Rapid Virologic Response to Brincidofovir in Children with Disseminated Adenovirus Infection

Disseminated adenovirus infections (d-ADV) after hematopoietic cell transplant (HCT) are often fatal with limited treatment options. Brincidofovir (BCV) a lipid ester of cidofovir is developed for this indication. We report four pediatric HCT recipients with d-ADV treated successfully with BCV.

Rapid Virologic Response to Brincidofovir in Children with Disseminated Adenovirus Infection

Disseminated adenovirus infections (d-ADV) after hematopoietic cell transplant (HCT) are often fatal with limited treatment options. Brincidofovir (BCV) a lipid ester of cidofovir is developed for this indication. We report four pediatric HCT recipients with d-ADV treated successfully with BCV.

Anatomical Variants of Lister's Tubercle: A New Morphological Classification Based on Magnetic Resonance Imaging

OBJECTIVE: Lister's tubercle is used as a standard anatomical landmark in hand surgery and arthroscopy procedures. In this study, we aimed to evaluate and propose a classification for anatomical variants of Lister's tubercle. MATERIALS AND METHODS: Between September 2011 and July 2014, 360 MRI examinations for wrists performed using 1.5T scanners in a single institution were retrospectively evaluated. The prevalence of anatomical variants of Lister's tubercle based on the heights and morphology of its radial and ulnar peaks was assessed. These were classified into three distinct types: radial peak larger than ulnar peak (Type 1), similar radial and ulnar peaks (Type 2) and ulnar peak larger than radial peak (Type 3). Each type was further divided into 2 subtypes (A and B) based on the morphology of the peaks. RESULTS: The proportions of Type 1, Type 2, and Type 3 variants in the study population were 69.2, 21.4, and 9.5%, respectively. For the subtypes, the Type 1A variant was the most common (41.4%) and conformed to the classical appearance of Lister's tubercle; whereas, Type 3A and 3B variants were rare configurations (6.4% and 3.1%, respectively) wherein the extensor pollicis longus tendon coursed along the radial aspect of Lister's tubercle. CONCLUSION: Anatomical variations of Lister's tubercle have potential clinical implications for certain pathological conditions and pre-procedural planning. The proposed classification system facilitates a better understanding of these anatomical variations and easier identification of at-risk and rare variants.

Clinics in diagnostic imaging (165). Oesophageal rupture secondary to malposition of an SB tube gastric balloon

Oesophageal rupture is a life-threatening complication of balloon tamponade for bleeding oesophageal varices. We herein describe the clinical course and imaging findings in a 33-year-old Indian man who had a Sengstaken-Blakemore (SB) tube inserted for uncontrolled haematemesis, which was unfortunately complicated by malposition of the gastric balloon with resultant oesophageal rupture. The inflated SB tube gastric balloon was visualised within the right hemithorax on chest radiography after the SB tube insertion. Further evaluation of the thorax on computed tomography confirmed the diagnosis of oesophageal rupture associated with right-sided haemopneumothorax. It is crucial for both the referring clinician and reporting radiologist to recognise early the imaging features of an incorrectly positioned SB tube gastric balloon, so as to ensure prompt intervention and a reduction in patient morbidity and mortality.

ACYCLOVIR NEUROTOXICITY IN A PATIENT WITH END-STAGE RENAL FAILURE UNDERGOING CONTINUOUS AMBULATORY PERITONEAL DIALYSIS — A CASE REPORT AND WHAT CAN BE LEARNT

A 65-year-old lady with End-Stage Renal Failure (ESRF) receiving Continuous Ambulatory Peritoneal Dialysis (CAPD) was admitted acutely for altered mental status and neurological symptoms. She presented to the Emergency Department with bilateral upper limb weakness and clumsiness, bilateral lower limb weakness for 1 day’s duration. In addition, her family members reported altered behaviour for the previous 1 day. On examination, the patient had slurred speech, weakness in all limbs and brisk reflexes throughout. Significantly, she had been diagnosed with herpes zoster 2 days earlier by a family physician, for which she was started on oral acyclovir. Our patient was diagnosed as having acyclovir toxicity and commenced on urgent haemodialysis. Her symptoms resolved completely after 2 days. Our case details the uncommon but potentially fatal complication of acyclovir toxicity in patients with renal impairment, reinforces the importance of dose reduction in these patients and demonstrates haemodialysis as a good form of treatment for acyclovir toxicity. Family physicians should be familiar with dose adjustments for common medications prescribed to ESRF patients in the outpatient setting as the burden of chronic kidney disease increases in Singapore.

Comparative Study of Long-and Short-acting Triptorelin on Pituitary Down-regulation in Long Protocol / 昆明医科大学学报

Objective To explore the efficacy of long- and short-acting triptorelin on pituitary down-regulation in long protocol and the pregnancy outcome in vitro fertilization and embryo transfer (IVF-ET) . Methods Three hundred and seventeen patients for IVF-ET were enrolled as study and randomized them into two groups. In group A (n=145), patients received single dose subcutaneous injection of 1.25 mg long-acting diphereline in mid-luteal phase. In group B (n=172), patients received 0.1 mg/d subcutaneous injection of short-acting diphereline in mid-luteal phase for 14-18 days until pituitary suppression were got,and then reduced to 0.05 mg/d until the injection of HCG. Results The dose and the days of gonadotropin administration in group A were bigger and longer than those in group B ( 0.05) . But clinical pregnancy rate of group B had increasing trend. Conclusion Administration of short-acting diphereline has the similar effect with that of long-acting diphereline on pituitary down-regulation in long protocol. Short-acting diphereline requires lower amount of gonadotropin and is more flexible,so it should be recommended.

Detection of heterogeneity and evolution of subclones in t(8;21) AML by QM-FISH / 中华血液学杂志

<p><b>OBJECTIVE</b>To explore the heterogeneous subclones in acute myeloid leukemia (AML) with t(8;21) by quantitative multicolor- fluorescence in situ hybridization (QM-FISH), and to figure out whether there is putative ancestral relationship among different subclones.</p><p><b>METHODS</b>Bacterial artificial chromosomes (BAC) clones that contain the targeted genes including AML1, ETO, WT1, p27 and c-kit were searched in the data base UCSC Genome Bioinformatics. Multicolor FISH probes were prepared by linking fluorescein labeled dUTP or dCTP to targeted genes by nick translation. Bone marrow mononuclear cells from t (8;21) AML patients are dropped on to the wet surface of glass slides after hypotonic treatment and fixation. After hybridization, the fluorescence signals were captured by Zeiss fluorescence microscope. The copy number of AML1, ETO, WT1, p27, c- kit and the AML1-ETO fusion gene in AML1-ETO positive cells was counted. The cells with same signals were defined as a subclone. Various subclones were recorded and their proportions were calculated, and their evolutionary relationship was deduced. The subclones in matched primary and relapsed samples were compared, the evolution of dominant clones were figured out and the genomic abnormality that is associated with relapse and drug resistance were speculated.</p><p><b>RESULTS</b>In this study, 36 primary AML with t(8;21) cases and 1 relapsed case paired with the primary case were detected. In these 36 primary cases, 4 cases (11.1%) acquired additional AML1-ETO fusion signal, 3(8.3%) had additional AML1 signal, 4(11.1%) had additional ETO signal, 20(55.6%) had additional WT1 signal, 15(41.7%) had additional p27 signal and 14(38.9%) had additional c-kit signal. In addition, 10(27.8%) displayed AML1 signal deletion, and such an aberration represents statistic significance in male patients. It seems that male patients usually accompany AML1 signal deletion. Of 36 cases, 28(77.8 %) harbored at least 2 subclones (ranged from 2 to 10). According to the genetic signature of subclones, we can assemble a putative ancestral tree, and the genetic architecture is linear or branching. In particular, the clonal architecture of the relapsed sample exhibited significant clonal evolution compared to its paired sample at diagnosis, including proportion changes in dominant clone, subclone disappearance and appearance of new dominant clones.</p><p><b>CONCLUSION</b>Genomic abnormality is very diverse in t(8;21) AML. Subclones have linear or complex branching evolutionary histories, and clonal architecture is dynamic.</p>

The Influence of Pregnancy Outcomes with Estradiol Valerate in Addition during Luteal Phase in IVF- ET Cycles / 昆明医科大学学报

Objective To evaluate the influence of pregnancy outcomes with different dosage of estradiol valerate in addition to progesterone for luteal supplementation in IVF-ET cycles. Methods From February 2011 to October 2012, 362 patients undergoing IVF-ET in the second affiliated hospital of Kunming Medical University were selected. The patients were randomly assigned into three groups. Since oocyte retrieval, all of them were injected luteal supplementation with progesterone in oil 60 mg/d, im. Group A as control group (112 cases) did not add with pentanoic acid estradiol;Group B for the experimental group (122 cases), added pentanoic acid estradiol 4 mg/d after embryo transfer;Group C for the experimental group (128 cases) added pentanoic acid estradiol 6 mg/d after embryo transfer. Finally the pregnancy outcome and implantation rate were compared for each group. Results There were no significant differences between group A and group B, group B and group C in the rate of embryos grow and pregnancy rate ( >0.05) . The embryo planting rate and pregnancy rate have significant difference between Group A and group C ( < 0.05) . Conclusion 6 mg/d fill estradiol valerate for luteal supplementation may improve implantation rate and pregnancy rate after IVF.

Induction of hair follicle regeneration in rat ear by microencapsulated human hair dermal papilla cells / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To induce hair follicle regeneration in rat ear by microencapsulated dermal papillae (DP) cells.</p><p><b>METHODS</b>Intact dermal papillae were obtained from human scalp follicles which were digested with collagenase I. The human hair DP cells were encapsulated with alginate-polylysine-alginate (APA) by a high-voltage electric field droplet generator. The diameters of the DP cell microcapsules were optimized by regulating the voltage, the distance between the needle head and the solution surface and the injection speed. Then DP cell microencapsulations were xenotransplanted into ears of 20 SD rats with a novel method. One rat was killed every week at the postoperative 2-12 weeks and the implantation sites were biopsied for histological observation.</p><p><b>RESULTS</b>The DP cell microencapsulations were found in a group of round, smooth and transparent microcapsules under a phase-contrast microscope. The optimal combination of parameters to obtain 0.4 mm DP cell microcapsules was voltage 7.0 kV, injection speed 55 mm/h, and distance 10 mm. After 4-12 weeks, 18 of 20 DP cell microcapsule implantations had produced high-density hair. Histological observation indicated that both large follicles and sebaceous gland structures were formed in the rat ear within 3-12 weeks.</p><p><b>CONCLUSIONS</b>These findings show that the DP cell microencapsulation maintain the capacity for initiating the follicle regeneration and can be considered as a substitute for fresh isolated dermal papillae.</p>