Perforation of cavum septi pellucidi in open spina bifida and need for hydrocephalus treatment by 1 year of age

OBJECTIVE

In-utero repair of an open neural tube defect (ONTD) reduces the risk of developing severe hydrocephalus postnatally. Perforation of the cavum septi pellucidi (CSP) may reflect increased intraventricular pressure in the fetal brain. We sought to evaluate the association of perforated CSP visualized on fetal imaging before and/or after in-utero ONTD repair with the eventual need for hydrocephalus treatment by 1 year of age.

METHODS

This was a retrospective cohort study of consecutive patients who underwent laparotomy-assisted fetoscopic ONTD repair between 2014 and 2021 at a single center. Eligibility criteria for surgery were based on those of the Management of Myelomeningocele Study (MOMS), although a maternal prepregnancy body mass index of up to 40 kg/m2 was allowed. Fetal brain imaging was performed with ultrasound and magnetic resonance imaging (MRI) at referral and 6 weeks postoperatively. Stored ultrasound and MRI scans were reviewed retrospectively to assess CSP integrity. Medical records were reviewed to determine whether hydrocephalus treatment was needed within 1 year of age. Parametric and non-parametric tests were used as appropriate to compare outcomes between cases with perforated CSP and those with intact CSP as determined on ultrasound at referral. Logistic regression analysis was performed to assess the predictive performance of various imaging markers for the need for hydrocephalus treatment.

RESULTS

A total of 110 patients were included. Perforated CSP was identified in 20.6% and 22.6% of cases on preoperative ultrasound and MRI, respectively, and in 26.6% and 24.2% on postoperative ultrasound and MRI, respectively. Ventricular size increased between referral and after surgery (median, 11.00 (range, 5.89-21.45) mm vs 16.00 (range, 7.00-43.5) mm; P < 0.01), as did the proportion of cases with severe ventriculomegaly (ventricular width ≥ 15 mm) (12.7% vs 57.8%; P < 0.01). Complete CSP evaluation was achieved on preoperative ultrasound in 107 cases, of which 22 had a perforated CSP and 85 had an intact CSP. The perforated-CSP group presented with larger ventricles (mean, 14.32 ± 3.45 mm vs 10.37 ± 2.37 mm; P < 0.01) and a higher rate of severe ventriculomegaly (40.9% vs 5.9%; P < 0.01) compared to those with an intact CSP. The same trends were observed at 6 weeks postoperatively for mean ventricular size (median, 21.0 (range, 13.0-43.5) mm vs 14.3 (range, 7.0-29.0) mm; P < 0.01) and severe ventriculomegaly (95.0% vs 46.8%; P < 0.01). Cases with a perforated CSP at referral had a lower rate of hindbrain herniation (HBH) reversal postoperatively (65.0% vs 88.6%; P = 0.01) and were more likely to require treatment for hydrocephalus (89.5% vs 22.7%; P < 0.01). The strongest predictor of the need for hydrocephalus treatment within 1 year of age was lack of HBH reversal on MRI (odds ratio (OR), 36.20 (95% CI, 5.96-219.12); P < 0.01) followed by perforated CSP on ultrasound at referral (OR, 23.40 (95% CI, 5.42-100.98); P < 0.01) and by perforated CSP at 6-week postoperative ultrasound (OR, 19.48 (95% CI, 5.68-66.68); P < 0.01).

CONCLUSIONS

The detection of a perforated CSP in fetuses with ONTD can reliably identify those cases at highest risk for needing hydrocephalus treatment by 1 year of age. Evaluation of this brain structure can improve counseling of families considering fetal surgery for ONTD, in order to set appropriate expectations about postnatal outcome. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.

Impacting on factors promoting intra-group aggression in secure psychiatric settings

Three preliminary and linked studies investigate the impact of making alterations to factors considered relevant to engaging in and experiencing intra-group aggression (bullying) among adult male patients detained in a single secure forensic hospital. Study one (n = 44) outlines the institutional factors, attitudes towards bullying and environmental factors that increase the likelihood of engaging in bullying and/or being victimised. Study two (n = 53 patients and 167 staff) assesses the effect of three variations of intervention that aimed to reduce intra-group aggression through direct alteration of the physical and psychosocial environment, using data from both patients and staff. Study three (n = 414) looks at the effects of two variations of the intervention used in study two, which offered patients’ participation in individual and communal activities. It was predicted that changes to the physical and social environment would produce a reduction in the factors shown to predict intra-group aggression. Attitudes supportive of bullying and the presence of social hierarchies each increased the likelihood of engaging in bullying. Indirect changes to the social environment on the wards had more positive effects than those incorporating direct alterations to the physical and social environment. The differences in effectiveness of the two approaches are discussed in relation to the established predictors of intra-group aggression. The research concludes by noting the preliminary nature of the research and outlining potential directions for future research and intervention.

Analysis of 161Tb by radiochemical separation and liquid scintillation counting

The determination of ¹⁶¹Tb activity is problematic due to its very low fission yield, short half-life, and the complication of its gamma spectrum. At AWE, radiochemically purified ¹⁶¹Tb solution was measured on a PerkinElmer 1220 Quantulus^TM Liquid Scintillation Spectrometer. Since there was no ¹⁶¹Tb certified standard solution available commercially, the counting efficiency was determined by the CIEMAT/NIST Efficiency Tracing method. The method was validated during a recent inter-laboratory comparison exercise involving the analysis of a uranium sample irradiated with thermal neutrons. The measured ¹⁶¹Tb result was in excellent agreement with the result using gamma spectrometry and the result obtained by Pacific Northwest National Laboratory.

Creatine supplementation patterns and perceived effects in select division I collegiate athletes

OBJECTIVE

To describe patterns of creatine use in select Division I collegiate athletes based on recommended dosages according to body weight. Further, to report the perceived effects noted with creatine supplementation.

DESIGN

Anonymous open-ended self-report descriptive questionnaire.

SETTING

National Collegiate Athletic Association Division I institution.

PARTICIPANTS

Two-hundred and nineteen male and female collegiate athletes representing eight varsity sports.

MAIN OUTCOME MEASURE(S)

An open-ended questionnaire was administered to determine patterns of creatine use during the loading and maintenance phases of this nutritional supplement. In addition, perceived positive, negative, and no effects associated with creatine usage patterns were determined from athlete responses on this self-report measure.

RESULTS

Considering this select group of collegiate athletes, highly variable patterns of creatine supplementation were noted for loading/maintenance phases based on recommended dosages/days and body weight. Of the 219 athletes surveyed, 90 (41%) reported using creatine, while creatine supplementation was more prevalent among men than women. Creatine users (80 athletes, 89%) reporting perceived positive effects were primarily at or below recommended dosages for the loading phase but above recommended dosages in the maintenance phase. Creatine users (34 athletes, 38%) reporting perceived negative effects were primarily at or below recommended dosages in the loading phase but noticeably above recommended dosages in the maintenance phase. Ironically, all creatine users who reported negative side effects also reported positive effects. Creatine users (10 athletes, 11%) reporting no effects were below recommended loading dosages but above recommended maintenance dosages.

CONCLUSIONS

The perceived positive effects noted support current research (strength/weight gains), while the perceived negative effects (cramping/gastrointestinal distress) were consistent with anecdotal reports surrounding creatine supplementation. Apparently, collegiate athletes in this study are in need of education regarding the proper use of creatine supplementation. Additional studies are needed to ascertain creatine supplementation patterns of collegiate athletes in various settings.

Seasonal variations and maturity stages in relation to differences in serum levels of gonadal steroids, vitellogenin, and thyroid hormones in the common dentex (Dentex dentex)

Seasonal variations in serum concentrations of 17beta-estradiol (E(2)), vitellogenin (Vg), testosterone (T), 11 ketotestosterone (11-KT), and thyroid hormones (T(4), l-thyroxine; and T(3), 3,5, 3'-triiodo-l-thyronine) were investigated during the first, second, and third reproductive cycles in intensively reared populations of common dentex, Dentex dentex, and correlated with gonadal development and spawning. In females, there were baseline E(2) values (<0.10 ng/ml) and negligible Vg concentrations during the postspawning and pregametogenesis period (June to December), and these increased thereafter to peak during the spawning period. Maximum T(3) and T(4) serum concentrations were found around spawning. There was a positive correlation during vitellogenesis and final maturation between Vg and T(3) (r(2) = 0.366). In addition, Vg and T(3) concentrations were statistically higher in the stages of vitellogenesis and final maturation than at the other stages (P<0.001). Minimum T(3) and T(4) concentrations (October) coincided with the decrease in water temperature and the associated decrease in the daily feeding rate and the specific growth rate. In males, as in females, seasonal changes in serum levels of T and 11-KT were well correlated with gonadal development. The presence of males in the stage of completed spermiogenesis in December coincided with the surge in both androgens and this increase lasted until the end of the spawning period. There were no significant differences in serum T(3) and T(4) levels among the maturity stages. The observed seasonal changes in serum gonadal steroids and Vg reflected the pattern of oocyte development and the spawning behavior of common dentex and were typical of the patterns described in most multiple spawners studied to date. Thyroid hormones may enhance early ovarian development and stimulate vitellogenesis in female dentex.

The effect of photoperiod on diel rhythms in serum melatonin, cortisol, glucose, and electrolytes in the common dentex, Dentex dentex

Diel rhythms in serum concentrations of melatonin, cortisol, glucose, sodium, chloride, and potassium were studied in the common dentex, Dentex dentex, under different photoperiods (DD, 8L:16D, 12L:12D, 16L:8D). Photoperiod affected both the diel rhythms and the absolute values of the estimated blood components. Regardless of the photoperiod, melatonin titers were elevated during the scotophase (384.3 +/- 13.9 pg/ml) compared with a mean baseline level of 54.4 +/- 2.7 pg/ml during the photophase. Serum melatonin concentrations reflected the prevailing photoperiod and constantly elevated melatonin levels with no diel rhythmicity were evident in fish held in the DD protocol. A circadian-like pattern in serum cortisol was observed in fish that were kept at the DD and 8L:16D protocols with cortisol peak at 18:00 h in the night. Fish exposed to the 16L:8D regime showed highest cortisol levels at 10:00 h, while no rhythmicity was evident under the 12L:12D protocol. A phase shift of 4 h between the peaks of cortisol and glucose was evident in fish exposed to the DD, 8L:16D, and 12L:12D regimes. Diel patterns of changes in serum Na+ and Cl- were observed only in the fish held in the DD protocol. Serum K+ values were lowest during the first part of the scotophase under all regimes, except the 16L:8D where no diel rhythmicity was detected. During the photophase, cortisol was positively correlated with glucose, Na+, and Cl- and negatively with K+. During the scotophase, melatonin was positively correlated with glucose and electrolytes. Results indicated that cortisol may be responsible for the observed rhythmicity of glucose and that melatonin may play a role in glucose and ion regulation in common dentex.

Radiographic evaluation of the soap man mummy

This article describes how mobile radiography was used to examine a mummified cadaver exhumed in 1875 and stored in the Smithsonian Museum. Radiographs revealed artifacts imbedded in the cadaver, indicating 1824 as the earliest possible interment. Through radiographic assessment of the skeleton, researchers were able to approximate the individual's age at death. In addition, evidence of pathology, possibly ideopathic skeletal hyperostosis, suggested the individual may have been employed in manual labor. The radiographs, when compared to x-rays of another cadaver exhumed at the same time and place, refuted information in museum records.

The effects of topical fluticasone propionate on allergen-induced immediate nasal airways response and eosinophil activation: preliminary results

Nasal application of grass pollen allergen in atopic individuals with seasonal rhinitis leads to an early rise in nasal airways resistance. The effects of fluticasone propionate, a powerful, topically active glucocorticosteroid, on nasal airways resistance and cellular infiltration of the nasal mucous membrane were investigated. Fluticasone propionate blunted the rise in nasal airway resistance following allergen challenge (P = 0.089). Although this glucocorticosteroid did not affect the total number of eosinophils in biopsies of nasal mucous membrane, the number of activated eosinophils was significantly reduced (P less than 0.05).

Aortic dissection with concurrent abdominal aortic aneurysm: computed tomography diagnosis

Thoracic aortic dissection in association with preexisting abdominal aortic aneurysm is rare. An illustrative case is presented in which an additional complication of contained aortic rupture and renal infarction occurred. Computed tomography was the primary diagnostic modality.

Effect of selenium-vitamin E on adriamycin-induced cardiomyopathy in rabbits

Administration of selenium-vitamin E (Se-E) to weanling rabbits chronically treated with adriamycin (ADR) resulted in decreased incidence and severity of cardiomyopathy and decreased cumulative mortality during a 10-week experiment. However, Se-E did not protect against extracardiac lesions or against a number of clinicopathologic alterations induced by chronic ADR toxicosis. Histopathologic alterations of ADR-induced cardiomyopathy were concentrated periarterially in the free and septal walls of the left ventricle. Initial vacuolar degeneration of injured cardiac muscle cells was followed by myofibrillar lysis and eventual cell death with subsequent interstitial fibrosis. Ultrastructurally, degenerated cardiac muscle cells had 3 prominent alterations: (1) sarcoplasmic vacuolization caused by distention of elements of sarcoplasmic reticulum and T-tubules, (2) degeneration of mitochondria forming large myelin figures from disrupted membranes, and (3) lysis of myofibrils producing granular sarcoplasmic masses. Severely injured fibers were necrotic and macrophages invaded to remove cellular debris. The interstitium was distended by edema and increased amounts of collagen. Extracardiac lesions in rabbits with chronic ADR toxicosis included the usually recognized alterations involving cell-renewal systems in kidney, testis, bone marrow, skin, and alimentary tract, as well as vacuolar degeneration of skeletal muscle and focal loss of pancreatic tissue, with ensuing pancreatic fibrosis and fat necrosis. Deaths in ADR-treated rabbits usually were precipitated by terminal septic embolism. The partial protection afforded by Se-E against ADR-induced cardiomyopathy may be associated with stabilization of the membranes of injured muscle cells or with prevention of ADR-induced inhibition of coenzyme Q10-dependent mitochondrial enzymes.