Frequency and patterns of abnormality detected by iodine-123 amine emission CT after cerebral infarction

Single photon emission computed tomography (SPECT) was performed in 31 patients with cerebral infarction and 13 who had had transient ischemic attacks, using iodine-123-labeled N,N,N'-trimethyl-N'-(2-hydroxyl-3-methyl-5-iodobenzyl)-1,3-propanediamin e (I-123-HIPDM) as the radiopharmaceutical. SPECT scans were compared with computed tomographic (CT) scans. SPECT was as sensitive as CT in detecting cerebral infarction (94% vs. 84%). The abnormalities were larger on the SPECT scans than on the CT scans in 19 cases, equal in seven, and smaller in five (SPECT abnormalities greater than or equal to CT abnormalities in 86% of cases). Fifteen of 30 patients with hemispheric infarction had decreased perfusion (decreased uptake of I-123-HIPDM) to the cerebellar hemisphere contralateral to the cerebral hemisphere involved by the infarction (crossed cerebellar diaschisis). Nine of these 15 patients had major motor deficits, while only one of the 15 without crossed cerebellar diaschisis had a major motor deficit.     

Left intraventricular pressure-impedance diagrams (DPZ) to assess cardiac function. Part II: determination of end-systolic loci

By means of tetrapolar intraventricular impedancimetric measurements and by modifying the aortic impedance with a brief volume unit step afterload increase, with a balloon catheter, we obtained the geometric locus of the end-systolic pressure-admittance points (PES-YES) from the beat to beat pressure-impedance diagram (DPZ), usually three or four beats after inflation. Six experiments in five anesthetized mongrel dogs (average weight 21.6 kg, SD 2.5) were carried out under control conditions and after a slow infusion (4 micrograms/kg/min) of epinephrine to change the myocardial inotropic state. In control, the PES-YES points fell in all cases on a straight line (average correlation 0.968, SD 0.033). After epinephrine, linearity was still good in four experiments (average correlation 0.938, SD 0.059). All animals showed displacements of the regression lines after epinephrine with respect to control. However, the direction of the shifts was not always consistent: three dogs yielded an upward-leftward shift; one showed a crossing point between the two regression lines with an increase in slope after epinephrine; in the remaining two experiments (same dog in different days), the post-epinephrine regression lines of the pressure-admittance end-systolic points were displaced downwards and rightwards. Five out of the six experiments increased the slopes of the lines after infusion of epinephrine. In conclusion: the method supplied the end-systolic point locus obtained from simple cardiac catheterization and this locus was altered by inotropic intervention.     

Impact of Multidetector CT on 3D CT Angiography

3D Computed Tomographic Angiography (CTA) is a noninvasive volumetric imaging technique increasingly used for evaluation of vascular system. The introduction of Multidetector CT (MDCT) has increased scanning speed, allowing shorter acquisition time, greater volume coverage and decreased contrast requirement while diminishing respiratory motion artifacts. Thin-slice collimation protocols are routinely used which generate isotropic 3D voxels that improve image quality. The ideal CTA study requires scanning at peak vascular enhancement for optimal opacification of arteries with separation of arteries and veins. MDCT has enabled complete lower extremity inflow and runoff studies with a single injection, as well as thin-section CTA covering the entirety of the Carotid arteries and Circle of Willis. Sixteen row MDCT has increased scanning speed further facilitating the development of novel applications such as coronary CTA. CTA when perfomed with MDCT offers a “one scan – many views” option useful in imaging vascular diseases. CTA has important advantages over conventional angiography, such as reduced risk, diminished time and better patient acceptance. With MDCT, 3D CTA is crossing vessel tortuosity and evaluation of vessel fragility.Key Words: Multidetector CT, CT angiography, Volume Rendering     

Clinical Assessment of a Novel Recombinant Simian Adenovirus ChAdOx1 as a Vectored Vaccine Expressing Conserved Influenza A Antigens

Adenoviruses are potent vectors for inducing and boosting cellular immunity to encoded recombinant antigens. However, the widespread seroprevalence of neutralizing antibodies to common human adenovirus serotypes limits their use. Simian adenoviruses do not suffer from the same drawbacks. We have constructed a replication-deficient chimpanzee adenovirus-vectored vaccine expressing the conserved influenza antigens, nucleoprotein (NP), and matrix protein 1 (M1). Here, we report safety and T-cell immunogenicity following vaccination with this novel recombinant simian adenovirus, ChAdOx1 NP+M1, in a first in human dose-escalation study using a 3+3 study design, followed by boosting with modified vaccinia virus Ankara expressing the same antigens in some volunteers. We demonstrate ChAdOx1 NP+M1 to be safe and immunogenic. ChAdOx1 is a promising vaccine vector that could be used to deliver vaccine antigens where strong cellular immune responses are required for protection.     

Coadministration of Seasonal Influenza Vaccine and MVA-NP+M1 Simultaneously Achieves Potent Humoral and Cell-Mediated Responses

Current seasonal influenza vaccines have reduced immunogenicity and are of suboptimal efficacy in older adults. We have previously shown that the novel candidate vaccine MVA-NP+M1 is able to boost memory T cell responses in adults aged 50–85 years. Preclinical studies have demonstrated that viral vectored vaccines can act as adjuvants when coadministered with protein-based vaccines. We have conducted a phase I clinical trial to compare the coadministration of seasonal influenza vaccine and MVA-NP+M1 with seasonal influenza vaccine alone in adults aged 50 years and above. This combination of vaccines was safe and well tolerated. T cell responses to internal influenza proteins were boosted to significantly higher levels in the group receiving MVA-NP+M1 compared with the group receiving seasonal influenza vaccine alone. Rates of seroprotection and seroconversion against the three vaccine strains were similar in both groups; however, there was a significant increase in the geometric mean titer ratio for the H3N2 component of seasonal influenza vaccine in the coadministration group. While some vaccine combinations result in immune interference, the coadministration of MVA-NP+M1 alongside seasonal influenza vaccine is shown here to increase some influenza strain-specific antibody responses and boost memory T cells capable of recognizing a range of influenza A subtypes.     

Calcium homeostasis: responses of a possible mathematical model

By using qualitative physiological information, a linear and simplified mathematical model of the calcium homeostatic mechanism is presented. Three simultaneous equations in thes domain are obtained and describe the concentration of plasma Ca, plasma thyrocalcitonin and plasma parathormone, from which theoretical responses can be derived for seven different cases, and two different types of control. These cases are summarised as: Ca response to i.v. Ca injection, thyrocalcitonin response to i.v. Cainjection, parathormone response to i.v. Ca injection, perfusion of thyroid with Ca, perfusion of parathyrode with Ca, parathormone response to thyrocalcitonin injection and thyrocalcitonin response to parathormone injection. The model suggests some avenues for experimentation and is also suitable for computer simulation.