Diseño y aplicación piloto de un atlas imagenológico de pelvis femenina utilizando dispositivos móviles como apoyo al aprendizaje de la anatomía humana / Design and pilot application of an image atlas of female pelvis using mobile devices to support the learning of human anatomy

Resumen: Introducción: Las imágenes médicas constituyen un recurso de enseñanza-aprendizaje que complementa las metodologías tradicionales en el estudio de la Anatomía Humana para las profesiones de la salud. La pelvis femenina es una entidad anatómica compleja que contiene estructuras de varios sistemas, cuyas relaciones anatómicas son susceptibles de estudiar con detalle utilizando imágenes de resonancia magnética. Propósito: Diseñar una aplicación móvil como complemento al aprendizaje de la anatomía radiológica de la pelvis femenina y realizar una aplicación piloto a baja escala. Metodología: Se diseñó una aplicación móvil de anatomía normal de la pelvis femenina utilizando recursos gratuitos disponibles en línea, a partir de imágenes anonimizadas de resonancia magnética del archivo digital local. A partir de literatura anatómica relevante se seleccionaron las estructuras a rotular. Para evaluar la percepción de los usuarios, se diseñó y aplicó una encuesta por vía digital. Resultados: La aplicación móvil interactiva fue diseñada para dispositivos Android, con 7 secciones y 107 imágenes. Existió una adecuada recepción de la herramienta por parte de los seis estudiantes que participaron en la implementación piloto, destacando la accesibilidad como el principal aspecto a mejorar. Conclusión: Este atlas imagenológico a través de dispositivos móviles es un complemento del aprendizaje de la anatomía humana utilizando imágenes médicas.

Abstract: Introduction: Medical imaging is a teaching-learning resource that complements traditional methodologies in the study of Human Anatomy to health professions. The female pelvis is a complex anatomical entity that contains structures of several systems, whose anatomical relationships can be studied in detail using magnetic resonance imaging. Purpose: To design a mobile application as a complement to the learning of the radiological anatomy of the female pelvis and to carry out a pilot application in a small scale. Methodology: A mobile application of normal anatomy of the female pelvis was designed using free resources available online from anonymized magnetic resonance images from the local digital archive. The structures to be labelled were selected from relevant anatomical literature. In order to evaluate user's perception, a digital survey was designed and applied. Results: The interactive mobile application was designed for Android devices, with 7 sections and 107 images. There was an adequate reception of the tool by the six students who participated in the pilot implementation, highlighting accessibility as the main aspect to improve. Conclusion: This atlas imaging through mobile devices is a complement to the learning of human anatomy using medical images.

No association of vitamin D intake or 25-hydroxyvitamin D levels in childhood with risk of islet autoimmunity and type 1 diabetes: the Diabetes Autoimmunity Study in the Young (DAISY).

AIMS/HYPOTHESIS: The aim of the study was to investigate the association between vitamin D intake and status and the risk of islet autoimmunity (IA) and subsequent type 1 diabetes in children at increased risk of type 1 diabetes. METHODS: The Diabetes Autoimmunity Study in the Young (DAISY) in Denver, CO, USA, has been following children at increased risk of diabetes since 1993. As of February 2011, 198 children developed IA during follow-up of 2,644 DAISY children. Vitamin D intake and plasma 25-hydroxyvitamin D [25(OH)D] were measured longitudinally. Proportional hazards regression analyses of time to IA, or type 1 diabetes in IA-positive children, were conducted, with vitamin D intake and 25(OH)D as time-varying covariates. HRs were calculated for a standard deviation difference in exposure, with adjustment for confounders. RESULTS: Intake of vitamin D was not associated with the risk of IA (adjusted HR 1.13; 95% CI 0.95, 1.35; p = 0.18) nor progression to diabetes in IA-positive children (adjusted HR 1.30; 95% CI 0.91, 1.86; p = 0.15). Moreover, 25(OH)D level was not associated with the risk of IA (adjusted HR 1.12; 95% CI 0.88, 1.43; p = 0.36), nor progression to diabetes in IA-positive children (adjusted HR 0.91; 95% CI 0.68, 1.22; p = 0.54). In the 128 children in whom we measured 25(OH)D at 9 months of age, 25(OH)D was not associated with risk of IA (n = 30 IA-positive children) (adjusted HR 1.02; 95% CI 0.96, 1.07; p = 0.58). CONCLUSIONS/INTERPRETATION: Neither vitamin D intake nor 25(OH)D levels throughout childhood were associated with the risk of IA or progression to type 1 diabetes in our population.

An exploration of Glo-3A antibody levels in children at increased risk for type 1 diabetes mellitus.

AIMS: To determine whether Glo-3A, (formerly referred to as homologue of Glb1 or Glb1) antibodies are associated with islet autoimmunity (IA) in children at increased risk for type 1 diabetes (T1D) and to investigate their relation with environmental correlates of T1D. METHODS: We selected a sample from the Diabetes Autoimmunity Study in the Young (DAISY), a prospective study of children at increased risk for T1D. Cases were positive for insulin, glutamic acid decarboxylase (GAD), or insulinoma-associated antigen-2 (IA-2) autoantibodies on two consecutive visits and either diagnosed with diabetes mellitus or still autoantibody positive when selected. Controls were from the same increased risk group, of similar age as the cases but negative for autoantibodies. Sera from 91 IA cases and 82 controls were analyzed in a blinded manner for immunoglobulin G (IgG) antibodies to Glo-3A by ELISA. RESULTS: Adjusting for family history of T1D and human leukocyte antigen (HLA)-DR4 positivity, Glo-3A antibodies were not associated with IA case status (OR: 1.01, 95% CI: 0.99-1.03). Adjusting for age, family history of T1D, and HLA-DR4 positivity, Glo-3A antibody levels were inversely associated with breast-feeding duration (beta = -0.08, p = 0.001) and directly associated with current intake of foods containing gluten (beta = 0.24, p = 0.007) in IA cases but not in controls. Zonulin, a biomarker of gut permeability, was directly associated with Glo-3A antibody levels in cases (beta = 0.73, p = 0.003) but not in controls. CONCLUSION: Differing correlates of Glo-3A antibodies in IA cases and controls suggest an underlying difference in mucosal immune response.

Transient antiislet autoantibodies: infrequent occurrence and lack of association with "genetic" risk factors.

We hypothesized that genetic determinants of expression of persistent antiislet autoantibodies would similarly influence the expression of transient autoantibodies. To test this hypothesis, we prospectively evaluated sera from 478 relatives (SOC: sibling-offspring cohort) of patients with type 1 diabetes as well as 793 newborns from the general population (NEC: newborn nonrelative cohort) selected for expression of specific human leukocyte antigen haplotypes. Eight relatives of 478 (1.7% of SOC) expressed a transient autoantibody, and none had the high risk genotype DR3/4(DQ2/8). In contrast, 28 relatives (5.9%) had persistent antiislet autoantibodies, and 14 (50%) were DR3/4(DQ2/8) heterozygotes. Thirteen children of 793 (1.6% of NEC) expressed a transient autoantibody, and none had the high risk genotype DR3/4(DQ2/8). Seven of the NEC (0.9%) had persistent antiislet autoantibodies, and 4 (57.1%) were DR3/4(DQ2/8) heterozygous. Expression of persistent autoantibodies was strongly related to human leukocyte antigen status and family history of type 1 diabetes. In contrast, the expression of transient antiislet autoantibodies did not differ by family history of diabetes, and none of the DR3/4(DQ2/8) relatives and DR3/4(DQ2/8) newborns expressed transient autoantibodies. Our results indicate that children can express transient antiislet autoantibodies, but such transient autoantibodies are relatively infrequent and are not correlated with known genetic risk factors for type 1 diabetes.

Lack of association between early childhood immunizations and beta-cell autoimmunity.

OBJECTIVE: To determine whether early childhood immunization history affects the risk of developing the beta-cell autoimmunity that precedes type 1 diabetes. RESEARCH DESIGN AND METHODS: This article describes a case-control study whose participants were 317 children aged < or = 12 years who have a first-degree relative with type 1 diabetes. The children were enrolled in a prospective cohort study of the etiology of beta-cell autoimmunity, the Diabetes Autoimmunity Study in the Young, in Denver, Colorado. The main outcome measure was beta-cell autoimmunity as determined by persistent autoantibodies against insulin, GAD, or islet cell antibody (IA-2) 512. The number of cases with beta-cell autoimmunity was 25, and the number of control subjects (the remainder of the cohort) was 292. RESULTS: There was no difference between cases and control subjects in the proportion receiving hepatitis B (HBV), Haemophilus influenzae b (Hib), polio, or diphtheria tetanus pertussis (DTP) vaccines before 9 months of age; in the proportion receiving HBV at birth rather than later; or in the median age at first HBV, Hib, polio, or DTP vaccination. CONCLUSIONS: The results suggest that changing the early childhood immunization schedule would not affect the risk of developing beta-cell autoimmunity or type 1 diabetes.

Population screening for glucose intolerant subjects using decision tree analyses.

The purpose of this study was to develop a method of screening for impaired glucose tolerance and previously undiagnosed NIDDM that could be used preliminary to the administration of an oral glucose tolerance test (OGTT) for final classification of glucose tolerance status. The purpose of a preliminary screening of this type would be to reduce the number of OGTT's needed to identify cases of IGT and NIDDM in the population. We used NIDDM risk indicators and decision tree analysis methods (CART software) to identify subgroups of the population at increased risk. We examined a population of Hispanic (n = 583) and non-Hispanic white (n = 768) subjects without a prior history of diabetes. Subjects were classified as normal, IGT or NIDDM (WHO criteria) based on results from a 75 g oral glucose tolerance test (OGTT). Sensitivity (SEN) and specificity (SPE) of the CART models were calculated using the OGTT as the 'gold standard.' Two approaches to screening were simulated. In the simultaneous approach all risk variables were entered into CART models at once. In the serial approach, risk variables were grouped according to degree of effort required for data collection, and were entered into CART models in stages. Fasting glucose, age and body mass index (BMI) were selected as risk variables by CART when simulating the simultaneous approach (SEN = 91%, SPE = 55%). In the serial approach, CART used age and BMI to eliminate 35% of the population from further screening, and then used fasting glucose, glycohemoglobin, age and BMI to classify the remaining higher risk subjects (SEN = 85%, SPE = 64%). These models suggest that screening for IGT and previously undiagnosed NIDDM can be based on measurement of relatively simple indicators, and yet maintain a level of both sensitivity and specificity acceptable for this type of preliminary screening.