Evaluation of a practical visual MRI rating scale of brain white matter hyperintensities for clinicians based on largest lesion size regardless of location.

BACKGROUND AND PURPOSE: Age-related white matter hyperintensities have prognostic implications, but no accepted clinical standard exists for their assessment. We propose a simple objective visual rating system by using 3T brain MR imaging. MATERIALS AND METHODS: MR imaging from 559 participants was processed by using an automated method to determine WMH volumes and evaluated with a new visual rating scale based on the single largest WMH lesion diameter regardless of location. The reproducibility of the visual system was assessed. The association of WMH visual scores and automated volumes was then compared with cognitive scores from the Montreal Cognitive Assessment, which was available for 510 participants. RESULTS: Inter-reader reproducibility was good for subsamples with both high (n=52) and low (n=40) prevalence of large automated WMH volumes (agreement of 67% and 87.5%, κ=0.71 and 0.76, respectively). Correlation between increased WMH and cognitive deficit measurements was equal for our visual ratings and automated volumes (Spearman ρ=0.118 and 0.109; P values=0.008 and 0.014, respectively). The visual scale retained a significant association with MoCA score after adjusting for age, sex, and education (standardized ß=-0.087, P=.042). CONCLUSIONS: We propose a simple visual WMH scoring system suitable for use as a baseline evaluation in clinical practice.

Elemental analysis of bone: proton-induced X-ray emission testing in forensic cases.

Proton-induced X-ray emission (PIXE) is a spectroscopic technique that provides the researcher with the elemental composition of a given target material. In this paper, we illustrate the utility of PIXE analysis in two forensic contexts: (1) case of cremation in which the nature of the remains is questioned and (2) cases of death by gunshot wound. In the first case, elemental analysis by PIXE reveals that the purported cremated remains are not bone. The last two cases show that radiopaque metallic residue embedded in bone is composed of lead from a projectile.

The effect of DNA structure on the catalytic efficiency and fidelity of human DNA polymerase beta on templates with platinum-DNA adducts.

DNA adducts formed by platinum-based anticancer drugs interfere with DNA replication. The carrier ligand of the platinum compound is likely to affect the conformation of the Pt-DNA adducts. In addition, the conformation of the adduct can also change upon binding of damaged DNA to the active site of DNA polymerase. From the crystal structures of pol beta ternary complexes it is evident that undamaged gapped and primed single-stranded (non-gapped) DNA templates exist in very different conformations when bound to pol beta. Therefore, one might expect that the constraints imposed on the damaged templates by binding to the polymerase active site should also affect the conformation of the Pt-DNA adducts and their ability to inhibit DNA replication. In support of this hypothesis we have found that the efficiency, carrier ligand specificity, site of discrimination (3'-G versus 5'-G of the Pt-GG adducts), and fidelity of translesion synthesis past Pt-DNA adducts by pol beta are strongly affected by the structure of the DNA template. Previous studies have suggested that the conformation of Pt-DNA adducts may be affected by the sequence context of the adduct. In support of this hypothesis, our data show that sequence context affects the efficiency, fidelity, and pattern of misincorporation by pol beta.

Use of radiographic atlases in a mass fatality.

In May and June of 1996, a forensic anthropology team from the C.A. Pound Human Identification Laboratory at the University of Florida identified 9 of 10 juveniles from the crash of ValuJet 592. The team relied primarily on a radiographic atlas developed and used by clinical practitioners to determine skeletal age. Postmortem radiographs of the juvenile victims were compared with radiographic standards to determine skeletal age. Skeletal age was then compared to a passenger list indicating the sex, weight, height, and chronological age of each individual. Tentative identifications based on the atlas method were organized into an exclusion matrix. Final identifications were based on this assessment in conjunction with other anthropological data such as appearance and fusion of ossification centers and estimation of stature.

Evidence of arteriosclerosis in cremated remains.

Severely burned or cremated human remains (i.e., cremains) are among the most challenging cases investigated by forensic pathologists, odontologists, and anthropologists. Exposure to extreme heat of long duration destroys all organic components of the body, leaving only the inorganic component of the skeleton. The numerous calcined osseous or dental fragments that remain after the cremation process rarely convey useful information to the investigator. In most cases, it is associated nonosseous artifacts that provide evidence of the decedent's identity. In a case investigated at the University of Florida's C. A. Pound Human Identification Laboratory, as well as in several cases examined during data collection for a research project, several fragments were identified as calcined plaque tubules from sclerotic blood vessels. These tubules provide direct evidence that the cremated individual had a variety of arteriosclerosis.

Radiographic determination of developmental age in fetuses and stillborns.

The gestational age and/or viability of a fetus can become an important forensic issue. Several investigators have produced linear regression formulas based on crown-heel length (CHL), crown-rump length, or body diameters to determine gestational age. This study re-examines the relationship between fetal long bone length and CHL and tests a method of estimating CHL, and therefore gestational age, from radiographic measurements of the major long bone diaphyses. The results are compared with data based on dry bone measurements. Data from 252 cases confirm a strong correlation between all long bone lengths and CHL (> or = r = .9063; p < 0.01). Long bone length means for each CHL group are presented, as well as regression formulas for estimating CHL from radiographic measurements of the long bone diaphyses. The findings correspond closely with results based on a European sample, thereby validating that reference population as a normative sample for fetal analysis in the United States. The radiographic method can be used in instances where skeletal preparation is impossible or undesirable.

Prophylactic transfusion for hypertrophic synovitis in children with hemophilia.

A 7- to 9-month protocol of prophylactic transfusion was used to treat 33 joints in 19 children with severe hemophilia (< 1 U/dL Factors VIII or IX) and hypertrophic synovitis. The overall rate of hemarthrosis was reduced, but only 36% (12 of 33 joints) achieved a good result (defined as 0-0.5 bleeding episodes per month and decreased synovial hypertrophy 1 year after completing treatment). Age and severity of arthropathy at initiation of treatment did not affect the result. The degree of synovial hypertrophy and involvement of the knee joint showed an adverse trend, but these factors did not achieve statistical significance. The number of episodes of breakthrough bleeding during the first 6 weeks of therapy was significantly associated with a poor result. Based on the results of this study, a trial of transfusion therapy is recommended for recurrent hemarthroses and synovitis in patients with hemophilia, but the duration of thrice weekly treatment has been increased and the duration of prophylaxis has been reduced in selected cases.

The anthropometry of contemporary commercial cremation.

This study establishes baseline parameters and examines those variables thought to influence cremains weights. Data were collected during the cremation of 100 individuals. A series of measurements was taken to determine relative skeletal robusticity. The weight, stature, sex, and age of each cadaver was recorded prior to cremation. The average cremains weight for the fully developed adults (n = 91) was 2430 g and ranged from 876 g to 3784 g. Male and female means were separated by 1053 g, but there was considerable overlap in the distribution. All cremains weights above 2750 g were male and all cremains weights below 1887 g were female. Five amputees and one long bone donor produced cremains weights below the means for their respective groups, reflecting the relative contribution of the thick cortical bone of the limbs to total skeletal weight, and thus to total cremains weight. Cremains weight represented approximately 3.5% of total body weight in adults, 2.5% of total body weight in children, and approximately 1% of total body weight in fetuses. The most accurate predictor of cremains weight was cadaver stature (r = .8473; p < .01). Calculated skeletal weight was also highly correlated with cremains weight (r = .7986; p < .01). Cadaveric weight was least correlated with cremains weight (r = .5470; p < .01). Regression formulae were calculated for each of the variables.

[Care of the chronically ill aged person]. / El cuidado del anciano crónicamente enfermo.

There should be a change of attitude on the part of the medical profession towards the care of the chronic sick. When this is established, the change will be reflected in nursing and other hospital staff. A higher standard and a great deal more work is needed in the care of the chronic sick. The creation of a specialty for geriatrics would stimulate better work and initiate research. The chronic sick should be diagnosed and treated in special blocks of a general hospital set up and equipped for the purpose. Chronic aged sick should be admitted to homes only through hospital units. All homes for chronic sick should be attached to hospital units to ensure close follow-up work.

The effects of recall-concurrent visual-motor distraction on picture and word recall.

The dual-coding model (Paivio, 1971, 1975) predicts a larger imaginal component in the recall of pictures relative to words and a larger imaginal component in the recall of concrete words relative to abstract words. These predictions were tested by examining the effect of a recall-concurrent imagery-suppression task (pursuit-rotor tracking) on the recall of pictures vs picture labels and on the recall of concrete words vs abstract words. The results showed that recall-concurrent pursuit-rotor tracking interfered with picture recall, but not word recall (Experiments 1 and 2); however, there was no evidence of an effect of recall-concurrent tracking on the recall of concrete words (Experiment 3). The results suggested a revision of the dual-coding model.

Methodological problems with the use of the retroactive interference design to infer what is stored.

The retroactive interference paradigm has been used in a variety of settings to investigate the nature of the representation of memory. Much of the research using this paradigm is methodologically flawed because it involves treatment comparisons which are inappropriate. It is argued that comparisons must be made between presentation conditions having the same interpolated activity and that, in addition, evidence is required that the differences are not confounded by acquisition level differences if one is to infer mode-specific interference and representation. The methodological issues are discussed in detail and the utility of the retroactive interference design is questioned. Studies employing the design are reviewed, and several conclusions are drawn: (1) there has been no unambiguous demonstration of visual mode-specific interference, (2) there has been no clear demonstration that imagery instructions produce memories that are more susceptible to visual than to auditory interpolation, and (3)no clear demonstrations are yet available that memory for spatial location is more susceptible to visual interference than memory for letters.