Precise and accurate measurement of proton T1 in human brain in vivo: Validation and preliminary clinical application

Precise and accurate inversion-recovery (PAIR) magnetic resonance (MR) measurements of T1 were obtained in eight brain regions and cerebrospinal fluid of 26 healthy volunteers. Accuracy of the technique was assessed by measuring T1 in small fluid volumes with the PAIR technique and with two independent spectroscopic techniques. The mean difference between T1 measured with PAIR and with the two spectroscopic techniques was 3.1% ± 1.3. The precision (reproducibility) of measurements with the PAIR technique was excellent. The coefficient of variation (CV) across 16 measurements in a head phantom was 2.0%, compared with a CV of 2.7% across 45 separate measurements in a single subject. The within-subject CV was 1.8% ± 0.6 in white matter and 1.4% ± 1.0 in basal ganglia. The between-subject CV in 26 healthy volunteers was 3.6% ± 0.6 in white matter and 4.1% ± 1.9 in basal ganglia. Comparison between a patient with an active recurrent brain tumor and an agematched patient with an inactive brain tumor showed that T1 was significantly elevated throughout the brain of the active-tumor patient, especially in white matter tracts, even though no tumor or edema was detected in the white matter on standard MR images. Comparisons between five brain tumor patients and four healthy volunteers of similar age showed that T1 was significantly and substantially elevated throughout the white matter tracts and in the caudate nucleus, putamen, and thalamus. These results are consistent with the hypothesis that white matter tracts are selectively vulnerable to edema and that T1 increases in white matter are a sensitive indicator of patient status or tumor aggressiveness.     

Abnormal lymphocyte reactivity to self-major histocompatibility antigens in rheumatoid arthritis

Proliferation of rheumatoid and control peripheral blood mononuclear cells to OKT3, phorbol myristic acid (PMA), phytohemagglutinin (PHA), tuberculin PPD and in the autologous mixed lymphocyte reaction (AMLR) was investigated. Only the responses to PPD and in the AMLR were depressed. This was not due to suppression by OKT8 lymphocytes. The proportion of antigen responsive (T4+ 4B4+) cells was normal but suppressor-inducer (T4+ 2H4+) cells were decreased. The depressed response was not completely restored by addition of recombinant interleukin-2. We propose that a basic defect in rheumatoid arthritis resides in T lymphocytes which react to self-major histocompatibility complex antigens either on their own, as in the AMLR, or as restriction elements in the presentations of soluble antigen.     

A survey of child care workers: Implications for administrators regarding job stress and satisfaction

Child care agencies in Ohio were surveyed concerning their programs and child care workers so as to better understand factors that contribute to job stress, attrition, and satisfaction. The survey provided data regarding the population served at the agencies and the characteristics of child care workers, their services, concerns, desires, and rewards. The findings indicate that environmental variables contribute largely to perceived concern and desired changes, whereas success with children provides a prominent source of job satisfaction.     

Effect of volume on spinal anesthesia level with hyperbaric tetracaine.

The purpose of this prospective, randomized, double-blind study was to determine if the volume of a fixed milligram dose of hyperbaric tetracaine hydrochloride injected into the subarachnoid space affected the average maximal dermatomal spread of sensory anesthesia, determined by pinprick testing. One hundred two adults received spinal hyperbaric tetracaine in a volume of 2 mL, 3 mL, or 4 mL with the dose based on the patient's height. The addition of 0.2 mg of epinephrine to the anesthetic solution was allowed at the discretion of the attending anesthesiologist. A two-way analysis of variance (ANOVA) demonstrated that neither the dose selected nor the use of epinephrine affected anesthetic spread. ANOVA showed that anesthetic volume insignificantly affects the spread of sensory anesthesia. A Tukey HSD multiple comparisons test demonstrated a mean difference greater than 1 sensory dermatome between volumes of 2 mL and 4 mL, which was clinically detectable but statistically insignificant. Increasing the volume of hyperbaric spinal tetracaine solutions to improve anesthetic spread is unjustified.     

First step towards a desired outcome. Preventing infection by risk recognition.

The need for effective infection control applies to all areas of patient care, but is often carried out on an ad hoc basis. Implementing infection control procedures as part of the nursing process will ensure this area of care is not overlooked.     

Quantitative MRI of the brain in children with sickle cell disease reveals abnormalities unseen by conventional MRI

Conventional MRI (cMRI) has shown that brain abnormalities without clinical stroke can manifest in patients with sickle cell disease (SCD). We used quantitative MRI (qMRI) and psychometric testing to determine whether brain abnormalities can also be present in patients with SCD who appear normal on cMRI. Patients 4 years of age and older with no clinical evidence of stroke were stratified by cMRI as normal (n = 17) or abnormal (n = 13). Spin-lattice relaxation time (T1) of gray and white matter structures was measured by the precise and accurate inversion recovery (PAIR) qMRI method. Patient cognitive ability was assessed with a standard psychometric instrument (WISC-III or WISC-R). In all 30 patients with SCD, qMRI T1 was lower than in 24 age- and race-matched controls, in cortical gray matter (P < .0006) and caudate (P < .0009), as well as in the ratio of gray-to-white matter T1 (P < .008). In the 17 patients who were shown to be normal by cMRI, qMRI T1 was still lower than in controls, in both cortical gray matter (P < .02) and caudate (P < .004). Histograms of voxel T1 show that the proportion of voxels with T1 values intermediate between gray and white matter (ie, consistent with encephalomalacia) was 9% higher than controls in patients shown to be normal by cMRI (P < .05) and 15% higher than controls in patients shown to be abnormal by cMRI (P < .0005). The full scale intelligence quotient (FSIQ) of all patients with SCD was 75, compared to the FSIQ of 88 in a historical control group of patient siblings (P < .001). The FSIQ of patients shown to be normal by cMRI was 79, significantly lower than the FSIQ of patient siblings (P < .04). The FSIQ of 71 in patients shown to be abnormal by cMRI was significantly lower than both the patient siblings (P < .005) and the patients shown to be normal by cMRI (P < .04). Patients shown to be abnormal by cMRI scored lower than patients shown to be normal by cMRI, specifically on the subtests of vocabulary (P = .003) and information (P = .03). Cognitive impairment is thus significant, even in patients with SCD who were shown to be normal by cMRI, suggesting that cMRI may be insensitive to subtle neurologic damage that can be detected by qMRI. Because cognitive impairment can occur in children normal by cMRI, our findings imply that prophylactic therapy may be needed earlier in the course of SCD to mitigate neurologic damage.     

Molecular and phenotypic analysis of the CS54 island of Salmonella enterica serotype typhimurium: identification of intestinal colonization and persistence determinants

The shdA gene is carried on a 25-kb genetic island at centisome 54 (CS54 island) of the Salmonella enterica serotype Typhimurium chromosome. In addition to shdA, the CS54 island of Salmonella serotype Typhimurium strain LT2 contains four open reading frames designated ratA, ratB, sivI, and sivH. DNA hybridization analysis revealed that the CS54 island is comprised of two regions with distinct phylogenetic distribution within the genus SALMONELLA: Homologues of shdA and ratB were detected only in serotypes of Salmonella enterica subsp. I. In contrast, sequences hybridizing with ratA, sivI, and sivH were present in S. enterica subsp. II and S. bongori in addition to S. enterica subsp. I. Deletion of the ratA and sivI genes did not alter the ability of Salmonella serotype Typhimurium to colonize the organs of mice. Insertional inactivation of the sivH gene resulted in defective colonization of the Peyer's patches of the terminal ileum but normal colonization of the cecum, mesenteric lymph nodes, and spleen. Deletion of the shdA gene resulted in decreased colonization of the cecum and Peyer's patches of the terminal ileum and colonization to a lesser degree in the mesenteric lymph nodes and spleen 5 days post-oral inoculation of mice. A strain containing a deletion in the ratB gene exhibited a defect for the colonization of the cecum but not of the Peyer's patches, mesenteric lymph nodes, and spleen. The shdA and ratB deletion strains exhibited a shedding defect in mice, whereas the sivH deletion strain was shed at numbers similar to the wild type. These data suggest that colonization of the murine cecum is required for efficient fecal shedding in mice.