Reliability of new software in measuring cervical multifidus diameters and shoulder muscle strength in a synchronized way; an ultrasonographic study

OBJECTIVES:

This study was conducted with the purpose of evaluating the inter-session reliability of new software to measure the diameters of the cervical multifidus muscle (CMM), both at rest and during isometric contractions of the shoulder abductors in subjects with neck pain and in healthy individuals.

METHOD:

In the present study, the reliability of measuring the diameters of the CMM with the Sonosynch software was evaluated by using 24 participants, including 12 subjects with chronic neck pain and 12 healthy individuals. The anterior-posterior diameter (APD) and the lateral diameter (LD) of the CMM were measured in a resting state and then repeated during isometric contraction of the shoulder abductors. Measurements were taken on separate occasions 3 to 7 days apart in order to determine inter-session reliability. Intraclass correlation coefficient (ICC), standard error of measurement (SEM), and smallest detectable difference (SDD) were used to evaluate the relative and absolute reliability, respectively.

RESULTS:

The Sonosynch software has shown to be highly reliable in measuring the diameters of the CMM both in healthy subjects and in those with neck pain. The ICCs 95% CI for APD ranged from 0.84 to 0.94 in subjects with neck pain and from 0.86 to 0.94 in healthy subjects. For LD, the ICC 95% CI ranged from 0.64 to 0.95 in subjects with neck pain and from 0.82 to 0.92 in healthy subjects.

CONCLUSIONS:

Ultrasonographic measurement of the diameters of the CMM using Sonosynch has proved to be reliable especially for APD in healthy subjects as well as subjects with neck pain.     

A Leishmania infantum FML-ELISA for the Detection of Symptomatic and Asymptomatic Canine Visceral Leishmaniasis in an Endemic Area of Iran

Background: Visceral leishmaniasis (VL) is caused by Leishmania infantum in Mediterranean basin and is an endemic disease in some parts of Iran. Canines are the main reservoirs of VL in most of the endemic areas. Different serological methods have been introduced for diagnosis of canine visceral leishmaniasis (CVL). Objective: In this survey a Fucose-Mannose Ligand (FML) ELISA, using native L. infantum antigen, was developed and its validity for detection of infected dogs in comparison with direct agglutination test (DAT) and PCR was evaluated. Methods: Blood samples of sixty ownership dogs (≤ 3 years old) were collected from Meshkin-shahr district in Ardabil province, North-west of Iran. Sera were separated for serological assays (DAT and FML-ELISA) and the buffy coats were collected for molecular evaluation. Results: Two out of the 60 (3.33%) samples were found to be positive (antibody titer of ≥ 1/320) in DAT while seven of the 60 (11.66%) samples were positive by FML-ELISA. Nine out of 60 (15%) buffy coat samples showed a band about 680 bp indicative of L. infantum in PCR. Three out of 60 dogs had Kala-azar symptoms and were positive by PCR and FML-ELISA, while two of these three dogs had antibody titers >1/320 in their serum samples. The sensitivity and specificity of FML-ELISA for the detection of CVL in both symptomatic and asymptomatic dogs were found to be 77.8% and 100%, respectively. Conclusion: Considering the acceptable sensitivity and high specificity of FML-ELISA, use of this serological method can be recommended for epidemiological surveys of CVL.     

Left ventricle wall motion quantification from echocardiographic images by non-rigid image registration

Purpose

The aim of this study is to evaluate the efficiency of applying a new non-rigid image registration method on two-dimensional echocardiographic images for computing the left ventricle (LV) myocardial motion field over a cardiac cycle.

Methods

The key feature of our method is to register all images in the sequence to a reference image (end-diastole image) using a hierarchical transformation model, which is a combination of an affine transformation for modeling the global LV motion and a free-form deformation (FFD) transformation based on B-splines for modeling the local LV deformation. Registration is done by minimizing a cost function associated with the image similarity based on a global pixel-based matching and the smoothness of transformation. The algorithm uses a fast and robust optimization strategy using a multiresolution approach for the estimation of parameters of the deformation model. The proposed algorithm is evaluated for calculating the displacement curves of two expert-identified anatomical landmarks in apical views of the LV for 10 healthy volunteers and 14 subjects with pathology. The proposed algorithm is also evaluated for classifying the regional LV wall motion abnormality using the calculation of the strain value at the end of systole in 288 segments as scored by two consensual experienced echocardiographers in a three-point scale: 1: normokinesia, 2: hypokinesia, and 3: akinesia. Moreover, we compared the results of the proposed registration algorithm to those previously obtained using the other image registration methods.

Results

Regarding to the reference two experienced echocardiographers, the results demonstrate the proposed algorithm more accurately estimates the displacement curve of the two anatomical landmarks in apical views than the other registration methods in all data set. Moreover, the p values of the t test for the strain value of each segment at the end of systole measured by the proposed algorithm show higher differences than the other registration method. These differences are between each pair of scores in all segments and in three segments of septum independently.

Conclusions

The clinical results show that the proposed algorithm can improve both the calculation of the displacement curve of every point of LV during a cardiac cycle and the classification of regional LV wall motion abnormality. Therefore, this diagnostic system can be used as a useful tool for clinical evaluation of the regional LV function.     

Attenuation of hepatic fibrosis through captopril and enalapril in the livers of bile duct ligated rats.

Hepatic fibrosis is a common feature in different types of chronic liver injury. The demonstration of the pro-fibrogenesis role of angiotensin II in chronic liver diseases brought up the idea that anti-angiotensin II agents may be effective on improvement of hepatic fibrosis by either blocking the angiotensin II receptor or inhibition of angiotensin converting enzyme (ACE). This study is aimed at comparing the anti-fibrogenesis effects of two ACE inhibitors, captopril and enalapril, in the livers of rats with bile duct ligation through biochemical and histopathological parameters. Male Albino Wistar rats were divided into four groups (n=4-5 each), including sham operated, bile duct ligated, captopril and enalapril treated. After 28 days of treatment, the liver was removed and the levels of hepatic hydroxyproline, glutathione and lipid peroxidation were determined. The degree of the development of fibrosis was evaluated through histopathological numerical scores. The results demonstrated that angiotensin converting enzyme inhibitors increased GSH, decreased lipid peroxidation and improved hepatic fibrosis as shown by histopathology as well as decreased hepatic content of hydroxyproline. Enalapril was significantly more effective than captopril (p<0.001) in improvement of hepatic fibrosis. Also it was shown that enalapril has a significant antioxidative effect (p<0.05) in comparison with captopril. In conclusion, the results of our study suggest that the antifibrotic effect of enalapril may be mostly related to the inhibition of angiotensin converting enzyme.     

Transjugular intrahepatic portosystemic stent shunt for medically refractory hepatic hydrothorax: A systematic review and cumulative meta-analysis

AIM: To assess the effectiveness of transjugular intrahepatic portosystemic stent shunt (TIPSS) in refractory hepatic hydrothorax (RHH) in a systematic review and cumulative meta-analysis.METHODS: A comprehensive literature search was conducted on MEDLINE, EMBASE, and PubMed covering the period from January 1970 to August 2014. Two authors independently selected and abstracted data from eligible studies. Data were summarized using a random-effects model. Heterogeneity was assessed using the I² test.RESULTS: Six studies involving a total of 198 patients were included in the analysis. The mean (SD) age of patients was 56 (1.8) years. Most patients (56.9%) had Child-Turcott-Pugh class C disease. The mean duration of follow-up was 10 mo (range, 5.7-16 mo). Response to TIPSS was complete in 55.8% (95%CI: 44.7%-66.9%), partial in 17.6% (95%CI: 10.9%-24.2%), and absent in 21.2% (95%CI: 14.2%-28.3%). The mean change in hepatic venous pressure gradient post-TIPSS was 12.7 mmHg. The incidence of TIPSS-related encephalopathy was 11.7% (95%CI: 6.3%-17.2%), and the 45-d mortality was 17.7% (95%CI: 11.34%-24.13%).CONCLUSION: TIPSS is associated with a clinically relevant response in RHH. TIPSS should be considered early in these patients, given its poor prognosis.     

Performance of a New Blunt-Tip Coaxial Needle for Percutaneous Biopsy and Drainage of “Hard-To-Reach” Targets

Aim

To present a new blunt-tip coaxial needle (SoftGuard) applied to access “hard-to-reach” targets undergoing percutaneous image-guided biopsy or drainage.

Materials and Methods

All consecutive patients presenting between August and December 2016 with “hard-to-reach” (<10 mm from a critical nearby structure such as vessels, nerves, bowel or adjacent parenchymal organs) solid lesions requiring biopsy (group A) or abscesses requiring drainage for sepsis (group B) were prospectively included. The individual features of each patient and lesion as well as technical and clinical data were collected and analysed.

Results

Twenty-six patients (18 males, 8 females, mean age 59.81 ± 17.53 years) were enrolled in group A and nine (6 males, 3 females, mean age 58.33 ± 13.8 years) in group B. Technical success was achieved in 92.3% of cases from group A and 100% of cases from group B. Five (19.2%) minor complications were noted in group A (four small self-limiting pneumothoraces and one small self-limiting peri-pancreatic haematoma). There were no complications in group B. Histological results in group A accounted for 95% sensitivity, 100% specificity and 95.2% diagnostic accuracy. In group B, mean post-operative C-reactive protein was 41 ± 48.3 mg/L in comparison with 155 ± 117.5 mg/L at baseline (P = 0.004).

Conclusions

The SoftGuard blunt-tip needle is a safe and effective tool when applied as a coaxial working cannula for percutaneous biopsy or drainage of “hard-to-reach” targets.

     

Allelic Exchange and Mutant Selection Demonstrate that Common Clinical embCAB Gene Mutations Only Modestly Increase Resistance to Ethambutol in Mycobacterium tuberculosis

Mutations within codon 306 of the Mycobacterium tuberculosis embB gene modestly increase ethambutol (EMB) MICs. To identify other causes of EMB resistance and to identify causes of high-level resistance, we generated EMB-resistant M. tuberculosis isolates in vitro and performed allelic exchange studies of embB codon 406 (embB406) and embB497 mutations. In vitro selection produced mutations already identified clinically in embB306, embB397, embB497, embB1024, and embC13, which result in EMB MICs of 8 or 14 μg/ml, 5 μg/ml, 12 μg/ml, 3 μg/ml, and 4 μg/ml, respectively, and mutations at embB320, embB324, and embB445, which have not been identified in clinical M. tuberculosis isolates and which result in EMB MICs of 8 μg/ml, 8 μg/ml, and 2 to 8 μg/ml, respectively. To definitively identify the effect of the common clinical embB497 and embB406 mutations on EMB susceptibility, we created a series of isogenic mutants, exchanging the wild-type embB497 CAG codon in EMB-susceptible M. tuberculosis strain 210 for the embB497 CGG codon and the wild-type embB406 GGC codon for either the embB406 GCC, embB406 TGC, embB406 TCC, or embB406 GAC codon. These new mutants showed 6-fold and 3- to 3.5-fold increases in the EMB MICs, respectively. In contrast to the embB306 mutants, the isogenic embB497 and embB406 mutants did not have preferential growth in the presence of isoniazid or rifampin (rifampicin) at their MICs. These results demonstrate that individual embCAB mutations confer low to moderate increases in EMB MICs. Discrepancies between the EMB MICs of laboratory mutants and clinical M. tuberculosis strains with identical mutations suggest that clinical EMB resistance is multigenic and that high-level EMB resistance requires mutations in currently unknown loci.Ethambutol (EMB) is a first-line antituberculosis drug that is often used in combination with other drugs to treat tuberculosis and to prevent the emergence of drug resistance. EMB also has a place in the treatment of drug-resistant and multidrug-resistant tuberculosis (2). The recent global increase in the incidence of drug-resistant tuberculosis has produced many strains that are resistant to EMB. Therefore, it is prudent to test isolates from all tuberculosis patients for their EMB susceptibility, especially when EMB is used to treat multidrug-resistant tuberculosis. Unfortunately, conventional culture-based EMB susceptibility test methods have poor intertest and interlaboratory reproducibilities (8, 21). This has made it difficult to firmly rule out the presence of EMB resistance by the use of conventional assays. Culture-based Mycobacterium tuberculosis drug susceptibility tests are also quite slow (12, 20).Genetic tests for EMB resistance are potentially more rapid and more accurate than conventional culture-based resistance testing. Genetic assays identify resistance by detecting mutations that encode EMB resistance on the M. tuberculosis chromosome, principally within the embB gene (5, 17, 25). The results of genetic assays can be available within hours; they have high interassay reproducibilities and have the potential to have high sensitivities (5, 25). However, genetic testing for EMB resistance has been hindered by a persistent uncertainty concerning the role of specific mutations in EMB resistance. Initially, the role of mutations within codon 306 of the embB gene (embB306) was questioned. Although embB306 mutations were present in 30 to 68% of EMB-resistant clinical isolates (1, 13, 22), some studies had noted a widespread presence of embB306 mutations in EMB-susceptible isolates (1, 7, 9). The role of embB306 mutations was firmly established to be a cause of low- and moderate-level (two to seven times the MIC for the wild type) EMB resistance in a recent allelic exchange study (19). However, that study also demonstrated that embB306 mutations do not in themselves cause high-level (MICs > 20 μg/ml) EMB resistance. Furthermore, the cause of EMB resistance in the 32 to 70% of clinical EMB-resistant M. tuberculosis isolates that did not have embB306 mutations remained an open question.Several clinical studies have suggested that other mutations in the embCAB operon are responsible for at least some of the remaining EMB-resistant tuberculosis cases. The most commonly occurring embCAB mutations other than embB306 have been found in embB406 and embB497. Importantly, these two mutations have been detected in clinical isolates with high-level EMB resistance (11, 14). However, other studies identified embB406 mutations in EMB-susceptible clinical isolates (7, 15, 23). Other mutations in the embB and embC genes have also been identified in EMB-resistant clinical M. tuberculosis isolates (6, 22, 23), but at low frequencies, making it difficult to firmly establish associations with EMB resistance. Thus, the actual role of non-embB306 mutations in EMB resistance has not been proven.In the study described here, we examined the role of embB mutations outside of the embB306 codon in EMB resistance. Using in vitro-selected mutants and allelic exchange techniques, our results demonstrate that non-embB306 mutations in the embCAB operon play an important role in EMB resistance, but like mutations in embB306, these mutations confer only a low to a moderate increase in EMB MICs. Our study strongly suggests that unrecognized mycobacterial gene targets for EMB resistance and high-level resistance remain to be discovered.