Comparison of CT and three MR sequences for detecting and categorizing early (48 hours) hemorrhagic transformation in hyperacute ischemic stroke

BACKGROUND AND PURPOSE: Our goal was to compare the sensitivity of CT and three MR sequences in detecting and categorizing early (48 hours) hemorrhagic transformation (HT) in hyperacute ischemic stroke. METHODS: Twenty-five consecutive patients with hyperacute ischemic stroke (<6 hours) without MR signs of cerebral bleeding at admission were included. Twenty-one underwent thrombolytic therapy. A standardized follow-up protocol, performed 48 hours after admission, combined brain CT scan and MR examination (1.5 T) including fast spin-echo-fluid-attenuated inversion recovery (FSE-FLAIR), echo-planar spin-echo (EPI-SE) T2-weighted, and EPI-gradient-recalled echo (GRE) T2*-weighted sequences. Both CT scans and MR images were obtained within as short a time span as possible between techniques (mean delay, 64 minutes). CT scans and MR images were independently rated as negative or positive for bleeding and categorized for bleeding severity (five classes) by two blinded observers. Prevalence of positive cases, intra- and interobserver agreement, and shifts in bleeding categorization between respective modalities and sequences were assessed. RESULTS: Twelve patients (48%) were rated positive for HT on the basis of findings of at least one technique or sequence. From this subset of bleeding patients, seven (58%) had positive CT findings, nine (75%) had positive FSE-FLAIR and EPI-SE T2-weighted findings, and 12 (100%) had positive EPI-GRE T2*-weighted findings. CT had lower intra- and interobserver agreement for positivity than did MR imaging. Among the seven patients with positive CT and MR findings, only two had convergent ratings for bleeding category based on findings of two modalities. The five remaining had upward grading from CT to MR, which varied according to pulse sequence. CONCLUSION: MR imaging depicted more hemorrhages and had higher intra- and interobserver agreement than did CT. The EPI-GRE T2*-weighted sequence demonstrated highest sensitivity. Equivocal upward shifts in bleeding categorization were observed from CT to MR imaging and between MR images.     

Robust estimation of interconnected systems subject to sensor nonlinearities

An efficient robust LMI‐based scheme is developed for decentralized state‐estimation of linear interconnected systems with static nonlinear interconnections and subjected to sensor nonlinearities. The interconnections satisfy quadratic constraints with manipulated parameters and the sensor nonlinearities are modeled as sector nonlinearities. The design procedure utilizes a general linear estimator structure and consists of two steps: the first giving a block‐diagonal Lyapunov matrix together with the robustness degree and the second determining the filter parameters. A numerical example is provided to illustrate the applicability of the method. Copyright © 2012 John Wiley & Sons, Ltd.     

Neonatal duodenum: fluid-aided US examination

In 261 infants with vomiting, 11 duodenal abnormalities were diagnosed with fluid-aided ultrasound (US). These abnormalities included duodenal obstruction, malrotation with and without associated volvulus, incomplete rotation, and duodenal stenosis. US was the initial modality used in the evaluation of vomiting in these neonates and young infants. The overall sensitivity and specificity of fluid-aided US evaluation of duodenal abnormalities were 100% and 99%, respectively. (Workup bias limits the reliability of these figures.) Fluid-aided US examination of the stomach and duodenum provided a dynamic view of duodenal rotation and anatomy, and at the very least provided a method of triaging those infants who may require surgery, upper gastrointestinal series, or follow-up US to make a definitive diagnosis.     

Regional anticoagulation and antiaggregation for CVVH in critically ill patients: a prospective, randomized, controlled pilot study

Background: The aim of this study is to assess the efficacy and clinical safety of regional anticoagulation (heparin pre-filter plus post-filter protamine) plus antiaggregation (pre-filter prostacyclin) [Group 1 (G1)] vs. only systemic heparin anticoagulation without antiaggregation [Group 2 (G2)] in critically ill patients with acute renal failure undergoing continuous veno-venous haemofiltration (CVVH).
Methods: One hundred and ten patients were randomized in a prospective, controlled pilot study. G1 patients received 1000 U/h pre-filter heparin, 10 mg/h post-filter protamine sulphate and 4 ng/kg/min pre-filter prostacyclin, while G2 patients received 1000 U/h pre-filter heparin. The haemofilter transmembrane pressure (TMP) and lifespan, as well as the platelet count were observed 1 h before, and at 6, 12, 18, 24 and 36 h from the beginning of CVVH.
Results: Haemofilter TMP remained unchanged in G1 while it increased up to three times in G2 ( P =0.0002). The median filter lifespan was 68 h in G1 and 19 h in G2. The rate of spontaneous circuit failure was 24% in G1 and 93% in G2 ( P =0.0001). The platelet count was stable over the treatment period in G1 while in G2 it decreased progressively ( P =0.0073).
Conclusion: In critically ill patients suffering from acute renal failure, regional anticoagulation with pre-filter heparin and post-filter protamine plus antiaggregation during CVVH is a simple and safe procedure that prevents increases in filter TMP and increases circuit life time compared with systemic anticoagulation with pre-filter heparin only.     

Changes in EEG power density of NREM sleep in depressed patients during treatment with citalopram

According to a recent hypothesis the therapeutic effects of antidepressants might be related to acute or cumulative suppression of NREM sleep intensity. This intensity has been proposed to be expressed in the EEG power density in NREM sleep. In the present study the relationship was examined between the changes of EEG power density in NREM sleep and the changes in clinical state in 16 depressed patients during treatment with citalopram, a highly specific serotonin uptake inhibitor. A one-week wash-out period was followed by 1 week of placebo administration, a medication period of 5 weeks, and a one-week placebo period. In order to minimize systematic influences of sleep duration and NREM-REM sleep alterations, EEG power was measured over the longest common amount of NREM sleep stages 2, 3 and 4 (91.5 min). During the last treatment week and the week after withdrawal, a significant decrease of EEG power as compared to baseline was found in the 8-9 Hz frequency range. No clear-cut change, however, was observed in the EEG power of the delta frequency range (1-4 Hz), which is considered to be the principle manifestation of NREMS intensity. Furthermore, no relationship between changes in EEG power density and changes in clinical state could be demonstrated.     

Salivary secretion, mucin concentrations and candida carriage in HIV-infected patients

Objectives:  To test whether the submandibular/sublingual (SMSL) salivary secretion, mucin concentration and candida carriage status were altered in human immunodeficiency virus-positive (HIV+) patients.
Subjects and methods:  SMSL saliva collected from 48 HIV-infected and 31 HIV-negative men were analyzed for flow rates, total protein and mucin concentrations. Salivary cultures were performed for Candida assessment.
Results:  The salivary flow rate and protein secretion of the HIV+ patients was 37% and 32% less than that of the controls ( P  <   0.0001, P  =   0.0087). The mucin concentrations (MG1 and MG2) were higher in the HIV+ subjects compared with controls ( P  =   0.0186, P  =   0.0014); however, the mucin secretions were not different. The frequency of Candida -positive cultures was higher in the HIV+ subjects than in the controls (61.4% vs 24.1%, P  =   0.0018). In the HIV-infected group, the unstimulated SMSL flow rates were lower in Candida -positive than in Candida -negative patients ( P  =   0.0158).
Conclusion:  The salivary secretion of the SMSL glands was reduced in HIV infection. Although the mucin concentration increased in HIV+ subjects, mucin secretion was not altered. Highly active antiviral therapy had no effect on salivary function. We found an association between the level of candida carriage and salivary flow rate in HIV-infected patients.     

Glucose kinetics in human obesity

Summary The kinetics of glucose utilization have been studied in 325 normal subjects, and 150 obese patients free from diabetes or other endocrine diseases. The investigation included measurements in the basal state by isotope dilution technique, determinations of glucose utilization rate induced by endogenous insulinic response (intravenous glucose load and tolbutamide) and by administration of various doses of exogenous insulin. — Results showed that whatever the test used, the disappearance rate constants (slope values or fractional disappearance rate) and the total uptakes (absolute value) of the obese patients were systematically lower than the corresponding values in the normal subjects. This metabolic abnormality is not favoured by ageing, but is not due to a diminished ability of the pancreas to release insulin: basal levels of plasma insulin and rises induced by glucose and by tolbutamide were significantly higher in obese patients. — The deficiency is better revealed by increasing the utilization rate by insulinic stimulation: the greater the slope value, the larger the impairment. In fact, there is a straight line relationship showing direct proportionality between the impairment of the glucose utilization rate constant and the velocity of the process, irrespective of the amount of insulin present or added. This feature strongly suggests in human obesity that the metabolic disturbance primarily affects the glucose uptake process itself rather than the action of insulin.

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Die kinetik der Glucoseutilisation bei der Fettsucht des Menschen

Zusammenfassung Die Kinetik der Glucoseutilisation wurde bei 325 Normalpersonen und 150 fettleibigen Patienten untersucht, die weder an Diabetes noch an anderen endokrinen Erkrankungen litten. Die Untersuchung umfaßte Messungen im Nüchternzustand mit der Isotopenverdünnungstechnik, Bestimmungen der Glucoseutilisationsrate unter dem Einfluß endogener Insulinfreisetzung (nach i.v. Glucosebelastung und Tolbutamid) und nach Gabe verschiedener Dosen exogenen Insulins. — Die Ergebnisse zeigten, daß die Konstante der Verschwinderate (K-Werte oder fraktionierte Verschwinderate) und die totale Aufnahme (in Absolutwerten) bei den fettleibigen Patienten bei allen verwendeten Testen übereinstimmend niedriger waren als die entsprechenden Werte der Normalpersonen. Diese Stoffwechselabnormität wird durch das Alter nicht begünstigt; sie kann auch nicht auf eine verminderte Fähigkeit des Pankreas zur Insulinfreisetzung zurückgeführt werden: die Ausgangswerte des Plasmainsulins und der Anstieg des Insulins nach Glucose und Tolbutamid waren bei den fettleibigen Patienten signifikant höher. — Diese Störung zeigt sich noch besser bei Ansteigen der Utilisationsrate durch Stimulation der Insulinsekretion: je größer die K-Werte, um so deutlicher die Verschlechterung. In der Tat läßt sich eine geradlinige Beziehung herstellen, die eine direkte Abhängigkeit zwischen der Verschlechterung der Konstante der Glucoseutilisationsrate und der Geschwindigkeit des Prozesses zeigt, unabhängig von der Menge des vorhandenen oder zugeführten Insulins. Diese Ergebnisse lassen vermuten, daß die Stoffwechselstörung bei der menschlichen Fettsucht primär eher den Prozeß der Glucoseaufnahme selbst als die Insulinwirkung betrifft.

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Cinétiques du glucose dans l'obésité humaine

Résumé La cinétique de l'utilisation du glucose a été étudiée chez 325 sujets normaux et 150 obèses exempts de diabète ou d'autres affections endocriniennes. L'investigation a comporté la détermination des vitesses de production et d'utilisation basales par dilution isotopique ainsi que les mesures des vitesses d'utilisation réactionnelles induites par stimulation pancréatique (injection intraveineuse d'une surcharge glucosée ou de tolbutamide) et par administration de doses variables d'insuline exogène. — Nos résultats montrent que quel que soit le type d'épreuve réalisé, les constantes de vitesse (constante K ou vitesses de disparition fractionnaires) et les vitesses d'utilisation (valeurs absolues) enregistrées chez les obèses sont systématiquement inférieures aux valeurs correspondantes des normaux. Ce trouble métabolique n'est ni favorisé par le vieillissement, ni dû à une diminution de la capacité secrétoire du pancréas: les taux plasmatiques de base et les accroissements insuliniques induits par injection de glucose et de tolbutamide sont significativement plus élevés chez les obèses que chez les normaux. Le trouble est d'autant plus facilement mis en évidence que l'on force la vitesse d'utilisation par stimulation insulinique. Il existe, en effet, une relation de proportionnalité directe entre l'altération des vitesses d'utilisation glucidique des différentes épreuves chez les obèses et ces vitesses elles-mêmes. Cette relation, qui n'est pas influencée par la quantité d'insuline présente ou ajoutée, suggère que le trouble primitif est plus lié au processus de captation tissulaire qu'à l'action de l'insuline.

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Part of this work was presented at the first annual meeting of the European Association for the Study of Diabetes in Montecatini 20. 4. – 22. 4. 1965.     

Quercetin Attenuates Benzo(α)pyrene-induced CYP1A Expression

<正>We studied effects of nutrient quercetin on cytochromes’Р450 1А(CYP1A)activities(measured spectrofluorimetrically using 7-ethoxy-resorufin for CYP1A1 and 7-methoxy-resorufin for CYP1A2 as substrates),on mR NA levels(measured by RT-PCR),and on DNA-binding activities(evaluated by an electrophoretic mobility shift assay)of proteins regulating CYP1A expression in untreated and benzo(α)pyrene(Ba P)-treated rats.Wistar rats     

Intrathoracic localisation of desmoid tumours: a familial case of isolated desmoid tumours and current published data

We present the case of large desmoid tumor of the anterior chest wall with pleural involvement, which persistently progressed despite hormonotherapy, chemotherapy and surgery. After many years of therapeutic failures, given the tumor size and its hemodynamic repercussions, the patient was presumed to be incurable and only supportive measures were given. One year later, the desmoid tumor had completely disappeared. Even though wide surgical excision is an essential element in the treatment of desmoid tumors, spontaneous regression may occur in very advanced disease.