MRI Detection of Carotid Intraplaque Hemorrhage and Postintervention Cognition

BACKGROUND AND PURPOSE

Cognitive improvement has been reported after carotid revascularization and attributed to treating stenosis and correcting hypoperfusion. This study investigated the effect of carotid intraplaque hemorrhage on postintervention cognition.

MATERIALS AND METHODS

In this institutional review board-approved single-center study, consecutive patients scheduled for carotid surgery were recruited for preoperative carotid MR imaging (MPRAGE) and pre- and postintervention cognitive testing using the Repeatable Battery for the Assessment of Neuropsychological Status. Pre- and postintervention scores were compared using t tests and multivariable linear regression.

RESULTS

Twenty-three participants were included, with endarterectomy performed in 20 (87%) and angioplasty/stent placement, in 3 (13%). Overall, statistically significant improvements occurred in the pre- versus postintervention mean Total Scale score (92.1 [SD, 15.5] versus 96.1 [SD, 15.8], P = .04), immediate memory index (89.4 [SD, 18.2] versus 97.7 [SD, 14.9], P < .001), and verbal index (96.1 [SD, 14.1] versus 103.0 [SD, 12.0], P = .002). Intraplaque hemorrhage (+) participants (n = 11) had no significant improvement in any category, and the attention index significantly decreased (99.4 [SD, 18.0] versus 93.5 [SD, 19.4], P = .045). Intraplaque hemorrhage (-) participants (n = 12) significantly improved in the Total Scale score (86.4 [SD, 11.8] versus 95.5 [SD, 12.4], P = .004), immediate memory index (82.3 [SD, 14.6] versus 96.2 [SD, 14.1], P = .002), delayed memory index (94.3 [SD, 14.9] versus 102.4 [SD, 8.0], P = .03), and verbal index (94.3 [SD, 13.2] versus 101.5 [SD, 107.4], P = .009). Postintervention minus preintervention scores for intraplaque hemorrhage (+) versus (-) groups showed statistically significant differences in the Total Scale score (-0.4 [SD, 6.8] versus 8.0 [SD, 8.5], P = .02), attention index (-5.9 [SD, 8.5] versus 4.3 [SD, 11.9], P = .03), and immediate memory index (4.2 [SD, 6.7] versus 12.2 [SD, 10.2], P = .04).

CONCLUSIONS

Cognitive improvement was observed after carotid intervention, and this was attributable to intraplaque hemorrhage (-) plaque. MR imaging detection of intraplaque hemorrhage status may be an important determinant of cognitive change after intervention.

Status and challenges for sustainable billfish fisheries in the Western Indian Ocean

Billfish species (families Istiophoridae and Xiphiidae) are caught in artisanal, recreational, and commercial fisheries throughout the Western Indian Ocean region. However, data and information on the interactions among these fisheries and the ecology of billfish in the WIO are not well understood. Using an in-depth analysis of peer-reviewed articles, grey literature, observation studies, and authors' insider knowledge, we summarize the current state of knowledge on billfish fisheries in 10 countries. To describe historical and current trends, we examined fisheries statistics from governmental and non-governmental agencies, sportfishing clubs' reports, diaries of sportfishing captains, and the catch and effort databases of the Indian Ocean Tuna Commission. We highlight two key points. First, billfish fisheries in the Western Indian Ocean are highly diverse, comprising two distinct segments-coastal and oceanic. However, data are poor for most countries with significant gaps in information especially for sport and artisanal fisheries. Second, the evidence assembled showed that billfish species have immense social, cultural, and economic value. Swordfish are targeted by both large-scale and semi-industrial fisheries, while other billfish species, particularly marlin, are highly sought after by sport fisheries in most countries. Our paper provides a comprehensive review of billfish fisheries and available information in the context of the WIO underscoring the need to strengthen data collection and reporting, citizen science, and collaborative sustainable development and management of billfish.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s11160-022-09725-8.

Phacoemulsification and intraocular lens implantation in a Canada lynx with phacoclastic uveitis

A 4-year-old male Canada lynx (Lynx canadensis) was referred to the ophthalmology service at the University of Saskatchewan with a 7-month history of cataract and chronic phacoclastic uveitis secondary to penetrating trauma from a lynx claw. Ophthalmic examination of the right eye revealed a corneal scar, marked aqueous flare, extensive fibrovascular membranes extending from the iris to the lens, anterior and posterior synechiae, immature cataract, and anterior vitritis; the fundus was not visible. Phacoemulsification surgery and intraocular lens implantation using a custom lens of D+46 and 14 mm (An-vision, West Jordan, Utah, USA) was performed. Post-operative medications included sub-conjunctival injections of atropine, cefazolin, and triamcinolone, and oral doxycycline and prednisolone. At the 5-month follow-up, the uveitis was controlled, and a normal fundus was visualized; at 21 mo, the eye remained comfortable and visual. This is the first case report to describe phacoemulsification in a wild felid as a treatment for a traumatic cataract and severe phacoclastic uveitis. Key clinical message: Despite chronic phacoclastic uveitis, phacoemulsification surgery can provide a positive outcome for mature wild felids with traumatic lens rupture, even when topical treatment cannot be administered.

Evaluation of an online toolkit for carers of people with a life-limiting illness at the end-of-life: health professionals' perspectives

Carers of people with a life-limiting illness report unmet information, practical, and emotional support needs, and are often unaware of services available to help improve preparedness, wellbeing, and reduce strain. CarerHelp is the first e-health toolkit that focuses on the information and support needs of carers of people with a life-limiting illness at the end-of-life, using a pathway approach. This study investigated the usefulness of CarerHelp, from the perspective of health professionals who care for these people. Through a 10-min online survey, health professionals provided feedback about their user experience and perceived usefulness of the website. Their expert opinion was sought to ascertain whether CarerHelp could increase carers' preparedness and confidence to support the person for whom they are caring and thereby improve carers' own psychological wellbeing. Health professionals also evaluated whether CarerHelp adequately raised awareness of support services available. CarerHelp was perceived as a useful resource for increasing preparedness for the caring role, including physical tasks and emotional support. Health professionals reported that CarerHelp would increase carers' knowledge of services, confidence to care and ability for self-care. Health professionals endorsed CarerHelp as a useful information source, guide for support, and would promote CarerHelp to clients and their families.

Root Coverage Predictability in the Treatment of Gingival Recessions on Mandibular Anterior Teeth

INTRODUCTION

Mandibular anterior teeth are most frequently affected by gingival recession. However, data regarding mucogingival treatment aimed at root coverage in this specific location are limited.

OBJECTIVE

The purpose of this study was to systematically review the scientific literature and to use the meta-analytic approach to address the following focused question: "What is the effectiveness of different surgical approaches on clinical and patient-related outcomes in the treatment of buccal gingival recessions on mandibular anterior teeth?"

METHODS

Studies were located by searching 3 electronic databases (Medline, Scopus, and Cochrane databases) and cross-referencing. Randomized and nonrandomized studies including at least 1 arm involving the use of pedicle flaps and/or free soft tissue grafts in the treatment of gingival recessions (recession type [RT] 1 and RT2) located on the buccal aspects of mandibular centrals, laterals and canines, were included in the analysis. Primary outcome was mean root coverage (mRC), expressed in percentage, based on a 3- to 12-mo follow-up observation. A Bayesian single-arm network meta-analysis was performed to identify a treatment hierarchy of the different surgical techniques.

RESULTS

Sixteen studies, with a total of 23 arms, were included in the quantitative analysis. The greatest mRC is associated with laterally positioned flap (LPF) + connective tissue graft (CTG) (91.2%) and tunnel (TUN) + CTG (89.4%), whereas LPF alone, coronally advanced flap (CAF) + CTG, and free gingival graft (FGG) showed lower mRC (79.1%, 78.9%, and 68.5% respectively). TUN + CTG provides significantly greater mRC compared to CAF+CTG. No difference among the procedures could be observed in terms of keratinized tissue width gain.

CONCLUSIONS

Treatment hierarchy generated by an arm-based network meta-analysis model suggested that tunnel and laterally positioned flap, both in combination with connective tissue graft, may provide the greatest mean root coverage in the treatment of mandibular anterior recessions.

KNOWLEDGE TRANSFER STATEMENT

The results of the present systematic review can be used by clinicians when deciding which approach to adopt when treating buccal gingival recessions on mandibular anterior teeth. In particular, procedures based on a laterally positioned flap or a tunneling technique, both in combination with connective tissue graft, seem to be the most predictable therapeutic decision.

Estimating degradation-related settlement in two landfill-reclaimed soils by sand-salt analogues

Landfill reclaimed soil here refers to largely degraded materials excavated from old landfill sites, which after processing can be reinstated as more competent fill, thereby restoring the former landfill space. The success of the process depends on the presence of remaining degradable particles and their influence on settlement. Tests on salt-sand mixtures, from which the salt is removed, have been used to quantify the impact of particle loss on settlement. Where the amount of particle loss is small, say 10% by mass or less, settlements are small and apparently independent of lost particle size. A conceptual model is presented to explain this behaviour in terms of nestling particles and strong force chains. At higher percentages of lost particles, greater rates of settlement together with some sensitivity to particle size were observed. The conceptual model was then applied to two landfill reclaimed soils, the long-term settlements of which were found to be consistent with the conceptual model suggesting that knowledge of particle content and relative size are sufficient to estimate the influence of degradable particles in landfill reclaimed soils.

Ca 125 and Survival in Ovarian Cancer: Preliminary Communication

CA 125 is an epithelial membrane marker which can be detected in the serum of patients with ovarian cancer and which may reflect tumour burden. In a group of 42 patients, the level of this marker has also been shown to be significantly related to survival.

What are the differences among occupational groups related to their palliative care-specific educational needs and intensity of interprofessional collaboration in long-term care homes?

Background

The purpose of this study was to compare the differences across occupational groups related to their end-of-life care-specific educational needs and reported intensity of interprofessional collaboration in long-term care (LTC) homes.

Methods

A cross-sectional survey, based on two questionnaires, was administered at four LTC homes in Ontario, Canada using a modified Dilman’s approach. The first questionnaire, End of Life Professional Caregiver Survey, included three domains: patients and family-centered communication, cultural and ethical values, effective care delivery. The Intensity of Interprofessional Collaboration Scale included two subscales: care sharing activities, and interprofessional coordination. In total, 697 LTC staff were given surveys, including personal support workers, support staff (housekeeping, kitchen, recreation, laundry, dietician aids, office staff), and registered staff (licensed nurses, physiotherapists, social workers, pharmacists, physicians).

Results

A total of 317 participants completed the survey (126 personal support workers, 109 support staff, 82 registered staff) for a response rate of 45%. Significant differences emerged among occupational groups across all scales and subscales. Specifically, support staff rated their comfort of working with dying patients significantly lower than both nurses and PSWs. Support staff also reported significantly lower ratings of care sharing activities and interprofessional coordination compared to both registered staff and personal support workers.

Conclusions

These study findings suggest there are differing educational needs and sense of interprofessional collaboration among LTC staff, specific to discipline group. Both the personal support workers and support staff groups appeared to have higher needs for education; support staff also reported higher needs related to integration on the interdisciplinary team. Efforts to build capacity within support staff related to working with dying residents and their families are needed. Optimal palliative care may require resources to increase the availability of support for all staff involved in the care of patients.

Altered brain network integrity after childhood maltreatment: A structural connectomic DTI-study

Childhood maltreatment is associated with alterations in neural architecture that potentially put these children at increased risk for psychopathology. Alterations in white matter (WM) tracts have been reported, however no study to date has investigated WM connectivity in brain networks in maltreated children to quantify global and local abnormalities through graph theoretical analyses of DTI data. We aimed for a multilevel investigation examining the DTI-based structural connectome and its associations with basal cortisol levels of 25 children with documented maltreatment experiences before age 3, and 24 matched controls (age: 10.6 ± 1.75 years). On the global and lobar level, maltreated children showed significant reductions in global connectivity strength, local connectivity and increased path length, suggesting deviations from the small-world network architecture previously associated with psychopathology. Reductions in global connectivity were associated with placement instability, attenuated cortisol secretion and higher levels of internalizing and externalizing behaviours. Regional measures revealed lower connectivity strength especially in regions within the ventromedial prefrontal cortex (vMPFC) in maltreated children. These findings show that childhood maltreatment is associated with systemic global neurodevelopmental alterations in WM networks next to regional alterations in areas involved in the regulation of affect. These alterations in WM organization could underlie global functional deficits and multi-symptom patterns frequently observed in children with maltreatment experiences. Hum Brain Mapp 38:855-868, 2017. © 2016 Wiley Periodicals, Inc.

Pharmacogenetics of antiepileptic drugs: A brief review

The goal of pharmacogenetic research is to assist clinicians in predicting patient response to medications when genetic variations are identified. The pharmacogenetic variation of antiepileptic drug response and side effects has yielded findings that have been included in drug labeling and guidelines. The goal of this review is to provide a brief overview of the pharmacogenetic research on antiepileptic drugs. It will focus on findings that have been included in drug labeling, guidelines, and candidate pharmacogenetic variation. Overall, several genes have been included in guidelines by national and international organizations; however, much work is needed to implement and evaluate their use in clinical settings.

A device for characterising the mechanical properties of the plantar soft tissue of the foot

The plantar soft tissue is a highly functional viscoelastic structure involved in transferring load to the human body during walking. A Soft Tissue Response Imaging Device was developed to apply a vertical compression to the plantar soft tissue whilst measuring the mechanical response via a combined load cell and ultrasound imaging arrangement. Accuracy of motion compared to input profiles; validation of the response measured for standard materials in compression; variability of force and displacement measures for consecutive compressive cycles; and implementation in vivo with five healthy participants. Static displacement displayed average error of 0.04 mm (range of 15 mm), and static load displayed average error of 0.15 N (range of 250 N). Validation tests showed acceptable agreement compared to a Houndsfield tensometer for both displacement (CMC > 0.99 RMSE > 0.18 mm) and load (CMC > 0.95 RMSE < 4.86 N). Device motion was highly repeatable for bench-top tests (ICC = 0.99) and participant trials (CMC = 1.00). Soft tissue response was found repeatable for intra (CMC > 0.98) and inter trials (CMC > 0.70). The device has been shown to be capable of implementing complex loading patterns similar to gait, and of capturing the compressive response of the plantar soft tissue for a range of loading conditions in vivo.

Blindness in a wild American black bear cub (Ursus americanus)

An approximately six-month-old wild American black bear (Ursus americanus) was found wandering in Saskatchewan and was presented to the Veterinary Medical Centre of the Western College of Veterinary Medicine for apparent blindness. Clinical examination confirmed an inability to navigate a photopic maze, bilateral tapetal hyper-reflectivity, fundi devoid of retinal vessels, and small pale optic nerve papillae. Single-flash electroretinography revealed A and B-wave amplitudes of approximately 40 and 140 microvolts, respectively, in both eyes. Histologic abnormalities included bilateral optic papillary mineralization and bilateral segmental optic nerve degeneration, with occasional intralesional lymphocytes confirmed with immunohistochemistry for CD3+. There was also bilateral multifocal retinal dysplasia, gliosis, lymphocytic retinitis, a complete lack of retinal blood vessels, an intravitreal vascular membrane, and a mild lymphocytic-plasmacytic uveitis with small pre-iridal cellular membranes. The presence of a positive ERG in a blind bear with numerous retinal ganglion cells and degenerative changes in the optic nerve are most consistent with vision loss due to optic nerve injury, which given the young age of the bear likely occurred during ocular development. The presence of ocular inflammation suggests this injury resulted from an inflammatory/infectious process. The etiology could not be determined. Hepatic concentrations of vitamin A were within the normal reference range for domestic species. Pan-herpesvirus PCR and immunohistochemistry for canine distemper virus and Toxoplasma gondii were negative, although this does not rule out these or other infectious etiologies. This represents the first case report of neonatal or congenital ocular abnormalities in an ursid species.

Tacrolimus to Belatacept Conversion Following Hand Transplantation: A Case Report

Vascularized composite allotransplantation (VCA) has emerged as a viable limb replacement strategy for selected patients with upper limb amputation. However, allograft rejection has been seen in essentially all reported VCA recipients indicating a requirement for substantial immunosuppressive therapy. Calcineurin inhibitors have served as the centerpiece agent in all reported cases, and CNI-associated complications associated with the broad therapeutic effects and side effects of calcineurin inhibitors have been similarly common. Recently, belatacept has been approved as a calcineurin inhibitor replacement in kidney transplantation, but to date, its use in VCA has not been reported. Herein, we report on the case of a hand transplant recipient who developed recurrent acute rejection with alloantibody formation and concomitant calcineurin inhibitor nephrotoxicity, all of which resolved upon conversion from a maintenance regimen of tacrolimus, mycophenolate mofetil and steroids to belatacept and sirolimus. This case indicates that belatacept may be a reasonable maintenance immunosuppressive alternative for use in VCA, providing sufficient prophylaxis from rejection with a reduced side effect profile, the latter being particularly relevant for nonlife threatening conditions typically treated by VCA.

A case of granulomatous slack skin cutaneous T-cell lymphoma: PET/CT imaging findings

A 24-year-old female presented with granulomatous slack skin (GSS) cutaneous T-cell lymphoma. The patient underwent systemic chemotherapy. Owing to the development of several chemotherapy-related complications, therapy was discontinued. Subsequently, disease progression was noted clinically. Our patient’s disease progression was clearly demonstrated by 18F-fludeoxyglucose positron emission tomography (PET)/CT findings. PET/CT imaging findings of GSS have not yet previously been reported. In this report, we present PET/CT characteristics of a patient with GSS.

An extremely high-altitude plume seen at Mars' morning terminator

The Martian limb (that is, the observed 'edge' of the planet) represents a unique window into the complex atmospheric phenomena occurring there. Clouds of ice crystals (CO2 ice or H2O ice) have been observed numerous times by spacecraft and ground-based telescopes, showing that clouds are typically layered and always confined below an altitude of 100 kilometres; suspended dust has also been detected at altitudes up to 60 kilometres during major dust storms. Highly concentrated and localized patches of auroral emission controlled by magnetic field anomalies in the crust have been observed at an altitude of 130 kilometres. Here we report the occurrence in March and April 2012 of two bright, extremely high-altitude plumes at the Martian terminator (the day-night boundary) at 200 to 250 kilometres or more above the surface, and thus well into the ionosphere and the exosphere. They were spotted at a longitude of about 195° west, a latitude of about -45° (at Terra Cimmeria), extended about 500 to 1,000 kilometres in both the north-south and east-west directions, and lasted for about 10 days. The features exhibited day-to-day variability, and were seen at the morning terminator but not at the evening limb, which indicates rapid evolution in less than 10 hours and a cyclic behaviour. We used photometric measurements to explore two possible scenarios and investigate their nature. For particles reflecting solar radiation, clouds of CO2-ice or H2O-ice particles with an effective radius of 0.1 micrometres are favoured over dust. Alternatively, the plume could arise from auroral emission, of a brightness more than 1,000 times that of the Earth's aurora, over a region with a strong magnetic anomaly where aurorae have previously been detected. Importantly, both explanations defy our current understanding of Mars' upper atmosphere.

Effects of a chelated copper as growth promoter on performance and carcass traits in pigs

Three studies were conducted to investigate whether a chelated Cu can replace CuSO₄ as a growth promoter in pigs. In Exp. 1, a total of 240 piglets (Large White×Landrace, 7.36±0.10 kg) were randomly allocated to 1 of 3 treatments with 8 replicates and 10 piglets per pen. Treatments included a NRC control (CuSO₄, 6 mg/kg), two Cu supplementations from either CuSO₄ or Cu(HMTBa)₂ at 170 mg/kg. Pigs fed Cu(HMTBa)₂ were 6.0% heavier than pigs fed either the NRC control or 170 mg/kg CuSO₄ (p = 0.03) at the end of the experiment. During the 42 days of experimental period, pigs fed Cu(HMTBa)₂ gained 9.0% more (p = 0.01), tended to eat more feed (p = 0.09), and had better feed efficiency (p = 0.06) than those fed CuSO₄. Compared with the 6 mg/kg CuSO₄ NRC control, liver Cu was increased 2.7 times with 170 mg/kg CuSO₄ supplementation, and was further increased with Cu(HMTBa)₂ (4.5 times, p<0.05). In Exp. 2, a total of 616 crossbred piglets (PIC, 5.01±0.25 kg) were randomly allocated to 1 of 4 treatments with 7 replicates and 22 piglets per pen. Treatments included a NRC control (from CuSO₄), and three pharmaceutical levels of Cu (150 mg/kg) supplemented either from CuSO₄, tri-basic copper chloride (Cu₂[OH]₃Cl), or Cu(HMTBa)₂. Pigs fed CuSO₄ or Cu(HMTBa)₂ had better feed efficiency (p = 0.01) and tended to gain more (p = 0.08) compared with those fed the NRC control. Pigs fed Cu₂(OH)₃Cl were intermediate. Pigs fed Cu(HMTBa)₂ had the highest liver Cu, which was significantly higher than those fed (Cu₂[OH]₃Cl) or the negative control (p = 0.01). In Exp. 3, a total of 1,048 pigs (PIC, 32.36±0.29 kg) were allotted to 6 treatments with 8 replicates per treatment and 20 to 22 pigs per pen. The treatments included a NRC control with 4 mg/kg Cu from CuSO₄, a positive control with 160 mg/kg Cu from CuSO₄, and incremental levels of Cu(HMTBa)₂ at 20, 40, 80, and 160 mg/kg. During the overall experimental period of 100 days, no benefit from 160 mg/kg CuSO₄ was observed. Pigs fed Cu(HMTBa)₂ had increased ADG (linear and quadratic, p≤0.05) and feed efficiency (linear and quadratic, p≤0.05) up to 80 mg/kg and no further improvement was observed at 160 mg/kg for the whole experimental period. Pigs fed 80 mg/kg Cu(HMTBa)₂ weighed 1.8 kg more (p = 0.07) and were 2.3 kg heavier in carcass (p<0.01) compared with pigs fed 160 mg/kg CuSO₄. In addition, loin depth was increased with increased Cu(HMTBa)₂ supplementation with pigs fed 80 mg/kg Cu(HMTBa)₂ had the greatest loin depth (p<0.05). In summary, Cu(HMTBa)₂ can be used to replace high CuSO₄ as a growth promoter in nursery and grower-finisher pigs.

Perchlorate levels in soil and waters from the Atacama Desert

Perchlorate is an anion that originates as a contaminant in ground and surface waters. The presence of perchlorate in soil and water samples from northern Chile (Atacama Desert) was investigated by ion chromatography-electrospray mass spectrometry. Results indicated that perchlorate was found in five of seven soils (cultivated and uncultivated) ranging from 290 ± 1 to 2,565 ± 2 μg/kg. The greatest concentration of perchlorate was detected in Humberstone soil (2,565 ± 2 μg/kg) associated with nitrate deposits. Perchlorate levels in Chilean soils are greater than those reported for uncultivated soils in the United States. Perchlorate was also found in superficial running water ranging from 744 ± 0.01 to 1,480 ± 0.02 μg/L. Perchlorate water concentration is 30-60 times greater than levels established by the United States Environmental Protection Agency (24.5 μg/L) for drinking.

Uptake and accumulation of four PPCP/EDCs in two leafy vegetables

Many pharmaceutical and personal care products (PPCPs) and endocrine-disrupting chemicals (EDCs) are present in reclaimed water, leading to concerns of human health risks from the consumption of food crops irrigated with reclaimed water. This study evaluated the potential for plant uptake and accumulation of four commonly occurring PPCP/EDCs, i.e., bisphenol A (BPA), diclofenac sodium (DCL), naproxen (NPX), and 4-nonylphenol (NP), by lettuce (Lactuca sativa) and collards (Brassica oleracea) in hydroponic culture, using (14)C-labeled compounds. In both plant species, plant accumulation followed the order of BPA > NP > DCL > NPX and accumulation in roots was much greater than in leaves and stems. Concentrations of (14)C-PPCP/EDCs in plant tissues ranged from 0.22 ± 0.03 to 927 ± 213 ng/g, but nearly all (14)C-residue was non-extractable. PPCP/EDCs, particularly BPA and NP, were also extensively transformed in the nutrient solution. Dietary uptake of these PPCP/EDCs by humans was predicted to be negligible.

Design and characterization of a laterally mounted phased-array transducer breast-specific MRgHIFU device with integrated 11-channel receiver array

PURPOSE

This work presents the design and preliminary evaluation of a new laterally mounted phased-array MRI-guided high-intensity focused ultrasound (MRgHIFU) system with an integrated 11-channel phased-array radio frequency (RF) coil intended for breast cancer treatment. The design goals for the system included the ability to treat the majority of tumor locations, to increase the MR image's signal-to-noise ratio (SNR) throughout the treatment volume and to provide adequate comfort for the patient.

METHODS

In order to treat the majority of the breast volume, the device was designed such that the treated breast is suspended in a 17-cm diameter treatment cylinder. A laterally shooting 1-MHz, 256-element phased-array ultrasound transducer with flexible positioning is mounted outside the treatment cylinder. This configuration achieves a reduced water volume to minimize RF coil loading effects, to position the coils closer to the breast for increased signal sensitivity, and to reduce the MR image noise associated with using water as the coupling fluid. This design uses an 11-channel phased-array RF coil that is placed on the outer surface of the cylinder surrounding the breast. Mechanical positioning of the transducer and electronic steering of the focal spot enable placement of the ultrasound focus at arbitrary locations throughout the suspended breast. The treatment platform allows the patient to lie prone in a face-down position. The system was tested for comfort with 18 normal volunteers and SNR capabilities in one normal volunteer and for heating accuracy and stability in homogeneous phantom and inhomogeneous ex vivo porcine tissue.

RESULTS

There was a 61% increase in mean relative SNR achieved in a homogeneous phantom using the 11-channel RF coil when compared to using only a single-loop coil around the chest wall. The repeatability of the system's energy delivery in a single location was excellent, with less than 3% variability between repeated temperature measurements at the same location. The execution of a continuously sonicated, predefined 48-point, 8-min trajectory path resulted in an ablation volume of 8.17 cm(3), with one standard deviation of 0.35 cm(3) between inhomogeneous ex vivo tissue samples. Comfort testing resulted in negligible side effects for all volunteers.

CONCLUSIONS

The initial results suggest that this new device will potentially be suitable for MRgHIFU treatment in a wide range of breast sizes and tumor locations.

Altered GABA and somatostatin modulation of proprioceptive feedback after spinal cord injury in lamprey

While various changes occur after spinal cord lesions, their influence on functional recovery is generally unclear. We have shown changes in proprioceptor and locomotor network properties below lesion sites in the lamprey spinal cord. The proprioceptive system offers a particularly tractable model for analyzing these changes. Here, we have sought evidence for changes in neuromodulatory effects below lesion sites by comparing the effects of gamma-aminobutyric acid (GABA) and somatostatin, both of which are located around the edge cells, on proprioceptive responses in lesioned and unlesioned spinal cords. Exogenously applied GABA significantly reduced or abolished bending-evoked responses in unlesioned animals. In lesioned animals bending-evoked responses were stronger and certain of the effects of exogenously applied GABA were reduced. However, blocking endogenous GABA with bicuculline significantly potentiated responses in lesioned but not unlesioned animals. This suggested that the potentiated responses in lesioned animals were nevertheless associated with stronger tonic GABAergic inhibition. There were significant differences in these effects when lesioned animals were separated on the basis of their degree of recovery: notably, bicuculline only potentiated responses in animals that recovered good locomotor function, suggesting a need for raised endogenous GABA levels. Somatostatin alone did not affect edge cell responses in lesioned or unlesioned animals, but in lesioned animals it reduced and thus further weakened the inhibitory effects of GABA. There are thus multiple changes in sensory modulation in the lesioned spinal cord, and differences in these effects may influence the degree of recovery.

Profiling of sputum inflammatory mediators in asthma and chronic obstructive pulmonary disease

Background

Asthma and chronic obstructive pulmonary disease (COPD) display features of overlap in airway physiology and airway inflammation. Whether inflammatory phenotypes in airway disease describe similar mediator expression is unknown.

Objectives

To explore the relationship of airway inflammation and cytokine and chemokine expression in asthma and COPD.

Methods

Subjects with asthma and COPD (n = 54 and n = 49) were studied. Clinical characteristics and sputum were collected at entry into the study. A 2-step sputum processing method was performed for supernatant and cytospin preparation. Meso Scale Discovery and Luminex platforms were used to measure cytokines, chemokines and matrix metalloproteinase levels.

Results

Analytes sensitive to dithiothreitol (DTT) that had increased recovery in the 2-step sputum process were IL-1β, 4, 5, 10, 13, IFN-γ, TNFRI, GM-CSF, CCL2, 3, 4, 5, 13 and 17. There was a differential expression in IL-8, TNFRI and TNFRII between asthma and COPD [mean fold difference (95% CI): IL-8, 2.6 (1.3–5.4), p = 0.01; TNFRI, 2.1 (1.3–5.4), p = 0.03; TNFRII, 2.6 (1.2–5.6), p = 0.02]. In neutrophilic and eosinophilic airway inflammation, TNFα, TNFRI, TNFRII, IL-6, IL-8 and IL-5 could differentiate between these phenotypes. However, these phenotypes were unrelated to the diagnosis of asthma or COPD.

Conclusion

Recovery of sputum mediators sensitive to DTT can be improved using the described sputum processing technique. Within airway inflammatory sub-phenotypes there is a differential pattern of mediator expression that is independent of disease. Whether these inflammatory phenotypes in asthma and COPD confer distinct pathogeneses, therapeutic responses and clinical phenotypes needs to be further evaluated.

High-resolution diffusion-weighted imaging of neck lymph nodes using 2D-single-shot interleaved multiple inner volume imaging diffusion-weighted echo-planar imaging at 3T

BACKGROUND AND PURPOSE

2D-ss-IMIV-DWEPI is an ss-DWEPI with greatly reduced geometric distortion. The purposes of this paper are to 1) evaluate of the utility of 2D-ss-IMIV-DWEPI for high-resolution neck LN imaging; 2) determine whether 2D-ss-IMIV-DWEPI can depict normal LN hilum; and 3) evaluate whether the inclusion of LN hilum within ROIs affects the measured LN ADC.

MATERIALS AND METHODS

HR-DWI was acquired with 1-mm² in-plane resolution and 2-mm section thickness by using 2D-ss-IMIV-DWEPI. In total, 58 LNs from 18 subjects were evaluated. The ADC map was calculated by using DWI with b = 10 and 300 s/mm². In those LNs where the LN hilum could be recognized, the LN ADC was measured with and without inclusion of the hilum, and the mean difference of the resulting ADC values was determined.

RESULTS

The hilar structure was identified by DWI in 15 LNs. The ADC of the hilum was 1.981 ± 0.331 × 10⁻³ mm²/s. In these 15 LNs, the ADC value excluding hilar structure was significantly lower than the ADC value including hilar structure (0.983 ± 0.169 versus 1.206 ± 0.244 × 10⁻³ mm²/s; P < .0001). The mean ADC in a total of 58 LNs excluding the hilar structure was significantly lower than the value obtained including the hilar structure (1.034 ± 0.183 versus 1.095 ± 0.213 × 10⁻³ mm²/s; P = .0002).

CONCLUSIONS

HR-DWI of neck LNs obtained by using 2D-ss-IMIV-DWEPI could identify the hilar structure. The ADC of normal neck LNs seemed significantly different when the hilum was included. The results suggest that HR-DWI may be helpful to aid selection of proper ROIs within LNs for accurate and reliable ADC measurements.

Cystic endometrial hyperplasia and chronic endometritis in a chinchilla

CASE DESCRIPTION

A 4-year-old nulliparous sexually intact female chinchilla (Chinchilla lanigera) was evaluated because of a 2-month history of blood being sporadically observed in its cage.

CLINICAL FINDINGS

Results of physical examination of the chinchilla were unremarkable except for the presence of blood-stained fur around the perineum. There were no external lesions to account for the bleeding. Findings on urinalysis, bacteriologic culture of urine, and whole-body radiography were unremarkable. The chinchilla's littermate had been evaluated because of similar clinical signs 2 years earlier, and these signs resolved following ovariohysterectomy.

TREATMENT AND OUTCOME

Ovariohysterectomy was performed, and gross changes were not observed in the reproductive tract. However, microscopic examination revealed multifocal cystic dilation of the endometrial glands, foci of microhemorrhage, and chronic suppurative inflammation consistent with a final diagnosis of cystic endometrial hyperplasia and chronic endometritis. Clinical signs did not recur.

CLINICAL RELEVANCE

Cystic endometrial hyperplasia has been documented in a variety of animals, but to the authors' knowledge, this was the first reported case in a chinchilla. Cystic endometrial hyperplasia and chronic endometritis should be considered as a differential diagnosis in an adult sexually intact female chinchilla with a history of suspected hemorrhagic vaginal discharge, suspected hematuria, or hemorrhage from an unknown source.

Determination of gap symmetry from angle-dependent H(c2) measurements on CeCu₂Si₂

The tetragonal heavy-fermion compound CeCu₂Si₂ exhibits a superconducting ground state (S type, T(c) = 0.67 K) close to a magnetic instability. Here, we present angle-resolved resistivity measurements of the upper critical field H(c2). In-plane rotation of S-type CeCu₂Si₂ single crystals reveals a fourfold oscillation of H(c2). An extended weak-coupling BCS model for a d-wave symmetry including strong Pauli-limiting effects confirms the aforementioned angular dependence and points towards d(xy) symmetry of the order parameter.