Morphological study of placental terminal villi in intrahepatic cholestasis of pregnancy: Histochemistry, light and electron microscopy

Histochemistry, light and electron microscopy were used to study the changes in the morphology of the terminal villi of four term placentae from anicteric ICP and two from icteric ICP as compared to three normal placentae. Alterations observed in ICP placentae were a reduction of the intervillous space, syncytial and cytotrophoblastic hyperplasia, decreased alkaline phosphatase reaction, absence of glycogen, dilatation of rough endoplasmic reticulum, basal folding, and an increase of lipoprotein-like bodies in the syncytium.     

Changes of Serum IgG Dimer Levels after Treatment with IVIg in Guillain-Barré Syndrome

Journal of Neuroimmune Pharmacology - Intravenous immunoglobulins (IVIg) are standard treatment for Guillain-Barré syndrome (GBS). Their exact mechanisms of action are versatile and not fully...     

Peripheral Neuropathy: Assessment of Proximal Nerve Integrity By Diffusion Tensor Imaging

Introduction: We investigated the utility of diffusion tensor imaging (DTI) for detecting neuropathic changes in proximal nerve segments in patients with peripheral neuropathy. Methods: Twenty‐one individuals with (n = 11) and without (n = 10) peripheral neuropathy underwent DTI of a defined sciatic nerve segment. Patients and controls were evaluated by clinical examination and nerve conduction studies at baseline and 6 months after the initial DTI scan. Results: The mean fractional anisotropy (FA) value was significantly lower in sciatic nerves from patients with peripheral neuropathy as compared with controls. Sciatic nerve FA values correlated with clinical disability scores and electrophysiological parameters of axonal damage at baseline and 6 months after MRI scan. Conclusions: DTI‐derived FA values are a sensitive measure to discriminate healthy from functionally impaired human sciatic nerve segments. DTI of proximal nerve segments may be useful for estimating the proximal axonal degeneration burden in patients with peripheral neuropathies. Muscle Nerve 48 : 889–896, 2013     

Probing renal blood volume with magnetic resonance imaging

Damage to the kidney substantially reduces life expectancy. Renal tissue hypoperfusion and hypoxia are key elements in the pathophysiology of acute kidney injury and its progression to chronic kidney disease. In vivo assessment of renal haemodynamics and tissue oxygenation remains a challenge. Blood oxygenation level–dependent (BOLD) magnetic resonance imaging (MRI) is sensitive to changes in the effective transversal relaxation time (T₂*) in vivo, and is non‐invasive and indicative of renal tissue oxygenation. However, the renal T₂* to tissue pO₂ relationship is not governed exclusively by renal blood oxygenation, but is affected by physiological confounders with alterations in renal blood volume fraction (BVf) being of particular relevance. To decipher this interference probing renal BVf is essential for the pursuit of renal MR oximetry. Superparamagnetic iron oxide nanoparticle (USPIO) preparations can be used as MRI visible blood pool markers for detailing alterations in BVf. This review promotes the opportunities of MRI‐based assessment of renal BVf. Following an outline on the specifics of renal oxygenation and perfusion, changes in renal BVf upon interventions and their potential impact on renal T₂* are discussed. We also describe the basic principles of renal BVf assessment using ferumoxytol‐enhanced MRI in the equilibrium concentration regimen. We demonstrate that ferumoxytol does not alter control of renal haemodynamics and oxygenation. Preclinical applications of ferumoxytol enhanced renal MRI as well as considerations for its clinical implementation for examining renal BVf changes are provided alongside practical considerations. Finally, we explore the future directions of MRI‐based assessment of renal BVf.     

Computer-aided placement of endosseous oral implants in patients after ablative tumour surgery: assessment of accuracy

The objective of this study was to evaluate the feasibility and accuracy of a novel surgical computer-aided navigation system for the placement of endosseous implants in patients after ablative tumour surgery. Pre-operative planning was performed by developing a prosthetic concept and modifying the implant position according to surgical requirements after high-resolution computed tomography (HRCT) scans with VISIT, a surgical planning and navigation software developed at the Vienna General Hospital. The pre-operative plan was transferred to the patients intraoperatively using surgical navigation software and optical tracking technology. The patients were HRCT-scanned again to compare the position of the implants with the pre-operative plan on reformatted CT-slices after matching of the pre- and post-operative data sets using the mutual information-technique. A total of 32 implants was evaluated. The mean deviation was 1.1 mm (range: 0-3.5 mm). The mean angular deviation of the implants was 6.4 degrees (range: 0.4 degrees - 17.4 degrees, variance: 13.3 degrees ). The results demonstrate, that adequate accuracy in placing endosseous oral implants can be delivered to patients with most difficult implantologic situations.     

Novel treatment for immune neuropathies on the horizon

Immune neuropathies represent a heterogeneous spectrum of acute and chronic peripheral nerve disorders of autoimmune origin. Despite the current available treatment options, immune neuropathies are still associated with severe neurological deficits and poor clinical prognosis. However, during the last years, significant advances have been made in unraveling some of the underlying pathomechanisms. The exploration of novel therapeutic approaches including monoclonal antibodies and oral immunosuppressants, known from other autoimmune disorders such as multiple sclerosis, suggests new approaches to treatment. Here, we review the available clinical data as well as the scientific rationale and expected benefits and risks for these strategies.     

Geographic differences in the target-controlled infusion estimated concentration of propofol: bispectral index response curves

Purpose

Variability in drug responses could result from both genetic and environmental factors. Thus, drug effect could depend on geographic location, although regional variation is not generally acknowledged as a basis for stratification. There is evidence that the pharmacokinetic set developed in a European population for the target-controlled infusion (TCI) of propofol does not apply in Chinese patients; however, we are not aware of previous studies comparing the estimated concentration-bispectral index (BIS) response of Caucasian patients in Europe with that of Chinese patients in China.

Methods

The Diprifusor^TM TCI pump, incorporating the pharmacokinetic model proposed by Marsh et al., was applied to 30 Caucasian patients in Austria and 30 Chinese patients in China. The estimated plasma concentration (C_p) of propofol for the two groups was set at 1 μg·mL^?1 and increased by 1 μg·mL^?1 every minute to gradually reach 5 μg·mL^?1 after 5 min. The BIS values were fitted against the estimated C_p and the predicted effect-site concentration (C_e) in a sigmoid E_max model.

Results

The sigmoid E_max curves were shifted significantly to the left in the Chinese group compared with the Austrian group. After 5 min, the BIS value in the Chinese group was lower than in the Austrian group (mean ± standard deviation [SD], 47.2 ± 3.6 vs 63.6 ± 5.4, respectively; P = 0.0006). The estimated C_p at loss of consciousness (LOC), predicted C_e at LOC, and time to LOC, were lower in the Chinese group than in the Austrian group (3.3 ± 0.8 μg·mL^?1, 1.6 ± 0.4 μg·mL^?1, 2.8 ± 0.6 min, respectively, vs 4.6 ± 2.8 μg·mL^?1, 2.4 ± 1.5 μg·mL^?1, 3.9 ± 0.5 min, respectively; P < 0.0001).

Conclusion

When propofol is given using the same TCI protocol, Chinese patients in China lost consciousness faster and at a lower estimated plasma concentration than Caucasians in Austria. Larger studies are needed to map geographically appropriate TCI infusion models.