Clinical Applications of Color Doppler Ultrasound in Chest Medicine

The wide application of recent advances in chest ultrasound has enabled color Doppler ultrasound (CDUS) to be used in evaluating thoracic lesions. Clinically, CDUS is helpful in assessing vessel signals within the thoracic lesions, differentiating lung cancers from benign lesions, assessing the neovascularity of lung cancers, diagnosing congenital vascular abnormalities (pulmonary sequestration and arteriovenous malformation), and avoiding the complication of US-guided needle biopsy injury to the great vessels. The CDUS “fluid color sign” can be used to detect minimal pleural effusion in thoracocentesis, and the CDUS “pulmonary artery vessel signal” is useful in predicting pulmonary benign lesions. Though CDUS still has some limitations in its capability to image vessel signals, the development of power Doppler US (US angiography) has improved images of vessel signals without angle limitation, and the newly developed dynamic flow US produces superior imaging quality with less color noise and blooming effect. The broad application and potential extension of CDUS in thoracic diseases has made CDUS a powerful and necessary imaging modality in chest medicine, especially in guiding transthoracic percutaneous needle biopsy of thoracic lesions and aiding in the differentiation of anatomic tissue

The epidemiology of patients with pterygium in southern Taiwanese adults: The Chiayi survey

AbstractPurposeTo investigate patients with pterygium in different geographic regions and the associated risk factors in southern Taiwan.MethodsA clinical observation survey was conducted in Chiayi County, a rural area in southern Taiwan. The subjects aged 40 years and above underwent complete ocular examinations. Associated risks factors were evaluated, including gender, age, occupations, smoking, and geographical living regions by univariant and multivariant logistic regression analysis.ResultsA total of 2197 participants (790 male, 36.0%) from 44 different villages were evaluated. In these, 554 participants (25.2%) have either unilateral or bilateral pterygium. Age is associated with the percentage of pterygium, and those aged between 60 and 69 had the highest percentage of 30.1% (p < 0.0001). The gender effect was higher among men than women (OR = 1.31, 95% CI: 1.08–1.60, p = 0.006). The percentage of pterygium lived in plain, seaside, and mountainous areas were 22.6%, 32.6%, and 14.5% respectively. Geographical regions also showed that seaside area had the highest percentage of pterygium (seaside area OR = 1.65, 95% CI: 1.35-2.03, and mountainous area OR = 0.58, 95% CI: 0.35-0.95 compared with plain areas). Primary outdoor workers and residents with smoking history had relative higher risk for pterygium (OR = 1.47, 95% CI: 1.17-1.86; OR = 1.36, 95% CI: 1.02-1.83).ConclusionsThe percentage of pterygium in southern Taiwan is about 25.2% among adults aged over 40 years in this survey. It is significantly higher in the age of 50 or more and in residents living in villages along the seaside than those living in the mountainous and the plain areas

Anatomical Asymmetry in Goiter: A Demonstration by Three-dimensional Power Doppler Ultrasound

The aim of the present study was to examine the anatomical differences in volumetric and intraparenchymal vascular parameters between the two thyroid lobes of patients with goiter, using three-dimensional power Doppler ultrasound. A total of 89 outpatients with goiter, including 55 with autoimmune thyroid disease (ATD) and 34 with simple goiter (SG), were evaluated by three-dimensional power Doppler ultrasound. Volumetric and intraparenchymal vascular indices including vascularization index, flow index and vascular flow index of each lobe were measured using the Virtual Organ Computer-Aided Analysis system. In all patients with goiter, the volume and vascular indices (vascularization index, flow index and vascular flow index) of the right thyroid lobe were significantly greater than those of the left lobe (p < 0.05). Differences in vascular indices were present in SG but not in ATD. ATD was associated with a larger thyroid volume and higher vascular indices compared with those of SG (p < 0.001), but there were no significant differences in volumetry and vascular indices between euthyroid ATD and SG. In conclusion, the right thyroid lobe was found to be significantly larger and more vascular than the left lobe in subjects with goiter, as measured by three-dimensional power Doppler ultrasound. In addition, ATD was associated with a higher thyroid volume and vascular indices compared with those of SG

Sitagliptin and Fractures in Type 2 Diabetes: A Nationwide Population-Based Propensity-Matching Study

Background: Sitagliptin, a dipeptidyl peptidase-4 inhibitor possibly affects bone turnover. We conducted this cohort study to determine whether sitagliptin is associated with an increased risk of fracture.Methods: The sitagliptin cohort included 1,578 patients aged 20 years and above. The nonsitagliptin cohort comprised propensity-score matched patients at a ratio of 1:1. The primary outcome was the incidence of fractures, which was evaluated using Kaplan–Meier survival analysis and proportional hazards modeling.Results: The mean age of patients in the sitagliptin and nonsitagliptin cohorts was 63.1 and 63.3 years, respectively. The incidence of fractures in the sitagliptin cohort was 46 per 1,000 person-years and that in the nonsitagliptin cohort was 40.8 per 1,000 person-years. Compared with patients in the nonsitagliptin cohort, those in the sitagliptin cohort who received sitagliptin for ≥250 days had a higher risk of fracture (aHR = 1.32, 95% CI = 1.06–1.64).Conclusion: Using sitaglipin ≥250 days was associated with an increased risk of fracture