Biomechanical comparison of titanium alloy additively manufactured and conventionally manufactured plate-screw constructs

AIM

To biomechanically compare the bending stiffness, strength, and cyclic fatigue of titanium additively manufactured (AM) and conventionally manufactured (CM) limited contact plates (LCP) of equivalent dimensions using plate-screw constructs.

METHODS

Twenty-four 1.5/2.0-mm plate constructs (CM: n = 12; AM: n = 12) were placed under 4-point bending conditions. Data were collected during quasi-static single cycle to failure and cyclic fatigue testing until implants plastically deformed or failed. Bending stiffness, bending structural stiffness, and bending strength were determined from load-displacement curves. Fatigue life was determined as number of cycles to failure. Median test variables for each method were compared using the Wilcoxon rank sum test within each group. Fatigue data was also analysed by the Kaplan-Meier estimator of survival function.

RESULTS

There was no evidence for a difference in bending stiffness and bending structural stiffness between AM and CM constructs. However, AM constructs exhibited greater bending strength (median 3.07 (min 3.0, max 3.4) Nm) under quasi-static 4-point bending than the CM constructs (median 2.57 (min 2.5, max 2.6) Nm, p = 0.006). Number of cycles to failure under dynamic 4-point bending was higher for the CM constructs (median 164,272 (min 73,557, max 250,000) cycles) than the AM constructs (median 18,704 (min 14,427, max 33,228) cycles; p = 0.02). Survival analysis showed that 50% of AM plates failed by 18,842 cycles, while 50% CM plates failed by 78,543 cycles.

CONCLUSION AND CLINICAL RELEVANCE

Additively manufactured titanium implants, printed to replicate a conventional titanium orthopaedic plate, were more prone to failure in a shorter fatigue period despite being stronger in single cycle to failure. Patient-specific implants made using this process may be brittle and therefore not comparable to CM orthopaedic implants. Careful selection of their use on a case/patient-specific basis is recommended.

Disseminated Rasamsonia argillacea infection in a dog

CASE HISTORY

A 4-year-old, male neutered Borzoi presented for unlocalised pain and frequent episodes of vocalisation.

CLINICAL FINDINGS

Pain was localised to the lumbar spine and radiographs revealed a L3-L4 lesion consistent with discospondylitis. The dog was treated for presumptive bacterial discospondylitis with surgical debridement, spinal stabilisation, and cephalexin. Samples collected from the affected intervertebral disc at the time of surgery revealed lymphoplasmacytic inflammation with no causative agent identified on histopathology or bacterial culture. After an initial period of improvement, signs recurred despite an 8-week antibiotic course, with the development of inappetence, weight loss, polydipsia, and polyuria. Repeat radiographs revealed a new cervical intervertebral lesion, and concurrent pyelonephritis was diagnosed based on blood and urine results. Fungal culture of urine resulted in growth of Rasamsonia argillacea species complex and disseminated fungal disease was clinically diagnosed. Antifungal treatment was commenced, however the dog deteriorated, and euthanasia was performed.

PATHOLOGICAL FINDINGS

Multifocal white plaques were grossly visualised in the spleen, mesenteric lymph nodes, cervical vertebrae, and kidneys. Periodic acid-Schiff-positive, fine, parallel-walled, occasionally branching, septate hyphae 5-10 μm in diameter, and conidia 5-7 μm in diameter were found on sectioning all organs. R. argillacea species complex was identified by fungal culture of urine and was considered the species of fungal organism seen histologically. The isolate was subsequently confirmed as R. argillacea by DNA sequencing.

DIAGNOSIS

Disseminated Rasamsonia argillacea infection.

CLINICAL RELEVANCE

Rasamsonia argillacea species complex is a recognised invasive mycosis in veterinary medicine, with disseminated disease causing significant clinical complications and death. This is believed to be the first report of infection caused by R. argillacea in a dog in Australasia and highlights the importance of awareness of a potential fungal aetiology in dogs with discospondylitis.Abbreviations: CLSI: Clinical and Laboratory Standards Institute; CRI: Constant rate infusion; MEC: Minimum effective concentration; MIC: Minimum inhibitory concentration; PAS: Periodic acid-Schiff.

A mechanistic physiologically based model to assess the effect of study design and modified physiology on formulation safe space for virtual bioequivalence of dermatological drug products

Physiologically based pharmacokinetic (PBPK) models are widely accepted tools utilised to describe and predict drug pharmacokinetics (PK). This includes the use of dermal PBPK models at the regulatory level including virtual bioequivalence (VBE) studies. The current work considers the Topicort® Spray formulation, which contains 0.25% desoximetasone (DSM), as an example formulation. Quantitative formulation composition and in vitro permeation testing (IVPT) data were obtained from the public literature to develop a mechanistic model using the multi-phase, multi-layer (MPML) MechDermA IVPT module in the Simcyp Simulator. In vitro-in vivo extrapolation functionality was used to simulate in vivo PK for various scenarios and predict a 'safe space' for formulation bioequivalence using the VBE module. The potential effect of vasoconstriction, impaired barrier function, and various dosing scenarios on the formulation safe space was also assessed. The model predicted 'safe space' for formulation solubility suggesting that a 50% change in solubility may cause bio-in-equivalence, whereas viscosity could deviate by orders of magnitude and the formulation may still remain bioequivalent. Evaporation rate and fraction of volatile components showed some sensitivity, suggesting that large changes in the volume or composition of the volatile fraction could cause bio-in-equivalence. The tested dosing scenarios showed decreased sensitivity for all formulation parameters with a decreased dose. The relative formulation bioequivalence was insensitive to vasoconstriction, but the safe space became wider with decreased barrier function for all parameters, except viscosity that was unaffected.

Electron microscope images of human coronaviruses - Reality versus illusion

Since the outbreak of COVID-19 as a pandemic disease earlier in 2020, several publications reported the electron microscope images of SARS-CoV-2. This article reviews 73 articles from March 1956 till April 2021, focusing on the ultrastructure characteristics of the coronaviruses. We present the scientific debate and provide an opinion on the current controversy of electron microscopic images interpreted as SARS-CoV-2 particles in specimens from patients with COVID-19. Finally, we report our findings in a post-mortem lung specimen of a COVID-19 patient. With this we hope to facilitate accurate interpretation of TEM findings, and contribute to the building of a unified database in the face of COVID-19 (Tab. 2, Fig. 8, Ref. 81). Keywords.

Surgical management of superficial digital flexor tendon luxation in dogs: 48 cases (2005-2020)

OBJECTIVES

To report the outcome, frequency of complications and potential prognostic factors associated with surgical repair of superficial digital flexor tendon (SDFT) luxation in dogs.

MATERIALS AND METHODS

Medical records from 10 referral hospitals were reviewed retrospectively for cases of SDFT luxation in dogs that underwent surgical stabilisation. Signalment, clinical presentation, diagnostic imaging, surgical method, type and length of post-operative limb immobilisation, nature of and length of exercise restriction, presence of post-operative complications and outcomes were recorded. Data were summarised descriptively and prognostic risk factors assessed for association with surgical outcome using risk ratios.

RESULTS

Forty-eight cases were included. A successful surgical outcome was recorded in 35 of 48 (73%) cases. Re-luxation of the SDFT occurred in seven of 48 (15%). Six out of 48 (13%) had a persistent lameness despite a stable non-luxating SDFT. A high frequency of post-operative complications occurred (71%), with the majority resolved medically. The risk of surgical failure was 60% higher (risk ratio 1.6, 95% confidence interval 1.1 to 2.4) where absorbable suture material was used compared to non-absorbable suture material. Surgical failure was more common in cases managed with non-rigid immobilisation post-operatively (57% failure) compared to cases managed with rigid immobilisation (19% failure), although this result was not statistically significant. Limb immobilisation of 6 weeks or longer did not significantly affect surgical outcome, compared to shorter periods of exercise restriction or limb immobilisation.

CLINICAL SIGNIFICANCE

A good outcome can be expected following surgical stabilisation of SDFT luxation. The use of non-absorbable suture was associated with a more successful surgical outcome.

Few Insights on the problem of COVID-19

The recent Coronavirus 2019 outbreak took the world by surprise and called for global drastic measures. At this early point in the timeline of the pandemic, several questions remain open until the results of large scale studies become available. This article offers few insights on scattered issues; including the clinical characteristics, pathology and diagnosis, as well as treatment perspectives and public health approach. Focusing healthcare resources on necessary treatment and prevention and combining efforts for developing feasible solutions will be decisive for time needed to achieve worldwide containment (Tab. 1, Ref. 23). Keywords: COVID-19, Coronavirus 2019, pandemic, public health.

Ependymal cells surface of human third brain ventricle by scanning electron microscopy

OBJECTIVES

The ependymal lining of the human brain ventricular system displays distinct structural differences and functional heterogeneity among individual ependymal cells (ECs). To date, multi-ciliated ECs (E1 cells), bi-ciliated ECs (E2 cells), uni-ciliated ECs (E3 cells), ECs without cilia, and ECs with cytoplasmic protrusions have been described in human brain ventricles.

METHOD

Using scanning electron microscopy (SEM), we evaluated ependymal samples from 6 defined regions of the third ventricle from 9 human brains. These regions were strictly defined according to the periventricular structures they neighbour with.

RESULTS

We observed different structures on the apical surface of the ECs. Various ECs differed from each other by the presence of microvilli, secretory bodies, and a variable number of cilia, which led us to divide the ECs into several exactly specified types according to their apical morphology.

CONCLUSION

We found all types of ECs in every examined region with a predominance of particular types of apical surface of ECs in the individual areas (Tab. 4, Fig. 7, Ref. 22).

Fertility maintenance in male oncological patients: current state and future perspectives

Growing cancer incidence in reproductive age goes hand in hand with a rising survival rate of patients who underwent anticancer therapy. This trend points to the necessity of discussion regarding the fertility maintenance. The patient´s future with respect to his reproductive ability has to be addressed properly to achieve a complex approach to cancer management. The germinal epithelium of the testes is highly susceptible to deleterious effects of chemotherapy. After the administration of gonadotoxic chemotherapeutic agents, a patient can develop oligospermia, or even azoospermia. Similarly, radiation exposure can damage spermatogenesis, while higher doses lead to azoospermia. This review brings an overview of the methods of assisted reproduction, which are currently in use for fertility maintenance in oncological patients, but also in those with non-malignant indications. Also, novel, yet still experimental, methods are discussed, which represent promising technologies applicable to prepubertal oncological patients. We also discuss historical milestones in the development of assisted reproduction, summarize the options of semen analysis, and we present a practical guide through the process of sperm cryopreservation and subsequent in vivo or in vitro fertilisation. We deem that fertility maintenance should be an integral part of the health care in oncological patients in reproductive age (Tab. 1, Ref. 85). Keywords: assisted reproduction technique, sperm cryopreservation, testicular tissue cryopreservation, spermatogenesis, sperm quality in oncological patients.

Sentinel lymph node - historical background and current views on its significance in complex management of breast cancer patients

Nowadays, breast cancer is the leading oncological diagnosis in women worldwide. On the other hand, breast cancer treatment can be considered one of the most progressive therapeutic approach in the medical field of oncology. The invasive types of breast cancer have a tendency to spread via lymphatic route, what brings in the issue of sentinel lymph node - the first node into which the lymph drains from a given anatomical location. This review paper discusses the historical background of the concept of sentinel lymph node and focuses on clinical significance of the positivity of sentinel lymph node(s) as well. Modern-day conservative therapeutic surgery of breast cancer should be in accordance with diagnostic and preventive interventions in the axilla, whose rate of invasiveness and morbidity must be also attenuated without worsening the patient´s prognosis and survival rate. Formerly, a complete axillary lymph node dissection was routinely performed for prophylactic and cancer staging purposes. The indiscriminate application of this approach was replaced by sentinel lymph node biopsy. Along with common histopathological examination, immunohistochemistry, as well as modern techniques of molecular biology are often employed. These state-of-the-art methods enabled the identification of micrometastases, or even nanometastases, though their real prognostic value is yet to be concluded (Ref. 52). Keywords: sentinel node, breast cancer, biopsy, historical background.

The effect of GnRH agonists on angiogenesis and its implications for the myocardium in patients with cardiac risk

Gonadotropin-releasing hormone agonists were described as anti-angiogenic factors in tumors. Simultaneously they were associated with increased cardiovascular risk in patients treated for prostate cancer, especially in those with preexisting cardiac disease. Studies aiming to elucidate the mechanisms by which androgen deprivation therapy causes cardiovascular effects are rare. We believe that gonadotropin-releasing hormone agonists can impair myocardial angiogenesis. That, in patients with myocardial disease can deepen hypoxia, significantly worsen the condition of the myocardium, and therefore increase the risk of cardiac failure. Careful assessment of the myocardial status and consequent timing and typing of therapy can minimalize the adverse effects. Ideally through close cooperation between cardiologists and oncologists (Fig. 1, Ref. 25). Keywords: angiogenesis, cardiovascular risk, follicle stimulating hormone, GnRH agonist, testosterone.

Artificial intelligence in service of medicine

The race to make the dream of artificial intelligence a reality comes parallel with the increasing struggle of health care systems to cope with information overload and translational pressure. It is clear that a shift in the way data is generated requires a shift in the way they are processed. This is where AI comes with great promises to solve the problem of volume versus applicability of information in science. In medicine, AI is showing exponential progress in the fields of predictive analysis and image recognition. These promises however, come with an intricate package of ethico-social, scientific and economic implications, towards which a reductionist approach leads to distorted and dramatic predictions. All this, in a time when the growing pressure on healthcare systems towards defensive medicine begs the question of the true need for AI for good medical practice.This article examines the concept and achievements of AI and attempts to offer a complex view on the realistic expectations from it in medicine, in the context of current practice (Ref. 38). Keywords: algorithms, artificial intelligence, image recognition, neural networks, predictive analysis.

Labelling of individual ependymal areas in lateral ventricles of human brain: ependymal tables

Different types of ependymal areas were studied and labelled in the human brain lateral ventricle. Periventricular structures were included in coining the names of the ependymal areas because they represent a basic and stable part of brain nerve structures suitable for the sake of clarity of localization of the ependyma. The labelling of individual ependymal areas was composed from letters: "Lv" (lateral ventricle); "E" (ependymal area) and letters for abbreviations of the closest periventricular structure, e.g. the septum pellucidum is "sp". The labelling for ependymal area over the septum pellucidum is thus "LvE-sp". The studied types of ependymal areas were arranged in so‑called ependymal tables for cornu anterius, pars centralis, cornu inferius and cornu posterius of the human lateral ventricle. Labelling of individual ependymal areas allows for better localization and characterisation of these areas in future studies carried out by various methods (e.g. morphological, biological, molecular) and will prevent from using misnomers with different types of ependymal areas in norm as well as in pathology (Tab. 5, Fig. 6, Ref. 22). Text in PDF www.elis.sk.

Comparative analysis of human omental milky spots between the patients with colon cancer and the control group

AIM

Morphological description of milky spots (MSs) in the human greater omentum.

METHOD

Samples of the greater omentum collected during surgical procedures were subjected to further histological analysis. Two groups of patients were studied. Group A consisted of patients with colon cancer and peritonitis (stimulated MSs), group B consisted of patients without colon cancer and without peritonitis (unstimulated MSs). In the research, we focused on the cellular composition and differences between stimulated and unstimulated MSs.

RESULTS

MSs detected in the study were predominantly oval (67 %), round (12 %) or irregular in shape (21 %). The average number of immune cells found in one milky spot (MS) in the group A was 454 (209-694), consisted of T cells in 44.7 % (27-55 %), B cells in 26.8 % (16-34 %), macrophages in 18.3 % (12-27 %) and other immune cells in 10.2 % (6-18 %). The average number of immune cells found in one MS in the group B was 58 (42-100 %), consisted of T cells in 21.1 % (16-22 %), B cells in 18.7 % (13-22 %), macrophages in 46.9 % (33-60 %) and other immune cells in 13.3 % (1-22 %). The average size of MSs in the group A was significantly higher than in the group B: 768 μm (313-1075) to 293 μm (197-421). The results showed that there were significant differences in terms of strong predominance of macrophages in unstimulated milky spots and strong predominance of T cells in stimulated milky spots.

CONCLUSION

MSs are specific immune active lymphatic structures on the greater omentum. They play a key role in defense mechanism, especially in peritonitis. Their function is not completely clear in cancer, some authors suggest they might play a significant role in omental metastasis. Further analysing of the morphology and cells interactions of MSs is needed (Tab. 2, Fig. 6, Ref. 20).

Induced pluripotent stem cells in modeling and cell-based therapy of amyotrophic lateral sclerosis

Amyotrophic lateral sclerosis (ALS) is a fatal neurological disease characterized by neuromuscular degeneration and the progressive loss of upper and lower motor neurons (MNs), causing weakness and paralysis. However, the underlying mechanisms of this disease are still unknown and there is no cure, or even treatment to stop or reverse its pathology. Consequently, most ALS patients die within 3 - 5 years after disease onset. While considerable progress has been made in studying animal models of ALS, they lack clinical suitability due to genetic differences. However, the recent development of induced pluripotent stem cells (iPSCs) has made it possible to study human disease-specific neuronal and glial cells to identify disease mechanisms and develop phenotypic screens for drug discovery. iPSCs provide researchers with a model of naturally occurring pathology under the human genetic background and MNs differentiated from human iPSCs bearing ALS-associated mutations offer a powerful model to study disease pathology. This paper reviews recent methods of differentiating iPSCs into neuronal cells and suggests further applications of these iPSCs-derived cells for ALS disease modeling, drug screening, and possible cell-based therapy.

Interaction Between Domperidone and Ketoconazole: Toward Prediction of Consequent QTc Prolongation Using Purely In Vitro Information

We aimed to investigate the application of combined mechanistic pharmacokinetic (PK) and pharmacodynamic (PD) modeling and simulation in predicting the domperidone (DOM) triggered pseudo-electrocardiogram modification in the presence of a CYP3A inhibitor, ketoconazole (KETO), using in vitro-in vivo extrapolation. In vitro metabolic and inhibitory data were incorporated into physiologically based pharmacokinetic (PBPK) models within Simcyp to simulate time course of plasma DOM and KETO concentrations when administered alone or in combination with KETO (DOM+KETO). Simulated DOM concentrations in plasma were used to predict changes in gender-specific QTcF (Fridericia correction) intervals within the Cardiac Safety Simulator platform taking into consideration DOM, KETO, and DOM+KETO triggered inhibition of multiple ionic currents in population. Combination of in vitro-in vivo extrapolation, PBPK, and systems pharmacology of electric currents in the heart was able to predict the direction and magnitude of PK and PD changes under coadministration of the two drugs although some disparities were detected.

The normal human newborns thymus

The thymic microenvironment constitutes a unique cell environment composed of thymic epithelial cells, myoid cells, and bone marrow-derived accessory cells for the differentiation, maturation and selection of T lymphocytes. The histological feature of thymus is markedly dependent on the age of individual and on various negative stimuli. Our study group consisted of fourteen newborns whose thymuses were removed during surgery performed for various congenital heart defects. We used a palette of seven monoclonal antibodies for exact localization of different cells creating the thymic microenvironment (cytokeratin AE1/AE3, desmin, actin, S100 protein, CD68, CD20, and CD45RO) as well as three monoclonal antibodies against proteins regulating the process of apoptosis (bcl2 oncoprotein, p53 protein, and survivin). We described and microphotographically illustrated the localization of thymic cytokeratin AE1/AE3-positive epithelial cells (subcapsular part of the cortex and medulla, especially Hassall's corpuscles), dendritic cells (medulla, often inside the Hassall's corpuscles), thymic myoid cells (medulla, often in close contact with Hassall's corpuscles), macrophages (mostly cortex, but also medulla and inside the Hassall's corpuscles), B lymphocytes (thymic medulla) and CD45RO-positive T lymphocytes (mostly thymic cortex). We found p53-positive thymic epithelial cell nuclei in subcapsular part of cortex and in outer epithelial cell layer of Hassall's corpuscles (very similar to the basal layer of epidermis). Bcl2 positive lymphocytes were mostly localized in thymic medulla, especially nearby Hassall's corpuscles. The thymuses were mostly survivin-negative with exception of round cells in border between cortex and connective tissue septa (probably migrating progenitor cells) (Tab. 1, Fig. 14, Ref. 66).

Interaction of human adipose tissue-derived mesenchymal stromal cells with breast cancer cells

Human adipose tissue was shown to be a very attractive source of mesenchymal stromal cells that have a wide scale of potential applications in reconstructive plastic surgery and regenerative medicine. However, these cells were described to have profound effects on biological behaviour of tumour cells. The aim of this study was to analyze the influence of adipose tissue-derived human mesenchymal stromal cells (AT-MSC) on the proliferation of breast cancer cells. We have tested proliferation of three different human breast cancer cell lines under the influence of AT-MSC derived soluble factors as well as in the direct cocultures. These data were supplemented with the expression analysis of cytokines and their cognate receptors on the target cells. We have observed stimulation of proliferation in breast cancer cells MDA-MB-361, T47D and EGFP-MCF7. AT-MSC were found to secrete wide scale of cytokines, chemokines and growth factors, thus we concluded that this pro-proliferative effect was a result of their synergistic action. These data bring out a need to evaluate whether primary breast tumour derived human cells would respond to these type of stimuli in a similar manner in order to exclude any potential clinical risk related to the application of human mesenchymal stromal cells under the context of patient with history of breast cancer malignancy.

The thymus: picture review of human thymus prenatal development

The thymus is derived from pharyngeal region; a region from which, in case of aquatic vertebrates, the gills develop. According to the classical hypothesis, the epithelial thymus stroma of human embryos is derived from the endodermal cells of the left and right ventral parts of the third pharyngeal pouches. But a close contact of the third pharyngeal pouch with its corresponding third pharyngeal clefts ectoderm plays an important role. Also an epithelial-mesenchymal interaction between the third pharyngeal pouch endoderm and surrounding neural crest derived-cells ectomesenchyme is necessary for the proliferation and differentiation of thymic epithelial cells. In our work we photographically presented the development of thymus from the 6th up to the 25th week of development. The first primordia of the thymus and parathyroid glands within the endoderm of third pharyngeal pouches can be seen in 8 to 9 mm stages. We found also an epithelial proliferation in the second pharyngeal pouches, but this "thymus secundus" stopped their differentiation. The thymus primordia at the 7th and 8th week of development contain almost exclusively epithelial cells. These cells are arranged at the periphery as a row of prismatic cells. The mesenchyme accumulates around the epithelial thymic primordium, and during 9th to 12th weeks of development, septa from mesenchyme fold between the epithelial cells and create the "openings" in the capsular surround. According to our observations, in the 13th week of development the differentiation of cortex and medulla becomes obvious and is completed from the 17th up to 18th week of development onward. The first developing Hassall's corpuscle was detected in the 13th week of development. The striking increase in the number of the Hassall's bodies was observed between the 16th and the 18th week of development, as well as between the 22nd and the 25th week of development (Fig. 14, Ref. 35).

Merkel cells--review on developmental, functional and clinical aspects

The objective of this review is to introduce Merkel cells, to provide a basic overview on the theoretical background of function, development and clinical importance of Merkel cells. Merkel cells (MCs) are post-mitotic neuroendocrine cutaneous cells primarily localized in the epidermal basal layer of vertebrates and concentrated in touch-sensitive areas in glabrous, hairy skin and in some mucosa. There is a great site variation in the density of MCs. In routine light microscopy human MCs can hardly be identified. Cytokeratine 20 is a reliable marker with highest degree of specifity. MCs can be also distinguished by electron microscopy. The origin of human MCs has been controversial. Some investigators believe that it is a neural crest derivate, whereas others have proposed that it is a differentiation product of the fetal epidermal keratinocytes. Most studies focus on neuroendocrine functions and their possible malignant transformation into Merkel cell carcinomas (MCC). MCC is an uncommon and often aggressive malignancy and found mainly in elderly patients. It occurs most frequently in the head and neck region. MCC may be difficult to diagnose, it appears as a firm, painless lump. Diagnosis is based on typical histology representation on haematoxylin-eosin stained slides together with the results of immunohistochemistry. Histologically, MCC has been classified into three distinct subtypes: trabecular, intermediate and small cell type. Radical surgery is the recomended procedure for the treatment of primary MCC. Oncological treatment is generally reserved for stage III. (distant metastases) cases of MCC (Tab. 1, Fig. 13, Ref. 58). Full Text in free PDF www.bmj.sk.

Endocrine organs and laser scanning confocal microscopy (LSCM) imaging: vascular bed in human spleen

OBJECTIVE

This work was aimed to utilize the precise method of laser confocal microscopy (LSCM) to depict the image of spatial relationships of the vessel network in the tissue structures of the human spleen.

METHODS

With the use of serial paraffin or vibratome sections of more than 20 μm thickness infiltrated with eosin fluorescence dye the images of arterial and venous walls of different calibres, capillaries, and venous sinuses were morphologically revealed.

RESULTS

Venous sinuses were frequently found to create mutually communicating branches and their lining projected into the lumen protruding cells with distinct spherically or ovally shaped nuclei, positioned on the brightly fluorescent and fragmented lamina basalis. The presence of lymphocytes was distinct in periarteriolar lymphoid sheath (PALS) and lymphatic follicles. Lining cells of the red pulp veins sporadically contained marked eosinophilic granules.

CONCLUSION

The method of LSCM allowed: 1. to reveal two-dimensional and sharp image of the human spleen structures, 2. to investigate the vertical course of venous structures in the tissue, 3. to obtain serial optic sections in z axis to their maximum spatial projections. These data will also serve for the creation of three-dimensional images of vessel network in the human spleen in the future studies.

Thymic Hassall's bodies of children with congenital heart defects

The development of the thymus and heart are closely related while in both, the neural crest cells play an important role. In our preliminary study, the thymic microscopic structures of the infant's thymuses with the congenital heart defects were observed. The study was conducted on 36 specimens of newborn thymuses removed due to surgery for cardiovascular malformations. Standard formalin-fixed paraffin-embedded tissue technique was used. Five-microm-thick sections were stained with hematoxylin and eosin and the microscopic examination was focused on the structure of Hassall's bodies. The Hassall's bodies showed considerable variations in size as well as in quantity. In most cases, the Hassall's bodies were large with the heterogeneous amorphous material enclosed in cystic dilatations. This type of Hassall's bodies is typical for adult thymuses. The most conspicuous changes (huge Hassall's bodies with the cystic dilatation filled up with cell detritus) were observed in patients with ventricular septal defect, atrioventricular septal defect and tetralogy of Fallot. Small-sized Hassall's bodies corresponding with infant age, were observed in cases with pulmonary valve atresia, atrial septal defect and in some cases of transposition of great arteries. We assume that the changes of microenvironment of the thymic medulla are associated with disrupted migration of the neural crest cells which are essential in the normogenesis of both heart and thymus (Tab. 1, Fig. 12, Ref. 33).

Anthropometry, nutrition status and thymic size of Gypsy newborns from southwestern Slovakia

Gypsy population represents a specific minority in Slovakia that differs from the majority population by its origin and genetic markers, as well as by generally lower social and economic status and lower hygienic standards of living. The aim of the present work is the analysis of anthropometric dimensions and indexes, as well as of thymus size, in the group of Gypsy and non-Gypsy newborns from the Southern Slovakia. Our group of 212 physiological newborns consisted of 33 Gypsy and 179 non-Gypsy newborns. All newborns were underwent anthropometric examination and their thymus size was assessed by ultrasonography and calculated as so-called Thymic Index". Gypsy newborns show statistically significant lower anthropometric dimensions (birth weight and birth body length, head and chest circumference) when compared to non-Gypsy newborns, however, they do not differ in the values of nutritional status indicators (arm circumference, Quételet index and Rohrer index). They do not differ even in the thymus size that can be regarded as a "barometer" of the nutrition and of some negative stimuli. In spite of generally deficient nutrition and lower health status of the Gypsy minority in Slovakia, we did not find any significant differences in the indicators of nutritional status or in thymus size (Tab. 2, Ref. 34).

DNA based prenatal testing for the skin blistering disorder epidermolysis bullosa simplex

Epidermolysis bullosa simplex (EBS) is a skin fragility disorder in which mild physical trauma leads to blistering. The phenotype of the disorder is variable, from relatively mild affecting only the hands and/or feet, to very severe with widespread blistering. For the severest forms of EBS there is a demand for prenatal diagnosis which until now has involved a fetal skin biopsy in the second trimester. The identification of mutations in the genes encoding keratins K5 and K14 as the cause of EBS opens up the possibility of much earlier diagnosis of the disease. We report here four cases in which prenatal testing was performed. In three of the cases the genetic lesions were unknown at the start of the pregnancy, requiring the identification of the causative mutation prior to testing fetal DNA. In two of the four cases novel mutations were identified in K14 and in the two remaining families, a previously identified type of mutation was found. Fetal DNA, obtained by chorionic villus sampling or amniocentesis, was analysed for the identified mutations. Three of the DNA samples were found to be normal; a mutant K14 allele was identified in the fourth case and the pregnancy was terminated. These results demonstrate the feasibility of DNA-based prenatal testing for EBS in families where causative mutations can be found.

The geriatric gravida: multifetal pregnancy reduction, donor eggs, and aggressive infertility treatments

OBJECTIVE

Recent technologic advances and societal acceptance have dramatically increased the use of donor eggs for infertile couples who require assisted reproductive technologies. Now many "older" couples can access assisted reproductive technologies to achieve pregnancies. We sought to evaluate the changing pattern of patients referred for multifetal pregnancy reduction as a result of donor eggs and age factors in aggressive infertility treatment.

STUDY DESIGN

Patients undergoing multifetal pregnancy reduction from 1986 to 1996 were included and categorized by year groupings, age, and the use of donor eggs.

RESULTS

A total of 523 patients were referred for and underwent multifetal pregnancy reduction. Before 1994, only 4 of 226 (1.8%) had received donor eggs, whereas in 1994 to 1996, 29 of 297 (9.8%) had received donor eggs (chi 2 = 12.6, p < 0.001). Eight of 9 patients aged > or = 45 years undergoing multifetal pregnancy reduction received donor eggs. There were no patients aged > or = 45 years before 1994 but 9 in 1994 to 1996. Four of 9 patients aged > or = 45 years with multifetal pregnancies chose reduction to singleton gestation. The proportions of patients aged > or = 40 years have increased from 0% to 11% in the last 8 years.

CONCLUSIONS

The availability of donor eggs has dramatically increased the use of assisted reproductive technologies and subsequent use of multifetal pregnancy reduction in older patients. Older patients are more inclined to want reduction to singleton gestation; they cite parental demands, financial issues, and their ability to parent in their 60s and 70s as reasons for reduction to singleton gestation.

Molecular epidemiology of HIV in Israel

The aim of this study was to identify the HIV types and subtypes prevalent in Israel among different populations in terms of risk or geographic origin of the HIV infection. A total of 149 blood samples were collected from HIV-positive persons from different risk groups for HIV infection who were living in Israel. HIV subtyping was performed by a V3-based peptide enzyme immunoassay, supplemented by direct sequencing of polymerase chain reaction products from the V3 region. Multiple HIV-1 subtypes were shown to circulate in Israel; whereas most of the infections among Israelis and Palestinians were of subtype B, infections among the large Ethiopian population in Israel were caused by HIV-1 subtype C. Occasionally, we found HIV-1 subtypes A and D and a putative B/C recombinant. No HIV-2 infection was identified. Sequence comparisons and phylogenetic tree analyses point at multiple introductions of HIV into the country. The presence of mainly two different HIV-1 subtypes, B and C, in two separated populations in Israel may result in two distinct epidemiologic patterns among HIV-infected individuals in Israel. Subtype C infection among the Ethiopians in Israel opens new research avenues toward better understanding the natural history of infection with HIV-1 subtype C in Ethiopians living in a Western society compared with those living in Ethiopia.

[Problems in carrying out baroreflex sensitivity measurements in clinical routine practice: practicability and complications]

Measurement of baroreflex sensitivity is a new method to identify patients after myocardial infarction with a high risk for sudden cardiac death, ventricular tachycardia or ventricular fibrillation. In this retrospective study the baroreflex sensitivity was obtained noninvasively by measuring the systolic blood pressure blood pressure with a FINAPRES-device and correlating this with the R-R intervals of the ECG after raising blood pressure with an intravenous dose of Norfenefrin-hydrochloride (Novadral). According to other investigators a correlation of > 0.7 with a significance of p < 0.05 was recommended for evaluable results with a baroreflex sensitivity < 3 ms/mm Hg being judged as decreased. We investigated 302 patients (mean age 59 +/- 17 years, 224 males, 78 females). 75% of the investigations showed acceptable results. In 77 cases (25%) reasonable results could not be achieved. We found premature ventricular beats to be responsible in 18 investigations (6% of all investigations). 41 (13.1%) of all investigations were not evaluable because of bad correlation for unknown reason. When we looked closely at these nonevaluable results, we found a significantly higher number of patients with impaired left ventricular ejection fraction (< 40%), diabetes or inducible sustained ventricular tachyarrhythmia in the electrophysiologic study in this group. During all investigations no severe side effects were observed. We conclude that the noninvasive measuring of the baroreflex sensitivity is a save method and leads to reasonable results in 75% of the investigations. In 13.1% it is not possible for unknown reason to achieve sufficiently correlating values. These measurements cannot be evaluated from nowadays' standards and have to be further investigated as they may indicate a population at high risk.

Divergent views--patient, career and staff perceptions of diagnosis and reasons for psychiatric admission to a district general hospital

This study explores the differing perceptions of patients, carers, and professional staff in relation to psychiatric admission. There is poor to moderate agreement between lay people and professional beliefs about diagnosis or purpose of admission, although good agreement about the necessity of admission. The chronicity of symptoms in admitted patients and a rural-urban divide in rates of admissions are also noted.

[SP-1 and beta-HCG in suspected ectopic pregnancy (author's transl)]

Serum levels of SP-1 and beta HCG as Trophoblastic Markers were measured in 31 women operated on suspected ectopic pregnancy. In all 24 patients with tubal pregnancy SP-1 levels estimated by enzyme immunoassay Enzygnost were higher than 5 ng/ml, whereas SP-1 levels in 7 cases with benign ovarian cysts were less than 2 ng/ml. Beta-HCG in serum was analysed by radioimmunoassay (Serono-Biodata): in cases with ectopic pregnancy serum levels were between 113 mIU/ml and 1040 mIU/ml, in the 7 nonpregnant cases the highest concentration was 7 mIU/ml. There was no correlation between serum concentration of SP-1 and beta-HCG (r = 0,571). In view of clinical practice preference is given to estimation of SP-1 by enzyme immunoassay over estimation of beta-HCG by radioimmunoassay, the reasons are discussed.