Pathological Values Research Articles

Comparison between caloric and video-head impulse tests in Ménière’s disease and vestibular neuritis

Objective To compare the diagnostic accuracies of air caloric testing with electronystagmography and the vHIT (video-head impulse test). Design Prospective, controlled study. Study sample MD (Ménière’s disease), 26; vestibular neuritis, 27; control, 56. Results In MD, CP (canal paresis) was pathological in 88.5%, the GA (gain asymmetry) on vHIT was pathological in 65.3%, and the gain was abnormal in only one patient. The GA and CP, were significantly higher in the MD group than in the control group, indicating hypofunction of the horizontal canals in MD, whereas a hyperfunction may also occur. No correlation was observed between the results of the two tests for evaluating MD, suggesting that pathological outcomes of one test do not guarantee abnormalities on the other test. For vestibular neuritis, significantly higher CP (96.3%), GA (81.5%), and gain (51.9%) values were detected. A correlation was identified between the two tests for vestibular neuritis, indicating a similar diagnostic efficiency. The higher percentage of pathological GA versus pathological gain values indicates that the asymmetry may be more informative. Conclusions The vHIT showed a higher specificity, whereas the caloric test a higher sensitivity. No correlation between the two methods was observed; therefore, the tests appear to provide complementary information.

Characteristics of blood pressure level in children with different body weight

BACKGROUND: Essential arterial hypertension (AH) develops more often in children with accompanying risk factors — obesity, overweight, positive heredity and genetic predisposition.AIM: Study of peculiarities of arterial hypertension clinical course in adolescents with normal body weight, overweight and obesity.MATERIALS AND METHODS: The study was conducted on children with arterial hypertension who received treatment in two hospitals in Voronezh in 2016–2020. A retrospective analysis of the children’s case histories was carried out taking into account the anamnesis, clinical laboratory and instrumental examination data and the pharmacotherapy. Some children underwent polymerase chain reaction genetic testing to determine pathological alleles of genes regulating blood pressure (BP).RESULTS: 96 patients aged 9 to 17 took part in the study. The group with normal body weight included 38 children (39.6%), median age 16.4 (aged 10.7; 17.9), with overweight — 33 people (34.4%), median age 15.2 (aged 12.0; 17.9), with obesity — 25 children (26.0%), median age 14.5 (aged 9.2; 17.9). Obese children developed arterial hypertension at earlier age (p = 0.023). According to blood pressure daily monitoring (BPDM), pathological values of systolic blood pressure (SBP) during the day (above the 95th percentile) among children with normal body weight were observed in 17 patients (44.7%), with excess body weight — in 14 people (42.4%), with obesity — in 16 people (64%), p = 0.031. Accurate difference values between the groups were obtained in terms of time index (TI) of SBP at night (p = 0.006). Time index of diastolic BP during the day > 50% was observed only in the obese children group — 4 people (16%) (p = 0.042). Pathological alleles of the angiotensinogen gene (AGT: 704 T>C), aldosterone synthase gene (CYP11B2: -344 C>T) and endothelial nitrogen synthase type 3 (NOS3: -786 T> C) were identified most frequently during genetic testing in some patients.CONCLUSION: Children with obesity developed earlier arterial hypertension compared to the same-age children with normal body weight and more often had unfavorable type of arterial hypertension according to BPDM. These results can be used to choose individual therapy and to develop special attention as regards certain target organs damage.

Idiopathic mast cell activation syndrome is more often suspected than diagnosed-A prospective real-life study.

Idiopathic mast cell activation syndrome (MCAS) is characterized by three diagnostic criteria: (1) episodic mast cell (MC)-driven signs/symptoms of at least two organ systems in the absence of clonal MC expansion and definite triggers, (2) episodic increase in tryptase, and (3) response to MC-targeted treatment. Many patients believe they have MCAS, but how often this is the case remains unknown. We prospectively investigated patients with suspected MCAS (n=100) for the diagnostic criteria including baseline tryptase, KIT D816V mutation, and patient-reported outcome measures (PROMs) over the course of 12weeks. Comorbid depression and anxiety were explored with the Hospital Anxiety and Depression Scale (HADS). In 53% of our patients (80% females), suspicion of MCAS was based on self-evaluation. In total, patients reported 87 different symptoms, mostly fatigue (n=57), musculoskeletal pain/weakness (n=49), and abdominal pain (n=43), with overall high disease activity and impact. Two of 79 patients had increased tryptase (by >20% +2ng/ml) following an episode. Only 5%, with any of the PROMs used, showed complete response to MC-targeted treatment. Depression and anxiety disorders were frequent comorbidities (n=23 each), and 65 patients had pathological HADS values, which were linked to high disease impact and poor symptom control. Mast cell activation syndrome was confirmed in only 2% of patients, which implies that it is not MC activation that drives signs and symptoms in most patients with suspected MCAS. There is a high need for comprehensive research efforts aimed at the identification of the true underlying pathomechanism(s) in patients with suspected MCAS.

Diagnostic Accuracy of the Five-Word Test for Mild Cognitive Impairment Due to Alzheimer's Disease.

New diagnostic methods have been developed for the early diagnosis of Alzheimer’s disease (AD) with the primary purpose of intercepting the transition-phase (mild cognitive impairment, MCI) between normal aging and dementia. We aimed to explore whether the five-word test (FWT) and the mini-mental state examination (MMSE) are predictive for the early diagnosis of MCI due to AD (AD-MCI). We computed ROC analyses to evaluate the sensitivity and specificity of MMSE and FWT in predicting abnormal CSF (t-Tau, p-Tau181, Aβ1–42) and amyloid-PET biomarkers. AD-MCI patients showed lower MMSE and FWT scores (all p < 0.001) than non-AD-MCI. The best predictor of amyloid plaques’ presence at amyloid-PET imaging was the encoding sub-score of the FWT (AUC = 0.84). Both FWT and MMSE had low/moderate accuracy for the detection of pathological CSF Aβ42, t-Tau and p-Tau181 values, with higher accuracy for the t-Tau/Aβ1–42 ratio. In conclusion, the FWT, as a single-domain cognitive screening test, seems to be prompt and moderately accurate tool for the identification of an underlying AD neuropathological process in patients with MCI, supporting the importance of associating biomarkers evaluation in the work-up of patients with dementing neurodegenerative disorders.

Homocysteine levels correlate with velocimetric parameters in patients with erectile dysfunction undergoing penile duplex ultrasound.

IntroductionHyperhomocysteinemia may contribute to the development of endothelial dysfunction and, consequently, atherosclerosis, a systemic disease involving the vessels that may affect the cavernous arteries leading to vasculogenic erectile dysfunction. Our study aims therefore to explore the relationship between homocysteine levels and velocimetric parameters detected by basal penile duplex ultrasound such as peak systolic velocity and flaccid penile acceleration in patients with erectile dysfunction.MethodsA cross‐sectional study was conducted collecting clinical, metabolic, hormonal, and instrumental (basal penile duplex ultrasound) data in patients affected by vasculogenic erectile dysfunction.ResultsData of 126 subjects affected by erectile dysfunction were collected. Mean age was 52.1 ± 12.6 years, whereas mean body mass index was 25.6 ± 4.0 kg/m2. Basal penile duplex ultrasound showed peak systolic velocity values of 13.1 ± 2.9 cm/s and mean flaccid penile acceleration of 2.28 ± 0.70 m/s2, with a strong correlation among these two parameters (r = 0.690; p < 0.001). Frankly pathological values of peak systolic velocity and flaccid penile acceleration were detected in 39.7% and 4.8% of the subjects examined, respectively. Mean homocysteine levels were 14.9 ± 9.5 μmol/l. Homocysteine values >15 μmol/l were found in 26% of the subjects with erectile dysfunction. Peak systolic velocity values and homocysteine levels showed an inverse correlation (r = –0.213; p = 0.03). Similarly, flaccid penile acceleration values were inversely correlated to homocysteine levels (r = –0.199; p = 0.05). In addition, an inverse correlation was found between both peak systolic velocity and flaccid penile acceleration and body mass index, atherogenic lipid pattern, and age. Homocysteine and metabolic parameters showed no significant correlations.ConclusionHyperhomocysteinemia is highly prevalent in erectile dysfunction patients. The results of our study show that homocysteine levels correlate with velocimetric parameters assessed by basal penile duplex ultrasound, confirming the role of hyperhomocysteinemia in the genesis of erectile dysfunction of arterial origin.

Association between post-reflux swallow-induced peristaltic wave index and esophageal mucosal integrity in patients with GERD symptoms.

Impedance-pH monitoring allows evaluation of esophageal chemical clearance, a response to reflux elicited by the esophago-salivary reflex, by means of the post-reflux swallow-induced peristaltic wave (PSPW) index; mucosal integrity can be evaluated by means of mean nocturnal baseline impedance (MNBI) and is regarded as a GERD marker. Currently, the relationship between PSPW index and MNBI has not yet been fully investigated and represents the aim of the present study. Impedance-pH tracings from consecutive patients were reviewed. ROC analysis and multivariate regression models were generated to evaluate the association between acid exposure time (AET), total refluxes (TRs), PSPW index, and MNBI. Patients were classified by means of AET thresholds and symptom-reflux association indexes into conclusive and inconclusive GERD, reflux hypersensitivity (RH), and functional heartburn (FH). Pathologic MNBI <2292 Ω was defined according to published outcome studies. Two hundred and thirty patients constituted the study cohort. Overall, a significant direct correlation was observed between PSPW index and MNBI (0.759, p<0.001). At ROC analysis, a PSPW index cut-off value of 53% was the best discriminator between normal from pathologic MNBI values (sensitivity 88%, specificity 86.4%). Considering AET cut-off of 4% or 6%, a sensitivity of 80.7% and 46% and a specificity of 62.5% and 93.2% were found, respectively. According to multivariate analysis, AET >4% and PSPW index value <53% or <61% were significantly associated with pathologic MNBI values. Esophageal chemical clearance is a major defense mechanism against reflux and its impairment represents a major determinant of reflux-associated mucosal damage.

Evaluation of MR-Tractography Findings in Hemifacial Spasm Patients Injected with Botulinum Neurotoxin.

Botulinum neurotoxin (BoNT) is a potent biological toxin extracted from Clostridium Botulinum bacteria. BoNT injection is mainly used for medical purposes; it is frequently used for cosmetic purposes as well. The hypothesis that frequent application of this treatment modality may also affect the central nervous system constitutes the subject of our study. We aimed to demonstrate the possible central effects of BoNT in hemifacial spasm patients. Diffusion tensor imaging was used for this study. Patients were divided into two groups, and the measured values for each determined bilateral neuroanatomic region were compared within the relevant group. Fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values were found to be closer to the pathological values in the right motor cortex and in the left internal capsule areas of the patients who were injected with BoNT into the left side, in the left motor cortex area of the patients who were injected with BoNT into the right side. No significant changes were detected in other regions. Botulinum neurotoxin administration in patients with hemifacial spasms may cause some changes in the central nervous system as well as peripheral effects. In the case of similar studies supporting pathological changes, BoNT treatment modalities or appropriate indications may be reviewed, and regulation on excessive cosmetic use may be in question.

Human study on cancer diagnostic probe (CDP) for real-time excising of breast positive cavity side margins based on tracing hypoxia glycolysis; checking diagnostic accuracy in non-neoadjuvant cases.

BackgroundCancer diagnostic probe (CDP) had been developed to detect involved breast cavity side margins in real‐time (Miripour et al. Bioeng Transl Med. e10236.). Here, we presented the results of the in vivo human model CDP studies on non‐neoadjuvant cases.MethodsThis study is a prospective, blind comparison to a gold standard, and the medical group recruited patients. CDP and frozen data were achieved before the permanent pathology experiment. The main outcome of the study is surgical margin status. From November 2018 to April 2020, 202 patients were registered, and 188 were assigned for the study. Breast‐conserving surgery at any age or gender, re‐surgery due to re‐currency, or involved margins are acceptable. Patients must be non‐neoadjuvant. The reliability of CDP scoring had been evaluated by the pathology of the scored IMs. Then, three models of the study were designed to compare CDP with the frozen sections. Receiver operating characteristic (ROC) curves and AUC were measured based on the permanent postoperative pathology gold standard.ResultsA matched clinical diagnostic categorization between the pathological results of the tested IMs and response peaks of CDP on 113 cases, was reported (sensitivity = 97%, specificity = 89.3%, accuracy = 92%, positive predictive value (PPV) = 84.2%, and negative predictive value (NPV) = 98%). Study A showed the independent ability of CDP for IM scoring (sensitivity = 80%, specificity = 90%, accuracy = 90%, PPV = 22.2%, and NPV = 99.2%). Study B showed the complementary role of CDP to cover the missed lesions of frozen sections (sensitivity = 93.8%, specificity = 91%, accuracy = 91%, PPV = 55.6%, and NPV = 99.2%). Study C showed the ability of CDP in helping the pathologist to reduce his/her frozen miss judgment (specificity = 92%, accuracy = 93%, PPV = 42.1%, and NPV = 100%). Results were reported based on the post‐surgical permanent pathology gold standard.ConclusionCDP scoring ability in intra‐operative margin detection was verified on non‐neoadjuvant breast cancer patients. Non‐invasive real‐time diagnosis of IMs with pathological values may make CDP a distinct tool with handheld equipment to increase the prognosis of breast cancer patients.

Indirect reference intervals using an R pipeline

BackgroundIndirect reference intervals require robust statistical approaches to separate the pathological and healthy values. This can be achieved with a data pipeline created in R, a freely available statistical programming language. MethodsA data pipeline was created to ingest, partition, normalize, remove outliers, and identify reference intervals for testosterone (Testo; n = 7,207) and aspartate aminotransferase (AST; n = 5,882) using data sets from NHANES. ResultsThe estimates for AST and Testo determined by this pipeline approximated current RIs. Care should be taken when using this pipeline as there are limitations that depend on the pathology of the analyte and the data set being used for RI estimation. ConclusionsR can be used to create a robust statistical reference interval pipeline.

About quantitative determination of the D-dimer in the blood by immunochromatographic method.

The paper presents the results of the development of a technology for the quantitative determination of D-dimer in blood with an immunochromatographic (LFIA) kit of reagents «LFIA-D-dimer» and instrument accounting of the results. Registration and processing of the digitized indicator of the intensity of staining of the LFIA-test strip using the LFIA-analyzer software allows quantifying the D-dimer content in the sample (in ng DDU/ml). The effectiveness of the proposed approach was evaluated on 258 clinical samples examined in the LFIA with visual and instrument accounting of the results, in comparison with the indicators of D-dimer determination in ELISA. The high reproducibility of the digitized LFIA results was shown - the coefficient of variation (CV) for samples in the range of 100-300 ng DDU/ml (near-threshold in relation to pathological values) was 2.5-5.1%; a tendency to increase CV with a further increase in the concentration of D-dimer was traced. A high correlation of the digitized LFIA result with the research data in the ELISA has been established, which makes it possible to recommend the technology for widespread use in urgent medicine.

Relationships between daily physical activity combinations and psychophysical health status of Italian breast cancer survivors

ABSTRACT In breast cancer survivors (BCS), the contemporaneous increase of sedentary time and reduction of physical activity (PA) requires early attention because it has negative consequences for their health. Aims of the study were to investigate: a) the correlations between PA, sedentarism, and health-related measures; b) the association between different patterns of daily activity and health-related outcomes. Two hundred and nineteen BCS (50.98 ± 6.28) were selected for this study. Psychological, anthropometric, endocrine, sleeping, and both daily sedentary time and PA variables were considered. Sedentarism and PA have opposite correlations with anthropometric variables, anxiety, depression, morning salivary cortisol, and sleeping characteristics. The first favors pathological values and the latter favors normal values. Regression tree analysis showed the impact of different daily sedentary time and PA combinations on the investigated variables and allowed the individualization of their optimal combination for health. Our results could be useful to healthcare providers and BCS.

Comparison of four indirect (data mining) approaches to derive within-subject biological variation.

Within-subject biological variation (CVi ) is a fundamental aspect of laboratory medicine, from interpretation of serial results, partitioning of reference intervals and setting analytical performance specifications. Four indirect (data mining) approaches in determination of CVi were directly compared. Paired serial laboratory results for 5,000 patients was simulated using four parameters, d the percentage difference in the means between the pathological and non-pathological populations, CVi the within-subject coefficient of variation for non-pathological values, f the fraction of pathological values, and e the relative increase in CVi of the pathological distribution. These parameters resulted in a total of 128 permutations. Performance of theExpected Mean Squares method (EMS), the median method, a result ratio method with Tukey's outlier exclusion method and a modified result ratio method with Tukey's outlier exclusion were compared. Within the 128 permutations examined in this study, the EMS method performed the best with 101/128 permutations falling within ±0.20 fractional error of the 'true' simulated CVi , followed by the result ratio method with Tukey's exclusion method for 78/128 permutations. The median method grossly under-estimated the CVi . The modified result ratio with Tukey's rule performed best overall with 114/128 permutations within allowable error. This simulation study demonstrates that with careful selection of the statistical approach the influence of outliers from pathological populations can be minimised, and it is possible to recover CVi values close to the 'true' underlying non-pathological population. This finding provides further evidence for use of routine laboratory databases in derivation of biological variation components.

Impact of CT-assessed changes in tumor size after neoadjuvant chemotherapy on pathological response and survival of patients with esophageal squamous cell carcinoma.

Neoadjuvant chemotherapy (NAC) followed by surgery is the standard treatment for advanced esophageal squamous cell carcinoma (ESCC) in Japan. Computed tomography (CT) is usually used to assess the therapeutic effect of NAC; however, there are no reliable criteria for predicting pathological response or patient prognosis. We included 84 patients who underwent esophagectomy between January 2009 and December 2018 and retrospectively reviewed their CT scans performed before and after NAC. The reduction rate of the largest tumor area (TA), long diameter (LD), and short diameter (SD) were measured on a transverse CT image. The pathological response and cutoff values were calculated using the receiver operating characteristic curve, and the most suitable ones for determining the effect were examined. The areas under the curve for predicting responders to NAC based on the reduction rate of the TA, LD, and SD were 0.755, 0.761, and 0.781, respectively. The optimal cutoff value of the SD reduction rate for predicting responders to NAC was 22%. An SD reduction ≥ 22% was an independent prognostic factor for overall survival in univariate (p = 0.005, hazard ratio [HR] = 2.755) and multivariate analyses (p = 0.030 HR 2.690). Furthermore, an SD reduction of ≥ 22% was also an independent prognostic factor for relapse-free survival in the univariate (p = 0.007, HR = 2.491) and multivariate analyses (p = 0.007, HR = 0.030). The reduction rate of the tumor SD is a simple predictor of pathological response and patient prognosis.

The Association of VEGF Expression with Degree of Differentiation and Lymphovascular Invasion in Colorectal Adenocarcinoma

BackgroundColorectal carcinoma is the third most common malignancy in the world. Colorectal carcinoma is a heterogeneous tumor withdifferent clinical pathologic features and prognostic values. For the same tumor-stage, patients could have difference prognosis andit has been suggested that the angiogenesis might be correlated with the prognosis, especially expression of vascular endothelialgrowth factor (VEGF) as the main pro-angiogenic factor. High VEGF expression in colorectal adenocarcinoma is associated withincreased blood vessels in invasive tumor area, cell proliferation and metastases. However, relation VEGF expression with thedegree of differentiation and lymphovascular invasion is not known.MethodsThis was a retrospective observational study with cross sectional approach. Samples were obtained from 39 paraffin blocks withdiagnosis adenocarcinoma not otherwise specific (NOS) in four Anatomical Pathology Laboratory in West Sumatera 2018 andevaluated for degree of differentiation and lymphovascular invasion. VEGF expressions in tumor cell were analyzed usingimmunohistochemistry staining. Bivariate statistical analysis used Fisher's Exact test and value p&lt;0.05 was considered significant.ResultsColorectal adenocarcinoma with high grade differentiation entirely had high VEGF expression (100%), while low gradedifferantiation with high VEGF expression was 60.7%. Lymphovascular invasion positive was mostly found with high VEGFexpression (80.6%). Statistical analysis showed significant association between VEGF expression with degree of differentiation(p=0.017) and lymphovascular invasion (p=0.028).ConclusionThe conclusion was VEGF expression had significant association with degree of differentiation and lymphovascular invasion ofcolorectal adenocarcinoma.

Prognostic Value of Preoperative Serum CA19-9 in Jaundiced Patients with Primary Resection of Pancreatic Head Adenocarcinoma – Analysis of the German StuDoQ/Pancreas Registry

Introduction: Pancreatic carcinoma patients with preoperative CA19-9 serum levels above 500U/ml are classified borderline resectable (BR-B). Up to date, the impact of jaundice on preoperative CA19-9 serum levels has remained unquantified in these patients. Methods: Data on oncologic pancreatic head resections (n=3.079) due to pancreatic carcinoma and prospectively acquired by the German Study, Documentation, and Quality (StuDoQ) registry were analyzed in relation to preoperative CA19-9 and bilirubin serum values. Preoperative CA19-9 values were corrected according to the results of a multivariable linear regression analysis of pathological parameters, bilirubin and CA19-9 values. The impact of CA19-9 adjustment on patient outcome was validated in a second patient cohort (n=345). Results: 420 (24.5%) out of 1703 PDAC patients presented with a preoperative CA19-9 > 500U/ml. While ROC-Analysis failed to determine exact CA19-9 cut-off values for prognostic indicators (R and N-Status), T-, N-, G-Status, UICC-stage and the number of simultaneous vein resections increased with the level of preoperative CA19-9, independent of concurrent jaundice. After adjustment of preoperative CA19-9 values, 18.5% of patients initially staged BR-B showed CA19-9 values below 500U/ml in the registry group. Overall and disease-free-survival of BR-B PDAC patients did not change after CA19-9 correction compared to the raw values (median 19 vs. 10, p<0.001 and 12 vs. 6 months, p<0.001). Conclusions: In this multicenter dataset of PDAC patients, elevation of preoperative CA19-9 correlates with well-defined prognostic pathological parameters. Moreover, this study provides a new CA19-9 correction formula to increase the prognostic value of preoperative CA19-9 serum values in jaundiced patients.

Determination of the tonographic effect in the human eye using a pneumatic pressure modulator

AbstractPurposeThe tonographic effect has been observed in several studies in occulopression, repeated tonometry or ophthalmodynamometry. It describes an intraocular pressure (IOP) decrease caused by an artifical IOP increase. In healthy eyes, an IOP drop of 2–3 mmHg/min was reported. However, there are studies that show a reduced decrease of the IOP drop for instance in glaucoma patients. In this work, we present a proof of principle to determine the tonographic effect in healthy eyes by utilizing a novel pneumatic pressure modulator.MethodsThe study was conducted on 8 healthy subjects (4 m, 4 f, 1 eye each, mean age 27.4 ± 7.1 yr). All subjects passed an ophthalmic examination procedure, including visual acuity determination, tonometry, objective refraction, slit lamp examination. Exclusion criteria were myopia &lt; ‐8 dpt, anamnestic surgeries, corneal scars, eye diseases, ocular hypertension, and ongoing ocular local therapy. No anaesthetics were used. A pressure modulator (IOPstim, Imedos Systems GmbH, Jena, Germany) was used to increase the IOP to initially pathologic IOP values of about 35 mmHg (36.6 ± 2.5 mmHg). The applied pressure was kept constant for 2 minutes. The IOP was measured 4 times (at 0s, 40s, 80s, and 120s) using a rebound tonometer (Icare PRO, Icare Finland Oy, Helsinki, Finland). Linear regression was performed to calculate the average IOP decrease within the 2‐minutes interval.ResultsFor all 8 subjects, a typical decrease of the IOP was observed during a 2 min constant pressure stimulation. The mean decrease of the pressure profiles was 2.77 mmHg/min (R2 = 0.94).ConclusionsWe successfully applied a pneumatic pressure modulator to determine the tonographic effect in the human eye. For 2 min we measured the mean decrease of the IOP drop with similar values known by the literature. Application of the pneumatic pressure modulator allows the investigation of pathological reduced IOP drops that differ from normal values as shown in this study.

Serum Creatinine versus Corrected Cockcroft-Gault Equation According to Poggio Reference Values in Patients with Arterial Hypertension

Introduction:Serum creatinine is not enough sensitive marker for the evaluation of glomerular filtration rate (GFR). Cockcroft-Gault (CG) formula is often used to assess GFR, but it is necessary to correct original one for body surface area (BSA), adipositas, and the creatinine tubular secretion. The values of the estimated creatinine clearance and GFR are considered to Poggio reference ones according to biological parameters (age and gender). The aim of the study was to determine the difference in renal function estimation between serum creatinine and corrected CG equation according to the Poggio reference values in the arterial hypertension patients.Materials and Methods:The research included 124 patients of both gender with arterial hypertension, excluding ones with the already verified chronic kidney disease. We estimated creatinine clearance and GFR by CG method corrected for the BSA, body mass index (BMI), and the creatinine tubular secretion according to Poggio reference values.Results:There was no significant difference in both age and gender groups among patients with physiological and pathological values of the renal function determined by the serum creatinine and estimated creatinine clearance by CG equation corrected for BMI, BSA. In both age and gender groups there was significant difference among subjects with physiological and pathological values of the renal function determined by serum creatinine and estimated GFR by CG method corrected for BMI, BSA, and creatinine tubular secretion.Conclusion:There is the most striking difference in the assessment of renal function between serum creatinine and estimated GFR by CG method with three corrections (BSA, BMI, the creatinine tubular secretion). Estimated GFR by CG method with three corrections can help in the early diagnosis of renal dysfunction and optimal treatment in patients with arterial hypertension.

Determination of optimal 68Ga-PSMA PET/CT imaging time in prostate cancers by total-body dynamic PET/CT.

68Ga-PSMA PET/CT has been widely used in patients with prostate cancer. Due to the limited axial field of view of conventional PET scanners, whole-body dynamic 68Ga-PSMA PET/CT has not been performed. We investigated the time-activity curves (TACs) of prostate cancer pathological lesions and physiologic bladder activity to determine the optimal 68Ga-PSMA PET/CT imaging time by total-body (TB) PET/CT. Dynamic TB-PET performed on 11 patients with prostate cancer was analyzed. TACs were obtained by drawing regions of interest in normal organs and pathological lesions (primary prostate lesions and lymph nodes and bone metastases). We evaluated the 68Ga-PSMA uptake pattern of normal organs, urinary bladder, and pathological lesions. The urinary bladder TAC increased slowly between 180 and 330s post-injection and then rapidly between 5.5 and 60.0min post-injection. The pathological lesion uptake increased rapidly during the first 5min post-injection and then slowly through the remaining 55min. Six minutes post-injection was the optimal time with the highest pathological lesion SUVmean values still higher than the urinary bladder activity value. However, these prostate lesion, lymph node metastasis, and bone metastasis SUVmean values were one-third, one-half, and one-half the corresponding values 60min post-injection, suggesting that early imaging might miss low PSMA uptake lesions. A minimum of 35min post-injection was required for the pathological lesions to have SUVmean values similar to the corresponding values at 60min post-injection (all P > 0.05), even though the pathological lesion SUVmean values showed a continuous upward trend through the 60min. Combining early dynamic 68Ga-PSMA PET (75-360s) and conventional static imaging 60min post-injection could avoid the urinary bladder activity interference to better detect pathological lesions and lesions with relatively low PSMA uptake. The pathological lesion SUVmean values at 35-59min and 60min post-injection were similar, so 68Ga-PSMA PET imaging could also be made at 35-59min post-injection.

Rapid renutrition improves health status in severely malnourished inpatients with AN - score-based evaluation of a high caloric refeeding protocol in severely malnourished inpatients with anorexia nervosa in an intermediate care unit.

ObjectiveRefeeding syndrome is a feared complication of refeeding patients with anorexia nervosa. There are now a number of controlled studies showing that refeeding with an initial high calorie count is more beneficial than cautious refeeding and is safe under continuous monitoring. However, there have yet not been studies in severe anorexia nervosa.MethodWe present an observational study in two different samples. The first sample consists of those 1075 out of a total of 3230 patients with anorexia nervosa treated in our hospital within 4 years for whom a complete admission laboratory was available and who had an age of at least 18 years at admission. A risk score was calculated from the number of pathological laboratory values out of 12 parameters indicating either refeeding syndrome or health hazards related to malnutrition. The second sample was obtained from a special ward for patients with eating disorders medically at‐risk. During the period in question, 410 patients with anorexia nervosa were treated there. 142 patients had a BMI of 13 or less and at the same time a complete data set with the mentioned 12 laboratory parameters at admission and weekly in the following 4 weeks after admission.ResultsThe risk represented by the laboratory parameters is significantly and negatively correlated to BMI and much higher for the group of patients with a BMI below 13 than for those with a higher BMI (χ 2 sig < 0.000). The 142 patients in the special care unit gain an average of more than 4.1 kg within 4 weeks on the high‐calorie diet. With this rapid weight gain, the risk score decreases highly significantly. Neither hypophosphatemia nor rhabdomyolysis is found under phosphate substitution. Hyperhydration occurred often, which manifests itself in the drop in haematocrit by the second week.DiscussionUnder thorough medical surveillance, supplementation of phosphate and thiamine, and substitution of electrolytes whenever necessary rapid renutrition appeared to be save even in extremely malnourished inpatients with anorexia nervosa. As measured by the laboratory values, the health status of the severely malnourished patients improves significantly on a high‐calorie diet. Except for hyperhydration, there was no evidence of a refeeding syndrome.

The natural history of alpha angle in the last seventeen centuries

Hip osteoarthritis is one of the most important and debilitating diseases affecting thousands of people all over the world. On the other hand, femoroacetabular impingement (FAI) is one of the known important causes of hip osteoarthritis. Cam deformity frequently presents in FAI showing an increased alpha angle. Increased alpha angle has been observed among young patients involved in demanding physical activities such as in sports (40-60%), whereas among the non-athletic population, increased alpha angle was observed in 15-20%. Although femoroacetabular pathology has been described over the recent years, it is not possible to determine when the angle increase actually begins prior to diagnosis. The aim of our study is to evaluate the femoral alpha angle in different human femurs in different civilization eras in West Mediterranean area. Available ancient femurs were selected from the Collection Center belonging to the archeological archives (ancient necropolis) from the fourth, fourteenth and eighteenth centuries. A comparison of the alpha angle was made of the measurements from the different groups accompanied by a sample of present-day femurs from the radiology database of CT scans. Data from 243 femoral bones were collected, 50 of which from the fourth century, 26 from the fourteenth century, 68 from the eighteenth century, and 99 femurs from the 20/twenty-first century. Alpha angles in all historical samples showed pathological values (> 55º) up to a maximum of 11.5% of the cases. Meanwhile, the actual series showed pathological alpha angle in 60.1% of the cases with statistical significant differences. The studied femurs of the western Mediterranean region from the fourth, fourteenth and eighteenth centuries showed pathological alpha angles in a smaller proportion than the actual sample. Level III, retrospective studies.