Early Detection Of Pathological Changes Research Articles

Usefulness of the second derivative of the finger photoplethysmogram for assessment of end-organ damage: the J-SHIPP study.

Early detection of pathological changes in the vasculature is required to identify individuals at risk of cardiovascular diseases. Noninvasive measurement of the second derivative of photoplethysmogram (SDPTG) might aid in evaluating vascular aging. Here we clarified the diagnostic significance of four SDPTG indices for end-organ damage. A total of 1613 community residents (65±10 years) were enrolled. Changes in blood flow volume at the forefinger were measured by photoplethysmography. SDPTG was computationally calculated from the plethysmogram, and the height of five peaks (a-e) on the SDPTG was measured. Carotid intima-media thickness (IMT), brachial-to-ankle pulse wave velocity (baPWV) and silent cerebral lesions were used as indices of end-organ damage. Multivariate analysis identified age, sex, systolic blood pressure and heart rate as strong determinants for the evaluated SDPTG indices, namely b/a, d/a and aging index ([b-d-c-e]/a). In addition, poor glycemic control and carotid IMT were also weakly associated with the SDPTG indices. Compared with other established risk factors, however, the association between the SDPTG indices and carotid IMT was weak or insignificant (b/a: β=0.069, P=0.002; d/a: β=-0.009, P=0.669; and aging index: β=0.047, P=0.037). Further, no significant association was noted between the SDPTG indices and silent lacunar infarction (b/a: P=0.111; d/a: P=0.263; and aging index: P=0.167) and periventricular hyperintensity (b/a: P=0.587; d/a: P=0.254; and aging index: P=0.429). Although the SDPTG indices evaluated here might represent structural and functional changes in arteries, they exhibited limited diagnostic significance for pathophysiological changes in large arteries, as well as small vessel diseases of the brain.

MRI methods for pulmonary ventilation and perfusion imaging

Separate assessment of respiratory mechanics, gas exchange and pulmonary circulation is essential for the diagnosis and therapy of pulmonary diseases. Due to the global character of the information obtained clinical lung function tests are often not sufficiently specific in the differential diagnosis or have a limited sensitivity in the detection of early pathological changes. The standard procedures of pulmonary imaging are computed tomography (CT) for depiction of the morphology as well as perfusion/ventilation scintigraphy and single photon emission computed tomography (SPECT) for functional assessment. Magnetic resonance imaging (MRI) with hyperpolarized gases, O2-enhanced MRI, MRI with fluorinated gases and Fourier decomposition MRI (FD-MRI) are available for assessment of pulmonary ventilation. For assessment of pulmonary perfusion dynamic contrast-enhanced MRI (DCE-MRI), arterial spin labeling (ASL) and FD-MRI can be used. Imaging provides a more precise insight into the pathophysiology of pulmonary function on a regional level. The advantages of MRI are a lack of ionizing radiation, which allows a protective acquisition of dynamic data as well as the high number of available contrasts and therefore accessible lung function parameters. Sufficient clinical data exist only for certain applications of DCE-MRI. For the other techniques, only feasibility studies and case series of different sizes are available. The clinical applicability of hyperpolarized gases is limited for technical reasons. The clinical application of the techniques described, except for DCE-MRI, should be restricted to scientific studies.

Diagnosing radiation-induced liver injury in rabbit using 3.0 Tesla magnetic resonance diffusion-weighted imaging

To evaluate the clinical value of magnetic resonance (MR) diffusion-weighted imaging (DWI) for diagnosing radiation-induced liver injury (RILI) and detecting changes in hepatic pathology at different post-irradiation times. Male New Zealand white rabbits received no irradiation (C0, control group; n = 10) or irradiation of 50 Gy/10F once every other day by virtual three dimensional conformal radiotherapy (3D-CRT) for one day (C1; n = 10), three days (C2; n = 10), two weeks (C3; n = 10), one month (C4; n = 10) or two months (C5; n = 10). One member of all groups were sacrificed for DWI examination and pathologic study on post-irradiation day 1, day 3, week 2, month 1 and month 2. The apparent diffusion coefficient (ADC) values were measured using a range of b values (50, 300, 600, 800 and 1000 s/mm2). Hematoxylin-eosin (H-E) staining showed that livers of rabbits in the C3, C4 and C5 groups had the characteristic features of veno-occlusive disease. DWI examination showed that the irradiated livers of rabbits in C2, C3, C4 and C5 groups had significantly lower ADC values than the livers of the non-irradiated rabbits at b values of 300, 600, 800 and 1000 s/mm2 (P less than 0.05). When the b value was 600 s/mm2, the best negative correlation between ADC values and pathological stage was seen for the irradiated livers (Spearman's rank, r = -0.459, P less than 0.01). The threshold ADC value to distinguish the normal group (C0) from an irradiated group (more than or equal toC1) was 1.955 * 10-3 mm2/s at 600 s/mm2 b value. When the b value was 1000 s/mm2, the threshold ADC value to predict an irradiated group with normal H-E staining (C1) from an irradiated group with abnormal H-E staining (more than or equal toC2) was 1.5250 * 10-3 mm2/s; the ADC threshold value was 1.5150 * 10-3 mm2/s to predict groups C0-2 and groups C3-5. DWI has high sensitivity for detecting RILI at three days after irradiation with proper b values. Use of the ADC value is feasible for estimating the evolutionary process of pathological features of RILI damage. DWI may represent an important clinical tool for detection of early pathological changes in RILI.

Color doppler in diagnosis of pathological changes in blood vessels

Color Doppler ultrasound is a method that allows noninvasive imaging of blood flow through a blood vessel and analysis of blood vessels, which can be made to flow disturbance and the presence of plaque and narrowing of the blood vessel. Color Doppler ultrasonography allows early detection of pathological changes in blood vessels, which contributes to adequate preventive and therapeutic procedures in the prevention of cerebrovascular disorders. The aim of this paper is to demonstrate the importance of color Doppler ultrasound blood vessels in the diagnosis of pathological changes in the blood vessels of the neck. To create a work used the material of the Cabinet of color Doppler ultrasonography of the Health Center in Donja Gusterica in a prospective study of a random sample of 60 patients were reviewed in January 2014. Gender analysis examined patients, women were 32 (53.33%) and 28 men (46.67%). Looking at the age of examined patients, we have found that most of them 43 (71.67%) over the age of 50 years, while we found 17 (28.33%) patients under 50 years. Atherosclerotic plaques were diagnosed in 36, a change in the shape of the carotid arteries in 29 patients. Atherosclerotic plaque, we usually find the bifurcation ACC and the Origin ACI in 23 (63.89%). Duplex sonography shows what angioneurologists and vascular surgeons are most interested in: the morphology of arterial lesions and hemodynamic effects.

PHASIC COURSE OF NON-ALCOHOLIC FATTY LIVER DISEASE IN PATIENTS WITH TYPE 2 DIABETES MELLITUS ACCORDING TO THE LIPID PEROXIDATION PRODUCTS (the review and own results)

t was introduced the review of the literature on the diagnosis of stages of non-alcoholic fatty liver disease (NAFLD) in patients with type 2 diabetes mellitus (DM). In the result of his own research was found the phasic course of NAFLD in patients with type 2 DM based on the levels of conjugated dienes (CD), and based on the study of their interrelationship with parameters of protein, lipid and carbohydrate metabolism. At the CD level of 200–400 nmol/l there is a steatosis stage, at the 400–600 nmol/l — steatohepatitis, at the 600 nmol/l or more — fibrotic changes in the liver. Using of the results of this study in clinical practice will allow non-invasive way to determine the stage NAFLD in patients with type 2 DM. This will expand the ability of diagnose this disease and provide early detection of pathological changes in the liver.

Detection and characterization of glaucoma-like canine retinal tissues using Raman spectroscopy

Early detection of pathological changes and progression in glaucoma and other neuroretinal diseases remains a great challenge and is critical to reduce permanent structural and functional retina and optic nerve damage. Raman spectroscopy is a sensitive technique that provides rapid biochemical characterization of tissues in a nondestructive and noninvasive fashion. In this study, spectroscopic analysis was conducted on the retinal tissues of seven beagles with acute elevation of intraocular pressure (AEIOP), six beagles with compressive optic neuropathy (CON), and five healthy beagles. Spectroscopic markers were identified associated with the different neuropathic conditions. Furthermore, the Raman spectra were subjected to multivariate discriminate analysis to classify independent tissue samples into diseased/healthy categories. The multivariate discriminant model yielded an average optimal classification accuracy of 72.6% for AEIOP and 63.4% for CON with 20 principal components being used that accounted for 87% of the total variance in the data set. A strong correlation (R2>0.92) was observed between pattern electroretinography characteristics of AEIOP dogs and Raman separation distance that measures the separation of spectra of diseased tissues from normal tissues; however, the underlining mechanism of this correlation remains to be understood. Since AEIOP mimics the pathological symptoms of acute/early-stage glaucoma, it was demonstrated that Raman spectroscopic screening has the potential to become a powerful tool for the detection and characterization of early-stage disease.

Normal values of aortic dimensions, distensibility and pulse wave velocity in children and young adults

Background Aortic enlargement and impaired bioelasticity is a focus of interest in several cardiac and non-cardiac diseases as it can lead to severe cardiovascular complications. Assessment of aortic anatomy and bioelasticity, namely aortic distensibility and pulse wave velocity (PWV), by cardiovascular magnetic resonance imaging (CMR) is accurate and reproducible and can help to identify anatomical and functional abnormalities of the aorta. However, normal CMR values for healthy children and young adults are lacking. Methods Seventy-one heart-healthy subjects (mean age 16.4 ± 7.6 y, range 2.3 - 28.3 y) were examined using a 3.0-T CMR scanner. Aortic cross-sectional areas and aortic distensibility were measured at four positions of the thoracic aorta. PWV was assessed from aortic phase-contrast flow measurements in a segment which includes the aorta between the ascending aorta and the proximal descending aorta. Reference percentile curves for aortic cross-sectional areas, aortic distensibility and PWV were computed with the Lambda-Mu-Sigma method by Cole. Results Aortic areas, aortic distensibility and PWV (aortic crosssectional areas: r= 0.8 to 0.9, p<0.001; aortic distensibility r= -0.43 to -0.62, p<0.001; PWV: r= 0.25 to 0.32, p= 0.047 to 0.009) correlated with height, weight, body surface area, and age. There were no significant sex differences. Percentile curves for aortic cross-sectional areas, aortic distensibility and PWV according to age are presented (Figure: Example of reference percentiles for PWV in the aortic arch). Conclusions This study provides percentile curves for cross-sectional areas, distensibility and PWV of the thoracic aorta in children and young adolescents between their 3rd and 29th year of life. These data may serve as a reference for the early detection of pathological changes of the aorta in various cardiovascular diseases. Funding None.

Moderne Aortenchirurgie beim Marfan-Syndrom 2011

Marfan syndrome is a hereditary disease with a prevalence of 2-3 in 10,000 births, leading to a fibrillin connective tissue disorder with manifestations in the skeleton, eye, skin, dura mater and in particular the cardiovascular system. Since other syndromes demonstrate similar vascular manifestations, but therapy may differ significantly, diagnosis should be established using the revised Ghent nosology in combination with genotypic analysis in specialized Marfan centres. The formation of aortic root aneurysms with the subsequent risk of acute aortic dissection type A (AADA) or aortic rupture limits life expectancy in patients with Marfan syndrome. Therefore, prophylactic replacement of the aortic root needs to be performed before the catastrophic event of AADA can occur. The goal of surgery is the complete resection of pathological aortic tissue. This can be achieved with excellent results by using a (mechanically) valved conduit that replaces both the aortic valve and the aortic root (Bentall operation). However, the need for lifelong anticoagulation with Coumadin can be avoided using the aortic valve sparing reimplantation technique according to David. The long-term durability of the reconstructed valve is favourable, and further technical improvements may improve longevity. Although results of prospective randomised long-term studies comparing surgical techniques are lacking, the David operation has become the surgical method of choice for aortic root aneurysms, not only at the Heidelberg Marfan Centre. Replacement of the aneurysmal dilated aortic arch is performed under moderate hypothermic circulatory arrest combined with antegrade cerebral perfusion using a heart-lung machine, which we also use in thoracic or thoracoabdominal aneurysms. Close post-operative follow-up in a Marfan centre is pivotal for the early detection of pathological changes on the diseased aorta.

Sensitivity and specificity of in vivo diffusion-weighted MRI in acute spinal cord injury

The aim of this study was to test the sensitivity and specificity of diffusion-weighted MRI for the detection of acute spinal cord injury. Forty female New Zealand white rabbits were randomly divided into four groups: the mild, moderate and severe injury groups, and the control (sham operation) group. Contusion of the spinal cord was induced using a weight-drop impactor. All animals were imaged using T1-weighted, T2-weighted, and diffusion-weighted imaging (DWI) sequences at 30 minutes, 6 hours, and 24 hours after injury. One animal from each group was killed at each time point for histologic examination of the spinal cord. DWI had a sensitivity of 100% at all time points, whereas T2-weighted MRI had a sensitivity of 43.33% at 30 minutes after injury, 81.48% at 6 hours after injury, and 95.83% at 24 hours after injury. Conversely, the specificity of DWI was lower than that of T2-weighted MRI at all time points. One animal in the control group had a non-specific high signal on DWI. Significant systematic differences were seen between DWI and T2-weighted MRI at both 30 minutes and 6 hours after injury. The apparent diffusion coefficient values of the lesion were lower than those of adjacent unaffected regions in the mild and moderate injury groups, but higher than adjacent unaffected regions in the severe injury group. The histological findings were reliably correlated with the magnetic resonance findings. We found that DWI has a higher sensitivity, but a lower specificity, than conventional MRI for the detection of early pathological changes after contusive injury.

Evaluation of Epithelial Dysplasia at the Surgical Margins in Patients with Early Tongue Carcinoma — Immunohistochemical Study of Recurrence of Epithelial Dysplasia

Objective: The diagnosis of epithelial dysplasia at the surgical margins in oral cancer plays an important role in its prognosis and requires careful evaluation. Epithelial dysplasia is usually asymptomatic, but often associated with recurrence and malignant transformation.Patients and Methods: The patients included 9 men and 5 women (mean age, 54.6 years; range, 31 to 76 years) with early tongue carcinoma and tumour-cell-'free " surgical margins. Immunohistochemical analysis of p53 and Ki-67 expression was performed in order to evaluate epithelial dysplasia and pathological changes.Results: None of the patients had cancer recurrence, but 2 showed recurrence of epithelial dysplasia. The resection margins at initial surgery and at recurrence were positive for p53 and Ki-67 in both these patients.Conclusions: Epithelial dysplasia, with positive staining for p53 and Ki-67, has the potential for morphological changes, with possible recurrence of epithelial dysplasia or malignant transformation. Such patients will require careful follow-up for local recurrence. Examination of surgical margins for these markers is useful for the early detection of pathological changes.

Tomografía computarizada pulmonar en niños con fibrosis quística en Asturias

The advent of computed tomography (CT) has allowed the early detection of pathological changes in patients with cystic fibrosis (CF). Description of the early pathological changes and distribution of bronchiectasis in children with CF is limited, because most studies have been performed in older children and adults with well-established lung disease. The aim of this study was to describe the distribution pattern of this disease in Asturius. We performed a retrospective study of the medical records and CT scans of patients followed up in our Cystic Fibrosis Unit. CT scans were scored by two radiologists according to Bhalla and Nathanson scores. Pathological changes were analyzed and correlated with clinical data and pulmonary function tests. The 41 CT reviewed contained between 10 and 47 slices, with a median of 16. The total number of slices was 758, of which 606 (79.95%) were considered acceptable and 152 were considered unacceptable by the radiologists. The most frequent lesions found were bronchiectasis (78.38%), followed by mucous plugs (37.84%). The most frequently affected bronchopulmonary segments were S1 and S2 in the right lung. Statistically significant correlations were found between Bhalla and Nathanson scores and disease duration. No statistically significant correlations were found between Bhalla and Nathanson scores and pulmonary function tests. The most frequent lesions in our environment were bronchiectasis followed by mucous plugs. The upper right lobe was the first to be affected, which correlates with findings in most published studies.

Hallazgos clínicos, endoscópicos y magnitud del reflujo de contenido gástrico y duodenal en pacientes con metaplasia intestinal cardial y esófago de Barrett corto, comparados con controles

The diagnosis of patients with short segments of intestinal metaplasia in the distal esophagus, has increased in recent years.To assess the clinical, pathological and functional features of patients with esophageal intestinal metaplasia.A prospective study was performed in 95 control subjects, 115 patients with cardial intestinal metaplasia and 89 patients with short Barret esophagus with intestinal metaplasia. All had clinical and endoscopic assessments, esophageal manometry and determination of 24 h esophageal exposure to acid and duodenal content.Control patients were younger and, in this group, the pathological findings in the mucosa distal to the squamous-columnar change, showed a preponderance of fundic over cardial mucosa. In patients with intestinal metaplasia and short Barret esophagus, there was only cardial mucosa, that is the place where intestinal metaplasia implants. Low grade dysplasia was only seen in the presence of intestinal metaplasia. Gastroesophageal sphincter pressure decreased and gastric and duodenal reflux increased along with increases in the extension of intestinal metaplasia.These findings confirm the need to obtain multiple biopsies from the squamous-columnar mucosal junction in all patients with gastroesophageal reflux symptoms, for the detection of early pathological changes of Barret esophagus and eventual dysplasia.

3-D analysis of F-actin in stereocilia of cochlear hair cells after loud noise exposure

Fluorescence microscopy can be a useful tool in the early detection of pathological changes in the stereocilia of outer hair cells which have undergone acoustic overstimulation. Fluorescent phalloidin, a highly specific F-actin stain, can be used to label F-actin in stereocilia. In this study, phalloidin label is used to determine quantitative changes of F-actin in the stereocilia of guinea pigs exposed to loud noise (117 dB; octave band noise, centered at 1 kHz; 4 h). Reliably determining three-dimensional (3-D) structural changes in stereocilia is a challenging problem in optical microscopy since stereocilia diameter is close to the optical resolution limit. In order to alleviate the problem, a computational 3-D microscopy technique is used (Avinash et al., 1992). Whole-mounts of the cochlear second and third turns were examined in a Leitz Orthoplan microscope through a Leitz Plan Apo objective lens (100 ×; 1.32 N. A.; 170 0.17 ). Images were acquired with a charge-coupled device camera where the focus was shifted in 0.2 μm steps using a piezoelectric translator. Images were processed with the appropriate point spread function of the optical system. Analysis of control cochleas indicate that our technique can resolve single stereocilia and distinguish between various intensities of label along each stereocilia. In noise-exposed cochleas, our data show length and intensity changes in the phalloidin label. These results suggest that both depolymerization and polymerization of F-actin can occur in stereocilia of outer hair cells after acoustic overstimulation. Our findings demonstrate the applicability of computational 3-D microscopy to quantitative and qualitative analysis of stereocilia.