Failure to demonstrate postpartum functional iron deficiency using quantitative red blood cell analysis.

OBJECTIVE: The aim of this prospective study was to assess erythropoiesis and test for functional iron deficiency in the postpartum period using quantitative red blood cell analysis. STUDY DESIGN: Parameters were determined on admission for delivery and postpartum from 82 obstetric patients at Zurich University Hospital: full blood count, hypochromic and microcytic red cells, reticulocyte count (including subsets), reticulocyte mean corpuscular volume, reticulocyte mean hemoglobin content and reticulocyte mean corpuscular hemoglobin concentration. RESULTS: Microcytic cells increased from 0.9% prepartum to 1.4% on day 42 postpartum; hypochromic cells decreased from 4.3 to 1.9%; reticulocyte mean corpuscular volume decreased from 134 to 125 fl; reticulocyte mean hemoglobin content was unchanged. CONCLUSION: To our knowledge, this is the first medium scale application of quantitative red blood cell analysis to normal pre- and postpartum women. Our data show no evidence of functional iron deficiency or increased erythropoiesis in the postpartum period.     

The Update on Instruments Used for Evaluation of Comorbidities in Total Hip Arthroplasty

IntroductionIt is a well-established fact that concomitant diseases can affect the outcome of total hip arthroplasty (THA). Therefore, careful preoperative assessment of a patient''s comorbidity burden is a necessity, and it should be a part of routine screening as THA is associated with a significant number of complications. To measure the multimorbidity, dedicated clinical tools are used.MethodsThe article is a systematic review of instruments used to evaluate comorbidities in THA studies. To create a list of available instruments for assessing patient''s comorbidities, the search of medical databases (PubMed, Web of Science, Embase) for indices with proven impact on revision risk, adverse events, mortality, or patient''s physical functioning was performed by two independent researchers.ResultsThe initial search led to identifying 564 articles from which 26 were included in this review. The measurement tools used were: The Charlson Comorbidity Index (18/26), Society of Anesthesiology classification (10/26), Elixhauser Comorbidity Method (6/26), and modified Frailty Index (5/26). The following outcomes were measured: quality of life and physical function (8/26), complications (10/26), mortality (8/26), length of stay (6/26), readmission (5/26), reoperation (2/26), satisfaction (2/26), blood transfusion (2/26), surgery delay or cancelation (1/26), cost of care (1/26), risk of falls (1/26), and use of painkillers (1/26). Further research resulted in a comprehensive list of eleven indices suitable for use in THA outcomes studies.ConclusionThe comorbidity assessment tools used in THA studies present a high heterogeneity level, and there is no particular system that has been uniformly adopted. This review can serve as a help and an essential guide for researchers in the field.     

Biomechanical analysis of knee hyperextension and of the impingement of the anterior cruciate ligament: a cinematographic MRI study with impact on tibial tunnel positioning in anterior cruciate ligament reconstruction

This study analyzed the interaction between the anterior cruciate ligament (ACL) and the intercondylar notch roof (INR) in hyperextension of the knee using magnetic resonance cinematography. Cinematographic image series of 15 knees were investigated. Two independent observers identified the image that displayed the beginning of contact between the ACL and the INR. They determined knee extension on this image and on the image that displayed maximum hyperextension of the knee. Correlations between a variable representing impingement and the inclination angle of the INR, the anterior laxity of the knee, and full hyperextension were examined. Theoretical, impingement-free tibial tunnel positions for the knees were calculated as a percentage of the anteroposterior tibial width. All ACLs of the knees in this study made contact with the INR. The average extension angle at the beginning of impingement was –6.3 ± 3.8°. There were significant correlations between impingement and maximum manual displacement as measured with the arthrometer ¶(r = 0.77; P < 0.001), maximum hyperextension (r = 0.67; P = 0.007), and notch roof angle (r = –0.73; P = 0.002). There were biomechanically acceptable tunnel positions for all knees but one. Hyperextension is physiologically associated with impingement of the ACL. In uninjured knees there was a correlation between ACL impingement and hyperextension, inclination of the INR, and maximum manual displacement of the tibia. Impingement free tibial tunnel positioning is possible in most knees without notchplasty.     

Nierentumorembolisation

Today the relevance of renal tumor embolization is not determined only by the technical and clinical success of the method. Progress in diagnosis of early stages of renal carcinomas as well as the improvement of both surgical techniques and anesthetic procedures have lead to a change in the selection of patients for embolization. Preoperative embolization of advanced renal cell carcinomas with tumor thrombus into the vena cava or of T4 tumors is now an established clinical procedure. The complete occlusion of the vascular bed of the tumors leads to a considerable reduction in intraoperative blood loss and to simplification of the surgical preparation. By using Ethibloc for embolization, palliation of a hemorrhage or of tumor-related pain in inoperable patients is usually successful. Although local control of the tumor disease, including complete tumor ablation, is achieved by embolization, the median survival rate of our palliatively embolized patients is only 3.5 months. This short life expectancy in the group of inoperable patients has to be acknowledged individually in patients considered for palliative embolization who are free of symptoms related the tumor.     

A Progressive Mouse Model of Parkinson’s Disease: The Thy1-aSyn (“Line 61”) Mice

Identification of mutations that cause rare familial forms of Parkinson’s disease (PD) and subsequent studies of genetic risk factors for sporadic PD have led to an improved understanding of the pathological mechanisms that may cause nonfamilial PD. In particular, genetic and pathological studies strongly suggest that alpha-synuclein, albeit very rarely mutated in PD patients, plays a critical role in the vast majority of individuals with the sporadic form of the disease. We have extensively characterized a mouse model over-expressing full-length, human, wild-type alpha-synuclein under the Thy-1 promoter. We have also shown that this model reproduces many features of sporadic PD, including progressive changes in dopamine release and striatal content, alpha-synuclein pathology, deficits in motor and nonmotor functions that are affected in pre-manifest and manifest phases of PD, inflammation, and biochemical and molecular changes similar to those observed in PD. Preclinical studies have already demonstrated improvement with promising new drugs in this model, which provides an opportunity to test novel neuroprotective strategies during different phases of the disorder using endpoint measures with high power to detect drug effects.     

Interactions between hippocampal activity and striatal dopamine in people at clinical high risk for psychosis: relationship to adverse outcomes

Preclinical models propose that increased hippocampal activity drives subcortical dopaminergic dysfunction and leads to psychosis-like symptoms and behaviors. Here, we used multimodal neuroimaging to examine the relationship between hippocampal regional cerebral blood flow (rCBF) and striatal dopamine synthesis capacity in people at clinical high risk (CHR) for psychosis and investigated its association with subsequent clinical and functional outcomes. Ninety-five participants (67 CHR and 28 healthy controls) underwent arterial spin labeling MRI and ¹⁸F-DOPA PET imaging at baseline. CHR participants were followed up for a median of 15 months to determine functional outcomes with the global assessment of function (GAF) scale and clinical outcomes using the comprehensive assessment of at-risk mental states (CAARMS). CHR participants with poor functional outcomes (follow-up GAF < 65, n = 25) showed higher rCBF in the right hippocampus compared to CHRs with good functional outcomes (GAF ≥ 65, n = 25) (p_fwe = 0.026). The relationship between rCBF in this right hippocampal region and striatal dopamine synthesis capacity was also significantly different between groups (p_fwe = 0.035); the association was negative in CHR with poor outcomes (p_fwe = 0.012), but non-significant in CHR with good outcomes. Furthermore, the correlation between right hippocampal rCBF and striatal dopamine function predicted a longitudinal increase in the severity of positive psychotic symptoms within the total CHR group (p = 0.041). There were no differences in rCBF, dopamine, or their associations in the total CHR group relative to controls. These findings indicate that altered interactions between the hippocampus and the subcortical dopamine system are implicated in the pathophysiology of adverse outcomes in the CHR state.Subject terms: Predictive markers, Psychosis     

Trichostatin A down-regulates CYP19 transcript and protein levels in MCF-7 breast cancer cells

Epidemiological and experimental evidence implicates estrogens in the etiology and progression of breast cancer. The biosynthesis of estrogens from androgens is catalyzed by an enzymatic complex designated as aromatase (CYP19).     

Single-trial P3 amplitude and latency informed event-related fMRI models yield different BOLD response patterns to a target detection task

Using single-trial parameters as a regressor in the General Linear Model (GLM) is becoming an increasingly popular method for informing fMRI analysis. However, the parameter used to characterise or to differentiate brain regions involved in the response to a particular task varies across studies (e.g. ERP amplitude, ERP latency, reaction time). Furthermore, the way in which the single-trial information is used in the fMRI analysis is also important. For example, the single-trial parameters can be used as regressors in the GLM or to modify the duration of the events modelled in the GLM. The aim of this study was to investigate the BOLD response to a target detection task when including P3 amplitude, P3 latency and reaction time parameters in the GLM. Simultaneous EEG-fMRI was recorded from fifteen subjects in response to a visual choice reaction time task. Including P3 amplitude as a regressor in the GLM yielded activation in left central opercular cortex, left postcentral gyrus, left insula, left middle frontal gyrus, left insula and left parietal operculum. Using P3 latency and reaction time as an additional regressor yielded no additional activation in comparison with the conventional fMRI analysis. However, when P3 latency or reaction time was used to determine the duration of events at a single-trial level, additional activation was observed in the left postcentral gyrus, left precentral gyrus, anterior cingulate cortex and supramarginal gyrus. Our findings suggest that ERP amplitudes and latencies can yield different activation patterns when used to modify relevant aspects of the GLM.