Real-time MR imaging of myocardial regional function using strain-encoding (SENC) with tissue through-plane motion tracking

PURPOSE: To implement real-time myocardial strain-encoding (SENC) imaging in combination with tracking the tissue displacement in the through-plane direction. MATERIALS AND METHODS: SENC imaging was combined with the slice-following technique by implementing three-dimensional (3D) selective excitation. Certain adjustments were implemented to reduce scan time to one heartbeat. A total of 10 volunteers and five pigs were scanned on a 3T MRI scanner. Spatial modulation of magnetization (SPAMM)-tagged images were acquired on planes orthogonal to the SENC planes for comparison. Myocardial infarction (MI) was induced in two pigs and the resulting SENC images were compared to standard delayed-enhancement (DE) images. RESULTS: The strain values computed from SENC imaging with slice-following showed significant difference from those acquired without slice-following, especially during systole (P < 0.01). The strain curves computed from the SENC images with and without slice-following were similar to those computed from the orthogonal SPAMM images, with and without, respectively, tracking the tag line displacement in the strain direction. The resulting SENC images showed good agreement with the DE images in identifying MI in infarcted pigs. CONCLUSION: Correction of through-plane motion in real-time cardiac functional imaging is feasible using slice-following. The strain measurements are more accurate than conventional SENC measurements in humans and animals, as validated with conventional MRI tagging.     

Disengagement from mental health services

This paper reviews the literature on disengagement from mental health services examining how the terms engagement and disengagement are defined, what proportion of patients disengage from services, and what sociodemographic variables predict disengagement. Both engagement and disengagement appear to be poorly conceptualised, with a lack of consensus on accepted and agreed definitions. Rates of disengagement from mental health services vary from 4 to 46%, depending on the study setting, service type and definition of engagement used. Sociodemographic and clinical predictors of disengagement also vary, with only a few consistent findings, suggesting that such associations are complex and multifaceted. Most commonly reported associations of disengagement appear to be with sociodemographic variables including young age, ethnicity and deprivation; clinical variables such as lack of insight, substance misuse and forensic history; and service level variables such as availability of assertive outreach provision. Given the importance of continuity of care in serious mental disorders, there is a need for a consensual, validated and reliable measure of engagement which can be used to explore associations between patient, illness and service related variables and can inform service provision for difficult to reach patients.     

Effects of water extracts of thyme (Thymus vulgaris) and ginger (Zingiber officinale Roscoe) on alcohol abuse

Introduction

Alcohol abuse has many harmful effects on human body. This study aimed to investigate the role of water extracts of thyme (Thymus vulgaris) and ginger (Zingiber officinale Roscoe) as natural product extracts to detoxify the injuries of alcohol abuse on liver and brain of mice.

Materials and methods

Alcohol at a dose of 1.25 ml/50 ml water was orally administered at the first day of treatment with continuously increase of 1.25 ml per day to the end of experiment (14 days, 0.1 ml/45 g /d). Mice also were orally administered with alcohol and water extracts of thyme and ginger in concentration of 500 mg /kg body weight for 2 weeks.

Results

The results showed very highly significant increase in nitric oxide and malondialdehyde level in liver and brain and a very highly significant decrease in the total antioxidant capacity and glutathione peroxidase activity in alcoholic group. In addition, the liver function enzymes such as l-γ-glutamyl transpeptidase and butyryl cholinesterase activities showed very highly significant increase in alcoholic group. In contrast, the water extracts of thyme and ginger showed significant amelioration on these changes both in liver and brain tissues.

Conclusion

The water extracts of thyme and ginger has detoxifying and antioxidant effects. Therefore, it is recommended to use them to avoid alcohol toxicity.     

Risk indicators and psychopathology in traumatised children and adolescents with a history of sexual abuse

PURPOSE: Childhood sexual abuse (CSA) is widespread amongst South African (SA) children, yet data on risk factors and psychiatric consequences are limited and mixed. METHODS: Traumatised children and adolescents referred to our Youth Stress Clinic were interviewed to obtain demographic, sexual abuse, lifetime trauma and psychiatric histories. RESULTS: Data for 94 participants (59 female, 35 male; mean age 14.25 [8.25-19] years) exposed to at least one lifetime trauma were analysed. Sexual abuse was reported in 53% of participants (42.56% females, 10.63% males) with 64% of violations committed by perpetrators known to them. Multinomial logistic regression analysis revealed female gender (P=0.002) and single-parent families (P=0.01) to be significant predictors of CSA (62.5%). CSA did not predict exposure to other traumas. Sexually abused children had significantly higher physical and emotional abuse subscale scores and total CTQ scores than non-abused children. Depression (33%, X(2)=10.89, P=0.001) and PTSD (63.8%, X(2)=4.79, P=0.034) were the most prevalent psychological consequences of trauma and both were significantly associated with CSA. CONCLUSIONS: High rates of CSA predicted high rates of PTSD in this traumatised sample. Associations we found appear consistent with international studies of CSA and, should be used to focus future social awareness, prevention and treatment strategies in developing countries.     

Dietary habits and prostate cancer detection: a case–control study

Background

Many studies have suggested that nutritional factors may affect prostate cancer development. The aim of our study was to evaluate the relationship between dietary habits and prostate cancer detection.

Methods

We studied 917 patients who planned to have transrectal ultrasonography–guided prostatic biopsy based on an elevated serum prostate-specific antigen (PSA) level, a rising serum PSA level or an abnormal digital rectal examination. Before receiving the results of their biopsy, all patients answered a self-administered food frequency questionnaire. In combination with pathology data we performed univariable and multivariable logistic regression analyses for the predictors of cancer and its aggressiveness.

Results

Prostate cancer was found in 42% (386/917) of patients. The mean patient age was 64.5 (standard deviation [SD] 8.3) years and the mean serum PSA level for prostate cancer and benign cases, respectively, was 13.4 (SD 28.2) μg/L and 7.3 (SD 4.9) μg/L. Multivariable analysis revealed that a meat diet (e.g., red meat, ham, sausages) was associated with an increased risk of prostate cancer (odds ratio [OR] 2.91, 95% confidence interval [CI] 1.55–4.87, p = 0.027) and a fish diet was associated with less prostate cancer (OR 0.54, 95% CI 0.32–0.89, p = 0.017). Aggressive tumours were defined by Gleason score (≥ 7), serum PSA level (≥ 10 μg/L) and the number of positive cancer cores (≥ 3). None of the tested dietary components were found to be associated with prostate cancer aggressivity.

Conclusion

Fish diets appear to be associated with less risk of prostate cancer detection, and meat diets appear to be associated with a 3-fold increased risk of prostate cancer. These observations add to the growing body of evidence suggesting a relationship between diet and prostate cancer risk.     

The multistage use of buccal mucosa grafts for complex hypospadias: histological changes

PURPOSE: We report our experience using buccal mucosa in the multistage repair of complex hypospadias, and the observed histological changes. MATERIALS AND METHODS: We evaluated 31 patients (14 adults and 17 children). A total of 19 patients presented after failed hypospadias repair with deficient ventral skin, 5 presented with scrotal hypospadias and 7 presented with perineal hypospadias. Patients who had previously undergone hypospadias repair had 3 to 7 failed trials. Two stage buccal mucosa graft was performed using the Bracka technique. In the first stage residual fibrosis was released, the glans was split and the buccal mucosa graft was sutured to the ventral surface of the penis to form a future urethral plate. Second stage reconstruction was performed after 6 months with interposed scrotal dartos tissue. Buccal mucosa was histologically studied before grafting, and at 6 months after graft uptake and exposure to the air. RESULTS: Buccal mucosa free graft showed excellent uptake within 5 days in all cases. At 6 months the buccal mucosa was well vascularized and pliable. Minute fistulas occurred in 3 cases (9.7%), which were closed at a later stage. Histological analysis of buccal mucosa tissues before and after graft and prolonged exposure to the air (more than 6 months) was conducted. The buccal mucosa displayed epithelial hyperplasia with mild and focal keratinization. The lamina propria was slightly edematous and minimally infiltrated by mononuclear inflammatory cells. The lamina propria papillae were elongated, extending to 75% of the mucosal thickness compared to the normal buccal mucosa. The buccal mucosal graft displayed good vascularization, similar to that of the normal mucosa. CONCLUSIONS: Multistage repair using buccal mucosa is an excellent option for urethral reconstruction. It guarantees excellent graft uptake and good vasculature, which improves success. It also provides supple tissue for glanular and urethral reconstruction in cases of severe complex hypospadias.     

Evidence-Based Choice of Esophageal Stent for the Palliative Management of Malignant Dysphagia

BACKGROUND: The type of stent used for the management of patients with malignant dysphagia is chosen according to subjective physician's preference. There is no recent study available to provide updated evidence on early outcomes related to the use of different types of stents. METHODS: A literature search was performed using Embase, MEDLINE, Cochrane Library, and Google Scholar databases for comparative studies assessing different types of stents. The primary end point was stent-related mortality; secondary end points included: stent-related morbidity, successful palliation of dysphagia, and 30-day mortality. A random-effects model was used and heterogeneity was assessed. RESULTS: Twelve studies that included 911 patients compared metallic (46.54%) and plastic stents (53.45%), and eight studies that included 564 patients compared covered (43.26%) and uncovered metal stents (56.73%). Meta-analysis of randomized, controlled trials showed that metallic stents were associated with significantly reduced stent-related mortality (1.7% vs. 11.1% for the plastic group, odds ratio (OR), 0.2; 95% confidence interval (CI), 0.06-0.74; P = 0.02), morbidity in the form of reduced esophageal perforation (1.4% vs. 9.4% for plastic stent, OR, 0.27; 95% CI, 0.08-0.89; P = 0.03), and stent migration, yet increased rate of tumor in-growth (13% vs. 1.6% for plastic stents, OR, 4.84; 95% CI, 0.99-23.76; P = 0.05). Covered metallic stents had significantly less tumor in-growth than the uncovered and an increased migration rate. There was no significant difference between metallic and plastic stents in terms of any other stent-related morbidity and 30-day mortality. CONCLUSION: Self-expanding metallic stents are superior to plastic stents in terms of stent insertion-related mortality, morbidity, and quality of palliation. The uncovered variety is disadvantaged by high rate of tumor in-growth; adequately designed randomized, controlled trials need to examine outcomes and cost-effectiveness of covered versus uncovered metallic stents.