Dynamic Angiography and Perfusion Imaging Using Flat Detector CT in the Angiography Suite: A Pilot Study in Patients with Acute Middle Cerebral Artery Occlusions.

BACKGROUND AND PURPOSE: Perfusion and angiographic imaging using intravenous contrast application to evaluate stroke patients is now technically feasible by flat detector CT performed by the angiographic system. The aim of this pilot study was to show the feasibility and qualitative comparability of a novel flat detector CT dynamic perfusion and angiographic imaging protocol in comparison with a multimodal stroke MR imaging protocol. MATERIALS AND METHODS: In 12 patients with acute stroke, MR imaging and the novel flat detector CT protocol were performed before endovascular treatment. Perfusion parameter maps (MTT, TTP, CBV, CBF) and MIP/volume-rendering technique images obtained by using both modalities (MR imaging and flat detector CT) were compared. RESULTS: Comparison of MIP/volume-rendering technique images demonstrated equivalent visibility of the occlusion site. Qualitative comparison of perfusion parameter maps by using ASPECTS revealed high Pearson correlation coefficients for parameters CBF, MTT, and TTP (0.95-0.98), while for CBV, the coefficient was lower (0.49). CONCLUSIONS: We have shown the feasibility of a novel dynamic flat detector CT perfusion and angiographic protocol for the diagnosis and triage of patients with acute ischemic stroke. In a qualitative comparison, the parameter maps and MIP/volume-rendering technique images compared well with MR imaging. In our opinion, this flat detector CT application may substitute for multisection CT imaging in selected patients with acute stroke so that in the future, patients with acute stroke may be directly referred to the angiography suite, thereby avoiding transportation and saving time.

C-arm CT measurement of cerebral blood volume and cerebral blood flow using a novel high-speed acquisition and a single intravenous contrast injection.

BACKGROUND AND PURPOSE: Assessment of perfusion parameters is important in the selection of patients who are most likely to benefit from revascularization after an acute ischemic stroke. The aim of this study was to evaluate the feasibility of measuring cerebral perfusion parameters with the use of a novel high-speed C-arm CT acquisition in conjunction with a single intravenous injection of contrast. MATERIALS AND METHODS: Seven canines had experimentally induced focal ischemic regions confirmed by CT perfusion imaging. Four hours after ischemic injury creation, each subject underwent cerebral perfusion measurements with the use of standard perfusion CT, immediately followed by the use of C-arm CT. Cerebral blood flow and cerebral blood volume maps measured by C-arm CT were quantitatively and qualitatively compared with those measured by perfusion CT for 6 of the 7 canine subjects. RESULTS: Results from independent observer evaluations of perfusion CT and C-arm perfusion maps show strong agreement between observers for identification of ischemic lesion location. Significant percentage agreement between observers for lesion detection and identification of perfusion mismatch between CBV and CBF maps indicate that the maps for both perfusion CT and C-arm are easy to interpret. Quantitative region of interest-based evaluation showed a strong correlation between the perfusion CT and C-arm CBV and CBF maps (R(2) = 0.68 and 0.85). C-arm measurements for both CBV and CBF were consistently overestimated when compared with perfusion CT. CONCLUSIONS: Qualitative and quantitative measurements of CBF and CBV with the use of a C-arm CT acquisition and a single intravenous injection of contrast agent are feasible. Future improvements in flat detector technology and software algorithms probably will enable more accurate quantitative perfusion measurements with the use of C-arm CT.

Risedronate preserves bone architecture in early postmenopausal women in 1 year as measured by three-dimensional microcomputed tomography.

Risedronate reduces the risk of vertebral fractures by up to 70% within the first year of treatment. Increases in bone mineral density or decreases in bone turnover markers explain only a portion of the anti-fracture effect, suggesting that other factors, such as changes in trabecular bone architecture, also play a role. Our objective was to determine the effects of risedronate on bone architecture by analyzing iliac crest bone biopsy specimens using three-dimensional microcomputed tomography (3-D micro CT). Biopsy specimens were obtained at baseline and after 1 year of treatment from women enrolled in a double-blind, placebo-controlled study of risedronate 5 mg daily for the prevention of early postmenopausal bone loss. Trabecular architecture deteriorated in the placebo group (n = 12), as indicated by a 20.3% decrease in bone volume (25.1% vs. 20.0%, P = 0.034), a 13.5% decrease in trabecular number (1.649 vs. 1.426 mm(-1), P = 0.052), a 13.1% increase in trabecular separation (605 vs. 684 microm, P = 0.056), and an 86.2% increase in marrow star volume (3.251 vs. 6.053 mm(3), P = 0.040) compared with baseline values. These changes in architectural parameters occurred in the presence of a concomitant decrease from baseline in lumbar spine bone mineral density (-3.3%, P = 0.002), as measured by dual energy x-ray absorptiometry. There was no statistically significant ( P < 0.05) deterioration in the risedronate-treated group (n = 14) over the 1-year treatment period. Comparing the actual changes between the two groups, the placebo group experienced decreases in bone volume (placebo, -5.1%; risedronate, +3.5%; P = 0.011), trabecular thickness (placebo, -20 microm; risedronate, +23 microm; P = 0.032), and trabecular number (placebo, -0.223 mm(-1); risedronate, +0.099 mm(-1); P = 0.010), and increases in percent plate (placebo, +2.79%; risedronate, -3.23%; P = 0.018), trabecular separation (placebo, +79 microm; risedronate, -46 microm; P = 0.010) and marrow star volume (placebo, +2.80 mm(3); risedronate, -2.08mm(3); P = 0.036), compared with the risedronate group. These data demonstrate that trabecular architecture deteriorated significantly in this cohort of early postmenopausal women, and that this deterioration was prevented by risedronate. Although there is no direct link in this study between fracture and preservation of architecture, it is reasonable to infer that the preservation of bone architecture may play a role in risedronate's anti-fracture efficacy.

The effect of segmental order on fricative labeling by children and adults.

We examined whether children modify their perceptual weighting strategies for speech on the basis of the order of segments within a syllable, as adults do. To this end, fricative-vowel (FV) and vowel-fricative (VF) syllables were constructed with synthetic noises from an/[symbol: see text]/-to-/s/continuum combined with natural/a/and/u/portions with transitions appropriate for a preceding or a following /[symbol: see text]/or/s/. Stimuli were played in their original order to adults and children (ages of 7 and 5 years) in Experiment 1 and in reversed order in Experiment 2. The results for adults and, to a lesser extent, those for 7-year-olds replicated earlier results showing that adults assign different perceptual weights to acoustic properties, depending on segmental order. In contrast, results for 5-year-olds suggested that these listeners applied the same strategies during fricative labeling, regardless of segmental order. Thus, the flexibility to modify perceptual weighting strategies for speech according to segmental order apparently emerges with experience.

Bismuth subsalicylate in the treatment of acute diarrhea in children: a clinical study.

Bismuth subsalicylate (BSS) and placebo were evaluated in a double-blind, placebo-controlled study as adjunct to rehydration therapy in 123 children, aged 4 to 28 months, hospitalized with acute diarrhea. The dosing regimen was 20 mg/kg five times daily for 5 days. Significant benefits were noted in the BSS group compared with placebo as manifested by decreases in stool frequency and stool weights and an improvement in stool consistency, significant improvement in clinical well-being, and shortening of the disease duration. Patients treated with BSS had a significant reduction in duration of hospital stay (6.9 days) compared with placebo-treated patients (8.5 days). Also, intravenous fluid requirements decreased significantly more rapidly and to a greater degree in the BSS-treated group. Bismuth subsalicylate was associated with clearance of pathogenic Escherichia coli from the stools in 100% of cases but was not different from placebo in rotavirus elimination. Bismuth subsalicylate was well tolerated with no reported adverse effects. Blood bismuth and serum salicylate levels were well below levels considered toxic. In this study, BSS provided effective adjunctive therapy for acute diarrhea, allowing children to get well sooner with less demand on the nursing and hospital staff.

In vitro antimicrobial activity of bismuth subsalicylate and other bismuth salts.

This report demonstrates that bismuth subsalicylate (BSS) effectively inhibits growth of a number of bacterial strains known to cause diarrhea, including Escherichia coli, Salmonella, Shigella, and Campylobacter. Other bismuth salts and sodium salicylate, a hydrolysis product of BSS in the gut, also were examined and were shown to have various degrees of activity. Growth of the organisms was monitored in vitro by inoculating culture fluid that contained one of the compounds to be tested and determining the concentration of viable organisms over a 24-hour period. Control cultures of each organism were grown in the absence of bismuth subsalicylate. BSS inhibited growth of all organisms examined in a dose-dependent fashion. Reductions of 2-6 logs, as compared with controls, were observed in cultures grown in the presence of 10-50 mM BSS. Other bismuth salts displayed various degrees of inhibition. These results suggest that the efficacy of BSS as an antidiarrheal agent may be related to an antimicrobial mechanism of action.

A clinical comparison of antibacterial mouthrinses: effects of chlorhexidine, phenolics, and sanguinarine on dental plaque and gingivitis.

This study compared the clinical efficacy of three mouthrinses containing either 0.12% chlorhexidine, phenolic compounds, or sanguinarine, which were used unsupervised, in a placebo-controlled, double-blind study of 6 months' duration. The study was conducted according to ADA clinical guidelines for evaluation of antigingivitis agents and was completed by 481 adults. Following baseline exams and a prophylaxis, subjects were randomly divided into treatment groups matched for age, gender, and gingivitis severity, and were instructed to use the rinses in accordance with manufacturer's directions. Followup examinations evaluated supragingival plaque, gingivitis, and gingival bleeding. Compared to placebo at 6 months, the group rinsing with 0.12% chlorhexidine had significantly less gingivitis (31% reduction), gingival bleeding (39% reduction), and plaque (49% reduction) and was significantly better than any of the other treatment groups (P less than 0.05). Both the phenolic and sanguinarine groups showed moderate, yet significant, reductions in plaque compared to placebo (24% and 12% respectively) yet were significantly less effective than the 0.12% chlorhexidine rinse (P less than 0.05). However, neither the phenolic nor sanguinarine rinses were significantly different than placebo in their effects on gingivitis or gingival bleeding. These results support previous published results on the superiority of 0.12% chlorhexidine when used in conjunction with professional care and as an adjunct to routine oral hygiene practices.

Prevention of traveler's diarrhea by the tablet form of bismuth subsalicylate.

In a randomized double-blind study, Swiss adults traveling to tropical countries for 12 to 28 days took a solid formulation of bismuth subsalicylate (1.05 or 2.1 g/day on a twice-daily regimen) or placebo. Efficacy was evaluated in 231 volunteers. Diarrheal incidence was reduced by 41% in persons taking the high dose (P = 0.007) and by 35% in those taking the low dose (P = 0.03) with excellent compliance. No serious adverse reactions occurred, but objectionable taste, constipation, and nausea were seen more frequently with active medication (P = 0.04). Twenty patients provided stool samples: no bacteria were detected in the 8 volunteers who were on active medication, but various bacteria were found in 5 of the 12 patients who had taken placebo (P = 0.04).

Evidence for pseudomonas exotoxin A receptors on plasma membrane of toxin-sensitive lm fibroblasts.

Pseudomonas exotoxin A enters mouse LM fibroblasts by receptor-mediated endocytosis and ultimately causes cell death. Here we present evidence for the existence of a specific receptor for the toxin. Toxin association with LM cells at 18 and 37 degrees C, but not at 4 degrees C, was highly specific. At 37 degrees C, the association increased with time, reaching a steady state by 5 h. Binding to paraformaldehyde-fixed cells at 37 degrees C was saturable (Kd = 5.4 nM), was reversible, and indicated ca. 100,000 binding sites per cell. It is believed that receptor-bound toxin is responsible for cell death. Once the kinetics of toxin entry were described, we examined the effect of reduced temperatures on the intracellular processing of toxin and thus its expression. Toxin-induced inhibition of protein synthesis was minimal at temperatures below 20 degrees C. This was seen even though at 20 degrees C sufficient toxin was internalized to kill cells, and toxin enzyme activity was maximal. Internalization of 125I-labeled toxin, but not of 125I-labeled horseradish peroxidase (marker of fluid-phase endocytosis), became rate limiting at 20 degrees C or below. These data suggest that reduced temperatures block a step in the receptor-mediated endocytic pathway essential for the expression of Pseudomonas toxin activity.

Receptor-mediated entry of Pseudomonas toxin: methylamine blocks clustering step.

Clustering of ligands into coated regions of the plasma membrane is an early step in receptor-mediated endocytosis. The association of Pseudomonas exotoxin A (PE) with mouse LM fibroblasts was visualized by using biotinyl-PE and avidingold. Movement of PE into coated regions occurred within 30 s of warming monolayers to 37 degrees C. This clustering was stopped by the primary amines methylamine and ammonium chloride but was not altered by the tertiary amine chloroquine. Toxin internalization was rapid, with a half-time of approximately 5 min. Although primary amines stopped clustering, they did not alter the rate of toxin internalization; they did alter the route followed after entry. We have shown previously that methylamine protects cells from the lethal action of PE. Here we suggest that methylamine protects, at least in part, by blocking clustering, and that receptor-mediated endocytosis is required for efficient expression of PE toxicity.

Tumor and histocompatibility antigen interaction: direct visualization by a double-label bridging technique for immuno-electron microscopy.

The nature of the interaction between the Ib tumor-associated surface antigen (Ib-TASA) and the Dk and Kk (Dk/Kk) regions of the major histocompatibility complex on the surface of line Ib lymphocytes was evaluated by immuno-electron microscopy using a double-label bridging technique. Quantitation of antigenic sites by direct counts showed 44% of the Ib-TASA sites coincident with Dk/Kk antigens. This is greater than the predicted random interaction of two independent cell surface determinants suggesting an associative interaction, i.e. 'altered-self' antigen. The remaining 56% of the Ib-TASA sites were in a non-associative mode. On the basis of data presented here, we postulate that the interaction between 'self'- and 'non-self' antigens is not an 'all or none' phenomenon.