GUIDANCE TO THE MATERNAL, FETAL AND NEONATAL MANAGEMENT OF RESISTANCE GRAVE'S DISEASE IN PREGNANCY.

Resistant Graves' disease in pregnancy is a rare entity. The clinical situation poses immense difficulty to the treating endocrinologist and obstetrician in optimizing maternal and fetal heath. No guidelines till date are available to manage resistant Grave's disease in pregnancy. We hereby present a case series on resistant Grave's in pregnancy and our institute experience in managing this rare and challenging clinical entity. Definitive management is total thyroidectomy in second trimester. Higher doses of ATDs and betablockers may have its fetopathic effects. Use of immunosuppressive agents are not advised in pregnancy to suppress the TRAb titre. Steroid therapy may be used as an adjuvant to permissible doses of anti-thyroid medications to curb the thyrotoxicosis in pregnancy. An alternate fetal friendly ATD is not available to add on to existing ATDs. TRAb estimation in maternal blood is mandatory. Mothers need frequent monitoring of cardiac status and need to avoid factors that can cause cardiac decompensation. Fetal surveillance includes growth monitoring and biophysical profile at nearby intervals, helps to ascertain the effects of excess thyroid hormones, TRAb and anti-thyroid drugs. Immediate neonatal cord blood screening for thyroid abnormalities is necessary. Maternal and fetal management in such a clinical situation is multidisciplinary.

Nanoscale surface photovoltage of organic semiconductors with two pass Kelvin probe microscopy.

Kelvin probe microscopy implemented with controlled sample illumination is used to study nanoscale surface photovoltage effects. With this objective a two trace method, where each scanning line is measured with and without external illumination, is proposed. This methodology allows a direct comparison of the contact potential images acquired in darkness and under illumination and, therefore, the surface photovoltage is simply inferred. Combined with an appropriate data analysis, the temporal and spatial evolution of reversible and irreversible photo-induced processes can be obtained. The potential and versatility of this technique is applied to MEH-PPV thin films. Photo-physical phenomena such as the mesoscale polymer electronic light-induced response as well as the local nanoscale electro-optical properties are studied.

AFM imaging and analysis of electrostatic double layer forces on single DNA molecules.

Electrical double layer (EDL) forces develop between charged surfaces immersed in an electrolyte solution. Biological material surrounded by its physiological medium constitutes a case where these forces play a major role. Specifically, this work is focused on the study of the EDL force exerted by DNA molecules, a standard reference for the study of single biomolecules of nanometer size. The molecules deposited on plane substrates have been characterized by means of the atomic force microscope operated in the force spectroscopy imaging mode. Force spectroscopy imaging provides images of the topography of the DNA molecules, and of the EDL force spectrum. Due to the size of the molecule being much smaller than that of the tip, both the tip-substrate and tip-molecule interactions need to be considered in the analysis of the experimental results. We solve this problem by linearly superposing the two contributions. EDL force images are presented where DNA molecules are clearly resolved. The lateral resolution of the EDL force is discussed and compared with that of the topography. The method also allows the estimation of the DNA surface charge density, thereby obtaining reasonable values.

Properties of metallic nanowires: from conductance quantization to localization.

Material structures of reduced dimensions exhibit electrical and mechanical properties different from those in the bulk. Measurements of room-temperature electronic transport in pulled metallic nanowires are presented, demonstrating that the conductance characteristics depend on the length, lateral dimensions, state and degree of disorder, and elongation mechanism of the wire. Conductance during the elongation of short wires (length l approximately 50 angstroms) exhibits periodic quantization steps with characteristic dips, correlating with the order-disorder states of layers of atoms in the wire predicted by molecular dynamics simulations. The resistance R of wires as long as l approximately 400 angstroms exhibits localization characteristics with In R(l) approximately l(2).

[Results of the percutaneous retrograde embolization as the first choice in the treatment of varicocele]. / Resultados de la embolización retrógrada percutánea como primera opción en el tratamiento del varicocele.

There is evidence that early varicocele treatment decreases testicular damage. The minimally invasive techniques such as laparoscopic varicocelectomy, antegrade sclerotherapy and percutaneous retrograde embolisation, are acquiring greater significance in the treatment of this disease. Since 1994, a series of 51 children, aged 7-16 years (mean, 12.9 years), with left-sided varicocele grades 2 (47%) and 3 (53%) were treated in our institution by percutaneous retrograde embolisation using coils. The right basilica vein was the most widely used (70%) followed by the right femoral vein. Seven children (13.7%) had complications: perforation of internal spermatic vein was the most frequent and treated conservatively. No child presented hydrocele after radiological procedures. Embolisation was accomplished succesfully at the first attempt in 35 (68.6%) of the 51 children and in 45 (88.2%) after a second embolisation. The follow-up ranges from 7 months to 5 ? years (mean, 1.8 years). The patients were monitored with clinical and doppler ultrasound examination 3, 6 and 12 months after the treatment. Retrograde embolisation is a safe and efficient minimally invasive treatment for correcting varicoceles in children. We performed retrograde embolisation as first choice of varicocele treatment in children; a second embolisation or conventional surgery for primary failure or late recurrence should be considered.

Jumping mode AFM imaging of biomolecules in the repulsive electrical double layer.

We present a method to image single biomolecules in aqueous media by atomic force microscope (AFM) without establishing any mechanical contact between the tip and the sample. It works by placing the feedback set point in the repulsive electrical double-layer curve just before the mechanical instability occurs. We use the jumping operation mode, where the set point is controlled at every image point and a stable imaging is achieved for several hours. This is a necessary condition for this method to be operative, otherwise the tip can fall in contact in a short time. The method is applied to image single-avidin protein molecules deposited on cleaved mica. In addition, the dependence of the height of avidin molecules as a function of ion concentration, due to differences in surface charge density of mica and avidin, is tentatively used to deduce relative values of these quantities.

WSXM: a software for scanning probe microscopy and a tool for nanotechnology.

In this work we briefly describe the most relevant features of WSXM, a freeware scanning probe microscopy software based on MS-Windows. The article is structured in three different sections: The introduction is a perspective on the importance of software on scanning probe microscopy. The second section is devoted to describe the general structure of the application; in this section the capabilities of WSXM to read third party files are stressed. Finally, a detailed discussion of some relevant procedures of the software is carried out.

Robotic stereotactic treatment for malignant metastasis of solid tumour in the pancreas: A multiple case report and review of literature.

Metastatic involvement of the pancreas occurs in 5% of patients affected by advanced malignancies. Surgical resection has been reported by number of authors as a valuable option to improve disease control, in particular in patients with limited disease burden and favourable histotypes; however, the benefit of this procedure has been questioned due to patient selection, technical challenges and relevant risk of perioperative mortality and severe complications. In the present study, a cohort of surgically unfit patients affected by a solitary metastasis in the pancreas from various primary tumours received stereotactic radiotherapy with an ablative dose schedule, obtaining promising local and distant disease progression-free delay with minor toxicity. This is the first report to our knowledge on the use of ablative stereotactic radiotherapy of metastasis in the pancreatic gland.

The release of soluble VAP-1/SSAO by 3T3-L1 adipocytes is stimulated by isoproterenol and low concentrations of TNFalpha.

Plasma level of the protein VAP-1/SSAO (Vascular Adhesion Protein-1/Semicarbazide-Sensitive Amine Oxidase) is increased in diabetes and/or obesity and may be related to vascular complications associated to these pathologies. The aim of this work was to complete a preceding study where we described the role played by some hormones or metabolites, implicated in diabetes and/or obesity, in the regulation of the release of VAP-1/SSAO by 3T3-L1 adipocytes. Here we focused on the previously observed effect produced by TNFalpha in the release of VAP-1/SSAO and studied the effect of a beta-adrenergic compound, isoproterenol. Both compounds stimulated the release of VAP-1/SSAO to the culture medium but had a different effect on the VAP-1/SSAO membrane form. While TNFalpha produced a decrease on VAP-1/SSAO membrane form content, isoproterenol did not modify it. We thus observed two different ways of regulation of the release of VAP-1/SSAO by 3T3-L1 adipocytes by metabolites implicated in diabetes and adipose tissue physiopathology. Our work permits a better understanding of this increased plasma VAP-1/SSAO levels observed in diabetes.

Analysis by atomic force microscopy of Med8 binding to cis-acting regulatory elements of the SUC2 and HXK2 genes of saccharomyces cerevisiae.

Med8 protein is a regulator that specifically binds to upstream activating sequences (UASs) of SUC2 promoter, to downstream repressing sequences (DRSs) of the HXK2 gene and to the carboxy-terminal domain of the RNA polymerase II. Atomic force microscopy has allowed for direct visualization of Med8 interactions with a 305 bp fragment of SUC2 promoter and with a 676 bp fragment of HXK2 gene, containing respectively the UASs and DRSs regulatory regions. This approach has provided complementary information about the position and the structure of the DNA-protein complexes. Med8 binding to DNA results in total covering of one of the two existing 7 bp motives (consensus, (A/C)(A/G)GAAAT) in the studied DNA fragments. No preference for binding either of the two UASs of SUC2 promoter as well as for the two DRSs of HXK2 gene has been found. We also discuss whether this protein works as dimer or as a monomer.

Characterization of surface roughness in titanium dental implants measured with scanning tunnelling microscopy at atmospheric pressure.

Characterization of the surface topography of implant materials is important for understanding tissue response. We have measured, for the first time, the topography of titanium surfaces used in osseointegrated dental implants. Scanning tunnelling microscopy (STM) which provides 3D real space images was used. In addition to clinical samples, electropolished and anodically oxidized surfaces were also measured. Clinical samples are rather inhomogeneous in character showing grooves and steps with a maximum depth of 0.11 micron. Micropores with an average diameter of about 30 nm are also present. Electropolished samples are rather homogeneous and very smooth, showing steps of 1 to 5 nm in height. The measurements were performed under atmospheric conditions at a resolution in the subnanometer range.

Speciation in Vanadium Bioinorganic Systems. 2. An NMR, ESR, and Potentiometric Study of the Aqueous H(+)-Vanadate-Maltol System.

A systematic study of the physiologically interesting vanadium-maltol (V-MaH) system has been performed in 0.150 M Na(Cl) at 25 degrees C, using NMR, ESR, and potentiometric techniques. Complexation occurs within a wide pH range, from around 1 up to 10.5. However, a pH-, concentration-, and time-dependent spontaneous reduction of vanadium(V) to vanadium(IV) occurs. From ESR spectra the conditions for this reduction are evaluated and discussed. From potentiometric (glass electrode) and quantitative (51)V NMR measurements, the full speciation in the H(+)-H(2)VO(4)(-)-MaH system was determined in the pH range 5-10.5. Data were evaluated with the computer program LAKE, which is able to treat combined emf and NMR data. The pK(a) value for MaH was determined to be 8.437 +/- 0.005. In the ternary system, three complexes are formed: VMa(2)(-), VMa(-), and VMa(2)(-), having log beta(0,1,2) = 7.02 +/- 0.03, log beta(0,1,1) = 2.66 +/- 0.05, and log beta(-)(1,1,1) = -7.37 +/- 0.21. The errors given are 3sigma. The VMa(2)(-) complex appears as the main species in a pH range from 4.5 to 8.5, whereas both mononuclear monoligand species are minor. Equilibrium conditions are illustrated in distribution diagrams, and the structures of the complexes formed are proposed.

DNA height in scanning force microscopy.

The measured height of DNA molecules adsorbed on a mica substrate by scanning probe microscopy is always less than the theoretical diameter. In this paper we show that, when imaged in ambient conditions, the molecules are usually immersed in the salt layer used to adsorb them to the substrate. This layer distorts the measurement of DNA height and is the main source of error but not the only one. We have performed different experiments to study this problem using two scanning force techniques: non-contact tapping mode in air and jumping mode in aqueous solution, where the dehydration phenomena is minimized. Height measurements of DNA in air using tapping mode reveal a height of 0.7+/-0.2nm. This value increases up to 1.5+/-0.2nm when the salt layer, in which the molecules are embedded, is removed. Jumping experiments in water give a value of 1.4+/-0.3nm when the maximum applied force is 300pN and 1.8+/-0.2nm at very low forces, which confirms the removal of the salt layer. Still, in all our experiments, the measured height of the DNA is less than the theoretical value. Our results show that although the salt layer present is important, some sample deformation due to either the loading force of the tip or the interaction with the substrate is also present.

Macroscopic water deposits on polycrystalline gold measured by scanning force microscopy.

Data of water adsorption on polycrystalline gold show the formation of a multilayer film of several nanometers with the increase of relative humidity. We have measured this adsorption process by scanning force microscopy in both dynamic and jumping modes. We find interesting differences in the adsorption of water on the terraces and at grain boundaries. Measurements of adhesion force are also reported.

Interaction forces and conduction properties between multi wall carbon nanotube tips and Au(111).

We have studied the interaction forces and electrical conduction properties arising between multiwall carbon nanotube tips and the Au(111) surface in air, by means of amplitude modulation scanning force microscopy, also called intermittent contact. We have centered our work on tips with metallic electronic structure and for the specific parameters used we have found a preliminary interaction range where there is no contact between tip and surface. Stable imaging in this non-contact range is possible with multiwall carbon nanotube tips. These tips have also been used to obtain simultaneous topographic and current maps of the surface. They show excellent properties as tips due to their high aspect ratio and durability, as a result of their elastic and non-reactive properties. Correspondingly, multiwall carbon nanotube tips allow high resolution local analysis of electrical conductivity on a nanometer scale.

Atomic force microscopy contact, tapping, and jumping modes for imaging biological samples in liquids.

The capabilities of the atomic force microscope for imaging biomolecules under physiological conditions has been systematically investigated. Contact, dynamic, and jumping modes have been applied to four different biological systems: DNA, purple membrane, Alzheimer paired helical filaments, and the bacteriophage phi29. These samples have been selected to cover a wide variety of biological systems in terms of sizes and substrate contact area, which make them very appropriate for the type of comparative studies carried out in the present work. Although dynamic mode atomic force microscopy is clearly the best choice for imaging soft samples in air, in liquids there is not a leading technique. In liquids, the most appropriate imaging mode depends on the sample characteristics and preparation methods. Contact or dynamic modes are the best choices for imaging molecular assemblies arranged as crystals such as the purple membrane. In this case, the advantage of image acquisition speed predominates over the disadvantage of high lateral or normal force. For imaging individual macromolecules, which are weakly bonded to the substrate, lateral and normal forces are the relevant factors, and hence the jumping mode, an imaging mode which minimizes lateral and normal forces, is preferable to other imaging modes.

[Mesenteric ischemia: update of new diagnostic techniques for an old disease, and review of radiological signs]. / Isquemia mesentérica: actualización de nuevas técnicas diagnósticas para una vieja enfermedad y revisión de signos radiológicos.

Acute arterial mesenteric ischemia is a medical emergency associated with a high rate of mortality (> 60%). A diagnostic delay may lead to disease progression, thus it is important to recognize this condition as early as possible. The development of imaging techniques, such as multidetector computed tomography (MDCT) allows an early diagnosis to be made as it detects typical radiographic signs such as, the presence of a thrombus within the superior mesenteric artery (SMA), pneumatosis in bowel loops, and air in the interior of the superior mesenteric and portal veins. It is important to know of these new imaging techniques applications and the typical radiographic signs of this disease as it is an emergency which, if confirmed, could lead to performing urgent surgery to prevent progression to intestinal necrosis and a possible fatal outcome.