Rapid kVp switching dual-energy CT in the assessment of urolithiasis in patients with large body habitus: preliminary observations on image quality and stone characterization

Abdominal Radiology - The purpose of this study was to investigate the image quality (IQ) considerations of rapid kVp switching dual-energy CT (rsDECT) in the assessment of urolithiasis in patients...     

Gallbladder Lesions Identified on Ultrasound. Lessons from the Last 10?Years

Background

Possible mass lesions identified on ultrasound (US) of the gallbladder may prompt an aggressive surgical intervention due to the possibility of a malignant neoplasm.

Aim

This study aims to utilize a large modern series of patients with gallbladder lesions identified on US to evaluate imaging characteristics consistent with malignancy.

Methods

A retrospective review was conducted of gallbladder ultrasound reports and clinicopathologic data of patients with a mass identified on US.

Results

Approximately 59,271 abdominal ultrasounds and 9,117 cholecystectomies were performed between February 2000 and February 2010. We identified 213 patients with a questionable gallbladder neoplasm on ultrasonography who underwent surgical exploration. Median age was 52?years (range?=?11?C87?years) and 147 (69%) were females. Final pathology demonstrated no neoplasm in 130 patients (61%), while 32 patients (15%) had a wall adenomyoma, 36 (17%) had a polyp (five of which were malignant), 14 (7%) had an adenocarcinoma not arising from a polyp, and one patient had a cystic papillary neoplasm. The smaller the lesion, the more likely it was to be a pseudo-mass. For lesions measuring <5?mm on US, 83% had no lesion found on final pathology. Significant predictors of malignancy were age >52?years (p?p?=?0.004), size >9?mm (p?p?5?mm (p?Conclusions Despite improvements in imaging, most apparent lesions measuring <5?mm on US are not identified in the surgical specimen. US size >9?mm, age >52?years, US suggestion of invasion at the liver interface, and wall thickening >5?mm, especially in the presence of gallstones, should raise the suspicion of malignancy.     

Biomechanical investigation of a novel integrated device for intra-articular stabilization of the C1-C2 (atlantoaxial) joint

Background contextThe anatomy of the atlantoaxial joint makes stabilization at this level challenging. Current techniques that use transarticular screw fixation (Magerl) or segmental screw fixation (Harms) give dramatically improved stability but risk damage to the vertebral artery. A novel integrated device was designed and developed to obtain intra-articular stabilization via primary interference fixation within the C1–C2 lateral mass articulation.PurposeTo assess the atlantoaxial stability achieved with a novel integrated device when compared with the intact, destabilized, and stabilized state using the Harms technique.Study designA biomechanical study of implants in human cadaveric cervical spines.MethodsSix human cadaveric specimens were used. Biomechanical testing was performed with moment control in flexion-extension, lateral bending, and axial rotation. Range of motion (ROM) was measured in the intact state, after both destabilization by creation of a Type II odontoid peg fracture and sequential stabilization using the integrated device and the Harms technique.ResultsMean flexion-extension ROM of the intact specimens at C1–C2 was 14.1°±2.9°. Destabilization increased the ROM to 31.6°±4.6°. Instrumentation with the Harms technique reduced flexion-extension motion to 4.0°±1.4° (p<.01). The integrated device reduced flexion-extension motion to 3.6°±1.8° (p<.01). In lateral bending, the respective mean angular motions were 1.8°±1.1°, 14.1°±5.8°, 1.4°±0.7°, and 0.4°±0.3° for the intact destabilized Harms technique and integrated device. For axial rotation, the respective mean values were 67.3°±13.8°, 74.2°±16.1°, 1.4°±0.7° and 0.9°±0.7°. Both the Harms technique and integrated device significantly reduced motion compared with the destabilized spine in flexion-extension, lateral bending, and axial rotation (p<.05). Direct comparison of the Harms technique and the integrated device revealed no significant difference (p>.10).ConclusionsThe integrated device resulted in interference fixation at the C1–C2 lateral mass joints with comparable stability to the Harms technique. Perceived advantages with the integrated device include avoidance of fixation below the C2 lateral mass where the vertebral artery is susceptible to injury, and access to the C1 screw entry point through the blade of the integrated device avoiding extended dissection superior to the C2 nerve root and its surrounding venous plexus.     

Isolated intramuscular fibrous band masquerading antral web in a premature neonate. A case report

Isolated fibrous gastric antral band in a neonate causing partial gastric obstruction and mimicking prepyloric antral web is not reported in the English literature, and we would like to report the first case. A premature neonate with feeding difficulties and bilious aspirate underwent upper gastrointestinal contrast examination. The upper gastrointestinal series showed a thin, radiolucent, circumferential band in the antrum with delayed gastric emptying. Radiographic diagnosis of prepyloric antral web with partial gastric obstruction was made. Intraoperatively, a circumferential fibrous cord was found in the muscle layer (tunica muscularis) of the antrum, which was completely divided. Clinically and radiographically, the 2 conditions could not be differentiated but require 2 separate surgical techniques for their management.     

1,4-Azaindole,a Potential Drug Candidate for Treatment of Tuberculosis

New therapeutic strategies against multidrug-resistant (MDR) and extensively drug-resistant (XDR) Mycobacterium tuberculosis are urgently required to combat the global tuberculosis (TB) threat. Toward this end, we previously reported the identification of 1,4-azaindoles, a promising class of compounds with potent antitubercular activity through noncovalent inhibition of decaprenylphosphoryl-β-d-ribose 2′-epimerase (DprE1). Further, this series was optimized to improve its physicochemical properties and pharmacokinetics in mice. Here, we describe the short-listing of a potential clinical candidate, compound 2, that has potent cellular activity, drug-like properties, efficacy in mouse and rat chronic TB infection models, and minimal in vitro safety risks. We also demonstrate that the compounds, including compound 2, have no antagonistic activity with other anti-TB drugs. Moreover, compound 2 shows synergy with PA824 and TMC207 in vitro, and the synergy effect is translated in vivo with TMC207. The series is predicted to have a low clearance in humans, and the predicted human dose for compound 2 is ≤1 g/day. Altogether, our data suggest that a 1,4-azaindole (compound 2) is a promising candidate for the development of a novel anti-TB drug.     

Modulation of Resting-State Amygdala-Frontal Functional Connectivity by Oxytocin in Generalized Social Anxiety Disorder

Generalized social anxiety disorder (GSAD) is characterized by aberrant patterns of amygdala-frontal connectivity to social signals of threat and at rest. The neuropeptide oxytocin (OXT) modulates anxiety, stress, and social behaviors. Recent functional neuroimaging studies suggest that these effects are mediated through OXT''s effects on amygdala reactivity and/or amygdala-frontal connectivity. The aim of the current study was to examine OXT''s effects on amygdala-frontal resting-state functional connectivity (rsFC) in GSAD patients and healthy controls (HCs). In a randomized, double-blind, cross-over design, 18 GSAD and 18 HC participants received intranasal OXT (24 IU or 40.32 μg) or placebo (PBO) before resting-state functional magnetic resonance imaging. In individuals with GSAD, OXT enhanced rsFC of the left and right amygdala with rostral anterior cingulate cortex (ACC)/medial prefrontal cortex (mPFC), and in doing so, reversed (ie, ‘normalized'') the reduced amygdala-frontal connectivity observed relative to HCs evident on PBO. Higher social anxiety severity in GSAD subjects correlated with lower amygdala-ACC/mPFC connectivity on PBO and higher social anxiety also correlated with greater enhancement in amygdala-frontal connectivity induced by OXT. These findings show that OXT modulates a neural circuit known for social threat processing and emotion regulation, suggesting a neural mechanism by which OXT may have a role in the pathophysiology and treatment of social anxiety disorder.     

The value of pharmacists in health care

The American health care system is concerned about the rise of chronic diseases and related resource challenges. Management of chronic disease traditionally has been provided by physicians and nurses. The growth of the care management industry, in which nurses provide remote telephonic monitoring and coaching, testifies to the increasing need for care management and to the value of nonphysician clinicians. However, this model is challenged by a number of factors, including low enrollment and the growing shortage of nurses. The challenges to the traditional model are causing policy makers and payers to consider innovative models. One such model includes the pharmacist as an essential provider of care. Not only is the number of pharmacists growing, but they are playing an ever broader role in a variety of settings. This article broadly surveys the current state of pharmacist provision of care management services and highlights the increasingly proactive role played by Walgreen Co. toward this trend, using recently conducted research. Pharmacists are making a noticeable impact on and contribution to the care of chronic diseases by improving adherence to medications, a key factor in the improvement of outcomes. Literature also suggests that pharmacies are increasingly encouraging, expanding, and highlighting the role and contributions of their professional pharmacists. Although the role of the pharmacist in chronic care management is still developing, it is likely to grow in the future, given the needs of the health care system and patients.