Longitudinal dynamic changes in factor VIII inhibitor titers in patients with hemophilia A and inhibitors receiving emicizumab prophylaxis

Emicizumab prophylaxis dramatically reduces bleeding events in patients with hemophilia A (PwHA) with or without factor VIII (FVIII) inhibitors. However, long-term dynamic changes in FVIII inhibitor titers during emicizumab prophylaxis remain to be investigated. We conducted a retrospective follow-up study of FVIII inhibitor titers after initiation of emicizumab prophylaxis in 25 PwHA carrying current or historical FVIII inhibitors. Nineteen PwHA had FVIII inhibitors at initiation of emicizumab prophylaxis (age: median 22 [range 4-60] years and inhibitor titer: 30 [1.0-1450] BU/mL). In 17 of the 19 patients, the inhibitor titers markedly decreased to a median of 1.2 (< 0.6-58) BU/mL at a median follow-up of 71 (38-111) months. In two patients, titers were slightly elevated after initiation of emicizumab but decreased in the long term. The remaining six patients had negative inhibitor status (< 0.6 BU/mL) when switched to emicizumab from FVIII prophylaxis. Five patients maintained negative titers. One patient had inhibitor recurrence, with a peak titer of 1.6 BU/mL that decreased to 0.9 BU/mL. In most cases, FVIII inhibitor titers can be expected to decrease spontaneously during emicizumab prophylaxis, but regular follow-up is necessary to manage breakthrough bleeds.

Factor VIII A3 domain residues 1793-1795 represent a factor IXa-interactive site in the tenase complex

BACKGROUND

Factor (F)VIII functions as a cofactor in the tenase complex responsible for conversion of FX to FXa by FIXa. Earlier studies indicated that one of the FIXa-binding sites is located in residues 1811-1818 (crucially F1816) of the FVIII A3 domain. A putative, three-dimensional structure model of the FVIIIa molecule suggested that residues 1790-1798 form a V-shaped loop, and juxtapose residues 1811-1818 on the extended surface of FVIIIa.

AIM

To examine FIXa molecular interactions in the clustered acidic sites of FVIII including residues 1790-1798.

METHODS AND RESULTS

Specific ELISA's demonstrated that the synthetic peptides, encompassing residues 1790-1798 and 1811-1818, competitively inhibited the binding of FVIII light chain to active-site-blocked Glu-Gly-Arg-FIXa (EGR-FIXa) (IC50; 19.2 and 42.9 μM, respectively), in keeping with a possible role for the 1790-1798 in FIXa interactions. Surface plasmon resonance-based analyses demonstrated that variants of FVIII, in which the clustered acidic residues (E1793/E1794/D1793) or F1816 contained substituted alanine, bound to immobilized biotin labeled-Phe-Pro-Arg-FIXa (bFPR-FIXa) with a 1.5-2.2-fold greater KD compared to wild-type FVIII (WT). Similarly, FXa generation assays indicated that E1793A/E1794A/D1795A and F1816A mutants increased the Km by 1.6-2.8-fold relative to WT. Furthermore, E1793A/E1794A/D1795A/F1816A mutant showed that the Km was increased by 3.4-fold and the Vmax was decreased by 0.75-fold, compared to WT. Molecular dynamics simulation analyses revealed the subtle changes between WT and E1793A/E1794A/D1795A mutant, supportive of the contribution of these residues for FIXa interaction.

CONCLUSION

The 1790-1798 region in the A3 domain, especially clustered acidic residues E1793/E1794/D1795, contains a FIXa-interactive site.

The prognostic value of 18F-FDG PET/CT taken immediately after completion of radiotherapy for lung cancer treated with concurrent chemoradiotherapy: A pilot study

PURPOSE

The prognostic value of F-18 fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) taken immediately after completion of radiotherapy in lung cancer patients is not well known. The purpose of this study is to assess the prognostic value of PET/CT taken immediately after completion of radiotherapy in lung cancer patients.

MATERIALS AND METHODS

Patients with primary lung cancer planned to undergo concurrent chemoradiotherapy were enrolled. Patients underwent PET/CT scans at 3 time points: before radiotherapy, within 24hours of completing radiotherapy (im-PET/CT), and 2-9 months after radiotherapy (post-PET/CT). Maximum standardized uptake value (SUV_max) was obtained. A post-PET/CT-SUV_max cut-off of 2.5 was determined as radiotherapy success.

RESULTS

Nineteen patients were enrolled. im-PET/CT-SUV_max for patients in the high post-PET/CT-SUV_max group was significantly higher than that of the low group (P=0.004). Receiver operator curve analysis indicated that im-PET/CT-SUV_max of 4.35 was an optimal cut-off value to discriminate between the two groups. Multivariable analysis showed that a high im-PET/CT-SUV_max was significantly associated with a high post-PET/CT-SUV_max (P=0.003).

CONCLUSION

PET/CT-SUV_max taken immediately following radiotherapy was associated with that evaluated 2-9 months after radiotherapy.

Longitudinal profiling of anti-factor VIII antibodies in Japanese patients with congenital hemophilia A during factor VIII replacement and immune-tolerance induction therapy

When patients with hemophilia A develop factor VIII (FVIII) inhibitors, FVIII replacement therapy becomes ineffective. Although immune-tolerance induction (ITI) therapy has been used to eradicate inhibitors, treatment is unsuccessful in approximately 30% of cases. However, the mechanism behind treatment failure remains unclarified. We retrospectively examined the longitudinal profiles of immunoglobulin G (IgG) subclasses and/or the inhibitory activities of FVIII in plasma samples from 14 Japanese patients with congenital hemophilia A during hemostatic, FVIII replacement, and/or ITI therapies. In five patients, an increase in IgG4 was observed simultaneously with a decrease in IgG1 when the patient had a history of relatively high FVIII inhibitor titers, reflecting an apparent change in humoral immunity. In addition, we examined the reactivity and specificity of the patients' anti-FVIII IgG1 and IgG4 to FVIII domains by immunoblotting. Under our experimental conditions, plasma from three patients with historically higher inhibitor titers appeared to have high titers of antibodies against the A2-a2 domain, which did not necessarily correlate with ITI failure. These observations may improve scientific understanding of the immune response to infused FVIII in patients with hemophilia A.

Generation of ozone during irradiation using medical linear accelerators: an experimental study

Background

Some patients have noted a foul odor during radiation therapy sessions, but the cause of the odor remains unknown. Since we suspected that this phenomenon is due to ozone generated by ionizing radiation, this experimental study measured ozone concentrations in the treatment room and in a coiled polyvinyl chloride (PVC) tube placed within the radiation field.

Methods

We measured ozone concentrations using an ultraviolet absorption method and an ozone monitor. A PVC tube (inner diameter 7 mm, outer diameter 10 mm) was used to mimic the environment of the nasal cavity. The tube (790 cm) was coiled and set between two 4-cm-thick (for X-rays) or 2-cm-thick (for electron beams) water-equivalent solid phantoms. The sampling tube of the ozone monitor was inserted into the PVC tube, and the joint was sealed to prevent environmental air contamination. To measure ozone concentrations in the atmosphere, the sampling tube supplied with the unit was used. A linac was used on a full-sized treatment field (40 cm × 40 cm at a source-to-axis distance of 100 cm). The effect of an electron beam on ozone concentrations was also evaluated with a full-sized treatment field (40 cm × 40 cm at a source-to-surface distance of 100 cm).

Results

Ozone levels in the treatment room were undetectable before the start of daily treatment but reached 0.008 parts per million (ppm) or more at 1 h after the start of treatment. Concentrations then remained nearly constant at 0.010–0.015 ppm throughout the day. The maximum ozone concentration in the PVC tube was only 0.006 ppm, even when it was irradiated at 2400 monitor units/min. Depending on the X-ray dose rate, the concentration increased to a maximum of 0.010 ppm with oxygen flowing into the other end of the tube at 1.5 L/min. Ozone concentrations in the PVC tube did not differ significantly between X-ray and electron-beam irradiation.

Conclusions

Only traces of ozone were found in the PVC tube that was used to mimic the nasal passages during radiation, these concentrations were too low for human perception. However, ozone concentrations did reach potentially detectable levels in the treatment room.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13014-022-02005-6.

Unusual visual and olfactory perceptions during radiotherapy sessions: an investigation of the organs responsible

During radiotherapy sessions to treat brain tumors or head-and-neck cancers, some patients experience unusual visual and/or olfactory perceptions. This prospective study sought to answer two questions: (i) what proportion of patients experience these unpleasant sensations?, and (ii) which organs are responsible? Eligible patients had brain or near-orbital tumors treated by helical tomotherapy. All were aged 10 years or older, able to communicate, and interviewed by a radiation oncologist at least once weekly during radiation therapy. If they had experienced such sensations, they were encouraged to join the second phase of the study. The patients were asked to indicate, using a button, when a sensation commenced and ended. The recorded data were collated with the treatment log. Thirty-eight consecutive patients were eligible. Twenty-six experienced visual and 13 olfactory sensations. The radiation doses to the organs related to the visual or olfactory sensations did not differ between patients who reported sensations and those who did not. Seventeen patients were enrolled in the second phase of the study. All 14 with visual sensations reported that the sensations occurred when the X-rays passed at eye level. Olfactory sensations were reported by eight out of nine patients when the X-rays passed through the olfactory epithelium and/or ethmoid sinus level. In conclusion, 68% of patients experienced visual sensations caused by X-rays passing through the level of the eyes, and 34% complained of olfactory sensations. With the exception of one patient, olfactory sensations occurred when the X-rays passed through the levels of the olfactory epithelium and/or ethmoid sinus.

Evaluation of 3-week-old layer chicks intratracheally challenged with Salmonella isolates from serogroup c1 (O:6,7) and Salmonella Enteritidis

With the exception to Salmonella enterica serotype Typhimurium and S. Enteritidis (serogroups B [O:4] and D [O:9], respectively), there have been very few studies conducted on the respiratory tract as route of infection in chickens with salmonellas from serogroup C1 (O:6,7). Therefore, the purpose of this present study was to determine the potential organ invasion by Salmonella enterica serotype Potsdam (SP), S. Mbandaka (SM), and S. Infantis (SI) from serogroup C1 (O:6,7) and compare their characteristics with those of S. Enteritidis (SE) on intratracheally (IT) challenged 3-week-old layer chicks. A total of 360 one-day-old White Leghorn layer chicks were acquired from a commercial hatchery and randomly assigned into four treatment groups (SP, SM, SI, and SE, respectively), consisting of three independent trials. Chicks were grown up to 21 days (3 weeks) and IT-challenged thereafter with 10⁶ CFU of respective salmonella organisms per group (n = 30). Chicks (n = 5) were humanely sacrificed every 24 h for 6 days post-IT infection and organs such as lung, heart, liver, spleen, kidney and caecal content were cultured for salmonella. All treatment groups exhibited colonization of lungs and caecal contents at 1 d (P = 0.475) and 4 d (P = 0.696) post-IT infection, respectively. There was no isolation of SP, SM, and SI in heart, liver, spleen, and kidney. In contrast, SE was obtained from heart, liver, and spleen of IT-infected chicks. The findings of this study contribute to a better understanding of the importance of the respiratory route in salmonella infection in poultry.

Low-Noise Photoplethysmography Sensor Using Correlated Double Sampling for Heartbeat Interval Acquisition

This study designs a low-power photoplethysmography (PPG) sensor based on the error compensation method for heartbeat interval acquisition. To perform heartbeat monitoring in daily life, it is necessary to obtain long-term and accurate heartbeat interval data with low power consumption, because of the limited size and battery capacity of the PPG sensor. Effective reduction in the power consumption of the sensor requires the duty-cycled LEDs and lowering pulse repetition frequency (PRF), i.e., decreasing the sampling rate. However, these methods reduce the accuracy of the heartbeat interval measurement because of signal-to-noise ratio (SNR) degradation and sampling errors. We propose an algorithm for heartbeat interval error compensation and incorporate a low-noise readout circuit to improve SNR. The readout circuit uses current integration to achieve low duty-cycle LED driving. A correlated double sampling (CDS) is introduced to minimize the random noise arising from the switching operation of the integration circuit. An error compensation method based on the PPG waveform similarity is also introduced using the autocorrelation and linear interpolation. The measurement results obtained from nine subjects show that a total current consumption of 28.2 μA is achieved with a 20-Hz PRF and 0.3% LED duty cycle. The proposed design effectively reduces the mean absolute error (MAE) of the heartbeat interval to an average of 6.2 ms.

Abstract P1-05-05: eEF1A2 facilitates PTEN-GSK3β mediated Aurora-A protein degradation during S-G2 phase inactivated in PTEN-deficient breast cancer

The AURKA gene, encoding Aurora kinase-A (Aurora-A), is frequently amplified and overexpressed across multiple cancer types correlating with poor prognosis. Although the AURKA gene is frequently amplified in human cancers, underlying mechanism(s) for Aurora-A protein stability through different phases of cell cycle are not well elucidated. Inhibiting the kinase activity and promoting protein degradation are two well-validated conceptual strategies for targeting protein kinases in cancers. Here, we demonstrate that Eukaryotic Elongation Factor 1 Alpha 2 (eEF1A2) facilitates PTEN-GSK3β mediated Aurora-A protein degradation through the SCF complex (SKP1-Cul1-FBXW7) during the S/G2 phase of proliferating cells. In contrast, this mechanism is inactivated in cancer cells accompanying PTEN-GSK3β pathway deficiency. Mechanistically, eEF1A2 interacts with Aurora-A, GSK3β, FBXW7 and Cul1-E3 ligase, as the SCF complex, to facilitate Aurora-A polyubiquitination for 26S proteasomal degradation. eEF1A2 promotes PTEN phosphorylation at T366 and stability, inactivates AKT and activates GSK3β which in turn phosphorylates Aurora-A at S283, S284 and S342. The phosphorylation of Aurora-A at S342 is detected during S/G2 phase of cell mitosis in parallel with eEF1A2-SCF complex formation with active form of GSK3β and neddylated Cul1. Conversely, genetic ablation of EEF1A2 and PTEN, activation of AKT, inhibition of GSK3β, expression of Aurora-A phosphodeficient-mutant attenuates the Aurora-A protein degradation which is corroborated in Aurora-A overexpressing mouse mammary carcinomas and human breast carcinomas. This study identifies a novel mechanism of Aurora-A protein degradation mediated eEF1A2-PTEN-GSK3β pathway and provides a framework for the discovery of Aurora-A therapeutic targets in breast cancer that harbors deficiency of PTEN tumor suppressor pathway.

Citation Format: Treekitkarnmongkol W, Solis LM, Kai K, Thompson AM, Tian W, Wistuba II, Sasai K, Jltsumori Y, Sahin AA, Hawke DH, Lee JM, Qin L, Bawa-Khalfe T, Rad R, Wong KK, Abbott CM, Katayama H, Sen S. eEF1A2 facilitates PTEN-GSK3β mediated Aurora-A protein degradation during S-G2 phase inactivated in PTEN-deficient breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-05-05.

Characterization of Ornithobacterium rhinotracheale from commercial layer chickens in eastern Japan

From a total of 72 commercial layer and pullet farms that were monitored in the eastern Japan area, 4 farms had mild to severe respiratory disease accompanied by decreased feed intake and drop in egg production. Microbiological analysis showed that 3 of the 4 farms, particularly from Fukushima, Tochigi, and Ibaraki prefectures, were positive for Ornithobacterum rhinotracheale (ORT). Out of 65 birds examined, ORT was isolated in 21 birds (32.31%). All isolates were Gram-negative pleomorphic rods with a colony size of 0.05 mm, translucent with grayish coloration, and with butyric smell after 48 h of incubation in 10% chicken blood agar at 37°C under microaerophilic conditions. All isolates reacted positively in the p-nitrophenyl-β-d-galactopyranoside test within 3 h and were positive in cytochrome oxidase tests with an API 20NE identification system biocode of 0-0-2-0-0-0-4. An agar gel precipitation test showed that all isolates were serotype-A. All strains were positive in PCR by yielding a 784 bp amplicon of the 16S rRNA gene. All strains were resistant to amikacin, colistin, gentamicin, kanamycin, neomycin, polymyxin b, streptomycin, and sulfamethoxazole trimethoprim and susceptible to amoxicillin clavulanic acid, ampicillin, doxycycline, spectinomycin, and tetracycline. This study is the first characterization of ORT from commercial layer chickens in eastern Japan.

Contribution of Factor VIII A2 Domain Residues 400–409 to a Factor X-Interactive Site in the Factor Xase Complex

The link between factor (F)VIII and FX is essential for optimum activity of the tenase complex. The interactive site(s) in FVIII for FX remains to be completely clarified, however. We investigated the FVIII A2 domain-FX association that was speculated from inhibitory mechanism(s) by an anti-A2 autoantibody. SDS-PAGE demonstrated that the purified inhibitor IgG recognizing residues 373–562 blocked FXa cleavage at Arg372 in FVIII, and surface-plasmon resonance (SPR)-based assays showed that intact A2 subunit directly bound to FX (K d; 63 nM). The FVIII structure model indicated possible FX-binding site(s) in residues 400–429 in A2. One peptide corresponding to residues 400–409 competitively inhibited both the A2–FX binding and FVIIIa/FIXa-dependent FXa generation. Covalent cross-linking was observed between this peptide and FX following reaction with EDC (1-ethyl-3-(3-dimethylaminopropyl)-carbodiimide) using SDS-PAGE. K408 and S409 were not evident in N-terminal sequence analysis of the cross-linked product, suggesting that two residues participated in cross-link formation. SPR-based assays using recombinant FVIII mutants with one or both residues substituted to alanine demonstrated that K408A and K408A/S409A had approximately fourfold high K d values of wild-type (WT-)FVIII. FXa cleavages at Arg372 in both mutants were significantly delayed, suggesting a contribution of K408 for FXa cleavage at Arg372. Furthermore, FXa generation assays with these mutants demonstrated that the K m values were 1.4- to 1.7-fold greater, and overall catalytic efficiency (k cat/K m) was 0.49- to 0.89-fold lower than with WT-FVIII, suggesting a significant contribution of K408 for FVIII–FX interaction in tenase assembly. We concluded that the K408 in the A2 domain provided an interactive-site for FX.

Development of a System that Generates Structured Reports for Chest X-ray Radiography

Objectives: Radiology reports are typically made in narrative form; this is a barrier to the implementation of advanced applications for data analysis or a decision support. We developed a system that generates structured reports for chest x-ray radiography.

Methods: Based on analyzing existing reports, we determined the fundamental sentence structure of findings as compositions of procedure, region, finding, and diagnosis. We categorized the observation objects into lung, mediastinum, bone, soft tissue, and pleura and chest wall. The terms of region, finding, and diagnosis were associated with each other. We expressed the terms and the relations between the terms using a resource description framework (RDF) and developed a reporting system based on it. The system shows a list of terms in each category, and modifiers can be entered using templates that are linked to each term. This system guides users to select terms by highlighting associated terms. Fifty chest x-rays with abnormal findings were interpreted by five radiologists and reports were made either by the system or by the free-text method.

Results: The system decreased the time needed to make a report by 12.5% compared with the free-text method, and the sentences generated by the system were well concordant with those made by free-text method (F-measure = 90%). The results of the questionnaire showed that our system is applicable to radiology reports of chest x-rays in daily clinical practice.

Conclusions: The method of generating structured reports for chest x-rays was feasible, because it generated almost concordant reports in shorter time compared with the free-text method.

Wireless EEG patch sensor on forehead using on-demand stretchable electrode sheet and electrode-tissue impedance scanner

A wireless electroencephalogram (EEG) sensor using a stretchable electrode sheet and electrode-tissue impedance measurement module is presented herein. The sensor can be attached to the forehead using biocompatible gel with the electrode sheet. The sensor is compactly designed for 3 cm × 9 cm × 6 mm with weight of 12 g. Impedance scanning circuit is also proposed to evaluate the skin surface condition before EEG measurements. We developed the impedance scanning board for 3 cm × 5 cm × 3 mm, with weight of 5.6 g. Results show that the proposed system demonstrates a promising performance in diagnosing the Alzheimer's disease using frequency domain analysis.

Design study of electron cyclotron resonance-ion plasma accelerator for heavy ion cancer therapy

Electron Cyclotron Resonance-Ion Plasma Accelerator (ECR-IPAC) device, which theoretically can accelerate multiple charged ions to several hundred MeV with short acceleration length, has been proposed. The acceleration mechanism is based on the combination of two physical principles, plasma electron ion adiabatic ejection (PLEIADE) and Gyromagnetic Autoresonance (GYRAC). In this study, we have designed the proof of principle machine ECR-IPAC device and simulated the electromagnetic field distribution generating in the resonance cavity. ECR-IPAC device consisted of three parts, ECR ion source section, GYRAC section, and PLEIADE section. ECR ion source section and PLEIADE section were designed using several multi-turn solenoid coils and sextupole magnets, and GYRAC section was designed using 10 turns coil. The structure of ECR-IPAC device was the cylindrical shape, and the total length was 1024 mm and the maximum diameter was 580 mm. The magnetic field distribution, which maintains the stable acceleration of plasma, was generated on the acceleration center axis throughout three sections. In addition, the electric field for efficient acceleration of electrons was generated in the resonance cavity by supplying microwave of 2.45 GHz.

Utility of weekly docetaxel combined with preoperative radiotherapy for locally advanced esophageal cancer from pathological analysis

Esophageal squamous cell cancer (ESCC) is a high-grade carcinoma that is treated with multidisciplinary approaches, including chemoradiotherapy (CRT) followed by surgery. Despite some success with these therapies, overall survival remains poor. In order to investigate a newer CRT regimen, we designed a comparative study to evaluate preoperative CRT using docetaxel (DOC) or 5-Fluorouracil and cisplatin (FU+CDDP [FP] therapy) for treatment of resectable ESCC. In a retrospective review of patients with resectable, locally advanced ESCC, 95 patients received preoperative CRT between 2001 and 2007. CRT was administered using either FP (n = 40) or DOC (n = 55). Pathological response and clinical outcomes were compared between the two groups. Hazard ratios and time-to-event analyses were used to assess outcomes; the ratios were controlled by multivariate logistic regression analysis of potential prognostic factors, and survival was presented with Kaplan-Meier curves. In the FP group, a significant curative effect was observed on the basis of pathological examination of postoperative lesions. However, the DOC group presented a significantly better prognosis on the basis of cumulative survival rates. Logistic regression analysis revealed that the presence of five or more lymph node metastases was an independent predictor of reduced survival. Patients with lymph node metastasis exhibited a better prognosis in the DOC group than those in the FP group. Preoperative CRT for locally advanced esophageal cancer using DOC results in similar or better long-term outcomes compared with FP-based CRT. Therefore, CRT using DOC is a promising therapy option for esophageal cancer.

SU-E-T-497: Study of Restricted Mass Stopping Power Ratio in Small Electron Tube Fields

PURPOSE

Electron tubes with small radii are useful to treat narrow regions which cannot accommodate normal electron applicators. In small electron fields, it is not trivial to estimate restricted mass stopping power ratio (MSR), which is needed to evaluate dose from ion chamber measurement. We studied MSRs in small electron tube fields using the Monte Carlo simulation.

METHODS

Electron tubes with radii, 3 and 2.5 cm, were used in this study. Nominal electron energies were 6 and 9 MeV. There were two types of tubes. One has a normal cut but the other has a 45-degree cut. For the normal cut tube, percent depth dose (PDD) in water was evaluated along the center of axis (CAX) of a beam. For the 45-degree cut tube, PDD was evaluated along the vertical line from the intersection of the CAX and the phantom surface with 45-degree gantry angle. The MSRs and mean electron energies were calculated using the Monte Carlo simulation.

RESULTS

We found good agreement between the measured and calculated PDDs. The changes of mean energies from those in the 10×10 cm² field at the depth of maximum dose (dmax) were very small for the normal cut electron tubes. For the 45-degree cut tubes, the changes of mean energies at dmax were less than 1 MeV. The MSRs in the normal cut tube fields were almost the same as those in the 10×10 cm² field at the corresponding depths. The MSRs for the 45-degree cut tubes deviated from those in the 10×10 cm² by about 1% (1.5 % at most).

CONCLUSIONS

We evaluated the mean energies and MSRs in small electron tube fields. The deviations of them from the values in the 10×10 cm² were small. The maximum difference of MSR was 1.5% in 45-degree cut tube fields. This work was supported by KAKENHI (23791449), Japan Society for the Promotion of Science, and Cancer Professional Training Plan, The Ministry of Education, Culture, Sports, Science and Technology, Japan.

Dynamic alteration of regional cerebral blood flow during carotid compression and proof of reversibility

Background

It is difficult to non-invasively visualize changes in regional cerebral blood flow caused by manual compression of the carotid artery.

Purpose

To visualize dynamic changes in regional cerebral blood flow during and after manual compression of the carotid artery.

Material and Methods

Two healthy volunteers were recruited. Anatomic features and flow directions in the circle of Willis were evaluated with time-of-flight magnetic resonance angiography (MRA) and two-dimensional phase-contrast (2DPC) MRA, respectively. Regional cerebral blood flow was visualized with territorial arterial spin-labeling magnetic resonance imaging (TASL-MRI). TASL-MRI and 2DPC-MRA were performed in three states: at rest, during manual compression of the right carotid artery, and after decompression. In one volunteer, time-space labeling inversion pulse (Time-SLIP) MRA was performed to confirm collateral flow.

Results

During manual carotid compression, in one volunteer, the right thalamus changed to be fed only by the vertebrobasilar system, and the right basal ganglia changed to be fed by the left internal carotid artery. In the other volunteer, the right basal ganglia changed to be fed by the vertebrobasilar system. 2DPC-MRA showed that the flow direction changed in the right A1 segment of the anterior cerebral artery and the right posterior communicating artery. Perfusion patterns and flow directions recovered after decompression. Time-SLIP MRA showed pial vessels and dural collateral circulation when the right carotid artery was manually compressed.

Conclusion

Use of TASL-MRI and 2DPC-MRA was successful for non-invasive visualization of the dynamic changes in regional cerebral blood flow during and after manual carotid compression.

Increased lymphocyte subpopulations and macrophages in the ovaries and oviducts of laying hens infected withSalmonella entericaserovar Enteritidis

Salmonella enterica serovar Enteritidis (SE) is a causative agent for human food poisoning cases throughout the world. The ovaries and the oviducts of the laying hens are the major sites of SE colonization from which vertical transmission to eggs occurs. In this study, Salmonella-induced changes in T lymphocytes, B lymphocytes and macrophages in the ovaries and oviducts were assessed after primary and secondary experimental inoculations of laying hen with SE. Statistically significant increases in the numbers of T cells (both CD4+ and CD8+) and macrophages were observed 7 to 14 days after primary inoculation, followed by a peak in B-cell numbers from the 14th day post-primary inoculation onwards in the secretory areas of the oviducts. The peak in lymphocyte numbers immediately preceded a decline in the rate of SE recovery from the reproductive tract beginning at day 14. The correlation of decreased Salmonella recovery with elevated lymphocyte and macrophage numbers strongly suggests that local cell-mediated immunity is involved in controlling SE injection in the ovaries and oviducts.