Dorsal metacarpal veins: anatomic variation and potential clinical implications

The dorsal metacarpal veins are frequently cannulated. Cannulation success is determined by several variable anatomic features. The objective of this study is to classify, for the first time, the anatomic variants of the dorsal metacarpal veins. In this cross-sectional study, 520 university students and staff were conveniently recruited. The dorsal metacarpal veins in 1040 hands were studied. Venous visibility was enhanced by either tourniquet application or near-infrared illumination. Variant patterns of the dorsal metacarpal veins were classified. The final analysis included 726 hands, for an exclusion rate of 30 %. Eight pattern types were identified. Three anatomic features informed the variation. Bilateral symmetry of the dorsal metacarpal veins was present in 352 participants (83 % of the total). The overall frequency distribution of variants in both hands was similar (P = 0.8). The frequency distribution of variants was subject to sexual dimorphism (P = 0.001), ethnic variation (P < 0.001), and technical variation (P < 0.001). The anatomic variants of the dorsal metacarpal veins were sorted into decreasingly frequent primary, secondary, and tertiary groups. The groups may signify a progressive increase in difficulty of peripheral cannulation, in the mentioned order. As such, primary patterns are the most common and likely the easiest to cannulate, while tertiary patterns are the least common and likely the most difficult to cannulate. The preceding premise, in tandem with the bilateral asymmetry of the veins, is clinically significant. With cannulation difficulty likely signifying an underlying tertiary pattern, the contralateral dorsal metacarpal veins are probabilistically characterized by a primary pattern and are, as such, the easier option for peripheral venous cannulation.     

Antiphospholipid syndrome: An update on risk factors for pregnancy outcome

Background

The optimal treatment of women with primary antiphospholipid syndrome (APS) is still debated. About 20–30% of women with APS remain unable to give birth to healthy neonates despite conventional treatment, consisting of prophylactic-dose heparin and low-dose aspirin. These cases are defined “refractory obstetric APS”. The early identification of risk factors associated with poor pregnancy outcome could be the optimal strategy to establish criteria for additional therapies, such as hydroxychloroquine, steroids, intravenous immunoglobulin, and plasma exchange.

Intravenous Immunoglobulins as a new opportunity to treat discoid lupus erythematosus: A case report and review of the literature

Discoid lupus erythematosus (DLE) is a chronic dermatological disease that can lead to scarring, alopecia and dyspigmentation, if not properly treated. Actually, no drugs are specifically approved for the treatment of CLE, although the first-line therapy usually consists of photoprotection associated to topical or oral steroids, topical calcineurin inhibitors and hydroxychloroquine (HCQ). In cases of DLE refractory to these medications, many other agents have been employed, such as dapsone, methotrexate, azathioprine, cyclophosphamide, biologic drugs and Intravenous Immunoglobulin (IVIG).We described the case of a DLE patient resistant to combination therapy with steroid and HCQ who was successfully treated with cyclical IVIG therapy. The treatment with IVIG resulted rapidly effective with persistent efficacy and low rates of relapses, although more cycles of IVIG are needed to achieve a stable clinical remission.We also discussed the beneficial and promising effects of IVIG in patients with Cutaneous Lupus reporting the previously published data.     

Paradoxical fall in proteinuria during pregnancy in an LCAT-deficient patient—A case report

A 29-year-old lady was diagnosed with lecithin:cholesterol acyltransferase (LCAT) deficiency having presented with bilateral corneal clouding, severely reduced high density lipoproteins cholesterol, and proteinuria. She is a compound heterozygote with two LCAT gene mutations, one of which is novel, c.321C>A in exon 3. Surprisingly, the level of proteinuria significantly improved during pregnancy, despite stopping the angiotensin-converting enzyme inhibitor. However, LCAT concentration and activity remained identical during pregnancy and postpartum. Her pregnancy was complicated by rising triglyceride levels from the second trimester requiring treatment with omega-3 fatty acid and fenofibrate. In the last trimester, a further complication arose when she became hypertensive and proteinuria worsened. She was diagnosed with pre-eclampsia and had an emergency cesarean section at 39 weeks delivering a healthy baby. This case adds to the knowledge of the pathophysiology of LCAT deficiency during pregnancy and will be useful in future patient management.     

Purinosome formation as a function of the cell cycle

The de novo purine biosynthetic pathway relies on six enzymes to catalyze the conversion of phosphoribosylpyrophosphate to inosine 5′-monophosphate. Under purine-depleted conditions, these enzymes form a multienzyme complex known as the purinosome. Previous studies have revealed the spatial organization and importance of the purinosome within mammalian cancer cells. In this study, time-lapse fluorescence microscopy was used to investigate the cell cycle dependency on purinosome formation in two cell models. Results in HeLa cells under purine-depleted conditions demonstrated a significantly higher number of cells with purinosomes in the G₁ phase, which was further confirmed by cell synchronization. HGPRT-deficient fibroblast cells also exhibited the greatest purinosome formation in the G₁ phase; however, elevated levels of purinosomes were also observed in the S and G₂/M phases. The observed variation in cell cycle-dependent purinosome formation between the two cell models tested can be attributed to differences in purine biosynthetic mechanisms. Our results demonstrate that purinosome formation is closely related to the cell cycle.Enzymes have been shown to form clusters in a cell to regulate metabolic processes (1–3). More recently, the concept of multienzyme complexes has been expanded to include mesoscale protein assemblies that appear to be substantially larger than a single protein (4). Depending on the metabolic or developmental state of the cells, these types of protein clusters range from transiently associated to very rigid and well defined (4). Examples of such enzyme clusters include the EF-Tu cytoskeleton, RNA degradosome, CTP synthase, carboxysomes, and nucleolus (5–9).In humans, purine nucleotides are synthesized by two different mechanisms. The first mechanism, de novo purine biosynthesis, converts phosphoribosylpyrophosphate (PRPP) to inosine 5′-phosphate (IMP) in 10 highly conserved steps catalyzed by six enzymes. These six enzymes include one trifunctional enzyme (TrifGART: GARS, GART, and AIRS domains), two bifunctional enzymes (PAICS: CAIRS and SAICARS domains; ATIC: AICART and IMPCH domains), and three monofunctional enzymes (PPAT, FGAMS, and ASL). ASL is also necessary for the conversion of IMP to AMP and may be classified as bifunctional (10). The second mechanism uses nucleotide salvage pathways to either phosphorylate a nucleoside (e.g., thymidine kinase) or add a purine base to ribose 5′-phosphate to regenerate the respective monophosphate. For example, hypoxanthine/guanine phosphoribosyl transferase (HGPRT) catalyzes the conversion of hypoxanthine to IMP and the conversion of guanine to guanosine 5′-phosphate (GMP). The de novo pathway is more energy-intensive, with the synthesis of 1 mole of IMP requiring 5 moles of ATP. Therefore, the salvage pathway is the preferred pathway for purine biosynthesis. Cells deficient in HGPRT, such as those that exhibit a Lesch–Nyhan disease (LND) phenotype, rely primarily on the de novo purine biosynthetic pathway to generate purine nucleotides (11–15).Recently, enzymes in the de novo purine biosynthetic pathway were shown to organize and reversibly assemble into punctate cellular bodies known as “purinosomes” under purine-depleted conditions (16). Further investigations into the organization of the purinosome showed that several of the enzymes form a core structure (PPAT, TrifGART, and FGAMS), whereas others appear to interact peripherally (PAICS, ASL, and ATIC) (17). The presence of this protein assembly and its putative function(s) clearly suggest that the spatial organization of pathway enzymes into purinosomes within a cell play an important role in meeting the cellular demand for purines (18). Although many studies have implied up-regulation of the de novo purine biosynthetic pathway during cell cycle progression (14, 19–21), here we used time-lapse microscopy to determine whether a correlation exists between the cell cycle stage and the number of cells with purinosomes or the cells’ purinosome content. Two different cell types, HeLa and LND cells, were used, with the latter deficient in purine salvage, to assess the effect of increased demand on the de novo pathway for purine biosynthesis and the attendant consequences for purinosome assembly.     

Lung function impairment in relation to cognition and vascular brain lesions: the Rotterdam Study

Journal of Neurology - To investigate the association of chronic obstructive pulmonary disease (COPD) and Preserved Ratio Impaired Spirometry (PRISm) with cognitive performance and presence of...     

Controversies in cardio-nephrology: contrast nephropathy

International Urology and Nephrology -     

Psychometrics and diagnostics of Italian cognitive screening tests: a systematic review

Neurological Sciences - Cognitive screening tests (CSTs) are crucial to neuropsychological diagnostics, and thus need to be featured by robust psychometric and diagnostic properties. However, CSTs...