Mm In Subjects Research Articles

ПРИМЕНЕНИЕ УЛЬТРАЗВУКОВОГО ИССЛЕДОВАНИЯ ДЛЯ КОЛИЧЕСТВЕННОЙ ОЦЕНКИ КЛЕТЧАТКИ ЗАБРЮШИННОГО ПРОСТРАНСТВА

The aim of the study was to explore the possibility of using ultrasound to quantify the fiber of the retroperitoneal space under normal conditions. Materials and methods. 3 linear dimensions between anatomical landmarks are proposed, which are well visualized with standard transabdominal ultrasound of the abdominal cavity and retroperitoneal space. These include: 1) the distance between the lower edge of the rectus abdominis and the aorta; 2) the distance between the upper pole of the right kidney and the lower border of the liver; and 3) the distance between the upper pole of the left kidney and the lower pole of the spleen. 145 practically healthy people were included in the study. All subjects were segregate into 3 groups according to body mass index (BMI). The first group consisted of persons with a BMI of 17.5 to 24.9 kg/m2, the second included persons with a BMI from 25 to 29.9 kg / m2, and the third consisted of people with a BMI ≥30 kg/m2. The median, minimum, maximum, upper and lower quartile values, as well as the 10th and 90th percentiles were used to describe the data obtained. Results. 80% of the distance values between the upper pole of the right kidney and the lower edge of the liver fit into the range of 10 mm to 25 mm in persons with a BMI of 17.5 to 24.9 kg/m2, in the range from 15 mm to 30 mm in persons with a BMI of 25 to 29.9 kg/m2, and in the range of 13.5 mm to 42.5 mm in obese individuals. The distance between the lower margin of the rectus abdominis and the aorta at a distance of 5 cm above the umbilicus along the midline is from 15 mm to 35 mm in people with a BMI of 17.5 to 24.9 kg/m2, from 25 mm to 60 mm in persons with a BMI of 25 to 29.9 kg/m2 and from 35 mm to 75 mm In obese individuals, it includes values between the 10th and 90th percentiles for this measurement point. Finally, 80% of the distance measurement values between the upper pole of the left kidney and the lower pole of the spleen fit in sizes from 10 mm to 30 mm for people with a BMI of 17.5 to 24.9 kg/m2, from 18 mm to 40 mm for people with a BMI from 25 to 29.9 kg/m2 and from 25 mm to 52.5 mm for subjects with obesity. Conclusion. The results obtained allow us to recommend ultrasound of retroperitoneal tissue for the evaluation of its condition.

Sonographic evaluation of common carotid artery intima-media thickness in adults with coexisting type two (2) diabetes and hypertension: A case-controlled study

Diabetes mellitus (DM) and hypertension (HTN) are the two leading risk factors for atherosclerosis. Carotid intima-media thickness (CIMT) is considered a reliable surrogate measure for detecting subclinical atherosclerosis including its progression and regression. The study aim at evaluating the intima-media thickness of the common carotid artery in adults with coexisting diabetes mellitus and hypertension (DM+HTN) and compare with healthy controls.. A prospective case control study involving 115 adult subjects with coexisting DM+HTN and 144 healthy adult controls was carried out. Common carotid intima-media thickness (CCIMT) was measured at point approximately 1 cm distal to the right and left carotid bulb using the 7-12 MHz, multi-frequency linear array transducer of high resolution, touch Venue 50 ultrasound machine equipped with electronic callipers. The overall mean CCIMT was 1.13±0.40 mm and 0.82±0.23 mm for subjects with coexisting DM and HTN; and healthy controls, respectively. There was a statistically significant difference in CIMT of subjects with DM+HTN compared to healthy controls (p=0.000 each for both males and females, respectively). There were positive correlations between CCIMT and age in subjects with DM+HTN (r=0.260 and r=0.424 for males and females respectively); with healthy controls (r=0.619 and 0.626 for males and females, respectively). There was a statistically significant difference in CCIMT between subjects with DM+HTN and healthy controls. This implies that the increase in CCIMT is associated with both DM and HTN. In addition, age has a significant positive relationship with CCIMT in both subjects with DM+HTN and healthy controls.

Common bile duct diameter reference values in patients with gallstone disease across various age-gender groups

Objective. Our goal was to establish common bile duct (CBD) diameter reference levels for abdominal ultrasound and percutaneous transhepatic cholecysto-cholangiography (PTCC) measurements with relevance to age and gender across the cohort of patients with underlying gallbladder disease excluding any intra- or extrahepatic bile ducts lesions.Materials and methods. 251 symptomatic patients with gallbladder disease and no signs of choledocholithiasis or biliary obstruction presenting to Liver and Pancreas Surgery Department, Sklifosovsky Research Institute for Emergency Medicine from January 2019 to June 2023 were reviewed. All the selected subjects underwent transabdominal ultrasound examination of hepato-biliary zone and PTCC. Common bile duct diameter, if not obscured, was measured at its widest visible portion by means of electronic calipers. The relationship between CBD size, age and gender was examined by nonparametric tests across stratified groups.Results. Mean sonographic CBD diameter was as high as 4.99 ± 1.17 mm with no evidence of correlation with age or gender. Mean cholecysto-cholangiography CBD diameter made up 6.49 ± 1.52 mm and reflected a considerable increase with age only: patients under 60 had CBD diameter significantly narrower, then those over 60. Basing upon the 95-percentile, we derived upper reference limit of 6.0 mm for US measurements without age and sex association, and for PTCC measurements regarding distinct age groups (8.0 mm in subjects < 60 years and 9.0 mm in subjects ≥ 60 years). Diameter of common bile duct was substantially higher on cholangiograms versus sonograms.Conclusion. Present study displayed notable common bile duct diameter discrepancies not only between ultrasound and cholangiography measurements, but also throughout age-dependent groups on cholangiograms. We imply those variations to be taken in consideration in case of contrasting various radiological evaluations of common bile duct, and in case of ruling out the diagnosis of choledocholithiasis or bile flow abnormality.

Comparison of common carotid artery luminal diameter between adults with diabetes mellitus and healthy controls in North-eastern Nigeria

Background: Common carotid artery luminal diameter (CCALD) is used in epidemiological and interventional studies as biomarker of carotid atherosclerosis especially in subjects with DM. However, there are paucity of studies on the CCALD in subjects with DM in the study locality. Purpose: This study is aimed at evaluating the CCALD in adults with DM differ from those of healthy controls Methodology: Common carotid artery luminal diameters (CCALD) of 82 adult subjects with DM and 144 healthy controls were evaluated using a high-resolution ultrasound machine (Venue 50) equipped with electronic callipers and a linear array, high-frequency transducer (7-12 mHz). Measurements were taken at a point 1 cm distal to the carotid bulb. Results: The overall mean CCALD was 6.12±1.47 mm and 5.88±0.77 mm for subjects with DM and healthy controls, respectively. The mean CCALD value is higher in subjects with DM compared to those of healthy controls though; there was no statistically significant difference in CCALD between the two groups. There were significant positive correlations between CCALD and age in male subjects with DM (r=0.488) while weak negative correlation exists in females (r=-0.073).Furthermore, weak negative correlation between CCALD and age among healthy controls (r=-0.117 and -0.020 for males and females, respectively). Conclusion: The overall mean CCALD value in subjects with DM is higher than those of healthy control. The mean CCALD value is positively and significantly related to age in only male subjects with DM.

Sonographic assessment of the common carotid artery luminal diameter in adults with co-existing diabetes mellitus and hypertension

Background: Diabetes mellitus (DM) and hypertension (HTN) are known to cause major in changes in arterial morphology and function, (remodelling) including alterations in carotid intima media thickness (CIMT), carotid artery luminal diameter (CALD), and arterial compliance and blood flow velocity. However, there is a paucity of data evaluating common carotid luminal diameter (CCALD) in an adult with both DM and HTN (DM+HTN) in the study locality. Objective: This study is therefore aimed at evaluating the CCALD in adults with DM+HTN. Methodology: One hundred and fifteen (115) adult subjects with co-existing DM+HTN and one hundred and fourty four (144) healthy controls participated in the study. Their ages ranged from 18 to 80 years. The common carotid artery luminal diameter (CCALD) at the diastolic phase of the cardiac cycles was scanned and measured using a venue 50 ultrasound scanners with electronic calipers and high frequency linear array transducer. Result: The overall mean CCALD was 6.43±0.87 mm and 5.88±0.77 mm for subjects with DM+HTN and healthy controls, respectively. The mean CCALD value was significantly higher in subjects DM+HTN compared to the healthy controls (0.000). The mean CCALD correlated positively with age in males with DM+HTN hypertensive females, while no significant correlations were observed among healthy controls. Males had significantly higher mean CCALD value when compared to their female counterparts in both subjects with DM+HTN and healthy controls. Conclusion: In this study, the mean CCALD value in subjects with DM+HTN is significantly higher compared to those of healthy controls.

Definition of age-dependent reference values for the diameter of the common bile duct and pancreatic duct on MRCP: a population-based, cross-sectional cohort study

ObjectiveChanges of the pancreaticobiliary ducts herald disease. Magnetic resonance cholangiopancreatography (MRCP) allows accurate duct visualisation. Data on reliable upper reference ranges are missing.DesignCross-sectional whole body MRI data from the population-based...

Time Course of Perceived Visual Distortion and Axial Length Growth in Myopic Children Undergoing Orthokeratology

Purpose: To establish the time course of the subjective visual function changes during the first month of orthokeratology treatment in myopic children, and to investigate how the time course variations are associated with the objective optical quality changes and the axial length growth (ALG) after 1 year of treatment.Methods: A total of 58 myopic children aged from 8 to 16 years participated in this self-controlled prospective study. All subjects were fitted with designed spherical four-zone orthokeratology lenses. Subjective visual function was evaluated with orientation discrimination threshold (ODT), and objective optical quality was quantified with the high-order aberration root-mean-square (HOA-RMS) and the changing speed of HOA. The measurements were done before the lens fitting and 1 day, 1-, 2-, and 4-weeks after lens wear. Axial length was obtained at baseline and 1-year follow-up, and ALG was defined as the difference. One-way ANOVA was conducted to compare the difference for statistical analysis.Results: After lens fitting, the ODT time courses peaked on day 1 in 28 children, 1 week in 15 children, 2 weeks in 11 children, and 4 weeks in 4 children. In contrast, the HOA-RMS steadily rose during the first month, and the changing speed of HOA was only transiently elevated on day 1 after the initial lens wear. The ALG was 0.12 ± 0.20 mm in subjects whose ODT peaked at day 1, 0.08 ± 0.09 mm in subjects whose ODT peaked on 1-week, and 0.12 ± 0.15 mm in subjects whose ODT peaked on 2-week or later. There was no difference in axial growth among the subjects whose ODT peaked at different days (P = 0.734).Conclusion: While half ODT time course resembled the changing speed of HOA with a transient elevation on day 1, about a quarter of the ODT time course resemble the steadily rising of HOA-RMS, and the rest was located in the middle. The ALGs in children with different types of ODT time courses were similar.

Comparison of a purely endoscopic three-layer technique versus pericranial flap for reconstruction of anterior skull base defects after sino-nasal tumor resection: assessment of postoperative frontal lobe sagging and frontal lobe falling.

The evolution of endoscopic skull base approaches has enabled surgeons to manage selected skull base tumors through a transnasal endoscope-assisted approach. On the other side, more extensive lesions may require a combined cranioendoscopic approach. In this paper, we analysed and compared the incidence of frontal lobe sagging after endoscopic multilayer (EM) reconstruction versus pericranial flap (PF) reconstruction. Subjects were selected retrospectively according to specific inclusion and exclusion criteria. The degree of frontal lobe sagging after surgery was calculated based on the most inferior position of the frontal lobe relative to the nasion-sellar line defined on preoperative and postoperative imaging. A positive value signified upward displacement, and a negative value represented frontal lobe sagging. Twenty subjects were enrolled in our study. In the EM technique group the average frontal lobe displacement was -2,34 ± 1,55 mm. The average postoperative frontal lobe sagging was -0,45 ± 8,92 mm in subjects reconstructed with the PF. The skull base defect size correlated with the degree of frontal lobe sagging in subjects reconstructed with the PF, but not in the other group and when merging the two groups. In conclusion, the EM technique and the PF reconstruction showed a good reliability for the closure of anterior skull base defects. Moreover the PF seemed to prevent frontal lobe sagging but, for larger skull base defects, it could be useful to be combined with other autologous or heterologous materials to avoid the frontal lobe falling.

Third ventricular width assessed by transcranial ultrasound correlates with cognitive performance in Parkinson's disease

IntroductionCognitive impairment and dementia are common in PD; however, no stable marker of cognitive dysfunction is available. Transcranial sonography can evaluate global and focal brain atrophy and has been widely used in the differential diagnosis of parkinsonism. Methods225 consecutive PD patients were recruited in a two-center cross sectional study and underwent a standardized sonographic protocol assessing the third ventricle's width and substantia nigra hyperechogenicity. All subjects were evaluated with an extensive motor and cognitive battery. Results222 PD patients were included and classified as PD with normal cognition (PDNC; n = 130), mild cognitive impairment (PD-MCI; n = 61) and dementia (PDD; n = 31). Ventricular width correlated strongly with cognitive performance in all cognitive domains (p < 0.001) while SN size did not. PDD patients had significantly wider ventricles than PD patients without dementia (p < 0.001) while differences between PD-MCI and PDNC or PDD were less strong (p < 0.05). There were no group differences in SN size.ROC analyses resulted in age-related cut-offs of third ventricular diameter for the prediction of PDD (6.0 and 7.5 mm for subjects < and ≥70 years of age, respectively). These cut-offs significantly differentiated PDD from PDNC (p < 0.001) and from all patients without dementia (PDNC + PD-MCI; p < 0.001). ConclusionsThe third ventricular diameter correlated with cognitive performance in all domains and was able to differentiate PDD patients from those without dementia. Longitudinal studies are warranted to evaluate whether transcranial sonography could identify PD patients at risk for a rapid cognitive decline.

Plasma lactate as a marker of metabolic health: Implications of elevated lactate for impairment of aerobic metabolism in the metabolic syndrome

BackgroundFasting lactate is elevated in metabolic diseases and could possibly be predictive of the risk of developing the metabolic syndrome. MethodsPlasma samples were analyzed for fasting lactate to compare lean subjects, nondiabetic subjects with severe obesity, and metabolically impaired subjects. Subjects with severe obesity were studied 1 week before and 1 week to 9 months after gastric bypass surgery. Subjects with components of the metabolic syndrome were studied before and after 6 months of an exercise intervention. ResultsMetabolically impaired subjects had higher fasting lactate concentrations (P < .0001) and respond to a glucose or insulin challenge with higher lactates than non-obese subjects (P < .004). Lactate was significantly reduced a week after gastric bypass surgery (P < .05) and further reduced 1 to 9 months after surgery (0.95 ± 0.04 mM in non-obese, 1.26 ± 0.12 mM in subjects with severe obesity, and 0.68 ± 0.03 mM 1–3 months after gastric bypass). Six months of chronic exercise resulted in a 16% reduction (P = .028) in fasting lactate. ConclusionFasting plasma lactate was elevated in obese subjects with the metabolic syndrome compared with healthy lean individuals. Lactate was reduced by exercise and bariatric surgery, interventions that improve metabolic health and risk for subsequent disease. The results of this study and those previously published by our research group suggest that elevated lactate may be caused by an impairment in aerobic metabolism and may offer a metric assessing the severity of the metabolic syndrome.

Evaluation of corneal flap symmetry in the optical center by anterior segment optical coherence tomography: mechanical versus femtolaser flaps

Objective The aim of this study was to evaluate corneal flap symmetry in the central 3 mm for subjects undergoing either laser in-situ keratomileusis or femtolaser in-situ keratomileusis for correction of myopia and/or astigmatism. Patients and methods This prospective study enrolled 160 eyes of 80 patients with mild to moderate myopia ( Results The mean central thickness of the VisuMax and Moria M2 flaps was 102.06±5.37 and 130.25±12.61 μm, respectively (P Conclusion The mean flap thickness measurements at each point showed more accurate outcomes in the femtolaser group. Moreover, slight vertical as well as horizontal asymmetry was found in the Moria group, although statistically insignificant.

Maxillary sinus augmentation with concentrated growth factors: radiographic evaluation

Aim This in vivo study aims to compare the quantity and quality of bone formation around dental implants inserted following Tatum’s approach with placement of Concentrated Growth Factors (CGF). Materials and methods This prospective study involved 20 patients requiring maxillary sinus augmentation for missing maxillary first molars. These patients were randomly divided into two groups: one in which sinus augmentation was followed by placement of CGF and simultaneous implant placement and the other in which no grafting material was used also followed by immediate implant placement. Radiographic assessment was carried out six months postoperatively using Cone Beam Computed Tomography (CBCT) to assess the quantity and quality of the new bone formed. Results CBCT analysis showed a mean bone gain of 3.193 mm in subjects in the test group and 4.47 mm in the control group. Also, a statistically significant difference was noted in bone quality in the test group when compared to controls. Conclusion This study indicates that direct sinus augmentation with CGF and immediate implant placement is a viable treatment option for the atrophic posterior maxilla. However, further studies are required to validate the quantity of bone formation preferably using Computed Tomography (CT).

Comparison Of Marker-based And Stereo Radiography Knee Kinematics In Assessment Of Activities Of Daily Living

Marker-based motion capture is the established standard for the quantification of human movement. Yet, small relative joint rotations and translations are difficult to measure with these systems. Measurement using high speed stereo radiography (HSSR) allows for direct analysis of joint level motion with a high level of accuracy. PURPOSE: Compare knee kinematics measured with marker-based motion capture to kinematics acquired using HSSR and assess the ability of marker-based motion capture to accurately represent true knee kinematics. METHODS: Two healthy subjects (1M/1F, 171.4±3.6cm,78.7±1.0kg) were recruited to perform seated knee extension, step down, and 90° pivot. Stereo radiography and motion capture data were collected simultaneously for each subject. Bone tracking was performed in Autoscoper (Brown University, RI) to obtain the pose of each bone throughout each task. Tibiofemoral rotations and translations were calculated from the pose. For marker-based tracking, commercially available software was used to create a lower-extremity model based on rigid body segment tracking with a 6 degree of freedom (DOF) knee joint. Knee kinematics were compared by mean error reported with standard deviation and total excursion in each DOF. RESULTS: Flexion showed a mean error of 4.75°±3.31° and -8.10°±4.21° for the flexion task over a range of 125.0° and 124.1° for subjects 1 and 2 respectively. Internal rotation showed a mean error of 1.81°±3.42° and 1.79°±1.95° over a range of 21.2° and 18.1° for subjects 1 and 2 for the pivot task. Anterior-posterior showed a mean error of -9.54mm±10.61mm and -5.41mm±4.83mm over a range of 7.0mm and 10.6mm for subjects 1 and 2 for the flexion task. CONCLUSIONS: Few studies have compared knee kinematics recorded using both traditional motion capture and stereo radiography. Results show lowest errors in the rotational axes taking into consideration total excursion during the task for each DOF. Errors in translation often exceed the excursion in that DOF suggesting the inability of motion capture to accurately assess translational DOFs at the knee using rigid body tracking algorithms. Future work will consider 8 healthy subjects and help to further increase the impact of the results.

Importance of Axial Migration of Spinal Cord Stimulation Trial Leads with Position

Background: Spinal cord stimulation (SCS) is an established treatment option for chronic pain. Prior to permanent implantation, temporary trials are performed to evaluate the SCS treatment. During the trial period, it is common for the patients to experience changes in paresthesias. However, it is unclear what the role of lead migration is, if any, in the changes in paresthesia. Objective: To evaluate the role of lead migration on the effect of postural stimulation changes during SCS trials. Study Design: Case series. Setting: University pain management center. Methods: X-rays of the patients with successful trials, in sitting and standing position, were obtained at the end of a 7 day SCS trial. Data were collected based on the need for adjustment of the stimulation settings due to changes in paresthesias with postural change of sitting versus standing. Results: The average lead migration was 3.05 mm inferiorly from a standing to sitting position for all subjects. The average migration was 2.85 mm in subjects requiring adjustment of the SCS setting due to change in paresthesia compared to 3.24 mm for those who did not require adjustment regardless of position. The results were insignificant based on P = 0.17. Limitations: Small sample size, case series. Conclusions: This case series demonstrates continued support for the role of the width of the cerebral spinal fluid space as the significant factor on paresthesia changes in SCS with respect to postural changes, even during the trial period. Key words: Spinal cord stimulation, postural change, lead migration, paresthesia, neurostimulation, chronic pain, dorsal column

BMP-2 Adverse Reactions Treated With Human Dose Equivalent Dexamethasone in a Rodent Model of Soft-Tissue Inflammation

Basic science rodent model of bone morphogenetic protein-2 (BMP-2) soft-tissue inflammation. This study investigated the anti-inflammatory effect of human dose equivalent (HDE) dexamethasone (DM) for treatment of BMP-2-related soft-tissue inflammation in a rodent model and suggests an appropriate dose for utilization in the clinical practice of spine surgeons. BMP-2 is frequently used in spinal surgery to augment fusion. Yet, side effects of soft-tissue inflammation have been observed. DM decreases proinflammatory cytokine production and cellular immune response. However, the anti-inflammatory effects of HDE DM in a rodent model of BMP-2-associated soft-tissue inflammation have not been reported. Five, 10, and 15 mg of HDE DM were administered 3 times perioperatively to rodent cohorts receiving BMP-2 paraspinal implants and compared against BMP-2 only positive controls and phosphate buffer negative controls (n = 6 subjects per group). Histopathology, magnetic resonance imaging, and gross dissection were used as measures of cellular, edematous, and exudative inflammatory response. Serial killings were made on day 2 and day 7 postoperatively. Magnetic resonance imaging volume rendering demonstrated inflammatory edema decreased by 49% from 605.4 mm to 304.03 mm in subjects treated with 5, 10, or 15 mg of HDE DM (P < 0.05). Histopathological analysis demonstrated inflammatory cross-sectional area decreased 28.8% from 1.84 mm to 1.31 mm in subjects treated with 5, 10 or 15 mg of HDE DM (P < 0.05). Immune cellular infiltration depth decreased 38.5% from 0.26 mm to 0.16 in subjects treated with 15 mg of HDE DM (P < 0.05). Gross anatomical inflammatory exudates were prevented in 100% of subjects treated with 10 or 15 mg of HDE DM (P < 0.05). Low-dose DM administration is effective in controlling the cellular inflammation and edema resulting from BMP-2. Ten or 15 mg of DM might be considered by spine surgeons for controlling the inflammation and edema seen in spine surgery with BMP-2.

The effect of chemexfoliation and anti‐aging regiments on fibroblast expression of IGF‐1: A pilot Study

The normalized IGF-1 levels for subjects 1,2 and 3 at baseline were 0.85, 0.59 and 0.87 respectively. When looking at the antioxidant creams the effect of the weaker antioxidant cream regiment of Effulgere and Effulgere P.M. demonstrated a decrease in IGF-1 levels in subject 1 while that of subjects 2 and 3 were virtually unchanged. The stronger antioxidant cream, Effulgere ultra, showed a decrease in IG F-1 levels of subject 1 while demonstrating a significant increase of IGF-1 levels of subjects 2 and 3. (Tables 1,2 and 3) When looking at the post-auricular sites, medium depth chemexfoliation via Jessner’s and 35% TCA peel, showed significant decrease in IGF-1 levels for subjects 1 and 3 and a slight decrease in levels for subject 2. The deeper chemexfoliation utilizing Baker’s solution, showed significant decrease in subjects 1 and 3 while it demonstrated an increase in subject 2. (Tables 1,2 and 3) Profilometry When evaluating the profilometry results the median depth of the wrinkles impression on the silicone cast were evaluated. Evaluating the effects of weaker antioxidant cream showed in subject 1 the median depth changed from 0.52 mm to 0.80 mm while, in subject 2 it changed from 1.15 mm to 0.71 mm and in subject 3 it changed from 0.68 mm to 0.62 mm. Looking at the stronger antioxidant cream, the values in subject 1 changed from 0.57 mm to 0.77 mm, in subject 2 these values changed from 1.07 mm to 0.70 mm and in subject 3 this valued changed from 0.74 mm to 0.50 mm. The specimens from the areas treated with medium depth chemexfoliation method showed change from 0.50 mm to 135 μ m in subject 1, while in subject 2 it increased from 0.64 mm to 1.05 mm and in subject 3 it increased from 0.87 mm to 1.44 mm. The sites treated with deeper chemexfoliation method showed a change from 0.89 mm to 0.52 mm in subject 1, change from 0.47 mm to 0.91 mm in subject 2 and a change from 1.0 mm to 0.41 mm. (Figure 1)

Quantitative Computed Tomography Measures of Emphysema and Airway Wall Thickness Are Related to Respiratory Symptoms

There is limited knowledge about the relationship between respiratory symptoms and quantitative high-resolution computed tomography measures of emphysema and airway wall thickness. To describe the ability of these measures of emphysema and airway wall thickness to predict respiratory symptoms in subjects with and without chronic obstructive pulmonary disease (COPD). We included 463 subjects with chronic obstructive pulmonary disease (COPD) (65% men) and 488 subjects without COPD (53% men). All subjects were current or ex-smokers older than 40 years. They underwent spirometry and high-resolution computed tomography examination, and completed an American Thoracic Society questionnaire on respiratory symptoms. Median (25th percentile, 75th percentile) percent low-attenuation areas less than -950 Hounsfield units (%LAA) was 7.0 (2.2, 17.8) in subjects with COPD and 0.5 (0.2, 1.3) in subjects without COPD. Mean (SD) standardized airway wall thickness (AWT) at an internal perimeter of 10 mm (AWT-Pi10) was 4.94 (0.33) mm in subjects with COPD and 4.77 (0.29) in subjects without COPD. Both %LAA and AWT-Pi10 were independently and significantly related to the level of dyspnea among subjects with COPD, even after adjustments for percent predicted FEV(1). AWT-Pi10 was significantly related to cough and wheezing in subjects with COPD, and to wheezing in subjects without COPD. Odds ratios (95% confidence intervals) for increased dyspnea in subjects with COPD and in subjects without COPD were 1.9 (1.5-2.3) and 1.9 (0.6-6.6) per 10% increase in %LAA, and 1.07 (1.01-1.14) and 1.11 (0.99-1.24) per 0.1-mm increase in AWT-Pi10, respectively. Quantitative computed tomography assessment of the lung parenchyma and airways may be used to explain the presence of respiratory symptoms beyond the information offered by spirometry.

Motion of the Cerebellar Tonsils in the Foramen Magnum during the Cardiac Cycle

Tonsil motion was measured with cine MR imaging in patients clinically suspected of having Chiari I malformation. Cardiac-gated sagittal 2D fast imaging employing steady-state acquisition (2D FIESTA) was performed in 11 patients with a Chiari I malformation and in 6 subjects without tonsil ectopia. Tonsil motion was measured through the cardiac cycle with a pixel-shift program designed for that purpose. Tonsil displacements in patients with Chiari I and those with normal cerebellar tonsils were compared. In patients with Chiari I and subjects with normal cerebellar tonsils, 2D FIESTA showed small-amplitude tonsil movement in cephalad and caudad directions during the cardiac cycle. The average total magnitude of motion was 0.43 mm in subjects with normal tonsils (controls) and 0.57 mm in patients with Chiari malformations, 33% greater than that in controls. Tonsil motion was 0.61 mm in the patients with syringomyelia and 0.50 mm in those without it (22% difference).

Arterial structure and function in young adults with the metabolic syndrome: the Cardiovascular Risk in Young Finns Study

To study the relations between the metabolic syndrome (MS) and subclinical atherosclerosis in young adults. International Diabetes Federation (msIDF), National Institute of Health Adult Treatment Panel III (msNCEP), and European Group for the Study of Insulin Resistance (msEGIR) definitions of MS were related to carotid artery intima-media thickness (cIMT), brachial flow-mediated dilatation (FMD), and carotid artery compliance (CAC) in 2163 Finnish adults (aged 32 +/- 5years). All definitions associated with increased cIMT and decreased CAC in both sexes. The cIMT values (mean+/-SD) were 0.576 +/- 0.088 mm in subjects without the syndrome, 0.615 +/- 0.102 mm in msIDF, 0.617 +/- 0.104 mm in msNCEP, and 0.607 +/- 0.097 mm in msEGIR (P < 0.0001). Corresponding CAC values were 2.26 +/- 0.72, 1.76 +/- 0.66, 1.73 +/- 0.66, 1.72 +/- 0.66%/10 mmHg (P < 0.001). Impaired brachial FMD was not related to MS but it modified the relations between MS and cIMT: MS correlated with increased cIMT in subjects with an impaired FMD response (P = 0.003) but not in subjects with an enhanced FMD response (P = 0.75). All current definitions of MS identify a population of young adults with evidence of increased subclinical atherosclerosis. Impaired brachial endothelial response is not a hallmark of MS in young adults, but the status of endothelial function modifies the association between metabolic risk factors and atherosclerosis.

920 The cumulative effect of risk factors on endothelial dysfunction in patients with chest pain and normal coronary angiogram

body mass index (BMI) ((kg)/(m)2), fasting glucose, total, HDL, LDL cholesterol, triglycerides, clMT, cDIST (cDIST=((CCAsD-CCAdD)/PP)/CCAsD, where CCAsD and CCAdD were respectively systolic and diastolic common carotid artery diameters). Patients were classified according to a grading of valvular/annular lesions with independent scores based on acoustic densitomelry: 1= annular/valvular sclerosis/calcification absence; 2 = annular/valvular sclerosis; 3 = annular calcification; 4 = annular-valvular calcification; 5 = valvular calcification with no recognition el the leaflets. The resulting patient score was the highest observed. Results: Mean clMT increased linearly with increasing of valvular calcification score, ranging lrom 4.1 +.9.6 mm in controls to 13.8-{-1.3 mm in subjects with score 5 (p<0.0001). Mean cDIST showed decreasing values lrom score 1 to 5, ranging from 147.8+39.8 to 50.5+17.5 (p<0.0001 ). In lh e first to fourth quartile el clM T values, respective maximal percenlual of score were: score 1 77.4%, score 2 70.7</0, score 4 51.5% and score 5 71.1% (p<0.0001). Percentual values el score 1 were more represented in the first quartile el cDIST (46.7%), while score 5 were 59.4% in the fourth quartile (p<0.0001); the remnant two quarliles showed a lower but significant association respectively with score 2 (2nd quartile) and score 3 (3rd quartile). Conclusion: MAC-AVC presence and grading can be easily detected by transthoracic echocardiography Using MAC and AVC values we can idenlily subgroups el patients with different clMT and cDIST values wich indicate dilferent incidence and prevalence el systemic atherosclerolic disease.