The impact of respiratory motion on electromagnetic fields and specific absorption rate in cardiac imaging at 7T.

PURPOSE: To present electromagnetic simulation setups for detailed analyses of respiration's impact on B 1 + $$ {B}_1^{+} $$ and E-fields, local specific absorption rate (SAR) and associated safety-limits for 7T cardiac imaging. METHODS: Finite-difference time-domain electromagnetic field simulations were performed at five respiratory states using a breathing body model and a 16-element 7T body transceiver RF-coil array. B 1 + $$ {B}_1^{+} $$ and SAR are analyzed for fixed and moving coil configurations. SAR variations are investigated using phase/amplitude shimming considering (i) a local SAR-controlled mode (here SAR calculations consider RF amplitudes and phases) and (ii) a channel-wise power-controlled mode (SAR boundary calculation is independent of the channels' phases, only dependent on the channels' maximum amplitude). RESULTS: Respiration-induced variations of both B 1 + $$ {B}_1^{+} $$ amplitude and phase are observed. The flip angle homogeneity depends on the respiratory state used for B 1 + $$ {B}_1^{+} $$ shimming; best results were achieved for shimming on inhale and exhale simultaneously ( | Δ C V | < 35 % $$ \mid \Delta CV\mid <35\% $$ ). The results reflect that respiration impacts position and amplitude of the local SAR maximum. With the local-SAR-control mode, a safety factor of up to 1.4 is needed to accommodate for respiratory variations while the power control mode appears respiration-robust when the coil moves with respiration (SAR peak decrease: 9% exhale→inhale). Instead, a spatially fixed coil setup yields higher SAR variations with respiration. CONCLUSION: Respiratory motion does not only affect the B 1 + $$ {B}_1^{+} $$ distribution and hence the image contrast, but also location and magnitude of the peak spatial SAR. Therefore, respiration effects may need to be included in safety analyses of RF coils applied to the human thorax.

Tenofovir alafenamide does not inhibit mitochondrial function and cholesterol biosynthesis in human T lymphoblastoid cell line.

In clinical trials, the concentration of tenofovir diphosphate (TFV-DP) in peripheral mononuclear cells was 4 to 5-fold higher in individuals treated with tenofovir alafenamide (TAF) compared to individuals treated with tenofovir disoproxil fumarate (TDF). We hypothesized that the higher intracellular accumulation of TFV-DP could cause mitochondrial toxicity from either polymerase gamma (Pol-γ)-dependent or Pol-γ-independent mechanism(s). To test this hypothesis, we cultured human T lymphoblastoid cell line (CEM cells) for up to 12 days with TAF or TDF (multiplicities of Cmax) to investigate the effects on mitochondrial function and respiration, and cholesterol biosynthesis. Both TAF and TDF treatments had no significant effect on cell growth, mitochondrial potential (ΔΨ), production of reactive oxygen species (ROS), and mitochondrial respiratory parameters. TAF had no statistically significant effect on expression of Pol-γ mRNA, mitochondria DNA (mtDNA) content, expression of proteins of the electron transport chain (ETC), and key genes of cholesterol biosynthesis. TDF had significant reduction in mtDNA content at 8xCmax, and statistically significant reduction in mRNA expression of squalene epoxidase (SQLE). Our findings do not support our hypothesis that the higher intracellular accumulation of TFV-DP in cells treated with TAF could cause mitochondrial dysfunction. In conclusion, our findings add to the emerging data that TAF may have a low potential for causing mitochondrial toxicity in HIV-infected individuals on TAF-containing regimens.

Performance of a Nonelectric Infant Warmer in Rwandan Health Centers.

Background. Neonatal hypothermia remains a challenge in resource-limited settings. Methods. We conducted a prospective mixed-methods cohort study in rural Rwandan health centers to assess the performance of an infant warmer we designed for low-resource settings. All hypothermic infants were eligible for enrollment. Outcomes. Safety: incidence of adverse reactions. Effectiveness: attainment of euthermia, rate of temperature rise. Feasibility: correct use of warmer, signs of wear. Interviews of caregivers and nurses. Findings. Of 102 encounters, there were no adverse reactions. Of 80 encounters for hypothermia when infants on warmer for ≥1 hour, 79 achieved euthermia; 73 in ≤2 hours. Of the 80 encounters, 64 had temperature rise ≥0.5°C/h. Of the 102 encounters, there were no instances of the warmer being prepared, used, or cleaned incorrectly. Five out of the 12 warmers exhibited wear. Interview participants were predominantly positive; some found time for readiness of warmer challenging. Interpretation. The warmer performed well. It is appropriate to study in larger scale.