Efficacy of ultrasound­guided platelet rich plasma injection for the management of de Quervain's tenosynovitis.

De Quervain's tenosynovitis (DQT) is a painful stenosing tenosynovitis of the first dorsal compartment of the wrist, which may be refractory to conservative treatments. The present study aimed to evaluate the efficacy of ultrasound (US)-guided platelet-rich plasma (PRP) injection for the management of DQT. For this purpose, from January, 2020 to February, 2021, 12 patients with DQT who received the US-guided PRP injection were studied prospectively. All patients were evaluated clinically for pain intensity using the visual analog scale and sonographically prior to treatment. The patients were followed-up at 1 and 3 months after the procedure to evaluate the efficacy of the treatment. In total, 12 hands of 12 female patients with DQT were analyzed in the present study. The post-treatment clinical evaluation revealed complete recovery in 4 (33.3%) of the patients, and 6 (50%) of them had recovered and returned to their daily activities. The sonographic evaluation revealed a significant reduction in the mean retinaculum thickness from 1.84 to 1.069 mm, and mean tendon sheath effusion from 2.06 to 1.25 mm, with only 58% of the cases having tendon sheath effusion at 3 months post-treatment. On the whole, the findings of the present study demonstrate that US-guided PRP injection with needle tenotomy can be used as an alternative non-surgical therapy for patients who do not respond to conventional conservative treatments, particularly in cases with sub-compartmentalization. The use of US may play a crucial role in the treatment of DQT, as improved clinical outcomes can be obtained with US-guided injections, particularly in cases with sub-compartmentalization.

Sonographic measurement of splenic size and its correlation with body parameters.

There are controversies regarding the normal size of the adult spleen and its correlation with age, sex and body parameters. The present study aimed to establish a reference value of splenic dimensions, volume and their correlations with different body parameters. The present cross-sectional study was conducted on 300 healthy adult volunteers of both sexes. Age, sex, height, weight and body mass index (BMI) were recorded. The ultrasound measurements of spleen parameters included length, thickness and width. The spleen volume was calculated using the standard prolate ellipsoid formula (length x thickness x width x0.523). The mean ± SD age was 38.7±14 years, the mean height was 166±9.9 cm, the mean weight was 74.7±15.8 kg and the mean BMI was 27±5 kg/m2. The mean spleen length, thickness, width and volume were 10.68±1.28 cm, 4.1±0.58 cm, 7.3±0.9 cm and 174.4±52.4 ml, respectively. Males had larger spleen parameters than females. Spleen volume significantly correlated with the subjects' height (r=0.655, P<0.001) and weight (r=0.643, P<0.001). However, weaker correlations were detected between age (r=-0.238, P<0.001) and BMI (r=0.299, P<0.001) with spleen volume. A higher significant correlation was found between spleen volume and spleen length rather than with its thickness and width. In the present study, the normative data of splenic dimensions and volume have been provided and may be used in certain clinical situations.

A Rare Case of Gorlin-Goltz Syndrome Presented to the Emergency Department as Facial Swelling.

INTRODUCTION: Gorlin-Goltz syndrome (GGS), also known as basal cell nevus syndrome, is a very rare autosomal dominant inherited disorder that is characterized by the development of numerous basal cell carcinoma. This article reports a case of GGS, emphasizing its clinical and radiographic manifestations. CASE PRESENTATION: We report here the case of a 35-year-old man who visited the maxillofacial emergency department due to left facial swelling. According to his clinical and radiographic examination we diagnosed him with GGS with no family history. The patient has multiple odontogenic keratocysts, rib anomalies, calcifications of the falx cerebri, lower jaw prognathism, frontal bossing, macrocephaly, and thick eyebrows. CONCLUSION: A definitive diagnosis of GGS should be made by a multidisciplinary team including a maxillofacial surgeon and medical specialists. Early diagnosis, treatment, and regular follow up are important to decrease complications, including oromaxillofacial deformation and destruction, and possible malignancy.

Allergic Respiratory Inflammation and Remodeling.

Asthma and rhinitis are inflammatory diseases of the respiratory tract. Respiratory inflammation of the adaptive and innate immune system is the focus of this review, and chronic inflammation is not limited to the respiratory tissue. The inflammatory response, which consists of phagocytes, eosinophils, mast cells, and lymphocytes, spreads along the respiratory tract, leading to tissue damage. Mast cells and eosinophils are commonly recognized for their detrimental role in allergic reactions on activation through the high- and low-affinity receptors for IgE FcɛRI. These cells rapidly produce and secrete many of the mediators responsible for the typical symptoms of asthma and rhinitis. However, increasing amount of evidence demonstrate that mast cells and leukocytes have vital roles in host defense against pathogenesis. Histological methods are used to study leukocytes and receptor expression pattern in different respiratory tract compartments. The overall aim of this review was to understand the relationship between upper and lower respiratory tract inflammation and remodeling in patients with allergic and non-allergic asthma and rhinitis. In conclusion, this review discusses the relationship between the upper and lower airway in respiratory disease and focuses on the effect of respiratory processes on laryngeal inflammation, remodeling, function, and symptoms; however, they also have a central role in the initiation of the allergic immune response. Our findings suggest that there are differences that contribute to the development of immunopathological mechanisms of these clinically distinct forms of asthma, rhinitis, and chronic obstructive pulmonary disease.

Fractal analysis of placenta mature villi in healthy, smoking and non-smoking women.

Not all the objects created by nature can be described by means of the classical Euclidean geometry rules. New, quickly developing fractal theory can provide another instrument for describing irregular surfaces of e.g. geometric structures and objects whose development results from growth, differentiation and degeneration processes. In the present study we decided to perform fractal analysis of mature, terminal villi of placenta taken from smoking and non-smoking women, during the third trimester of pregnancy. The aim of this study was to find another morphometric parameter, independent of subjective factors, which would provide new information about the studied structure. Placentas were taken from healthy women, untreated primiparas, who did not undergo any hormonal treatment, aged 18 to 27. The material was divided into: control group--placentas from non-smoking women, and two experimental groups--placentas from non-smoking up to 30 cigarettes daily and placentas from women smoking up to 30 cigarettes daily and placentas from women smoking over 30 cigarettes daily. Fractal dimension was determined by three methods: box counting, dilation and mass scaling method. Taking under consideration the results obtained in the present study it seems that fractal dimension, objectively and independently of many factors, allows to perform mathematical estimation of the parameter which is the terminal villi occurrence density within placenta. Among the applied fractal analysis methods, used for placenta terminal villi density grade estimation, the most useful seems to be the box counting method, whereas for estimating villi surface complication--the ratio--mass scaling method. Comparing obtained fractal dimension results, we have found that they increase together with the amount of cigarettes smoked during pregnancy.

Antiepileptic teratogen valproic acid (VPA) modulates organisation and dynamics of the actin cytoskeleton.

The antiepileptic drug valproic acid (VPA) and teratogenic VPA analogues have been demonstrated to inhibit cell motility and affect cell morphology. We here show that disruption of microtubules or of microfilaments by exposure to nocodazole or cytochalasin D had different effects on morphology of control cells and cells treated with VPA, indicating that VPA affected the cytoskeletal determinants of cell morphology. Furthermore, VPA treatment induced an increase of F-actin, and of FAK, paxillin, vinculin, and phosphotyrosine in focal adhesion complexes. These changes were accompanied by increased adhesion of VPA-treated cells to the extracellular matrix. Treatment with an RGD-containing peptide reducing integrin binding to components of the extracellular matrix partially reverted the motility inhibition induced by VPA, indicating that altered adhesion contributed to, but was not the sole reason for the VPA mediated inhibition of motility. In addition it is shown that the actomyosin cytoskeleton of VPA-treated cells was capable of contraction upon exposure to ATP, indicating that the reduced motility of VPA-treated cells was not caused by an inhibition of actomyosin contraction. On the other hand, VPA caused a redistribution of the actin severing protein gelsolin, and left the cells unable to respond to treatment with a gelsolin-peptide known to reduce the amount of gelsolin bound to phosphatidylinositol bisphosphate (PIP2), leaving a larger amount of the protein in a potential actin binding state. These findings indicate that VPA affects cell morphology and motility through interference with the dynamics of the actin cytoskeleton.

Studies on the teratogen pharmacophore of valproic acid analogues: evidence of interactions at a hydrophobic centre.

Propyl-4-yn-valproic acid (2-propyl-4-pentynoic acid), an analogue of valproic acid with a triple bond in one alkyl side chain, potently induces exencephaly in mice. Given that propyl-4-yn-valproic acid is a branched chain carboxylic acid, we synthesized a series of analogues with n-alkyl side chains of increasing length and correlated their potential to induce neural tube defects and to inhibit proliferation and induce differentiation in cells of neural origin, the latter being crucial to the orderly structuring of the embryo. All analogues significantly increased the incidence of neural tube defects in the embryos of dams exposed to a single dose of 1.25 mmol/kg on day 8 of gestation. This effect occurred in a dose-dependent manner and the rate of exencephaly increased with the progressive increase in n-alkyl side chain length. Moreover, increasing chain length resulted in a dose-dependent inhibition of C6 glioma proliferation rate over a concentration range of 0-3 mM and this was independent of the cell type employed and mode of estimating proliferative rate. The antiproliferative action of these analogues was associated with profound shape change in neuro-2A neuroblastoma involving extensive neuritogenesis and an associated increase in neural cell adhesion molecule (NCAM) prevalence at points of cell-cell contact, the latter exhibiting a dose-dependent increase when the n-alkyl chain was extended to five carbon units. These results suggest an interaction with a specific site in which the n-alkyl side is proposed to serve as an 'anchor' within a hydrophobic pocket to facilitate the ionic and/or H-bonding of the carboxylic acid and high electron density of the carbon-carbon triple bond.

A simple procedure for morphometric analysis of processes and growth cones of neurons in culture using parameters derived from the contour and convex hull of the object.

Morphometric estimation of neuronal processes is currently laborious and time-consuming, since the individual processes (axons and dendrites) have to be traced manually. In order to facilitate the measurement of cellular processes, we have tested a series of parameters derived from the contour and the convex hull of an object and estimated to which extent they reflect process length and number. The parameters included the area, perimeter and form factor of the object and convex hull, their ratios as well as object length, breadth, width, length/width and spreading index. Some new parameters derived from the contour and convex hull of the object, were also computed: process index (the number of areas contained within the convex hull outside the object contour), process domain (the total area contained within the convex hull outside the object contour), their ratio and the square root of the process domain (SR process domain). In total, 18 parameters were estimated. Populations of motoneurons, growth cones of cerebellar granule cells and N2a neuroblastoma cells were utilized due to their diversity in morphological features. The processes of each object were drawn by hand to establish the actual length and number. Total process length per object correlated strongly with object perimeter, process domain and SR process domain. The number of processes per object correlated well with perimeter ratio, process index and form factor, whereas object length, convex hull perimeter and spreading index correlated acceptably with the average process length. Using these parameters for the evaluation of neurite outgrowth in developing of hippocampal neurons in vitro, variables such as object perimeter, process domain and SR process domain were found to be very well suited for estimation of the total length of neurites. We conclude that based on the contour and convex hull of an object it is possible to calculate a series of parameters which may substitute direct measurements of process length.

Cell proliferation, migration and CAM-dependent neurite outgrowth as developmental in vitro endpoints for screening teratogenic potential: Application to valproic acid and related analogues of varying potency.

The in vivo teratogenic potential of valproic acid (VPA) and related teratogenic and non-teratogenic analogues has been correlated with their effects on specific in vitro endpoints of cell proliferation, migration and CAM-dependent neurite outgrowth, as these events are common to crucial epochs of development. The (+/-)-2-n-propyl-4-pentynoic acid [(+/-)-4-yn-VPA] and S-2-n-propyl-4-pentynoic acid [S(-)-4-yn-VPA] analogues increased the incidence of neural tube defects in mouse embryos exposed to a single dose, whereas the E-2-n-propyl-2-pentenoic acid (E-2-en-VPA) analogue and R-2-n-propyl-4-pentynoic acid [R( + )-4-yn-VPA] enantiomer were without effect. VPA and related analogues tested exerted comparable G1 phase antiproliferative effects in C6 glioma and limb bud cells in a dose range of 0-3 mM; however, their relative potency did not correlate with in vivo teratogenicity. In contrast, VPA and all teratogenic analogues, at 3 mM, inhibited neuronal cell aggregation and limb bud chondrocyte differentiation in a manner that exhibited a reasonable correlation with their in vivo teratogenicity. The teratogenic S(-)-4-yn-VPA and non-teratogenic R( + )-4-yn-VPA enantiomers exhibited a differential inhibition of primary neurone outgrowth of neuntes stimulated by cell adhesion molecules [L1 and N-cadherin (NCAD)]. Half-maximal inhibition was observed at approximately 150 muM for the teratogenic S(-)-4-yn-VPA enantiomer, but not the non-teratogenic R( + )-4-yn-VPA form. These results suggest that in vitro perturbations of differentiation are likely to provide the greatest discriminatory power for in vivo teratogenicity.

Teratogenic potency of valproate analogues evaluated by quantitative estimation of cellular morphology in vitro.

To develop a simple prescreening system for teratogenicity testing, a novel in vitro assay was established using computer assisted microscopy allowing automatic delineation of contours of stained cells and thereby quantitative determination of cellular morphology. The effects of valproic acid (VPA) and analogues with high as well as low teratogenic activities-(as previously determined in vivo)-were used as probes for study of the discrimination power of the in vitro model. VPA, a teratogenic analogue (+/-)-4-en-VPA, and a non-teratogenic analogue (E)-2-en-VPA, as well as the purified (S)- and (R)-enantiomers of 4-yn-VPA (teratogenic and non-teratogenic, respectively), were tested for their effects on cellular morphology of cloned mouse fibroblastoid L-cell lines, neuroblastoma N2a cells, and rat glioma BT4Cn cells, and were found to induce varying increases in cellular area: Furthermore, it was demonstrated that under the chosen conditions the increase in area correlated statistically significantly with the teratogenic potency of the employed compounds. Setting the cellular area of mouse L-cells to 100% under control conditions, the most pronounced effect was observed for (S)-4-yn-VPA (211%, P = < 0.001) followed by VPA (186%, P < 0.001), 4-en-VPA (169%, P < 0.001) and non-teratogenic 2-en-VPA (137%, P < 0.005) and (R)-4-yn-VPA (105%). This effect was independent of the choice of substrata, since it was observed on L-cells grown on plastic, fibronectin, laminin and Matrigel. However, when VPA-treated cells were exposed to an arginyl-glycyl-aspartate (RGD)-containing peptide to test whether VPA treatment was able to modulate RGD-dependent integrin interactions with components of the extracellular matrix, hardly any effect could be observed, whereas control cells readily detached from the substratum, indicating a changed substrate adhesion of the VPA-treated cells. The data thus indicate that measurement of cellular area may serve as a simple in vitro test in the early pre-screening evaluation of teratogenicity of novel therapeutic agents.

The effect of attenuated vaccinia virus AS strain on multiple myeloma; a case report.

The case of a 67-year-old male with IgA multiple myeloma successfully treated with AS strain of vaccinia virus is reported. The intravenous injection of this virus strain caused a definite decrease in the levels of monoclonal IgA from 1,309 mg/dl in the early stage of the treatment to 432 mg/dl on the 96th day of the regime. NK cell activity rose from 20.0% on the 10th day to 33% on the 106th day of the treatment. No adverse effects were observed throughout the entire course of the treatment. These results strongly suggest that AS strain vaccinia virus is a most promising and safe agent for the treatment of human malignancy. The possible mechanism of the beneficial effects of this virus strain is also briefly discussed.

Age related change in the frequency of ara C-induced chromosome aberrations in human peripheral blood lymphocytes.

1-beta-D-Arabinofuranosylcytosine (ara C) has been known to inhibit repair replication in the G1 phase of cell cycle and to convert certain types of DNA damage into chromosome-type exchanges: e.g., dicentric or ring chromosomes. It is then considered to be a useful cytogenetic method to investigate the frequency of ara C-induced dicentric and ring chromosomes (dic and ring) for estimating cellular DNA damage or capacity to repair it. Peripheral blood lymphocytes from donors ranging from newborn to 91 years old were treated with 10 microM ara C in their G1 phase and the resulting disc and ring were observed to investigate whether age-related change in peripheral lymphocytes would be present in the amount of spontaneous DNA damage or in the capacity to repair it. Chromatid-type (Ct) aberrations and sister chromatid exchanges (SCEs) were also scored for additional cytogenetic indices of DNA damage in the lymphocytes. The results showed that the frequency of dic and ring had a negatively linear correlation with the logarithm of the age of the blood donors, but that the frequencies of Ct aberrations and SCEs were not influenced by the age. The present study suggests the presence of age-related change in the amount or in the capacity to repair certain types of DNA damage in the G1 phase of human peripheral lymphocytes. Other possible explanations for the present results are also discussed.

Properdin factor B frequencies in four Asian populations.

The distribution of Properdin factor B (Bf) phenotypes and their gene frequencies were investigated in four Asian populations (Chinese, Filipino, Thai and Japanese). The frequency of the BfS phenotype in Filipinos (0.717) was significantly lower than that in Chinese (0.900) and Thai (0.889) (p less than 0.01), but not different from the Japanese (0.840). One variant, BfF 0.65 S, was identified in a Japanese subject. Thus, in the Asian populations studied, Bfs frequencies were high and the frequency of variants other than F and S were low.

Comparative studies on immunological characteristics of IDDM among Asian populations.

Very little information is available related to possible differences in immunological characteristics of IDDM among Asian populations, though it has been reported that IDDM is associated with Bw54-DR4 and B17-DR3 in Japanese and Chinese, respectively. There is virtually no report related to comparative studies on Bf-DM association among Asian populations, while Bf-DM association is reported to be stronger than HLA-DM association in Caucasians. In the present paper, the results of our studies on anti-thyroid antibodies (ATA) of IDDM in Japanese, Chinese and Filipinos are presented. In Japanese, the incidence of ATA positive was higher in IDDM with a duration of less than one year (35.7%) than that in the patients with a duration of one year or more (12.5%). But, there was no such a duration dependent decrease in the incidences of ATA among Chinese or Filipino IDDM. The frequency of BfSS in Filipinos is lower than in Japanese or Chinese. However, no association was found between Bf phenotypes and IDDM in Asian populations. These results indicate that autoimmunity is transient in Japanese IDDM, but persistent in Chinese and Filipinos, and that it is too early to postulate in general that Bf-IDDM association in general populations is stronger than HLA-IDDM association.

Reliability of HbA1 assay in the mass survey for diabetes mellitus, with special reference to the preservation and transportation of blood samples.

Studies on the reliability of the HbA1 assay in mass surveys for diabetes mellitus were carried out with special reference to the preservation and transportation of blood samples. It is essential to confirm that the preservation and transportation of samples have no effect on values for HbA1, since most of the mass surveys are carried out as field works. In our experience the levels of HbA1 remained unchanged for one week, both in samples kept at 4 degrees C, and in frozen samples kept at -40 degrees C or -80 degrees C and transported on solid CO2. The levels of HbA1 in the samples transported from Manila to Wakayama by the above-mentioned methods did not differ from those obtained in corresponding fresh samples. There was a good correlation between levels of HbA1 and levels of plasma glucose obtained 1 or 2 hr after breakfast (PPG). It was concluded that the use of both criteria (HbA1 of more than 8.00% and PPG of more than 120 mg/100 ml) in the diagnosis of diabetes mellitus is more reliable than use of either one alone.

Thyrotrophin-binding inhibitory immunoglobulins and HLA-DRW3-two prognostic factors in Graves' disease.

Thyrotrophin-binding inhibitory immuno-globulin (TBII) activity and HLA typing were performed in 38 Chinese patients with Graves' disease to find out the relationship among TBII activity, HLA antigen and relapse. Twelve out of 13 patients who were TBII-positive at anti-thyroid drug withdrawal relapsed. All seven patients with HLA-DR3 antigen relapsed, whereas all ten patients in remission did not have DR3. Therefore, both TBII activity at drug withdrawal and DR3 antigen could predict subsequent relapse. However, a larger patient sample is required to determine the precise relationship between TBII activity and HLA-DR3 antigen.