Antenatal Diagnosis of Iniencephaly: Sonographic and MR Correlation: A Case Report

Iniencephaly is an uncommon and fatal neural tube defect involving the occiput and inion, this occurs together with rachischisis of the cervical and thoracic spine, and retroflexion of the head. We report the ultrasound (US) and magnetic resonance (MR) imaging findings of a case of iniencephaly with clubfeet and arthrogryposis. The diagnosis of iniencephaly is easy to make on ultrasound due to the typical star-gazing fetus. However, the details of the fetal brain and spinal cord may not be adequately delineated on US. We found MR imaging to be superior for depicting central nervous system abnormalities. MR imaging has evolved as an imaging modality and it is complementary to fetal US, yet US remains the screening modality of choice.     

Using Real‐time Tissue Elastography for Breast Lesion Evaluation

Objective . The purpose of this study was to prospectively assess the performance of real‐time tissue elastography (RTE) in the evaluation of breast masses and correlate RTE and American College of Radiology Breast Imaging Reporting and Data System (BI‐RADS) assessments with pathologic findings. Methods . Informed consent was obtained from all patients for this Health Insurance Portability and Accountability Act–compliant, Institutional Review Board–approved study. Patients with sonographically visible breast lesions for which a biopsy was recommended were considered potential study participants. Between October 2006 and February 2008, 186 consecutive women with 200 lesions were enrolled. Twelve lesions in 11 patients were excluded, resulting in a study population of 188 lesions in 175 women. After routine B‐mode sonographic examination, RTE was performed using a manual free‐hand compression technique. Study lesions were assigned elasticity scores (ES) based on the system proposed by Itoh et al (Radiology 2006; 239:341–350), where 1 is normal and 5 represents abnormal strain. The lesion size on RTE and B‐mode imaging was compared. Results were correlated with BI‐RADS assessment and pathologic findings. Results . Pathologic examination revealed 61 of 188 malignancies (32.4%) and 127 of 188 benign lesions (67.6%). Of the malignant lesions, 84% had ES of 5 and 4, whereas 76% of benign lesions had ES of 1 and 2. The sensitivity of RTE was 92.7%, and specificity was 85.8%, with 4 false‐negative and 16 false‐positive results. Of the biopsy‐proven benign BI‐RADS 4A lesions, 63 of 76 (82.9%) had ES of 1 and 2, consistent with normal tissue. Conclusions . Real‐time tissue elastography may provide additional characterization of breast lesions, improving specificity, particularly for low‐suspicion lesions.     

Concentrations of methylated naphthalenes, anthracenes, and phenanthrenes occurring in Czech river sediments and their effects on toxic events associated with carcinogenesis in rat liver cell lines

Alkylated polycyclic aromatic hydrocarbons (PAHs) are important environmental pollutants. In the present study, we determined levels of monomethylated naphthalenes (MeNap), phenanthrenes (MePhe), and anthracenes (MeAnt) in Czech river sediments. The levels of MePhe generally were lower than the concentrations of phenanthrene. In contrast, both MeNap and MeAnt were found at levels higher than their respective parent compounds in the majority of sampling sites. We then investigated their aryl hydrocarbon receptor (AhR)-mediated activity, accumulation of phosphorylated p53 protein, induction of expression of cytochrome P450 1A1 (CYP1A1), inhibition of gap junctional intercellular communication (GJIC), and effects on cell proliferation in rat liver cell models to evaluate the relative importance of these toxicity mechanisms of low-molecular-weight methylated PAHs. Methylated phenanthrene and anthracene compounds were weak inducers of AhR-mediated activity as determined both in a reporter gene assay system and by detection of the endogenous gene (Cyp1a1) induction. 2-Methylphenanthrene was the most potent AhR ligand. Contribution of MeAnt and MePhe to overall AhR-inducing potencies should be taken into account in PAH-contaminated environments. Nevertheless, their effects on AhR were not sufficient to modulate cell proliferation in a normal rat liver progenitor cell model system. These PAHs only had a marginal effect on p53 phosphorylation at high doses of 1-, 3-, and 9-MePhe as well as 1 MeAnt. On the other hand, both 2- and 9-MeAnt as well as all the MePhe under study were efficient inhibitors of GJIC, suggesting that these compounds might act as tumor promoters. In summary, inhibition of GJIC and partial activation of AhR seem to be the most prominent toxic effects of the methylated PAHs in the present study.     

Prevalence of insulin resistance and prediction of glucose intolerance and type 2 diabetes mellitus in women with polycystic ovary syndrome.

BACKGROUND: Diabetes mellitus type 2 (DM2) affects 10% of women with polycystic ovary syndrome (PCOS). We evaluated the sensitivity and specificity of clinical and fasting biochemical parameters in screening for impaired glucose tolerance (IGT) and DM2. METHODS: Women with PCOS [n=244, age 27.4+/-7.5 years, body mass index (BMI) 27.5+/-6.9 kg/m(2)] and healthy women (n=57, age 26.8+/-5.8 years, BMI 21.3+/-2.1 kg/m(2)) underwent basal blood sampling and an oral glucose tolerance test (oGTT). RESULTS: Insulin resistance was identified in 40.2% of PCOS women. Impaired fasting glucose (5.6-6.9 mmol/L) was found in 30 subjects (12.3%), but the oGTT revealed IGT in only six of these cases and DM2 in one subject. IGT was found in 23 (9.4%) and DM2 in four (1.6%) of the women with PCOS. The conventional upper limits for total cholesterol, triglycerides, systolic and diastolic blood pressure and fasting glucose revealed low sensitivity for the identification of impaired glucose metabolism. CONCLUSIONS: No single parameter nor any combination of them showed an accuracy sufficient for screening of IGT or DM2 in PCOS patients. All PCOS patients should be screened using an oGTT to identify disturbances in glucose metabolism.     

Evaluation of chemical dot thermometers for measuring body temperature of orally intubated patients.

BACKGROUND: Recent research indicates that oral measurement of body temperature is a reliable option in orally intubated patients. In situations such as protective isolation, where dedicated electronic thermometers are not available, are single-use chemical dot thermometers an acceptable alternative? OBJECTIVE: To determine the accuracy of single-use chemical dot thermometers in orally intubated adult patients. METHODS: Subjects included a convenience sample of 85 adult patients admitted to 1 of 2 intensive care units (surgical trauma and neuroscience). For each patient, oral temperatures were measured concurrently (within 5 minutes) with a chemical dot thermometer and an electronic thermometer. The sequence of temperature measurements was alternated with each subsequent patient. Both thermometers were placed in the same posterior sublingual pocket opposite the side of the endotracheal tube. RESULTS: Measurements obtained with electronic and single-use chemical dot thermometers correlated strongly (r = 0.937). With the chemical dot thermometer, body temperature was overestimated in 11.8% of the measurements and underestimated in 10.8% of the measurements by 0.4 degree C or more. The difference between oral temperatures measured with the 2 different thermometers was not related to the patient's age, sex, or sublingual pocket location or to the order of thermometer use. CONCLUSION: The chemical dot thermometer is useful and reliable for measuring body temperature of orally intubated patients. When measurements of body temperature have important consequences for decisions about treatment, clinicians should use an electronic thermometer to confirm measurements made with a chemical dot thermometer.     

Tumor necrosis factor inhibits conversion of dehydroepiandrosterone sulfate (DHEAS) to DHEA in rheumatoid arthritis synovial cells: a prerequisite for local androgen deficiency

OBJECTIVE: Use of anti-tumor necrosis factor (anti-TNF) antibody therapy in rheumatoid arthritis (RA) has expanded our understanding of possible mechanisms by which this treatment reduces inflammation. Beyond its effects on local immune responses, anti-TNF treatment may also modulate the local hormone supply. Because androgens are thought to inhibit immune responses, their presence in inflamed tissue is an additional important antiinflammatory factor. METHODS: We investigated conversion of the ubiquitous dehydroepiandrosterone sulfate (DHEAS), the biologically inactive precursor of DHEA, to the androgen DHEA in mixed synovial cells from patients with RA and patients with osteoarthritis (OA), making use of thin-layer chromatography and phosphorimaging. Using immunohistochemical analysis, we detected the key enzyme, steroid sulfatase. RESULTS: DHEAS-to-DHEA conversion in synovial cells from patients with RA was significantly lower than that in synovial cells from patients with OA (mean +/- SEM 3.3 +/- 0.5% versus 6.0 +/- 0.9% of applied (3)H-DHEAS per 10(6) synovial cells; P = 0.042). In RA, but not in OA, the level of converted (3)H-DHEA was inversely correlated with the density of synovial macrophages (for RA, R(rank) = -0.725, P = 0.005; for OA, R(rank) = 0.069, P not significant [NS]) and T cells (for RA, R(rank) = -0.621, P = 0.024; for OA, R(rank) = 0.247, P NS). Double immunohistochemistry analysis revealed that steroid sulfatase was located mainly in synovial macrophages but was also observed in fibroblasts. Neutralization of TNF largely up-regulated the conversion of DHEAS to DHEA in RA, but not in OA. A similar neutralizing effect was observed with polyclonal human immunoglobulins; this effect is most probably mediated via TNF neutralization at low TNF concentrations. CONCLUSION: These data indicate that TNF inhibits the conversion of DHEAS to DHEA in RA synovial cells. Because androgens are antiinflammatory mediators, TNF-induced inhibition of the local androgen supply is a supplementary proinflammatory factor. Consequently, anti-TNF strategies may also exert their positive effects by increasing tissue androgens.     

Ovarian intrafollicular processes as a target for cigarette smoke components and selected environmental reproductive disruptors

Steroidogenesis, expansion of oocyte-cumulus complex, and meiotic maturation of the oocyte represent intrafollicular processes taking important part in the background of successful fertilisation. The reproductive health of female could be affected by a number of endogenous as well as exogenous factors, such as exposure to agents from specific lifestyle habits, environmental pollutants with endocrine disrupting properties, or heavy metals. Published data indicate that exposure to chemicals may cause alterations in reproductive behavior and contribute to sub-fecundity, infertility, or ovarian failure. Female reproductive functions can be compromised by exposure to toxic chemicals at a variety of sites, including ovary or reproductive tract. Substantial harmful effects of cigarette smoke on fecundity and reproduction have become apparent but are not generally appreciated. The effects of cigarette smoke components (cadmium, nicotine, cotinine) absorbed into the organism on intrafollicular processes may thus in part explain the negative impact of smoking on female fertility. Moreover, it is now evident that a variety of man-made pollutants present in the environment are capable to disrupt normal endocrine function in many species. Examples of these "endocrine disrupters" include plasticizers, such as phthalates and bisphenol A. The effects of selected environmental chemicals on the processes of steroidogenesis, expansion of oocyte-cumulus complex, and meiotic maturation of the oocyte are summarized in the present paper and possible mechanisms of action of these agents are suggested. However, for complete understanding the mechanisms by which chemical agents from the environment can affect the intrafollicular processes, a lot of further investigation is needed.     

Combination therapy of trichloroacetic acid,human autologous fibroblast injection and fibroblast seeded microfibrous collagen scaffold as a novel treatment for osteomyelitis diabetic foot ulcer

A severe complication associated with diabetes is diabetic foot ulcer (DFU). Most patients with DFU require amputation. Although treatment of non-healing diabetic ulcers is challenging, the use of novel therapies can be effective. In this report, we present the case of a woman with type 2 diabetes with DFU-related osteomyelitis, who was treated with a combination therapy of trichloroacetic acid, calcium alginate and foam dressings, human autologous fibroblast injection, and a fibroblast cell-seeded collagen scaffold. The results showed the positive effects of combination therapy on DFU. In the initial treatment, the wound area was measured to be 14 × 7 cm², with a depth of 4 cm. After 6 months, the wound was measured to be 1.5 cm², showing a 90% reduction of the wound area. Overall, this combination therapy was highly effective in the treatment of DFU-related osteomyelitis, and could markedly prevent amputation among DFU patients.     

Multilocus Sequence Analysis of Clinical “Candidatus Neoehrlichia mikurensis” Strains from Europe

“Candidatus Neoehrlichia mikurensis” is the tick-borne agent of neoehrlichiosis, an infectious disease that primarily affects immunocompromised patients. So far, the genetic variability of “Ca. Neoehrlichia” has been studied only by comparing 16S rRNA genes and groEL operon sequences. We describe the development and use of a multilocus sequence analysis (MLSA) protocol to characterize the genetic diversity of clinical “Ca. Neoehrlichia” strains in Europe and their relatedness to other species within the Anaplasmataceae family. Six genes were selected: ftsZ, clpB, gatB, lipA, groEL, and 16S rRNA. Each MLSA locus was amplified by real-time PCR, and the PCR products were sequenced. Phylogenetic trees of MLSA locus relatedness were constructed from aligned sequences. Blood samples from 12 patients with confirmed “Ca. Neoehrlichia” infection from Sweden (n = 9), the Czech Republic (n = 2), and Germany (n = 1) were analyzed with the MLSA protocol. Three of the Swedish strains exhibited identical lipA sequences, while the lipA sequences of the strains from the other nine patients were identical to each other. One of the Czech strains had one differing nucleotide in the clpB sequence from the sequences of the other 11 strains. All 12 strains had identical sequences for the genes 16S rRNA, ftsZ, gatB, and groEL. According to the MLSA, among the Anaplasmataceae, “Ca. Neoehrlichia” is most closely related to Ehrlichia ruminantium, less so to Anaplasma phagocytophilum, and least to Wolbachia endosymbionts. To conclude, three sequence types of infectious “Ca. Neoehrlichia” were identified: one in the west of Sweden, one in the Czech Republic, and one spread throughout Europe.