Intravascular ultrasound

A new technique has been developed to compute left ventricular (LV) time activity curves from gated blood pool (GBP) studies without the use of manual, semiautomated or fully automated edge detection algorithms. The method utilizes the correlation of entropy calculated from the counts of a fixed region of interest covering the left ventricle during a cardiac cycle to compute the LV volume curve for a new patient. The new LV volume curve is obtained through interpolation of those volume curves of a data base which are associated with the closest variations in normalized entropy to the new one. The computed LV time activity curves agree with those obtained from manual or fully automated outlines of the left ventricle within 9 percent for the selected set of 67 patients demonstrating the potential of the method. The accuracy of calculated LV volume curves can be improved theoretically to any degree by increasing the number of cases in the data base of known statistical feature vectors associated with the LV images and LV volume curves. The new method for computation of LV curves is very efficient and robust when compared to traditional techniques.     

Interactions Between Reappraisal and Emotional Nonacceptance in Psychopathology: Examining Disability and Depression Symptoms in Generalized Anxiety Disorder

Recent research has emphasized the importance of studying the interaction between adaptive and maladaptive emotion regulation strategies in predicting mental health. In this respect, putatively maladaptive strategies (e.g., avoidance) have been found to moderate the link between putatively adaptive strategies (e.g., reappraisal) and psychopathology symptoms (e.g., Aldao and Nolen-Hoeksema in J Abnorm Psychol 121(1):276–281, 2012; Aldao et al. in J Anxiety Disord 28(4):382–389, 2014). Moreover, this line of work suggests that the direction of this moderation might vary as a function of symptom severity. However, research has yet to: (1) simultaneously examine how this interaction differs between clinical and non-clinical groups, and (2) test the interaction between specific emotion regulation strategies rather than composite scores of adaptive and maladaptive strategies. Doing so is essential in order to develop a more sophisticated understanding of the disturbances in the use of emotion regulation strategies in psychopathology. To that end, we investigated the interaction between reappraisal and emotional nonacceptance in participants diagnosed with generalized anxiety disorder (GAD) and non-anxious controls. In the GAD group, there was a negative association between reappraisal and disability only when the use of nonacceptance was low, suggesting that the use of maladaptive strategies might interfere with the benefits typically associated with utilizing adaptive strategies. In the non-anxious group, there was a negative association between reappraisal and disability and depression symptoms, only when the use of nonacceptance was high, likely reflecting a compensatory and flexible use of regulation strategies. These findings highlight the importance of modeling interactions between specific emotion regulation strategies when seeking to understand their relationship to psychological functioning in GAD.     

Usefulness of late gadolinium enhancement combined with MRI and 67-Ga scintigraphy in the diagnosis of cardiac sarcoidosis and disease activity evaluation

We report a case in which late gadolinium enhancement (LGE) and 67-Ga scintigraphy were useful for the diagnosis of cardiac sarcoidosis and for the evaluation of the disease activity.The patient was a 60-year-old woman who had been diagnosed as having eye sarcoidosis when she was 48. Two years previously her electrocardiogram had shown abnormalities but the coronary angiography had shown normal coronary arteries; however, an aneurysm was detected in the apical portion by left ventriculography. A II degree AV block was noted on the electrocardiogram and she was referred to us for further detailed evaluation. Since the biopsy findings of skin eruptions on both eyelids indicated an epithelial cell granuloma, she was diagnosed as having cutaneous sarcoidosis. On the 67-Ga scintigram, myocardial accumulation of gallium was recognized, and on cardiovascular magnetic resonance (CMR), LGE was recognized. She was diagnosed as cardiac sarcoidosis and steroid therapy started with 30 mg prednisolone. The myocardial accumulation of gallium on the 67-Ga scintigram disappeared after the 30th day of steroid therapy. On the other hand, no changes in LGE patterns were seen after steroid therapy. In this case, LGE was useful for the diagnosis of cardiac sarcoidosis, and 67-Ga scintigram was useful for the evaluation of the disease activity. This case shows that both imaging techniques are important for the diagnosis of cardiac sarcoidosis and evaluation of the disease.     

Comparison of cooling methods to induce and maintain normo- and hypothermia in intensive care unit patients: a prospective intervention study

Background  

Temperature management is used with increased frequency as a tool to mitigate neurological injury. Although frequently used, little is known about the optimal cooling methods for inducing and maintaining controlled normo- and hypothermia in the intensive care unit (ICU). In this study we compared the efficacy of several commercially available cooling devices for temperature management in ICU patients with various types of neurological injury.     

Can hyperbaric oxygen be used as adjunctive heart failure therapy through the induction of endogenous heat shock proteins

Heart failure (HF) is a chronic condition that is expected to increase in incidence along with increased life expectancy and an aging population. As the incidence of HF increases, the cost to national healthcare budgets is expected to run into the billions. The costs of lost productivity and increased social reliance on state support must also be considered. Recently, acute myocardial infarction (AMI) has come to be seen as the major contributing factor to HF. Although thrombolysis may restore coronary perfusion after an AMI, it may also introduce ischemic reperfusion injury (IRI). In an attempt to ameliorate sustained protein damage caused by IRI, endogenous chaperone proteins known as heat shock proteins (HSPs) are induced as a consequence of the stress of IRI. Recently, hyperbaric oxygen has been shown to induce the production of HSPs in noncardiac tissue, with a resultant protective effect. This current opinion review article suggests a possible role for hyperbaric oxygen, as a technologically modern drug, in augmenting the induction of endogenous HSPs to repair and improve the function of failing hearts that have been damaged by AMI and IRI. In addition, this simple, safe, noninvasive drug may prove useful in easing the economic burden of HF on already overextended health resources.     

Timing of therapeutic intervention determines functional and survival outcomes in a mouse model of late infantile batten disease.

Classical late infantile neuronal ceroid lipofuscinosis (cLINCL) is a monogenic disorder caused by the loss of tripeptidyl peptidase 1 (TPP1) activity as a result of mutations in CLN2. Absence of TPP1 results in lysosomal storage with an accompanying axonal degeneration throughout the central nervous system (CNS), which leads to progressive neurodegeneration and early death. In this study, we compared the efficacies of pre- and post-symptomatic injections of recombinant adeno-associated virus (AAV) for treating the cellular and functional abnormalities of CLN2 mutant mice. Intracranial injection of AAV1-hCLN2 resulted in widespread human TPP1 (hTPP1) activity in the brain that was 10-100-fold above wild-type levels. Injections before disease onset prevented storage and spared neurons from axonal degeneration, reflected by the preservation of motor function. Furthermore, the majority of CLN2 mutant mice treated pre-symptomatically lived for at least 330 days, compared with a median survival of 151 days in untreated CLN2 mutant controls. In contrast, although injection after disease onset ameliorated lysosomal storage, there was evidence of axonal degeneration, motor function showed limited recovery, and the animals had a median lifespan of 216 days. These data illustrate the importance of early intervention for enhanced therapeutic benefit, which may provide guidance in designing novel treatment strategies for cLINCL patients.     

Why do GPs with a special interest in headache investigate headache presentations with neuroradiology and what do they find?

The general practitioner with a special interest in headache offers an important contribution to the management of headache in primary care where the majority of presentations take place. A number of guidelines have been developed for neuroradiological investigation of headache, but their clinical utility and relevance is not known. Fourteen general practitioners with a special interest in headache recorded consecutive headache consultations over a 3-month period, whether patients were investigated with neuroradiology and if so the reason for investigation and outcome. Reason for investigation was compared to the guidelines published for the use in primary care. 895 patients were seen, of whom 270 (30.1%) were investigated. 47% of indications were outside the guidance framework used, the most common reason for investigation being reassurance. Of those investigated, 5.6% showed positive findings but only 1.9% of findings were felt to be of clinical significance. General practitioners with a special interest investigated with neuroradiology a greater level than general practitioners, but less than neurologists. However, yields of significant findings are broadly comparative across all groups. This report confirms other studies that suggest that even when there is a high level of clinical suspicion, yields of significant findings are very low.     

Clinical application of a new method that segments the region of interest into multiple layers for RF amplitude histogram analysis in the cirrhotic liver

Purpose We used texture analysis in conjunction with an alternative method of analyzing the amplitude histogram using a radiofrequency (RF) signal to differentiate ultrasonograms of normal and cirrhotic livers. This method segments the region of interest (ROI) into multiple layers (sub-ROIs). In each sub-ROI of a homogeneous medium, the histogram of enveloped-amplitude of RF backscattered echoes resembles a Rayleigh distribution. Theoretically, the values of the signal-to-noise ratio (SNR), skewness, and kurtosis for Rayleigh statistics are constant and independent of the mean scattering intensity, which is contributed by such undesirable effects as tissue attenuation, beam diffraction, and incident waveforms. These values, which averaged overall sub-ROI, should provide an unbiased estimator.Methods We studied 36 normal livers and 28 cirrhotic livers, all confirmed by clinical findings including laboratory and pathology data; the SNR, skewness, and kurtosis values of the disease groups were compared. At the same time, these values were estimated using the conventional method, which did not segment the ROI into multiple sub-ROIs. The unpaired t-test was used to determine statistical significance.Results With the new method, all values obtained from cirrhotic livers differed significantly from those obtained from normal livers, and the standard deviation of these values was smaller than those obtained using the conventional method.Conclusions These results suggest that the new method can be used to diagnose the cirrhotic liver objectively.This article is translated from the Japanese version, which was published in J Med Ultrasonics 2001;28:J25–33     

Usefulness of six non-proprietary indirect markers of liver fibrosis in patients with chronic hepatitis C.

BACKGROUND: The aim of the study was to perform a comprehensive diagnostic evaluation of six popular, non-proprietary, indirect markers of liver fibrosis in a cohort of patients with chronic hepatitis C representing the full spectrum of disease severity. METHODS: A total of 167 consecutive, hepatitis C virus RNA positive, untreated patients with chronic hepatitis C were studied. Liver biopsy with histological evaluation and age/platelet index, aspartate aminotransferase/alanine aminotransferase ratio, aspartate aminotransferase to platelet ratio index, Bonacini's discriminant score, Forn's fibrosis index and FibroIndex were assessed in all patients. RESULTS: The area under the receiver operating characteristic curves of the six tests was always greater when performed to discriminate patients with METAVIR score F4 than when assessed to discriminate patients with METAVIR score > or =F2. At step-wise discriminant analysis the only indirect marker of fibrosis entered was FibroIndex, with the following correct classification of the patients: total=52.1, patients with scores F0-F1=62.2, patients with scores F2-F3=26.0 and patients with score F4=68.4. CONCLUSIONS: The ability to correctly classify patients using a panel of non-proprietary indirect markers of liver fibrosis is far from being ideal. Among them, FibroIndex appears to possess the best discriminating capacity. The simultaneous use of several indirect markers of liver fibrosis does not improve their diagnostic accuracy.     

Primary multicentric anaplastic pleomorphic xanthoastrocytoma with atypical features

Pleomorphic xanthoastrocytoma (PXA) is a rare tumor with good prognosis after surgery. Few cases of anaplastic PXA (either de novo or secondary to transformation of a recurrent low grade PXA) have been reported. Moreover, primary anaplastic PXA with dissemination at diagnosis has been described only in two patients, to our knowledge. We report the first case of primary multicentric anaplastic PXA and discuss its atypical features and the pertinent literature.