On generating functions in additive number theory, II: lower-order terms and applications to PDEs

We obtain asymptotics for sums of the form ∑ n = 1 P e α k n k + α 1 n , involving lower order main terms. As an application, we show that for almost all α 2 ∈ [ 0 , 1 ) one has sup α 1 ∈ [ 0 , 1 ) | ∑ 1 ≤ n ≤ P e α 1 n 3 + n + α 2 n 3 | ≪ P 3 / 4 + ε , and that in a suitable sense this is best possible. This allows us to improve bounds for the fractal dimension of solutions to the Schrödinger and Airy equations.

Efficacy and safety of erenumab (AMG334) in episodic migraine patients with prior preventive treatment failure: A subgroup analysis of a randomized, double-blind, placebo-controlled study

BACKGROUND

Erenumab was effective and well tolerated in a pivotal clinical trial of episodic migraine that included subjects both naïve to, and those who had failed, previous preventives. Here we evaluated the efficacy and safety of erenumab (70 mg or 140 mg) versus placebo in the subgroup of patients who had previously failed preventive treatment(s): ≥1 or ≥2 prior failed migraine preventive categories, and in patients who had never failed.

METHODS

Prespecified subgroup analyses evaluated change from baseline to months 4-6 (the primary endpoint of the blinded study phase) in monthly migraine days, achievement of ≥50% and ≥75% reduction in monthly migraine days, and change from baseline in acute migraine-specific medication days. Adverse events were also evaluated.

RESULTS

Treatment with both doses of erenumab resulted in greater reductions in monthly migraine days at months 4-6 (treatment difference versus placebo [95% CI], never failed subgroup: -0.9 [-1.5, -0.3] for 70 mg and -1.3 [-1.9, -0.7] for 140 mg; ≥1 prior failed medication categories subgroup: -2.0 [-2.8, -1.2] for 70 mg and -2.5 [-3.4, -1.7] for 140 mg; ≥2 prior failed medication categories subgroup: -1.3 [-2.6, 0.0] for 70 mg and -2.7 [-4.0, -1.4] for 140 mg). Similar results were observed in the monthly acute migraine-specific medication days endpoint, and in the achievement of ≥50% and ≥75% reduction in monthly migraine days. For the ≥50% reduction in monthly migraine day endpoint, placebo response in the no prior treatment failed group was 32.6%, in the ≥1 failed treatment 17.5%, and in the ≥2 failed treatments 11.1%.

CONCLUSION

Erenumab showed consistent efficacy in episodic migraine patients who had failed prior preventive treatments and was well tolerated across subgroups. The data suggest prior patients with prior treatment failures have lower placebo response rates.

Fatty degeneration of the deltoid muscle associated with displaced proximal humerus fractures

INTRODUCTION

The use of reverse shoulder arthroplasty (RSA) has increased dramatically over the last two decades, with many surgeons now indicating RSA for the acute management of displaced proximal humerus fractures (PHF) in the elderly. RSA relies on adequate deltoid muscle function to obtain a good outcome, yet no literature to date exists which discusses preoperative assessment of deltoid structure prior to RSA. The purpose of this study was to assess for preoperative fatty deltoid-degeneration in patients with displaced PHF.

MATERIALS AND METHODS

We reviewed the axial CT scans of 100 consecutive patients with a displaced PHF. Fatty degeneration within each of the three deltoid-heads was graded at three levels, according to Goutallier and colleagues. Fractures were classified according to Neer.

RESULTS

Seventy-nine percent of the patients were female, 75% showed 3 or 4 parts fractures. The average cross-sectional area of the posterior deltoid was greatest-representing 37%, 40% and 42% of total area at each level, respectively. Severe fatty degeneration (Stages 3 and 4) was observed in the posterior deltoid only (26%). Absence of fatty degeneration (Stage 0) was observed in < 25% of cases. The Inter-Observer-Reliability for the continuous variables proved to be high.

CONCLUSION

Preoperative deltoid fatty degeneration is common in displaced PHF in the elderly. Because CT is commonly obtained to assess fracture morphology and for preoperative planning purposes, it is an ideal tool to assess the deltoid additionally. Future studies are warranted to determine whether preoperative fatty infiltration of the deltoid correlates with mid and long term functional outcomes when RSA is used acutely to manage a PHF.

LEVEL OF EVIDENCE

Level IV-consecutive case series.

Vergleich zwischen Eigenschaften des Echten Ackerbohnenmosaik-Virus und des broad bean mottle-Virus

Broad bean true mosaic virus (EAMV) has been studied in comparison with broad bean mottle virus (BBMV), after both viruses had been purified by the same procedure. Spectrophotometric and/or chemical determinations revealed a nucleic acid content of 32% for EAMV and 23% for BBMV. Serologically, the two viruses are unrelated since in reciprocal testings they react with their homologous antisera only. The diameter of of the particles has been determined to 25 mμ for EAMV and 20 mμ for BBMV. Further differences include thermal inactivation point, seed transmission, host range, and symptomatology.

There are no indications for a relationship among both viruses as suggested in the list of Common names (Review of Applied Mycology, Vol. 35, Suppl.).

Randomized controlled study of telcagepant plus ibuprofen or acetaminophen in migraine

OBJECTIVE

To evaluate the efficacy and tolerability of telcagepant when co-administered with ibuprofen or acetaminophen for the acute treatment of migraine.

BACKGROUND

Telcagepant is an oral calcitonin gene-related peptide receptor antagonist which is being evaluated for the acute treatment of migraine. Combining telcagepant with analgesics that have a different mechanism of action could produce greater efficacy.

METHODS

Randomized, double-blind, placebo-controlled study. Patients were randomized to treat a moderate or severe migraine headache with either telcagepant 280 mg + ibuprofen 400 mg (N = 171), telcagepant 280 mg + acetaminophen 1000 mg (N = 171), telcagepant 280 mg (N =170), or placebo (N = 171). The primary efficacy endpoint was 2-hour pain freedom. The study had approximately 88% power to detect an additive effect of at least 15 percentage points (telcagepant combination vs telcagepant monotherapy) and 48% power to detect an additive effect of at least 10 percentage points. Safety and tolerability were assessed by adverse events and laboratory tests.

RESULTS

The percentages of patients with 2-hour pain freedom were greater in each active treatment group compared to placebo (P < .001): telcagepant + ibuprofen = 35.2%, telcagepant + acetaminophen = 38.3%, telcagepant = 31.2%, placebo = 10.9%. No significant differences were seen for either of the combination groups vs telcagepant monotherapy, but both were numerically larger than telcagepant monotherapy. All the active treatments were generally well tolerated. The percentage of patients reporting any adverse event within 48 hours was higher in the active treatment groups than placebo: telcagepant + ibuprofen = 30.3%, telcagepant + acetaminophen = 31.6%, telcagepant = 24.8%, placebo = 18.2%. The most common adverse events reported by ≥ 4 patients in one or more of the treatment groups that included telcagepant were fatigue, nausea, dizziness, somnolence, dry mouth, and tremor.

CONCLUSIONS

The combination of telcagepant 280 mg with either ibuprofen 400 mg or acetaminophen 1000 mg did not show a statistically significant difference from telcagepant alone. Numerically greater treatment effects in the combination treatment groups over the telcagepant 280 mg monotherapy suggest that telcagepant combination treatments may merit further evaluation in studies powered to detect smaller additive benefits. (Clinicaltrials.gov; NCT00758836).

Bacterial abundance and composition in marine sediments beneath the Ross Ice Shelf, Antarctica

Marine sediments of the Ross Sea, Antarctica, harbor microbial communities that play a significant role in the decomposition, mineralization, and recycling of organic carbon (OC). In this study, the cell densities within a 153-cm sediment core from the Ross Sea were estimated based on microbial phospholipid fatty acid (PLFA) concentrations and acridine orange direct cell counts. The resulting densities were as high as 1.7 × 10⁷ cells mL⁻¹ in the top ten centimeters of sediments. These densities are lower than those calculated for most near-shore sites but consistent with deep-sea locations with comparable sedimentation rates. The δ¹³C measurements of PLFAs and sedimentary and dissolved carbon sources, in combination with ribosomal RNA (SSU rRNA) gene pyrosequencing, were used to infer microbial metabolic pathways. The δ¹³C values of dissolved inorganic carbon (DIC) in porewaters ranged downcore from -2.5‰ to -3.7‰, while δ¹³C values for the corresponding sedimentary particulate OC (POC) varied from -26.2‰ to -23.1‰. The δ¹³C values of PLFAs ranged between -29‰ and -35‰ throughout the sediment core, consistent with a microbial community dominated by heterotrophs. The SSU rRNA gene pyrosequencing revealed that members of this microbial community were dominated by β-, δ-, and γ-Proteobacteria, Actinobacteria, Chloroflexi and Bacteroidetes. Among the sequenced organisms, many appear to be related to known heterotrophs that utilize OC sources such as amino acids, oligosaccharides, and lactose, consistent with our interpretation from δ¹³CPLFA analysis. Integrating phospholipids analyses with porewater chemistry, δ¹³CDIC and δ¹³CPOC values and SSU rRNA gene sequences provides a more comprehensive understanding of microbial communities and carbon cycling in marine sediments, including those of this unique ice shelf environment.

Topiramate treatment of chronic migraine: a randomized, placebo-controlled trial of quality of life and other efficacy measures

OBJECTIVE

To define yet more clearly the utility of topiramate in the treatment of chronic migraine, we evaluated prespecified secondary endpoints from a recent randomized, double-blind, placebo-controlled, multicenter clinical trial.

BACKGROUND

We previously reported that topiramate 100 mg per day produced a statistically significant reduction in mean monthly migraine/migrainous and migraine headache days compared with placebo treatment and that it was safe and generally well tolerated.

METHODS

Variables analyzed included between-treatment group differences in percent responders, change in the mean monthly rate of total headache days and headache-free days, change in average and worst daily headache severity, change in the mean monthly use of acute headache medications, and absolute change and percent change in a headache index. Additional analyses included evaluation of changes in: the associated symptoms of photophobia, phonophobia, and nausea; Migraine-Specific Quality of Life Questionnaire scores; Migraine Disability Assessment Scale scores; and Physician's and Subjects Global Impression of Change.

RESULTS

The intent-to-treat population consisted of 306 patients (topiramate, n = 153; placebo, n = 153). Categorical responder rates of reductions in mean monthly migraine/migrainous days for topiramate- vs placebo-treated subjects were as follows: for > or =25% reduction: 68.6% vs 51.6% (P = .005); > or =50%: 37.3% vs 28.8% (P = .093); and > or =75%: 15.0% vs 9.2% (P = .061). The decrease in mean monthly total headache days and headache-free days for topiramate vs placebo treatment was 5.8 vs 4.7 days (P = .067). Compared with placebo, topiramate treatment resulted in statistically significant mean improvements in the Role Restrictive (P = .028) and Emotional Function (P = .036) domains of the Migraine-Specific Quality of Life Questionnaire, in the worst daily severity of migraine (P = .016), severity of photophobia (P = .032), frequency of vomiting (P = .018), photophobia (P = .038), phonophobia (P = .010), unilateral pain (P = .015), pulsatile pain (P = .023), and pain worsened because of physical activity (P = .047). In addition, there were trends observed (favoring topiramate) in average daily severity of migraine (P = .077), acute headache medication use (P = .127), severity of nausea (P = .098), frequency of nausea (P = .166), the Role Preventive domain of the Migraine-Specific Quality of Life Questionnaire (P = .061), and severity of phonophobia (P = .062).

CONCLUSIONS

In addition to significantly reducing mean monthly migraine/migrainous and migraine headache days, treatment of chronic migraine with topiramate was effective with regard to several traditionally important and clinically relevant secondary outcomes in migraine prevention trials. Treatment with topiramate was well tolerated and not associated with serious adverse events.

Speed of onset, efficacy and tolerability of zolmitriptan nasal spray in the acute treatment of migraine: a randomised, double-blind, placebo-controlled study

INTRODUCTION

Migraine is a common, disabling condition that has a significant impact on patients and relatives, and is a considerable economic burden on society. Migraine patients want fast-acting treatments with high efficacy. Previous studies have demonstrated that orally administered formulations of zolmitriptan are rapidly and highly effective in the acute treatment of migraine. The objective of this study was to assess the efficacy, speed of onset and tolerability of the nasal spray formulation of zolmitriptan in migraine treatment.

METHODS

This multicentre, randomised, double-blind study recruited 2122 patients (aged 18-65 years) who had an established diagnosis of migraine (according to International Headache Society criteria), with or without aura. Patients were randomised to receive zolmitriptan 5mg nasal spray or placebo to treat up to two migraine attacks within 15 minutes of headache pain becoming moderate or severe. The primary endpoint was headache response (reduction in migraine pain from severe/moderate to mild/none) at 2 hours, 1 hour, 30 minutes and 15 minutes post-dose (analysed using a step-down approach). Secondary endpoints included headache response at 4 hours, pain-free rates at 30 minutes and 1, 2 and 4 hours, and sustained headache response and pain-free status at 24 hours post-dose.

RESULTS

The headache response rate at 2 hours post-dose was 66.2% for the zolmitriptan group, compared with 35.0% for the placebo group (p < 0.001). Zolmitriptan nasal spray also produced significantly higher headache response rates than placebo at all earlier timepoints assessed, starting as early as 15 minutes post-dose (p < 0.001). Similar results were obtained for the analysis of the first attack. Significantly higher pain-free rates were obtained with zolmitriptan nasal spray, compared with placebo, from 15 minutes post-dose onward (p < 0.005). Zolmitriptan nasal spray was also significantly superior to placebo for headache response at 4 hours, sustained headache response at 24 hours and sustained pain-free rate at 24 hours. Zolmitriptan nasal spray was well tolerated, with most adverse events being of short duration and mild or moderate intensity.

CONCLUSIONS

Zolmitriptan nasal spray is highly effective in the acute treatment of migraine and has a very fast onset of action, producing significant headache response and pain-free rates as early as 15 minutes post-dose (the earliest assessment in this study). In addition to the very fast onset of action, zolmitriptan nasal spray produced significantly higher sustained headache response and pain-free rates at 24 hours post-dose compared with placebo. These desirable efficacy outcomes were combined with good tolerability.

Migraine treatment strategies: the global Migraine And Zolmitriptan Evaluation (MAZE) survey--phase IV

OBJECTIVE

To determine which medications UK migraineurs have access to and assess the usage of these products in a 'real-life' setting.

RESEARCH DESIGN AND METHODS

Data were collected using an online questionnaire, which subjects were directed to by advertisements in pharmacies, a UK national newspaper, on the internet and information on the Migraine Action Association website and newsletters. Respondents were eligible for inclusion if attacks fulfilled International Headache Society criteria for migraine and/or if previously diagnosed by a physician as having migraine.

MAIN OUTCOME MEASURES

Respondents were asked to specify which products had been prescribed or purchased for migraine treatment. The pattern of use of these products was determined, including the reasons why respondents chose particular products to treat attacks.

RESULTS

Of 3072 eligible respondents, the majority had purchased a variety of over-the-counter (OTC) medicines for treatment of attacks. Eighty-seven per cent had been diagnosed by a physician and were prescribed multiple products (average 1.68); 45% received triptans, but 26% were still prescribed products that were also available OTC. Over half (52%) of respondents initially used an OTC medicine to treat the last migraine attack. However, 73% required a second dose/product, mainly as a result of lack of efficacy of the first dose/product. Respondents using triptans were less likely to require a second dose/product than those not using triptans (52% vs. 78%, respectively). The two main reasons for choosing a triptan to treat an attack were the need for quick control and the severity of the attack. Satisfaction with regard to migraine medication was higher among triptan-users than nontriptan users.

CONCLUSIONS

Medicines that are available OTC are often used as first-line therapy for migraine despite many migraineurs having access to prescription therapies such as triptans. Many migraineurs require a second dose/product, possibly indicating sub-optimal treatment efficacy. Physicians should consider the range of migraine-specific treatments available, including triptans, in order to develop a treatment plan that is based on the patient's needs and preferences.

Impact of migraine on patients and their families: the Migraine And Zolmitriptan Evaluation (MAZE) survey--Phase III

OBJECTIVE

To investigate the impact of migraine on migraineurs and their families and evaluate migraineurs' preference for different treatment formulations. This study also assessed the prevalence and impact of migraine with menstruation.

METHODS

Participants (n = 1028) from around the world (USA [39%], Canada [20%], Europe [37%] and other countries [4%]) completed an online questionnaire. Of these, 866 were migraineurs and 162 were non-migraineurs living with/related to migraineurs. Migraineurs were identified based on responses to a modified Kiel questionnaire and/or diagnosis of migraine by a doctor. Disability was quantified using the Migraine Disability Assessment Scale (MIDAS).

RESULTS

Migraineurs missed more days from family/leisure activities than from work/school (mean 4.2 vs 2.4 days) in the previous 3 months. On an additional 6.2 days within the 3-month period, productivity at work/school was reduced by at least half. Inability and reduced ability (by at least half) to perform household work were reported on 6.0 and 6.5 days, respectively. Of the women surveyed, 51% identified menstruation as a trigger for attacks and 6% reported attacks solely with menstruation (i. e. attacks occurred during menstruation on at least 9 out of 10 occasions), the latter associated with a higher pain score than other attacks. Living with or being related to a migraineur decreased nonmigraineurs' ability to participate in home/family life (moderate/great impact 49%) and social/leisure activities (moderate/great impact 47%). In a tradeoff analysis, 60% of treatment choice was driven by formulation type and 40% was driven by speed of onset. As migraine disability increased, speed of onset became more important.

CONCLUSIONS

This study confirms the significant burden of migraine on patients and families/cohabitants, highlighting not only reduced productivity and absences from work/school, but also time missed from family/social occasions. Many women identify menstruation to be associated with more painful attacks. Overall, in terms of treatment choice, formulation type was a more important driver than speed of onset; however, as migrainerelated disability escalates, speed of onset becomes more important. To optimise migraine management, treatment choice should be based on individual patients' needs and preferences.

Randomized, placebo-controlled trial of rofecoxib in the acute treatment of migraine

OBJECTIVE

To investigate the clinical profile of rofecoxib, a long-acting (approximately 17-hour half-life) selective cyclo-oxygenase-2 inhibitor, for the acute treatment of migraine.

METHODS

A randomized, double-blind, placebo-controlled, parallel-group study was conducted. Patients age > or =18 treated a moderate or severe migraine headache with placebo (n = 182), rofecoxib 25 mg (n = 183), or rofecoxib 50 mg (n = 192). The primary efficacy measure was headache relief (mild or no pain) 2 hours after dose.

RESULTS

The proportions of patients with migraine headache relief at 2 hours after dose were 34.3% for placebo, 54.0% for rofecoxib 25 mg (p < 0.001 vs placebo), and 56.7% for rofecoxib 50 mg (p < 0.001 vs placebo). Rofecoxib 25 and 50 mg were superior to placebo in providing pain freedom at 2 hours, 24-hour sustained headache relief, and 24-hour sustained pain freedom; in reducing photophobia, phonophobia, nausea (50 mg only), and functional disability at 2 hours after dose; and in improving some quality-of-life scores over 24 hours. More patients on rofecoxib 50 mg reported adverse events (39.6%) than patients on rofecoxib 25 mg (26.8%) or placebo (23.6%) regardless of drug relatedness; however, the incidences of drug-related adverse events were similar between treatment groups. These adverse events were generally mild or moderate in severity. The most commonly reported adverse events were dry mouth, dizziness, somnolence, nausea, dyspepsia, paresthesia, and asthenia, with similar incidences between treatment groups.

CONCLUSION

Rofecoxib 25 and 50 mg were effective and generally well tolerated for the acute treatment of migraine attacks.

Migraine prevalence and treatment patterns: the global Migraine and Zolmitriptan Evaluation survey

OBJECTIVE

The objectives of the Migraine And Zolmitriptan Evaluation (MAZE) survey were to assess the prevalence of migraine in the general population across 5 different countries, to understand migraineurs' experience of migraine and its management on a global level, and to assess patient perceptions and preferences of current and future treatment formulations.

METHODS

A two-phase, international survey was performed in France, Germany, Italy, the UK, and the USA, and involved a total of 5553 adults. In Phase I, >/=1000 adults from the general population in each country were interviewed by telephone using a routine consumer survey. The proportion of subjects meeting International Headache Society (IHS) criteria for migraine was assessed using an adapted Kiel headache questionnaire, whereas the impact of migraine on daily life was assessed using the Migraine Disability Assessment Scale (MIDAS) questionnaire. In Phase II, >/=100 clinically diagnosed migraineurs per country were recruited through their general practitioners and migraine clinics. Semi-structured interviews based on written questionnaires assessed the impact of, and attitudes toward, migraine and its treatments. Respondents also completed the MIDAS questionnaire. Patients also sampled a demonstrator version of the new orange-flavored orally disintegrating tablet of zolmitriptan.

RESULTS

Phase I: An estimated 5% to 12% of the population in the different countries were classified as suffering from migraine, with most attacks categorized as fairly severe to very severe. Between 23% and 42% of migraineurs reported>24 attacks in the previous 12 months. Approximately one-half of all migraineurs did not seek medical advice. Of those who did consult a physician, only 3% to 19% were prescribed triptans. In all countries, the most commonly used current treatment was simple analgesics (22% to 54%). Phase II: Current migraine therapy was consistently effective in only 19% to 31% of patients, and only 21% to 50% of patients were satisfied with their current treatment. Many sufferers supplemented their prescription therapy with alternative management strategies, including herbal and homeopathic remedies, stress management, relaxation therapy, avoidance of trigger factors, and bed rest. Patients indicated that the most important attributes of migraine therapies are high efficacy and rapid pain relief. When asked to identify delivery options that they would like to see more of in the future, most patients (73%) specified "a dissolve-in-the-mouth tablet." Ninety percent of patients who sampled the demonstrator version of the zolmitriptan orally disintegrating tablet considered it to be "very easy" to use, and 99% stated it was suitable for use "anytime/anywhere."

CONCLUSIONS

In the general population samples we surveyed, there was a 5% to 12% prevalence of migraine across 5 different countries. As reported from previous epidemiologic studies, we found that many migraineurs still do not consult a physician. Despite high levels of disability, as assessed by MIDAS scores and evidenced by the need for bed rest during attacks, many migraineurs continue to treat their headaches with simple analgesics, which, if ineffective, leads to dissatisfaction with treatment. Patients desire a medication with high efficacy and a rapid onset of action, and an orally disintegrating tablet such as that used for the new zolmitriptan formulation, is a favored formulation and route of administration.

A review of urea and creatinine kinetics in predicting CAPD outcome

The adequacy of the peritoneal dialysis prescription is of great concern. Although the use of urea kinetics has become the standard in hemodialysis, its usefulness in peritoneal dialysis is unclear. It has been suggested that creatinine clearance may correlate with clinical outcome in CAPD but, as with urea kinetics, its predictive value is not established. The efficacy number (EN), which only requires a four hour exchange, was introduced as a simpler approach to creatinine kinetics. These three kinetic models were correlated to clinical outcome in 18 stable CAPD patients over a 12 month study period. The patients were divided into three groups: good (G), intermediate (I), and poor (P) based on uremic symptoms, mortality, hospital days, biochemical indices and the need for transfer to hemodialysis. Both forms of creatinine kinetics (weekly creatinine clearance, EN) were able to differentiate between the G, I, and P outcome groups (P < 0.05). The weekly uea Kt/V was able to differentiate between the G and P groups (P < 0.05) but not between the I and the other two outcome groups. Both urea and creatinine kinetics predict clinical outcome in CAPD. However, creatinine kinetics may be a more sensitive predictor. The efficacy number was just as sensitive as creatinine clearance in predicting clinical outcome yet simpler to gather the data for its calculation.

Hemorrhagic ovarian cyst detection by transvaginal sonography: the great imitator

The sonograms of 102 hemorrhagic ovarian cysts (HOC) were reviewed to ascertain the full spectrum of sonographic findings as visualized by transvaginal sonography (TVS). The diagnoses, in 11 cases, were proven by surgery and the rest have undergone conservative follow-up until resolution (clinically and sonographically). The accurate diagnosis of HOCs by transabdominal sonography is quite difficult. The appearance of these cysts as visualized by TVS is described. We advise TVS as a better means for identification of HOCs, thus decreasing the rate of diagnostic invasive procedures.

Metastatic brain tumor following negative second-look operation for ovarian carcinoma

Three patients with stage III ovarian cancer had brain metastases following aggressive chemotherapy with Platinol and Adriamycin, and negative second-look surgery. The possibility of brain metastasis following complete control of intraperitoneal ovarian disease should be considered in patients with neurological symptoms.

Successful surgical management of a severe case of starch peritonitis

A severe case of starch peritonitis is presented where surgical intervention and resection of the major granuloma abruptly improved the patient's condition. The theoretical basis of the syndrome and the treatment are discussed.

Immunofluorescent studies of the endometrial arteries in the first trimester of pregnancy

Endometrial spiral arteries from curetted endometrium of 110 first-trimester pregnancies were studied by immunofluorescent (IF) technics using antibodies against human G, M, and A immunoglobulins, C3, C4, and fibrinogen. Heavy deposition of C3 in the arterial walls was found in 16 (14.6%) cases. Immunoglobulins, C4, and fibrinogen were found in only a few cases, and their staining was weak and not considered in this study. There was also a statistically significant (P less than 0.01) higher deposition of C3 in arterial walls of primipara (14 of 52), as compared to multipara (2 of 58). The possible mechanisms of C3 deposition and the importance of the higher incidence of this deposition in primipara are discussed in relation to suggested immunologic pathogenetic alterations in preeclampsia.

Vascular changes of endometrium in early pregnancy

Spiral arteries, from curetted endometrium, of first-trimester pregnancies, were examined in 342 consecutive cases, comprising 150 primigravida and 192 multigravida . Vascular changes, similar to the "acute atherosis ," described at the end of pregnancy in preeclamptic women, were found. Primigravida had a statistically higher incidence of vascular changes than multigravida . The light microscopic changes were those of intimal proliferation with the presence of foam cells. These intimal cells were mostly myofibroblasts. Mucopolysaccharides also were found in the intima by both light microscopy and ultrastructural studies. The possible importance of the finding of vascular changes in spiral arteries in early pregnancy is discussed.

The ultrastructure of the interface between a glass ceramic and bone

The interface of alkali-poor glass ceramic implanted in femora of male Sprague-Dawley rats shows soft tissue, chondroid, osteoid, and bone in connection with the implant. The ultrastructure of the interface with soft tissue mainly exhibits a corrosion process, during which the dissolution of the crystalline phase of the glass ceramic precedes the dissolution of the glassy phase. Macrophages are involved in this process phagocytosing debris of the glassy phase and removing as well as dissolving the remainders of the glass ceramic. Under circumstances not yet fully understood, the corrosion stops, and ground substance like material is deposited, which can be, at least partially, mineralized. After the disappearance of macrophages, chondroblasts, and/or osteoblasts lay down collagen fibrils and ground substance in which matrix vesicles are discernible, representing initial foci of mineralization. Areas with bone connection display collagen fibers and deposits of apatite crystals in close relationship to the bulk glass ceramic as well as small particles mainly derived from the glassy phase of the implant, providing the micromorphological substrate for the shearing and tensile strength of the interface between glass ceramic and bone.

Primary mineralization and extracellular matrix vesicles in rat bone after administration of glass-ceramic implants

Glass-ceramic implants were administered into cavities prepared in rat femoral shaft. Electron microscope examination revealed formation of collagenous rich matrix in the implant-bone interface. Features typical to primary mineralization as well as bone and implant resorption were present in the interface. Primary mineralization was characterized by the occurrence of active forming cells, extracellular matrix vesicles and calcifying calcospheritic structures. Intensive primary mineralization in association with the implants indicates that glass-ceramic may be stimulative to ossification, allowing favorable tissue-implant relationship.