How to handle adsorption of cerebrospinal fluid amyloid β (1–42) in laboratory practice? Identifying problematic handlings and resolving the issue by use of the Aβ42/Aβ40 ratio

Introduction

We aimed to investigate factors defining amyloid β (1–42) (Aβ_1–42) adsorption during preanalytical workup of cerebrospinal fluid (CSF).

Yersinia enterocolitica infection does not confer an increased risk of thyroid antibodies: evidence from a Danish twin study

Understanding of the aetiological basis of thyroid autoimmunity may be gained by studying the early stages of the disease process. We aimed to (1) investigate the relationship between thyroid antibody status and Yersinia enterocolitica (YE) infection in euthyroid subjects and (2) explore the relative importance of genetic and environmental risk factors in the acquisition of YE infection. The association between thyroid antibody status and YE infection was explored using a case-control design. Furthermore, thyroid antibody-positive twins were compared with their thyroid antibody-negative co-twin. In 468 twins, IgA and IgG antibodies to virulence-associated outer-membrane proteins (YOPs) of YE were measured. Of these, 147 were thyroid antibody-positive (cases). A total of 147 age- and gender-matched twins were chosen as controls. The prevalence of YOP antibodies was lower among thyroid antibody-positive individuals than among controls. Yersinia infection was not associated with a positive thyroid antibody status: the odds ratio (with 95% CI) for YOP IgA-ab was 0.66 (0.42-1.05), P = 0.078 and for YOP IgG-ab it was 0.95 (0.60-1.50), P = 0.816. Within discordant twin pairs, the thyroid antibody-positive twin did not have an increased risk of Yersinia infection compared to the thyroid antibody-negative co-twin [odds ratio: YOP IgA-Ab: 0.94 (0.49-1.83), P = 0.866, and YOP IgG-Ab: 1.35 (0.72-2.53), P = 0.345]; 41% (95% CI 10-67% of the liability of being YOP antibody-positive was due to genetic effects. In conclusion, Yersinia infection does not confer an increased risk of thyroid antibodies. The genetic contribution in the acquisition of Yersinia infection is modest.     

Strahlenhygiene in der medizinischen Röntgenbildgebung, Teil 1

In this first part of a series of three articles on radiation hygiene in medical X-ray imaging the characteristics of X-rays, their interactions with matter and the components of X-ray equipment are described from a radiation protection point of view. The fundamental radiation protection measures like filtration and beam limitation are introduced as well as the various conventional and digital image receptor systems. Moreover the absorbed dose and other practical dose terms as well as metrological and theoretical methods for dose assessment are introduced. The aim of this paper is to explain the essential physical and technical basics of X-ray imaging and the assessment of the resulting radiation dose.     

The mode of delivery in patients with preeclampsia at term subject to elective or emergency Cesarean section

Purpose

Preeclampsia is accompanied by high maternal and fetal morbidity and mortality. Thus, delivery needs to be planned carefully. The aim of this study was to determine the most favorable delivery for patients with preeclampsia between the week 37 and 41 of gestation.

Methods

For this retrospective study, patient data from 2003 to 2011 was collected. Study participants were women having a Cesarean section during week 37 and 41 of gestation. The population was classified into four groups: patients without hypertensive disorders having an elective or emergency Cesarean section and patients suffering from preeclampsia with elective or emergency Cesarean section. Analysis included mode of delivery and neonatal outcome, defined by Apgar score, rate of NICU admission and pH value of the umbilical cord.

Results

A total of 130 cases of preeclampsia were recorded. Compared to the control group, we observed a significantly higher Apgar score in the study group with emergency Cesarean section. Furthermore, within the study group the Apgar score at 5 and 10 min was also significantly increased in cases delivered by emergency Cesarean section. Moreover, the pH value of the umbilical cord was significantly higher in the study group. Considering the delivery mode, significant differences were found in favor of the elective Cesarean section. There were no differences in the rate of NICU admission between the groups.

Conclusion

The most frequent mode of delivery for women suffering from preeclampsia is elective Cesarean section; however, neonates delivered by emergency Cesarean section did not show an adverse neonatal outcome.     

Pain,osteolysis, and periosteal reaction are associated with the STRYDE limb lengthening nail: a nationwide cross-sectional study

Background and purpose — Observing serious adverse events during treatment with the Precice Stryde bone lengthening nail (NuVasive, San Diego, CA, USA), we conducted a nationwide cross-sectional study to report the prevalence of adverse events from all 30 bone segments in 27 patients treated in Denmark.Patients and methods — Radiographs of all bone segments were evaluated regarding radiographic changes in February 2021. We determined the number of bone segments with late onset of pain and/or radiographically confirmed osteolysis, periosteal reaction, or cortical hypertrophy in the junctional area of the nail.Results — In 30 bone segments of 27 patients we observed radiographic changes in 21/30 segments of 20/27 patients, i.e., 19/30 osteolysis, 12/30 periosteal reaction (most often multi-layered), and 12/30 cortical hypertrophy in the area of the junction between the telescoping nail parts. Late onset of pain was a prominent feature in 8 patients. This is likely to be a prodrome to the bony changes. Discoloration (potential corrosion) at the nail interface was observed in multiple removed nails. 15/30 nails were still at risk of developing complications, i.e., were not yet removed.Interpretation — All Stryde nails should be monitored at regular intervals until removal. Onset of pain at late stages of limb lengthening, i.e., consolidation of the regenerate, should warrant immediate radiographic examination regarding osteolysis, periosteal reaction, and cortical hypertrophy, which may be associated with discoloration (potential corrosion) of the nail. We recommend removal of Stryde implants as early as possible after consolidation of the regenerate.

Bone reconstruction and lengthening surgery entails many risks and unplanned surgeries are common (Frost et al. 2021, Morrison et al. 2020, Sheridan et al. 2020). However, since many adverse events can be managed with or without surgical intervention without affecting the long-term outcome, Paley (1990) redefined complications by subdividing these adverse events into problems, obstacles, and complications. Similarly, other groups suggest grading the severity of adverse events (class I–II–IIIA–IIIB) and dividing these into device and non-device-related complications (Black et al. 2015, Frost et al. 2021). The introduction of an all internal Stryde bone lengthening nail (NuVasive, Specialized Orthopedics, San Diego, CA) in May 2018 was a game changer for bone-lengthening surgery because it enabled the majority of patient to fully weight-bear. Furthermore, the first publications showed promising clinical results with only few device-related complications and good biocompatibility without signs of corrosion (Robbins and Paley 2020, Iliadis et al. 2021).However, on February 4, 2021 the Danish Medicines Agency released an urgent field safety notice from NuVasive regarding Stryde and all PRECICE system devices. This notice came to prominence based on the British Medicines & Healthcare products Regulatory Agency (MHRA) identifying safety concerns. In the MHRA reference 2020/012/009/226/001 issued January 20, 2021 one concern that was raised was the “unknown long-term biological safety profile. This includes reports of pain and bony abnormalities at the interface between the telescoping nail segments.”We evaluated the prevalence of radiographic changes in terms of osteolysis, periosteal reactions, and cortical hypertrophy at the junction of the telescoping nail segments as well as late onset of pain and/or swelling in the area.     

European directive on electromagnetic fields

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European directive on electromagnetic fields