Three-dimensional analysis of craniofacial shape in obstructive sleep apnea syndrome using geometric morphometrics / Análisis tridimensional de la forma craneofacial en el síndrome de apnea obstructiva del sueño mediante morfometría geométrica

SUMMARY: Craniofacial morphology is a risk factor for obstructive sleep apnea syndrome. The general aim of this study was to investigate the craniofacial shape differences in adults with and without obstructive sleep apnea syndrome, using geometric morphometric methods. A descriptive study conducted in 106 adult Turkish subjects, consisting of 50 patients with OSAS diagnosed by polysomnography and 56 non-OSAS controls. Three dimensional craniofacial scanning processes were performed on patient subjects on the same day as the PSG. Twelve standard craniofacial landmarks were collected from each subject's 3D craniofacial scan. Geometric morphometric analysis was used to compare the craniofacial shape differences between the OSAS and non-OSAS control groups. No statistically significant difference in terms of general shape in face shapes was found between the OSAS group and control group. However, local significance differences were found. There were significant differences between the groups in some of the interlandmark distances: 11 % of the interlandmark distances were greater in OSAS patients, and 29 % were greater in controls. Greater measured distances in OSAS are concentrated in the nasal region. In the control group, the difference is not concentrated in a specific region. Given the relationship of craniofacial structural alterations and sleep disordered breathing, we hypothesized that inter-landmark distance measurements in the craniofacial anatomy of patients might be predictive of OSA.

RESUMEN: La morfología craneofacial es un factor de riesgo para el síndrome de apnea obstructiva del sueño. El objetivo general de este estudio fue investigar las diferencias de forma craneofacial en adultos con y sin síndrome de apnea obstructiva del sueño utilizando métodos morfométricos geométricos. Un estudio descriptivo realizado en 106 sujetos turcos adultos, de 50 pacientes con SAOS diagnosticados mediante polisomnografía y 56 controles no SAOS. El proceso de escaneo craneofacial tridimensional se realizó en pacientes sujetos el mismo día que el PSG. Se recogieron doce puntos de referencia craneofaciales estándar del escaneo craneofacial 3D de cada sujeto. Se usó el análisis morfométrico geométrico para comparar las diferencias de forma craneofacial entre los grupos de control SAOS y no SAOS. No se encontraron diferencias estadísticamente significativas en términos de forma general en las formas de la cara entre el grupo SAOS y el grupo control. Sin embargo, se encontraron diferencias de significación local. Hubo diferencias significativas entre los grupos en algunas de las distancias interlandmark: el 11 % de las distancias interlandmark fueron mayores en los pacientes con SAOS y el 29 % en los controles. Las mayores distancias medidas en SAOS se concentran en la región nasal. En el grupo de control, la diferencia no se concentra en una región específica. Dada la relación de las alteraciones estructurales craneofaciales y la alteración de la respiración durante el sueño, planteamos la hipótesis de que las mediciones de distancias inter-hito en la anatomía craneofacial de los pacientes podrían ser predictivas de la SAOS.

Can clinical factors be determinants of bone metastases in non-small cell lung cancer?

The aim of this study was to investigate the correlations among symptoms, laboratory findings of bone metastasis and whole body bone scanning [WBBS] and the frequency of occurrence of bone metastases. Hundred and six patients who were diagnosed with non-small cell lung cancer [NSCLC] between June 2001 and September 2005 were investigated retrospectively. Bone pain, detection of bone tenderness on physical examination, hypercalcemia and increased serum alkaline phosphatase were accepted clinical factors of bone metastases. Presence of multiple asymmetric lesions in WBBS was also accepted as bone metastases. Subjects whose clinical factors and WBBS indicated doubtful bone metastases were evaluated with magnetic resonance and/or biopsy. Occurrence of bone metastases was 31.1% among all patients. Bone metastases were determined in 21 [52.5%] of 40 patients who had at least one clinical factor. Asymptomatic bone metastases without any clinical factors were established in 11.3% of all NSCLC patients and 15.3% of 26 operable patients. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of the clinical factors of bone metastases were 63.6, 73.9, 52.5, 81.8 and 70.7% respectively. There was no significant relationship between histologic type and bone metastases. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of WBBS in detection of bone metastases were 96.9, 86.3, 76.2, 98.4, 89.6% respectively. Sensitivity and specificity of the clinical factors of bone metastases are quite low. Routine WBBS prevented futile thoracotomies. Therefore, routine WBBS should be performed in all NSCLC patients, even in the absence of bone-specific clinical factors