Infrared spectroscopy as a novel tool to diagnose onychomycosis.

BACKGROUND: The determination of causative organisms of onychomycosis is still not optimal. There remains a need for a cheap, fast and easy-to-perform diagnostic tool with a high capacity to distinguish between organisms. OBJECTIVES: To determine whether attenuated total-reflectance Fourier transform infrared (ATR-FTIR) spectroscopy can detect and differentiate causative agents in culture-based, ex vivo nail and in vivo nail models. METHODS: A methodological study was conducted. Both the ex vivo nail model and in vivo pilot study were carried out in an academic university hospital. RESULTS: Analysis of cultured fungi revealed spectral differences for dermatophytes (1692-1606 and 1044-1004 cm-1 ) and nondermatophytes and yeasts (973-937 cm-1 ), confirmed by dendrograms showing an excellent separation between samples from different genera or species. Exploration of dermatophytes, nondermatophytes and yeasts growing on ex vivo nails exposed prominent differences from 1200 to 900 cm-1 . Prediction models resulted in a 96·9% accurate classification of uninfected nails and nails infected with dermatophytes, nondermatophytes and yeasts. Overall correct classification rates of 91·0%, 97·7% and 98·6% were obtained for discrimination between dermatophyte, nondermatophyte and yeast genera or species, respectively. Spectra of in vivo infected and uninfected nails also revealed distinct spectral differences (3000-2811 cm-1 , 1043-950 cm-1 and 1676-1553 cm-1 ), illustrated by two main clusters (uninfected vs. infected) on a dendrogram. CONCLUSIONS: Our data suggest that ATR-FTIR spectroscopy may be a promising, fast and accurate method to determine onychomycosis, including identification of the causative organism, bypassing the need for lengthy fungal cultures.

Standardized added metabolic activity (SAM) IN ¹8F-FDG PET assessment of treatment response in colorectal liver metastases.

PURPOSE: Standardized added metabolic activity (SAM) is a PET parameter for assessing the total metabolic load of malignant processes, avoiding partial volume effects and lesion segmentation. The potential role of this parameter in the assessment of response to chemotherapy and bevacizumab was tested in patients with metastatic colorectal cancer with potentially resectable liver metastases (mCRC). METHODS: (18)F-FDG PET/CT was performed in 18 mCRC patients with liver metastases before treatment and after five cycles of FOLFOX/FOLFIRI and bevacizumab. Of the 18 patients, 16 subsequently underwent resection of liver metastases. Baseline and follow-up SUVmax, and SAM as well as reduction in SUVmax (∆SUVmax) and SAM (∆SAM) of all liver metastases were correlated with morphological response, and progression-free and overall survival (PFS and OS). RESULTS: A significant reduction in metabolic activity of the liver metastases was seen after chemotherapy with a median ∆SUVmax of 25.3% and ∆SAM of 94.5% (p = 0.033 and 0.003). Median baseline SUVmax and SAM values were significantly different between morphological responders and nonresponders (3.8 vs. 7.2, p = 0.021; and 34 vs. 211, p = 0.002, respectively), but neither baseline PET parameters nor morphological response was correlated with PFS or OS. Follow-up SUVmax and SAM as well as ∆SAM were found to be prognostic factors. The median PFS and OS in the patient group with a high follow-up SUVmax were 10.4 months and 32 months, compared to a median PFS of 14.7 months and a median OS which had not been reached in the group with a low follow-up SUVmax (p = 0.01 and 0.003, respectively). The patient group with a high follow-up SAM and a low ∆SAM had a median PFS and OS of 9.4 months and 32 months, whereas the other group had a median PFS of 14.7 months and a median OS which had not been reached (p = 0.002 for both PFS and OS). CONCLUSION: (18)F-FDG PET imaging is a useful tool to assess treatment response and predict clinical outcome in patients with mCRC who undergo chemotherapy before liver metastasectomy. Follow-up SUVmax, follow-up SAM and ∆SAM were found to be significant prognostic factors for PFS and OS.

Value of DCE-MRI and FDG-PET/CT in the prediction of response to preoperative chemotherapy with bevacizumab for colorectal liver metastases.

BACKGROUND: The purpose of this study was to assess the role of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and (18)F-fluorodeoxyglucose positron emission tomography computed tomography (FDG-PET/CT) for evaluation of response to chemotherapy and bevacizumab and for prediction of progression-free survival (PFS) in patients with metastatic colorectal cancer (mCRC) with potentially resectable liver lesions. METHODS: A total of 19 mCRC patients were treated with FOLFOX/FOLFIRI and bevacizumab followed by surgery. Dynamic contrast-enhanced magnetic resonance imaging and FDG-PET/CT were performed before treatment and after cycle 5. PET results were quantified by calculating maximum standardised uptake value (SUV(max)) whereas area under the enhancement curve (AUC), initial AUC (iAUC) and the endothelial transfer constant (K(trans)) were used to quantify DCE-MRI. Pathological analysis of the resection specimen was performed, including measurement of microvessel density (MVD) and proliferation index. RESULTS: Both AUC and iAUC were significantly decreased following bevacizumab therapy (median change of 22% (P=0.002) and 40% (P=0.001) for AUC and iAUC, respectively). Progression-free survival benefit was shown for patients with >40% reduction in K(trans) (P=0.019). In the group of radiological responders, the median baseline SUV(max) was 3.77 (IQR: 2.88-5.60) compared with 7.20 (IQR: 4.67-8.73) in nonresponders (P=0.021). A higher follow-up SUV(max) was correlated with worse PFS (P=0.012). Median MVD was 10.9. Progression-free survival was significantly shorter in patients with an MVD greater than 10, compared with patients with lower MVD (10 months compared with 16 months, P=0.016). CONCLUSION: High relative decrease in K(trans), low follow-up SUV(max) and low MVD are favourable prognostic factors for mCRC patients treated with bevacizumab before surgery.

[Reorganisation of the mental health services in Belgium in 2011. Will this lead to better care for patients with a serious mental illness?]. / Reorganisatie van de Belgische ggz; betere zorg voor mensen met een ernstige psychiatrische aandoening?

BACKGROUND: In Article 107 of the hospital legislation the Belgian government provides for a possible reorganisation of current mental health care. According to the Article, hospital managers and the medical staff of residential care units in each region are permitted tot re-allocate resources in such a way that their current government allowance is used for the development of an alternative type of health care that is more community-based. AIM: To explore the possible consequences that such a step is likely to have on the current users of long-term residential care. METHOD: We looked critically at the draft text which was circulated in order tot explain the proposed reorganisation. We evaluated the scientific evidence concerning the feasibility of the ideas put forward in the text, focusing particularly on the care of patients with a serious mental illness. RESULTS: The method, which involves the re-allocation of funds in order to stimulate the reorganisation of care, is considered to be self-defeating. On the one hand, it constitutes a threat, leading to possible closure of the least profitable services, including hospital wards for long-stay patients. On the other hand, the proposed health care organisation poses a threat to the very group of patients who reside in such hospitals and it may in fact lower the level of care they receive. CONCLUSION: It will be necessary to check on the effects that this reorganisation will have on patients with a serious mental illness. We therefore propose some ways of monitoring the effects that the planned reorganisation is likely to have on this vulnerable group of patients.

[Enlarged marginal incision in rhinoplasty: an anatomic and clinic study]. / La voie marginale élargie en rhinoplastie: étude anatomique et clinique.

OBJECTIVE: This study is an evaluation of technical feasibility and clinical results of the wide marginal rhinoplasty. MATERIALS AND METHODS: A wide marginal approach has been used in remodeling and positioning cartilage grafts in 13 cadavers. The clinical study was focused on 20 patients with aesthetics indications and no functional need. The practise was a work on the dorsum, the tip, resections of alar and cartilage graft positioning. We investigated the feasibility of different procedures, quality of exposure and we have identified the problems and incidents of dissection. In additional a subjective evaluation of patient satisfaction and a 6 to 15 months photographic follow up were performed. RESULTS: The operative incidents and problems were similar in anatomic and clinical study. Our study found an excellent technical feasibility with an easy job in the lateral areas and more difficult in median area. CONCLUSION: Wide marginal approach in rhinoplasty doesn't substitute open rhinoplasty but can be used in specific indications.

Synthesis, radiosynthesis and in vivo evaluation of [I]-4-(2-(bis(4-fluorophenyl)methoxy)ethyl)-1-(4-iodobenzyl)piperidine as a selective tracer for imaging the dopamine transporter.

Dopamine transporter (DAT) neuroimaging is a useful tool in Parkinson's disease diagnosis, staging and follow-up providing information on the integrity of the dopaminergic neurotransmitter system in vivo. 4-(2-(Bis(4-fluorophenyl)-methoxy)ethyl)-1-(4-iodobenzyl)piperidine (7) has nanomolar affinity for DAT and better selectivity over the other monoamine transporters compared with the existing SPECT radioligands for DAT. The aim of this study was to synthesize and evaluate [(123)I]-7 as an in vivo tracer for DAT.The tributylstannyl precursor was synthesized with an overall yield of 25%. [(123)I]-7 was synthesized by electrophilic destannylation with a yield of 40±10%. Radiochemical purity appeared to be >98%, whereas specific activity was at least 667 GBq/µmol. Biodistribution studies in mice showed brain uptake of 0.96±0.53%ID/g at 30 s post injection (p.i.) and 0.26±0.02%ID/g at 3 h p.i. High blood activity was observed at all time points. Pretreatment with Cyclosporin A raised brain uptake indicating that [(123)I]-7 is transported by P-glycoprotein (P-gp) pumps. In rats, regional brain distribution of [(123)I]-7 was not in agreement with DAT distribution. These results indicate that [(123)I]-7 is not suitable for mapping DAT in vivo but could be a useful tracer for the P-gp transporter.

Effect of cyclosporin A administration on the biodistribution and multipinhole muSPECT imaging of [123I]R91150 in rodent brain.

PURPOSE: P-glycoprotein (Pgp) is an efflux protein found amongst other locations in the blood-brain barrier. It is important to investigate the effect of Pgp modulation on clinically used brain tracers, because brain uptake of the tracer can be altered by blocking of the Pgp efflux transporter. The function of Pgp can be blocked with cyclosporin A. METHODS: We investigated the effect of cyclosporin A administration on the biodistribution of [(123)I]R91150 in rodents, and the effect of Pgp blocking on the quality of multipinhole muSPECT imaging with [(123)I]R91150. The influence of increasing doses of cyclosporin A on the brain uptake of [(123)I]R91150 was investigated in NMRI mice. A biodistribution study with [(123)I]R91150 was performed in male Sprague-Dawley rats pretreated with cyclosporin A and not pretreated. Brain uptake of [(123)I]R91150 after cyclosporin A injection was compared to the brain uptake in untreated animals, and a displacement study with ketanserin was performed in both groups. A multipinhole muSPECT brain imaging study was also performed using a Milabs U-SPECT-II camera in male Sprague-Dawley rats. To exclude the effect of possible metabolites, a metabolite study was also performed. RESULTS: At the highest cyclosporin A dose (50 mg/kg), a sevenfold increase in brain radioactivity concentration was observed in NMRI mice. Also, a dose-response relationship was established between the dose of cyclosporin A and the brain uptake of [(123)I]R91150 in mice. Compared to the control group, a five-fold increase in [(123)I]R91150 radioactivity concentration was observed in the brain of Sprague-Dawley rats after cyclosporin A treatment (50 mg/kg). Radioactivity concentration in the frontal cortex increased from 0.24+/-0.0092 to 1.58+/-0.097% injected dose per gram of tissue after treatment with cyclosporin A (at the 1-h time-point). Blood radioactivity concentrations did not increase to the same extent. The cortical activity was displaced by administration of ketanserin. A metabolite study confirmed that there was no increased metabolism of [(123)I]R91150 due to cyclosporin A. The visual quality of multipinhole muSPECT images with [(123)I]R91150 in Sprague-Dawley rats improved markedly after cyclosporin A pretreatment. CONCLUSION: From the results obtained in the biodistribution studies, it can be concluded that [(123)I]R91150 is a substrate for Pgp in rodents. A relationship between the administered dose of cyclosporin A and the increase in [(123)I]R91150 brain radioactivity concentration was established. The overall quality of our multipinhole muSPECT images with [(123)I]R91150 in rats improved markedly after pretreatment of the animals with cyclosporin A.

[Venous malformations of the parotid in adults. Report of two cases and review of the literature]. / Les malformations veineuses de la parotide chez l'adulte. A propos de deux cas et revue de la littérature.

Parotid vascular malformation in the adult is a very rare and benign tumor; only 47 cases were described in the world literature. This vascular malformation, mostly of venous origin is, on the opposite of the clinical, histological and evolution features of parotid hemangiomas in children, which are more frequent. Some clinical and radiological elements are pathognomonic allowing preoperative diagnosis. We present 2 cases of intraparotid venous malformation in adults, and based on an exhaustive study of the world literature discuss frequency, diagnosis and treatment of this disease.

The prolonged P(300) latency in recently detoxified alcohol-dependent patients is related to activation of the inflammatory response system.

The aims of this study were to examine the late components of the auditory event-related potentials (AERPs), i.e. N(100), P(200) and P(300), in recently detoxified alcohol-dependent patients compared to normal controls and to investigate whether there is a relationship between alterations in these AERPs and signs of activation of the inflammatory response system (IRS). The study subjects consisted of 14 healthy volunteers and 14 recently detoxified alcohol-dependent patients. All subjects performed a two-tone auditory discrimination task, using a standard "oddball" paradigm. The alcohol-dependent patients had their blood sampled to examine IRS markers, such as erythrocyte sedimentation rate (ESR), serum copper concentrations and the number of leukocytes. The P(300) latency was significantly greater in recently detoxified alcohol-dependent patients than in normal controls. There were significant correlations between the P(300) latency and the ESR (r = 0.84, p = 0.009), serum copper concentrations (r = 0.73, p = 0.01) and number of monocytes (r = 0.71, p = 0.006). It is concluded that the P(300) latency is prolonged in detoxified, chronic alcohol-dependent patients and is positively related to indicators of IRS activation. It is hypothesized that activation of the IRS may play a role in the delayed P(300) latency in recently detoxified, alcohol-dependent patients.