Ultra-high resolution Fourier domain optical coherence tomography for old master paintings

In the last 10 years, Optical Coherence Tomography (OCT) has been successfully applied to art conservation, history and archaeology. OCT has the potential to become a routine non-invasive tool in museums allowing cross-section imaging anywhere on an intact object where there are no other methods of obtaining subsurface information. While current commercial OCTs have shown potential in this field, they are still limited in depth resolution (> 4 μm in paint and varnish) compared to conventional microscopic examination of sampled paint cross-sections (~1 μm). An ultra-high resolution fiber-based Fourier domain optical coherence tomography system with a constant axial resolution of 1.2 μm in varnish or paint throughout a depth range of 1.5 mm has been developed. While Fourier domain OCT of similar resolution has been demonstrated recently, the sensitivity roll-off of some of these systems are still significant. In contrast, this current system achieved a sensitivity roll-off that is less than 2 dB over a 1.2 mm depth range with an incident power of ~1 mW on the sample. The high resolution and sensitivity of the system makes it convenient to image thin varnish and glaze layers with unprecedented contrast. The non-invasive 'virtual' cross-section images obtained with the system show the thin varnish layers with similar resolution in the depth direction but superior clarity in the layer interfaces when compared with conventional optical microscope images of actual paint sample cross-sections obtained micro-destructively.

Atrial fibrillation in patients with cryptogenic stroke

BACKGROUND

Atrial fibrillation is a leading preventable cause of recurrent stroke for which early detection and treatment are critical. However, paroxysmal atrial fibrillation is often asymptomatic and likely to go undetected and untreated in the routine care of patients with ischemic stroke or transient ischemic attack (TIA).

METHODS

We randomly assigned 572 patients 55 years of age or older, without known atrial fibrillation, who had had a cryptogenic ischemic stroke or TIA within the previous 6 months (cause undetermined after standard tests, including 24-hour electrocardiography [ECG]), to undergo additional noninvasive ambulatory ECG monitoring with either a 30-day event-triggered recorder (intervention group) or a conventional 24-hour monitor (control group). The primary outcome was newly detected atrial fibrillation lasting 30 seconds or longer within 90 days after randomization. Secondary outcomes included episodes of atrial fibrillation lasting 2.5 minutes or longer and anticoagulation status at 90 days.

RESULTS

Atrial fibrillation lasting 30 seconds or longer was detected in 45 of 280 patients (16.1%) in the intervention group, as compared with 9 of 277 (3.2%) in the control group (absolute difference, 12.9 percentage points; 95% confidence interval [CI], 8.0 to 17.6; P<0.001; number needed to screen, 8). Atrial fibrillation lasting 2.5 minutes or longer was present in 28 of 284 patients (9.9%) in the intervention group, as compared with 7 of 277 (2.5%) in the control group (absolute difference, 7.4 percentage points; 95% CI, 3.4 to 11.3; P<0.001). By 90 days, oral anticoagulant therapy had been prescribed for more patients in the intervention group than in the control group (52 of 280 patients [18.6%] vs. 31 of 279 [11.1%]; absolute difference, 7.5 percentage points; 95% CI, 1.6 to 13.3; P=0.01).

CONCLUSIONS

Among patients with a recent cryptogenic stroke or TIA who were 55 years of age or older, paroxysmal atrial fibrillation was common. Noninvasive ambulatory ECG monitoring for a target of 30 days significantly improved the detection of atrial fibrillation by a factor of more than five and nearly doubled the rate of anticoagulant treatment, as compared with the standard practice of short-duration ECG monitoring. (Funded by the Canadian Stroke Network and others; EMBRACE ClinicalTrials.gov number, NCT00846924.).

18Flurodeoxyglucose positron emission tomography in the localization of ectopic ACTH-secreting neuroendocrine tumours

OBJECTIVE

Neuroendocrine tumours (NET) are a rare cause of Cushing's syndrome. These tumours can be very small and therefore difficult to identify. Current localization techniques include CT, MRI and radioisotope scanning, but in a proportion of cases the NET remains occult. Positron emission tomography (PET) scanning, is a relatively new imaging modality that is increasingly used to detect and monitor lesions with high metabolic activity. We report on the use of PET scanning in the evaluation of the ectopic ACTH syndrome.

PATIENTS

Three patients with ectopic ACTH-dependent Cushing's syndrome with varying difficulty in NET localization are included in the report.

MEASUREMENT

Positron emission tomography scanning using 18flurodeoxyglucose (FDG) identifies tissue with high metabolic activity. 18FDG-PET scanning was used in each of these patients and the imaging is presented along with biochemical data.

RESULTS

In each case the NET was easily identified using 18FDG-PET, aiding clinical decision making and therapeutic outcome. A cure was identified by clinical resolution of symptoms and undetectable ACTH levels postsurgery.

CONCLUSIONS

18FDG-PET assisted in localizing small metabolically active NETs, suggesting this imaging modality may have a useful role in identifying NET causing Cushing's syndrome as a result of ectopic ACTH production.

Enhanced cellular immune response and reduced CD8(+) lymphocyte apoptosis in acutely SIV-infected Rhesus macaques after short-term antiretroviral treatment

Losing the decisive virus-specific functions of both CD4(+) and CD8(+) T lymphocytes in the first weeks after immunodeficiency virus infection ultimately leads to AIDS. The SIV/rhesus monkey model for AIDS was used to demonstrate that a 4-week chemotherapeutic reduction of viral load during acute SIV infection of macaques allowed the development of a competent immune response able to control virus replication after discontinuation of treatment in two of five monkeys. Increasing SIV-specific CD4(+) T-helper-cell proliferation was found in all macaques several weeks after treatment, independent of their viral load. However, only macaques with low viral loads showed persistent T-cell reactivity of lymph node cells. In contrast to animals with higher viral loads, T-helper-cell counts and memory T-helper cells did not decline in the two macaques controlling viral replication. Lymphocyte apoptosis was consistently low in all treated macaques. In contrast, high CD8(+) lymphocyte death but only slightly increased CD4(+) lymphocyte apoptosis were observed during the first weeks after infection in untreated control animals, indicating that early apoptotic death of virus-specific CTL could be an important factor for disease development. Antiretroviral treatment early after infection obviously retained virus-specific and competent T lymphocytes, whereby a virus-specific immune response could develop in two animals able to control the viral replication after cessation of treatment.

Homozygosity for a conserved Mhc class II DQ-DRB haplotype is associated with rapid disease progression in simian immunodeficiency virus-infected macaques: results from a prospective study

In human immunodeficiency virus type 1 (HIV-1)-infected individuals, disease progression varies considerably. This is also observed after experimental infection of macaques with simian immunodeficiency virus (SIV). Major histocompatibility complex (MHC) genes may influence disease progression in both species. Homozygosity for Mhc-Mamu (Macaca mulatta)-DQB1*0601 was previously identified to be associated with rapid disease progression in SIV-infected macaques. To validate the association of this genotype with disease progression, a prospective study was carried out. Six unrelated monkeys homozygous for Mamu-DQB1*0601 and DRB1*0309-DRB*W201 and 6 heterozygous monkeys were infected with SIVmac. Five of the homozygous and only 1 of the heterozygous monkeys died rapidly after infection, with manifestations of AIDS. These results were validated by a retrospective survival analysis of 71 SIV-infected monkeys. The identified DQ-DRB genotype is frequent among monkeys of different breeding colonies and allows a fairly reliable selection before infection of monkeys predisposed for rapid disease progression.

Kinetics of lymphocyte apoptosis in macaques infected with different simian immunodeficiency viruses or simian/human immunodeficiency hybrid viruses

Increased rates of T-cell apoptosis have been detected in human immunodeficiency virus (HIV)-infected individuals and in the simian immunodeficiency model (SIV) for AIDS research. We have infected macaques with virulent SIV or SIV/HIV hybrid viruses (SHIV) of different pathogenic potentials to study the early kinetics of apoptosis in this model. Animals infected with SIV showed an increased degree of apoptosis in their peripheral blood mononuclear cells as early as 8 weeks after virus inoculation. Apoptotic cells were detected in the CD4 and CD8 cell populations of infected animals. In contrast, apathogenic SHIV did not lead to increased lymphocyte apoptosis and moderately pathogenic SHIV induced only transient apoptosis. T-cell death was temporally linked to viral replication in vivo. Furthermore, lymphocyte apoptosis in infected macaques was associated with impaired proliferative responses of helper T-cells and with CD4 cell depletion. The monkey model described here provides the opportunity for testing early therapeutic interventions to prevent virus-induced programmed cell death and the subsequent onset of AIDS.

Generation of herpes virus saimiri-transformed T-cell lines from macaques is restricted by reactivation of simian spuma viruses

Herpes virus saimiri (HVS) transforms human T-cells in vitro to stable growth. These T-cell lines retain their immunological characteristics of the parent cells and do not release infectious virus. Recently, lymphocytes of Old World monkeys were efficiently transformed by HVS. In parallel to these studies we initiated transformation experiments by infecting peripheral blood cell cultures of 45 monkeys, 35 rhesus and 10 cynomolgus macaques. In only three cases, we obtained transformed T-cell lines. The transformed T-cells were largely double-positive for CD4 and CD8. They responded with increased proliferation to mitogenic or IL-2 stimulation and transcribed mRNA for IL-2, IL-4, and IL-10. However, most initiated T-cell cultures from macaques developed giant cells. The cytopathic agent was identified as simian foamy virus (SFV) as confirmed by PCR, immunofluorescence, and coculture experiments. Treatment of the T-cell cultures with AZT- and SFV-specific sera did only shortly prolong the life-span of the cultures. Therefore, the reactivation of SFV caused remarkable difficulties in the establishment of macaque T-cell lines by HVS. This seems to be a general problem since most animals from several breeding colonies are SFV-positive.

Impaired mitogen-driven proliferation and cytokine transcription of lymphocytes from macaques early after simian immunodeficiency virus (SIV) infection

Altered cytokine transcription might play an important role in the pathogenesis of human immunodeficiency virus (HIV) infection in humans. The infection of rhesus macaques with simian immunodeficiency virus (SIV) provides a relevant animal model for HIV infection. Therefore, we evaluated the cyokine transcription of phytohemagglutinin (PHA)-stimulated lymphocytes in the early phase after infection of four rhesus macaques with pathogenic SIV-mac239. To determine transcription of interleukin (IL)-2, interferon (IFN)-gamma, IL-4, IL-6, and IL-10 we established a semiquantitative reverse transcriptase polymerase chain reaction (RT-PCR). After inoculation with SIV, all monkeys became productively infected and developed an acquired immunodeficiency syndrome (AIDS) like disease. Infection was associated with a proliferation dysfunction of monkey lymphocytes in response to PHA. In addition, a decreasing overall cytokine transcription could be observed during the course of SIV infection. These findings demonstrate that an impairment of the lymphocyte function is associated with a reduced cytokine transcription in the early phase of an immunodeficiency virus infection. The observed differences of cytokine expression might contribute to the impaired immune response of SIV-infected monkeys and HIV-infected humans.

T cell apoptosis in human immunodeficiency virus type 2- and simian immunodeficiency virus-infected macaques

Recent evidence suggests that T cell apoptosis could be involved in the pathogenesis of HIV infection. In addition, lymphocyte apoptosis has been described in SIV-infected macaques that developed simian AIDS. To investigate further the role of apoptosis in AIDS pathogenesis, we studied lymphocytes of HIV-2-infected cynomolgus macaques that did not develop simian AIDS. We compared apoptosis of lymphocytes from animals infected with non-pathogenic HIV-2 to that in macaques infected with pathogenic SIV. Unfractionated peripheral blood mononuclear cells of SIV- and HIV-2-infected macaques showed evidence of apoptosis by electron microscopy, flow cytometry (terminal dUTP nick end labelling) and visualization of DNA fragmentation. Between 30-50% apoptotic cells could be detected in SIV-infected animals, compared to approximately 30% in HIV-2-infected and 5-12% in uninfected monkeys. However, separation of PBMC into T cell subpopulations revealed striking differences in apoptosis between SIV- and HIV-2-infected macaques. In SIV-infected monkeys both CD4 and CD8 cells underwent apoptosis to a large extent. In contrast, in the HIV-2-infected macaques apoptosis was restricted to the CD8 cell compartment. The lack of apoptosis in CD4 cells of healthy HIV-2-infected macaques implies an important role for CD4 cell apoptosis in AIDS pathogenesis.

Cell-mediated immune response of macaques immunized with low doses of simian immunodeficiency virus (SIV)

Many uninfected people at high risk of HIV infection developed an HIV-specific cellular immune response despite their lack of seroconversion. Therefore, they must have been exposed to HIV without subsequent infection. It has been concluded from these data, that cell-mediated immunity (CMI) rather than humoral immunity might confer protection to HIV infection. Therefore, we tried to induce such a strong CMI in macaques by different immunization strategies. Five or seven animals were immunized with high or low doses of a whole SIV split vaccine. The lower dose of the vaccine provoked a stronger T-helper cell (TH) proliferation than the higher dose, which led to a pronounced humoral immune response. To induce a strong CMI without any specific antibody response, five macaques were inoculated with low doses of infectious SIV. None of these animals seroconverted but each animal developed a SIV-specific TH response. Interestingly, we could neither detect an SIV-specific CTL activity in the animals nor did we find typical TH1- or TH2-like cytokine profiles investigating stimulated bulk-cultures from SIV-exposed animals by RT-PCR. 24 weeks after the first low dose SIV exposure the animals were boosted by a second low dose of SIV followed by a subsequent intravenous challenge with a high dose of SIV 12 weeks later. Unexpectedly, none of the animals was found to be protected against infection and the development of AIDS-like symptoms.

The practical medical aspects of acupuncture

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