MRI monitoring of lesions created at temperature below the boiling point and of lesions created above the boiling point using high intensity focused ultrasound

Magnetic Resonance Imaging (MRI) was utilized to monitor lesions created at temperature below the boiling point and lesions created at temperature above the boiling point using High Intensity Focused Ultrasound (HIFU) in freshly excised kidney, liver and brain and in vivo rabbit kidney and brain. T2-weighted fast spin echo (FSE) was proven as an excellent MRI sequence that can detect lesions with temperature above the boiling point in kidney. This advantage is attributed to the significant difference in signal intensity between the cavity and the thermal lesion. In liver the MRI sequence of Proton Density is recommended to detect lesions above boiling. In brain T1-W FSE was the optimum pulse sequence to detect lesions of either type. In order to monitor the temperature elevation during a HIFU exposure, T1-weighted fast spoiled gradient (FSPGR) was used. The shape of the focal temperature distribution was uniform with the absence of boiling, whereas with an exposure affected by boiling, the temperature distribution could be of irregular shape, demonstrating the drastic effects taking place during boiling. In order to confirm that boiling occurred, the temperature was estimated using the widely used method of Proton Resonance Frequency (PRF) shift

Heart ablation using a planar rectangular high intensity ultrasound transducer and MRI guidance

The aim of this study was to evaluate a flat rectangular (3 × 10 mm2) MRI compatible transducer operating at 5 MHz. The main task was to explore the feasibility of creating deep lesions in heart at a depth of at least 15 mm. The size of thermal necrosis in heart tissue was estimated as a function of power and time using a simulation model. The system was then tested in an excised lamb heart. In this study, we were able to create lesions of 15 mm deep with acoustic power of 6 W for an exposure of approximately 1 min. The contrast to noise ratio (CNR) between lesion and heart tissue was evaluated using fast spin echo (FSE). The CNR value was approximately 22 using T1 W FSE. Maximum CNR was achieved with repetition time (TR) between 300 and 800 ms. Using T2W FSE, the corresponding CNR was approximately 13 for the 14 in vivo experiments. The average lesion depth was 11.93 mm with a standard deviation of 0.62 mm. In vivo irradiation conditions were 6 W for 60 s. The size of the lesion in the other two dimensions was close to 3 × 10 mm2 (size of the transducer element)

Penetration of high intensity focused ultrasound in vitro and in vivo rabbit brain using MR imaging

In this paper magnetic resonance imaging (MRI) is investigated for monitoring the penetration of high intensity focused ultrasound (HIFU) ex vivo and in vivo rabbit brain. A single element spherically focused transducer of 5 cm diameter, focusing at 10 cm and operating at 2 MHz was used. A prototype MRI- compatible positioning device is described. MRI images were taken using fast spin echo (FSE). The length of the lesions in vivo rabbit brain was much higher than the length ex vivo, proving that the penetration in the ex vivo brain is limited by reflection due to trapped bubbles in the blood vessels

VIEWS FROM GP AND PSYCHIATRIC TRAINEES ABOUT GETTING EXPERIENCE IN EACH OTHER’S SPECIALTY DURING TRAINING: A WAY TO DEVELOP A SHARED CULTURE?

The need to deliver holistic medical care that addresses both physical and mental health requirements has never been more important. The UK medical training system has been designed to provide all medical graduates with a broad experience of different medical specialities and psychiatry prior to entering specialist training. Furthermore there is a distinct crossover between Psychiatric and General Practice training, with programmes providing trainees with the opportunity to work alongside each other in the care of mental health patients. The video presentation will explain the UK medical training system in more detail, before going on to explore how the organisation of training may foster a shared culture among different specialities and how it could form a model for improving parity of esteem of medical and physical health care. In addition it will discuss the strengths and weaknesses of this system from a trainee perspective and will conclude with comments from eminent Psychiatrists whom have special interests in medical training and developingparity of mental and physical health care

Winning Fights Induces Hyperaggression via the Action of the Biogenic Amine Octopamine in Crickets

Winning an agonistic interaction against a conspecific is known to heighten aggressiveness, but the underlying events and mechanism are poorly understood. We quantified the effect of experiencing successive wins on aggression in adult male crickets (Gryllus bimaculatus) by staging knockout tournaments and investigated its dependence on biogenic amines by treatment with amine receptor antagonists. For an inter-fight interval of 5 min, fights between winners escalated to higher levels of aggression and lasted significantly longer than the preceding round. This winner effect is transient, and no longer evident for an inter-fight interval of 20 min, indicating that it does not result from selecting individuals that were hyper-aggressive from the outset. A winner effect was also evident in crickets that experienced wins without physical exertion, or that engaged in fights that were interrupted before a win was experienced. Finally, the winner effect was abolished by prior treatment with epinastine, a highly selective octopamine receptor blocker, but not by propranolol, a ß-adrenergic receptor antagonist, nor by yohimbine, an insect tyramine receptor blocker nor by fluphenazine an insect dopamine-receptor blocker. Taken together our study in the cricket indicates that the physical exertion of fighting, together with some rewarding aspect of the actual winning experience, leads to a transient increase in aggressive motivation via activation of the octopaminergic system, the invertebrate equivalent to the adrenergic system of vertebrates

Haploinsufficiency of the E3 Ubiquitin Ligase C-Terminus of Heat Shock Cognate 70 Interacting Protein (CHIP) Produces Specific Behavioral Impairments

The multifunctional E3 ubiquitin ligase CHIP is an essential interacting partner of HSP70, which together promote the proteasomal degradation of client proteins. Acute CHIP overexpression provides neuroprotection against neurotoxic mitochondrial stress, glucocorticoids, and accumulation of toxic amyloid fragments, as well as genetic mutations in other E3 ligases, which have been shown to result in familial Parkinson's disease. These studies have created a great deal of interest in understanding CHIP activity, expression and modulation. While CHIP knockout mice have the potential to provide essential insights into the molecular control of cell fate and survival, the animals have been difficult to characterize in vivo due to severe phenotypic and behavioral dysfunction, which have thus far been poorly characterized. Therefore, in the present study we conducted a battery of neurobehavioral and physiological assays of adult CHIP heterozygotic (HET) mutant mice to provide a better understanding of the functional consequence of CHIP deficiency. We found that CHIP HET mice had normal body and brain weight, body temperature, muscle tone and breathing patterns, but do have a significant elevation in baseline heart rate. Meanwhile basic behavioral screens of sensory, motor, emotional and cognitive functions were normative. We observed no alterations in performance in the elevated plus maze, light-dark preference and tail suspension assays, or two simple cognitive tasks: novel object recognition and spontaneous alternation in a Y maze. Significant deficits were found, however, when CHIP HET mice performed wire hang, inverted screen, wire maneuver, and open field tasks. Taken together, our data indicate a clear subset of behaviors that are altered at baseline in CHIP deficient animals, which will further guide whole animal studies of the effects of CHIP dysregulation on cardiac function, brain circuitry and function, and responsiveness to environmental and cellular stress

Physiological responses during ascent to high altitude and the incidence of acute mountain sickness.

Acute mountain sickness (AMS) occurs when there is failure of acclimatisation to high altitude. The aim of this study was to describe the relationship between physiological variables and the incidence of AMS during ascent to 5300 m. A total of 332 lowland-dwelling volunteers followed an identical ascent profile on staggered treks. Self-reported symptoms of AMS were recorded daily using the Lake Louise score (mild 3-4; moderate-severe ≥5), alongside measurements of physiological variables (heart rate, respiratory rate (RR), peripheral oxygen saturation (SpO2 ) and blood pressure) before and after a standardised Xtreme Everest Step-Test (XEST). The overall occurrence of AMS among participants was 73.5% (23.2% mild, 50.3% moderate-severe). There was no difference in gender, age, previous AMS, weight or body mass index between participants who developed AMS and those who did not. Participants who had not previously ascended >5000 m were more likely to get moderate-to-severe AMS. Participants who suffered moderate-to-severe AMS had a lower resting SpO2 at 3500 m (88.5 vs. 89.6%, p = 0.02), while participants who suffered mild or moderate-to-severe AMS had a lower end-exercise SpO2 at 3500 m (82.2 vs. 83.8%, p = 0.027; 81.5 vs. 83.8%, p 5000 m (OR 2.740, p-value 0.003) predicted the development of moderate-to-severe AMS. The Xtreme Everest Step-Test offers a simple, reproducible field test to help predict AMS, albeit with relatively limited predictive precision

High PEEP in ARDS: quantitative evaluation between improved oxygenation and decreased oxygen delivery

Background: Positive end-expiratory pressure (PEEP) is widely used to improve oxygenation and prevent alveolar collapse in mechanically ventilated patients with the acute respiratory distress syndrome (ARDS). While PEEP predictably improves arterial oxygenation, high PEEP strategies have demonstrated equivocal improvements in ARDS mortality. The effect of PEEP on tissue oxygen delivery is poorly understood and is difficult to quantify or investigate in the clinical environment. Methods: We investigated the effects of PEEP on tissue oxygen delivery in ARDS using a novel, high-fidelity, computational model with highly integrated respiratory and cardiovascular systems. The model was configured to replicate published clinical trial data on the responses of individual ARDS patients to changes in PEEP. These virtual patients were subjected to increasing PEEP levels during a lung-protective ventilation strategy (0 - 20 cmH2O). Measured variables included arterial oxygenation, cardiac output, peripheral oxygen delivery and alveolar strain. Results: As PEEP increased, tissue oxygen delivery decreased in all subjects (mean reduction 25% at 20 cmH2O PEEP), despite an increase in arterial oxygen tension (mean increase 6.7 kPa, at 20 cmH2O PEEP). Changes in arterial oxygenation and tissue oxygen delivery differed between subjects, but showed a consistent pattern. Static and dynamic alveolar strain decreased in all patients as PEEP increased. Conclusions: Incremental PEEP in ARDS appears to protect alveoli and improve arterial oxygenation, but also appears to significantly impair tissue oxygen delivery due to reduced cardiac output. We propose why this trade-off may explain the poor improvements in mortality associated with high PEEP ventilation strategies