sFlt-1/PlGF for prediction of early-onset pre-eclampsia: STEPS (Study of Early Pre-eclampsia in Spain).

OBJECTIVE: A high ratio of soluble fms-like tyrosine kinase-1 (sFlt-1) to placental growth factor (PlGF) has been linked to pre-eclampsia (PE). We evaluated the sFlt-1/PlGF ratio as a predictive marker for early-onset PE in women at risk of PE. METHODS: This prospective, Spanish, multicenter study included pregnant women with a risk factor for PE, including intrauterine growth restriction, PE, eclampsia or hemolysis, elevated liver enzymes and low platelet count syndrome in previous pregnancy, pregestational diabetes or abnormal uterine artery Doppler. The primary objective was to show that the sFlt-1/PlGF ratio at 20, 24 and 28 weeks' gestation was predictive of early-onset PE (< 34 + 0 weeks). Serum sFlt-1 and PlGF were measured at 20, 24 and 28 weeks. Multivariate logistic regression was used to develop a predictive model. RESULTS: A total of 819 women were enrolled, of which 729 were suitable for analysis. Of these, 78 (10.7%) women developed PE (24 early onset and 54 late onset). Median sFlt-1/PlGF ratio at 20, 24 and 28 weeks was 6.3 (interquartile range (IQR), 4.1-9.3), 4.0 (IQR, 2.6-6.3) and 3.3 (IQR, 2.0-5.9), respectively, for women who did not develop PE (controls); 14.5 (IQR, 5.5-43.7), 18.4 (IQR, 8.2-57.9) and 51.9 (IQR, 11.5-145.6) for women with early-onset PE; and 6.7 (IQR, 4.6-9.9), 4.7 (IQR, 2.8-7.2) and 6.0 (IQR, 3.8-10.5) for women with late-onset PE. Compared with early-onset PE, the sFlt-1/PlGF ratio was significantly lower in controls (P < 0.001 at each timepoint) and in women with chronic hypertension (P < 0.001 at each timepoint), gestational hypertension (P < 0.001 at each timepoint) and late-onset PE (P < 0.001 at each timepoint). A prediction model for early-onset PE was developed, which included the sFlt-1/PlGF ratio plus mean arterial pressure, being parous and previous PE, with areas under the receiver-operating characteristics curves of 0.86 (95% CI, 0.77-0.95), 0.91 (95% CI, 0.85-0.97) and 0.93 (95% CI, 0.86-0.99) at 20, 24 and 28 weeks, respectively, and was superior to models using the sFlt-1/PlGF ratio alone or uterine artery mean pulsatility index. CONCLUSIONS: The sFlt-1/PlGF ratio can improve prediction of early-onset PE for women at risk of this condition. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

Mouthwashes with CPC Reduce the Infectivity of SARS-CoV-2 Variants In Vitro.

Oral mouthwashes decrease the infectivity of several respiratory viruses including SARS-CoV-2. However, the precise agents with antiviral activity in these oral rinses and their exact mechanism of action remain unknown. Here we show that cetylpyridinium chloride (CPC), a quaternary ammonium compound in many oral mouthwashes, reduces SARS-CoV-2 infectivity by inhibiting the viral fusion step with target cells after disrupting the integrity of the viral envelope. We also found that CPC-containing mouth rinses decreased more than a thousand times the infectivity of SARS-CoV-2 in vitro, while the corresponding vehicles had no effect. This activity was effective for different SARS-CoV-2 variants, including the B.1.1.7 or Alpha variant originally identified in United Kingdom, and in the presence of sterilized saliva. CPC-containing mouth rinses could therefore represent a cost-effective measure to reduce SARS-CoV-2 infectivity in saliva, aiding to reduce viral transmission from infected individuals regardless of the variants they are infected with.

Mycobacterium tuberculosis effects on fibroblast collagen metabolism.

BACKGROUND: Type I collagen synthesis and degradation are important events during Mycobacterium tuberculosis (MTb) granuloma or cavity formation, and fibroblasts are cells involved in these processes. OBJECTIVE: We examined the MTb effects on fibroblast collagen metabolism to understand the virulence factors involved in tuberculosis pathogenesis. METHODS: Human lung fibroblasts were incubated with culture medium or sonicated MTb H37Ra (avirulent) or H37Rv (virulent) strains. The effects on collagen synthesis, fibroblast proliferation and collagenase activity were examined. Matrix metalloproteinase-1 (MMP-1), MMP-13 and tissue inhibitors of metalloproteinases (TIMP-1) mRNA levels were analyzed by quantitative real-time PCR amplification. Protein expression was explored by Western blot technique. RESULTS: Collagen synthesis and fibroblast proliferation were significantly increased by H37Ra medium. In contrast, cells incubated with H37Rv medium showed an increase in collagenase activity. MMPs quantitative real-time PCR amplification revealed an increase on MMP-13 mRNA levels in fibroblasts cultured with H37Rv medium, with little effect observed on MMP-1 expression. Western blot assay demonstrated that H37Rv medium stimulated MMP-1 and MMP-13 proenzyme synthesis. This medium had a large effect on MMP-1 activation. TIMP-1 transcription was increased in cells incubated with medium and sonicated from H37Ra, although the highest TIMP-1 protein expression was found in fibroblasts cultured with sonicated H37Rv. CONCLUSIONS: These results suggest that MTb had direct effects on fibroblast collagen turnover, with differences in collagen synthesis and degradation depending on the strain.

Symptomatic subependymoma: report of four new cases studied with computed tomography and review of the literature.

The authors describe four cases of subependymoma studied with computed tomography (CT) and review 18 previously reported cases in an attempt to define the most characteristic CT presentation of this rare, benign tumor. Subependymoma usually appears as an isodense, or even hypodense, intraventricular tumor on plain CT scan and shows minimal or no enhancement in postcontrast studies. Differential diagnosis between subependymoma and the more malignant true ependymoma is difficult, particularly when the tumor occurs in the posterior fossa. Recognition of subependymoma should prompt the surgeon to attempt radical tumor removal because it can be achieved without sacrificing contiguous tissue and carries a good prognosis.

Bioavailability, biodistribution, and toxicity of BioZn-AAS(1): a new zinc source. comparative studies in rats.

Food fortification with a proper zinc compound is an economic and effective strategy to prevent zinc deficiency. BioZn-AAS, a zinc gluconate stabilized with glycine, was compared with zinc sulfate (reference standard), zinc hydroxide, and zinc gluconate, all of them labeled with (65)Zn. This preclinical study was performed on Sprague-Dawley rats of both sexes, and the administered dose was 85 microg/kg of zinc. Bioavailability studies showed that absorption of BioZn-AAS was not statistically different than absorption from other sources in female rats (25.65% +/- 2.20% for BioZn-AAS, 28.24% +/- 4. 60% for ZnSO(4), 24.91% +/- 4.02% for Zn[OH](2), and 25.51% +/- 2. 70% for Zn-gluconate). In the case of the male rats, absorption of BioZn-AAS (27.97% +/- 4.20%) was higher (P<0.05) than that from the other compounds (23.15% +/- 2.90% for ZnSO(4), 22.62% +/- 3.90% for Zn[OH](2), and 22.30% +/- 3.90% for Zn-gluconate). Biodistribution studies demonstrated that the zinc from BioZn-AAS followed the same metabolic pathway as zinc from the other sources. Toxicity studies were performed with 50 female and 50 male rats. The value of oral lethal dose 50 (LD(50)) was 2000 mg/kg for female rats and 1900 mg/kg for male rats. Therefore, we conclude that BioZn-AAS has adequate properties to be considered a proper zinc compound for food fortification or dietary supplementation.

Intracranial seeding from an intramedullary malignant astrocytoma.

The authors report a case of intracranial seeding from a spinal intramedullary astrocytoma. The possible mechanisms of seeding and the literature are reviewed.

Microencapsulated ferrous sulfate to fortify cow milk: absorption and distribution in mice.

To determine the absorption and biodistribution of iron from microencapsulated ferrous sulfate (SFE-171), used to fortify dairy products with iron, a comparative study in four groups of 30 mice each was carried out. In two of the groups, the absorption of iron from ferrous ascorbate in water (13.3 +/- 4.3%) and from ferrous sulfate in water (12.7 +/- 3.9%) was determined and taken as reference standards. In the third group the iron absorption from SFE-171 in milk was determined, giving a value of 12.1 +/- 4.2%, which statistically does not differ from the data obtained with either reference standard. In the fourth group, the absorption of iron from ferrous sulfate in milk showed a value of 7.7 +/- 3.4%, which statistically differs with a p < 0.01 from the data corresponding to the other three groups. The biodistribution studies showed that the iron from the SFE-171 follows the same metabolic pathway as the iron from the reference standards thus, giving a higher radioactivity percentage and radioactivity concentration in organs or systems, principally blood, that are closely related to iron metabolism. Our studies allow us to conclude that the iron from SFE-171 in milk follows the same behavior as the nonhemic iron, with a higher absorption than that of ferrous sulfate in milk.

Study of industrial microencapsulated ferrous sulfate by means of the prophylactic-preventive method to determine its bioavailability.

Radio-iron tests are frequently used to measure the bioavailability of different iron sources for food fortification. As the labeling procedures must be done under laboratory conditions, complementary studies should be carried out to evaluate the bioavailability of iron sources produced on an industrial scale. The iron bioavailability of SFE-171 (ferrous sulfate microencapsulated with phospholipids) was studied in previous reports using the compounds labeled with 59Fe and 55Fe; the results showed an iron bioavailability similar to that of ferrous sulfate. In the present work, the iron bioavailability of industrial SFE-171 was studied by the prophylactic-preventive method in rats using ferrous sulfate as the reference standard. Elemental iron powder was also studied by the same method for comparative purposes. The liver iron concentration of each animal was determined at the end of the experiment in order to evaluate the influence of each iron source on the liver iron stores. Relative biological values of 98 and 34% were found for SFE-171 and elemental iron powder, respectively, while the corresponding relative liver iron concentrations were 104 and 45%. The results provided by the prophylactic-preventive method show that the iron bioavailability of industrial SFE-171 is similar to that of ferrous sulfate; these results are also in agreement to those obtained with the radioactive compounds. We can conclude that the SFE-171 obtained by industrial procedures for massive use in iron food fortification has the same bioavailability as that of the SFE-171 produced and labeled under laboratory conditions.

Modification of the ferrozine technique to analyze iron contents in different foods: comparative study using an internal standard as reference methodology.

A methodology for the determination of iron in foods fortified with this element or in nutritional products is important and has to be sensitive and rapid. In developing countries, an inexpensive and reliable methodology is also required. For this purpose, the Gordon's Ferrozine technique was slightly modified and assayed with yogurt, dry powdered milk, and cereal mixtures, all of them fortified with iron, using an internal standard as the reference methodology. The obtained results demonstrate a close correlation between the standard curve interpolation method and the internal standard reference method (correlation coefficient r2 = 0.9950) in a wide range of concentrations. The slope (0.9998+/-0.0040) demonstrates that both procedures measure equal amounts of iron. The conclusion is that the proposed technique is a reliable, practical, and inexpensive methodology for iron determination in different foods fortified with iron.

[Gelatinous nutritional supplements: a useful alternative in dysphagia]. / Suplementos nutricionales gelatinizados: una alternativa válida para la disfagia.

The oropharingeal dysphagia is a very prevalent syndrome among the elderly, and even more among institutionalized individuals. Dysphagia is frequently caused by neurodegenerative and cerebrovascular conditions, the dementia syndrome being the most common of them, where the latest stages of the process are often accompanied by frequent swallowing problems requiring to incorporate thick foodstuffs in the diet of the elderly, such as the pudding. Nutritional supplements with a puddinglike consistency are not financed by the National Health System. Therefore, when they are needed, patients must either pay their full price for them or thicken the liquid supplements financed by the National Health System. This is normally done in an individualized way, through the powder thickeners in the market. It is a very laborious and highly changeable process regarding the resulting consistency, with a poor homogeneous aspect; thus, it is complicated to implement this method in big community dwelling. We hereby present a different way to use these financed supplements, this is: mixing them up with commercial jelly resulting in a refined product with a homogeneous texture. These supplements will remain stable in their composition and safe to be used within 5 days.

[Diffuse pulmonary meningotheliomatosis: an uncommon cause of the micronodular pattern]. / Meningoteliomatosis pulmonar difusa: causa infrecuente de patrón micronodular.

Pulmonary meningotheliomas are rare tumors that manifest as small nodules. They are most common in the sixth and seventh decades of life and are more common in women. Their cause is unknown and the imaging differential diagnosis should include other diseases that course with nodular patterns. Several authors have documented a statistically significant association between pulmonary meningotheliomatosis and diverse lung diseases, with adenocarcinoma of the lung being the most frequently associated disease. Very few cases of radiologically documented meningotheliomatosis have been reported. We present a case of a patient with a history of metachronous breast and rectal cancer. A micronodular pattern was observed in both lungs during CT examination to determine the extent of rectal cancer. The radiologic findings were initially interpreted as metastases and the definitive diagnosis of meningotheliomatosis was reached after lung biopsy.

[Urethral diverticulum. Complication in males with spinal cord lesions]. / Divertículo uretral. Complicación en varones con lesión medular.

We report on 4 spinal cord injury patients with urethral diverticulum from urethral lesions caused by urine collecting systems. We advocate one-stage surgical repair with the following precautions: treatment of the septic condition prior to surgery, puncture cystostomy, and closure of the surgical wound using methylene blue.

Male discomfort during the digital rectal examination: does examiner gender make a difference?

To determine if examiner gender affects men's perceived pain and embarrassment during an emergency department (ED) digital rectal examination, we prospectively studied male ED patients undergoing rectal examination. Each subject's perceived pain and embarrassment was gauged using 100 mm visual analog scales. Age, complaint, and examiner gender and training level were recorded. Two-tailed Mann-Whitney or Kruskal-Wallis tests examined significant differences among group mean pain and embarrassment scores. Of 126 subjects, 60 had female and 66 had male examiners. Mean pain scores were similar for patients of female (36.5 mm) and male (37.4 mm) examiners (95% CI -9.8 to 11.5, P = .73). Mean embarrassment scores were similar for female (36.6 mm) and for male (32.9 mm) examiners (95% CI -7.9 to 15.3, P = .67). Younger male patients experienced more pain and embarrassment (P < .027). Examiner training level and prostatic examination did not affect the score.

Outcome in children with severe head injuries.

We present a series of 56 children who suffered severe head injuries, with a Glasgow Coma Score (GCS) of less than 8. The cases were classified according to the type of morphologic lesion on computed tomography (CT) scan. Intracranial pressure (ICP) was monitored in all children in this series. A protocol that included artificial ventilation and other measures of treatment for intracranial hypertension was applied. Results were analyzed according to age, type of lesion, and ICP. The usefulness of the ICP recording and of obtaining a correct classification of lesions using the CT scan is emphasized.

Kikuchi-Fujimoto necrotizing lymphadenitis associated with cutaneous lupus erythematosus: a case report.

Histiocytic necrotizing lymphadenitis or Kikuchi-Fujimoto disease is a rare entity, and even more rarely, it is associated with other diseases. In a few cases, the condition is associated with cutaneous lupus erythematosus (CLE). Histiocytic necrotizing lymphadenitis predominantly affects young women, who present with solitary or multiple cervical lymphadenopathy accompanied by symptoms such as fever, weight loss, sweating, or, in exceptional cases, hepatosplenomegaly. Laboratory examinations show normal or nonspecific results. The disease is of unknown origin, although a viral origin has been suggested, with the suspected agents including Epstein-Barr virus, herpesvirus type 6, and cytomegalovirus (CMV). Although the first and most of the more recent cases have been reported in Oriental patients, the disease has a wide geographic distribution. The clinical evolution is favorable, with spontaneous remission in less than 4 months in almost all cases. We present a case of a 37-year-old woman from Peru who presented with cervical adenopathies on two occasions. Biopsy of a lymph node revealed a histopathologic picture compatible with Kikuchi-Fujimoto histiocytic necrotizing lymphadenitis. The adenopathy disappeared in a few months. A year later, she presented with a maculopapular rash in the nasal and malar regions. The results of the skin biopsy and immunofluorescence examination were compatible with chronic CLE. The results of the serology testing for CMV were positive. Treatment with chloroquine was initiated, with almost complete recovery by 5 months. No manifestations of systemic lupus erythematosus have occurred since. The epidemiologic, clinical, and anatomopathologic aspects as well as the differential diagnosis of this entity are reviewed.