Arterial wall stiffness in insulin-dependent diabetes mellitus. An in vivo study

The arterial wall stiffness in the common femoral artery was determined by means of an ultrasound technique in 47 insulin-dependent diabetics and 24 controls aged 20 to 39 years. They were all without vascular symptoms and signs, and were selected in such a way that they were thought to be free of age correlated changes. Furthermore, patients in potential risk groups, as for arterial disease of non-diabetic type, were excluded. The arterial wall stiffness was significantly increased in the diabetic group as compared with a control group. Furthermore, there was a significant correlation to the diabetic duration. Possible pathogenetic reasons are discussed.     

Neuro-AIDS: a multicenter neuroradiological study

The results are described of a retrospective multicentric CT/MR study of 141 neuro-AIDS patients (IV group CDC classification); 114 patients were drug addicted, 13 homosexual, 8 polytransfused, and 6 had other risk factors. The mean age was 29.6 years. The pathologic agent was identified in 47 cases by c.s. fluid examination, biopsy, autopsy or specific treatment response: it was HIV in 20 cases, toxoplasmosis in 11, cryptococcosis in 9, leishmaniasis, salmonella and papovavirus in single cases. In the follow up of 2 cases, a Kaposi's sarcoma and a primitive CNS lymphoma occurred. The main clinical features were AIDS-dementia complex (45% of cases) and focal neurologic manifestations (36%). The neuroradiological protocol consisted of 238 CT exams (97 controls), most of them with DDD (delayed double dose) technique, 7 MR exams (0.15 T) and 2 angiographies. CT findings were divided into 3 groups: negative (16%), atrophic (47%) and focal lesions (37%). In the first and second group, HIV and cryptococcal infections were the main pathologic agents. In the third group toxoplasma infections were discovered, and TB granulomas and other pathologic conditions, with ring-like or nodular enhancement, in cortical/cortico-medullary location. In follow-up patients a high tendency of evolution towards focal lesions was observed, even in negative cases. The DDD enhancement technique allowed in most cases both the demonstration of very small lesions and their grading. According to the literature CT, though a highly sensitive method, is inferior to MR imaging; however our experience in this field is currently insufficient. The specific diagnosis of pathologic agents of neuro-AIDS is difficult, due to the high number of opportunistic AIDS-related infections and neoplasms, with overlapping features: differential diagnostic criteria can be assessed only by comparing the clinical, microbiological, topographic, CT and MR findings. CT and MR exams are necessary to guide and monitor therapy and to plan stereotaxis biopsy.     

Postoperative ultrasonography surveillance in patients with follicular thyroid carcinoma: a multicenter study

Objective

This study aimed to evaluate the locoregional recurrence rate of follicular thyroid carcinoma (FTC) and to assess the appropriate frequency of postoperative ultrasonography (US) surveillance for detecting tumor recurrence.

Methods

The review boards of the seven participating institutions approved this study. From 2000 to 2011, 186 patients underwent at postoperative US at least once; US was performed by experienced radiologists at each institution. Based on the US and histopathological results, locoregional tumor recurrence was assessed.

Results

The T stages of the 186 patients were T1a (8.1%), T1b (21.5%), T2 (39.8%), T3 (30.6%), T4a (0%), and T4b (0%). The N stages were unknown (24.2%), N0 (71.5%), N1a (3.2%), and N1b (1.1%), and the M stages unknown (29.6%), M0 (66.1%), and M1 (4.3%). Tumors recurred in only 6 (3.2%) patients during the follow-up period over 5 years. Among them, no patients showed the initial suspicion of recurrences on routine follow-up US. The session number and interval of postoperative US differed significantly between patients with recurrence and those without recurrence. The mean interval of postoperative follow-up US at the first detection time of tumor recurrence was 37.5 ± 18.5 months (range 9–62 months). Significantly more FTCs were at an advanced N and M stage in the recurrence group than in the non-recurrence group (p < 0.05).

Conclusions

Routine postoperative US surveillance may be unnecessary for detecting tumor recurrence after thyroid surgery in FTC patients.

     

Long-term sequelae of Farmer's lung disease in HRCT: a 14-year follow-up study of 88 patients and 83 matched control farmers

The aim of this study was to compare high-resolution computed tomography (HRCT) findings of long-term farmer's lung (FL) patients and control farmers. We studied 88 FL patients and 83 matched control farmers with a mean follow-up time of 14 years. Emphysematous, fibrotic, and miliary changes were recorded by HRCT. The pattern of emphysema and location and distribution of other findings were evaluated in detail. Emphysema was found in 20 (23%) FL patients and in 6 (7%) controls (p=0.005). Recurrences of FL attacks increased (p=0.021) the risk of emphysema. Prevalence of fibrosis (17 vs 10%, p=0.16) and miliary changes (11 vs 4%, p=0.06) did not differ significantly in patients and controls. Among FL patients, emphysematous, fibrous, and miliary changes were more pronounced at the base than in the upper parts of the lung (p<0.02). In slice analysis, the pattern of emphysema was more polymorphous (p=0.001) and the distribution of fibrotic and miliary changes was more variable among FL patients than controls. Emphysema in HRCT is more common in FL patients than matched control farmers, and the occurrence is increased by recurrences of FL. Emphysematous, fibrous, and miliary changes in FL patients HRCT are multiform and predominate in the lower parts of the lung.     

Treatment of high-flow priapism with superselective transcatheter embolization in 27 patients: a multicenter study

PURPOSE: To evaluate the effectiveness and safety of treatment of high-flow priapism (HFP) with superselective transcatheter embolization at nine university hospitals. MATERIALS AND METHODS: Between May 1994 and October 2006, 27 patients underwent superselective embolization of the cavernous artery for HFP. Trauma was apparent in 22 patients, there was self-administered intracavernosal injection for erectile dysfunction in two, and the remaining three did not recall any penile or perineal trauma. The embolic agents used were autologous blood clot (n = 12), gelatin sponge (n = 12), microcoils combined with gelatin sponge (n = 1), polyvinyl alcohol (n = 1), and N-butyl cyanoacrylate (n = 1). Recurrence of priapism and change in erectile function were evaluated during a mean follow-up of 13 months. Differences in results between patients treated with autologous blood clot versus gelatin sponge were statistically analyzed with use of the chi(2) test. RESULTS: In 24 of 27 patients (89%), a single embolization was sufficient for complete resolution of priapism. Repeat embolization was required in two patients (7%), and in the remaining patient (4%), shunt surgery was performed after embolization as a result of HFP coexisting with corporeal venoocclusive dysfunction. Eighteen of 23 patients (78%) who had premorbid normal erectile function showed maintained potency during the follow-up period. There was no significant difference affecting required repeat embolization (P = .537) and change in quality of erection (P = .615) during the follow-up period between the autologous blood clot and gelatin sponge treatment groups. CONCLUSIONS: Superselective transcatheter embolization in the treatment of HFP is effective and ensures a high level of preservation of premorbid erectile function.     

Evaluation of Y-chromosomal STRs: a multicenter study

A multicenter study has been carried out to characterize 13 polymorphic short tandem repeat (STR) systems located on the male specific part of the human Y chromosome (DYS19, DYS288, DYS385, DYS388, DYS389I/II, DYS390, DYS391, DYS392, DYS393, YCAI, YCAII, YCAIII, DXYS156Y). Amplification parameters and electrophoresis protocols including multiplex approaches were compiled. The typing of non-recombining Y loci with uniparental inheritance requires special attention to population substructuring due to prevalent male lineages. To assess the extent of these subheterogeneities up to 3825 unrelated males were typed in up to 48 population samples for the respective loci. A consistent repeat based nomenclature for most of the loci has been introduced. Moreover we have estimated the average mutation rate for DYS19 in 626 confirmed father-son pairs as 3.2 × 10^–3 (95% confidence interval limits of 0.00041–0.00677), a value which can also be expected for other Y-STR loci with similar repeat structure. Recommendations are given for the forensic application of a basic set of 7 STRs (DYS19, DYS389I, DYS389II, DYS390, DYS391, DYS392, DYS393) for standard Y-haplotyping in forensic and paternity casework. We recommend further the inclusion of the highly polymorphic bilocal Y-STRs DYS385, YCAII, YCAIII for a nearly complete individualisation of almost any given unrelated male individual. Together, these results suggest that Y-STR loci are useful markers to identify males and male lineages in forensic practice. Received: 30 December 1996 / Received in revised form: 26 February 1997     

Salivary-gland lesions in HIV-positive patients

Chronic enlargement of salivary glands and mainly of parotid glands has been noted in HIV-positive patients. Such alterations are due mainly to adenopathies (mainly intraglandular) or to the formation of lymphoepithelial cysts. During the period between January 1990 to June 1993 we studied 63 HIV-positive patients with enlargement (mainly monolateral) of the parotid glands and one patient with involvement of the submandibular gland. There were 59 adults (44 males and 15 females) 22–50 years of age, and five children 3–8 years. The fastest, least expensive and most appropriate investigative means for this pathology is echography, which was carried out in all patients. Only 18 patients were also studied with CT. We observed lymphadenopathies within or outside the parotid glands and lymphoepithelial cysts. Within some intraparotid cysts we observed an ultrasonographic pattern consisting of small high-level formations in suspension which, from cytologic evaluation of material obtained by needle aspiration, were referable to small crystals of calcium oxalate. We hypothesize that such microcalculi may play a role in the obstructive mechanism of the ducts in association with lymphoepithelial infiltration of the parotid ducts. Correspondence to: S. Vona     

Nomogram for prediction of fatal outcome in patients with severe COVID-19:a multicenter study

Background:To develop an effective model of predicting fatal outcomes in the severe coronavirus disease 2019(COVID-19) patients.Methods:Between February 20,2020...     

Arterial stiffness and wave reflection following exercise in resistance-trained men

PURPOSE: Resistance training increases arterial stiffness and pressure wave reflection. We tested the hypothesis that potentially greater tonic arterial stiffness in resistance-trained (RT) men may alter the vascular response to an acute exercise stressor. METHODS: Thirty participants (age 22 +/- 0.5 yr; 15 highly RT men and 15 sedentary non-RT men) underwent measures of central (carotid femoral) and peripheral (femoral dorsalis pedis) pulse wave velocity (PWV) and augmentation index (AIx; index of central pressure wave reflection derived from radial artery applanation tonometry and pulse wave analysis) before and 10, 20, and 30 min after maximal aerobic exercise. RESULTS: RT men were significantly stronger (bench press 143 +/- 7 vs 85 +/- 2 kg, P < 0.05) and heavier (93 +/- 3 vs 82 +/- 3 kg, P < 0.05) than sedentary men. Groups did not differ in resting central/peripheral PWV or in AIx. AIx was not changed at 10 min after maximal aerobic exercise in both groups and was reduced similarly in both groups at 20 and 30 min after maximal aerobic exercise (P < 0.05). Peripheral PWV decreased similarly at all time points after maximal aerobic exercise in both groups and was not recovered by 30 min (P < 0.05). There was no change in central PWV after maximal aerobic exercise. CONCLUSIONS: The arterial response to maximal aerobic exercise was similar in highly RT and non-RT men. There was no change in intensity of central pressure wave reflection 10 min after exercise, despite significant reductions in peripheral muscular artery stiffness. Arterial reactivity to an acute exercise stressor is not impaired in young, highly RT men.     

高血压患者血管僵硬度与心功能相互关系初步研究

目的:应用QAS技术评价高血压患者动脉僵硬度,探讨血管僵硬度与心功能之间的相互关系。方法:分别获取高血压患者(77例)与对照组(76例)受检者的心功能指标(E/e、Tei指数和EF)和颈动脉血管僵硬度参数(β、CC和PWV),并进行两组间比较及相关分析。结果:高血压组,收缩压、舒张压及脉压均高于对照组;血管僵硬度参数β和PWV高于对照组,CC低于对照组,差异有统计学意义(P0.05)。相关分析提示,心脏舒张功能参数E/e与PWV呈正相关(P0.05);心功能收缩与舒张功能参数Tei指数与PWV呈正相关(P0.05～0.001)。收缩功能参数EF与血管僵硬度参数相关性无统计学意义(P0.05)。结论:高血压导致动脉僵硬度增高及心功能障碍;动脉僵硬度能反映早期心功能障碍。     

Validation of a knowledge-based boundary detection algorithm: a multicenter study

A completely operator-independent boundary detection algorithm for multigated blood pool (MGBP) studies has been evaluated at four medical centers. The knowledge-based boundary detector (KBBD) algorithm is nondeterministic, utilizing a priori domain knowledge in the form of rule sets for the localization of cardiac chambers and image features, providing a case-by-case method for the identification and boundary definition of the left ventricle (LV). The nondeterministic algorithm employs multiple processing pathways, where KBBD rules have been designed for conventional (CONV) imaging geometries (nominal 45° LAO, nonzoom) as well as for highly zoomed and/or caudally tilted (ZOOM) studies. The resultant ejection fractions (LVEF) from the KBBD program have been compared with the standard LVEF calculations in 253 total cases in four institutions, 157 utilizing CONV geometry and 96 utilizing ZOOM geometries. The criteria for success was a KBBD boundary adequately defined over the LV as judged by an experienced observer, and the correlation of KBBD LVEFs to the standard calculation of LVEFs for the institution. The overall success rate for all institutions combined was 99.2%, with an overall correlation coefficient ofr=0.95 (P<0.001). The individual success rates and EF correlations (r), for CONY and ZOOM geometers were: 98%,r=0.93 (CONV) and 100%,r=0.95 (ZOOM). The KBBD algorithm can be adapted to varying clinical situations, employing automatic processing using artificial intelligence, with performance close to that of a human operator.This material was presented, in part, at the 39th annual meeting of the Society of Nuclear Medicine, Toronto, Canada.     

Localized proton NMR spectroscopy in the striatum of patients with idiopathic parkinson's disease: a multicenter pilot study

Single voxel proton MRS was used to study brain metabolism in the striatum of patients diagnosed with idiopathic Parkinson's disease (PD). Peak metabolite ratios in long echo time spectra were evaluated in 151 patient spectra and 97 age-matched control spectra collected at four participating institutions using identical hardware and clinical protocols. Combining data from all ages (27–83 years old) showed no significant difference between patient and control ratios. However, in an elderly subset of patients (51–70 years old), a significant decrease in striatal N-acetylaspartate (NAA)/choline (Cho) was observed. Also, a significant decrease in the mean NAA/Cho ratio was observed in patients versus controls for patients not being treated with Sinemet (Du Pont Pharm, Wilmingon, DE) (hereafter referred to as levodopa/carbidopa). This result is consistent with the hypothesis that NAA may provide a reversible spectroscopic marker for neuronal dysfunction, although a prospective follow-up study will be needed to confirm this. Quantitation of MRS would be useful to exclude the possibility that a change in Cho levels affected the NAA/Cho ratios.     

Neurosyphilis in HIV-positive and HIV-negative patients: neuroimaging findings.

PURPOSETo evaluate and describe the neuroimaging findings of patients with neurosyphilis.METHODSThe neuroimaging studies of 35 patients with documented neurosyphilis were reviewed. Diagnosis was established in 34 patients with cerebrospinal fluid for a Venereal Disease Research Laboratory test, complemented by autopsy in 1 and brain biopsy in 1. All patients had reactive fluorescent treponemal antibody tests with absorption in their sera. Imaging studies included plain and contrast-enhanced CT of the brain, plain and gadolinium-enhanced MR, MR angiography, and conventional angiography. Imaging findings were also correlated with the relevant pathologic findings at autopsy in three additional patients with neurosyphilis who did not have brain imaging studies.RESULTSOf the 35 patients with imaging studies, 32 tested human immunodeficiency virus (HIV)-seropositive, and 3 were HIV-seronegative. Eleven (31%) of 35 patients had normal radiographic findings. Cerebral infarctions were seen in 8 (23%) of 35 patients, and nonspecific white matter lesions in 7 (20%) of 35. Cerebral gummas and extraaxial enhancement indicating meningitis were noted in 2 (6%) of 35 patients, respectively. Arteritis was demonstrated in 2 (50%) of 4 patients who underwent either MR angiography or conventional angiography. The 3 subjects who had autopsy but not imaging studies were found to have manifestations of meningovascular syphilis, including syphilitic leptomeningitis and an obliterative endarteritis.CONCLUSIONWe conclude that findings of vascular occlusive disease manifested as infarction or arteritis, enhancing cortical lesions with or without adjacent meningeal enhancement, focal or diffuse extraaxial enhancement, and white matter disease, although nonspecific, in the proper clinical setting should prompt appropriate testing for neurosyphilis, a treatable disease, in patients with and without HIV infection.     

Obesity and neurocognitive recovery after sports-related concussion in athletes: a matched cohort study

Objectives: Sports-related concussions (SRCs) are a significant public health concern in athletes. Data exist suggesting a link between obesity and decreased neurocognitive function, yet the effect of body mass index (BMI) on neurocognitive function and recovery after a SRC is unknown. The goal of our study was to discern the effect of BMI on recovery after SRC.

Methods: This study was a retrospective observational cohort study. Between 2013 and 2014, 7,606 athletes between the ages of 13–20 years valid baseline neurocognitive testing performed at multiple regional concussion centers sustained a concussion. Out of these athletes, 711 normal weight athletes and 711 obese athletes were matched by age, gender, number of previous concussions, and sport. The proportions of athletes returning to baseline within two weeks between the groups were defined by using 80% confidence reliable change index (RCI) criteria and were compared using Fisher’s Exact Test. Kaplan-Meier survival curve analysis with log-rank test was used to compare the median time to neurocognitive recovery between groups.

Results: Fewer obese athletes returned to baseline within 2 weeks on measures of verbal memory, visual motor speed, reaction time, postconcussion symptom scale (PCSS), and overall recovery compared to normal weight athletes. Obese athletes also had greater median time of return to baseline with respect to reaction time, PCSS, and overall recovery.

Conclusion: Using RCI methodology, there exists an association between obesity and increased time to return to neurocognitive and symptom baseline after SRC in athletes, specifically reaction time, symptom scores, and overall recovery.     

超声弹性成像在肌肉硬度评估中的应用进展

许多神经肌肉疾病和脑血管病都会导致肌肉硬度的改变,超声弹性成像技术能实时、无创和准确地测量软组织硬度的改变,从而评估各种疾病对肌肉机械特性的影响。综述超声弹性成像技术在健康人群肌肉硬度测量以及不同病理条件下肌肉硬度评估中的应用价值,归纳总结了超声弹性成像对肌肉评估的可行性、影响因素及肌肉病变测量的最新进展。     

Lung nodule CAD software as a second reader: a multicenter study

RATIONALE AND OBJECTIVES: The purpose of this multicenter, multireader study was to evaluate the performance of computed tomography (CT) lung nodule computer-aided detection (CAD) software as a second reader. METHODS AND MATERIALS: The study involved 109 patients from four sites. The data were collected from a variety of multidetector CT scanners and had different scan parameters. Each chest CT scan was divided into four quadrants. A group of three expert thoracic radiologists identified nodules between 4 and 30 mm in maximum diameter within each quadrant. The standard of reference was established by a consensus read of these experienced radiologists. The cases were then interpreted by 10 other radiologist readers with varying degrees of experience, without and then with CAD software. These readers identified nodules and assigned an actionability rating to each quadrant before and after using CAD software. Receiver operating characteristic curves were used to measure the performance of the readers without and with CAD software. RESULTS: The average increase in area under the curve for the 10 readers with CAD software was 1.9% for a 95% confidence interval (0.8-8.0%). The area under the curve without CAD software was 86.7% and with CAD software was 88.7%. A nonsignificant correlation was observed between the improvement in sensitivity and experience of the radiologists. The readers also showed a greater improvement in patients with cancer as compared to those without cancer. CONCLUSIONS: In this multicenter trial, CAD software was shown to be effective as a second reader by improving the sensitivity of the radiologists in detecting pulmonary nodules.     

Spinal disease in neurologically symptomatic HIV-positive patients

We review the MRI findings of human immunodeficiency virus (HIV)-positive patients with “spinal” symptoms and review the literature. In 23 consecutive HIV-positive patients presenting with acute neurologic complaints thought to be referable to the spine, we reviewed spinal MRI, medical charts, and laboratory, pathologic, and autopsy data. In the early stages of HIV infection, the common causes of spinal complaints (i. e., degenerative spine and disc disease) predominated. However, pathology may be missed without contrast-enhanced MRI of the spine. In more advanced cases, the differential diagnosis includes one or more neoplastic and/or infectious causes which require contrast-enhanced MRI for detection. In these cases, normal cerebrospinal fluid findings should not preclude contrast-enhanced MRI of the spine. Imaging of the brain may also be indicated in cases when the spinal study is negative. Received: 30 December 1997 Accepted: 12 October 1998