A prospective randomized trial of fk506 versus cyclosporine after human pulmonary transplantation

We have conducted a unique prospective randomized study to compare the effect of PK506 and cyclosporine (CsA) as the principal immunosuppressive agents after pulmonary transplantation. Between October 1991 and March 1993, 74 lung transplants (35 single lung transplants [SLT], 39 bilateral lung transplant [BLT]) were performed on 74 recipients who were randomly assigned to receive either FK or CsA. Thirty-eight recipients (19 SLT, 19 BLT) received FK and 36 recipients (16 SLT, 20 BLT) received CsA. Recipients receiving FK or CsA were similar in age, gender, preoperative New York Heart Association functional class, and underlying disease. Acute rejection (ACR) was assessed by clinical, radiographic, and histologic criteria. ACR was treated with methylprednisolone, 1 g i.v./day, for three days or rabbit antithymocyte globulin if steroid-resistant.During the first 30 days after transplant, one patient in the FK group died of cerebral edema, while two recipients treated with CsA died of bacterial pneumonia (1) and cardiac arrest (1) (P=NS). Although one-year survival was similar between the groups, the number of recipients free from ACR in the FK group was significantly higher as compared with the CsA group (P<0.05). Bacterial and viral pneumonias were the major causes of late graft failure in both groups. The mean number of episodes of ACR/ 100 patient days was significantly fewer in the FK group (1.2) as compared with the CsA group (2.0) (P<0.05). While only one recipient (1/36=3%) in the group treated with CsA remained free from ACR within 120 days of transplantation, 13% (5/38) of the group treated with FK remained free from ACR during this interval (P<0.05). The prevalence of bacterial infection in the CsA group was 1.5 episodes/100 patient days and 0.6 episodes/100 patient days in the FK group. The prevalence of cytomegaloviral and fungal infection was similar in both groups.Although the presence of bacterial, fungal, and viral infections was similar in the two groups, ACR occurred less frequently in the FK-treated group as compared with the CsA-treated group in the early postoperative period (<90 days). Early graft survival at 30 days was similar in the two groups, but intermediate graft survival at 6 months was better in the FK group as compared with the CsA group. © 1994 by Williams and Wilkins

A CPH-Like Picture in Two Patients with an Orbitocavernous Sinus Syndrome

Two patients with retroorbital pain syndromes with or without paresis of cranial nerves developed weeks after ipsilateral headache resembling chronic paroxysmal hemicrania (CPH) but without autonomic features. These findings might support the hypothesis that CPH may be caused by a pathological process in the region of the cavernous sinus, as has been proposed for the Tolosa-Hunt syndrome (THS)

Cranial Nerve I

This unit presents the basic protocol for imaging cranial nerve I. The olfactory bulbs and tracts mediate the sense of smell from the nasal cavity to the brain. Unfortunately they are located in a precarious position for MR imaging, above the air‐filled nasal cavity and ethmoid sinuses at a bone‐air‐soft tissue interface. This creates problems with susceptibility artifact. This issue, plus the very small size of the structures to be studied and the superimposed eye motion artifact makes imaging of the olfactory system a technical challenge.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/145299/1/cpmia0701.pd

FUNCTIONAL PRINCIPAL COMPONENTS MODEL FOR HIGH-DIMENSIONAL BRAIN IMAGING

We establish a fundamental equivalence between singular value decomposition (SVD) and functional principal components analysis (FPCA) models. The constructive relationship allows to deploy the numerical efficiency of SVD to fully estimate the components of FPCA, even for extremely high-dimensional functional objects, such as brain images. As an example, a functional mixed effect model is fitted to high-resolution morphometric (RAVENS) images. The main directions of morphometric variation in brain volumes are identified and discussed

IS MRI-BASED VOLUME A MEDIATOR OF THE ASSOCIATION OF CUMULATIVE LEAD DOSE WITH COGNITIVE FUNCTION?

This work considers the pathway through which past occupational lead exposure impacts cognitive function using cross-sectional data. It is motivated by studies linking cumulative lead dose with brain volumes, volumes with cognitive function, and lead dose with cognitive function. It is hypothesized that the brain regions associated with lead mediate a portion of the association between lead dose and cognitive function. The data were derived from an ongoing study of 513 former organolead manufacturing workers. Using MRIs, a novel analysis was performed to investigate Mediation. Volumes associated with cognitive function and lead dose were derived using registered images and used in a subsequent mediation analysis. Cumulative lead dose was associated with adverse function in the visuo-construction, executive functioning and eye-hand coordination domains. Of these, there was strong evidence of volumetric mediation of lead’s effect on cognition in the visuo-construction domain, a moderate amount for eye-hand coordination, and limited evidence for executive functioning. A second path analysis based approach was also performed. To address the possibility that chance associations explained these findings, a permuted analysis was conducted, the results of which support the mediation inferences. The approach to the evaluation of volumetric mediation may have general applicability in epidemiologic neuroimaging settings

Policies and reporting guidelines for small biopsy specimens of mediastinal masses

目前，胸腺恶性肿瘤治疗方案大多是根据术\ud 后病理确定，然而，多数临床治疗决策需要在术前\ud 通过活检小标本的病理报告来制定。所以，术前活\ud 检小标本的正确获取和病理解读对治疗决策的制定\ud 显得非常重要[1]。这些标本包括细针活检标本，带\ud 芯穿刺活检标本和手术切取活检标本[2-7]。由于胸\ud 腺肿瘤的病理诊断对组织的获取方法和获取量都有较高\ud 的要求，加之对病理的描述也没有统一的标准，使得小\ud 标本在诊断胸腺瘤方面存在诸多问题。为此，ITMIG在\ud 病理科医生和外科医生回顾相关文献和提出初步建议的\ud 基础上，经集体讨论制定了活检规范操作流程，提出了\ud 对纵隔肿物小活检标本处理和病理报告的建议。旨在为\ud 术前患者的治疗提供一个统一和具有循证医学证据的方\ud 法；同时，将有利于全球数据之间的比较和开展合作研\ud 究，充分利用医疗资源

Cranial Nerves III to VI

Cranial nerves III, IV, V, and VI are small structures that travel in a reproducible manner from the midbrain and pons to the cavernous sinus and then to the orbit. While there are branches that course through other foramina of the skull, the emphasis in MRI is to evaluate the brainstem, the cavernous sinus, and the pericavernous regions for pathology. This unit present a basic protocol for imaging cranial nerves III to VI. Because the nerves run from a posterior to an anterior position, coronal scanning is ideal for visualizing the nerves in cross‐section. Thin sections and contrast enhancement are required to best visualize the diseases that affect these nerves. An alternate protocol is also discussed for the case when demyelinating etiologies for the cranial nerve deficits are considered.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/145278/1/cpmia0702.pd

MULTILEVEL FUNCTIONAL PRINCIPAL COMPONENT ANALYSIS FOR HIGH-DIMENSIONAL DATA

We propose fast and scalable statistical methods for the analysis of hundreds or thousands of high dimensional vectors observed at multiple visits. The proposed inferential methods avoid the difficult task of loading the entire data set at once in the computer memory and use sequential access to data. This allows deployment of our methodology on low-resource computers where computations can be done in minutes on extremely large data sets. Our methods are motivated by and applied to a study where hundreds of subjects were scanned using Magnetic Resonance Imaging (MRI) at two visits roughly five years apart. The original data possesses over ten billion easurements. The approach can be applied to any type of study where data can be unfolded into a long vector including densely bserved functions and images

Relationship between fibroblastic foci profusion and high resolution CT morphology in fibrotic lung disease

Background Fibroblastic foci profusion on histopathology and severity of traction bronchiectasis on highresolution computed tomography (HRCT) have been shown to be predictors of mortality in patients with idiopathic pulmonary fibrosis (IPF). The aim of this study was to investigate the relationship between fibroblastic foci (FF) profusion and HRCT patterns in patients with a histopathologic diagnosis of usual interstitial pneumonia (UIP), fibrotic non-specific interstitial pneumonia (NSIP) and chronic hypersensitivity pneumonitis (CHP). Methods The HRCT scans of 162 patients with a histopathologic diagnosis of UIP or fibrotic NSIP (n = 162) were scored on extent of groundglass opacification, reticulation, honeycombing, emphysema and severity of traction bronchiectasis. For each patient, a fibroblastic foci profusion score based on histopathologic appearances was assigned. Relationships between extent of fibroblastic foci and individual HRCT patterns were investigated using univariate correlation analysis and multivariate linear regression. Results Increasing extent of reticulation (P < 0.0001) and increasing severity of traction bronchiectasis (P < 0.0001) were independently associated with increasing FF score within the entire cohort. Within individual multidisciplinary team diagnosis subgroups, the only significant independent association with FF score was severity of traction bronchiectasis in patients with idiopathic pulmonary fibrosis (IPF)/UIP (n = 66, r2 = 0.19, P < 0.0001) and patients with chronic hypersensitivity pneumonitis (CHP) (n = 49, r2 = 0.45, P < 0.0001). Furthermore, FF score had the strongest association with severity of traction bronchiectasis in patients with IPF (r2 = 0.34, P < 0.0001) and CHP (r2 = 0.35, P < 0.0001). There was no correlation between FF score and severity of traction bronchiectasis in patients with fibrotic NSIP. Global disease extent had the strongest association with severity of traction bronchiectasis in patients with fibrotic NSIP (r2 = 0.58, P < 0.0001). Conclusion In patients with fibrotic lung disease, profusion of fibroblastic foci is strikingly related to the severity of traction bronchiectasis, particularly in IPF and CHP. This may explain the growing evidence that traction bronchiectasis is a predictor of mortality in several fibrotic lung diseases