Slim Patients Research Articles

The impact of biomarkers of malignancy (IMWG SLiM criteria) in myeloma in a real-world population: Clinical characteristics, therapy and outcomes from the Australian and New Zealand Myeloma and Related Diseases Registry (ANZ MRDR).

A decade after International Myeloma Working Group (IMWG) biomarkers (SLiM criteria) were introduced, this real-world study examined their impact on diagnosis, therapy and outcomes in myeloma. Using the ANZ MRDR, 3489 newly diagnosed patients from 2013 to 2023, comprising 3232 diagnosed by CRAB ('CRAB patients', including 1758 who also satisfied ≥1 SLiM criteria) and 257 by SLiM ('SLiM patients') criteria were analysed. CRAB patients had higher R-ISS and lower performance status, with no difference in cytogenetic risk. SLiM patients had improved progression-free survival (PFS, 37.5 vs. 32.2 months, hazard ratio [HR] 1.31 [1.08-1.59], p = 0.003), overall survival (80.9 vs. 73.2 months, HR 1.64 [1.26-2.13], p < 0.001) and PFS2 (54.6 vs. 40.3 months, HR 1.51 [1.22-1.86], p < 0.001) compared with CRAB patients, partially explained by earlier diagnosis, with no differential impact between the plasma cell and light-chain criteria on PFS. However, 34% of CRAB patients did not manifest SLiM characteristics, raising the possibility that SLiM features are associated with different biological behaviours contributing to a better prognosis, for example, improved PFS2 in SLiM patients suggested less disease resistance at first relapse. These data support earlier initiation of therapy by SLiM. The superior survival outcomes of SLiM versus CRAB patients highlight the importance of defining these subgroups when interpreting therapeutic outcomes at induction and first relapse.

Elbowplasty: Arm Contouring in The Absence of Massive Weight Loss

Background : While there is significant discussion of brachioplasty and other arm contouring procedures after massive weight loss, there is a paucity of literature on upper extremity aesthetic surgeries of the average-weight patient. The limited distribution of excess tissue in this patient population presents a risk for over excision directly impacting elbow flexion. This case of skin excision for excess elbow soft tissue demonstrates improvement of aesthetic perception while minimizing tension and protecting function. Objectives : The authors report a case of arm contouring to address excess skin laxity at the elbow. Methods : With the patient upright, markings for elliptical incisions were made just superior to each olecranon in horizontal orientation. The excess elbow skin was incised to the subcutaneous fascia, the edges were undermined slightly, and the skin was then closed in two layers. Results: Improved arm contour while balancing the threat of hindering elbow flexion with the need to minimize excess skin of the elbow. Conclusions : The authors believe elbowplasty to have potential in future discussion of treatment options for slim patients with complaints of skin laxity.

Patient-specific Effective Dose Estimation from Dose-Length Product in Lung Computed Tomography Using Monte Carlo Simulation.

Computed tomography (CT) imaging has a large portion in the dose of patients from radiological procedures; therefore, accurate calculation of radiation risk estimation in this modality is inevitable. In this study, a method for determining the patient-specific effective dose using the dose-length product (DLP) index in lung CT scan using Monte Carlo (MC) simulation is introduced. EGSnrc/BEAMnrc MC code was used to simulate a CT scanner. The DOSxyznrc simulation code was used to simulate a specific voxelized phantom from the patient's lungs and irradiate it according to X-ray parameter of routing lung CT scan, and dose delivered to thorax organs was calculated. Three types of phantoms were simulated according to three different body habits (slim, standard, and fat patients) in two groups of men and women. A factor was used to convert the relative dose per particle in MC code to the absolute dose. The dose was calculated in all lung organs, and the effective dose was calculated for all three groups of patient body habits. DLP index and volume CT dose index (CTDIvol) were extracted from the patient's dose report in the CT scanner. The DLP to effective dose conversion factor (k-factor) for patients with different body habitus was calculated. Lung radiation dose in slim, standard, and fat patients in men was 0.164, 0.103, and 0.078 mGy/mAs and in women was 0.164, 0.105, and 0.079 mGy/mAs, respectively. The k-factor in the group of slim patients, especially in women, was higher than in other groups. CT scan dose indexes for slim patients are reported to be underestimated in studies. The dose report in CT scan systems should be modified in proportion to the patient's body habitus, to accurately estimate the radiation risk.

Polycystic Ovary Syndrome (PCOS): A Concerning Hormonal Condition and its Bodily Impact on Women

Polycystic Ovary Syndrome (PCOS) is a prevalent hormonal disorder that have severe health consequences for women. It arises in the early puberty stage and affects a large percentage of the world’s population. While the exact cause is unknown, it’s known to cause hyperandrogenism, insulin resistance, menstrual irregularities, and ovulatory dysfunction, all of which can lead to infertility and endometrial cancer. Long-term cardiometabolic risks and comorbidities are seen in both slim and obese PCOS patients. Given these serious implications, it’scritical to fully comprehend the pathophysiological relationships that underpin PCOS, so that better treatment plans can be developed and the standard of living for women having this condition may improve. This condition is diagnosed using three separate criteria. Rotterdam criterion is mostly utilized for PCOS diagnosis. Different symptoms of PCOS are treated in different ways. It’s imperative to comprehensively treat these patients as soon as possible in order to cope with the emotion burden associated with the disease that is often ignored. PCOScan be managed by early diagnosis and long-term treatment, allowing women to maintain a healthy lifestyle and avoiding long-term complications, including metabolic syndrome and cardiovascular diseases.

Lean metabolic syndrome is associated with similar long-term prognosis as metabolic syndrome in overweight/obese patients. Analysis 47,399 Patients from nationwide LIPIDOGRAM 2004–2015 cohort studies

Abstract Background Obesity was once though as an indispensable component of metabolic syndrome. Therefore, there a lot of definitions of metabolic syndrome with only few not including obesity as a criterion. The necessity of the obesity criterion in the metabolic health assessment is being questioned, as similar metabolic disturbances can occur in normal weight individuals. This relatively new concept is often referred as lean metabolic syndrome. Data on long term prognosis is scarce. Purpose To evaluate association between metabolic health and long-term prognosis. Methods Lipidogram studies were carried out in Poland in 2004, 2006 and 2015 in the population representative for patients in primary care setting. Patients were recruited in all 16 administrative regions in Poland and physicians were proportionally to the number of inhabitants in a given administrative region. Each patient was given a questionnaire on chronic diseases, treatment and lifestyle. Questionnaire was administered by physician. The diagnosis of metabolic syndrome was based on the presence of at least two of the following: 1) systolic blood pressure (SBP) ≥130 mmHg or diastolic blood pressure (DBP) ≥85 mmHg, 2) triglycerides (TG) &amp;gt;150 mg/dl, 3) high-density lipoprotein cholesterol (HDL-C) &amp;lt;40 mg/dl men and &amp;lt;50 mg/dl in women, 4) total cholesterol (TC) &amp;gt;200 mg/dl, and 5) fasting glucose (FBG) &amp;gt;100 mg/dl. Basing on those criteria and BMI with a cut off value of 25 kg/m2, patients were divided into four categories: healthy slim, metabolically healthy overweight/obese, lean metabolic syndrome and overweight/obese metabolic syndrome. The median follow up was 5570. this analysis data were censored at 3650 days. Results The median age of the study participants was 56.4 years. 7901 (16.7%) fell into category healthy slim, 14607 (30.8%) were classified as metabolically healthy overweight/obese, 3827 (8.1%) fulfilled criteria for lean metabolic syndrome whilst the remaining 21063 (44.4%) patients were diagnosed with overweight/obese metabolic syndrome. There were 4065 deaths during 10 years follow-up. Patients with lean metabolic syndrome had similar risk as patients with overweight/obese metabolic syndrome (HR=1.33, 95% CI: 1.17–1.52, p&amp;lt;0.001 and HR=1.32, 95% CI: 1.20–1.45, p&amp;lt;0.001). Metabolically heathy overweight/obese patients had only slightly higher risk of dying than healthy slim patients but this difference was less pronounced (HR=1.11, 95% CI: 1.08–1.23, p=0.03). Conclusions Lean metabolic syndrome confers similar risk as metabolic syndrome in overweigh/obese patients. Funding Acknowledgement Type of funding sources: Private company. Main funding source(s): The present study was funded by an unrestricted educational grant from Valeant. As a supporter of the study, Valeant played no role in the study design, data analysis, data interpretation, or writing of the report. The present study was also supported by Silesian Analytical Laboratories (SLA, Katowice, Poland).

CME: Can Slim People Have Type-2 Diabetes?

CME: Can Slim People Have Type-2 Diabetes? Abstract. Most patients with type-2 diabetes mellitus are obese or overweight. In slim patients with suspected type 2 diabetes mellitus the possibility of other types of diabetes must be considered. In addition to type-1 diabetes in adulthood and genetic forms of diabetes (MODY, mitochondrial diabetes), it could also be diabetes due to a disease of the exocrine pancreas, a condition which is generally underdiagnosed.

Short-term glucocorticoids reduce risk of chronic NSAID and analgesic use in early methotrexate-treated rheumatoid arthritis patients with favourable prognosis: subanalysis of the CareRA randomised controlled trial

ObjectiveTo explore non-steroidal anti-inflammatory drug (NSAID) and analgesic use in early rheumatoid arthritis (eRA) patients with a favourable risk profile initiating methotrexate (MTX) with or without glucocorticoid (GC) bridging.MethodsPatients with...

The PAP Flap Breast Reconstruction: A Practical Option for Slim Patients.

The posterior thigh-based profunda artery perforator (PAP) flap has been an emerging option as a secondary choice in breast reconstructions. However, whether a PAP flap could consistently serve as the secondary option in slim patients has not been investigated. Records of immediate unilateral breast reconstructions performed from May 2017 to June 2019 were reviewed. PAP flap breast reconstructions were compared with standard deep inferior epigastric perforator (DIEP) flap breast reconstructions, and were grouped into single or stacked PAP flaps for further analysis. Overall, 43 PAP flaps were performed to reconstruct 32 breasts. Eleven patients underwent stacked PAP flap reconstruction, while 17 patients underwent 21 single PAP flap reconstruction. The average body mass index (BMI) of the patients was 22.2 ± 0.5 kg/m2. The results were as follows: no total loss, one case of venous congestion (2.3%), two donor site wound dehiscence cases (4.7%), and one case of fat necrosis from partial flap loss (2.3%). When compared with 192 DIEP flap reconstructions, the final DIEP flap supplied 98.1 ± 1.7% of mastectomy weight, while the final PAP flap supplied 114.1 ± 6.2% of mastectomy weight (p < 0.005), demonstrating that PAP flaps can successfully supply final reconstruction volume. In a separate analysis, single PAP flaps successfully supplied 104.2% (84.2-144.4%) of mastectomy weights, while stacked PAP flaps supplied 103.7% (98.8-115.2%) of mastectomy weights. In our series of PAP flap reconstructions performed in low-to-normal BMI patients, we found that PAP flaps, as single or stacked flaps, provide sufficient volume to reconstruct mastectomy defects.

Error analysis of collimated and uncollimated SeHCAT retention measurement using a gamma camera.

There is increasing interest in using collimated gamma cameras for [75Se]tauroselcholic acid (SeHCAT) studies to image the distribution and to make use of the collimator pressure sensitive devices (PSD) for patient safety. However, the use of a collimator will substantially decrease the sensitivity of the gamma camera. The aim of this article is to enable departments to calculate the uncertainty of SeHCAT retention measurements so that the acquisition time can be optimised to perform a reliable SeHCAT study. We derive a mathematical equation from the first principles that can be used to calculate the uncertainty in SeHCAT retention measurements on the basis of Poisson counting statistics. The equation takes account of background subtraction, use of the geometric mean for anterior/posterior attenuation compensation and the day 7 to day 0 quotient calculation. Uncertainties in SeHCAT retention measurement using an intrinsic (uncollimated) gamma camera counting for 100 s are very low, typically of the order 15 ± 0.1%. Uncertainties from collimated gamma camera counting significantly increase for the same 100 s counting duration: 15 ± 0.8% for slim patients and 15 ± 4% for obese patients. The acquisition time must be increased for collimated gamma camera SeHCAT counting to achieve acceptable counting statistics for an acceptable total uncertainty in the SeHCAT retention measurement. For slim patients, a minimum counting time of 2 min is required. For larger patients, the acquisition time needs to be increased to 30 min and further increased to 50 min for obese patients.

Comparison of obese and non-obese patients in terms of sharp object injuries: A retrospective evaluation

Aim: In our study, we aimed to investigate the effect of BMI on surgical treatments and general outcomes, as well as on the severity of the injury caused by the sharp object. From an anatomical point of view, increased body mass index (BMI) is expected to have a protective effect in limiting organ damage in the case of sharp object injuries. Material and Methods: Data of the patients with penetrating abdominal injuries who applied to the emergency service of the University between January 2015 and January 2020 were analyzed retrospectively. Patients’ ages, genders, body mass indexes (BMIs), needs for surgical intervention, injury severity scores (ISS) and mortality were evaluated. Patients were divided into 2 groups: obese patients (BMI>30; Group1) and non-obese patients (BMI30; Group2). Results: Seventy-eight patients whose data were available were included in the study. Thirty-three of the patients were determined to be obese (Group1) while 45 were determined to be non-obese (Group2). The mean age of the patients in group1 was significantly higher than the patients in group 2 (p=0.011). The mean ISS of the patients in group 1 was 11.03±8.24 while it was 16.93±13.68 in group 2. The ISS was significantly higher in group2 (p=0.031). Alcohol intoxication levels of the patients in Group 2 were significantly higher than Group 1 (p=0.006). A statistically significant difference was not present between the groups in terms of number of past surgical interventions (p=0.627); however, it was determined that 57% of the surgical interventions in Group 1 were performed for diagnostic purposes and that no pathologies were detected in 45% thereof. Discussion: As a result, increased BMI is associated with lower injury severity scores and decreased need for operation in sharp object injuries. Slim patients are more likely to need surgery and be severely injured.

Physical parameters affecting the distribution of X-ray dose during hysterosalpingography

Objective: Hysterosalpingography (HSG) is based on the administration of a shading agent to the uterine cavity and fallopian tubes using a Schulze apparatus. An X-ray beam (X) is then directed at the abdominal area of the patient and diagnostic images are obtained for evaluation. The radiation beam and its mode of administration have a decisive influence on the radiation dose to which the patient is exposed. The aim of this study was to determine the physical parameters of this exposure in such a way that the dose distribution during the HSG examination was the most beneficial for the patient. Materials and Methods: Measurements to evaluate the effect of exposure parameters on the quality of radiological images obtained during HSG in slim and obese patients were made in 216 repetitions of the standard HSG test. Additional research data was obtained from measurements made in the X-ray laboratory at the Clinical Hospital. Results: The comparison of all measurements made for experimental models simulating a slim and obese patient demonstrated that the dose distribution most advantageous for the patient is obtained for pulsations of an X-ray tube for PPS = 6, regardless of the thickness of the patient. Conclusions: The image quality and size of the radiation dose received during the HSG examination depends on the individual characteristics of the patient. During the measurements performed in order to compare the exposure conditions set by the automatic exposure control (AEC) system and the resulting dose, this study demonstrated that the dose distribution most advantageous for the patients is obtained for pulsations on an X-ray tube for PPS = 6, regardless of the thickness of the patient.

Tissue-Dependent Co-Matching Method for Dual-Mode Antenna in Implantable Neurostimulators

A dual-mode antenna with cooperative matching (co-matching) was designed for implantable neurostimulators functioning within the Medical Implant Communications Service (MICS) band. In the proposed matching method, the first and third modes of a spiral monopole were appropriately designed and cooperatively matched for the patients with different body shapes. For obese patients, the neurostimulator was implanted in the fat layer (low permittivity), operating in the first mode. For slim patients, the neurostimulator was placed around the muscle tissue (high permittivity), operating in the third mode. Although there were different modes of operation in modified environments, the antenna was consistently well matched using a single lumped inductor to cover the desired band. The proposed matching strategy was validated by experiments, which followed the findings of our simulation data, exhibiting potential applications for implantable neurostimulators in different body types.

What is the Real Usefulness of Glycated Hemoglobin Levels for Diabetes Screening in Patients With Cystic Fibrosis?

What is the Real Usefulness of Glycated Hemoglobin Levels for Diabetes Screening in Patients With Cystic Fibrosis?

Application of dual-pedicle abdominal flap for unilateral breast reconstruction

To explore the effectiveness of dual-pedicle abdominal flap for unilateral breast reconstruction. Between March 2014 and March 2018, a clinical data of 19 female patients underwent dual-pedicle abdominal flap reconstruction because of unilateral mastectomy defect was reviewed retrospectively. The median age was 45 years (range, 32-51 years), including 3 immediate breast reconstruction and 16 delayed breast reconstruction, and left side in 7 cases and right side in 12 cases. Unilateral breast reconstruction were performed for 8 patients with unilateral pedicle transverse rectus abdominis musculocutaneous (TRAM) flap and contralateral free TRAM flap, for 3 patients with pedicle TRAM flap and contralateral deep inferior epigastric perforator (DIEP) flap, for 7 patients with bilateral DIEP flaps, for 1 patient with free muscle-sparing TRAM flap and contralateral DIEP flap. The size of abdominal flap ranged from 24 cm×7 cm to 43 cm×13 cm. The donor sites were closed directly. Vascular crisis ocuurred in 1 flap and relieved after surgical exploration. The other flaps survived. Poor wound healing in abdominal incision occurred in 1 patient and was successfully treated with debridement. The other donor sites healed without any other complication. The patients were followed up with a median period of 12 months (range, 4-42 months). Four patients received reparative operation of their reconstructive breast, and 2 patients received mamopexy of the contralateral breast due to mastoptosis. The abdominal BREAST-Q score was 84.1±11.7, chest score was 86.5±8.9, and breast score was 67.6±16.4 at last follow-up. The dual-pedicle abdominal flap for unilateral breast reconstruction provides adequate soft tissue volume and good blood supply. It is a reliable and effective breast reconstructive method for patients who need large tissue volume to make symmetric with the contralateral breast, or slim patients with few tissue in the donor site, or patients with scars in the donor site, especially vertical abdominal scars.

Application of Adaptive Statistical Iterative Reconstruction-V With Combination of 80 kV for Reducing Radiation Dose and Improving Image Quality in Renal Computed Tomography Angiography for Slim Patients

To explore the application of adaptive statistical iterative reconstruction-V (ASIR-V) with combination of 80 kV for reducing radiation dose and improving image quality in renal computed tomography angiography (CTA) for slim patients compared with traditional filtered back projection (FBP) reconstruction using 120 kV. Eighty patients for renal CTA were prospectively enrolled and randomly divided into group A and group B. Group A used 120 kV and 600 mgI/kg contrast agent and FBP reconstruction, while group B used 80 kV and 350 mgI/kg contrast agent and both FBP and ASIR-V reconstruction from 10%ASIR-V to 100%ASIR-V with 10%ASIR-V interval. The CT values and SD values of the right renal artery and left renal artery were measured to calculate the signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR). The image quality was subjectively scored by two experienced radiologists blindly using a five-point criterion. The contrast agent, volumetric CT dose index (CTDIvol), and dose length product in both groups were recorded and the effective radiation dose was calculated. There were no significant difference in patient characteristics between two groups (p > 0.05). The CTDIvol, dose length product and effective radiation dose in group B were 59.0%, 65.0%, and 65.1% lower than those in group A, respectively (all p < 0.05), and the contrast agent in group B was 42.2% lower than that in group A (p < 0.05). In group B, with the increase of ASIR-V percentage, CT values showed no significant difference, SD values decreased gradually, SNR values and CNR values increased gradually. The CT values showed no statistically significant difference (p > 0.05) between two groups with different reconstructions. The SD values with 40%ASIR-V to 100%ASIR-V reconstruction in group B was significantly lower(p < 0.5), while the SNR values with 50% ASIR-V to 100% ASIR-V reconstruction and CNR values with 70%ASIR-V to 100%ASIR-V were significantly higher than those of group A with FBP reconstruction (p < 0.5). Two radiologists had excellent consistency in subjective scores of image quality for renal CTA (kappa >0.75, p < 0.05). The subjective scores with 60% ASIR-V to 90% ASIR-V in group B were significantly higher than those of FBP in group A (p < 0.5), of which 70%ASIR-V reconstruction obtained the highest subjective score for renal CTA. ASIR-V with combination of 80 kV can significantly reduce effective radiation dose (about 65.1%) and contrast agent (about 42.2%) and improve image quality in renal CTA for slim patients compared with traditional FBP reconstruction using 120 kV, and the 70% ASIR-V was the best reconstruction algorithm in 80 kV renal CTA. Using 80 kV with combination of ASIR-V can significantly reduce radiation dose and contrast agent dose as well as improve image quality in renal CTA for thin patients when compared with FBP using 120 kV.

Weight analysis of mastectomy specimens and abdominal flaps used for breast reconstruction in Koreans.

BackgroundSlim patients or those with large breasts may be ineligible for breast reconstruction with an abdominal flap, as the volume of the flap may be insufficient. This study aimed to establish that abdominal tissue–based breast reconstruction can be well suited for Korean patients, despite their thin body habitus.MethodsA total of 252 patients who underwent postmastectomy breast reconstruction with an abdominal flap from October 2006 to May 2013 were retrospectively reviewed. The patients’ age and body mass index were analyzed, and a correlation analysis was performed between the weight of the mastectomy specimen and that of the initial abdominal flap.ResultsThe average weights of the mastectomy specimen and initial abdominal flap were 451.03 g and 644.95 g, respectively. The ratio of the weight of the mastectomy specimen to that of the initial flap was 0.71±0.23. There was a strong positive linear relationship between the weight of the mastectomy specimen and that of the initial flap (Pearson correlation coefficient, 0.728). Thirty nulliparous patients had a final-to-initial flap weight ratio of 0.66±0.11. The 25 patients who underwent a contralateral procedure had a ratio of 0.96±0.30. The adjusted ratio of the final flap weight to the initial flap weight was 0.66±0.12.ConclusionsBreast weight had a strong positive relationship with abdominal flap weight in Koreans. Abdominal flaps provided sufficient soft tissue for breast reconstruction in most Korean patients, including nulliparous patients. However, when the mastectomy weight is estimated to be >700 g, a contralateral reduction procedure may be considered.

Altered drug release from Orfiril® long following ethanol consumption - extent and consequences.

Orfiril® long is a widely used antiepileptic drug preparation despite being characterized by features associated with susceptibility to ethanol induced changes to drug release. In vitro dissolution studies revealed that 30 % ethanol was required in order to cause dose dumping of valproic acid within two hours at pH 1. However, after exposure to only 5 % of ethanol for 45 minutes at pH 1, the subsequent release of sodium valproate increased by ~ 10 % for the first two hours in ethanol-free media of pH 6.8. The drug solubility increases with pH, likely to also increase the vulnerability to ethanol. This indicates that Orfiril® long is affected by exposure to low concentrations of ethanol as well, only that this effect was exclusively displayed at an elevated pH value not part of the standard regulatory recommendations. Even so, simplified pharmacokinetic simulations revealed no risk of a lower therapeutic effect. Postponing the drug intake in case of moderate drinking, likely to increase the risk of omission altogether, is therefore not necessary. However, for slim patients with a small volume of distribution and low tolerability, a longer duration of mild side effects such as drowsiness and nausea might be experienced.

Double diabetes: the cardiovascular implications of combining type 1 with type 2 diabetes

Double diabetes: the cardiovascular implications of combining type 1 with type 2 diabetes

Invitro evaluation of a new iterative reconstruction algorithm for dose reduction in coronary artery calcium scoring.

BackgroundCoronary artery calcium (CAC) scoring is a widespread tool for cardiac risk assessment in asymptomatic patients and accompanying possible adverse effects, i.e. radiation exposure, should be as low as reasonably achievable.PurposeTo evaluate a new iterative reconstruction (IR) algorithm for dose reduction of in vitro coronary artery calcium scoring at different tube currents.Material and MethodsAn anthropomorphic calcium scoring phantom was scanned in different configurations simulating slim, average-sized, and large patients. A standard calcium scoring protocol was performed on a third-generation dual-source CT at 120 kVp tube voltage. Reference tube current was 80 mAs as standard and stepwise reduced to 60, 40, 20, and 10 mAs. Images were reconstructed with weighted filtered back projection (wFBP) and a new version of an established IR kernel at different strength levels. Calcifications were quantified calculating Agatston and volume scores. Subjective image quality was visualized with scans of an ex vivo human heart.ResultsIn general, Agatston and volume scores remained relatively stable between 80 and 40 mAs and increased at lower tube currents, particularly in the medium and large phantom. IR reduced this effect, as both Agatston and volume scores decreased with increasing levels of IR compared to wFBP (P < 0.001). Depending on selected parameters, radiation dose could be lowered by up to 86% in the large size phantom when selecting a reference tube current of 10 mAs with resulting Agatston levels close to the reference settings.ConclusionNew iterative reconstruction kernels may allow for reduction in tube current for established Agatston scoring protocols and consequently for substantial reduction in radiation exposure.

Ultrasound Proof of Pre-Reflux Stages of Venous Insufficiency

There are several attempts to explain the origin of venous insufficiency, like hereditary or acquired modifications of receptors and transmitters by wall extension or shear stress. With use of novel high-resolution ultrasound systems (12-40 MHz), valvular structures and low-flow microaggregates may be depicted. This study examined associations between the appearance of microaggregates, changes of valve cusps, valve function, and variations of vein flow (B-flow) in patients with different patterns of vein stress. There were 33 patients (21 women, 11 men; 32-58 years), including professions with >6 hours of sitting (n = 22) or standing (n = 12), with inconspicuous findings of the great saphenous vein (GSV) during routine ultrasonography (5-10 MHz) who underwent ultrasound examination with high-resolution systems (8-16 MHz, peak up to 40 MHz). A total of 120 well-depicted GSV vein valves were selected for this study. Criteria were shape, thickness, mobility, and closure mechanism of vein valves but in particular the appearance of microaggregates and the ability of the patients to resolve these aggregates by movements, simulating their daily life. Furthermore, the effects of newly worn medical compression stockings (class II) and additional daily walking distances (+3 miles) were investigated. The higher the resolution of the chosen ultrasound mode, the more intense is the appearance of low-flow pseudoaggregates, which is the basis for B-flow mode. The definition is that pseudoaggregates are always resolvable by flow increase. True microaggregates, characterized by failing dissolution or mobilization, were found within the sinus of 47 of 120 “healthy” vein valves (39.1%). Pathologic findings were more frequent in valves of subjects with sitting or standing professions (87/96; 90.6%). Focal thickenings of valve cusps could be detected only in slim patients (depth of GSV <2.5 cm; n = 11); all of them were associated with local microaggregates. Measurements after 4 weeks with medical compression stockings or increased daily walking distances did not detect relevant changes. The observations seem to support a thesis of inflammation-induced changes of vein valves; inflammation is generated by local accumulation of blood particles. Long periods with decreased or stagnant flow, typically in individuals with lack of movement or exercise, seem to promote the formation of such aggregates. However, to eliminate microaggregates or the underlying impaired venous flow, 4 weeks of medical compression stockings or walking exercise seem to be too short. As the study is continued, updates will be presented.