Current peri-operative imaging concepts surrounding shoulder arthroplasty.

Glenohumeral osteoarthritis is a prevalent degenerative disease that can lead to excruciating pain and debility. End-stage osteoarthritis can be treated by both conservative and surgical interventions. Along with a comprehensive history and physical exam, pre-operative imaging with plain radiographs, computerized tomography, and magnetic resonance imaging plays an essential role in the decision-making process guiding whether the patient undergoes a shoulder hemiarthroplasty, anatomic total shoulder arthroplasty, or a reverse total shoulder arthroplasty. The most important pre-operative imaging factors are the integrity of the rotator cuff and presence of significant glenoid erosion. Imaging is also critical postoperatively, as signs of prosthetic loosening, rotator cuff failure (especially involving the subscapularis), periprosthetic fracture, and stress fractures are important entities to recognize. This article will review pertinent imaging findings related to the pre- and post-operative management of patients with glenohumeral osteoarthritis.

KinImmerse: Macromolecular VR for NMR ensembles.

BACKGROUND: In molecular applications, virtual reality (VR) and immersive virtual environments have generally been used and valued for the visual and interactive experience - to enhance intuition and communicate excitement - rather than as part of the actual research process. In contrast, this work develops a software infrastructure for research use and illustrates such use on a specific case. METHODS: The Syzygy open-source toolkit for VR software was used to write the KinImmerse program, which translates the molecular capabilities of the kinemage graphics format into software for display and manipulation in the DiVE (Duke immersive Virtual Environment) or other VR system. KinImmerse is supported by the flexible display construction and editing features in the KiNG kinemage viewer and it implements new forms of user interaction in the DiVE. RESULTS: In addition to molecular visualizations and navigation, KinImmerse provides a set of research tools for manipulation, identification, co-centering of multiple models, free-form 3D annotation, and output of results. The molecular research test case analyzes the local neighborhood around an individual atom within an ensemble of nuclear magnetic resonance (NMR) models, enabling immersive visual comparison of the local conformation with the local NMR experimental data, including target curves for residual dipolar couplings (RDCs). CONCLUSION: The promise of KinImmerse for production-level molecular research in the DiVE is shown by the locally co-centered RDC visualization developed there, which gave new insights now being pursued in wider data analysis.

Contamination of catheter-drawn blood cultures.

To assess the risk of contamination, we reviewed retrospectively 1,408 matched pairs of simultaneous catheter-drawn and venipuncture blood cultures. Catheter-drawn cultures were equally likely to be truly positive (14.4 versus 13.7%) but more likely to be contaminated (3.8 versus 1.8% [P = 0.001]). Direct venipuncture cultures are preferred.

Promotion of the development of enteric neurons and glia by neuropoietic cytokines: interactions with neurotrophin-3.

Neurotrophin-3 (NT-3) is known to promote enteric neuronal and glial development. Ciliary neurotrophic factor (CNTF) and leukemia inhibitory factor (LIF) were investigated to test the hypothesis that the development of subsets of enteric neurons and/or glia is also affected by a neuropoietic cytokine, by itself, or together with NT-3. Crest-derived cells, immunoselected from the fetal rat gut (E14) with antibodies to p75NTR, were found by RT-PCR and immunocytochemistry (after culture) to express both alpha (CNTER alpha) and beta components (gp130 and LIFR beta) of the tripartite CNTF receptor. In situ, myenteric ganglia below the esophagus were CNTFR alpha-immunoreactive by E16-E18. In vitro, CNTF and LIF induced in crest-derived cells nuclear translocation of STAT3 (signal transducer and activator of transcription 3), a concentration-dependent increase in expression of neuronal or glial markers, and a decrease in expression of the precursor marker, nestin. LIFR beta was expressed by more cells than CNTFR alpha; therefore, although the factors were equipotent, the maximal effect of LIF > CNTF. The cytokines and NT-3 were additive in promoting neuronal but not glial development. Specifically, the development of neurons expressing NADPH-diaphorase activity (an early marker found in inhibitory motor neurons) was promoted by CNTF and NT-3. These observations support the idea that a ligand for the tripartite CNTF receptor complex plays a role in ENS development.

Value of gating of technetium-99m sestamibi single-photon emission computed tomographic imaging.

OBJECTIVES: The purpose of this study was to determine how frequently and for what reasons the addition of electrocardiographically gated technetium-99m (Tc-99m) sestamibi single-photon emission computed tomographic (SPECT) images add value to nongated SPECT perfusion images. BACKGROUND: Electrocardiographic gating of Tc-99m sestamibi SPECT images permits assessment of regional and global left ventricular function and may assist in differentiating attenuation artifacts from myocardial scar. METHODS: A total of 285 consecutive patients (143 women and 142 men; mean age 57.6 +/- 11.5 years) underwent gated SPECT Tc-99m sestamibi imaging (212 with exercise, 63 with dipyridamole and 10 with dobutamine). The conventional stress and rest tomograms were interpreted first by means of a 14-segment scoring system, and then the studies were reinterpreted while the gated images were viewed. RESULTS: In the total group of 285 patients, the number of "borderline" interpretations was reduced from 89 to 29. In the 137 patients with a < or = 10% pretest likelihood of coronary artery disease, the addition of gated images added significantly to the percentage of interpretations that were designated "normal" (74% [101 of 137] vs. 93% [127 of 137], p < 0.0001), due to a reduction in borderline normal and borderline abnormal readings. In 49 patients with a previous infarction or recent angiography with > or = 70% stenosis, or both, the addition of gated images changed the percentage of "abnormal" scan interpretations from 78% (38 of 49) to 92% (45 of 49). This result was not significant (p = 0.09, two-tailed), but the trend was toward a greater number of unequivocal abnormal interpretations in this subgroup. CONCLUSIONS: The addition of electrocardiographically gated Tc-99m sestamibi SPECT images to the reading of stress and rest perfusion images alone resulted in shifting the final scan interpretations to a more normal designation in patients with a low pretest likelihood of coronary artery disease, and to more abnormal defects consistent with coronary artery disease in patients with known coronary artery disease. The number of "borderline normal" and "borderline abnormal" interpretations are significantly reduced when gated SPECT images are interpreted simultaneously with stress and rest perfusion images.

Immunohistochemical localization of netrin-1 in the embryonic chick nervous system.

Netrin-1 has profound in vitro effects on the growth properties of vertebrate embryonic axons. In addition, netrin-1 mRNA is found in the floor plate of the embryonic nervous system, an intermediate target of many axons, including commissural axons that are affected by netrin-1 in vitro. Moreover, genetic studies of netrin-1 homologs in Caenorhabditis elegans and Drosophila implicate these proteins in commissure formation. We raised polyclonal antisera that recognize chick netrin-1 in fixed tissue sections. The antisera were used to immunohistochemically map netrin-1 in the embryonic spinal cord, brain, and retina. The relationship between netrin-1 localization and the growth of pioneering axons suggests roles for netrin-1 in the regulation of circumferential, commissural, and longitudinal axon growth in the spinal cord and brain. The data also suggest that the primary or sole effect of netrin-1 on pioneering spinal cord commissural axons is haptotactic. Furthermore, the pattern of netrin-1 localization raises the possibility that this protein helps mediate neuronal migration in the spinal cord, brain, and retina.

Immunohistochemical localization of ciliary neurotrophic factor receptor alpha expression in the rat nervous system.

Ciliary neurotrophic factor receptor alpha (CNTFR alpha) is essential for normal embryonic development and may be involved in postnatal and adult neuronal maintenance. In addition, a rapidly growing body of evidence suggests that CNTFR alpha serves as a site of action for future growth factor therapeutics capable of treating a wide variety of disorders resulting from neuronal loss. We raised two polyclonal, anti-CNTFR alpha antisera against synthetic peptides corresponding to independent regions of rat CNTFR alpha. Western blot and immunohistochemical analyses indicated that affinity-purified preparations of both antisera specifically recognize CNTFR alpha. In the adult brain, the highest levels of CNTFR alpha immunoreactivity were found in the perikarya, dendrites and, occasionally, the axons of several distinct classes of neurons including hippocampal formation neurons, some sensory neurons, and many neurons involved in motor control. CNTFR alpha immunoreactivity also was concentrated in the following: perikarya, dendrites, and axons of ventral horn motor neurons in adult spinal cord; perikarya and axons of adult dorsal root ganglion neurons; and axons in adult peripheral nerve. In embryonic tissue, the highest levels of CNTFR alpha immunoreactivity were observed in differentiating neurons and their processes. Therefore, the present data suggest that CNTFR alpha serves several diverse functions in adulthood and during development.

Ciliary neurotrophic factor receptor alpha mRNA in NB41A3 neuroblastoma cells: regulation by cAMP.

Ciliary neurotrophic factor (CNTF) affects the in vitro and in vivo survival and differentiation of several classes of neurons by binding to the CNTF receptor alpha. We examined the possibility that intracellular cAMP can regulate CNTF receptor alpha mRNA levels in two neuronal cell lines that display cAMP-dependent process outgrowth. Dibutyryl cAMP did not affect CNTF receptor alpha mRNA levels in PC12 cells but elicited a dose- and time-dependent increase in NB41A3 cell CNTF receptor alpha mRNA levels. Forskolin similarly increased CNTF receptor alpha mRNA levels in NB41A3 cells. The data suggest that signal transduction mechanisms involving cAMP may 'crosstalk' with CNTF-initiated signal transduction in a cell type-specific manner and that CNTF receptor alpha expression is not generally linked to neuronal process outgrowth.

Dipyridamole thallium-201 imaging versus dobutamine echocardiography for the evaluation of coronary artery disease in patients unable to exercise.

The present study used 51 patients in a prospective, crossover, blinded comparison of dipyridamole thallium-201 imaging and dobutamine echocardiography for (1) detection of coronary artery disease (CAD), (2) detection of inducible ischemia, and (3) determination of myocardial viability. The detection of CAD was based on quantitative defects on initial planar thallium-201 images and resting or inducible wall motion abnormalities on echocardiography. Detection of ischemia was based on redistribution on delayed thallium-201 images and inducible wall motion abnormality on echocardiography. The myocardium in a region with resting wall motion abnormality was considered viable if it showed either redistribution or > 50% activity on delayed thallium-201 images, and if regional function either improved or worsened on echocardiography. The tests were comparable for the detection of CAD (53 and 59%, respectively, p = 0.23). Thallium-201 was superior to echocardiography for the detection of ischemia (35 vs 14%, respectively, p = 0.01). Although the incidence of viable myocardium was equivalent by the 2 tests (100 and 96%, respectively, p = 0.99) for each abnormally moving segment in the 24 patients with resting wall motion abnormality on echocardiography, it was greater on thallium-201 imaging (98 vs 68%, p < 0.01). It is concluded that because of its better ability to detect inducible myocardial ischemia and determine viability in myocardial segments showing reduced function, dipyridamole thallium-201 imaging appears to be superior to dobutamine echocardiography for the evaluation of CAD in patients unable to exercise.

Blinded evaluation of planar technetium-99m-sestamibi myocardial perfusion studies.

Sestamibi planar myocardial perfusion studies were performed at Hotel-Dieu de Montreal on 28 patients with documented coronary artery disease and 16 normal subjects. Stress and rest studies were performed on separate days. These studies were sent to Virginia for interpretation while blinded as to age, sex, and other clinical information. Studies were quantitated independently by two operators (using a computer program modified for Sestamibi), and interpreted independently by two experienced interpreters. Computer quantitation of 2816 segments gave an average interoperator deviation of 2.2%. Pure quantitative criteria were applied for computer interpretation. By varying the detection threshold, we produced the entire ROC curve relating sensitivity and specificity as a function of detection threshold. Using only computer criteria for normal or abnormal, interoperator agreement by patient was 98% and 93% by view. The computer could achieve equal positive and negative predictive accuracy of 87%. Interpreters, allowed both quantitative and subjective judgment, agreed on 91% of 44 patients, 90% of 132 views, and 92% of 660 segments. Interpreters averaged 94% positive and 86% negative predictive accuracy.

Quantitative planar imaging with technetium-99m methoxyisobutyl isonitrile: comparison of uptake patterns with thallium-201.

To compare the myocardial uptake pattern of 99mTc-labeled methoxyisobutyl isonitrile [( 99mTc] MIBI) and 201TI, planar scintigraphy were performed in both patients with documented coronary artery disease and subjects with a low likelihood of disease. Quantitative analysis was employed using a standard interpolative background subtraction algorithm and a new algorithm modified to better accommodate for the differences in extracardiac activity seen with [99mTc]MIBI rest images. Among patients with coronary artery disease, the standard algorithm yielded no significant difference in relative defect magnitude between [99mTc]MIBI and 201TI on stress scintigrams (p = 0.48), although the magnitude of [99mTc]MIBI defects was greater on resting images (p = 0.02). When the modified algorithm was employed, defect magnitude was similar for both stress (p = 0.91) and rest (p = 0.20) images. Normal segmental uptake ratios derived from a comparison of contralateral segments (e.g., septal:posterolateral) in the low likelihood patients were similar for both [99mTc]MIBI and 201TI. Thus, modification of the standard interpolative background subtraction algorithm is necessary for quantitative planar [99mTc]MIBI perfusion imaging. When appropriate background subtraction is employed, myocardial uptake and quantitative defect magnitude of [99mTc]MIBI and 201TI planar images are similar.