Simulador radiográfico antropomórfico de mama humana

Mammography is a diagnostic imaging method in which interpretation depends on knowledge of radiological aspects as well as the clinical exam and pathophysiology of breast diseases. In this work a mammography phantom was developed to be used for training in the operation of mammographic x-ray equipment, image quality evaluation, self-examination and clinical examination of palpation. Polyurethane was used for the production of the phantoms for its physical and chemical properties and because it is one of the components normally used in prostheses. According to the range of flexibility of the polyurethane, it was possible to simulate breasts with higher or lower amount of adipose tissue. Pathologies such as areolar necrosis and tissue rejection due to surgery reconstruction after partial mastectomy were also simulated. Calcifications and nodules were simulated using the following materials: polyethylene, poly (methyl methacrylate), polyamide, polyurethane and poly (dimethyl silicone). Among these, polyethylene was able to simulate characteristics of calcification as well as breast nodules. The results from mammographic techniques used in this paper for the evaluation of the phantoms are in agreement with data found in the literature. The image analyses of four phantoms indicated significant similarities with the human skin texture and the female breast parenchyma. It was possible to detect in the radiographic images produced regions of high and low radiographic optical density, which are characteristic of breasts with regions of different amount of adipose tissue. The stiffnesses of breast phantoms were adjusted according to the formulation of the polyurethane which enabled the production of phantoms with distinct radiographic features and texture similar to human female breast parenchyma. Clinical palpation exam of the phantoms developed in this work indicated characteristics similar to human breast in skin texture, areolar region and parenchyma

Sensibilidad a la insulina mediante la prueba de tolerancia oral a la glucosa en adultos mayores en el cantón Cuenca, en el año 2015

INTRODUCCIÓN: Si se valora a tiempo la Sensibilidad a la insulina, se evitara padecer diabetes tipo 2; en los adultos mayores hay cambios como el aumento de tejido adiposo y sarcopenia, relacionados con disminución de la sensibilidad a la insulina. OBJETIVO: Determinar la sensibilidad a la insulina mediante la prueba de tolerancia oral a la glucosa en la población adulta mayor del cantón Cuenca, en el año 2015. METODOLOGÍA: Estudio descriptivo en 120 adultos mayores del cantón Cuenca; 60 casos con síndrome metabólico según el criterio ATP III y 60 casos sin síndrome metabólico. Se trata de una muestra no probabilística por conveniencia debido al costo de las pruebas de laboratorio. Se tomaron dos muestras de sangre una en ayunas y otra postprandial y se dosifico glucosa e insulina. Los datos fueron analizados en SPSS 22, Excel empleando frecuencias, porcentajes, medidas de tendencia central como mediana, promedio, medidas de dispersión, desvío stándar. RESULTADOS: El 39,2 % de adultos mayores presentó insulinemia postprandial alterada. Según el método HOMA-IR el 42 % presenta baja sensibilidad a la insulina y según el método QUICKI el 91,7 % presenta sensibilidad disminuida a la insulina. La baja sensibilidad a la insulina según género, edad y estado civil no fue significativa; en cambio con el IMC elevado se tiene más probabilidad de padecer insulinorresistencia (p=0,03) .Siendo más significativo los pacientes con síndrome metabólico aumenta dos veces la probabilidad de padecer insulinorresistencia (p=0.02, OR 2.3 IC 95% 1.09 – 4.85)

Sensibilidad a la insulina mediante la prueba de tolerancia oral a la glucosa en adultos mayores en el cantón Cuenca, en el año 2015

INTRODUCCIÓN: Si se valora a tiempo la Sensibilidad a la insulina, se evitara padecer diabetes tipo 2; en los adultos mayores hay cambios como el aumento de tejido adiposo y sarcopenia, relacionados con disminución de la sensibilidad a la insulina. OBJETIVO: Determinar la sensibilidad a la insulina mediante la prueba de tolerancia oral a la glucosa en la población adulta mayor del cantón Cuenca, en el año 2015. METODOLOGÍA: Estudio descriptivo en 120 adultos mayores del cantón Cuenca; 60 casos con síndrome metabólico según el criterio ATP III y 60 casos sin síndrome metabólico. Se trata de una muestra no probabilística por conveniencia debido al costo de las pruebas de laboratorio. Se tomaron dos muestras de sangre una en ayunas y otra postprandial y se dosifico glucosa e insulina. Los datos fueron analizados en SPSS 22, Excel empleando frecuencias, porcentajes, medidas de tendencia central como mediana, promedio, medidas de dispersión, desvío stándar. RESULTADOS: El 39,2 % de adultos mayores presentó insulinemia postprandial alterada. Según el método HOMA-IR el 42 % presenta baja sensibilidad a la insulina y según el método QUICKI el 91,7 % presenta sensibilidad disminuida a la insulina. La baja sensibilidad a la insulina según género, edad y estado civil no fue significativa; en cambio con el IMC elevado se tiene más probabilidad de padecer insulinorresistencia (p=0,03) .Siendo más significativo los pacientes con síndrome metabólico aumenta dos veces la probabilidad de padecer insulinorresistencia (p=0.02, OR 2.3 IC 95% 1.09 – 4.85).

Feasibility, design and conduct of a pragmatic randomized controlled trial to reduce overweight and obesity in children: the electronic games to aid motivation to exercise (eGAME) study

BACKGROUND: Childhood obesity has reached epidemic proportions in developed countries. Sedentary screen-based activities such as video gaming are thought to displace active behaviors and are independently associated with obesity. Active video games, where players physically interact with images onscreen, may have utility as a novel intervention to increase physical activity and improve body composition in children. The aim of the Electronic Games to Aid Motivation to Exercise (eGAME) study is to determine the effects of an active video game intervention over 6 months on: body mass index (BMI), percent body fat, waist circumference, cardio-respiratory fitness, and physical activity levels in overweight children.

METHODS/DESIGN: Three hundred and thirty participants aged 10-14 years will be randomized to receive either an active video game upgrade package or to a control group (no intervention).

DISCUSSION: An overview of the eGAME study is presented, providing an example of a large, pragmatic randomized controlled trial in a community setting. Reflection is offered on key issues encountered during the course of the study. In particular, investigation into the feasibility of the proposed intervention, as well as robust testing of proposed study procedures is a critical step prior to implementation of a large-scale trial.

The effect of sugar-free versus sugar-sweetened beverages on satiety, liking and wanting: an 18 month randomized double-blind trial in children

BACKGROUND: Substituting sugar-free for sugar-sweetened beverages reduces weight gain. A possible explanation is that sugar-containing and sugar-free beverages cause the same degree of satiety. However, this has not been tested in long-term trials.

METHODS: We randomized 203 children aged 7-11 years to receive 250 mL per day of an artificially sweetened sugar-free beverage or a similarly looking and tasting sugar-sweetened beverage. We measured satiety on a 5-point scale by questionnaire at 0, 6, 12 and 18 months. We calculated the change in satiety from before intake to 1 minute after intake and 15 minutes after intake. We then calculated the odds ratio that satiety increased by 1 point in the sugar-group versus the sugar-free group. We also investigated how much the children liked and wanted the beverages.

RESULTS: 146 children or 72% completed the study. We found no statistically significant difference in satiety between the sugar-free and sugar-sweetened group; the adjusted odds ratio for a 1 point increase in satiety in the sugar group versus the sugar-free group was 0.77 at 1 minute (95% confidence interval, 0.46 to 1.29), and 1.44 at 15 minutes after intake (95% CI, 0.86 to 2.40). The sugar-group liked and wanted their beverage slightly more than the sugar-free group, adjusted odds ratio 1.63 (95% CI 1.05 to 2.54) and 1.65 (95% CI 1.07 to 2.55), respectively.

CONCLUSIONS: Sugar-sweetened and sugar-free beverages produced similar satiety. Therefore when children are given sugar-free instead of sugar-containing drinks they might not make up the missing calories from other sources. This may explain our previous observation that children in the sugar-free group accumulated less body fat than those in the sugar group.

Fat mass- and obesity-associated genotype, dietary intakes and anthropometric measures in European adults: the Food4Me study

The interplay between the fat mass- and obesity-associated (FTO) gene variants and diet has been implicated in the development of obesity. The aim of the present analysis was to investigate associations between FTO genotype, dietary intakes and anthropometrics among European adults. Participants in the Food4Me randomised controlled trial were genotyped for FTO genotype (rs9939609) and their dietary intakes, and diet quality scores (Healthy Eating Index and PREDIMED-based Mediterranean diet score) were estimated from FFQ. Relationships between FTO genotype, diet and anthropometrics (weight, waist circumference (WC) and BMI) were evaluated at baseline. European adults with the FTO risk genotype had greater WC (AA v. TT: +1·4 cm; P=0·003) and BMI (+0·9 kg/m2; P=0·001) than individuals with no risk alleles. Subjects with the lowest fried food consumption and two copies of the FTO risk variant had on average 1·4 kg/m2 greater BMI (Ptrend=0·028) and 3·1 cm greater WC (Ptrend=0·045) compared with individuals with no copies of the risk allele and with the lowest fried food consumption. However, there was no evidence of interactions between FTO genotype and dietary intakes on BMI and WC, and thus further research is required to confirm or refute these findings.

Effects of resistance or aerobic exercise training on interleukin-6, C-reactive protein, and body composition

PURPOSE: To determine the effects of 10 wk of resistance or aerobic exercise training on interleukin-6 (IL-6) and C-reactive protein (CRP). Further, to determine pretraining and posttraining associations between alterations of IL-6 and CRP and alterations of total body fat mass (TB-FM), intra-abdominal fat mass (IA-FM), and total body lean mass (TB-LM). METHODS: A sample of 102 sedentary subjects were assigned to a resistance group (n = 35), an aerobic group (n = 41), or a control group (n = 26). Before and after intervention, subjects were involved in dual-energy x-ray absorptiometry, muscular strength and aerobic fitness, measurements and further provided a resting fasted venous blood sample for measures of IL-6, CRP, cholesterol profile, triglycerides, glucose, insulin, and glycosylated hemoglobin. The resistance and the aerobic groups completed a respective 10-wk supervised and periodized training program, whereas the control group maintained sedentary lifestyle and dietary patterns. RESULTS: Both exercise training programs did not reduce IL-6; however, the resistance and the aerobic groups reduced CRP by 32.8% (P < 0.05) and 16.1% (P = 0.06), respectively. At baseline, CRP was positively correlated with IL-6 (r = 0.35), (TB-FM) (r = 0.36), and IA-FM (r = 0.31) and was inversely correlated with aerobic fitness measures (all r values > or = -0.24). Compared with the resistance and the control groups, the aerobic group exhibited significant (P < 0.05) improvements in all aerobic fitness measures and significant reductions in IA-FM (7.4%) and body mass (1.1%). Compared with the aerobic and the control groups, the resistance group significantly (P < 0.05) improved TB-FM (3.7%) and upper (46.3%) and lower (56.6%) body strength. CONCLUSION: Despite no alteration in baseline IL-6 and significantly smaller reductions in measures of adipose tissue as compared with the aerobic training group, only resistance exercise training resulted in significant attenuation of CRP concentration.

The role of leptin and ghrelin in appetite regulation in the Australian Spinifex hopping mouse, Notomys alexis, during long-term water deprivation

Water deprivation of the Spinifex hopping mouse, Notomys alexis, induced a biphasic pattern of food intake with an initial hypophagia that was followed by an increased, and then sustained food intake. The mice lost approximately 20% of their body mass and there was a loss of white adipose tissue. Stomach ghrelin mRNA was significantly higher at day 2 of water deprivation but then returned to the same levels as water-replete (day 0) mice for the duration of the experiment. Plasma ghrelin was unaffected by water deprivation except at day 10 where it was significantly increased. Plasma leptin levels decreased at day 2 and day 5 of water deprivation, and then increased significantly by the end of the water deprivation period. Water deprivation caused a significant decrease in skeletal muscle leptin mRNA expression at days 2 and 5, but then it returned to day 0 levels by day 29. In the hypothalamus, water deprivation caused a significant up-regulation in both ghrelin and neuropeptide Y mRNA expression, respectively. In contrast, hypothalamic GHSR1a mRNA expression was significantly down-regulated. A significant increase in LepRb mRNA expression was observed at days 17 and 29 of water deprivation. This study demonstrated that the sustained food intake in N. alexis during water deprivation was uncoupled from peripheral appetite-regulating signals, and that the hypothalamus appears to play an important role in regulating food intake; this may contribute to the maintenance of fluid balance in the absence of free water.

Polycystic ovary syndrome as a proinflammatory state:the role of adipokines

Background: Polycystic Ovary Syndrome (PCOS) is a complex heterogeneous disorder and the most common endocrinopathy amongst women of reproductive age. It is characterized by androgen excess, chronic anovulation and an altered cardiometabolic profile. PCOS is linked to impaired adipose tissue (AT) physiology and women with this disorder present with greater risk for insulin resistance (IR), hyperinsulinemia, central adiposity, nonalcoholic fatty liver disease (NAFLD) and type 2 diabetes mellitus (T2DM) than matched for age and body mass index (BMI) women without PCOS. Hyperandrogenaemia appears to be driving adipocyte hypertrophy observed in PCOS under the influence of a hyperinsulinaemic state. Changes in the function of adipocytes have an impact on the secretion of adipokines, adipose tissue-derived proinflammatory factors promoting susceptibility to low grade inflammation. Methods: In this article, we review the existing knowledge on the interplay between hyperandrogenaemia, insulin resistance, impaired adipocyte biology, adipokines and chronic low-grade inflammation in PCOS. Results: In PCOS, more than one mechanisms have been suggested in the development of a chronic low-grade inflammation state with the most prevalent being that of a direct effect of the immune system on adipose tissue functions as previously reported in obese women without PCOS. Despite the lack of conclusive evidence regarding a direct mechanism linking hyperandrogenaemia to pro-inflammation in PCOS, there have been recent findings indicating that hyperandrogenaemia might be involved in chronic inflammation by exerting an effect on adipocytes morphology and attributes. Conclusion: Increasing evidence suggests that there is an important connection and interaction between proinflammatory pathways, hyperinsulinemia, androgen excess and adipose tissue hypertrophy and, dysfunction in PCOS. While lifestyle changes and individualized prescription of insulin-sensitizing drugs are common in managing PCOS, further studies are warranted to eventually identify an adipokine that could serve as an indirect marker of adipocyte dysfunction in PCOS, used as a reliable and pathognomic sign of metabolic alteration in this syndrome.

Gain de poids à l’âge adulte et densité mammaire

L’adiposité est un facteur de risque connu pour le cancer du sein et le gain de poids à l’âge adulte semble l’être également. Au niveau mammaire, le tissu adipeux peut être étudié au travers des mesures de densité. En effet, la zone non-dense reflète le gras mammaire et le pourcentage de densité, l’un des plus importants facteurs de risque pour le cancer du sein, reflète la proportion de tissu fibroglandulaire. Le premier objectif de ce mémoire était d’évaluer, chez 1435 femmes recrutées lors d’une mammographie de dépistage, l’association entre le gain de poids à l’âge adulte et trois paramètres de mesure de densité mammaire : le pourcentage de densité et les zones dense et non-dense en valeurs absolues. Le second objectif était de présenter un texte de synthèse et de discussion portant sur les interrelations entre l’adiposité, la densité mammaire et le risque de cancer du sein.