Safety and Diagnostic Efficacy of Gadobenate Dimeglumine in MRI of the Brain and Spine of Neonates and Infants.

BACKGROUND AND PURPOSE: Contrast-enhanced MR imaging provides essential information for pediatric imaging applications. We evaluated gadobenate dimeglumine for contrast-enhanced MR imaging of infants younger than 2 years of age. MATERIALS AND METHODS: Ninety children younger than 2 years of age (including 55 children younger than 1 year) who underwent enhanced MR imaging of the CNS with gadobenate dimeglumine at 0.1 mmol/kg body weight ± 25% by volume were retrospectively enrolled at 2 imaging centers. Safety data were assessed for adverse events and, when available, vital signs and electrocardiogram and clinical laboratory values obtained from 48 hours before until 48 hours after the MR imaging examination. The efficacy of gadobenate dimeglumine-enhanced MR imaging was evaluated prospectively by 3 blinded, unaffiliated readers in terms of the accuracy of combined pre- and postcontrast images relative to precontrast images alone for differentiation of tumor from non-neoplastic disease and the correct diagnosis of specific disease. Differences were tested using the McNemar test. A possible effect of dose on diagnostic accuracy was assessed using the Fisher exact test. RESULTS: Nine nonserious adverse events were reported for 8 (8.8%) patients. Five adverse events occurred in patients 12 months of age or older. All events occurred at least 24 hours after gadobenate dimeglumine administration, and in each case, the investigating radiologist considered that there was no reasonable possibility of a relationship to gadobenate dimeglumine. No clinically meaningful changes in vital signs, electrocardiogram results, or laboratory parameters were reported. Accurate differentiation of tumor from non-neoplastic disease and exact matching of each specific MR imaging-determined diagnosis with the on-site final diagnosis were achieved in significantly more patients by each reader following evaluation of combined pre- and postcontrast images relative to precontrast images alone (91.0%-94.4% versus 75.3%-87.6%, P < .04, and 66.3%-73.0% versus 52.8%-58.4%, P < .02, respectively). No significant differences (P > .133) in diagnostic accuracy were noted between patients receiving ≤0.08 mmol/kg of gadobenate dimeglumine and patients receiving >0.08 mmol/kg of gadobenate dimeglumine. CONCLUSIONS: Gadobenate dimeglumine is safe and effective for pediatric MR imaging.

Mechanochemical synthesis of high coercivity Nd2(Fe,Co)14B magnetic particles.

With increasing demand for magnets in energy conversion systems, the quest for the development and understanding of novel processing routes to produce permanent magnets has become urgent. We report a novel mechanochemical process for the synthesis of Nd2(Fe,Co)14B magnetic particles with a high coercivity of 12.4 kOe. This process involves the reduction of neodymium oxide, iron oxide, cobalt oxide and boron anhydride in the presence of a calcium reducing agent and a CaO diluent. The formation mechanism of Nd2(Fe,Co)14B changed with increasing CaO content, and the average crystal size of the Nd2(Fe,Co)14B particles also increased, resulting in an increase in the coercivity values. The reaction mechanism during milling was revealed through a study of the phase transformations as a function of milling time. It was found that unlike self-propagating reactions, this reduction reaction during milling requires continuous input of mechanical energy to reach a steady state.

Clinical significance of small airway obstruction markers in patients with asthma.

BACKGROUND: The role of small airway obstruction in the clinical expression of asthma is incompletely understood. OBJECTIVE: We tested the hypotheses that markers of small airway obstruction are associated with (i) increased asthma severity, (ii) impaired asthma control and quality of life and (iii) frequent exacerbations. METHODS: Seventy-four adults with asthma and 18 healthy control subjects underwent impulse oscillometry (IOS), multiple breath inert gas washout (MBW), body plethysmography, single-breath determination of carbon monoxide uptake and spirometry. Patients completed the six-point Asthma Control Questionnaire (ACQ-6) and standardized Asthma Quality of Life Questionnaire [AQLQ(S)]. Asthma severity was classified according to the Global Initiative for Asthma (GINA) treatment steps. RESULTS: The putative small airway obstruction markers Sacin , resistance at 5 Hz minus resistance at 20 Hz (R5-R20) and reactance area (AX) were not independently associated with asthma severity, control, quality of life or exacerbations. In contrast, markers of total (R5) and mean airway resistance of large and small airways (R20) were significantly higher in the severe asthma group compared with the mild-moderate group (0.47 vs. 0.37, P < 0.05 for R5; 0.39 vs. 0.31, P < 0.01 for R20). The strongest independent contributors to ACQ-6 score were R20 and forced expiratory volume in one second (% pred.), and the strongest independent contributors to AQLQ(S) score were R20 and forced vital capacity (% pred.). A history of one or more exacerbations within the previous year was independently associated with R20. CONCLUSIONS AND CLINICAL RELEVANCE: Previously reported markers of small airway obstruction do not appear to be independently associated with asthma disease expression. In contrast, the IOS parameter R20, a marker of mean airway resistance of both large and small airways, appears to have independent clinical significance. These observations require confirmation in prospective longitudinal studies.

Raise the bar and lower the dose: current and future strategies for radiation dose reduction in head and neck imaging.

SUMMARY: Technologic advances in CT have generated a dramatic increase in the number of CT studies, with a resultant increase in the radiation dose related to CT scanning. Such increase in radiation dose is becoming a concern for the radiology community, especially with increasing public awareness of the dose burden related to examinations. To cope with the increase in CT-related radiation exposure, it is becoming necessary to optimize CT imaging protocols and apply radiation dose reduction techniques to ensure the best imaging with the lowest radiation dose.

High-resolution MRI evaluation of neonatal brachial plexus palsy: A promising alternative to traditional CT myelography.

BACKGROUND AND PURPOSE: Despite recent improvements in perinatal care, the incidence of neonatal brachial plexus palsy remains relatively common. CT myelography is currently considered to be the optimal imaging technique for evaluating nerve root integrity. Recent improvements in MR imaging techniques have made it an attractive alternative to evaluate nerve root avulsions (preganglionic injuries). We aim to demonstrate utility of MR imaging in the evaluation of normal and avulsed spinal nerve roots. MATERIALS AND METHODS: All study patients with clinically diagnosed neonatal brachial plexus palsy underwent MR imaging by use of a high-resolution, heavily T2-weighted (driven equilibrium) sequence. MR imaging findings were reviewed for presence of nerve root avulsion from C5-T1 and for presence of pseudomeningocele. The intraoperative findings were reviewed and compared with the preoperative MR imaging findings. RESULTS: Thirteen patients (9 male, 4 female) underwent MR imaging; 6 patients underwent nerve reconstruction surgery, during which a total of 19 nerve roots were evaluated. Eight avulsions were noted at surgery and in the remainder, the nerve injury was more distal (rupture/postganglionic injury). Six of the 8 nerve root avulsions identified at surgery were at C5-6 level, whereas 1 nerve root avulsion was identified at C7 and C8 levels, respectively. The overall sensitivity and specificity of MR imaging for nerve root avulsions was 75% and 82%, respectively. CONCLUSIONS: Our preliminary results demonstrate that high-resolution MR imaging offers an excellent alternative to CT myelography for the evaluation of neonatal brachial plexus palsy with similar sensitivity compared with CT myelography.

TL1A/TNFSF15 directly induces proinflammatory cytokines, including TNFα, from CD3+CD161+ T cells to exacerbate gut inflammation.

Tumor necrosis factor (TNF)-like cytokine 1A (TL1A)/TNF superfamily member 15 (TNFSF15) is a proinflammatory cytokine and TNFα superfamily member that is linked preclinically and clinically to inflammatory bowel disease (IBD). By homology and function, TNFα is its closest family member. In this study, we investigated the mechanism of TL1A-induced inflammation in CD4+ T cells and compared it with the TNFα pathway. We found that TL1A induces proinflammatory cytokines, including TNFα, from isolated human CD4+CD161+ T cells, whereas these cells were resistant to TNFα treatment. Anti-TNFα failed to block TL1A-induced cytokine production, indicating that the effects of TL1A are direct. Lastly, CD161 and TL1A expression were significantly and selectively increased in gut tissue biopsies, but not in the peripheral blood, from IBD patients. Thus, TLIA not only functions upstream of TNFα, driving its expression from CD161+ T cells, but is also independent of TNFα. These findings may have therapeutic IBD implications.

Gelastic syncope: an unusual condition.

Gelastic syncope or laughter-induced syncope is a rare disease often misdiagnosed as narcolepsy or cataplexy. We report a 54-year-old man with syncopal episodes. Each episode started after laughter, leading to light-headedness with blurring of vision and loss of consciousness for a few seconds. The episodes resolved spontaneously. The treatment of gelastic syncope is the same as that for neurally mediated syncope.

SABRE-B: an evaluation of paclitaxel and bevacizumab with or without sunitinib as first-line treatment of metastatic breast cancer.

BACKGROUND: The vascular endothelial growth factor (VEGF) pathway can be targeted through VEGF neutralization or VEGF receptor (VEGFR) blockade using tyrosine kinase inhibition. Because laboratory models suggest that combining these approaches might be synergistic, we sought to evaluate the feasibility and efficacy of combining sunitinib with paclitaxel + bevacizumab (PB). METHODS: Patients with human epidermal growth factor receptor 2 (HER2)-negative, metastatic breast cancer receiving first-line chemotherapy were randomized to PB or PB with sunitinib (PBS), with planned escalation of the sunitinib dose. RESULTS: Forty-six patients were randomized to PB or PBS with sunitinib dosed at 25 mg p.o. daily. Patients receiving PBS encountered substantial toxicity that precluded adequate treatment. The percentage of patients with grade ≥3 adverse events was greater in the PBS arm than the PB arm (83% versus 57%), and sunitinib dosing was modified in 78% of patients, most often due to neutropenia, febrile neutropenia, and fatigue. In addition, 44% of patients had sunitinib dose reduction to 12.5 mg, and 39% required discontinuation. Patients receiving PBS had more bevacizumab treatment interruptions and discontinuations because of toxicity. Median treatment duration was longer in the PB arm compared with the PBS arm (14.1 versus 11.1 weeks), reflecting early treatment discontinuation of PBS. Because of poor tolerability of the addition of sunitinib to PB, the planned sunitinib dose escalation was halted and the study accrual was terminated. CONCLUSION: Adding sunitinib to standard doses of bevacizumab plus paclitaxel for metastatic breast cancer is not feasible. Different strategies will be required to evaluate whether there is additional clinical benefit to combining VEGF/VEGFR-targeted agents.

Fruit and vegetable peels: Paving the way towards the development of new generation therapeutics.

Cardiovascular diseases (CVDs), diabetes mellitus (DM), cancer, and thyroid abnormalities are major health problems prevalent around the world and are responsible for a large portion of morbidity and mortality out of health problems overall. Advances in genomics and proteomics in recent years have led to an explosion in the number of possible therapeutic targets and drug candidates through use of molecular approaches, chemical synthesis, traditional medicinal chemistry, and phyto-chemistry and through the exploration of novel herbal preparations. However, virtually none of these candidates are devoid of potential adverse drug reaction(s) or undesirable side effects. Therefore, the clear need is to look to alternative ways to develop novel drug candidates with fewer side effects and less cost. Interestingly, the last few years have seen an increase in the number of available reports on fruits and vegetable peels, and particularly on their biological activity, their content of different bioactive compounds, their chemical characterization, understanding of their structure-activity relationships, isolation and purification of commercially important chemicals without using high throughput techniques, etc. Therefore, research in the field of fruit and vegetable peels should present immense possibilities for drug discovery and development of cost-effective therapies that have fewer or practically no side effects. This virtual explosion of interest in fruit and vegetable peels as a source of medicinal and nutritional value has led to the present review.

Comparative analysis of free radical scavenging potential of several fruit peel extracts by in vitro methods.

We studied the radical scavenging potential of several fruit peel extracts using various standard chemical and biochemical in vitro methods. Peel extracts of C. sinensis (CS), P. granatum (PG), M. paradisiaca (MP), C. vulgaris (CV), C. melo (CM), M. indica (MI), and C. papaya (CP) were used in the present study and butylated hydroxyl anisole (BHA) was used as a standard. Marked 1,1-diphenyl-2-picrylhydrazyl (DPPH) radical scavenging activity was observed with 25 µg/mL of CS and MP and 50 µg/mL of PG, while all the studied doses of CP were found to be pro-oxidative. ß-Carotene bleaching revealed a higher singlet oxygen scavenging potential of all the peel extracts except MI. High NO-radical scavenging activity was observed at 25 µg/mL of PG and MP. Inhibition test of H2O2-induced LPO in erythrocytes or in liver tissue showed that all the peels tested were effective on peroxy-radicals at one or other doses. The present study revealed the radical scavenging activity of the test peel extracts in a manner that was dose- and radical/methodspecific. Therefore, evaluation of the efficacy of herbal extracts should be carried out using different methods and not merely a single in vitro method.

The thrust plate prosthesis in the treatment of osteoarthritis of the hip. Clinical and radiological outcome with minimum 5-year follow-up.

The thrust plate prosthesis (TPP) is a neck preserving femoral component in total hip arthroplasty (THA). We present our mid-term results from using the thrust plate prosthesis in young patients with hip arthritis. We conducted a retrospective review of a consecutive series of patients with a minimum of 5 years follow-up after total hip arthroplasty using the thrust plate prosthesis. Harris Hip Score (HHS) and Oxford Hip Score (OHS) were recorded preoperatively and at the last clinical review. Radiographic analysis was performed and patient satisfaction levels and complications were recorded. Between 1996 and 2000 we implanted 41 prostheses in 38 consecutive patients (3 bilateral). The mean age at time of surgery was 56 years (41-67) and the mean length of follow-up was 71 months. The HHS improved from a mean of 42 points preoperatively to 88 points at the last clinical review and the mean OHS also improved from 40 points to 18 points. Eighty-three percent of patients expressed that they were 'very satisfied' with the procedure. Implant survivorship was 95% at 5 years follow-up with revision surgery being the end point. Eight patients suffer discomfort when lying on the operated side. Many patients treated with the TPP show excellent improvement in clinical outcome scores and a high level of patient satisfaction but the complication rate gives some concern. We support the selective use of the TPP to treat young patients with hip osteoarthritis.

Antiperoxidative, antithyroidal, antihyperglycemic and cardioprotective role of Citrus sinensis peel extract in male mice.

An extract of Citrus sinensis (CS) peel was evaluated for its efficacy in ameliorating L-thyroxine (L-T(4)) induced tissue lipid peroxidation (LPO), hyperthyroidism and hyperglycemia in mice. In a preliminary investigation, of the three different doses of CS (12.5 mg/kg, 25 mg/kg and 50.0 mg/kg) peel extract, 25 mg/kg was found to be the most effective and antiperoxidative, while 50 mg/kg was proved to be hepatotoxic. Therefore in the pilot experiment the effects of 25 mg/kg/day of CS for 10 days were studied in L-T(4) induced hyperthyroid animals. L-T(4) (500 microg/kg/day for 10 days) increased the levels of thyroxine (T(4)) and triiodothyronine (T(3)) with a concomitant increase in serum glucose concentration, alpha-amylase activity, heart/body weight ratio (HW/BW), kidney/body weight ratio (KW/BW) and cardiac as well as hepatic LPO. However, it decreased the concentration of different serum lipids such as total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C) and very low-density lipoprotein cholesterol (VLDL-C). Administration of CS extract (25 mg/kg/day) in hyperthyroid animals reversed most of these observations revealing the ameliorating potential of CS extract against various adverse effects of hyperthyroidism. It appears that the test extract primarily acts through its antioxidative/free radical-scavenging, antithyroidal and HDL-C stimulating properties.

Cardio-protective role of Terminalia arjuna bark extract is possibly mediated through alterations in thyroid hormones.

Terminalia arjuna bark extract is believed to exhibit cardio-protective effects. In the present study we investigated the possible involvement of thyroid hormones in the amelioration of cardiac and hepatic lipid peroxidation (LPO) by a bark extract of the plant in albino rats. While L-thyroxine (L-T4) treatment increased the level of thyroid hormones, heart/body weight ratio as well as cardiac and hepatic lipid peroxidation, simultaneous administration of 21.42 and 42.84 mg/kg of the plant extract decreased the level of thyroid hormones and also the cardiac LPO, suggesting the possible mediation of the drug action through an inhibition in thyroid function. These effects were comparable to a standard antithyroid drug, propyl thiouracil (PTU). When the drug was administered to euthyroid animals, serum concentrations of thyroid hormones were decreased, whereas the hepatic LPO increased indicating a drug induced toxicity in euthyroid subjects. Although a suboptimal dose of the drug was found to be non-toxic to the liver, it appeared to be of no use, as it could neither affect the thyroid functions nor the cardiac lipid peroxidation. Since in euthyroid animals, thyroid hormones were decreased and hepatic LPO was increased, it is suggested that high amounts of this plant extract should not be consumed, as hepatotoxicity as well as hypothyroidism may be caused.

Intraosseous haemangioma of the proximal femur: imaging findings.

Haemangiomas of bone are uncommon lesions, accounting for approximately 1% of all primary bone tumours. The most frequent sites of involvement are the calvaria and the vertebral column. When haemangiomas involve long tubular bones, they are usually found in the diaphysis or metadiaphysis. Juxta-articular or epiphyseal location for a long bone haemangioma is rare. We present the imaging findings in a case of a histopathologically proven juxta-articular intraosseous haemangioma of the proximal femur. We believe ours is the first report of a haemangioma involving the proximal end of the femur.

Early experiences with diffusion tensor imaging and magnetic resonance tractography in stroke patients.

INTRODUCTION: Recent advances in magnetic resonance (MR) diffusion tensor imaging technique enable evaluation of the anisotropy of white matter tracts in-vivo, as well as the integrity of fibre tracts and their orientation. We describe our initial experiences with diffusion tensor imaging and MR tractography techniques to evaluate the structural degeneration of white matter tracts following stroke. METHODS: Diffusion tensor imaging data were acquired in 11 cases with stroke on a 3T MR imaging scanner, with three-dimensional diffusion tensor imaging-based colour maps and MR tractography performed offline. We evaluated the spatial relationships of the eloquent white matter tracts to the infarcts and areas of haemorrhage, and classified therewith the tracts as either disrupted or displaced. We compared these with the clinical severity of the neurological deficits and prognosis. RESULTS: A good correlation was found between tractography findings and patient's clinical recovery. All the patients with disruption of white matter tracts had residual deficits on clinical follow-up, whereas the patients with displaced tracts had near complete neurological recovery. CONCLUSION: Diffusion tensor imaging and MR tractography provide a novel and useful method to directly visualise changes in the white matter tracts in stroke. This can potentially allow clinical-imaging correlation with prognostic potential.

Normal variants of the intracranial circulation demonstrated by MR angiography at 3T.

Magnetic resonance angiography (MRA) at 3T offers increased signal to noise ratio with better background suppression, leading to exquisite depiction of the intracranial circulation. We present a pictorial review of the normal variations and anomalies of the intracranial circulation detected on MRA performed on a high field 3T clinical scanner using parallel imaging techniques. The salient imaging features of these anomalies and normal variations are discussed with relevance to clinical practice.

The role of the IPSS (International Prostate Symptoms Score) in predicting acute retention of urine in patients undergoing major joint arthroplasty.

BACKGROUND: Acute urinary retention following major joint arthroplasty is common. It does necessitate instrumentation, puts patients at risk of complications, and causes discomfort and embarrassment. The aim of the study was to find a test to help the surgeon to predict the possibility of acute retention of urine. METHODS: Male patients admitted for elective major joint arthroplasty filled in an IPSS (International Prostate Symptoms Score) during the pre-operative visit. They were observed post-operatively to document if they passed urine spontaneously or went into acute retention. RESULTS: There was a strong correlation between the IPSS and the likelihood of developing acute retention. Patients with moderate to high IPSS had a 55% to 100% chance of developing acute retention of urine, respectively. CONCLUSION: The IPSS proved to be a simple and reliable test to help the surgeon in predicting the possibility of developing acute retention. It might be a good addition to the pre-admission clinic investigations in patients undergoing major surgery. It could consolidate the decision to pre-emptive catheterisation in patients at risk.

Female genital tuberculosis: hysterosalpingographic appearances.

Genital tuberculosis is an important cause of infertility in developing countries and hysterosalpingography (HSG) is the initial procedure performed for the evaluation. Reviewing 37 cases of female genital tuberculosis, we encountered various appearances on HSG. Of 579 HSGs performed over a period of 4 years, 492 (85%) were performed as part of infertility work up. Genital tuberculosis was found in 6.3% of all the patients who underwent HSGs and 7.5% of all patients investigated for infertility. The various features of proven tuberculosis cases are illustrated in this pictorial review. We briefly discuss the pathology and these appearances along with radiopathological correlation.