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This is the sixth in a series of Radiologic-Pathobogic Correlation Conferences from the State University of New York SUNY ; Upstate Medical Center at Syracuse. Dr. Howard Pollack, Professor of Radiology and Director of the Uroradiology Section from the University of Pennsylvania, was the radiologic consultant. The conference was moderated by Dr. Philip J. Kenney, Chief of the Urobogic Radiology Section at Upstate Medical Center, who prepared the clinical resum.
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1. Bauman A, Owen N. Physical activity of adult Australians: epidemiological evidence and potential strategies for health gain. J Sci Med Sport 1999; 2: 3041. US Department of Health and Human Services. Physical activity and health: a report of the Surgeon General. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion; 1996. 3. Ministry of Health. Taking the pulse: the New Zealand Health Survey 1996 7. Wellington: Ministry of Health; 1999. 4. Simmons G, Jackson R, Swinburn B, Yee RL. The increasing prevalence of obesity in New Zealand: is it related to recent trends in smoking and physical activity? NZ Med J 1996; 109: 902. Hillary Commission. Physical Activity Taskforce Report. More people, more active, more often. Wellington: Hillary Commission; 1998. 6. Hillary Commission. Push Play facts. Wellington: Hillary Commission; 1999. 7. Bauman A. Precepts and principles of mass media campaign evaluation in Australia. Health Promot J Aust 2000; 10: 8992. McGuire WJ. Public communication as a strategy for inducing health-promoting behavioral change. Prev Med 1984; 13: 299319. Bauman AE, Bellew B, Owen N, Vita P. Impact of an Australian mass media campaign targeting physical activity in 1998. J Prev Med 2001; 21: 417. Wimbush E, MacGregor A, Fraser E. Impacts of a national mass media campaign on walking in Scotland. Health Promot Internation 1998; 13: 4553. Hillsdon M, Cavill N, Nanchahal K, et al. National level promotion of physical activity: results from England's ACTIVE for LIFE campaign. J Epidemiol Community Health 2001; 55: 75561. Cavill N, Bauman A. Changing social norms to promote health-enhancing physical activity: do mass media campaigns have a role? J Sports Sci. In press 2003. 13. Sport and Recreation New Zealand SPARC ; . SPARC facts 19972001. Results of the New Zealand Sport and Physical Activity Surveys 19972001 ; . Wellington: SPARC; 2003 and risedronate. Aceon aceon is a prescription drug that is used for the treatment of high blood pressure.
Barbara L Naydeck, Univ of Pittsburgh, Pittsburgh, PA; Richard A Kronmal, Univ of Washington, Seattle, WA; Daniel Edmundowicz, Univ of Pittsburgh, Pittsburgh, PA; Kim Sutton-Tyrrell, Lewis H Kuller, Anne B Newman; Univ of Pittsburgh, Pittsburgh, PA Most but not all adults over age 70 have coronary artery calcium CAC ; on ultrafast CT scan, but it is not known if CAC continues to progress late in life. We conducted a study of CAC progression in 255 participants of the Cardiovascular Health Study in Pittsburgh mean age 79.6, range 70 92 ; . 405 participants without clinical cardiovascular disease at the baseline scan, 255 63% ; had a second scan after mean 3.4 years - 0.49 ; . Others died n 44, 11% ; , were too ill or in a nursing home n 41, 10% ; , refused or had moved away n 61, 15% ; or had bypass surgery or stent placement n 4 ; . Progression was defined as conversion from CAC score 0 to CAC 0 or as 20% annualized change in total Agatston score when baseline score was above 0. Of 30 participants with initial CAC 0, 14 remained at 0 and 16 had scores which increased to a maximum of 41 median 4.2 ; . Of these 30, progression occurred among 4 of 6 men and 12 of 24 women, and those with progression were older 77.7 years versus 75.5, p .003 ; . Of the 225 participants with initial CAC 0, CAC score increased from median 255 to 400 with a correlation of 0.97 and a mean log change in log scores of 0.52. Mean log change and the prevalence of progression of 20% was higher among women and those with lower initial CAC scores. Other characteristics age, race, diabetes, lipid lowering medications, ever smoking and years since quitting among former smokers ; did not differ between those with and without progression. One participant had an initial CAC 100 and follow-up CAC 400. This study documents that a large proportion of very old adults with no prior history of CVD, especially women, show progression in CAC score over four years. Only 5% remained with a CAC 0. C. Harold Mielke, Jr., Sylvia A Oliver, Washington State Univ, Spokane, WA; William E Schulte, Inland Imaging, Spokane, WA; Robert Short, Washington State Univ, Spokane, WA; Bryan E Fuhs, Pierre P Leimgruber; Spokane Cardiology, PSC, Spokane, WA Coronary artery disease CAD ; continues to be the major cause of morbidity and mortality in industrialized nations. Although advances in diagnosis and treatment have reduced mortality in symptomatic people, over half of patients who suffer clinical events such as MI or sudden death are asymptomatic and unaware they have CAD. Early detection of CAD in asymptomatic subjects AS ; and accurate risk stratification are therefore crucial in our attempts to reduce morbidity and mortality. Coronary artery calcium CAC ; , an accurate indicator of coronary atherosclerosis as measured by Electron Beam CT EBCT ; , is being used increasingly to identify AS who are at intermediate or high risk for developing a cardiovascular event. The Spokane Heart Study SHS ; , a 10-year prospective, longitudinal study following AS 579 men, 452 women ; every two years using measures of CAC in combination with traditional and nontraditional risk factors, has identified subgroups of AS who accumulate CAC at varying rates zero, slow or fast accumulation ; . Of 13 clinical events that have been identified, 12 have occurred in AS classified as fast accumulators. Breaking AS into CAC accumulation subgroups is also revealing associations with both traditional and nontraditional risk factors that were not identified when analyzing for single measures of CAC. For example, initial evaluation of baseline fasting cholesterol levels of all AS showed a weak correlation with baseline CAC. However, when the same AS were broken out into CAC accumulation subgroups, statistically significant trends by ANOVA were noted in both men and women showing higher cholesterol levels in fast accumulators Table 1 representing data from 388 men M ; and 203 women W ; with at least three sequential EBCT scans ; . Similar findings were noted for Body Mass Index BMI ; and glucose in men, but not women Table 1 ; . The SHS will continue to study the link between risk factors and CAC accumulation rates to better predict clinical events in AS and salmeterol.
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Highly coherent path, the citation network of glaucoma, which is fully comparable in size, displays far less unity and the patterns of convergence are partial and untidy. As shown in Figure 3, when the paradigm of IOP started to be challenged towards the end of the 1950s, papers cluster distinctively in groups A, B and C. Around the 1980s, a partial convergence appears to take place in cluster D, after which clusters E and F branch out to occupy the extreme areas of the diagram after the mid-1990s. The early years were a highly exploratory period as indicated by the horizontal deviations from core streams. These correspond to the growth of complementary fields of analysis, whose building blocks are the much-cited treatises by Posner and Schlossman 1948 ; on the clinical course of glaucoma, and by Paul Chandler 1952 ; and Otto Barkan 1954 ; on pupillary block and angle-closure glaucoma. INSERT FIGURE 3 ABOUT HERE Cluster A roughly 1954-1987 ; contains papers mainly focused on Primary angle-closure glaucoma.9 Papers in cluster B roughly 1949-1967 ; , investigated hereditary forms of glaucoma. The connected cluster C roughly 1956-1982 ; targets the refinement of the concept of Open-Angle glaucoma and the process of aqueous outflow through experimental glaucoma. The important works by Quigley 1981; 1982 ; on the mechanisms underlying optic nerve damage also figure prominently in this cluster and it is through his contributions that this cluster connects with cluster D roughly 1983-1991 ; , where the system temporarily appears to converge. Here we find turning points in the growth of medical knowledge on glaucoma, such as the contributions of Airaksinen 1983; 1984a; 1984b , Drance 1986 ; and Jonas 1988; 1989; 1991 ; , which are considered the foundations of modern ophthalmology. These works to some extent unified the dispersed hypotheses previously formulated on the damage of the optic nerve by discovering the retinal nerve fibre layer and the association between its changes and the progression of glaucoma. From this point onwards, divergent streams of research can be identified to show how modern ophthalmology has further evolved across disciplinary boundaries. Cluster F top far right ; contains a number of technology-related papers that deal with the repetitive scanning of the optic nerve head, notably by means of Scanning Laser Polarimetry. Cluster E top left ; , instead contains studies on a number of developments following the discovery of the TIGR gene in 1993. Interestingly, in this cluster journals chiefly concerned with ophthalmology coexist with publications in the area of genetics and molecular biology, signalling a drastic shift not only from the study of IOP, but also from analysis of the structure of the optic nerve. Comparison between Figure 2 and Figure 3 reveals tidier lines of research in interventional cardiology than in glaucoma. While this may signal that a robust trajectory has emerged in the first, in the second research efforts are more scattered, and although coherent patterns can be identified over time, exploration of the search space appears to take very different streams. The objection could be advanced that this is due to the different time periods considered for CAD 30 years ; and for glaucoma 50 years ; , which are justified by the emergence at different times of comparably radical breakthroughs the invention of coronary angioplasty and the challenge to the IOP paradigm respectively ; . In fact, as the algorithm underpinning and fluticasone.
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