Spleen volume is independently associated with non-alcoholic fatty liver disease, liver volume and liver fibrosis

Non-alcoholic fatty liver disease (NAFLD) can lead to irreversible liver damage manifesting in systemic effects (e.g., elevated portal vein pressure and splenomegaly) with increased risk of deadly outcomes. However, the association of spleen volume with NAFLD and related type 2-diabetes (T2D) is not fully understood. The UK Biobank contains comprehensive health-data of 500,000 participants, including clinical data and MR images of >40,000 individuals. The present study estimated the spleen volume of 37,066 participants through automated deep learning-based image segmentation of neck-to-knee MR images. The aim was to investigate the associations of spleen volume with NAFLD, T2D and liver fibrosis, while adjusting for natural confounders. The recent redefinition and new designation of NAFLD to metabolic dysfunction-associated steatotic liver disease (MASLD), promoted by major organisations of studies on liver disease, was not employed as introduced after the conduct of this study. The results showed that spleen volume decreased with age, correlated positively with body size and was smaller in females compared to males. Larger spleens were observed in subjects with NAFLD and T2D compared to controls. Spleen volume was also positively and independently associated with liver fat fraction, liver volume and the fibrosis-4 score, with notable volumetric increases already at low liver fat fractions and volumes, but not independently associated with T2D. These results suggest a link between spleen volume and NAFLD already at an early stage of the disease, potentially due to initial rise in portal vein pressure.

Short-term effects of obesity surgery versus low-energy diet on body composition and tissue-specific glucose uptake: a randomised clinical study using whole-body integrated 18F-FDG-PET/MRI

AIMS/HYPOTHESIS

Obesity surgery (OS) and diet-induced weight loss rapidly improve insulin resistance. We aim to investigate the impact of either Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) surgery compared with a diet low in energy (low-calorie diet; LCD) on body composition, glucose control and insulin sensitivity, assessed both at the global and tissue-specific level in individuals with obesity but not diabetes.

METHODS

In this parallel group randomised controlled trial, patients on a waiting list for OS were randomised (no blinding, sealed envelopes) to either undergo surgery directly or undergo an LCD before surgery. At baseline and 4 weeks after surgery (n=15, 11 RYGB and 4 SG) or 4 weeks after the start of LCD (n=9), investigations were carried out, including an OGTT and hyperinsulinaemic-euglycaemic clamps during which concomitant simultaneous whole-body [18F]fluorodeoxyglucose-positron emission tomography (PET)/MRI was performed. The primary outcome was HOMA-IR change.

RESULTS

One month after bariatric surgery and initiation of LCD, both treatments induced similar reductions in body weight (mean ± SD: -7.7±1.4 kg and -7.4±2.2 kg, respectively), adipose tissue volume (7%) and liver fat content (2% units). HOMA-IR, a main endpoint, was significantly reduced following OS (-26.3% [95% CI -49.5, -3.0], p=0.009) and non-significantly following LCD (-20.9% [95% CI -58.2, 16.5). For both groups, there were similar reductions in triglycerides and LDL-cholesterol. Fasting plasma glucose and insulin were also significantly reduced only following OS. There was an increase in glucose AUC in response to an OGTT in the OS group (by 20%) but not in the LCD group. During hyperinsulinaemia, only the OS group showed a significantly increased PET-derived glucose uptake rate in skeletal muscle but a reduced uptake in the heart and abdominal adipose tissue. Both liver and brain glucose uptake rates were unchanged after surgery or LCD. Whole-body glucose disposal and endogenous glucose production were not significantly affected.

CONCLUSIONS/INTERPRETATION

The short-term metabolic effects seen 4 weeks after OS are not explained by loss of body fat alone. Thus OS, but not LCD, led to reductions in fasting plasma glucose and insulin resistance as well as to distinct changes in insulin-stimulated glucose fluxes to different tissues. Such effects may contribute to the prevention or reversal of type 2 diabetes following OS. Moreover, the full effects on whole-body insulin resistance and plasma glucose require a longer time than 4 weeks.

TRIAL REGISTRATION

ClinicalTrials.gov NCT02988011 FUNDING: This work was supported by AstraZeneca R&D, the Swedish Diabetes Foundation, the European Union's Horizon Europe Research project PAS GRAS, the European Commission via the Marie Sklodowska Curie Innovative Training Network TREATMENT, EXODIAB, the Family Ernfors Foundation, the P.O. Zetterling Foundation, Novo Nordisk Foundation, the Agnes and Mac Rudberg Foundation and the Uppsala University Hospital ALF grants.

Voxel-wise body composition analysis using image registration of a three-slice CT imaging protocol: methodology and proof-of-concept studies

BACKGROUND

Computed tomography (CT) is an imaging modality commonly used for studies of internal body structures and very useful for detailed studies of body composition. The aim of this study was to develop and evaluate a fully automatic image registration framework for inter-subject CT slice registration. The aim was also to use the results, in a set of proof-of-concept studies, for voxel-wise statistical body composition analysis (Imiomics) of correlations between imaging and non-imaging data.

METHODS

The current study utilized three single-slice CT images of the liver, abdomen, and thigh from two large cohort studies, SCAPIS and IGT. The image registration method developed and evaluated used both CT images together with image-derived tissue and organ segmentation masks. To evaluate the performance of the registration method, a set of baseline 3-single-slice CT images (from 2780 subjects including 8285 slices) from the SCAPIS and IGT cohorts were registered. Vector magnitude and intensity magnitude error indicating inverse consistency were used for evaluation. Image registration results were further used for voxel-wise analysis of associations between the CT images (as represented by tissue volume from Hounsfield unit and Jacobian determinant) and various explicit measurements of various tissues, fat depots, and organs collected in both cohort studies.

RESULTS

Our findings demonstrated that the key organs and anatomical structures were registered appropriately. The evaluation parameters of inverse consistency, such as vector magnitude and intensity magnitude error, were on average less than 3 mm and 50 Hounsfield units. The registration followed by Imiomics analysis enabled the examination of associations between various explicit measurements (liver, spleen, abdominal muscle, visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), thigh SAT, intermuscular adipose tissue (IMAT), and thigh muscle) and the voxel-wise image information.

CONCLUSION

The developed and evaluated framework allows accurate image registrations of the collected three single-slice CT images and enables detailed voxel-wise studies of associations between body composition and associated diseases and risk factors.

Application of PET/MRI in Gynecologic Malignancies

The diagnosis, treatment, and management of gynecologic malignancies benefit from both positron emission tomography/computed tomography (PET/CT) and MRI. PET/CT provides important information on the local extent of disease as well as diffuse metastatic involvement. MRI offers soft tissue delineation and loco-regional disease involvement. The combination of these two technologies is key in diagnosis, treatment planning, and evaluating treatment response in gynecological malignancies. This review aims to assess the performance of PET/MRI in gynecologic cancer patients and outlines the technical challenges and clinical advantages of PET/MR systems when specifically applied to gynecologic malignancies.

Improved automated tumor segmentation in whole-body 3D scans using multi-directional 2D projection-based priors

Early cancer detection, guided by whole-body imaging, is important for the overall survival and well-being of the patients. While various computer-assisted systems have been developed to expedite and enhance cancer diagnostics and longitudinal monitoring, the detection and segmentation of tumors, especially from whole-body scans, remain challenging. To address this, we propose a novel end-to-end automated framework that first generates a tumor probability distribution map (TPDM), incorporating prior information about the tumor characteristics (e.g. size, shape, location). Subsequently, the TPDM is integrated with a state-of-the-art 3D segmentation network along with the original PET/CT or PET/MR images. This aims to produce more meaningful tumor segmentation masks compared to using the baseline 3D segmentation network alone. The proposed method was evaluated on three independent cohorts (autoPET, CAR-T, cHL) of images containing different cancer forms, obtained with different imaging modalities, and acquisition parameters and lesions annotated by different experts. The evaluation demonstrated the superiority of our proposed method over the baseline model by significant margins in terms of Dice coefficient, and lesion-wise sensitivity and precision. Many of the extremely small tumor lesions (i.e. the most difficult to segment) were missed by the baseline model but detected by the proposed model without additional false positives, resulting in clinically more relevant assessments. On average, an improvement of 0.0251 (autoPET), 0.144 (CAR-T), and 0.0528 (cHL) in overall Dice was observed. In conclusion, the proposed TPDM-based approach can be integrated with any state-of-the-art 3D UNET with potentially more accurate and robust segmentation results.

Automatic segmentation of large-scale CT image datasets for detailed body composition analysis

BACKGROUND

Body composition (BC) is an important factor in determining the risk of type 2-diabetes and cardiovascular disease. Computed tomography (CT) is a useful imaging technique for studying BC, however manual segmentation of CT images is time-consuming and subjective. The purpose of this study is to develop and evaluate fully automated segmentation techniques applicable to a 3-slice CT imaging protocol, consisting of single slices at the level of the liver, abdomen, and thigh, allowing detailed analysis of numerous tissues and organs.

METHODS

The study used more than 4000 CT subjects acquired from the large-scale SCAPIS and IGT cohort to train and evaluate four convolutional neural network based architectures: ResUNET, UNET++, Ghost-UNET, and the proposed Ghost-UNET++. The segmentation techniques were developed and evaluated for automated segmentation of the liver, spleen, skeletal muscle, bone marrow, cortical bone, and various adipose tissue depots, including visceral (VAT), intraperitoneal (IPAT), retroperitoneal (RPAT), subcutaneous (SAT), deep (DSAT), and superficial SAT (SSAT), as well as intermuscular adipose tissue (IMAT). The models were trained and validated for each target using tenfold cross-validation and test sets.

RESULTS

The Dice scores on cross validation in SCAPIS were: ResUNET 0.964 (0.909-0.996), UNET++ 0.981 (0.927-0.996), Ghost-UNET 0.961 (0.904-0.991), and Ghost-UNET++ 0.968 (0.910-0.994). All four models showed relatively strong results, however UNET++ had the best performance overall. Ghost-UNET++ performed competitively compared to UNET++ and showed a more computationally efficient approach.

CONCLUSION

Fully automated segmentation techniques can be successfully applied to a 3-slice CT imaging protocol to analyze multiple tissues and organs related to BC. The overall best performance was achieved by UNET++, against which Ghost-UNET++ showed competitive results based on a more computationally efficient approach. The use of fully automated segmentation methods can reduce analysis time and provide objective results in large-scale studies of BC.

MO621AGE-RELATED PATTERNS OF KIDNEY PARENCHIMAL VOLUME IN T1D, T2D AND DIFFERENT TREATMENT GROUPS OF T2D: A CROSS-SECTIONAL STUDY OF 35,703 UK BIOBANK PARTICIPANTS

Background and Aims

Kidney parenchymal volume (KPV) presents a natural variation with respect to sex, age, and body size, and is also affected by diseases such as diabetes. The UK Biobank (UKBB) is a large-scale study including clinical and MRI data. The current project investigated the association between KPV and age in UKBB participants without diabetes and with diabetes type 1 (T1D), and type 2 (T2D). In addition, the effect of different treatments for T2D on KPV was investigated.

Method

KPV was estimated in 35,703 UKBB participants (52% women, age = 45-82 years) with a deep-learning-based segmentation of both kidneys (Dice = 0.956, error < 4%). The cohort was classified into Control, T1D and T2D subjects using an algorithm developed on UKBB clinical data (Eastwood et al 2016). Individuals with T2D were further divided into groups related to treatment: Lifestyle (no pharmaceuticals, i.e. light treatment, mean disease duration of 6.2 years), Metformin (metformin as the only pharmaceutical, i.e. intermediate treatment, mean disease duration of 8.3 years), and Other (more potent treatment, combination of pharmaceuticals, mean disease duration of 14.1 years). KPV was studied as a function of age in the different groups, divided according to sex. The statistical difference in mean KPV between groups was tested. For each group, the association between KPV and age was assessed by linear regression. Comparison of line slopes was conducted to investigate whether age-related patterns in KPV differed statistically between groups.

Results

The moving average curve of KPV vs age, in controls and subjects with T1D and T2D, is shown in Fig 1A (with a 15-year sliding window). The corresponding curve for different T2D treatment groups is depicted in Fig 1B. Fig 2A-D presents results for the comparison of KPV and regression line slope between the subject groups. According to Fig 1A and 2A, KPV is usually higher in subjects with T1D and T2D than in controls. As shown in Fig 1B and 2B, T2D subjects with longer disease duration and on pharmaceutical treatment (Metformin or Other) are generally more prone to large KPV than subjects with adapted lifestyle as treatment. The decreasing KPV pattern with age is faster in T2D subjects than controls but not significantly different between T1D subjects and controls (Fig 1A and 2C). Women in group Other also show a pattern of steeper age-related decline in KPV compared to remaining women with T2D treatment (Fig 1B and 2D).

Conclusion

Compared to controls, T1D subjects show enlarged KPV similar to that of T2D subjects, which is in line with previous literature. Subjects with T2D show a pattern of steeper age-related decline in KPV compared to controls. Female T2D subjects with longer disease duration, usually on a more potent treatment (beyond adaption of lifestyle and metformin as the only pharmaceutical), are more prone to enlarged KPV and exhibit a pattern of steeper age-related decline in KPV. This may be due to hyperfiltration caused by diabetes, resulting in increased kidney size. The normal loss of glomeruli with age could be accelerated by diabetes, leading to a greater loss in KPV per year in diabetics. Steeper KPV decline patterns in disease could also be caused by selection bias where old subjects with large KPV and related complications are less likely to participate in the study.

Brown adipose tissue estimated with the magnetic resonance imaging fat fraction is associated with glucose metabolism in adolescents

BACKGROUND

Despite therapeutic potential against obesity and diabetes, the associations of brown adipose tissue (BAT) with glucose metabolism in young humans are relatively unexplored.

OBJECTIVES

To investigate possible associations between magnetic resonance imaging (MRI) estimates of BAT and glucose metabolism, whilst considering sex, age, and adiposity, in adolescents with normal and overweight/obese phenotypes.

METHODS

In 143 subjects (10-20 years), MRI estimates of BAT were assessed as cervical-supraclavicular adipose tissue (sBAT) fat fraction (FF) and T2* from water-fat MRI. FF and T2* of neighbouring subcutaneous adipose tissue (SAT) were also assessed. Adiposity was estimated with a standardized body mass index, the waist-to-height ratio, and abdominal visceral and subcutaneous adipose tissue volumes. Glucose metabolism was represented by the 2h plasma glucose concentration, the Matsuda index, the homeostatic model assessment of insulin resistance, and the oral disposition index; obtained from oral glucose tolerance tests.

RESULTS

sBAT FF and T2* correlated positively with adiposity before and after adjustment for sex and age. sBAT FF, but not T2* , correlated with 2h glucose and Matsuda index, also after adjustment for sex, age, and adiposity. The association with 2h glucose persisted after additional adjustment for SAT FF.

CONCLUSIONS

The association between sBAT FF and 2h glucose, observed independently of sex, age, adiposity, and SAT FF, indicates a role for BAT in glucose metabolism, which potentially could influence the risk of developing diabetes. The lacking association with sBAT T2* might be due to FF being a superior biomarker for BAT and/or to methodological limitations in the T2* quantification.

Magnetic resonance imaging cooling-reheating protocol indicates decreased fat fraction via lipid consumption in suspected brown adipose tissue

Objectives

To evaluate whether a water-fat magnetic resonance imaging (MRI) cooling-reheating protocol could be used to detect changes in lipid content and perfusion in the main human brown adipose tissue (BAT) depot after a three-hour long mild cold exposure.

Materials and Methods

Nine volunteers were investigated with chemical-shift-encoded water-fat MRI at baseline, after a three-hour long cold exposure and after subsequent short reheating. Changes in fat fraction (FF) and R₂*, related to ambient temperature, were quantified within cervical-supraclavicular adipose tissue (considered as suspected BAT, denoted sBAT) after semi-automatic segmentation. In addition, FF and R₂* were quantified fully automatically in subcutaneous adipose tissue (not considered as suspected BAT, denoted SAT) for comparison. By assuming different time scales for the regulation of lipid turnover and perfusion in BAT, the changes were determined as resulting from either altered absolute fat content (lipid-related) or altered absolute water content (perfusion-related).

Results

sBAT-FF decreased after cold exposure (mean change in percentage points = -1.94 pp, P = 0.021) whereas no change was observed in SAT-FF (mean = 0.23 pp, P = 0.314). sBAT-R₂* tended to increase (mean = 0.65 s^-1, P = 0.051) and SAT-R₂* increased (mean = 0.40 s^-1, P = 0.038) after cold exposure. sBAT-FF remained decreased after reheating (mean = -1.92 pp, P = 0.008, compared to baseline) whereas SAT-FF decreased (mean = -0.79 pp, P = 0.008, compared to after cold exposure).

Conclusions

The sustained low sBAT-FF after reheating suggests lipid consumption, rather than altered perfusion, as the main cause to the decreased sBAT-FF. The results obtained demonstrate the use of the cooling-reheating protocol for detecting changes in the cervical-supraclavicular fat depot, being the main human brown adipose tissue depot, in terms of lipid content and perfusion.

Agreement between ambulance nurses and physicians in assessing stroke patients

OBJECTIVES

If an ambulance nurse could bypass the emergency department (ED) and bring suspected stroke patients directly to a CT scanner, time to thrombolysis could be shortened. This study evaluates the level of agreement between ambulance nurses and emergency physicians in assessing the need for a CT scan, and interventions and monitoring beforehand, in patients with suspected stroke and/or a lowered level of consciousness.

METHODS

From October 2008 to June 2009, we compared the ambulance nurses' and ED physicians' judgement of 200 patients with stroke symptoms. Both groups answered identical questions on patients' need for a CT scan, and interventions and monitoring beforehand.

RESULTS

There was poor agreement between ambulance nurses and ED physicians in judging the need for a CT scan: κ = 0.22 (95% confidence interval (CI), 0.06-0.37). The nurses' ability to select the same patients as the physician for a CT scan had a sensitivity of 84% (95% CI, 77-89) and a specificity of 37% (95% CI, 23-53). Agreement concerning the need for interventions and monitoring was also low: κ = 0.32 (95% CI, 0.18-0.47). In 18% of cases, the nurses considered interventions before a CT scan unnecessary when the physicians' deemed them necessary.

CONCLUSIONS

Additional tools to support ambulance nurses decisions appear to be required before suspected stroke patients can be taken directly to a CT scanner.

An individual-based modeling approach for evaluation of endpoint sensitivity in harpacticoid copepod life-cycle tests and optimization of test design

In the present study, an individual-based model for Nitocra spinipes was developed and used to optimize the test design of a proposed Organisation for Economic Co-operation and Development test guideline for harpacticoid copepods. The variability between individuals was taken into account, based on measured data, leading to stochastic model output. Virtual experiments were performed with the model to analyze the endpoint sensitivity and the effect of number of replicates and inspection intervals on statistical power. The impact of mortality was evaluated; most sublethal effects could not be determined if the mortality was ≥70%. Most sensitive to mortality was the determination of effects on brood size, for which the statistical power was reduced at 10% mortality. Our simulations show that increasing the number of replicates from 72 to 96 or 144 has little impact on the statistical power, whereas 25 replicates disallow relevant endpoint detection. Furthermore, it was demonstrated that the proposed 1D inspection interval can be shifted to a 3D interval, without losing statistical power. It was demonstrated that developmental endpoints have a higher statistical power than reproductive endpoints in the current test design. The present study highlights the usefulness of individual-based models for optimizing the experimental design. The use of such models in the development of standard test guidelines will lead to a faster and less resource-demanding process.

Characterization of additional sewage treatment technologies: ecotoxicological effects and levels of selected pharmaceuticals, hormones and endocrine disruptors

In the present study, two conventional (with and without sand filter) and four additional (moving bed biofilm reactor, ozone, moving bed biofilm reactor combined with ozone and a membrane bio reactor) treatment technologies were operated in small-scale at Hammarby Sjöstad sewage treatment plant, Stockholm, Sweden. The effluents were tested with five short-term (≤ 7 days exposure) ecotoxicological tests, and analyzed for a number of target analytes, comprising pharmaceuticals, natural hormones and industrial chemicals. Overall, the tested effluents generated few adverse effects at lower concentrations (< 50% sewage effluent), and no major differences were observed between any of the treatments. The effluent treated with the moving bed biofilm reactor resulted in the lowest effects in the ecotoxicological tests. The most efficient treatment technology with regard to the pharmaceutical residues was the ozone treatment, which however caused negative effects in some of the ecotoxicological tests.

Comparison of six sewage effluents treated with different treatment technologies--population level responses in the harpacticoid copepod Nitocra spinipes

Since conventional treatment technologies may fail in removing many micro-pollutants, there is currently a focus on the potential of additional treatment technologies for improved sewage treatment. The aim of the present study was to evaluate six different effluents from Henriksdal Sewage Treatment Plant in Stockholm, Sweden. The effluents were; conventionally treated effluent (chemical phosphorous removal in combination with an activated sludge process, including biological nitrogen removal and a sand filter), with additional treatments individually added to the conventional treatment; active carbon filtration, ozonation at 5 mg l(-1), ozonation at 15 mg l(-1), ozonation at 5 mg l(-1)+moving bed biofilm reactor and irradiation with ultraviolet radiation+hydrogen peroxide. The evaluation was done by characterizing and comparing the effluents using a Lefkovitch matrix model based on a life cycle test with the harpacticoid copepod Nitocra spinipes, combined with analysis of juvenile development and survival over time. The conventionally treated effluent resulted in the most negative effects, leading to the conclusion that all additional treatments in the present study created effluents with less negative impacts on the copepod populations. The ozone treatments with the low dose treatment in particular, resulted in the overall least negative effects. Moving bed biofilm reactor combined with ozone did not improve the quality of the effluent in the sense that slightly more negative effects on the population abundance were seen for this treatment technology compared to ozonation alone. The active carbon treatment had more negative effects than the ozone treatments, most of which could possibly be explained by removal of essential metal ions. The effluent which was treated with ultraviolet radiation+hydrogen peroxide resulted in few developmental and survival effects over time, but still showed negative effects on the population level. Matrix population modeling proved a useful tool for biologically characterizing and comparing the effluents. Basing the assessment either on the individual level data (development and survival over time or total reproductive output) or the population level data (lambda values and projected population abundances) would not have resulted in the same conclusions as combining both analyses. The juvenile development and survival over time allowed for closer monitoring of the important molting process, whereas the population modeling provided an integrated measure of potential effects at the population level. If the dilution of the effluent in the recipient is considered, the biological effects recorded in the present study were not of substantial significance for the copepod populations, regardless of treatment technology.

Testosterone addition during menopausal hormone therapy: effects on mammographic breast density

OBJECTIVE

To study the effect on mammographic breast density of testosterone addition during combined estrogen/progestogen therapy in postmenopausal women.

METHODS

A prospective, randomized, double-blind, placebo-controlled trial. A total of 99 women were given 2 mg 17beta-estradiol and 1 mg norethisterone acetate in combination with either a testosterone patch (300 mug/24 h) or a placebo patch. Mammographic breast density at baseline and after 6 months was assessed by visual classification scales and by digitized quantification. A standardized questionnaire was used to quantify subjective breast symptoms.

RESULTS

Visual classifications showed an increase in mammographic density in 18-30% of the women, with no significant differences between the treatment groups. The mean increase of the area of dense breast during treatment according to digitized assessment was 7.4% in the placebo group and 5.4% in the testosterone group. Breast symptoms showed a positive association with the increase in density (r(s) = 0.34; p < 0.01). Symptoms were most pronounced at 2 months of treatment. Density, both at baseline (r(s) = -0.35; p < 0.01) and change during treatment (r(s) = -0.28; p < 0.01) showed a negative association with free testosterone levels.

CONCLUSION

The addition of testosterone does not appear to influence mammographic breast density in women concurrently treated with a common oral estrogen/progestogen regimen for a period of 6 months.

Expression of syndecan-1 in histologically normal breast tissue from postmenopausal women with breast cancer according to mammographic density

OBJECTIVE

To analyze the expression of Syndecan-1 in dense and non-dense human breast tissue.

METHODS

Specimens of histologically normal tissue were obtained from postmenopausal women undergoing surgery for breast cancer. Each tissue block was subject to radiological examination and pair-wise samples of dense and non-dense tissue were collected. Semi-quantitative assessment of immunohistochemical staining intensity for Syndecan-1 and estrogen receptor subtypes was performed.

RESULTS

The expression of Syndecan-1 in all tissue compartments was significantly higher in dense than in non-dense specimens. The strongest staining was recorded in stromal tissue. There was a strong correlation between epithelial estrogen receptor alpha and stromal cell Syndecan-1 expression in dense tissue (rs = 0.7; p = 0.02). This association was absent in non-dense tissue.

CONCLUSION

An increase of Syndecan-1 in all tissue compartments and a redistribution from epithelium to stroma may be a characteristic feature for dense breast tissue.

Neutral effect of ultra-low-dose continuous combined estradiol and norethisterone acetate on mammographic breast density

OBJECTIVE

To compare the effects of two different ultra-low doses of continuous combined hormone therapy and placebo on mammographic breast density in postmenopausal women.

METHODS

A subpopulation of 255 postmenopausal women from the CHOICE trial were randomly assigned to 0.5 mg 17beta-estradiol (E2) + 0.25 mg norethisterone acetate (NETA), 0.5 mg E2 + 0.1 mg NETA, or placebo. Women using hormone replacement therapy (HRT) up to 2 months prior to the study were excluded; 154 women fulfilled the inclusion criteria. Mammograms were performed at baseline and after 6 months. Breast density was evaluated by visual classification scales and a computer-assisted digitized technique.

RESULTS

No significant differences were detected between the active treatment groups and the placebo group in the digitized quantification. The mean baseline values for density around 20% were unchanged after 6 months. Also, visual classifications showed no increase in breast density in any study group.

CONCLUSION

In contrast to currently available bleed-free regimens, the new ultra-low-dose combination of 0.5 mg E2 and 0.1 mg NETA seems to have very little or even a neutral effect on the breast. Both digitized quantification and visual assessment of breast density were unchanged after 6 months. Larger prospective studies should be performed to confirm this new finding.

Prevalence of disabling spasticity 1 year after first-ever stroke

OBJECTIVE

To estimate the prevalence of disabling spasticity (DS) 1 year after first-ever stroke.

DESIGN

Cross-sectional survey 1 year after first-ever stroke.

METHODS

Patients above 18 years from one county with first-ever stroke were identified by use of the national stroke registry. A representative sample of 163 patients was created and 140 of these were followed up. Assessments of motor function and ability with the modified Ashworth Scale, the modified Rankin Scale (mRS), the Barthel Index (BI) and clinical evaluation were performed in order to identify patients with spasticity-related disability.

RESULTS

The observed prevalence of any spasticity was 17% and of DS 4%. Patients with DS scored significantly worse than those with no DS on the mRS (P = 0.009) and the BI (P = 0.005). DS was more frequent in the upper extremity, correlated positively with other indices of motor impairment and inversely with age. There was an independent effect of severe upper extremity paresis (OR 22, CI 3.9-125) and age below 65 years (OR 9.5, CI 1.5-60).

CONCLUSIONS

The prevalence of DS after first-ever stroke is low but corresponds to a large number of patients and deserves further attention with regards to prevention and treatment.

Using high-power lasers for detection of elastic photon-photon scattering

The properties of four-wave interaction via the nonlinear quantum vacuum is investigated. The effect of the quantum vacuum is to generate photons with new frequencies and wave vectors, due to elastic photon-photon scattering. An expression for the number of generated photons is derived, and using state-of-the-art laser data it is found that the number of photons can reach detectable levels. In particular, the prospect of using the high-repetition Astra Gemini system at the Rutherford Appleton Laboratory is discussed. The problem of noise sources is reviewed, and it is found that the noise level can be reduced well below the signal level. Thus, detection of elastic photon-photon scattering may for the first time be achieved.

Objective assessment of cervical dystonia: a pilot study

OBJECTIVES

The aims were to characterize the movements in cervical dystonia (CD) by using an estimate of the mechanical power and work involved in the movements and to describe this through a movement energy index (MEI).

MATERIALS AND METHODS

The subjects (patients n = 6, controls n = 6) were seated in front of a screen with a laser pointer attached to a headband while they performed standardized movements. A three-dimensional motion capture system was used and a test-retest was performed.

RESULTS

The mean value of MEI was significantly higher for the patients than for the controls. There was no significant difference between MEI from test to retest for the patients but there was a significant difference between MEI from test to retest for the controls.

CONCLUSION

This study suggests that MEI could be a useful measure for the quantification of movement dysfunction in CD and thus an objective outcome measure in comparison of different therapies.

Increased prevalence of atherosclerosis in patients with medium term rheumatoid arthritis

OBJECTIVE

To measure the extent of atherosclerosis in patients with rheumatoid arthritis (RA) with a disease duration of considerable length, and in age and sex matched individuals.

METHODS

Thirty-nine patients with RA (30 women, 9 men) with disease onset occurring between 1974 and 1978, and less than 65 years of age at the time of investigation, were enrolled together with 39 sex and age matched controls. Quantitative measurement of intima-media thickness (IMT) and semiquantitative assessment of the presence of plaque were undertaken by B-mode ultrasound of the common carotid artery (CCA-IMT) and the common femoral artery on the right-hand side. Echo Doppler cardiography was performed with an Accuson Aspen. The results were related to disease activity variables and accumulated disease activity, to lipid levels [i.e., cholesterol, high density lipoproteins, low density lipoproteins, triglycerides (TG)], to hemostatic factors [tissue plasminogen activator antigen (tPAag), plasminogen activator inhibitor-1 (PAI-1), von Willebrand factor (vWF)], and to soluble adhesion molecules (sICAM-1 and sE-selectin).

RESULTS

Patients with RA had higher maximal and mean IMT values compared with controls. The difference concerning mean CCA-IMT reached statistical significance in patients with RA and correlated significantly with lipids (cholesterol, LDL, LDL/HDL ratio, TG) and tPAag. The prevalence of plaques, as well as of aortic cusp sclerosis, was higher in RA but only the difference in aortic cusp sclerosis was statistically significant. Patients with plaques had significantly higher levels of lipids (cholesterol, LDL, LDL/HDL ratio) than patients without plaques, while patients with cusp sclerosis had significantly higher cholesterol and TG levels. sICAM-1 was significantly higher both in patients with plaques and in those with aortic cusp sclerosis compared to patients without.

CONCLUSION

Our results suggest an accelerated atherosclerosis in patients with RA that is related mainly to lipid levels.

Mammographic breast density during hormone replacement therapy: effects of continuous combination, unopposed transdermal and low-potency estrogen regimens

OBJECTIVE

The aim of this study was to evaluate the impact of different hormone replacement therapy (HRT) regimens on mammographic breast density.

STUDY DESIGN

Mammographic density was recorded in women participating in a population-based screening program. At first mammogram, all women were non-users of HRT, and thereafter reported continuous use of the same HRT regimen. The study population comprised 158 women: a total of 52 women were using continuous combined HRT (conjugated equine estrogen 0.625 mg plus medroxyprogesterone acetate 5 mg); 51 women were using low-dose oral estrogen alone (estriol 2 mg daily); and 55 women were using unopposed transdermal estrogen given as a patch (estradiol 50 micrograms/24 h). Films were coded and analyzed for mammographic density by an independent radiologist blinded to treatments. Mammographic density was classified according to Wolfe.

RESULTS

An increase in mammographic density was much more common among women taking continuous combined HRT (40%) than for those using oral low-dose estrogen (6%) and transdermal (2%) treatment. The increase in density was already apparent at the first visit after starting HRT. During long-term follow-up, there was very little change in mammographic status.

CONCLUSION

HRT regimens were shown to have different effects on the normal breast. There is an urgent need to clarify the biological nature and significance of a change in mammographic density during treatment and, in particular, its relation to symptoms and breast cancer risk.

Mammographic breast density during hormone replacement therapy: differences according to treatment

OBJECTIVE

Our purpose was to investigate the effects of various hormone replacement regimens on mammographic breast density.

STUDY DESIGN

Mammographic density was recorded in women participating in a population-based screening program. All women were nonusers of hormone replacement therapy at first mammogram and thereafter reported continuous use of the same treatment: estrogen alone (n = 50) or estrogen in cyclic (n = 75) or continuous (n = 50) combination with progestogen. Mammographic density was quantified according to the Wolfe classification.

RESULTS

An increase in mammographic density was much more common among women receiving continuous combination hormone replacement therapy (52%) than among those receiving cyclic (13%) and estrogen-only (18%) treatment. The increase in density was apparent already at first visit after the start of hormone replacement therapy. There was little change in mammographic status during long-term follow-up.

CONCLUSION

Regimens of hormone replacement therapy were shown to have different effects on the normal breast. There is an urgent need to clarify the biologic nature and significance of a change in mammographic density during treatment and, in particular, its relation to symptoms and breast cancer risk.

Acoustic and perceptual evaluation of voice and speech quality: a study of patients with laryngeal cancer treated with laryngectomy vs irradiation

OBJECTIVE

To compare voice and speech function in patients who underwent laryngectomy with that of 2 control groups.

DESIGN

A cross-sectional study comparing acoustic and temporal variables with perceptual evaluations in 3 subject groups.

SETTING

University hospital in Göteborg, Sweden.

SUBJECTS

Two groups of patients with laryngeal carcinoma were examined: 12 male patients who had laryngectomy and were using a tracheoesophageal prosthesis and 12 male patients treated with radical radiotherapy who had a preserved larynx. The third group consisted of 10 normal controls without laryngeal disease.

MAIN OUTCOME MEASURES

Acoustic variables were fundamental frequency, absolute fundamental frequency perturbation, speech rate, and maximum phonation time. Perceptual evaluation included 15 listeners' perceptual evaluation and the patients' self-assessment of speech intelligibility, voice quality, and speech acceptability.

RESULTS

No significant acoustic or temporal differences were found between the laryngectomy and radical radiotherapy groups. There was a significant difference between the patient groups in perceptual evaluation. Both groups of patients differed from normal controls in acoustic and temporal measures, where the laryngectomy group generally deviated more from the normal controls than the patient group treated with radiotherapy. There was a weak, but significant, correlation between absolute fundamental frequency perturbation and perceived voice quality.

CONCLUSIONS

Perceptual evaluations could indicate significant differences between the patients who underwent laryngectomy and irradiated patients, where the acoustic analysis failed to reflect these differences. Both patient groups could be distinguished according to acoustic and temporal measures when compared with normal controls. The acoustic analyses were more sufficient in voices without severe dysfunction.