Cerebral Ketones Detected by 3T MR Spectroscopy in Patients with High-Grade Glioma on an Atkins-Based Diet.

BACKGROUND AND PURPOSE: Ketogenic diets are being explored as a possible treatment for several neurological diseases, but the physiologic impact on the brain is unknown. The objective of this study was to evaluate the feasibility of 3T MR spectroscopy to monitor brain ketone levels in patients with high-grade gliomas who were on a ketogenic diet (a modified Atkins diet) for 8 weeks. MATERIALS AND METHODS: Paired pre- and post-ketogenic diet MR spectroscopy data from both the lesion and contralateral hemisphere were analyzed using LCModel software in 10 patients. RESULTS: At baseline, the ketone bodies acetone and ß-hydroxybutyrate were nearly undetectable, but by week 8, they increased in the lesion for both acetone (0.06 ± 0.03 ≥ 0.27 ± 0.06 IU, P = .005) and ß-hydroxybutyrate (0.07 ± 0.07 ≥ 0.79 ± 0.32 IU, P = .046). In the contralateral brain, acetone was also significantly increased (0.041 ± 0.01 ≥ 0.16 ± 0.04 IU, P = .004), but not ß-hydroxybutyrate. Acetone was detected in 9/10 patients at week 8, and ß-hydroxybutyrate, in 5/10. Acetone concentrations in the contralateral brain correlated strongly with higher urine ketones (r = 0.87, P = .001) and lower fasting glucose (r = -0.67, P = .03). Acetoacetate was largely undetectable. Small-but-statistically significant decreases in NAA were also observed in the contralateral hemisphere at 8 weeks. CONCLUSIONS: This study suggests that 3T MR spectroscopy is feasible for detecting small cerebral metabolic changes associated with a ketogenic diet, provided that appropriate methodology is used.

Characterization and applications of auto-locked vacuum-sealed diode lasers for precision metrology.

We demonstrate the performance characteristics of a new class of vacuum-sealed, autolocking diode laser systems and their applications to precision metrology. The laser is based on adaptations of a design that uses optical feedback from an interference filter and it includes a vacuum-sealed cavity, an interchangeable base-plate, and an autolocking digital controller. A change of the base-plate allows operation at desired wavelengths in the visible and near infrared spectral range, whereas the autolocking ability allows the laser to be tuned and frequency stabilized with respect to atomic, molecular, and solid-state resonances without human intervention using a variety of control algorithms programmed into the same controller. We characterize the frequency stability of this laser system based on the Allan deviation (ADEV) of the beat note and of the lock signal. We find that the ADEV floor of 2 × 10-12 and short-term linewidth of ∼200 kHz are strongly influenced by current noise and vacuum sealing. Reducing the current noise and cavity pressure decreases the ADEV floor and increases the averaging time at which the floor occurs, which is a signature of long-term stability. We also show that evacuating the cavity to ∼1 Torr reduces the range of the correction signal of the feedback loop by approximately one order of magnitude, thereby increasing the lock range of the controller. The long-term stability allows the laser to be incorporated into a commercial gravimeter for accurate measurements of gravitational acceleration at the level of a few parts-per-billion, which are comparable to values obtained with an iodine-stabilized He-Ne laser. The autolocking and pattern-matching features of the controller allow the laser to be tuned and stabilized with respect to a temperature tunable transmission spectrum of a fiber-Bragg grating. This capability may be suitable for the development of a differential absorption LIDAR transmitter that can generate data at both on-line and off-line lock points using a single laser.

Reflecting on progress since the 2005 NARSTO emissions inventory report.

Emission inventories are the foundation for cost-effective air quality management activities. In 2005, a report by the public/private partnership North American Research Strategy for Tropospheric Ozone (NARSTO) evaluated the strengths and weaknesses of North American emissions inventories and made recommendations for improving their effectiveness. This paper reviews the recommendation areas and briefly discusses what has been addressed, what remains unchanged, and new questions that have arisen. The findings reveal that all emissions inventory improvement areas identified by the 2005 NARSTO publication have been explored and implemented to some degree. The U.S. National Emissions Inventory has become more detailed and has incorporated new research into previously under-characterized sources such as fine particles and biomass burning. Additionally, it is now easier to access the emissions inventory and the documentation of the inventory via the internet. However, many emissions-related research needs exist, on topics such as emission estimation methods, speciation, scalable emission factor development, incorporation of new emission measurement techniques, estimation of uncertainty, top-down verification, and analysis of uncharacterized sources. A common theme throughout this retrospective summary is the need for increased coordination among stakeholders. Researchers and inventory developers must work together to ensure that planned emissions research and new findings can be used to update the emissions inventory. To continue to address emissions inventory challenges, industry, the scientific community, and government agencies need to continue to leverage resources and collaborate as often as possible. As evidenced by the progress noted, continued investment in and coordination of emissions inventory activities will provide dividends to air quality management programs across the country, continent, and world. Implications: In 2005, a report by the public/private partnership North American Research Strategy for Tropospheric Ozone (NARSTO) evaluated the strengths and weaknesses of North American air pollution emissions inventories. This paper reviews the eight recommendation areas and briefly discusses what has been addressed, what remains unchanged, and new questions that have arisen. Although progress has been made, many opportunities exist for the scientific agencies, industry, and government agencies to leverage resources and collaborate to continue improving emissions inventories.

Trisomía 9: reporte de un caso / Trisomy 9: a case report

La trisomía 9 es una enfermedad rara, que ha sido descrita por primera vez en 1970, a la fecha existen más de 150 casos reportados, caracterizados por dismorfias faciales, anomalías congénitas y retraso en el desarrollo psicomotor y/o discapacidad intelectual. Este es el primer caso reportado en nuestra población en un infante de sexo masculino con peso y talla bajos, fisura labiopalatina y retraso madurativo en varias áreas del desarrollo, en quien el cariotipo mostró un mosaico cromosómico con el 70% de sus células con la trisomía del cromosoma 9. El asesoramiento genético en estos casos es de vital importancia para orientar a los padres sobre posibles causas y explicar sobre la condición genética, su manejo y establecer pautas de seguimiento para hacer prevención terciaria

A case of granulomatous slack skin cutaneous T-cell lymphoma: PET/CT imaging findings.

A 24-year-old female presented with granulomatous slack skin (GSS) cutaneous T-cell lymphoma. The patient underwent systemic chemotherapy. Owing to the development of several chemotherapy-related complications, therapy was discontinued. Subsequently, disease progression was noted clinically. Our patient's disease progression was clearly demonstrated by 18F-fludeoxyglucose positron emission tomography (PET)/CT findings. PET/CT imaging findings of GSS have not yet previously been reported. In this report, we present PET/CT characteristics of a patient with GSS.

Another "great mimicker": FDG-PET/CT imaging findings of sarcoid-like reaction.

Sarcoid-like reaction (SLR) is a cause of non-caseating granulomas in some of the cancer patients with otherwise no signs or symptoms of sarcoidosis. SLR has been described in a variety of solid organ malignancies, including breast and lung cancer. SLR may result in hypermetabolic activity in 18-fludeoxyglucose positron emission tomography (PET)/CT scan, resulting in false positive reporting for malignancy. The purpose of this case series is to expose residents/practising physicians who interpret PET/CT to a series of cases illustrating findings of SLR.

Spectroscopic research on ultrahigh pressure (UHP) macrodiamond at Copeton and Bingara NSW, Eastern Australia.

Millions of macrodiamonds were mined from Cenozoic placers across Eastern Australia, 98% from within the Copeton and Bingara area (85 km across) in the Phanerozoic New England region of New South Wales (NSW). Raman spectroscopy of inclusions in uncut diamond, from the Copeton and Bingara parcels, identifies them as ultrahigh pressure (UHP) macrodiamond formed during termination of subduction by continental collision. Infrared spectral properties of the two parcels are critically similar in terms of nitrogen abundance (low in zoned diamond, high in unzoned diamond), requiring a pair of different growth mechanisms/protoliths. Within each parcel, the degrees of nitrogen aggregation are relatively strong and coherent, but they are so different from each other (moderate aggregation for Bingara, strong for Copeton) that the two parcels require separate primary and local sources. The local sources are post-tectonic alkali basaltic intrusions which captured UHP minerals (garnet, pyroxene, diamond) from eclogite-dominated UHP terranes (density stranded at depth-mantle, lower crust). X-ray diffraction studies on Copeton diamond indicate a normal density, despite previous reports of anomalously high density. For non-fluorescent diamond, a 2nd order Raman peak, which is prominent in theoretical perfect diamond and in African cratonic diamond, is suppressed in Copeton and Bingara UHP macrodiamond. Pervasive deformation during macrodiamond growth probably causes this suppression, the strong nitrogen aggregation, and the exceptional durability documented through industrial use.

New rabies virus variant found during an epizootic in white-nosed coatis from the Yucatan Peninsula.

In February 2008, three white-nosed coatis (Nasua narica) were found dead in a recreational park in Cancun, Mexico. The diagnosis of rabies virus (RABV) infection was confirmed by direct immunofluorescence test. The phylogenetic analysis performed with the complete RABV nucleoprotein gene positioned this isolate close to a sequence of a human rabies case reported during 2008 from Oaxaca, Mexico, sharing 93% similarity. In turn, these two variants are related to another variant found in rabid Tadarida brasiliensis mexicana bats across North America. Anti-RABV neutralizing activity (1.3 IU/ml) was found in the serum of one white-nosed coati captured with another five that cohabited with the dead animals. Enhanced rabies surveillance and pathogenesis studies should be conducted in coatis and insectivorous bats of the region to clarify the role of these species as potential emergent or long-term unidentified RABV reservoirs.

Chemoprotective effect of Spirulina (Arthrospira) against cyclophosphamide-induced mutagenicity in mice.

The aim of this study was to investigate the antimutagenic effects of Spirulina (SP) on male and female mice by the dominant lethal test using cyclophosphamide (CP) as a mutagen. Animals of both sex were given SP orally at 0, 200, 400 or 800 mg/kg body weight (b.w.) for 2 weeks prior to starting the CP treatment. CP was i.p. injected daily for 5 days at 40 mg/kg b.w. For the male-dominant lethal test, each male was caged with untreated females per week for 3 weeks. For the female-dominant lethal test the above doses and schedule treatments were used and treated females were caged for one week with untreated males (1-2). On days 13-15 after breeding was |started all the females were evaluated for incidence of pregnancy, total corpora lutea, total implants and pre- and post-implant losses. In the male-dominant lethal test, the CP induced pre- and post-implant losses in untreated females were inhibited at all SP doses. In the female-dominant lethal test only post-implantation losses were prevented at the same doses. Semen examination of a separate group of mice showed that SP improved its quality. Our results illustrate protective effects of SP in relation to CP-induced genetic damage to germ cells.

Disability certifications in adult workers: a practical approach.

Family physicians are frequently asked to complete disability certification forms for workers. The certification process can be contentious because of the number of stakeholders, the varying definitions of disability and the nature of the administrative systems. Insufficient training on disability during medical school and residency complicates this process. Disability systems discussed include workers' compensation, private disability insurance, the Americans with Disabilities Act and the Family and Medical Leave Act. Strategies that help the physician complete disability certification forms effectively include identification of disability type, ascertainment of the definition of disability being applied, evaluation of workplace demands and essential job functions, assessment of worker capacity, and accurate and timely completion of the forms in their entirety.

Maturation and fertilization in Lottia gigantea oocytes: intracellular pH, Ca(2+), and electrophysiology.

Intracellular pH and Ca(2+) were measured with BCECF- and Calcium Green-dextran during maturation and fertilization of oocytes of the limpet Lottia gigantea. Maturation of oocytes from prophase to metaphase I of meiosis was induced in seawater adjusted to pH 9 with NH(4)OH. Intracellular pH rose during maturation induction, and maturation was also induced by microinjecting pH 8, but not pH 7, HEPES buffer. Intracellular Ca(2+) rose during NH(4)OH-induced maturation, but maturation was not inhibited when the increase was blocked by microinjection of BAPTA. When the metaphase I oocytes were fertilized(), there was an abrupt increase in intracellular Ca(2+), and activation (polar body formation) failed to occur in BAPTA-injected oocytes. Intracellular pH did not rise during fertilization. These observations show that maturation from prophase to metaphase I of meiosis is pH-dependent and activation of the metaphase I oocytes is Ca(2+)-dependent. A Ca(2+) action potential was present in both immature and mature oocytes but was more prominent in mature oocytes whose input resistance was higher. Fertilization produced a long-lasting (17-20 min) Na(+)-dependent fertilization potential with superimposed oscillations resembling Ca(2+) action potentials.

The "SAPHO" syndrome: a case report of a patient with unusual bone scan findings.

PURPOSE: The authors describe the clinical and bone scintigraphic findings of the SAPHO syndrome, which is characterized by synovitis, acne, palmoplantar pustulosis, hyperostosis, and osteitis. The case report illustrates the significance of bone scintigraphy in the diagnosis. It shows that Tc-99m MDP scanning can detect signs of arthritis not seen with other imaging methods, because the arthritis is inflammatory in nature and does not always cause bone erosion. Thus it is not visualized on plain radiographs. Knowledge of this disorder may help in the differential diagnosis of arthritis. MATERIALS AND METHODS: Tc-99m MDP bone scintigraphy was used to diagnose arthritic changes. Whole-body and multiple delayed spot images were obtained in a 39-year-old diabetic, hypertensive woman who had tenderness in the plantar aspect of her heels. Swelling of the small and large joints of the feet, ankles, knees, hips, right sacroiliac joints, and shoulders was noted. She also had hydradenitis suppurativa and a history of a previous episode in which the arthritis improved after surgical treatment for the hydradenitis. RESULTS: All active joint lesions were visualized on the bone scan, including the arthritis, which was not detected with other imaging methods. They were all well demonstrated in the bone scintiscan. The scan findings, along with the presence of hydradenitis, led to the correct diagnosis of SAPHO syndrome. CONCLUSION: Tc-99m MDP bone scanning may be helpful in diagnosing arthritis as associated with the SAPHO syndrome.

Gonadotropin-releasing hormone content in the brain and pituitary of male and female grass rockfish (Sebastes rastrelliger) in relation to seasonal changes in reproductive status.

The involvement of individual molecular forms of GnRH in the regulation of reproductive cyclicity in a viviparous marine teleost, the grass rockfish (Sebastes rastrelliger), was evaluated by relating the brain and pituitary content of the neuropeptide to reproductive status. The presence of sea bream (sb) GnRH, chicken GnRH-II, and salmon GnRH in the brain was confirmed by their elution pattern on HPLC and RIA. In addition, HPLC elution profiles suggest that there may be a fourth form of GnRH. All forms of GnRH were found in male and female brains in all reproductive conditions. However, only sbGnRH could be detected in appreciable amounts in the pituitary. Of the four forms of GnRH found in the rockfish, only sbGnRH fluctuated during the reproductive cycle and large accumulations were detected in the brains and pituitaries of postspawn females and regressed males. The accumulation of sbGnRH at the end of the reproductive cycle is suggested to reflect a decline in GnRH secretion relative to synthesis. The dominance of sbGnRH in the pituitary and its individual fluctuation in relation to seasonal changes in reproductive status suggests that sbGnRH is an important regulator of gonadotropin-mediated reproductive activity in rockfish.

Radionuclide lung imaging in respiratory decompression sickness: potential role in the diagnosis and evaluation of hyperbaric therapy.

Of the more than 3.5 million trained divers in the United States, many will experience various illnesses specific to divers. Most of these illnesses are related to the changes in absolute pressure that divers experience while diving. During and after ascent, a diver is at risk for decompression sickness and pulmonary barotrauma. A very rare casualty is pulmonary decompression sickness from immersion. This is a literature review and case report of a young woman with acute respiratory decompression sickness who had defects on perfusion lung imaging after a diving accident and after hyperbaric oxygen therapy. However, the perfusion defects reverted to normal in less than 24 hours. Possible explanations for the changes in the appearances of the scans are offered and discussed. This case report shows the potential utility of lung scanning in the diagnostic examination of these patients and the evaluation of the adequacy of treatment with hyperbaric oxygen therapy. A greater use of ventilation-perfusion lung scans in the treatment of such patients may establish its role more definitely.

A bone marrow report of absent stainable iron is not diagnostic of iron deficiency.

The absence of stainable iron in a bone marrow aspirate is widely considered to be diagnostic of iron deficiency anemia (IDA). We re-evaluated this concept by studying a cohort of 108 consecutive bone marrow specimens from an unselected series of patients who were seen at a hematology clinic and in whom iron stores were reported as being absent. A review of the pathologic reports revealed 19 inadequate specimens and 15 with decreased, but not absent, iron stores. Thus, only 74 of the 108 cases had been accurately reported. In 37 of these cases, adequate clinical and laboratory data were available and allowed further analysis. In 18 patients, careful review of patient history, physical examination, results of endoscopic procedures, and follow-up information failed to suggest the presence of IDA (group A). The review process in the remaining 19 patients suggested the possibility of IDA (group B). Significant differences between groups A and B were observed in serum ferritin (P = 0.001) and red blood cell mean corpuscular volume (P = 0.004). In contrast, the two groups did not differ significantly in hemoglobin concentration, serum iron, total iron-binding capacity, transferrin saturation, or erythrocyte sedimentation rate. These observations suggest that a pathology report of absent bone marrow hemosiderin may be inaccurate in more than 30% of cases and, even when accurate, may not necessarily signify the presence of IDA. Measurement of the serum ferritin level is needed to confirm a clinical diagnosis.

Parameters of differentiation and proliferation in adult granulosa cell tumors of the ovary.

We evaluated parameters of cell differentiation and proliferation to improve prognostication of ovarian adult granulosa cell tumors. Recurrent tumors (n = 10, REC group) and nonrecurrent tumors (n = 30, NED group) were compared in terms of cellular atypia, nuclear area, p53 overexpression, ploidy, DNA index, mitosis count, S-phase fraction, and nucleolar organizer region number and area per cell. Cellular atypia was significantly more frequent in REC than NED tumors (50% versus 13%; P = .03). Mean nuclear area was significantly larger in the REC than in the NED group (44 microm2 versus 36 microm2; P = .006). Mitotic count was significantly higher in REC than NED tumors (mean of 4.8 versus 1.7; P = .004). S-phase fraction and ploidy did not predict outcome: neither did nucleolar organizer region numbers and area per cell, or p53 overexpression. Cellular atypia and mitotic count may help in determining the prognosis of adult granulosa tumors of the ovary. The histochemical parameters evaluated did not provide additional information.

Technetium-99m sestamibi uptake in a maxillary brown tumor.

Brown tumors have been reported to take up TI-201 when dual-tracer parathyroid scintigraphy using TI-201 and Tc-99m pertechnetate was performed. With the change to the more favorable Tc-99m sestamibi parathyroid scanning, similar phenomena of tracer uptake in brown tumors have been reported. The authors describe a 44-year-old man with a left maxillary swelling. Laboratory investigations revealed elevated parathyroid hormone levels. Computed tomography of the head showed a left maxillary expansile mass. Subsequently, a Tc-99m sestamibi scan was performed to rule out a parathyroid adenoma. Left inferior parathyroid retention of the tracer was seen, indicating a parathyroid adenoma. An incidental finding was the uptake of Tc-99m MIBI in the left maxillary brown tumor. This case suggests the utility and possible specificity of Tc-99m MIBI uptake in diagnosing brown tumors.

Potential pitfall in parathyroid sestamibi imaging resulting from a cardiac pacemaker.

A 47-year-old woman with a history of end-stage renal disease and hyperparathyroidism after total parathyroidectomy had Tc-99m sestamibi imaging to identify possible ectopic parathyroid tissue. This study was prompted by increasing calcium and parathyroid hormone levels after several years of taking calcium supplements necessitated by a surgically induced hypoparathyroid state and end-stage renal disease. The scan showed persistent linear activity in the upper right mediastinum in delayed images, after washout of the thyroid had occurred. Because of the unusual configuration of this finding, investigation of the patient's clinical history and other imaging studies was undertaken. The authors concluded that the unusual mediastinal uptake was not hyperactive parathyroid tissue, but rather was attributed to the presence of central venous pacemaker wires. Thus, this case illustrates a potential pitfall in parathyroid sestamibi imaging, the uptake of which may increase in the presence of a cardiac pacemaker, and it emphasizes the importance of correlative imaging.