The striatal dopamine transporter in first-episode, drug-naive schizophrenic patients: evaluation by the new SPECT-ligand[99mTc]TRODAT-1

Following the current hypothesis that acute schizophrenic psychotic illness is associated with a striatal 'hyperdopaminergic state', presynaptic integrity and dopamine transporter (DAT) density in first-episode, neuroleptic-naive schizophrenic patients was measured by single-photon-emission-tomography (SPECT) and compared with that in healthy control subjects. A new SPECT-ligand for assessment of the striatal DAT, the Technetium-99m-labelled tropane TRODAT-1 ([99mTc]TRODAT-1), was used. Ten inpatients suffering from a first acute schizophrenic episode and 10 age- and sex-matched healthy control subjects underwent SPECT with [99mTc]TRODAT-1. On the day of SPECT, psychopathological ratings were performed with the Brief Psychiatric Rating Scale (BPRS), the Positive and Negative Syndrome Scale (PANSS) and Schedule for Assessment of Negative Symptoms (SANS). Patients had not previously received any neuroleptic or antidepressant medication. Mean specific TRODAT-1 binding in the striatum did not differ significantly between the patient and the age- and sex-matched control group (1.25 vs. 1.28). Variance was significantly higher in the patient group. The data obtained with the new ligand in first-episode, drug-naive schizophrenic patients are in line with the PET results from the group of Laakso et al. in a comparable patient sample. [99mTc]TRODAT-1 seems to be a valuable new SPECT-ligand in the evaluation of the presynaptic site of the striatal dopaminergic synapse in schizophrenia.

Search for long-lived doubly charged Higgs bosons in pp collisions at sqrt[s] = 1.96 TeV

We present a search for long-lived doubly charged Higgs bosons (H(+/- +/-)), with signatures of high ionization energy loss and muonlike penetration. We use 292 pb(-1) of data collected in pp collisions at sqrt[s] = 1.96 TeV by the CDF II detector at the Fermilab Tevatron. Observing no evidence of long-lived doubly charged particle production, we exclude H(+/- +/-)(L) and H(+/- +/-)(R) bosons with masses below 133 GeV/c(2) and 109 GeV/c(2), respectively. In the degenerate case we exclude H(+/- +/-) mass below 146 GeV/c(2). All limits are quoted at the 95% confidence level.

Evidence for B0 s-->phiphi decay and measurements of branching ratio and A(CP) for B+ -->phiK+

We present the first evidence of charmless decays of the B(0)(s) meson, the decay B(0)(s)--> phiphi, and a measurement of the branching ratio BR(B(0)(s)--> phiphi) using 180 pb(-1) of data collected by the CDF II experiment at the Fermilab Tevatron collider. In addition, the BR and direct CP asymmetry for the B+-->phiK+ decay are measured. We obtain BR(B(0)(s)--> phiphi)=[14(+6)(-5)(stat)+/-6(syst)] x 10(-6), BR(B+-->phiK+)=[7.6+/-1.3(stat)+/-0.6(syst)] x 10(-6), and A(CP)(B+-->phiK+)= -0.07+/-0.17(stat)+0.03 / -0.02(syst). Both decays are governed in the standard model by second order (penguin) b-->s(-)ss amplitudes.

Search for anomalous kinematics in tt dilepton events at CDF II

We report on a search for anomalous kinematics of tt dilepton events in pp collisions at square root of s=1.96 TeV using 193 pb(-1) of data collected with the CDF II detector. We developed a new a priori technique designed to isolate the subset in a data sample revealing the largest deviation from standard model (SM) expectations and to quantify the significance of this departure. In the four-variable space considered, no particular subset shows a significant discrepancy, and we find that the probability of obtaining a data sample less consistent with the SM than what is observed is 1.0%-4.5%.

Measurement of the cross section for prompt diphoton production in pp collisions at square root of s=1.96 TeV

We report a measurement of the rate of prompt diphoton production in pp collisions at square root of s=1.96 TeV using a data sample of 207 pb(-1) collected with the upgraded Collider Detector at Fermilab. The background from nonprompt sources is determined using a statistical method based on differences in the electromagnetic showers. The cross section is measured as a function of the diphoton mass, the transverse momentum of the diphoton system, and the azimuthal angle between the two photons and is found to be consistent with perturbative QCD predictions.

Measurement of the W(+)W(-) production cross section in pp collisions at square root[s]=1.96 TeV using dilepton events

We present a measurement of the W(+)W(-) production cross section using 184 pb(-1) of p(p) collisions at a center-of-mass energy of 1.96 TeV collected with the Collider Detector at Fermilab. Using the dilepton decay channel W(+)W(-)-->l(+)nul(-), where the charged leptons can be either electrons or muons, we find 17 candidate events compared to an expected background of 5.0(+2.2)(-0.8) events. The resulting W(+)W(-) production cross-section measurement of sigma(pp-->W(+)W(-))=14.6(+5.8)(-5.1)(stat)(+1.8)(-3.0)(syst) +/- 0.9(lum) pb agrees well with the standard model expectation.

BENEFIT Niere - Bedeutung eines Nephrologie-Screenings für Interventionsbeginn und Therapieerfolg

BACKGROUND AND OBJECTIVE

Early specialist care of patients with renal disease, including timely and planned onset of dialysis, determine the course of the disease, quality of life, hospitalization and life expectancy. A multi-centre enquiry by standardized questionnaire was undertaken to define and analyse medical care of newly dialysis-requiring patients.

PATIENTS AND METHODS

Data on 551 patients in five different regions of Germany who for the first time required renal replacement treatment were prospectively collected between July 2002 and March 2003. Documentation of history, clinical findings and biochemical tests was done on consecutive patients with a standardized questionnaire, until the desired number of cases was reached.

RESULTS

The mean age of the patients (55.4% males) was 64.8 years. 30.7% had diabetes mellitus, 22.3% arterial hypertension/nephrosclerosis and 16.9% glomerulonephritis/vasculitis. Early predominantly nephrological care had been undertaken in 38.7% of patients. 59.0% were cared for almost exclusively by their general practitioner until the time when dialysis was started. 229 patients (41.6%) were referred to specialist (nephrologists) only when dialysis had become necessary. The onset of dialysis was at the right time in only 50.5% of this group. Comparing the care given by nephrologists with that by general practitioners, elective (i.e. planned) dialysis was begun in 81.0% vs. 48.0% (p<0.05). Hospitalization in the two groups was 54.5% vs. 83.7% (p<0.05), the duration of hospital stay 11.4 vs. 17.4 days (p<0.05).

CONCLUSION

Fewer than 40% of patients with chronic renal disease in preterminal renal failure (stage IV) were under the care of nephrologists. The lower the degree of nephrological care the more frequent was there a delay in the onset of dialysis treatment. The incidence and the duration of hospital stay was longer. Structured treatment pathways and incentives need to be formulated to reduce the incidence of wrong or substandard treatment of patients with impaired renal function.

[Guideline on radiation protection in medicine requires documentation of radioiodine therapy and follow-up: What are the benefits of an electronic database?]

AIM

The lately updated German guideline on radiation protection in medicine (Richtlinie Strahlenschutz in der Medizin) requires the physician who administers radioactive substances for therapy, to perform and document follow-ups. In order to decrease the administrative burden, an electronic database was developed that interfaces with a word processing software to generate written reports and statistic analysis.

METHODS

Based on Microsoft Access and Microsoft Visual Basic a database was created to monitor patients with benign and malignant thyroid disorders after radioiodine therapy. It permits automatic creation of therapy documents and necessary patient reports in Microsoft Word. Intuitive handling, third level of normalization in database architecture and automatic plausibility checks guarantee integrity of the data and the efficacy of the database.

RESULTS, CONCLUSION

The new software has been a success in over 1500 patients and over 3800 in- and outpatient therapies and visits. The effort of data entry is easily offset by the automatic generation of the necessary patient reports. The required supervision of the follow-up appointments is now also user-friendly and efficient.

Measurement of partial widths and search for direct CP violation in D0 meson decays to K-K+ and pi-pi+

We present a measurement of relative partial widths and decay rate CP asymmetries in K-K+ and pi(-)pi(+) decays of D0 mesons produced in pp collisions at sqrt[s]=1.96 TeV. We use a sample of 2x10(5) D(*+)-->D0pi(+) (and charge conjugate) decays with the D0 decaying to K-pi(+), K-K+, and pi(-)pi(+), corresponding to 123 pb(-1) of data collected by the Collider Detector at Fermilab II experiment at the Fermilab Tevatron collider. No significant direct CP violation is observed. We measure Gamma(D0-->K-K+)/Gamma(D0-->K-pi(+))=0.0992+/-0.0011+/-0.0012, Gamma(D0-->pi(-)pi(+))/Gamma(D0-->K-pi(+))=0.035 94+/-0.000 54+/-0.000 40, A(CP)(K-K+)=(2.0+/-1.2+/-0.6)%, and A(CP)(pi(-)pi(+))=(1.0+/-1.3+/-0.6)%, where, in all cases, the first uncertainty is statistical and the second is systematic.

Measurement of the lifetime difference between Bs mass eigenstates

We present measurements of the lifetimes and polarization amplitudes for B(0)(s)-->J/psiphi and B(0)(d)-->J/psiK(*0) decays. Lifetimes of the heavy and light mass eigenstates in the B(0)(s) system are separately measured for the first time by determining the relative contributions of amplitudes with definite CP as a function of the decay time. Using 203+/-15 B(0)(s) decays we obtain tau(L) = (1.05(+0.16)(-0.13) +/- 0.02) ps and tau(H) = (2.07(+0.58)(-0.46) +/- 0.03) ps. Expressed in terms of the difference DeltaGamma(s) and average Gamma(s), of the decay rates of the two eigenstates, the results are DeltaGamma(s)/Gamma(s) = (65(+25)(-33) +/- 1)% and DeltaGamma(s) = (0.47(+0.19)(-0.24) +/- 0.01) ps(-1).

Search for excited and exotic electrons in the egamma decay channel in pp collisions at sqrt[s] = 1.96 TeV

We present a search for excited and exotic electrons (e(*)) decaying to an electron and a photon, both with high transverse momentum. We use 202 pb(-1) of data collected in pp collisions at sqrt[s] = 1.96 TeV with the Collider Detector at Fermilab II detector. No signal above standard model expectation is seen for associated ee(*) production. We discuss the e(*) sensitivity in the parameter space of the excited electron mass M(e(*)) and the compositeness energy scale Lambda. In the contact interaction model, we exclude 132 GeV/c(2)<M(e(*))<879 GeV/c(2) for Lambda = M(e(*)) at 95% confidence level (C.L.). In the gauge-mediated model, we exclude 126 GeV/c(2) < M(e(*)) < 430 GeV/c(2) at 95% C.L. for the phenomenological coupling f/Lambda approximately 10(-2) GeV-1.

First measurements of inclusive W and Z cross sections from run II of the fermilab tevatron collider

We report the first measurements of inclusive W and Z cross sections times leptonic branching ratios for pp collisions at square root[s]=1.96 TeV, based on their decays to electrons and muons. The data correspond to an integrated luminosity of 72 pb(-1) recorded with the CDF detector at the Fermilab Tevatron. We test e-mu universality in W decays, and we measure the ratio of leptonic W and Z rates from which the leptonic branching fraction B(W-->lnu) can be extracted as well as an indirect value for the total width of the W and the Cabibbo-Kobayashi-Maskawa matrix element, |V(cs)|.

A placebo-controlled trial of gabapentin for painful HIV-associated sensory neuropathies

BACKGROUND

Painful HIV-associated sensory neuropathies (HIV-SN) are a common complication of HIV infection. The pathogenesis is unknown and the treatment very limited. Gabapentin (GBP) is effective in painful diabetic neuropathy and postherpetic neuralgia and its effectiveness on painful HIV-SN has been reported anecdotally.

DESIGN

Multicenter, prospective, randomised, double-blind, placebo-controlled study.

METHODS

Patients were followed for a 1-week screening, a 4-week double-blind and a 2-week open treatment phase. GBP was initiated at 400 mg/d, titrated over 2 weeks to 1200 mg/d, and then either maintained at this level or-if not beneficial-titrated to 2400 mg/d. After 4 weeks the medication was unblinded and the patient had the choice to begin, to maintain or to increase GBP to 3600 mg/d. The primary outcome measure was an improvement in median pain on the Visual Analogue Scale (VAS) from the screening week compared to the 4(th) treatment week. A secondary efficacy measure was the median sleep score (VAS).

RESULTS

15 patients received GBP and 11 placebo. In each group one patient dropped out during the doubleblind phase. Median pain (GBP 5.1; placebo 4.7) and sleep score (GBP 4.5; placebo 5.6) did not differ between both groups at baseline. In the GBP-group there was a significant decrease of the pain to 2.85 (-44.1 %) as well as of the sleep VAS to 2.3 (-48.9 %). No significant decrease in the pain (median VAS=3.3, -29.8 %) as well as in the sleep score (median VAS=4.95, -11.6 %) was observed in the placebo-group. GBP was generally well tolerated. The most frequent side effect was somnolence reported in 80% of GBP-treated patients.

CONCLUSIONS

GBP was more effective than placebo in reducing pain and sleep interference in patients with HIV-SN.

Measurement of Wgamma and Zgamma production in pp collisions at square root s=1.96 TeV

The standard model predictions for Wgamma and Zgamma production are tested using an integrated luminosity of 200 pb(-1) of pp collision data collected at the Collider Detector at Fermilab. The cross sections are measured by selecting leptonic decays of the W and Z bosons, and photons with transverse energy ET>7 GeV that are well separated from leptons. The production cross sections and kinematic distributions for the Wgamma and Zgamma data are compared to SM predictions.

Thalamic volume in first-episode and chronic schizophrenic subjects: a volumetric MRI study

OBJECTIVE

The thalamus, as a composite of several functionally very different nuclei, is a major relay and filter station in the CNS and is significantly involved in information processing and gating. The aim of our study is to investigate first-episode and chronic patients and controls to shed light on the potential pathogenetic role of the thalamus in schizophrenia and to assess the relationship between thalamic volumes and psychopathology ratings.

METHODS

Forty-three male right-handed chronic and 25 male right-handed first-episode schizophrenic patients treated at the psychiatric hospital of the Ludwig-Maximilians University in Munich and 50 male control subjects were enrolled into the study. Demographic information and current symptom profile of all schizophrenic subjects were assessed using a semistructured interview, including a variety of measures relevant to the study. Volumetry of the thalamic gray and white matter was obtained with 1.5 T MRI, using the BRAINS software application.

RESULTS

No significant differences regarding thalamic volumes were detected across groups. However, negative symptoms were significantly correlated with thalamic volumes in first-episode patients, whereas duration of illness and extrapyramidal symptoms were related to thalamic volumes in chronic patients.

SUMMARY

Our findings indicate that, while the thalamus might be involved in the pathogenesis of negative symptoms, thalamic volume reduction is not a required element in the pathophysiology of the schizophrenic phenotype.

[Comparison of high resolution whole-body MRI using parallel imaging and PET-CT. First experiences with a 32-channel MRI system]

PURPOSE

To compare the accuracy in the detection and staging of various malignant tumors with high resolution whole-body MRI using parallel imaging with whole-body dual-modality PET-CT.

PATIENTS AND METHODS

Preliminary results of an interim analysis from a prospective, blinded study are presented, in which 20 patients (mean age 59 years, range 27-77 years) with different oncological diseases underwent whole-body dual modality FDG-PET-CT screening for tumor search or staging in case of confirmed or suspected metastatic disease. All patients also underwent whole-body MRI imaging with the use of parallel imaging (iPAT). High-resolution coronal T1w- and STIR-sequences of 5 body levels with 512 x 512 matrix, axial fast T2w imaging of lung and abdomen (HASTE), contrast-enhanced dynamic and static T1w-sequences of liver, brain, abdomen, and pelvis were performed. Using a 32-channel whole-body MRI scanner (Magnetom Avanto, Siemens Medical Solutions) with a total field of view of 205 cm and free table movement, all patients could be covered from head to toe within one examination. With this technique, high spatial resolution and acceptable scanning times could be obtained. Two experienced radiologists read the MRI-scans, one radiologist and one nuclear scientist read PET-CT scans, each in consensus in a clinical setting. Delineation of the primary tumor (T-stage) or recurrent tumor, pathologic lymph node involvement, as well as degree and localization of metastatic disease, was assessed using PET-CT as standard of reference.

RESULTS

Metastases from gastrointestinal tumor (25%) and breast cancer (25%), genitourinary tumor (15%) and malignant melanoma (15%) were detected. In 4/20 patients the primary tumor was identified, 2/20 patients showed recurrent tumor. Of 140 malignant lesions detected by PET-CT, 124 lesions were detected with MRI, resulting in a sensitivity of 89% at a specificity of 86%. In malignant lymph node detection, sensitivity of MRI was 83% and specificity 85%.

CONCLUSION

Whole-body MRI is a promising technique in the detection of primary tumor and metastatic disease. Sensitivity in the assessment of lymph node metastases seems to be limited. With the use of parallel imaging (iPAT), dedicated high-resolution whole-body MRI is possible within acceptable scanning times.

Assessing DTI data quality using bootstrap analysis

Diffusion tensor imaging (DTI) is an established method for characterizing and quantifying ultrastructural brain tissue properties. However, DTI-derived variables are affected by various sources of signal uncertainty. The goal of this study was to establish an objective quality measure for DTI based on the nonparametric bootstrap methodology. The confidence intervals (CIs) of white matter (WM) fractional anisotropy (FA) and Clinear were determined by bootstrap analysis and submitted to histogram analysis. The effects of artificial noising and edge-preserving smoothing, as well as enhanced and reduced motion were studied in healthy volunteers. Gender and age effects on data quality as potential confounds in group comparison studies were analyzed. Additional noising showed a detrimental effect on the mean, peak position, and height of the respective CIs at 10% of the original background noise. Inverse changes reflected data improvement induced by edge-preserving smoothing. Motion-dependent impairment was also well depicted by bootstrap-derived parameters. Moreover, there was a significant gender effect, with females displaying less dispersion (attributable to elevated SNR). In conclusion, the bootstrap procedure is a useful tool for assessing DTI data quality. It is sensitive to both noise and motion effects, and may help to exclude confounding effects in group comparisons.

Search for doubly charged Higgs bosons decaying to dileptons in pp collisions at square root of s=1.96 TeV

We present the results of a search for doubly charged Higgs bosons (H+/-+/-) decaying to dileptons (ll(')) using approximately 240 pb(-1) of pp collision data collected by the CDF II experiment at the Fermilab Tevatron. In our search region, given by same-sign ll(') mass m(ll('))>80 GeV/c(2) (100 GeV/c(2) for ee channel), we observe no evidence for H+/-+/- production. We set limits on sigma(pp -->H++H---->l(+)l('+)l(-)l('-)) as a function of the mass of the H+/-+/- and the chirality of its couplings. Assuming exclusive same-sign dilepton decays, we derive lower mass limits on H(+/-+/-)(L) of 133, 136, and 115 GeV/c(2) in the ee, mumu, and emu channels, respectively, and a lower mass limit of 113 GeV/c(2) on H(+/-+/-)(R) in the mumu channel, all at the 95% confidence level.

[PET-CT interventional tumour therapy]

Multifocal metastatic spread of solid tumours is often a diagnostic and therapeutic challenge. Those patients often cannot undergo curative surgery. Since several years, various types of interventional tumour therapy have been introduced, which may represent a promising option in those cases. In some cases morphological imaging is not able to assess the viability of a previously treated lesion. The combination of computed tomography and positron emission tomography has the potential to ease planning and guiding of interventional procedures and to improve postinterventional control. Due to its higher sensitivity and specificity, PET/CT enables for a more precise selection of patients for interventional tumor therapy. The success of a particular therapy could be assessed with greater accuracy using PET/CT as compared with the separate modalities. PET/CT was also able to improve planning and guiding interventional therapy. As of yet, no data are available concerning the success rate and long-term survival of PET/CT associated interventional procedures.

Ganzk�rper-MRT und PET-CT in der Tumordiagnostik

Tumor staging according to the TNM-system influences prognosis and therapeutical options of patients with a malignant disease. It is the challenge of diagnostic imaging to depict the exact localization of the primary tumor and to detect or rule out lymph node involvement or distant metastases. In doing so, the complete body anatomy should be covered with a modality that offers high sensitivity and specificity. As these requirements could not or only partially be achieved by previous ordinary procedures, the use of multiple different modalities became necessary. Last but not least, in consideration of the costs it would be preferable to replace this cascade of different modalities by a "whole body examination", preconditioned that the same accuracy is achieved.With PET/CT and whole-body MRI, two newly available promising methods for a systemic tumor staging have been developed. First experiences indicate PET/CT as a method of first choice. With the introduction of new whole-body MRI scanners using parallel imaging technique (iPAT) and free table movement, MRI plays a more and more important role in whole body tumor staging.