influenced by several technical factors including testing environment, walkway design, the need of an accompanying evaluator who provides verbal encouragements. [ 3 ] These technical limitations not only have hindered adoption of 6MWT in routine clinical use but limited its utility as a screening tool in tracking physical capability changes during large scale community based research and services. [ 1 , 2 , 3 ]
Recent research on wearable technology in Parkinson’s disease has shown that sixminute walking test can be automated using wearable technology to eliminate
Guoxin Wang, Xiang Liu, Sheng Wang, Nan Ge, Jintao Guo and Siyu Sun
additional assistive tools may be required. Another challenge is the potential loss of visualization and access to the small bowel due to the advancement of the wire through the needle pushing the small bowel away from the stomach. Both the need for extra steps and the loss of visualization can potentially result in technical failure and stent misdeployment. [ 36 , 39 , 40 ]
Rendezvous endoscopic ultrasound-guided gastroenterostomy
This technique consists of capturing the guidewire in the duodenum or proximal jejunum and pulling it back through the obstruction and
Rajesh Kumar Wadhwa, Zaigham Abbas, Syed Mujahid Hasan, Nasir Hasan Luck, Mahira Younus, Sabiha Anis and Muhammed Mubarak
Background: Esophageal varices (EVs) are serious consequences of liver cirrhosis. Several studies have evaluated the possible non-invasive markers for the diagnosis of EVs to reduce the number of endoscopic procedures in patients with cirrhosis but without varices. This study was performed to evaluate the diagnostic performance of two such parameters (platelet count to splenic diameter ratio and splenoportal index) for the detection of EVs. Materials and Methods: A total of 111 patients with liver cirrhosis were analyzed after performing upper gastrointestinal endoscopy and non-invasive tests including platelet count and ultrasound abdomen including Doppler study. Appropriate statistical tests were applied to compare the non-invasive tests with the gold standard of endoscopy. Results: Of 111 liver cirrhotics, 80 (72.1%) were male and 31 (27.9%) were female. EVs were present in 68 (61.3%) patients and absent in 43 (38.7%) patients. In platelet count to splenic diameter ratio, a cut-off value of 1014 was obtained, which gave a sensitivity of 75.0%, specificity of 65.1%, positive predictive value (PPV) of 77.3%, negative predictive value (NPV) of 62.2% and diagnostic accuracy of 71.2%. In the splenoportal index, a cut-off value of 3.5 cm/s was obtained, which gave a sensitivity of 79.4%, specificity of 72.0%, PPV of 81.8%, NPV of 68.8% and diagnostic accuracy of 76.5% for the diagnosis of EVs. Conclusions: The platelet count to spleen diameter ratio and splenoportal index are non-invasive and fairly accurate alternatives in identifying the presence or absence of EVs in patients with compensated cirrhosis.
. Langsetmo L, Poliquin S, Hanley DA et al. Dietary patterns in Canadian men and women ages 25 and older: relationship to demographics, body mass index, and bone mineral density. BMC Musculoskelet Disord 11:20, 2010.
9. Mc Henry EW. Nutrition in Toronto. Can Med J 30: 4-13, 1939.
10. Kruse HU, Palmer CE, Schmidt W, Wienc DG. Medical evaluation of nutritional status. Methods used in a survey of high school students. Milbank Mem Fund Q 18:257-98, 1940.
11. Burke BS. The dietary history as a tool in research. J Am Dien Assoc 23
Brain dysfunction is a frequent complication of sepsis even in cases of extra-cranial origin and is related to several underlying mechanisms. Encephalography (EEG) seems to be a useful tool in detecting the presence of encephalopathy in patients with sepsis. Although EEG is not a specific test, it is sensitive and can detect abnormalities even when clinical neurologic examination is normal. The aim of this study was to document the EEG abnormalities and search for correlations between EEG findings and commonly used severity and prognostic scores
Hongting Wang, Zuan-tao Lin, Yulin Yuan and Tianfu Wu
and the risk of death and end-stage renal disease across diverse populations.[ 21 ] The renal transplant recipients and most of the cystatin C-based equations showed improvements in 30% and 50% accuracy compared with the creatinine-based MDRD equation. The cystatin C-based equations may offer an advantage over the MDRD equation in kidney transplant recipients.[ 22 ] The elevated levels of urinary CYSC are associated with interstitial fibrosis and tubular atrophy in renal transplant recipients, and may become a useful tool for monitoring kidney allografts.[ 23
Gianluca Rigatelli, Marco Zuin, Fabio Dell’Avvocata, Aravinda Nanjundappa, Ramesh Daggubati and Thach Nguyen
pathologic models. In the same way, different stent types and configurations seem to impact the local fluid dynamic. High kissing appears to be more favourable in respect of the aortic Carrefour, in particular at 45° angle, than low kissing.
CFD, being able to be derived both from computed tomography scan or invasive angiography, appears to be an ideal tool to predict fluid dynamic profile before and after stenting in aortoiliac bifurcation.
Conflict of Interest : None of the other authors have identified a conflict of interest.
1 Deswal A
Ciprian Constantin, Aurelian Ranetti, Georgiana Constantin, Cristina Ioniţă, Irina Gal and Dan Mircea Cheţa
Background and Aims: A complete evaluation of complications should be done each time a new case of Type 2 Diabetes Mellitus (T2DM) is diagnosed. A good screening of complications will be the background of an oriented treatment. Our aim was to assess the vibratory and thermal sensitivity using a Computer Aided Sensory Analyzer (CASEIVSystem) in newly diagnosed T2DM patients and to compare it with the threshold determined by classical methods. Material and Methods: We sequentially enrolled 260 patients with newly diagnosed T2DM. The threshold of peripheral vibratory and thermal sensitivity was comparatively assessed using CASEIVSystem and classic tools. Other neurological scores were obtained from patients. Results: The vibratory threshold was abnormal in 56.92% (hand) and respectively 75.00% (foot) of subjects. Altered perception for the thermal threshold was registered in 76.15% and, respectively, 76.92% of subjects for the same sites. The 10g-monofilament exam was positive for 28.46% and the 128Hz-tuning-fork exam was positive for 20.38% of the examined patients. Mean time for a complete CASEIVSystem exam was around 27.23±9.34min vs. 3.21±0.24min (p<0.05) for a classic exam. Conclusions: In our study, CASEIVSystem allowed the assessment of the vibratory and thermal thresholds. The time needed for investigation renders this tool difficult to use in a time effective manner
This article reviews the application of contrast-enhanced ultrasound (CEUS) in gauging renal microvascular perfusion in diverse renal diseases. The unique nature of the contrast agents used in CEUS provides real-time and quantitative imaging of the vasculature. In addition to the traditional use of CEUS for evaluation of kidney masses, it also emerges as a safe and effective imaging approach to assess microvascular perfusion in diffuse renal lesions, non-invasively. Although the precise CEUS parameters that may best predict disease still warrant systematic evaluation, animal models and limited clinical trials in humans raise hopes that CEUS could outcompete competing modalities as a first-line tool for assessing renal perfusion non-invasively, even in ailments such as acute kidney injury and chronic kidney disease.
Cristina Muntean, Bogdan Cătălin, Valerica Tudorică and Maria Moţa
Background and Aims: Little data regarding distal symmetric polyneuropathy (DSP) prevalence in Romania is available. The aim of the present study was to assess the prevalence of DSP in our cohort, to characterize it depending on glycemic control, and also to find an easy-to-apply method for DSP screening which could be used in Romania.
Material and Methods: We performed a cross-sectional study enrolling 51 patients followed in the Diabetes, Nutrition and Metabolic Diseases Clinic, Clinical County Hospital of Craiova, Romania. A complete evaluation protocol consisting in clinical examination and Michigan Neuropathy Screening Instrument (MNSI), together with nerve conduction studies were applied for evaluation.
Results: Among the type 2 diabetic patients investigated, 72.54% had DSP. Three-quarters of them had poor glycemic control (HbA1c ≥7%). Mean HbA1c level was 9.17%. Poor glycemic control led to a more severe DSP form as proven by nerve conduction studies and clinical examination. Allodynia and motor deficit were predominantly found with HbA1c ≥7%. Mean MNSI score for the group was 2.55, strongly correlated with nerve conduction studies.
Conclusion: MNSI is a simple and validated diagnostic tool for DSP with a strong correlation to electrophysiological parameters. Therefore, its daily implementation in clinical practice could help identify and follow patients at risk for DSP.