Sodium MRI of the human kidney at 3 Tesla.

The sodium concentration gradient in the kidney (from the cortex to the medulla) serves to regulate fluid homeostasis and is tightly coupled to renal function. It was previously shown that renal function and pathophysiology can be characterized in rat kidneys by measuring the sodium gradient with (23)Na MRI. This study demonstrates for the first time the ability of (23)Na MRI to map the distribution of sodium in the human kidney and to quantify the corticomedullary sodium gradient. The study was performed on a 3T Signa LX scanner (GE) using an in-house-built quadrature surface coil. (23)Na images of volunteers were acquired using a 3D coronal gradient-echo sequence at a spatial resolution of 0.3 x 0.3 x 1.5 cm(3) in a 25-min scan time. The signal intensity (relative to the noise) increased linearly from the cortex to each of the medullae with a mean slope of 1.6 +/- 0.2 in relative arbitrary units per mm (Rel.u./mm, N = 6) and then decreased, as expected, toward the renal pelvis. Water deprivation (12 hr) induced a significant increase of 25% (P < 0.05) in this gradient. Based on these results, we suggest that sodium MRI can serve as a valuable noninvasive method for functional imaging of the human kidney.     

In vivo MRI of cancer cell fate at the single-cell level in a mouse model of breast cancer metastasis to the brain.

Metastasis (the spread of cancer from a primary tumor to secondary organs) is responsible for most cancer deaths. The ability to follow the fate of a population of tumor cells over time in an experimental animal would provide a powerful new way to monitor the metastatic process. Here we describe a magnetic resonance imaging (MRI) technique that permits the tracking of breast cancer cells in a mouse model of brain metastasis at the single-cell level. Cancer cells that were injected into the left ventricle of the mouse heart and then delivered to the brain were detectable on MR images. This allowed the visualization of the initial delivery and distribution of cells, as well as the growth of tumors from a subset of these cells within the whole intact brain volume. The ability to follow the metastatic process from the single-cell stage through metastatic growth, and to quantify and monitor the presence of solitary undivided cells will facilitate progress in understanding the mechanisms of brain metastasis and tumor dormancy, and the development of therapeutics to treat this disease.     

Association between atrial fibrillation and central sleep apnea

BACKGROUND: We previously described an association between atrial fibrillation and central sleep apnea in a group of patients with congestive heart failure. We hypothesized that the prevalence of atrial fibrillation might also be increased in patients with central sleep apnea in the absence of other cardiac disease. METHODS AND RESULTS: We compared the prevalence of atrial fibrillation in a series of 60 consecutive patients with idiopathic central sleep apnea (apnea-hypopnea index > 10 events per hour, > 50% central events) with that in 60 patients with obstructive sleep apnea (apnea-hypopnea index > 10, > 50% obstructive events) and 60 patients without sleep apnea (apnea-hypopnea index < 10), matched for age, sex, and body mass index. Subjects with a history of congestive heart failure, coronary artery disease, or stroke were excluded from the study. The prevalence of atrial fibrillation among patients with idiopathic central sleep apnea was found to be significantly higher than the prevalence among patients with obstructive sleep apnea or no sleep apnea (27%, 1.7%, and 3.3%, respectively, P < .001). However, hypertension was most common and oxygen desaturation most extreme among patients with obstructive sleep apnea. CONCLUSIONS: We conclude that there is a markedly increased prevalence of atrial fibrillation among patients with idiopathic central sleep apnea in the absence of congestive heart failure. Moreover, the high prevalence of atrial fibrillation among patients with idiopathic central sleep apnea is not explainable by the presence of hypertension or nocturnal oxygen desaturation, since both of these were more strongly associated with obstructive sleep apnea.     

Intraocular pressure fluctuations during strabismus operations and the postoperative period

PURPOSE: To evaluate the intraocular pressure (IOP) variations which occur during and after strabismus surgery. METHOD: We measured the IOP in 34 eyes of 20 pediatric patients undergoing primary strabismus surgery under general anesthesia. Measurements were performed by the Tono-Pen (Mentor O&Q Inc. Norwell, MA) prior to surgery, immediately after suturing of the conjunctive, and 1 week and 4 weeks after surgery. All patients received the same local antibiotics and steroid solutions postoperatively. RESULTS: IOP decreased from baseline to the end of surgery by a mean of 8.26 +/- 1.8 mmHg and increased from baseline to 4 weeks after surgery by a mean of 3.6 +/- 1.8 mmHg. Thirty-eight percent of the eyes had an IOP of 21 mmHg or more during the postoperative period. CONCLUSION: IOP variations are prevalent during and after strabismus surgery. Careful postoperative measurements are recommended in order to identify individuals who may be prone to iatrogenically increased IOP.     

Using the clay slip game in art therapy: a sensory intervention

ABSTRACT

The goal of the present study was to achieve a better understanding of the experience of playing with slip and the ways in which participants experience the Clay Slip Game and how they perceive the therapeutic qualities of the material, thus including the potential for art therapists to add the Slip Game to their toolbox. Ten experienced qualified art therapists and 48 art therapy students took part. All participants engaged in the Slip Game during the study and reported their experiences in an interview (therapists) or in written personal reflections (students). Data analysis adhered to the principles of Grounded Theory [Charmaz (2006). Constructing grounded theory: A practical guide through qualitative analysis. London: Sage Publications]. The findings indicate that the experience of the Slip Game is mainly a sensory (tactile), playful, pleasant and calming experience of making without the need to produce an end product. The experience is more internal (meditative) and stimulates feelings of regression. The therapeutic qualities of the material, as discussed by the participants, are related to the regressive and sublimative processes afforded by the material, and as a material that enables sensory, behavioural, emotional, and motor regulation.

Plain-language summary

Art therapy is a type of psychotherapy that uses artistic materials and creative processes in the therapeutic process. Since art materials are the primary tools through which the art therapy processes occur, therapists need to have an in-depth understanding of the art materials they offer to their clients [Moon (2010). Materials & media in art therapy: Critical understandings of diverse artistic vocabularies. New York, NY: Routledge].

Slip is a mixture of water with an additional substance that produces a thick and saline-type paste [De Montmollin (2010). The barbotine game-challenge of creativity. Antwerpen.]. It can be made by diluting and filtering any kind of clay to make it semi-fluid. Playing with slip as a distinct and separate technique was defined as a ‘game’ by Daniel De Montmollin, a ceramicist. De Montmollin created the Slip Game as a way to help people free themselves from internal and external censorship or criticism.

The goal of this study was to understand the participants’ experience of the Slip Game and whether they found the process therapeutic. Forty-eight art therapy students and 10 art therapists took part in the study. After engaging in the Slip Game, the art therapists reported their experiences in an interview and the students wrote personal reflections. These were then analysed using Grounded Theory.

The findings show that the participants experienced the Slip Game as mainly sensory and reported it was pleasant, calming, playful and tactile, a way of ‘making’ without the need to produce an end product. They also found the experience to be meditative, that it stimulated feelings of regression and felt that engaging with slip also improved behaviour, emotional control and fine hand-movement skills.     

Progressive dyspnea associated with a crazy-paving appearance on a chest computed tomography scan

A ‘crazy-paving’ appearance of the lungs on computed tomography scanning of the chest was first described nearly 20 years ago in patients with pulmonary alveolar proteinosis, and was thought to be characteristic of this condition. However, this pattern has subsequently been reported in a variety of pulmonary diseases and is now considered to be nonspecific. The present report describes a case of a 74-year-old man in whom congestive heart failure presented with a crazy-paving appearance of the lungs on a chest computed tomography scan. This uncommon association illustrates the importance of the correlation of clinical and radiographic information.