The conundrum of neuropsychiatric systemic lupus erythematosus: Current and novel approaches to diagnosis.

Recognising neuropsychiatric involvement by systemic lupus erythematosus (SLE) is of growing importance, however many barriers to this exist at multiple levels of our currently available diagnostic algorithms that may ultimately delay its diagnosis and subsequent treatment. The heterogeneous and non-specific clinical syndromes, serological and cerebrospinal fluid (CSF) markers and neuroimaging findings that often do not mirror disease activity, highlight important research gaps in the diagnosis of neuropsychiatric SLE (NPSLE). Formal neuropsychological assessments or the more accessible screening metrics may also help improve objective recognition of cognitive or mood disorders.

Comparison between viral vector and mRNA based COVID-19 vaccination in prevalence and severity of regional immune reactions, and F-FDG PET/CT features.

Objectives: The coronavirus pandemic caused by SARS-CoV-2 commenced in late 2019, and global wide vaccination appears to be the only reasonable solution to fight this dreadful virus. There are two main types of COVID-19 immunization using viral vector and mRNA-based vaccines. However, the impact of each of type on F-FDG PET/CT needs to be accurately assessed.

How unmeasured muscle mass affects estimated GFR and diagnostic inaccuracy.

Background: Estimated glomerular filtration (eGFR) results based on serum creatinine are frequently inaccurate with differences against measured GFR (mGFR) often attributed to unmeasured non-functional factors, such as muscle mass.

Methods: The influence of muscle mass (measured by dual-energy x-ray absorptiometry, DEXA) on eGFR error (eGFR-mGFR) was evaluated using isotopic mGFR (Tc DTPA plasma clearance) in 137 kidney transplant recipients. Serum creatinine was measured by isotopic-calibrated enzymatic analysis, converted to eGFR using Chronic Kidney Disease EPIdemiology (CKD-EPI) formula, then unindexed from body surface area.

Positional ischaemia of transplant kidney: A rare cause of early graft dysfunction.

Kinking of the kidney transplant vessels late after the operation is a rare complication that can lead to significant morbidity and mortality. We present a case of positional ischemia of the renal allograft resulting from dynamic and positional kinking of the graft vasculature, which was diagnosed by ultrasonography with the patient standing. The graft was repositioned into the sub-rectus pocket and the ischaemic injury resolved.

Multicentre, randomised, blinded, control trial of drug-eluting balloon vs Sham in recurrent native dialysis fistula stenoses.

Background: Endovascular treatment of autogenous arteriovenous haemodialysis fistula stenosis has high reintervention rates. We investigate the effect of drug-eluting balloons in the treatment of recurrent haemodialysis fistula stenosis.

Methods: This is a randomised, controlled, investigator-initiated and run, prospective, blinded, multicentre trial.

Capturing tumor complexity in vitro: Comparative analysis of 2D and 3D tumor models for drug discovery.

Two-dimensional (2D) cell cultures growing on plastic do not recapitulate the three dimensional (3D) architecture and complexity of human tumors. More representative models are required for drug discovery and validation. Here, 2D culture and 3D mono- and stromal co-culture models of increasing complexity have been established and cross-comparisons made using three standard cell carcinoma lines: MCF7, LNCaP, NCI-H1437.

Intravascular metastatic melanoma: a difficult diagnosis.

Melanoma is a common cancer with the potential for widespread metastasis; however intravascular metastasis is extremely rare. We report an unusual case of a patient with metastatic melanoma in whom (18) F-fluorodeoxyglucose positron emission tomography-computed tomography (FDG PET-CT) demonstrated an intravascular melanoma metastasis in the superior vena cava (SVC), successfully treated with external beam radiotherapy. To our knowledge, this is the first reported case where FDG PET-CT was used to make this diagnosis.

Defining a significant stenosis in an autologous radio-cephalic arteriovenous fistula for hemodialysis.

The current definition of a significant stenosis in an autologous arteriovenous fistula (aAVF), the percentage narrowing compared with the adjacent "normal" vessel, is inaccurate. We believe a significant stenosis in the aAVF is an absolute minimal luminal diameter determined by the requirements of the hemodialysis pump. To determine what absolute diameter constitutes a hemodynamically significant stenosis in a radio-cephalic autologous arteriovenous fistula (RC aAVF), the minimal luminal diameter of dysfunctional RC aAVF was compared to that of functional RC aAVF using grayscale and color ultrasound.

Colour duplex ultrasound accurately identifies focal stenoses in dysfunctional autogenous arteriovenous fistulae.

Aims: The aims of this study is to correlate colour duplex ultrasonography (US) with contrast fistulography for the detection of functional stenoses in the autogenous AVF (arterio-venous fistula) circuit.

Methodology: Colour duplex US scans of 93 dialysis patients with dysfunctional AVF were compared with fistulograms performed within 6 weeks of the US. The AVF circuit was divided into six zones: inflow artery; anastomosis; distal vein; mid vein; proximal vein; and central vein.

Ventilation-perfusion mismatch resulting from iatrogenic pulmonary vein stenosis after radiofrequency ablation: a case report.

A lobar ventilation-perfusion mismatch is reported in a patient with right superior pulmonary vein stenosis, developing after radiofrequency ablation for atrial fibrillation. Radionuclide lung perfusion tomography was performed to assist with clinical management. Serial planar lung scintigraphy demonstrated no improvement in the perfusion abnormality despite interventional stenting.

The fourth molybdenum containing enzyme mARC: cloning and involvement in the activation of N-hydroxylated prodrugs.

The recently discovered mammalian molybdoprotein mARC1 is capable of reducing N-hydroxylated compounds. Upon reconstitution with cytochrome b(5) and b(5) reductase, benzamidoxime, pentamidine, and diminazene amidoximes, N-hydroxymelagatran, guanoxabenz, and N-hydroxydebrisoquine are efficiently reduced. These substances are amidoxime/N-hydroxyguanidine prodrugs, leading to improved bioavailability compared to the active amidines/guanidines.

Impaired glycosylation and cutis laxa caused by mutations in the vesicular H+-ATPase subunit ATP6V0A2.

We identified loss-of-function mutations in ATP6V0A2, encoding the a2 subunit of the V-type H+ ATPase, in several families with autosomal recessive cutis laxa type II or wrinkly skin syndrome. The mutations result in abnormal glycosylation of serum proteins (CDG-II) and cause an impairment of Golgi trafficking in fibroblasts from affected individuals. These results indicate that the a2 subunit of the proton pump has an important role in Golgi function.

Sonographic appearance of a postpartum pyomyoma with gas production.

Pyomyoma or suppurative leiomyoma is a potentially fatal complication of uterine leiomyomas. It is a rare condition with only a small number of reported cases since the era of antibiotics, and the descriptions of its sonographic appearance has been limited. We present a case of a pyomyoma associated with gas production, including a brief review of the reported sonographic features.

Doppler sonography in the diagnosis of round ligament varicosities during pregnancy.

Round ligament varicosities during pregnancy are an important differential diagnosis of complicated inguinal hernias and have been reported only rarely. Diagnosis is reassuring and may prevent unnecessary surgical exploration. We describe a case of round ligament varicosities presenting during pregnancy that was readily diagnosed with Doppler sonography.

Neonatal fungal ventriculitis.

Intracranial fungal infection is increasingly seen in the neonatal intensive care setting, with premature infants at greatest risk. We report a case of fungal ventriculitis in an extremely low birth weight neonate due to Candida species. Cranial sonographic examination revealed extensive ventricular stranding with complete resolution in response to therapy.

Primary sclerosing cholangitis: correlation of hepatobiliary scintigraphy with clinical and laboratory status.

The aim of this study was to determine whether hepatobiliary scintigraphy using (99m)technetium based di-isopropryl-imino-diacetic acid correlated to clinical or laboratory status of patients with primary sclerosing cholangitis (PSC). We carried out a retrospective case-control study involving 15 patients with proven PSC. Fifty-seven hepatobiliary scintigraphic studies were reviewed by consensus of two experienced observers using a semiquantitative scheme to score liver size and degree of radiopharmaceutical uptake, intrahepatic or extrahepatic biliary stasis, segmental liver clearance half-times and gall bladder visualization.

In vivo production of artificial nonribosomal peptide products in the heterologous host Escherichia coli.

Nonribosomal peptide synthetases represent the enzymatic assembly lines for the biosynthesis of pharmacologically relevant natural peptides, e.g., cyclosporine, vancomycin, and penicillin.

Oral cyclosporine but not tacrolimus reduces renal transplant blood flow.

Background: Calcineurin inhibitors are important immunosuppressive agents, but cause nephrotoxicity.

Methods: Instantaneous intra-renal transplant hemodynamics were assessed in 22 patients using quantitative cineloop color Doppler imaging after dosing with microemulsion cyclosporine (CSA) or tacrolimus (TAC).

Results: CSA dosing resulted in renal hypoperfusion, with a mean relative reduction of 43%+/-20% (range 22-76%) in maximal fractional area (MFA) of color pixels to nadir, compared to baseline.

Detection of chronic allograft nephropathy by quantitative doppler imaging.

Background: Chronic allograft nephropathy (CAN) is the major cause of graft loss, and early detection is desirable to avoid irreversible graft damage. We have evaluated a new technique of color Doppler quantification using Cineloop (Philips Medical Systems, Bothell, WA) imaging for noninvasive diagnosis of CAN.

Methods: Provisional normal ranges were defined by pilot study (n=13) and prospectively tested in stable recipients in whom CAN was independently quantified by contemporaneous histology (n=67), using the Banff schema.

Technique of color Doppler quantification of vascularity in transplanted kidneys.

A new technique for the quantification of vascularity based on the analysis of color Doppler images is described. We utilized velocity information obtained directly from cineloops transferred to a computer for off-line analysis. This methodology was used in transplanted kidneys to assess parenchymal vascularity on the basis of percentage color pixel density and mean flow velocity in mid-kidney cross-sectional regions of interest and the distance from the most peripheral color pixels to the capsule of the kidney.

The incidence of left iliac fossa uptake of (99m)Tc-DTPA in renal scanning.

In rare cases, extrarenal uptake of technetium-99m diethylenetriamine penta-acetic acid ((99m)Tc-DTPA) has been reported, e.g. in tumours or abscesses.

Postural renal transplant obstruction: a case report and review of the literature.

A 48-year-old woman underwent cadaveric renal transplantation for end-stage renal failure secondary to polycystic kidney disease. Nine months after transplantation, intermittent renal dysfunction and severe graft hydronephrosis developed despite the presence of a ureteric stent. A Tc-99m MAG3 scan performed with the patient standing showed complete transplant obstruction.

Diagnosis of kidney transplant obstruction using Mag3 diuretic renography.

Kidney transplant obstruction (KTO) following renal transplantation remains an important reversible cause of allograft dysfunction, requiring prompt diagnosis to prevent long-term graft damage. Although ultrasound can accurately diagnose renal transplant hydronephrosis, it cannot be used to assess its functional significance. We prospectively assessed the utility of technetium-99m mercaptoacetyltriglycine (Tc99m MAG3) diuretic renography for the diagnosis of allograft KTO, using standard visual and quantitative parameters, as well as calculated renal output efficiency (OE), which has been postulated to improve diagnostic yield.