Evaluation of the INTERPRET decision-support system: can it improve the diagnostic value of magnetic resonance spectroscopy of the brain?

Purpose

We evaluated in a clinical setting the INTERPRET decision-support system (DSS), a software generated to aid in MRS analysis to achieve a specific diagnosis for brain lesions.

Methods

The material consisted of 100 examinations of focal intracranial lesions with confirmed diagnoses. MRS was obtained at 1.5 T using TE 20–30 ms. Data were processed with the LCModel for conventional analysis. The INTERPRET DSS 3.1. was used to obtain specific diagnoses. MRI and MRS were reviewed by one interpreter. DSS analysis was made by another interpreter, in 80 cases by two interpreters. The diagnoses were compared with the definitive diagnoses. For comparisons between DSS, conventional MRS analysis, and MRI, the diagnoses were categorised: high-grade tumour, low-grade tumour, non-neoplastic lesion.

Results

Interobserver agreement in choosing the diagnosis from the INTERPRET database was 75%. The diagnosis was correct in 38/100 cases, incorrect in 57 cases. No good match was found in 5/100 cases. The diagnostic category was correct with DSS/conventional MRS/MRI in 67/58/52 cases, indeterminate in 5/8/20 cases, incorrect in 28/34/28 cases. Results with DSS were not significantly better than with conventional MRS analysis. All definitive diagnoses did not exist in the INTERPRET database. In the 61 adult patients with the diagnosis included in the database, DSS/conventional MRS/MRI yielded a correct diagnosis category in 48/32/29 cases (DSS vs conventional MRS: p = 0.002, DSS vs MRI: p = 0.0004).

Conclusion

Use of the INTERPRET DSS did not improve MRS categorisation of the lesions in the unselected clinical cases. In adult patients with lesions existing in the INTERPRET database, DSS improved the results, which indicates the potential of this software with an extended database.

Electronic supplementary material

The online version of this article (10.1007/s00234-018-2129-7) contains supplementary material, which is available to authorized users.

Anxiety in early pregnancy: prevalence and contributing factors

Antenatal anxiety symptoms are not only a health problem for the expectant mother. Research has found that maternal anxiety may also have an impact on the developing baby. Therefore, it is important to estimate the prevalence of maternal anxiety and associated factors. The current study aims to estimate the prevalence of anxiety symptoms during the first trimester of pregnancy and to identify associated risk factors. Secondly, to investigate other factors associated with anxiety during early pregnancy including fear of childbirth and a preference for cesarean section. In a population-based community sample of 1,175 pregnant women, 916 women (78%) were investigated in the first trimester (gestation week 8-12). The Hospital Anxiety Depression Scale (HADS-A) was used to measure anxiety symptoms. The prevalence of anxiety symptoms (HADS-A scores≥8 during pregnancy) was 15.6% in early pregnancy. Women under 25 years of age were at an increased risk of anxiety symptoms during early pregnancy (OR 2.6, CI 1.7-4.0). Women who reported a language other than Swedish as their native language (OR 4.2, CI 2.7-7.0), reported high school as their highest level of education (OR 1.6, CI 1.1-2.3), were unemployed (OR 3.5, CI 2.1-5.8), used nicotine before pregnancy (OR 1.7, CI 1.1-2.5), and had a self-reported psychiatric history of either depression (OR 3.8, CI 2.6-5.6) or anxiety (OR 5.2, CI 3.5-7.9) before their current pregnancy were all at an increased risk of anxiety symptoms during early pregnancy. Anxiety symptoms during pregnancy increased the rate of fear of birth (OR 3.0, CI 1.9-4.7) and a preference for cesarean section (OR 1.7, CI 1.0-2.8). Caregivers should pay careful attention to history of mental illness to be able to identify women with symptoms of anxiety during early pregnancy. When presenting with symptoms of anxiety, the women might need counseling and or treatment in order to decrease her anxiety.

Cardiac outcome after sevoflurane versus propofol sedation following coronary bypass surgery: a pilot study

BACKGROUND

Studies of volatile anesthetic administration during coronary artery bypass grafting (CABG) report reduced serum levels of post-operative cardiac troponin-T (cTnT). Our primary objective was to evaluate whether short-term sedation with sevoflurane in the intensive care unit (ICU)--after CABG--could affect the release of cTnT, compared with propofol sedation.

METHODS

Following isolated CABG with cardiopulmonary bypass, 100 patients were randomized to either sevoflurane via the Anesthetic Conserving Device (AnaConDa(®)) or propofol for ICU sedation. Study drugs were administered for 2 h during mechanical ventilation and thereafter until extubation criteria were met. The primary endpoint was cTnT 12 h post-operatively. Crude cTnT data were not normally distributed and therefore compared with the Mann-Whitney U-test. Because of the skewed pre-operative and post-operative cTnT data, we performed a post hoc analysis of the change in cTnT between pre-operative values and 12 h post-operatively.

RESULTS

There was no statistically significant difference between groups in the primary endpoint cTnT values at 12 h post-operatively, cardiac events or the need for hemodynamic support. In the post hoc analysis, the cTnT increase from pre-operative values to 12 h post-operatively was less pronounced in the sevoflurane group (P=0.008).

CONCLUSION

Post-operative short-term sevoflurane sedation following CABG, in comparison with propofol, did not affect the cTnT values at 12 h post-operatively and clinical outcome was equal between groups. The result from the post hoc analysis, with less cTnT change over time, is nevertheless hypothesis-generating and warrants a larger study.

Low-threshold femtosecond optical parametric oscillator based on chirped-pulse frequency conversion

We report what is to our knowledge the first demonstration of a femtosecond optical parametric oscillator based on chirped-pulse frequency conversion in a long crystal of aperiodically poled potassium titanyl phosphate. The minimum pump threshold power was 15 mW, and a signal slope efficiency of 35% was achieved. Continuous tuning from 1190 to 1450 nm was obtained for an average pump power of 800 mW.

Single-mode near-infrared optical parametric oscillator amplifier based on periodically poled KTiOPO4

A singly resonant, single-axial-mode, optical parametric oscillator (OPO) based on periodically poled KTiOPO4 (PPKTP) is reported. Signal (1.68 micron) and idler (2.90 micron) optical bandwidths have been narrowed to <400 MHz by use of a diffraction grating at grazing incidence. The OPO generates 370 microJ of signal radiation when pumped by 3.1 mJ of 1.064-micron radiation. We implemented a single-pass PPKTP amplifier to yield 2.15-mJ signal and 1.17-mJ idler radiation without broadening the spectral bandwidths.

Widely and continuously tunable optical parametric oscillator based on a cylindrical periodically poled KTiOPO(4) crystal

We report on what is to our knowledge the first realization of a quasi-phase-matched optical parametric oscillator (OPO) based on a crystal with a cylindrical shape. The main reason for interest in this device is its broad, continuous tuning. In experiments with a 1064-nm pump, the signal tuning range was equal to 525 nm (1515-2040 nm), and the corresponding idler was continuously tuned over 1340 nm (2220-3560 nm). The angular tuning was 26 degrees , with only a minor variation of the OPO threshold over the entire tuning range.

High-power optical parametric oscillation in large-aperture periodically poled KTiOPO(4)

Electric field poling has been employed to fabricate 3-mm-thick periodically poled KTiOPO>(4) crystal for a high-power optical parametric oscillator. The maximum output power of the singly resonant optical parametric oscillator reached 13 mJ with 45% efficiency when the resonator was pumped with a 2.2-mm-diameter beam from a Q-switched Nd:YAG laser. The influence of the cavity design on the spectral and spatial qualities of the output parametric radiation is also discussed.

Efficient femtosecond traveling-wave optical parametric amplification in periodically poled KTiOPO(4)

We report, for the first time to our knowledge, high-power femtosecond traveling-wave optical parametric amplification by use of periodically poled KTiOPO(4) . With a single pass through a 4-mm-long sample of 1.23-mm thickness we achieved 40% internal conversion efficiency and 5microJ of single-pulse idler energy near 3.8microm , using only 75microJ of energy from the output of a conventional 1-kHz Ti:sapphire regenerative amplifier. The 210-fs-long idler pulses were almost transform limited. We discuss the specific problems encountered in high-power parametric conversion, such as unwanted quasi-phase-matched upconversion processes for polarization configurations that utilize the largest (d(33)) nonlinear coefficient and the related formation of color centers (gray tracking) in KTiOPO(4) .

Differential expression of nerve terminal protein isoforms in VAChT-containing varicosities of the spinal cord ventral horn

Of the different types of synaptic contacts with the mammalian spinal motoneuron, the synapse made by the cholinergic, so-called C-terminal of unknown origin and function has special morphological characteristics. Thus, in this synapse, there is no postsynaptic density but rather a large subsynaptic cistern in the motoneuron. To see whether this particular arrangement imposes special demands on the transmitter release machinery, we examined the presence of nerve terminal proteins in the C-terminal by using immunohistochemistry. Cholinergic nerve fibers and terminals in the spinal cord ventral horn were identified with an antiserum to the vesicular acetylcholine transporter (VAChT) protein. Immunohistochemistry in combination with confocal laser microscopy showed the presence of synaptosomal-associated protein of 25 kDa (SNAP-25)-, syntaxin-, cysteine string protein (CSP)-, synuclein-, synapsin I-, synapsin I/II-, synaptotagmin I-, synaptotagmin I/II-, synaptophysin-, and synaptobrevin-2-like immunoreactivity (-LI) in VAChT-containing C-terminals. Synaptotagmin III and synaptobrevin 1 could not be demonstrated in this type of terminal. VAChT-containing varicosities in the Renshaw cell area, with a probable origin from motoneuron axon collaterals, exhibited CSP, synapsin I/II, and synaptobrevin-1-LI, but not SNAP-25-, syntaxin-, synuclein-, synapsin I-, synaptotagmin I-, synaptotagmin I/II-, synaptophysin- and synaptobrevin-2-LI. The results suggest a differential content of nerve terminal proteins and their isoforms in cholinergic C-terminals apposing motoneurons and in the Renshaw cell area. It is concluded that C-terminals contain synaptic proteins necessary for fast transmitter release, and their origin should not be the motoneurons themselves.

Efficient nanosecond optical parametric oscillators based on periodically poled KTP emitting in the 1.8-2.5-mum spectral region

The use of periodically poled KTiOPO(4) as a gain medium in efficient nanosecond optical parametric oscillators pumped by a flash-lamp-pumped Q-switched Nd:YAG laser is demonstrated. Parametric radiation in the 1.8-2.5-mu m spectral region was achieved when the crystal temperature was tuned from 10 to 100 degrees C. A maximum total output energy of 1.8 mJ was obtained at a pump level of 3.5 mJ. Stable operation was achieved, with conversion efficiencies reaching 50%. No gray tracking or laser damage was observed, even for pump intensities of 450MW/cm(2).

Neurotoxicity of methylmercury in squirrel monkeys. Cerebral cortical pathology, interference with scotopic vision, and changes in operant behavior

Blood mercury was raised to levels exceeding 1,000 ng/gm by weekly oral doses of methylmercury hydroxide to squirrel monkeys. Operant behavior tests were employed and neurological signs were recorded on film. Sudden visual disturbance occured with subacute exposure. Prolonged exposure resulted in impaired coordination with impairment of scotopic vision and possibly also sensory disturbances. Scotopic vision was tested by determining the critical fusion intensity (cfi) at 10 cps. An increase in cfi was the earliest neurological sign appearing in some monkeys months before other signs could be detected. Poisoned monkeys exhibited typical cerebral cortical lesions. The visual cortex was invariably involved. Extension to adjacent cortical areas increased with increasing duration of exposure and increasing brain mercury. The microgram per gram brain tissue was the lowest concentration of methylmercury seen wiht morphological lesions.