Gated blood-pool SPECT (GBPS), inherently 3-dimensional (3D), has the potential to replace planar equilibrium radionuclide angiography (ERNA) for computation of left ventricular ejection fraction ...(LVEF), analysis of regional wall motion (RWM), and analysis of right heart function. The purpose of this study was to compare GBPS and ERNA for the assessment of ventricular function in a large, multicenter cohort of patients.
One hundred seventy-eight patients referred in the usual manner for nuclear medicine studies underwent ERNA followed by GBPS. Each clinical site followed a GBPS acquisition protocol that included 180 degrees rotation, a 64 by 64 matrix, and 64 or 32 views using single- or double-head cameras. Transverse GBPS images were reconstructed with a Butterworth filter (cutoff frequency, 0.45-0.55 Nyquist; order, 7), and short-axis images were created. All GBPS studies were processed with a new GBPS program, and LVEF was computed from the isolated left ventricular chamber and compared with standard ERNA LVEF. Reproducibility of GBPS LVEF was evaluated, and right ventricular ejection fraction (RVEF) was computed in a subset of patients (n = 33). Using GBPS, RWM and image quality from 3D surface-shaded and volume-rendered cine displays were evaluated qualitatively in a subset of patients (n = 30).
The correlation between GBPS LVEF and planar LVEF was excellent (r = 0.92). Mean LVEF was 62.2% for GBPS and 54.1% for ERNA. The line of linear regression was GBPS LVEF = (1.04 x ERNA LVEF) + 6.1. Bland-Altman plotting revealed an increasing bias in GBPS LVEF with increasing LVEF (Y = 0.13x + 0.61; r = 0.30; mean difference = 8.1% +/- 7.0%). Interoperator reproducibility of GBPS LVEF was good (r = 0.92). RVEF values averaged 59.8%. RWM assessment using 3D cine display was enhanced in 27% of the studies, equivalent in 67%, and inferior in 7%.
GBPS LVEF was reproducible and correlated well with planar ERNA. GBPS LVEF values were somewhat higher than planar ERNA, likely because of the exclusion of the left atrium.
Radiation dosimetry studies were performed in patients with non-Hodgkin's lymphoma (NHL) treated with
90Y
Zevalin™ (
90yttrium ibritumomab tiuxetan, IDEC-Y2B8) on a Phase III open-label prospectively ...randomized multicenter trial. The trial was designed to evaluate the efficacy and safety of
90Y Zevalin radioimmunotherapy compared to rituximab (Rituxan®, MabThera®) immunotherapy for patients with relapsed or refractory low-grade, follicular, or transformed NHL. An important secondary objective was to determine if radiation dosimetry prior to
90Y Zevalin administration is required for safe treatment in this patient population.
Methods: Patients randomized into the Zevalin arm were given a tracer dose of 5 mCi (185 MBq)
111In Zevalin (
111indium ibritumomab tiuxetan) on Day 0, evaluated with dosimetry, and then administered a therapeutic dose of 0.4 mCi/kg (15 MBq/kg)
90Y Zevalin on Day 7. Both Zevalin doses were preceded by an infusion of 250 mg/m
2 rituximab to clear peripheral B-cells and improve Zevalin biodistribution. Following administration of
111In Zevalin, serial anterior and posterior whole-body scans were acquired and blood samples were obtained. Residence times for
90Y were estimated for major organs, and the MIRDOSE3 computer software program was used to calculate organ-specific and total body radiation absorbed dose. Patients randomized into the rituximab arm received a standard course of rituximab immunotherapy (375 mg/m
2 weekly×4).
Results: In a prospectively defined 90 patient interim analysis, the overall response rate was 80% for Zevalin vs. 44% for rituximab. For all patients with Zevalin dosimetry data (
N=72), radiation absorbed doses were estimated to be below the protocol-defined upper limits of 300 cGy to red marrow and 2000 cGy to normal organs. The median estimated radiation absorbed doses were 71 cGy to red marrow (range: 18–221 cGy), 216 cGy to lungs (94–457 cGy), 532 cGy to liver (range: 234–1856 cGy), 848 cGy to spleen (range: 76–1902 cGy), 15 cGy to kidneys (0.27–76 cGy) and 1484 cGy to tumor (range: 61–24 274 cGy). Toxicity was primarily hematologic, transient, and reversible. The severity of hematologic nadir did not correlate with estimates of effective half-life (half-life) or residence time of
90Y in blood, or radiation absorbed dose to the red marrow or total body.
Conclusion:
90Y Zevalin administered to NHL patients at non-myeloablative maximum tolerated doses delivers acceptable radiation absorbed doses to uninvolved organs. Lack of correlation between dosimetric or pharmacokinetic parameters and the severity of hematologic nadir suggest that hematologic toxicity is more dependent on bone marrow reserve in this heavily pre-treated population. Based on these findings, it is safe to administer
90Y Zevalin in this defined patient population without pre-treatment
111In-based radiation dosimetry.
About 10 μs after the Big Bang, the universe was filled—in addition to photons and leptons—with strong-interaction matter consisting of quarks and gluons, which transitioned to hadrons at ...temperatures close to kT = 150 MeV and densities several times higher than those found in nuclei. This quantum chromodynamics (QCD) matter can be created in the laboratory as a transient state by colliding heavy ions at relativistic energies. The different phases in which QCD matter may exist depend for example on temperature, pressure or baryochemical potential, and can be probed by studying the emission of electromagnetic radiation. Electron–positron pairs emerge from the decay of virtual photons, which immediately decouple from the strong interaction, and thus provide information about the properties of QCD matter at various stages. Here, we report the observation of virtual photon emission from baryon-rich QCD matter. The spectral distribution of the electron–positron pairs is nearly exponential, providing evidence for a source of temperature in excess of 70 MeV with constituents whose properties have been modified, thus reflecting peculiarities of strong-interaction QCD matter. Its bulk properties are similar to the dense matter formed in the final state of a neutron star merger, as apparent from recent multimessenger observation.
Other people sometimes have problems with handling my disability. Because of this, they avoid talking with me and find it difficult to gauge my mood and situation. Measures are applied by many health ...professionals, all intended to help (see box). Give patients and their relatives enough time to adjust and to get used to the idea of impending changes Give emotional and mental support. Doctors are often too busy with the medical aspects of the disease; they should pay more attention to the whole patient and his emotional wellbeing. Living with Duchenne means continuous adaptation and continuous regression-because of this, continuous emotional support is needed Professionals try to find solutions for problems. The solution to a practical problem, like a new alarm system, is not the same as the solution for the underlying emotional difficulties. Psychosocial support is needed to deal with clients' questions and emotions Practical support should be attuned to individual needs and wishes The whole family should have support, since Duchenne is difficult for all family members Some patients and family members wrestle with feelings of responsibility. Professionals should be aware of this and should support patients and family members who express responsibilities felt for others Contributors: Because SS is incapacitated, he told his story to KS during an interview. All authors have completed the unified competing interest form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare no support from any organisation for the submitted work; no financial relationships with any organisation that might...
Flow coefficients vn of the orders n = 1 – 6 are measured with the High-Acceptance Spectrometer (HADES) at GSI for protons, deuterons, and tritons as a function of centrality, transverse momentum, ...and rapidity in Au + Au collisions at √sNN = 2.4 GeV. Combining the information from the flow coefficients of all orders allows us to construct for the first time, at collision energies of a few GeV, a multidifferential picture of the angular emission pattern of these particles. It reflects the complicated interplay between the effect of the central fireball pressure on the emission of particles and their subsequent interaction with spectator matter. The high precision information on higher order flow coefficients is a major step forward in constraining the equation of state of dense baryonic matter.
Summary When bacteria develop drug-resistant mutations, there is often an associated biological cost; however, some strains can exhibit low- or no-cost mutations. In the present study, a quantitative ...resazurin reduction assay was used to measure the biological cost of Mycobacterium tuberculosis isolates that contained different mutations in the rpsL , rrs , rpoB , and katG genes, and showed different resistance profiles. Biological costs were determined by comparing the growth curves of drug-resistant isolates with drug-susceptible strains. Some strains, such as those with rpoB mutations other than S531L and strains with mutations in all of the studied genes, grew more slowly than did drug-susceptible strains. However, some strains grew more quickly than drug-susceptible strains, such as those that had only the rpsL K43R mutation. Strains with the mutation katG S315T presented heterogeneous biological costs. When analyzed individually, strains with the mutations rpsL 43/ katG 315, rpoB 531, and rpoB 531/ katG 315 grew faster than drug-susceptible strains. The results suggest that some strains with the most common mutations correlated to a high resistance toward streptomycin, isoniazid and rifampicin can grow as well as or better than susceptible strains.
Purpose: This study was to evaluate lung shunting from Tc99m MAA and Y90 imaging, and its effect on treatment planning. Y90 Microspheres (Therasphere, MDS Nordion) have been used for the treatment of ...unresectable hepatocellular carcinoma (HCC). Tc99m MAA imaging is utilized to assess pulmonary shunting which will affect treatment dose. Standard shunting compares the ratios of activity in the liver and lungs. Method and Materials: Twenty five patients were randomly selected to examine shunting ratios. Eight studies required the redrawing of RoIs to correct the variance in geometric mean. Actual activity was determined following treatment planning guidelines based on standard and measured shunting. Y‐90 imaging of patients was also investigated for radionuclide distribution. Results: Inadequate RoIs were identified in 8 patients, which yielded up to 5% (mean 0.79%, STD 1.76%) difference (p=0.90) in lung shunting. The treatment dose showed 5.29% (mean 0.74%, STD 2.21%) deviation (p=0.91) caused by the ratios. It was further compared with standard ratios of 4% for none‐HCC and 7% for HCC. Difference in the treatment doses from corrected ratios and the standard was: mean 9.01%, STD 19.7%, p=0.19 for the 4% and mean 5.18%, STD 19.0%, p=0.55 for the 7%. Y‐90 patients images did not provide activity distribution in lungs when there was high shunting based on Tc99m MAA imaging, but demonstrated Y‐90 activity in liver. Conclusion: Tc99m MAA imaging is important in treatment planning to avoid error from lung shunting. RoIs should be accurate and consistent to reduce error in treatment dose. Y‐90 imaging depends on scatter characteristic of tissue and does not yield appropriate shunting images with Yttrium‐90.
Purpose: This study was to identify problems and investigate camera parameters that would create effective biodistribution images for treatment planning and dosimetry in patients receiving Y‐90 ...radionuclide therapy. Method and Materials: Y‐90 energy spectra under different interacting conditions were recorded from MCA, uptake probe and gamma camera. Y‐90 (17.6 MBq) was added to an Anthropomorphic Torso Phantom, with or without water in its tank, with following distribution: liver, 70% with water; right lung, 15% with water; left lung, 15% without water. Imaging was performed on a Siemens eCam, dual head camera with HEGP/MEGP collimators at various energy settings. Y‐90 patient imaging was performed with retained activities of 1.52 GBq and 6.7 kBq Y‐90 labeled microspheres and with 3.7 GBq Y‐90 labeled Zevalin. At 30 minutes post Zevalin injection, a whole body scan was performed using a 194 cm bed length (5 cm/min, total 48 min), 256 × 1024 × 16 matrix without zooming. Results: Y‐90 spectra indicated a characteristic X‐ray peak (Pb. K‐alpha) at 75 keV along with characteristic Bremsstrahlung distribution. Phantom tests found an energy window of 75 keV/50% to produce practical images. Significant uptake in the right lung of the phantom versus other structures was identified. Patient's lungs could not be easily visualized. Conclusion: An energy window (75keV/50%) is adequate for characteristic X‐ray and Bremsstrahlung imaging. Y‐90 imaging depends on scatter characteristic of tissue and does not provide direct biodistribution of Yttrium‐90. Further investigations of imaging technique are needed to assess effective Y‐90 patient imaging.
Background
: Pantoprazole is a benzimidazole derivative which selectively inhibits the proton pump H+, K+‐ATPase, necessary for the final step in gastric acid secretion.
Aim
: To assess safety and ...efficacy of oral pantoprazole (40 mg o.d.) used as a prophylaxis against relapse in patients with healed reflux oesophagitis during an open‐label, 2‐year study.
Methods
: Outpatients (n=157) with healed stage II or III reflux oesophagitis (Savary–Miller classification) were enrolled into a long‐term, multicentre maintenance study. Endoscopy was performed at entry into the study, after 12 and 24 months, or when disease‐specific symptoms occurred on more than three consecutive days. Symptoms were assessed at 3‐monthly intervals. Endoscopically confirmed relapses (at least stage I) were evaluated as treatment failures.
Results
: Of the 178 adverse events, experienced by 88 (56%) patients (intention‐to‐treat population), 12 (7%) were assessed by the investigators as possibly related to the study medication. Median serum gastrin levels increased from a baseline of 46 ng/L to 90 ng/L, reaching a plateau after 9 months. For the intention‐to‐treat population the endoscopic remission rates after 12 and 24 months were 87% and 76%, respectively (Life‐Table survival analysis, Kaplan–Meier).
Conclusion
: Pantoprazole 40 mg proved to be safe and efficacious during a 2‐year prophylaxis treatment in patients with healed reflux oesophagitis.
South Africa offers a valuable laboratory to study criminality because of its high levels of crime due to a heterogeneous environment of people, cultures, and economic development. This paper ...assesses the limitations of conventional practices in combating crime and illustrates the application of innovative artificial intelligence software to assumed unrelated databases – demographic, geographic, socio-economic and others – to find more effective ways to prevent criminal incidents. True unsupervised machine learning artificial intelligence software developed in South Africa provides neural network prediction of criminal incidents by identification of supposedly unrelated variables. Application of the software to find the hidden critical factors leading to bank robberies is illustrated in a specific case, where a robbery at a specific bank branch was predicted with an exceptionally high level of accuracy.
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