Proactive consultation of laboratory medicine increased diagnostic rate of multiple myeloma: One single center's 12-year experience.

Multiple myeloma (MM) was one of the hardest cancers to diagnose because of numerous nonspecific symptoms, leading to diagnostic delay. Proactive consultation of laboratory medicine (PCLM) could help timely diagnosis of blood cancers, avoiding diagnostic delay. This study aimed to evaluate the effect of PCLM on diagnosis and outcomes in MM. This retrospective study was conducted in newly diagnosed MM patients from 2011 to 2022. Implementation of PCLM initiated in 2015 with a laboratory-oriented algorithm. The annual diagnostic rate, patient demographics, the time intervals from symptom onset to diagnosis and to treatment, and clinical outcomes were analyzed. A total of 134 patients were newly diagnosed during the study interval. The diagnostic rate increased from 4.65 ±â€…1.59 to 7.43 ±â€…1.52 per million patient-visits after implementation of PCLM. The median time interval from symptom onset to diagnosis was significantly shortened after implementation of PCLM (50 days with interquartile range [IQR]: 24-136 days vs 150 days with IQR: 41-385 days, P = .003). Besides, the 1-year survival was significantly higher in patients diagnosed as MM after implementation of PCLM (72.4% vs 51.7%, P = .035). Implementation of PCLM not only increased diagnostic rate of MM and improved outcomes, but also raise awareness for MM and promote multidisciplinary collaboration in healthcare.

Assessments of polymerization shrinkage by optical coherence tomography-based digital image correlation analysis-Part II: Effects of restorative composites.

OBJECTIVES: To examine the polymerization shrinkage of different resin-based composite (RBC) restorations using optical coherence tomography (OCT) image-based digital image correlation (DIC) analysis. METHODS: The refractive index (RI) of three RBCs, Filtek Z350XT (Z350), Z350Flowable (Z350F), and BulkFill Posterior (Bulkfill), was measured before and after polymerization to calibrate their axial dimensions under OCT. Class I cavities were prepared in bovine incisors and individually filled with these RBCs under nonbonded and bonded conditions. A series of OCT images of these restorations were captured during 20-s light polymerization and then input into DIC software to analyze their shrinkage behaviors. The interfacial adaptation was also examined using these OCT images. RESULTS: The RI of the three composites ranged from 1.52 to 1.53, and photopolymerization caused neglectable increases in the RI values. For nonbonded restorations, Z350F showed maximal vertical displacements on the top surfaces (-16.75 µm), followed by Bulkfill (-8.81 µm) and Z350 (-5.97 µm). In their bonded conditions, all showed increased displacements. High variations were observed in displacement measurements on the bottom surfaces. In the temporal analysis, the shrinkage of nonbonded Z350F and Bulkfill decelerated after 6-10 s. However, Z350 showed a rebounding upward displacement after 8.2 s. Significant interfacial gaps were found in nonbonded Z350 and Z350F restorations. SIGNIFICANCE: The novel OCT image-based DIC analysis provided a comprehensive examination of the shrinkage behaviors and debonding of the composite restorations throughout the polymerization process. The flowable composite showed the highest shrinkage displacements. Changes in the shrinkage direction may occur in nonbonded conventional composite restorations.

Assessments of polymerization shrinkage by optical coherence tomography-based digital image correlation analysis-Part I: Parameter identification.

OBJECTIVE: To investigate the feasibility of optical coherence tomography (OCT)-based digital image correlation (DIC) analysis and to identify the experimental parameters for measurements of polymerization shrinkage. METHODS: Class I cavities were prepared on bovine incisors and filled with Filtek Z350XT Flowable (Z350F). One OCT image of the polymerized restoration was processed to generate virtually displaced images. In addition, the tooth specimen was physically moved under OCT scanning. A DIC software analyzed these virtual and physical transformation sets and assessed the effects of subset sizes on accuracy. The refractive index of unpolymerized and polymerized Z350F was measured via OCT images. Finally, different particles (70-80 µm glass beads, 150-212 µm glass beads, and 75-150 µm zirconia powder) were added to Z350F to inspect the analyzing quality. RESULTS: The analyses revealed a high correlation (>99.99%) for virtual movements within 131 pixels (639 µm) and low errors (<5.21%) within a 10-µm physical movement. A subset size of 51 × 51 pixels demonstrated the convergence of correlation coefficients and calculation time. The refractive index of Z350F did not change significantly after polymerization. Adding glass beads or zirconia particles caused light reflection or shielding in OCT images, whereas blank Z350F produced the best DIC analysis results. SIGNIFICANCE: The OCT-based DIC analysis with the experimental conditions is feasible in measuring polymerization shrinkage of RBC restorations. The subset size in the DIC analysis should be identified to optimize the analysis conditions and results. Uses of hyper- or hypo-reflective particles is not recommended in this method.

Dinoprostone tablet versus continuous vaginal insert (Propess®) for elective induction in low-risk nulliparous women at term.

OBJECTIVE: To evaluate the efficacy and safety of dinoprostone tablet and continuous vaginal insert (Propess®) in low-risk nulliparous women at term with insufficient cervical ripening receiving elective induction. MATERIALS AND METHODS: A retrospective study was conducted between March 2020 and February 2022 and included 230 women who underwent elective induction with dinoprostone tablet or vaginal insert. The primary endpoint was failure of induction. Secondary endpoints included time to vaginal delivery, vaginal delivery rate, as well as maternal and neonatal complications and adverse outcomes. RESULTS: No statistically significant differences were found between the two groups regarding the main outcome measures; however, the high responders had a significant higher proportion of hyperstimulation and non-reassuring fetal status. The high responder in the Propess group was statistically significant younger (31.68 ± 4.73 vs. 33.82 ± 4.39, p = 0.027), while they had a significantly lower BMI at delivery time of the tablet group (24.49 ± 2.24 vs. 27.42 ± 4.32, p = 0.024). Factors associated with success of vaginal delivery within 24 h (p = 0.015, OR = 0.9, 95%CI = 0.82-0.98) and the Cesarean section (p < 0.001, OR = 1.17, 95%CI = 1.08-1.27) was BMI at delivery time. CONCLUSION: Slow-release vaginal insert and dinoprostone tablet had similar efficacy and safety for elective induction in low risk nulliparous women at term. Women with younger maternal age or lower BMI at delivery time may have a better response to dinoprostone and had a significantly higher proportion of hyperstimulation and non-reassuring fetal status.

Activation Model and Origins of Selectivity for Chiral Phosphoric Acid Catalyzed Diradical Reactions.

To develop new radical synthesis strategies, a profound understanding of the electronic transfer mechanism is critical. An activation model called relayed proton-coupled electron transfer (relayed-PCET) was developed and investigated for chiral phosphoric acid-catalyzed diradical reactions by density functional theory (DFT). The driving force of electron transfer from the nucleophile to the electrophile is the proton transfer that occurs via the chiral phosphoric acid (CPA) catalyst to the electrophile. Moreover, the origins of the selectivity can be explained by distortion of the catalyst, favorable hydrogen bonding, and strong interactions of the substrates with substituents of the CPAs.

An improved risk zoning method of bed-separation water inrush in underground coal mines: a case study in Ningxia, China.

Bed-separation water inrush (BSWI) is a new type of coal mine disaster that has caused serious damage. The shortcomings of previous studies on this topic are as follows: 1) most studies focused on the BSWI mechanism, evolution, and control methods, and there is a lack of research on BSWI risk assessment methods and 2) previous risk assessment studies ignored the factors of the water yield property. First, based on the proposed BSWI engineering geological model, three first-order factors are proposed: 1) separation space between layers, 2) water production characteristics, and 3) water resistance effect. Then, eight secondary factors are determined: 1) production thickness (MT), 2) hard rock thickness (HRT), 3) improved lithology index (ILCI), 4) core recovery (CR), 5) aquifer depth (AD), 6) drilling fluid consumption (DFC), 7) protective layer thickness (PLT), and 8) self-healing potential index (SPI). Subsequently, the corresponding weights are calculated, and the multifactor superposition method is used to draw the BSWI risk map. The area is divided into three risk grades: low, medium, and high. The results are validated by observations of BSWI accidents and bed-separation water exploration and discharge boreholes in the study area. The proposed method can be used to effectively prevent BSWI disasters in other coal mines with similar geological conditions.

Reversible Myocardial Calcification Following Acute Heart Failure and Kidney Injury Caused by Valsalva Sinus Rupture.

A 47-year-old previously healthy man was referred to a local hospital with chest tightness, oliguria, and lower extremity edema for seven days. An initial investigation revealed acute heart failure and kidney injury. The patient was intensively treated with cardiac and renal replacement therapy, and cardiorenal function improved one week later. Two months later, echocardiography was performed because chest tightness and edema had not resolved. Echocardiography showed Valsalva sinus rupture, and the patient was transferred to our center. Myocardial calcification was observed in the left ventricular wall on computed tomography after admission. The patient underwent cardiac surgery and recovered smoothly. At the three-year follow up, the patient was asymptomatic with normal renal function and serum electrolytes. Imaging revealed a significant reduction in diffuse calcification of the left ventricular wall. This case indicates that this rare form of reversible myocardial calcification may be associated with acute heart and renal failure caused by Valsalva sinus rupture. The results of this case will guide clinicians about further management and timely referral of such patients to appropriate specialties.

The role of pleural fluid lactate dehydrogenase-to-adenosine deaminase ratio in differentiating the etiology of pleural effusions.

Exudative pleural effusion includes tuberculous pleural effusion (TPE), parapneumonic pleural effusion (PPE), and malignant pleural effusion (MPE). An elevated pleural fluid adenosine deaminase (ADA) typically implies TPE, but the rule may not apply to every individual case. Recent studies proposed that the pleural fluid lactate dehydrogenase (LDH)-to-ADA ratio showed a higher diagnostic power than pleural fluid ADA alone in differentiating the etiology of pleural effusion. Hence, we aimed to investigate the performance of pleural fluid LDH-to-ADA ratio as a biomarker in assistance with the diagnosis of TPE, PPE, and MPE. All patients who underwent thoracentesis for the first time with a pleural fluid ADA >40 U/L were included in this retrospective study. The clinical data including pleural fluid ADA and LDH-to-ADA ratio were analyzed. A total of 311 patients were enrolled during the study interval. The pleural fluid LDH-to-ADA ratio <14.2 (sensitivity: 74.2%; specificity: 90.4%) favored TPE, while the pleural fluid LDH-to-ADA ratio >14.5 (sensitivity: 79.9%; specificity: 78.5%) favored PPE. Besides, the pleural fluid LDH-to-ADA ratio >46.7 (sensitivity: 56.3%; specificity: 78.3%) favored MPE owing to primary lung cancers. In conclusion, the pleural fluid LDH-to-ADA ratio was an effective indicator in differentiating the etiology of pleural effusions in the cases of high ADA level in the pleural fluid.

The abrogated role of premedication in the prevention of transfusion-associated adverse reactions in outpatients receiving leukocyte-reduced blood components.

BACKGROUND AND OBJECTIVES: Although it remains controversial, premedication before transfusion is a common clinical practice to prevent transfusion-associated adverse reactions (TAARs) in Taiwan. Thus, we aimed to investigate whether premedication prevented outpatients from developing TAARs and whether an educational programme could improve the understanding of physicians related to the unnecessary use of premedication, and this could elicit changes in their prescribing activities without affecting the occurrence of TAARs. MATERIALS AND METHODS: Clinical data from outpatients receiving transfusion therapy, including predisposing diseases, histories of transfusion and TAARs, premedication and the occurrence of TAARs in the period April 2017 to October 2018, were retrospectively obtained. The evidence-based transfusion programme implemented to educate physicians was started in January 2018. RESULTS: A total of 5018 blood units were transfused to 803 outpatients, with 2493 transfusion events reported in the study interval. The most frequently transfused component was leukocyte-reduced packed red cells (n = 4338), followed by leukocyte-reduced apheresis platelets (n = 540) and other blood components. The overall premedication rate significantly decreased from 92.4% to 76.7% after the educational programme (p < 0.001). There was no remarkable change in the occurrence of TAARs per patient event between the periods before and after the educational programme (1.11% vs. 1.14%, p = 0.964). Besides, it was shown that the occurrence of TAARs was associated with the history of TAARs and inversely related to multiple transfusions, but not premedication. CONCLUSION: Decreased premedication was not associated with increased incidence of TAARs in outpatients; these findings provide important evidence to support the need to revise clinical practices in the era of leukocyte-reduced blood products.

Phytochemistry and pharmacological activities of Arundina graminifolia (D.Don) Hochr. And other common Orchidaceae medicinal plants.

ETHNOPHARMACOLOGICAL RELEVANCE: Arundina graminifolia (Orchidaceae) has been widely used for heat clearance and detoxification, anti-inflammatory diuretic, and anti-microbes for two thousand years in national minorities, especially among the Dai people. It was known as "Zhuyelan" (Chinese: ), "Wenshanghai" (Chinese: ) and "Baiyangjie" (Chinese: ) in the Dai nationality, and mainly used as antidote, which is characterized by "relieving the poison before getting sick and treating illness". Therefore, it has been typically applied in the treatment of food poisoning, snake bites, rheumatism, stomachache and traumatic injuries. It is also used to treat bronchitis, tuberculosis and pneumonia in the Bulang and the Wa ethnic people. AIM OF THIS REVIEW: This review aims to provide up-to-date information about the botanical characterization, traditional uses, phytochemistry, and pharmacology of A. graminifolia, and the related importantly medicinal plants (e.g. Bletilla striata, Cremastra appendiculata, and Dendrobium officinale) of the same Orchidaceae family. Our work aims to further promote scientific cognition, basic research and in-depth discovery of potential drug candidates for Minority Medicine of our nation. MATERIALS AND METHODS: Relevant information was obtained via piles of resources including classic books about Chinese herbal medicine, and worldwide accepted scientific databases including Web of Science, Pubmed, Google Scholar, SciFinder, Elsevier, Springer, NCBI, ACS Publications, CNKI and Wanfang data. RESULTS: Phytochemical investigations have been intensively performed for these two decades, over 134 compounds, mainly include stilbenoids, phenanthrenes, quinones, ketones, phenolic acids, and glycosides, have been isolated and identified from A. graminifolia. The literature surveys exhibited that the ethnomedicinal uses of A. graminifolia, such as detoxification, anti-inflammation and the ability to cure trauma and pain associated with infections, are correlated with its modern pharmacological activities, including antibacterial, anti-oxidation, anti-lipid peroxidation. Stilbenoids and phenanthrenes have been regarded as the main active substances, among which stilbenoids with open ring style have superior antitumor activity. Furthermore, phytochemical investigations, biological activities, as well as the main molecular mechanism involved the coexisted stilbenoids and phenanthrenes from other most common used medicinal plants of the same Orchidaceae family were presented, compared and discussed together. CONCLUSIONS: This review presents the current research findings of A. graminifolia and three other related medicinal plants of the same family. Some of the traditional uses of A. graminifolia have been assessed by pharmacological studies. Despite A. graminifolia is used as an antidote and anti-aging dote, a few unsolved problems including the molecular mechanism underlying biological activities, pharmacokinetics, and in vivo detoxification tests still need to be settled extensively. Therefore, it is necessary to conduct a comprehensive survey and collect investigation information on A. graminifolia.

The predictive and prognostic role of hematologic and biochemical parameters in the emergency department among coronavirus disease 2019 patients.

Coronavirus disease 2019 (COVID-19) had caused a worldwide pandemic with public health emergencies since 2020. For the symptomatic patients, high mortality rate was observed if without timely and optimized management. In this study, we aimed to investigate the predictive and prognostic roles of hematologic and biochemical parameters obtained in the emergency department (ED) for COVID-19 patients. We conducted a retrospective study in a dedicated COVID-19 medical center, recruiting a total of 228 COVID-19 patients with 86 severe and 142 non-severe cases. Both the hematologic and biochemical parameters obtained in the ED upon arrival were analyzed to evaluate the association of the biomarkers with disease severity and prognosis among COVID-19 patients. Among these parameters, neutrophil-to-lymphocyte ratio (NLR), C-reactive protein (CRP), procalcitonin (PCT), lactate dehydrogenase (LDH), ferritin, and D-dimer were significantly higher in the severe group than the non-severe one, whereas the platelet count and lymphocyte-to-monocyte ratio were significantly lower. Receiver operating characteristic curve analysis revealed that the areas under curve of CRP, PCT, LDH, ferritin, D-dimer, and NLR for differentiating the severity of COVID-19 were 0.713, 0.755, 0.763, 0.741, 0.733, and 0.683, respectively, whereas the areas under curve of CRP, PCT, LDH, ferritin, D-dimer, and NLR for differentiating the mortality of COVID-19 were 0.678, 0.744, 0.680, 0.676, 0.755, and 0.572, respectively. Logistic regression analysis revealed that CRP, PCT, LDH, ferritin, D-dimer, and NLR were independent indicators for prediction of severe COVID-19, and LDH and ferritin were independent factors associated with the mortality in COVID-19. In conclusion, higher CRP, PCT, LDH, ferritin, D-dimer, and NLR were associated with severe COVID-19, whereas higher LDH and ferritin were associated with the mortality in COVID-19. These findings could help early risk stratification in the ED and contribute to optimized patient management.

Improved surface adhesion and wound healing effect of madecassoside liposomes modified by temperature-responsive PEG-PCL-PEG copolymers.

Madecassoside (MA) exhibits excellent therapeutic effects in wound healing and scar management. However, its high hydrophilic nature and low permeability through skin tissue limits its topical application. Liposomes are widely used to deliver drugs due to their high structural similarity and biocompatibility with cell membranes. However, normal liposome formulations are too fluid to maintain sufficient adhesion to the wound surface. In this study, in order to make an MA formulation conducive to topical administration, poly(ethylene glycol)-poly(ε-caprolactone)-poly(ethylene glycol) (PEG-PCL-PEG, PECE), a biodegradable and temperature-responsive copolymer material, was synthesized and applied to improve the adhesion properties of MA liposomes. The mean particle size of the PECE-modified MA liposomes was 213.43±4.68 nm, and the zeta potential was -23.80±15.37 mV under the optimal conditions of EPC (egg yolk lecithin) to PECE at a mass ratio of 1:1. Additionally, PECE-modified MA liposomes maintained a hydrogel state for better adhesion until the temperature reached 43°C. Furthermore, the PECE-modified MA liposomes showed superior wound contraction effects relative to the MA liposomes in second-degree burn experiments using a rat model. These results indicated that PECE-modified MA liposomes have better surface adhesion performance and healing effects than unmodified MA liposomes.

High-content screen using zebrafish (Danio rerio) embryos identifies a novel kinase activator and inhibitor.

In this report we utilized zebrafish (Danio rerio) embryos in a phenotypical high-content screen (HCS) to identify novel leads in a cancer drug discovery program. We initially validated our HCS model using the flavin adenosine dinucleotide (FAD) containing endoplasmic reticulum (ER) enzyme, endoplasmic reticulum oxidoreductase (ERO1) inhibitor EN460. EN460 showed a dose response effect on the embryos with a dose of 10µM being significantly lethal during early embryonic development. The HCS campaign which employed a small library identified a promising lead compound, a naphthyl-benzoic acid derivative coined compound 1 which had significant dosage and temporally dependent effects on notochord and muscle development in zebrafish embryos. Screening a 369 kinase member panel we show that compound 1 is a PIM3 kinase inhibitor (IC50=4.078µM) and surprisingly a DAPK1 kinase agonist/activator (EC50=39.525µM). To our knowledge this is the first example of a small molecule activating DAPK1 kinase. We provide a putative model for increased phosphate transfer in the ATP binding domain when compound 1 is virtually docked with DAPK1. Our data indicate that observable phenotypical changes can be used in future zebrafish screens to identify compounds acting via similar molecular signaling pathways.

Lambert-Eaton myasthenic syndrome in a patient with small-cell lung cancer: A case report.

Lambert-Eaton myasthenic syndrome (LEMS) is a neuromuscular junction disorder characterized by fluctuating proximal limb muscle weakness, decreased deep tendon reflexes and various autonomic symptoms. LEMS is reportedly the most common neurological paraneoplastic syndrome. This is the case report of a patient with small-cell lung cancer (SCLC) who developed LEMS. A 68-year-old male patient presented with a 6-month history of progressive weakness of the proximal limbs and a 2-month history of xerostomia. The patient was admitted to the Department of Neurology of the People's Liberation Army General Hospital of Shenyang Military Region (Shenyang, China). The symptoms of the patient were not relieved with supportive therapy. Further laboratory tests, electrodiagnostic studies, chest computed tomography and immunohistochemical staining confirmed the diagnosis of LEMS in the presence of SCLC. Following administration of two cycles of rescue chemotherapy with a combination of etoposide and cisplatin, the symptoms of the patient were gradually relieved and, after six cycles of therapy, the primary malignancy completely regressed. In conclusion, a diagnosis of LEMS may lead to the timely detection of SCLC, significantly improving patient prognosis and survival.

Extensive hepatic infarction in severe preeclampsia as part of the HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets): evolution of CT findings and successful treatment with plasma exchange therapy.

OBJECTIVE: We describe the serial computed tomography (CT) findings of extensive hepatic infarction and successful plasma exchange therapy in a severe preeclamptic woman with postpartum HELLP syndrome. CASE REPORT: A 38 year-old woman presented with elevated blood pressure of 140-180/90-120 mmHg and 3+ proteinuria at 28 weeks of gestation. Two days after admission, the patient suddenly complained of severe epigastric pain and headache. Her blood pressure rose sharply to 195/120 mmHg. A 980 g female was delivered by emergency cesarean section. Following delivery, the patient's clinical condition and laboratory values deteriorated, with progressive liver insufficiency (peak AST level = 4246 IU/L, ALT = 3685 IU/L, LDH = 6237 IU/L, platelets = 72,000/mm(3)). Two consecutive plasma exchanges (PEX) were undertaken on the 3(rd) and 4(th) postpartum day. A contrast-enhanced CT of the abdomen performed 8 days postpartum showed geographically wedge-shaped areas of low attenuation, with a mottled appearance in the right hepatic lobe. Shortly thereafter, the patient recovered and all laboratory parameters gradually normalized 3 weeks after delivery. Follow-up CT-scan of the liver 2 months postpartum showed no evidence of infarction, with complete recovery. CONCLUSION: We recommend that severely ill patients with HELLP syndrome having epigastric pain should undergo CT imaging of the liver. A trial of postpartum PEX therapy should be considered for treatment of the HELLP syndrome complicated with hepatic infarction, which is recalcitrant to conventional medical management, and fails to abate within 72-96 hours of delivery.

Mutation R184Q of connexin 26 in hearing loss patients has a dominant-negative effect on connexin 26 and connexin 30.

Hearing impairment is the most common sensory disorder worldwide. In a recent study, the authors have shown that a heterozygous missense mutation, p.R184Q, in the connexin 26 (Cx26) is causally related to hearing loss. However, the functional change in the Cx26R184Q mutant remains unknown. This study compared the intracellular distribution and assembly of mutant Cx26R184Q with that of the wild-type (WT) Cx26 and Cx30WT in tet-on HeLa cells and the effect that the mutant protein had on those cells. Fluorescent localization assay of WT Cx26 showed the typical punctuate pattern of gap junction channel between neighboring expression cells. Conversely, the p.R184Q missense mutation resulted in accumulation of the Cx26 mutant protein in the Golgi apparatus rather than in the cytoplasmic membrane. Cx26R184Q coexpressed with either Cx26WT or Cx30WT showed perinuclear localization by bidirectional tet-on expression system, suggesting the impairment of the ability of both WT proteins to intracellular trafficking and targeting to the plasma membrane. Therefore, we proposed that Cx26R184Q has a dominant-negative effect on the function of WT Cx26 and Cx30.

Prenatal detection of bladder wall involvement in invasive placentation with sequential two-dimensional and adjunctive three-dimensional ultrasonography.

OBJECTIVE: The purpose of this study was to determine the diagnostic capability of sequential two-dimensional (2D) and adjunctive three-dimensional (3D) ultrasonography (US) in identifying the location and extent of placental invasion of the bladder. MATERIALS AND METHODS: Forty-five patients at risk of placenta previa were examined sequentially with 2D US and then with a targeted scan of the region of interest with adjunctive 3D US to determine whether those patients suspected of having advanced invasive placentation by conventional ultrasonographic evidence had placental invasion of the bladder. The images were coded as positive, negative or indeterminate (equivocal) for bladder invasion. Follow-up postoperative outcomes were obtained. RESULTS: Seven of the 45 patients exhibited characteristic ultrasonographic findings for placenta increta/percreta. Among these seven patients with advanced invasive placentation, a targeted scan with adjunctive 3D US correctly provided additional corroborative information to the 2D US indeterminate diagnosis in patients who were found with variable degrees of bladder wall involvement at surgery. CONCLUSION: 3D US may be a useful adjunctive tool in refining 2D ultrasonographic techniques to identify the extent and degree of placental invasion of the bladder. The advantages of 3D US are: (1) a multiplanar image display allows viewing of sections from sagittal, coronal and axial planes at the same time, thereby more accurately determining the location and extent of placental invasion; (2) the viewing planes of the spatial angioarchitecture network can be arbitrarily manipulated to better delineate the aberrant vessels protruding into the bladder; (3) 3D reconstruction images can be clearly displayed by live 3D in a rotation mode for a better illustrative effect.

Estrogen receptor alpha polymorphism is associated with pelvic organ prolapse risk.

Estrogen and estrogen receptors are known to play important roles in the pathophysiology of pelvic organ prolapse (POP). We investigated whether estrogen receptor alpha (ERalpha) gene polymorphisms were associated with POP risk by conducting a case-control association study in 88 women with POP and 153 women without POP. Genotypes of the ERalpha (ESR1) gene polymorphisms (rs17847075, rs2207647, rs2234693, rs3798577, and rs2228480) were determined by polymerase chain reaction, followed by restriction fragment length polymorphism analysis. There was significant difference between women with and those without POP in the distribution of the ESR1 rs2228480 genotypes evaluated. By using multivariable logistic regression, age and ESR1 rs2228480 genotype GA were significantly associated with POP risk. Although the sample size of women with POP studied is small, the present study shows that ERalpha genotype may be associated with POP risk.

Vascular leakage induced by exposure to arsenic via increased production of NO, hydroxyl radical and peroxynitrite.

Previous studies have shown that in situ exposure to arsenic induced increased vascular leakage. However, the underlying mechanism remains unclear. Reactive nitrogen and oxygen species such as nitric oxide (NO) and hydroxyl radical (OH(-)) are known to affect vascular permeability. Therefore, the goal of our present studies is to investigate the functional impact of the generation of NO or OH(-) on arsenic-induced vascular leakage. Vascular permeability changes were evaluated by means of Evans blue (EB) assay. Rats were anesthetized and intravenously injected with EB. Permeability changes were induced in back skin by intradermal injections of sodium arsenite mixed with NOS inhibitor: N(omega)-Nitro-L-arginine methyl ester (L-NAME) or aminoguanidine (AG) and OH(-) scavenger: 1,3 Dimethyl-2 thiourea (DMTU). Experiments were also performed to determine whether DMTU mixed with L-NAME would further inhibit arsenic-induced vascular leakage as compared with attenuation effects by either DMTU or L-NAME. One hour after administration, EB accumulated in the skin was extracted and quantified. Both L-NAME (0.02, 0.1 and 0.5 micromol/site) and DMTU (0.05, 0.2 and 1.2 micromol/site) inhibited the increase in vascular leakage induced by arsenite. However, only high dose (1 micromol/site) of AG significantly attenuated arsenite-induced vascular leakage. In contrast, neither D-NAME (0.02, 0.1 and 0.5 micromol/site) nor AG (0.04 and 0.2 micromol/site) attenuated increased vascular leakage by arsenic. DMTU mixed with L-NAME caused no further inhibition of arsenic-induced vascular leakage by either DMTU or L-NAME. The techniques of India ink and immunostaining were used to demonstrate both vascular labeling and nitrotyrosine staining in tissue treated with arsenic. L-NAME apparently reduced the density of leaky vessels and the levels of peroxynitrite staining induced by arsenite. These results suggest that NO, OH(-) and peroxynitrite play a role in increased vascular permeability induced by arsenic exposure.