Planimetrische Me\methode an Röntgenbildern kindlicher Hirnschädel mit Normwerten für das Kindesalter

Zusammenfassung Begründung und technische Beschreibung einer neuen planimetrischen Meßmethode an Röntgenbildern kindlicher Hirnschädel. Unter Verwendung eines Planimeters werden die Flächen der Stirn und Scheitelebene bei 1250 Kindern al ler Altersstufen bis zu 13Jahren meßtechnisch erfaßt. Ihre normale Größe und ihr normales Wachstum im Verlaufe der kindlichen Entwicklung wird in Normdiagrammen festgehalten. Im Bewußtsein der Tatsache, daß Röntgenbilder dem Gesetz der Zentralprojektion und damit der projektionsbedingten Vergrößerung unterliegen, können allgemeingültige Aussagen über echte Größe und Wachstum des Hirnschädels nur dann gemacht werden, wenn Messungen am Röntgenbild umgerechnet werden. Mit Hilfe des 2. Strahlensatzes gelingt die mathematische Korrektur der in der Filmebene planimetrisch gemessenen, durch Projektion vergrößerten Flächenwerte in die Objektivwerte der Schädelebene des Probanden. Das Prinzip der Entwicklung entsprechender mathematischer Gleichungen für die Umrechnung der Meßwerte wird erläutert. Die Flächenwerte der Stirn- und Scheitelebene werden als nichtkorrigierte und korrigierte Werte in Wachstumsdiagrammen dargestellt. Es zeigt sich dabei deutlich, daß die Differenz zwischen den Mittelwertskurven der Flächenwerte am Röntgenbild und den mathematisch korrigierten Werten der wahren Schädelgröße am Objekt mit zunehmendem Alter größer wird. Das normale Wachstum des kindlichen Hirnschädels nach Beurteilung von Flächenwerten der Stirn- und Scheitelebene weist drei Perioden unterschiedlicher Wachstumsbeschleunigungen auf. Die erste, kürzeste Periode der schnellsten Wachstumsbeschleunigung innerhalb der ersten 13–14 Monate macht alleine 60% der gesamten Größenzunahme der Hirnschädelflächen in 13 Jahren aus.

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Method of planimetric measurement of the neurocranium on roentgenograms, with normal childhood values

A new planimetric method for the measurement and calculation of the planes of the neurocranium in frontal and sagittal projection is described. Roentgenograms of 1250 children have been evaluated by this method. The large number of cases enabled us to divide them into 35. The results obtained by this method are shown in diagrams with percentiles 5% and 95%. These relative measurements of the roentgenographic planes have been mathematically corrected to obtain the actual planes for the first time. This correction was actually computed with the aid of the second proposition of straight lines (2. Strahlensatz). The calculated values for the plane of the neurocranium make valid data concerning its size and growth possible. The uncorrected and corrected values are shown in two diagrams. Three periods of growth can be distinguished; first a period of rapid growth which ends at the age of about 12 months and is followed by the second period where growth is moderate, which ends at the age of 3 years 4–6 months; in the third and final period growth is wery slow and is not yet completed at the age of 13 years. These results were found in both the sagittal and the frontal planes. The difference between corrected and uncorrected measurements of the planes can easily be demonstrated. This difference increases with age. The results of this research give a general view of the growth of the neurocranium in childhood, undisturbed by technical interference.

     

Application of alternative anthropometric measurements to predict metabolic syndrome

OBJECTIVE:

The association between rarely used anthropometric measurements (e.g., mid-upper arm, forearm, and calf circumference) and metabolic syndrome has not been proven. The aim of this study was to assess whether mid-upper arm, forearm, calf, and waist circumferences, as well as waist/height ratio and waist-to-hip ratio, were associated with metabolic syndrome.

METHODS:

We enrolled 387 subjects (340 women, 47 men) who were admitted to the obesity outpatient department of Istanbul Medeniyet University Goztepe Training and Research Hospital between September 2010 and December 2010. The following measurements were recorded: waist circumference, hip circumference, waist/height ratio, waist-to-hip ratio, mid-upper arm circumference, forearm circumference, calf circumference, and body composition. Fasting blood samples were collected to measure plasma glucose, lipids, uric acid, insulin, and HbA1c.

RESULTS:

The odds ratios for visceral fat (measured via bioelectric impedance), hip circumference, forearm circumference, and waist circumference/hip circumference were 2.19 (95% CI, 1.30-3.71), 1.89 (95% CI, 1.07-3.35), 2.47 (95% CI, 1.24-4.95), and 2.11(95% CI, 1.26-3.53), respectively. The bioelectric impedance-measured body fat percentage correlated with waist circumference only in subjects without metabolic syndrome; the body fat percentage was negatively correlated with waist circumference/hip circumference in the metabolic syndrome group. All measurements except for forearm circumference were equally well correlated with the bioelectric impedance-measured body fat percentages in both groups. Hip circumference was moderately correlated with bioelectric impedance-measured visceral fat in subjects without metabolic syndrome. Muscle mass (measured via bioelectric impedance) was weakly correlated with waist and forearm circumference in subjects with metabolic syndrome and with calf circumference in subjects without metabolic syndrome.

CONCLUSION:

Waist circumference was not linked to metabolic syndrome in obese and overweight subjects; however, forearm circumference, an unconventional but simple and appropriate anthropometric index, was associated with metabolic syndrome and bioelectric impedance-measured visceral fat, hip circumference, and waist-to-hip ratio.     

Photographic Facial Soft Tissue Analysis of Healthy Turkish Young Adults: Anthropometric Measurements

Background  The purpose of this study was to establish facial soft tissue norms for Turkish young adults. Methods  Anthropometric measurements of the facial soft tissue were taken from 281 female and 149 male Turkish adults aged between 18 and 24 years. The soft tissue facial profiles were digitally analyzed using linear (17 vertical and 10 horizontal) measurements made with standardized photographic records, taken in a natural head position, to determine the average soft tissue facial profile for males and females. Results  A statistically significant difference was found between males and females in 20 of 27 measurements taken (p < 0.001). The most prominent differences between the sexes were observed in the measurements taken from the face region. Results were compared with other ethnic groups.     

Research and applications: A rational free energy-based approach to understanding and targeting disease-causing missense mutations

Background and significance

Intellectual disability is a condition characterized by significant limitations in cognitive abilities and social/behavioral adaptive skills and is an important reason for pediatric, neurologic, and genetic referrals. Approximately 10% of protein-encoding genes on the X chromosome are implicated in intellectual disability, and the corresponding intellectual disability is termed X-linked ID (XLID). Although few mutations and a small number of families have been identified and XLID is rare, collectively the impact of XLID is significant because patients usually are unable to fully participate in society.

Objective

To reveal the molecular mechanisms of various intellectual disabilities and to suggest small molecules which by binding to the malfunctioning protein can reduce unwanted effects.

Methods

Using various in silico methods we reveal the molecular mechanism of XLID in cases involving proteins with known 3D structure. The 3D structures were used to predict the effect of disease-causing missense mutations on the folding free energy, conformational dynamics, hydrogen bond network and, if appropriate, protein-protein binding free energy.

Results

It is shown that the vast majority of XLID mutation sites are outside the active pocket and are accessible from the water phase, thus providing the opportunity to alter their effect by binding appropriate small molecules in the vicinity of the mutation site.

Conclusions

This observation is used to demonstrate, computationally and experimentally, that a particular condition, Snyder-Robinson syndrome caused by the G56S spermine synthase mutation, might be ameliorated by small molecule binding.     

中医与西医治疗抑郁症临床试验结局指标及测量工具的比较研究＊

目的 比较分析中医与西医治疗抑郁症随机对照试验（Randomized Controlled Trial，RCT）的结局指标及测量工具使用现状，为今后研究开展提供参考。方法 检索6个临床研究注册平台，获取中医和西医治疗成人抑郁症RCT的注册信息；检索9个中英文数据库，补充中医治疗抑郁症的RCT文献；提取并分析其报告的结局指标及测量工具。结果 共获注册的西医RCT 1033项，中医RCT 195项（注册29项、发表166项）。西医RCT使用的结局指标共581个，评价内容全面涵盖心理功能和躯体功能、日常活动能力、环境反应以及生存质量等结局指标域，涉及406个量表。11%研究关注了安全性结局。中医RCT使用的结局指标共118个，评价内容仅涵盖心理功能和躯体功能、药物不良反应和中医证候等结局指标域，涉及14个量表；极少文献使用了中医疗效评价指标；安全性结局报告率为47%；86.7%研究使用汉密尔顿抑郁量表作为测量工具。结论 西医研究使用的结局指标及测量工具涵盖范围广且研究间差异较大，而中医研究使用的结局指标及测量工具范围小且集中。今后开展的抑郁症临床研究在结合研究目的的基础上，可参考国际抑郁症核心指标集，结合中医药潜在作用点来选择结局指标及适合的测量工具以评价中医药疗效和安全性。     

Influence of Probe Pressure on Ultrasound-Based Shear Wave Elastography of the Liver Using Comb-Push 2-D Technology

It has been postulated that in the liver, applying increased probe pressure during ultrasound-based shear wave elastography (SWE) might lead to a false increase in the SWE result. We aimed to determine the influence of increased intercostal probe pressure when performing SWE of the liver. We also investigated the number of measurements required to achieve technically successful and reliable SWE examinations. This prospective, clinical study included 112 patients and 2240 SWE measurements of the liver. We applied probe pressure intercostally, to reduce the skin-to-liver capsule distance (SCD), which could stabilize the SWE signal and thus increase the number of technically successful measurements. We performed 10 measurements with maximum probe pressure and 10 with normal pressure in each patient. Thus, two analysis groups were compared for differences. Compared with normal pressure, maximum probe pressure significantly reduced the SCD (p < 0.001) and significantly increased the number of technically successful measurements from 981 to 1098, respectively (p < 0.001). The SWE results with normal and maximum probe pressure were 5.96 kPa (interquartile range: 2.41) and 5.45 kPa (interquartile range: 1.96), respectively (p < 0.001). In obese patients, a large SCD poses a diagnostic challenge for ultrasound SWE. We found that maximum intercostal probe pressure could reduce the SCD and increase the number of technically successful measurements, without falsely increasing the SWE result. Only three measurements were required to achieve technically successful and reliable SWE examinations.     

Aerodynamic Measurements in Medialization Thyroplasty

Objective --External vocal fold medialization thyroplasty is a standard technique for improving voice, swallowing and breathing impairments due to insufficient glottal closure caused by either unilateral vocal fold paralysis or deficit of vocal fold tissue (i.e. as a result of cordectomy, scarring processes or sulcus glottidis). However, only scant information is available concerning the effect of the medialization thyroplasty on aerodynamic parameters. The aim of this study was to investigate the effect of vocal fold medialization thyroplasty on the degree of laryngeal stenosis using selected aerodynamic parameters. Material and Methods --Thirty patients (12 female, 18 male) underwent external vocal fold medialization with a titanium vocal fold medialization implant under local anesthesia supplemented by i.v. sedation. Pulmonary function tests were performed pre- and postoperatively and selected parameters were analyzed statistically. Results --All patients reported improved self-control of breathing during speaking, laughing, coughing and physical activity. The postoperative values of the parameters tested showed no significant alteration in comparison to the preoperative data. Conclusions --The analysis of the aerodynamic findings indicated that the medialization procedure using an implant did not cause an increase in the laryngeal resistance.     

Quality of Life after Anterior Resection versus Abdominoperineal Extirpation for Rectal Cancer

Background: Abdominoperineal extirpation has been assumed to put patients at higher risk of disruption to quality of life than sphincter-preserving surgery in rectal cancer surgery. The aim of this study was to investigate quality of life in patients after anterior resection versus abdominoperineal extirpation for rectal cancer and to evaluate the psychometrics of the Danish version of a symptom-specific Fecal Incontinence Quality of Life Scale. Methods: Fourteen patients undergoing abdominoperineal extirpation and 26 undergoing anterior resection. The generic quality of life instrument SF-36 together with a new symptomspecific Fecal Incontinence Quality of Life Scale were used. Psychometric analysis of the symptom-specific scale was carried out. Results: The only significant difference between the two groups was found in the total score of the symptom-specific scale in favour of anterior resection ( P = 0.02). Psychometric evaluation of the symptom-specific fecal incontinence questionnaire proved it reliable and valid. Conclusions: The present study shows that a stoma influences quality of life only slightly, while a relatively high anterior resection does not. However, a few appropriate newer studies indicate that the cost of spinchter-preserving techniques in the form of incontinence disturbances may influence the quality of life seriously, which should be borne in mind when low anterior resection is intended. Further studies in this field are necessary and could benefit from use of the Fecal Incontinence Quality of Life Scale, including its total score.