Prenatal Ventriculomegaly - Diagnosis, Prognostication and Management

Fetal ventriculomegaly (VM) refers to the abnormal enlargement of one or more ventricles of the brain in-utero. The enlargement may or may not be related to ventricular obstruction and increased intracranial pressure; therefore, the term "hydrocephalus" is not used. VM is diagnosed usually in the mid-trimester when the atrial diameter (AD) of the lateral ventricle is more than 10 mm on one or both sides. A thorough workup is then required to identify the cause as the etiology is diverse. Fetal magnetic resonance imaging (MRI) may yield additional information. Serial ultrasound follow-up would be required to assess its progression with advancing gestation. The prognosis and long-term outcomes greatly depend upon the etiology, the severity at diagnosis, progression, and associations. This article reviews the definitions, diagnosis, and workup of fetal VM, discusses follow-up protocols and prognosis, and examines the role of fetal therapy, including fetoscopic surgery in its prenatal management.

Approaches to management of adenocarcinoma following colocystoplasty

Primary adenocarcinoma of the urinary bladder is rare and more so is adenocarcinoma arising in an augmented colocystoplastic bladder. We present a case of adenocarcinoma developing in a urinary bladder after colocystoplasty which was managed by radical cystectomy with bilateral pelvic lymphadenectomy. The post-operative histopathology showed the lesion to be an Adenocarcinoma with spread to the pericolic lymphnodes and not the pelvic lymphnodes. There are no guidelines for bladder screening in these patients who appear to be at risk. Radical Cystectomy remains the treatment of choice. Though post op irradiation has been reported, its role is not clearly defined. Role of chemotherapy in the adjuvant setting is yet to be defined. Following this is the literature review and a discussion on Adenocarcinoma arising in a colocystoplastically augmented bladder.

KEYWORDS

Adenocarcinoma, urinary bladder, cystoplastically augmented bladder, radical cystectomy.

Evaluation of ergocalciferol or cholecalciferol dosing, 1,600 IU daily or 50,000 IU monthly in older adults

CONTEXT

Whether ergocalciferol (D(2)) and cholecalciferol (D(3)) are equally effective to increase and maintain serum 25-hydroxyvitamin D [25(OH)D] concentration is controversial.

OBJECTIVE

The aim of the study was to evaluate the effect of daily and once monthly dosing of D(2) or D(3) on circulating 25(OH)D and serum and urinary calcium.

DESIGN, SETTING AND PARTICIPANTS

In a university clinical research setting, 64 community dwelling adults age 65+ were randomly assigned to receive daily (1,600 IU) or once-monthly (50,000 IU) D(2) or D(3) for 1 yr.

MAIN OUTCOME MEASURES

Serum 25(OH)D, serum calcium, and 24-h urinary calcium were measured at months 0, 1, 2, 3, 6, 9, and 12. Serum PTH, bone-specific alkaline phosphatase, and N-telopeptide were measured at months 0, 3, 6, and 12.

RESULTS

Serum 25(OH)D was less than 30 ng/ml in 40% of subjects at baseline; after 12 months of vitamin D dosing, levels in 19% of subjects (n = 12, seven receiving daily doses and five monthly doses) remained low, despite compliance of more than 91%. D(2) dosing increased 25(OH)D(2) but produced a decline (P < 0.0001) in 25(OH)D(3). Substantial between-individual variation in 25(OH)D response was observed for both D(2) and D(3). The highest 25(OH)D observed was 72.5 ng/ml. Vitamin D administration did not alter serum calcium, PTH, bone-specific alkaline phosphatase, N-telopeptide, or 24-h urine calcium.

CONCLUSIONS

Overall, D(3) is slightly, but significantly, more effective than D(2) to increase serum 25(OH)D. One year of D(2) or D(3) dosing (1,600 IU daily or 50,000 IU monthly) does not produce toxicity, and 25(OH)D levels of less than 30 ng/ml persist in approximately 20% of individuals. Substantial between-individual response to administered vitamin D(2) or D(3) is observed.

Space flight alters bacterial gene expression and virulence and reveals a role for global regulator Hfq

A comprehensive analysis of both the molecular genetic and phenotypic responses of any organism to the space flight environment has never been accomplished because of significant technological and logistical hurdles. Moreover, the effects of space flight on microbial pathogenicity and associated infectious disease risks have not been studied. The bacterial pathogen Salmonella typhimurium was grown aboard Space Shuttle mission STS-115 and compared with identical ground control cultures. Global microarray and proteomic analyses revealed that 167 transcripts and 73 proteins changed expression with the conserved RNA-binding protein Hfq identified as a likely global regulator involved in the response to this environment. Hfq involvement was confirmed with a ground-based microgravity culture model. Space flight samples exhibited enhanced virulence in a murine infection model and extracellular matrix accumulation consistent with a biofilm. Strategies to target Hfq and related regulators could potentially decrease infectious disease risks during space flight missions and provide novel therapeutic options on Earth.

Time and motion study: a comparison of two photostimulable phosphor imaging systems used in dentistry

OBJECTIVES

To compare two photostimulable phosphor (PSP) dental radiographic systems in terms of time efficiency in making full mouth intraoral X-ray surveys (FMS).

METHODS

PSP systems compared were (1) DenOptix) (Kavo/Gendex, Des Plaines, IL) and (2) ScanX) (Air Techniques, Hicksville, NY). Twenty one FMS of a DXTRR) Manikin (Dentsply, Des Plaines, IL) were made with each of the systems. Time for each procedural step was determined using a stopwatch. Steps studied were: (1) plate erasure; (2) packaging; (3) positioning/exposure; (4) unpacking, loading processor, scanning; and (5) image transfer to virtual FMS mount. The first six test runs for each system were excluded to eliminate the learning curve period influencing results. An independent groups t-test was employed for statistical analysis. The a priori was set at P< or =0.05.

RESULTS

The total time involved in producing a FMS was not proven to be statistically significant comparing DenOptix) and ScanX). The mean procedure time for DenOptix) was 31.2 min; for ScanX) it was 27.1 min. While the processing time with ScanX) (mean time: 3.9 min) was shorter than for DenOptix) (mean time =7.8 min), the opposite was true for the image transfer to FMS format with the time much shorter with DenOptix) using VixWin) software (mean time =2.0 min) compared with ScanX) using Vipersoft) (mean time =3.9 min). The differences between the systems for these two steps did prove to be statistically significant (P< or =0.05).

CONCLUSIONS

Although the mean time to make a FMS was slightly shorter on average with ScanX) than DenOptix), this difference was not proven to be statistically significant (P>0.05) in terms of time efficiency in producing a FMS.

Impact of ambient lighting intensity and duration on the signal-to-noise ratio of images from photostimulable phosphor plates processed using DenOptix®and ScanX®systems

OBJECTIVES

To evaluate the impact on photostimulable phosphor (PSP) image signal-to-noise ratio (SNR) of pre-scanning ambient lighting exposures.

METHOD

PSP imaging plates (IPs) were exposed to different radiation exposures to achieve flat field images. The exposed IPs were subjected variously to visible light of different intensities (300, 150 or 20 lux) for durations ranging from < 10 s to 120 s. They were processed using laser scanners from two systems for further comparison (DenOptix versus ScanX). Histogram analysis was performed in each case and mean pixel value and its standard deviation were used as surrogates to assess SNR. Statistical methods applied included analysis of variance with Tukey honestly significant difference test for pair wise comparisons. The a priori alpha was set at P < or = 0.05.

RESULTS

SNR decreased with increased duration and intensity of pre-scanning light exposure. Lower X-ray exposures resulted in decreased signal resulting in reduced SNR, and increased the need to reduce ambient lighting. No statistically significant differences were found comparing ScanX and DenOptix digital imaging systems in terms of SNR.

CONCLUSION

Reduced ambient lighting is preferred for handling IPs prior to processing in the laser scanner.

Mechanisms of bacterial pathogenicity

Pathogenic bacteria utilise a number of mechanisms to cause disease in human hosts. Bacterial pathogens express a wide range of molecules that bind host cell targets to facilitate a variety of different host responses. The molecular strategies used by bacteria to interact with the host can be unique to specific pathogens or conserved across several different species. A key to fighting bacterial disease is the identification and characterisation of all these different strategies. The availability of complete genome sequences for several bacterial pathogens coupled with bioinformatics will lead to significant advances toward this goal.

Three-dimensional tissue assemblies: novel models for the study of Salmonella enterica serovar Typhimurium pathogenesis

The lack of readily available experimental systems has limited knowledge pertaining to the development of Salmonella-induced gastroenteritis and diarrheal disease in humans. We used a novel low-shear stress cell culture system developed at the National Aeronautics and Space Administration in conjunction with cultivation of three-dimensional (3-D) aggregates of human intestinal tissue to study the infectivity of Salmonella enterica serovar Typhimurium for human intestinal epithelium. Immunohistochemical characterization and microscopic analysis of 3-D aggregates of the human intestinal epithelial cell line Int-407 revealed that the 3-D cells more accurately modeled human in vivo differentiated tissues than did conventional monolayer cultures of the same cells. Results from infectivity studies showed that Salmonella established infection of the 3-D cells in a much different manner than that observed for monolayers. Following the same time course of infection with Salmonella, 3-D Int-407 cells displayed minimal loss of structural integrity compared to that of Int-407 monolayers. Furthermore, Salmonella exhibited significantly lower abilities to adhere to, invade, and induce apoptosis of 3-D Int-407 cells than it did for infected Int-407 monolayers. Analysis of cytokine expression profiles of 3-D Int-407 cells and monolayers following infection with Salmonella revealed significant differences in expression of interleukin 1alpha (IL-1alpha), IL-1beta, IL-6, IL-1Ra, and tumor necrosis factor alpha mRNAs between the two cultures. In addition, uninfected 3-D Int-407 cells constitutively expressed higher levels of transforming growth factor beta1 mRNA and prostaglandin E2 than did uninfected Int-407 monolayers. By more accurately modeling many aspects of human in vivo tissues, the 3-D intestinal cell model generated in this study offers a novel approach for studying microbial infectivity from the perspective of the host-pathogen interaction.

Msx1 is required for the induction of Patched by Sonic hedgehog in the mammalian tooth germ

We have used the mouse developing tooth germ as a model system to explore the transmission of Sonic hedgehog (Shh) signal in the induction of Patched (Ptc). In the early developing molar tooth germ, Shh is expressed in the dental epithelium, and the transcripts of Shh downstream target genes Ptc and Gli1 are expressed in dental epithelium as well as adjacent mesenchymal tissue. The homeobox gene Msx1 is also expressed in the dental mesenchyme of the molar tooth germ at this time. We show here that the expression of Ptc, but not Gli1, was downregulated in the dental mesenchyme of Msx1 mutants. In wild-type E11.0 molar tooth mesenchyme SHH-soaked beads induced the expression of Ptc and Gli1. However, in Msx1 mutant dental mesenchyme SHH-soaked beads were able to induce Gli1 but failed to induce Ptc expression, indicating a requirement for Msx1 in the induction of Ptc by SHH. Moreover, we show that another signaling molecule, BMP4, was able to induce Ptc expression in wild-type dental mesenchyme, but induced a distinct expression pattern of Ptc in the Msx1 mutant molar mesenchyme. We conclude that in the context of the tooth germ Msx1 is a component of the Shh signaling pathway that leads to Ptc induction. Our results also suggest that the precise pattern of Ptc expression in the prospective tooth-forming region is controlled and coordinated by at least two inductive signaling pathways.

Free radical and antioxidant status in urban and rural Tirupati men: interaction with nutrient intake, substance abuse, obesity and body fat distribution

Rapid growth in urbanisation and industrialisation causes exposure to toxicant pollution which may contribute to increased incidences of non-communicable diseases. The present study reports on plasma lipid peroxides (LPO), lymphocyte free radicals, antioxidants and DNA damage in relation to life-style, obesity and body fat distribution measures among 56 urban men and 45 age matched rural men. Significant increases in plasma LPO, free radical generation (superoxide anion and hydrogen peroxide), and DNA damage indicated by malondialdehyde (MDA) levels were observed in urban compared to rural men. In vitro assay of DNA damage showed a higher level of MDA in samples of urban men than those of rural men. There were no significant differences in antioxidant enzymes between urban and rural men. Neither body mass index nor fat distribution had a significant influence on free radical generation, while the habits of smoking and alcohol consumption were associated with increased levels of free radicals, plasma LPO and DNA damage and reduced levels of antioxidant enzymes such as glutathione-S-transferase (GST), superoxide dismutase (SOD) and catalase in urban men. Dietary energy and fat intakes were positively correlated with free radical generation. Both superoxide anion and hydrogen peroxide were positively correlated with LPO and DNA damage, and negatively correlated with antioxidant enzymes in urban men. The marked elevation of free radical generation, LPO, DNA damage and depletion in antioxidant levels in urban men may suggest that exposure to environmental toxicant pollution is a risk factor for oxidative damage. It was of interest in this study that, whilst BMI was not greater in urban than rural men, abdominal fatness was. Hypothetically, fat distribution could be altered by the process of oxidative damage if it altered regulation of metabolically active omental fat.