Light therapy: methodological issues from an engineering perspective.

Light therapy is increasingly administered and studied as a non-pharmacologic treatment for a variety of health-related problems, including treatment of people with dementia. Light therapy comes in a variety of ways, ranging from being exposed to daylight, to being exposed to light emitted by light boxes and ambient bright light. Light therapy is an area in medicine where medical sciences meet the realms of physics, engineering and technology. Therefore, it is paramount that attention is paid in the methodology of studies to the technical aspects in their full breadth. This paper provides an extensive introduction for non-technical researchers on how to describe and adjust their methodology when involved in lighting therapy research. A specific focus in this manuscript is on ambient bright light, as it is an emerging field within the domain of light therapy. The paper deals with how to (i) describe the lighting equipment, (ii) describe the light measurements, (iii) describe the building and interaction with daylight. Moreover, attention is paid to the uncertainty in standards and guidelines regarding light and lighting for older adults.

Protracted systemic changes in bone biology after segmented unloading in the rat.

To investigate whether the decreased bone formation observed in most experimental situations of disuse was caused by an increased inhibition by the bone microenvironment of osteoblast (OB) proliferation, we studied the inhibiting power on ROS 17/2.8 proliferation of the bone marrow extracellular fluid (IPEF) in loaded and unloaded bones of rats submitted to two situations of partial disuse: tail suspension (TS) for 3 days to 2 weeks and around the knee tenectomy (KT) for 2-10 weeks. Histomorphometric parameters and osteoblast precursors dynamics were studied in parallel. Bone volume was lost in the unloaded bones, but not in loaded bones, in both experimental situations. Bone formation was low at early times (7-14 days) in TS rats. However, in KT at later times (4-10 weeks), the osteoblastic index of the unloaded tibia was increased. IPEF was not increased in the unloaded bones 3-7 days after TS. It was decreased later in the course of unloading (after 2 weeks of TS and 2-10 weeks after KT). This decrease was observed in the loaded bones as well. Unexpectedly, we also found that the number of FCFUs was decreased in both loaded and unloaded limbs in TS and KT, and that the yield of cells obtained in primary culture from tibial metaphysis was decreased in both tibiae from KT animals. These data show that an increased IPEF does not play a role in the early inhibition of bone formation responsible for the loss of bone after unloading in the TS model. Its later decrease could be permissive for the increased osteoblastic index observed in the KT model. They also show that, contrary to the usual assumptions, bone biology is changed all over the skeleton after partial unloading, even if the changes result in bone loss in the unloaded bones only. Thus, as yet, unidentified systemic factors probably superimpose on the local factors that control bone volume.

Evaluation of technetium-99m-ciprofloxacin (Infecton) for detecting sites of inflammation in arthritis.

OBJECTIVE: To study the frequency of technetium-99m-positive ciprofloxacin scans (Infecton scintigraphy) thought to be specific for bacterial DNA in patients with arthritis and to assess the clinical relevance of positive scans. METHODS: Four groups of adults with arthritis were studied. Group 1: 53 patients with inflammatory arthritis, 36 with spondylarthropathy (SpA) and 17 with rheumatoid arthritis (RA); group 2: five patients with crystal arthropathy; group 3: those patients with osteoarthritis (OA) of the knee, wrist or spine; and group 4: 28 patients who had no arthritis but were being investigated for renal infection. Patients were injected with 10 mCi 99Tcm-ciprofloxacin with isotope uptake analysis at 4 h. Clinically swollen joints were assessed by a rheumatologist and the positive scans assessed by a physician in nuclear medicine. RESULTS: Increased Infecton uptake was noted in inflamed joints independent of the pathology. It was seen in 10 of 17 patients with SpA, 12 of 17 with RA, all five with crystal arthropathy, eight with knee OA, two with wrist OA, none with spinal OA and none in uninflamed joints. A close correlation between clinically swollen joints and articular Infecton uptake was noted (P = 0.0003), with the uptake being in the distribution of the synovial perimeter. Additional uptake was noted in the abdomen (n = 9) and pulmonary region (n = 2) of SpA patients. CONCLUSION: The Infecton scan is not specific for infection but may be a reliable procedure for identifying the presence and distribution of the inflammation within joints. It has the potential for monitoring the response of inflamed joints to treatment.

Anion selectivity by the sodium iodide symporter.

The iodide transporter of the thyroid (NIS) has been cloned by the group of Carrasco. The NIS-mediated transport was studied by electrophysiological methods in NIS-expressing Xenopus oocytes. Using this method, the anion selectivity of NIS was different from that previously reported for thyroid cells, whereas perchlorate and perrhenate were found not transported. In this study we compared the properties of human NIS, stably transfected in COS-7 cells to those of the transport in a thyroid cell line, the FRTL5 cells, by measuring the transport directly. We measured the uptake of (125)I(-), (186)ReO(4)(-), and (99m)TcO(4)(-) and studied the effect on it of known competing anions, i.e. ClO(4)(-), SCN(-), ClO(3)(-), ReO(4)(-), and Br(-). We conclude that the properties of the NIS transporter account by themselves for the properties of the thyroid iodide transporter as described previously in thyroid slices. The order of affinity was: ClO(4)(-) > ReO(4)(-) > I(-) >/= SCN(-) > ClO(3)(-) > Br(-). NIS is also inhibited by dysidenin (as in dog thyroid).

[The nuclear medicine department and the TEP/Biomedical Cyclotron unit]. / Le Service de Médecine Nucléaire et l'Unité TEP/Cyclotron Biomedical.

During the last 25 years, the clinical and experimental activity in nuclear medicine at Erasme hospital has been influenced by the implementation of positron emission tomography (PET) in 1990 as a method of brain functional investigation. The activity of the PET/biomedical cyclotron unit has been dedicated to various subjects in neurology, neurosciences, psychiatry, oncology and cardiology. This has been made possible by developments in radiochemistry. The radiochemistry laboratory has designed and produced original tracers such as 9-[(3-[18F]fluoro-1-hydroxy-2-propoxy)-methyl]guanine (FHPG), a tracer of viral thymidine kinase activity in gene therapy protocols. We have brought new applications of PET, such as its integration into stereotactic neurosurgical and radioneurosurgical techniques in order to improve their diagnostic and therapeutic performance in neurooncology. We have also conducted multiple studies on brain physiology and pathophysiology, in particular with the use of functional and metabolic brain mapping methods and the use of tracers of neurotransmission systems. The Department of nuclear medicine has also performed studies on bone metabolism and investigated in vivo imaging methods of infectious and immune processes.

Selenium deficiency-induced growth retardation is associated with an impaired bone metabolism and osteopenia.

Although the importance of selenium for bone metabolism is unknown, some clinical conditions such as Kashin-Beck osteoarthropathy have been associated with selenium deficiency. Although selenium deficiency induces growth retardation in rats, it has not been established whether this growth inhibition is associated with changes in bone metabolism. We investigated the effect of selenium deficiency on bone metabolism in growing male rats fed a selenium-deficient diet for two generations (Se-). In Se- rats, erythrocyte glutathione peroxidase activity and plasma selenium concentration were strongly reduced compared with pair-fed selenium-adequate rats (Se+). Weight and tail length were reduced by 31% and 13% in the Se- rats, respectively (p < 0.001). The Se- diet was associated with a 68% reduction of pituitary growth hormone (GH; p = 0.01) and a 50% reduction of plasma insulin-like growth factor I (IGF-I; p < 0.001). Plasma calcium was lower and urinary calcium concentration was greater in Se- rats. This group had a 2-fold increase in parathyroid hormone (PTH) and 1,25-dihydroxyvitamin D3 [1,25(OH)2D3] in plasma. Plasma osteocalcin and urinary deoxypyridoline were reduced by 25% and 57% in the Se- rats (p < 0.001). Selenium deficiency resulted in a 23% and 21% reduction in bone mineral density (BMD) of the femur and tibia (p < 0.001) and this effect persisted after adjustment for weight in a linear regression model. A 43% reduction in trabecular bone volume of the femoral metaphysis (p < 0.001) was found in Se- rats. This experimental study shows that growth retardation induced by selenium deficiency is associated with impaired bone metabolism and osteopenia in second-generation selenium-deficient rats.

Bone, bone marrow, and MIBI scintigraphic findings in Gaucher's disease "bone crisis".

PURPOSE: The authors report the utility of Tc-99m MIBI imaging in Gaucher's disease, which results in the accumulation of glucocerebroside in macrophages. Inflated macrophages, or Gaucher's cells, involve the reticuloendothelial organs. MATERIALS AND METHODS: A 38-year-old man with type I Gaucher's disease, splenectomy, and early bone involvement was examined for a low back "bone crisis." He had a history of total left hip replacement. Results of pelvic radiographs were normal. Magnetic resonance imaging showed complete infiltration of the bone marrow in the lumbar spine and the sacrum. The left iliac bone, the sacrum, and the adjacent part of L5 showed heterogeneously decreased uptake on bone scintigraphs. Hematopoietic bone marrow was absent in these regions and in the left femur. No infection of the prosthesis was revealed with labeled granulocytes. RESULTS: Avascular necrosis in the left iliac bone was diagnosed, which is a very unusual location. There was no uptake of MIBI in the iliac bones or the femurs. CONCLUSION: These findings suggest that MIBI may not be a good tool for the evaluation of medullary infiltration by Gaucher's cells.

Deposition of nacystelyn from a dry powder inhaler in healthy volunteers and cystic fibrosis patients.

The aim of this study was to compare, using gamma scintigraphy, the lung deposition of a novel mucoactive agent, Nacystelyn (NAL), administered as a dry powder inhaler (DPI) in six healthy volunteers, six adult patients with cystic fibrosis (CF), and six children and adolescents patients with CF. The correlation between in vitro and in vivo results was also tested. It was first demonstrated that the method of labeling of NAL with 99mTc was reliable as tested by three in vitro methods (multistage liquid impinger, multistage cascade impactor, and 2-stage glass impinger). The deposition of unlabeled NAL, labeled NAL, and the radiolabel was similar in all stages of each device. Furthermore, the fine particle fraction (FPF) was the same on all apparatuses. The mean lung deposition obtained in volunteers was 27.5 +/- 13.5%. The results are approximately three times higher than the results obtained previously in healthy volunteers with NAL metered-dose inhalers (MDIs). As expected, the lung deposition observed in patients with CF was lower, e.g., 23.5 +/- 7.0% for adults and 16.5 +/- 5.9% for children and adolescents. A significant correlation was found between lung deposition and both the patient weight (p < 0.02) and height (p < 0.04). Surprisingly, the peripheral:central (P:C) ratio was similar for the three populations, indicating that the presence of mucus in moderately ill patients with CF does not modify the lung distribution of NAL. The FPF measured in vitro was similar to that obtained in volunteers but higher than that found in both patient populations. The DPI formulation of NAL developed will probably improve patient compliance and comfort in future clinical trials and postmarketing use of the drug.

Fate of 6-deoxy-6-[123I]iodo-D-glucose in normal and diabetic rats.

The D-glucose analog 6-deoxy-6-¿123Iiodo-D-glucose (6-DIG) was recently proposed as a potential tracer for the in vivo characterization of D-glucose transport in distinct cell types. In this study, the validity of such a proposal was investigated in both control and streptozotocin-induced diabetic rats. 6-DIG was injected intravenously in either control or diabetic rats. The fate of 6-DIG was assessed by scintigraphy of the injected animals, blood and urine sampling, and measurement of tissue radioactivity at the time of sacrifice, 140 min after 6-DIG injection. The half-life for 6-DIG in plasma and its accumulation in kidney and urinary bladder indicated that it was mainly eliminated from the body by glomerular filtration. The urinary elimination of 6-DIG was accelerated, however, in the polyuric diabetic rats. Bile formation also apparently contributed to the clearance of 6-DIG. Its uptake by liver, heart and muscles yielded values lower than blood concentration. The usefulness of 6-DIG as a tracer for D-glucose transport in selected organs in the perspective of clinical application, e.g. by single photon emission computed tomography, requires further investigations.

Age-related inhibitory activity of rat bone marrow supernatant on osteoblast proliferation.

Because histomorphometric indices of bone formation (osteoblastic index, tetracyclin-labeled perimeter) are deeply depressed in aged rats, while in vitro proliferation of trabecular bone cells was found increased, we hypothesized that a signal to proliferate, correctly induced by increased strains on scarce bone, could be opposed in vivo by an inhibitor present in the bone marrow extracellular medium. Thus, we tested the effect of bone marrow extracellular fluid (BM supernatant) of rat femoral diaphysis on cultures of primary osteoblasts and osteoblastic cell lines and found that it inhibited bone cell proliferation. In a group of 69 female rats aged 4, 12, and 15/21 months, there was a stepwise increase in the inhibitory activity of the BM supernatant. The double reciprocal plots relating inhibition power of the medium to BM supernatant dilution suggest that we deal with a simple system and that the kinetics of the phenomenon are the same in older and younger animals. Moreover, proliferation inhibition by BM supernatant and trabecular bone surface measured by histomorphometry in the distal femoral metaphysis were inversely correlated. Because the extracellular fluid of bone marrow is also the medium surrounding the osteoblasts and their precursor cells, our results suggest that the bone marrow negatively regulates osteogenic cells and that this inhibition could contribute to the inability of older animals to supply osteoblasts to bone in proportion to the demand. Preliminary biochemical characterization of the inhibitor suggests it to be a protein of 30-40 kDa with an isoelectric point (pI) of about 6.5.

Maximum-likelihood reconstruction with ordered subsets in bone SPECT.

UNLABELLED: This study was aimed at determining whether the ordered-subset expectation maximum (OSEM) is more effective than filtered backprojection (FBP) for bone SPECT in the routine clinical context. METHODS: Fifty-seven consecutive bone SPECT studies were analyzed. They included pelvic and lumbar spine, thoracolumbar spine, head and neck, feet and shoulders. A 64-projection SPECT study was acquired over 360 degrees by single-head cameras 2-3 h after the injection of 750 MBq 99mTc-methylene diphosphonate. Three observers compared the OSEM and FBP reconstructed images. RESULTS: Streak artifacts, always present with FBP, were rarely generated with the OSEM. When present (n = 24), artifacts associated with negative values near hyperactivities in FBP were not generated with the OSEM in 67% of the cases (n = 16), permitting a satisfactory interpretation of these regions. In half of the other cases (17%, n = 4/24), interpretation was precluded. In only one case did the three observers agree that more hyperactivities were seen with the OSEM. Ninety-six percent of the OSEM pictures were superior or equal to FBP for anatomic resolution and were clearly better in 12% of the cases. The extent of the lesion with the OSEM seemed better or equally defined in 96% and clearly better in 14% of the cases. The low-activity regions were better or equally visualized in all cases and were clearly better seen in 23% of the cases. The quality of the pictures was found to be better or superior with the OSEM in 98% of the cases and definitely better in 65% of the cases. CONCLUSION: Replacement of FBP by the OSEM in bone SPECT would be beneficial to clinical practice.

99mTc-sesta-(2-methoxy-isobutyl-isonitrile) uptake by pancreatic islets, parotid cells, and mammary carcinoma cells.

99mTc-sesta-(2-methoxy-isobutyl-isonitrile)(Tc-MIBI) is currently used for imaging of several organs. In the present study, its uptake by rat pancreatic islets, rat parotid cells, and human breast adenocarcinoma cells (MCF-7 cells) was found to be grossly proportional to its concentration (up to 0.1 microM), time-related (with a fractional turnover rate close to 2-3 10(-2).min(-1)), and stimulated by D-glucose. Comparable values for the fractional turnover rate were found in prelabeled islets and MCF-7 cells, D-glucose failing to affect Tc-MIBI efflux from prelabeled islets. In the islets, the uptake of Tc-MIBI was decreased at low temperature, in the presence of mitochondrial poisons and at high extracellular K+ concentration, unaffected by the absence of extracellular Ca2+, and increased by nutrient secretagogs, such as 2-ketoisocaproate and the association of L-leucine and L-glutamine. These findings are consistent with the view that Tc-MIBI uptake is ruled by its extracellular concentration, and the polarization of both plasma and mitochondrial membranes. It is proposed that this lipophilic cation may be useful to detect alteration of nutrient metabolism in pancreatic islets deprived of any exogenous fuel.

Ectopic Cushing's syndrome and pulmonary carcinoid tumour identified by [111In-DTPA-D-Phe1]octreotide.

The differential diagnosis and management of Cushing's syndrome remain difficult, particularly for ectopic adrenocorticotropin (ACTH) syndromes resulting from small bronchial carcinoids. We report the case of a 41-year-old man with ectopic ACTH-dependent Cushing's syndrome. Two computed tomography scans of the thorax were normal and magnetic resonance imaging of the chest showed a 6-mm hyperintense T1-weighted area close to the left pulmonary hilus, interpreted as probably vascular by the radiologists. An [111In-DTPA-D-Phe1]octreotide scintigraphy scan demonstrated a positive image for somatostatin receptors in exactly the same location and surgery confirmed the presence of a small ACTH-secreting carcinoid tumour in the upper left lung lobe which was resected. Surgery cured the hypercorticism of the patient. The differential diagnosis of Cushing's syndrome and the procedure for localisation of an ACTH source are discussed.