A quickly reversible occlusion in the vertebrobasilar circulatory bed: often unrecognized?

HISTORY AND FINDINGS: A 29-year-old man presented in another hospital because of discoordination of all extremities with sudden onset. After fast reversal of the symptoms, he was discharged without a clear diagnosis. Because of remaining discrete dysarthria, computed tomography and magnetic resonance imaging were performed which demonstrated bilateral cerebellar infarcts. The cause was assumed to be a transient embolic occlusion of the distal basilar artery. TREATMENT AND COURSE: Intravenous heparin was started to prevent further occlusions. Because no source for emboli or other causes were found, the patient was discharged after 14 days on acetylic acid (250 mg/d) as secondary prevention therapy. CONCLUSIONS: A vascular or neurological cause is often not considered when neurological symptoms are quickly reversible after a transient occlusion of the basilar artery. In these cases, the suspected diagnoses of psychiatric illness, alcohol abuse, drug intoxication, infection or myocardial infarction do not lead to the necessary investigations. Thus, a potentially life-threatening situation may be disregarded.     

Urea briquette applicator for transplanted rice

A plunger-type, completely hand-operated applicator prototype, made of polyvinyl chloride (PVC), for deep placement of urea briquettes (UB), i.e., pillow-shaped urea supergranules with edges, in line transplanted rice has been developed for use by small-scale rice farmers. The field evaluation of the applicator was conducted in the Philippines during the 1989 dry season. The applicator consistently placed UB at proper depth (7 to 8 cm), which resulted in low concentrations of urea N (<7 ppm) in about 4 cm of floodwater 1 day after placement. These findings indicated that the prototype worked properly. Average work output of the applicator was 0.20 ha workday^–1 and may increase with practice. The yields of irrigated transplanted rice in the field trials show that agronomic efficiencies of hand-placed UB and applicator-placed UB were equal and were superior to those of split-applied prilled urea.     

Conservative surgical management of tubal pregnancy

In an attempt to maintain optimal fertility in the patient treated for midtubal pregnancy, an investigation of conservative surgical procedure was made. The technic developed utilizes tubal excision, reanastomosis, and a single hydrotubation with Dextran. Tubal patency was maintained without the use of stents that may damage the fimbria. The procedure is compared to other conservative technics and its advantages discused. Thus far 2 patients have undergone this excision and reanastomosis, and both patients successfully established intrauterine gestations within 2 months of returning to normal active coital frequency. Both were in the midtrimester of pregnancy at the time of this report.     

Chemical Reactions Between Dentin and Bonding Agents

The possible interaction between dentin and a proprietary dentin bonding agent (DBA), Gluma, was studied by Phase Photoacoustic FTIR. The determination of the existence and nature of a chemical bond between the DBA and the substrate can be of great importance in explaining the performance of these agents. Human dentin was treated by solutions of 2-hydroxyethyl methacrylate (HEMA), glutaraldehyde and a combination of both (Gluma Primer). Spectra of dentin samples treated with 35% and 100% HEMA as well as Gluma Primer show loss of both the hydroxyl (O-H stretch) and methylene (CH₂ stretches) peaks from HEMA while other peaks are retained, even after thorough washing. This indicates a reaction between HEMA and the collagenous fraction of dentin.     

An FT-Raman spectroscopic investigation of dentin and collagen surfaces modified by 2-hydroxyethylmethacrylate

Although 2-hydroxyethylmethacrylate (HEMA) is commonly used for adhesive bonding to dentin, its role in promoting adhesion is not completely understood. Here, we use FT-Raman spectroscopy to elucidate further the nature of the interaction of HEMA with dentin. Ground dentin was exposed to 2.5% (w/w) nitric acid, washed, dried in air, and treated with HEMA. The samples were then sequentially washed with distilled water, with FT-Raman spectra being obtained after different wash times. Hydroxyapatite and bovine type I collagen were similarly treated with HEMA except for the acid exposure. The FT-Raman spectra of these samples were also recorded. The spectra of HEMA-treated water-washed dentin and collagen revealed the following changes: (1) The band intensities of HEMA absorbed on dentin and collagen decreased with increasing wash times (2) the nu(C=O) and nu(CCO) modes of HEMA at 1718 and 607 cm-1, respectively, either disappeared or decreased after extensive washing; (3) the nu (C=C) (1640 cm-1) and delta (=CH2), (1403 cm-1) bands exhibited minor variations in band position and relative intensity. These results demonstrate that HEMA interacts with dentin both physically and chemically. The chemical interaction can be interpreted by either hydrogen bonding or the formation of a new bond to the ester group of HEMA.     

The Effect of Conditioning on Adhesion to Human Dentin

The effect of conditioning dentin was investigated using ethyleneglycol bis(aminoethylether) tetraacetic acid (EGTA) and three proprietary agents containing ethylenediamine tetraacetic acid (EDTA), maleic acid and dipentaerythritol pentaacrylate phsophoric acid ester (PENTA). Ground dentin was treated with EGTA or one of the three proprietary agents. After adhering composite resin to treated surfaces, the shear bond strength (SBS) was determined with and without thermal stress. Scanning electron and atomic force microscopies were used to assess morphological effects of each of the agents, while low resolution X-ray photoelectron spectroscopy (XPS) was employed to evaluate elemental changes due to treatment. Mean bond strength was greatest for the PENTA-conditioned surfaces. EDTA and maleic acid demineralized the dentin surface while the agent containing PENTA produced an adherent surface film. The XPS survey showed a reduction in Ca and an increase in N for agents containing EGTA, EDTA and maleic acid, while a simultaneous reduction in both these species was observed for PENTA. EGTA did not improve adhesion for systems which were based on smear layer removal and substrate demineralization. For the PENTA-based system, which relied on the development of a molecular overlayer, EGTA degraded bond strength.     

Oxides and apoptosis in inflammatory myopathies.

Reactive oxygen intermediates (ROI) and nitric oxide (NO(.)) are produced in abundance in the inflammatory muscle diseases of autoimmune origin polymyositis (PM), dermatomyositis (DM), and inclusion body myositis (IBM). However, their role in the pathogenesis of these diseases is so far not clear. In contrast to demyelinating neuropathies, there is no convincing evidence for oxide-induced apoptosis either in myocytes or in lymphocytes and phagocytes in inflammatory myopathies. On the contrary, NO(.) released at low concentrations at target sites may even have cell-protective effects. A major mechanism of protection from apoptosis in both myocytes and inflammatory cells seems to be the upregulation of anti-apoptotic proteins like Bcl-2. Caution is warranted to apply antioxidative and anti-apoptotic agents to patients with inflammatory myopathies as long as the pathogenic role of oxides and apoptosis in the individual case is not resolved.     

Environmental change in Lake Champlain revealed by long-term monitoring

Long-term monitoring data on Lake Champlain spanning the past two to five decades were analyzed to document water quality and biological changes in the lake. August mean surface water temperatures increased during 1964–2009 in most Lake Champlain regions at rates (0.035–0.085 °C/year) similar to what has been observed in the Laurentian Great Lakes and elsewhere. Secchi disk transparency increased by over a meter during 1964–2009 in regions along the main stem of the lake, with much of the increase occurring after the 1993 zebra mussel invasion. Transparency declined in northeastern regions where zebra mussel densities were lower. No trends in hypolimnetic dissolved oxygen concentrations or depletion rates were found in any of the deep lake regions during 1990–2009. Sodium concentrations tripled in the Main Lake region since the 1960s. Chloride increased in the Main Lake by 30% since 1992, but declined in northeastern regions of the lake during recent years, coincident with reductions in road salt use in Vermont. Total phosphorus concentrations decreased during 1979–2009 in southern and northwestern lake regions, but increased by 72% in Missisquoi Bay where chlorophyll-a concentrations doubled over the period. There was a general lakewide trend of decreasing total nitrogen levels during 1992–2009 that may have been due in part to reductions in atmospheric nitrogen loading to the watershed. Cyanobacteria increased their dominance within the phytoplankton community in northeastern regions of the lake since the 1970s.     

Immunoglobulins for intravenous use inhibit TNF alpha cytotoxicity in vitro

Intravenous immunoglobulins (IVIg) have been used as an immunomodulatory therapy in a variety of diseases. Several mechanisms of action have been proposed, one of which is interference with the cytokine network. We have investigated the effect of IVIg on the cytotoxicity of human TNF alpha. IVIg was capable of protecting L929 fibroblasts from TNF alpha induced cell death. This effect was not species specific and was mediated by both the Fc and the Fab portion of immunoglobulins. Since the effect was also seen when IVIg was added after the removal of TNF alpha from the culture medium, it seems to be independent of the interaction of TNF alpha with its receptor. We conclude that IVIg either act on some point of the TNF alpha signalling pathway or influence the cell cycle unspecifically. The cytoprotective effect of IVIg potentially could contribute to the beneficial effect described for various diseases.     

McDonald Criteria 2010 and 2005 Compared: Persistence of High Oligoclonal Band Prevalence Despite Almost Doubled Diagnostic Sensitivity

The 2010 McDonald criteria were developed to allow a more rapid diagnosis of relapsing-remitting multiple sclerosis (MS) by only one MRI of the brain. Although cerebrospinal fluid (CSF) is not a mandatory part of the latest criteria, the evidence of an intrathecal humoral immunoreaction in the form of oligoclonal bands (OCB) is crucial in the diagnostic workup. To date, the impact of the 2010 McDonald criteria on the prevalence of OCB has not been investigated. We retrospectively evaluated data of 325 patients with a clinical relapse suggestive of demyelination that were treated in a German university hospital between 2010 and 2015. One hundred thirty-six patients (42%) were diagnosed with MS and 189 patients with CIS when the criteria of 2010 were applied. The criteria of 2005 allowed only 70 patients (22%) to be designated as MS. In contrast, the prevalence of OCB was marginal affected in MS patients with 96% for the criteria of 2010 and 98.5% for the criteria of 2005. In conclusion, OCB are prevalent in most MS patients and reflect the chronic inflammatory nature of the disease. We recommend CSF examination to exclude alternative diagnoses and reevaluation of the diagnosis MS in patients with negative OCB.