Optimal initial position and technique for the front foot contact phase of cricket fast bowling: Commonalities between individual-specific simulations of elite bowlers

Group-based and individual-based studies in cricket fast bowling have identified common technique characteristics associated with ball release speed. The applicability of these findings to individual bowlers is often questioned, however, due to research approach limitations. This study aims to identify whether the optimal initial body position at front foot contact and subsequent technique to maximise ball release speed exhibit common characteristics for elite male cricket fast bowlers using individual-specific computer optimisations. A planar 16-segment whole-body torque-driven simulation model of the front foot contact phase of fast bowling was customised, evaluated, and the initial body position and subsequent movement pattern optimised, for ten elite male fast bowlers. The optimised techniques significantly increased ball release speed by 4.8 ± 1.3 ms-1 (13.5 ± 4.1%) and ranged between 37.8 and 42.9 ms-1, and in lower peak ground reaction forces and loading rates. Common characteristics were observed within the optimal initial body position with more extended front knees, as well as more flexion of the front and bowling arm shoulders than in current performances. Delays to the onset of trunk flexion, front arm and bowling arm shoulder extension, and wrist flexion were also common in the subsequent movement during the front foot contact phase. Lower front hip extensor and front shoulder flexor torques, as well as greater bowling shoulder extensor torques were also evident. This is useful knowledge for coach development, talent identification, and coaching practice.

Effects of racket moment of inertia on racket head speed, impact location and shuttlecock speed during the badminton smash

How the racket properties impact performance of the badminton smash is relatively unknown, and further insight could help players/coaches select the most appropriate racket. Three-dimensional position data of the racket and shuttlecock were collected (500 Hz) for 20 experienced badminton players performing a series of forehand smashes with five swingweight ([Formula: see text]) perturbed rackets, ranging from 85-106 kg·cm2. [Formula: see text] was calculated using a balance board and simple pendulum method, and modal analysis was performed using laser vibrometry to capture the fundamental frequency and distal node location for each racket. As [Formula: see text] increased a reduction in racket head speed was found with on average a 0.7 m·s-1 decrease per 5 kg·cm2 increase in [Formula: see text], however this did not lead to slower shuttlecock speeds. The impact location tended to move closer to the tip as the fundamental frequency node moved closer to the tip (as [Formula: see text] increased), providing some evidence that participants may subconsciously strike the shuttlecock at the node location to provide desirable sensory feedback. The increase in racket head speed but not shuttlecock speed was likely due to the distal increase in longitudinal impact location as [Formula: see text] increased, as well as an increase in effective mass for a given impact location. Additionally, removal of the deformation component (additional racket head speed due to the racket noticeably bending and recovering) of racket head speed increased the effect size of the relationship with [Formula: see text], where rackets with greater [Formula: see text] had larger deformation velocities. The research provides further insight into the smash performance characteristics of experienced badminton players, particularly based on racket properties. Further research is required to confirm the coincidence between node location and longitudinal impact location.

Cricket fast bowling: The relationship between range of motion and key performance and injury technique characteristics

Fast bowling technique characteristics associated with performance and injury have been established; however, the effect of joint range of motion (ROM) on technique remains unknown. This study aimed to investigate ROM and its effect on fast bowling technique. Eighteen ROM measures and thirteen technique parameters were determined for 45 elite male fast bowlers. Twenty-three significant correlations were found between the shoulder, hip, and ankle ROM measures and technique parameters (r = 0.300-0.452; p < 0.05). Shoulder ROM was observed to have the highest number of correlations with fast bowling technique. Increased internal rotation, less external rotation, and greater total arc of rotation were associated with technique characteristics previously linked with increased ball release speed and decreased lumbar stress injury risk. Although hip and ankle ROM were also correlated with technique, their association is yet to be understood. Future research should aim to determine the impact of ROM on fast bowling movement patterns. This knowledge is likely to be useful in enhancing the coaching and rehabilitation of fast bowlers from lumbar stress injuries.

Migratory earthquake precursors are dominant on an ice stream fault

Simple fault models predict earthquake nucleation near the eventual hypocenter (self-nucleation). However, some earthquakes have migratory foreshocks and possibly slow slip that travel large distances toward the eventual mainshock hypocenter (migratory nucleation). Scarce observations of migratory nucleation may result from real differences between faults or merely observational limitations. We use Global Positioning System and passive seismic records of the easily observed daily ice stream earthquake cycle of the Whillans Ice Plain, West Antarctica, to quantify the prevalence of migratory versus self-nucleation in a large-scale, natural stick-slip system. We find abundant and predominantly migratory precursory slip, whereas self-nucleation is nearly absent. This demonstration that migratory nucleation exists on a natural fault implies that more-observable migratory precursors may also occur before some earthquakes.

Surface acceleration transmission during drop landings in humans

The purpose of this study was to quantify the magnitude and frequency content of surface-measured accelerations at each major human body segment from foot to head during impact landings. Twelve males performed two single leg drop landings from each of 0.15 m, 0.30 m, and 0.45 m. Triaxial accelerometers (2000 Hz) were positioned over the: first metatarsophalangeal joint; distal anteromedial tibia; superior to the medial femoral condyle; L5 vertebra; and C6 vertebra. Analysis of acceleration signal power spectral densities revealed two distinct components, 2-14 Hz and 14-58 Hz, which were assumed to correspond to time domain signal joint rotations and elastic wave tissue deformation, respectively. Between each accelerometer position from the metatarsophalangeal joint to the L5 vertebra, signals exhibited decreased peak acceleration, increased time to peak acceleration, and decreased power spectral density integral of both the 2-14 Hz and 14-58 Hz components, with no further attenuation beyond the L5 vertebra. This resulted in peak accelerations close to vital organs of less than 10% of those at the foot. Following landings from greater heights, peak accelerations measured distally were greater, as was attenuation prior to the L5 position. Active and passive mechanisms within the lower limb therefore contribute to progressive attenuation of accelerations, preventing excessive accelerations from reaching the torso and head, even when distal accelerations are large.

Identical and Nonidentical Twins: Risk and Factors Involved in Development of Islet Autoimmunity and Type 1 Diabetes

OBJECTIVE

There are variable reports of risk of concordance for progression to islet autoantibodies and type 1 diabetes in identical twins after one twin is diagnosed. We examined development of positive autoantibodies and type 1 diabetes and the effects of genetic factors and common environment on autoantibody positivity in identical twins, nonidentical twins, and full siblings.

RESEARCH DESIGN AND METHODS

Subjects from the TrialNet Pathway to Prevention Study (N = 48,026) were screened from 2004 to 2015 for islet autoantibodies (GAD antibody [GADA], insulinoma-associated antigen 2 [IA-2A], and autoantibodies against insulin [IAA]). Of these subjects, 17,226 (157 identical twins, 283 nonidentical twins, and 16,786 full siblings) were followed for autoantibody positivity or type 1 diabetes for a median of 2.1 years.

RESULTS

At screening, identical twins were more likely to have positive GADA, IA-2A, and IAA than nonidentical twins or full siblings (all P < 0.0001). Younger age, male sex, and genetic factors were significant factors for expression of IA-2A, IAA, one or more positive autoantibodies, and two or more positive autoantibodies (all P ≤ 0.03). Initially autoantibody-positive identical twins had a 69% risk of diabetes by 3 years compared with 1.5% for initially autoantibody-negative identical twins. In nonidentical twins, type 1 diabetes risk by 3 years was 72% for initially multiple autoantibody-positive, 13% for single autoantibody-positive, and 0% for initially autoantibody-negative nonidentical twins. Full siblings had a 3-year type 1 diabetes risk of 47% for multiple autoantibody-positive, 12% for single autoantibody-positive, and 0.5% for initially autoantibody-negative subjects.

CONCLUSIONS

Risk of type 1 diabetes at 3 years is high for initially multiple and single autoantibody-positive identical twins and multiple autoantibody-positive nonidentical twins. Genetic predisposition, age, and male sex are significant risk factors for development of positive autoantibodies in twins.

Comparison of biomechanical characteristics between male and female elite fast bowlers

This study investigated ball release speed and performance kinematics between elite male and female cricket fast bowlers. Fifty-five kinematic parameters were collected for 20 male and 20 female elite fast bowlers. Group means were analysed statistically using an independent samples approach to identify differences. Significant differences were found between: ball release speed; run-up speed; the kinematics at back foot contact (BFC), front foot contact (FFC), and ball release (BR); and the timings between these key instants. These results indicate that the female bowlers generated less whole body linear momentum during the run-up than the males. The male bowlers also utilised a technique between BFC and FFC which more efficiently maintained linear momentum compared to the females. As a consequence of this difference in linear momentum at FFC, the females typically adopted a technique more akin to throwing where ball release speed was contributed to by both the whole body angular momentum and the large rotator muscles used to rotate the pelvis and torso segments about the longitudinal axis. This knowledge is likely to be useful in the coaching of female fast bowlers although future studies are required to understand the effects of anthropometric and strength constraints on fast bowling performance.

A Type 1 Diabetes Genetic Risk Score Predicts Progression of Islet Autoimmunity and Development of Type 1 Diabetes in Individuals at Risk

OBJECTIVE

We tested the ability of a type 1 diabetes (T1D) genetic risk score (GRS) to predict progression of islet autoimmunity and T1D in at-risk individuals.

RESEARCH DESIGN AND METHODS

We studied the 1,244 TrialNet Pathway to Prevention study participants (T1D patients' relatives without diabetes and with one or more positive autoantibodies) who were genotyped with Illumina ImmunoChip (median [range] age at initial autoantibody determination 11.1 years [1.2-51.8], 48% male, 80.5% non-Hispanic white, median follow-up 5.4 years). Of 291 participants with a single positive autoantibody at screening, 157 converted to multiple autoantibody positivity and 55 developed diabetes. Of 953 participants with multiple positive autoantibodies at screening, 419 developed diabetes. We calculated the T1D GRS from 30 T1D-associated single nucleotide polymorphisms. We used multivariable Cox regression models, time-dependent receiver operating characteristic curves, and area under the curve (AUC) measures to evaluate prognostic utility of T1D GRS, age, sex, Diabetes Prevention Trial-Type 1 (DPT-1) Risk Score, positive autoantibody number or type, HLA DR3/DR4-DQ8 status, and race/ethnicity. We used recursive partitioning analyses to identify cut points in continuous variables.

RESULTS

Higher T1D GRS significantly increased the rate of progression to T1D adjusting for DPT-1 Risk Score, age, number of positive autoantibodies, sex, and ethnicity (hazard ratio [HR] 1.29 for a 0.05 increase, 95% CI 1.06-1.6; P = 0.011). Progression to T1D was best predicted by a combined model with GRS, number of positive autoantibodies, DPT-1 Risk Score, and age (7-year time-integrated AUC = 0.79, 5-year AUC = 0.73). Higher GRS was significantly associated with increased progression rate from single to multiple positive autoantibodies after adjusting for age, autoantibody type, ethnicity, and sex (HR 2.27 for GRS >0.295, 95% CI 1.47-3.51; P = 0.0002).

CONCLUSIONS

The T1D GRS independently predicts progression to T1D and improves prediction along T1D stages in autoantibody-positive relatives.

Kinematic parameters contributing to the production of spin in elite finger spin bowling

The aim of this study was to identify the key kinematic parameters which contribute to higher spin rates in elite finger spin bowling. Kinematic data were collected for twenty-three elite male finger spin bowlers with thirty kinematic parameters calculated for each delivery. Stepwise linear regression and Pearson product moment correlations were used to identify kinematic parameters linked to spin rate. Pelvis orientation at front foot contact (r = 0.674, p < 0.001) and ball release (r = 0.676, p < 0.001) were found to be the biggest predictors of spin rate, with both individually predicting 43% of the observed variance in spin rate. Other kinematic parameters correlated with spin rate included: shoulder orientation at ball release (r = 0.462, p = 0.027), and pelvis-shoulder separation angle at front foot contact (r = 0.521, p = 0.011). The bowlers with the highest spin rates adopted a mid-way pelvis orientation angle, a larger pelvis-shoulder separation angle and a shoulder orientation short of side-on at front foot contact. The segments then rotated sequentially, starting with the pelvis and finishing with the pronation of the forearm. This knowledge can be translated to coaches to provide a better understanding of finger spin bowling technique.

Subthalamic nucleus pathology contributes to repetitive behavior expression and is reversed by environmental enrichment

Repetitive motor behaviors are common in neurodevelopmental, psychiatric and neurological disorders. Despite their prevalence in certain clinical populations, our understanding of the neurobiological cause of repetitive behavior is lacking. Likewise, not knowing the pathophysiology has precluded efforts to find effective drug treatments. Our comparisons between mouse strains that differ in their expression of repetitive behavior showed an important role of the subthalamic nucleus (STN). In mice with high rates of repetitive behavior, we found significant differences in dendritic spine density, gene expression and neuronal activation in the STN. Taken together, these data show a hypoglutamatergic state. Furthermore, by using environmental enrichment to reduce repetitive behavior, we found evidence of increased glutamatergic tone in the STN with our measures of spine density and gene expression. These results suggest the STN is a major contributor to repetitive behavior expression and highlight the potential of drugs that increase STN function to reduce repetitive behavior in clinical populations.

Improved frame-based estimation of head motion in PET brain imaging

PURPOSE

Head motion during PET brain imaging can cause significant degradation of image quality. Several authors have proposed ways to compensate for PET brain motion to restore image quality and improve quantitation. Head restraints can reduce movement but are unreliable; thus the need for alternative strategies such as data-driven motion estimation or external motion tracking. Herein, the authors present a data-driven motion estimation method using a preprocessing technique that allows the usage of very short duration frames, thus reducing the intraframe motion problem commonly observed in the multiple frame acquisition method.

METHODS

The list mode data for PET acquisition is uniformly divided into 5-s frames and images are reconstructed without attenuation correction. Interframe motion is estimated using a 3D multiresolution registration algorithm and subsequently compensated for. For this study, the authors used 8 PET brain studies that used F-18 FDG as the tracer and contained minor or no initial motion. After reconstruction and prior to motion estimation, known motion was introduced to each frame to simulate head motion during a PET acquisition. To investigate the trade-off in motion estimation and compensation with respect to frames of different length, the authors summed 5-s frames accordingly to produce 10 and 60 s frames. Summed images generated from the motion-compensated reconstructed frames were then compared to the original PET image reconstruction without motion compensation.

RESULTS

The authors found that our method is able to compensate for both gradual and step-like motions using frame times as short as 5 s with a spatial accuracy of 0.2 mm on average. Complex volunteer motion involving all six degrees of freedom was estimated with lower accuracy (0.3 mm on average) than the other types investigated. Preprocessing of 5-s images was necessary for successful image registration. Since their method utilizes nonattenuation corrected frames, it is not susceptible to motion introduced between CT and PET acquisitions.

CONCLUSIONS

The authors have shown that they can estimate motion for frames with time intervals as short as 5 s using nonattenuation corrected reconstructed FDG PET brain images. Intraframe motion in 60-s frames causes degradation of accuracy to about 2 mm based on the motion type.

Inhibition of cholesterol metabolism underlies synergy between mTOR pathway inhibition and chloroquine in bladder cancer cells

Mutations to fibroblast growth factor receptor 3 (FGFR3) and phosphatase and tensin homologue (PTEN) signalling pathway components (for example, PTEN loss, PIK3CA, AKT1, TSC1/2) are common in bladder cancer, yet small-molecule inhibitors of these nodes (FGFR/PTENi) show only modest activity in preclinical models. As activation of autophagy is proposed to promote survival under FGFR/PTENi, we have investigated this relationship in a panel of 18 genetically diverse bladder cell lines. We found that autophagy inhibition does not sensitise bladder cell lines to FGFR/PTENi, but newly identify an autophagy-independent cell death synergy in FGFR3-mutant cell lines between mTOR (mammalian target of rapamycin) pathway inhibitors and chloroquine (CQ)—an anti-malarial drug used as a cancer therapy adjuvant in over 30 clinical trials. The mechanism of synergy is consistent with lysosomal cell death (LCD), including cathepsin-driven caspase activation, and correlates with suppression of cSREBP1 and cholesterol biosynthesis in sensitive cell lines. Remarkably, loss of viability can be rescued by saturating cellular membranes with cholesterol or recapitulated by statin-mediated inhibition, or small interfering RNA knockdown, of enzymes regulating cholesterol metabolism. Modulation of CQ-induced cell death by atorvastatin and cholesterol is reproduced across numerous cell lines, confirming a novel and fundamental role for cholesterol biosynthesis in regulating LCD. Thus, we have catalogued the molecular events underlying cell death induced by CQ in combination with an anticancer therapeutic. Moreover, by revealing a hitherto unknown aspect of lysosomal biology under stress, we propose that suppression of cholesterol metabolism in cancer cells should elicit synergy with CQ and define a novel approach to future cancer treatments.

The effect of elbow hyperextension on ball speed in cricket fast bowling

This study investigates how elbow hyperextension affects ball release speed in fast bowling. A two-segment planar computer simulation model comprising an upper arm and forearm + hand was customised to an elite fast bowler. A constant torque was applied at the shoulder and elbow hyperextension was represented using a damped linear torsional spring at the elbow. The magnitude of the constant shoulder torque and the torsional spring parameters were determined by concurrently matching three performances. Close agreement was found between the simulations and the performances with an average difference of 3.8%. The simulation model with these parameter values was then evaluated using one additional performance. Optimising ball speed by varying the torsional spring parameters found that elbow hyperextension increased ball release speed. Perturbing the elbow torsional spring stiffness indicated that the increase in ball release speed was governed by the magnitude of peak elbow hyperextension and the amount that the elbow recoils back towards a straight arm after reaching peak elbow hyperextension. This finding provides a clear understanding that a bowler who hyperextends at the elbow and recoils optimally will have an increase in ball speed compared to a similar bowler who cannot hyperextend. A fast bowler with 20° of elbow hyperextension and an optimal level of recoil will have increased ball speeds of around 5% over a bowler without hyperextension.

Measurement of viscoelastic properties in multiple anatomical regions of acute rat brain tissue slices

Mechanical property data for brain tissue are needed to understand the biomechanics of neurological disorders and response of the brain to different mechanical and surgical forces. Most studies have characterized mechanical behavior of brain tissues over large regions or classified tissue properties for either gray or white matter regions only. In this study, spatially heterogeneous viscoelastic properties of ex vivo rat brain tissue slices were measured in different anatomical regions including the cerebral cortex, caudate/putamen, and hippocampus using an optical coherence tomography (OCT) indentation system. Cell viability was also tested to observe neuronal degeneration and morphological changes in tissue slices and provide a proper timeline for mechanical tests. Shear modulus was estimated by fitting normalized deformation data (D/ti), which was defined as the ratio of deformation depth (D) to initial thickness of the tissue slice (ti), to a viscoelastic finite element model. The estimated shear modulus decayed nonlinearly over 10min in each anatomical region, and the range of instantaneous to equilibrium shear modulus was 3.8-0.54kPa in the cerebral cortex, 1.4-0.27kPa in the hippocampus and 1.0-0.17kPa in the caudate/putamen. Although these regions are all gray matter structures, their measured mechanical properties were significantly different. Accurate measurement of inter-regional variations in mechanical properties will contribute to improved understanding organ-level structural parameters and regional differential susceptibility to deformation injury within CNS tissues.

Optically based-indentation technique for acute rat brain tissue slices and thin biomaterials

Currently, micro-indentation testing of soft biological materials is limited in its capability to test over long time scales due to accumulated instrumental drift errors. As a result, there is a paucity of measures for mechanical properties such as the equilibrium modulus. In this study, indentation combined with optical coherence tomography (OCT) was used for mechanical testing of thin tissue slices. OCT was used to measure the surface deformation profiles after placing spherical beads onto submerged test samples. Agarose-based hydrogels at low-concentrations (w/v, 0.3-0.6%) and acute rat brain tissue slices were tested using this technique over a 30-min time window. To establish that tissue slices maintained cell viability, allowable testing times were determined by measuring neuronal death or degeneration as a function of incubation time with Fluor-Jade C (FJC) staining. Since large deformations at equilibrium were measured, displacements of surface beads were compared with finite element elastic contact simulations to predict the equilibrium modulus, μ(∞) . Values of μ(∞) for the low-concentration hydrogels ranged from 0.07 to 1.8 kPa, and μ(∞) for acute rat brain tissue slices was 0.13 ± 0.04 kPa for the cortex and 0.09 ± 0.015 kPa for the hippocampus (for Poisson ratio = 0.35). This indentation technique offers a localized, real-time, and high resolution method for long-time scale mechanical testing of very soft materials. This test method may also be adapted for viscoelasticity, for testing of different tissues and biomaterials, and for analyzing changes in internal structures with loading.

Human peripheral blood leucocyte non-obese diabetic-severe combined immunodeficiency interleukin-2 receptor gamma chain gene mouse model of xenogeneic graft-versus-host-like disease and the role of host major histocompatibility complex

Immunodeficient non-obese diabetic (NOD)-severe combined immune-deficient (scid) mice bearing a targeted mutation in the gene encoding the interleukin (IL)-2 receptor gamma chain gene (IL2rgamma(null)) engraft readily with human peripheral blood mononuclear cells (PBMC). Here, we report a robust model of xenogeneic graft-versus-host-like disease (GVHD) based on intravenous injection of human PBMC into 2 Gy conditioned NOD-scid IL2rgamma(null) mice. These mice develop xenogeneic GVHD consistently (100%) following injection of as few as 5 x 10(6) PBMC, regardless of the PBMC donor used. As in human disease, the development of xenogeneic GVHD is highly dependent on expression of host major histocompatibility complex class I and class II molecules and is associated with severely depressed haematopoiesis. Interrupting the tumour necrosis factor-alpha signalling cascade with etanercept, a therapeutic drug in clinical trials for the treatment of human GVHD, delays the onset and progression of disease. This model now provides the opportunity to investigate in vivo mechanisms of xenogeneic GVHD as well as to assess the efficacy of therapeutic agents rapidly.

Angiogenin protects motoneurons against hypoxic injury

Cells can adapt to hypoxia through the activation of hypoxia-inducible factor-1 (HIF-1), which in turn regulates the expression of hypoxia-responsive genes. Defects in hypoxic signaling have been suggested to underlie the degeneration of motoneurons in amyotrophic lateral sclerosis (ALS). We have recently identified mutations in the hypoxia-responsive gene, angiogenin (ANG), in ALS patients, and have shown that ANG is constitutively expressed in motoneurons. Here, we show that HIF-1alpha is sufficient and required to activate ANG in cultured motoneurons exposed to hypoxia, although ANG expression does not change in a transgenic ALS mouse model or in sporadic ALS patients. Administration of recombinant ANG or expression of wild-type ANG protected motoneurons against hypoxic injury, whereas gene silencing of ang1 significantly increased hypoxia-induced cell death. The previously reported ALS-associated ANG mutations (Q12L, K17I, R31K, C39W, K40I, I46V) all showed a reduced neuroprotective activity against hypoxic injury. Our data show that ANG plays an important role in endogenous protective pathways of motoneurons exposed to hypoxia, and suggest that loss of function rather than loss of expression of ANG is associated with ALS.

The alpha7 nicotinic receptor agonist 4OH-GTS-21 protects axotomized septohippocampal cholinergic neurons in wild type but not amyloid-overexpressing transgenic mice

While activation of alpha7 nicotinic receptors protects neurons from a variety of apoptotic insults in vitro, little is known about this neuroprotective action in vivo, especially under amyloidogenic conditions that mimic Alzheimer's disease. We therefore investigated the effects of 4OH-GTS-21, a selective partial agonist for these receptors, on septohippocampal cholinergic and GABAergic neuron survival following fimbria fornix (FFX) lesions in three strains of mice: C57BL/6J wild type mice; human presenilin-1 mutant M146L (PS1) transgenic mice; and mice expressing both mutant PS1 and Swedish mutant K670N/M671L amyloid precursor protein (APP). Initial studies to demonstrated that 4OH-GTS-21 is likely brain permeant based on its ability to improve passive avoidance and Morris water task behaviors in nucleus basalis-lesioned rats. In FFX-lesioned mice, twice per day i.p. injections of 1 mg/kg of 4OH-GTS-21 for 2 weeks promoted the survival and prevented the atrophy of septal cholinergic neurons. Septal parvalbumin-staining GABAergic neurons were not protected by this treatment, although they also express alpha7 nicotinic receptors, suggesting an indirect, nerve growth factor (NGF)-mediated mechanism. No protection of cholinergic neurons was observed in similarly treated PS1 or APP/PS1 transgenic mice. 4OH-GTS-21 treatment actually reduced cholinergic neuronal size in APP/PS1 mice. Hippocampal amyloid deposition was not affected by FFX lesions or treatment with this alpha7 nicotinic receptor agonist in APP/PS1 mice under these conditions. These results indicate that brain alpha7 nicotinic receptors are potential targets for protecting at-risk brain neurons in Alzheimer's disease, perhaps via their effects on NGF receptors; however, this protection may be sensitive under some conditions to environmental factors such as inhibitory amyloid-peptides.

Diffusion tensor microscopy indicates the cytoarchitectural basis for diffusion anisotropy in the human hippocampus

BACKGROUND AND PURPOSE

Observing changes to water diffusivity and fractional anisotropy (FA) for particular hippocampal regions may improve the sensitivity and specificity of diffusion tensor MR imaging for hippocampal pathologies like Alzheimer disease and mesial temporal sclerosis. As a first step toward this goal, this study characterized the cytoarchitectural features underlying diffusion anisotropy in human hippocampus autopsy specimens at 60-microm in-plane resolution.

MATERIALS AND METHODS

Eight-millimeter coronal segments of the hippocampal body were dissected from 5 autopsy specimens (mean = 55.6 +/- 6.2 years of age) with short postmortem intervals to fixation (21.2 +/- 5.7 hours) and no histologic evidence of neuropathology. Diffusion tensor microscopy data were collected from hippocampal specimens by using a 14.1T magnet with a protocol that included 21 unique diffusion gradient orientations (diffusion time = 17 ms, b = 1250 s/mm(2)). The resulting images were used to determine the mean diffusivity, FA, and principal fiber orientation for manually segmented hippocampal regions that included the stratum oriens, stratum radiatum, stratum pyramidale (CA1 and CA3), stratum lacunosum-molecular, hilus, molecular layer, granule cell layer, fimbria, and subiculum.

RESULTS

Diffusion-weighted images had high signal-to-noise ratios (31.1 +/- 13.0) and delineated hippocampal anatomy well. Water diffusivity ranged from 1.21 +/- 0.22 x 10(-4) mm(2)/s in the fimbria to 3.48 +/- 0.72 x 10(-4) mm(2)/s in granule cells (analysis of variance, P<.001). Color fiber-orientation maps indicated the underlying microstructures responsible for diffusion anisotropy in the hippocampal lamina.

CONCLUSION

Diffusion tensor microscopy provided novel microstructural information about the different lamina of the human hippocampus. These ex vivo data obtained at high-magnetic-field strengths can be used to study injury-specific diffusion changes to susceptible hippocampal regions and may lead to more specific MR imaging surrogate markers for Alzheimer disease or epilepsy.

alpha7 Nicotinic receptor gene delivery into mouse hippocampal neurons leads to functional receptor expression, improved spatial memory-related performance, and tau hyperphosphorylation

Brain alpha7 nicotinic receptors have become therapeutic targets for Alzheimer's disease (AD) based on their memory-enhancing and neuroprotective actions. This study investigated the feasibility of increasing neuronal alpha7 receptor functions using a gene delivery approach based on neuron-selective recombinant adeno-associated virus (rAAV)-derived vectors. In order to determine whether alpha7 receptor-mediated cytotoxicity was dependent on receptor density, rat alpha7 nicotinic receptors were expressed at high concentrations in GH4C1 cells as measured with nicotine-displaceable [3H]methyllycaconitine (MLA) binding. The potency of GTS-21 (an alpha7 receptor agonist) to induce cell loss was similar in these cells to that seen in pheochromocytoma (PC12) cells expressing nine-times-lower receptor levels, suggesting that cytotoxicity was more dependent on agonist concentration than receptor density. Hippocampal transduction with rat alpha7 nicotinic receptors increased [3H]MLA binding in this region in wild type and alpha7 receptor-knockout (KO) mice without apparent cytotoxicity. No difference was observed in Kd values for MLA binding between endogenous and transgenic receptors. Single cell recordings demonstrated that dentate granule cells that normally have no alpha7 receptor response did so following alpha7 receptor gene delivery in wild type mice. Recovery of alpha7 function was also observed in stratum oriens and stratum radiatum neurons of KO mice following gene delivery. Wild type mice exhibited improved acquisition performance in the Morris water task 1 month after bilateral hippocampal transductions with the rat alpha7 receptor gene compared with green fluorescent protein-transduced controls. However, both groups reached similar training levels and there was no difference in subsequent probe performance. Finally, this gene delivery approach was used to test whether alpha7 receptors affect tau-phosphorylation. Chronic (i.e. 2 month but not 2 week) expression of high levels of alpha7 receptors in hippocampus increased AT8 staining characteristic of hyperphosphorylated tau in that region, indicating that endogenous agonist-mediated receptor activation may be able to modulate this process.

Impact of respiratory motion on the detection of small pulmonary nodules in SPECT imaging

The objective of this investigation is to determine the impact of respiratory motion on the detection of small solitary pulmonary nodules (SPN) in single photon emission computed tomographic (SPECT) imaging. We have previously modeled the respiratory motion of SPN based on the change of location of anatomic structures within the lungs identified on breath-held CT images of volunteers acquired at two different stages of respiration. This information on respiratory motion within the lungs was combined with the end-expiration and time-averaged NCAT phantoms to allow the creation of source and attenuation maps for the normal background distribution of Tc-99m NeoTect. With the source and attenuation distribution thus defined, the SIMIND Monte Carlo program was used to produce SPECT projection data for the normal background and separately for each of 150 end-expiration and time-averaged simulated 1.0 cm tumors. Normal and tumor SPECT projection sets each containing one lesion were combined with a clinically realistic noise level and counts. These were reconstructed with RBI-EM using 1) no correction (NC), 2) attenuation correction (AC), 3) detector response correction (RC), and 4) attenuation correction, detector response correction, and scatter correction (AC_RC_SC). The post-reconstruction parameters of number of iterations and 3-D Gaussian filtering were optimized by human-observer studies. Comparison of lesion detection by human-observer LROC studies reveals that respiratory motion degrades tumor detection for all four reconstruction strategies, and that the magnitude of this effect is greatest for NC and RC, and least for AC_RC_SC. Additionally, the AC_RC_SC strategy results in the best detection of lesions.

Evaluation of Multiclass Model Observers in PET LROC Studies

A localization ROC (LROC) study was conducted to evaluate nonprewhitening matched-filter (NPW) and channelized NPW (CNPW) versions of a multiclass model observer as predictors of human tumor-detection performance with PET images. Target localization is explicitly performed by these model observers. Tumors were placed in the liver, lungs, and background soft tissue of a mathematical phantom, and the data simulation modeled a full-3D acquisition mode. Reconstructions were performed with the FORE+AWOSEM algorithm. The LROC study measured observer performance with 2D images consisting of either coronal, sagittal, or transverse views of the same set of cases. Versions of the CNPW observer based on two previously published difference-of-Gaussian channel models demonstrated good quantitative agreement with human observers. One interpretation of these results treats the CNPW observer as a channelized Hotelling observer with implicit internal noise.

An Evaluation of Iterative Reconstruction Strategies on Mediastinal Lesion Detection Using Hybrid Ga-67 SPECT Images

Hybrid LROC studies can be used to more realistically assess the impact of reconstruction strategies, compared to those constructed with digital phantoms. This is because hybrid data provides the background variability that is present in clinical imaging, as well as, control over critical imaging parameters, required to conduct meaningful tests. Hybrid data is obtained by adding Monte Carlo simulated lesions to disease free clinical projection data. Due to Ga-67 being a particularly challenging radionuclide for imaging, we use Ga-67 hybrid SPECT data to study the effectiveness of the various correction strategies developed to account for degradations in SPECT imaging. Our data was obtained using GE-VG dual detector SPECT-CT camera. After determining a target lesion contrast we conduct pilot LROC studies to obtain a near-optimal set of reconstruction parameters for the different strategies individually. These near-optimal parameters are then used to reconstruct the final evaluation study sets. All LROC study results reported here were obtained employing human observers only. We use final LROC study results to assess the impact of attenuation compensation, scatter compensation and detector resolution compensation on data reconstructed with the RBI-EM algorithm. We also compare these with FBP reconstructions of the same dataset. Our experiment indicates an improvement in detection accuracy, as various degradations inherent in the image acquisition process are compensated for in the reconstruction process.

Estimation of the Rigid-Body Motion from Three-Dimensional Images Using a Generalized Center-of-Mass Points Approach

We present an analytical method for the estimation of rigid-body motion in sets of three-dimensional SPECT and PET slices. This method utilizes mathematically defined generalized center-of-mass points in images, requiring no segmentation. It can be applied to compensation of the rigid-body motion in both SPECT and PET, once a series of 3D tomographic images are available. We generalized the formula for the center-of-mass to obtain a family of points co-moving with the object's rigid-body motion. From the family of possible points we chose the best three points which resulted in the minimum root-mean-square difference between images as the generalized center-of-mass points for use in estimating motion. The estimated motion was used to sum the sets of tomographic images, or incorporated in the iterative reconstruction to correct for motion during reconstruction of the combined projection data. For comparison, the principle-axes method was also applied to estimate the rigid-body motion from the same tomographic images. To evaluate our method for different noise levels, we performed simulations with the MCAT phantom. We observed that though noise degraded the motion-detection accuracy, our method helped in reducing the motion artifact both visually and quantitatively. We also acquired four sets of the emission and transmission data of the Data Spectrum Anthropomorphic Phantom positioned at four different locations and/or orientations. From these we generated a composite acquisition simulating periodic phantom movements during acquisition. The simulated motion was calculated from the generalized center-of-mass points calculated from the tomographic images reconstructed from individual acquisitions. We determined that motion-compensation greatly reduced the motion artifact. Finally, in a simulation with the gated MCAT phantom, an exaggerated rigid-body motion was applied to the end-systolic frame. The motion was estimated from the end-diastolic and end-systolic images, and used to sum them into a summed image without obvious artifact. Compared to the principle-axes method, in two of the three comparisons with anthropomorphic phantom data our method estimated the motion in closer agreement to than of the Polaris system than the principal-axes method, while the principle-axes method gave a more accurate estimation of motion in most cases for the MCAT simulations. As an image-driven approach, our method assumes angularly complete data sets for each state of motion. We expect this method to be applied in correction of respiratory motion in respiratory gated SPECT, and respiratory or other rigid-body motion in PET.

Glutamate-mediated neuroplasticity in a limbic input to the hypothalamus

Emotionally-salient stressors are processed by cortical and limbic circuits that provide important regulatory input to the hypothalamic-pituitary-adrenal (HPA) axis. However, exposure to chronic or severe stress may cause disregulation of the axis and a variety of physiological and psychological symptoms. The mechanisms that underlie stress-induced alterations in HPA axis function are not well characterized, but one possibility is that severe stress causes plastic changes in limbic inputs to the hypothalamus. We examined plasticity within the bed nucleus of stria terminalis (BNST) and the hypothalamic paraventricular nucleus (PVN) with a stimulating electrode in the BNST and a recording electrode in the PVN. High-frequency BNST stimulation produced long-lasting suppression of evoked field potentials recorded from the PVN, and this effect was blocked by administration of MK-801. Accordingly, rapid glutamate-mediated neuroplasticity in the BNST to PVN neurocircuitry may contribute to plasticity in limbic regulation of the HPA axis.

A Multiclass Model Observer for Multislice-Multiview Images

A human-model observer for tumor detection-localization studies featuring multislice-multiview (or volumetric) image displays has been introduced. This volumetric observer, an extension of multiclass linear observers previously tested with single-slice and multislice displays, produces rating and localization data by integrating perception measurements from the different image views. A channelized NPW (CNPW) version of the observer was evaluated against humans for a background-known-exactly (BKE) detection task involving localization of Tc-99m Neotect lesions in simulated SPECT lung images. An LROC study evaluated two RBI reconstruction strategies that used different combinations of corrections for attenuation, scatter, and distance-dependent system resolution, and coronal, sagittal, and transverse slices were presented to the observers. Model-observer ranking of these strategies did not match that of the humans. Follow-up studies exploring several possible remedies for the model observer, including strategy-specific search regions and an internal-noise mechanism, showed little change. Future work will examine variations from the BKE assumption as a means of reconciling the rankings.

4-thiophenoxy-N-(3,4,5-trialkoxyphenyl)pyrimidine-2-amines as potent and selective inhibitors of the T-cell tyrosine kinase p56lck

We have developed a series of 4-thiophenoxy-N-(3,4,5-trialkoxyphenyl) pyrimidine-2-amines as potent and selective inhibitors of p56lck tyrosine kinase activity. In particular, the most potent inhibitor shows cellular activity in T-cell receptor (TCR) stimulated models of cytokine release, which suggests an immunomodulatory role for this class of inhibitor.

Coping with perturbations to a layout somersault in tumbling

Tumbling is a dynamic movement requiring control of the linear and angular momenta generated during the approach and takeoff phases. Both of these phases are subject to some variability even when the gymnast is trying to perform a given movement repeatedly. This paper used a simulation model of tumbling takeoff to establish how well gymnasts can cope with perturbations of the approach and takeoff phases. A five segment planar simulation model with torque generators at each joint was developed to simulate tumbling takeoffs. The model was customised to an elite gymnast by determining subject specific inertia and torque parameters and a simulation was produced which closely matched a performance of a layout somersault by the gymnast. The performance of a layout somersault was found to be sensitive to the approach characteristics and the activation timings but relatively insensitive to the elasticity of the track and maximum muscle strength. Appropriate variation of the activation timings used during the takeoff phase was capable of coping with moderate perturbations of the approach characteristics. A model of aerial movement established that variation of body configuration in the flight phase was capable of adjusting for takeoff perturbations that would lead to rotation errors of up to 8%. Providing the errors in perceiving approach characteristics are less than 5% or 5 degrees and the errors in timing activations are less than 7ms, perturbations in the approach can be accommodated using adjustments during takeoff and flight.

Chronic ethanol treatment reduces the magnitude of hippocampal LTD in the adult rat

Human alcoholics and animals that have received chronic ethanol treatment (CET) display memory deficits. Previous work in our laboratory has shown that CET produces damage to the hippocampus and a reduction in the magnitude of hippocampal long-term synaptic potentiation. In the present report we examined the effects of CET on hippocampal long-term depression (LTD). We used in vitro hippocampal slices to examine LTD after rats received 38-41 weeks of paired feeding on liquid diets containing ethanol or isocaloric sucrose. Stimulation delivered through electrodes in the CA3-CA1 Schaffer collateral pathway activated synaptic population responses in CA1. LTD of CA1 stratum radiatum evoked field potential slope was not induced by 900 single pulses at 1 Hz, but was elicited by 900 pulse pairs separated by 50 or 200 msec delivered at 1 Hz (pLFS50, pLFS200). LTD evoked by pLFS200, but not by pLFS50, was significantly reduced in slices from ethanol-treated rats. The N-methyl D-aspartate (NMDA) receptor antagonist 2-amino-5-phosphonopentanoic acid (AP5) (50 micro M) blocked LTD induced by pLFS50 and pLFS200 equally, but the L-type calcium channel blocker nimodipine (10 micro M) had no effect on either type of LTD. Thus, direct effects on these channels cannot explain how CET selectively reduces the magnitude of pLFS200 LTD. Finally, we describe a novel and robust LTD of the presynaptic afferent volley that is resistant to CET, NMDAR antagonists, GABA-A receptor blockade, and blockade of L-type calcium channels.

Induction of uncoupling protein 1 by central interleukin-6 gene delivery is dependent on sympathetic innervation of brown adipose tissue and underlies one mechanism of body weight reduction in rats

Interleukin-6 (IL-6) is a multifunctional cytokine that may have a role in energy regulation. Using a recombinant adeno-associated viral vector expressing murine interleukin-6 (rAAV-IL-6), we examined the chronic effects of centrally expressed IL-6 on food intake, body weight and adiposity in male Sprague-Dawley rats, and investigated the underlying mechanisms. Direct delivery of rAAV-IL-6 into rat hypothalamus suppressed weight gain and visceral adiposity without affecting food intake over a 5-week period. rAAV-IL-6 enhanced uncoupling protein 1 (UCP1) protein levels in interscapular brown adipose tissue (BAT). To investigate if the induction of UCP1 and the reduction in body weight are dependent on sympathetic innervation of BAT, we administered rAAV-IL-6 or a control vector into the hypothalamus of rats in which the interscapular BAT was unilaterally denervated. Over 21 days, there was no difference in food consumption or body weight between rAAV-IL-6- and control vector-treated rats. rAAV-IL-6 delivery increased UCP1 mRNA and protein levels in innervated BAT pads but not denervated BAT pads. Hypothalamic IL-6 signal transduction, indicated by phosphorylated signal transducer and activator of transcription 3 (P-STAT3) levels, was elevated by 2.6-fold at day 21, but returned to control levels by day 35. However, the suppressor of cytokine signaling-3 mRNA level was significantly elevated both at day 21 and day 35. These data demonstrate that chronic elevation of IL-6 in the CNS reduces body weight gain and visceral adiposity without affecting food intake. The mechanism involves sympathetic induction of UCP1 in BAT and, presumably, enhanced thermogenesis in BAT. Furthermore, chronic central IL-6 stimulation desensitizes IL-6 signal transduction characterized by reversal of elevated P-STAT3 levels.

Idiopathic generalised epilepsy of adult onset: clinical syndromes and genetics

OBJECTIVE

To study the clinical features and genetics of idiopathic generalised epilepsy (IGE) beginning in adult life.

METHODS

Consecutive patients with IGE, defined as generalised seizures with spike or polyspike and wave on EEG, were studied in the setting of a first seizure clinic where an early postictal EEG record is part of the protocol. Patients were divided into two groups: "classical IGE" with onset before 20 years and inclusive of all the IGE subsyndromes recognised by the international classification; and "adult onset IGE", when seizure onset was at age 20 years or later. Seizure patterns, clinical features, and genetics of the adult onset group were examined.

RESULTS

Of 121 patients with an electro-clinical diagnosis of IGE, 34 (28%) were diagnosed as adult onset IGE. The seizure patterns in these 34 cases were tonic-clonic seizures + absences (3), tonic-clonic seizures + myoclonus (6), and tonic-clonic seizures alone (25). Tonic-clonic seizures were often precipitated by alcohol or sleep deprivation. The proportion of affected first and second degree relatives did not differ between the classical and adult onset IGE groups. Twenty adult onset cases were treated with sodium valproate, four with other antiepileptic drugs, and 10 were untreated. Follow up of 32 of the 34 cases (for 31 (22) months (mean (SD)) showed that tonic-clonic seizures recurred in eight patients: five with identified provocative factors and three without.

CONCLUSIONS

Adult onset IGE is a relatively frequent and benign disorder. Seizures are usually provoked and are easy to control. Patients in this age group may often be misdiagnosed as having non-lesional partial epilepsy. Early postictal EEG and sleep deprivation studies may improve the detection of these patients. Pedigree analysis suggests that adult onset IGE, like classical IGE, has a genetic aetiology.

The effects of chronic ethanol consumption on neurotrophins and their receptors in the rat hippocampus and basal forebrain

Damage to the basal forebrain frequently results in deficits in learning and memory. Mnenonic dysfunction also occurs following prolonged ethanol consumption in humans and in animal models of chronic ethanol intake, accompanied by specific abnormalities in synaptic transmission between the basal forebrain and hippocampus. The integrity of at least some of the reciprocal neuronal connections between these brain regions is influenced by target-derived neurotrophic factors. We used a semiquantitative reverse transcription polymerase chain reaction technique to measure the messenger RNA for neurotrophins BDNF and NGF, and for their receptors trkB, trkA, and the low affinity receptor, p75(NTR) in the hippocampus and basal forebrain of rats after 28 weeks of alcohol consumption without malnutrition. This chronic ethanol treatment (CET) resulted in a marked and selective reduction in basal forebrain trkA mRNA. Western blotting revealed a similar reduction of basal forebrain trkA protein. CET effects on basal forebrain trkA may reflect impaired NGF signaling that could compromise septohippocampal synaptic connections, cholinergic differentiation, and emergent functional abilities dependent on these properties.

Narcolepsy and psychopathology: is there an association?

BACKGROUND

It is widely believed that patients with narcolepsy show high rates of associated psychiatric disturbance, especially schizophrenia and depression. However, surveys have produced conflicting findings and have not addressed the potential confounding effects of stimulant drug treatment.

METHOD

Forty-five patients with narcolepsy attending a sleep disorder clinic and 50 matched normal controls underwent structured psychiatric interview. Using a 'lifetime' approach, psychiatric symptoms and diagnoses were established for both groups.

RESULTS

Four of the narcolepsy patients but none of the controls had experienced psychotic symptoms. All four patients were taking amphetamines, and the symptoms resolved when the dose was lowered or treatment was changed to modafinil. The lifetime frequency of various depressive syndromes did not differ significantly between the groups.

CONCLUSIONS

Contrary to previous claims this study found little to suggest that narcolepsy is associated with schizophrenia. Nor, despite its serious social and occupational consequences, does narcolepsy appear to be associated with an increased frequency of diagnosable depressive disorders.

Potentiation of opioid analgesia in dopamine2 receptor knock-out mice: evidence for a tonically active anti-opioid system

Dopamine systems are intimately involved with opioid actions. Pharmacological studies suggest an important modulatory effect of dopamine and its receptors on opioid analgesia. We have now examined these interactions in a knock-out model in which the dopamine(2) (D(2)) receptor has been disrupted. Loss of D(2) receptors enhances, in a dose-dependent manner, the analgesic actions of the mu analgesic morphine, the kappa(1) agonist U50,488H and the kappa(3) analgesic naloxone benzoylhydrazone. The responses to the delta opioid analgesic [d-Pen(2),d-Pen(5)]enkephalin were unaffected in the knock-out animals. Loss of D(2) receptors also potentiated spinal orphanin FQ/nociceptin analgesia. Antisense studies using a probe targeting the D(2) receptor revealed results similar to those observed in the knock-out model. The modulatory actions of D(2) receptors were independent of final sigma receptor systems because the final sigma agonist (+)-pentazocine lowered opioid analgesia in all mice, including the D(2) knock-out group. Thus, dopamine D(2) receptors represent an additional, significant modulatory system that inhibits analgesic responses to mu and kappa opioids.

Prolonged cortical silent period after transcranial magnetic stimulation in generalized epilepsy

Transcranial magnetic stimulation (TMS) produces a cortical silent period (CSP) during a voluntary contraction. The duration of the CSP was used to assess the level of intracortical inhibition in patients with untreated idiopathic generalized epilepsy (IGE). Mean CSP duration was assessed at three TMS stimuli in 21 patients with IGE compared with 19 normal control subjects. Mean CSP duration was increased at all stimulus intensities, indicating that intracortical inhibition is increased in patients with IGE.

Resolution recovery for list-mode reconstruction in SPECT

The purpose of the study was to evaluate the resolution recovery in the list-mode iterative reconstruction algorithm (LMIRA) for SPECT. In this study we compare the performance of the proposed method with other iterative resolution recovery methods for different noise levels. We developed an iterative reconstruction method which uses list-mode data instead of binned data. The new algorithm makes use of a more accurate model of the collimator structure. We compared the SPECT list-mode reconstruction with MLEM, OSEM and RBI, all including resolution recovery. For the evaluation we used Gaussian shaped sources with different FWHM at three different locations and three noise levels. For these distributions we calculated the reconstructed images for a different number of iterations. The absolute error for the reconstructed images was used to evaluate the performance. The performance of all four methods is comparable for the sources located in the centre of the field of view. For the sources located out of the centre, the error of the list-mode method is significantly lower than that of the other methods. Splitting the system model into a separate object-dependent and detector-dependent module gives us a flexible reconstruction method. With this we can very easily adapt the resolution recovery to different collimator types.

The influence of attenuation and scatter compensation on the apparent distribution of Tc-99m sestamibi in cardiac slices

BACKGROUND

Our objective was to study the differences in relative count distributions in the left ventricular walls with attenuation compensation (AC) versus AC and triple-energy-window scatter compensation (SC), compared with standard filtered backprojection (FBP).

METHODS AND RESULTS

Two hundred patients identified as having normal cardiac perfusion with FBP after undergoing either pharmacologically or physiologically induced stress were included in this study. Projection data were reconstructed with FBP, 10 iterations of ordered-subset expectation-maximization (OSEM) with AC, and OSEM with AC+SC. A comparison was made of average percentage of maximum counts within each of 9 regions of CEqual (Marconi Medical Systems, Inc, Cleveland, Ohio) polar maps (ie, the apex, 4 midventricular regions, and 4 basal regions). Compared with OSEM(AC), a slight decrease at the apex exists when SC is included. The elevated inferior-to-anterior count ratio in the midventricular and basal regions noted with OSEM(AC) decreased to close to 1.0 with OSEM(AC+SC). The anterior-to-lateral ratio for both regions was closest to 1.0 for OSEM(AC+SC). In the midventricular region, the lateral-to-septal ratio decreased further below 1.0 with OSEM(AC+SC) than it did with OSEM(AC). This was the only basal ratio not to improve to close to 1.0 with OSEM(AC+SC). In a subset of patients identified at the time of clinical reading as having a possible attenuation-caused decrease in the inferior region, AC elevated the inferior-to-anterior ratio to above 1.0 for the midventricular region. AC+SC resulted in a ratio of near 1.0 for this region. In another subset of patients identified as having anterior attenuation artifacts, compensation methods (either AC or AC+SC) failed to show an improvement compared with FBP.

CONCLUSIONS

AC and SC improve the uniformity of the polar map, especially by bringing the inferior-to-anterior ratio closer to 1.0. Further investigation is necessary to determine the cause of the increased midventricular septal polar map count. In addition, the subset of patients identified as having breast-like attenuation artifacts causing a decreased polar map count in the anterior wall (relative to the inferior wall) also needs further attention.

Estrogens decrease reperfusion-associated cortical ischemic damage: an MRI analysis in a transient focal ischemia model

BACKGROUND AND PURPOSE

Early identification of irreversible cerebral ischemia is critical in defining strategies that influence neuronal survival after stroke. We used MRI to investigate the effects of 17beta-estradiol (E2) on the temporal evolution of focal ischemia.

METHODS

Female rats were ovariectomized and divided into 1 of 2 groups: ovariectomy alone (OVX; n=4) or ovariectomy with estrogen replacement (OVX+E2; n=3). Both groups were then subjected to 1-hour middle cerebral artery occlusion (MCAO), with the use of a standardized endovascular monofilament model, followed by reperfusion. Sequential diffusion-weighted (DWI) and T2-weighted (T2WI) MRI were obtained during and after the MCAO. In separate groups of animals (n=5 for OVX and OVX+E2), cerebral blood flow (CBF) was measured by laser-Doppler methods before, during, and after occlusion.

RESULTS

DWI detected similar lesion characteristics during MCAO in both groups. In the OVX group, lesion size did not change during reperfusion, but the signal intensity ratio increased early and stabilized during the latter stages. In contrast, DWI lesion size decreased during reperfusion in OVX+E2 rats by 50% to 60% (P<0.05), a size reduction almost exclusively limited to cortical regions. During MCAO, the signal intensity ratio in OVX+E2 rats was reduced compared with OVX rats. Reperfusion further attenuated the signal intensity ratio in cortical but not subcortical regions (P<0.05 versus OVX). T2WI revealed no lesions in either group during MCAO, but it detected lesion sizes similar to that of DWI during reperfusion. Furthermore, similar patterns and magnitudes of estrogen treatment-related decrease in lesion size were noted after reperfusion. T2WI demonstrated less intense signal intensity ratio changes in both groups compared with DWI. There were no differences in CBF between groups either during occlusion, early reperfusion, or 1 day after reperfusion.

CONCLUSIONS

This study strongly suggests that estrogens selectively protect cortical tissue from ischemic damage during MCAO and that this protection is exerted during both the occlusion and reperfusion phases of ischemia and does not involve an estrogen-related change in CBF.

Multidisciplinary case conference reviews: improving outcomes for nursing home residents, carers and health professionals

AIM OF STUDY

This study sought to determine whether multidisciplinary case conference reviews improved outcomes for nursing home residents, and the effects of this team approach to resident care on carers, including the hands-on carers employed by the nursing home, and health professionals.

METHOD

245 residents of three Canberra nursing homes were enrolled in this non-randomised controlled trial. The intervention consisted of sessions of three case conference reviews held between 10/4/96 and 4/12/96. These sessions were attended by the General Practitioners (GPs) of the residents discussed, the GP project officer from the ACT Division of General Practice, a clinical pharmacist, senior nursing staff, other health professionals e.g. physiotherapist, and occasionally the resident concerned or their representative. At each review, a case presentation by the resident's GP was followed by a multidisciplinary discussion of all aspects, medical and non-medical, of the resident's care. The review concluded with a management plan for the resident. In total 75 residents were reviewed.

MAIN OUTCOME MEASURES

Medication use and cost, and mortality.

RESULTS

One month after the reviews were completed comparisons between those who were reviewed and those who were not showed non-significant reductions in medication orders, medication cost, and mortality in the reviewed group. Many of the 92 recommendations in the management plans that were carried out benefited the residents (n = 37) and/or carers (n = 24). The responses of the GPs and the Directors of Nursing to the reviews were overwhelmingly positive.

CONCLUSION

Recommendations arising from multidisciplinary case conferences were carried out to the benefit of patients and carers. Given the support shown by key stakeholders, multidisciplinary conferences should be used more.

An interior point iterative maximum-likelihood reconstruction algorithm incorporating upper and lower bounds with application to SPECT transmission imaging

The algorithm we consider here is a block-iterative (or ordered subset) version of the interior point algorithm for transmission reconstruction. Our algorithm is an interior point method because each vector of the iterative sequence [x(k)], k = 0, 1, 2, ... satisfies the constraints a(j) < x(j)k < b(j), j = 1, ..., J. Because it is a block-iterative algorithm that reconstructs the transmission attenuation map and places constraints above and below the pixel values of the reconstructed image, we call it the BITAB method. Computer simulations using the three-dimensional mathematical cardiac and torso phantom, reveal that the BITAB algorithm in conjunction with reasonably selected prior upper and lower bounds has the potential to improve the accuracy of the reconstructed attenuation coefficients from truncated fan beam transmission projections. By suitably selecting the bounds, it is possible to restrict the over estimation of coefficients outside the fully sampled region, that results from reconstructing truncated fan beam projections with iterative transmission algorithms such as the maximum-likelihood gradient type algorithm.

Health-related quality of life in narcolepsy

Narcolepsy is a chronic sleep disorder characterised by symptoms of excessive daytime sleepiness and cataplexy. The aim of this study was to describe the health-related quality of life of people with narcolepsy residing in the UK. The study comprised a postal survey of 500 members of the UK narcolepsy patient association, which included amongst other questions the UK Short Form 36 (SF-36), the Beck Depression Inventory (BDI), and the Ullanlinna Narcolepsy Scale (UNS). A total of 305 questionnaires were included in the final analysis. The results showed that the subjects had significantly lower median scores on all eight domains of the SF-36 than normative data, and scored particularly poorly for the domains of role physical, energy/vitality, and social functioning. The BDI indicated that 56.9% of subjects had some degree of depression. In addition, many individuals described limitations on their education, home, work and social life caused by their symptoms. There was little difference between the groups receiving different types of medication. This study is the largest of its type in the UK, although the limitations of using a sample from a patient association have been recognised. The results are consistent with studies of narcolepsy in other countries in demonstrating the extensive impact of this disorder on health-related quality of life.

Improvement of image resolution and quantitative accuracy in clinical Single Photon Emission Computed Tomography

Clinical Single Photon Emission Computed Tomography (SPECT) is a scanning technique which acquires gamma-camera images ('projections') over a range of angles around a patient. These projections allow the reconstruction of cross sectional ('tomographic') images of the gamma-radiating pharmaceutical distribution in the patient, thus providing interesting information about the functioning of organs and tissues.SPECT images are seriously affected by a variety of image degrading processes. Restrictions on the amount of radio-pharmaceutical that can be administered to a patient cause noise in the projections and the limited spatial resolution of the gamma-camera results in blurring of the projections. In addition to these image degradations, the reconstruction of cross-sections is complicated by Compton scattering of gamma-photons in tissue, which causes attenuation of the photon flux received by the gamma-camera and causes improper detection of photons which have been scattered in tissue. This results in some additional blurring and loss of accuracy of the SPECT images in predicting activity concentrations. Tremendous efforts have been made to improve the quantitative accuracy and the spatial resolution of SPECT, and to reduce the noise in the reconstructed images. These efforts have resulted in corrective reconstruction algorithms, which are generally based on incorporation of accurate models of the main image degrading factors. Improvements of the data acquisition hardware can further increase image quality. In this paper, the image formation process of SPECT, including image-degrading factors, is explained. In addition, reconstruction algorithms and hardware modifications are reviewed, and their effects on image quality are illustrated with physical phantom and simulation experiments.

Outcomes of a randomized controlled trial of a clinical pharmacy intervention in 52 nursing homes

AIMS

To evaluate whether a year long clinical pharmacy program involving development of professional relationships, nurse education on medication issues, and individualized medication reviews could change drug use, mortality and morbidity in nursing home residents.

METHODS

A cluster randomised controlled trial, where an intervention home was matched to three control homes, was used to examine the effect of the clinical pharmacy intervention on resident outcomes. The study involved 905 residents in 13 intervention nursing homes and 2325 residents in 39 control nursing homes in south-east Queensland and north-east New South Wales, Australia. The outcome measures were: continuous drug use data from government prescription subsidy claims, cross-sectional drug use data on prescribed and administered medications, deaths and morbidity indices (hospitalization rates, adverse events and disability indices).

RESULTS

This intervention resulted in a reduction in drug use with no change in morbidity indices or survival. Differences in nursing home characteristics, as defined by cluster analysis with SUDAAN, negated intervention-related apparent significant improvements in survival. The use of benzodiazepines, nonsteroidal anti-inflammatory drugs, laxatives, histamine H2-receptor antagonists and antacids was significantly reduced in the intervention group, whereas the use of digoxin and diuretics remained similar to controls. Overall, drug use in the intervention group was reduced by 14.8% relative to the controls, equivalent to an annual prescription saving of A64 dollars per resident (approximately 25 pound sterling).

CONCLUSIONS

This intervention improved nursing home resident outcomes related to changes in drug use and drug-related expenditure. The continuing divergence in both drug use and survival at the end of the study suggests that the difference would have been more significant in a larger and longer study, and even more so using additional instruments specific for measuring outcomes related to changes in drug use.

Transgene delivery with a cationic lipid in the presence of amyloid beta (betaAP) peptide

The ability of a cationic lipid to deliver plasmid DNA (pDNA) in presence of the neurotoxic fragment of amyloid beta-peptide was evaluated. Pre-treatment of cells with betaAP (25-35) peptide resulted in a modest increase in transgene expression. When betaAP (25-35) peptide was mixed with the pDNA/liposome complex and used, the complexes lost their ability to transfect. However, the reverse sequenced betaAP (35-25) peptide demonstrated no significant differences in transgene expression in pre-treated cells, and in cells where betaAP (35-25) peptide was mixed with pDNA/liposome complexes and transfected. The amount of pDNA delivered to the cells was decreased in presence of betaAP (25-35) as measured with flow cytometry using fluorescently labeled liposomes. The decreased endocytosis may be due to their rod-like structure formation as demonstrated by electron microscopy and atomic force microscopy (AFM). These results demonstrate that betaAP (25-35) peptide may interfere with gene delivery with cationic systems.

Peroxide mediates ethanol-induced cytotoxicity in PC12 cells

Pheochromocytoma (PC12) cell cultures exhibited a loss of cells and increase in intracellular oxidative stress when exposed to ethanol (EtOH) for 24 h. Catalase, an enzyme that hydrolyzes hydrogen peroxide (H(2)O(2)) to O(2) and H(2)O can attenuate EtOH-induced cell loss and oxidative stress in PC12 cells. This study provides the first clear evidence that oxidative stress in the form of elevated intracellular H(2)O(2) is a primary mechanism of EtOH neurotoxicity in PC12 cells.