Clinical Evaluation of Scout Accelerated Motion Estimation and Reduction Technique for 3D MR Imaging in the Inpatient and Emergency Department Settings.

BACKGROUND AND PURPOSE: A scout accelerated motion estimation and reduction (SAMER) framework has been developed for efficient retrospective motion correction. The goal of this study was to perform an initial evaluation of SAMER in a series of clinical brain MR imaging examinations. MATERIALS AND METHODS: Ninety-seven patients who underwent MR imaging in the inpatient and emergency department settings were included in the study. SAMER motion correction was retrospectively applied to an accelerated T1-weighted MPRAGE sequence that was included in brain MR imaging examinations performed with and without contrast. Two blinded neuroradiologists graded images with and without SAMER motion correction on a 5-tier motion severity scale (none = 1, minimal = 2, mild = 3, moderate = 4, severe = 5). RESULTS: The median SAMER reconstruction time was 1 minute 47 seconds. SAMER motion correction significantly improved overall motion grades across all examinations (P < .005). Motion artifacts were reduced in 28% of cases, unchanged in 64% of cases, and increased in 8% of cases. SAMER improved motion grades in 100% of moderate motion cases and 75% of severe motion cases. Sixty-nine percent of nondiagnostic motion cases (grades 4 and 5) were considered diagnostic after SAMER motion correction. For cases with minimal or no motion, SAMER had negligible impact on the overall motion grade. For cases with mild, moderate, and severe motion, SAMER improved the motion grade by an average of 0.3 (SD, 0.5), 1.1 (SD, 0.3), and 1.1 (SD, 0.8) grades, respectively. CONCLUSIONS: SAMER improved the diagnostic image quality of clinical brain MR imaging examinations with motion artifacts. The improvement was most pronounced for cases with moderate or severe motion.

Dental, oral pH, orthodontic and salivary values in children with obstructive sleep apnea.

OBJECTIVES: Mouth breathing is a key feature of obstructive sleep apnea (OSA). The current study evaluated dental, salivary and orthodontic characteristics of children with OSA, and compared them to those of children without OSA. MATERIALS AND METHODS: Twenty-two children (mean age 5.3 years, 13 males) with OSA and 21 children without OSA who served as a control group (mean age 6.8 years, 11 males) underwent dental examinations. The OSA group was classified according to the apnea-hypopnea Index. Clinical examination included plaque index, gingival index, caries status, pH at 7 oral sites, salivary carries bacterial counts and inflammatory cytokine levels. Orthodontics measurements were calculated as the percentage of children with values in the normal range, in each group. RESULTS: The mean values of the decayed, missing and filled teeth (DMFT)/dmft index, the gingival index and the plaque index were higher in the OSA than the control group. Salivary Mutans streptococci and lactobacilli counts were significantly higher in the OSA than the control group; as were pH values in the hard and soft palate, and in the posterior and middle tongue. Significantly lower values were observed in the OSA than the control group for most of the orthodontic variables examined. Similarly, stratification of AHI according to severity shows the lowest values among those with mild OSA, and the highest among those with severe AHI. CONCLUSIONS: Compared to a control group, mouth breathing children with obstructive sleep apnea had differences in oral microbiota, greater acidity and poorer dental status. CLINICAL RELEVANCE: Clinicians should be aware of the various oral disturbances that may accompany OSA, and implement preventive measures.

Evaluation of Ultrafast Wave-Controlled Aliasing in Parallel Imaging 3D-FLAIR in the Visualization and Volumetric Estimation of Cerebral White Matter Lesions.

BACKGROUND AND PURPOSE: Our aim was to evaluate an ultrafast 3D-FLAIR sequence using Wave-controlled aliasing in parallel imaging encoding (Wave-FLAIR) compared with standard 3D-FLAIR in the visualization and volumetric estimation of cerebral white matter lesions in a clinical setting. MATERIALS AND METHODS: Forty-two consecutive patients underwent 3T brain MR imaging, including standard 3D-FLAIR (acceleration factor = 2, scan time = 7 minutes 50 seconds) and resolution-matched ultrafast Wave-FLAIR sequences (acceleration factor = 6, scan time = 2 minutes 45 seconds for the 20-channel coil; acceleration factor = 9, scan time = 1 minute 50 seconds for the 32-channel coil) as part of clinical evaluation for demyelinating disease. Automated segmentation of cerebral white matter lesions was performed using the Lesion Segmentation Tool in SPM. Student t tests, intraclass correlation coefficients, relative lesion volume difference, and Dice similarity coefficients were used to compare volumetric measurements among sequences. Two blinded neuroradiologists evaluated the visualization of white matter lesions, artifacts, and overall diagnostic quality using a predefined 5-point scale. RESULTS: Standard and Wave-FLAIR sequences showed excellent agreement of lesion volumes with an intraclass correlation coefficient of 0.99 and mean Dice similarity coefficient of 0.97 (SD, 0.05) (range, 0.84-0.99). Wave-FLAIR was noninferior to standard FLAIR for visualization of lesions and motion. The diagnostic quality for Wave-FLAIR was slightly greater than for standard FLAIR for infratentorial lesions (P < .001), and there were fewer pulsation artifacts on Wave-FLAIR compared with standard FLAIR (P < .001). CONCLUSIONS: Ultrafast Wave-FLAIR provides superior visualization of infratentorial lesions while preserving overall diagnostic quality and yields white matter lesion volumes comparable with those estimated using standard FLAIR. The availability of ultrafast Wave-FLAIR may facilitate the greater use of 3D-FLAIR sequences in the evaluation of patients with suspected demyelinating disease.

Salivary biochemical variables in liver transplanted children and young adults.

PURPOSE: To investigate associations between levels of blood parameters used to monitor liver-transplanted children with their salivary levels, and compare the salivary parameters of transplant recipients with those of healthy controls. METHODS: Saliva and blood samples from 30 liver transplanted recipients, mean age 11.7 years and saliva from age and sex matched 27 healthy patients were analyzed using a standard complete blood count test. RESULTS: Uric acid and alkaline phosphatase levels correlated significantly between saliva and blood samples in the transplanted subjects. Median salivary sodium level was significantly lower and the median salivary potassium level significantly higher in transplant recipients compared with healthy subjects. No differences were found between the groups in salivary glucose, urea, chloride, total protein, albumin, calcium, phosphorus, uric acid, total bilirubin, alkaline phosphatase, lactate dehydrogenase (LDH), glutamic oxaloacetic transaminase (GOT), triglycerides, cholesterol, iron, transferrin, glutamic pyruvic transaminase (GPT) and gamma-glutamyltranspeptidase (GGT). CONCLUSION: Specific correlations of serum and salivary chemistry were found in liver transplant patients. Such information may lead to the development of noninvasive monitoring tools for this population.

Evaluation of Ultrafast Wave-CAIPI MPRAGE for Visual Grading and Automated Measurement of Brain Tissue Volume.

BACKGROUND AND PURPOSE: Volumetric brain MR imaging typically has long acquisition times. We sought to evaluate an ultrafast MPRAGE sequence based on Wave-CAIPI (Wave-MPRAGE) compared with standard MPRAGE for evaluation of regional brain tissue volumes. MATERIALS AND METHODS: We performed scan-rescan experiments in 10 healthy volunteers to evaluate the intraindividual variability of the brain volumes measured using the standard and Wave-MPRAGE sequences. We then evaluated 43 consecutive patients undergoing brain MR imaging. Patients underwent 3T brain MR imaging, including a standard MPRAGE sequence (acceleration factor [R] = 2, acquisition time [TA] = 5.2 minutes) and an ultrafast Wave-MPRAGE sequence (R = 9, TA = 1.15 minutes for the 32-channel coil; R = 6, TA = 1.75 minutes for the 20-channel coil). Automated segmentation of regional brain volume was performed. Two radiologists evaluated regional brain atrophy using semiquantitative visual rating scales. RESULTS: The mean absolute symmetrized percent change in the healthy volunteers participating in the scan-rescan experiments was not statistically different in any brain region for both the standard and Wave-MPRAGE sequences. In the patients undergoing evaluation for neurodegenerative disease, the Dice coefficient of similarity between volumetric measurements obtained from standard and Wave-MPRAGE ranged from 0.86 to 0.95. Similarly, for all regions, the absolute symmetrized percent change for brain volume and cortical thickness showed <6% difference between the 2 sequences. In the semiquantitative visual comparison, the differences between the 2 radiologists' scores were not clinically or statistically significant. CONCLUSIONS: Brain volumes estimated using ultrafast Wave-MPRAGE show low intraindividual variability and are comparable with those estimated using standard MPRAGE in patients undergoing clinical evaluation for suspected neurodegenerative disease.

Bovine Bone Promotes Osseous Protection via Osteoclast Activation.

The current study aimed at investigating the long-term biological mechanisms governing bone regeneration in osseous defects filled with bovine bone (BB). Tooth extraction sockets were filled with BB or left unfilled for natural healing in a C57BL/6 mouse alveolar regeneration bone model (n = 12). Seven weeks later, the alveolar bone samples were analyzed histologically with hematoxylin/eosin and tartrate-resistant acid phosphatase staining. A separate group (n = 10) was used for RNA sequencing. Osteoclast inhibition was induced by zoledronic acid (ZA) administration at 2 wk postextraction in a third group (n = 28) for examination of osseous changes and cellular functions with micro-computed tomography and quantitative reverse transcription polymerase chain reaction, respectively. Histological and radiological osseous healing was observed in both BB-filled and normal-healing sockets. However, BB regenerated bone showed significant robust expression of genes associated with bone homeostasis and osteoclasts' function. Osteoclasts' inhibition in BB-filled sockets led to decreased bone resorption markers and reduced bone formation to a greater extent than that observed in osteoclasts' inhibition with natural healing. BB displays long-term biologically active properties, despite a naive osseous histological appearance. These include activation of osteoclasts, which in turn promotes osseous remodeling and maturation of ossified bone.

Altered expression of regulatory molecules in the skin of psoriasis.

The presence of T regulatory cells (Tregs) is highly required in normal skin in order to maintain immune tolerance to commensal microbes and to prevent the development of immune-mediated inflammation. Psoriasis is a chronic inflammatory skin disease in which effector T cells, namely, Th17 and their relevant pro-inflammatory cytokines are increased in peripheral blood as well as in the inflamed skin. The status of Tregs in psoriatic skin is continuously studied. In this case, CD4 + CD25high T cells and other regulatory cytokines such as IL-35 are demonstrated to be significantly decreased. Aiming to better characterize Tregs in psoriatic skin and to establish the finding of their abnormal balance, we assessed the expression of semaphorin3A and neuropilin-1 (both reported as biomarkers of Tregs). Semaphorin3A and neuropilin-1 expressing Tregs were found to be significantly decreased in psoriatic skin when compared to normal skin. These findings were supported by demonstrating the downregulation of IL-10 expression in psoriatic skin. Our findings suggest that semaphoring3A may turn to be a new promising therapeutic approach in the process of improving Treg function in psoriasis.

Association of dental and maxillary sinus pathologies with ear, nose, and throat symptoms.

OBJECTIVES: To investigate the correlation between cone-beam computerized tomography (CBCT) findings in the maxillary sinus, ear-nose-throat (ENT) symptoms and dental pathologies in asymptomatic patients. MATERIALS AND METHODS: A total 81 patients were referred for CBCT and filled a standard ENT visual analog scale (VAS) questionnaire. CBCT images were analyzed for sinus ostium obstruction, Schneiderian membrane thickening, sinus floor turbidity, and the presence of polyps. Dental pathologies were evaluated with the aid of CBCT images, periapical X-rays, and clinical examination. A possible correlation between the CBCT findings and the ENT/dental parameters was examined by applying Student's t test and the chi-squared test. RESULTS: Despite being asymptomatic, most of the 81 patients reported ENT symptoms in the questionnaire, thereby indicating that these symptoms were mainly subclinical. A significant correlation was found between the presence of polyps in the sinus and a decrease in smell/taste. Obstruction of the sinus meatus was associated with coughing; turbidity was associated with ear congestion. Thickening of the Schneiderian membrane showed an association with both coughing and ear congestion. The mean number of missing posterior teeth correlated with postnasal drip and nasal congestion. Periapical pathology was associated with nasal discharge/runny nose. CONCLUSION: The results emphasize the need to evaluate ENT symptoms when radiographic findings are identified in CBCT.

Host susceptibility to periodontitis: mapping murine genomic regions.

Host susceptibility to periodontal infection is controlled by genetic factors. As a step toward identifying and cloning these factors, we generated an A/J x BALB/cJ F2 mouse resource population. A genome-wide search for Quantitative Trait Loci (QTL) associated with periodontitis was performed. We aimed to quantify the phenotypic response of the progenies to periodontitis by microCT analysis, to perform a genome-wide search for QTL associated with periodontitis, and, finally, to suggest candidate genes for periodontitis. We were able to produce 408 F2 mice. All mice were co-infected with Porphyromonas gingivalis and Fusobacterium nucleatum bacteria. Six weeks following infection, alveolar bone loss was quantified by computerized tomography (microCT) technology. We found normal distribution of the phenotype, with 2 highly significant QTL on chromosomes 5 and 3. A third significant QTL was found on chromosome 1. Candidate genes were suggested, such as Toll-like receptors (TLR) 1 and 6, chemokines, and bone-remodeling genes (enamelin, ameloblastin, and amelotin). This report shows that periodontitis in mice is a polygenic trait with highly significant mapped QTL.

["Stealing madness"--kleptomania].

Kleptomania is one of the common less diagnosed impulse control disorders, which could be treated by the combination of psychological and pharmacological therapy. The most effective treatment regimens include cognitive behavioral therapy and interpersonal psychotherapy in the psychological field, and antidepressants and mood stabilizers as pharmacological treatment. Most of the patients with kleptomania are initially treated only for a comorbid psychiatric disorder, since kleptomaniac symptoms had not been raised in the anamnesis. The aim of our article is to inform the physicians about the possible diagnosis and treatment options for this disorder in order to prevent co-morbidity with other psychiatric disorders. Some specific cases are presented in order to explain symptomatology.

[Unstable coronary disease--clinical course and significance of exercise tests in patients with left coronary artery stenosis]. / Niestabilna choroba wiencowa--obraz kliniczny i wartosc próby wysilkowej u chorych ze zwezeniem pnia lewej tetnicy wiencowej.

This study aimed at evaluating predictive value of exercise tests in case of left coronary artery stenosis. The study involved 57 patients with left coronary artery stenosis, including 10 patients with isolated left main stenosis (group X), and 47 patients with left coronary artery stenosis and multivessel involvement (group Y). Unstable angina was staged according to Booth et al. classification as type I or II. Exercise tests were performed according to Bruce's protocol. Unstable angina of type I was diagnosed in 51 (89%) patients, and type II in 6 (11%) patients. Electrocardiographic evidence of myocardial ischemia both et rest and anginal pain was seen in 46 (80%) patients. Electrocardiographic recording was within normal limits in 11 (20%) patients at rest. Clinical and ECG improvement was seen in 38 (66%) patients. Exercise tests in all of these patients were positive at low load work--mean 50 W. The obtained results suggest that patients with left coronary stenosis constitute heterogenous group. Therefore, prediction of the left main stenosis on the clinical ground alone is impossible. Exercise tests producing positive results at low load indicate with high probability critical multivessel lesions and/or left main stenosis in such patients.

[Epidemiologic characteristics of human parvovirus B19. Report of an epidemic of erythema infectiosum in the area of Belgrade]. / Epidemioloske osobenosti humanog parvovirusa B19. Prikaz epidemije Erythema infectiosum otkrivene na teritoriji Beograda.

During the period 29.10.1987-10.5.1988 an outbreak of an illness with rash resembling Erythema Infectiosum occurred among school children in one part of Belgrade-Mladenovac. This is the first outbreak of Erythema Infectiosum reported in Yugoslavia and confirmed in University College of Middlesex School of Medicine, London, in November 1989. Of 720 school children exposed to infection of Human Parvovirus B 19 two hundred and eighty four (39.4%) have had clinical symptoms and 166 (58.4%) of them were in the age group 10-14. The sero-epidemiologic investigations excluded infection of Rubella virus, Cytomegalovirus and Coxsackie viruses A 9 and B 5. To detect the infection Elisa IgM antibody, complement fixation, inhibition of hemagglutination and isolation have been used. Clinical symptoms of illness have been manifested as Rubella like exanthemas on extremities in 92.5%, extremities and body in 26.5% and the phenomenon "slapped Cheek" was discovered in 76.25% of all patients. Reappearance of rash has been observed in 25% of cases.

[Cerebellitis during Mycoplasma pneumoniae infection]. / Cerebelitis u toku infekcije Mycoplasmom pneumoniae.

Mycoplasma pneumoniae is the primary cause of respiratory system diseases in school children and young adults. Most often an infection of the upper respiratory airways is in question, with or without pharyngitis, while clinically manifest pneumonia occurs in only 3-10% of patients. However, multisystemic manifestations of Mycoplasma pneumoniae infections can also occur, usually during the first 14 days after the start of respiratory symptomatology, but can also occur as isolated in some cases, with no prior respiratory illness, nor its later occurrence. In our patient there came to a development of pneumonia, exudative pleuritis, sinusitis and cerebellitis. The duration of the disease was protracted, but recovery was complete, without sequelae. The etiological diagnosis was set retrospectively on the basis of the dynamics of the titer of complement fixating antibodies. Mycoplasma pneumoniae should be considered as a possible etiological agent of various clinical syndromes.

[Severe hypotension in cesarean section. Aortocaval compression and regional anesthesia]. / Alvorlig hypotensjon ved keisersnitt. Aortokaval kompresjon og regional anestesi.

Three patients due to be operated by caesarean section under regional anaesthesia developed severe hypotension/circulatory collapse. The sympaticus blockade induced by epidural-/spinal anaesthesia aggravates the effect of aortocaval compression present in all pregnant women at term. We discuss prophylactic measures and treatment of hypotension.

A modified laparoscopic approach for liver biopsy in dogs.

A modified laparoscopic technique for liver biopsy in dogs was developed, using an otoscope to observe the liver and to guide the biopsy needle. The procedure was used to obtain liver biopsy specimens from 7 control dogs and 22 treated dogs during studies of the hepatic effects of long-term anticonvulsant drug therapy. In addition, biopsy specimens were obtained from 10 clinical patients with diffuse liver disease. Diagnostic liver specimens were obtained from all dogs with minimal complications. The procedure used basic principles of needle biopsy technique under visual control. It enabled the operator to observe the liver, select a biopsy site, and obtain diagnostic samples quickly, with considerably less expense than by use of fiberoptic laparoscopy. The results of this study indicate that the modified laparoscopic approach is a safe, practical method for liver biopsy in dogs.

Acute hemolytic anemia, methemoglobinemia, and heinz body formation associated with ingestion of red maple leaves by horses.

From June 1975 through June 1979, acute hemolytic anemia developed in 11 horses from 7 New York farms. Of the 7 horses that died, 6 had methemoglobinemia. In the 4 horses that recovered, methemoglobinemia was not observed. but Heinz body formation was seen in 3 of the 4. On 2 of the premises involved, frank methemoglobinemia was observed concurrently with Heinz body formation, suggesting a relationship between the pathogenesis of methemoglobinemia and Heinz body formation in the hemolytic process. In addition to the 11 cases described, 22 clinically similar cases were reported to us during the period of this investigation by practicing veterinarians from New York, Pennsylvania, and the New England states. All 33 cases of hemolytic anemia occurred between June and October of each year, and affected horses had access to outside paddocks or fields containing a variety of native grasses, weeds, and trees. On 2 farms, hemolytic anemia developed after the horses were observed browsing fallen branches of red maple trees (Acer rubrum). Red maple leaves and bark were obtained from 1 of these farms, and approximately 1 kg of a leaf and bark mixture was fed to each of 2 ponies. Within 48 hours, both ponies became ill. The syndrome was indistinguishable from that observed in clinical patients and was characterized by methemoglobinemia and intravascular hemolysis. The ponies died 5 and 6 days after which time the packed cell volumes were 6% and 7% respectively. It was concluded that many cases of hemolytic anemia in horses in northeastern states may be related to ingestion of leaves or bark from red maple trees. The studies did not, however, define the factors that predispose to poisoning and did not exclude the possibility that other environmental toxins may have been involved.