Correlation of Preoperative Radiological Evaluation of Skull Base and Non-skull Base Meningiomas with Clinical and Surgical Data

AIM

To determine whether neuroradiological assessment of skull base and non-skull base meningioma consistency and vascularity can be used to improve the surgical approach.

MATERIAL AND METHODS

Forty meningioma cases were split into skull base (n=16) and non-skull (n=24) base groups, and intraoperative surgical reports of observed tumor consistency (stiffness) and vascularity were compared with preoperative neuroradiological magnetic resonance (MR) perfusion and postoperative histopathological analysis of collagen and CD34 levels.

RESULTS

The skull base group had significantly higher CD34 levels (p=0.004) than the non-skull base group. Further comparison of CD34 levels also revealed significantly higher CD34 levels (p=0.032) in transitional versus fibroblastic subtypes. Observationbased vascularity scoring did not reveal a significant correlation between tumor grade and relative cerebral blood volume (p=0.604). In contrast, there was a statistically modest, but significant correlation between intraoperative observation-based consistency and Verhoeff-van Gieson collagen scores (rs=0.400).

CONCLUSION

Preoperative assessment of consistency and vascularity using MR imaging was ambiguous. Overall, one of the most important limiting factors was the subjective observational assessment of tumor consistency and vascularity by surgical teams.

Large variation in ESBL-producing Escherichia coli carriers in six European countries including Russia

We investigated the faecal carriage prevalence of extended-spectrum β-lactamase production in Escherichia coli (EP-EC) and/or Klebsiella pneumoniae (EP-KP) and risk factors associated with carriage among adult study subjects in Finland, Germany, Latvia, Poland, Russia and Sweden (partner countries). The aim was to get indicative data on the prevalence of ESBL-carriage in specific populations in the region. Faecal samples were collected from four study populations and screened on ChromID-ESBL and ChromID-OXA-48 plates. Positive isolates were further characterised phenotypically. Our results show a large variation in carrier prevalence ranging from 1.6% in Latvia to 23.2% in Russia for EP-EC. For the other partner countries, the prevalence of EP-EC were in increasing numbers, 2.3% for Germany, 4.7% for Finland, 6.6% for Sweden, 8.0% for Poland and 8.1% for all partner countries in total. Carriers of EP-KP were identified only in Finland, Russia and Sweden, and the prevalence was < 2% in each of these countries. No carriers of carbapenemase-producing isolates were identified. This is the first study reporting prevalence of carriers (excluding traveller studies) for Finland, Latvia, Poland and Russia. It contributes with important information regarding the prevalence of EP-EC and EP-KP carriage in regions where studies on carriers are limited.

Immunohistochemical Evaluation of Hemostatic Changes in Glioblastoma Multiforme and Low-Grade Astrocytoma

AIM

In glioblastoma multiforme, the balance between the procoagulant system, anticoagulant system and fibrinolytic system is impaired in favour of hypercoagulability. The aim of this study was to compare glioblastoma multiforme with astrocytoma grade II by subjectively evaluating the levels of prothrombin and biotinylation thrombin, and G protein serum protease activatin receptors, as tissue factors causing hypercoagulation and affecting coagulation.

MATERIAL AND METHODS

Specimens from 35 cases with glioblastoma multiforme and 23 cases with astrocytoma grade II were evaluated immunohistochemically. The specimens were stained with hematoxylen-eosin and immunohistochemically for prothrombin, biotinylation thrombin and protease activating factor receptors to determine the correlation between the tumor malignancy and coagulation factor receptors.

RESULTS

An increase in malignancy was seen to result in an increase in prothrombin, biotinylation thrombin, protein activator receptor 1, protein activator receptor 3, and protein activator receptor 4 levels, and a decrease in protein activator receptor 2 level. These data showedthat there was hypercoagulability in glioblastoma multiforme. Descriptive statistics and Mann-Whitney U analysis were used to evaluate the results.

CONCLUSION

In glioblastoma multiforme, if there is no radiologicalevidence of hemorrhage, low molecular weight heparin should be administered peroperatively and continued for 3 months postoperatively to prevent the development of deep venous thrombosis. This will also be useful in the prevention of invasion, angiogenesis, metastasis and tumour progression.

Achievable Central Nervous System Concentrations of the Green Tea Catechin EGCG Induce Stress in Glioblastoma Cells in Vitro

The polyphenolic compounds present in green tea are preventative against cancer in several animal tumor models. However, direct cytotoxic effects on cancer cells have also been reported. In order to determine whether drinking of green tea has chemopreventive or cytotoxic effects on brain cancer cells, we investigated the effect of the major green tea polyphenol EGCG as a pure substance and as tea extract dietary supplement on primary human glioblastoma cell cultures at the CNS-achievable concentration of 100 nM reported in the literature. We compared this with the effect of the cytotoxic concentration of 500 μM determined to be specific for the investigated primary glioblastoma cultures. After treatment with 500 µM EGCG, strong induction of autophagy and apoptosis was observed. Under treatment with 100 nM EGCG, glioblastoma cells proliferated over the entire observation period of 6 days without any detectable signs of cell death. Only within the first 12 h of treatment was increased accumulation of autophagic vacuoles and increased reactive oxygen species production as a stress response demonstrated. Mild forms of stress, such as treatment with 100 nM EGCG, activate different endogenous repair mechanisms to protect cells. Our data imply that drinking of green tea may have chemopreventive effects, but no direct cytotoxic properties.

Evaluation of the statutory surveillance system for invasive MRSA infections in Germany, 2016-2017

BACKGROUND

Mandatory notification of invasive methicillin-resistant Staphylococcus aureus (MRSA) infections was introduced for laboratories in Germany in 2009. The aims were to support local health authorities (LHAs) in their mandate to prevent and control infections in hospitals and to improve population-based nationwide surveillance of healthcare associated infections. We evaluated the MRSA surveillance system to assess whether its aims were met and to identify areas for improvement.

METHODS

Using the updated guidelines for evaluating public health surveillance systems by the Centers for Disease Control and Prevention we assessed the attributes simplicity, timeliness, data quality, acceptability, and usefulness. In 2016/2017 we interviewed staff in LHAs, state health authorities (SHAs), and laboratories and analyzed surveillance data of cases notified between 2009 and 2016.

RESULTS

We interviewed 10% of LHAs (n = 38), 63% of SHAs (n = 10), 5 selected laboratories and analyzed information on 27,706 notified MRSA cases. LHAs reported that on receiving notifications from laboratories they contacted hospitals for clinical information, which was time-consuming and complicated as physicians were hard to reach or refused to answer questions, citing doctor-patient confidentiality. LHAs suggested reducing the amount of information collected as some clinical information was unnecessary for implementing control measures. LHAs stated that they received notifications on time, however surveillance data analysis showed some delay. Data completeness exceeded 90% for most variables, however it was only 68% and 80% for dates of disease onset and hospital admission respectively making it impossible to discriminate between hospital and community acquired infections in half of the cases. The surveillance system was well accepted by half of the interviewees. A third however stated that the benefits of the surveillance system were outweighed by the work associated with it. The majority rated the system to be useful for recognizing trends in the MRSA incidence and the ability to check up on infection control measures in hospitals.

CONCLUSIONS

The surveillance system proved to be useful by fulfilling its aims. It was timely, acceptable and provided complete data for most variables. However, the system was complicated; ensuring that only relevant variables are reported could simplify the system without losing any of its usefulness.

Six Novel and Three Recurrent Mutations in Nine Austrian Patients with Hemophilia B

In this report we describe the molecular basis of the factor IX (FIX) deficiency in nine patients with severe (n = 6), moderate (n = 1) or mild (n = 2) hemophilia B. The following genetic defects were identified by enzymatic amplification with the polymerase chain reaction (PCR) and subsequent direct sequencing of all exons and exon-intron-junctions: patient B.B. (FIX “Vienna I”): deletion of nucleotides 6343 to 6362; patient M.H. and W. J. (FIX “Vienna II”): nucleotide 17704 (C to G), Gin 97 to Glu; patient L. K. (FIX “Vienna III”): nucleotide 17761 (C to T), Arg 116 to stop; patient U. A. (FIX “Vienna IV”): nucleotide 10415 (C to G), Pro 55 to Ala; patient H.G. (FIX “Vienna V”): nucleotide 6488 (C to T), Thr 38 to lie; patient H. M. (FIX “Vienna VI”): nucleotide 31276 (G to C), Trp 385 to Cys; patient L. C. (FIX “Vienna VII”): deletion of nucleotide 6700; patient S.F. (FIX “Vienna VIII”): nucleotide 10392 (A to T), Asp 47 to Val. The causative mutation was detected in the FIX gene in each of the nine patients with hemophilia B. There was one small deletion, one point deletion and seven point mutations. The latter include six missense mutations and one nonsense mutation. The mutations in Vienna III, IV and V have already been described in previous studies. The two deletions, Vienna I and Vienna VII have not been reported previously. The genetic defects observed in Vienna II, VI and VIII are novel missense mutations which result in amino acid changes at residues 97,47 and 385, respectively.

Giant convexity chondroma with meningeal attachment

OBJECTIVE

Intracranial chondroma is a rare and benign tumor with usual onset in young adulthood. The skull base is the most common site of occurrence although, less often, the tumors can appear at the falx cerebri or at the dural convexity. The differentiation of these lesions from meningiomas through imaging is generally difficult.

PATIENT AND METHODS

Clinical case presentation and review of the current literature.

RESULTS / CASE PRESENTATION

We report a case of a 25-year-old male patient with a giant convexity chondroma with meningeal attachment in the right frontal lobe that was detected after a first generalized seizure. Based on the putative diagnosis of meningioma, the tumor was completely resected via an osteoplastic parasagittal craniotomy. The postoperative MRI confirmed the complete tumor resection. Histopathological analysis revealed the presence of a chondroma.

CONCLUSION

Intracranial chondromas are a rarity and their preoperative diagnosis based on neuroimaging is difficult. In young patients and those with skeletal disease, the differential diagnosis of a chondroma should be considered. In symptomatic patients, operative resection is sensible. In most cases total removal of the tumor is possible and leads to full recovery. When the finding is merely incidental in older patients, a watchful waiting approach is acceptable, given the benign and slow-growing nature of the lesion.

Comparison of eosin-thiazin and Papanicolaou-Shorr staining for endometrial cytologies of broodmares

Introduction: Exfoliative endometrial cytology is an easy and valuable diagnostic tool for the detection of inflammatory processes of the uterus that correlates well to culture results. The practical use of this procedure is limited due to the time-consuming Papanicolaou-Shorr staining technique. In this study the suitability of the rapid eosin-thiazin staining for endometrial smears was investigated. Material and methods: Sample collection was carried out with a guarded culture swab (Knudsen-catheter) in 27 broodmares during routine gynaecological examination. Two smears were prepared from each collection. One was stained according to Papanicolaou-Shorr and the second using the eosin-thiazin method (Hemacolor®, Merck). Specimens with more than 0.5% neutrophil granulocytes were classified as positive for endometritis. The presentability of polymorphonuclear neutrophils (PMN), proportion of positive/negative samples, as well as the PMN contents were compared between the two staining methods. Results: PMN were easily identifiable in both specimens. In Papanicolaou-Shorr stained smears 10 samples showed > 0.5% neutrophil granulocytes (37%), whereas in the eosin-thiazin staining 12 samples were positive (44%). Thus results corresponded in 25 mares (95%). Conclusion: Eosin-thiazin staining is a suitable staining method for endometrial smears of broodmares, which surpassed Papanicolaou-Shorr method in two cases. Clinical relevance: The use of eosin-thiazin staining provides a considerable gain of time and renders endometrial cytology more attractive for routine stud farm practice.

Gestationsketose mit Hyperlipidämie bei einer Alpakastute

Gegenstand und Ziel: Beschrieben werden die klinische Symptomatik, die diagnostische Vorgehensweise und die Therapie bei einer Alpakastute mit hochgradiger Gestationsketose. Material und Methoden: Eine 3-jährige Alpakastute, die sich im 11. Trächtigkeitsmonat befand, wurde wegen einer seit 2 Wochen bestehenden Inappetenz und apathischen Verhaltens in die Klinik eingeliefert. Sie wurde klinisch und labordiagnostisch untersucht und die dabei festgestellte Stoffwechselstörung behandelt. Ergebnisse: Als einzige klinische Symptome zeigte das Tier apathisches Verhalten, Inappetenz sowie Abmagerung. Der hohe Ketonkörpergehalt des Harns sowie das milchig getrübte Serum bei starker Hyperglykämie (27,5 mmol/l), hohen β-Hydroxybutyrat- (13 mmol/l) und NEFA-Werten (4,9 mmol/l) in Verbindung mit erhöhten Leberenzymaktivitäten, metabolischer Azidose (BE: –6,8 mmol/l) und Hypokaliämie (2,3 mmol/l) sprachen für das Vorliegen einer hochgradigen Gestationsketose. Die Infusionstherapie mit Glukose- und Aminosäurelösung sowie Injektionen von Heparin und einem Antibiotikum führten innerhalb von 3 Tagen zu einer deutlichen Verbesserung des Allgemeinbefindens und der Blutwerte. Einen Tag später brachte die Stute ein vitales Fohlen zur Welt. Nach der Entlassung aus der Klinik berichtete der Besitzer, dass das Tier weiterhin ein ungestörtes Allgemeinbefinden zeigte und nach dem Trockenstellen an Körpergewicht zugenommen hatte. Schlussfolgerung und klinische Relevanz: Bei hochtragenden Neuweltkameliden muss – ähnlich wie bei Schafen und Ponys – mit einer Gestationsketose und Hyperlipidämie gerechnet werden. Aufgrund der unspezifischen klinischen Symptomatik, wie Apathie und Inappetenz, sollte in Verdachtsfällen immer eine labordiagnostische Abklärung anhand der Untersuchung von Blut- und Urinproben erfolgen, um die Diagnose rechtzeitig absichern zu können. Therapeutisch ist vor allem eine Infusionstherapie mit Glukoseund Aminosäurelösungen von entscheidender Bedeutung.

An approach to treating a patient with a HeartMate II™ left ventricularassist device in a multiplace hyperbaric chamber: a case report

INTRODUCTION

Left-ventricular assist devices (LVAD) are becoming a common therapy for end-stage heart failure. These devicesare not tested for pressurization in a hyperbaricchamber by the manufacturer. In this article, we present an approach to modify the power supply in order to safely treat a patient with an LVAD.

MATERIALS AND METHODS

Our patient had a HeartMateII™ LVAD and presented for hyperbaric oxygen treatments for severe radiation cystitis. In order to modify this patient's equipment to be compliant with NFPA6 safety standards we made several modifications. In brief, this included eliminating the usage of lithium-ion batteries, modifying the cord to be compatible with Fink chamber outlets, and enclosing the power module in a nitrogen purge. We then used a mock circulatory system to test our modifications and make sure the LVAD continued to have appropriate flow rates. We then conducted training for staff and developed a disaster plan should the LVAD fail at any point.

RESULTS

Once we felt comfortable with the modifications and had a plan developed should any problems arise, we then proceeded to treat our patient in the hyperbaric chamber. He successfully underwent 44 hyperbaric treatments for radiation cystitis without complications.

CONCLUSION

This case is the second reported patient in the literature with an LVAD that was successfully treated in a multiplace hyperbaric chamber. As LVADs become increasingly popular to manage heart failure, more patients with these devices will present for hyperbaric treatments. With a few modifications, an LVAD patient can be safely and successfully treated in a hyperbaric chamber.

Brownian dynamics simulations of analytical ultracentrifugation experiments exhibiting hydrodynamic and thermodynamic non-ideality

Hydrodynamic and thermodynamic non-ideality are important phenomena when studying concentrated and interacting systems in analytical ultracentrifugation (AUC). Here we present an extended Brownian Dynamics (BD) based algorithm which incorporates hydrodynamic and thermodynamic non-ideality. It can serve as an independent and versatile approach for the theoretical description of interparticulate interactions in AUC, as it allows tracking the trajectory of individual particles. Concentration dependencies of the sedimentation and diffusion coefficient have been implemented and validated for the extended BD model. For monodisperse systems, it is shown that profiles obtained by BD are in excellent agreement with well-established Lamm equation solvers. Moreover, important limits and restrictions of current Lamm equation based analysis methods are discussed. In particular, BD allows modeling and evaluation of AUC data of non-ideal polydisperse systems. This is relevant as most nanoparticulate systems are polydisperse in size. Here, a simulation for a polydisperse system including concentration effects is presented for the first time.

Validation of Reference Genes for Expression Studies in Human Meningiomas under Different Experimental Settings

Quantitative polymerase chain reaction (qPCR) is a sensitive technique for the quantitative analysis of gene expression levels. To compare mRNA transcripts across tumour and non-pathological tissue, appropriate reference genes are required for internal standardisation. Validation of these reference genes in meningiomas has not yet been reported. After mRNA transcription of meningioma (WHO grade I-III) and meningeal tissue from three different experimental sample types (fresh tissue, primary cell cultures and FFPE tissue), 13 candidate reference genes (ACTB, B2M, HPRT, VIM, GAPDH, YWHAZ, EIF4A2, MUC1, ATP5B, GNB2L, TUBB, CYC1, RPL13A) were chosen for quantitative expression analysis. Two statistical algorithms (GeNorm and NormFinder) were used for validation of gene expression stability. All candidate housekeepers tested for stability were checked within and across the three tissue analysis groups. Pearson correlation, the ΔC _t method and ranking analysis identified the most non-regulated genes suitable for internal standardisation. TUBB, HPRT and ACTB were the most stably expressed genes for all analysis groups across meningioma and non-pathological meningeal tissue combined. In contrast, analysis of the consistency of reference gene expression within specific meningioma and meningeal tissues resulted in specific reference gene rankings for each tissue type. Future gene expression analyses require reference genes to be chosen that are suitable for the tissue types and for the experimental paradigms being studied. Validation of candidate housekeeper genes in meningiomas for quantitative real-time polymerase chain reaction revealed for the first time TUBB, ACTB and HPRT as the most consistently expressed genes among meningioma and non-pathological meningeal tissue across a range of experimental settings.

Determination of the length and diameter of nanorods by a combination of analytical ultracentrifugation and scanning mobility particle sizer

A combination of orthogonal measurement techniques is utilized in this study to predict the average lengths and diameters of colloidal nanorods. Sedimentation coefficient distributions and electrical mobility distributions obtained from analytical ultracentrifugation and a scanning mobility particle sizer, respectively, are used for the hydrodynamic correlation. The method is validated theoretically and application to Au and ZnO nanorod samples is shown. The results demonstrate that the combination of both measurement techniques is an excellent method for the two-dimensional characterization of nanorods.