Subtraction radiography for the diagnosis of periapical bone lesions

Abstract Subtraction and conventional radiography were evaluated for the diagnostic potential to assess periapical bone lesions. The periapical region of dry human mandibles was radio-graphically examined, subjectively evaluated and measured by ¹²⁵I absorptiometry before and after the creation of bone defects. Both conventional radiographs and subtraction images made from the conventional radiographs after digitization were interpreted by 10 dentists. Receiver operating characteristic (ROC) analysis technique was used to compare the two techniques. There was a higher diagnostic accuracy using subtraction technique. For a lesion depth corresponding to < 2 mm of compact bone, there was a clear difference between the techniques, but for deeper lesions the conventional technique gained force. The subtraction technique was significantly superior for lesions confined to cancellous bone. The statistical difference in the diagnostic utility of subtraction compared with conventional technique was found to be less for lesions of the cortical bone. Therefore, the conclusion is that subtraction radiography improves the detection of small lesions in the periapical bone area.     

Transluminal balloon dilation of ureteral stricture in a child. A case report

A 12-year-old girl complained of left flank pain 4 months after the onset of symptoms of polyarthritis nodosa with hypertension, multiple neuritis and impaired renal function. Intravenous pyelography (IVP) revealed no stone. Several months later the flank pain recurred, and IVP now showed a calcified stone midway in the left ureter. Ureterolithotomy was performed, and a 3 cm long stone embedded in the mucosa was removed. Two months postoperatively IVP showed severe ureteric obstruction due to stenosis at the level of the incision. Dilation of the stricture was accomplished with a 4 mm balloon, and further dilation 2 weeks later with a 6 mm balloon. A third dilation was performed with a 4 mm balloon. At examination 3 months later the girl was free from symptoms and IVP with forced diuresis was normal, as were the findings after 6 more months. Transluminal balloon dilation of postoperative ureteral strictures in children should be considered as an alternative to surgery.     

Effects of advanced glycation end-product inhibition and cross-link breakage in diabetic rats

The accelerated formation of advanced glycation end-products (AGEs) due to elevated glycemia has repeatedly been reported as a central pathogenic factor in the development of diabetic microvascular complications. The effects of a novel inhibitor of AGE formation, NNC39-0028 (2,3-diaminophenazine), and a breaker of already formed AGE cross-links, N-phenacylthiazolium bromide (PTB), were investigated in streptozotocin-diabetic female Wistar rats. Diabetes for 24 weeks resulted in decreased tail collagen pepsin solubility, reflecting the formation of AGE cross-linking. Collagen solubility was significantly ameliorated by treatment with NNC39-0028, whereas PTB had no effect. Increased urinary albumin excretion (UAE) in diabetic rats was observed in serial measurements throughout the study period, and was not reduced by any treatment. Vascular dysfunction in the eye, measured as increased clearance of 125I-albumin, was induced by diabetes. NNC39-0028 did not affect this abnormality. This study demonstrated a pharmacological inhibition of collagen solubility alterations in diabetic rats without affecting diabetes-induced pathophysiology such as the increase in UAE or albumin clearance. Treatment with PTB, a specific breaker of AGE cross-links, had no effects in this study.     

Comparison of BACTEC™ blood culture media for the detection of fungemia

The aim of the present study was to investigate whether addition of the BACTEC? Mycosis bottle to the standard BACTEC? aerobic and anaerobic bottles contributed to a higher detection rate and a faster time to detection (TTD) of fungi. This was a retrospective cohort study of all patients with a positive blood culture with Candida species delivered to the Department of Clinical Microbiology, Herlev and Gentofte Hospital, Denmark in the 8-year period 2006 through 2014. The patients had at least one BACTEC? aerobic and one Mycosis bottle sampled at the same time and at least one of the bottles yielded growth of fungi. Among 184 patients included, 173 were examined using BACTEC? aerobic, anaerobic and Mycosis bottles. The anaerobic vial generally had the lowest detection rate and the longest TTD. The detection rate of BACTEC? aerobic plus anaerobic with the BACTEC? Mycosis bottle was significantly higher than the detection rate of BACTEC? aerobic plus anaerobic without BACTEC? Mycosis bottle for all species after 1–5 days, and specially for Candida glabrata at 2, 3, 4 and 5 days. TTD for C. glabrata was significantly shorter for BACTEC? Mycosis than TTD for BACTEC? aerobic or anaerobic bottles after ½ to 4 days. When combining “first or only” detection, the BACTEC? Mycosis bottle had a significantly higher detection as compared to the aerobic bottle. Addition of the BACTEC? Mycosis bottle to the standard BACTEC? aerobic and anaerobic bottles significantly contributed to a higher detection rate and a faster TTD of fungemia.     

Malaria in pregnancy in the Asia-Pacific region

Most pregnant women at risk of for infection with Plasmodium vivax live in the Asia-Pacific region. However, malaria in pregnancy is not recognised as a priority by many governments, policy makers, and donors in this region. Robust data for the true burden of malaria throughout pregnancy are scarce. Nevertheless, when women have little immunity, each infection is potentially fatal to the mother, fetus, or both. WHO recommendations for the control of malaria in pregnancy are largely based on the situation in Africa, but strategies in the Asia-Pacific region are complicated by heterogeneous transmission settings, coexistence of multidrug-resistant Plasmodium falciparum and Plasmodium vivax parasites, and different vectors. Most knowledge of the epidemiology, effect, treatment, and prevention of malaria in pregnancy in the Asia-Pacific region comes from India, Papua New Guinea, and Thailand. Improved estimates of the morbidity and mortality of malaria in pregnancy are urgently needed. When malaria in pregnancy cannot be prevented, accurate diagnosis and prompt treatment are needed to avert dangerous symptomatic disease and to reduce effects on fetuses.     

No influence on disease progression of non-HLA susceptibility genes in MS

Role of mannose binding lectin (MBL) complement activation pathway, an arm of innate immunity in multiple sclerosis (MS) was evaluated by analyzing the expression of MBL, MBL-associated serine protease-2 (MASP-2), and functional MBL/MASP-2 mediated C4 cleavage (fMBL) in 87 plasma and cerebrospinal fluid (CSF) samples from MS patients and non-MS controls. Median fMBL and MASP-2 plasma levels were higher in MS vs. non-MS cases. These associations remained in an analysis of subtypes of MS disease. These findings suggest a potential activation of MBL complement pathway in MS that may possibly alter the risk or progression of MS disease.     

Ultrasound of the acute abdomen performed by surgeons in training

AIM: Ultrasound has a well-established role in the diagnostic assessment of acute abdominal pain where some ultrasonically easily-accessible organs account for several diagnostic possibilities. The objective of the present study was to evaluate whether surgeons without ultrasound experience could perform valid abdominal ultrasound examinations of patients referred with acute abdominal pain. METHODS: Patients referred with acute abdominal pain had an ultrasound examination by a surgeon in training as well as by an experienced consultant radiologist whose results served as the gold standard. All participating surgeons were without any pre-existing ultrasound experience and received one hour of introduction to abdominal ultrasound. RESULTS: Thirty patients underwent 40 surgeon performed and 30 radiologist performed ultrasound examinations. Regarding gallstone and cholecholecystitis the sensitivity, specificity and kappa-agreement of the surgeon performed ultrasound examination was 1.00 (0.77-1.00), 0.96 (0.79-0.99), 0.94 (0.3-1.00) and 0.40 (0.12-0.77), 0.97 (0.83-0.99), 0.44 (0.00-0.96); respectively. Visualization of the common bile duct was poor having 73% non-diagnostic surgeon-performed ultrasound examinations. CONCLUSION: Surgeons in training without pre-existing ultrasound experience and only a minimum of formal ultrasound education can perform valid and reliable ultrasound examinations of the gallbladder in patients admitted with acute abdominal pain.     

TNFα receptor genotype influences smoking-induced muscle-fibre-type shift and atrophy in mice

Systemic manifestations of chronic obstructive pulmonary disease (COPD) include muscle wasting, and tumour necrosis factor alpha (TNFalpha) could represent a major inducer of these processes. We studied skeletal muscle histology in a murine model of cigarette smoke (CS)-induced COPD, comparing mice with different TNFalpha receptor genotypes. Muscles from hind limbs of wild type (WT), TNFalpha receptor 1 knockout (TNF alpha R1KO) and TNF alpha R2KO mice were prepared and weighed. The lower body weight, which was observed in CS-exposed WT and TNF alpha R1KO mice, was paralleled by reduced weights of gastrocnemius and biceps femoris muscle. The gastrocnemius muscle was evaluated for muscle fibre apoptosis and atrophy, and fibre-type distribution. CS-induced apoptosis was observed in all genotypes, while a significant reduction of cross-sectional areas of myofibres was present only in TNF alpha R2KO mice. A CS-induced fibre-type shift from the IIa to the IIb phenotype was observed in WT mice, an increase of muscle-fibre-type IIx was noticed in CS-exposed TNF alpha R2KO mice. Our data suggest that the skeletal muscle manifestations associated with this murine COPD model are under complex regulation by both TNFalpha receptors, but that TNF alpha R2 may be the most important determinant for the outcome of CS-induced myofibre apoptosis.