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1.
Eur J Dent Educ ; 2021 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-33386660

RESUMO

INTRODUCTION: Due to COVID-19, innovative, virtual educational methods are being developed to provide students with learning experiences comparable to established clinical practices. Our objective was to produce the Periodontal Senior Case Clinical Challenge (PSCCC) that would provide fourth-year students an alternative for senior case presentations and would be a formative assessment for which student opinions would be provided and analysed. The PSCCC would utilise an online, case-based, written, clinical assessment and follow-up, structured discussion to challenge students to demonstrate ability to apply didactic periodontal knowledge to patient-based experiences. We hypothesised the PSCCC would provide effective learning and a formative assessment. MATERIAL AND METHODS: Relevant didactic resources were distributed to 48 students for independent review. The PSCCC was delivered in two sections, (1) a case-based assessment via a virtual classroom with written student responses, and (2) oral discussions conducted via virtual meetings that were moderated and assessed by ten periodontists, with the collaboration of nine residents. A voluntary six-statement survey was used to evaluate the students' opinions of the PSCCC. The scores for 75% (36/48) of students who participated were evaluated for statistical and clinical importance. RESULTS: The value of our PSCCC was supported by 91.7% (33/36) of the analyses (p < .0008). DISCUSSION: The PSCCC was a successful alternative pathway to assess students' clinical and didactic integrated knowledge in periodontics. It provided a unified vision of treatment of the selected case, building on all aspects of the students' periodontal education whilst allowing interaction in a simultaneous, three-tiered educational approach, involving dental students, periodontal residents and faculty. CONCLUSION: In support of our hypothesis, for each of the 6 statements, ≥94.44% (34/36) of the scores given by the students were considered exceptionally strong clinical support for our pedagogical strategy that combines educational resources and can be successfully implemented in other programmes.

3.
AJR Am J Roentgenol ; 215(5): 1163-1170, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32901564

RESUMO

OBJECTIVE. The purpose of this study was to investigate the reproducibility of three quantitative MRI parameters associated with patellar instability and to determine whether they measure anatomic predisposition to patellar instability individually or in combination with the other parameters. MATERIALS AND METHODS. In this retrospective study, 100 patients diagnosed with a patellar dislocation injury and 100 age- and sex-matched control patients were examined using MRI. The distance between the tibial tubercle and posterior cruciate ligament (TT-PCL), distance between the tibial tubercle and trochlear groove (TT-TG), and TG depth (trochlear dysplasia) were measured independently by three fellowship-trained musculoskeletal radiologists. Intraclass correlation coefficient (ICC) was used to assess intraobserver and interobserver reliability. The parameters in both groups were tested for interdependence on each other and were compared for prevalence and association with patellar instability. RESULTS. All three parameters showed almost perfect intraobserver (TT-PCL ICC, ≥ 0.88; TT-TG ICC, 0.96; trochlear dysplasia ICC, ≥ 0.92) and interobserver (TT-PCL ICC, 0.82; TT-TG ICC, 0.94; trochlear dysplasia ICC, 0.91) reliability and were significantly more common in the patellar instability group. Trochlear dysplasia had the highest association with patellar instability, both as a unique parameter and in pairwise combination with an abnormal TT-TG. Optimal cutoff thresholds for normal TT-TG and TT-PCL were 15.00 mm or less and 21.30 mm or less, respectively. The optimal normal cutoff threshold for evaluating trochlear dysplasia via trochlear depth was 4.95 mm or more. CONCLUSION. Patellar instability is multifactorial. Highly reproducible parameters derived from MRI reveal both unique and overlapping anatomic predispositions, and considering all parameters together may help individualize patient management when selecting orthopedic procedures.

4.
Oral Health Prev Dent ; 17(4): 339-347, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31093613

RESUMO

PURPOSE: To evaluate the efficacy of SmartMouth Clinical DDS compared with 0.12% chlorhexidine and placebo mouthrinses. MATERIALS AND METHODS: Seventy-six subjects with gingivitis or chronic periodontitis were enrolled in a double-blind, placebo-controlled, clinical study. Examinations included Gingival Index (GI), Bleeding Score (BS), Plaque Index (PI), Tooth Stain Index (TSI), and Calculus Index (CI). Subjects were given a prophylaxis and oral hygiene instructions at the time of enrolment. Subjects were assigned to one of three groups: SmartMouth Clinical DDS (SM), 0.12% chlorhexidine (CHX), or placebo (PL). Subjects were examined at 3 and 6 weeks. Data were evaluated as differences from baseline for each group. Analysis of variance (ANOVA), t tests or non-parametric alternatives were used to analyse data. RESULTS: The GI, BS and PI decreases from baseline were statistically significant at both 3 and 6 weeks for all three groups (p ≤ 0.025). Differences between groups were not statistically significant, except that the PI decrease for CHX was significantly greater than PL at 6 weeks (p = 0.048). At 6 weeks there was a statistically significant increase in TSI for CHX (p ≤ 0.001). CI decreased significantly for all groups at 3 weeks (p ≤ 0.004) and for PL at 6 weeks (p ˂ 0.001). At 3 weeks and 6 weeks, the percentages for compliance were significantly higher for SM and PL than for CHX (p ˂ 0.001). SM had less taste alteration reported than CHX (p = 0.003). CONCLUSION: While all three groups were shown to improve GI, BS and PI scores; non-prescription SM resulted in less taste alteration, less tooth stain and better compliance than CHX.


Assuntos
Anti-Infecciosos Locais , Placa Dentária , Gengivite , Clorexidina , Índice de Placa Dentária , Método Duplo-Cego , Humanos , Antissépticos Bucais
5.
J Magn Reson Imaging ; 49(5): 1285-1295, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30230096

RESUMO

BACKGROUND: Diffusion tensor imaging (DTI) has been used to characterize calf skeletal muscle architecture. PURPOSE: To assess the diffusional properties of the calf muscles of subjects with and without diabetes, at rest and during isometric plantarflexion exercise. STUDY TYPE: Prospective. SUBJECTS: Twenty-six subjects in two groups: 13 healthy and 13 subjects with type 2 diabetes (DM); each group consisted of seven females and six males. FIELD STRENGTH/SEQUENCE: 3T/2D single-shot spin echo planar imaging. ASSESSMENT: Fractional anisotropy (FA), mean diffusivity (MD), diffusion eigenvalues, and fiber tracking indices were obtained from the medial gastrocnemius (MG), lateral gastrocnemius (LG), and soleus (SOL) muscles of the calf at rest and during isometric plantarflexion exercise. STATISTICAL TESTS: We used a combination of nonparametric (Wilcoxon) and parametric (t-test) statistical assessments. RESULTS: The medial gastrocnemius muscle had more indices with significant differences between the two groups (six indices with P < 0.05) than did the lateral gastrocnemius (three indices with P < 0.05) and soleus muscles (only one index with P < 0.05). While the healthy group showed elevated MD values from rest to exercise (MG = 5.83%, LG = 13.45%, and SOL = 11.68%), the diabetic MD showed higher increases (MG = 19.74%, LG = 29.31%, and SOL = 20.84%) that were different between groups (MG: P = 0.009, LG: P = 0.037, and SOL: P = 0.049). DATA CONCLUSION: Our results indicate considerable diffusional changes between healthy subjects and subjects with diabetes at rest and during isometric plantarflexion exercise in the calf muscles. The medial gastrocnemius muscle displayed the most diffusion sensitivity to diabetes-related microstructural changes. LEVEL OF EVIDENCE: 2 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019;49:1285-1295.


Assuntos
Diabetes Mellitus Tipo 2 , Imagem de Tensor de Difusão/métodos , Perna (Membro)/diagnóstico por imagem , Músculo Esquelético/diagnóstico por imagem , Adulto , Idoso , Anisotropia , Imagem Ecoplanar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Estudos Prospectivos
6.
J Clin Densitom ; 21(4): 485-492, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-28668579

RESUMO

Inflammation-mediated foot osteopenia may play a pivotal role in the etiogenesis, pathogenesis, and therapeutic outcomes in individuals with diabetes mellitus (DM), peripheral neuropathy (PN), and Charcot neuroarthropathy (CN). Our objective was to establish a volumetric quantitative computed tomography-derived foot bone measurement as a candidate prognostic imaging marker to identify individuals with DMPN who were at risk of developing CN. We studied 3 groups: 16 young controls (27 ± 5 years), 20 with DMPN (57 ± 11 years), and 20 with DMPN and CN (55 ± 9 years). Computed tomography image analysis was used to measure metatarsal and tarsal bone mineral density in both feet. The mean of 12 right (7 tarsals and 5 metatarsals) and 12 left foot bone mineral densities, maximum percent difference in bone mineral density between paired bones of the right and the left feet, and the mean difference of the 12 right and the 12 left bone mineral density measurements were used as input variables in different classification analysis methods to determine the best classifier. Classification tree analysis produced no misclassification of the young controls and individuals with DMPN and CN. The tree classifier found 7 of 20 (35%) individuals with DMPN to be classified as CN (1 participant developed CN during follow-up) and 13 (65%) to be classified as healthy. These results indicate that a decision tree employing 3 measurements derived from volumetric quantitative computed tomography foot bone mineral density defines a candidate prognostic imaging marker to identify individuals with diabetes and PN who are at risk of developing CN.


Assuntos
Esclerose Amiotrófica Lateral/diagnóstico por imagem , Densidade Óssea , Neuropatias Diabéticas/diagnóstico por imagem , Ossos do Pé/diagnóstico por imagem , Doenças do Sistema Nervoso Periférico/diagnóstico por imagem , Adulto , Idoso , Esclerose Amiotrófica Lateral/fisiopatologia , Biomarcadores , Densidade Óssea/fisiologia , Doenças Ósseas Metabólicas/diagnóstico por imagem , Árvores de Decisões , Neuropatias Diabéticas/fisiopatologia , Diagnóstico Precoce , Ossos do Pé/fisiopatologia , Humanos , Pessoa de Meia-Idade , Doenças do Sistema Nervoso Periférico/fisiopatologia , Prognóstico , Fatores de Risco , Tomografia Computadorizada por Raios X , Adulto Jovem
7.
Pancreas ; 46(10): 1366-1372, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28930867

RESUMO

OBJECTIVES: The aims of this study were to assess computed tomography enhancement of pancreatic neuroendocrine tumors (NETs), determine correlation with histological vascularity and fibrosis, and identify a biomarker for tumor aggression. METHODS: The arterial and venous enhancement of NET was calculated on computed tomography for 56 patients. Tumor size and vascularity/fibrosis were assessed. Tumor aggression was grouped by World Health Organization and Hochwald grade and the presence of metastases. Variables were assessed for correlation. Groups were compared using t test/Wilcoxon rank sum test. RESULTS: Arterial enhancement and dynamic washout (r = 0.35, P = 0.02; r = 0.34, P = 0.02, respectively) correlate with vascularity. There is inverse correlation between vascularity and fibrosis (r = -0.62, P < 0.001), but no correlation between enhancement and fibrosis. Metastatic NET had less arterial (mean, -2 [standard deviationi {SD}, 27.1] Hounsfield unit [HU]; 35.7 [SD, 57.5] HU; P = 0.01) and venous (12.6 [SD, 14.4] HU; 29.2 [SD, 38.3] HU; P = 0.04) enhancement and less washout (8.5 [SD, 18.5] HU; 26.8 [SD, 30] HU, P = 0.02) compared with nonmetastatic NET. These differences were not present when comparing by tumor grade. Arterial hypoenhancement was the only significant predictor of metastases. CONCLUSIONS: Aggressive tumors, as determined by metastases, but not histological grade, enhance less than nonmetastatic tumors.


Assuntos
Tumores Neuroendócrinos/diagnóstico por imagem , Pâncreas/diagnóstico por imagem , Neoplasias Pancreáticas/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Metástase Neoplásica , Tumores Neuroendócrinos/patologia , Pâncreas/irrigação sanguínea , Neoplasias Pancreáticas/patologia , Adulto Jovem
8.
J Dent Educ ; 81(9): 1062-1067, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28864787

RESUMO

If a dental student diagnoses a patient in a dental school clinic as being at high risk of prediabetes or diabetes, the patient should be referred to his or her physician for further diagnostic evaluation, and the physician should send back the evaluation results so that the dental team can optimize treatment and health care choices if the diagnosis is confirmed. The primary aim of this study was to evaluate physicians' responses to written and oral requests for information regarding follow-up diabetes testing. A secondary aim was to evaluate patients' compliance with recommendations to seek medical care after being determined to be at high risk of prediabetes or diabetes in the dental clinic. Based on at least one positive risk factor for diabetes, 74 patients in one U.S. dental school's clinic were screened by third- and fourth-year dental students for prediabetes or diabetes and underwent point of care HbA1C (glycalated hemoglobin) blood tests between June 2014 and June 2015. Patients with an HbA1C value of 5.7% or above were referred to their physicians for follow-up testing. The physician was mailed the patient's HIPAA release and a request for updates to the student regarding the patient's diabetes status. If the physician did not provide the requested information, a dental student telephoned him or her to obtain the patient's diabetes status. Of the 74 patients, 34 (46%) tested positive with HbA1C tests and were referred to their physicians. Of those 34 referred patients, 20 (59%) saw their physicians for additional evaluations within six months of referral. None of the 20 physicians responded to the written requests for information on additional diabetes testing. After one or two telephone requests, all 20 physicians provided the test results. This study found that most of the patients (59%) followed their dental practitioner's advice to seek follow-up care with their physician, supporting the value of conducting these tests in a dental clinic. However, the results also suggested that a single written request may be insufficient to prompt physicians to return those results and that follow-up communication in a phone call may be more effective.


Assuntos
Diabetes Mellitus/diagnóstico , Comunicação Interdisciplinar , Médicos , Estudantes de Odontologia , Clínicas Odontológicas , Feminino , Pesquisas sobre Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Cooperação do Paciente , Encaminhamento e Consulta , Instituições Acadêmicas , Faculdades de Odontologia
9.
Abdom Radiol (NY) ; 42(9): 2334-2339, 2017 09.
Artigo em Inglês | MEDLINE | ID: mdl-28357530

RESUMO

PURPOSE: To determine if and when fetal structures are identifiable during first trimester pregnancy on magnetic resonance imaging (MRI) in women with acute abdominopelvic pain. METHODS: Sixty-four first trimester MRI examinations performed for evaluation of abdominopelvic pain were reviewed retrospectively. T2-weighted images were assessed independently by three radiologists for the presence of gestational sac, yolk sac, fetal pole, and limb buds. Mean sac diameter and sac volume were determined, and logistic regression analyses were performed. Criterion values for fetal structures and gestational sac size were calculated using receiver operating characteristic analysis. RESULTS: A gestational sac is present in all but two cases. The yolk sac is never identified. A fetal pole is identified at a gestational age (GA), mean sac diameter (MSD), and gestational sac volume (GSV) of greater than 6.4 weeks, 1.7 cm, and 8.9 mL, respectively. Limb buds are identified at a GA, MSD, and GSV of greater than 8.1 weeks, 3.4 cm, and 27.1 mL, respectively. There is a significant correlation between GA and gestational sac size, including the MSD (r 2 = 0.85, P < 0.01) and GSV (r 2 = 0.86, P < 0.01). CONCLUSIONS: The gestational sac is readily demonstrated on T2-weighted images, but the yolk sac is not identified on routine MRI. The fetal pole and limb buds are seen on MRI at a similar GA and MSD as with published values using transvaginal sonography.


Assuntos
Abdome Agudo/diagnóstico por imagem , Saco Gestacional/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Primeiro Trimestre da Gravidez , Adolescente , Adulto , Feminino , Idade Gestacional , Humanos , Gravidez , Estudos Retrospectivos
10.
PLoS One ; 11(6): e0155731, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27275928

RESUMO

The Liang Bua hominins from Flores, Indonesia, have been the subject of intense scrutiny and debate since their initial description and classification in 2004. These remains have been assigned to a new species, Homo floresiensis, with the partial skeleton LB1 as the type specimen. The Liang Bua hominins are notable for their short stature, small endocranial volume, and many features that appear phylogenetically primitive relative to modern humans, despite their late Pleistocene age. Recently, some workers suggested that the remains represent members of a small-bodied island population of modern Austro-Melanesian humans, with LB1 exhibiting clinical signs of Down syndrome. Many classic Down syndrome signs are soft tissue features that could not be assessed in skeletal remains. Moreover, a definitive diagnosis of Down syndrome can only be made by genetic analysis as the phenotypes associated with Down syndrome are variable. Most features that contribute to the Down syndrome phenotype are not restricted to Down syndrome but are seen in other chromosomal disorders and in the general population. Nevertheless, we re-evaluated the presence of those phenotypic features used to support this classification by comparing LB1 to samples of modern humans diagnosed with Down syndrome and euploid modern humans using comparative morphometric analyses. We present new data regarding neurocranial, brain, and symphyseal shape in Down syndrome, additional estimates of stature for LB1, and analyses of inter- and intralimb proportions. The presence of cranial sinuses is addressed using CT images of LB1. We found minimal congruence between the LB1 phenotype and clinical descriptions of Down syndrome. We present important differences between the phenotypes of LB1 and individuals with Down syndrome, and quantitative data that characterize LB1 as an outlier compared with Down syndrome and non-Down syndrome groups. Homo floresiensis remains a phenotypically unique, valid species with its roots in Plio-Pleistocene Homo taxa.


Assuntos
Síndrome de Down/patologia , Síndrome de Down/fisiopatologia , Hominidae/anormalidades , Fenótipo , Animais , Síndrome de Down/diagnóstico , Hominidae/classificação , Indonésia
11.
J Magn Reson Imaging ; 44(4): 940-6, 2016 10.
Artigo em Inglês | MEDLINE | ID: mdl-26970103

RESUMO

PURPOSE: To develop a noncontrast oximetric angiosome imaging approach to assess skeletal muscle oxygenation in diabetic feet. MATERIALS AND METHODS: In four healthy and five subjects with diabetes, the feasibility of foot oximetry was examined using a 3T clinical magnetic resonance imaging (MRI) scanner. The subjects' feet were scanned at rest and during a toe-flexion isometric exercise. The oxygen extraction fraction of skeletal muscle was measured using a susceptibility-based MRI method. Our newly developed MR foot oximetric angiosome model was compared with the traditional angiosome model in the assessment of the distribution of oxygen extraction fraction. RESULTS: Using the traditional angiosome during the toe-flexion exercise, the oxygen extraction fraction in the medial foot of healthy subjects increased (4.9 ± 3%) and decreased (-2.7 ± 4.4%) in subjects with diabetes (difference = 7.6%; 95% confidence interval = -13.7 ± 1.4; P = 0.02). Using the oximetric angiosome, the percent difference in the areas of oxygen extraction fraction within the 0.7-1.0 range (expected oxygen extraction fraction during exercise) between rest and exercise was higher in healthy subjects (8 ± 4%) than in subjects with diabetes (4 ± 4%; P = 0.02). CONCLUSION: This study demonstrates the feasibility of measuring skeletal muscle oxygen extraction fraction in the foot muscle during a toe-flexion isometric exercise. Instead of assessing oxygen extraction fraction in a foot muscle region linked to a supplying artery (traditional angiosome), the foot oximetric angiosome model assesses oxygen extraction fraction by its different levels in all foot muscle regions and thus may be more appropriate for assessing local ischemia in ulcerated diabetic feet. J. Magn. Reson. Imaging 2016. J. MAGN. RESON. IMAGING 2016;44:940-946.


Assuntos
Pé Diabético/diagnóstico por imagem , Pé Diabético/metabolismo , Angiografia por Ressonância Magnética/métodos , Músculo Esquelético/diagnóstico por imagem , Músculo Esquelético/metabolismo , Oximetria/métodos , Oxigênio/metabolismo , Idoso , Teste de Esforço/métodos , Feminino , Humanos , Interpretação de Imagem Assistida por Computador/métodos , Masculino , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Distribuição Tecidual
12.
AJR Am J Roentgenol ; 205(4): 886-93, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-26397340

RESUMO

OBJECTIVE: This practice quality improvement study of pediatric voiding cystourethrogram (VCUG) investigated the adequacy of substituting last-image capture for digital-spot images and dose reduction when this substitution was implemented and determined correlations between dose-area products (DAPs), patient ages, and fluoroscopy times. MATERIALS AND METHODS: The study consisted of three phases: phase 1 documented baseline data and evaluated diagnostic accuracy between last-image capture and digital-spot images. Phase 2 documented the change in dose after substituting last-image capture for digital-spot images. Phase 3 measured doses 3 years later. Each phase-1 VCUG study was segregated into two image sets: last-image capture and digital-spot images. Three radiologists graded vesicoureteral reflux on each side using the international grading scale. Weighted kappa statistics assessed grading differences between image sets. Patient age, fluoroscopy time, and DAP were assessed with parametric and nonparametric statistics. RESULTS: Seventy-seven, 65, and 71 VCUGs were assessed for phases 1, 2, and 3, respectively. Weighted κ = 0.94-0.99 indicated nearly perfect agreement between last-image-capture and digital-spot-image interpretations. For phase 2, last-image capture was substituted for digital-spot images for early-filling and voiding images. DAP decreased for all three radiologists (p ≤ 0.01). Five of six (83%) correlations between DAP and age were higher than the correlations between DAP and fluoroscopy time. The dose remained significantly lower in phase 3. CONCLUSION: This project changed practice by substituting last-image capture for digital-spot images without affecting vesicoureteral reflux grading while reducing radiation exposure. Monitoring DAP is a better assessment of radiation exposure than is fluoroscopy time.


Assuntos
Melhoria de Qualidade , Doses de Radiação , Urografia/métodos , Refluxo Vesicoureteral/diagnóstico por imagem , Criança , Meios de Contraste , Feminino , Fluoroscopia , Humanos , Masculino , Proteção Radiológica/métodos
13.
J Pediatr ; 166(3): 660-5, 2015 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-25556013

RESUMO

OBJECTIVES: To test our hypothesis that obese adolescents have left ventricular (LV) dysfunction and remodeling that are associated with markers of cardiovascular risk and insulin resistance (IR). STUDY DESIGN: In a cross-sectional study of 44 obese and 14 lean age-, sex-, Tanner stage-, and race-matched adolescents, IR, markers of cardiovascular risks, conventional and 2-dimensional speckle tracking echocardiography measures of LV function and structure were evaluated and compared. RESULTS: The obese adolescents had significantly increased body mass index Z-score, systolic blood pressure, fasting insulin, IR, and atherogenic lipids compared with the lean adolescents. A subgroup of obese adolescents had LV remodeling characterized by significantly increased LV mass index (g/m(2.7)) and relative wall thickness. Almost all obese adolescents had LV dysfunction with peak LV global longitudinal strain (GLS, %), systolic GLS rate (GLSR, %/s), and early diastolic GLSR significantly lower than in lean adolescents and in the normal pediatric population. Body mass index Z-score predicted LV remodeling (LV mass index [R(2) = 0.34] and relative wall thickness [R(2) 0.10]), and peak LV GLS (R(2) 0.15), and along with systolic blood pressure, predicted systolic GLSR (R(2) 0.16); (P ≤ .01 for all). Fasting insulin predicted early diastolic GLSR (R(2) 0.17, P ≤ .01). CONCLUSIONS: Obese adolescents have subclinical ventricular dysfunction associated with the severity of obesity, increased systolic blood pressure, and IR. Ventricular remodeling is present in a subgroup of obese adolescents in association with the severity of obesity. These findings suggest that obesity may have an early impact on the cardiovascular health of obese adolescents.


Assuntos
Biomarcadores/sangue , Índice de Massa Corporal , Resistência à Insulina , Obesidade Pediátrica/complicações , Disfunção Ventricular Esquerda/etiologia , Adolescente , Doenças Cardiovasculares/sangue , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etiologia , Criança , Estudos Transversais , Ecocardiografia , Feminino , Humanos , Incidência , Masculino , Obesidade Pediátrica/sangue , Obesidade Pediátrica/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Estados Unidos/epidemiologia , Disfunção Ventricular Esquerda/epidemiologia , Disfunção Ventricular Esquerda/fisiopatologia
14.
Eur Radiol ; 25(1): 99-105, 2015 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-25100334

RESUMO

OBJECTIVE: The purpose of this study is to develop a non-contrast magnetic resonance imaging (MRI) approach to evaluate skeletal muscle perfusion in the diabetic foot based on the concept of angiosomes of the foot. METHODS: Five healthy volunteers and five participants with diabetes (HbA1c = 7.2 ± 1.8%) without a history of peripheral artery disease were examined. The non-contrast perfusion measurements were performed during a toe flexion challenge. Absolute perfusion maps were created and two regions (medial and lateral) on the maps were segmented based on angiosomes. RESULT: Regional difference in the perfusion of foot muscle was readily visualized in the MRI perfusion angiosomes during the challenge. In the participants with diabetes, the perfusion during toe flexion challenge was significantly lower than in healthy volunteers (P < 0.01). The average perfusion for the medial plantar region of the right foot was lower in subjects with diabetes (38 ± 9 ml/min/100 g) than in healthy subjects (93 ± 33 ml/min/100 g). CONCLUSIONS: Non-contrast MRI perfusion angiosome maps demonstrate the feasibility of determining regional perfusion in foot muscles during toe challenge and may facilitate evaluation of muscle perfusion in diabetic feet. KEY POINTS: • Non-contrast MRI perfusion angiosome maps measure regional perfusion in foot muscles non-invasively. • Foot perfusion response to challenge is reduced in persons with diabetes. • MRI perfusion angiosome maps may help evaluation of regional foot muscle perfusion.


Assuntos
Pé Diabético/patologia , Pé/irrigação sanguínea , Músculo Esquelético/irrigação sanguínea , Idoso , Análise de Variância , Meios de Contraste , Estudos de Viabilidade , Humanos , Angiografia por Ressonância Magnética/métodos , Pessoa de Meia-Idade , Músculo Esquelético/fisiopatologia , Doença Arterial Periférica/patologia , Estudos Prospectivos
15.
J Vasc Interv Radiol ; 25(10): 1580-8, 2014 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-25088935

RESUMO

PURPOSE: To describe a new complication and retrospectively identify the incidence and risk factors for hip chondrolysis and femoral head osteonecrosis associated with percutaneous cryoablation of periacetabular malignancies. MATERIALS AND METHODS: In this retrospective study, 45 patients with a total of 113 musculoskeletal lesions were treated by percutaneous image-guided cryoablation between May 2008 and June 2013. Included in the treated population were 10 patients with a total of 12 periacetabular lesions. Clinical and imaging follow-up of at least 2 months was reviewed for evidence of femoral head osteonecrosis or hip chondrolysis. Parametric and nonparametric statistical methods were used to assess patient demographics and treatment technique and parameters on the development of hip chondrolysis/femoral head osteonecrosis. RESULTS: Hip chondrolysis/femoral head osteonecrosis developed in 40% of patients (four of 10) and in 33% of treated periacetabular lesions (four of 12). All patients in whom chondrolysis/osteonecrosis developed were women. Needle proximity to the acetabulum (< 5 mm) was a significant predictor of chondrolysis/osteonecrosis development (P = .01). Three of the four patients in whom chondrolysis/osteonecrosis developed have undergone total joint replacement. CONCLUSIONS: Periacetabular cryoablation can result in transarticular extension of the ablation zone, which may result in the development of hip chondrolysis and femoral head osteonecrosis. The proximity of the cryoablation probe to the acetabulum is a significant risk factor in the development of this complication.


Assuntos
Acetábulo/cirurgia , Neoplasias Ósseas/cirurgia , Doenças das Cartilagens/epidemiologia , Cartilagem Articular , Criocirurgia/efeitos adversos , Necrose da Cabeça do Fêmur/epidemiologia , Articulação do Quadril , Metastasectomia/efeitos adversos , Acetábulo/diagnóstico por imagem , Acetábulo/patologia , Adulto , Idoso , Artroplastia de Quadril , Neoplasias Ósseas/secundário , Doenças das Cartilagens/diagnóstico , Doenças das Cartilagens/cirurgia , Cartilagem Articular/diagnóstico por imagem , Cartilagem Articular/patologia , Cartilagem Articular/cirurgia , Feminino , Necrose da Cabeça do Fêmur/diagnóstico , Necrose da Cabeça do Fêmur/cirurgia , Articulação do Quadril/diagnóstico por imagem , Articulação do Quadril/patologia , Articulação do Quadril/cirurgia , Humanos , Incidência , Imagem por Ressonância Magnética , Masculino , Metastasectomia/métodos , Pessoa de Meia-Idade , Reoperação , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Adulto Jovem
16.
NMR Biomed ; 27(6): 681-91, 2014 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-24700565

RESUMO

The aim of this study was to compare diffusion-weighted MRI (DW-MRI) with positron emission tomography/computed tomography (PET/CT) for the staging and evaluation of the treatment response in patients with diffuse large B-cell lymphoma (DLBCL). Institutional review board approval was obtained for this study; all subjects gave informed consent. Twelve patients were imaged before treatment and eight of these were also imaged after two cycles of chemotherapy using both DW-MRI and PET/CT. Up to six target lesions were selected at baseline for response assessment based on International Working Group criteria (nodes > 1.5 cm in diameter; extranodal lesions > 1 cm in diameter). For pretreatment staging, visual analysis of the numbers of nodal and extranodal lesions based on PET/CT was performed. For interim response assessment after cycle 2 of chemotherapy, residual tumor sites were assessed visually and the percentage changes in target lesion size, maximum standardized uptake value (SUVmax ) and apparent diffusion coefficient (ADC) from pretreatment values were calculated. In 12 patients studied pretreatment, there were 46 nodal and 16 extranodal sites of lymphomatous involvement. Agreement between DW-MRI and PET/CT for overall lesion detection was 97% (60/62 tumor sites; 44/46 nodal and 16/16 extranodal lesions) and, for Ann Arbor stage, it was 100%. In the eight patients who had interim assessment, five of their 49 tumor sites remained abnormal on visual analysis of both DW-MRI and PET/CT, and there was one false positive on DW-MRI. Of their 24 target lesions, the mean pretreatment ADC value, tumor size and SUVmax were 772 µm(2) /s, 21.3 cm(2) and 16.9 g/mL, respectively. At interim assessment of the same 24 target lesions, ADC values increased by 85%, tumor size decreased by 74% and SUVmax decreased by 83% (all p < 0.01 versus baseline). DW-MRI provides results comparable with those of PET/CT for staging and early response assessment in patients with DLBCL.


Assuntos
Imagem de Difusão por Ressonância Magnética/métodos , Linfoma Difuso de Grandes Células B/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Projetos Piloto , Tomografia por Emissão de Pósitrons , Estudos Prospectivos , Tomografia Computadorizada por Raios X
17.
Mult Scler ; 20(3): 349-55, 2014 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-23836876

RESUMO

BACKGROUND: Conventional magnetic resonance imaging (MRI) methods do not quantify the severity of multiple sclerosis (MS) white matter lesions or measure pathology within normal-appearing white matter (NAWM). OBJECTIVE: Gradient Echo Plural Contrast Imaging (GEPCI), a fast MRI technique producing inherently co-registered images for qualitative and quantitative assessment of MS, was used to 1) correlate with disability; 2) distinguish clinical MS subtypes; 3) determine prevalence of veins co-localized within lesions in WM. METHODS: Thirty subjects representing relapsing-remitting MS (RRMS), secondary progressive MS (SPMS) and primary progressive MS (PPMS) subtypes were scanned with clinical and GEPCI protocols. Standard measures of physical disability and cognition were correlated with magnetic resonance metrics. Lesions with central veins were counted for RRMS subjects. RESULTS: Tissue damage load (TDL-GEPCI) and lesion load (LL-GEPCI) derived with GEPCI correlated better with MS functional composite (MSFC) measures and most other neurologic measures than lesion load derived with FLAIR (LL-FLAIR). GEPCI correctly classified clinical subtypes in 70% subjects. A central vein could be identified in 76% of WM lesions in RRMS subjects on GEPCI T2*-SWI images. CONCLUSION: GEPCI lesion metrics correlated better with neurologic disability than lesion load derived using FLAIR imaging, and showed promise in classifying clinical subtypes of MS. These improvements are likely attributable to the ability of GEPCI to quantify tissue damage.


Assuntos
Encéfalo/patologia , Imagem por Ressonância Magnética/métodos , Esclerose Múltipla/patologia , Fibras Nervosas Mielinizadas/patologia , Veias/patologia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
18.
Odontology ; 102(2): 232-40, 2014 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-23334869

RESUMO

The aim of this study is to evaluate the effectiveness over application time of different formulations of a novel endodontic irrigant (QMix™ 2in1) composed of a polyaminocarboxylic acid chelating agent, a bisbiguanide antimicrobial agent, a surfactant and deionized water to remove the root canal smear layer and expose patent dentinal tubules compared to a standard solution of 17% EDTA. Eighty human tooth roots from extracted, single-rooted teeth were instrumented (size 40.06) using 0.2 mL of sodium hypochlorite (6.15%) between each file size with a 3 mL water rinse after final instrumentation. Eight groups of 10 roots were irrigated with 3 mL of different formulations of QMix: QMix A, QMix B, and QMix C, or 17% EDTA for 60 and 90 s, respectively, then rinsed with 5 mL of sterile water. The roots were irrigated using a standard irrigation syringe and a 30 ga side-vent needle with an apical-coronal motion to within 1 mm of the working length. The coronal, middle and apical thirds of one canal surface of each root was evaluated at 1000× using scanning electron microscopy. The presence of smear layer was scored using a 5-point scale. Data were analyzed with the Kruskal-Wallis rank sums test, the Steel-Dwass, all-pairs comparison test, and the Steel method (with control) test. Irrigant type was highly significant (p < 0.007). Combined 60 and 90 s exposure data indicated QMix A (p = 0.014) and QMix C (p = 0.028) were superior to EDTA. While at the 90 s exposure time, smear layer removal by solutions QMix A (p = 0.043), QMix B (p = 0.018), and QMix C (p = 0.011) was superior to EDTA. All irrigants removed smear layer more effectively at the coronal and middle levels compared to the apical level (p < 0.001). Analysis showed all three QMix formulations were superior to EDTA in smear layer removal and exposure of dentinal tubules in the root canal system in single-rooted teeth.


Assuntos
Irrigantes do Canal Radicular/administração & dosagem , Humanos , Técnicas In Vitro , Microscopia Eletrônica de Varredura , Preparo de Canal Radicular
19.
Pediatr Cardiol ; 35(3): 411-8, 2014 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-24061276

RESUMO

The Doppler Tei index is an independent predictor of outcomes in adult heart failure. Tissue Doppler imaging (TDI) may be a superior method to measure the Tei index in children because it is less affected by heart rate variability. We hypothesized that the TDI Tei index reflects severity of illness in pediatric heart failure. Twenty-five pediatric heart failure patients were prospectively enrolled. Listing for heart transplantation or death were the outcomes used to define severity of illness. Baseline demographics, brain natriuretic peptide (BNP), and standard echocardiographic and TDI-derived parameters were analyzed to determine outcome indicators. Ten of the 25 patients (40%) were listed for transplantation. There were no deaths. Multivariate analysis combining age, heart rate, standard echocardiographic parameters, and BNP resulted in shortening fraction (p = 0.002) as the best indicator of listing for transplantation (R(2) = 0.32). A second multivariate analysis combining age, heart rate, TDI parameters, and BNP resulted in age (p = 0.03) and septal Tei index (p = 0.03) as the best predictive model (R(2) = 0.36). The area under the receiver operating characteristic (ROC) curve for septal Tei index was 0.84 (95% confidence interval = 0.64-0.96,), and it was comparable with the ROC curve for shortening fraction, p = 0.76. Optimal values of sensitivity (100%) and specificity (60%) were obtained with septal Tei index values >0.51. The TDI septal Tei index is an indicator of disease severity in pediatric heart failure patients and offers potential advantages compared with standard echocardiographic measures of left-ventricular ejection.


Assuntos
Ecocardiografia Doppler , Insuficiência Cardíaca/diagnóstico por imagem , Insuficiência Cardíaca/fisiopatologia , Adolescente , Biomarcadores/sangue , Criança , Pré-Escolar , Feminino , Frequência Cardíaca/fisiologia , Humanos , Lactente , Masculino , Peptídeo Natriurético Encefálico/sangue , Valor Preditivo dos Testes , Estudos Prospectivos , Índice de Gravidade de Doença
20.
J Bone Joint Surg Am ; 95(13): 1206-13, 2013 Jul 03.
Artigo em Inglês | MEDLINE | ID: mdl-23824389

RESUMO

BACKGROUND: Charcot neuropathic osteoarthropathy associated foot deformity can result in joint instability, ulceration, and even amputation. The purpose of the present study was to follow patients with and without active Charcot osteoarthropathy for as long as two years to examine the magnitude and timing of foot alignment changes. METHODS: We studied fifteen subjects with Charcot osteoarthropathy and nineteen subjects with diabetes mellitus and peripheral neuropathy without Charcot osteoarthropathy for one year; eight of the subjects with osteoarthropathy and five of the subjects with diabetes and peripheral neuropathy were followed for two years. Bilateral weight-bearing radiographs of the foot were made at baseline for all subjects, with repeat radiographs being made at six months for the osteoarthropathy group and at one and two years for both groups. Radiographic measurements included the Meary angle, cuboid height, calcaneal pitch, and hindfoot-forefoot angle. RESULTS: The Meary angle, cuboid height, and calcaneal pitch worsened in feet with Charcot osteoarthropathy over one year as compared with the contralateral, uninvolved feet and feet in patients with diabetes and peripheral neuropathy. Cuboid height continued to worsen over the two-year follow-up in the feet with Charcot osteoarthropathy. These feet also had a greater change in the hindfoot-forefoot angle at one year as compared with the feet in patients with diabetes and peripheral neuropathy and at two years as compared with the contralateral, uninvolved feet. CONCLUSIONS: In patients with Charcot neuropathic osteoarthropathy, radiographic alignment measurements demonstrate the presence of foot deformity at the time of the initial clinical presentation and evidence of progressive changes over the first and second years. The six-month data suggest worsening of medial column alignment prior to lateral column worsening. This radiographic evidence of worsening foot alignment over time supports the need for aggressive intervention (conservative bracing or surgical fixation) to attempt to prevent limb-threatening complications.


Assuntos
Artropatia Neurogênica/complicações , Deformidades Adquiridas do Pé/etiologia , Adulto , Artropatia Neurogênica/classificação , Artropatia Neurogênica/patologia , Mau Alinhamento Ósseo/etiologia , Neuropatias Diabéticas/complicações , Progressão da Doença , Feminino , Seguimentos , Humanos , Imobilização , Masculino , Ossos do Tarso/patologia
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