COVID-19: looking beyond the peak. Challenges and tips for radiologists in follow-up of a novel patient cohort.

As the coronavirus pandemic evolves, the focus of radiology departments has begun to change. The acute phase of imaging a new disease entity whilst rationalising radiology services in the face of lockdown has passed. Radiologists are now becoming familiar with the complications of COVID-19, particularly the lung parenchymal and pulmonary vascular sequelae and are considering the impact follow-up imaging may have on departments already struggling with a backlog of suspended imaging in the face of reduced capacity. This review from the British Society of Thoracic Imaging explores both the thoracic and extra-thoracic complications of COVID-19, recognising the importance of a holistic approach to patient follow-up. The British Thoracic Society guidelines for respiratory follow-up of COVID-19 will be discussed, together with newly developed reporting templates, which aim to provide consistency for clinicians as well as an opportunity for longer-term data collection.

Supporting parents following childhood traumatic brain injury: a qualitative study to examine information and emotional support needs across key care transitions.

INTRODUCTION: Traumatic brain injury (TBI) is the leading cause of death and acquired disability in childhood. Research has demonstrated that TBI can lead to long-term physical, cognitive, emotional and behavioural difficulties for children and parental stress. Less is known about how parents experience a childhood brain injury and their information and support needs. This study aimed to examine parents' experiences and support needs following a childhood TBI from the time of the accident to their child's discharge home. METHODS: Qualitative semi-structured interviews were conducted with 29 parents/carers of children who had experienced a severe TBI. Participants were recruited from one children's tertiary centre in the UK. Data were analysed using the Framework approach. RESULTS: Parents had unmet information and emotional support needs across the care trajectory from the time of the accident to their child's return home. Information needs related to the impact of the TBI on their child; current and future treatment/rehabilitation plans; helping their child and managing their behaviour; accessing services/support. They lacked information and support for care transitions. In different settings parents faced particular barriers to having their information needs met. Parents' felt they needed emotional support in coming to terms with witnessing the accident and the loss of their former child. Lack of community support related not only to service availability but to a general lack of understanding of the impact of TBI on children, particularly when this was invisible. Overall parents felt unsupported in coping with children's behavioural and psychological difficulties. DISCUSSION: Taking a holistic approach to examining parents' experiences and support needs has enabled their changing needs to be highlighted across key care transitions within hospital and community settings and the service implications identified. Improvements in care co-ordination across care transitions are needed to ensure continuity of care and integration of support.

The pancreas-specific protein disulphide-isomerase PDIp interacts with a hydroxyaryl group in ligands.

Using a cross-linking approach, we have recently demonstrated that radiolabelled model peptides or misfolded proteins specifically interact in vitro with two members of the protein disulphide- isomerase family, namely PDI and PDIp, in a crude extract from sheep pancreas microsomes. In addition, we have shown that tyrosine and tryptophan residues within a peptide are the recognition motifs for the binding to PDIp. Here we examine non-peptide ligands and present evidence that a hydroxyaryl group is a structural motif for the binding to PDIp; simple constructs containing this group and certain xenobiotics and phytoestrogens, which contain an unmodified hydroxyaryl group, can all efficiently inhibit peptide binding to PDIp. To our knowledge this is the first time that the recognition motif of a molecular chaperone or folding catalyst has been specified as a simple chemical structure.

Ultrastructure of two oil-degrading bacteria isolated from the tropical soil environment.

Two oil-degrading bacteria identified as Pseudomonas aeruginosa and Micrococcus luteus were isolated from crude-oil-polluted soils in Nigeria. The organisms were grown on n-hexadecane and sodium succinate and then examined for the presence of hydrocarbon inclusions. Inclusion bodies were found in n-hexadecane-grown cells and were absent in succinate-grown cells. Formation of hydrocarbon inclusion bodies appears to be a general phenomenon among hydrocarbon utilizers.

Guidelines for the nonpharmacologic management of migraine in clinical practice. Canadian Headache Society.

OBJECTIVE: To provide physicians and allied health care professionals with guidelines for the nonpharmacologic management of migraine in clinical practice. OPTIONS: The full range and quality of nonpharmacologic therapies available for the management of migraine. OUTCOMES: Improvement in the nonpharmacologic management of migraine. EVIDENCE AND VALUES: The creation of the guidelines followed a needs assessment by members of the Canadian Headache Society and included a statement of objectives; development of guidelines by multidisciplinary working groups using information from literature reviews and other resources; comparison of alternative clinical pathways and description of how published data were analysed; definition of the level of evidence for data in each case; evaluation and revision of the guidelines at a consensus conference held in Ottawa on Oct. 27-29, 1995; redrafting and insertion of tables showing key variables and data from various studies and tables of data with recommendations; and reassessment by all conference participants. BENEFITS, HARMS AND COSTS: Augmentation of the use of nonpharmacologic therapies for the acute and prophylactic management of migraine is likely to lead to substantial benefits in both human and economic terms. RECOMMENDATIONS: Both the avoidance of migraine trigger factors and the use of nonpharmacologic therapies have a part to play in overall migraine management. VALIDATION: The guidelines are based on consensus of Canadian experts in neurology, emergency medicine, psychiatry, psychology and family medicine, and consumers. Previous guidelines did not exist. Field testing of the guidelines is in progress.

Gay, lesbian and bisexual health care issues and medical curricula.

The authors respond to Nancy Robb's account of the inadequacy of medical school curricula in addressing health care issues relevant to gay, lesbian and bisexual people (see page 765 of this issue) by proposing a framework for curriculum reform. This framework supports the development of knowledge, attitudes and skills necessary to the provision of sensitive and comprehensive care for these patient groups through four types of learning experiences: didactic instruction, small-group discussions, simulated patient encounters, and supervised encounters with real patients. Equally important is the attitudinal context in which learning takes place. Without fostering a supportive and accepting environment for education about gay, lesbian and bisexual health care issues, medical schools cannot ensure that future physicians will be equipped to provide appropriate care for all members of society.

Mental health services: critical component of integrated primary care and substance abuse treatment.

The documented high incidence of mental health disorders among individuals in substance abuse treatment argues for the importance of studying the provision of mental health services to this population. This survey documents how the Linkage Programs assembled an array of mental health services based on the assessed health care needs of clients. Specialty and nonspecialty personnel addressed the extensive mental health needs of ethnically diverse, multiproblem clients with substance abuse problems. The innovative use of nonconventional providers, however, did not eliminate the shortfall between the number of clients with mental health problems and the number who were referred to and received mental health services; nor did it enable all Linkage Programs to address the mental health needs of the most severely ill clients. There is a continuing need to forge relationships between mental health providers and integrated providers of primary care and substance abuse treatment.

A direct, general approach based on isobolograms for assessing the joint action of drugs in pre-clinical experiments.

Pharmacologists and other biologists frequently use methods based on the interpretation of isobolograms to quantify the extent of synergy or antagonism between drugs used in combination in pre-clinical studies. Most methods have been unsatisfactory from a statistical viewpoint, many because they have relied solely on visual evaluation, others because the methods have not taken into account the variability of the measurements. We describe a direct approach for quantifying the joint potency of two drugs, a central feature being the use of simple isobole models that lead directly to response surface models for the expected experimental outcomes. The approach is general in the sense that one can use it for discrete or continuous responses, different underlying probability distributions, linear or non-linear dose-response functions of the drugs used singly, and a variety of experimental designs. Our approach extends the suggestions made by Hewlett for measuring the joint potency of drugs, and is similar in spirit to the approaches proposed by Greco et al. and Weinstein et al. We describe the analysis of data from an in vitro experiment conducted to evaluate the efficacy of the antiviral drugs AZT and ddI used in combination.

Haemostasis during carpal tunnel release under local anaesthesia: a controlled comparison of a tourniquet and adrenaline infiltration.

A randomized controlled comparison of tourniquet and local adrenaline infiltration for control of bleeding was performed in patients undergoing bilateral carpal tunnel release under local anaesthesia. Visual analogue scores for intra-operative pain were substantially greater for tourniquet (mean score 4.7) than for adrenaline (2.2). Incomplete control of bleeding was responsible for longer operating time and for the surgeons' perception of slightly greater operative difficulty with the use of adrenaline. There were no complications attributable to the use of adrenaline. The use of adrenaline-containing local anaesthesia for carpal tunnel release avoids tourniquet pain and is preferred by patients.

The use of magnetic resonance imaging in diagnosing Wilms' tumor mimicking a lumbosacral strain and sprain.

Wilms' tumor is the most common tumor of the kidney in childhood. This article discusses the case of a young adult with a Wilms' tumor whose initial presentation appeared similar to a lumbosacral strain. The use of magnetic resonance imaging in diagnosing Wilms' tumor is discussed, along with the common clinical picture of the disease.

Use of magnetic resonance imaging in the decision-making process for lumbar intervertebral disc syndrome.

Magnetic resonance imaging was used to determine the presence or absence of a lumbar herniated nucleus pulposus in a patient suffering from acute sciatica. Treatment decisions were made as a result of this diagnostic process and comparative history and physical exam findings revealed marked improvement in less than 1 wk.

Warfarin and cataract extraction.

Ten cataract extractions were performed on eight patients for whom warfarin was not discontinued prior to surgery. Three were complicated by hyphaema. No retrobulbar haemorrhages occurred in the four cases given a local anaesthetic. Cataract surgery can be performed successfully without discontinuing warfarin.

Gonadotrophin-releasing activity of neurohypophysial hormones: I. Potential for modulation of pituitary hormone secretion in rats.

Neurohypophysial hormones have been implicated in the control of anterior pituitary function, and oxytocin has been shown to stimulate gonadotrophin excretion and ovarian follicular development in certain species. To determine the role of neurohypophysial peptides in the control of gonadotrophin release, their actions on LH and FSH secretion were analysed in rats in vivo and in vitro. In adult female rats, administration of oxytocin during early pro-oestrus advanced the spontaneous LH surge and markedly increased peripheral LH levels at 15.00 h compared with control animals. In cultured pituitary cells from adult female rats, oxytocin and vasopressin elicited dose-related increases in LH and FSH release. Such responses were not affected by a potent gonadotrophin-releasing hormone (GnRH) antagonist that abolished GnRH agonist-induced release of LH and FSH. Oxytocin did not enhance GnRH agonist-stimulated gonadotrophin release to the same extent as it increased basal secretion, but at low concentrations of GnRH agonist the effects were additive. The gonadotrophin responses to oxytocin and vasopressin were inhibited by the specific neurohypophysial hormone antagonists, [d(CH2)5D-Ile2,Ile4,Arg8]vasopressin and [d(CH2)5Tyr (Me),Arg8]vasopressin. These results provide direct evidence that neurohypophysial hormones can stimulate gonadotrophin secretion through a receptor system distinct from the GnRH receptor. Such a mechanism could represent a complementary hypothalamic control system for long-term modulation of LH and FSH secretion by exerting a basal or tonic influence on gonadotrophin production.

Linearity of the accumulation of various dosages of uranium in the major organs of mature male Japanese quail. Effect of various doses of estradiol-17 beta.

1. Male Japanese quail were given 2.20 x 10(-4)-14.53 mg uranium/kg intravenously as uranyl ion (235U label). 2. The relationship between dosage and the 18-hr accumulation of U in leg bones, liver, kidneys and testes was linear. 3. Increases in U deposition with increased dosage were approximately 1:1, except for kidneys where 10-fold increases in dosage resulted in 25-fold increases in deposition. 4. Estradiol-17 beta increased U deposition in bones by 15-fold thereby providing some protection for the kidneys as now the ratio of dosage to accumulation was 1:1.

Distribution of nanomole quantities of 235U in young and adult Japanese quail and in the F1 generation. Comparison with 153Gd.

Enriched uranium, 93.16% for 235U, served as a tracer of uranium deposition in an avian species, the Japanese quail. A second label, 153Gd, provided for monitoring of procedures and for estimation of the 235U content of live eggs. Depositions of 235U were greater than for 153Gd in all tissues except the yolk sac and the liver. Skeletal levels for 235U were age- and sex-dependent. Feathers contained only 0.11% of the 235U tracer in contrast to 50% of the endogenous uranium. The results show that 235U provides for tracing uranium metabolism in small animals, since in quail the tracer increased the uranium burden of the body by only 1-8%.

Radiological and magnetic resonance imaging of cervical spine instability: a case report.

Hypermobility and instability following injury and degenerative joint disease is poorly understood and often not recognized as the cause of the patients symptoms. Routine radiographs should be complemented by flexion/extension studies. Magnetic resonance imaging has been found useful in demonstrating degenerative disc disease, disc herniations, cord impingements and instabilities that are not amenable to diagnosis by myelograms and computed tomography.

Increased deposition of uranium in the bones of vitellogenic male Japanese quail. Effect of estradiol-17 beta on the distribution of uranium (VI), thorium (IV), gadolinium (III), and calcium (II).

Japanese quail were given, intramuscularly, either 16-mumol estradiol-17 beta (E2) in .25-ml ethanol solution/100 g body weight or .25 ml ethanol/100 g. Four days later, these quail were given, intravenously, 1.5-mumol UO2(NO3)2, Th(NO3)4, GdCl3 (153Gd-labeled) or CaCl2 (47Ca-labeled)/.15 ml .03 N HCl solution/100 g. The distribution of uranium among selected tissues was markedly different than for thorium or gadolinium and was approximately the same as for calcium. For example, 18 hr after giving the metal ions to the quail, the mean uranium content of the femora + tibiotarsi of E2-treated males was 15.4 +/- 1.3% (SE; n = 12) vs. 3.07 +/- .59% (12; P less than .001) for the control males. Similarly, 18 hr after giving calcium, the femora + tibiotarsi of E2-treated males had accumulated 20.8 +/- 1.5% (4) of the label vs. 9.94 +/- .46% (4; P less than .001) for controls. The livers of E2-treated males had 41.9 +/- 8.5% (4) of the thorium by 18 hr vs. 90.9 +/- 7.1% (4; P less than .01) for the controls, or 34.3 +/- 3.1% (8) of the gadolinium vs. 68.9 +/- 3.4% (8; P less than .001) for controls. The 18-hr accumulation of calcium in the femora + tibiotarsi of the E2-treated females was 18.0 +/- 1.1% (4) vs. 10.7 +/- 1.9% (4; P less than .05) for the controls.(ABSTRACT TRUNCATED AT 250 WORDS)

Tandem Van de Graaff accelerator production of positron labeled radiopharmaceuticals for routine clinical use.

This paper describes a facility to produce positron labeled radiopharmaceuticals with a tandem Van de Graaff accelerator. 11C labeled carbon monoxide (11CO), 15O labeled H2O (H2 15O) and 18F labeled 2-deoxy-2-fluoro-D-glucose ([18F]2FDG), were chosen so that physiological measurements of cerebral blood volume, cerebral blood flow, and the cerebral metabolic rate for glucose could be made routinely in our PET center. This facility uses a tandem Van de Graaff accelerator which is relatively remote from the clinical area. Measurements of radionuclide yield and beam penetration showed that it was feasible to deliver sufficient amounts of radioactivity for the measurements. Both 11CO and H2 15O presented significant delivery problems due to their shorter half-lives. For H2 15O a continuous delivery system for water vapour and an infusion system for the administration of H2 15O in saline were designed and constructed. 11CO and [18F]2FDG were hand carried. This facility has demonstrated that a tandem Van de Graaff accelerator can routinely supply a PET center with adequate quantities of these three radiopharmaceuticals.