Automated multivolume placental reconstruction using three-dimensional power Doppler ultrasound and infrared camera tracking

OBJECTIVE

Placental insufficiency contributes to many obstetric pathologies however there is no bedside clinical tool to evaluate placental perfusion. We have developed a method to acquire multiple three-dimensional power Doppler ultrasound (3D PD-US) volumes of placental vasculature with infrared camera tracking providing global coordinates. These are automatically reconstructed ('stitched') into a model of the entire placenta. The purpose of the study was to evaluate the accuracy of automated reconstruction in an US phantom and apply this technique to human placentas.

METHODS

A custom-designed acrylic phantom was constructed with dimensions mimicking a third-trimester placenta, containing 12 quadrilateral towers of varying heights submersed in tissue-mimicking solution. Triplicated three-dimensional ultrasound volumes of this phantom were acquired at three different acquisition angles using infrared camera tracking. Data was transformed into a three-dimensional cartesian volume and automatically stitched. A single-centre, cross-sectional feasibility study was conducted on uncomplicated second-to-third trimester singleton pregnancies using standardised obstetric settings. Multiple 3D PD-US and grayscale volumes of the placenta were acquired with infrared camera tracked coordinates. Volumes were stitched to create a model of placental vasculature.

RESULTS

6 phantom datasets were reconstructed at each of 3 volume angles with a median of 9 volumes required. Perfect volume alignment occurred in 66.7% of 648 datapoints. Mean distance error for volume misalignment was 2.92mm. Measurements of 210 distances in each stitched volume (2160 total distances) differed an average of 1.51mm from true measurements. These compare favourably with recent literature, though for a substantially larger phantom. 17 participants were scanned with 92% reconstruction success per placental volume set and 100% participant achievability. Median reconstruction time was 10 minutes. Placental vasculature was qualitatively assessed to be present, continuous, and detailed throughout. Volume measurement of entire segmented placentas was highly repeatable (ICC 0.96).

CONCLUSION

We present an automated method to model the entire structure and vasculature of second-to-third trimester placentas, with verified accuracy and clinical feasibility for grayscale and power Doppler. This study builds the foundation to develop a practical screening tool for detecting placental insufficiency, and expansion to adult organ perfusion evaluation. This article is protected by copyright. All rights reserved.

A Rare Case of Hydralazine-Induced Diffuse Alveolar Hemorrhage

Hydralazine-induced anti-neutrophil cytoplasmic antibody (ANCA) vasculitis may occur any time after hydralazine initiation. General internists should recognize diffuse alveolar hemorrhage (DAH) as a rare complication of this condition, as early treatment reduces the associated high risk of mortality. We describe the case of an 82-year-old female with diastolic heart failure who presented with a one-month history of worsening dyspnea on exertion and a one-week history of scant hemoptysis and fatigue. Her medications included aspirin and hydralazine. She was hypoxic with bilateral expiratory wheezes on exam. Labs showed new anemia, elevated creatinine, proteinuria, and hematuria. Chest computed tomography showed asymmetric bilateral upper lobe ground-glass attenuation superimposed on interlobular septal thickening and intralobular lines. Further testing showed anti-nuclear antibody, positive ANCA, perinuclear ANCA (p-ANCA), and anti-myeloperoxidase ANCA (anti-MPO-ANCA). Renal biopsy revealed MPO-ANCA, pauci-immune, necrotizing, and crescentic glomerulonephritis. She was diagnosed with DAH secondary to hydralazine-induced ANCA-associated vasculitis (AAV). Hydralazine is an anti-hypertensive medication with known potential for autoimmune reactions. Of these, AAV is a rare sequela mediated by anti-MPO and most commonly affects the kidneys. In rare circumstances, patients with AAV can develop pulmonary-renal syndrome, resulting in both glomerulonephritis and DAH with an associated high risk of mortality. Diagnosis requires a high index of suspicion in patients with acute kidney injury of unclear etiology. Early diagnosis through immune work-up and kidney biopsy should be pursued, as prompt recognition of the vasculitis, cessation of hydralazine, immunosuppression, and early plasma exchange are essential to an improved prognosis.

A Rare Case of Olmesartan-Associated Enteropathy Successfully Managed With Steroid Taper

Olmesartan is a commonly used antihypertensive medication belonging to the class of angiotensin II receptor blockers. Though generally well-tolerated, olmesartan can rarely cause olmesartan-associated enteropathy (OAE) with non-bloody diarrhea, weight loss, abdominal pain, and vomiting. Patients may develop enteropathy months to years after drug initiation. In severe cases, patients may develop complications that require hospitalization. Diagnosis is often delayed due to unfamiliarity of OAE, nonspecific presenting symptoms, and normal-appearing gross endoscopic findings. Esophagogastroduodenoscopy (EGD) with biopsy is essential to the diagnosis, showing sprue-like enteropathy with intestinal villous atrophy and mucosal inflammation. This report describes a case of a 70-year-old man who presented with three months of profuse watery diarrhea and 40-pound unintentional weight loss. After an extensive workup, including EGD with duodenal biopsies, the patient was diagnosed with OAE. The biopsies showed findings consistent with acute and chronic duodenitis, mucosal desquamation and ulceration, blunting of villi, and a sprue-like pattern with neutrophils. Celiac serologies and anti-enterocyte antibodies were negative, further supporting the diagnosis of OAE. Complete resolution of symptoms was achieved by discontinuing olmesartan and administering a steroid taper. Considering the frequent use of olmesartan, the increasing occurrence of OAE, and the wide range of associated symptoms, it is crucial for providers to recognize OAE and consider early discontinuation of olmesartan. This approach can help prevent further intestinal damage, protracted symptoms, unnecessary diagnostic tests, and financial burdens on both patients and the healthcare system.

In vitro Analysis of the Hemostatic Properties of Whole Blood Products Prepared with a Platelet-Sparing Leukoreduction Filter

Background

Warm fresh whole blood (WFWB) is an ideal resuscitation fluid for exsanguinating patients but there are myriad logistic and infectious issues associated with its use. Cold whole blood (CWB) may be an acceptable alternative to the reconstituted whole blood (RWB), the current standard of care. A leukoreduction filter has been developed which maintains platelet count while eliminating white blood cells but its effect on platelet function is unknown. We hypothesize that CWB will retain an acceptable functional coagulation profile after filtration and over time.

Study Design and Methods

WFWB and CWB samples were obtained from eight donors and four units of RWB were created. The quantitative and qualitative in vitro coagulation profiles of WFWB, RWB, and CWB over time were compared.

Results

Filtration was successful at removing white blood cells (5.5 ± 1.2 vs. 0.3 ± 0.3 × 10⁶/L) while retaining an adequate platelet count (172.0 ± 47.0 to 166.0 ± 42.3 × 10⁹/L) and hemoglobin concentration (13.7 ± 0.5 vs. 13.0 ± 0.7 g/dL). Rotational Thromboelastography (ROTEM) results revealed a similar clotting time (CT) before and after filtration (64.9 ± 5.1 vs. 64.1 ± 6.8 s) but a decreased maximum clot firmness (MCF) (58.6 ± 4.2 vs. 54.9 ± 4.6 mm). Platelet aggregation decreased substantially (28.8 ± 6.7 vs. 9.3 ± 2.1 ohm) immediately after filtration. CWB function continued to diminish over time.

Conclusion

CWB holds great promise as a surrogate for WFWB, but use of a platelet-sparing LR filter diminishes platelet function almost immediately after filtration.

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A cross was made of Elymus repens onto the wheat cultivar Crocus and BC1 progeny advanced to BC1F7 by single seed descent. Sixteen lines were selected based on agronomic performance and evaluated in an FHB epiphytotic nursery. Eight lines with FHB resistance were selected. Based on GISH analysis, line P1142-3-1-5 had 42 chromosomes with one pair of chromosomes showing telomeric translocations on both arms. This chromosome was identified as 3D by using SSR markers. An evaluation of lines with single translocations revealed that FHB resistance was contributed by the translocation on the long arm of chromosome 3D. That line has minimal linkage drag and should be amenable to applications in breeding for disease resistance.

Serum apolipoprotein C-II is prognostic for survival after pancreatic resection for adenocarcinoma

BACKGROUND

Pancreaticoduodenectomy remains a major undertaking. A preoperative blood test, which could confidently predict the benefits of surgery would improve the selection of pancreatic cancer patients for surgery. This study aimed to identify protein biomarkers prognostic for long-term survival and to validate them with clinico-pathological information.

METHODS

Serum from 40 preoperative patients was used to train for predictive biomarkers using surface-enhanced laser desorption/ionisation time-of-flight mass spectrometry (SELDI), and the results were verified on 21 independent samples. Two predictive proteins were identified by tryptic peptide mass fingerprinting and sequencing, and validated on serum from another 57 patients by enzyme-linked immunosorbent assay (ELISA). The influence of these proteins on growth and invasion of two cancer cell lines was tested in-vitro.

RESULTS

The SELDI panel of m/z 3700, 8222 and 11 522 peaks predicted <12 months' survival (ROC AUC: 0.79, 0.64-0.90; P<0.039). When CA19-9 was added, the ROC AUC increased to 0.95 (0.84-0.99; P<0.0001). The six subjects in the verification group who died within 12 months were correctly classified. The m/z 8222 and 11 522 proteins were identified as Serum ApoC-II and SAA-1, respectively. In the validation samples, ELISA results confirmed that ApoC-II was predictive of survival (Kaplan-Meier P<0.009), but not SAA-I. ApoC-II, CA19-9 and major-vessel involvement independently predicted survival. ApoC-II and SAA-1 increased cell growth and invasion of both cancer cell lines.

CONCLUSION

Serum ApoC-II, CA19-9 and major-vessel invasion independently predict survival and improves selection of patients for pancreaticoduodenectomy.

Molecular cytological characterization of two novel durum--Thinopyrum intermedium partial amphiploids with resistance to leaf rust, stem rust and Fusarium head blight

Thinopyrum intermedium, a wild relative of wheat, is an excellent source of disease resistance. Two novel partial amphiploids, 08-47-50 and 08-53-55 (2n = 6x = 42), were developed from wide crosses between durum wheat and Th. intermedium. Meiotic analysis showed that pollen mother cells of the two partial amphiploids formed an average 20.49 bivalents for 08-47-50 and 20.67 bivalents for 08-53-55, indicating that they are basically cytologically stable. GISH analysis revealed that the two partial amphiploids carried different chromosome compositions. 08-47-50 had fourteen chromosomes from Th. intermedium and its alien chromosomes included six St-, four E(e) - and four E(e)-St translocated chromosomes, whereas 08-53-55 had four St- and ten E(e)-St translocated chromosomes. Fungal disease evaluation indicated that both partial amphiploids had a high level of resistance to FHB, leaf rust and stem rust race Ug99. These two novel partial amphiploids with multiple disease resistance could be used as a new source of multiple disease resistance in bread wheat and durum wheat breeding programs.

Molecular cytogenetic analysis of wheat – Elymus repens introgression lines with resistance to Fusarium head blight

Elymus repens (L.) Gould (2n = 6x = 42, StStStStHH) is a hexaploid perennial wheatgrass species from the tribe Triticeae, distantly related to bread wheat Triticum aestivum L. (2n = 6x = 42, AABBDD). As a potential source of resistance to Fusarium head blight (FHB), E. repens was crossed to common wheat to transfer resistance genes. The progeny were advanced to homozygosity by single seed descent. A total of eight BC1F9 progeny lines were selected and characterized in this study. The chromosome numbers of these derived lines ranged from 42 to 56, including lines with 44, 52, and 54 chromosomes. All of the lines were cytologically stable in terms of meiotic chromosome behavior. The univalent frequency in the lines varied between 0.34 and 2.36 per cell. Similarly, the multivalent frequency did not exceed 1% in any of the lines. GISH analysis revealed that the number of intact wheat chromosomes in the various lines varied between 40 and 44. Numerous translocated chromosomes were detected in all lines. The translocations involved chromosomal segments from wheat, and the St and H genomes of E. repens. Furthermore, trigenomic translocated chromosomes were detected in some of the lines. The introgression into wheat chromosomes included not only terminal types but also interstitial segments. The Fusarium head blight resistance of the eight lines, following point inoculation, varied from 5.65% infected florets to 11.46% compared with the check cultivars T. aestivum ‘Roblin’ and T. aestivum ‘Crocus’ at 100% and 85%, respectively.

Procoagulant activity, but not number, of microparticles increases with age and in individuals after a single venous thromboembolism

The Calibrated Automated Thrombogram (CAT), a plate-based assay that measures thrombin generation and inhibition in plasma samples, is modified to measure the procoagulant activity of phospholipid associated with plasma microparticles (MP). The assay uses a tissue factor trigger without addition of 4 μM exogenous phospholipid (PL) used in the standard CAT. Calibrated with 4:1 posphatidylcholine- phosphatidylserine (PCPS) liposomes, the assay defines a median of 40 nM procoagulant phospholipid (PPL) equivalents in plasma containing MPs from 50 normal donors, with a range from 20 - 200 nM. Like the standard CAT, the modified assay detected no difference in plasma from 36 individuals with a history of a single episode of venous thromboembolism. However the male cases had double the PPL activity, as measured by rate of thrombin generation, of females; and there was a significant correlation among cases of increased thrombin generation with age. In contrast, there were no gender disparities or age correlations among control plasmas. The findings suggest that procoagulant activity of plasma microparticles, facilitated by a simplified, one-stage plate-based assay, offer a promising avenue of investigation of mechanisms and management of venous thromboembolic disorders.

Biological management of Fusarium head blight and mycotoxin contamination in wheat

Fusarium head blight (FHB), caused by Gibberella zeae is a harmful disease of wheat. To manage FHB and mycotoxin contamination in wheat, field experiments were conducted from 2007 to 2008 to evaluate a total of 20 selected bioagents for their ability to inhibit perithecial production of G. zeae and for the control of FHB and deoxynivalenol (DON) contamination, in comparison with the registered fungicide Folicur (tebuconazole). All 20 bioagents significantly reduced the perithecial production compared to the untreated control. Clonostachy rosea strain ACM941 was the most effective treatment, reducing the production of perithecia by 63.7% in 2007 and 67.5% in 2008. These effects were significantly better than Folicur fungicide, which reduced perithecial production by 30.4% and 20.5%, for 2007 and 2008, respectively. When sprayed on to wheat heads, seven of the 20 bioagents significantly reduced the FHB index, one reduced Fusarium damaged kernels (FDK), and six reduced DON content in grains in 2007. ACM941 was the only treatment that significantly reduced FHB index, FDK, and DON, by 46.4%, 29.0% and 28.7%, respectively. Among the six bioagents and three formulated products evaluated in two separate field trials in 2008, ACM941 and its formulated product ACM941-CU were the only treatments that significantly reduced FHB index, FDK, and DON. The treatments reduced FHB index by 30.8% and 31.4%, FDK by 17.8% and 43.8%, and DON by 30.8% and 37.1%, for ACM941 and ACM941-CU, respectively. These effects were less marked than those of the Folicur fungicide that reduced FHB index by 98.8%, FDK by 94.2%, and DON by 92.1%. Results of this study suggest that ACM941 is a promising bioagent against G. zeae and may be used as a control measure in organic farming and in an integrated FHB and DON management program for wheat production.

Quantitative trait loci for lodging resistance, plant height and partial resistance to mycosphaerella blight in field pea (Pisum sativum L.)

With the development of genetic maps and the identification of the most-likely positions of quantitative trait loci (QTLs) on these maps, molecular markers for lodging resistance can be identified. Consequently, marker-assisted selection (MAS) has the potential to improve the efficiency of selection for lodging resistance in a breeding program. This study was conducted to identify genetic loci associated with lodging resistance, plant height and reaction to mycosphaerella blight in pea. A population consisting of 88 recombinant inbred lines (RILs) was developed from a cross between Carneval and MP1401. The RILs were evaluated in 11 environments across the provinces of Manitoba, Saskatchewan and Alberta, Canada in 1998, 1999 and 2000. One hundred and ninety two amplified fragment length polymorphism (AFLP) markers, 13 random amplified polymorphic DNA (RAPD) markers and one sequence tagged site (STS) marker were assigned to ten linkage groups (LGs) that covered 1,274 centi Morgans (cM) of the pea genome. Six of these LGs were aligned with the previous pea map. Two QTLs were identified for lodging resistance that collectively explained 58% of the total phenotypic variation in the mean environment. Three QTLs were identified each for plant height and resistance to mycosphaerella blight, which accounted for 65% and 36% of the total phenotypic variation, respectively, in the mean environment. These QTLs were relatively consistent across environments. The AFLP marker that was associated with the major locus for lodging resistance was converted into the sequence-characterized amplified-region (SCAR) marker. The presence or absence of the SCAR marker corresponded well with the lodging reaction of 50 commercial pea varieties.

Food intake patterns in urban Beijing Chinese

This study investigated the food consumption patterns of 430 Beijing Chinese adults and assessed the impact on these patterns of the following socio-demographic characteristics: gender, age, educational achievement, and gross household income. Food intake by category, food variety and meal patterns were assessed using a 156-item food frequency questionnaire. It was found that gender and age were the most important factors to influence food consumption patterns. Men consumed more wheat products, red meat and tea, whereas women consumed more vegetables, fruit, nuts, fish, eggs and milk. Women also tended to consume a wider variety of food than did men. Furthermore, it was found that younger and more educated people tended to consume a wider variety of food. Age also had an important influence on the food intake. Younger and generally more educated adults tended to consume foods associated with affluence: meats, soft drinks and beer, while the older population tended to consume more vegetables (women only), milk and tea in their diets. Because education is closely correlated with age in this Beijing Chinese population, it appeared to have little effect on the food intake patterns, after adjusting for age. The older members of this population, who probably have a decreased functional reserve of nutrients, and the less educated, appeared not to be taking advantage of the availability of a wide variety of food, further increasing the risk of nutrient deficiency. On the other hand, the younger and more educated, who tended to consume a wide variety of foods, were more likely to maintain adequate nutritional standards. However, their tendency to consume food associated with affluence, such as meat and beer, may point toward an increased risk of those diseases prevalent in affluent societies, such as obesity, diabeties, cardiovascular disease, certain cancers and osteoporosis. Ongoing nutrition surveillance and appropriate nutrition education will be required increasingly for Beijing Chinese and similar communities.

Construction of hybridomas secreting monoclonal antibody against sweet potato feathery mottle virus and use of antibody for detection of SPFMV

Two hybridomas stably secreting monoclonal antibodies (McAb) against sweet potato feathery mottle virus (SPFMV) were constructed by fusing mouse myeloma (Sp2/0-Ag14) with mouse splenocytes immunized with SPFMV-LF. The McAb secreted by the two hybridomas specifically reacted with both SPFMV-LF (China strain) and SPFMV-RC (American strain) in dot-blot-ELISA. A large amount of McAb was produced with BALB/c mice. The titer of hybridoma cultured supernatant was 1:256, and that of the ascitic fluids was 1:1 x 10(4); and the immunoglobulins of McAb were IgG2a and IgG3 respectively. The detection of SPFMV-infected sweet potato plants with McAb confirmed that the McAb obtained in this test were desirable for large-scale routine surveys of SPFMV. This study on construction of hybridomas and detection of SPFMV using McAb is the first report in the world.

Effect of selenium deficiency on the chronic toxicity of adriamycin in rats

The effect of selenium deficiency on the chronic toxicity of adriamycin was examined in rats fed diets adequate in vitamin E. Selenium-deficient and selenium-supplemented diets were fed to rats for 10 wk, after which groups of 10 rats fed each diet were given weekly intravenous injections of adriamycin in saline at doses of 0, 0.5 or 1.0 mg/kg body weight for 12 wk. All rats were killed at 24 wk. Even though the cardiac glutathione peroxidase activity in the selenium-deficient group was less than 1% of that of the selenium-supplemented group, the severity of the adriamycin-induced cardiomyopathy was similar in both groups. However, the selenium-deficient rats were more sensitive to the growth-inhibiting effect of the higher dose of adriamycin than the selenium-supplemented rats. Moreover, the lower dose of adriamycin caused a mild nephropathy in 70% of the deficient rats but affected only 10% of the supplemented rats. Selenium status may have to be considered when adriamycin is used as a chemotherapeutic agent.

Keshan disease-an endemic cardiomyopathy in China

Keshan disease, an endemic cardiomyopathy in China, was prevalent in rural areas located in a long belt region where the selenium content was low in foods. Intervention studies with well controlled subjects revealed a prophylactic effect of sodium selenite. Multifocal necrosis and fibrous replacement of the myocardium characterized the histopathological features and myocytolysis was present in most cases. Ultrastructural observations on twelve postmortem cases revealed remarkable changes in many organelles of which mitochondria appeared to be most important in the development of myocardial lesions. Three kinds of specific granules, which have not been found in other reports on cardiomyopathies, were represented and other factors which might also contribute to the aetiology are discussed.