Adrenal Biopsy under Wide-Bore MR Imaging Guidance

Twenty-four magnetic resonance (MR) imaging–guided percutaneous adrenal biopsies performed between April 2009 and October 2016 were reviewed retrospectively. Epidemiologic, procedural, and histopathologic data were retrospectively collected. Mean size of tumors was 4.3 cm (range, 1.5–16.0 cm). Mean procedure time was 49 min (range, 24–95 min). Mean needle angulation was 27.7° (range, 0°–60°). Mean depth was 9.6 cm (range, 5.8–13.7 cm). The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of MR imaging–guided biopsy were 95.5%, 100%, 100%, 66.7%, and 95.8%, respectively. There were no immediate or delayed complications. MR imaging guidance seems safe and accurate to target adrenal-gland masses.     

The association between smoking status and hospital length of stay: evidence from a hospital-based cohort

Objectives: Smoking is recognized as one of the main preventable causes of mortality and morbidity that imposes a high financial burden on healthcare systems and society. This study aimed to examine the association between smoking status and hospital length of stay (LOS) among patients with lung cancer (LC), chronic obstructive pulmonary disease (COPD) and ischemic heart diseases (IHD) in Iran in 2014.

Methods: A total of 1271 patients (415 LC patients, 427 COPD patients and 429 IHD patients) were included in the study. Data on age, sex, insurance status and LOS was extracted from the patients’ medical records and smoking status was obtained from the patients using telephone survey. The LOS among current smokers, former smokers, and nonsmokers was compared using a zero-truncated poisson regression. Analysis was done using STATA v.12.

Results: The mean LOS for current smokers, former smokers and nonsmokers was 9.4±8.4, 7.3 ±5.3 and 6.02±5.05 days, respectively. The unadjusted and adjusted probabilities of LOS for current smokers and former smokers were 56% and 21% and 48% and 15% higher, respectively, than when compared with the nonsmoker category.

Conclusion: The study demonstrated longer LOS for the current and former smokers, contributing to the drain on large hospital resources in Iran. The results of the study provide useful information for health-policy makers that contribute to the planning and designing of smoking cessation interventions in this area.     

Influence of dTMP on the phenotypic appearance and intracellular persistence of Staphylococcus aureus

Thymidine-dependent small-colony variants (SCVs) of Staphylococcus aureus are frequently associated with persistent and recurrent infections in cystic fibrosis patients. The phenotypic appearance of S. aureus SCVs or normal-colony variants (NCVs) is postulated to be affected by the intracellular amount of dTMP. This hypothesis was proven by metabolic pathway assays revealing altered intracellular dTMP concentrations, followed by investigation of the associated phenotype. Inhibition of the staphylococcal thymidylate synthase, which generated intracellular dTMP from dUMP, using 5-fluorouracil and co-trimoxazole resulted in an SCV phenotype. Inhibition of a nucleoside transporter, which provided the bacterial cell with extracellular thymidine, caused growth inhibition of SCVs. In turn, reversion of SCVs to NCVs was achieved by supplying extracellular dTMP. High-performance liquid chromatography additionally confirmed the intracellular lack of dTMP in SCVs, in contrast to NCVs. Moreover, the dTMP concentration is postulated to influence the intracellular persistence of S. aureus. Cell culture experiments with cystic fibrosis cells revealed that clinical and co-trimoxazole-induced SCVs with a diminished amount of dTMP showed significantly better intracellular persistence than NCVs. In conclusion, these results show that the dTMP concentration plays a key role in both the phenotypic appearance and the intracellular persistence of S. aureus.     

Clodronate inhibits the secretion of proinflammatory cytokines and NO by isolated microglial cells and reduces the number of proliferating glial cells in excitotoxically injured organotypic hippocampal slice cultures

Treatment of excitotoxically injured organotypic hippocampal slice cultures (OHSC) with clodronate is known to result in the inhibition of microglial activation. We hypothesized that this is due to direct effects of clodronate on microglial cells, and investigated microglial proliferation in OHSC, and cytokine and NO secretion in isolated microglial cells. N-methyl-D-aspartate (NMDA) lesioning of OHSC resulted in a massive increase in the number of proliferating, bromo-desoxy-uridine (BrdU)-labeled cells that was reduced to control levels after treatment with clodronate (0.1, 1, 10 microg/ml). Triple-labeling revealed that clodronate abrogated the proliferation of both glial fibrillary acidic protein (GFAP)-labeled astrocytes and Griffonia simplicifolia isolectin B4 (IB4)-labeled microglial cells. Furthermore, isolated microglial cells were treated with clodronate after stimulation with lipopolysaccharide (LPS) or macrophage colony stimulating factor (M-CSF). Clodronate (0.01, 0.1, 1 microg/ml) significantly down-regulated the LPS-stimulated microglial secretion of tumor necrosis factor (TNF)-alpha, Interleukin (IL)-1beta and NO, but not of IL-6. In contrast, clodronate significantly reduced the microglial IL-6-release induced by M-CSF, indicating different intracellular pathways. The number and morphology of isolated microglial cells did not change significantly after treatment with clodronate. In summary, the number of proliferating microglial cells and astrocytes after excitotoxic injury is reduced to control levels after treatment with clodronate. Furthermore, clodronate inhibits microglial secretion of proinflammatory cytokines and NO. Clodronate could therefore prove to be a useful tool in the investigation of interactions between damaged neurons and microglial cells.     

Evaluation of the effectiveness of anterior transposition of the inferior oblique muscle in dissociated vertical deviation with or without inferior oblique overaction

PURPOSE: Anterior transposition of the inferior oblique muscle (ATIO) has been reported to be an effective treatment for dissociated vertical deviation (DVD). In this study, we evaluated the effectiveness of this surgical procedure in patients with DVD alone and in those with DVD with concurrent overactive inferior oblique muscle and compared the results. METHODS: Nineteen eyes with DVD alone (group 1) and 15 eyes with DVD and concurrent inferior oblique overaction (group 2) underwent ATIO. The amount of DVD and inferior oblique overaction before and after the operation was measured and statistically analyzed. RESULTS: The average follow-up time for group 1 and group 2 was 9.4 and 9.0 months, respectively. Of a total of 34 eyes, 7 had DVD of more than 15 prism-diopters (pd) [four eyes from group 1 and three eyes from group 2] in which the residual DVD after surgery was more than 5 pd. However, in the 27 eyes with DVD of 15 pd or less (15 from group 1 and 12 from group 2), the residual DVD after the operation was less than 5 pd. (Fisher's exact test, P = .014). CONCLUSION: ATIO is an effective method for correcting DVD with and without inferior oblique overaction, especially in deviations of less than 15 pd.     

The immunosuppressant mycophenolate mofetil improves preservation of the perforant path in organotypic hippocampal slice cultures: a retrograde tracing study

Previous studies with excitotoxically lesioned organotypic hippocampal slice cultures (OHSC) have revealed that the immunosuppressant mycophenolate mofetil (MMF) inhibits microglial activation and suppresses neuronal injury in the dentate gyrus. We here investigate whether MMF also has beneficial effects on axon survival in a long-range projection, the perforant path. Complex OHSC including the entorhinal cortex were obtained from Wistar rats (p8); the plane of section ensuring that perforant path integrity was preserved. These preparations were cultured for 9 days in vitro with or without MMF (100 microg/ml). After fixation, the perforant path was retrogradely labeled by application of the fluorescent dye DiI (1,1'-dioctadecyl-3,3,3',3'-tetramethylindo-carbocyanine) in the hilus of the dentate gyrus, and neuronal perikarya were immunohistochemically stained by the neuron-specific marker NeuN. Analysis of DiI-labeled and NeuN-stained OHSC by confocal laser scanning microscopy revealed double-labeled neurons in the entorhinal cortex, which projected to the dentate gyrus via the perforant path. Quantitative analysis showed that the number of these double-labeled neurons was 19-fold higher in OHSC treated with MMF than in control cultures (P < 0.05). Our findings indicate that MMF treatment improves preservation of the perforant path and encourage further studies on development and regeneration of long-range projections under the influence of immunosuppressants.     

Rapid immunohistochemical detection of tumor cells in gastric carcinoma

The detection of single tumor cells or tumor cell clusters represents an important issue in intraoperative frozen section analysis. For example, surgical margins may be evaluated in order to minimize the number of additional operations. Furthermore, intraoperative diagnosis of lymph node micrometastasis (LNM) may help to define the area of appropriate lymph node dissection. In addition to haematoxylin and eosin (H&E)-stained sections, immunohistochemical detection of single tumor cells or cell clusters may be helpful in this context. The aim of this study was to evaluate the clinical significance, reliability and sensitivity of intraoperative rapid immunostaining of frozen sections. Therefore, we compared the results of rapid immunohistochemical staining of frozen sections and paraffin sections applying the EnVision and Histofine(R) detection systems. In a prospective immunohistochemical study, paraffin and frozen sections of 20 gastric cancer specimens were analyzed. Paraffin as well as frozen sections were stained immunohistochemically applying the EnVision and Histofine detection systems. As primary antibodies, AE1/AE3 (anti-cytokeratin), EMA (anti-MUC1) and B lymphocyte marker anti-CD20 were applied. The rapid immunostaining procedure was able to be completed within 10-13 min. Rapid immunohistochemical staining of frozen and paraffin sections of the same tumors resulted in comparable immunoreactivity. The rapid EnVision and Histofine procedures allowed immunostaining of frozen sections in less than 13 min. These methods can represent useful additional tools in routine surgical pathology and research, enabling a more accurate frozen section diagnosis compared to staining with H&E alone. Intraoperative rapid immunostaining can be a simple and useful technique to detect LNM.