Computer-based assessment for facioscapulohumeral dystrophy diagnosis.

The paper presents a computer-based assessment for facioscapulohumeral dystrophy (FSHD) diagnosis through characterisation of the fat and oedema percentages in the muscle region. A novel multi-slice method for the muscle-region segmentation in the T1-weighted magnetic resonance images is proposed using principles of the live-wire technique to find the path representing the muscle-region border. For this purpose, an exponential cost function is used that incorporates the edge information obtained after applying the edge-enhancement algorithm formerly designed for the fingerprint enhancement. The difference between the automatic segmentation and manual segmentation performed by a medical specialists is characterised using the Zijdenbos similarity index, indicating a high accuracy of the proposed method. Finally, the fat and oedema are quantified from the muscle region in the T1-weighted and T2-STIR magnetic resonance images, respectively, using the fuzzy c-mean clustering approach for 10 FSHD patients.

Deposition and fine particle production during dynamic flow in a dry powder inhaler: a CFD approach.

In this work the dynamic flow as well as the particle motion and deposition in a commercial dry powder inhaler, DPI (i.e., Turbuhaler) is described using computational fluid dynamics, CFD. The dynamic flow model presented here is an extension of a steady flow model previously described in Milenkovic et al. (2013). The model integrates CFD simulations for dynamic flow, an Eulerian-fluid/Lagrangian-particle description of particle motion as well as a particle/wall interaction model providing the sticking efficiency of particles colliding with the DPI walls. The dynamic flow is imposed by a time varying outlet pressure and the particle injections into the DPI are assumed to occur instantaneously and follow a prescribed particle size distribution, PSD. The total particle deposition and the production of fine particles in the DPI are determined for different peak inspiratory flow rates, PIFR, flow increase rates, FIR, and particle injection times. The simulation results for particle deposition are found to agree well with available experimental data for different values of PIFR and FIR. The predicted values of fine particle fraction are in agreement with available experimental results when the mean size of the injected PSD is taken to depend on the PIFR.

Flow and particle deposition in the Turbuhaler: a CFD simulation.

In this work the steady-state flow in a commercial dry powder inhaler device, DPI (i.e., Turbuhaler) is described using computational fluid dynamics. The Navier-Stokes equations are solved using commercial CFD software considering different flow models, i.e., laminar, k-ε, k-ε RNG, and k-ω SST as well as large Eddy simulation. Particle motion and deposition are described using a Eulerian-fluid/Lagrangian-particle approach. Particle collisions with the DPI walls are taken to result in deposition when the normal collision velocity is less than a critical capture velocity. Flow and particle deposition, for a range of mouthpiece pressure drops (i.e., 800-8800 Pa), as well as particle sizes corresponding to single particles and aggregates (i.e., 0.5-20 µm), are examined. The total volumetric outflow rate, the overall particle deposition as well as the spatial distribution of deposition sites in the DPI are determined. The transitional k-ω SST model for turbulent flow was found to produce results most similar to a reference solution obtained with LES, as well as experimental results for the pressure drop in the DPI. Overall, the simulation results are found to be in agreement with the available experimental data for local and total particle deposition.

Relocation of ventricular catheter trough ventriculostomy due to congenital unilateral hydrocephalus: Nine year follow-up.

BACKGROUND: Congenital unilateral hydrocephalus is an uncommon entity occurring almost exclusively in children. Atresia, stenosis, membranous occlusion and even functional obstruction of the foramen of Monro have been described to be the main cause of this type of hydrocephalus. There are two options available in the surgical management of unilateral hydrocephalus: one is the placement of shunt CSF diversion from the dilated ventricle and the other is fenestration of the occluded foramen of Monro or septum pellucidum by endoscopy or by stereotactic method. Migration of the ventriculoperitoneal (VP) shunt in or out of ventricles is not so uncommon, but the relocation of the ventricular tip of a catheter from the ventricle into the quadrigeminal cisterns and superior vermis in association with ventriculostomy is extremely rare. Spontaneous ventriculostomy is a rare event and results from spontaneous rupture of a ventricle into the subarachnoid space. CASE DESCRIPTION: A 5½-month-old baby with a right-sided congenital unilateral hydrocephalus underwent a VP shunt andhad experienced an uneventful outcome. Four years later on an MR imaging examination, the tip of the ventricular catheter passing through the medial wall of the ventricle and the quadrigeminal cistern was found to be situated in the superior vermis. During the follow-up period, there were no neurological difficulties. The cognitive and motor skill development corresponded well with the child's age. It transpired that the hydrocephalic ventricle reduced its size dramatically to normal. CONCLUSION: We have described the extremely rare site of the relocation of the ventricular catheter after the treatment of the congenital unilateral hydrocephalus by VP shunting. Spontaneous ventriculostomy as a rare phenomenon may be the explanation of the relocation of the ventricular catheter.

Cancer by negative heterosis: breast and ovarian cancer excess in hybrids of inbred ethnic groups.

Breast and ovarian cancer rates in Pakistan are significantly higher than in neighboring countries. The cancer rate discrepancies cannot be explained with discrepancies of their risk factors. We propose that observed cancer excess in Pakistan is due to cancer development by negative heterosis. Heterosis occurs when a hybrid has a phenotypic characteristic significantly different from that in either parent (hybrid vigor). At a molecular level, heterosis occurs in a heterozygote when one of the two alleles is inactivated. Gene inactivation occurs by methylation of cytosine in a promoter region of a gene. Initiation of allele inactivation is linked to the factors like stress, gender, diet, or another gene. In heterozygote, inactivation of one of the two tumor-suppressor alleles leads to monoallelic expression. This increases cancer risk in the same way the risk is increased in individual who inherit a single mutated tumor-suppressor gene (hereditary cancer syndrome). In both, cancer by heterosis and inherited cancer syndrome, cancer develops after inactivation of a second allele (second hit hypothesis). In a population, conditions that favor development of cancer by heterosis are those that favor mating of a large number of different homozygotes because they produce a large number of different heterozygotes. Among a large number of heterozygotes, there is an increased chance that some of hybrids will develop cancer by heterosis. In Pakistan, conditions were favorable for cancer development by heterosis because country has a high number of different ethnic groups and brotherhoods all of which have a higher rate of homozygosity due to a high frequency of consanguineous marriages, and marriages between members of different groups occurred because of intense population mixing. Result was birth of a large number of inter-ethnic/brotherhood hybrids (heterozygotes), some of which have developed cancer by heterosis.

Effect of advanced glycation endproducts on cell cycle and their relevance for Alzheimer's disease.

In Alzheimer's disease, neurons in affected regions re-enter the cell cycle, leave the G0 state and appear to be arrested at both the G1/S and G2/M phase with resulting cell death, predominantly by apoptosis. Further hallmarks of AD are crosslinked protein deposits (amyloid plaques and neurofibrillary tangles), which time-dependently become modified by "advanced glycation endproducts (AGEs)". Since AGEs activate both mitogenic and redox-sensitive pathways, they might be involved both in cell cycle re-entry and arrest.

Glycoxidative stress creates a vicious cycle of neurodegeneration in Alzheimer's disease--a target for neuroprotective treatment strategies?

Accumulation of Advanced Glycation Endproducts (AGEs) in the brain is a feature of ageing and degeneration, especially in Alzheimer's disease (AD). Increased AGE levels explain many of the neuropathological and biochemical features of AD such as extensive protein crosslinking (beta-amyloid and MAP-tau), glial activation, oxidative stress and neuronal cell death. Oxidative stress and AGEs initiate a positive feedback loop, where normal age-related changes develop into a pathophysiological cascade. Combined intervention using antioxidants, anti-inflammatory drugs and AGE-inhibitors may be a promising neuroprotective strategy.

Advanced glycation endproducts co-localize with inducible nitric oxide synthase in Alzheimer's disease.

Advanced glycation endproducts (AGEs), protein-bound oxidation products of sugars, have been shown to be involved in the pathophysiological processes of Alzheimer's disease (AD). AGEs induce the expression of various pro-inflammatory cytokines and the inducible nitric oxide synthase (iNOS) leading to a state of oxidative stress. AGE modification and resulting crosslinking of protein deposits such as amyloid plaques may contribute to the oxidative stress occurring in AD. The aim of this study was to immunohistochemically compare the localization of AGEs and beta-amyloid (Abeta) with iNOS in the temporal cortex (Area 22) of normal and AD brains. In aged normal individuals as well as early stage AD brains (i.e. no pathological findings in isocortical areas), a few astrocytes showed co-localization of AGE and iNOS in the upper neuronal layers, compared with no astrocytes detected in young controls. In late AD brains, there was a much denser accumulation of astrocytes co-localized with AGE and iNOS in the deeper and particularly upper neuronal layers. Also, numerous neurons with diffuse AGE but not iNOS reactivity and some AGE and iNOS-positive microglia were demonstrated, compared with only a few AGE-reactive neurons and no microglia in controls. Finally, astrocytes co-localized with AGE and iNOS as well as AGE and were found surrounding mature but not diffuse amyloid plaques in the AD brain. Our results show that AGE-positive astrocytes and microglia in the AD brain express iNOS and support the evidence of an AGE-induced oxidative stress occurring in the vicinity of the characteristic lesions of AD. Hence activation of microglia and astrocytes by AGEs with subsequent oxidative stress and cytokine release may be an important progression factor in AD.

Protein "AGEing"--cytotoxicity of a glycated protein increases with its degree of AGE-modification.

Non-enzymatic glycation of proteins with reducing sugars and subsequent transition metal-catalyzed oxidations leads to the formation of protein-bound "advanced glycation endproducts" (AGEs). They accumulate on long-lived proteins including on and in the vicinity of the beta-amyloid plaques in Alzheimer's disease (AD). Since the AGE modification of a protein increases with time, and such a "long-term incubation" might also occur in the AD brain, we investigated whether an increase in the cytotoxic effects of an AGE-modified model protein occurs over time. Bovine serum albumin (BSA) was modified by glucose for defined time periods, and the viability of SH-SY5Y neuroblastoma cells, incubated with the differentially AGE-modified BSA samples, was measured with the MTT assay. Cytotoxicity of the AGE-modified BSAs increased in correlation to the incubation time with glucose. Among the AGE-specific markers, browning (OD 400) correlated best with cytotoxicity, followed by AGE-specific fluorescence and the defined AGE, carboxymethyllysine. Since AGEs accumulate in AD over time, they may be one of the "age-related" factors contributing to neuronal cell death in Alzheimer's disease.

Anti-inflammatory antioxidants attenuate the expression of inducible nitric oxide synthase mediated by advanced glycation endproducts in murine microglia.

Advanced glycation endproducts (AGEs) accumulate on long-lived protein deposits including beta-amyloid plaques in Alzheimer's disease (AD). AGE-modified amyloid deposits contain oxidized and nitrated proteins as markers of a chronic neuroinflammatory condition and are surrounded by activated microglial and astroglial cells. We show in this study that AGEs increase nitric oxide production by induction of the inducible nitric oxide synthase (iNOS) on the mRNA and protein level in the murine microglial cell line N-11. Membrane permeable antioxidants including oestrogen derivatives (e.g. 17beta-oestradiol) thiol antioxidants (e.g. (R+)-alpha-lipoic acid) and Gingko biloba extract EGb 761, but not phosphodiesterase inhibitors such as propentophylline, prevent the up-regulation of AGE-induced iNOS expression and NO production. These results indicate that oxygen free radicals serve as second messengers in AGE-induced pro-inflammatory signal transduction pathways. As this pharmacological mechanism is not only relevant for Alzheimer's disease, but also for many chronic inflammatory conditions, such membrane-permeable antioxidants could be regarded not only as antioxidant, but also as potent therapeutic anti-inflammatory drugs.

[Acute fatty liver in pregnancy]. / Akutna masna jetra u trudnoci.

Acute fatty liver in pregnancy (AFLP) is a rare disease with sudden onset in the third trimester of pregnancy characterized by jaundice, bleeding, liver failure and encephalopathy. The cause of AFLP is unknown. It is of short duration and high risk of mortality. The aim of this paper is to describe a patient who was hospitalised in the 36th week of pregnancy due to jaundice and bleeding. Upon arrival the patient delivered a dead infant, and thereafter jaundice, severe bleeding and encephalopathy deteriorated. The patient's laboratory results revealed AFLP which was confirmed with increased echogenicity of the liver. Spontaneous delivery and maximal supportive therapy contributed to successful recovery of the patient in spite of severe haemorrhage, encephalopathy, acute ranal failure, polyserositis and adult respiratory distress syndrome.