Ocular Lateral Deviation as a Vestibular Clinical Sign of Medial Posterior Inferior Cerebellar Artery Strokes: A Case Report.

We report a case of posterior circulation stroke that presented with a unique ocular vestibular sign called Ocular Lateral Deviation (OLD). OLD is eye deviation to one side that is made more prominent by brief eye closure. OLD has been reported to occur ipsilesional in a third of medullary strokes, and occasionally in other posterior fossa strokes. Here we report a case of acute stroke that presented with contralesional eye deviation consistent with OLD due to inferior vermis stroke. To our knowledge, this presentation has not been reported before. Clinicians should be aware of potential ocular manifestations of posterior circulation strokes, as these syndromes may not generate significant NIHSS scores and may be missed.

Accuracy and Clinical Utility of Reports from Outside Hospitals for CT of the Cervical Spine in Blunt Trauma.

BACKGROUND AND PURPOSE: Multidetector CT is the workhorse for detecting blunt cervical spine injury. There is no standard of care for re-interpretation of radiology images for patients with blunt trauma transferred to a higher level of care. The clinical impact of discrepancies of cervical spine CT reads remains unclear. We evaluated the discordance between primary (from referring hospitals) and secondary radiology interpretations (from a receiving level I tertiary trauma center) of cervical spine CT scans in patients with blunt trauma and assessed the clinical implications of missed cervical spine fractures. MATERIALS AND METHODS: Medical records of patients with blunt trauma transferred to our institution between 2008 and 2015 were reviewed. Primary and secondary interpretations were compared and categorized as concordant and discordant. Two senior neuroradiologists adjudicated discordant reports. The benefit of re-interpretation was determined. For discordant cases, outcomes at discharge, injury severity pattern, treatment, and arrival in a cervical collar were assessed. RESULTS: Six hundred fifty patients were included; 608 (94%) presented with concordant reports: 401 (61.7%) with fractures and 207 (31.8%) with no fractures. There were 42 (6.5%) discordant reports; 18 (2.8%) were cervical spine injuries undetected on the primary interpretation. Following adjudication, the secondary interpretation improved the sensitivity (99.3% versus 95.7%) and specificity (99.1% versus 91.7%) in detecting cervical spine fractures compared with the primary interpretation alone (P < .001). CONCLUSIONS: There was an overall 6.5% discordance rate between primary and secondary interpretations of cervical spine CT scans. The secondary interpretation of the cervical spine CT increased the sensitivity and specificity of detecting cervical spine fractures in patients with blunt trauma transferred to higher-level care.

Chemical reactions and applications of the reductive surface of porous silicon.

The chemical reactivity of freshly prepared porous silicon is similar to that of a reducing agent on the surface of the nanocrystallites. Ag+ spontaneously reduces to form Ag0 granular coatings on the surface of porous silicon at the expense of the oxidation of silicon hydride and silicon. Atomic Force Microscopy shows that the thickness and topography of the Ag0 coating depend on the concentration of Ag+ with the porous silicon surface being the limiting reagent. In-situ Raman Spectroscopy shows an Ag layer on the silicon and Si:O layer immediately after etching and exposure to Ag+ and O2 respectively. Ag0 coated on the surface and in the pores of the porous silicon proves to be an excellent material for Surface Enhanced Raman Spectroscopy and the natural low electron affinity on the surface of porous silicon replaces the need for a negative bias to prepare very stable diamond coatings on the surface of silicon.

Diagnosis and management of a fracture of the lateral trochlear ridge of the talus in a dog.

An eight-month-old, 31.2 kg, entire male Golden Retriever was presented for evaluation because it had a four-week history of right hindlimb lameness and audible popping occurring in association with movement of the right hindlimb. Mild right hindlimb lameness was noted upon gait analysis. Moderate to severe effusion and pain on extension were appreciated on palpation of the right tarsus. Dorsoplantar and lateral radiographs of the right tarsus revealed significant soft tissue swelling over the lateral aspect of the tarsus and widening of the joint space over the lateral trochlear ridge of the talus. A fracture of the lateral ridge was appreciated upon evaluation of the flexed dorsoplantar view. Un-enhanced computed tomography of the right tarsus confirmed fracture of the talus; one large and two small bone fragments were noted adjacent to the lateral aspect of the lateral trochlear ridge and medial to the fibula. The fracture was surgically repaired via a lateral approach; a fibular osteotomy was performed. The fragment was manually reduced and secured with a 1.5 mm cortical screw placed in lag fashion. The fibular osteotomy site was reduced and fixed with two 1.6 mm Kirshner wires and a tension band composed of 0.9 mm cerclage wire. The patient made a complete clinical recovery, however, the union was fibrous and evidence of mild osteo- arthritis was noted on postoperative radiographs.

Osteomyelitis-related sequestrum formation in association with the combination tibial plateau levelling osteotomy and cranial closing wedge osteotomy procedure.

A twenty-eight-month old female spayed American Bulldog was presented for evaluation of a chronic draining tract and intermittent left hindlimb lameness twenty-eight weeks after a combination tibial plateau levelling osteotomy and cranial closing wedge osteotomy (TLPO/CCWO) had been performed. The patient had developed an infection of the surgical site three weeks postoperatively. Drainage persisted despite implant removal 10 weeks postoperatively and several weeks of culture and sensitivity-directed antibiotic therapy. Twenty-eight weeks postoperatively, a sequestrum was identified on radiographs. Surgical removal of the sequestrum resulted in resolution of the drainage. While osteomyelitis is a known complication of TPLO surgery, this case represents the first described case of osteomyelitis-related sequestrum formation in association with the combined TPLO/CCWO procedure.

Direct cloning of human transcripts with HnRNA from hybrid cell lines.

A library of human-derived complementary DNA from a human-hamster hybrid cell line containing the Xq24-qter region has been constructed. Complementary DNA synthesis was primed from heterogeneous nuclear (hn) RNA by oligonucleotides derived from conserved regions of human Alu repeats. At least 80% of these cloned sequences were of human origin, providing an enrichment of at least two orders of magnitude. Two clones, one containing a fragment of the primary transcript of the human hypoxanthine-guanine phosphoribosyltransferase (HPRT) gene at Xq26 and another recognizing a family of human genes mapping to two regions of Xq24-qter, were characterized. Additional hncDNA clones mapped to a variety of sites in the Xq24-qter region, demonstrating the isolation of many transcriptionally active loci. These clones provide probes for identification of genetic loci on the terminal region of the X chromosome long arm, which is the location of a number of inherited disorders.

Construction of a cDNA to the hamster CAD gene and its application toward defining the domain for aspartate transcarbamylase.

cDNA complementary to hamster mRNA encoding the CAD protein, a multifunctional protein which carries the first three enzymes of pyrimidine biosynthesis, was constructed. The longest of these recombinants (pCAD142) covers 82% of the 7.9-kilobase mRNA. Portions of the cDNA were excised and replaced by a lac promoter-operator-initiation codon segment. The resultant plasmids were transfected into an Escherichia coli mutant defective in aspartate transcarbamylase, the second enzyme of the pathway. Complementation of the bacterial defect was observed with as little as 2.2 kilobases of cDNA sequence, corresponding to the 3' region of the mRNA. DNA sequencing in this region of the hamster cDNA reveals stretches which are highly homologous to the E. coli gene for the catalytic subunit of aspartate transcarbamylase; other stretches show no homology. The highly conserved regions probably reflect areas of protein structure critical to catalysis, while the nonconserved regions may reflect differences between the quaternary structures of E. coli and mammalian aspartate transcarbamylases, one such difference being that the bacterial enzyme in its native form is allosterically regulated and the mammalian enzyme is not.

Local structure of M-DNA at the Nitrogen K-edge: evidence towards a metal ion induced conduction band in DNA.

M-DNA is an engineered duplex DNA that is synthesized from high doping of transition metal ions (Ni2+, Co2+ and Zn2+) into B-DNA at high pH. X-ray Absorption Near Edge Structure (XANES) of the Nitrogen K-edge shows remarkable differences between the doped and undoped DNA. A metal ion induced conduction band in the M-DNA is used to explain the XANES results.

Synthesis of the nonconserved dihydroorotase domain of the multifunctional hamster CAD protein in Escherichia coli.

CAD is the multifunctional protein of higher eukaryotes which catalyzes the first three steps of pyrimidine biosynthesis. Its enzymatic activities exist as independent domains in the order: N terminus-carbamylphosphate synthetase II(CPSase)-dihydroorotase(DHOase)-aspartate transcarbamylase(ATCase)-C terminus. To functionally define the minimum hamster cDNA region required to encode an active DHOase, expression constructs were generated. Many such constructs complement Escherichia coli mutants defective not only in DHOase but also in ATCase. Constructs deleted for most of the sequence encoding the ATCase domain continue to complement E. coli mutants defective in DHOase. All of these smaller constructs also lack the region encoding CPSase. Therefore, a 'genetic cassette', containing information for neither the CPSase nor the ATCase domain, can direct the synthesis of a polypeptide with DHOase activity. Interestingly, inclusion of a portion of the DHOase-ATCase interdomain bridge appears to be required for optimum activity.

CNS pseudovasculitis in a patient with pheochromocytoma.

The authors report a patient with angiographic findings resembling CNS vasculitis (CNS pseudovasculitis) who was found to have a pheochromocytoma. The angiographic changes resolved after surgical resection of the pheochromocytoma. Pheochromocytoma should be included in the differential diagnosis of angiographic findings suggestive of CNS vasculitis.

Characterisation of IS1126 from Porphyromonas gingivalis W83: a new member of the IS4 family of insertion sequence elements.

The nucleotide sequence of IS1126, the only insertion sequence so far isolated from the oral pathogen Porphyromonas gingivalis, has been determined. It had a nucleotide sequence of 1338 base pair (bp) flanked by 12 bp perfect inverted repeats and generated a 5 bp target site duplication. The single major open reading frame encoded a predicted protein of 361 amino acids and molecular mass of 41 kDa. The gene encoding the transposase was subcloned into pUC18 and the transposase expressed in Escherichia coli minicells. The predicted amino acid sequence of the transposase had homology to putative transposases of IS1106 and IS1186 both of which belong to the IS5 group within the IS4 super-family of insertion elements. On the basis of this homology we propose that IS1126 should also be included in the IS5 group. Southern-blot analysis of a number of P. gingivalis strains using IS1126 as a probe revealed a unique pattern of hybridisation for each strain and the absence of IS1126 from other closely related Porphyromonas species. This should allow IS1126 to be used as a rapid epidemiological tool in studying oral infections by P. gingivalis.

The introduction of colonic-Bacteroides shuttle plasmids into Porphyromonas gingivalis: identification of a putative P. gingivalis insertion-sequence element.

Two Escherichia coli-Bacteroides plasmid-shuttle vectors pNJR5 and pNJR12 were introduced for the first time into Porphyromonas gingivalis W83 by conjugal transfer from E. coli. The transfer frequencies were comparable to those obtained when using colonic Bacteroides as recipients. Both plasmids were maintained in P. gingivalis W83 and could be isolated and introduced back into E. coli. Plasmid DNA extracted from one P. gingivalis W83 pNJR12 transconjugant had an additional 1.5 kb of inserted DNA. Southern-blot analysis of P. gingivalis W83 chromosomal DNA using this inserted DNA as a probe revealed the presence of multiple copies of this sequence on the chromosome. We propose that this DNA represents a P. gingivalis insertion sequence (IS) element and should be referred to as IS1126. This is the first IS element to be isolated from a Gram-negative oral anaerobic bacterium.

Severe occlusive carotid artery disease: hemodynamic assessment by MR perfusion imaging in symptomatic patients.

BACKGROUND AND PURPOSE: Cerebral hemodynamic status has been reported to influence the occurrence and outcome of acute stroke. The purpose of this study was to assess hemodynamic compromise in symptomatic patients with severe occlusive disease of the carotid artery by the use of echo-planar perfusion imaging. METHODS: Spin-echo echo-planar perfusion imaging was performed in 11 patients (two had bilateral disease) with severe stenosis or occlusion of the carotid artery who had experienced either a recent transient ischemic attack or minor stroke. Relative cerebral blood volume (rCBV) maps and relative mean transit time (rMTT) maps were generated from the time-concentration curve. Findings on T2-weighted images, angiograms, rCBV maps, and rMTT maps were compared and assessed qualitatively and quantitatively. RESULTS: Although the abnormalities on T2-weighted images were absent, minimal, and/or unrelated to the degree of stenosis or collateral circulation, rMTT maps showed much larger and more distinct perfusion abnormalities along the vascular distribution of the affected vessels in all 13 vascular territories of the 11 patients. Despite obvious abnormalities on rMTT maps, none of the patients had evidence of decreased rCBV in the affected brain tissue (increased in three, normal in eight). A statistically significant difference in rMTT values was found between the affected and unaffected brain tissue, whereas no significant difference was seen in rCBV values. CONCLUSION: Echo-planar perfusion imaging is a noninvasive and rapid method for evaluating the hemodynamics in severe occlusive carotid artery disease and the compensatory vascular changes, and it may be useful in patient management.

Outcome of acute ischemic lesions evaluated by diffusion and perfusion MR imaging.

BACKGROUND AND PURPOSE: Diffusion and perfusion MR imaging have been reported to be valuable in the diagnosis of acute ischemia. Our purpose was to ascertain the value of these techniques in the prediction of ischemic injury and estimation of infarction size, as determined on follow-up examinations. METHODS: We studied 18 patients with acute ischemic stroke who underwent echo-planar perfusion and diffusion imaging within 72 hours of symptom onset. Quantitative volume measurements of ischemic lesions were derived from relative mean transit time (rMTT) maps, relative cerebral blood volume (rCBV) maps, and/or apparent diffusion coefficient (ADC) maps. Follow-up examinations were performed to verify clinical suspicion of infarction and to calculate the true infarction size. RESULTS: Twenty-five ischemic lesions were detected during the acute phase, and 14 of these were confirmed as infarcts on follow-up images. Both ADC and rMTT maps had a higher sensitivity (86%) than the rCBV map (79%), and the rCBV map had the highest specificity (91%) for detection of infarction as judged on follow-up images. The rMTT and ADC maps tended to overestimate infarction size (by 282% and 182%, respectively), whereas the rCBV map appeared to be more precise (117%). Significant differences were found between ADC and rMTT maps, and between rCBV and rMTT maps. CONCLUSION: Our data indicate that all three techniques are sensitive in detecting early ischemic injury within 72 hours of symptom onset but tend to overestimate the true infarction size. The best methods for detecting ischemic injury and for estimating infarction size appear to be the ADC map and the rCBV map, respectively, and the diffusion abnormality may indicate early changes of both reversible and irreversible ischemia.

Contrast dosage in the neuroimaging of brain tumors. Principles and indications.

No single dose of MR contrast agent is optimal or adequate for the evaluation of all types of CNS lesions. This article discusses the fundamental principles and various background suppression techniques for lesion detection and delineation. An understanding of all factors influencing lesion conspicuity is important in deciding the optimal dose, if any, of contrast agent and the technique necessary for the procedure.

Ultrathin W-Al dual interlayer approach to depositing smooth and adherent nanocrystalline diamond films on stainless steel.

The adherence of diamond coated on steel is commonly low and needs to be strengthened with thick intermediate layers. In this paper, a nanoscale W-Al dual metal interlayer has been applied on SS304 substrates to facilitate deposition of continuous, adherent and smooth diamond thin films. During the microwave plasma-enhanced chemical vapor deposition process, the Al inner layer 30 nm thick diffuses into steel surface inhibiting carbon diffusion and graphitization. The W outer layer 20 nm thick is transformed into W carbides, both preventing carbon diffusion and enhancing diamond nucleation. The diamond films synthesized are of high purity and have smooth surfaces and dense structures. Indentation and shear deformation tests indicate high delaminating tolerance of the diamond films.

Processes of diversification and dispersion of rice yellow mottle virus inferred from large-scale and high-resolution phylogeographical studies.

Phylogeography of Rice yellow mottle virus (RYMV) was reconstructed from the coat protein gene sequences of a selection of 173 isolates from the 14 countries of mainland Africa where the disease occurred and from the full sequences of 16 representative isolates. Genetic variation was linked to geographical distribution and not to host species as isolates from wild rice always clustered with isolates from cultivated rice of the same region. Genetic variation was not associated to agro-ecology, viral interference and insect vector species. Distinct RYMV lineages occurred in East, Central and West Africa, although the Central African lineage included isolates from Benin, Togo and Niger at the west, adjacent to countries of the West African lineage. Genetic subdivision at finer geographical scales was apparent within lineages of Central and West Africa, although less pronounced than in East Africa. Physical obstacles, but also habitat fragmentation, as exemplified by the small low-lying island of Pemba offshore Tanzania mainland, explained strain localization. Three new highly divergent strains were found in eastern Tanzania. By contrast, intensive surveys in Cote d'Ivoire and Guinea at the west of Africa did not reveal any new variant. Altogether, this supported the view that the Eastern Arc Mountains biodiversity hotspot was the centre of origin of RYMV and that the virus spread subsequently from east to west across Africa. In West Africa, specific strains occurred in the Inner Niger Delta and suggested it was a secondary centre of diversification. Processes for diversification and dispersion of RYMV are proposed.

Identification of the junction between the glutamine amidotransferase and carbamyl phosphate synthetase domains of the mammalian CAD protein.

The hamster CAD gene encodes a protein that catalyzes the first three steps of pyrimidine biosynthesis. We have sequenced a portion of a CAD cDNA and determined the location of the carbamyl phosphate synthetase II coding region. Subdomains coding for the glutamine hydrolyzing and carbamyl phosphate synthesizing functions have been identified through their high degree of similarity to carbamyl phosphate synthetase genes from a variety of organisms. The proline-rich junction between the glutaminase and synthetase domains, however, does not appear to be conserved among carbamyl phosphate synthetases.