Severe erythroblastopenia and hemolytic anemia during a hepatitis A infection

A 41-year-old woman had acute hepatitis A infection complicated with severe anemia due to selective erythroblastopenia and hemolysis. A mechanism involving a cellular immune reaction is suggested. The hematological complications resolved during steroid treatment. She later developed a transient seropositive arthritis.     

Ptosis surgery: shortening the levator aponeurosis of Müller's muscle and the tarsus using an anterior approach

In cases of moderate congenital ptosis, better lid elevation can be achieved by resection of the levator muscle through a skin incision, combined with tarsectomy and shortening of the superior tarsal muscle. The function of the levator muscle can thus be fully exploited.     

High prevalence of Clostridium difficile diarrhoea during intensive chemotherapy for disseminated germ cell cancer.

A prospective, consecutive study of the aetiology of treatment-associated diarrhoea was conducted in 25 patients with disseminated germ cell cancer treated with intensive chemotherapy. Clostridium difficile was isolated in 45% of the diarrhoea episodes, which makes this species the most important bacterial pathogen in the development of clinically significant diarrhoea in this group of immunocompromised patients.     

Temporal disparity in pineal and retinal ontogeny

The development of photoreceptors and two putative neurotransmitter systems in the pineal organ and retina was studied during embryogenesis in the three-spined stickleback Gasterosteus aculeatus L. The investigation was performed by aid of immunocytochemistry using well characterized antisera to the retinal proteins alpha-transducin (TD alpha) and S-antigen (SA) (photoreceptor-markers), antisera against L-glutamic acid decarboxylase (GAD), gamma-aminobutyric acid (GABA), choline-O-acetyltransferase (ChAT) and with acetylcholinesterase (AChE) histochemistry (neurotransmitter-markers). It was possible to set up the following developmental time-table concerning the first appearance of positive immuno- and enzyme-reactive cells in the pineal organ and retina: I AChE-activity and TD alpha- and SA-immunoreactive cells in the pineal organ; II GAD- and GABA-immunoreactive cells in the pineal organ and retina; ChAT immunoreactivity and AChE activity in the retina; III hatching; IV SA-immunoreactive cells in the retina. The obtained results provide good evidence that while photoreceptor cells develop much earlier in the pineal organ than in the retina, neurons develop simultaneously in the pineal organ and retina.     

Survey of the effectiveness of masking noises during dental treatment--a pilot study.

OBJECTIVE: The aim of this study was to test the effectiveness of a newly developed system, using masking noises with specific frequencies and amplitudes, adjusted to typical noises experienced during dental treatment such as the high-speed hand-held drill. METHOD AND MATERIALS: In accordance with an analysis of typical noises experienced during dental treatment, masking noises with specific frequencies (frequency range 0.02 to 20 kHz) and amplitudes were created, with the aim of reducing the patients' awareness of typical treatment noises by overlaying frequencies. Two hundred fifty-four outpatients (113 males, 141 females) with a mean age of 32 years (+/- 10.5 years) were enrolled in this study. Patients were treated 15 minutes with and 15 minutes without the masking noise. Patients and practitioners filled out questionnaires aimed to evaluate the effectiveness of the system, sensitivity to noise (scale 0 to 10; 0 = effective, 10 = noneffective), psychologic aspects, and statements of fear. RESULTS: There was a significant reduction in patients' awareness of noise using this system during dental treatment. Most of the patients regarded the masking noise as a pleasureable supplementation to common treatment and would select this manner of dental treatment employing the device again (81.5%); 48.2% said they were more relaxed. The system does not, in principle, interfere with dental treatment, and in most instances, the device does not impede the communication between practitioners and patients. CONCLUSION: The present study demonstrates that using masking noises during dental treatment reduces the sensitivity to drill noise, reduces fear and stress, and may be useful in dental practice as an adjunct to common dental treatment.     

Congenital malformation of the feet with low body height

Among 75 members of a Danish family, 12 were found with a syndrome not previously described. Clinically, the syndrome consists of low body height and rigid flat feet, with weight-bearing pain in the feet. Radiologically, the deformation of the feet is a medial synostosis between the talus and the calcaneus combined with ankle joint dysplasia. The cause of the syndrome is most probably an autosomal dominant gene with complete penetrance. No linkage was found of the gene to 18 marker genes.     

Functional histology of the human thymus

Summary The thymus develops from a paired epithelial anlage in the neck. This review considers how ectoderm (vesicula cervicalis) and endoderm (third pharyngeal pouch) contribute to the epithelial stroma of the thymus. Stromal elements of mesodermal origin are capillaries, septae and perivascular spaces and single invading cells. These elements separate the thymus into pseudolobuli. The thymus epithelial space and the perivascular spaces are always separated from each other by a closed, flat epithelial cell layer, with a basal lamina which contributes to the blood-thymus barrier. From the 9th gestational week, prethymic precursor cells from hemopoietic centers, begin to invade the thymus anlage. There they finally mature to committed post-thymic T cells. The thymus microenvironment of postnatal thymus is composed of six different types of epithelial cells and several stromal cells of mesodermal origin. The location of these diverse stationary cells is described, and their functional significance is discussed. Obviously these stromal cell types have a special function in providing the proper environment for T-cell maturation. The function of the thymus includes the maturation and/or selection of antigen specific T-cells. The main issue of intra-thymic T-cell differentiation is the development and expression of T-cell-antigen receptors. The great diversity of these receptors is generated by a rearrangement of the T-cell-receptor-genes in order to furnish the host with a mature T-cell repertoire that is capable of recognizing the world of extrinsic antigens. In a synopsis the manyfold interrelationships between the thymus microenvironment and the developing thymocytes are summarised.Abbreviations BALT Bronchus Associated Lymphoid Tissue - CD Cluster of Differentiation - cCD3 cytoplasmic CD3 - mCD3 membranous CD3 - C.R. Crown Rump - GALT Gut Associated Lymphoid Tissue - HLA Human Leucocyte antigen - HLA-DR Gene product of the MHC-class II (this antigen is a surface molecule of numerous stationary and free cells of the immune system) - IDC Interdigitating Cell - IL1 Interleukin 1 (cytokine derived mainly from makrophages, but also from other cell types) - IL2 and IL4 Interleukin 2 and 4 (cytokines derived mainly from T-cell, but also from other cell types) - IL4R Interleukin 4-Receptor - Mab Monoclonal antibody - MHC Major Histocompatibility Complex - p.c. post conception - TCR T-Cell-Receptor - TNC Thymic Nurse Cell - TdT Terminal deoxynucleotidyl Transferase     

Prevalence of transmitted HIV-1 drug resistance and the role of resistance algorithms: data from seroconverters in the CASCADE collaboration from 1987 to 2003

OBJECTIVES: To examine factors influencing the rate of transmitted drug resistance (TDR) among seroconverters, with particular emphasis on 3 widely used genotypic drug resistance algorithms. METHODS: The study used data from CASCADE (Concerted Action on Seroconversion to AIDS and Death in Europe), a collaboration of seroconverter cohorts in Europe and Canada. Genotypic resistance data were derived within 18 months of the last seronegative test or date of laboratory evidence of acute infection and before the initiation of antiretroviral therapy. The Stanford algorithm was used to analyze each individual's nucleotide sequence. A multivariate logistic model was used to assess independent relationships between the presence of TDR and exposure category, sex, age at seroconversion, and year of seroconversion. The paper also describes 3 alternative definitions of resistance: the Stanford algorithm, the key resistance mutations defined by the International AIDS Society, and the Agence Nationale de Recherches sur le Sida (ANRS) algorithm. RESULTS: Forty-five of 438 patients (10.3%) seroconverting between 1987 and 2003 were infected with a drug-resistant HIV-1 variant. Forty patients (9.1%) showed resistance mutations to only 1 class of antiretroviral drugs, 2 (0.5%) to 2 classes, and 3 (0.7%) to 3 classes of antiretroviral therapy. It was suggested that individuals seroconverting later in calendar time were more likely to have TDR (relative risk 3.89 and 95% CI: 0.84 to 18.02, and relative risk 4.69 and 95% CI: 1.03 to 21.31, for 1996-1999 and 2000-2003, respectively, compared with pre-1996; P trend = 0.08). This trend was apparent regardless of the definition of TDR used. The total estimated proportion of individuals with TDR varied between 10.3% and 15.5% according to which definition was used. CONCLUSIONS: Evidence was found for the rise of TDR over time. A specific definition of what constitutes TDR rather than a simple list of mutations is needed.     

Improving COVID-19 Research of University Hospitals in Germany: Formative Usability Evaluation of the CODEX Feasibility Portal

Background  Within the German “Network University Medicine,” a portal is to be developed to enable researchers to query on novel coronavirus disease 2019 (COVID-19) data from university hospitals for assessing the feasibility of a clinical study. Objectives  The usability of a prototype for federated feasibility queries was evaluated to identify design strengths and weaknesses and derive improvement recommendations for further development. Methods  In the course of a remote usability test with the thinking-aloud method and posttask interviews, 15 clinical researchers evaluated the usability of a prototype of the Feasibility Portal. The identified usability problems were rated according to severity, and improvement recommendations were derived. Results  The design of the prototype was rated as simple, intuitive, and as usable with little effort. The usability test reported a total of 26 problems, 8 of these were rated as “critical.” Usability problems and revision recommendations focus primarily on improving the visual distinguishability of selected inclusion and exclusion criteria, enabling a flexible approach to criteria linking, and enhancing the free-text search. Conclusion  Improvement proposals were developed for these user problems which will guide further development and the adaptation of the portal to user needs. This is an important prerequisite for correct and efficient use in everyday clinical work in the future. Results can provide developers of similar systems with a good starting point for interface conceptualizations. The methodological approach/the developed test guideline can serve as a template for similar evaluations.