Cells were grown in the Neratinib chemical structure presence of glucose as indicated; molecular weight markers are given on the left side (in kDa). The

following EIICBGlc derivatives were used in combination with SgrT-3HA: EIICBGlc-K382A-His; 2. EIICBGlc-T383A-His; 3. EIICBGlc-P384A-His; 4. EIICBGlc-P384R-His; 5. EIICBGlc-G385A-His; 6. EIICBGlc-R386A-His; Inhibitors,research,lifescience,medical 7. EIICBGlc-E387A-His; 8. EIICBGlc-D388A-His; 9. EIICBGlc-His (wild type). These results indicate that the crucial residues for the interaction between the two proteins are in the center of the KTPGRED motif. (b) Lane 1 shows a crosslinking experiment with strain JKA12 expressing SgrT-3HA (pACYC184sgrT3HA) and the so called “relaxed” mutant EIICBGlc-V12F-His (pRR48GH-V12F). Cells were grown in the presence of glucose. These results indicate an interaction between SgrT and the “relaxed” derivative of EIICBGlc. (c) This part of the figure shows Inhibitors,research,lifescience,medical crosslinking

experiments between SgrT-3HA and the “locked in” mutant EIICBGlc-K150E-His (pRR48GH-K150E) in different genetic backgrounds. Lane 1 shows a sample of strain JKA12 expressing SgrT-3HA and EIICBGlc-K150E-His, lanes 2 and 3 exhibit samples of LJ140 expressing the same proteins. Cells were grown in the absence or presence of glucose as indicated. Inhibitors,research,lifescience,medical These results indicate no interaction between SgrT and EIICBGlcK150E in a PTS-positive strain, but a strong interaction in a ptsHIcrr deletion background. Inhibitors,research,lifescience,medical The mutation P384R in EIICBGlc has previously been described to cause a so-called “relaxed” conformation [16], which allows a facilitated transport of substrates like mannose, glucosamine or fructose. The exact nature of the conformational difference, however, is still unclear. To test whether this “relaxed” conformation in general interferes with the SgrT interaction, we tested the EIICBGlcV12F derivative in the crosslinking assay. This Inhibitors,research,lifescience,medical mutation has also been attributed with properties which cause the same “relaxed” phenotype and thus belongs

to the same class of mutants [10]. As shown in Figure 3B, in contrast to EIICBGlcP384R the unphosphorylated V12F derivative these exhibited a strong interaction with SgrT, which means that a “relaxed” conformation per se has no influence on the interplay with this small regulatory peptide. A different class of mutations, such as those caused by the substitution K150E, leads to a so-called “locked-in” conformation of EIICBGlc. In this case, the transporter can be phosphorylated but cannot transfer the phosphate group to the bound glucose molecule [10]. Thus, the transporter remains phosphorylated and cells carrying this mutation are not capable of transporting glucose by the Glc-PTS. Accordingly, no interaction between SgrT and EIICBGlcK150E could be detected in PTS-positive strains in the presence of glucose (Figure 3C, lane 1).

We examined the effect of EPO in the first 4 post-CABG weeks. Time needed for the LV function improvement depends

on the level of degeneration and connective tissue proliferation. Some AR-A014418 supplier studies have found no alteration or deterioration in segmental wall motion within the first week postoperatively and showed myocardial improvement by assessing the WMSI and LVEF at 3 to 6 months after surgery.27-29 In contrast, other studies have reported improvement in myocardial contractibility within the first intraoperative days or within the first postoperative weeks.24,27,30 Inhibitors,research,lifescience,medical Further and long-term follow-up is required in these patients to determine whether EPO has efficacy in the WMSI changes and ventricular function after CABG.

It is worthy of note that most of our patients had EF>30% and only 6 patients had EF<30%. As a result, it is possible that the efficacy of EPO on the ventricular function in patients with lower EF is higher than in patients with acceptable Inhibitors,research,lifescience,medical EF. We suggest that future studies recruit patients with lower EF to examine the effect of EPO on these patients. Recent studies have disagreed about the effective dosage of EPO for lessening the damage of ischemia-reperfusion. Inhibitors,research,lifescience,medical Animal experimental models have used higher doses than human experimental models. Of the former group, the results of a study by L. Javadi16 showed that 5000 IU/kg of EPO could reduce the infarct area, minimize cell damage, and reduce myocytes apoptosis. In Lipsic at al’s.31 study, the same dosage was used and similar results were obtained. Salient among Inhibitors,research,lifescience,medical the human experimental models, with lower doses of EPO, is a case-control study by Mocini et al.19 who used 40000 IU of EPO and found no differences in troponin I and CKMB levels in both EPO and control groups; the authors concluded that there might be a correlation Inhibitors,research,lifescience,medical between this result and the EPO dosage. In the present

study, we used 700 IU/kg of PD-Poietin, which was estimated to be equal to the EPO dosage in the Mocini et al.19 study. The optimal time for EPO infusion has yet to be fully elucidated. In some studies, EPO was infused 24 hours before ischemia and reperfusion.16,18 Resminostat In Lipsic et al’s.31 study, the effectiveness of EPO was measured according to the rate of apoptosis and percentage of active caspase-3 enzyme, and subsequently the time of EPO prescription was evaluated; it was concluded that the best time for EPO infusion was after the onset of reperfusion post ischemia during surgery. In Mocini et al’s.19 study, EPO was injected in the immediate pre-surgical period. In our study, we used EPO at the start of tissue reperfusion after aorta clamping. Therefore, as was mentioned before, further research is required to clearly determine the optimal time for EPO prescription in human experiments.

Competing interests The authors declare that they have no competing interests. Authors’ contributions TI, TI, TK, CN, TS, KT, SH, TN, TS, OT, TK, AH, and TS participated in the idea formation, study design, data analyses, interpretation of results and writing of the report. All the authors read and approved the final manuscript. Pre-publication history The pre-publication history for this paper can be accessed here: http://www.biomedcentral.com/1471-227X/13/24/prepub Acknowledgments We are greatly

indebted to all of the EMS personnel at the Osaka Municipal Inhibitors,research,lifescience,medical Fire Department and concerned physicians in Osaka City for their indispensable cooperation and support. Financial support This research was supported by a grant for Emergency Management Scientific Research from the Fire Disaster Inhibitors,research,lifescience,medical Management Agency (Study concerning strategy for applying the results of Utstein report for improvement of emergency service). The study sponsors had no involvement in the study design, in the collection, analysis and interpretation of data, in the writing of the manuscript or in the decision to submit the manuscript for publication.
Currently Inhibitors,research,lifescience,medical older persons

make up an important group of patients served by Emergency Departments (EDs). The elderly have higher rates of utilisation of emergency services than other patient groups; in developed countries, older people represent 12% to 21% of all ED encounters [1]. The proportion

of older people aged 60 years and over is expected to rise from 19% in Inhibitors,research,lifescience,medical 2000 to 34% by 2050 [2], resulting in a commensurate increase in ED presentations by older persons. Awareness of the connection between ED use and the health of older people, has led to an increased focus on the quality of geriatric emergency medical care and patient outcomes [3-5]. Emergency practice is FK866 order characterised by high volumes of high acuity and high complexity patients. This, Inhibitors,research,lifescience,medical combined with often-incomplete information and frequent interruptions, heptaminol creates an environment prone to error [6,7]. Older people have been identified as a particularly vulnerable population in ED, having substantially inferior clinical outcomes, with higher rates of missed diagnoses, and medication errors, when compared with younger, severity-matched controls [8-12]. Older persons discharged from ED are at high risk of adverse outcomes, such as functional decline, ED re-admission and hospitalisation, death, and institutionalisation [12-17]. While the quality of care for older people is a key issue, there may also be a need to consider older people with special needs as a separate sub-group as they may have some additional significant quality of care issues.

142 The results of these studies suggest that antipsychotic efficacy can be achieved in the absence of a direct effect on forebrain dopamine, an effect alluded to in earlier research showing a temporal disconnect between the behavioral effects of PCP and modulation of DA, but not glutamate, brain levels.126 Positive allosteric modulation of mGlu2 receptors Efforts to refine the mGlu2/3 agonists have focused upon finding a ligand that selectively activates mGlu2 receptors.

Discriminating between mGluR2 and mGluR3 subtypes has been difficult, as they share >90% sequence homology. Expression studies Inhibitors,research,lifescience,medical suggest mGluR2 are predominately localized to presynaptic sites,143 while mGluR3 are localized more postsynaptically and in glial cells.144 Using mGluR2-deficient mice, the apparent antipsychotic effects of mGluR2/3 agonists have been attributed to mGluR2 selleckchem activation.145,146 These studies demonstrate the potential for selective activiation of mGluR2; however, efforts to develop Inhibitors,research,lifescience,medical agonists of the glutamate-binding (orthosteric) site have not surprisingly fallen short. Recently, greater efforts have been undertaken to pursue ligands that activate the receptor through sites other than agonist binding site, termed allosteric sites. The success of these efforts illustrate that while the orthosteric site is highly conserved between

the two receptors, Inhibitors,research,lifescience,medical allosteric sites are located in less conserved regions of the receptor and can be selectively targeted to modulate agonist-induced signaling.147 Allosteric modulators can be either positive or negative in direction of activity, causing an increase or decrease, respectively, in the Inhibitors,research,lifescience,medical activity of orthosteric ligand induced signaling by altering agonist affinity and/or efficacy of G-protein coupling.148 In the case of mGlu2 receptors, efforts have been Inhibitors,research,lifescience,medical directed towards identifying

positive allosteric modulators (PAMs). To date, numerous PAMs haven been identified and shown to possess selective efficacy to enhance agonist activity at mGlu2 receptors with dramatic selectivity over other targets.135,149,150 These ligands increase the ability of endogenous glutamate and exogenous medroxyprogesterone agonists to reduce evoked excitatory postsynaptic potentials in brain slice preparations.135,139,149,151 Behavioral studies show that mGlu2 receptor PAMs possess efficacy similar to that of mGluR2/3 agonists, reducing PCP induced locomotion,134,135 decreasing fearpotentiated startle150,151 and diminishing hallucinogen-induced stereotypies.139 Interestingly, one study showed that one PAM, biphenyl-idanone A (BINA), was capable of uniquely reducing PCP-induced deficits in PPI. These studies demonstrate the validity and therapeutic potential of selectively targeting mGluR2. While issues of in vivo potency remain for currently available ligands, PAMs possess potential benefits.

Twenty patients were identified, representing 23 individual anatomic targets treated between May 2006 and April 2008. Details identified included radiation treatment specifications, pre- and post-SBRT CT/ [18F] fluorodeoxyglucose-positron emission tomography (FDG)-PET scans, serum liver function tests,

and follow-up clinic exams. A Whole-Body Vaclock (Med-Tec), a device that immobilizes the patient by creating a rigid, conformal mold around the patient’s body as well as utilizing straps around the patient, was used for each patient at the time of simulation. Next, a pancreatic protocol 3D CT scan was performed with the patient in the treatment position. If respiratory motion was anticipated, Inhibitors,research,lifescience,medical Inhibitors,research,lifescience,medical a 4D CT “gated” scan was performed using the Real-time Position Management system (Varian) and images were transferred to the 4D workstation (GE Medical) for motion analysis. The images from the CT scan (3D and/or gated) were then transferred from the workstation to the Eclipse Treatment Planning System (Varian) for stereotactic Inhibitors,research,lifescience,medical radiation planning. Response analysis The response rate and toxicity data were analyzed using Kaplan-Meier statistics.

Response to treatment was determined by comparing pre-SBRT and post-SBRT CT and FDG-PET scans at various intervals after SBRT. Each scan was individually reviewed, and tumor size measurements were Inhibitors,research,lifescience,medical determined by an individual PS-341 ic50 observer and compared to the official radiology report. Tumor size on CT was determined by the product of the maximal orthogonal diameters. Maximum SUV values were based on the

official report. Definitions of response were based on a combination of RECIST criteria and the revised lymphoma response criteria (20)-(22). Complete Response (CR) = complete resolution of FDG activity (to background levels) on PET with no increase in size on CT. Partial Response (PR) ≥ 30% decrease in diameter product of lesion on CT, with no increase in mean SUV on FDG-PET; or >10% decrease in mean SUV on PET with no increase in diameter Inhibitors,research,lifescience,medical product of lesion on CT. Progressive Disease (PD) ≥ 25% increase in diameter product of lesion on CT, or >10% increase in mean SUV on FDG-PET. Stable Disease (SD) = does not meet why criteria for CR, PR, or PD. Local Control (LC) = (CR + PR + SD). Follow-up clinical visits at 1 week and 1 month were used to asses for acute symptomatic toxicity. Acute GI toxicity was scored based on the Common Terminology Criteria for Adverse Events version 3.0. For patients with liver metastases, or those patients with target volumes encompassing any portion of the liver, serum liver function tests (AST, ALT, and alkaline phosphatase) were drawn pre-and post-SBRT at 1 week and 1 month per a related institutional phase I dose escalation protocol. Liver toxicity was graded according to the RTOG Cooperative Group Common Toxicity Criteria.

, St Joseph, MI). Detailed description of the pre-experimental procedures, blood sampling, sample preparation, derivatization and GC/TOFMS protocol are found in the supporting text. 4.2.Selection

of Representative Samples Two alternatives for the selection of representative sample subsets for data processing were investigated; (1) to base the selection on metadata and (2) to base the selection on already acquired analytical data (GC/TOFMS). The selection was based on the systematic variation captured in the meta- or analytical data by principal component analysis Inhibitors,research,lifescience,medical (PCA). Each sample subsets was selected so that the systematic variation in the original set was maintained in the best possible way [54,55,56]. 4.2.1. Subset Selection 1— Metadata The included human subjects were characterized by 34 metadata variables including age, weight, maximum pulse at pre-test, VO2peak, load at different percentage Inhibitors,research,lifescience,medical of VO2peak, serum glucose and hemoglobin levels (supporting table S5). The metadata variables were subjected to PCA and the inter-sample relationship was investigated for deviating observations before diversity-based selections were PLX4032 carried out. A subset was selected mimicking a representative Inhibitors,research,lifescience,medical selection of samples from a sample bank. The subset was separately analyzed by GC/TOFMS, resolved by means of H-MCR to obtain a reliable quantification and

identification of detected metabolites, i.e., a reference table of putative metabolites in the analyzed samples. The quantified metabolites in the reference table were analyzed by multivariate OPLS-DA classification modeling. The reference table based on the selected subset was then used to detect and quantify the metabolites in the in the remaining independently analyzed Inhibitors,research,lifescience,medical samples, i.e., predictive processing. 4.2.2. Subset Selection 2—Analytical data Acquired GC/TOFMS data for all samples from test occasion one and two

were subjected to hierarchical multivariate data compression [32], providing a fast and crude description of the compositional differences among the Inhibitors,research,lifescience,medical samples while retaining the systematic variation in the data. PCA was applied to the resulting intensity vector data. The inter-sample relationship was investigated for deviating observations before diversity-based selections were carried out. The selection was performed using a space-filling design which maximizes the minimum Euclidean distance between the nearest neighbors of the selected observations [57], thus PDK4 maximizing the variation in all properties in the original space. Pre- and post- exercise samples corresponding to the selected subset were then resolved to create a metabolite reference table by means of H-MCR and multivariately classified using OPLS-DA. The reference table based on the selected subset was then used to detect and quantify the metabolites in the in the remaining samples, i.e., predictive processing. 4.3.

They concluded that the atypical antipsychotics’ apparent advantage in terms of EPSs was not enough to improve their overall tolerability or to warrant recommending them as first-line treatments. To summarize the existing Transferase inhibitor evidence, it is reasonably clear that, atypical antipsychotics are at least, as effective as the conventional antipsychotics in reducing positive symptoms in patients with schizophrenia. Claims that they are superior in reducing Inhibitors,research,lifescience,medical positive symptoms have not yet been proven.21,22 Olanzapine and risperidone appear to be slightly more effective than conventional antipsychotics in reducing negative symptoms, but it is not

clear whether this is due to a direct therapeutic effect or to less frequent EPSs or other secondary causes of negative symptoms.21 Long-term trials of the effectiveness of atypical

antipsychotics in reducing negative symptoms are needed.7 Existing studies have found that atypical antipsychotics cause fewer EPSs than their Inhibitors,research,lifescience,medical conventional counterparts, especially when the conventional comparator is haloperidol. In spite of marketing claims, studies of effects Inhibitors,research,lifescience,medical on cognitive function are wholly inconclusive, as are studies of the effects on mood symptoms. The effects of these drugs on long-term outcome, relapse prevention, social and vocational functioning, suicide prevention, quality of life, and family and caregiver

burden have just begun to be explored. Although first introduced only in the mid-1990s, risperidone, Inhibitors,research,lifescience,medical olanzapine, and quetiapine now account for more than half the new antipsychotic prescriptions in the USA and Canada. The rates of usage vary in Europe, Asia, and South America from as low as 5% to as much as 40%. Patients who had inadequate therapeutic responses to conventional antipsychotics or who suffered problematic side effects were the first to be switched to the atypical antipsychotics. Now, however, many newly diagnosed or first-episode Inhibitors,research,lifescience,medical patients are initially prescribed these newer agents with the hope (not yet backed by evidence) of giving them every early advantage.27 Worldwide, many patients with schizophrenia, continue treatment Dichloromethane dehalogenase with the conventional antipsychotics. Because there are no long-acting atypical preparations yet available, conventional antipsychotics in a long-acting injectable form retain an important role for patients who cannot, adhere to oral regimens. (At the beginning of 2001, a long-acting version of risperidone was in phase 2 trials.) Atypical antipsychotic medications are several times more expensive than conventional antipsychotics in the USA, averaging $5000 or more per patient per year. Thus, these medications have substantial potential for influencing the use of scarce resources.

Results Clinical this website diagnosis To provide a comparison for the accuracy of imaging data, and evaluate its cost-benefit characteristics, we first provide information on the accuracy of clinical diagnosis against postmortem neuropathology. Simple screening measures, such as the Mini-Mental

State Examination (MMSE), often provide good diagnostic accuracy. For example, Muller et al and Wahlund et al reported reasonable sensitivity and specificity values for the MMSE alone and in combination with a verbal recall test.12,13 More informative results were obtained with standardized clinical measures when validated against neuropathological diagnosis. In Inhibitors,research,lifescience,medical Jobst et al, 200 affected cases were compared with normal controls by standardized clinical measures, and then validated with histopathologic diagnosis.14 Using NINCDS Inhibitors,research,lifescience,medical possible or probable AD criteria, Jobst et al reported a maximum sensitivity of 96%, with associated specificity of 61 %. In the same study, the use of DSM-III-R criteria applied to

the same study groups resulted in a sensitivity of 51%, and specificity of 97%. Other authors, Inhibitors,research,lifescience,medical noted in Table I, obtained similar results.15-21 Overall, the range of sensitivity of clinical diagnosis was 39% to 98%, and the range of specificity was 33% to 100%. There was a significant negative correlation (r = -0.79, P=0.01) between sensitivity and specificity, Inhibitors,research,lifescience,medical as expected, reflecting the necessary tradeoff. Thus, for instance, to achieve

a specificity greater than 80%, four out. of five studies had to settle for sensitivity lower than 70%. This correlation is depicted in Figure 1 Figure 1. Sensitivity and specificity of clinical diagnosis against neuropathological diagnosis. Table I. Sensitivity and specificity of clinical measurements. AD, Alzheimer’s disease; CERAD, CERAD (Consortium to Establish a Registry for Alzheimer Disease) probable or definite AD (neuropathology); Other, other neuropathological review; DSM-III-R, Inhibitors,research,lifescience,medical Diagnostic … A number of studies used the criteria “NINCDS possible or probable AD” or other nonstandard clinical measures (data not shown). 14-18,20,22-27 While clinical diagnosis is often see more used to validate imaging findings, and neuro-pathological diagnosis is the overall “gold standard,” and despite the existence of modern standardized criteria, the application of these standards should not be considered free of ambiguity. A good example is provided by Hoffman et al.15 The clinical NINCDS criteria allow the definition of probable or possible AD, reflecting different, degrees of confidence. The Consortium to Establish a Registry for Alzheimer Disease (CERAD) pathological criteria allow the finding of “pure” AD or AD in addition to other pathology.

28). Controlling for age and IQ To control for the potential confounding effects of subject age and estimated IQ, partial correlation analyses between dACC Glu/Cr, resting state dACC signal, rs-FC of the dACC, and delay discounting with age and IQ as covariates were carried out. After controlling for age or IQ, dACC Glu/Cr was still significantly correlated with DDT scores, dACC rs-FC with the midbrain, and rs-FC

of dACC with the left and right PCC (all P-values < 0.04). DDT scores were still significantly correlated with rs-FC of the dACC with the midbrain after controlling for age (P = 0.004) and Inhibitors,research,lifescience,medical IQ (P = 0.002). Discussion Our study Inhibitors,research,lifescience,medical is the first to combine evidence from ¹H MRS and rs-fMRI to predict individual differences in impulsive decision making in healthy volunteers. We found evidence that individual differences in impulsive decision making are learn more associated with dACC function under task-free conditions in terms of glutamate concentrations and resting state functional connectivity. Inhibitors,research,lifescience,medical In line with previous research (Hoerst et al. 2010), we found that higher impulsivity was associated with higher glutamate concentrations in the dACC. Dorsal ACC glutamate concentrations were also found to be increased in untreated children with ADHD, a disorder characterized by impaired impulse control (Hammerness et al. 2012).

Inhibitors,research,lifescience,medical In addition, increased functional coupling between the left dACC and a midbrain region including VTA and SN was associated with

steeper discounting of delayed rewards, whereas a negative functional coupling was associated with less discounting and therefore lower impulsive decision making. Our findings of an association between resting state functional connectivity between dACC and the midbrain and impulsivity are consistent with a previous study of Tian et al. Inhibitors,research,lifescience,medical (2006) who showed increased resting state connectivity between dACC and the midbrain in adolescents with ADHD, a disorder characterized by high levels of impulsivity. already In addition, a task-related fMRI study of Diekhof and Gruber (2010) found that preference for immediate rewards was associated with increased functional coupling between the PFC and the midbrain. The stronger interaction between brain regions involved in decision strategy (dACC) and subjective valuation of rewards (midbrain) under rest in high impulsive subjects as observed in the current and above mentioned studies might indicate a potential trait marker for impulsive decision making, especially because low impulsive decision making was associated with no or even a negative coupling between the left dACC and the midbrain. In addition, the current study suggests that this increased functional coupling between the dACC and the midbrain might be driven by glutamate neurotransmission.

Consequently, the approach for neoadjuvant chemoradiation therapy prior to pancreaticoduodenectomy is gaining wider acceptance and more patients with pancreatic cancer will require pre-operative biliary drainage in the future. Current data unequivocally supports the use of SEMS for patients presenting with malignant biliary obstruction due to potentially resectable pancreatic cancer

undergoing neoadjuvant chemoradiation therapy. On the other hand, for patients who have Inhibitors,research,lifescience,medical resectable pancreatic cancer, many centers may consider to proceed with curative surgery upfront. In such cases where patients may be undergoing curative surgery without neoadjuvant therapy, SEMS or any other stents may not be warranted. Lastly, when the stage of disease Inhibitors,research,lifescience,medical and treatment plan are not completely defined at the time of diagnosis, the vast majority of patients with symptomatic malignant distal

bile duct obstruction may be best served by placement of SEMS rather than a plastic stent at the initial endoscopic intervention, due to the superior patency, lower rate of Inhibitors,research,lifescience,medical complications, and cost-effectiveness of SEMS. Acknowledgements Disclosure: The authors declare no conflict of interest.
A 27 year-old Hispanic female G1P0202 presented to the emergency room with severe abdominal pain. She described a 2 day history of worsening intermittent “crampy” pain located in the periumbilical region that was exacerbated with touch. She also reported 3 episode of non-bloody vomiting earlier that day. Review of systems was unremarkable. Past medical and surgical histories revealed a caesarean section of twins one month prior for premature rupture of membranes at 35 weeks. She denied any social or family histories. Vitals were within normal Inhibitors,research,lifescience,medical limits. The abdomen was soft with normal bowel sounds and focal tenderness BX795 elicited on palpation

of the right lower quadrant. On deep palpation a 3 cm hardened mass was found in the right periumbilical area. Laboratory findings revealed leukocytosis Inhibitors,research,lifescience,medical of 11.9 K (4.5-11.0 k/mm3). Complete blood count, coagulation profile, urine pregnancy, and basic (-)-p-Bromotetramisole Oxalate metabolic panel were unremarkable. Liver related tests were mildly elevated: ALT-113 (0-31 U/L), AST-76 (0-32 U/L), alkaline phosphatase of 124 (39-117 U/L), total bilirubin of 1.2 (0.0-1.0 mg/dL). A CT of the abdomen/pelvis with oral and IV contrast revealed possible volvulus. A repeat CT of the abdomen/pelvis with rectal contrast was then ordered for further characterization demonstrating a suspicious rounded area of low attenuation with peripheral high density (appendix) as a lead point consistent with an intussusception (Figures 1,​,2).2). The patient was taken to the operating room where an exploratory laparotomy was performed urgently to relieve the intussusception. A midline excision was made extending from the xiphoid to the pubic symphysis. The uterus, fallopian tubes, and ovaries appeared grossly normal.