An outbreak of methicillin-resistant Staphylococcus aureus skin infections resulting from horse to human transmission in a veterinary hospital

There are increasing reports of methicillin-resistant Staphylococcus aureus (MRSA) infection and colonization in horses and evidence that MRSA can be transmitted between horses and humans. The objective of this study was to investigate reports of skin infection in personnel working with a foal with community-associated MRSA colonization and subsequent infection. Clinical diagnostic specimens were collected from individuals reporting skin lesions following contact with the affected foal. Nasal and groin screening swabs were collected from other veterinary personnel that attended a voluntary screening clinic. MRSA skin infections were identified in three neonatal intensive care unit personnel. Nasal colonization was subsequently identified in 10/103 (9.7%) other veterinary hospital personnel. Isolates were indistinguishable by pulsed field gel electrophoresis, classified as Canadian epidemic MRSA-5, possessed SCCmecIV, were negative for the Panton-Valentine leukocidin and were multidrug resistant. Transmission to veterinary personnel despite short-term contact with standard protective barriers highlights the potential importance of MRSA as an emerging zoonotic pathogen, and indicates that further evaluation of interspecies transmission of MRSA and means to prevent zoonotic infection are required.

New time-shifted Z-score and Student's test in fMRI

A new approach to compute z-score and Student's test in functional MRI has been developed. This approach tends to involve standard z-score and Student's test computation. This approach is based on the delay of the response compared to the stimulation introduced by many authors. The results obtained prove the methods efficiency; moreover these methods can be easily adapted in a clinical context. This paper presents the new computation and the validation.

Methicillin-resistant Staphylococcus Aureus in Horses at a Veterinary Teaching Hospital: Frequency, Characterization, and Association with Clinical Disease

Methicillin-resistant Staphylococcus aureus (MRSA) is an emerging equine pathogen. To attempt to control nosocomial and zoonotic transmission, an MRSA screening program was established for all horses admitted to the Ontario Veterinary College Veterinary Teaching Hospital, whereby nasal screening swabs were collected at admission, weekly during hospitalization, and at discharge. MRSA was isolated from 120 (5.3%) of 2,283 horses: 61 (50.8%) at the time of admission, 53 (44.2%) during hospitalization, and 6 from which the origin was unclear because an admission swab had not been collected. Clinical infections attributable to MRSA were present or developed in 14 (11.7%) of 120 horses. The overall rate of community-associated colonization was 27 per 1,000 admissions. Horses colonized at admission were more likely to develop clinical MRSA infection than those not colonized at admission (OR 38.9, 95% CI 9.49 160, P < 0.0001). The overall nosocomial MRSA colonization incidence rate was 23 per 1,000 admissions. The incidence rate of nosocomial MRSA infection was at the rate of 1.8 per 1,000 admissions, with an incidence density of 0.88 per 1,000 patient days. Administration of ceftiofur or aminoglycosides during hospitalization was the only risk factor associated with nosocomial MRSA colonization. MRSA screening of horses admitted to a veterinary hospital was useful for identification of community-associated and nosocomial colonization and infection, and for monitoring of infection control practices.

A biomechanical model of the pelvic cavity: first steps

The surgical treatments of genital prolapsus are still empirical and poorly valued. We plan to achieve a method for the objective assessment of the troubles of the pelvic statics and of the various surgical strategies. The methodology considers 3 axes: building a 3D mechanical model of the pelvic cavity, mechanical characterization of the concerned organic tissues, in-vivo measurement of the intravaginal pressures. The MRI images are acquired according 3 orientations (sagittal, axial and coronal); the organs (bladder, vagina and rectum) are manually outlined and their 3D shape is then rebuilt. Uniaxial tensile tests are initially developed on animal samples before being applied to peroperative human samples. In-vivo measurements of the intravaginal pressures are made thanks to a set of 8 strain gauges specially designed. We show results obtained on 2 patients with a different rank of prolapsus. These first steps will be continued by a more detailed geometry of the organs and a characterization of healthy tissues. Dynamic behaviour of the mechanical stresses will also be investigated.

Oxalate degradation by intestinal lactic acid bacteria in dogs and cats

This study evaluated the ability of the lactic acid bacteria (LAB) component of canine and feline feces to degrade oxalate in vitro. Oxalate degradation by individual canine-origin LAB was also evaluated. The effects of various prebiotics on in vitro oxalate degradation by selected oxalate-degrading canine LAB was also evaluated. Canine fecal samples reduced oxalate levels by 78 +/- 12.2% (mean +/- S.D.; range: 44-97%, median: 81%). Feline results were similar, with oxalate reduction of 69.7 +/- 16.7% (mean +/- S.D.; range: 40-96%, median: 73%). Thirty-seven lactic acid bacteria were isolated from canine fecal samples. Mean oxalate degradation was 17.7 +/- 16.6% (mean +/- S.D.; range: 0-65%, median: 13%). No oxalate degradation was detected for four (11%) isolates, and 10/37 (27%) degraded less than 10% of oxalate. The effects of lactitol, arabinogalactan, guar gum, gum Arabic, inulin, maltodextrin or a commercial fructooligosaccharide (FOS) product on in vitro oxalate degradation by five canine LAB isolates were highly variable, even within the same bacterial species. Overall, in vitro degradation was significantly greater with guar gum compared to arabinogalactan (P < 0.05), gum Arabic (P < 0.05), and lactitol (P < 0.01). This study suggests that manipulation of the LAB component of the canine and feline gastrointestinal microflora may decrease intestinal oxalate, and correspondingly intestinal oxalate absorption and renal excretion, thus potentially reducing oxalate urolithiasis.

[Predictive criteria of early recurrence of atrial arrhythmia after reduction by electrical cardioversion]

The management of atrial arrhythmias aims not only to restore sinus rhythm but also to maintain it. Ten to thirty per cent of patients have early recurrence of atrial arrhythmias, the treatment of which remains empiric. The aim of this study was to define factors predictive of early recurrence of atrial arrhythmias and the consequences on the length of hospital stay. A series of 131 patients who underwent reduction of atrial arrhythmias by electrical cardioversion was studied retrospectively. A recurrence within 24 hours was observed in 12.2% of the patients. These recurrences significantly increased the length of hospital stay (6.8+/-6.3 versus 3.6+/-3.8 days, p=0.005). This study confirms two previously reported results with respect to more long-term recurrences. In the "early recurrence" group, the duration of the atrial arrhythmia was longer (p=0.003) and there were fewer treatments with amiodarone (p=0.03). In addition, original results were obtained. In the "early recurrence" group, the patients were more often treated with furosemide (p=0.02), class Ic antiarrhythmics (p=0.007) or anaesthetised with thiopental (p=0.002) than patients without early recurrences. Experimental data explain these results. However, they require confirmation by a prospective randomised trial.

[External electrical cardioversion of atrial arrhythmia: predictive criteria of success]

AIM

Supraventricular arrhythmia is a major public health problem because of its prevalence and clinical consequences. The first step of the treatment usually consists in restoring sinusal rhythm. The aim of this study is to evaluate results and predictive factors of success of electrical cardioversion.

METHODS

We studied a series of 143 consecutive electric cardioversion preformed in 131 French patients.

RESULTS

The rate of successful direct current cardioversion was 91.2%. Negative predictive factors are the height body mass index and the age of arrhythmia. Atrial flutter is a predictive factor of success. These results agree with published results. Our study highlights the interest of some nonantiarrhythmic drugs received by the patient during the period before the direct current cardioversion. Thus, a spironolactone treatment appears to be a new predictive factor of the success of electrical cardioversion (success in patients treated with spironolactone: 100% vs 89% without, P = 0.04).

CONCLUSIONS

Our results agree with usual predictive factors of the success of cardioversion. Nevertheless, a new approach is that of the positive effect of spironolactone on cardioversion. A prospective randomized study is necessary to confirm this result.

Involvement of occupational therapy departments in research: a provincial survey

It is increasingly recognized that research is necessary to advance the practice of occupational therapy. The objective of this study was to determine whether occupational therapy departments in Quebec were commonly involved in research, and whether participation varied with the size of department and type of work setting. Secondly, enablers and barriers to participation in research were identified. A random sample of occupational therapy departments, stratified by size, were surveyed by mail. Participation rate was 74.8% (107/143). Participation in research was noted in half of the departments surveyed (51/107), most frequently as collaborator. Involvement in research was associated (p < .001) with a greater number of therapists in the department. Furthermore, occupational therapy departments in rehabilitation centres and in university hospitals were more likely to participate in research (79% and 90% respectively), whereas participation was lower for long-term care facilities (29%) and community health clinics (38%). When asked to rank factors that may facilitate participation in research, the highest rankings were given to: time allotted to research, research as a priority for administration, adequate financial support, and presence of an occupational therapy researcher and a research centre on site. This survey demonstrates that a number of factors can promote or prevent the realization of research activities within the clinical setting. Strategies are proposed to enhance the integration of research into clinical practice.

Volume delineation by fusion of fuzzy sets obtained from multiplanar tomographic images

Techniques of three-dimensional (3-D) volume delineation from tomographic medical imaging are usually based on 2-D contour definition. For a given structure, several different contours can be obtained depending on the segmentation method used or the user's choice. The goal of this work is to develop a new method that reduces the inaccuracies generally observed. A minimum volume that is certain to be included in the volume concerned (membership degree mu = 1), and a maximum volume outside which no part of the volume is expected to be found (membership degree mu = 0), are defined semi-automatically. The intermediate fuzziness region (0 < mu < 1) is processed using the theory of possibility. The resulting fuzzy volume is obtained after data fusion from multiplanar slices. The influence of the contrast-to-noise ratio was tested on simulated images. The influence of slice thickness as well as the accuracy of the method were studied on phantoms. The absolute volume error was less than 2% for phantom volumes of 2-8 cm3, whereas the values obtained with conventional methods were much larger than the actual volumes. Clinical experiments were conducted, and the fuzzy logic method gave a volume lower than that obtained with the conventional method. Our fuzzy logic method allows volumes to be determined with better accuracy and reproducibility.

3D reconstruction of the encapsulating contour of arteriovenous malformations for radiosurgery using digital subtraction angiography

PURPOSE

Treatment planning for radiosurgery depends on the precise definition of radiation target volumes. For vascular pathologies such as arteriovenous malformations (AVM), the most usual technique remains standard X-ray projection imaging, most often carried out under stereotactic conditions. To further benefit from the advantages of two-dimensional digital subtraction angiography (DSA), the authors have developed a method for determining the three-dimensional shape of arteriovenous malformations from two views.

METHODS AND MATERIALS

After correction of image intensifier distortion and calibration of both views, the 3D shape of the AVM was determined from two DSA projections using epipolarity geometry. The AVM-encapsulating contour was modeled by triangulation of a stack of almost parallel ellipses. The method was technically validated using artificial targets in a skull phantom. Clinical validation was carried out on 10 patients who were examined using both conventional angiography under stereotactic conditions (SX-ray) and DSA.

RESULTS

There was excellent agreement between the artificial target volumes measured with SX-ray and with DSA. The correspondence between AVM volumes found for patients was not as good as with the phantom.

CONCLUSIONS

The different image characteristics of the two modalities lead to some differences in AVM estimations. However, the results were sufficiently satisfactory to justify routine use of this AVM modeling technique for radiosurgery planning.

[Dosimetry with radiosensitive gels in radiotherapy. Methods]

The goal of conformal radiotherapy is to concentrate the dose in a well-defined volume by avoiding the neighbouring healthy structures. This technique requires powerful treatment planning software and a rigorous control of estimated dosimetry. The usual dosimetric tools are not adapted to visualize and validate complex 3D treatment. Dosimetry by radiosensitive gel permits visualization and measurement of the three-dimensional dose distribution. The objective of this work is to report on current work in this field and, based on our results and our experience, to draw prospects for an optimal use of this technique. Further developments will relate to the realization of new radiosensitive gels satisfying, as well as possible, cost requirements, easy realization and use, magnetic resonance imagery (MRI) sensitivity, tissue equivalence, and stability. Other developments focus on scanning methods, especially in MRI to measure T1 and T2.

MR-guided balloon angioplasty of stenosed aorta: in vivo evaluation using near-standard instruments and a passive tracking technique

The purpose of this study was to assess the feasibility of magnetic resonance (MR)-guided balloon angioplasty of a stenosed aorta on an open low-field magnet using a passive tracking technique. Visualization of vessels and position of instruments were realized by using a fast low-angle shot (FLASH) sequence. Catheters and guidewire were prepared for susceptibility-based MR visualization. Standard balloon catheters were inflated with diluted gadolinium, and nitinol guidewires were modified by incorporation of iron oxide markers into their walls. After validation on a flow phantom, balloon angioplasty was performed on an in vivo model of arterial stenosis. Creation of abdominal aorta stenosis was realized in five piglets. MR-guided balloon angioplasty of the aorta was performed with success in all but one. In one of them, stent implantation was achieved in the descending aorta. Balloon angioplasty using a passive tracking technique is a simple concept that can be realized with near-standard instruments and any MR imaging system. This represents an advance toward MR-guided vascular interventions in the future.

Accurate localization of needle entry point in interventional MRI

In interventional magnetic resonance imaging (MRI), the systems designed to help the surgeon during biopsy must provide accurate knowledge of the positions of the target and also the entry point of the needle on the skin of the patient. In some cases, this needle entry point can be outside the B(0) homogeneity area, where the distortions may be larger than a few millimeters. In that case, major correction for geometric deformation must be performed. Moreover, the use of markers to highlight the needle entry point is inaccurate. The aim of this study was to establish a three-dimensional coordinate correction according to the position of the entry point of the needle. We also describe a 2-degree of freedom electromechanical device that is used to determine the needle entry point on the patient's skin with a laser spot.

Gel electrophoretic mobility of single-stranded DNA: the two reptation field-dependent factors

The reptation model is the dominant theory in understanding the electrophoretic separation of single-stranded DNA molecules in gels or entangled polymer solutions. Recently, we showed that the Ogston and reptation regimes are separated by an entropic trapping regime at low field intensities. Here, we report the first comparison of the field-dependent part of the DNA mobility for both small and long reptating molecules. We show that both mobilities increase linearly with field intensity, with the mobility of the longer (comigrating) fragments increasing faster than that of the smaller ones. We compare our results to the predictions of the biased reptation model.

(17alpha,20E/Z)-iodovinyl- and 16alpha-iodP618-homoestradiol derivatives: synthesis and evaluation for estrogen receptor imaging

Three new 125I-radioiodinated estrogens featuring a 13beta-ethyl instead of the natural 13beta-methyl group, i.e. 18-homoestradiols, were synthesized and evaluated as potential estrogen receptor imaging agents. The 16alpha-iodo-18-methylestradiol and the 125I-labeled analog were synthesized from the corresponding 16beta-bromo analog by the halogen-exchange method. The cis-bromohydrin precursor was obtained by bromination of an estrone enolacetate, followed by epimerization and reduction. The isomeric (17alpha,20E/Z)-iodovinyl-18-methylestradiols were prepared via the vinyltin intermediates. Treatment of 18-methyl-17alpha-ethynylestradiol with tri-n-butyltin hydride, in the presence of azobisisobutyronitrile as catalyst and heating at 90-100 degrees C afforded the (17alpha,20E)-tri-n-butylstannyl isomer as the major product. Changing the catalyst for triethyl borane, at room temperature, mainly gave the 20Z-isomer. The nca 125I-labeled analogs were obtained from their corresponding tin intermediates upon treatment with [125I]NaI in the presence of H2O2. The 16alpha-[125I]iodo- and isomeric (17alpha,20E/Z)-[125I]iodovinyl-18-methylestradiols were evaluated for estrogen receptor-mediated uterine uptake in immature female rats. Homologation of the C13-methyl group did improve the uterine uptake of the iodovinyl derivatives, but also increased blood retention, resulting in lower target uptake ratios. In the case of the 16alpha-iodo analog uterine retention decreased upon C13-homologation.

Automatic quality assessment protocol for MRI equipment

The authors have developed a protocol and software for the quality assessment of MRI equipment with a commercial test object. Automatic image analysis consists of detecting surfaces and objects, defining regions of interest, acquiring reference point coordinates and establishing gray level profiles. Signal-to-noise ratio, image uniformity, geometrical distortion, slice thickness, slice profile, and spatial resolution are checked. The results are periodically analyzed to evaluate possible drifts with time. The measurements are performed weekly on three MRI scanners made by the Siemens Company (VISION 1.5T, EXPERT 1.0T, and OPEN 0.2T). The results obtained for the three scanners over approximately 3.5 years are presented, analyzed, and compared.

[Interventional MRI. Analysis of data and prospects]

In spite of its many advantages: 3D imaging, improved tissue characterization, and lack of ionizing radiation, interventional MRI remains seldom used. Several factors are involved. The purpose of this paper is to analyze the factors preventing or slowing the development of this technique based on a review of data from the literature, work presented at the second symposium on interventional MRI (Düsseldorf, 1997), and our own experimental data. The following elements will be discussed: difficulties related to image quality and open magnets, control of targeted image acquisitions, MR environment and problems related to asepsis, as well as advances of other techniques. Finally, short-term and mid-term perspectives will be presented. These are related to the goals of the technique: open or short bore closed magnets? MR unit installed in a radiology department? MR unit dedicated to interventional procedures only or mixed diagnostic-interventional unit? interventional MR unit placed in a neurosurgery operating room? interventional MR unit installed in a general surgery operating room?

Brain metabolic alterations in Cushing's syndrome as monitored by proton magnetic resonance spectroscopy

Proton magnetic resonance spectroscopy ((1)H MRS) was used to evaluate changes in cerebral metabolites in 13 patients with Cushing's syndrome (including seven with pituitary corticotroph adenomas and six with primary adrenal disease) as compared to 40 normal subjects. Data were recorded in the frontal, thalamic and temporal areas; quantification of the MRS signals demonstrated a statistically significant decrease of the Cho/Cr ratio in the frontal and thalamic areas but not in the temporal area for patients with Cushing's syndrome. The largest decrease in Cho/Cr was measured in the thalamic area of patients with a Cushing's syndrome secondary to an adrenal disease. No statistically significant changes in the NAA/Cr ratio were measured in any of the areas studied. These results suggest that the quantification of choline levels could be helpful for monitoring the cerebral metabolite alterations in patients with hypercortisolism.

3D reconstruction of the cerebral arterial network from stereotactic DSA

The authors present an automatic algorithm for 3D reconstruction of cerebral blood vessels by digital subtracted angiography. The patient is localized by a stereotactic method. The reconstruction algorithm includes two steps: first vessel extraction then 2D matching and reconstruction. Accurate vessel skeletons are generated by a combination of mathematical morphological algorithms and adaptive filters. The 3D reconstruction algorithm is based on the reconstruction of vessels center lines. For that purpose, three different projections of the vascular network are used. Reconstruction is computed segment by segment (a curved line between two nodes). For each segment point, the algorithm defines all epipolar solutions on the other views. These epipolar solutions are sorted and pooled by 2D continuity and 3D proximity criteria resulting in a 3D graph. Optimal 3D segment is defined by a recursive algorithm that looks up the better path in the 3D graph. The algorithms have been implemented on a Compatible-PC computer in C language. More than 95% of static copper phantom was reconstructed in 5 min and with 1 mm 3D accuracy. 70% of arteries (from carotid to the seventh node) of a true patient arterial network were reconstructed is less than 30 min.