Role of low dose CT angiography in the follow-up after endovascular aneurysm repair of abdominal aorta.

BACKGROUND: Computed tomography angiography (CTA) is the most employed modality in the follow-up after endovascular aneurysm repair (EVAR) of abdominal aorta (AA); repeated standard controls expose patients to a high cumulative radiation dose (RD). PURPOSE: To compare image quality and RD between 100 kV and 120 kV protocols in the same group of patients, previously treated with EVAR. MATERIAL AND METHODS: Thirty patients, who had performed a previous CTA at 120 kV, underwent a low dose CTA with the same 64-detector machine. Images were evaluated qualitatively and quantitatively. The influence of body mass index (BMI), considering three groups of patients (normal weight, overweight, and obese) was also assessed. RD values (volume CT dose index and effective dose) were calculated. RESULTS: The mean qualitative score at 100 kV was worse than that at 120 kV, but the difference was not statistically significant and in all cases the image quality was satisfactory. At 100 kV the vessels mean attenuation value was significantly higher; signal-to-noise ratio significantly lower; contrast-to-noise ratio lower, but the difference was not significant. Regarding BMI, the difference in the qualitative score was significant in the obese group, but not in the other two groups; of the quantitative parameters only the signal-to-noise ratio presented a significant difference in the obese group. The average CTDIvol was reduced by 22% and the mean effective dose by 36% with the 100 kV protocol compared to the 120 kV protocol. Both differences were significant. CONCLUSION: The 100 kV protocol allowed a consistent RD reduction, maintaining a satisfactory image quality in all patients.

In the rat brain acetyl-L-carnitine treatment modulates the expression of genes involved in neuronal ceroid lipofuscinosis.

Acetyl-L-carnitine (ALC) is a naturally occurring substance that, when administered at supraphysiological concentration, is neuroprotective. It is a molecule of considerable interest for its clinical application in various neural disorders, including Alzheimer's disease and painful neuropathies. Suppression subtractive hybridization methodology was used for the generation of subtracted cDNA libraries and the subsequent identification of differentially expressed transcripts in the rat brain after ALC treatment. The method generates an equalized representation of differentially expressed genes irrespective of their relative abundance and it is based on the construction of forward and reverse cDNA libraries that allow the identification of the genes which are regulated by ALC. We report that ALC treatment: (1) upregulates lysosomal H(+)/ATPase gene expression and (2) downregulates myelin basic protein gene expression. The expression of these genes is altered in some forms of neuronal ceroid lipofuscinosis (NCL) pathologies. In this case, ALC might rebalance the disorders underlying NCL disease represented by a disturbance in pH homeostasis affecting the acidification of vesicles transported to lysosomal compartment for degradation. This study provides evidence that ALC controls genes involved in these serious neurological pathologies and provides insights into the ways in which ALC might exert its therapeutic benefits.

Point Shear Wave Elastography of the Spleen: Its Role in Patients with Portal Hypertension.

The goals of the study described here were to evaluate the feasibility and reproducibility of measuring spleen stiffness (SS) using point shear wave elastography in a series of cirrhotic patients and to investigate whether SS, liver stiffness (LS) and other non-invasive parameters are correlated with the presence of esophagogastric varices (EVs). Fifty-four cirrhotic patients with low-grade EVs or without EVs at esophago-gastro-duodenoscopy were enrolled. They underwent abdominal ultrasound and Doppler ultrasound of hepatic vessels simultaneously with p-SWE of the liver and spleen. In 42 patients, the accuracy of LS and SS, as well as of platelet count and spleen longitudinal diameter, in predicting the presence of EVs was evaluated. The technical success was 90.74% for LS (49/54 patients) and 77.78% for SS (42/54 patients). Inter-observer agreement for SS measurement was high. Both LS and SS correlated with esophago-gastro-duodenoscopy: LS had the highest accuracy in predicting the presence of EVs (area under the receiver operating characteristic curve [AUROC] = 0.913); SS had the lowest accuracy (AUROC = 0.675); platelet count and spleen diameter had intermediate accuracy (AUROC = 0.731 and 0.729, respectively). SS did not have an advantage over LS in predicting low-grade EVs and cannot be proposed as a useful tool in the diagnostic process of cirrhotic patients who require screening esophago-gastro-duodenoscopy.

Differentially expressed genes in Hirudo medicinalis ganglia after acetyl-L-carnitine treatment.

Acetyl-L-carnitine (ALC) is a naturally occurring substance that, when administered at supra-physiological concentration, is neuroprotective. It is involved in membrane stabilization and in enhancement of mitochondrial functions. It is a molecule of considerable interest for its clinical application in various neural disorders, including Alzheimer's disease and painful neuropathies. ALC is known to improve the cognitive capability of aged animals chronically treated with the drug and, recently, it has been reported that it impairs forms of non-associative learning in the leech. In the present study the effects of ALC on gene expression have been analyzed in the leech Hirudo medicinalis. The suppression subtractive hybridisation methodology was used for the generation of subtracted cDNA libraries and the subsequent identification of differentially expressed transcripts in the leech nervous system after ALC treatment. The method detects differentially but also little expressed transcripts of genes whose sequence or identity is still unknown. We report that a single administration of ALC is able to modulate positively the expression of genes coding for functions that reveal a lasting effect of ALC on the invertebrate, and confirm the neuroprotective and neuromodulative role of the substance. In addition an important finding is the modulation of genes of vegetal origin. This might be considered an instance of ectosymbiotic mutualism.

Abdominal vascular emergencies: US and CT assessment.

Acute vascular emergencies can arise from direct traumatic injury to the vessel or be spontaneous (non-traumatic).The vascular injuries can also be divided into two categories: arteial injury and venous injury.Most of them are life-treatening emergencies, sice they may cause an important ipovolemic shock or severe ischemia in their end organ and require prompt diagnosis and treatment.In the different clinical scenarios, the correct diagnostic approach to vascular injuries isn't firmly established and advantages of one imaging technique over the other are not obvious.Ultrasound (US) is an easy accessible, safe and non-invasive diagnostic modality but Computed Tomography (CT) with multiphasic imaging study is an accurate modality to evaluate the abdominal vascular injuries therefore can be considered the primary imaging modality in vascular emergencies.The aim of this review article is to illustrate the different imaging options for the diagnosis of abdominal vascular emergencies, including traumatic and non traumatic vessel injuries, focusing of US and CT modalities.

Modulation of gene expression in contextual fear conditioning in the rat.

In contextual fear conditioning (CFC) a single training leads to long-term memory of context-aversive electrical foot-shocks association. Mid-temporal regions of the brain of trained and naive rats were obtained 2 days after conditioning and screened by two-directional suppression subtractive hybridization. A pool of differentially expressed genes was identified and some of them were randomly selected and confirmed with qRT-PCR assay. These transcripts showed high homology for rat gene sequences coding for proteins involved in different cellular processes. The expression of the selected transcripts was also tested in rats which had freely explored the experimental apparatus (exploration) and in rats to which the same number of aversive shocks had been administered in the same apparatus, but temporally compressed so as to make the association between painful stimuli and the apparatus difficult (shock-only). Some genes resulted differentially expressed only in the rats subjected to CFC, others only in exploration or shock-only rats, whereas the gene coding for translocase of outer mitochondrial membrane 20 protein and nardilysin were differentially expressed in both CFC and exploration rats. For example, the expression of stathmin 1 whose transcripts resulted up regulated was also tested to evaluate the transduction and protein localization after conditioning.

Modulation of myelin basic protein gene expression by acetyl-L-carnitine.

Acetyl-L-carnitine (ALC), the acetyl ester of L-carnitine, is a naturally occurring molecule which plays an essential role in intermediary and mitochondrial metabolism. It has also neurotrophic and antioxidant actions, demonstrating efficacy and high tolerability in the treatment of neuropathies of various etiologies. ALC is a molecule of considerable interest for its clinical application in various neural disorders, although little is known regarding its effects on gene expression. Suppression subtractive hybridization methodology was used for the generation of subtracted complementary DNA libraries and the subsequent identification of differentially expressed transcripts in the rat brain after chronic ALC treatments. We provided evidence for a downregulation of the expression of all of the isoforms of myelin basic protein gene following prolonged ALC treatment, indicating a possible role in the modulation of myelin basic protein turnover, stabilizing and maintaining myelin integrity.