Total dietary fiber intake is inversely associated with metabolically unhealthy status in adolescents with excess weight

Little is known about the relationship between dietary fiber and metabolic health status in adolescents. This study was performed to investigate total dietary fiber intake and metabolic health status in a sample of Iranian adolescents with overweight/obesity. We hypothesized that higher total dietary fiber intake would reduce odds of metabolically unhealthy status. In this cross-sectional study, 203 adolescents (aged 12-18 years) with overweight/obesity were randomly recruited from several educational areas with different socioeconomic statuses using a multistage cluster sampling approach. Dietary intakes were evaluated by a validated food frequency questionnaire. Demographic, anthropometric, and cardiometabolic data were gathered through standard methods. Adolescents were categorized as having either metabolically healthy overweight/obesity or metabolically unhealthy overweight/obesity (MUO) phenotypes according to the International Diabetes Federation (IDF) and IDF/Homeostasis Model Assessment Insulin Resistance (HOMA-IR) criteria. Subjects had mean age of 13.97 (years) and mean fiber intake of 19.5 (g/d). After considering potential confounders, adolescents with the highest fiber intake, compared with the lowest intake, had decreased odds of MUO based on IDF (odds ratio [OR] = 0.14; 95% confidence interval [CI], 0.04-0.46) and IDF/HOMA-IR (OR = 0.16; 95% CI, 0.04-0.56) definitions. Also, each additional unit of total dietary fiber intake (1 g/d) was associated with lower chance of MUO phenotype considering IDF and IDF/HOMA-IR criteria. Individuals with higher intakes of dietary fiber were also less likely to have hyperglycemia (in fully adjusted model: OR = 0.17; 95% CI, 0.06-0.52). We found that consumption of total dietary fiber was inversely associated with odds of MUO among Iranian adolescents. Further prospective studies are required for confirming our results.

Association of priori-defined DASH dietary pattern with metabolic health status among Iranian adolescents with overweight and obesity

There was no evidence on the relationship of Dietary Approaches to Stop Hypertension (DASH) with metabolic health condition in adolescents with overweight and obesity. The purpose of this research was to investigate the association of priori-defined DASH dietary pattern with metabolic health status among adolescents with overweight and obesity in Iran. A cross-sectional survey performed on a representative sample of adolescents with overweight and obesity (n = 203). Dietary intakes were collected via a validated food frequency questionnaire and DASH score was characterized according to eight components. Data of anthropometric measures, blood pressure, circulating insulin, fasting blood sugar, and lipid profile were collected. Metabolic health status was defined based on criteria of International Diabetes Federation (IDF) and insulin resistance (IR). Based on IDF and IDF/IR criteria, 38.9% and 33.0% of adolescents suffered from metabolically unhealthy overweight/obesity (MUO). After controlling all confounders, subjects in the highest vs. lowest tertile of DASH diet had respectively 92% and 91% lower odds of MUO based on IDF definition (OR = 0.08; 95%CI 0.03-0.22) and IDF/IR criteria (OR = 0.09; 95%CI 0.03-0.29). Subgroup analysis by sex and body mass index determined that this relationship was more powerful in girls and overweight individuals. Also, in fully adjusted model, highest vs. lowest adherence to DASH diet was linked to decreased odds of hyperglycemia (OR = 0.07; 95% CI 0.03-0.21), hypertriglyceridemia (OR = 0.26; 95% CI 0.09-0.73), low HDL cholesterolemia (OR = 0.30; 95% CI 0.12-0.73) and insulin resistance (OR = 0.07; 95% CI 0.02-0.28), as metabolic health components. Greater compliance to DASH dietary pattern was linked to a remarkable lower odd of metabolic unhealthy condition among Iranian adolescents, especially in overweight subjects and girls. More prospective surveys are required to assert these results.

Association between alternative healthy eating index (AHEI) with metabolic health status in adolescents with overweight and obesity

BACKGROUND

There has been lack of evidence on the association between healthy dietary patterns and metabolic health status of adolescents. The present study aimed to evaluate the association between alternative healthy eating index (AHEI) and metabolic health status among a relatively representative sample of Iranian adolescents with overweight/obesity.

METHODS

Adolescents with extra body weight (n = 203, aged 12-18 y), were selected for this cross-sectional study by a multistage cluster random-sampling method. Habitual dietary intakes and diet quality of individuals were assessed using validated food frequency questionnaire and AHEI-2010, respectively. Data on other covariates were also gathered by pre-tested questionnaires. To determine fasting glucose, insulin and lipid profiles, fasting blood samples were collected. Participants were categorized as having metabolically healthy overweight/obesity (MHO) or metabolically unhealthy overweight/obesity (MUO) phenotypes, based on two approaches (International Diabetes Federation (IDF) and combination of IDF with Homeostasis Model Assessment Insulin Resistance (HOMA-IR)).

RESULTS

The overall prevalence of MUO was 38.9% (based on IDF criteria) and 33.0% (based on IDF/HOMA-IR criteria). After considering all potential confounders, participants in highest tertiles of AHEI-2010 had lower odds of MUO profile according to both IDF (OR = 0.05; 95% CI: 0.01-0.15) and IDF/HOMA-IR (OR = 0.05; 95% CI: 0.02-0.19) definitions. This association was stronger in adolescents with overweight compared with obese ones and also among girls than boys. Moreover, each unit increase in AHEI-2010 score was associated with lower risk of MUO based on both criteria.

CONCLUSIONS

Higher adherence to AHEI-2010 was inversely associated with odds of MUO in Iranian adolescents with overweight/obesity.

Associations of Fruit and Vegetable Intake with Metabolic Health Status in Overweight and Obese Youth

INTRODUCTION

The objective of this study was to assess the relationship between fruit and vegetable intake with metabolic health status among overweight and obese Iranian youth.

METHODS

In total, 203 obese and overweight youth including 101 boys and 102 girls, 12-18 years, were randomly recruited through a multistage cluster sampling approach in this study. A validated Persian format of food frequency questionnaire was used to estimate participants' usual food intake. Adolescents were categorized in accordance with the International Diabetes Federation (IDF) criteria as well as IDF plus insulin resistance (HOMA-IR) definition into metabolically healthy obese and metabolically unhealthy obese (MUO).

RESULTS

Based on IDF criteria, youth in the third tertile of vegetable and the combination of fruit and vegetable intake had 66% (odds ratio = 0.34, 95% CI: 0.12-0.95) and 73% (odds ratio = 0.27, 95% CI: 0.09-0.81) lower odds of MUO compared to those in the first tertile, in the fully-adjusted model. According to IDF plus HOMA-IR definition, inverse associations were also found between vegetable (odds ratio = 0.36, 95% CI: 0.12-1.02) and the combination of fruit and vegetable (odds ratio = 0.25, 95% CI: 0.08-0.79) intake with MUO phenotype. Stratified analysis indicated inverse associations between intake of vegetables and the combination of fruits and vegetables with MUO phenotype (based on IDF definition) in overweight, but not obese subjects.

CONCLUSION

The current study demonstrated that greater consumption of vegetables as well as the combination of fruits and vegetables was related to a lower risk of MUO phenotype, particularly in overweight youth.

The relation between dietary phytochemical index and metabolic health status in overweight and obese adolescents

Previous studies have rarely investigated dietary phytochemicals consumption in relation to metabolic health of adolescents. The current study was performed to investigate dietary phytochemical index (DPI) in relation to metabolic health status in overweight and obese adolescents. This cross-sectional study was conducted among 203 adolescents with overweight or obesity. Dietary intakes of participants were obtained through a validated 147-item food frequency questionnaire. DPI was calculated [(dietary energy derived from phytochemical-rich foods (kcal)/total daily energy intake (kcal)) ⨯100]. Glycemic and lipid profiles, blood pressure, and anthropometric indices were also measured. A metabolically unhealthy overweight/obesity (MUO) profile was determined based on the International Diabetes Federation (IDF) and IDF/Homeostasis Model Assessment Insulin Resistance (HOMA-IR) definitions. Study subjects had a mean age of 13.98 years and 50.2% of them were girls. According to IDF and IDF/HOMA-IR criteria, 38.9% (37 boys, and 42 girls) and 33% (35 boys, and 32 girls) of the study participants were respectively MUO. According to IDF and IDF/HOMA-IR definitions, adolescents in the third DPI tertile had respectively 61% (maximally-adjusted OR = 0.39, 95%CI 0.16-0.91) and 67% (maximally-adjusted OR = 0.33, 95%CI 0.13-0.83) lower odds of being MUO, compared to the first tertile. Stratified analysis by sex indicated that DPI was inversely related to MUO phenotype based on IDF criteria in girls (maximally-adjusted OR = 0.25, 95%CI 0.06-0.98), but not in boys. The current study found that adolescents with a higher dietary intake of phytochemicals have lower odds of being MUO, particularly among girls. However, further large-scale prospective cohort studies are required to confirm this finding.

Association of legumes and nuts consumption with metabolic health status in Iranian overweight and obese adolescents

Limited data are available on the association of legumes and nuts consumption with health status in pediatrics. So, we assessed the relation of legumes and nuts intake with metabolic health status in Iranian adolescents. A random sample of overweight/obese adolescents aged 12 to 18 years was included in this cross-sectional study. Dietary intakes were gathered using a validated 147-item food frequency questionnaire (FFQ). We measured metabolic indices including blood pressure, lipid profile, glycemic and anthropometrics indices. Two strategies were used for classification of adolescents to metabolically healthy obese (MHO) or unhealthy obese (MUO): International Diabetes Federation (IDF) and combination of IDF with Homeostasis Model Assessment Insulin Resistance (HOMA-IR). Information on 203 overweight/obese adolescents (50.2% girls and 49.8% boys) with an average age of 13.98 (± 1.61) years and a mean weight of 73.48 (± 11.60) kg/m² was evaluated. Based on the IDF and IDF/HOMA-IR definition, higher consumption of legumes and nuts consumption was related to a 66% and 61% decreased odds of MUO in crude model (OR = 0.34, 95%CI 0.17-0.69), (OR = 0.39, 95%CI 0.19-0.80); but in fully-adjusted model, these relations disappeared. After adjustment for potential cofounders, an inverse association was found between legumes and nuts consumption and odds of hyperglycemia (OR = 0.35, 95%CI 0.16-0.78). Moreover, although inverse significant associations were found between legumes and nuts consumption and odds of MUO in girls and overweight subjects in crude models, these associations disappeared after adjustment for all confounders. After taking potential confounders into account, no significant association was found between consumption of legumes and nuts and MUO in Iranian adolescents. The findings should be affirmed by further prospective studies.

Dairy intake in relation to metabolic health status in overweight and obese adolescents

There was a lack of evidence on the association between dairy intake and metabolic health status in overweight/obese adolescents. This study evaluated the association between dairy intake and metabolic health status in overweight/obese Iranian adolescents. Overweight/obese adolescents (n = 203; 101 boys and 102 girls) selected by a multistage cluster random sampling method have participated in this cross-sectional study. Dietary intake was assessed using a validated 147-item food frequency questionnaire. Anthropometric indices, blood pressure, fasting glucose, insulin, and lipid profile were measured. Participants were categorized to metabolically healthy obese (MHO) and metabolically unhealthy obese (MUO) according to International Diabetes Federation (IDF) criteria and a combination of IDF with Homeostasis Model Assessment Insulin Resistance (HOMA-IR) criteria. The frequency of MUO based on IDF, and IDF/HOMA-IR definitions was 38.9% and 33.0%, respectively. In fully-adjusted model, participants in the highest tertile of dairy intake had 61% lower odds of MUO based on IDF criteria (OR = 0.39, 95% CI 0.15-0.99). Higher dairy intake was associated with a non-significant lower risk of MUO according to IDF/HOMA-IR definition in the maximally-adjusted model (OR = 0.44, 95% CI 0.17-1.16). Stratifies analysis by sex and body mass index revealed that the association was stronger in girls and overweight subjects. Furthermore, higher intake of low-fat dairy was related to a reduced likelihood of MUO, while higher intake of high-fat dairy was related to increased odds of MUO. This community-based cross-sectional study revealed that higher intake of dairy was associated with a significant lower odd of MUO among Iranian adolescents, especially in girls and overweight subjects.

Dietary total antioxidant capacity in relation to metabolic health status in overweight and obese adolescents

Background

Although several studies evaluated the relationship between individual dietary antioxidants and metabolic health conditions, data on the association between dietary total antioxidant capacity and metabolic health among children and adolescents is limited. This study investigated the relationship between dietary total antioxidant capacity and metabolic health status in Iranian overweight/obese adolescents.

Methods

This cross-sectional study was conducted on 203 overweight/obese adolescents. Dietary intakes were evaluated by a validated food frequency questionnaire. Ferric Reducing-Antioxidant Power (FRAP) was considered to indicate dietary total antioxidant capacity. Anthropometric parameters and blood pressure status were measured. Fasting blood samples were obtained to determine circulating insulin, glucose, and lipid profile. Two different methods (modified International Diabetes Federation (IDF) criteria and IDF criteria along with insulin resistance) were applied to classify participants as metabolically healthy obese (MHO) or metabolically unhealthy obese (MUO).

Results

According to IDF and IDF/HOMA definitions, a total of 79 (38.9%) and 67 (33.0%) adolescents were respectively defined as MUO. Considering IDF criteria, the highest tertile of FRAP was related to lower odds of being MUO in the maximally-adjusted model (OR: 0.40; 95%CI: 0.16–0.96), compared to the lowest tertile. However, based on the IDF/HOMA-IR criteria, no significant relation was found between FRAP and odds of MUO (OR: 0.49; 95%CI: 0.19–1.23) after considering all possible confounders.

Conclusions

Adolescents with higher intakes of dietary antioxidants have a lower possibility of being MUO based on IDF criteria. However, no substantial relation was found considering HOMA-IR/IDF definition. Further prospective cohort studies need to be done to confirm these findings.

Dietary total, plant and animal protein intake in relation to metabolic health status in overweight and obese adolescents

Few studies have investigated dietary total protein intake and its subtypes in relation to metabolic health status. We explored the relation between dietary total, plant and animal protein intake with metabolic health status in Iranian overweight/obese adolescents. Overweight/obese adolescents (n = 203) were selected for this cross-sectional study by multistage cluster random-sampling method. A validated food frequency questionnaire was used to evaluate dietary intakes. Total, plant and animal protein intake were considered as percentage of energy intake. Anthropometric indices, blood pressure, lipid and glycemic profiles were collected. Participants were classified as metabolically healthy obese (MHO) or unhealthy obese (MUO) based on International Diabetes Federation (IDF) and IDF/Homeostasis Model Assessment Insulin Resistance (HOMA-IR) definitions. Subjects had a mean age of 13.98 years, and 50.2% of them were girls. Based on IDF criteria, adolescents in the top tertile of total (OR = 0.32; 95% CI 0.13–0.77), plant (OR = 0.30; 95% CI 0.10–0.91), and animal (OR = 0.20; 95% CI 0.08–0.54) protein intake had lower odds of being MUO compared to the reference category. Considering IDF/HOMA-IR criteria, subjects in the highest tertile of total (OR = 0.31; 95% CI 0.12–0.79) and animal (OR = 0.17; 95% CI 0.06–0.49) protein intake were less likely to be MUO. However, no substantial association was observed with plant protein intake. Also, an inverse association was observed between each SD increase in total and animal protein with MUO odds. We found inverse association between total, plant and animal protein intake and chance of being MUO in adolescents. Further prospective studies are needed to confirm the findings.

Association of Dietary Insulin Index and Dietary Insulin Load With Metabolic Health Status in Iranian Overweight and Obese Adolescents

Background

Limited data are available on the association of dietary insulin load (DIL) and dietary insulin index (DII) with health status in pediatrics. We aimed to investigate the relationship of DIL and DII with metabolic health status in Iranian overweight/obese adolescents.

Methods

In this cross-sectional study, using a multistage cluster random-sampling method, 203 overweight/obese adolescents (aged 12 to <18 years) were included. A validated 147-item food frequency questionnaire (FFQ) was used for a dietary intake assessment. Glycemic and lipid profile, blood pressure (BP), and anthropometric indices were measured. Participants were categorized as metabolically healthy obese (MHO) or metabolically unhealthy obese (MUO) using the two methods of the International Diabetes Federation (IDF) and a combination of IDF with Homeostasis Model Assessment Insulin Resistance (HOMA-IR).

Results

According to IDF and IDF/HOMA-IR strategies, 38.9% (n = 79) and 33.0% (n = 67) of participants belonged to MUO category. After adjustments for potential confounders, subjects in the highest tertile of DIL in comparison with those in the lowest tertile had the odds ratio (OR) values of 8.44 (95% CI: 2.24-31.78) and 5.86 (95% CI: 1.39-24.58) for MUO based on IDF and IDF/HOMA-IR definitions, respectively. Moreover, after considering potential confounders, adolescents in the highest tertile of DII, compared to the lowest tertile, were, respectively, 6.93 (OR: 6.93; 95% CI: 2.59-18.57) and 5.26 (OR: 5.26; 95% CI: 1.85-14.97) times more likely to be MUO, based on IDF and IDF/HOMA-IR definitions. A significant decreasing trend was observed for OR of MUO in tertiles of DIL and DII. The stratified analysis revealed that these associations were stronger in obese participants; in overweight subjects, the association was not independent of confounders.

Conclusion

This population-based study revealed that higher DIL and DII were strongly related to increased OR of MUO in Iranian adolescents, especially in obese participants. Further investigations, especially with a prospective design, are needed to affirm these findings.

Adherence to Mediterranean Diet and Its Association with Metabolic Health Status in Overweight and Obese Adolescents

BACKGROUND

Obesity is becoming more prevalent around the world and greatly contributes to chronic disease progression. Previous studies have investigated individual food groups in relation to metabolic health status of adolescents, mainly in Western countries. Limited data are available on the association between dietary patterns and metabolic health in Middle East nations, where childhood overweight/obesity is increasing drastically. Therefore, we investigated the relationship between the Mediterranean diet and metabolic health status among Iranian adolescents.

METHODS

This cross-sectional study was conducted on 203 overweight/obese adolescents. Dietary intakes were evaluated by a validated food frequency questionnaire. Anthropometric parameters and blood pressure were measured. Fasting blood samples were obtained to determine circulating insulin, glucose, and lipid profile. Two different methods were applied to classify participants as metabolically healthy obese (MHO) or unhealthy obese (MUO): International Diabetes Federation (IDF) criteria and IDF along with insulin resistance (HOMA-IR) criteria.

RESULTS

A total of 79 (38.9%) and 67 (33.0%) adolescents were, respectively, categorized as MUO, based on IDF and IDF/HOMA definitions. Considering IDF criteria, higher adherence to the Mediterranean diet was related to lower odds of being MUO, both in the crude (OR: 0.17; 95%CI: 0.08-0.37) and fully adjusted model (OR: 0.33; 95% CI: 0.13-0.84). Excluding each component from the score made the association insignificant, except for two components of meat and dairy products. Based on the IDF/HOMA-IR criteria, there was no significant association between Mediterranean diet score and MUO, after considering all potential confounders (OR: 0.47; 95% CI: 0.17-1.30).

CONCLUSIONS

We found an inverse association between the Mediterranean diet and odds of MUO among Iranian adolescents, based on IDF criteria. No significant relation was found when MUO was defined based on HOMA-IR/IDF criteria. Further prospective cohort studies are needed to confirm these findings.

Prevalence of psychological disorders among caregivers of children with intellectual disabilities and motor disabilities in Shiraz

Introduction

The prevalence of mental disorders plays an important role in identifying the state of mental health of the community and estimate the required facilities at any time.

Objectives

Therefore, the purpose of this study was to investigate the prevalence of psychological disorders in caregivers of children with intellectual disabilities and motor disabilities in Shiraz.

Methods

The research was descriptive and cross-sectional survey. The statistical population consisted of all mothers of children with disabilities who were admitted to welfare centers and clinics of Shiraz in 2019. Of these families, 35 mothers with children with intellectual disability and 35 mothers with children with motor disability were selected as the sample group. SCL-90-R (1976) was used to collect of data. For analyze the data, MANOVA test was used.

Results

The results of this study showed that the most common psychological disorders in caregivers of children with intellectual disability were aggression (hostility), hypersensitivity to interpersonal relationships, anxiety and depression, and in caregivers of children with motor disabilities were physical complaints, sensitivity to interpersonal relationships, paranoid thoughts and anxiety.

Conclusions

According to the findings of this research, it can be concluded that caregivers of children with special needs in terms of mental health are not in a favorable situation, which is due to the lack of proper adaptation with the disability of their child and the failure to meet their needs.

Disclosure

No significant relationships.

The impact of 18F-FDOPA-PET/MRI image fusion in detecting liver metastasis in patients with neuroendocrine tumors of the gastrointestinal tract

Background

This study assesses the value of image fusion using 18F-fluoro-L-DOPA (18F-DOPA) positron emission tomography (PET) and magnetic resonance imaging (MRI) for examining patients with neuroendocrine tumors (NETs) and a suspicion of metastasis of the liver.

Methods

Eleven patients (five women and six men aged between 20 and 81, with a mean age of 54.6 years) were included in the study. All patients underwent whole-body 18F-DOPA PET examinations and contrast-enhanced MRI with diffusion-weighted sequences (DWS). Image fusion was performed using a semiautomatic voxel-based algorithm. Images obtained using PET and MRI were assessed separately. Side-by-side evaluations of fused PET/MRI images were also performed.

Results

In total, 55 liver lesions (52 liver metastases and 3 benign lesions) were detected in the 11 patients. Sensitivity detection for liver lesions was higher when using PET/CT than when using contrast-enhanced MRI without DWSs and lower than using MRI with DWSs. The sensitivity of PET/MRI image fusion in the detection of liver metastasis was significantly higher than that of MRI with DWSs (P < 0.05).

Conclusion

Images of the liver obtained using PET and MRI in patients with NETs exhibited characteristic features. These findings suggest that an appropriate combination of available imaging modalities can optimize patient evaluations.

Decisive Diagnosis of Seronegative Polyarthritis by 3-phase Bone Scintigraphy

Inflammatory joint disease is mainly diagnosed on grounds of clinical investigation, laboratory testing (acute phase reactants), and radiography. Radionuclide imaging has recently been added to the armamentarium of clinician. This case report points out the role of three-phase bone scan and HIG (human immunoglobulin) scan in the discovery of the inflammatory nature of polyarthralgia in a young woman with equivocal clinical and laboratory results. In the aim of diagnosing arthritis early in its course scintigraphy proved to be superior to conventional radiography. It also allows more discriminating selection of subsequent X-ray examination to limit radiation exposure.

Targeted diagnostic magnetic nanoparticles for medical imaging of pancreatic cancer

Highly aggressive cancer types such as pancreatic cancer possess a mortality rate of up to 80% within the first 6months after diagnosis. To reduce this high mortality rate, more sensitive diagnostic tools allowing an early stage medical imaging of even very small tumours are needed. For this purpose, magnetic, biodegradable nanoparticles prepared using recombinant human serum albumin (rHSA) and incorporated iron oxide (maghemite, γ-Fe2O3) nanoparticles were developed. Galectin-1 has been chosen as target receptor as this protein is upregulated in pancreatic cancer and its precursor lesions but not in healthy pancreatic tissue nor in pancreatitis. Tissue plasminogen activator derived peptides (t-PA-ligands), that have a high affinity to galectin-1 have been chosen as target moieties and were covalently attached onto the nanoparticle surface. Improved targeting and imaging properties were shown in mice using single photon emission computed tomography-computer tomography (SPECT-CT), a handheld gamma camera, and magnetic resonance imaging (MRI).

Enhanced osteoconductivity of polyethersulphone nanofibres loaded with bioactive glass nanoparticles in in vitro and in vivo models

OBJECTIVES

There is growing need for new scaffold constructions for synthetic bone graft substitutes to repair large bone lesions. A very promising and important class of new implants for tissue engineering is based on three-dimensional scaffolds and bioceramics.

MATERIALS AND METHODS

In this study, after investigation of mechanical properties of polyethersulphone (PES) nanofibres, fabricated by electrospinning methodology and coated with bioactive glass (BG), cells of the MG-63 line were cultured on surfaces of these scaffolds. Their capacity to support MG-63 proliferation was also investigated in vitro by MTT assay. Osteoconductivity on these scaffolds was investigated by the common osteogenic markers alkaline phosphatase (ALP) activity, calcium mineral deposition and bone-related gene activation. Next, a bone reconstruction of rat critical-size defects model was evaluated using radiographic imaging analysis (digital mammography), computed tomography and histological examination.

RESULTS

In vitro results indicated that biocompatibility and osteogenic markers of MG-63 cells were significantly enhanced after coating PES with BG. Based on in vivo results, new bone formation in the defect site was enhanced in implanted rats in comparison with a control group. The highest reconstruction was observed in animals implanted with BG-coated nanofibres.

CONCLUSIONS

Osteoconductivity of PES nanofibres was markedly enhanced after coating them with BG, and introduction of this construct as new bone-graft substitute for bone loss and defects is indicated.

New approaches in nuclear medicine for early diagnosis of Alzheimer's disease

Dementia, Alzheimer's disease (AD) being the most common cause of it, is a major and growing medical and social problem, particularly in the advanced age, with the highest rate in the population over 75 y. Recent sophisticated therapeutic measures require more sensitive diagnostic tests to recognize early stages of the disease. In this paper, the current neuronuclear imaging literature is reviewed with regard to early and differential diagnosis of dementia. Functional imaging with single photon emission computed tomography (SPECT) and positron emission tomography (PET) could provide the clinician with additional information complementary to morphological assessments, thus contributing to achieve a more adequate diagnosis, and also with information regarding prodromal stages of AD.

Gluteal injection site granulomas: false positive finding on FDG-PET in patients with non-small cell lung cancer

Positron-emission-tomography (PET) with fludeoxyglucose F-18 ([(18)F] fluoro-2-deoxy-D-glucose, FDG) has become an established imaging modality in patients with lung cancer for mediastinal lymph node staging and the detection of extrathoracic metastases. However, tracer accumulations are not limited to malignant tissue but are also found in muscles and benign inflammatory processes. We report on two patients with lung cancer in whom FDG-PET revealed suspicious tracer accumulations in the buttock. Ultrasound (US) revealed a hyperechogenic nodule with poorly defined margins in both patients. On specific inquiry both patients reported on repeated "intramuscular" gluteal injections. Histology after US guided biopsy showed an accumulation of macrophages within fibrous tissue, compatible with injection site granulomas. The reported cases underline that (18)F-FDG may accumulate in benign, ancillary processes that have to be distinguished from distant metastases. Tracer accumulation in the buttocks may be highly suggestive of injection site granulomas, especially if the patient reports on "intramuscular" injections. In this setting, US is a widely available modality to distinguish metastasis from adipose tissue necrosis.

Expression of somatostatin receptors in inflammatory lesions and diagnostic value of somatostatin receptor scintigraphy in patients with ANCA-associated small vessel vasculitis

OBJECTIVE

To assess the usefulness of somatostatin receptor (SSTR) scintigraphy for the evaluation of disease activity in the upper and lower respiratory tract in ANCA-associated vasculitis (AASV).

METHODS

Thirty-two consecutive patients with AASV were subjected to SSTR scintigraphy as part of their initial diagnostic evaluation and follow-up. The presence of SSTRs in inflammatory lesions was evaluated with immunohistochemistry in selected cases.

RESULTS

In AASV, specificity of SSTR scintigraphy for active vs non-active disease was 96% for pulmonary disease and 100% for ear, nose and throat (ENT) involvement, while sensitivity was 86% and 68%, respectively. Absence of previously present tracer accumulation characterized treatment responders, and treatment resistance was reflected by repeated positive scintigraphy. We could demonstrate the expression of SSTRs in lung and mucosal biopsies obtained from patients with active Wegener's granulomatosis and with microscopic polyangiitis.

CONCLUSION

SSTR scintigraphy is useful for the assessment of AASV, indicating disease activity, disease extent and treatment efficacy. SSTRs are expressed in both granulomatous as well as non-granulomatous AASV.

Metabolic impairment of brain metabolism in patients with Lewy body dementia

A reliable assessment of dementia is essential for a differentiated treatment. Recent studies have demonstrated a poor accuracy of clinical criteria for diagnosis of Lewy body dementia. Diffuse Lewy body disease (LBD) is the second most common cause of senile degenerative dementia and is characterized histologically by the occurrence of Lewy bodies in allocortical, neocortical and subcortical structures. Seven male patients (mean age 81 years) with clinically suspected diffuse LBD were investigated with 18F-fluorodeoxyglucose (FDG)-PET using a Siemens ECAT-ART PET-scanner. The 18F-FDG-PET showed a diffuse glucose hypometabolism in the entire cerebral cortex with relative sparing of the primary sensory-motor cortex in all patients. This diffuse metabolic impairment in the entire cortex with relative sparing of central region seems to be a typical pattern for LBD, distinct from Alzheimer's disease.

[New design concept to improve medical application software]

Up to now, there has been no software model available that adequately addresses the growing importance of flexibility in using different information tools. Based on Java, Jini technology provides distributed and therefore robust software architecture. In case of an application crash, Jini is able to minimize the damage by adding functions that reverse the effects of the crash. Owing to increasing user mobility, it is necessary to be able to receive location-independent information. The growing use of powerful telecommunications suggests the application of 'wireless application protocol' (WAP) mobile telephones also for medical purposes. This paper presents the application of these new software trends (Jini and wireless application protocol).

Sentinel lymph node detection with large human serum albumin colloid particles in breast cancer

Detection of metastatic involvement of lymph nodes is essential for management and prognostic evaluation in breast cancer patients. The success of lymphatic mapping depends on identifying the sentinel lymph node(s) draining the primary tumour. However, when mapping is performed with a radiocolloidal agent, the number of hot lymph nodes varies with the agent and its size, among other factors. In this study, we evaluated prospectively the detection rate of sentinel lymph nodes in breast cancer when injecting large particles (100-600 nm) of human serum albumin colloids (Senti-Scint). In 128 consecutive breast cancer patients without palpable lymph nodes, pre-operative static lymphoscintigraphic mapping of the breast was performed after subcutaneous injection of 15 MBq of the radiocolloid. Lymphoscintigrahic results were compared with intra-operative surgical gamma detection probe and blue dye mapping data. Pre-operative lymphoscintigraphy and surgical gamma detection probe both correctly detected 203 sentinel lymph nodes in 122/128 patients (95%), while blue dye mapping showed only 183 sentinel lymph nodes in 82% of the patients. Only one or two sentinel lymph nodes were identified in each patient, which allowed the surgeon easily to find the sentinel lymph node(s) intra-operatively. In conclusion, lymphoscintigraphy with large particles of human serum albumin colloids is a helpful and reliable procedure for the surgical management of breast cancer.

[Determination of therapy management in rectal carcinoma by staging with 18-FDG-PET]

The curative treatment of carcinoma of the rectum in the early stage of the disease is radical local surgery. If there is a solitary liver metastasis, resection is also a curative treatment. This report describes a female patient with rectal carcinoma, in whom a solitary liver metastasis in the left lobe was diagnosed only by FDG-PET and verified at surgery. This case report demonstrates the potential role of FDG-PET even for primary staging in detecting occult hepatic and extrahepatic metastases, thus significantly influencing the therapeutic management and prognosis of these patients.

Regional cerebral blood flow in patients suffering from post-traumatic stress disorder

OBJECTIVE

The aim of the study was to determine whether regional cerebral blood flow in survivors of torture suffering from post-traumatic stress disorder (PTSD) differed significantly from that in healthy controls.

METHOD

We examined the cerebral regional distribution of 99m-technetium-hexamethylpropyleneamineoxime (HMPAO) using single photon emission computed tomography (SPECT) in 8 patients and in 8 healthy controls. A semi-quantitative analysis was performed in which symmetrical regions of interest (ROI) were drawn in all subjects.

RESULTS

Regional blood flow was markedly more heterogeneous in patients suffering from PTSD than in healthy controls. The differences are significant.

CONCLUSION

Severe psychological trauma induced by torture can cause neurobiologic alterations that may contribute, even years after the original trauma, to a number of complaints commonly expressed by patients suffering from PTSD.

Distributed nuclear medicine applications using World Wide Web and Java technology

At present, medical applications applying World Wide Web (WWW) technology are mainly used to view static images and to retrieve some information. The Java platform is a relative new way of computing, especially designed for network computing and distributed applications which enables interactive connection between user and information via the WWW. The Java 2 Software Development Kit (SDK) including Java2D API, Java Remote Method Invocation (RMI) technology, Object Serialization and the Java Advanced Imaging (JAI) extension was used to achieve a robust, platform independent and network centric solution. Medical image processing software based on this technology is presented and adequate performance capability of Java is demonstrated by an iterative reconstruction algorithm for single photon emission computerized tomography (SPECT).

Scintimammography enhances negative predictive value of non-invasive pre-operative assessment of breast lesions

AIMS

The aim of this study was to develop a criterion with a high negative predictive value for the evaluation of breast lesions. We aimed to determine the value of combining three non-invasive tests, mammography (MM), ultrasonography (USS) and 99mTc-methoxyisobutylisonitrite (99mTc-MIBI) scintimammography (scinti-MM).

METHODS

We included 94 consecutive patients with suspected lesions detected by mammography or on physical examination. MM, USS and scinti-MM were performed no more than 4 weeks prior to excisional biopsy in all patients. We then compared the biopsy results with a score calculated for each patient, derived from the results of the three tests, which we termed 'mamma malignancy index' (MMI).

RESULTS

Each of the three exams yielded a score ranging from 0 to 2, with 0 representing an almost certainly benign lesion, 1 an indeterminate finding and 2 a likely malignant lesion, and hence giving a total score ranging from 0 to 6. The biopsy results showed that the lesions in 64 patients were benign. Forty-nine (77%) of these patients had received an MMI score of 0 or 1. The negative predictive value for malignancy in patients with a score less than 2 was 100%.

CONCLUSIONS

Since the smallest detected lesion was 9 mm in diameter, we conclude that MMI may be a highly useful diagnostic tool in the delineation of breast lesions > or =1 cm which should not be routinely referred for biopsy but may be followed non-invasively. Although fine needle aspiration has limitations, we would recommend it as a less invasive method to evaluate suspected lesions smaller than 1 cm.

A Jini service to reconstruct tomographic data

Distributed computing that uses dynamic networks will change the way we work and communicate thanks to the interaction of devices and services, that are automatically added and removed from the network as needed. The Jini technology, which is built atop the Java programming language, provides a homogenous view of the network and extends the ability of code to migrate in Java. This software design model simplifies the configuration and access to hardware devices and software services in a network. Thus, it becomes possible to execute new services without pre-installing software on client machines. This new programming paradigm is especially important in medical applications, where the reliable transmission of information is essential. This paper demonstrates how single photon emission computerized tomography data can be iteratively reconstructed using a Jini service.

Psychological disorders in survivors of torture: exhaustion, impairment and depression

Post-traumatic stress disorder (PTSD) has been described as the characteristic sequel to extreme events in life such as war and especially torture. This limitation to a single approach in regard to diagnosis and treatment has been criticised as being a too narrow concept to describe the effects following extreme events in life, especially as most studies so far were limited to PTSD and a small range of symptoms or disorders. The study presents data on psychiatric disorders in a group of exiled survivors of torture presenting to an out-patient department for psychiatry. A DSM-III-R-based psychiatric interview, including the general assessment of functioning scale (GAF), an open list of symptoms and the Vienna diagnostic criteria in regard to depression were used to evaluate a broader range of possible sequels. The most frequent present diagnosis in 44 patients seen over a period of 3 years was PTSD (n = 40), but criteria for a present diagnosis of other disorders were fulfilled in 34 patients, even years after torture, mainly major depression or dysthymia (n = 26). Criteria for functional psychosis were fulfilled in 4 patients. Many patients reported symptoms not assessed by DSM-III-R criteria, including feelings of shame and guilt, and ruminations on existential fears. The impairment as indicated by the GAF (mean 59.1) correlated best with the presence of the endogenomorphic-depressive axial syndrome, but not with duration of imprisonment, age or other factors. Research on sequels to extreme trauma should not be restricted to a simple diagnosis of PTSD, but should continue to look for a broader conceptualisation, including neglected categories like the axial syndrome, as PTSD is common, but might not be the only factor of importance for research and treatment. ICD-10 might offer a more adequate interpretation of sequels.