Twin embolization syndrome: prenatal sonographic detection and significance

Twin embolization syndrome (TES) is a complication of monozygotic twinning following in utero demise of the co-twin. Passage of thromboplastic material into the circulation of the surviving twin results in ischemic structural defects of the central nervous system, gastrointestinal tract, and genitourinary system. In six cases of this rare abnormality, sonographically normal fetuses subsequently demonstrated ventriculomegaly, porencephaly, cerebral atrophy, or microcephaly following demise of the co-twin. Extracranial abnormalities included small bowel atresia (two cases) and renal cortical necrosis (one case). Surviving twins all had neurodevelopmental delay at follow-up. Two fetuses were aborted because of sonographically apparent, progressively severe brain abnormality. The lone survivor of a dizygotic triplet gestation was normal, despite sonographic findings of TES in the co-triplets. Because of poor outcome, prenatal sonographic diagnosis of TES may influence antenatal or neonatal management of the surviving monozygous twin. Recognition of TES may permit accurate postnatal counseling of prognosis and recurrence risks.     

SMALL JOINT SYNOVTTIS IN RHEUMATOID ARTHRITIS: SHOULD IT BE ASSESSED SEPARATELY?

In the assessment of disease activity in rheumatoid arthritis(RA) small joint synovitis is traditionally included only asa component of active, tender or swollen joint counts. By contrast,in the assessment of disease damage in RA, the X-ray score ofhands and feet represents one of the most common parametersused and is regarded as a major indicator of outcome. Data presentedin this study lead us to hypothesize that the small joints requireseparate assessment in any study of disease activity or outcomein RA: (i) there is clear evidence that small joint synovitisoften occurs in the absence of an abnormal acute phase response(ESR or C-reactive protein) and (ii) measured synovitis is anindividual (PIP) joint has been shown to be reliable and tobe related to subsequent X-ray changes in the same joint. Ourfindings show that, in a study of a treatment of RA, it is quitepossible for disease activity measures to appear controlledwhile inflammation continues in the small joints causing radiologicaldamage. This radiological damage is reflected as an adverseoutcome. Hence the paradox of improving disease activity butnot outcome. We argue that small joint inflammation and damageshould be recognized as one aspect of the RA disease processoffering unique information and as such should be assessed independently. KEY WORDS: Rheumatoid arthritis, Disease activity, Small joint synovitis, X-ray     

周期性机械牵张刺激对C_2C_(12)小鼠成肌细胞增殖和有氧代谢能力的影响

目的探讨不同频率牵张刺激对C_2C_(12)小鼠成肌细胞增殖及细胞有氧代谢能力的影响。方法采用Flexercell细胞应力加载装置对体外培养的C_2C_(12)成肌细胞分别加载1、2 Hz不同频率的牵张刺激,牵张幅度为15%,牵张时长为2 h/d,连续进行4 d。以静置培养的C_2C_(12)成肌细胞作为对照组。实验期间通过倒置相差显微镜观察细胞生长状态,利用CCK-8试剂盒测定细胞增殖情况。实验结束后,分别收取各组细胞,经胰酶消化处理,然后利用荧光探针,通过能量代谢设备检测细胞耗氧量比率。结果细胞经机械牵张刺激后,显微镜下细胞形态为典型的长梭形,排列呈现一定方向性,与牵张刺激方向平行,生长状况良好;与对照组细胞相比,1、2 Hz频率牵张刺激均可显著促进细胞增殖(P0.05),且在第3、4 d,1 Hz实验组的增殖情况优于2 Hz实验组;实验组与对照组细胞耗氧量比率均有增加,但各组之间并无显著差异(P0.05)。结论周期性机械牵张刺激能有效促进C_2C_(12)小鼠成肌细胞增殖,且与牵张刺激的频率有关,其中1 Hz的牵张频率最佳,但牵张刺激对C_2C_(12)小鼠成肌细胞的有氧代谢能力无明显影响。     

Periodontic-endodontic lesions: diagnostic and therapeutic indications

The presence of connections between periodontium and endodontium can lead to the diffusion of an infection from one apparatus to another. The involvement of both periodontium and endodontium is defined as Combined Periodontic-Endodontic lesions. This definition is not based on the initial etiology of the lesion and either the endodontic or periodontal lesion may be the cause or the result of the other or both may develop independently. The lesions must be correctly diagnosed for the best therapeutic approach. The diagnosis is based on clinical symptoms and radiographic analysis; clinical signs must show the presence of periodontal probing and pulpal necrosis. Radiographic examination can confirm the involvement of both periodontium and endodontium only if the lesion is present on the mesial and distal part of the diseased tooth; in the case of a palatal/lingual or vestibular lesion such evidence will not be detectable. The therapeutic approach is always based on an initial endodontic treatment followed, if needed, by the proper periodontal treatment.     

Supernumerary teeth diagnosis and treatment approach. Six case reports

Supernumerary teeth are relatively common in the general population, affecting the primary and the permanent dentition and have been reported in many genetic syndromes. They are classified according to form and shape. Seven different examples of hyperodontia are presented to highlight the numerical and morphological variation in dental abnormalities manifestations, empathising the importance of thorough clinical and radiological examination and of a correct therapeutic approach. The patients presented single or multiple hyperodontia, with particular interest for a 12 supernumerary teeth case. The clinical problems linked to supernumerary teeth were: impaction or ectopic eruption, crowding, possible root resorption of adjacent teeth. The therapeutical approach of supernumerary teeth varied on the position of the element in excess and on the complexity of the clinical case. In some cases the single extraction of the supernumerary tooth was indicated, while in other cases the extraction of the tooth was needed in addition to orthodontic treatment to gain sufficient space for the tooth with delayed eruption.     

Molecular and cellular signatures of human vaccine adjuvants

Oil-in-water emulsions are potent human adjuvants used for effective pandemic influenza vaccines; however, their mechanism of action is still unknown. By combining microarray and immunofluorescence analysis, we monitored the effects of the adjuvants MF59 oil-in-water emulsion, CpG, and alum in the mouse muscle. MF59 induced a time-dependent change in the expression of 891 genes, whereas CpG and alum regulated 387 and 312 genes, respectively. All adjuvants modulated a common set of 168 genes and promoted antigen-presenting cell recruitment. MF59 was the stronger inducer of cytokines, cytokine receptors, adhesion molecules involved in leukocyte migration, and antigen-presentation genes. In addition, MF59 triggered a more rapid influx of CD11b+ blood cells compared with other adjuvants. The early biomarkers selected by microarray, JunB and Ptx3, were used to identify skeletal muscle as a direct target of MF59. We propose that oil-in-water emulsions are the most efficient human vaccine adjuvants, because they induce an early and strong immunocompetent environment at the injection site by targeting muscle cells.