Non-Contrast Enhanced MR Angiography (NCE-MRA) of the Calf: A Direct Comparison between Flow-Sensitive Dephasing (FSD) Prepared Steady-State Free Precession (SSFP) and Quiescent-Interval Single-Shot (QISS) in Patients with Diabetes

Objectives

To compare the image quality and diagnostic performance of two non-contrast enhanced MR angiography (NCE-MRA) techniques using flow-sensitive dephasing (FSD) prepared steady-state free precession (SSFP) and quiescent-interval single-shot (QISS) for the calf arteries in patients with diabetes.

Materials and Methods

Twenty six patients underwent the two NCE-MRA techniques followed by contrast-enhanced MRA (CE-MRA) of lower extremity on a 1.5T MR system. Image quality scores, arterial stenosis scores, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), vessel sharpness, and diagnostic accuracy for detecting more than 50% arterial stenosis were evaluated and statistically compared using CE-MRA as the reference standard.

Results

All examinations were performed successfully. Of the total 153 calf arterial segments obtained in the 26 patients, FSD and QISS showed no significant difference in the number of diagnostic arterial segments (151 [98%] vs. 147 [96%], respectively, P>0.05). The image quality of FSD was higher than that of QISS in the peroneal artery and posterior tibial artery (P<0.05), but no significant difference in the anterior tibial artery (P>0.05). SNR and CNR of FSD were higher than those of QISS (P<0.01), while FSD showed comparable vessel sharpness compared with QISS (P>0.05). The time efficiency of SNR and CNR between FSD and QISS showed no significant difference when taking into account the times for FSD-related scout scans. There was no difference in sensitivity (95% vs. 93%, P>0.05) and negative predictive value (98% vs. 97%, P>0.05) between FSD and QISS for detecting stenosis greater than 50%. However, FSD showed higher specificities (99% vs. 92%, P<0.05) and diagnostic accuracy (98% vs. 92%, P<0.05) compared to QISS.

Conclusion

Both FSD and QISS had similar high sensitivity and negative predictive value for detecting calf arteries with over 50% stenosis, but FSD showed slightly higher diagnostic specificity and better depiction of arterial lesions due to its isotropic submillimeter spatial resolution. QISS, being an easier to use and less time-consuming technique, could be a method of choice for rapid screening of arterial disease of the lower extremity.     

Evaluation of Flow Velocity in Unilateral Middle Cerebral Artery Stenosis by Transcranial Doppler

To determine the optimal velocity values in diagnosing unilateral middle cerebral artery (MCA) stenosis by Transcranial Doppler (TCD), and improve the diagnostic accuracy using magnetic resonance angiography (MRA), a total of 302 unilateral MCA stenosis patients undergoing TCD also consented to a MRA of the intracranial arteries. The peak systolic velocity (PSV) and each MCA spectrum for each patient were recorded. Using the MRA to confirm, the degree of middle cerebral artery stenosis was categorized into four groups: normal (normal caliber and signal), mild (<50 %), moderate (50–69 %), severe (70–99 %, or no flow detected). The velocity difference among these four groups was significant (P < 0.001). The optimal PSV values for normal and stenosis were 160 cm/s. For mild and moderate were 200 cm/s, for moderate and severe were 280 cm/s. Using PSV as the diagnostic criteria, the Kappa number was >0.668. The optimal PSV differential value for mild and moderate was 70 cm/s, for moderate and severe at 120 cm/s. Optimal combined criteria for moderate stenosis were PSV >200 cm/s and PSV differential value >70 cm/s (specificity 87.2 %), for severe stenosis were PSV >280 cm/s and PSV differential value >120 cm/s (sensibility 81.6 %). Transcranial Doppler distinguishes normal and MCA stenosis with a reduced lumen diameter of less than 50 %. Using the PSV criteria, TCD has a high coincidence rate with MRA in the diagnosis of MCA stenosis. Combined PSV differential value and the abnormal spectrum may improve the accuracy of TCD in diagnosing moderate or severe stenosis.     

Haemodynamic analysis of vessel remodelling in STA-MCA bypass for Moyamoya disease and its impact on bypass patency

The purpose of this study is to estimate the remodelling characteristics of STA-MCA bypass and its influence on patency via the use of computational fluid dynamic (CFD) technology. The reconstructed three-dimensional geometries from MRA were segmented to create computational domains for CFD simulations. Eleven patients, who underwent regular MRA both immediately following surgery and at the six months follow-up, were studied. The flow velocities at STA were measured via the use of quantitative MRA (QMRA) to validate simulation results. STA-MCA bypass patency was confirmed for each patient immediately following surgery. The simulation indicated that the remodelling of the arterial pedicle in nine patients was associated with a reduction in the resistance to flow through the bypass. For these cases, the modelling of a driving pressure of 10 mmHg through the bypass at 6 months post-surgery resulted in a 50% greater blood flow than those found immediately following surgery. However, two patients were found to exhibit contradictory patterns of remodelling, in which a highly curved bending at the bypass immediately post-surgery underwent progression, with increased resistance to flow through the bypass at 6 months follow-up, thereby resulting in a modelled flow rate reduction of 50% and 25%, respectively. This study revealed that STA-MCA bypass has a characteristic remodelling that usually reduces flow resistance. The initial morphology of the bypass may have had a significant effect on the outcome of vessel remodelling.     

Effects of Eurycoma longifolia Jack on sexual qualities in middle aged male rats

The effects of Eurycoma longifolia Jack were studied on the sexual qualities of middle aged male rats after dosing them with 0.5 g/kg of various fractions of E. longifolia whilst the control group received 3 ml/kg of normal saline daily for 12 weeks. Results showed than E. longifolia Jack enhanced the sexual qualities of the middle aged male rats by decreasing their hesitation time as compared to controls with various fractions of E. longifolia Jack produced 865-916 (91-96), 860-914 (92-98), 850-904 (93-99), 854-890 (95-99), 844-880 (94-98), 840-875 (94-98), 830-870 (94-98), 825-860 (94-98), 820-850 (96-99), 800-840 (93-98), 750-795 (94-99) and 650-754 sec (82-95%) in contrast to controls which produced 950 (100), 934 (100), 910 (100), 900 (100), 895 (100), 890 (100), 885 (100), 880 (100), 855 (100), 860 (100), 800 (100) and 790 sec (100%) throughout the investigation period. Besides these, there was a transient increase in the % of the male rats responding to the right choice after chronic administration of 0.5 g/kg E. longifolia Jack, with more than 50% of the male rats scored right choice after 2 weeks post-treatment and the effect was more prominent at the dose of the observation period. However, there was no sexual enhancement of the middle aged male rats which consumed normal saline since only 45-55% of the male rats responded to right choice throughout the investigation period. Hence, this study shows that E. longifolia Jack enhanced the sexual qualities of the middle aged male rats, further supports the folkuse of E. longifolia Jack as an aphrodisiac.     

Diagnostic Accuracy of Computer Tomography Angiography and Magnetic Resonance Angiography in the Stenosis Detection of Autologuous Hemodialysis Access: A Meta-Analysis

Purpose

To compare the diagnostic performances of computer tomography angiography (CTA) and magnetic resonance angiography (MRA) for detection and assessment of stenosis in patients with autologuous hemodialysis access.

Materials and Methods

Search of PubMed, MEDLINE, EMBASE and Cochrane Library database from January 1984 to May 2013 for studies comparing CTA or MRA with DSA or surgery for autologuous hemodialysis access. Eligible studies were in English language, aimed to detect more than 50% stenosis or occlusion of autologuous vascular access in hemodialysis patients with CTA and MRA technology and provided sufficient data about diagnosis performance. Methodological quality was assessed by the Quality Assessment of Diagnostic Studies (QUADAS) instrument. Sensitivities (SEN), specificities (SPE), positive likelihood ratio (PLR), negative likelihood values (NLR), diagnostic odds ratio (DOR) and areas under the receiver operator characteristic curve (AUC) were pooled statistically. Potential threshold effect, heterogeneity and publication bias was evaluated. The clinical utility of CTA and MRA in detection of stenosis was also investigated.

Result

Sixteen eligible studies were included, with a total of 500 patients. Both CTA and MRA were accurate modality (sensitivity, 96.2% and 95.4%, respectively; specificity, 97.1 and 96.1%, respectively; DOR [diagnostic odds ratio], 393.69 and 211.47, respectively) for hemodialysis vascular access. No significant difference was detected between the diagnostic performance of CTA (AUC, 0.988) and MRA (AUC, 0.982). Meta-regression analyses and subgroup analyses revealed no statistical difference. The Deek’s funnel plots suggested a publication bias.

Conclusion

Diagnostic performance of CTA and MRA for detecting stenosis of hemodialysis vascular access had no statistical difference. Both techniques may function as an alternative or an important complement to conventional digital subtraction angiography (DSA) and may be able to help guide medical management.     

Study of the collateral capacity of the circle of Willis of patients with severe carotid artery stenosis by 3D computational modeling

This numerical study aims to investigate the capacity of the circle of Wills (CoW) to provide collateral blood supply for patients with unilateral carotid arterial stenosis. The basic 3D geometry of the CoW was reconstructed based on a magnetic resonance angiogram of a normal human subject. A total of 52 computational fluid dynamics simulations were performed for four geometry configurations of the CoW with an artificially inserted axisymmetric stenosis of different luminal area reductions in an internal carotid artery (ICA) under a variety of boundary conditions. The CoW geometric configurations included (a) a normal CoW with all communicating arteries; (b) as model (a) but with enlarged communicating arterial diameters; (c) as (a) but with the ipsilateral posterior communicating artery missing, and (d) as (c) but with enlarged communicating arteries. It is found that the blood perfusion pressure drop between the ipsilateral ICA and the middle cerebral artery (MCA) only becomes significant when the degree of stenosis is greater than 86%. The cerebral autoregulation range varied significantly between the different CoW configurations for the severe stenosis cases. Without causing the flow rates to decrease at the efferent arterial ends, the mean perfusion pressure in the ipsilateral ICA can drop from 100 to 73, 67, 92 and 84mmHg for the CoW models (a)-(d) with 96% luminal area reduction stenosis, respectively. The additional pathways are able to raise the ipsilateral MCA pressure significantly without reducing the total flow perfusion. Cerebral autoregulation effects were not directly included in the study. Therefore, the findings in the study should be interpreted with cautions when comes to the biological and clinical significance.     

12株猪瘟病毒E2基因主要抗原区域的序列差异分析

用RTPCR扩增了12个不同时期分离的HCV毒株E2基因主要抗原区域的cDNA片段并对其进行了序列测定。应用DNAstar序列分析软件对所测的12个HCV毒株与国内外已知的6个毒株Alfort株、Ald株、Brescia株、Gpe株、C株、CW株及早期已测定的HCLV株、HCVSM株和北京顺义株(BJSY2/96)3个毒株的相应片段进行了同源性比较分析。E2基因主要区域长度均为224 bp,包括从HCV 2485到2708位的E2基因B、C区域。所测的疫苗株HCLV与国外测得的疫苗株C株核苷酸及氨基酸同源性分别为991%和100%,表明目前应用的疫苗株是稳定的;用目前我国流行的部分野毒株对HCLV株免疫猪的攻击试验表明,HCLV对野毒株均具有很好的免疫力,这与序列分析结果相吻合。根据系统树分析,可将HCV分为两大群,5株90年代的野毒株及1株80年代的野毒株(其中北京3株、河南2株、广东1株)均与国内外C株、标准株属同一群(即第一群),其核苷酸及氨基酸的同源性分别为857%～100%和838%～100%;与Alfort株同属第二群的有6个野毒株(广西北海、辽宁、河北黄骅、吉林、深圳光明、四川成都),其中80年代与90年代的野毒株各有三株,核苷酸及氨基酸的同源性分别为843%～100%和851%～100%;21株HCV的核苷酸及氨基酸的同源性分别为781%～100%和784%～100%。两群之间的特征性差异表现在713和729位氨基酸位点的不同,经分析发现猪瘟野毒株具有复杂性与多样性。     

应用高压液相层析（HPLC）评价乙肝疫苗纯度方法的建立和应用

应用高压液相层析（ＨＰＬＣ）方法，对血源乙肝疫苗、ＣＨＯ基因工程乙肝疫苗及酵母基因工程乙肝疫苗进行了检测，其纯度分别为８８～９４％，８７～９６％和９８～１００％。     

In Vivo Validation of Simultaneous Non-Contrast Angiography and intraPlaque Hemorrhage (SNAP) Magnetic Resonance Angiography: An Intracranial Artery Study

Objectives

Simultaneous Non-contrast Angiography and intraPlaque hemorrhage (SNAP) technique was recently proposed for joint MRA and intraplaque hemorrhage (IPH) imaging. The purpose of this study is to validate SNAP’s MRA performance in patients with suspected intracranial artery disease.

Methods

SNAP and time-of-flight (TOF) techniques with matched field of view and resolution were applied on 15 patients with suspected intracranial artery disease. Both techniques were evaluated based on their detection of luminal stenosis of bilateral middle cerebral arteries (MCA) and the delineation of smallest visible branches (SVB) of the MCA. Statistical analysis was conducted on the artery level.

Results

The SNAP MRA was found to provide similar stenosis detection performance when compared with TOF (Cohen’s κ 0.79; 95% Confidence Interval: 0.56–0.99). For the SVB comparison, SNAP was found to provide significantly better small artery delineation than TOF (p = 0.017). Inter-reader reproducibility for both measurements on SNAP was over 0.7. SNAP also detected IPH lesions on 13% of the patients.

Conclusions

The SNAP technique’s MRA performance was optimized and compared against TOF for intracranial artery atherosclerosis imaging and was found to provide comparable stenosis detection accuracy. Along with its IPH detection capability, SNAP holds the potential to become a first-line screening tool for high risk intracranial atherosclerosis disease evaluation.     

The laser-assisted end-to-side microvascular anastomosis

A simple method of performing the laser-assisted end-to-side microvascular anastomosis was devised. This technique was tested on 150 Sprague-Dawley rats in two separate series of experiments. In the first, end-to-side anastomoses were performed on the iliac artery under the normal tension due to the elastic recoil of severed vessels. Four stay sutures were placed 90 degrees apart, and the intervals were "spot welded" with a low-wattage CO2 microsurgical laser unit. The patency rate (96 percent) was equivalent to that found in a control group utilizing the conventional all-suture method (92 percent), but there was a significantly higher aneurysm rate (44 versus 11 percent). In a second model, an arterial bypass with very low anastomotic tension was performed around an obstruction created in the carotid artery. This model resulted in turbulent flow but low anastomotic tension. Here the laser-anastomosis patency rate was 98 percent, versus 42 percent for the conventional all-suture method. The placement of fewer sutures in association with turbulent flow in this model may account for the improved patency rate. The avoidance of excessive tension at the anastomotic site reduced the incidence of aneurysms to a negligible level.     

An inelastic multi-mechanism constitutive equation for cerebral arterial tissue

Intracranial aneurysms (ICA) are abnormal saccular dilations of cerebral arteries, commonly found at apices of arterial bifurcations and outer walls of curved arterial segments. Histological evidence suggests the stages in ICA development include the deformation of a segment of arterial wall into a “bleb” with no identifiable neck region followed by the development of an aneurysm with a clear neck. Afterwards, the aneurysm may undergo further enlargement, possibly with significant biological response including calcification and thrombosis. Past studies of the biomechanics of cerebral aneurysm tissue have been directed at modeling elastic deformations of pre-existing aneurysms. Taking this approach, the aneurysm wall is treated as a different entity than the arterial tissue from which it developed. In the current work, a nonlinear, inelastic, dual-mechanism constitutive equation for cerebral arterial tissue is developed. It is the first to model the recruitment of collagen fibers and degradation of the internal elastic lamina, two important characteristics of early stage aneurysm formation.     

Slight vapor deficit accelerates graft union healing of tomato plug seedling

The application of grafting in tomato production has substantially improved tomato quality and yields. It has been demonstrated that humidity plays an important role in the graft healing of seedlings. This study focuses on the optimum relative humidity (RH) conditions for scion and rootstock healing of grafted tomato (Solanum lycopersicum L.) seedlings. Two tomato cultivars, ‘Super Sunload’ and ‘Super Dotaerang’, grafted onto ‘B-Blocking’ rootstock were subjected to one of three RH regimens: 70–80, 80–90, or 90–100%. The results showed that the scions of both cultivars showed apparent wilting under the 70–80 and 80–90% RH treatments. On this basis, the 90–100% RH treatment was subdivided into 95–96, 97–98, and 99–100% RH treatments, which were then applied. Among these subdivided RH treatments, the fresh weights of the scions and rootstocks significantly increased in response to the treatments of 97–98 and 99–100% RH, and the graft union connection of both cultivars was also enhanced after two days of healing. Furthermore, lower levels of endogenous H₂O₂ and less activity of antioxidant enzymes were observed in both cultivars in response to treatment with 95–96 or 97–98% RH, which indicated that less oxidative stress occurred. Overall, it is suggested that 97–98% is the optimal RH level for the graft healing of tomato seedlings.     

经胸腔镜建立巴马小型猪冠状动脉狭窄模型

目的探讨一种高效、稳定的经胸腔镜构建不同程度冠状动脉狭窄动物模型的方法。方法 20头巴马小型猪,在胸腔镜直视下手术丝线永久性环扎左前降支近端,从而造成前降支不同程度的狭窄。术后进行定量冠状动脉造影检查评价狭窄程度。结果 20头小型猪中18头手术顺利完成,2头术中出现室颤,除颤成功后分别于术后8 h和48 h死亡。术后行定量冠状动脉造影显示7头小型猪狭窄程度不超过50%,6头狭窄程度在50%到70%,5头狭窄程度在70%以上,即时手术成功率100%,建模成功率90%。结论完全胸腔镜下应用丝线环扎法可成功地制作不同程度的冠脉狭窄动物模型。     

Follow up study of 70 patients with renal artery stenosis treated by percutaneous transluminal dilatation.

Between April 1978 and April 1981, 70 patients with hypertension and renal artery stenosis were treated by percutaneous transluminal arterial dilatation. Selection of the patients was based solely on arteriographic criteria. Arteriography after dilatation showed considerable widening of the stenosed area in all patients. In 65 patients the effect of treatment on the blood pressure was assessed during follow up periods of one to four years. In 14 of these patients the hypertension was cured, in 29 it was improved, and in 22 there was no change. Patients with fibromuscular lesions benefited distinctly more than did those with atheromatous stenosis, only one of the 21 patients with fibromuscular lesions showing no change as compared with 21 of the 44 patients with atheromatous lesions. The only serious complication encountered was microcholesterol emboli, which developed in two patients with severe atheromatous lesions of the aorta. In the atheromatous group age and overall renal function had no influence on the blood pressure response. In the subgroup of patients with a unilateral lesion the renal vein renin ratios and asymmetrical curves obtained by renography had only a very limited predictive value. In experienced hands percutaneous transluminal arterial dilatation is relatively safe, and this study suggests that it should be attempted in all patients with renal artery stenosis. Only in patients with severe atheromatosis of the aorta should the risk associated with the catheterisation be weighed against the 50% or so chance of benefit from the procedure.     

Effects of stent porosity on hemodynamics in a sidewall aneurysm model

Computation and experiment have been complementarily performed to study the fluid flow inside a stented lateral aneurysm anchored on the straight parent vessel. The implicit solver was based on the time-dependent incompressible Navier-Stokes equations of laminar flow. Solutions were generated by a cell-center finite-volume method that used second-order upwind and second-order center flux difference splitting for the convection and diffusion term, respectively. The second-order Crank-Nicolson method was used in the time integration term. Experimental techniques used were flow visualization (FV) and particle tracking velocimetry (PTV). Experimentally, the straight afferent vessel had an inner diameter 10mm. The diameters of the aneurysmal orifice, neck, and fundus were 14, 10, and 15 mm, respectively, and the distance between the orifice and dome measured 20mm. A 30 mm long helix-shaped stent was tested. Four stent porosities of 100%, 70%, 50%, and 25% were examined. Volume-flow rate waveform of a cerebral artery was considered with a maximum Reynolds number of 250 and Womersley number of 3.9. Results are presented in terms of the pulsatile main and secondary flow velocity vector fields, the volume inflow rates into the aneurysm, and the wall shear stress (WSS) and wall pressure at the aneurysm dome. Some comparisons of computed results with the present FV and PTV results and with the data available from the literature are also made. The maximum flow velocity inside the aneurysm ostium and the WSS in the dome region at the peak flow can, respectively, be suppressed to less than 5% of the parent vessel bulk velocity (or 20% of the unstented case) and 8% of the unstented case if the stent porosity is smaller than 40% (about the porosity of the two-layer stents). In general, the three-layer stents seem not as effective as the two-layer stents in reducing the magnitude of aneurysm inflow rate and WSS.     

Influence of arterial wall-stenosis compliance on the coronary diagnostic parameters

Functional diagnostic parameters such as Fractional Flow Reserve (FFR), which is calculated from pressure measurements across stenosed arteries, are often used to determine the functional severity of coronary artery stenosis. This study evaluated the effect of arterial wall-stenosis compliance, with limiting scenarios of stenosis severity, on the diagnostic parameters. The diagnostic parameters considered in this study include an established index, FFR and two recently developed parameters: Pressure Drop Coefficient (CDP) and Lesion Flow Coefficient (LFC). The parameters were assessed for rigid artery (RR; signifying high plaque elasticity), compliant artery with calcified plaque (CC; intermediate plaque elasticity) and compliant artery with smooth muscle cell proliferation (CS; low plaque elasticity), with varying degrees of epicardial stenosis. A hyperelastic Mooney-Rivlin model was used to model the arterial wall and plaque materials. Blood was modeled as a shear thinning, non-Newtonian fluid using the Carreau model. The arterial wall compliance was evaluated using the finite element method. The present study found that, with an increase in stenosis severity, FFR decreased whereas CDP and LFC increased. The cutoff value of 0.75 for FFR was observed at 78.7% area stenosis for RR, whereas for CC and CS the cutoff values were obtained at higher stenosis severities of 81.3% and 82.7%, respectively. For a fixed stenosis, CDP value decreased and LFC value increased with a decrease in plaque elasticity (RR to CS). We conclude that the differences in diagnostic parameters with compliance at intermediate stenosis (78.7-82.7% area blockage) could lead to misinterpretation of the stenosis severity.     

Molecular systematics of basal subfamilies of ants using 28S rRNA (Hymenoptera: Formicidae)

For many years, the ant subfamily Ponerinae was hypothesized to contain the basal (early branching) lineages of ants. Recently the Ponerinae were reclassified into six poneromorph subfamilies based on morphological analysis. We evaluate this new poneromorph classification using 1240 base pairs of DNA sequence data obtained from 28S rRNA gene sequences of 68 terminal taxa. The molecular tree supported the monophyly of the ant family Formicidae, with 100% parsimony bootstrap (PB) support and posterior probabilities (PP) of 1.00, with the ant subfamily Leptanillinae as a sister group to all other ants (PB=62, PP=93). However, our analyses strongly support the polyphyly of the Poneromorph subfamilies (sensu Bolton). The Ectatomminae and Heteroponerinae are more closely related to the Formicoid subfamilies than to the rest of the poneromophs (PB=96, PP=100). The Amblyoponinae (PB=52, PP=96), Paraponerinae (PB=100, PP=100), Ponerinae (PB<50, PP=71), and Proceratiinae (PB=98, PP=100) appear as distinct lineages at the base of the tree and are identified as a poneroid grade. Monophyletic origins for the poneroid subfamilies Amblyoponinae, Paraponerinae, Ponerinae and Proceratiinae are supported in our analysis. However, the genus Platythyrea forms a distinct sister group to the Ponerini within the Ponerinae. The Heteroponerinae, based on our sample of Heteroponera, are associated with the subfamily Ectatomminae (PB=98, PP=100). Furthermore, our data indicate the genus Probolomyrmex belongs to the Proceratiinae as suggested by recent morphological analysis (PB=98, PP=100).     

Effect of erythrocyte aggregation at normal human levels on functional capillary density in rat spinotrapezius muscle

Previous studies have shown that functional capillary density (FCD) is substantially reduced by erythrocyte aggregation. However, only supranormal levels of aggregability were studied. To investigate the effect of erythrocyte aggregability at the level seen in healthy humans, the FCD of selected capillary fields in rat spinotrapezius muscle was determined with high-speed video microscopy under normal (nonaggregating) conditions and after induction of erythrocyte aggregation with Dextran 500 (200 mg/kg). To examine shear rate dependence, the effect was studied both at normal and reduced arterial pressures (50 and 25 mmHg), the latter achieved by short periods of hemorrhage. In a separate study, volume flow was determined in arterioles (52.1 +/- 3.7 microm) under the same conditions. Before Dextran 500 infusion, FCD fell to 91% and 76% of control values, respectively, when arterial pressure was reduced to 50 and 25 mmHg. After Dextran 500 infusion, FCD was 96% at normal arterial pressure and fell to 79% and 37% of normal control values at 50 and 25 mmHg. All FCD values were significantly lower after dextran infusion. FCD reduction after lowering arterial pressure or dextran infusion appeared to be due to plasma skimming rather than capillary plugging. Reduction of FCD by dextran at reduced pressure was compensated by increased red blood cell flux in capillaries with red blood cell flow. We conclude that the level of aggregability seen in healthy humans is an important determinant of FCD only at reduced arterial pressure.     

Carotid Doppler evaluation in cerebrovascular disease.

The Doppler technique has proven to be a useful noninvasive technique for evaluating the patency of the carotid artery in patients at risk of stroke. The data obtained from 246 carotid Doppler examinations were compared with the angiographic findings in the same patients. The sensitivity, specificity and accuracy were high when the degree of stenosis was greater than 50%, but occlusions were less reliably detected, with 8 (33%) of the 24 being misdiagnosed as high-grade stenoses. Carotid Doppler evaluation guides and accelerates decisions regarding further investigations, such as cerebral angiography. It helps one decide whether a neck bruit is of arterial origin and aids assessment following cerebrovascular surgery. It is not a substitute for cerebral angiography because it poorly visualizes both the posterior and the intracranial circulations and cannot accurately detect low-grade (less than 50%) stenoses or ulcerated arterial plaques. Detection of stenosis in a carotid artery in an otherwise uncertain case is an indication for cerebral angiography, so the Doppler technique will probably increase the number of angiograms performed. However, this technique is also useful in follow-up, being without hazard, and should, therefore, reduce the likelihood of unnecessary angiographic examinations.     

Comparison of a nested polymerase chain reaction--restriction fragment length polymorphism method, the PATH antigen detection method, and microscopy for the detection and identification of malaria parasites.

A nested polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method, the PATH antigen detection method, and light microscopy were compared for their capacity to detect and identify Plasmodium species. One hundred and thirty-six blood specimens obtained from patients suspected of having malaria were examined by each of the three methods. Forty-four specimens were positive for malaria using microscopy as the "gold standard". The sensitivity for nested PCR was 100%, and the specificity was 98%. For the detection of Plasmodium falciparum, the antigen detection method had a sensitivity of 100% and a specificity of 97%. Species identification obtained using PCR-RFLP was identical or superior to light microscopy in 42 cases (96%). Although the nested PCR-RFLP method was more sensitive and specific, the rapid turnaround time and high sensitivity of the antigen detection method makes it a useful adjunct to standard microscopy.