Magnetic functionalization of ZnO nanoparticles surfaces via optically generated methyl radicals

The combination of nuclear and electron magnetic resonance techniques, in pulse and continuous wave regimes, is used to unravel the nature and features of the light-induced magnetic state arising at the surface of chemically prepared zinc oxide nanoparticles (NPs) occurring under 120 K when subjected to a sub-bandgap (405 nm) laser excitation. It is shown that the four-line structure observed around g ∼ 2.00 in the as-grown samples (beside the usual core-defect signal at g ∼ 1.96) arises from surface-located methyl radicals (•CH3), originating from the acetate capped ZnO molecules. By functionalizing the as-grown zinc oxide NPs with deuterated sodium acetate, the •CH3 electron paramagnetic resonance (EPR) signal is replaced by trideuteromethyl (•CD3). For •CH3, •CD3, and core-defect signals, an electron spin echo is detected below ∼100 K, allowing for the spin-lattice and spin-spin relaxation-time measurements for each of them. Advanced pulse-EPR techniques reveal the proton or deuteron spin-echo modulation for both radicals and give access to small unresolved superhyperfine couplings between adjacent •CH3. In addition, electron double resonance techniques show that some correlations exist between the different EPR transitions of •CH3. These correlations are discussed as possibly arising from cross-relaxation phenomena between different rotational states of radicals.

AB1455 VERY LOW FREQUENCY ANAS/DFS70 PATTERN POSITIVITY IN A LARGE COHORT OF AUTOIMMUNE/AUTOINFLAMMATORY AND CONTROLS IN A SINGLE HOSPITAL FROM COLOMBIA

Background

Antinuclear antibodies (ANA) have diagnostic significance in rheumatology. Anti-DFS70 (Dense Fine Speckle-70 kd) antibodies may be an exclusionary marker for systemic autoimmune rheumatic disease (SARD). Low frequency of this pattern has previously been described in healthy populations.

Objectives

To evaluate ANAS/DFS70 positivity and autoantibody profile in a large Colombian population with rheumatoid arthritis (RA), psoriasis (PsO), as well as, undifferentiated connective tissue diseases (UCTD), first degree relatives (FDR), and healthy controls (HC).

Methods

A cross-sectional study was conducted. We analyzed 531 individuals between 18-65 years, 101 RA patients (ACR/EULAR 2010 classification criteria), 137 relatives from RA, 60 PsO patients (Colombian classification consensus), 47 UCTD patients, and 186 HC matched by age and sex. The determination of ANAS-HEp2 antibodies, was carried out. The ANAS/DFS70 positive results used as a confirmatory test the determination by Knocked out, for the psip gen and CytoBead by indirect immunofluorescence-IFI technique. Absolute and relative frequencies were established and associations with chi square test.

Results

The distribution by diagnostic group was RA: 19%, PsO: 11,3%, UCTD: 8,9%, 25,8% RA relatives, and 35% healthy controls. RA was ANA test (+) in 42%, PsO 41,7%, UCTD 78,7%, FDR 26,3%, and HC 26,9%. The positive frequency of ANA/DFS70 in the total group was 2.3% and 1,4% in SARD (n=12; 2 FDR, 6 HC, 3 UCTD, and PsO 1), no RA patients were positive. These 12 participants were negative for rheumatoid factor (RF) and anti-citrullinated protein antibody (ACPA), one patient with UCTD were positive for Anti SSB/La, Anti Sm, Anti RNP, and anti DNAds, another was positive for anti Sm IgG and IgM B2GP, and IgG ACA. Most participants had negative acute phase reactants (erythrosedimentation rate ESR[-] 83,3% and C-reactive protein CRP[-] 66,6%). ANAS/DFS70 was associated with positivity for ANAS independently of ANAS titers, (p <0,001). None of the patients’ positives ANAS DFS70 in the UCTD group in 5 years developed definitive autoimmune disease.

Conclusion

Despite the low frequency in the group in general, it has been shown that anti-DFS70 is more prevalent in healthy individuals than in patients with SARD, which was found in this group of individuals. ANAS/DFS70 autoantibodies were present in very low frequency in Colombian patients with SARD. Thus, patients with a positive result tend to have a mild or non-progressing phenotype of autoimmune or autoinflammatory diseases. This analysis reinforce evidence of ANA/DFS70 positivity as well as autoantibody negativity described abroad as a negative predictive marker of SARD.

Table 1.

Clinical and demographical variables for ANAS/DFS70 patients n=12.

AGEGENDERANASESRCRPRFACPARoLaSmRNPDNAdsACA IgGACA IgMACA IgAB2GP IgGB2GP IgMUCTD30F1/160------+--+--++UCTD61F1/320-----++++-----UCTD42F1/160-+------+-----PsO43F1/320--------------FDR31M1/80--------------FDR32F1/160+-------------HC50F1/80--------------HC26F1/80+-------------HC27F1/160--------------HC54F1/320--------------HC32F1/160--------------HC53F1/320-+------------

Rheumatoid arthritis (RA), Psoriasis (PsO), as well as, Undifferentiated connective tissue diseases (UCTD), first degree relatives (FDR), healthy controls (HC), rheumatoid factor (RF) and anti-citrullinated protein antibody (ACPA), erythrosedimentation rate (ESR), and C-reactive protein (CRP).

Acknowledgements

Hospital Militar Central / Universidad del Bosque

Disclosure of Interests

None declared

SAT0580 ANALYSIS OF ANAS/DFS70 PATTERN IN A LARGE COHORT OF AUTOIMMUNE/AUTOINFLAMMATORY DISEASES COMPARED WITH FIRST DEGREE RELATIVES AND HEALTHY CONTROLS EVALUATED IN A SINGLE HOSPITAL FROM COLOMBIA

Background:

Autoimmune diseases have a broad phenotypic spectrum, with great variability in clinical manifestations. Anti-DFS70/LEDGFp75 (ANAS/DFS70) antibodies have attracted interest as a positive result in patients without clinical evidence of autoimmune systemic rheumatic disease (SARD). It has been proven in non-rheumatic inflammatory diseases and in “apparently healthy” individuals.

Objectives:

To assess ANAS/DFS70 performance in a large population with autoimmune/autoinflammatory diseases compared with first degree relatives and healthy controls.

Methods:

A cross-sectional study was conducted. We analysed 531 individuals between 18-65 years old, 101 rheumatoid arthritis (RA) patients (ACR/EULAR 2010 classification criteria), 137 relatives from RA, 60 psoriasis (Ps) patients (Colombian classification consensus), 47 Undifferentiated connective tissue diseases(UCTD) patients and 186 healthy controls matched by age and sex. The healthy control group were individuals who lived and work similarly like those patients those criteria of exclusion criteria were to present autoimmune or auto-inflammatory disease, infectious, neoplasms, diabetes, antibiotic treatment, pregnancy or lactation, consanguinity with autoimmune entities. Ethical Committee approved.

The determination of ANAS-HEp2 antibodies (ANA-Hep-2 AESKU.Dignostic®, Autoantiboy test SYSTEM IMCO DIAGNOSTICS REF 1103® and ANA-Hep-2 AESKU.Dignostic®) was carried out. The positive results (standard AC-2) are used as a confirmatory test the determination of ANAS / DFS70: AUTOANTIBOY TEST SYSTEM IMMCO DIAGNOSTICS (Knocked out, for the psip gene) REF 1108® and CytoBead ANA Generic Assays ref 8065 ® by indirect immunofluorescence-IFI technique. In addition, serum levels of C-reactive protein (PCR), erythrocyte sedimentation rate (ESR), IgG/IgA antibodies against citrullinated peptide (ACPA), and rheumatoid factor (RF). Absolute and relative frequencies were established.

Results:

531 participants were included: RA 19%, 25,8% RA relatives, Ps 11,3%, UCTD 8,9%, and 35% healthy controls. RA mean age was 41,8±12,2 years, female 82,2%, with ANA test(+) result 42%. In Ps mean age 49,1±15,7 years, female 53,3%, ANA test(+) 41,7%. UCTD mean age 41,3±15,2 years, female 85,1%, and ANA test(+) 78,7%. Relatives of RA mean age 38,7±12,2 years, female 73%, ANA test(+) 26,3%. And healthy controls mean age 41,3±12,2 years, female 74,7%, and ANA test(+) 26,9%.

ANA/DFS70 was positive in a 6,4% in UCTD, 3,2% in healthy controls, 1,7% in Ps, 1,5% in Relatives of RA, no RA had positive results. These 12 participants were negative for acute phase reactants (ESR[-] 83,3% and CRP[-] 66,6%), as well as they were all negative for RF and two were positive for APCA from UCTD.

Conclusion:

ANAS/DFS70 autoantibodies were present in very low frequency in patients with SARD. Thus, patients with a positive result tend to have a mild or non-progressing phenotype of autoimmune/inflammatory diseases, as UTCD. This is the first time ANA/DFS70 are tested in a large population cohort in Latin American countries which coincide with previous results in RA and RA relatives.

Acknowledgments:

Hospital Militar Central-Universidad El Bosque-Immco diagnosis-Dizar Ltda and Generic Assay-Medipan.

Disclosure of Interests:

Consuelo Romero-Sánchez: None declared, Omar-Javier Calixto Employee of: Worked in Janssen Cilag as medical manager from 2016 to 2018, V Romero-A: None declared, A Vargas: None declared, Luis Castro: None declared, Julio Amador: None declared, Pedro Lopez-Mojica: None declared, Daniela Marin: None declared, Diana Acero-M: None declared, M Acevedo: None declared, Diana Rincón-Riaño: None declared, Juan Manuel Bello-Gualtero: None declared

Cord blood NK cells engineered to express IL-15 and a CD19-targeted CAR show long-term persistence and potent antitumor activity

Chimeric antigen receptors (CARs) have been used to redirect the specificity of autologous T cells against leukemia and lymphoma with promising clinical results. Extending this approach to allogeneic T cells is problematic as they carry a significant risk of graft-versus-host disease (GVHD). Natural killer (NK) cells are highly cytotoxic effectors, killing their targets in a non-antigen-specific manner without causing GVHD. Cord blood (CB) offers an attractive, allogeneic, off-the-self source of NK cells for immunotherapy. We transduced CB-derived NK cells with a retroviral vector incorporating the genes for CAR-CD19, IL-15 and inducible caspase-9-based suicide gene (iC9), and demonstrated efficient killing of CD19-expressing cell lines and primary leukemia cells in vitro, with marked prolongation of survival in a xenograft Raji lymphoma murine model. Interleukin-15 (IL-15) production by the transduced CB-NK cells critically improved their function. Moreover, iC9/CAR.19/IL-15 CB-NK cells were readily eliminated upon pharmacologic activation of the iC9 suicide gene. In conclusion, we have developed a novel approach to immunotherapy using engineered CB-derived NK cells, which are easy to produce, exhibit striking efficacy and incorporate safety measures to limit toxicity. This approach should greatly improve the logistics of delivering this therapy to large numbers of patients, a major limitation to current CAR-T-cell therapies.

The first case of acute unilateral pan-ureteritis caused by BK polyomavirus in an allogeneic stem cell transplant patient

Several cases of ureteral obstruction have been reported in stem cell transplant (SCT) patients; however, they were bilateral and concomitant with or preceded by hemorrhagic cystitis. We describe, to our knowledge, a first case of acute unilateral pan-ureteritis caused by BK polyomavirus (BKPyV) in an SCT patient. This case may represent an early phase of BKPyV reactivation. BKPyV infection should be considered as a potential cause of acute unilateral ureteritis even among SCT recipients.

High prevalence and risk factors associated with latent tuberculous infection in two Colombian prisons

SETTING

Two prisons in Medellín and Itagüí, Colombia.

OBJECTIVE

To determine the prevalence of tuberculin skin test (TST) positivity in prisoners and the annual risk of tuberculous infection (ARTI), to identify risk factors associated with a positive result, and to describe progression to active disease.

DESIGN

Cross-sectional study. Inmates were included if time of incarceration was ⩾1 year and excluded if subjects had had previous or active tuberculosis (TB), or conditions that could hamper TST administration or interpretation.

RESULTS

We screened 1014 inmates. The overall prevalence of TST positivity was 77.6%. The first TST administration resulted in 66% positivity, and the second TST an additional 11.6%. In Prison One, the ARTI was 5.09% in high TB incidence cell blocks and 2.72% in low TB incidence blocks. In Prison Two, the ARTI was 2.77%. Risk factors associated with TST positivity were history of previous incarceration and length of incarceration. Among all those included in the study, four individuals developed active pulmonary TB.

CONCLUSION

Prevalence of TST positivity in prisoners and the ARTI were higher than in the general population, but differed between prisons; it is important to apply a second TST to avoid an overestimation of converters during follow-up.

[NONINVASIVE VENTILATION IN THE POSTOPERATIVE PERIOD]

Acute respiratory failure is relatively common postoperative complication, occurs frequently in patients with preexisting compromised respiratory function and/or undergoing major thoracoabdominal procedures. Although endotracheal intubation and mechanical ventilation is still considered the cornerstone for the treatment of patients with acute respiratory failure, literature data have shown that mortality of these patients is closely associated to complications of intubation and mechanical ventilation. Therefore, the goal is to prevent complications and if possible to avoid endotracheal intubation. Noninvasive ventilation (NIV) is a form of mechanical support that does not require endotracheal intubation and is nowadays often used in prophylactic and therapeutic purposes in surgical patients with acute respiratory failure. In this article we give a brief overview of the indications and limitations of non-invasive ventilation in perioperative period.

Giant thoraco-abdominal tumor -- a surgical challenge. Case report

BACKGROUND

During the last three decades, several improvements in surgical and anesthetic techniques have allowed a better management of primary and secondary tumors of the chest wall.

OBJECTIVES

Chest wall tumors, regardless of their location,anterior, posterior or lateral, have always been a challenge for the thoracic surgeon through technical and tactical problems they entail. The most common techniques to reconstruct a full thickness defect are by the use of alloplastic material and filling the soft tissue defect with myocutaneous flap.

METHOD

We present the unusual case of a 45 years old patient with a giant right thoraco-abdominal tumor, developing for the last 22 years. The tumor occupied the lower half of the right hemithorax and the right hemi abdomen, down to the right iliac crest. The tumor also developed inside the thoracic cavity, with the invasion of the last 3 ribs, of the diaphragm(partial) and with intra-abdominal invasion of a liver section and the right kidney.

RESULTS

The surgery team had special problems related to:providing training and logistics, in-block tumor resection in oncological limits, followed by complex thoraco-abdominal reconstruction. The results were very good, with a favorable postoperative evolution, without any complications, the patient being discharged with the recommendation to come for follow-up on his condition.

CONCLUSIONS

A complex surgical intervention proved to be the only solution for saving the patient, for which the life due to the tumor's size became almost unbearable.

Minimally invasive repair for pectus excavatum -- aesthetic and/or functional?

INTRODUCTION

Pectus excavatum is the most frequent anterior thoracic wall congenital malformation. This malformation is increasing its effects with the aging process and has its peak during teenage, when the clinical symptoms become more acute and psychological effects are really important. Across the course of time many treatment techniques have been proposed, among which conservative or surgical correction techniques. The minimally invasive repair of pectus excavatum, "Nuss technique", developed after 1987, is the most frequently performed technique world wide.

MATERIAL AND METHOD

This article analyzes 52 patients, admitted to the University Emergency Military Hospital "Carol Davila" - Thoracic Surgery Department, diagnosed, investigated and surgically treated according to Nuss procedure. Therapeutic and diagnostic protocols will be presented and analyzed: clinical and paraclinical evaluation, indications and contraindications of Nuss procedure, as well as possible intraoperative and postoperative complications.

RESULTS AND CONCLUSIONS

Nuss procedure's benefits will be presented, as well as improvements of functional and aesthetic parameters. Nuss procedure has a series of advantages: minimally invasive surgical procedure reduced operative time, minimal blood loss and fast socio-professional reinstatement.

Anterior thoracic wall giant tumor--special surgical procedure

We describe the case of a 39 years old male known with an anterior thoracic traumatism in 1993 who observed ananterior thoracic wall tumor since 2000. After one and half year of empiric treatment the tumor starts growing very fast, reaching 30/40/35 cm by the date of his hospital admission (march 2003). Due to this accelerate growth and the size of the tumor the patient is proposed for a particular surgical procedure removing the tumor along with the anterior thoracic wall and the reconstruction using "spider web" technique, Thoratex reinforced mesh and muscle flaps. Thisprocedure had agood result, the patient returned to his anterior lifestyle few months after. The patient did not come for follow-up, although he was recommended to come every tree months. Four years after surgery (2007) the patient came back with local recurrence of the tumor. In 2007 the patient underwent another surgical intervention, removing the tumor recurrence. Chest wall tumors are complex surgical conditions requiring complex treatment. The empiric treatment and the fact that the patient did not come as planned for follow-up, prolonged his sufferance, leading to a second surgical intervention.

Brain perfusion SPECT in patients with PHACES syndrome under propranolol treatment

INTRODUCTION

Children with PHACES syndrome (PS) and visual impairment or stridor show a dramatic and immediate response to propranolol. However, this beta-blocking drug could be responsible for an eventually increased risk of ischemic stroke due to the underlying cerebral vascular disease. To more accurately understand the effects of propranolol on brain vascularization, we examined PS patients treated with this drug for airway or visual complications using brain perfusion SPECT (Single Photon Emission Computed Tomography). In the past, this examination has been shown to be useful in the management of patients with different neurovascular disorders.

METHODS

Clinical records and imaging studies were reviewed in 7 patients with a diagnosis of PS. All patients underwent magnetic resonance angiography (MRA), echocardiography, chest X-ray and ophthalmologic, neurological, and cardiologic assessments. They received 2-3 mg/kg/day propranolol in an attempt to treat stridor or avoid ophthalmologic occlusion. We performed SPECT after 3-6 months of treatment.

RESULTS

SPECT showed a normal uptake in the frontal and temporal regions despite vascular abnormalities found with MRA imaging. Significant improvements of symptoms and in the volume of the hemangioma were noted in all cases without signs of a reduction of brain blood perfusion.

CONCLUSIONS

Propranolol treatment was safe in our patients who did not show signs of perfusion changes. The high sensitivity for detecting functional impairment makes brain perfusion SPECT useful in the diagnosis and follow-up of patients with PS considered at risk of neurovascular impairment. Accurate knowledge of its pathophysiological basis, together with the appropriate technique and careful interpretation of reporting, will enhance the clinical use of brain SPECT in those patients.

Effect of varying contrast material iodine concentration and injection technique on the conspicuity of hepatocellular carcinoma during 64-section MDCT of patients with cirrhosis

OBJECTIVES

The aim of this study was to compare the intraindividual effects of contrast material with two different iodine concentrations on the conspicuity of hepatocellular carcinoma (HCC) and vascular and hepatic contrast enhancement during multiphasic, 64-section multidetector row CT (MDCT) in patients with cirrhosis using two contrast medium injection techniques.

METHODS

Patients were randomly assigned to one of two groups with an equal iodine dose but different contrast material injection techniques: scheme A, fixed injection duration (25 s), and scheme B, fixed injection flow rate (4 ml s(-1)). For each group, patients were randomised to receive both moderate-concentration contrast medium (MCCM) and high-concentration contrast medium (HCCM) during two CT examinations within 3 months. Enhancement of the aorta, liver and portal vein and the tumour-to-liver contrast-to-noise ratio (CNR) were compared between MCCM and HCCM.

RESULTS

30 patients (mean age 59 years; range 45-80 years; 16 patients in scheme A and 14 in scheme B) with a total of 31 confirmed HCC nodules were prospectively enrolled. For scheme B, the mean contrast enhancement of the aorta and tumour-to-liver CNR were significantly higher with HCCM than with MCCM during the hepatic arterial phase (+350.5 HU vs +301.1 HU, p = 0.001, and +7.5 HU vs +5.5 HU, p = 0.004). For both groups, there was no significant difference between MCCM and HCCM for all other comparisons.

CONCLUSION

For a constant injection flow rate, HCCM significantly improves the conspicuity of HCC lesions and aortic enhancement during the hepatic arterial phase on 64-section MDCT in patients with cirrhosis.

KIR2DS1 genotype predicts for complete cytogenetic response and survival in newly diagnosed chronic myeloid leukemia patients treated with imatinib

Natural killer (NK) cells are expanded in chronic myeloid leukemia (CML) patients on tyrosine kinase inhibitors (TKI) and exert cytotoxicity. The inherited repertoire of killer immunoglobulin-like receptors (KIR) may influence response to TKI. We investigated the impact of KIR-genotype on outcome in 166 chronic phase CML patients on first-line imatinib treatment. We validated our findings in an independent patient group. On multivariate analysis, KIR2DS1 genotype (RR=1.51, P=0.03) and Sokal risk score (low-risk RR=1, intermediate-risk RR=1.53, P=0.04, high-risk RR=1.69, P=0.034) were the only independent predictors for failure to achieve complete cytogenetic response (CCyR). Furthermore, KIR2DS1 was the only factor predicting shorter progression-free (PFS) (RR=3.1, P=0.03) and overall survival (OS) (RR=2.6, P=0.04). The association between KIR2DS1 and CCyR, PFS and OS was validated by KIR genotyping in 174 CML patients on first-line imatinib in the UK multi-center SPIRIT-1 trial; in this cohort, KIR2DS1(+) patients had significantly lower 2-year probabilities of achieving CCyR (76.9 vs 87.9%, P=0.003), PFS (85.3 vs 98.1%, P=0.007) and OS (94.4 vs 100%, P=0.015) than KIR2DS1(-) patients. The impact of KIR2DS1 on CCyR was greatest when the ligand for the corresponding inhibitory receptor, KIR2DL1, was absent (P=0.00006). Our data suggest a novel role for KIR-HLA immunogenetics in CML patients on TKI.

Hepatocellular carcinoma in cirrhotic patients at multidetector CT: hepatic venous phase versus delayed phase for the detection of tumour washout

OBJECTIVES

Our aim was to compare retrospectively hepatic venous and delayed phase images for the detection of tumour washout during multiphasic multidetector row CT (MDCT) of the liver in patients with hepatocellular carcinoma (HCC).

METHODS

30 cirrhotic patients underwent multiphasic MDCT in the 90 days before liver transplantation. MDCT was performed before contrast medium administration and during hepatic arterial hepatic venous and delayed phases, images were obtained at 12, 55 and 120 s after trigger threshold. Two radiologists qualitatively evaluated images for lesion attenuation. Tumour washout was evaluated subjectively and objectively. Tumour-to-liver contrast (TLC) was measured for all pathologically proven HCCs.

RESULTS

48 HCCs were detected at MDCT. 46 of the 48 tumours (96%) appeared as either hyper- or isoattenuating during the hepatic arterial phase subjective washout was present in 15 HCCs (33%) during the hepatic venous phase and in 35 (76%) during the delayed phase (p<0.001, McNemar's test). Objective washout was present in 30 of the 46 HCCs (65%) during the hepatic venous phase and in 42 of the HCCs (91%) during the delayed phase (p=0.001). The delayed phase yielded significantly higher mean TLC absolute values compared with the hepatic venous phase (-16.1±10.8 HU vs -10.5±10.2 HU; p<0.001).

CONCLUSIONS

The delayed phase is superior to the hepatic venous phase for detection of tumour washout of pathologically proven HCC in cirrhotic patients.

Detection of hepatic metastases from colorectal cancer: prospective evaluation of gray scale US versus SonoVue® low mechanical index real time-enhanced US as compared with multidetector-CT or Gd-BOPTA-MRI

PURPOSE

To compare ultrasound (US), low-mechanical index contrast enhanced US (CEUS) and multidetector-CT (MDCT) for the detection of hepatic metastases from colorectal cancer.

METHODS AND MATERIALS

From January to June 2006, 110 patients (65 males, 45 females; mean age 62 years; range 39-78) with suspected hepatic lesions from colorectal cancer were prospectively evaluated with US, CEUS and MDCT by two independent readers. Intraoperative ultrasonography (IOUS, n = 45) or a follow-up up for at least 6 months by using MDCT or Gd-BOPTA-enhanced MRI was considered the gold standard. McNemar test was employed.

RESULTS

Reference standards revealed 430 metastases in 110 patients. On a patient-by-patients analysis, CEUS improved US sensitivity from 67.4-71.6% to 93.4-95.8% (p < 0.05). On a lesion-by-lesion analysis, CEUS improved the sensitivity of US from 60.9-64.9% to 85.3-92.8% (p < 0.001). The specificity increased from 50-60% to 76.7-83.3%. No significant differences in sensitivity or specificity between CEUS and MDCT were found. Contrast-enhanced US was significantly more sensitive than baseline US in the detection of metastases smaller than 1 cm (p < 0.001) with an increase in sensitivity from 29.1-35% to 63.3-76.6% no significant statistical difference was identified when compared with MDCT (sensitivity of 73.3-75.8%).

CONCLUSIONS

CEUS is significantly more accurate than US and highly comparable with MDCT in the detection of liver metastases from colorectal cancer. Therefore, in the evaluation of patients with suspected hepatic metastases from colorectal tumour, US examination must be performed after contrast administration.

MediNet: personalizing the self-care process for patients with diabetes and cardiovascular disease using mobile telephony

This paper describes MediNet, a mobile healthcare system that is being developed to personalize the self-care process for patients with both diabetes and cardiovascular disease. These two diseases were chosen based on their interrelationship. Patients with diabetes are at least twice as likely to have heart disease or a stroke as compared to persons without diabetes. Furthermore, persons with diabetes also tend to develop heart disease or have strokes at an earlier age than other people. MediNet uses a reasoning engine to make recommendations to a patient based on current and previous readings from monitoring devices connected to the patient and on information that is known about the patient. It caters for the uniqueness of each patient by personalizing its recommendations based on individual level characteristics of the patient, as well as on characteristics that groups of patients tend to share.

Diagnostic utility of different MRI and MR angiography measures in Fabry disease

BACKGROUND

Neurologic hallmarks of Fabry disease (FD) include small fiber neuropathy as well as cerebral micro- and macroangiopathy with premature stroke. Cranial MRI shows progressive white matter lesions (WML) at an early age, increased signal intensity in the pulvinar, and tortuosity and dilatation of the larger vessels. To unravel the most promising imaging tool for the detection of CNS involvement in FD we compared the diagnostic utility of the different MR imaging findings.

METHODS

Twenty-five clinically affected patients with FD (age 36.5 +/- 11.0) and 20 age-matched controls were investigated by structural MRI, MR angiography, and diffusion tensor imaging (DTI). Individual WML volumes, global mean diffusivity (MD), and mean cerebral artery diameters were determined.

RESULTS

Using receiver operating characteristic analyses, enlarged diameters of the following cerebral arteries significantly separated patients with FD from controls: middle cerebral artery: area under curve (AUC) = 0.75, p = 0.005; posterior cerebral artery: AUC = 0.69, p = 0.041; carotid artery: 0.69, p = 0.041; basilar artery: AUC = 0.96, p < 0.0005. A total of 87% of the individuals were correctly classified by basilar artery diameters (sensitivity 95%, specificity 83%). WML volumes and global MD values did not significantly separate patients from controls.

CONCLUSIONS

With an accuracy of 87%, basilar artery diameters were superior to all other MR measures for separating patients with Fabry disease (FD) from controls. Future studies should adopt basilar artery measurements for early detection and monitoring of brain involvement in FD. Moreover, further investigations should reveal if the dilated vasculopathy in FD could be a screening marker to detect FD in a cohort of other cerebrovascular diseases, especially in cryptogenic stroke.

Molds and mycotoxin content of cereals in southeastern Romania

Fungal species and toxin contamination were determined in 110 cereal samples (54 maize, 35 wheat, and 21 barley) collected in the southeastern part of Romania from 2002 to 2004. The most frequent fungal contaminants belonged to Aspergillus and Fusarium, and maize was the most contaminated cereal. The main toxigenic species identified were Aspergillus flavus, Aspergillus fumigatus, Fusarium graminearum, and Fusarium culmorum in all cereals and Fusarium verticillioides in maize. The presence of aflatoxin B1 (AFB1), deoxynivalenol (DON), zearalenone (ZEA), fumonisins, and ochratoxin A was determined by enzyme-linked immunosorbent assay. More than 90% of the samples were contaminated with at least one toxin. Around 30% of maize samples were contaminated with AFB1, and in 20% of these samples the level of toxin exceeded that allowed by European Union regulations. In 48 and 42% of samples, levels of DON and ZEA, respectively, exceeded those allowed by the European Union. Neither fumonisins nor ochratoxin A were found in samples from any year or cereal. These results indicate that cereals produced in Romania have a particular pattern of mycoflora and mycotoxin contamination because DON and ZEA in addition to AFB1 were found.

Focal nodular hyperplasia: typical and atypical MRI findings with emphasis on the use of contrast media

Focal nodular hyperplasia is a benign hypervascular hepatic tumour, frequently detected in asymptomatic patients undergoing imaging studies for unrelated reasons. Magnetic resonance imaging (MRI) generally allows a confident differential diagnosis with other hypervascular liver lesions, either benign or malignant. In addition, due to the recent development of hepatospecific MRI contrast agents, MRI concomitantly enables functional and morphological information to be obtained, thus providing important clues for the detection and characterization of focal nodular hyperplasia lesions.