A New Cell Enzyme-Linked Immunosorbent Assay Demonstrates Gamma Interferon Suppression by Beta Interferon in Multiple Sclerosis

Multiple sclerosis (MS) is a demyelinating disorder of the central nervous system of unknown etiology. Immune mechanisms involving the proinflammatory cytokine gamma interferon (IFN-γ) are believed to play an important role in the pathogenesis of MS. IFN-β-1b has been introduced as a treatment for MS and was found to reduce the number and severity of clinical exacerbations. To examine the influence of IFN-β-1b on myelin basic protein (MBP)-specific and phytohemagglutinin-induced IFN-γ production, we developed a cell-released capturing enzyme-linked immunosorbent assay (CRC-ELISA), which rapidly measures spontaneous and antigen- or mitogen-induced cellular IFN-γ production. CRC-ELISA documented a significant MBP-specific T-cell response in the blood of untreated MS patients, as assessed by IFN-γ production. This response was suppressed in MS patients treated with IFN-β-1b. The present work confirms in vivo the in vitro suppressive effects of IFN-β-1b on IFN-γ production in MS. Moreover, it provides a powerful new technique for detection of cytokines.     

Spontaneous first trimester posterior uterine rupture in a multiparous woman with scarred uterus: A case report

Uterine rupture (UR) is a life threatening peripartum complication with high incidence of maternal morbidity and mortality. Posterior wall uterine rupture is a rare presentation especially in the first trimester. Herein, we experienced a case of spontaneous UR in a 24-year-old gravida 3 para 2 pregnant woman at gestational age of 10 weeks presented with acute abdomen. Clinical and ultrasonographic findings were suspicious towards ruptured ectopic pregnancy. However, abdominal exploration revealed posterior wall UR away from the site of lower segment cesarean scar. The tear was repaired in three layers and the patient was discharged after 4 days of hospital stay. UR should be considered in any pregnant woman with hemoperitoneum, Posterior uterine wall rupture is a rare presentation in the first trimester, but must be kept in mind as early intervention is the only way to save the mother's life.     

The Use of Behavior Change Theory in Internet-Based Asthma Self-Management Interventions: A Systematic Review

Background

The high prevalence rate of asthma represents a major societal burden. Advancements in information technology continue to affect the delivery of patient care in all areas of medicine. Internet-based solutions, social media, and mobile technology could address some of the problems associated with increasing asthma prevalence.

Objective

This review evaluates Internet-based asthma interventions that were published between 2004 and October 2014 with respect to the use of behavioral change theoretical frameworks, applied clinical guidelines, and assessment tools.

Methods

The search term (Asthma AND [Online or Internet or Mobile or Application or eHealth or App]) was applied to six bibliographic databases (Ovid MEDLINE, PubMed, BioMed Central, ProQuest Computing, Web of Knowledge, and ACM Digital Library) including only English-language articles published between 2004 and October 2014. In total, 3932 articles matched the priori search terms and were reviewed by the primary reviewer based on their titles, index terms, and abstracts. The matching articles were then screened by the primary reviewer for inclusion or exclusion based on their abstract, study type, and intervention objectives with respect to the full set of priori inclusion and exclusion criteria; 331 duplicates were identified and removed. A total of 85 articles were included for in-depth review and the remaining 3516 articles were excluded. The primary and secondary reviewer independently reviewed the complete content of the 85 included articles to identify the applied behavioral change theories, clinical guidelines, and assessment tools. Findings and any disagreement between reviewers were resolved by in-depth discussion and through a consolidation process for each of the included articles.

Results

The reviewers identified 17 out of 85 interventions (20%) where at least one model, framework, and/or construct of a behavioral change theory were applied. The review identified six clinical guidelines that were applied across 30 of the 85 interventions (35%) as well as a total of 21 assessment tools that were applied across 32 of the 85 interventions (38%).

Conclusions

The findings of this literature review indicate that the majority of published Internet-based interventions do not use any documented behavioral change theory, clinical guidelines, and/or assessment tools to inform their design. Further, it was found that the application of clinical guidelines and assessment tools were more salient across the reviewed interventions. A consequence, as such, is that many Internet-based asthma interventions are designed in an ad hoc manner, without the use of any notable evidence-based theoretical frameworks, clinical guidelines, and/or assessment tools.     

Clinical outcomes and mortality in elderly peritoneal dialysis patients

OBJECTIVES:

To evaluate the clinical outcomes and identify the predictors of mortality in elderly patients undergoing peritoneal dialysis.

METHODS:

We conducted a retrospective study including all incident peritoneal dialysis cases in patients ≥65 years of age treated from 2001 to 2014. Demographic and clinical data on the initiation of peritoneal dialysis and the clinical events during the study period were collected. Infectious complications were recorded. Overall and technique survival rates were analyzed.

RESULTS:

Fifty-eight patients who began peritoneal dialysis during the study period were considered for analysis, and 50 of these patients were included in the final analysis. Peritoneal dialysis exchanges were performed by another person for 65% of the patients, whereas 79.9% of patients preferred to perform the peritoneal dialysis themselves. Peritonitis and catheter exit site/tunnel infection incidences were 20.4±16.3 and 24.6±17.4 patient-months, respectively. During the follow-up period, 40 patients were withdrawn from peritoneal dialysis. Causes of death included peritonitis and/or sepsis (50%) and cardiovascular events (30%). The mean patient survival time was 38.9±4.3 months, and the survival rates were 78.8%, 66.8%, 50.9% and 19.5% at 1, 2, 3 and 4 years after peritoneal dialysis initiation, respectively. Advanced age, the presence of additional diseases, increased episodes of peritonitis, the use of continuous ambulatory peritoneal dialysis, and low albumin levels and daily urine volumes (<100 ml) at the initiation of peritoneal dialysis were predictors of mortality. The mean technique survival duration was 61.7±5.2 months. The technique survival rates were 97.9%, 90.6%, 81.5% and 71% at 1, 2, 3 and 4 years, respectively. None of the factors analyzed were predictors of technique survival.

CONCLUSIONS:

Mortality was higher in elderly patients. Factors affecting mortality in elderly patients included advanced age, the presence of comorbid diseases, increased episodes of peritonitis, use of continuous ambulatory peritoneal dialysis, and low albumin levels and daily urine volumes (<100 ml) at the initiation of peritoneal dialysis.     

The role of gender in patients with diffuse large B cell lymphoma treated with rituximab-containing regimens: a meta-analysis

Introduction

Diffuse large B cell lymphoma (DLBCL) is the most common subtype of non-Hodgkin lymphoma (NHL). Although gender has not been included in prognostic systems, male gender has been found as a bad prognostic indicator in Hodgkin lymphoma, follicular lymphoma and chronic lymphocytic leukemia. The relationship between gender and prognosis is not clear in patients with DLBCL treated with rituximab-containing regimens. The aim of this meta-analysis is to determine the prognostic/predictive role of gender in patients with DLBCL treated with rituximab-containing regimens.

Material and methods

We systematically searched for studies investigating the relationships between gender and prognosis in DLBCL treated with rituximab-containing regimens. After careful review, survival data were extracted from eligible studies. A meta-analysis was performed to generate combined hazard ratios for overall survival, disease-free survival (DFS) and event-free survival (EFS).

Results

A total of 5635 patients from 20 studies were included in the analysis. Our results showed that male gender was associated with poor prognosis in terms of overall survival (OS) (hazard ratio (HR) = 1.155; 95% confidence interval (CI): 1.037–1.286; p < 0.009). The pooled hazard ratio for DFS and EFS showed that male gender was not statistically significant (HR = 1.219; 95% CI: 0.782–1.899; p = 0.382, HR = 0.809; 95% CI: 0.577–1.133; p = 0.217).

Conclusions

The present meta-analysis indicated male gender to be associated with a poor prognosis in patients with DLBCL treated with rituximab-containing regimens.     

Primary diffuse large B cell lymphoma of the breast eight years after the diagnosis of gastric MALT lymphoma: report of first case

Primary breast lymphoma (PBL) is an uncommon type of extranodal non-Hodgkin’s lymphoma (NHL), accounting for approximately 1% of all extranodal NHL. Diffuse large B cell lymphoma (DLBCL) is the most frequent histology. Both primary mucosa-associated lymphoid tissue (MALT) lymphoma of the breast and its relapse have been documented previously. We report on a 63-year-old woman with primary DLBCL of the breast which was diagnosed 8 years after gastric MALT lymphoma. Following chemotherapy, complete response was obtained. We suggest that for women presenting with a breast mass who received cytotoxic treatment for the other lymphoma, PBL should be considered in the differential diagnosis of the breast mass together with primary breast carcinoma.     

Pressure-Controlled vs Volume-Controlled Ventilation During Laparoscopic Gynecologic Surgery

Study ObjectiveTo quantify and compare the effects of conventional volume-controlled ventilation (VCV) with the alternative mode, pressure-controlled ventilation (PCV), on respiratory mechanics and noninvasive hemodynamic parameters in patients undergoing laparoscopic gynecologic surgery.DesignRandomized controlled trial (Canadian Task Force classification I).SettingRespiratory mechanics and hemodynamic parameters were recorded for each patient at time T1, 10 minutes after induction, in the supine position; T2, 15 minutes after pneumoperitoneum, in the Trendelenburg position; and T3, 10 minutes after pneumoperitoneum withdrawal, in the supine position.PatientsSixty women, aged 20 to 50 years, undergoing laparoscopic gynecologic surgery, with American Society of Anesthesiologists classes I and II disease.InterventionsPatients were randomly allocated to 1 of 2 groups. In the VCV group (n = 30), ventilation mode was maintained, whereas in the PCV group (n = 30), ventilation mode was changed to PVC.Measurements and Main ResultsBoth groups were comparable insofar as patient characteristics, operating time, pneumoperitoneum time, anesthesia time, and mean operative time. VCV was associated with a significant increase in peak airway pressure, plateau pressure, and airway resistance at T2 (p < .05). Compliance was significantly higher in the PCV group at T2 (p < .05). No other statistically significant differences were found between the groups.ConclusionsBoth VCV and PCV seem to be equally suited for use in patients undergoing laparoscopic gynecologic surgery. However, lower peak airway pressure, plateau pressure, and airway resistance, and higher compliance are observed with PCV in laparoscopic gynecologic surgery.     

Vasculogenic Erectile Dysfunction and Metabolic Syndrome

IntroductionErectile dysfunction (ED), defined as the inability to achieve and/or maintain a penile erection sufficient for sexual intercourse, is a health problem affecting more than one-half of men between the age of 40 and 70 years.AimThe aim of the present study was to determine the potential factors affecting penile vascular flow and predictability of vascular flow in patients with ED.MethodsTotally 163 male patients between 29 and 82 years of age who were admitted to our outpatient clinic with complaints of ED were included. After a detailed medical history was obtained, all patients were asked to complete the International Index of Erectile Function (IIEF) questionnaire. Blood samples were obtained for measurements of serum cholesterol, triglycerides, and fasting blood glucose (FBG), and the body mass index (BMI) was calculated.Main Outcome MeasuresPenile color Doppler ultrasonography (PDU) was performed to evaluate flow patterns, Mann–Whitney U-test and Spearman correlation analyses were used to assess the relationship of PDU findings with hypertension, obesity (BMI ≥ 25 kg/m²), FBG, and cholesterol levels measurements.ResultsThe mean age, IIEF score, and BMI of the study population was 51.3 ± 12.1 years, 11.9 ± 6.1 and 28.5 ± 4.0 kg/m², respectively. When the vascular pathologies detected with PDU and the presence of risk factors were compared, no significant correlation was determined between arterial insufficiency and metabolic syndrome (MS), whereas there was a significant correlation between veno-occlusive dysfunction and MS.ConclusionThe prevalence of ED increases with advanced age and with the presence of a systemic disease. Basic evaluations may not always be sufficient for assessment of ED. In the presence of MS, the use of penile Doppler ultrasonography should be considered for the evaluation of penile vascular structures in ED patients. Koca O, Çal??kan S, Öztürk M?, Güne? M, K?l?ço?lu G, and Karaman MI. Vasculogenic erectile dysfunction and metabolic syndrome.     

SLC26A4 mutations are associated with a specific inner ear malformation

BACKGROUND AND AIM: Inner ear anomalies have been reported in approximately 30% of children with early onset deafness. Identification of causative genetic factors in a large proportion of these patients was not successful. Mutations in the SLC26A4 gene have been detected in individuals with enlarged vestibular aqueduct (EVA) or Mondini dysplasia. We aimed to characterize the inner ear anomalies associated with SLC26A4 mutations. METHODS: The SLC26A4 gene has been screened for mutations in 16 subjects from 14 unrelated Turkish families with a variety of inner ear anomalies ranging from Michel aplasia to incomplete partition-II and EVA. None of the patients was diagnosed to have a recognizable genetic syndrome. Additional four patients with Pendred syndrome from three families were included. RESULTS: Only one patient with EVA was found to have a heterozygous mutation (c.1586delT) in SLC26A4. All patients with Pendred syndrome had homozygous mutations and were noted to have either EVA or EVA associated with incomplete partition-II on the computed tomography of the temporal bone. CONCLUSION: SLC26A4 mutations are not associated with a large spectrum of inner ear anomalies. They, instead, result in a specific morphological appearance consistent with EVA or incomplete partition-II.