Multidetector CT findings of splenic artery aneurysm in children with chronic liver disease

BACKGROUND: Splenic artery aneurysm (SAA) is a well-known complication of chronic liver disease and portal hypertension in adults. The incidence of SAA in children undergoing selective hepatic angiography prior to liver transplantation is reported as 4%, but there are few systematic studies. OBJECTIVE: To investigate the SAAs detected by multidetector CT angiography (MDCTA) among children with chronic liver disease. MATERIALS AND METHODS: A total of 124 children (71 girls, 53 boys; mean age 118 months; age range 5 days to 204 months) with chronic liver disease underwent MDCTA to display the vascular anatomy and any vascular complications during the pretransplantation period. Of these children, 23 also underwent coeliac angiography. The digital subtraction angiography (DSA) and MDCTA findings were compared. RESULTS: SAAs were detected in 13 children (10.4%); none was detectable by US. All patients had more than one aneurysm; ten patients had more than three. In all except one patient, the SAAs were located only in the intraparenchymal branches of the splenic artery; in one patient they were located in the intraparenchymal segment and in the distal third of the splenic artery. The mean size of the aneurysms was 6.5 mm (range 2.5-18 mm). All patients with aneurysms had splenomegaly and vascular collaterals. Nine of the children with SAAs had portal vein pathologies (two occlusions, two stenoses, five dilatations). A statistically significant difference existed with regard to the size of spleen (P < 0.05) and patient age (P < 0.05) between children with SAAs and children without SAAs. There was an increased risk of SAAs in patients with portal vein pathologies. In 19 patients without SAAs on MDCTA, no SAAs were seen on DSA. CONCLUSIONS: It is likely that the incidence of SAA in children with chronic liver disease will increase with improved survival of children with long-standing portal hypertension and chronic liver disease. MDCTA with multiplanar reconstruction is a noninvasive and effective means of imaging paediatric patients with SAAs, especially during the peritransplantation period, which is considered to be a time of significant risk for SAA rupture in this patient population.     

Does fresh or frozen embryo transfer affect imprinted gene expressions in human term placenta?

Our research aimed to compare the epigenetic alterations between placentae of in vitro fertilization (IVF) patients and spontaneous pregnancies. Additionally, the expression levels of proliferation markers (PCNA, Ki67) and glucose transporter proteins (GLUT1, GLUT3) were assessed in control and IVF placentae to examine the possible consequences of epigenetic alterations on placental development. Control group placentae were obtained from spontaneous pregnancies of healthy women (n = 16). IVF placentae were obtained from fresh (n = 16) and frozen (n = 16) embryo transfer pregnancies. A group of maternal and paternal imprint genes H19, IGF2, IGF2, IGF2R, PHLDA2, PLAGL1, MASH2, GRB10, PEG1, PEG3, and PEG10 were detected by Real-Time PCR. Additionally, PCNA, Ki67, GLUT1, and GLUT3 protein levels were assessed by immunohistochemistry and western blot. In the fresh embryo transfer placenta group (fETP), gene expression of paternal PEG1 and PEG10 was upregulated compared with the control group. Increased gene expression in paternal PEG1 and maternal IGFR2 genes was detected in the frozen embryo transfer placenta group (FET) compared with the control group. Conversely, expression levels of H19 and IGF2 genes were downregulated in the FET group. On the other hand, GLUT3 and PCNA expression was increased in FET group placentae. IVF techniques affect placental imprinted gene expressions which are important for proper placental development. Imprinted genes are differently expressed in fresh ET placentae and frozen ET placentae. In conclusion, these data indicate that altered imprinted gene expression may affect glucose transport and cell proliferation, therefore play an important role in placental development.     

乌鲁木齐市某区2014年高中毕业生身体基本状况

目的 了解乌鲁木齐市高中毕业生身体基本状况。 方法 采用整群抽样的方法,随机抽取乌鲁木齐市某区1 183名学生为研究对象,按照《普通高等学校招生体检工作指导意见》,由专业人员进行体检。 结果 男生平均BMI指数[(24.02±4.74)kg/m²]高于女生平均BMI指数[(22.36±3.91)kg/m²],差异有统计学意义(t=6.578,P<0.001);营养状况正常的学生人数为716人(60.52%),营养不良、超重和肥胖的学生人数分别为20人(1.69%)、224人(18.93%)和223人(18.85%),女生营养状况正常的比例高于男生,差异有统计学意义(χ²=14.09,P<0.001),男生超重的比例高于女生,差异有统计学意义(χ²=9.25,P=0.002);视力状况正常的学生人数为135人(11.41%),视力轻度低下、中度低下和重度低下人数分别为99人(8.37%)、110人(9.30%)和839人(70.92%),男生视力轻度低下和中度低下的比例高于女生,差异有统计学意义(χ²=8.03,P=0.005;χ²=6.41,P=0.011),女生视力重度低下的比例高于男生,差异有统计学意义(χ²=20.96,P<0.001)。 结论 该区高中生营养过剩(超重及肥胖)和视力低下情况严重,应加强健康教育,提高学生身体素质,改善视力状况。     

The effect of galantamine added to clozapine on cognition of five patients with schizophrenia

Although clozapine may be beneficial for the treatment of cognitive dysfunction in schizophrenia, it may also impair some cognitive skills as a result of its anticholinergic activity. In this case series, the impact of galantamine administration on 5 patients with schizophrenia who had been treated with clozapine are reported. Neuropsychological assessment was administered before and after 8 weeks of 16 mg/d galantamine treatment. In this case series, galantamine was well tolerated by all of the patients. Three of the patients were much improved in sustained attention tasks. Most of the patients were also improved in psychomotor speed and selective attention tasks. Two patients with low pretreatment memory scores seemed to also be improved. Our results suggest that the possible role of galantamine as a cognitive enhancer in schizophrenia should be investigated in controlled trials.     

Imaging of congenital mesoblastic nephroma with pathological correlation

Background  

There are a variety of imaging findings for congenital mesoblastic nephroma (CMN) and two main pathological variants: classic and cellular.     

Management of isolated duodenal rupture due to blunt abdominal trauma: case series and literature review

Introduction  

Duodenal injuries are uncommon and are associated with significant morbidity and mortality due to delayed diagnosis (in the case of blunt trauma) or associated major vascular injuries (in the case of penetrating trauma). Isolated blunt injuries may have a subtle clinical presentation, and are particularly difficult to diagnose when the perforation is located in the retroperitoneal part of the duodenum.     

Predicting the likelihood of nonsentinel lymph node metastases in triple negative breast cancer patients with a positive sentinel lymph node: Turkish Federation of Breast Disease Associations protocol MF09-01

BackgroundTriple negative (TN) tumor has a relatively high rate of recurrence and distant metastasis, but results of studies revealed that triple positive tumor is an independent predictor of axillary lymph node involvement. Our aim was to evaluate the frequency of nonsentinel lymph node metastasis (NSLNM) involvement in operable TN breast cancer with positive sentinel lymph node (SLN) and predicting the likelihood of NSLNM in this cohort of patients by using 4 different nomograms.MethodsA total of 128 patients with TN and SLN⁺ underwent complete axillary lymph node dissection in 14 different centers in Turkey. For comparison, we used our previous multicenter MF08-01 Protocol, which identified 441 patients with estrogen receptor (ER⁺) who had a positive SLN biopsy and underwent subsequent complete axillary lymph node dissection. Turkish, Cambridge, and Stanford nomograms and the Tenon Score system were used to calculate the probability of NSLNM.ResultsPatients with TN tumor had a larger tumor size. The actual percentage of NSLN positivity was 41% in the TN group and 47.1% in patient with ER⁺. The Tenon Score was ≤3.5 in 12% of patients with TN and ER⁺; the area under the curve in the receiver operating characteristics curve were 0.53 and 0.59, respectively. Based on the Turkish, Cambridge, and Stanford nomograms, areas under the curve were 0.54, 0.53, and 0.61, respectively in patients with TN, and were 0.79, 0.72, and 0.70, respectively, in patients with ER⁺.ConclusionUsing the Tenon Score system underestimates NSLN positivity, and tested nomograms are not good discriminators of NSLNM in patients with TN and positive SLN.     

Apricot sulfurization: an occupation that induces an asthma-like syndrome in agricultural environments

BACKGROUND: Several cases of bronchial asthma have been presenting with acute attacks during the seasons of apricot sulfurization. The aim of this study was to reveal the effects of sulfur dioxide (SO(2)) exposure on the airways of the workers involved in this process. METHODS: SO(2) levels in air were measured on 15 apricot farms, while the symptom scores of 69 workers were recorded before, during, and after SO(2) exposure. Physical examination and pulmonary function tests (PFT) of the workers were also done prior to and after exposure periods. RESULTS: The measured SO(2) concentrations ranged between 106.6 and 721.0 ppm. Dyspnea (80%), cough (78%), and eye and nose irritation (83-70%) were the most commonly observed symptoms. The workers had significant decreases in pulmonary functions after SO(2) exposure. Decrements in FEV(1), FEV(1)/FVC%, and FEF(25-75%) showed that the acute effect of SO(2) on pulmonary functions of the workers was mostly of obstructive pattern. CONCLUSIONS: Acute exposure to SO(2) induces "asthma-like syndrome" (ALS) in apricot sulfurization workers. SO(2) which has not been previously reported in agricultural environments as a cause of ALS may be considered as a new agent.     

Salvage repair of anastomotic dehiscence following colon surgery using an expanded polytetrafluoroethylene graft

Anastomotic dehiscence is a serious complication of colorectal surgery that causes death in up to 40% of cases in which it occurs. Edema and inflammation due to abdominal sepsis can prevent the use of standard management (i.e., colostomy, ileostomy or Hartmann’s procedure), in which case alternative salvage repair methods are required. The present report describes the treatment of a 73-year-old female patient at high risk of mortality because of intraabdominal sepsis due to suture dehiscence following a right hemicolectomy and ileo-transversostomy. Several surgical repair procedures were tried, but all failed. We then used an expanded polytetrafluoroethylene (ePTFE) graft in salvage repair, and this approach proved successful. This is the first report to describe clinical, macroscopic and histopathological findings, following use of an ePTFE graft in colorectal repair in humans.