Preferential expression of insulin-like growth factor binding proteins-1, -3, and -5 during early diabetic renal hypertrophy in rats

The renal insulin-like growth factor-I (IGF-I) system has been implicated in the pathogenesis of renal hypertrophy, altered hemodynamics, and extracellular matrix expansion associated with early diabetes. The relative abundance of IGF binding proteins (IGFBPs) in the renal microenvironment may modulate IGF-I actions. However, the precise IGFBPs expressed in the glomerular and tubulointerstitial compartments during diabetic renal growth have not been characterized. In the present study, in situ hybridization studies were performed to examine the expression of IGFBP-1 to -6 messenger RNAs (mRNAs) 3, 7, and 14 days after streptozotocin (STZ) injection in rats. In control, nondiabetic kidneys, all six IGFBP mRNAs were differentially expressed with a predominance of IGFBP-5. The onset of renal hypertrophy in STZ-induced diabetes was associated with a rapid and site-specific induction of IGFBP-1, -3, and -5 mRNAs. In contrast, basal expression of IGFBP-2, -4, and -6 mRNAs was not altered in diabetic rats. IGFBP-5 mRNA expression increased in diabetic glomeruli, cortical, and inner medullary peritubular interstitial cells at days 3, 7, and 14. Although normal glomeruli failed to express IGFBP-3, it was induced concomitantly with IGFBP-5 in diabetic glomeruli and cortical peritubular interstitial cells. IGFBP-1 mRNA levels also increased in cortical tubular cells at each time point tested. Peak induction of IGFBP-3 and -5 was observed at day 3, whereas IGFBP-1 was delayed until day 7. IGFBP-1, -3, and -5 mRNA levels declined by day 14, but remained persistently elevated above control. By immunoperoxidase staining, similar alterations in the pattern of IGFBP-3 and -5 protein expression were observed at each time point. The preferential and site-specific increase in IGFBP-1, -3, and -5 suggest that these IGFBPs may regulate the local autocrine and/or paracrine actions of IGF-I and contribute to the pathogenesis of the early manifestations of diabetic nephropathy.     

High-pitch dual-source CT angiography of supra-aortic arteries: assessment of image quality and radiation dose

Introduction

High-pitch CT angiography (CTA) is a recent innovation that allows significant shortening of scan time with volume coverage of 43 mm per second. The aim of our study was to assess this technique in CTA of the head and neck.

Methods

CTA of supra-aortic arteries was performed in 50 patients using two acquisition protocols: conventional single-source 64-slice (pitch 1.2) and high-pitch dual-source 128-slice CT (pitch 3.2). Subjective and objective image quality of supra-aortic vessel ostia as well as intra- and extra-cranial segments was retrospectively assessed by blinded readers and radiation dose compared between the two protocols.

Results

Conventional and high-pitch CTA achieved comparable signal-to-noise ratios in arterial (54.3?±?16.5 versus 57.3?±?14.8; p?=?0.50) and venous segments (15.8?±?6.7 versus 18.9?±?8.9; p?=?0.21). High-pitch scanning was, however, associated with sharper delineation of vessel contours and image quality significantly improved at the level of supra-aortic vessel ostia (p?<?0.0001) as well as along the brachiocephalic trunk (p?<?0.0001), the subclavian arteries (p?<?0.0001), proximal common carotid arteries (p?=?0.01), and vertebral V1 segments (p?<?0.0001). Using the high-pitch mode, the dose-length product was reduced by about 35 % (218.2?±?30 versus 141.8?±?20 mGy?×?cm).

Conclusions

Due to elimination of transmitted cardiac motion, high-pitch CTA of the neck improves image quality in the proximity of the aortic arch while significantly lowering radiation dose. The technique thus qualifies as a promising alternative to conventional spiral CTA and may be particularly useful for identification of ostial stenosis.     

Distinguishing enhancing from nonenhancing renal masses with dual-source dual-energy CT: iodine quantification versus standard enhancement measurements

Purpose

To compare the diagnostic accuracy of iodine quantification and standard enhancement measurements in distinguishing enhancing from nonenhancing renal masses.

Materials and methods

The Institutional Review Board approved this retrospective study conducted from data found in institutional patient databases and archives. Seventy-two renal masses were characterised as enhancing or nonenhancing using standard enhancement measurements (in HU) and iodine quantification (in mg/ml). Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of standard enhancement measurements and iodine quantification were calculated from χ ² tests of contingency with histopathology or imaging follow-up as the reference standard. Difference in accuracy was assessed by means of McNemar analysis.

Results

Sensitivity, specificity, PPV, NPV and diagnostic accuracy for standard enhancement measurements and iodine quantification were 77.7 %, 100 %, 100 %, 81.8 %, 89 % and 100 %, 94.4 %, 94.7, 100 % and 97 %, respectively. The McNemar analysis showed that the accuracy of iodine quantification was significantly better (P?<?0.001) than that of standard enhancement measurements.

Conclusion

Compared with standard enhancement measurements, whole-tumour iodine quantification is more accurate in distinguishing enhancing from nonenhancing renal masses.

Key Points

? Enhancement of renal lesions is important when differentiating benign from malignant tumours. ? Dual-energy CT offers measurement of iodine uptake rather than mere enhancement values. ? Whole-tumour iodine quantification seems more accurate than standard CT enhancement measurements.     

The asthma accession standard: a survival analysis of military recruits, 1995 to 1997

Asthma has a significant impact on U.S. military expenditures and readiness. Every year approximately 1,000 recruits are discharged for asthma during their first 6 months of service. This study was done to evaluate the practice of allowing some individuals with a history of asthma to enter military service (waiving). A survival analysis was performed to compare length of time until discharge and asthma-related failure for individuals waived for asthma (cases) and individuals not disqualified for asthma (controls). Cases were 587 recruit applicants initially disqualified who received waivers for asthma and accessed in the years 1995 to 1997. Controls were 1,761 matched enlisted recruits starting basic training in those years. No significant differences were found with respect to general attrition. The statistical differences for asthma-related hospitalization or discharge did not translate into practical differences. Waiving for asthma was not a significant occupational liability in terms of asthma-related hospitalization or early military attrition.     

Microsurgical clipping of previously coiled intracranial aneurysms

Objective

Endovascular coiling techniques for the treatment of intracranial aneurysms have rapidly developed as an alternative option to surgical clipping. A distinct problem after endovascular coiling is the management of a residual aneurysm neck due to incomplete filling, compaction of coils or regrowth of the aneurysm. Treatment options in this situation include surgical clipping, re-coiling, stent implantation or observation.

Methods

From June 2006 to August 2011, 15 patients underwent surgical clipping of residual or recurrent aneurysms after previous endovascular treatment. The mean age of the patients was 50.6 years (range, 27–85 years). The mean interval between coiling and clipping was 76.5 weeks (range, 0–288 weeks).

Results

Thirteen patients revealed a regrowth of coiled aneurysms, and in 5 patients compaction of coils was present. Coil extrusion was observed in 9 patients intraoperatively. In case of coil obstruction at the aneurysmal neck during surgery, coils were partially or completely removed. In all cases complete occlusion of the aneurysms was surgically achieved.

Conclusion

Coiled aneuryms with incomplete occlusion, coil compaction or regrowth of the aneurysmal neck can be successfully treated with microsurgical clipping. Coil extrusion was more often observed intraoperatively than expected. Complete occlusion of the aneurysm can be performed safely, even if loops of coils protrude into the aneurysmal neck. In these cases intraoperative removal of the coils enables secure closure of the aneurysm with a surgical clip.     

高效液相色谱法同时测定五加中剌五加苷B、苷E的含量

目的测定甘肃产五加中剌五加苷B、苷E的含量。方法高效液相色谱法,ODSKromasal柱。水乙晴(955)为流动相,检测波长222nm,柱温度25℃。结果本文可同时测定剌五加苷B、苷E的含量。剌五加苷B、苷E分别在0.064～0.320μg/ml;0.074～0.370μg/ml范围内峰面积与浓度呈线性关系,平均回收率分别为102.5%,RSD=4.2%,95.5%,RSD=4.6%。结论剌五加苷B、苷E在红毛五加中含量最高;茎皮中含量最高;剌五加苷E的含量高于苷B。     

Intramedullary ependymoma associated with Lhermitte-Duclos disease and Cowden syndrome

The authors describe the case of a 45-year-old man with progressive gait ataxia and sensorimotor deficits of the upper and lower extremities. The patient had been diagnosed earlier with Lhermitte-Duclos disease (LDD) in the left cerebellar hemisphere and Cowden syndrome (CS). MR imaging studies revealed an intraspinal tumor at C6-C7. Microsurgical gross total resection of the tumor was achieved. Histolopathological examination revealed an intramedullary ependymoma. Postoperatively, neurological deficits gradually improved. This is the first reported case of ependymoma in a patient with LDD and CD. Coexistence of an intraspinal ependymoma with cerebellar LDD and CS appears to be rare, but can lead to treatment failure if missed.     

Speech recognition impairments in patients with intractable right temporal lobe epilepsy

PURPOSE: To evaluate speech recognition in patients with focal intractable epilepsy and surgical resections in the nondominant (right) hemisphere. METHODS: Speech recognition was tested prospectively, under different listening conditions, in 22 patients with right temporal lobe (11 patients) or extra-temporal lobe epilepsy. All were left-hemisphere dominant for language on preoperative intracarotid sodium amobarbital testing. RESULTS: All patients demonstrated normal auditory recognition of words and environmental sounds before and after surgery. However, when real-world listening conditions were simulated by using acoustically degraded (filtered) words, patients with temporal lobe epilepsy performed significantly worse than patients with frontal or parietooccipital lobe epilepsy before and after surgery (p<0.0001). CONCLUSIONS: Patients with intractable right temporal lobe epilepsy are at risk for speech recognition impairments in real-world listening environments, independent of surgery. The impact of speech recognition difficulties on verbal communication, coupled with the prevalence of adverse listening environments, underscores the importance of testing speech recognition under different listening conditions in patients with intractable right temporal lobe epilepsy.     

Endoscopic third ventriculostomy in the treatment of shunt-related over-drainage: Preliminary experience with a new approach how to render ventricles navigable

OBJECTIVE: Endoscopic third ventriculostomy (ETV) is increasingly used for the treatment of shunt-related complications in hydrocephalic patients, particularly if the etiology of the underlying hydrocephalus is of obstructive nature. PURPOSE: Due to the slit-like configuration of the ventricles, ventricular dilatation must be achieved prior to ETV in patients with problems due to over-drainage. This has been accomplished by ligating or explanting the shunt. Here we present an alternative procedure using a gravitational antisiphon device. MATERIALS AND METHODS: In two patients with over-drainage due to shunted occlusive hydrocephalus ventricles were dilated by integrating an antisiphon device (Miethke ShuntAssistant, Aesculap AG, Tuttlingen, Germany) into their shunt systems. The resistance of the antisiphon device, which is available in configurations from 10 to 35 cm H2O was chosen 10 cm H2O higher than necessary to prevent siphoning in the individual patient. RESULTS: Both patients gradually recovered from their over-drainage symptoms and the ventricles enlarged enough to allow access with an endoscope. Using a standard procedure, ETV was performed 7 days and 1 month later, respectively. In the same operative session the shunts were occluded. Shunts were removed within 6 weeks after ETV. During follow-up of more than 3 years, both patients remained free of symptoms. CONCLUSION: The incorporation of an antisiphon device with resistance level selected 10 cm H2O higher than needed to prevent anti-siphoning into a pre-existing shunt system in patients suffering from shunt-related over-drainage is a safe and effective technique to render ventricles large enough to allow endoscopic access for ETV.