Emerging Use of Ultra-High-Field 7T MRI in the Study of Intracranial Vascularity: State of the Field and Future Directions

Cerebrovascular disease is a major source of mortality that commonly requires neurosurgical intervention. MR imaging is the preferred technique for imaging cerebrovascular structures, as well as regions of pathology that include microbleeds and ischemia. Advanced MR imaging sequences such as time-of-flight, susceptibility-weighted imaging, and 3D T2-weighted sequences have demonstrated excellent depiction of arterial and venous structures with and without contrast administration. While the advantages of 3T compared with 1.5T have been described, the role of ultra-high-field (7T) MR imaging in neurovascular imaging remains poorly understood. In the present review, we examine emerging neurosurgical applications of 7T MR imaging in vascular imaging of diverse conditions and discuss current limitations and future directions for this technique.

Assessment and management of water quality of Kshipra River in Ujjain City (Madhya Pradesh), India

This paper shows the water quality status and its assessment through Water Quality Index (WQI), various sources of pollution in the river and the possible strategies to restore the water quality of River Kshipra to its pristine status. The data procured from M.P. Pollution Control Board and WQI reveals that its water quality ranges from medium to bad. The study reveals that Khan River water is a major source of pollution to the River Kshipra. Implementation of sustainable management plan along with proper sewerage planning, watershed management and maintaining sufficient dilution flow will control the pollution in the River Kshipra.

Double-blind, placebo-controlled evaluation of extended-release bupropion in elderly patients with major depressive disorder

Major depressive disorder in the elderly is associated with increased morbidity and reduced quality of life. This 10 week, placebo-controlled study investigated the efficacy and tolerability of extended-release bupropion (150-300 mg once daily) in depressed patients aged 65 years or older. The statistical assumptions necessary for the validity of the protocol-specified analysis of covariance were not met for the analysis of the primary outcome variable (Montgomery-Asberg Depression Rating Scale total score at Week 10, last observation carried forward). Alternative statistical methods used for the analysis of this variable demonstrated statistical significance. Statistically significant improvements were observed on the majority of secondary end points when compared with placebo, including the health outcome measures for motivation and energy, and life satisfaction and contentment. Adverse events were generally mild to moderate and similar between treatment groups. This study demonstrated that the extended-release bupropion is an effective, well-tolerated treatment for major depression in the elderly.

In situ derivatization hollow fiber mediated liquid phase microextraction of alkylphosphonic acids from water

Alkylphosphonic acids (APAs), particularly the methyl-, ethyl-, isopropyl- and n-propyl-phosphonic acids are important markers of extremely toxic nerve agents. Hence, their detection and identification is of vital importance to verification of chemical weapons convention (CWC). Verification analysis of CWC requires development of fast, reliable, simple and reproducible sample preparation methods of water and soil samples. Present investigation is focused on the optimization of alkylation of APAs in water with subsequent extraction of alkylated acids by hollow fiber liquid phase microextraction (HF-LPME). This simple and sensitive sample preparation of APAs from water offered better recoveries in comparison to conventionally used extraction technique. Under optimized conditions, the APAs were detected at the concentration of 0.5-0.75 microg/mL with S/N ratio > or = 5, whereas the LODs for alkyl APAs (monobasic APAs) were achieved up to 0.1 microg/mL. The developed method was finally tested with water samples supplied in 19th official proficiency test conducted by the OPCW.

Giant synovial cysts of the hip joint: An important but rare differential diagnosis of an inguinal swelling

Synovial cysts around the hip joint are commonly mistaken for other more common causes of an inguinal swelling. We present a report on two patients in whom abnormal pulsatile masses in the groin caused diagnostic difficulty. Patients were initially admitted under vascular surgeons with a clinical diagnosis of aneurysm. Ultrasound examination was useful in excluding aneurysm. Detailed clinical examination revealed painful restricted hip movements and a radiograph showed evidence of arthritis in the hip joint. CT scan confirmed it to be a synovial cyst. Computed arthrotomogram or arthrography showed communication of the cyst with the hip joint. Synovial cysts and iliopsoas bursa enlargement may be more common than previously reported and should be considered as a differential diagnosis in patients with unusual inguinal swelling. (Hip International 2004; 14: 51-4).

Eosinophilic gastritis--an unusual cause of gastric outlet obstruction

Eosinophilic gastroenteritis is a rare entity. We report a 41-year-old man who presented with features of gastric outlet obstruction due to a submucosal lesion in the distal end of the stomach. Distal gastrectomy with Billroth II reconstruction was done. Histology showed eosinophilic gastritis infiltrating the muscular and serosal layers of the pylorus and antrum.

Simple time weighted average level air-monitoring method for sulfur mustard in work places

A simple air-monitoring method was developed and validated for vesicant sulfur mustard (HD) in the work place at time weighted average levels. XAD-2 adsorbent was used for the collection of HD vapours for 8 h followed by liquid desorption with carbon tetrachloride. The trace level analysis was carried out by gas chromatography-photoionization detection and was confirmed by gas chromatography-mass spectrometric detection in the selected ion mode.

Reemergence of sexual dysfunction in patients with major depressive disorder: double-blind comparison of nefazodone and sertraline

BACKGROUND

Several different classes of antidepressants have been associated with sexual adverse effects. This double-blind, randomized trial compared the effects of nefazodone and sertraline on reemergence of sexual dysfunction in depressed patients who had experienced sexual dysfunction as a result of sertraline treatment. Depressive symptoms were also monitored.

METHOD

One hundred five patients with DSM-III-R major depressive episode who were experiencing sexual dysfunction attributable to sertraline (100 mg/day) were screened for entry. Eligible patients entered a 1-week washout period that was followed by a 7- to 10-day single-blind placebo phase. Patients without symptoms of sexual dysfunction at the end of the single-blind placebo phase were randomly assigned to receive double-blind treatment with either nefazodone (400 mg/day) or sertraline (100 mg/day) for 8 weeks.

RESULTS

Nearly 3 times more sertraline-treated patients (76%; 25/33) experienced reemergence of sexual dysfunction (ejaculatory and/or orgasmic difficulty) than did nefazodone-treated patients (26%; 10/39) (p < .001). In addition, patients treated with nefazodone were more satisfied with their sexual functioning than were patients treated with sertraline. Both treatment groups demonstrated a similar and sustained improvement in depressive symptoms. Both drugs were well tolerated, and the overall incidence of adverse reactions was similar for both treatment groups; however, 9 sertraline-treated patients (26%) discontinued because of adverse events compared with 5 nefazodone-treated patients (12%). Of the patients discontinuing therapy for adverse events, 5 of the sertraline-treated patients did so because of sexual dysfunction reported as an adverse event, whereas only 1 of the nefazodone-treated patients discontinued therapy secondary to sexual dysfunction.

CONCLUSION

In this sample of patients with major depression who had recovered from sexual dysfunction induced by treatment with sertraline, nefazodone treatment resulted in significantly less reemergence of sexual dysfunction than did renewed treatment with sertraline and provided continued antidepressant activity.

Nefazodone versus sertraline in outpatients with major depression: focus on efficacy, tolerability, and effects on sexual function and satisfaction

BACKGROUND

The efficacy, tolerability, and effects on sexual function and satisfaction of nefazodone and sertraline were compared in a multicenter, randomized, double-blind, parallel-group study in outpatients with major depression.

METHOD

One hundred sixty patients, 18 years of age or older, who met DSM-III-R criteria for single or recurrent nonpsychotic major depressive episodes were randomly assigned to 6 weeks of treatment with either nefazodone (100-600 mg/day) or sertraline (50-200 mg/day). Symptoms were assessed before and during treatment using the 17-item Hamilton Rating Scale for Depression (HAM-D-17), Clinical Global Impressions (CGI) Improvement scale, the CGI Severity of Illness scale, and a sexual function questionnaire.

RESULTS

Of 143 patients evaluable for efficacy, 72 received sertraline and 71 received nefazodone. The mean modal daily dose at endpoint was 148 mg for sertraline and 456 mg for nefazodone. Analysis of efficacy measures (HAM-D-17 and CGI) showed consistent and comparable improvement in symptoms of depression for both treatment groups. Sertraline had negative effects on sexual function and satisfaction in both men and women, and nefazodone had no adverse effect on sexual well-being. Safety assessments based on adverse events, vital sign measurements, electrocardiographs, physical examinations, and clinical laboratory tests revealed no serious adverse events or organ toxicity associated with nefazodone or sertraline administration.

CONCLUSION

Nefazodone and sertraline are well tolerated, and there was no statistically significant difference in their antidepressant activity. Sertraline treatment has negative effects on sexual function and performance in both sexes, while nefazodone has none. These findings may have clinical implications when choosing antidepressant therapy.

Long-term safety and clinical acceptability of venlafaxine and imipramine in outpatients with major depression

The antidepressant efficacy and safety of venlafaxine was shown previously in 6-week, placebo-controlled trials. We evaluated the long-term safety and clinical acceptability of venlafaxine and imipramine in a double-blind, parallel-group, comparative study. Two hundred ninety depressed outpatients were treated with venlafaxine, and an additional 91 received imipramine for as long as clinically necessary, up to 1 year. The total daily dose of each drug could vary from 75 to 225 mg. The Clinical Global Impressions Scale and a therapeutic response rate that was based on Clinical Global Impressions Scale-Improvement and incorporated discontinuation information were used to evaluate efficacy. Safety determinations and patient subjective ratings were used to evaluate safety and clinical acceptability. During the study, the adverse events were generally mild to moderate and most subsided with continued treatment; the most frequent were nausea for venlafaxine and dry mouth for imipramine. The anticholinergic side effect burden was significantly higher in the imipramine group than in the venlafaxine group. Venlafaxine was judged significantly more acceptable than imipramine, on the basis of the subjective ratings by patients. Fewer venlafaxine-treated patients than imipramine-treated patients withdrew because of adverse events and unsatisfactory response. There was a consistent trend in the therapeutic response rates in favor of venlafaxine that reached statistical significance at months 2, 6, and 12. In this long-term study, patient acceptability was greater for venlafaxine than for imipramine, suggesting therapeutic advantages for venlafaxine in the long-term treatment of depression. Additional studies with other active comparators are underway to confirm and extend these encouraging results.

A simple screening procedure for detection of infraclinical cases of multiple myeloma

Agarose Gel Serum Electrophoresis is a simple, rapid and sensitive technique routinely used for diagnosis of Multiple Myeloma. Its effectiveness as a screening tool for detecting infraclinical cases of Multiple Myeloma is brought out in this study. 29 out of the 219 patients presenting with unexplained osteoporosis and pain are found to be positive for M proteins. These patients were earlier adjudged organic disease free after preliminary investigation and examination.

A study comparing paroxetine placebo and imipramine in depressed patients

These data provide evidence for the antidepressant efficacy of paroxetine. Paroxetine- and imipramine-treated patients were significantly different from placebo-treated patients, but little different to each other, on all depressive outcome measures. However, paroxetine appeared to have a possibly greater and earlier beneficial effect on anxiety symptoms associated with depression, when compared with imipramine. Both active therapies were effective in treating patients with severe depression. Side effects for paroxetine were typical of other serotonin (5-HT) uptake inhibitors but different from those of imipramine. In particular, anticholinergic and cardiovascular symptoms were reduced, and premature withdrawal less likely.

A double-blind comparison of paroxetine, imipramine, and placebo in major depression

Results from a single-center, 6-week, double-blind, randomized prospective study of paroxetine, a selective serotonin reuptake inhibitor; imipramine; and placebo are reported. One hundred twenty outpatients with a moderate-to-severe DSM-III diagnosis of major depression were randomly assigned to one of the three treatments following a 4- to 10-day single-blind placebo washout period. Significant differences favoring paroxetine over placebo were present at endpoint on most major efficacy measures. Paroxetine was also well tolerated; 5 (15%) paroxetine and 5 (14%) placebo patients dropped out of the study due to adverse effects. Imipramine, however, was comparatively poorly tolerated. Forty-five percent of imipramine-treated patients (N = 17) dropped out of the study due to adverse effects. None of the efficacy measures showed a significant difference between imipramine and placebo. This finding was probably due to the high number of imipramine patients who discontinued before they could improve. These results support the efficacy of paroxetine in the treatment of major depression and underline its favorable side effect profile compared with tricyclic antidepressants.

A comparison of paroxetine, imipramine and placebo in depressed out-patients

To compare the safety and antidepressant efficacy of paroxetine, imipramine, and placebo, data from six centres using the same protocol were pooled. A double-blind parallel-group design was used, with therapy lasting six weeks. From week 2 onwards, both the 240 paroxetine-treated and the 237 imipramine-treated patients were significantly different from the 240 placebo-treated patients, but no different from each other. Side-effects with paroxetine were less likely to lead to drop-out than with imipramine. Paroxetine had a possible earlier antidepressant effect than imipramine, and a possible earlier beneficial effect on anxiety symptoms associated with depression.

A double-blind placebo-controlled study of fluvoxamine and imipramine in out-patients with primary depression

1 A double-blind placebo-controlled study of fluvoxamine and imipramine was performed in a group of depressed patients. Twenty-two patients received fluvoxamine (mean dose 101 mg/day), 25 received imipramine (mean dose 127 mg/day) and 22 received placebo. 2 Apart from an increase in the SGOT and SGPT values of four imipramine patients, no statistically significant changes in haematology or urinalysis were judged to be medically relevant. Fluvoxamine exhibited fewer anticholinergic side effects than imipramine. 3 Both fluvoxamine treated patients and imipramine-treated patients exhibited a statistically significant improvement at the end of the 28-day treatment period with respect to the placebo patients, as measured using the Hamilton Rating Scale for Depression, and the Clinical Global Impression Scale. Evaluations of the results of the Beck Depression Inventory and the Profile of Mood States revealed a statistically significant improvement for imipramine patients with respect to placebo at week 4, but not for fluvoxamine patients. It is postulated on the basis of quantitative pharmaco-EEG findings, that the slight superiority of imipramine over fluvoxamine was due to underdosing of the latter.

Clozapine in tardive dyskinesia

Clozapine, which has had limited clinical testing in the U.S.A., was evaluated in 12 chronic schizophrenic patients with tardive dyskinesia. Its antipsychotic activity was again demonstrated and it suppressed the symptoms of tardive dyskinesia with a marked rebound occurring in these symptoms when it was withdrawn; there was no rigidity or other Parkinsonian symptoms. However, out of a total of 12 patients, neutropenia (800 and 1120) occurred in two patients, convulsion in one patient, marked withdrawal effects in three patients, and a hypotensive collapse with atrial fibrillation in one patient. If these adverse effects are confirmed in a larger sample size, then despite the novel desirable effects of clozapine it would seem unlikely that it will gain widespread or routine use.

Studies on the cholesterol synthesis in the human adipose tissue: I - effects of amino acids and ascorbic acid

Incubation of various amino acids in glucose-saline-ascorbic acid medium with human adipose tissue homogenates gives very high cholesterol values. Ascorbic acid thus is an important factor in cholesterol synthesis as well as in general metabolic shifts from pyruvic acid and acetyl CoA.

Studies on biosynthesis of sterol/steroid from dopamine

The in vitro incubation of the anterior kidney, posterior kidney, liver, brain, spleen and ovarian tissue homogenates of the fish Nandus nandus with DOPA has been studied with regards to cholesterol production. All tissues except liver give highly positive results. There is also an increase in the neutral 17-ketosteroids. Injections of Dopamine also produce similar results. It is then concluded that DOPA and Dopamine are important precursors of cholesterol in the fish tissues.

3:4-Dihydroxyphenzylalanine and biosynthesis of cholesterol in vivo and in vitro experimental studies

In vitro incubation of 24 amino acids with frog liver homogenate shows 4 grades of cholesterogenic values. 1. Alanine, Phenylalanine, Tyrosine and DOPA give positive results. Other amino acids were able to sustain the original amounts of cholesterol to different proportions e.g. 2. Aspartic acid, Proline and Valine (50%). 3. Sodium Acetate, Arginine, Cysteine, Leucine, Norleucine, Methionine and Serine (more than 50%). 4. Aminobutyric, Glutamic, Glycine, Histidine, Hydroxyproline, Isoleucine, Lysine, Ornithine, Threonine and Tryptophan (less than 50% to negligible). DOPA gives the maximum yield of 73.1% It also shows high cholesterogenic values in different organs both in vitro and in vivo. It is thus a major precursor of cholesterol in animal tissues. Scheme of biosynthesis of cholesterol from DOPA ARE GIVEN ON THE BASIS OF KNOWN FACTS. A postulated scheme of direct synthesis of sterid molecule from DOPA is also provided. DOPA also showns sympathomimetic effects upon subcutaneous administration and blood cholesterol is reduced to more than 50%. Although there are numerous publications detailing the various aspects of biosynthesis of cholesterol and hyper and hypo-cholesterolemia yet the exact realtionship between the amino acids and cholesterol synthesis is not properly understood. Recent publications of Shrivastava (1975 a,b,c) have aspecially drawn attention to the high cholesterogenic effects of 3:4-dihydroxyphenylalanine. This work presents evidence that DOPA is infact a major and potential source of cholesterol not only in liver but in other animal tissues as well.