The objective of this review is to summarise the available evidence on the frequency and management of incidental findings in imaging diagnostic tests. Original articles were identified by a systematic search of the MEDLINE, EMBASE and Cochrane Library Plus databases using appropriate medical headings. Extracted variables were study design; sample size; type of imaging test; initial diagnosis; frequency and location of incidental findings; whether clinical follow-up was performed; and whether a definitive diagnosis was made. Study characteristics were assessed by one reviewer and checked by a second reviewer. Any disagreement was solved by consensus. The relationship between the frequency of incidental findings and the study characteristics was assessed using a one-way ANOVA test, as was the frequency of follow-up of incidental findings and the frequency of confirmation. 251 potentially relevant abstracts were identified and 44 articles were finally included in the review. Overall, the mean frequency of incidental findings was 23.6% (95% confidence interval (CI) 15.8-31.3%). The frequency of incidental findings was higher in studies involving CT technology (mean 31.1%, 95% CI 20.1-41.9%), in patients with an unspecific initial diagnosis (mean 30.5, 95% CI 0-81.6) and when the location of the incidental findings was unspecified (mean 33.9%, 95% CI 18.1-49.7). The mean frequency of clinical follow-up was 64.5% (95% CI 52.9-76.1%) and mean frequency of clinical confirmation was 45.6% (95% CI 32.1-59.2%). Although the optimal strategy for the management of these abnormalities is still unclear, it is essential to be aware of the low clinical confirmation in findings of moderate and major importance.

Iron-related insulin-resistance is improved by iron depletion or treatment with iron chelators. The aim of this study was to evaluate insulin sensitivity and insulin secretion after blood letting in patients who had high-ferritin type 2 diabetes and were randomized to blood letting (three phlebotomies [500 ml of blood] at 2-week intervals, group 1) or to observation (group 2). Insulin secretion and sensitivity were tested at baseline and 4 and 12 months thereafter. The two groups were matched for age, BMI, pharmacologic treatment, and chronic diabetic complications. All patients were negative for C282Y mutation of hereditary hemochromatosis. Baseline glycated hemoglobin (6.27 ± 0.9% vs. 6.39 ± 1.2%), insulin sensitivity (2.75 ± 1.8 vs. 3.2 ± 2.1 mg · dl−1 · min−1), and area under the curve for C-peptide (AUCC-peptide; 38.7 ± 11.6 vs. 37.6 ± 14.1 ng · ml−1 · min−1) were not significantly different between the two groups of patients. Body weight, blood pressure, blood hematocrit levels, and drug treatment remained essentially unchanged during the study period. As expected, serum ferritin, transferrin saturation index, and blood hemoglobin decreased significantly at 4 months only in patients who received blood letting. In parallel to this changes, blood HbA1c decreased significantly only in group 1 subjects (mean differences, −0.61; 95% CI, −0.17 to −1.048; P = 0.01). AUCC-peptide decreased by −10.2 ± 6.3% after blood letting. In contrast, a 10.4 ± 6.4% increase in AUCC-peptide was noted in group 2 subjects at 4 months (P = 0.032). At 12 months, AUCC-peptide returned to values not significantly different from baseline in the two groups of subjects. At 4 months, the change in insulin sensitivity from baseline was significantly different between the two groups (80.6 ± 43.2% vs. −8.6 ± 9.9% in groups 1 and 2, respectively, P = 0.049). At 12 months, the differences between the two groups were even more marked (55.5 ± 24.8% vs. −26.8 ± 9.9%; P = 0.005). When the analysis was restricted to those subjects who completed the follow-up until 12 months, results did not show differences compared with the changes observed at 4 months, except for insulin sensitivity. A statistically significant increase in insulin sensitivity was observed in the blood-letting group (from 2.30 ± 1.81 to 3.08 ± 2.55 mg · dl−1 · min−1 at 4 months, to 3.16 ± 1.85 mg · dl−1 · min−1 at 12 months; P = 0,045) in contrast with group 2 subjects (from 3.24 ± 1.9 to 3.26 ± 2.05 mg · dl−1 · min−1 at 4 months, to 2.31 ± 1.35 mg · dl−1 · min−1 at 12 months). In summary, blood letting led simultaneously to decreased blood HbA1c levels and to changes in insulin secretion and insulin resistance that were significantly different from those observed in a matched observational group of subjects with high-ferritin type 2 diabetes. The mechanisms for improvement in peripheral insulin sensitivity after blood letting should be investigated further.

To describe the spread of hepatitis C virus (HCV) among HCV/human immunodeficiency virus (HIV)–coinfected injection drug users (IDUs), the molecular

Background: Identification of monosodium urate (MSU) and calcium pyrophosphate dehydrate (CPPD) crystals in synovial fluid samples is diagnostic of gout and CPPD crystal related arthropathy. Various studies have shown poor consistency in results of crystal analysis. Objective: To determine whether training of the analysts increases the consistency. Methods: An expert rheumatologist gave a course on crystal detection and identification. The four trained observers then blindly and independently examined synovial fluid samples previously classified by the expert which had been obtained from patients with both crystal arthropathies and other non-crystal related inflammatory joint conditions. Results: 194 observations were made on 64 synovial fluid samples: 96 without crystals (49.4%), 55 with CPPD crystal (28.4%), and 43 with MSU crystals (22.2%). For crystal detection (presence or absence of crystals), sensitivity was 95.9% and specificity 86.5%. For identification of MSU crystals, sensitivity was 95.3% and specificity 97.2%. For identification of CPPD crystals, sensitivity was 92.7% and specificity 92.1%. The κ index of agreement with the reference standard between the observers was 0.84 for any crystal detection, 0.93 for MSU crystal sample identification, and 0.79 for CPPD crystal sample identification. Conclusions: For trained observers, the detection and identification of crystals in synovial fluid is a consistent procedure.

Obesity has a serious impact on public health. Sugar-sweetened beverages (SSBs) are implicated in the obesity epidemic. Regulation has been suggested as one approach to limit consumption. The aim of this study was to synthesize existing evidence related to the impact of taxes on the consumption, purchase, or sales of SSBs. A systematic review was conducted by using MEDLINE through PubMed (https://www.ncbi.nlm.nih.gov/pubmed), the Cochrane Library (http://www.cochranelibrary.com/), the Web of Science (https://login.webofknowledge.com/error/Error?PathInfo=%2F&Error=IPError), and Scopus (https://www.scopus.com/search/form.uri?display=basic) in the period 2011–2017 for studies that analyzed the impact of fiscal regulatory measures on the consumption, purchase, or sales of SSBs. The quality of evidence was assessed according to the CONSORT (Consolidated Standards of Reporting Trials) and the TREND (Transparent Reporting of Evaluations with Nonrandomized Designs) statements. Of the 17 studies, 5 (29.4%) evaluated the impact of a tax on SSBs in naturalistic experiments by county or city in the United States and in Mexico. Findings indicated that purchases or sales of SSBs decreased significantly with taxation amounts of 8% (Berkeley, CA) and 10% (Mexico). One study found no effect on sales of SSBs in 2 states that enacted a 5.5% tax on sodas. Twelve (70.6%) studies were based on virtual or experimental conditions evaluating either purchasing behavior or sales (6 studies; 50.0%) or behavioral intent (6 studies; 50.0%), resulting in a decrease in either purchasing behavior or sales or intent behavior with heterogeneity according to the tax rate. Taxation significantly influences planned purchases and increases the probability of the purchase of healthy beverages. SSB taxes have the potential to reduce calorie and sugar intake, but further research is needed to evaluate effects on diet quality.