Κυριακή 14 Οκτωβρίου 2018
A “Kelp-Like” Microorganism Within the Belly
A 50-year-old woman suffering from paranoid schizophrenia with carelessness symptom was referred on day 0 for peritonitis caused by a perforated gastro-duodenal ulcer. In her recent medical history, anorexia, constipation, and impairment of general health condition were reported. A biological inflammatory syndrome was noticed at admission, with C-reactive protein of 320.1 mg/L, procalcitonin of 216.68 µg/L, and polymorphonuclear neutrophil count of 16.4 × 109/L. To note, blood calcium, total serum protein, and hemoglobin were low at 1.77 mmol/L, 40 g/L (including 16 g/L for albumin), and 81 g/L, respectively. Several intraperitoneal abscesses were detected by computed tomography on day 3 (Figure 1). Abscess aspirate showed a moderately inflammatory liquid with no malignant cells (day 4). On the third day following the sampling (day 7), flat colonies started growing in vitro at 30°C on Sabouraud dextrose agar (BD Sabouraud Glucose Agar, Becton-Dickinson, Pont-Le-Claix, France) (Figure 2). Broad-spectrum antibiotic therapy (initially based on intravenous ceftriaxone, metronidazole, and fluconazole; amoxicillin and erythromycin were added on day 4 and on day 9, respectively) was inefficient. Noteworthy, on day 18, measurement of (1,3)-β-D-glucan antigen was positive at 474 ng/mL in serum. All blood cultures remained sterile.
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Bivalirudin fails to prevent atrial thrombus development in heparin-induced thrombocytopaenia and thrombosis syndrome
An 81-year-old woman presented with acute decompensated heart failure due to new-onset atrial fibrillation and a flail myxomatous mitral valve which necessitated surgical mitral valve repair. No atrial thrombi were noted on transoesophageal echocardiograms performed prior to surgery and intraoperatively. Immediately postoperatively, while treated with unfractionated heparin, the patient developed thrombocytopaenia with positive platelet factor 4 antibodies and an abnormal serotonin functional platelet assay, consistent with heparin-induced thrombocytopaenia. The anticoagulation therapy was changed to the direct thrombin inhibitor bivalirudin with an improvement in the platelet count. Despite bivalirudin therapy, a left atrial layering thrombus was revealed on transoesophageal echocardiogram performed in preparation for cardioversion of the symptomatic atrial fibrillation. Anticoagulation was changed to warfarin, and the patient was discharged without thromboembolic complications neither during her hospital stay nor the 3-year outpatient follow-up.
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Suspicious Yersinia granulomatous enterocolitis mimicking appendicitis
We present the case of a fit and well 12-year-old boy who presented with signs and symptoms suggestive of appendicitis. On laparoscopy, he was found to have a sinister-looking right iliac fossa mass with associated mesenteric lymphadenopathy. He proceeded to have an oncological right hemicolectomy, while the subsequent histology returned an unexpected result. The aim of this report is to highlight an unusual and complex clinical presentation in a young patient presenting with right iliac fossa pain.
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Cannabis hyperemesis syndrome
A young woman with chronic cannabis use presents with 2-day history of cyclical nausea, vomiting and abdominal pain. Clinical and laboratory examination excluded other causes. Patient's symptoms improved with topical capsaicin, hot showers, antiemetics and she was subsequently discharged home 4 days later. The patient was educated on side effects of cannabis use and chose to stop cannabis use completely.
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Interstitial lung disease and inflammatory myopathy in antisynthetase syndrome with PL-12 antibody
We report the case of an 80-year-old Caucasian man with PL-12 antibody positive antisynthetase syndrome. He presented with progressive dyspnoea and weight loss, later developing dysphagia, mild proximal muscle weakness and mild sicca symptoms. Investigations revealed interstitial lung disease, inflammatory myopathy and an immunology profile consistent with PL-12 antisynthetase syndrome. Prednisolone and cyclophosphamide resulted in a significant improvement of all his symptoms.
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The illness experience of an undocumented immigrant in the USA
Approximately 11 million people living and working in the USA do so without documentation. This group represents a disenfranchised minority with adverse experiences and unique comorbidities that faces significant obstacles to receiving healthcare, including fear of deportation, language barriers, financial barriers and difficulty navigating an inconsistent and fragmented system. Healthcare is therefore often sought once symptoms have become critical, which can lead to more severe disease processes and multiple new diagnoses at presentation even in previously healthy patients. Here we present the case of a previously healthy 32-year-old undocumented immigrant who presented to a South Florida hospital with abdominal pain, diarrhoea and leg pain. He was diagnosed with both diabetes mellitus and chronic myelogenous leukaemia after a prolonged 20-day hospital stay. Culturally sensitive providers and dedicated staff play a major role in connecting patients to outpatient care after an acute illness, which most often occurs at charity clinics.
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Disseminated tuberculosis caused by Mycobacterium bovis presenting as a tongue base mass
An 80-year-old woman presented with dysphagia, odynophagia and progressive weight loss. Initial investigations suggested a large base of tongue squamous cell carcinoma. At panendoscopy, biopsies were taken which revealed granulomatous inflammation with multinucleated giant cells and areas of caseous necrosis. Acid-fast bacilli were identified on Ziehl-Neelsen stain and the appearances were consistent with Mycobacterium bovis. Closer inspection of the patient's medical history revealed that she had previously undergone right hemicolectomy for an ascending colon stricture. The histology had shown granulomatous inflammation consistent with intestinal tuberculosis but no systemic treatment had been instigated at the time. This case highlights the importance of taking a detailed clinical history as well as the need to be cognisant of tuberculosis masquerading as cancer in the head and neck.
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Brown spots: Whats the diagnosis?
Description
A 3-year-old boy presented to a paediatric consult with a rash consisting of reddish-brown non-pruritic spots. This rash initially appeared in his first months of age, with no identified triggers or associated symptoms and had been previously interpreted as eczema. Skin examination revealed irregularly bordered, hyperpigmented, cafe-au-lait macules on his trunk, neck and right forearm, the largest around 2 cm in diameter (figures 1 and 2). Rubbing one of the skin lesions elicited localised erythema—positive Darier's sign (figure 3).
Figure 1
Skin lesions on the trunk (back).
Figure 2
Skin lesions on the trunk (front).
Figure 3
Darier's sign.
Laboratory investigation showed both normal blood count and serum tryptase levels. He was diagnosed with urticaria pigmentosa (UP), a type of cutaneous mastocytosis. The patient...
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Preoperative embolisation of a hypervascular, calvarial paraganglioma metastasis via a combined percutaneous and transophthalmic arterial approach
Description
A 30-year-old male patient with a history of malignant, metastatic paraganglioma presented with a rapidly enlarging, expansile left calvarial mass. CT and ultrasound imaging demonstrated a 60x46x31 mm soft-tissue lesion centred on the left frontal bone which was markedly hypervascular (figure 1A,B).
Figure 1
(A) non-contrast CT demonstrating the left-sided expansile calvarial lesion with osseous destruction and frontal lobe compression (black arrow). (B) Colour flow Doppler ultrasound of the lesion demonstrating pronounced hypervascularity (white arrows). (C) Lateral left external carotid artery DSA demonstrating extensive superficial scalp supply to the lesion from multiple, enlarged superficial temporal artery (black arrowheads) and occipital artery (white arrowheads) branches. (D) Lateral left internal carotid artery DSA demonstrating deep dural arterial supply to the lesion from the MMA (white arrowheads) originating from the ophthalmic artery (black arrowhead). DSA, digital subtraction angiogram; MMA, middle meningeal artery.
A cerebral digital...
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Rotational carotid insufficiency: an unusual cause of bow hunters syndrome
We report an unusual case in which physiologic neck rotation impeded perfusion through the internal carotid artery. The patient had a history of prior radical neck surgery and radiation for malignancy. He presented withbow hunter's-like symptoms with transient loss of consciousness and right-sided weakness with left lateral neck rotation. A self-expanding peripheral stent was successfully used to treat the patient by preventing rotatory carotid compression. In select patients with prior neck surgery and radiation, carotid injections should be part of a dynamic cerebral angiogram if the vertebral arteries are unremarkable.
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A nomogram to predict pathologic complete response (pCR) and the value of tumor-infiltrating lymphocytes (TILs) for prediction of response to neoadjuvant chemotherapy (NAC) in breast cancer patients
Abstract
Purpose
The value of tumor-infiltrating lymphocytes (TILs) for prediction of pathologic complete response (pCR) in breast cancer (BC) patients treated with neoadjuvant chemotherapy (NAC) has received increasing attention. In human epidermal growth factor receptor 2 (HER2)-positive BC, advances in HER2-targeted therapy have not yet clarified the clinical implications of pre-NAC TILs. Likewise, the prognostic role of TILs for long-term survival is not well established.
Methods
Pre- and post-NAC TIL levels were evaluated in 248 pair-matched pre-NAC biopsy and post-NAC resection samples, and analyzed for predictive and prognostic significance with other clinicopathologic parameters. Additional 60 pre-NAC biopsy samples of HER2-positive BC treated with a TCHP regimen (docetaxel, carboplatin, and a combination of trastuzumab and pertuzumab) were also assessed.
Results
High pre-NAC TILs, clinical nodal stage 0–1 (cN0–1), and negative ER expression were shown to be strong predictive markers for pCR. A nomogram based on these significant clinicopathologic predictors was developed, providing integrated probability of achieving pCR after NAC. The association between high pre-NAC TIL levels and significantly increased pCR rate was also confirmed in HER2-positive BC patients treated with a TCHP regimen. After chemotherapy, increased quantity of post-NAC TILs was shown to have extended BC-specific survival and disease-free survival in univariable and multivariable analyses.
Conclusions
High pre-NAC TIL levels were significantly predictive of pCR in BC, and can act as a surrogate marker for predicting therapeutic effects of a TCHP regimen for HER2-positive BC. Post-NAC TILs in residual disease were a new prognostic marker of risk stratification for long-term survival.
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Aphasia Recovery: When, How and Who to Treat?
Abstract
Purpose of Review
We now know that speech and language therapy (SALT) is effective in the rehabilitation of aphasia; however, there remains much individual variability in the response to interventions. So, what works for whom, when and how?
Recent Findings
This review evaluates the current evidence for the efficacy of predominantly impairment-focused aphasia interventions with respect to optimal dose, intensity, timing and distribution or spacing of treatment. We conclude that sufficient dose of treatment is required to enable clinical gains and that e-therapies are a promising and practical way to achieve this goal. In addition, aphasia can be associated with other cognitive deficits and may lead to secondary effects such as low mood and social isolation.
Summary
In order to personalise individual treatments to optimise recovery, we need to develop a greater understanding of the interactions between these factors.
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Population-level sexual behaviours in adolescent girls before and after introduction of the human papillomavirus vaccine (2003-2013) [Research]
BACKGROUND:
The human papillomavirus (HPV) vaccine is delivered widely through school-based immunization programs. Some groups have expressed concern that HPV vaccination programs will result in an increase in sexual risk-taking behaviours among adolescents. We aimed to evaluate population-level changes in sexual behaviours before and after implementation of the school-based HPV vaccination program in British Columbia.
METHODS:In 2008, a school-based HPV vaccination program for girls was introduced in British Columbia. Using data from the BC Adolescent Health Survey — a longitudinal provincial survey administered in schools to capture adolescent physical and emotional health indicators, we conducted a linear trend analysis on sexual health behaviours and risk factors in adolescent girls before and after the implementation of vaccination for HPV (2003, 2008 and 2013).
RESULTS:We analyzed data for 298 265 girls who self-identified as heterosexual. The proportion of girls reporting ever having sexual intercourse decreased from 21.3% (2003) to 18.3% (2013; adjusted odds ratio [OR] 0.79). Self-report of sexual intercourse before the age of 14 years decreased significantly from 2008 to 2013 (adjusted OR 0.76), as did reported substance use before intercourse (adjusted OR for 2003–2013 0.69). There was no significant change in the number of sexual partners reported (2003–2013). Between 2003 and 2013, girls' reported use of contraception and condoms increased, while pregnancy rates decreased.
INTERPRETATION:Since the implementation of school-based HPV vaccination program in BC, sexual risk behaviours reported by adolescent girls either reduced or stayed the same. These findings contribute evidence against any association between HPV vaccination and risky sexual behaviours.
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Characterisation of homologous recombination deficiency in paired primary and recurrent high-grade serous ovarian cancer
Characterisation of homologous recombination deficiency in paired primary and recurrent high-grade serous ovarian cancer
Characterisation of homologous recombination deficiency in paired primary and recurrent high-grade serous ovarian cancer, Published online: 15 October 2018; doi:10.1038/s41416-018-0268-6
Characterisation of homologous recombination deficiency in paired primary and recurrent high-grade serous ovarian cancer
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Profilin-1 deficiency leads to SMAD3 upregulation and impaired 3D outgrowth of breast cancer cells
Profilin-1 deficiency leads to SMAD3 upregulation and impaired 3D outgrowth of breast cancer cells
Profilin-1 deficiency leads to SMAD3 upregulation and impaired 3D outgrowth of breast cancer cells, Published online: 15 October 2018; doi:10.1038/s41416-018-0284-6
Profilin-1 deficiency leads to SMAD3 upregulation and impaired 3D outgrowth of breast cancer cells
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Target-based therapeutic matching of phase I trials in patients with metastatic breast cancer in a tertiary referral centre
Target-based therapeutic matching of phase I trials in patients with metastatic breast cancer in a tertiary referral centre
Target-based therapeutic matching of phase I trials in patients with metastatic breast cancer in a tertiary referral centre, Published online: 15 October 2018; doi:10.1038/s41416-018-0290-8
Target-based therapeutic matching of phase I trials in patients with metastatic breast cancer in a tertiary referral centre
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Mice deficient in the mitochondrial branched-chain aminotransferase (BCATm) respond with delayed tumour growth to a challenge with EL-4 lymphoma
Mice deficient in the mitochondrial branched-chain aminotransferase (BCATm) respond with delayed tumour growth to a challenge with EL-4 lymphoma
Mice deficient in the mitochondrial branched-chain aminotransferase (BCATm) respond with delayed tumour growth to a challenge with EL-4 lymphoma, Published online: 15 October 2018; doi:10.1038/s41416-018-0283-7
Mice deficient in the mitochondrial branched-chain aminotransferase (BCATm) respond with delayed tumour growth to a challenge with EL-4 lymphoma
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A phase I trial of pembrolizumab with hypofractionated radiotherapy in patients with metastatic solid tumours
A phase I trial of pembrolizumab with hypofractionated radiotherapy in patients with metastatic solid tumours
A phase I trial of pembrolizumab with hypofractionated radiotherapy in patients with metastatic solid tumours, Published online: 15 October 2018; doi:10.1038/s41416-018-0281-9
A phase I trial of pembrolizumab with hypofractionated radiotherapy in patients with metastatic solid tumours
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Epigenetically regulated miR-1247 functions as a novel tumour suppressor via MYCBP2 in methylator colon cancers
Epigenetically regulated miR-1247 functions as a novel tumour suppressor via MYCBP2 in methylator colon cancers
Epigenetically regulated miR-1247 functions as a novel tumour suppressor via MYCBP2 in methylator colon cancers, Published online: 15 October 2018; doi:10.1038/s41416-018-0249-9
Epigenetically regulated miR-1247 functions as a novel tumour suppressor via MYCBP2 in methylator colon cancers
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Phenotype-independent DNA methylation changes in prostate cancer
Phenotype-independent DNA methylation changes in prostate cancer
Phenotype-independent DNA methylation changes in prostate cancer, Published online: 15 October 2018; doi:10.1038/s41416-018-0236-1
Phenotype-independent DNA methylation changes in prostate cancer
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An IL13Rα2 peptide exhibits therapeutic activity against metastatic colorectal cancer
An IL13Rα2 peptide exhibits therapeutic activity against metastatic colorectal cancer
An IL13Rα2 peptide exhibits therapeutic activity against metastatic colorectal cancer, Published online: 15 October 2018; doi:10.1038/s41416-018-0259-7
An IL13Rα2 peptide exhibits therapeutic activity against metastatic colorectal cancer
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Plexiform Schwannoma of the Tongue in a Pediatric Patient with Neurofibromatosis Type 2: A Case Report and Review of Literature
Introduction. Plexiform schwannoma is a rare variant of schwannoma that accounts for only 5% of all schwannomas. Herein, we present a rare case of plexiform schwannoma of the tongue in a pediatric patient with neurofibromatosis type 2 (NF2). Case Presentation. A 13-year-old female presented with a growing left-sided tongue mass. The patient has a past medical history of NF2. The tongue mass was excised and histopathological examination revealed a spindle cell tumor with multinodular growth pattern, with Verocay bodies' formation. Tumor cells were strongly positive for S-100 protein and negative for smooth muscle actin (SMA), and EMA highlighted perineural fibroblasts surrounding tumor nodules. These findings were diagnostic of plexiform schwannoma. Conclusion. Plexiform schwannoma of the tongue is an extremely rare tumor seen in patients with NF2. Clinical examination and histopathological evaluation are important for diagnosis of plexiform schwannoma.
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Inflammatory Myofibroblastic Tumors in Paranasal Sinus and Nasopharynx: A Clinical Retrospective Study of 13 Cases
Background. Inflammatory myofibroblastic tumor (IMT), as a mesenchymal tumor, is common in the lung and abdomen but rare in the paranasal sinus and nasopharynx. Objective. This study aimed to summarize the clinical characteristics of IMT in the paranasal sinus and nasopharynx and analyze the relationship between the treatment and the overall survival (OS). Method. The clinical features, treatment, and follow-up data of patients diagnosed with IMT of the paranasal sinus or nasopharynx from 2006 to 2017 were retrospectively analyzed, and the previous literature was reviewed. Results. IMT often presents as an ill-defined soft-tissue mass with bone destruction and invasion of surrounding structures. The treatment methods used in this study were different combinations of surgery, prednisone, radiotherapy, and chemotherapy or observation alone. Three of the 13 patients were lost and the follow-up time of the remaining 10 cases ranged from 2 to 87 months (median, 39 months). Two patients died of the disease; the other eight patients were stable. The 5-year survival rate was 72%. Among the four methods of treatment, only treatment with prednisone was significantly correlated with better OS (P = 0.046). Conclusions. IMT is an intermediate tumor that often mimics malignancy. We are not sure if IMTs in the nasal cavity are more aggressive because of the biology or if the location and local therapy in the head region is more complicated. Radiologic findings help know the extent of the lesion. For unresectable nasal IMT, combined therapy with glucocorticoids, chemotherapy, and radiotherapy is sometimes a better choice. Glucocorticoids are especially recommended as a basic part of the integrated therapy. However, the standard treatment needs further research.
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Association between a Single Nucleotide Polymorphism in the 3-UTR of ARHGEF18 and the Risk of Nonidiopathic Pulmonary Arterial Hypertension in Chinese Population
ARHGEF18 has been identified as upregulated in the lung tissues of rat models of pulmonary artery hypertension introduced by hypoxia or monocrotaline (MCT). We used online SNP function prediction tools to screen the candidate SNPs that might be associated with the regulation of the ARHGEF18 expression. The result suggested that rs3745357 located in the 3-untranslated region of ARHGEF18 is probably a genetic modifier in the process. In the present study, we aimed to investigate the association between ARHGEF18 rs3745357 polymorphism and nonidiopathic pulmonary arterial hypertension susceptibility (niPAH). A total of 293 participants were included in the case-control study (117 patients and 176 healthy controls). The rs3745357 variant was discriminated by using cleaved amplification polymorphism (CAP) sequence-tagged site technology. Although the overall allele and genotype frequencies of rs3745357 in niPAH patients were close to those of the control group, significant differences have been identified when we further divided the niPAH patients into subgroups with or without coronary heart disease (CHD). Rs3745357 C allele frequency was significantly higher in niPAH patients without CHD history (), while the frequency was significantly lower in niPAH patients with CHD history () when compared to control subjects. The distribution of genotype frequencies was also quite different. After adjustment by gender and age, significant differences were found between patients with CHD history and controls. The results suggest that the ARHGEF18 rs3745357 variant may be used as a marker for the genetic susceptibility to niPAH.
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A Noninvasive Score to Predict Liver Fibrosis in HBeAg-Positive Hepatitis B Patients with Normal or Minimally Elevated Alanine Aminotransferase Levels
Noninvasive fibrosis tests are highly needed but have not been well studied in chronic hepatitis B patients with normal or minimally elevated alanine aminotransferase (ALT) levels. This study is aimed at developing a noninvasive score system to predict liver fibrosis in these patients. HBeAg-positive chronic hepatitis B patients with ALT levels of
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Nasal Chondromesenchymal Hamartoma: Rare Case Report in an Elderly Patient and Brief Review of Literature
Hamartomas are considered a mixture of nonneoplastic tissue, which may be indigenous to a different location in the body. As such, they may be epithelial, mesenchymal, or mixed. In the sinonasal region, the following hamartomatous lesions are considered to lie on a spectrum and include respiratory epithelial adenomatoid hamartoma (REAH), chondro-osseous respiratory epithelial adenomatoid hamartoma (COREAH), and nasal chondromesenchymal hamartoma (NCMH). To our knowledge, less than 50 cases of sinonasal hamartomas have been reported in the English literature so far with NCMH being very rare and primarily a tumor in infancy, with only 2 cases reported in individuals older than 16 years of age. We report a highly unusual case of a NCMH in the right maxillary sinus of a 70-year-old female.
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Single versus Double Skin Preparation for Infection Prevention in Proximal Humeral Fracture Surgery
Preoperative skin preparation plays a major role in preventing postoperative infections. This study aims to compare a single skin preparation (povidone iodine) with a double skin preparation (chlorhexidine gluconate followed by povidone iodine). Forty patients affected by proximal humeral fracture were included in the study. The day of surgery the two skin preparation strategies were performed in the same shoulder, divided into two areas, at the level of the deltopectoral approach. Skin swabs were collected from each area and subjected to microbiological analysis. Both skin preparations significantly reduced the positive culture rate. Coagulase-negative staphylococci (CoNS) dropped from 92.5% to 40% and to 7.5% after the single and double skin preparation (p
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Bacterial contamination of coins obtained from school canteen and green market
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Hip fractures – treatment and functional outcome The development over 25 years
Publication date: Available online 13 October 2018
Source: Injury
Author(s): Emma Turesson, Kjell Ivarsson, Karl-Göran Thorngren, Ami Hommel
Abstract
Background
Nearly 18000 individuals suffer from hip fracture in Sweden each year. The choice in operation method for femoral neck fractures has changed over the years as well as the overall management. Functional outcome after hip fracture is affected by several factors and the overall functional level for old people in Sweden has improved over the last decades.
Objective
To describe and analyse the functional outcome and choice of operation method for hip fracture patients between 1988 and 2012.
Patients and methods
All patients with cervical or trochanteric hip fracture treated at Lund University Hospital from 1988 until 2012 were collected from the National Quality Register for hip fracture patients, RIKSHÖFT. Patients younger than 50 years and those with pathological fractures were excluded. Data regarding patient characteristics, fracture type, operation method and housing, walking ability and use of walk aids prefracture and at 4-months follow-up was retrieved and analysed.
Results
For this study 8723 patients were included with a mean age of 81.6 (men 79.3, women 82.5).
The mean age significantly increased over the period studied. Sliding hip screw dominates as method of choice for the trochanteric fractures. For the cervical fractures there is a clear shift from osteosynthesis to arthroplasty. There is a significant decrease in functional outcome at follow-up compared to prefracture. No significant trend change can be seen over 25 years. Functional outcome are worse for the patients with trochanteric fracture.
Conclusion
Although there have been changes in operation methods for hip fractures and the management has developed, our study does not show any effect on functional outcome over a 25-year period. The medical condition of these patients with increasing age seems to counteract efforts to improve the care.
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The Expedited Discharge of Patients With Multiple Traumatic Rib Fractures Is Cost-Effective
Publication date: Available online 13 October 2018
Source: Injury
Author(s): Michael K. Dalton, Michael J. Minarich, Kimberly J. Twaddell, Joshua P. Hazelton, Nicole M. Fox
Abstract
Introduction
Rib fractures are a cause of significant morbidity and mortality in trauma patients. It is well documented that optimizing pain control, mobilization, and respiratory care decreases complications. However, the impact of these interventions on hospital costs and length of stay is not well defined. We hypothesized patients with multiple rib fractures can be discharged within three hospital days resulting in decreased hospital costs.
Methods
A retrospective review of adult patients (≥18yrs) admitted to our Level 1 trauma center (2011-2013) with ≥ 2 rib fractures was performed. Patients were excluded if they were intubated, admitted to the ICU, required chest tube placement, or sustained significant multi-system trauma. (n = 202) Demographics, clinical characteristics, hospital costs, and outcome data were analyzed. Patients discharged within three hospital days of admission were considered to have achieved expedited discharge (ED). Univariate and multivariate analyses determined predictors of failure to achieve ED. A p value of <0.05 was considered significant.
Results
Study patients (n = 202) were 60 (SD = 19) years of age with an injury severity score (ISS) of 10 (SD = 5), and 4 (SD = 2) rib fractures. Of 202 patients, 127 (63%) achieved ED while 75 (37%) did not. No differences in chest AIS, ISS, smoking status or history of pulmonary disease were identified between the two groups (all p > 0.05). Average LOS (2 (SD = 1) vs. 7 (SD = 4) days; p < 0.001) and hospital costs ($2,865 (SD = 1,200) vs. $6,085 (SD = 3,033)); p < 0.001). were lower in the ED group A lower percentage of ED patients required placement in rehabilitation facilities (6% vs. 48%; p < 0.001). There were no readmissions within 30 days in either group. After controlling for potential confounding variables, multiple variable logistic regression analysis revealed that advancing age (OR 1.05 per year, 1.02-1.07) independently predicted failure to achieve ED.
Conclusion
The majority of patients admitted to the hospital with multiple rib fractures can be discharged within three days. This expedited discharge results in significant cost savings to the hospital. Early identification of patients who cannot meet the goal of expedited discharge can facilitate improvement in management strategies.
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Hirschsprung’s Associated Enterocolitis (HAEC) Personalized Treatment with Probiotics Based on Gene Sequencing Analysis of the Fecal Microbiome
Approximately 40% of children with Hirschsprung's disease (HD) suffer from Hirschsprung's associated enterocolitis (HAEC) despite correct surgery. Disturbances of the intestinal microbiome may play a role. Treatment with probiotics based on individual analyses of the fecal microbiome has not been published for HD patients with recurrent HAEC yet. A boy with trisomy 21 received transanal pull-through at the age of 6 months for rectosigmoid HD. With four years, he suffered from recurrent episodes of HAEC. The fecal microbiome was measured during three healthy and three HAEC episodes by next-generation sequencing. The patient was started on daily probiotics for 3 months; the fecal microbiome was measured weekly. The fecal microbiome differed significantly between healthy and HAEC episodes. HAEC episodes were associated with significant decreases of Actinobacteria and significant increases of Bacteroidetes and Proteobacteria. Probiotic treatment led to a significant increase of alpha diversity and a significant increase of Bifidobacterium and Streptococcus as well as decreases of Rikenellaceae, Pseudobutyrivibrio, Blautia, and Lachnospiraceae. A longitudinal observation of the microbiome has never been performed following correction of Hirschsprung's disease. Probiotic treatment significantly changed the fecal microbiome; the alterations were not limited to strains contained in the administered probiotics.
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Randomized, Double-Blind, Placebo-Controlled Study of Modified Erzhi Granules in the Treatment of Menopause-Related Vulvovaginal Atrophy
Objective. To evaluate the clinical therapeutic efficacy and safety of modified Erzhi granules (MEG) in patients with menopause-related vulvovaginal atrophy (VVA). Methods. This randomized, double-blind, placebo-controlled study comprised two groups, including the treatment and control groups. Patients receive MEG and placebo for 12 weeks, respectively. Vaginal health score (VHS), vaginitis score, vaginal maturation index (VMI), female sexual function index (FSFI), and modified Kupperman Index (modified KI) were used as efficacy endpoints and assessed at baseline, 4, 8, and 12 weeks during administration, and 4 weeks after drug withdrawal. At baseline and 12 weeks, serum estradiol (E2), follicle stimulating hormone (FSH), pelvic ultrasound, breast ultrasound, and other safety parameters were measured, recording adverse events. Results. At 12 weeks, VHS, percentage of superficial cells in the vaginal epithelium and FSFI were significantly increased, while vaginitis score, percentage of basal cells in the vaginal epithelium, and modified KI were significantly decreased in comparison with baseline and control group (all P0.05). Serum E2 and FSH levels, endometrial thickness, and breast thickness in all patients were within the normal ranges before and after treatment, with no serious adverse reactions observed. Conclusion. MEG significantly alleviates menopause-related vulvovaginal atrophy, with no overt adverse effects on the endometrium, breast, hepatic, and renal functions.
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Efficacy and Safety of Ginkgo Biloba Pills for Coronary Heart Disease with Impaired Glucose Regulation: Study Protocol for a Series of N-of-1 Randomized, Double-Blind, Placebo-Controlled Trials
Background. Coronary heart disease has become a serious challenge to China with its high prevalence and mortality. The impaired glucose regulation is prevalent in patients with cardiovascular disease. However, there are few drugs that interfere early with impaired glucose regulation. Ginkgo biloba extract not only is a commonly used drug for cardiovascular diseases, but also has a significant effect in reducing blood sugar. Therefore, this study used a single-case randomized controlled trial to explore the efficacy of Ginkgo biloba pills in the treatment of coronary heart disease patients with impaired glucose regulation. Methods/Design. This is a randomized, double-blind, placebo-controlled, three-period crossover trial for a single subject. A total of 12 subjects will be recruited in this trial. The trial is divided into three cycles, and one cycle has two treatment periods. Ginkgo biloba pills and placebo will be randomized during the treatment period. The test period will last for 58 weeks and subjects will take 48 weeks. Subjects will be selected by the researcher strictly in accordance with the inclusion and exclusion criteria. Discussion. Ginkgo biloba preparations are widely used in cardiovascular diseases both at home and abroad due to their definite curative effect, few side effects, various dosage forms, and convenient and safe use. Diabetes mellitus is a high-risk factor for the occurrence of cardiovascular disease. Therefore, it is of great significance to control the impaired glucose regulation and slow down the development of diabetes and reduce the incidence and mortality of cardiovascular diseases. This trial is registered with ClinicalTrials.gov (ID: NCT03483779).
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Biological Activities of Four Adaptogenic Plant Extracts and Their Active Substances on a Rotifer Model
Rotifers have been widely used as well-characterized models of aging, since their multiorgan character makes them suitable as in vivo toxicological and lifespan models. Here we report the assessment of four adaptogenic plants and their extracts for the first time in this model. The effects on rotifer viability of extracts and characteristic active markers of Panax ginseng, Withania somnifera, Leuzea carthamoides, and Rhodiola rosea were tested in vivo. The crude extracts were nontoxic to Philodina acuticornis bdelloid rotifers; however, the pure substances of the plants influenced negatively the viability. Ginsenoside Rb1 and secondary metabolites of Withania somnifera exerted deleterious effect on the animals. The aglycone tyrosol and cinnamyl alcohol (from Rhodiola rosea) were more toxic than their glycosides salidroside and rosavin. Although the 20-OH-ecdysone and ajugasterone C (from Leuzea carthamoides) are chemically very similar, the latter was less toxic.
https://ift.tt/2Ej6Kqb
The Influence of Body Mass Composition on the Postural Characterization of School-Age Children and Adolescents
Introduction. In recent years a significant increase in the percentage of children with postural problems has been observed. It is necessary to focus on preventing the phenomenon and on analysis of existing postural defects. Aim. The aim of this work was to assess the potential relationship between body mass composition and body posture in school-age children. Material and Methods. 464 school-age children ranging from 6 to 16 years (234 boys and 230 girls) were qualified for the study. Body mass composition was assessed using the analyzer Tanita MC 780 MA. Assessment of body posture was performed using Zebris system. All the results were analyzed with statistical methods. The accepted level of significance was p
https://ift.tt/2QO8B7O
Technetium-99 Conjugated with Methylene Diphosphonate Ameliorates Glucocorticoid Induced Osteoporosis by Inhibiting Osteoclastogenesis
Technetium-99 conjugated with methylene diphosphonate (99Tc-MDP) is an effective anti-inflammatory drug in treating rheumatoid arthritis (RA) for over 15 years in China. However, as a special form of bisphosphonate, the antiosteoporotic effect of 99Tc-MDP is unclear. We systematically investigated the effects of 99Tc-MDP on cancellous and cortical bone, respectively, in glucocorticoid induced osteoporosis (GIO) animal models. Forty-eight Sprague-Dawley rats were randomly divided into six groups: blank, negative control, high dose, medium dose, low dose, and positive control groups. After dexamethasone was given to all groups except the blank group to induce osteoporosis, the rats in different groups were treated with saline, MDP, or different doses of 99Tc-MDP. After treatment, all rats were sacrificed, and their tibiae and femora were analyzed with microcomputed tomography (micro-CT), histology and biomechanics. Micro-CT analyses showed that (1) 99Tc-MDP reversed glucocorticoid induced bone microarchitecture destruction by increasing BV/TV, Tb.Th, and Tb.N and decreasing BS/BV, Tb.Sp, and TBPf; (2) effect of 99Tc-MDP increased as its dosage increased; and (3) 99Tc-MDP could improve cortical bone thickness while MDP failed to do so. Micro-CT spatial structure analysis and histology also yielded consistent results, indicating that 99Tc-MDP increased trabecular number and connectivity morphologically. Secondly, biomechanics revealed that 99Tc-MDP can enhance the extrinsic stiffness of bone by changing bone geometry. Finally, 99Tc-MDP could inhibit osteoclastogenesis in PBMCs in human. In conclusion, 99Tc-MDP exerted antiosteoporotic effect by improving both cancellous and cortical bone, as well as increasing extrinsic bone stiffness which might be attributed to the its inhibition of osteoclast differentiation. The antiosteoporotic effect of 99Tc-MDP may suggest a potential clinical application for patients with GIO.
https://ift.tt/2CKx5vV
CT Myocardial Perfusion Imaging: A New Frontier in Cardiac Imaging
The past two decades have witnessed rapid and remarkable technical improvement of multidetector computed tomography (CT) in both image quality and diagnostic accuracy. These improvements include higher temporal resolution, high-definition and wider detectors, the introduction of dual-source and dual-energy scanners, and advanced postprocessing. Current new generation multidetector row (≥64 slices) CT systems allow an accurate and reliable assessment of both coronary epicardial stenosis and myocardial CT perfusion (CTP) imaging at rest and during pharmacologic stress in the same examination. This novel application makes CT the unique noninvasive "one-stop-shop" method for a comprehensive assessment of both anatomical coronary atherosclerosis and its physiological consequences. Myocardial CTP imaging can be performed with different approaches such as static arterial first-pass imaging, and dynamic CTP imaging, with their own advantages and disadvantages. Static CTP can be performed using single-energy or dual-energy CT, employing qualitative or semiquantitative analysis. In addition, dynamic CTP can obtain quantitative data of myocardial blood flow and coronary flow reserve. The purpose of this review was to summarize all available evidence about the emerging role of myocardial CTP to identify ischemia-associated lesions, focusing on technical considerations, clinical applications, strengths, limitations, and the more promising future fields of interest in the broad spectra of ischemic heart disease.
https://ift.tt/2Ch3hpF
Association of Resistin Gene Polymorphisms with Oral Squamous Cell Carcinoma Progression and Development
Oral squamous cell carcinoma (OSCC) accounts for over 90% of malignant neoplasms of the mouth. In Taiwan, OSCC is the fourth most common male cancer and the fourth leading cause of male cancer death. Resistin (RETN) is an adipokine that is associated with obesity, inflammation, and various cancers. Here, we examine the association between four single nucleotide polymorphisms (SNPs) of the RETN gene (rs3745367, rs7408174, rs1862513, and rs3219175) and OSCC susceptibility as well as clinical outcomes in 935 patients with OSCC and in 1200 cancer-free healthy controls. We found that, in 1465 smokers, RETN polymorphisms carriers with the betel-nut chewing habit had a 6.708–10.882-fold greater risk of having OSCC compared to RETN wild-type carriers without the betel-nut chewing habit. Patients with OSCC who had A/A homozygous of RETN rs3219175 polymorphism showed a high risk for an advanced tumor size (> T2), compared to those patients with G/G homozygotes. In addition, A/T/G/G haplotype significantly increased the risks for OSCC by 1.376-fold. This study is the first to examine the risk factors associated with RETN SNPs in OSCC progression and development in Taiwan.
https://ift.tt/2CGsY3G
Risk Evaluation of Azithromycin-Induced QT Prolongation in Real-World Practice
Background. Azithromycin exposure has been reported to increase the risk of QT prolongation and cardiovascular death. However, findings on the association between azithromycin and cardiovascular death are controversial, and azithromycin is still used in actual practice. Additionally, quantitative assessments of risk have not been performed, including the risk of QT prolongation when patients are exposed to azithromycin in a real-world clinical setting. Therefore, in this study, we aimed to evaluate the risk of exposure to azithromycin on QT prolongation in a real-world clinical setting using a 21-year medical history database of a tertiary medical institution. Methods. We analyzed the electrocardiogram results and relevant electronic health records of 402,607 subjects in a tertiary teaching hospital in Korea from 1996 to 2015. To evaluate the risk of QT prolongation of azithromycin, we conducted a case-control analysis using amoxicillin for comparison. Multiple logistic regression analysis was performed to correct for age, sex, accompanying drugs, and disease. Results. The odds ratio (OR) for QT prolongation (QTc>450 ms in male and >460 ms in female) on azithromycin exposure was 1.40 (95% confidence interval [CI], 1.23-1.59), and the OR for severe QT prolongation (QTc>500 ms) was 1.43 (95% CI, 1.13-1.82). On the other hand, the ORs on exposure to amoxicillin were 1.06 (95% CI, 0.97-1.15) and 0.88 (95% CI, 0.70-1.09). In a subgroup analysis, the risk of QT prolongation in patients aged between 60 and 80 years was significantly higher when they are exposed to azithromycin. Conclusions. The risk of QT prolongation was increased when patients, particularly the elderly aged 60-79 years, were exposed to azithromycin. Therefore, clinicians should pay exercise caution using azithromycin or consider using other antibiotics, such as amoxicillin, instead of azithromycin.
https://ift.tt/2CeNojg
The Therapeutic Effect of the Chinese Herbal Medicine, Rehmanniae Radix Preparata, in Attention Deficit Hyperactivity Disorder via Reversal of Structural Abnormalities in the Cortex
Rehmanniae radix preparata is extracted from wine-steaming the Rehmannia root, a scrophulariaceae plant. It has been used for thousands of years with effects of nourishing kidney-yin, benefiting essence and filling marrow based on traditional Chinese medicine (TCM) theory. Rehmanniae radix preparata has antioxidant, antisenescence, anti-inflammatory, and neuroprotective properties. It is the most popular Traditional Chinese medicinal compound (TCMC) used in attention deficit hyperactivity disorder (ADHD) therapy. However, few studies have been conducted exploring the effects and potential mechanisms of Rehmanniae radix preparata alone on ADHD. Recent studies have shown that Rehmanniae radix preparata inhibits spontaneous activity in mice, improves learning and memory in rats following thalamic arcuate nucleus injury, and exhibits antidepressant effects. Catalpol, an active component of Rehmanniae radix preparata, elevates brain-derived neurotrophic factor (BDNF), and attenuates neuronal apoptosis and energy metabolism failure. ADHD is characterized by hyperactivity-impulsivity and impairments in learning and memory. Its pathomechanism is closely related to structural abnormalities in the cortex that is mediated by dysfunction in neuronal development, apoptosis, and energy metabolism. We hypothesize that Rehmanniae radix preparata may be effective at treating ADHD by alleviating neurodevelopmental abnormalities, neuronal apoptosis, and energy metabolism failure.
https://ift.tt/2OrOpfr
Vitamin D supplementation and neurofilament light chain in multiple sclerosis
Acta Neurologica Scandinavica, Volume 0, Issue ja, -Not available-.
https://ift.tt/2IUEeK9
Finite Element Analysis and Biomechanical Testing to Analyze Fracture Displacement of Alveolar Ridge Splitting
The alveolar ridge splitting technique enables reconstruction of atrophied alveolar ridges prior implantation. However, in cases of severe atrophy, there is an unpredictable risk of fracturing the buccal lamella during the expansion. Currently, there is no preoperative assessment to predict the maximum distraction of the lamella. The aim of this study was to develop a biomechanical model to mimic the alveolar ridge splitting and a finite element (FE) model to predict the experimental results. The biomechanical testing was conducted on porcine mandibles. To build the FE model high resolution peripheral quantitative computer tomography scans of one specimen was performed after the osteotomy outline, but before the lamella displacement. A servo-electric testing machine was used for the axial tension test to split the lamellae. Results showed, in line with clinical observations, that the lamellae broke primarily at the base of the splits with a median displacement of 1.27 mm. The FE model could predict fracture force and fracture displacement. Fracture force showed a nonlinear correlation with the height of the bone lamella. In conclusion, good correspondence between mechanical testing and virtual FE analysis showed a clinically relevant approach that may help to predict maximum lamella displacement to prevent fractures in the future.
https://ift.tt/2QRwDil
Antitumor activity of sulforaphane in mice model of skin cancer via blocking sulfatase‐2
Experimental Dermatology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2Ophesz
Acceleration of cancer science with genome editing and related technologies
Cancer Science, Volume 0, Issue ja, -Not available-.
https://ift.tt/2yDhJET
Lack of correlation between the costs of anticancer drugs and clinical benefits in Japan
Cancer Science, Volume 0, Issue ja, -Not available-.
https://ift.tt/2ygsJbM
Xenoantigen Deletion and Chemical Immunosuppression Can Prolong Renal Xenograft Survival
Objective: Xenotransplantation using pig organs could end the donor organ shortage for transplantation, but humans have xenoreactive antibodies that cause early graft rejection. Genome editing can eliminate xenoantigens in donor pigs to minimize the impact of these xenoantibodies. Here we determine whether an improved cross-match and chemical immunosuppression could result in prolonged kidney xenograft survival in a pig-to-rhesus preclinical model. Methods: Double xenoantigen (Gal and Sda) knockout (DKO) pigs were created using CRISPR/Cas. Serum from rhesus monkeys (n = 43) was cross-matched with cells from the DKO pigs. Kidneys from the DKO pigs were transplanted into rhesus monkeys (n = 6) that had the least reactive cross-matches. The rhesus recipients were immunosuppressed with anti-CD4 and anti-CD8 T-cell depletion, anti-CD154, mycophenolic acid, and steroids. Results: Rhesus antibody binding to DKO cells is reduced, but all still have positive CDC and flow cross-match. Three grafts were rejected early at 5, 6, and 6 days. Longer survival was achieved in recipients with survival to 35, 100, and 435 days. Each of the 3 early graft losses was secondary to IgM antibody-mediated rejection. The 435-day graft loss occurred secondary to IgG antibody-mediated rejection. Conclusions: Reducing xenoantigens in donor pigs and chemical immunosuppression can be used to achieve prolonged renal xenograft survival in a preclinical model, suggesting that if a negative cross-match can be obtained for humans then prolonged survival could be achieved.https://ift.tt/2CLR26d
Status of Helicobacter pylori infection and gastric mucosal atrophy in patients with gastric cancer; Analysis based on the Japan Endoscopy Database
Digestive Endoscopy, Volume 0, Issue ja, -Not available-.
https://ift.tt/2pRInFW
Cirrhotic Cardiomyopathy After Transplantation: Neither the Transient Nor Innocent Bystander
Hepatology, EarlyView.
https://ift.tt/2NGjbfc
Pay It Forward: Building Capacity to Treat Hepatitis C by Training Our Own Residents
Hepatology, EarlyView.
https://ift.tt/2pSEBfK
Eosinophilia and reduced STAT3 signalling affect neutrophil cell death in autosomal‐dominant Hyper‐IgE syndrome
European Journal of Immunology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2OofXlv
Evaluating the IgMi mouse as a novel tool to study B cell biology
European Journal of Immunology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2IUSTot
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Αλέξανδρος Γ. Σφακιανάκης Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,0030693260717...
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heory of COVID-19 pathogenesis Publication date: November 2020Source: Medical Hypotheses, Volume 144Author(s): Yuichiro J. Suzuki ScienceD...
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