Brain Imaging in Cases with Positive Serology for Dengue with Neurologic Symptoms: A Clinicoradiologic Correlation

BACKGROUND AND PURPOSE

Dengue is a common arboviral disease, which uncommonly involves the brain. There has been a recent surge in dengue cases and dengue-related deaths in tropical countries. The aim of this study was to describe brain imaging findings in patients with dengue infection having neurologic symptoms.

MATERIALS AND METHODS

Thirty-five patients with positive serology for dengue with CNS symptoms undergoing imaging of the brain were included in the study. Clinical, laboratory, and imaging parameters were assessed and correlated to poor outcome.

RESULTS

A Glasgow Coma Scale score of ≤12 at presentation, clinical classification of severe-type dengue, and the presence of acute renal failure were associated with poor outcome. Imaging parameters associated with poor outcome were involvement of the thalami and cerebellar peduncles and the presence of diffusion restriction and hemorrhagic foci in the brain parenchyma.

CONCLUSIONS

Although not specific, dengue infection has imaging findings that can be used to narrow down the differential list and help in prognostication.

Ventilation, indoor air quality, and health in homes undergoing weatherization

Ventilation standards, health, and indoor air quality have not been adequately examined for residential weatherization. This randomized trial showed how ASHRAE 62-1989 (n=39 houses) and ASHRAE 62.2-2010 (n=42 houses) influenced ventilation rates, moisture balance, indoor air quality, and self-reported physical and mental health outcomes. Average total airflow was nearly twice as high for ASHRAE 62.2-2010 (79 vs. 39 cfm). Volatile organic compounds, formaldehyde and carbon dioxide were all significantly reduced for the newer standard and first-floor radon was marginally lower, but for the older standard, only formaldehyde significantly decreased. Humidity in the ASHRAE 62.2-2010 group was only about half that of the ASHRAE 62-1989 group using the moisture balance metric. Radon was higher in the basement but lower on the first floor for ASHRAE 62.2-2010. Children in each group had fewer headaches, eczema, and skin allergies after weatherization and adults had improvements in psychological distress. Indoor air quality and health improve when weatherization is accompanied by an ASHRAE residential ventilation standard, and the 2010 ASHRAE standard has greater improvements in certain outcomes compared to the 1989 standard. Weatherization, home repair, and energy conservation projects should use the newer ASHRAE standard to improve indoor air quality and health.

Mother to child transmission of hepatitis B virus: a cause for concern

Mother to child transmission of hepatitis B virus (HBV) is an important public health issue. India introduced HBV vaccine in 10 states as part of its Universal Immunization Program (UIP). Here we show evidence of mother-to-child transmission of HBV in three families from Jharkhand and Bihar states where HBV vaccination is not yet included in the UIP. This report illustrates the need for active screening of HBV in pregnant women and implementation of HBV vaccine across all states in India to reduce the burden of disease.

Preclinical efficacy evaluation of ixabepilone (BMS-247550) in combination with cetuximab or capecitabine in human colon and lung carcinoma xenografts

12017

Background: Ixabepilone belongs to a class of structurally novel, microtubule-stabilizing agents that exert their antimitotic action by binding to tubulin with a binding mode that is distinct from the taxanes. Preclinical findings that ixabepilone has antitumor activity in a broad spectrum of tumor types, including taxane-resistant tumors, is borne out by Phase II clinical trials where ixabepilone has demonstrated activities in multiple tumor types including breast, renal, pancreatic, prostate and lymphoma. The aim of this series of studies was to further characterize the therapeutic potential of ixabepilone in combination with currently approved chemotherapy agents. Methods: Antitumor activity was evaluated in the GEO human colon and L2987 human lung carcinoma xenografts. Therapeutic synergism of the combination was defined as the attainment of efficacy that was significantly better than the best response of the individual single agents administered at their maximum-tolerated dose (MTD) or optimal dose (OD). Results: In the GEO tumors, single-agent ixabepilone produced 1.1 log cell kill (LCK) at its MTD. Cetuximab at its OD yielded 0.8 LCK. The combination of ixabepilone and cetuximab produced 1.7 LCK which was significantly superior to ixabepilone alone (P=0.0173) and cetuximab alone (P=0.0002). Similar synergistic efficacy was observed in the L2987 tumors. The combined efficacy of capecitabine plus ixabepilone was evaluated in the GEO tumors. In this tumor, single-agent ixabepilone was modestly active (LCK = 0.8) at its MTD. Single-agent capecitabine was not effective (LCK = 0.4) at its MTD. However, the combination of the two agents produced therapeutic synergism, yielding antitumor efficacy (1.9 LCK) that was superior to either of the agents alone at their MTDs (P=0.035 and 0.0004, respectively). Conclusions: Ixabepilone demonstrates robust synergistic antitumor efficacy when used in combination with cetuximab or capecitabine in human xenografts providing a biologic rationale for these combinations in the treatment of cancer.

[Table: see text]

Thymosin beta4 enhances endothelial cell differentiation and angiogenesis

When human umbilical vein endothelial cells (HUVEC) differentiate into capillary-like tubes, there is a five-fold upregulation of the mRNA for thymosin beta4 (Tbeta4) (Grant et al. J Cell Sci 1995; 108: 3685-94 [1]) and this endogenous expression plays an important role in endothelial cell attachment to and spreading on matrix components. We now show that exogenous addition of thymosin beta4 (in the ng-microg range) to HUVEC in culture can induce several biological responses. These responses include increased tube formation in vitro. Additionally, exogenous thymosin beta4 enhances vascular sprouting in the coronary artery ring angiogenesis assay. Measurements of these vascular sprouts show a doubling of the vessel area (via increased branching) with as little as 100 ng of synthetic thymosin beta4. These processes appear to involve the binding of thymosin beta4 to an unknown cell surface receptor and internalization of the protein. This cell surface-binding appears not to be mediated through the thymosin beta4-actin binding domain LKTET. An increase in thymosin beta4 cytoplasmic staining in HUVEC exposed 10 microg of the peptide appears to occur without increased mRNA translation. In summary Tbeta4 induces an increase in cell-matrix attachment, proliferation, tube formation, internalization of the peptide and rearrangement of the actin cytoskeleton. The data now defines both an autocrine and paracrine role for thymosin beta4 in vessel formation.

Neuropeptide Y: a novel angiogenic factor from the sympathetic nerves and endothelium

Sympathetic nerves have long been suspected of trophic activity, but the nature of their angiogenic factor has not been determined. Neuropeptide Y (NPY), a sympathetic cotransmitter, is the most abundant peptide in the heart and the brain. It is released during nerve activation and ischemia and causes vasoconstriction and smooth muscle cell proliferation. Here we report the first evidence that NPY is angiogenic. At low physiological concentrations, in vitro, it promotes vessel sprouting and adhesion, migration, proliferation, and capillary tube formation by human endothelial cells. In vivo, in a murine angiogenic assay, NPY is angiogenic and is as potent as a basic fibroblast growth factor. The NPY action is specific and is mediated by Y1 and Y2 receptors. The expression of both receptors is upregulated during cell growth; however, Y2 appears to be the main NPY angiogenic receptor. Its upregulation parallels the NPY-induced capillary tube formation on reconstituted basement membrane (Matrigel); the Y2 agonist mimics the tube-forming activity of NPY, whereas the Y2 antagonist blocks it. Endothelium contains not only NPY receptors but also peptide itself, its mRNA, and the "NPY-converting enzyme" dipeptidyl peptidase IV (both protein and mRNA), which terminates the Y1 activity of NPY and cleaves the Tyr1-Pro2 from NPY to form an angiogenic Y2 agonist, NPY3-36. Endothelium is thus not only the site of action of NPY but also the origin of the autocrine NPY system, which, together with the sympathetic nerves, may be important in angiogenesis during tissue development and repair.

The central New Jersey neonatal brain haemorrhage study: design of the study and reliability of ultrasound diagnosis

Over a 34-month period, 1105 newborns weighing between 501 and 2000 g at birth were enrolled in a prospective study of the aetiology and consequences of neonatal brain haemorrhage. The three participating hospitals care for approximately 85% of births in the study weight range in Middlesex, Monmouth and Ocean counties, New Jersey. Cranial ultrasonographic imaging through the anterior fontanelle was carried out a mean age of 4.9 +/- 2.2 hours, 25.5 +/- 4.8 hours and 7.2 +/- 0.8 days to detect haemorrhage and other brain lesions. In 93.2% of study infants, scans were read by two independent expert readers (blind to the clinical status of the child) with submission of the scan to a third reader in cases of disagreement. Confirmation of both presence or absence and, when present, scan of first diagnosis of germinal matrix and/or intraventricular haemorrhage (GM/IVH) by two independent readers was achieved in 76.3% of study infants. The first two readers agreed as to presence or absence of GM/IVH in 82.4% of infants (Kappa = 0.56). Interobserver agreement was affected by the reported scan quality and by the number of scans available, but not by the hospital of origin, race or birthweight of the infant.

Total parenteral nutrition and the patient with chronic obstructive pulmonary disease

Patients with chronic obstructive pulmonary disease (COPD) are generally malnourished. A catabolic state predisposes these patients to infection and a subsequent increase in mortality. Nutritional support may be mandatory to prevent visceral deterioration, but side effects of total parenteral nutrition (TPN) feeding can be harmful to patients with COPD. The use of glucose concentrates causes an increase of CO2, creating a metabolic demand for O2 that usually cannot be met. Specific formulas of TPN for COPD patients, using lipids for calories and limiting glucose, lower the respiratory quotient. There still remains a dilemma for adequate nutritional repletion, however, because all nutrients alter respiratory demand. Patients in acute respiratory failure or those requiring mechanical ventilation create a vital challenge for the health care provider.

A model for selecting a clinical laboratory information system. A four-phase process

Laboratory information systems (LISs) have become an essential part of an efficient and effective laboratory. In the past, selecting an LIS was a relatively simple procedure because there were only a few candidates to select from. Now, however, selecting an LIS from the myriad available has become a time-consuming and complex process. This article presents a multi-attribute utility (MAU) method for selecting an LIS. This MAU method has four phases: identifying LIS vendors and disseminating requests for proposals (RFPs), analyzing RFP responses and selecting the top three vendors, validating responses of the top three vendors, and selecting a primary vendor and preparing a formal recommendation. By following this four-phase process, laboratories will simplify the complex LIS selection process and increase their chances of selecting the best LIS for their needs.

[Nail-patella syndrome]

In a case report the rare nail-patella-syndrome is presented. Typical and pathognomonic signs are: nail aplasia or dystrophy, iliac horns, hypoplasia or aplasia of the patellae, elbow dysplasia and a nephropathy with electron microscopic demonstrable collagen-like deposition in the glomerular basal membrane. The clinical relevance is determined by the course of the renal disease.

[The secretory performance of eccrine sweat glands from the nephrologic viewpoint--II: Middle molecules]

By means of gel-chromatographic investigations in the serum, sweat, urine and ultrafiltrate of healthy test persons, patients with renal insufficiency at the stage of the compensated and decompensated retention and of patients undergoing dialysis in the eccrine sweat substances in the area of so-called molecules of medium size from 1,100 to 2,050 Dalton are made evident. On account of the well-known heterogeneity of the gel-chromatographically separated fraction the concentration of the molecules of medium size is not unequivocally to be determined. It is, judged according to the peak hights of the chromatograms, less than 1/12 of the concentrations in the serum and the urine, but approximately corresponds to the content in the ultrafiltrate of patients undergoing haemodialysis. In patients with renal diseases the secretory possibility of the eccrine sudoriferous gland for molecules of medium size is not disturbed. A compensatory increased secretion of medium-size molecules via sweat in chronic renal insufficiency is not to be proved. The method of the gel-chromatography and the importance of the medium-size molecules for the pathogenesis of uraemia are critically discussed.

[The elderly dialysis patient]

By the experience of two smaller dialysis centers the prognosis and problems of dialysis therapy in older patients are described. The age in the onset of dialysis treatment ranged from 45 to 54 years. In the beginning of dialysis the average life expectancy of older patients is markedly lower in comparison with younger patients, but remarkable in single cases with more than 4 and 5 years. The problems of adaptation and complications do require much attention and allowance. Contra-indications to dialysis therapy in older patients could not be explained. The demand for a stronger consideration of this patient group in planning of dialysis capacity is established through an international comparison and a possible rehabilitation of the patients.

Interobserver variability in neonatal cranial ultrasonography

The reliability of cranial ultrasound diagnosis in the premature neonate was examined using data from an ongoing multicentre study of the epidemiology and long-term consequences of neonatal brain haemorrhage. First week ultrasound films (obtained at 4 hours, 24 hours and 7 days) from 60 study subjects were randomly selected for independent review by two groups of experienced interpreters, and results were recorded separately for observations (i.e. presence or absence of an abnormal echodense area on a film) and interpretations (i.e. presence or absence of haemorrhage or ventricular dilatation) in each hemisphere. Because of deaths in the first week of life, the total number of films examined was 138. Concordance on the presence or absence of an abnormal echodensity was examined for each individual film for three areas of interest: the germinal matrix, the ventricles and the parenchyma. Concordance on the presence or absence of haemorrhage or ventricular dilatation was examined only for the seventh-day film, or the final film prior to death. Finally, concordance was analysed with the diagnostic interpretations grouped into categories thought to differ prognostically for long-term outcome. In general, concordance was poorest for germinal matrix lesions and best for parenchymal lesions. Concordance was lower for observations made on each individual film than it was for interpretation of the final film in each case. Fifty-five of 60 cases (92%) were assigned to the same major prognostic category by both readers. Ultrasound review conferences were held periodically and there was evidence that concordance in ultrasound reading and interpretation improved during the course of the study.

[Treatment of chronic renal failure associated with hereditary acroosteolysis by repeated hemodialysis]

We report the case of a 22-year old male patient with terminal renal failure consecutive to hereditary osteolysis affecting the tarsal and carpal bones associated with chronic glomerulonephritis. This is one of the first cases where prolonged survival was obtained by repeated haemodialysis and kidney transplantation. The various clinical features of this syndrome are described, together with its possible repercussions on bone abnormalities induced by repeated haemodialysis of kidney transplantation.

[Secretory performance of eccrine sweat glands from the nephrologic viewpoint]

The question is of nephrological interest, whether the secretory product of eccrine sudoriferous glands apart from the well known function for thermoregulation is useful as excretory product for the therapy of renal insufficiency. In 17 healthy subjects and 39 patients with renal insufficiency thermal sweat was obtained by exposition in the sauna and four-tub bath. Control of the trainability of sweating in 23 patients during six weeks in the Kneipp cure sanatory. For the daily fluid balance remarkable quantities of sweat could be achieved. The sweat performance is trainable. The content of soluta in the sweat of patients with renal insufficiency surmounts that of healthy test persons. The excretion of nitrogen metabolites, electrolytes and acidity is quantitatively different and is analysed individually. Apart from the reliable methods of the conservative and invasive therapy of the uraemia the thermically stimulated sweating can be recommended as an adjuvant therapeutic regime.

Gas Emissions and the Eruptions of Mount St. Helens Through 1982

The monitoring of gas emissions from Mount St. Helens includes daily airborne measurements of sulfur dioxide in the volcanic plume and monthly sampling of gases from crater fumaroles. The composition of the fumarolic gases has changed slightly since 1980: the water content increased from 90 to 98 percent, and the carbon dioxide concentrations decreased from about 10 to 1 percent. The emission rates of sulfur dioxide and carbon dioxide were at their peak during July and August 1980, decreased rapidly in late 1980, and have remained low and decreased slightly through 1981 and 1982. These patterns suggest steady outgassing of a single batch of magma (with a volume of not less than 0.3 cubic kilometer) to which no significant new magma has been added since mid-1980. The gas data were useful in predicting eruptions in August 1980 and June 1981.

Structural modifications of anguidin and antitumor activities of its analogues

Approximately 60 derivatives of anguidin were prepared for evaluation of antitumor activities. Positions 3, 4, 8-10, and 15 were modified, and the resultant derivatives were screened against P-388 leukemia. It was found that introduction of the C3-keto and C3,C8-diketo groups markedly improved the antileukemic activity, whereas epoxidation of the C9-C10 double bond or oxidation of the C15 position diminished its activity. Selected derivatives were further tested in the L1210, B16, Lewis lung, Colon 36, and Colon 38 tumor lines. Among these compounds, 4 beta, 15-diacetoxyscirpene-3,8-dione (54) and 4 beta-(chloroacetoxy)-15-acetoxyscirpene-3,8-dione (55) were found to be most active in various tumors. Inhibitory action of several analogues on protein synthesis was also examined using H-HeLa cells.

Some Problems in Applying the Hassler Relative Permeability Method

In 1945 Hassler described a method for relative permeability measurement that was conceptually permeability measurement that was conceptually well founded but from the start has presented laboratory workers with various measurement problems. Recent as well as earlier analyses of problems. Recent as well as earlier analyses of the situation, for example, have been motivated by the need for an independent standard against which relative permeability data obtained by other (more convenient, less exacting) techniques can be calibrated. The latter is wanted as a hedge against the possibility that reservoir simulation predictions of possibility that reservoir simulation predictions of reserves and recovery will exhibit marked sensitivity to the input relative permeability data.The purpose of this paper is to call attention to a previously unmentioned type of measurement previously unmentioned type of measurement problem that appears to be inherent to the Hassler problem that appears to be inherent to the Hassler flow systems (Fig. 1). For simplicity, attention will be limited to two-phase colinear flow of a wetting and a nonwetting fluid. In such a case, the intention is that the pressure drop be identical in the contiguous immiscible fluids so that the capillary pressure gradient (and, hence, the saturation gradient) will be zero along the flow path when the relative permeability measurements are being made. permeability measurements are being made.For example, suppose that in a particular run a pressure, p1, is set where the wetting fluid enters the pressure, p1, is set where the wetting fluid enters the inflow capillary barrier, and a pressure, p4 less than p1, is set where the wetting fluid exits from the outflow capillary barrier. Then, as schematized in Fig. 2, the internal wetting-fluid pressures at the surfaces of discontinuity between the core sample and the capillary barriers, p2 and p3 less than p2, will assume values according to Darcy's law that depend on factors such as the ratio of the length of the core sample to that of an end barrier M and the ratio of the effective permeability of the core (to the flow of the wetting permeability of the core (to the flow of the wetting fluid) to the absolute permeability of the barrier material N. In fact, it is easy to show that the relationships under discussion are

(1a)

and

(1b)

The critically important things in Hassler work, of course, is to have the pressures p2 and p3 measured or otherwise immediately known just as soon as two-phase flow is being initiated at each step in the measurement of the relative permeability curves. This is because the relative permeability data are to be referred to particular values of saturation and types (e.g., drainage, imbibition) of saturation distribution and specifically to those that are prescribed by the particular values of capillary prescribed by the particular values of capillary pressure, Pc, that have been imposed before each pressure, Pc, that have been imposed before each two-phase flow episode. In other words, the inflow and outflow pressures in the nonwetting fluid, p5 and p6, respectively, must be set at precisely the same time p1 and p4 are set (i.e., as two-phase flow is initiated simultaneously in both fluids) in such a way that the following condition is met.

(2)

The dashed curves of Fig. 2, for example, depict how pressure would be distributed in the wetting fluid for a representative case where the constraint condition, Eq. 2, has not been met. The consequence of encountering such a situation in a Hassler-like relative permeability run is illustrated in Figs. 3 and 4. The dashed curves indicate that a positive capillary pressure gradient gives rise to a negative saturation pressure gradient gives rise to a negative saturation gradient in the direction of two-phase flow (and vice versa).

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[Dialysis costs. 2. Ward-integrated dialysis]

It is described how with a small personnel and material expenditure in a nephrologic ward since several years haemodialytic therapies are performed successfully and effectively. The expenses for this form of dialysis integrated into the ward were compared with those in the dialysis centre. Demands of cost and personnel are essentially lower. In this paper the suggestion shall be given to test the organization of similar dialysis units in other places. The fund at disposal would then used more rationally and the degree of care for patients who need this therapy improved.

17Beta-hydroxysteroid: NAD (P)-oxydoreductase plasma enzyme-activity levels in threatened abortion, inevitable abortion and pregnancies complicated by diabetes mellitus

Changes in the enzyme-activity levels of the placental steroid enzyme, 17&#914;-hydroxysteroid:NAD(P)-oxydoreductase were examined in the plasma of women with normal and pathological pregnancies. The behaviour of the enzyme-activity levels in normal pregnancies did not differ from pregnancies complicated by temporary signs of threatened abortion. Imminent and recent inevitable abortions showed significantly <i>higher</i> and old-protracted inevitable abortions significantly <i>lower</i> enzyme levels than normal controls. It is concluded that the placental enzyme in the plasma of pregnant women could be of use in monitoring threatened abortion and distinguishing it from inevitable abortion. In pregnancies complicated by diabetes mellitus, there was increased antenatal incidence of pathological enzyme levels above and below the normal 95 percent tolerance limits in poorly controlled cases, heavy babies, heavy placentas, hydramnion and fetal distress.