Molecular imaging of atherosclerosis with integrated PET imaging

Atherosclerotic diseases account for nearly half of all deaths and are leading causes of adult disability. Our understanding of how atherosclerosis leads to cardiovascular disease events has evolved: from a concept of progressive luminal narrowing, to that of sudden rupture and thrombosis of biologically active atheroma. In concert with this conceptual shift, contemporary imaging techniques now allow imaging of biological processes that associate with plaque instability: active calcification and plaque inflammation. This review focuses on opportunities provided by positron emission tomography/computed tomography, to identify these high-risk biological features of atherosclerosis.BH is supported by Research Training grant from Alexandria University. NRE is supported by a Research Training Fellowship from The Dunhill Medical Trust [Grant Number RTF44/0114]. JHFR is part supported by the NIHR Cambridge Biomedical Research Centre, the British Heart Foundation, EPSRC, and the Wellcome Trust. AT reports grants from NIH/NHLBI, Actelion, Genentech and Takeda, and personal fees from Actelion, Amgen AstraZeneca, and Takeda, all outside the submitted work

A new option in airway management: evaluation of the TotalTrack® video laryngeal maski

Background: The TotalTrack® Video Laryngeal Mask (VLM) is a novel airway management device consisting of a disposable laryngeal mask paired with a reusable video display. Prior to the commencement of this study, there was no published literature on the performance of the TotalTrack®.Methods: The device was evaluated in sixty patients without predictors for difficult airway under general anaesthesia with neuromuscular blockade. Primary outcomes were laryngeal mask seal pressures and success of tracheal intubation through the device.Results: Insertion and ventilation was successful in 98.3% of cases. Median static leak and maximal inflation pressures of the laryngeal mask component were 32 and 40 cm H₂O respectively. Tracheal intubation through the device was successful in 95% of cases, with a mean intubation time of 9.5 s. No gastric insufflation occurred. Haemodynamic variability was found to be clinically insignificant. No significant side-effects were reported.Conclusions: In this initial study, the TotalTrack® VLM was found to be effective as a laryngeal mask airway, exhibiting good sealing pressures. It facilitated predictable, easy intubating conditions under video guidance, with minimal interruption of ventilation.Keywords: airway management, intubation, laryngeal masks, laryngoscope

PET imaging of the neurovascular interface in cerebrovascular disease

Cerebrovascular disease encompasses a range of pathologies affecting different components of the cerebral vasculature and brain parenchyma. Large artery atherosclerosis, acute cerebral ischaemia, and intracerebral small vessel disease all demonstrate metabolic processes that are key to pathogenesis. Although structural imaging has been a mainstay of stroke clinical care and research, it has limited ability to detect these pathophysiological processes in vivo. Positron emission tomography (PET) provides a means to detect and quantify metabolic processes in each facet of cerebrovascular disease non-invasively. The use of PET has helped shape the understanding of key concepts in cerebrovascular medicine, including the vulnerable atherosclerotic plaque, salvageable ischaemic penumbra, neuroinflammation and selective neuronal loss after ischaemic insult, and the relationships between chronic hypoxia, neuroinflammation, and amyloid deposition in cerebral small vessel disease. This review considers how the ability to image these processes at the neurovascular interface has contributed to our understanding of cerebrovascular disease and facilitated translational research to advance clinical care.N.R.E. is supported by a research training fellowship from The Dunhill Medical Trust (grant number RTF44/0114). J.M.T. is supported by a Wellcome Trust research training fellowship (104492/Z/14/Z). J.H.F.R. is part-supported by the Higher Education Funding Council for England (HEFCE), the British Heart Foundation, and the Wellcome Trust. H.S.M. is supported by the Medical Research Council (MRC) as a National Institute for Health Research (NIHR) Senior Investigator. E.A.W. is supported by the British Heart Foundation. H.S.M., J.H.F.R., and E.A.W. are supported by the NIHR Cambridge Biomedical Research Centre

An Investigation of Racing Performance and Whip Use by Jockeys in Thoroughbred Races

Concerns have been expressed concerning animal-welfare issues associated with whip use during Thoroughbred races. However, there have been no studies of relationships between performance and use of whips in Thoroughbred racing. Our aim was to describe whip use and the horses' performance during races, and to investigate associations between whip use and racing performance. Under the Australian Racing Board (ARB) rules, only horses that are in contention can be whipped, so we expected that whippings would be associated with superior performance, and those superior performances would be explained by an effect of whipping on horse velocities in the final 400 m of the race. We were also interested to determine whether performance in the latter sections of a race was associated with performance in the earlier sections of a race. Measurements of whip strikes and sectional times during each of the final three 200 metre (m) sections of five races were analysed. Jockeys in more advanced placings at the final 400 and 200 m positions in the races whipped their horses more frequently. Horses, on average, achieved highest speeds in the 600 to 400 m section when there was no whip use, and the increased whip use was most frequent in the final two 200 m sections when horses were fatigued. This increased whip use was not associated with significant variation in velocity as a predictor of superior placing at the finish

Reliability of temporal summation, thermal and pressure pain thresholds in a healthy cohort and musculoskeletal trauma population

Traumatic injuries affect approximately 978 million people worldwide with 56.2 million requiring inpatient care. Quantitative sensory testing (QST) can be useful in predicting outcome following trauma, however the reliability of multiple QST including temporal summation (TS), heat and cold pain thresholds (HPT, CPT) and pressure pain thresholds (PPT) is unknown. We assessed intra (between day) and inter-rater (within day) reliability of QST in asymptomatic participants (n = 21), and inter-rater (within day) reliability in participants presenting with acute musculoskeletal trauma (n = 25). Intra-class correlations with 95% confidence intervals (ICC 3,2), standard error of measurement (SEM) and Bland Altman Plots for limits of agreement were calculated. For asymptomatic participants, reliability was good to excellent for HPT (ICC range 0.76 0.95), moderate to good for PPT (ICC range 0.52 0.93), with one site rated poor (ICC 0.41), and poor to excellent for TS scores (ICC range 0.20 0.91). For musculoskeletal trauma participants reliability was good to excellent for HPT and PPT (ICC range 0.76 0.86), and moderate to good reliability for TS (ICC range 0.69 0.91). SEM for HPT for both sets of participants was 1°C and an average of 7N for asymptomatic participants and less than 8N for acute musculoskeletal trauma participants for PPT. This study demonstrates moderate to excellent intra and inter-rater reliability for HPT and PPT in asymptomatic participants and good to excellent inter-rater reliability for acute musculoskeletal trauma participants, with TS showing more variability for both sets of participants. This study provides foundations for future work evaluating the sensory function over time following acute musculoskeletal trauma

Excavating the 'Rutland Sea Dragon': The largest ichthyosaur skeleton ever found in the UK (Whitby Mudstone Formation, Toarcian, Lower Jurassic)

An almost complete ichthyosaur skeleton 10 m long was discovered in January 2021 at the Rutland Water Nature Reserve in the county of Rutland, UK. This was excavated by a small team of palaeontologists in the summer of the same year. Nicknamed ‘The Rutland Sea Dragon’, this almost fully articulated skeleton is an example of the large-bodied Early Jurassic ichthyosaur Temnodontosaurus. The specimen was analysed in situ, recorded (including a 3D scan using photogrammetry), excavated and removed from the site in a series of large plaster field jackets to preserve taphonomic information. Significantly, the specimen is the largest ichthyosaur skeleton to have been found in the UK and it may be the first recorded example of Temnodontosaurus trigonodon to be found in the country, extending its known geographic range significantly. It also represents the most complete skeleton of a large prehistoric reptile to have been found in the UK. We provide an account of the discovery and describe the methods used for excavating, recording and lifting the large skeleton which will aid palaeontologists facing similar challenges when collecting extensive remains of large and fragile fossil vertebrates. We also discuss the preliminary research findings and the global impact this discovery has had through public engagement

Paleolimnological Assessment of Six Lakes on the Kissimmee Chain, with Implications for Restoration of the Kissimmee-Okeechobee-Everglades system, Florida, USA

Whitmore TJ, Riedinger-Whitmore MA, Reed ZE, Curtis JH, Yang H, Evans DE, Cropper NR, Alvarado KS, Lauterman FM, Scott A, Leonard CR, Franklin DL. 2020. Paleolimnological assessment of six lakes on the Kissimmee Chain, with implications for restoration of the Kissimmee–Okeechobee–Everglades system, Florida, USA. Lake Reserv Manage. 36:218–242. The Kissimmee Basin in south central Florida contains a large, freshwater network that includes the Kissimmee River and nearly 2 dozen lakes that are headwaters of the Florida Everglades. Management of these lakes is an important part of Everglades restoration. We report a paleolimnological investigation of 6 lakes in the Upper Kissimmee Basin. Engineering activities connected the lakes and permanently altered hydrology in the 19th and 20th centuries. The lakes were naturally meso-eutrophic, but changes in lake levels and nutrient loading contributed to different degrees of eutrophication. Cyanobacteria were present historically at low levels in Lakes East Tohopekaliga, Cypress, and Tohopekaliga, but increased during the 20th century. Lake Jackson lacked cyanobacteria until recently, but Lakes Kissimmee and Marian have had high levels of cyanobacteria since predisturbance times. Profound changes in the lakes occurred after engineering activities eliminated natural large fluctuations in water levels that periodically dried large portions of the basins. Salt-tolerant biological indicators previously alternated with freshwater organisms. Large water-level fluctuations moderated aquatic-plant standing crops and reduced organic matter accumulation. Lakes Kissimmee and Marian showed greatest evidence of former associated wetlands, but lacked large variations in water levels. We recommend disconnecting these lakes from each other and from the Kissimmee River to reestablish large, natural fluctuations in water levels that were part of healthy ecosystem function. Former wetlands should be restored to slow the downstream cascade of nutrients to Lake Okeechobee and the Everglades. This study demonstrates that paleolimnology is useful for assessing hydrological changes that potentially affect lake restoration efforts