The impact of exogenous dietary nucleotides in ameliorating Clostridium perfringens infection and improving intestinal barriers gene expression in broiler chicken.

The current study aimed to evaluate the efficiency of dietary nucleotides-supplementation on broiler chickens to alleviate the intestinal Clostridium perfringens (C. perfringens) levels and its adverse effect on gut and growth performance parameters. In this study, a total of 270 one-day-old mixed broiler chicks (Cobb 500) were randomly divided into six treatment groups with three replicates of 15 chicks/ replicate. Treatment 1 (CX), a negative control group was fed corn-soybean basal diet without added nucleotides. Treatment 2 (CN 0.05) and treatment 3 (CN 0.1), consisted of chicks were fed the basal diet with the addition of nucleotides on top at two levels (0.05 and 0.1%) respectively. Treatment 4 (PX), treatment 5 (PN 0.05), and treatment 6 (PN 0.1) consisted of chicks that were challenged with C. perfringens inoculum (~4 × 108 CFU/ml) on day 14, 15, 16 and 17of the experiment and were fed diets similar to treatments 1, 2, and 3 respectively. The trial continued for 35 days. At the end of the experiment, the intestinal C. perfringens counts, microscopic lesion scores, intestinal histomorphology, intestinal barriers (occludin and mucin mRNA expression) and growth parameters were determined. The results showed that the pathogen challenge significantly (P˂0.05) increased both C. perfringens levels and intestinal lesion scores. Which adversely affects intestinal barriers and intestinal histomorphology resulting in a significant decrease (P˂0.05) in body weight gain (BWG) with an increase in feed conversion ratio (FCR). Whereas, nucleotides-supplementation, at 0.1%, significantly decreased both C. perfringens levels and intestinal lesion scores, and significantly improved intestinal barriers and intestinal histomorphology which consequently resulted in improved growth performance parameters to be nearly the same as that of the control un-supplemented group. In conclusion, nucleotides markedly ameliorated the negative effects of C. perfringens challenge by improving the intestinal barrier function and intestinal histomorphology which positively reflected on the growth performance of challenged birds.

Psychosocial Evaluation in Patients Undergoing Left Ventricular Assist Device Implantation Using the Transplant Evaluation Rating Scale.

BACKGROUND: It has been recommended that all candidates for left ventricular assist device (LVAD) implantation undergo preoperative psychologic evaluation for risk assessment. OBJECTIVE: We used the transplant evaluation rating scale (TERS) that was established for pretransplant evaluation to investigate the psychosocial assessment of patients undergoing LVAD implantation. METHODS: This study retrospectively analyzed data from 125 patients with advanced heart failure who were evaluated by the TERS before LVAD implantation. Postoperative follow-up included survival, total length of hospital stay, readmissions, and post-LVAD out-of-hospital days after discharge. The cohort was stratified according to the TERS scores into low-, moderate-, and high-risk groups. The outcomes were analyzed to evaluate whether the TERS score was associated with post-LVAD adverse events. RESULTS: The TERS, when stratified into 3 risk groups showed significant difference in 8 of the 10 psychosocial domains (p < 0.001). The mean number of outpatient days after discharge was significantly different between the low-, moderate-, and high-risk groups (p < 0.001). All other outcomes were not significantly different. CONCLUSIONS: This study showed that the TERS is successful in stratifying our patients with an LVAD into 3 risk groups, indicating the internal validity of this test. The number of out-of-hospital (outpatient) days after discharge was significantly shorter in the TERS high-risk group, which may affect the quality of life and cost of post-LVAD care.

[Implications of choice of products and impression technique on the thickness of the dento-prosthetic interface of the CAD-CAM crowns]. / Incidences du choix des produits et de la technique d'empreinte sur l'épaisseur de l'interface dento-prothétique des couronnes CAD/CAM.

The purpose of this study is to find out what type of impression material is able to achieve a CAD-CAM (Procera) crown with minimal thickness at the dental-prosthetic interface, taking into account the effect of the oversize replica and dimensional variations of the impression materials over time. The accuracy of the marginal adaptation will therefore depend on the oversize replica of clinical preparation controlled by the constant K. Three different types of impression materials: medium viscosity polyether (Impregum 3M-ESPE, Germany), silicones polyvinyl siloxane A (Putty + Very Light) and (Heavy + Light) (Express 3M-ESPE, Germany), were used for making impressions of fifteen initial prototype maxillary teeth made of nickel chrome. The cast of the impressions were poured with plaster type IV (Zhermack, Italy), on which thirty Procera crowns were fabricated. The thickness of the dental-prosthetic interface was then studied at three levels: 0, 1 and 2 mm. The results show that the impression material has a statistically significant impact on the thickness of the dental-prosthetic interface at all three levels. The most compressive impression technique, Putty + Very Light gave the best results at the three levels pre-cited. The results analyzed under optical microscopy show a statistically significant difference between the three impression material products (p-value < 0.05). The calibration constant K, according to each clinical situation, can therefore lead to optimal dental-prosthetic inter-face.

Expression of ECM1 and MMP-2 in follicular thyroid lesions among Egyptians.

BACKGROUND: Thyroid nodules require pre-surgical cytological assessment for possible risk of malignancy. Many techniques were introduced to enhance differential diagnosis and to avoid unnecessary diagnostic surgery. OBJECTIVE: The study aims to investigate the potential use of ECM1 gene and MMP-2 protein as preoperative tumor markers in suspicious follicular thyroid lesions. METHODS: The study included 40 Egyptian cases with solitary thyroid nodules. They underwent preoperative FNAB followed by thyroidectomy. MMP-2 protein and ECM1 gene were detected using immunostaining and conventional semi-quantitative RT-PCR techniques; respectively. The diagnostic accuracy of FNAB, gene and protein expression level cutoffs was calculated by using ROC. RESULTS: Both MMP-2 protein and ECM1 gene expressions were significantly higher in malignant than benign group (P < 0.001). Both were significantly higher in higher tumor stages (PMMP-2= 0.002; PECM1 = 0.032) but only ECM1 significantly differed with tumor size (P < 0.006). The diagnostic performances of ECM1 expression scores was significantly better than that of FNAB (P = 0.049). A significant direct correlation was detected between ECM1 gene and MMP-2 protein expressions in cases of FVPC and of FC (P = 0.014). CONCLUSIONS: MMP-2 protein and ECM1 gene are useful preoperative markers for defining malignancy in suspicious thyroid nodules.

Novel techniques for enhancement and segmentation of acne vulgaris lesions.

BACKGROUND: More than 99% acne patients suffer from acne vulgaris. While diagnosing the severity of acne vulgaris lesions, dermatologists have observed inter-rater and intra-rater variability in diagnosis results. This is because during assessment, identifying lesion types and their counting is a tedious job for dermatologists. To make the assessment job objective and easier for dermatologists, an automated system based on image processing methods is proposed in this study. OBJECTIVES: There are two main objectives: (i) to develop an algorithm for the enhancement of various acne vulgaris lesions; and (ii) to develop a method for the segmentation of enhanced acne vulgaris lesions. METHODS: For the first objective, an algorithm is developed based on the theory of high dynamic range (HDR) images. The proposed algorithm uses local rank transform to generate the HDR images from a single acne image followed by the log transformation. Then, segmentation is performed by clustering the pixels based on Mahalanobis distance of each pixel from spectral models of acne vulgaris lesions. RESULTS: Two metrics are used to evaluate the enhancement of acne vulgaris lesions, i.e., contrast improvement factor (CIF) and image contrast normalization (ICN). The proposed algorithm is compared with two other methods. The proposed enhancement algorithm shows better result than both the other methods based on CIF and ICN. In addition, sensitivity and specificity are calculated for the segmentation results. The proposed segmentation method shows higher sensitivity and specificity than other methods. CONCLUSION: This article specifically discusses the contrast enhancement and segmentation for automated diagnosis system of acne vulgaris lesions. The results are promising that can be used for further classification of acne vulgaris lesions for final grading of the lesions.

Primary cytomegalovirus infection in pregnant Egyptian women confirmed by cytomegalovirus IgG avidity testing.

OBJECTIVE: To determine the frequency of primary cytomegalovirus (CMV) infection in pregnant Egyptian women using CMV IgG avidity testing. SUBJECTS AND METHODS: A cross-sectional study was conducted at Suez Canal University Hospital, Ismailia, Egypt. A total of 546 pregnant women, presenting for routine antenatal screening, were tested for CMV IgG and IgM using a commercially available enzyme-linked immunosorbent assay (ELISA). Sera from CMV IgM-positive women were tested by CMV IgG avidity assay. RESULTS: All the 546 pregnant women were seropositive for anti-CMV IgG. Of the 546 women, 40 (7.3%) were positive or equivocal for IgM antibodies. All sera from the 40 women (IgG+/IgM+) showed a high or intermediate CMV IgG avidity index. Of the 40 women, 23 (57.5%) were in the second or third trimesters of pregnancy and had their first-trimester blood retrieved, and the tested CMV IgG avidity assay showed a high avidity index. CONCLUSION: Women who were IgM positive had no primary CMV infection in the index pregnancy as evidenced by the high CMV IgG avidity testing.

High prevalence of Klebsiella pneumoniae carbapenemase-mediated resistance in K. pneumoniae isolates from Egypt.

The emergence and rapid spread of antibiotic-resistant Klebsiella pneumoniae isolates harbouring the blaKPC gene that encodes for carbapenemase production have complicated the management of patient infections. This study in a tertiary care hospital in Egypt used real-time PCR assay to test ertapenem-nonsusceptible isolates of K. pneumoniae for the presence of the blaKPC gene and compared the results with modified Hodge test. Antibiotic sensitivity was performed by standard methods, and interpreted following both the old CLSI breakpoints (M100-S19) for carbapenems and the revised breakpoints (M100-S22). From the 45 non-duplicate isolates of K. pneumoniae recovered from different clinical specimens, a high prevalence of ertapenem-nonsusceptible isolates (44.4%) was reported using the new lower CLSI breakpoints. The blaKPC gene was confirmed in 14/20 (70.0%) of these isolates. The high prevalence of ertapenem nonsusceptibility at a tertiary care hospital in Egypt was predominantly attributed to K. pneumoniae carbapenemase-mediated resistance mechanisms in K. pneumoniae isolates.

High prevalence of Klebsiella pneumoniae carbapenemase-mediated resistance in K. pneumoniae isolates from Egypt

The emergence and rapid spread of antibiotic-resistant Klebsiella pneumoniae isolates harbouring the blaKPC gene that encodes for carbapenemase production have complicated the management of patient infections. This study in a tertiary care hospital in Egypt used real-time PCR assay to test ertapenem-nonsusceptible isolates of K. pneumoniae for the presence of the blaKPC gene and compared the results with modified Hodge test. Antibiotic sensitivity was performed by standard methods, and interpreted following both the old CLSI breakpoints [M100-S19] for carbapenems and the revised breakpoints [M100-S22]. From the 45 non-duplicate isolates of K. pneumoniae recovered from different clinical specimens, a high prevalence of ertapenem-nonsusceptible isolates [44.4%] was reported using the new lower CLSI breakpoints. The blaKPC gene was confirmed in 14/20 [70.0%] of these isolates. The high prevalence of ertapenem nonsusceptibility at a tertiary care hospital in Egypt was predominantly attributed to K. pneumoniae carbapenemase-mediated resistance mechanisms in K. pneumoniae isolates

Somatotropin adenoma and resistance to thyroid hormone.

Resistance to thyroid hormone (RTH) is a rare disease characterized by non-suppressed TSH in spite of high free thyroid hormone levels. Up to date, in the literature, there are more than 600 RTH cases, but co-incidental hypophyseal adenoma was reported in only 1 case. In the literature, despite reported cases with thyrotropinoma accompanying RTH, we could not find a case with somatotropinoma accompanying RTH. Here, we report a 34-yr-old male patient, who was admitted to the hospital with complaints of dyspnea, chest pain, and palpitation in 2003. His alpha- subunit value was normal and the alpha-subunit/TSH molar ratio was <1. His response to TRH stimulation test was normal. His TSH level was suppressed in the T3 suppression test. Hypophyseal magnetic resonance imaging showed a 6-mm hypophyseal microadenoma. Levels of all anterior hypophyseal hormones, including GH and IGF-I, were normal. Oral glucose tolerance test (OGTT)-GH suppression test was normal. The patient was followed with the diagnosis of RTH and incidental hypophyseal adenoma. After 3 yr, because of high levels of IGF-I: 901 ng/ml (68-324), the OGTT-GH suppression test was reported and no suppression was detected. Thus, the patient was referred to surgery with the pre-diagnosis of RTH and acromegaly. Immunohistochemistry was showed as strong GH staining with low Ki 67 index while TSH and other anterior hypophyseal hormones stainings were negative. Post-operative thyroid hormones were still high.

Prevalence and clinical significance of antineutrophil cytoplasmic antibody in Graves' patients treated with propylthiouracil.

Development of antineutrophil cytoplasmic antibody (ANCA) during therapy with propylthiouracil (PTU) is not uncommon and PTU-induced ANCA-positive vasculitis is also reported. The aim of this study was to assess the presence and clinical significance of ANCA positivity in Graves' patients treated with PTU. Newly diagnosed Graves' disease patients (prospective group, n = 58) were evaluated before and during therapy with PTU to investigate the development of ANCA positivity. ANCA positivity is also investigated in previously diagnosed Graves' patients who had already been receiving PTU treatment (cross-sectional group, n = 51). Comparisons with Hashimoto thyroiditis (n = 55) and toxic nodular goitre (n = 20) patients, and healthy control subjects (n = 20) were carried out to define the possible influence of hyperthyroidism and/or thyroid autoimmunity on ANCA positivity. At baseline evaluation, ANCA was negative in all newly diagnosed Graves' patients. Only 28 of the 58 patients in prospective group completed 2 years of follow-up which occurred at 3-month intervals. ANCA positivity was detected 32.1% (n = 9) in a mean period of 11.7 +/- 6.1 months in prospective group. Only two (3.9%) patients in a cross-sectional group had ANCA positivity in a mean treatment period of 7.6 +/- 4.6 months. None of the patients with ANCA positivity developed symptoms and signs related to vasculitis. None of the patients with Hashimoto thyroiditis and toxic nodular goitre, and healthy control subjects had ANCA positivity. PTU therapy is associated with asymptomatic production of ANCA in a time-dependent manner, which mostly disappears after discontinuation of therapy. Hyperthyroidism or autoimmunity per se does not appear to have effect on development of ANCA positivity.

Dysphagia and hemispheric stroke: a transcranial magnetic study.

INTRODUCTION: Dysphagia is a common and distressing consequence of hemispheric stroke. STUDY AIM: To verify the usefulness of transcranial magnetic stimulation (TMS) studies of swallowing in healthy subjects and in stroke patients. MATERIAL AND METHODS: TMS studies of the motor cortical projections to the upper esophageal sphincter were performed in 45 patients with acute mono-hemispheric stroke (26 patients with dysphagia) and 20 healthy adult volunteers. RESULTS: TMS of either hemisphere in normal volunteers evoked motor evoked potentials (MEP) in the esophagus. The average point of optimal excitability was slightly more anterior in the right hemisphere; otherwise, MEP amplitudes and latencies were similar from both hemispheres as were the areas of the cortical map. The cortical map area and amplitude of MEPs were significantly smaller and the latencies longer after stimulation of the affected hemisphere compared with the unaffected hemisphere and pooled control data. Twenty-four dysphagic patients (92.3%) had abnormalities of MEP of the affected hemisphere, while only five non-dysphagic patients (26%) had these abnormalities. Dysphagic patients were older and had more disability compared with non-dysphagic patients. MEPs of the affected hemisphere of patients with dysphagia were later and smaller in amplitude than MEPs of non-dysphagic patients. The cortical map area was also smaller. CONCLUSION: The esophagus is represented bilaterally in motor cortex, but the hot spot lies more anterior to Cz in right hemisphere compared to left hemisphere. Both the severity of stroke and neuroplasticity of the unaffected hemisphere have implications in the development of dysphagia.

The impact of processing load on emotion.

This event-related fMRI study examined the impact of processing load on the BOLD response to emotional expressions. Participants were presented with composite stimuli consisting of neutral and fearful faces upon which semi-transparent words were superimposed. This manipulation held stimulus-driven features constant across multiple levels of processing load. Participants made either (1) gender discriminations based on the face; (2) case judgments based on the words; or (3) syllable number judgments based on the words. A significant main effect for processing load was revealed in prefrontal cortex, parietal cortex, visual processing areas, and amygdala. Critically, enhanced activity in the amygdala and medial prefrontal cortex seen during gender discriminations was significantly reduced during the linguistic task conditions. A connectivity analysis conducted to investigate theories of cognitive modulation of emotion showed that activity in dorsolateral prefrontal cortex was inversely related to activity in the ventromedial prefrontal cortex. Together, the data suggest that the processing of task-irrelevant emotional information, like neutral information, is subject to the effects of processing load and is under top-down control.

Which thyroid-stimulating hormone level should be sought in hypothyroid patients under L-thyroxine replacement therapy?

We sought to determine whether relationships exist between level of thyroid-stimulating hormone (TSH) suppression and cardiovascular risk parameters such as plasma homocysteine, C-reactive protein (CRP), fibrinogen, D-dimer and serum cholesterol in patients taking L-thyroxine-replacement therapy (LT4-RT). Four hundred and two hypothyroid patients under LT4-RT were cross-sectionally evaluated. Patients were grouped according to their achieved TSH (mIU/l) levels under LT4-RT on an arbitrary manner. Those patients having a TSH value 0.4-2 were defined as group 1 (n = 154), a TSH level of 2 to less than 5.5 were defined as group 2 (n = 176) and a TSH level of 5.5 to less than 20 with a normal free T3 and free T4 level were defined as group 3 (n = 72). The three groups of patients were also compared with overt hypothyroid patients (n = 71) and healthy controls (n = 97). Homocysteine levels (micromol/l) were significantly different between the three groups (10.4 +/- 4 for group 1, 11.3 +/- 3.7 for group 2 and 13.5 +/- 4.7 for group 3; p < 0.01 for all groups). Significant differences in CRP (mg /l) levels were present between the three groups (2.6 +/- 2.6 for group 1, 3.3 +/- 2.9 for group 2 and 4.8 +/- 4.1 for group 3; p < 0.01 for all groups). Univariate analysis showed that both homocysteine and CRP levels significantly correlated with free T4 and TSH level (p < 0.01 for both groups). No statistically significant differences were noticed in respect to fibrinogen and d-dimer levels between three groups. In examining the effect of LT4-RT on lipid parameters, a tendency towards beneficial effects without achieving statistical significance was observed. Practically speaking, a target TSH level of less than 2 might be advisable to lower CRP levels and homocysteine levels, and possibly lipid parameters.

Severe reversible dilated cardiomyopathy in a patient with multiple endocrine neoplasia 2A syndrome.

Pheochromocytoma may infrequently lead to dilated cardiomyopathy, which may reverse partially or completely after treatment. Progressive dyspnea, palpitations, and paroxysmal attacks of severe hypertension leading to cardiac failure had developed in a 25-yr-old woman. Chest radiography and echocardiography revealed a massive 4-chamber dilatation of the heart with an ejection fraction of 12%. Twenty-four-h urinary vanillylmandelic acid and metanephrine levels were elevated. Magnetic resonance imaging detected a large mass lesion in the right adrenal gland. Oral glucose tolerance testing revealed diabetes mellitus. Medical drug therapy with alpha-blocker, angiotensin converting enzyme inhibitor, beta-blocker, digoxin, and diuretic rapidly improved her cardiac condition. Repeat echocardiogram showed that the left ventricular function had improved substantially. The clinical condition of excess catecholaminemia (and thus, arterial hypertension and the abnormality of the glucose metabolism) subsided with complete resolution of the congestive heart failure following the surgical removal of the tumor. Evaluation for medullary thyroid carcinoma (MTC) revealed an elevated calcitonin level demonstrated by fine needle aspiration biopsy. There were no biochemical evidences for primary hyperparathyroidism. Multiple endocrine neoplasia 2 (MEN 2A) syndrome was diagnosed. An overwhelming secretion of catecholamine might cause severe cardiomyopathy and impair glucose metabolism, as evidenced by the improvement of both conditions following the medical treatment of catecholaminemia and surgical resection of the tumor.