Spectrum of high-resolution MRI findings in diabetic neuropathy

OBJECTIVE: Diabetes is the most common cause of neuropathy. Focal diabetic neuropathy, although less common than entrapment neuropathy, clinically mimics entrapment neuropathy. This article depicts the spectrum of MR abnormalities in diabetic subjects- from abnormal T2 hyperintensity and fascicular enlargement in the acute and subacute stages to atrophic-appearing fascicles with intraepineurial fat deposition in the chronic stage-on high-resolution high-field (3-T) MRI. CONCLUSION: A spectrum of imaging abnormalities is observed in diabetic neuropathy. It is important for radiologists to understand the pathophysiology and recognize high-resolution MR appearances of these lesions and of related entities in the differential diagnosis for appropriate diagnosis and patient treatment.     

Magnetic resonance neurography of median neuropathies proximal to the carpal tunnel

This review provides magnetic resonance neurography (MRN) imaging appearances of median neuropathy proximal to the carpal tunnel. Carpal tunnel syndrome (CTS) and its imaging have been extensively described in the literature; however, there is a relative paucity of information on the MR imaging appearances of different pathologies of the median nerve proximal to the carpal tunnel.     

Multimodality correlations of patellar height measurement on X-ray, CT, and MRI

Purpose

To investigate whether the universally accepted range of normal patellar height ratios derived from radiography for the Insall–Salvati (IS) and Blackburne–Peel (BP) methods could be similarly applied to both CT and MRI.

Materials and methods

Institutional review board approval was obtained with waiver of informed consent for this HIPPA-compliant study. A total of 45 knees in 42 patients (15 men, 27 women; age range 11 to 75?years, mean age 39?±?20?years) who underwent tri-modality (radiograph, CT, and MRI) examinations were selected. All patients had knee imaging obtained for a variety of reasons and measurements were performed by two independent readers who were blinded to each other’s measurements or the respective measurements derived from each of the methods. Paired t test was used to compare the mean values among the modalities. Inter-observer and inter-method agreements were assessed using intra-class correlation coefficients.

Results

Statistically significant, but small quantitative differences are noted between tri-modality patellar height ratios. For comparable results, the small addition of 0.13 and 0.10 are needed for the Insall–Salvati measurements on MRI and CT respectively, compared with radiographs. For the Blackburne–Peel ratio, an additional adjustment of 0.09 is needed between radiographs and MRI, but not between radiographs and CT. These adjustments are independent of gender. The interobserver reproducibility was excellent (ICC?≥?0.94) for both the Insall–Salvati and Blackburne–Peel methods for all modalities.

Conclusion

The results indicate that cut-off values for patella alta and baja derived from radiographs should not be directly transposed to CT and MRI; however, the adjustments are relatively minor. These measurements show excellent reproducibility for all modalities currently used for patellar height measurements.     

Predictors of Medication Adherence in an Urban Latino Community with Healthcare Disparities

Ethnic disparities exist when comparing glycemic control: Latino patients have suboptimal glycemic control as compared to non-Latino whites. A key factor to achieving optimal diabetes management and control is medication adherence. We conducted a nested, cross-sectional retrospective study of data (n?=?61) collected from a larger parallel, randomized, longitudinal study conducted at an urban primary care practice examining a culturally tailored community-based peer counselor intervention. Baseline demographic and medication utilization covariates were evaluated for eligibility into the multivariate logistic regression to predict medication adherence. Significant correlates of medication adherence were physician or healthcare team support (OR 12.79, 95% CI 1.04, 157.21), and increasing numbers of medications taken (OR 1.24, 95% CI 1.04, 1.48). Receipt of government benefits was associated with medication non-adherence (OR 0.06, 95% CI 0.01, 0.51). Modifiable factors such as the number of medications and the patient-healthcare team relationship appear to play a role in medication adherence.     

Long-term stability of bronchial reactivity in guinea pigs

Measurement of lung function and bronchial reactivity are widely used as outcome parameters to assess the efficacy of therapeutic interventions. In order to interpret the results correctly, it is necessary that the outcome parameters are themselves stable over time so that any significant changes measured may be attributed to the interventions. Specific airway conductance (SGaw) and airway reactivity to histamine are two commonly used parameters in animal models such as guinea pigs. Although short-term variability of these parameters has been investigated, there has been no study of long-term stability. In the present paper, SGaw and bronchial reactivity to histamine were measured in 111 conscious guinea pigs using a non-invasive, whole body plethysmograph. Baseline values of SGaw and ED35 histamine were measured and followed for eight weeks at weekly intervals. At baseline, mean SGaw in guinea pigs was 0.17 +/- 0.055 sec-1 cm H2O-1 and ED35 histamine ranged from 0.064 to more than 10 mg/ml. The distribution of ED35 histamine values was gaussian. We observed that the changes in SGaw and ED35 histamine recorded using this technique are highly reproducible over eight weeks. The reactivity varied by less than a doubling dose of histamine over any two consecutive weeks. Thus, the technique described in this paper is quick, easily learned, reproducible, independent of temperature-humidity artifact and highly suitable for studies of repeated measurements as in the study of dietary interventions and evaluation of effect of drugs.     

Experimental Evaluation of the Elastic Determinants of Myocardial Function in vivo

Shortening of myocardial fibers occurs following force development in those fibers. The extent, speed and timing of shortening are determined by kinetics and extent of force. However, shortening is also influenced by the elastance/viscosity of the muscle tissue, because that determines the coupling between force and shortening. In the in vivo dog heart, we estimated that coupling by measuring local myocardial force and fiber shortening independently under various conditions. We determined the effect of positive and negative inotropy (by intracoronary injection of dobutamine and acetylcholine, respectively), and of dysfunctional contraction produced by local ischemia/reperfusion and BDM. Under baseline and both positive and negative intropy, most shortening occurred during systole, and dobutamine increased the proportion of total shortening in early systole from 45.8 ± 8.5% to 74.9 ± 9.6%. During reperfusion following ischemia, shortening in early systole was markedly reduced to 16.5 ± 2.9; BDM caused a similar reduction to 16.5 ± 8.1. Most of the shortening occurred during early diastole (53.0 ± 6.8 for reperfusion, and 54.0 ± 10.3 for BDM). These effects were all reversible. It is concluded that energetic efficiency is greatly affected by the elastic properties coupling force and shortening. Thus appropriate analysis of muscle function must take into account the changeable elastic properties of the tissue—both force and shortening, and their interaction must be considered.     

Patterns of smoking in Delhi and comparison of chronic respiratory morbidity among beedi and cigarette smokers

Tobacco smoking is common in developing countries including India with beedi and cigarette smoking being the main types. A community-based study carried out to study the chronic respiratory morbidity in the urban areas of Delhi was analyzed to determine the patterns of tobacco smoking and to compare the chronic respiratory morbidity among beedi and cigarette smokers. A random, stratified sample was selected from among the permanent residents, aged above 18 years, from nine clusters in Delhi. A standardized respiratory symptoms questionnaire was administered and clinical examination carried out followed by spirometry. The questionnaire included a detailed smoking history including type of smoking, number of cigarettes smoked per day and number of years the person had smoking. Chronic respiratory morbidity in beedi and cigarette smokers was measured in terms of prevalence of chronic respiratory symptoms (chronic cough, phlegm, breathlessness and wheezing) and by lung function results. It was observed that nearly 40% of adult males were current smokers. Beedi smoking was overall the commonest type of smoking in the community. Cigarette smoking was more common in the higher income groups and among the graduates and postgraduates. Beedi smoking was the main form of smoking among the lower and middle-income groups and among the illiterates and the less educated people. Very few female subjects admitted to smoking. The prevalence of symptomatics (those having one or more of chronic chest symptoms) was significantly higher in beedi smokers as compared to cigarette smokers in those smoking greater than 2.5 pack years. Prevalence of wheezing was however not significantly different. Multiple logistic regression analysis revealed type of smoking to be a significant independent determinant of occurrence of respiratory symptoms with the odds for occurrence of symptoms being 1.67 times greater in beedi smokers as compared to cigarette smokers. Lung function (FEV1/FVC and FEV1% predicted) showed significantly greater airways obstruction in beedi smokers as compared to cigarette smokers. It was concluded that the beedi smoking was as or more likely to cause clinical and functional impairment of lungs compared to cigarette smoking.