Case for diagnosis

The Osler-Weber-Rendu syndrome or Hereditary Hemorrhagic Telangiectasia (HHT) is a systemic fibrovascular dysplasia characterized by defects in the elastic and vascular walls of blood vessels, making them varicose and prone to disruptions. Lesions occur in different organs and can lead to hemorrhage in the lungs, digestive tract and brain. We describe the case of a patient with cutaneous manifestations and severe impairment of the digestive tract. It is important for the dermatologist to recognize this syndrome, since the cutaneous lesions may play a key role in diagnosis.     

Effect of erosive challenge with HCl on restorative materials

Objective

Investigate the effect of erosive challenge with hydrochloric acid (HCl) on the surface of five different restorative materials.

Material and methods

Ten plates of five restorative materials (Admira Fusion, Activa BioActive-Restorative, Charisma, Equia Forte HT Fil/EF, Filtek Universal Restorative/FU) were obtained. Half of the plate surfaces was covered with an adhesive tape, creating a control area, and the other side was submitted to the HCl (0.06 M HCl; pH 1.2; at 37 °C; for 30 h). Plates with control and HCl-treated areas were analyzed regarding the surface roughness (Sa), roughness profile (Rv), surface loss (SL), microhardness (MI), and gloss (GL) (n?=?10). Surface morphology was analyzed by SEM and chemical elements were identified by EDX (n?=?5). Data were evaluated by ANOVA and Tukey’s test (α?=?0.05).

Results

Most materials were not affected by HCl. FU showed the lowest Sa and Rv, and the highest GL after HCl. On the other hand, EF presented the highest Sa, Rv, and SL, and the lowest GL. The MI of materials was not changed after HCl. Topographical and chemical alterations were observed after HCl only for EF.

Conclusions

The composites showed minor surface changes after HCl, which was not observed for the glass ionomer cement (EF). FU presented the best performance regarding the parameters evaluated.

Clinical relevance

The effects of erosive challenge with HCl on composites were minimal, while the glass ionomer cements might not be indicated as restorative material for patients with gastroesophageal reflux disease.

     

Increase in dopaminergic, but not serotoninergic, receptors in T-cells as a marker for schizophrenia severity

Schizophrenia is characterized by a slow deteriorating mental illness. Although the pathophysiology mechanisms are not fully understood, different studies have suggested a role for the immune system in the pathogenesis of schizophrenia. To date, an altered expression or signaling of neurotransmitters receptors is observed in immune cells during psychiatric disorders. In the present study, we investigated the expression of different serotonin and dopamine receptors in T-cells of schizophrenic and control patients. We used flow cytometry to determine the pattern of expression of dopamine (D2 and D4) and serotonine receptors (SR1A, SR1C, SR2A, SR2B), as well as serotonin transporter (ST), in T-cell subsets (CD4 and CD8). Expression of serotonin receptors and ST in T-cells of schizophrenic patients were not different from controls. However, the percentages of CD4+D4+ and CD8+D4+ were increased in schizophrenic patients as compared to controls. In addition, increased percentages of CD8+D2+ cells were also observed in schizophrenic patients, albeit this population revealed lower CD4+D2+ cells in comparison to controls. Interestingly, a relationship between clinical symptoms and immunological parameters was also observed. We showed that the Brief Psychiatric Rating Scale (BPRS), the Positive and Negative Syndrome Scale (PANSS) and the Abnormal Involuntary Movement Scale (AIMS) were positively related to CD8+D2+ cells, though AIMS was inversely related to CD4+D4+ cells. In conclusion, the alteration in the pattern of cell population and molecules expressed by them might serve as a promising biomarker for diagnosis of schizophrenia.     

Analysis of slow- and fast-α band asymmetry during performance of a saccadic eye movement task: dissociation between memory- and attention-driven systems

This study aimed at analyzing the relationship between slow- and fast-alpha asymmetry within frontal cortex and the planning, execution and voluntary control of saccadic eye movements (SEM), and quantitative electroencephalography (qEEG) was recorded using a 20-channel EEG system in 12 healthy participants performing a fixed (i.e., memory-driven) and a random SEM (i.e., stimulus-driven) condition. We find main effects for SEM condition in slow- and fast-alpha asymmetry at electrodes F3-F4, which are located over premotor cortex, specifically a negative asymmetry between conditions. When analyzing electrodes F7-F8, which are located over prefrontal cortex, we found a main effect for condition in slow-alpha asymmetry, particularly a positive asymmetry between conditions. In conclusion, the present approach supports the association of slow- and fast-alpha bands with the planning and preparation of SEM, and the specific role of these sub-bands for both, the attention network and the coordination and integration of sensory information with a (oculo)-motor response.     

In Vitro Activity of Terbinafine Combined with Caspofungin and Azoles against Pythium insidiosum

In this text we evaluated the in vitro antifungal activities of terbinafine combined with caspofungin, miconazole, ketoconazole, and fluconazole against 17 Pythium insidiosum strains by using the microdilution checkerboard method. Synergistic interactions were observed with terbinafine combined with caspofungin (41.2% of the strains), fluconazole (41.2%), ketoconazole (29.4%), and miconazole (11.8%). No antagonistic effects were observed. The combination of terbinafine plus caspofungin or terbinafine plus fluconazole may have significant therapeutic potential for treatment of pythiosis.Pythiosis is a life-threatening infectious disease in humans and animals that is caused by the aquatic oomycete Pythium insidiosum (9). Horses are the most frequently infected animals, and equine pythiosis typically involves ulcerative granulomas (8). In humans, the infection occurs as ophthalmic, subcutaneous, and systemic forms, which are frequently associated with α- and β-thalassemia (5, 7). Pythiosis therapy, which is based on amphotericin B or azoles, has been ineffective or controversial, and the associated prognosis for human and equine pythiosis is poor (5, 7, 8, 9, 12). Therefore, surgical procedures, including amputation, are often effective, but disease reoccurrence rates are unfortunately high (7).Combinations of antifungal agents against pythiosis have not been thoroughly studied, and therefore, such in vitro combinatory activities against P. insidiosum require attention (1, 6).The purpose of this study was to investigate the in vitro activity of terbinafine (TRB) combined with caspofungin (CAS), miconazole (MNZ), ketoconazole, and fluconazole (FLC) against 17 strains of Pythium insidiosum isolated from animals.A total of 15 Brazilian P. insidiosum strains isolated from equines with pythiosis and two standard strains (ATCC 58637 and CBS 101555) were tested. All strains were maintained in cornmeal agar, and strain identification was confirmed by a PCR-based assay (4).The susceptibility of the P. insidiosum strains to the antifungal agents was tested by microdilution, based on protocol M38-A2 (2). The inoculum consisted of P. insidiosum zoospores obtained following zoosporogenesis. Cell numbers of zoospores were counted on a hemocytometer; zoospores were diluted in RPMI 1640 containing l-glutamine and buffered to pH 7.0 with 0.165 M MOPS (morpholinepropanesulfonic acid) to obtain a final concentration range of 2 × 10³ to 3 × 10³ zoospores/ml (10).The combinations of TRB (Novartis) plus CAS (Merck), TRB plus MNZ (Labware), TRB plus ketoconazole (Janssen), and TRB plus FLC (Pfizer) were evaluated using the checkerboard technique, according to the broth microdilution design (2, 14). In the individual tests, 100 μl of each drug concentration was plated in microplate wells and an equal volume of the inoculum was added to each well. In the combination tests, the antifungals were plated at a 4× concentrate of 50 μl of drug A plus 50 μl of drug B and 100 μl of the inoculum, resulting in a final 1× drug concentration of each compound. The microplates were incubated at 37°C for 24 h. The MIC was defined as the lowest drug concentration at which there was 100% inhibition of fungal growth by visual readings. The tests were performed in duplicate, and the assay was repeated when disparate values were obtained. The interactions, based on the respective fractional inhibitory concentration index (FICI), were interpreted as the following: FICI ≤ 0.5, synergism; FICI > 0.5 to ≤4, indifference; FICI > 4, antagonism. FICIs were obtained using the formula FICI = (MIC of drug A in combination/MIC of drug A alone) + (MIC of drug B in combination/MIC of drug B alone).The in vitro activities of individual antifungal agents against P. insidiosum are shown in Table ​Table1.1. In general, the patterns of susceptibility demonstrated that individual drugs had only weak antifungal activity or none.

TABLE 1.

In vitro activities of TRB, CAS, and azoles against isolates of Pythium insidiosum

Independent component analysis of dynamic contrast-enhanced magnetic resonance images of breast carcinoma: a feasibility study

PURPOSE: To study the possibility of using independent component analysis (ICA) to identify breast lesions as separate hemodynamic sources on dynamic contrast-enhanced (DCE) MR images, as depicted by the passage of contrast medium. MATERIALS AND METHODS: Six patients who were histopathologically confirmed with breast carcinoma underwent DCE MRI with 5 precontrast and 60 postcontrast scans at a time-resolution of 8 s. A spatial ICA algorithm was applied on the DCE MRI data set to extract spatial component maps corresponding to source locations with different signal time-intensity patterns. To verify the present hypothesis of the ability of ICA to reveal tumor voxels as a separate hemodynamic phase, tumor margins were outlined by an experienced radiologist who was blinded from the ICA results, and the manual outlines were compared with the ICA maps. RESULTS: Consistently for each of the six patient study cases, it was found that ICA yields a tumor component map associated with typical tumor enhancement patterns of rapid enhancement with washout or plateau. Tumor outlines manually drawn by the radiologist were in good agreement with the tumor locations depicted in the tumor component maps. CONCLUSION: ICA may provide an objective method for identifying the outlines of enhancing breast tumors on DCE MR images and to automatically extract the tumor signal intensity-time curve for subsequent tracer kinetics analysis.     

Enhancement of Calcium/Vitamin D Supplement Efficacy by Administering Concomitantly Three Key Nutrients Essential to Bone Collagen Matrix for the Treatment of Osteopenia in Middle-Aged Women: A One-Year Follow-Up

Two vitamins and proline (CB₆Pro), three nutrients essential for bone collagen, were used in combination to a 1000 mg calcium/250 IU vitamin D (Ca/D) daily supplement to treat osteopenia as a preventive measure against osteoporosis later in life. Middle-aged women not using estrogen were screened for osteopenia using the WHO criteria and divided into three groups (n = 20 each): 1) placebo healthy controls with normal bone mineral density (BMD); 2) control Ca/D-treated osteopenic patients; and 3) Ca/D + CB₆Pro-treated osteopenic patients. The three groups were comparable at baseline except for BMD. After one-year treatment, cortical diaphyseal BMD remained constant in each group, but trabecular bone loss persisted (at 5 lumbar sites) in osteopenic group 2. No further bone loss was detected in osteopenic group 3. A loss of 2% was evidenced in the placebo group at one lumbar site. Markers of bone formation (which increase in coupling to resorption) decreased significantly in both osteopenic groups. Although biomarkers of resorption did not change, hormone (PTH and 1,25(OH)₂D₃)-induced osteoclastic activity was significantly reduced. No decline in BMD occurred at any bone site in osteopenic group 3, highlighting the importance of improving the quality of bone matrix concomitantly to mineral replacement.