Immune Responses of Healthy Pregnant Women following an Elective Cesarean Section: Effects of Anesthetic Procedures

A weakened immune system and more inflammatory cytokines being released are possible effects of the surgical stress that a cesarean section induces. This kind of reaction, in addition to the altered reaction to catecholamines, has the potential to significantly affect the immune system of the mother and the patients' general postoperative course. This prospective study compared the plasma levels of catecholamines and cytokines in healthy pregnant patients having cesarean sections under spinal anesthesia versus general anesthesia. A total of 30 pregnant women undergoing elective cesarean sections were divided into two groups: 15 who received general anesthesia (GA) and 15 who received spinal anesthesia (SA). Blood samples were collected from all subjects before anesthesia induction (pre-OP), 6 h postoperatively (6 h post-OP), and 12 h (12 h post-OP), to measure levels of tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), IL-8, IL-4, IL-10, norepinephrine (NE), and epinephrine (EPI). When we compared the two groups, we discovered that only IL-6 and IL-4 had significantly higher levels pre-OP, whereas all studied cytokines exhibited an increase in the GA versus SA group at 6 and 12 h post-OP. In the case of catecholamines, we discovered that serum levels are positively related with pro-inflammatory or anti-inflammatory cytokines, depending on the time of day and type of anesthetic drugs. Compared to SA, GA has a more consistent effect on the inflammatory response and catecholamine levels. The findings of this study confirm that the type of anesthesia can alter postoperative immunomodulation to various degrees via changes in cytokine and catecholamine production. SA could be a preferable choice for cesarean section because it is an anesthetic method that reduces perioperative stress and allows for less opioid administration, impacting cytokine production with proper immunomodulation.

Retrospective Study of a Patient with Multiple de Novo Skin Tumor Formations

In Romania, the incidence of malignant melanocytic tumors is continuously increasing. According to the World Health Organization, the incidence of melanocytic and non-melanocytic skin neoplasms has increased considerably and globally, in the last decade. We present the case of a 49-year-old patient who, over the course of 7 years, came in the Plastic Surgery Clinic of the Emergency County Hospital of Craiova for the excision of a number of 25 skin tumor formations, located on the face, cervical region, trunk and upper limbs. Treatment included complete microsurgical excision and supervision. In the end, the patient's treatment compliance decreased significantly.

Potassium carbonate-mediated β-selective anomeric O-alkylation with primary electrophiles: Application to the synthesis of glycosphingolipids

Stereoselective construction of a variety of β-glycosides can be achieved using abundant and inexpensive K₂CO₃-mediated stereoselective anomeric O-alkylation of sugar lactols with primary electrophiles. In addition, application of this methodology to the synthesis of various azido-modified glycosphingolipids has been accomplished in good yields and excellent anomeric selectivity using sphingosine-derived primary triflate.

Analysis of the relationship between placental histopathological aspects of preterm and term birth

OBJECTIVES

This study aims to establish a correlation between placental histopathological and immunohistochemical (IHC) changes and preterm birth with fetal growth restriction (FGR, formerly called intrauterine growth restriction - IUGR).

PATIENTS, MATERIALS, AND METHODS

This prospective study was performed on a group of 30 parturients, with singleton gestation, of which 15 patients gave birth at term, and the other 15 patients gave birth prematurely. After the statistical correlation of the clinical and demographic data with premature birth (PB) and term birth (TB), we performed histological and IHC research on the respective placentae. To observe normal and pathological microscopic placental structures, we used the Hematoxylin-Eosin (HE) and Periodic Acid Schiff-Hematoxylin (PAS-H) classical stainings, but also special immunostaining with anti-cluster of differentiation 34 (CD34) and anti-vascular endothelial growth factor (VEGF) antibodies.

RESULTS

We found a statistically significant difference between the TB∕PB categories and the age of the patients, their antepartum weight, the weight of the newborns, and the placenta according to the sex of the newborn. Histological analysis revealed in the case of TB, small areas of perivillous amyloid deposition, with the significant extension of these areas both intravillous and perivillous in the case of PB. Massive intravillous calcifications, syncytial knots, and intravillous vascular thrombosis were also frequently present in PB. With PAS-H staining were highlighted the intra∕extravillous vascular basement membranes, but especially the massive fibrin deposits rich in glycosaminoglycans. By the IHC technique with the anti-CD34 antibody, we noticed the numerical vascular density, higher in the case of TB, but in the case of PB, there were large areas of placental infarction, with a lack of immunostaining in these areas. Through the anti-VEGF antibody, we observed the presence of signal proteins that determined and stimulated the formation of neoformation vessels in the areas affected by the lack of post-infarction placental vascularization. We observed a highly significant difference between placental vascular density between TB∕PB and newborn weight, sex, or placental weight.

CONCLUSIONS

Any direct proportional link between the clinical maternal-fetal and histological elements yet studied must be considered. Thus, establishing an antepartum risk group can prevent a poor pregnancy outcome.

Artificial Intelligence for Modeling Complex Systems: Taming the Complexity of Expert Models to Improve Decision Making

Major societal and environmental challenges involve complex systems that have diverse multi-scale interacting processes. Consider, for example, how droughts and water reserves affect crop production and how agriculture and industrial needs affect water quality and availability. Preventive measures, such as delaying planting dates and adopting new agricultural practices in response to changing weather patterns, can reduce the damage caused by natural processes. Understanding how these natural and human processes affect one another allows forecasting the effects of undesirable situations and study interventions to take preventive measures. For many of these processes, there are expert models that incorporate state-of-the-art theories and knowledge to quantify a system's response to a diversity of conditions. A major challenge for efficient modeling is the diversity of modeling approaches across disciplines and the wide variety of data sources available only in formats that require complex conversions. Using expert models for particular problems requires integration of models with third-party data as well as integration of models across disciplines. Modelers face significant heterogeneity that requires resolving semantic, spatiotemporal, and execution mismatches, which are largely done by hand today and may take more than 2 years of effort.

We are developing a modeling framework that uses artificial intelligence (AI) techniques to reduce modeling effort while ensuring utility for decision making. Our work to date makes several innovative contributions: (1) an intelligent user interface that guides analysts to frame their modeling problem and assists them by suggesting relevant choices and automating steps along the way; (2) semantic metadata for models, including their modeling variables and constraints, that ensures model relevance and proper use for a given decision-making problem; and (3) semantic representations of datasets in terms of modeling variables that enable automated data selection and data transformations. This framework is implemented in the MINT (Model INTegration) framework, and currently includes data and models to analyze the interactions between natural and human systems involving climate, water availability, agricultural production, and markets. Our work to date demonstrates the utility of AI techniques to accelerate modeling to support decision-making and uncovers several challenging directions for future work.

OSA treatment with CPAP: Randomized crossover study comparing tolerance and efficacy with and without humidification by ThermoSmart

OBJECTIVES

Adherence to continuous positive airway pressure (CPAP) remains an issue, as adverse effects (AE) such as rhinitis, dry/congested nose, dry mouth or throat are commonly experienced. The aim of the study was to compare CPAP efficacy and tolerance in severe obstructive sleep apnea (OSA) patients with or without (w/o) heated humidification using the ThermoSmart system.

METHODS

Multicenter RCT study in which CPAP-naive patients with severe OSA and meeting one or more of the following criteria: >65 years, using >1 drying medication, previous nasal symptoms or nasal surgery, were included. Patients were randomized to CPAP w/o heated humidification for 1 month and then crossed-over to the other treatment arm for another month. Naso-pharyngeal symptoms, Quality of life (FOSQ-10), sleepiness (ESS) and CPAP compliance and efficacy data were collected.

RESULTS

Forty patients were enrolled: age 62 ± 9 years, diagnostic AHI 46.7 ± 15.3/hour. About 70% were using >1 drying medication, mainly antihypertensives. Both treatment modalities were found to normalize AHI and decrease sleepiness with no differences between 2 modes, compliance (4.63 ± 0.39 vs 4.70 ± 0.36 h/night) or leaks (32.4 ± 2.0 versus 31.1 ± 1.7l/min). With heated humidification, there was a significant decrease in nasal symptoms such as dry/congested nose. At the study end, 26 patients preferred ThermoSmart ON, 3 did not have preference and 11 preferred ThermoSmart OFF.

CONCLUSION

ThermoSmart helps to decrease nose and throat discomfort because of CPAP therapy, these effects did not translate to better compliance but patients had a preference for ThermoSmart.

Pathological fractures of humerus in children. Therapeutic and pathological considerations

INTRODUCTION

A pathological fracture appears after a low-energy trauma or minor trauma on bones with a modified histological structure; sometimes, the patient reports shoulder pain antedating the fracture. The most common benign bone tumors that cause pathological fractures in children are simple bone cysts, aneurysmal bone cysts, non-ossifying fibromas and fibrous dysplasia. This type of bone tumors is usually asymptomatic until they reach a large size and cause a pathological fracture after minor trauma. The optimal treatment remains controversial. Our objective was to describe our modern treatment strategies of the large benign osseous tumors of the humerus complicated by pathological humerus fractures and histological aspects in these cases.

PATIENTS, MATERIALS AND METHODS

The study was prospective and included patients who were diagnosed with pathological humeral fractures, which required surgically orthopedic treatment. We selected three cases of pathological fractures of humerus in children each with its particularities, treated in the Department of Pediatric Surgery and Orthopedics, Emergency County Hospital, Arad, Romania. Treatment included curettage of the cyst, sampling for histopathological (HP) examination, bone substitution and titanium elastic nails (TEN) osteosynthesis.

RESULTS

No complications and no recurrence were seen in the early postoperative period.

CONCLUSIONS

Osteosynthesis with TEN and bone substitution is a viable option for treatment of pathological fracture of humerus, secondary to the osseous benign tumors, which required surgically treatment, despite the different HP aspects. By using a combined treatment in these cases, we eliminate the disadvantages of isolated use of the described techniques in the literature.

Elastostatic reversibility in thermally formed bulk metallic glasses: nanobeam diffraction fluctuation electron microscopy

The unparalleled shaping ability of bulk metallic glasses can revolutionize commercial products having multi-length scale features with a processing time of several minutes. Despite the widespread shaping ability of these polymer-like multicomponent alloys, thermoplastic forming (TPF) can severely degrade the intrinsic properties, particularly when complex stress states are activated. The present work emphasizes the importance of elastostatic loading (ESL) which not only fully reverses deteriorated room temperature plasticity originating under TPF or post-cryostatic conditions, but also activates a rejuvenation mechanism by rendering an extended resistance against strain softening. Furthermore, the reduction in the supercooled liquid region and crystallization enthalpy measured by differential scanning calorimetry are found to be temporary, and can be fully reversed to the initial condition. HRTEM imaging of the samples are performed with an imaging spherical aberration corrector. Individual nanobeam diffraction patterns obtained by the fluctuation electron microscopy (FEM) measurements are acquired using a scanning transmission electron microscope with a probe size of 1.2 nm from a 10 × 10 raster, yielding 100 diffraction patterns. The normalized variance of a series of nanodiffraction patterns of the post-elastostatically loaded sample reveals a height decrease in the first broad peak of normalized intensity variance V(k) suggesting modifications in the medium-range structural order which in turn dramatically restores the mechanical and thermal properties. Overall, the combination of TPF and post-ESL treatment in advanced glassy metals can open a new avenue for ultra-high mechanical and thermal performance micro- and nanomechanical devices for biosensors, MOSFETs and robotics.

Atomic-Level Processes of Shear Band Nucleation in Metallic Glasses

The ability to control the plastic deformation of amorphous metals is based on the capacity to influence the percolation of the shear transformation zones (STZs). Despite the recent research progress, the mechanism of STZ self-assembly has so far remained elusive. Here, we identify the structural perturbation generated by an STZ in the surrounding material and show how such a perturbation triggers the activation of the neighboring STZ. The mechanism is based on the autocatalytic generation of successive strong strain and rotation fields, leading to STZ percolation and, ultimately, to the formation of a shear band.

A randomized controlled trial to validate the Alice PDX ambulatory device

BACKGROUND

Obstructive sleep apnea (OSA) is a highly prevalent condition; however, the majority of patients remain undiagnosed. There is a potential to expand the diagnostic capacity of sleep laboratories. The study objective was to validate a portable respiratory monitoring device (Alice PDX) against polysomnography (PSG) in the laboratory and to assess its reliability at home.

METHODS

A total of 85 patients with suspected OSA (80% male, mean age 49.1±13.5 years, body mass index 29.7±6.9 kg/m², Epworth Sleepiness Scale 10.0±5.1) were randomized to 3 diagnostic nights: 1 night simultaneous in-laboratory PSG and PDX recording; 1 night self-applied PDX at home, and 1 night in-laboratory PSG. Study data were manually scored according to American Academy of Sleep Medicine criteria.

RESULTS

The Alice PDX was in diagnostic agreement with simultaneously recorded reference PSG in 96.4% of studies. In 2.4% of studies the in-laboratory PDX underestimated and in 1.2% of studies it overestimated the apnea hypopnea index (AHI). The difference between the AHI from the reference PSG and the home study was similar to the difference between the PSGs (2.79 vs 0.79, p=0.08).

CONCLUSION

In a population with a high suspicion of OSA, the Alice PDX showed a high level of diagnostic agreement with a simultaneous PSG and performed valid home diagnostic studies for OSA. If manually scored, the portable device can be used by sleep specialists for diagnosing moderate-to-severe obstructive sleep apnea in cases with a high pretest probability for the disease over a wide range of disease severity. The technology can be deployed reliably outside of the sleep laboratory setting.

Brittle-to-Ductile Transition in Metallic Glass Nanowires

When reducing the size of metallic glass samples down to the nanoscale regime, experimental studies on the plasticity under uniaxial tension show a wide range of failure modes ranging from brittle to ductile ones. Simulations on the deformation behavior of nanoscaled metallic glasses report an unusual extended strain softening and are not able to reproduce the brittle-like fracture deformation as found in experiments. Using large-scale molecular dynamics simulations we provide an atomistic understanding of the deformation mechanisms of metallic glass nanowires and differentiate the extrinsic size effects and aspect ratio contribution to plasticity. A model for predicting the critical nanowire aspect ratio for the ductile-to-brittle transition is developed. Furthermore, the structure of brittle nanowires can be tuned to a softer phase characterized by a defective short-range order and an excess free volume upon systematic structural rejuvenation, leading to enhanced tensile ductility. The presented results shed light on the fundamental deformation mechanisms of nanoscaled metallic glasses and demarcate ductile and catastrophic failure.

Low Young's modulus Ti-based porous bulk glassy alloy without cytotoxic elements

A new a biocompatible Ti42Zr40Ta3Si15 (atomic %) porous bulk glassy alloy was produced by combination of rapid solidification and powder metallurgy techniques. Amorphous alloy ribbons were fabricated by melt spinning, i.e. extremely fast quenching the molten alloy with 10(6)K/s from T=1973K down to room temperature. The ribbons were then cryo-milled at liquid nitrogen temperature in order to produce powder, which was subsequently hot pressed. The resulting thick pellets have a porosity of about 14vol%, a high compression strength of 337MPa and a Young's modulus of about E=52GPa, values very close to those characteristic of cortical bone. Moreover, the morphology of the samples is very similar to that of cortical bone. The biocompatibility, which is due to the absence of any toxic element in the chemical composition, together with the suitable mechanical behavior, make these samples promising for orthopedic and dentistry applications.

STATEMENT OF SIGNIFICANCE

Ti-based alloys are nowadays the standard solution for biomedical implants. However, both the conventional crystalline and amorphous alloys have higher rigidity as the human bone, leading to the damage of the bone at the interface, and contains harmful elements like vanadium, aluminum, nickel or beryllium. The hierarchical porous structures based on glassy alloys with biocompatible elements is a much better alternative. This work presents for the first time the manufacturing of such porous bodies starting from Ti-based amorphous alloy ribbons, which contains only non-harmful elements. The morphology and the compressive mechanical properties of these new products are analyzed in regard with those characteristic to the cortical bone.

Obstructive Sleep Apnoea Modulates Airway Inflammation and Remodelling in Severe Asthma

Background

Obstructive sleep apnoea (OSA) is frequently observed in severe asthma but the causal link between the 2 diseases remains hypothetical. The role of OSA-related systemic and airway neutrophilic inflammation in asthma bronchial inflammation or remodelling has been rarely investigated. The aim of this study was to compare hallmarks of inflammation in induced sputum and features of airway remodelling in bronchial biopsies from adult patients with severe asthma with and without OSA.

Materials and Methods

An overnight polygraphy was performed in 55 patients referred for difficult-to-treat asthma, who complained of nocturnal respiratory symptoms, poor sleep quality or fatigue. We compared sputum analysis, reticular basement membrane (RBM) thickness, smooth muscle area, vascular density and inflammatory cell infiltration in bronchial biopsies.

Results

In total, 27/55 patients (49%) had OSA diagnosed by overnight polygraphy. Despite a moderate increase in apnoea-hypopnoea index (AHI; 14.2±1.6 event/h [5–35]), the proportion of sputum neutrophils was higher and that of macrophages lower in OSA than non-OSA patients, with higher levels of interleukin 8 and matrix metalloproteinase 9. The RBM was significantly thinner in OSA than non-OSA patients (5.8±0.4 vs. 7.8±0.4 μm, p<0.05). RBM thickness and OSA severity assessed by the AHI were negatively correlated (rho = -0.65, p<0.05). OSA and non-OSA patients did not differ in age, sex, BMI, lung function, asthma control findings or treatment.

Conclusion

Mild OSA in patients with severe asthma is associated with increased proportion of neutrophils in sputum and changes in airway remodelling.

Therapeutic management of massive subcutaneous emphysema, bilateral pneumothorax and pneumomediastinum after anterior cordectomy for in situ vocal cord carcinoma - case report

We present the case of a 70 year-old smoker patient, who was admitted in hospital for removal of a tumour located on the left vocal cord. After direct suspension laryngoscopy (with tumorbiopsy sampling), preliminary histopathological exam revealed an in situ carcinoma. At 2 weeks after histopathological confirmation, the left vocal cord was removed by anterior approach, under general anesthesia. In the first 24 hours after surgery, the patient presented an ischaemic stroke, with a deep coma and left hemiplegia, which necessitated mechanical ventilation and specific neurological treatment. Under mechanical ventilation, the patient developed massive subcutaneous emphysema, bilateral pneumothorax and pneumomediastinum,which required tracheostomy and bilateralpleural drainage, in order to limit suddenly installed respiratory insufficiency. After an 18-day interval of intensive care therapy,the patient was released at home, considered to be surgically cured and had a moderate remaining left brachial monoplegia,which was almost totally cured in the next six months.

Gastrointestinal stromal tumor, jejunal atresia and stenosis in a neonate

Gastrointestinal stromal tumors could rise in different areas of the digestive tract, at any age, but very rarely in neonates. We present the case of a 5-day-old male, with intestinal stenosis and atresia (type II) operated for peritonitis. On the resected specimen, the histopathological examination revealed a small gastrointestinal tumor of 8 mm. The immunohistochemical analysis indicated a low malignant potential. He is currently at two years of oncologic follow-up with no evidence of disease.

Site-specific protein labelling and immobilization mediated by microbial transglutaminase

Microbial transglutaminase (mTG) mediates site-specific propargylation of target proteins, allowing their subsequent modification in in vitro bio-conjugation applications.

Using the galactomannan antigen assay in the diagnosis of invasive aspergillosis after hematopoietic stem cell transplantation

Invasive aspergillosis (IA) is the most common life-threatening infections after hematopoietic stem cell transplant (HSCT). The serum galactomannan (GM) is recognized as an indirect mycological criteria for an early diagnosis of IA. Starting January 2011, we implementing in Fundeni Clinical Institute, Bucharest, for the first time in Romania, the detection of GM antigen (Platelia Aspergillus EIA, Bio-Rad). In 2011, patients undergoing HSCT were screened with the galactomannan ELISA; we performed a retrospective chart review of 162 SCT patients who underwent galactomannan testing. Thirteen of the patients (8.02%) had at least one positive galactomannan ELISA, and four had multiple positive tests. When calculated in reference to a proved or probable diagnosis of aspergillosis, the galactomannan ELISA had a sensitivity of 0.857 and a specificity of 0.913. The positive predictive value was 0.46, and the negative predictive value was 0.993. The Platelia Aspergillus galactomannan antigenemia assay may assist physicians in making an early diagnosis of IA, in correlation with clinical and radiological criteria. The test has a high sensitivity and specificity and a very good negative predictive value. We found the screening of GM ELISA to be a highly specific diagnostic tool in detecting IA manifested in patients undergoing HSCT.

Left ventricle remodelling is associated with sleep-disordered breathing in non-ischaemic cardiopathy with systolic dysfunction

Sleep-disordered breathing (SDB) is associated with left ventricle (LV) remodelling in patients with normal LV function. Sleep-disordered breathing is common in chronic heart failure (CHF) with systolic LV dysfunction, and may contribute to LV remodelling and CHF progression. Our aim was to determine the consequence of SDB on LV geometry in patients with CHF. We hypothesised that SDB severity was correlated with the degree of LV hypertrophy (LVH). One-hundred and sixty patients with CHF with a non-ischaemic systolic LV dysfunction were assessed by overnight polygraphy and echocardiography. Patients were classified in four groups according to their apnoea-hypopnoea index (AHI): <5 (no-SDB); 5-14 (mild); 15-29 (moderate); ≥30 (severe). Left ventricular mass index (LVM Ind) was calculated using the usual echocardiographic M-Mode parameters. Their mean age, New York Heart Association and left ventricular ejection fraction were, respectively: 56 ± 13 years, 2.4 ± 0.8 and 30 ± 10%, and 77% were men. Body mass index, interventricular septal and posterior LV wall thicknesses, and LVM Ind were significantly increased in severe SDB versus no-SDB. LVM Ind was correlated to the AHI (R = 0.27, P = 0.0006) and, using logistic regression, AHI was the unique independent factor of LVH in this population. In non-ischaemic CHF, SDB severity is associated with LV remodelling.

The arthroscopy-histological criterion link in the result's estimation of the endoscopic treatment by resection of the knee's meniscus lesions

The authors present the results of a statistical, clinical, imaging X-ray and optical microscopic studies of some lesions of knee's meniscus, the arthroscopy allowing this structure's biopsy during the endoscopic procedures of resection. These histological criterions are very important estimation factors of long-term results of these techniques, often the microstructure looking different to the appearing normal macroscopic aspect.

On the atomic structure of Zr60Cu20Fe20 metallic glass

The structure of Zr(60)Cu(20)Fe(20) metallic glass has been studied with high-energy x-ray diffraction, neutron diffraction and extended x-ray absorption spectroscopy and modelled with the reverse Monte Carlo simulation technique. It is found that Cu and Fe atoms prefer Zr as a nearest neighbour. The mean interatomic distance between Cu/Fe and Zr atoms in the glass is remarkably shorter than the sum of the respective atomic radii. The coordination numbers for Cu/Fe-Cu/Fe pairs are very close to each other, suggesting a regular distribution of Cu and Fe atoms in the Zr(60)Cu(20)Fe(20) metallic glass.

[Alternatives to allogenous blood transfusion]

Blood transfusion is usually meant to lower morbidity and mortality rates. Allogenous blood transfusion implies certain risks that can be avoided by autologous blood transfusions techniques including: preoperatory autologous blood donation, acute normovolemic hemodilution, intraoperatory and postoperatory blood salvage. Preoperatory blood donation and acute normovolemic hemodilution are used for planned interventions with an estimated blood loss higher than 20% of blood volume. These methods imply Erythropoietin and iron treatment. Intraoperatory and postoperatory blood salvage is performed by personnel trained in blood donation, handling and storage. Autologous blood transfusions are used for certain surgical procedures that commonly require transfusions: orthopedic surgery, radical prostatectomy, cardiovascular surgery, organ transplantation. An alternative to allogenous blood transfusion is the use of artificial oxygen transporters: human or animal hemoglobin solutions or pefluorocarbonate solutions. These solutions do not require cross reactions, do not carry diseases and are generally well tolerated and easily stored in the operating room, ambulance and other transport means. They have however a slight degree of toxicity.