Sodium MRI of human articular cartilage in vivo

Preliminary results from in vivo sodium MRI of human patellar articular cartilage are presented. Sodium images generated of an in vitro bovine patella clearly distinguish the region of proteoglycan depletion from the region of healthy cartilage. This provides the first evidence that sodium imaging may be used to detect changes due to osteoarthritis in vivo. The process of optimizing imaging time and signal-to-noise ratio, as well as potential implications in the detection of osteoarthritic change, are discussed.

The Splendore-Hoeppli phenomenon in hepatic botryomycosis

A 68 year old diabetic man developed septicaemia and multiple liver abscesses due to Streptococcus intermedius. Liver biopsy revealed streptococcal botryomycosis which showed the Splendore-Hoeppli phenomenon. Diabetes mellitus is an example of the immunosuppressed states that have been associated with botryomycosis.

Off-resonance proton T1rho dispersion imaging of 17O-enriched tissue phantoms

Proton T1rho dispersion imaging is a recently described method for indirect detection of 17O. However, clinical implementation of this technique is hindered by the requirement for a high-amplitude spin-locking field (gammaB1 > 1 kHz) that exceeds current limitations in specific absorption rate (SAR). Here, a strategy is offered for circumventing high SAR in T1rho dispersion imaging of 17O through the use of low-amplitude off-resonance spin-locking pulses (gammaB1 < 300 Hz). Proton spin-lattice relaxation times in the off-resonance rotating frame were measured in H2(17)O-enriched tissue phantoms. On- and off-resonance T1rho dispersion imaging was implemented at 2 T using a spin-locking preparatory pulse cluster appended to a standard spin-echo sequence. On- and off-resonance dispersion images exhibited similar 17O-based image contrast. Magnetization transfer effects did not depend on 17O concentration and had no effect on image contrast. In conclusion, off-resonance proton T1rho dispersion imaging shows promise as a safe, sensitive technique for generating 17O-based T1rho contrast without exceeding SAR limitations.

Adenylation of small RNAs in human cells. Development of a cell-free system for accurate adenylation on the 3'-end of human signal recognition particle RNA

The 3'-end sequences of several human small RNAs were determined, and the results show that a fraction of human cytoplasmic 7SL, ribosomal 5S, and nuclear U2, U6, and 7SK small RNAs contain a post-transcriptionally added adenylic acid residue on their 3'-ends. Incubation of HeLa cell extract in vitro in the presence of [alpha-32P]ATP resulted in labeling of several small RNAs including ribosomal 5S and cytoplasmic 7SL as well as U2 and U6 small nuclear RNAs. Analysis of 7SL RNA labeled in this in vitro adenylation system showed that a single adenylic acid residue is added to the 3'-end. These results show that the adenylation observed in the in vitro system reflects the post-transcriptional adenylation occurring in vivo.

A comparative study of retentive strengths of zinc phosphate, polycarboxylate and glass ionomer cements with stainless steel crowns--an in vitro study

This study was conducted on 30 extracted human primary molars to assess the retentive strengths of zinc phosphate, polycarboxylate and glass ionomer cements. The teeth were embedded in resin blocks and were randomly divided into 3 groups of 10 each. The occlusal surfaces of all teeth were reduced uniformly by 1.0 to 1.5 mm. All mesial, distal undercuts were removed and sharp angles rounded. This was followed by cementing pretrimmed and precontoured stainless steel crowns on each tooth with hand pressure and storing in artificial saliva at 37 degrees C for 24 hours. Retentive strength was tested using Instron Universal Testing Machine. The load was applied starting from a zero reading and gradually increased until the cemented stainless steel crowns showed signs of movement and then the readings were recorded. It was found that retentive strengths of zinc phosphate and glass ionomer cements were statistically better (P < 0.05) when compared to the polycarboxylate cement. Negligible difference (0. 59 kg/cm2) was however observed between zinc phosphate and glass ionomer cements.

Percutaneous dilatation of biliary strictures through the afferent limb of a modified Roux-en-Y choledochojejunostomy or hepaticojejunostomy

BACKGROUND

This report is a 13-year prospective evaluation of percutaneous balloon dilatation of benign biliary strictures through the subcutaneous or subfascially positioned afferent limb of a choledocho or hepaticojejunostomy in 30 patients.

DATA SOURCE

Twenty-seven strictures developed after a common duct injury sustained at the time of cholecystectomy, two after hepatectomy reconstruction for trauma and one following a gastrectomy. Twelve injuries (40%) were recognized at operation. Of the 18 patients where the injury was unrecognized at the time of operation, 8 had not been reoperated at the time of referral, 7 had late repairs by the referring physician, and 3 had late repairs at our institution. The follow-up is 1 to 13 years.

RESULTS

There has been 1 late death and 6 patients are lost alive. The jejunal-limb was accessed 50 times with two minor and no major complications. There have been two parajejunal hernia repairs, but there have not been any reoperations for recurrent biliary strictures.

CONCLUSIONS

Benign biliary strictures can be effectively managed by repeat balloon dilatations thru the afferent limb of a choledocho or hepaticojejunostomy, thus eliminating the need for repeat surgical interventions.

Vital signs services for secure telemedicine applications

Telemedicine using teleconference provides only a part of the picture. The remote patient's electronic medical record and vital signs may often be essential for proper diagnosis and treatment. While there are commercial solutions for telemonitoring, they do not address issues such as security and interoperability leveraging the growing public communications infrastructure. On the other hand there are performance considerations due to the quality of service over available communications media that can hinder real-time operation. The objective of this research effort is to develop secure tele-monitoring facilities that enable healthcare providers to collaborate over public communication networks; to securely convey their patient's vital signs to a remote specialist; and to enable "near real-time" examination of those vital sign data. It is our belief that such applications can help overcome barriers to quality healthcare in the scattered populations of rural areas enabling telemedicine to be a part of the practice of medicine. The authors, who are developing secure telemedicine applications, describe their approach in developing secure vital signs services.

Small RNA database

The small RNA database is a compilation of all the small size RNA sequences available to date, including nuclear, nucleolar, cytoplasmic and mitochondria small RNAs from eukaryotic organisms and small RNAs from prokaryotic cells as well as viruses. Currently, approximately 600 small RNA sequences are in our database. It also gives the sources of individual RNAs and their GenBank accession numbers. The small RNA database can be accessed through the WWW (World Wide Web). Our WWW URL address is: http://mbcr.bcm.tmc. edu/smallRNA/smallrna.html . The new small RNA sequences published since our last compilation are listed in this paper (Table 1).

T1rho-relaxation in articular cartilage: effects of enzymatic degradation

Spin-lattice relaxation in the rotating frame (T1rho) dispersion spectroscopy and imaging were used to study normal and enzymatically degraded bovine articular cartilage. Normal specimens demonstrate significant T1rho "dispersion" (approximately 60 to approximately 130 ms) in the 100 Hz to 9 kHz frequency range. Proteoglycan-degraded specimens have 33% greater T1rho values than collagen-degraded or normal samples. T1rho-weighted images reveal structure not found in conventional T1- or T2-weighted images. Our results suggest that T1rho measurements are selectively sensitive to proteoglycan content. The potential of this method in distinguishing the early degenerative changes in cartilage associated with osteoarthritis is discussed.

Peripheral fibroma with calcification--a case report

A female patient aged 10 years reported with an intra oral swelling on the labial aspect of 32 & 33, appearing to originate from the marginal gingiva & interdental papilla. The swelling was pedunculated, mobile, non-tender, firm in consistency with an irregular surface. The colour of the gingiva was normal with slight ulceration. The swelling was excised & diagnosed histopathologically as peripheral cementifying/ossifying fibroma.

A simplified sequence for observing deoxymyoglobin signals in vivo: myoglobin excitation with dynamic unexcitation and saturation of water and fat (MEDUSA)

This paper describes a new, simplified pulse sequence for observing NMR signals from deoxymyoglobin in vivo. Paramagnetically shifted resonances from deoxymyoglobin can be exploited to noninvasively calculate intracellular oxygen tension in striated muscle. However, special sequences are required to observe these weak signals against the larger water and fat signals encountered in vivo. The pulse sequence described here, which is based on inversion recovery sequences, efficiently suppresses both water and fat resonances and can be implemented with short repetition rates. Moreover, it is perfectly suited for studies with surface coils, where RF inhomogeneities render other popular suppression sequences ineffective.

High resolution, short echo time sodium imaging of articular cartilage

The sodium present in articular cartilage interacts with the negatively charged proteoglycan aggregates in the matrix of the cartilage. Sodium images of short echo time may be useful for detecting changes that occur in the proteoglycan content of the cartilage. Such changes are indicative of early osteoarthritic damage, for example. Using an asymmetric short echo technique, sodium images of high resolution and signal-to-noise ratio that demonstrate anatomic features of the cartilage are presented. These images were obtained with echo times as short as 1 msec, at an in-plane resolution of 39 microns by 117 microns and signal-to-noise ratios of up to 40:1.

Expression of MAGE genes in ocular melanoma during progression from primary to metastatic disease

Primary melanomas that form within the eye have a unique pattern of disease progression as compared with melanomas that form within the skin. A high percentage of patients (approximately 50%) develop metastatic tumors that occur predominately in the liver. An unusual characteristic of ocular melanomas is the prolonged disease-free interval that extends for many years between the development of primary and metastatic tumors. It is estimated that the shortest interval between dissemination of tumor cells from the eye and the appearance of clinically detectable metastases is 6 years. A recent report indicated that fresh uveal melanoma tissue and metastatic tumor biopsies failed to express melanoma antigen gene (MAGE)-1, MAGE-2, or MAGE-3. In the present study, we examined the expression of MAGE genes on fresh and cultured tumor cells obtained from an ocular melanoma patient during different stages of progressive disease. MAGE gene expression was determined by reverse transcription-polymerase chain reaction using MAGE-1, MAGE-2 and MAGE-3 specific primers. Our results demonstrate that primary ocular tumor tissue and cultured tumor cells both express significant levels of MAGE-1, 2, and 3 at the time of enucleation. A high percentage of tumor cells within the primary tumor appear to express MAGE as demonstrated by consistent MAGE expression in 16 tumor cell clones. Metastatic liver tumors that developed 3 years after enucleation and 18 years after the initial formation of the primary tumor also expressed high levels of MAGE-1, -2, and -3. MAGE was expressed on fresh tumor tissue from a single biopsy and cultured tumor cells obtained from three of four different metastatic tumor nodules. When the MAGE-negative metastatic tumor cells were treated with the demethylating agent 5-Aza-2-Deoxycytidine (5-Aza-dC), transcription of MAGE-1 was restored, indicating the MAGE genes were not deleted. Our results demonstrate that in some patients, MAGE genes are expressed on primary and metastatic ocular melanomas.

Formation of 2',3'-cyclic phosphates at the 3' end of human U6 small nuclear RNA in vitro. Identification of 2',3'-cyclic phosphates at the 3' ends of human signal recognition particle and mitochondrial RNA processing RNAs

Approximately 90% of human U6 small nuclear RNA (snRNA) contains uridine cyclic phosphate (U>p) at its 3'-end (Lund, E., and Dahlberg, J. E. (1992) Science 255, 327-330). We studied the formation of U>p at the 3' end of human U6 snRNA using an in vitro system where uridylic acid residues are added from UTP precursor and U>p is formed. Analysis of U6 snRNAs with varying number of uridylic acid residues showed that each of these species contains U>p where the phosphate originated from alpha-phosphate of UTP precursor. The cyclic phosphate formation occurred on U6 snRNA in extracts where essential spliceosomal snRNAs were specifically degraded, thereby indicating that U>p formation is not coupled to pre-mRNA splicing. A subpopulation of human signal recognition particle and mitochondrial RNA processing RNAs isolated from HeLa cells also contained cyclic phosphates at their 3' ends. These data suggest that U>p in U6 snRNA is unlikely to be related to its participation in splicing of pre-mRNAs. It appears that cyclic phosphate is an intermediate product in the metabolism of these small RNAs.

Triple quantum sodium imaging of articular cartilage

Triple quantum (TQ) sodium imaging of bovine articular cartilage is presented. True triple quantum imaging sequence was modified to incorporate asymmetric echo acquisition. Triple quantum signal expression in the presence of residual quadrupolar interaction is presented. The filtering capability of the sequence is first demonstrated on an agarose phantom. Both single and triple quantum images of articular cartilage are compared. The TQ image shows non-zero signal intensity solely from cartilage, indicating complete suppression of signals from bone marrow and saline. The advantages of TQ imaging of articular cartilage, its feasibility in in vivo situations and further improvements in SNR are described.

Collaboration Technology for Rural Health-care

Health-care is a collaborative endeavor involving a number of individuals and organizations with diverse perspectives. Computer-supported collaboration technologies have great potential to enable health-care providers to improve the quality of care provided to their patients. Such technologies have the potential to overcome barriers to quality health-care in the small, scattered populations of rural areas. Rapid changes in technology are making it more and more possible for collaborative telemedicine to be a part of the practice of medicine. The World Wide Web has amply demonstrated that the globe has shrunk and information from afar is a mere mouse click away. However, the ease with which information is accessed along with the potential disclosure and misuse of personal information has raised serious concerns about the ability to restrict such information to legitimate accesses by duly authorized health-care providers. The authors present their experience in developing a health-care collaboration facility, ARTEMIS, which enabled Web-based access to electronic medical records, and provide a vision of their experiment to provide secure telemedicine for rural health-care practitioners.

In vivo sodium multiple quantum spectroscopy of human articular cartilage

The authors report, for the first time, sodium properties of human articular cartilage in vivo using sodium multiple-quantum-filtered methods with a surface coil. A flip angle-independent, phase-cycled pulse sequence was used to obtain triple-quantum-filtered spectra as a function of preparation time. Biexponential relaxation rates were calculated by fitting the triple-quantum-filtered spectral amplitudes to a theoretical expression. Theoretical analysis of the flip angle dependence of even rank two-quantum coherence (T2[2]), odd rank two-quantum coherence (T2[3]), and triple-quantum coherence are presented and verified against experimental results on a cartilage specimen. Sodium multiple-quantum-filtered spectral lineshapes obtained in vivo correlate well with those observed on in vitro specimens. Relaxation rates obtained from asymptomatic volunteers were found to be: T(2rise) = 1.0 + 0.12 ms, T(2decay) = 12.0 +/- 0.75 ms (mean +/- SD). The diagnostic potential of this method in detecting early changes in articular cartilage is described.

Point mutations in the 23S rRNA gene of Helicobacter pylori associated with different levels of clarithromycin resistance

Fifty-four of 59 (91.5%) clarithromycin-resistant isolates of Helicobacter pylori from different patients possessed either the A2143G (formerly A2058G) or the A2144G (formerly A2059G) mutation in the gene encoding 23S rRNA. The A2143G mutation was significantly more likely to occur in isolates with MICs exceeding 64 mg/L (65% versus 30% with the A2144G mutation; P = 0.01). The majority (26 of 31; 83.9%) of isolates with the A2143G mutation had MICs exceeding 64 mg/L. Peptic ulcer disease recurred in a substantial proportion of patients infected with H. pylori strains containing either the A2143G or the A2144G mutation.

Laparoscopic evaluation of liver disease in chronic renal failure prior to renal transplantation

BACKGROUND

Diagnostic laparoscopy with liver biopsy has been shown to be safe and effective in the evaluation of patients with chronic liver disease. Patients with end-stage renal disease may be more prone to bleeding complications secondary to liver biopsy as a result of multiple factors directly related to their underlying renal condition.

METHODS AND PATIENTS

From January 1994 to June 1996, 16 patients with end-stage renal disease and hepatic dysfunction (6 women and 10 men) underwent diagnostic laparoscopy with liver biopsy prior to renal transplantation at the University of Miami School of Medicine. Laparoscopy was performed using a 5 mm video laparoscope with a left paramedian approach. The mean patient age was 46 years. Fourteen patients had chronic hepatitis C with a reactive anti-HCV by ELISA; one patient had chronic hepatitis B with reactive HBsAg, and one patient was co-infected with both hepatitis B and C viruses.

RESULTS

Two patients developed hypotension related to the procedure and one patient developed an intra-abdominal hemorrhage 5 days after laparoscopy that did not require surgical intervention. Biopsy findings were as follows: 13 patients had mild chronic hepatitis; 2 patients had chronic hepatitis with bridging fibrosis; and 1 patient was cirrhotic. Prior kidney transplantation or peritoneal dialysis did not preclude the performance of laparoscopy.

CONCLUSION

Diagnostic laparoscopy can be safety performed in patients with end-stage renal disease with acceptable morbidity and mortality.

Reproducibility of exercise-induced modulation of cardiovascular responses to cold stress

The modulation of cardiovascular responses to the cold pressor test (CPT) as produced by exercise was studied in 13 volunteers. The reproducibility of the measurements selected for the study, i.e. heart rate (HR), blood pressure (BP), blood flow (BF) and skin temperature (ST), was investigated through repeat experiments in the fall of 1994 and the winter of 1995. HR was monitored before, during and after a 10-min period of bicycling at 70% of reserve HR. BP, cutaneous BF and ST were measured before and after exercise. Two CPTs (hand into ice-cold water for 1 min) were performed: one preceding exercise and another at 3 min after exercise. The results obtained allow us to conclude that in non-hypertensive volunteers (1) the pronounced cardiovascular responses (ST, BF and BP) induced by CPT are reproducible (p > 0.2) when compared to basal level values and (2) cardiovascular responses to cold stress are significantly attenuated by exercise (p < 0.03). Our study, therefore, supports and validates the use of our coupled exercise-CPT method in ongoing epidemiological studies attempting to identify individuals at risk for the development of hypertension as well as those most likely to benefit from preventative exercise programs.

17O-decoupled proton MR spectroscopy and imaging in a tissue model

17O-decoupled proton MR spectroscopy and imaging were implemented at 2 T. Their sensitivity and accuracy in vitro were examined using semisolid tissue phantoms doped with H2(17)O. A double-tuned solenoidal coil was used to irradiate the same volume of 17O and 1H nuclei, as well as to facilitate direct calibration of the decoupling power. Decoupling efficiency was optimized as was 17O detection sensitivity. Decoupling was most efficient at RF amplitudes below 2.5 kHz (expressed as gamma [17O] x H1), which is within the limits of the acceptable specific absorption rate. Propagation of error analysis demonstrated that 17O detection sensitivity is optimal at a TE equal to the T2 of 17O-depleted water protons. Based on Meiboom's work, a simple theory was formulated for estimating the transverse relaxivity of H2(17)O and the proton signal enhancement produced by decoupling. There was excellent agreement between theory and experiment. Overall, 17O-decoupled spectroscopy and imaging were highly sensitive and accurate in quantifying H2(17)O in vitro.

Collaboration Technology for Rural Health-care

Health-care is a collaborative endeavor involving a number of individuals and organizations with diverse perspectives. Computer-supported collaboration technologies have great potential to enable health-care providers to improve the quality of care provided to their patients. Such technologies have the potential to overcome barriers to quality health-care in the small, scattered populations of rural areas. Rapid changes in technology are making it more and more possible for collaborative telemedicine to be a part of the practice of medicine. The World Wide Web has amply demonstrated that the globe has shrunk and information from afar is a mere mouse click away. However, the ease with which information is accessed along with the potential disclosure and misuse of personal information has raised serious concerns about the ability to restrict such information to legitimate accesses by duly authorized health-care providers. The authors present their experience in developing a health-care collaboration facility, ARTEMIS, which enabled Web-based access to electronic medical records, and provide a vision of their experiment to provide secure telemedicine for rural health-care practitioners.

Small RNA database

The small RNA database is a compilation of all the small size RNA sequences available to date, including nuclear, nucleolar, cytoplasmic and mitochondrial small RNAs from eukaryotic organisms and small RNAs from prokaryotic cells as well as viruses. Currently, about 600 small RNA sequences are in our database. It also gives the sources of individual RNAs and their GenBank accession numbers. The small RNA database can be accessed through WWW(World Wide Web). Our WWW URL address is: http://mbcr.bcm.tmc.edu/smallRNA/smallrna. html . The new small RNA sequences published since our last compilation are listed in this paper.