Takayasu's arteritis: assessment of disease activity with contrast-enhanced MR imaging

OBJECTIVE: The purpose of this study was to evaluate the role of contrast-enhanced MR imaging in the determination of disease activity in patients with Takayasu's arteritis. SUBJECTS AND METHODS: High-resolution contrast-enhanced T1-weighted spinecho MR imaging using small fields of view (14-20 cm) and thin slices (4-5 mm) was performed in 26 patients with Takayasu's arteritis and 16 healthy subjects. The degree of aortic mural enhancement was assessed by measuring signal intensity and by visually estimating it in comparison with that of the myocardium. RESULTS: Contrast-enhanced MR imaging showed more enhancement of thickened aortic wall compared with myocardium, thus suggesting active Takayasu's arteritis on MR imaging in 16 patients. Determination of disease activity using contrast-enhanced MR imaging was concordant with clinical findings in 23 patients (88.5%). Contrast-enhanced MR findings were concordant with laboratory findings in most patients (erythrocyte sedimentation rate in 92.3% [24/26] and C-reactive protein in 84.6% [22/26]). The measured signal intensity of the aortic wall relative to that of myocardium during the early phase of contrast-enhanced MR imaging correlated well with the erythrocyte sedimentation rate (r = 0.78, p < 0.005) and with the C-reactive protein level (r = 0.63, p < 0.005). CONCLUSION: Contrast-enhanced MR imaging provides information about disease activity of Takayasu's arteritis, which may be useful in the diagnosis and treatment of Takayasu's arteritis.     

Increased fetoplacental active renin production in pregnancy-induced hypertension

Since pregnancy-induced hypertension is associated with impaired uteroplacental blood flow, we studied fetoplacental and maternal renin production in controls and subjects with pregnancy-induced hypertension. We measured total, active, and inactive (pro-) renin in maternal serum, fetal arterial and venous blood, and chorion homogenate in eight normotensive term patients and 18 patients with pregnancy-induced hypertension. No differences in active or prorenin were found in maternal blood from normal women or patients with pregnancy-induced hypertension. In contrast, fetal artery and vein, as well as chorionic tissue, contained significantly higher active renin in pregnancy-induced hypertension compared with normal subjects. No difference in fetal or chorionic prorenin was seen in the two groups. Thus active to total renin ratio was higher in the fetus and chorion of subjects with pregnancy-induced hypertension, which suggests enhanced active renin production. These results suggest that pregnancy-induced hypertension is associated with increased activity of the renin-angiotensin system in the fetoplacental unit, which is not reflected in the maternal circulation. This may be an attempt by the fetus and chorionic membranes to maintain vascular homeostasis in the face of altered uteroplacental blood flow.     

Clinical Impact of Empirical Antibiotic Therapy in Patients With Coronavirus Disease 2019 Requiring Oxygen Therapy

Despite the low prevalence of secondary bacterial infection in coronavirus disease 2019 (COVID-19) patients, most of them were administered antibiotic therapy empirically. However, the prognostic impact of empirical antibiotic therapy has not been evaluated. We conducted retrospective propensity score-matched case-control study of 233 COVID-19 patients with moderate to severe illnesses who required oxygen therapy and evaluated whether empirical antibiotic therapy could improve clinical outcomes. Empirical antibiotic therapy did not improve clinical outcomes including length of stay, days with oxygen requirement, the proportion of patients with increased oxygen demand, the proportion of patients who required mechanical ventilation, and overall mortality. This finding implies that routine administration of antibiotics for the treatment of COVID-19 is not essential and should be restricted.     

Ovarian carcinoma as an incidental finding during cesarean section in a preeclamptic woman: case report

Gynecologic malignancies are rarely associated with pregnancy and ovarian tumors diagnosed during cesarean section are very uncommon. A 38-year-old grandmultipara with no prenatal care was hospitalized at an estimated 28 weeks of gestation for high blood pressure and increased proteinuria but no other symptoms of preeclampsia. We present a rare case of advanced ovarian carcinoma diagnosed during cesarean section.     

A novel mutation in TRIM37 is associated with mulibrey nanism in a Turkish boy

Mulibrey nanism is a rare autosomal-recessive disorder characterized by prenatal onset severe growth retardation and pericardial constriction associated with abnormalities of muscle, liver, brain and eye. More than 80% of previously reported patients are of Finnish origin in whom a founder mutation in the TRIM37 gene have been described. We report on a 7-year-old Turkish boy who presented with classical phenotypic features of mulibrey nanism. Mutation screening of the TRIM37 gene revealed that the proband had a homozygous two base pair deletion, c.1894_1895delGA, resulting in a frame-shift and a premature termination codon. Our proband is one of the rare examples of mulibrey nanism outside Finland and extends the mutation spectrum in this disorder.     

NMDA受体依赖的神经元存活及保护作用的机制

NMDA受体属于谷氨酸受体,它在突触传递和突触可塑性中都发挥着非常重要的作用,其介导的兴奋性毒性是脑缺血、缺氧和脑外伤等导致脑损伤的重要分子机制.但是,近年来的研究发现,在生理和某些病理情况下,NMDA受体的激活具有促进神经元存活及保护神经元免受损伤的作用.     

SARS诊疗信息数据库的设计与实现

对于人类尚未完全认识与控制的SARS,无论是临床、辅助诊断、基础研究,还是卫生行政部门都非常需要得到这些病人的诊疗信息．以便进行分析研究。基于“军字一号”医院信息系统,对SARS诊疗信息数据库的功能、内容与信息规范进行设计,对系统实现中平台环境、数据结构以及应用系统等进行了较为详尽的描述。     

Contemporary multilevel analysis of the effectiveness of water fluoridation in Australia

Aims: Water fluoridation was extended in Queensland, Australia, across 2009–2011. A research program was commenced to inform the rationale for and the outcome of this program, to estimate the effectiveness of water fluoridation in preventing caries and to predict changes in caries experience as a result of the extension of fluoridation. Methods: Queensland children were selected through a stratified random sample selection in 2010–2012. Oral epidemiological examinations provided individual‐level outcomes for decayed, missing or filled primary or permanent tooth surfaces: dmfs (among 5–8‐year‐olds) and DMFS (9–14‐year‐olds). Explanatory factors at the individual‐level, school‐level and area‐level fluoridation status were derived. Data were weighted to represent the population. Three‐level multilevel multivariable models were sequentially specified for negative binomial distribution of dmfs/DMFS to estimate rate ratios (RR). The effectiveness of area‐level water fluoridation was evaluated in the full models controlling for other factors. Results: Data from 2,214 5–8 year‐olds and 3,186 9–14 year‐olds from 207 schools in 16 areas were analysed. Queensland's average dmfs was 4.23 and DMFS 1.47. The lowest levels of dental caries were observed in long‐term fluoridated Townsville. In the full models, Townsville children had significantly lower caries experience (RR for dmfs: 0.61 (95%CI: 0.44–0.82); RR for DMFS 0.60 (95%CI: 0.42–0.88)) compared with children in non‐fluoridated areas. Conclusion: Comparison of caries experience of children at the time of the extension of water fluoridation supported the rationale for this population health measure.     

Extrahepatic collateral supply of hepatocellular carcinoma by the intercostal arteries

PURPOSE: To evaluate computed tomographic (CT) and angiographic findings of extrahepatic collateral supply of hepatocellular carcinoma (HCC) by the intercostal artery (ICA) and the efficacy of transcatheter arterial chemoembolization (TACE) in the ICA. MATERIALS AND METHODS: The CT and angiographic findings of 30 ICA collateral supplies of HCC in 19 patients were evaluated. TACE of the ICA collaterals was performed in 10 patients. The clinical outcomes and complications were evaluated. RESULTS: ICA collaterals were found at the first to 18th sessions of TACE of HCC. The CT findings were: large HCC (mean diameter, 10.3 cm), subcapsular location (94.7%), defect in iodized oil retention or progression of HCC at subcapsular region (31.6%), HCC abutting the abdominal wall in a broad area with or without abdominal wall invasion (63.2%), hypertrophied ICA (31.6%), and branching collateral vessels coursing from the abdominal wall to the HCC (26.3%). On angiograms, all ICA collaterals originated from the right side at levels of T8 (6.7%), T9 (30.0%), T10 (46.7%), or T11 (16.7%). Twelve sessions of TACE of the ICA collaterals were performed in 10 patients. Follow-up angiography was performed in six patients and showed persistent obliteration in one, recanalization in three, and progression in two. Complications were shoulder pain (n = 2), itching sensation (n = 1), erythema of skin (n = 1), and skin necrosis (n = 1). CONCLUSION: ICA collateral supply of HCC usually occurs in advanced HCC or after multiple sessions of TACE. When there are suggestive CT findings, ICA collaterals should be sought when TACE is performed in the management of HCC.