The clinical effects of increased water intake on autosomal dominant polycystic kidney disease (ADPKD) progression are unknown.
ADPKD patients with creatinine clearance ≧ 50 mL/min/1.73 m(2) were ...divided into high (H-, n = 18) and free (F-, n = 16) water-intake groups, mainly according to their preference. Prior to the study, 30 patients underwent annual evaluation of total kidney volume (TKV) and 24-h urine for an average of 33 months. During the 1-year study period, TKV and 24-h urine were analyzed at the beginning and end of the study and every 4 months, respectively.
During the pre-study period, urine volume (UV) in the H-group was higher (P = 0.034), but TKV and kidney function and their slopes were not significantly different between the two groups. After the study commenced, UV further increased (P < 0.001) in the H-group but not in the F-group. During the study period, TKV and kidney function slopes were not significantly different between the two groups (primary endpoint). Plasma copeptin was lower (P = 0.024) in the H-group than in the F-group. TKV and kidney function slopes became worse (P = 0.047 and 0.011, respectively) after high water intake (H-group) but not in the F-group. High UV was associated with increased urine sodium, and urine sodium positively correlated with the % TKV slope (P = 0.014).
Although the main endpoint was not significant, high water intake enhanced disease progression in the H-group when compared with the pre-study period. These findings necessitate a long-term randomized study before drawing a final conclusion.
The CA1 pyramidal neurons in the hippocampus are selectively vulnerable to transient ischemic damage. In experimental animals, the CA1 pyramidal neurons undergo cell death several days after brief ...forebrain ischemia. It remains, however, unknown whether this delayed neuronal death is necrosis or apoptosis. To investigate the degenerating processes of the CA1 pyramidal neurons in gerbil hippocampus after brief ischemia, lysosomal and nuclear alterations in the cells were examined using immunocytochemistry, in situ nick-end labeling, and Southern blotting. By light and electron microscopy, immunoreactivity for cathepsins B, H, and L, representative lysosomal cysteine proteinases, increased in the CA1 pyramidal neurons 3 d after ischemic insult, which showed cell shrinkage. By morphometric analysis, the volume density of cathepsin B-positive lysosomes markedly increased 3 d after ischemic insult, while that of autophagic vacuole-like structures also increased at this stage, suggesting that cathepsin B-immunopositive lysosomes increasing in the neurons after ischemic insult are mostly autolysosomes. Nuclei of the CA1 neurons were nick-end labeled by biotinylated dUTP mediated by terminal deoxytransferase 3 and 4 d after ischemic insult, but not in the prior stages. Simultaneously, dense chromatin masses appeared in nuclei of the neurons. By Southern blotting, laddering of DNA occurred only in CA1 hippocampal tissues obtained 4 d after ischemic insult. Confocal laser scanning microscopy demonstrated that the fragmented DNA in the CA1 pyramidal layer was phagocytosed by microglial cells. The results suggest that delayed death of the CA1 pyramidal neurons after brief ischemia is not necrotic but apoptotic.
To compare helical computed tomography (CT) and dynamic, magnetic resonance (MR) imaging in the evaluation of pancreatic ductal adenocarcinoma.
Dynamic MR images obtained with breath holding, 256 ...phase- and 512 frequency-encoding steps, 5-mm section thickness, phased-array multicoil, and double-dose gadolinium were available from 21 patients. Dynamic MR images were retrospectively compared with helical CT images in the evaluation of tumor detection, local tumor extension, and vascular involvement.
Tumors were detected on dynamic MR images of 19 of 21 (90%) patients and on helical CT scans of 16 (76%) patients. Dynamic MR imaging had equal or better sensitivity, accuracy, and agreement of tumor grade than did helical CT in the comparison of imaging findings and histopathologic findings. Dynamic MR imaging also had equal or better specificity than had helical CT in determination of local tumor extension and vascular involvement, except in the factors of duodenal invasion and portal venous system involvement. However, there was no statistically significant difference among any of these measurements.
Dynamic MR imaging may be better than helical CT in the preoperative detection and evaluation of local tumor extension and of vascular involvement of pancreatic ductal adenocarcinomas.
Aim To determine whether cerebral computed tomography (CT) angiography with a 16-detector row system can be performed using a reduced dose of contrast material. Materials and methods Twenty-eight ...patients were assigned to one of four protocols: A = 50 ml of 350 mg I/ml with a saline flush (SF, 40 ml); B = 75 ml of 350 mg I/ml with an SF; C = 75 ml of 350 mg I/ml without an SF; and D = 100 ml of 300 mg I/ml without an SF. The attenuation of the internal carotid, middle cerebral, and anterior cerebral arteries were measured. The demonstration of vessels was also assessed. Results There were no significant attenuation differences of the arteries among the four groups, neither were any significant differences noted on the visual assessment. Conclusions By using a reduced dose (50 ml) at higher iodine concentration (350 mg I/ml) with an SF, CT angiograms comparable with those acquired with a standard dose and concentration can be obtained.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Purpose: To report a technique developed for visualizing cervical nerve roots and distal nerve fibers using diffusion-weighted magnetic resonance imaging employing parallel imaging.
Material and ...Methods: We performed maximum intensity projection for a stack of isotropic axial diffusion-weighted images obtained with parallel imaging applying a motion-probing gradient in six directions with a b-value of 500 s mm2 in a preliminary series of 13 subjects.
Results: This method worked well for visualizing the spinal cord and most of the nerve roots, the dorsal root ganglia, and proximal peripheral nerves.
Conclusion: Although the technique remains limited in depicting the brachial plexus and distal nerves, the ability to visualize the proximal peripheral nervous system at the cervical level is promising.
We assessed the effect of iodine delivery rates (IDRs) and a saline flush in CT angiography that covered both cervical and cerebral arteries when a contrast material of higher concentration (350 ...mgI/mL) was employed. In three patient groups whose CT angiography was performed at different IDRs with or without a saline flush, we measured the attenuation of target vessels and visually evaluated the images obtained. Our results indicated that a higher IDR was effective to increase the attenuation value of both cervical and cerebral arteries without changing that of the venous system, although it did not significantly affect visualization of these vessels. Further, the addition of a saline flush could reduce the injection speed without a decrease in the attenuation of the target vessels.
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NUK, OILJ, SAZU, UKNU, UL, UM, UPUK, VSZLJ
We assessed the feasibility of modifying the contrast dose and injection rate based on patient weight in four patient groups in whom CT angiography was performed with contrast agent 350 mgI/mL at ...different injection doses in combination with a saline flush (40 mL). Patients were assigned to one of four groups: group A: injection dose (ID) of 1.3 mgI/kg; group B: ID of 1.1 mgI/kg; group C: ID of 0.9 mgI/kg; and group D (the control group): a fixed dose of 75 mL at 3 mL/s (25 s). In groups A to C, the injection time was fixed at 20 s. We measured the attenuation of target vessels and visually assessed the images obtained. The average dose and rates were 81.3/4.1, 63.8/3.2, and 49.4/2.5 (mL/mL/s) for groups A, B, and C, respectively. The doses of groups B and C were significantly smaller that that of group D. Cerebral vessels showed no significant attenuation difference between group D and groups A and B, but the attenuation of only a few assessed regions was significantly lower in group C than in group D. In the visual assessment, no difference was found among the four groups. Cervical and cerebral CT angiograms can be obtained at a dose of 1.1 mgI/kg, which can effectively reduce the contrast dose.
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NUK, OILJ, SAZU, UKNU, UL, UM, UPUK, VSZLJ
To understand the bone resorption and lysosomal proteinases in osteoclasts, we examined by immunohistochemistry the localization of lysosomal cysteine and aspartic proteinases, acid phosphatase, and ...cystatin-beta in the rat tibial bone. Immunoreactivity for cathepsins B, C, H, and L, cathepsin D, acid phosphatase, and cystatin-beta was demonstrated in various cells of the bone tissue; in particular, large multinucleated osteoclasts attached to the bone surface and chondroclasts in the proximal growth plate. These cells showed intense immunoreactivity for these lysosomal enzymes and cystatin-beta. Bone surface-lining osteoblasts displayed distinct immunoreactivity for cathepsins B, C, D, H, and acid phosphatase, while osteocytes often exhibited that for cathepsins D, H and acid phosphatase. Chondrocytes in the growth plate demonstrated intense immunoreactivity for cathepsins B, D, and acid phosphatase. Immunoreactivity for cystatin-beta was detected in osteoclasts and chondroclasts only. Large, round multinucleated cells free from the bone surface exhibited weak, faint, or no immunoreactivity for the lysosomal enzymes and cystatin-beta. These results suggest that lysosomal cysteine and aspartic proteinases may play a role in the degradation of organic constituents of the bone matrix. Moreover, cystatin-beta can serve as an excellent marker protein for osteoclasts.
The purpose of this study was to determine the usefulness of diffusion-weighted MR imaging with single-shot echoplanar imaging in characterizing focal hepatic lesions by apparent diffusion ...coefficient (ADC) and contrast-to-noise ratio (CNR) measurements.
Diffusion-weighted imaging on a 1.5-T MR unit was performed in 46 patients with 74 known focal hepatic lesions (11 hemangiomas, 15 metastases, and 48 hepatocellular carcinomas HCCs). Mean values for ADCs and CNRs of all lesions were calculated. Mean values for CNRs with diffusion-weighted imaging were also compared with those for breath-hold T2-weighted fast spin-echo images.
The mean values for ADCs were different for each type of tumor (5.39 x 10(-3) mm2/sec +/- 1.23 in hemangiomas, 2.85 x 10(-3) mm2/sec +/- 0.59 in metastases, and 3.84 x 10(-3) mm2/sec +/- 0.92 in HCCs), and each of them was significantly greater than the mean values for ADCs of the normal liver (2.28 x 10(-3) mm2/sec +/- 1.23 in normal liver p < .05 except metastasis versus normal liver p < .1). Also, the mean values for ADCs were based on differences of ADC values. Only four (6%) of 63 malignant tumors (three HCCs and one metastasis) could not be differentiated from hemangiomas. The mean value for CNRs with diffusion-weighted images (14.4 +/- 8.54 in HCC and 29.0 +/- 6.79 in metastasis) was significantly higher than the mean values for CNRs obtained with T2-weighted fast spin-echo images in both metastases and HCCs (p < .05), whereas no significant difference was seen for hemangiomas.
Mean values for ADCs differed for the three types of the hepatic lesions and were higher than ADCs of the normal liver. We suggest that diffusion-weighted imaging may be useful for increased detection of HCCs and metastases and in distinguishing these entities from hemangiomas.
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