The role of small diffusion-weighted imaging lesions in cerebral small vessel disease.

OBJECTIVE: To investigate the prevalence of asymptomatic diffusion-weighted imaging-positive (DWI+) lesions in individuals with cerebral small vessel disease (SVD) and identify their role in the origin of SVD markers on MRI. METHODS: We included 503 individuals with SVD from the Radboud University Nijmegen Diffusion Tensor and Magnetic Resonance Imaging Cohort (RUN DMC) study (mean age 65.6 years [SD 8.8], 56.5% male) with 1.5T MRI in 2006 and, if available, follow-up MRI in 2011 and 2015. We screened DWI scans (n = 1,152) for DWI+ lesions, assessed lesion evolution on follow-up fluid-attenuated inversion recovery, T1 and T2* images, and examined the association between DWI+ lesions and annual SVD progression (white matter hyperintensities [WMH], lacunes, microbleeds). RESULTS: We found 50 DWI+ lesions in 39 individuals on 1,152 DWI (3.4%). Individuals with DWI+ lesions were older (p = 0.025), more frequently had a history of hypertension (p = 0.021), and had a larger burden of preexisting SVD MRI markers (WMH, lacunes, microbleeds: all p < 0.001) compared to individuals without DWI+ lesions. Of the 23 DWI+ lesions with available follow-up MRI, 14 (61%) evolved into a WMH, 8 (35%) resulted in a cavity, and 1 (4%) was no longer visible. Presence of DWI+ lesions was significantly associated with annual WMH volume increase and yearly incidence of lacunes and microbleeds (all p < 0.001). CONCLUSION: Over 3% of individuals with SVD have DWI+ lesions. Although DWI+ lesions play a role in the progression of SVD, they may not fully explain progression of SVD markers on MRI, suggesting that other factors than acute ischemia are at play.

Metallosis: A diagnosis not only in patients with metal-on-metal prostheses.

Although the real actual incidence of metallosis is unknown, it is described as a rare diagnosis with a 5% estimated incidence in the hip prosthetic replacements. The adoption of non-metallic articular prosthetic devices, made of polyethylene and ceramic, is the main reason to the diminishing number of reported cases. We present a case of metallosis with a clinical systemic presentation in a patient with a non-metallic hip prosthesis, which occurred due to a fracture of the acetabular liner component, leading to abnormal metal-metal contact. The metallic debris leads to a massive local and systemic release of cytokines. Revision is necessary whenever osteolysis and loosening of the prosthesis occur. Imaging evaluation, especially CT, has a central role in diagnosis and planning the surgical treatment.

Analysis of phenolic compounds in Portuguese wild and commercial berries after multienzyme hydrolysis.

Berry fruits are a good source of phenolic compounds and thus, potentially beneficial to health. Phenolic compounds are mainly present as a variety of conjugated forms, either with sugars via O-glycosidic bonds or with other polyols as esters. This chemodiversity makes characterization and identification highly demanding. Selected varieties of commercial blueberries, raspberries and blackberries and the two wild berries Portuguese crowberry and strawberry tree fruits were characterized for individual phenolic content by liquid chromatography-diode array detection and mass spectrometry (HPLC-DAD-MS) after hydrolysis by a novel combination of the fungal glycosidases hesperidinase and cellulase. This approach is shown to be a simple alternative to other existing methods for analysis of plant phenolic compound aglycones. The hydrolysis of glycosides and organic acid esters is efficient and less aggressive than acid and alkaline hydrolysis. This method is able to disclose new sources of dietary phenolic compounds, and the potential usefulness of Portuguese crowberry and strawberry tree fruit is herein demonstrated.