Epstein-Barr virus infection induces aberrant TLR/MyD88 activation pathway and fibroblast-myofibroblast conversion in systemic sclerosis. (P6322)

Activated fibroblasts, mainly myofibroblasts are considered the principal mediators of fibrogenesis in systemic sclerosis (SSc), although the origin of persistent activation of fibroblasts and myofibroblasts is unclear. Activation of Interferon by Toll-like receptors in immune cells may play a role in the pathogenesis of inflammation in many autoimmune diseases, including SSc. We investigated whether fibroblasts persistently activated by innate immune and infectious stimuli might induce IFNs and TGFβ, two major markers of inflammation and fibrosis implicated in SSc pathogenesis. Since Epstein-Barr virus has been a leading candidate in triggering several autoimmune diseases, we developed methodology for infecting SSc fibroblasts with this virus. We found that EBV signals through the TLR/MyD88-pathway in infected-fibroblasts, activating a distinct innate immune response characterized by the expression of selected IFN- and TGFβ-inducible genes. Intriguingly, activation of the TLR/MyD88-pathway by CpGODN2006 or R837 ligand, significantly induced IFN-regulated genes, but no expression of TGFβ-regulated genes was detected in TLR/MyD88-stimulated fibroblasts. EBV-TLR/MyD88 aberrant activation induces the expression of selected IRFs, ISGs, TGFβ1 and several markers of fibroblast activation, such as smooth-muscle-actin and Endothelin-1, and all of these genes play a key role in determining the pro-fibrotic phenotype in SSc-fibroblasts.

KSHV ORF67 encoded lytic protein localizes on the nuclear membrane and alters emerin distribution

p29, a newly identified Kaposi's sarcoma-associated herpesvirus (KSHV) protein, is the product of ORF67, the positional homolog of the conserved herpesvirus protein UL34. Like its homologues in other herpesviruses, p29 is expressed early during viral lytic cycle, and is localized on the nuclear rim. Upon chemical induction of viral replication in primary effusion lymphoma cells, p29 interacts with p33, encoded by ORF69, the positional homolog of the conserved herpesvirus protein UL31, and both proteins colocalize on the nuclear membrane. IFA and biochemical analysis of infected or transfected cells showed that p29 expression resulted in delocalization and hyperphosphorylation of emerin, whereas other nuclear lamin associated proteins, such as LUMA, LB1 and LBR were not affected. Mislocalization of emerin was robustly increased upon combined expression of p29 and p33, suggesting that emerin destabilization might represent the first step in nuclear lamina disassembling, a process necessary for nucleocapsid maturation.

Note: Comparison between a prism-based and an acousto-optic tunable filter-based spectrometer for diffusive media

This paper compares two continuously tunable systems for time-resolved spectroscopy of diffusive media based on a supercontinuum laser source. Two approaches for spectral selection are considered relying either on a dispersive prism or on a commercial acoustic-optic tunable filter (AOTF) device. The comparison was performed first in terms of extracted power and spectral response function, then in terms of distortions introduced in the retrieved absorption and scattering spectra. Simulations and experiments on diffusive phantoms confirmed that, besides narrower FWHM in the AOTF bandpass, the prism solution is superior with respect to the distortions produced on the recovered spectra.

Parvovirus B19 in pregnancy: possible consequences of vertical transmission

OBJECTIVE

The aim was to determine the outcome of pregnancies complicated by maternal Parvovirus B19 (B19) infection.

METHOD

Among 175 pregnant women referred to our clinic because of suspicion of a B19 infection, 63 with confirmed laboratory diagnosis of acute/recent B19 infection were followed up by ultrasound and Doppler measurement of the middle cerebral artery peak systolic velocity.

RESULTS

The vertical transmission rate was 31.7% (20/63). Of the 20 infected, 8 had hydrops, 1 had signs suggestive of meconium peritonitis and 1 had an isolated hydrothorax. Three fetuses presenting with hydrops were treated with intrauterine blood transfusion. Two of them died while the last showed resolution of anemia. Among the five untreated hydropic fetuses, one presented with mild signs that resolved spontaneously, two died at 16 and 17 weeks of gestation and two had also cardiomegaly and the parents opted for elective termination of pregnancy. All the anemic fetuses had middle cerebral artery peak systolic velocity values more than 1.8 multiples of the median. No stillbirth occurred.

CONCLUSIONS

The outcome of uncomplicated cases with B19 infection is good. In the presence of hydrops prognosis was very poor. It seems therefore logical to attempt to pick up this ominous signs early.

Blue rubber bleb nevus: an uncommon cause of intestinal intussusception

The blue rubber bleb nevus syndrome or Bean syndrome is a rare disorder characterized by cutaneous and gastrointestinal vascular malformations. A 5-year-old girl with Bean syndrome hospitalized in a pediatric unit came under our observation with abdominal pain and vomiting. An X-ray of the abdomen showed an intestinal occlusion and an ultrasonography showed a suspected intestinal invagination. She underwent emergency laparoscopic surgery using three trocars. Laparoscopy revealed a huge ascitis and multiple vascular lesions located on the loops and on the parietal peritoneum, and we identified also an ileo-ileal invagination. We performed a laparoscopic disinvagination that showed one huge vascular lesion producing the invagination and causing a stenosis of intestinal lumen. We performed an intestinal resection after exteriorizing the loops through the umbilicus as well as a termino-terminal ileal anastomosis.

CONCLUSIONS

Our case shows that an intestinal invagination due to Bean syndrome is extremely rare in pediatric patients but possible. In the emergency, laparoscopy seems to be a safe and effective procedure to confirm the diagnosis and to perform the disinvagination mini-invasivally. In addition, laparoscopy permits to have a clear picture of other intra-abdominal lesions linked to Bean syndrome.

Brainstem-vermis and brainstem-tentorium angles allow accurate categorization of fetal upward rotation of cerebellar vermis

OBJECTIVE

To evaluate the role of the brainstem-vermis (BV) and brainstem-tentorium (BT) angles in the differential diagnosis of upward rotation of the fetal cerebellar vermis.

METHODS

The BV and BT angles were measured retrospectively on median sonographic views of the brain in 31 fetuses at 19-28 weeks' gestation with upward rotation of the cerebellar vermis due to Blake's pouch cyst (n = 12), Dandy-Walker malformation (n = 12) and cerebellar vermian hypoplasia (n = 7). Eighty normal fetuses at 20-24 weeks were included as controls.

RESULTS

In the control group, BV and BT angles were 9.1 ± 3.5° (range, 4-17°) and 29.3 ± 5.8° (range, 21-44°), respectively. The BV angle was significantly increased in each of the three subgroups of anomalies: Blake's pouch cyst (23 ± 2.8°; range, 19-26°), vermian hypoplasia (34.9 ± 5.4°; range, 24-40°) and Dandy-Walker malformation (63.5 ± 17.6°; range, 45-112°), the angle increasing with increasing severity of the condition. The BT angle had a similar pattern but there was overlap among the different groups.

CONCLUSION

The BV angle and, to a lesser degree, the BT angle are simple and reproducible measurements that provide valuable additional information for the categorization of upward rotation of the fetal cerebellar vermis. From mid gestation, a BV angle > 45° is strongly suggestive of a Dandy-Walker malformation, while a measurement < 30° favors the diagnosis of a Blake's pouch cyst.

Unilateral inguinal hernia: laparoscopic or inguinal approach. Decision making strategy: a prospective study

The management of the contralateral region in a child with a known unilateral inguinal hernia is a debated issue among paediatric surgeons. The available literature indicates that the perspective of the child's parents is seldom. This study was performed to evaluate parents' views on this topic. After the Ethical Committee's approval, 100 consecutive patients under 12 years of age with a unilateral inguinal hernia were studied prospectively from March 2010 to September 2010. After an oral interview, a study form was given to the parents about the nature of an inguinal hernia, the incidence of 20 to 90% of a contralateral patency of the peritoneal-vaginal duct and the possible surgical options (inguinal repair or laparoscopic repair). The parents' decision and surgical results were analyzed. Eighty-nine parents chose laparoscopic approach, and 11 parents preferred inguinal exploration. Regarding their motives, all 89 parents requesting laparoscopic approach indicated that the convenience and risk to have a second anaesthesia was the primary reason of their decision. The 11 parents who preferred inguinal approach indicated that the fear of a new surgical technology was their primary reason. Conclusion There is no consensus about the management of paediatric patients with a unilateral inguinal hernia. We believe that a correct decision-making strategy for parents' choice is to propose them the both procedures. Our study shows that parents prefer laparoscopic inspection and repair in the vast majority of cases.

HHV-8 reduces dendritic cell migration through down-regulation of cell-surface CCR6 and CCR7 and cytoskeleton reorganization

BACKGROUND

For an efficient immune response against viral infection, dendritic cells (DCs) must express a coordinate repertoire of receptors that allow their recruitment to the sites of inflammation and subsequently to the secondary lymphoid organs in response to chemokine gradients.Several pathogens are able to subvert the chemokine receptor expression and alter the migration properties of DCs as strategy to escape from the immune control.

FINDINGS

Here we report the inhibitory effect of Human Herpesvirus 8 (HHV-8) on the migratory behavior of immature and mature DCs. We found that the virus altered the DC chemokine receptor expression and chemokine induced migration. Moreover HHV-8 was also able to interfere with basal motility of DCs by inducing cytoskeleton modifications.

CONCLUSION

Based on our findings, we suggest that HHV-8 is able to subvert the DC migration capacity and this represents an additional mechanism which interferes with their immune-functions.

Preoperative assessment of respiratory function in severely obese patients undergoing biliopancreatic diversion

Since severe obesity is often associated with a pulmonary function defect and abdominal surgery increases the risks of respiratory postoperative complications (RPC), an increased incidence of RPC might occur after bariatric operations. A cohort of 146 severely obese patients undergoing biliopancreatic diversion (BPD) was retrospectively evaluated for the occurrence of RPC. Respiratory function was evaluated prior to BPD from the quotient between measured and predicted values of forced vital capacity (FVC), forced expiratory volume in 1 s (FEV(1)) and the Tiffeneau index (TI: FEV(1)/FVC). In this cohort of obese individuals the BMI degree prior to the operation was totally unrelated to the standardized values of TI and to the presence of restrictive or obstructive pulmonary disease. Globally, a very low rate of RPC (7.5%) was found; in patients with suspected restrictive pulmonary impairment, a high occurrence of RPC was observed (p < 0.05). When data are controlled for preoperative BMI values, smoking status and presence of sleep apnoea, a logistic regression model indicates that respiratory function data cannot predict the occurrence of RPC after bariatric surgery.

[LDL-apheresis in patients with familial autosomal recessive hypercholesterolemia]

LDL-apheresis reduces the cardiovascular risk in patients with familial hypercholesterolemia. The addition of statin therapy in patients with autosomal recessive hypercholesterolemia may change the lipid profile to a less atherogenic pattern.

Accuracy of fetal gender determination in the first trimester using three-dimensional ultrasound

OBJECTIVES

To evaluate the accuracy of three-dimensional (3D) ultrasound in fetal gender assignment in the first trimester.

METHODS

A series of pregnant women attending at 11 to 13 + 6 weeks for the nuchal translucency (NT) scan were enrolled into the study. An ultrasound volume of each fetus was obtained and stored for offline analysis. On the reconstructed mid-sagittal plane, the angle between the genital tubercle and an imaginary line passing tangentially through the fetal back (genital angle) was estimated and a receiver-operating characteristics (ROC) curve was constructed to determine the best cut-off for genital angle in fetal male gender determination. Fetal gender was subsequently ascertained in all cases. To calculate the interobserver variability, a second operator repeated the measurements.

RESULTS

There were 85 cases included in the study. The genital angle in males was significantly higher than that in females (51.2 ± 11.3° (n = 36) vs. 18.9 ± 4.1 (n = 49), P < 0.001). The ROC curve revealed the estimated genital angle to have a high degree of accuracy in fetal gender determination (area under the curve ± SE = 1.000 ± 0.001). The best cut-off for male gender determination was found to be between 27° and 29° (sensitivity, 100%; specificity, 98.0%). There was a high degree of correlation between the two operators (r(2) = 0.998; coefficient of variation = 5.4%).

CONCLUSIONS

3D ultrasound is a highly accurate and reproducible tool for fetal gender assignment prior to 14 weeks of gestation.

Persistence of increased uterine artery resistance in the third trimester and pregnancy outcome

OBJECTIVE

To evaluate whether the persistence of abnormal findings in the third trimester following increased uterine artery (UtA) resistance in the second trimester is related to adverse pregnancy outcome.

METHODS

Low-risk nulliparous women with increased UtA mean pulsatility index (PI) at 20-22 weeks underwent repeat Doppler interrogation at 26-28 weeks and were divided into two groups: those with persistently abnormal Doppler and those with normalized UtA findings. Pregnancy outcome was noted for all patients and compared with that of 104 controls.

RESULTS

We examined 104 women with increased UtA resistance in the second trimester and in 62 (59.6%) cases the abnormal uteroplacental Doppler findings persisted to 26-28 weeks. Compared with controls and with patients with normalized Doppler at the third-trimester scan, patients with persistently abnormal Doppler results had a significantly higher risk of pre-eclampsia (10/62 vs. 1/104, P = 0.002 and 10/62 vs. 1/42, P = 0.047, respectively), small-for-gestational age (SGA) fetus (20/62 vs. 1/104, P < 0.001 and 20/62 vs. 4/42; P = 0.007, respectively) and admission of the infant to a neonatal intensive care unit (16/62 vs. 4/104; P < 0.001 and 16/62 vs. 1/42; P < 0.001, respectively). Compared with controls, cases with normalization had an increased risk of SGA (4/42 vs. 1/104, P = 0.03), but there were no significant differences for the other outcome measures.

CONCLUSIONS

In low-risk nulliparous women with increased UtA resistance in the second trimester, the persistence of abnormal Doppler findings at 26-28 weeks is associated with an increased risk of obstetric complications when compared with both controls and patients with third-trimester Doppler normalization.

Three-dimensional ultrasound in monitoring progression of labor: a reproducibility study

OBJECTIVE

The aim of this study was to evaluate the intraobserver and interobserver reproducibility of measurements, obtained from stored ultrasound volumes, related to fetal head progression in the birth canal.

METHODS

From January to September 2009, serial ultrasound volumes were obtained from women in labor, stored and separately evaluated by two different operators using the SonoVCAD™ labor software. Volumes were aligned using the pubic bone and the urethra as references. In the sagittal plane of the pelvis, the following data were calculated: head progression distance (the distance between the infrapubic line and the lowest part of the fetal skull), head direction (the angle between the infrapubic line and the major longitudinal axis of the fetal head) and head progression angle (the angle between the longitudinal axis of the pubic bone and a line joining the lowest edge of the pubis to the lowest convexity of the fetal skull). In the transverse plane, the angle formed by the midline with the anteroposterior axis of the maternal pelvis (midline angle) was also measured. For each measurement, intraobserver and interobserver reproducibility was determined.

RESULTS

We analyzed 30 ultrasound volumes. For all parameters, interobserver variation was significantly higher than intraobserver variation. Reproducibility was good for all parameters, except for the midline angle. Among the different ultrasound measurements, the progression angle presented the highest reproducibility.

CONCLUSIONS

Measurements obtained from stored ultrasound volumes to assess fetal head progression in the second stage of labor have good reproducibility, with progression distance and progression angle being the most reproducible parameters.

Dual-time-point [18F]-FDG PET/CT in the diagnostic evaluation of suspicious breast lesions

PURPOSE

The authors sought to evaluate whether the reacquisition of images 3 h after administration of radiotracer improves the sensitivity of fluorine-18 fluorodeoxyglucose positron emission tomography computed tomography ([(18)F]-FDG PET/CT) in patients with suspicious breast lesions.

MATERIALS AND METHODS

Forty-eight patients with 59 breast lesions underwent an [(18)F]-FDG PET/CT study in the prone position with a dual-time-point acquisition performed in the early phase 1 h after FDG administration (PET-1) and in the delayed phase 3 h after FDG administration (PET-2). Both examinations were evaluated qualitatively and semiquantitatively with calculation of the mean percentage variation of the standard uptake values (Delta% SUV(max)) between PET-1 and PET-2. All lesions with an SUV(max) >or=2.5 at PET-1 or a reduction in SUV between PET-1 and PET-2 were considered benign. The definitive histopathological diagnosis was available for all patients included in the study.

RESULTS

The dual-time-point acquisition of [(18)F]-FDG PET/CT displayed an accuracy of 85% for lesions with an SUV(max) >or=2.5 and/or positive Delta% SUV(max), with sensitivity and specificity values of 81% and 100% compared with 69%, 63% (both p<0.001) and 100% (p=n.s.), respectively, for the single-time-point acquisition. Malignant lesions showed an increase in FDG uptake between PET-1 and PET-2, with a Delta% SUV(max) of 10+/-7 (p<0.04). In contrast, benign lesions showed a decrease in SUV between PET-1 and PET-2, with a Delta% SUV(max) of -21+/-7 (p<0.001).

CONCLUSIONS

The delayed repeat acquisition of PET images improves the accuracy of [(18)F]-FDG PET/CT in patients with suspicious breast lesions with respect to the single-time-point acquisition. In addition, malignant breast lesions displayed an increase in FDG uptake over time, whereas benign lesions showed a reduction. These variations in FDG uptake between PET-1 and PET-2 are a reliable parameter that can be used for differentiating between benign and malignant breast lesions.

Polychlorinated biphenyls, organochlorine pesticides, and polycyclic aromatic hydrocarbons in wild, farmed, and frozen marine seafood marketed in Campania, Italy

Polychlorinated biphenyls (PCBs), organochlorine pesticides, and polycyclic aromatic hydrocarbons (PAHs) were detected in fresh-catch, farmed, and frozen marine fish marketed in Campania, Italy. Additionally, polychlorobiphenyl congeners were found: six were non-dioxin-like (NDL-PCB) (IUPAC no. 28, 52, 101, 138, 153, and 180), and one was dioxin-like (DL-PCB) (IUPAC no. 118). In all, 93% of fresh-catch, 100% of aquaculture, and 74% of the frozen specimens contained PCBs at concentrations varying from 0.12 to 35.11 ng/g, wet weight; NDL-PCBs ranged between 0.12 and 32.44 ng/g. Penta-, hexa-, and heptachlorobiphenyls were predominant. Regarding organochlorine pesticides, hexachlorobenzene was detected in 35% of fresh catch, 36% of farmed, and 46% of the frozen fish specimens, in a range between < 0.01 and 3.29 ng/g. Contents of the dichlorodiphenyltrichloroethane isomer amounted to 0.12 to 11.00 ng/g. Finally, PAHs were detected in 100% of the specimens. Benzo[a]pyrene was detected in 66% of the aquaculture, 35% of the fresh catch, and 24% of the frozen species, at concentrations varying from 0.03 to 9.18 ng/g. On the basis of annual fish consumption, an average daily intake of NDL-PCBs of 6.02 ng/kg of body weight was estimated. Calculated daily hexachlorobenzene and total dichlorodiphenyltrichloroethane intakes were, respectively, 0.11 and 0.90 ng/kg of body weight per day. The contribution of fish to the daily consumption of the noncarcinogenic PAHs can be considered low; for benzo[a]pyrene, the estimated daily intake is considerably lower than the doses considered carcinogenic for experimental animals by the European Union Scientific Committee on Food.

Predisposing factors for massive hemorrhage during Cesarean section in patients with placenta previa

OBJECTIVES

To investigate whether maternal history and ultrasound findings can be predictors for massive hemorrhage during Cesarean section in patients with placenta previa and adherence of the placenta.

METHODS

We reviewed 127 singleton pregnancies with placenta previa. Maternal history, antenatal ultrasound findings of the placenta, including location, presence of placental lacunae, lack of a clear zone, presence of sponge-like findings of the cervix and presence of a marginal sinus in cases of placenta previa were reviewed retrospectively, and their association with amount of bleeding during Cesarean section was analyzed.

RESULTS

Logistic regression analysis revealed that advanced maternal age (odds ratio (OR), 5.4; 95% CI, 1.8-16.4), previous Cesarean section (OR, 20.4; 95% CI, 4.0-105.2) and sponge-like findings in the cervix (OR, 5.6; 95% CI, 1.8-17.0) were associated with massive bleeding (> 2500 mL). Placental adherence occurred in five cases and was more frequent in cases where the placenta was located at the site of the scar of a previous Cesarean section (OR, 123.1; 95% CI, 4.5-3395.2) and where there was lack of a clear zone (OR, 48.0; 95% CI, 3.8-604.7).

CONCLUSIONS

Advanced maternal age, previous Cesarean section and presence of sponge-like findings in the cervix are risk factors for massive bleeding during Cesarean section in cases of placenta previa, regardless of whether placental adherence is present. Placental location on the scar of a previous Cesarean section and lack of a clear zone are risk factors for placental adherence. When these findings are identified preoperatively, management should be tailored accordingly.

Diagnosis of station and rotation of the fetal head in the second stage of labor with intrapartum translabial ultrasound

OBJECTIVE

To investigate the ability of intrapartum translabial sonography to diagnose fetal station in the second stage of labor.

METHODS

Patients with uncomplicated pregnancies at term gestation with fetuses in vertex presentation in the second stage of labor underwent serial translabial sonography and digital examinations. In a sagittal section of the maternal pelvis, the direction of the head was noted and categorized as downward, horizontal or upward. By rotating the transducer in the transverse plane the cerebral midline echo was also visualized and the rotation of the head was noted. Clinical and ultrasound data were compared using Somer's d-test.

RESULTS

Sixty patients underwent a total of 168 clinical and sonographic examinations. When on the sonogram the fetal head was directed downward, the station assessed clinically was most frequently <or= + 1 cm from the ischial spines (44/57 (77.2%) cases); when the direction was horizontal, the station was most frequently <or= + 2 cm (53/59 (89.8%) cases); when the fetal head was directed upward, the station was usually >or= + 3 cm (46/52 (88.5%) cases). Failure to visualize the cerebral midline or a rotation >or= 45 degrees were associated with a station of + 2 cm or less in 98/103 (95.1%) examinations. Conversely, a rotation of < 45 degrees was associated with a station of + 3 cm or more in 45/65 (69.2%) examinations. All comparisons between clinical and sonographic findings demonstrated a statistically significant relationship (P < 0.0001). The probability of a station + 3 cm or more was particularly high when an upward direction of the head was seen in combination with a rotation of < 45 degrees (40/42 (95.2%) examinations). The interobserver variability (Cohen's kappa 0.795 and 0.727 for station and rotation, respectively; P < 0.001) and intraobserver variability (0.845 for both station and rotation, P < 0.001) suggested good reproducibility of the method.

CONCLUSIONS

Translabial sonography allows a diagnosis of fetal station with an accuracy comparable to that of digital examination and may provide useful information for diagnosing obstructed labor in the second stage as well as assisting in the choice of instrumental delivery.