bluuebunny/crossref_metadata_2025 huggingface dataset:
Low-Grade Chronic Inflammation in the Relationship between Insulin Sensitivity and Cardiovascular Disease (RISC) Population
Authors: de Rooij Susanne R. , Nijpels Giel , Nilsson Peter M. , Nolan John J. , Gabriel Rafael , Bobbioni-Harsch Elisabetta , Mingrone Geltrude , Dekker Jacqueline M. ,   for the Relationship Between Insulin Sensitivity and Cardiovascular Disease (RISC) Investigators
Published: April 2009

OBJECTIVE

Low-grade chronic inflammation has been hypothesized to underlie the constellation of cardiometabolic risk factors, possibly by inducing insulin resistance. In the present study, we investigated associations between inflammation markers, insulin sensitivity (expressed as the ratio of the M value to the mean plasma insulin concentrations measured during the final 40 min of the clamp [M/I]), and a range of cardiometabolic risk factors in a large, healthy population.

RESEARCH DESIGN AND METHODS

The Relationship between Insulin Sensitivity and Cardiovascular Disease (RISC) cohort includes 1,326 nondiabetic European men and women, aged between 30 and 60 years. We measured cardiometabolic risk factors and performed a hyperinsulinemic-euglycemic clamp. We determined total white blood cell count (WBC) and erythrocyte sedimentation rate (ESR) as markers of chronic inflammation.

RESULTS

WBC and ESR were both strongly associated with M/I. WBC and ESR were further associated with a range of cardiometabolic risk factors. Associations between WBC and HDL cholesterol, triglycerides, heart rate, fasting C-peptide, and insulin and 2-h insulin in men and women and between WBC and 2-h glucose in women remained significant after adjustment for both M/I and waist circumference. Associations between ESR and HDL cholesterol, heart rate, fasting, and 2-h insulin in men and women and between ESR and fat mass in women remained significant after adjustment for M/I and waist circumference.

CONCLUSIONS

This study showed that low-grade chronic inflammation is associated with the cardiometabolic risk profile of a healthy population. Insulin resistance, although strongly associated with inflammation, does not seem to play a large intermediary role.
Comparative Study of the Effects of a 1-Year Dietary Intervention of a Low-Carbohydrate Diet Versus a Low-Fat Diet on Weight and Glycemic Control in Type 2 Diabetes
Authors: Davis Nichola J. , Tomuta Nora , Schechter Clyde , Isasi Carmen R. , Segal-Isaacson C.J. , Stein Daniel , Zonszein Joel , Wylie-Rosett Judith
Published: April 2009

OBJECTIVE

To compare the effects of a 1-year intervention with a low-carbohydrate and a low-fat diet on weight loss and glycemic control in patients with type 2 diabetes.

RESEARCH DESIGN AND METHODS

This study is a randomized clinical trial of 105 overweight adults with type 2 diabetes. Primary outcomes were weight and A1C. Secondary outcomes included blood pressure and lipids. Outcome measures were obtained at 3, 6, and 12 months.

RESULTS

The greatest reduction in weight and A1C occurred within the first 3 months. Weight loss occurred faster in the low-carbohydrate group than in the low-fat group (P = 0.005), but at 1 year a similar 3.4% weight reduction was seen in both dietary groups. There was no significant change in A1C in either group at 1 year. There was no change in blood pressure, but a greater increase in HDL was observed in the low-carbohydrate group (P = 0.002).

CONCLUSIONS

Among patients with type 2 diabetes, after 1 year a low-carbohydrate diet had effects on weight and A1C similar to those seen with a low-fat diet. There was no significant effect on blood pressure, but the low-carbohydrate diet produced a greater increase in HDL cholesterol.
Ranirestat for the Management of Diabetic Sensorimotor Polyneuropathy
Authors: Bril Vera , Hirose Toshiyuki , Tomioka Sasagu , Buchanan Robert ,   for the Ranirestat Study Group
Published: April 2009

OBJECTIVE

Aldose reductase inhibitors (ARIs) are potential disease modifiers for diabetes complications. We aimed to determine whether ranirestat, an ARI, could slow or reverse the course of diabetic sensorimotor polyneuropathy (DSP).

RESEARCH DESIGN AND METHODS

A total of 549 patients with DSP were randomly assigned to treatment with placebo or 10, 20, or 40 mg/day ranirestat for 52 weeks in this multicenter, double-blind study. Efficacy was evaluated by nerve conduction studies, the modified Toronto Clinical Neuropathy Score (mTCNS), and quantitative sensory tests (QSTs).

RESULTS

At week 52, the summed sensory (bilateral sural plus proximal median sensory) nerve conduction velocity (NCV) did not show significant changes from baseline (2.0 m/s for placebo compared with 3.2–3.8 m/s for ranirestat). Significant improvement in the summed motor (peroneal, tibial, and median) NCV was observed with 20 and 40 mg/day ranirestat treatment at week 12 (P ≤ 0.05) and at weeks 24 and 36 and in peroneal motor NCV at weeks 36 and 52 (P ≤ 0.05) for the 20 mg/day ranirestat group. The mTCNS and QST results did not differ among the groups during the study. Ranirestat was well tolerated with no pertinent differences in drug-related adverse events or in effects on clinical laboratory parameters, vital signs, or electrocardiograms among the four groups.

CONCLUSIONS

Treatment with ranirestat appears to have an effect on motor nerve function in mild to moderate DSP, but the results of this study failed to show a statistically significant difference in sensory nerve function relative to placebo.
Automated Ankle-Brachial Pressure Index Measurement by Clinical Staff for Peripheral Arterial Disease Diagnosis in Nondiabetic and Diabetic Patients
Authors: Clairotte Cécile , Retout Sylvie , Potier Louis , Roussel Ronan , Escoubet Brigitte
Published: April 2009

OBJECTIVE

Peripheral arterial disease (PAD) is a prognostic marker in cardiovascular disease. The use of Doppler-measured ankle-brachial pressure index (Dop-ABI) for PAD diagnosis is limited because of time, required training, and costs. We assessed automated oscillometric measurement of the ankle-brachial pressure index (Osc-ABI) by nurses and clinical staff.

RESEARCH DESIGN AND METHODS

Clinical staff obtained Osc-ABI with an automated oscillometric device in 146 patients (83 with diabetes) at the time of Dop-ABI measurement and ultrasound evaluation.

RESULTS

Measurements were obtained in most legs (Dop-ABI 98%; Osc-ABI 95.5%). Dop- and Osc-ABI were significantly related in diabetic and nondiabetic patients with good agreement over a wide range of values. When Dop-ABI ≤0.90 was used as the gold standard for PAD, receiver operating characteristic curve analysis showed that PAD was accurately diagnosed with Osc-ABI in diabetic patients. When ultrasound was used to define PAD, Dop-ABI had better diagnostic performance than Osc-ABI in the whole population and in diabetic patients (P = 0.026). Both methods gave similar results in nondiabetic patients. The cutoff values for the highest sensitivity and specificity for PAD screening were between 1.0 and 1.1. Estimation of cost with the French medical care system fees showed a potential reduction by three of the screening procedures.

CONCLUSIONS

PAD screening could be improved by using Osc-ABI measured by clinical staff with the benefit of greater cost-effectiveness but at the risk of lower diagnostic performance in diabetic patients.
Customized Feedback to Patients and Providers Failed to Improve Safety or Quality of Diabetes Care
Authors: O'Connor Patrick J. , Sperl-Hillen JoAnn , Johnson Paul E. , Rush William A. , Crain A. Lauren
Published: April 2009

OBJECTIVE

To assess whether providing customized clinical information to patients and physicians improves safety or quality of diabetes care.

RESEARCH DESIGN AND METHODS

Study subjects included 123 primary care physicians and 3,703 eligible adult diabetic patients with elevated A1C or LDL cholesterol, who were randomly assigned to receive customized feedback of clinical information as follows: 1) patient only, 2) physician only, 3) both the patient and physician, or 4) neither patient nor physician. In the intervention groups, patients received customized mailed information or physicians received printed, prioritized lists of patients with recommended clinical actions and performance feedback. Hierarchical models were used to accommodate group random assignment.

RESULTS

Study interventions did not improve A1C test ordering (P = 0.35) and negatively affected LDL cholesterol test ordering (P < 0.001) in the 12 months postintervention. Interventions had no effect on LDL cholesterol values (P = 0.64), which improved in all groups over time. Interventions had a borderline unfavorable effect on A1C values among those with baseline A1C ≥7% (P = 0.10) and an unfavorable effect on A1C values among those with baseline A1C ≥8% (P < 0.01). Interventions did not reduce risky prescribing events or increase treatment intensification. Time to next visit was longer in all intervention groups compared with that for the control group (P < 0.05).

CONCLUSIONS

Providing customized decision support to physicians and/or patients did not improve quality or safety of diabetes care and worsened A1C control in patients with baseline A1C ≥8%. Future researchers should consider providing point-of-care decision support with redesign of office systems and/or incentives to increase appropriate actions in response to decision-support information.
Anti–Heat Shock Protein 27 Antibody Levels and Diabetes Complications in the EURODIAB Study
Authors: Burt Davina , Bruno Graziella , Chaturvedi Nish , Schalkwijk Casper , Stehouwer Coen D. , Witte Daniel R. , Fuller John H. , Pinach Silvia , Cavallo Perin Paolo , Gruden Gabriella
Published: April 2009

OBJECTIVE

To assess whether serum anti–heat shock protein 27 (HSP27) antibody levels are associated with micro- and macrovascular complications of type 1 diabetes.

RESEARCH DESIGN AND METHODS

Anti-HSP27 IgG antibody levels were measured in 531 type 1 diabetic subjects recruited as part of the cross-sectional analysis of the EURODIAB Prospective Complications Study. Case subjects (n = 363) were defined as individuals with one or more diabetes complications and control subjects (n = 168) as individuals with no evidence of any diabetes complication.

RESULTS

Anti-HSP27 levels were comparable in case and control subjects (19.6 arbitrary units/ml [11.3–32.7] vs. 20.4 arbitrary units/ml [11.7–35.3], geometric mean [interquartile range]), and there was no correlation between HSP27 and anti-HSP27 levels (r = 0.01, P = 0.81). In logistic regression analysis, anti-HSP27 was not associated with the presence of complications, even after adjustment for main risk factors.

CONCLUSIONS

Anti-HSP27 antibody levels are not a marker of vascular complications in type 1 diabetes.
Etanercept Treatment in Children With New-Onset Type 1 Diabetes
Authors: Mastrandrea Lucy , Yu Jihnhee , Behrens Torsten , Buchlis John , Albini Christine , Fourtner Shannon , Quattrin Teresa
Published: April 2009

OBJECTIVE

To gather preliminary data on the feasibility and efficacy of etanercept therapy to prolong endogenous insulin production in pediatric patients with newly diagnosed type 1 diabetes.

RESEARCH DESIGN AND METHODS

This was a 24-week double-blind, randomized, placebo-controlled study conducted at the Diabetes Center, Women and Children's Hospital of Buffalo. Eighteen subjects (11 male and 7 female, aged 7.8–18.2 years) were randomly assigned to receive either placebo or etanercept. Inclusion criteria included age 3–18 years, GAD-65 and/or islet cell antibody positivity, A1C >6%, three insulin injections per day, white blood cell count 3,000–10,000, platelets >100,000, and normal liver and renal function. Intention-to-treat analysis was used.

RESULTS

A1C at week 24 was lower in the etanercept group (5.91 ± 0.5%) compared with that in the placebo group (6.98 ± 1.2%; P < 0.05) with a higher percent decrease from baseline than in the placebo group (etanercept 0.41 ± 0.1 vs. placebo 0.18 ± 0.21; P < 0.01). The percent change in C-peptide area under the curve from baseline to week 24 showed a 39% increase in the etanercept group and a 20% decrease in the placebo group (P < 0.05). From baseline to week 24 insulin dose decreased 18% in the etanercept group compared with a 23% increase in the placebo group (P < 0.05). Seventeen patients completed the study, and none withdrew because of adverse events.

CONCLUSIONS

In this small pilot study, treatment of pediatric patients newly diagnosed with type 1 diabetes with etanercept resulted in lower A1C and increased endogenous insulin production, suggesting preservation of β-cell function. A larger study is needed to further explore safety and efficacy.
Costs to Medicare of the Informatics for Diabetes Education and Telemedicine (IDEATel) Home Telemedicine Demonstration
Authors: Moreno Lorenzo , Dale Stacy B. , Chen Arnold Y. , Magee Carol A.
Published: April 2009

OBJECTIVE

To estimate the impacts on Medicare costs of providing a particular type of home telemedicine to eligible Medicare beneficiaries with type 2 diabetes.

RESEARCH DESIGN AND METHODS

Two cohorts of beneficiaries (n = 1,665 and 504, respectively) living in two medically underserved areas of New York between 2000 and 2007 were randomized to intensive nurse case management via televisits or usual care. Medicare service use and costs covering a 6-year follow-up period were drawn from claims data. Impacts were estimated using regression analyses.

RESULTS

Informatics for Diabetes Education and Telemedicine (IDEATel) did not reduce Medicare costs in either site. Total costs were between 71 and 116% higher for the treatment group than for the control group.

CONCLUSIONS

Although IDEATel had modest effects on clinical outcomes (reported elsewhere), it did not reduce Medicare use or costs for health services. The intervention's costs were excessive (over $8,000 per person per year) compared with programs with similar-sized clinical impacts.
Microalbuminuria in Type 1 Diabetes Is Associated With Enhanced Excretion of the Endocytic Multiligand Receptors Megalin and Cubilin
Authors: Thrailkill Kathryn M. , Nimmo Teresa , Bunn R. Clay , Cockrell Gael E. , Moreau Cynthia S. , Mackintosh Samuel , Edmondson Ricky D. , Fowlkes John L.
Published: April 2009

OBJECTIVE

Proteinuria is the hallmark of diabetic nephropathy; yet, glomerular histology does not fully explain mechanisms contributing to proteinuria. Our objective was to identify proteins in the urine of individuals with type 1 diabetes and microalbuminuria that might implicate a mechanistic pathway operative in proteinuria.

RESEARCH DESIGN AND METHODS

Using a GeLC/MS platform proteomics approach, we compared the urine proteome from 12 healthy nondiabetic individuals, 12 subjects with type 1 diabetes yet normal urinary albumin excretion rates, and 12 subjects with type 1 diabetes and microalbuminuria (type 1 diabetes + microalbuminuria).

RESULTS

The abundance of megalin and cubilin, two multiligand receptors expressed in kidney proximal tubule cells and involved with the reuptake of filtered albumin and megalin/cubilin ligands, was significantly increased in type 1 diabetes + microalbuminuria urine, compared with both nonalbuminuric groups.

CONCLUSIONS

Aberrant shedding of megalin and cubilin could contribute to albuminuria in diabetes and to deficiency states of important vitamins and hormones.
Insulin Analogs Versus Human Insulin in the Treatment of Patients With Diabetic Ketoacidosis
Authors: Umpierrez Guillermo E. , Jones Sidney , Smiley Dawn , Mulligan Patrick , Keyler Trevor , Temponi Angel , Semakula Crispin , Umpierrez Denise , Peng Limin , Cerón Miguel , Robalino Gonzalo
Published: April 2009

OBJECTIVE

To compare the safety and efficacy of insulin analogs and human insulins both during acute intravenous treatment and during the transition to subcutaneous insulin in patients with diabetic ketoacidosis (DKA).

RESEARCH DESIGN AND METHODS

In a controlled multicenter and open-label trial, we randomly assigned patients with DKA to receive intravenous treatment with regular or glulisine insulin until resolution of DKA. After resolution of ketoacidosis, patients treated with intravenous regular insulin were transitioned to subcutaneous NPH and regular insulin twice daily (n = 34). Patients treated with intravenous glulisine insulin were transitioned to subcutaneous glargine once daily and glulisine before meals (n = 34).

RESULTS

There were no differences in the mean duration of treatment or in the amount of insulin infusion until resolution of DKA between intravenous treatment with regular and glulisine insulin. After transition to subcutaneous insulin, there were no differences in mean daily blood glucose levels, but patients treated with NPH and regular insulin had a higher rate of hypoglycemia (blood glucose <70 mg/dl). Fourteen patients (41%) treated with NPH and regular insulin had 26 episodes of hypoglycemia and 5 patients (15%) in the glargine and glulisine group had 8 episodes of hypoglycemia (P = 0.03).

CONCLUSIONS

Regular and glulisine insulin are equally effective during the acute treatment of DKA. A transition to subcutaneous glargine and glulisine after resolution of DKA resulted in similar glycemic control but in a lower rate of hypoglycemia than with NPH and regular insulin. Thus, a basal bolus regimen with glargine and glulisine is safer and should be preferred over NPH and regular insulin after the resolution of DKA.
Central Processing of Gut Pain in Diabetic Patients With Gastrointestinal Symptoms
Authors: Frøkjær Jens Brøndum , Søfteland Eirik , Graversen Carina , Dimcevski Georg , Egsgaard Line Lindhardt , Arendt-Nielsen Lars , Mohr Drewes Asbjørn
Published: April 2009

OBJECTIVE

To evaluate the brain's responses to painful visceral and somatic stimuli in diabetic patients with gastrointestinal symptoms.

RESEARCH DESIGN AND METHODS

The sensitivity to electrical esophageal and median nerve stimulations was assessed in 15 healthy volunteers and 14 type 1 diabetic patients with autonomic neuropathy and gastrointestinal symptoms using a euglycemic-hyperinsulinemic clamp. Evoked brain potentials were recorded.

RESULTS

Patients had reduced sensitivity to esophageal (48%; P < 0.001) and median nerve (80%; P < 0.001) stimulations. They also had increased (8.8%; P = 0.007) and nonreproducible (P = 0.006) latencies of evoked potentials in response to esophageal stimulations, with 26% reduction in amplitude (P = 0.011). No potential differences were seen to median nerve stimulations. In diabetic patients, the topographic location of the first peak in potentials was more central (P < 0.001) and gastrointestinal symptoms correlated with characteristics of brain potentials (P = 0.049).

CONCLUSIONS

This study supports that diabetes induces changes in peripheral visceral nerves as well as in the central nervous system.
A randomized controlled clinical trial of the use of benazepril and heparin for the treatment of chronic kidney disease in dogs
Authors: Tenhündfeld Jörg , Wefstaedt Patrick , Nolte Ingo J. A.
Published: April 2009

Objective—To investigate the effects of benazepril and heparin on renal function and blood pressure in dogs with chronic kidney disease.

Design—Randomized controlled clinical trial.

Animals—26 dogs with chronic kidney disease.

Procedures—Dogs were randomly assigned to receive benazepril hydrochloride (0.5 mg/kg [0.23 mg/lb], PO, q 24 h; n = 10), benazepril and heparin (150 U/kg [68 U/lb], SC, q 8 h, for the first 6 days; 10), or a placebo (6) and were followed up for 180 days.

Results—Health status score at the end of the study (ie, day 180) was significantly higher for dogs in the 2 treatment groups than for dogs in the placebo group. In addition, glomerular filtration rate was significantly increased and the urine protein-to-creatinine ratio was significantly decreased, compared with baseline rates, at the end of the study for dogs in both treatment groups but not for dogs in the placebo group. Systolic and diastolic blood pressures were significantly decreased on day 6 for dogs in both treatment groups.

Conclusions and Clinical Relevance—Results suggested that administration of benazepril had beneficial effects in dogs with chronic kidney disease but that short-term administration of heparin in conjunction with benazepril did not appear to provide any additional benefit.
Diffuse osteopenia and myelopathy in a puppy fed a diet composed of an organic premix and raw ground beef
Authors: Taylor Mark B. , Geiger David A. , Saker Korinn E. , Larson Martha M.
Published: April 2009

Case Description—An 8-month-old Shetland Sheepdog was evaluated because of the sudden onset of signs of neck pain, collapse, and inability to rise. A cursory diet history indicated that the dog had been fed a raw meat–based diet.

Clinical Findings—Initial evaluation of the dog revealed small physical stature, thin body condition, and signs of cranial cervical myelopathy. Radiographically, diffuse osteopenia of all skeletal regions was identified; polyostotic deformities associated with fracture remodeling were observed in weight-bearing bones, along with an apparent floating dental arcade. Hypocalcemia and hypophosphatemia were detected via serum biochemical analyses. The dog's diet was imbalanced in macronutrients and macrominerals.

Treatment and Outcome—The dog received supportive care and treatment of medical complications; neurologic abnormalities improved rapidly without intervention. Dietary changes were implemented during hospitalization, and a long-term feeding regimen was established. Following discharge from the hospital, exercise restriction was continued at home. Serial follow-up evaluations, including quantitative bone density measurements, revealed that dietary changes were effective. After 7 months, the dog was clinically normal.

Clinical Relevance—In the dog of this report, vitamin D–dependent rickets type I and suspected nutritional secondary hyperparathyroidism developed following intake of a nutritionally incomplete and unbalanced diet. The raw meat–based, home-prepared diet fed to the dog was not feed-trial tested for any life stage by the Association of American Feed Control Officials, and its gross nutrient imbalance induced severe metabolic, orthopedic, and neurologic abnormalities. Inadvertent malnutrition can be avoided through proper diet assessment and by matching nutrient profiles with patients' nutritional needs.
Successful management of a dog that had severe rhabdomyolysis with myocardial and respiratory failure
Authors: Wells Raegan J. , Sedacca Cassidy D. , Aman Anna M. , Hackett Timothy B. , Twedt David C. , Shelton G. Diane
Published: April 2009

Case Description—A 6-year-old castrated male Llewelyn Setter was evaluated because of an acute onset of myalgia and respiratory distress.

Clinical Findings—Physical examination revealed a stiff stilted gait, swollen muscles that appeared to cause signs of pain, panting, and ptyalism. The dog had a decrease in palpebral reflexes bilaterally and a decrease in myotatic reflexes in all 4 limbs. The panniculus reflex was considered normal, and all other cranial nerve reflexes were intact. Serum biochemical analysis revealed markedly high cardiac troponin-I concentration and creatine kinase and aspartate aminotransferase activities. Urinalysis revealed myoglobinuria. Results for thoracic and abdominal radiography, blood pressure measurement, and an ECG were within anticipated limits. Echocardiographic findings were consistent with secondary systolic myocardial failure. Arterial blood gas analysis confirmed hypoxemia and hypoventilation. The dog had negative results when tested for infectious diseases. Examination of skeletal muscle biopsy specimens identified necrotizing myopathy.

Treatment and Outcome—Treatment included ventilatory support; IV administration of an electrolyte solution supplemented with potassium chloride; administration of dantrolene; vasopressor administration; parenteral administration of nutrients; use of multimodal analgesics; administration of clindamycin, furosemide, mannitol, and enrofloxacin; and dietary supplementation with L-carnitine and coenzyme Q10. Other medical interventions were not required, and the dog made a rapid and complete recovery.

Clinical Relevance—Necrotizing myopathy resulting in rhabdomyolysis and myoglobinuria can lead to life-threatening physical and biochemical abnormalities. Making a correct diagnosis is essential, and patients require intensive supportive care. The prognosis can be excellent for recovery, provided there is no secondary organ dysfunction.
Lipoprotein(a) in Chronic Renal Failure
Authors: Čabarkapa Velibor , Đerić Mirjana , Stošić Zoran , Sakač Vladimir , Kojić-Damjanov Sunčica , Eremić Nevena
Published: April 2009

Lipoprotein(a) in Chronic Renal Failure

Cardiovascular diseases are the leading cause of mortality in patients with chronic renal failure. Among the parameters contributing to cardiovascular disease development is the elevated serum concentration of lipoprotein(a) diagnosed in these patients, especially in the terminal stage of CRF. However, an elevated concentration of lipoprotein(a) could influence the renal failure progression. The objective of this study is to examine the lipoprotein(a) serum levels in chronic renal failure, and to establish the relation between the stage of renal function preservation and the level of this lipoprotein. In this study 127 subjects were included, divided into three groups. The first group contained 42 subjects (15 females and 27 males) in different CRF stages, the second group contained 32 subjects (7 females and 25 males) on a chronic hemodialysis program, and the control group contained 53 subjects (22 females and 31 males) with regular renal function. The results obtained point to significantly higher frequency of hyper-Lp(a) lipoproteinaemia in dialysed patients compared to the control group, as well as significantly higher Lp(a) values in both groups of patients compared to the control group. It can be concluded that for the risk assessment of premature atherosclerotic changes, but also renal failure progression in patients with CRF, determination of the Lp(a) serum concentration is recommendable.
Arthrosonography and the Biomarker Cartilage Oligomeric Matrix Protein in the Detection of Knee Osteoarthrosis Effusion
Authors: Živanović Sandra , Rackov Ljiljana , Vučetić Dušan , Mijušković Zoran
Published: April 2009

Arthrosonography and the Biomarker Cartilage Oligomeric Matrix Protein in the Detection of Knee Osteoarthrosis Effusion

Osteoarthrosis of the knee is a degenerative disease with inflammatory episodes objectively shown by arthrosonography. Cartilage Oligomeric Matrix Protein - COMP is a useful biomarker for early cartilage destruction. The aim of this paper is a comparative analysis of the clinical, arthrosonographic findings and the COMP concentration in the sera of patients for the detection of joint inflammation. The analysis included 88 patients with knee OA. Clinical examination determined the outflow, arthrosonography the size of synovitis and effusion, and serum analysis the COMP concentration (ng/ml). Minimum outflow had 34.1% of patients, moderate 22.7%, and significant 4.5%. Sensitivity of the clinical diagnosis of outflow is 73%, and specificity 73% (p=0.000). Seventy five percent of patients had effusion; 28.4% of patients in the suprapatellar recessus (SR), 27.3% in the medial (MR), and 62.5% in the lateral (LR). In SR, effusion was 10.13±4.35 mm, MR 8.53±2.27 mm, LR 11.38±4.44 mm. Synovitis was found in 67% of patients, in SR the size of 4.84±3.57 mm, in MR 3.15±1.86 mm, in LR 6.09±2.80 mm. The average value of the size of effusion in patients with significant outflow in SR was 13.85 (10.36-17.43) mm (p=0.000), MR 4.9 (0-10.22) mm (p=0.008), LR 12.0 (11.34-14.50) mm (p=0.000), in LR with moderate outflow 6.94 (1.16-8.13) mm and minimum outflow 4.9 (0-7.25) mm. There is a significant correlation between the size of synovitis and effusion in the SR, MR and LR (p=0.000). The average value of the concentration of COMP in patients without effusion was 54 (44.5-58) ng/ml, with effusion 57 (48.75-64.25) ng/ml (p=0.030). Arthrosonography and the determination of the COMP concentration are sensitive methods for diagnosing joint effusion.
IEC/EN standards relating to diagnostic radiology equipment, and testing according to these standards
Authors: Porubszky Tamas , Barsai Janos
Published: April 2009

IEC/EN standards relating to diagnostic radiology equipment, and testing according to these standards

The paper gives an outlook of history, present and future of international (IEC) and European (EN) standards relating to diagnostic radiology equipment. These standards may be safety, quality assurance or performance standards; all of them include testing methods. Elaboration and publication of a new series of safety standards is in progress.

Acceptance and conformance testing activity of the accredited Radiohygiene Department Laboratory of NRIRR according to these standards is reported.
An analysis of calibration coefficients measured in water and in air for Farmer-type cylindrical ionization chambers
Authors: Bulski Wojciech , Ulkowski Piotr , Gwiazdowska Barbara , Rostkowska Joanna
Published: April 2009

An analysis of calibration coefficients measured in water and in air for Farmer-type cylindrical ionization chambers

A comparison of calibration coefficients of Farmer-type cylindrical ionization chambers calibrated in a Co-60 beam according to the IAEA Reports 277 and 398 formalisms.

91 calibration coefficients measured in air and in water.

The
398ND, W/277ND, W
ratios were calculated, taking into account the wall material of the chambers. The correlation between
398ND, W
and NK, ND, air
277ND, W
was made and the equations of the regression straight lines were determined.

Calibration coefficients, determined according to the IAEA Report 398, are higher by about 1% than those determined according to the IAEA Report 277, and they depend slightly on the wall material of the chamber.

The introduction of the IAEA dosimetry Report 398 resulted in an increase in the doses delivered to patients by about 1% as compared with the period of application of Report 277. The regression equations may assure increased accuracy in retrospective comparative calculation of doses according to both reports as compared with the correction based on mean percent values.
Spectrometric measurements of radioisotope activity in the thyroid
Authors: Osko Jakub , Golnik Natalia
Published: April 2009

Spectrometric measurements of radioisotope activity in the thyroid

The results of measurements of iodine 131I and technetium 99mTc uptake in human thyroid, performed with scintillation or semiconductor detectors can exhibit a considerable uncertainty due to the differences in the thyroid position in the patient's neck. Basic physical laws of radiation attenuation and scattering show that the final shape of the registered spectrum should depends on the thyroid position in the neck and on the thickness of the tissue between the thyroid and the detector. The use of the spectrometric measuring method is proposed in this work for determination of the iodine gathering effective depth. The performed studies showed that the measurements results can be used for improving the accuracy of the iodine 131I activity in thyroid measurements and for selection of the group of patients for whom the anatomical position of the thyroid or the spatial distribution of the iodine gathering is much different than the standard one, assumed during the calibration of the counters. The results of the measurements were in agreement with Monte-Carlo calculations of the detector response. The method was used in routine monitoring of occupationally exposed persons, using the thyroid counter. A group of six persons with measurable internal contamination was selected and the measurements were performed on consecutive days, so the results could be registered at decreasing iodine activities in the thyroid. Larger series of measurements were performed at Brodno Regional Hospital in Warsaw, for a group of 95 patients after diagnostic administration of iodine 131I.
Entropy as a quality descriptor for the dose distribution — theory and practice for the patient target volume
Authors: Moravek Zdenek , Bogner Ludwig
Published: April 2009

Entropy as a quality descriptor for the dose distribution — theory and practice for the patient target volume

The most common and established way to evaluate the quality of a radiotherapy plan is to use the dose-volume histogram (DVH). The evaluation of the DVH, however, is a subjective procedure. This may not be crucial as long as the two plans are significantly different. In the case of several plans obtained with different planning or optimisation strategies the differences are often subtle and therefore a more objective comparison method is desirable. A commonly used approach is based on evaluation of the conformity index, however we show how it can fail for plans of similar quality.

Therefore we propose a new method based on the similarity of DVH to statistical distributions, which can be characterised uniquely by their entropy. The concept is defined separately for target volumes, where it is derived from the Fermi-like distribution, and for organs at risk, where the traditional approach is also considered in its derivation. The artificial illustratory and clinical examples show the properties of the entropy as the quality descriptor and compare it to the conformity index. The examples are focused to the patient target volumes, where the advantage of the concept is more evident.
IMRT versus 3D-CRT for thyroid cancer
Authors: Gizynska Marta , Zawadzka Anna
Published: April 2009

IMRT versus 3D-CRT for thyroid cancer

A 3D-CRT involving a 4-field (5-field, 6-field, etc.) technique (photon and electron beams) and an alternative IMRT 7-field technique with 6 MV photon fields for thyroid cancer were compared. The IMRT allows reduction in the dose to the spinal cord of about 12 Gy and permits better coverage of the target volume with smaller standard deviation (average 4.65% for 3D-CRT as compared with 1.81% for IMRT). The time needed to prepare therapy (TPS, dosimetry, preparing boluses and electron aperture) and the session time are about the same for both techniques.
Assesing multileaf collimator effect on the build-up region using Monte Carlo method
Authors: Moreno M. , Teixeira N. , Jesus A. , Mora G.
Published: April 2009

Assesing multileaf collimator effect on the build-up region using Monte Carlo method

Previous Monte Carlo studies have investigated the multileaf collimator (MLC) contribution to the build-up region for fields in which the MLC leaves were fully blocking the openings defined by the collimation jaws. In the present work, we investigate the same effect but for symmetric and asymmetric MLC defined field sizes (2×2, 4×4, 10×10 and 3×7 cm2). A Varian 2100C/D accelerator with 120-leaf MLC is accurately modeled for a 6MV photon beam using the BEAMnrc/EGSnrc code.

Our results indicate that particles scattered from accelerator head and MLC are responsible for the increase of about 7% on the surface dose when comparing 2×2 and 10×10 cm2 fields. We found that the MLC contribution to the total build-up dose is about 2% for the 2×2 cm2 field and less than 1% for the largest fields.
An Unbiased View of the History of Polish Medical Physics by a Senior Polish Medical Physicist
Authors: Chomicki Oskar
Published: April 2009

An Unbiased View of the History of Polish Medical Physics by a Senior Polish Medical Physicist
Optimal assignment of workers to supporting services in a hospital
Authors: Sawik Bartosz , Mikulik Jerzy
Published: April 2009

Optimal assignment of workers to supporting services in a hospital

Supporting services play an important role in health care institutions such as hospitals. This paper presents an application of operations research model for optimal allocation of workers among supporting services in a public hospital. The services include logistics, inventory management, financial management, operations management, medical analysis, etc. The optimality criterion of the problem is to minimize operations costs of supporting services subject to some specific constraints. The constraints represent specific conditions for resource allocation in a hospital. The overall problem is formulated as an integer program in the literature known as the assignment problem, where the decision variables represent the assignment of people to various jobs. The results of some computational experiments modeled on a real data from a selected Polish hospital are reported.
National protocol for quality assurance in DXA-bone densitometry
Authors: Slavchev A. , Avramova-Cholakova S. , Vassileva J.
Published: April 2009

National protocol for quality assurance in DXA-bone densitometry

Osteoporosis becomes largely one of the most important socially significant and costly diseases. Modern techniques (DXA, US) are applied for bone densitometry. The paper presents a protocol for quality assurance especially of DXA-bone densitometers including quality control made in compliance with international standards (ISCD, IOF). The methodology has been tested in practice by measurements on site-functional assessment, entrance dose, radiation protection, calibration, in-vitro precision. It is expected to raise the quality of the diagnostic process in concert with the EU Medical Directive 97/43 particularly for population screening and sensitive groups. The protocol is an essential part of the National Program for constraining osteoporosis which has been elaborated at the Ministry of Health and at present under implementation throughout the country. It aims at reducing the risk, factors spreading, at diminishing the fracture risk the morbidity and the mortality from osteoporosis. An integral multidisciplinary approach to the problem solving is applied as well as training on three levels — doctors, patients, population, which effectively will contribute for obtaining real results in preventing osteoporosis.
Skin dosimetry of patients during interventional cardiology procedures in the Czech Republic
Authors: Sukupova Lucie , Novak Leos
Published: April 2009

Skin dosimetry of patients during interventional cardiology procedures in the Czech Republic

The aim of the study is to determine distribution of air kerma-area product, fluoro time and number of frames values for the two most frequent procedures in the interventional cardiology, to reconstruct skin dose distributions for some patients undergoing coronarography and percutaneous transluminal coronary angioplasty procedures. Patient dose data were obtained from X-ray unit dose monitoring software report from one hospital and the reconstructions were performed in MATLAB. Dependence of maximum skin dose on air kerma-area product, fluoro time and number of frames was determined to assess trigger levels of these quantities, which can indicate possible exceeding of the 2 Gy skin dose threshold.
Changes in the cardiac muscle electric activity as a result of Coronary Artery Bypass Graft operation
Authors: Grajek Magdalena , Krzyminiewski Ryszard , Kalawski Ryszard , Kulczak Mariusz
Published: April 2009

Changes in the cardiac muscle electric activity as a result of Coronary Artery Bypass Graft operation

Many bioelectric signals have a complex internal structure that can be a rich source of information on the tissue or cell processes. The structure of such signals can be analysed in detail by applying digital methods of signal processing. Therefore, of substantial use in diagnosis of the coronary arterial disease is the method of digital enhancement of increasing signal resolution ECG (NURSE-ECG), permitting detection of temporary changes in the electric potentials in the cardiac muscle in the process of depolarisation. Thanks to the application of NURSE-ECG it has become possible to detect relatively small changes in the electric activity of particular fragments of the cardiac muscle undetectable by the standard ECG method, caused by ischemia, the effect of a drug or infarct.

The aim of this study was to identify and analyse changes in the electric activity of the cardiac muscle as a result of the Coronary Artery Bypass Graft (CABG) operation. In this study the method of NURSE-ECG has been applied in order to identify and analyse changes in the electric activity of the cardiac muscle as a result of the CABG operation. In the study performed in cooperation of the Institute of Physics Adam Mickiewicz University and the Strus Hospital, Cardiac Surgery Ward, 37 patients with advanced coronary arterial disease were asked to participate. The patients were examined prior to the operation, on the day after the operation and two months after the operation and a year after the operation. The ECG recordings were subjected to a numerical procedure of resolution enhancement by a NURSE-ECG program to reveal the tentative changes in the electric potential of the cardiac muscle on its depolarisation. Results of the study have shown that the NURSE ECG method can be applied to monitor changes in the electric activity of the cardiac muscle occurring as a result of CABG operation. One the second day after the operation in the majority of patients (70%) a rapid decrease of the total cardiac muscle activity was observed. The NURSE ECG seems to be a promising supplementary method in medical diagnosis. In particular it can be applied for qualification of patients for CABG operation and for verification of the operation effects.
Contribution of landscape metrics to the assessment of scenic quality - the example of the landscape structure plan Havelland/Germany
Authors: Herbst Helge , Förster Michael , Kleinschmit Birgit
Published: April 2009

The scenic quality of a landscape is a natural resource that is to be preserved according to German and international law. One important indicator for the evaluation of this value is the structural diversity of the landscape. Although Landscape Metrics (LM) represent a well-known instrument for the quantification of landscape patterns, they are hardly used in applied landscape and environmental planning. This study shows possibilities for the integration of LM into a commonly used method to assess scenic quality by the example of a Landscape Structure Plan. First results indicate that especially Shannon's Diversity Index and Edge Density are suitable to achieve an objective evaluation of the structural diversity as indicator for scenic quality. The addition of qualitative parameters to the objective structural analysis is discussed. Moreover, the use of landscape scenery units and raster cells as basic geometry has been compared. It shows that LM can support the evaluation of the aesthetic quality in environmental planning, especially when integrated into commonly used evaluation methods.
The Effect of Global-Scale Map-Projection Knowledge on Perceived Land Area
Authors: Battersby Sarah E.
Published: April 2009

The acquisition and conceptualization of spatial knowledge are important topics in human spatial cognition. At the global scale, maps are our primary graphic source of information; however, they distort the size and shape of geographic features. If a distorted reference is used and the reader assumes it to be accurate, it may inappropriately influence decision making and, possibly, the shape of our global-scale cognitive maps. This paper examines trends in perception of land area, using equal-area and non-equal-area references, as well as investigating how map-projection knowledge can influence interpretation of land area. Results from the land-area studies show that map readers attempted compensation for projection distortion only when using the Mercator projection as a reference, and only for certain regions displayed on the Mercator projection. For other reference materials there is no attempted compensation for perceived distortion, even when participants believe that the reference is distorting land area. It is also apparent that most participants have limited projection knowledge and have difficulty transferring this knowledge to other projections or to practical application tasks. Both of these findings have implications for understanding perceptual issues in map reading and for determining where distortions can be introduced at the encoding stage of cognitive map development.
Theory, Practice, and History in Critical GIS: Reports on an AAG Panel Session
Authors: Wilson Matthew W. , Poore Barbara S.
Published: April 2009

Extending a special session held at the 2008 annual meeting of the Association of American Geographers in Boston, this commentary collection highlights elements of the critical GIS research agenda that are particularly pressing. Responding to a Progress report on critical GIS written by David O'Sullivan in 2006, these six commentaries discuss how different interpretations of ‘critical’ are traced through critical GIS research. Participants in the panel session discussed the need for a continued discussion of a code of ethics in GIS use in the context of ongoing efforts to alter or remake the software and its associated practices, of neo-geographies and volunteered geographies. There were continued calls for hope and practical ways to actualize this hope, and a recognition that critical GIS needs to remain relevant to the technology. This ‘relevance’ can be variously defined, and in doing so, researchers should consider their positioning vis-à-vis the technology. Throughout the commentaries collected here, a question remains as to what kind of work disciplinary sub-fields such as critical GIS and GIScience perform. This is a question about language, specifically the distance that language can create among practitioners and theoreticians, both in the case of critical GIS and more broadly throughout GIScience.
Genetic analysis of salinity tolerance in rice
Authors: Ray PK Saha , Islam M Amirul
Published: April 2009

The genetics of salinity tolerance in rice was studied by visual scoring in parents F1 F2 and backcross generations of six crosses. Segregation analysis indicated partial dominance for salinity tolerance. Estimation of genetic parameters under epistatic model indicated the importance of additive effects in the inheritance of salinity tolerance. Highly significant additive type of gene action in Pokkali/BR29 and both additive and dominance type of gene action in Nonabokra/BR29 without interaction were observed suggesting absence of epistasis and validity of additive dominance model. Significant dominance effect of genes in Nonabokra/BR29 suggests the use of hybrid rice where production of hybrid rice seed is feasible. The non-interactions with duplicate type of epistasis were observed in the crosses with moderately tolerant and susceptible parents. As heritability of the trait was low to moderate, the breeding population must he large and selection for tolerance must be exercised in later generations under controlled conditions. Key words: Genetic analysis, salinity, rice.doi: 10.3329/bjar.v33i4.2284 Bangladesh J. Agril. Res. 33(4) : 519-529, December 2008