Investigations on the role of the salmon louse, Lepeophtheirus salmonis (Caligidae), as a vector in the transmission of Aeromonas salmonicida subsp. salmonicida.

A bacteria-parasite challenge model was used to study the role of sea lice, Lepeophtheirus salmonis (Copepoda), as a vector of Aeromonas salmonicida subsp. salmonicida. Three hypotheses were tested: (i) L. salmonis can acquire A. salmonicida subsp. salmonicida via water bath exposure; (ii) L. salmonis can acquire the bacteria via parasitizing infected Atlantic salmon, Salmo salar; and (iii) L. salmonis can transmit the bacteria to naïve Atlantic salmon via parasitism. Adult L. salmonis exposed to varying A. salmonicida subsp. salmonicida suspensions (10(1) -10(7)  cells mL(-1) ) for 1.0, 3.0 or 6.0 h acquired the bacteria externally (12.5-100%) and internally (10.0-100%), with higher prevalences associated with the highest concentrations and exposures. After exposure to 10(7)  cells mL(-1) , viable A. salmonicida subsp. salmonicida could be isolated from the external carapace of L. salmonis for 120 h. Lepeophtheirus salmonis also acquired the bacteria externally and internally from parasitizing infected fish. Bacterial transmission was observed only when L. salmonis had acquired the pathogen internally via feeding on 'donor fish' and then by parasitizing smaller (<50 g) 'naive' fish. Under specific experimental conditions, L. salmonis can transfer A. salmonicida subsp. salmonicida via parasitism; however, its role as a mechanical or biological vector was not defined.

Use of digital images to aid in the decision-making for acute upper extremity trauma referral.

UNLABELLED: This study evaluated the use of digital smartphone images in the decision-making for acute upper extremity trauma referrals. Surgeons (n = 15) were presented with ten upper limb trauma scenarios for consideration of immediate transfer. Based on verbal history and with additional images, participants were asked questions regarding diagnosis, injured tissues, recommended management and diagnostic and treatment confidence. Statistical analyses evaluated confidence level changes and relationships between confidence levels and independent variables. Confidence levels for diagnosis and treatment were increased with the provision of smartphone images, and this was statistically significant. The decision to transfer was changed in 22%. The photographs were more useful for amputation versus non-amputation injuries (diagnosis and treatment) and hand versus forearm injuries (diagnosis), and these differences reached statistical significance. Smartphone digital images were shown to be useful for decision-making in acute upper extremity trauma referrals. This improved communication may have implications for health cost savings and patient burden by minimizing unnecessary acute transfers. LEVEL OF EVIDENCE: Diagnostic Level III.

Contribution of regional brain melanocortin receptor subtypes to elevated activity energy expenditure in lean, active rats.

Physical activity and non-exercise activity thermogenesis (NEAT) are crucial factors accounting for individual differences in body weight, interacting with genetic predisposition. In the brain, a number of neuroendocrine intermediates regulate food intake and energy expenditure (EE); this includes the brain melanocortin (MC) system, consisting of MC peptides as well as their receptors (MCR). MC3R and MC4R have emerged as critical modulators of EE and food intake. To determine how variance in MC signaling may underlie individual differences in physical activity levels, we examined behavioral response to MC receptor agonists and antagonists in rats that show high and low levels of physical activity and NEAT, that is, high- and low-capacity runners (HCR, LCR), developed by artificial selection for differential intrinsic aerobic running capacity. Focusing on the hypothalamus, we identified brain region-specific elevations in expression of MCR 3, 4, and also MC5R, in the highly active, lean HCR relative to the less active and obesity-prone LCR. Further, the differences in activity and associated EE as a result of MCR activation or suppression using specific agonists and antagonists were similarly region-specific and directly corresponded to the differential MCR expression patterns. The agonists and antagonists investigated here did not significantly impact food intake at the doses used, suggesting that the differential pattern of receptor expression may by more meaningful to physical activity than to other aspects of energy balance regulation. Thus, MCR-mediated physical activity may be a key neural mechanism in distinguishing the lean phenotype and a target for enhancing physical activity and NEAT.

Early and Long-term Outcome after Open Surgical Suprarenal Aortic Fenestration in Patients with Complicated Acute Type B Aortic Dissection.

OBJECTIVES: The purpose of this retrospective cohort study was to determine the early and long-term mortality and morbidity as well as to reveal risk factors influencing the long-term prognosis in patients with complicated acute type B aortic dissection (CABAD) undergoing open surgical suprarenal aortic fenestration (OSSAF). METHODS: Fifty-two patients with CABAD, defined as (impending) rupture, acute enlargement of the false lumen, malperfusion, and/or unrelenting back pain or uncontrollable hypertension despite maximum medical therapy were treated with by surgical repair between 2002 and 2008. Ten patients with (impending) rupture had aortic graft replacement, while 42 (33 men, mean age 55 ± 11 years) had OSSAF. Follow up visits were scheduled at 1, 3-6 and 12 months after the surgery and annually thereafter. Clinical examination and computed tomography angiography findings were investigated at baseline and at subsequent visits. RESULTS: The indications for OSSAF were acute enlargement of the false lumen in four (10%), malperfusion in 17 (40%) (11 lower extremity [26%], 6 visceral [14%]), and unrelenting back pain or uncontrollable hypertension in 21 cases (50%). The 30 day mortality was 21.4% (2 multiple organ failure, 2 heart failure, 3 pneumonia, 1 intestinal necrosis, 1 major hemorrhage). The mean follow up was 84 ± 40 months. The 5 year survival was 70.6%. Eight patients (19%) died during the follow up period (6 aortic ruptures, 2 myocardial infarctions). None of the patients became paraplegic after the surgery. Further surgery or stenting was indicated in nine cases (21%). CONCLUSIONS: OSSAF has been performed with an acceptable early mortality and low paraplegia rate, but late mortality is frequently related to aortic rupture. Stentgraft coverage of the primary entry tear decreases late aortic related deaths, but suprarenal fenestration remains an option for cases not suitable for endovascular techniques.

The importance of identity and empowerment to teenagers with developmental co-ordination disorder.

AIMS: The aim of the current study was to gain an understanding of the experiences and aspirations of young people living with Developmental Coordination Disorder (DCD) in their own words. METHODS: Eleven young people aged 11-16 years with a prior diagnosis of DCD were identified from child health records of two participating NHS trusts. The sample included seven boys and four girls, from different socio-economic backgrounds living in different parts of one large urban area in England. In depth one-to-one semi-structured interviews and subsequent follow-up small group interviews were carried out with the young people. Interviews were enhanced using participatory arts-based techniques. All interviews were recorded verbatim and transcribed. Narrative data were analysed using Lindseth's interpretive phenomenology. RESULTS: The central theme of 'We're all different' described how the young person saw themselves and encompassed the formation of identity. Subthemes illustrated the attitude of the young people to their day to day lives, their difficulties and strategies used by the young people to overcome these difficulties in school and at home. The attitude of the school to difference, the presence of bullying, the accepting nature of the class, teachers and peers were vitally important. Areas of life that encouraged a positive sense of identity and worth included being part of a social network that gave the young people a sense of belonging, potentially one that valued differences as well as similarities. CONCLUSION: The current work highlights the need for services to adopt a model of DCD where the young person talks about what they can do and considers strategies of overcoming their difficulties. This has implications for education and future intervention strategies that focus on fostering psychological resilience and educational coping strategies rather than simply attempting to improve motor skills.

'Providing more scaffolding': parenting a child with developmental co-ordination disorder, a hidden disability.

BACKGROUND: Few studies exist reporting the experiences of parents of children with developmental co-ordination disorder (DCD) a common disorder with a prevalence of 1.8-6%. DCD is characterized by poor motor co-ordination, not caused by a general medical condition, but significantly affecting daily living. This study explores the experiences of parents living with a child with DCD in obtaining a diagnosis; the impact of the diagnosis on parenting and the effect on parents as individuals. METHODS: Semi-structured interviews with a purposive sample of 15 parents of children with DCD data were recorded and then transcribed. Data were analysed using a coding framework and themes identified similar to Attride-Stirling (2001, Qualitative Research, 1, 385-405). FINDINGS: DCD was an all-encompassing condition that dominated all aspects of family life and was a 'hidden disability'. Parents were frustrated by the poor knowledge and expertise of health and education professionals working with children with DCD and the lack of good quality accessible information and support services. Parents became by default the 'expert' on DCD for schools and other services; they were advocates for DCD and their own children. They provided additional support for longer to their child with DCD and had concerns for their future. Parenting a child with DCD was frustrating, exhausting, guilt-ridden as well as rewarding. There was little available time to provide for the needs of other family members. CONCLUSION: A better-trained, knowledgeable workforce would redress the balance for families with DCD by providing better information, support and advocacy freeing parents to parent their families.

Effects of dietary enzymes on performance and intestinal goblet cell number of broilers exposed to a live coccidia oocyst vaccine.

An experiment was conducted to evaluate the effects of dietary enzymes on performance, tibia ash, and intestinal goblet cells of broilers administered a live coccidia oocyst vaccine (Coccivac B, Schering Plough, Kenilworth, NJ). Cobb 500 straight-run broilers were obtained and one-half of the chicks were sprayed with the live coccidia oocyst vaccine. Chicks were weighed and placed in battery brooders with respect to nonvaccinated or vaccinated group according to dietary treatment. The 8 dietary treatments were a positive control (0.90% Ca and 0.45% available P), a negative control (NC; 0.80% Ca and 0.35% available P), NC + phytase (PHY), NC + protease (PRO), NC + xylanase (XYL), NC + PHY+ PRO, NC + PHY + XYL, and NC + PHY + PRO + XYL. A diet × vaccination interaction (P > 0.05) was not observed for feed intake or BW gain. Feed conversion ratio was improved (P ≤ 0.05) in birds fed NC + PHY + XYL compared with NC. Vaccination reduced (P ≤ 0.05) feed intake and BW gain from d 0 to 18. Tibia ash was reduced (P ≤ 0.05) in the NC and PRO or XYL diets. Vaccination increased goblet cell numbers in the duodenum of birds fed XYL, whereas no differences were found in goblet cell numbers between nonvaccinated and vaccinated birds in other dietary treatments, which resulted in a diet × vaccination interaction (P ≤ 0.05). Protease decreased and NC + PHY+ PRO increased goblet cells in the jejunum at d 7, which resulted in a diet × vaccination interaction (P ≤ 0.05). At d 18, NC + PHY + XYL was the only diet in which vaccination decreased goblet cells in the jejunum, resulting in a diet × vaccination interaction (P ≤ 0.05). The data indicate that NC + PHY + XYL improved the feed conversion ratio in broilers fed corn-soybean meal diets. The vaccination × dietary enzyme interaction altered the number of goblet cells in the small intestine. Dietary enzyme supplementation did not alleviate reductions in growth performance associated with the use of a live coccidia oocyst vaccine.

Resurfacing of colour-mismatched free flaps on the face with split-thickness skin grafts from the scalp.

Free-tissue transfer is commonly used in micro-vascular head and neck reconstruction. In a significant proportion of cases, the reconstruction involves the placement of a conspicuous, colour-mismatched skin paddle on the face. This article presents our experience in resurfacing of free flaps on the face in seven patients, using split-thickness skin grafts harvested from the scalp. All patients had a noticeable improvement in colour match. This relatively minor procedure can significantly improve aesthetic outcome and merits consideration in appropriate patients.

Central neural and endocrine mechanisms of non-exercise activity thermogenesis and their potential impact on obesity.

The rise in obesity is associated with a decline in the amount of physical activity in which people engage. The energy expended through everyday non-exercise activity, called non-exercise activity thermogenesis (NEAT), has a considerable potential impact on energy balance and weight gain. Comparatively little attention has been paid to the central mechanisms of energy expenditure and how decreases in NEAT might contribute to obesity. In this review, we first examine the sensory and endocrine mechanisms through which energy availability and energy balance are detected that may influence NEAT. Second, we describe the neural pathways that integrate these signals. Lastly, we consider the effector mechanisms that modulate NEAT through the alteration of activity levels as well as through changes in the energy efficiency of movement. Systems that regulate NEAT according to energy balance may be linked to neural circuits that modulate sleep, addiction and the stress response. The neural and endocrine systems that control NEAT are potential targets for the treatment of obesity.

Supplementation of Avizyme 1502 to corn-soybean meal-wheat diets fed to turkey tom poults: the first fifty-six days of age.

A study was designed to determine the effects of enzyme supplementation on poults fed commercially based diets that included corn, soybean meal, and ground wheat with meat and bone meal (0 to 21 d) or Pro-Pak (22 to 56 d). Day-old turkey poults (n = 3,850) were divided into 35 pens and fed 1 of 5 dietary treatments for 56 d. Treatments were a positive control, a negative control (corn matrix adjustment of 140 kcal), and negative control diets supplemented with Avizyme 1502 at 250, 500, or 750 g/tonne. Feed intake, live weight gain, feed conversion ratio, and mortality were measured for the periods 0 to 21 d, 21 to 42 d, and 42 to 56 d, as well as for the cumulative 0 to 56 d. The 0- to 21-d period was further divided into subperiods (0 to 4 d, 4 to 8 d, 8 to 12 d, 12 to 16 d, 16 to 21 d) to evaluate early nutritional development. Ileal contents along with duodenal, jejunal, and ileal sections (n = 7/treatment) were sampled to determine apparent digestibility and morphology. In most instances, production response differences between the positive and negative controls were not significant, making definitive interpretation of enzyme addition difficult. Energy and protein ileal digestibilities of the negative control diets were lower than those of the positive control diet at 4, 8, 12, 16, and 42 d. Enzyme supplementation significantly improved energy and protein beyond that of the PC diet on d 42. Villus height and crypt depth did not respond to dietary treatment, although there was a significant interaction of age by treatment on jejunal villus height. The similarity between the controls, as well as the high inclusion of CuSO(4), may be responsible for the low response with enzyme inclusion.

The effect of dietary protein level and total sulfur amino acid:lysine ratio on egg production parameters and egg yield in Hy-Line W-98 hens.

A 3 x 3 treatment arrangement varying in dietary protein and TSAA:Lys was used to evaluate the effect of low-protein diets fed to Hy-Line W-98 laying hens. Phase I was 20 to 43 wk of age with 18.9, 17.0, and 14.4 g of protein/hen per day and 0.97, 0.85, and 0.82 TSAA:Lys, whereas phase II was 44 to 63 wk of age with 16.3, 14.6, and 13.8 g of protein/hen per day and 0.92, 0.82, and 0.72 TSAA:Lys. Egg production and feed consumption decreased from 83.7 to 82.2% and 98.8 to 95.6 g, respectively. Feed efficiency improved from 1.680 to 1.645 g of feed/g of egg mass with decreasing dietary protein. Body weight gain was similar for hens fed high or medium protein diets. In phase II, hens consuming 13.8 g of protein/day had significantly reduced egg weight compared with hens consuming 14.6 or 16.3 g of protein/day. Wet and dry albumen percentage, albumen solids, and albumen and yolk protein percentages were significantly decreased with feeding low-protein diets. Yolk protein percentage was increased from 14.85 to 15.11% when decreasing the ratio from 0.97 to 0.82. Hens consuming a low-protein diet produced eggs with the lowest specific gravity. An interaction was observed for protein retention during phase I, feeding 14.4 g of protein/day or a ratio of 0.97 improved protein retention by 9 and 16%, respectively. Overall, hens consuming 16.3 or 14.6 g of protein/hen per day performed similar to hens consuming 18.9 and 17.0 g of protein/hen per day during P1 and P2, respectively. Also, hens consuming diets containing 0.97 and 0.92 TSAA:Lys produced eggs with improved shell quality as compared with other ratios during P1 and P2, respectively.

Neuromedin U in the paraventricular and arcuate hypothalamic nuclei increases non-exercise activity thermogenesis.

Brain neuromedin U (NMU) has been associated with the regulation of both energy intake and expenditure. We hypothesized that NMU induces changes in spontaneous physical activity and nonexercise activity thermogenesis (NEAT) through its actions on hypothalamic nuclei. We applied increasing doses of NMU directly to the paraventricular (PVN) and arcuate hypothalamic nuclei using chronic unilateral guide cannulae. In both nuclei, NMU significantly and dose-dependently increased physical activity and NEAT. Moreover, NMU increased physical activity and NEAT during the first hour of the dark phase, indicating that the reduction of sleep is unlikely to account for the increased physical activity seen with NMU treatment. As a positive control, we demonstrated that paraventricular NMU also significantly decreased food intake, as well as body weight. These data demonstrate that NMU is positively associated with NEAT through its actions in the PVN and arcuate nucleus. In co-ordination with its suppressive effects on feeding, the NEAT-activating effects of NMU make it a potential candidate in the combat of obesity.

Orexin A mediation of time spent moving in rats: neural mechanisms.

The brain regulates energy balance and spontaneous physical activity, including both small- and large-motor activities. Neural mediators of spontaneous physical activity are currently undefined, although the amount of time spent in sedentary positions versus standing and ambulating may be important in the energetics of human obesity. Orexin A, a neuropeptide produced in caudal hypothalamic areas and projecting throughout the neuraxis, enhances arousal and spontaneous physical activity. To test the hypothesis that orexin A affects the amount of time spent moving, we injected orexin A (0-1000 pmol) into three orexin projection sites in male Sprague-Dawley rats: hypothalamic paraventricular nucleus, rostral lateral hypothalamic area and substantia nigra pars compacta, and measured spontaneous physical activity. Orexin A affects local GABA release and we co-injected orexin A with a GABA agonist, muscimol, in each brain site. Dopamine signaling is important to substantia nigra function and so we also co-injected a dopamine 1 receptor antagonist (SCH 23390) in the substantia nigra pars compacta. In all brain sites orexin A significantly increased time spent vertical and ambulating. Muscimol significantly and dose-dependently inhibited orexin A effects on time spent moving only when administered to the rostral lateral hypothalamic area. In the substantia nigra pars compacta, SCH 23390 completely blocked orexin A-induced ambulation. These data indicate that orexin A influences time spent moving, in three brain sites utilizing separate signaling mechanisms. That orexin A modulation of spontaneous physical activity occurs in brain areas with multiple roles indicates generalization across brain site, and may reflect a fundamental mechanism for enhancing activity levels. This potential for conferring physical activity stimulation may be useful for inducing shifts in time spent moving, which has important implications for obesity.

Broiler performance and intestinal alterations when fed drug-free diets.

A study was carried out to investigate the effects of a drug-free feeding program on broiler performance and intestinal morphology. Chicks vaccinated against coccidia were randomly assigned to 4 dietary treatments: 1) negative control (NC), basal diet; 2) positive control (PC), diet 1 + Lincomycin; 3) program 1 (PG1); diet 1 + Bio-Mos, Vegpro, MTB-100, Acid Pak 4-Way, and All-Lac XCL; 4) and program 2 (PG2), diet 1 + Bio-Mos and All-Lac XCL, each of which were assigned to 13 pens (48 birds in each of 52 pens). Growth traits (BW, feed intake, yield, mortality, BW gain, and feed conversion rate) were obtained through 49 d. At d 14, 3 chicks per pen were challenged with coccidia. Segments of duodenum, ileum, and ceca were removed to measure intestinal morphology at d 14, 28, 35, and 49. Final BW gain of broilers on PC (2.736 kg) was numerically higher than those for NC (2.650 kg). Cumulative feed conversion rate at d 49 was improved (P < 0.05) in birds consuming PC and PG2 compared with NC. Overall, mortality was higher for birds consuming the NC (P < 0.05) than the PC, PG1, and PG2 diets. Interaction of dietary treatments with age and age alone were evident (P < 0.0001) for morphology of duodenum, ileum, and ceca. Lamina propria in ceca was thicker (P < 0.008) in broilers consuming the NC than PG1 and PG2 diets. The results of this study indicated that feeding birds without growth promoters resulted in higher mortality and decreased growth performance than did feeding a diet with an antibiotic, and the combination of Bio-Mos and All-Lac XCL helped to reduce negative effects.

Comparison of prophylactic or therapeutic dietary administration of capsaicin for reduction of Salmonella in broiler chickens.

In three experiments the effects of prophylactic or therapeutic dietary inclusion of capsaicin, the pungent component of peppers, were evaluated as a nonantibiotic alternative for reduction of Salmonella in broiler chickens through culture and morphologic assessment of cecal tissue. Expt. 1 evaluated the effects of 0 or 10 ppm purified capsaicin (CAP) in the starter phase (days 1-16) on chicks challenged with Salmonella Enteritidis (SE) on day of age. Therapeutic inclusion of 10 ppm purified CAP increased (P < 0.05) liver/spleen (L/S) and ceca positive results for SE. In Expt. 2, capsaicin oleoresin (CO) was included in the finisher diet (days 30-37) at 0, 5, or 20 ppm with SE challenge on day 31. Inclusion of 5 ppm CO increased ceca positive results for SE, and a linear decrease in cecal lamina propria thickness of SE-challenged birds was observed with increased CO concentration in the diet. Expt. 3 evaluated prophylactic CO treatment at 0, 5, or 20 ppm in starter, grower, and finisher diets for resistance to SE or Salmonella Typhimurium (ST) challenge on day 14 or 29. With challenge on day 14, 5 and 20 ppm prophylactic CO feeding reduced ceca SE positive results by 37% and 26%, respectively, and ST culture rate was reduced similarly with 5 ppm CO. Lamina propria thickness of the ceca increased with 5 ppm CO feeding in SE-challenged birds, whereas a decrease was observed in nonchallenged birds fed 5 ppm CO. Challenge on day 29 of birds fed 20 ppm CO resulted in reduced L/S positive results for SE. Lamina propria thickness decreased with 5 ppm CO and SE or ST challenge compared with nonchallenged birds fed 5 ppm. An increase was observed in ST- or SE-challenged birds fed 20 ppm CO compared with nonchallenged birds fed 20 ppm CO. No differences were observed in mast cell number in either Expt. 2 or 3. These data provide evidence that prophylactic or therapeutic dietary capsaisin differentially affects broiler susceptibility to Salmonella.

Animal management to reduce phosphorus losses to the environment.

Water quality in the United States is threatened by contamination with nutrients, primarily nitrogen and phosphorus. Animal manure can be a valuable resource for farmers, providing nutrients, improving soil structure, and increasing vegetative cover to decrease erosion potential. At the same time, application of manure nutrients in excess of crop requirements can result in environmental contamination. Environmental concerns with P are primarily associated with pollution of surface water (streams, lakes, rivers). This pollution may be caused by runoff of P when application to land is in excess of crop requirements. Increased specialization and concentration of livestock and crop production has led to the net export of nutrients from major crop-producing areas of the country to areas with a high concentration of animal agriculture. Concentrated animal agriculture has been identified as a significant source of P contamination of surface water. Areas facing the dilemma of an economically important livestock industry concentrated in an environmentally sensitive area have few options. If agricultural practices continue as they have in the past, continued damage to water resources and a loss of fishing and recreational activity are inevitable. If agricultural productivity is decreased, however, the maintenance of a stable farm economy, a viable rural economy, and a reliable domestic food supply are seriously threatened. Decreasing the P content of manure through nutrition is a powerful, cost-effective approach to reducing P losses from livestock farms and will help farmers meet increasingly stringent environmental regulations. This paper reviews opportunities available to reduce the P content of livestock manure, including more accurate interpretation of the published P requirements of animals, improved diet formulation and group-feeding strategies to more precisely meet requirements, and approaches to improve availability of feed P for monogastric and ruminant species.

GABA(B) receptor activation in the suprachiasmatic nucleus of diurnal and nocturnal rodents.

Diurnal (day-active) and nocturnal (night-active) animals have very different daily activity patterns. We recently demonstrated that the suprachiasmatic nucleus (SCN) responds to GABAergic stimulation differently in diurnal and nocturnal animals. Specifically, GABAA receptor activation with muscimol during the subjective day causes phase delays in diurnal grass rats while producing phase advances in nocturnal hamsters. The aim of the following experiments was to determine if diurnal and nocturnal animals differ in their response to GABAB receptor activation in the SCN. Baclofen, a GABAB receptor agonist, was microinjected into the SCN region of grass rats or hamsters under free-running conditions and phase alterations were analyzed. Changes in phase were not detected after baclofen treatment during the subjective day in either grass rats or hamsters. During the night, however, GABAB receptor activation significantly decreased the ability of light to induce phase delays in grass rats. Taken together with previous data from our laboratory, these results demonstrate that, in both hamsters and grass rats, GABAB receptor activation in the SCN significantly affects circadian phase during the night, but not during the day.

[Clinical evaluation of a software for automated localization of lung nodules at follow-up CT examinations]. / Klinische Evaluation einer Software zur automatischen Lokalisation von Lungenrundherden in CT-Verlaufskontrollen.

PURPOSE: To evaluate a software algorithm for automated localization of pulmonary nodules at follow-up CT examinations of the chest and to determine factors influencing the rate of correctly matched nodules. MATERIALS AND METHODS: The "real-time automatic matching" (RAM) algorithm (Siemens LungCare trade mark software) was applied to 22 follow-up multirow-detector CT (MDCT) examinations in 11 patients (Siemens Somatom VolumeZoom, tube voltage 120 kVp; effective tube current 20 mAs (n = 18) or 100 mAs (n = 4); 4 x 1 mm detector configuration, 1.25 mm slice thickness; 0.8 mm reconstruction increment; standard lung kernel B50f) with a total of 190 lung nodules (mean diameter 6.7 +/- 3.5 mm, range 2 - 17 mm). The following nodule features were recorded: diameter, edge definition (well- or ill-defined), location (upper, middle or lower third; central or peripheral; right or left lung) and inspiration level (considered identical if the difference of diaphragm-apex distance between baseline and follow-up examination was < 5 %, otherwise it was considered different). A nodule was regarded as correctly localized if the marking box drawn by the software was visible on at least one slice together with the nodule and the center of the nodule was located inside the marking box. chi(2)-test was used to describe influence of nodule features on detection rate. Influence of nodule size was assessed using Mann-Whitney-U-Test. RESULTS: RAM correctly located 164 of 190 of all lung nodules (86.3 %). Detection rate did not depend on nodule location (left vs. right lung: p = 0.48; upper vs. middle vs. lower third: p = 0.96; peripheral vs. central: p = 0.47) or diameter (p = 0.30). Influence of inspiration level was highly significant (p < 0.001): nodules were detected in 100 % (146/146) for identical inspiration levels and in 40.9 % (18/44) for different inspiration levels. The observation of a significant better localization of ill-defined nodules (p = 0.028) corresponds to a statistical artifact due to the inhomogeneous distributions of this specific feature in our data. CONCLUSION: RAM is a valuable tool for follow-up of lung nodules at CT. Only very different inspiration levels influenced detection rate.

Neuropeptide Y and N-methyl-D-aspartic acid interact within the suprachiasmatic nuclei to alter circadian phase.

Circadian rhythms are reset by exposure to photic stimuli and nonphotic stimuli. Glutamate appears to be the primary neurotransmitter that communicates photic stimuli to the circadian clock located in the suprachiasmatic nucleus. There is also substantial evidence that neuropeptide Y (NPY) mediates the effects of at least some nonphotic stimuli on the circadian clock. The purpose of this study was to investigate how NPY and glutamate receptor activation interact to reset the phase of the circadian clock. Microinjection of the glutamate agonist N-methyl-D-aspartic acid (NMDA) during the subjective day significantly decreased NPY-induced phase advances. During the late subjective night, NMDA induced light-like phase advances, which were significantly reduced by microinjection of NPY. Microinjection of NPY inhibited NMDA-induced phase advances during the late subjective night, even when sodium-dependent action potentials were inhibited by tetrodotoxin. These data support the hypothesis that, during the subjective night, NPY and NMDA act on the same clock cells or on cells that communicate with clock cells by mechanisms not requiring action potentials. Although NPY and NMDA appear to be mutually inhibitory during both the day and the night, the mechanisms of this inhibition appear to be different during the day versus the night.