Bilateral microphthalmia with cyst,facial clefts,and limb anomalies: a new syndrome with features of Waardenburg syndrome,cerebro-oculo-nasal syndrome,and craniotelencephalic dysplasia

We report a patient with bilateral microphthalmia with cyst, limb anomalies, and multiple facial malformations. This patient has clinical features similar to Waardenburg ophthalmo-acromelic syndrome, cerebro-oculo-nasal syndrome, and craniotelencephalic dysplasia. Although all of these syndromes are characterized by microphthalmia, the presently reported patient does not have the complete pattern of any of these syndromes, It is possible that he has a previously undescribed syndrome, most closely related to the cerebro-oculo-nasal syndrome with malformations outside the craniofacial region. More case reports are needed to further delineate this possibly new syndrome.     

Functional consequences of ROMK mutants linked to antenatal Bartter's syndrome and implications for treatment

The antenatal variant of Bartter's syndrome is an autosomal recessive kidney disease characterized by polyhydramnios, premature delivery, hypokalemic alkalosis and hypercalciuria. It is genetically heterogeneous, having been linked recently to mutations in an ATP- sensitive, renal outer medullary K+channel, ROMK, and earlier to mutations in the Na-K-2Cl co-transporter, NKCC2. We characterized four of the mutations reported in three heterozygous ROMK variants of antenatal Bartter's and found that each expressed a distinct phenotype in Sf9 cells. One mutation expressed normal function and appears to be an allelic polymorphism. The other three mutations produced channels with significantly reduced K+fluxes. However, the mechanisms in each case were different and reflected abnormalities in phosphorylation, proteolytic processing or protein trafficking. The different mechanisms may be important in the design of appropriate therapy for patients with this disease.      

Detecting pre-ovulatory luteinizing hormone surges in urine

The study objectives were to determine (i) if pre-ovulatory luteinizing hormone (LH) surges, undetected in urine by two immunoradiometric assays (IRMA), were detectable by an ultrasensitive immunofluorometric assay (IFMA) and (ii) the influence of creatinine adjustment on the detection and timing of the urinary LH surges. Daily urine specimens were contributed by healthy 25-36 year old volunteers during 14 ovulatory menstrual cycles for an epidemiological study conducted in 1983-1985. Specimens were selected as having been previously assayed by two IRMA without consistently detecting LH surges. These urine specimens were remeasured using an IFMA and adjusted for creatinine concentration. IFMA measurements revealed unambiguous LH surges in all cycles. Adjusting IRMA urinary LH values for creatinine concentrations revealed previously undetected LH surges in four of eight cycles. Creatinine adjustment also altered the timing of IRMA and IFMA LH surges by 1-5 days. These results demonstrate an IFMA that detects pre- ovulatory LH surges in unpreserved, frozen urine from cycles where such surges were previously undetectable. Further, creatinine adjustment can markedly affect detection and timing of the onset and peak of the urinary LH surge. While our analysis suggests that this adjustment improves the validity of the LH measure, this requires further investigation.      

Single dipole localization: Some numerical aspects and a practical rejection criterion for the fitted parameters

Summary There have been a number of attempts in the last years to localize the generators of brain electromagnetic activity, considering one current dipole as the source model. Single Dipole Localization (SDL) requires the selection of an optimization algorithm (OA). General aspects related with the selection, implementation and evaluation of some of the OA employed for SDL are discussed in this paper. Specifically the performance of two algorithms, those of Hooke-Jeeves and Levenberg-Marquardt, are tested by simulations. Suggestions for including restrictions to the dipole position and comments about some commonly used measures of the goodness of fit are given. Examples of erroneous implementations of these algorithms are also illustrated. A simple graphic rejection criterion, which can be easily used by inexperienced researchers, is introduced and tested in noisy and noise free simulations.The authors are grateful to Roberto D. Pascual Marqui for programming the Hooke-Jeeves algorithm.     

Immunoglobulin G and immunoglobulin M polar staining of Toxoplasma gondii in the indirect immunofluorescence test.

Polar staining (PS) of Toxoplasma gondii in the indirect immunofluorescence test has been considered a nonspecific reaction caused exclusively by certain immunoglobulin M (IgM) antibodies and confined to the anterior end of the parasite. After we observed a patient with positive serology for Chagas' disease who presented an IgG PS reaction, we studied sera from 120 patients with Chagas' disease, 20 sera from patients with Leishmania donovani infection, and 30 sera from patients with Leishmania braziliensis infection. When only those specimens having no detectable anti-Toxoplasma activity were considered, a significantly (P less than 0.01) higher prevalence of IgG PS was found in the Chagas' disease and L. donovani groups than in sera from normal American and Brazilian adults. Those sera also showed higher PS titers (1:64 to 1:1,024) when compared with controls (1:16 to 1:64). IgG PS titers did not decrease after serum treatment with 2-mercaptoethanol. However, the same treatment removed completely IgM PS. IgG PS, but not IgM PS, could be removed by adsorption with Trypanosoma cruzi epimastigotes. IgM PS was found in all samples studied, except in 41 of a group of 43 umbilical cord sera. It was found that the antigen source and the microscopy system can influence the detection of PS. It is proposed that after finding an intense IgG PS reaction, the laboratory should screen such serum also for anti-T. cruzi antibodies which may be undetected in the sample.     

Valoración de parámetros clínicos y analíticos preoperatorios en apendicitis aguda complicada. Score para predecir apendicitis complicada

BackgroundTo analyze whether clinical and analytical parameters differ according to histopathology in cases of acute appendicitis (AA).MethodsThis is a retrospective, observational study including patients (>14 years of age) admitted for suspicion of AA from 1 April 2014 to 31 July 2016. Histopathology was divided into complicated (including perforated and gangrenous AA) and uncomplicated appendicitis (phlegmonous). Sex, age, temperature of patients on admission to the Emergency Department, symptom duration, preoperative white blood cell (WBC) count, neutrophil percentage, mean platelet volume (MPV), platelet distribution width (PDW), C-reactive protein (CRP) and hospital stay were compared in the two groups.ResultsThree hundred and thirty-five patients were analyzed, and 284 were included. Appendicitis was uncomplicated in 194 (68.3%) and complicated in 90 (31.7%). Age, symptom duration, neutrophil percentage, CRP and hospital stay were higher in the complicated AA group (P < .05). The mean differences between uncomplicated and complicated AA were: age 13.2 years (95% CI: 8.2-18.2), symptom duration 14.1 hours (95% CI: 6.3-21.9), neutrophil percentage 5.0% (95% CI: 3.2-6.8), CRP 73.6 mg/l (95% CI: 50.0-97.2) and hospital stay 2.2 days (95% CI: 1.4-3.0), with p<0.05 for all these variables. A model based on the preoperative parameters (age, symptom duration, neutrophil percentage and CRP) was calculated to predict the likelihood of complicated AA. The receiver operating characteristic (ROC) of the model had an area under the curve of 0.80 (95% CI 0.75-0.85).ConclusionThis model is able to diagnose complicated AA without the need for imaging techniques, although it must be validated with prospective analysis.     

Figures of merit to compare distributed linear inverse solutions

Summary This paper introduces the concept of the resolution matrix as the basis for an objective theoretical comparison of distributed linear inverse solutions to the neuroelectromagnetic inverse problem. In particular, we describe how figures of merit derived from the resolution matrices can be represented graphically to evaluate merits and shortcomings of the different solutions. The use of the figures of merit is illustrated with two solutions that consider minimal a priori information about the generators: Classical Minimum Norm and Backus Gilbert. We recommend to start any analysis with the individual exploration of the resolution kernel for each grid point or at least for those points where the activity is likely to occur. This analysis might help in selecting the optimal inverse for the sources that are supposed to be active in the process under study.This work was supported by a grant from the Deutsche Forschungsgemeinschaft (Klinische Forschergruppe Biomagnetismus and Biosignalanalyse). Partial support was received from Swiss National Foundation grant 4038-044081/1.