Lower Mean Volume Research Articles

Air-blood barrier thickening and alterations of alveolar epithelial type 2 cells in mouse lungs with disrupted hepcidin/ferroportin regulatory system.

Iron accumulates in the lungs of patients with common respiratory diseases or transfusion-dependent beta-thalassemia. Based on our previous work, we hypothesized that systemic iron overload affects the alveolar region of the lung and in particular the surfactant producing alveolar epithelial type II (AE2) cells. Mice with a point mutation in the iron exporter ferroportin, a model for human hemochromatosis type 4 were compared to wildtype mice (n = 5 each). Lungs were fixed and prepared for light and electron microscopy (EM) according to state-of-the-art protocols to detect subcellular iron localization by scanning EM/EDX and to perform design-based stereology. Iron was detected as electron dense particles in membrane-bound organelles, likely lysosomes, in AE1 cells. AE2 cells were higher in number but had a lower mean volume in mutated mice. Lamellar body volume per AE2 cell was lower but total volume of lamellar bodies in the lung was comparable to wildtype mice. While the volume of alveoli was lower in mutated mice, the volume of alveolar ducts as well as the surface area, volume and the mean thickness and composition of the septa was similar in both genotypes. The thickness of the air-blood barrier was greater in the mutated than in the WT mice. In conclusion, disruption of systemic iron homeostasis affects the ultrastructure of interalveolar septa which is characterized by membrane-bound iron storage in AE1 cells, thickening of the air-blood barrier and hyperplasia and hypotrophy of AE2 cells despite normal total intracellular surfactant pools. The functional relevance of these findings requires further analysis to better understand the impact of iron on intra-alveolar surfactant function.

IPEG 2018The 27th Annual Congress for Endosurgery in ChildrenApril 11–14, 2018, Seattle, Washington

IPEG 2018The 27^th Annual Congress for Endosurgery in ChildrenApril 11–14, 2018, Seattle, Washington

Periprocedural Fluid Type and Volume Reduce the Risk of Post-ERCP Pancreatitis in High-Risk Patients: A Secondary Analysis of a Randomized Controlled Trial: 2017 ACG Governors Award for Excellence in Clinical Research

Introduction: Aggressive hydration with lactated Ringer's was recently shown to be efficacious in reducing the incidence of post-ERCP pancreatitis (PEP) in a randomized controlled trial (RCT) of average risk patients undergoing ERCP. The impact of fluid on the incidence of PEP has not been evaluated in high risk patients. Methods: We conducted a secondary analysis of the effect of volume and type of intravenous fluid administered on the incidence of PEP in high risk patients who underwent ERCP as a part of a double blinded RCT comparing the efficacy of rectal indomethacin versus a combination of papillary spray of epinephrine and rectal indomethacin for the prevention of PEP. High risk patients were defined on the basis of prospectively validated patient and procedure-related risk factors. Patients who underwent planned therapeutic pancreatic stenting and those with suspected sphincter of Oddi dysfunction (SOD) type 3 were excluded from the study. PEP was defined as per the consensus criteria. The volume and type of fluid(s) infused during and after ERCP (periprocedural) were evaluated for their impact on the incidence of PEP using univariable logistic regression analysis. Results: A total 959 patients (mean age of 52.33±14.96 years; 551 (57.4%) females) were randomized during the trial, of whom 476 (49.6%) received periprocedural fluids (mean fluid administered 1245±629mL). The incidence of PEP was reduced in patients who received periprocedural fluid vs those who did not receive periprocedural fluid (5.2% vs 8.0%, P=0.079; OR, 0.65; 95% CI 0.38-1.09). Patients who developed PEP received a lower mean volume of fluid compared to those who did not develop PEP (752±783mL vs. 1012±725mL, P=0.036). There were 174 patients (37%) who received lactated Ringer's (LR). Patients who developed PEP received a lower mean volume of LR compared to those who did not develop PEP (329±356 vs. 570±559mL, P=0.006). The use of LR was associated with a lower risk of PEP compared to those who received all other types of fluid (5.8% vs 9.8%, P=0.047; OR, 0.56; 95% CI 0.31-0.99, P=0.047). Conclusion: Higher mean volume of periprocedural fluids and use of lactated Ringer's solution further reduces the incidence of post-ERCP pancreatitis beyond rectal indomethacin based on this subgroup analysis of a pharmacological prophylaxis PEP trial conducted in high risk patients.Table: No Caption available.

Heterogeneity and Homogeneity of Regional Brain Structure in Schizophrenia

Schizophrenia is associated with alterations in mean regional brain volumes. However, it is not known whether the clinical heterogeneity seen in the disorder is reflected at the neurobiological level, for example, in differences in the interindividual variability of these brain volumes relative to control individuals. To investigate whether patients with first-episode schizophrenia exhibit greater variability of regional brain volumes in addition to mean volume differences. Studies that reported regional brain volumetric measures in patients and controls by using magnetic resonance imaging in the MEDLINE, EMBASE, and PsycINFO databases from inception to October 1, 2016, were examined. Case-control studies that reported regional brain volumes in patients with first-episode schizophrenia and healthy controls by using magnetic resonance imaging were selected. Means and variances (SDs) were extracted for each measure to calculate effect sizes, which were combined using multivariate meta-analysis. Relative variability of regional brain volumetric measurements in patients compared with control groups as indexed by the variability ratio (VR) and coefficient of variation ratio (CVR). Hedges g was used to quantify mean differences. A total of 108 studies that reported measurements from 3901 patients (1272 [32.6%] female) with first-episode schizophrenia and 4040 controls (1613 [39.9%] female) were included in the analyses. Variability of putamen (VR, 1.13; 95% CI, 1.03-1.24; P = .01), temporal lobe (VR, 1.12; 95% CI, 1.04-1.21; P = .004), thalamus (VR, 1.16; 95% CI, 1.07-1.26; P < .001), and third ventricle (VR, 1.43; 95% CI, 1.20-1.71; P < 1 × 10-5) volume was significantly greater in patients, whereas variability of anterior cingulate cortex volume was lower (VR, 0.89; 95% CI, 0.81-0.98; P = .02). These findings were robust to choice of outcome measure. There was no evidence of altered variability of caudate nucleus or frontal lobe volumes. Mean volumes of the lateral (g = 0.40; 95% CI, 0.29-0.51; P < .001) and third ventricles (g = 0.43; 95% CI, 0.26-0.59; P < .001) were greater, whereas mean volumes of the amygdala (g = -0.46; -0.65 to -0.26; P < .001), anterior cingulate cortex (g = -0.26; 95% CI, -0.43 to -0.10; P = .005), frontal lobe (g = -0.31; 95% CI, -0.44 to -0.19; P = .001), hippocampus (g = -0.66; 95% CI, -0.84 to -0.47; P < .001), temporal lobe (g = -0.22; 95% CI, -0.36 to -0.09; P = .001), and thalamus (g = -0.36; 95% CI, -0.57 to -0.15; P = .001) were lower in patients. There was no evidence of altered mean volume of caudate nucleus or putamen. In addition to altered mean volume of many brain structures, schizophrenia is associated with significantly greater variability of temporal cortex, thalamus, putamen, and third ventricle volumes, consistent with biological heterogeneity in these regions, but lower variability of anterior cingulate cortex volume. This finding indicates greater homogeneity of anterior cingulate volume and, considered with the significantly lower mean volume of this region, suggests that this is a core region affected by the disorder.

The Absence of Fever Is Associated With Higher Mortality and Decreased Antibiotic and IV Fluid Administration in Emergency Department Patients With Suspected Septic Shock.

This study evaluates whether emergency department septic shock patients without a fever (reported or measured) receive less IV fluids, have decreased antibiotic administration, and suffer increased in-hospital mortality. This was a secondary analysis of a prospective, observational study of patients with shock. The study was conducted in an urban, academic emergency department. The original study enrolled consecutive adult (aged 18 yr or older) emergency department patients from November 11, 2012, to September 23, 2013, who met one of the following shock criteria: 1) systolic blood pressure less than 90 mm Hg after at least 1L IV fluids, 2) new vasopressor requirement, or 3) systolic blood pressure less than 90 mm Hg and IV fluids held for concern of fluid overload. The current study is limited to patients with septic shock. Patients were grouped as febrile if they had a subjective fever or a measured temperature >100.4°F documented in the emergency department; afebrile patients lacked both. Among 378 patients with septic shock, 207 of 378 (55%; 50-60%) were febrile by history or measurement. Afebrile patients had lower rates of antibiotic administration in the emergency department (81% vs 94%; p < 0.01), lower mean volumes of IV fluids (2,607 vs 3,013 mL; p < 0.01), and higher in-hospital mortality rates (33% vs 11%; p < 0.01). After adjusting for bicarbonate less than 20 mEq/L, lactate concentration, respiratory rate greater than or equal to 24 breaths/min, emergency department antibiotics, and emergency department IV fluids volume, being afebrile remained a significant predictor of in-hospital mortality (odds ratio, 4.3; 95% CI, 2.2-8.2; area under the curve = 0.83). In emergency department patients with septic shock, afebrile patients received lower rates of emergency department antibiotic administration, lower mean IV fluids volume, and suffered higher in-hospital mortality.

Evaluation of mesh- and binary-based contour propagation methods in 4D thoracic radiotherapy treatments using patient 4D CT images

Based on four dimensional (4D) computed tomography (CT) images, mesh- and binary-based contour propagation algorithms for 4D thoracic radiotherapy treatments were evaluated. Gross tumor volumes (GTVs), lungs, hearts and spinal cords on the CT images at the end-exhale and end-inhale phases for six patients were delineated by the physician. All volumes of interest (VOIs) were automatically propagated from the end-exhale phase to the end-inhale phase using two propagation methods. The propagated VOIs were quantitatively compared with the VOIs contoured at the end-inhale phase by the physician using Dice Similarity Coefficient (DSC), Mean Slicewise Hausdorff Distance (MSHD), Center Of Mass (COM) displacement and volume difference. A two-sided Student’s t test was implemented to examine the significance of the differences between the results obtained from the two algorithms. For GTVs, statistically significant differences between the two algorithms were not observed. For all the other VOIs, the mesh-based method showed higher mean DSCs for the heart, left lung, right lung and spinal cord, lower mean MSHD for the spinal cord, lower mean COM displacement for the heart, and lower mean volume differences for the left lung, right lung and spinal cord with statistically significant differences than the binary-based method. The running time for propagation was approximately 3s and 3min for the mesh- and binary-based methods, respectively. Collectively, the mesh-based algorithm provides superiorities in running time and reliability for contour propagation in 4D radiotherapy.

A Cross-Sectional Study: Chest Tube Drainage Practice Patterns among Canadian Thoracic Surgeons Following Pulmonary Surgery

Background: High chest tube drainage following lung surgery is a rate-limiting step to discharge, increasing length of hospital stay. There is a paucity of evidence-based clinical research on safe maximal daily chest tube drainage prior to removal. Objectives: To describe the practice patterns of Canadian thoracic surgeons with respect to daily chest tube drainage after routine pulmonary surgery. Methods: A self-reported electronic questionnaire was administered to members of the Canadian Association of Thoracic Surgeons (CATS). Data was tabulated on the primary outcome of acceptable maximal daily pleural output prior to chest tube removal, and secondary outcomes of: years in clinical practice, academic versus community setting and rational for chest tube management. Descriptive and univariate analysis was conducted for each response by maximal daily pleural drainage category. Results: A total of 124 surveys were distributed. Response rate was 56%, with a 93% completion rate. Acceptable maximal pleural drainage among surgeons was highly variable. Rationale for tube removal was also variable, including individual clinical experiences (n = 23, 33%), evidence based guidelines (n = 18, 26%), and group practice pattern (n = 12, 17%). Academic surgeons comprised 72% of respondents. Community based surgeons were more likely to remove tubes at a lower mean volume. Years in clinical practice did not influence acceptable daily pleural drainage. Conclusion: There is great variability in post-operative management of chest tube fluid output among Canadian thoracic surgeons. Future research on this topic is warranted, with the aim of developing an evidence-based chest tube management algorithm incorporating daily chest tube drainage volumes as a key variable.

Is there a role for homeopathy in breast cancer surgery? A first randomized clinical trial on treatment with Arnica montana to reduce post-operative seroma and bleeding in patients undergoing total mastectomy.

This study aimed to evaluate the benefits of Arnica montana on post-operative blood loss and seroma production in women undergoing unilateral total mastectomy by administering Arnica Montana 1000 Korsakovian dilution (1000 K). From 2012 to 2014, 53 women were randomly assigned to A. montana or placebo and were followed up for 5 days. The main end point was the reduction in blood and serum volumes collected in drainages. Secondary end points were duration of drainage, a self-evaluation of pain, and the presence of bruising or hematomas. The per-protocol analysis revealed a lower mean volume of blood and serum collected in drainages with A. montana (-94.40 ml; 95% confidence interval [CI]: 22.48-211.28; P = 0.11). A regression model including treatment, volume collected in the drainage on the day of surgery, and patient weight showed a statistically significant difference in favor of A. montana (-106.28 ml; 95% CI: 9.45-203.11; P = 0.03). Volumes collected on the day of surgery and the following days were significantly lower with A. montana at days 2 (P = 0.033) and 3 (P = 0.0223). Secondary end points have not revealed significant differences. A. montana 1000 K could reduce post-operative blood and seroma collection in women undergoing unilateral total mastectomy. Larger studies are needed with different dilutions of A. montana to further validate these data.

Do CAD/CAM dentures really release less monomer than conventional dentures?

ObjectivesComputer-aided design (CAD)/computer-aided manufacturing (CAM) dentures are assumed to have more favourable material properties than conventionally fabricated dentures, among them a lower methacrylate monomer release. The aim of this study was to test this hypothesis.Materials and methodsCAD/CAM dentures were generated from ten different master casts by using four different CAD/CAM systems. Conventional, heat-polymerised dentures served as control group. Denture weight and volume were measured; the density was calculated, and the denture surface area was assessed digitally. The monomer release after 7 days of water storage was measured by high-performance liquid chromatography.ResultsWhole You Nexteeth and Wieland Digital Dentures had significantly lower mean volume and weight than conventional dentures. Baltic Denture System and Whole You Nexteeth had a significantly increased density. Baltic Denture System had a significantly smaller surface area. None of the CAD/CAM dentures released significantly less monomer than the control group.ConclusionsAll tested dentures released very low amounts of methacrylate monomer, but not significantly less than conventional dentures. A statistically significant difference might nevertheless exist in comparison to other, less recommendable denture base materials, such as the frequently used autopolymerising resins.Clinical relevanceCAD/CAM denture fabrication has numerous advantages. It enables the fabrication of dentures with lower resin volume and lower denture weight. Both could increase the patient comfort. Dentures with higher density might exhibit more favourable mechanical properties. The hypothesis that CAD/CAM dentures release less monomer than conventional dentures could, however, not be verified.

In vitro analysis of volume-reduced washed platelet concentrates stored in bicarbonated Ringer's solution containing less than 5% residual plasma.

Volume-reduced washed platelet (PLT) concentrates (PCs) can prevent circulatory overload and allergic reactions in patients undergoing PLT transfusions. For these reasons, they are in demand for paediatric settings and for patients at risk of circulatory overload. Here, we evaluated the quality of volume-reduced washed PCs stored for 5 days in a novel acetate-free PLT additive solution (PAS) containing glucose and bicarbonate (BRS-A) with <5% residual plasma protein. PCs from two apheresis donations were mixed and divided equally into control and test units. For the test unit (volume-reduced washed PCs), PLTs were washed and stored in 90 ml BRS-A with <5% plasma protein. PLTs in the control unit were stored in 200 ml 100% plasma without any washing manipulations. The in vitro properties of PLTs in both units were compared over a 5-day storage period. The procedure for volume-reduced washed PCs effectively removed >98% plasma protein in 100% plasma PCs and yielded an approximately twofold lower mean volume (91 ml) compared to that observed with the control units. Immediately after washing, the mean PLT concentration of the test units was 20·5 × 10(11) /l, twofold higher than that of the control units. The pH (37°C) levels in the test unit remained above 7·0 for 5 days. Glucose consumption and lactate production rates of the test units on days 1-3 were higher than those of the control units, leading to glucose exhaustion in the test unit by Day 3. Hypotonic shock responses and CD62P and CD42b expression levels in both units were comparable during 5-day storage. Considering the pH buffering capacity of BRS-A, a 90-ml volume may be acceptable for maintaining the in vitro quality of washed PLTs for at least 2 days.

Population pharmacokinetics modeling and analysis of foretinib in adult patients with advanced solid tumors

Foretinib is a multikinase inhibitor that inhibits multiple receptor tyrosine kinases, including MET and VEGFR, with the potential for treatment of solid tumors. Hepatocellular carcinoma (HCC) pathogenesis is associated with overexpression of MET, and physiologic changes in the livers of HCC patients may decrease CYP3A isozyme-mediated metabolism of foretinib. A population pharmacokinetic model of foretinib was developed to explore the effect of tumor type, formulation, and other covariates. Data from 1 HCC study in Asia and 3 non-HCC studies in the United States with varying foretinib regimens and formulations were used for analysis. A 2-compartment model with a linear first-order absorption and elimination and lag time in absorption adequately described foretinib pharmacokinetics in 132 advanced non-HCC and HCC patients and identified an effect of formulations on bioavailability. The bisphosphate salt capsules and freebase tablets had a relative bioavailability 37% and 20% higher, respectively, than the solution formulation. HCC patients had ≈19.6% lower mean clearance (70.14 L/h), ≈16% lower mean volume of distribution (1725.6 L), and higher dose-normalized exposure compared with non-HCC patients. This could be a result of differences in metabolism in HCC patients, body weight, or activity of CYP3A isozymes between Asian and Western cancer patients.

Effect of initial air pressure on the detonation activity of an explosive aerosuspension

The effect of air pressure (0.01–0.3 MPa) on the detonatability of an aerosuspension of secondary explosive particles at a low mean volume density of the explosive (0.14–1.28 mg/cm3) is experimentally studied. The structure and basic parameters of detonation depending on the explosive density and initial gas pressure are determined, and the mechanism of low-velocity detonation propagation in explosive aerosuspensions is revealed. The lower concentration limits of detonation at different initial gas pressures are found.

Hardwood Tree Growth after Eight Years on Brown and Gray Mine Soils in West Virginia

Surface coal mining in Appalachia disturbs hundreds of hectares of land every year with the removal of valuable and ecologically diverse eastern deciduous forests. After the passage of the Surface Mining Control and Reclamation Act in 1977, coal mine operators began planting a variety of grasses and legumes as a fast and economical way to reestablish a permanent vegetative cover to meet erosion and site stabilization requirements. However, soil compaction and competitive forage species have arrested the recolonization of native hardwood tree species on these reclaimed sites. Three 2.8-ha demonstration plots were established at Catenary Coal's Samples Mine in Kanawha County, West Virginia, of weathered brown sandstone and unweathered gray sandstone. Half of each plot was compacted. Each plot was hydroseeded with a low-competition herbaceous cover and planted with 11 hardwood tree species. After eight growing seasons, average tree volume index was nearly 10 times greater for trees grown in the brown sandstone treatments, 3853 cm, compared with 407 cm in gray sandstone. Trees growing on compacted treatments had a lower mean volume index, 2281 cm, than trees growing on uncompacted treatments, 3899 cm. Average pH of brown sandstone was 5.2 to 5.7, while gray sandstone was 7.9. The gray sandstone had much lower fine soil fraction (<2-mm) content (40%) than brown sandstone (70%), which influenced nutrient- and water-holding capacity. Brown sandstone showed significantly greater tree growth and survival and at this stage is a more suitable topsoil substitute than gray sandstone on this site.

The urodynamic characteristics and prognostic factors of patients with interstitial cystitis/bladder pain syndrome

The role of urodynamic study (UDS) in diagnosis of interstitial cystitis/bladder pain syndrome (IC/BPS) remains inconclusive, nor has the predictor for a treatment success been elucidated. We evaluated the diagnostic and prognostic values of UDS in patients with IC/BPS. IC/BPS patients with complete data of a symptom assessment, video UDS, potassium chloride (KCl) test, cystoscopic hydrodistention and treatment records were reviewed retrospectively. O'Leary-Sant symptom index and problem index (ICSI, ICPI) were available in part of the patients. The associations between UDS parameters with symptom scores, KCl test result, cystoscopy findings and treatment outcome were analysed. The UDS parameters, including first sensation of filling (FSF), first desire to void (FD), strong desire to void (SD), cystometric bladder capacity (CBC), maximum flow rate (Q(max)), detrusor pressure at Q(max) (Pdet), voided volume (VV) and postvoid residual (PVR). Univariate and multivariate logistic regression analyses were used to identify the variable predicting treatment success. A total of 214 IC/BPS patients were enrolled in this study. The mean volumes at FSF, FD, SD, CBC and VV were inversely correlated with ICSI and ICPI (all p < 0.05). The patients with a positive KCl test had significantly lower mean volumes at SD, CBC, VV and lower Q(max) (all p < 0.05). Significantly lower mean volumes for FSF, FD, SD, CBC and VV were found in patients with higher grade of glomerulation under cystoscopy (all p < 0.01). The anaesthetic maximal bladder capacity (MBC) was positively correlated with FSF, FD, SD, CBC, Q(max) and VV (all p < 0.01). Female gender and the volume at SD were found to be the independent predictors for treatment outcome. Our study demonstrated that there might be a role of UDS to help in diagnosis and prognostication for IC/BPS. Future prospective investigations are warranted.

Comparison of pharmacokinetic variables for creatinine and iohexol in dogs with various degrees of renal function

To compare pharmacokinetics and clearances of creatinine and iohexol as estimates of glomerular filtration rate (GFR) in dogs with various degrees of renal function. 50 Great Anglo-Francais Tricolor Hounds with various degrees of renal function. Boluses of iohexol (40 mg/kg) and creatinine (647 mg/kg) were injected IV. Blood samples were collected before administration and 5 and 10 minutes and 1, 2, 4, 6, and 8 hours after administration. Plasma creatinine and iohexol concentrations were assayed via an enzymatic method and high-performance liquid chromatography, respectively. A noncompartmental approach was used for pharmacokinetic analysis. Pharmacokinetic variables were compared via a Bland-Altman plot and an ANOVA. Compared with results for creatinine, iohexol had a significantly higher mean ± SD plasma clearance (3.4 ± 0.8 mL/min/kg vs 3.0 ± 0.7 mL/min/kg) and a significantly lower mean volume of distribution at steady state (250 ± 37 mL/kg vs 539 ± 73 mL/kg), mean residence time (80 ± 31 minutes vs 195 ± 73 minutes), and mean elimination half-life (74 ± 20 minutes vs 173 ± 53 minutes). Despite discrepancies between clearances, especially for high values, the difference was < 0.6 mL/min/kg for 34 (68%) dogs. Three dogs with a low GFR (< 2 mL/min/kg) were classified similarly by both methods. Plasma iohexol and creatinine clearances can be used interchangeably for screening patients suspected of having chronic kidney disease (ie, low GFR), but large differences may exist for dogs with a GFR within or above the reference range.

Preoperative clinical, demographic, and urodynamic measures associated with failure to demonstrate urodynamic stress incontinence in women enrolled in two randomized clinical trials of surgery for stress urinary incontinence

The unexpected absence of urodynamic stress incontinence (USI) in women planning surgery for stress urinary incontinence (SUI) is a challenge to surgeons. We examined the prevalence and clinical and demographic factors associated at baseline (preoperatively) with the unexpected absence of USI among study participants of two multicenter randomized clinical trials of surgery for treating SUI. Women with SUI symptoms and positive stress tests on physical examination enrolled in two separate clinical trials-one comparing the autologous fascial sling with the Burch colposuspension [Stress Incontinence Surgical Treatment Efficacy Trial (SISTEr), and the other comparing the retropubic mid-urethral sling with the transobturator midurethral sling [Trial of Mid-Urethral Slings (TOMUS)]-were evaluated for USI preoperatively. The association of clinical, demographic, and urodynamic parameters was examined in women without USI in univariate and multivariate analyses. Overall, 144 of 1,233 women (11.7 %) enrolled in the two studies showed no USI. These women had a significantly lower mean volume at maximum cystometric capacity than those with USI (347.5 vs. 395.8 in SISTEr, p = 0.012), (315.2 vs. 358.2 in TOMUS, p = 0.003) and a lower mean number of daily accidents reported on a 3-day diary (2.2 vs 2.7 in SISTEr, p = 0.030) (1.7 vs 2.7 in TOMUS, p < 0.001). Additionally, those without demonstrable USI were more likely to have Pelvic Organ Prolapse Quantification (POP-Q) stage III/IV (31.7 % vs 14.4 % in SISTEr, p = 0.002), (15.5 % vs 6.9 % in TOMUS, p = 0.025). SUI severity as recorded on the Urogenital Distress Inventory (UDI) correlated strongly with the presence of USI in both studies. We observed that about one of eight women planning surgery for SUI does not show USI. Stage 3/4 POP was strongly associated with the unexpected absence of USI. A diminished urodynamic bladder capacity among women who did not display USI may reflect an inability to reach the limits of capacity during urodynamics, at which these women normally leak.

The basic pharmacoepidemiology of benzodiazepine use in Norway 2004-9

Objectives: Benzodiazepines are effective and safe drugs for treatment of insomnia, anxiety, epilepsy and muscle spasm, but there is also a potential for harmful use, abuse and addiction. Even though these drugs are used extensively, have been on the market for 50 years, and quite a few reports have been published on risk factors and patterns of use, the basic epidemiological parameters of use, such as incidence, prevalence, mean volume used and duration of use have not been documented in Norway. The aim of this study was to describe these basic pharmacoepidemiological parameters of benzodiazepine use.Methods: Data were drawn from the Norwegian prescription database with an observation period of 5 years and 10 months between January 2004 and October 2009.Results: Around 61 per 1000 Norwegians filled at least one prescription each year in the observation period. The annual incidence rate of new users was 15 per 1000 in 2007, falling to 12 per 1000 in 2009. Of the users of benzodiazepines 65% were female, and they used a lower mean volume than men did. The mean volume used was often very low and for the most part was quite stable. The average length of use was estimated to bebetween 9 and 15 years. In addition to fewer incident users, the mean volume used also seemed to be declining.Conclusion: Most benzodiazepine use in Norway lasted a short period or at a very low level. Some individuals, however, carried on using benzodiazepines for years

TU‐C‐211‐12: Performance of a Novel Region Growing Segmentation Method for Nuclear Medicine

Purpose: To investigate the performance improvement of a novel region growing (SRG) and “segmentation‐by‐consensus” (SBC) technique for delineation of lesions in FDG‐PET. Further, the improvement in lesion segmentation using time‐of‐flight (TOF) PET was investigated. Methods: The NEMA image quality phantom was filled to give 3:1 and 7:1 contrast ratios between spheres (0.44 – 27.13 cc) and background. Contrast added to the sphere volumes and a hi‐resolution CT allowed segmentation of the true activity distribution. Ten minute list‐mode scans were acquired on a GE Discovery 690 PET/CT system. Images were reconstructed representing 1, 2 and 5 minute acquisitions using TOF and NTF methods. Four commonly used segmentation methods, 40%max 50%max, K‐means, fuzzy C‐means, and the SRG technique, were used to segment the six spheres. The SBC approach creates volumes from voxels segmented by a majority of the techniques. Absolute volume differences and volume overlap were metrics for evaluating each algorithmˈs performance. Results: All techniques performed poorly for the small (0.44 &amp; 1.08 cc) spheres with mean volume errors between 10–30 cc (3:1 contrast), and 5.5–12 cc (7:1). SRG consistently had lower average volume errors (4.25–6.30 cc) but 40%max had the highest absolute volume overlap for the largest sphere (0.7795– 0.8090). However, SRG dramatically outperformed 40%max for the 1.08 cc sphere (0.4338–0.4952 vs. 0.0124–0.0173). For the high (7:1) contrast, k‐ means consistently gave lower average volume errors (0.09–6.95 cc) and higher average volume overlap (0.4741–0.5765) than SRG (8.57–10.15 cc and 0.3543–0.3967). No noticeable difference with TOF was observed. SBC gave results within the above ranges for both 3:1 and 7:1 with less variation and was close to the highest performing technique in each scenario. Conclusions: TOF offers comparable results to NTF PET for the volumes segmented. The SRG technique provided lower mean volume errors and good volume overlap in low contrast situations.

Impact of abdominal visceral and subcutaneous adipose tissue on cardiometabolic risk factors: the Jackson Heart Study.

Obesity is a major driver of cardiometabolic risk. Abdominal visceral adipose tissue (VAT) and sc adipose tissue (SAT) may confer differential metabolic risk profiles. We investigated the relations of VAT and SAT with cardiometabolic risk factors in the Jackson Heart Study cohort. Participants from the Jackson Heart Study (n=2477; 64% women; mean age, 58 yr) underwent multidetector computed tomography, and the volumetric amounts of VAT and SAT were assessed between 2007 and 2009. Cardiometabolic risk factors were examined by sex in relation to VAT and SAT. Men had a higher mean volume of VAT (873 vs. 793 cm3) and a lower mean volume of SAT (1730 vs. 2659 cm3) than women (P=0.0001). Per 1-sd increment in either VAT or SAT, we observed elevated levels of fasting plasma glucose and triglyceride, lower levels of high-density lipoprotein-cholesterol, and increased odds ratios for hypertension, diabetes, and metabolic syndrome. The effect size of VAT in women was larger than that of SAT [fasting plasma glucose, 5.51±1.0 vs. 3.36±0.9; triglyceride, 0.17±0.01 vs. 0.05±0.01; high-density lipoprotein-cholesterol, -5.36±0.4 vs. -2.85±0.4; and odds ratio for hypertension, 1.62 (1.4-1.9) vs. 1.40 (1.2-1.6); diabetes, 1.82 (1.6-2.1) vs. 1.58 (1.4-1.8); and metabolic syndrome, 3.34 (2.8-4.0) vs. 2.06 (1.8-2.4), respectively; P<0.0001 for difference between VAT and SAT]. Similar patterns were also observed in men. Furthermore, VAT remained associated with most risk factors even after accounting for body mass index (P ranging from 0.006-0.0001). The relationship of VAT to most risk factors was significantly different between women and men. Abdominal VAT and SAT are both associated with adverse cardiometabolic risk factors, but VAT remains more strongly associated with these risk factors. The results from this study suggest that relations with cardiometabolic risk factors are consistent with a pathogenic role of abdominal adiposity in participants of African ancestry.

Three-Dimensional Surface Mapping of the Caudate Nucleus in Late-Life Depression

To compare the volumes of the caudate nucleus, using traditional volumetry and a three-dimensional brain mapping technique, in a group of individuals with late-life depression and a group of age- and education-equated nondepressed comparison subjects. Cross-sectional. University Medical Center. Twenty-three nondemented subjects with late-life depression and 15 age- and education-equated elderly comparison subjects (depressed mean years of age: 70.5 +/- 5.7 SD, comparison subjects = 69.9 years +/- 6.4) with no history of psychiatric or neurologic disease. Structural magnetic resonance imaging. Three-dimensional (3-D) surface models were created from manually traced outlines of the caudate nucleus from spoiled gradient echo images. Models were geometrically averaged across subjects and statistical maps created to localize any regional volume differences between groups. Relative to comparison subjects, depressed subjects had significantly lower mean volumes for both the left (p = 0.029) and right (p = 0.052) caudate nucleus as well as total caudate volume (p = 0.032). Total volumes were 13.1% less in the depressed group (13.5% on the left and 12.6% on the right). 3-D maps further localized these reductions to the caudate head. Volume reductions were correlated with depression severity, as measured by the 17-item Hamilton Depression Rating Scale. Late-life depression is associated with left and right caudate nucleus reduction especially in anterior portions. Among depressed subjects, greater caudate reduction was associated with more severe depression. These results are consistent with growing evidence that the anterior caudate nucleus, especially the head, may be structurally and functionally abnormal in affective disorders.