Nutrient Intake in Postmenopausal Rheumatoid Arthritis Women with Osteoporosis: Results from the Korean National Health and Nutrition Examination Survey

OBJECTIVE: Osteoporosis (OP) is one of the principal comorbidities in women with rheumatoid arthritis (RA). Proper nutrition for these patients is required not only to improve bone health but to better manage their chronic illness. Thus, our aim was to assess the status of key nutrient intake in postmenopausal RA women with OP. METHODS: Using cross-sectional data of 4,933 postmenopausal women in the Korean National Health and Nutrition Examination Survey (K-NHANES IV, V) conducted between 2008 and 2011, we investigated the daily nutrient intake in RA subjects and their bone mineral density (BMD). We examined the association of nutrient intake and BMD after adjusting age, level of education, body mass index, family history, alcohol use, and total calorie intake in the osteoporosis, osteopenia, and normal BMD group using multivariable linear regression. RESULTS: We included 222 RA women and 320 controls whose BMD and T-score data were available. Low calcium and phosphorous intake were associated with reduced BMD T-scores in postmenopausal RA women. Additionally, β-carotene, potassium, riboflavin, and vitamin C intake were significantly lower in RA women with OP. Multivariable linear regression analysis showed a strong positive association of intake of β-carotene, potassium, riboflavin, and calcium with higher T-scores at the lumbar spine, femur neck, and total hip (all p<0.0001, respectively). CONCLUSION: We found insufficient intake of nutrients such as β-carotene, potassium, riboflavin, and vitamin C in Korean postmenopausal RA women with low BMD. Dietary counseling and recommendations are warranted for these subjects to attain better bone health.

Development of Resilience Scale for Nurses / 기본간호학회지

PURPOSE: This study was done to develop a measure resilience in nurses. METHODS: Forty preliminary items were extracted from a view of the literature on concept analysis and scale development, and from in-depth interviews with nurses. These items were examined for content validity, reliability and validity. The scale was verified with 496 nurses working in three advanced general hospitals located in Seoul and Gyeonggido. RESULTS: Factor analysis resulted in the creation of the final scale, which consisted of 30 items that were grouped into 5 factors: dispositional pattern, relational pattern, situational pattern, philosophical pattern and professional pattern. The explanatory variance was 56.25%. The reliability of the scale was Cronbach's alpha = .95. Correlation of the scale with the Korean version of the Connor-Davidson Resilience Scale (K-CD-RISC), established its construct and concurrent validity (r=.74, p<.001). CONCLUSION: The resilience scale for nurses was found to have reliability and validity, and as developed in this study reflects nurses' disposition and was confirmed as a basis for developing and evaluating programs to increase nurses' resilience.

Malignant-looking thyroid nodules with size reduction: core needle biopsy results

PURPOSE: The aim of this study was to evaluate whether malignant-looking thyroid nodules with size reduction were malignant or not. METHODS: From November 2010 to July 2011, we retrospectively enrolled 16 patients with 16 nodules (11 females and five males; mean age, 55 years) who underwent core needle biopsy (CNB), and whose thyroid nodules had malignant ultrasonographic (US) features, although they showed size reduction (>20% decrease in maximum diameter) during the follow-up period (mean, 37±27 months). The histologic findings of the CNB specimen were reviewed and correlated with the US findings. US studies were analyzed for their internal content, shape, margin, echogenicity, the presence of microcalcification and macrocalcification, inner isoechoic rim, and low-echoic halo. RESULTS: All nodules were confirmed as benign by CNB. Pathologic analysis was available for 12 CNB specimens. US imaging showed central hypoechogenicity or marked hypoechogenicity in all cases and a peripheral isoechoic rim in 15 nodules. US-pathologic correlation showed that the central hypoechoic area was primarily composed of fibrosis (12/12) and hemorrhage (8/12) and that the isoechoic rim was composed of follicular cells. CONCLUSION: In our study, the CNB results of all of the malignant-looking thyroid nodules with size reduction were benign and were primarily composed of internal fibrosis and hemorrhage. Understanding these US and pathologic features could prevent repeated fine-needle aspiration or unnecessary diagnostic surgery.

Development of Korean Intensive Care Delirium Screening Tool (KICDST)

PURPOSE: This study was done to develop of the Korean intensive care delirium screening tool (KICDST). METHODS: The KICDST was developed in 5 steps: Configuration of conceptual frame, development of preliminary tool, pilot study, reliability and validity test, development of final KICDST. Reliability tests were done using degree of agreement between evaluators and internal consistency. For validity tests, CVI (Content Validity Index), ROC (Receiver Operating Characteristics) analysis, known group technique and factor analysis were used. RESULTS: In the reliability test, the degree of agreement between evaluators showed .80~1.00 and the internal consistency was KR-20=.84. The CVI was .83~1.00. In ROC analysis, the AUC (Area Under the ROC Curve) was .98. Assessment score was 4 points. The values for sensitivity, specificity, correct classification rate, positive predictive value, and negative predictive value were found to be 95.0%, 93.7%, 94.4%, 95.0% and 93.7%, respectively. In the known group technique, the average delirium screening tool score of the non-delirium group was 1.25+/-0.99 while that of delirium group was 5.07+/-1.89 (t= - 16.33, p <.001). The factors were classified into 3 factors (cognitive change, symptom fluctuation, psychomotor retardation), which explained 67.4% of total variance. CONCLUSION: Findings show that the KICDST has high sensitivity and specificity. Therefore, this screening tool is recommended for early identification of delirium in intensive care patients.

Long Term Follow-up Study of Patients with Kawasaki Disease

PURPOSE: To investigate the long-term prognosis of patients with Kawasaki disease in Korea, and discuss the need for long-term follow-up. METHODS: The subjects were 48 patients among 354 who had been hospitalized due to Kawasaki disease, and who consented to echocardiography and exercise challenge testing. The mean duration from the onset of disease to follow-up testing after rehospitalization was 11.6 years (8.2-17.0). Patients without coronary artery aneurysms at the initial presentation of the disease were classified in group 1, and patients with small aneurysms were in group 2. Test abnormalities and differences between the two groups were analyzed. RESULT: There were no significant differences in the results of follow-up echocardiography and exercise challenge testing between the two groups. Although no abnormal findings were noted at follow-up in most patients, a 9-year-old boy in group 2 showed coronary artery dilation. The exercise test indicated normal results in both groups, and echocardiography results were also normal in 100% of cases in group 1 and 93.3% of cases in group 2. CONCLUSIONS: As some patients with coronary aneurysms showed coronary artery dilation, we believe that long-term follow-up may be selectively required in patients with coronary artery complications.

Is Diffusion-Weighted MRI Useful for Differentiation of Small Non-Necrotic Cervical Lymph Nodes in Patients with Head and Neck Malignancies?

OBJECTIVE: To evaluate the usefulness of measuring the apparent diffusion coefficient (ADC) in diffusion-weighted magnetic resonance imaging to distinguish benign from small, non-necrotic metastatic cervical lymph nodes in patients with head and neck cancers. MATERIALS AND METHODS: Twenty-six consecutive patients with head and neck cancer underwent diffusion-weighted imaging (b value, 0 and 800 s/mm2) preoperatively between January 2009 and December 2010. Two readers independently measured the ADC values of each cervical lymph node with a minimum-axial diameter of > or = 5 mm but < 11 mm using manually drawn regions of interest. Necrotic lymph nodes were excluded. Mean ADC values were compared between benign and metastatic lymph nodes after correlating the pathology. RESULTS: A total of 116 lymph nodes (91 benign and 25 metastatic) from 25 patients were included. Metastatic lymph nodes (mean +/- standard deviation [SD], 7.4 +/- 1.6 mm) were larger than benign lymph nodes (mean +/- SD, 6.6 +/- 1.4 mm) (p = 0.018). Mean ADC values for reader 1 were 1.17 +/- 0.31 x 10-3 mm2/s for benign and 1.25 +/- 0.76 x 10-3 mm2/s for metastatic lymph nodes. Mean ADC values for reader 2 were 1.21 +/- 0.46 x 10-3 mm2/s for benign and 1.14 +/- 0.34 x 10-3 mm2/s for metastatic lymph nodes. Mean ADC values between benign and metastatic lymph nodes were not significantly different (p = 0.594 for reader 1, 0.463 for reader 2). CONCLUSION: Measuring mean ADC does not allow differentiating benign from metastatic cervical lymph nodes in patients with head and neck cancer and non-necrotic, small lymph nodes.

Angioarchitecture of Spinal Dural Arteriovenous Fistula - Evaluation with 3D Rotational Angiography / 신경중재치료의학

PURPOSE: The complex angioarchitecture of spinal dural arteriovenous fistulas (SDAVFs) sometimes preclude angiographic analyses or superselective procedures. Therefore, the effectiveness of 3 dimensional rotational angiography (3DRA) as a detailed imaging technique for SDAVFs was evaluated. MATERIALS AND METHODS: Of 57 patients with spinal vascular malformations, recent 13 SDAVF patients underwent 3DRA. The advantage of 3DRA compared to digital subtraction angiography (DSA) in imaging SDAVF was assessed. Angioarchitecture of SDAVF was focused on location, number, and course of feeders and draining vein. Appropriate angled views were also selected to reveal the segmental artery and feeders. RESULTS: 3DRA technique provided additional information for imaging evaluation of SDAVFs compared to DSA; the presence of multiple feeders, including their transdural portions, as well as their courses. The contralaterally angled anterior-oblique-caudal (spider) view showed the radicular feeder by separating the intercostal artery and the dorsal muscular branch. The bottom-to-up (tunnel) view was useful for revealing the location (ventral vs. dorsal) including sharp medial turn of the dural feeder. The dual mode, which displays both vessels and bones, revealed the course of the feeders and the fistula related to the spinal bony column. CONCLUSION: Because spinal vasculature overlaps in DSA, 3DRA revealed additional information for evaluations of the number and transdural course of fistular feeders in SDAVFs, and it offers working angles to obtain appropriate views.

A Structural Equation Model on Health Behavior Adherence for Elders with Prehypertension: Based on Self-Determination Theory / 기본간호학회지

PURPOSE: The purpose of this study was to develop and test a hypothetical model which explains health behavior adherence in elderly people with prehypertension. The model was based on self-determination theory (SDT). METHODS: Data were collected from June 21 to July 15, 2010, using self-report questionnaires. The participants were 140 elders with prehypertension who lived in D Metropolitan City. Collected data were analyzed using PASW 18.0 for descriptive statistics and correlation analysis and AMOS 5.0 for covariance structure analysis. RESULTS: It appeared that the overall fit index was good with a chi2 score of 13.23 (p<0.05), GFI of 0.97, AGFI of 0.79 and RMR of 0.28 in the modified model. The results revealed that significant main effects of both health provider's autonomy support and autonomous motivations were found on the measure of health behavior adherence. These factors explained 72% of variance in the participants, health behavior adherence. CONCLUSION: The overall findings may provide useful assistance in developing effective motivation-enhanced programs for health behavior adherence.

Enhancement Pattern of the Normal Facial Nerve on Three - Dimensional (3D) - Fluid Attenuated Inversion Recovery (FLAIR) Sequence at 3.0 T MR Units

PURPOSE: To compare the enhancement pattern of normal facial nerves on 3D-FLAIR and 3D-T1-FFE-F) sequences at 3.0 T MR units. MATERIALS AND METHODS: We assessed 20 consecutive subjects without a history of facial nerve abnormalities who underwent temporal bone MRI with contrast enhancement between January 2008 and March 2009. Two neuroradiologists independently reviewed pre-/post-enhanced 3D-T1-FFE-FS and 3D-FLAIR images respectively with 2-week interval to assess the enhancement of normal facial nerves divided into five anatomical segments. The degree of enhancement in each segment was graded as none, mild or strong, and the results of 3D-FLAIR and 3D-T1-FFE-FS image sets were compared. RESULTS: On 3D-FLAIR images, one of the two reviewers observed mild enhancement of the genu segment in two (10%) subjects. On 3D-T1-FFE-FS images, at least one segment of the facial nerve was enhanced in 13 (65%) subjects. At least one reviewer found that 17 of the 100 segments showed enhancement on 3D-T1-FFE-FS images, with the mastoid segment being the most commonly enhanced. Interobserver agreement on 3D-T1-FFE-FS images was good for enhancement of the normal facial nerve (kappa= 0.589). CONCLUSION: In contrast to 3D-T1-FFE-FS, normal facial nerve segments rarely showed enhancement on 3D-FLAIR images.

Impact of Critical Thinking Disposition, General Self-Efficacy, and Leadership on Clinical Competence in Nursing Students / 한국의학교육

PURPOSE: The purpose of this study was to evaluate the relationships among critical thinking disposition, general self-efficacy, leadership and clinical competence, and identify the factors influencing clinical competence in nursing students. METHODS: In this descriptive study, 153 nursing students (from 2nd to 4th school year) of a university in South Korea were enrolled in December 2010. The instruments for this study were the Korean versions of the Critical Thinking Disposition Scale, General Self-Efficacy Scale, Leadership Inventory, and Clinical Competence Scale. Data were analyzed by descriptive statistics, t-test, MANOVA, Pearson correlation, and multiple linear regression with PASW 18.0 software. RESULTS: The mean scores (ranging from 1 to 5) in nursing students for critical thinking disposition, general self-efficacy, leadership, and clinical competence were 3.44, 3.51, 3.55, and 3.42, respectively. Positive correlations were found for clinical competence with critical thinking disposition, general self-efficacy, and leadership. The strongest predictor of clinical competence was leadership. In addition, leadership, nursing school year, and subjective academic achievement accounted for 34.5% of variance in clinical competence. CONCLUSION: This study revealed that developing leadership, critical thinking disposition, and self-efficacy in undergraduate nursing education is important to improve clinical competence of nursing students.

The Use of Protection Device in Landmark-wire Technique of Symptomatic Subclavian Artery Occlusion with Combined Approach via Trans-femoral vs. Trans-brachial Arteries: Technical note / 신경중재치료의학

PURPOSE: Since we reported about a landmark technique to reopen an occluded subclavian artery, we have faced difficulty in using protection devices in the vertebral artery to protect against thromboembolism from the reversed steal phenomenon after angioplasty and stenting. Therefore, we are presenting an optimal solution in using a protection device while recanalizing the occluded subclavian artery. MATERIALS AND METHODS: Among 21 cases of stenting for subclavian artery steno-occlusion, we applied the landmark technique at the opposite end of an occluded segment in 4 patients and used a protection device in two patients. Because the embolic protection device was placed in the vertebral artery via the brachial artery, optimal angioplasty and stenting via the brachial route were limited. Therefore, angioplasty via the trans-brachial approach was needed to be followed by stenting through a trans-femoral approach. We estimated the safe and optimal steps for placement and retrieval of the protection devices in addition to stenting. RESULTS: The procedure was safely performed when a stent was introduced via the femoral artery and a protection device was used via the brachial artery. However, in cases when a guidewire wasn't passed via the transfemoral route, simultaneous use of two systems via the brachial route could cause friction of devices or trapping of protection devices in a stent. When a protection device was trapped in a deployed stent, we retrieved the protection device with a 4F angiocatheter by selectively rotating the catheter tip. To avoid such procedural difficulty, we recommend using a transbrachial angioplasty followed by trans-femoral stenting while placing the protection device in the vertebral artery via the trans-brachial route. CONCLUSION: If a guidewire is not passed through using a trans-femoral approach while performing the landmark technique, changing the stenting route from brachial to the femoral artery can be useful after securing the lumen in the occluded subclavian artery after angioplasty via the brachial artery.

Treatment Strategy Based on Multimodal Management Outcome of Cavernous Sinus Dural Arteriovenous Fistula (CSDAVF) / 신경중재치료의학

PURPOSE: Angiographic finding including venous drainage pattern should be correlated to the presenting symptom pattern (SxP) in CSDAVF. We present outcome of CSDAVF management and suggest a strategy according to SxP and type of treatment based on our experience. MATERIALS AND METHODS: We evaluated SxP, angiographic type (proliferative, restrictive or late restrictive), mode of treatment (embolization, Gamma Knife Radiation (GKR) or conservative management), mode of embolization (transarterial or transvenous), and final clinical status (cure, improvement, aggravation or no change). Ninety consecutive patients were included from a prospective database. The mean follow-up was 17 months. We compared the outcomes according to SxP, angiographic type, mode of treatment, and embolization using the chi-square or Fisher's exact test. RESULTS: Ninety patients with 34 proliferative, 40 restrictive, and 16 late restrictive types of CSDAVF were treated by embolization (n = 63), GKR (n = 7), and conservative management (n = 20). Cure or improvement was 91% after embolization, 88% after conservative management, and 72% after GKR. Following embolization, 100% of 24 proliferative types, 87% of 30 restrictive types, and 90% of 10 late restrictive types were cured or improved. Cure or improvement after transvenous embolization was 98% (43/44) compared with 88% (15/17) after transarterial embolization (p = 0.003). CONCLUSION: Various factors of SxP, angiographic type, and mode of treatment should be considered in order to obtain a more favorable outcome for patients with CSDAVF. Embolization via venous approach tended to result in a more complete cure than that via arterial approach.

Bilateral Inferior Petrosal Sinus Sampling by Unilateral Femoral Venous Approach / 신경중재치료의학

PURPOSE: Bilateral inferior petrosal sinus sampling (IPSS) is a direct method of distinguishing between pituitary and ectopic ACTH secretion. We present unilateral femoral route technique avoiding bilateral femoral venous puncture using two 4F catheters into both sides of IPSS in these obese patients. MATERIALS AND METHODS: Unilateral femoral puncture using 9F guiding catheter allowed two 4F catheters which can be introduced in each side of inferior petrosal sinus. To reduce bleeding in the gap between 2 catheters at the diaphragm of the 9F femoral sheath, we introduced a short guidewire provided along with femoral sheath. After removing the 9F sheath after procedure, we applied manual compression as usual. We evaluated any technical difficulty and other complications including the presence of hematoma at the puncture site 1 day and 30 days later. RESULTS: Bilateral IPSS by using two 4F catheters in both inferior petrosal sinuses was possible via unilateral femoral route via 9F sheath. There was no technical difficulty introducing 4F catheters into each IPS of both sides. After removing 9F femoral sheath, there was no other complication and no hematoma at the puncture site at 1 day and 30 days later. CONCLUSION: Unilateral femoral venous approach with a 9-French sheath can be used in IPSS. This technique allowed to pass two 4F catheters for IPSS at both sides and could avoid unnecessary bilateral femoral puncture in these obese patients without any hematoma formation after the procedure.

Bilateral Extraocular Muscle Metastasis of Nasal Rhabdomyosarcoma Mimicking a Thyroid Associated Orbitopathy: A Case Report

Metastases to the orbit usually affect the intraorbital fat and bone than the extraocular muscles. Metastasis to the extracoular muscles commonly occurs unilaterally, and diffuse enlargement of the bilateral extraocular muscles due to metastasis is extremely rare. In this report, we will describe a case of diffuse metastasis to the bilateral extraocular muscles from nasal rhabdomyosarcoma masquerading as thyroid associated orbitopathy. We will also discuss about the MR imaging findings helpful for differential diagnosis from thyroid associated orbitopathy.

Validation of the Korean Version of the General Practitioner Assessment of Cognition (K-GPCog) / 재활간호학회지

PURPOSE: The purpose of this study was to examine the psychometric properties of the Korean version of the General Practitioner Assessment of Cognition (K-GPCog) scale. METHOD: The K-GPCog consists of the 2 subscales, patients and caregivers. Using a sample of 412 community-based Korean older adults, internal consistency reliability was estimated using Cronbach's alpha. To evaluate validity of the K-GPCog, correlational analysis was conducted using Pearson r between K-GPCog and the Korean Dementia Screening Questionnaire (KDSQ). RESULTS: Cronbach's alpha coefficients of the K-GPCog patients' and caregivers' subscales .788 and .794 respectively. Pearson's correlation coefficients were r=-.374, r=-.481, and r=-.493, respectively for the subscales of patients and primary caregivers, and total K-GPCog. The degree of diagnostic agreement about the risk for cognitive disorders of older adults showed 11.7% and 11.2% respectively for the K-GPCog and the KDSQ. CONCLUSION: The findings provided preliminary evidence of the K-GPCog as a useful screening measure for detecting mild cognitive disorders of Korean older adults. The K-GPCog is particularly useful to identify cognitive disorders from primary caregivers when it is difficult to assess the level of cognition of older adults.

Analysis of Family Function and Mental Health State for Low-income Middle-aged Women / 재활간호학회지

PURPOSE: The purpose of this study was to identify the types of family function and mental health in low-income middle aged women using the circumplex model. METHOD: A descriptive research design was used. A sample of 116 low income middle aged women participated in the study. The Family Adaptability and Cohesion Evaluation Scale III was used to measure the types of family function. Mental health was measured by the SCL. RESULTS: The types of family function identified were balance family (59.4%), extreme family (25.9%), and mid-range family (14.7%). Significant differences were found in mental health by the family cohesion (F=3.44, p=.019) and family adaptability (F=3.31, p=.023). The mental health status of extreme family was better than mid-range family and balanced family, but such result was not statistically significant (F=0.25, p=.783). CONCLUSION: The Circumplex model's main hypothesis was not empirically supported that extreme family has more problematic than mid-range family and balance family. These findings emphasize the need for the development of a family system model for Korean family.

Computational Flow Dynamics Study in Severe Carotid Bulb Stenosis with Ulceration / 신경중재치료의학

PURPOSE: Computational fluid dynamics (CFD) applications for atherosclerotic carotid stenosis have not been widely used due to limited resolution in the severely stenotic lumen as well as small flow dimension in the stenotic channel. MATERIALS AND METHODS: CT data in DICOM format was transformed into 3 dimensional (3D) CFD model of carotid bifurcation. For computational analysis of blood flow in stenosis, commercial finite element software (ADINA Ver. 8.5) was used. The blood flow was assumed to be laminar, viscous, Newtonian, and incompressible. The distribution of wall shear stress (WSS), peak velocity and pressure across the average systolic and diastolic blood pressures permitted construction of a contour map of the velocity in each cardiac cycle. RESULTS: Computer simulation of WSS, flow velocity and wall pressure could be demonstrated three dimensionally according to flow vs. time dimension. Such flow model was correlated with angiographic finding related to maximum degree of stenosis associated with ulceration. Combination of WSS map and catheter angiogram indicated that the highest WSS corresponded to the most severely stenotic segment at systolic phase, whereas ulceration, which is the weakest point of the plaque, appeared at the downstream side of the carotid bulb stenosis. CONCLUSION: Our preliminary study revealed that 3D CFD analysis in carotid stenosis was feasible from CT angiography source image and could reveal WSS, flow velocity and wall pressure in the severe carotid bulb stenosis with ulceration. Further CFD analysis is warranted to apply such hemodynamic information to the atherosclerotic lesion in the more practical way.

Family Function and Successful Aging for Vulnerable Elderly Based on Circumplex Model / 성인간호학회지

PURPOSE: The objective of this study was to identify the relationships between family function and successful aging of vulnerable elderly using the circumplex model. METHODS: The participants were the elderly (N=401) who were over 65 years old living in H city under the National Livelihood Security Act. Family Adaptability and Cohesion Evaluation Scale III and Successful Aging Instrument were used. RESULTS: The family function perceived by the study subjects was average 43.20 +/- 16.62 out of maximum 100 points. According to the analysis on family types suggested by circumplex model, there were 183 people for balance family (45.6%) and 218 people (54.4%) for extreme family. The total points on successful aging were 1.67 +/- 0.37 out of 3 points. When the difference in points on the Successful Aging instrument were analyzed according to the scores on the Family Adaptability and Cohesion Scale those points of the balanced family were statistically significant (t=2.087, p=.038). CONCLUSION: In case of the balanced family type, the level of perceiving successful aging was relatively higher. For the improvement of family function, it is advised that the successful aging perception among vulnerable elderly can be uplifted through a program that enables effective communication with other family members.

A Meta Analysis on the Effects of Exercise on Bone Mineral Density among Middle-aged and Older Women

PURPOSE: This study was to examine the effectiveness of exercise for bone mineral density (BMD). METHODS: Four investigators reviewed English articles from Pub Med and CINAHL, selecting randomized controlled trials on exercise programs for middle-aged and older women. Out of 25 studies identified, 14 that satisfied with the inclusion criteria were included in the meta-analysis. The quality of the studies was assessed using recognized methods and the effect size was calculated as a Hedges' g using Comprehensive Meta-analysis Version 2.0. Primary outcomes were changes in BMD at femoral neck, trochanter, and lumbar spine. Subgroup analysis included changes in BMD according to exercise style. RESULTS: Weight bearing exercise was effective (Q = 20.1, p > .05, ES = 0.32), and resistance exercise was effective in case of comparing to pre and post intervention (Q = 4.15, p = .98, ES = 0.14). At the femoral neck, 9 study groups were homogeneous and the experimental groups demonstrated a positive effect on BMD (Q = 19.5, p > .05, ES = 0.33). In contrast, marked heterogeneity (Q = 33.3, p < 0.01) was apparent in 7 study groups evaluating trochanter. CONCLUSION: These findings suggest that weight bearing is effective for BMD of the femoral neck, and is relevant to the non-pharmacological treatment of bone loss for middle-aged and older women.

Non-Mass Image-Forming Low Echoic Areas on Breast US: Pathologic Correlation

PURPOSE: We wanted to analyze the mammographic and clinical findings of the non-mass image-forming low echoic areas seen on breast ultrasonography (US) and investigate their pathologic results. MATERIALS AND METHODS: Sixty-nine patients with 72 non-mass image-forming low echoic areas seen on breast US and who had undergone mammography and biopsy were included in this study. The mammographic findings were divided into 2 groups: 1) the negative or probably benign group and 2) the suspicious for malignancy group. The US findings were divided into 3 groups: focal, segmental and diffuse distributions. The clinical findings were divided into 2 groups: the non-palpable and palpable groups. We investigated the pathologic results according to each group. RESULTS: Of the 72 lesions, 49 (68.1%) were benign and 23 (31.9%) were malignant. On the mammography, 42 (93.3%) of the 45 negative or probably benign findings and 7 (25.9%) of 27 suspicious for malignancy findings were pathologically benign (p < 0.001). On the US, 38 (76%) of the 50 focal distributions and 11 (52.4%) of 21 segmental distributions were benign (p = 0.090). Thirty (73.2%) of the 41 nonpalpable lesions and 19 (61.3%) of the 31 palpable lesions were benign (p = 0.609). CONCLUSIONS: A non-mass image-forming low echoic area seen on breast US was malignant at a higher rate when it was found in conjunction with suspicious mammographic finding. There was no significant correlation between the distribution of the non-mass image-forming low echoic areas on US or their palpability and the pathologic results.