Use of an Online Forum for Relatives of People With Psychosis and Bipolar Disorder: Mixed Methods Study

BACKGROUND

Relatives of people with psychosis or bipolar disorder experience high levels of distress but are typically not offered the support they need. Online peer forums may offer a solution, but knowledge about who uses them, how, and why is limited. This study reported on online forum use during the Relatives Education and Coping Toolkit (REACT) trial.

OBJECTIVE

We aimed to report who used the forum and why; how sociodemographic factors are associated with participation; the relationship among frequency, type of use, and outcomes; and how the forum was used.

METHODS

The relationships between key sociodemographic characteristics, levels of forum use, and distress were statistically analyzed. We used thematic and semantic analyses to understand the reasons for relatives joining the forum and the key topics initiated by them. We also used the University Centre for Computer Corpus Research on Language Semantic Analysis System to compare how relatives and REACT supporters (moderators) used the forum.

RESULTS

A total of 348 participants with full forum use data from REACT were included in this study. The forum was accessed by 59.4% (207/348) of the relatives across the entire age range, with no significant associations between sociodemographic factors and forum participation, or between level or type of use and relatives' distress levels. Relatives joined the forum primarily to find people in similar circumstances, express concerns, and talk about stressful events. Relatives were most concerned about recent events, negative emotions linked to caring, experiences of conflict or threat, and concerns about suicide. These posts underscored both the challenges the relatives were facing and the fact that they felt safe sharing them in this context.

CONCLUSIONS

Although only a proportion of REACT participants engaged actively with its forum, they were widely distributed across age and other sociodemographic groupings. Relatives used the forum for information, support, and guidance and to offer detailed information about their experiences. The topics raised highlighted the burden carried by relatives and the potential value of easy-access, moderated, peer-supported forums in helping relatives to manage the challenges they faced.

The anticonvulsant effect of chronic treatment with topiramate after pilocarpine-induced status epilepticus is accompanied by a suppression of comorbid behavioral impairments and robust neuroprotection in limbic regions in rats

Epilepsy is a widespread neurological disorder frequently associated with a lot of comorbidities. The present study aimed to evaluate the effects of the antiseizure medication topiramate (TPM) on spontaneous motor seizures, the pathogenesis of comorbid mood and cognitive impairments, hippocampal neuronal loss, and oxidative stress and inflammation in a rat model of temporal lobe epilepsy (TLE). Vehicle/TPM treatment (80 mg/kg, p.o.) was administered 3 h after the pilocarpine (pilo)-induced status epilepticus (SE) and continued for up to 12 weeks in Wistar rats. The chronic TPM treatment caused side effects in naïve rats, including memory disturbance, anxiety, and depressive-like responses. However, the anticonvulsant effect of this drug, administered during epileptogenesis, was accompanied by beneficial activity against comorbid behavioral impairments. The drug treatment suppressed the SE-induced neuronal damage in limbic structures, including the dorsal (CA1 and CA2 subfield), the ventral (CA1, CA2 and CA3) hippocampus, the basolateral amygdala, and the piriform cortex, while was ineffective against the surge in the oxidative stress and inflammation. Our results suggest that neuroprotection is an essential mechanism of TPM against spontaneous generalized seizures and concomitant emotional and cognitive impairments.

Reduced neuroinflammation and enhanced neurogenesis following chronic agomelatine treatment in rats undergoing chronic constant light

Experimental studies have revealed the involvement of neuroinflammation mediated by activated microglia in the pathophysiology of depression, suggesting a novel target for treatment. The atypical antidepressant Agomelatine (Ago) has an advantage compared to the classical antidepressants due to its chronobiotic activity and unique pharmacological profile as a selective agonist at the melatonin receptors and an antagonist at the 5HT_2C receptors. We have recently revealed that Ago can exert a potent antidepressant effect in rats exposed to a chronic constant light (CCL). In the present study, we hypothesized that the anti-inflammatory activity of this melatonin analog on activated neuroglia in specific brain structures might contribute to its antidepressant effect in this model. Chronic Ago treatment (40 mg/kg, i.p. for 21 days) was executed during the last 3 weeks of a 6-week period of CCL exposure in rats. The CCL-vehicle-treated rats showed a profound neuroinflammation characterized by microgliosis and astrogliosis in the hippocampus, basolateral amygdala (BL) and partly in the piriform cortex (Pir) confirmed by immunohistochemistry. With the exception of the Pir, the CCL regime was accompanied by neuronal damage, identified by Nissl staining, in the hippocampus and basolateral amygdala and impaired neurogenesis with reduced dendritic complexity of hippocampal neuroprogenitor cells detected by doublecortin-positive cells in the dentate gyrus (DG) subgranular zone compared to the control group. Ago reversed the gliosis in a region-specific manner and partially restored the suppressed DG neurogenesis. Ago failed to produce neuroprotection in CCL exposed rats. The present results suggest that the beneficial effects of Ago represent an important mechanism underlying its antidepressant effect in models characterized by impaired circadian rhythms.

Chronic agomelatine treatment alleviates icvAβ-induced anxiety and depressive-like behavior through affecting Aβ metabolism in the hippocampus in a rat model of Alzheimer's disease

Recently, we reported that the atypical antidepressant agomelatine (Ago) exerted a beneficial impact on behavioral changes and concomitant neuropathological events in icvSTZ rat model of sporadic Alzheimer diseases (AD). In the present study, we aimed to explore the effect of Ago (40 mg/kg, i.p. for 30 days) on beta-amyloid (Aβ) metabolism in icvAβ_1-42 rat model of AD. The melatonin analogue was administered either simultaneously with Aβ_1-42 (AβAgo1) or 30 days later during the late stage of the progression of AD (AβAgo2). Treatment with Ago in the early stage of AD attenuated anxiety and depressive-like responses but was inefficient against Aβ-induced impairment of hippocampus-dependent spatial memory. The melatonin analogue, administered both during the early and the late stage of AD, corrected to control level the elevated Aβ_1-42 in the frontal cortex (FC) and the hippocampus. The concentration of α-secretase was enhanced by AβAgo1 compared to the sham- and Aβ-veh groups in the hippocampus. No changes in the concentration of β-secretase in the FC and the hippocampus as well as of γ-secretase in the FC were observed among groups. Both the AβAgo1 and AβAgo2 attenuated to control level the Aβ-induced increased concentration of γ-secretase in the hippocampus. AβAgo1 exerted also structure-specific neuroprotection observed mainly in the CA1, septal CA3b subfield of the dorsal hippocampus and septo-temporal piriform cortex (Pir) and partially in the temporal CA3c, septal and temporal Pir. These findings suggest that Ago treatment in the early stage of AD can exert beneficial effects on concomitant behavioral impairments and neuroprotection in associated brain structures. The antidepressant administration both in the early stage and after the progression of AD affected Aβ metabolism via decreasing of γ-secretase concentration in the hippocampus.

Changing frames of obesity in the UK press 2008-2017

Obesity is a persistently newsworthy topic for the UK press and in recent years levels of coverage have increased. In this study, we examine the ways in which obesity has been framed by the press over a ten-year period (2008-2017), focussing both on areas of stability and change. The analysis is based on a ~36 million-word database of all UK newspaper articles mentioning the words 'obese' or 'obesity' published within this time frame and draws upon techniques from corpus linguistics - a collection of computational methods for examining recurrent linguistic patterns in large bodies of language data. Our analysis shows that, over time, obesity is represented increasingly as a biomedical problem that is both caused and should be prevented by individual action. Meanwhile, focus on wider environmental determinants of health, including the role of Government and the food industry, decreases over time. In the paper, we situate these trends within the wider context of UK society and argue that they both represent the increasing dominance of neoliberal models of health but also have the potential to contribute to weight stigma and the blaming of individuals. Accordingly, it is argued that the press should seek greater balance in its reporting of the potential causes of and solutions to obesity, as well as closer alignment with scientific evidence. By doing so, the press could begin to report on obesity in a way that raises useful public awareness around the topic and which challenges some of the stigma that currently attends to this social justice issue.

Is the Newly Described Interstitial Network the Anatomical Basis of Acupuncture Meridians? A Commentary

A network passing through interstitial tissues of the human body has been recently described. Despite its functional importance is yet unknown, we try to briefly summarize the known data and to interpret it from the viewpoint of Traditional Chinese medicine. We consider the peculiarities of the interstitium to be the morphological basis of at least some of the known phenomena along acupuncture meridians.

Agomelatine alleviates neuronal loss through BDNF signaling in the post-status epilepticus model induced by kainic acid in rat

Recently, we have reported that while agomelatine (Ago) is unable to prevent development of epilepsy it exerts a strong neuroprotective and anti-inflammatory response in the KA post-status epilepticus (SE) rat model. In the present study, we aimed to explore whether the brain-derived neurotrophic factor (BDNF) in the hippocampus is involved in the neuroprotective effect of Ago against the KA-induced SE and epileptiform activity four months later in rats. Lacosamide (LCM) was used as a positive control. The EEG-recorded seizure activity was also evaluated in two treatment protocols. In Experiment#1, Ago given repeatedly at a dose of 40 mg/kg during the course of SE was unable neither to modify EEG-recorded epileptiform activity nor the video- and EEG-recorded spontaneous seizures four months later compared to LCM (50 mg/kg). However, both Ago and LCM inhibited the expression of BDNF in the mossy fibers and also prevented neuronal loss in the dorsal hippocampal and the piriform cortex after SE. In Experiment#2, acute injection of Ago and LCM on epileptic rats, characterized by high seizure rates, did not prevent EEG-recorded paroxysmal events while only LCM decreased either absolute or relative powers of gamma (28-60 Hz) and high (HI) (60-120 Hz) frequency bands to baseline in the frontal and parietal cortex, respectively. Our results suggest that the protection against neuronal loss in specific limbic regions and overexpressed BDNF in the mossy fibers resulting from the repeated treatment with Ago and LCM, respectively, during SE is not a prerequisite for alleviation of epileptogenesis and development of epilepsy. In addition, a reduction of gamma and HI bands in the frontal and parietal cortex is not associated with EEG-recorded paroxysmal events after acute injection of LCM.

Antidepressant agomelatine attenuates behavioral deficits and concomitant pathology observed in streptozotocin-induced model of Alzheimer's disease in male rats

Experimental findings suggest that the melatonin system has a beneficial role in models of Alzheimer's disease (ADs). The aim of the present study was to explore whether the atypical antidepressant agomelatine (Ago), which is a melatonin MT₁ and MT₂ agonist and 5-HT_2C antagonist, is effective against behavioral, biochemical and histological impairments in streptozotocin (STZ)-induced model of ADs in male rats. Male Sprague Dawley rats were treated intraperitoneally (i.p.) with Ago (40 mg/kg) for 30 days starting three months following the intracerebroventricular (icv) injection of STZ. Chronic Ago treatment reduced anxiety-like behavior of STZ-treated rats in the elevated plus maze, increased the preference to saccharine and corrected the spatial memory impairment in the eight-arm radial arm maze test. This melatonin analogue restored STZ-induced biochemical changes, including an increase of beta amyloid (Aβ) protein, and signal markers of inflammation (TNF-alpha and IL-1 beta). Ago exerted partial neuroprotection, specifically in the temporal CA3b subfield of the dorsal hippocampus and temporal piriform cortex. The ability of Ago to alleviate behavioral symptoms and concomitant neuropathological events observed in a model of sporadic ADs suggests that this melatonin alternative can be considered a promising adjuvant in this disease.

Thermo-rheological responsive microcapsules for time-dependent controlled release of human mesenchymal stromal cells

Human mesenchymal stromal cells (hMSCs) are adult-source cells that have been extensively evaluated for cell-based therapies. hMSCs delivered by intravascular injection have been reported to accumulate at the sites of injury to promote tissue repair and can also be employed as vectors for the delivery of therapeutic genes. However, the full potential of hMSCs remains limited as the cells are lost after injection due to anoikis and the adverse pathologic environment. Encapsulation of cells has been proposed as a means of increasing cell viability. However, controlling the release of therapeutic cells over time to target tissue still remains a challenge today. Here, we report the design and development of thermo-rheological responsive hydrogels that allow for precise, time dependent controlled-release of hMSCs. The encapsulated hMSCs retained good viability from 76% to 87% dependent upon the hydrogel compositions. We demonstrated the design of different blended hydrogel composites with modulated strength (S parameter) and looseness of hydrogel networks (N parameter) to control the release of hMSCs from thermo-responsive hydrogel capsules. We further showed the feasibility for controlled-release of encapsulated hMSCs within 3D matrix scaffolds. We reported for the first time by a systematic analysis that there is a direct correlation between the thermo-rheological properties associated with the degradation of the hydrogel composite and the cell release kinetics. This work therefore provides new insights into the further development of smart carrier systems for stem cell therapy.

Losartan suppresses the kainate-induced changes of angiotensin AT1 receptor expression in a model of comorbid hypertension and epilepsy

AIMS

Experimental and clinical studies have demonstrated that components of renin-angiotensin system are elevated in the hippocampus in epileptogenic conditions. In the present work, we explored the changes in the expression of angiotensin II receptor, type 1 (AT₁ receptor) in limbic structures, as well as the effect of the AT1 receptor antagonist losartan in a model of comorbid hypertension and epilepsy.

MAIN METHODS

The expression of AT₁ receptors was compared between spontaneously hypertensive rats (SHRs) and Wistar rats by using immunohistochemistry in the kainate (KA) model of temporal lobe epilepsy (TLE). The effect of losartan was studied on AT₁ receptor expression in epileptic rats that were treated for a period of 4weeks after status epilepticus.

KEY FINDINGS

The naive and epileptic SHRs were characterized by stronger protein expression of AT₁ receptor than normotensive Wistar rats in the CA1, CA3a, CA3b, CA3c field and the hilus of the dentate gyrus of the dorsal hippocampus but fewer cells were immunostained in the piriform cortex. Increased AT₁ immunostaining was observed in the basolateral amygdala of epileptic SHRs but not of epileptic Wistar rats. Losartan exerted stronger and structure-dependent suppression of AT₁ receptor expression in SHRs compared to Wistar rats.

SIGNIFICANCE

Our results confirm the important role of AT₁ receptor in epilepsy and suggest that the AT₁receptor antagonists could be used as a therapeutic strategy for treatment of comorbid hypertension and epilepsy.

Climate change on Twitter: Content, media ecology and information sharing behaviour

This article presents a study of the content, use of sources and information sharing about climate change analysing over 60,000 tweets collected using a random week sample. We discuss the potential for studying Twitter as a communicative space that is rich in different types of information and presents both new challenges and opportunities. Our analysis combines automatic thematic analysis, semantic network analysis and text classification according to psychological process categories. We also consider the media ecology of tweets and the external web links that users shared. In terms of content, the network of topics uncovered presents a multidimensional discourse that accounts for complex causal links between climate change and its consequences. The media ecology analysis revealed a narrow set of sources with a major role played by traditional media and that emotionally arousing text was more likely to be shared.

Representations of mental health and arts participation in the national and local British press, 2007–2015

We analysed news articles published in national and local British newspapers between 2007 and 2015 to understand (1) how mental health and arts participation were framed and (2) how the relationships between participants in arts initiatives were conceptualised. Using corpus-assisted qualitative frame analysis, we identified frames of recovery, stigma and economy. The recovery frame, which emphasised that mental illness can be treated similarly to physical illness, positioned arts participation as a form of therapy that can complement or substitute medication. The stigma frame presented arts participation as a mechanism for challenging social conceptions that mentally ill individuals are incapable of productive work. The economy frame discussed the economic burden of mentally ill individuals and portrayed arts participation as facilitating their return to employment. Using thematic analysis, which paid attention to the representation of social actors, we found that service users were identified as the prime beneficiaries of arts initiatives, and arts participation was conceptualised as a way to bring people with mental health issues together. We discuss these findings against existing research on media representations of mental health and the concept of ‘mutual recovery’ and suggest what wider concurrent developments in the areas of mental health and the media may account for the uncovered frames and themes.

Agomelatine protects against neuronal damage without preventing epileptogenesis in the kainate model of temporal lobe epilepsy

Recent studies about the novel antidepressant agomelatine, which is a mixed MT₁ and MT₂ melatonin receptor agonist and 5HT_2C serotonin receptor antagonist possessing an anticonvulsant and neuroprotective action, suggest that it may have potential to contribute against epileptogenesis and epilepsy-induced memory impairment. In order to ascertain whether protection of some brain structures could suppress epileptogenesis, in the present study, we evaluated the effect of chronic post-status treatment with agomelatine on epileptogenesis, behavioral and neuronal damage induced by kainate acid (KA) status epilepticus (SE). Agomelatine/vehicle treatment (40mg/kg, i.p.) started one hour after SE and continued up to 10weeks in Wistar rats. Latency for onset of spontaneous motor seizures (SMS) and their frequency was detected by a 24-h video-recording. Locomotor activity, anxiety and hippocampus-dependent spatial memory in open field (OF), elevated plus maze (EPM), light-dark test (LDT) and radial arm maze (RAM) test, respectively, were evaluated during the last two weeks after SE. Agomelatine significantly decreased the latency for onset of SMS and increased the seizure frequency during the 2nd and the 3rd week of treatment. The MT₁ and MT₂ receptor agonist and serotonin 5HT_2C receptor antagonist exacerbated the KA-induced hyperlocomotion and impulsive behavior and it was unable to prevent spatial memory impairment of epileptic rats. However, agomelatine induced a neuroprotection in the dorsal hippocampus, specifically in the CA1, septal CA2 and partially in the CA3c region, the hilus of the dentate gyrus, piriform cortex and septo-temporal and temporal basolateral amygdala. Our findings suggest that the beneficial impact against SE-induced neuronal loss exerted by agomelatine is not crucial for the suppression of epileptogenesis and its deleterious consequences in KA model of temporal lobe epilepsy.

Acupuncture causes serotonin release by mast cells

Mast cells (MCs) are important object in experimental acupuncture due to their putative involvement in local reactions to needling. In the rat, they are shown to contain in their granules, among other tissue mediators, serotonin, also called 5-hydroxytryptamine (5-HT). The aim of this study is to examine the normal distribution of 5-HT-containing MCs in soft tissues of Zusanli (ST36) acupuncture point (acupoint) and their morphological changes caused by experimental acupuncture. We observed 5-HT-immunopositive MCs in the tissues and in the vicinity of the needle tract formed after acupuncture. As a result of acupuncture needling, the tissue integrity is disrupted and certain folds are formed in the direction of the needle tract. Connective tissue in the vicinity of the needle tract gets compressed and displaced, together with the 5-HT-immunoreactive MCs seen there. Some of those 5-HT-immunopositive MCs showed signs of degranulation with numerous discharged granules, some of them found at a considerable distance form the cell. Furthermore, 5-HT-immunopositive MCs are unevenly distributed in soft tissues of ST36 acupoint. Larger numbers of 5-HT-containing MCs were visualized in subcutis and dermis, compared to the observed in striated muscles. Placing the acupuncture needle into the rat skin caused a formation of an apparent needle tract, tissue displacement and degranulation of 5-HT-immunopositive MCs. The demonstrated serotonin release by means of MC degranulation might be involved in the local tissue response to acupuncture.

Obesity frames and counter-frames in British and German online newspapers

By featuring news articles highlighting certain aspects of obesity and backgrounding others, the media can frame these aspects as especially applicable to how obesity should be understood and addressed. Despite the highest rates in Europe, news reports from Britain and Germany have come under little scholarly scrutiny. In this article, we explore frames and their frequency of use in British and German online newspapers. Our findings reveal a dominant cross-national framing of obesity in terms of ‘self-control’, which places a more pronounced emphasis on individual responsibility than demonstrated by earlier studies and may contribute to a culture of weight bias and stigma. The results also reveal evidence for cross-national efforts to challenge this individualising framing with counter-frames of ‘acceptance’ and ‘coming out’. We argue that this is a positive development, which demonstrates the potential of media frames to function not only as possible contributors to weight bias and stigma but also as mechanisms for countering entrenched social conceptions of obesity.

Effect of endurance training on seizure susceptibility, behavioral changes and neuronal damage after kainate-induced status epilepticus in spontaneously hypertensive rats

The therapeutic efficacy of regular physical exercises in an animal model of epilepsy and depression comorbidity has been confirmed previously. In the present study, we examined the effects of endurance training on susceptibility to kainate (KA)-induced status epilepticus (SE), behavioral changes and neuronal damage in spontaneously hypertensive rats (SHRs). Male SHRs were randomly divided into two groups. One group was exercised on a treadmill with submaximal loading for four weeks and the other group was sedentary. Immediately after the training period, SE was evoked in half of the sedentary and trained rats by KA, while the other half of the two groups received saline. Basal systolic (SP), diastolic (DP) and mean arterial pressure (MAP) of all rats were measured at the beginning and at the end of the training period. Anxiety, memory and depression-like behaviour were evaluated a month after SE. The release of 5-HT in the hippocampus was measured using a liquid scintillation method and neuronal damage was analyzed by hematoxylin and eosin staining. SP and MAP of exercised SHRs decreased in comparison with the initial values. The increased resistance of SHRs to KA-induced SE was accompanied by an elongated latent seizure-free period, improved object recognition memory and antidepressant effect after the training program. While the anticonvulsant and positive behavioral effects of endurance training were accompanied by an increase of 5-HT release in the hippocampus, it did not exert neuroprotective activity. Our results indicate that prior exercise is an effective means to attenuate KA-induced seizures and comorbid behavioral changes in a model of hypertension and epilepsy suggesting a potential influence of hippocampal 5-HT on a comorbid depression. However, this beneficial impact does not prevent the development of epilepsy and concomitant brain damage.

Histochemical demonstration of tripeptidyl aminopeptidase I in the rat carotid body

Tripeptidyl aminopeptidase I (TPP I) is a lysosomal exopeptidase that is widely distributed throughout the central nervous system (CNS) and internal organs in many mammalian species. The enzyme is involved in the breakdown of collagen and different peptides. The carotid body (CB) is the main peripheral arterial chemoreceptor playing an important role in the control of breathing and the autonomic control of cardiovascular function. In response to hypoxia its neuron-like glomus cells release a variety of peptide transmitters that trigger an action potential through the afferent fibers, thus conveying the chemosensory information to the CNS. In the present study we investigated the histochemical localization of TPP I in the CB of rats. Enzyme histochemistry showed high activity of TPP I in CB glomeruli. In particular, the glomus cells contained many TPP I-positive granules, while the glial-like sustentacular cells displayed a slightly fainter reaction. The interglomerular connective tissue was also weakly stained. The results show that both the parenchymal cells of the rat CB express, albeit with different intensity, TPP I. Taken together with our previous enzyme histochemical investigations on the rat CB, it seems likely that the glomus cells possess enzymatic equipment necessary for the neuropeptide intracellular and collagen extracellular initial degradation. These findings also suggest that TPP I is involved in the general turnover of chemotransmitters between glomus cells and sensory nerve endings which emphasizes its importance for chemoreception under hypoxic conditions.

[CLINICAL PERFORMANCE OF DIFFERENT METHODS FOR CERVICAL SCREENING]

Cervical cancer is a serious medical and social issue as it affects women at active age and it is diagnosed too late. In Bulgaria morbidity and mortality show continuous increasing trend. The aim of this study is to compare the clinical performance of cytology and other alternative methods for cervical screening that could be used to assess the the cervix.

MATERIAL AND METHODS

This is a prospective study which included 317 patients aged between 18 and 65 years. Women were divided into four groups: I-st--cytology, Il-nd--visual inspection with acetic acid (VIA), III-th--visual inspection with Lugol's iodine (VILI) and IV-th--spectrophotometric analysis with TruScreen®. The results showed that the most appropriate screening method for cervical cancer remains cytology. In the absence of cytological laboratory or cytopathologist spectrophotometric analysis with TruScreen® can be used for primary cervical screening. Its main advantages are that it is a real time technique, user easy and it is well accepted by women. If TruScreen is not available in the gynecologist's practice it is possible to perform visual inspection with acetic acid (VIA).

[ABERRANT RIGHT SUBCLAVIAN ARTERY (ARSA)--A NEW ULTRASOUND MARKER FOR CHROMOSOMAL FETAL ABNORMALITIES]

The development of the fetal aorta ends with the formation of the aortic arch which normally branches into three blood vessels: 1) a. brachiocephalica (a. innominata), which divides into the right subclavian artery (RSA) and the right carotid artery; 2) the left carotid artery; and 3) the left subclavian artery. Occasionally, RSA originates as a separate fourth branch of the aortic arch, passing behind the trachea with an oblique course to the right shoulder. This rare variant is called an aberrant right subclavian artery (ARSA) and is observed in approximately 2% of normal individuals. On the other hand, the reported incidence of ARSA varies between 25 and 37% in cases with Down syndrome and other chromosomal abnormalities.

OBJECTIVE

To evaluate the success rate of ultrasound visualization of the fetal RSA between 18 and 23 weeks of gestation and to establish the importance of the prenatal diagnosis of ARSA in the risk assessment for fetal chromosomal abnormalities in the second trimester.

RESULTS

Three experienced sonographers scanned 992 fetuses in MC "Markovs", Sofia between 01.09.2013-01.06.2014 with Voluson 730 Expert (GE Healthcare) ultrasound equipment. Visualization of RSA was successful in 92.7% of cases. Overall, 17 cases with ARSA were diagnosed in the study period. ARSA was an isolated sonographic finding in 13 of them. The remaining 4 cases had additional pathology. In the first case ARSA was associated with a short femurand humerus, short nasal bone and borderline nuchal thickness without any other soft markers or structural abnormalities. Trisomy 21 was diagnosed after amniocentesis and the pregnancy was terminated at patient's request. In the second case ARSA was associated with severe polymalformation syndrome. Trisomy 18 was diagnosed by DNA analysis post abortem. In the third case ARSA was associated with an unilateral cleft lip and cleft palate. Abnormalities of the fetal karyotype and Di George syndrome were excluded by amniocentesis. The fourth case was associated with a single umbilical artery without any structural and chromosomal abnormalities. The pregnancy had a favourable perinatal outcome at term.

CONCLUSION

Visualization of RSA and prenatal diagnosis of ARSA in the second trimester is relatively easy in experienced hands. The examination slightly prolongs the fetal morphology scan. Since there is an obvious association between ARSA and chromosomal fetal abnormalities, implementation of its sonographic evaluation in the protocol of fetal echocardiography in the second trimester is strongly recommended.

Obesity in the news: directions for future research

Obesity attracts large volumes of news coverage. This in turn has spawned academic studies investigating how news framing may affect views about causes of and solutions to obesity. We use key studies to demonstrate that although existing research has made valuable discoveries about how obesity is defined in various media outlets, some methodological and theoretical questions remain unaddressed. We argue that extant research has focused on one dimension of analysis--the problematization of obesity in news stories--precluding insights into the entire process of obesity communication. Drawing on framing and media studies research, we propose a multidimensional approach to shed more light on factors affecting the production of obesity news stories by journalists and how they may be received by audience members. Ways of moving research into this multidimensional direction are proposed, including analysis of journalistic news values, political leaning and style of media outlets, emotion-eliciting language, readers' comments and obesity-related news visuals. Knowledge resulting from the exploration of these dimensions of the issue of obesity can be used to improve strategies to inform and engage audience members.

[Three-dimensional sonoembryology--myth or reality]

OBJECTIVE

To describe the normal development of the embryonic central nervous system (CNS) using three-dimensional (3D) transvaginal (TV) ultrasound (US) between 7 and 10 w.g. and to compare the embryonic development visualized by 3D TV US with that of the classical embryology.

METHODS

A prospective longitudinal study was conducted over a period of 10 months with high-end ultrasound equipment (Voluson 730 Expert, GE Healthcare, U.S.). Thirty six pregnant women between 7 and 10 weeks of gestation (w.g.) were examined. In all cases a high-frequency 30 TV probe was used to acquire a 3D volume of the embryo, including the cranial pole. Subsequently, the acquired volume information was post-processed and analyzed with specialized software 4D View ver. 9.1 (GE Healthcare, U.S.). The duration of the examinations was about 15 minutes.

RESULTS

Three-dimensional TV US allows adequate visualization of the embryonic CNS in accordance with the Carnegie stages from the classical embryology. In 7 w.g. it is possible to identify the diencephalon (future third ventricle), mesencephalon (future aqueductus Sylvii), rhombencephalon (future fourth ventricle), and the two hemispheres. In 8 w.g. the choroid plexus in the lateral ventricles, the fourth ventricle and the cerebellum can also be recognized. The developmental changes in the size, shape and relationship of the described structures can be progressively assessed in 9 and 10 w.g.

CONCLUSIONS

Implementation of high-frequency 3D TV probes allows good visualization of the developing embryo, detailed anatomical description of all main cerebral structures, as well as adequate reconstruction of the brain ventricular system between 7 and 10 w.g. There is a good correlation between the embryonic development visualized by 3D TV U.S. and that of the classical embryology.

[First trimester cystic structures in the fetalabdomen: diagnosis and prognostic value]

AIM

To define the major sonographic findings used in the diagnosis and differential diagnosis of fetal abdominal cysts in the first trimester and to establish their clinical relevance to the perinatal outcome.

METHODS

A prospective longitudinal study of 5 antenatally detected cases of fetal abdominal cysts between 11-14 w.g. was performed in the University Hospital of Obstetrics and Gynecology "Maichin dom" and MC "Markovs", Sofia between Jan 2007 and Aug 2009. In all cases color flow mapping was used to differentiate the cystic structure from the fetal bladder by identifying the two umbilical arteries. All continuing pregnancies were carefully followed up sonographically at 14-16 w.g, 18-22 w.g. and 28-32 w.g., including with fetal echocardiography. Genetic amniocentesis was offered in all cases to exclude associated chromosomal abnormality. Termination of pregnancy was an option in all affected cases. Information about the perinatal outcome was ascertained by the hospital records, the referring physicians and/or the patients themselves.

RESULTS

There were 5 cases of fetal abdominal cysts diagnosed between 11-14 w.g. during the study period (2--megacystis, 3--cystic structures from the gastro-intestinal tract). In one case of megacystis the patients opted for termination of pregnancy at 15 w.g. The second affected case was a male fetus from a twin pregnancy. The patient delivered at term by Cesarean section with a subsequent surgical treatment of the newborn. In one of the remaining three cases of fetal abdominal cysts the patients opted for termination of pregnancy at 12 w.g. The other two were followed up sonographically. Eventually, a complete resolution of the cystic structure was demonstrated. Both newborns had an uneventful perinatal outcome and were delivered at term with no complications in the early neonatal period.

CONCLUSION

Megacystis is a common fetal abdominal cyst in early pregnancy. Abdominal cysts with other origin often resolve spontaneously or remain small in the second and third trimester. Thus, they usually have a good perinatal outcome. Nevertheless, some first trimester fetal abdominal cysts can be associated with structural abnormalities or other complications from the gastrointestinal tract.

[Absent intracranial translucency--new ultrasound marker for spina bifida at 11-13+6 weeks of gestation]

Spina bifida is the most common abnormality of the fetal central nervous system. Prenatal diagnosis is usually made by ultrasound in the second or third trimester of pregnancy. However, first trimester detection of spina bifida is still a challenge. A new indirect ultrasound sign of open spina bifida between 11-13 6 weeks of gestation (w.g.) has been recently described. The marker is associated with an absence of intracranial translucency (IT) in the mid-sagittal plane. We present a case report of an open spina bifida detected at 13+2 weeks of gestation with an absent IT. The main ultrasound characteristics of normal and absent IT are described. In addition, the diagnostic role of three-dimensional (3D) transvaginal ultrasound is also discussed.

[Hormonal treatment of recurrent spontaneous abortions]

A retrospective study with 79 pregnant women was conducted. All of them were diagnosed as spontaneous abortion. The patients were separated in two group and the women have been treated in two schemes--51%--Utrogestan and 49%--Utrogestan and Profasi. The medication was applied only into the first trimester of the pregnancy. The duration of the therapy was 15.0 +/- 12.34 days. The mean gestational age in this study was 7.6 +/- 3.0 gestational weeks. Women with a first pregnancy and spontaneous abortion were excluded from the study. The number of this hormonal treated pregnancy was 2.84 +/- 1.13. 10.2% of the followed women had 3 and more than 3 miscarriages. The followed group of women was historically and clinically heterogenic. For that reason we think that many other factors could play a role in the optimum outcome of this pregnancy. The criteria for positive result we accepted the vital embryo/fetus on the time of dehospitalization. From these pregnancy only 3 terminated with miscarriage--3.79%. The rest of 96.2% went at home with intact pregnancy. The authors try to find a theoretical support for use of micronized progesterone Utrogestan--there could be some changes in the cellular and humoral immunity at repeated abortions, related to the change of the cytokine production. It could be find an ability to realize a readjustment of the endocrine system of the mother and to control the immune reaction in the fetoplacental unit.

Conduction block--the diagnostic value in the early stage of Guillain-Barre syndrome

Immune-mediated segmental demyelination is the basic pathomorphological substrate of the Guillain-Barre syndrome (GBS). The aim of the study is to determine the diagnostic value of the conduction block in the early stage of GBS, as well as its changes during of the development of the disease. Sixteen patients with GBS were examined. Electroneurography (motor nerve conduction studies) was performed at interval from the third day of the onset till the first year. Partial CB in the early stage of the disease (range 0-15 days) was registered in 81,2% of the patients. In demyelinating forms of GBS partial CB was determined in 61% of the investigated nerves. It is the most often observed in peroneal nerves, followed by tibial, ulnar and median nerves in the same order. The maximal reduction of the amplitude of the CMAP (maximal CB) was registered before the 30th day from the onset of the disease with following recovery on the sixth month and first year. Partial CB is more often observed in the early phase of GBS, when it could be the only sign of demyelination. When patients reached a clinical plateau, progressive slowing of motor nerve conduction and increasing CB were registered. Proximal CB was revealed more often than distal CB, because of the typical initial localization of the process. In the early phase of GBS, proximal CB is most often found in lower limbs (in peroneal nerve, followed by tibial nerve). In patients with axonal damage, CB was more severe than in demyelinating group. Partial CB is an important diagnostic criterion for segmental demyelination, which helps for confirming the diagnosis of early GBS, when conduction velocity and other electrodiagnostic criteria for demyelination are normal.

[A modified method of hepaticocholedochojejunal anastomosis]

"Declive" latero-terminal and latero-lateral hepaticocholedocho-jejunoanastomosis with a loop of the small intestine isolated by the Roux method was carried out in 6 patients (5 females and 1 male) according to absolute indications. In this type of anastomosis, the longitudinal incision in the hepaticocholedochus is made not on the midline but latero-dorsally on its right supraduodenal circumference. The anastomosis is formed by means of a modified suture or a suture commonly used for bilio-digestive anastomoses; the needle is inserted through the wall of the bile duct 2-2.5 mm from the border of its opening and the sutures are placed at a similar distance from one another, the seromusculo-submucous sutures are applied 6-7 mm from the edge of the opening and at a distance of 3-3.5 mm from one another. Comparison with patients in whom heapticocholedochojejunoanastomosis was established by the routine method showed the results to be better in the modified method.