Nocardiosis of the lung: chest radiographic findings in 21 cases

Pulmonary manifestations of nocardial infection were present in 21 patients, with microbiologic proof in all and pathologic proof in 12. An analysis of the findings in these patients, combined with a review of previous reports of nocardiosis, suggests several important conclusions for radiologists. First, nocardiosis may occur in otherwise healthy persons but is most common in compromised patients, especially those being treated with anti-inflammatory agents, particularly corticosteroids, for chronic obstructive pulmonary disease and other systemic diseases. As pathologic manifestations are both suppurative and granulomatous, the chest radiographic manifestations are pleomorphic and not specific. Consolidations and large irregular nodules, often cavitary, are most common; nodules, masses, and interstitial patterns also occur. Pleural effusions are quite common, and lymph nodes may be enlarged. Difficulty and slowness of culture growth, along with the lack of a serologic test for nocardiosis, necessitate its inclusion in the differential diagnosis for both compromised and noncompromised patients in whom an apparent pulmonary infection cannot be rapidly diagnosed.     

In vivo efficacy in airway disease models of roflumilast, a novel orally active PDE4 inhibitor

We have investigated the bronchodilator and anti-inflammatory properties of roflumilast (3-cyclopropylmethoxy-4-difluoromethoxy-N-[3,5-dichloropyrid-4-yl]-benzamide), a novel, highly potent, and selective phosphodiesterase 4 (PDE4) inhibitor. Additionally, we compared the effects of roflumilast and its N-oxide, the primary metabolite in vivo, with those of the PDE4 inhibitors piclamilast, rolipram, and cilomilast. Roflumilast inhibited the ovalbumin-evoked contractions of tracheal chains prepared from sensitized guinea pigs (EC(50) = 2 x 10(-7) M) but showed no relaxant effect on tissues contracted spontaneously. In spasmogen-challenged rats and guinea pigs, intravenously administered roflumilast displayed bronchodilatory activity (ED(50) = 4.4 and 7.1 micromol/kg, respectively). Furthermore, roflumilast dose dependently attenuated allergen-induced bronchoconstriction in guinea pigs (ED(50) = 0.1 micromol/kg i.v.). Roflumilast given orally (ED(50) = 1.5 micromol/kg) showed equal potency to its N-oxide (ED(50) = 1.0 micromol/kg) but was superior to piclamilast (ED(50) = 8.3 micromol/kg), rolipram (ED(50) = 32.5 micromol/kg), and cilomilast (ED(50) = 52.2 micromol/kg) in suppressing allergen-induced early airway reactions. To assess the anti-inflammatory potential of orally administered roflumilast, antigen-induced cell infiltration, total protein, and TNFalpha concentration in bronchoalveolar lavage fluid of Brown Norway rats were determined. Roflumilast and its N-oxide equally inhibited eosinophilia (ED(50) = 2.7 and 2.5 micromol/kg, respectively), whereas the reference inhibitors displayed lower potency (ED(50) = 17-106 micromol/kg). Besides, orally administered roflumilast abrogated LPS-induced circulating TNFalpha in the rat (ED(50) = 0.3 micromol/kg), an effect shared by its N-oxide, with both molecules exhibiting 8-, 25-, and 310-fold superiority to piclamilast, rolipram, and cilomilast, respectively. These results, coupled with the in vitro effects of roflumilast on inflammatory cells, suggest that roflumilast represents a potential new drug for the treatment of asthma and chronic obstructive pulmonary disease.     

Effects of a Systemic Pesticide Along an Aquatic Tri-Trophic Food Chain

Bulletin of Environmental Contamination and Toxicology - Systemic pesticides, such as the neonicotinoid imidacloprid, can be introduced into aquatic ecosystems through contaminated plant material,...     

DIGITAL ISCHAEMIA: AN UNUSUAL PRESENTATION OF DYSBARISM

SUMMARY Dysbaric symptoms following ascent from a scuba dive are due to symptomatic nitrogen or air emboli with clear patterns of associated injury. This case report highlights an unusual presentation of dysbaric injury treated successfully with a prostacyclin analogue.     

Illness perception in pediatric somatization and asthma: complaints and health locus of control beliefs

Background  

Health- and illness-related cognitions of pediatric patients with asthma or somatization and of their caregivers are considered relevant for patient education and for cognitive-behavioral interventions. This study investigates the relationship between diagnosis and illness perception by child and parent in two different chronic conditions such as somatization disorder and asthma.     

Isolation of intestinal spirochaetes from homosexuals

Spirochaetes were isolated from rectal swabs of two homosexuals and the faeces of a third, using simple isolation techniques not previously applied to specimens of this type. The ease of culture of these organisms will enable their distribution and pathogenicity to be studied, particularly in relation to their significance in homosexuals.     

Pre-therapy Somatostatin Receptor-Based Heterogeneity Predicts Overall Survival in Pancreatic Neuroendocrine Tumor Patients Undergoing Peptide Receptor Radionuclide Therapy

Purpose

Early identification of aggressive disease could improve decision support in pancreatic neuroendocrine tumor (pNET) patients prior to peptide receptor radionuclide therapy (PRRT). The prognostic value of intratumoral textural features (TF) determined by baseline somatostatin receptor (SSTR)-positron emission tomography (PET) before PRRT was analyzed.

Procedures

Thirty-one patients with G1/G2 pNET were enrolled (G2, n?=?23/31). Prior to PRRT with [¹⁷⁷Lu]DOTATATE (mean, 3.6 cycles), baseline SSTR-PET computed tomography was performed. By segmentation of 162 (median per patient, 5) metastases, intratumoral TF were computed. The impact of conventional PET parameters (SUV_mean/max), imaging-based TF, and clinical parameters (Ki67, CgA) for prediction of both progression-free survival (PFS) and overall survival (OS) after PRRT were evaluated.

Results

Within a median follow-up of 3.7 years, tumor progression was detected in 21 patients (median, 1.5 years) and 13/31 deceased (median, 1.9 years). In ROC analysis, the TF entropy, reflecting derangement on a voxel-by-voxel level, demonstrated predictive capability for OS (cutoff?=?6.7, AUC?=?0.71, p?=?0.02). Of note, increasing entropy could predict a longer survival (>?6.7, OS?=?2.5 years, 17/31), whereas less voxel-based derangement portended inferior outcome (<?6.7, OS?=?1.9 years, 14/31). These findings were supported in a G2 subanalysis (>?6.9, OS?=?2.8 years, 9/23 vs. <?6.9, OS?=?1.9 years, 14/23). Kaplan–Meier analysis revealed a significant distinction between high- and low-risk groups using entropy (n?=?31, p?<?0.05). For those patients below the ROC-derived threshold, the relative risk of death after PRRT was 2.73 (n?=?31, p?=?0.04). Ki67 was negatively associated with PFS (p?=?0.002); however, SUV_mean/max failed in prognostication (n.s.).

Conclusions

In contrast to conventional PET parameters, assessment of intratumoral heterogeneity demonstrated superior prognostic performance in pNET patients undergoing PRRT. This novel PET-based strategy of outcome prediction prior to PRRT might be useful for patient risk stratification.

     

心房颤动的电生理重构

心房颤动 (atrial fibrillation,AF)是临床上最常见的一种持续性心律失常 ,其发病率随年龄而增加 ,40岁以下人群发病率约为 0 .2 %～ 0 .3% ,6 0～ 90岁年龄组发病率增至5 %～ 9% [1 ] 。新近 Framingham的研究表明 AF可以成为一种独立的因素使患者病死率增加 [2 ] 。 AF的发病机制尚未完全清楚 ,可能为非单一机制 ,普遍认为持续性 AF是由于心房内的多子波折返 ,每 1个折返环本身都在不停地改变其大小及传导方向。近年来 ,在 AF的基础及临床研究中 ,两个方面的进展具有十分重要的意义 :一是发现部分 AF起源于心房内某些部位如肺静脉口…