Complications of the Neovagina in Male-to-Female Transgender Surgery: A Systematic Review and Meta-analysis with Discussion of Management

Abstract

Introduction

Gender-affirmation surgery is often the final gender-confirming medical intervention sought by those patients suffering from gender dysphoria. In the male-to-female transgendered patient, the creation of aesthetic and functional external female genitalia with a functional vaginal channel is of the utmost importance. The aim of this review and meta-analysis is to evaluate the epidemiology, presentation, management and outcomes of neovaginal complications in the male-to-female transgender reassignment surgery patients.

Materials and Methods

PUBMED was searched a in accordance with PRISMA guidelines for relevant articles (n=125). Ineligible articles were excluded and articles meeting all inclusion criteria went on to review and analysis (n=13).

Results

Ultimately, studies reported on 1684 patients with an overall complication rate of 32.5% and a reoperation rate of 21.7% for non-aesthetic reasons. The most common complication was stenosis of the neo-meatus (14.4%). Wound infection was associated with an increased risk of all tissue-healing complications. Use of sacrospinous ligament fixation (SSL) was associated with a significantly decreased risk of prolapse of the neovagina.

Conclusions

Gender-affirmation surgery is important in the treatment of gender dysphoric patients, but there is a high complication rate in the reported literature. Variability in technique and complication reporting standards makes it difficult to assess the accurately the current state of male-to-female gender reassignment surgery. Further research and implementation of standards is necessary to improve patient outcomes. This article is protected by copyright. All rights reserved.

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The Development of a Core Syllabus for the Teaching of Oral Anatomy, Histology and Embryology to Dental Students via an International ‘Delphi Panel’

Abstract

The formulation of core syllabuses for the biomedical sciences within medical and dental courses is partially driven by the need to cope with decreased time allocations for these subjects as a result of major curricular changes taking place worldwide. There is also a requirement to deal with the request for increased clinical relevance. In response to such demands, the International Federation of Associations of Anatomists (IFAA) is devising core syllabuses for the anatomical sciences relating to the education and training of both scientific and clinical professions. The process initially involves using Delphi Panels consisting of a team of anatomists, scientists and clinicians who evaluate syllabus content in detail and accord each element/topic 'essential', 'important', 'acceptable' or 'not required' status. Their conjectures, published on the IFAA website, provide merely a framework to enable other stakeholders to comment. The approach is international in scope, is conceptually 'democratic', and is developmentally fluid in being readily available for amendment. The aim is to set internationally recognized standards and thus to provide guidelines concerning anatomical knowledge when engaged in course development. This paper presents the deliberations of an IFAA Delphi Panel into a core syllabus for oral anatomy, histology and embryology within the dental curriculum. This article is protected by copyright. All rights reserved.

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Clinical features and biological implications of different U2AF1 mutation types in myelodysplastic syndromes

Abstract

U2AF1 mutations (U2AF1MT) occur commonly in myelodysplastic syndromes (MDS) without ring sideroblasts. The aim of this study was to investigate the clinical and biological implications of different U2AF1 mutation types in MDS. We performed targeted gene sequencing in a cohort of 511 MDS patients. Eighty-six patients (17%) were found to have U2AF1MT, which occurred more common in younger patients (P=0.001) and represented ancestral lesions in a substantial proportion (71%) of cases. ASXL1MT and isolated +8 were significantly enriched in U2AF1MT-positive cases, whereas TP53MT, SF3B1MT and complex karyotypes were inversely associated with U2AF1MT. U2AF^S34 subjects were enriched for isolated +8 and were inversely associated with complex karyotypes. U2AF1MT was significantly associated with anemia, thrombocytopenia, and poor survival in both lower risk and higher risk MDS. U2AF1^S34 subjects had more frequently platelet levels of <50 × 10⁹/L (P=0.043) and U2AF1^Q157/U2AF1^R156 subjects had more frequently hemoglobin concentrations at <80 g/L (P=0.008) and more often overt fibrosis (P=0.049). In conclusion, our study indicates that U2AF1MT is one of the earliest genetic events in MDS patients and that different types of U2AF1MT have distinct clinical and biological characteristics. This article is protected by copyright. All rights reserved.

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Electric-Field-Controlled Phase Transformation in WO3 Thin Films through Hydrogen Evolution

Abstract

Field-effect transistors with ionic-liquid gating (ILG) have been widely employed and have led to numerous intriguing phenomena in the last decade, due to the associated excellent carrier-density tunability. However, the role of the electrochemical effect during ILG has become a heavily debated topic recently. Herein, using ILG, a field-induced insulator-to-metal transition is achieved in WO₃ thin films with the emergence of structural transformations of the whole films. The subsequent secondary-ion mass spectrometry study provides solid evidence that electrochemically driven hydrogen evolution dominates the discovered electrical and structural transformation through surface absorption and bulk intercalation.

Using ionic-liquid gating, a field-induced insulator-to-metal transition is achieved in WO₃ thin films with the emergence of structural transformations of the whole films. Subsequent secondary-ion mass spectrometry provides solid evidence that electrochemically driven hydrogen evolution dominates the discovered electrical and structural transformation through surface absorption and bulk intercalation.

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Biomolecule-Responsive Hydrogels in Medicine

Abstract

Recent advances and applications of biomolecule-responsive hydrogels, namely, glucose-responsive hydrogels, protein-responsive hydrogels, and nucleic-acid-responsive hydrogels are highlighted. However, achieving the ultimate purpose of using biomolecule-responsive hydrogels in preclinical and clinical areas is still at the very early stage and calls for more novel designing concepts and advance ideas. On the way toward the real/clinical application of biomolecule-responsive hydrogels, plenty of factors should be extensively studied and examined under both in vitro and in vivo conditions. For example, biocompatibility, biointegration, and toxicity of biomolecule-responsive hydrogels should be carefully evaluated. From the living body's point of view, biocompatibility is seriously depended on the interactions at the tissue/polymer interface. These interactions are influenced by physical nature, chemical structure, surface properties, and degradation of the materials. In addition, the developments of advanced hydrogels with tunable biological and mechanical properties which cause no/low side effects are of great importance.

Biomolecules such as glucose, proteins, nucleic acids and polypeptides, involved in all living organisms, serve as the most fundamental and vital parts of living systems. Biomolecule-responsive hydrogels are divided into three categories: glucose-responsive hydrogels, protein-responsive hydrogels, and nucleic acid-responsive hydrogels. These modified hydrogels can be applied in various medical areas including: cancer, drug/gene delivery, regenerative medicine and tissue engineering.

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The relationship between physical and psychological symptoms and health care utilization in hospitalized patients with advanced cancer

BACKGROUND

Patients with advanced cancer often experience frequent and prolonged hospitalizations; however, the factors associated with greater health care utilization have not been described. We sought to investigate the relation between patients' physical and psychological symptom burden and health care utilization.

METHODS

We enrolled patients with advanced cancer and unplanned hospitalizations from September 2014-May 2016. Upon admission, we assessed physical (Edmonton Symptom Assessment System [ESAS]) and psychological symptoms (Patient Health Questionnaire 4 [PHQ-4]). We examined the relationship between symptom burden and healthcare utilization using linear regression for hospital length of stay (LOS) and Cox regression for time to first unplanned readmission within 90 days. We adjusted all models for age, sex, marital status, comorbidity, education, time since advanced cancer diagnosis, and cancer type.

RESULTS

We enrolled 1,036 of 1,152 (89.9%) consecutive patients approached. Over one-half reported moderate/severe fatigue, poor well being, drowsiness, pain, and lack of appetite. PHQ-4 scores indicated that 28.8% and 28.0% of patients had depression and anxiety symptoms, respectively. The mean hospital LOS was 6.3 days, and the 90-day readmission rate was 43.1%. Physical symptoms (ESAS: unstandardized coefficient [B], 0.06; P < .001), psychological distress (PHQ-4 total: B, 0.11; P = .040), and depression symptoms (PHQ-4 depression: B, 0.22; P = .017) were associated with longer hospital LOS. Physical (ESAS: hazard ratio, 1.01; P < .001), and anxiety symptoms (PHQ-4 anxiety: hazard ratio, 1.06; P = .045) were associated with a higher likelihood for readmission.

CONCLUSIONS

Hospitalized patients with advanced cancer experience a high symptom burden, which is significantly associated with prolonged hospitalizations and readmissions. Interventions are needed to address the symptom burden of this population to improve health care delivery and utilization. Cancer 2017. © 2017 American Cancer Society.

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Response to "Opioid warning label" [Letters]

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Canadian funders and institutions are lagging on reporting results of clinical trials [Commentary]

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Depression and mortality in a longitudinal study: 1952-2011 [Research]

BACKGROUND:

Many studies have shown that depression increases mortality risk. We aimed to investigate the duration of time over which depression is associated with increased risk of mortality, secular trends in the association between depression and mortality, and sex differences in the association between depression and mortality.

METHODS:

We conducted a cohort study of 3410 adults enrolled in 3 representative samples of a county in Atlantic Canada in 1952 (n = 1003), 1970 (n = 1203) or 1992 (n = 1402) (the Stirling County Study). Depression was measured using a diagnostic algorithm based on the presence of depressed mood and associated symptoms, duration of more than 1 month, and substantial impairment. Vital status of participants through 2011 was determined using probabilistic linkages to the Canadian Mortality Database.

RESULTS:

Depression was associated with a heightened risk of mortality among men during the 3 time periods of the study, with hazard ratios (HRs) of 2.90 (95% confidence interval [CI] 1.69–4.98) between 1952 and 1967, 1.97 (CI 1.34–2.89) between 1968 and 1990, and 1.52 (CI 1.09–2.13) between 1991 and 2011. Elevated risk of mortality was noted among women only between 1990 and 2011 (HR = 1.51; CI = 1.11–2.05).

INTERPRETATION:

The association between depression and mortality persists over long periods of time and has emerged among women in recent decades, despite contemporaneous improvements in the treatment of depression and reduction of stigma associated with depression. Further research is needed to better understand the mechanisms involved.

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Rich nations are feeding research predators [News]

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Legionellosis following water birth in a hot tub in a Canadian neonate [Practice]

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Opioid warning label [Letters]

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A case of blood sweating: hematohidrosis syndrome [Practice]

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COPD research and treatment pioneer [News]

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Sweating blood: history and review [Humanities]

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Researchers may be part of the problem in predatory publishing [News]

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QTc-prolongation during ciprofloxacin and fluconazole combination therapy: prevalence and associated risk factors

Abstract

Aim (s)

Ciprofloxacin and fluconazole combination therapy is frequently used as prophylaxis for and treatment of infections in patients with haematological malignancies. However, both drugs are known to prolong the QTc-interval, which is a serious risk factor for Torsade de Pointes (TdP). Therefore, the aim of this study was to assess the prevalence of QTc-prolongation during ciprofloxacin and fluconazole use. The secondary objective was to determine associated risk factors of QTc-prolongation in these patients.

Methods

A prospective observational study was performed in patients admitted to the Erasmus University Medical Centre and treated with ciprofloxacin and fluconazole. A twelve-lead electrocardiogram (ECG) was recorded at the T_max of the lastly added drug. Main outcome was the proportion of patients with QTc-prolongation during treatment. The following potential risk factors were collected: patient characteristics, serum electrolyte levels, dosage of ciprofloxacin and fluconazole, renal and liver function and concomitant use of other QTc-prolonging drugs and CYP3A4-inhibitors.

Results

170 patients were included, of which 149 (87.6%) were treated for haematological malignancies. The prevalence of QTc-prolongation was 4.7%. No risk factors were found to be associated with QTc-prolongation. The QTc-interval increased with 10.7 ms (95% confidence interval (CI) 7.2 – 14.1 ms) during ciprofloxacin – fluconazole therapy.

Conclusion

The prevalence of QTc-prolongation in patients using ciprofloxacin and fluconazole is low compared to the prevalence in the general population which is varying from 5 – 11%. Also, no risk factors were found. Given the low prevalence, routine ECG monitoring in patients on this therapy should be reconsidered.

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Molecular control of regulatory T cell development and function

Yohko Kitagawa | Shimon Sakaguchi

http://ift.tt/2yKOdyM

Insights into immune tolerance from AIRE deficiency

Irina Proekt | Corey N Miller | Michail S Lionakis | Mark S Anderson

http://ift.tt/2yKOd1K

Antidyslipidemic, Anti-Inflammatory, and Antioxidant Activities of Aqueous Leaf Extract of Dioscoreophyllum cumminsii (Stapf) Diels in High-Fat Diet-Fed Rats

Dioscoreophyllum cumminsii (Stapf) Diels leaves are widely used in the treatment of diabetes, obesity, and cardiovascular related complications in Nigeria. This study investigates the anti-inflammatory and antiobesity effect of aqueous extract of Dioscoreophyllum cumminsii leaves in high-fat diet- (HFD-) induced obese rats. HFD-fed rats were given 100, 200, and 400 mgkg−1 body weight of aqueous extract of Dioscoreophyllum cumminsii leaves for 4 weeks starting from 9th week of HFD treatment. D. cumminsii leaves aqueous extract reversed HFD-mediated decrease in the activities of superoxide dismutase, catalase, glutathione peroxidase, glutathione reductase, and glucose 6-phosphate dehydrogenase. Moreover, HFD-mediated elevation in the levels of conjugated dienes, lipid hydroperoxides, malondialdehyde, protein carbonyl, and DNA fragmentation in rats liver was lowered. HFD-mediated alterations in serum total cholesterol, triacylglycerol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and very low-density lipoprotein cholesterol were significantly reversed by the extract. The treatment of HFD-fed rats reduced the levels of insulin, leptin, protein carbonyl, fragmented DNA, and tumour necrosis factor-α and interleukin- (IL-) 6 and IL- 8 and increased the adiponectin level. This study showed that aqueous extract of Dioscoreophyllum cumminsii leaves has potential antiobesity and anti-inflammatory effects through modulation of obesity-induced inflammation, oxidative stress, and obesity-related disorder in HFD-induced obese rats.

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Comparative safety of systemic and low-bioavailability steroids in inflammatory bowel disease: Systematic review and network meta-analysis.

SUMMARY

Aims

Oral systemic corticosteroids have been used to induce remission in patients with active inflammatory bowel disease (IBD) for over 50 years; however, the wide array of adverse events (AEs) associated with these drugs prompted the development of steroid compounds with targeted delivery and low systemic bioavailability. This study assessed corticosteroids' comparative harm using network meta-analysis.

Methods

We searched PubMed, Scopus, Embase, the Cochrane Library, clinical trial registries, regulatory authorities' websites and major conference proceedings, through March 2017. Randomized controlled trials that recruited adult IBD patients and compared oral systemic corticosteroids (prednisone/prednisolone) or compounds/formulations with low systemic bioavailability (budesonide, budesonide MMX, and beclomethasone dipropionate) with placebo, or against each other, were considered eligible for inclusion. Two reviewers independently extracted study data and outcomes, and rated each trial's risk-of-bias.

Results

We identified and synthesized evidence from 31 trials including 5689 IBD patients. Budesonide MMX was associated with significantly less corticosteroid-related AEs than oral systemic corticosteroids (OR: 0.25, 95% CI: 0.13–0.49) and beclomethasone (OR: 0.35, 95% CI: 0.13–1.00), but not significantly less AEs than budesonide (OR: 0.64, 95% CI: 0.37–1.11); it performed equally good with placebo. On the other hand, the occurrence of serious AEs, and treatment discontinuations due to AEs, did not differ between the comparator treatments.

Conclusions

Budesonide MMX is associated with less corticosteroid-related AEs than its comparator steroid treatments for adult IBD patients. Further high-quality research is warranted to illuminate the steroid drugs' comparative safety profiles.

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CyPA and Emmprin play a role in peri-implantitis

Abstract

Background

Cyclophilin A (CyPA) and Emmprin play important roles in peri-implantitis. However, their roles in the diagnosis and treatment of the disease are still unclear.

Purpose

The aim of this split-mouth animal study was to describe variable trends of biomarkers during the progression of peri-implantitis and to define relationships among CyPA, Emmprin, and peri-implantitis.

Materials and Methods

Six male adult Labradors were used. The mandibular premolars and the first molar were extracted, and sixteen implants were placed after 3 months. Peri-implantitis was induced around the implants on one side, which were the test group, and the implants on the other side were included in the control group. Clinical parameters such as probing depth, gingival index, and bleeding index and periapical X-rays were recorded at weeks 0, 2, 4, 6, 8, 10, and 12. Peri-implant crest fluid (PICF) and gingiva around the implants were collected and analyzed by ELISA and real-time PCR, respectively.

Results

The clinical parameters of the test group indicated severe inflammation around the implants. Radiographs showed obvious bone loss beginning at week 4, and it continued over time. The concentration of CyPA in the peri-implantitis group increased at first and then decreased beginning at week 6, and the concentration of Emmprin decreased at first and then increased beginning at week 6. Emmprin, matrix metalloproteinase-9 and Tissue Inhibitor of Metalloproteinase-1 showed similar changes over time. CyPA showed a consistent trend with Interleukin-1β, but showed an opposite trend to Transforming growth factor-β. Both the concentration of CyPA in PICF and gene expression in gingival tissue increased before bone absorption occurred.

Conclusion

Despite the limitations of this study, CyPA may be an early signal for peri-implantitis. A CyPA-Emmprin interaction exists in peri-implantitis and is Emmprin-dependent. Emmprin is related to clinical attachment loss in peri-implantitis.

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Cephalometric Soft Tissue Characteristics of Unilateral Cleft Lip and Palate Patients in Relation to Missing Teeth

Objective. This study aimed to evaluate cephalometric soft tissue characteristics in individuals with unilateral complete cleft lip and palate (UCCLP) both with and without missing teeth. Design. A retrospective investigation of patient records, who are being treated at the cleft lip and palate (CLP) clinics at the College of Dentistry. Ninety-six consecutive records of nonsyndromic UCCLP subjects were recruited (33 subjects without missing teeth and 63 subjects with missing teeth). Linear and angular soft tissue measurements obtained from lateral cephalometric radiographs were evaluated and compared among the studied samples. Results. Lower lip was significantly retruded and shorter (), , respectively; in addition to the fact that shallower mentolabial sulcus () was found in the subjects with missing teeth, the rest of the soft tissue was not significantly different between the two groups. Conclusion. In subjects with a UCCLP anomaly, missing teeth have an effect on lower lip position and length, which influenced the mentolabial sulcus. Lower lip position and length differ between cleft patients who present with either multiple missing teeth or with no missing teeth, and this needs to be considered during orthodontic treatment planning and surgical management for the cleft defect.

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Exploring Deep Space - Uncovering the Anatomy of Periventricular Structures to Reveal the Lateral Ventricles of the Human Brain

This paper demonstrates the effective use of a fiber dissection method to reveal the superficial white matter tracts and periventricular structures of the human brain, in three-dimensional space, to aid student comprehension of ventricular morphology.

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Using the Sleeve Technique in a Mouse Model of Aortic Transplantation - An Instructional Video

We present an orthotopic aortic transplantation model using the sleeve technique in mice. It is a very rapid anastomosis method, which can be employed in studies of vascular disease.

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Evaluation of Resins for Stereolithographic 3D-Printed Surgical Guides: The Response of L929 Cells and Human Gingival Fibroblasts

Additive manufacturing is becoming increasingly important in dentistry for the production of surgical guides. The development of cost-effective desktop stereolithography (SLA) printing systems and the corresponding resins makes this novel technique accessible to dental offices and dental laboratories. The aim of the study was to reveal the response of soft tissue cells to Clear and Dental SG resins used in desktop SLA printing systems at different stages of processing. Cell activity of L929 cells and gingival fibroblasts (GF) in response to the materials was examined in indirect and direct monolayer culture models and a direct spheroid culture model based on MTT, resazurin-based toxicity assays, and live-dead staining. Overall we found that the impact of Clear and Dental SG resins on L929 and GF depends on the processing stage of the materials. Liquid Clear resin induced a stronger reduction of cell activity compared to Dental SG resin. Printing and postcuring reduced the impact on cell activity and viability. As in-house 3D printing for surgical guides is getting integrated in the digital workflow, our data suggest that careful adherence to processing guidelines—especially postcuring—is of clinical relevance.

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In Vivo Studies on the Influence of Bacteriophage Preparations on the Autoimmune Inflammatory Process

Phage preparations used for phage therapy may have not only direct antibacterial action but also immunomodulating effects mediated by phages themselves as well as by bacterial antigens. Therefore phage application in patients with immune disorders, and especially with autoimmune diseases, requires special attention. The aim of this study was to investigate the effect of phage lysates (staphylococcal phages A3/R, phi200, and MS-1 cocktail, enterococcal phage 15/P, Pseudomonas phage 119x, and E. coli T4 phage) as well as purified T4 phage on the course of murine collagen-induced arthritis (CIA), commonly used as an animal model of rheumatoid arthritis. Intraperitoneal application of phage lysates or purified T4 phage did not aggravate the course of autoimmune joint disease. Moreover, although endotoxins are known to potentiate CIA, the systemic administration of phage lysate of Pseudomonas aeruginosa, which contains debris of this Gram-negative bacillus, did not significantly influence CIA although the sonicate of the corresponding bacterial strain did. Interestingly, a purified T4 phage revealed some anti-inflammatory activity when applied under the therapeutic scheme. Our preliminary results do not suggest that phages may aggravate the symptoms of rheumatoid arthritis. In contrast T4 phage may even exert an immunosuppressive effect.

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Ragweed pollen as an oral vaccine delivery system: Mechanistic insights.

Related Articles

Ragweed pollen as an oral vaccine delivery system: Mechanistic insights.

J Control Release. 2017 Oct 17;:

Authors: Uddin MJ, Gill HS

Abstract
We have recently developed pollen grains (PGs) as a unique method to deliver vaccines orally. Extensive chemical processing ensures allergen-free pollen microcapsules that can be loaded with vaccine antigens. Successful oral vaccine delivery has been previously demonstrated by us in a mouse model. However, the underlying mechanisms that help the processed PGs to achieve this goal were not fully understood. In this study, we wanted to understand the effects of chemically processed ragweed pollen (Ambrosia elatior) on the innate immune system. Intestinal epithelial cells, macrophages, and dendritic cells all bridge the innate and adaptive immunity. This study has shown that in response to ragweed pollen all these cells release inflammatory cytokines and chemokines. Scanning electron microscopy imaging revealed that macrophages can engulf ragweed pollen. In addition, in the presence of ragweed, mouse dendritic cells upregulated their activation markers, that is, CD40, CD80, CD86, and MHC class II molecules. Ragweed pollens did not cause significant cell membrane damage as compared to similarly sized poly (lactic-co-glycolic acid) particles. Moreover, ragweed did not affect the integrity of the intestinal epithelial cells. Ragweed pollens were also found in the subepithelial region of the small intestine 24h after pollens were gavaged to mice. Our current findings lead to the conclusion that besides transporting the vaccine cargo, ragweed pollen shells have additional immunomodulatory properties that help the orally delivered antigen to effectively induce an immune response.

PMID: 29054371 [PubMed - as supplied by publisher]

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Proanthocyanidins Attenuation of H2O2-Induced Oxidative Damage in Tendon-Derived Stem Cells via Upregulating Nrf-2 Signaling Pathway

Proanthocyanidins (PCs) have shown inhibition of oxidative damage by improving Nrf-2 expression in many tissues. However, the cytoprotective effects of PCs on H2O2-induced tendon damage have not been verified. The current study was aimed at assessing the cytoprotection of PCs on the oxidative cellular toxicity of tendon-derived stem cells (TDSCs) induced by H2O2. The TDSCs were isolated from patellar tendons of Sprague Dawley (SD) rats, and the cells after third passage were used for subsequent experiments. The isolated cells were identified by flow cytometry assay and multidifferentiation potential assay. Cell Counting Kit-8 assay was performed to examine cell viability. Real-Time PCR and Western Blot were employed to, respectively, assess the mRNA and protein expressions of Nrf-2, GCLM, NQO-1, and HO-1. PCs significantly improved the cell viability of TDSCs. Furthermore, H2O2 upregulated Nrf-2, GCLM, NQO-1, and HO-1 without significant difference, while the proteins expressions were increased with significant difference in PCs group and PCs + H2O2 cotreated group. All the findings indicated that PCs could protect against the oxidative damage induced by H2O2 in TDSCs, and the cytoprotective effects might be due to the ability of PCs to activate the expressions of GCLM, HO-1, and NQO-1 via upregulating Nrf-2 signaling pathway.

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Plasma Fibulin-3 as a Potential Biomarker for Patients with Asbestos-Related Diseases in the Han Population

Fibulin-3 has been reported as a potential biomarker for mesothelioma. However, little is known about the diagnostic efficacies of fibulin-3 for asbestos-related diseases (ARDs) in China. This study was to investigate the utility of fibulin-3 for asbestos exposure and ARDs. A total of 430 subjects were recruited from Southeast China, including healthy individuals, asbestos-exposed (AE) individuals, and patients with pleural plaques (PP), asbestosis, and malignant pleural mesothelioma (MPM). Plasma fibulin-3 was measured using the enzyme-linked immunosorbent assay. Linear regression analyses were applied to explore the influencing factors of fibulin-3. Receiver operating characteristic curves were used to determine the cutoff values. The median fibulin-3 level of subjects in the mesothelioma group was higher than that in other groups. Subjects in the asbestosis group had higher median fibulin-3 level than those in the control group. A higher fibulin-3 level was found in the group with ≥10 years of asbestos exposure as compared with control groups. The AUCs of fibulin-3 for distinguishing MPM subjects from control, AE, PP, and asbestosis subjects were 0.92, 0.88, 0.90, and 0.81, respectively. Our study provided evidence that fibulin-3 could be a potential biomarker for the early screening of MPM, but not of other nonmalignant ARDs in Chinese populations.

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Vitamin D Status, Disease Activity, and Endothelial Dysfunction in Early Rheumatoid Arthritis Patients

Cardiovascular diseases represent important complications in rheumatoid arthritis (RA) patients, generated by an accelerated atherosclerosis. The aim of this study is represented by the assessment of the correlations between serum levels of vitamin D, disease activity, and endothelial dysfunction in patients with early RA. Material and Methods. The study was performed on a group of 35 patients with early RA and 35 healthy subjects matched for age and gender, as controls. In all studied subjects, the following were determined: inflammatory markers, insulin resistance, vitamin D levels, and endothelial dysfunction. Statistical analysis were performed using the Student's t-test and the Pearson's test. p values of less than 0.05 were considered statistically significant. Results. The group of patients with RA patients presented inflammation, low levels of vitamin D, elevated insulin resistance, and reduced flow-mediated vasodilation, statistically significant compared to the control group (). Significant inverse correlations between the levels of 25(OH) vitamin D and DAS28, respective insulin resistance, and significant positive correlation between 25(OH) vitamin D and endothelial function were demonstrated. Conclusion. In early RA patients with moderate and high disease activity, low serum levels of vitamin D were associated with disease activity, increased insulin resistance, and endothelial dysfunction.

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A Case of Nivolumab-Induced Severe Mononeuropathy Multiplex and Rhabdomyolysis

We report an 81-year-old man with multiple liver metastases after tumorectomy for primary mediastinal malignant melanoma, who experienced limb weakness and sensory disturbance after nivolumab monotherapy. He was diagnosed with nivolumab-induced mononeuropathy multiplex and rhabdomyolysis based on serologic examination, muscle biopsy, magnetic resonance imaging of the limbs, and a nerve conduction study. A course of intravenous methylprednisolone (mPSL) was initiated at 1 g/day for 3 days. After that, oral prednisolone (PSL) was started at 1 mg/kg/day and gradually tapered. Limb muscle strength improved, but when PSL was reduced to 0.3 mg/kg/day, the weakness recurred, and a nerve conduction study showed exacerbation of mononeuropathy multiplex. The patient was again administered intravenous mPSL (0.5 g/day for 3 days) followed by oral PSL at 0.5 mg/kg/day, and his neurological symptoms improved. Nivolumab, an immune checkpoint inhibitor, is used for the treatment of advanced melanoma and other cancers and causes various immune-related adverse events (irAEs). However, neurological irAEs related to nivolumab are rare. Furthermore, there are no reports of simultaneous nerve and muscle impairment. Unexpected irAEs affecting various organs should be recognized and treated appropriately.

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Recurrent Huge Left Bartholin’s Gland Abscess for One Year in a Teenager

Bartholin's gland abscess is the commonest worldwide reported abscess in gynaecological outpatient clinics; it has also been reported that Bartholin's gland abscess is three times more common in occurrences compared to Bartholin's gland cyst. It is more common in women who are at risk of acquiring sexually transmitted infections; however, other causes of infection should be investigated to exclude other causes of disease. We present the case of an 18-year-old female patient, a teenager of the reproductive age group, with the recurrent development of huge Bartholin's gland abscess in a period of one year. The marsupialization surgical technique of repair was performed successfully. She was discharged home and she was scheduled to visit STI's clinic where she was receiving regular screening for STI's and she was also given health education regarding preventive measures for STI's.

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Renoprotective Effects of Total Glucosides from Paeony against Nephrotoxicity Induced by Total Alkaloids from Semen Strychni

Semen Strychni have been shown to have therapeutic effect in improving blood circulation, relieving rheumatic pain, and treating cancer. However, Semen Strychni could cause severe nephrotoxicity. The present study was designed to evaluate whether treatment with total glucosides from paeony (TGP) has renoprotective effect against nephrotoxicity induced by total alkaloids from Semen Strychni (TAS). The levels of blood urea nitrogen (BUN) and creatinine (Cr) were determined and histopathological changes were also examined to evaluate renal injury. Moreover, a HPLC-MS method was developed and validated to investigate the comparative toxicokinetics of strychnine and brucine in rats plasma after oral administration of TAS and pretreatment with TGP. Results demonstrated that the levels of BUN and Cr were significantly increased () in TAS group, together with tubule epithelium cloudy swelling, degeneration, and glomerular atrophy in rats' kidneys. The TAS-induced kidney damage was alleviated after pretreatment with TGP. Besides, of strychnine and brucine were increased and of strychnine and brucine were decreased after pretreatment with TGP. The toxicokinetics study showed that pretreatment with TGP could attenuate the absorption of strychnine and brucine, as well as accelerate their elimination. These results suggest that TGP possesses renoprotective effects.

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Correlation between Traditional Chinese Medicine Constitution and Dyslipidemia: A Systematic Review and Meta-Analysis

Objective. To study the correlation between Traditional Chinese Medicine (TCM) constitution and dyslipidemia. Methods. CNKI, VIP, Wanfang database, CBMdisc, PubMed, and Embase were searched, and meta-analysis was performed by Review Manager 5.2 software. Results. Altogether 11 studies were included with 12890 individuals. The results showed that balanced constitution was a protective factor of dyslipidemia (OR = 0.62, 95% CI 0.47~0.82) while phlegm-dampness constitution was a risk factor of it (OR = 2.50, 95% CI 2.22~2.80), and the effect of phlegm-dampness constitution in South China (OR = 3.31, 95% CI 1.71~6.43) was more obvious than that in East (OR = 2.40, 95% CI 2.06~2.80) and North China (OR = 2.24, 95% CI 1.81~2.78). Conclusion. This study provides evidence for the prevention and treatment of dyslipidemia in TCM. However, most of the studies included are of moderate quality; more high quality, multicenter, large-sample studies are expected to provide higher level evidence.

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Quantitative Serum Proteomic Analysis of Essential Hypertension Using iTRAQ Technique

Essential hypertension (EH) is a risk factor for some severe diseases. This study aimed to screen out serum special proteins and seek interaction between them, which would provide new therapeutic targets and elucidate the comprehensive pathophysiological mechanism for EH. Patients with EH (Group A, ) and healthy controls (HC) (Group B, ) were recruited in this study. Serums from the two groups were analyzed with isobaric tags for relative and absolute quantitation coupled two-dimensional liquid chromatography followed by electrospray ionization-tandem mass spectrometry technique, while the candidate special proteins were verified with ELISA and western blot. A total of 404 proteins were identified, of which 30 proteins were upregulated (>1.2-fold, ) and 81 proteins were downregulated (

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Development of an Indirect ELISA and Dot-Blot Assay for Serological Detection of Rice Tungro Disease

Rice tungro disease (RTD) is one of the most destructive diseases of rice in South and Southeast Asia. RTD is routinely detected based on visual observation of the plant. However, it is not always easy to identify the disease in the field as it is often confused with other diseases or physiological disorders. Here we report the development of two serological based assays for ease of detection of RTD. In this study we had developed and optimized an indirect ELISA and dot-blot assay for detection of RTD. The efficiency of both assays was evaluated by comparing the specificity and sensitivity of the assays to PCR assay using established primer sets. The indirect ELISA showed 97.5% and 96.6%, while the dot-blot assay showed 97.5% and 86.4% sensitivity and specificity, respectively, when compared to established PCR method. The high sensitivity and specificity of the two assays merit the use of both assays as alternative methods to diagnose RTD. Furthermore, the dot-blot assay is a simple, robust, and rapid diagnostic assay that is suitable for field test for it does not require any specialized equipment. This is a great advantage for diagnosing RTD in paddy fields, especially in the rural areas.

http://ift.tt/2xepI9u