Wash Out Research Articles

What proportion of LI-RADS 5 observations reported in clinical practice do not meet LI-RADS 5 criteria?

Liver Imaging Reporting and Data System (LI-RADS, LR) category 5 (definite hepatocellular carcinoma [HCC]) is assigned based on combinations of major imaging features (MFs): size, arterial-phase hyperenhancement (APHE), washout (WO), enhancing capsule, and threshold growth. The criteria were simplified in v2018 compared to v2017. The goal of this study is to assess the proportion of LR-5 observations reported in clinical practice with LI-RADS v2017 or v2018 that did not meet LR-5 criteria based on reported MFs. All MR and CT reports using a standardized LI-RADS template between April 2017 and September 2020 were identified retrospectively. For each reported LR-5 observation, size, MFs, and LI-RADS version (v2017 or v2018) were extracted. Reported MFs were used to determine whether LR-5 criteria were met using the applied version of LI-RADS. The data was summarized descriptively. Three hundred eight observations in 234 patients (67.6% male, mean age 66.2years) were reported as LR-5, including 136 (44.2%) with v2017 and 172 (55.8%) with v2018. 8/136 (6%) v2017 LR-5 observations and 6/172 (3%) v2018 LR-5 observations did not meet LR-5 criteria. Of 8 incorrectly categorized v2017 observations, 3 (43%) lacked APHE, 1 (14%) was a 16-mm new observation with APHE only, and 4 (43%) were 10-19mm with APHE and WO. Of the 6 incorrectly categorized v2018 observations, 5 (83%) lacked APHE and 1 (17%) was < 10mm. Depending on the LI-RADS version, 3-6% of LR-5 observations reported in clinical practice do not meet LR-5 criteria based on reported MFs. Key Points • Depending on the LI-RADS version, 3-6% of LR-5 observations in clinical practice do not meet LR-5 criteria based on reported major imaging features. • Assigning LR-5 category to observations without nonrim arterial-phase hyperenhancement was the most common error.

Alcohol-Based Hand Sanitizers: A Systematic Review on Effectiveness and Effects

A Hand Sanitizer dispensing machine is automatic, alcohol based hand sanitizer dispenser and non contact which is used in offices, hospitals, schools, work places etc. Basically, alcohol is a solvent and very good disinfectant as compared to liquid or solid soap. It is volatile and vaporizes fatly so it does not need water to wash out. It is proved that a concentration of &gt; 70 % alcohol which can kills corona or other viruses in hands ultrasonic sensor which senses hand when placed near it, microcontroller used in that is the Arduino uno and which senses the distance and the result is the sanitizer.

The Value of Contrast-Enhanced Ultrasound in Diagnosing Small Renal Cell Carcinoma Subtypes and Angiomyolipoma.

To retrospectively explore the value of contrast-enhanced ultrasound (CEUS) in differentiating small renal cell carcinomas (RCCs) from angiomyolipomas (AMLs), and distinguishing between clear cell RCC (ccRCC), papillary RCC (pRCC), and chromophobe RCC (chRCC). A total of 151 patients with small renal masses (110 ccRCCs, 12 pRCCs, 9 chRCCs, and 20 AMLs) were enrolled between August 2016 and October 2019. There were significant differences in terms of enhancement intensity (EI), enhancement homogeneity, perilesional rim-like enhancement (PRE), wash in, and wash out (WO) between RCC and AML (P=.000, .011, .000, .001, .000, respectively). Although there was no significant difference in EI between pRCC and chRCC (P=.272), EI of ccRCC was higher than that of pRCC (P=.000) and chRCC (P=.010). Multivariate regression analysis showed PRE and fast WO were related to RCC (OR=18.189, 15.141, respectively). Although there were no significant differences in the sensitivity and area under the curve (AUC) between PRE and fast WO (95.0% vs. 95.0%, P=1.000 and .880 vs. 0.799, P=.123, respectively), the specificity of PRE in predicting RCC was higher than that of fast WO (80.92% vs. 64.89%, P=.011). The sensitivity, specificity, and AUC of the two characteristics combination for differentiating RCC from AML were 95.0%, 90.8%, and 0.920, respectively, and that of EI for differentiating between ccRCC, pRCC, and chRCC were 81.0%, 78.2%, and 0.796, respectively. CEUS has value in differentiating small RCCs from AMLs and distinguishing ccRCC, a subtype associated with a greater likelihood of malignant behavior from pRCC and chRCC.

Effects of D-allulose on glucose tolerance and insulin response to a standard oral sucrose load: results of a prospective, randomized, crossover study

IntroductionCurrent dietary guidelines recommend limiting sugar intake for the prevention of diabetes mellitus (DM). Reduction in sugar intake may require sugar substitutes. Among these, D-allulose is a non-calorie rare monosaccharide...

Inspiratory/expiratory xenon-enhanced area-detector CT: Capability for quantitative assessment of lung ventilation changes in surgically treated non-small cell lung cancer patients

PurposeTo evaluate the capability of inspiratory/expiratory Xe-enhanced ADCT for assessment of changes in pulmonary function and regional ventilation of surgically treated NSCLC patients. Method and materialsForty consecutive surgically treated NSCLC patients underwent pre- and postoperative inspiratory/expiratory Xe-enhanced ADCT and pulmonary function tests. For each patient, pre- and post-operative data were analyzed and pre- and post-operative wash-in (WI) and wash-out (WO) indexes and ventilation ratio (VR=[WI-WO]/WI) maps generated by means of pixel-by-pixel analyses. Differences between pre- and postoperative WI (ΔWI), WO (ΔWO) and VR (ΔVR) were also determined. To determine the relationship between all ventilation index changes and pulmonary functional loss, Pearson’s correlation was used to correlate each ventilation index change with the corresponding pulmonary functional parameter change. In addition, stepwise regression analysis was performed for all ventilation index changes and each corresponding pulmonary functional parameter change. ResultsFEV1/FVC% change showed fair or good and significant correlations with ΔWI (r = 0.39, p = 0.01) and ΔVR (r = 0.68, p = 0.001), %FEV1 change good or moderate and significant correlations with ΔWI (r = 0.56, p = 0.0001) and ΔVR (r = 0.76, p < 0.0001), and %VC change moderate yet significant correlation with ΔWI (r = 0.65, p < 0.0001) and ΔVR (r = 0.67, p < 0.0001). Stepwise regression analysis demonstrated that FEV1/FVC% change (r2 = 0.56, p < 0.0001) significantly affected two factors, ΔVR (p < 0.0001) and ΔWI (p = 0.006), as did %FEV1 change (r2 = 0.68, p < 0.0001) [ΔVR (p < 0.0001) and ΔWI (p = 0.0001)], and %VC change (r2 = 0.63, p < 0.0001) [ΔVR (p < 0.0001) and ΔWI (p = 0.0001)]. ConclusionInspiratory/expiratory Xe-enhanced ADCT has the potential to demonstrate that pre- and postoperative ventilation status of surgically treated NSCLC patients correlates with pulmonary function.

Rare Surgical Complication of In Vitro Fertilisation Treatment: Bladder Injury During Oocyte Retrieval

Current literature suggests that surgical complications from oocyte retrievals (ORs) are uncommon. Here, we present a rare case of bladder injury during OR and its subsequent management. A 37-year-old nulliparous woman underwent assisted reproductive therapy (ART) for primary infertility secondary to anovulatory cycle. During OR, there was an inadvertent puncture of the bladder, with active intra-bladder bleeding seen on transvaginal ultrasound. Bladder washout followed by continuous drainage was instituted with antibiotic coverage over several days. Bladder integrity ascertained through computer tomography urogram and cystoscopy were unremarkable. She was discharged well and continued with her fertility treatment. Transvaginal OR is associated with few complications. Bladder injury, albeit rare, can present with massive hematuria and hemodynamic instability. Early identification of the injury is key to management with insertion of the indwelling urinary catheter, hemodynamic resuscitation and bladder irrigation. With a urological multi-disciplinary approach, most bladder injuries can be resolved non-invasively. J Med Cases. 2021;12(3):102-106 doi: https://doi.org/10.14740/jmc3632

Focal Nodular Hyperplasia: The 7 Characteristic Features on Imaging

Focal nodular hyperplasia or FNH is the second most common benign liver tumour after hemangiomas. It is caused by abnormal alignment of hepatocytes, due to hypoperfusion or hyper perfusion in the hepatic lobule, from anomalous arteries [1-2]. It affects women mostly, in their reproductive age, and is usually asymptomatic, discovered incidentally through imaging, however, sometimes when enlarged it may cause discomfort and vague abdominal pain. Magnetic Resonance Imaging (MRI) is the method of choice for its diagnosis. The importance of recognizing FNH resides in its differential diagnosis: Hepatic adenoma, Hepatocellular carcinoma and hypervascular metastases (Figure 1). To confirm diagnosis, there are 7 characteristic features on imaging: 1. It is a homogeneous, non-capsulated lesion, with well-defined margins that are sometimes lobulated. 2. It is isoechoic on ultrasound. 3. In MRI: It is isointense on T1 weighted images or slightly hypointense and isointense on T2 weighted images or slightly hyperintense, because it contains disorganized hepatocytes, thus, signal stays homogeneous to liver signal 4. Surrounded liver parenchyma is respected. 5. It contains a central scar that may be seen in 50%-80% of the cases. 6. Contrast enhancement is typically intense and homogeneous at arterial phase, and becomes iso intense in the late phase. The central scar is hypointense in arterial phase, but becomes enhanced in the late phase. It presents no wash out. 7. It contains a feeding arteriole that develops towards the central scar. When asymptomatic, Patients only need an imaging follow up and no treatment is required, however, when symptomatic, surgical resection is necessary. Keywords: Liver; Focal; Lesion; Imaging; FNH References [1] Venturi A, Piscaglia F, Vidili G, Flori S, and Righini R, et al. (2007) Diagnosis and management of hepatic focal nodular hyperplasia. J Ultrasound. 10:116-127. [2] Matos AP, Velloni F, Ramalho M, AlObaidy M, and Rajapaksha A, & Semelka, et al. (2015) Focal liver lesions: Practical magnetic resonance imaging approach. World J Hepatol. 7: 1987-8

Influence of Probiotics on the Salivary Microflora Oral Streptococci and Their Integration into Oral Biofilm.

Probiotics’ ability to integrate into dental biofilms is not yet clarified. The aim of this trial was to detect probiotic bacteria from probiotic products in dental biofilm and saliva during and after intake. In this parallel, randomized clinical trial, 39 subjects wore customized appliances to build up intra-oral biofilms (72-h periods). The trial was divided into screening (S) to determine baseline biofilm flora, intervention (I), and wash out (WO). During I (28 days), subjects consumed a product containing (a) Enterococcus faecalis (b) Lactobacillus casei, or (c) Lactobacillus rhamnosus GG. Probiotic bacteria and Streptococci spp. were detected in the biofilms and saliva of the 35 subjects that were included in the analysis. During I and WO, the ratio of probiotics in the biofilm was very low compared to total bacterial load, while saliva had slightly but not significantly higher values. No significant changes of probiotic bacteria (p > 0.05) were found at any visit during I or WO. The proportion of streptococci was significantly reduced (p < 0.05) during I and even lower in WO, compared to S. Probiotic bacteria could neither integrate nor persist in dental biofilm and saliva but did influence the growth of streptococci in biofilm and saliva.

Energy washout: A New Method to Achieve Well-Being and Health

Energy washout: A New Method to Achieve Well-Being and Health

Temporal patterns of tramadol in hair after a single dose

This controlled study aimed to measure concentrations of tramadol (TRA) and its two main metabolites, N-desmethyltramadol (NDMT) and O-desmethyltramadol (ODMT), in hair following a single dose ingestion and to investigate the distribution patterns in hair by segmental analysis of hair samples taken at several sampling time points after ingestion. An oral dose (50 or 100mg) of TRA was administered to 17 healthy volunteers. Hair samples were collected prior to drug administration and 14, 30, 60 and 120 days after ingestion. Each sample was segmented in 5mm segments and washed. The analytes were extracted from pulverized hair by incubation in extraction media for 18h at 37°C. A validated UHPLC–MS/MS method was used to quantify the analytes at a LLOQ of 0.001ng/mg. Hair segments corresponding to the time of ingestion were positive for TRA and the metabolites of each sampling time point, although neighboring segments also showed positive results. The highest concentrations for both dosage groups were observed in the proximal segment of hair collected 14 days after ingestion for all subjects: 0.061–0.95ng TRA/mg, 0.012–0.86ng NDMT/mg and 0.009–0.17ng ODMT/mg (n=16). Generally, the TRA concentration was higher than the metabolites concentrations but depended on the CYP2D6 phenotype. The metabolite to TRA ratios were stable within a subject over the sampling time points, however it varied greatly between subjects. No significant differences in hair concentrations were found between the two dosage groups at each sampling time. Several confounding factors were identified such as hair pigmentation and internal sweat. We showed that analysis of 5mm segments improved the determination of the exposure time after a single ingestion of TRA. In addition, in the later sampling time points the analytes were spread more between segments and the total drug amount of each later sampling time point declined up to a 100% (median: 75%) due to wash out. The presented results are important additions to the sparse literature reporting single dose of psychoactive drugs in hair.

Изменение поглотительной способности почв по элементам рельефа балочных водосборов ЦЧР

Работа посвящена изучению особенностей состава почвенного поглощающего комплекса (ППК) по элементам рельефа балочного водосбора. Целью работы является выявление зависимости ППК от степени развития и характера водной эрозии и аккумуляции. Для достижения поставленной цели был решен ряд задач: проведение площадной почвенно-эрозионной съемки балочного водосбора; определение физико-химических и физических свойств почв по ГОСТированным и общепринятым методикам; сравнительный анализ поглотительных свойств почв по элементам рельефа балочного водосбора. Высокая степень эродированности территории определяет актуальность исследования поглотительных свойств почв, подверженных смыву и намыву. Объектом исследования являются почвы водосборной площади балки «Лог Репный». Согласно почвенно-эрозионному районированию Воронежской области объект исследования расположен в Семилукско-Нижнедевицком районе. Наблюдалось обеднение всего профиля почв водораздельных склонов и берега балки илистой фракцией за счет влияния эрозии почв и денудации. На днище балки было зафиксировано обогащение верхней части почвенного профиля илистой фракцией под влиянием аккумуляции почвенного материала, смываемого с вышележащих склонов. Поглотительная способность почв различных элементов рельефа водосборной площади балки «Лог Репный» может быть охарактеризована с помощью величины суммы поглощенных оснований. Наибольшая сумма поглощенных оснований наблюдалась на водораздельном плато (15.73 ммоль/100 г почвы). На берегу балки в условиях влияния процесса денудации зафиксировано уменьшение суммы поглощенных оснований в 2.5 раза. На днище балки в зоне преимущественной аккумуляции смываемого со склонов почвенного материала сумма поглощенных оснований была ниже, чем на водоразделе в 1.4 раза. Это связано с различным содержанием илистой фракции в этих почвах. Так, в почвах водоразделов илистая фракция составляла 24.8%, на берегу балки ее содержание было в 2.5 раза ниже, а на днище балки вновь возрастало до 22.4 %. Установлена зависимость суммы поглощенных оснований почв от перераспределения илистой фракции под влиянием эрозии и аккумуляции почв.

Assessment of the Treatment Response of Hepatocellular Carcinoma to Radiofrequency Ablation Using Dynamic and Diffusion MR Imaging according to LI-RADS v2018 Treatment Response Algorithm

Abstract Background: Hepatocellular carcinoma is the most com-mon primary liver malignancy and considered as the fifth most common cancer worldwide. Resection and liver trans-plantation have a high survival in adequately selected patients, however locoregional ablative therapeutic techniques has several advantages over surgery like hepatic parenchymal preservation and overall have less morbidity and mortality. Aim of Study: The aim of this study was to evaluate the role of diffusion and dynamic MR imaging in the assessment of the treatment response of hepatocellular carcinoma after radiofrequency ablation according to the LI-RADS treatment response v2018. Patients and Methods: A retrospective study included 40 patients with 45 HCC lesions underwent radiofrequency ablation and followed-up by dynamic and diffusion MR imaging. The data were collected from the PACS of Radiology Department, Cairo University Hospitals. The MR images were assessed according to LI-RADS 2018 treatment response algorithm. Results: According to LI-RADS treatment response cri-teria, dynamic MRI has sensitivity of 100%, specificity 95.8%, Positive Predictive Value (PPV) 94.1% and Negative Predictive Value (NPV) 100% compared to sensitivity of 64.3%, specif-icity 95.8%, PPV 90% and NPV 82.1% for the diffusion weighted images in the detection of tumoural viability. Arterial Phase Hyperenhancement (APHE) was found in 87.5% of viable lesions while delayed wash out was found in 100% of the viable lesions. Conclusion: Dynamic MRI is the cornerstone in the assessment of treatment response of hepatocellular carcinoma to radiofrequency ablation. Arterial phase hyperenhancement and delayed wash out are the main criteria for diagnosis of tumoural viability according to LI-RADS treatment response algorithm. Diffusion imaging and ADC measurement are good negative techniques for exclusion of tumoural activity and also can confirm the dynamic findings in viable cases.

No effect of anti‐hypertensive treatment during the metaboreflex in patients with essential hypertension

In healthy subjects (HS), when the muscle metaboreflex (MM) is activated, the target mean blood pressure (MBP) is reached thanks to cardiac output (CO) increments, whilst systemic vascular resistance (SVR) plays a minor role 1. Differently, in essential hypertension (EHT) hemodynamics during the MM has been often reported to be dys‐regulated, with exaggerated SVR response (i.e. arteriolar vasoconstriction) and reduced CO 2. We tested the hypothesis that standard anti‐hypertensive treatment could improve this abnormal hemodynamics. 20 patients in pharmacological treatment for EHT (10 females; age 54.5±10.4 yrs, time since diagnosis 8.5±6.9 yrs) participated in this study together with a control group of 20 age‐matched HS. At baseline (BAS), they underwent randomly assigned the following protocol to study the MM activity: 1) post‐exercise muscle ischemia (PEMI), and 2) control exercise recovery CER) test. Exercise was dynamic handgrip performed at 30% of the maximum previously assessed. The EHT group performed again the test at least 7 days later (interval 7–15 days) after pharmacological wash‐out (WHT). Response to the MM for each cardiovascular parameter was assessed as PEMI minus CER level. Hemodynamic variables were evaluated by impedance cardiography. Results demonstrated that in EHT, SVR response did not change at the BAS and at the WHT (338.0±452.7 vs. 371.8±465.3 dynes•s‐1•cm‐5 at BAS and at WHT respectively). Moreover, EHT showed higher SVR response than HS (20.9±399.6 dynes•s‐1•cm‐5, p&lt;0.05 vs. both the BAS and the WHT test). However, the MBP response was similar between groups and conditions. Likewise CO was not different between groups. It was concluded that the anti‐hypertensive treatment was not able to counteract the arteriolar vasoconstriction and the increased SVR response experienced by ETH patients during the MM. Further study is warranted to better understand what causes the hemodynamic abnormalities of EHT patients during the MM activation.Support or Funding InformationThis study was supported by the University of Cagliari and the Italian Ministry of Scientific Research.

Diurnal differences in the transcriptome of peripheral blood mononuclear cells in response to a meal

AbstractEating at night has been linked to impaired glucose metabolism and dyslipidaemia that is likely a consequence of an underlying disrupted circadian rhythm in metabolic processes. An understanding of the mechanisms causing metabolic disruption after eating at night is important for prevention and management of disease risk factors. The aim of this study was to explore the transcriptomic differences in nutrient metabolism after eating a meal at night compared with the same meal in the morning. In a cross over design, 10 healthy adults fasted for &gt; 10 hours and then completed two acute meal challenges at 8am and 8pm on non-consecutive days separated by a wash out. Fasting and postprandial blood samples were collected to assess glucose and insulin responses. For a subset of five participants RNA sequencing was completed on the Illumina NextSeq500. Total RNA was extracted from peripheral blood mononuclear cells at fasting (baseline) and 2 h after the test meal, the quality of all samples was above RIN 8 (AATI Fragment Analyzer). Differential expression analysis was completed using the DESeq2 package. False discovery rate correction was applied at the pathway analysis level, conducted in PathVisio. Postprandial blood glucose was significantly higher at 8pm vs. 8am (208.8(154.1)mmol/L.3hr vs 36.4(99.6)mmol/L.3hr, p = 0.005) no concurrent changes in insulin responses were observed (p = 0.100). Under fasting conditions, 704 genes were differentially expressed between morning and night, with 60% of these genes being down regulated at night. The meal challenges were associated with changes in gene expression compared with fasting in the morning 552 genes were differentially expressed and 532 genes were differentially expressed in the evening, however only 7% were commonly differentially regulated at both times of day. Pathway analysis of the differentially expressed genes identified that more immune system and signal transduction pathways were enriched after eating at night compared with morning, where as a greater number of pathways involved in lipid metabolism were enriched in the morning. The time of day a meal is consumed has an effect on which genes are differentially regulated in the acute postprandial period, and the biological pathways they are involved in. Investigating the differences in the transcriptomic response to food at night provides a greater understanding of the mechanisms underlying the phenotypic dissimilarities observed in circulating metabolic biomarkers according to the time of day.

Contrast enhancement patterns of hepatocellular carcinoma with portal vein thrombosis

Purpose. To study contrast enhancement patterns of hepatocellular carcinoma (HCC) in cases with portal thrombosis and without it.Materials and methods. 61 consecutive patients with HCC were included in the study and divided into two groups: 41 patient with portal vein thrombosis (main group) and 20 patients without thrombosis (control group). Each patient underwent a abdominal CE MDCT for the analysis of the lesion contrast enhancement.Results. The 1st – “classic” – contrast enhancement pattern with a peak at arterial phase was observed in 2 (5%) patients with HCC complicated by portal thrombosis and in 10 (50%) patients without thrombosis (p &lt; 0.01). The 2nd – “hypervascular” pattern with a peak shifted in 60–120s after contrast agent administration and no wash out was observed in 14 (34%) patients in the main group and in 10 (50%) patients in the control group (p = 0.4). The 3rd pattern – inhomogeneous contrast enhancement of liver parenchyma in the territory of thrombosed vein without visible tumor was discovered in 17 (41%) cases (p &lt; 0.01). The 4th pattern – peripheral enhancement in arterial and portal phase with insignificant central enhancement in delayed phase was visualized in 8 cases (20%, p = 0.072).Conclusion. Portal thrombosis, which complicates the course of HCC, significantly changes the patterns of tumor’s contrast enhancement. This should be taken into account when image analysis to avoid diagnostic errors.

Short-term Supplemental Dietary Potassium from Potato and Potassium Gluconate Effect on Potassium Retention in Pre-Hypertensive-to-Hypertensive Adults (P24-051-19)

ObjectivesPotassium is an essential nutrient of concern according to recent Dietary Guidelines for Americans Advisory Committees. Current recommendations established by the Institute of Medicine (IOM) are given as an Adequate Intake (AI) of 4700 mg/d, met by less than 3% of the population. Little is known about potassium (K) tissue retention and less is understood on how retention may affect health outcomes. In this clinical trial, we assessed the effects of K intake from potato sources and a K supplement on overall K balance. MethodsThirty pre-hypertensive-to-hypertensive (Systolic BP ≥ 120 mmHg) men (N = 15) and women (N = 15) with a mean ± SD age, BMI, and BP (systolic(SBP)/diastolic(DBP)) of 48.2 ± 15 y, 31.4 ± 6.1, and 136.3 ± 11.9/86.1 ± 7.1 mmHg, respectively, were enrolled in a cross-over randomized control diet trial. Participants were assigned to a random order of four 16-day dietary K interventions including a basal diet (control) of 2300 mg/d(∼60 mmol/d), and three periods of an additional 1000 mg/d(3300 mg/d(∼85 mmol/d) total) of K in the form of potatoes (baked, boiled, or pan-heated with no additional fat), French fries, or a K gluconate supplement. Each intervention period was separated by two or more weeks of wash out. Twenty-four hour urine and stool samples were collected throughout each intervention phase, and assessed via ICP-OES for K, sodium (Na), and calcium (Ca) content. Results for differences in mineral balance were assessed as % (%) of intake by 15-day sums as follows: retention = dietary intake – urine + stool losses. ResultsUsing a mixed model with repeated measures and follow-up contrast analyses, initial analysis shows no significant differences (P > 0.05) in % mineral retention (± SE) for K (control: 28.92 ± 7.19, French fries: 30.37 ± 5.81, potatoes: 26.39 ± 5.11, supplement: 34.52 ± 6.53), Na (control: 23.42 ± 10.34, French fries: 30.37 ± 8.03, potatoes: 20.15 ± 6.86, supplement: 26.47 ± 10.14), or Ca (control: 25.21 ± 11.23, French fries: 16.61 ± 13.47, potatoes: 24.22 ± 4.56, supplement: 31.46 ± 8.22). ConclusionsAlthough there appears to be no difference in mineral retention due to source, these findings may challenge the current dogma that K and Na intake are equivalent to urinary output, and raise the question of how retention in various tissues can influence health outcomes. Funding SourcesThe Alliance for Potato Research and Education.

Abstract P091: Short-term Increased Dietary Potassium From Potato and Potassium Gluconate Has No Effect on Blood Pressure and Microcirculation in Pre-hypertensive-to-hypertensive Adults

Potassium is an essential nutrient of concern according to recent Dietary Guidelines for Americans Advisory Committees, with less than 3% of the population meeting the current adequate intake (AI) level of 4700mg/d. Increases in potassium intake have been linked to improvements in cardiovascular and other metabolic health outcomes. Blood pressure (BP) is currently the primary criterion for determining potassium requirements. In this clinical trial, we assessed the effects of increasing potassium intake on BP and microcirculation (endothelial function). Thirty pre-hypertensive-to-hypertensive (Systolic BP ≥ 120mmHg) men (N=15) and Women (N=15) with a mean ± SD age, BMI, and BP (systolic(SBP)/ diastolic(DBP)) of 48.2 ± 15 y, 31.4 ± 6.1, and 136.3 ± 11.9/ 86.1 ± 7.1 mmHg, respectively, were enrolled in a cross-over randomized control diet trial. Participants were assigned to a random order of four 16-day dietary potassium interventions including a basal diet (control) of 2300mg/d(~60mmol/d), and three periods of an additional 1000mg/d(3300mg/d(~85mmol/d) total) of potassium in the form of potatoes (baked, boiled, or pan-heated with no additional fat), French fries, or a potassium gluconate supplement. Each intervention period was separated by two or more weeks of wash out. Blood pressure was measured in triplicate using manual auscultation on days 1, 4, 6, 8, 11, 13, 15, 16, and 17 of each intervention. Microvascular and endothelial function were assessed via thermal hyperemia, utilizing laser Doppler flowmetry (LDF), at baseline and at the end of each intervention. Results for differences in both SBP and DBP ± SE were assessed at the end treatment (average of day 15, 16, and 17 measurements) using a mixed model with repeated measures and Dunnett adjustment (P &lt; 0.05), with no significant differences among groups (control: 128.7 ± 2.1/ 83.6 ± 1.6, French fries: 127.7 ± 2.2/ 83.7 ± 1.6, potatoes: 127.6 ± 2.3/ 85.1 ± 1.6, supplement: 128.0 ± 2.2/ 83.7 ± 1.7). Utilizing the same statistical analysis, there were also no significant differences in endothelial function (measured as percent of cutaneous vascular conductance max (%CVCmax) ± SE) among groups (control: 87.4 ± 1.5%, French Fries: 87.7 ± 1.4%, potatoes: 88.3 ± 1.1%, supplement: 88.9 ± 1.0%). In this small, controlled feeding study of short duration, increased potassium from potatoes or supplement achieved 70% of recommended intakes, but had no significant benefit to blood pressure or microvascular function in men and women with higher cardiometabolic risk.

Efficacy and Safety of a Water-Based Head Lice Lotion: A Randomized, Controlled, Investigator-Blinded, Comparative, Bicentric Study.

IntroductionSilicones (e.g., dimethicone) are effective and safe alternatives to insecticides for the treatment of head lice. However, silicones are lipophilic substances and do not only leave the hair greasy but they are also difficult to wash out. We have evaluated the efficacy and safety of a potential solution to this problem: an aqueous dispersion of a novel silylated polyol that has the same mode of action as dimethicone (suffocation) without its negative impact on hair characteristics.MethodsThis was a randomized, controlled, investigator-blinded, bicentric study that was conducted at two locations in the state of Florida (USA) to compare the test product (medical device) to a pyrethrum-based pediculicide that is a first-line, prescription-free treatment against head lice in the USA. The subjects (n = 70) were randomly divided into two groups of 35 persons (test product group and reference product group), with each participant receiving two applications (day 0 and 7) of the product to be tested, according to the instructions for use. Efficacy and safety was evaluated at distinct time points. The primary objective was to establish a cure rate for the test product that was better than 70% at study end (day 10). Esthetic effects of the test product versus dimethicone were evaluated in a blinded, cross-over consumer study (n = 100).ResultsAt study end, the cure rate (corrected for re-infestation) of 88.2% with the test product significantly surpassed the pre-defined target of 70%, and thus the superiority of the test product versus the reference product was confirmed. The number of subjects cured (free of head lice) after the first treatment was remarkably higher with the test product than with the reference product (57.1 vs. 2.9%, respectively). Both products were safe and well tolerated and both showed beneficial esthetical effects. The consumer test demonstrated that the test product had better washing-out properties than dimethicone, as reflected by a significantly lower average rinsing time and number of washings required to restore the visual aspect of the hair, especially in terms of greasiness.ConclusionAqueous dispersions of silylated polyols are a promising new class of pediculicides that combine high cure rates with optimal user convenience (short treatment period, easy wash-out with positive effect on hair quality).Trial RegistrationClinicalTrials.gov identifier, NCT03617926.FundingOystershell Laboratories.

Conventional, diffusion, and permeability MR findings in ocular medulloepithelioma.

To describe the neuroradiological features of intraocular medulloepithelioma. We retrospectively analyzed the clinical, histopathological, and MRI data of five children with medulloepithelioma. In addition to conventional images, DWI was performed in four patients and mean ADC was calculated; this was limited to the technique of this cohort of patients. DCE was performed in all patients. This is the first paper that presents diffusion and perfusion characteristics of medulloepithelioma. Four tumors were malignant teratoid variants, two non-teratoid variants. Tumors were hyperintense on T1-weighted images and hypointense on T2-weighted images. Calcifications were detectable in two out of five tumors. Cavities were detectable in three out of five tumors. All tumors showed some degree of enhancement. The mean ADC of all four patients was 1.156 ± 242.75 × 10-3mm2/s. Mean ktrans, Ve, Kep, TME, AUC, SER, and peak enhancement were 0.082 ± 0.054, 0.19 ± 0.076, 0.31 ± 0.084, 0.97 ± 0.0784, 1.22 ± 0.81, 67.34 ± 31.7, and 14.84 ± 7.34 respectively. TICs showed a very high ratio of slow increase, > 50% persistence and some degree of wash out. Teratoid variants showed higher K-trans, AUC, VE, TME, and persistent TIC pattern than non-teratoid ones, while plateau pattern ratio was lower. Conventional MR findings were similar to previously reported cases. Mean ADCs were moderately high. TICs showed slow increase and presence of wash out. K-trans, AUC, VE, and TME were higher in teratoid variants. Permeability parameters in differential diagnosis with lesions mimicking medulloepithelioma need further investigations.

Myocardial 123I-mIBG scintigraphy in relation to markers of inflammation and long-term clinical outcome in patients with stable chronic heart failure

AimChronic heart failure (CHF) results in both increased cardiac sympathetic activity and myocardial inflammation. The aim of this study was to identify the relationship between severity of heart failure (i.e., NT-proBNP and LVEF), cardiac sympathetic activity (123I-mIBG scintigraphy), and measures of inflammation in subjects with stable, optimally treated CHF. In addition, the predictive value for cardiac events (i.e., ventricular arrhythmia, progression of CHF and cardiac death) of 123I-mIBG parameters and these inflammatory markers was evaluated. Materials and MethodsFifty-five CHF patients (age 66.3 ± 8.0 years, 78% male, LVEF 22.4 ± 6.3) referred for cardiac 123I-mIBG imaging were included. At 15 minutes (early) and 4 hours (late) after i.v. administration of 123I-mIBG (185 MBq), planar images were acquired. Early Heart/Mediastinum (H/M) ratio, late H/M ratio, and 123I-mIBG washout (WO) were calculated. NT-proBNP and markers of inflammation (i.e., C-reactive protein (CRP), IL-1β, IL-6, IL-8, IL-10, IL-12p40, tumor necrosis factor-α (TNF-α), soluble (s)E-selectin, myeloperoxidase (MPO), plasminogen activator inhibitor-1 (PAI-1), tPA, tumor necrosis factor receptor (TNFR) 1 and 2, and interferon (IFN) α and β) were measured in blood plasma samples, taken just before 123I-mIBG administration. ResultsMean early H/M ratio was 2.12 ± 0.39, late H/M ratio was 1.84 ± 0.40, and 123I-mIBG WO was 13.0 ± 10.9. LVEF was the only independent predictor of late H/M ratio (adjusted R2 = 0.100, p = 0.011). NT-proBNP was an independent predictor of 123I-mIBG WO (adjusted R2 = 0.090, p = 0.015). CRP, IL12p40, TNF-α, sE-selectin, MPO, PAI-1, tPA, and TNFR2 were not related to late H/M ratio and 123I-mIBG WO. During a median follow-up of 34 months (2–58 months), 13 patients experienced a cardiac event [ventricular arrhythmia (4), progression of CHF (4), and cardiac death (5)]. Univariate Cox regression analysis showed that the risk of a cardiac event was associated with CRP (HR 1.047 [1.013–1.081]), NT-proBNP (HR 1.141 [1.011–1.288]), MPO (HR 0.998 [0.996–1.000]), and late H/M ratio (HR 0.182 [0.035–0.946]). Multivariate Cox regression analysis showed that only CRP, NT-proBNP, MPO, and IL-12p40 were predictors of a cardiac event. ConclusionInflammation and cardiac sympathetic activity seem not to be related in stable CHF patients. This is corroborated by the finding that they both provide prognostic information in this specific CHF population. The current findings should be regarded as insightful but preliminary.