Safety and efficacy of helminth treatment in relapsing-remitting multiple sclerosis: Results of the HINT 2 clinical trial.

BACKGROUND: The hygiene hypothesis suggests that microbial replacement may be therapeutic in allergic and autoimmune diseases. Nevertheless, the results of helminth treatment, including in multiple sclerosis (MS), have been inconclusive. OBJECTIVE: To assess safety and brain magnetic resonance imaging (MRI) activity in subjects with relapsing-remitting multiple sclerosis (RRMS) during oral administration of ova from the porcine whipworm, Trichuris suis (TSO). METHODS: A total of 16 disease-modifying treatment (DMT) naive RRMS subjects were studied in a baseline versus treatment (BVT) controlled prospective study. MRI scans were performed during 5 months of screening-observation, 10 months of treatment, and 4 months of post-treatment surveillance. RESULTS: No serious symptoms or adverse events occurred during treatment. For the cohort, there was a trend consistent with a 35% diminution in active lesions when observation MRIs were compared to treatment MRIs ( p = 0.08), and at the level of individuals, 12 of 16 subjects improved during TSO treatment. T regulatory lymphocytes were increased during TSO treatment. CONCLUSION: TSO is safe in RRMS subjects. Potentially favorable MRI outcomes and immunoregulatory changes were observed during TSO treatment; however, the magnitude of these effects was modest, and there was considerable variation among the responses of individual subjects.

Flat-Panel CT for Cochlear Implant Electrode Imaging: Comparison to Multi-Detector CT.

HYPOTHESIS: Flat-panel computed tomography (FPCT) will allow more accurate localization of cochlear implants with decreased metallic artifact and decreased radiation dose when compared with multi-detector CT (MDCT). BACKGROUND: The measurement of scalar location and intra-scalar position of cochlear implantation (CI) electrodes using computed tomography (CT) is complicated by metallic image artifact and insufficient scalar resolution. FPCT has been shown to improve upon the resolution of MDCT while reducing artifact. Previous studies of FPCT imaging employed isolated temporal bones and did not compare FPCT with MDCT. METHODS: A total of 11 CI electrodes (Flex-24, MED-EL Corp, Innsbruck, Austria) were intentionally placed into either the scala tympani (ST) or scala vestibule (SV) in whole cadaver heads and imaged with MDCT and FPCT. The relative radiation dose was measured at the ocular lens for each modality. The implanted cochleae were then isolated and imaged with micro-CT which was used to assess electrode position. Images were reviewed and scored according to electrode array scalar compartment (ST, SV, scala media [SM]), intra-scalar position within each compartment (perimodiolar, mid modiolor, lateral wall) and for the presence of artifact by five readers blinded to the imaging method and approach for electrode insertion. RESULTS: FPCT showed less metallic CI artifact (p = 0.002) and decreased radiation dosage when compared with MDCT. Reviewers were able to identify the scalar compartment and intra-scalar position of all electrodes more accurately with FPCT than with MDCT (p < 0.001). CONCLUSION: FPCT more accurately resolves the scalar compartment and intra-scalar position of CI electrodes with reduced radiation exposure and metallic artifact than MDCT.

Cerebrovascular trauma.

Significant progress has been made recently in the recognition, screening, diagnosis, and treatment of blunt cerebrovascular vascular injury (BCVI). Although controversy still exists as to optimal screening algorithms and best diagnostic modality, the vital and growing role of noninvasive imaging in identifying patients at high risk for BCVI and in characterizing the injury itself has been clearly established. There has been promising early work in stratifying BCVI patients into risk categories by initially evaluating them with high-resolution head, maxillofacial, and cervical computed tomographic examinations with the ultimate goal of maximizing diagnostic yield and enabling prompt initiation of therapy.