Patterns and the Occurrence of KRAS Mutations in Metastatic Colorectal Cancers—a Study from Indian Regional Cancer Centre

Abstract

Mutation analysis of the KRAS oncogene is established as a predictive biomarker in Colorectal cancer (CRC). Many prospective clinical trials have shown that only CRCs with wild-type KRAS respond to anti-epidermal growth factor receptor (EGFR) treatment. Hence, mutation analysis is mandatory before treatment of metastatic CRCs. There are very few studies on the KRAS mutation status in the Indian setting. Hence, this study was done to document the patterns of KRAS mutations in CRCs reporting to a regional cancer centre in South India. Among 150 cases of metastatic colorectal cancer reporting over a period of 20 months, 48 random cases were analyzed for the KRAS mutational status of codons 12 and 13 of the KRAS gene by genomic sequencing. KRAS mutations in codons 12 and 13 were present in 9/48 (18.75%) of all analyzed CRCs. The common types of mutations were glycine to aspartate on codon 12 (p.G12D), glycine to valine on codon 12 (p.G12 V), and glycine to aspartate on codon 13 (p.G13D).

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An EEG Tool for Monitoring Patient Engagement during Stroke Rehabilitation: A Feasibility Study

Objective. Patient engagement is of major significance in neural rehabilitation. We developed a real-time EEG marker for attention, the Brain Engagement Index (BEI). In this work we investigate the relation between the BEI and temporary functional change during a rehabilitation session. Methods. First part: 13 unimpaired controls underwent BEI monitoring during motor exercise of varying levels of difficulty. Second part: 18 subacute stroke patients underwent standard motor rehabilitation with and without use of real-time BEI feedback regarding their level of engagement. Single-session temporary functional changes were evaluated based on videos taken before and after training on a given task. Two assessors, blinded to feedback use, assessed the change following single-session treatments. Results. First part: a relation between difficulty of exercise and BEI was identified. Second part: temporary functional change was associated with BEI level regardless of the use of feedback. Conclusions. This study provides preliminary evidence that when BEI is higher, the temporary functional change induced by the treatment session is better. Further work is required to expand this preliminary study and to evaluate whether such temporary functional change can be harnessed to improve clinical outcome. Clinical Trial Registration. Registered with clinicaltrials.gov, unique identifier: NCT02603718 (retrospectively registered 10/14/2015).

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Bilateral Breast and Axillary Lymph Nodes Metastases of an Ovarian Serous Cystadenocarcinoma

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Creation of a Dense Transposon Insertion Library Using Bacterial Conjugation in Enterobacterial Strains Such As Escherichia Coli or Shigella flexneri

Presented here is a simple method for creating a high-density transposon insertion library in Escherichia coli or Shigella flexneri using bacterial conjugation. This protocol allows the creation of a collection of hundreds of thousands of unique mutants in bacteria by the random genomic insertion of a transposon.

http://ift.tt/2hnO8dI

Effects of Transcranial Alternating Current Stimulation on the Primary Motor Cortex by Online Combined Approach with Transcranial Magnetic Stimulation

Transcranial Alternating Current Stimulation (tACS) allows the modulation of cortical excitability in a frequency-specific fashion. Here we show a unique approach which combines online tACS with single pulse Transcranial Magnetic Stimulation (TMS) in order to "probe" cortical excitability by means of Motor Evoked Potentials.

http://ift.tt/2fhW4Jb

Nonalcoholic Fatty Liver Disease Incidence and Impact on Metabolic Burden and Death: a 20 Year-Community Study

ABSTRACT

Recent population-based data on nonalcoholic fatty liver disease (NAFLD) epidemiology in general and incidence in particular, are lacking. We examined trends in NAFLD incidence in a US community, and the impact of NAFLD on incident metabolic comorbidities (MC), cardiovascular (CV) events and mortality. A community cohort of all adults diagnosed with NAFLD in Olmsted County, MN between 1997-2014 was constructed using the Rochester Epidemiology Project database. The yearly incidence rate was calculated. The impact of NAFLD on incident MC, CV events and mortality was studied using a multi-state model, with a 4:1 age and sex-matched general population as reference. We identified 3,869 NAFLD subjects (median age 53, 52% women) and 15,209 controls; median follow-up was 7 (1 to 20) years. NAFLD incidence increased 5-fold, from 62 to 329/100,000 person-years. The increase was highest (7-fold) in young adults, age 18-39 years. The 10-year mortality was higher in NAFLD subjects (10.2%) than controls (7.6%) (p<0.0001). NAFLD was an independent risk factor for incident MC and death. Mortality risk decreased as the number of incident MC increased: RR= 2.16 (95% CI 1.41-3.31), 1.99 (95% CI 1.48-2.66), 1.75 (95% CI 1.42-2.14) and 1.08 (95% CI 0.89-1.30) when 0, 1, 2, or 3 MC were present, respectively. The NAFLD impact on CV events was significant only in subjects without MC (RR=1.96, 95% CI=1.35-2.86). NAFLD reduced life expectancy by 4 years, with more time spent in high metabolic burden. Conclusion: The incidence of NAFLD diagnosis in the community has increased 5-fold, particularly in young adults. NAFLD is a consequence but also a precursor of MC. Incident MC attenuates the impact of NAFLD on death and annuls its impact on CV disease. This article is protected by copyright. All rights reserved.

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Hepatitis C Virus Testing for Case Identification in Persons Born during 1945-1965: Results from Three Randomized Controlled Trials

ABSTRACT

CDC and U.S. Preventive Services Task Force recommend one-time hepatitis C virus (HCV) testing for persons born during 1945-1965 (birth cohort). However, few studies estimate the effect of birth cohort (BC) testing implementation on HCV diagnoses in primary care settings. We aimed to determine the probability of identifying HCV infections in primary care using targeted BC testing compared with usual care at three academic medical centers. From December 2012 to March 2014, each center compared one of three distinct interventions to usual care using an independently-designed randomized controlled trial. Across centers, BC patients with no clinical documentation of previous HCV testing or diagnosis were randomly assigned to receive a one-time offering of HCV antibody (anti-HCV) testing via one of three independent implementation strategies (repeated-mailing outreach, EMR-integrated provider best practice alert [BPA], and direct patient-solicitation) or assigned to receive usual care. We estimated model-adjusted risk ratios (aRR) of anti-HCV positive (anti-HCV+) identification using BC testing versus usual care. In the repeated-mailing trial, 8,992 patients (intervention=2,993; control=5,999) were included in the analysis. The intervention was eight times as likely to identify anti-HCV+ patients compared with control (aRR 8.0, 95%CI 2.8-23.0; adjusted probabilities: intervention=0.27%; control=0.03%). In the BPA trial, data from 14,475 patients (BC=8,928; control=5,547) were analyzed. The intervention was 2.6 times as likely to identify anti-HCV+ patients versus control (aRR 2.6, 95%CI 1.1-6.4; adjusted probabilities: intervention=0.29%; control=0.11%). In the patient-solicitation trial, 8,873 patients (BC=4,307; control=4,566) were analyzed. The intervention was five times as likely to identify anti-HCV+ patients compared with control (aRR 5.3, 95%CI 2.3-12.3; adjusted probabilities: intervention=0.68%; control=0.11%). Conclusion: BC testing was effective in identifying previously undiagnosed HCV infections in primary care settings. This article is protected by copyright. All rights reserved.

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Plasma biomarkers to diagnose alcoholic hepatitis – are we there yet?

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Two cases of benign fibrous histiocytomas (dermatofibromas) associated with Langerhans cell histiocytosis

Abstract

We report two cases of fibrous histiocytoma (FH) associated with discrete nodular aggregates of Langerhans cells (LCs) resembling Langerhans cell histiocytosis (LCH). In addition, the LCs showed positivity for BRAF V600E immunohistochemistry, a finding reported in neoplastic but not reactive LCs ¹. To our knowledge, these cases represent the first published association of FH and LCH.

This article is protected by copyright. All rights reserved.

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Hypoglycaemia Represents a Clinically Significant Manifestation of PIK3CA- and CCND2-Associated Segmental Overgrowth

The PI3K-AKT signalling cascade has a highly conserved role in a variety of processes including cell growth and glucose homoeostasis. Variants affecting this pathway can lead to one of several segmental overgrowth disorders. These conditions are genetically heterogeneous and require tailored, multidisciplinary involvement throughout life. Hypoglycaemia is common in other overgrowth syndromes but has been described only sporadically in association with PIK3CA and CCND2 variants. We report a cohort of 6 children with megalencephaly-capillary malformation syndrome (MCAP) and megalencephaly-polydactyly-polymicrogyria-hydrocephalus syndrome (MPPH) who developed clinically significant hypoglycaemia. Based on our findings, we suggest that segmental overgrowth patients should be screened for low blood glucose levels during childhood and there should be early specialist endocrine review in any children who develop hypoglycaemia.

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The Significance of L1CAM Expression in Clear Cell Carcinoma of the Endometrium

Abstract

Clear cell carcinoma is an uncommon histotype of endometrial carcinoma, representing less than 1% of cases (1). Although clear cell carcinoma is generally considered to be a clinically aggressive, "high risk" cancer (2), reported patient outcomes have been markedly variable at every stage of disease (3-8), possibly reflecting an underlying biologic heterogeneity that is inherent to the histotype (9). Indeed, somatic mutation profiling of cases classified as clear cell carcinoma have shown them to be markedly heterogeneous at the molecular level, with subsets resembling serous carcinomas, endometrioid carcinoma, neither, or both (10-12).

This article is protected by copyright. All rights reserved.

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Labile carbon ‘primes’ fungal use of nitrogen from submerged leaf litter

Abstract

Microbial decomposers colonising submerged leaf litter are in close spatial proximity with periphytic algae and can use carbon (C) exudates released during photosynthesis. We investigated whether labile C delivered as algal exudates could affect the microbial colonisation and decomposition of leaf litter. Using microcosms, we submerged leaf litter in pond water and monitored fungal and bacterial growth over time and tested the effect of algal photosynthetic exudates by comparing microcosms in light and dark. In order to experimentally assign the effect of algal products to labile C delivery and test for a C driven mechanism, we ran a parallel experiment with microcosms in the dark where we mimicked the delivery of algal labile C by continuously adding glucose. Labile C delivered as algal exudates or glucose resulted in a dominance of fungal decomposers over bacteria, and stimulated the acquisition of more N-rich OM fractions from litter during periods of active fungal growth. Our results highlight that labile C stimulates fungal decomposers and increases N removal from leaf litter. Since fungal necromass is more resistant to degradation than bacterial, we expect that a fungal-dominated litter degradation might contribute to more protected C pools.

http://ift.tt/2wEGij7

Identification and characterization of bacterial symbionts in three species of filth fly parasitoids

Abstract

Facultative bacterial symbionts are widespread among insects and have diverse effects on their biology. Here, we focused on bacterial symbionts of three ecologically and economically important filth flies parasitoid species—Spalangia cameroni, Spalangia endius and Muscidifurax raptor. Both Spalangia species harbored a Sodalis bacterium that is closely related to Spalangia praecaptivus (a free-living bacterium) and to Sodalis symbionts of weevils. This is the only case of Sodalis infection in the important order Hymenoptera. We also found, for the first time in this parasitoid guild, a Rickettsia infecting the two Spalangia spp., albeit in much higher prevalence in S. cameroni. Molecular and phylogenetic analyses revealed that it is closely related to Rickettsia felis and other Rickettsia species from the 'transitional' group. All three parasitoid species harbored Wolbachia. Using multi-locus sequence typing, we found that M. raptor harbors a single Wolbachia strain whereas the Spalangia spp. have multiple strains. By controlled crossings, we found that Wolbachia infection in S. endius causes incomplete cytoplasmic incompatibility and increased longevity, thereby promoting Wolbachia's spread. In contrast, no effects of Wolbachia on the reproduction and longevity of M. raptor were found. This study underscores the diversity and nature of symbiotic interactions between microbes and insects.

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Retention of seed trees fails to lifeboat ectomycorrhizal fungal diversity in harvested Scots pine forests

Abstract

Fennoscandian forestry has in the past decades changed from natural regeneration of forests towards replantation of clear-cuts, which negatively impacts ectomycorrhizal fungal (EMF) diversity. Retention of trees during harvesting enables EMF survival, and we therefore expected EMF communities to be more similar to those in old natural stands after forest regeneration using seed trees compared to full clear-cutting and replanting. We sequenced fungal internal transcribed spacer 2 (ITS2) amplicons to assess EMF communities in 10- to 60-year-old Scots pine stands regenerated either using seed trees or through replanting of clear-cuts with old natural stands as reference. We also investigated local EMF communities around retained old trees. We found that retention of seed trees failed to mitigate the impact of harvesting on EMF community composition and diversity. With increasing stand age, EMF communities became increasingly similar to those in old natural stands and permanently retained trees maintained EMF locally. From our observations, we conclude that EMF communities, at least common species, post-harvest are more influenced by environmental filtering, resulting from environmental changes induced by harvest, than by the continuity of trees. These results suggest that retention of intact forest patches is a more efficient way to conserve EMF diversity than retaining dispersed single trees.

http://ift.tt/2vpVT4S

All the Right Noises: Background Variability Helps Early Word Learning

Abstract

Variability is prevalent in early language acquisition, but, whether it supports or hinders learning is unclear; while target variability has been shown to facilitate word learning, variability in competitor items has been shown to make the task harder. Here, we tested whether background variability could boost learning in a referent selection task. Two groups of 2-year-old children saw arrays of one novel and two known objects on a screen, and they heard a novel or known label. Stimuli were identical across conditions, with the exception that in the constant color condition objects appeared on a uniform white background, and in the variable color condition backgrounds were different, uniform colors. At test, only children in the variable condition showed evidence of retaining label-object associations. These data support findings from the adult memory literature, which suggest that variability supports learning by decontextualizing representations. We argue that these data are consistent with dynamic systems accounts of learning in which low-level entropy adds sufficient noise to the developmental system to precipitate a change in behavior.

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Cancers, Vol. 9, Pages 129: Alcohol Misuse Link to POEMS Syndrome in a Patient

Cancers, Vol. 9, Pages 129: Alcohol Misuse Link to POEMS Syndrome in a Patient

Cancers doi: 10.3390/cancers9100129

Authors: John Neary Susan Goodwin Lawrence Cohen Manuela Neuman

Previously called Crow–Fukase syndrome, POEMS syndrome is characterized by poly-neuropathy, osteo-sclerotic myeloma, organomegaly, endocrinopathy, monoclonal plasma cell disorder, and skin changes. Extremely elevated levels of serum vascular endothelial growth factor (VEGF) are characteristic of the syndrome. Chronic hepatitis B (HBV) and C (HCV) infections can also be present in POEMS. The pathogenesis of the syndrome is not well understood. The link between chronic alcohol consumption and this malignant condition has not been reported until now. In addition, no previous study has evaluated the influence of cytokine and chemokines or viruses in the severity and evolution of POEMS. Objectives: (1) to describe a heavy-alcohol user, who was diagnosed with POEMS; (2) to demonstrate the utility of quantitative measurement of serum levels of VEGF in the diagnosis of POEMS and the monitoring of therapeutic interventions; (3) to demonstrate that overproduction of pro-inflammatory cytokines is a characteristic of POEMS. Methods: We describe a case of a POEMS patient presenting HCV and who is a heavy drinker; we compare the serum levels of cytokines and chemokines between the POEMS patient with 80 patients with HCV, 12 healthy controls, and 80 individuals with alcoholic liver disease (ALD). We quantified (ELISA pg/mL) the levels of VEGF, Interferon gamma (IFN-γ), Tumor Necrosis Factor alpha (TNF-α), Regulated-upon-Activation Normal-T-cell-Expressed and presumably-Secreted (RANTES), and Nuclear Factor kappa-B (NFκB). Results: In POEMS patients, VEGF levels were elevated versus control or other diseases, TNFα levels were higher versus control, but lower when compared with HCV or ALD patients. VEGF levels in POEMS patients decreased with therapeutic intervention. Conclusions: Chronic alcohol misuse can be a strong risk factor to rare malignancies such as POEMS syndrome. Extreme elevation of VEGF levels is diagnostic for POEMS syndrome, and should be followed to assess response to therapy. In addition, other comorbidities should be considered individually to ensure personalized therapeutic intervention.

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Trichostatin A preferentially reverses the upregulation of gene expression levels induced by gain of chromosome 7 in colorectal cancer cell lines

Abstract

Epithelial cancers are defined by a tumor-specific distribution of chromosomal aneuploidies that are maintained when cells metastasize and are conserved in cell lines derived from primary tumors. Correlations between genomic copy number and gene expression have been observed for different tumors including, colorectal (CRC), breast and pancreatic cancer. These ploidy-driven transcriptional deregulations are characterized by low-level expression changes of most genes on the affected chromosomes. The emergence of these aberrations at an early stage of tumorigenesis and the strong selection for the maintenance of these aneuploidies suggests that aneuploidy-dependent transcriptional deregulations might contribute to cellular transformation and maintenance of the malignant phenotype. The histone deacetylase inhibitor (HDACi) Trichostatin A (TSA) has anticancer effects and is well known to lead to large scale gene expression changes. Here we assessed if TSA could disrupt the aneuploidy-driven gene expression in the aneuploid colon cancer cell line SW480 and the artificially generated aneuploid cell line DLD-1 + 7. We found that TSA increases transcriptional activity throughout the genome, yet inhibits aneuploidy-induced gene expression changes on chromosome 7. Among the TSA affected genes on chromosome 7 we identified potential CRC oncogenes. These experiments represent the first attempt to explain how histone acetylation affects aneuploidy-driven gene expression changes. This article is protected by copyright. All rights reserved.

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Spotlight on reticular pseudodrusen

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Quantifying metamorphopsia with M-CHARTS in patients with idiopathic macular hole

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Comparison of a hydrogel corneal inlay and monovision laser in situ keratomileusis in presbyopic patients: focus on visual performance and optical quality

http://ift.tt/2hlZU8o

Differential association of elevated inflammatory cytokines with postoperative fibrous proliferation and neovascularization after unsuccessful vitrectomy in eyes with proliferative diabetic retinopathy

http://ift.tt/2hpBbfP

Posterior vitreous detachment - prevalence of and risk factors for retinal tears

http://ift.tt/2hoAjru

Ectasia following small-incision lenticule extraction (SMILE): a review of the literature

http://ift.tt/2hoffoN

Modified 30 G needle trypan blue staining technique under air for a uniform and consistent anterior capsule staining

http://ift.tt/2jtxKca

Effect of topical 3% diquafosol sodium on eyes with dry eye disease and meibomian gland dysfunction

http://ift.tt/2hn6Dih

Comparison of intraocular pressure fluctuations before and after ab interno trabeculectomy in pseudoexfoliation glaucoma patients

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In vitro release of two anti-muscarinic drugs from soft contact lenses

http://ift.tt/2hof8tn

Approach to MPN Symptom Assessment

Abstract

Purpose of Review

Myeloproliferative neoplasms (MPNs) are recognized for their debilitating symptom burdens. The purpose of this review is to understand the complexity of the MPN symptom burden and identify how validated MPN Patient Reported Outcome (PRO) tools may be integrated into clinical practice to assess the MPN symptom burden.

Recent Findings

Significant heterogeneity exists both within and between MPN subtypes. Surrogates of disease burden such as risk scores and MPN chronicity often fail to correlate with symptomatic burden. Validated MPN PROs allow for precise and rapid assessment of the MPN symptom burden in clinical and trial settings. Their growing use among investigators has resulted in improved understanding of how the MPN disease burden and overall patient experience is impacted by novel and traditional therapies.

Summary

PRO tools are an integral part of National Comprehensive Cancer Center (NCCN) guidelines for MPN treatment and should be regularly employed in disease burden assessment.

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Status of implementation and organization of cancer screening in the European Union Member States - summary results from the second European screening report

Abstract

The second report on the implementation status of cancer screening in European Union (EU) was published in 2017. The report described the implementation status, protocols and organization (updated till 2016) and invitation coverage (for index year 2013) of breast, cervical and colorectal cancer screening in the EU. Experts in screening programme monitoring (N=80) from the EU Member States having access to requisite information in their respective countries provided data on breast, cervical and colorectal cancer screening through online questionnaires. Data was collected for screening performed in the framework of publicly mandated programmes only. Filled in questionnaires were received from 26 Member States for all three sites and from one Member State for breast cancer only.

Substantial improvement in screening implementation using population-based approach was documented. Among the age-eligible women, 94.7% were residents of Member States implementing or planning population-based breast cancer screening in 2016, compared to 91.6% in 2007. The corresponding figures for cervical cancer screening were 72.3% and 51.3% in 2016 and 2007 respectively. Most significant improvement was documented for colorectal cancer screening with roll-out ongoing or completed in 17 Member States in 2016, compared to only five in 2007. So the access to population-based screening increased to 72.4% of the age-eligible populations in 2016 as opposed to only 42.6% in 2007. The invitation coverage was highly variable, ranging from 0.2%-111% for breast cancer, 7.6%-105% for cervical cancer and 1.8%-127% for colorectal cancer in the target populations.

In spite of the considerable progress, much work remains to be done to achieve optimal effectiveness. Continued monitoring, regular feedbacks and periodic reporting are needed to ensure the desired impacts of the programmes. This article is protected by copyright. All rights reserved.

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Clinical trial transparency: a reassessment of industry compliance with clinical trial registration and reporting requirements in the United States

Objective

To evaluate the accuracy of a 2015 cross-sectional analysis published in the BMJ Open which reported that pharmaceutical industry compliance with clinical trial registration and results reporting requirements under US law was suboptimal and varied widely among companies.

Design

We performed a reassessment of the data reported in Miller et al to evaluate whether statutory compliance analyses and conclusions were valid.

Data sources

Information from the Dryad Digital Repository, ClinicalTrials.gov, Drugs@FDA and direct communications with sponsors.

Main outcome measures

Compliance with the clinical trial registration and results reporting requirements under the Food and Drug Administration Amendments Act (FDAAA).

Results

Industry compliance with FDAAA disclosure requirements was notably higher than reported by Miller et al. Among trials subject to FDAAA, Miller et al reported that, per drug, a median of 67% (middle 50% range: 0%–100%) of trials fully complied with registration and results reporting requirements. On reanalysis of the data, we found that a median of 100% (middle 50% range: 93%–100%) of clinical trials for a particular drug fully complied with the law. When looking at overall compliance at the trial level, our reassessment yields 94% timely registration and 90% timely results reporting among the 49 eligible trials, and an overall FDAAA compliance rate of 86%.

Conclusions

The claim by Miller et al that industry compliance is below legal standards is based on an analysis that relies on an incomplete dataset and an interpretation of FDAAA that requires disclosure of study results for drugs that have not yet been approved for any indication. On reanalysis using a different interpretation of FDAAA that focuses on whether results were disclosed within 30 days of drug approval, we found that industry compliance with US statutory disclosure requirements for the 15 reviewed drugs was consistently high.

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Fulminant myocardial bleeding: another clinical course of vascular Ehlers-Danlos Syndrome

Vascular Ehlers-Danlos Syndrome (vEDS) is a dominantly inherited connective tissue disorder characterised by colon rupture and arterial aneurysm, dissection and rupture. A patient was diagnosed with vEDS after a spontaneous colon rupture when he was brought to our institute because of sudden chest pain. An ECG revealed wide regional ST elevation, which was initially suggestive of acute myocarditis. On the second day, haemodynamics suddenly deteriorated because of a rapid accumulation of bloody pericardial effusion, and the patient died. Autopsy revealed an excessive spontaneous myocardial haemorrhage owing to fragility, which suggested an underlying disease—vEDS.

http://ift.tt/2xvCwLd

Congenital melanocytic nevus mimicking a turban tumour in an 18-year-old Filipino male

Congenital melanocytic nevi (CMN) are nevi that are present at birth or arise within the first few weeks of life. They are often found on the trunk, head and neck and extremities. We report herein an unusual presentation of a CMN as a cerebriform tumour presenting as secondary cutis verticis gyrata on the scalp of an 18-year-old Filipino male.

http://ift.tt/2wNrDkh

Microbubble-enhanced ultrasound to demonstrate urethral transection in a case of penile fracture

A 47-year-old man attended the emergency department following trauma during sexual intercourse after which he developed penile swelling and haematuria several hours later. A penile fracture was suspected but given the slightly atypical history, ultrasound was performed to look for a fracture. Given the history of haematuria, both a standard Doppler ultrasound and a microbubble-enhanced retrograde ultrasound urethrogram were performed. The Doppler confirmed the suspected diagnosis of penile fracture, and microbubble urethrogram demonstrated a urethral injury. This facilitated prompt surgical treatment and helped guide the surgical approach. Retrograde microbubble enhanced ultrasound urethrogram is a novel technique that can be used in conjunction with standard ultrasound to confirm the presence of a concurrent urethral rupture in penile fracture.

http://ift.tt/2xvtm12

Case of methaemoglobinaemia caused by tree oils and kerosene

We report a case of a young man who allegedly consumed 100 mL of an indigenous pesticide which is used for the killing of rats in households in India. The constituents were azadirachtin oil (40%), tea oil (15%), pine oil (25%) and kerosene oil (20%). He presented to us with shortness of breath and altered sensorium and was found to have fMetHb (fraction of methaemoglobin) level of 80%, which has been postulated to have a fatal outcome. He responded to a low dose of methylene blue along with intravenous vitamin C and the level of fMetHb came down to 20% within 1 hour. His sensorium improved markedly with a decrease in fMetHb to non-toxic levels and he was discharged 5 days after admission. A literature review pertaining to these constituents individually or in combination causing methaemoglobinaemia is discussed in the context of this case.

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Catastrophic cement reaction following cementation for megaprosthesis for proximal femoral fracture

Bone cement implantation syndrome (BCIS) is a well-described and potentially fatal complication of orthopaedic surgery involving pressurised bone cement. Although also described for certain spinal procedures, it is most commonly associated with cemented hip and knee arthroplasty and with cemented hemiarthroplasty following neck of femur fracture in particular.

Donaldson et alproposed the definition of BCIS as a syndrome "characterized by hypoxia, hypotension or both and/or unexpected loss of consciousness occurring around the time of cementation, prosthesis insertion, reduction of the joint or, occasionally, limb tourniquet deflation in a patient undergoing cemented bone surgery". Other features include increased vascular resistance, cardiac arrhythmias and cardiac arrest post cement use.

We describe a case of a patient who suffered a catastrophic reaction to cement during surgery for a comminuted proximal femoral fracture.

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Endoscopic surgical management of a large Morel-Lavallee lesion

The Morel-Lavallée lesion is a closed degloving injury that usually occurs following high-energy trauma. We present a case demonstrating endoscopic management of this lesion. A 44-year-old man fell from scaffolding. Initial assessment demonstrated no significant injury. An ultrasound scan 2 days post injury revealed a large fluid collection along the lateral right thigh. This subsequently became infected and did not respond to antibiotic therapy.

Due to the extent of the lesion, we were reluctant to perform a traditional open drainage. An endoscopic probe was inserted at the proximal and distal poles of the lesion and the wound debrided.

This resulted in a rapid improvement in symptoms and a complete resolution of the lesion at 1 year postsurgery, with no wound-associated morbidity.

This is only the second description of endoscopic debridement of a large, acute Morel-Lavallée lesion, with an excellent outcome.

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Disseminated herpes zoster causing acute respiratory distress syndrome in an immunocompetent patient

Disseminated cutaneous varicella herpes zoster with visceral involvement is rare and seen almost exclusively in immunocompromised patients. We describe an unusual case of fulminant herpes zoster (HZ) in a healthy, immunocompetent 37-year-old woman. She initially presented to an urgent care centre with a classic HZ rash localised to her neck, and upper respiratory symptoms and was treated with prednisone and cephalexin. Within 1 week, the rash became diffuse and her clinical status rapidly deteriorated with development of severe acute respiratory distress syndrome. Varicella zoster infection was confirmed via skin biopsy, bronchial viral PCR and serology for varicella antibodies. She was successfully treated with intravenous acyclovir and aggressive supportive care. Though physicians readily recognise typical zoster infection, this case reminds clinicians that HZ infection can be fulminant and potentially life-threatening in younger, immunocompetent individuals. Early recognition and antiviral therapy is important to reduce morbidity and mortality.

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The entrapped twin: a case of fetus-in-fetu

Fetus-in-fetu (FIF) is a rare entity in which malformed parasitic twin grows inside the body of its twin. It is most commonly presented with mass in the abdomen. We present a case of a 15-year-old boy who presented with abdominal mass since infancy. Radiological investigations are suggestive of FIF. Intraoperatively, malformed fetus in a sac was found and excised. Postoperatively the patient recovers well and was put on follow-up.

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Nasofrontal dermoid sinus

Description

A 19-year-old woman presented with recurrent episodes of headache and intermittent caseous discharge from a midline pit near the rhinion, since childhood. There was no fever, nausea, vomiting or seizure. Physical examination revealed a widened nasal bridge and a midline aperture with a protruding hair. Patient's neurological examination was normal. A contrast-enhanced CT scan of the head showed a small hypodense lesion at the anterior basifrontal region. T1-weighted MRI images identified a hyperintense intracranial lesion, which showed suppression with fat suppression sequences. T2-weighted images also revealed a high signal lesion modelling the cerebral parenchyma (figure 1), with a small tract going up to the nasal bridge (figure 2). The patient was diagnosed with a nasofrontal dermoid cyst with the extracranial nasal sinus tract and surgical excision was proposed. The histopathological analysis confirmed the previous diagnosis.

Figure 1

Coronal T2-weighted MRI image showing a hyperintense...

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Successful treatment using rituximab in a patient with refractory polymyositis complicated by scleroderma renal crisis

Corticosteroids are the first-line treatment for patients with inflammatory myopathies. Myositis can be a clinical feature of scleroderma (polymyositis–scleroderma overlap syndrome), and treatment of this syndrome is a challenge for clinicians because moderate to high doses of corticosteroids are considered a risk factor for development of acute kidney injury in affected patients. We report here the case of a 56-year-old woman with scleroderma who developed polymyositis and was successfully treated with rituximab. Initial treatment of the polymyositis with prednisolone 40 mg/day was rapidly tapered to 2.5 mg/day due to development of scleroderma renal crisis, for which four weekly infusions of rituximab (500 mg; off-label) were given. She responded well to rituximab in addition to prednisolone 2.5 mg/day. Rituximab may improve inflammatory myopathies, even in cases where high-dose corticosteroids should be avoided due to complications. Rituximab should be considered as a treatment option in cases of refractory polymyositis.

http://ift.tt/2wNBPt5

Extreme bony pelvic deformity in a renal transplant patient

A 35-year-old female renal transplant recipient was referred to the metabolic bone clinic because of a 15 cm loss of height. She was noted to have thoracic kyphosis and vertebral X-ray confirmed a wedge fracture of the eighth thoracic vertebra. She was managed accordingly but on subsequent follow-up mentioned in passing that her gynaecologist had been unable to obtain a cervical smear for routine screening. This led to further questioning, and the patient reported intermittent urinary stress incontinence, feelings of vaginal fullness and severe dyspareunia. It became apparent that these symptoms had been ongoing for 4 years, but the patient had not brought them to the attention of a healthcare practitioner due to feelings of embarrassment and her religious beliefs. These complaints prompted radiological investigation, which revealed extensive bony pelvic deformity, thought to be an extreme manifestation of chronic kidney disease mineral and bone disorder.

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Rapidly enlarging lipoma

Lipoma is a common subcutaneous tumour composed of fat tissue. It may occur as a sporadic solitary lesion or as multiple lesions. They often grow very slowly. They vary between 2 and 10 cm in size. There are rarely any subjective symptoms. Lipomas do not usually require treatment unless they are big enough to be symptomatic. We reported a 75-year-old man with a rapidly enlarging and ulcerated mass on his right upper thigh.

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Asymptomatic pyogenic liver abscesses secondary to Fusobacterium nucleatum and Streptococcus vestibularis in an immunocompetent patient

A 66-year-old male patient presented with symptoms and signs of L4/5 radiculopathy. He was found to be anaemic with elevated inflammatory markers and deranged hepatic enzymes. Imaging revealed lumbar canal stenosis and the presence of pyogenic liver abscesses from which Fusobacterium nucleatum and Streptococcus vestibularis were isolated. The hepatic abscesses were attributed to asymptomatic diverticular perforation. Multiple coexisting incidental infections were discovered, including oesophageal candidiasis, Helicobacter pylori, stool cultures positive for Strongyloides stercoralis, and sputum cultures positive for Enterobacter cloacae, Escherichia coli and Mycobacterium avium. Extensive investigations for possible underlying immunosuppression were negative.

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Severe unicuspid aortic valve stenosis: VACTERL association

Description

A 24-year-old man with a known history of horseshoe kidney leading to end-stage renal disease, scoliosis and small ventricular septal defect consistent with VACTERL association, who presented with worsening dyspnoea on exertion. Transthoracic echocardiogram (TTE) showed a unicuspid aortic valve (UAV) with severe aortic stenosis (AS) (valve area of 0.6 cm² and mean gradient of 44 mm Hg). TTE also showed moderate aortic insufficiency and severely reduced left ventricular systolic function with estimated ejection fraction of 20%. Transoesophageal echocardiography (TEE) confirmed a UAV with single commissure located anteriorly (figure 1A–D; online  and ) and severe AS (figure 1B, C). In preparation for surgical repair, chest CT angiogram showed dilated ascending aorta measuring 4 cm with no evidence of aortic dissection. The patient underwent aortic valve replacement surgery with 21 mm CarboMedics mechanical valve. TEE showed a well-seated prosthesis without evidence of paravalvular leak (figure 1E). The patient...

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PHACE syndrome in a child with segmental IH of face

Description

An 8-month-old female infant was referred for paediatric and dermatology consultation for evaluation of a facial haemangioma with progressive growth since the first days of life. The observation showed a large segmental infantile haemangioma (IH) over the right face (figure 1), a small vulvar haemangioma and exotropia of the right eye.

Figure 1

Right facial segmental infantile haemangioma at the level of the mandible, with extension to the lower lip.

Due to the segmental appearance of the facial IH, we prompted the investigation of PHACE syndrome, an acronym corresponding to a set of alterations: Posterior fossa anomalies, Haemangioma, Arterial lesions, Cardiac abnormalities/coarctation of the aorta alterations and Eye anomalies.1

The MR angiography showed an absence of the right internal carotid artery, with circulation assured through the circle of Willis (figure 2). Ophthalmology assessment revealed microphthalmia and...

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A rare highly aggressive tumour: lymphoepithelioma-like thymic carcinoma

Lymphoepithelioma-likethymic carcinoma is a rare neoplasm that presents with compressive symptoms or as an incidental radiological finding of an anterior mediastinal mass. It is an aggressive carcinoma with a high rate of invasion, metastasis and recurrence. Its diagnosis usually carries a poor prognosis largely due to propensity for late diagnosis. To date, guidance for treatment remains limited. This is a case of lymphoepithelioma-like thymic carcinoma in a young male adult who presented initially with back pain. Despite prompt initiation of chemotherapy with cisplatin, doxorubicin and cyclophosphamide, he had a complicated hospital course leading to demise within 2 months of diagnosis.

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Dog bites and diabetic peripheral neuropathy: a dangerous combination

All animal bites have the potential to cause significant infection. In the UK, dogs are the most common source of bites. Incidence of hospital attendances attributable to dog bites has risen over the last decade. Patient groups at particular risk of bites and/or complications of infection include those at extremes of age, immunosuppressed and patients with diabetes. We report the case of a patient with diabetic peripheral neuropathy, who was admitted on two separate occasions with unprovoked bites to his toes whilst asleep, by his pet dog. He ultimately required terminalisation of the affected digits. Although unusual, this mechanism of injury has been previously described in literature. However, we are unaware of cases reporting multiple separate incidences involving the same patient and animal. We present this case to highlight the perils of untrained pet ownership in diabetic patients with peripheral neuropathy and the importance of prompt medical and surgical treatment of injuries.

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When all else fails: supervised treatment in outpatient for schizophrenia (STOPS)

This was about a case of a patient requiring admission to psychiatry ward twice a year for relapse schizophrenia due to medication non-compliance. Medication adherence was previously monitored by her husband. However, following the death of her husband, she stopped treatment. The lack of insight and poor family support further contributed to her relapse. She presented with positive and negative symptoms of schizophrenia during her relapse, neglecting her hygiene and oral intake. She was also found to have anaemia as a result of poor diet when she was in relapse. Community psychiatry services had attempted to ensure compliance with postdischarge plan but failed as patient was not present every home visits. Supervised treatment in outpatient for schizophrenia (STOPS) provided an alternative method to ensure compliance in this patient. Patient has remained in remission for 1 year since the use of STOPS.

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Aftermath of induced inflammation: acute periaortitis due to nivolumab therapy

Description

A 57-year-old man with medical history of left upper lobe metastatic squamous cell carcinoma of lung and seizures due to brain metastasis was admitted with acute-onset low back pain. Patient also had a known history of infrarenal aortic and left common iliac artery aneurysm stable on regular surveillance CT over the past 3 years with the most recent CT scan 1 month prior to presentation showing no signs of inflammation around the infrarenal aneurysmal aorta as seen in figure 1. Positron emission tomography 1 year prior to presentation did not show signs of inflammation in the region of aortic aneurysm as shown in figure 2. For his metastatic lung cancer, he was initially started on carboplatin and gemcitabine therapy but unfortunately had progression of cancer in left lung on the regimen. Subsequently, he was placed on nivolumab therapy. After being on the medication for 9 months, patient presented with acute...

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Confusion and abdominal symptoms following a rugby tackle

A 19-year-old man was sent to the emergency department following a pitch-side assessment for suspected concussion, unexplained upper abdominal tenderness and vomiting, following a high-impact tackle during a rugby match. A Focussed Assessment with Sonography for Trauma (FAST) scan performed in the emergency department suggested intra-abdominal free fluid, and subsequent head and abdominal CT imaging showed no intracranial lesion but confirmed a significant haemoperitoneum due to large splenic tear and bleeding. An emergency splenectomy was performed, which confirmed the rupture of an enlarged spleen with blood loss of almost 2 L into the peritoneal cavity. The patient made a full recovery following surgery. A subsequent histological examination revealed granulomatous inflammation characteristic of infectious mononucleosis. This unique case illustrates that physically fit patients with early hypovolaemic shock can present with symptoms mimicking concussion.

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Quantitative analysis of the effect of end-tidal carbon dioxide on regional cerebral oxygen saturation in patients undergoing carotid endarterectomy under general anaesthesia

Summary

Aim

Regional cerebral oxygen saturation (rSO₂) is currently the most used measure in clinical practice to monitor cerebral ischemia in patients undergoing carotid endarterectomy (CEA). Although end-tidal carbon dioxide (P_ETCO₂) is known as a factor that influences rSO₂, the relationship between P_ETCO₂ and rSO₂ has not been quantitatively evaluated in patients with severe arteriosclerosis. This study aimed to evaluate the effect of P_ETCO₂ on rSO₂ in patients undergoing CEA under general anaesthesia.

Methods

The intervention to change P_ETCO₂ was conducted between skin incision and clamping of the carotid artery. The rSO₂ values were observed by changing P_ETCO₂ in the range of 25-45 mmHg. The P_ETCO₂–rSO₂ relationship was characterized by population analysis using a turnover model.

Results

In total, 1,651 rSO₂ data points from 30 patients were used to determine the pharmacodynamic characteristics. Hypertension (HTN) and systolic blood pressure (SBP) were significant covariates on the slope factor in the stimulatory effect of P_ETCO₂ on rSO₂ and fractional turnover rate constant (k_out), respectively. The estimates of the parameters were k_out(min^-1): 3.59 for SBP < 90 mmHg and 0.491 for SBP ≥ 90 mmHg, slope: 0.00321 for patients with HTN and 0.00664 for patients without HTN.

Conclusion

The presence of hypertension attenuates the response of rSO₂ after a change in P_ETCO₂. When cerebral blood flow is in a state of decline caused by a decrease in SBP to less than 90 mmHg, the response of rSO₂ to P_ETCO₂ is increased. It is advisable to maintain SBP above 90 mmHg in patients with hypertension during CEA.

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Exosomes from human adipose derived stem cells promote proliferation and migration of skin fibroblasts

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A novel method to assess the potential role of sweating abnormalities in the pathogenesis of AD

Abstract

Background

Although atopic dry skin is believed to be caused by defects in skin genes important for maintaining skin barrier function, the role of sweat in atopic dermatitis (AD) has been apparently underestimated. Given the great capacity of sweat to maintain and increase skin hydration, defective sweating responses may be a logical place to look for changes that predispose individuals to the disease.

Methods

We investigated how disease process and sweating defects progress from early asymptomatic stages to the onset of clinically apparent disease by employing the impression mold technique, which allows an accurate quantification of individual sweat gland/duct activity in relation to skin surface topography. Insensible and sensible sweating responses under baseline conditions and after thermal stimulus, respectively, were measured in various stages of AD patients and healthy controls.

Results

In controls, under baseline conditions sweat ducts/glands at the dermal folds secreted basal levels of sweat (insensible sweating), thereby maintaining skin hydration. Not only such insensible sweating but also sensible sweating markedly decreased even in the earliest asymptomatic stage and the decrease was followed by compensatory hyperhidrosis at the ridge: leakage of sweat into the dermis could represent the initial event resulting in the decreased sweating and inflammation. The defects eventually progressed involving all of the ducts/glands to develop systemic dry skin.

Conclusion

AD skin is characterized by varying degrees of functional impairment of sweat ducts/glands depending on the stage and this defect would be among the reasons for the inability of AD patients to maintain skin hydration.

This article is protected by copyright. All rights reserved.

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Nanoparticles prepared from porcine cells support the healing of cutaneous inflammation in mice and wound re-epithelialization in human skin

Abstract

Previous reports have demonstrated that cell-derived nanoparticles (CDNPs) composed of bovine or porcine protein complexes exerted therapeutic effects against viral infections and cancer in mice and humans. Based on these observations, we asked whether CDNPs would improve inflammatory skin disorders. To address this, we utilized two distinct mouse models of cutaneous inflammation: the autoimmune skin blistering disease epidermolysis bullosa acquisita (EBA) as an example of an autoantibody-induced cutaneous inflammation, and Leishmania major (L. major) infection as an example of a pathogen-induced cutaneous inflammation. In both models, we observed that CDNPs increased mRNA expression of the Th2 cytokine IL-4. Clinically, CDNPs decreased inflammation due to EBA and increased L. major-specific IgG1 levels without major effects on infected skin lesions. In addition, CDNPs supported the growth of keratinocytes in human skin cultures. In vitro studies revealed that CDNPs were taken up predominantly by macrophages, leading to a shift towards the expression of anti-inflammatory cytokine genes. Altogether, our data demonstrate that treatment with porcine CDNPs may be a new therapeutic option for the control of autoimmune-mediated inflammatory skin disorders.

This article is protected by copyright. All rights reserved.

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Transglutaminases in autoimmune and inherited skin diseases: The phenomena of epitope spreading and functional compensation

Abstract

Transglutaminases (TGs) are structurally and functionally related enzymes that modify the posttranslational structure and activity of proteins or peptides, and thus are able to turn on or switch off their function. Depending on location and activities, TGs are able to modify the signaling, the function and the fate of cells and extracellular connective tissues. Beside mouse models also human diseases enable us to appreciate the function of various TGs. In this paper skin diseases induced by genetic damages or autoimmune targeting of these enzymes will be discussed. TG1, TG3 and TG5 contribute to the cutaneous barrier and thus to the integrity and function of epidermis. TGM1 mutations relate to autosomal recessive ichthyosis subtypes, TGM5 mutations to a mild epidermolysis bullosa phenotype and as novelty TGM 3 mutation to uncombable hair syndrome will be discussed. Autoimmunity to TG2, TG3 and TG6 may develop in a few of those genetically determined individuals who lost tolerance to gluten, and manifest as celiac disease, dermatitis herpetiformis or gluten-dependent neurological symptoms, respectively. These gluten responder diseases commonly occur in combination. In autoimmune diseases the epitope spreading is remarkable, while in some inherited pathologies a unique compensation of the lost enzyme function is noted.

This article is protected by copyright. All rights reserved.

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The Graham–Cassidy Plan — The Most Harmful ACA-Repeal Bill Yet

New England Journal of Medicine, Ahead of Print.


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Reply to “MRI Assessment of Sacroiliac Joints According to Assessment in SpondyloArthritis International Society Criteria”

American Journal of Roentgenology, Volume 209, Issue 4, Page W252-W252, October 2017.


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Correction

American Journal of Roentgenology, Volume 209, Issue 4, Page 949-949, October 2017.


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Injectable Viscoelastic Supplements: A Review for Radiologists

American Journal of Roentgenology, Volume 209, Issue 4, Page 883-888, October 2017.


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Improving Your Reviewer Score: It's Not That Difficult

American Journal of Roentgenology, Volume 209, Issue 4, Page 711-712, October 2017.


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MRI Assessment of Sacroiliac Joints According to Assessment of SpondyloArthritis International Society Criteria

American Journal of Roentgenology, Volume 209, Issue 4, Page W251-W251, October 2017.


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Macro- and Microelement Status in Animal and Human Hypertension: the Role of the ACE Gene I/D Polymorphism

Abstract

Genetic factors that predispose to hypertension may contribute to element disturbances observed in hypertensive patients. We tested the hypothesis that the deletion allele of the angiotensin-converting enzyme (ACE) gene is associated with element imbalances in hypertension. The concentrations of elements in genetically predisposed to hypertension rats (SHRs) and their controls (WKY rats) were also examined. ICP-MS was used for elemental analysis of human hair and animal fur. Genotyping was performed by PCR. We also measured micronuclei frequency and distribution of peripheral blood leukocytes in cell cycle phases by flow cytometry and studied the correlations of these parameters with element contents. In general, the tendency for higher levels of toxic and lower levels of essential elements is observed in hypertension, specifically in patients carrying the D allele. Hypertensive men had significantly higher Be, V, Cr, As, Mo, Ag, Sb, and Na levels and lower Ca, Zn, Ba, and U levels compared with control subjects; the differences were not significant for Mg, Al, K, Mn, Fe, Co, Ni, Cu, Se, Cd, Tl, Pb, and Th. The D allele was associated with higher Be, Mo, and Th levels and lower Zn, Se, and Tl levels. The concentrations of Ca, Co, Mo and U were higher in SHR than those in the WKY rats. Mo, an antagonist of Cu, positively correlated with the S-phase cells, and Cu positively correlated with micronuclei frequency. The results suggest an involvement of the ACE I/D polymorphism in element imbalances in hypertension and attract attention to the possible significant role of genetic factors in Mo accumulation.

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Serum Level of Zinc and Copper in Sudanese Women with Polycystic Ovarian Syndrome

Abstract

The study aimed to evaluate the serum level of zinc and copper in women with polycystic ovarian syndrome (PCOS). A case-control study was conducted at Saad Abualila infertility center (Khartoum, Sudan). The cases were women who had a PCOS based on Rotterdam criteria. The controls were infertile women with no evidence of PCOS. The socio-demographic characteristics and medical history data were gathered using questionnaires. Zinc and copper levels were measured using atomic absorption spectrophotometer. While there was no difference in zinc and copper levels between the two groups (50 women in each arm), mean (SD) of body mass index (BMI) was significantly higher in women with PCOS compared to the controls [28.4 (4.2) vs. 25.6 (5.7) kg/m²; P = 0.006], respectively. There were no significant differences in the level of luteinizing hormone (LH), follicle stimulating hormone (FSH), LH/FSH, prolactin, testosterone, cholesterol, triglycerides and low-density lipoprotein (LDL) between the cases and the controls. In linear regression analyses, none of the investigated factors were associated with PCOS. Zinc and copper were not associated with PCOS in this setting.

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Trace Element Levels in Scalp Hair of School Children in Shigatse, Tibet, an Endemic Area for Kaschin-Beck Disease (KBD)

Abstract

Kaschin-Beck disease (KBD) is an endemic osteoarthritis, and the etiology is closely related with levels of trace elements in the human body. Currently, it is clear that the selenium (Se) status of children in KBD areas is lower than that in non-KBD areas in the Tibetan Plateau, whereas role of other elements are yet unknown. This study aimed to assess some essential trace elements (Se, Mo, Mn, Zn, Fe, Cu, Co, and Sr) in children using scalp hair as a biomarker, and 157 samples from school children aged 8–14 years old were collected from both KBD and non-KBD areas in Shigatse, Tibet. Se and Mo were measured by inductive coupled plasma mass spectrometry, and the other elements were determined by inductive coupled plasma optical emission spectrometry. Compared with the non-KBD areas, Se, Mo, Mn, Fe, Zn, Co, and Sr levels of children in KBD areas were found to be significantly different (P < 0.05); while in linear discriminant analysis, only Se and Zn were found to contribute to the KBD prevalence in the study area. The hair Se level of children in KBD areas ranged from 0.115 to 0.299 mg/kg, while in non-KBD areas it ranged from 0.135 to 0.519 mg/kg. The Zn content of children's hair was between 83 and 207 mg/kg in KBD areas, while it was 37 and 219 mg/kg in non-KBD areas. Lower Se and higher Zn levels in children in KBD areas was found when compared with non-KBD groups. In addition, Mo levels were found to be different between KBD areas and non-KBD areas on the opposite side of the Yarlung Zangbo River, but no close relationship was shown because there was no difference compared with the non-KBD area on the same side of the river. Our observations suggest that Se deficiency is still an important factor for the occurrence and prevalence of KBD, while the relationship between Zn and KBD needs to be further explored in the Tibetan Plateau.

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Dietary Intake of Minerals, Vitamins, and Trace Elements Among Geriatric Population in India

Abstract

The geriatric population is at a high risk of developing deficiencies of essential micronutrients such as minerals, vitamins, and trace elements and their related deficiency signs and symptoms. Scarce data is available on the dietary intake of essential micronutrients among geriatric subjects in India. Hence, to fill the gap in the existing knowledge, a community-based cross-sectional study was conducted during 2015–2016 in District Nainital, Uttarakhand State, India. A total of 255 geriatric subjects were enrolled from 30 clusters (villages) identified by using population proportionate to size sampling methodology. Data were collected on sociodemographic profile and dietary intake of essential micronutrients (24-h dietary recall, food frequency questionnaire) from all the geriatric subjects. A high percentage of geriatric subjects did not consume the recommended daily intake for essential micronutrients such as energy (78%), protein (78%), calcium (51%), thiamine (33%), riboflavin (64%), niacin (88%), vitamin C (42%), iron (72%), folic acid (72%), magnesium (48%), zinc (98%), copper (81%) and chromium (89%) adequately. Food groups rich in essential micronutrients such as pulses, green leafy vegetables, roots and tubers, other vegetables, fruits, nonvegetarian food items, and milk and milk products were consumed irregularly by the subjects. The overall intake of energy and essential micronutrients was inadequate among the geriatric population in India, possibly due to poor quality and quantity of the diet consumed.

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Experimental Research Showing the Reduction of Naloxone-Place Aversion by Oral Zinc Administration in Rats

Abstract

Previous studies showed the attenuation of both morphine-dependence and morphine-place preference by zinc. Conditioned place preference and aversion are experimental models frequently used to test the reward-stimulating, respectively the aversive effects induced by different stimuli or substances. Addictive substances usually induce place preference (exhibit reward-stimulating properties), while their antagonists determine place-avoidance (aversion). The present study aimed to assess the effect determined by zinc sulphate oral administration (2 and 4 mg/kg/day, 14 days, prior to habituation) on the place aversion induced by two naloxone doses (1.5 and 2.5 mg/kg/administration). The results show a robust, dose-dependent reduction of the aversion determined by both naloxone doses (the aversion induced by 1.5 mg/kg naloxone was reduced with 15%—the lower zinc dose and with 24%—the higher zinc dose; the aversion induced by 2.5 mg/kg naloxone was reduced with 16%—the lower zinc dose and with 29%—the higher zinc dose). This represents a new proof of the interactions between zinc and opioidergic system and a further argument for dietary zinc supplementation in patients on opioids for cancer-related chronic pain.

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The Concentration of Vanadium in Pathologically Altered Human Kidneys

Abstract

Vanadium has a unique and beneficial effect on both humans and animal organisms; however, excessive amount of the above-mentioned metal can cause many alterations in tissues and organs, including the kidneys. The aim of the study was to determine the concentration of vanadium (V) in the kidneys removed from patients due to lesions of various etiologies, including the rejection of the transplanted kidneys. Additionally, we determined the influence of selected biological and environmental factors on the V concentration. The study material consisted of the kidneys with tumor lesions (n = 27) and extracted kidney grafts (n = 10) obtained from patients from the north-western Poland. The V concentrations were assessed by atomic absorption spectrophotometry emission in inductively coupled argon plasma and expressed in concentrations in dry weight (dw). Statistically significant differences were observed for V concentrations in the renal medulla between the kidneys with tumors and renal grafts, where the lowest concentration of V was observed. The kidneys in more advanced stages of the tumor (T3 + T4) contained more vanadium than the kidneys of T1 + T2 stages and medians were 2.07 and 1.51, respectively. We also compared the V concentration in the kidneys between the renal grafts (K2) and the kidneys with tumor (K1) in two stages of advancement: T1 with T2 (K1_1 + 2) and T3 with T4 (K1_3 + 4). Statistically significant differences were noted between the renal medullae of the above-mentioned groups of kidneys.

According to the previous studies on the concentrations of other heavy metals, renal grafts accumulate less vanadium than cancerous kidneys, what can be associated with the immunosuppressive drugs taken by patients after the transplantation.

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Effects of Excess Dietary Fluoride on Serum Biochemical Indices, Egg Quality, and Concentrations of Fluoride in Soft Organs, Eggs, and Serum of Laying Hens

Abstract

This study was conducted to investigate the effects of excess dietary fluoride (F) on serum biochemical indices, egg quality, and concentrations of F in soft tissues, eggs, and serum of laying hens. Commercial laying hens (n = 576, 51 weeks of age) were randomly allotted to 6 treatments with 6 replicates of 16 birds. The basal diets contained fluorine inclusions at a level of 16 mg/kg, and graded sodium fluoride was added to the basal diet to achieve fluorine inclusions, respectively, at a level of 200, 400, 600, 800, and 1000 mg/kg in the experimental diets. Dietary F levels at 600, 800, and 1000 mg/kg decreased (P < 0.05) albumin height and yolk color, while eggshell strength and eggshell thickness significantly decreased at 800 and 1000 mg/kg, respectively, compared with the control group. Fluoride concentrations in eggshell, albumin, yolk, liver, kidney, ovary, and oviduct responded to dietary F levels positively, and F concentrations in eggshell were the highest. Fluorine concentrations in albumin and yolk increased with the feeding time at the same dietary F levels (P < 0.05). Dietary F level at 400 mg/kg increased serum calcium level and activity of glutamic oxalacetic transaminase (P < 0.05). In conclusion, dietary F levels at 600 mg/kg decreased albumin height and yolk color, while eggshell strength and eggshell thickness significantly decreased at 800 and 1000 mg/kg, respectively. F concentrations in soft tissues, albumin, yolk, and eggshell of layers had a positive correlation with dietary F levels. By disturbing Ca and phosphorus metabolism, dietary F levels affected the formation of eggshell, reducing eggshell strength and eggshell thickness.

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Role of Selenium from Different Sources in Prevention of Pulmonary Arterial Hypertension Syndrome in Broiler Chickens

Abstract

Pulmonary arterial hypertension (PAH) syndrome in broilers is associated with hypoxia, which prevails at high altitude. Oxidative stress is the pathogenic mechanism underlying PAH. Because selenium is key element in the structure of antioxidant enzymes, we evaluated pulmonary hypertensive responses in broiler chickens fed with diets supplemented with organic or nano-selenium. One hundred forty-four broilers (starting at 5 days old) were fed with (i) control group: birds received a standard diet; (ii) nano-selenium group: birds were fed with basal diet supplemented with nano-selenium at 0.3 mg/kg; and (iii) organic selenium group: birds received basal diet supplemented with organic selenium at 0.3 mg/kg. We assessed growth performance, carcass characteristics, antioxidant variables, blood parameters, and small intestine morphology. Although Se supplementation did not affect growth performance, carcass traits, and organ weight (P > 0.05), the right to total ventricular weight ratio (RV:TV), malondialdehyde concentration in the liver, and heterophil to lymphocyte ratio were significantly lower in the nano-selenium group relative to the control (P < 0.05). Chickens that received nano-selenium also elicited significantly higher antibody titers after 24 h of an injection of sheep red blood cells (P < 0.05). Nano-selenium supplementation also significantly increased villus height, absorptive surface area, and lamina propria thickness relative to the control (P < 0.05) in different segments of the small intestine. In contrast, organic selenium supplement improved intestinal morphometry only in the jejunum. We conclude that dietary supplementation of 0.30 mg/kg nano-selenium could prevent right ventricular hypertrophy as reflected by reduced RV:TV, reduced levels of lipid peroxidation in the liver, and improved gut function.

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The Effects of Agaricus blazei Murill Polysaccharides on Cadmium-Induced Apoptosis and the TLR4 Signaling Pathway of Peripheral Blood Lymphocytes in Chicken

Abstract

In this study, we investigated the effects of Agaricus blazei Murill polysaccharides (ABP) on cadmium (Cd)-induced apoptosis and the TLR4 signaling pathway of chicken peripheral blood lymphocytes (PBLs). Seven-day-old healthy chickens were randomly divided into four groups, and each group contained 20 males. The cadmium-supplemented diet group (Cd group) was fed daily with full feed that contained 140 mg cadmium chloride (CdCl₂)/kg and 0.2 mL saline. The A. blazei Murill polysaccharide diet group (ABP group) was fed daily with full feed with 0.2 mL ABP solution (30 mg/mL) by oral gavage. The cadmium-supplemented plus A. blazei Murill polysaccharide diet group (Cd + ABP group) was fed daily with full feed containing 140 mg CdCl₂/kg and 0.2 mL ABP solution (30 mg/mL) by gavage. The control group was fed daily with full feed with 0.2 mL saline per day. We measured the apoptosis rate and messenger RNA (mRNA) levels of apoptosis genes (caspase-3, Bax, and Bcl-2), the mRNA levels of TLR4 and TLR4 signaling pathway-related factors (MyD88, TRIF, NF-κB, and IRF3), the TLR4 protein expression, and the concentrations of inflammatory cytokines (IL-1β, IL-6, and TNF-α) in chicken PBLs. The results showed that the PBL apoptosis rate was significantly increased, the mRNA levels of caspase-3 and Bax were significantly increased, while that of Bcl-2 was significantly reduced. The Bax/Bcl-2 ratio was significantly increased in the Cd group at 20, 40, and 60 days after treatment compared with that in the control group. After treatment with ABP, the above changes were clearly suppressed. At the same time, ABP reduced the concentrations of IL-1β, IL-6, and TNF-α induced by Cd. We also found that ABP inhibited the TLR4 mRNA level and protein expression and inhibited the mRNA levels of MyD88, TRIF, NF-κB, and IRF3. The results demonstrated that Cd could induce apoptosis, activate the TLR4 signaling pathway, and induce the expression of inflammatory cytokines in chicken PBLs, and that the administration of ABP clearly inhibited Cd-induced effects on chicken PBLs.

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The Cytotoxicity and Genotoxicity of Particulate and Soluble Cobalt in Human Urothelial Cells

Abstract

Cobalt use is increasing particularly due to its use as one of the primary metals in cobalt-chromium-molybdenum (CoCrMo) metal-on-metal prosthetics. CoCrMo is a high-strength, wear-resistant alloy with reduced risk for prosthetic loosening and device fracture. More than 500,000 people receive hip implants each year in the USA which puts them at potential risk for exposure to metal ions and particles released by the prosthetic implants. Data show cobalt ions released from prosthetics reach the bloodstream and accumulate in the bladder. As patients with failed hip implants show increased urinary and blood cobalt levels, no studies have considered the effects of cobalt on human urothelial cells. Accordingly, we investigated the cytotoxic and genotoxic effects of particulate and soluble cobalt in urothelial cells. Exposure to both particulate and soluble cobalt resulted in a concentration-dependent increase in cytotoxicity, genotoxicity, and intracellular cobalt ions. Based on intracellular cobalt ion levels, we found, when compared to particulate cobalt, soluble cobalt was more cytotoxic, but induced similar levels of genotoxicity. Interestingly, at similar intracellular cobalt ion concentrations, soluble cobalt induced cell cycle arrest indicated by a lack of metaphases not observed after particulate cobalt treatment. These data indicate that cobalt compounds are cytotoxic and genotoxic to human urothelial cells and solubility may play a key role in cobalt-induced toxicity.

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Gene Silencing of Selenoprotein K Induces Inflammatory Response and Activates Heat Shock Proteins Expression in Chicken Myoblasts

Abstract

In the present study, specific small interfering RNA (siRNA) for selenoprotein K (Selk) gene was designed and transfected into chicken myoblasts. Then, the expressions of inflammatory factors (including induced nitric oxide synthase [iNOS], nuclear factor-kappa B [NF-κB], heme-oxygenase-1 [HO-1], cyclooxygenase-2 [COX-2], and prostaglandin E synthase [PTGEs]), inflammation-related cytokines (including interleukin [IL]-1β, IL-6, IL-7, IL-8, IL-17, and interferon [IFN]-γ), and heat shock proteins (HSPs) (including HSP27, HSP40, HSP60, HSP70, and HSP90) were examined at 24 and 72 h after transfection. The results showed that messenger RNA (mRNA) expressions of iNOS, NF-κB, HO-1, COX-2, IL-6, IL-7, IL-8, HSP 27, HSP 40, HSP 60, HSP 70, and HSP 90 were significantly increased (p < 0.05) at 24 and 72 h after siRNA transfection, and the mRNA expressions of PTGEs, IL-1β, IL-17, and IFN-γ were significantly increased and decreased (p < 0.05) at 24 and 72 h after siRNA transfection. The results also showed that the protein expressions of iNOS, NF-κB, HO-1, COX-2, HSP60, HSP70, and HSP90 were significantly increased (p < 0.05) at 24 and 72 h after siRNA transfection. The correlation analysis and principal component analysis (PCA) showed that PTGEs, IL-1β, IL-17, IFN-γ, HSP40, and HSP90 might play special roles in response to Selk silencing in chicken myoblasts. These results indicated that Selk silencing induced inflammation response by affecting the expression levels of inflammatory factors and inflammation-related cytokines, and the heat shock proteins might play protective roles in this response in chicken myoblasts.

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The Reference Intervals of Hair Trace Element Content in Hereford Cows and Heifers ( Bos taurus )

Abstract

The objective of the present study was to assess hair trace element content in Hereford heifers and cows (Bos taurus) living in South Ural region and calculate the site-specific reference intervals. Hair trace element content in 150 cows and heifers farmed in the Southern Urals of Russia was assessed using inductively coupled plasma mass-spectrometry. Dietary trace element content corresponded to the adequate values as estimated by recommendations of USSR State Agriculture Committee and U.S. National Research Council. Comparative analysis demonstrated that heifers are characterized by significantly higher hair Se (3-fold), Hg (4-fold), and Sn (46%) content, whereas cows had significantly higher levels of hair Co (56%), I (33%), Si (2-fold), V (27%), B (55%), Cd (19%), Pb (47%), and Sr (23%). At the same time, no significant group difference in hair Cr, Cu, Fe, Li, Mn, Zn, As, and Ni was detected between Hereford cows and heifers. The reference intervals and 90% confidence intervals for the lower and upper limits were calculated in agreement with the American Society for Veterinary Clinical Pathology Quality Assurance and Laboratory Standard Guidelines.

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A Preliminary Study about the Potential Effects of Heavy Metals on the Human Male Reproductive Parameters in HIV-Infected Population in China

Abstract

Due to the inconsistent effects of human immunodeficiency virus (HIV) on the human male reproduction in previous studies and the impacts of environmental exposures, such as heavy metals, on male reproduction receiving little attention in HIV-infected population, the aim of present study was to investigate whether heavy metals have potential effects on reproductive parameters in HIV-infected men. The current study assessed the associations between semen quality or serum hormone and concentration of the three heavy metal toxicants (lead (Pb), cadmium (Cd), and zinc (Zn)) in seminal, urine, and serum, and 50 HIV-infected men were recruited in the present study. Concentrations of Pb, Cd, and Zn were measured in three fluids by graphite furnace atomic absorption spectrophotometer. Semen analyses were performed according to World Health Organization criteria. Serum samples were analyzed for follicle-stimulating hormone, luteinizing hormone, and testosterone. HIV RNA viral load was determined by HIV virus loads kit. Spearman's rank correlations were used for correlation analyses. The results showed that the concentrations of Pb, Cd, and Zn were significantly correlated with semen quality and serum hormone. HIV-1 virus loads were significantly associated with increased seminal Pb. However, HIV-1 virus loads were not statistically associated with semen quality and serum hormone. Our findings suggested that environmental heavy metals had potential effects on reproductive parameters in HIV-infected men in China.

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Relationships Between Element Contents in Polish Children’s and Adolescents’ Hair

Abstract

Environment, sex, and age are the main factors which determine the elemental composition of hair. The objective of the study is to determine the contents of calcium (Ca), magnesium (Mg), zinc (Zn), copper (Cu), iron (Fe), lead (Pb), and cadmium (Cd) in girls' and boys' hair in five age groups (within 1–19-year range) corresponding to successive human ontogenesis phases as well as to evaluate the relationships between these elements. Quantitative analysis has been carried out using atomic absorption spectrometry (AAS). Experimental results were analyzed using classic and principal component (PCA) statistical analyses. In particular, differences between contents of particularly Ca, Mg, and Zn in girls' and boys' hair were found, and substantial differences between age groups were stated. In general, larger amounts of Ca, Mg, and Zn as compared to boys' hair have been observed for girls' hair and higher toxic element (Pb, Cd) contents for boys were measured in some age groups. An increasing trend was found for bioelements (Ca, Mg, Zn) both for girls and boys in all age groups, while for Cu and Fe content, changes are insignificant and even decreasing for teenagers. The most frequently correlating element pairs are Ca–Mg, Ca–Zn, Mg–Zn, and Pb–Cd. Classic and PCA statistics show, in general, a satisfactory consistence. The elemental composition of hair varies depending on the gender and age of children and young people.

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A Rat Experimental Study of the Relationship Between Fluoride Exposure and Sensitive Biomarkers

Abstract

Chronic excessive fluoride exposure impairs human health and damages not only the skeletal system and the teeth but also the soft tissues such as the brain, liver, kidneys, pancreas and spinal cord. However, there is limited research regarding the exposure levels and sensitive biomarkers. This study was aimed to establish the relationship between fluoride exposure and sensitive biomarkers. Ninety-six rats were randomly divided into six groups, with each group exposed to 0, 2, 4, 8, 16 and 32 mg NaF/(kg.bw), respectively. Correlation analysis of the exposure levels, the tissue distributions and the effects was done, and the possible mathematical relationship between the exposure and sensitive biomarkers is discussed. Our findings revealed that the level of serum fluoride can serve as one of the sensitive indicators to reflect the ex-exposure levels (in the present article, ex-exposure means the fluoride exposure pathway from the outside, which differs from the burden of the organism). Furthermore, an equation determining the external exposure dose of serum fluoride was obtained by fitting the coefficient 0.901. Simultaneously, enzyme levels were closely compared with the burden of the tissue, which showed that the activities of alkaline phosphatase significantly correlated with serum fluoride levels (R ² = −0.259, p < 0.05), as well as with the fluoride levels of the lung (R ² = 0.463, ρ < 0.01), the thymus (R ² = 0.429, ρ < 0.05) and the ovary/testicle (R ² = 0.685, ρ < 0.01). Results suggested that excessive fluoride exposure might affect reproduction by altering the activities of alkaline phosphatase. In addition, some indicators related to immunity and calcium absorption exhibited sensitivity to tissue burden, among which activating transcriptional factor 4 (ATF4), an important indicator involved in bone metabolism, was found sensitive to the ex-exposure level. These findings highlight the gap between health effects in epidemiology research and the total intake amount of fluoride from the environment. This study presents a novel insight into the method of establishing the relationship between fluoride exposure and sensitive biomarkers.

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The epidemiology of work-related injury admissions to hospitals in the Midland region of New Zealand

Publication date: Available online 22 September 2017
Source:Injury
Author(s): Bridget Kool, Shanthi Ameratunga, Nina Scott, Ross Lawrenson, Grant Christey
ObjectiveTo describe the epidemiological characteristics of patients with work-related injuries (WRI) admitted to hospitals in New Zealand's Midland Trauma System (MTS) during a four year period.MethodsA retrospective review was conducted of trauma registry records for adults (≥15years) admitted to four hospitals in the MTS as a result of WRI between 1 January 2012 and 31 December 2015. We describe the patterns of injury incidence by demographic characteristics, employment industry, mechanism of injury, body regions injured, injury severity score (ISS), month, day and time of injury, duration of hospital stay, domicile District Health Board (DHB), and discharge destination.ResultsThe 2169 WRI trauma admissions, corresponded to an annualised rate of 205.8 per 100,000 workers or 234.3 per 100,000 full time employment employees (FTE). Injury rates were highest among males (238.0 per 100,000 workers) and those aged 15-24 years (227.1 per 100,000 workers), and lowest among Asians (83 per 100,000 workers). The highest injury rates occurred among the 'agriculture/forestry/fishing', 'manufacturing', and 'transport/postal/warehousing' industries. 'Contact with machinery' was the most common mechanism of injury, and the 'extremities or pelvic girdle' the most common body region injured. The in-hospital case fatality rate <0.5%.ConclusionThe predominance of WRI in the 'agriculture/forestry/fishing' industries in the Midland region is consistent with national estimates. The high rate of injuries amongst males, young adults, and Māori requires further exploration.



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Protective, repairing and fibrinolytic effects of rivaroxaban on vascular endothelium

Abstract

Aim

Rivaroxaban, a direct inhibitor of activated factor X (FXa), is the only new oral anticoagulant approved for secondary prevention after acute coronary syndrome. Our objective was to identify the possible molecular mechanisms of rivaroxaban that contributes to endothelial function.

Methods

Cell viability and growth of human umbilical vein endothelial cells (HUVEC) were registered. Gene expression studies comparing the effects of rivaroxaban and FXa were conducted by a selective RNA array and confirmed by protein quantification. Wound-healing experiments on HUVEC, platelet adhesion, enzymatic activity, and cell-based assays for fibrin formation were performed with rivaroxaban.

Results

Rivaroxaban (50 nM) only altered (>2 fold change) the expression of matrix metallopeptidase 2 and urokinase plasminogen activator (u-PA), but counteracted the FXa (9 nM)-induced up-regulation of several pro-inflammatory genes (p < 0.05) and FXa-enhanced platelet adhesion over HUVEC. Rivaroxaban increased u-PA protein expression in HUVEC supernatants and enhanced u-PA activity (up to 4 IU/ng of u-PA). Rivaroxaban (1 nM – 1 μM) showed a significant and dose-dependent positive effect on HUVEC growth that was inhibited by BC-11-hydroxibromide, an inhibitor of u-PA. Healing properties after a wound on HUVEC cultures, and fibrinolytic properties were also showed by rivaroxaban. Both effects were reverted by BC-11-hydroxibromide.

Conclusions

Rivaroxaban enhanced viability, growth and migration of HUVEC, mainly by u-PA activation and up-regulation, which also participate in the rivaroxaban-induced fibrinolytic activity at endothelial level. Rivaroxaban also protected from the pro-inflammatory effects of FXa on HUVEC. Altogether may improve endothelial functionality and could contribute to the cardiovascular benefits of rivaroxaban.

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