Iterative metal artefact reduction in CT: can dedicated algorithms improve image quality after spinal instrumentation?

AIM: To investigate the value of dedicated computed tomography (CT) iterative metal artefact reduction (iMAR) algorithms in patients after spinal instrumentation. MATERIALS AND METHODS: Post-surgical spinal CT images of 24 patients performed between March 2015 and July 2016 were retrospectively included. Images were reconstructed with standard weighted filtered back projection (WFBP) and with two dedicated iMAR algorithms (iMAR-Algo1, adjusted to spinal instrumentations and iMAR-Algo2, adjusted to large metallic hip implants) using a medium smooth kernel (B30f) and a sharp kernel (B70f). Frequencies of density changes were quantified to assess objective image quality. Image quality was rated subjectively by evaluating the visibility of critical anatomical structures including the central canal, the spinal cord, neural foramina, and vertebral bone. RESULTS: Both iMAR algorithms significantly reduced artefacts from metal compared with WFBP (p<0.0001). Results of subjective image analysis showed that both iMAR algorithms led to an improvement in visualisation of soft-tissue structures (median iMAR-Algo1=3; interquartile range [IQR]:1.5-3; iMAR-Algo2=4; IQR: 3.5-4) and bone structures (iMAR-Algo1=3; IQR:3-4; iMAR-Algo2=4; IQR:4-5) compared to WFBP (soft tissue: median 2; IQR: 0.5-2 and bone structures: median 2; IQR: 1-3; p<0.0001). Compared with iMAR-Algo1, objective artefact reduction and subjective visualisation of soft-tissue and bone structures were improved with iMAR-Algo2 (p<0.0001). CONCLUSION: Both iMAR algorithms reduced artefacts compared with WFBP, however, the iMAR algorithm with dedicated settings for large metallic implants was superior to the algorithm specifically adjusted to spinal implants.

Timing of Mean Transit Time Maximization is Associated with Neurological Outcome After Subarachnoid Hemorrhage.

PURPOSE: Computed tomography perfusion (CTP) has gained significant relevance for the radiological screening of patients at risk of developing delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage (aSAH). Particularly, the impact of MTTPEAK, i.e., the maximal mean transit time value in a series of CTP measurements, for the prediction of long-term outcome has recently been demonstrated by our group. Complementing this recent work, the present study investigated how the timing of MTTPEAK affected the long-term outcome after aneurysmal subarachnoid hemorrhage. METHODS: CTP examinations from 103 patients with clinical deterioration attributed to DCI after aSAH were retrospectively analyzed for time interval between SAH ictus and onset of MTTPEAK in association with modified Rankin Scale (mRS) 23.1 months after SAH. RESULTS: Patients with unfavorable outcome (mRS > = 2) suffered significant earlier MTTPEAK onsets than patients with favorable outcome (mRS = 0 and 1). MTTPEAK within the first week was associated with significantly higher mRS scores compared to later MTTPEAK. Timing of MTTPEAK together with the value of MTTPEAK and initial World Federation of Neurosurgical Societies (WFNS) grade was a significant predictor for an unfavorable outcome (mRS > = 2). CONCLUSIONS: The current findings suggest a presumably higher vulnerability of the brain to early microcirculatory impairments after aSAH and highlight that timing of MTT elevations could be considered for the identification of patients at increased risk for poor neurological outcome due to DCI.

PaMiNI-Derived Co-Activation Patterns Indicate Differential Hierarchical Levels for Two Ventral Visual Areas of the Fusiform Gyrus.

PURPOSE: To investigate the distribution of co-activation patterns of the recently identified ventral visual areas FG1 and FG2 of the posterior fusiform gyrus using the novel meta-analytic approach PaMiNI (Pattern Mining in NeuroImaging). MATERIALS AND METHODS: All neuroimaging experiments reporting activation foci within FG1 or FG2 were retrieved from the BrainMap database. The stereotaxic activation foci in standard reference space were analyzed with PaMiNI. Here, Gaussian mixture modeling was applied to the stereotaxic coordinates of all foci to identify the underlying brain regions of each dataset. Then, association analysis was performed to reveal frequent co-activations across the modeled brain regions. RESULTS: Co-activation patterns of FG1 were mainly found within the visual system, i.e. in early visual areas, and were symmetrically distributed across both hemispheres. FG2 features several extra-visual co-activations, mainly to inferior frontal, premotor and parietal regions. Furthermore, the co-activations of FG2 showed clear lateralization to the left FG2. CONCLUSION: FG1 shows characteristics of an intermediate visual area between the early ventral visual cortex and the category-specific higher-order areas. Co-activation patterns of FG2 indicate that FG2 is a higher-order visual area that probably corresponds to the posterior fusiform face area and partly the visual word-form area. Key points. Co-activation patterns of areas FG1 and FG2 were analyzed with PaMiNI. FG1 features mainly symmetric co-activations to areas of the visual system. FG2 shows several extra-visual co-activations, which are left-lateralized. FG1 corresponds to a hierarchically intermediate, FG2 to a higher-order visual area. The PaMiNI approach is extended to seed-specific mapping of co-activation patterns.

Measurement of a compact colorless 3 dB hybrid plasmonic directional coupler.

We fabricated and measured a compact 3 dB hybrid plasmonic directional coupler for silicon photonics integrated circuits with a length of 21.2 µm. The coupler has a 50∶50 coupling ratio over a spectral bandwidth of more than 100 nm around a wavelength of 1.55 µm and has an insertion loss of less than 1 dB.

Experimental demonstration of an integrated hybrid plasmonic polarization rotator.

We experimentally demonstrate an ultracompact (3.7 µm long) hybrid plasmonic polarization rotator operating around 1.55 µm for integrated silicon photonics circuits. The TM polarization of a silicon waveguide is rotated to the TE polarization with insertion losses as low as 1.5 dB and polarization extinction ratios larger than 13.5 dB.

Compact low loss and broadband hybrid plasmonic directional coupler.

We propose a novel broadband coupler for silicon photonics using a hybrid plasmonic waveguide section. The hybrid plasmonic waveguide is used to create an asymmetric section in the middle of a silicon nanowire waveguide coupler to introduce a phase delay to allow for a 3-dB power coupling ratio over a 150 nm bandwidth around 1.55 µm. The device is very compact (<8.5 µm) and has a low insertion loss (<0.15 dB).

Compact hybrid plasmonic polarization rotator.

We propose a novel ultracompact (5 µm) hybrid plasmonic polarization rotator operating at telecommunication wavelength for integrated silicon photonic circuits. The polarization mode of a silicon waveguide is rotated with >14 dB polarization extinction ratio and low total insertion losses of 2.1 dB.

Experiments on the meaning of four types of single-accent intonation patterns in Dutch.

The Grammar of Dutch Intonation (GDI) provides a description of the possible intonation contours of Dutch. The GDI distinguishes accent-lending and nonaccent-lending pitch configurations, but refrains from further functional statements. This paper describes an experimental attempt to verify meaning hypotheses for four Dutch single-accent pitch patterns as postulated in the linguistic literature. The four pitch accent types were realized on proper names; the abstract meanings, in terms of the manipulation of an element of the background shared between speaker and listener, were incorporated in situational contexts, distinguishing between a "default" and a vocative use of the proper name ("orientation"). Listeners ranked the four melodic shapes from most to least appropriate in their specific context. After revision of part of the materials a second perception experiment was conducted, in which subjects had a rank four contexts from most to least appropriate for a specific pitch accent type. Results show a distinct effect of "orientation" on the appropriateness of two of the investigated pitch accent types in the various context types; the other two pitch accent types are associated with the predicted context types (and vice versa) well above chance, indicating the viability of at least two of the linguistic proposals.

Lipid-Drug Interaction and Colligative Properties in Phospholipid Vesicles.

Imipramine penetration into the lipid core of a membrane was demonstrated through measurements on lipid monolayers (surface pressure and surface potential). The surface pressure measurements allow us to calculate the intrinsic binding constant (partition coefficient) for the lipid-Imipramine interaction. This latter value is in correct agreement with the results obtained by electrophoretic mobility measurements on liposomes. In addition, it was observed that the same mole fraction of "lipid-soluble drug" (Chlorpromazine or Imipramine) incorporated in a given lipidic phase (DPPC) induced the same shift in the transition temperature. Copyright 1999 Academic Press.

Physico-chemical characterization of a double long-chain cationic amphiphile (Vectamidine) by microelectrophoresis.

We recently synthesized a novel cationic amphiphile (N-t-butyl-N'-tetradecyl-3-tetradecylaminopropionamidine or Vectamidine (previously described as diC14-amidine)) that associates with DNA and RNA and facilitates their entry and expression into eukaryotic cells. Among several parameters that have been shown to influence the transfection process, the surface charge density plays a key role. Quantitative information about that charge density associated to the cationic amphiphiles organized in liposomal structure is not yet available. We provide here evidence by titration and microelectrophoresis measurements that an evaluation of the intrinsic acidity constants, the surface pH and the counterion binding constants allows to determine the charge density at physiological pH of Vectamidine liposomes. The knowledge of this superficial charge is a prerequisite to a molecular understanding of the DNA-cationic amphiphile complex formation. The method described could be extended to any kind of cationic amphiphile.

Who's next? The melodic marking of question vs. continuation in Dutch.

The present study is concerned with functional differences between the accent-lending rise followed by sustained level pitch (GDI-notation "10," cf., 't Hart, Collier, and Cohen, 1990) and the combination of the accent-lending rise and final rise ("12") in Dutch. Theoretical analyses of the meaning of Dutch intonation claim that "10" can be interpreted as a question. In contrast, recent investigations of the relevance of intonation for turn-taking indicate that "10" signals that the speaker wants to keep the turn. The main goal of the present experimental investigation is to find evidence for the idea that speakers may use contour "10" to keep the floor. Thirty subjects were presented with short utterances bearing either a "12" or a "10" contour in three perception experiments. Results support the hypothesis that "10" is not readily interpreted as a question, as opposed to contour "12," which indicates that contour "10" may play a role in signaling turn-keeping in Dutch.

Effect of food intake on the activity of liver enzymes in partially hepatectomized rats treated with tumor necrosis factor.

After partial hepatectomy (PHx), there are significant changes in the activity of a number of enzymes in the regenerating rat liver. Administration of low doses of recombinant human tumor necrosis factor-alpha (rHu-TNF) to normal rats induces similar changes in some of the enzymes but not in others. Because certain observations suggest that TNF may play a dominant role in liver regeneration, we speculated that the discrepancies in enzyme activities may be due to the decrease in food intake caused by PHx. Accordingly, the activities of eleven liver enzymes of 70% PHx rats additionally treated i.p. with rHu-TNF (20-50 micrograms/kg/day for 3-4 days) were compared with those of (i) PHx controls fed ad lib., and (ii) PHx controls pair-fed the same amount of food. When pair-fed controls were used, the discrepancies in the activities of the enzymes that are affected by fasting tended to disappear, suggesting that the decrease in the food intake was responsible for the differences.

Tumor necrosis factor induces enzymatic changes in liver comparable to those in extrahepatic cancer.

Human recombinant tumor necrosis factor was administered to rats in small doses to determine whether it causes changes in the activity of liver enzymes similar to those observed in cancer growing extrahepatically. Intraperitoneal injection of increasing doses of tumor necrosis factor (20-100 micrograms/kg/day for 5 days) resulted in a 20-50% decrease in hepatic alanine aminotransferase (P < or = 0.05), a 10-20% decrease in aspartate aminotransferase (P < or = 0.04), and a 50-200% increase in alkaline phosphatase (P < or = 0.02). The activity of hepatic 5'-nucleotidase was unchanged. In the serum, there was no significant change in the activity of any of the enzymes. Histologically, there was no damage detectable by light or electron microscopic examination of the liver, and no evidence of biliary obstruction. However, in frozen liver sections stained histochemically for alkaline phosphatase, there was a dramatic increase in the activity of this enzyme in hepatocytes, which was confined to the bile canaliculi. There was also a 3- to 9-fold increase in the mitotic activity of hepatocytes. Comparable changes have been reported in the tumor-free liver of animals with cancer.

[Effect of pneumatic compression in connection with ergotherapeutic treatment of Colles' fracture. A clinical controlled trial]. / Effekten af trykbandagebehandling i forbindelse med ergoterapeutisk behandling af Colles-fraktur. En klinisk kontrolleret undersøgelse.

We followed forty women with functional deficits in the wrist and hand after sustaining a Colles' fracture. The women participated in occupational therapy three times a week for three weeks. At the initial evaluation, after three weeks, and at a three month evaluation, we measured the following: range of joint movement, grip strength, hand volume (oedema), pain and ADL. There was significant improvement in most of the parameters measured after three weeks of occupational therapy, with a less significant improvement from three weeks to three months. Seventeen of the forty women received twenty minutes of intermittent pneumatic compression before occupational therapy. These patients showed significant improvement in wrist extension, compared with the control group of twenty-three patients. Occupational therapy is recommended for patients showing a functional deficit after Colles' fracture. Intermittent pneumatic compression is recommended as a supplement to occupational therapy.

Effects of time pressure on the phonetic realization of the Dutch accent-lending pitch rise and fall.

The goal of this experiment is to find the most important phonetic features of Dutch accent-lending pitch movements, in terms of shape, pitch level and alignment with the segmental structure. Time pressure is used as a heuristic method to isolate important phonetic aspects of pitch movements, assuming that under time pressure the speaker will preserve those aspects. In a production experiment, accent-lending rises ('1') and falls ('A') were realized under various types of time pressure. The pitch rise is time-compressed under all pressure types, which would mean that the shape of the rise is relatively unimportant. The segmental alignment of the rise proved to be more important: the onset of the rise is synchronized with the syllable onset. For the fall no fixed synchronization point was found, but its shape was relatively invariant, indicating that shape rather than exact timing is the more important feature of the fall.

Homogeneous trinder-coupled assay for the determination of glucose-6-phosphatase activity in tissue extracts.

We describe an automated, homogeneous, glucose oxidase-coupled method for the determination of glucose-6-phosphatase activity in tissue extracts. The method is based on measurement of the rate of glucose formation by the Trinder reaction, in which the end product is a quinoneimine dye which absorbs maximally at 505 nm and has a molar extinction coefficient of 5700. The incubation mixture contains 20 microL of tissue extract, 25 microL of 0.5 M phosphate buffer, pH 7.0, 175 microL of Trinder/glucose-6-phosphate reagent, and 30 microL of distilled water. After a delay period of 15 min, to exhaust any glucose endogenously present in the extract, glucose production from glucose-6-phosphate is monitored at 505 nm for 5 min in a centrifugal analyzer. The Km was 13 mM over a 10-fold range in glucose-6-phosphate concentration and the reaction was linear up to about 250 U/L. Within-run CV of the assay at activities of 48 and 190 U/L ranged between 2.5-5.0%. The between-run CV at 190 U/L was 5.1%.

Determination of serum catalase activity on a centrifugal analyzer by an NADP/NADPH coupled enzyme reaction system.

We developed a simple, kinetic method for the determination of catalase activity in which i) the enzyme catalyzes the peroxidation of ethanol by hydrogen peroxide to acetaldehyde and water, and ii) the acetaldehyde so formed is rapidly oxidized to acetic acid and NADPH by the addition of an excess of NADP+ and aldehyde dehydrogenase. The rate of NADPH production was monitored at 340 nm in a COBAS centrifugal analyzer. The reaction was linear to 800 U/L or a delta A of 0.020/min. Using human serum pools containing 80 and 460 U/L of peroxidase activity, the within-run coefficients of variation (CV) were 1.9 and 1.3%, respectively. Between-run CV values were 5% for both pools. The reference range for sera from 72 males and 52 females was 23 to 158 U/L (mean + 2 SD) by log normal transformation. The activity in red cells was 600 U/g hemoglobin but did not change the reference range appreciably provided that serum without visible hemolysis was used. Preliminary observations on sera from nine patients with various pancreatic disorders showed a poor correlation between the activities of catalase (peroxidase) and amylase in serum. The reasons for this discrepancy are under investigation.

Tumor necrosis factor/cachectin decreases catalase activity of rat liver.

Tumor bearing hosts and animals treated with endotoxin commonly show a decrease in the catalase activity of the liver and kidney. Since tumor necrosis factor (TNF)/cachectin may play a significant role in these conditions, we investigated its effects on the catalatic and peroxidatic activity of catalase in the liver and kidney of the rat. The activities of glucose-6-phosphate dehydrogenase and lactate dehydrogenase were measured simultaneously to monitor the pentose phosphate and glycolytic pathways, respectively. Injection i.p. of 100 micrograms/kg/day human recombinant TNF-alpha for 5 days resulted in a significant (P less than 0.01) decrease in the catalatic activity of the liver when compared to rats fed ad libitum. The decrease in four experiments ranged from 21 to 56%. A significant decrease (18%; P = 0.01) in liver catalatic and peroxidatic activity was also observed in another experiment using pair fed rats as controls. The peroxidatic activity of catalase with ethanol as hydrogen donor closely paralleled the catalatic activity. TNF treatment had no detectable effect on the catalatic or peroxidatic activity of catalase in the kidney. The activity of glucose-6-phosphate dehydrogenase increased (31-80%) significantly (P less than or equal to 0.02) in the liver and, to a lesser extent, in the kidney (5-27%, P = 0.05). Lactate dehydrogenase activity decreased (14-19%) significantly (P less than or equal to 0.05) in the liver and kidney but mainly in rats treated with TNF and additionally fasted for 24 h. Electron microscopic examination of liver sections showed that the hepatocytes of TNF-treated rats were undamaged but contained fewer and smaller peroxisomes than those of the control rats.

Colles fracture: does the anatomical result affect the final function?

Thirty patients who had sustained a Colles' fracture at least four years previously were examined functionally and radiographically. Seventeen had a good radiological result and 13 were considered to have malunion. Functionally the displaced group performed significantly worse than the undisplaced group. We conclude that malunion of a Colles' fracture results in a weak, deformed, stiff and probably painful wrist.

Ionization state of amiodarone mediates its mode of interaction with lipid bilayers.

Amiodarone is a potent antianginal and antiarrhythmic drug which affects the lipid dynamics. The influence of amiodarone ionization on the lipid transition temperature and enthalpy associated to the liquid crystalline to gel state transition was studied in multilamellar vesicles (MLV) of dipalmitoylphosphatidylcholine (DPPC) by differential scanning measurements (DSC) at different pH. These data were correlated with the calculated number of charged amiodarone molecules inserted into the lipid vesicles. The procedure of calculation requires the knowledge of the intrinsic ionization constant of amiodarone and the area occupied per amiodarone molecule in the close packed state; it can be applied successfully to water insoluble amphiphilic molecules. Only the ionized form of amiodarone molecule destabilizes the lipid matrix organisation whereas no effect was observed with the uncharged form. This destabilizing effect could be explained in terms of a modification of the drug structure induced by its ionization state or in terms of its distribution in the lipid matrix, as an isolated molecule or assembled in clusters depending on its ionization state.