Revisiting imaging features and the embryologic basis of third and fourth branchial anomalies

BACKGROUND AND PURPOSE

There is wide discrepancy between common clinical and radiologic presentations of branchial sinuses arising from the pyriform fossa and the theoretic course of third and fourth branchial arch anomalies. The purpose of this study was to revisit the clinical presentations and imaging features of such anomalies in children.

MATERIALS AND METHODS

A retrospective review of institutional and diagnostic imaging data bases from 1998 to 2008 for reported cases of third and fourth branchial cleft anomalies was conducted. Clinical presentation, pharyngoscopy results, and imaging features in all the patients were evaluated. Surgical and histopathology correlation in patients who underwent excision of the tract was also obtained.

RESULTS

Twenty reported cases described as third or fourth branchial apparatus anomalies were identified. There were 12 females and 8 males with a mean age of 84.6 months. The most common presentation was an inflammatory neck mass (18/20, 90%) almost always involving the thyroid gland. Most lesions were on the left side (16/20, 80%). Pharyngoscopy showed a sinus opening at the piriform fossa in 18/20 (90%) cases. None of the cases followed the classic theoretic pathway of third and fourth arch remnants. Histopathology showed tracts lined with pseudostratified squamous epithelium or ciliated columnar epithelium often associated with inflammatory changes in 17 surgically resected cases.

CONCLUSIONS

Branchial sinuses arising from the pyriform fossa often present with an inflammatory neck mass involving the thyroid lobe, most often on the left side. Imaging and surgical findings suggest that they arise from the embryonal thymopharyngeal duct of the third branchial pouch, because they do not follow the hypothetic course of third or fourth arch fistulas.

Increased myoepithelial cells of bronchial submucosal glands in fatal asthma

BACKGROUND

Fatal asthma is characterised by enlargement of bronchial mucous glands and tenacious plugs of mucus in the airway lumen. Myoepithelial cells, located within the mucous glands, contain contractile proteins which provide structural support to mucous cells and actively facilitate glandular secretion.

OBJECTIVES

To determine if myoepithelial cells are increased in the bronchial submucosal glands of patients with fatal asthma.

METHODS

Autopsied lungs from 12 patients with fatal asthma (FA), 12 patients with asthma dying of non-respiratory causes (NFA) and 12 non-asthma control cases (NAC) were obtained through the Prairie Provinces Asthma Study. Transverse sections of segmental bronchi from three lobes were stained for mucus and smooth muscle actin and the area fractions of mucous plugs, mucous glands and myoepithelial cells determined by point counting. The fine structure of the myoepithelial cells was examined by electron microscopy.

RESULTS

FA was characterised by significant increases in mucous gland (p = 0.003), mucous plug (p = 0.004) and myoepithelial cell areas (p = 0.017) compared with NAC. When the ratio of myoepithelial cell area to total gland area was examined, there was a disproportionate and significant increase in FA compared with NAC (p = 0.014). Electron microscopy of FA cases revealed hypertrophy of the myoepithelial cells with increased intracellular myofilaments. The NFA group showed changes in these features that were intermediate between the FA and NAC groups but the differences were not significant.

CONCLUSIONS

Bronchial mucous glands and mucous gland myoepithelial cell smooth muscle actin are increased in fatal asthma and may contribute to asphyxia due to mucous plugging.

The current status of materials for posterior composite restorations: the advent of low shrink

Polymerization contraction, and the stresses associated with this, have presented problems with resin composite materials, particularly when used to restore cavities in posterior teeth. This paper summarizes the problems associated with polymerization contraction and examines methods used to overcome this, in particular, by the use of materials which have reduced percentage contraction when compared with traditional materials.

CLINICAL RELEVANCE

Use of a material with reduced polymerization contraction should lead to simpler restoration placement.

Comparison between phytoestrogens and estradiol in the preventionof atheroma in ovariectomized cholesterol-fed rabbits

OBJECTIVES

There is increasing interest in the role of complementary and alternative medicines for the treatment of menopause-related problems. This study compared the preventive effect on atheroma formation of a commercially available mixed phytoestrogen concentrate with that of estradiol.

METHODS

An ovariectomized cholesterol-fed rabbit model of atheroma formation was used. Rabbits were ovariectomized before the commencement of the 12-week treatment period. There were two control groups. Control Group 1 received isoflavone-free rabbit chow whilst Control Group 2 received 1% cholesterol-enriched isoflavone-free rabbit chow. Rabbits in Group 3 received 1% cholesterol-enriched isoflavone-free rabbit chow plus a 500 mg tablet containing a concentrated extract of Trifolium pretense (red clover). Rabbits in Group 4 received 1% cholesterol-enriched isoflavone-free rabbit chow plus a 0.5 mg tablet of oral estradiol. Atheroma formation was measured by, first, calculation of the area of atheroma on the intimal surface, and, second, measuring the cholesterol content in the aorta.

RESULTS

There were no significant differences in serum cholesterol between the cholesterol-fed control Group 2 and the treatment Groups 3 and 4. However, there was significantly less staining for atheroma and significantly less cholesterol accumulation in the aorta in Group 4 (estradiol-treated) rabbits compared with either control Group 2 or Group 3 (phytoestrogen-treated) rabbits.

CONCLUSION

In this study, only estradiol was shown to have a significant protective effect against atheroma formation.

Optimizing the encounter rate in biological interactions: Ballistic versus Lévy versus Brownian strategies

Bartumeus et al. [Phys. Rev. Lett. 88, 097901 (2002)] compared the efficiency of a Lévy random walk predator strategy with a Brownian random walk strategy in a periodic one-dimensional domain with nonrevisitable moving targets. Their findings from numerical simulations conclude that "a Lévy search strategy is the best option in some, but not all, cases for a random search process." Using the same methodology, we show that the simplest random search strategy of all, ballistic motion in a random direction, outperforms a Lévy strategy in almost every case. We further show that, in the small set of cases where the ballistic strategy is not optimal, the periodic model does not capture the more realistic nonperiodic case. In the nonperiodic case, the ballistic strategy again outperforms the Lévy strategy.

Optimal foraging: Lévy pattern or process?

Many different species have been suggested to forage according to a Lévy walk in which the distribution of step lengths is heavy-tailed. Theoretical research has shown that a Lévy exponent of approximately 2 can provide a higher foraging efficiency than other exponents. In this paper, a composite search model is presented for non-destructive foraging behaviour based on Brownian (i.e. non-heavy-tailed) motion. The model consists of an intensive search phase, followed by an extensive phase, if no food is found in the intensive phase. Quantities commonly observed in the field, such as the distance travelled before finding food and the net displacement in a fixed time interval, are examined and compared with the results of a Lévy walk model. It is shown that it may be very difficult, in practice, to distinguish between the Brownian and the Lévy models on the basis of observed data. A mathematical expression for the optimal time to switch from intensive to extensive search mode is derived, and it is shown that the composite search model provides higher foraging efficiency than the Lévy model.

Environmental risk assessment: a critical approach of the European TGD in an in situ application

The aim of this study was to test field relevance of the prospective methodology for the assessment of environmental risk described in the EU technical guidance document (TGD) [European Commission 2003. Technical guidance document in support of Commission Directive 93/67/EEC on Risk assessment for new notified substances and Commission Regulation (EC) No 1488/94 on Risk assessment for existing substances and Commission Directive (EC) 98/8 on biocides, second ed. European Commission, Luxembourg, Part 1, 2 and 3, 760 pp.]. To achieve this goal, an environmental risk assessment was performed according to the TGD for two major contaminants, atrazine and diuron, that are present in the Seine River estuary (France) and listed in the EU Water Framework Directive (Directive 2000/60/CE). Results showed that atrazine presented a source of risk in the upper- and mid-estuary throughout the 1993 and 1996 spring seasons. Diuron introduced a risk into the same areas throughout spring periods of 1993-2005. Results are discussed and some suggestions for a more realistic in situ risk assessment are given. For the computation of a more relevant PNEC for pesticides, their specific mode of action should be taken into consideration as well as ecotoxicological data on species endemic to the considered area.

Increased levels of cysteinyl-leukotrienes in saliva, induced sputum, urine and blood from patients with aspirin-intolerant asthma

BACKGROUND

A diagnosis of aspirin-intolerant asthma requires aspirin provocation in specialist clinics. Urinary leukotriene E(4) (LTE(4)) is increased in aspirin-intolerant asthma. A study was undertaken to investigate new biomarkers of aspirin intolerance by comparing basal levels of cysteinyl-leukotrienes (CysLTs) and leukotriene B(4) (LTB(4)) in saliva, sputum and ex vivo stimulated blood in subjects with aspirin-intolerant and aspirin-tolerant asthma. The effects of aspirin- and allergen-induced bronchoconstriction on leukotriene levels in saliva and ex vivo stimulated blood were also compared with the effects of the provocations on urinary mediators.

METHODS

Induced sputum, saliva, urine and blood were obtained at baseline from 21 subjects with asthma. At a separate visit, 11 subjects showed a positive response to lysine-aspirin inhalation and 10 were aspirin tolerant. Saliva, blood and urine were also collected on the provocation day. Analyses of CysLTs and LTB(4) and the prostaglandin D(2) metabolite 9alpha,11beta-prostaglandin F(2) were performed and the fraction of exhaled nitric oxide was measured.

RESULTS

Subjects with aspirin-intolerant asthma had higher exhaled nitric oxide levels and higher baseline levels of CysLTs in saliva, sputum, blood ex vivo and urine than subjects with aspirin-tolerant asthma. There were no differences in LTB(4) levels between the groups. Levels of urinary LTE(4) and 9alpha,11beta-prostaglandin F(2) increased after aspirin provocation whereas leukotriene levels in saliva and ex vivo stimulated blood did not increase.

CONCLUSION

These findings support a global and specific increase in CysLT production in aspirin-intolerant asthma. Measurement of CysLTs in saliva has the potential to be a new and convenient non-invasive biomarker of aspirin-intolerant asthma.

Prevalence of Staphylococcus aureus carriage among dogs and their owners

Case reports have indicated transmission of Staphylococcus aureus between humans and pets. We investigated associations between level of contact between dog and owner, and S. aureus colonization. In a cross-sectional study, nasal carriage and antibiotic susceptibility of S. aureus was determined for 830 dogs and 736 owners. Relatedness of isolates was investigated using antibiograms and pulsed-field gel electrophoresis (PFGE). Associations between carriage and demographics or amount of contact between owners and dogs were documented. S. aureus was isolated in 24% of humans and 8.8% of dogs. Antibiotic resistance was significantly more common in canine isolates. Of 17 owner/dog colonized pairs, six were indistinguishable by PFGE. Colonization of dogs was not associated with close human contact, but was strongly associated with health-care occupations (OR 3.29, 95% CI 1.49-7.26, P=0.002). In outbreak situations health-care workers' pets should be considered as a source of S. aureus. High rates of resistance indicate increased monitoring of antibiotic use in veterinary practice is needed.

Extracellular matrix components and regulators in the airway smooth muscle in asthma

There is an intimate relationship between the extracellular matrix (ECM) and smooth muscle cells within the airways. Few studies have comprehensively assessed the composition of different ECM components and its regulators within the airway smooth muscle (ASM) in asthma. With the aid of image analysis, the fractional areas of total collagen and elastic fibres were quantified within the ASM of 35 subjects with fatal asthma (FA) and compared with 10 nonfatal asthma (NFA) patients and 22 nonasthmatic control cases. Expression of collagen I and III, fibronectin, versican, matrix metalloproteinase (MMP)-1, -2, -9 and -12 and tissue inhibitor of metalloproteinase-1 and -2 was quantified within the ASM in 22 FA and 10 control cases. In the large airways of FA cases, the fractional area of elastic fibres within the ASM was increased compared with NFA and controls. Similarly, fibronectin, MMP-9 and MMP-12 were increased within the ASM in large airways of FA cases compared with controls. Elastic fibres were increased in small airways in FA only in comparison with NFA cases. There is altered extracellular matrix composition and a degradative environment within the airway smooth muscle in fatal asthma patients, which may have important consequences for the mechanical and synthetic functions of airway smooth muscle.

The protective effect of farm animal exposure on childhood allergy is modified by NPSR1 polymorphisms

BACKGROUND

Little is known about the asthma candidate gene neuropeptide S receptor 1 (NPSR1) in relation to environmental exposures, but recent evidences suggest its role as an effect modifier.

OBJECTIVES

To explore the interaction between NPSR1 polymorphisms and environmental exposures related to farming lifestyle and to study the in vitro effects of lipopolysaccharide (LPS) stimulation on NPSR1 expression levels.

METHODS

We studied 3113 children from PARSIFAL, a European cross-sectional study on environmental/lifestyle factors and childhood allergy, partly focused on children brought up on a farm. Information on exposures and outcomes was primarily obtained from parental questionnaires. Seven tagging polymorphisms were analysed in a conserved haplotype block of NPSR1. Multivariate logistic regression was used to evaluate a multiplicative model of interaction. NPSR1 protein and messenger RNA (mRNA) levels in monocytes were measured after LPS stimulation by fluorescence activated cell sorting (FACS) and quantitative real-time polymerase chain reaction (PCR).

RESULTS

A strong interaction was seen between current regular contact to farm animals and several NPSR1 polymorphisms, particularly rs323922 and rs324377 (p<0.005), with respect to allergic symptoms. Considering the timing of initiation of such current regular farm animal contact, significant interactions with these and two additional polymorphisms (SNP546333, rs740347) were revealed. In response to LPS, NPSR1-A protein levels in monocytes were upregulated (p = 0.002), as were NPSR1-A mRNA levels (p = 0.02).

CONCLUSIONS

The effect of farm animal contact on the development of allergic symptoms in children is modified by NPSR1 genetic background.

A genome-wide association scan for asthma in a general Australian population

To date, almost every chromosome has been implicated in genetic susceptibility to asthma to some degree. When compared with single nucleotide polymorphism, microsatellite markers exhibit high levels of heterozygosity and therefore provide higher statistical power in association. The objective of this study was to perform a genome-wide association study using 23,465 in-house microsatellite markers to detect asthma susceptibility regions in the Busselton population. In this study, three separate pooled DNA screenings yielded 18 markers with significantly different estimated frequencies in the three separate "case and control" pools: each pool consisting of 60 males and 60 females. These markers were evaluated by individual typing in 360 cases and 360 controls. Two markers showed significant differences between cases and controls (P = 0.001 and P = 0.003). Regions surrounding the two markers were subjected to high-density association mapping with a total of 14 additional markers. We were able to confirm and fine map the association in these two regions by typing 14 additional microsatellite markers (1805A09 (D18S0325i), P = 0.002; 1806D05 (D18S0181i), P = 0.001). Each region contains a predicted gene that showed strong associations with asthma. Further studies are underway to characterize the novel candidate asthma susceptibility genes identified in this genome-wide study.