Two-step anomalous diffusion tensor imaging

We extend the formalism of anomalous diffusion imaging to include directional anisotropy of fitted parameters. The resulting technique is termed anomalous diffusion tensor imaging (aDTI), and allows the directional properties of the distributed diffusion coefficient (α) and the anomalous diffusion exponent, (γ) to be analysed using the same analytical techniques as regular diffusion tensor imaging (DTI). Together, these parameters quantify the rate of diffusion (α) and the complexity of the diffusion environment (γ). We generated tensor images for the anomalous exponent tensor (Γ) and distributed diffusivity tensor (A) from in vivo human brain data and present images of eigenvalues, eigenvectors, Trace/3 (Tr), fractional anisotropy (FA) and tensor shape measures. In white matter, A is found to have a median Tr = 0.56 × 10^{? 3}mm²s^{? 1}, FA = 0.58 and Γ Tr = 0.69, FA = 0.13. We observed that white matter shows a similar anisotropic geometry for the distributed diffusion tensor as for the regular diffusion tensor, whereas the anomalous exponent tensor exhibits a different shape characteristic which may be informative of tissue microstructure. Copyright © 2011 John Wiley & Sons, Ltd.     

Endoscopic findings in upper gastrointestinal bleeding patients at Lacor hospital,northern Uganda

Background

Upper gastrointestinal bleeding (UGIB) is a common emergency medical condition that may require hospitalization and resuscitation, and results in high patient morbidity. Upper gastrointestinal endoscopy is the preferred investigative procedure for UGIB because of its accuracy, low rate of complication, and its potential for therapeutic interventions.

Objective

To determine the endoscopic findings in patients presenting with UGIB and its frequency among these patients according to gender and age in Lacor hospital, northern Uganda.

Methods

The study was carried out at Lacor hospital, located at northern part of Uganda. The record of 224 patients who underwent endoscopy for upper gastrointestinal bleeding over a period of 5 years between January 2006 and December 2010 were retrospectively analyzed.

Results

A total of 224 patients had endoscopy for UGIB which consisted of 113 (50.4%) males and 111 (49.6%) females, and the mean age was 42 years ± SD 15.88. The commonest cause of UGIB was esophagealvarices consisting of 40.6%, followed by esophagitis (14.7%), gastritis (12.6%) and peptic ulcer disease (duodenal and gastric ulcers) was 6.2%. The malignant conditions (gastric and esophageal cancers) contributed to 2.6%. Other less frequent causes of UGIB were hiatus hernia (1.8), duodenitis (0.9%), others-gastric polyp (0.4%). Normal endoscopic finding was 16.1% in patients who had UGIB

Conclusions

Esophageal varices are the commonest cause of upper gastrointestinal bleeding in this environment as compared to the west which is mainly peptic ulcer disease.     

Success with lifestyle monotherapy in youth with new-onset type 2 diabetes

BACKGROUND:

Evidence is lacking to support the efficacy of lifestyle modification as first-line therapy in the clinical management of type 2 diabetes mellitus (T2DM) in adolescents.

METHODS:

A retrospective chart review of youth diagnosed with T2DM between 1999 and 2008 was conducted. The authors describe the percentage of youth presenting with glycosylated hemoglobin (HbA_1c) of <9% who achieved/maintained target glycemic control (HbA_1c ≤7.0%) with lifestyle monotherapy during the year following diagnosis.

RESULTS:

Among the 275 youth with T2DM, 38% (n=104) presented with an HbA_1c <9% and were prescribed lifestyle monotherapy at diagnosis. Of the 80 youth who had sufficient follow-up data over 12 months, 54% successfully maintained target glycemic control solely with lifestyle management. The mean HbA_1c score at diagnosis was lower in youth who where successful on lifestlye monotherapy compared with those who were not successful.

CONCLUSIONS:

A significant proportion of youth newly diagnosed with T2DM presenting with an HbA_1c <9% effectively achieved/maintained target glycemic control with lifestyle recommendations alone for 12 months.     

Using touch-screen technology to assess smoking in a low-income primary care clinic: a pilot study

This pilot study examined the use of a touch-screen tablet personal computer to assess smoking and alcohol use among low-income primary care patients (N = 100) and tested cross-method consistency with a paper assessment. Data were collected in 2009. A touch-screen survey assessed smoking, alcohol use, partner smoking, and acceptability. A separate paper survey assessed smoking, partner smoking, and acceptability. The touch-screen assessment was highly acceptable and reliable. Implications and limitations are noted. Future research should explore the use of touch-screen technology for clinical endeavors requiring a quick assessment of substance use. There was no outside funding for this study.     

Readiness to change and training expectations prior to a training workshop for substance abuse clinicians

Understanding clinicians' readiness to change their clinical practice, as well as their training expectations prior to a clinical workshop, may be helpful for improving technology transfer in the substance user treatment field. This study aimed to explore both these areas prior to a workshop designed to offer a new clinical intervention for their practice. Fifty-four clinicians volunteered to participate in a Behavioral Couples Therapy (BCT) workshop. Using negative binomial regression models, significant associations were found between clinicians' readiness to change and training expectations. Participants were found to be highly motivated to learn new technologies and highly endorsed notions of adopting elements of BCT into their practice. There was greater caution with regard to committing to adopt the full protocol. Exploring some of the obstacles in adopting new treatment approaches by even the most motivated of clinicians could be a fruitful area for future research.     

The distribution of porcine pancreatic beta-cells at ages 5, 12 and 24 weeks

Jay TR, Heald KA, Carless NJ, Topham DE, Downing R. The distribution of porcine pancreatic beta-cells at ages 5, 12 and 24 weeks. Xenotransplantation 1999; 6: 131-140. ©Munksgaard, Copenhagen Islet transplantation is a potential treatment for diabetes mellitus and porcine pancreata may provide a readily available source of islets. The size, number and distribution of islets within the pancreas may influence the choice of age of donor for xenotransplantation. Samples (n = 3 per age group) from the dorsal and ventral pancreas of 5-, 12- and 24-week-old hybrid pigs were fixed in formal saline, processed in paraffin wax and stained with an avidin/biotin immunohistochemical kit for insulin, glucagon, somatostatin and pancreatic polypeptide. The arrangement of endocrine cells within the pancreata were studied and mean diameter of β-cell groups were measured (from insulin stained sections) in 1 mm² grid areas (n = 10 per section) and collated into groups according to size. Percentage volume density of β-cells in relation to the whole pancreas was calculated and also the distribution of β-cell groups, according to their size, within the total β-cell mass. There were differences in the frequency and arrangement of endocrine cells within islets at the different ages studied. β-Cell groups < 50 µm in diameter occupied 70 to 80% of the total β-cell mass at 5 weeks but, as the age of the pig increased, larger cell groups were more abundant. However, the percentage volume density of β-cells within the total pancreas did not change as the pancreas matured.This study shows that the endocrine porcine pancreas was maturing and its structure changed between the ages of 5 and 24 weeks. The relevance of these findings may have implications on the isolation and function of islets if young pigs are to be used as donors for transplantation as a treatment for diabetes mellitus.