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Purpose: To evaluate the benefit of CEUS (contrast enhanced ultrasound) regarding depiction of ischaemic lesions and AVFs (arterio venous fistula) in renal transplants compared to standard ultrasound (US) (grey-scale and color Doppler). Materials and methods: In this study 22 patients suspected of having acute vascular complication after renal transplantation were investigated using standard ultrasound (grey-scale US and color Doppler US) and CEUS, respectively. Validity of the respective US-techniques regarding depiction of ischaemic lesions and AVF was compared. Dynamic CTA (computed tomography angiography) served as the standard of reference. Results: In 10 renal transplants arterial embolism associated with kidney infarctions were observed. Very good correlation to dynamic CTA was yielded using CEUS, whereas grey scale US and color Doppler US was limited in the accurate depiction of renal infarctions. Additionally CEUS was superior in displaying arteriovenous fistulas compared to standard US. Conclusion: CEUS as a fast and bedside available imaging modality not associated with dose exposure or renal toxicity facilitates improved detection of ischaemic lesions and AVFs compared to standard US and thus should be considered for short term follow up of renal transplants. [ABSTRACT FROM AUTHOR]

Background: Coronary calcification is a well-established risk factor for cardiovascular events. This retrospective study sought to determine the predictive value of coronary calcification in a specific group of patients with chronic kidney disease., Methods: We included 1094 asymptomatic patients (724 males, 370 females, age 62 ± 9.3 years) referred for cardiological examination. Patents were divided into two groups depending on their renal function. Coronary calcification was determined with a multi-slice computer tomography (CT) scanner. For quantification of coronary calcification the Agatston score was calculated. Over a mean follow up period of 6.2 ± 1.3 years we observed the rate of cardiovascular events (185 events, 61 myocardial infarctions, 103 revascularizations, 21 cardiac deaths)., Results: The calcium score was significantly higher in patients with severe kidney disease (glomerular filtration rate (GFR) ≤30 mL/min/1.72 m 2 ) compared with those with normal to moderate reduced renal function (GFR ≥30 mL/min/1.72 m 2 ) (207 ± 190 vs .121 ± 169, p ≤ 0.001). The event rate in patients with severe impaired renal function was significantly higher compared to patients with normal to moderate reduced renal function (20.6% vs . 14.8%, p = 0.0001). The hazard ratio for cardiovascular events increased constantly with the calcium score in both groups. The hazard ratio in patients with severe kidney disease was significantly lower compared to patients in corresponding groups with regular to moderate reduced renal function (7.3 vs . 9.3, p = 0.01). No cardiac events were observed in patients with a calcium score of 0., Conclusions: We could demonstrate that risk prediction with the calcium score is possible in patients with severe chronic kidney disease even if the calcium score overestimates the risk for future cardiovascular events compared to patients with normal to moderate reduced renal function., Competing Interests: The authors declare no conflict of interest., (Copyright: © 2024 The Author(s). Published by IMR Press.)

Objectives  To evaluate the intra- and inter-observer measurement variability of an existing osteoarthritis (OA) stifle scoring system. Methods  Paired caudocranial and mediolateral canine stifle radiographs were selected randomly. A total of 15 assessment points were evaluated independently and graded twice (integer numeric scale: 1-4) at an interval of 2 weeks by three observers with different levels of experience. The grades for each of the 15 factors were summed to obtain the OA score for each patient. Results  The 15 independent assessment points measured by the three observers showed high reproducibility and low intra-observer variability. Inter-observer variability was also low (mean: 1.09 ± 4.99, 95% CI [confidence interval]: -0.35 to 2.55). The most discordant ratings among the three observers involved sesamoid bones of gastrocnemius muscle (assessment point 11 of 15) and popliteal surface of femur (assessment point 10 of 15). Clinical Significance  A validated and feasible OA scoring method is prerequisite for reliable radiographic assessment of OA progression. The low overall inter- and intra-observer variabilities among the 15 independent measures of the OA scoring system presented herein support its feasibility for application in clinical practice as an objective tool for radiographic scoring of stifle OA., Competing Interests: Conflict of Interest: The authors do not have any potential conflicts of interest to declare., (Schattauer GmbH Stuttgart.)

Objectives The aim of this study was to examine histologically intact and ruptured cranial cruciate ligaments in cats, in order to evaluate whether degeneration is a prerequisite for rupture. Methods We performed a histological examination of 50 intact and 19 ruptured cranial cruciate ligaments in cadaver or client-owned cats, respectively, using light microscopy. Cats with stifle pathology were further divided into five age groups in order to investigate the relationship of changes in the ligament with lifespan. Cats with ruptured cranial cruciate ligaments were divided into two groups according to medical history (with presumed history of trauma or without any known history of trauma) in order to investigate the relationship of ligament rupture with a traumatic event. Data from 200 healthy cats were selected randomly and reviewed to make a statistical comparison of cats with and without cranial cruciate ligament rupture (reference group). Results On histological examination, the intact cranial cruciate ligaments showed basic parallel arrangement of the collagen fibres, with no relation to age. While cats of a more advanced age showed fibrocartilage in the middle of the cranial cruciate ligament - a likely physiological reaction to compression forces over the lifespan - degenerative changes within the fibrocartilage were absent in all cases, regardless of age or rupture status. Cats suffering from cranial cruciate ligament rupture without history of trauma were significantly older than cats in the reference group. Conclusions and relevance This study showed that differentiation of fibrocartilage in the middle of the cranial cruciate ligament is likely a physiological reaction to compressive forces and not a degenerative change associated with greater risk of rupture in advanced age. This finding in cats is distinct from the known decrease in differentiation of fibrocartilage in dogs with cranial cruciate ligament rupture. Furthermore, the histological examination of cats revealed no other signs of degeneration in the cranial cruciate ligaments. Thus, degeneration is likely not an aetiological factor for cranial cruciate ligament rupture in cats.

Objective : The purpose of this study was to evaluate the perceived effectiveness and learning potential of 3 Web-based educational methods in a postgraduate radiology setting. Methods : Three chiropractic radiology faculty from diverse geographic locations led mini-courses using asynchronous discussion boards, synchronous Web conferencing, and asynchronous voice-over case presentations formatted for Web viewing. At the conclusion of each course, participants filled out a 14-question survey (using a 5-point Likert scale) designed to evaluate the effectiveness of each method in achieving specified course objectives and goals and their satisfaction when considering the learning potential of each method. The mean, standard deviation, and percentage agreements were tabulated. Results : Twenty, 15, and 10 participants completed the discussion board, Web conferencing, and case presentation surveys, respectively. All educational methods demonstrated a high level of agreement regarding the course objective (total mean rating >4.1). The case presentations had the highest overall rating for achieving the course goals; however, all but one method still had total mean ratings >4.0 and overall agreement levels of 70%-100%. The strongest potential for interactive learning was found with Web conferencing and discussion boards, while case presentations rated very low in this regard. Conclusions : The perceived effectiveness in achieving the course objective and goals was high for each method. Residency-based distance education may be a beneficial adjunct to current methods of training, allowing for international collaboration. When considering all aspects tested, there does not appear to be a clear advantage to any one method. Utilizing various methods may be most appropriate.

Introduction: Neutrophil gelatinase-associated lipocalin (NGAL) is a powerful biomarker for the early detection of acute kidney injury. However, recent data suggest that NGAL also plays an important role in chronic kidney disease (CKD), reflecting the level of acute kidney damage within the CKD condition. To study whether elevated NGAL levels in CKD are a consequence of damaged tubular cells or rather due to extrarenal production, we investigated NGAL levels in anephric patients on dialysis., Methods: Plasma NGAL levels were investigated in 14 dialysis patients who underwent bilateral nephrectomy (anephric group), 18 anuric dialysis patients with remaining kidneys (dialysis group) and 12 healthy patients (healthy group)., Results: Plasma NGAL levels were significantly lower in the healthy group compared with the anephric group (143 vs. 981 ng/mL; P < 0·001) or the dialysis group (143 vs. 838 ng/mL; P < 0·001), respectively. However, NGAL levels did not differ between the anephric group and the dialysis group (981 vs. 838 ng/mL; P = 0·19)., Discussion: Assuming that NGAL is highly expressed in chronically damaged kidneys due to tubular stress, there should be significantly less NGAL in anephric patients compared with anuric dialysis patients with remaining kidneys. In contrast to this hypothesis, we found no difference in NGAL expression between these two groups, proving the entire extrarenal NGAL production in anephric patients and suggesting that the tubular NGAL expression seems to be negligible in anuric dialysis patients., (© 2013 Stichting European Society for Clinical Investigation Journal Foundation. Published by John Wiley & Sons Ltd.)

Background/aims: Transcatheter aortic valve implantation (TAVI) has emerged as a new therapeutic option for high-risk patients. However, dialysis patients were excluded from all previous studies. The aim of this study is to compare the outcomes of TAVI for dialysis patients with those for patients with chronic kidney disease (CKD) stages 3 and 4 and to compare TAVI with open surgery in dialysis patients., Methods: Part I: comparison of 10 patients on chronic hemodialysis with 116 patients with non-dialysis-dependent CKD undergoing TAVI. Part II: comparison of transcatheter (n = 15) with open surgical (n = 24) aortic valve replacement in dialysis patients., Results: Part I: dialysis patients were significantly younger (72.3 vs. 82.0 years; p < 0.01). Hospital stay was significantly longer in dialysis patients (21.8 vs. 12.1 days; p = 0.01). Overall 30-day mortality was 3.17%, with no deaths among dialysis patients. Six-month survival rates were similar (log-rank p = 0.935). Part II: patient age was comparable (66.5 vs. 69.5 years; p = 0.42). Patients in the surgical group tended to stay longer in hospital than TAVI patients (29.5 vs. 22.5 days; p = 0.35)., Conclusion: TAVI is a safe procedure in patients on chronic hemodialysis. Until new data become available, we find no compelling reason to refuse these patients TAVI., (Copyright © 2012 S. Karger AG, Basel.)

Objective: To present the phenomenon of growth restart lines and create awareness of the possible differential diagnoses., Clinical Features: Two case reports outlining the presentation of growth restart lines found in the vertebrae of trampolinists. Emphasis in each case is placed on correlating the patient history with radiographic findings., Intervention and Outcome: In both cases a conservative chiropractic treatment plan was initiated once the differential diagnoses could be ruled out., Conclusion: Although the range of etiologies of growth restart lines is extensive, these case reports illustrate the importance of a comprehensive case history when presented with the radiographic finding of growth restart lines.

Objectives: To determine the feasibility of a dynamic CT angiography-protocol in regard to simultaneous assessment of morphology and function., Method and Materials: Fourteen patients with renal graft dysfunction received a dynamic computed tomography angiography (CTA) using a 128-slice CT-scanner with continuous bi-directional table movement, allowing to cover a scan range of 18 cm within 1.75 seconds. Twelve scans of the entire kidney were acquired every 3.5 seconds with the aim to simultaneously obtain CTA and renal function data. The glomerular filtration rate (GFR) was calculated by a modified Patlak method and compared with creatinine-based formulas (MDRD 4 and endogenous creatinine clearance), that served as reference standard., Results: GFR obtained from dynamic CTA correlates well with the GFR derived by creatinine-based formulas with a correlation coefficient of r = 0.8986; P < 0.0001. The average absolute deviation was 8.1 mL/min. The mean amount of contrast medium required was 35 mL. The average effective dose was 13.8 mSv., Conclusion: Dynamic CTA offers the possibility to determine the GFR and thus facilitates simultaneous assessment of morphology and function. Additionally, our dynamic CTA-protocol helps to significantly reduce the amount of contrast medium, which is beneficial for patients with impaired renal function.

History and Clinical Findings: A 26-year-old woman with no contributory medical history became anuric after several days of nausea and vomiting. She was admitted to our hospital with suspected acute renal failure., Investigations: Laboratory tests revealed greatly elevated BUN and creatinine. There was no evidence of postrenal obstruction, infection or systemic disease. Kidney biopsy showed interstitial nephritis., Diagnosis, Therapy and Clinical Course: Further questioning revealed poisoning with a nephrotoxic mushroom of the genus Cortinarius, which the patient had eaten together with her husband nine days before admission. The patient's husband developed anuric renal failure, too, and was admitted to our hospital. Hemodialysis was instituted on day 1. More than one year later, both patients remain on chronic dialysis., Conclusions: Intoxication with mushrooms of the genus Cortinarius should be considered in the differential diagnosis of otherwise unexplained acute renal failure, especially in autumn and late summer. These mushrooms can cause an interstitial nephritis. Once dialysis has to be instituted the prognosis is rather poor: 50 % of these patients develop chronic renal failure. So far there is no causative therapy. In case of chronic renal failure, kidney transplantation is possible.

Tandem affinity purification (TAP) and mass spectrometric peptide sequencing showed that the DEAD-box RNA helicase RHII/Gu is a functional interaction partner of c-Jun in human cells. The N-terminal transcription activation region of, c-Jun interacts with a C-terminal domain of RHII/Gu. This interaction is stimulated by anisomycin treatment in a manner that is concurrent with, but independent of, c-Jun phosphorylation. A possible explanation for this effect is provided by the observation that RHII/Gu translocates from nucleolus to nucleoplasm upon anisomycin or UV treatment or when JNK signaling is activated by overexpression of a constitutively active form of MEKK1 kinase. Several experiments show that the RNA helicase activity of RHII/Gu supports c-Jun-mediated target gene activation: dominant-negative forms of RHII/Gu, as well as a neutralizing antibody against the enzyme, significantly interfered with c-Jun target gene activity but not with transcription in general. These findings clarify the mechanism of c-Jun-mediated transcriptional regulation, and provide evidence for an involvement of RHII/Gu in stress response and in RNA polymerase II-catalyzed transcription in mammalian cells.

The time constant of the left ventricular isovolumic pressure decline (Tc) was determined according to the Weiss equation in 23 patients with chest pain who underwent cardiac catheterization. Out of them 15 patients had significant coronary artery stenosis (CAD). Tc was compared to 21 diastolic Doppler data derived from the transmitral inflow. We could predict the Tc from Doppler data using a stepwise multiple regression model, Tc = (0.072 x A-Vpeak)-(0.387 x A-dect)-(0.137 x E-dect) + 0.050 (r = 0.7493, p < 0.0011 SEE = 0.007 All Doppler data and the predicted Tc were examined among the CAD and the healthy groups, the predicted Tc and E/A ratio indicated the best discriminant functions.

The authors examined the left ventricular diastolic function at rest and in pain-free period in patients with chest pain but without previous myocardial infarction. Two patient group were formed according to the results of coronarography: 15 patients had significant coronary artery stenosis, while the coronarography was negative in case of 11 patients. Four Doppler echocardiographic parameters were taken and their sensitivity, specificity, positive and negative predictive values were determined on the base of the result of the coronarography. The small number of patients allows only preliminary evaluation but the results suggest that the altered diastolic function enhances the probability of the presence of significant coronary artery disease, while a normal diastolic function decreases its probability.

The systolic and diastolic functions were examined using digitized M-mode and Doppler echocardiography in 27 patients with previous myocardial infarction and in 20 healthy subjects. Both methods separated well the patients from the control group but their difference was significantly greater when the ventricular function was assessed with Doppler parametres, digitized M-mode and Doppler echocardiographical results were controlled for possible correlations, but only time intervals showed significant correlations. The highest correlation was found between the values for isovolumic relaxation period. The authors conclude that Doppler echocardiography is to be preferred as a method for assessing the systolic and diastolic functions of the left ventricle.

A detoxified substance (rdLPS) was produced from Haemophilus influenzae endotoxin by ionizing radiation and its capacity to prevent attacks of dyspnoea elicited by endotoxin inhalation in mice has been studied. The rdLPS proved to be an effective stimulant of aspecific immune resistance of mice but it could only partly prevent attacks of dyspnoea.

A single injection of Bordetella pertussis vaccine, applied intraperitoneally one day before intracerebral lymphocytic choriomeningitis virus infection depressed the immune response both in conventional and germfree adult mice, but the rate of the immunosuppressive effect differed. In adult mice with a normal immune system the vaccine only delayed the manifestation of fatal lymphocytic choriomeningitis, while it prevented its development in germfree mice with an underdeveloped lymphoid system, i.e. it inhibited the cellular immune response to the virus infection.

The diastolic function of 25 patients with ischemic heart disease was studied by both digitized M-mode and Doppler echocardiography. The control groups were a group of healthy subjects and patients with hypertension, resp. There was a significant difference in the diastolic parametres of the healthy and the diseased groups. The altered diastolic function of the latter showed, however, little variation. A new complex diastolic index was formed from the parametres involved in Doppler and M-mode echocardiography. It contains early and late diastolic filling rates, the isovolumic relaxation period, and the diametric change of the left ventricle during the isovolumic relaxation period. This index allowed us to separate the altered diastolic functions of patients with ischemic heart disease from those with left ventricular hypertrophy.

Germfree and conventional mice responded similarly to pertussis vaccine treatment. In both groups, lymphocytosis and splenomegaly developed in a similar proportion. The formalin stress reaction of germfree and conventional mice with hypertrophic lymphoid organs induced by pertussis vaccine differed from that of untreated mice: the treated germfree and conventional mice showed a acute increase of lymphocytosis without an significant change in splenomegaly.

Aging mice treated with radio-detoxified endotoxin and subsequently inoculated intracerebrally with lymphocytic choriomeningitis (LCM) virus died earlier and in a higher rate than the virus infected and otherwise untreated controls. Thus, in mice with insufficient T lymphocyte function due to aging, the radio-detoxified endotoxin pretreatment contributed to the outcome of LCM virus infection in the form of lethal meningitis. That indicates a stimulatory effect on the reduced cellular immunological reaction to the virus infection.

Death occurred earlier and its rate was higher in suckling mice treated with parent or radio-detoxified endotoxin and subsequently inoculated intracerebrally with lymphocytic choriomeningitis (LCM) virus than in their virus infected but untreated control littermates. Thus, in suckling mice both the parent and the radio-detoxified endotoxin pretreatment contributed to the outcome of LCM virus infection in the form of lethal meningitis indicating its increasing effect on the cellular immunological reaction to the virus infection.

A single injection of 15 mg/kg dianhydrodulcitol caused death at a higher proportion of germfree, specific pathogen free, and conventional mice with lymphocytosis and spleen hypertrophy induced by Bordetella pertussis vaccine pretreatment, than of unvaccinated controls.

The cellular immune response to lymphocytic choriomeningitis virus infection was found to be normal in 6-month-old mice with physiological thymus involution, while it was reduced in 18-month-old mice. The Bordetella pertussis vaccine elicited immunosuppression in 6-month-old mice with normal immunological responsiveness, while it failed to affect the physiologically diminished cellular immune response in 18-month-old mice. The extent of immunosuppression elicited by the vaccine changed parallel to its concomitant spleen hypertrophy inducing effect.

A 18 mg/kg dose of dianhydrodulcitol, a lymphotropic cytostatic agent produced the same death rate among germfree as a 12 mg/kg dose did in conventional mice. Pretreatment with the same dose of an irradiated immunomodulatory endotoxin preparation had increased the sensitivity to these dianhydrodulcitol doses in the same degree in germfree as in conventional mice. A study of the lymphoid organs and the intestinal wall indicate that both in germfree and conventional mice the dianhydrodulcitol sensitivity increasing effect of the endotoxin preparation was due to its stimulation of the lymphoid system. The higher resistance of germfree mice to dianhydrodulcitol is ascribed to their lack of a normal intestinal flora.