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Background: Persisting post-concussion symptoms (PPCS) is a complex, multifaceted condition in which individuals continue to experience the symptoms of mild traumatic brain injury (mTBI, concussion) beyond the timeframe that it typically takes to recover. Currently, there is no way of knowing which individuals may develop this condition. Method: Patients presenting to a hospital emergency department (ED) within 48 h of sustaining a mTBI underwent neuropsychological assessment and demographic, injury-related information and blood samples were collected. Concentrations of blood-based biomarkers neuron specific enolase, neurofilament protein-light, and glial fibrillary acidic protein were assessed, and a subset of patients also underwent diffusion tensor&ndash, magnetic resonance imaging, both relative to healthy controls. Individuals were classified as having PPCS if they reported a score of 25 or higher on the Rivermead Postconcussion Symptoms Questionnaire at ~28 days post-injury. Univariate exact logistic regression was performed to identify measures that may be predictive of PPCS. Neuroimaging data were examined for differences in fractional anisotropy (FA) and mean diffusivity in regions of interest. Results: Of n = 36 individuals, three (8.33%) were classified as having PPCS. Increased performance on the Repeatable Battery for the Assessment of Neuropsychological Status Update Total Score (OR = 0.81, 95% CI: 0.61&ndash, 0.95, p = 0.004), Immediate Memory (OR = 0.79, 95% CI: 0.56&ndash, 0.94, p = 0.001), and Attention (OR = 0.86, 95% CI: 0.71&ndash, 0.97, p = 0.007) indices, as well as faster completion of the Trails Making Test B (OR = 1.06, 95% CI: 1.00&ndash, 1.12, p = 0.032) at ED presentation were associated with a statistically significant decreased odds of an individual being classified as having PPCS. There was no significant association between blood-based biomarkers and PPCS in this small sample, although glial fibrillary acidic protein (GFAP) was significantly increased in individuals with mTBI relative to healthy controls. Furthermore, relative to healthy age and sex-matched controls (n = 8), individuals with mTBI (n = 14) had higher levels of FA within the left inferior frontal occipital fasciculus (t (18.06) = &minus, 3.01, p = 0.008). Conclusion: Performance on neuropsychological measures may be useful for predicting PPCS, but further investigation is required to elucidate the utility of this and other potential predictors.

Background Anterior hip pain after total hip replacement (THR) can be caused by iliopsoas impingement (IPI). Validation of CT measured cup version is well published; however quantification of the anterior cup prominence has not been validated. Therefore, we did an in vitro study aiming to: (1) assess the accuracy of the current method of measuring the prominence of the acetabular component using a dry bone model; (2) develop a CT protocol based on bony anatomical landmarks that improves the accuracy of these measurements. Hypothesis We hypothesise that utilising reproducible anatomical landmarks on the acetabulum will improve the accuracy of measurement of anterior prominence at the psoas valley. Methods A dry bone pelvic model was implanted with bilateral acetabular cups. The cup was manipulated into ten different combinations of inclination and version, and anterior prominence directly measured in relation to the acetabular rim. A CT scan was performed for each position. Anterior prominence was then measured by two radiologists, first using standard methods (axial slice at level of centre of femoral head) and then again using a novel protocol (based on the position of the psoas valley in relation to the inferior medial acetabular notch). Results Mean errors between direct measurement of anterior prominence and radiologist reported measurements using standard protocol were 6.94 mm ± 5.24 (SD) (95%Confidence Interval: 3.25–4.27) and 5.14 mm ± 3.07 (95%CI: 1.9–2.5) with a tendency towards overestimation of prominence. Using an anatomical landmark based protocol; mean error was reduced to 3.0 mm ± 1.9 (95%CI: 1.16–1.53) and 4.3 mm ± 4.3 (95%CI: 2.67–351) on the first attempt, and to 1.7 mm ± 1.9 (95%CI: 1.15-1.52) and 2.1 mm ± 1.4 (95%CI: 0.87–1.15) on the second attempt. Concordance correlation improved from 0.43 (95% CI: 0.19–0.68) and 0.59 (95% CI: 0.44–0.79) using the standard protocol, to 0.88 (95%CI: 0.61–0.91) and 0.9 (95%CI: 0.56–0.92) using the novel protocol. Conclusions There is a difference in mean error and reliability between radiologically measured values for anterior prominence and values measured directly with present methods. The use of our novel protocol based on bony acetabular landmarks, significantly improves the accuracy of measurement. This protocol may improve reproducibility and the accuracy of this measurement and aid in the decision between tenotomy or revision of the acetabular component. Level of evidence III, in vitro study comparing diagnostic tools.

Descending necrotising mediastinitis (DNM) is an uncommon clinical entity which may arise secondary to primary odontogenic or neck infection in susceptible patients. Infection may spread contiguously via the alar or ’danger' space, a potential anatomical space posterior to the true retropharyngeal space.(1) Spread of infection to the mediastinum almost always necessitates urgent cardiothoracic surgical intervention.(2–4) This case report describes a male patient whose clinical deterioration following the diagnosis of submandibular abscess was investigated with CT imaging of the chest, where a diagnosis of DNM was made. Diagnosis was confirmed following surgical intervention and aspiration of pus from the mediastinum.

Context:Familial hypobetalipoproteinemia (FHBL) is a codominant disorder of lipoprotein metabolism characterized by decreased plasma concentrations of low-density lipoprotein (LDL)-cholesterol and apolipoprotein B (apoB).Objective:The objective was to examine the effect of heterozygous APOB L343V FHBL on postprandial triglyceride-rich lipoprotein (TRL) and fasting lipoprotein metabolism.Methods:Plasma incremental area under the curve apoB-48 and apoB-48 kinetics were determined after ingestion of a standardized oral fat load using compartmental modeling. Very low-density lipoprotein (VLDL)-, intermediate-density lipoprotein (IDL)-, and LDL-apoB kinetics were determined in the fasting state using stable isotope methods and compartmental modeling.Results:The postprandial incremental area under the curve (0–10 h) in FHBL subjects (n = 3) was lower for large TRL-triglyceride (−77%; P < .0001), small TRL-cholesterol (−83%; P < .001), small TRL-triglyceride (−88%; P < .001), and for plasma triglyceride (−70%; P < .01) and apoB (−63%; P < .0001) compared with controls. Compartmental analysis showed that apoB-48 production was lower (−91%; P < .05) compared with controls. VLDL-apoB concentrations in FHBL subjects (n = 2) were lower by more than 75% compared with healthy, normolipidemic control subjects (P < .01). The VLDL-apoB fractional catabolic rate (FCR) was more than 5-fold higher in the FHBL subjects (P = .07). ApoB production rates and IDL- and LDL-apoB FCRs were not different between FHBL subjects and controls.Conclusions:We conclude that when compared to controls, APOB L343V FHBL heterozygotes show lower TRL production with normal postprandial TRL particle clearance. In contrast, VLDL-apoB production was normal, whereas the FCR was higher in heterozygotes compared with lean control subjects. These mechanisms account for the marked hypolipidemic state observed in these FHBL subjects.

Objective: Familial hypobetalipoproteinemia (FHBL) is characterized by mutations in APOB, the majority of these causing protein truncations, and low plasma levels of apolipoprotein (apo) B. The hypobetalipoproteinemia may be due to enhanced clearance and possibly reduced production of apoB-containing lipoproteins;the mechanism may depend on the length of the apoB truncation. We studied fasting lipoprotein metabolism in an FHBL subject heterozygous for a mutation causing a truncated apoB, apoB-80. Design and Methods: Very low density lipoprotein (VLDL)-, intermediate density lipoprotein (IDL)-, and low density lipoprotein (LDL)-apoB kinetics were determined in the fasting state using stable isotope methods and compartmental modeling. Results: Compared with lean normolipidemic controls the apoB-80 FHBL subject had an elevated VLDL-apoB fractional catabolic rate and lower LDL production. ApoB production rates and IDL- and LDL-apoB fractional catabolic rates were not different. Conclusion: FHBL subjects heterozygous for a mutation truncating apoB to 80% of full-length are able to produce VLDL-apoB normally, but have rapid clearance of these particles, resulting in low levels of circulating apoB. (C) 2016 The Canadian Society of Clinical Chemists. Published by ELSEVIER. All rights reserved.

Background and Purpose— Elevated concentrations of homocysteine are associated with cerebral small vessel disease (CSVD). b-vitamin supplementation with folate and vitamins b 12 and b 6 reduces homocysteine concentrations. In a substudy of the VITAmins TO Prevent Stroke (VITATOPS) trial, we assessed the hypothesis that the addition of once-daily supplements of b vitamins would reduce the progression of CSVD-related brain lesions. Methods— A total of 359 patients with recent stroke or transient ischemic attack, who were randomly allocated to double-blind treatment with placebo or b vitamins, underwent brain MRI at randomization and after 2 years of b-vitamin supplementation. MR images were analyzed blinded to treatment allocation. Outcomes related to the prespecified hypothesis were progression of white matter hyperintensities and incident lacunes. We also explored the effect of b-vitamin supplementation on the incidence of other ischemic abnormalities. Results— After 2 years of treatment with b vitamins or placebo, there was no significant difference in white matter hyperintensities volume change (0.08 vs 0.13cm 3 ; P =0.419) and incidence of lacunes (8.0% vs 5.9%, P =0.434; odds ratio=1.38). In a subanalysis of patients with MRI evidence of severe CSVD at baseline, b-vitamin supplementation was associated with a significant reduction in white matter hyperintensities volume change (0.3 vs 1.7cm 3 ; P =0.039). Conclusions— Daily b-vitamin supplementation for 2 years did not significantly reduce the progression of brain lesions resulting from presumed CSVD in all patients with recent stroke or transient ischemic attack but may do so in the subgroup of patients with recent stroke or transient ischemic attack and severe CSVD. Clinical Trial Registration— http://vitatops.highway1.com.au/ . Unique identifier: NCT00097669 and ISRCTN74743444.

We examined the association between cauda equina nerve root volume and sensory block height in 15 patients undergoing spinal anaesthesia with 0.5% glucose-free bupivacaine. Magnetic resonance imaging and a separate image segmentation program were used to calculate the volume of the nerve roots. Nerve root volume was also correlated with lumbosacral cerebrospinal fluid volume and with patients' physical characteristics. Nerve root volume correlated negatively with sensory block height (Spearman rho -0.61 (95% CI -0.85 to -0.14)) and body mass index (Spearman rho -0.66 (95% CI -0.87 to -0.24)) but positively with cerebrospinal fluid volume (Spearman rho 0.76 (95% CI 0.43-0.91)). Factors that are thought to influence cerebrospinal fluid volume, such as body mass index, might similarly affect the volume of the nerve roots. The size of the nerve roots may influence the spread of spinal anaesthesia.

Objectives This randomised controlled crossover trial examined the efficacy of botulinum toxin type A (BoNT-A) injection, plus an exercise programme, to remediate chronic anterior knee pain (AKP) associated with quadriceps muscle imbalance. Methods 24 individuals with refractory AKP received either BoNT-A (500 U Dysport) or the same volume saline injection to the vastus lateralis (VL) muscle and performed home exercises focusing on re-training the vastus medialis (VM) muscle. All subjects were offered open-label injection at 12 weeks. Knee-related disability (anterior knee pain scale; AKPS) and activity-induced pain (10 cm visual analogue scale) at 12 weeks were the primary outcomes. Peak isometric extensor force was recorded and normalised VL:VM ratios were derived from simultaneous surface electromyography. Selfreported pain and disability measures were collected at six time points to a mean of 20±8 months. Results 14 subjects received BoNT-A and 10 placebo injection. Improvement at 12 weeks was significantly greater for BoNT-A compared with placebo-injected subjects for the AKPS (p

Objective: To examine the association between the kinetics of very-low-density-lipoprotein (VLDL)-apolipoprotein B-100 (apoB) and intraperitoneal, retroperitoneal, subcutaneous abdominal, and total adipose tissue masses (IPATM, RPATM, SAATM, and TATM, respectively) in overweight/obese men. Research Methods and Procedures: Hepatic secretion of VLDL was measured using an intravenous infusion of 1-[13C]-leucine in 51 men with a wide range of body mass index (25.1 to 42.2 kg/m2). Isotopic enrichment of VLDL-apoB was measured using gas chromatography-mass spectrometry and a multicompartmental model used to estimate VLDL-apoB metabolic parameters. IPATM, RPATM, and SAATM (kilograms) were quantified between T11 and S1 using magnetic resonance imaging; TATM (kilograms) was determined using bioelectrical impedance. Insulin resistance was estimated by homeostasis model assessment (HOMA) score. Results: In stepwise regression, IPATM was the best predictor of hepatic secretion of VLDL-apoB (r = 0.390, p < 0.005) and TATM was the best predictor of VLDL-apoB fractional catabolic rate (r = 0.282, p < 0.05). IPATM remained significantly associated with VLDL-apoB secretion after adjusting for TATM or HOMA score (r = 0.360, p < 0.01 and r = 0.310, p < 0.05, respectively). This association was also independent of age, dietary intake, and body mass index. None of the fat compartments were significantly associated with the fractional catabolic rate of VLDL-apoB after adjusting for HOMA score. Discussion: In overweight/obese men, the quantity of both IPATM and TATM determine the kinetics of VLDL-apoB. The effect of IPATM on VLDL-apoB secretion is independent of both total fat mass and the degree of insulin resistance.

Some previously immunodeficient HIV patients responding to antiretroviral therapy display poor recovery of CD4+ T cells. Evaluation of the contribution of thymic function requires sensitive detection and quantitation of metabolically active thymic tissue. We describe patients with low but detectable

There are limited data detailing the pattern of age and gender-related changes to the thoracic vertebral bodies and intervertebral discs. A retrospective MR investigation, involving T1-weighted midsagittal images from 169 cases, was undertaken to examine age influences on the anterior wedge (anteroposterior height ratio or Ha/Hp), biconcavity (midposterior height ratio or Hm/Hp), and compression indices (posterior height/anteroposterior diameter or Hp/D) of the thoracic vertebral bodies. Disc degenerative changes in the annulus, nucleus, end-plate and disc margin were noted on T2-weighted sagittal images for the 169 cases, based on a 3-level grading system. A linear age-related decline in the Ha/Hp and Hm/Hp indices was noted. The Hp/D index increased during the first few decades of life, then decreased gradually thereafter. The prevalence of abnormal findings in the annuli, nuclei and disc margins increased with increasing age, particularly in the mid and lower thoracic discs. Greater disc degenerative changes were observed in males. These findings provide further insight into the nature of thoracic vertebral shape changes across the lifespan, and the typical patterns of degeneration of the thoracic intervertebral discs.

We aimed to examine the effect of genetic poly- morphisms of apolipoprotein B-100 (apoB) signal peptide and apolipoprotein E (apoE) on the hepatic secretion of very low density lipoprotein (VLDL) apoB in 29 men with visceral obesity. We studied apoB secretion using a primed (1 mg/kg), constant (1 mg/kg/h) intravenous infusion of (1- 13 C)leucine. The isotopic enrichment of VLDL apoB was determined using gas chromatography-mass spectrometry (GCMS). A multi-compartmental model was used to esti- mate the fractional turnover rate of VLDL apoB. Genotypes for the apoB signal peptide length polymorphism, 27 amino acid (SP27) and 24 amino acid (SP24), and apoE genotypes were determined using polymerase chain reaction. In sub- jects who were not apoE2 carriers and were homozygous for the SP27 of the apoB signal peptide, the hepatic secretion of VLDL apoB was significantly higher than in subjects who were not apoE2 carriers and were either heterozygous or homozygous for the SP24 allele (31.3 6 11.8 mg/kg fat-free mass/day, n 5 8 vs. 16.9 6 12.2 mg/kg fat-free mass/day, n 5 13, P 5 0.01). In subjects who were not apoE4 carriers and were either heterozygous or homozygous for the apoB SP24 allele, the hepatic secretion of VLDL apoB was significantly lower than in subjects who were not apoE4 carriers and were homozygous for the SP27 allele (15.8 6 12.9 mg/kg fat-free mass/day, n 5 13 vs. 27.4 6 11.5 mg/kg fat-free mass/day, n 5 7, P 5 0.03). The data suggest that in men with visceral obesity, the apoB signal peptide and apoE gen- otypes appear to be involved in the hepatic secretion of apoB.— Riches, F. M., G. F. Watts, F. M. van Bockxmeer, J. Hua, S. Song, S. E. Humphries, and P. J. Talmud. Apolipo- protein B signal peptide and apolipoprotein E genotypes as determinants of the hepatic secretion of VLDL apoB in obese men. J. Lipid Res. 1998. 39: 1752-1758.

Some previously immunodeficient HIV patients responding to antiretroviral therapy display poor recovery of CD4⁺ T cells. Evaluation of the contribution of thymic function requires sensitive detection and quantitation of metabolically active thymic tissue. We describe patients with low but detectable thymopoiesis assessed as circulating CD4⁺ naive T cells expressing CD31. High-resolution computed tomography and PET scans found no residual thymic tissue even though metabolic activity was demonstrable by PET in lymph nodes.

The editorial by Wallin and Fladby highlights the clinical importance of white matter hyperintensities on magnetic resonance imaging as a marker of small vessel disease in elderly people.1 Prevalence ranges from 11-21% at age 64 …

The 3-D skeletal images obtained from reconstruction of CT scans and X-rays, and soft-tissue images produced by MRI, provide invaluable information of the internal and gross anatomy of the north-western marsupial mole (Notoryetes caurinus). The conical skull, which is quite thin-walled dorsally and anteriorly but strong in the basicranial region, has little evidence of the orbit or zygomatic arch, and the smoothly-curved posterior region has no sagittal or occipital crests. The vertebral column is remarkably strengthened, and in lateral view has an unusual flat-shape. The cervical vertebrae appear to be greatly compressed; 4 or 5 are completely fused (which is unique among marsupials). The thoracic vertebrae are fairly robust with large neural spines. The lumbar vertebrae are distinct, becoming large posteriorly towards the pelvis. The sacral vertebrae are greatly expanded in size and are fused with the pelvis. Particularly in the middle of the tail, the caudal vertebrae are greatly developed, with large transverse processes and chevron bones. The pectoral girdle is very anterior, with the shoulder articulation level with the anterior cervical vertebrae just behind the skull, and low on the side of the body. The humerus is robust, and the radius and ulna are very short. The bones of the pelvis are highly derived, and fused to sacral vertebrae. The epipubic bones are small and not ossified. An ossified patella is present and it has an unusual large triangular keel. The most apparent soft-tissue structure by MRI is a large amount of subcutaneous fat, particularly around the ventral surface of the pelvis but also dorsal to the pelvis and anteriorly around the shoulders. The major muscle groups are visible, but distinction between individual muscles is not possible except for the very large muscles of the thigh, upper arm and base of the tail. The muscles of the tail are strongly developed, more so ventrally than dorsally.