Congenital high airway obstruction syndrome (CHAOS): Natural history,prenatal management strategies,and outcomes at a single comprehensive fetal center

PurposeCongenital high airway obstruction syndrome (CHAOS) is a devastating fetal condition of complete airway discontinuity resulting in significant hydrops and extreme lung hyperplasia. It is universally fatal with survival reported only in the rare spontaneous fistulization or EXIT intervention (Ex Utero Intrapartum Treatment). Even in these cases, mortality remains high, and current investigations are targeting prenatal interventions. This report describes our experience with management and fetal interventions for CHAOS, including laser laryngotomy.MethodsWe retrospectively reviewed all patients diagnosed with CHAOS at a single academic institution between 2006 and 2017.ResultsFifteen patients were identified. Eight had obstruction at the trachea and seven at the larynx. In the laryngeal obstructions, three expired shortly after birth, and one survived after spontaneous fistulization and subsequent EXIT to tracheostomy. The remaining three underwent in-utero treatment with laser laryngotomy. One had preterm premature rupture of membranes (PPROM), delivered 3 days post-operatively, and died. Two underwent EXIT to tracheostomy with one surviving to discharge and is currently 2 years old.ConclusionOur study demonstrates the outcomes of a large series of patients diagnosed with CHAOS. While mortality remains high, options for fetal intervention are being explored to allow alterations in the prenatal natural history and improve postnatal outcomes.Type of StudyRetrospective Treatment Study.Level of EvidenceLevel IV.     

自噬在高糖条件下视网膜色素上皮细胞表达血管内皮生长因子促进RF/6A细胞血管生成中的作用

目的　研究高糖条件下诱导的人视网膜色素上皮细胞株（ARPE-19）自噬对其表达血管内皮生长因子（vascular endothelial growth factor，VEGF），及恒河猴脉络膜视网膜血管内皮细胞（RF/6A）迁移和管腔形成的影响。方法　根据不同干预将ARPE-19细胞随机分为对照组、高糖组及3-甲基腺嘌呤（3-MA）+高糖组。对照组细胞在无糖DMEM培养基中常规培养24 h，高糖组细胞在DMEM培养基中加入30 mmol·L^-1葡萄糖溶液处理24 h，3-MA+高糖组细胞先用10 mmol·L^-1 3-MA处理24 h，然后更换培养基再加入30 mmol·L^-1葡萄糖溶液处理24 h。Western blot法检测细胞自噬标志性蛋白微管相关蛋白1 轻链 3（microtubule-related protein 1 light chain 3，LC3）II型和I型的比值(LC3-II/LC3-I)、Beclin-1及细胞中自噬相关基因3（autophagy-related gene 3，Atg3）的蛋白表达。ELISA法检测ARPE-19细胞上清液中VEGF的蛋白表达。比较三组ARPE-19细胞LC3-II/LC3-I、Beclin-1、Atg3及VEGF的蛋白表达量。然后将以上三组ARPE-19细胞上清液分别加入RF/6A细胞培养基中，将RF/6A细胞也按以上方法分组，分别采用Transwell法及Matrigel胶法检测并比较三组RF/6A细胞迁移数及细胞管腔形成数。结果　对照组、高糖组和3-MA+高糖组ARPE-19细胞中LC3-II/LC3-I比值分别为0.405±0.095、0.932±0.024和0.635±0.048；Beclin-1蛋白相对表达量分别为0.205±0.035、0.590±0.120和0.425±0.082；Atg3蛋白相对表达量分别为0.277±0.035、0.539±0.071和0.389±0.019。ARPE-19细胞上清液中VEGF的蛋白表达量三组分别为（44.03±9.08）ng·L^-1、（205.70±17.90）ng·L^-1和（112.52±21.06）ng·L^-1；RF/6A细胞迁移数三组分别为（125.60±6.35）个、（153.60±19.20）个和（67.40±7.95）个；细胞管腔形成数三组分别为（12.22±0.84）个、（18.44±1.68）个和（5.44±0.51）个；整体比较差异均有统计学意义（均为P<0.01）。与对照组相比，高糖组ARPE-19细胞的LC3-II/LC3-I比值、Beclin-1及Atg3蛋白相对表达量均明显增加（均为P<0.01），VEGF表达水平均明显升高（P<0.01），RF/6A细胞迁移数和管腔形成数均明显增加（均为P<0.01），3-MA+高糖组ARPE-19细胞中LC3-II/I比值、Beclin-1和Atg3蛋白相对表达量、VEGF表达量、RF/6A细胞迁移数和细胞管腔形成数均较高糖组明显降低（均为P<0.01）。结论　高糖激活ARPE-19细胞自噬，进而上调VEGF的表达并促进RF/6A细胞迁移和管腔形成，自噬抑制剂3-MA可抑制ARPE-19细胞自噬，并下调VEGF的表达从而抑制RF/6A细胞的血管形成能力。     

Fertility Outcome After Renal Transplantation: A Single-Center Experience

BackgroundWomen suffering from kidney disease are more prone to fertility problems, due to uremia. Fortunately, their fertility rate increases dramatically after renal transplantation. This study analyzes the predictors/risk factors of successful pregnancy with live birth outcome while presenting an overview of the 7-year experience of a single center.MethodsThis retrospective cohort study includes 239 women of reproductive age (18–40 years) who underwent renal transplantation in a tertiary Turkish clinic between October 1, 2011, and August 24, 2017. The subjects were invited to take part in a survey questioning their obstetric characteristics and they were assessed in 2 groups: fertile and infertile. Multivariable linear regression analysis was conducted to determine the predictors of a successful pregnancy.ResultsThirty-five 35 patients wished to become pregnant: 12 got pregnant spontaneously, while 21 failed to become pregnant (spontaneously). The mean age of the patients at the survey was 34 ± 7. Regular menstrual cycles after renal transplantation, tacrolimus-mycophenolate mofetil maintenance protocol, and age at transplantation were found to be predictors of spontaneous pregnancy. The duration of peritoneal dialysis was significantly longer in the infertile group (48 vs 12 months).ConclusionEnd-stage renal disease's negative impacts, including menstrual abnormality and fertility problems, can be overcome by successful kidney transplantation with appropriate immunosuppression. Minimizing the duration of peritoneal dialysis, particularly in patients who desire future fertility, may be accepted as a logical management strategy.     

An ultrasonographic monitoring of skin condition in patients receiving radiotherapy for head and neck cancers

Radiodermatitis is one of the commonest side effects of radiotherapy. They are usually assessed by semi‐quantitative clinical scores, which are not validated and may be subject to inter‐observer variability. A few previous studies suggested that high‐frequency ultrasonography (HF‐USG) is useful in the assessment of the acute phase of radiation dermatitis in breast cancer patients. (a) To monitor skin changes by HF‐USG during the course of radiotherapy due to head and neck cancers, and (b) to determine whether there is any connection between skin sonograms and the skin scoring criteria. This prospective, observational study includes patients diagnosed with head and neck cancers, treated with radiotherapy or concomitant chemoradiation. The final analysis includes six patients. In every patient, the HF‐USG as well as dermatological assessment (target lesion score—TLS and CACE v. 4.0) were performed 4×: before, in the middle, day after, and 3 months after radiotherapy. There were significant differences between non‐irradiated skin thickness and thickness of skin with clinically obvious radiodermatitis (TLS grade 1‐4; P < .0001), as well as between irradiated, unchanged skin thickness (TLS grade 0) and thickness of skin with clinically obvious radiodermatitis (TLS grade 1‐4; P = .0002). There was no significant difference between non‐irradiated and irradiated, unchanged skin thickness (TLS grade 0; P = .9318). In four patients, we demonstrated subepidermal low echogenic band (SLEB). HF‐USG can be useful tool to noninvasive and objective assessment of skin changes during radiotherapy.     

OCTA在评估高度近视眼底形态及血流变化中应用的研究进展

近视是世界范围内发病率最高的眼部疾病，且发病原因尚不明确，是全球关注的公共卫生问题。高度近视眼及其眼底并发症严重影响视功能。光学相干断层扫描血管成像（OCTA）技术是一种对视网膜、脉络膜自动精确分层，通过量化血流面积、无血流面积和血流密度区域，对视网膜、脉络膜多层面进行定性、定量的研究手段。应用OCTA，可对高度近视眼的发病机制从视网膜各层次微血管层面进行深入研究。笔者就高度近视眼底形态改变以及OCTA在评估高度近视眼底结构、功能及血流密度变化中的应用进行综述，期望为高度近视发病机制探究及干预提供指导。     

Protection of White Leghorn chickens by recombinant fowlpox vector vaccine with an updated H5 insert against Mexican H5N2 avian influenza viruses

Despite decades of vaccination, surveillance, and biosecurity measures, H5N2 low pathogenicity avian influenza (LPAI) virus infections continue in Mexico and neighboring countries. One explanation for tenacity of H5N2 LPAI in Mexico is the antigenic divergence of circulating field viruses compared to licensed vaccines due to antigenic drift. Our phylogenetic analysis indicates that the H5N2 LPAI viruses circulating in Mexico and neighboring countries since 1994 have undergone antigenic drift away from vaccine seed strains. Here we evaluated the efficacy of a new recombinant fowlpox virus vector containing an updated H5 insert (rFPV-H5/2016), more relevant to the current strains circulating in Mexico. We tested the vaccine efficacy against a closely related subcluster 4 Mexican H5N2 LPAI (2010 H5/LP) virus and the historic H5N2 HPAI (1995 H5/HP) virus in White Leghorn chickens. The rFPV-H5/2016 vaccine provided hemagglutinin inhibition (HI) titers pre-challenge against viral antigens from both challenge viruses in almost 100% of the immunized birds, with no differences in number of birds seroconverting or HI titers among all tested doses (1.5, 2.0, and 3.1 log₁₀ mean tissue culture infectious doses/bird). The vaccine conferred 100% clinical protection and a significant decrease in oral and cloacal virus shedding from 1995 H5/HP virus challenged birds when compared to the sham controls at all tested doses. Virus shedding titers from vaccinated 2010 H5/LP virus challenged birds significantly decreased compared to sham birds especially at earlier time points. Our results confirm the efficacy of the new rFPV-H5/2016 against antigenic drift of LPAI virus in Mexico and suggest that this vaccine would be a good candidate, likely as a primer in a prime-boost vaccination program.     

Varicella-zoster-virus vaccination of immunosuppressed children with inflammatory bowel disease or autoimmune hepatitis: A prospective observational study

Background and aimsChildren with inflammatory bowel disease (IBD) and autoimmune hepatitis (AIH) receiving immunosuppressive treatment are at risk for severe varicella zoster virus (VZV)-induced disease. This study evaluated vaccination of susceptible patients with stable disease and documented immunoreactivity without interruption of their current immunosuppression (IS).MethodsThis prospective multicentre observational study used a prevaccination checklist to select patients with low-intensity and high-intensity IS for VZV vaccination. Tolerability and safety after immunization were assessed by questionnaire. The immune response was measured by the VZV-IgG concentration, relative avidity index (RAI), and specific lymphocyte proliferative response.ResultsA total of 29 VZV vaccinations were performed in 17 seronegative patients aged 3–16 years (IBD n = 15, AIH n = 2). Eight patients received high-intensity immunosuppression, another six low-intensity immunosuppression, and three patients interrupted IS before VZV vaccination.All 29 vaccinations were well tolerated; only minor side effects such as fever and abdominal pain, were reported in two patients. One patient experienced a flare of Crohn’s disease the day after vaccination.The VZV-IgG-concentration increased significantly (p = 0.018) after vaccination, and a specific lymphocyte response towards VZV in vitro was detected in all tested patients which correlated with the RAI (r = 0.489; p = 0.078).ConclusionsVZV vaccination was well tolerated, safe and immunogenic in children receiving ongoing IS due to IBD and AIH. Ensuring immunoreactivity by clinical and laboratory parameters, rather than the type and dosage of IS, is a reasonable approach to decide on live-attenuated virus vaccinations in immunosuppressed children (German clinical trials DRKS00016357).