Gender-specific differences in the prevention of asthma-like symptoms in high-risk infants

The prevalence of asthma in children has increased in the last decades, and gender-specific differences in asthma development have recently been suggested. The present study investigates whether gender differences are present in a population of young children (0-2 yr) with a high risk for the development of asthma on the basis of the presence of asthma in first-degree relative(s). The study was performed on 222 children (118 boys, 104 girls) with a familial predisposition of asthma, which received standardized recommendations to reduce exposure to allergens (dust mite, pets and food allergens) and to passive smoking. Health outcome (wheezing episodes and shortness of breath) and compliance with allergen-reducing measures were studied by means of multiple regression analyses. Boys suffered more from asthma-like complaints than girls, as diagnosed by the general practitioner (32% vs. 18%, respectively, p = 0.023). Compliance with intervention measures was similar for boys and girls for most allergens, but food allergen reduction was better applied for girls: duration of exclusive breastfeeding was longer in girls (median 9 wk vs. 4 wk, p = 0.009). Further analysis showed that 4 wk of longer breastfeeding reduced the number of wheezing episodes and shortness of breath in boys by 19% and 15%, respectively, but not in girls, suggesting sex as an effect modifier in the relationship between breastfeeding and asthma-like symptoms. The present findings indicate that application and effects of prevention strategies for children with a high risk for developing asthma might be gender-specific and suggest a special importance of breastfeeding boys.     

Improved visualization of breast lesions with gadolinium-enhanced magnetization transfer MR imaging

A pulse sequence with magnetization transfer as the main contrast mechanism (MT-FLASH) was developed for improved imaging of breast lesions that requires neither fat suppression nor postprocessing. After optimization of the sequence in phantom and volunteer studies, a clinical pilot study with 14 patients was performed. In carcinomas the relative signal increase after Gd-DTPA administration was on average 34% in MT-FLASH images compared with 169% in conventional T₁ weighted (T1W) three-dimensional FLASH images. In MT-FLASH images, all lesions demonstrated a signal intensity higher than that of fat; in T1W images, all lesions have a lower signal intensity. The average postcontrast carcinoma-to-fat contrast-to-noise ratios were +11.6 and ?14.2, respectively. The conspicutty of 12 of 13 carcinomas was improved in postcontrast MT-FLASH images compared with postcontrast T1w images. Thus, MT-FLASH imaging enables excellent visualization of Gd-DTPA-enhancing breast lesions.     

Metabolism of very-low-density lipoprotein triglyceride by human placental cells: the role of lipoprotein lipase.

Several studies have shown lipoprotein lipase (LPL) activity in human placenta, but the quantitative significance and cellular specificity of LPL in this organ are unknown. The objective of this report is to investigate the metabolism of very-low-density lipoprotein triglycerides (VLDL-TG) by the placenta, the role of LPL in this process, and the types of cells involved. Placental cells were obtained by enzymatic digestion (collagenase, hyaluronidase, and DNA-ase) and separated on a 40% Percoll gradient. The trophoblasts were the predominant cell type (80% to 85% pure) isolated at d = 1.033 to 1.048 and macrophages were predominant at d = 1.077 to 1.100 (greater than 95% pure), as characterized by eight immunocytochemical assays using cell protein-specific monoclonal antibodies. Macrophages represented 50% to 60% of cells isolated, and trophoblasts, 40% to 50%. LPL activity was assessed by VLDL-TG hydrolysis in primary 3- to 4-day tissue culture. In a representative experiment, LPL activity (nmol fatty acids (FA)/mg protein/24 h) was 101.3 +/- 5.3 in macrophages and 29.9 +/- 6.5 in the predominant trophoblast cell types, with approximately 20% of these amounts incorporated and reesterified. VLDL-TG hydrolysis and cell lipid uptake in both placental cell types was essentially abolished by a monoclonal anti-LPL antibody. When compared with a model of hepatocytes (Hep G2 cells), the hydrolysis of VLDL-TG was almost undetectable in these cells. In contrast, free fatty acids (FFA) uptake by Hep G2 cells was fourfold to sixfold greater than that by macrophages and trophoblasts, respectively. In conclusion, macrophages and trophoblasts are the two predominant placental cells isolated by enzymatic digestion.(ABSTRACT TRUNCATED AT 250 WORDS)     

In utero thrombosis and neonatal gangrene in an infant of a diabetic mother

We report an infant of a diabetic mother (IDM) with in utero brachial artery thrombosis and neonatal gangrene to illustrate that there may be an increased risk for arterial as well as venous thrombosis in IDMs. The diagnosis of brachial artery thrombosis was made by using Doppler sonography flow studies and was confirmed with autopsy. The postnatal period was complicated by aortic and mesenteric artery thrombosis, with subsequent necrotizing enterocolitis, renal infarction, and death. Gangrene of a limb presenting at birth is rare, with 32 individuals reported in the literature, including this patient. Twenty-two percent (7/32) of the infants with peripartum limb gangrene were IDMs. This implies a marked increase in arterial thrombosis in IDMs over the general population. Changes in coagulation factors have been reported in newborn IDMs with poor control of maternal diabetes. Increased clotting and decreased fibrinolysis found in diabetics may lead to arterial thrombosis in IDMs in utero and postnatally. Use of anticoagulants in at-risk infants should be considered to prevent further thrombosis postnatally. Additionally, IDMs may be at increased risk for thrombotic complications from umbilical artery catheter. In utero thrombosis of the brachial artery may be one mechanism which leads to limb reduction defects in IDMs.     

Radiotherapy treatment planning of basal meningiomas: improved tumor localization by correlation of CT and MR imaging data.

A localization technique, based on three-dimensional CT and MR imaging data for precision radiotherapy of basal meningiomas, is presented. Indications for radiotherapy included unresected tumors, gross disease remaining despite surgery, and recurrences. The patient's head was fixed in a stereotactic localization system which is usable at the CT, MR and the linear accelerator installations. The geometrical distortion of MR imaging data was evaluated in three dimensions by phantom measurements. The geometrical distortion was "corrected" (reducing displacements to the size of a pixel) by calculations based on modelling the distortion as a fourth order two-dimensional polynomial. The target volume was defined in three-dimensional MR imaging data after application of 0.1 mmol/kg b.w. Gd-DTPA solution and transferred precisely from MR onto CT data to provide a map of the radiation attenuation coefficient for dose calculation. The superior soft tissue contrast of MR showed an excellent tumor delineation especially when the bony base of the skull obscured the target in CT images. Target volume, calculated dose distribution, and critical structures could be transferred between CT and MR imaging data and displayed as three-dimensional shaded structures for better assessment for matching of target volume and dose distribution. With the described planning system a more precise target definition of basal meningiomas was possible by integration of the superior tumor delineation in MR compared with CT.     

Face-to-face vs. online peer support groups for prostate cancer: A cross-sectional comparison study

Background

As social media are evolving rapidly online support groups (OSG) are becoming increasingly important for patients. Therefore, the aim of our study was to compare the users of traditional face-to-face support groups and OSG.

Patients and methods

We performed a cross-sectional comparison study of all regional face-to-face support groups and the largest OSG in Germany. By applying validated instruments, the survey covered sociodemographic and disease-related information, decision-making habits, psychological aspects, and quality of life.

Results

We analyzed the complete data of 955 patients visiting face-to-face support groups and 686 patients using OSG. Patients using OSG were 6 years younger (65.3 vs. 71.5 years; p < 0.001), had higher education levels (47 vs. 21%; p < 0.001), and had higher income. Patients using OSG reported a higher share of metastatic disease (17 vs. 12%; p < 0.001). Patients using OSG reported greater distress. There were no significant differences in anxiety, depression, and global quality of life. In the face-to-face support groups, patient ratings were better for exchanging information, gaining recognition, and caring for others. Patients using OSG demanded a more active role in the treatment decision-making process (58 vs. 33%; p < 0.001) and changed their initial treatment decision more frequently (29 vs. 25%; p < 0.001).

Conclusions

Both modalities of peer support received very positive ratings by their users and have significant impact on treatment decision-making.

Implications for cancer survivors

Older patients might benefit more from the continuous social support in face-to-face support groups. OSG offer low-threshold advice for acute problems to younger and better educated patients with high distress.

Trial registration

www.germanctr.de, number DRKS00005086