bluuebunny/crossref_metadata_2025 huggingface dataset:
Inhaled antibiotics for stable non-cystic fibrosis bronchiectasis: a systematic review
Authors: Brodt Alessandra Monteiro , Stovold Elizabeth , Zhang Linjie
Published: June 2014

We conducted a meta-analysis of randomised trials to evaluate the efficacy and safety of inhaled antibiotics in patients with stable non-cystic fibrosis (CF) bronchiectasis.

We searched the Cochrane Airways Group Register of Trials from inception until March 2014.

12 trials with 1264 adult patients were included, of which five were unpublished studies. Eight trials on 590 patients contributed data to the meta-analysis. Amikacin, aztreonam, ciprofloxacin, gentamicin, colistin or tobramycin were used for 4 weeks to 12 months. Inhaled antibiotics were more effective than placebo or symptomatic treatment in reducing sputum bacterial load (five trials; weighted mean difference −2.65 log10CFU·g−1, 95% CI -4.38– -0.92 log10CFU·g−1), eradicating the bacteria from sputum (six trials; risk ratio 4.2, 95% CI 1.66–10.64) and reducing the risk of acute exacerbations (five trials; risk ratio 0.72, 95% CI 0.55–0.94). Bronchospasm occurred in 10% of patients treated with inhaled antibiotics compared with 2.3% in the control group (seven trials; risk ratio 2.96, 95% CI 1.30–6.73), but the two groups had the same withdrawal rate due to adverse events (12.2%).

Inhaled antibiotics may provide an effective suppressive antibiotic therapy with an acceptable safety profile in adult patients with stable non-CF bronchiectasis and chronic bronchial infection.
COPD detected with screening: impact on patient management and prognosis
Authors: Bertens Loes C.M. , Reitsma Johannes B. , van Mourik Yvonne , Lammers Jan-Willem J. , Moons Karel G.M. , Hoes Arno W. , Rutten Frans H.
Published: June 2014

It is uncertain whether screening of older persons for chronic obstructive pulmonary disease (COPD) is worthwhile because the effects on patient management and prognosis are unknown.

We aimed to assess the short-term consequences of detecting COPD in frail elderly subjects with dyspnoea, considering pulmonary drug use, hospitalisations and all-cause mortality.

Community-dwelling frail elderly subjects, aged 65 years and older, with dyspnoea, participating in a screening study on COPD and heart failure were included. Final diagnoses were assigned by an expert panel based on all data from the screening strategy, including spirometry. Follow-up data were collected from the general practitioners.

Of the 386 patients, 84 (21.8%) were received a new diagnosis of COPD. Overall, changes in pulmonary drug prescription during 6 months of follow-up were infrequent (n = 53, 13.7%; among new cases of COPD, 15 (17.9%) out of 84). Of all participants, 25.9% were hospitalised in the first year of follow-up, with the highest rate in patients with newly detected COPD (32.1%).

Many new cases of COPD could be detected by screening frail elderly subjects with dyspnoea, but the impact on patient management seems limited. Our study underlines the importance of obtaining follow-up data to assess the true impact of a (screen-detected) diagnosis of COPD on patient management and outcome.
Reliance on end-expiratory wedge pressure leads to misclassification of pulmonary hypertension
Authors: LeVarge Barbara L. , Pomerantsev Eugene , Channick Richard N.
Published: June 2014

Current guidelines recommend measurement of pulmonary artery wedge pressure (PAWP) at end-expiration. However, this recommendation is not universally followed and may not be physiologically appropriate. We investigated the performance of end-expiratory PAWP in the evaluation of precapillary pulmonary hypertension patients.

329 spontaneously breathing patients undergoing right heart catheterisation were retrospectively classified as having a precapillary, post-capillary or mixed phenotype based on standardised clinical criteria. Tracings were reviewed to compare end-expiratory PAWP with PAWP averaged throughout the respiratory cycle; these values were correlated with the clinical classifications. Predictors of large respirophasic variation in PAWP were determined.

Elevated end-expiratory PAWP (>15 mmHg) occurred in 29% of subjects with precapillary phenotype. There were no differences in demographics or clinical history between those with elevated and normal end-expiratory PAWP. Those with elevated end-expiratory PAWP had greater right atrial pressure and respirophasic PAWP variation. Among all subjects, the magnitude of respirophasic variation in PAWP was positively correlated with body mass index and respirophasic variation in left ventricular end-diastolic pressure.

A significant proportion of precapillary pulmonary hypertension patients have end-expiratory PAWP >15 mmHg. Spontaneous positive end-expiratory intrathoracic pressure may contribute; in those cases, PAWP averaged throughout respiration may be a more accurate measurement.
Sequencing and characterization of the transcriptome of half-smooth tongue sole (Cynoglossus semilaevis)
Authors: Wang Wenji , Yi Qilin , Ma Liman , Zhou Xiaosu , Zhao Haitao , Wang Xubo , Qi Jie , Yu Haiyang , Wang Zhigang , Zhang Quanqi
Published: June 2014

Background

Half-smooth tongue sole (Cynoglossus semilaevis) is a valuable fish for aquaculture in China. This fish exhibits sexual dimorphism, particularly different growth rates and body sizes between two genders. Thus, C. semilaevis is a good model that can be used to investigate mechanisms responsible for such dimorphism, this model can also be utilized to answer fundamental questions in evolution and applied fields of aquaculture. Hence, advances in second-generation sequencing technology, such as 454 pyrosequencing, could provide a robust tool to study the genome characteristics of non-model species.

Results

In this study, C. semilaevis was subjected to de novo transcriptome sequencing and characterization. A total of 749,954 reads were generated using a single 454 sequencing run in a full PicoTiter plate. These reads were then assembled into 62,632 contigs with a 10-fold average sequencing coverage. A total of 26,589 sequences were successfully annotated based on sequence similarities; among these sequences, 3,451 transcripts exhibited gene ontology terms and 2,362 showed enzyme commissions associated with 186 pathways from Kyoto Encyclopedia of Gene and Genomes pathways. A search of repetitive elements was performed, and 1,898 transposable elements were identified. Approximately 7,800 simple-sequence repeats and 21,234 single-nucleotide polymorphisms were also detected.

Conclusions

Our data provided an integrated and comprehensive transcriptome resource for C. semilaevis. These data could be used for further research in population genetics, gene function, and tissue-specific gene expressions.
Purification and biocompatibility of fermented hyaluronic acid for its applications to biomaterials
Authors: Choi Sungchul , Choi Woncheol , Kim Sekweon , Lee Su-Yeon , Noh Insup , Kim Chan-Wha
Published: June 2014

Background

Hyaluronic acid (HA) is of importance due to its diverse applications in pharmaceuticals and medical devices such as dermal filler, adhesion barriers, carrier for cells and bioactive molecules as well as scaffold biomaterials for tissue engineering. Evaluations of purification and biocompatibility of HA are required for its applications to biomaterials.

Results

After synthesizing HA by fermentation of
streptococcus zooepidemicus
for 25 hr, extensively purification of the fermented broth was performed to remove impurities using a filtration process for insoluble components and cells, and diverse adsorbents for soluble impurities. Its
in vitro
biocompatibility has been evaluated by measurement of cell counting and assay of cell live and dead. 60% yield of white HA powder was obtained, having 15–17 dL/g intrinsic viscosity with a molecular weight of approximately 1,000 kDa. While low molecular weight impurities and insoluble impurities were successfully removed using a ultrafiltration membrane with 50 KDa molecular weight cut, endotoxins, high molecular weight proteins and nucleic acids were removed from the broth by employing adsorbents such as alumina and activated carbons. Alumina showed the best results for the removal of endotoxins, all of the activated carbons were very effective in the removal of high molecular weight proteins and nucleic acids. The purified HA solution showed excellent cell compatibility with no cell damages as observed by both measurement of cell proliferation and observation of cell viability.

Conclusions

We obtained high molecular weight HA with excellent biocompatibility as judged by both measurement of cell proliferation and viability, indicating high possibility of its applications to biomaterials.
Stimulated migration and penetration of vascular endothelial cells into poly (L-lactic acid) scaffolds under flow conditions
Authors: Koo Min-Ah , Kang Jae Kyeong , Lee Mi Hee , Seo Hyok Jin , Kwon Byeong-Ju , You Kyung Eun , Kim Min Sung , Kim Dohyun , Park Jong-Chul
Published: June 2014

Background

The initial procedure of the development of engineered tissues is cell seeding into three-dimensional polymer scaffolds. However, it is hard to make the cells invade into scaffold due to the characteristic of pore and material. Electrospun poly (L-lactic acid) scaffold and flow perfusion system were used to overcome these seeding problems.

Results

Before starting the experiment, we set up the parallel plate chamber system to observe endothelial cell migration under flow condition. In individual cell migration model, human umbilical endothelial cells started to migrate in the direction of flow at 8 dyne/cm
2
and we observed the cytoskeleton alignment at 8 dyne/cm
2
.

This study has demonstrated the possibility to evaluate and analyze cell migration using the parallel plate chamber system and we may predict
in vivo
cell migration under flow condition based on these results. Also the flow perfusion system was established for the effective cell seeding into at three dimensional scaffolds. Moreover, shear stress induced by flow can enhance cell migration into PLLA scaffold that is in the form of cotton.

Conclusions

Result indicated that cell penetration was achieved under flow condition better and more than under static condition throughout the matrix.
Elevated C-reactive protein is associated with lower increase in knee muscle strength in patients with knee osteoarthritis: a 2-year follow-up study in the Amsterdam Osteoarthritis (AMS-OA) cohort
Authors: Sanchez-Ramirez Diana C , van der Leeden Marike , van der Esch Martin , Roorda Leo D , Verschueren Sabine , van Dieën Jaap H , Dekker Joost , Lems Willem F
Published: June 2014

Introduction

The aim of this study was to examine the associations of elevated serum C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) with change in muscle strength in patients with established knee osteoarthritis (OA), at 2 years.

Methods

Data from 186 patients with knee OA were gathered at baseline and at 2-year follow-up. CRP (in milligrams per liter) and ESR (in millimeters per hour) were measured in serum from patients’ blood. Strength of quadriceps and hamstrings muscles was assessed by using an isokinetic dynamometer. The association of inflammatory markers with change in knee muscle strength was analyzed by using uni- and multi-variate linear regression models.

Results

Patients with elevated CRP values at both baseline and 2-year follow-up exhibited a lower increase in knee muscle strength for a period of 2 years (β = -0.22; P = 0.01) compared with the group with non-elevated levels at both times of assessment. The association persisted after adjustment for relevant confounders. Elevated ESR values at both times of assessment were not significantly associated with change in knee muscle strength (β = -0.05; P = 0.49).

Conclusions

Our results indicate that elevated CRP values are related to a lower gain in muscle strength over time in patients with established knee OA. Although the mechanism to explain this relationship is not fully elucidated, these results suggest inflammation as a relevant factor influencing muscle strength in this group of patients.
Gains in employment status following antidepressant medication
or cognitive therapy for depression
Authors: Fournier Jay C. , DeRubeis Robert J. , Amsterdam Jay , Shelton Richard C. , Hollon Steven D.
Published: June 2014

Background

Depression can adversely affect employment status.

Aims

To examine whether there is a relative advantage of cognitive therapy or
antidepressant medication in improving employment status following
treatment, using data from a previously reported trial.

Method

Random assignment to cognitive therapy (n = 48) or the
selective serotonin reuptake inhibitor paroxetine (n =
93) for 4 months; treatment responders were followed for up to 24 months.
Differential effects of treatment on employment status were examined.

Results

At the end of 28 months, cognitive therapy led to higher rates of
full-time employment (88.9%) than did antidepressant medication among
treatment responders (70.8%), χ21 = 5.78, P = 0.02, odds ratio (OR) = 5.66,
95% CI 1.16–27.69. In the shorter-term, the main effect of treatment on
employment status was not significant following acute treatment
(χ21 = 1.74, P = 0.19, OR = 1.77, 95% CI
0.75–4.17); however, we observed a site×treatment interaction
(χ21 = 6.87, P = 0.009) whereby cognitive
therapy led to a higher rate of full-time employment at one site but not
at the other.

Conclusions

Cognitive therapy may produce greater improvements in employment
v. medication, particularly over the longer term.
On the Time Course, Generality, and Regulation of Plasma Progesterone Release in Male Rats by Stress Exposure
Authors: Hueston Cara M. , Deak Terrence
Published: June 2014

Although progesterone is most commonly regarded in terms of its role in the female estrous cycle, reproductive behavior, and pregnancy, progesterone is also a precursor to corticosterone (CORT) and is released from the adrenal glands of both sexes in response to stress. However, the relationship between plasma CORT and progesterone during times of stress has not been well established. To better characterize dynamic changes in progesterone release as a result of stressor exposure, plasma progesterone levels were measured using enzyme immunoassay under multiple conditions, including after stress exposure (footshock, restraint, and forced swim), manipulations of the hypothalamic-pituitary-adrenal axis (injection of metyrapone or dexamethasone, or adrenalectomy), and in response to CRH and ACTH injections. When plasma levels of ACTH, CORT, and progesterone were analyzed across studies, CORT and progesterone were found to be highly correlated and rarely dissociated. Additionally, it appears that in male rats, the adrenal glands are the principle source of circulating progesterone in response to stress. Interestingly, a detailed time course indicated lack of a circadian rhythm of progesterone secretion, despite a robust rhythm of circulating CORT. The current studies provide critical new information on the coincident release of progesterone and CORT in response to stress and their somewhat paradoxical dissociation across the circadian rhythm. These findings provide an important foundation for future studies that will examine the role of stress-induced progesterone in behavioral, neuroimmune, and neuroendocrine responses to stress.
Compromised Bone Microarchitecture and Estimated Bone Strength in Young Adults With Cystic Fibrosis
Authors: Putman Melissa S. , Milliren Carly E. , Derrico Nicholas , Uluer Ahmet , Sicilian Leonard , Lapey Allen , Sawicki Gregory , Gordon Catherine M. , Bouxsein Mary L. , Finkelstein Joel S.
Published: June 2014

Context:

Young adults with cystic fibrosis (CF) are at risk for low bone density and fractures, but the underlying alterations in bone microarchitecture that may contribute to their increased fracture risk are currently unknown.

Objective:

The main goal of this study was to use high-resolution peripheral quantitative computed tomography (HR-pQCT) to characterize the bone microarchitecture, volumetric bone mineral density (vBMD), and estimated strength of the radius and tibia in young adults with CF compared with healthy volunteers.

Design and Setting:

This was a cross-sectional study at an outpatient clinical research center within a tertiary academic medical center.

Participants:

Thirty young adults with CF, 18 to 40 years of age, were evaluated and compared with 60 healthy volunteers matched by age (±2 years), gender, and race.

Main Outcome Measures:

The primary outcomes were HR-pQCT–derived cortical and trabecular vBMD, bone microarchitecture, and estimates of bone strength.

Results:

At the radius and tibia, young adults with CF had smaller bone cross-sectional area and lower vBMD. Cortical and trabecular microarchitecture were compromised at both sites, most notably involving the trabecular bone of the tibia. These differences translated into lower estimated bone strength both at the radius and tibia. After accounting for body mass index differences, young adults with CF had lower bone area and estimated bone strength at the radius and had compromised trabecular microarchitecture and lower total and trabecular vBMD and estimated bone strength at the tibia. Alterations in trabecular bone density and microarchitecture and estimated strength measures of the tibia were also greater than expected based on dual-energy x-ray absorptiometry-derived areal BMD differences.

Conclusions:

Young adults with CF have compromised bone microarchitecture and lower estimated bone strength at both the radius and tibia, even after accounting for their smaller body size. These skeletal deficits likely explain the higher fracture risk observed in young adults with CF.
Large hypomethylated domains serve as strong repressive machinery for key developmental genes in vertebrates
Authors: Nakamura Ryohei , Tsukahara Tatsuya , Qu Wei , Ichikawa Kazuki , Otsuka Takayoshi , Ogoshi Katsumi , Saito Taro L. , Matsushima Kouji , Sugano Sumio , Hashimoto Shinichi , Suzuki Yutaka , Morishita Shinichi , Takeda Hiroyuki
Published: June 2014

DNA methylation is a fundamental epigenetic modification in vertebrate genomes and a small fraction of genomic regions is hypomethylated. Previous studies have implicated hypomethylated regions in gene regulation, but their functions in vertebrate development remain elusive. To address this issue, we generated epigenomic profiles that include base-resolution DNA methylomes and histone modification maps from both pluripotent cells and mature organs of medaka fish and compared the profiles with those of human ES cells. We found that a subset of hypomethylated domains harbor H3K27me3 (K27HMDs) and their size positively correlates with the accumulation of H3K27me3. Large K27HMDs are conserved between medaka and human pluripotent cells and predominantly contain promoters of developmental transcription factor genes. These key genes were found to be under strong transcriptional repression, when compared with other developmental genes with smaller K27HMDs. Furthermore, human-specific K27HMDs show an enrichment of neuronal activity-related genes, which suggests a distinct regulation of these genes in medaka and human. In mature organs, some of the large HMDs become shortened by elevated DNA methylation and associate with sustained gene expression. This study highlights the significance of domain size in epigenetic gene regulation. We propose that large K27HMDs play a crucial role in pluripotent cells by strictly repressing key developmental genes, whereas their shortening consolidates long-term gene expression in adult differentiated cells.
FGF signaling activates a Sox9-Sox10 pathway for the formation and branching morphogenesis of mouse ocular glands
Authors: Chen Ziyan , Huang Jie , Liu Ying , Dattilo Lisa K. , Huh Sung-Ho , Ornitz David , Beebe David C.
Published: June 2014

Murine lacrimal, harderian and meibomian glands develop from the prospective conjunctival and eyelid epithelia and produce secretions that lubricate and protect the ocular surface. Sox9 expression localizes to the presumptive conjunctival epithelium as early as E11.5 and is detected in the lacrimal and harderian glands as they form. Conditional deletion showed that Sox9 is required for the development of the lacrimal and harderian glands and contributes to the formation of the meibomian glands. Sox9 regulates the expression of Sox10 to promote the formation of secretory acinar lobes in the lacrimal gland. Sox9 and FGF signaling were required for the expression of cartilage-associated extracellular matrix components during early stage lacrimal gland development. Fgfr2 deletion in the ocular surface epithelium reduced Sox9 and eliminated Sox10 expression. Sox9 deletion from the ectoderm did not affect Fgf10 expression in the adjacent mesenchyme or Fgfr2 expression in the epithelium, but appeared to reduce FGF signaling. Sox9 heterozygotes showed a haploinsufficient phenotype, in which the exorbital branch of the lacrimal gland was absent in most cases. However, enhancement of epithelial FGF signaling by expression of a constitutively active FGF receptor only partially rescued the lacrimal gland defects in Sox9 heterozygotes, suggesting a crucial role of Sox9, downstream of FGF signaling, in regulating lacrimal gland branching and differentiation.
The dynamic DNA methylation cycle from egg to sperm in the honey beeApis mellifera
Authors: Drewell Robert A. , Bush Eliot C. , Remnant Emily J. , Wong Garrett T. , Beeler Suzannah M. , Stringham Jessica L. , Lim Julianne , Oldroyd Benjamin P.
Published: June 2014

In honey bees (Apis mellifera), the epigenetic mark of DNA methylation is central to the developmental regulation of caste differentiation, but may also be involved in additional biological functions. In this study, we examine the whole genome methylation profiles of three stages of the haploid honey bee genome: unfertilised eggs, the adult drones that develop from these eggs and the sperm produced by these drones. These methylomes reveal distinct patterns of methylation. Eggs and sperm show 381 genes with significantly different CpG methylation patterns, with the vast majority being more methylated in eggs. Adult drones show greatly reduced levels of methylation across the genome when compared with both gamete samples. This suggests a dynamic cycle of methylation loss and gain through the development of the drone and during spermatogenesis. Although fluxes in methylation during embryogenesis may account for some of the differentially methylated sites, the distinct methylation patterns at some genes suggest parent-specific epigenetic marking in the gametes. Extensive germ line methylation of some genes possibly explains the lower-than-expected frequency of CpG sites in these genes. We discuss the potential developmental and evolutionary implications of methylation in eggs and sperm in this eusocial insect species.
Preparation and Solvent-dependent Photochromism of Triptycene-bonded Dithienylethenes
Authors: Luo Qianfu , Bao Shumin , Wang Qiu , Qu Dahui , Liu Maoqi
Published: June 2014

Two new, stable photochromic dithienylethenes DTE-1 and DTE-2 based on triptycene were conveniently synthesized in one pot. Their spectral properties and photochromism in different solvents were studied extensively. It was revealed that the two DTE–triptycene conjugates undergo special UV–vis absorption and color change in chloride solvents when irradiated by UV light.
Synthesis and Polymerization of a para-Disubstituted T8-caged Hexaisobutyl-POSS Monomer
Authors: Maegawa Takayuki , Irie Yasuyuki , Fueno Hiroyuki , Tanaka Kazuyoshi , Naka Kensuke
Published: June 2014

A para-substituted bis(3-aminopropyl)hexaisobutyl-polyhedral oligomeric silsesquioxane (POSS) was successfully synthesized via a selective corner-opening reaction of 3-aminopropylheptaisobutyl-POSS and a subsequent corner-capping reaction. The selectivity of the corner-opening reaction was studied by density functional theory calculations. Polymerization of the POSS monomer with pyromellitic dianhydride resulted in a yellow, self-standing film.
Comparison of dynamic contrast enhanced MRI and Doppler ultrasound in the pre-operative assessment of the portal venous system.
Authors: Naik K S , Ward J , Irving H C , Robinson P J
Published: June 2014

The purpose of this study was to compare dynamic contrast enhanced MRI (DCEMR) with Doppler ultrasound (US) in the assessment of portal venous anatomy and to analyse the causes of discrepancy. Over a 1 year period, 97 patients undergoing assessment prior to hepatic surgery underwent imaging of the liver and portal venous system using US with colour and spectral Doppler and MRI with axial T2 weighted spin echo (SE) and coronal oblique T1 weighted rapid gradient echo (GRE) imaging before and immediately after bolus injection of Gd-DTPA (0.1 mmol kg-1). When the US and MRI findings were discrepant, the images were reviewed by two observers and compared with surgical findings. US and DCEMR were concordant in 90 patients (portal vein patent in 80, occluded in 10). In three patients with cirrhosis and gross ascites the portal vein was reported as occluded on US and patent on MRI; surgery confirmed the MRI findings. In one patient the portal vein was patient on US but not on MRI, but there was a 3 week interval between the examinations. In three patients the portal vein was patent on US, but MRI detected occlusion of intrahepatic portal vein branches in two, and encasement of an intrahepatic branch in the third case. Spontaneous splenorenal shunts were seen in 15 patients only on MRI; varices were seen in 39 patients on MRI and in 22 patients on US. Both US and DCEMR contribute to the pre-operative assessment of the portal venous system. MRI provides additional information over US in assessing intrahepatic portal branches and detecting varices and splenorenal shunts, and is recommended for all surgical candidates and in patients with abnormal portal venous anatomy and equivocal US findings.
Risk of childhood cancer from fetal irradiation.
Authors: Doll R , Wakeford R
Published: June 2014

The association between the low dose of ionizing radiation received by the fetus in utero from diagnostic radiography, particularly in the last trimester of pregnancy, and the subsequent risk of cancer in childhood provides direct evidence against the existence of a threshold dose below which no excess risk arises, and has led to changes in medical practice. Initially reported in 1956, a consistent association has been found in many case-control studies in different countries. The excess relative risk obtained from combining the results of these studies has high statistical significance and suggests that, in the past, a radiographic examination of the abdomen of a pregnant woman produced a proportional increase in risk of about 40%. A corresponding causal relationship is not universally accepted and this interpretation has been challenged on four grounds. On review, the evidence against bias and confounding as alternative explanations for the association is strong. Scrutiny of the objections to causality suggests that they are not, or may not be, valid. A causal explanation is supported by evidence indicating an appropriate dose-response relationship and by animal experiments. It is concluded that radiation doses of the order of 10 mGy received by the fetus in utero produce a consequent increase in the risk of childhood cancer. The excess absolute risk coefficient at this level of exposure is approximately 6% per gray, although the exact value of this risk coefficient remains uncertain.
Nicotinamide reduces tumour interstitial fluid pressure in a dose- and time-dependent manner.
Authors: Peters C E , Chaplin D J , Hirst D G
Published: June 2014

Nicotinamide radiosensitizes a number of experimental tumours, and increases blood flow and mean pO2 in some tumours. It has been suggested that nicotinamide reduces tumour interstitial fluid pressure (IFP), thereby reducing transient vessel non-perfusion and acute hypoxia, and radiosensitizing tumours. To test this hypothesis, tumour IFP, transient vessel non-perfusion, and radiosensitivity after nicotinamide administration were examined in the murine carcinoma NT. Nicotinamide at doses of 500 and 1000 mg kg-1 significantly reduced tumour IFP within 20 min of administration, with recovery to control values by 60-80 min; 100 mg kg-1 had no effect. The percentage of previously non-perfused vessels that became perfused 20 min after administering 1000 mg kg-1 of nicotinamide significantly exceeded the percentage that became perfused within 20 min in the absence of nicotinamide. By 90 min after nicotinamide administration, this differential effect was abolished. The correlation in the time courses of reduced IFP and increased vessel perfusion after nicotinamide administration suggest that decreased IFP may accompany vessel reperfusion. However, 1000 mg kg-1 of nicotinamide radiosensitized the NT carcinoma 80 min after administration, whilst no radiosensitization was seen within 10 min. Thus it is unlikely that increased vessel perfusion is the sole mechanism of nicotinamide-induced radiosensitization in this tumour.
Radiation exposure to children during cardiac catheterization.
Authors: Boothroyd A , McDonald E , Moores B M , Sluming V , Carty H
Published: June 2014

The purpose of this study was to assess the suitability of different radiation dosimetry methods and record radiation exposures during paediatric catheterization. Three methods of dosimetry were employed: thermoluminescent dosimetry (TLD), dose-area product and calculation of entrance surface dose from calibrated exposure factors. Examinations included bi-plane fluoroscopy, and cineangiography for diagnosis and treatment of congenital heart disease. The most suitable method of radiation dosimetry for cardiac catheterization is the use of calculated entrance dose or a dose-area product meter. Children were exposed to high levels of radiation during cardiac catheterization but there was a wide variation in radiation dosage. Careful consideration should be given to the suitability of radiation dosimetry for cardiac catheterization.
Does carotid duplex imaging render angiography redundant before carotid endarterectomy?
Authors: Khaw K T
Published: June 2014

Carotid duplex imaging is now recognized as the best non-invasive screening test for carotid artery stenosis. The evidence for its use as the sole diagnostic imaging modality prior to carotid endarterectomy is examined. Providing it is carried out by experienced trained operators using validated duplex criteria, carotid duplex imaging is safe, highly sensitive and specific, and superior to angiography at plaque characterization and evaluation of flow disturbance. Cerebral CT or MRI should be performed if symptoms are atypical or if there is an evolved stroke. Angiography is required when duplex imaging is suboptimal or equivocal, in the presence of atypical symptoms or uncommon vascular abnormalities. In the majority of patients requiring endarterectomy for symptomatic high grade ICA stenosis, angiography seldom adds relevant information, and clinical assessment and carotid duplex imaging alone can be safely used in preoperative assessment.
A protocol for the measurement of downtime of medical equipment.
Authors: Cook D A
Published: June 2014

The downtime of medical equipment has become an issue of increasing concern within the National Health Service over recent years. No protocol exists to formalize measurement and recording of downtime. A survey of 129 purchasers and providers of radiotherapy maintenance services at 68 establishments in the UK was undertaken, with replies received from 66. Information was gathered on 16 factors affecting the measurement of downtime of radiotherapy equipment. The results of the survey are presented and analysed. The conclusions drawn demonstrate the practicality of introducing a protocol for the measurement of downtime and availability. A draft protocol has been developed from the results of the survey.
Primary multilocular cystic undifferentiated (embryonal) sarcoma of the liver in childhood resembling hydatid cyst of the liver.
Authors: Joshi S W , Merchant N H , Jambhekar N A
Published: June 2014

Undifferentiated (embryonal) sarcoma (UES) is a very rare primary malignant tumour of the liver; typically presenting in later childhood. This tumour usually appears on CT and ultrasound as a predominantly solid mass with or without cystic areas. We report a case of primary UES which had a multilocular cystic appearance resembling a hydatid cyst on imaging.
The value of ventilation-perfusion imaging in pregnancy.
Authors: Balan K K , Critchley M , Vedavathy K K , Smith M L , Vinjamuri S
Published: June 2014

Pulmonary embolism (PE) is a major cause of maternal death during pregnancy. The aims of this retrospective study were to review 5 years experience of ventilation-perfusion (V/Q) imaging in pregnancy, to evaluate the effect of the V/Q scan report on the referring clinician's use of anticoagulants and to monitor the course and outcome of pregnancy. 82 patients (aged 17-44 years, gestation 6-40 weeks) underwent V/Q imaging for suspected PE, over a 5 year period. Modified PIOPED criteria were used to assess the probability of PE. 31 patients were shown to have normal scans (38%); 19 (23%) had low probability (LP) scans; 14 (17%) had intermediate probability (IP) scans and 18 (22%) had high probability (HP) scans for PE. Referring clinicians saw the reports and took action within 12 h. Anticoagulation was continued or started in 31 patients (all HP, 12 IP and 1 LP). Anticoagulation was considered unnecessary in 52 patients (all normal, 19 LP and 2 IP). None of the patients with normal or LP scans had documented PE during the follow-up period (median 25 months, range 3-60 months). No complications of anticoagulation were observed and no adverse outcome of pregnancy were reported. V/Q imaging is a valuable technique in the management of pregnant women suspected of having PE.
A survey of routine head CT protocols in Australia.
Authors: Smith A N , Shah G A
Published: June 2014

The choice of scanning protocol in CT will affect the dose delivered to the patient. A nationwide survey of CT operators was carried out in Australia in 1994 to determine the variation in routine head CT protocols. Only 29% of respondents used the supraorbitomeatal (SOM) baseline and thus avoided scanning the eyes. At 74% of sites, the routine protocol included scans both before and after injection of contrast. However, the post-contrast protocol differed from that used in the pre-contrast series in a number of cases. Where 5 mm thick slices were used, the mAs was 16% higher than for 10 mm thick slices. Increased awareness of the influence of baseline, slice thickness/spacing and accompanying exposure factors on patient dose may lead to greater standardization of head CT scanning protocols.
Imaging appearances of ileouterine fistula complicating recurrent adenocarcinoma of the rectum.
Authors: Hession P , Mannion R A , Finan P , Chalmers A G
Published: June 2014

Enterouterine fistulae are rare and nowadays are most commonly due to pelvic tumours. We review the literature and present the case of a woman who presented with an ileouterine fistula following surgery and radiotherapy for recurrent rectal adenocarcinoma. The presence of tumour within the fistula track may also have been a significant aetiological factor. Magnetic resonance imaging (MRI) is an excellent method to demonstrate the site and size of the track and has not, to date, been used to identify such a fistula.
Three-dimensional CT demonstration of intrahepatic portosystemic venous shunt draining into the inferior vena cava.
Authors: Kanematsu M , Hoshi H , Imaeda T , Mizuno S , Yokoyama R
Published: June 2014

An unusual form of intrahepatic portosystemic venous shunt draining into the inferior vena cava was demonstrated using three-dimensional images reconstructed from spiral CT during arterial portography, colour Doppler ultrasonography with flow velocity measurement, and digital subtraction portovenography. The utilization of modern radiological techniques in evaluating intrahepatic portosystemic venous shunts is discussed.
Radiation-induced malignant mesenchymoma of the chest wall following treatment for breast cancer.
Authors: Rustemeyer P , Micke O , Blasius S , Peters P E
Published: June 2014

21 years after radiotherapy for breast cancer, a 63-year-old woman developed a malignant mesenchymoma of the chest wall. The total irradiation dose was 132 Gy. The first clinical symptom of this second malignancy was a slight irregular calcification around the implanted silicon protheses observed in a conventional chest X-ray. Radiation-induced sarcoma is a very rare complication of radiotherapy. In cases of chest wall calcification after radiation therapy further investigation should be carried out, because some patients with radiation-induced sarcoma could be saved, if an early diagnosis is reached.
MRI of breast cancer: influence of chemotherapy on sensitivity.
Authors: Rieber A , Zeitler H , Rosenthal H , Görich J , Kreienberg R , Brambs H J , Tomczak R
Published: June 2014

MR mammography (MRM) seems to be a sensitive method for detection of breast cancer. The effect of cytotoxic agents on the dynamics of contrast medium uptake in primary breast carcinoma or recurrent disease is not known. This study addresses this question and evaluates MRM as a method of monitoring therapeutic success. A total of 13 patients (age range 34-62 years) with histologically confirmed breast cancer were investigated. The patients received neoadjuvant intravenous (iv) chemotherapy. MRM and interpretation of the dynamic measurements were performed in a standardized manner after positioning the patient in a double breast coil. A gradient echo sequence (Flash 3D, TE 5 ms, TR 12 ms, flip angle 25 degrees) was acquired before and 1, 2, 3 and 8 min after intravenous injection of Gd-DTPA 0.15 mmol kg-1 body weight. A T2 weighted SE sequence (TE 103 ms, TR 6900 ms, 4 mm, field of view 350 mm) was also obtained. MRM was performed prior to histological evaluation and after chemotherapy. All cases of malignancy were correctly diagnosed with MRM. Based on MR findings, eight patients were classified as "responders" and the remaining as "non-responders". In the "responders" a flattening of the Gd-DTPA uptake curve after the first cycle of chemotherapy of complete absence of Gd-DTPA uptake after the fourth cycle was observed. The change in Gd-DTPA uptake behaviour led to an underestimation of the extent of tumour in two patients and false negative findings in four patients. MRM provides information regarding response to therapy following the first cycle. MRM does not provide information regarding invasive tumour tissue in "responders".
Technetium-99m sestamibi scintigraphy, magnetic resonance imaging and venous blood sampling in persistent and recurrent hyperparathyroidism.
Authors: Fayet P , Hoeffel C , Fulla Y , Legmann P , Hazebroucq V , Luton J P , Chapuis Y , Richard B , Bonnin A
Published: June 2014

Surgical treatment for primary hyperparathyroidism (HPT) is effective in 90% of cases. Recurrent or persistent HPT occurs in 10% of cases. Parathyroid imaging is indicated to confirm and locate an abnormal gland before reoperation. The aim of this study was to evaluate whether the combination of 99Tcm sestamibi scintigraphy, MRI and venous blood sampling (VBS) improved the overall sensitivity for abnormal parathyroid gland detection. 18 patients with recurrent or persistent HPT underwent sestamibi scintigraphy (n = 18), MRI (T1 weighted and STIR sequences) (n = 18) and venous blood sampling (n = 12) at different sites (internal jugular veins, innominate veins, and superior vena cava). All patients underwent surgical exploration. MRI yielded positive results in 15 cases (sensitivity 88%), sestamibi scintigraphy in 14 cases (83%) and VBS in 10 cases out of 12 (83%). Combined results of MRI, sestamibi and VBS yielded positive results in 16 cases (94%). The combination of MRI, sestamibi scintigraphy and VBS improved accuracy in detecting abnormal parathyroid glands before reoperation.
A comparison between 111In-anti-E-selectin mAb and 99Tcm-labelled human non-specific immunoglobulin in radionuclide imaging of rheumatoid arthritis.
Authors: Jamar F , Chapman P T , Manicourt D H , Glass D M , Haskard D O , Peters A M
Published: June 2014

We have developed and validated a method for imaging inflammation using a monoclonal antibody (1.2B6) against E-selectin, an endothelial-cell specific adhesion molecule. This study was undertaken to compare 111In-1.2B6 with 99Tcm-labelled non-specific IgG (99Tcm-HIG) in the detection of synovitis in 11 patients with rheumatoid arthritis (RA). Imaging was performed 4 h and 20-24 h post-injection (pi) of 555 MBq 99Tcm-HIG and 15 MBq 111In-1.2B6. Scintigraphic results were compared with clinical scores of joint involvement. Joint uptake was semiquantitated. The scintigraphic appearances with both tracers correlated well, although 111In-1.2B6 at 24 h showed the highest detection rate. Taking joint tenderness or swelling as evidence of clinical activity, the sensitivity of 111In-1.2B6 at 4 h and 24 h was 69% and 82%, respectively, compared with 69% and 62% for 99Tcm-HIG. 111In-1.2B6 also displayed abnormal activity over a number of joints that appeared silent on clinical examination. Joint-to-soft tissue ratios were higher for 111In-1.2B6 at 24 h (4.0 +/- 1.9; p < 0.0001 vs all) than at 4 h (2.4 +/- 1.4) or than for 99Tcm-HIG at 4 h and 24 h (1.6 +/- 0.5 and 2.3 +/- 0.7, respectively). Net 111In counts over joints increased significantly between 4 h and 24 h (mean change: 54 +/- 40%). This study demonstrates that 111In-1.2B6 scintigraphy is a sensitive method by which to assess RA activity and that targeting is more intense and specific than using 99Tcm-HIG. However, the optimum time for 111In-1.2B6 scintigraphy is 24 h whereas good results are already obtained with 99Tc-HIG at 4 h pi. Current efforts are directed at developing 99Tcm-labelled 1.2B6 for imaging endothelial activation.
Influence of number of views and mammographic film density on the detection of invasive cancers: results from the NHS Breast Screening Programme.
Authors: Young K C , Wallis M G , Blanks R G , Moss S M
Published: June 2014

The National Health Service Breast Screening Programme (NHSBSP) has recommended the adoption of two view mammography at the prevalent screen, and the use of a target film density in the range 1.4-1.8. The aim of this study was to review the impact of number of views and optical density on the detection of invasive cancers. The last four annual returns for screening centres in the NHSBSP have been analysed retrospectively for 2827342 women aged 50-64 years attending their first (prevalent) screening examination. The detection of invasive cancers was assessed in relation to the number of views and film density using the age adjusted, Standardized Detection Ratio measure of screening performance. Typical film densities were reported for each screening year by local physicists, and the average value for all mammography sets at each programme calculated, and found to vary from 0.85 to 1.85. The mean film density across the NHSBSP rose progressively from 1.30 (SD = 0.21) in 1991/2 to 1.57 (SD = 0.12) in 1994/5. Programmes using single view mammography (MLO) and an optical density less than 1.4 detected 76% (95% CI 74-79%) of the expected invasive cancers. Programmes using two view mammography (MLO and CC) and an optical density equal to or greater than 1.4 detected 95% (95% CI 92-98%) of the expected invasive cancers. In 1994/95 when more programmes used the recommended screening modes, the NHSBSP detected 96% (95% CI 92-101%) of the expected invasive cancers at prevalent screening. The detection of invasive cancers was highest where programmes used two views with a film density in the range 1.4-1.8. The results provide evidence of the benefit of the recommended protocol for prevalent screening and indicate that from 1995/96 when all programmes will be using the recommended protocol, it is likely that the detection rates and interval cancer rates from prevalent screens in the NHSBSP will be close to the figures in the Swedish-Two County Trial.
Patient dose reduction by audit of grid usage in barium enemas.
Authors: Seymour R
Published: June 2014

Patient dose reduction may be achieved by removal of the antiscatter grid during fluoroscopy when fine detail is not required, such as during the filling phase of barium enemas. A questionnaire revealed that none of 22 trainee radiologists routinely removed the grid for the filling phase of adult barium enemas. Following this, 100 consecutive barium enemas were observed, with assessment of patient radiation dose by means of a dose-area product meter. The grid was removed in only six examinations. Phantom measurements implied a possible 46% reduction in dose for the filling phase by correct grid usage. These data were presented at a local clinical audit meeting, resulting in a change in departmental policy to recommend routine removal of the grid for the filling phase of barium enemas. In a follow-up audit the grid was removed in 96 of 100 consecutive enemas, resulting in a significant 46.5% dose reduction for the filling phase (95% confidence interval 38-61%). Further re-audit has demonstrated continued good practice.
Measurement of femoral antetorsion and tibial torsion by magnetic resonance imaging.
Authors: Schneider B , Laubenberger J , Jemlich S , Groene K , Weber H M , Langer M
Published: June 2014

Several methods for measuring femoral and tibial torsion by CT have been described since 1980. Alternative methods of measurement to CT are needed to avoid irradiating young patients facing derotation osteotomy. In this study, MRI was used to quantify femoral and tibial torsion in normal adult volunteers, firstly with transverse sections analogous to those of CT in order to establish reference values; and secondly, with sections along the axis of the neck of femur to assess the influence of the orientation of the slices on the measured values. The images were acquired using fast T1 weighted gradient echo sequences in 0.2 and 1 T magnets. Average femoral antetorsion (CT-analogous method) was 10.4 degrees (average side difference = 4.6 degrees); average tibial torsion was 41.7 degrees (average side difference = 6.1 degrees). A steeply inclined slice along the axis of the femoral neck gave a mean measurement of the angle of antetorsion that was significantly higher than the mean obtained from either slightly inclined or transverse sections (16.7 degrees vs 12.1 degrees and 11.2 degrees, respectively, p < 0.001). In conclusion, MRI provides an alternative to CT in the measurement of femoral and tibial torsion. MRI enables one to orientate the slice along the axis of the femoral neck, thus obtaining a single cross-section of the entire neck. However, the normal range of measurements will vary according to the plane of image.