Characterization of carotid atherosclerosis and detection of soft plaque with use of black-blood MR imaging

BACKGROUND AND PURPOSE

In the treatment of carotid atherosclerosis, the rate of stenosis and characteristics of plaque should be assessed to diagnose vulnerable plaques that increase the risk for cerebral infarction. We performed carotid black-blood (BB) MR imaging to diagnose plaque components and assess plaque hardness based on MR signals.

MATERIALS AND METHODS

Three images of BB-MR imaging per plaque were obtained from 70 consecutive patients who underwent carotid endarterectomy (CEA) to generate T1- and T2-weighted images. To evaluate the relative signal intensity (rSI) of plaque components and the relationship between histologic findings and symptoms, we prepared sections at 2-mm intervals from 34 intact plaques. We then calculated the relative overall signal intensity (roSI) of 70 plaques to assess the relationship between MR signal intensity and plaque hardness and symptoms.

RESULTS

The characteristics of rSI values on T1- and T2-weighted images of fibrous cap (FC), fibrosis, calcification, myxomatous tissue, lipid core (LC) with intraplaque hemorrhage (IPH), and LC without IPH differed. Symptomatic plaques were associated with FC disruption (P < .001) and LC with IPH (P < .05). The roSI on T1-weighted images was significantly higher for soft than nonsoft plaques. When the roSI cutoff value was set at 1.25 (mean of the roSI), soft plaques were diagnosed with 79.4% sensitivity and 84.4% specificity. The roSI was also significantly higher for symptomatic than for asymptomatic plaques. Soft and nonsoft plaques as well as symptomatic and asymptomatic plaques did not significantly differ on T2-weighted images.

CONCLUSION

BB-MR imaging can diagnose plaque components and predict plaque hardness. This procedure provides useful information for planning therapeutic strategies of carotid atherosclerosis.

Natural history of extensive Mongolian spots in mucopolysaccharidosis type II (Hunter syndrome): a survey among 52 Japanese patients

BACKGROUND

Recent reports have shown a correlation between extensive Mongolian spots and mucopolysaccharidosis type II (Hunter syndrome). However, a statistical survey of the incidence and natural history of extensive Mongolian spots among the patients with Hunter syndrome is lacking.

OBJECTIVES

To determine the prevalence of extensive Mongolian spots, to determine the natural course of the spots according to age in Japanese patients with Hunter syndrome, and to compare them with the results obtained from the patients' brothers who did not have Hunter syndrome.

PATIENTS/METHODS

Fifty-two males with Hunter syndrome aged 3 to 40 years were studied. Twenty-five patients were examined in two clinics to determine the existence and characteristics of the spots. We interviewed their families about the spots in their neonates and the natural course of the spots according to their ages. The same survey was done among another 27 patients using a mailed questionnaire to their families. As control, we investigated 21 brothers of the patients by a mailed questionnaire to their families.

RESULTS

The extensive Mongolian spots are identified in almost all the infants with Hunter syndrome and disappear extremely later in their life. The lesions had a high incidence of deep-blue hyperpigmentation. Regardless of age, the overall incidence was 78%. All of the brothers who did not have Hunter syndrome had common-type Mongolian spots in neonates, which regressed during their childhood.

CONCLUSION

Our results confirm a strong correlation between extensive Mongolian spots and Hunter syndrome for the Japanese population. The presence of extensive Mongolian blue spots should alert the physician to the possibility of Hunter syndrome.

Momordica charantia is a Weed Host Reservoir for Papaya ringspot virus Type P in Jamaica

Papaya rinsgpot virus type P (PRSV), a member of the genus Potyvirus in the family Potyviridae, is primarily transmitted by aphids in a nonpersistent manner (2). The virus is geographically widespread but has a narrow host range within the plant families Caricaceae, Chenopodiaceae, and Cucurbitaceae (2). The first reported epidemic of PRSV in Jamaica was during the late 1980s (1). Since then, the virus has spread across the island and is recognized as a potential problem for continued production of papaya (Carica papaya L.). In the summers of 1999 and 2000, prominent vein clearing symptoms were observed on leaves of a common weed, cerasee (Momordica charantia L.), in papaya orchards of western Jamaica. This weed, a climbing annual in the Cucurbitaceae family used in a variety of local herbal preparations, was found to be growing on fences or the ground along the periphery of the orchards. Leaf samples were collected and tested for PRSV by double-antibody sandwich (DAS)-ELISA with polyclonal antibodies (Agdia Inc, Elkhart, IN). In addition, crude sap extracts from 12 cerasee leaf samples that were diluted 1:20 were mechanically inoculated onto six plants each of cerasee and papaya. Within 2 weeks, vein clearing symptoms were observed on cerasee and symptoms (vein clearing followed by mosaic development and leaf distortions) typical of PRSV infection were obtained on papaya (2). All original leaf samples and inoculated plants tested positive in DAS-ELISA. In subsequent vector transmission tests, 10 healthy cerasee or papaya seedlings were inoculated with aphids (Aphis gossypii) that were previously permitted to feed on PRSV-infected papaya or cerasee. High rates of virus transmission were achieved in three tests from cerasee to papaya (77 to 83%), papaya to cerasee (90 to 93%), and cerasee to cerasee (60 to 70%). Total RNA from papaya samples was subjected to reverse transcriptase-PCR using primers to the capsid protein gene (3). A single fragment of the expected size (approximately 996 bp) was amplified and sequenced and showed high nucleotide identity (90.3 to 91.4%) with previously reported PRSV type P from Jamaica (GenBank Accession No. DQ104823), Cuba (GenBank Accession No. DQ089482), Florida (GenBank Accession No. AF196839), Brazil (GenBank Accession No. AF344650), and Hawaii (GenBank Accession No. S46722). To our knowledge, this is the first report of the natural occurrence of PRSV on a weed host in Jamaica. Because of its widespread distribution and potential of serving as a reservoir of PRSV, cerasee may play a role in the epidemiology of PRSV. References: (1) M. Chin et al. Jam. J. Sci. Technol. 14:58, 2003. (2) D. Purcifull et al. No 292 in: Descriptions of Plant Viruses. CMI/AAB, Surrey, England, 1984. (3) J. Slightom. Gene 100:251, 1991.

Varying genetic diversity of Papaya ringspot virus isolates from two time-separated outbreaks in Jamaica and Venezuela

Coat protein sequences of 22 Papaya ringspot virus isolates collected from different locations in Jamaica and Venezuela in 1999 and 2004, respectively, were determined and compared with sequences of isolates from earlier epidemics in 1990 and 1993. Jamaican isolates collected in 1999 exhibited nucleotide sequence identities between 98 and 100% but shared lower identities of 92.2% with an isolate collected in 1990. Isolates from the 2004 epidemic in Venezuela exhibited more heterogeneity, with identities between 88.7 and 98.8%. However, isolates collected in 1993 were more closely related (97.7%). The viral populations of the two countries are genetically different and appear to be changing at different rates; presumably driven by introductions, movement of plant materials, geographical isolation, and disease management practices.

Hypercalcemia in childhood acute lymphoblastic leukemia: frequent implication of parathyroid hormone-related peptide and E2A-HLF from translocation 17;19

Hypercalcemia is relatively rare but clinically important complication in childhood leukemic patients. To clarify the clinical characteristics, mechanisms of hypercalcemia, response to management for hypercalcemia, incidence of t(17;19) and final outcome of childhood acute lymphoblastic leukemia (ALL) accompanied by hypercalcemia, clinical data of 22 cases of childhood ALL accompanied by hypercalcemia (>12 mg/dl) reported in Japan from 1990 to 2005 were retrospectively analyzed. Eleven patients were 10 years and older. Twenty patients had low white blood cell count (<20 x 10(9)/l), 15 showed hemoglobin> or =8 g/dl and 14 showed platelet count > or =100 x 10(9)/l. Parathyroid hormone-related peptide (PTHrP)-mediated hypercalcemia was confirmed in 11 of the 16 patients in whom elevated-serum level or positive immunohistochemistry of PTHrP was observed. Hypercalcemia and accompanying renal insufficiency resolved quickly, particularly in patients treated with bisphosphonate. t(17;19) or add(19)(p13) was detected in five patients among 17 patients in whom karyotypic data were available, and the presence of E2A-HLF was confirmed in these five patients. All five patients with t(17;19)-ALL relapsed very early. Excluding the t(17;19)-ALL patients, the final outcome of ALL accompanied by hypercalcemia was similar to that of all childhood ALL patients, indicating that the development of hypercalcemia itself is not a poor prognostic factor.

Laparoscopic resection of colorectal cancer

Laparoscopic surgery has revolutionised procedures such as cholecystectomy since its inception in the 1980s. After initial enthusiasm with laparoscopic colorectal resections in the early 1990s, resection of colorectal malignancy was largely abandoned outside clinical trials because of reports of inferior oncological outcomes including local and port-site recurrence. More recently, however, an increasing number of reports have demonstrated that laparoscopic surgery for colorectal cancer though technically demanding is feasible, and the results of large multi-centred randomised trials showing oncological equivalence are becoming available. Technological advances in laparoscopic equipment along with the increasing skills and experience of laparoscopic surgeons have extended the indications and reduced the contraindications for laparoscopic colectomy. This, along with the use of fast- track protocols is changing the way we manage patients. The future of laparoscopic colorectal surgery is assured, driven not only by the physical benefits to the patient in the short and medium term, the reduced financial burden on in-patient stay, and post-operative return to work, but also increasing patient demand. This in turn requires that surgeons should ensure high quality training and operative competence to maintain the high standards achieved by the pioneers in this field.

Phase engineering for ring enhanced Mach-Zehnder interferometers

Ring resonators are waveguide realizations of Fabry-Perot resonators which can be readily integrated in array geometries to implement many useful functions. Its nonlinear phase response can be readily incorporated into a Mach-Zehnder interferometer to produce specific intensity output function. We present two generalized array configurations of ring-coupled MZI and discuss their characteristics in terms of the amplitude and phase response of the ring arrays as well as the transmission output of the MZIs. The two types of array have distinct transfer functions and effective phase shifts, and can be tailored to phase-engineer a wide range of MZI transmission functions.

The effect of haematopoietic stem cell transplant on papules with 'pebbly' appearance in Hunter's syndrome

BACKGROUND

Hunter's syndrome is associated with several cutaneous findings. For instance, papules with 'pebbly' appearance are a specific marker for the disease. However, it remains uncertain whether they disappear after haematopoietic stem cell transplant (HSCT).

OBJECTIVES

To investigate the papules with 'pebbly' appearance before and after HSCT in infants with Hunter's syndrome, and to clarify the effect of HSCT on papules.

PATIENTS

We observed five Japanese boys with Hunter's syndrome who had received HSCT at 4-11 years of age.

RESULTS

The post-HSCT physical examinations revealed that papules disappeared completely within 35 days after the transplant with progressive reduction of cutaneous tightness in all the patients. Histochemical findings showed that papules contained a large amount of hyaluronic acid in the extracellular materials of the dermis and sulphated acid mucopolysaccharides in dermal fibroblasts before HSCT.

CONCLUSIONS

These results suggest that papules with a 'pebbly' appearance fade away through the digestion of a large amount of hyaluronic acid in cutaneous tissues by normal tissue histiocytes or enzymes of donor origin at an early stage after HSCT.