NK cells from tuberculous pleurisy express high ICAM‐1 levels and exert stimulatory effect on local T cells

Tuberculous pleurisy, one of the most common manifestations of extrapulmonary tuberculosis, is characterized by a T‐cell‐mediated hypersensitivity reaction along with a Th1 immune profile. In this study, we investigated functional cross‐talk among T and NK cells in human tuberculous pleurisy. We found that endogenously activated pleural fluid‐derived NK cells express high ICAM‐1 levels and induce T‐cell activation ex vivo through ICAM‐1. Besides, upon in vitro stimulation with monokines and PAMP, resting peripheral blood NK cells increased ICAM‐1 expression leading to cellular activation and Th1 polarization of autologous T cells. Furthermore, these effects were abolished by anti‐ICAM‐1 Ab. Hence, NK cells may contribute to the adaptive immune response by a direct cell‐contact‐dependent mechanism in the context of Mycobacterium tuberculosis infection.     

Computer vision techniques for breast tumor ultrasound analysis

In this paper, we present a new approach to the segmentation and analysis of solid breast nodules in ultrasonography. We have applied computer vision techniques to segment the nodules and analyze a series of diagnostic criteria which can help discriminate malignant and benignant tumors. The segmentation is carried out in a semiautomatic way, whereas the analysis of the diagnostic criteria involves several computational methods. The techniques which we propose have provided quite satisfactory results and show the usefulness of image processing in the diagnosis through medical imaging.     

Studying the human brain anatomical network via diffusion-weighted MRI and Graph Theory

Our goal is to study the human brain anatomical network. For this, the anatomical connection probabilities (ACP) between 90 cortical and subcortical brain gray matter areas are estimated from diffusion-weighted Magnetic Resonance Imaging (DW-MRI) techniques. The ACP between any two areas gives the probability that those areas are connected at least by a single nervous fiber. Then, the brain is modeled as a non-directed weighted graph with continuous arc weights given by the ACP matrix. Based on this approach, complex networks properties such as small-world attributes, efficiency, degree distribution, vulnerability, betweenness centrality and motifs composition are studied. The analysis was carried out for 20 right-handed healthy subjects (mean age: 31.10, S.D.: 7.43). According to the results, all networks have small-world and broad-scale characteristics. Additionally, human brain anatomical networks present bigger local efficiency and smaller global efficiency than the corresponding random networks. In a vulnerability and betweenness centrality analysis, the most indispensable and critical anatomical areas were identified: putamens, precuneus, insulas, superior parietals and superior frontals. Interestingly, some areas have a negative vulnerability (e.g. superior temporal poles, pallidums, supramarginals and hechls), which suggest that even at the cost of losing in global anatomical efficiency, these structures were maintained through the evolutionary processes due to their important functions. Finally, symmetrical characteristic building blocks (motifs) of size 3 and 4 were calculated, obtaining that motifs of size 4 are the expanded version of motif of size 3. These results are in agreement with previous anatomical studies in the cat and macaque cerebral cortex.     

Proposal of new regression formulae for the estimation of age in infant skeletal remains from the metric study of the pars basilaris

In the context of physical and forensic anthropology, when a child’s skeleton is damaged or in poor condition, which is common, many of the metric methods for the estimation of skeletal age cannot be used. In these circumstances, those more resistant bones, such as the pars basilaris, will be most useful. The aims of this study were to test existing methods for estimating skeletal age from the metric study of the pars basilaris and to propose new regression formulae. One hundred fourteen individuals aged between 5 months of gestation and 6 years were analyzed; seven measures were taken from each pars basilaris using a digital caliper. The chronological age was compared with the estimated age using the methods published by Fazekas and Kósa in 1978 and by Scheuer and MacLaughlin in 1994. New regression formulae are proposed, obtained by classical calibration, which include confidence intervals at 50 and 97.5 % to express the error. With both methods, significant differences were observed; the method of Fazekas and Kósa shows a tendency to underestimate the age, and the method of Scheuer and MacLaughlin tends to overestimate it. The proposed formulae represent a good tool for estimating age in many different contexts because they are relatively easy to apply, although other analysis systems, such as Bayesian approach or geometric morphometry, offer more robust and effective results.

     

Recurrent malignant otitis externa: management and outcome

Necrotizing (malignant) external otitis (NEO) is an infection involving the temporal and the adjacent bones. It is a rare type of external otitis that occurs primarily in immunocompromised persons. The present study aimed to evaluate its management and outcome in recurrent cases. Ten patients attending the ENT Department, Alexandria University were included. They had recurrence of otitis externa over a period of 6 months after-cure, as well as severe night otalgia and high ESR level. Peri-auricular soft tissue swelling, cranial nerve paralysis and trismus were the main persistent or developing presentations in recurrent cases. Extensive surgical intervention was performed in four patients with unsatisfactory outcome. On the other hand, satisfactory results were obtained with those treated with specific medical therapy after culture and sensitivity test and those who underwent minimal surgical intervention. In conclusion, NEO is an aggressive disease that necessitates conservative management and local debridement of sequestrated tissues. The ESR is a good indicator of treatment response. It is recommended to be meticulous in treatment of cases with recurrent NEO and extensive surgical interventions are discouraged.     

Cognitive impairment in survivors of out-of-hospital cardiac arrest

Background

The huge importance of rapid provision of care, especially early defibrillation, for survival of out-of-hospital cardiac arrest (OHCA) is well known. This prospective cohort study investigated cognitive functioning of OHCA survivors in relation to the time-related elements of the resuscitation.

Methods

Fifty-seven consecutive survivors, from a cohort of 308 witnessed OHCA patients with ventricular fibrillation as the initial rhythm, underwent extensive neuropsychologic examination, including tests of memory, attention, and executive functioning, 6 months after the resuscitation. Time-related aspects of the resuscitation were collected on scene. Cognitive functioning was studied in relation to the administration of cardiopulmonary resuscitation (CPR) prior to ambulance arrival, and time from collapse to start of CPR, defibrillation, and return of spontaneous circulation (ROSC).

Results

Depending of the test, between 11% and 28% of survivors were cognitively impaired, while 58% scored unimpaired for all tests. Daily life activities were limited in 19% of the patients. Patients who received CPR prior to arrival of the ambulance showed a trend towards overall better cognitive functioning and significant better immediate memory and visuomotor tracking (P = .03 and P < .01). We found a weak correlation between the time to CPR, time to defibrillation, or time to ROSC and cognitive functioning.

Conclusions

The majority of survivors of OHCA with ventricular fibrillation as the initial rhythm are cognitively unimpaired. Long delays to ROSC are compatible with good cognitive outcome. Initiation and cessation of resuscitation efforts should not be based on the duration of circulatory arrest.     

Patients' characteristics and clinical implications of suboptimal CD4 T-cell gains after 1 year of successful antiretroviral therapy

To describe characteristics and prognosis of patients with suboptimal immunological response to combined antiretroviral therapy (CART). Using data from a multicenter cohort study, we selected patients who initiated CART and showed suboptimal CD4-T cell response (defined as <50 cells/L increase) after 1 year of therapy, despite sustained virological suppression. Characteristics of those patients were compared with subjects who showed optimal immunological response. Of 650 patients with virological suppression, 108 (16.6%) showed suboptimal CD4-T cell response. Independent predictors of suboptimal response were previous injection drug use (OR, 1.85; 95% CI, 1.12-2.98) and age at CART initiation (OR, 1.04 per year increase; 95%CI, 1.01-1.06). Hepatitis C virus coinfection was not associated with impaired immunological response. As compared with patients with optimal immunological response, those with suboptimal response had a higher mortality rate (3.22 versus 0.71 per 100 person-years; p=.001), but a similar rate of new AIDS-defining events. In patients with sustained virological suppression with CART, previous injection drug use, but not hepatitis C virus coinfection, and older age at initiation of therapy were associated with suboptimal CD4 T-cell responses. Patients with suboptimal response had a higher mortality over time, mainly due to diseases other than AIDS-defining events.     

Trained first-responders with an automated external defibrillator: how do they perform in real resuscitation attempts?

INTRODUCTION: The quality of first-responder performance at the end of automated external defibrillator (AED) training may not predict the performance adequately during a real resuscitation attempt. METHODS: Between January and December 2000, we evaluated 67 resuscitation attempts in Amsterdam and surroundings, where police officers used an AED. We compared their performance with their assessment at the end of their ERC AED training course. One of the main goals of training was to deliver a shock within 90 s after switching the power on in the AED. RESULTS: We analysed 127 police officers working in 67 police-teams. The police officers had a mean age of 35 years (range 23-54 years), 73% was male. The interval between AED training and the first resuscitation attempt was a median of 4 months (range 1-13). 78% percent of the 67 teams consisted of two police officers who both were qualified as "competent" after the initial training. Successful completion of the course correlated well with good performance during a resuscitation attempt (p = 0.009). When measured switching the power on in the AED, 92% of the victims received a shock within 90 s. CONCLUSIONS: Successful training correlates well with successful performance in the field. Competence of a team may be better than competence of two separate individuals.