A comparison of Power Doppler with conventional sonographic imaging for the evaluation of renal artery stenosis

BACKGROUND: Power Doppler (PD) has improved diagnostic capabilities of vascular sonography, mainly because it is independent from the angle of insonation. We evaluated this technique in a prospective comparison with conventional imaging, consisting in Duplex and Color Doppler, for the evaluation of Renal Artery (RA) stenosis. METHODS: Sensitivity, specificity and predictive values of PD and conventional imaging were assessed in a blinded fashion on eighteen patients, 9 with angiographic evidence of unilateral RA stenosis (hypertensive patients) and 9 with angiographically normal arteries (control group). PD images were interpreted with an angiography-like criteria. RESULTS: In the control group both techniques allowed correct visualization of 16 out of the 18 normal arteries (93% specificity). Only in five hypertensive patients RA stenosis was correctly identified with conventional technique (56% sensitivity and 86% negative predictive value); PD was successful in all hypertensive patients (100% sensitivity and negative predictive value), since the operators could obtain in each case of RA stenosis a sharp color signal of the whole vessel with a clear "minus" at the point of narrowing of the lumen. All results were statistically significant (p < 0.01). CONCLUSIONS: This study demonstrates that PD is superior to conventional imaging, in terms of sensitivity and specificity, for the diagnosis of RA stenosis, because it allows a clear visualization of the whole stenotic vascular lumen. Especially if it is used in concert with the other sonographic techniques, PD can enable a more accurate imaging of renovascular disease with results that seem comparable to selective angiography

Miscanthus Establishment and Overwintering in the Midwest USA: A Regional Modeling Study of Crop Residue Management on Critical Minimum Soil Temperatures

Miscanthus is an intriguing cellulosic bioenergy feedstock because its aboveground productivity is high for low amounts of agrochemical inputs, but soil temperatures below ‒3.5°C could threaten successful cultivation in temperate regions. We used a combination of observed soil temperatures and the Agro-IBIS model to investigate how strategic residue management could reduce the risk of rhizome threatening soil temperatures. This objective was addressed using a historical (1978–2007) reconstruction of extreme minimum 10 cm soil temperatures experienced across the Midwest US and model sensitivity studies that quantified the impact of crop residue on soil temperatures. At observation sites and for simulations that had bare soil, two critical soil temperature thresholds (50% rhizome winterkill at ‒3.5°C and ‒6.0°C for different Miscanthus genotypes) were reached at rhizome planting depth (10 cm) over large geographic areas. The coldest average annual extreme 10 cm soil temperatures were between ‒8°C to ‒11°C across North Dakota, South Dakota, and Minnesota. Large portions of the region experienced 10 cm soil temperatures below ‒3.5°C in 75% or greater for all years, and portions of North and South Dakota, Minnesota, and Wisconsin experienced soil temperatures below ‒6.0°C in 50–60% of all years. For simulated management options that established varied thicknesses (1–5 cm) of miscanthus straw following harvest, extreme minimum soil temperatures increased by 2.5°C to 6°C compared to bare soil, with the greatest warming associated with thicker residue layers. While the likelihood of 10 cm soil temperatures reaching ‒3.5°C was greatly reduced with 2– 5 cm of surface residue, portions of the Dakotas, Nebraska, Minnesota, and Wisconsin still experienced temperatures colder than ‒3.5°C in 50–80% of all years. Nonetheless, strategic residue management could help increase the likelihood of overwintering of miscanthus rhizomes in the first few years after establishment, although low productivity and biomass availability during these early stages could hamper such efforts

Effect of aminoguanidine on plasma nitric oxide by-products and blood flow during chronic peritoneal sepsis

We hypothesized that plasma nitric oxide (NO), generated via inducible NO synthase (iNOS) or endothelial constitutive NO synthase and measured via its by-products NO2- and NO3- (NO2- + NO3- = NOx) would increase and remain elevated during chronic peritoneal sepsis. We further hypothesized that treatment with aminoguanidine (AG; 50 mg/kg), a selective iNOS inhibitor, would decrease NO production and alter blood flow. Sprague Dawley rats were randomized to septic and nonseptic groups. Septic rats received an intraperitoneal cecal slurry (200 mg of cecal material/5 mL 5% dextrose-H2O/kg); control rats received sterile 5% dextrose-H2O (5 mL/kg) only. Plasma NOx and hemodynamics were measured 0, 4, 12, 24, and 48 h after sepsis or sham induction. We also examined the effect of AG, an iNOS inhibitor, on plasma NOx levels and tissue blood flow at 24 h. Septic rats uniformly displayed signs of sepsis, including lethargy, piloerection, and diarrhea. NOx levels were significantly elevated compared with controls at 4, 12, 24, and 48 h (p \u3c .05). Septic rats also demonstrated hypotension (t = 12, 24, and 48 h) and tachycardia (t = 4, 12, 24, and 48 h). The infusion of AG (50 mg/kg intravenously for 30 min) at 24 h significantly decreased plasma NOx in septic animals. Plasma NOx concentrations returned to basal levels by 90 min after infusion of AG. In addition, blood flow studies demonstrated that AG treatment in nonseptic rats resulted in a significant decrease in blood flow to the stomach, skin, and adipose tissue, whereas AG infusion did not significantly alter the regional perfusion profile in septic animals. Furthermore, treatment with AG did not significantly alter mean arterial pressure in either group; however, nonseptic animals exhibited a decrease in stroke volume, and septic animals demonstrated an increase in heart rate. In contrast to the rise and fall of NOx levels in endotoxemia, this study demonstrates that the initial rise is sustained during 48 h of peritoneal sepsis. This sustained increase in NOx levels in this model correlated with the observable signs of systemic infection and may relate to enhanced iNOS activity. AG infusion demonstrated variable effects on regional tissue blood flow profiles in septic and nonseptic animals and attenuated the increase in plasma NOx levels in septic animals, an index of iNOS activity

Simulated soil temperature trends across the Midwest US.

<p>(a) Total change (from linear regression) in annual average 10 cm soil temperatures for 1948–2007 for the MAIZE+TILL (bare soil) simulation; (b) total change (from linear regression) in annual extreme minimum 10 cm soil temperature for the MAIZE+TILL (bare soil) simulation from 1948–2007; (c) total change (from linear regression) in annual extreme minimum 10 cm soil temperature for the MAIZE+TILL (bare soil) simulation from 1981–2007. Regions bounded by solid white lines indicate trends with P<0.05.</p

Frequency of 10 cm soil temperatures reaching −3.5°C or colder for varied miscanthus residue thicknesses.

<p>Fraction of total years during the 1978–2007 time period that simulated annual 10 cm soil temperatures were at or below a −3.5°C threshold (based on a 3-day running mean) for (a) MAIZE+TILL (bare soil), (b) MISCAN+R_{1 cm}, (c) MISCAN+R_{2.5 cm}, and (d) MISCAN+R_{5 cm} simulations.</p