Increased erythrocyte osmotic fragility in pregnancy

An unexpected increase in erythrocyte osmotic fragility during pregnancy in two healthy women prompted a study of the effects of pregnancy on osmotic fragility. The incubated glycerol lysis time, a rapid, sensitive measure of osmotic fragility, was determined in 100 pregnant women and 50 nonpregnant control subjects. Twenty-two of the pregnant women (22%) showed abnormal results when compared to normal nonpregnant women (p < 0.0005). Increased erythrocyte fragility was observed primarily in the last trimester of pregnancy. Twenty-one of 65 women in the last trimester (32.3%) had abnormal incubated glycerol lysis time values, but only one of 34 (2.9%) showed increased fragility during early pregnancy. Physiologic shifts in erythrocyte osmotic fragility may create a problem in the diagnosis of hereditary spherocytosis during the last trimester of pregnancy.     

How do we modulate our emotions? Parametric fMRI reveals cortical midline structures as regions specifically involved in the processing of emotional valences

One of the major problems in affective neuroscience of healthy subjects as well as of patients with emotional dysfunctions is to disentangle emotional core functions and non-emotional processes. Emotional valence is considered an emotional key process. The present study employed a parametric functional magnetic resonance imaging (fMRI) study to address this question. Thirteen healthy volunteers were scanned during emotional stimulus processing (International Affective Picture System). The presented pictures covered the entire range of emotional valences. The fMRI data were consecutively subjected to a preliminary categorical (valence-independent) and a detailed parametric analysis, the latter using individual valence ratings as regressor. The parametric analysis revealed a linear valence-dependent modulation of the BOLD signal in the orbito- and dorsomedial prefrontal cortex (OMPFC, DMPFC), medial parietal cortex (MPC), and insula. In addition, we observed that emotional valence exerts its effects predominantly via modulation of signal decreases. We conclude that the psychological concept of emotional valence may be related to neural processing in cortical midline regions.     

Poor outcome of two children with relapsed state stage IV alveolar rhabdomyosarcoma after allogeneic stem cell transplantation

The authors report on 2 boys, 11(1/2) and 13 years old, who received allogeneic stem cell transplantation (alloSCT) from their HLA-identical sibling after relapse of stage IV alveolar rhabdomyosarcoma. Both patients were transplanted in a non-remission status. After alloSCT both patients experienced disease progression at the primary tumor location sites and died due to the underlying disease 146 and 379 days after transplantation. The authors conclude that an alloSCT derived graft versus tumor effect might not be effective enough to overcome alveolar rhabdomyosarcoma when transplantation is carried out in a nonremission status.     

Interleukin-1 gene cluster variants and abdominal aortic aneurysms

Inflammation is a key factor in the pathogenesis of abdominal aortic aneurysms (AAA). Interleukin 1 (IL-1), a fundamental regulator of the inflammatory cascade, has been shown to be involved in this process. Several functional polymorphisms in the IL-1 gene cluster are known. In this matched case-control study, we investigated a potential association between six genetic variants in IL-1 and IL-1 receptor antagonist (IL-1 RN) with AAA. We enrolled 405 individuals, 135 consecutive patients with AAA were individually age- and sex-matched to 270 patients with coronary artery disease (CAD).Traditional cardiovascular risk factors and IL-1 genotypes were determined, and the distribution of six single nucleotide polymorphisms were compared between patients and controls by multivariable conditional logistic regression analysis: IL-1A (-889) C>T, IL-1A (+4845) G>T, IL-1B (-511) C>T, IL-1B (-31) C>T, IL-1B (+3954) C>T and IL-1RN (+2018) C>T. IL-1A (-889) C>T and IL-1A (+4845) G>T (kappa 0.98,95% CI 0.96 to 1.00), and IL-1B (-511) C>T and IL-1B (-31) C>T (kappa 0.98, 95% CI 0.96 to 1.00) were closely linked, therefore IL-1A (-889) C>T and IL-1B (-31) C>T were not considered for further analyses. None of the 4 remaining polymorphisms showed a significant association with AAA: IL-1RN (+2018) C>T (p = 0.061), IL-1B (+3954) C>T (p = 0.51), IL-1B (-511) C>T (p = 0.61) and IL-1A (+4845) G>T (p = 0.81). No significant first-degree interactions between the genetic variants and AAA were detected. In conclusion,these six genetic variants in the interleukin- I gene cluster do not seem to play a clinically relevant role in the pathogenesis of AAA, although we cannot rule out the existence of higher degree gene-gene or gene-environment interactions.     

High-concentration contrast media in multiphasic abdominal multidetector-row computed tomography: effect of increased iodine flow rate on parenchymal and vascular enhancement

OBJECTIVE: The purpose of this study was to assess the influence of the iodine flow rate on parenchymal and vascular enhancement during multiphasic abdominal multidetector-row computed tomography (MDCT). METHODS: Fifteen patients underwent MDCT at an iodine flow rate of 1.2 g/s as well as 1.6 g/s (group A, protocols 1 and 2), and 90 patients underwent MDCT at an iodine flow rate of 1.2 g/s (group B) or 1.6 g/s (group C). Measurements were performed for all groups in the liver, spleen, pancreas, portal vein, inferior vena cava, and abdominal aorta. RESULTS: Aortal and pancreatic enhancement during the arterial phase was significantly higher with the higher iodine flow rate. The mean difference in aortal enhancement was 60 Hounsfield units (HU) between protocols 1 and 2 of group A, and the mean difference was 70 HU between groups B and C. The mean difference in pancreatic enhancement was 10 HU between protocols 1 and 2 of group A and 17 HU between groups B and C. During the portal and hepatic venous phases, no significant difference in enhancement was observed. CONCLUSION: A high iodine flow rate in multiphasic abdominal MDCT improves enhancement of the aorta and the pancreas during the arterial phase but does not influence later phases.     

Partial ceramic crowns: influence of preparation design and luting material on internal adaptation

The influence of three different cavity preparations on the marginal integrity of partial ceramic crowns (PCC) luted with four different luting systems was investigated in this in vitro study. PCC preparations were performed in 144 extracted human molars using one of the following preparation designs (n=48/preparation): A--Coverage of functional cusps/butt joint preparation; B--horizontal reduction of functional cusps and C--complete reduction of functional cusps/butt joint preparation. Non-functional cusps were not covered; mesial and distal proximal boxes were extended 1 mm below the cemento-enamel-junction. PCC were fabricated from Vita Mark II ceramic (Vita) with a Cerec 3 Unit (Sirona) and adhesively luted to the cavities using the following luting systems: (VL) Variolink II/Excite (Vivadent), (PA) Panavia F/ED Primer (Kuraray), (DY) Dyract/Prime & Bond NT (DeTrey/Dentsply) and (FU) Fuji Plus/GC Cavity Conditioner (GC). Samples were simultaneously exposed to thermocycling and mechanical loading (TC: 5000x8-55 degrees C, 30 seconds/cycle; ML: 500000x72.5N, 1.6Hz). Marginal adaptation was assessed by evaluating dye penetration on multiple sections by relating the actual penetration distance to the maximal length of the corresponding cavity wall (100%). Ceramic- and tooth-luting material interfaces were evaluated separately. The data were statistically analyzed with the Mann Whitney U-test and Wilcoxon Rank Sumtest. In general, no significant differences could be found between preparations A, B and C. The combination of preparation C and luting material PA showed a tendency for the lowest dye penetration values, especially within dentin (30%). Significant differences could be determined between luting materials: Composite luting materials PA (0%) and VL (1%) revealed less dye penetration than the compomer DY (6%) and resin-modified glass ionomer cement (RMGIC) FU (26%); use of RMGIC caused fractures of the restorations. The dentin/luting material interface showed the highest penetration values, ranging from 17% to 100%. In conclusion, with adhesively bonded partial ceramic crowns, the choice of luting material proved to be more relevant than preparation design under the limitations of this study. Margins below the cemento-enamel junction reveal significant loss of adhesion in spite of subsequent application of adhesive luting techniques. RMGIC cannot be recommended as a luting material for feldspathic PCC.     

Oligodendroglioma and juvenile pilocytic astrocytoma presenting as synchronous primary brain tumors. Case report with histological and molecular differentiation of the tumors and review of the literature

Multiple metastatic brain tumors and multifocal primary brain tumors of a single histological type are well described in the literature. The concurrent presence of multiple primary brain tumors with different histological characteristics, however, is very rare. The authors describe the first known case in which an oligodendroglioma and a juvenile pilocytic astrocytoma (JPA) presented as synchronous primary brain tumors in the same patient. This 43-year-old man presented with a 2-month history of progressive headaches, nausea, and vomiting. Magnetic resonance imaging demonstrated an enhancing heterogeneous right medial cerebellar lesion and a larger calcified, nonenhancing, heterogeneous right frontal lesion with surrounding edema and a mass effect. The results of a metastatic workup were unremarkable. The patient underwent an initial right frontotemporal craniotomy and a subsequent suboccipital craniectomy 2 years later for resection of the posterior fossa lesion. Histological examination revealed the frontal and cerebellar lesions to be an oligodendroglioma and JPA, respectively. A molecular analysis detected a deletion of chromosome 1p36 in the oligodendroglioma, but not in the JPA. After the initial operation, the patient received follow-up care for his oligodendroglioma, but eventually required temozolomide for tumor progression. His condition remains stable both neurologically and according to imaging studies. The authors describe the first known case in which a low-grade oligodendroglioma and a JPA presented as synchronous primary brain tumors. They review the literature on multiple primary brain tumors with different histological characteristics and discuss potential mechanisms for the development of these lesions.     

Efficacy of multiple intraarterial papaverine infusions for improvement in cerebral circulation time in patients with recurrent cerebral vasospasm

OBJECT: Cerebral vasospasm that is caused by aneurysmal subarachnoid hemorrhage and that is refractory to maximal medical management can be treated with selective intraarterial papaverine infusions. The effects of single papaverine treatments on cerebral circulation time are well known. The purpose of this study was to assess the efficacy of multiple, repeated papaverine infusions on the cerebral circulation time in patients with recurrent vasospasm. METHODS: A retrospective study was conducted in 17 patients who received multiple intraarterial papaverine infusions in 91 carotid artery (CA) territories for the treatment of cerebral vasospasm. Cerebral circulation times were measured from the first angiographic image, in which peak contrast was seen above the supraclinoid internal CA, to the peak filling of cortical veins. Glasgow Outcome Scale (GOS) scores assessed 12 months after discharge were reviewed. Cerebral circulation times in 16 CA territories were measured in a control group of 11 patients. Seventeen patients received a total of 91 papaverine treatments. Prolonged cerebral circulation times improved after 90 (99%) of 91 papaverine treatments. The prepapaverine mean cerebral circulation time was 6.54 seconds (range 3.35-27 seconds) and the immediate postpapaverine mean cerebral circulation time was 4.19 seconds (range 2.1-12.6 seconds), an overall mean decrease of 2.35 seconds (36%, p < 0.001). Recurrent vasospasm reflected by prolonged cerebral circulation times continued to improve with subsequent papaverine infusions. Repeated infusions were just as successful quantitatively as the primary treatment (mean change 2.06 seconds). The mean cerebral circulation time in the control group was 5.21 seconds (range 4-6.8 seconds). In five patients a dramatic reversal of low-attenuation changes was detected on computerized tomography scans. The mean GOS score at 12 months after discharge was 3.4. CONCLUSIONS: The preliminary results indicate that multiple intraarterial papaverine treatments consistently improve cerebral circulation times, even with repeated infusions in cases of recurrent vasospasm.     

Capsule induction technique in a rat model for bladder wall replacement: an overview

The search for a reliable technique for functional genitourinary tissue replacement remains a challenging task. The most recent advances in cell biology and tissue engineering have utilized various avascular and acellular collagen scaffolds with or without seeded cells. These techniques, however, are frequently complicated by tissue necrosis, contracture and resorption due to limited vascularization. We employed a new three-stage, evolving animal model with stage I optimizing the culture delivery vehicle, stage II employing a seeded vascularized capsule flap, and stage III adding a contractile matrix in the form of pedicled gracilis muscle prelaminated with autologous, in vitro-expanded urothelial cells to reconstruct an entire supratrigonal bladder-wall defect in rats.Specimens stained with hematoxylin and eosin (H&E), alpha(1)-actin staining, and a specific immunohistochemical staining (AE(1)&AE(3)-anticytoceratin monoclonal antibody stain) showed a continuous, multilayered, functioning urothelial lining along the transposed prelaminated gracilis flap in the animals of the final-stage experiment.Successful urinary reconstruction requires a contractile neoreservoir resistant to resorption over time and a stable, protective urothelial lining. We demonstrated that a gracilis muscle flap can be seeded with autologous cultured urothelial cells suspended in fibrin glue. This prelaminated flap can be safely transposed onto its pedicle and become successfully integrated into the remaining bladder wall, demonstrating urothelial lining and the potential to contract. Further studies in larger animals with urodynamic assessment is warranted to determine if this type of bladder-wall replacement technique is suitable for urinary reconstruction in humans.