Cardiac remodeling and pre-eclampsia: an overview of microRNA expression patterns.

Pre-eclampsia (PE) is strongly associated with heart failure (HF) later in life. During PE pregnancy, the left ventricle undergoes concentric remodeling which often persists after delivery. This aberrant remodeling can induce a molecular signature that can be evaluated in terms of microRNAs (miRNAs) and which may help to explain the associated increased risk of HF. For this review, we performed a literature search of PubMed (National Center for Biotechnology Information), identifying studies on miRNA expression in concentric remodeling and on miRNA expression in PE. The miRNA data were stratified based on origin (isolated from humans or animals and from tissue or the circulation) and both datasets compared in order to generate a list of miRNA expression patterns in concentric remodeling and in PE. The nine miRNAs identified in both concentric remodeling and PE-complicated pregnancy were: miR-1, miR-18, miR-21, miR-29b, miR-30, miR-125b, miR-181b, miR-195 and miR-499-5p. We found five of these miRNAs (miR-18, miR-21, miR-125b, miR-195 and miR-499-5p) to be upregulated in both PE pregnancy and cardiac remodeling and two (miR-1 and miR-30) to be downregulated in both; the remaining two miRNAs (miR-29b and miR-181b) showed upregulation during PE but downregulation in cardiac remodeling. This innovative approach may be a step towards finding relevant biomarkers for complicated pregnancy and elucidating their relationship with remote cardiovascular disease. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

Retrospective record review: reinforced zinc oxide-eugenol pulpotomy: a retrospective study.

PURPOSE: The purpose of this retrospective study was to evaluate pulpotomies completed without the use of a fixative, preservative, or astringent agent prior to placement of a reinforced zinc oxide-eugenol (ZOE) sub-base in the pulp chamber and subsequent restoration. METHODS: Clinical and radiographic data were collected from a private pediatric dental office in Toronto, Ontario, Canada. The pulpotomy technique used involved: amputation of coronal pulp; radicular hemostasis via pressure with dry cotton pellet; placement of ZOE into the pulp chamber; and restoration with stainless steel crown or amalgam. RESULTS: One-hundred-ninety primary molars in 116 children (follow-up=6-94 months; mean=35.8 months) met the inclusion criteria. The radiographic, clinical, and overall success rates were approximately 95%, 97%, and 94%, respectively. The most frequently observed pathologic pulpal response was furcation radiolucency (N=7, ∼4%). The patient's age at time of pulpotomy, restoration type, tooth type, arch, and location of treatment (in-office vs general anesthesia) were not statistically significant factors influencing the success of the reinforced ZOE pulpotomy technique. CONCLUSION: The success rates indicate that the reinforced zinc oxide-eugenol pulpotomy technique may be an acceptable treatment modality for primary molars requiring vital pulp therapy.

The primary care diagnosis of dementia in Europe: an analysis using multidisciplinary, multinational expert groups.

OBJECTIVES: To explore the extent of variation in the detection of dementia in primary care across Europe, and the potential for the development of European guidelines. METHOD: A mixture of focus group and adapted nominal group methods involving 23 experts of different disciplines and from eight European countries. RESULTS: The diagnosis of dementia should be 'timely' rather than 'early'. Timeliness has an impact on the patient, on the caregiver, on healthcare professionals, and on society. Ethical and moral issues may interfere with the aim of timely diagnosis. Guidelines may be important for facilitating a timely diagnosis of dementia, but were infrequently used and not even available in three of the eight countries. Referral pathways often depended on health care system characteristics, differing throughout the eight European countries, whilst diagnostic strategies differed due to varied cultural influences. There was consensus that national variations can be reduced and timely diagnosis enhanced by combining simple tests using a systematic stepwise case-finding strategy, in conjunction with a strong infrastructure of multidisciplinary collaboration. CONCLUSIONS: This study identified three key themes that should be considered in harmonizing European approaches to the diagnosis of dementia in primary care: (1) a focus on timely diagnosis, (2) the need for the development and implementation of guidelines, and (3) the identification of appropriate referral pathways and diagnostic strategies including multi-professional collaboration. The content of guidelines may be determined by the perspectives of the guideline developers.

Impact of diagnostic disclosure in dementia on patients and carers: qualitative case series analysis.

Adequate diagnostic information can be considered a basic intervention in dementia care. However, clear diagnostic disclosure in dementia is not yet regular practice and the evidence regarding patients' preferences for or against disclosure is scarce. The aim of this study was to give an in-depth description of the impact of receiving the diagnosis of dementia, both on patients and the patients' proxies. The method used was the design of a grounded theory interview study. Analysis of the interviews revealed that disclosure had an impact on three key domains: awareness of dementia, partnership, and social relationships. Most patients and carers reported that they had experienced the disclosure of the diagnosis as a confirmation of their assumptions. A minority of patients and carers felt threatened and shocked by the diagnosis, because they did not expect it. The findings of this analysis challenge current opinions and practice about diagnostic disclosure like obstacles anticipated by clinicians such as inducing negative feelings and causing harm. Disclosure of the diagnosis of dementia can generally be carried out without introducing stress for the patient or carer and facilitates guidance. Therefore regular practice should include the careful planning and performance of diagnostic disclosure.

Variations in meeting centers for people with dementia and their carers. Results of a multi-center implementation study.

In this study we investigated whether a support program based on the model of the Amsterdam meeting centers for people with dementia and their carers, is in line with the needs and possibilities in other areas in the Netherlands, or if variations in the program are indicated. This study is part of a larger study into the nationwide implementation of meeting centers in the Netherlands. The data gathered on the basis of questionnaires shows that, although the support offer is almost identical on the interregional level, there are differences in terms of initiator(s), type of location, frequency of discussion groups and monthly meeting for all participants, background of staff members, number of volunteers and structural funding. The people with dementia who use the meeting centers in the various regions do not differ significantly on sex, age, civil status, severity of dementia and physical invalidity. The family carers also exhibit more similarities than differences on the interregional level. In every region the majority of carers are female, married or cohabiting, and a minority are gainfully employed.They generally share a household with the person with dementia, or they live in the same municipality. In nearly all centers the majority of carers exhibit psychological and/or psychosomatic symptoms. In most regions participants make use of all elements of the support program (social club, discussion groups, informative meetings, consultation hour). The study shows that the support program based on the Amsterdam model meets general needs of people with dementia and their carers and is therefore generally applicable, but adaptive implementation is desirable.

[Diagnostic alertness to patients having a personality disorder with changing symptoms]. / Diagnostische alertheid bij een persoonlijkheidsstoornis met veranderd symptomenbeeld.

The diagnosis of mood disorders in patients with a personality disorder is complex because there may be a significant overlap of symptomatology between both disorders. A 33-year-old man with a borderline personality disorder, for which he had been treated for several years with marginal success, developed a depression that was not recognised and treated until late. Besides the similarity between the two disorders, emotional and personal factors on the part of the physician played an important role in the failure to diagnose the depression. In such complex situations, the use of practice guidelines may be helpful because these prescribe professional attitudes that, in this case, would probably have prevented the non-recognition of the depression.

[Palliative cryosurgery in rectal carcinoma]. / Palliatieve cryochirurgie bij rectumcarcinoom.

OBJECTIVE: Analysis of palliative cryosurgery in rectal cancer patients. DESIGN: Descriptive. SETTING: Department of surgery, University Hospital Vrije Universiteit, Amsterdam, the Netherlands. METHODS: Ninety-three patients (age: 45-92 years) underwent palliative cryosurgery for primary rectal cancer. They were excluded from surgical resection because of old age, accompanying disease(s), inoperability and the presence of hematogenous metastases. The palliative effect of cryosurgery on local symptoms was classified as good, moderate or none. The duration of palliation was calculated in relation to survival as a palliative index: the number of months of (moderate or good) palliation divided by the number of months of survival from the start of the treatment, multiplied by 100%. RESULTS: In 58 patients (62%) there was complete relief of local symptoms with a palliative index of 87%. In 13 patients (14%) palliation was moderate and in 22 patients (24%) no palliation was achieved. The 50% survival duration in the 58 patients was 37 months. Especially symptoms of blood and/or mucous discharge could be easily alleviated. Good alleviation of local symptoms was associated with the extent of the primary tumour process. Palliative effect could be assessed after a few treatments. Patients with circular rectal tumours seldom had long term palliative effects of cryosurgery. CONCLUSION: Cryosurgery for rectal cancer is a simple and safe treatment. It should be considered for alleviation of local symptoms in patients with rectal cancer who are unsuitable for radical surgery.

Teaching intonation to young deaf children with the intonation meter.

Incorrect production of intonation contours is a common phonatory problem in prelingually, profoundly deaf speakers. To help deaf speakers improve this, a visual display system for teaching intonation has been developed. In this system, called the Intonation Meter, visual feedback of intonation is given as a continuous representation of the pitch contour containing only the perceptually relevant aspects of the intonation pattern. This pitch-contour representation is supposed to facilitate the interpretation of the visual feedback of the pitch contour. A study was carried out, using a Single-Subject Design, in which subjects alternately received intonation training by means of regular methods and intonation training by means of regular methods in which also use was made of the Intonation Meter, to evaluate the effectiveness of the Intonation Meter for teaching intonation to young deaf children. Prelingually profoundly deaf children aged 6 to 7 years and 9 to 11 years participated in this study. The results showed that the 9 to 11 year old children showed most progress when the Intonation meter was used in intonation training whereas 6 to 7 year olds progressed well irrespective of whether or not the Intonation Meter was used, which is in accordance with the theory of a critical period for language learning. Alternatively, it is hypothesized that the cognitive requirements of the visual feedback might be to advanced for very young children to be helpful in learning to produce certain pitch contours.

Cryosurgery for locally recurrent rectal cancer.

Locally recurrent rectal cancer is, in most cases, unresectable and incurable. Palliative treatment is warranted in many cases because of the presence of severe distressing symptoms. In recurrent disease, intraluminal cryotherapy is an option for palliation. Twenty patients with local recurrence after anterior resection were treated palliatively with cryosurgery for their local symptoms. Six patients had previously had a colostomy before they were referred for palliative treatment. Thirteen patients had more than one symptom. Distant metastases were present in ten cases. The beneficial effect of cryosurgery was evident after two to three sessions. In nine patients cryotherapy achieved complete relief of local symptoms. In these patients the symptom free interval varied from 1 to 24 months (median 11 months); five patients died of disease without local symptoms. Three of these nine patients underwent a bowel diversion at a later stage because of complete stenosis. The number of treatment sessions in this group of patients varied from three to 14. The palliative index varied from 37 to 100% (mean 78%). In nine patients cryotherapy of the local recurrence gave no relief at all. Our results show that in almost half of the patients cryosurgery can palliate local complaints resulting from recurrent tumor growth after anterior resection.

Intraluminal ultrasound of rectal tumours: a prerequisite in decision making.

The use of intraluminal ultrasound (IUS) as a staging technique was evaluated in 58 patients with a rectal tumour. Thirty-four patients had a rectal carcinoma, four had a local recurrence after a previous anterior resection and 20 other patients had a villous adenoma. IUS assessment of rectal wall invasion, infiltration into adjacent organs, and the presence of perirectal lymph node involvement was compared with the definitive histological findings. In 90% of all patients the pre-operative local tumour staging was predicted correctly. In 38 patients with a rectal carcinoma the overall accuracy for the T grade was 84%. The sensitivity for the detection of perirectal fat infiltration was 91%, with a specificity of 70% and a negative predictive value of 78%. The accuracy in predicting direct infiltration into adjacent organs was 100% (n = 5). In the four patients with a local recurrence, the diagnosis was suspected by means of IUS and confirmed by biopsies. Extraluminal tumour growth was predicted correctly in all cases, with extension into the coccygeal bone in one patient. IUS identified lymph nodes in 29 of 38 cases, with a sensitivity of 57% and a specificity of 76%. All 20 villous adenomas were correctly staged as non-infiltrative tumours. After transmural excision, three adenomas proved to contain a completely removed T1 carcinoma. IUS is the most accurate tool in predicting the depth of local tumour invasion and needs a place in the preoperative screening programme in patients with a rectal tumour, as well as in the postoperative follow-up.(ABSTRACT TRUNCATED AT 250 WORDS)

Retrosternal dislocation of the clavicle.

Retrosternal dislocation of the clavicle is an uncommon injury which may affect the mediastinal structures in a life-threatening way. Therefore, computed tomography is mandatory. Manipulation in the acute situation is the treatment of choice. In case of failure or old dislocation, open reduction with stabilization of the joint is required. The literature on this subject has been reviewed and an additional two cases are reported.

Anal sphincter imaging in fecal incontinence using endosonography.

Clinical anal examination, manometry (resting and squeeze pressures), and single-fiber electromyography were compared with endosonography of the anal sphincters in 14 patients with fecal incontinence. Technical aspects of the procedure and normal imaging of the puborectal muscle and both sphincters were defined. Defects in both sphincters were seen in nine patients. The defect is visualized as a clear discontinuity in the muscular ring. Compared with the conventional studies, anal endosonography gave significant information in six patients (four male patients after perianal surgery and two women), showing sphincter defects in five patients and integrity of the sphincters in another one. This information obtained by endosonography was important in understanding the type and extension of the lesion and deciding upon the surgical repair. Anal endosonography is an imaging technique of the sphincters that can assess their integrity in fecal incontinence.

Kinetics and dosimetry of iodine-131-labelled antibody fragments after local administration in patients with rectal cancer.

In 11 patients with rectal cancer, a mixture of F(ab')2 fragments of anti-carcinoembryonic antigen and anti-CA 19.9 labelled with a diagnostic dose of iodine-131 (3-10 MBq) was administered submucosally around the tumour. In this study, the local kinetics in and the dose to the rectal wall, the whole body kinetics and the effective dose equivalent are presented. The early disappearance of the activity from the injection spot was characterized by a T1/2 of 21 h. Initially, about 50% of the plasma activity was due to free 131I. After 4 h, the plasma activity was almost completely protein bound (86%). Maximum plasma activity was observed after the 2nd day. From 72 h p.i., the plasma activity decreased with a T1/2 of 53 h. In the first 24 h, 14% of the injected dose was excreted in the urine and within 4 days about half of the administered activity. The absorbed radiation dose to the rectal wall was estimated to be 0.2 Gy/MBq, presuming a 20 cm3 distribution volume. The dose to the bone marrow was 0.2 mGy/MBq or 0.4 mGy/MBq, assuming a homogeneous tracer distribution or equal blood and bone marrow activity concentrations, respectively. The effective dose equivalent is 1.9 mSv/MBq, mainly determined by the dose to the rectal wall and to a lesser extent by the dose to the remaining body. Postulating comparable kinetics, 123I- or 111In- or 99mTc-labelled fragments would result in 4-25-fold lower effective dose equivalents.(ABSTRACT TRUNCATED AT 250 WORDS)

Qualitative and quantitative kinetics of submucosally administered antibody fragments in patients with rectal carcinoma: the detection of lymph node metastasis in relation to local tracer diffusion.

Immunoscintigraphy after submucosal administration of a mixture of 131I-anti-CEA and 131I-anti-CA-19-9 around the tumor in patients with rectal carcinoma may improve pre-operative staging and may contribute to the selection of patients eligible for local treatment. However, visual discrimination of local lymph node metastasis appears unreliable, partly because of scatter from the injection site and substantial diffusion of the radiotracer into the interstitium. Analysis of the diffusion profile, however, may improve the sensitivity and accuracy of this immunoscintigraphic approach.

Postoperative sepsis in malnourished cancer patients

As infeccoes pos-operatorias representam uma das principais causas de aumento de morbidade e mortalidade, hospitalizacao prolongada e custos excessivos do tratamento cirurgico. Com objetivo de avaliar as possiveis influencias de fatores nutricionais e metabolicos sobre o advento de complicacoes bacterianas, estudaram-se 31 pacientes consecutivos com cancer. A maioria das operacoes executadas nesta populacao foi paliativa (54,8 por cento), mas intervencoes radicais (16,1 por cento) e laparotomias exploradas foram igualmente efetuadas. A desnutricao calorico-proteica foi diagnosticada no pre-operatorio em 80,6 por cento dos pacientes, e transfusoes de sangue foram empregadas em 51,6 por cento das operacoes...

Ileal obstruction due to tumorous heterotopic gastric mucosa.

A patient is reported with intermittent ileal obstruction due to tumorous heterotopic gastric mucosa not associated with an anatomic anomaly.