T1-Weighted, Dynamic Contrast-Enhanced MR Perfusion Imaging Can Differentiate between Treatment Success and Failure in Spine Metastases Undergoing Radiation Therapy

BACKGROUND AND PURPOSE

Current imaging techniques have difficulty differentiating treatment success and failure in spinal metastases undergoing radiation therapy. This study investigated the correlation between changes in dynamic contrast-enhanced MR imaging perfusion parameters and clinical outcomes following radiation therapy for spinal metastases. We hypothesized that perfusion parameters will outperform traditional size measurements in discriminating treatment success and failure.

MATERIALS AND METHODS

This retrospective study included 49 patients (mean age, 63 [SD, 13] years; 29 men) with metastatic lesions treated with radiation therapy who underwent dynamic contrast-enhanced MR imaging. The median time between radiation therapy and follow-up dynamic contrast-enhanced MR imaging was 62 days. We divided patients into 2 groups: clinical success (n = 38) and failure (n = 11). Failure was defined as PET recurrence (n = 5), biopsy-proved (n = 1) recurrence, or an increase in tumor size (n = 7), while their absence defined clinical success. A Mann-Whitney U test was performed to assess differences between groups.

RESULTS

The reduction in plasma volume was greater in the success group than in the failure group (-57.3% versus +88.2%, respectively; P < .001). When we assessed the success of treatment, the sensitivity of plasma volume was 91% (10 of 11; 95% CI, 82%-97%) and the specificity was 87% (33 of 38; 95% CI, 73%-94%). The sensitivity of size measurements was 82% (9 of 11; 95% CI, 67%-90%) and the specificity was 47% (18 of 38; 95% CI, 37%-67%).

CONCLUSIONS

The specificity of plasma volume was higher than that of conventional size measurements, suggesting that dynamic contrast-enhanced MR imaging is a powerful tool to discriminate between treatment success and failure.

Influence of socioeconomic factors on discharge disposition following traumatic cervicothoracic spinal cord injury at level I and II trauma centers in the United States

BACKGROUND

Discharge to acute rehabilitation is strongly correlated with functional recovery after traumatic injury, including spinal cord injury (SCI). However, services such as acute care rehabilitation and Skilled Nursing Facilities (SNF) are expensive. Our objective was to understand if high-cost, resource-intensive post-discharge rehabilitation or alternative care facilities are utilized at disparate rates across socioeconomic groups after SCI.

METHODS

We performed a cohort analysis using the National Trauma Data Bank® tabulated from 2012-2016. Eligible patients had a diagnosis of cervical or thoracic spine fracture with spinal cord injury (SCI) and were treated surgically. We evaluated associations of sociodemographic and psychosocial variables with non-home discharge (e.g., discharge to SNF, other healthcare facility, or intermediate care facility) via multivariable logistic regression while correcting for injury severity and hospital characteristics.

RESULTS

We identified 3933 eligible patients. Patients who were older, male (OR=1.29 95% Confidence Interval [1.07-1.56], p=.007), insured by Medicare (OR=1.45 [1.08-1.96], p=.015), diagnosed with a major psychiatric disorder (OR=1.40 [1.03-1.90], p=.034), had a higher Injury Severity Score (OR=5.21 [2.96-9.18], p<.001) or a lower Glasgow Coma Score (3-8 points, OR=2.78 [1.81-4.27], p<.001) had a higher chance of a non-home discharge. The only sociodemographic variable associated with lower likelihood of utilizing additional healthcare facilities following discharge was uninsured status (OR=0.47 [0.37-0.60], p<.001).

CONCLUSIONS

Uninsured patients are less likely to be discharged to acute rehabilitation or alternative healthcare facilities following surgical management of SCI. High out-of-pocket costs for uninsured patients in the United States may deter utilization of these services.

NutriCoviD30 : étude nationale sur l’évaluation de l’état de santé et la prise en charge nutritionnelle à 1 mois d’une hospitalisation pour COVID-19

Introduction et but de l’étude

Matériel et méthodes

Résultats et analyse statistique

Conclusion

Systems biology analysis of G protein and MAP kinase signaling in yeast

Approximately a third of all drugs act by binding directly to cell surface receptors coupled to G proteins. Other drugs act indirectly on these same pathways, for example, by inhibiting neurotransmitter reuptake or by blocking the inactivation of intracellular second messengers. These drugs have revolutionized the treatment of human disease. However, the complexity of G protein signaling mechanisms has significantly hampered our ability to identify additional new drug targets. Moreover, today's molecular pharmacologists are accustomed to working on narrowly focused problems centered on a single protein or enzymatic process. Here we describe emerging efforts in yeast aimed at identifying proteins and processes that modulate the function of receptors, G proteins and MAP kinase effectors. The scope of these efforts is far more systematic, comprehensive and quantitative than anything attempted previously, and includes integrated approaches in genetics, proteomics and computational biology.

Giant Barkas effect observed for light ions channeling in Si

Measurements of the electronic energy loss are presented for (4)He and (7)Li ions channeling along the Si main axial directions at intermediate to high projectile energies. The Barkas effect, an energy-loss enhancement proportional to the third power of the projectile charge at high energies, is clearly separated from other processes. It reaches about 50% for Li ions channeling along the Si [110] direction. The observed Barkas contribution from the valence-electron gas is in fair agreement with the Lindhard model.

Airway obstruction in neonates and children: surgical treatment

OBJECTIVE

This review of 54 infants and children with airway obstruction who were treated surgically emphasizes the importance of the surgical indications with respect to various anomalies causing airway obstruction and the surgical approach to their management.

PATIENTS

There were 4 etiologic groups of airway obstruction. Group A comprised 12 infants with subglottic stenosis; Group B--20 infants with tracheomalacia; 21 patients (Group C) with anatomic narrowing of the trachea; and 1 infant (Group D) with laceration of a main bronchus.

METHODS

The surgical procedures performed included anterior laryngotracheal decompression in 12 infants, aortopexy in 19; 1 pulmonary arteriopexy; tracheal stenting with an autologous rib graft in 3 and with Marlex mesh in 1. Tracheal widening, using a free tibia autologous graft, was performed in 3 patients; transbronchoscopic excision in 12; anterior tracheal wedge resection in 4, and segmental tracheal resection and anastomosis in 1 patient. The lacerated bronchus was repaired with fine Dexon sutures.

RESULTS

There were no operative deaths. With respect to the original indications for surgery, there were 3 failures--2 in Group A and 1 in Group C. Two patients died from causes unrelated to the procedures--one 10 days postoperatively, and the other 3 months after surgery.

CONCLUSIONS

The surgical approach to tracheal obstruction in infants and children offers effective treatment, with no operative mortality, a low complication rate, and good long term survival.

Continuous esophageal pH monitoring during laparoscopic cholecystectomy

Gastro-esophageal regurgitation (GER) and eventual aspiration is considered a major risk during general anesthesia. High intraperitoneal pressure produced during laparoscopic cholecystectomy (LC) is a possible source of increased GER. We investigated the incidence of GER using continuous esophageal pH monitoring in 14 patients undergoing elective LC. Only two brief episodes of acid reflux (pH < 4) occurred during LC. Apparently the high intraperitoneal pressure during LC carries no increased risk of regurgitation and aspiration.

Acute toxicity and effects on hepatic oxidative drug metabolism of mopyridone

Mopyridone (CAS 82822-14-8) is a new chemotherapeutic with a strong antiviral effect (vs. influenza- and toga viruses) and certain advantages over the chemotherapeutics known so far. Toxicological studies reveal its low oral and intraperitoneal toxicity in mice and rats. The 5- and 14-day administration of mopyridone (37.5 mg/kg b.w., orally) to male rats established a growing tendency to the shortening of hexobarbital sleeping time, associated with moderate changes in the hepatic oxidase activity on the 15th day, most pronounced for amidopyrine N-demethylase (by 37%) and less for benzphetamine N-demethylase (by 17%). Aniline hydroxylase activity was slightly diminished (by 18% and 16%, resp.). No significant changes in the components of the electron-transport chain of cytochrome P-450 were established--the content of cytochrome P-450, cytochrome b-5 and cytochrome C reductase, both after 5- and 14-day mopyridone administration.

Acetic acid visualization of the cervix to detect cervical dysplasia

OBJECTIVE

To determine whether acetic acid visualization of the cervix can identify cervical dysplasia and improve detection of lesions missed by Papanicolaou test screening.

METHODS

During a 2-year period, patients attending family planning clinics for regular gynecologic examinations had acetic acid applied to the cervix, followed by gross visualization without magnification. Patients with suspicious acetowhite lesions and normal Papanicolaou tests were referred for colposcopic evaluation. Findings from these examinations and corresponding biopsy results were analyzed retrospectively.

RESULTS

Eighty-five women were referred for colposcopy because of abnormal acetowhite areas on the cervix. Thirteen patients (15%) had cervical intraepithelial neoplasia (CIN) (nine CIN I, four CIN II), 22 (26%) had koilocytosis, and 16 (19%) had benign histologic findings. In total, 51 patients had suspicious lesions at colposcopy for which biopsies were performed, and 34 (40%) had normal colposcopic examinations.

CONCLUSIONS

Acetic acid visualization of the cervix can detect dysplasia otherwise missed by Papanicolaou test screening. However, further refinements in technique are required to decrease false-positive findings and unnecessary referrals for colposcopy.

HIV roundtable. Professional perspectives

As the HIV epidemic escalates, concern is mounting over the implications of infection among health care workers. Should all medical professionals be tested? Should supervisors and/or patients be notified if the results are positive? Should the infected PA continue to practice? What about performing surgery? Should he or she be considered impaired? And what about the long-term stress of working with HIV patients? Experts discuss the AAPA's latest recommendations, and share suggestions on prevention and patient care with the audience.

HIV roundtable. Strategies to enhance professional awareness and involvement. Part II

Despite extensive public attention to the social and medical problems associated with HIV infection and AIDS, many clinicians remain largely uninvolved in public health and patient counseling programs aimed at preventing infection and getting patients into treatment. Suggestions to enhance professional involvement include improved schooling and continuing medical education; increased liaison and exchange of information among the various groups working with AIDS patients and at-risk populations; and programs to help clinicians confront their own feelings and concerns relating to AIDS.

HIV roundtable. Strategies to enhance professional awareness and involvement, Part I

Despite extensive public attention to the social and medical problems associated with HIV infection and AIDS, many clinicians remain largely uninvolved in public health and patient counseling programs aimed at preventing infection and getting patients into treatment. Suggestions to enhance professional involvement include improved schooling and continuing medical education; increased liaison and exchange of information among the various groups working with AIDS patients and at-risk populations; and programs to help clinicians confront their own feelings and concerns relating to AIDS.

A rat hybridoma model of Heymann nephritis: production of a monoclonal anti GP330 from a nephritic rat

Autologous (Heymann) nephritis was induced by immunizing Sprague-Dawley rats with a crude membrane extract (Fx1A) prepared from renal cortical tubules. Urine protein excretion was monitored to determine the onset of nephritis and then the spleens of nephritic rats were fused with a non-secretor rat myeloma cell line. Supernatants from hybridoma cultures were first screened for production of anti-brush border membrane (BBM) antibody by immunodot blotting of highly purified rat BBM on nitrocellulose. Positive hybrids were then tested by indirect immunofluorescence for the presence of IgG, which binds to the brush border of rat renal proximal tubules. Those hybrids which were positive by both screening assays were subcloned twice. Two monoclonal antibodies (C5, D11) were studied in some detail. Both C5 and D11 immunoprecipitated a single polypeptide from BBM, labelled with 125I by the lactoperoxidase method. Radioautography of gradient 4-11% slab sodium dodecyl sulphate polyacrylamide gels revealed that the polypeptide against which C5 and D11 were directed co-migrated with the polypeptide immunoprecipitated by (i) IgG eluted from the renal cortex of nephritic rats, and by (ii) a mouse anti-rat monoclonal against gp 330 [a BBM constituent with proven pathogenicity [9]]. Supernatants which tested positive by immunodot blotting but negative by indirect immunofluorescence showed no detectable immunoprecipitate after reaction with BBM. Immunocytochemical staining by immunoperoxidase and immunogold methods localized C5 and D11 to the BBM of the renal proximal tubule and to the urine face of the glomerular epithelium.(ABSTRACT TRUNCATED AT 250 WORDS)

Carotid endarterectomy under local anesthesia supplemented with neuroleptic analgesia

Surgical treatment of the carotid artery is being performed increasingly under local rather than general anesthesia. The advantage of local anesthesia is that neurologic function can be continuously assessed while the carotid arteries are cross-clamped, and unnecessary shunting can, thus, be avoided, with resulting sedation, analgesia, alpha blockade and blood pressure stability. The main objection to the use of local anesthesia is the anxiety of the patient. We overcame this difficulty in a series of 42 patients by supplementing the local anesthetic with neuroleptic analgesia. The possible disadvantages of neuroleptic administration are apnea and prolonged sedation. Only one of the patients we studied required an intraluminal shunt. One patient died of cardiac disease and one suffered an early postoperative stroke, which subsequently resolved. We believe that local anesthesia, supplemented by neuroleptic sedation and analgesia to overcome patient anxiety, should be more widely used for carotid endarterectomy.

PA impairment due to HIV infection. Part II: Building a professional support network. Forum

Several members of the AAPA's Lesbian and Gay Physician Assistants Caucus who participated in the roundtable PAs and HIV-Antibody Testing: The Need for Guidelines When the Practitioner Is at Risk (1989;13[5]:146-158) met with members of the 12-Step/Caduceus Caucus to begin developing a cooperative effort to assist PAs who test positive for antibodies to the human immunodeficiency virus, and to explore other HIV-associated impairment issues. Part II focuses on concerns of the provider who is HIV-antibody positive as well as ways PA groups can cooperate to raise the profession's conciousness further and recommend guidelines and policy.

Immunocytochemical characterization of cells in rat glomerular culture

Identification and characterization of cells in glomerular tissue culture has been an ongoing concern of experimental renal biologists. We examined the immunocytochemical staining profiles of primary and passaged rat glomerular cultures using a battery of commercially available antisera. In all culture systems examined, two distinct cell populations could be distinguished. One cell type stained positively for desmin and had ultrastructurally smooth muscle features typical of contractile mesangial cells. The second cell type proliferated in a manner classically described for "epithelial" cells but, intriguingly, did not express any of the numerous epithelial markers tested. The second cell population may represent an undifferentiated reserve cell type. Immunocytochemical methods offer an independent modality to the evaluation of cells which proliferate in glomerular cell culture.

PAs and HIV-antibody testing. The need for guidelines when the practitioner is at risk. Discussion

The PA profession should establish guidelines for PAs at risk for infection with the human immunodeficiency virus (HIV) who wish to be tested for HIV antibody. Confidentiality and anonymity are critical factors, along with the employer's established policies. PAs working in emergency and surgical settings may be at greater professional risk of exposure to HIV; those with personal risk factors may consider being tested if their work exposes them to opportunistic infections. A clearinghouse for information should be established through the American Academy of Physician Assistants and state chapters.

Biochemical investigation of the pathogenesis of Heymann nephritis

This study describes biochemical comparison of proximal tubule antigens from the brush border membrane (BBM) of dog and rat kidney. The purpose was to determine if a difference in BBM composition could explain the inability to produce either active or passive Heymann Nephritis in the dog. Although the membrane composition as revealed by coomassie blue staining on 4 to 11 per cent polyacrylamide electrophoresis varied considerably between rats and dogs, polyclonal antibodies (rabbit anti-rat, rabbit anti-dog) against purified BBM from both species immunoprecipitated five identical polypeptides. Four bands were visualized between 70 kd and 170 kd; but the major polypeptide had an apparent molecular wt of approximately 460 kd. This high molecular wt constituent and three of the other peptides were bound specifically to lentil lectin column, confirming their glycoprotein nature. Only the 460 kd polypeptide was immunoprecipitated by monoclonal antibody against gp 330. Since both rat and dog BBM contain gp 330, believed to be the sole pathogenic antigen in Heymann Nephritis, we conclude that failure to produce active or passive Heymann Nephritis in the dog using the same protocol that is successful in rats cannot be attributed to differences in antigenic make-up of the brush border membrane.

Congenital afibrinogenemia: an unusual case

We describe a congenitally afibrinogenemic young man who experienced massive spontaneous bleeding episodes at unusual sites, including the thigh muscles, lung and brain. Each of these life-threatening episodes raised theoretical and critical practical problems. A large local hematoma was responsible for an accelerated consumption of fibrinogen, which was relieved following evacuation. It is unusual for an afibrinogenemic patient to survive a number of potentially lethal bleeding episodes.

Biopsy proven evolution of post streptococcal glomerulonephritis to rapidly progressive glomerulonephritis of a post infectious type

A 15 year old boy with chronic impetigo was admitted with severe acute oliguric renal failure requiring temporary dialytic treatment. Renal biopsy revealed typical diffuse and proliferative glomerulonephritis of the poststreptococcal type. Subsequently high temperature developed with flank pains at the biopsy site, concomitantly with deterioration of renal function. On exploration, a sterile perirenal hematoma was found and a wedge renal biopsy revealed crescentic rapidly progressive glomerulonephritis of the post infectious type. Deterioration to end stage renal failure occurred within a few months. Although universally accepted, biopsy proven evolution from diffuse proliferative and exudative glomerulonephritis to crescentic form of post streptococcal glomerulonephritis has been rarely reported.

Spinal narcotics and central nervous system depression

A case of central nervous system depression which developed 7 hours after an intrathecal injection of 4 mg of morphine is described. The patient lapsed into coma with bradypnoea and "pin-point' pupils and there was no response to naloxone 0.4 mg. Treatment was continued for 3 hours. No postoperative analgesics were required for 126 hours. The problems associated with the use of intrathecal opiates are reviewed, delay in onset being the usual feature. Use of hyperbaric solutions of the narcotic and maintenance of a head-up posture may protect against respiratory depression.

Bradykinin, plasma protein fraction, and hypotension

A directive from the Food and Drug Administration indicates that the use of plasma protein fraction (PPF) is contraindicated during cardiopulmonary bypass because of possible hypotension. Bradykinin has been implicated as the cause of this hypotension. Bradykinin levels were measured by radioimmunoassay in PPF and in 5% albumin and were found to be consistently elevated in the former and occasionally in the latter. The addition of PPF to pump primes resulted in significantly elevated levels of bradykinin, which rapidly cleared, indicating that extrapulmonary sites of bradykinin inactivation were efficient. The potential hypotensive effect of PPF was observed by determining the change in mean perfusion pressure in two groups of patients: one group with a 3,000 ml crystalloid prime and the other with a prime of 2,000 ml of crystalloid and 1,000 ml of PPF. There was no significant difference in the perfusion pressure between the two groups at any point, and the hypotensive effects seen in both groups were readily treated, suggesting that the directive against the use of PPF during cardiopulmonary bypass may be unnecessarily restrictive.

Epidural morphine in treatment of pain

Epidural injections of a 2 mg morphine were given to 10 patients with severe acute or chronic pain. All cases had considerable amelioration of pain, which commenced within 2-3 min, reached a peak in 10-15 min, and was effective for 6-24 h. It is suggested that the morphine reached the subarachnoid space and produced its effect by direct action on the specific opiate receptors in the substantia gelatinosa of the posterior-horn cells of the spinal cord.

[Liver cirrhosis in Israel (author's transl)]

The incidence of death caused by cirrhosis of the liver has increased in Israel during the last 20 years as it has in other parts of the world; still the incidence is much lower than in most countries. Increasing alcoholism and higher rates of hepatitis probably play a role, however in many cases the cause of cirrhosis remains in the dark.