86 workers. Five histologically confirmed lung cancers were found. Only one of the five cancers was also detected by plain chest radiography and three were from the group of patients with a pre-estimated lower cancer probability. Two lung cancers were stage Ia and were radically operated. In total, 277 individuals presented 343 incidental findings of which 46 required further examination. Four of these were regarded as clinically important. In conclusion, computed tomography and high-resolution computed tomography proved to be superior to plain radiography in detecting lung cancer in asbestos-exposed workers with many confounding chest findings. The numerous incidental findings are a major concern for future screenings, which should be considered for asbestos-exposed ex-smokers and current smokers.

Proliferation of mycobacteria in a piggery environment revealed by mycobacterium-specific real-time quantitative PCR and 16S rRNA sandwich hybridization.

Pig mycobacteriosis is the most common animal mycobacterial disease in Finland with a long-term average prevalence of 0.34% and temporary peaks as high as 0.85%. In the current study Mycobacterium-specific real-time qPCR and 16S rRNA sandwich hybridization were utilized for culture-independent detection and measurement of potentially infectious mycobacteria in selected piggeries. Participating herds (n=5) were selected according to prevalence of tuberculous lesions (>4%) in slaughtered carcasses. When DNA extracted from piggery bedding materials was analyzed by Mycobacterium-targeted qPCR using the SYBR green I dye for detection of amplification products, 10(5) to 10(7) cell equivalents of mycobacterial DNA were detected in unused bedding materials and 10(8) to 10(10)g(-1) dry weight in used bedding materials. When Mycobacterium-specific hybridization probes were used for detection of amplification products, 10(5) to 10(7) cell equivalents of mycobacterial DNA g(-1) dry weight were detected in unused bedding materials in four out of the five piggeries studied and up to 10(8) cell equivalents in used bedding material. The results were confirmed by the Mycobacterium-specific 16S rRNA sandwich hybridization assay. The present results show, that mycobacteria occur in organic materials commonly used on pig farms, and may proliferate in bedding materials during use. We also show that DNA- and RNA-based methods may be utilized for detection of environmental reservoirs of mycobacteria causing porcine and human infection.

Impact of the number of readers on mammography interpretation.

PURPOSE: To evaluate the impact of the number of readers on sensitivity and specificity, and compare it with conference consensus reading. MATERIAL AND METHODS: Eight readers read mammography films of 200 women (including 35 false-negative and 16 screen-detected cancers). The sensitivities and specificities of the two methods were calculated: either at least a single cancer-positive opinion within the group (summarized independent reading) or the cancer-positive opinion of the reader majority (conference consensus reading) was considered decisive. RESULTS: The mean sensitivity for summarized independent readings of different groups was 64.7% as compared to the 43.1% mean sensitivity of conference consensus readings. The mean specificities were 92.4% and 97.7%, respectively. The greatest sensitivity of 74.5% was achieved when the readings of the four best-performing readers were combined. CONCLUSION: The sensitivity of reading is maximal when any positive opinion within a pair or a group of readers is taken into consideration. Discordant double reading may best be judged as screening positive, and the value of a third opinion should be questioned.

Effects of bisphosphonates on prostaglandin E2 and thromboxane B2 production in human whole blood and monocytes stimulated by lipopolysaccharide and A23187.

Bisphosphonates are antiatherosclerotic, suppress monocyte-macrophages, and modulate proinflammatory mediators. Prostaglandin (PG) E(2), thromboxane (TX) A(2), and cyclooxygenase-2 (COX-2) enzyme are involved in inflammation and atherosclerosis. We studied the effects of four bisphosphonates (etidronate, clodronate, tiludronate, and alendronate) on PGE(2) and TXB(2) production in human whole blood and monocytes. PGE(2) and TXB(2) were determined by direct radioimmunoassay and COX-2 expression by Western blot. In whole blood, the bisphosphonates did not modulate the increase in PGE(2) and TXB(2) concentrations induced by calcium ionophore A23187 or lipopolysaccharide (LPS). None of the bisphosphonates did change PGE(2) and TXB(2) concentration after spontaneous clotting. A23187- and spontaneous clotting-induced PGE(2) and TXB(2) productions were inhibited over 90% by acetylsalicylic acid (ASA), and LPS-induced PGE(2) and TXB(2) formations were inhibited over 90% by nimesulide. None of the bisphosphonates altered these inhibitions. In monocytes, etidronate and clodronate augmented A23187-stimulated PGE(2) production 2.5- to 3.2-fold (p < 0.05). LPS- or A2318-induced elevations in TXB(2) were not influenced by the bisphosphonates. The tested bisphosphonates neither induced COX-2 expression nor modulated LPS-induced COX-2 expression in monocytes. The results suggest that the antiatherosclerotic effects of bisphosphonates are not mediated via PGE(2), TXA(2), or COX-2, and the bisphosphonates do not interfere with the suppression of platelet COX-1 activity by ASA and COX-2 activity by nimesulide.

Aggrecan core protein of a certain length is protective against hand osteoarthritis.

OBJECTIVE: To study the contribution of aggrecan VNTR (variable number of tandem repeats) polymorphism to clinically differing manifestations of hand osteoarthritis (OA). DESIGN: Five hundred thirty Finnish females representing two academically similar occupations with completely diverse exposure to hand load were included. Radiographs of hands were analysed, the OA findings were graded and the subjects were divided into categories. Aggrecan VNTR alleles were identified by Southern hybridization. Statistical analyses were used to compare joint involvement and pathological findings with the prevalences of the alleles and genotypes. RESULTS: Subjects homozygous for the most common aggrecan VNTR allele, A27 with 27 repeats, had a significantly lower risk of hand OA, with OR 0.46 (95% CI 0.27-0.78) for OA of grade 2 or more. Our results suggest that carrying two copies of the alleles with less than 27 repeats could predispose a subject to a severe hand OA (OR 2.45, 95% CI 1.17-5.12) and carrying two copies of the alleles with more than 27 repeats also increases the risk of the disease (OR 1.73, 95% CI 1.03-2.89). CONCLUSIONS: These findings indicate that allele A27 provides protection from hand OA and that alleles shorter or longer than this may predispose subjects to the disease. Furthermore, they suggest that a certain number of tandem repeats provide for optimal functioning of the aggrecan molecule and that the contribution of genetic factors to the development of hand OA may be even more important than that of environmental factors.

Effect of computer-aided detection on mammographic performance: experimental study on readers with different levels of experience.

PURPOSE: To evaluate the effect of computer-aided detection (CAD) on the reader's performance. MATERIAL AND METHODS: Four screening radiologists, two novice radiologists, and two residents with no prior experience in CAD read films of 200 women without and with CAD. The films, including 16 screen-detected cancers and 35 cancers "missed" on prior screening, were divided into two rollers: A (free time schedule) and B (prompted time schedule). Reading times were noted. Individual readings without and with CAD were compared, sensitivities and specificities were calculated. RESULTS: The sensitivity of CAD was 70.6% and specificity 15.8%. In 408 cancer readings, the screeners found 10 and other readers 7 new cancers with the aid of CAD. The screeners changed their opinion four times and others six times from true positive to false negative when CAD was negative. CAD output produced 12 versus 13 new false-positive findings respectively after 2352 readings. CAD did not significantly affect the reader's sensitivities/specificities regardless of the time limit (P = not significant). The use of CAD increased mean time for roller reading from 56 to 63 min (P = 0.053). CONCLUSION: Screening radiologists benefited slightly more from CAD than other readers did, but no statistical significant difference was found in personal readings without and with CAD.