The prognostic value of ductal plate malformation and other histologic parameters in biliary atresia: an immunohistochemical study

Ductal plate malformation, a term given to intrahepatic bile ducts that retain the fetal configuration, is observed in some cases of biliary atresia. We examined 21 livers from patients with biliary atresia; ductal plate malformation occurred in 38% of cases, and its presence was predictive of poor clinical outcome (P =.04).

Rules for clinical diagnosis in babies with ambiguous genitalia

Intersex disorders are rare and complex; yet, in each case of genital ambiguity, accurate and expeditious management is required of the clinician. This article reviews the embryology of sexual differentiation, from which some 'rules' of diagnosis are derived. A simplified approach to the interpretation of clinical signs in ambiguous genitalia is presented and discussed.

Childhood temporal bone osteoblastoma: a case report

Osteoblastoma is a rare primary tumor of the bone. Its sites of predilection are the vertebrae and the long bones. Occurrence in the skull is rare. The authors describe an unusual case of osteoblastoma occurring in the temporal bone of a child. Interestingly, although the clinical and radiological features were suggestive of an aggressive lesion, the histological features were consistent with that of a benign tumor. Although generally regarded as benign, osteoblastoma has potential for recurrence, local invasion, and, rarely, malignant transformation. As such, complete resection, whenever possible, is preferred over conventional curettage.

Cystic hepatic mesenchymal hamartoma: the role of radiology in diagnosis and perioperative management

A 13-month-old male presented with large hepatic mass that was confirmed diagnostically to be a cystic hepatic mesenchymal hamartoma. The sieve-like appearance of the solid components of the mass, as seen at ultrasonography, and findings of dynamic post-contrast MRI are highlighted here. Beyond diagnostic imaging, we extended our role in patient management through ultrasound-guided intra-operative aspiration of fluid from the cystic components of the tumour to reduce its volume and thereby facilitate surgical resection.

Lethal comorbidity with genital anomaly in the infant

OBJECTIVE

Genital anomaly (GA) carries a risk of life-threatening comorbidity which is not well defined and is under reported. We aimed to determine the associated anomalies in children with GA who died.

MATERIALS AND METHODS

We retrospectively reviewed the deaths among all GA patients presenting to our institution over 32 years (1970-2001). Seventy children with exstrophy/epispadias were excluded, leaving 200 patients, of whom 26 had died. Hospital and postmortem records were examined for biographical data, karyotype, morphological anomalies and causes of death.

RESULTS

Sixty-eight out of 200 patients had congenital adrenal hyperplasia (CAH), with two deaths, from cardiomyopathy and encephalitis. Of the 132 non-CAH patients, 24 (17%) died. Sixteen deaths were in the non-CAH intersex group of patients with GA. There were eight deaths in the non-intersex genital anomaly group, which included five with a cloacal anomaly (+/- VATER association). Fifteen had major cardiac anomalies and 10 had facial dysmorphism suggesting a syndrome. Two infants died of renal failure with Denys-Drash syndrome.

CONCLUSIONS

Infants with a non-CAH intersex GA have a high risk of mortality, particularly from an associated cardiac anomaly. This mortality may decrease in the future with cardiac surgical advances. There is a significant mortality in infants with non-intersex GA (anorectal malformations and cloacal anomalies) also due to complex cardiac and/or renal anomalies. Major chromosomal aberrations and facial dysmorphism were noted in some patients in both study groups. GA associated with testicular dysgenesis and/or imperforate anus requires screening for cardiac defects, chromosomal anomalies and dysmorphology syndromes.

A Comparison of an Australian Observational Longitudinal Alzheimer's Disease Cohort to Community-Based Australian Data

Background

Observational Alzheimer's disease (AD) cohorts including the Australian, Biomarkers, Imaging and Lifestyle (AIBL) Study have enhanced our understanding of AD. The generalizability of findings from AIBL to the general population has yet to be studied.

Objective

We aimed to compare characteristics of people with AD dementia in AIBL to 1) the general population of older Australians using pharmacological treatment for AD dementia, and to 2) the general population of older Australians who self-reported a diagnosis of dementia.

Methods

Descriptive study comparing people aged 65 years of over (1) in AIBL that had a diagnosis of AD dementia, (2) dispensed with pharmacological treatment for AD in Australia in 2021 linked to the Australian census in 2021 (refer to as PBS/census), (3) self-reported a diagnosis of dementia in the 2021 Australian census (refer to as dementia/census). Baseline characteristics included age, sex, highest education attainment, primary language, and medical co-morbidities.

Results

Participants in AIBL were younger, had more years of education, and had a lower culturally and linguistically diverse (CALD) population compared to the PBS/census cohort and dementia/census cohort (mean age±standard deviation - AIBL 79±7 years, PBS/census 81±7, p < 0.001, dementia/census 83±8, p < 0.001; greater than 12 years of education AIBL 40%, PBS/census 35%, p = 0.020, dementia/census 29%, p < 0.001; CALD - AIBL 3%, PBS/census 20%, p < 0.001, dementia/census 22%, p < 0.001).

Conclusions

Our findings suggest that care should be taken regarding the generalizability of AIBL in CALD populations and the interpretation of results on the natural history of AD.

How Can We Use Mathematical Modeling of Amyloid-β in Alzheimer's Disease Research and Clinical Practices?

The accumulation of amyloid-β (Aβ) plaques in the brain is considered a hallmark of Alzheimer's disease (AD). Mathematical modeling, capable of predicting the motion and accumulation of Aβ, has obtained increasing interest as a potential alternative to aid the diagnosis of AD and predict disease prognosis. These mathematical models have provided insights into the pathogenesis and progression of AD that are difficult to obtain through experimental studies alone. Mathematical modeling can also simulate the effects of therapeutics on brain Aβ levels, thereby holding potential for drug efficacy simulation and the optimization of personalized treatment approaches. In this review, we provide an overview of the mathematical models that have been used to simulate brain levels of Aβ (oligomers, protofibrils, and/or plaques). We classify the models into five categories: the general ordinary differential equation models, the general partial differential equation models, the network models, the linear optimal ordinary differential equation models, and the modified partial differential equation models (i.e., Smoluchowski equation models). The assumptions, advantages and limitations of these models are discussed. Given the popularity of using the Smoluchowski equation models to simulate brain levels of Aβ, our review summarizes the history and major advancements in these models (e.g., their application to predict the onset of AD and their combined use with network models). This review is intended to bring mathematical modeling to the attention of more scientists and clinical researchers working on AD to promote cross-disciplinary research.

Exploring the association between cancer and cognitive impairment in the Australian Imaging Biomarkers and Lifestyle (AIBL) study

An inverse association between cancer and Alzheimer's disease (AD) has been demonstrated; however, the association between cancer and mild cognitive impairment (MCI), and the association between cancer and cognitive decline are yet to be clarified. The AIBL dataset was used to address these knowledge gaps. The crude and adjusted odds ratios for MCI/AD and cognitive decline were compared between participants with/without cancer (referred to as C+ and C- participants). A 37% reduction in odds for AD was observed in C+ participants compared to C- participants after adjusting for all confounders. The overall risk for MCI and AD in C+ participants was reduced by 27% and 31%, respectively. The odds of cognitive decline from MCI to AD was reduced by 59% in C+ participants after adjusting for all confounders. The risk of cognitive decline from MCI to AD was halved in C+ participants. The estimated mean change in Clinical Dementia Rating-Sum of boxes (CDR-SOB) score per year was 0.23 units/year higher in C- participants than in C+ participants. Overall, an inverse association between cancer and MCI/AD was observed in AIBL, which is in line with previous reports. Importantly, an inverse association between cancer and cognitive decline has also been identified.

Intestinal atresia of co-twin after spontaneous cessation of blood flow through an acardiac twin

A 33-year-old woman was diagnosed at 15 weeks gestation with a twin pregnancy complicated by an acardiac acephalic foetus. The patient opted for expectant management with close foetal surveillance. Serial ultrasonography showed polyhydramnios at 22 weeks gestation. However, subsequent scans over the next two weeks showed cessation of blood flow in the acardiac foetus, decreasing size of the foetal mass, as well as gradual resolution of the polyhydramnios. Subsequent follow-up was rather uneventful and she underwent an uncomplicated elective caesarean section at 35 weeks, resulting in a healthy 2,820 g girl. The baby was found to have intestinal atresia at birth. She underwent surgery successfully and was well when discharged. The possible causes and pathophysiology of intestinal atresia are discussed.

Basic Science and Pathogenesis

BACKGROUND

Mounting evidence support the involvement of adaptive immune system in the pathogenesis of Alzheimer's disease (AD). The current study investigated the age-dependent changes in the abundance of B and T cell subtypes in APP/PS1 mice, a commonly used model for AD.

METHOD

Peripheral blood was collected through cardiac puncture from 6-, 9-, 12-month-old APP/PS1 transgenic (TG) mice (APPsw+ and PSEN1dE9+, n = 8-12) and their wildtype (WT) littermates (C57BL/6J, n = 12-15). Flow cytometry (BD FACSCalibur™) was employed to quantify B and T lymphocytes and their subtypes. Surface markers such as CD19, Gl7, CD93, CD3, CD4, CD8 and CD25 were used for identifying early and activated B cells, as well as helper T cells, cytotoxic T cells and regulatory T cells, respectively.

RESULT

A 3-fold increase in the abundance of early B cells were observed in 6-month-old TG mice compared to WT, while their abundance decreased (42.4% P = 0.0106, and 46.2% P = 0.0431) in 9- and 12-month-old TG mice compared to WT. The abundance of activated B cells was significantly decreased in 6-, 9-, and 12-month-old TG mice compared to WT (54.3% P = 0.0499, 36.7% P = 0.0071, 45.6% P = 0.0082). A significant reduction in helper T cells (10.6%, P = 0.0056) was observed only in 6-month-old TG mice compared to WT. The abundance of cytotoxic T cells was found increase in 9- and 12-month-old TG mice compared to WT (1.25-fold P = 0.0001, 1.20-fold P = 0.0252, respectively). A significant decrease in regulatory T cells (34.5% P = 0.048) was noted in TG mice compared to WT at 12-month-old but not at earlier age.

CONCLUSION

The study on APP/PS1 mice revealed an age-dependent alteration in the abundance of B and T cell subtypes, supporting the involvement of adaptive immune system in AD. Future studies could address how these changes are related to AD pathological changes and confirm these changes in human blood samples.

Exploring the link between comorbidities and Alzheimer's dementia in the Australian Imaging, Biomarker & Lifestyle (AIBL) study

INTRODUCTION

Mounting evidence suggests that certain comorbidities may influence the clinical evolution of Alzheimer's dementia (AD).

METHODS

We conducted logistic regression analyses on the medical history and cognitive health diagnoses of participants in the Australian Imaging, Biomarker & Lifestyle study (n = 2443) to investigate cross-sectional associations between various comorbidities and mild cognitive impairment (MCI)/AD.

RESULTS

A mixture of associations were observed. Higher comorbidity of anxiety and other neurological disorders was associated with higher odds of AD, while arthritis, cancer, gastric complaints, high cholesterol, joint replacement, visual defect, kidney and liver disease were associated with lower odds of AD.

DISCUSSION

This study underscores the links between specific comorbidities and MCI/AD. Further research is needed to elucidate the longitudinal comorbidity-MCI/AD associations and underlying mechanisms of these associations.

Highlights

Comorbidities that significantly increased AD odds included anxiety and other neurological disorders.Arthritis, cancer, gastric complaints, high cholesterol, joint replacement, visual defect, kidney and liver disease were associated with lower odds of AD.Alcohol consumption had the most significant confounding effect in the study.Visual-AD association was modified by age, sex, and APOE ε4 allele status.Anxiety-AD and depression-AD associations were modified by sex.

Isolated fallopian tube torsion in prepubertal females

Isolated fallopian tube torsion is an uncommon diagnosis. It is particularly rare in the paediatric and post-menopausal age groups. It lacks pathognomonic symptoms, signs and imaging findings, yet each of these diagnostic steps plays a crucial role in early diagnosis. We describe two cases of isolated fallopian tube torsion in prepubertal females.

Swallowed foreign bodies in children: report of four unusual cases

INTRODUCTION

Although a majority of ingested foreign bodies (FBs) pass down the gastrointestinal tract spontaneously, those that are sharp, pointed or large in size need removal to avert serious complications. We highlight the urgent need and utility of endoscopic accessories and technical artistry in safe retrieval of FBs in children.

CLINICAL PICTURE

Four children had accidentally swallowed a nail, metallic dumbbell, open safety pin and a cushion pin respectively. They were symptom-free and the abdominal plain radiographs revealed foreign body in the stomach in all the cases.

TREATMENT

Oesophago-gastro-duodenoscopy (OGD) was done in all the patients and could retrieve the nail, metallic dumbbell and open safety pin successfully using a Dormia basket, a polypectomy snare and a pair of rat-tooth forceps respectively. The cushion pin had migrated to the duodeno-jejunal junction within 4 hours of ingestion and necessitated open duodenotomy and retrieval.

OUTCOME

All patients did well after the procedure with no complications.

CONCLUSIONS

Swallowed FBs with pointed or sharp ends or large enough to cross the pylorus and duodenal sweep need removal and in the majority of the cases they can be retrieved by OGD. Sharp or pointed FBs that have crossed the second part of the duodenum necessitate urgent laparotomy for retrieval to prevent complications.

Polyunsaturated fatty acids-induced ferroptosis suppresses pancreatic cancer growth

Despite recent advances in science and medical technology, pancreatic cancer remains associated with high mortality rates due to aggressive growth and no early clinical sign as well as the unique resistance to anti-cancer chemotherapy. Current numerous investigations have suggested that ferroptosis, which is a programed cell death driven by lipid oxidation, is an attractive therapeutic in different tumor types including pancreatic cancer. Here, we first demonstrated that linoleic acid (LA) and α-linolenic acid (αLA) induced cell death with necroptotic morphological change in MIA-Paca2 and Suit 2 cell lines. LA and αLA increased lipid peroxidation and phosphorylation of RIP3 and MLKL in pancreatic cancers, which were negated by ferroptosis inhibitor, ferrostatin-1, restoring back to BSA control levels. Similarly, intraperitoneal administration of LA and αLA suppresses the growth of subcutaneously transplanted Suit-2 cells and ameliorated the decreased survival rate of tumor bearing mice, while co-administration of ferrostatin-1 with LA and αLA negated the anti-cancer effect. We also demonstrated that LA and αLA partially showed ferroptotic effects on the gemcitabine-resistant-PK cells, although its effect was exerted late compared to treatment on normal-PK cells. In addition, the trial to validate the importance of double bonds in PUFAs in ferroptosis revealed that AA and EPA had a marked effect of ferroptosis on pancreatic cancer cells, but DHA showed mild suppression of cancer proliferation. Furthermore, treatment in other tumor cell lines revealed different sensitivity of PUFA-induced ferroptosis; e.g., EPA induced a ferroptotic effect on colorectal adenocarcinoma, but LA or αLA did not. Collectively, these data suggest that PUFAs can have a potential to exert an anti-cancer effect via ferroptosis in both normal and gemcitabine-resistant pancreatic cancer.

Swallowed Foreign Bodies in Children: Report of Four Unusual Cases

Introduction: Although a majority of ingested foreign bodies (FBs) pass down the gastrointestinal tract spontaneously, those that are sharp, pointed or large in size need removal to avert serious complications. We highlight the urgent need and utility of endoscopic accessories and technical artistry in safe retrieval of FBs in children. Clinical Picture: Four children had accidentally swallowed a nail, metallic dumbbell, open safety pin and a cushion pin respectively. They were symptom-free and the abdominal plain radiographs revealed foreign body in the stomach in all the cases. Treatment: Oesophago-gastro-duodenoscopy (OGD) was done in all the patients and could retrieve the nail, metallic dumbbell and open safety pin successfully using a Dormia basket, a polypectomy snare and a pair of rat-tooth forceps respectively. The cushion pin had migrated to the duodeno-jejunal junction within 4 hours of ingestion and necessitated open duodenotomy and retrieval. Outcome: All patients did well after the procedure with no complications. Conclusions: Swallowed FBs with pointed or sharp ends or large enough to cross the pylorus and duodenal sweep need removal and in the majority of the cases they can be retrieved by OGD. Sharp or pointed FBs that have crossed the second part of the duodenum necessitate urgent laparotomy for retrieval to prevent complications. Key words: Complications, Ingestion, Treatment