Measurement of T1ρ dispersion with compressed sensing and magnetization prepared radial balanced steady-state free precession in spontaneous human osteoarthritis.

PURPOSE: To assess the potential for accelerating continuous-wave (CW) T1ρ dispersion measurement with compressed sensing approach via studying the effect that the data reduction has on the ability to detect differences between intact and degenerated articular cartilage with different spin-lock amplitudes and to assess quantitative bias due to acceleration. METHODS: Osteochondral plugs (n = 27, 4 mm diameter) from femur (n = 14) and tibia (n = 13) regions from human cadaver knee joints were obtained from commercial biobank (Science Care, USA) under Ethical permission 134/2015. MRI of specimens was performed at 9.4T with magnetization prepared radial balanced SSFP (bSSFP) readout sequence, and the CWT1ρ relaxation time maps were computed from the measured data. The relaxation time maps were evaluated in the cartilage zones for different acceleration factors. For reference, Osteoarthritis Research Society International (OARSI) grading and biomechanical measurements were performed and correlated with the MRI findings. RESULTS: Four-fold acceleration of CWT1ρ dispersion measurement by compressed sensing approach was feasible without meaningful loss in the sensitivity to osteoarthritic (OA) changes within the articular cartilage. Differences were significant between intact and OA groups in the superficial and transitional zones, and CWT1ρ correlated moderately with the reference measurements (0.3 < r < 0.7). CONCLUSION: CWT1ρ was able to differentiate between intact and OA cartilage even with four-fold acceleration. This indicates that acceleration of CWT1ρ dispersion measurement by compressed sensing approach is feasible with negligible loss in the sensitivity to osteoarthritic changes in articular cartilage.

A five year retrospective study on Syphilis in the Sexual Transmitted Disease Centre (STDC) of the teaching Hospital Umberto I in Rome.

OBJECTIVES: A retrospective study describing syphilis epidemiological and clinical features in patients referring to an infectious diseases centre in Rome, Italy. METHODS: Between January 2011 and December 2015 demographic, behavioral and clinical data were collected from all adult patients attending the Sexually Transmitted Diseases Centre of the Teaching Hospital Umberto I in Rome. RESULTS: Overall 723 patients, 495 males and 228 females, with syphilis infection diagnosis were included. Average age 39.6 ± 13.6 years (median 38) was higher in men than women (41.1 ± 13.6 vs. 36.3 ± 13.1; p<0.001). Patients were from Italy (486 or 67.2%), EU (90 or 12.4%), rest of Europe (38 or 5.3 %), Americas (46 or 6.4%), Africa (36 or 5.0%) and Asia (27 or 3.7%). One-hundred-twenty-three (17.0%) presented primary syphilis, 43 (5.9%) secondary syphilis, 8 (1.1%) tertiary syphilis, 246 (34.0%) serological syphilis, 80 (11.1%) preceding syphilis, 56 (7.7%) gravidic syphilis and 167 (23.1%) came to the Sexually Transmitted Diseases Centre to control a preceding syphilis treatment. Fifty-six (24.6%) women were diagnosed with syphilis during their pregnancies. Among Chinese female patients, those pregnant represented 87.5%. There were 100 subjects (13.8%) simultaneously HIV+ and 623 (86.2%) HIV- patients. HIV co-infection affected more frequently men (RR 5.30; CI 2.62 - 10.72; p<0.001). In males HIV co-infection affected more frequently homosexuals (RR 11.72; CI 6.72 - 20.45; p<0.001). Overall HIV co-infection affected more frequently foreign patients, specially from the Americas (26.1%), Africa (25.7%) and Asia (22.2%). CONCLUSION: A serious problem of "gravidic syphilis" suggests the need for Public Health preventive action. Also an early diagnosis of both syphilis and HIV infection should be reinforced.

HMGCR and ApoE mutations may cause different responses to lipid lowering statin therapy.

Coronary artery disease (CAD) and its complications are the major causes of death in the world. Although statins have been used to lower lipid levels in CAD patients, this goal can not be attained in 1/3 of the patients. The objective of this study was to investigate whether common variations in HMG-CoA Reductase(HMGCR) and Apolipoprotein E (ApoE) genes involved in lipid and statin metabolism modify the effect of statins on serum lipid and lipoprotein concentrations in CAD patients.A hundred  CAD patients were enrolled into the study. At the beginning of the study biochemical measurements were performed to determine the baseline levels performed. Patients were treated with 40 mg atorvastatin for 2 months and biochemical measurements were repeated. According to the post-treatment, LDL-c levels,  patients were divided into 2 groups as non-responders and responders, respectively. The information regarding the risk factors such as smoking, alcohol consumption etc. were also obtained. DNA was isolated from peripheral blood. The presence of rs17244841 ve rs17238540 mutations in HMGCR and ε2, ε3 and ε4 variants of ApoE were determined by using RT-PCR. Results were evaluated statistically. HMGCR mutatations were mostly found in responders and ε4 variant of ApoE was mostly found in non-responders. It was also found that presence of HMGCR mutations causes a significant reduction in total cholesterol and LDL-c levels. Also presence of ε2 variant of ApoE causes a statistically significant increase in trigliseride levels. Our findings should be investigated with other researchers to clarify the mechanism.

Clinical, angiographic and procedural characteristics of longitudinal stent deformation.

Recently, longitudinal stent deformation (LSD) has been reported increasingly. Even though the reported cases included almost all stent designs, most cases were seen in the Element™ stent design (Boston Scientific, Natick, MA, USA). It is considered that stent design, lesion and procedural characteristics play a role in the etiology of LSD. Yet, the effect of LSD on long-term clinical outcomes has not been studied well. Element stents implanted between January 2013 and April 2015 in our hospital were examined retrospectively. Patients were grouped into two according to the presence of LSD, and their clinical, lesion and procedural characteristics were studied. Twenty-four LSD's were detected in 1812 Element stents deployed in 1314 patients (1.83 % of PCI cases and 1.32 % of all Element stents). LMCA lesions (16.7 % vs 1.6 %, p < 0.001), complex lesions (75 % vs 35.1 %, p < 0.001), bifurcation lesions (37.5 % vs 18.3 %, p = 0.017), ostial lesions (33.3 % vs 12.8 %, p = 0.003), using of extra-support guiding catheter (54.2 % vs 22.3 %, p < 0.001) and extra-support guidewire (37.5 % vs 16.2 %, p = 0.005) were found to be more frequent in cases with LSD than in cases without it. In addition, the number of stents, stent inflation pressure and the use of post-dilatation were significantly different between the two groups. Two patients had an adverse event during the follow-up period. LSD is a rarely encountered complication, and is more common in complex lesions such as ostial, bifurcation and LMCA lesions. The use of extra-support guiding catheter, extra-support guidewires and low stent inflation pressure increases the occurrence of LSD. Nevertheless, with increased awareness of LSD and proper treatment, unwanted long-term outcomes can be successfully prevented.

Investigation of short- and long-term effects of ovarian hyperstimulation syndrome on ovarian reserve: an experimental study.

PURPOSE: To investigate the short and long-term effects of ovarian hyperstimulation syndrome (OHSS) on serum levels of vascular endothelial growth factor (VEGF) and endothelin-1 and ovarian follicular reserve (OFR). MATERIALS AND METHODS: An experimental case-control study was conducted on a university animal laboratory with 20 immature (22-day-old) virgin female Wistar Albino rats. Firstly, rats were divided into two groups. Group 1 (n = 10): control and Group 2 (n = 10): experimental OHSS induced rats. Secondly, Group 2 was randomly divided into two groups on the day of OHSS development (27th day) as follows: Group 3 (n = 5): 27-day-old OHSS induced rats and Group 4 (n = 5): 27-day-old OHSS induced rats supervised for seven days. Group 1 was divided into two groups to constitute age-matched controls as follows: Group 5 (n = 5): 27-day-old rats, Group 6 (n = 5): 35-day-old rats. The comparisons of Group 3 vs Group 5 and Group 4 vs Group 6 were performed. Main outcome measures were OFR, serum levels of VEGF, and endothelin-1. RESULTS: While the OFR and primordial follicle number (PFN) of Group 3 were significantly lower than those of Group 5 (p < 0.05); VEGF and endothelin-1 levels and atretic follicle number (AFN) were significantly higher in Group 3 compared to Group 5 (p < 0.05). In Group 4, PFN was significantly lower (p < 0.05) and AFN was significantly (p < 0.05) higher than Group 6. However, there were no statistically significant difference between Group 4 and Group 6 regarding the parameters of OFR, serum levels of VEGF, and endothelin-1. CONCLUSION: This experimental OHSS model revealed increased serum VEGF and endothelin-1 levels and decreased OFR during short-term of OHSS. OHSS showed detrimental effect on PFN of rats during long-term.

Retrieval of a malpositioned left subclavian artery stent from the ascending aorta: combined percutaneous and surgical management.

Chronic upper limb ischemia is an uncommon clinical condition and is most often caused by subclavian artery stenosis. Surgical and percutaneous treatment modalities have been shown to be effective for the management of subclavian artery occlusion. Because of lower mortality and morbidity rates, percutaneous interventions for subclavian arterial occlusions are more acceptable than surgery. Chronic total occlusions of the subclavian artery are challenging to treat percutaneously because of the structure and complexity of the lesion. The complexity of the lesion causes its own complications. In this paper, we report a case of a completely occluded left subclavian artery that was complicated by a malpositioned stent hanging into the aortic arch and the ascending aorta during percutaneous intervention, which was successfully managed by our heart team.

Cilostazol decreases total atrial conduction time in patients with peripheral artery disease.

OBJECTIVE: Total atrial conduction time (TACT) is the most important parameter in predicting the development of new-onset atrial fibrillation. We investigated the effect of cilostazol therapy on TACT in patients with peripheral artery disease. METHODS: Thirty patients with peripheral artery disease were treated with cilostazol (200 mg/day) for 6 months. The baseline echocardiographic total atrial conduction time parameter was compared with the 6-month follow-up. RESULTS: The TACT duration was decreased in all patients compared with the baseline after therapy (121.8 ± 19.3 vs. 109.1 ± 15.9 milliseconds, p<0.001). However, left atrial (LA) diameter was not changed with the therapy. The reduction of TACT duration was correlated with the increase in mitral E wave velocity/mitral A wave velocity ratio (r=-0.48, p<0.003). CONCLUSION: Our results showed that 200 mg cilostazol treatment decreased TACT duration in patients with peripheral artery disease, which may also prevent the development and/or recurrence of atrial fibrillation (AF).

Atypical cutaneous manifestation of HSV-2 with Candida albicans co-infection in a patient with HIV-1.

Herpes simplex virus type 2 (HSV-2) infection was one of the first opportunistic infections identified among patients with AIDS. In the literature there are many data suggesting that the natural history of HSV-2 infection is altered in HIV-HSV-2 co-infected patients. Furthermore, a relationship between HIV seropositivity and HBV infection because of their analogous way of transmission is also described. We report the case of a 37-year-old patient who suffered from multiple painful ulcerative lesions of the perianal region. Laboratory examination showed positivity for HIV and HBV infections. In HIV-positive patients perianal HSV-2 can have atypical manifestations, especially if co-infection by Candida albicans occurs.

Genital porokeratosis.

We report on a negroid male suffering from porokeratosis of the scrotum. Porokeratosis in the genital area is rare, as is its occurrence in negroid people. In our patient, we found an asymptomatic non-HIV associated immunosuppression. In this case, the disease might be called porokeratosis of Mibelli. The diagnosis should be suspected in patients not belonging to one of the classical at-risk ethnical groups if the skin lesions seem typical.

Effects of vitamin D on the growth of normal and malignant B-cell progenitors.

As the effects of vitamin D3, 1,25-dihydroxyvitamin D3 (1,25-(OH)2-D3) (VD, calcitriol) on the proliferation and differentiation potential of normal and leukaemic cells in vitro of myeloid lineage are known, we investigated the response to VD on the growth of both normal and malignant lymphoid progenitors. Effects of vitamin D on normal human lymphoid progenitors and B lineage acute lymphoblastic leukaemia (ALL) progenitors were assessed by using an in vitro cell colony assay specific for either B or T cell lineages. The expression of VDR on B untreated malignant progenitors at diagnosis was investigated by RT-PCR analysis. VD induced a significant inhibition of normal lymphoid cell progenitors growth of both T and B lineage. VD inhibited significantly also the growth of malignant B cell lineage lymphoid progenitors, without inducing cytotoxic effect. As it has been reported that VD effects on activated lymphocytes are mediated by 1,25-(OH)2-D3 nuclear receptor (VDR), we investigated VDR expression on malignant B cell progenitors. We did not detect VDR expression on these cells examined at diagnosis. We demonstrated that VD inhibited in vitro the clonogenic growth of both normal and malignant lymphoid B cell progenitors and that this inhibitory effect on malignant B cell progenitors was not related to VDR. Our work contributes to understanding of the mechanism of action of this hormone in promoting cellular inhibition of clonal growth of malignant lymphoid B cell progenitors, suggesting that the regulation of some critical growth and differentiation factor receptors could be a key physiological role of this hormone.

Florid cutaneous and mucosal papillomatosis with acanthosis nigricans revealing a primary lung cancer.

This is the report of an 80-year-old patient with diffuse brownish hyperpigmentation and velvety thickening of the skin with onset 1 year before. Warty lesions on his limbs were present as well as papillomatous and verrucous lesions on his lips, mouth and eyelid conjunctivae with hyperkeratosis of the nipples. Biopsies, performed at different sites, showed histological pictures consistent with a diagnosis of acanthosis nigricans (AN) with florid cutaneous and mucosal papillomatosis. This type of AN is frequently associated with internal malignancy. In our patient serum levels of tissue polypeptide antigen, carcinoembryonic antigen, cytokeratin fragment and squamous cell carcinoma antigen were high and chest computed tomography scan indicated a large tumour infiltrating the right lung and extending to the mediastinum. Cytological examination of bronchial drainage revealed the presence of neoplastic cells, non-small cell type carcinoma. The most frequent cancer associated with malignant AN is gastric adenocarcinoma. Lung tumour has rarely been reported with AN. Malignant AN is sometimes associated with other cutaneous and mucosal warty lesions, as in our patient. These various skin and mucosal lesions are the expression of a systemic epithelial disorder and may help clinicians to suspect a malignant form of AN.

The presence of HPV types 6/11, 16/18, 31/33/51 in Bowenoid papulosis demonstrated by DNA in situ hybridization.

Bowenoid papulosis (BP) is an unusual dermatosis with variable clinical presentation: multiple, generally small, round, papules, isolated or confluent, with smooth or papillomatous surface, sometimes with desquamation. The colour is variable from rose, reddish-purple to brown. These papules are localized mostly on the genital mucosa or perigenital skin of young adults. The aetiopathogenesis of the disorder is not well defined, but it may be linked to human papillomavirus (HPV) infection. We report a case of BP with some particular aspects: (1) misdiagnosis of the disease for 2 years; (2) contemporaneous presence of different types of HPV.

[Bowenoid papulosis: myth or reality?]. / Papulosi bowenoide mito o realtà.

The authors present a review of recent theories about clinical entity of Bowenoid Papulosis (P.B.), considering histological and etiopathogenesis aspects. The starting point of this review was recent observation of some clinical cases of P.B. The HPV is clearly involved in the start and the growth of this pathology. However, we have serious doubts regarding the etiopathology role of such virus of the pathology and the element of the start of a simil-neoplastic shape because the HPV was not found in the clinical shapes that we have examined. The frequent spread of the illness might give an answer to the immunology of the patient even though there was not significant immunity deficit in the previous cases that we have examined. Another remark was noticed by therapy writers. They are wondering whether they should practice a therapy called "wait" rather than treatment which is sometimes harmful and collateral effects. The last patients who have been treated by dtc in the beginning were restricted to local therapies with podofilotoxines in rare cases where they were examined after their treatment.

[The cell-mediated response after measles vaccination]. / Studio della risposta cellulo-mediata dopo vaccinazione anti-morbillosa.

Natural measles virus infection is recognized for causing prolonged abnormalities in immune responses, that contribute to the severe and complicated evolution of the disease. Immunization with live measles virus vaccine could be considered a mild form of the measles infection. Results of investigation of in vitro immune response after measles immunization with live attenuate vaccine have been conflicting. In this work we studied cellular immune parameters in children aged between 3 and 12 years. T cells, CD4+ and CD8+ subsets were analyzed by cytometry. CD3+ cells were significantly reduced compared to controls (p < 0.01) whereas CD4+/CD8+ ratio was normal. The in vitro proliferative response to polyclonal mitogen was significantly reduced (p < 0.01). This study confirms the presence of a mainly functional immunosuppression of cellular response in a cohort of children belonging to a developed area. These findings improve the understanding of the mechanism of immune response to virus measles and provide suggestions for the development of a better approach to immunization, taking account for the strain, vaccine titre, age and environmental conditions of the target population.

[Clinico-diagnostic considerations on various cases of lymphogranuloma venereum]. / Considerazioni clinico-diagnostiche su alcuni casi di linfogranuloma venereo.

The authors report some recently observed cases of lymphogranuloma venereum and focus their attention on the complex approach to clinical and laboratory diagnosis. Furthermore they underline the importance and the spread of this disease in new geographical area, such as Europe.