Huntington's disease(HD) is a progressive and fatal neurodegenerative disorder caused by an expanded tri-nucleotide CAG sequence in huntingtin gene(HTT) on chromosome 4. HD manifests with chorea, cognitive and psy...Huntington's disease(HD) is a progressive and fatal neurodegenerative disorder caused by an expanded tri-nucleotide CAG sequence in huntingtin gene(HTT) on chromosome 4. HD manifests with chorea, cognitive and psychiatric symptoms. Although advances in genetics allow identification of individuals carrying the HD gene, much is still unknown about the mechanisms underly-ing the development of overt clinical symptoms and the transitional period between premanifestation and mani-festation of the disease. HD has no cure and patients rely only in symptomatic treatment. There is an urgent need to identify biomarkers that are able to monitor disease progression and assess the development and efficacy of novel disease modifying drugs. Over the past years, neuroimaging techniques such as magnetic resonance imaging(MRI) and positron emission tomog-raphy(PET) have provided important advances in our understanding of HD. MRI provides information about structural and functional organization of the brain, while PET can detect molecular changes in the brain. MRI and PET are able to detect changes in the brains of HD gene carriers years ahead of the manifestation of the dis-ease and have also proved to be powerful in assessingdisease progression. However, no single technique hasbeen validated as an optimal biomarker. An integrativemultimodal imaging approach, which combines differ-ent MRI and PET techniques, could be recommendedfor monitoring potential neuroprotective and preventivetherapies in HD. In this article we review the currentneuroimaging literature in HD.展开更多
Solid organ transplant recipients have an elevated risk of tuberculosis(TB) with high mortality. Data about TB in this population in the United States is sparse. We present four cases of active tuberculosis in kidney ...Solid organ transplant recipients have an elevated risk of tuberculosis(TB) with high mortality. Data about TB in this population in the United States is sparse. We present four cases of active tuberculosis in kidney transplant recipients at our center. All patients had possible TB exposure prior to transplant and all were diagnosed with active TB within the first year of transplant. Disseminated TB was seen in half of the patients with extra-pulmonary TB being more common affecting lymph nodes, pericardium, and the kidney allograft. Delay in diagnosis from onset of symptoms ranged from fifteen days to two months. Two patients died from TB. TB is a largely preventable and curable disease. However, challenges remain in the diagnosis due to most recipients presenting with atypical symptoms. Physicians should maintain a high degree of suspicion for TB to promptly diagnose and treat posttransplant thereby minimizing complications. A review of the literature including the epidemiology, pathogenesis, clinical presentation, diagnosis and treatment options are discussed.展开更多
Background: Heavy metal ions can cause allergic and inflammatory reactions that might be associated with in-stent restenosis. This randomized multicenter clinical study was designed to determine if carbon ion-implante...Background: Heavy metal ions can cause allergic and inflammatory reactions that might be associated with in-stent restenosis. This randomized multicenter clinical study was designed to determine if carbon ion-implanted stents reduce luminal late loss by blocking heavy metal ion diffusion into the surrounding tissue. Methods: A total of 225 patients with 230 native coronary lesions were randomly assigned to receive either a carbon ion-implanted ArthosInert stent(group 1, n=113) or a bare metal Arthos stent(group 2, n=117). The primary endpoint was in-stent luminal late loss at 6-month angiographic follow-up, and the secondary endpoints were the 6-month angiographic restenosis rate and the occurrence of the major adverse cardiac events(MACE) including death, nonfatal myocardial infarction, and target lesion revascularization at 12 months. Results: The baseline characteristics were similar in the 2 groups. In-hospital events did not occur in any patients. Angiographic follow-up at 6 months was obtained in 184 lesions(80%). At follow-up, the luminal late loss was similar in the 2 groups(0.91±0.77mm in group 1 vs 0.88±0.80 mm in group 2, P=.79), and the angiographic restenosis rates were 11.0%in group 1 and 16.1%in group 2(P=.31). The occurrence rates of MACE at 12 months were 9.1%in group 1 and 10.4%in group 2(P=.73). Conclusions: The initial and long-term outcomes of the carbon ion-implanted stent were excellent. However, it did not improve long-term outcomes vs the bare metal stent.展开更多
文摘Huntington's disease(HD) is a progressive and fatal neurodegenerative disorder caused by an expanded tri-nucleotide CAG sequence in huntingtin gene(HTT) on chromosome 4. HD manifests with chorea, cognitive and psychiatric symptoms. Although advances in genetics allow identification of individuals carrying the HD gene, much is still unknown about the mechanisms underly-ing the development of overt clinical symptoms and the transitional period between premanifestation and mani-festation of the disease. HD has no cure and patients rely only in symptomatic treatment. There is an urgent need to identify biomarkers that are able to monitor disease progression and assess the development and efficacy of novel disease modifying drugs. Over the past years, neuroimaging techniques such as magnetic resonance imaging(MRI) and positron emission tomog-raphy(PET) have provided important advances in our understanding of HD. MRI provides information about structural and functional organization of the brain, while PET can detect molecular changes in the brain. MRI and PET are able to detect changes in the brains of HD gene carriers years ahead of the manifestation of the dis-ease and have also proved to be powerful in assessingdisease progression. However, no single technique hasbeen validated as an optimal biomarker. An integrativemultimodal imaging approach, which combines differ-ent MRI and PET techniques, could be recommendedfor monitoring potential neuroprotective and preventivetherapies in HD. In this article we review the currentneuroimaging literature in HD.
文摘Solid organ transplant recipients have an elevated risk of tuberculosis(TB) with high mortality. Data about TB in this population in the United States is sparse. We present four cases of active tuberculosis in kidney transplant recipients at our center. All patients had possible TB exposure prior to transplant and all were diagnosed with active TB within the first year of transplant. Disseminated TB was seen in half of the patients with extra-pulmonary TB being more common affecting lymph nodes, pericardium, and the kidney allograft. Delay in diagnosis from onset of symptoms ranged from fifteen days to two months. Two patients died from TB. TB is a largely preventable and curable disease. However, challenges remain in the diagnosis due to most recipients presenting with atypical symptoms. Physicians should maintain a high degree of suspicion for TB to promptly diagnose and treat posttransplant thereby minimizing complications. A review of the literature including the epidemiology, pathogenesis, clinical presentation, diagnosis and treatment options are discussed.
文摘Background: Heavy metal ions can cause allergic and inflammatory reactions that might be associated with in-stent restenosis. This randomized multicenter clinical study was designed to determine if carbon ion-implanted stents reduce luminal late loss by blocking heavy metal ion diffusion into the surrounding tissue. Methods: A total of 225 patients with 230 native coronary lesions were randomly assigned to receive either a carbon ion-implanted ArthosInert stent(group 1, n=113) or a bare metal Arthos stent(group 2, n=117). The primary endpoint was in-stent luminal late loss at 6-month angiographic follow-up, and the secondary endpoints were the 6-month angiographic restenosis rate and the occurrence of the major adverse cardiac events(MACE) including death, nonfatal myocardial infarction, and target lesion revascularization at 12 months. Results: The baseline characteristics were similar in the 2 groups. In-hospital events did not occur in any patients. Angiographic follow-up at 6 months was obtained in 184 lesions(80%). At follow-up, the luminal late loss was similar in the 2 groups(0.91±0.77mm in group 1 vs 0.88±0.80 mm in group 2, P=.79), and the angiographic restenosis rates were 11.0%in group 1 and 16.1%in group 2(P=.31). The occurrence rates of MACE at 12 months were 9.1%in group 1 and 10.4%in group 2(P=.73). Conclusions: The initial and long-term outcomes of the carbon ion-implanted stent were excellent. However, it did not improve long-term outcomes vs the bare metal stent.
