Liquid and Droplet Transport in Brush-Coated Cylindrical Nanochannels: Brush-Assisted Droplet Formation

We study, by coarse-grained molecular dynamics simulations, equilibrium and flow properties of a liquid in cylindrical nanochannels, coated with polymer brushes. The parameters of the interaction potential model confer a chemical incompatibility between brush monomers and liquid particles. First, we study cylindrical channels whose radii are larger than the brush height and a continuous column of liquid forms at the center of the channel. These results are contrasted to the limiting case in which the radius of the cylinder is comparable to the brush height. In this second case, the grafted polymers interact across the channel and "close" it. We observe a train of droplets as the stable liquid morphology. The droplet size is comparable to the cylinder radius. By applying a constant body force onto the liquid, we induce a Poiseuille-like flow and investigate the morphology and flow rate as a function of driving force. Upon increasing the driving force, we encounter a nonequilibrium transition from a closed channel with slowly moving droplets to a flowing liquid thread at the center. The switching between these two states is reversible.

Dysregulation in B-cell responses and T follicular helper cell function in ADA2 deficiency patients

Adenosine deaminase 2 deficiency (DADA2) is an autoinflammatory disease characterized by inflammatory vasculopathy, early strokes associated often with hypogammaglobulinemia. Pure red cell aplasia, thrombocytopenia, and neutropenia have been reported. The defect is due to biallelic loss of function of ADA2 gene, coding for a protein known to regulate the catabolism of extracellular adenosine. We therefore investigated immune phenotype and B- and T-cell responses in 14 DADA2 patients to address if ADA2 mutation affects B- and T-cell function. Here, we show a significant decrease in memory B cells, in particular class switch memory, and an expansion of CD21^low B cells in DADA2 patients. In vitro stimulated B lymphocytes were able to secrete nonfunctional ADA2 protein, suggesting a cell intrinsic defect resulting in an impairment of B-cell proliferation and differentiation. Moreover, CD4⁺ and CD8⁺ T cells were diminished; however, the frequency of circulating T follicular helper cells was significantly increased but they had an impairment in IL-21 production possibly contributing to an impaired B cell help. Our findings suggest that ADA2 mutation could lead to a B-cell intrinsic defect but also to a defective Tfh cell function, which could contribute to the immunodeficient phenotype reported in DADA2 patients.

A novel knock-in mouse model of cryopyrin-associated periodic syndromes with development of amyloidosis: Therapeutic efficacy of proton pump inhibitors

BACKGROUND

Cryopyrin-associated periodic syndromes (CAPS) are a group of autoinflammatory diseases linked to gain-of-function mutations in the NOD-like receptor family, pyrin domain containing 3 (NLRP3) gene, which cause uncontrolled IL-1β secretion. Proton pump inhibitors (PPIs), which are commonly used as inhibitors of gastric acid production, also have anti-inflammatory properties, protect mice from sepsis, and prevent IL-1β secretion by monocytes from patients with CAPS.

OBJECTIVE

We sought to develop a novel Nlrp3 knock-in (KI) mouse model of CAPS to study amyloidosis, a severe CAPS complication, and test novel therapeutic approaches.

METHODS

We generated KI mice by engineering the N475K mutation, which is associated with the CAPS phenotype, into the mouse Nlrp3 gene. KI and wild-type mice received PPIs or PBS intraperitoneally and were analyzed for survival, inflammation, cytokine secretion, and amyloidosis development.

RESULTS

Mutant Nlrp3 KI mice displayed features that recapitulate the immunologic and clinical phenotype of CAPS. They showed systemic inflammation with high levels of serum proinflammatory cytokines, inflammatory infiltrates in various organs, and amyloid deposits in the spleen, liver, and kidneys. Toll-like receptor stimulated macrophages from KI mice secreted high levels of IL-1β, IL-18, and IL-1α but low amounts of IL-1 receptor antagonist. Treatment of KI mice with PPIs had a clear clinical effect, showing a reduction in inflammatory manifestations, regression of amyloid deposits, and normalization of proinflammatory and anti-inflammatory cytokine production by macrophages.

CONCLUSION

Nlrp3 KI mice displayed a CAPS phenotype with many characteristics of autoinflammation, including amyloidosis. The therapeutic effectiveness of PPIs associated with a lack of toxicity indicates that these drugs could represent relevant adjuvants to the anti-IL-1 drugs in patients with CAPS and other IL-1-driven diseases.

Efficacy and Adverse Events During Janus Kinase Inhibitor Treatment of SAVI Syndrome

Objectives

Mutations affecting the TMEM173 gene cause STING-associated vasculopathy with onset in infancy (SAVI). No standard immunosuppressive treatment approach is able to control disease progression in patients with SAVI. We studied the efficacy and safety of targeting type I IFN signaling with the Janus kinase inhibitor, ruxolitinib.

Methods

We used DNA sequencing to identify mutations in TMEM173 in patients with peripheral blood type I IFN signature. The JAK1/2 inhibitor ruxolitinib was administered on an off-label basis.

Results

We identified three patients with SAVI presenting with skin involvement and progressive severe interstitial lung disease. Indirect echocardiographic signs of pulmonary hypertension were present in one case. Following treatment with ruxolitinib, we observed improvements of respiratory function including increased forced vital capacity in two patients, with discontinuation of oxygen therapy and resolution of echocardiographic abnormalities in one case. Efficacy was persistent in one patient and only transitory in the other two patients. Clinical control of skin complications was obtained, and one patient discontinued steroid treatment. One patient, who presented with kidney involvement, showed resolution of hematuria. One patient experienced increased recurrence of severe viral respiratory infections. Monitoring of peripheral blood type I interferon signature during ruxolitinib treatment did not show a stable decrease.

Conclusions

We conclude that targeting type I IFN receptor signaling may represent a promising therapeutic option for a subset of patients with SAVI syndrome and severe lung involvement. However, the occurrence of viral respiratory infection might represent an important cautionary note for the application of such form of treatment.

Electronic supplementary material

The online version of this article (10.1007/s10875-019-00645-0) contains supplementary material, which is available to authorized users.

Pressure responsive gating in nanochannels coated by semiflexible polymer brushes

We study by coarse-grained molecular-dynamics simulations the liquid flow in a slit channel with the inner walls coated by semiflexible polymer brushes. The distance between walls is close enough such that polymers grafted to opposing walls interact among each other and form bundles across the channel in poor solvent conditions. The solvent is simulated explicitly, including particles that fill the interior of the channel. The system is studied in equilibrium and under flow, by applying a constant body force on each particle of the system. A non-linear relation between external force and flow rate is observed, for a particular set of parameters. This non-linear response is linked to a morphological change of the polymer brushes. For large enough forces, the bundle structures formed across the channel break as the chains lean in the direction of the flow, and clear the middle of the channel. This morphological alteration of the polymer configurations translates in a sudden increase in the flow rate, acting as a pressure-responsive gate. The relation between flow and external force is investigated for various parameters, such as grafting density, quality of the solvent and polymer bending rigidity. We observe a non-monotonic dependence of the flow as a function of the polymer rigidity, and find an optimum value for the persistence length. We also find that the force threshold at which the morphological changes happen in the polymer brush, depends linearly on the grafting density. These findings can lead to new flow control techniques in micro and nano-fluidic devices.

CD70 Deficiency due to a Novel Mutation in a Patient with Severe Chronic EBV Infection Presenting As a Periodic Fever

Primary immunodeficiencies with selective susceptibility to EBV infection are rare conditions associated with severe lymphoproliferation. We followed a patient, son of consanguineous parents, referred to our center for recurrent periodic episodes of fever associated with tonsillitis and adenitis started after an infectious mononucleosis and responsive to oral steroid. An initial diagnosis of periodic fever, aphthous stomatitis, pharyngitis, cervical adenitis syndrome was done. In the following months, recurrent respiratory infections and episodes of keratitis were also observed, together with a progressive reduction of immunoglobulin levels and an increase of CD20⁺ cells. Cell sorting and EBV PCR showed 25,000 copies for 100,000 leukocytes with predominant infection of B lymphocytes. Lymph node’s biopsy revealed reactive lymphadenopathy with paracortical involvement consistent with a chronic EBV infection. Molecular analysis of XIAP, SHA2D1A, ITK, and CD27 genes did not detect any pathogenic mutation. The patients underwent repeated courses of anti-CD20 therapy with only a partial control of the disease, followed by stem cell transplantation with a complete normalization of clinical and immunological features. Whole exome sequencing of the trio was performed. Among the variants identified, a novel loss of function homozygous c.163-2A>G mutation of the CD70 gene, affecting the exon 2 AG-acceptor splice site, fit the expected recessive model of inheritance. Indeed, deficiency of both CD27, and, more recently, of its ligand CD70, has been reported as a cause of EBV-driven lymphoproliferation and hypogammaglobulinemia. Cell surface analysis of patient-derived PHA-T cell blasts and EBV-transformed lymphoblastoid cell lines confirmed absence of CD70 expression. In conclusion, we describe a case of severe chronic EBV infection caused by a novel mutation of CD70 presenting with recurrent periodic fever.

Droplet Transport in a Nanochannel Coated by Hydrophobic Semiflexible Polymer Brushes: The Effect of Chain Stiffness

We study the influence of chain stiffness on droplet flow in a nanochannel, coated with semiflexible hydrophobic polymers by means of nonequilibrium molecular dynamics simulations. The studied system is then a moving droplet in the slit channel, coexisting with its vapor and subjected to periodic boundary conditions in the flow direction. The polymer chains, grafted by the terminal bead to the confining walls, are described by a coarse-grained model that accounts for chain connectivity, excluded volume interactions and local chain stiffness. The rheological, frictional and dynamical properties of the brush are explored over a wide range of persistence lengths. We find a rich behavior of polymer conformations and concomitant changes in the friction properties over the wide range of studied polymer stiffnesses. A rapid decrease in the droplet velocity was observed as the rigidity of the chains is increased for polymers whose persistence length is smaller than their contour length. We find a strong relation between the internal dynamics of the brush and the droplet transport properties, which could be used to tailor flow properties by surface functionalization. The monomers of the brush layer, under the droplet, present a collective "treadmill belt" like dynamics which can only be present due the existence of grafted chains. We describe its changes in spatial extension upon variations of polymer stiffness, with bidimensional velocity and density profiles. The deformation of the polymer brushes due to the presence of the droplet is analyzed in detail. Lastly, the droplet-gas interaction is studied by varying the liquid to gas ratio, observing a 16% speed increase for droplets that flow close to each other, compared to a train of droplets that present a large gap between consecutive droplets.

Murine Rankl-/- Mesenchymal Stromal Cells Display an Osteogenic Differentiation Defect Improved by a RANKL-Expressing Lentiviral Vector

Autosomal recessive osteopetrosis (ARO) is a severe bone disease characterized by increased bone density due to impairment in osteoclast resorptive function or differentiation. Hematopoietic stem cell transplantation is the only available treatment; however, this therapy is not effective in RANKL-dependent ARO, since in bone this gene is mainly expressed by cells of mesenchymal origin. Of note, whether lack of RANKL production might cause a defect also in the bone marrow (BM) stromal compartment, possibly contributing to the pathology, is unknown. To verify this possibility, we generated and characterized BM mesenchymal stromal cell (BM-MSC) lines from wild type and Rankl^-/- mice, and found that Rankl^-/- BM-MSCs displayed reduced clonogenicity and osteogenic capacity. The differentiation defect was significantly improved by lentiviral transduction of Rankl^-/- BM-MSCs with a vector stably expressing human soluble RANKL (hsRANKL). Expression of Rankl receptor, Rank, on the cytoplasmic membrane of BM-MSCs pointed to the existence of an autocrine loop possibly activated by the secreted cytokine. Based on the close resemblance of RANKL-defective osteopetrosis in humans and mice, we expect that our results are also relevant for RANKL-dependent ARO patients. Data obtained in vitro after transduction with a lentiviral vector expressing hsRANKL would suggest that restoration of RANKL production might not only rescue the defective osteoclastogenesis of this ARO form, but also improve a less obvious defect in the osteoblast lineage, thus possibly achieving higher benefit for the patients, when the approach is translated to clinics. Stem Cells 2017;35:1365-1377.

Fluctuation-induced forces between rings threaded around a polymer chain under tension

We characterize the fluctuation properties of a polymer chain under external tension and the fluctuation-induced forces between two ring molecules threaded around the chain. The problem is relevant in the context of fluctuation-induced forces in soft-matter systems, features of liquid interfaces, and to describe the properties of polyrotaxanes and slide-ring materials. We perform molecular-dynamics simulations of the Kremer-Grest bead-spring model for the polymer and a simple ring-molecule model in the canonical ensemble. We study transverse fluctuations of the stretched chain as a function of chain stretching and in the presence of ring-shaped threaded molecules. The fluctuation spectra of the chains are analyzed in equilibrium at constant temperature, and the differences in the presence of two-ring molecules are compared. For the rings located at fixed distances, we find an attractive fluctuation-induced force between the rings, proportional to the temperature and decaying with the ring distance. We characterize this force as a function of ring distance, chain stretching, and ring radius, and we measure the differences between the free chain spectrum and the fluctuations of the chain constrained by the rings. We also compare the dependence and range of the force found in the simulations with theoretical models coming from different fields.

Measuring the composition-curvature coupling in binary lipid membranes by computer simulations

The coupling between local composition fluctuations in binary lipid membranes and curvature affects the lateral membrane structure. We propose an efficient method to compute the composition-curvature coupling in molecular simulations and apply it to two coarse-grained membrane models-a minimal, implicit-solvent model and the MARTINI model. Both the weak-curvature behavior that is typical for thermal fluctuations of planar bilayer membranes as well as the strong-curvature regime corresponding to narrow cylindrical membrane tubes are studied by molecular dynamics simulation. The simulation results are analyzed by using a phenomenological model of the thermodynamics of curved, mixed bilayer membranes that accounts for the change of the monolayer area upon bending. Additionally the role of thermodynamic characteristics such as the incompatibility between the two lipid species and asymmetry of composition are investigated.

Brushes of semiflexible polymers in equilibrium and under flow in a super-hydrophobic regime

We performed molecular dynamics simulations to study the equilibrium and flow properties of a liquid in a nano-channel with confining surfaces coated with a layer of grafted semiflexible polymers. The coverage spans a wide range of grafting densities from essentially isolated chains to dense brushes. The end-grafted polymers were described by a bead spring model with a harmonic potential to include the bond stiffness of the chains. We varied the rigidity of the chains, from fully flexible polymers to rigid rods, in which the configurational entropy of the chains is negligible. The brush-liquid interaction was tuned to obtain a super-hydrophobic channel, in which the liquid did not penetrate the polymer brush, giving rise to a Cassie-Baxter state. Equilibrium properties such as brush height and bending energy were measured, varying the grafting density and the stiffness of the polymers. We also studied the characteristics of the brush-liquid interface and the morphology of the polymer chains supporting the liquid for different bending rigidities. Non-equilibrium simulations were performed, moving the walls of the channel in opposite directions at constant speed, obtaining a Couette velocity profile in the bulk liquid. The molecular degrees of freedom of the polymers were studied as a function of the Weissenberg number. Also, the violation of the no-slip boundary condition and the slip properties were analyzed as a function of the shear rate, grafting density and bending stiffness. At high grafting densities, a finite slip length independent of the shear rate or bending constant was found, while at low grafting densities a very interesting non-monotonic dependence on the bending constant is observed.

Mean properties and free energy of a few hard spheres confined in a spherical cavity

We use analytical calculations and event-driven molecular dynamics simulations to study a small number of hard sphere particles in a spherical cavity. The cavity is also taken as the thermal bath so that the system thermalizes by collisions with the wall. In that way, these systems of two, three, and four particles, are considered in the canonical ensemble. We characterize various mean and thermal properties for a wide range of number densities. We study the density profiles, the components of the local pressure tensor, the interface tension, and the adsorption at the wall. This spans from the ideal gas limit at low densities to the high-packing limit in which there are significant regions of the cavity for which the particles have no access, due the conjunction of excluded volume and confinement. The contact density and the pressure on the wall are obtained by simulations and compared to exact analytical results. We also obtain the excess free energy for N = 4, by using a simulated-assisted approach in which we combine simulation results with the knowledge of the exact partition function for two and three particles in a spherical cavity.

Nanotribology of biopolymer brushes in aqueous solution using dissipative particle dynamics simulations: an application to PEG covered liposomes in a theta solvent

We undertake the investigation of sheared polymer chains grafted onto flat surfaces to model liposomes covered with polyethylene glycol brushes as a case study for the mechanisms of efficient drug delivery in biologically relevant situations, for example, as carriers for topical treatments of illnesses in the human vasculature. For these applications, specific rheological properties are required, such as low viscosity at high shear rates, to improve the transport of the liposomes. Therefore, extensive non-equilibrium, coarse-grained dissipative particle dynamics simulations of polymer brushes of various lengths and shear rates are performed to obtain the average viscosity and the friction coefficient of the system as functions of the shear rate and polymerization degree under theta-solvent conditions, and we find that the brushes experience considerable shear thinning at large shear rates. The viscosity (η) and the friction coefficient (μ) are shown to obey the scaling laws η ∼ γ dot above (-0.31) and μ ∼ γ dot above (0.69) at high shear rates (γ dot above) in a theta solvent, irrespective of the degree of polymerization of brushes. These results confirm recent scaling predictions and reproduce very well trends in measurements of the viscosity at a high shear rate (γ dot above) of red blood cells in a liposome containing medium.

Molecular transport and flow past hard and soft surfaces: computer simulation of model systems

The equilibrium and flow of polymer films and drops past a surface are characterized by the interface and surface tensions, viscosity, slip length and hydrodynamic boundary position. These parameters of the continuum description are extracted from molecular simulations of coarse-grained models. Hard, corrugated substrates are modelled by a Lennard-Jones solid while polymer brushes are studied as prototypes of soft, deformable surfaces. Four observations are discussed. (i) If the surface becomes strongly attractive or is coated with a brush, the Navier boundary condition fails to describe the effect of the surface independently of the strength and type of the flow. This failure stems from the formation of a boundary layer with an effective, higher viscosity. (ii) In the case of brush-coated surfaces, flow induces a cyclic, tumbling motion of the tethered chain molecules. Their collective motion gives rise to an inversion of the flow in the vicinity of the grafting surfaces and leads to strong, non-Gaussian fluctuations of the molecular orientations. The flow past a polymer brush cannot be described by Brinkman's equation. (iii) The hydrodynamic boundary condition is an important parameter for predicting the motion of polymer droplets on a surface under the influence of an external force. Their steady-state velocity is dictated by a balance between the power that is provided by the external force and the dissipation. If there is slippage at the liquid-solid interface, the friction at the solid-liquid interface and the viscous dissipation of the flow inside the drop will be the dominant dissipation mechanisms; dissipation at the three-phase contact line appears to be less important on a hard surface. (iv) On a soft, deformable substrate like a polymer brush, we observe a lifting-up of the three-phase contact line. Controlling the grafting density and the incompatibility between the brush and the polymer liquid we can independently tune the softness of the surface and the contact angle and thereby identify the parameters for maximizing the deformation at the three-phase contact.

Frictional forces between strongly compressed, nonentangled polymer brushes: molecular dynamics simulations and scaling theory

By means of molecular dynamics simulations and scaling theory we study the response of opposing polymer brushes to constant shear motion under good solvent conditions. Model systems that contain explicit solvent molecules (Lennard-Jones dimers) are compared to solvent-free systems while varying of the distance between the grafted layers and their molecular parameters, chain length and grafting density. Our study reveals a power-law dependence of macroscopic transport properties on the Weissenberg number, W, beyond linear response. For instance, we find that the kinetic friction constant scales as mu approximately W(0.57) for large values of W. We develop a scaling theory that describes our data and previous numerical data including recent experiments.

Comparison of dissipative particle dynamics and Langevin thermostats for out-of-equilibrium simulations of polymeric systems

In this work we compare and characterize the behavior of Langevin and dissipative particle dynamics (DPD) thermostats in a broad range of nonequilibrium simulations of polymeric systems. Polymer brushes in relative sliding motion, polymeric liquids in Poiseuille and Couette flows, and brush-melt interfaces are used as model systems to analyze the efficiency and limitations of different Langevin and DPD thermostat implementations. Widely used coarse-grained bead-spring models under good and poor solvent conditions are employed to assess the effects of the thermostats. We considered equilibrium, transient, and steady state examples for testing the ability of the thermostats to maintain constant temperature and to reproduce the underlying physical phenomena in nonequilibrium situations. The common practice of switching off the Langevin thermostat in the flow direction is also critically revisited. The efficiency of different weight functions for the DPD thermostat is quantitatively analyzed as a function of the solvent quality and the nonequilibrium situation.

Static and dynamic properties of the interface between a polymer brush and a melt of identical chains

Molecular-dynamics simulations of a short-chain polymer melt between two brush-covered surfaces under shear have been performed. The end-grafted polymers which constitute the brush have the same chemical properties as the free chains in the melt and provide a soft deformable substrate. Polymer chains are described by a coarse-grained bead-spring model, which includes excluded volume and backbone connectivity of the chains. The grafting density of the brush layer offers a way of controlling the behavior of the surface without altering the molecular interactions. We perform equilibrium and nonequilibrium molecular-dynamics simulations at constant temperature and volume using the dissipative particle dynamics thermostat. The equilibrium density profiles and the behavior under shear are studied as well as the interdigitation of the melt into the brush, the orientation on different length scales (bond vectors, radius of gyration, and end-to-end vector) of free and grafted chains, and velocity profiles. The obtained boundary conditions and slip length show a rich behavior as a function of grafting density and shear velocity.

Advanced practice nursing role: nurse practitioner

Nurse Practitioners are advanced practice nurses (APNs) who provide primary and acute care to individuals in many settings. The NP diagnoses and treats medical and surgical conditions that require acute, short-term management and chronic, long-term treatment. States vary in regulating processes regarding collaborative agreements, prescriptive authority, medical staff privileges, and insurance/third party reimbursement.

Leiomyomas of the gallbladder and splenic calcifications in an HIV-infected child

Smooth muscle neoplasms seem to be particularly frequent in children with AIDS, and several cases of such lesions, both benign and malignant (leiomyomas and leiomyosarcomas), have recently been reported in the literature. We describe here the imaging findings in a boy with AIDS who developed two leiomyomas of the gallbladder wall as well as calcification of the intraparenchymal splenic arteries.

Screening for abdominal aortic aneurysms and associated risk factors in a general population

OBJECTIVES

To evaluate the prevalence of abdominal aortic aneurysms (AAA) in a general population and to compare the results with those of similar studies in other countries.

DESIGN

Ultrasound screening study and collection of clinical and biochemical data.

SETTING

An urban Health Service District in Genoa, Italy.

MATERIALS

A general population, aged 65-75 years, invited by personal letter between 1991-1994.

RESULTS

1601 subjects (741 males and 860 females) out of 2734 invited (58.5%) were evaluated. According to the ultrasound findings, 27 patients (1.7%) had an aortic dilatation of 26-29 mm; an AAA of 30-39 mm was found in 37 (2.3%) and an AAA > or = 40 mm in 33 (2.1%). The overall prevalence for AAA was 4.4% (8.8% in males and 0.6% in females respectively). The prevalence of smoking, alcohol consumption, coronary heart disease, chronic obstructive pulmonary disease and arterial disease were significantly higher in patients with AAA (p < 0.01).

CONCLUSIONS

Ultrasound screening for AAA is a reliable and useful method and should be focused on men, regardless of concurrent disease.

[Screening for abdominal aortic aneurysms in the general population. Preliminary results]

Between March 1991 and April 1993, 1188 subjects aged 65-75 years, out of 2734 invited, underwent abdominal ultrasound for screening of asymptomatic abdominal aortic aneurysms (AAA). For each patient the maximal anteroposterior and transverse diameters of the suprarenal and infrarenal aorta were measured. According to the literature data an AAA is defined as an aortic dilatation > 29 mm. AAA < 40 mm are followed by ultrasound every 6 months and the AAA > 39 mm are considered for surgical repair after complete clinical work-up. In addition any aortic dilatation ranging 26-29 mm is followed too, using the same criteria. The aorta was normal in 1112 patients (95.12%), an infrarenal aortic dilatation was found in 21 patients (1.79%), an AAA < 40 mm in 15 patients (1.28%) and an AAA > 39 mm in 21 patients (1.79%). The global prevalence of AAA > 29 mm was 3.07% (0.3% for the females and 6.8% for the males), similar to that reported by other authors. The statistically significant (p < 0.01) risk factors were: smoking, alcohol consumption, coronary disease and chronic lung obstruction. Hypertension and dyslipidaemia were not significant (but HDL-cholesterol and Apo-B), according to a different etiology of the aneurysms. In addition 38.5% of the patients had total cholesterol > 240 mg/dl but only 34.9% of these was under medical treatment and/or on a diet. Our preliminary data confirm the results of similar studies in other countries: screening for AAA is worthwhile on the general population and, looking to a better cost-benefit rate, it might be focused only on males.

Case report: imaging of a bilobed gallbladder

Imaging of the gallbladder demonstrates a wide range of anatomical variants, including anomalies in location, number and shape. Duplication anomalies are quite rare and are characterized by a large variety of configurations depending on the size and degree of fusion of the two lobes, and on the number and disposition of the cystic ducts. We present a case of a deeply cleft, bilobed gallbladder imaged by computed tomography (CT), ultrasonography (US) and oral cholecystography (OCG). The anomaly consisted of complete duplication of the body and fundus into two distinct and separated lobes both of which entered a single infundibulum. Awareness of congenital gallbladder variants may help in recognizing and correctly classifying gallbladder abnormalities, thus preventing misdiagnoses.

Analysis of echotexture of tendons with US

To evaluate changes in echotexture of normal tendons at different frequencies and establish an anatomic correlation for fibrillar echoes, normal calcaneal tendons were examined in vitro at 7.5, 10, 13, and 15 MHz in calves (n = 8) and sheep (n = 6) and in vivo in humans (n = 8). Histologic correlation was obtained in vitro with 22-gauge needles that marked the position of echogenic fibrils under ultrasound (US) guidance. The human study group consisted of 25 patients with a clinical diagnosis of calcaneal tendon disease and 15 patients who underwent surgery for rupture of the Achilles tendon. At all four frequencies, normal tendons showed an internal network of fine parallel and linear fibrillar echoes that became more numerous and thinner as US frequency increased. These echoes were caused by specular reflections at the interface between collagen bundles and endotendineum septa. In patients, tendons showed a variety of basic changes in fibrillar pattern: increased fibrillar thickness (33 patients), interruption (17 patients), fragmentation (12 patients), and disappearance of echotexture (15 patients). It is concluded that US holds promise in detection of minimal changes in tendinous structure.

[Color-Doppler echography of the testis. Study technique and vascular anatomy]

Color-Doppler sonography has recently made it possible to image scrotal vascularity non-invasively. This study was undertaken to determine the normal color-Doppler appearance and distribution of scrotal vessels and to define the technical principles of the examination. Color-Doppler imaging was effective in detecting both funicolar and testicular vessels. Among these, capsular (25/25), trans-testicular (10/25), centripetal and recurrent (25/25) arteries were easily identified. Waveforms analysis allowed to differentiate veins from arteries within testis and to distinguish (8/10) supratesticular (high impedance pattern with absent diastolic flow) from intratesticular arteries (low impedance pattern with high levels of diastolic flow). The optimal color depiction of scrotal vascularity needed the appropriate selection of several imaging parameters to increase detection of low-velocity, low-volume flows within the small testicular vessels. Such parameters included: PRF (ranging 1500 to 600 Hz), wall filters (ranging 25 to 50 Hz), color gain (maximized for optimal sensitivity while avoiding excessive color noise), color vs. echo priority (ranging 70 to 90%) and color persistence (adjusted to high values). In conclusion, color-Doppler imaging is capable of reliably showing the normal anatomy of testicular vessels. It could make a reliable substitute for scintigraphy and continuous wave Doppler in diagnosing scrotal conditions that alter blood flow.

Gradient echo MRI of portal vein thrombosis

The MR appearance of thrombosis of the portal vein and its branches using gradient echo (GRE) sequences is described. The study consists of two separate parts. In the first part, five normal volunteers were examined to select the optimal section plane for each portal vessel to be studied. Given the "time of flight" effect of GRE sequences, a scan plane perpendicular to the direction of flow was used to obtain maximal signal enhancement of flowing blood. In the second part of the study, 13 patients with thrombosis of the portal system diagnosed by Doppler sonography, CT, and digital subtraction angiography were examined with the GRE technique. Gradient echo MR confirmed the presence and defined the extent of vessel thrombosis with high diagnostic accuracy. In addition, it proved accurate in detecting portosystemic collaterals. We concluded that the GRE technique can be effectively used as a complement to conventional SE MR to further delineate portal vessels.

[Gastromiro vs gastrografin vs prontobario CAT for computerized tomography. Multicenter study]

The opacification of intestinal loops is mandatory, during CT examination of the abdomen, to prevent the gut from being mistaken for a pathological process or vice versa. The authors compared Gastrografin and Prontobarium-CT with a new, orally administrable, non-ionic contrast medium (Gastromiro) to investigate whether the non-ionic molecule presents any advantages over the other contrast media usually employed with CT. Five hundred ml of water solution/suspension at 11.1% (Gastromiro or Gastrografin) and 1.7% (Prontobarium-CT) were administered 20 minutes before examination to 818 consecutive patients. Different parameters were considered--i.e., patient tolerance as far as "taste and vomiting" were concerned, gut opacification, and any reaction which might have occurred to the patients within 24 hours after examination. The results, statistically analyzed, are the following: no significant difference in the quality of opacification of stomach, duodenum, and large bowel; significant difference in the quality of opacification of small bowel, where Gastromiro proved to have the highest contrast resolution; Gatromiro stimulated diarrhea significantly less than Gastrografin and Prontobarium-CT.