Rapid screening for bacteriuria in pregnancy

Summary We evaluated a bioluminescence assay as a screening test for the detection of bacteriuria in pregnancy. A total of 1,000 urine specimens from a randomly selected group of pregnant women undergoing prenatal surveillance was investigated. Sequential dilution of urine specimens on CLED agar plates served as a reference method. Set against the reference group, bioluminescence screening scored a 93% sensitivity, a 78% specificity and a 99% predictive accuracy for negative results. All urine specimens were also analysed chemically for the presence of nitrite and leucocyte esterase by dip sticks. Dip sticks proved to be insufficient because of poor sensitivities of 54% and 59%, respectively. The bioluminescence assay is an effective, time- as well as labor-saving but questionably cost-effective method for the detection of bacteriuria in pregnancy.

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Rascher Nachweis der Bakteriurie bei Schwangeren

Zusammenfassung In der vorliegenden Studie prüften wir die klinische Wertigkeit eines Biolumineszenz-Verfahrens zum Nachweis der Bakteriurie bei Schwangeren. Insgesamt wurden 1000 Routine-Harnproben von Schwangeren untersucht. Als Referenzmethode diente die sequentielle Verdünnung der Harnproben und Ausstreichen auf CLED-Agarplatten. Eine signifikante Bakteriurie konnte mit der Biolumineszenz-Methode mit einer Sensitivität von 93% und einer Spezifität von 78% erkannt werden. Die Voraussagewahrscheinlichkeit für negative Resultate war 99%. Gleichzeitig untersuchten wir alle Harnproben auf Vorhandensein von Nitrit und Leukozyten-Esterase mittels Teststreifen. Die Sensitivitäten lagen nur bei 54% bzw. 59%. Mit Hilfe der Biolumineszenz-Methode kann eine signifikante Bakteriurie bei Schwangeren rasch, verläßlich, aber nur bei relevanter Probenanzahl auch kostengünstig nachgewiesen werden.

     

Impact of obesity treatment on gastroesophageal reflux disease

Gastroesophageal reflux disease(GERD) is a frequently encountered disorder. Obesity is an important risk factor for GERD, and there are several pathophysiologic mechanisms linking the two conditions. For obese patients with GERD, much of the treatment effort is focused on weight loss and its consistent benefit to symptoms, while there is a relative lack of evidence regarding outcomes after novel or even standard medical therapy is offered to this population. Physicians are hesitant to recommend operative anti-reflux therapy to obese patients due to the potentially higher risks and decreased efficacy, and these patients instead are often considered for bariatric surgery. Bariatric surgical approaches are broadening, and each technique has emerging evidence regarding its effect on both the risk and outcome of GERD. Furthermore, combined antireflux and bariatric options are now being offered to obese patients with GERD. However, currently Rouxen-Y gastric bypass remains the most effective surgical treatment option in this population, due to its consistent benefits in both weight loss and GERD itself. This article aims to review the impact of both conservative and aggressive approaches of obesity treatment on GERD.     

The risk of lymph node metastasis in colorectal polyps with invasive adenocarcinoma

One hundred fifty-one patients with colorectal polyps containing invasive adenocarcinoma treated by resection were studied to determine the incidence of lymph node metastasis and whether lymph node metastasis was related to the depth of invasion. Other variables evaluated included size and configuration of the polyp, grade of adenocarcinoma, presence or absence of lymphovascular invasion, and degree of differentiation. In patients with sessile polyps, the incidence of lymph node metastasis was 10 percent. Eighty percent of these lesions had lymphovascular invasion. For pedunculated polyps, the overall incidence of lymph node metastasis was 6 percent. However, there was no incidence of lymph node metastasis when the depth of invasion was limited to the head, neck, and stalk of the polyp (Levels 1, 2, and 3). Only when the depth of invasion reached to the base of the stalk (Level 4) was the risk of lymph node metastasis high (27 percent). The other risk factors were not associated with lymph node metastasis. We concluded that the most significant risk factor for lymph node metastasis in patients with invasive carcinoma in a polyp was invasion into the submucosa of the bowel wall (Level 4).Presented in part at the Tripartite Meeting, Birmingham, United Kingdom, June 19–21, 1989.     

Regenerative Potential of Human Schneiderian Membrane: Progenitor Cells and Epithelial‐Mesenchymal Transition

An innate osteogenic potential of the Schneiderian membrane (SM) is progressively assessed in studies ranging from non‐human species to human subjects. It has relevance for endosteal placement and osseointegration. Nestin‐expressing osteogenic progenitor cells are allegedly involved in bone formation and remodelling. Nestin phenotype was not assessed previously in human SM. We therefore aimed to fill that particular gap in the literature. Bioptic samples of human adult SM were obtained during surgery from eight adult patients, operated for non‐malignant pathologies. Immunohistochemistry on paraffin‐embedded tissue samples used primary antibodies against nestin, CD45, CD146, cytokeratin 7 (CK7), and alpha‐smooth muscle actin (α‐SMA). Nestin expression was consistently found in endothelial cells, and was scarcely encountered in pericytes, putative stromal stem/progenitor cells, as well as in glandular epithelial cells. Moreover, woven bone formation in the periosteal layer of the SM can also be regarded as evidence of the osteogenic potential of this membrane. Nestin and CD45 expression in cells of the primary bone supports the osteogenic potential of SM nestin‐expressing cells and a possible involvement of hematopoietic stem cells in maxillary sinus floor remodeling. CD146, a known inducer of epithelial‐mesenchymal transition (EMT), was expressed in epithelia, as was CK7. Isolated stromal cells were found expressing CD146, CK7 and α‐SMA, suggesting that regenerative processes happening in the SM may also involve processes of EMT which generate stem/progenitor cells. This study provides additional evidence for the regenerative potential of the Schneiderian membrane and identifies potential roles for cells of its stem niche in osteogenesis. Anat Rec, 298:2132–2140, 2015. © 2015 Wiley Periodicals, Inc.     

Overview of Surgical Scar Prevention and Management

Management of incisional scar is intimately connected to stages of wound healing. The management of an elective surgery patient begins with a thorough informed consent process in which the patient is made aware of personal and clinical circumstances that cannot be modified, such as age, ethnicity, and previous history of hypertrophic scars. In scar prevention, the single most important modifiable factor is wound tension during the proliferative and remodeling phases, and this is determined by the choice of incision design. Traditional incisions most often follow relaxed skin tension lines, but no such lines exist in high surface tension areas. If such incisions are unavoidable, the patient must be informed of this ahead of time. The management of a surgical incision does not end when the sutures are removed. Surgical scar care should be continued for one year. Patient participation is paramount in obtaining the optimal outcome. Postoperative visits should screen for signs of scar hypertrophy and has a dual purpose of continued patient education and reinforcement of proper care. Early intervention is a key to control hyperplastic response. Hypertrophic scars that do not improve by 6 months are keloids and should be managed aggressively with intralesional steroid injections and alternate modalities.

Graphical Abstract

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Predictive energy landscapes for protein–protein association

We investigate protein–protein association using the associative-memory, water-mediated, structure, and energy model (AWSEM), a coarse-grained protein folding model that has been optimized using energy-landscape theory. The potential was originally parameterized by enforcing a funneled nature for a database of dimeric interfaces but was later further optimized to create funneled folding landscapes for individual monomeric proteins. The ability of the model to predict interfaces was not tested previously. The present results show that simulated annealing of the model indeed is able to predict successfully the native interfaces of eight homodimers and four heterodimers, thus amounting to a flexible docking algorithm. We go on to address the relative importance of monomer geometry, flexibility, and nonnative intermonomeric contacts in the association process for the homodimers. Monomer surface geometry is found to be important in determining the binding interface, but it is insufficient. Using a uniform binding potential rather than the water-mediated potential results in sampling of misbound structures that are geometrically preferred but are nonetheless energetically disfavored by AWSEM, as well as in nature. Depending on the stability of the unbound monomers, nonnative contacts play different roles in the association process. For unstable monomers, thermodynamic states stabilized by nonnative interactions correspond to productive, on-pathway intermediates and can, therefore, catalyze binding through a fly-casting mechanism. For stable monomers, in contrast, states stabilized by nonnative interactions generally correspond to traps that impede binding.     

The effect of video-guidance on passive movement in patients with cerebral palsy: fMRI study

In patients with cerebral palsy (CP), neuroimaging studies have demonstrated that passive movement and action–observation tasks have in common to share neuronal activation in all or part of areas involved in motor system. Action observation with simultaneous congruent passive movements may have additional effects in the recruitment of brain motor areas. The aim of this functional magnetic resonance imaging (fMRI) study was to examine brain activation in patients with unilateral CP during passive movement with and without simultaneous observation of simple hand movement. Eighteen patients with unilateral CP (fourteen male, mean age 14 years and 2 months) participated in the study. Using fMRI block design, brain activation following passive simple opening–closing hand movement of either the paretic or nonparetic hand with and without simultaneous observation of a similar movement performed by either the left or right hand of an actor was compared. Passive movement of the paretic hand performed simultaneously to the observation of congruent movement activated more “higher motor areas” including contralesional pre-supplementary motor area, superior frontal gyrus (extending to premotor cortex), and superior and inferior parietal regions than nonvideo-guided passive movement of the paretic hand. Passive movement of the paretic hand recruited more ipsilesional sensorimotor areas compared to passive movement of the nonparetic hand. Our study showed that the combination of observation of congruent hand movement simultaneously to passive movement of the paretic hand recruits more motor areas, giving neuronal substrate to propose video-guided passive movement of paretic hand in CP rehabilitation.     

Dissociating anticipation from perception: Acute pain activates default mode network

Few studies have explored the effect of acute pain on attentional networks and on the default mode network. Moreover, these studies convey conflicting results, seemingly caused by design. To reassess this issue, we studied 20 healthy subjects with functional magnetic resonance imaging while delivering painful electric shocks. The design was purposely constructed to separate rest, anticipation, and pain perception. We found that default mode network activity in response to pain was biphasic. It deactivated during anticipation when the dorsal attentional network was activated. During pain perception, the default mode network was activated, as were attentional networks. The left posterior fusiform gyrus showed the same dynamics as the default mode network, and its activity was negatively correlated to the subject's pain intensity rating. The associative pregenual anterior cingulate cortex seemed to play a key role in these coactivations. These results concur with data from the literature showing that enhanced pain perception results in greater default mode network activity and that the anticorrelation between the default mode network and the dorsal attentional network disappears in chronic pain patients. Hum Brain Mapp 34:2228–2243, 2013. © 2012 Wiley Periodicals, Inc.