Diagnostic performance of neuroimaging in suspected idiopathic intracranial hypertension.

The diagnostic utility of neuroradiologic signs associated with idiopathic intracranial hypertension (IIH) for the evaluation of patients presenting with papilloedema remains yet to be elucidated. This multicentre retrospective cohort study assessed consecutive patients presenting with suspected papilloedema to Auckland District Health Board (NZ) and Stanford University Medical Centre (US), between 2005 and 2019, undergoing magnetic resonance imaging and venography (MRI/MRV) or computed tomography and venography (CT/CTV) prior to lumbar puncture assessment for diagnostic suspicion of IIH. Data were collected regarding demographic, clinical, radiologic, and lumbar puncture parameters, and the diagnosis of IIH was determined according to the Friedman criteria for primary pseudotumor cerebri syndrome. A total of 204 participants (174 females; mean ± SD age 29.9 ± 12.2 years) were included, and 156 (76.5%) participants fulfilled the diagnostic criteria for IIH. The presence of any IIH-associated radiologic sign on MRI/MRV demonstrated a sensitivity (95% CI) of 74.8% (65.8%-82.0%) and specificity (95% CI) of 94.7% (82.7%-98.5%), while radiologic signs on CT/CTV exhibited a sensitivity (95% CI) of 61.0% (49.9%-71.2%) and specificity (95% CI) of 100.0% (83.2%-100.0%). In summary, the modest sensitivities of radiologic signs of IIH would support the routine use of lumbar puncture assessment following neuroimaging to secure the diagnosis. However, the high specificities might lend limited support for the judicious deferment of lumbar puncture assessment among typical IIH demographic patients who consent to the inherent small risk of missed pathology, which has been proposed by some clinicians.

Swim bladder as a primary site of mycobacterial infection in Nothobranchius 'belly sliders'.

The swim bladder inflates early after fish hatching via its interconnection with the digestive tract (ductus pneumaticus). This interconnection may serve as a portal to foreign particles, including bacteria, causing deficiencies in primary swim bladder inflation. We histologically examined 134 African annual killifish (genus Nothobranchius) with secondary loss of swim bladder function ('belly sliders'). We demonstrate that these fish lost the ability of air regulation in their swim bladders likely due to Mycobacterium spp. infection at an individual-specific age. Nearly all examined belly sliders had thickened swim bladder walls, and their swim bladder was filled with material containing mycobacteria, cell debris, young monocytic cells and phagocyting macrophages. Mycobacterial infection was restricted to the swim bladder in juveniles, where mycobacteria likely enter the host through the ductus pneumaticus. Infection in adults was systemic and mycobacteria were present in all examined organs. Presence of mycobacteria in the epithelial lining and submucosal layers of the digestive tract of adults suggests that it may also serve as the entrance site of infection. We suspect 2 sources of Mycobacterium contamination: dietary (with bloodworms) and/or contaminated hatching substrate. These sources of contamination may be eliminated by use of laboratory dry feed and egg disinfection prior to hatching.

Nutrition in open abdomen.

Open abdomen is known as a serious consequence of various intra-abdominal pathologies. Initially, patients often have a life-threatening condition, sepsis or septic shock. Severe stress related malnutrition, mineral and fluid imbalance develop as metabolic consequences. Intestinal fistulas also occur as a frequent complication in patients with open abdomen. In such patients, a comprehensive approach is needed, including rehabilitation, nutritional support using optimal formulas, and local care for the open abdomen. Our case report presents a patient with open abdomen and enterocutaneous fistulation. A complex nutritional approach in the course of the disease is described and its importance is discussed. Finally, a summary of nutritional care for open abdomen patients is provided based on current recommendations.

Exploring topical anti-glaucoma medication effects on the ocular surface in the context of the current understanding of dry eye.

PURPOSE: To assess tear film parameters, ocular surface characteristics, and dry eye symptomology in patients receiving topical anti-glaucoma medications. METHODS: Thirty-three patients with a diagnosis of open angle glaucoma or ocular hypertension, receiving unilateral topical anti-glaucoma medication for at least 6 months, were recruited in a cross-sectional, investigator-masked, paired-eye comparison study. Tear film parameters, ocular surface characteristics, and dry eye symptomology of treated and fellow eyes were evaluated and compared. RESULTS: The mean ±â€¯SD age of the participants was 67 ±â€¯12 years, and the mean ±â€¯SD treatment duration was 5.3 ±â€¯4.4 years. Treated eyes had poorer non-invasive tear film breakup time (p = 0.03), tear film osmolarity (p = 0.04), bulbar conjunctival hyperaemia (p = 0.04), eyelid margin abnormality grade (p = 0.01), tear meniscus height (p = 0.03), and anaesthetised Schirmer value (p = 0.04) than fellow eyes. There were no significant differences in dry eye symptomology, meibomian gland assessments, and ocular surface staining between treated and fellow eyes (all p > 0.05). CONCLUSIONS: Adverse changes in tear film stability, tear osmolarity, conjunctival hyperaemia, and eyelid margins were observed in treated eyes. This suggests that inflammatory mechanisms may be implicated in the development of dry eye in patients receiving long term topical anti-glaucoma therapy.

Survey: interpolation methods for whole slide image processing.

Evaluating whole slide images of histological and cytological samples is used in pathology for diagnostics, grading and prognosis . It is often necessary to rescale whole slide images of a very large size. Image resizing is one of the most common applications of interpolation. We collect the advantages and drawbacks of nine interpolation methods, and as a result of our analysis, we try to select one interpolation method as the preferred solution. To compare the performance of interpolation methods, test images were scaled and then rescaled to the original size using the same algorithm. The modified image was compared to the original image in various aspects. The time needed for calculations and results of quantification performance on modified images were also compared. For evaluation purposes, we used four general test images and 12 specialized biological immunohistochemically stained tissue sample images. The purpose of this survey is to determine which method of interpolation is the best to resize whole slide images, so they can be further processed using quantification methods. As a result, the interpolation method has to be selected depending on the task involving whole slide images.

ASPP2 deficiency causes features of 1q41q42 microdeletion syndrome.

Chromosomal abnormalities are implicated in a substantial number of human developmental syndromes, but for many such disorders little is known about the causative genes. The recently described 1q41q42 microdeletion syndrome is characterized by characteristic dysmorphic features, intellectual disability and brain morphological abnormalities, but the precise genetic basis for these abnormalities remains unknown. Here, our detailed analysis of the genetic abnormalities of 1q41q42 microdeletion cases identified TP53BP2, which encodes apoptosis-stimulating protein of p53 2 (ASPP2), as a candidate gene for brain abnormalities. Consistent with this, Trp53bp2-deficient mice show dilation of lateral ventricles resembling the phenotype of 1q41q42 microdeletion patients. Trp53bp2 deficiency causes 100% neonatal lethality in the C57BL/6 background associated with a high incidence of neural tube defects and a range of developmental abnormalities such as congenital heart defects, coloboma, microphthalmia, urogenital and craniofacial abnormalities. Interestingly, abnormalities show a high degree of overlap with 1q41q42 microdeletion-associated abnormalities. These findings identify TP53BP2 as a strong candidate causative gene for central nervous system (CNS) defects in 1q41q42 microdeletion syndrome, and open new avenues for investigation of the mechanisms underlying CNS abnormalities.

[Ten years of endovenous ablation - achievements, failures and future]. / Deset let endovenózní ablace varixu, úspechy, neúspechy a budoucnost.

Endovenous ablation of varicose veins is a very frequent treatment method which has more or less replaced the classic stripping method. It has its limitations, advantages as well as disadvantages. The authors present a summarizing article and their own experience with these methods. Histology examinations performed prove differences in the reaction of the endothelium to the individual types of endovenous therapy. Causes of varicose veins treatment failures are discussed.

Elevated percentage of HLA-DR⁺ and ICAM-1⁺ conjunctival epithelial cells in active Graves' orbitopathy.

BACKGROUND: To evaluate if conjunctival epithelial cells' expression of HLA-DR and ICAM-1 could be helpful as early topical markers of inflammation in Graves' orbitopathy (GO). METHODS: The ocular examination evaluated a clinical activity score (CAS) by assessment of clinical features, (e.g., eyelid or conjunctival inflammation, lid width, lid closure, proptosis, ocular motility). Conjunctival epithelial cell specimens for flow-cytometric evaluations of ICAM-I and HLADR expression were collected by impression cytology from ten eyes with active GO (CAS ≥ 4 and duration ≤ 12 months), from 15 eyes with Graves' disease (GD) without active GO (CAS 0-2) and from 15 normal specimens without any ocular disorders. RESULTS: The percentage of HLA-DR + conjunctival epithelial cells was significantly elevated in patients with active GO comparing to GD without active GO and healthy controls, 10.7 % (8.5-17.7) and 7.78 % (3.92-10.1) (p < 0.05) vs. control 4.89 % (3.5-5.5) (p < 0.005), respectively. The expression of ICAM - 1+ conjunctival epithelial cells was greater only in patients with GO vs. controls, 5.5 % (4.8-7.03) and 1.46 % (0.69-2.51) (p < 0.005), respectively. CONCLUSION: The percentage of HLA-DR⁺ and ICAM-1⁺ conjunctival epithelial cells in patients with the active GO may serve as a topical inflammation marker in Graves' orbitopathy.

[Endoscopic retrograde cholangiography with a single-balloon enteroscope in patients with Roux-en-Y hepatico jejunal anastomosis]. / Endoskopická retrográdní cholangiografie pomocí jednobalónkového enteroskopu u pacientu s Roux-Y hepatikojejunoanastomózou.

AIMS OF THE STUDY: The aim of this retrospective study was to evaluate our experience with using a single-balloon enetroscope for diagnostic and therapeutic endoscopic retrograde cholangiography (ERC) in patients with Roux-en-Y hepatico jejunal anastomosis (HJA). Due to the considerably changed anatomic circumstances after the surgery, ERC is, in comparison to the standard endoscopic retrograde cholangiopancraeaticography (ERCP), significantly more difficult to perform. PATIENT SAMPLE AND METHODOLOGY: The sample was followed up from January 2009 to September 2011. The study retrospectively reviewed 14 patients with Roux-en-Y HJA with symptoms of biliary obstruction. A total of 21 ERCs were performed in these 14 Roux-en-Y HJA patients using the single-balloon videoenetroscope Olympus SIF Q 180. RESULTS: Diagnostic ERC cannulation was successful in 11 of the 14 patients (79% success rate for the diagnostic ERC). One of the 11 patients had a normal finding on the ERC. The remaining 10 patients had a pathological finding on ERC that, in one patient (cystic dilatation of bile duct), was subsequently managed surgically. Endoscopic treatment was initiated in the remaining 9 patients (HJA stenosis in 4, choledocholithiasis in 2 and concurrent HJA stenosis and choledocholithiasis in 3) immediately after the diagnostic ERC; the surgery was successful in 8 of the 9 patients (89% success rate for the therapeutic ERC). The performed endoscopic therapeutic procedures included: balloon dilatation of HJA stenosis 9 times (6 patients), choledocholithiasis extraction - 5 times (5 patients), biliary plastic stent placement - 5 times (3 patients), removal of biliary stents placed by us - 5 times (3 patients). We did not observe any complications in our sample of 14 patients. CONCLUSIONS: ERC using a single-balloon enteroscope in patients with Roux-Y HJA is significantly more difficult than the standard ERCP due to different post-surgical anatomy. In our sample of patients, we achieved 79% success rate for the diagnostic ERC and 89% success rate for the therapeutic ERC. Additional time should be allowed for the individual procedures. Furthermore, the presence of an anaesthesiologist during these operations (deep analgosedation) is essential. This is a technically very demanding technique that, however, is effective and safe and importantly extends the options available for the management of biliary pathologies in these patients.

Evaluation of the influence of ozonotherapy on the clinical parameters and MMP levels in patients with chronic and aggressive periodontitis.

PURPOSE: A comparison of the clinical status and salivary MMP levels after SRP alone or with ozonotherapy in patients with aggressive and chronic periodontitis. MATERIAL/METHODS: The study was performed in 52 generally healthy subjects with chronic or aggressive periodontitis. Group CP-S consisted of 12 patients with chronic periodontitis, who underwent scaling and root planing (SRP). In group CP-O there were 25 patients with chronic periodontitis who additionaly to SRP underwent ozonotherapy. The same therapy was performed in group AP, containing 15 patients with aggressive periodontitis. Plaque index, approximal plaque index, bleeding on probing, sulcus bleeding index, probing pocket depth and clinical attachment loss were measured at baseline, at two weeks and two months post-therapy. The levels of MMP-1, MMP-8 and MMP-9 were estimated in non-stimulated saliva with an ELISA method. RESULTS: All the clinical parameters assessed in the study groups were reduced after treatment. SRP with additional ozonotherapy provided an increase in MMP levels in patients with chronic periodontitis and a reduction in MMP levels in patients with aggressive periodontitis. CONCLUSIONS: SRP followed by ozonotherapy does not lead to further improvement in clinical periodontal parameters in patients with AP and CP.

Assessment of aprotinin influence on periodontal clinical status and matrix metalloproteinases 1, 2 and their tissue inhibitors saliva concentrations in patients with chronic periodontitis.

PURPOSE: Assessment of the effect of treatment with aprotinin-containing drug on the clinical status of the periodontal tissue and on the concentrations of metalloproteinases released in the course of periodontitis (MMP-1, MMP-2) as well as their tissue inhibitors (TIMP-1 and TIMP-2) in the saliva of patients with chronic periodontitis (CP). MATERIAL/METHODS: The study involved 25 subjects with CP (39-68 years), including 16 women and 9 men. The patients were prescribed aprotinin preparation to be taken for 2 weeks. The control group (C) involved 14 healthy subjects (41-65 years), including 10 women and 4 men. Two periodontal indices were assessed: the approximal plaque index (API) and bleeding on probing index (BOP). Periodontal pocket depth and clinical attachment level were also evaluated. The concentrations of MMP-1 and MMP-2 as well as TIMP-1 and TIMP-2 were determined by the ELISA method. RESULTS: The mean salivary MMP-1 concentration in patients with CP was significantly higher before and after treatment, as compared to healthy subjects. The mean salivary MMP-2 concentration in CP patients at baseline was also higher as compared to the C group and increased after treatment. The mean salivary TIMP-1 and TIMP-2 concentration in CP patients was higher as compared to C group and increased after treatment. CONCLUSIONS: Since the mean MMPs levels were found to be growing it can be assumed that aprotinin has no significant effect on the regulation of MMPs in the saliva of CP patients. It thus seems that aprotinin application after scaling has no additional therapeutic effect.

[Open pleural window at treatment of the advanced thoracic empyema: 20 high-risk patients' treatment experience]. / Otevrené pleurální okénko v lécbe pokrocilého empyému hrudníku: zkusenosti s lécbou dvaceti rizikových pacientu.

UNLABELLED: The aim of the retrospective clinical study was the analysis of the 20 high-risk patients operated in our department within years 2000-2008 by the modified Eloesser procedure for the serious thoracic empyema. MATERIAL AND METHODS: We have analyzed the data of the 17 men and 3 women. The most important objectives were the cause of the disease, type of procedure, perioperative mortality, length of stay and subsequent procedures. The underlying disease was the malignant intrathoracic disease in 40%, diabetes mellitus was found in 25%. The cause of empyema was pleuropneumonia in 45%, postresectional empyema occurred in 35%. RESULTS: There were two perioperative deaths (10%), remaining patients were all dismissed in a stabilized condition the 22nd postoperative day at average. Six subsequent reconstructive procedures were performed. There was no early death for the postpneumonectomy empyema. CONCLUSION: In case of the serious pleural empyema in a high-risk patient is the modified Eloesser procedure safe and life saving surgical operation. The timing of the procedure and correct indication for surgery are essential.

Expression of FasR, Fas-L and Bcl-2 in CD4+ and CD8+ subpopulations of T lymphocytes in the cord blood of healthy full-term newborns, is gender of influence?

PURPOSE: The expression of FasR, Fas-L and Bcl-2 on CD4+ and CD8+ T lymphocytes subpopulations from the cord blood were assayed. The results in blood from boys and girls were analyses separately and compared. MATERIAL AND METHODS: Twenty four full-term newborns: 13 females and 11 males were included into the study. Blood from the umbilical vein was collected immediately after cutting the umbilical cord. The staining with monoclonal antibodies against CD4, CD8, FasR, Fas-L and Bcl-2 was performed within 2 hours after collection and followed with flow cytometry acquisition and analysis. RESULTS: The percentage of CD4+ and CD8+ T lymphocytes and CD4+:CD8+ ratio was within normal range. The expression of FasR, Fas-L was higher on CD4+ T lymphocytes than on CD8+ T lymphocytes (10,36% vs 6,79% and 6,66% vs 5,63% respectively). The expression of Bcl-2 was comparable (91,9% and 93,75% respectively). The comparison between males and females showed higher percentage of CD4+ lymphocytes on lymphocytes from girls' blood (56% vs 38,69%, p=0.0003). The expression of FasR and Fas-L on CD4+ T lymphocytes was higher on CD4+ T lymphocytes from girls' blood (13,8% vs 7,53% and 6,8% vs 6,52% respectively) but without statistical significance. Bcl-2 expression was higher on CD4+ T lymphocytes from boys' blood (99,65% vs 89,7%) but without statistical significance. Similar pattern of FasR, Fas-L and Bcl-2 expression was noted on CD8+ T lymphocytes analysed separately for girls' and boys' blood origin cells. The difference in Bcl-2 expression was more prominent than on CD4+ T lymphocytes and reached statistical significance. CONCLUSIONS: The lymphocytes from cord blood of boys showed the more immature immunophenotype than T lymphocytes from cord blood of girls'. Impaired apoptosis (as a consequence of low expression of FasR, Fas-L) in neonatal cells may contribute to prolonged inflammation in newborns after oxidative stress or infection.

Molecular and functional assessment of bacterial community convergence in metal-amended soils.

Species diversity and the structure of microbial communities in soils are thought to be a function of the cumulative selective pressures within the local environment. Shifts in microbial community structure, as a result of metal stress, may have lasting negative effects on soil ecosystem dynamics if critical microbial community functions are compromised. Three soils in the vicinity of a copper smelter, previously contaminated with background, low and high levels of aerially deposited metals, were amended with metal-salts to determine the potential for metal contamination to shape the structural and functional diversity of microbial communities in soils. We hypothesized that the microbial communities native to the three soils would initially be unique to each site, but would converge on a microbial community with similar structure and function, as a result of metal stress. Initially, the three different sites supported microbial communities with unique structural and functional diversity, and the nonimpacted site supported inherently higher levels of microbial activity and biomass, relative to the metal-contaminated sites. Amendment of the soils with metal-salts resulted in a decrease in microbial activity and biomass, as well as shifts in microbial community structure and function at each site. Soil microbial communities from each site were also observed to be sensitive to changes in soil pH as a result of metal-salt amendment; however, the magnitude of these pH-associated effects varied between soils. Microbial communities from each site did not converge on a structurally or functionally similar community following metal-salt amendment, indicating that other factors may be equally important in shaping microbial communities in soils. Among these factors, soil physiochemical parameters like organic matter and soil pH, which can both influence the bioavailability and toxicity of metals in soils, may be critical.

Flow cytometric analysis of HLA-DR antigen in conjunctival epithelial cells of patients with cystic fibrosis.

PURPOSE: Cystic fibrosis (CF) is an autosomal-recessive genetic disorder. The disease affects all secretory epithelia including the eye and belongs to the group of ocular surface epithelial diseases, termed keratoconjunctivitis sicca that develop in dry eye. In the pathogenesis of dry eye, inflammation plays a crucial role. The aim of this study was to investigate the expression of HLA-DR on conjunctival epithelial cells from patients with CF. MATERIALS AND METHODS: Twenty-five patients with CF and 25 normal subjects underwent ocular examination. Tear film break-up time (TBUT), Schirmer test, lissamine green staining, and conjunctival impression cytology were carried out. Cells were processed for flow cytometry, by using monoclonal antibodies to HLA-DR. RESULTS: The Schirmer test and TBUT scores were significantly lower in CF patients compared with controls. A significant increase of HLA-DR expression on epithelial cells was found in patients with CF compared with normal eyes. The Schirmer and TBUT test were positively correlated with HLA-DR expression for the percentage of cells. CONCLUSION: These results suggest that conjunctival epithelial cells play an important proinflammatory role in ocular changes in CF patients. Our findings confirm the presence of an inflammatory background and the immune nature of this disease. HLA-DR measurement might be a useful method for monitoring of inflammatory processes in the conjunctiva and could be helpful in the use of anti-inflammatory drugs in the treatment of ocular findings in CF patients.

[Tension pneumofluidothorax of the right pleural cavity resulting from a rupture of the oesophagus during gastrectasy]. / Tenzní pneumofluidotorax pravé pleurální dutiny na podklade ruptury jícnu pri gastrektazii.

The authors present a case of the tension pneumofluidothorax followed by a right pleural cavity empyema resulting from a rupture of the oesophagus during a major gastrectasy. The gastric dilation was indicated for a pyloro-duodenal stenosis following a duodenum-preserving resection of the pancreatic head, which was completed six years ago for a chronic pancreatitis. The symptoms developed fully shortly after lifting a heavy weight.

Evaluation of mCD14 expression on monocytes and the blood level of sCD14 in patients with generalized aggressive periodontitis.

PURPOSE: Lipopolysaccharides (LPS), a major component of the cell membrane of gram-negative bacteria, are the main stimulants of the host immune response, initiating inflammatory changes and responsible for periodontal tissue destruction. The mCD14, which is found primarily on monocytes and macrophages, is the key membranous receptor involved in LPS binding. CD14 is also present in the serum as a soluble form (sCD14) released due to shedding from monocytes. The aim of the study was to assess CD14 expression on peripheral blood monocytes in patients with generalized aggressive periodontitis (GAP). The level of sCD14 was also determined in the serum of GAP patients. MATERIAL AND METHODS: The study group consisted of 16 patients with generalized aggressive periodontitis, the control group had 13 systemically and periodontally healthy subjects. The expression of mCD14 was determined by flow cytometry and expressed as mean intensity of fluorescence (MIF). Serum sCD14 level was examined with ELISA method. RESULTS: The expressions of mCD14 on monocytes in GAP patients and control subjects were comparable. No statistically significant differences were noted in the mean serum sCD14 level between GAP and control subjects. CONCLUSIONS: As periodontitis is a local disorder affecting a small fragment of the oral cavity it seems likely that chronic bacterial infection existing there is not reflected in the peripheral parameters.

[Severe lead intoxication after ingestion of lead shots]. / Tezká otrava olovem po pozití broku.

The authors describe severe lead intoxication in a male patient who swallowed about 20 lead shots by accident. It caused an acute lead intoxication with highest blood lead reaching about 2.4 fold value of biological exposure limit for blood lead concentration for occupational exposure (0.97 mg/l), coproporphyrines in urine reaching 30 fold increase of biological exposure limit (1000 nmol/mmol creatinine), and 5-aminolevulic acid about 2.7 fold increase of biological limit (35.0 micromol/mmol creatinine). After first dose of chelating antidote (calcium disodium edetate, EDTA) the patient excreted 9.0 mg of lead in urine during 24 hours. Clinical symptoms and results of examinations led to suspicion of gastroduodenal ulcer at first. Diagnosis was defined after detailed examination and completing of the patient's history. Typical symptoms of intoxication developed--normocytic normochromic anemia and saturnine colics. Elimination of shots from digestive tract and treatment with 8 doses of antidote led to crucial change and improvement in the course of one month. The article should serve as an instruction to early recognition of lead intoxication.