Association of baseline C-reactive protein and prior anti-tumor necrosis factor therapy with need for weekly dosing during maintenance therapy with adalimumab in patients with moderate to severe Crohn's disease

OBJECTIVE

A post hoc analysis of data from the adalimumab Crohn's disease (CD) maintenance trial (CHARM, NCT00077779), examining the relationship between adalimumab dosing and maintenance of remission and response in subgroups stratified by previous anti-TNF use and baseline CRP.

METHODS

All patients received open-label induction (adalimumab: 80 mg, week [wk] 0; 40 mg, wk 2). At wk 4, all patients were randomized to double-blind maintenance adalimumab (40 mg weekly or every other week [eow]) or placebo for 52 weeks. In this analysis, clinical remission (CDAI <150) and clinical response (CR-100) at wk 26 and wk 56 by baseline CRP (high: ≥ 10 mg/L, or low: <10 mg/L) and prior anti-TNF use were determined for patients with CR-70 at wk 4.

RESULTS

Of 498 patients in this analysis, 260 (52.2%) were anti-TNF-naïve. For anti-TNF-naïve patients, the wk 56 remission rates in the adalimumab groups were significantly greater than placebo (P < 0.05) for both high and low CRP cohorts, with no statistically significant differences between remission rates with eow and weekly dosing within each CRP cohort (high: 52.8% eow, 53.5% weekly; low: 34.7% eow, 41.9% weekly). For anti-TNF-exposed patients, wk 56 remission rates were higher than placebo with both eow and weekly dosing within each cohort; weekly dosing in the high CRP cohort and eow dosing in the low CRP cohort achieved statistical significance (P < 0.05). In the high CRP cohort, remission rate with weekly dosing (46.9%) was statistically significantly greater compared with eow dosing (22.5%). There were no significant differences between eow (23.1%) and weekly (37.0%) dosing in the low CRP group. For all subgroups, clinical remission (wk 26) and clinical response (wk 26 and wk 56) patterns were similar to those observed for wk 56 remission.

CONCLUSIONS

These subgroup analyses suggest that in patients with moderately to severely active CD, weekly dosing may be most effective in the anti-TNF-experienced patients with elevated CRP at baseline.

Bacillus cereus var. toyoi promotes growth, affects the histological organization and microbiota of the intestinal mucosa in rainbow trout fingerlings

In this preliminary study, we evaluated the effects of a gram-positive soil bacteria Bacillus cereus var. toyoi on the growth performance, digestive enzyme activities, intestinal morphology, and microbiota in rainbow trout Oncorhynchus mykiss fingerlings. Trout were maintained in a recirculation system and fed 2 diets: 1) a commercial trout feed deprived of the probiotic and 2) the same diet but with the spores of the probiotic bacteria dissolved in fish oil during the manufacturing of the feed (final concentration = 2 × 10(4) cfu/g). Each diet was tested in three 400-L cylindroconical tanks (125 fish per tank; initial density = 1.3 kg/m(3); 13.2°C) for a period of 93 d. The probiotic-supplemented diet promoted growth, and the final mean BW and standard length in fish fed the probiotic were 3.4% and 2.1%, respectively, which was greater than the control group (P < 0.05). Fish fed the probiotic showed a more homogeneous distribution in the final BW, with a greater frequency of individuals around the modal of the normal distribution of the population. This result is of practical importance because homogenous production lots can improve rearing practices, reducing hierarchical dominance situations arising from individuals of larger sizes. In addition, the probiotic-supplemented diet increased the level of leukocyte infiltration in the lamina propria of the intestinal mucosa, the number of goblet cells (P < 0.010), and villi height (P < 0.001) but did not affect villi width. The administration of the probiotic changed the intestinal microbiota as indicated by 16S rDNA PCR-restriction fragment length polymorphism. In this sense, fish fed the probiotic formed a well-defined cluster composed of 1 super clade, whereas compared control fish had a greater degree of diversity in their gut microbiota. These changes in gut microbiota did not affect the specific activity of selected pancreatic and intestinal digestive enzymes. These results indicate that the inclusion of the probiotic bacteria in trout feeds could be beneficial for the host by enhancing its intestinal innate immune function and promoting growth.

Acute stroke: basic concepts and use of imaging for clinicians

In this article we review basic and some advanced concepts of stroke imaging. The benefits and caveats of both CT and MRI are stressed and we attempt to familiarize the reader with current concepts regarding collateral brain circulation, its nature, and its importance in acute stroke.

Solid-phase extraction procedure of polar benzene- and naphthalenesulfonates in industrial effluents followed by unequivocal determination with ion-pair chromatography/electrospray-mass spectrometry

Highly water soluble benzene- and naphthalenesulfonates are widely used in the chemical, pharmaceutical, tannery, paper, and textile industries. In this work, Isolute ENV+ polystyrene divinylbenzene sorbent was used for the enrichment of 14 benzene- and naphthalenesulfonates from industrial wastewaters. The elution step was performed by adding 1 mL of water containing ion-pair reagent (5 mM of triethylamine (TEA) and 5 mM of acetic acid at pH 6.5) and 9 mL of methanol at 1 mL/min. The most relevant contribution was the use of ion-pair liquid chromatography followed by an orthogonal electrospray interface coupled to mass spectrometry in the negative ionization mode with postcolumn addition at 0.2 mL/min of methanol in combination with a volatile substance (triethylamine) as an ion-pair reagent. [M-H](-) ion was the base peak using low fragmentor voltages of 80 V with the electrospray interface. Significant fragmentation of the quasimolecular [M-H](-) ion occurs at high fragmentor voltage, producing [M-SO(2)H](-), [M-SO(3)H](-), and [SO(3)](•)(-) as diagnostic ions. Collision-induced dissociation of the parent ions for the benzene- and naphthalenesulfonates studied gave the [SO(3)](•)(-) fragment ion common to sulfonated compounds. At high fragmentor voltages of 150 V, [M-SO(3)H](-) ion is more abundant and therefore has a larger peak than the [M-H](-) peaks for 1,5-naphthalenedisulfonate, 2,6-naphthalenedisulfonate, 1-hydroxy-3,6-naphthalenedisulfonate, 2-hydroxy-3,6-naphthalenedisulfonate, and 2-amino-1,5-naphthalenedisulfonate. Recoveries were higher than 70%, with relative standard deviations between 1.3 and 10.7% with the exception of two naphthalenesulfonate compounds that had recoveries between 26 and 41%. Limits of detection (signal-to-noise ratio, 3) ranging from 0.6 pg to 0.13 ng (0.03-6.48 μg/L) were achieved when 150 mL of groundwater was processed. The aromatic sulfonates 3-nitrobenzenesulfonate, 4-methylbenzenesulfonate, 4-chlorobenzenesulfonate, 1-hydroxy-4-naphthalenosulfonate, 1-amino-6-naphthalenosulfonate, 1-amino-7-naphthalenosulfonate, and 1-naphthalenesulfonate and the linear alkyl benzenesulfonates C(10)-LAS and C(11)-LAS were unequivocally identified and quantitatively determined in μg/L, in wastewater samples from wastewater treatment plants and textile and tannery industries. 2-Naphthalenesulfonate was found as a major pollutant at mg/L concentration levels.

Influence of lamb rennet paste on the lipolytic and sensory profile of Murcia al Vino cheese

The influence of lamb rennet paste (71.1% chymosin, 177 international milk-clotting units/mL, 4.57U/g of lipase activity) during the ripening of Murcia al Vino goat cheese was studied. The aim of this study was to improve the knowledge of the effect of lamb rennet paste on the lipolytic patterns in this type of cheese by reference to the evolution of total and free fatty acids. A sensory analysis was carried out to compare cheeses made with commercial and paste rennet. The rennet paste showed higher lipolytic activity, enhancing the production of short-chain free fatty acids. In addition, the cheese produced with lamb rennet paste had a slightly more bitter and piquant taste, making it an attractive commercial alternative that can be used to develop new varieties of goat cheese.

Usefulness of a large field of view sensor for physicochemical, textural, and yield predictions under industrial goat cheese (Murcia al Vino) manufacturing conditions

The applicability of a light backscatter sensor with a large field of view was tested for on-line monitoring of coagulation and syneresis in a goat cheese (Murcia al Vino) manufactured under industrial conditions. Cheesemaking was carried out concurrently in a 12-L pilot vat and a 10,000-L industrial vat following the normal cheesemaking protocol. Cheese moisture, whey fat content, hardness, springiness, and adhesiveness were measured during syneresis. The results obtained show that cutting time is best predicted by considering the coagulation ratio at the inflection point and the percentage increase in the ratio during coagulation, with no need for the first derivative. The large field of view reflectance ratio provided good results for the prediction of moisture content, yield, hardness, springiness, and adhesiveness of the final cheese.

Cerebral fat embolism detection with susceptibility-weighted images in sickle cell disease

Cerebral fat embolism is a known but feared complication of sickle cell disease, which leads to significant morbidity. Although trauma-related fat embolism is more frequent and its diagnosis is straightforward, fat embolism secondary to bone infarcts after vaso-occlusive events can be unrecognized. Lack of criteria make the clinical diagnosis of sickle cell disease related fat embolism challenging. The neuroimaging findings are helpful to support the clinical diagnosis. Magnetic resonance imaging findings of fat embolism have been described including those seen on susceptibility-weighted imaging. Even though susceptibility-weighted imaging has been used for the diagnosis of cerebral fat embolism due to trauma, to the best of our knowledge its use has not been described in patients with sickle cell disease. We report an uncommon case of a 60-year-old woman with sickle cell disease who developed cerebral fat embolism and in which the findings on susceptibility-weighted imaging were characteristic and established the diagnosis.

Sinonasal cavernous haemangioma: a case report

Cavernous haemangiomas arising in the paranasal sinuses are very rare. Even though the lesion is benign in nature, its imaging features are non-specific, leading to an incorrect pre-operative diagnosis in most patients. We present a case of a maxillary sinus cavernous haemangioma in a young male. The clinical presentation and imaging characteristics of this entity are reviewed.

Postnatal Growth Patterns in a Chilean Cohort: The Role of SES and Family Environment

Objective. This study examined how family environmental characteristics served as mediators in the relationship between socioeconomic conditions and infant growth in a cohort of Chilean infants. Methods. We studied 999 infants, born between 1991 and 1996, from a longitudinal cohort which began as an iron deficiency anemia preventive trial. SES (Graffar Index), the Life Experiences Survey, and the Home Observation for Measurement of the Environment (HOME) were assessed in infancy. Using path analysis, we assessed the relationships between the social factors, home environment, and infant growth. Results. During the first year, weight and length gain averaged 540 grams/month and 6.5 cm/month, respectively. In the path analysis model for weight gain, higher SES and a better physical environment were positively related to higher maternal warmth, which in turn was associated with higher average weight gain. Higher SES was directly related to higher average length gain. Conclusions. In our cohort, a direct relationship between SES and length gain developed during infancy. Higher SES was indirectly related to infant weight gain through the home environment and maternal warmth. As the fastest growing infants are at risk for later obesity, new strategies are needed to encourage optimal rather than maximal growth.

Postpublication errors in imaging-related journals

BACKGROUND AND PURPOSE

Assessment of postpublication errors in peer-reviewed journals is difficult and the numbers and types are unknown. We reviewed published errata in major clinical imaging journals in an attempt to understand the numbers and sources of errors in published articles.

MATERIALS AND METHODS

Five clinical imaging journals with the highest IFs were searched on-line using the terms "erratum" or "errata" anywhere in the title, abstract, or author listing for a total of 5 years. Each erratum was reviewed and categorized by type and source of responsibility.

RESULTS

The following journals were assessed: JNM, Radiology, AJNR, AJR, and RadioGraphics. There were a total of 158 total errata and each was placed in 1 of the following categories: typographical (94), factual (6), image-related (48), statistical calculation (7), or serious foundational errors (3). Errata were also labeled as author (107) or journal responsibility (51). One hundred forty-eight errata were categorized as minor (typographical, factual, and image-related) and 10 as major (statistical calculation, foundational errors).

CONCLUSIONS

Analysis of the 8910 articles published by the 5 journals during the study period, revealed the number of minor and major errors were few, 1.66% and 0.11%, respectively. Of these errors, 93.7% were considered minor and 6.3% major. Most major errors were judged to be the responsibility of the authors, whereas most minor ones were the responsibility of the journals.

Differentiation of pyogenic brain abscesses from necrotic glioblastomas with use of susceptibility-weighted imaging

BACKGROUND AND PURPOSE

A common imaging finding in brain abscess and necrotic glioblastoma is a T2 hypointense margin. The features of this hypointense rim on SWI have not been previously described, to our knowledge. We aimed to differentiate abscesses from glioblastomas by assessing the morphology of their lesion margin by using SWI.

MATERIALS AND METHODS

T2WI and SWI were performed in 12 abscesses and 20 rim-enhancing glioblastomas. On T2WI and SWI, the prevalence and the border types (complete versus incomplete) of hypointense rims were qualitatively assessed. On SWI, the contour (smooth versus irregular) and the location of hypointense rims relative to the contrast-enhancing rims as well as the prevalence of the "dual rim sign," defined as 2 concentric rims at lesion margins with the outer one being hypointense and the inner one hyperintense relative to cavity contents, were also analyzed.

RESULTS

Prevalence and the border types of the hypointense rims on T2WI were not different between abscesses and glioblastomas. On SWI, there were significantly more hypointense rims that were complete (P < .001) and smooth (P < .001), having the same location as the contrast-enhancing rims (P < .001) for abscesses. A dual rim sign was present in 9 of 12 abscesses but absent in all glioblastomas (P < .001).

CONCLUSIONS

SWI may be helpful in differentiating pyogenic abscesses from necrotic glioblastomas. The dual rim sign is the most specific imaging feature distinguishing the 2.

Preliminary evaluation of endogenous milk fluorophores as tracer molecules for curd syneresis

A front-face fluorescence spectroscopy probe was installed in the wall of a laboratory-scale cheese vat. Excitation and emission filters were chosen for the selective detection of vitamin A, tryptophan, and riboflavin fluorescence. The evolution of the fluorescence of each fluorophore during milk coagulation and syneresis was monitored to determine if they had the potential to act as intrinsic tracers of syneresis and also coagulation. The fluorescence profiles for 2 of the fluorophores during coagulation could be divided into 3 sections relating to enzymatic hydrolysis of κ-casein, aggregation of casein micelles, and crosslinking. A parameter relating to coagulation kinetics was derived from the tryptophan and riboflavin profiles but this was not possible for the vitamin A response. The study also indicated that tryptophan and riboflavin may act as tracer molecules for syneresis, but this was not shown for vitamin A. The evolution of tryptophan and riboflavin fluorescence during syneresis followed a first-order reaction and had strong relationships with curd moisture and whey total solids content (r=0.86-0.96). Simple 1- and 2-parameter models were developed to predict curd moisture content, curd yield, and whey total solids using parameters derived from the sensor profiles (standard error of prediction=0.0005-0.394%; R(2)=0.963-0.999). The results of this study highlight the potential of tryptophan and riboflavin to act as intrinsic tracer molecules for noninvasive inline monitoring of milk coagulation and curd syneresis. Further work is required to validate these findings under a wider range of processing conditions.

Spontaneous internal carotid artery pseudoaneurysm in a patient with behçet disease

We describe the uncommon case of a patient with Behçet disease who developed a giant spontaneous cervical internal carotid artery pseudoaneurysm confirmed at surgery. We also discuss the implications of this rare complication.

Differentiation of tumefactive demyelinating lesions from high-grade gliomas with the use of diffusion tensor imaging

BACKGROUND AND PURPOSE

TDLs may be indistinguishable from high-grade gliomas on conventional MR imaging. The role of DTI in differentiating TDLs from high-grade gliomas is not clear, and quantitative comparison between the 2 has not been reported. Here we aimed to differentiate TDLs from high-grade gliomas by using DTI.

MATERIALS AND METHODS

DTI was performed in 8 TDLs and 13 high-grade gliomas. The presence of 3 findings (ie, intralesional hyperintensities on the FA map, restricted diffusion in the lesion periphery, and a perilesional hyperintense FA rim) was assessed by visual inspection. The FA and MD values were measured in the central nonenhancing portion, peripheral enhancing portion, and perilesional edema for each lesion and compared between the 2 groups respectively.

RESULTS

TDLs had a significantly higher incidence of intralesional hyperintensities on FA maps (P = .049) but a lower incidence of a perilesional hyperintense FA rim (P < .001), compared with those of high-grade gliomas on visual inspection. TDLs had significantly higher FA (P = .004) and lower MD (P = .001) values in the peripheral enhancing portions of the lesions compared with those of high-grade gliomas. In perilesional edema, FA values were significantly higher in high-grade gliomas (P = .001).

CONCLUSIONS

DTI is helpful in differentiating TDLs from high-grade gliomas by using visual inspection and quantitative analysis.

MRI Evaluation of the Temporomandibular Joints in Juvenile Rheumatoid Arthritis: A Retrospective Review

The purpose of this study was to evaluate the MRI findings of children with rheumatoid arthritis (JRA) affecting the temporomandibular joints (TMJ) and correlate these findings with symptoms. MRI studies of the TMJ in 26 children with a clinical diagnosis of JRA were retrospectively reviewed. All studies included oblique and sagittal T1, T2*, proton density/T2, and coronal T1-weighted images. T1 and proton density/T2-images were repeated with the mouth open. Post contrast sagittal and coronal T1-images were obtained in 19 patients. All studies were done on either 1.5 Tesla or 3.0 Tesla units with dedicated surface coils. By consensus, two radiologists evaluated the studies for abnormal condyles, bone erosions, presence or absence of discs, effusions, contrast enhancement and pannus. Open mouth views were assessed for incomplete or abnormal translation. Clinical records were reviewed to correlate symptoms with MRI findings. Abnormal condyles were seen in 49%. Discs were identifiable in 71%. Abnormal translation was seen in 71% and pannus in 49%. Erosions were seen in 37%, effusions in 24% and contrast enhancement in 50%. Correlation with clinical examination showed that of five asymptomatic patients, three had abnormal translation. Fifteen patients presented joint asymmetry on clinical examination and all showed abnormal translation on MRI. Our findings suggest that abnormal translation and joint enhancement may be the most common MRI findings in JRA patients with TMJ arthritis. Abnormalities may occur even in the absence of symptoms and the most common finding in symptomatic patients is abnormal translation.

Sildenafil-induced cervical spinal cord infarction

We present a patient with an acute cervical spinal cord infarction resulting from the use of sildenafil (Viagra) in combination with his hypertension medication. Symptoms were acute and rapidly progressive, and MR imaging with DWI was crucial in confirming the diagnosis.

The new World Health Organization Classification of Central Nervous System Tumors: what can the neuroradiologist really say?

The WHO Classification of Tumors of the Central Nervous System has become the worldwide standard for classifying and grading brain neoplasms. The most recent edition (WHO 2007) introduced a number of significant changes that include both additions and redefinitions or clarifications of existing entities. Eight new neoplasms and 4 new variants were introduced. This article reviews these entities, summarizing both their histology and imaging appearance. Now with more than 3 years of clinical experience following publication of the newest revision, we also ask, "What can the neuroradiologist really say?" Are there imaging findings that could suggest the preoperative diagnosis of a new tumor entity or variant?

Differentiation of brain abscesses from necrotic glioblastomas and cystic metastatic brain tumors with diffusion tensor imaging

BACKGROUND AND PURPOSE

The differentiation of abscesses from glioblastomas and metastases may not always be possible on the basis of DWI. Our hypothesis was that differences in diffusion properties as detected by DTI allow differentiation of abscess from glioblastomas and metastasis. Furthermore, diagnostic performance of tensor metrics quantifying anisotropy or tensor shapes is better than that of ADC in measuring mean diffusivity for this purpose.

MATERIALS AND METHODS

DTI was performed in 15 abscesses, 15 necrotic glioblastomas, and 26 cystic metastases. In each lesion, manually segmented into 4 regions of interest (ie, cystic cavity, enhancing rim, and immediate [edema most adjacent to the enhancing rim] and distant zones of edema), FA, ADC, C(l), C(p), and C(s) values were measured and statistically compared among groups and evaluated with ROC curve analysis. The presence of a hyperintense FA rim (a rim of edematous tissue that was hyperintense on the FA map) was assessed visually.

RESULTS

Abscess was significantly different from glioblastoma for all tensor metrics measured in the cystic cavity and immediate zone of edema and for all except C(l) in the enhancing rim. Abscess was significantly different from metastasis for all tensor metrics measured in the cystic cavity and enhancing rim and for FA, ADC, and C(l) in immediate zone of edema. The incidence of a hyperintense FA rim was significantly higher in glioblastoma and metastasis compared with abscess. The 3 tensor metrics with the highest performance in differentiating abscess from glioblastoma and metastasis were FA, C(l), and C(s) of the cystic cavity.

CONCLUSIONS

DTI is able to differentiate abscess from glioblastoma and metastasis. FA, C(l), and C(s) outperformed ADC in diagnostic performance comparisons.

Pediatric sensorineural hearing loss, part 2: syndromic and acquired causes

This article is the second in a 2-part series reviewing neuroimaging in childhood SNHL. Previously, we discussed the clinical work-up of children with hearing impairment, the classification of inner ear malformations, and congenital nonsyndromic causes of hearing loss. Here, we review and illustrate the most common syndromic hereditary and acquired causes of childhood SNHL, with an emphasis on entities that demonstrate inner ear abnormalities on cross-sectional imaging. Syndromes discussed include BOR syndrome, CHARGE syndrome, Pendred syndrome, Waardenburg syndrome, and X-linked hearing loss with stapes gusher. We conclude the article with a review of acquired causes of childhood SNHL, including infections, trauma, and neoplasms.

Pediatric sensorineural hearing loss, part 1: Practical aspects for neuroradiologists

SNHL is a major cause of childhood disability worldwide, affecting 6 in 1000 children. For children with prelingual hearing loss, early diagnosis and treatment is critical to optimizing speech and language development, academic achievement, and social and emotional development. Cross-sectional imaging has come to play an important role in the evaluation of children with SNHL because otolaryngologists routinely order either CT or MR imaging to assess the anatomy of the inner ears, to identify causes of hearing loss, and to provide prognostic information related to potential treatments. In this article, which is the first in a 2-part series, we describe the basic clinical approach to imaging of children with SNHL, including the utility of CT and MR imaging of the temporal bones; we review the most recent proposed classification of inner ear malformations; and we discuss nonsyndromic congenital causes of childhood SNHL.