Evidence Of Atrophy Research Articles

Determination of Alzheimer's disease based on morphology and atrophy using machine learning combined with automated segmentation.

To evaluate the degree of cerebral atrophy for Alzheimer's disease (AD), voxel-based morphometry has been performed with magnetic resonance imaging. Detailed morphological changes in a specific tissue area having the most evidence of atrophy were not considered by the machine-learning technique. To develop a machine-learning system that can capture morphology features for determination of atrophy of brain tissue in early-stage AD and classification of healthy participants or patients. Three-dimensional T1-weighted (3D-T1W) data were obtained from AD Neuroimaging Initiative (200 healthy controls and 200 patients with early-stage AD). Automated segmentation of 3D-T1W data was performed. Deep learning (DL) and support vector machine (SVM) were trained using 66-segmented volume values as input and AD diagnosis as output. DL was performed using 66 volume values or gray matter (GM) and white matter (WM) volume values. SVM learning was performed using 66 volume values and six regions with high variable importance. 3D convolutional neural network (3D-CNN) was trained using the segmented images. Accuracy and area under curve (AUC) were obtained. Variable importance was evaluated from logistic regression analysis. DL for GM and WM volume values, accuracy 0.6; SVM for all volume values, accuracy 0.82 and AUC 0.81; DL for all volume values, accuracy 0.82 and AUC 0.8; 3D-CNN using segmental images of the whole brain, accuracy 0.5 and AUC 0.51. SVM using volume values of six regions, accuracy 0.82; image-based 3D-CNN, highest accuracy 0.69. Our results show that atrophic features are more considerable than morphological features in the early detection of AD.

Histology of Type 3 Macular Neovascularization and Microvascular Anomalies in Treated Age-Related Macular Degeneration: A Case Study.

To investigate intraretinal neovascularization and microvascular anomalies by correlating invivo multimodal imaging with corresponding exvivo histology in a single patient. A case study comprising clinical imaging from a community-based practice, and histologic analysis at a university-based research laboratory (clinicopathologic correlation). A White woman in her 90s treated with numerous intravitreal anti-VEGF injections for bilateral type 3 macular neovascularization (MNV) secondary to age-related macular degeneration (AMD). Clinical imaging comprised serial infrared reflectance, eye-tracked spectral-domain OCT, OCT angiography, and fluorescein angiography. Eye tracking, applied to the 2 preserved donor eyes, enabled the correlation of clinical imaging signatures with high-resolution histology and transmission electron microscopy. Histologic/ultrastructural descriptions and diameters of vessels seen in clinical imaging. Six vascular lesions were histologically confirmed (type 3 MNV, n= 3; deep retinal age-related microvascular anomalies [DRAMAs], n= 3). Pyramidal (n= 2) or tangled (n= 1) morphologies of type 3 MNV originated at the deep capillary plexus (DCP) and extended posteriorly to approach without penetrating persistent basal laminar deposit. They did not enter the subretinal pigment epithelium (RPE)-basal laminar space or cross the Bruch membrane. Choroidal contributions were not found. The neovascular complexes included pericytes and nonfenestrated endothelial cells, within a collagenous sheath covered by dysmorphic RPE cells. Deep retinal age-related microvascular anomaly lesions extended posteriorly from the DCP into the Henle fiber and the outer nuclear layers without evidence of atrophy, exudation, or anti-VEGF responsiveness. Two DRAMAs lacked collagenous sheaths. External and internal diameters of type 3 MNV and DRAMA vessels were larger than comparison vessels in the index eyes and in aged normal and intermediate AMD eyes. Type 3 MNV vessels reflect specializations of source capillaries and persist during anti-VEGF therapy. The collagenous sheath of type 3 MNV lesions may provide structural stabilization. If so, vascular characteristics may be useful in disease monitoring in addition to fluid and flow signal detection. Further investigation with longitudinal imaging before exudation onset will help determine if DRAMAs are part of the type 3 MNV progression sequence. Proprietary or commercial disclosure may be found after the references.

Identification of novel step-up regimen of intralesional triamcinolone acetonide in scalp alopecia areata based on a double-blind randomized controlled trial.

Although intralesional triamcinolone acetonide (TA) is the most commonly prescribed treatment for localized alopecia areata (AA), the literature regarding the optimal concentration for attaining better efficacy with the most acceptable side effects is scarce. To compare hair regrowth and local side effects of various concentrations of intralesional TA in scalp AA using clinical and dermoscopic parameters. A double-blind randomized control trial with four treatment groups (10, 5, 2.5 mg/ml TA and normal saline [NS]) was conducted between March 2018 and August 2019. After recruitment, each AA patch was divided into quadrants and randomized before first injection. Injections were given and outcome parameters were analyzed every 4-weekly till 12-weeks. Statistical analysis was done by the R software employing generalized estimation equation. P-value <.05 was considered significant. Out of 105-patients (168-AA patches), 75-patients (121-patches) completed the study. Hair regrowth scale of all TA concentrations was better than NS group (P < .001). Other parameters such as quadrants with poor clinical response and dermoscopic disease activity signs were also favorable in TA groups in comparison to NS. However the evidence of atrophy and telangiectasia was maximum in 10 mg/mL group. 10 mg/mL TA showed a comparatively better response at the cost of increased adverse effects. Based on the clinical benefit and adverse risk assessment from our study, it may be better to start with 2.5 mg/mL intralesional TA in limited scalp AA patients. It can be implied that the concentration of TA can be increased as a step-up regimen based on the serial clinical and dermoscopic response.

Human Rotator Cuff Tears Have an Endogenous, Inducible Stem Cell Source Capable of Improving Muscle Quality and Function After Rotator Cuff Repair

Background: The muscle quality of the rotator cuff (RC), measured by atrophy and fatty infiltration (FI), is a key determinant of outcomes in RC injury and repair. The ability to regenerate muscle after repair has been shown to be limited. Purpose: To determine if there is a source of resident endogenous stem cells, fibroadipogenic progenitor cells (FAPs), within RC injury patients, and if these cells are capable of adipogenic, fibrogenic, and pro-myogenic differentiation. Study Design: Controlled laboratory study. Methods: A total of 20 patients between the ages of 40 and 75 years with partial- or full-thickness RC tears of the supraspinatus and evidence of atrophy and FI Goutallier grade 1, 2, or 3 were selected from 2 surgeons at an orthopaedic center. During the surgical repair procedure, supraspinatus muscle biopsy specimens were obtained for analysis as were deltoid muscle biopsy specimens to serve as the control. FAPs and satellite cells were quantified using fluorescence-activated cell sorting. Muscle FI and fibrosis was quantified using Oil Red O and Masson trichrome staining. FAP differentiation and gene expression profiles were compared across tear sizes after culture in adipogenic, fibrogenic, and beta-3 agonist (amibegron) conditions. Analysis of variance was used for statistical comparisons between groups, with P < .05 as statistically significant. Results: Histologic analysis confirmed the presence of fat in biopsy specimens from patients with full-thickness tears. There were more FAPs in the full-thickness tear group compared with the partial-thickness tear group (9.43% ± 4.25% vs 3.84% ± 2.54%; P < .01). Full-thickness tears were divided by tear size, with patients with larger tears having significantly more FAPs than those with smaller tears. FAPs from muscles with full-thickness tendon tears had more adipogenic and fibrogenic potential than those with partial tears. Induction of a beige adipose tissue (BAT) phenotype in FAPs was possible, as demonstrated by increased expression of BAT markers and pro-myogenic genes including insulin-like growth factor 1 and follistatin. Conclusion: Endogenous FAPs are present within the RC and likely are the source of FI. These FAPs were increased in muscles with in larger tears but are capable of adopting a pro-myogenic BAT phenotype that could be utilized to improve muscle quality and patient function after RC repair.

Expérience de l’abord scrotal unique dans les abaissements testiculaires après chirurgie inguinale ou échec d’orchidopexie préalable

To report our experience of the unique scrotal incision for the redo cases of orchiopexy after previous inguinal surgery or orchiopexy for undescended testis with a special attention regarding the place of the single scrotal approach. Thirty-six patients operated between January 2003 and September 2015 in our surgical unit for secondary orchiopexy after previous inguinal surgery or orchiopexy for undescended testis (UDT) were included in a retrospective study. The secondary surgical procedure was initiated by a scrotal incision (Bianchi). In cases of difficulty by the scrotal incision an inguinal approach by the prior skin inguinal incision was performed. Patients were divided in two groups a group 1 of 10 patients with reascending testis following inguinal hernia repair and a group 2 of 26 patients with reascending testis after previous orchiopexy for UDT. A good result was defined as testis in scrotal position without evidence of atrophy. All the patients of group 1 were treated by a unique scrotal incision. In group 2, seven patients required a complementary inguinal approach. One hematoma complicated a scrotal procedure leading to a testicular atrophy. A good result was achieved in 35/36 patients (97%). Single scrotal incision is an efficient and easy way to perform secondary orchiopexy after hernia repair. After surgery for UDT, as for primary cases, it cannot be an exclusive approach, higher testis need a combined or an inguinal approach. 5.

Crisaborole: Phosphodiesterase inhibitor for treatment of atopic dermatitis.

Atopic dermatitis (AD) is an extremely common condition affecting as many as 10-20% of children and 2-10% of adults. A particularly distressing symptom of AD is pruritus. One of the important aspects of AD is inflammation associated with increased activity of phosphodiesterase 4 (PDE4), resulting in decreased intracellular levels of cyclic adenosine monophosphate, which in turn causes increased production of inflammatory cytokines. Crisaborole was developed as a small-molecule, boron-based, selective PDE4 inhibitor that can be used topically. Clinical trials have demonstrated its efficacy in treating patients with mild to moderate AD, resulting in significant relief of pruritus. Unlike PDE4 inhibitors that act systemically, crisaborole does not cause significant gastrointestinal adverse effects. The most common adverse effect has been temporary stinging and burning in about 4% of patients upon application of the 2% ointment. To date there is no evidence of atrophy, telangiectasia or hypopigmentation resulting from its use. Crisaborole is the first topically applied PDE4 inhibitor to be approved by the FDA for use in AD.

High-frequency aflibercept injections in persistent neovascular age-related macular degeneration.

To report the 1-year outcomes of every-4-weeks (Q4W) as-needed aflibercept treatment in resistant neovascular age-related macular degeneration (nAMD) patients who had been treated and failed prior bevacizumab or ranibizumab injections, and who also responded poorly to every-8-weeks (Q8W) aflibercept treatment. Forty-three eyes of 39 patients with persistent nAMD despite monthly bevacizumab and/or ranibizumab injections and who were switched to Q8W 2-mg aflibercept injections, but showed persistence of fluid were included. Patients were treated with as-needed Q4W aflibercept injections with monthly monitoring. Maximum retinal thickness (MRT), central macular thickness (CMT), maximum pigment epithelial detachment height (PED) and best-corrected visual acuity (BCVA) were assessed and compared to baseline when high-frequency aflibercept was initiated. A mean of 8 (interquartile range, 4-11) Q4W injections were given during the follow-up. MRT and CMT significantly decreased at all follow-up visits (p < 0.05); however, there was no significant change in maximum PED height (p > 0.05) at any visit. Mean BCVA was 0.38 ± 0.28 (logMAR) (≈20/63, Snellen) at baseline, and 0.4 ± 0.34 (logMAR) (≈20/76, Snellen) at 1 year (p = 0.76). Seventy-two percent of eyes maintained a final BCVA of 20/63 or better. Twelve eyes (28%) had some subretinal scar tissue formation and 5 eyes (11.6%) had evidence of atrophy at 1 year. A stepwise algorithm with Q4W as-needed aflibercept treatment led to anatomic improvement in previously treated eyes which failed other therapies, including aflibercept every 8weeks. Lack of visual improvement may be due to a ceiling effect as our eyes generally had good visual acuity.

Progression from normal cognition to mild cognitive impairment in a diverse clinic-based and community-based elderly cohort

IntroductionInvestigation of the conversion rates from normal cognition (NC) to mild cognitive impairment (MCI) is important, as effective early intervention could potentially prevent or substantially delay the onset of dementia. However, reported conversion rates differ across studies and recruitment source. Our study examined predictors of conversion from NC to MCI in a racially and ethnically diverse sample drawn both from community and clinic recruitment sources. MethodsRates and predictors of conversion were assessed in an ongoing prospective longitudinal study at University of California, Davis, Alzheimer's Disease Center from 2000 to 2015. Participants (n = 254) were recruited through a clinic (5%) and community sample (95%). They were clinically confirmed as cognitively normal at baseline and followed up to seven years. Recruitment source, demographic factors (age, gender, race/ethnicity, year of education, APOE ε4 positive), cognitive measures (SENAS test scores), functional assessments (CDR sum of boxes), and neuroimaging measures (total brain volume, total hippocampal volume, white hyperintensity volume) were assessed as predictors of conversion from cognitively normal to mild cognitive impairment using proportional hazards models. ResultsOf 254 participants, 62 (11 clinic, 51 community) progressed to MCI. The clinic-based sample showed an annual conversion rate of 30% (95% CI 17%–54%) per person-year, whereas the community-based sample showed a conversion rate of 5% (95% CI 3%–6%) per person-year. Risk factors for conversion include clinic-based recruitment, being older, lower executive function and worse functional assessment at baseline, and smaller total brain volume. DiscussionOlder adults who sought out a clinical evaluation, even when they are found to have normal cognition, have increased risk of subsequent development of MCI. Results are consistent with other studies showing subjective cognitive complaints are a risk for future cognitive impairment, but extend such findings to show that those who seek evaluation for their complaints are at particularly high risk. Moreover, these individuals have subtle, but significant differences in functional and cognitive abilities that, in the presence of concerns and evidence of atrophy on by brain imaging, warrant continued clinical follow-up. These risk factors could also be used as stratification variables for dementia prevention clinical trial design.

Shoulder Pain in a Swimmer

HISTORY: A 17 year old male, right hand dominant, competitive swimmer presented to clinic with a 2 week history of right shoulder pain. Initial pain was associated with coughing secondary to an upper respiratory infection and localized to the right upper trapezius and scapula. Several days later, he playfully lifted a heavy friend, felt more pain in the same area, and dropped his friend due to severe pain. Pain occasionally radiated down posterior arm. Exacerbating factors included overhead activities including swimming, shoulder abduction, cross body reaching, deep breathing and coughing. Past history included possible right shoulder dislocation in fifth or sixth grade, when shoulder “popped in and out”. PHYSICAL EXAM: Peripheral pulses intact, normal capillary refill. Breathing unlabored; pain with deep breathing. Strength, reflexes, and sensation normal. No evidence of atrophy, scapular winging, or swelling. No obvious tenderness to palpation. Full active shoulder range of motion with pain at terminal arc of forward flexion and abduction. No glenohumeral internal rotation deficit. Pain with horizontal cross-body adduction, Neer’s maneuver and resisted shoulder external rotation. DIFFERENTIAL DIAGNOSIS: 1. Rotator cuff injury 2. Shoulder impingement 3. Labral tear 4. Myofascial pain 5. Cervical strain or radiculopathy 6. Brachial plexitis/Parsonage turner 7. Spontaneous pneumothorax 8. Rib injury TEST AND RESULTS: Shoulder radiograph - Complete transverse fracture right 1st rib with associated soft tissue swelling. - Flattening of greater tuberosity of right humerus posterolaterally suspicious for a Hill-Sachs fracture. Slight deformity of tuberosity on external rotation view raises possibility of fracture. FINAL/WORKING DIAGNOSIS: Right first rib fracture TREATMENT AND OUTCOMES: 1. Initial treatment: No swimming. Encouraged rest, analgesia with Tylenol and avoidance of overhead activities and activities that caused pain including lifting. 2. Return visit 5 weeks after initial pain onset: Right rib radiograph showed a slightly comminuted and displaced fracture of the lateral aspect of the right 1st rib. On physical exam, full non-painful range of motion and strength of shoulder. 3. At 6 weeks, he gradually re-introduced upper body activity. 4. Returned successfully to competitive swimming.

The shoulder.

The shoulder.

MRI segmentation analysis in temporal lobe and idiopathic generalized epilepsy

BackgroundTemporal lobe epilepsy (TLE) and idiopathic generalized epilepsy (IGE) patients have each been associated with extensive brain atrophy findings, yet to date there are no reports of head to head comparison of both patient groups. Our aim was to assess and compare between tissue-specific and structural brain atrophy findings in TLE to IGE patients and to healthy controls (HC).MethodsTLE patients were classified in TLE lesional (L-TLE) or non-lesional (NL-TLE) based on presence or absence of MRI temporal structural abnormalities. High resolution 3 T MRI with automated segmentation by SIENAX and FIRST tools were performed in a group of patients with temporal lobe epilepsy (11 L-TLE and 15 NL-TLE) and in15 IGE as well as in 26 HC. Normal brain volume (NBV), normal grey matter volume (NGMV), normal white matter volume (NWMV), and volumes of subcortical deep grey matter structures were quantified. Using regression analyses, differences between the groups in both volume and left/right asymmetry were evaluated. Additionally, laterality of results was also evaluated to separately quantify ipsilateral and contralateral effects in the TLE group.ResultsAll epilepsy groups had significantly lower NBV and NWMV compared to HC (p < 0.001). L-TLE had lower hippocampal volume than HC and IGE (p = 0.001), and all epilepsy groups had significantly lower amygdala volume than HC (p < = 0.004). In L-TLE, there was evidence of atrophy in both ipsilateral and contralateral structures.ConclusionsOur study revealed that TLE and IGE patients demonstrated similar overall tissue-specific brain atrophy, although specific structures differences were appreciated. L-TLE also appeared to behave differently than NL-TLE, with atrophy not limited to the ipsilateral side.

A case of esophagogastric junctional cancer in a &lt;i&gt;Helicobacter pylori&lt;/i&gt;-negative patient treated by endoscopic submucosal dissection

A 58-year-old man with gastric carcinoma was referred to our hospital for further examination and treatment. Esophagogastroduodenoscopy showed a depressed lesion measuring approximately 25 mm in diameter below the esophagogastric junction (EGJ) , which was slightly elevated proximally. Pathological examination of biopsy specimens revealed well-differentiated adenocarcinoma. No evidence of atrophy was detected in the background gastric mucosa, and serological examination showed negative results for Helicobacter pylori infection. Although we assumed submucosal invasion in the proximal part, the patient opted for endoscopic treatment. No metastases were detected by computed tomography ; therefore, endoscopic submucosal dissection was performed. Histopathological examination of the resected specimen revealed well- to moderately differentiated adenocarcinoma (Type 0-IIc, 20×27 mm, pT1b1, ly0, v0, pHM0, pVM0) . The proximal part was found to be due to an esophageal retention cyst, and there was no evidence of submucosal invasion. Histopathology ruled out Barrett’s esophagus, and we diagnosed EGJ carcinoma. With a decrease in the incidence of H. pylori infection, the detection rate of lesions such as EGJ cancer may be expected to increase. However, such lesions are likely to be overlooked; thus, careful examination is required even in H. pylori-negative patients.

Testis sparing surgery in a case of small unilateral testicular cancer

A 22-year-old male presented at our institution with an incidentally ultrasound-detected testicular tumor. Magnetic resonance imaging showed a contrast-enhanced right intratesticular mass over 1 cm in size. The patient underwent testis sparing surgery. Pathologic examination revealed seminoma. A follow-up nine months later showed no residual tumor, a normal contour of the testis and no evidence of atrophy. Testis sparing surgery is an option for patients with small unilateral testicular tumors even in the presence of a healthy contralateral testis.

Inflammatory Proteins in Plasma Are Associated with Severity of Alzheimer’s Disease

Markers of Alzheimer’s disease (AD) are being widely sought with a number of studies suggesting blood measures of inflammatory proteins as putative biomarkers. Here we report findings from a panel of 27 cytokines and related proteins in over 350 subjects with AD, subjects with Mild Cognitive Impairment (MCI) and elderly normal controls where we also have measures of longitudinal change in cognition and baseline neuroimaging measures of atrophy. In this study, we identify five inflammatory proteins associated with evidence of atrophy on MR imaging data particularly in whole brain, ventricular and entorhinal cortex measures. In addition, we observed six analytes that showed significant change (over a period of one year) in people with fast cognitive decline compared to those with intermediate and slow decline. One of these (IL-10) was also associated with brain atrophy in AD. In conclusion, IL-10 was associated with both clinical and imaging evidence of severity of disease and might therefore have potential to act as biomarker of disease progression.

Hirayama disease: Role of diffusion tensor imaging

CASE REPORT A 28­year­old male patient presented with progressive weakness of both forearms and hands along with clawing of hands for past eight years. Right side was affected more than the left. There was no history of similar illness in the family. There was no past history of any prolonged illness in childhood. There was no history of sensory, pyramidal or bladder dysfunction. There was evidence of atrophy of muscles of both forearms and hands. Muscle power was normal in both upper limbs. Nerve conduction studies showed reduced amplitude in bilateral median and ulnar nerves. Tendon reflexes were normal. Magnetic resonance imaging (MRI) examination was performed in non­flexion and flexed position. Subsequently, diffusion tensor imaging (DTI) was performed in non­flexion, which very clearly showed the cord atrophy at C7 – T1 level (Figure 1). This cord atrophy was not appreciated on routine flexion and non­flexion studies. The diagnosis of Hirayama Disease (HD) was thus established on DTI. CLINICAL IMAGES OPEN ACCESS

Partial Orchiectomy for Bilateral Synchronous Testicular Masses in a Prepubescent Boy: A Case Report

Testicular masses in prepubescent children are typically benign. Most masses are mature teratomas, epidermoid cysts, and stromal tumors. Synchronous bilateral testicular masses in children are rare. The etiology of these includes synchronous primary testicular masses, lymphoma, leukemia, and adrenocortical rest hyperplasia. Partial orchiectomy, or testis-sparing surgery, is now preferred in the management of testicular masses deemed to be benign. We present a case of benign bilateral testicular masses managed with testis-sparing surgery. Six-month follow-up revealed no residual tumor, normal contour of the testes, and no evidence of atrophy.

Altered diffusion tensor imaging measurements in aged transgenic Huntington disease rats

Rodent models of Huntington disease (HD) are valuable tools for investigating HD pathophysiology and evaluating new therapeutic approaches. Non-invasive characterization of HD-related phenotype changes is important for monitoring progression of pathological processes and possible effects of interventions. The first transgenic rat model for HD exhibits progressive late-onset affective, cognitive, and motor impairments, as well as neuropathological features reflecting observations from HD patients. In this report, we contribute to the anatomical phenotyping of this model by comparing high-resolution ex vivo DTI measurements obtained in aged transgenic HD rats and wild-type controls. By region of interest analysis supplemented by voxel-based statistics, we find little evidence of atrophy in basal ganglia regions, but demonstrate altered DTI measurements in the dorsal and ventral striatum, globus pallidus, entopeduncular nucleus, substantia nigra, and hippocampus. These changes are largely compatible with DTI findings in preclinical and clinical HD patients. We confirm earlier reports that HD rats express a moderate neuropathological phenotype, and provide evidence of altered DTI measures in specific HD-related brain regions, in the absence of pronounced morphometric changes.

NazvanCapabilities of non-atrofic antral helicobacter-associated gastritis diagnostics at the patients suffering from a duodenal ulcer combnined with bronchial asthma when examining Gastropanel test system

This paper presents the results obtained by the investigation of morphological condition of a gastric mucosa and serum concentration of pepsinogen-I, pepsinogen-II, and gastrin-17, as well as H. pylori IgG antibodies using «Gastropanel» test system when examining patients suffering from a duodenal ulcer combined with bronchial asthma. It was reveled that the level of serum concentration is in close relation to gastritis activity and Helicjbacter pylori bacterization in the gastric mucosa, thus expanding the «Gastropanel» test system application for diagnosing not only atrophic gastritis, but also for helicobacter gastritis without evidence of atrophy.

Cavum Septi Pellucidi in Boxers

Objective Controversy exists over the significance of the isolated finding of cavum septi pellucidi (CSP) and its prevalence rate in healthy individuals and in professional boxers. Few magnetic resonance imaging (MRI) studies have looked at large cohorts of boxers. The aim of this study was to identify the prevalence and extent of a CSP among professional boxers and to compare these with a control group. Methods MRI studies of 164 male boxers scanned for annual British boxing board license renewal were reviewed and compared with 43 control patients. CSP prevalence, size, and extent were recorded. Extent was classified as type 1, anterior to the fornix; type 2, extending up to the fornix; and type 3, extending into the cavum vergae. Parenchymal abnormalities were documented, and the Evan's ratio was used as an indication of brain atrophy. Results A CSP was present in 40% of controls and 49% of boxers. There was a trend to a higher CSP prevalence in boxers ( P = .099). No control patient had type 2 or 3 extension ( P < .0009), as opposed to 30% and 16% prevalence in boxers. Three boxers increased their extent over serial imaging. No difference in CSP size was established between the 2 groups ( P = .43), but there was an association between progressive scans and increased CSP size over time in boxers, independent of age ( P = .05). Eight boxers demonstrated a CSP on a subsequent scan not seen on an earlier scan. Conclusion The prevalence of a CSP is high among both control patients and boxers. There is a trend to a larger CSP with increasing number of scans without evidence of atrophy and independent of age. Boxers also have a greater posterior extent than controls. The findings may be explained by sudden increases in intracranial pressure that forced cerebrospinal fluid (CSF) through small defects in the septal leaflets, which result in an increase in size and or extent of a CSP.

Systemic Immunization with Unadjuvanted Whole Helicobacter pylori Protects Mice Against Heterologous Challenge

Adjuvant-free vaccines have many benefits, including decreased cost and toxicity. We examined the protective effect of systemic vaccination with adjuvant-free formalin-fixed Helicobacter pylori or bacterial lysate and the ability of this vaccine to induce protection against heterologous challenge. Mice were vaccinated subcutaneously with H. pylori 11637 lysate or formalin-fixed bacteria, with or without ISCOMATRIX adjuvant, then orally challenged with H. pylori SS1. Serum was taken prior to challenge to examine specific antibody levels induced by the vaccinations, and protection was assessed by colony-forming assay. Vaccination with H. pylori 11637 lysate or formalin-fixed bacteria delivered systemically induced significantly higher levels of Helicobacter-specific serum IgG than the control, unvaccinated group and orally vaccinated group. After heterologous challenge with H. pylori SS1, all vaccinated groups had significantly lower levels of colonization compared with unvaccinated, control mice, regardless of the addition of adjuvant or route of delivery. Protection induced by systemic vaccination with whole bacterial preparations, without the addition of adjuvants, was only associated with a mild cellular infiltration into the gastric mucosa, with no evidence of atrophy. Subcutaneous vaccination using unadjuvanted formalin-fixed H. pylori has the potential to be a simple, cost-effective approach to the development of a Helicobacter vaccine. Importantly, this vaccine was able to induce protection against heterologous challenge, a factor that would be crucial in any human Helicobacter vaccine. Further studies are required to determine mechanisms of protection and to improve protective ability.