Patterned edge-illuminated display for clinical examination of visual evoked potentials using simultaneous magnetic resonance imaging.

PURPOSE: Commonly used technologies for visual pattern stimulation cannot operate in a magnetic resonance imaging room because they can interfere with the operation of the scanner and are vulnerable to its electromagnetic and magnetic fields. The aim of this single-center prospective observational study was to introduce a novel, structurally uncomplicated, easy-to-maintain, patterned edge-illuminated display (PEID) device for visual pattern-reversal stimulation, compare it with a commonly used cathode ray tube screen, and verify the equivalence of quantitative assays. MATERIALS AND METHODS: The left and right eyes of 36 healthy participants with undilated pupils were examined on a commercial visual evoked potential (VEP) apparatus and on the PEID device, where pattern-reversal transient VEPs were elicited by checkerboard stimuli with large (0.89°; 0.86°-0.92°) and small (0.21°; 0.20°-0.23°) checks. RESULTS: The PEID device demonstrated the required reliability and dynamic characteristics, as well as precise time-locking required for a VEP diagnosis. The results of Deming's correlation analysis showed that both the commercial cathode ray tube monitor and the PEID device produced identical VEP results within the context of experimental uncertainty. The standard deviation of Deming's regression may indicate the uncertainty of the VEPs measured in clinical practice. The Bland-Altman analysis of the mean showed no significant difference in the amplitude and peak time of VEPs measured on the PEID device compared to that of the commercial cathode ray tube monitor. CONCLUSIONS: The presented PEID device meets all the required standards and can be easily installed in various types of commercial magnetic resonance imaging scanners.

Visualization of human optic nerve by diffusion tensor mapping and degree of neuropathy.

Diffusion-weighted magnetic resonance imaging of the human optic nerve and tract is technically difficult because of its small size, the inherent strong signal generated by the surrounding fat and the cerebrospinal fluid, and due to eddy current-induced distortions and subject movement artifacts. The effects of the bone canal through which the optic nerve passes, and the proximity of blood vessels, muscles and tendons are generally unknown. Also, the limited technical capabilities of the scanners and the minimization of acquisition times result in poor quality diffusion-weighted images. It is challenging for current tractography methods to accurately track optic pathway fibers that correspond to known anatomy. Despite these technical limitations and low image resolution, here we show how to visualize the optic nerve and tract and quantify nerve atrophy. Our visualization method based on the analysis of the diffusion tensor shows marked differences between a healthy male subject and a male subject with progressive optic nerve neuropathy. These differences coincide with diffusion scalar metrics and are not visible on standard morphological images. A quantification of the degree of optic nerve atrophy in a systematic way is provided and it is tested on 9 subjects from the Human Connectome Project.

The Learning Curve and Inter-Observer Variability in Contouring the Hippocampus under the Hippocampal Sparing Guidelines of Radiation Therapy Oncology Group 0933.

Hippocampal-sparing brain radiotherapy (HS-BRT) in cancer patients results in preservation of neurocognitive function after brain RT which can contribute to patients' quality of life (QoL). The crucial element in HS-BRT treatment planning is appropriate contouring of the hippocampus. Ten doctors delineated the left and right hippocampus (LH and RH, respectively) on 10 patients' virtual axial images of brain CT fused with T1-enhanced MRI (1 mm) according to the RTOG 0933 atlas recommendations. Variations in the spatial localization of the structure were described in three directions: right-left (X), cranio-caudal (Y), and forward-backward (Z). Discrepancies concerned three-dimensional localization, shape, volume and size of the hippocampus. The largest differences were observed in the first three delineated cases which were characterized by larger hippocampal volumes than the remaining seven cases. The volumes of LH of more than half of hippocampus contours were marginally bigger than those of RH. Most differences in delineation of the hippocampus were observed in the area of the posterior horn of the lateral ventricle. Conversely, a large number of hippocampal contours overlapped near the brainstem and the anterior horn of the lateral ventricle. The most problematic area of hippocampal contouring is the posterior horn of the lateral ventricle. Training in the manual contouring of the hippocampus during HS-BRT treatment planning under the supervision of experienced radiation oncologists is necessary to achieve optimal outcomes. This would result in superior outcomes of HS-BRT treatment and improvement in QoL of patients compared to without HS-BRT procedure. Correct delineation of the hippocampus is problematic. This study demonstrates difficulties in HS-BRT treatment planning and highlights critical points during hippocampus delineation.

Midazolam: Safety of use in palliative care: A systematic critical review.

PURPOSE: The undesired effects of midazolam can be life-threatening. This paper delineates the findings related to the pharmacokinetics, adverse effects and drug-drug interactions as well as associated therapeutic implications for safe midazolam use. METHODS: A systematic review of literature was conducted. RESULTS: The pharmacokinetics of midazolam depends on hepatic and renal functions, fat tissue mass, route and duration of administration, as well as potential drug-drug interactions. Palliative care patients constitute a high-risk group prone to side effects of drugs, due to polytherapy and multi-organ failure. CONCLUSION: Midazolam is one of three most frequently administered drugs in palliative care. The indications for its use include anxiety, dyspnea, seizures, vomiting refractory to treatment, agitation, myoclonus, status epilepticus, restlessness, delirium, pruritus, hiccups, insomnia, analgosedation, palliative sedation and preventing or counteracting undesired effects of ketamine.

Upper metastable limit osmolality of urine as a predictor of kidney stone formation in children.

High fluid intake has been universally recommended for kidney stone prophylaxis. We evaluated 24-h urine osmolality regarded as the best biomarker of optimal hydration and upper metastable limit osmolality after water evaporation from urine sample to the onset of spontaneous crystallization and its usefulness as a new risk index that would describe an individual lithogenic potential. We collected 24-h urine from 257 pediatric patients with kidney stones and 270 controls. After volume and osmolality assessment, the urine samples were subjected to volume reduction in vacuum rotavapor continued to the onset of an induced urinary crystallization. The upper metastable limit osmolality of urine sample was calculated based on its initial osmolality value and the amount of water reduction. Pediatric stone formers presented with higher urine volume and lower urine osmolality than healthy controls. Despite that, their urine samples required much lower volume reduction to induce the spontaneous crystallization than those of controls. The ROC analysis revealed an AUC for the upper metastable limit osmolality of 0.9300 (95% CI 0.9104-0.9496) for distinguishing between stone formers and healthy subjects. At the cutoff of 2696 mOsm/kg, the test provided sensitivity and specificity of 0.8638 and 0.8189, respectively. 24-h urine osmolality provided the information about current hydration status, whereas evaporation test estimated the urinary potential to crystalize dependent on urine composition. Upper metastable limit osmolality may estimate the individual lithogenic capability and identify people at risk to stone formation when exposed to dehydration.

Determining normal values of urinary phosphorus excretion in 3913 healthy children aged 2-18 to aid early diagnosis and treatment for urolithiasis.

AIM: This study determined the specific reference values for urinary phosphorus excretion in healthy children and adolescents aged 2-18 years and evaluated whether they changed with age during growth and were gender dependent. METHODS: We enrolled 3913 healthy children and adolescents aged 2-18 years to this study. The study population was divided into age groups, and the analysis was performed in one-year periods, separately for boys and girls. Urinary phosphorus excretion was analysed using four categories: P1 in mmol/24 hour units, P2 in mmol/kg/24 hours, P3 in mmol/1.73 m2 /24 hours and P4 in mmol/mmol creatinine. RESULTS: Clear differences in urinary exertion for girls and boys were observed as well as systematic changes with age. The boys presented with significantly higher daily urinary phosphorus excretion independent of its manner of expression (p < 0.001). The median urinary phosphorus (P1) rose with age (p < 0.001). Percentile tables of phosphorous exertion are presented. CONCLUSION: This was the largest study of urinary phosphate excretion based on a randomly selected sample of girls and boys aged 2-18 years. It highlights the importance of determining phosphorus reference values for children of different ages to provide early diagnosis and treatment for urolithiasis.

Structure of iron ions in some acetone based electrolytes.

X-ray absorption, Mössbauer, and Raman spectroscopy were combined to determine the local environment of iron ions in acetone based solutions of FeCl2. It is shown that part of the Fe(II) ions change their oxidation state, accompanied by symmetry change from octahedral Fe(H2O)6(2+) to tetrahedral [FeCl4](-) at large acetone concentrations. The ratio of Fe(II)/Fe(III) determined by Mössbauer spectroscopy agrees well with that determined by the X-ray absorption studies. Raman measurements confirm quantitative estimations of [FeCl4](-) species in acetone rich solutions.

X-ray absorption near edge structure and extended X-ray absorption fine structure analysis of Fe(II) aqueous and acetone solutions.

X-ray absorption spectroscopy measurements were used to determine the structure of the first coordination shell of Fe(II) ions in aqueous and acetone based solutions. Extended X-ray absorption fine structure analysis coupled with ab initio X-ray absorption near edge structure calculations confirms the octahedral coordination of the iron ion in water based solution. Data collected for acetone rich solutions can be reproduced assuming coexistence of the octahedral Fe(H(2)O)(6)(2+) and tetrahedral [FeCl(4)](2-) complexes. Distortion of the tetrahedral coordination of ion was detected in some of the acetone based solutions.

Composite polarizability and the construction of an invariant function of refraction and mass density for solutions.

Re-examination of dynamical ionic polarizabilities in water solutions leads to the formulation of a solution function r(c), which combines the indices of refraction and mass densities of solutions. We show that this function should be independent of ionic concentration if the composite polarizabilities of hydrated solute clusters are constant. Using existing experimental data for a number of aqueous salt and organic solutions, we find that the r(c) function is either constant or varies linearly with concentration, in most cases with negligible slope. We use this function to compare ionic polarizabilities of crystals and aqueous solutions and to highlight how solute polarizabilities at infinite dilution scale with the electronic valence shell of cations and anions. The proposed r(c) function can be used generally to verify the consistency of experimental measurements and of simulation results, and it provides a test of assumptions in current theories of ionic polarizabilities.

[Face cancer infiltrating of ethmoid-orbito-nasal complex]. / Raki plaskonablonkowe skóry twarzy naciekajace masyw nosowo-sitowo-oczodolowy.

Face cancer is one of the most common skin tumors and because of its locations is usually early diagnosed. In spite of this a lot of recurrence after surgical treatment are observed. It is caused a lack of proper margins in sequence of limitation excision because of esthetic and functional reasons. The recurrence of skin cancer primarily localized in periocular region and infiltrating intraorbital, ethmoidal and nasal tissues demand extensive and injurious surgical procedures. The authors present their experience in diagnostic and treatment patients with recurrent cancers infiltrating of ethmoid-orbito-nasal complex.

[Early intubation of lacrimal duct in traumatic and operative lower eyelid loss and medial canthal region defects, with simultaneous reconstruction dressed by application of self constructed battlefield ophthalmic dressing]. / Wczesne protezowanie dróg lzowych w urazowych i operacyjnych ubytkach powieki dolnej i przysrodkowego kata oka z jednoczasowa ich rekonstrukcjq i zastosowaniem opatrunku polowego wlasnej konstrukcji.

The treatment of acquired, imperfect drainage of tears through the lacrimal duct system in the situation of medial canthal region defect (operative or traumatic), is an important part of clinical ophthalmology and reconstructive surgery. The multidisciplinary approach to the reconstruction of all soft tissues with use of early prosthetic reconstruction and lower canalicular intubation by use of silicone tube or simple nylon thread, is the theme of the paper. The lacrimal duct repair should be performed on primarily, as well as coverage or reconstruction of skin defect. The authors compared the efficiency of simple lower canalicular intubation with use of normal surgical thread or silicone tube, with immediate medial canthal region defect plastic reconstruction. Simultaneously, the original self-constructed special battlefield ocular dressing was tested in the analyzed cases, to determine whether it is the suitable or not, in the procedure. The results were estimated on the base of clinical criteria: degree of epiphora after 6/12 weeks (subjective and evaluated accordingly to Munk score), early lacrimal obstruction/stenosis, comfort/discomfort of patient, and utility of the military dressing (bad/good/very good). The proposed own method of simple use of nylon thread seems to be useful, particularly in traumatic damage of lower canaliculus associated with multilayer medial canthus soft tissues defects and facial bone structures impairment. In analyzed material, it was more comfortable for patients than silicone intubation and may be utilize in definitive reconstruction, as well as in temporary splinting of lacrimal system and creation of artificial lacrimal drainage through the lower canaliculus. It is useful at the battlefield conditions. The battlefield ocular dressing tested on was very high evaluated in traumatic cases and considered as good in neoplastic patients.