Test–retest reliability of the Vestibular Ocular Motor Screening (VOMS) tool and modified Balance Error Scoring System (mBESS) in US military personnel

The Military Acute Concussion Evaluation 2 (MACE 2), which includes the Vestibular-Ocular Motor Screening (VOMS) tool and the single-leg stance component of the modified Balance Error Scoring System (mBESS), was introduced in 2018 as an assessment of acute mTBI in US military personnel. However, the reliability of the VOMS and mBESS in this population has not been established.ObjectivesThe primary purpose of this study was to examine the reliability of the VOMS across a 6-month period in healthy, uninjured US Army Special Operations Command (USASOC) personnel.DesignActive duty/heathy military personnel (n = 108) completed the VOMS and mBESS at baseline and follow-up 6 months later (±1 month).MethodCronbach's alpha was used to examine the internal consistency of the VOMS and mBESS at both time points. Two-way mixed intra-class correlation coefficients (ICC) with consistency agreement were used to evaluate test–retest reliability.ResultsVOMS demonstrated excellent internal consistency (α = 0.99), whereas, the mBESS demonstrated poor internal consistency (α = 0.29). Test–retest reliability of VOMS items was moderate-to-good with ICCs ranging from 0.60 to 0.81. Test–retest reliability was moderate for mBESS total score (ICC = 0.59) and double-leg stance (ICC = 0.73), while single-leg (ICC = 0.49) and tandem (ICC = 0.02) stances were poor.ConclusionsThe findings suggest that VOMS has high internal consistency and moderate-to-good test–retest reliability. mBESS has poor internal consistency and poor-to-moderate test–retest reliability. The results suggest that VOMS is a reliable addition to the MACE-2, whereas, mBESS single-leg stance is less reliable. As such, mBESS double-leg stance may be a more reliable measure of balance in this population.     

The role of time-resolved imaging of contrast kinetics (TRICKS) magnetic resonance angiography (MRA) in the evaluation of head–neck vascular anomalies: a preliminary experience

Objectives:

In this preliminary report, we describe our experience with time-resolved imaging of contrast kinetics–MR angiography (TRICKS-MRA) in the assessment of head–neck vascular anomalies (HNVAs).

Methods:

We prospectively studied six consecutive patients with clinically suspected or diagnosed HNVAs. All of them underwent TRICKS-MRA of the head and neck as part of the routine for treatment planning. A digital subtraction angiography (DSA) was also performed.

Results:

TRICKS-MRA could be achieved in all cases. Three subjects were treated based on TRICKS-MRA imaging findings and subsequent DSA examination. In all of them, DSA confirmed the vascular architecture of HNVAs shown by TRICKS-MRA. In the other three patients, a close follow up to assess the evolution of the suspected haemangioma was preferred.

Conclusions:

TRICKS sequences add important diagnostic information in cases of HNVAs, helpful for therapeutic decisions and post-treatment follow up. We recommend TRICKS-MRA use (if technically possible) as part of routine MRI protocol for HNVAs, representing a possible alternative imaging tool to conventional DSA.     

Kinetics of the uptake and distribution of the dopamine D(2,3) agonist (R)-N-[1-(11)C]n-propylnorapomorphine in brain of healthy and MPTP-treated Göttingen miniature pigs

The binding of radioligand agonists to dopamine receptors in living brain can be informative about the abundance of receptors which are coupled to intracellular second messenger systems. Therefore, we developed a radiosynthesis for the dopamine D(2,3) partial agonist (R)-N- [1-(11)C]n-propylnorapomorphine ([(11)C]NPA). The uptake of this tracer in brain of anesthetized G?ttingen miniature pigs was recorded by positron emission tomography (PET) and analyzed by compartmental analysis using the metabolite-corrected arterial input, and using reference tissue methods. [(11)C]NPA had a blood-brain unidirectional clearance of approximately 0.35 ml g(-1) min(-1) and an apparent distribution volume of 6 ml g(-1) in cerebellum. The ligand had a binding potential of 1.5 in striatum, comparable to that reported previously for the receptor antagonist [(11)C]raclopride in the same strain of animals. Significant binding was detected in the hypophysis, thalamus, and medial forebrain bundle. The binding in striatum was of comparable magnitude in normal pigs and in pigs with a documented 50% dopamine depletion produced by MPTP-intoxication. Deep brain stimulation of the subthalamus was without conspicuous effect on the binding of [(11)C]NPA in vivo. Results of this preliminary study indicate that this tracer meets many requirements for assaying dopamine agonist binding sites by PET.     

Giant aneurysm at the junction of the internal carotid and persistent primitive trigeminal artery (PPTA) treated with endovascular GDC coiling, a case report of experience in Ramathibodi hospital

Introduction　Thetrigeminalarteryisthemostcommonpersistentcarotid basilaranastomoticchannelobservedinadultlife ,anditsoccurrenceprobablyrepresentsadefectincerebrovasculardevelopment .Itcanbeassociatedwithothercongenitalabnormalitiessuchascerebralaneu rysms ,butonlyrarelydoaneurysmsoftheprimitivetri geminalarteryitselfarise .TheprevalenceofintracranialaneurysmsinpatientswithPPTAwasapproximately 3%andisnogreaterthantheprevalenceofintracranialaneurysmsinthegeneralpopulation .Weretrospectivelyre…     

A simple way of varying the source efficiency for the extrapolation method in 4π(PC)-γ coincidence counting

A simple way of varying the source efficiency in 4π(PC)-γ coincidence counting is described. A wet source is put into the 4π flow proportional counter and measured repeatedly; the 4π(PC) counting efficiency increases smoothly to a maximum value as the water evaporates. It is possible to reproduce the measurement with the same source by rewetting it. The method has been applied to more than 20 radionuclides and the accuracy of the extrapolation improved significantly.     

Measurement of the 59.5-keV gamma-ray emission probability in the decay of 241Am with a 4π-CsI(T1) - sandwich spectrometer

The 59.5-keV γ-ray emission rate of ²⁴¹Am sources has been measured with a windowless 4π-CsI(T1)-sandwich spectrometer. Photon attenuation by the α-particle absorbers was minimized by an optimal shape of these absorbers. The disintegration rates of the same ²⁴¹Am sources were obtained by α-particle counting under defined low solid angles. The ratio of the two measured quantities, the 59.5-keV γ-ray emission probability, was found to be 0.3636 ± 0.0017 which is slightly higher than the recommended value of 0.359 ± 0.004.     

The Bücherer-Strecker synthesis of d- and l-(1-11C)tyrosine and the in vivo study of l-(1-11C)tyrosine in human brain using positron emission tomography

The synthesis of d-and l-(1-¹¹C)tyrosine, starting with ¹¹C-cyanide, is reported. dl-(1-¹¹C)Tyrosine was prepared by the Bücherer-Strecker reaction, from carrier added ¹¹C-cyanide with an incorporation of 80% in 20 min. The isolation of the pure d- and l-amino acid isomers from the enantiomeric mixture was accomplished within 15 min by preparative HPLC using a chiral stationary phase and a phosphate buffer as the mobile phase. Typically, the total synthesis time was 50 min (including purification) from end of trapping of ¹¹C-cyanide, with a radiochemical yield of d- and l-amino acid of 40%–60%. The d- and l-(1-¹¹C)tyrosine were both obtained optically pure, with a carrier added specific activity of 0.3–0.5 Ci/mmol and a radiochemical purity better than 99%. The ¹¹C labelled l-tyrosine was used in an in vivo study in the human brain using positron emission tomography (PET).     

Comparison of iodine-123 labelled 2β-carbomethoxy-3β-(4-iodophenyl)tropane and 2β-carbomethoxy-3β-(4-iodophenyl)-N-(3-fluoropropyl)nortropane for imaging of the dopamine transporter in the living human brain

Several cocaine congeners are of potential for imaging the dopamine transporter (DAT). Previous studies have shown that iodine-123 labelled 2-carbomethoxy-3-(4-iodophenyl)tropane ([¹²³I]-CIT) is a promising radiotracer for imaging the serotonin (5-HT) and dopamine (DA) transporters in the living human brain with single-photon emission tomography (SPET). [¹²³I]-CIT was found to be not very practical for 1-day DAT imaging protocols since peak DAT uptake occurs later than 8 h. Here we report a pilot comparison of [¹²³I]-CIT and 2-carbomethoxy-3-(4-iodophenyl)-N-(3-fluoropropyl)nortropane ([¹²³I]-CIT FP), using SPET imaging in four healthy male subjects. Peak uptake of [¹²³I]-CIT-FP into the basal ganglia occurred earlier (3–4 h after injection of tracer) than that of [¹²³I]-CIT (>8 h). However, the specific DAT binding of [¹²³I]-CIT-FP in the basal ganglia was somewhat less (0.813±0.047) than that of [¹²³I]-CIT (0.922±0.004). Imaging quality is excellent with both tracers and they are potentially of value for brain imaging in various neuropsychiatric disorders.     

The use of 3′-deoxy-3′-18F-fluorothymidine (FLT) PET in the assessment of long-term survival in breast cancer patients treated with neoadjuvant chemotherapy

Annals of Nuclear Medicine - To assess the role of serial FLT-PET scans during early neoadjuvant treatment as a prognostic marker of response to treatment and survival. This study is a prospective...     

Identification and quantitation of two new naphthoylindole drugs-of-abuse, (1-(5-hydroxypentyl)-1H-indol-3-yl)(naphthalen-1-yl)methanone (AM-2202) and (1-(4-pentenyl)-1H-indol-3-yl)(naphthalen-1-yl)methanone, with other synthetic cannabinoids in unregulated “herbal” products circulated in the Tokyo area

During our continual surveillance of unregulated drugs in May–June 2011, we found two new compounds as adulterants in herbal products obtained at shops in the Tokyo area. These compounds were identified by liquid chromatography–mass spectrometry, gas chromatography–mass spectrometry, accurate mass spectrometry, and nuclear magnetic resonance spectroscopy. The first compound identified was a naphthoylindole (1-(5-hydroxypentyl)-1H-indol-3-yl)(naphthalen-1-yl)methanone (AM-2202, 1), which is a side-chain hydroxyl analogue of JWH-018. The second compound was (1-(4-pentenyl)-1H-indol-3-yl)(naphthalen-1-yl)methanone (2), which is side-chain double bond analogue of JWH-018. This is the first report to identify 1 and 2 in a commercial “herbal” product to our knowledge. For quantitation of the above compounds 1 and 2, and chemical analysis for previously reported compounds (AM-2201, 3; JWH-203, 4; JWH-019, 7; JWH-210, 8; mitragynine, 9), each product was extracted with methanol under ultrasonication to prepare solutions for analysis by liquid chromatography with ultraviolet detection. For the sake of identifying JWH-203 (4) and its positional isomers [JWH-203-3-chloroisomer (5) and 4-chloroisomer (6)] correctly, simultaneous liquid chromatography analysis on fluorocarbon-bonded silica gel column was performed. And a case report of commercially available products containing synthetic cannabinoids 7 and 8, and a natural occurring alkaloid 9, was also shown. Each of 6 commercially circulated products contained compounds 1–4 and 7–9; the amounts of the compounds ranged from 4.1 to 222 mg per pack.     

Analysis of azepane isomers of AM-2233 and AM-1220, and detection of an inhibitor of fatty acid amide hydrolase [3′-(aminocarbonyl)(1,1′-biphenyl)-3-yl]-cyclohexylcarbamate (URB597) obtained as designer drugs in the Tokyo area

During our careful survey of unregulated drugs from November 2011 to January 2012 in the Tokyo area, we found two new compounds in commercial products. The first was identified as the benzoylindole (2-iodophenyl)[1-(1-methylazepan-3-yl)-1H-indol-3-yl]methanone (2), which is the azepane isomer of AM-2233 (1). Compound 2 was isolated by silica gel column chromatography, and was identified through a combination of liquid chromatography–mass spectrometry, gas chromatography–mass spectrometry, accurate mass spectrometry, and nuclear magnetic resonance spectroscopy. The second compound was identified as [3′-(aminocarbonyl)(1,1′-biphenyl)-3-yl]-cyclohexylcarbamate (URB597, 5) by comparing analytical data with that of the authentic compound. For quantitation of these three compounds, each commercial product was extracted with methanol under ultrasonication to prepare the solution for analysis by liquid chromatography with ultraviolet detection. The occurrence of compounds 1 and 2, and AM-1220 (3) and its azepane isomer (4) in 29 commercial products found in the Tokyo area are also shown in this report.     

Drug-induced perturbations in the in vivo distribution of oncological radiotracers—II. 5-[125I]iodo-2′-deoxyuridine influenced by nitrobenzylthioinosine-5′-phosphate (NBMPR-P) and acyclothymidine (ACT)

Nitrobenzylthioinosine (NBMPR), a potent inhibitor of facilitated nucleoside transport in vitro and in vivo, and acyclothymidine (ACT), a potent inhibitor of pyrimidine nucleoside phosphoryolase in vitro, have been used in an attempt to modulate the biodistribution of ¹²⁵I-labelled iododeoxyuridine ([¹²⁵I]IUdR). ACT or NBMPR-P (a water-soluble prodrug of NBMPR) were injected into BDF₁ mice bearing implanted Lewis lung tumors, according to protocols which would provide high and low plasma levels of the inhibitor. Compared with controls, bot inhibitors induced transient, marginal increases in hepatic, renal and blood levels of [¹²⁵I]IUdR, and decreased levels in tumors at short time intervals after injection. It is concluded that there is a mild tumor-sparing effect when either NBMPR or ACT are administered together with single i.v. diagnostic doses of [¹²⁵I]IUdR.