Antiatherogenic effect of Pistacia lentiscus via GSH restoration and downregulation of CD36 mRNA expression

Pistacia lentiscus var. Chia (Anacardiaceae) grows almost exclusively on Chios Island, Greece, and gives a resinous exudate resin used for culinary purposes by Mediterranean people. We investigated the molecular mechanisms through which total polar extract of the resin inhibits oxidized low-density lipoprotein (oxLDL) cytotoxic effect on peripheral blood mononuclear cell (PBMC). Cells exposed to oxLDL underwent apoptosis and necrosis, dependent on the duration of exposure. When culturing cells with oxLDL and the polar extract concurrently, we observed inhibition of both the phenomena. Because under oxidative stress the pro-oxidant systems outbalance the antioxidant, potentially producing oxidative damage and ultimately leading to cell death, we measured the levels of intracellular antioxidant glutathione (GSH). Additionally, we measured CD36 expression, a class B scavenger receptor, on CD14-positive cells, as CD36 has been identified as the oxLDL receptor in macrophages and may play a pivotal role in atherosclerotic foam cell formation. oxLDL decreased GSH levels and upregulated CD36 expression. P. lentiscus extract restored GSH levels and downregulated CD36 expression, even at the mRNA level. In order to find out the biologically drastic constituents of the resin's polar extract, fractions derived from RP-HPLC analysis were examined for their antioxidant effect on oxidatively stressed PBMC. The triterpenoid fraction revealed remarkable increase in intracellular GSH. We suggest GSH restoration and downregulation of CD36 mRNA expression as the pathways via which P. lentiscus triterpenes exert antioxidant/antiatherogenic effect. Additionally, our results provide strong evidence of the resin's antiatherogenic effect; therefore it is credited with beneficial health aspects.     

Congenital bronchopulmonary sequestration presenting as a thoracic tumor: a case report

The accurate diagnosis of fetal thoracic tumors still remains unclear despite the progress in imaging technology. The differential diagnosis between tumors and congenital anomalies of the fetus respiratory system, largely depends on the diagnostic approaches involved. We report a case of a 25-year-old woman, gravida 3 para 0, who was seen at the 23rd gestational week for routine obstetric examination. The ultrasound scan detected a lung mass, occupying the whole left hemithorax with a significant shifting of the mediastinum exhibiting features compatible with cystic adenomatoid malformation (CAM). No other congenital anomalies were noted. Color Doppler ultrasound failed to detect any blood supply to the mass. Amniocentesis disclosed a normal male karyotype. Pregnancy termination was performed according to the parents' request, with the use of misoprostol and a 500 g dead fetus was delivered. The autopsy followed by detailed histological examination, disclosed the diagnosis of pulmonary sequestration. It is important to emphasize that the initial impression concerning the sonographic appearance and the size of the mass is not always in accordance with the diagnosis of the lesion and the outcome of the pregnancy. These data suggest that in cases of fetal pulmonary tumors, a thorough and comprehensive combination of imaging approaches should be employed followed by a pathologic examination of the congenital anomaly in order to establish a definitive diagnosis.     

Eagle syndrome presenting with external carotid artery pseudoaneurysm

Eagle syndrome refers to a clinical syndrome caused by the abnormal elongation of the styloid process with calcification/ossification of the stylohyoid ligament. We present the first reported case of Eagle syndrome resulting in an external carotid artery (ECA) pseudoaneurysm. A patient presented to emergency room with an expanding, painful right-neck mass. CT angiography with three-dimensional volume rendering showed a bilobed 4.0-cm right ECA pseudoaneurysm and bilateral ossification of the stylohyoid ligaments with a sharpened edge of the right styloid process at the level of the carotid artery. Aneurysmectomy was performed, and a common carotid to internal carotid bypass with reversed saphenous vein restored arterial continuity. Local resection of the styloid process with a rotational sternocleidomastoid flap was performed. The pathology report was consistent with a diagnosis of a pseudoaneurysm. A six-month clinical follow-up confirmed the complete resolution of symptoms with no neurological deficits.     

Significance of hypocarbia in the development of periventricular leukomalacia in preterm infants

BACKGROUND: Despite rapid advances in the management of preterm infants, periventricular leukomalacia (PVL) remains a considerable problem in neonatal intensive care. The aim of this study was to determine whether hypocarbia is associated with the development of PVL in mechanically ventilated, preterm infants and to emphasize the importance of avoiding this disturbance. METHODS: The authors evaluated 52 mechanically ventilated infants with a gestational age of <34 weeks, who exhibited hypocarbia in the first three postnatal days (lowest carbon dioxide tension being <25 mmHg). These infants were then compared with 52 infants in a control group not exhibiting hypocarbia, matched for birthweight and gestational age. A diagnosis of PVL was made on the basis of the results of cranial ultrasonography. Confounding factors potentially associated with the development of PVL were controlled in logistic regression analyses. RESULTS: Of the 52 mechanically ventilated preterm infants with hypocarbia, 10 (19.2%) developed cystic PVL, and six (11.5%) developed periventricular echodensity. Of the 52 infants in the control group only two (3.8%) developed cystic PVL, and one (1.9%) infant developed periventricular echodensity. The authors observed no significant differences in other prenatal and perinatal risk factors between the two groups. CONCLUSION: Hypocarbia in mechanically ventilated preterm infants during the first days of life is suggested as being an independent predictor of PVL, predisposing these infants to subsequent neurodevelopmental delay.     

Perinatal outcome of twin pregnancies after in vitro fertilization

BACKGROUND: There are conflicting data concerning perinatal outcome of twin, in vitro fertilization (IVF) pregnancies. The aim of this study was to evaluate and compare perinatal and neonatal outcomes in twin IVF pregnancies to those of spontaneously conceived twin gestations. METHODS: The medical files of 73 IVF and 148 naturally conceived twin pregnancies were studied retrospectively. Data concerning maternal characteristics, obstetric complications, and neonatal outcome were recorded and compared by chi2 test. The one-way analysis of variance (anova) was used to compare the means of groups. RESULTS: Mean maternal age, the proportion of nulliparous women, and the incidence of premature rupture of membranes, cesarean section, and premature delivery were significantly higher in the study group. The mean birthweight was significantly lower, the frequency of admission to the intensive care unit and the duration of hospitalization were significantly higher in the study group. The incidence of intraventricular hemorrhage was significantly higher in the IVF group. The number of perinatal deaths was similar. CONCLUSION: IVF twin pregnancies are at greater risk for obstetric complications and adverse neonatal outcome in comparison with naturally conceived twin gestations.     

Reshaping Radiology Precall Preparation: Integrating a Cloud-Based PACS Viewer Into a Flipped Classroom Model

Preparing residents for the on-call experience in Radiology is one of the most important aspects of education within a training program. Traditionally, this preparation has occurred via a combination of case conferences and didactic lectures by program faculty, daily teaching at the workstation, and precall assessments. Recently, a blended curricular model referred to as the flipped classroom has generated a lot of attention within the realm of graduate medical education. We applied this technique to resident precall education in the subspecialty of Neuroradiology, and surveyed the participants about their perceptions of the course. The structure, implementation, and web-based platform used to create the flipped classroom experience is described herein.     

Gestational diabetes exhibits lack of carnitine deficiency despite relatively low carnitine levels and alterations in ketogenesis.

OBJECTIVE: Previous studies have underlined the importance of the carnitine shuttle system and its dysfunction both in normal pregnancy and in type 1 and 2 diabetes. The objective of this paper was to delineate more systematically the role of the carnitine shuttle system in normal pregnancy and in gestational diabetes. METHODS: A total of 119 women matched for age comprised three groups: 40 normal adult non-pregnant women (NNP), 46 normal pregnant women with uncomplicated pregnancy (NP) and 33 women with gestational diabetes (GDM). The latter group was further subdivided into those being managed either by diet alone (25 women, GDM-D) or by insulin (8 women,GDM-I). The following biochemical parameters were assayed: fasting plasma total, free and acyl-carnitine, FFA and beta-OH-butyrate, together with several essential anthropometric parameters. RESULTS: Women with GDM, in contrast to the control groups, displayed the biochemical features characteristic of insulin resistance: higher body weight, higher BMI, higher skinfold and higher HbAlc levels. No differences on any parameters were found between the two GDM subgroups. Both NP and GDM groups had low levels of total carnitine compared to NNP control group, but surprisingly, the GDM group did not exhibit any further decrease of carnitine levels, as would have been expected by the combination of pregnancy and diabetes. Both groups, despite these low carnitine levels, had no clinical symptoms of carnitine deficiency. Furthermore, the GDM group displayed higher levels of FFA and beta-hydroxybutyrate, which were statistically significant compared to the other two control groups. CONCLUSIONS: The data corroborate the negative effect of normal gestation on the carnitine shuttle system, while they document for the first time that GDM does not further affect the efficiency of the carnitine system. The mild effect of GDMon carnitine status could be explained by the concurrent increased gluconeogenesis, a process which does not affect directly carnitine metabolism.     

Transverse myelitis associated with herpes simplex virus infection.

The case of an otherwise healthy 6-year-old boy with symptoms and signs of acute transverse myelitis is presented. The diagnosis was confirmed by magnetic resonance imaging. An episode of gingivostomatitis had preceded, and serology indicated herpes simplex virus type 1 infection. The child recovered gradually, and no relapses were noted during a 30-month follow-up period.