Multiple sclerosis: modulation of apoptosis susceptibility by glatiramer acetate

OBJECTIVES: We investigated whether therapy of multiple sclerosis (MS) with glatiramer acetate (GA) involves the modulation of programmed cell death (apoptosis) in disease-relevant T-helper lymphocytes. MATERIAL AND METHODS: Blood was drawn from 15 relapsing-remitting MS patients both before (baseline) as well as 6, 12, and 18 weeks after GA therapy and from 15 healthy controls. Detection of apoptosis was performed in response to in vitro stimulation with GA, myelin basic protein or medium alone. RESULTS: T-helper lymphocytes from untreated MS patients displayed an overall increased apoptosis susceptibility in vitro, compared to controls. During subsequent GA therapy, apoptosis vulnerability of these T cells in MS patients significantly declined under the initial baseline before treatment, and was finally equal in treated patients and controls. GA itself had no direct apoptosis-modulatory properties in vitro. CONCLUSION: Our findings indicate that therapy of multiple sclerosis with glatiramer acetate presumably involves the compensation of altered apoptosis in T-helper lymphocytes.     

Maternal serum advanced glycation end products level as an early marker for predicting preterm labor/PPROM: a prospective preliminary study

Objective: To evaluate the value of maternal serum advanced glycation end products (AGEs) level at 11–13 weeks’ gestation for the prediction of preterm labor and or preterm premature rupture of membranes (PPROM).

Materials and methods: This prospective cross-sectional study is performed in a university-affiliated hospital between February and April 2016. The participants of this study are low-risk pregnant women. Blood samples for maternal AGEs level were collected in the first trimester of pregnancy and all women completed their antenatal follow-up and delivered in our center. During the follow-up 21 women developed preterm labor/PPROM. The first trimester maternal AGEs levels of preterm labor/PPROM cases were compared with uncomplicated cases (n?=?25) matched for age-parity and BMI. The predictive value of AGEs levels for preterm labor/PPROM was also assessed.

Results: First-trimester AGEs levels were significantly higher in cases complicated with preterm labor/PPROM (1832 (415–6682) versus 1276 (466–6445) ng/L, p?=?.001 and 1722 (804–6682) versus 1343 (466–6445) ng/L, p?=?.025). According to receiver-operating characteristic curve analysis, the calculated cut off value of AGEs was 1538?ng/L with the sensitivity 91.7%, specificity 73.8%; and the negative and positive predictive values were 91.6% and 29.5%, respectively.

Conclusions: For the prediction of preterm labor/PPROM, the relatively high AGEs levels in the first trimester might be a useful marker.     

Autologous serum skin test response in chronic spontaneous urticaria and respiratory diseases and its relationship with serum interleukin-18 level

Autologous serum skin test (ASST) is mostly used in chronic spontaneous urticaria (CSU) to show autoreactivity. Interleukin-18 (IL-18) has also been shown to be involved in autoimmune conditions. To investigate the role of autoreactivity assessed by ASST in CSU and respiratory diseases and to investigate whether this autoreactive state is related to IL-18 level or other clinical covariates. Fifty-five patients with CSU (mean age: 40.3 ± 12.3 years), 70 patients with persistent asthma (mean age: 43.7 ± 9.6 years), 21 patients with seasonal allergic rhinitis (SAR) (mean age: 35.5 ± 11.8 years) and 20 normal controls (mean age: 37.7 ± 9.8) were included. All subjects underwent a laboratory examination and skin prick test. ASST was performed and serum IL-18 levels were measured in all subjects. Positive response to ASST and serum IL-18 levels were higher in CSU patients than those with respiratory diseases (asthma and SAR) (P = 0.034 and 0.002, respectively) and normal controls (P = 0.004 and 0.031, respectively). Considering all patients, IL-18 levels were higher in patients with positive ASST (301.8 ± 194.4 vs. 241.8 ± 206.3 pg/ml, P = 0.036) than ASST negative patients. ASST response was associated with disease severity in CSU (P = 0.037) and asthma patients (P = 0.001). Multivariate analysis showed that positive response to ASST was significantly associated with diagnosis of CSU (OR: 3.13, 95% CI: 1.25–7.87) and female gender (OR: 3.98, 95% CI: 1.19–13.38). ASST response could be related with activity of the disease. A positive ASST response found in respiratory diseases patients suggests that it may occur as a result of some inflammatory events during the diseases’ process.     

Comparing the effectiveness of “plasma knife” tonsillectomy with two well-established tonsillectomy techniques: Cold dissection and bipolar electrocautery. A Prospective randomized Study

Objective

To evaluate the effectiveness of a new device “plasma knife” for tonsillectomy by comparing to two well-established tonsillectomy techniques: cold dissection, and bipolar electrocautery.

Methods

A prospective, randomized study conducted on 110 patients undergoing tonsillectomy. Subjects were randomized to plasma knife (PKT), cold dissection (CDT) and bipolar electrocautery (BET) groups. Operative time, intraoperative blood loss and postoperative complications were recorded. Pain/discomfort level of patients and healing time of the tonsillar fossae were assessed postoperatively. Data were recorded and statistically analyzed.

Results

Operative time with plasma knife and bipolar electrocautery were associated with a significant decrease in operative time compared to cold dissection (p < 0.05). Intraoperative blood loss was significantly decreased with plasma knife, compared to cold dissection and bipolar electrocautery (p < 0.05). Less postoperative pain was observed with plasma knife compared to bipolar electrocautery but more postoperative pain was observed with both compared to CDT (p < 0.05). Postoperative healing time was longer with plasma knife and bipolar electrocautery, compared to cold dissection (p < 0.05).

Conclusion

Plasma knife is a useful and safe device in tonsillectomy. Its use reduces intraoperative blood loss and provides a fast tonsillectomy with acceptable morbidity.     

Comparison of the Tzanck test and polymerase chain reaction in the diagnosis of cutaneous herpes simplex and varicella zoster virus infections

Background: Although the diagnosis of herpes simplex virus (HSV) and varicella zoster virus (VZV) infections is usually made clinically, the Tzanck test, electron microscopy, viral culture, polymerase chain reaction (PCR), and serologic tests can be utilized to verify the diagnosis. METHODS: We conducted a study on a total of 98 patients (77 patients with recurrent herpes simplex and 21 patients with herpes zoster) to evaluate the reliability and reproducibility of the Tzanck test in comparison with PCR. RESULTS: In herpes virus infections, the general positivity rates of the Tzanck test and PCR were 61.2% and 79.6%, respectively. The difference between the positivity rates of the two tests was statistically significant. The positivity rates of the tests differed according to the type and duration of the lesions. CONCLUSIONS: Although PCR was superior to the Tzanck test, the Tzanck test has also been proven to be a reliable diagnostic method, with a sensitivity of 76.9% and a specificity of 100%. We recommend the use of this easy, quick, reproducible, and inexpensive diagnostic test more often in dermatologic practice, especially in cutaneous herpes virus infections.     

Matrix metalloproteinase-9 expression in retinal ganglion cell layer and effect of topically applied brimonidine tartrate 0.2% therapy on this expression in an endothelin-1-induced optic nerve ischemia model

The purpose of this research is to investigate the expression of matrix metalloproteinase-9 (MMP-9) in retinal ganglion cells (RGC) and the impact of topically applied brimonidine tartrate 0.2% (BMD) on this expression in an endothelin-1 (ET-1)-induced chronic optic nerve (ON) ischemia model of rabbit. Osmotically driven minipumps were implanted in one eye of 16 New Zealand albino rabbits to deliver ET-1 at the constant rate of 0.5 μl/h for 2 weeks. ET-1 was given with (group 3) and without topical BMD therapy (group 1). Groups 2 and 4 were taken as controls. MMP-9 expression by immunohistochemically and proportion of cells undergoing apoptosis in RGC layer were investigated. The correlation between the MMP-9 immunopositivity and the proportion of cells undergoing apoptosis in the RGC layer was evaluated. MMP-9 immunopositivity was found to be significantly higher in both groups 1 and 3 compared to that of the controls. There was no difference between groups 1 and 3 regarding MMP-9 expression (p = 0.495). A positive correlation was found between the proportion of cells undergoing apoptosis and MMP-9 expressions in the RGC layer in group 1 (p = 0.031, r = 0.754). MMP-9 expression in the RGC layer seems to significantly increase in the ET-1-induced chronic ON ischemia model. Topical BMD therapy does not seem to affect this MMP-9 expression.     

Preoperative evaluation of hyperparathyroidism: the role of dual-phase parathyroid scintigraphy and ultrasound imaging

Objective The aim of this study was to evaluate the efficacy of dual-phase 99mTc-methoxyisobutylnitrile (MIBI) parathyroid scintigraphy (PS) and ultrasound (US) in primary (pHPT) and secondary (sHPT) hyperparathyroidism. Methods A total of 69 patients (mean age 47 ± 16; age range 14–79 years), including 19 patients with sHPT were enrolled in this study. Preoperative serum intact parathyroid hormone (iPTH) levels, calcium (Ca), phosphate (P), alkaline phosphatase, and 24-h urinary-free Ca measurements were obtained. Concomitant thyroid pathology was also recorded. Results Histopathology revealed 30 solitary adenomas and 71 hyperplastic glands in 55 patients. The remaining patients’ histopathology revealed normal parathyroid, thyroid, or lymph nodes. The sensitivities of MIBI and US in pHPT were 70% and 60%, respectively. It was 60% for both procedures in sHPT. The overall sensitivity of combined US + MIBI in pHPT and sHPT was 81% and 71%, respectively. The overall specificity of MIBI and US was 87% and 91%; positive predictive value (PPV) was 94% and 92%, respectively. MIBI and US identified the parathyroid pathology in 92% and 85% of patients in the non-concomitant thyroid disease group, and in 53% and 47% of patients in the concomitant thyroid disease group, respectively. The weight of the gland between primary and secondary hyperparathyroidism did not reveal a significant difference (P = 0.4). Significant differences were found with respect to age, PTH, Ca, and P levels between the pHPT and sHPT (P < 0.001). Intact PTH levels showed significant differences between MIBI positive and negative patients (P = 0.013), and also US positive and negative patients (P = 0.012). A significant negative correlation was found between iPTH and Ca at sHPT (P < 0.001). Conclusions The concomitancy of thyroid disease greatly influences scintigraphic and ultrasonographic detection of parathyroid pathology in pHPT and sHPT. The combination of MIBI and US appears promising for localizing parathyroid pathology in patients with both primary and secondary hyperparathyroidism. The concordance rate is high together with a lower chance of missing concomitant thyroid pathology, which might alter the surgical approach.     

Retropharyngeal hematoma as a complication of anticoagulation therapy

Reports in the literature of retropharyngeal hematoma as a complication of anticoagulation therapy are rare. When this complication does occur, it can become life-threatening if the airway is compromised. However, no consensus exists as to which approach--intubation, tracheotomy, or conservative therapy--is best for managing the airway in these cases. We report a case of retropharyngeal hematoma that occurred as a sequela to a trivial blunt trauma in a 48-year-old man who had been undergoing anticoagulation therapy with warfarin. The hematoma had caused airway obstruction, and the patient was hospitalized. He was treated conservatively, and the hematoma slowly resolved over the course of 2 weeks. On the basis of our experience and the findings of our literature review, we suggest that conservative management can be initiated for small nonexpanding hematomas that do not seriously compromise the airway. Securing the airway with intubation or tracheotomy should be reserved for patients who are in serious respiratory distress; the choice between intubation and tracheotomy should be made on an individual basis.