Isolation of macrophages (Hofbauer cells) from human term placenta and their prostaglandin E2 and thromboxane production

Placental macrophages (Hofbauer cells) are located close to trophoblast cells and fetal capillaries, which makes them ideal candidates for involvement in regulatory processes within the villous core. Their production of various cytokines and prostaglandin (PG) synthesizing enzymes has previously been shown immunohistochemically. Hofbauer cells were isolated from human placenta after term deliveries by Ficoll and Percoll gradient centrifugation. Remaining trophoblast cells were removed with anti-epidermal growth factor (EGF)-receptor-coated Dynabeads followed by differential adherence. The identity of isolated cells was investigated by immunohistochemistry with anti-CD68, which showed that >90% cells were positive. After a 36 h recovery period in either 20% O2 or 5% O2, fresh medium was applied and PGE2 and thromboxane (TXA2) production analysed by enzyme immunoassay at 4, 8, and 24 h. PGE2 and TXA2 were both produced by placental macrophages with PGE2 synthesis being predominant. Concentrations of both could be stimulated by lipopolysaccharide with maximum effect after 24 h. Culture in low oxygen caused decreased PGE2 concentrations, whereas TXA2 production remained unchanged. In conclusion, the presented isolation protocol allows further study of Hofbauer cell function. This study also presents novel findings regarding the prostaglandin production of term Hofbauer cells under normal and hypoxic conditions.      

The additive value of second opinion teleconsulting in the management of patients with challenging inflammatory,neoplastic skin diseases: a best practice model in dermatology?

BACKGROUND: Telemedicine is the practice of healthcare using interactive processes of communication to facilitate healthcare delivery, including diagnosis, consultation and treatment, as well as education and transfer of medical data. The aim of teledermatology, just as telemedicine, is to promote best practice procedures and to improve the consistency and competence of health care. AIM: To investigate the diagnostic additive value of second opinion teleconsulting in patients with challenging dermatoses, among dermatologists working in two different dermatology departments. SETTING: Thirty-three cases of patients with challenging inflammatory and neoplastic skin diseases at the University of L'Aquila Department of Dermatology were sent for teleconsultation to the Department of Dermatology, Medical University of Graz, Austria. METHODS: All cases were selected in the outpatient service in L'Aquila. After face-to-face consultation with a local colleague had been completed, images were sent using a store-and-forward (SAF)-based system (http://www.telederm.org) to Graz. Histopathological examination together with follow-up of the patient represents the diagnostic gold standard for this study. RESULTS: Telediagnosis was correct in 26 of 33 (78.8%) cases. Sixteen of 33 cases (48.5%) had already been diagnosed face-to-face by at least one of the two dermatologists in L'Aquila. In 10 of 33 cases (30.3%), the correct diagnosis was made in teleconsultation only. CONCLUSIONS: Second opinion teleconsulting may represent an additive value in the diagnosis of numerous challenging inflammatory and neoplastic skin diseases. It may be particularly useful as a best practice model for smaller departments in order to discuss and/or to confirm diagnoses and also for the management of patients with unusual difficult dermatoses.     

Value of the clinical history for different users of dermoscopy compared with results of digital image analysis

BACKGROUND: The clinical history of a given pigmented lesion could influence the therapeutic decision. Teledermatology and automated image analysis also hold great potential for revolutionizing dermatology services. AIM: The aim of this retrospective study was to evaluate the diagnostic accuracy of users with different experiences in dermoscopy with and without information about patients and their history compared with classification by an automated analysing system. SETTING: One hundred and fifty-seven dermoscopic images of pigmented lesions, taken and proved by histopathology at the Pigmented Lesions Clinic of the Department of Dermatology of the University Tuebingen, Germany, were included. METHODS: All images were viewed by three investigators with different experience: excellent (A), average (B) and beginner (C). In the first dermoscopic classification, no information was available. After 3 months the same images were once more classified by the three investigators, now with the information about the patients and their history. The melanocytic lesions were tested by the Tuebinger Mole Analyser. RESULTS: For user A the sensitivity, specificity and diagnostic accuracy revealed no improvement on including the history (81.3% to 84.4%, 94.6% to 92.3% and 92.0% to 90.7%), whereas user B clearly improved his results (75.0% to 87.5%, 76.9% to 88.5% and 76.5% to 88.3%). No change in the sensitivity was seen by user C (84.4%), but there was a clear improvement in the specificity (69.2% to 87.7%) and diagnostic accuracy (72.2% to 87.0%). Using the computer algorithm, a sensitivity of 100%, a specificity of 76.9% and a diagnostic accuracy of 81.9% were achieved. CONCLUSIONS: The study revealed results relevant to the use of dermoscopy: (1) continuing dermoscopic education influences the diagnostic accuracy; (2) the history is helpful for averaged users and beginners in dermoscopy; (3) digital image analysis has the highest sensitivity, but a lower specificity compared to the clinicians; and (4) digital dermoscopy could be used for store-and-forward systems in teledermoscopy.     

MIS approach for diverticula of the esophagus

Purpose

Diverticula of the esophagus represent a rare pathological entity. Distinct classifications of the disease imply different surgical concepts. Surgery should be reserved for symptomatic patients only. Minimally invasive surgery (MIS) for treatment of esophageal diverticula encompasses rigid and flexible intraluminal endoscopy, thoracoscopy and laparoscopy. We here give an overview on the pathogenesis of esophageal diverticula, the minimally invasive surgical techniques for treatment and the recent literature. Additionally, we present our own experience with MIS for midthoracic diverticula.

Methods

We analyzed the cases of patients who underwent MIS for midthoracic diverticula with regard to preoperative symptoms, perioperative and follow-up data.

Results

Three patients (two female, one male, age 79, 78 and 59 years) received thoracoscopic surgery for midthoracic diverticula. All patients reported of dysphagia and regurgitation. In two patients pH-investigation showed pathological reflux but manometry was normal in all patients. Operating time was 205, 135 and 141 minutes. We performed intraoperative intraluminal endoscopy in all patients. There were no intraoperative complications and although no surgical complications occured postoperatively one patient developed pneumonia which advanced to sepsis and lethal multi organ failure. Upon follow-up the two patients did not have recurrent diverticula or a recurrence of previous symptoms.

Conclusions

Surgery for diverticular disease of the esophagus has been associated with high rates of morbidity and mortality. Despite the lethal non-surgical complication we encountered, with regard to recent publications minimally invasive apporaches to treat patients with symptomatic esophageal diverticula entail lower rates of complications with better long term results in comparison to open surgery.     

How much does the levator hiatus have to stretch during childbirth?

Objective  This study was designed to define the degree of stretch/strain required of the levator hiatus in childbirth. There have been attempts at defining the distension required for vaginal childbirth with the help of individual data sets, but from previous work it is clear that hiatal dimensions and distensibility are likely to vary greatly between individuals.
Design  Retrospective observational study.
Setting  Nepean Hospital, University of Sydney.
Population  Nulliparous women at 36–38 week's gestation.
Methods  The ultrasound data sets of 227 nulliparous women examined at 36–38 week's gestation were investigated using post-processing software. Minimal hiatal diameters, subpubic arch, circumference and area were measured at rest, on Valsalva and pelvic floor muscle contraction. To estimate required hiatal distension at vaginal birth we used neonatal biometric data obtained in a Caucasian population. The muscle 'strain' or 'stretch ratio' required to allow delivery of a Caucasian baby of average size was calculated from dimensions at rest and on maximal Valsalva.
Main outcome measures  Degree of stretch/strain required of the levator hiatus in childbirth.
Results  The mean strain (stretch ratio) required for vaginal delivery was calculated as 1.47 (range 0.62–2.76; SD 0.39) from resting length, and 1.07 (range 0.25–2.45; SD 0.44) when calculated from dimensions at maximal Valsalva. This implies that, from dimensions at maximal Valsalva, some women will have to distend only 25%, others by 245%
Conclusions  We have obtained normative data for the required distension of the levator hiatus in a largely Caucasian population.     

八珍汤对红细胞免疫功能作用的实验研究

目的：探讨八珍汤对红细胞免疫功能的作用。方法：观察小白鼠随年龄增长其红细胞免疫功能的变化及古方八珍汤对老龄小白鼠红细胞免疫功能的影响。结果：①老龄小白鼠的红细胞c3b受体花环率（RBC．C3bRR）显著低于低龄者（P＜0．01）,而老龄小白鼠的循环免疫复合物花环率（RBC．ICRR）则明显高于低龄者（P＜0．01）。②老龄小白鼠服用八珍汤（20g/kg）后的RBC．C3bRR明显高于服药前水平（P＜0．01）,而服药后的RBC．ICRR则明显低于药前水平（P＜0．01）。结论：①随着年龄的增长,红细胞免疫功能呈明显低下状态,②古方八珍汤具有一定增强老龄机体红细胞免疫功能而起到抗衰老的作用。