Irisin Levels Are not Associated to Resistance Training-Induced Alterations in Body Mass Composition in Older Untrained Women with and without Obesity.

OBJECTIVE: The present study aimed to determine whether Irisin levels are correlated with body composition changes following 16 weeks of resistance training (RT) in older women with and without obesity. Design, Setting, Participants, Intervention: We recruited 49 inactive women (n = 23, non-obese: < 41.0% and n = 26, obese: ≥ 41.0% of body fat) aged 61-68 years to perform 16-week of RT consisting of 10 exercises (three sets of 10 exercises, 6-12 repetitions maximum and 1-min and 30-s rest intervals between sets and exercises, respectively) with two sessions per week. MEASUREMENTS: Before and after the intervention period, blood samples were collected to determine Irisin levels and body composition (percentage body fat and fat-free mass) was measured by dual energy x-ray absorptiometry. RESULTS: Circulating Irisin displayed a decrease for the non-obese group as compared with pre-intervention and obese group (p = 0.01 and p = 0.04, respectively), with no change for the obese group (p = 0.79). In addition, fat mass displayed a significant reduction (p < 0.05) following the training period only for the obese group. Furthermore, there was no association between changes in circulating Irisin with body mass index, body fat, fat-free mass and muscle strength. There was an increase in muscle strength (p < 0.05), regardless of obesity status. CONCLUSION: The modulation of body composition and muscle strength induced by 16-week of resistance training in older women with and without obesity is not associated with changes in circulating Irisin levels.

Magnetic resonance imaging findings in giant cell arteritis.

PurposeGiant cell arteritis (GCA) is a systemic vasculitis that affects medium-to-large-caliber arteries. Early diagnosis and treatment is essential as involvement of the ophthalmic artery or its branches may cause blindness. Radiographic findings may be variable and non-specific leading to delay in diagnosis. We conducted a review of the literature on neuroimaging findings in GCA and present a retrospective case series from tertiary-care ophthalmic referral centers of three patients with significant neuroimaging findings in biopsy-proven GCA.MethodsRetrospective case series of biopsy-proven GCA cases with neuroimaging findings at the Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital between 2010-2015 were included in this study. Literature search was conducted using Google Scholar and Medline search engines between the years 1970 and 2015.ResultsWe report findings of optic nerve enhancement, optic nerve sheath enhancement, and the first description in the English-language ophthalmic literature, to our knowledge, of chiasmal enhancement in biopsy-proven GCA. We describe four main categories of neuroimaging findings that may be seen in GCA from our series and from past cases in the literature.DiscussionIt is essential that clinicians be aware of the possible radiographic findings in GCA. Appropriate and prompt treatment should not be delayed based upon these findings.

Development of a diffusion-weighted MRI protocol for multicentre abdominal imaging and evaluation of the effects of fasting on measurement of apparent diffusion coefficients (ADCs) in healthy liver.

OBJECTIVE: To assess the effect of fasting and eating on estimates of apparent diffusion coefficient (ADC) in the livers of healthy volunteers using a diffusion-weighted MRI protocol with b-values of 100, 500 and 900 s mm(-2) in a multicentre study at 1.5 T. METHODS: 20 volunteers were scanned using 4 clinical 1.5-T MR scanners. Volunteers were scanned after fasting for at least 4 h and after eating a meal; the scans were repeated on a subsequent day. Median ADC estimates were calculated from all pixels in three slices near the centre of the liver. Analysis of variance (ANOVA) was used to assess the difference between ADC estimates in fasted and non-fasted states and between ADC estimates on different days. RESULTS: ANOVA showed no difference between ADC estimates in fasted and non-fasted states (p = 0.8) nor between ADC estimates on different days (p = 0.8). The repeatability of the measurements was good, with coefficients of variation of 5.1% and 4.6% in fasted and non-fasted states, respectively. CONCLUSION: There was no significant difference in ADC estimates between fasted and non-fasted measurements, indicating that the perfusion sensitivity of ADC estimates obtained from b-values of 100, 500 and 900 s mm(-2) is sufficiently low that changes in blood flow in the liver after eating are undetectable beyond the variability in the measurements. ADVANCES IN KNOWLEDGE: Assessment of the effect of prandial state on ADC estimates is critical, in order to determine the appropriate patient preparation for biological validation in clinical trials.

Monitoring the response of bone metastases to treatment with Magnetic Resonance Imaging and nuclear medicine techniques: a review and position statement by the European Organisation for Research and Treatment of Cancer imaging group.

Assessment of the response to treatment of metastases is crucial in daily oncological practice and clinical trials. For soft tissue metastases, this is done using computed tomography (CT), Magnetic Resonance Imaging (MRI) or Positron Emission Tomography (PET) using validated response evaluation criteria. Bone metastases, which frequently represent the only site of metastases, are an exception in response assessment systems, because of the nature of the fixed bony defects, their complexity, which ranges from sclerotic to osteolytic and because of the lack of sensitivity, specificity and spatial resolution of the previously available bone imaging methods, mainly bone scintigraphy. Techniques such as MRI and PET are able to detect the early infiltration of the bone marrow by cancer, and to quantify this infiltration using morphologic images, quantitative parameters and functional approaches. This paper highlights the most recent developments of MRI and PET, showing how they enable early detection of bone lesions and monitoring of their response. It reviews current knowledge, puts the different techniques into perspective, in terms of indications, strengths, weaknesses and complementarity, and finally proposes recommendations for the choice of the most adequate imaging technique.

Use of apparent diffusion coefficient as a response biomarker in bone: effect of developing sclerosis on quantified values.

OBJECTIVE: To investigate the effect of sclerosis on apparent diffusion coefficient measurements in bone metastases from prostate cancer undergoing treatment. MATERIALS AND METHODS: Sixteen patients underwent CT scans and MRI at baseline and 12 weeks following commencement of chemotherapy. For each patient, up to five bone metastases were selected. Hounsfield units were measured on CT and apparent diffusion coefficient (ADC) was measured on diffusion weighted MRI at both time points. Correlations between changes in apparent diffusion coefficient and Hounsfield units were investigated. RESULTS: Corresponding pre- and post-treatment apparent diffusion coefficient and Hounsfield units were available on 60 lesions from 16 patients. Overall, there was no significant correlation between changes in apparent diffusion coefficient with Hounsfield units. However, where changes in Hounsfield units increased by more than 50 %, there was a trend for an associated ADC rise. CONCLUSIONS: Increasing sclerosis of bone metastases on treatment does not significantly impede diffusion.

Morphology of the midgut of Rhipicephalus sanguineus (Latreille, 1806) (Acari: Ixodidae) adult ticks in different feeding stages.

The intestinal epithelial cells of ticks are fundamental for their full feeding and reproductive success, besides being considered important sites for the development of pathogens. Rhipicephalus sanguineus ticks are known for their great medical and veterinary importance, and for this reason, the knowledge of their intestinal morphology may provide relevant subsidies for the control of these animals, either by direct acaricidal action over these cells or by the production of vaccines. Therefore, this study aimed to describe the midgut morphology of male and female R. sanguineus ticks in different feeding stages, by means of histological analysis. Significant differences were observed between the genders, and such alterations may refer mainly to the distinct demands for nutrients, much higher in females, which need to develop and carry out the egg-laying process. In general, the midgut is coated by a thin muscle layer and presents a pseudostratified epithelium, in which two basic types of cells can be observed, connected to a basal membrane-generative or stem and digestive cells. The latter was classified as follows: residual, deriving from the phase anterior to ecdysis; pinocytic, with vesicles containing liquid or pre-digested components of blood; phagocytic, with entire cells or remnants of nuclear material inside cytoplasmic vesicles; and mature, free in the lumen. Digestion is presumably intracellular and asynchronous and corresponds to a process which starts with the differentiation of generative cells into pinocytic digestive cells, which subsequently start to phagocytize intact blood cells and finally detach from the epithelium, being eliminated with feces.

Assessing response in bone metastases in prostate cancer with diffusion weighted MRI.

OBJECTIVES: To determine whether changes in ADC of bone metastases secondary to prostate carcinoma are significantly different in responders compared with progressors on chemotherapy. METHODS: Twenty-six patients with known bone metastases secondary to prostate carcinoma underwent diffusion-weighted MRI of the lumbar spine and pelvis at baseline and 12 weeks following chemotherapy. RECIST assessment of staging CT and PSA taken at the same time points were used to classify patients as responders, progressors or stable. ADC (from b = 0,50,100,250,500,750 smm⁻²) and ADC(slow) (from b = 100,250,500,750 smm⁻²) were calculated for up to 5 lesions per patient. RESULTS: Mean ADC/ADC(slow) in lesions from responders and progressors showed a significant increase. Although the majority of lesions demonstrated an ADC/ADC(slow) rise, some lesions in both responders and progressors demonstrated a fall in ADC beyond the limits of reproducibility. CONCLUSIONS: Mean ADC is not an appropriate measure of response in bone metastases. The heterogeneity of changes in ADC is likely to be related to the composition of bone marrow with changes that have opposing effects on ADC.

SUPPORT Tools for evidence-informed health Policymaking (STP) 9: assessing the applicability of the findings of a systematic review

This article is part of a series written for people responsible for making decisions about health policies and programmes and for those who support these decision makers. Differences between health systems may often result in a policy or programme option that is used in one setting not being feasible or acceptable in another. Or these differences may result in an option not working in the same way in another setting, or even achieving different impacts in another setting. A key challenge that policymakers and those supporting them must face is therefore the need to understand whether research evidence about an option can be applied to their setting. Systematic reviews make this task easier by summarising the evidence from studies conducted in a variety of different settings.

Diffusion-weighted imaging of the prostate and rectal wall: comparison of biexponential and monoexponential modelled diffusion and associated perfusion coefficients.

This study compares parameters from monoexponential and biexponential modelling of diffusion-weighted imaging of normal and malignant prostate tissue and normal rectal wall tissues. Fifty men with Stage Ic prostate cancer were studied using endorectal T(2)-weighted imaging and diffusion-weighted imaging with 11 diffusion-sensitive values (b-values = 0, 1, 2, 4, 10, 20, 50, 100, 200, 400, 800 s/mm(2)). Regions of interest were drawn within non-malignant central gland and peripheral zone, malignant prostate tissue and normal rectal wall tissue. Both a monoexponential and biexponential model was fitted over various b-value ranges, giving an apparent diffusion coefficient (ADC) from the monoexponential model and a diffusion coefficient, perfusion coefficient and perfusion fraction from the biexponential model. In all tissues, over the full range of b-values, the ADC from the monoexponential model was significantly higher than the corresponding diffusion coefficient from the biexponential model. As the minimum b-value increased, the ADC decreased and was equal to the diffusion coefficient for some b-value ranges. The biexponential model best described the data when low b-values were included, suggesting that there is a fast perfusion component. Neither model could distinguish between benign prostate tissues on the basis of diffusion coefficients, but the rectal wall tissue and malignant prostate tissue had significantly lower diffusion coefficients than normal prostate tissues. Perfusion coefficients and fractions were highly variable within the population, so their clinical utility may be limited, but removal of this variable perfusion component from reported diffusion coefficients is important when attributing clinical differences to diffusion within tissues.

Cassava starch fermentation wastewater: characterization and preliminary toxicological studies.

Cassava starch fermentation wastewater is an industrial residue composed mainly of lactic acid bacteria with predominance of the genera Lactobacillus, and organic acids. To evaluate the safety of this residue for possible production of probiotic beverages, acute in mice and sub-chronic (28-day repeated dose) toxicity studies in rats were carried. The administration of a single dose of 5 g/kg/body weight did not produce mortality in mice. Rats treated with water containing 0 (control), 25%, 50%, and 100% of the residue for 28 days, did not present alterations in behaviour or in food and water consumption. There were no treatment-related changes of toxicological significance in the relative weight of the organs neither in the haematological nor in the biochemical parameters. Histopathologic alterations observed in the small intestine did not seem to be associated with the treatment.

Membrane cleaning in the dairy industry: a review.

Membrane separation processes have become part of the set of basic unit operations for dairy process design and product development. These processes are employed in a variety of separation and concentration duties, but in all cases, the membranes must be cleaned regularly to remove both organic and inorganic material deposited on the surface from the fluid stream being processed. Cleaning is a vital step in maintaining the permeability and selectivity of the membrane and is necessary to return the plant to its original capacity, to minimize risks of bacteriological contamination, and to produce acceptable products. Caustic-, acidic-, and enzyme-based cleaners may be used for membrane cleaning and are usually formulated with additives to best match the specific cleaning duty. Cleaning generates significant volumes of wastewater and reduces membrane life and plant productivity, so each regime must be optimized with respect to concentration, order and duration of cleaning steps, temperature, pressure, and flow rate. This article reviews the key mechanisms governing cleaning performance and suggests directions by which further optimization may be achieved.

Hepatic capillariasis in children: report of 3 cases in Brazil.

Capillaria hepatica is a helminth that may cause an extremely rare condition of parasitic hepatitis. Only 29 cases have been published, 2 of them in Brazil. We report here 3 cases of children in Brazil with massive hepatic capillariasis who presented the characteristic triad of this type of infection, i.e., persistent fever, hepatomegaly, and eosinophilia. The diagnosis was made by liver biopsy. All children responded well after treatment with thiabendazole (case 1), albendazole (case 3), and albendazole in combination with a corticoid (case 2). Case 1 has been followed-up for 24 years, an event not previously reported in the literature.

Myometrial zonal differentiation and uterine junctional zone hyperplasia in the non-pregnant uterus.

Human non-gravid myometrium differentiates in response to ovarian sex steroids into a subendometrial layer or junctional zone and an outer myometrial layer. Compared to the outer myometrial layer, the junctional zone myocytes are characterized by higher cellular density and lower cytoplasmic-nuclear ratio. These structural differences allow in-vivo visualization of the myometrial zonal anatomy by T2-weighted magnetic resonance (MR) imaging. The human myometrium is also functionally polarized. Video-vaginosonography studies have shown that propagated myometrial contractions in the non-pregnant uterus originate only from the junctional zone and that the frequency and orientation of these contraction waves are dependent on the phase of the menstrual cycle. The mechanisms underlying zonal myometrial differentiation are not known, but growing evidence suggests that ovarian hormone action may be mediated through cytokines and uterotonins locally released by the basal endometrial layer and endometrio-myometrial T-lymphocytes. Irregular thickening of the junctional zone due to inordinate proliferation of the inner myometrium, junctional zone hyperplasia, is a common MR finding in women suffering from menstrual dysfunction. Preliminary data suggest that junctional zone hyperplasia is further characterized by loss of normal inner myometrial function. Although irregular thickening of the junctional zone has been associated with diffuse uterine adenomyosis, the precise relationship between subendometrial smooth muscle proliferation and myometrial invasion by endometrial glands and stroma remains to be established.

Avaliaçäo da contagem diferencial de células sangüíneas por metodologia automatizada e microscopia / Diferential blood cells counting evaluation by automated methodology and optical microscopy

O hemograma é uma importante análise laboratorial de triagem na avaliaçäo dos fatores estimuladores e diferenciadores dos precursores hemopoiéticos medulares. Em condiçöes fisiológicas há equilíbrio entre a produçäo e a destruiçäo das células sangüíneas, realizada através de microscopia óptica e/ou automatizada, pode revelar possíveis variaçöes fisiológicas ou mesmo situaçöes patológicas. O objetivo deste estudo foi comparar os resultados da contagem de células sangüínas, empregando-se metodologia automatizada, com aqueles obtidos através da avaliaçäo diferencial por microscopia óptica. As análises das células sangüíneas de 558 pacientes atendidos no Hospital Universitário foram realizadas no setor de Hematologia do Laboratório de Análises Clínicas. Os resultados deste estudo demonstram que através da metodologia automatizada determinou-se número significamente maior de neutrófilos (p<0,05) e de monócitos (p<0,0001), em relaçäo àqueles determinados por microscopia óptica. Nas determinaçöes de plaquetas, linfócitos, eosinófilos e basófilos, näo foram observadas variaçöes significativas entre os métodos avaliados (p>0,05). Esses dados sugerem que apesar da agilidade dos métodos automatizados, quando o aparelho apresentar alarmes específicos em sua leitura, a análise por microscopia óptica, ainda é indispensável afim de minimizar as limitaçöes na contagem diferencial das células sangüíneas realizadas em aparelhos automatizados, e assim garantir a qualidade do resultado

Endoscopic laser ablation of the prostate (ELAP): changes in magnetic resonance imaging and clinical outcome at 1 year.

OBJECTIVE: To assess the ability of magnetic resonance imaging (MRI) to detect tissue changes immediately after laser ablation of the prostate and to correlate these changes with clinical outcome by detecting changes that may improve the outcome by allowing the laser dosimetry to be adjusted during therapy by monitoring effects on gland morphology. PATIENTS AND METHODS: Eight men with proven bladder outlet obstruction had a standard four-quadrant laser ablation of the prostate with a side-firing non-contact fibre. MRI scans were performed before, during and immediately after treatment and again after one week, 3 months and one year. RESULTS: The clinical outcome was a decrease in the American Urological Association (AUA)-7 symptom score from a pre-operative mean of 21.3-12.0 1 year after treatment and a corresponding increase in peak urinary flow rates from a mean of 8.9 mL/s to 12.3 mL/s. Immediately after treatment, MRI showed marked swelling of the gland (mean increase in volume 34%, range 12-75) with the loss of internal architecture. A low-signal thin periurethral band was present in six of the eight patients after 1 week and was replaced by a wider periurethral ring at 3 months in four of the six patients. No patient had evidence of prostatic cavitation after treatment or a significant reduction in prostate volume at 1 year. CONCLUSION: MRI can detect tissue changes after laser ablation of the prostate. The marked swelling seen on MRI immediately after laser prostatectomy may explain the delayed improvement in symptoms. The periurethral ring may indicate the depth to which laser energy has an effect on the tissue and could delineate an area of necrosis. The lack of cavitation at one year questions the durability of the effect of laser treatment delivered in this way.

Uterine junctional zone: function and disease.

The myometrium is usually thought of as a homogeneous mass of smooth muscle fibres. However, magnetic resonance studies of the uterus have revealed two distinct zones--the subendometrial myometrium or junctional zone and the outer myometrium. The junctional zone is not only structurally but also functionally different from the outer myometrium. For instance, myometrial contractions in a non-pregnant woman originate exclusively from the junctional zone, and their amplitude, frequency, and direction depend on the phase of the cycle. Irregular thickening of the junctional zone has been proposed as the magnetic resonance criterion for the diagnosis of diffuse adenomyosis. However, this magnetic resonance appearance relies on the disruption of the inner myometrial architecture secondary to smooth muscle hyperplasia but does not provide proof of mucosal invasion of the myometrium. We postulate that adenomyosis is a dichotomous disease characterised primarily by disruption of the inner myometrial architecture and function, with secondary infiltration of endometrial elements into the myometrium under certain circumstances. This hypothesis focuses on the inner myometrium and may explain the high incidence of superficial adenomyosis in dysfunctional uterine bleeding.

Endovaginal ultrasonography in the diagnosis of adenomyosis uteri: identifying the predictive characteristics.

OBJECTIVE: To evaluate prospectively the role of endovaginal ultrasonography in the diagnosis of adenomyosis and to identify predictive characteristics. SETTING: In Vitro Fertilisation Unit, Hammersmith Hospital. SUBJECTS: Fifty-six women with menorrhagia and dysmenorrhea. DESIGN: Endovaginal sonography was performed and uterine body morphometry and myometrial echogenicity were assessed. The sonographic suspicion of adenomyosis was scored high or low depending on the degree of uterine enlargement, uterine asymmetry not due to fibroids and heterogenicity of myometrial echoes. The sonographic diagnosis was compared either with the histological findings after hysterectomy (n = 34) or to the appearances on magnetic resonance imaging (n = 22). RESULTS: Adenomyosis was diagnosed in 28 patients: 15 by histology and 13 by magnetic resonance imaging. Endovaginal ultrasound demonstrated a sensitivity of 86%, a specificity of 50%, a positive predictive value of 86%, and a negative predictive value of 77%. Uterine morphometry alone did not predict adenomyosis: although the mean length of the longitudinal, anteroposterior and transverse axis was larger in uteri with, compared with those without, adenomyosis, this did not reach statistical significance. The uterine asymmetry ratio was 1.43 (SD 0.6) and 1.34 (SD 0.4) (P = 0.26) in uteri with and without adenomyosis, respectively, but in the presence of adenomyosis the mean posterior wall was significantly thicker than the mean anterior wall: 25.6 (SD 6.6) mm compared with 21.8 (SD 5.0) mm, P = 0.02. Therefore, adenomyosis was best predicted on the basis of ill-defined myometrial heterogeneity. However, leiomyomas and various echogenic shadows and artefacts often complicate subjective assessment of the myometrial echogenicity. CONCLUSION: Endovaginal sonography in symptomatic patients can be a sensitive but not a specific procedure for the diagnosis of adenomyosis.