Early diagnosis of asymptomatic neurocutaneous melanosis (60 month follow‐up)

Neurocutaneous melanosis (NCM) is a rare, sporadic, congenital neuroectodermal dysplasia. Large congenital melanocytic nevi (CMN) can evolve in a certain percentage of patients to NCM. Meningeal deposits are benign, but can be prone to malignant transformation in some cases. We describe the case of an infant with asymptomatic NCM, and typical magnetic resonance imaging (MRI) findings. The diagnosis was established shortly after delivery, and the patient was followed for 60 months. At that time, the girl did not have any neurologic symptoms; she reached normal developmental milestones and did not show mental retardation and did not develop malignant melanoma; further follow‐up will be needed, although there are no reliable guidelines as to the time range of follow up of asymptomatic NCM in the literature. We report the typical MRI signal abnormalities of the brain, and present a review of the literature regarding this rare and mysterious congenital disorder.     

Carbonic anhydrase IX deposits are associated with increased ascending aortic dilatation

Objectives. Carbonic anhydrase IX (CA IX) expression is induced by local hypoxia. We studied whether CA IX deposits associate with ascending aortic dilatation. Design. Aortic wall histology, CA IX expression, presence of leukocytes, plasma cells, macrophages, endothelial cells, smooth muscle cells, cell proliferation, elastin and collagen were studied in histological specimens collected from 30 patients who underwent surgery for ascending aorta. The samples were grouped according to presence of CA IX deposits. Results. Twenty out of 30 patients had CA IX-positive deposits within the adventitia, whereas 10 specimens remained negative. Adventitial inflammation was increased in CA IX-positive samples as compared with CA IX-negative ones (p?<?0.01). The mean diameter of the ascending aorta at the sinotubular junction increased significantly in patients with CA IX-positive staining as compared with CA IX-negative cases (63?±?3 vs 53?±?2?mm, p?<?0.02). Receiver operating characteristic curve analysis confirmed the association of CA IX positivity with increased ascending aortic dilatation (AUC 0.766; S.E. 0.090; p?=?0.020; 95% C.I. 0.590–0.941). Conclusions. Positive CA IX staining in certain aortic specimens suggests that increased CA activity may contribute to ascending aortic dilatation.     

Patterns of surface temperatures in two mole-rats (Bathyergidae) with different social systems as revealed by IR-thermography

Furred subterranean mammals face the problem of dissipating heat to the environment because high humidity and absence of air flow in sealed belowground tunnels constrain heat loss from body by convection and evaporation. In order to detect body areas responsible for heat loss, surface temperatures in two species of African mole-rats were measured at different ambient air temperatures by infrared thermography. Fur characteristics were also evaluated. Thinner pelage of the ventrum, its moderate temperature and large size suggest that ventral side of the body is the main thermal avenue for heat loss in both species. Interspecific differences could be explained by different fur characteristics connected with social thermoregulation. Compared to the social Fukomys mechowii, the solitary Heliophobius argenteocinereus has denser and longer fur on most of its body; its surface temperature was thus lower than in F. mechowii at lowered ambient temperatures. On the other hand, the denser and longer hair cover in H. argenteocinereus impedes heat dissipation at highest ambient temperatures (and probably also during digging activity) resulting in increase of core body temperature. H. argenteocinereus seems to be more sensitive to overheating than F. mechowii. At lower air temperatures, the social species may uses huddling to combat hypothermia.     

Effect of air-drying temperature on the effectiveness of silane primers and coupling blends in the repair of a microhybrid resin composite

PURPOSE: To evaluate the effect of different silane agents and air-drying temperatures on the repair strength of a microfilled hybrid composite. MATERIALS AND METHODS: Composite cylinders (8 x 4 mm) of Gradia Direct Anterior (GC, N=36), stored in a saline solution at 37 degrees C for 1 month, were sandblasted (50-microm aluminium oxide), cleaned (35% phosphoric acid) and randomly divided into six groups (n=6). Two prehydrolyzed silane primers (Monobond-S, Ivoclar-Vivadent, Porcelain Primer, Bisco), a non prehydrolyzed silane primer (Porcelain Liner M, Sun Medical) and three silane/adhesive coupling agents (Porcelain Bond Activator-PBA/Clearfil New Bond, PBA/Clearfil SE Bond, PBA/Clearfil Tri-S Bond, Kuraray) were investigated. Silane-coated surfaces were air dried at two different temperatures (23 degrees C and 38 degrees C) and repairs (8 x 8 mm) were fabricated (Gradia Direct Anterior). Unrepaired composite cylinders (8 x 8 mm, n=6) were used as control to evaluate the cohesive strength of the material. Microtensile bond strength measurements (microTBS) were performed. Results: The silane agent applied (p < 0.001), the airdrying temperature (p < 0.001) and their interaction (p < 0.001) were significant factors (two-way ANOVA, Tukey test; p < 0.05). Silane primers achieved inferior microTBS when air dried at 23 degrees C as compared to silane/adhesive blends. Warm air-drying was significantly beneficial to composite repairs mediated by silane primers. Comparable results were achieved by silane/adhesive couplings at 23 degrees C and 38 degrees C. At 38 degrees C all the intermediate agents resulted in repair microTBS that were comparable to the 24-h cohesive strength of the composite (one-way ANOVA, Dunnett t-tests; p < 0.05). CONCLUSION: The chemical interactions between silane primers and compozite substrate may be optimized through warm airdrying. Silane/adhesive couplings were not influenced by the air drying temperature.     

Hydrolytic stability of composite repair bond

The hydrolytic stability of composite repairs is a desirable property. In the present study, the composite repair microtensile bond strength, failure mode distribution, and nanoleakage occurrence before and after thermocycling were evaluated. Standardized, 1-month-old composite substrates were roughened, cleaned, and randomly assigned to seven groups according to the intermediate agent applied. Resin-based, silane-based, and combined silane/adhesive coupling agents were investigated. The same resin composite as the substrate was used for repair. For each group, repaired samples were wet stored for 24 h (37 degrees C) or thermocycled (5,000 cycles, 5-55 degrees C). Failure mode and silver nitrate penetration were examined by stereomicroscopy. Intermediate agent, experimental condition, and their interaction were significant factors. Hydrophobic flowable composites resulted in statistically higher repair strengths, lower occurrence of adhesive failures, and good quality interfacial coupling without any silver uptake in both conditions. Light-curing, hydrophilic resin monomer-based intermediate agents, although not affected by thermocycling, showed a more pronounced silver penetration. The composite repair strength of a self-curing silane/adhesive agent was significantly affected by thermal stresses, despite the absence of silver uptake. A prehydrolized silane agent recorded the lowest repair strength, with minimal or no evidence of interfacial silver impregnation after thermocycling. In conclusion, flowability and hydrophobic nature can be considered important properties when selecting intermediate agents for composite repair.     

Clinical characteristics and functional outcome of patients with West Nile neuroinvasive disease in Serbia

Neurologic manifestations are prominent characteristic of West Nile virus (WNV) infection. The aim of this article was to describe neurological manifestations in patients with WNV neuroinvasive disease and their functional outcome at discharge in the first human outbreak of WNV infection in Serbia. The study enrolled patients treated in the Clinic for Infectious and Tropical Diseases, Clinical Center Serbia in Belgrade, with serological evidence of acute WNV infection who presented with meningitis, encephalitis and/or acute flaccid paralyses (AFP). Functional outcome at discharge was assessed using modified Rankin Scale (mRS) and Barthel index. Fifty-two patients were analysed. Forty-four (84.6 %) patients had encephalitis, eight (15.4 %) had meningitis, and 13 (25 %) had AFP. Among patients with AFP, 12 resembled poliomyelitis and one had clinical and electrodiagnostic findings consistent with polyradiculoneuritis. Among patients with encephalitis, 17 (32.7 %) had clinical signs of rhombencephalitis, and eight (15.4 %) presented with cerebellitis. Respiratory failure with subsequent mechanical ventilation developed in 13 patients with WNE (29.5 %). Nine (17.3 %) patients died, five (9.6 %) were functionally dependent (mRS 3–5), and 38 (73.1 %) were functionally independent at discharge (mRS 0–2). In univariate analysis, the presence of AFP, respiratory failure and consciousness impairment were found to be predictors of fatal outcome in patients with WNV neuroinvasive disease (p < 0.001, p < 0.001, p = 0.018, respectively). The outbreak of human WNV infection in Serbia caused a notable case fatality ratio, especially in patients with AFP, respiratory failure and consciousness impairment. Rhombencephalitis and cerebellitis could be underestimated presentations of WNV neuroinvasive disease.     

Factors associated with weight changes in successful quitters participating in a smoking cessation program

Objective

To identify possible predictors of post-cessation weight gain in smoking abstainers.

Patients and methods

A sample of 607 successful abstainers seen at the Centre for Tobacco-Dependent in Prague, Czech Republic, between 2005 and 2010, was included in this analysis. This sample was followed up for 1 year and included 47.9% women (N = 291) with the mean age of 48 years (18–85).

Findings

Post-cessation weight gain occurred in 88.6% of the 607 abstainers. The mean weight gain after one year post-quit was 5.1 kg (95% confidence interval 4.7–5.5 kg). Baseline characteristics associated with increased weight gain included a higher baseline smoking rate (p < 0.001), more severe cigarette dependence (p = 0.003), less physical activity (p = 0.008), and a report of increased appetite on the baseline assessment of withdrawal symptoms (p < 0.001).

Conclusions

Smokers who are more dependent and have minimal physical activity are at increased risk for post-cessation weight gain. For these smokers, incorporating interventions targeting the weight issue into tobacco dependence treatment is recommended. Further research should be done to identify reasons for this important quitting complication.