Visual Scoring System Research Articles

Vigna angularis inhibits IL-6-induced cellular signalling and ameliorates collagen-induced arthritis

The present study was conducted in order to assess whether extracts or isolated compounds from Vigna angularis were able to suppress IL-6 signalling and to show the therapeutic effect on collagen-induced arthritis (CIA) in mice. The effect of V. angularis on IL-6 signalling was studied by measuring Stat3-dependent luciferase activity, expression of inflammation-related genes, and phosphorylation of Janus kinase 2 (JAK2), signal transducer and activator of transcription 3 (STAT3) and extracellular signal-regulated kinase (ERK) induced by IL-6. CIA was induced by immunizing with bovine type II collagen. V. angularis extract (VAE) was administrated orally at 50 and 100 mg/kg from day 1 to day 28. Induction of arthritis was evaluated with a visual scoring system and histological analysis. Extracts or two triterpenoid compounds from V. angularis showed potent inhibitory effects on pSTAT3-inducible luciferase activity, STAT3 tyrosine phosphorylation and the expression of inflammation-related genes induced by IL-6. Administration of VAE significantly suppressed the progression of CIA, accompanied by a reduced antibody response to type II collagen and protection from tissue damage in knee joints. Administration of VAE has a therapeutic effect on CIA and this effect is associated with the inhibitory activity on IL-6/STAT3 signalling. These results suggest that extracts or compounds from V. angularis could be a useful treatment for diseases related to IL-6, including RA.

The efficacy of 320-detector row computed tomography for the assessment of preoperative pulmonary vasculature of candidates for pulmonary segmentectomy

The purpose of this study was to compare the efficacy of 320-detector row computed tomography (CT) with that of 64-detector row CT for three-dimensional assessment of pulmonary vasculature of candidates for pulmonary segmentectomy. We included 32 patients who underwent both 320- and 64-detector CT before pulmonary segmentectomy, which was performed by cutting the pulmonary artery and bronchi of the affected segment followed by dissection of the intersegmental plane along the intersegmental vein. Before the operation, three-dimensional pulmonary vasculature images were obtained for each patient, and the arteries and intersegmental veins of the affected segments were identified. Two thoracic surgeons independently assessed the vessels with visual scoring systems, and kappa analysis was used to determine interobserver agreement. The Wilcoxon signed-rank test was used to compare the visual scores for the assessment of the visualization capabilities of the two methods. In addition, the final determination of pulmonary vasculature at a given site was made by consensus from thoracic surgeons during operation, and receiver operating characteristic analysis was performed to compare their efficacy of pulmonary vasculature assessment. Sensitivity, specificity and accuracy of either method were also compared by means of McNemar's test. Of the 32 cases, there were no operative complications, but 1 patient died of postoperative idiopathic interstitial pneumonia. Visualization scores for the pulmonary vessels were significantly higher for 320- than those for 64-detector CT (P < 0.0001 for the affected arteries and P < 0.0001 for the intersegmental veins). As for pulmonary vasculature assessment, the areas under the curve showed no statistically significant differences in between the two methods, while the specificity and accuracy of intersegemental vein assessment were significantly better for 320- than those for 64-detector row CT (P < 0.05). Interobserver agreement for the assessment yielded by either method was almost perfect for all cases. Three hundred and twenty-detector row CT is more useful than conventional 64-detector row CT for preoperative three-dimensional assessment of pulmonary vasculature, especially when we identify the intersegmental veins, in candidates for pulmonary segmentectomy.

Effectiveness of a New Fluoride Varnish for Caries Prevention In Pre-School Children

To investigate the effectiveness of a new fluoride varnish (Clinpro White Varnish, 3MEspe, Seefeld, Germany) with regard to the caries incidence within a 2-year period A non-randomized sample of 400 children from the Kyffhäuser district (Thuringia, Germany) was divided into a fluoride group (FG, biannual application of fluoride varnish) and control group (CG, no intervention). (Non-)cavitated caries lesions were recorded using World Health Organization (WHO) and Universal Visual Scoring System (UniViSS) criteria. Parents were given questionnaires to gather information about their socio-economic status (SES). Non-parametric methods and binomial logistic regression were used for data analysis. There was a significant increase in caries incidence in both groups. The number of non-cavitated carious lesions was significantly lower in the FG (mean 2.2; sd 2.3) compared with the CG (mean 2.9; sd 1.9). Initial statistical analysis revealed that fluoride varnish might prevent non-cavitated carious lesions. When including SES as a confounder into regression model, potential preventive effect was lost. This study underlines the importance of the multi-factorial etiology of caries and illustrates that the effectiveness of biannual fluoride varnish application was evident in non-cavitated carious lesions only.

Awareness and attitudes related to dental erosive wear among 18‐yr‐old adolescents in Oslo, Norway

The aim of the present study was to describe awareness and attitudes related to dental erosive wear among 18-yr-old adolescents in Oslo and to explore attitudinal differences between participants with and without the condition. All 18-yr-old subjects scheduled for their routine examination at the Public Dental Service clinics during 2008 (n = 3,206) were invited, and 1,456 agreed to participate (a response rate of 45%). The data were collected using structured questionnaires and by clinical examination of the participants. Dental erosive wear was assessed using a pictorial manual - the Visual Erosion Dental Examination scoring system - as a guide. Overall, 88% of participants had heard about dental erosive wear; however, of participants with erosive lesions only 56% were aware of, and only 47% could recall their dentist mentioning, the condition. Participants with erosive wear were more likely to have low or moderate positive attitudes towards acidic drink consumption and to be reluctant to change. In multivariate analyses controlling for gender and behavioural variables, weak or moderate positive awareness of acidic drinks remained significantly associated with higher erosion risk. This study emphasizes the importance of assessment and understanding of awareness and attitudinal aspects in relation to dental erosive wear.

Evaluating hippocampal internal architecture on MRI: Inter-rater reliability of a proposed scoring system

Asymmetry of hippocampal internal architecture (HIA) has been reported to be a frequent imaging finding in epilepsy patients with temporal lobe epilepsy (TLE) who exhibit other signs of hippocampal sclerosis. HIA asymmetry may also be an independent predictor of the side of seizure onset in patients with otherwise normal MRI scans. The study of HIA asymmetry and its relationship to the laterality of TLE would benefit from a reliable method of assessing the clarity of HIA in MRI scans. We propose a visual scoring system that rates HIA clarity from 1 (imperceptible) to 4 (excellent) and report the inter-rater reliability (IRR) of this system. In the initial preliminary phase of this study we examined IRR using a kappa statistic (κ) among a mixed group of expert and non-expert reviewers using only a brief description of the scoring system to score single images from a series of patients. In the second phase we explored the effect of training on the use of our HIA scoring system by assessing IRR among neuroimaging experts before and after a brief interactive training session. In this phase, multiple slices from each patient were scored. Separate κ values and intraclass correlation coefficients (ICC) were calculated from the scores given to each hippocampal image and from the asymmetry of scores between left and right for each slice. In the third phase the effect of training on non-expert reviewers was explored using a similar approach as with the expert reviewers. In the preliminary phase of the study, HIA scoring of single images showed substantial agreement among expert reviewers (κHIA=0.65), fair agreement among non-expert reviewers (κHIA=0.27), and a fair to moderate degree of agreement among all the reviewers as a whole (κHIA=0.40). In the second phase, prior to training there was substantial agreement among expert reviewers in regard to the individual HIA scores (κHIA=0.62; ICCHIA=0.81) but only moderate agreement on the degree of asymmetry (κAsym=0.47; ICCAsym=0.71). Training improved agreement on the individual HIA scores (κHIA=0.58-0.72; ICCHIA=0.76-0.84) and on the degree of asymmetry (κAsym=0.61-0.67; ICCAsym=0.81-0.85). Among non-expert reviewers, scores improved from only a fair degree of agreement pre-training (κHIA=0.25, κAsym=0.25; ICCHIA=0.68, ICCAsym=0.66) to a moderate level of agreement after training (κHIA=0.54, κAsym=0.52; ICCHIA=0.78, ICCAsym=0.81). The proposed HIA scoring system has a substantial degree of inter-rater reliability among experienced neuroimaging reviewers. Training improves the detection of asymmetries in HIA score in particular. Non-expert reviewers can employ the system with a moderate degree of reliability, and training has an even greater impact on the improvement of scoring reliability.

Predictive value of hippocampal internal architecture asymmetry in temporal lobe epilepsy

Asymmetry of hippocampal internal architecture (HIA) clarity has been suggested to be a sign of hippocampal sclerosis (HS) and is frequently associated with other MRI findings of HS. The goal of this work is to use a previously developed HIA visual scoring system (Ver Hoef et al., 2013) to quantify HIA asymmetry in a retrospective series of consecutive temporal lobe epilepsy (TLE) patients and evaluate its value in predicting laterality of seizure onset both in patients with other signs of HS (HS+) and those without (HS-). The HIA scoring system was used to rate hippocampal asymmetry and to assess the agreement between HIA and seizure lateralization. The median values of the average HIA scores for each hippocampus were compared for HS+ epileptogenic hippocampi, HS- epileptogenic hippocampi, and non-epileptogenic hippocampi with a Kruskal-Wallis one-way analysis of variance by ranks. Pair-wise differences between groups were evaluated with the two-tailed Mann-Whitney U test. A logistic regression model examined the utility of average HIA asymmetry score in predicting the true laterality of seizure onset as determined by video-EEG. Sensitivity and specificity are calculated using various asymmetry thresholds in each patient group. Fifty-five patients were identified who met inclusion criteria. Thirteen patients (24%) were found to have hippocampal atrophy and/or signal abnormality indicative of HS (HS+) and 42 did not (HS-). Significant differences were observed in the distribution of individual and average HIA scores between each of the groups of hippocampi, with HS+ hippocampi having the lowest HIA scores and non-epileptogenic hippocampi having the highest. Logistic regression analysis showed that the average HIA asymmetry score was a strong predictor of the laterality of seizure onset (β=3.93508, p<0.001). HIA asymmetry remained significant even after adjustment for HS+/HS- status (β=3.8854, p<0.001). Among HS- patients, when the average HIA asymmetry score was equal to or exceeded a threshold value of 0.5, the specificity for correctly predicting the side of seizure onset was between 95% and 100% with a sensitivity of 40-45%. Among HS+ patients, a threshold of 0.3 yielded a sensitivity of 85% and specificity of 100%. In this report we show for the first time that HIA asymmetry is a significant predictor of the laterality of seizure onset in TLE patients with otherwise normal MRI findings, and that the proposed HIA scoring system has high specificity and moderate sensitivity for lateralizing seizure onset in patients with TLE.

Identification of lymph node metastases by use of whole-body diffusion-weighted imaging in non-small cell lung cancer patients

Objective To prospectively and directly compare the capability of whole-body DWI,MRI and/or CT (MRI-CT),and whole-body DWI with MRI-CT for assessment of lymphatic metastases in non-small cell lung cancer (NSCLC) patients. Methods The institutional review board approved this study; informed consent was obtained from patients.A total of 56 NSCLC patients underwent whole-body DWI and thoracic CT scan prospectively.Conventional MRI was performed in suspicious lymphatic metastases parts within one week after inspection.Final diagnosis of the lymphatic metastases in each patient was determined on the basis of results of all radiologic and follow-up examinations.Two chest radiologists independently assessed all examination results and used a five-point visual scoring system to evaluate the probability of metastases.Final diagnosis based on each of the methods was made by consensus of two readers.Receiver operating characteristic (ROC) analysis was used to compare the capability for lymphatic metastases assessment among whole-body DWI,MRI-CT and whole-body DWI with MRI-CT.The detection abilities of lymph nodes with different size were compared withχ2test.Value of apparent diffusion coefficient (ADC) in the differential diagnosis of benign and malignant lymph nodes was compared with the variance Key words: Lymphatic metastasis; Carcinoma,non-small-cell lung; Magnetic resonance imaging

Lipoic acid decreases peritoneal adhesion formation in a rat uterine scar model

To investigate the effects of lipoic acid in the prevention of postoperative pelvic adhesions by a visual scoring system and immunohistochemistry in a rat uterine horn model with full thickness injury. Twenty-eight female Wistar albino rats were randomised into four groups: uterine trauma control, 15 days and 30 days, and uterine trauma + lipoic acid, 15 days and 30 days. A full thickness defect was established by incising a segment of approximately 1.0 cm in length from each uterine horn, leaving the mesometrium intact. Extension and severity of the adhesions in each group were scored by a visual scoring system and evaluated immunohistochemically. Adhesion scores were 2.00±0.81, 2.14±0.69 0.71±0.75, and 0.85±0.69 for extent and 2.28±0.48, 2.14±0.69, 0.85±0.69, and 1.14±0.69 for severity in Groups 1, 2, 3 and 4, respectively. Adhesion extent and severity were significantly less for groups treated by lipoic acid but no difference was observed between long and short administration. Both Vitronectin and u-PAR staining were significantly increased in treatment groups when compared to the control group. Lipoic acid was found to be effective in reducing postoperative adhesion formation in a rat model.

Surgery for secondary spontaneous pneumothorax: risk factors for recurrence and morbidity

Secondary spontaneous pneumothorax (SSP) is more common in elderly patients; it has high rates of recurrence and mortality, even if surgery is performed. There has been little study on the surgical treatment of SSP. Therefore, we analysed the outcomes of surgical treatment of SSP patients, and investigated the risk factors of recurrence and morbidity. We studied 97 consecutive surgical treatments on 94 patients with SSP who had emphysematous changes of lung retrospectively. Emphysematous changes on preoperative computed tomography image were evaluated by the Goddard score, which is a visual scoring system. First, video-assisted thoracoscopic surgery was performed, followed by bullectomy for the responsible lesions. The rate of morbidity was 20.6% and that of mortality was 4.1%. Recurrence rate was 9.3%. By multivariate analysis, a Goddard score≥7 (odds ratio: 8.93, P=0.033) and treatment of bulla without the use of staplers (odds ratio: 11.57, P=0.019) were significant risk factors for morbidity, while pulmonary fibrosis tended to increase the risk of recurrence (hazard ratio: 4.21, P=0.051), and a Goddard score≥7 (hazard ratio: 7.79, P=0.023) was a significant risk factor for recurrence. Surgical treatment in patients with SSP had favourable results. Treatment in which the base of the bulla cannot be definitely shut off with staplers is associated with increased morbidity. Significant emphysematous change on preoperative computed tomography image and pulmonary fibrosis are predictors of recurrence. Patients with these findings should be investigated in terms of the indications of surgery and additional treatment, not only bullectomy.

Is it Feasible to Use the Commercially Available Autoquantitation Software for the Evaluation of Myocardial Viability on Small-Animal Cardiac F-18 FDG PET Scan?

To evaluate the reliability of quantitation of myocardial viability on cardiac F-18 fluorodeoxyglucose (FDG) positron emission tomography (PET) scans with three different methods of visual scoring system, autoquantitation using commercially available autoquantitation software, and infarct-size measurement using histogram-based maximum pixel threshold identification on polar-map in rat hearts. A myocardial infarct (MI) model was made by left anterior descending artery (LAD) ligation in rat hearts. Eighteen MI rats underwent cardiac FDG-PET-computed tomography (CT) twice within a 4-week interval. Myocardium was partitioned into 20 segments for the comparison, and then we quantitated non-viable myocardium on cardiac FDG PET-CT with three different methods: method A-infarct-size measurement using histogram-based maximum pixel threshold identification on polar-map; method B-summed MI score (SMS) by a four-point visual scoring system; method C-metabolic non-viable values by commercially available autoquantitation software. Changes of non-viable myocardium on serial PET-CT scans with three different methods were calculated by the change of each parameter. Correlation and reproducibility were evaluated between the different methods. Infarct-size measurement, visual SMS, and non-viable values by autoquantitation software presented proportional relationship to each other. All the parameters of methods A, B, and C showed relatively good correlation between each other. Among them, infarct-size measurement (method A) and autoquantitation software (method C) showed the best correlation (r = 0.87, p < 0.001). When we evaluated the changes of non-viable myocardium on the serial FDG-PET-CT- however, autoquantitation program showed less correlation with the other methods. Visual assessment (method B) and those of infarct size (method A) showed the best correlation (r = 0.54, p = 0.02) for the assessment of interval changes. Commercially available quantitation software could be applied to measure the myocardial viability on small animal cardiac FDG-PET-CT scan. This kind of quantitation showed good correlation with infarct size measurement by histogram-based maximum pixel threshold identification. However, this method showed the weak correlation when applied in the measuring the changes of non-viable myocardium on the serial scans, which means that the caution will be needed to evaluate the changes on the serial monitoring.

Conversion Arthrodesis for Failed First Metatarsophalangeal Joint Hemiarthroplasty

Arthrodesis is currently the most commonly performed surgical procedure for the treatment of arthritis of the first metatarsophalangeal (MTP) joint. Hemiarthroplasty of the first MTP joint has been shown to have inferior clinical results and higher revision rates. The objective of this study was to assess the clinical outcome of the salvage of failed hallux phalangeal hemiarthroplasty with conversion to arthrodesis. A retrospective review of patients who underwent salvage of the first MTP joint hemiarthroplasty with conversion to arthrodesis was performed. Preoperative assessment included the visual analog pain (VAP) scale and AOFAS Hallux Metatarsophalangeal Interphalangeal scoring system (AOFAS-HMI). Postoperative outcomes were graded via AOFAS-HMI, VAP, and Foot and Ankle Ability Measure (FAAM). Twenty-one hemiarthroplasties were converted to arthrodesis in 21 patients, with 18 available for follow-up included in the study. There were 13 women and 5 men. Local autologous bone graft was used in 12 cases, while 6 patients required tricortical iliac crest bone graft for the treatment of extensive bone loss. At final follow-up, at a mean of 4.3 years, the average VAS pain score had diminished to 0.75 from 7.8 preoperatively out of 10, while the mean AOFAS-HMI improved from 36.2 out of 100 preoperatively to 85.3 out of 90 (modified to exclude first MTP motion). The mean FAAM ADL/sports were 97.3/91.3, respectively. All patients achieved fusion although at a longer interval than primary fusions. Conversion from a failed hallux phalangeal hemiarthroplasty to arthrodesis showed similar success to primary arthrodesis which was achieved in the majority of cases with the use of regional bone graft for small defects. However, the time to fusion was longer than that of primary arthrodesis, and it sometimes required structural bone graft for augmentation. Level IV, retrospective case series.

Pulmonary MR imaging with ultra-short TEs: Utility for disease severity assessment of connective tissue disease patients

PurposeTo evaluate the utility of pulmonary magnetic resonance (MR) imaging with ultra-short echo times (UTEs) at a 3.0 T MR system for pulmonary functional loss and disease severity assessments of connective tissue disease (CTD) patients with interstitial lung disease (ILD). Materials and methodsThis prospective study was approved by the institutional review board, and written informed consent was obtained from 18 CTD patients (eight men and ten women) and eight normal subjects with suspected chest disease (three men and five women). All subjects underwent thin-section MDCT, pulmonary MR imaging with UTEs, pulmonary function test and serum KL-6. Regional T2* maps were generated from each MR data set, and mean T2* values were determined from ROI measurements. From each thin-section MDCT data set, CT-based disease severity was evaluated with a visual scoring system. Mean T2* values for normal and CTD subjects were statistically compared by using Student's t-test. To assess capability for pulmonary functional loss and disease severity assessments, mean T2* values were statistically correlated with pulmonary functional parameters, serum KL-6 and CT-based disease severity. ResultsMean T2* values for normal and CTD subjects were significantly different (p=0.0019) and showed significant correlations with %VC, %DLCO, serum KL-6 and CT-based disease severity of CTD patients (p<0.05). ConclusionPulmonary MR imaging with UTEs is useful for pulmonary functional loss and disease severity assessments of CTD patients with ILD.

The role of lacrimal stent in endoscopic dacryocystorhinostomy

Dear Editor, We are grateful to the questioner for the comments on our manuscript [1]. The correspondent’s first question was about the size of bone resection during endoscopic dacryocystorhinostomy (DCR). I agree that complete bone resection exposing the full length of the lacrimal sac is one of the most important parts affecting the surgical result. The boundaries of complete bone resection are inferiorly from the level of the inferior turbinate, superiorly to the level of the fundus (the level common canaliculus joining to the lacrimal sac), and anteriorly and posteriorly the edge of the lacrimal sac. The bone covering the posterior part of the lacrimal sac is lacrimal bone, which is thin and can be easily fractured and removed with an elevator. The anterior part is the frontal process of the maxilla. After removal of lacrimal bone, we use a rongeur (Koros Osteo-Punch Rongeurs , 2 mm, T. Koros Surgical Instruments Corp., CA, USA) engaging and removing the free edge of the frontal process of the maxilla. However, sometimes there is a limitation in resection of the superior part with the rongeur; then, a diamond DCR bur (High Speed Diamond DCR Bur , 2.5 mm, 20 curved, Medtronic Xomed, Inc., FL, USA) is introduced. The questioner has mentioned articles [2,3] recommending creation of a 15–20 mm antero-posterior diameter osteotomy. Because we do not perform postoperative computed tomography (CT) scans, we have no data on how large we make bone resections in length, but we estimate that it is around 10 mm antero-posteriorly. The articles the questioner has mentioned were based on external DCR, not endoscopic DCR. In endoscopic DCR, because the bone work is performed under direct visualization of the lacrimal sac from the nose, the appropriate amount of bone resection is possible and it is not same for everyone. Several previous articles on endoscopic DCR showed excellent success rates without mentioning such a large size of bone resection, 15–20 mm [4–6]. The second comment was on our surgical results. In the common canalicular obstruction group of our series, the success rate of the no stent group was 57.1%, compared with 84.5% in the stent group. Even though there was no statistical significance, we concluded that the silicone stent group seems to have a higher success rate. Just like the questioner said, the statistical significance would have been reached with a greater sample size. Although there was no statistical significance, we thought that the silicone stent seems to have a beneficial role in common canalicular obstruction. However, we agree with the questioner’s point and have no further comments on this matter. The third criticism concerned the assessment of the surgical outcome. Surgery was considered successful if the patients had marked improvement of preoperative chronic epiphora and endoscopic findings revealing a patent rhinostomy on nasal endoscopy. We used a visual analog scoring system, 0 to 10. Zero stands for no symptom and 10 for the most severe symptom. Every enrolled patient’s preoperative score was more than 5, and ‘marked improvement’ was considered if the score was 2 or less. An objective method like a flow test of fluorescein from the conjunctiva to the nose could have made this study more perfect. However, we still think that the patients’ symptom improvement is the most important part. Again, we thank the questioner for the interest in our manuscript.

Effectiveness of Bone Metastases Treatment by Sm-153 Oxabifore in Combination with Monoclonal Antibody Denosumab (Xgeva): First Experience

Breast and prostate cancer have a propensity to metastasize to bones and cause osteolysis and abnormal new bone formation. Metastases locally disrupt normal bone remodeling. Although metastases from prostate cancer have been classified as osteoblastic based on the radiographic appearance of the lesion, data gleaned from a rapid autopsy program indicate that the same prostate cancer patient may have evidence of both osteolytic and osteoblastic disease as shown by histologic examinations. Thus, bone metastases are heterogeneous, requiring combined treatment targeting on both osteolytic and osteoblastic lesions. While Samarium-153 (Sm-153) oxabifore treatment is widely used for the relief of pain in patients with osteoblastic metastatic bone lesions, Xgeva (Denosumab) is indicated for the prevention of skeletal-related events in patients with bone metastases from solid tumors. It is a fully human monoclonal antibody that has been designed to target receptor activator of nuclear factor-kB ligand (RANKL), a protein that acts as the primary signal to promote bone removal. In many bone loss conditions, RANKL overwhelms the body's natural defense against bone destruction. The main objectives of the current pilot study were to estimate the effectiveness of bone metastases treatment by a combination of Sm-153 oxabifore and Xgeva (Denosumab). Five patients (four female and one male, aged 35-64, mean age 50.8) with multiple skeletal metastases from prostatic carcinoma (1) and breast carcinoma (4) were studied. Their mean objective pain score according to visual analog scoring system on a 1-10 scoring system was 7.8 ± 0.5 (range 6-9). Sm-153 oxabifore was administered at the standard bone palliation dose of 37 MBq/kg body weight. Xgeva (Denosumab) was administered at a dosage of 120 mg every 4 weeks, with the monitoring of calcium level and administration of calcium, magnesium, and vitamin D. Whole body (WB) bone scan was performed before and 3 months after treatment in all patients. After Sm-153 oxabifore administration, pain relief occurred within 4.4 ± 1.25 days (range 2-9 days) and the objective pain score decreased to 0.2 ± 0.2 (range 0-1). There was statistically significant difference found, according to the pain score system, before and after treatment (P < 0.0001). WB bone scan showed that in one patient, there was significant reduction in the number and intensity of bone metastases, and in four patients, there was no evidence of bone metastases found. Based on our first experience, combined treatment of bone metastases with Sm-153 oxabifore and Denosumab is effective and safe.

The Effect of Sonophoresis on Topical Anesthesia: A Pilot Project

The dental anesthesia sonophoresis device (DASD) is a novel device that is intended to reduce the discomfort associated with intraoral mucosa needle puncture. The DASD produces ultrasonic energy that provides a sonophoretic effect on the oral mucosa, generating microchannels through the lipids between the keratinized cells that make up the stratum corneum. Once the topical anesthetic has permeated the stratum corneum, it quickly diffuses through the soft tissue, desensitizing the nerve endings and reducing the perception of pain caused by needle penetration. The aim of this study is to evaluate whether topical anesthesia applied using the DASD will reduce the discomfort of the needle puncture when compared to the control device. A split-mouth model, using 50 healthy subjects with puncture site at the maxillary canine vestibule, was used for this study. Subjects received a needle puncture on both sides of the mouth. Prior to the needle puncture, there was randomized application of 5% lidocaine with the DASD and a control device. Subjects rated their discomfort after needle punctures utilizing the visual analog scale pain scoring system. There was no statistically significant difference in the pain perception using the DASD versus the control device.

Anaesthetic arthrography of the shoulder joint in dogs

To evaluate the use of intra-articular anaesthesia combined with positive contrast arthrography (collectively called 'anaesthetic arthrography' [AA]) in the shoulder in order to identify and confirm the source of pain in lame dogs. Anaesthetic arthrography was performed in 30 dogs with shoulder joint lameness with a mixture of contrast medium (iohexol: 240 mg I/ml) and a local anaesthetic (mepivacaine 2%: 20 mg/ml). The effect of intra-articular anaesthesia was evaluated by an objectified visual scoring system and the arthrograms were evaluated for their diagnostic value. This study showed that AA was positive in 28 out of 30 dogs. Dilution of the contrast medium with a local anaesthetic produced an arthrogram of good quality for each shoulder joint. In 16 out of 18 cases of osteochondritis dissecans, a cartilage flap could be identified following arthrography. In all cases the flap was not identified from plain radiographs. Biceps brachii tendon pathology was diagnosed on arthrography in seven dogs but was missed in two dogs. Calcification at the caudal rim of the glenoid cavity was diagnosed in three dogs, but was of clinical importance in only two dogs. In addition one infection was diagnosed during synovial aspiration. Anaesthetic arthrography of the shoulder is a simple, safe, and reliable diagnostic test to confirm shoulder joint pain and simultaneously identify a lesion. This procedure may be of particular importance in cases of occult shoulder joint lameness when clinical findings and plain radiographs are inconclusive.

The Effect of Methyl Jasmonate Vapour on Some Characteristics of Fruit Ripening, Carotenoids and Tomatine Changes in Tomato (Lycopersicon esculentum Mill.)

Tomato ripening in normal red-fruited cultivar (Fiorin) was delayed by treatment with methyl jasmonate (JA-Me) vapour. A visual scoring system for describing tomato ripening was used. Surface of fruits exposed to JA-Me vapour, increased in yellow and decreased in red as determined by HunterLab colour meter. JA-Me significantly altered the firmness of fruits after 21 days storage. Vapour of JA-Me enhanced the level of β-carotene in outer part (peel with 3 mm pericarp tissue) of fruit, while it had no effect in peeled fruit pericarp. JA-Me treatment decreased the level of lycopene in outer part and pericarp tissue, however, in outer part lycopene content decreased at a higher rate than in pericarp. Amount of tomatine in fruits treated with JA-Me had enhanced four-fold in outer part and by 62% in peeled fruit pericarp as compared with the control.

Evaluation of a Practical Visual MRI Rating Scale of Brain White Matter Hyperintensities for Clinicians Based on Largest Lesion Size Regardless of Location

Age-related white matter hyperintensities have prognostic implications, but no accepted clinical standard exists for their assessment. We propose a simple objective visual rating system by using 3T brain MR imaging. MR imaging from 559 participants was processed by using an automated method to determine WMH volumes and evaluated with a new visual rating scale based on the single largest WMH lesion diameter regardless of location. The reproducibility of the visual system was assessed. The association of WMH visual scores and automated volumes was then compared with cognitive scores from the Montreal Cognitive Assessment, which was available for 510 participants. Inter-reader reproducibility was good for subsamples with both high (n=52) and low (n=40) prevalence of large automated WMH volumes (agreement of 67% and 87.5%, κ=0.71 and 0.76, respectively). Correlation between increased WMH and cognitive deficit measurements was equal for our visual ratings and automated volumes (Spearman ρ=0.118 and 0.109; P values=0.008 and 0.014, respectively). The visual scale retained a significant association with MoCA score after adjusting for age, sex, and education (standardized β=-0.087, P=.042). We propose a simple visual WMH scoring system suitable for use as a baseline evaluation in clinical practice.

Oxygen-Enhanced MRI, Thin-Section MDCT, and Perfusion SPECT/CT: Comparison of Clinical Implications to Patient Care for Lung Volume Reduction Surgery

The purpose of our study was to prospectively and directly compare capability of O2-enhanced MRI, MDCT, and perfusion SPECT/CT to clinical outcome measurements in candidates for lung volume reduction surgery (LVRS). Twenty-five consecutive candidates for LVRS (20 men and five women; age range, 45-76 years) underwent MDCT, O2-enhanced MRI, and perfusion SPECT/CT before and after LVRS. Clinical outcomes for each candidate were evaluated in terms of differences between pre- and postoperative percentage forced expiratory volume in 1 second (%FEV1), Pao2, and 6-minute walking distance. Quantitatively assessed upper/lower lung ratios on O2-enhanced MRI, MDCT, and SPECT/CT were calculated from regional relative enhancement ratios, functional lung volumes, and radioisotope uptakes between upper and lower lungs. Qualitatively assessed upper/lower lung ratios on O2-enhanced MRI, MDCT, and SPECT/CT were estimated using visual scoring systems. To evaluate the correlation for individual upper/lower lung ratios and clinical outcomes, all upper/lower lung ratios were correlated with clinical outcomes. Improvements in mean relative enhancement ratio were directly correlated with clinical outcomes to assess the capability of O2-enhanced MRI to assess therapeutic effect. All quantitatively (-0.63≤r≤-0.47, p<0.05) and qualitatively (0.41≤r≤0.57, p<0.05) assessed upper/lower lung ratios showed moderate and statistically significant correlation with clinical outcomes, and improvement in mean relative enhancement ratio showed moderate or good correlation, both statistically significant (-0.44≤r≤0.71, p<0.05). O2-enhanced MRI shows potential for more accurate evaluation of postoperative clinical outcome for LVRS candidates than SPECT/CT and can be considered at least as reliable as MDCT.

Novel endoscopic delivery modality of infrared coagulation therapy for internal hemorrhoids

BackgroundA novel endoscopic delivery system for infrared coagulation therapy (IRC) has been designed recently. IRC is a well-established treatment for symptomatic internal hemorrhoids. Patients frequently undergo lower endoscopy before hemorrhoid treatment to eliminate other sources of bleeding. Current treatment options are difficult to perform without an anal retractor, adequate lighting, and specialized instruments. Endoscopic IRC is an attractive alternative to standard IRC, because it can be performed during the lower endoscopy.TechniqueEndoscopic IRC utilizes infrared radiation generated by a control box, which is applied to the tissue through a flexible, fiber optic light guide (Precision Endoscopic Infrared Coagulator™). The light guide is placed through the colonoscope or flexible sigmoidoscope in the same chamber as other endoscopic instruments.MethodsA retrospective review was performed using a prospectively collected database. A standardized protocol was utilized in all patients. Patients graded their symptoms before and after therapy by using the visual analog symptom severity scoring system (range, 0–10). These results were analyzed by using the nonparametric Wilcoxon signed-rank test. Exact P values were computed by using the R function wilcox.exact.ResultsA total of 55 patients underwent endoscopic IRC for predominately grade II and grade III symptomatic internal hemorrhoids (71 %). There were 22 (40 %) female patients. Posttherapy results indicated a significant improvement in global symptoms (pretreatment average global score = 2.24 vs. posttreatment average global score = 0.28; P < 0.0001). There have been no adverse events reported to date.ConclusionsEndoscopic IRC provides improved visibility and efficiency, allowing simultaneous treatment of symptomatic internal hemorrhoids at the time of lower endoscopy. Patients experienced significant improvement in their symptoms after a single session of endoscopic IRC. There are a variety of additional endoscopic IRC therapeutic utilities: endoscopic management of angiodysplasia, inflammation, hemostasis, and NOTES applications.