Are commercial warming kits interchangeable for vitrified human blastocysts? Further evidence for the adoption of a Universal Warming protocol

Journal of Assisted Reproduction and Genetics - To study whether a new combination of different warming kits is clinically effective for vitrified human blastocysts. This is a longitudinal cohort...     

Fulminant multifocal motor neuropathy: a report of two cases

Multifocal motor neuropathy (MMN) shows stepwise progression over decades. The multifocal weakness usually remains asymmetric, confined to distal limb muscles, while sparing cranial, phrenic, and sensory nerves. One electrophysiological hallmark is partial motor conduction block (CB) at sites not exposed to compression; whether CB is an essential feature remains debatable. High titer of anti-GM1 antibodies is found with figures usually between 40% and 50% of patients. Intravenous immuneglobulin (IVIg) is effective in almost 80%, but plasmapheresis and steroids are not. The condition is reported as lethal exceptionally, mimicking motor neuron diseases (MND). We have studied two patients who failed to respond to treatment and who died with respiratory failure; one of the two had high titer of IgM antibody to the ganglioside GM1. Our cases confirm that great attention should be paid in order to define the borderland between MMN and MND and the entity of their clinical and electrophysiological overlaps.     

Noninvasive and invasive ventilation and enteral nutrition for ALS in Italy

Introduction: We performed a population‐based study to assess amyotrophic lateral sclerosis (ALS) survival after noninvasive ventilation (NIV), invasive ventilation (IV), and enteral nutrition (EN). Methods: We included patients diagnosed from 2000 to 2009 in Modena, where a prospective registry and a Motor Neuron Diseases Centre have been active since 2000. Results: Of the 193 incident cases, 47.7% received NIV, 24.3% received tracheostomy, and 49.2% received EN. A total of 10.4% of the patients refused NIV, 31.6% refused IV, and 8.7% refused EN. The median survival times after NIV, IV, and EN were 15, 19, and 9 months, respectively. Of the tracheostomized patients, 79.7% were discharged from the hospital; 73.0% were discharged to home. The median survival times for tracheostomized patients who were cared for at home and in nursing homes were 43 and 2 months, respectively. The multivariate analysis demonstrated that the place of discharge was the only independent prognostic factor after IV (P < 0.01). Conclusions: Service organizations may promote adherence to NIV, IV, EN, and influence postprocedure survival. These data may be useful in defining health plans regarding advanced ALS care and in patient counseling. Muscle Nerve 50: 508–516, 2014     

Free erythrocyte protoporphyrin as an indicator of the biological effect of lead in adult males

Summary The relationship between FEP and the indicators of dose (PbB, PbU, PbU-EDTA) was examined in a group of male subjects who had left lead-exposing jobs more than 12 months previously.In these subjects, FEP and PbB and FEP and PbU were correlated to a distinctly lower degree compared to previous findings in currently exposed subjects, although the correlations were still statistically significant. In the previously exposed subjects the erythrocyte metabolite displayed definitely higher values than those found in currently exposed subjects at the same PbB or PbU levels.A very close correlation was found between FEP and PbU-EDTA, as was found in exposed subjects. The regression curve assumed an identical profile in the two situations. From these results it may be concluded that FEP persists at high levels for a long time after cessation of exposure due to a direct inhibition of heme synthetase caused by lead released from the tissue deposits.It should be noted that FEP proved to be a valid test for predicting the amount of lead storage, even a long time after cessation of exposure.Abbreviations PbB blood lead (g/100 ml) - PbU lead in urine (g/l) - PbU-EDTA amount of chelatable lead excreted with 24 h urine after administration of Ca NA₂ EDTA (1 g intravenously) - FEP free erythrocyte protoporphyrin (g/100 ml RBC) - ALAU urinary delta-aminolevulinic acid (mg/l) - CPU urinary coproporphyrin (g/l)     

Free erythrocyte protoporphyrin as an indicator of the biological effect of lead in adult males

In previous research we established that FEP is a suitable and valid test for evaluating the metabolic damage caused by lead absorption.In this study, in the same sample consisting of adult male subjects with PbB levels ranging from 15 to 150 g/100 ml, we examined the relationship existing between PbB and the other indicators of effect so as to compare their behavior with that of FEP and establish whether there is a field of application where the erythrocyte metabolite is to be preferred.     

The testimony of political repression as a therapeutic instrument

The use of testimony--tape-recorded by the therapist and revised jointly by therapist and patient into a written document--as a therapeutic technique with former prisoners and with relatives of prisoners of the Chilean military government is described and evaluated. The testimony, aimed at facilitating integration of the traumatic experience and restoration of self-esteem, was found effective in providing symptomatic relief for certain patients.     

Indicators of internal dose in current and past exposure to lead

Summary Chelatable lead (PbU-EDTA) is the best indicator of lead concentration at the critical organ level (indicator of dose). However, since this test is not easily applicable for the biological monitoring of lead-exposed subjects, the current practice is to determine lead in blood (PbB) and/or in urine (PbU). But these tests are indicators of exposure and not of dose. To analyze the reliability of PbB and PbU in estimating lead dose, the relationships between PbU-EDTA and PbB and between PbU-EDTA and PbU were studied in two groups of male lead workers: 48 currently exposed and 45 with past exposure to lead.In currently exposed workers the correlation between PbU-EDTA and PbB and between PbU-EDTA and PbU was very close (r = 0.85, r = 0.74, respectively); in past exposed workers the correlation with PbU-EDTA was decidedly lower for PbB (r = 0.54) and not significant for PbU (r = 0.29). In both cases the relationship between the variables was linear. In the previously exposed men, PbB displayed lower values than those found in currently exposed men.These results indicate that both PbB and PbU allow an indirect estimation to be made of the internal dose in currently exposed subjects, whereas the tests cannot be used for this purpose in subjects who have long since ceased to be exposed. In these cases chelatable lead must be determined.     

Myocardial infarction due to late stent thrombosis following epileptic convulsive seizures

We report the first case in the literature of acute myocardial infarction due to very late (5 years) drug-eluting stent (DES) thrombosis presenting with inferior ST-elevation myocardial infarction immediately after epileptic convulsive seizures in a patient with known coronary artery disease. A bare-metal stent had been implanted in the left anterior descending coronary artery in 2002, and a drug-eluting stent implanted in the right coronary artery in 2003. We discuss the possible pathogenetic mechanisms implied in convulsive epileptic crisis resulting in development of very late DES thrombosis.