Duodenal and Rectal Hematomas Complicating Endoscopic Biopsy

Objective. Intramural duodenal hematomas (IDHs) after nontherapeutic endoscopic biopsy are rare. Rectal hematomas (RHs) have not been reported previously. A review of the literature revealed 18 cases of IDHs. Methods. We reviewed 3 cases that occurred within a 4‐month period at our institution. Results. We report a series of 3 cases occurring within a 4‐month period. In addition, we report a concurrent RH in 1 of these cases. After becoming symptomatic, 2 of these patients had a diagnosis by computed tomography, the third by sonography. All patients had conservative management and were followed with sonography. Conclusions. Sonography was found to be an accurate, safe, and nonionizing way to diagnose and follow hematomas in pediatric patients.     

Favipiravir for the treatment of COVID-19 in elderly patients—what do we know after 2 years of COVID-19?

GeroScience - Since the appearance of coronavirus disease 2019 (COVID-19), numerous studies have been conducted to find effective therapeutics. Favipiravir (FVP) is one of the repurposed drugs...     

Granulosa cell production of anti-Müllerian hormone is increased in polycystic ovaries

CONTEXT: There has been renewed interest in anti-Müllerian hormone (AMH) because of its role in the ovary. Data on its actions are sparse, but it appears to inhibit follicle growth. Interestingly, serum AMH is two to three times higher in women with polycystic ovary (PCO) syndrome than women with normal ovaries. OBJECTIVE: We examined the production of AMH by cells from a range of follicle sizes from normal ovaries and compared this with production by ovulatory and anovulatory (anov) PCOs. DESIGN: Granulosa cells (GCs) and theca and follicular fluid (ff) were isolated from intact follicles. Cells were cultured for 48 h +/- FSH or LH, and AMH was measured in ff and cell-conditioned media (CM). RESULTS: AMH levels in ff and GC-CM ranged from 42 to 2240 and 0.025 to 1.7 ng/ml, respectively, and were low or undetectable in ff and GC-CM from follicles greater than 9 mm, luteinized cells, and theca and stroma. The mean level of AMH was four times higher in GC-CM from ovulatory PCOs [mean (range) 1.56 (0.025-7)] and 75 times higher from anovPCO [21.4 (17.2-43 ng/ml)] than normal ovaries [0.37 (0.025-1.7)]. Neither LH nor FSH had an effect on AMH production by GCs from normal ovaries, but in cells from PCOs, FSH significantly decreased AMH, and in contrast, LH increased AMH. CONCLUSIONS: The reduction of AMH in follicles greater than 9 mm from normal ovaries appears to be an important requirement for the selection of the dominant follicle. AMH production per GC was 75 times higher in anovPCOs, compared with normal ovaries. This increase in AMH may contribute to failure of follicle growth and ovulation seen in polycystic ovary syndrome.     

Mesenchymal stem cells inhibit dendritic cell differentiation and function by preventing entry into the cell cycle

BACKGROUND: Mesenchymal stem cells (MSCs) play a crucial role in hematopoietic development and have been shown to exert a powerful immunosuppressive effect. In this study, we investigated the effect of bone marrow MSC on the differentiation and function of peripheral blood monocytes into dendritic cells (DCs). METHODS: Human MSCs, generated from normal bone marrow, were added to peripheral blood monocytes stimulated in vitro with granulocyte-macrophage colony stimulating factor and interleukin-4 to become DCs. Monocytes were then examined for the expression of markers characteristic of DCs and their ability to stimulate allogeneic T cells. In addition, the effect of MSCs on the cell cycle of monocyte-derived DCs and the expression of various cell cycle proteins were analyzed by cytometric analysis and Western blotting with specific antibodies. RESULTS: MSCs blocked the differentiation of monocytes into DCs and impaired their antigen-presenting ability. This resulted from a block of monocytes from entering the G1 phase of the cell cycle with a progressive number of cells accumulating in the G0 phase. Cyclin D2 was downregulated. However, differently from what was observed in T-cells stimulated in the presence of MSCs, the expression of p27 was found decreased, suggesting the involvement of similar but not identical pathways. CONCLUSIONS: We conclude that MSCs impair monocyte differentiation and function by interfering with the cell cycle. These findings imply that MSC-induced immunosuppression might be a side product of a more general antiproliferative effect.     

Automated respiratory inductive plethysmography to evaluate breathing in infants at risk for postoperative apnea

Purpose: Although respiratory inductive plethysmography (RIP) is the method of choice for the assessment of sleep disordered breathing, it has not been applied to the study of infants at risk for postoperative apnea (POA). The purpose of this study was to apply RIP to evaluate breathing in these infants. An additional purpose was to implement, simultaneously, three novel algorithms to detect movement artifact, respiratory pauses, and thoracoabdominal asynchrony, since their combined output both detects respiratory pauses and classifies them as obstructive or central in origin. Methods: A prospective study design was employed to record the analogue output of RIP, saturation, and finger plethysmography in a convenience sample of infants. The data record underwent a dual analysis: 1) automated detection of respiratory events; and 2) visual coding of the cardiorespiratory data. A novel index, coined pause density, was calculated as the sum of all respiratory pauses. Results: Twenty infants, whose mean postconceptional ages and weights were 44.47±2.88 weeks and 4.21±0.99 kg, respectively, were recruited. Data recording ranged from four to 24 hr. Ten infants (term=5) experienced POA: central apnea=5, mixed obstructive apnea=6, and two former premature infants experienced both. Twenty-five central apneic events were detected, and the majority followed a sigh. Infants who experienced apnea also had high values of pause density. Conclusion: Respiratory inductive plethysmography may provide a useful method to evaluate breathing in infants at risk for POA. The study of short respiratory pauses may prove useful in predicting apnea risk.     

Phenomenology of children and adolescents with bipolar spectrum disorders

CONTEXT: Children and adolescents who present with manic symptoms frequently do not meet the full DSM-IV criteria for bipolar I disorder (BP-I). OBJECTIVE: To assess the clinical presentation and family history of children and adolescents with BP-I, bipolar II disorder (BP-II), and bipolar disorder not otherwise specified (BP-NOS). DESIGN: Subjects and their primary caretaker were assessed by semistructured interview, and family psychiatric history was obtained from interview of the primary caretaker. SETTING: Outpatient and inpatient units at 3 university centers. PARTICIPANTS: A total of 438 children and adolescents (mean +/- SD age, 12.7 +/- 3.2 years) with BP-I (n = 255), BP-II (n = 30), or BP-NOS (n = 153). MAIN OUTCOME MEASURES: Lifetime psychiatric history and family history of psychiatric disorders. RESULTS: Youth with BP-NOS were not diagnosed as having BP-I primarily because they did not meet the DSM-IV duration criteria for a manic or mixed episode. There were no significant differences among the BP-I and BP-NOS groups in age of onset, duration of illness, lifetime rates of comorbid diagnoses, suicidal ideation and major depression, family history, and the types of manic symptoms that were present during the most serious lifetime episode. Compared with youth with BP-NOS, subjects with BP-I had more severe manic symptoms, greater overall functional impairment, and higher rates of hospitalization, psychosis, and suicide attempts. Elevated mood was present in 81.9% of subjects with BP-NOS and 91.8% of subjects with BP-I. Subjects with BP-II had higher rates of comorbid anxiety disorders compared with the other 2 groups and had less functional impairment and lower rates of psychiatric hospitalization than the subjects with BP-I. CONCLUSIONS: Children and adolescents with BP-II and BP-NOS have a phenotype that is on a continuum with that of youth with BP-I. Elevated mood is a common feature of youth with BP-spectrum illness.     

An improved method for the estimation of firing rate dynamics using an optimal digital filter

In most neural systems, neurons communicate by means of sequences of action potentials or 'spikes'. Information encoded by spike trains is often quantified in terms of the firing rate which emphasizes the frequency of occurrence of action potentials rather than their exact timing. Common methods for estimating firing rates include the rate histogram, the reciprocal interspike interval, and the spike density function. In this study, we demonstrate the limitations of these aforementioned techniques and propose a simple yet more robust alternative. By convolving the spike train with an optimally designed Kaiser window, we show that more robust estimates of firing rate are obtained for both low and high-frequency inputs. We illustrate our approach by considering spike trains generated by simulated as well as experimental data obtained from single-unit recordings of first-order sensory neurons in the vestibular system. Improvements were seen in the prevention of aliasing, phase and amplitude distortion, as well as in the noise reduction for sinusoidal and more complex input profiles. We review the generality of the approach, and show that it can be adapted to describe neurons with sensory or motor responses that are characterized by marked nonlinearities. We conclude that our method permits more robust estimates of neural dynamics than conventional techniques across all stimulus conditions.