The prevalence and predictive value of dipstick urine protein in HIV-positive persons in Europe.

INTRODUCTION Proteinuria (PTU) is an important marker for the development and progression of renal disease, cardiovascular disease and death, but there is limited information about the prevalence and factors associated with confirmed PTU in predominantly white European HIV+ persons, especially in those with an estimated glomerular filtration rate (eGFR) of 60 mL/min/1.73 m(2). PATIENTS AND METHODS Baseline was defined as the first of two consecutive dipstick urine protein (DPU) measurements during prospective follow-up >1/6/2011 (when systematic data collection began). PTU was defined as two consecutive DUP >1+ (>30 mg/dL) >3 months apart; persons with eGFR <60 at either DPU measurement were excluded. Logistic regression investigated factors associated with PTU. RESULTS A total of 1,640 persons were included, participants were mainly white (n=1,517, 92.5%), male (n=1296, 79.0%) and men having sex with men (n=809; 49.3%). Median age at baseline was 45 (IQR 37-52 years), and CD4 was 570 (IQR 406-760/mm(3)). The median baseline date was 2/12 (IQR 11/11-6/12), and median eGFR was 99 (IQR 88-109 mL/min/1.73 m(2)). Sixty-nine persons had PTU (4.2%, 95% CI 3.2-4.7%). Persons with diabetes had increased odds of PTU, as were those with a prior non-AIDS (1) or AIDS event and those with prior exposure to indinavir. Among females, those with a normal eGFR (>90) and those with prior abacavir use had lower odds of PTU (Figure 1). CONCLUSIONS One in 25 persons with eGFR>60 had confirmed proteinuria at baseline. Factors associated with PTU were similar to those associated with CKD. The lack of association with antiretrovirals, particularly tenofovir, may be due to the cross-sectional design of this study, and additional follow-up is required to address progression to PTU in those without PTU at baseline. It may also suggest other markers are needed to capture the deteriorating renal function associated with antiretrovirals may be needed at higher eGFRs. Our findings suggest PTU is an early marker for impaired renal function.

The value of susceptibility-weighted imaging (SWI) in patients with non-neonatal hypoxic-ischemic encephalopathy

OBJECTIVE In susceptibility-weighted imaging (SWI) in the normal brain, cortical veins appear hypointense due to paramagnetic properties of deoxy-hemoglobin. Global cerebral anoxia decreases cerebral oxygen metabolism, thereby increasing oxy-hemoglobin levels in cerebral veins. We hypothesized that a lower cerebral oxygen extraction fraction in comatose patients with non-neonatal hypoxic ischemic encephalopathy (IHE) produce a pattern of global rarefied or pseudo-diminished cortical veins due to higher oxy-hemoglobin. PURPOSE 1. To investigate the topographic relationship between susceptibility effects in cortical veins and related diffusion restrictions on diffusion-weighted imaging (DWI) in patients with IHE. 2. To relate imaging findings to patterns of altered resting activity on surface EEG. METHODS Twenty-three IHE patients underwent MRI. EEG patterns were used to classify the depth of coma. Regional vs. global susceptibility changes on SWI and patterns of DWI restrictions were compared with the depth of coma. RESULTS All patients exhibited areas of restricted cortical diffusion and SWI abnormalities. The dominant DWI restrictions encompassed widespread areas along the precuneus, frontal and parietal association cortices and basal ganglia. For SWI, nineteen patients had generalized bi-hemispherical patterns, the EEG patterns correlated with coma grades III to V. Four patients had focal decreases of deoxy-hemoglobin following DWI restrictions; associated with normal EEGs. CONCLUSION Focal patterns of diamagnetic effects on SWI according to relative decreases in deoxy-hemoglobin due to reduced metabolic demand are associated with normal EEG in IHE patients. Global patterns indicated increased depth of coma and widespread cortical damage. CLINICAL RELEVANCE The results indicate a potential diagnostic value of SWI in patients with IHE.

Metastases in normal-sized pelvic lymph nodes: detection with diffusion-weighted MR imaging

PURPOSE To prospectively assess the diagnostic performance of diffusion-weighted (DW) magnetic resonance (MR) imaging in the detection of pelvic lymph node metastases in patients with prostate and/or bladder cancer staged as N0 with preoperative cross-sectional imaging. MATERIALS AND METHODS This study was approved by an independent ethics committee. Written informed consent was obtained from all patients. Patients with no enlarged lymph nodes on preoperative cross-sectional images who were scheduled for radical resection of the primary tumor and extended pelvic lymph node dissection were enrolled. All patients were examined with a 3-T MR unit, and examinations included conventional and DW MR imaging of the entire pelvis. Image analysis was performed by three independent readers blinded to any clinical information. Metastases were diagnosed on the basis of high signal intensity on high b value DW MR images and morphologic features (shape, border). Histopathologic examination served as the standard of reference. Sensitivity and specificity were calculated, and bias-corrected 95% confidence intervals (CIs) were obtained with the bootstrap method. The Fleiss and Cohen κ and median test were applied for statistical analyses. RESULTS A total of 4846 lymph nodes were resected in 120 patients. Eighty-eight lymph node metastases were found in 33 of 120 patients (27.5%). Short-axis diameter of these metastases was less than or equal to 3 mm in 68, more than 3 mm to 5 mm in 13, more than 5 mm to 8 mm in five; and more than 8 mm in two. On a per-patient level, the three readers correctly detected metastases in 26 (79%; 95% CI: 64%, 91%), 21 (64%; 95% CI: 45%, 79%), and 25 (76%; 95% CI: 60%, 90%) of the 33 patients with metastases, with respective specificities of 85% (95% CI: 78%, 92%), 79% (95% CI: 70%, 88%), and 84% (95% CI: 76%, 92%). Analyzed according to hemipelvis, lymph node metastases were detected with histopathologic examination in 44 of 240 pelvic sides (18%); the three readers correctly detected these on DW MR images in 26 (59%; 95% CI: 45%, 73%), 19 (43%; 95% CI: 27%, 57%), and 28 (64%; 95% CI: 47%, 78%) of the 44 cases. CONCLUSION DW MR imaging enables noninvasive detection of small lymph node metastases in normal-sized nodes in a substantial percentage of patients with prostate and bladder cancer diagnosed as N0 with conventional cross-sectional imaging techniques.

Incremental value of heart-type fatty acid-binding protein in suspected acute myocardial infarction early after symptom onset.

BACKGROUND The early diagnosis of acute myocardial infarction (AMI) very soon after symptom onset remains a major clinical challenge, even when using high-sensitivity cardiac troponin (hs-cTnT). METHODS AND RESULTS We investigated the incremental value of heart-type fatty acid-binding protein (hFABP) in a pre-specified subgroup analysis of patients presenting with suspected AMI within 1 h of symptom onset to the emergency department (ED) in a multicentre study. HFABP was measured in a blinded fashion. Two independent cardiologists using all available clinical information, including hs-cTnT, adjudicated the final diagnosis. Overall, 1411 patients were enrolled, of whom 105 patients presented within 1 h of symptom onset. Of these, 34 patients (32.4%) had AMI. The diagnostic accuracy as quantified by the area under the receiver-operating characteristics curve (AUC) of hFABP was high (0.84 (95% CI 0.74-0.94)). However, the additional use of hFABP only marginally increased the diagnostic accuracy of hs-cTnT (AUC 0.88 (95% CI 0.81-0.94) for hs-cTnT alone to 0.90 (95% CI 0.83-0.98) for the combination; p=ns). After the exclusion of 18 AMI patients with ST-segment elevation, similar results were obtained. Among the 16 AMI patients without ST-segment elevation, six had normal hs-cTnT at presentation. Of these, hFABP was elevated in two (33.3%) patients. CONCLUSIONS hFABP does not seem to significantly improve the early diagnostic accuracy of hs-cTnT in the important subgroup of patients with suspected AMI presenting to the ED very early after symptom onset.

Realización de un procedimiento para la medida del coeficiente de absorción sonora normal

El objetivo de este trabajo es la elaboración de un procedimiento para la medida del coeficiente de absorción sonora normal en un tubo de impedancia. Para ello se han estudiado los fundamentos básicos de la ecuación de ondas y sus soluciones. Se han considerado las soluciones pertinentes que describen el comportamiento de una onda sonora dentro de un tubo rígido. Se ha considerado también la teoría básica de funciones de transferencia. Estas teorías son claves a la hora de poder desarrollar el procedimiento de medida, ya que el coeficiente de absorción acústica se obtendrá con la ayuda de un tubo de impedancias que mide las funciones de transferencia entre dos posiciones de micrófonos incorporados en una de las caras del tubo. La utilización de esta técnica tiene como principal ventaja, la necesidad de poco espacio en un laboratorio y el empleo de muestras pequeñas de material. La implementación de los visto teóricamente a su aplicación práctica se ha hecho a través de un procedimiento de medida que sigue la Norma UNE-EN ISO 10534-2 (2002) “Determinación del coeficiente de absorción sonoro y la impedancia en tubos de impedancia Parte 2: método función de transferencia”. El valor del coeficiente de absorción se puede obtener a través de una instrumentación específica y un programa computador. Para poder validar los cálculos que realiza el programa utilizado, se ha realizado una batería de medidas del coeficiente de absorción a diferentes tipos de materiales acústicos, y los cálculos se han hecho por la vía del programa y por la vía de una hoja de cálculo. Como parte del procedimiento de medida se ha calculado la incertidumbre en las medidas. En definitiva se pretende contribuir con este trabajo a establecer un procedimiento de medida del comportamiento acústico de diversos materiales. SUMMARY. The aim of this work is the development of a procedure for measuring the sound absorption coefficient normal of an impedance tube. To this end we have studied the basics of the wave equation and its solutions. We have considered the relevant solutions that describe the behavior of a sound wave in a rigid tube. It has also considered the basic theory of transfer functions. These theories are key when we want to develop the measurement method, since the absorption coefficient is obtained with the aid of an impedance tube measuring transfer functions between two positions of microphones incorporated into one side of the tube. The use of this technique has the main advantage, the need of little space on a laboratory and use of small samples of material. The implementation of theoretically seen to his practical application has been made through a measurement procedure following the UNE-EN ISO 10534-2 (2002) "Determination of sound absorption coefficient and impedance in impedance tubes Part 2 : transfer function method ". The value of the absorption coefficient can be obtained through a specific instrumentation and computer software. In order to validate the calculations performed by the program used, there has been realized a series of measures of the absorption coefficient at different types of acoustical materials, and calculations were made by means of the program and by means of a spreadsheet. As part of the measurement procedure has been estimated uncertainty in the measurements. Ultimately it’s tried to contribute with this work to establish a procedure measuring the acoustic behavior of various materials.

Estudo cefalométrico-radiográfico individualizado do posicionamento da maxila em indivíduos com oclusão normal

O posicionamento da maxila no esqueleto craniofacial tem sido motivo de investigação por diversos autores ao longo do tempo. Traduzindo suas idéias por meio de medidas lineares ou angulares, tais autores definiram o que consideraram como a posição ideal , normal , ou aceitável da maxila, relacionando-a, na maioria das vezes, com a base do crânio. A partir da avaliação de indivíduos com oclusão considerada normal e com bom equilíbrio facial, eram calculados valores médios e desvios-padrão de determinadas medidas, os quais eram tomados como parâmetros para avaliações cefalométricas de pacientes distintos. Diante das divergências de opiniões encontradas na literatura, a proposta do presente estudo foi avaliar o posicionamento da maxila nos sentidos vertical, ântero-posterior e a sua inclinação, numa amostra de 94 indivíduos com oclusão normal. Foram determinadas correlações entre medidas do próprio indivíduo: OPI-N com OPI-ENA e N-ENA com ENA-ENP. A partir dos fortes índices de correlação encontrados, concluiu-se que a medida OPI-N pode ser tomada como referência para determinação de OPI-ENA, da mesma forma que ENA-ENP pode ser considerada para determinação de N-ENA, definindo respectivamente a posição da maxila nos sentidos sagital e vertical. A inclinação da maxila, representada aqui pelo ângulo OPI.ENA.ENP, teve valor médio estatisticamente próximo a 0o (zero), indicando forte tendência do prolongamento posterior do plano palatino (ENA-ENP) tangenciar a base posterior do crânio (ponto OPI), o que se revela uma importante característica de indivíduos com oclusão normal.

Estudo cefalométrico-radiográfico individualizado do posicionamento da maxila em indivíduos com oclusão normal

O posicionamento da maxila no esqueleto craniofacial tem sido motivo de investigação por diversos autores ao longo do tempo. Traduzindo suas idéias por meio de medidas lineares ou angulares, tais autores definiram o que consideraram como a posição ideal , normal , ou aceitável da maxila, relacionando-a, na maioria das vezes, com a base do crânio. A partir da avaliação de indivíduos com oclusão considerada normal e com bom equilíbrio facial, eram calculados valores médios e desvios-padrão de determinadas medidas, os quais eram tomados como parâmetros para avaliações cefalométricas de pacientes distintos. Diante das divergências de opiniões encontradas na literatura, a proposta do presente estudo foi avaliar o posicionamento da maxila nos sentidos vertical, ântero-posterior e a sua inclinação, numa amostra de 94 indivíduos com oclusão normal. Foram determinadas correlações entre medidas do próprio indivíduo: OPI-N com OPI-ENA e N-ENA com ENA-ENP. A partir dos fortes índices de correlação encontrados, concluiu-se que a medida OPI-N pode ser tomada como referência para determinação de OPI-ENA, da mesma forma que ENA-ENP pode ser considerada para determinação de N-ENA, definindo respectivamente a posição da maxila nos sentidos sagital e vertical. A inclinação da maxila, representada aqui pelo ângulo OPI.ENA.ENP, teve valor médio estatisticamente próximo a 0o (zero), indicando forte tendência do prolongamento posterior do plano palatino (ENA-ENP) tangenciar a base posterior do crânio (ponto OPI), o que se revela uma importante característica de indivíduos com oclusão normal.

Theory for normal and impaired experience-dependent plasticity in neocortex of adult rats

We model experience-dependent plasticity in the cortical representation of whiskers (the barrel cortex) in normal adult rats, and in adult rats that were prenatally exposed to alcohol. Prenatal exposure to alcohol (PAE) caused marked deficits in experience-dependent plasticity in a cortical barrel-column. Cortical plasticity was induced by trimming all whiskers on one side of the face except two. This manipulation produces high activity from the intact whiskers that contrasts with low activity from the cut whiskers while avoiding any nerve damage. By a computational model, we show that the evolution of neuronal responses in a single barrel-column after this sensory bias is consistent with the synaptic modifications that follow the rules of the Bienenstock, Cooper, and Munro (BCM) theory. The BCM theory postulates that a neuron possesses a moving synaptic modification threshold, θM, that dictates whether the neuron's activity at any given instant will lead to strengthening or weakening of its input synapses. The current value of θM changes proportionally to the square of the neuron's activity averaged over some recent past. In the model of alcohol impaired cortex, the effective θM has been set to a level unattainable by the depressed levels of cortical activity leading to “impaired” synaptic plasticity that is consistent with experimental findings. Based on experimental and computational results, we discuss how elevated θM may be related to (i) reduced levels of neurotransmitters modulating plasticity, (ii) abnormally low expression of N-methyl-d-aspartate receptors (NMDARs), and (iii) the membrane translocation of Ca2+/calmodulin-dependent protein kinase II (CaMKII) in adult rat cortex subjected to prenatal alcohol exposure.

Comparative analysis of the relationship between anterior and posterior corneal shape analyzed by Scheimpflug photography in normal and keratoconus eyes

Background To analyze and compare the relationship between anterior and posterior corneal shape evaluated by a tomographic system combining the Scheimpflug photography and Placido-disc in keratoconus and normal healthy eyes, as well as to evaluate its potential diagnostic value. Methods Comparative case series including a sample of 161 eyes of 161 subjects with ages ranging from 7 to 66 years and divided into two groups: normal group including 100 healthy eyes of 100 subjects, and keratoconus group including 61 keratoconus eyes of 61 patients. All eyes received a comprehensive ophthalmologic examination including an anterior segment analysis with the Sirius system (CSO). Antero-posterior ratios for corneal curvature (k ratio) and shape factor (p ratio) were calculated. Logistic regression analysis was used to evaluate if some antero–posterior ratios combined with other clinical parameters were predictors of the presence of keratoconus. Results No statistically significant differences between groups were found in the antero–posterior k ratios for 3-, 5- and 7-mm diameter corneal areas (p ≥ 0.09). The antero–posterior p ratio for 4.5- and 8-mm diameter corneal areas was significantly higher in the normal group than in the keratoconus group (p < 0.01). The k ratio for 3, 5, and 7 mm was significantly higher in the keratoconus grade IV subgroup than in the normal group (p < 0.01). Furthermore, significant differences were found in the p ratio between the normal group and the keratoconus grade II subgroup (p ≤ 0.01). Finally, the logistic regression analysis identified as significant independent predictors of the presence of keratoconus (p < 0.01) the 8-mm anterior shape factor, the anterior chamber depth, and the minimal corneal thickness. Conclusions The antero-posterior k and p ratios are parameters with poor prediction ability for keratoconus, in spite of the trend to the presence of more prolate posterior corneal surfaces compared to the anterior in keratoconus eyes.

Ischaemia and outcome with normal coronary arteries

This editorial refers to 'Long-term survival of patients with chest pain syndrome and angiographically normal or near-normal coronary arteries: the additional prognostic value of dipyridamole echocardiography test'dagger by R. Sicari et al., on page 2136.

A simple implementation of a normal mixture approach to differential gene expression in multiclass microarrays

Motivation: An important problem in microarray experiments is the detection of genes that are differentially expressed in a given number of classes. We provide a straightforward and easily implemented method for estimating the posterior probability that an individual gene is null. The problem can be expressed in a two-component mixture framework, using an empirical Bayes approach. Current methods of implementing this approach either have some limitations due to the minimal assumptions made or with more specific assumptions are computationally intensive. Results: By converting to a z-score the value of the test statistic used to test the significance of each gene, we propose a simple two-component normal mixture that models adequately the distribution of this score. The usefulness of our approach is demonstrated on three real datasets.

Cardiac syndrome X: relevance of arterial pressure waveform analysis to patients with chest pain and normal coronary arteries

We report the case study of a 68-year-old female with cardiac syndrome X presenting with abnormal pressure waveforms and a hypertensive response to exercise with ST-segment depression. After amlodipine treatment, pressure waveform morphology was significantly improved, exercise testing was normal and symptoms had resolved. This case emphasizes the potential clinical value of arterial waveform analysis.

Ultrasonic measurement technique of burning metals in normal and reduced gravity

The in situ real time measurement of the regression rate of a melting interface (RRMI) is performed by the ultrasonic measurement system reported here. The RRMI is the rate at which a solid/liquid interface (SLI) moves along a metallic rod while burning in an oxygen-enriched atmosphere and is an important flatnmability indicator. The ultrasonic transducer and associated equipment used to drive the transducer and record the echo signal is described, along with the process that transforms the acquired signals into a RRMI value. Test rods of various metals and geometric shapes were burned at several test conditions in different test facilities. The RRMI results with quantified errors are presented and reviewed. The effect of reduced gravity on burning metals is important to space-applications and RRMI results obtained in a reduced gravity environment are also presented.

Estudo cefalométrico-radiográfico individualizado do posicionamento da maxila em indivíduos com oclusão normal

O posicionamento da maxila no esqueleto craniofacial tem sido motivo de investigação por diversos autores ao longo do tempo. Traduzindo suas idéias por meio de medidas lineares ou angulares, tais autores definiram o que consideraram como a posição ideal , normal , ou aceitável da maxila, relacionando-a, na maioria das vezes, com a base do crânio. A partir da avaliação de indivíduos com oclusão considerada normal e com bom equilíbrio facial, eram calculados valores médios e desvios-padrão de determinadas medidas, os quais eram tomados como parâmetros para avaliações cefalométricas de pacientes distintos. Diante das divergências de opiniões encontradas na literatura, a proposta do presente estudo foi avaliar o posicionamento da maxila nos sentidos vertical, ântero-posterior e a sua inclinação, numa amostra de 94 indivíduos com oclusão normal. Foram determinadas correlações entre medidas do próprio indivíduo: OPI-N com OPI-ENA e N-ENA com ENA-ENP. A partir dos fortes índices de correlação encontrados, concluiu-se que a medida OPI-N pode ser tomada como referência para determinação de OPI-ENA, da mesma forma que ENA-ENP pode ser considerada para determinação de N-ENA, definindo respectivamente a posição da maxila nos sentidos sagital e vertical. A inclinação da maxila, representada aqui pelo ângulo OPI.ENA.ENP, teve valor médio estatisticamente próximo a 0o (zero), indicando forte tendência do prolongamento posterior do plano palatino (ENA-ENP) tangenciar a base posterior do crânio (ponto OPI), o que se revela uma importante característica de indivíduos com oclusão normal.