[Laser-based endoscopic measurement of airway dimensions]. / Lasergestützte endoskopische Vermessung der grossen Atemwege.

Bronchoscopy is the technique of choice for the evaluation of a stenosis in the large airways. However, no system has been successfully employed for the bronchoscopic measurement of airway stenosis. The purpose of these study was the development and validation of a method for measuring the cross-sectional areas in the large airways. Furthermore, this application should be used for the 3D-reconstruction and visualisation of airway stenosis. A laser probe inserted into the operating channel of the bronchoscope enabled assessment of the distance between the images and the tip of the bronchoscope by means of projecting a ring of light on to the endoluminal wall. Image distortion due to the wide-angle lens was corrected by a computer program developed by us. Plastic tubes with known diameters were used for validation. Additionally, distortion-corrected bronchoscopic images were compared with distortion-free videoscopic image analysis of tracheal slices taken from pigs. When plastic tubes were used, the correlation coefficient (r) was slightly higher (r = 0,99, p < 0,01) than the correlation of cross-sectional areas between bronchoscopic and videoscopic images of tracheal slices (r = 0,88, p < 0,01). Furthermore the system could be used in a few patients for 2D and 3D measurement and visualisation of airway stenosis. Application of the present method offer quantitative assessment of airway stenosis located in the large airways.

TRIP-Br: a novel family of PHD zinc finger- and bromodomain-interacting proteins that regulate the transcriptional activity of E2F-1/DP-1.

We report the isolation of TRIP-Br1, a transcriptional regulator that interacts with the PHD-bromodomain of co-repressors of Krüppel-associated box (KRAB)-mediated repression, KRIP-1(TIF1beta) and TIF1alpha, as well as the co-activator/adaptor p300/CBP. TRIP-Br1 and the related protein TRIP-Br2 possess transactivation domains. Like MDM2, which has a homologous transactivation domain, TRIP-Br proteins functionally contact DP-1, stimulating E2F-1/DP-1 transcriptional activity. KRIP-1 potentiates TRIP-Br protein co-activation of E2F-1/DP-1. TRIP-Br1 is a component of a multiprotein complex containing E2F-1 and DP-1. Co-expression of the retinoblastoma gene product (RB) abolishes baseline E2F-1/DP-1 transcriptional activity as well as TRIP-Br/KRIP-1 co-activation, both of which are restored by the adenovirus E1A oncoprotein. These features suggest that TRIP-Br proteins function at E2F-responsive promoters to integrate signals provided by PHD- and/or bromodomain- containing transcription factors. TRIP-Br1 is identical to the cyclin-dependent kinase 4 (cdk4)-binding protein p34(SEI-1), which renders the activity of cyclin D/cdk4 resistant to the inhibitory effect of p16(INK4a) during late G(1). TRIP-Br1(p34(SEI-1)) is differentially overexpressed during the G(1) and S phases of the cell cycle, consistent with a dual role for TRIP-Br1(p34(SEI-1)) in the regulation of cell cycle progression through sequential effects on the transcriptional activity of E2F-responsive promoters during G(1) and S phases.

A new bronchoscopic method to measure airway size.

Bronchoscopic evaluation of stenosis is limited due to radial distortion of bronchoscopic images and the unknown distance between the endoscope and the stenotic area. The purpose of this study was the development and validation of a method for measuring cross-sectional areas in large airways. Distance measurements were performed using a laser probe inserted into the working channel of a bronchoscope. The laser probe was positioned to the locus of interest in the airway, a ring of light (helium/neon) projected on to the luminal wall and the images acquired using an electronic bronchoscope. The images taken were distortion-corrected by means of a computer program. The method was validated by simulating airways using tubes of known diameter. Additionally, distortion-corrected bronchoscopic images were compared with distortion-free videoscopic image analysis of tracheal slices taken from pigs. In the case of the plastic tubes, Pearson's correlation coefficient (r) as well as the intraclass correlation coefficient (ICC) were slightly higher (r=0.99, p<0.01, ICC=0.97) than the correlation of cross-sectional areas between bronchoscopic and videoscopic images of tracheal slices (r=0.88, p<0.01, ICC=0.87). This concept allows accurate and reproducible determination of cross-sectional areas in large airways.

[4-Tesla 1H MR spectroscopy in patients with temporal lobe epilepsy]. / 4-Tesla 1H-MR-Spektroskopie bei Patienten mit Temporallappenepilepsie.

7 patients with drug-resistant temporal lobe epilepsy (TLE) and localized EEG-focus were investigated with a 4 Tesla whole body MR-scanner. Proton (1H) magnetic resonance (MR) spectra were analyzed quantitatively and compared to the healthy side. MRS allowed the differentiation of the following metabolites in 5 patients: N-acetyl-aspartate (NAA), creatine and phosphocreatine, phosphorylcholine and glycerophosphorylcholine, beta- and gamma-glutamate (GLU). To compare the results with those of an already evaluated normal population, these metabolites were measured also in parietal region. The standard deviation was 42-46% in the patients. Unfortunately, in the temporal region, the field homogeneity was worse than parietal and thus the spectral analysis less distinct especially for GLU with a standard deviation of 45% for NAA and 66% for GLU on the healthy side. Thus, no significant findings were seen on focus side. There was only a tendency to an elevation of glutamate and a reduction of N-acetyl-aspartate.

Physiological effects of fast oscillating magnetic field gradients.

To evaluate the physiological thresholds of neuromuscular stimulation relevant to very fast NMR imaging studies that use gradient switching at frequencies of 1-2 kHz and a maximum magnetic field of up to 10 mT, a series of studies were done with human volunteers using an experimental echo planar gradient coil set. The threshold for induction of localized and momentary sensations in the human back and abdomen for 10 subjects is 60 T/s for sinusoidally oscillating magnetic fields at 1.27 kHz. The threshold relates to an E field of 6 V/m and is shown to vary with number of oscillations and frequency in accord with theory. Using a simple model of E field induction, the threshold for stimulation of cardiac electrical events should be greater than 4 times this value.

Sodium-23 imaging of supratentorial lesions at 4.0 T.

In 27 patients with low and high grade gliomas (n = 17), meningiomas (n = 4), and other supratentorial tumors and lesions (n = 6), the results of sodium-23 MR imaging with high spatial resolution were compared to CT and proton MRI. The Na MR studies were performed with a 4.0-T whole-body MR system and an isotropic 3D-Flash sequence (TR 70 ms, TE 11 ms), which depicts the long T2 component of sodium. All patients tolerated the sodium study at 4.0 T well. The sodium images revealed almost all lesions, but the resolution was inferior to that of the reference methods. Two small meningiomas did not show up at all in the sodium study. Furthermore in one case small hemorrhages and calcifications within one of the tumors could not be found. Sodium imaging of the long T2 component did not provide any additional information regarding the histology, grading, size, and differentiation of the tumor from the surrounding edema which had not already been provided by CT or H MRI.

In vivo magnetic resonance imaging and spectroscopy of humans with a 4 T whole-body magnet.

A research-type 4 T whole-body magnet, built by Siemens AG, Erlangen, FRG, was used to investigate magnetic resonance at high field strengths. Designs for head and body coils operating at 170 MHz are described. Proton images of the human head and body are degraded by dielectric resonances and penetration effects. The nature of the dielectric resonances was demonstrated in phantoms containing distilled and saline doped water. Radiation damping at 170 MHz generates secondary echoes after a spin echo sequence. This effect was observed in phantoms and with reduced amplitude in the human head. Hydrogen spectra of the human head were selected utilizing stimulated and spin echoes. The latter technique allows the volume size to be reduced to 1 cm3. Examples of brain tumors that have been routinely investigated with volumes of 8 cm3 are given. Natural abundance carbon and phosphorus spectra of muscle and liver demonstrate the expected increase in spectral resolution and signal to noise ratio. Carbon spectra from the liver show the glycogen signal. Fluorine spectroscopy was used to study the time course of the absorption and emptying of a fluorinated antibiotic from the human stomach.

What happens to learning when the workshop is over?

This article presents findings from a study conducted to identify factors that facilitate and hinder the process by which professionals incorporate learning into practice. While a majority of learners identified their new knowledge as a facilitative factor for the incorporation process, nearly a third acknowledged that a knowledge deficit or the task's complexity would hinder the incorporation process. References to administrative support more frequently identified hindrances rather than facilitators.

[ECG changes caused by the effect of static magnetic fields of nuclear magnetic resonance tomography using magnets with a field power of 0.5 to 4.0 Telsa]. / EKG-Veränderungen durch Einwirkung von statischen Magnetfeldern bei der Kernspintomographie in Magneten der Feldstärke 0,5 bis 4,0 Tesla.

ECG-alterations under the influence of static magnetic fields were investigated in phantoms (1.5 Tesla), animals and volunteers (4.0 Tesla), as well as in 12 patients (0.5, 1.0, and 1.5 Tesla). Under the influence of static magnetic fields high- and low-frequency voltages are superimposed on the ECG. Motions of the electrical leads induce high-frequency waves, which can alter the ECG to the extent that only the QRS-complex can be recognized. Electrolytes moved by the blood stream in static magnetic fields also induce voltages (Hall-effect) which, according to the patient's position, result in ST-segment- and partial T-wave-elevations or depressions. All ECG-alterations are reversible after exposition to the static magnetic field. Rhythm disturbances do not occur. The results indicate that static magnetic fields up to 4.0 Tesla do not have permanent adverse effects on the human ECG.

Effect of intravenous fructose on the P-31 MR spectrum of the liver: dose response in healthy volunteers.

Dynamic phosphorus-31 magnetic resonance (MR) spectroscopy of the liver after intravenous administration of fructose has been suggested as a test of liver function. To establish dose-response curves of the phosphorus metabolites in the normal human liver, each of four healthy volunteers was given two to four different fructose doses on separate days: 62.5, 125, 250, 375, or 500 mg per kilogram of body weight. P-31 MR spectra of the liver were acquired with a 2-T whole-body magnetic, both before and after fructose administration, at 2.5-minute intervals over at least 30 minutes. The fructose load caused a significant, linearly dose-dependent accumulation of phosphomonoesters (r = .72, P less than .01) and a decrease in inorganic phosphate (r = .78, P less than .005) and adenosine triphosphate (r = .73, P less than .01). On the basis of these experiments, dynamic P-31 MR spectroscopy seems promising in the assessment of liver function.

Whole-body MR imaging and spectroscopy with a 4-T system.

The clinical potential and limitations of magnetic resonance imaging and spectroscopy at 4 T were investigated with the use of a newly constructed system, which has been in use since January 1987. The magnet has a warm bore that measures 1.25 m in diameter, and its homogeneity in a sphere with a diameter of 50 cm is better than +/- 2.5 ppm. It was hypothesized that the improvement in the signal-to-noise ratio (S/N) afforded by the higher field strength would be useful in reducing imaging time and in improving spatial resolution. In experiments in human volunteers, believed to be the first in which an entire human body was exposed to a magnetic flux density of that magnitude, the subjects were exposed to 4 T for 10-30 minutes. They showed no changes in well-being or heart activity. The expected gain in spectral resolution due to chemical-shift scaling was achieved with the 4-T system, and an improvement in S/N was verified for phosphorus at 34 and 68 MHz. In sodium imaging, the high flux density appears to be useful in reducing imaging time, which should increase the usefulness of sodium imaging in evaluating brain tumors and strokes. In spectroscopy, the increase in flux density improves the quality of the spectra.

[Effect of a static magnetic field (3.5 T) on the reproductive behavior of mice, on the embryo and fetal development and on selected hematologic parameters]. / Wirkung eines statischen Magnetfeldes (3.5 T) auf das Reproduktionsverhalten von Mäusen, auf die embryonale und fetale Entwicklung und auf ausgewählte hämatologische Parameter.

To investigate possibilities of magnetic resonance imaging at high magnetic fields in humans, a whole-body magnet with a magnetic field density of 4 T was developed. Due to the few data that are available at present on biological effects and side effects of such high fields, a reproduction experiment with NMRI mice was performed using a crossover design. The mice were allowed to mate during a 7-day period within the field or after their stay in the field. The number of pregnant mice and foetuses were recorded and compared to the controls. Another group was held within the magnetic field during the whole period of pregnancy until day 18, one day before delivery. In all groups, development of the foetuses was studied. Additionally, haematological parameters of the males and females were estimated and necroscopy was performed. Brains, lungs and optical nerves were investigated using pathohistological techniques. It could be shown that in case of mating within the magnetic field, the number of pregnant mice was considerably reduced. This effect was, however, completely reversible if mating occurred after the stay in the field. Malformations, retardations or an increased number of resorptions were never found. The haematological parameters were, in general, not changed. Necroscopy as well as pathohistological investigations showed no pathological alterations. Therefore, it appears that whereas high magnetic fields reduce the activity of mating behaviour, they do not exert any influence on physiological parameters.