Repeatability of ultrasonographic median nerve measures

In this study we investigated the reliability of ultrasound in measuring median nerve characteristics including cross‐sectional area (CSA), flattening ratio (FR), swelling ratio (SR), and mean grayscale. Generalizability theory was used to assess inter‐ and intrarater reliability using the dependability coefficient (?), normalized standard error of measurement, and normalized minimum detectable change (MDC_NORM) for multiple study design protocols. Interrater reliability was generally moderate. Intrarater reliability was mostly good (? > 0.876) when using a single image, captured on one occasion, and being read once. Intrarater MDC_NORM ranged from 3.8% to 6.2% for all CSA measures and SR. Using multiple images and/or readings at multiple occasions did not appreciably improve reliability measures. Ultrasound is a reliable tool for measuring median nerve characteristics. We recommend that a single evaluator capture all images for protocols aimed at quantifying median nerve ultrasound measures. We believe an appropriately designed protocol can utilize ultrasound to accurately assess changes in median nerve characteristics after activity. Muscle Nerve, 2010     

Haemagglutinin and neuraminidase characterization of low pathogenic H5 and H7 avian influenza viruses isolated from Northern pintails (<Emphasis Type="Italic">Anas</Emphasis> <Emphasis Type="Italic">acuta</Emphasis>) in Japan,with special reference to genomic and biogeographical aspects

Pintails constitute an important host of avian influenza viruses (AIVs). Genetic, molecular, and antigenic characteristics of H5 and H7 AIVs, which we isolated from northern pintails (Anas acuta) wintering in Japan, were analyzed and found to be linked to various ecological features, chiefly in terms of gene geography, as shaped by various migratory aquatic host species. Although all the isolates were found to be of low pathogenicity (LP), we explored gene predispositions that may potentially underlie tentative transition to high pathogenicity (HP). Evolutionarily, the HA and NA genes of the isolates affiliated mostly with Eurasian lineage. The viruses closely related to ours were derived from China, Korea, Mongolia, Japan, and Australia. Comprehensive ecophylogenetic evaluations revealed that the pintail populations we sampled might have given rise to or been involved in the emergence of a LPAI H7N6 subtype that caused outbreaks in quail (Coturnix japonica) farms in Japan, as well as of the first H5N9 subtype ever isolated in Asia. The latter strain isolated by us showed, yet, notable affinity to certain North American and Australian strains, thereby signifying apparent intercontinental interfaces accounted for by extensive water-bird flyways. Noticeable conservation of certain antigenic sites within both Eurasian and North American H7 HAs is apparently an outcome of their advantageous survival value, in terms of restricted immunogenicity. Besides, the Japanese–Korean–Siberian regional axis seems to be particularly important for ongoing generation of novel viral strains due to conveyance of certain genes and genomes by migratory ducks, including such that circulate among pigs and human.     

The Role of Sex Steroid Receptors on Lipogenesis in Breast and Prostate Carcinogenesis: A Viewpoint

Cancer cells require both nutrients and mitogens to multiply and survive in the unfavorable microenvironment of solid tumors or metastases before angiogenesis. Most cancer cells do not use fatty acids (FA) from the circulation but synthesize them in situ especially to make membranes and lipid signals required for continuously dividing cells. Three lipogenic enzymes are overexpressed, induced by sex steroid hormones and responsible for the in situ increased lipogenesis in cancer cells. We propose that in the early stages of human breast and prostate carcinogenesis, an increased activity of sex steroid receptors is partly responsible for the overexpression of FA synthase (FASN) whose regulation in cancer cells has been particularly studied. Increased activity of androgen receptor (AR), via different mechanisms, was extensively reported in prostate cancer. An increased level/and or activity of progesterone receptors, correlated with an increased expression of FASN, was found both in early stages of breast carcinogenesis and during the hormone replacement therapy of menopausal women. While the majority of recent targeted therapies are based on inhibition of mitogenic pathways, the inhibition of cancer cell nutrition by interfering with lipid synthesis and hormone action should open the way to new therapeutic and preventive approaches of hormone-dependent cancers.     

Palpebral subconjunctival hemorrhages in herpes zoster ophthalmicus

A 75-year-old previously healthy woman was referred for evaluation of pain and foreign body sensation in her left eye of 4 days' duration. Two weeks before presentation she was diagnosed with herpes zoster involving the left forehead and temple area and started on famciclovir treatment. Examination of her left cornea revealed inferior superficial punctate keratitis, but no dendrites or pseudodendrites. Upper eyelid eversion disclosed unusual raised palpebral subconjunctival hemorrhages on the left side. She was started on topical prednisolone eyedrops in the left eye, and her symptoms improved over the following week. Herpes zoster ophthalmicus can initially present in the eyelids. Careful follow-up with particular attention to the eyelids and eyelid eversion is recommended in any patient presenting with herpes zoster to detect early ocular involvement.     

Influence of visual inputs on quasi-static standing postural steadiness in individuals with spinal cord injury

Postural steadiness while standing is impaired in individuals with spinal cord injury (SCI) and could be potentially associated with increased reliance on visual inputs. The purpose of this study was to compare individuals with SCI and able-bodied participants on their use of visual inputs to maintain standing postural steadiness. Another aim was to quantify the association between visual contribution to achieve postural steadiness and a clinical balance scale. Individuals with SCI (n = 15) and able-bodied controls (n = 14) performed quasi-static stance, with eyes open or closed, on force plates for two 45 s trials. Measurements of the centre of pressure (COP) included the mean value of the root mean square (RMS), mean COP velocity (MV) and COP sway area (SA). Individuals with SCI were also evaluated with the Mini-Balance Evaluation Systems Test (Mini BESTest), a clinical outcome measure of postural steadiness. Individuals with SCI were significantly less stable than able-bodied controls in both conditions. The Romberg ratios (eyes open/eyes closed) for COP MV and SA were significantly higher for individuals with SCI, indicating a higher contribution of visual inputs for postural steadiness in that population. Romberg ratios for RMS and SA were significantly associated with the Mini-BESTest. This study highlights the contribution of visual inputs in individuals with SCI when maintaining quasi-static standing posture.     

CT and F-deoxyglucose (FDG) image fusion for optimization of conformal radiotherapy of lung cancers

Purpose: To validate a computed tomography (CT) and ¹⁸F-deoxyglucose (FDG) image fusion procedure and to evaluate its usefulness to facilitate target definition and treatment planning in three-dimensional conformal radiation therapy (3D-CRT) for non–small-cell lung cancer.

Methods and Materials: Twelve patients were assessed by CT and FDG-coincidence mode dual-head gamma camera (CDET) before radiotherapy. The patients were placed in a similar position during CT and FDG-CDET. Matching was achieved by minimizing the cost function by 3D translation and rotation between four landmarks drawn on the patient’s skin. Virtual simulation was performed from image fusion and estimated dose–volume histograms (DVH) were calculated.

Results: Quantitative analysis indicated that the matching error was < 5 mm. Fusion of anatomic and metabolic data corrected staging of lymph nodes (N) for 4 patients and staging of metastases for 1 patient. In these 5 patients, DVH revealed that the lung volume irradiated at 20 Gy (Vl₂₀) was decreased by an average of 22.8%, and tumor volume irradiated at the 95% isodose (V₉₅) was increased by 22% and 8% for 2 patients, respectively, and was decreased by an average of 59% for 3 patients after fusion. No difference in terms of Vl₂₀ and V₉₅ was observed for the other 7 patients.

Conclusion: We have validated CT and FDG-CDET lung image fusion to facilitate determination of lung cancer volumes, which improved the accuracy of 3D-CRT.