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1.
Ultrasound Obstet Gynecol ; 60(4): 559-569, 2022 10.
Article in English | MEDLINE | ID: mdl-35633511

ABSTRACT

OBJECTIVE: To estimate the diagnostic test accuracy of magnetic resonance imaging (MRI) and pelvic floor ultrasound for levator ani muscle (LAM) avulsion in a general parous population, with view to establishing if ultrasound could substitute for MRI to diagnose LAM avulsion. METHODS: This was a cross-sectional study of 135 women 4 years after their first delivery. Signs and symptoms of pelvic floor dysfunction were assessed using validated methods. All women underwent four-dimensional transperineal ultrasound (TPUS), three-dimensional endovaginal ultrasound (EVUS) and MRI. Images were acquired at rest, on pelvic floor muscle contraction (PFMC) and on maximum Valsalva maneuver, and analyzed by two blinded observers. Predefined cut-off values were used to diagnose LAM avulsion. In the absence of a reference standard, latent class analysis (LCA) was used to establish diagnostic test characteristics for LAM avulsion as the primary outcome measure. Secondary outcomes were kappa (κ) agreement between imaging techniques, intraclass correlation coefficients (ICC) for hiatal measurements at rest, on PFMC and on maximum Valsalva maneuver, and the association of LAM avulsion with signs and symptoms of pelvic floor dysfunction. RESULTS: The prevalence of LAM avulsion was 23.0% for MRI, 11.1% for TPUS and 17.8% for EVUS. The prevalence of LAM avulsion using LCA was 15.7%. The sensitivity for LAM avulsion of TPUS (71% (95% CI, 50-90%)) and EVUS (91% (95% CI, 74-100%)) was lower than that of MRI (100% (95% CI, 84-100%)). The specificity of TPUS (100% (95% CI, 97-100%)) and EVUS (95% (95% CI, 91-99%)) was higher than that of MRI (91% (95% CI, 85-97%)). MRI and EVUS had high predictive values for the assessment of major LAM avulsion (positive predictive value (PPV), 95% and negative predictive value (NPV), 100%; PPV, 100% and NPV, 98%, respectively), while TPUS had high predictive values for minor LAM avulsion (PPV, 100% and NPV, 95%). Major LAM avulsion on MRI and EVUS was associated with anterior vaginal wall prolapse, which was not found for TPUS. The agreement in the diagnosis of LAM avulsion (κ, 0.69) and hiatal measurements (ICC, 0.60-0.81) was highest between MRI and EVUS. CONCLUSIONS: Pelvic floor ultrasound can be implemented as a triage test to assess parous women for LAM avulsion because of its high specificity. Ultrasound cannot substitute for MRI because of its lower sensitivity. The predictive ability of ultrasound is moderate for the presence, and very good for the absence, of LAM avulsion. A positive test should be confirmed by a different observer or imaging technique. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.


Subject(s)
Diagnostic Tests, Routine , Pelvic Floor , Cross-Sectional Studies , Female , Humans , Magnetic Resonance Imaging , Pelvic Floor/diagnostic imaging , Pregnancy , Ultrasonography/methods
2.
J Endocrinol Invest ; 42(11): 1353-1360, 2019 Nov.
Article in English | MEDLINE | ID: mdl-31273631

ABSTRACT

PURPOSE: Parathyroid hormone (PTH) concentrations are routinely measured in the diagnosis and management of bone and kidney diseases, but reference ranges can be overestimated if determined in otherwise healthy individuals for whom vitamin D deficiency was not evaluated. We establish PTH reference ranges in apparently healthy, normocalcemic, normophosphatemic individuals categorized by 25-hydroxyvitamin D (25(OH)D) status using the Elecsys® PTH (cobas e 601) and Elecsys® Vitamin D total II electrochemiluminescence immunoassays (cobas e 411). METHODS: This prospective, non-interventional study measured PTH in serum from 653 apparently healthy adults [56.7% female; 68.2% white/Caucasian; 28.6% African American; median age 44 years (range 21-83)] from three diverse geographic sites across the USA during summer and winter months. Subjects were classified by concomitant vitamin D sufficiency (≥ 30 ng/mL), insufficiency (> 20 to < 30 ng/mL) or deficiency (≤ 20 ng/mL). RESULTS: In vitamin D sufficiency, median PTH was 31.9 pg/mL [range (2.5th-97.5th percentile) 17.9-58.6] compared with 35.5 pg/mL (17.0-60.4) for insufficiency, and 39.8 pg/mL (19.5-86.4) for deficiency. A significant inverse relationship was found between PTH and 25(OH)D (P < 0.001). After accounting for vitamin D, potential effects of race or season as covariates were relatively small or absent. CONCLUSIONS: Upper reference limits (URL) for PTH in vitamin D sufficiency/insufficiency were similar and lower than current values. Clinically important PTH elevations were observed in vitamin D deficiency, where revised reference ranges with a higher URL may be appropriate. These data may help to distinguish vitamin D-related PTH elevations from other causes [e.g., primary (normocalcemic) or secondary hyperparathyroidism].


Subject(s)
Biomarkers/blood , Parathyroid Hormone/blood , Vitamin D Deficiency/blood , Vitamin D/blood , Vitamins/blood , Adult , Aged , Aged, 80 and over , Female , Follow-Up Studies , Humans , Male , Middle Aged , Prognosis , Prospective Studies , Reference Values , United States/epidemiology , Vitamin D Deficiency/epidemiology , Young Adult
3.
J Physiol Pharmacol ; 69(2)2018 Apr.
Article in English | MEDLINE | ID: mdl-29980144

ABSTRACT

A strong correlation between raised aldosterone levels and increased risk of thrombotic disorders has been provided. Clinical studies have demonstrated the benefits of the addition of the aldosterone receptor antagonist to the standard therapy with angiotensin-converting enzyme inhibitor in the reduction of cardiovascular events in patients. We suggest that the benefits of this dual renin-angiotensin-aldosterone system (RAAS) blockade may be related to the drug's effects on the hemostatic and oxidative balance. Thus, we investigated the effect of combined spironolactone (SPIRO) and quinapril (QUIN) administration on thrombosis, hemostasis and oxidative stress in hypertensive rats. A two-kidney, one-clip model of renovascular hypertension in Wistar rats was used. QUIN, SPIRO, or QUIN + SPIRO were administered for 10 days. Venous thrombosis was induced by vena cava ligation. Thrombus weight and incidences of thrombosis were assessed. Bleeding time, platelet adhesion, tissue factor (TF), tissue plasminogen activator (t-PA), plasminogen activator inhibitor (PAI-1), thrombin activatable fibrynolysis inhibitor (TAFI), malonyl dialdehyde, and hydrogen peroxide plasma levels were assayed. Aortic expression of NADPH oxidase and superoxidase dismutase were measured. We observed significant RAAS activation associated with hypercoagulability and oxidative stress augmentation in renovascular hypertensive rats. Thrombosis was reduced only in rats treated with QUIN + SPIRO. In all groups, decreases in TF, PAI-1, and TAFI levels were observed, however in the QUIN + SPIRO group those changes were more pronounced. The inhibition of platelet adhesion was also stronger in rats treated with QUIN + SPIRO. The oxidative stress parameters were markedly reduced in rats treated with QUIN or SPIRO, although the most evident changes were observed in the QUIN + SPIRO group. Dual RAAS blockade with aldosterone receptor antagonist and angiotensin-converting enzyme inhibitor provides additional benefits for experimental thrombosis associated with the antiplatelet, anticoagulative, profibrinolytic, and antioxidative effects in renovascular hypertensive rats.


Subject(s)
Angiotensin-Converting Enzyme Inhibitors/therapeutic use , Hypertension/drug therapy , Mineralocorticoid Receptor Antagonists/therapeutic use , Spironolactone/therapeutic use , Tetrahydroisoquinolines/therapeutic use , Venous Thrombosis/drug therapy , Aldosterone/blood , Angiotensin-Converting Enzyme Inhibitors/pharmacology , Animals , Antigens, Tumor-Associated, Carbohydrate/blood , Aorta/drug effects , Aorta/metabolism , Bleeding Time , Blood Pressure/drug effects , Carboxypeptidase B2/blood , Collagen/metabolism , Drug Therapy, Combination , Hypertension/blood , Male , Mineralocorticoid Receptor Antagonists/pharmacology , Plasminogen Activator Inhibitor 1/blood , Platelet Adhesiveness/drug effects , Quinapril , Rats, Wistar , Renin/blood , Spironolactone/pharmacology , Tetrahydroisoquinolines/pharmacology , Tissue Plasminogen Activator/blood , Venous Thrombosis/blood
4.
Ultrasound Obstet Gynecol ; 52(6): 784-791, 2018 Dec.
Article in English | MEDLINE | ID: mdl-29882224

ABSTRACT

OBJECTIVE: To establish the diagnostic test accuracy of two-dimensional (2D) and four-dimensional (4D) transperineal ultrasound (TPUS) for diagnosis of posterior pelvic floor disorders in women with obstructed defecation syndrome (ODS), in order to assess if 4D ultrasound imaging provides additional value. METHODS: This was a prospective cohort study of 121 consecutive women with ODS. Symptoms of ODS and pelvic organ prolapse on clinical examination were assessed using validated methods. All women underwent both 2D- and 4D-TPUS. Imaging analysis was performed by two blinded observers. Posterior pelvic floor disorders were dichotomized into presence or absence, according to predefined cut-off values. In the absence of a reference standard, a composite reference standard was created from a combination of results of evacuation proctography, magnetic resonance imaging and endovaginal ultrasound. Primary outcome measures were diagnostic test characteristics of 2D- and 4D-TPUS for rectocele, enterocele, intussusception and anismus. Secondary outcome measures were interobserver agreement, agreement between the two imaging techniques, and association of severity of ODS symptoms and degree of posterior vaginal wall prolapse with conditions observed on imaging. RESULTS: For diagnosis of all four posterior pelvic floor disorders, there was no difference in sensitivity or specificity between 2D- and 4D-TPUS (P = 0.131-1.000). Good agreement between 2D- and 4D-TPUS was found for diagnosis of rectocele (κ = 0.675) and moderate agreement for diagnoses of enterocele, intussusception and anismus (κ = 0.465-0.545). There was no difference in rectocele depth measurements between the techniques (19.9 mm for 2D vs 19.0 mm for 4D, P = 0.802). Interobserver agreement was comparable for both techniques, although 2D-TPUS had excellent interobserver agreement for diagnosis of enterocele and rectocele depth measurements, while this was only moderate and good, respectively, for 4D-TPUS. Diagnoses of rectocele and enterocele on both 2D- and 4D-TPUS were significantly associated with degree of posterior vaginal wall prolapse on clinical examination (odds ratio (OR) = 1.89-2.72). The conditions observed using either imaging technique were not associated with severity of ODS symptoms (OR = 0.82-1.13). CONCLUSIONS: There is no evidence of superiority of 4D ultrasound acquisition to dynamic 2D ultrasound acquisition for the diagnosis of posterior pelvic floor disorders. 2D- and 4D-TPUS could be used interchangeably to screen women with symptoms of ODS. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.


Subject(s)
Imaging, Three-Dimensional/methods , Intestinal Obstruction/etiology , Pelvic Floor Disorders/diagnostic imaging , Adult , Aged , Aged, 80 and over , Female , Humans , Intestinal Obstruction/diagnostic imaging , Middle Aged , Observer Variation , Pelvic Floor Disorders/complications , Prospective Studies , Sensitivity and Specificity , Ultrasonography
5.
Mol Pharm ; 13(4): 1308-16, 2016 Apr 04.
Article in English | MEDLINE | ID: mdl-26981876

ABSTRACT

The purpose of this paper is to investigate the influence of nanoconfinement on the molecular mobility, as well as on the physical stability, of amorphous ezetimibe drug. Two guest/host systems, ezetimibe-Aeroperl 300 and ezetimibe-Neusilin US2, were prepared and studied using various experimental techniques, such as X-ray diffraction (XRD), differential scanning calorimetry (DSC), and broadband dielectric spectroscopy (BDS). Our investigation has shown that the molecular mobility of the examined anticholesterol agent incorporated into nanopore matrices strongly depends on the pore size of the host system. Moreover, it was found that the amorphous ezetimibe confined in 30 nm pores of Aeroperl 300 has a tendency to recrystallize, while the drug incorporated into the smaller--5 nm--pores of Neusilin US2 is not able to crystallize. It has been shown that this significant stabilization of ezetimibe drug can be achieved by an interplay of three factors: changes in molecular dynamics of the confined amorphous drug, the immobilization effect of pore walls on a part of ezetimibe molecules, and the use of host materials with pores that are smaller than the critical size of the drug crystal nuclei.


Subject(s)
Ezetimibe/chemistry , Aluminum Compounds/chemistry , Calorimetry, Differential Scanning , Magnesium Compounds/chemistry , Molecular Dynamics Simulation , Nanopores , Silicates/chemistry , X-Ray Diffraction
6.
Health Promot Chronic Dis Prev Can ; 35(7): 113-4, 2015 Sep.
Article in English, French | MEDLINE | ID: mdl-26378770

ABSTRACT

In 2012, Canada and other United Nations (UN) Member States endorsed the "Rio Political Declaration on Social Determinants of Health" (Rio Declaration), a non-binding pledge which calls on World Health Organization (WHO) Member States to improve/influence the working and living conditions that affect health and well-being. The Rio Declaration sets out actions to address health inequities in five themes: to adopt better governance for health and development; to promote participation in policy making and implementation; to further reorient the health sector towards reducing health inequities; to strengthen global governance and collaboration; and to monitor and increase accountability. In 2013, following the endorsement of the Rio Declaration, the Government of Canada released a report to begin to document Canadian actions related to its five themes. Building on this first report, and in anticipation of WHO reporting on Member State implementation of the Rio Declaration at the May 2015 World Health Assembly, the Government of Canada developed the report, Rio Political Declaration on Social Determinants of Health: A Snapshot of Canadian Actions 2015, which showcases Canada's recent actions since 2013 contributing to the advancement of the five Rio Declaration themes. The report provides a current picture of the diverse spectrum of activities undertaken across levels of government and sectors to advance health equity and address social determinants of health in Canada, and intends to stimulate global and domestic exchange and uptake of promising practices to advance health equity.


TITRE: Note de synthèse - Déclaration politique de Rio sur les déterminants sociaux de la santé : aperçu des mesures canadiennes de 2015. INTRODUCTION: En 2012, le Canada et d'autres États membres des Nations unies ont adopté la Déclaration politique de Rio sur les déterminants sociaux de la santé (Déclaration de Rio), un engagement non contraignant par lequel les États membres de l'Organisation mondiale de la santé (OMS) promettent d'améliorer les conditions de travail et de vie qui influent sur la santé et le bien-être. La Déclaration de Rio énonce plus précisément cinq engagements visant à réduire les inégalités en santé : adopter une meilleure gouvernance pour la santé et le développement, promouvoir la participation à l'élaboration et à la mise en oeuvre des politiques, réorienter davantage le secteur de la santé pour réduire les inégalités en santé, renforcer la gouvernance et la collaboration mondiales et enfin suivre les progrès et accroître la responsabilisation. En 2013, à la suite de l'adoption de la Déclaration de Rio, le gouvernement du Canada a publié un premier rapport pour rendre compte des mesures prises. En 2015, en prévision de la présentation d'un rapport par l'OMS sur la mise en oeuvre de la Déclaration de Rio par les États membres à l'Assemblée mondiale de la santé en mai et en s'appuyant sur ce premier rapport, le gouvernement du Canada a rédigé le rapport Déclaration politique de Rio sur les déterminants sociaux de la santé : aperçu des mesures canadiennes de 2015, qui présente les mesures relevant des cinq engagements de la Déclaration et prises depuis 2013 par le Canada. Ce rapport donne un aperçu des activités entreprises par les différents ordres de gouvernement et secteurs pour promouvoir l'équité en santé et agir sur les déterminants sociaux de la santé. Il vise de plus à encourager la mise en commun et l'adoption de pratiques prometteuses visant à promouvoir l'équité en santé à l'échelle nationale et internationale.


Subject(s)
Social Determinants of Health , Canada , Health Status Disparities , Healthcare Disparities , Humans , International Cooperation , Politics , United Nations , Vulnerable Populations , World Health Organization
7.
Br J Radiol ; 87(1040): 20140145, 2014 Aug.
Article in English | MEDLINE | ID: mdl-24959953

ABSTRACT

OBJECTIVE: Comprehensive assessment of the pelvic floor (PF) provides information and diagnoses of coexisting abnormalities that may affect operative decisions. Our aim was to establish if pre-operative PF ultrasonography (PFUS) in patients complaining of PF dysfunction can complement clinical findings and contribute to additional management strategies. METHODS: Females were recruited from the urogynaecology/gynaecology clinics between July and October 2009 and underwent pelvic organ prolapse quantification (POPQ) by an independent examiner. PFUS was performed using two-dimensional (2D) transperineal ultrasound (TPUS), high-frequency 2D/three-dimensional (3D) endovaginal ultrasound (EVUS) using a biplane probe with linear and transverse arrays and a 360° rotational 3D-EVUS. The clinician performing PFUS was blinded to POPQ results. POPQ and PFUS were repeated at 1 year. Two clinicians analysed the scans independently. RESULTS: 158 of 160 females had a POPQ and PFUS. 105 females had pelvic organ prolapse and/or incontinence and 53 asymptomatic females were controls. 26 additional ultrasound diagnoses were noted at baseline and 46 at 1 year using 2D-TPUS and EVUS. Only one female with additional diagnoses on PFUS needed surgical intervention for this condition. CONCLUSION: Multicompartment PFUS identifies additional conditions to that diagnosed on clinical assessment. However, it neither changes the initial surgical management nor the management at 1-year follow-up and therefore clinical assessment should not be substituted by PFUS. ADVANCES IN KNOWLEDGE: PFUS can be helpful in providing additional information; however, it does not change the initial management of the patient and therefore should not replace clinical assessment.


Subject(s)
Genital Diseases, Female/diagnostic imaging , Pelvic Organ Prolapse/diagnostic imaging , Adult , Aged , Case-Control Studies , Endosonography/methods , Female , Humans , Imaging, Three-Dimensional , Middle Aged , Pelvic Floor/diagnostic imaging , Prospective Studies , Young Adult
8.
Chronic Dis Inj Can ; 34(1): 30-5, 2014 Feb.
Article in English, French | MEDLINE | ID: mdl-24618379

ABSTRACT

BACKGROUND: Hysterectomy is one of the most frequently performed surgical procedures among Canadian women. The consequence is a population that no longer requires cervical cancer screening. The objective of our analysis was to provide more accurate estimates of eligible participation in cervical screening by estimating the age-specific prevalence of hysterectomy among Canadian women aged 20 to 69 by province and territory between 2000/2001 and 2008. METHODS: Self-reported hysterectomy prevalence was obtained from the 2000/2001, 2003 and 2008 Canadian Community Health Survey. Age-specific prevalence and 95% confidence intervals (CIs) were estimated for Canada and provinces and territories for the three time periods. RESULTS: Interprovincial variations in hysterectomy prevalence were observed among women in each age group and time period. Among women aged 50 to 59, prevalence was as high as 35.1% (95% CI: 25.8-44.3) (p<.01) in 2008 and appeared to decrease in all provinces from 2000/2001 to 2008. CONCLUSION: Interprovincial and time period variation suggest that using hysterectomy prevalence to adjust the population eligible for cervical cancer screening may be helpful to inform more comparable screening participation rates. In addition, both cervical cancer incidence and mortality rates can be adjusted by hysterectomy to ensure estimates across time and provinces and territories are also comparable.


TITRE: Prévalence de l'hystérectomie autodéclarée chez les Canadiennes, 2000-2001 à 2008. INTRODUCTION: L'hystérectomie est l'une des interventions chirurgicales les plus souvent pratiquées chez les Canadiennes. Le dépistage du cancer du col de l'utérus n'est donc plus nécessaire dans cette population. Notre analyse visait à obtenir des estimations plus exactes de la participation au dépistage du cancer du col utérin dans la population admissible en déterminant la prévalence de l'hystérectomie selon l'âge chez les Canadiennes de 20 à 69 ans, par province ou territoire, entre 2000-2001 et 2008. MÉTHODOLOGIE: Les données relatives à la prévalence de l'hystérectomie autodéclarée ont été tirées de l'Enquête sur la santé dans les collectivités canadiennes de 2000-2001, de 2003 et de 2008. Nous avons estimé la prévalence selon l'âge et les intervalles de confiance (IC) à 95 % pour le Canada et les provinces et territoires pour les trois périodes. RÉSULTATS: Des variations interprovinciales de la prévalence de l'hystérectomie ont été observées chez les femmes dans chaque groupe d'âge et au cours de chaque période. Chez les femmes de 50 à 59 ans, la prévalence a semblé diminuer dans toutes les provinces entre 2000-2001 et 2008, le plus haut taux provincial atteint en 2008 étant 35,1% (IC à 95%: 25,8 à 44,3; p < 0,01). CONCLUSION: Les variations selon les provinces et au cours du temps laissent penser qu'il pourrait être bon d'utiliser la prévalence de l'hystérectomie pour ajuster la population admissible au dépistage du cancer du col de l'utérus, de manière à obtenir des taux plus comparables de participation. Il est en outre possible d'ajuster à la fois les taux d'incidence du cancer du col utérin et de mortalité par cancer du col utérin de façon à ce que les estimations dans le temps et pour l'ensemble des provinces et territoires soient comparables.


Subject(s)
Early Detection of Cancer/statistics & numerical data , Hysterectomy/statistics & numerical data , Self Report , Uterine Neoplasms/prevention & control , Adult , Age Distribution , Aged , Canada/epidemiology , Confidence Intervals , Female , Health Surveys , Humans , Middle Aged , Papanicolaou Test/statistics & numerical data , Prevalence , Primary Prevention/organization & administration , Surveys and Questionnaires , Young Adult
9.
Int Urogynecol J ; 23(11): 1555-60, 2012 Nov.
Article in English | MEDLINE | ID: mdl-22543548

ABSTRACT

INTRODUCTION AND HYPOTHESIS: We determined the relationship between clinical assessment of female pelvic organ prolapse (POP) using the validated Pelvic Organ Prolapse Quantification (POP-Q) and dynamic 2D transperineal ultrasound (TPUS). METHODS: Women attending the urogynecology clinics between July and October 2009 were recruited. Prolapse was assessed using the POP-Q. Points Ba, Bp and C (anterior, posterior and middle compartments, respectively) were measured. TPUS was performed at maximum Valsalva by another clinician. As the TPUS probe compresses the prolapse that extends beyond the hymen, these women were excluded. A reference line was drawn parallel to the inferoposterior margin of the pubic symphysis, perpendicular to which the leading edge of descent was measured. The offset measured from the curved array of the probe to the reference line was added to the prolapse quantification on ultrasound (US) scan to make it objectively comparable with the POP-Q reference of the hymen. Points Ba, Bp and C on POP-Q were then compared with points of maximum descent achieved on TPUS. RESULTS: One hundred and fifty-eight women had a POP-Q and TPUS; 20 scans (12.6 %) were not analysable, and 41 women had prolapse beyond the hymen. Ninety-seven women were thus analysed. The correlation between 2D TPUS (with/without the addition of the offset) and POP-Q was statistically significant (p value <0.0001) for all three compartments. The proportion of correct predictions was 59.6 %, 61.5 % and 32.6 % for bladder, bowel and middle-compartment prolapse, respectively. CONCLUSION: These findings suggest that the accuracy of pelvic floor US staging is limited and that clinical assessment remains the gold standard.


Subject(s)
Diagnostic Techniques, Obstetrical and Gynecological , Pelvic Organ Prolapse/diagnostic imaging , Pelvic Organ Prolapse/pathology , Ultrasonography/methods , Adult , Cystocele/diagnostic imaging , Cystocele/pathology , Female , Humans , Middle Aged , Pelvic Floor/diagnostic imaging , Pelvic Floor/pathology , Pelvic Organ Prolapse/diagnosis , Pubic Symphysis/diagnostic imaging , Pubic Symphysis/pathology , Severity of Illness Index
10.
Eur J Radiol ; 81(1): e7-e12, 2012 Jan.
Article in English | MEDLINE | ID: mdl-20970275

ABSTRACT

OBJECTIVES: Assessment of the urethral complex and defining its morphological characteristics with 3-dimensional endovaginal ultrasonography with the use of high frequency rotational 360° transducer. Defining inter-observer reliability of the performed measurements. MATERIALS AND METHODS: Twenty-four asymptomatic, nulliparous females (aged 18-55, mean 32 years) underwent high-frequency (12MHz) endovaginal ultrasound with rotational 360° and automated 3D data acquisition (type 2050, B-K Medical, Herlev, Denmark). Measurements of the urethral thickness, width and length, bladder neck-symphysis distance, intramural part of the urethra as well as rhabdosphincter thickness, width and length were taken by three investigators. Descriptive statistics for continuous data was performed. The results were given as mean values with standard deviation. The relationships among different variables were assessed with ANOVA for repeated measures factors, as well as T-test for dependent samples. Intraclass correlation (ICC) was calculated for each parameter. Intra- and interobserver reliability was assessed. Statistical significance was assigned to a P value of <0.05 (two-tailed). RESULTS: Excellent reliability was observed for urethral measurements (length, width, thickness and volume) (ICC>0.8) and good reliability for rhabdosphincter measurements (ICC>0.6) between all three investigators. CONCLUSIONS: Advanced EVUS provides detailed information on anatomy and morphology of the female urethral complex. Our results show that 360° rotational transducer with automated 3D acquisition, currently routinely used for proctological scanning is suitable for the reliable assessment of the urethral complex and can be applied in a routine diagnostics of pelvic floor disturbances in females.


Subject(s)
Algorithms , Image Interpretation, Computer-Assisted/methods , Imaging, Three-Dimensional/methods , Ultrasonography/methods , Vagina/diagnostic imaging , Adolescent , Adult , Female , Humans , Image Enhancement/methods , Middle Aged , Observer Variation , Reproducibility of Results , Sensitivity and Specificity , Young Adult
11.
Chronic Dis Inj Can ; 31(4): 152-6, 2011 Sep.
Article in English | MEDLINE | ID: mdl-21978638

ABSTRACT

INTRODUCTION: Participation rate is an important indicator for a screening program's effectiveness; however, the current approach to measuring participation rate in Canada is not comparable with other countries. The objective of this study is to review the measurement of screening mammography participation in Canada, make international comparisons, and propose alternative methods. METHODS: Canadian breast cancer screening program data for women aged 50 to 69 years screened between 2004 and 2006 were extracted from the Canadian Breast Cancer Screening Database (CBCSD). The fee-for-services (FSS) mammography data (opportunistic screening mammography) were obtained from the provincial ministries of health. Both screening mammography program participation and utilization were examined over 24 and 30 months. RESULTS: Canada's screening participation rate increases from 39.4% for a 24-month cut-off to 43.6% for a 30-month cut-off. The 24-month mammography utilization rate is 63.1% in Canada, and the 30-month utilization rate is 70.4%. CONCLUSION: Due to the differences in health service delivery among Canadian provinces, both programmatic participation and overall utilization of mammography at 24 months and 30 months should be monitored.


Subject(s)
Breast Neoplasms/diagnosis , Mammography/statistics & numerical data , Aged , Canada , Delivery of Health Care/statistics & numerical data , Early Detection of Cancer/statistics & numerical data , Female , Humans , Middle Aged , Patient Acceptance of Health Care/statistics & numerical data
12.
World J Urol ; 29(5): 615-23, 2011 Oct.
Article in English | MEDLINE | ID: mdl-21671056

ABSTRACT

The paper presents the role of various ultrasound modalities in the diagnostics of female pelvic floor disorders (PFD). It describes the use of two/three/four-dimensional transperineal ultrasound and endocavitary transducers, which, up to now, have been used for proctological examinations and prostate cancer brachytherapy. Ultrasonography is the most widely available imaging modality. As a result of technical progress, novel transducers and more sophisticated software have recently been introduced to the market providing more information about the anatomy of pelvic organs. Some features of these transducers, such as higher frequency and multiplanar imaging, enable better visualisation of pelvic floor organs. In-depth knowledge of the technical and physical properties of modern ultrasonography, as well as its advantages and limitations, could provide an integrated approach to imaging of PFD. Technical modalities, the wide availability of ultrasonographic techniques, and an understanding of the imaging possible with modern ultrasonography could improve our understanding of PFD and allow better assessment in pre- and post-surgical management.


Subject(s)
Pelvic Floor Disorders/diagnostic imaging , Female , Humans , Ultrasonography/methods
13.
Ultrasound Obstet Gynecol ; 37(4): 381-96, 2011 Apr.
Article in English | MEDLINE | ID: mdl-20814874

ABSTRACT

Surgical management of pelvic floor disorders depends on a comprehensive understanding of the structural integrity and function of the pelvic floor. For visualizing this region, ultrasonography has emerged as a procedure that is relatively easy to perform, cost-effective and widely available. In this review, pelvic floor ultrasonography, including two-dimensional (2D), three-dimensional (3D) and 4D imaging as well as transvaginal, endoanal and transperineal techniques, is discussed from a global and multicompartmental perspective, rather than using a compartmentalized approach. The role of the different sonographic modalities in the major disorders of the pelvic floor-urinary and fecal incontinence, pelvic organ prolapse and obstructed defecation syndrome-is evaluated critically.


Subject(s)
Fecal Incontinence/diagnostic imaging , Urinary Incontinence/diagnostic imaging , Uterine Prolapse/diagnostic imaging , Anal Canal/diagnostic imaging , Female , Humans , Imaging, Three-Dimensional , Pelvic Floor/diagnostic imaging , Rectal Diseases/diagnostic imaging , Ultrasonography/methods , Vagina/diagnostic imaging
14.
Environ Pollut ; 157(7): 2061-5, 2009 Jul.
Article in English | MEDLINE | ID: mdl-19282074

ABSTRACT

Concentrations of the elements Cd, Co, Cr, Cu, Fe, Mn, Ni, Pb and Zn were measured in the leaves and bark of Robinia pseudoacacia and the soil in which it grew, in the town of Olesnica (SW Poland) and at a control site. We selected this town because emission from motor vehicles is practically the only source of air pollution, and it seemed interesting to evaluate its influence on soil and plants. The self-organizing feature map (SOFM) yielded distinct groups of soils and R. pseudoacacia leaves and bark, depending on traffic intensity. Only the map classifying bark samples identified an additional group of highly polluted sites along the main highway from Wroclaw to Warszawa. The bark of R. pseudoacacia seems to be a better bioindicator of long-term cumulative traffic pollution in the investigated area, while leaves are good indicators of short-term seasonal accumulation trends.


Subject(s)
Environmental Pollution/analysis , Models, Theoretical , Neural Networks, Computer , Robinia/chemistry , Vehicle Emissions , Cities , Environmental Monitoring/methods , Metals, Heavy/analysis , Plant Bark/chemistry , Plant Leaves/chemistry , Poland , Seasons , Soil/analysis
15.
Cell Death Differ ; 16(4): 638-47, 2009 Apr.
Article in English | MEDLINE | ID: mdl-19148187

ABSTRACT

Cellular stress eliminates irreversibly damaged cells by initiating the intrinsic death pathway. Cell stress is sensed by pro- and antiapoptotic members of the Bcl-2 protein family, which regulate the release of apoptogenic factors, such as cytochrome c, from mitochondria. Exposure of cells to hyperthermia results in the activation of the proapoptotic Bcl-2 family protein Bax, which plays an essential role in cytochrome c release. Heat directly affects Bax activity in vitro; however, antiapoptotic Bcl-2 family proteins, such as Bcl-xL, can suppress this activation, suggesting that a second heat-sensitive step must be breached before apoptosis ensues in cells exposed to hyperthermia. Here we show that heat shock causes the loss of Mcl-1 protein. Depletion of Noxa by short hairpin RNA protected cells from hyperthermia by preventing Mcl-1 degradation. Heat shock caused the dissociation of Noxa from Mcl-1, which allowed binding of the BH3-containing ubiquitin ligase Mule followed by Mcl-1 ubiquitination and degradation. Overexpression of Hsp70, which prevents heat-induced Bax activation, stabilized Mcl-1 protein levels in heat-shocked cells. This resulted from reduced Mule binding and ubiquitination as well as enhanced Mcl-1 expression compared with cells without Hsp70. Our results demonstrate that loss of Mcl-1 is a critical heat-sensitive step leading to Bax activation that is controlled by Hsp70.


Subject(s)
Apoptosis/physiology , HSP70 Heat-Shock Proteins/metabolism , Hot Temperature , Proto-Oncogene Proteins c-bcl-2/antagonists & inhibitors , Proto-Oncogene Proteins c-bcl-2/metabolism , Apoptosis/genetics , Cell Line , Cell Line, Tumor , Cell Survival/genetics , HSP70 Heat-Shock Proteins/genetics , Humans , Immunoblotting , Immunoprecipitation , Myeloid Cell Leukemia Sequence 1 Protein , Protein Binding/genetics , Proto-Oncogene Proteins c-bcl-2/genetics , RNA Interference , Tumor Suppressor Proteins , Ubiquitin-Protein Ligases/genetics , Ubiquitin-Protein Ligases/metabolism , Ubiquitination , bcl-2-Associated X Protein/genetics , bcl-2-Associated X Protein/metabolism
16.
Arch Environ Contam Toxicol ; 56(4): 717-22, 2009 May.
Article in English | MEDLINE | ID: mdl-18931962

ABSTRACT

Concentrations of the elements Al, Be, Cd, Co, Cr, Cu, Fe, Mn, Ni, Pb, V, and Zn were measured in the terrestrial moss Brachythecium rutabulum and the soil on which it grew. Soil and moss plants were sampled at sites situated 1.5, 3, 6, 9 and 15 km to the north, south, east and west of the Legnica copper smelter (SW Poland). The self-organizing feature map (SOFM) or Kohonen network was used to classify the soil and moss samples according to the concentrations of the elements. The self-organizing map yielded distinct groups of B. rutabulum and soil samples, depending on the distance from and direction to the source of pollution. When the map-identified groups of sites with similar soil metal concentrations were combined with the map-identified groups of sites with similar metal concentrations in B. rutabulum, these maps were found to correspond closely. The SOFMs accurately represented the least polluted, moderately polluted and severely polluted sites, reflecting the distribution of metals that is typical of the smelter area, caused by the prevailing westerly and northerly winds.


Subject(s)
Bryophyta/chemistry , Copper/analysis , Metallurgy , Soil Pollutants/analysis , Soil/analysis , Trace Elements/analysis , Bryophyta/metabolism , Copper/metabolism , Environmental Monitoring/methods , Poland , Soil Pollutants/metabolism , Trace Elements/metabolism
17.
Chemosphere ; 67(5): 954-60, 2007 Mar.
Article in English | MEDLINE | ID: mdl-17166549

ABSTRACT

Concentrations of the elements Al, Be, Ca, Cd, Co, Cr, Cu, Fe, K, Mg, Mn, Ni, Pb and Zn were measured in the aquatic bryophytes Fontinalis antipyretica, Platyhypnidium riparioides and Scapania undulata. These bryophytes were sampled from streams flowing through granites/gneisses, limestones/dolomites and sandstones in the Tatra national park in Poland. The Self-organizing feature map (SOFM) or Kohonen network was used to classify the bryophytes according to the concentrations of the elements. This method was verified using principal component analysis (PCA) to check whether this well-known technique would give similar results. Both the self-organizing map and ordination by PCA yielded distinct groups of aquatic bryophytes growing in streams flowing through different types of rock, groups which differed significantly in the concentrations of certain elements. Bryophytes from granites/gneisses were distinguished by higher concentrations of Cd and Pb, while those from sandstones had a higher concentration of Cr and those from limestones/dolomites had higher concentrations of Ca and Mg. The SOFM and PCA ordinations thus yield identical classifications of bryophytes from the Tatra mountains streams.


Subject(s)
Bryopsida/metabolism , Geology , Hepatophyta/metabolism , Metals/analysis , Rivers , Water Pollutants, Chemical/analysis , Bryopsida/classification , Environmental Monitoring , Geological Phenomena , Hepatophyta/classification , Metals/metabolism , Neural Networks, Computer , Poland , Principal Component Analysis , Water Pollutants, Chemical/metabolism
18.
J Phys Condens Matter ; 18(16): 3993-4005, 2006 Apr 26.
Article in English | MEDLINE | ID: mdl-21690753

ABSTRACT

The ferroelectric phase transition of crystalline sodium trihydrogen selenite has been characterized by domain observations and measurements of electric permittivity, pyroeffect and spontaneous polarization. The first-order character of the phase transition is clearly demonstrated by the phase coexistence and temperature autostabilization. The considerable heating effect at 50 Hz ac field is described. The electric field effect on the temperature variation of the electric permittivity, in the phase transition region, shows a considerable domain structure contribution to the permittivity value. It is demonstrated that the dielectric properties of x- and y-samples can be described by classical dielectric state equations: the set of coefficients has been determined. It is concluded that the x-component of spontaneous polarization plays a predominant role in the phase transition.

19.
J Physiol Pharmacol ; 56(4): 571-85, 2005 Dec.
Article in English | MEDLINE | ID: mdl-16391415

ABSTRACT

Although there are some in vitro evidence that angiotensin II (Ang II) may promote thrombosis, there is still no data concerning effect of Ang II on arterial thrombus formation. In the present study we have investigated the influence of Ang II on electrically induced arterial thrombosis in a common carotid artery of renovascular hypertensive rats. Furthermore, we examined if Ang II effect is mediated via AT1 receptor. We measured some coagulation and fibrinolytic parameters at the same time. Since platelets play crucial role in the initiation of arterial thrombosis their contribution in the mode of Ang II action was also determined. Intravenous infusion of Ang II caused significant increase in arterial thrombus weight, which was reversed by losartan, selective AT1 receptor antagonist. The prothrombotic effect of Ang II was accompanied by increase in haemostatic and decrease in fibrinolytic potential of rat plasma. While number of data has clearly demonstrated that Ang II can augment human platelets aggregation, at least in rats, platelets were not involved in the mechanism of Ang II action. Our study shows that Ang II via AT1 receptor accelerates arterial thrombosis in renovascular hypertensive rat, therefore may be considered as a risk factor of myocardial infarction or stroke.


Subject(s)
Angiotensin II/pharmacology , Carotid Artery Thrombosis/metabolism , Carotid Artery, Common , Hypertension, Renovascular/metabolism , Receptor, Angiotensin, Type 1/metabolism , Vasoconstrictor Agents/pharmacology , Angiotensin II Type 1 Receptor Blockers/administration & dosage , Animals , Carotid Artery Thrombosis/etiology , Carotid Artery Thrombosis/pathology , Disease Models, Animal , Dose-Response Relationship, Drug , Electric Stimulation , Fibrinolysis/drug effects , Hemostasis/drug effects , Hypertension, Renovascular/pathology , Infusions, Intravenous , Losartan/administration & dosage , Male , Rats , Rats, Wistar , Receptor, Angiotensin, Type 1/agonists , Time Factors
20.
Addict Biol ; 7(3): 307-14, 2002 Jul.
Article in English | MEDLINE | ID: mdl-12126490

ABSTRACT

Ethanol oxidation to acetaldehyde and next to acetate is accompanied by free radical generation. Free radicals can affect cell integrity when antioxidant mechanisms are no longer able to cope with the free radical generation observed in ethanol intoxication. Natural antioxidants are particularly useful in such a situation. The present study was designed to investigate the efficacy of green tea as a source of water-soluble antioxidants (catechins) on the liver and blood serum antioxidative potential of rats chronically (28 days) intoxicated with ethanol. Alcohol caused a decrease in liver superoxide dismutase, glutathione peroxidase and catalase activities and an increase in activity of glutathione reductase. Moreover, a decrease in the level of reduced glutathione, ascorbic acid, vitamins A and E and beta-carotene were observed. The activity of serum glutathione peroxidase decreased while glutathione reductase activity increased. The level of serum non-enzymatic antioxidants was also decreased in the liver. Alcohol administration caused an increase in the liver and serum lipid peroxidation products, measured as thiobarbituric acid-reactive substances. However, green tea prevents the changes observed after ethanol intoxication. Green tea also protects membrane phospholipids from enhanced peroxidation. These results indicate a beneficial effect of green tea in alcohol intoxication.


Subject(s)
Alcoholic Intoxication/physiopathology , Antioxidants/pharmacology , Beverages , Catechin/pharmacology , Free Radical Scavengers/blood , Liver/drug effects , Phytotherapy , Animals , Antioxidants/metabolism , Lipid Peroxidation/drug effects , Liver/physiology , Male , Membrane Lipids/metabolism , Rats , Rats, Wistar , Thiobarbituric Acid Reactive Substances/metabolism
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