Investigation of Acoustic Changes Resulting from Contrast Enhancement in Through-Transmission Ultrasonic Imaging

Through-transmitted ultrasonic waves can be used for computed projection imaging of the breast. The goal of this research was to analyze the acoustic properties changes associated with the propagation of ultrasonic waves through media before and after ultrasound contrast agent (UCA) injection and to study the feasibility of a new imaging method combining projection imaging and UCA. Two transmission techniques were examined: Gaussian pulses and pulse inversion. In the latter, three different double inverted pulses were studied: double Gaussian, double square and double sine. A computerized automatic ultrasonic scanning system was used for imaging. To simulate blood vessels, a phantom, consisting of a latex tube through which saline was circulated, was assembled. The phantom was placed within the scanner and sets of acoustic projection images were acquired. Then, a suspension of the UCA Definity™ was added to the saline and a new set of images was obtained. The pre and postcontrast images were quantitatively compared in terms of amplitude and time-of-flight (TOF). In addition, nonlinearity was evaluated by comparing the relative alteration of the positive and negative parts of the signal. Statistically significant (p < 0.001) changes in the projection images resulting from the UCA injection were observed in wave amplitude (22% ± 13%), TOF (7.9 ns ± 6.3 ns) and nonlinear properties (35% ± 32% and 56% ± 17% for Gausian pulses and pulse inversion, respectively). One in vivo study of a female breast is also presented and its preliminary outcomes discussed. Together, these results indicate the technical feasibility of the suggested method and its potential to detect breast tumors. (E-mail:haim@bm.technion.ac.il)     

Is there an ideal way to discontinue the ketogenic diet?

It is unclear what the ideal weaning speed of the ketogenic diet should be and the resultant risk of seizure worsening. A retrospective chart review was performed of children who discontinued the ketogenic diet at Johns Hopkins Hospital from January 2000 to June 2010. Speed of discontinuation was categorized into immediate (<1 week), quick (1-6 weeks), or slow (>6 weeks) rates. One hundred and eighty-three children were identified. Children with both a longer diet duration (p=0.004) and lower seizure frequency (p<0.001) were weaned more slowly by our group. There was no significant difference in the incidence of seizures worsening between discontinuation rates. However, there was an increased risk of seizures worsening in those specifically with a 50-99% seizure reduction (30% vs. 8%, p<0.0001) and for that level of seizure improvement, in those who were receiving more anticonvulsants (1.4 vs. 0.8, p=0.01). In summary, there does not appear to be an increased risk of seizure exacerbation with rapid ketogenic diet discontinuations. Those who improved 50-99% and were receiving more anticonvulsants were at the highest risk overall. Discontinuing the ketogenic diet over weeks rather than months appears safe.     

Home-guided use of the ketogenic diet in a patient for more than 20 years

A 26-year-old man with tuberous sclerosis complex and multifocal seizures presented to the ketogenic diet clinic for management of his epilepsy. He had been started on the ketogenic diet at another institution at age 6 years, and his family had managed all nutritional aspects for the previous 10 years. Despite the lack of ongoing medical care, excellent seizure control and large urinary ketosis had been maintained, and side effects were limited only to poor growth. He remains on the diet to date, now for 21 years of continuous duration.     

Edema of the paretic hand in elderly post-stroke nursing patients

Post-stroke edema of the paretic hand constitutes an additional, functional, and esthetic nuisance for the patient. Although often encountered in daily practice, it is not even mentioned in the stroke chapters of the various textbooks. The phenomenon is far from being elucidated and various aspects are still obscure. In this study we tried to estimate the extent of post-stroke hand edema (PSHE) in a sample of elderly patients. The study group consisted of 188 elderly post-stroke nursing patients with hemi or only hand paresis. Seventy, age matched, non-paretic patients were examined as controls. The basis of comparison was the difference in circumference between the two arms at three sites: mid-finger, hand, and wrist as measured in the control group. Values above two standard deviations (S.D.) of the mean difference in circumference of the controls, at two or three sites, were considered as edema. Edema of the paretic hand was detected in 37% of post-stroke patients. Most (about three-quarters), could be classified as simple PSHE, while the rest may have had reflex sympathetic dystrophy (RSD).     

Early antidepressant effect of memantine during augmentation of lamotrigine inadequate response in bipolar depression: a double-blind, randomized, placebo-controlled trial

Anand A, Gunn AD, Barkay G, Karne HS, Nurnberger JI, Mathew SJ, Ghosh S. Early antidepressant effect of memantine during augmentation of lamotrigine inadequate response in bipolar depression: a double‐blind, randomized, placebo‐controlled trial.
Bipolar Disord 2012: 14: 64–70. © 2012 The Authors.
Journal compilation © 2012 John Wiley & Sons A/S. Background: Recent studies indicate that modulation of glutamate neurotransmission is associated with antidepressant response. Lamotrigine, an anticonvulsant which decreases presynaptic glutamate release, has been shown to be effective in the depressive phase of bipolar disorder (BD‐D); however, only 40–50% of patients have a full response. This pilot study investigated whether memantine, a low‐affinity N‐methyl‐D‐aspartate (NMDA) receptor antagonist approved for Alzheimer’s disease, can augment the effects of lamotrigine. Methods: BD‐D outpatients in a major depressive episode on a stable dose of lamotrigine (100 mg or more) were randomized to either memantine (starting dose of 5 mg increased up to 20 mg over four weeks, then 20 mg stable dose from four to eight weeks) or matching pill placebo for eight weeks. Patients were rated on the 17‐item Hamilton Depression Rating Scale (HDRS) and other behavioral measures weekly. Results: The eight‐week repeated‐measures mixed‐effect model for HDRS was not significant for memantine (n = 14) versus placebo (n = 15). Exploratory mixed‐effect analyses for the first four weeks, while the memantine dose was being titrated up every week, revealed a significant decrease in HDRS scores from baseline (p = 0.007). Conclusion: This proof‐of‐concept study failed to show a statistically significant benefit of memantine augmentation of lamotrigine for patients with BD‐D over eight weeks. However, memantine had an antidepressant effect early on in the treatment while its dose was being titrated up. Larger placebo‐controlled studies are needed to ascertain optimal timing and dosing for memantine augmentation of lamotrigine in BD‐D.     

How do parents find out about the ketogenic diet?

It has been previously reported that child neurologists often view the ketogenic diet (KD) as a treatment of last resort. An anonymous survey was provided to parents of 107 consecutive children starting the KD at our institution. The average time from epilepsy to KD onset was 2.8years, but the average wait time for KD onset was only 1.7months after referral. The most common reason for starting the KD was seizure reduction, followed by less intense seizures, medication reduction, and cognitive improvement. The majority (72%) obtained information about the KD from their neurologist; however, more than half also had viewed related websites. The mean neurologist supportiveness score was 7.9/10; 53% reporting their neurologist as maximally supportive (score of 10). A score of 10 was more likely seen in those who also scored their pediatrician with 10 (69% vs. 15%, p<0.001) and who were self-referred from our institution (56% vs. 27%, p=0.001).     

Enhanced osseointegration of grit-blasted,NaOH-treated and electrochemically hydroxyapatite-coated Ti–6Al–4V implants in rabbits

Osseointegration, in terms of the bone apposition ratio (BAR) and the new bone area (NBA), was measured by backscattered electron imaging. The results were compared for four implant types: grit-blasted and NaOH-treated Ti–6Al–4 V (Uncoated-NaOH), electrodeposited with hydroxyapatite without alkali treatment (ED-HAp), electrodeposited with hydroxyapatite after alkali treatment (NaOH-ED-HAp), and plasma sprayed with hydroxyapatite (PS-HAp). No heat treatment was done after soaking in NaOH. The implants were press fitted into the intramedullary canal of mature New Zealand white rabbits and analyzed, both at the diaphyseal and at the metaphyseal zones, either 1 week or 12 weeks after surgery. NaOH-ED-HAp already exhibited a higher BAR value than the ED-HAp at 1 week, and was as good as the commercial PS-HAp at 12 weeks. The NBA value for NaOH-ED-HAp at 12 weeks was the highest. The higher content of octacalcium phosphate in NaOH-ED-HAp, as evident from the X-ray photoelectron spectroscopy analysis of the oxygen shake-up peaks, and the associated increase in the solubility of this coating in vivo are considered responsible for the enhanced osseointegration. Taking into account also the reduced occurrence of delamination and the inherent advantages of the electrodeposition process, electrodeposition of HAp following soaking in NaOH may become an attractive alternative for the traditional plasma-sprayed process for coating of orthopedic and dental implants.     

Ursodeoxycholic Acid Suppresses Extent of Lipid Peroxidation in Diseased Liver in Experimental Cholestatic Liver Disease

The therapeutic benefit of ursodeoxycholic acid (UDCA) in treating cholestatic liver disease is globally recognized. It is generally accepted that the mechanism of action of UDCA can be attributed to several diverse processes that appear to be uniformly targeted towards minimizing the deleterious actions of accumulated hydrophobic bile acids in the cholestatic liver. Since hydrophobic bile acids are prooxidants, emerging in vitro evidence suggests that UDCA may have an antioxidant mechanism of action. We hypothesize that UDCA suppresses the extent of lipid peroxidation in the cholestatic liver. This hypothesis was tested by assessing the extent of lipid peroxidation in livers harvested from chronic bile duct ligated (CBDL) rats dosed daily for 24 days with 5, 10, or 15 mg/kg UDCA. The extent of lipid peroxidation was evaluated by determining the hepatic content of conjugated dienes, lipid peroxides, and malondialdehyde. The data were compared with identical data collected from unoperated control and 24-day bile duct manipulated (SO) rats. In the two groups of control rats, UDCA has no effect on the serum indices of liver function. In CBDL rats, UDCA suppressed the increased extent of lipid peroxidation in the liver in a dose-dependent manner in the absence of improvement of laboratory parameters of liver function and hepatic architecture. In conclusion, UDCA suppresses the augmented extent of lipid peroxidation in the diseased liver of CBDL rats.     

Trends in sunscreen use among U.S. high school students: 1999-2009

PurposeTo examine trends in sunscreen use during 1999–2009 among U.S. high school students.MethodsData from the 1999–2009 national Youth Risk Behavior Surveys were analyzed. The surveys used a three-stage cluster sample design to produce nationally representative samples of students in grades 9–12 attending public and private schools. Student participation in the survey was anonymous and voluntary. Participants completed a self-administered questionnaire during a regular class period. The overall response rates ranged from 63% to 72%.ResultsDuring 1999–2009, the percentage of white students who never or rarely wore sunscreen when outside on a sunny day for >1 hour increased (from 57.5% to 69.4%), as did the percentage among Hispanic students (from 71.6% to 77.9%). This increase was most pronounced among white female students. The percentage of white and Hispanic students who most of the time or always wore sunscreen decreased during this same period. Rates of sunscreen use did not change among black students.ConclusionsBecause of declines in sunscreen use, professionals in clinical, school, and community settings should emphasize the important role sunscreen may play in preventing skin cancer.