The varied clinical and radiological manifestations of contrast-induced encephalopathy following coronary angiography

Contrast-induced encephalopathy (CIE) is a rare complication of imaging using ionidated contrast media. Its pathogenesis remains unknown, and its clinical presentation is variable. We present two cases of CIE following coronary angiography (CAG) that underscore the multitude of clinical manifestations and imaging findings associated with the disorder. In patients 1, CIE manifested during the CAG with agitation and decreased consciousness, followed by left hemiparesis and visual neglect. Native computed tomography (CT) of the head was unremarkable but CT perfusion (CTP) showed extensive hypoperfusion of the right hemisphere with corresponding slow-wave activity in the electroencephalogram (EEG). These findings were more pronounced the next day. Magnetic Resonance Imaging (MRI) revealed multiple small dot-like ischemic lesions across the brain. By day six she had fully recovered. Patient 2 developed transient expressive aphasia during the CAG followed by migraineous symptoms. Native head CT showed a large area of parenchymal edema, sulcal effacement and variable subarachnoid hyperdensity in the right hemisphere. He developed mild left side hemiparesis, spontaneous gaze deviation and inattention. Brain MRI showed small dot-like acute ischemic lesions across the brain. The next morning, he had a generalized tonic-clonic seizure (GTCS) after which native head CT was normal, but the EEG showed a post-ictal finding covering the right hemisphere. His hemiparesis resolved within two months. The diversity in clinical and radiographic presentations suggest that CIE involve many pathophysiological processes.

High estradiol levels during a long agonist IVF protocol are associated with decreased food intake, higher leptin concentrations, and lower levels of high-sensitivity C-reactive protein

PURPOSE

To study whether different hormonal phases affect appetite regulation, food intake, and concentrations of leptin, glucagon-like peptide-1 (GLP-1), and high-sensitivity C-reactive protein (hs-CRP) during a long agonist in vitro fertilization (IVF) protocol.

METHODS

Fifty-four infertile women were encountered thrice, the first of which was at the beginning of their period (low estradiol). The other two visits were during a gonadotrophin-releasing hormone (GnRH) analog downregulation (low estradiol) and at the end of a follicle-stimulating hormone (FSH) stimulation (high estradiol). The first visit was the reference; the women served as their controls. The concentrations of leptin, GLP-1, and hs-CRP were assessed from plasma. Dietary intake was assessed using food records (FRs). In addition, weight, height, body mass index (BMI), and plasma levels of estradiol, glucose, HbA1c, insulin, and lipids were monitored. Twenty-six of the subjects also had a postprandial test.

RESULTS

During the stimulation protocol, leptin concentrations elevated (P < 0.001), and energy intake decreased (P = 0.03), while estradiol levels increased (P < 0.001). GLP-1 levels unchanged (P = 0.75) and hs-CRP (P = 0.03) concentrations diminished, while estradiol levels increased.

CONCLUSION

No increased food intake or weight gain occurred during the stimulation protocol; thus, leptin may protect from overeating during high estradiol levels, and leptin resistance may not occur during a short follow-up. Also, a favorable anti-inflammatory effect was detected. During this study, we observed no harmful metabolic effects, which might affect negatively maternal health.

Factors associated with severity of atopic dermatitis - a Finnish cross-sectional study

BACKGROUND

Severity-associated factors in atopic dermatitis (AD) have focussed on early onset, concomitant atopic diseases, markers of Th2-shifted inflammation and filaggrin mutations.

OBJECTIVES

To investigate factors associated with severe AD in Finnish patients.

METHODS

We conducted a single-centre, cross-sectional observational study with 502 AD patients aged 4.79 to 79.90 years (mean 32.08 years). Disease severity was assessed with the Rajka-Langeland severity score and EASI and associated clinical signs were evaluated. Data regarding onset, relatives, atopic and other comorbidities was gathered retrospectively. We investigated total serum IgE-levels, a panel of filaggrin null mutations and functional variants of genes associated with skin barrier defects.

RESULTS

Factors more frequent in severe AD included early onset (P = 0.004, 95%CI 0.000-0.024), male sex (P = 0.002, 95%CI 0.000-0.11), history of smoking (P = 0.012, 95%CI 0.000-0.024), concomitant asthma (P = 0.001, 95%CI 0.000-0.011), palmar hyperlinearity (P = 0.013, 95%CI 0.014-0.059), hand dermatitis (P = 0.020, 95%CI 0.000-0.029) and history of contact allergy (P = 0.042, 95%CI 0.037-0.096). Body mass indices (P < 0.000, 95%CI 0.000-0.011) and total serum IgE-levels (P < 0.000, 95%CI 0.000-0.011) were higher in severe AD. No differences were observed for allergic rhinitis, allergic conjunctivitis, food allergy, peanut allergy, prick positivity, keratosis pilaris, history of herpes simplex infections, filaggrin null mutations and other gene variants.

CONCLUSIONS

Severity determinants in Finnish patients seem to be early-onset, male sex, smoking, overweight, concomitant asthma, palmar hyperlinearity, hand dermatitis and high IgE-levels. A sub-typing of patients in relation to confirmed severity determinants may be useful for course prediction, prognosis and targeted AD management.

Female-induced selective modification of sperm protein SUMOylation-potential mechanistic insights into the non-random fertilization in humans

In many species, mate choice continues after the mating via female‐ or egg‐derived biochemical factors that induce selective changes in sperm pre‐fertilization physiology and behaviour. Recent studies have indicated that gamete‐mediated mate choice likely occurs also in humans, but the mechanistic basis of the process has remained virtually unexplored. Here, we investigated whether female‐induced modifications in sperm protein SUMOylation (post‐translational modification of the proteome) could serve as a novel mechanism for gamete‐mediated mate choice in humans. We treated the sperm of ten males with the oocyte‐surrounding bioactive liquid (follicular fluid) of five females and investigated motility, viability and global protein SUMOylation status of the sperm in all (n = 50) of these male–female combinations (full‐factorial design). All the measured sperm traits were affected by male–female combinations, and sperm protein SUMOylation status was also negatively associated with sperm motility. Furthermore, our results indicate that female‐induced sperm protein SUMOylation is selective, potentially allowing females to increase sperm motility in some males, whereas decreasing it in the others. Consequently, our findings suggest that follicular fluid may non‐randomly modify the structure and function of sperm proteome and in this way facilitate gamete‐mediated mate choice in humans and possibly many other species. However, due to the relatively low number of female subjects and their potential infertility problems, our results should be replicated with larger subset of fully fertile women.

Endothelial function and concentrations of high-sensitivity C-reactive protein, interleukin-6, and tumor necrosis factor-alpha during a long agonist IVF protocol

We examined possible changes in endothelial function during a long agonist in vitro fertilization (IVF) protocol. We measured flow-mediated dilatation (FMD) and FMD percent (FMD%) from the brachial artery and plasma levels of high-sensitivity C-reactive protein (hsCRP), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-〈). We studied longitudinally three time points in 27 women undergoing a long agonist IVF treatment at Kuopio University Hospital. The first visit was at the beginning of their period (low estradiol). The other two visits were during gonadotrophin-releasing hormone (GnRH) analog downregulation (low estradiol) and at the end of follicle-stimulating hormone (FSH) stimulation (high estradiol). The first visit was used as the reference, and the women served as their own controls. During the stimulation protocol, FMD and FMD% remained. Toward the end of stimulation, hsCRP (P = 0.003), IL-6 (P = 0.04), and TNF-〈 (P = 0.008) concentrations all decreased, while estradiol levels increased (P < 0.001). Correlations between estradiol and proinflammatory factors or FMD were, however, non-significant. The only significant correlation appeared between FMD% and hsCRP at Visit 2 (r = 0.485, P = 0.01). In conclusion, IVF stimulation promoted no change in endothelial function, whereas hsCRP, IL-6, and TNF-〈 decreased. These findings indicate that estrogen may improve the cytokine profile among healthy women undergoing IVF, but this is not reflected in endothelial function.

BENCHMARKING OF THE SERPENT 2 MONTE CARLO CODE FOR FUSION NEUTRONICS APPLICATIONS

Analyses of radiation fields resulting from a deuterium-tritium (DT) plasma in fusion devices is a critical input to the design and validation of many aspects of the reactor design, including, shielding, material lifetime and remote maintenance requirements/scheduling. Neutronics studies, which perform in-depth analysis are typically performed using radiation transport codes such as MCNP, TRIPOLI, Serpent, FLUKA and OpenMC. The Serpent 2 Monte-Carlo code, developed by VTT in Finland, is the focus of this work which seeks to benchmark the code for fusion applications. The application of Serpent 2 in fusion specific analysis requires validation of the codes performance in an energy range, and a geometrical description, which significantly differs to conventional nuclear fission analysis, for which the code was originally developed.

A Serpent model of the Frascati Neutron Generator (FNG) Helium Cooled Pebble Bed (HCPB) mock up experiment has been prepared and the calculated results compared against experimental data, as well as the reference Monte Carlo code MCNP. The analysis is extended to a model of DEMO with HCPB blanket concept. For this model, the flux, nuclear heating, tritium production and DPA are calculated, all of which are integral nuclear responses in fusion reactor analysis. In general, a very good agreement is demonstrated for both of the benchmarks, with any discrepancies pinpointed to different physics models implemented.

THE McSAFE PROJECT - HIGH-PERFORMANCE MONTE CARLO BASED METHODS FOR SAFETY DEMONSTRATION: FROM PROOF OF CONCEPT TO INDUSTRY APPLICATIONS

The increasing use of Monte Carlo methods for core analysis is fostered by the huge and cheap computer power available nowadays e.g. in large HPC. Apart from the classical criticality calculations, the application of Monte Carlo methods for depletion analysis and cross section generation for diffusion and transport core simulators is also expanding. In addition, the development of multi-physics codes by coupling Monte Carlo solvers with thermal hydraulic codes (CFD, subchannel and system thermal hydraulics) to perform full core static core analysis at fuel assembly or pin level has progressed in the last decades. Finally, the extensions of the Monte Carlo codes to describe the behavior of prompt and delay neutrons, control rod movements, etc. has been started some years ago. Recent coupling of dynamic versions of Monte Carlo codes with subchannel codes make possible the analysis of transient e.g. rod ejection accidents and it paves the way for the simulation of any kind of design basis accidents as an alternative option to the use of diffusion and transport based deterministic solvers. The H2020 McSAFE Project is focused on the improvement of methods for depletion considering thermal hydraulic feedbacks, extension of the coupled neutronic/thermal hydraulic codes by the incorporation of a fuel performance solver, the development of dynamic Monte Carlo codes and the development of methods to handle large depletion problems and to reduce the statistical uncertainty. The validation of the multi-physics tools developed within McSAFE will be performed using plant data and unique tests e.g. the SPERT III E REA test. This paper will describe the main developments, solution approaches, and selected results.

The effect of different estradiol levels on carotid artery distensibility during a long agonist IVF protocol

BACKGROUND

This study was made to figure out, does low and high estradiol levels during in vitro fertilization (IVF) cycles have a different effect on carotid artery distensibility (Cdis), carotid artery diameter (Cdia), blood pressure and metabolic factors? Can the stimulation protocol be considered safe to women's vasculature?

METHODS

We studied 28 women having a long agonist protocol IVF-treatment in Kuopio University Hospital during the years 2011-2016. Patients were examined at three time points: in the beginning of their own period (low estradiol), during the gonadotrophin releasing hormone (GnRH) analogue downregulation (low estradiol) and during the follicle stimulating hormone (FSH) stimulation (high estradiol). Women served as their own controls and their menstrual phase (2- to 5-day period after the beginning of menstruation with low estrogen) was used as the reference. Cdis and Cdia were assessed using ultrasound. Blood pressure, weight, estradiol levels and lipids were monitored.

RESULTS

Cdis, Cdia, systolic and diastolic blood pressures peaked during the GnRH-analogue treatment with the lowest estradiol levels. Cdis, Cdia and systolic blood pressures declined by 11% (P = 0.002), 3,8% (P < 0.001) and 2,5% (P = 0.026) during the FSH-stimulation when the estradiol levels were high. Cdis correlated significantly (P < 0.05) with systolic blood pressure, diastolic blood pressure and triglycerides in high estrogenic environment and with diastolic blood pressure (P < 0.05) when estrogen profiles were low.

CONCLUSIONS

Carotid artery stiffens during the high estradiol levels compared to low levels and this was not explained by the higher diameter of the carotid artery, hyperlipidemia or blood pressure profiles. All the changes in Cdis and Cdia are variations of normal, and if there is no history of cardiovascular problems, it can be considered, that the stimulation protocol is not hazardous to vasculature.

Mobile health and wellness application framework

OBJECTIVES

There is an increasing need for user-friendly and interoperable mobile applications in health and wellness domain. The objective of this work has been to provide support for rapid and cost-effective development of such applications.

METHODS

We have introduced an application framework which provides a generic tool for mobile application designers. We have demonstrated the usage of the application framework by providing an example implementation and demonstrating its usage in a Tele-ECG use case. In order to support interoperability we propose a solution compatible with clinical document standards such as the HL7 CDA.

RESULTS

A new mobile platform applicable for a wide range of telemedicine and wellness applications is introduced. The platform provides connectivity between healthcare professionals, patients and measurement devices. It is based on an open application framework that provides interfaces for measurement, user interface, database and network connectivity implementations.

CONCLUSIONS

Mobile application development based on the application framework was demonstrated successfully. The developed UPHIAC platform adopts a new technical approach using a local database solution for caching of information at the mobile terminal. The platform applies a document-based approach providing a versatile and reliable way of sharing and collaboratively complementing of health information including standard information model documents (HL7/CDA), and integration with health information systems and personal storages. The implemented mobile tele-ECG case demonstrates the overall function of the platform. The platform can be used as a basis for developing new applications for specific purposes.

Synthesis and in-vitro/in-vivo evaluation of orally administered entacapone prodrugs

Entacapone is a new inhibitor of catechol-O-methyltransferase (COMT) that is used as an adjunct to L-dopa therapy in the treatment of Parkinson's disease. The bioavailability of orally administered entacapone is, however, relatively low (29-46%). In this study we have prepared more lipophilic acyl and acyloxyacyl esters, an acyloxy alkyl ether and an alkyloxycarbonyl ester of entacapone, and we have evaluated them as potential prodrugs to enhance the oral bioavailability of entacapone. All the derivatives fulfilled prodrug criteria and released entacapone in human serum in-vitro. The oral bioavailability of monopivaloyl (1a) and dipivaloyl (1b) esters of entacapone were investigated further in rats. The lipophilicity of 1b was high (log Papp 4.0 at pH 7.4) but its oral bioavailability was low (F = 0.6%), most probably due to its low aqueous solubility. The monopivaloyl ester of entacapone (1a) had a higher lipophilicity (log Papp 0.80) than entacapone (log Papp 0.18) at pH 7.4 while maintaining an aqueous solubility equal to entacapone. However, oral bioavailability was not increased when compared with the parent drug entacapone (F = 7.0% and 10.4%, respectively).

Synthesis of a water-soluble prodrug of entacapone

Entacapone was reacted with phosphorous oxychloride in dry pyridine to yield a phosphate ester. The phosphate promoiety increased aqueous solubility of the parent drug by more than 1700- and 20-fold at pH 1.2 and 7.4, respectively. The phosphate ester provides adequate stability (t(1/2) = 2227 h; pH 7.4) towards chemical hydrolysis, and allowed for release of the parent drug via enzymatic hydrolysis in liver homogenate.

Bacteriologic findings in tonsillitis and pericoronitis

Bacteriologic samples from 31 young men were cultured quantitatively for aerobes and anaerobes; these samples included 31 specimens of tonsils (16 infected and 15 healthy), 16 specimens from pericoronal pockets of lower third molars (11 infected and 5 symptom-free), and 6 postoperative specimens from lower-third-molar extraction sockets. Anaerobes were isolated more often from infected third molars than from infected tonsils (14.5 isolates vs. 8.4 isolates, respectively; P < .001). Infected tonsil samples contained significantly more anaerobic species if an adjacent partly erupted lower third molar was present rather than absent (10.3 isolates vs. 6.9 isolates, respectively; P < .05). Eubacterium aerofaciens, Clostridium species, Peptostreptococcus micros, and Prevotella oris were frequently isolated. Streptococcus salivarius was found more frequently in tonsillar specimens, whereas Corynebacterium species, Prevotella denticola, Capnocytophaga species, Peptostreptococcus anaerobius, and Lactobacillus species were more common in pericoronal pocket samples. Thus, partial eruption of lower third molars increases the number of anaerobic bacterial species on tonsils and many species can be isolated simultaneously from both tonsils and lower third molars.

Pericoronitis and tonsillitis: clinical and darkfield microscopy findings

OBJECTIVE

Upper respiratory tract infections and tonsillitis and pharyngitis in particular increase the risk of lower third molar pericoronitis. The study was made to investigate clinical and microbiologic associations between pericoronitis and tonsillitis.

STUDY DESIGN

The subjects were 20-year-old Finnish male conscripts. Thirty-eight patients had tonsillitis without and 33 patients had tonsillitis with a symptom-free erupting lower third molar; 27 patients had pericoronitis but healthy tonsils. All subjects were examined clinically. Bacterial samples were taken from healthy and diseased tonsils and from healthy and diseased third molar pericoronal pockets. The microbes were classified morphologically with the use of a darkfield microscope.

RESULTS

Eighty-two percent of infected tonsils had deep crypts and 52% of them exudated pus compared with 36% (p < 0.001) and 0% (p < 0.001) in healthy tonsils, respectively. Infected lower third molars were less than half erupted and had on average 8.8 mm deep pericoronal pockets compared with pockets 5.5 mm deep recorded in symptom-free cases (p < 0.001). Spirochetes were more common in infected pockets than in symptom-free cases comprising 8.2% versus 3.0% of the total bacterial count (p = 0.044). Rods were more common in infected tonsils than healthy ones (8.9% versus 4.8%, p = 0.041).

CONCLUSION

There were similarities in morphologic microbiota of pericoronitis and tonsillitis. However, clinical findings of tonsils did not appear to link with the findings of third molars.