Four new sesquiterpenoid derivatives from the heartwood of Mansonia gagei

Four new sesquiterpenoid derivatives named mansonones N (1), O (2), P (3), and Q (4) were isolated from a dichloromethane extract of the heartwood of Mansonia gagei, a plant used in folk medicine in Thailand. Their structures were resolved on the basis of spectrometric data interpretation and the single-crystal X-ray analysis of 1 and 2.     

Anti-head lice effect of Annona squamosa seeds

The present study focused on the separation and identification of the active compounds against head lice from the hexane extract of Annona squamosa L seed. Chromatographic and spectroscopic techniques revealed that two major compounds of the hexane seed extract were oleic acid and triglyceride with one oleate ester. The yields of these compounds were 13.25% and 7.74% dry weight, respectively. The compounds were tested in vitro against head lice, comparing to the crude hexane extract of the seed. The triglyceride with one oleate ester and the crude hexane extract diluted with coconut oil 1:1. These compounds were found to kill all tested head lice in 49, 11 and 30 minutes, respectively. The triglyceride ester can be used as a marker for quantitative analysis of the active compound for quality control of the raw material A. squamosa seed and its extract. This first finding will be useful for quality assessment and the chemical stability of the antihead lice preparation from this plant.     

Grading Gliomas Capability: Comparison between Visual Assessment and Apparent Diffusion Coefficient (ADC) Value Measurement on Diffusion-Weighted Imaging (DWI)

Background: To compare diagnostic accuracy between DWI visual scale assessment and ADC value measurement of solid portion of the tumor in grading gliomas. Methods: This retrospective study included 38 patients who had pathologically proven gliomas between January 2013 and August 2018 with 18 low grade and 20 high grade tumors. All patients underwent MRI and biopsy. Two readers reviewed DWI visual scale independently. Disagreement was resolved by consensus. One reviewer measured ADC value of entire solid part of the tumor in single axial slice with greatest dimension of tumor which was chosen by consensus. Two data sets of visual scale and ADC value were analyzed and comparison of diagnostic accuracy in glioma grading was done by using area under the curve (AUC) of receiver operating characteristic curve (ROC). Results: Visual scale and ADC value could be used to distinguish between low and high grade gliomas with a statistically significant difference. (P-value 0.002 and <0.001). Almost all high grade gliomas had visual scale 5. The sensitivity, specificity, PPV NPV and accuracy were 50%, 100%, 100% , 64.3%,73.68% respectively. The cutoff level for the ADC value was determined to be 1119.48 x10-6 mm2/s in differentiation between low and high grade gliomas with the sensitivity, specificity, PPV, NPV, accuracy of 90%, 88.89% , 90%, 88.9% and 89.47% respectively. There was no statistically significant difference(P-value = 0.163). Conclusion: Both Visual scale and ADC value were capable of differentiating between low and high grade gliomas. Although visual scale may not replace ADC measurement, larger scale prospective study is needed for validate this initial result.     

MRI findings in acute disseminated encephalomyelitis following varicella infection in an adult

There are no abnormal magnetic resonance imaging (MRI) findings in children with acute disseminated encephalomyelitis (ADEM) after varicella infection. Here, we report abnormal MRI findings in an adult, namely: hyperintense signal in the right medullary olive, the right side of the pons, the left middle cerebellar peduncle, the dorsal aspect of both thalami and the periventricular white matter of both cerebral hemispheres. The patient's condition improved after 1 week of corticosteroid treatment. Four months later, MRI of the brain showed almost complete resolution and there were no further attacks of motor weakness at 18-months follow-up.     

Intracranial meningeal disease: comparison of contrast-enhanced MR imaging with fluid-attenuated inversion recovery and fat-suppressed T1-weighted sequences

BACKGROUND AND PURPOSE: Contrast-enhanced fluid-attenuated inversion recovery (FLAIR) imaging has been reported to have higher sensitivity for detecting leptomeningeal disease compared with contrast-enhanced T1-weighted MR imaging. The purpose of this study was to compare contrast-enhanced T1-weighted MR images with fat suppression to contrast-enhanced FLAIR images to determine which sequence was superior for depicting meningeal disease. METHODS: We reviewed MR images of 24 patients (35 studies) with a variety of meningeal diseases. The MR imaging protocol included contrast-enhanced T1-weighted MR images with fat suppression (FS) and contrast-enhanced fluid-attenuated inversion recovery (FLAIR) images that were reviewed by three neuroradiologists and were assigned a rating of positive, equivocal, or negative for abnormal meningeal enhancement. The two sequences were compared side by side to determine which better depicted meningeal disease. RESULTS: Abnormal meningeal enhancement was positive in 35 contrast-enhanced T1-weighted MR images with FS and in 33 contrast-enhanced FLAIR studies. In the first group, which had the T1-weighted sequence acquired first (21 of 33 studies), contrast-enhanced T1-weighted images with FS showed superior contrast enhancement in 11 studies (52%), inferior contrast enhancement in six studies (29%), and equal contrast enhancement in four studies (19%) compared with the contrast-enhanced FLAIR images. In the second group, which had the FLAIR sequence acquired first (12 of 33), contrast-enhanced T1-weighted images with FS showed superior contrast enhancement in seven studies (58%), inferior contrast enhancement in two studies (17%), and equal contrast enhancement in three studies (25%). CONCLUSION: Contrast-enhanced T1-weighted MR imaging with FS is superior to contrast-enhanced FLAIR imaging in most cases for depicting intracranial meningeal diseases.     

CT interpretation by ASPECTS in hyperacute ischemic stroke predicting functional outcomes

Purpose

To determine whether the Alberta Stroke Program Early CT Scores (ASPECTS) can predict posttreatment functional outcomes in hyperacute stroke patients who receive recombinant tissue-type plasminogen activator (rt-PA) treatment within 4.5 h.

Materials and methods

We studied 162 patients treated with rt-PA within 4.5 h of clinical onset. Of those, 29 patients (17.90 %) received rt-PA treatment between 3 and 4.5 h. Systematic CT scoring with the ASPECTS method was done. The primary outcome was the correlations between ASPECTS and the functional status at 3 months follow-up using the modified Rankin Scale.

Results

Clinical variables between those who received rt-PA treatment before and after 3 h were mostly comparable except the proportion of male gender. There were 116 patients (71.60 %) who were classified as independent. Time to receive CT scan or rt-PA treatment was not significantly associated with patients’ functional status. Baseline NIHSS and ASPECTS scores were significant factors associated with dependent status or death at 3 months after rt-PA treatment. The adjusted odds ratios were 1.133 [95 % confidence interval (CI), 1.047–1.226] and 0.844 (95 % CI, 0.720–0.990), respectively.

Conclusion

The ASPECTS predicts the functional status of acute stroke patients who received rt-PA treatment within the 4.5-h golden period.     

Interrater Reliability of Various Thyroid Imaging Reporting and Data System (TIRADS) Classifications for Differentiating Benign from Malignant Thyroid Nodules

Background: Thyroid ultrasound(US) is used as the first diagnostic tool to assess the management of disease butis operator dependent. There have been few reports evaluating interrater variability in US assessment. Therefore, weevaluated interrater reliability in US assessment of thyroid nodules and estimated its diagnostic accuracy for variousTIRADS systems. Methods: This retrospective study included 24 malignant nodules and 84 benign nodules fromJanuary 2015 to October 2017. Two blinded observers independently reviewed stored US images by using TIRADS. Allanalyses followed guidelines proposed by ACR-TR, Siriraj-TR and EU-TR systems. Interrater reliability was calculatedusing Cohen’s Kappa statistics. Diagnostic accuracy were also calculated. Results: Interobserver agreement showedsubstantial agreement for composition (K=0.616); echogenicity and echogenic foci showed fair agreement (K=0.327and 0.288, respectively); margin showed slight agreement (K=0.143). Interrater reliability for the final assessment;moderate agreement for ACR-TIRADS system (K=0.500); fair agreement for EU-TIRADS system (K=0.209) andslight agreement (K=0.114) for Siriraj-TIRADS system. The diagnostic performance from the two observers; ACRTIRADSsystem; sensitivities were 75% and 79.2%, specificities were 58.3% and 56%, positive predictive value (PPV)were 34% and 33.9% and negative predictive value (NPV) were 89.1% and 90.4%. For the Siriraj-TIRADS system,sensitivities were 41.7% and 25%, specificities were 84.5% and 89.3%, positive predictive value (PPV) were 43.5%and 40% and negative predictive value (NPV) were 83.5% and 80.6%. For the EU-TIRADS system, sensitivities were45.8% and 66.7%, specificities were 79.8% and 72.6%, positive predictive value (PPV) were 39.3% and 41% andnegative predictive value (NPV) were 83.8% and 88.4%. Conclusion: The ACR-TIRADS had highest interobserveragreement, a trend to have highest sensitivity and negative predictive value for diagnosis of malignant thyroid nodules.Siriraj-TIRADS had higher specificity and accuracy, but     

The appropriate neuroimaging study in persons with epilepsy

This article presents the appropriate neuroimaging for persons with epilepsy (PWE) in resource-limited facilities. PWE from the Epilepsy Clinic, Srinagarind Hospital between November 1, 2003 and January 30, 2005 were enrolled. The inclusion criteria were PWE aged more than 15 years who underwent computed tomography (CT) or magnetic resonance imaging (MRI) of the brain. We compared the abnormal neuroimaging findings by both imaging modalities. A total of 180 out of 370 PWE met the inclusion criteria, comprising 101 men (56.1%) and 79 women (43.9%). There were 75 PWE who underwent only CT imagings, 85 PWE who underwent only MRI and 20 PWE who underwent both CT and MRI studies. CT scan significantly detected brain abnormalities more than MRI in PWE (P = 0.0131). It was also found that CT scan was superior than MRI in detecting stroke and cysticercosis in PWE, whereas MRI was significantly better in the diagnosis of hippocampal sclerosis. Clinicians should be able to choose appropriate brain imaging for PWE, particularly in resource-limited countries. MRI should be preserved for particular brain lesion owing to availability and cost effectiveness.