Improved accuracy and robustness of electron density profiles from JET's X-mode frequency-modulated continuous-wave reflectometers

JET's frequency-modulated continuous wave (FMCW) reflectometers have been operating well with the current design since 2005, and density profiles have been automatically calculated intershot since then. However, the calculated profiles had long suffered from several shortcomings: poor agreement with other diagnostics, sometimes inappropriately moving radially by several centimeters, elevated levels of radial jitter, and persistent wriggles (strong unphysical oscillations). In this research, several techniques are applied to the reflectometry data analysis, and the shortcomings are significantly improved. Starting with improving the equilibrium reconstruction that estimates the background magnetic field, adding a ripple correction in the reconstructed magnetic field profile, and adding new inner-wall reflection positions estimated through ray-tracing, these changes not only improve the agreement of reconstructed profiles to other diagnostics but also solve density profile wriggles that were present during band transitions. Other smaller but also persistent wriggles were also suppressed by applying a localized correction to the measured beat frequency where persistent oscillations are present. Finally, the burst analysis method, as introduced by Varela et al. [Nucl. Fusion 46 S693 (2006)], has been implemented to extract the beat frequency from stacked spectrograms. Due to the strong suppression of spurious reflections, the radial jitter that sometimes would span several centimeters has been strongly reduced. The stacking of spectrograms has also been shown to be very useful for stacking recurring events, like small gas puff modulations, and extracting transport coefficients that would otherwise be below the noise level.

P058 Epidemiological clinical, etiologic spectrum and follow-up results of uveitis in children: a single center experience

Background

Uveitis refers to the inflammation of the vascular tunic of the eye. This inflammation varies greatly in its clinical expressions and etiologies and is often a majordiagnostic challenge for physicians. These data cover symptoms, clinical examination results, complications, etiologies and treatments

Methods

A retro-prospective monocentric study was carried out on 22patients hospitalized in the pediatric department of the issaadhassani hospital of Algiers during the period of January 2017 to December 2021.

Results

The sex ratio is 1,2. Their average age was 8 years (4–15Y). Most of thepatients consulted for the three cardinal signs of uveitis: 81% for a decrease in visual acuity, 59% for redness, and 43% for ocular pain. Uveitis was bilateral in 55% of the cases. Inanatomical localization, 45,5% of patients had total uveitis, 27% had anterior uveitis, and 18% had intermediate uveitis, and 9% had anterior and intermediate uveitis. An etiologic diagnosis was made in 32% of the cases. The most frequent causes were inflammatory. Treatments consisted of local corticosteroid therapy for all thepatients, a general corticoid treatment for all of the patients, associated with an immunosuppressive treatment for 50% and biologic anti TNF α treatment (adalimumab) for23% cases. A good evolution after treatment was noted among patients with visual acuity <3/10 with a substantial decrease from 67% to 2%.77.5% are in remission, 13.5% are improving and 9% are in relapse the duration of the follow-up is 1 ½ years with intervals of 2 months and 5 years.

Conclusion

The results of the current study are generally compatible with the literature. however. The percentage of etiologies covered remains a point to improve, The pooled prevalence of uveitis in pediatric rheumatic diseases widely varied based on the underlying disease requiring more investigations in different subtypes of rheumatic diseases. The biologic medications, especially Adalimumab are the most effective treatments for uveitis in pediatric rheumatic diseases; however, a combination of the safe, available alternatives is preferred to achieve the most desirable treatment response.

P075 Contribution of biothérapy in pediatric rheumatology: tolérance and efficacy

Background

Biotherapy result of spectacular advances in genetics and research in molecular and cellular biology, has considerably improved the management of rheumatic and autoinflammatory diseases in children. The Objective is to assess the efficacy and tolerance of biotherapy in pediatrics

Methods

A retro-prospective study was carried out in the Pediatric Department B at the pediatric rheumatology consultation, university hospital center. An operating sheet was drawn up including epidemiological, clinical, paraclinical and therapeutic data of the cases diagnosed as well as their evolution on biotherapy.

Results

26 children received treatment with biotherapy. 73% presented with JIA (54% systemic, 19% polyarticular with positive RF, 19% severe uveitis, and 4% familial Mediterranean fever. 4% behçet disease

The mean time to start biotherapy was 12 months [2–48]. There is a clear clinical and biological improvement for 93% of patients. Etanercept was effective in polyarticular-progressive JIA, Adalimumab in oligoarthritis with severe uveitis, Tocilizumab in systemic forms of JIA and Anakinra in familial Mediterranean fever resistant to colchicine and systemic arthritis.

The adverse reactions noted were: one case of tuberculosis, hepatic cytolysis in 4 cases, and one case of psoriasis.

Conclusion

The introduction of biotherapy in pediatric has considerably improved the management of inflammatory rheumatic diseases and transformed the prognosis of these chronic diseases. The maintenance of the good response to treatment and the good tolerance of biotherapy must be evaluated prospectively over the long term.

Association of high-sensitivity C-reactive protein with susceptibility to Schizophrenia in Tunisian population

The pathogenic mechanisms underlying Schizophrenia (SZ), one of the most frequent mental disorders, are complex and poorly understood. Several evidences suggest that inflammatory processes may underpin some of its neurobiological correlates. The aim of this study was: (i) to analyze the potential association between circulating levels of the C-reactive protein (CRP), a crucial inflammatory marker, and Schizophrenia in Tunisian patients and healthy controls (HC) cohorts; (ii) to investigate the genetic diversity of three CRP variants (rs1417938, rs1130864 and rs1205) and; (iii) to analyze a potential relationship between expression and genetic data and clinical and socio demographical characteristics. CRP polymorphisms were exanimated for 155 patients and 203 HC by taqMan5'-nuclease. High-sensitivity CRP (hs-CRP) serum level was measured in 128 clinically stable out-patient SZ patients and 63 HC subjects via an automated biochemical analyzer. We found that hs-CRP levels were significantly higher in SZ patients as compared to HC. No significant differences were found when the proportions of CRP variants were compared in patients and HC. Further analysis according to clinical and socio demographical characteristics revealed a positive association with age and hypertension. Our data on an original Tunisian sample confirm the previous finding in others population groups.

The potential utility of high-intensity ultrasound to treat osteoarthritis

Osteoarthritis (OA) is a widespread musculoskeletal disease that reduces quality of life and for which there is no cure. The treatment of OA is challenging since cartilage impedes the local and systemic delivery of therapeutic compounds (TCs). This review identifies high-intensity ultrasound (HIU) as a non-contact technique to modify articular cartilage and subchondral bone. HIU enables new approaches to overcome challenges associated with drug delivery to cartilage and new non-invasive approaches for the treatment of joint disease. Specifically, HIU has the potential to facilitate targeted drug delivery and release deep within cartilage, to repair soft tissue damage, and to physically alter tissue structures including cartilage and bone. The localized, non-invasive ultrasonic delivery of TCs to articular cartilage and subchondral bone appears to be a promising technique in the immediate future.

Tension Suture Technique Combined with Lidocain-Adrenalin-Saline-Infiltration Decreases Complications in Abdominoplasty

Backgrounds and Aims:

Due to growing interest into body contouring has abdominoplasty become one of the most common aesthetic operations. New techniques have appeared to reduce the relatively high incidence of complications in abdominplasty. One technique is the tension suture technique, which can be combined with lidocain-adrenalin-saline-infiltration. Our aim was to analyse the results of this combined technique.

Material and Methods:

This retrospective study consisted of 95 women operated on in a private hospital by one senior plastic surgeon between years 2004 and 2009. Sixty patients had other operations in addition to abdominoplasty: 49 liposuctions, six breast reductions or mastopexies, three umbilical hernioplasties, one brachioplasty, one partial excision of labias, and one blepharoplasty.

Results and Conclusions:

The operative time was 82 minutes ranging from 45 to 173 minutes. Peroperative bleeding was a mean of 196 ml in abdominoplasty only and 254 ml when combined with additional operation. Patients did not have any major complications and the total incidence of minor — not clinically significant — complications was 12.6%. Obesity, smoking, comorbidities, previous operations on belly area or additional operations did not affect the complication rates. Our study supports the view that the tension suture technique combined with lidocain-adrenalin-saline-infiltration decrease the formation of seroma and wound complications in abdominoplasty. Lidocain-adrenalin-saline-infiltration also fastens and eases the operation without increasing the risk of bleeding in experienced hands.

Arterial stiffness, inflammatory and pro-atherogenic markers in gestational diabetes mellitus

Background: This study aims to determine whether gestational diabetes mellitus (GDM) is associated with increased arterial stiffness, inflammatory and pro-atherogenic markers compared to age matched controls. Patients and methods: This is a cross-sectional study involving 53 pregnant women in the early third trimester of pregnancy consisting of 31 women with normal pregnancy and 22 women with GDM. Subjects were grouped into GDM and control groups based on modified oral glucose tolerance test results; they were considered GDM if fasting blood glucose (FBG) was >= 6.1 mmol/L and/or the two hours post-glucose intake was >= 7.8 mmol/L. Arterial stiffness was assessed non-invasively using the parameters augmentation index (AIx) obtained via pulse wave analysis and carotid femoral pulse wave velocity (PWV). Tumor necrosis factor alpha (TNF-alpha), high sensitivity C- reactive protein (hsCRP) and plasminogen activator inhibitor-1 (PAI-1) were measured using enzyme linked immunoassay technique (ELISA). Aortic and brachial blood pressure (BP) indices were also recorded. Results: Mean ages and gestational ages (GA) for the control and GDM groups showed no significant differences (31.1 ± 5.68 vs. 32.9 ± 8.46 years; 29.0 ± 2.43 vs. 29.6 ± 1.54 weeks respectively). FBG and 2 hour post-glucose levels were significantly higher in GDM; (5.27 ± 1.19 vs. 3.94 ± 0.44 mmol/L, p < 0.001; 9.66 ± 1.76 vs. 5.68 ± 1.10 mmol/L, p < 0.001). TNF-alpha, PAI-1 and hsCRP levels were significantly higher in GDM compared to controls (0.81 ± 0.15 vs. 0.72 ± 0.13 pg/ml, 54.48 ± 13.07 vs. 36.16 ± 15.58 cm/ml, 7.91 ± 1.16 vs. 6.70 ± 1.45 mg/l respectively). PWV (8.28 ± 1.48 vs. 7.97 ± 1.12) and AIx (16.73 ± 10.98 vs. 16.13 ± 9.64 %) were not significantly different between the two groups. No significant differences were seen for aortic and brachial BP, mean arterial pressure and body mass index. Conclusions: The inflammatory markers TNF-alpha and hsCRP, and the pro-atherogenic marker PAI-1 were elevated in GDM compared to age matched controls. No significant difference was seen between the two groups in their arterial stiffness.

A key to improved ion core confinement in the JET tokamak: ion stiffness mitigation due to combined plasma rotation and low magnetic shear

New transport experiments on JET indicate that ion stiffness mitigation in the core of a rotating plasma, as described by Mantica et al. [Phys. Rev. Lett. 102, 175002 (2009)] results from the combined effect of high rotational shear and low magnetic shear. The observations have important implications for the understanding of improved ion core confinement in advanced tokamak scenarios. Simulations using quasilinear fluid and gyrofluid models show features of stiffness mitigation, while nonlinear gyrokinetic simulations do not. The JET experiments indicate that advanced tokamak scenarios in future devices will require sufficient rotational shear and the capability of q profile manipulation.

An adult case of eosinophilic pyloric stenosis maintained on remission with oral budesonide

We describe an isolated eosinophilic pyloric stenosis in a young female. She was referred for abdominal pain, fever, weight loss and eosinophilia. A sonographic examination revealed a concentric pyloric stenosis, with antral palsy and ascites. The endoscopy confirmed the diagnosis of eosinophilic infiltration of the pylorum. After a short course of systemic steroids, the patient was switched to oral budesonide, which effectively maintained a long-term remission. Eosinophilic gastroenteritis limited to pylorum is exceptional in adults, and in our patient it was not associated with allergic other disorders. This case emphasizes the usefulness of sonografy for diagnosis and monitoring, and the clinical efficacy of oral budesonide.

The anomalous currents in the front foils of the JET lost alpha diagnostic KA-2

We have examined the observed currents in the front foils of the JET Faraday cup lost alpha particle diagnostic KA-2. In particular, we have sought to understand the currents during Ohmic plasmas for which the ion flux at the detectors was initially assumed to be negligible. We have considered two sources of this current: plasma ions (both deuterium and impurity) in the vicinity of the detector (including charge exchange neutrals) and photoemission from scattered UV radiation. Based upon modeling and empirical observation, the latter source appears most likely and, moreover, seems to be applicable to the currents in the front foil during ELMy H-mode plasmas. A very thin gold or nickel foil attached to the present detector aperture is proposed as a solution to this problem, and realistic calculations of expected fluxes of lost energetic neutral beam ions during TF ripple experiments are presented as justification of this proposed solution.

Influence of magnetic field ripple on the intrinsic rotation of tokamak plasmas

Using the unique capability of JET to monotonically change the amplitude of the magnetic field ripple, without modifying other relevant equilibrium conditions, the effect of the ripple on the angular rotation frequency of the plasma column was investigated under the conditions of no external momentum input. The ripple amplitude was varied from 0.08% to 1.5% in Ohmic and ion-cyclotron radio-frequency (ICRF) heated plasmas. In both cases the ripple causes counterrotation, indicating a strong torque due to nonambipolar transport of thermal ions and in the case of ICRF also fast ions.

Radiofrequency ablation of hepatocellular carcinoma in patients with and without cirrhosis

INTRODUCTION

Hepatocellular carcinoma (HCC) is a leading cause of death in patients with cirrhosis. Around 12% of all cases are associated with chronic liver disease without cirrhosis. The aim of our study was to compare primary tumor ablation rates, local tumor progression, safety, and long-term outcomes of radiofrequency ablation for single (less than 3.5 cm in diameter) or multiple HCC nodules (up to three nodules, each less than 3 cm) in both types of patients.

METHODS

We treated 200 consecutive HCC patients recruited from a local sonographic screening program: 175 with cirrhosis and 25 with non-cirrhotic chronic liver disease.

RESULTS

Complete ablation was achieved in 150 of the 175 patients (85.7%) (174 of the 206 nodules treated, 84.4%) in the cirrhotic group and in 24 of the 25 patients (96%) (27 of the 29 nodules treated; 93%) in the non-cirrhotic group. The two groups were not significantly different in terms of local tumor progression rates 1, 3, and 5 years after treatment (11%, 23%, and 24% among cirrhotics vs. 4%, 14%, and 14% among non-cirrhotic patients). Multifocal disease was more frequent among the cirrhotics. One-, three- and five-year survival rates were also similar in the cirrhotic (93%, 77%, and 61%) and non-cirrhotic groups (92%, 72%, and 64%). There were no treatment-related deaths. Severe complications occurred only in the cirrhotic group (2.2%).

CONCLUSIONS

Radiofrequency ablation is safe and effective treatment for HCC in patients with or without cirrhosis. The latter group has a significantly lower rate of multifocal disease.

Experimental study of the ion critical-gradient length and stiffness level and the impact of rotation in the JET tokamak

Experiments were carried out in the JET tokamak to determine the critical ion temperature inverse gradient length (R/LTi=R|nablaTi|/Ti) for the onset of ion temperature gradient modes and the stiffness of Ti profiles with respect to deviations from the critical value. Threshold and stiffness have been compared with linear and nonlinear predictions of the gyrokinetic code GS2. Plasmas with higher values of toroidal rotation show a significant increase in R/LTi, which is found to be mainly due to a decrease of the stiffness level. This finding has implications on the extrapolation to future machines of present day results on the role of rotation on confinement.

Survival of patients with early hepatocellular carcinoma treated by percutaneous alcohol injection

BACKGROUND

Once small (<10 mm) nodules, suspicious for hepatocellular carcinoma, are detected in cirrhotics, the European Association for the Study of the Liver guidelines recommend to delay histological confirmation and treatment until they increase in size.

AIM

To validate this policy by evaluating survival of 450 cirrhotics in Child-Pugh class A or B with unifocal 'early' hepatocellular carcinoma treated by percutaneous alcohol injection.

METHODS

Patients were sorted by nodular size into three groups: < or =10 mm (n = 36, group A), >10 to < or = 20 mm (n = 142, group B) and >20 to < or = 30 mm (n = 272, group C). Overall and tumour-free survivals were estimated by Kaplan-Meier method.

RESULTS

In groups A, B and C, mean follow-up was 33 +/- 26, 34 +/- 22 and 35 +/- 25 months (P = 0.89), mean survival time was 63 +/- 54, 57 +/- 48 and 62 +/- 66 months (P = 0.69) and mean tumour-free survival was 44 +/- 47, 46 +/- 58 and 41 +/- 68 months (P = 0.51), respectively. When patients were sorted by Child status, mean survival time was 76 +/- 82 and 38 +/- 29 months in Child A and B (P < 0.0001).

CONCLUSIONS

The comparable survival of percutaneous alcohol injection-treated patients with single, early hepatocellular carcinoma sorted by nodular size supports the European Association for the Study of the Liver 'wait-and-see' policy for patients with lesions <10 mm, and suggests that allowing the nodules to grow prior to taking further diagnostic or therapeutic actions would not harm these patients.

Probing internal transport barriers with heat pulses in JET

The first electron temperature modulation experiments in plasmas characterized by strong and long-lasting electron and ion internal transport barriers (ITB) have been performed in JET using ion cyclotron resonance heating in mode conversion scheme. The ITB is shown to be a well localized narrow layer with low heat diffusivity, characterized by subcritical transport and loss of stiffness. In addition, results from cold pulse propagation experiments suggest a second order transition process for ITB formation.

Ossifying fibromyxoid tumour in a child

Ossifying fibromyxoid tumor (OFMT) is a rare benign tumor, most of which occurs in adults with localization in the subcutaneous tissue or muscle of the extremities. A five-year-old girl presented with a mass in her right upper thigh. Due to the large size of the mass (10 x 7 cm), our provisional diagnosis was a soft tissue sarcoma. A tru-cut biopsy showed that the lesion was benign. The mass was excised and has not recurred since. To the best of our knowledge, this patient is the youngest case of OFMT reported in the English literature.

Neutralizing antibodies reduce MxA protein induction in interferon-beta-1a-treated MS patients

BACKGROUND

Neutralizing antibodies (NAb) during interferon-beta (IFNbeta) treatment of MS are associated with reduced clinical and MR efficacy. NAb inhibit the IFN- inducible MxA gene expression and neutralize the capability of IFNbeta to inhibit virus growth in vitro. Presently, there is no clear concept of the biologic importance of IFNbeta antibodies; most of the tests applied for the detection of NAb in previous publications are not widely available, and the results are not fully comparable.

METHODS

A 1-year prospective study of the development of binding antibodies (BAb) and NAb and their relationship to IFN-inducible MxA protein levels in peripheral blood leukocytes in 20 IFNbeta-1a-treated patients with relapsing-remitting MS was conducted.

RESULTS

In seven of nine NAb-positive patients, IFNbeta-1a was unable to induce MxA protein. BAb were detected in 11 patients, and they preceded or paralleled the development of NAb in all the patients. The titer of NAb correlated positively with BAb titer and negatively with MxA expression level. There was also a weaker but clear correlation between BAb titers and MxA levels.

CONCLUSIONS

NAb, in most but not all cases, inhibited the in vivo function of IFNbeta. Analysis of MxA protein in lymphocytes together with analysis of NAb is a promising marker for evaluating the biologic effects of IFNbeta treatment in MS patients.

Expression of interleukin-4 but not of interleukin-10 from a replicative herpes simplex virus type 1 viral vector precludes experimental allergic encephalomyelitis

We have used interleukin (IL)-4 and -10-producing HSV-1 gamma(1)34.5 deletion viruses in gene therapy of a BALB/c model of experimental allergic encephalomyelitis (EAE), a T cell-mediated demyelinating disease of the central nervous system. It is known that in EAE of mice the Th2-type cytokines are down-regulated and the Th1-type cytokines up-regulated during the onset and relapse of the disease. Therefore, we tested two HSV-1 recombinants expressing the Th2-type cytokines IL-4 and IL-10. The recombinant viruses were injected intracranially (i.c.) in BALB/c mice 6 days after induction of EAE. As control groups we used mice without any infection, mice infected with backbone virus R3659 and mock-infected mice. Weights and symptoms of the mice were recorded daily and the tissue specimens were collected at specific time-points. The results indicate that the intracranial infection with IL-4-producing virus (1) precludes EAE symptoms, (2) protects the spinal cord from massive leukocyte infiltrations and (3) prevents demyelination and axonal loss. The IL-10-expressing virus R8308 did not have a similar favorable effect on the recovery of the mice as did the IL-4 virus R8306.

Cell membrane-associated measles virus components inhibit antigen processing

Measles virus (MV)-induced immune suppression is an important reason for MV-associated mortality and morbidity. Despite numerous studies, the mechanisms of immune suppression still remain poorly defined. In the present study we analyzed the effect of MV components on the T-cell recognition of specific non-MV antigens. We demonstrated that even inactivated MV could inhibit the presentation of unprocessed protein antigen to specific T cells, whereas MV did not affect the responses of specific T cells to representative synthetic peptide epitopes derived from complex antigens. The inhibition was induced by MV-infected cell membranes. The kinetics of the MV-dependent inhibition suggested an impaired antigen processing in mononuclear cells as addition of MV-infected cell debris 4 h after the beginning of cell cultures no longer inhibited T-cell responsiveness.

Expression of sex steroid receptors and Ki-67 in the endometria of menorrhagic women: effects of intrauterine levonorgestrel

The levonorgestrel-releasing intrauterine system (LNG-IUS) has proven to be the most effective medical treatment in reducing the amount of menstrual blood loss. However, the molecular mechanisms underlying menorrhagia and/or accounting for the therapeutic effect of the LNG-IUS are still obscure. In this study, we used immunohistochemistry to compare the distribution of sex steroid receptors and the proliferation marker Ki-67 in the endometria of women with and without menorrhagia before and after 6 and 12 months of treatment with an LNG-IUS. The study sample included 67 women (aged 35-49 years) who had spontaneous ovulatory cycles. In women with menorrhagia, secretory phase endometrium exhibited more proliferative activity than in women without menorrhagia. No significant differences were found in the immunoreactivity of the oestrogen or progesterone receptors in women either with or without menorrhagia suggesting that, in addition to endocrine hormones, other factors are involved in the regulation of endometrial proliferation and menstrual blood loss. A total of 35 women were treated with LNG-IUS. After 6 months use of an LNG-IUS, the immunoreactivity of both epithelial and stromal progesterone receptors, as well as those of epithelial Ki-67 declined, and no differences were detectable between the women in the menorrhagia and control groups. Breakthrough bleeding remained a problem for nine (26%) LNG-IUS users, with no association with the pre-treatment amount of bleeding. No significant differences were found in the parameters studied between the women with and without breakthrough bleeding 6 months after insertion of an LNG-IUS.

Postoperative changes in blood flow in free muscle flaps: a prospective study

We used color Doppler ultrasound (US) to study postoperative changes in blood flow in 10 non-innervated free latissimus dorsi (LD) muscle flaps transplanted onto lower extremities. The peak, mean, and minimum velocities, resistance index, and diameter of the pedicle, and the recipient and control arteries were recorded preoperatively and on the 2nd, 5th, and 10th days after surgery. In the pedicle of the transplant, the peak and mean velocities increased but not significantly during the follow-up. The minimum velocity value in the thoraco-dorsal artery was (mean+/-SD) 4+/-5 cm/sec preoperatively, and was in the leg 19+/-9 cm/sec (P < 0.05) on the 5th and 17+/-10 cm/sec (P < 0.05) on the 10th postoperative day. The preoperative value of the resistance index decreased from 0.92+/-0.12 to 0.79+/-0.08 on the 10th postoperative day (P < 0.05). In the recipient artery, the peak (117+/-37) and mean (35+/-16 cm/sec) velocities increased significantly on the 5th postoperative day compared to the preoperative value (79+/-22 and 14+/-6 cm/sec, respectively). The minimum velocity increased but not significantly. The resistance index was preoperatively 1.23+/-0.09 and 0.88+/-0.16 (P < 0.05) on the 10th postoperative day. This prospective clinical study demonstrates that blood flow in the pedicle and in the recipient artery of a free muscle flap increases after surgery. This phenomenon may be due to loss of vascular tone and decreased resistance after denervation. Increased blood flow helps to keep the microanastomosis open and also promotes wound healing.

Secondary measles vaccine failures identified by measurement of IgG avidity: high occurrence among teenagers vaccinated at a young age

Failure to seroconvert (primary vaccine failure) is believed to be the principal reason (approx. > 95%) why some vaccinees remain susceptible to measles and is often attributed to the persistence of maternal antibodies in children vaccinated at a young age. Avidity testing is able to separate primary from secondary vaccine failures (waning and/or incomplete immunity), but has not been utilized in measles epidemiology. Low-avidity (LA) and high-avidity (HA) virus-specific IgG antibodies indicate primary and secondary failure, respectively. Measles vaccine failures (n = 142; mean age 10.1 years, range 2-22 years) from an outbreak in 1988-9 in Finland were tested for measles-virus IgG avidity using a protein denaturating EIA. Severity of measles was recorded in 89 failures and 169 non-vaccinees (mean age 16.2 years, range 2-22 years). The patients with HA antibodies (n = 28) tended to have clinically mild measles and rapid IgG response. Among failures vaccinated at < 12, 12-15 and > 15 months of age with single doses of Schwarz-strain vaccine in the 1970s, 50 (95% CI 1-99), 36 (CI 16-56) and 25% (CI 8-42) had HA antibodies, respectively. When a single measles, mumps and rubella (MMR) vaccine had been given after 1982 at 15 months of age, only 7% (CI 0-14) showed HA antibodies. Omitting re-vaccinees and those vaccinated at < 15 months, Schwarz-strain recipients had 3.6 (CI 1.1-11.5) higher occurrence of HA responses compared to MMR recipients. Apart from one municipality, where even re-vaccinees had high risk of primary infection, 89% (CI 69 to approximately 100) of the infected re-vaccinees had an HA response. Secondary measles-vaccine failures are more common than was more previously thought, particularly among individuals vaccinated in early life, long ago, and among re-vaccinees. Waning immunity even among individuals vaccinated after 15 months of age, without the boosting effect of natural infections should be considered a relevant possibility in future planning of vaccination against measles.

Etiology of hepatocellular carcinoma in Italian patients with and without cirrhosis

We performed a case-control study to assess the role of hepatitis B virus (HBV), hepatitis C virus (HCV), GB virus C/hepatitis G virus (HGV), TT virus, alcohol intake, and tobacco smoking as risk factors for hepatocellular carcinoma (HCC) in the presence or absence of cirrhosis. We prospectively recruited 174 patients with a first diagnosis of HCC admitted to the main hospitals in Brescia, North Italy. On the basis of histological, clinical, and radiological criteria, the presence of cirrhosis was established in 142 cases, excluded in 21 cases, and remained undefined in 11 cases. Among the HCC cases without cirrhosis, a histological picture of normal liver was found in a single patient, chronic viral hepatitis was found in 11 patients, alcoholic hepatitis was found in 5 patients, nonspecific reactive hepatitis was found in 3 patients, and hemochromatosis was found in 1 patient. As controls, we also included 610 subjects unaffected by hepatic diseases and admitted to the same hospitals as cases. The odds ratios for having HCC according to positivity for HCV RNA, HBsAg and/or HBV DNA, and alcohol intake > 80 g/day (95% confidence interval) were as follows, in the presence and absence of cirrhosis, respectively: (a) 33.5 (17.7-63.4) and 19.7 (6-64.8) for HCV RNA; (b) 17.6 (9.0-34.4) and 20.3 (5.7-72.6) for HBsAg; and (c) 5.5 (3.1-9.7) and 4.6 (1.5-13.8) for alcohol intake. No association was found with HGV or TT virus infections or tobacco. This study has shown that most HCC cases arising in the area are due to HBV, HCV, or alcohol intake, in both the presence and absence of cirrhosis.

The association between c-fos and c-jun expression and estrogen and progesterone receptors is lost in human endometrial cancer

In normal human endometrium, expressions of the proto-oncogenes c-fos and c-jun parallel. We have previously shown that the expression of c-jun is related to proliferation and estrogen receptor (ER) status in endometrial epithelial cells. In this study, we analyzed endometrial cancer tissues for c-fos and c-jun messenger RNA (mRNA) expression by Northern blotting. Proto-oncogene expression was compared with ER and progesterone receptor (PR) status and with the proliferation marker Ki-67, as well as with histological grade and the use of hormone-replacement therapy (HRT). Messenger RNA for c-fos was detected in 35 of 37 cancer tissues and mRNA for c-jun in 37 of 40 tissue samples studied. No correlation was observed between the relative mRNA levels of c-fos and c-jun, suggesting distinct control mechanisms, if any, in endometrial cancer. In contrast to normal endometrium, there was no correlation between the proto-oncogene expression and Ki-67, ER or PR immunoreactivity. Neither were there any correlations between c-fos or c-jun expression and the histological grade of the tumor or preceding HRT. Our results reveal the loss of association between proto-oncogene expression and ovarian steroid receptors or cell proliferation in malignant endometrium. This gives further support to the hypothesis that alterations in estrogen and progesterone signalling pathways are involved in the pathogenesis of endometrial cancer.

Characterization of T cell epitopes in measles virus nucleoprotein

T cell epitopes of the measles virus (MV) nucleoprotein were studied by synthesizing overlapping 20 aa peptides over the known sequence of the protein and analysing the proliferation responses of a panel of MV-specific T cell lines and clones against these peptides. T cell lines were established from eleven healthy controls and seven multiple sclerosis patients, all with a history of past MV infection. The epitopes recognized by these lines were concentrated in a few regions of the polypeptide chain. Overlapping peptides containing aa 321-340 and 331-350 were most often recognized. Other epitopes were detected close to the amino-terminal end of the polypeptide chain as each of the peptides 1-20, 21-40, 31-50 and 51-70 contained stimulating moieties. Some responses were also detected towards peptides 151-200 and 221-250, but the carboxy-terminal end of the polypeptide was not recognized by any of the tested T cell lines. The amino acid sequences of the peptides that stimulated the T cell clones and lines, as a rule, contained binding motifs described for HLA-DR alleles found in T cell donors. The regions of protein sequence which did not reveal any T cell epitopes were, instead, relatively free of binding motifs. The results suggest that only a few epitopes of the MV nucleoprotein are important in establishing T cell immunity.

The effect of intrauterine levonorgestrel use on the expression of c-JUN, oestrogen receptors, progesterone receptors and Ki-67 in human endometrium

The major regulators of endometrial function are oestrogen and progesterone, which act through binding their nuclear receptors and by activating transcription of their target genes. Interactions between steroid receptors and transcription proteins, e.g. c-JUN/AP-1, can modulate steroid action at the transcriptional level. The 19-nortestosterone-derived progestin, levonorgestrel, is used for contraception, treatment of menorrhagia and for endometrial protection during hormone replacement therapy, but the signalling pathways of its action are totally undefined. We examined the effect of an intrauterine system, releasing 20 microg of levonorgestrel per 24 h (LNG-IUS), on immunoreactive oestrogen receptor, progesterone receptor, c-JUN and Ki-67 expression in 29 endometrial specimens, obtained from fertile women using the LNG-IUS for contraception. Moderate to strong immunostaining for oestrogen receptors was observed in the stromal cells in all specimens, in glandular epithelial cells in 26 cases and in flattened luminal epithelial cells in 17 specimens. Decidualized stromal cells showed no progesterone receptor immunoreactivity in 19 of the 29 specimens, and weak to moderate immunostaining in 10 cases. Luminal epithelial cells were negative for progesterone receptor in all samples. Intense nuclear staining for C-JUN was observed in epithelial cells in 26 and in decidualized stromal cells in all 29 of the samples. In 16 samples, Ki-67 immunoreactivity was evaluated as weak to moderate in decidualized stroma, and in 13 samples absent. Our data demonstrate that intrauterine release of LNG maintains constant expression of C-JUN and exerts progestational effects in the endometrium in the absence of progesterone receptors. In contrast, LNG-IUS inhibits several cellular responses to oestrogen despite the presence of endogenous oestrogen and oestrogen receptors. These data suggest that the progestational effects induced by progesterone and levonorgestrel are mediated through different signalling pathways.

Ultrasound-guided fine needle biopsy of pancreatic masses: results of a multicenter study

OBJECTIVE

The aim of this study was to investigate the results of ultrasound-guided fine needle biopsy of pancreatic masses in a large multicenter series.

METHODS

This study collected the data of 510 patients who had a final diagnosis available and who had undergone ultrasound-guided fine needle biopsy of the pancreas. Retrieval rate, sensitivity, specificity, and overall diagnostic accuracy of the whole series, by three different bioptic procedures (cytology, histology, and cytology plus histology) were evaluated. The reliability of ultrasound-guided fine needle biopsy to allow a correct diagnosis in the different pancreatic pathologies was calculated. Finally, any complications were collected.

RESULTS

For cytology, histology, and cytology plus histology, retrieval rate values were: 94%, 96%, and 97%; sensitivity was: 87%, 94%, and 94%, specificity: 100%; and diagnostic accuracy: 91%, 90%, and 95%, respectively. Ultrasound-guided fine-needle biopsy correctly diagnosed all the cases of pancreatic metastases or non-Hodgkin's lymphoma (23 of 510 cases as 5%; in eight of 23 it led to the first diagnosis of the primary tumor) and all the cases of abscesses, 97% of the cases of pseudocysts, 86% of pancreatic adenocarcinomas, 62% of cystic neoplasms, 35% of the cases of chronic pancreatitis (in this case, the bioptic procedures were reviewed), and 33% of neuroendocrine tumors. There were complications in one case of asymptomatic peripancreatic hematoma, three cases of vaso-vagal reactions, and 21 cases of pain.

CONCLUSION

Ultrasound-guided fine needle biopsy of the pancreas is efficacious, without any difference between the various bioptic modalities (with the exception of chronic pancreatitis, in which histology is better). The technique is safe. Moreover, the procedure allows the identification of patients affected by pancreatic tumors other than adenocarcinoma (in our survey 5% of the total); in about one third of these patients it leads to the diagnosis of the primary tumor, thus avoiding inappropriate treatments.

Ultrasound-guided fine needle biopsy of pancreatic masses: results of a multicenter study

OBJECTIVE

The aim of this study was to investigate the results of ultrasound-guided fine needle biopsy of pancreatic masses in a large multicenter series.

METHODS

This study collected the data of 510 patients who had a final diagnosis available and who had undergone ultrasound-guided fine needle biopsy of the pancreas. Retrieval rate, sensitivity, specificity, and overall diagnostic accuracy of the whole series, by three different bioptic procedures (cytology, histology, and cytology plus histology) were evaluated. The reliability of ultrasound-guided fine needle biopsy to allow a correct diagnosis in the different pancreatic pathologies was calculated. Finally, any complications were collected.

RESULTS

For cytology, histology, and cytology plus histology, retrieval rate values were: 94%, 96%, and 97%; sensitivity was: 87%, 94%, and 94%, specificity: 100%; and diagnostic accuracy: 91%, 90%, and 95%, respectively. Ultrasound-guided fine-needle biopsy correctly diagnosed all the cases of pancreatic metastases or non-Hodgkin's lymphoma (23 of 510 cases as 5%; in eight of 23 it led to the first diagnosis of the primary tumor) and all the cases of abscesses, 97% of the cases of pseudocysts, 86% of pancreatic adenocarcinomas, 62% of cystic neoplasms, 35% of the cases of chronic pancreatitis (in this case, the bioptic procedures were reviewed), and 33% of neuroendocrine tumors. There were complications in one case of asymptomatic peripancreatic hematoma, three cases of vaso-vagal reactions, and 21 cases of pain.

CONCLUSION

Ultrasound-guided fine needle biopsy of the pancreas is efficacious, without any difference between the various bioptic modalities (with the exception of chronic pancreatitis, in which histology is better). The technique is safe. Moreover, the procedure allows the identification of patients affected by pancreatic tumors other than adenocarcinoma (in our survey 5% of the total); in about one third of these patients it leads to the diagnosis of the primary tumor, thus avoiding inappropriate treatments.

Cellular localization of c-jun messenger ribonucleic acid and protein and their relation to the proliferation marker Ki-67 in the human endometrium

We studied cellular c-jun messenger RNA (mRNA) expression in the human endometrium during the menstrual cycle (n = 47) and in human decidua during pregnancy (n = 8), by using digoxigenin-labeled RNA probes in in situ hybridization. The same tissue samples were also analyzed for c-Jun protein and the proliferation marker Ki-67. In the proliferative endometrium, strong expression of c-jun was detected in luminal and glandular epithelium as well as in fibroblast-like stromal cells. During the early luteal phase, strong hybridization signals were identified in both epithelial and stromal compartments, with the strongest hybridization in the stromal cells beneath the epithelium. c-jun mRNA was markedly diminished in luminal and glandular epithelia of mid- and late secretory phase endometria, but it remained unchanged in the stroma. Regardless of the phase of the menstrual cycle, significant hybridization was identified in endothelial cells in the endometrium and myometrium, and a low signal was detected in myometrial muscle cells as well. During early gestation, weak expression of c-jun mRNA was observed in glandular epithelial cells and in decidualized stromal cells. In term pregnancy decidua, only low-level hybridization was detected in a few decidual cells. Nuclear immunostaining of c-Jun was detected in luminal and glandular epithelia and in stroma throughout the menstrual cycle. The location of Ki-67 antigen was temporally related to the c-jun mRNA expression in cycling endometrium and pregnancy decidua. From our data we conclude that 1) c-jun mRNA is differentially expressed in endometrial epithelial and stromal cells; 2) c-jun mRNA is cyclically regulated in the human endometrial epithelium; 3) c-jun mRNA expression is temporally related to epithelial proliferation in the endometrium; and 4) c-Jun protein is present in the human endometrium throughout the menstrual cycle.

Percutaneous ethanol injection in the treatment of hepatocellular carcinoma. A multicenter survey of evaluation practices and complication rates

BACKGROUND

Percutaneous ethanol injection (PEI) has become a widely used procedure in the treatment of hepatocellular carcinoma (HCC). However, the criteria for selecting patients are not standardized, and little information is available about the complications of the procedure.

METHODS

A questionnaire was sent to 11 experienced Italian centers. It investigated: the size and the number of HCC nodules suitable for treatment and the Child-Pugh risk class of the associated cirrhosis; the performance of the procedure; the number and characteristics of the patients treated; and, finally, any complications.

RESULTS

Most of the centers performed PEI in single HCC nodules less than 5 cm in diameter or in multiple nodules if fewer than three, the larger being less than 3 cm. Patients in Child-Pugh's classes A, B, and C with single nodules were generally considered for PEI. A prothrombin time of less than 40% and a platelet count of less than 40,000/mm3 contraindicated PEI in most of the centers. PEI was generally performed on outpatients, using Chiba or spinal needles. One thousand and sixty-six patients (8118 sessions) were enrolled; 74% had a single HCC nodule and 26% multiple nodules. All except four had cirrhosis; 53% were in Child class A, 38% in class B, and 9% in class C. The mean number of sessions needed to destroy an HCC nodule was 6.7 (range, 2-14), with a mean alcohol injection volume of 5.0 ml per session (range, 2-20 ml). One death (0.09%) and 34 complications (3.2%) were reported. Among the complications we call attention to the hemorrhagic ones (eight cases) and tumoral seeding (seven cases). Severe pain experienced during the maneuver led to discontinuation of the procedure in 3.7% of the patients; 13.5% of the patients required analgesics and 24% had fever after PEI.

CONCLUSIONS

Some procedural aspects of PEI treatment differ among the various centers a standardization is advisable. In the present survey PEI is a low-risk technique.

The interleukin-1 system in gestational tissues at term: effect of labour

Previous studies suggest that the interleukin-1 (IL-1) system is involved in preterm labour, at least in cases associated with intrauterine infection. To investigate the effect of term labour without infection on the IL-1 system, the messenger ribonucleic acid (mRNA) expression of IL-1 beta, IL-1 receptor type I (IL-1R tI), IL-1 receptor antagonist (IL-1ra), and IL-1 beta converting enzyme (ICE) were examined by Northern blot analysis and by reverse transcriptase-polymerase chain reaction (RT-PCR) in paired samples of decidua and placenta obtained from women having spontaneous vaginal delivery (group 1) or elective caesarean section (group 2) at term. In addition, concentrations of IL-1 beta and IL-1ra proteins were measured by ELISA in paired decidual and placental cytosols. In all decidual samples, IL-1 beta mRNA was expressed strongly, and the IL-1 beta concentration was 40- to 50-fold higher than in paired placental samples, in which the signal for IL-1 beta mRNA could be detected by RT-PCR only, and the amount of IL-1 beta protein was undetectable or very low. A comparison between the study groups revealed that the decidual IL-1 beta mRNA level tended to be higher in group 1, and the median IL-1 beta concentration in decidual cytosols was significantly higher in group 1 than in group 2 (P < 0.05). The IL-1R tI mRNA transcript was stronger in decidual than in paired placental samples in both groups. The mRNAs encoding ICE and IL-1ra were detected by RT-PCR in decidual and placental samples from both groups. The IL-1ra concentration tended to be higher in decidual cytosols than in paired placental cytosols, but there was no difference between the study groups. The IL-1ra/IL-1 beta ratio was significantly lower in decidual samples in women with spontaneous labour than in women without labour (P < 0.05). The results of this study confirm that decidua is the major site of IL-1 beta production and action in term gestational tissues. Furthermore, the results show that the major change in decidual/placental IL-1 system during parturition is the increase in decidual IL-1 beta production. Whether the increased IL-1 beta production precedes or is a consequence of labour, remains still unclear.