No abstract

Summary Zika virus (ZIKV), which emerged in regions endemic to Dengue virus (DENV), is vertically transmitted and results in adverse pregnancy outcomes. Antibodies to DENV can cross-react with ZIKV, but whether these antibodies influence ZIKV vertical transmission remains unclear. Here, we find that DENV antibodies increase ZIKV infection of placental macrophages (Hofbauer cells [HCs]) from 10% to over 80% and enhance infection of human placental explants. ZIKV-anti-DENV antibody complexes increase viral binding and entry into HCs but also result in blunted type I IFN, proinflammatory cytokine and antiviral responses. Additionally, ZIKV infection of HCs and human placental explants are enhanced in an IgG subclass-dependent manner, and targeting FcRn reduces ZIKV replication in human placental explants. Collectively, these findings support a role for pre-existing DENV antibodies in enhancement of ZIKV infection of select placental cell types and indicate that pre-existing immunity to DENV should be considered when addressing in ZIKV vertical transmission.

In order to examine the reliability and validity of the SF-36 for use with individuals with TBI, the SF-36 and three measures of health-related problems in persons with TBI (BDI-II, TIRR Symptom Checklist, Health Problems List) were administered to 271 individuals without a disability, 98 individuals with mild TBI, and 228 individuals with moderate-severe TBI. Internal consistency (reliability) was demonstrated for all SF-36 scales. Significant correlations were found between the SF-36 scales and the other measures, with stronger correlations emerging in the TBI groups. The TBI groups obtained significantly lower SF-36 scores than the comparison group, and the mild TBI group scored lower than the moderate-severe group. For the most part, the differences between the TBI groups disappeared when BDI-II scores were controlled for. These findings suggest that the SF-36 is a reliable and valid measure for use with persons with TBI.

Laparoscopic cystectomy (LC) is at present viewed as the first-line means of diagnosing and treating endometriosis. This prospective study sought to identify factors related to postoperative recurrence in 315 women with endometriosis whose mean age was 31 years and who were followed up for an average of 21 months following LC. The procedure was performed using transvaginal ultrasonography. Four experienced gynecologists-not the ones who performed LC-evaluated the patients at 6-month intervals. Recurrent disease was defined as a diffuse, hypoechoic area whose long axis extended for at least 2 cm. Severity of disease was assessed using the revised American Society of Reproductive Medicine (r-ASRM) score.Bilateral LC was carried out in 102 patients and hemilateral LC in 213. The overall rate of recurrent disease was 16%, and the estimated cumulative recurrence rate for all patients 5 years after LC was 32%. The 51 women who became pregnant included 36 of 141 whose chief complaint at the time of primary surgery was sterility (25.5%). In comparison, 9% of women who did not complain of sterility became pregnant. Recurrent disease was relatively frequent in younger patients and those with more severe disease as indicated by their r-ASRM scores. Neither the size of cysts nor the presence of multiple lobules correlated significantly with recurrent disease. Patients undergoing hemilateral LC had a 5% rate of recurrence in the ovary that, at the time of initial surgery, appeared to be normal.In this prospective study, younger women with endometriosis and those with severe disease were at the highest risk of developing recurrent disease. It is likely that recurrences include both cysts that form spontaneously and others that develop from residual disease in lesions treated by cystectomy. GYNECOLOGYVolume 62, Number 2 OBSTETRICAL AND GYNECOLOGICAL SURVEY

These findings argue against a specific TBI personality syndrome, but rather a diversity of personality disorders reflective of the persistent challenges and compensatory coping strategies developed by individuals post-TBI. Prospective need for clinical assessment, pro-active education and focused treatment approaches are discussed.