The Expression of Toll-like Receptors (TLR7 and TLR9) in Class III and Class IV of Recently Diagnosed Lupus Nephritis with 12-Month Follow-Up.

Renal involvement is an important cause of morbidity and mortality in systemic lupus erythematosus (SLE). The present study included patients with recently diagnosed Class III and Class IV lupus nephritis (LN) treated by Rheumatology who, upon the detection of alterations in their kidney function, were referred to Nephrology for the joint management of both medical specialties. The purpose of this study was to compare the plasma expression of Toll-Like Receptor 7 (TLR7) and TLR9 in healthy control (HC) subjects and newly diagnosed Class III and Class IV LN patients with 12-month follow-ups. The plasma expression of TLR7 and TLR9 proteins was determined by the ELISA method. A significant increase in the expression of TLR7 protein was found in Class III LN in the basal determination compared to the expression in the HC (p = 0.002) and at 12 months of follow-up (p = 0.03) vs. HC. The expression of TLR9 showed a behavior opposite to that of TLR7. TLR9 showed decreased protein expression in LN Class III patients' baseline and final measurements. The result was similar in the basal and final determinations of LN Class IV compared to the expression in HC. A significant decrease in SLEDAI -2K was observed at 12 months of follow-up in patients in Class III (p = 0.01) and Class IV (p = 0.0001) of LN. Complement C3 levels improved significantly at 12-month follow-up in Class IV patients (p = 0.0001). Complement C4 levels decreased significantly at 12-month follow-up in LN Class III compared to baseline (p = 0.01). Anti-DNA antibodies decreased significantly at 12 months of follow-up in Class IV LN (p = 0.01). A significant increase in proteinuria was found at 12 months of follow-up in Class III LN, compared to the baseline determination (p = 0.02). In LN Class IV, proteinuria decreased at 12 months of follow-up compared to baseline (p = 0.0001). Albuminuria decreased at 12 months of follow-up in LN Class IV (p = 0.006). Class IV LN, albuminuria also decreased at 12 months of follow-up (p = 0.009). Hematuria persisted in all patients and the glomerular filtration rate did not change. Three Class IV patients died before 12 months of follow-up from various causes. In conclusion, although the rheumatologic data appeared to improve, the renal function data remained inconsistent. Decreased expression of TLR9 and increased expression of TLR7 could be useful in the early diagnosis of Class III and Class IV LN is correct.

The Inflammatory and Oxidative Status of Newly Diagnosed Class III and Class IV Lupus Nephritis, with Six-Month Follow-Up.

Lupus nephritis (LN) is the most frequent and severe complication of systemic lupus erythematosus (SLE). A prospective cohort with a six-month follow-up was performed. Twelve SLE patients diagnosed with LN Class III, twelve NL Class IV patients, and twelve healthy control subjects (HC) were included. SLE data, renal function, oxidants, antioxidants, and inflammation were determined at baseline and six-month follow-up. During the six-month follow-up, the SLE Disease Activity Index (SLEDAI-2K) decreased in both LN Class III (20.08 ± 6.92 vs. 11.92 ± 5.87, p < 0.001) and LN Class IV (25.33 ± 6.01 vs. 13.83 ± 5.52, p < 0.001) patients. Furthermore, the values of the C4 component also increased during follow-up for LN Class III (25.36 ± 6.34 vs. 30.91 ± 9.22, p = 0.027) and LN Class IV (12.18 ± 3.90 vs. 20.33 ± 8.95, p = 0.008) groups. Regarding inflammation markers, both groups presented decreased C-reactive protein (CRP), but this was only significant for patients with LN class III (7.93 ± 1.77 vs. 4.72 ± 3.23, p = 0.006). Renal function remained stable in both groups, with no changes in eGFR. Patients with LN Class III and Class IV showed higher baseline levels for lipoperoxides (Class III p < 0.01, Class IV p < 0.1) and carbonyl groups in proteins (Class III p < 0.01, Class IV p < 0.1) compared to HC. Moreover, both groups presented lower baseline values of total antioxidant capacity (Class III p < 0.01, Class IV p < 0.1) and catalase (Class III p < 0.01, Class IV p < 0.1) compared to HCs. However, antioxidant and oxidant markers did not show significant differences between baseline values and at six months for either of the two study groups. In conclusion, patients show an imbalance in the oxidative state characterized by the increase in the oxidants LPO and protein carbonyl groups and the decrease in the activity of the antioxidant enzymes TAC and CAT compared to HC. However, the patients did not present an increase in disease activity and renal function improvement. The glomerular filtration rate did not change during the length of the study, and SLEDAI -2K, C3, and C4 improved. The early co-management between Rheumatologists and Nephrologists is essential to prevent the rapid progression of LN. It would be interesting to administer antioxidant supplements to patients with a recent diagnosis of LN and evaluate its effect in a follow-up study.

CT Perfusion Imaging Guides Clinical Decision-Making in a Case of Thalamic Stroke: A Case Report.

This case highlights a patient presenting with a stroke code in the emergency department with decreased consciousness. The patient was later found to have bilateral thalamic strokes due to ischemia of the artery of Percheron. Initial head computed tomography (CT) and CT angiogram (CTA) of the head and neck showed no abnormalities. CT perfusion (CTP) showed a perfusion deficit of 169 mL with a T-max greater than 4 s and 4 mL with a T-max greater than 6 s in the posterior circulation. The patient received IV alteplase. This case report emphasizes the importance of perfusion neuroimaging in the evaluation of acute ischemic stroke.

Synthetic pulmonary perfusion images from 4DCT for functional avoidance using deep learning.

Purpose.To develop and evaluate the performance of a deep learning model to generate synthetic pulmonary perfusion images from clinical 4DCT images for patients undergoing radiotherapy for lung cancer.Methods. A clinical data set of 58 pre- and post-radiotherapy99mTc-labeled MAA-SPECT perfusion studies (32 patients) each with contemporaneous 4DCT studies was collected. Using the inhale and exhale phases of the 4DCT, a 3D-residual network was trained to create synthetic perfusion images utilizing the MAA-SPECT as ground truth. The training process was repeated for a 50-imaging study, five-fold validation with twenty model instances trained per fold. The highest performing model instance from each fold was selected for inference upon the eight-study test set. A manual lung segmentation was used to compute correlation metrics constrained to the voxels within the lungs. From the pre-treatment test cases (N = 5), 50th percentile contours of well-perfused lung were generated from both the clinical and synthetic perfusion images and the agreement was quantified.Results. Across the hold-out test set, our deep learning model predicted perfusion with a Spearman correlation coefficient of 0.70 (IQR: 0.61-0.76) and a Pearson correlation coefficient of 0.66 (IQR: 0.49-0.73). The agreement of the functional avoidance contour pairs was Dice of 0.803 (IQR: 0.750-0.810) and average surface distance of 5.92 mm (IQR: 5.68-7.55).Conclusion. We demonstrate that from 4DCT alone, a deep learning model can generate synthetic perfusion images with potential application in functional avoidance treatment planning.

Genetic diversity among multidrug-resistant Mycobacterium tuberculosis strains in Mexico.

Tuberculosis is an important public health problem in Mexico. However, limited information about the genetic diversity of Mycobacterium tuberculosis strains circulating in the country is available. In this work, 109 multidrug-resistant (MDR) M. tuberculosis isolates collected in 23 different states of Mexico in 2003 were retrospectively characterized by spoligotyping and MIRU-VNTRs. All isolates, except for a single cluster containing two strains (subcluster E1), were split when information from the 12-loci MIRUs and spoligo-pattern was simultaneously analyzed. The discriminative power of 12-loci MIRU-VNTR and spoligotyping, by the Hunter-Gaston index, were 0.9998 and 0.9011, respectively. These findings suggest that almost all cases were epidemiologically unrelated. Instead, the genetic variations observed among these strains are suggestive of emergence of acquired drug-resistance during the course of treatment. The results suggest a high degree of genetic variability and a high frequency of SIT53 (T1 family) spoligotype among the MDR M. tuberculosis isolates included in the study.

Rapid hepatitis C virus divergence among chronically infected individuals.

Here, we analyze the viral divergence among hepatitis C virus (HCV) chronic cases infected with genotype 1. The intrahost viral evolution was assessed by deep sequencing using the 454 Genome Sequencer platform. The results showed a rapid nucleotide sequence divergence. This notorious short-term viral evolution is of the utmost importance for the study of HCV transmission, because direct links between related samples were virtually lost. Thus, rapid divergence of HCV significantly affects genetic relatedness studies and outbreak investigations.

Low level laser in odontostomatology practice, a critical review / Láser de baja potencia en la práctica odontoestomatológica, una revisión bibliográfica

The application of laser as a therapeutic measure in nervous regeneration in dentistry has not been a discussed subject, even though the knowledge about the response of the peripheral nervous system is very important inpractice as well as in the recovery of the patient. It has been proposed that low-level laser (LLL) therapy has beneficial effects on tissues; LLL therapy acts as an analgesic, anti-inflammatory, anti-edematous, anti-cellulitic tool, and it stimulates cellular trofism. In the present study, we conducted a meta-analysis of available literature regarding the response of the injured nerveto low-power laser using search engines EBSCO and PUBMED. The literature refers to the stimulant effect of the low-level laser in the neoformation of vessels and to the existing bibliographic evidence to propose that this mechanism is important in nervous regeneration. There is limited bibliographic evidence on the effects of LLL therapy in dentistry.

La aplicación de láser como medio terapéutico en la regeneración nerviosa en odontología, no ha sido un tema muy discutido, aún cuando el conocimiento de la respuesta del sistema nervioso periférico es muy importante tanto en la práctica como en la recuperación del paciente. Se ha propuesto que el láser de baja potencia (LBP) tiene efectos benéficos en los tejidos, entre ellos antiálgico, antiinflamatorio, antiedematoso, anticelulítico y bioestimulante del trofismo celular. En el presente estudio se realizó un metaanálisis de la literatura disponible en relación con la respuesta del nervio lesionado ante la aplicación de láser de baja potencia utilizando los buscadores EBSCO y PUBMED. La literatura se refiere al efecto estimulante del LBP en la neoformación de vasos y existiendo evidencia bibliográfica para proponer a este mecanismo como importante en la regeneración nerviosa. Los efectos del láser de baja potencia en Odontología presentaron una escasa evidencia bibliográfica.

Neuralgia del trigémino secundaria a un meningioma en el ligamento petroclinoideo: reporte de un caso / Trigeminal neuralgia secondary to meningioma in the petroclinoid ligament: a case report

La neuralgia del trigémino es una patología que se caracteriza por un dolor paroxístico ante estímulos inocuos, principalmente tactiles y que afecta a una de las divisiones del nervio trigémino. En este artículo se presenta un caso de neuralgia secundaria a la compresión del ganglio trigeminal, producto de un meningioma del ligamento petroclinoideo y una breve revisión de la literatura.

The trigeminal neuralgia is a pathology that is characterized by a paroxictic pain before innocuous stimuli, mainly tactile and that it affects one of the divisions of the trigeminal nerve. In this article we present a case of secondary trigeminal neuralgia, due to meningioma of the petroclinoid ligament and a brief revision of the literature.