Advanced dual-energy CT applications for the evaluation of the soft tissues of the neck.

There are multiple emerging advanced computed tomography (CT) applications for the evaluation of the neck, many based on dual-energy CT (DECT). DECT is an advanced form of CT in which scan acquisition is performed at two different energies, enabling spectral tissue characterisation beyond what is possible with conventional single-energy CT and potentially providing a new horizon for quantitative analysis and tissue characterisation, particularly in oncological imaging. The purpose of this review is to familiarise the reader with DECT principles and review different clinical applications for the evaluation of the soft tissues of the neck. The article will begin with an overview of DECT scan acquisition, material characterisation, reconstructions, and basic considerations for implementation in the clinical setting. This will then be followed by a review of different clinical applications. The focus will be on oncological imaging, but artefact reduction and other miscellaneous applications will also be discussed.

'Health, Environment and Training': Guidance on conduct of physical exertion in hot and humid climates.

BACKGROUND: Military operations and training in hot environments present a special set of challenges to medical personnel who must support them. METHODS: Various meteorological parameters such as relative humidity (RH), ambient air temperature (Ta) and radiant temperature (Tg), were evaluated at training sites in a desert region. Development of a colour coded Heat Stress Prevention Decision Aid Tool was done using an existing guideline chart. RESULTS: Temperatures were being recorded routinely by ordinary meteorological instruments mounted within a Stevenson Screen. Onsite measurements with a USB datalogger was found to be relevant in making a decision on suitability of weather for conduct of training. Heat casualties occur when the stresses imposed by some combination of environment, work, and clothing combine to exceed individual tolerance limits. Personnel may encounter high environmental heat loads while working outdoors; during road marches; and while carrying loads or undertaking mechanical maintenance activities. Preventive strategies cannot be expected to eliminate heat stress but should minimize its impact on training while preserving the health of personnel to the extent possible. CONCLUSION: It is recommended that onsite measurement of meteorological parameters should be done, and a decision tool should be utilized for arriving at a spot decision by junior leaders.

Growth and biochemical characteristics of an indigenous freshwater microalga, Scenedesmus obtusus, cultivated in an airlift photobioreactor: effect of reactor hydrodynamics, light intensity, and photoperiod.

The freshwater green algae, Scenedesmus obtusus, was cultivated in a 3.4 L airlift photobioreactor. The hydrodynamic parameters were estimated at different inlet gas flow rates (1, 2, 3, and 4 LPM) and their subsequent impact on the growth and biochemical characteristics of microalgae was studied. The biomass concentration and productivity increased with an increase in flow rates from 1 to 4 LPM. A maximum of 0.07 g L-1 day-1 productivity of biomass was attained at 3 LPM. An increase of total carbohydrate content from 19.6 to 26.4% was noticed with increment in the inlet flow rate of gas from 1 to 4 LPM. Major variations in total fatty acid content were not observed. The impact of light irradiance on growth and biochemical characteristics of S. obtusus was also evaluated. A maximum biomass productivity of 0.103 g L-1 day-1 was attained at an illumination of 150 µmol m-2 s-1 under continuous light. The major fatty acids reported were palmitic acid (C16:0), α-linolenic acid (C18:3), linoleic acid (C18:2), and oleic acid (C18:1). Biodiesel properties of the microalgae were estimated under various culture conditions. The light profile inside the airlift reactor was experimentally measured and the predictive modelling of light profile was also attempted.

Revelations of an overt water contamination.

BACKGROUND: Contaminated water sources are major cause of water borne diseases of public health importance. Usually, contamination is suspected after an increase in patient load. METHODS: Two health teams investigated the episode. First team conducted sanitary survey, and second team undertook water safety and morbidity survey. On-site testing was carried out from source till consumer end. Investigation was also undertaken to identify factors which masked the situation. Prevention and control measures included super chlorination, provision of alternate drinking water sources, awareness campaign, layout of new water pipeline bypassing place of contamination, repair of sewers, flushing and cleaning of water pipelines, and repeated water sampling and testing. RESULTS: Multiple sources of drinking water supply were detected. Water samples from consumer end showed 18 coliforms per 100 ml. Sewer cross connection with active leakage in water pipeline was found and this was confirmed by earth excavation. Water safety and morbidity survey found majority of households receiving contaminated water supply. This survey found no significant difference among households receiving contaminated water supply and those receiving clean water. Average proportion of household members with episode of loose motions, pain abdomen, vomiting, fever, and eye conditions was significantly more among households receiving contaminated water. CONCLUSION: The present study documents detailed methodology of investigation and control measures to be instituted on receipt of contaminated water samples. Effective surveillance mechanisms for drinking water supplies such as routine testing of water samples can identify water contamination at an early stage and prevent an impending outbreak.

Characterization and proinflammatory response of airborne biological particles from wastewater treatment plants.

Wastewater contains a variety of microorganisms, and unit operations in the plants could release these biological components into the air environment. These airborne biological particles could have adverse health effects on plant workers and the downwind population. This study provides a first report on the concentration and characterization of the airborne biological particles in six wastewater treatment plants in Mumbai, India. The study indicates that 49% and 27% of the samples exceed, respectively, the exposure limit for airborne endotoxin and bacteria in occupational settings. Endotoxin was identified as the single most important component of the particulate matter responsible for induction of proinflammatory indicator (tumor necrosis factor-α) in in vitro assay. Identification of several clinically important bacterial species in the samples suggests that the workers at the treatment plant are exposed to opportunistic and infectious bacteria. Principal component analysis was used to identify the groups among the bacterial species which serves as the signature for transport study. Analysis also shows that the component related to spore-forming bacteria is present in all samples.

Simple surface modification techniques for immobilization of biomolecules on SU-8.

SU-8, an epoxy based negative photoresist polymer has found wide range of applications in the field of microfabrication based biosensors. SU-8 surfaces need to be modified in order to immobilize bioreceptors. We studied the possibility of grafting desired functional groups by means of simple chemical treatments under normal laboratory conditions. These chemical treatments involve the use of crosslinkers that are expected to react with epoxy groups or hydroxyl groups generated by acid/alkali treatment. Here, a comparison of the results obtained on surface modification using glycine and 11-mercapto undecanoic acid as crosslinkers is presented. Human Immunoglobin G (HIgG) was covalently immobilized to carboxylic acid on SU-8 surface using carbodiimide/succinimide chemistry. The activity of immobilized HIgG was verified by using fluorescence imaging of FITC tagged goat anti HIgG bound to the surface. Fluorescence imaging was used to determine the chemistry best suited to functionalize SU-8 surface for biosensor applications.

Season-controlled changes in biochemical constituents and oxidase enzyme activities in tomato (Lycopersicon esculentum Mill.).

Season-controlled changes in biochemical constituents viz. carotenoids (carotene and xanthophyll) and pectic substances along with IAA-oxidase and polyphenol oxidase (PPO) enzyme activities were estimated/assayed in leaves of Lycopersicon esculentum Mill. (tomato) in two developmental stages--pre-flowering (35 days after sowing) and post-flowering (75 days after sowing) in three different seasons--summer rainy and winter Carotenoid content along with pectic substances were highest in winter and declined significantly in summer followed by rainy i.e. winter > summer > rainy. Carotenoid content was significantly higher in the pre-flowering as compared to post-flowering in all three seasons while pectic substances increased in the post-flowering as compared to pre-flowering throughout the annual cycle. IAA oxidase and PPO enzyme activities were enhanced in rainy and decreased sharply in summer and winter i.e. rainy > summer > winter. Both the enzymes exhibited higher activity in the post-flowering stage as compared to pre-flowering in all three seasons. These results indicate winter to be the most favourable season for tomato plants while rainy season environmental conditions prove to be unfavourable (stressful) with diminished content of carotenoid and pectic substances and low activities of IAA oxidase and PPO, ultimately leading to poor growth and productivity.

Initial experience of 3-tesla apparent diffusion coefficient values in characterizing squamous cell carcinomas of the head and neck.

BACKGROUND: With the increased clinical use of 3-Tesla (3T) magnets, it becomes important to identify the potential applications of advanced magnetic resonance (MR) imaging techniques such as diffusion-weighted imaging in head and neck pathologies. PURPOSE: To establish the 3T apparent diffusion coefficient (ADC) values for normal neck structures, and to examine the utility of ADC values in distinguishing head and neck squamous cell carcinomas (HNSCC) from normal neck anatomy. MATERIAL AND METHODS: 3T diffusion-weighted imaging was performed on 10 normal volunteers and 10 patients with known HNSCC. In the volunteers, mean ADC was calculated in the parotid gland, submandibular gland, base of the tongue, pterygoid muscle, masseter muscle, paraspinal muscles, true vocal cord, thyroid gland, thyroid cartilage, cricoid cartilage, and lymph nodes. The mean tumor ADC value was calculated from the 10 patients with HNSCC and compared with the normal ADC values from various neck structures. RESULTS: The mean ADC value measured in the HNSCC was 1.101 (+/-0.214) x 10(-3) mm(2)/s. This was significantly lower than ADC values of paraspinal muscles, pterygoid muscle, masseter muscle, thyroid gland, and base of the tongue (P=0.0006, 0.0002, 0.0001, 0.001, and 0.002, respectively). The tumor ADC values were not significantly different from ADC values of parotid and submandibular glands (P=0.057 and 0.14, respectively). CONCLUSION: 3T ADC values show potential for distinguishing HNSCC from normal extracranial head and neck structures.

A case of lower lid ulcer secondary to reverse migration of silicone punctal plug.

Silicone punctal plugs are effective and relatively safe method of managing keratoconjunctivitis sicca. We present a case where a silicone punctal plug migrated to cause aseptic necrosis of the surrounding tissue leading to a lid ulcer.

Can pretreatment CT perfusion predict response of advanced squamous cell carcinoma of the upper aerodigestive tract treated with induction chemotherapy?

BACKGROUND AND PURPOSE: Treatment of advanced stage squamous cell carcinoma of the upper aerodigestive tract with nonsurgical organ preservation protocols demonstrates improved cure rates with fewer comorbidities compared with surgery and radiation. The purpose of this study was to prospectively assess whether pretreatment evaluation of the primary site with quantitative CT perfusion measurements predicted response to induction chemotherapy and to create a prediction model to predict the response to induction chemotherapy in future patients. METHODS: Seventeen patients who were enrolled in a prospective trial assessing surgical intervention versus a nonsurgical protocol underwent a pretreatment CT perfusion followed by direct laryngoscopy. After induction chemotherapy, tumor response was determined by the surgeon's estimate of tumor volume. The CT perfusion parameters were correlated with the clinical response using a Wilcoxon rank-sum analysis. A logistic regression model was used to create a prediction based on the most significant CT perfusion parameter. RESULTS: Elevated values of blood volume (P = .004) and blood flow (P = .03) were significantly correlated with >50% reduction in tumor volume after chemotherapy. A prediction model based on tumor blood volume demonstrated 91.7% sensitivity and 80.0% specificity, with an area under the receiver operating characteristic curve of 0.95. CONCLUSION: Our preliminary data imply that tumors with elevated blood volume and blood flow were statistically associated with response to induction chemotherapy. These results suggest that pretreatment CT perfusion may be able to identify patients who will successfully respond to induction chemotherapy, which could potentially eliminate this step for subsequent patients when deciding on the appropriate treatment regimen.

Performance measures in neuroradiology.

Performance measurement has been added to the Medicare payment scheme as of July 2007. Two performance measures are applicable to neuroradiology, pertaining to brain and vascular imaging in stroke. These measures are early attempts to rigorously define the meaning of effective performance of neuroradiology.

Biotreatment of waste gas containing pyridine in a biofilter.

Industrial waste gas emissions containing pyridine are generated from pyridine manufacturing industries, and in industrial operations where pyridine is used as a solvent, as an intermediate for synthesis and as a catalyst for a variety of applications. Pyridine has unpleasant fishy odor with an odor index of 2390 and waste gaseous emissions containing pyridine require proper treatment prior to discharge. A biofilter, packed with compost and wood chips and inoculated with Pseudomonas pseudoalcaligenes-KPN for enrichment of pyridine-degrading microorganisms, was operated on a continuous feed basis for a period of more than 2 years. The results indicate that the biofilter medium with optimal moisture content of 68% and an effective bed retention time (EBRT) of 28.50s could degrade pyridine effectively (>99%) at a loading of 434 g pyridine m(-3)h(-1). The treated waste gas was also found to be free from pyridine odor.

Setting the Stage for 2018: How the Changes in the American Joint Committee on Cancer/Union for International Cancer Control Cancer Staging Manual Eighth Edition Impact Radiologists.

The updated eighth edition of the Cancer Staging Manual of the American Joint Committee on Cancer will be implemented in January 2018. There are multiple changes to the head and neck section of the manual, which will be relevant to radiologists participating in multidisciplinary head and neck tumor boards and reading pretreatment head and neck cancer scans. Human papillomavirus-related/p16(+) oropharyngeal squamous cell carcinoma will now be staged separately; this change reflects the markedly better prognosis of these tumors compared with non-human papillomavirus/p16(-) oropharyngeal squamous cell carcinoma. Nodal staging has dramatically changed so that there are different tables for human papillomavirus/p16(+) oropharyngeal squamous cell carcinoma, Epstein-Barr virus-related nasopharyngeal carcinoma, and all other head and neck squamous cell carcinomas. Extranodal extension of tumor is a new clinical feature for this third staging group. In the oral cavity, the pathologically determined depth of tumor invasion is a new staging criterion, while extrinsic tongue muscle invasion is no longer part of staging. This review serves to educate radiologists on the eighth edition changes and their rationale.

Unilateral submandibular gland aplasia associated with ipsilateral sublingual gland hypertrophy.

Congenital absence of the major salivary glands is an infrequent disorder. Clinically, patients may be asymptomatic or may present with dryness of the mouth, difficulty in chewing and swallowing, and dental caries. The absence of the submandibular gland may be associated with hypertrophy of the contralateral submandibular gland. We report a case of ipsilateral sublingual hypertrophy associated with unilateral submandibular aplasia.

Absent semicircular canals in CHARGE syndrome: radiologic spectrum of findings.

BACKGROUND AND PURPOSE: This paper describes the CT findings that characterize the middle and inner ear anomalies in coloboma, heart defects, choanal atresia, mental retardation, genitourinary, and ear anomalies (CHARGE) syndrome. With this information, neuroradiologists will be better prepared to provide clinically relevant information to their referring physicians regarding this rare syndrome. MATERIALS AND METHODS: CT studies from 13 patients were reviewed by 2 neuroradiologists with Certificate of Additional Qualification. Each ear was counted separately for a total of 26 ears. Middle and inner ear anomalies associated with CHARGE syndrome were categorized. Investigational review board approval was obtained. RESULTS: Twenty of 26 (77%) ears demonstrated cochlear aperture atresia. Four of these ears were evaluated with MR imaging and were found to lack a cochlear nerve. Twenty-one of 26 (81%) cochlea had some form of dysplasia. Six of 26 (23%) round windows were aplastic. Three of 26 (12%) round windows were hypoplastic. Twenty-one of 26 (81%) oval windows were atretic or aplastic. Fifteen of 26 (58%) vestibules were hypoplastic or dysplastic. There were 5 of 26 (19%) enlarged vestibular aqueducts. Twelve of 26 (46%) vestibular aqueducts had an anomalous course. All cases demonstrated absent semicircular canals. Twenty-three of 26 (88%) facial nerve canals had an anomalous course. Four of 26 (15%) tympanic segments were prolapsed. Three of 26 (12%) temporal bones had an anomalous emissary vein referred to as a petrosquamosal sinus. Twenty-one of 26 (81%) middle ear cavities were small. Twenty-three of 26 (93%) ossicles were dysplastic with ankylosis. Three of 26 (12%) internal auditory canals were small. CONCLUSION: The CT findings that correlate to the anomalies of CHARGE syndrome affect conductive as well as sensorineural hearing. Stenosis of the aperture for the cochlear nerve aperture on CT is suggestive of hypoplasia or absence of the cochlear nerve, which has been demonstrated in some cases by MR. Absence of the cochlear nerve would be a contraindication to cochlear implantation.

Correlation between initial and early follow-up CT perfusion parameters with endoscopic tumor response in patients with advanced squamous cell carcinomas of the oropharynx treated with organ-preservation therapy.

BACKGROUND AND PURPOSE: Current organ-preservation regimens for upper aerodigestive tract squamous cell carcinoma (SCCA) require endoscopic procedures under general anesthesia to evaluate the tumor response. The purpose of our study was to determine whether CT perfusion (CTP) parameters correlate with response to induction chemotherapy as assessed by endoscopy under general anesthesia. METHODS: Nine patients with advanced (stage 3 or 4) SCCA of the oropharynx were enrolled in a nested phase 2 prospective trial in which induction chemotherapy was used to assess the tumor response. Patients underwent direct laryngoscopy and CTP before and 3 weeks after one cycle of induction chemotherapy. The outcome variables were the surgeon's estimate of tumor volume during endoscopy with biopsy under anesthesia and CTP parameters (capillary permeability (CP), blood volume (BV), blood flow (BF), and mean transit time (MTT)). Wilcoxon rank sum analysis was used to correlate the baseline values of BF and BV with response to induction chemotherapy. Comparison of agreement between the reduction in tumor volume and change in CTP parameters was performed by using kappa estimates. RESULTS: Seven of 9 patients demonstrated > or =50% tumor volume reduction, representing positive response to induction chemotherapy. In the responder group, the following changes in mean pre- and postinduction chemotherapy values were noted: mean BF, 114.2 mL/100 g /min (preinduction) to 45.1 mL/100 g/min (postinduction); mean BV, 5.11 mL/100 g to 3.1 mL/100 g; mean CP, 25.6 mL/100 g /min (preinduction) to 18.3 mL/100 g / min (postinduction); mean MTT, 4.9 seconds (preinduction) to 8.0 seconds (postinduction). In the nonresponder group, the following changes were noted: mean BF, 56.9 mL/100 g/min to 75.9 mL/100 g/min; mean, BV 2.7 mL/100 g to 4.71 mL/100 g; mean CP, 24.1 mL/100 g/min to 23.7 mL/100 g/min; mean MTT, 4.3 seconds to 5.34 seconds. Higher baseline (pretherapy) values of BV showed significant correlation with endoscopic tumor response (P < .05). Reduction in the BV (by >/=20%) on follow-up studies also showed substantial agreement with clinical response as assessed with endoscopy (kappa = 0.73). The agreement between decreased BF, decreased CP, and increased MTT and clinical response was fair (kappa = 0.37). CONCLUSION: These preliminary results show that deconvolution-based CTP technique offers potential for noninvasive monitoring of response to induction chemotherapy in patients with oropharyngeal cancers. Percentage reduction of BV is significantly correlated to endoscopic response to induction chemotherapy, though we acknowledge that the data correspond to short-term outcomes and long-term durability of response cannot be established. Nevertheless, validation of the use of deconvolution CTP parameters as predictors of tumor response may permit replacement of an invasive diagnostic procedure conducted under anesthesia currently used to assess response with noninvasive perfusion CT imaging.

Evaluation of indigenous fresh water microalga Scenedesmus obtusus for feed and fuel applications: Effect of carbon dioxide, light and nutrient sources on growth and biochemical characteristics.

Scenedesmus obtusus, a freshwater microalga, was evaluated for its growth and biochemical characteristics under various culture conditions. S. obtusus was tolerant at all tested CO2 concentrations up to 20%. Among the different nitrogen sources, urea showed enhanced biomass productivities up to 2-fold compared to control, where the nitrogen source was sodium nitrate. Light intensity and photoperiod had a significant effect on growth rate and biomass productivity. The growth rate was observed maximum under continuous light exposure at the light intensities, 30µmolm(-2)sec(-1) and 60µmolm(-2)sec(-1) The species was able to tolerate the salinity levels up to 25mM NaCl, where, the increase in the concentration of NaCl suppressed the growth. Ammonium acetate and glycine showed better growth rate and biomass productivity indicating mixotrophic ability of S. obtusus. Supplementation of acetate and bicarbonate significantly enhanced the biomass productivity. Biodiesel properties of S. obtusus cultivated at various culture conditions were estimated.

Preradiotherapy computed tomography as a predictor of local control in supraglottic carcinoma.

PURPOSE: To determine the utility of pretreatment computed tomography (CT) for predicting primary site control in patients with supraglottic squamous cell carcinoma (SCC) treated with definitive radiotherapy (RT). MATERIALS AND METHODS: Pretreatment CT studies in 63 patients were reviewed. Minimum length of follow-up was 2 years. Local recurrence and treatment complications resulting in permanent loss of laryngeal function were documented. Tumor volume was calculated using a computer digitizer, and pre-epiglottic space (PES) spread was estimated. The data were analyzed using a combination of Fisher's exact test, logistic regression modeling, and multivariate analyses. Five-year local control rates were calculated using the product-limit method. RESULTS: Local control rates were inversely and roughly linearly related to tumor volume, although there seemed to be a threshold volume at which primary site prognosis diminished. Local control was 89% in tumors less than 6 cm3 and 52% when volumes were > or =6 cm3 (P = .0012). The likelihood of maintaining laryngeal function also varied with tumor volume: 89% for tumors less than 6 cm3 and 40% for tumors > or =6 cm3 (P = .00004). Pre-epiglottic space involvement by tumor of > or =25% was associated with a reduced chance of saving the larynx (P = .0076). Multivariate analyses revealed that only tumor volume independently altered these end points. CONCLUSION: Pretreatment CT measurements of tumor volume permits stratification of patients with supraglottic SCC treated with RT alone (which allows preservation of laryngeal function) into groups in which local control is more likely and less likely. Pre-epiglottic space spread is not a contraindication to using RT as the primary treatment for supraglottic SCC.

Tumor uptake and elimination of 2',2'-difluoro-2'-deoxycytidine (gemcitabine) after deoxycytidine kinase gene transfer: correlation with in vivo tumor response.

PURPOSE: We hypothesized that tumor uptake and elimination of 2',2'-difluoro-2'-deoxycytidine/2',2'-difluoro-2'-deoxycytidine 5'-triphosphate (dFdCyd/dFdCTP) would be altered after dCK gene transfer and that this change would result in an enhanced cytotoxic effect. To test this hypothesis, we examined dFdCyd/dFdCTP uptake and clearance in HT-29 human colon carcinoma xenografts in nude mice by high-performance liquid chromatography (HPLC) and fluorine-19 magnetic resonance spectroscopy (F-19 MRS). EXPERIMENTAL DESIGN: HT-29 tumors were grown from cells infected with either the retroviral vector alone (LNPO-LacZ) or vector containing the dCK gene (LNPO-dCK). HPLC and F-19 MRS analyses were performed after a single 160 mg/kg i.p. injection of dFdCyd. Tumor response was determined in animals receiving a similar dosing schedule of dFdCyd. RESULTS: HPLC experiments revealed an increased tumor accumulation of dFdCTP in xenografts overexpressing dCK compared with wild-type controls (P < or = 0.05). dFdCTP in the dCK-infected tumors was easily identified at 24 h postinjection. Conversely, no dFdCTP could be detected in the control xenografts 14 h postinjection. Subsequent F-19 MRS experiments confirmed an altered uptake, revealing a 2.5-fold greater accumulation of dFdCyd/dFdCTP in the dCK xenografts. Whereas a modest tumor growth delay was observed in the wild-type tumors receiving dFdCyd, dCK xenografts demonstrated a marked tumor growth delay following treatment (P < or = 0.05). CONCLUSIONS: These data support the hypothesis that increased expression of dCK cDNA in HT-29 xenografts results in an enhanced dFdCTP accumulation and prolonged elimination kinetics, and ultimately a potentiated in vivo tumor response to dFdCyd. Related to these effects, changes in the overall tumor metabolism of dFdCyd/dFdCTP was detectable by noninvasive F-19 MRS. These data are relevant to future preclinical and clinical studies evaluating dCK gene transfer and dFdCyd therapy.