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Multiphase contrast-enhanced CT of the liver with a multislice CT scanner.

Our objective was to assess the effects of the injection rate of contrast material and of a 5% dextrose flush on enhancement in multiphase hepatic CT using a multislice CT scanner. Most patients had chronic hepatitis and/or liver cirrhosis. One hundred eighty examinations, in which two sequential acquisitions were performed during a single breath-hold followed by third- and fourth-pass acquisitions, were randomized into four protocols: contrast injection at 0.1 ml/kg body weight s(-1) over 21 s without and with a 30-ml flush in groups 1 and 2, respectively, and contrast injection at 0.07 ml/kg body weight s(-1) over 30 s without and with a flush in groups 3 and 4, respectively. Contrast enhancement in each acquisition was measured in the aorta, portal vein, and liver. The visualization of hepatic arterial branches was scored by visual assessment. The highest aortic enhancement was observed in the first-pass acquisition in all groups. At the higher injection rate (groups 1 and 2), aortic enhancement in the first-pass acquisition was significantly more intense, whereas portal venous and hepatic enhancement was significantly less intense. The use of a flush considerably improved aortic enhancement at the beginning of the second-pass acquisition. In the visual assessment of hepatic arterial branches, the protocols with the higher injection rate received significantly higher grades. Multislice CT permits the entire liver to be imaged during an almost exclusively arterial phase by shortening the injection duration for a given volume of contrast material.

Adult↗

Amyloid beta peptide 1-42 highly correlates with capillary cerebral amyloid angiopathy and Alzheimer disease pathology.

Recent studies reported both positive [Thal et al. (2003) J Neuropathol Exp Neurol 62:1287-1301] and negative [Tian et al. (2003) Neurosci Lett 352:137-140] correlations between cerebral amyloid angiopathy (CAA) and Alzheimer's disease (AD) pathology. We have recently shown high correlations between neuritic AD pathology and amyloid beta peptide (Abeta) deposits in the capillary/pericapillary compartment (CapCAA) with only low correlations to general CAA (non-capillary). We have now studied the relationship between CapCAA and AD pathology with respect to the distribution of Abeta40 and 42 in the frontal cortex of 100 human postmortem brains from both male and female, demented and non-demented patients (mean age +/- SD 84.3 +/- 9.3 years). Using polyclonal antibodies to Abeta40 and 42, capillary and plaques positivity were assessed semiquantiatively on a four-point scale. Abeta42 deposits in capillaries correlated highly with both Abeta42 deposits in plaques and morphological AD criteria (CERAD, Braak stages, and NIA-Reagan-Institute criteria), while only a low correlation with CAA was observed. Abeta40 deposits in capillaries differed morphologically from Abeta42 ones: they were limited to capillary walls, were significantly less frequent in both capillaries and plaques compared to Abeta42 ( P < 0.01), and showed a low correlation with morphological AD criteria ( P < 0.05) and general CAA ( P < 0.01). By contrast, Abeta42 deposits were seen in the glia limitans rather than in capillary walls themselves, and showed high correlation with morphological AD criteria ( P < 0.01). These data indicate that CapCAA is characterized by Abeta42 deposits in pericapillary spaces or in the glia limitans. A low correlation between CAA and CapCAA, but high correlations between morphological AD criteria and CapCAA suggest different pathomechanisms for both types of CAA, and a close relation between CapCAA and AD pathology (both neuritic and plaque type). These data support the concept of a neuronal origin of Abeta via drainage from interstitial fluid from the central nervous system along basement membranes to capillaries.

Aged↗

Gender differences in brain activity toward unpleasant linguistic stimuli concerning interpersonal relationships: an fMRI study.

Women are more vulnerable to psychosocial stressors such as interpersonal conflicts than men, and are more susceptible to some psychiatric disorders. We hypothesized that there are differences in the brain activity of men and women while perceiving unpleasant linguistic stimuli concerning interpersonal relationships, and that they underlie the different sensitivity toward these stressful stimuli. We carried out a functional magnetic resonance imaging (fMRI) study on 13 young female adults and 13 young male adults who performed an emotional decision task including sets of unpleasant words concerning interpersonal relationships and sets of neutral words. In the women, the unpleasant words more significantly activated the bilateral caudate nuclei and left putamen than the neutral words. However, among the men, there was no difference in the level of activation of any brain area induced by the unpleasant or neutral word stimuli. Upon performing the task, there was a significant gender difference in brain activation. Moreover, among the female subjects, the activation in the bilateral caudate nuclei and left thalamus was negatively correlated with the average rating of pleasantness of the words concerning interpersonal conflicts by the subject. These results demonstrate gender differences in brain activity in processing unpleasant linguistic stimuli related to interpersonal conflicts. Our data suggest that the bilateral caudate nuclei and left putamen play an important role in the perception of words concerning interpersonal conflicts in women. The bilateral caudate nuclei and left thalamus may regulate a woman's sensitivity to unpleasant information about interpersonal difficulties.

Adult↗

Intrathecal sICAM-1 production in multiple sclerosis--correlation with triple dose Gd-DTPA MRI enhancement and IgG index.

In this study the aim was to evaluate the intrathecal sICAM-1 production in multiple sclerosis (MS) patients during relapse and remission. In addition to this, we assessed whether there is a correlation between intrathecal sICAM-1 production and other disease activity markers such as IgG index and gadolinium enhancement in magnetic resonance imaging (MRI). Twenty four relapsing-remitting MS patients were included in the study. Serum and cerebrospinal fluid (CSF) samples were obtained both during relapse and remission. The soluble form of ICAM (sICAM) was measured by the ELISA method in serum and CSF. Cranial MRI with triple dose gadolinium injection was performed for each patient both during relapse and remission. Serum levels of sICAM-1 (245.23 +/- 92.88 ng/ml) were higher during relapse than those in remission (219.90 +/- 110.94 ng/ml), but the difference was not statistically significant. In relapse periods CSF levels of sICAM-1 (1.304 +/- 0.92 ng/ml) were higher than those in remission (1.06 +/- 0.86 ng/ml), but this was not significant. However, during relapse periods patients had significantly higher sICAM-1 index values (1.76 +/- 0.60) than those found during remission periods (1.01 +/- 0.44) (p < 0.05). The IgG index values were higher in relapse periods than in remission (0.88 +/- 0.37 vs. 0.67 +/- 0.28) (p < 0.005). On T1 weighted images following triple dose Gd injection, at least two or more enhancing lesions were present in 22/24 of the patients (91%) in relapse and 4/24 of the patients (19%) in remission. There was strong correlation both between the sICAM-1 index and Gd enhancement (r =0 .72 p < 0.05) and sICAM-1 index and IgG index in relapse (r = 0.69 p < 0.05). In conclusion, there is association between high sICAM-1 and IgG indices, as well as between high sICAM-1 index and Gd enhancing MRI lesions in relapsing MS patients.

Adult↗

A quantitative method for the assessment of intraepidermal nerve fibers in small-fiber neuropathy.

OBJECTIVES: The purpose of this paper is to present an easy-to-use and reproducible morphometrical method of determining the density of intraepidermal nerve fibers (IENF) per epidermal area with the corresponding reference range of the IENF-counts. METHODS: Thirty patients and 22 controls were included in this study. The patients were divided into three groups: small-fiber (SFN), diabetic and demyelinating neuropathy. All subjects underwent punch skin biopsy. Specimens were fixed routinely in formalin and thereafter embedded in paraffin. Nerve fibers were revealed using immunoperoxidase staining with panaxonal antibody PGP 9.5. Using light microscopy, immunopositive nerves were counted morphometrically per epidermal area (NPEA) and, for comparison, per epidermal length (NPEL). RESULTS: Both the NPEA and NPEL estimates of SFN and diabetic neuropathy group differed significantly from those of control specimen (p < 0.001 and p < 0.001, Mann-Whitney test). Our method of counting, NPEA, shows a good correlation to NPEL (r = 0.945). CONCLUSIONS: IENF-counting by a new morphometric modification is reproducible and diagnostically sensitive and can easily be adopted in any laboratory familiar with the basic immunohistochemical methodology. The method is less dependent on costly technical support systems and seems to be less time consuming when compared with conventional methods for IENF-counting.

Biopsy, Needle↗

Differences in systemic and central nervous system cellular immunity relevant to relapsing-remitting multiple sclerosis.

In order to elucidate the differences between systemic and central nervous system (CNS) immunity that are relevant to exacerbations of multiple sclerosis (MS), paired peripheral blood and cerebrospinal fluid (CSF) samples obtained from 36 non-treated patients with relapsing-remitting MS (RRMS) were simultaneously examined using flow cytometry to determine the percentages of functional lymphocyte subsets, as well as enzyme-linked immunosorbent assays for measuring soluble immune mediators. Active RRMS patients (n = 27) were characterized by an increase in CD4+ CXCR3+ Th1 cells in blood as compared with inactive patients (n = 9), and this parameter was inversely correlated with plasma levels of IL-10 and IL- 12p70. In contrast, an increase in the percentage of CD4+ CD25+ cells and a decrease in the percentage of CD8+ CD11a(high) cells were features of CSF samples from those with active RRMS. Further, CSF CD4+ CD25+ cells had a close association with leukocyte counts as well as albumin and CXCL10 levels in the CSF, and, thus, could be useful as a measure for inflammatory reactions in the CNS. On the other hand, CD8+ CD11a(high) cells may function as immunoregulatory cells, as their percentage in the CSF showed a positive correlation with CSF levels of the anti-inflammatory cytokine IL-4. These findings suggest that MS relapses occur in a combination with altered cell-mediated immunity that differs between the peripheral blood and CSF compartments, while measurement of lymphocyte subsets may be helpful for monitoring disease status.

Antigens, CD↗

Correlation of midbrain diameter and gait disturbance in patients with idiopathic normal pressure hydrocephalus.

BACKGROUND AND PURPOSE: Although gait disturbance is an important feature of idiopathic normal pressure hydrocephalus (NPH), only tentative theories have been offered to explain its pathophysiology. It has been suggested that the mesencephalic locomotor region is the anatomical substrate for the development of the hypokinetic NPH gait. To investigate this possibility, we evaluated the correlation between gait disturbance and midbrain diameter. METHODS: We enrolled 21 patients with NPH and 20 age-matched control subjects for the study. The maximal diameter of the midbrain and pons, and the width of the lateral and third ventricles were measured using midsagittal T1-weighted MRI and axial T2-weighted MRI, respectively. Gait disturbance, cognitive dysfunction, and incontinence were semiquantified. RESULTS: The maximal midbrain diameter was significantly smaller in the NPH group than in the controls (14.8 +/- 0.9 vs. 17.1 +/- 0.7 mm, p < 0.001). There were inverse correlations between the midbrain diameter and the widths of the two ventricles (r = -0.562, p = 0.008 for the third ventricle, and r = -0.510, p = 0.018 for the lateral ventricle). The severity of gait disturbance was negatively correlated with the midbrain diameter (r = -0.598, p = 0.004), but the degree of cognitive dysfunction and incontinence showed no significant correlation with midbrain diameter or ventricular width. CONCLUSIONS: This study suggests that midbrain atrophy is significantly associated with gait disturbance in NPH.

Aged↗

A case-control study on the psychophysical and psychological characteristics of the phantom tooth phenomenon.

The objective of this study was to determine whether patients with phantom tooth symptoms have an altered sensory perception as compared to pain-free subjects. Ten patients (mean age 56, range 32-71, nine females) were diagnosed as suffering from "phantom tooth" according to a specifically designed phantom tooth questionnaire including components of the McGill Pain Questionnaire. An SCL-90 form was completed and assessment of sensory perception was carried out by determination of the threshold level for light touch sensation, two-point discrimination, and thermal sensation in a case-control design. Results. Of all the observed questionnaires, 5.7% seemed to deal with phantom tooth, with a female preponderance (ratio 9:1). Complaints were predominantly reported in the upper jaw (ratio 8:2) with the majority in the molar region (ratio 5:3). Phantom tooth subjects showed significantly lower threshold levels for light touch sensation, most markedly on the affected side. The average psychoneurotic profile showed a tendency towards higher scores for the phantom tooth subjects. Conclusion. The phantom tooth phenomenon may show a number of features which might aid differential diagnosis. To verify influences such as upper molar predominance and increased light touch sensation, another study should be performed on a larger patient sample.

Adult↗

Caries experience and caries predictors--a study of Tanzanian children consuming drinking water with different fluoride concentrations.

The aim of this investigation was to assess the role of predictors of caries experience among children in urban and rural areas of northern Tanzania. Children of the different communities had varying dietary habits and consumed water with varying fluoride (F) concentration. Subjects (n=256) aged 9-14 years were examined in high-F areas (3.6 mg F/l, Arusha and Arusha Meru, n=101) and low-F areas (<0.4 mg F/l, Moshi and Kibosho, n=155). Dental caries was assessed under field conditions using the decayed, missing, filled teeth (DMFT) index and the WHO criteria. The prevalence of caries was 14%. The mean DMFT score was 0.22 (n=256), the range between areas 0.07-0.66. Carious lesions were mainly observed in mandibular first molars. Logistic regression analyses indicated that subjects in the high-F and urban Arusha municipality were at a significantly higher risk of dental caries than children in the low-F areas (odds ratio [OR] 2.6). Controlling for ethnicity, children in urban areas were at higher risk for caries (OR 5.4) than children living in low-F rural Kibosho.

Adolescent↗

Contamination of interdental brushes by periodontopathogens.

Experimental studies have shown that intraoral transmission of bacteria can occur. Of course, the question arises as to how this transmission may happen. In this study, the contamination of interdental brushes by periodontopathogens is examined and compared to the microbial load of the periodontal pockets. In ten untreated chronic periodontitis patients, four interdental sites were professionally brushed with one interdental brush per patient. Subsequently, samples from the depths of the pockets (of the specific interdental sites) were obtained with paper-points. The interdental brush samples and the samples of the subgingival plaque, obtained by the pooled paper-points, were processed for dark-field microscopy examination as well as anaerobic culturing. The results showed that, although significant differences could be found between the brushes and paper-points with direct microscopy, the culturing did not uncover many differences. On the contrary, the detection frequencies of specific bacterial species were almost the same between the two. The total anaerobic colony-forming units (CFU), P. gingivalis, F. nucleatum, and E. corrodens found on the brushes showed a significant correlation with the subgingival plaque samples (P<0.005). These results suggest that, in untreated situations, interdental brushes are contaminated relatively easily by putative periodontopathogens in numbers comparable to their presence in periodontal pockets. This contamination could be a factor in the intraoral spread of bacteria.

Adult↗

Perceived taste disturbance in adults: prevalence and association with oral and psychological factors and medication.

Taste disturbance may cause subjective discomfort and impair appetite and food intake. The aim of this study was to estimate the prevalence of perceived taste disturbance and analyze its association to age, gender, whole salivary flow rate, subjective oral dryness, burning mouth, medication, and psychological factors. Five hundred forty-seven men and 656 women aged 20 to 69 years were randomly selected from the Public Dental Health Service register in northern Sweden. Oral complaints were registered and whole salivary flow rate measured. Medication, anxiety, depression, and stress were assessed. Thirty individuals (2.5%), five men (0.9%) and 25 women (3.8%), reported perceived taste disturbances (distorted taste or loss of taste). In men, no individual with taste disturbance was found in the youngest and oldest age groups. The prevalence in the 30-39-year age group was 1.9% and in the 40-49-year group 1.8%. In women, one individual (1%) with taste disturbance was found in the youngest age group. In the 30-39-year group, the prevalence was 3.8%, increasing to 5.1% in the oldest age group. Illness, subjective oral dryness, state anxiety, perceived stress, depression, use of antiasthmatics, and trait anxiety were associated with taste disturbance. It was concluded that perceived taste disturbance might be an interaction of various health factors such as illness and mental condition.

Adult↗

Occlusal wear of a resin-modified glass ionomer cement following three surface treatments.

Unacceptable occlusal wear has been reported for resin-modified glass ionomer cements (RMGICs) placed in permanent molar teeth. Three different surface treatments of a RMGIC were evaluated over periods of up to 2 years for their effects on restoration wear behaviour: (a) sealing with a thin layer of low viscosity unfilled resin (sealed restoration), (b) sealing with a thicker layer of a lightly-filled pit and fissure sealant (sealant restoration), and (c) co-curing the RMGIC with a posterior resin composite (co-cured restoration). After 2 years the cumulative median (quartiles) wear was for (a) 100 (50-150) microns, (b) 25 (0-50) microns, and (c) 25 (25-38) microns. Although method (b) effectively reduced the surface wear of the RMGIC, this treatment required frequent re-sealing, involving 52% of the restorations. Sealing the surface of a RMGIC placed in permanent molars was not a satisfactory method for reducing occlusal wear. However, co-curing the RMGIC with a posterior resin composite reduced occlusal wear significantly (P < 0.0001), without the need for frequent reapplications of a pit and fissure sealant to the RMGIC.

Adolescent↗

Treatment and standard evaluation using the Peer Assessment Rating Index.

The aim of this retrospective study was to determine the outcome of orthodontic treatment carried out on patients by postgraduate students at the Katholieke Universiteit Leuven, Belgium. The treatment outcome of 292 'final examination' patients and of 287 'control' patients was compared by means of the Peer Assessment Rating (PAR) index. The sample consisted of dental casts representing a wide range of malocclusions at the start of treatment and post-treatment. All patients received non-surgical treatment between 1987 and 1996 by one of 18 different postgraduate students. The data were analysed with a variant of the analysis of covariance. A significantly higher (P < 0.001) treatment standard was found for final examination patients compared to the control, indicated by the mean percentage PAR score reduction of 79.1% and 70.7%, respectively. When the results are expressed in terms of treatment outcome, 44.5% of the examination patients and 44.0% of the controls were allocated to the 'Greatly improved' group, while 3.1% of the patients examined and 7.3% of the control patients were classified as 'Worse or no different'.

Adolescent↗

Hydrogen peroxide and superoxide anion production by polymorphonuclear neutrophils in patients with chronic periapical granuloma, before and after surgical treatment.

Chronic periapical granuloma represents a localized tissue injury with well established signs of systemic immunological reactions. The aim of the study was to investigate changes in superoxide anion and hydrogen peroxide production by polymorphonuclear neutrophils (PMN) in patients with chronic periapical granuloma before and after surgical treatment. The affected teeth were extracted from 20 patients with chronic periapical lesions. Blood samples were obtained at admission, before extraction and on day 14. PMNs were isolated from blood samples and superoxide anion (O2-) and hydrogen peroxide (H2O2) production were estimated without stimulation and after stimulation of the cells with opsonized zymosan. Similar procedures were performed with blood samples obtained from 20 healthy controls. Superoxide anions as well as hydrogen peroxide production by unstimulated cells obtained from patients before treatment were significantly higher in comparison with controls. Fourteen days after extraction O2- production by unstimulated cells was higher than the controls and significantly lower in comparison to PMNs obtained before treatment, while H2O2 production was not significantly higher when compared to controls and significantly lower in comparison with PMNs obtained before extraction. The results obtained strongly imply the termination of a generalized inflammatory response after elimination of local inflammation by tooth extraction.

Adult↗

Cytokine concentrations in stimulated whole saliva among patients with primary Sjögren's syndrome, secondary Sjögren's syndrome, and patients with primary Sjögren's syndrome receiving varying doses of interferon for symptomatic treatment of the condition: a preliminary study.

Sjögren's syndrome is an autoimmune disorder which causes diminished salivary flow due to autoimmune sialoadenitis. This decrease in saliva flow is the result of inflammation and atrophy of the salivary glands. Most treatment regimens are palliative in nature, but treatment with interferon (IFN) holds promise for Sjögren's syndrome sufferers. Several studies have investigated cytokine concentrations in the salivary glandular tissues from Sjögren's syndrome patients; however, there is little information concerning cytokine expression in saliva. This is especially true with respect to treatment modalities and their effects on local cytokines. A clinical study was conducted to determine salivary interleukin (IL)-6, IFN, and IL-2, concentrations among subjects diagnosed with primary and secondary Sjögren's syndrome and a healthy control group. The primary Sjögren's syndrome showed significantly higher salivary IL-2 and salivary IL-6 than the control and secondary Sjögren's groups. There were no between group differences for salivary IFN concentrations. In addition, the study assessed salivary IL-6, IFN, and IL-2 concentrations among 18 Sjögren's syndrome patients before and after administration of IFN via the oral mucosal route. The results of the study showed that the mean values for the pre- and post-treatment groups for stimulated whole saliva flow rates were 3.15 and 3.74 ml/5 min, respectively. The post-treatment group exhibited a 16.8% increase in stimulated whole saliva flow rates. The salivary IL-6 concentration was 53.3% lower for the post-treatment group (17.79) as compared to the baseline value (33.35). The values for salivary IFN and salivary total protein were virtually unchanged from their baseline values. Salivary IL-2 values, however, were 50% lower in the post-treatment group (3.07) when compared to their respective baseline values (6.10). The results of this study suggest that healthy individuals exhibit lower salivary IL-2 and IL-6 as compared to individuals suffering from primary and secondary Sjögren's syndrome. The results also suggest that administration of IFN via the oral mucosal route may increase salivary flow rates and depress certain cytokines (IL-2, IL-6) associated with inflammatory destruction of salivary glandular tissues in Sjögren's syndrome patients.

Adjuvants, Immunologic↗

Evaluation of pH and erosion time on demineralisation.

In the current study the effect of various pH values of citric acid and erosion time on erosion depth and subsurface demineralisation of human enamel was studied. In a laboratory investigation, six groups of 10 samples were eroded in 0.3% citric acid for 2 h at pH 2.54, for 2 h or 4 h at pH 3.2 and for 2 h, 4 h or 8 h at pH 4.5. The erosion depth was measured using a profilometer. The demineralised layer was then removed by ultrasonicating the samples with profilometric measurements taken at 5, 30, 120, 240 and 480 s ultrasonication time. The six test groups were classified by analysis of variance into four homogeneous groups according to their erosion depth and into three homogeneous groups according to their subsurface demineralisation. Erosion depth clearly depended on the pH value of the acid and the contact time. Depth of subsurface demineralisation and surface morphology did not depend on erosion depth. Similar subsurface demineralisation depths can be produced by appropriate combinations of pH and contact time.

Analysis of Variance↗

Clinical controlled study on plaque and gingivitis reduction under long-term use of low-dose chlorhexidine solutions in a population exhibiting good oral hygiene.

The aim of this randomized, parallel-group, placebo-controlled, blind clinical study was to examine the dental plaque and the gingivitis inhibitory effects of two low-dose 0.06% chlorhexidine (CHX) preparations in comparison to a commercially available 0.1% CHX solution, an amine fluoride/stannous fluoride (ASF) solution and a water control as an adjunct to the daily mechanical oral-hygiene measures. After prophylaxis, 81 medical students performed their tooth cleaning and were asked to rinse for 30 s, according to the instructions given by the manufacturers with the assigned amount of the following solutions: once daily 10 ml ASF 250 ppm or twice daily each 10 ml CHX 0.06% with fluoride, 10 ml CHX 0.06% without fluoride, 15 ml CHX 0.1% or 100 ml tap water. The plaque index (PlI), the gingival index (GI) and the discoloration index (DI) were taken at day -14 and months (M) 0, 1, 2, 3 and 6. In this study group with good oral hygiene, all test products led to a reduction of the PlI scores when used as supplements to the usual mechanical hygiene measures. At M3 subjects using both the 0.1% as well as the 0.06% CHX showed significantly less plaque accumulation than those using ASF. In the GI a significant difference between the control and 0.1 % CHX was found at M3 and at M6. If a further decrease in the GI is wanted, a minimum concentration of 0.1% CHX for long-term use in association with habitual cleaning is needed, which, however, should be limited to special patients. If maintaining clinical health is the goal, the other solutions are a good alternative to 0.1% CHX because they exhibit less staining.

Adolescent↗