Abstract This study prospectively investigated the accuracy and radiation dose reduction of CT coronary artery calcium scoring (CACS) using a 100kVp acquisition protocol with tin filtration ...(Sn100kVp) compared to the standard 120kVp acquisition protocol. 70 patients (59% male, 62.1±10.7 years) who underwent a clinically-indicated CACS acquisition using the standard 120kVp protocol on a 3rd generation dual-source CT (DSCT) system were enrolled. An additional Sn100kVp CACS scan was performed. Agatston scores and categories, percentile-based risk categorization, and radiation dose estimates were derived from 120kVp and Sn100kVp studies and compared. Median Agatston scores from the Sn100kVp and 120kVp acquisitions were 38.2 and 41.2, respectively ( p <0.0001). Excellent correlation of Agatston scores was found between the two acquisitions ( r =0.99, p <0.0001). Even though the Agatston scores were systematically lower with Sn100kVp than with 120kVp, the comparison of Agatston score categories and percentile-based cardiac risk categories showed excellent agreement (ĸ=0.98 and ĸ=0.98). Image noise was 26.3±5.7HU in Sn100kVp and 17.6±4.1HU in 120kVP scans ( p <0.0001). The dose-length-product was 14.1±3.7mGy*cm with Sn100kVp and 58.5±23.5mGy*cm with 120kVp scans ( p <0.0001), resulting in a significantly lower effective radiation dose (0.19±0.05mSv vs. 0.82±0.32mSv, p <0.0001) for Sn100kVp scans. CACS using a low voltage tin filtration protocol shows excellent correlation and agreement with the standard method with regards to the Agatston score and subsequent cardiac risk categorization, while achieving a 75% reduction in radiation dose.
Research Highlights • 5 year follow-up on epidural prefrontal cortical stimulation treatment for depression • Long-term safety and efficacy outcomes were assessed • All 5 patients tolerated therapy ...at 5 years, 3/5 continued to be in remission • 5 adverse events resulting in suicidal ideation and/or hospitalization occurred
Renin angiotensin aldosterone system inhibitors/antagonists/blockers (RAASi) are a cornerstone in treatment of patients with cardiovascular diseases especially in those with heart failure (HF) due to ...their proven effect on surrogate and hard endpoints. Renin angiotensin aldosterone system inhibitors are also the basis in treatment of arterial hypertension, and they are furthermore indicated to reduce events and target organ damage in patients with diabetes and chronic kidney disease, where they have specific indication because of the evidence of benefit. Renin angiotensin aldosterone system inhibitor therapy, however, is associated with an increased risk of hyperkalaemia. Patients with chronic kidney disease and HF are at increased risk of hyperkalaemia and ∼50% of these patients experience two or more yearly recurrences. A substantial proportion of patients receiving RAASi therapy have their therapy down-titrated or more often discontinued even after a single episode of elevated potassium (K+) level. Since RAASi therapy reduces mortality and morbidity in patients with cardiovascular disease steps should, when hyperkalaemia develops, be considered to lower K+ level and enable patients to continue their RAASi therapy. The use of such measures are especially important in those patients with the most to gain from RAASi therapy.
An integrative approach was used to obtain pure cultures of previously uncultivated members of the divisions Acidobacteria and Verrucomicrobia from agricultural soil and from the guts of wood-feeding ...termites. Some elements of the cultivation procedure included the following: the use of agar media with little or no added nutrients; relatively long periods of incubation (more than 30 days); protection of cells from exogenous peroxides; and inclusion of humic acids or a humic acid analogue (anthraquinone disulfonate) and quorum-signaling compounds (acyl homoserine lactones) in growth media. The bacteria were incubated in the presence of air and in hypoxic (1 to 2% O2 vol/vol) and anoxic atmospheres. Some bacteria were incubated with elevated concentrations of CO2 (5% vol/vol). Significantly more Acidobacteria were found on isolation plates that had been incubated with 5% CO2. A simple, high-throughput, PCR-based surveillance method (plate wash PCR) was developed. This method greatly facilitated detection and ultimate isolation of target bacteria from as many as 1,000 colonies of nontarget microbes growing on the same agar plates. Results illustrate the power of integrating culture methods with molecular techniques to isolate bacteria from phylogenetic groups underrepresented in culture.
Aims Pre-treatment with mineralocorticoid receptor (MR) antagonists is reported to reduce myocardial infarct size from ischaemia/reperfusion. Here, we tested whether the MR antagonists potassium ...canrenoate and eplerenone could protect in the more clinically relevant schedule of administration at the end of ischaemia. Methods and results In all models, hearts were subjected to 30 min regional ischaemia followed by 120 min (rabbits 4 h) reperfusion. A bolus of canrenoate 5 min prior to reperfusion in open-chest mice decreased infarct size in a dose-dependent manner. Maximum protection was seen at 1 mg/kg where infarction was 18% of that in the control (P < 0.001). Ecto-5'-nucleotidase (CD73) as well as adenosine A2b receptor knock-out mice could no longer be protected, suggesting a role for adenosine and the A2b receptor in the mechanism. A 1 mg/kg bolus of canrenoate prior reperfusion also reduced infarct size in open-chest rabbits. To explore the underlying mechanisms, we studied isolated rat hearts. Eplerenone (10 µM) at the end of ischaemia was similarly protective in the rat heart and the protection was abolished by co-treatment with inhibitors of the adenosine receptor, protein kinase C, PI3-kinase, and ERK. In addition, eplerenone or canrenoate treatment increased phosphorylation of the pro-survival kinases Akt and ERK1/2 at reperfusion in the rat hearts. Conclusion Taken together, MR antagonists when given at the end of ischaemia are highly effective and potent cardioprotective drugs with a signalling similar to that of ischaemic pre-conditioning and, hence, could be a very promising candidate for the treatment of acute myocardial infarction in man.
The ratio of the nucleon $F_2$ structure functions, $F^n_2/F^p_2$, is determined by the MARATHON experiment from measurements of deep inelastic scattering of electrons from 3H and 3He nuclei. The ...experiment was performed in the Hall A Facility of Jefferson Lab using two high-resolution spectrometers for electron detection, and a cryogenic target system which included a low-activity tritium cell. The data analysis used a novel technique exploiting the mirror symmetry of the two nuclei, which essentially eliminates many theoretical uncertainties in the extraction of the ratio. The results, which cover the Bjorken scaling variable range 0.19 < x < 0.83, represent a significant improvement compared to previous SLAC and Jefferson Lab measurements for the ratio. They are compared to recent theoretical calculations and empirical determinations of the $F^n_2/F^p_2$ ratio.
Background Diagnosis of mucinous pancreatic cysts (MPCs) is challenging due to the poor sensitivity of cytology provided by EUS-guided-FNA (EUS-FNA). Objective To quantify the test characteristics of ...molecular (DNA) analysis in suspected low-risk MPCs. Design A prospective cohort study performed in between 2008 and 2011. Setting Academic referral center. Patients Consecutive patients who underwent EUS-FNA of suspected MPCs. Intervention EUS-FNA and molecular (DNA) analysis of cyst fluid. Main Outcome Measurements The sensitivity and specificity of molecular analysis in the diagnosis of MPCs using the criterion standard of surgical pathology in resected cysts. Results Patients with suspected MPCs underwent EUS-FNA and cyst fluid DNA analysis. Surgical resection was performed in 48 patients (17%), confirming a mucinous pathology in 38 (79%). In this group, molecular analysis had a sensitivity of 50% and a specificity of 80% in identifying MPCs (accuracy of 56.3%). The combination of molecular analysis with cyst fluid carcinoembryonic antigen (CEA) and cytology resulted in higher MPC diagnostic performance than either one of its individual components, with a sensitivity, specificity, and accuracy of 73.7%, 70%, and 72.9%, respectively. There was no significant difference in accuracy between molecular analysis and CEA/cytology in this group. Limitations Single-center experience. Conclusion Molecular analysis aids in the diagnosis of MPCs when cytology is nondiagnostic or cyst fluid is insufficient for CEA or its level is indeterminate. Our results do not support the routine use of molecular analysis, which should be used selectively after review of imaging findings and cyst fluid studies. Further studies are needed to assess DNA's performance in malignant cysts.
The effects of the Securinega alkaloid (+)-phyllanthidine on Leishmania (L.) amazonensis and the first chemical investigation of Margaritaria nobilis L.f. (Phyllanthaceae) are described. Treating the ...parasites with this alkaloid caused a dose-dependent reduction in promastigote growth of 67.68% (IC50 82.37 μg/mL or 353 µM) and in amastigote growth of 83.96% (IC50 49.11 μg/mL or 210 µM), together with ultrastructural alterations in the promastigotes. No cytotoxic effect was detected in mammalian cells (CC50 1727.48 µg/mL or CC50 5268 µM). Classical chromatographic techniques and spectral methods led to the isolation and identification of betulinic acid, kaempferol, corilagin, gallic acid and its methyl ester, besides (+)-phyllanthidine from M. nobilis leaves and stems. Margaritaria nobilis is another source of the small group of Securinega alkaloids, together with other Phyllanthaceae (Euphorbiaceae s.l.) species. The low toxicity to macrophages and the effects against promastigotes and amastigotes are suggestive that (+)-phyllanthidine could be a promising antileishmanial agent for treating cutaneous leishmaniasis.
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