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Despite several advances in medicine, ischaemic heart disease remains a major cause of morbidity and mortality. The unravelling of molecular mechanisms underlying disease pathophysiology has revealed targets for pharmacological interventions. However, transfer of these pharmcological possibilities to clinical use has been disappointing. Considering the complexity of ischaemic disease at the cellular and molecular levels, an equally multifaceted treatment approach may be envisioned. The pharmacological principle of ‘one target, one key’ may fall short in such contexts, and optimal treatment may involve one or many agents directed against complementary targets. Here, we introduce a ‘multi‐target approach to cardioprotection’ and propose heat shock protein 90 (HSP90) as a target of interest. We report on a member of a distinct class of HSP90 inhibitor possessing pleiotropic activity, which we found to exhibit potent infarct‐sparing effects.

This is an overview of radiological imaging of the hand highlighting the various imaging modalities used in the work-up and diagnosis of a range of orthopaedic and rheumatological disorders. The biomechanics and anatomy of the human hand is extremely complex, and a good understanding is required to diagnose pathology. In this article we explain the anatomy and highlight pathology of the hand from a radiological perspective with respect to plain film, CT, ultrasound and MR imaging. Trauma of the hand is extremely common and radiology plays an important role in the diagnosis of treatable injuries including fractures, dislocations and ligament tears. Plain radiography and CT are excellent at evaluating bony injury (e.g. Rolondo or Bennett's fracture) whereas ultrasound and MR are better at evaluating soft tissue injury (e.g. Stener lesion). The hands are a common location for degenerate and inflammatory arthropathies which all have hallmark radiological features. Radiology also plays an important role in the diagnosis and work-up of bone lesions in the hand including enchondromas, osteoid osteomas and chondrosarcomas.

Clinical introductionA healthy 8-year-old boy presented to the ED with acute left shoulder pain. He had been playing football and his left arm was pulled by an opposition team member. He fell to the ground and landed on his left shoulder causing pain. On examination after analgesia, active and passive movement of the shoulder joint was possible in all directions but range of motion was limited by pain. There was no visible swelling or bruising throughout the shoulder girdle. A radiograph of the shoulder was obtained (figure 1).Figure 1Plain radiograph of the left shoulder.QuestionWhat radiographic finding is seen for this patient?Glenohumeral lipohaemarthrosis.Acromioclavicular joint disruption.Intra-articular gas.Intra-articular loose body.

A penile fracture is defined as a tear of the tunica albuginea, surrounding the corpus cavernosa. It occurs when the erect penis is subjected to an abnormal ‘bending’ force, inducing an acute increase in intracavernosal pressures, exceeding the tensile strength of the tunica albuginea, which is

Background: Pharmacogenomic studies have shown that ADCY9 genotype determines the effects of the CETP (cholesteryl ester transfer protein) inhibitor dalcetrapib on cardiovascular events and atherosclerosis imaging. The underlying mechanisms responsible for the interactions between ADCY9 and CETP activity have not yet been determined. Methods: Adcy9 -inactivated ( Adcy9 Gt/Gt ) and wild-type (WT) mice, that were or not transgenic for the CETP gene (CETPtg Adcy9 Gt/Gt and CETPtg Adcy9 WT ), were submitted to an atherogenic protocol (injection of an AAV8 [adeno-associated virus serotype 8] expressing a PCSK9 [proprotein convertase subtilisin/kexin type 9] gain-of-function variant and 0.75% cholesterol diet for 16 weeks). Atherosclerosis, vasorelaxation, telemetry, and adipose tissue magnetic resonance imaging were evaluated. Results: Adcy9 Gt/Gt mice had a 65% reduction in aortic atherosclerosis compared to WT ( P Adcy9 Gt/Gt mice compared to WT animals ( P Adcy9 Gt/Gt mice (versus WT, P Adcy9 Gt/Gt ( P Adcy9 Gt/Gt mice allowed significantly less adhesion of splenocytes compared to WT ( P Adcy9 Gt/Gt mice gained more weight than WT with the atherogenic diet; this was associated with an increase in whole body adipose tissue volume ( P Adcy9 Gt/Gt compared to WT mice ( P P P =0.0572). Adcy9 inactivation–induced effects on atherosclerosis, endothelial function, weight gain, adipose tissue volume, and feed efficiency were lost in CETPtg Adcy9 Gt/Gt mice ( P >0.05 versus CETPtg Adcy9 WT ). Conclusions: Adcy9 inactivation protects against atherosclerosis, but only in the absence of CETP activity. This atheroprotection may be explained by decreased macrophage accumulation and proliferation in the arterial wall, and improved endothelial function and autonomic tone.

Nephrolithiasis contributes significantly to the worldwide healthcare burden. Patient-reported outcome measures (PROMs) are widely recognized as important outcome measures for patient-centered care. We sought to summarize what is currently known about PROMs in urinary stone disease and to characterize use of PROMs in randomized controlled trials (RCTs) for nephrolithiasis.Health-related quality of life (HRQOL) in patients with nephrolithiasis is reviewed. A search of both MEDLINE and EMBASE databases for RCTs in nephrolithiasis was performed to assess utilization of PROMs in these trials. All searches were for articles published between 1990 and 2014. Two independent reviewers reviewed all abstracts to determine inclusion for full-text review, with disagreements reviewed by a separate arbitrator.Validated methods for collecting PROMs include symptom diaries, pain scales, and validated HRQOL instruments. HRQOL is impacted in patients with nephrolithiasis and may be related to gender, proximity of a recent colic episode, or treatment modality. One validated instrument has been created in the nephrolithiasis population, while a treatment-specific questionnaire on ureteral stents has also been developed. PROMs are variably reported in RCTs for nephrolithiasis. Few trials utilize validated HRQOL instruments and none utilizes a disease-specific instrument.HRQOL is diminished in patients with urolithiasis, especially in times near to an acute stone event. Only one validated HRQOL instrument exists specific to nephrolithiasis. No validated instrument exists to assess the outcomes from different management options for renal and ureteral stones. Development of condition-specific PROMs instruments should aim to account for the heterogeneous and episodic nature of the disease and its treatment. Effective reporting of PROMs is lacking in the RCTs for nephrolithiasis. Future RCTs for urolithiasis standardize reporting of PROMs.

The number of substances detector dogs are trained to detect varies depending on the mission of the agency they serve. No studies have been conducted concerning how training multiple odor discriminations affects detection performance and refresher training requirements. This study used a controlled field setting to examine the effects of training dogs to detect multiple substances on their subsequent detection performance and refresher training requirements. Dogs were first trained to detect a single odor. Their detection performance was tested 10 days later and refresher training was then given to bring their performance back up to a predetermined standard. Following refresher training, detection of a new substance was trained, and approximately 10 days later the detection of both trained substances was tested. This sequence of testing, refresher training, and new odor training continued every 10 days until the dogs had been trained and tested on 10 odors. The detection of previously learned odors did not decrease as the number of substances trained increased. In fact, the amount of training required to refresh detection performance and to train new odor discriminations tended to decrease as more odor discriminations were trained.

Aortic arch atheroma is a major source of cerebral embolism and transesophageal echocardiography (TEE) is the gold standard for the detection of aortic atheroma and for morphological analysis of the plaques. Computed tomography angiography (CT angiography) of the aorta is helpful, but lacks sensitivity (1). Here we report an illustration with images that reminds the practitioners that we are, the role of TEE in the detection and the characterization of aortic atheroma in ischemic stroke of undetermined cause. A 66-year-old man with a history of tobacco use and recently stopped alcohol abuse was admitted for the assessment of a new onset of right lateral homonymous hemi-anopsia. Brain magnetic resonance imaging showed a left occipital ischemic stroke. A full evaluation failed to find a cause to this stroke. Transthoracic echocardiography was normal and CT angiography of the aortic arch was not contributory at the first reading. A transesophageal echocardiography (TEE) was then requested. The conventional imaging using a multiplane TEE probe showed protruding and ulcerated complex aortic arch atheroma (Fig. 1a). The ‘Biplane prepare’ modality, a new echocardiographic technique which allows simultaneous viewing of two different planes (Fig. 1b). After a slight modification of the section plane (Fig. 1c,d), this imaging modality showed a ruptured atherosclerotic plaque cap, not visualized by the conventional multiplane mode. Color Doppler imaging showed in the ‘Biplane prepare’ view, a circulating flow (arrow, Fig. 1d), allowing the authentication of plaque rupture. Correspondence: Nadia Benyounes*, Cardiology Unit, Fondation Adolphe de Rothschild, Paris 75019, France. Email: nbenyounes@fo-rothschild.fr

Subarachnoid haemorrhage is an important condition with a high mortality, so prompt diagnosis is essential. This article will review the investigation of subarachnoid haemorrhage with a radiological bias. Appropriate clinical correlation will be included and it will look at some of the more interesting areas in the investigation of this condition.

We present a case of an inferior pancreaticoduodenal artery pseudoaneurysm treated by computed tomography (CT)-guided percutaneous injection of thrombin. As far as we are aware, we present the first documented case of successful long-term (9 months) follow-up with no evidence of recurrence.

Dogs are often required to detect target substances under challenging conditions. One of these challenges is to detect contraband in the presence of extraneous odors, whether they are part of the ambient environment or placed there for the purpose of evading detection. This paper presents the results of two studies evaluating the ability of dogs to detect target substances in the presence of varying concentrations of extraneous odors. The studies were conducted under behavioral laboratory conditions, providing good control over vapor sources and a clear basis for evaluation of detection responses. Dogs were trained to sample an air stream consisting of the extraneous odor only or the extraneous odor plus the target odor and then press the appropriate lever to earn food. The results are described in terns of the ability of dogs to detect target odors in the presence of a wide range of concentrations of the extraneous odors.

Dogs are capable of detecting and discriminating a number of compounds constituting a complex odor. However, they use only a few of these to recognize a substance. The focus of this research is to determine the compounds dogs learn to use in recognizing explosives. This is accomplished by training dogs under behavioral laboratory conditions to respond differentially on separate levers to 1) blank air, 2) a target odor, such as an explosive, and 3) all other odors (non-target odors). Vapor samples are generated by a serial dilution vapor generator whose operation and output is characterized by GC/MS. Once dogs learn this three-lever discrimination, testing sessions are conducted containing a number of probe trials in which vapor from constituent compounds of the target is presented. Which lever the dogs respond to on these probe trials indicates whether they can smell the compound at all (blank lever) or whether it smells like toe target odor (e.g., the explosive) or like something else. This method was conducted using TNT, C-4, and commercial dynamite. The data show the dogs' reactions to each of the constituent compounds tested for each explosive. Analysis of these data reveal the canine detection odor signature for these explosives.

Dogs are capable of detecting and discriminating a number of compounds constituting a complex odor. However, they use only a few of these to recognize a substance. The focus of this research is to determine the compounds dogs learn to use in recognizing explosives used in land mines. This is accomplished by training dogs under behavioral laboratory conditions to respond differentially on separate levers to (1) blank air, (2) a target odor such as an explosive, and (3) all other odors (non-target odors). Vapor samples are generated by a serial dilution vapor generator whose operation and output is characterized by GC/MS. Once dogs learn this three-lever discrimination, testing sessions are conducted containing a number of probe trials in which vapor from constituent compounds is presented. Which lever the dogs respond to on these probe trials indicates whether they can smell the compound at all (blank lever) or whether it smells like the target odor (e.g., the explosive) or like something else. This method was conducted using TNT and C-4. The data show the dogs' reactions to each of the constituent compounds tested for each explosive. Analysis of these data reveal the canine detection odor signature for these explosives.

Depression in primary care: Evidence and practiceSimon Gilbody & Peter Bower (Eds)Cambridge: Cambridge University Press, 2010172 pp., £29.99 pbkISBN 978-0-521-87050-4This is a book aimed at those i...

The Third World in the World Economy. Regimes, International Economic Organizations and Development Diplomacy. The International Monetary Fund in the Third World. The World Bank and the Third World. The General Agreement on Tariffs and Trade and the Third World. The United Nations Conference on Trade an Development and the Third World. Justice, Efficiency and International Economic Organizations.