Diagnostic Accuracy of Cervical Low-Grade Squamous Intraepithelial Lesions Is Improved With MIB-1 Immunostaining.

There is considerable interobserver variation in the diagnosis of low-grade squamous intraepithelial lesion that involves mature squamous epithelium. Our aim was to evaluate the utility of MIB-1 immunostaining as an adjunct test to increase diagnostic accuracy. Consecutive cervical biopsies originally diagnosed as normal (n = 26) or low-grade squamous intraepithelial lesion (n = 23) were reviewed by three pathologists to obtain a consensus diagnosis. MIB-1 immunostaining was performed, and positive staining was defined as a cluster of at least two stained nuclei in the upper two thirds of the epithelial thickness. Human papillomavirus (HPV) DNA detection was performed using a polymerase chain reaction assay. All cases were subsequently reclassified as low-grade squamous intraepithelial lesion (LSIL) or normal (NL) when two or three of three gold standard criteria were satisfied (LSIL gold standard criteria = consensus diagnosis of LSIL, HPV+, MIB-1+; NL gold standard criteria = consensus diagnosis of NL, HPV-, MIB-1-). Using the gold standard diagnoses, we have identified that 14 normal cases (36%) were originally overdiagnosed as LSIL, and one LSIL case (10%) was originally underdiagnosed as normal. All MIB-1-positive cases were HPV+ and identified as LSIL in the consensus review. All MIB-1-negative cases were NL by gold standard criteria. The sensitivity (1.0) and the specificity (1.0) of MIB-1 staining for identifying LSIL were superior to the sensitivity (0.9) and the specificity (0.8) of HPV testing. In conclusion, MIB-1 is a highly sensitive and specific marker for identifying low-grade squamous intraepithelial lesion and is helpful in verifying the diagnosis of equivocal cases.     

Reverse redistribution: fact or fiction?

It has been well documented that it is not uncommon for a thallium-201 perfusion defect to develop or become more evident on delayed exercise thallium scintigraphic imaging, as compared with the initial image immediately following stress. The pathophysiology and clinical significance of the phenomenon are currently unclear. Literature on this subject is reviewed, and it is concluded that reverse redistribution of ²⁰¹Tl in the post-myocardial infarction patient is indeed a fact. In this context it represents a low-risk condition and may imply successful thrombolysis, patent infarct-related coronary artery, improved wall motion at the infarct site and retained myocardial viability in that segment. Correspondence to: A. Labiri     

Współwystępowanie dwóch rzadkich chorób genetycznych: fenyloketonurii oraz zespołu Pradera i Williego. Opis przypadku

Phenylketonuria (PKU) is an autosomal recessive metabolic disease caused by an error of phenylalanine metabolism. Delayed treatment or treatment performed unsystematically might lead to neurological disorders and progressive intellectual disability. In the Prader-Willi syndrome (PWS) clinical manifestations change with age. Feeding difficulties resulting from the poor suck and hypotonia are typical in the neonatal period and early infancy. As patients grow their activities increase, muscle tone improves, the extreme hyperphagia appears – the main cause of obesity. Mental development of patients is usually mildly retarded. We report the case of a patient affected by two genetic diseases: PKU and PWS. Variety of clinical symptoms and abnormal results of laboratory analyses make the correct diagnosis difficult. Elevated phenylalanine level in screening newborn test, disorders of muscle tone, poor suck, and low urine biopterin concentration did not allow to clearly rule out the hyperphenylalaninemia caused by a tetrahydrobiopterin deficiency (BH₄). Data from obstetric anamnesis and the early postnatal clinical findings suggested the PWS. Hyperphagia and the increased risk of carbohydrates tolerance disorders in patients with PWS make it very difficult to balance properly the low-phenylanine diet necessary in PKU treatment. The patient presented by us needs well-coordinated multidisciplinary medical care which aims to provide proper physical development and to support the boy's mental potential as well as appropriate functioning in the society.     

Add-on treatment with nebulized hypertonic saline in a child with plastic bronchitis after the Glenn procedure,

Plastic bronchitis (PB), although a rare cause of airway obstruction, has mortality rates up to 50% in children after Fontan-type cardiac surgery. We present the case of an 18-month-old female patient with PB following pneumonia. At 6 months of age, the patient underwent the Glenn procedure due to functionally univentricular heart. Fiberoptic bronchoscopy revealed complete blockage of the left bronchus by mucoid casts. Pharmacotherapy consisted of glucocorticosteroids, azithromycin, and enalapril maleate. The child also received nebulized 3% NaCl solution, which proved to be beneficial. In children submitted to Fontan-type procedures, physicians must be alert for PB, which can be triggered by respiratory tract infection.     

Forgiveness and gratitude trajectories among persons undergoing alcohol addiction therapy

Background: The first studies concerning changes in moral virtues during alcohol addiction therapy were published during the last decade. However, as all of these studies applied a variable-oriented approach, it is impossible to capture differences between starting points and changes in variables of interest. 

Method: In this study, we employed a person-oriented approach to identify trajectories of change in two moral virtues—forgiveness and gratitude—during alcohol addiction treatment. The sample consisted of 358 alcohol-dependent individuals who were receiving outpatient therapy. Measurements were taken (1) at the beginning of the basic treatment, (2) after its completion (5–7?weeks from baseline), and (3) about six months later. Three forgiveness scales and the Gratitude Questionnaire (GQ-6) were used to assess the patients’ moral virtues. 

Results: Latent class growth analysis (LCGA) revealed four trajectories for self-forgiveness and gratitude, and three trajectories for forgiveness of others and feeling forgiven by God. For patients with a low baseline level of moral virtues, the changes varied depending on the kind of moral virtue. Patients with a relatively high initial level of moral virtues maintained that level in subsequent measurements. Significant correlates of trajectory class membership were gender, education, age, religiosity, diagnosis of coexisting psychiatric disorders, and frequency of attending Alcoholics Anonymous (AA) meetings. 

Conclusions: This study highlights the clinical importance of considering differences at the baseline level and in changes of forgiveness and gratitude, as well as personal and alcohol-related correlates of trajectory group membership among people who participate in alcohol addiction therapy.     

Sorption of pharmaceuticals and personal care products (PPCPs) onto a sustainable cotton based adsorbent

The significant rise in contamination of wastewater, water and ground water or sediments with PPCPs is a clear evidence that nowadays applied treatment methods are inefficient in removal of these contaminants. In this study a novel cotton based adsorbent is used for efficient sorption of naproxen (NAP), caffeine (CAF) and triclosan (TCS). The adsorption of tested contaminants differed significantly: the highest amount of PPCPs sorbed was noted for TCS sorption onto CMT9 137 mg g^?1, whereas the lowest adsorbed amount, 19.73 mg g^?1, was observed for NAP sorption onto CMT13. The presence of co-solute affected both the mechanism of sorption and the amount of PPCPs sorbed: in the presence of TCS the sorption of NAP was changed from chemical to physical. Similarly, in the presence of TCS the mechanism of NAP sorption onto CMT13 changed from chemisorption to diffusion inside the pores. The presence of CAF definitely increased NAP sorption and partitioning. The presence of TCS increased CAF sorption, whereas the presence of NAP in the solution increased CAF sorption only onto CMT11. The NAP sorption in the presence of CAF was significantly enhanced and data confirmed that diffusion through the pores is the most often observed mechanism of selected PPCPs sorption onto CMTs. It is believed that the synthesized cotton-based adsorbents offer a unique opportunity for the sustainable PPCP removal from wastewater.