Seroconversion to human immunodeficiency virus (HIV) in hemophiliacs. Relation to lymphadenopathy

The authors studied the natural history of human immunodeficiency virus (HIV) exposure in 187 hemophiliacs followed for an average of 45 months. Overall, 55 percent developed antibody specific for HIV and 21 percent developed persistent generalized lymphadenopathy. Most patients seroconverted sometime between early 1982 and the end of 1984. Four patients developed acquired immune deficiency syndrome (AIDS) and four seropositive patients developed idiopathic thrombocytopenia (ITP). One of the four patients who developed AIDS and three of the four with ITP had preexisting lymphadenopathy. None of the 10 patients with lymphadenopathy or the 20 asymptomatic patients was seropositive for human T-lymphotropic virus, type I. Although seropositivity and lymphadenopathy have been found in many of the authors' patients, few have developed clinical disease that can be related to HIV infection.     

Effekte von Ganzkörpervibrationen auf die neuromuskuläre Leistungsfähigkeit von Frauen über dem 65. Lebensjahr

Sarcopenia is linked to an increased risk of morbidity and mortality in the aging. Whole body vibration (WBV) exercises are currently discussed as a “gentle” alternative to conventional exercises to improve muscle mass. The present study scrutinized whether a multipurpose (exercise) training program using WBV can improve muscle mass and neuromuscular capacity, while lowering fall risk. A total of 151 postmenopausal women were randomized into three groups: exercise group (TG), exercise group with vibration (VTG), and fitness control group (CG). The TG group participated in an exercise program including leg strengthening training twice a week over 12 months, while the VTG carried out an identical program with the leg exercises performed under WBV. Despite a positive trend regarding lean body mass in the two exercise groups, there was no difference between groups. Both exercise groups showed a significant increase (vs. KG) in trunk strength. An improvement in both exercise groups was also measured with respect to leg strength, but only the VTG showed significant differences compared to the CG. In addition, a significant lower risk of falls compared with the CG was evident only in VTG.     

结节性硬化症的CT诊断（附7例分析）

目的：探讨结节性硬化症（TSC）的CT表现和鉴别诊断。方法：分析7例诊断为结节性硬化症的CT资料。重点观察病变部位、大小、钙化程度及其他改变。结果：7例均有室管膜下结节,共计77个,其中钙化结节39个．80％结节位于侧脑室体部室管膜下;5例皮质及皮质下多发结节均无钙化,额枕叶为著,其次为颞顶叶：4例皮质下白质有不同程度低密度改变,主要围绕侧脑室体部及额角周围。4例合并其他畸形。结论：室管膜下多发结节并钙化,皮质异常脑回及不规则形低密度影、脑白质放射状分布的低密度改变是CT诊断结节性硬化症的主要征象,其中室管膜下结节并钙化是较有特征性的表现。CT结合临床可做出明确诊断并发现其他畸形。     

乌审旗3000名妇女宫颈癌筛查结果分析

目的：了解乌审旗妇女宫颈癌及癌前病变的发病现状,探讨子宫颈液基细胞学（Thinprep paptest,TCT）结合阴道镜检查的诊断价值。方法：对3 000名乌审旗妇女进行TCT筛查,对TCT阳性（细胞学TBS分类为不典型鳞状细胞以上）的妇女进行阴道镜及镜下多点活组织检查（活检）,分析TCT阳性者的阴道镜检查及活检结果,比较TCT阳性者中不同年龄段患者的活检结果。结果：3 000名受检者中,TCT阳性537例（17.9%）,其中经活检证实为宫颈上皮内瘤变（cervical intraepthelial neoplasia,CIN）190例（6.3%）,宫颈浸润癌2例（0.07%）,537例TCT阳性者中,阴道镜检查正常264例（49.2%）,其中活检结果为CIN34例,阴道镜的假阴性率为12.9%,异常273例（50.8%）,其中活检结果为湿疣34例,CIN或浸润癌158例,阴道镜与活检的诊断符合率达70.3%（192/273）。TCT为轻度鳞状上皮内病变、高度鳞状上皮内病变、鳞状细胞癌的病例与活检的诊断符合率分别为50.4%,88.3%和2/2,假阳性率则分别为49.6%、11%和0。537例TCT阳性者中,2030岁组、3140岁组,4147岁组的CIN检出率分别为33.7%、44.5%2、6.7%（P〈0.05）。结论：乌审旗妇女CIN的发生率高,是宫颈癌的高发人群。TCT结合阴道镜检查是较好的宫颈癌筛查手段之一。     

Effect of sunitinib on metastatic gastrointestinal stromal tumor in patients with neurofibromatosis type 1： A case report

Gastrointestinal stromal tumor (GIST) represents the most common mesenchymal malignancy of the gastrointestinal (GI) tract. In neurofibromatosis (NF), the increased incidence of tumor needs to be considered even in non-symptomatic individuals. Patients with neurofibromatosis NF type 1 have an increased risk of developing GI tumors including rare types such as GIST. We report a case of GIST in a 53-year-old male patient with neurofibromatosis. The patient was diagnosed with NF four years ago and his medical history revealed that he was hospitalized 5 times with a provisional diagnosis of massive lower gastrointestinal bleeding. GIST was diagnosed at explorative laparotomy and the tumor was 21 cm × 13 cm × 7 cm in size. Immunohistochemical examination showed that vimentin, actin and CD117 were positive. Computerized tomography showed peritoneal implants three months later. Imatinib mesylate (600 mg/d) was initiated. However, control computerized tomography revealed liver and omental metastasis. The dosage was elevated to 800 mg/d. Despite high dosage, the progression of the metastatic lesions continued in the liver and omentum. The patient started oral sunitinib malate (Sutent? Pfizer Inc, New York, NY, USA) 50 mg per day for 4 consecutive weeks, followed by 2 wk off per treatment cycle. The metastatic lesions in the liver and omentum were decreased in size after four courses, suggesting that sunitinib is also an effective treatment modality for metastatic GIST in NF patients.     

A crucial role for TNF-α in mediating neutrophil influx induced by endogenously generated or exogenous chemokines,KC/CXCL1 and LIX/CXCL5

Background and purpose:

Chemokines orchestrate neutrophil recruitment to inflammatory foci. In the present study, we evaluated the participation of three chemokines, KC/CXCL1, MIP-2/CXCL2 and LIX/CXCL5, which are ligands for chemokine receptor 2 (CXCR2), in mediating neutrophil recruitment in immune inflammation induced by antigen in immunized mice.

Experimental approach:

Neutrophil recruitment was assessed in immunized mice challenged with methylated bovine serum albumin, KC/CXCL1, LIX/CXCL5 or tumour necrosis factor (TNF)-α. Cytokine and chemokine levels were determined in peritoneal exudates and in supernatants of macrophages and mast cells by elisa. CXCR2 and intercellular adhesion molecule 1 (ICAM-1) expression was determined using immunohistochemistry and confocal microscopy.

Key results:

Antigen challenge induced dose- and time-dependent neutrophil recruitment and production of KC/CXCL1, LIX/CXCL5 and TNF-α, but not MIP-2/CXCL2, in peritoneal exudates. Neutrophil recruitment was inhibited by treatment with reparixin (CXCR1/2 antagonist), anti-KC/CXCL1, anti-LIX/CXCL5 or anti-TNF-α antibodies and in tumour necrosis factor receptor 1-deficient mice. Intraperitoneal injection of KC/CXCL1 and LIX/CXCL5 induced dose- and time-dependent neutrophil recruitment and TNF-α production, which were inhibited by reparixin or anti-TNF-α treatment. Macrophages and mast cells expressed CXCR2 receptors. Increased macrophage numbers enhanced, while cromolyn sodium (mast cell stabilizer) diminished, LIX/CXCL5-induced neutrophil recruitment. Macrophages and mast cells from immunized mice produced TNF-α upon LIX/CXCL5 stimulation. Methylated bovine serum albumin induced expression of ICAM-1 on mesenteric vascular endothelium, which was inhibited by anti-TNF-α or anti-LIX/CXCL5.

Conclusion and implications:

Following antigen challenge, CXCR2 ligands are produced and act on macrophages and mast cells triggering the production of TNF-α, which synergistically contribute to neutrophil recruitment through induction of the expression of ICAM-1.     

Flat panel detector angiographic CT for stent-assisted coil embolization of broad-based cerebral aneurysms

BACKGROUND AND PURPOSE: The purpose of this work was to evaluate angiographic CT (ACT) in the combined application of a self-expanding neurovascular stent and detachable platinum coils in the management of broad-based and fusiform intracranial aneurysms. MATERIALS AND METHODS: Eleven patients harboring wide-necked intracranial aneurysms were treated with a flexible self-expanding neurovascular stent and subsequent aneurysm embolization with platinum microcoils. ACT was performed after the interventional procedure to analyze stent position and the relationship of coils to the stent. Postprocessing included multiplanar reconstructions (MPRs) and maximum intensity projections (MIPs). ACT volume datasets were postprocessed for soft tissue visualization. RESULTS: Accurate stent placement with subsequent coil occlusion of the aneurysms was feasible in all of the patients. Similar to nonsubtracted digital subtraction angiography (DSA) images, radiopaque platinum stent markers showed excellent visibility in ACT as well. The stent struts themselves, hardly visible in nonsubtracted DSA, were visible in MPRs and MIPs of ACT in all of the patients. In aneurysms larger than 10 mm in diameter, accurate stent assessment at the level of the coils was limited due to beam hardening artifacts. Postprocedural ACT in all of the patients did not reveal any evidence of procedure-related intracranial hemorrhage. CONCLUSION: ACT provides cross-sectional, 3D visualization of endovascular stents otherwise hardly visible with plain fluoroscopy. ACT enables us to accurately determine stent position, which may be helpful in complex stent-assisted aneurysm coiling procedures. However, in aneurysms larger than 10 mm in diameter, beam hardening artifacts caused by the endoaneurysmal coil package impair visibility of the stent. Further data are necessary to evaluate the usefulness of ACT in stent-assisted aneurysm coiling.     

Differential effects of strength versus power training on bone mineral density in postmenopausal women: a 2-year longitudinal study

Objectives

To investigate the effect of two different schemes of loading in resistance training on bone mineral density (BMD) and pain in pretrained postmenopausal women.

Methods

53 pretrained women (mean (SD) age 58.2 (3.7) years) who carried out a mixed resistance and gymnastics programme were randomly assigned to a strength training (ST) or power training (PT) group. The difference between the two groups was the movement velocity during the resistance training (ST, 4 s (concentric)/4 s (eccentric); PT, explosive/4 s). Otherwise both groups carried out periodised progressive resistance training (10–12 exercises, 2–4 sets, 4–12 repetitions at 70–92.5% of the one‐repetition maximum (2/week) for 2 years. Mechanical loading was determined with a force measuring plate during the leg press exercise. At baseline and after 2 years, BMD was measured at different sites with dual x‐ray absorptiometry. Pain was assessed by questionnaire.

Results

Loading magnitude, loading/unloading rate, loading amplitude and loading frequency differed significantly (p<0.001) between the two groups. After 2 years, significant between‐group differences were detected for BMD (PT, −0.3%; ST, −2.4%; p<0.05) and bone area (PT, 0.4%; ST, −0.9%; p<0.05) at the lumbar spine. At the hip, there was a non‐significant trend in favour of the PT group. Also the incidence of pain indicators at the lumbar spine was more favourable in the PT group.

Conclusion

The results show that PT may be superior for maintaining BMD in postmenopausal women. Furthermore, PT was safe as it did not lead to increased injury or pain.