[Four types of old patients in the emergency department : A geriatric medicine qualitative and economic viewpoint]. / Vier Typen von alten Patienten in der Notaufnahme : Eine altersmedizinische, qualitative und ökonomische Betrachtung.

BACKGROUND: Lack of clinical management of old patients in the emergency department. QUESTION: How can we manage old patients in the emergency department more effectively, medically and economically? METHODS: Evaluation of current selection and screening methods and recommendations for old patients in the emergency department. Acute inpatient treatment needs, presence of dysfunction in at least two core areas and assessment of advance care needs are examined. RESULT: The identification of old patients in the emergency department as geriatric patients alone shows no control potential. Combining the three test criteria of acute inpatient need for treatment, the presence of dysfunction in at least two core areas and the assessment of advance care needs generates four old patient types that have interesting control potential: the medical traumatology patient, the acute geriatric patient, the rehabilitative geriatric patient, and the ambulatory patient. DISCUSSION: in addition to identifying geriatric patients, screening should map acute inpatient treatment needs, assessment of dysfunction, and analysis of advance care needs to define clinically steerable old patients.

In-plane simultaneous multisegment imaging using a 2D RF pulse.

PURPOSE: To develop an in-plane simultaneous multisegment (IP-SMS) imaging technique using a 2D-RF pulse and to demonstrate its ability to achieve high spatial resolution in EPI while reducing image distortion. METHODS: The proposed IP-SMS technique takes advantage of periodic replicates of the excitation profile of a 2D-RF pulse to simultaneously excite multiple segments within a slice. These segments were acquired over a reduced FOV and separated using a joint GRAPPA reconstruction by leveraging virtual coils that combined the physical coil sensitivity and 2D-RF pulse spatial response. Two excitations were used with complementary spatial response profiles to adequately cover a full FOV, producing a full-FOV image that had the benefits of reduced FOV with high spatial resolution and reduced distortion. The IP-SMS technique was implemented in a diffusion-weighted single-shot EPI sequence. Experimental demonstrations were performed on a phantom and healthy human brain. RESULTS: In the phantom experiment, IP-SMS enabled a four-fold acceleration using an eight-channel coil without causing residual aliasing artifacts. In the human brain experiment, diffusion-weighted images with high in-plane resolution (1 × 1 mm2 ) and substantially reduced image distortion were obtained in all imaging planes in comparison with a commercial diffusion-weighted EPI sequence. The capability of IP-SMS for contiguous whole-brain coverage was also demonstrated. CONCLUSION: The proposed IP-SMS technique can realize the benefits of reduced-FOV imaging while achieving a full-FOV coverage with good image quality and time efficiency.

Evaluation of a fractional-order calculus diffusion model and bi-parametric VI-RADS for staging and grading bladder urothelial carcinoma.

OBJECTIVES: To evaluate the feasibility of high b-value diffusion-weighted imaging (DWI) for distinguishing non-muscle-invasive bladder cancer (NMIBC) from muscle-invasive bladder cancer (MIBC) and low- from high-grade bladder urothelial carcinoma using a fractional-order calculus (FROC) model as well as a combination of FROC DWI and bi-parametric Vesical Imaging-Reporting and Data System (VI-RADS). METHODS: Fifty-eight participants with bladder urothelial carcinoma were included in this IRB-approved prospective study. Diffusion-weighted images, acquired with 16 b-values (0-3600 s/mm2), were analyzed using the FROC model. Three FROC parameters, D, ß, and µ, were used for delineating NMIBC from MIBC and for tumor grading. A receiver operating characteristic (ROC) analysis was performed based on the individual FROC parameters and their combinations, followed by comparisons with apparent diffusion coefficient (ADC) and bi-parametric VI-RADS based on T2-weighted images and DWI. RESULTS: D and µ were significantly lower in the MIBC group than in the NMIBC group (p = 0.001 for each), and D, ß, and µ all exhibited significantly lower values in the high- than in the low-grade tumors (p ≤ 0.011). The combination of D, ß, and µ produced the highest specificity (85%), accuracy (78%), and the area under the ROC curve (AUC, 0.782) for distinguishing NMIBC and MIBC, and the best sensitivity (89%), specificity (86%), accuracy (88%), and AUC (0.892) for tumor grading, all of which outperformed the ADC. The combination of FROC parameters with bi-parametric VI-RADS improved the AUC from 0.859 to 0.931. CONCLUSIONS: High b-value DWI with a FROC model is useful in distinguishing NMIBC from MIBC and grading bladder tumors. KEY POINTS: • Diffusion parameters derived from a FROC diffusion model may differentiate NMIBC from MIBC and low- from high-grade bladder urothelial carcinomas. • Under the condition of a moderate sample size, higher AUCs were achieved by the FROC parameters D (0.842) and µ (0.857) than ADC (0.804) for bladder tumor grading with p ≤ 0.046. • The combination of the three diffusion parameters from the FROC model can improve the specificity over ADC (85% versus 67%, p = 0.031) for distinguishing NMIBC and MIBC and enhance the performance of bi-parametric VI-RADS.

Magnetic resonance imaging with submillisecond temporal resolution.

PURPOSE: To demonstrate an MRI technique-Submillisecond Periodic Event Encoded Dynamic Imaging (SPEEDI)-for capturing cyclic dynamic events with submillisecond temporal resolution. METHODS: The SPEEDI technique is based on an FID or an echo signal in which each time point in the signal is used to sample a distinct k-space raster, followed by repeated FIDs or echoes to produce the remaining k-space data in each k-space raster. All acquisitions are synchronized with a cyclic event, resulting in a set of time-resolved images of the cyclic event with a temporal resolution determined by the dwell time. In SPEEDI, spatial encoding is accomplished by phase encoding. The SPEEDI technique was demonstrated in two experiments at 3 T to (1) visualize fast-changing electric currents that mimicked the waveform of an action potential, and (2) characterize rapidly decaying eddy currents in an MRI system, with a temporal resolution of 0.2 ms and 0.4 ms, respectively. In both experiments, compressed sensing was incorporated to reduce the scan times. Phase difference maps related to the dynamics of electric currents or eddy currents were then obtained. RESULTS: In the first experiment, time-resolved phase maps resulting from the action potential-mimicking current waveform were successfully obtained and agreed well with theoretical calculations (normalized RMS error = 0.07). In the second experiment, spatially resolved eddy current phase maps revealed time constants (27.1 ± 0.2 ms, 41.1 ± 3.5 ms, and 34.8 ± 0.7 ms) that matched well with those obtained from an established method using point sources (26.4 ms, 41.2 ms and 34.8 ms). For both experiments, phase maps from fully sampled and compressed-sensing-accelerated k-space data exhibited a high structural similarity (> 0.8) despite a two-fold to three-fold acceleration. CONCLUSIONS: We have illustrated that SPEEDI can provide submillisecond temporal resolution. This capability will likely lead to future exploration of ultrafast, cyclic biomedical processes using MRI.

Quartile histogram assessment of glioma malignancy using high b-value diffusion MRI with a continuous-time random-walk model.

The purpose of this study is to investigate the feasibility of using a continuous-time random-walk (CTRW) diffusion model, together with a quartile histogram analysis, for assessing glioma malignancy by probing tissue heterogeneity as well as cellularity. In this prospective study, 91 patients (40 females, 51 males) with histopathologically proven gliomas underwent MRI at 3 T. The cohort included 42 grade II (GrII), 19 grade III (GrIII) and 29 grade IV (GrIV) gliomas. Echo-planar diffusion-weighted imaging was conducted using 17 b-values (0-4000 s/mm2 ). Three CTRW model parameters, including an anomalous diffusion coefficient Dm , and two parameters related to temporal and spatial diffusion heterogeneity α and ß, respectively, were obtained. The mean parameter values within the tumor regions of interest (ROIs) were computed by utilizing the first quartile of the histograms as well as the full ROI for comparison. A Bonferroni-Holm-corrected Mann-Whitney U-test was used for the group comparisons. Individual and combinations of the CTRW parameters were evaluated for the characterization of gliomas with a receiver operating characteristic analysis. All first-quartile mean CTRW parameters yielded significant differences (p-values < 0.05) between pair-wise comparisons of GrII (Dm : 1.14 ± 0.37 µm2 /ms; α: 0.904 ± 0.03, ß: 0.913 ± 0.06), GrIII (Dm : 0.88 ± 0.21 µm2 /ms; α: 0.888 ± 0.01, ß: 0.857 ± 0.06) and GrIV gliomas (Dm : 0.73 ± 0.22 µm2 /ms; α: 0.878 ± 0.01; ß: 0.791 ± 0.07). The highest sensitivity, specificity, accuracy and area-under-the-curve of using the combinations of the first-quartile parameters were 84.2%, 78.5%, 75.4% and 0.76 for GrII and GrIII classification; 86.2%, 89.4%, 75% and 0.76 for GrIII and GrIV classification; and 86.2%, 85.7%, 84.5% and 0.90 for GrII and GrIV classification, respectively. Quartile-based analysis produced higher accuracy and area-under-the-curve than the full ROI-based analysis in all classifications. The CTRW diffusion model, together with a quartile-based histogram analysis, offers a new way for probing tumor structural heterogeneity at a subvoxel level, and has potential for in vivo assessment of glioma malignancy to complement histopathology.

Condensation Artifact.

During the ongoing COVID-19 pandemic, an artifact with hyperintense signal was observed on the brain images of a number of patients or research subjects, particularly those with heavy body weight and/or increased respiratory rate. The artifact was primarily seen on 3D or 2D sagittal or coronal T2-weighted images, although it occasionally also appeared in the axial plane. It manifested as a bright spot or a cluster of bright spots at similar locations, superior or lateral superior to the skull. This artifact was found to be caused by condensed water droplet(s) in the head coil as a consequence of the altered moisture flow pattern associated with each exhalation due to the mask on the patient. We call this artifact condensation artifact. Several strategies have been proposed to prevent or resolve the artifact. LEVEL OF EVIDENCE: 5 TECHNICAL EFFICACY: Stage 1.

In vivo assessment of Lauren classification for gastric adenocarcinoma using diffusion MRI with a fractional order calculus model.

OBJECTIVES: To evaluate the performance of a fractional order calculus (FROC) diffusion model for imaging-based assessment of Lauren classification in gastric adenocarcinoma. METHODS: In this study, 43 patients (15 females, 28 males) with gastric adenocarcinoma underwent MRI at 1.5 T. According to pathology-based Lauren classification, 10 patients had diffuse-type, 20 had intestinal-type, and 13 had mixed-type lesions. The diffuse and mixed types were combined as diffuse-and-mixed type to be differentiated from the intestinal type using diffusion MRI. Diffusion-weighted images were acquired by using eleven b-values (0-2000 s/mm2). Three FROC model parameters comprising diffusion coefficient D, intravoxel diffusion heterogeneity ß, and a microstructural quantity µ, together with a conventional apparent diffusion coefficient (ADC), were estimated. The mean parameter values in the tumour were computed by using a percentile histogram analysis. Individual or linear combinations of the mean parameters in the tumour were used to differentiate the diffuse-and-mixed type from the intestinal type using descriptive statistics and receiver operating characteristic (ROC) analyses. RESULTS: Significant differences were observed between diffuse-and-mixed-type and intestinal-type lesions in D (0.99 ± 0.20 µm2/ms vs. 1.11 ± 0.23 µm2/ms; p = 0.036), ß (0.37 ± 0.08 vs. 0.43 ± 0.11; p = 0.043), µ (7.92 ± 2.79 µm vs. 9.87 ± 1.52 µm; p = 0.038), and ADC (0.81 ± 0.34 µm2/ms vs. 0.96 ± 0.19 µm2/ms; p = 0.033). Among the individual parameters, µ produced the largest area under the ROC curve (0.739). The combinations of (D, ß, µ) and (ß and µ) produced the best overall performance with a sensitivity of 0.739, specificity of 0.750, accuracy of 0.744, and area under the curve of 0.793 (95% confidence interval: 0.657-0.929). CONCLUSION: Diffusion MRI with the FROC model holds promise for non-invasive assessment of Lauren classification for gastric adenocarcinoma. KEY POINTS: • High b-value diffusion MRI with a FROC model that is sensitive to tissue microstructures can differentiate the diffuse-and-mixed type from intestinal type of gastric adenocarcinoma. • The combination of FROC parameters produced the best result for distinguishing the diffuse-and-mixed type from the intestinal type with an area under the receiver operating characteristic curve of 0.793. • The FROC model parameters, individually or conjointly, hold promise for repeated, non-invasive evaluations of gastric adenocarcinoma at various time points throughout disease progression or regression to complement conventional Lauren classification.

Laparoscopy versus robotic-assisted pyeloplasty in children: preliminary results of a pilot prospective randomized controlled trial.

PURPOSE: The aim of this randomized controlled trial (RCT) is to compare the outcomes of conventional laparoscopic pyeloplasty (LP) versus robotic-assisted laparoscopic pyeloplasty (RALP) in the treatment of ureteropelvic junction obstruction (UPJO) in children. METHODS: A total of 53 patients with UPJO were randomized as LP (Group 1, n: 27) and RALP (Group 2, n: 26). Redo cases and patients with anatomical abnormalities were excluded. Urinary ultrasound was performed at postoperative 3, 6 and 12 months; whereas, diuretic renal scintigraphy was performed at 1 year. Failure was defined as progressive hydronephrosis on ultrasound, decline in renal function, or symptom relapse. All parameters were statistically compared. RESULTS: The mean age of the patients was 55.53 ± 57.25 months. There were no statistical differences between the groups in terms of patient gender, body mass index, laterality, preoperative renal function, renal pelvis antero-posterior diameter and presence of crossing vessel. Mean total operative time in LP group was longer than RALP (139 min vs 105 min, respectively, p = 0.001). The hospital stay was similar between the two groups. After a mean follow-up of 12.43 ± 5.34 months, the complication and success rates were found comparable. Only two patients required re-do pyeloplasty in LP group. The mean total cost of RALP procedure was approximately four times higher than LP. CONCLUSIONS: This is the first RCT comparing LP and RALP in pediatric population. Both LP and RALP are safe and effective in children with comparable success and complication rates. Operative time was longer for LP; whereas, total cost was higher for RALP.

High-Spatial-Resolution Diffusion MRI in Parkinson Disease: Lateral Asymmetry of the Substantia Nigra.

Background Motor symptoms in Parkinson disease (PD) have exhibited lateral asymmetry, suggesting asymmetric neuronal loss in the substantia nigra (SN). Diffusion MRI may be able to help confirm tissue microstructural alterations in the substantia nigra to probe for the presence of asymmetry. Purpose To investigate lateral asymmetry in the SN of patients with PD by using diffusion MRI with both Gaussian and non-Gaussian models. Materials and Methods In this cross-sectional study conducted from March 2015 to March 2017, 27 participants with PD and 27 age-matched healthy control (HC) participants, all right handed, underwent MRI at 3.0 T. High-spatial-resolution diffusion images were acquired with a reduced field of view by using seven b values up to 3000 sec/mm2. A continuous-time random-walk (CTRW) non-Gaussian diffusion model was used to produce anomalous diffusion coefficient (Dm) and temporal (α) and spatial (ß) diffusion heterogeneity indexes followed by a Gaussian diffusion model to yield an apparent diffusion coefficient (ADC). Individual or linear combinations of diffusion parameters in the SN were unilaterally and bilaterally compared between the PD and HC groups. Results In the bilateral comparison between the PD and HC groups, differences were observed in ß (0.67 ± 0.06 [standard deviation] vs 0.64 ± 0.04, respectively; P = .016), ADC (0.48 µm2/msec ± 0.08 vs 0.53 µm2/msec ± 0.06, respectively; P = .03), and the combination of CTRW parameters (P = .02). In the unilateral comparison, differences were observed in all diffusion parameters on the left SN (P < .03), but not on the right (P > .20). In a receiver operating characteristic (ROC) analysis to delineate left SN abnormality in PD, the combination of Dm, α, and ß produced the best sensitivity (sensitivity, 0.78); the combination of Dm and ß produced the best specificity (specificity, 0.85); and the combination of α and ß produced the largest area under the ROC curve (area under the ROC curve, 0.73). Conclusion These results suggest that quantitative diffusion MRI is sensitive to brain tissue changes in participants with Parkinson disease and provide evidence of substantia nigra lateral asymmetry in this disease. © RSNA, 2019 Online supplemental material is available for this article.

Does the identification of seniors at risk (ISAR) score effectively select geriatric patients on emergency admission?

The number of older patients admitted to emergency departments (ED) increases continuously. The Identification of Seniors at Risk (ISAR) score is currently recommended to screen patients in German ED, but its appropriateness is being criticized. ISAR scores and clinical characteristics from 98 emergency admissions (EA), 80 from acute geriatrics (AG) and 89 from a geriatric rehabilitation (GR) unit were compared retrospectively. No significant differences were found between groups, being the ISAR score positive in 87.7% of EA, 94.9% of AG and 94.4% of GR cases. None of positively identified geriatric patients in the EA was transferred to the geriatric ward of competence. EA patients showed significantly higher number of functional impairments (p = 0.001) and higher BI score (p < 0.0001) compared to AG and GR groups. A higher ISAR score threshold and additional functional information might be needed to better select patients in need of prompt treatment by a geriatric team.

Do independent geriatric outpatients with nocturnal polyuria profit from desmopressin?

OBJECTIVE: To compare the efficacy of desmopressin and placebo in independent geriatric outpatients with nocturnal polyuria (NP). METHODS: A prospective, randomized, single-center, national, double blind, placebo-controlled, fixed-dose, parallel group comparative trial was carried out. The study included 110 geriatric outpatients, 55 patients per treatment group using desmopressin acetate nasal spray (strength: 0.1 mg/ml) once daily of 10 µg/spray blast or placebo. MEASUREMENT: The NP positive geriatric outpatients with >33% nocturnal urine output volume, antidiuretic hormone (ADH) positive or negative were treated over 10 days with intranasal spray in the evening time (7 p.m.), drug or placebo. On day 1 voiding frequency, voiding volumes day and night, serum osmolarity and arginine-vasopressin (AVP) were measured at 7 p.m. On days 2, 5 and 10 creatinine, blood urea nitrogen (bun), blood count and C­reactive protein (CrP), vena cava diameter and bioimpedance were measured and a structured interview was implemented (voiding frequency, sleeping behavior and subjective and cognitive behavior). RESULTS: The NP patients showed a mean night voiding volume of 50.60%, 39.21% (n = 102) showed a low AVP level at baseline with no correlation to sodium concentration or voiding frequencies. The primary efficacy criterion, a decrease of the nocturnal voiding frequency during the course of the clinical trial as change from baseline at day 10 (visit 4) was 50% versus 41.40% in the verum versus placebo group, respectively but the differences were not significant. The U­test showed superiority of AVP-positive NP patients to a positive reaction on desmopressin. Sleeping time hours increased in both groups without significant differences. CONCLUSION: In this 10-day clinical trial desmopressin was not proven to be therapeutically superior to placebo with respect to micturition frequency or sleeping hours. Independent geriatric outpatients with decreased ADH levels seemed to respond and benefit from active treatment with desmopressin. The unexpected results in the placebo group may be due to the effect of intensive outpatient care and information on NP outpatients with normal AVP levels.

A fractional motion diffusion model for a twice-refocused spin-echo pulse sequence.

The purpose of this study was to develop an analytical expression for a fractional motion (FM) diffusion model to characterize diffusion-induced signal attenuation in a twice-refocused spin-echo (TRSE) sequence that is resilient to eddy currents, and to demonstrate its applicability to human brain imaging in vivo. Based on the FM theory, which provides a unified statistical description for Langevin motions, the diffusion-weighted (DW) MR signal was measured with a TRSE sequence that balances the concomitant gradients. The analytical expression was fitted to a set of DW images acquired with 14 b-values (0-4000 s/mm2 ) from a total of 10 healthy human subjects at 3 T, yielding three FM parameter maps based on anomalous diffusion coefficient Dφ, ψ , diffusion increment variance φ, and diffusion correlation ψ, respectively. These parameters were used to characterize different brain regions in gray matter (GM), white matter (WM), and cerebrospinal fluid. The analytical expression for the TRSE-based FM model accurately described diffusion signal attenuation in healthy brain tissues at high b-values. TRSE's robustness against eddy currents was illustrated by comparing results from an expression for a conventional Stejskal-Tanner sequence. The TRSE-based FM model also produced consistent GM-WM contrast (p < 0.01) across all brain regions studied, whereas the consistency was not observed with the Stejskal-Tanner-based FM model. This new analytical expression is expected to enable further investigations to probe tissue structures by exploiting anomalous diffusion properties without being hindered by eddy-current perturbations at high b-values.

Sinomenine ameliorates the airway remodelling, apoptosis of airway epithelial cells, and Th2 immune response in a murine model of chronic asthma.

BACKGROUND: Sinomenine (SIN), an alkaloid isolated from the root of Sinomenium acutum which has a variety of pharmacological effects, including anti-inflammation, immunosuppression and anti-angiogenesis. The present study aimed to evaluate the effects of SIN on airway remodelling, epithelial apoptosis, and T Helper (Th)-2 derived cytokine levels in a murine model of chronic asthma. METHODS: Twenty-two BALB/c mice were divided into four groups; I (control), II (placebo), III, IV. Mice in groups III and IV received the SIN (100mg/kg), and dexamethasone (1mg/kg) respectively. Epithelium thickness, sub-epithelial smooth muscle thickness, number of mast and goblet cells of samples isolated from the lung were measured. Immunohistochemical scorings of the lung tissue for matrix metalloproteinase-9 (MMP-9), vascular endothelial growth factor (VEG-F), transforming growth factor-beta (TGF-ß), terminal deoxynucleotidyl transferase-mediated dUTP nick endlabeling (TUNEL) and cysteine-dependent aspartate-specific proteases (caspase)-3 were determined. IL-4, IL-5, IL-13, Nitric oxide in bronchoalveolar lavage fluid (BALF) and ovalbumin-specific immunoglobulin (Ig) E in serum were quantified by standard ELISA protocols. RESULTS: The dose of 100mg/kg SIN treatment provided beneficial effects on all of the histopathological findings of airway remodelling compared to placebo (p<0.05). All cytokine levels in BALF and serum and immunohistochemical scores were significantly lower in 100mg/kg SIN treated group compared to the placebo (p<0.05). CONCLUSIONS: These findings suggested that the dose of 100mg/kg SIN improved all histopathological changes of airway remodelling and its beneficial effects might be related to modulating Th-2 derived cytokines and the inhibition of apoptosis of airway epithelial cells.

Brain white matter changes in CPAP-treated obstructive sleep apnea patients with residual sleepiness.

PURPOSE: To investigate white matter (WM) structural alterations using diffusion tensor imaging (DTI) in obstructive sleep apnea (OSA) patients, with or without residual sleepiness, following adherent continuous positive airway pressure (CPAP) treatment. Possible quantitative relationships were explored between the DTI metrics and two clinical assessments of somnolence. MATERIALS AND METHODS: Twenty-nine male patients (30-55 years old) with a confirmed diagnosis of OSA were recruited. The patients were treated with CPAP therapy only. The Psychomotor Vigilance Task (PVT) and Epworth Sleepiness Scale (ESS) were performed after CPAP treatment and additionally administered at the time of the magnetic resonance imaging (MRI) scan. Based on the PVT results, the patients were divided into a nonsleepy group (lapses ≤5) and a sleepy group (lapses >5). DTI was performed at 3T, followed by an analysis using tract-based spatial statistics (TBSS) to investigate the differences in fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (λ1 ), and radial diffusivity (λ23 ) between the two groups. RESULTS: A higher MD (P < 0.05) was observed in the sleepy group than the nonsleepy group in the whole-brain TBSS analysis in the WM. The increased MD (17.8% of the fiber tracts; P < 0.05) was caused primarily by an elevated λ23 . Axial diffusivity (λ1 ) exhibited no significant difference (P > 0.17). The alterations in FA or MD of individual fiber tracts occurred mainly in the internal/external capsule, corona radiata, corpus callosum, and sagittal stratum regions. The FA and MD values correlated with the PVT and ESS assessments from all patients (R ≥ 0.517, P < 0.05). CONCLUSION: Global and regional WM alterations, as revealed by DTI, can be a possible mechanism to explain why OSA patients with high levels of CPAP use can have differing responses to treatment. Compromised myelin sheath, indicated by increased radial diffusivity, can be involved in the underlying WM changes. Evidence level: 1 J. MAGN. RESON. IMAGING 2017;45:1371-1378.

Origanum vulgare essential oil affects pathogens causing vaginal infections.

AIMS: This study aimed to investigate the application of Origanum vulgare L. essential oil (EO) as an alternative antimicrobial agent against vaginal infections. METHODS AND RESULTS: Microdilution methods were applied for the detection of the minimal inhibitory (MIC) and the minimal bactericidal/fungicidal (MBC/MFC) concentration of 15 clinical strains originating from women with symptoms of vaginal infection. Optical density determination (OD) was used for detection of the Candida growth rate. Staining with DAPI was used to detect the influence of EO on nuclear condensation and fragmentation, while the brine shrimp bioassay was used to determine the toxicity of EO. Chemical composition analysis was done using GS-MS. According to the MIC and MBC/MFC values, the most susceptible strains to EO were: Escherichia coli 1, E. coli 2, Staphylococcus aureus 3 and Candida albicans 1-3. Inhibition of C. albicans filamentation was detected at 0·45 µl ml-1 . CONCLUSIONS: The obtained inhibition (%) from Candida growth curves points to a shorter period of time (24 h) for determining IC50 as MIC and IC99 as MFC value. These values could be recommended as valid parameters for the faster detection of the effectiveness of EO on Candida isolates. SIGNIFICANCE AND IMPACT OF THE STUDY: Examination of potential of the O. vulgare EO as a main antimicrobial constituent within vaginalettes in gynaecological practice.

Efficacy of parthenolide on lung histopathology in a murine model of asthma.

BACKGROUND: Parthenolide is the active constituent of the plant 'Tanacetum parthenium' (Feverfew) which has been used for centuries as a folk remedy for inflammatory conditions. AIM OF THE STUDY: In this study we aimed to investigate the effects of parthenolide in a murine model of chronic asthma. MATERIALS AND METHODS: Thirty-five BALB/c mice were divided into five groups; I (control), II (placebo), III (dexamethasone), IV (parthenolide) and V (dexamethasone and parthenolide combination). Lung histology was evaluated after treatment with the study drugs. Levels of interleukin (IL)-4 and IL-5 were determined by ELISA. RESULTS: Histologic parameters except the number of mast and goblet cells improved in the parthenolide group when compared with placebo. All parameters except basal membrane thickness and number of mast cells were improved significantly better in the group receiving dexamethasone when compared with the parthenolide group. Improvement of most of the histologic parameters was similar in Groups III and V. Interleukin-4 levels were significantly reduced in the parthenolide group when compared to the placebo group. CONCLUSION: We demonstrated that parthenolide administration alleviated some of the pathological changes in asthma. But parthenolide alone is not efficient as dexamethasone therapy and the parthenolide and dexamethasone combination also did not add any beneficial effect to the dexamethasone treatment.

Beneficial effects of ursodeoxycholic acid via inhibition of airway remodelling, apoptosis of airway epithelial cells, and Th2 immune response in murine model of chronic asthma.

BACKGROUND AND AIMS: In previous studies, anti-inflammatory, anti-apoptotic and immunomodulatory effects of ursodeoxycholic acid (UDCA) on liver diseases have been shown. In this study, we aimed to investigate the effects of UDCA on airway remodelling, epithelial apoptosis, and T Helper (Th)-2 derived cytokine levels in a murine model of chronic asthma. METHODS: Twenty-seven BALB/c mice were divided into five groups; PBS-Control, OVA-Placebo, OVA-50mg/kg UDCA, OVA-150mg/kg UDCA, OVA-Dexamethasone. Mice in groups OVA-50mg/kg UDCA, OVA-150mg/kg UDCA, OVA-Dexamethasone received the UDCA (50mg/kg), UDCA (150mg/kg), and dexamethasone, respectively. Epithelium thickness, sub-epithelial smooth muscle thickness, number of mast and goblet cells of samples isolated from the lung were measured. Immunohistochemical scorings of the lung tissue for matrix metalloproteinase-9 (MMP-9), vascular endothelial growth factor (VEG-F), transforming growth factor-beta (TGF-ß), terminal deoxynucleotidyl transferase-mediated dUTP nick endlabeling (TUNEL) and cysteine-dependent aspartate-specific proteases (caspase)-3 were determined. IL-4, IL-5, IL-13, Nitric oxide, ovalbumin-specific immunoglobulin (Ig) E levels were quantified. RESULTS: The dose of 150mg/kg UDCA treatment led to lower epithelial thickness, sub-epithelial smooth muscle thickness, goblet and mast cell numbers compared to placebo. Except for MMP-9 and TUNEL all immunohistochemical scores were similar in both UDCA treated groups and the placebo. All cytokine levels were significantly lower in group IV compared to the placebo. CONCLUSIONS: These findings suggested that the dose of 150mg/kg UDCA improved all histopathological changes of airway remodelling and its beneficial effects might be related to modulating Th-2 derived cytokines and the inhibition of apoptosis of airway epithelial cells.

HGF/C-MET PATHWAY HAS A ROLE IN TESTICULAR DAMAGE IN DIABETES INDUCED BY STREPTOZOTOCIN.

OBJECTIVE: The aim of the study was to investigate the role of Hepatocyte Growth Factor (HGF)/c-Met pathway in testicular damage provoked by streptozotocin (STZ)- induced diabetes and the effects of insulin treatment on the HGF/c-Met pathway. METHODS: Total 21 paraffin-embedded testicular tissues of control (n=7), streptozotocin (STZ)-induced diabetic (n=7) and insulin-treated diabetic (n=7) Wistar albino rats were used in this study. Testicular damage was examined histologically and by Johnsen's score was also evaluated. Immunohistochemical stainings of HGF and c-Met were analysed by using antibodies against HGF and c-Met. RESULTS: We found the degeneration in seminiferous tubule epithelium and disorganization of spermatogenetic cell series in testis tissues of diabetic rats. We also determined decrease both in seminiferous tubule diameter and Johnsen's scores in diabetic group. The expressions of HGF and c-Met in seminiferous tubule epithelium and in spermatogenic cells (especially spermatocytes and spermatids) were significantly increased in diabetic rats compared to those of control. Insulin treatment significantly reduced the diabetes-induced morphological changes and HGF/c-Met over expressions in the diabetic rat testis. CONCLUSION: HGF/c-Met pathway might have a role in diabetes- induced testicular damage. Drugs acting on this pathway might be effective to prevent or delay the testicular damage induced by diabetes.

Differentiating low- and high-grade pediatric brain tumors using a continuous-time random-walk diffusion model at high b-values.

PURPOSE: To demonstrate that a continuous-time random-walk (CTRW) diffusion model can improve diagnostic accuracy of differentiating low- and high-grade pediatric brain tumors. METHODS: Fifty-four children with histopathologically confirmed brain tumors underwent diffusion MRI scans at 3Twith 12 b-values (0-4000 s/mm(2) ). The diffusion imageswere fit to a simplified CTRW model to extract anomalous diffusion coefficient, Dm , and temporal and spatial heterogeneity parameters, α and ß, respectively. Using histopathology results as reference, a k-means clustering algorithm and a receiver operating characteristic (ROC) analysis were employed to determine the sensitivity, specificity, and diagnostic accuracy of the CTRW parameters in differentiating tumor grades. RESULTS: Significant differences between the low- and high-grade tumors were observed in the CTRW parameters (p-values<0.001). The k-means analysis showed that the combination of three CTRW parameters produced higher diagnostic accuracy (85% vs. 75%) and specificity (83% vs. 54%) than the apparent diffusion coefficient (ADC) from a mono-exponential model. The ROC analysis revealed that any combination of the CTRW parameters gave a larger area under the curve (0.90-0.96) than using ADC (0.80). CONCLUSION: With its sensitivity to intravoxel heterogeneity, the simplified CTRW model is useful for non-invasive grading of pediatric brain tumors, particularly when surgical biopsy is not feasible. Magn Reson Med 76:1149-1157, 2016. © 2015 Wiley Periodicals, Inc.

What does delirium cost? An economic evaluation of hyperactive delirium.

BACKGROUND: Demographic changes have resulted in an increase in the number of older (> 75 years) multimorbid patients in clinics. In addition to the primary acute diagnoses that lead to hospitalization, this group of patients often has cognitive dysfunctions, such as delirium. According to clinical experience, delirium patients are more time-consuming for clinicians and their function is often poor. The costs caused by delirium patients are currently unknown. In the present study, a retrospective examination of a database was carried out to calculate the costs that arise during the clinical treatment of documented delirium patients. SETTING AND METHODS: The purpose of this retrospective analysis was to collect information recorded by nursing personnel trained in the treatment of delirium and information from a manual documentation matrix for additional time expenditure. In the database analysis anonymous data of previously discharged patients for a time window of 3 months were analyzed. Documented additional expenditure for patients with hyperactive delirium at hospitalization were analyzed by personnel. Material costs, the duration of hospitalization by main diagnosis and age clusters during hospitalization until discharge were also examined. The analysis was performed in a hospital with internal wards. RESULTS: Data for 82 hyperactive delirium patients were examined and an average of approximately 240 min of additional personnel expenditure for these patients was found. These patients were approximately 10 years older (p < 0.01) and were hospitalized for an average of 4.2 days longer (p < 0.01) than non-delirium patients. Hyperactive delirium usually developed within the first 5 days of hospitalization and lasted 1.6 days on average. Patients for whom hyperactive delirium was detected early were hospitalized for significantly less time than those for whom it was detected late (6.85 versus 13.61 days, p = 0.002). Additionally, calculated personnel and material costs, including costs affecting the hospitalization period, amounted to approximately 1200 € per hyperactive delirium patient. This corresponds to approximately 0.3 CMP (casemix points) per patient. CONCLUSION: The calculations of personnel and material costs and duration of hospitalization in patients with hyperactive delirium demonstrated significant additional costs. Early routine detection of delirium can be achieved through training and this approach leads to a shortening of the hospitalization period and lower costs.