Detecting reflux: does ureteric jet Doppler waveform have a role?

Background

Vesicoureteral reflux (VUR) has a prevalence of 30–40 % post-febrile urinary tract infection (UTI). If not detected early and treated, renal scarring, hypertension, and renal failure may occur. Micturating cystourethrography (MCU) is an invasive procedure associated with radiation exposure. Hence, this study aimed at evaluating the utility of ureteric jet Doppler waveform (UJDW) as a screening tool in detecting VUR, and at assessing the feasibility of performing it in children aged 2–4 years.

Methods

Any child 2–18 years old who needed an MCU was included. Exclusion criteria were active UTI, indwelling catheter, and inability to drink the required amount of fluid. The UJDW was performed prior to the MCU.

Results

One hundred eighty-two ureteric units were analyzed. Sensitivity and specificity of UJDW in detecting VUR was 80.3 and 87.9 %. Twenty-three children (45 ureteric units), aged 2–4 years were compared with 73 children (137 ureteric units), aged 5–18 years. Sensitivity and specificity of UJDW in detecting VUR in 2–4 years was 77.3 and 91.3 %, respectively; while in children ≥5 years, it was 81.8 and 87.1 %, respectively.

Conclusions

UJDW has a uniformly high specificity regardless of age or etiological groups, making it a good tool for follow-up. UJDW is a feasible technique, even in children aged 2–4 years.     

Selective detection of trinitrophenol by a Cd(ii)-based coordination compound

A Cd(ii)-based coordination compound, [CdI₂(4-nvp)₂] (1), has been synthesized using CdI₂ and monodentate N-donor ligand 4-(1-naphthylvinyl)pyridine (4-nvp). The solid-state supramolecular architecture has been characterized by X-ray crystallography. An acute thermal stability and excellent level of phase purity tempted us to use it for material applications. Interestingly, compound 1 exhibits a high selectivity towards trinitrophenol (TNP) in the presence of other nitroaromatics. Therefore, this material may be used for anti-terrorist activities in the detection of explosive materials as well as in the recognition of TNP in analytical laboratories.

A Cd(ii)-based coordination compound, [CdI₂(4-nvp)₂] (1), has been synthesized using CdI₂ and monodentate N-donor ligand 4-(1-naphthylvinyl)pyridine (4-nvp).     

Bilateral inverse Duane's retraction syndrome--a case report.

Duane's retraction syndrome is a well known congenital musculo-facial anomaly. Various explanations have been given for the aetiology of this syndrome. Inverse Duane's retraction syndrome is a condition with reverse clinical features. Abduction of the affected eye is possible to some extent and is accompanied by retraction of the eyeball, narrowing of the palpebral fissure and pseudoptosis. There may be some restriction of movement on adduction. The primary lesion is suspected to be in the medial rectus muscle. Frequently the muscle is found to be entrapped following trauma to the medial wall of the orbit. A case of bilateral inverse Duane's retraction syndrome and convergent squint along with left-sided perceptive deafness is reported. As is usually the case there was no structural abnormality or entrapment of the muscle from trauma.     

Lack of evidence to support present medial release methods in total knee arthroplasty

Purpose

The aim of this review was to identify a reliable sequential medial release protocol for restoration of soft tissue balance in total knee arthroplasty of the varus osteoarthritic knee and to allow for improved intraoperative decision-making.

Method

Current medial release sequences and applicability based upon pre-operative deformity have been reviewed. Furthermore, risks associated with over release, and the necessity of medial release, are discussed.

Results

The different medial release sequences are discussed in relation to pre-operative deformity, along with potential complications associated with medial release. It was found that release sequences may include the deep and superficial components of the medial collateral ligament, the posteromedial capsule, the posterior oblique ligament, the pes anserinus (pes A), and tendons of the semimembranosus and medial gastrocnemius muscle. The sequences described were found to vary substantially between studies, and very few studies had systematically quantified the effect of each release on balance.

Conclusion

While medial release is the standard intraoperative mode of balancing, there is a lack of evidence to support current methods. The correct method for defining intraoperatively the sequence, extent and magnitude of releases required remains ill-defined. It could be argued that the classic extensive medial release may be unnecessary and may be associated with iatrogenic injury to the pes A and saphenous nerve, instability and abnormal knee kinematics. Minimal medial release may allow for improved soft tissue balancing leading ultimately to improved functional outcome.

Level of evidence

V (expert opinion).     

Progesterone suppresses the invasion and migration of breast cancer cells irrespective of their progesterone receptor status - a short report

Purpose

Pre-operative progesterone treatment of breast cancer has been shown to confer survival benefits to patients independent of their progesterone receptor (PR) status. The underlying mechanism and the question whether such an effect can also be observed in PR negative breast cancer cells remain to be resolved.

Methods

We performed proteome profiling of PR-positive and PR-negative breast cancer cells in response to progesterone using a phospho-kinase array platform. Western blotting was used to validate the results. Cell-based phenotypic assays were conducted using PR-positive and PR-negative breast cancer cells to assess the effect of progesterone.

Results

We found that progesterone induces de-phosphorylation of 12 out of 43 kinases tested, which are mostly involved in cellular invasion and migration regulation. Consistent with this observation, we found through cell-based phenotypic assays that progesterone inhibits the invasion and migration of breast cancer cells independent of their PR status.

Conclusion

Our results indicate that progesterone can inhibit breast cancer cell invasion and migration mediated by the de-phosphorylation of kinases. This inhibition appears to be independent of the PR status of the breast cancer cells. In a broader context, our study may provide a basis for an association between progesterone treatment and recurrence reduction in breast cancer patients, thereby providing a lead for modelling a randomized in vitro study.

     

Cholera outbreak secondary to contaminated pipe water in an urban area, West Bengal, India, 2006

Outbreaks of cholera are common in West Bengal. In April 2006, Garulia municipality reported a cluster of diarrhea cases. We investigated this cluster to identify the etiological agent, source of transmission and propose control measures. We defined a case of diarrhea as occurrence of ≥3 loose/watery stools a day among the residents of Garulia since April 2006. We searched for cases of diarrhea in health care facilities and health camp. We conducted a gender- and age-matched case-control study to identify risk factors. We inspected the sanitation and water supply system. We collected rectal swabs from diarrhea patients and water specimens from the affected areas for laboratory investigation. Two hundred and ninety-eight cases of diarrhea were reported to various health care facilities (attack rate: 3.5/1000, no deaths). The attack rate was highest among children (6.4/1000). Vibrio cholerae El Tor O1 Inaba was isolated from two of 7 rectal swabs. The outbreak started on 10 April 2006, peaked on 26 April and lasted till 6 May. Cases clustered in an area distal to leaking water pipelines. Drinking municipal water exclusively was significantly associated with the illness (OR 13, 95% CI=6.5-27). Eight of the 12 water specimens from the affected area had fecal contamination and poor chlorine content. This outbreak was due to a contaminated municipal piped water supply and V. cholera 01 Inaba was possibly the causative organism.