Quality Assessment of Cardiac Magnetic Resonance Images at 1.5/3.0 T: Description and Validation of Standardized Criteria

PURPOSE: Cardiovascular magnetic resonance (CMR) has become a robust and important diagnostic imaging modality in cardiovascular medicine. However,insufficient image quality may compromise its diagnostic accuracy. No standardized criteria are available to assess the quality of CMR studies. We aimed todescribe and validate standardized criteria to evaluate the quality of CMR studies including: a) cine steady-state free precession, b) delayed gadoliniumenhancement, and c) adenosine stress first-pass perfusion. These criteria will serve for the assessment of the image quality in the setting of the Euro-CMR registry.METHOD AND MATERIALS: First, a total of 45 quality criteria were defined (35 qualitative criteria with a score from 0-3, and 10 quantitative criteria). Thequalitative score ranged from 0 to 105. The lower the qualitative score, the better the quality. The quantitative criteria were based on the absolute signal intensity (delayed enhancement) and on the signal increase (perfusion) of the anterior/posterior left ventricular wall after gadolinium injection. These criteria were then applied in 30 patients scanned with a 1.5T system and in 15 patients scanned with a 3.0T system. The examinations were jointly interpreted by 3 CMR experts and 1 study nurse. In these 45 patients the correlation between the results of the quality assessment obtained by the different readers was calculated.RESULTS: On the 1.5T machine, the mean quality score was 3.5. The mean difference between each pair of observers was 0.2 (5.7%) with a mean standarddeviation of 1.4. On the 3.0T machine, the mean quality score was 4.4. The mean difference between each pair of onservers was 0.3 (6.4%) with a meanstandard deviation of 1.6. The quantitative quality assessments between observers were well correlated for the 1.5T machine: R was between 0.78 and 0.99 (pCONCLUSION: The described criteria for the assessment of CMR image quality are robust and have a low inter-observer variability, especially on 1.5T systems.CLINICAL RELEVANCE/APPLICATION: These criteria will allow the standardization of CMR examinations. They will help to improve the overall quality ofexaminations and the comparison between clinical studies.

Patients's satisfaction concerning postoperative analgesia after caesarean section: a comparison of 4 alternative analgesic regimen

Introduction: Different routes of postoperative analgesia may be used after cesarean section: systemic, spinal or epidural [1]. Although the efficacy of these alternative analgesic regimen has already been studied [2, 3], very few studies have compared patients' satisfaction between them. Methodology: After ethical committee acceptation, 100 ASA 1 patients scheduled for an elective cesarean section were randomized in 4 groups. After a standardized spinal anesthesia (hyperbaric bupivacaine 10 mg and fentanyl 20 μg), each group had a different postoperative analgesic regimen: - Group 1: oral paracetamol 4x1 g/24 h, oral ibuprofene 3x600 mg/24 h and subcutaneous morphine on need (0.1 mg/kg 6x/24 h) - Group 2: intrathecal morphine (100 μg) and then same as Group 1 - Group 3: oral paracetamol 4x1 g/24 h, oral ibuprofene 3x600 mg/24 h and PCEA with fentanyl 5 μg/ml epidural solution - Group 4: oral paracetamol 4x1g/24 h, oral ibuprofene 3x600 mg/ 24 h and PCEA with bupivacaine 0.1% and fentanyl 2 μg/ml epidural solution After 48 hours, a specific satisfaction questionnaire was given to all patients which permitted to obtain 2 different scores concerning postoperative analgesia: a global satisfaction score (0-10) and a detailed satisfaction score (5 questions scored 0-10 with a summative score of 0-50). Both scores, expressed as mean ± SD, were compared between the 4 groups with a Kruskall-Wallis test and between each group with a Mann-Whitney test. A P-value <0.05 was considered significant. Results: Satisfaction scores Gr. 1 (n = 25) Gr. 2 (n = 25) Gr. 3 (n = 25) Gr. 4 (n = 25) P-value global (0-10) 8.2 ± 1.2 9.0 ± 1.0 7.8 ± 2.1 6.5 ± 2.5 0.0006 detailed (0-50) 40 ± 6 43 ± 5 38 ± 6 34 ± 8 0.0002 Conclusion: Satisfaction scores were significantly better in patients who received a systemic postoperative analgesia only (Groups 1 and 2) compared to patients who received systemic and epidural postoperative analgesia (Groups 3 and 4). The best scores were achieved with the combination of intrathecal morphine and multimodal systemic analgesia (Group 2) which allowed early ambulation without significant pain. Patients treated with postoperative epidural analgesia with combined local anesthetics and opioids (Group 4) obtained the worse scores (more restrictive nursing with less mobility, frequent asymmetrical block with insufficient analgesia on one side and motor block on the other)

Phase 3 randomized trial on larynx preservation comparing sequential vs alternating chemotherapy and radiotherapy.

BACKGROUND: Both induction chemotherapy followed by irradiation and concurrent chemotherapy and radiotherapy have been reported as valuable alternatives to total laryngectomy in patients with advanced larynx or hypopharynx cancer. We report results of the randomized phase 3 trial 24954 from the European Organization for Research and Treatment of Cancer. METHODS: Patients with resectable advanced squamous cell carcinoma of the larynx (tumor stage T3-T4) or hypopharynx (T2-T4), with regional lymph nodes in the neck staged as N0-N2 and with no metastasis, were randomly assigned to treatment in the sequential (or control) or the alternating (or experimental) arm. In the sequential arm, patients with a 50% or more reduction in primary tumor size after two cycles of cisplatin and 5-fluorouracil received another two cycles, followed by radiotherapy (70 Gy total). In the alternating arm, a total of four cycles of cisplatin and 5-fluorouracil (in weeks 1, 4, 7, and 10) were alternated with radiotherapy with 20 Gy during the three 2-week intervals between chemotherapy cycles (60 Gy total). All nonresponders underwent salvage surgery and postoperative radiotherapy. The Kaplan-Meier method was used to obtain time-to-event data. RESULTS: The 450 patients were randomly assigned to treatment (224 to the sequential arm and 226 to the alternating arm). Median follow-up was 6.5 years. Survival with a functional larynx was similar in sequential and alternating arms (hazard ratio of death and/or event = 0.85, 95% confidence interval = 0.68 to 1.06), as were median overall survival (4.4 and 5.1 years, respectively) and median progression-free interval (3.0 and 3.1 years, respectively). Grade 3 or 4 mucositis occurred in 64 (32%) of the 200 patients in the sequential arm who received radiotherapy and in 47 (21%) of the 220 patients in the alternating arm. Late severe edema and/or fibrosis was observed in 32 (16%) patients in the sequential arm and in 25 (11%) in the alternating arm. CONCLUSIONS: Larynx preservation, progression-free interval, and overall survival were similar in both arms, as were acute and late toxic effects.

An Analysis of the Benefit of Using HEV Genotype 3 Antigens in Detecting Anti-HEV IgG in a European Population

Introduction Quatre génotypes pathogènes de l'hépatite E (HEV) sont actuellement connus. Ils présentent des caractéristiques épidémiologiques différentes. Les génotypes 1 et 2 infectent uniquement l'homme et sont à l'origine d'épidémies dans des pays en voie de développement. Les génotypes 3 et 4 se présentent sous forme de zoonose, endémiques chez des cochons et autres mammifères dans des pays industrialisés. Ces derniers génotypes sont à l'origine de cas sporadiques d'hépatite E autochtones. La majorité des tests de sérologie actuellement commercialisés se basent sur des virus de génotype 1 et 2. Le bénéfice de l'utilisation d'un test sérologique basé sur le génotype 3 dans des pays industrialisés n'a pas été étudié jusqu'à présent. Dans cette étude, les performances de tests sérologiques basés sur des antigènes de plusieurs génotypes de l'HEV ont été comparées. Méthode Les tests ont été appliqués à deux populations distinctes: une population de 20 patients, chez qui une infection aiguë d'hépatite E, génotype 3, a été documentée par PCR sanguine, et une population de 550 donneurs de sang de la région de Lausanne. Le dépistage des IgGs anti-HEV a été effectué dans le sérum des deux populations par trois «Enzyme Immuno Assays» (EIA) à savoir MP Diagnostics, Dia.Pro et Fortress. Les échantillons positifs avec au moins un des EIA ont été testés par un «Immunodot Assay», le recomLine HEV IgG/IgM. Tous les EIA sont basés sur des antigènes des génotypes 1 et 2, alors que l'immunodot se base sur des antigènes des génotypes 1 et 3. Résultats Tous les échantillons des cas d'hépatite E documentés et 124 sur 550 échantillons des donneurs de sang étaient positifs avec au moins un des tests sérologique. Parmi les cas confirmés par PCR, 45 %, 65 %, 95 % et 55 % étaient respectivement positifs avec le test de MP Diagnostics, Dia.Pro, Fortress et recomLine. Parmi les échantillons positifs des donneurs de sang avec au moins un des tests, 120/124 (97 %) étaient positifs avec le test Fortress, 19/124 (15 %) étaient positifs avec tous les EIA et 51/124 (41 %) étaient positifs avec le recomLine. Parmi les cas d'hépatite E confirmés, 11/20 (55 %) étaient positifs avec le recomLine et parmi ceux-ci, une réactivité plus forte pour le génotype 3 était observée dans 1/11 (9 %) et une réactivité identique dans 5/11 (45.5 %) cas. Conclusions Même si le recomLine contient des protéines dérivées de l'HEV génotype 3, sa sensibilité est inférieure à l'EIA de Fortress dans les cas d'hépatite E aiguë de génotype 3. De plus, chez environ 45 % des patients, le recomLine ne parvient pas à identifier une infection comme étant causé par un virus du génotype 3. Dans la population de donneurs de sang, nous avons observe de grandes variations dans les séroprévalences mesurées, allant de 4.2 % à 21.8 % selon les tests sérologiques employés.

Submissão às recomendações do BI-RADS™ por médicos e pacientes: análise preliminar de 3.000 exames realizados em uma clínica particular

O Breast Imaging Reporting and Data System (BI-RADS™) do American College of Radiology é um sistema que objetiva padronizar o laudo mamográfico, reduzir os fatores de confusão na descrição e interpretação das imagens e facilitar a emissão do resultado final do exame. OBJETIVO: Buscar identificar o grau de submissão das mulheres e médicos às recomendações do BI-RADS em Goiânia, GO. MATERIAIS E MÉTODOS: Foram avaliadas, prospectivamente, 3.000 mulheres submetidas à mamografia em um serviço radiológico particular em Goiânia (janeiro a dezembro de 2002). Os laudos foram emitidos de acordo com o BI-RADS. As mulheres classificadas nas categorias 0, 3, 4 e 5 foram acompanhadas por contato telefônico. RESULTADOS: Mulheres que se recusaram a seguir orientação: categorias 0 (11,5%), 3 (13,8%), 4 (28%) e 5 (0%). Não houve orientação médica para seguir recomendação: categorias 0 (18,2%), 3 (17%), 4 (20%). Mulheres que se submeteram à recomendação: categorias 0 (1,8%), 3 (5,7%), 4 (40%), 5 (100%). Perdidas no seguimento: categorias 0 (68,5%), 3 (39%) e 4 (12%). CONCLUSÃO: É baixa a submissão às recomendações do BI-RADS nas categorias 0 e 3, e moderada na categoria 4. Aproximadamente 30% das mulheres classificadas na categoria 0 não se submeteram à avaliação adicional por imagem, por recusa própria ou por falta de orientação médica.

Síntese de novas fitotoxinas derivadas do 8-oxabiciclo[3.2.1]oct-6-en-3-ona

The [4+3] cycloaddition was utilized in order to prepare 8-oxabicyclo[3.2.1]oct-6-en-3-one (1) derivatives. The correspondent acetonide 6 was converted into several alcohols (11-16). Addition of aryllithium reagents to 6 resulted in 3-(2-fluorophenyl)-6,7-exo-isopropylidenedioxy -8-oxabicyclo[3.2.1]octan-3alpha-ol (11, 72%) and 3-(2,4-dimethoxyphenyl)-6,7-exo-isopropylidenedioxy-8-oxabicyclo[3.2.1]octan -3alpha-ol (16, 20%). The 3-butyl-6,7-exo-isopropylidenedioxy-8-oxabicyclo[3.2.1]octan-3 alpha-ol (15, 56%) was obtained through a Grignard reaction. Reduction of 6 resulted in 6,7-exo-isopropylidenedioxy-8-oxabicyclo[3.2.1]octan-3 beta-ol (7, 62%) and 6,7-exo-isopropylidenedioxy-8-oxabicyclo[3.2.1]octan-3 alpha-ol (8, 20%). The alcohols were treated with thionyl chloride in pyridine, and the corresponding alkenes were obtained with 31-80% yield. The effect of these compounds on the development of radicle and aerial parts of Sorghum bicolor was evaluated.

Monoterpenos di-hidroxilados e hidróxi-nitrogenados 1,2 e 1,3 como ligantes quirais em reação de reformatsky assimétrica

This study describes the use of three (-)-alpha-pinene derivatives, one diol-1,2 [(-)-(1R, 2R, 3S, 5R)-2,6,6-trimethylbicyclo[3.1.1]heptane-2,3-diol 4] and two piridine-hydroxy derivatives [(+)-(1R,2S,3R,5S)-2,6,6-trimethyl-3-(2-pyridinylmethyl)bicyclo[3.1.1]heptan-3-ol 7 and (-)-(1R,2S,3R,5S)-2,6,6-trimethyl-3-[2-(2-pyridinyl) ethyl]bicyclo[3.1.1]heptan-3-ol 8]; one diol-1,3 [(-)-(1S,2R,5S)-2-(1-hydroxy-1-methylethyl)-5-methylcyclohexanol 5] derived from (+)-isopulegol 2 and one diol-1,3 [(+)-(1R,2R,5R)-2-(1-hydroxy-1-methylethyl)-5-methylcyclohexanol 6] derived from (+)-neo-isopulegol 3, as ligands in the asymmetric Reformatsky reaction. The best enantiomeric excess of beta-hydroxy ester obtained in the Reformatsky asymmetric reaction was 18% using ligand 6, and the chemical yield of the reactions was 65% on average.

Steroidal and phenolic compounds from Sidastrum paniculatum (L.) Fryxell and evaluation of cytotoxic and anti-inflammatory activities

Sidastrum paniculatum (L.) Fryxell belongs to the family Malvaceae and is popularly known as "malva roxa" or "malvavisco". The phytochemical study of the hexane, CHCl3 and EtOAc phases from the crude ethanol extract of S. paniculatum led to the isolation of six compounds: a mixture of β-sitosterol and stigmasterol, 4-methoxy-3-hydroxybenzoic acid, 4-methoxy-3-hydroxybenzaldehyde, N-trans-feruloyltyramine and kaempferol-3-O-β-D-(6''-E-p -coumaroyl) glucoside. The structural identification of the compounds was made on the basis of spectroscopic methods such as IR, ¹H and 13C NMR with the aid of including two-dimensional techniques, besides comparison with literature data. The β-sitosterol and stigmasterol mixture showed a significant anti-inflammatory activity.

Cumarinas e alcaloides de Rauia resinosa (rutaceae)

The genus Rauia, that is poorly chemically studied, belongs to the Rutaceae family. This family has been known to contain a large variety of secondary metabolites. Our phytochemical investigation of the stem and leaves of Rauia resinosa has led to the identification of the structurally related coumarins: murralongin (1), murrangatin (2), munomicrolin (3), murrangatin diacetate (4), umbelliferone (5), rauianin (6) and one novel coumarin: 3-ethylrauianin (7); the alkaloids: N-methyl-4-methoxy-2-quinolone (8), mirtopsine (9), dictamine (10), γ-fagarine (11), skimmianine (12), Z-dimethylrhoifolinate (13), zantodioline (14), zantobungeanine (15), veprissine (16), one novel alkaloid 7-hydroxy-8-methoxy-N-methylflindersine (17) and 8-hydroxy-N-methylflindersine (18) that is described as a natural product for the first time, and a mixture of steroids: as sitosterol and stigmasterol.

Quinoline alkaloids and friedelane-type triterpenes isolated from leaves and wood of Esenbeckia alata kunt (Rutaceae)

This work describes the phytochemical exploration of the ethanol extract from leaves and wood of Esenbeckia alata, leading to the isolation and identification of quinoline alkaloids 4-methoxy-3-(3'-methyl-but-2'-enyl)-N-methyl-quinolin-2(1 H)-one, N-methylflindersine, dictamine, kokusaginine, Γ-fagarine, flindersiamine, as well as the fridelane-type triterpenes, frideline, fridelanol and its acetate derivative. Identification of these compounds was based on full analyses of spectroscopic data (¹H, 13C, 1D, 2D, IR, MS) and comparison with data reported in literature. Compound 4-methoxy-3-(3'-methyl-but-2'-enyl)-N-methyl-quinolin-2(1 H)-one is reported for the first time for the genus Esenbeckia.

Synthesis and biological activity of sulfur compounds showing structural analogy with combretastatin A-4

We extended our previous exploration of sulfur bridges as bioisosteric replacements for atoms forming the bridge between the aromatic rings of combretastatin A-4. Employing coupling reactions between 5-iodo-1,2,3-trimethoxybenzene and substituted thiols, followed by oxidation to sulfones with m-CPBA, different locations for attaching the sulfur atom to ring A through the synthesis of nine compounds were examined. Antitubulin activity was performed with electrophoretically homogenous bovine brain tubulin, and activity occurred with the 1,2,3-trimethoxy-4-[(4-methoxyphenyl)thio]benzene (12), while the other compounds were inactive. The compounds were also tested for leishmanicidal activity using promastigote forms of Leishmania braziliensis (MHOM/BR175/M2904), and the greatest activity was observed with 1,2,3-trimethoxy-4-(phenylthio)benzene (10) and 1,2,3-trimethoxy-4-[(4-methoxyphenyl) sulfinyl]benzene (15).

Flavonoides e terpenoides de Croton muscicarpa (Euphorbiaceae)

A new sesquiterpene and twelve known compounds comprising eight flavonoids and four terpenoids, were isolated from the leaves, stems, roots and exudate of Croton muscicarpa Müll. Arg.. Their structures were identified as the terpenoids 6α-methoxy-cyperene, dammaradienol, squalene, acetyl aleuritolic acid and spathulenol, and as the flavonoids retusin, 3,7,4'-trimethoxy kaempferol, ombuine, pachipodol, kaempferol, casticin, 5-hydroxy-3,6,7,4'-tetramethoxyflavone and artemetin. All isolated compounds were characterized based on IR, MS, ¹H and 13C NMR, including 2D analyses (COSY, HSQC, HMBC, NOESY) and comparison with data from the literature.

Associação de Rhizoctonia solani Grupo de Anastomose 4 (AG-4 HGI e HGIII) à espécies de plantas invasoras de área de cultivo de batata

Os grupos 3 e 4 de anastomose (AG-3 e AG-4) do fungo Rhizoctonia solani são importantes grupos associados à batata no mundo. No Brasil, o AG-3 é relatado afetando principalmente batata e fumo. Já o AG-4 causa perdas consideráveis em culturas de importância econômica, como a soja, o feijão e o amendoim, podendo ocorrer também em hortaliças como o espinafre, o pimentão, o brócolis, o tomate, a batata e frutíferas como o melão. Recentemente foi constatada, em Brasília-DF, a associação de R. solani a plantas invasoras em áreas de cultivo de batata. Entretanto, não há informação a respeito da etiologia do patógeno bem como do papel de espécies invasoras como outras hospedeiras no ciclo do patógeno. Objetivou-se com esse estudo caracterizar isolados de R. solani obtidos de batata e de outras três espécies de plantas invasoras associadas a áreas de cultivo da cultura: juá-de-capote [Nicandra physaloides (L.) Pers., Solanaceae], beldroega (Portulaca oleracea L., Portulacaceae), e caruru (Amaranthus deflexus L., Amaranthaceae). Foi confirmada a hipótese de que os isolados obtidos de R. solani de beldroega, caruru e juá-de-capote pertencem ao grupo 4 de anastomose e são patogênicos à batata, exceto o isolado de beldroega. Estes isolados apresentaram patogenicidade cruzada às três espécies e também patogênicos à maria-pretinha (Solanum americanum Mill.), uma outra espécie de Solanaceae invasora. A classificação dos isolados no grupo AG-4 HGI ou no grupo AG-4 HGIII (isolado de caruru) foi confirmada através de características culturais e moleculares (seqüenciamento da região ITS-5.8S do rDNA). Os resultados deste trabalho trazem implicações importantes para o manejo das podridões radiculares de Rhizoctonia em batata.

Acurácia diagnóstica da biópsia percutânea com agulha grossa orientada por estereotaxia nas lesões mamárias categoria BI-RADS® 4

OBJETIVO: avaliar a acurácia da biópsia com agulha grossa (BAG) orientada por estereotaxia nas lesões mamárias categoria BI-RADS® 4. MÉTODOS: realizou-se uma análise retrospectiva das lesões categoria BI-RADS® 4 que foram submetidas à BAG orientada por estereotaxia no período de junho de 1998 a junho de 2003. As pacientes com resultados benignos, mas com baixa suspeição à imagem radiográfica, foram orientadas a acompanhamento mamográfico. As pacientes com resultados malignos ou com lesões especiais (atipias e lesões papilíferas) foram submetidas ao tratamento padronizado. Aquelas com resultado benigno, mas que apresentavam imagem mamográfica de maior risco, foram encaminhadas para biópsia cirúrgica (BC). Foram considerados padrão-ouro (1) o acompanhamento radiográfico inalterado por, no mínimo, três anos daquelas lesões de baixa suspeição que resultaram benigno na BAG e (2) os resultados das biópsias cirúrgicas, quando essas foram realizadas (nas BAG cujos resultados foram malignos ou benignos com imagem de maior risco). Foram realizados os cálculos estatísticos de sensibilidade, especificidade e valor preditivo positivo e negativo do método. RESULTADOS: das 118 lesões não palpáveis categoria BI-RADS® 4 submetidas à BAG orientada por estereotaxia, 27 casos correspondiam à doença maligna, 81 eram benignas e 10 eram lesões com atipia ou papilíferas. Para a análise estatística, foram selecionados 108 pacientes (excluídas as lesões com atipia e papilíferas). A sensibilidade da BAG foi de 87,1% e a especificidade foi de 100%. O valor preditivo positivo foi de 100% e o negativo, de 95,1%. A acurácia da BAG nessa casuística foi de 96,3%. A taxa de falso-negativo foi de 3,7% (4/108). A prevalência de diagnóstico de malignidade nas lesões BI-RADS® 4 nessa amostra foi de 29,7% (31/118). CONCLUSÕES: a biópsia estereotáxica com agulha grossa mostrou-se uma alternativa segura à BC. Quando seu resultado é positivo, orienta o planejamento terapêutico, e, quando negativo (em imagens radiográficas de baixa suspeição), permite o acompanhamento.

Comparative allelopathic potential of metabolites of two Alternanthera species against germination and seedling growth of rice

A laboratory study was conducted to investigate the allelopathic effect of aqueous extracts of plant parts of Alternanthera philoxeroides and A. sessilis and soil incorporated residues on germination and seedling growth of rice (Oryza sativa). Aqueous extracts prepared from different plant parts of Alternanthera species delayed rice germination. Alternanthera philoxeroides and A. sessilis inhibited rice germination by 9-100% and 4-49%, respectively. Germination of rice seeds was reduced with increasing concentration of aqueous leaf extracts of both weed species. Early seedling growth (root and shoot lengths) and seedling vigor index were significantly reduced by 5% aqueous leaf extract compared with distilled water treated control. Germination, root and shoot lengths, root and shoot dry weights and seedling vigor index of rice were drastically reduced by 3 and 4% in residue infested soil compared with residue free soil. The inhibitory effect of A. philoxeroides in terms of germination and seedling growth of rice was greater than that of A. sessilis. Five percent aqueous leaf extract and 4% residue infested soil of A. philoxeroides caused complete failure of rice seed germination. Alternanthera philoxeroides contained water soluble phenolics, namely 4 hydroxy-3-methoxy benzoic acid (16.19 mg L-1) and m-coumaric acid (1.48 mg L-1), whereas Alternanthera sessilis was rich in chlorogenic acid (17.85 mg L-1), gallic acid (11.03 mg L-1) and vanillic acid (9.88 mg L-1). The study indicates that the allelopathic potential of Alternanthera species may play an important role in enhancing the invasiveness of these species and may suppress rice plants in the vicinity.