Value In Male Patients Research Articles

Sex Differences and Utility of Treadmill Testing in Long-QT Syndrome.

Background Diagnosis of congenital long-QT syndrome (LQTS) is complicated by phenotypic ambiguity, with a frequent normal-to-borderline resting QT interval. A 3-step algorithm based on exercise response of the corrected QT interval (QTc) was previously developed to diagnose patients with LQTS and predict subtype. This study evaluated the 3-step algorithm in a population that is more representative of the general population with LQTS with milder phenotypes and establishes sex-specific cutoffs beyond the resting QTc. Methods and Results We identified 208 LQTS likely pathogenic or pathogenic KCNQ1 or KCNH2 variant carriers in the Canadian NLQTS (National Long-QT Syndrome) Registry and 215 unaffected controls from the HiRO (Hearts in Rhythm Organization) Registry. Exercise treadmill tests were analyzed across the 5 stages of the Bruce protocol. The predictive value of exercise ECG characteristics was analyzed using receiver operating characteristic curve analysis to identify optimal cutoff values. A total of 78% of male carriers and 74% of female carriers had a resting QTc value in the normal-to-borderline range. The 4-minute recovery QTc demonstrated the best predictive value for carrier status in both sexes, with better LQTS ascertainment in female patients (area under the curve, 0.90 versus 0.82), with greater sensitivity and specificity. The optimal cutoff value for the 4-minute recovery period was 440 milliseconds for male patients and 450 milliseconds for female patients. The 1-minute recovery QTc had the best predictive value in female patients for differentiating LQTS1 versus LQTS2 (area under the curve, 0.82), and the peak exercise QTc had a marginally better predictive value in male patients for subtype with (area under the curve, 0.71). The optimal cutoff value for the 1-minute recovery period was 435 milliseconds for male patients and 455 milliseconds for femal patients. Conclusions The 3-step QT exercise algorithm is a valid tool for the diagnosis of LQTS in a general population with more frequent ambiguity in phenotype. The algorithm is a simple and reliable method for the identification and prediction of the 2 major genotypes of LQTS.

Three-dimensional study of the orbit-related structures according to sex, age and skeletal deformities

Objective: This study aimed to evaluate the relations between orbit-related structures and sex, age and skeletal deformities using cone-beam computed tomography (CBCT). Methods: This retrospective study evaluated 216 consecutive CBCT scans of patients, who were divided according to: sex (male, n=105; female, n=111), age (A1: 18-32 years, n=71; A2: 33-47 years, n=78; A3: 48-62 years, n=67), and skeletal deformities (Class I, n=70; Class II, n=75; Class III, n=71). The supraorbital foramen (SOF) location, volume of orbit, optic canal (OC) and infraorbital canal (IOC) were evaluated. Results were analyzed using the Gamma model test. The Tukey-Kramer post-hoc test was used to compare the variables with three factors (p<0.05). Results: The IOC volume showed higher values for male, A3 and class I patients. The SOF location and the orbital volume also showed higher values for male patients. Regarding the volume of CO, it showed higher values ​​for male and class I patients. Conclusions: According to our results, sex has been shown to have a significant influence on orbit-related structures. Age and skeletal deformities also influenced the volume of IOC and OC. These results eventually help the clinical practice, being useful for orbital reconstruction surgeries, anthropological studies, gender identification and identification of susceptibility to pathological conditions related to sexual dimorphism.

Clinical characteristics of platelets and its possible gender dimorphism in patients with nonalcoholic fatty liver disease (NAFLD)

ABSTRACT Objective This study aimed to analyze the characteristics of platelet-associated parameters in nonalcoholic fatty liver disease (NAFLD) patients with varying degrees of disease severity and investigate the sexual dimorphism of platelet features in NAFLD patients. Methods A total of 829 NAFLD patients were divided into separate groups based on body mass index (BMI), liver stiffness measurement (LSM), controlled attenuation parameter (CAP), and alanine aminotransferase (ALT) levels. The platelet count (PC), mean platelet volume (MPV), and platelet distribution width (PDW) parameters were analyzed among different groups, and the sex-based differences were compared. Results The PC decreased with age in both sexes; in 30–59-year-old female subjects, the PC decreased by a conspicuous margin. The MPV increased with age in females, but not in males. The PDW increased significantly in females aged 30–59 years. With the increase in BMI and CAP, the PC showed a decreasing trend. The MPV increased with the increasing CAP value in male patients. With the increasing LSM value, the PC displayed a decreasing trend. Conclusion The PC showed marked sex-based differences in NAFLD patients and is affected by age and BMI. Regular changes of platelet parameters could be found in patients with varying degrees of NAFLD. These changes might be helpful in assessing the severity of NAFLD.

2314-PUB: The Uric Acid Is Differentiated by Thyroid Hormones Levels in Obese Patients with Acanthosis Nigricans

Purpose: To investigate the serum levels of uric acid (UA) in obese acanthosis nigricans (AN) patients with different thyroid hormones (THs) levels within the normal range. Methods: We investigated 834 obese patients (385 females and 449 males) with euthyroid function in the department of endocrinology of shanghai 10th people’s hospital from 2011 to 2019 with the median age of 29 years (interquartile range 22-36 years) for this study. 343 patients were diagnosed of AN. The cut-offs for thyroid-stimulating hormone (TSH), free triiodothyronine (FT3) and free thyroxine (FT4) were 2mIU/L, 16mIU/L and 5mIU/L, respectively. Results: In male obese patients, AN patients with high TSH and FT4 had higher levels of UA compared to those with high TSH and low FT4 (523.20±120.98 vs. 477.56±86.92umol/L, P=0.036) and showed a correlation with fasting C-peptide (FCP) (r=0.330, P=0.029). The TSH, FT3, and FT4 alone did not showed any predictive value in male patients. In female patients, high FT3 was associated with higher levels of UA (388.47±100.95 vs. 366.33±82.40umol/L, P=0.019). However, the predictive value of FT3 in female was obtained only in low TSH subgroup (low TSH+ high FT3 vs. low TSH+ low FT3, P=0.033) not in high TSH patients. The levels of fasting insulin, 2h-insulin, FCP, 2h C-peptide, total cholesterol, triglyceride and testosterone were in correlation with higher UA levels in female obese patients with low TSH and high FT3(all P<0.05). Conclusion: The metabolic characteristics of UA are found to differ in obese patients with euthyroid function, in which AN plays an important role for male obese patients with high TSH and high FT4. But in the case of female, a combination of THs instead of AN showed it’s unique in UA metabolism. Disclosure J. Zhang: None. G. Li: None. X. Cheng: None. X. Wang: None. M. Jayachandran: None. Y. Huang: None. S. Qu: None. Funding National Key Research and Development Program of China (2018YFC1314100); National Natural Science Foundation of China (81970677); Shanghai Pujiang Program (2019PJD040); Effect of ApoC3 High Expression on Islet Cells and Related Molecular Mechanism (03.05.18.002)

Model-based analysis of therapeutic efficacy of blonanserin and risperidone in schizophrenia patients and effects on prolactin: A randomized double-blind study.

This study examined randomized controlled trial data for blonanserin and risperidone in Chinese schizophrenia patients (N = 264). Data related to historical changes in the Positive and Negative Syndrome Scale (PANSS) were used to successfully construct a longitudinal Emax model. Results: (a) The efficacy of the two drugs was similar after week 8, showing a small difference in PANSS reduction. (b) Using the model, we predicted that each 5-point increase in the baseline FPOS (positive score in PANSS five-factor subscales) leads to a decrease in the PANSS total scores at week 8 for 2 points in patients administered blonanserin. (c) The effect of blonanserin on prolactin (PRL) elevation was less. The model was used to predict that prolactin elevations in patients administered risperidone were 2.41-fold of those in patients administered blonanserin. (d) Model quantitation showed that gender is a risk factor for prolactin elevation. Prolactin elevations in female patients were 2.95-fold of the value in male patients administered the same drug. The model demonstrated Blonanserin has similar antischizophrenic efficacy and less serum prolactin rising compared to risperidone in Chinese patients.

Mammographic screening in male patients at high risk for breast cancer: is it worth it?

To investigate the utility of mammography for breast cancer screening in a population of males at increased risk for breast cancer. In this HIPAA-compliant institutional review board-approved single-institution study, mammography records and clinical data of 827 male patients who underwent digital mammography from September 2011-July 2018 were analyzed via the electronic medical record. 664 of these men presented with masses, pain, or nipple discharge and were excluded from this study. The remaining 163 asymptomatic men with familial and/or personal history of breast cancer, or with a known germline mutation in BRCA, underwent screening mammography and were included in this analysis. 163 asymptomatic men (age: mean 63years, range 24-87years) underwent 806 screening mammograms. 125/163 (77%) had a personal history of breast cancer and 72/163 (44%) had a family history of breast cancer. 24/163 (15%) were known mutation carriers: 4/24 (17%) BRCA1 and 20/24 (83%) BRCA2. 792/806 (98%) of the screening mammograms were negative (BI-RADS 1 or 2); 10/806 (1.2%) were classified as BI-RADS 3, all of which were eventually downgraded to BI-RADS 2 on follow-up. 4/806 (0.4%) mammograms were abnormal (BI-RADS 4/5): all were malignant. The cancer detection rate in this cohort was 4.9 cancers/1000 examinations. In our cohort, screening mammography yielded a cancer detection rate of 4.9 cancers/1000 examinations which is like the detection rate of screening mammography in a population of women at average risk, indicating that screening mammography is of value in male patients at high risk for breast cancer.

Morphometric Study of Lower End Femur by Using Helical Computed Tomography.

Background:A mismatch between the prosthesis size and bone may result in a number of complications. Keeping this in view, it is essential to analyze the morphological differences of the knee observed across various ethnic groups to improve the performance of total knee arthroplasty (TKA). The current study was aimed at studying the computed tomography (CT) profile of distal femur in Indian population and evaluates it morphologically.Materials and Methods:This descriptive study was conducted on 62 patients presenting to the Department of Orthopedics in a tertiary care center in rural north-west India for features suggestive of osteoarthritis and trauma of knee from September 17, 2015 to September 16, 2016. Helical CT of both knees was done, and the data were analyzed using Statistical Package for Social Sciences Version 17.0 statistical significance was assessed with the help of t-test and the value of P < 0.05 was considered to be statistically significant.Results:The mean mediolateral (ML) value in male patients was 72.74 ± 4.45 while the mean ML value in female patients was lower (63.59 ± 2.61). The mean anteroposterior (AP) value in male patients was significantly (statistically) higher (49.62 ± 3.86) in comparison to mean AP value in female patients (45.11 ± 4.4). The mean anterior lateral condylar height (ALCH) value in male patients was higher (17.53 ± 2.72) in comparison to mean ALCH value in female patients (14.63 ± 3.42).Conclusions:The current study highlights the need to develop components and implants for use in TKA and fractures of distal femur keeping the age- and sex-specific anatomical features of people of different ethnic origins in view.

Incremental clinical value of ultrasound in men with mammographically confirmed gynecomastia

PurposeTo determine whether ultrasound is of any value in male patients presenting with focal symptoms who have classic features of gynecomastia but no concerning findings on mammography. Materials and MethodsOver a 3-year period, all male patients who underwent mammographic evaluation were identified in this retrospective study. Patients with a mammographic diagnosis of gynecomastia and subsequent breast ultrasound at a large tertiary academic medical center comprised the study cohort. Men whose ultrasound diagnosis differed from the initial mammographic evaluation were analyzed for both additional benign findings as well as findings that warranted biopsy. ResultsA total of 353 mammograms were obtained from 327 unique patients (ages 18–95, mean 51 years). Of all mammographic examinations, gynecomastia was the sole finding in 73% (259). In those 259 studies, 85% were further evaluated with ultrasound, in which 6 (2.7%) showed additional benign findings, and 4 (1.8%) showed suspicious findings for which biopsy was recommended. No malignancies were detected in those patients. Furthermore, no malignancies were detected in patients whose mammogram revealed only normal fatty parenchyma or only gynecomastia. In all cases of cancer, mammography revealed visible masses. ConclusionJudicious use of breast ultrasound in men improves outcome. Our data suggest that targeted ultrasound is of limited value in symptomatic male patients where mammography is negative or reveals only gynecomastia and leads to unnecessary benign biopsies in these patients. When mammography reveals concerning findings, ultrasound adds positively to clinical management.

Influence of age and hypertension on the association between small artery compliance and coronary artery disease

Small artery elasticity index (SAEI) as determined by a new non-invasive pulse-wave contour analysis has been used to identify abnormalities of the arterial wall associated with aging, hypertension (HT), endothelial dysfunction, and coronary artery disease (CAD). The present study examined the influence and interaction of CAD risk factors on the association between SAEI in risk-associated patients with CAD (case subjects, n = 178) and without CAD (control subjects, n = 202). Case subjects had a lower SAEI than control subjects, and age was consistently and negatively correlated with SAEI. The HT was related to reduced SAEI in female subjects overall and in male case subjects. In male patients with hypertension, the association between SAEI and CAD was significant (P < .05) after considering conventional risk factors of CAD. In conclusion, age and HT should be considered when using SAEI in the early diagnosis of CAD, and lower SAEI could be of greatest diagnostic value in male patients with HT.

Spinal trabecular bone mineral content in patients with non-steroid treated rheumatoid arthritis.

Spinal trabecular bone mineral content was measured in the first, second, and third lumbar vertebrae by quantitative computed tomography in 88 patients with non-steroid treated rheumatoid arthritis. Results were compared with those obtained in 105 healthy control subjects. The mean bone mineral content in the patient group, 135.8 (SD 32.8) mg/ml K2HOP4, was significantly lower than that in the controls (151.9 (32.1) mg/ml, p less than 0.01). Division of patients and controls into three age groups showed that the reduction in bone mineral content was most marked in the youngest age group (21-40 years), the mean value in male patients being significantly lower than in controls (149.6 (51.3) v 171.7 (23.9) mg/ml K2HPO4, p less than 0.05); in female patients in this age group the corresponding values were 160 (26.1) v 178.4 (22.0) mg/ml, 0.05 less than p less than 0.1). No significant difference in mean values between patients and controls was found in the other age groups. Of the 88 patients, six (7%) had abnormally low values, defined as a bone mineral content greater than 2 SD below the normal mean. One vertebral crush fracture was found in one patient but not in any of the controls. No correlation was found between bone mineral content and body weight, duration of disease, or disability as assessed by the London and Steinbroker methods. These results demonstrate a lower spinal trabecular bone mineral content in non-steroid treated patients with rheumatoid arthritis than in age and sex matched controls, the difference being most marked in younger patients. The finding of abnormally low values in 7% of the patients indicates a slightly increased prevalence of spinal osteoporosis in these patients.