Quantitation in gated perfusion SPECT imaging: the Cedars-Sinai approach.

Cedars-Sinai's approach to the automation of gated perfusion single photon emission computed tomography (SPECT) imaging is based on the identification of key procedural steps (processing, quantitation, reporting), each of which is then implemented, in completely automated fashion, by use of mathematic algorithms and logical rules combined into expert systems. Our current suite of software applications has been designed to be platform- and operating system-independent, and every algorithm is based on the same 3-dimensional sampling scheme for the myocardium. The widespread acceptance of quantitative software by the nuclear cardiology community (QGS alone is used at over 20,000 locations) has provided the opportunity for extensive validation of quantitative measurements of myocardial perfusion and function, in our opinion, helping to make nuclear cardiology the most accurate and reproducible modality available for the assessment of the human heart.     

Early volatile depletion on planetesimals inferred from C–S systematics of iron meteorite parent bodies

During the formation of terrestrial planets, volatile loss may occur through nebular processing, planetesimal differentiation, and planetary accretion. We investigate iron meteorites as an archive of volatile loss during planetesimal processing. The carbon contents of the parent bodies of magmatic iron meteorites are reconstructed by thermodynamic modeling. Calculated solid/molten alloy partitioning of C increases greatly with liquid S concentration, and inferred parent body C concentrations range from 0.0004 to 0.11 wt%. Parent bodies fall into two compositional clusters characterized by cores with medium and low C/S. Both of these require significant planetesimal degassing, as metamorphic devolatilization on chondrite-like precursors is insufficient to account for their C depletions. Planetesimal core formation models, ranging from closed-system extraction to degassing of a wholly molten body, show that significant open-system silicate melting and volatile loss are required to match medium and low C/S parent body core compositions. Greater depletion in C relative to S is the hallmark of silicate degassing, indicating that parent body core compositions record processes that affect composite silicate/iron planetesimals. Degassing of bare cores stripped of their silicate mantles would deplete S with negligible C loss and could not account for inferred parent body core compositions. Devolatilization during small-body differentiation is thus a key process in shaping the volatile inventory of terrestrial planets derived from planetesimals and planetary embryos.

Major volatiles (H, C, N, and S) are inherently plentiful in the interstellar medium and abundant in primitive carbonaceous chondrites (CCs) (1, 2), but are scarce in terrestrial planets, which gained most of their mass from the inner parts of the solar nebula (3, 4). Formation of volatile-poor planets from a volatile-rich protoplanetary disk is a result of processes in the solar nebula, in accretion of precursor solids, and in interior differentiation. Addition of volatiles to nascent planets varies during accretion as protoplanetary systems become dynamically excited, contributing material originating from different heliocentric distances (3) and with different thermal histories. Much of this mass arrives in larger bodies (planetesimals or planetary embryos) that differentiated soon after formation (5). Key uncertainties include the nebular history of bulk materials that contributed volatiles to the rocky planets and how that affected their volatile cargos (6), and how planetesimal and planet formation influenced volatile distributions in accreted parent bodies.Processes responsible for volatile deficits in terrestrial planets (7, 8) can occur either in the nebular, planetesimal, or planetary environment. Nebular volatile depletion could result from chemical interactions between nebular gas and dust, chondrule formation, or the accretion of thermally processed solids (9–11), perhaps owing to the hotter conditions prevailing closer to the protosun (4). Li et al. (6) argue that the comparatively small C inventory of the bulk Earth requires that nebular materials experienced significant early (<1 Ma) heating, before the “soot line” moved inward of 1 AU. Planetesimal processes involve loss to space during differentiation or processing of intermediate-sized bodies of tens to hundreds of kilometers in diameter (e.g., refs. 12 and 13). Planetary loss processes occur on large (thousands of kilometers in diameter) bodies (14, 15) in which gravity plays an appreciable role—including loss from impacts (16). The sum of these is an important determinant for whether terrestrial planets form with volatiles sufficient for habitability but not so great as to become ocean worlds (17) or greenhouse hothouses (18).A key goal in the study of exoplanets and of young stellar systems is predicting environments and processes that could lead to habitable planets, including development of models that account for the distribution, acquisition, and loss of key volatile elements. Astronomical studies can reveal the architecture of other solar systems (19), the compositions of observable exoplanet atmospheres (ref. 20 and references therein), and the dust and volatile gas structure and composition of protoplanetary disks (ref. 21 and references therein), including interactions of the disk with gas- or ice-giant protoplanets. However, only limited astronomical observations can be made about conversion of disk materials (gas, dust, and pebbles) to planets in other solar systems. To understand this conversion, we must necessarily rely on planetesimals and their remnants (meteorites) as records of the processes that occurred. In this paper, we focus on volatile loss during planetesimal differentiation by examining evidence chiefly from iron meteorites. We note that ephemeral metal enrichments in white dwarf atmospheres confirm that differentiated planetesimals are common around other stars (22), and that our findings apply to how materials would have been processed during the assembly of other planetary systems.In classic oligarchic growth models of planetary origin, planets and embryos grow from accretion of planetesimals with characteristic radii of tens to a few hundreds of kilometers (3). In pebble accretion models of terrestrial planet formation, the fraction of planetesimals in accreting material varies with time and protoplanetary mass (23), but still remains significant. Thus, for understanding volatile delivery to growing planets, an important question is whether the volatile inventory of accreting planetesimals (or larger objects) remained similar to that of primitive materials, typically taken to be comparable to chondritic meteorites, or had diminished significantly from prior differentiation.^*Achondritic meteorites are fragments of differentiated planetesimals and provide direct evidence of processes on small bodies.^† Evidence for volatile loss on silicate achondritic parent bodies comes from elemental concentrations and from isotopes (24–27). However, the best-studied silicate achondritic suites, such as the eucrites and angrites, are igneous crustal rocks (28), and their compositions may not reflect average major volatile contents of their parent bodies. Volatile loss could have been locally enhanced by the igneous activity that produced the planetesimal crusts (29).Iron meteorites offer an additional record of volatile processing in planetesimals. Many, known as “magmatic” irons, originated as metallic cores of planetesimals (30) and potentially record volatile depletions in their parent planetesimals at the time of alloy–silicate separation. Iron meteorites contain measurable amounts both major (S, C, N) and moderately volatile (Ge, Ga) elements and represent the cores of at least 50 parent bodies (31). Thus, known parent body cores are likely survivors from a population of planetesimals that were mostly incorporated into larger bodies and planets. Additionally, isotopic evidence links iron meteorites with both carbonaceous (CC) and noncarbonaceous (NC) chondrites (32), thereby correlating the differentiated planetesimals to their primitive chondritic heritage.Here, we address the problem of planetesimal volatile loss by focusing on carbon and sulfur, two siderophile volatile elements that give important clues to the degassing history of metallic cores recorded iron meteorites and thereby their parent planetesimals.^‡ We begin by examination of C–S systematics in different classes of chondrites. Although chondritic parent bodies formed later than most parent bodies of iron meteorites (33), they provide the best available guide to undifferentiated materials in the early solar system. Their isotopic kinships to iron meteorites (32) suggest that they derive from similar, although not necessarily identical, reservoirs, and so they provide a basis for comparison to those estimated for parent body cores. They also reveal devolatilization processes associated with planetesimal metamorphism. We then examine iron meteorite groups and reconstruct the compositions of their respective parent cores. Finally, we consider a spectrum of simple planetesimal core-formation scenarios and model the resulting C and S distributions. Comparison of these to reconstructed parent core C and S places new constraints on the magnitude of degassing occurring from planetesimal interiors.     

Increased Ligament Thickness in Previously Sprained Ankles as Measured by Musculoskeletal Ultrasound

Context:Lateral ankle sprains are among the most common injuries in sport, with the anterior talofibular ligament (ATFL) most susceptible to damage. Although we understand that after a sprain, scar tissue forms within the ligament, little is known about the morphologic changes in a ligament after injury.Objective:To examine whether morphologic differences exist in the thickness of the ATFL in healthy, coper, and unstable-ankle groups.Design:Cross-sectional study.Setting:Laboratory.Results:A group-by-limb interaction was evident (P = .038). The ATFLs of the injured limb for the coper group (2.20 ± 0.47 mm) and the injured limb for the unstable group (2.28 ± 0.53 mm) were thicker than the ATFL of the “injured” limb of the healthy group (1.95 ± 0.29 mm) at P = .015 and P = .015, respectively. No differences were seen in the uninjured limbs among groups.Conclusions:Because ATFL thicknesses of the healthy group''s uninjured ankles were similar, we contend that lasting morphologic changes occurred in those with a previous injury to the ankle. Similar differences were seen between the injured limbs of the coper and unstable groups, so there must be another explanation for the sensations of instability and the reinjuries in the unstable group.Key Words: ankle instability, anterior talofibular ligament, morphology

Key Points

• The anterior talofibular ligament can be viewed using musculoskeletal ultrasound imaging.
• The anterior talofibular ligaments of previously sprained ankles were thicker than those of uninjured ankles.
• Although coper ankles were more functionally similar to healthy ankles than to unstable ankles, they were structurally different. Only further research can determine the relationship between ligament damage and functional stability of the ankle.

Musculoskeletal ultrasound (MSUS) imaging is a new technique being used in the sports medicine setting. Compared with other imaging techniques, such as radiographic or magnetic resonance imaging (MRI), MSUS offers a safer, more time-efficient, and more cost-effective alternative. A real-time image can be captured via MSUS by using a transducer to send high-frequency sound waves into the body and recording the echo of the sound waves reflecting back, providing an image of the internal structure.^1,2 This method has been found to be effective in imaging upper extremity, lower extremity, and joint injuries.^1,3,4Oae et al³ reported greater than 90% accuracy for both MSUS and MRI in identifying injuries to the ankle. Lateral ankle sprains (LASs) are among the most common injuries in sport.⁵ An estimated 850 000 new ankle sprains occur each year in the United States,⁷ which does not include a 70% reinjury rate at the ankle.⁶ Ankle stability plays an important role in injury prevention. Passive stability of the ankle is predominantly the responsibility of ligaments supporting the bony structure of the talocrural joint because there are no musculotendinous insertions on the talus. Ligaments supporting the lateral complex of the ankle include the anterior talofibular ligament (ATFL), calcaneofibular ligament, and posterior talofibular ligament. The ATFL is a flat ligament that attaches from the anterior border of the lateral malleolus to the talus, just anterior to the lateral malleolus articular surface.⁸ The ATFL limits plantar flexion and inversion, motions that coincide with the most common mechanism of injury.⁸ As a result, the ATFL becomes vulnerable in a plantar-flexed and inverted position and is most susceptible to damage during an LAS.^5,6,9 An isolated tear of the ATFL occurs in about 80% of LASs.^10,11After an LAS, the fibrous structure of an ankle ligament is often disrupted by severe damage. Using MRI, Takao et al¹² reported visible scarring of the ATFL after injury. Using MSUS, McCarthy et al¹³ described a thickened ATFL, osseous spurs, and synovitic lesions after injury. Thickness values for the ATFL have been derived primarily from cadaveric studies^14,15; however, MRI-based in vivo studies demonstrated thickness of the ATFL to be in the range of 2 to 3 mm.^16,17 An abnormal ligament could affect the stabilizing properties of the ligament. In animal studies, although scar tissue formed within a ligament after injury, the newly scarred ligament allowed normal movement; however, the load capacity of that ligament was decreased by 60%.^18–20 Therefore, the strength of a ligament can be sufficient for active movement and injury rehabilitation soon after injury, but the decrease in load capacity of the scarred ligament may affect its stabilizing properties.Despite medical treatment and postinjury rehabilitation, more than 50% of individuals who sustain a moderate or severe ankle sprain experience some degree of residual disability and impairment due to symptoms such as pain, instability, loss of range of motion, and edema.^6,21 Those who do not fully recover from their ankle sprain often develop chronic ankle instability (CAI), which limits function not only in sport but also in activities of daily living. Patients with CAI typically complain of the ankle “giving way” or of repeated ankle sprains under seemingly low-risk conditions.²²Typically, CAI researchers have categorized participants into 2 groups: those with ankle instability (unstable) and those without ankle instability (healthy). The unstable group consists of individuals who experience recurrent sprains, sensations of instability, or both. Unfortunately, this method of grouping ignores those who sustained an ankle sprain but did not experience recurrent sprains or sensations of instability. In general, an ankle “coper” refers to an individual who has experienced an initial ankle sprain but not a subsequent sprain.²³ Only recently have copers been addressed in ankle-instability research.^24–29 Because copers are still a new cohort in this research, the classification of ankle copers differs somewhat among researchers.^25,28Although we understand that the fibrous nature of a ligament is disrupted after an LAS, little is known about the actual morphologic changes in a ligament. Therefore, the purpose of our study, using a mixed-model analysis, was to determine whether MSUS can be used to see differences in ligament thickness between the uninjured limb and the injured limb among the healthy, coper, and unstable groups. We hypothesized that the ligaments of the previously injured ankles would be thicker than the uninjured ankles.     

Functional tricuspid regurgitation secondary to aortic annular abscess: An unusual presentation of infective endocarditis

An unusual case of aortic annular abscess is presented, in which the patient presented with features of gross tricuspid regurgitation. There was no direct involvement of the tricuspid valve. Tricuspid regurgitation disappeared following surgical repair of the annular abscess. The present case also illustrates the utility of trans-oesophageal echocardiography in establishing the diagnosis and planning surgical intervention.     

Denaturing gradient gel electrophoresis: a novel method for determining Rh phenotype from genomic DNA

Denaturing gradient gel electrophoresis (DGGE) was carried out on PCR products amplified from exons 2 and 5 of RHD and RHCE. Exon 2 of RHD and exon 2 of the C allele of RHCE have an identical sequence, which differs from that of the c allele of RHCE. One band representing D and/or C, and another representing c, could be distinguished by DGGE of exon 2 amplifications of genomic DNA from individuals with the appropriate Rh phenotype. C and c could only be distinguished in D-negative samples. Exon 5 of RHD and exon 5 of the E and e alleles of RHCE all have different nucleotide sequences. Bands representing D, E and e could be distinguished following DGGE of the products of exon 5 amplification of genomic DNA from individuals with red cells of the appropriate Rh phenotype. In samples from individuals with VS+ red cells (V+ or V?) there was a shift of the band representing e. Sequencing demonstrated that VS is associated with a RHCE e sequence with a single base change predicting a Leu245 → Val substitution in the Rh polypeptide. This substitution may be responsible for the VS and e^s antigens.