scholarly journals POS1391 MEASURING SUBCLINICAL INFLAMMATION IN HAND AND FOREFOOT IN PATIENTS WITH ARTHRALGIA USING 1.5T OR 3.0T MRI: DOES FIELD STRENGTH MATTER?

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 978.1-978
Author(s):  
D. Krijbolder ◽  
M. Verstappen ◽  
F. Wouters ◽  
L. R. Lard ◽  
P. D. De Buck ◽  
...  
Keyword(s):  
Field Strength ◽  
Scientific Evidence ◽  
Correlation Coefficients ◽  
Daily Practice ◽  
Scientific Data ◽  
Imaging Features ◽  
Subclinical Inflammation ◽  
The Individual ◽  
3.0T Mri ◽  
Inflammation Score

Background:Magnetic resonance imaging (MRI) of small joints sensitively detects inflammation. MRI-detected subclinical inflammation, and tenosynovitis in particular, has been shown predictive for RA development in patients with arthralgia. These scientific data are mostly acquired on 1.0T-1.5T MRI scanners. However, 3.0T MRI is nowadays increasingly used in practice. Evidence on the comparability of these field strengths is scarce and it has never been studied in arthralgia where subclinical inflammation is subtle. Moreover, comparisons never included tenosynovitis, which is, of all imaging features, the strongest predictor for progression to RA.Objectives:To determine if there is a difference between 1.5T and 3.0T MRI in detecting subclinical inflammation in arthralgia patients.Methods:2968 locations (joints, bones or tendon sheaths) in hands and forefeet of 28 arthralgia patients were imaged on both 1.5T and 3.0T MRI. Two independent readers scored for erosions, osteitis, synovitis (according to RAMRIS) and tenosynovitis (as described by Haavaardsholm et al.). Scores were also summed as total inflammation (osteitis, synovitis and tenosynovitis) and total RAMRIS (erosions, osteitis, synovitis and tenosynovitis) scores. Interreader reliability (comparing both readers) and field strength agreement (comparing 1.5T and 3.0T) was assessed with interclass correlation coefficients (ICCs). Next, field strength agreement was assessed after dichotomization into presence or absence of inflammation. Analyses were performed on patient- and location-level.Results:ICCs between readers were excellent (>0.90). Comparing 1.5 and 3.0T revealed excellent ICCs of 0.90 (95% confidence interval 0.78-0.95) for the total inflammation score and 0.90 (0.78-0.95) for the total RAMRIS score. ICCs for individual inflammation features were: tenosynovitis: 0.87 (0.74-0.94), synovitis 0.65 (0.24-0.84) and osteitis 0.96 (0.91-0.98). The field strength agreement on dichotomized scores was 83% for the total inflammation score and 89% for the total RAMRIS score. Of the individual features, agreement for tenosynovitis was the highest (89%). Analyses on location- level showed similar results.Conclusion:Agreement of subclinical inflammation scores on 1.5T and 3.0T were good to excellent, in particular for tenosynovitis. This suggests that scientific evidence on predictive power of MRI in arthralgia patients, obtained on 1.5T, can be generalized to 3.0T when this field strength would be used for diagnostic purposes in daily practice.Disclosure of Interests:None declared

Safeguarding Infant Brains: A Multidisciplinary Challenge—Results of a Survey, Update on Current Scientific Evidence, and Recommendations on How to Deal with Possible Anesthetic Drug Neurotoxicity

2017 ◽  
Vol 28 (05) ◽  
pp. 400-405
Author(s):  
John Vlot ◽  
Rene Wijnen ◽  
Frank Weber
Keyword(s):  
Pediatric Surgery ◽  
Scientific Evidence ◽  
Pediatric Anesthesia ◽  
Daily Practice ◽  
Scientific Data ◽  
Shared Responsibility ◽  
Neutral Position ◽  
Anesthetic Drug ◽  
Anesthetic Drugs ◽  
Prospective Longitudinal

Introduction Potential neurotoxicity of anesthetic drugs has been among the most intensively discussed issue in pediatric anesthesia for more than 10 years. It remains unclear how far this discussion has reached the European pediatric surgical community. Our aim was to investigate the thoughts of pediatric surgeons regarding this topic. In addition, we provide an update on the current scientific evidence regarding neurotoxicity together with recommendations for clinical practice. Materials and Methods A web-based survey to assess the thoughts of practicing European pediatric surgeons regarding neurotoxicity and how it may have influenced their daily practice of pediatric surgery was launched via the European Pediatric Surgeons' Association Web site. Results A total of 72 responses could be analyzed. A majority of the respondents were interested in the topic but felt a need to further explore it. Thirty-one respondents have changed their daily practice of pediatric surgery due to potential anesthetic drug toxicity. Eighteen respondents reported to be concerned about neurotoxicity, 29 held a neutral position, and 8 were not concerned. Twenty-seven respondents found it a shared responsibility of the surgeon and the anesthesiologist to deal with the neurotoxicity issue. The majority of respondents found a necessity for further research on anesthetic drug neurotoxicity, assigning the highest priority to prospective longitudinal human studies and the lowest to animal studies. Conclusion The neurotoxicity question has reached the pediatric surgical community. Currently available scientific data do not support the theory of anesthetic drug-induced neurotoxicity in young children. Recent interdisciplinary clinical research focuses on neurodevelopmental outcome after surgery in neonates and infants. The European Safe Anesthesia For Every Tot initiative suggests focusing on proper conduct of anesthesia in children rather than on possible anesthetic drug neurotoxicity.

Treatment of varicose tributaries with sclerotherapy with polidocanol 0.5 % foam

VASA ◽  
2010 ◽  
Vol 39 (2) ◽  
pp. 169-174 ◽  
Author(s):  
Reich-Schupke ◽  
Weyer ◽  
Altmeyer ◽  
Stücker
Keyword(s):  
Scientific Evidence ◽  
Daily Practice ◽  
Severe Adverse Effect ◽  
Safe Procedure ◽  
Efficacy And Safety ◽  
Foam Sclerotherapy ◽  
History Of ◽  
One Year ◽  
Additional Therapy

Background: Although foam sclerotherapy of varicose tributaries is common in daily practice, scientific evidence for the optimal sclerosant-concentration and session-frequency is still low. This study aimed to increase the knowledge on foam sclerotherapy of varicose tributaries and to evaluate the efficacy and safety of foam sclerotherapy with 0.5 % polidocanol in tributaries with 3-6 mm in diameter. Patients and methods: Analysis of 110 legs in 76 patients. Injections were given every second or third day. A maximum of 1 injection / leg and a volume of 2ml / injection were administered per session. Controls were performed approximately 6 months and 12 months after the start of therapy. Results: 110 legs (CEAP C2-C4) were followed up for a period of 14.2 ± 4.2 months. Reflux was eliminated after 3.4 ± 2.7 injections per leg. Insufficient tributaries were detected in 23.2 % after 6.2 ± 0.9 months and in 48.2 % after 14.2 ± 4.2 months, respectively. Only 30.9 % (34 / 110) of the legs required additional therapy. In 6.4 % vein surgery was performed, in 24.5 % similar sclerotherapy was repeated. Significantly fewer sclerotherapy-sessions were required compared to the initial treatment (mean: 2.3 ± 1.4, p = 0.0054). During the whole study period thrombophlebitis (8.2 %), hyperpigmentation (14.5 %), induration in the treated region (9.1 %), pain in the treated leg (7.3 %) and migraine (0.9 %) occurred. One patient with a history of thrombosis developed thrombosis of a muscle vein (0.9 %). After one year there were just hyperpigmentation (8.2 %) and induration (1.8 %) left. No severe adverse effect occurred. Conclusions: Foam sclerotherapy with injections of 0.5 % polidocanol every 2nd or 3rd day, is a safe procedure for varicose tributaries. The evaluation of efficacy is difficult, as it can hardly be said whether the detected tributaries in the controls are recurrent veins or have recently developed in the follow-up period. The low number of retreated legs indicates a high efficacy and satisfaction of the patients.

scholarly journals Imaging diagnosis of classical and new pneumoconiosis: predominant reticular HRCT pattern

2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Akira Masanori
Keyword(s):  
Computed Tomography ◽  
Interstitial Lung Disease ◽  
Imaging Features ◽  
Imaging Findings ◽  
Imaging Diagnosis ◽  
High Resolution Computed Tomography ◽  
Pleural Fibrosis ◽  
Pathologic Findings ◽  
Characteristic Imaging ◽  
The Individual

AbstractOur understanding of the manifestations of pneumoconioses is evolving in recent years. Associations between novel exposures and diffuse interstitial lung disease have been newly recognized. In advanced asbestosis, two types of fibrosis are seen, probably related to dose of exposure, existence of pleural fibrosis, and the host factor status of the individual. In pneumoconiosis of predominant reticular type, nodular opacities are often seen in the early phase. The nodular pattern is centrilobular, although some in metal lung show perilymphatic distribution, mimicking sarcoidosis. High-resolution computed tomography enables a more comprehensive correlation between the pathologic findings and clinically relevant imaging findings. The clinician must understand the spectrum of characteristic imaging features related to both known dust exposures and to historically recent new dust exposures.

scholarly journals Insights to enhance the examination of tool marks in human cartilage

2021 ◽  
Author(s):  
Matthias Weber ◽  
Anja Niehoff ◽  
Markus A. Rothschild
Keyword(s):  
Light Microscope ◽  
Cross Correlation ◽  
Costal Cartilage ◽  
Correlation Coefficients ◽  
Human Cartilage ◽  
Cut Marks ◽  
Tool Marks ◽  
The Cross ◽  
Cleaning Methods ◽  
The Individual

AbstractThis work deals with the examination of tool marks in human cartilage. We compared the effectiveness of several cleaning methods on cut marks in porcine cartilage. The method cleaning by multiple casts achieved the significantly highest scores (P = 0.02). Furthermore, we examined the grain-like elevations (dots) located on casts of cut cartilage. The results of this study suggest that the casting material forms these dots when penetrating cartilage cavities, which are areas where the strong collagen fibres leave space for the chondrocytes. We performed fixation experiments to avoid this, without success. In addition, 31 casting materials were compared regarding contrast under light-microscope and 3D tool marks scanner. Under the light-microscope, brown materials achieved significantly higher values than grey (P = 0.02) or black (P = 0.00) whereas under the 3D scanner, black materials reached higher contrast values than grey (P = 0.04) or brown (P = 0.047). To compare the accuracy and reproducibility of 6 test materials for cartilage, we used 10 knives to create cut marks that were subsequently scanned. During the alignment of the individual signals of each mark, the cross-correlation coefficients (Xmax) and lags (LXmax) were calculated. The signals of the marks in agarose were aligned with significantly fewer lags and achieved significantly higher cross-correlation coefficients compared to all tested materials (both P = 0.00). Moreover, we determined the cross-correlation coefficients (XC) for known-matches (KM) per material. Agarose achieved significantly higher values than AccuTrans®, Clear Ballistics™, and gelatine (all P = 0.00). The results of this work provide valuable insights for the forensic investigation of marks in human costal cartilage.

scholarly journals Traditional Applications of Tannin Rich Extracts Supported by Scientific Data: Chemical Composition, Bioavailability and Bioaccessibility

Foods ◽  
2021 ◽  
Vol 10 (2) ◽  
pp. 251
Author(s):  
Maria Fraga-Corral ◽  
Paz Otero ◽  
Lucia Cassani ◽  
Javier Echave ◽  
Paula Garcia-Oliveira ◽  
...  
Keyword(s):  
Chemical Composition ◽  
Chemical Nature ◽  
Scientific Evidence ◽  
Scientific Data ◽  
Attractive Alternative ◽  
Chemical Profile ◽  
Traditional Use ◽  
Starting Point ◽  
Scientific Approach ◽  
Food Applications

Tannins are polyphenolic compounds historically utilized in textile and adhesive industries, but also in traditional human and animal medicines or foodstuffs. Since 20th-century, advances in analytical chemistry have allowed disclosure of the chemical nature of these molecules. The chemical profile of extracts obtained from previously selected species was investigated to try to establish a bridge between traditional background and scientific data. The study of the chemical composition of these extracts has permitted us to correlate the presence of tannins and other related molecules with the effectiveness of their apparent uses. The revision of traditional knowledge paired with scientific evidence may provide a supporting background on their use and the basis for developing innovative pharmacology and food applications based on formulations using natural sources of tannins. This traditional-scientific approach can result useful due to the raising consumers’ demand for natural products in markets, to which tannin-rich extracts may pose an attractive alternative. Therefore, it is of interest to back traditional applications with accurate data while meeting consumer’s acceptance. In this review, several species known to contain high amounts of tannins have been selected as a starting point to establish a correlation between their alleged traditional use, tannins content and composition and potential bioaccessibility.

scholarly journals Objectivation of an Educational Model in Cranial Osteopathy Based on Experience

Medicina ◽  
2021 ◽  
Vol 57 (3) ◽  
pp. 246
Author(s):  
Jesús Requena-García ◽  
Evelyn García-Nieto ◽  
David Varillas-Delgado
Keyword(s):  
Scientific Evidence ◽  
Correlation Coefficients ◽  
Lateral Compression ◽  
Educational Model ◽  
Reliability Study ◽  
Intra Class Correlation ◽  
Observer Reliability ◽  
Fundamental Part ◽  
Manual Palpation ◽  
Base Of The Skull

Background and Objectives: The techniques directed to the cranial field in osteopathy are the most questioned due to the lack of scientific evidence. In osteopathic practice, manual palpation is essential and, therefore, measuring reliability is fundamental. The objective of this study is to assess the precision and objectification of an educational model in cranial osteopathy based on experience. Materials and Methods: A reliability study was conducted in a cadaver skull where a strain gauge was placed on the sphenobasilar synchondrosis (SBS) of the base of the skull. Three cranial osteopathic techniques (lateral compression, anteroposterior compression, and compression maneuver of the mastoids) were performed 25 times by osteopaths with different degrees of experience (5–10 years, 1–5 years, <1 year). Measurements were computed for each of the three techniques of each group in comparison with the osteopath with >15 years of experience. Data were analyzed to check for inter- and intra-observer reliability using intra-class correlation coefficients (ICC). Results: Reliability in osteopaths with 5–10 years’ experience (observer 1 and observer 2) performing all three techniques was higher (p < 0.001) than the osteopath with >15 years’ experience. Little or no reliability were observed in osteopaths with less experience. Conclusions: The experience of the osteopaths determines the reliability and effectiveness of the cranial techniques, a fundamental part in objectifying these techniques. This model can help implement objective training in cranial osteopathy formation.

Scientific basis of the System for Analysis of Validity in Evaluation: The SAVE Metaprotocol.

2021 ◽  
Vol 2 (2) ◽  
pp. 3679-3684
Author(s):  
Antonio Domínguez-Muñoz
Keyword(s):  
Disability Pension ◽  
Scientific Evidence ◽  
Daily Practice ◽  
Scientific Basis ◽  
Third Party ◽  
Significant Advance ◽  
Fraud Triangle ◽  
Clinical Context ◽  
Academic Knowledge ◽  
Flexible Application

There are multiple situations, often related to the administrative or judicial field, in which it is necessary to use a healthy skepticism, to question the validity of an assertion, appealing to the evidence that can prove or disprove it. (Shermer, 2008). From a child custody issue to facing a harsh criminal conviction, to applying for a disability pension or obtaining an indemnity in an insurance context; in all of them, there is the opportunity to use deception for one's own benefit, harming a third party, through fraud. As we know, opportunity, together with prior motivation or incentive and subsequent justification, constitute the classic fraud triangle proposed by Cressey (1961).             This questioning of the validity of the case understood as its accuracy or correspondence with what it pretends to be and independently of its various types, is only possible from a method of analysis based on scientific evidence that benefits from using a system ordered by rules for the investigation - which we know as a protocol (Amezcua, 2000) - as well as a multiple approaches (Campbell and Fiske, 1959) that is proportionate to a conception of the detection and demonstration of deception from the approach of complexity (Cardozo, 2011). If, in addition, such a system was sufficiently flexible to be useful in the daily practice of the various fields in which it may be necessary to use it, it could represent a significant advance in this area.             These, together with those of Behavior Analysis in Ethology, Criminology, and Psychology, are the initial theoretical bases on which the System of Analysis of Validity in Evaluation (SAVE) is designed, establishing four phases in two domains of multiple and orderly but flexible application, to scientifically question the validity of a case and provide it with consistency and even legal value when appropriate. Although SAVE was born in a clinical context (Domínguez-Muñoz et al., 2014) its main area of knowledge is the study of lying and deception, an area in which there is a large bibliography, somewhat dispersed among various disciplines, which must be incorporated as a source of academic knowledge for its use in the applied field (Domínguez-Muñoz et al., 2017).    

scholarly journals Evidence-Based Medicine in judicial decisions concerning right to healthcare

2016 ◽  
Vol 14 (1) ◽  
pp. 1-5 ◽  
Author(s):  
Eduardo Rocha Dias ◽  
Geraldo Bezerra da Silva Junior
Keyword(s):  
Health Insurance ◽  
Evidence Based Medicine ◽  
Private Health Insurance ◽  
Scientific Evidence ◽  
Federal Court ◽  
Public Healthcare ◽  
Evidence Based ◽  
Unified Health System ◽  
The Individual ◽  
Based Medicine

ABSTRACT Objective To analyze, from the examination of decisions issued by Brazilian courts, how Evidence-Based Medicine was applied and if it led to well-founded decisions, searching the best scientific knowledge. Methods The decisions made by the Federal Courts were searched, with no time limits, at the website of the Federal Court Council, using the expression “Evidence-Based Medicine”. With regard to decisions issued by the court of the State of São Paulo, the search was done at the webpage and applying the same terms and criterion as to time. Next, a qualitative analysis of the decisions was conducted for each action, to verify if the patient/plaintiff’s situation, as well as the efficacy or inefficacy of treatments or drugs addressed in existing protocols were considered before the court granted the provision claimed by the plaintiff. Results In less than one-third of the decisions there was an appropriate discussion about efficacy of the procedure sought in court, in comparison to other procedures available in clinical guidelines adopted by the Brazilian Unified Health System (Sistema Único de Saúde) or by private health insurance plans, considering the individual situation. The majority of the decisions involved private health insurance plans (n=13, 68%). Conclusion The number of decisions that did consider scientific evidence and the peculiarities of each patient was a concern. Further discussion on Evidence-Based Medicine in judgments involving public healthcare are required.

scholarly journals How effective is dog culling in controlling zoonotic visceral leishmaniasis? a critical evaluation of the science, politics and ethics behind this public health policy

2011 ◽  
Vol 44 (2) ◽  
pp. 232-242 ◽  
Author(s):  
Carlos Henrique Nery Costa
Keyword(s):  
Visceral Leishmaniasis ◽  
Control Measure ◽  
Scientific Evidence ◽  
Critical Evaluation ◽  
Scientific Data ◽  
Ethical Considerations ◽  
Brazilian Government ◽  
Kala Azar ◽  
Scientific Results

INTRODUCTION: Zoonotic kala-azar, a lethal disease caused by protozoa of the genus Leishmania is considered out of control in parts of the world, particularly in Brazil, where transmission has spread to cities throughout most of the territory and mortality presents an increasing trend. Although a highly debatable measure, the Brazilian government regularly culls seropositive dogs to control the disease. Since control is failing, critical analysis concerning the actions focused on the canine reservoir was conducted. METHODS: In a review of the literature, a historical perspective focusing mainly on comparisons between the successful Chinese and Soviet strategies and the Brazilian approach is presented. In addition, analyses of the principal studies regarding the role of dogs as risk factors to humans and of the main intervention studies regarding the efficacy of the dog killing strategy were undertaken. Brazilian political reaction to a recently published systematic review that concluded that the dog culling program lacked efficiency and its effect on public policy were also reviewed. RESULTS: No firm evidence of the risk conferred by the presence of dogs to humans was verified; on the contrary, a lack of scientific support for the policy of killing dogs was confirmed. A bias for distorting scientific data towards maintaining the policy of culling animals was observed. CONCLUSIONS: Since there is no evidence that dog culling diminishes visceral leishmaniasis transmission, it should be abandoned as a control measure. Ethical considerations have been raised regarding distorting scientific results and the killing of animals despite minimal or absent scientific evidence

Malnutrition–Inflammation Score is a Useful Tool in Peritoneal Dialysis Patients

2006 ◽  
Vol 26 (6) ◽  
pp. 705-711 ◽  
Author(s):  
Bariş Afşar ◽  
Siren Sezer ◽  
Fatma Nurhan Ozdemir ◽  
Huseyin Celik ◽  
Rengin Elsurer ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Assessment Tool ◽  
Clinical Laboratory ◽  
Correlation Coefficients ◽  
Severe Malnutrition ◽  
Maintenance Hemodialysis ◽  
Anthropometric Parameters ◽  
Mortality And Morbidity ◽  
Moderate Malnutrition ◽  
Inflammation Score

Background Malnutrition–Inflammation Score (MIS) is a quantitative assessment tool based on Subjective Global Assessment (SGA) and predicts mortality and morbidity in maintenance hemodialysis patients. However, there are not enough data about the use of MIS in peritoneal dialysis (PD). In this study, relationships between MIS and prospective hospitalization indices, risk of developing peritonitis, anemia indices, and laboratory and anthropometric parameters were analyzed and compared with SGA in PD. Methods 50 PD patients (M/F 26/24, age 45.2 ± 14.9 years, mean PD duration 30.8 ± 23.1 months) were included. The same physician performed the SGA and MIS evaluations. Clinical, laboratory, and anthropometric parameters were measured. Results 18 patients were classified as SGA-A (without malnutrition), 24 as SGA-B (with moderate malnutrition), and 8 as SGA-C (with severe malnutrition). Increment in MIS was concordant with SGA groups A to C ( p < 0.0001). Peritonitis rate, number of hospitalizations, total number of hospitalization days, erythropoietin requirements, C-reactive protein (CRP), and ferritin levels were positively correlated with MIS ( p < 0.0001). Midarm muscle circumference ( p = 0.04), albumin ( p < 0.0001), prealbumin ( p = 0.001), creatinine ( p = 0.04), hemoglobin ( p = 0.003), transferrin ( p < 0.0001), and cholesterol ( p = 0.009) were negatively correlated with MIS. Correlation coefficients of hospitalization indices, peritonitis rate, anemia indices, erythropoietin requirements, albumin, prealbumin, CRP, and anthropometric parameters were higher with MIS than with SGA. In logistic regression analysis, a higher MIS was independently associated with a higher risk of future hospitalization ( p = 0.029, odds ratio 2.14, confidence interval 1.082 – 4.146). Conclusions This study demonstrated that MIS significantly correlated with clinical, nutritional, inflammatory, and anthropometric parameters and anemia indices in PD patients, and that those correlations were stronger than those with SGA.

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