Murine cerebral malaria development is independent of toll-like receptor signaling

Malaria pigment hemozoin was reported to activate the innate immunity by Toll-like receptor (TLR)-9 engagement. However, the role of TLR activation for the development of cerebral malaria (CM), a lethal complication of malaria infection in humans, is unknown. Using Plasmodium berghei ANKA (PbA) infection in mice as a model of CM, we report here that TLR9-deficient mice are not protected from CM. To exclude the role of other members of the TLR family in PbA recognition, we infected mice deficient for single TLR1, -2, -3, -4, -6, -7, or -9 and their adapter proteins MyD88, TIRAP, and TRIF. In contrast to lymphotoxin alpha-deficient mice, which are resistant to CM, all TLR-deficient mice were as sensitive to fatal CM development as wild-type control mice and developed typical microvascular damage with vascular leak and hemorrhage in the brain and lung, together with comparable parasitemia, thrombocytopenia, neutrophilia, and lymphopenia. In conclusion, the present data do not exclude the possibility that malarial molecular motifs may activate the innate immune system. However, TLR-dependent activation of innate immunity is unlikely to contribute significantly to the proinflammatory response to PbA infection and the development of fatal CM.     

Association of dietary calcium,magnesium, sodium,and potassium intake and hypertension: a study on an 8-year dietary intake data from the National Health and Nutrition Examination Survey

BACKGROUND/OBJECTIVESThere has been an increased interest in determining calcium magnesium, sodium, and potassium''s distinct effects on hypertension over the past decade, yet they simultaneously regulate blood pressure. We aimed at examining the association of dietary calcium, magnesium, sodium, and potassium independently and jointly with hypertension using National Health and Nutrition Examination Survey data from 2007 to 2014.MATERIALS/METHODSThe associations were examined on a large cross-sectional study involving 16684 US adults aged>20 years, using multivariate analyses with logistical models.RESULTSSodium and calcium quartiles assessed alone were not associated with hypertension. Potassium was negatively associated with hypertension in the highest quartile, 0.64 (95% confidence interval [CI], 0.48–0.87). When jointly assessed using the high and low cut-off points, low sodium and corresponding high calcium, magnesium, and potassium intake somewhat reduced the odds of hypertension 0.39 (95% CI, 0.20–0.76). The sodium-to-potassium ratio was positively associated with hypertension in the highest quartile1.50 (95% CI, 1.11–2.02). When potassium was adjusted for sodium intake and sodium-to-potassium ratio assessed among women, increased odds of hypertension were reported in the highest quartile as 2.02 (95% CI, 1.18–3.34) and 1.69 (95% CI, 1.12–2.57), respectively. The association of combined minerals on hypertension using dietary goals established that men meeting the reference intakes for calcium and exceeding for magnesium had reduced odds of hypertension 0.51 (95% CI, 0.30–0.89). Women exceeding the recommendations for both calcium and magnesium had the lower reduced odds of 0.30 (95% CI, 0.10–0.69).CONCLUSIONSOur results suggest that the studied minerals'' association on hypertension is stronger when jointly assessed, mostly after gender stratification. As compared to men, women increased their risk of hypertension even with a low sodium intake. Women would also reasonably reduce their risk of developing hypertension by increasing calcium and magnesium intake. In comparison, men would somewhat be protected from developing hypertension with calcium intake meeting the dietary goals and magnesium exceeding the nutritional goals.     

Accuracy of transmission CT and FDG-PET in the detection of small pulmonary nodules with integrated PET/CT

Purpose The purpose of this study was to determine the accuracy of detection of small pulmonary nodules on quiet breathing attenuation correction CT (CTAC) and FDG-PET when performing integrated PET/CT, as compared with a diagnostic inspiratory CT scan acquired in the same imaging session.Methods PET/CT scans of 107 patients with a history of carcinoma (54 male and 53 female, mean age 57.3 years) were analyzed. All patients received an integrated PET/CT scan including a CTAC acquired during quiet respiration and a contrast-enhanced CT acquired during inspiration in the same session. Breathing CTAC scans were reviewed by two thoracic radiologists for the presence of pulmonary nodules. FDG-PET scans were reviewed to determine accuracy of nodule detection. Diagnostic CT was used as the gold standard to confirm or refute the presence of nodules.Results On the CTAC scans 200 nodules were detected, of which 183 were true positive (TP) and 17, false positive. There were 109 false negatives (FN). Overall, 51 (48%) patients had a false interpretation, including 19 in whom CT was interpreted as normal for lung nodules. The average size of the nodules missed was 3.8±2 mm (range 2–12 mm). None of the nodules missed on the CTAC scans were detected by PET. In the right lung there were 20 TP, 42 true negative (TN), 11 FP, and 34 FN interpretations with a sensitivity in nodule detection of 37% (CI 24–51%) and a specificity of 79% (CI 66–89%). In the left lungs there were 16 TP, 65 TN, 3 FP, and 23 FN interpretations, with a sensitivity of 41% (CI 26–58%) and a specificity of 96% (CI 88–99%).Conclusion The detection of small pulmonary nodules by breathing CTAC and FDG-PET is relatively poor. Therefore an additional diagnostic thoracic CT scan obtained during suspended inspiration is recommended for thorough evaluation of those patients in whom detection of pulmonary metastases is necessary for management.     

Acute isolated velopharyngeal insufficiency in children: case report and systematic review of the literature

Acute isolated velopharyngeal insufficiency (VPI) is a clinical entity mainly reported in children. We undertook a systematic review in order to better characterize its features. Following a Medline search (1960–2012), the authors reviewed and analyzed the cases of acute VPI in children; 36 cases were found. The most common presenting features were hypernasal speech (97 %), nasal reflux (73 %), and dysphagia (49 %). 73 % of the children were males and 27 % females, of 8.9 ± 2.5 years. In all the cases the VPI was unilateral. One quarter of the children had a recent episode of febrile illness and 11 % of the children had an identified infection at the time of presentation (HAV, parvovirus B19, measles, and Coxsackie virus). No associated cause was found in the other cases. All cases resolved completely (67 %) or partially (33 %) without any treatment (89 %) or with prednisolone (11 %). Acute VPI represents a separate entity within the spectrum of VPI and it is a benign self-limiting disorder. The cause remains undetermined but an infectious disorder may play a role at least in some cases. Follow-up is mandatory in order to eliminate progressive conditions such as brainstem neoplasms or inflammatory diseases.     

Hybrid FDG-PET/MR compared to FDG-PET/CT in adult lymphoma patients

Purpose

The goal of this study is to evaluate the diagnostic performance of simultaneous FDG-PET/MR including diffusion compared to FDG-PET/CT in patients with lymphoma.

Methods

Eighteen patients with a confirmed diagnosis of non-Hodgkin’s (NHL) or Hodgkin’s lymphoma (HL) underwent an IRB-approved, single-injection/dual-imaging protocol consisting of a clinical FDG-PET/CT and subsequent FDG-PET/MR scan. PET images from both modalities were reconstructed iteratively. Attenuation correction was performed using low-dose CT data for PET/CT and Dixon-MR sequences for PET/MR. Diffusion-weighted imaging was performed. SUV_max was measured and compared between modalities and the apparent diffusion coefficient (ADC) using ROI analysis by an experienced radiologist using OsiriX. Strength of correlation between variables was measured using the Pearson correlation coefficient (r _p).

Results

Of the 18 patients included in this study, 5 had HL and 13 had NHL. The median age was 51 ± 14.8 years. Sixty-five FDG-avid lesions were identified. All FDG-avid lesions were visible with comparable contrast, and therefore initial and follow-up staging was identical between both examinations. SUV_max from FDG-PET/MR [(mean ± sem) (21.3 ± 2.07)] vs. FDG-PET/CT (mean 23.2 ± 2.8) demonstrated a strongly positive correlation [r _s = 0.95 (0.94, 0.99); p < 0.0001]. There was no correlation found between ADC_min and SUV_max from FDG-PET/MR [r = 0.17(?0.07, 0.66); p = 0.09].

Conclusion

FDG-PET/MR offers an equivalent whole-body staging examination as compared with PET/CT with an improved radiation safety profile in lymphoma patients. Correlation of ADC to SUV_max was weak, understating their lack of equivalence, but not undermining their potential synergy and differing importance.

     

Consumption of a Diet Rich in Cottonseed Oil (CSO) Lowers Total and LDL Cholesterol in Normo-Cholesterolemic Subjects

Animal data indicates that dietary cottonseed oil (CSO) may lower cholesterol; however, the effects of a CSO-rich diet have not been evaluated in humans. Thirty-eight healthy adults (aged 18%#x2013;40; 12 males, 26 females) consumed a CSO rich diet (95 g CSO daily) for one week. Anthropometric measurements were obtained, and blood was drawn pre- and post-intervention. Serum lipids (total cholesterol (TC), high density lipoprotein (HDL), low density lipoprotein (LDL), triglyceride (TG), and free fatty acids (FFA)) were assayed. There was no change in weight or waist circumference among participants. There was no change in HDL (Pre: 1.27 ± 0.4 mmol/L; Post: 1.21 ± 0.3 mmol/L) or TG (Pre: 0.91 ± 0.6 mmol/L; Post: 1.06 ± 1.0 mmol/L). Total cholesterol and LDL were reduced (TC Pre: 4.39 ± 0.9 mmol/L; Post: 4.16 ± 0.8 mmol/L; LDL Pre: 2.70 ± 0.8 mmol/L; Post: 2.47 ± 0.6 mmol/L). When data were grouped by sex, total cholesterol was reduced in female participants (Pre: 4.34 ± 0.9 mmol/L; Post: 4.09 ± 0.8 mmol/L). Consumption of a high fat, CSO-rich diet for one week reduced total cholesterol in female participants without reducing HDL.