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OBJECTIVE: This study investigated the relationship between PDZK1 expression and Dynamic Contrast-Enhanced MRI (DCE-MRI) perfusion parameters in High-Grade Glioma (HGG). METHODS: Preoperative DCE-MRI scanning was performed on 80 patients with HGG to obtain DCE perfusion transfer coefficient (Ktrans), vascular plasma volume fraction (vp), extracellular volume fraction (ve), and reverse transfer constant (kep). PDZK1 in HGG patients was detected, and its correlation with DCE-MRI perfusion parameters was assessed by the Pearson method. An analysis of Cox regression was performed to determine the risk factors affecting survival, while Kaplan-Meier and log-rank tests to evaluate PDZK1's prognostic significance, and ROC curve analysis to assess its diagnostic value. RESULTS: PDZK1 was upregulated in HGG patients and predicted poor overall survival and progression-free survival. Moreover, PDZK1 expression distinguished grade III from grade IV HGG. PDZK1 expression was positively correlated with Ktrans 90, and ve_90, and negatively correlated with kep_max, and kep_90. CONCLUSION: PDZK1 is upregulated in HGG, predicts poor survival, and differentiates tumor grading in HGG patients. PDZK1 expression is correlated with DCE-MRI perfusion parameters.
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Neoplasias Encefálicas , Medios de Contraste , Glioma , Imagen por Resonancia Magnética , Clasificación del Tumor , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven , Neoplasias Encefálicas/diagnóstico por imagen , Neoplasias Encefálicas/patología , Neoplasias Encefálicas/irrigación sanguínea , Glioma/diagnóstico por imagen , Glioma/patología , Glioma/irrigación sanguínea , Estimación de Kaplan-Meier , Imagen por Resonancia Magnética/métodos , Pronóstico , Curva ROCRESUMEN
Abstract Objective This study investigated the relationship between PDZK1 expression and Dynamic Contrast-Enhanced MRI (DCE-MRI) perfusion parameters in High-Grade Glioma (HGG). Methods Preoperative DCE-MRI scanning was performed on 80 patients with HGG to obtain DCE perfusion transfer coefficient (Ktrans), vascular plasma volume fraction (vp), extracellular volume fraction (ve), and reverse transfer constant (kep). PDZK1 in HGG patients was detected, and its correlation with DCE-MRI perfusion parameters was assessed by the Pearson method. An analysis of Cox regression was performed to determine the risk factors affecting survival, while Kaplan-Meier and log-rank tests to evaluate PDZK1′s prognostic significance, and ROC curve analysis to assess its diagnostic value. Results PDZK1 was upregulated in HGG patients and predicted poor overall survival and progression-free survival. Moreover, PDZK1 expression distinguished grade III from grade IV HGG. PDZK1 expression was positively correlated with Ktrans 90, and ve_90, and negatively correlated with kep_max, and kep_90. Conclusion PDZK1 is upregulated in HGG, predicts poor survival, and differentiates tumor grading in HGG patients. PDZK1 expression is correlated with DCE-MRI perfusion parameters.
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BACKGROUND: The study of muscle health has become more relevant lately, due to global aging and a higher incidence of musculoskeletal pathologies. Current exploration techniques, such as electromyography, do not provide accurate spatial information. OBJECTIVE: The objective of this work is to perform a systematic review of the literature to synthesize the contributions that can offer functional MRI techniques commonly used in neuroimaging, applied to skeletal muscle: Blood Oxygen Level Dependent (BOLD), IntraVoxel Incoherent Motion (IVIM), Arterial Spin Labeling (ASL) and Dynamic Contrast Enhanced (DCE). EVIDENCE ACQUISITION: Web of Science and Medline databases were searched, over the last 10 years, focused on the use of BOLD, ASL, IVIM or DCE in skeletal muscle. EVIDENCE SYNTHESIS: 59 articles were included after applying the selection criteria. 37 studies were performed in healthy subjects, and 22 in patients with different pathologies: in peripheral arterial disease, systemic sclerosis, diabetes, osteoporosis, adolescent idiopathic scoliosis, and dermatomyositis. Reference values in healthy subjects still vary in some cases. CONCLUSION: The studies show the feasibility of implementing functional MRI through BOLD, ASL, IVIM or DCE imaging in several muscles and their possible utility in different pathologies. A synthesis of how to implement such exploration is given here. CLINICAL IMPACT: These four techniques are based on sequences already present in clinical MRI scanners, therefore, their use for functional muscle exploration does not require additional investment. These techniques allow visualization and quantification of parameters associated with the vascular health of the muscles and represent interesting support for musculoskeletal exploration.
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Medios de Contraste , Imagen por Resonancia Magnética , Adolescente , Imagen de Difusión por Resonancia Magnética , Humanos , Movimiento (Física) , Músculo Esquelético/diagnóstico por imagen , Marcadores de SpinRESUMEN
OBJECTIVE: To evaluate patients' preferences for various attributes of insulin treatment, including route of insulin delivery. METHODS: We used a discrete choice experiment (DCE) to quantify patients' preferences. The attributes (and levels) included in the DCE questionnaire were: glucose control, frequency of hypoglycemic events, weight gain, route of administration for the long-acting and the short-acting insulin, and out-of-pocket cost. Data were analyzed using conditional logit regression and segmented models were also developed to evaluate differences in preferences between subgroups. RESULTS: Two hundred and seventy-four questionnaires were completed. The mean age (SD) of participants was 56.7 (12.9) years. Forty-nine percent of participants were insulin users, and 17% had type 1 diabetes. Overall, patients' ideal insulin treatment would provide better glucose control, result in fewer adverse reactions, have the lowest cost, and be administered orally. Overall, there was a strong positive preference for better glucose control relative to the other attributes. Segmented analyses by insulin use and type of diabetes suggest that there may be an important psychosocial barrier to initiating insulin therapy but that patients tend to adjust to subcutaneous administration once they initiate therapy. CONCLUSIONS: This study illustrates the importance that patients with diabetes place on glucose control and how preferences for insulin therapy differ between subgroups. Specifically, efforts need to be made to overcome the psychosocial barriers to initiating insulin therapy which may lead to improved control through improved treatment acceptance and ultimately improve patients' quality of life and reduce the economic burden of the disease.
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O Código de Ética Odontológica (CEO) brasileiro, Resolução CFO-71 de maio/2006, é um instrumento elaborado para orientar a conduta dos cirurgiões-dentistas sobre os aspectos éticos da prática profissional. O objetivo do estudo é analisar o CEO comparando os enfoques deontológico e bioético. Para tal, realizou-se a análise interpretativa do CEO e de doze textos selecionados, seis sobre bioética e seis sobre deontologia, por meio da classificação metodológica das unidades de contexto, parágrafos textuais e itens do código, nas seguintes categorias: os referenciais do principialismo bioético - autonomia, beneficência, não-maleficência e justiça -, aspectos técnicos e virtudes morais relacionados à profissão. Os quatro princípios somados representaram 22,9 por cento, 39,8 por cento e 54,2 por cento do conteúdo do CEO, dos textos deontológicos e dos bioéticos, respectivamente. No CEO, 42 por cento dos itens referiam-se às virtudes, 40,2 por cento, a aspectos técnicos e apenas 22,9 por cento, aos princípios. As virtudes relacionadas aos profissionais e os aspectos técnicos juntos representam 70,1 por cento do código. O CEO, em vez de centrar-se no paciente como sujeito do processo de atenção à saúde bucal, focaliza o profissional, sendo predominantemente voltado para aspectos legalistas e corporativistas.
The Brazilian Dentistry Code of Ethics (DCE), Resolution CFO-71 from May 2006, is an instrument created to guide dentists' behavior in relation to the ethical aspects of professional practice. The purpose of the study is to analyze the above mentioned code comparing the deontological and bioethical focuses. In order to do so, an interpretative analysis of the code and of twelve selected texts was made. Six of the texts were about bioethics and six on deontology, and the analysis was made through the methodological classification of the context units, textual paragraphs and items from the code in the following categories: the referentials of bioethical principlism - autonomy, beneficence, nonmaleficence and justice -, technical aspects and moral virtues related to the profession. Together the four principles represented 22.9 percent, 39.8 percent and 54.2 percent of the content of the DCE, of the deontological texts and of the bioethical texts respectively. In the DCE, 42 percent of the items referred to virtues, 40.2 percent were associated to technical aspects and just 22.9 percent referred to principles. The virtues related to the professionals and the technical aspects together amounted to 70.1 percent of the code. Instead of focusing on the patient as the subject of the process of oral health care, the DCE focuses on the professional, and it is predominantly turned to legalistic and corporate aspects.