Aneurysm of the abdominal aorta and horseshoe kidney. Apropos of a case and review of the literature

A case report of a 75 year old man with abdominal aortic aneurysm and horseshoe kidney is presented. The diagnosis of this unusual association was made prior to surgery and the aneurysmectomy was carried out without great problems, by insertion of a dacron tube combined with reimplantation of an accessory right renal artery. There was an uneventful postoperative recovery and outcome. Previous publications are reviewed. The authors insist of the importance of CT-Scan, intravenous pyelogram and aortography to establish a complete preoperative diagnosis of this rare association with anomalous vasculature and pyeloureteral pattern. The prognosis of an aneurysm in association with a horseshoe kidney should not be worse than that of routine resection of an ordinary aneurysm.     

Effects of corticopuncture (CP) and low-level laser therapy (LLLT) on the rate of tooth movement and root resorption in rats using micro-CT evaluation

The aim of this study was to compare the rate of tooth displacement, quantity of root resorption, and alveolar bone changes in five groups: corticopuncture (CP), low-level laser therapy (LLLT), CP combined with LLLT (CP?+?LLLT), control (C), and negative control (NC). A total of 60 half-maxilla from 30 male Wistar rats (10 weeks old) were divided randomly into five groups: three (CP, LLLT, and CP?+?LLLT) test groups with different stimulation for accelerated-tooth-movement (ATM), one control (C) group, and one negative control (NC) group with no tooth movement. Nickel-titanium coil springs with 50 g of force were tied from the upper left and right first molars to micro-implants placed behind the maxillary incisors. For the CP and CP?+?LLLT groups, two perforations in the palate and one mesially to the molars were performed. For the LLLT and CP?+?LLLT groups, GaAlAs diode laser was applied every other day for 14 days (810 nm, 100 mW, 15 s). The tooth displacements were measured directly from the rat’s mouth and indirectly from microcomputer (micro-CT) tomographic images. Bone responses at the tension and compression sites and root resorption were analyzed from micro-CT images. The resulting alveolar bone responses were evaluated by measuring bone mineral density (BMD), bone volume fraction (BV/TV), and trabecular thickness (TbTh). Root resorption crater volumes were measured on both compression and tension sides of mesial and distal buccal roots. The tooth displacement in the CP?+?LLLT group was the greatest when measured clinically, followed by the CP, LLLT, and control groups (C and NC), respectively (p?<0.05). The tooth movements measured from micro-CT images showed statistically higher displacement in the CP and CP?+?LLLT groups compared to the LLLT and control groups. The BMD, BV/TV, and TbTh values were lower at the compression side and higher at the tension side for all three test groups compared to the control group. The root resorption crater volume of the distal buccal root was higher in the control group, followed by CP, LLLT, and CP?+?LLLT, mostly at the compression site. Combining corticopuncture and low-level laser therapy (CP?+?LLLT) produced more tooth displacement and less root resorption at the compression side. The combined technique also promoted higher alveolar bone formation at the tension side.     

Axons of callosal neurons bifurcate transiently at the white matter before consolidating an interhemispheric projection

The main alternative output routes of adult cortical axons are the internal capsule and the corpus callosum. How do callosal axons choose their trajectories? We hypothesized that bifurcation followed by elimination of one branch is a developmental strategy for accomplishing this aim. Using embryonic and postnatal mice, we labelled cortical projecting neurons and quantified their axonal bifurcations in correlation with the mediolateral position of their somata. Bifurcating axons were numerous in the younger brains but declined during further development. Most bifurcating axons pertained to neurons located in the dorsolateral cortex. Moreover, callosal neurons bifurcate more often than subcortically projecting cells. We then quantified bifurcations formed by dissociated green fluorescent cells plated onto cortical slices. Cells grown over dorsolateral cortex bifurcated more often than those grown over medial cortex, irrespective of their positional origin in the donor. Removal of intermediate targets from the slices prevented bifurcation. We concluded that transient bifurcation and elimination of the lateral branch is a strategy employed by developing callosal axons in search of their targets. As cell body position and intermediate targets determine axon behaviour, we suggest that bifurcations are regulated by cues expressed in the environment.     

Integrated CT-PET imaging of esophageal cancer: unexpected and unusual distribution of distant organ metastases

CT-PET imaging is being increasingly used for the initial staging, assessment of treatment response, and follow-up of patients with esophageal carcinoma, primarily because of its superior detection of distant metastases compared to conventional methods. Our recent experience has shown that metastases from esophageal cancer can occur in unusual locations and have an unexpected presentation. Recognition of the distribution and appearance of esophageal metastases is important for optimal image interpretation in order to avoid confusion with more benign disease. This article reviews the location and appearance of metastases detected by CT-PET imaging in patients with esophageal cancer either at presentation or after preoperative or definitive chemoradiation therapy.     

Identification and Treatment of Osteoporosis among Elderly Patients with Hip Fractures

OBJECTIVE:

To evaluate the profile of osteoporosis treatment among patients hospitalized due to hip fractures at a tertiary-level university hospital. To compare the impact of hospitalization on approaches toward treating bone mass losses.

METHOD:

The medical records of 123 hip fracture patients aged 60 years and over at the Institute of Orthopedics, Hospital das Clínicas, University of São Paulo School of Medicine, between 2004 and 2006 were reviewed and analyzed with respect to approaches towards investigating osteoporosis and treatments before and after fracture.

RESULTS:

The patients’ mean age was 78 ± 8.3 years, and the majority were women (71.54%). The patients had a mean of 2.72 comorbidities and used 3.26 medications on average. Among these patients, 12.3% reported a previous diagnosis of osteoporosis, and 5.83% were on medication for this. The mean waiting time for surgery was 6.3 ± 7.54 days, and seven patients (5.7%) died during the hospitalization. There were no investigations using bone densitometry, no changes in osteoporosis therapy between admission and discharge (p = 0.375), and no reports of referrals for the patient to have access to treatment.

CONCLUSIONS:

Investigations and treatments of osteoporosis and strategies for preventing new fractures were not implemented during the hospitalization of these elderly patients with hip fractures, even though this is the most feared complication of osteoporosis. These data need to be disseminated so that professionals dealing with elderly patients are attentive to the need for primary and secondary prevention of osteoporosis because of the impact of fractures on these patients’ quality of life, independence, morbidities, and mortality.     

From the Cover: Deep phenotyping to predict live birth outcomes in in vitro fertilization

Nearly 75% of in vitro fertilization (IVF) treatments do not result in live births and patients are largely guided by a generalized age-based prognostic stratification. We sought to provide personalized and validated prognosis by using available clinical and embryo data from prior, failed treatments to predict live birth probabilities in the subsequent treatment. We generated a boosted tree model, IVF_BT, by training it with IVF outcomes data from 1,676 first cycles (C1s) from 2003–2006, followed by external validation with 634 cycles from 2007–2008, respectively. We tested whether this model could predict the probability of having a live birth in the subsequent treatment (C2). By using nondeterministic methods to identify prognostic factors and their relative nonredundant contribution, we generated a prediction model, IVF_BT, that was superior to the age-based control by providing over 1,000-fold improvement to fit new data (p < 0.05), and increased discrimination by receiver–operative characteristic analysis (area-under-the-curve, 0.80 vs. 0.68 for C1, 0.68 vs. 0.58 for C2). IVF_BT provided predictions that were more accurate for ∼83% of C1 and ∼60% of C2 cycles that were out of the range predicted by age. Over half of those patients were reclassified to have higher live birth probabilities. We showed that data from a prior cycle could be used effectively to provide personalized and validated live birth probabilities in a subsequent cycle. Our approach may be replicated and further validated in other IVF clinics.     

Differential growth inhibition and induction of apoptosis by gossypol between HCT116 and HCT116/Bax(-/-) colorectal cancer cells

1. Bax is a very important pro-apoptosis molecule. HCT116/Bax(-/-) cells do not express the pro-apoptosis Bcl-2 family member, Bax. In the present study, the anticancer effects of gossypol on HCT116 and HCT116/Bax(-/-) cells were compared in terms of inhibition of cell growth, inhibition of colony formation and induction of apoptosis. 2. Following treatment with concentrations more than 20 micromol/L gossypol, only slight differences (not significant) were seen between HCT116 and HCT116/Bax(-/-) cells in terms of the inhibition of cell growth and induction of apoptosis. No difference was seen in the inhibition of colony formation. Gossypol had no effect at concentrations < 2 micromol/L. The only effective concentration of gossypol to result in differences between HCT116 and HCT116/Bax(-/-) cells was 5 micromol/L. However, even at this concentration, Bax deficiency did not result in complete abolition of gossypol-induced growth inhibition or apoptosis. Exposure of cells to 5 micromol/L gossypol for 24 h did not cause any significant difference in the activation of caspase 2 between HCT116 and HCT116/Bax(-/-) cells; however, activation of caspase 3, 8 and 9 was significantly elevated in HCT116 cells, with the effect on caspase 3 activation being the greatest, compared with HCT116/Bax(-/-) cells. 3. These findings suggest that the contribution of Bax to gossypol-induced growth inhibition and apoptosis is dose dependent and that gossypol-induced apoptosis requires activation of caspase 3, 8, and 9.     

The United Kingdom Primary Immune Deficiency (UKPID) registry 2012 to 2017

This is the second report of the United Kingdom Primary Immunodeficiency (UKPID) registry. The registry will be a decade old in 2018 and, as of August 2017, had recruited 4758 patients encompassing 97% of immunology centres within the United Kingdom. This represents a doubling of recruitment into the registry since we reported on 2229 patients included in our first report of 2013. Minimum PID prevalence in the United Kingdom is currently 5·90/100 000 and an average incidence of PID between 1980 and 2000 of 7·6 cases per 100 000 UK live births. Data are presented on the frequency of diseases recorded, disease prevalence, diagnostic delay and treatment modality, including haematopoietic stem cell transplantation (HSCT) and gene therapy. The registry provides valuable information to clinicians, researchers, service commissioners and industry alike on PID within the United Kingdom, which may not otherwise be available without the existence of a well‐established registry.