Vulvite granulomateuse de type Miescher

Publication date: Available online 6 June 2018
Source:Annales de Dermatologie et de Vénéréologie
Author(s): K. Alhazmi, S. Berville, M. Moyal-Barracco, F. Plantier
IntroductionLa chéilite de Miescher, isolée ou dans le cadre d'un syndrome de Melkerssohn-Rosenthal, est une inflammation granulomateuse rare de cause inconnue dont il existe un équivalent génital encore plus rare. Nous en décrivons un cas, avec son évolution sur douze années.ObservationUne femme de 27 ans présentait des poussées d'œdème vulvaire unilatéral, régressives au début puis aboutissant au fil du temps à des tuméfactions permanentes, vulvaire et périnéale. Les prélèvements histologiques montraient des granulomes histiocytaires épithélioïdes, si discrets qu'ils étaient passés inaperçus au début de l'évolution. L'œdème demeurait un signe isolé pendant douze ans et deux bilans digestifs à la recherche d'une maladie de Crohn étaient négatifs, permettant d'écarter ce diagnostic.DiscussionLa vulvite granulomateuse de type Miescher est un diagnostic d'élimination, essentiellement de la maladie de Crohn. Notre observation illustre la difficulté du diagnostic de cette pathologie rare et les incertitudes concernant sa physiopathologie. Le diagnostic impose de savoir répéter les prélèvements et pratiquer des biopsies profondes avec des niveaux de coupes répétés pour identifier les granulomes paravasculaires caractéristiques, parfois très discrets.BackgroundMiescher's cheilitis, whether occurring alone or as part of Melkersson-Rosenthal syndrome, is a rare type of granulomatous inflammation of unknown cause with an even rarer genital equivalent. Herein, we describe a case of the latter condition developing over a 12-year period.Patients and methodsA 27-year-old woman presented episodes of unilateral vulvar oedema, which initially regressed but resulted over time in permanent vulvar and perineal tumefaction. Histology revealed epithelioid histocytic granulomas so mild that they were not noticed at the start of the disease. The oedema remained the sole sign for 12years and two gastrointestinal screening tests for Crohn's disease proved negative, diagnosis of the latter condition was ruled out.DiscussionMiescher's granulomatous vulvitis requires differential diagnosis, essentially with regard to Crohn's disease. Our case illustrates the difficulty in diagnosing this rare disease as well as the uncertainties surrounding its physiopathology. Diagnosis rests upon repeated sampling and biopsies with repeated levels of sections in order to identify the characteristic perivascular granulomas, which may be very mild.



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Cerebellar degeneration in primary Sjögren syndrome

Neurological manifestations are reported as a consequence of primary Sjögren syndrome (PSS). Any part of the brain and peripheral nervous system can be involved in PSS. However, cerebellar degeneration and atrophy associated with PSS have been rarely reported. Our report describes a 22-year-old woman who presented with cerebellar ataxia, arthritis and arthralgia. Evaluation of her symptoms, autoantibodies and salivary gland pathology was in favour of the diagnosis of Sjögren syndrome. Also, her brain MRI revealed cerebellar degeneration. There are only four patients reported to be affected by cerebellar atrophy associated with PSS. Administration of high doses of methylprednisolone and cyclophosphamide leads to substantial improvement in the cerebellar symptoms of this case. In addition, after 2 months of follow-up, the patient's ataxia recovered significantly. It could be concluded that in addition to neurological degenerative disorders, in some cases cerebellar atrophy could also be associated with autoimmune conditions such as PSS.

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Campylobacter jejuni and Pseudomonas coinfection in the setting of ulcerative colitis

A 66-year-old woman presented with 2 days of fever and severe diarrhoea. She has a history of ulcerative colitis (UC), well controlled with medication. She also has a history of Ehlers-Danlos syndrome, infective endocarditis following aortic valve replacement and pulmonary embolism. She had complained of passing stool with traces of blood about 30 times per day. Stool testing for Clostridium difficile, routine culture and microscopy was done. She was started on ceftriaxone. CT scan revealed thick-walled colon consistent with UC flare. Flexible sigmoidoscopy showed active continuous colitis extending from the rectum to the proximal descending colon. Campylobacter jejuni was isolated from the stool and blood cultures yielded Pseudomonas aeruginosa. The antibiotic was transitioned to intravenous piperacillin/tazobactam and azithromycin followed by 2 weeks of intravenous cefepime. Her diarrhoea was controlled, and she was discharged for follow-up in 2 months.

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Lupus of the larynx: when bamboo nodes lead to diagnosis...

Description 

An 18-year-old patient consulted complaining of dysphonia for 3 months associated with severe weakness, headache and diffuse articular pain, with haematoma at the slightest trauma.

Laryngoscopy showed a submucosal oval lesion in the middle third of the two vocal folds resembling bamboo joint nodes (figure 1). Laboratory analysis showed the presence of antinuclear antibodies, antidouble-stranded DNA, antinucleosome, anti-SSA (117), anti-SSB (115) and anti-Sm (25) antibodies associated with thrombocytopaenia, haemolytic anaemia and severe ADAMTS-13 deficiency (under 5%). The patient was admitted to the hospital for monitoring, plasma exchange and glucocorticoid therapy. The diagnosis of systemic lupus erythematosus was made. The laryngeal lesions were bamboo nodes. The patient received Solu-Medrol 500 mg/day and prednisone 60 mg/day combined with speech therapy. The bamboo nodes partially regressed under treatment with a marked improvement of the voice. A few months later, laryngeal injection of triamcinolone 40 mg under local anaesthesia was performed with a favourable...

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Small bowel obstruction caused by vas deferens: a first documented report

Small bowel obstruction (SBO) is one of the most common causes for an acute surgical admission. Most of the time SBO is a result of common causes such as postoperative adhesions. However, rare and unusual causes of SBO do exist which can be challenging for surgeons. We report a first documented case of SBO caused by a remnant of the vas deferens in a 24-year-old patient with a history of gastroschisis and left orchidectomy. Clinical presentation, investigations, imaging and management of this case are described. To summarise, clinicians should keep an open mind in dealing with patients with intestinal obstruction due to the rare and atypical causes.

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Avascular necrosis: a growing concern for the HIV population

A 33-year-old woman with history of HIV presented with 4 months of gradually progressing right hip pain and was found to have avascular necrosis (AVN) of both femoral heads. She had no other risk factors for AVN including sickle cell disease, systemic lupus erythematosus, prolonged steroid used or trauma. She initially failed conservative management and ultimately had bilateral hip core decompressions. After decompression therapy, the left femoral head collapsed and patient underwent a left total hip arthroplasty. Her postsurgical course was complicated by the left sciatic nerve neuropathy for which she is currently being managed with duloxetine. She has yet to follow-up with her orthopaedic surgeon for further evaluation.

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Radiological appearance of primary extracranial meningioma of the pelvis in a middle-aged woman

Description 

A 47-year-old woman came with the complaints of on-and-off constipation for 6 months with the inability to pass stool for 2 days. She also complained of poor urinary stream and increased urine frequency for 1 year and had a history of hysterectomy with bilateral salpingo-oophorectomy. Her general and systemic examinations were unremarkable. Abdominal radiograph revealed diffuse opacification of the pelvis with left lateral displacement and compression of the rectal shadow (figure 1A). CT of abdomen and pelvis (figure 1B–F) revealed a large, well-defined heterogeneously enhancing lobulated lesion in the presacral region and central pelvis showing multiple coarse calcifications within. The lesion was abutting the distal sigmoid colon and rectum causing their left lateral displacement with luminal compression and loss of intervening fat plane. There was resultant dilatation of the large and distal small bowel loops suggestive of intestinal obstruction. The fat plane between the lesion and the...

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Small intestinal bacterial overgrowth (SIBO) and vitamin K-responsive coagulopathy: a previously unrecorded association

A 17-year-old woman, with a history of three operations on the upper gut in early life and intermittent diarrhoea, presented with a history of epistaxis and leg ecchymosis for the previous 3 months. Initial investigation revealed mild anaemia, low serum albumin, moderately elevated aminotransferases and an exceedingly prolonged prothrombin time (PT) which was promptly shortened to normal by intravenous vitamin K. Additional investigations revealed a grossly abnormal glucose hydrogen breath test, a dilated duodenum and deficiencies of vitamins A, D and E. Repeated courses of antimicrobial agents caused prompt but transient shortening of PT and eventually a duodenal–jejunal anastomosis was performed. Since then, up to 36 months later, the patient has been in good general health and PT has been consistently normal with no vitamin K supplementation. Small intestinal bacterial overgrowth has previously been associated with several conditions but this is the first description of its association with vitamin K-responsive coagulopathy.

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Melanoma with rhabdomyosarcomatous differentiation

Melanoma with rhabdomyosarcomatous differentiation is an extremely rare observation with a review of the literature revealing fewer than 15 previously identified cases. The authors describe a case of a 72-year-old man with a cutaneous lesion of the left scalp that was diagnosed as malignant melanoma on biopsy and wide excision. One month later, a punch biopsy of the excisional area revealed rhabdomyosarcomatous proliferation. Re-examination of the wide-excision specimen with muscle markers revealed areas of neoplastic melanoma cells consistent with rhabdomyosarcomatous differentiation.

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Lipschütz ulcer and group A streptococcal tonsillitis

Lipschütz ulcers (LU) are non-sexually related genital ulcers, rarely reported. We describe a healthy 11-year-old girl, who presented with fever and a painful vulvar ulcer associated with erythematous tonsillitis. Throat swab test for Group A Streptococcus (GAS) was positive. She was treated with amoxicillin. Further investigation was negative, including Herpes Simplex virus DNA from ulcer swab and serology for Epstein-Barr virus, cytomegalovirus and Mycoplasma pneumoniae. Antistreptolysin O titre was high. The ulcer healed in 2 weeks, with no recurrence in a 1 year follow-up period. The association of LU with GAS tonsillitis is very rare.

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Ombitasvir/paritaprevir/ritonavir plus dasabuvir regimen may be used safely in combination with sirolimus for the treatment of chronic hepatitis C

The era of direct acting antivirals has revolutionised the management of chronic hepatitis C infection and improved patient outcomes. The optimal management of patients who require liver transplantation remains a matter of ongoing discussion. Treatment in the post-transplantation setting may be complicated by significant drug–drug interactions between antiviral agents and standard immune suppressive treatment regimens. We describe what we believe to be the first reported case of a patient successfully treated for CHC with ombitasvir/paritaprevir/ritonavir plus dasabuvir, while taking sirolimus following liver transplantation.

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Isolated hepatobiliary tuberculosis: a diagnostic challenge

Hepatobiliary system involvement is frequently seen as part of disseminated tubercular infection. But primary isolated hepatobiliary tuberculosis with no evidence of tuberculosis elsewhere in the body is extremely rare. Isolated hepatobiliary tuberculosis can cause diagnostic dilemma as the clinical, laboratory and imaging features are non-specific in majority of the cases. We report the case of a 50-year-old woman who presented with hepatobiliary tuberculosis with no pulmonary or extra hepatic involvement. Liver function tests were abnormal and ultrasonography (USG), CT and MR cholangiopancreatography showed multiple focal lesions in the liver. The diagnosis of tuberculosis was confirmed by a USG-guided biopsy of the liver lesions. In endemic regions with the presence of supportive imaging findings, in the appropriate clinical setting, the possibility of hepatic tuberculosis should be considered and diagnosis has to be confirmed with histopathological examination.

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IgG4-related periarteritis in the coronary artery and subclinical pericarditis assessed the presence and monitoring of therapy response by PET and CT scan

Description 

A 70-year-old woman suffered from bilateral lacrimal gland enlargement from 2 years ago (figure 1). Geranium-enhanced MRI disclosed diffuse enlargement of bilateral eyelids indicating IgG4-related disease (IgG4RD), especially Mikulicz's disease. Laboratory tests showed elevation of serum IgG4 concentration and histopathological findings of the lacrimal glands showed IgG4-positive cell infiltration and obliterated veins by inflammatory cells, which consist of lymphocytes and plasma cells (obliterative phlebitis).

Figure 1

Bilateral lacrimal gland enlargement with predominance of right ones observed as a representative pathophysiological finding in this patient with IgG4-related disease.

Then, she was diagnosed with IgG4RD. We performed chest CT as screening for comorbidities of Mikulicz's disease. Chest CT revealed left circumflex artery (LCX) wall thickening. Coronary CT showed thickening of the left anterior descending artery and LCX. For suppressing physiological myocardial uptake, the patient was asked to restrict carbohydrate intake 24 hours before...

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Unexpected early complication of implantable-cardioverter defibrillator

A 41-year-old woman was visiting Oxford, where she had a sudden cardiac arrest. Cardiopulmonary resuscitation was started by a bystander until the paramedics arrived, who found her in ventricular fibrillation, and delivered three shocks. After 28 min she had return of spontaneous circulation. Emergency coronary angiography revealed normal coronary arteries. Echocardiography followed by a cardiac MRI showed non-dilated left ventricles with no evidence of late gadolinium enhancement. She had a single-chamber implantable-cardioverter defibrillator (ICD). A chest CT showed sternal fracture and subsegmental pulmonary embolism, for which she was anticoagulated and was discharged.

Several days later, the patient presented to another hospital with atypical chest pain and dizziness. She had haemodynamic instability and echocardiography showed the ICD lead perforating through the right ventricle, with a large pericardial effusion and tamponade, for which pericardiocentesis was done. Afterwards, the patient had repositioning of the ICD lead safely.

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Mutual promotion of electrochemical-localized surface plasmon resonance on nanochip for sensitive sialic acid detection

Publication date: 15 October 2018
Source:Biosensors and Bioelectronics, Volume 117
Author(s): Shuang Li, Jinglong Liu, Yanli Lu, Long Zhu, Candong Li, Lijiang Hu, Jun Li, Jing Jiang, Szeshin Low, Qingjun Liu
Localized surface plasmon resonance (LSPR) induced charge separation were concentrated on the metal nanoparticles surface, which made it sensitive to the surface refractive index changes during optical sensing. Similarly, electrochemical detection was based on the electron transformation on the electrode surface. Herein, we fabricated a nanochip by decorating a nanocone-array substrate with gold nanoparticles and silver nanoparticles for dynamic electro-optical spectroscopy. Mercaptophenyl boronic acid (MPBA) was immobilized firmly on the nanochip by the metal-S bond for sensitive sialic acid sensing. Owing to the high stability of gold nanoparticles and the high sensitivity of silver nanoparticles, the nanochip showed good performance in LSPR detection with rich and high responses. Besides, the nanochip also showed sensitive electrical signals during electrochemical detection due to the excitation of the energetic charges from the nanoparticles surface to the reaction system. The dynamic electro-optical spectroscopy was based on a unique combination of LSPR and linear sweep voltammetry (LSV). On the one hand, electrochemical signals activated the electrons on the nanochip to promote the propagation and resonance of surface plasmon. On the other hand, LSPR concentrated the electrons on the nanochip surface, which made the electrons easily driven to enhance the current in electrochemical detection. Results showed that mutual promotion of electrochemical-LSPR on nanochip covered a linear dynamic range from 0.05 mM to 5 mM on selective sialic acid detection with a low detection limit of 17 μM. The synchronous amplification of the electro-optical response during electrochemical-LSPR, opened up a new perspective for efficient and sensitive biochemical detection.



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Highly selective aptamer based organic electrochemical biosensor with pico-level detection

Publication date: 15 October 2018
Source:Biosensors and Bioelectronics, Volume 117
Author(s): Nileshi Saraf, Eric R. Woods, Madison Peppler, Sudipta Seal
An organic aptamer functionalized electrochemical transistor has been developed to detect the presence of epinephrine molecule which acts as an excitatory neurotransmitter. The abnormalities in the level of epinephrine are the direct symptoms of some diseases such as Takotsubo cardiomyopathy, myocardial infarction, arrhythmias and other heart related diseases. The present approach is based on immobilization of aptamers on the gate electrode which selectively binds to epinephrine with high affinity. The introduction of epinephrine in the system causes screening of negative charge of aptamers as well as the production of Faradaic current due to oxidation of epinephrine. The synergistic effect of these two events decreases the overall channel current which was seen in both transfer characteristics and current-time curve. Additional experiments against common interfering agents (dopamine, ascorbic acid, DOPAC etc) showed no decrease in the current which indicates high specificity of the sensor. Overall, the incorporation of aptamers in the transistor has allowed us to obtain a sensor exhibiting the lowest limit of detection for epinephrine (90 pM) till date which is comparable to normal physiological level. This approach provides a real-time detection of a large range of biomolecules and viral proteins in a time and cost-effective manner and has applications in point-of-care testing tool for several diagnostic applications.



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Interferometric nanoimmunosensor for label-free and real-time monitoring of Irgarol 1051 in seawater

Publication date: 15 October 2018
Source:Biosensors and Bioelectronics, Volume 117
Author(s): Blanca Chocarro-Ruiz, Sonia Herranz, Adrián Fernández Gavela, Josep Sanchís, Marinella Farré, M. Pilar Marco, Laura M. Lechuga
An interferometric nanobiosensor for the specific and label-free detection of the pollutant Irgarol 1051 directly in seawater has been settled. Due to the low molecular weight of Irgarol pollutant and its expected low concentration in seawater, the sensor is based on a competitive inhibition immunoassay. Parameters as surface biofunctionalization, concentration of the selective antibody and regeneration conditions have been carefully evaluated. The optimized immunosensor shows a limit of detection of only 3 ng/L, well below the 16 ng/L set by the EU as the maximum allowable concentration in seawater. It can properly operate during 30 assay-regeneration cycles using the same sensor biosurface and with a time-to-result of only 20 min for each cycle. Moreover, the interferometric nanosensor is able to directly detect low concentrations of Irgarol 1051 in seawater without requiring sample pre-treatments and without showing any background signal due to sea matrix effect.



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Electroactive Au@Ag nanoparticles driven electrochemical sensor for endogenous H2S detection

Publication date: 15 October 2018
Source:Biosensors and Bioelectronics, Volume 117
Author(s): Yuan Zhao, Yaxin Yang, Linyan Cui, Fangjie Zheng, Qijun Song
In this work, a novel and facile electrochemical sensor is reported for the highly selective and sensitive detection of dissolved hydrogen sulfide (H2S), attributing to the redox reaction between Au@Ag core-shell nanoparticles (Au@Ag NPs) and H2S. Electroactive Au@Ag NPs not only possess excellent conductivity, but exhibit great electrochemical reactivity at 0.26 V due to the electrochemical oxidation from Ag° to Ag⁺. In the presence of H2S, the Ag shell of Au@Ag NPs can be oxidized to Ag2S, resulting in the decrease of differential pulse voltammetry (DPV) peak at 0.26 V. The electrochemical sensor exhibits a wide linear response range from 0.1 nM to 500 nM. The limit of detection (LOD) for H2S is as low as 0.04 nM. The developed sensor shows significant prospects in the study of pathological processes related to the mechanism of H2S production.



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Application of bioconjugation chemistry on biosensor fabrication for detection of TAR-DNA binding protein 43

Publication date: 15 October 2018
Source:Biosensors and Bioelectronics, Volume 117
Author(s): Yifan Dai, Chunlai Wang, Liang-Yuan Chiu, Kevin Abbasi, Blanton S. Tolbert, Geneviève Sauvé, Yun Yen, Chung-Chiun Liu
A simple-prepare, single-use and cost-effective, in vitro biosensor for the detection of TAR DNA-binding protein 43 (TDP-43), a biomarker of neuro-degenerative disorders, was designed, manufactured and tested. This study reports the first biosensor application for the detection of TDP-43 using a novel biosensor fabrication methodology. Bioconjugation mechanism was applied by conjugating anti-TDP 43 with N-succinimidyl S-acetylthioacetate (SATA) producing a thiol-linked anti-TDP 43, which was used to directly link with gold electrode surface, minimizing the preparation steps for biosensor fabrication and simplifying the biosensor surface. The effectiveness of this bioconjugation mechanism was evaluated and confirmed by FqRRM12 protein, using nuclear magnetic resonance (NMR). The surface coverage of the electrode was analyzed by Time-of-Flight-Secondary Ion Mass Spectrometry (TOF-SIMS). Differential pulse voltammetry (DPV) was acted as the detection transduction mechanism with the use of [Fe(CN)6]^3-/4-redox probe. Human TDP-43 peptide of 0.0005 µg/mL to 2 µg/mL in undiluted human serum was analyzed using this TDP-43 biosensor. Interference study of the TDP-43 biosensor using β-amyloid 42 protein and T-tau protein confirmed the specificity of this TDP-43 biosensor. This bioconjugation chemistry based approach for biosensor fabrication circumvents tedious gold surface modification and functionalization while enabling specific detection of TDP-43 in less than 1 h with a low fabrication cost of a single biosensor less than $3.

Graphical abstract

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Mastectomy skin flap thickness

Publication date: July 2018
Source:European Journal of Surgical Oncology, Volume 44, Issue 7
Author(s): Stuart A. Robertson, Ramsey I. Cutress




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Prehabilitation and functional recovery for colorectal cancer patients

Publication date: July 2018
Source:European Journal of Surgical Oncology, Volume 44, Issue 7
Author(s): Enrico Maria Minnella, Francesco Carli
Cancer and its treatments are associated with functional decline that has impactful consequences on quality of life, and care continuum. Thus, optimizing perioperative functional capacity has been identified as a research and clinical priority in cancer care. The process of enhancing physical fitness before an operation to enable the patient to withstand the stress of surgery has been termed prehabilitation. Main elements are preoperative exercise, nutrition therapy, and anxiety-reduction techniques. Given the growing body of evidence on prehabilitation efficacy, this narrative review will summarize the rational underlying preoperative interventions, and propose a structured clinical pathway aimed at optimizing preoperative functional capacity.



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Obesity as a determinant of perioperative and postoperative outcome in patients following colorectal cancer surgery: a population-based study (2009–2016)

Publication date: Available online 6 June 2018
Source:European Journal of Surgical Oncology
Author(s): Youri Q.M. Poelemeijer, Niki Lijftogt, Robin Detering, Marta Fiocco, Rob A.E.M. Tollenaar, Michel W.J.M. Wouters
BackgroundObesity is an increasing problem worldwide that can influence perioperative and postoperative outcomes. However, the relationship between obesity and treatment-related perioperative and short-term postoperative morbidity after colorectal resections is still subject to debate.StudyPatients were selected from the DCRA, a population-based audit including 83 hospitals performing colorectal cancer (CRC) surgery. Data regarding primary resections between 2009 and 2016 were eligible for analyses. Patients were subdivided into six categories: underweight, normal weight, overweight and obesity class I, II and III.ResultsOf 71,084 patients, 17.7% with colon and 16.4% with rectal cancer were categorized as obese. Significant differences were found for the 30-day overall postoperative complication rate (p < 0.001), prolonged hospitalization (p < 0.001) and readmission rate (colon cancer p < 0.005; rectal cancer p < 0.002) in obese CRC patients. Multivariate analysis identified BMI ≥ 30 kg/m² as independent predictor of a complicated postoperative course in CRC patients. Furthermore, obesity-related comorbidities were associated with higher postoperative morbidity, prolonged hospitalization and a higher readmission rate. No significant differences in performance were observed in postoperative outcomes of morbidly obese CRC patients between hospitals performing bariatric surgery and hospitals that did not.ConclusionThe real-life data analysed in this study reflect daily practice in the Netherlands and identify obesity as a significant risk factor in CRC patients. Obesity-related comorbidities were associated with higher postoperative morbidity, prolonged hospitalization and a higher readmission rate in obese CRC patients. No differences were observed between hospitals performing bariatric surgery and hospitals that did not.



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Anatomic versus non-anatomic resection for hepatocellular carcinoma: A systematic review and meta-analysis

Publication date: July 2018
Source:European Journal of Surgical Oncology, Volume 44, Issue 7
Author(s): Dimitrios Moris, Diamantis I. Tsilimigras, Ioannis D. Kostakis, Ioannis Ntanasis-Stathopoulos, Kevin N. Shah, Evangelos Felekouras, Timothy M. Pawlik
ObjectiveThe relative benefit of anatomic resection (AR) versus non-anatomic resection (NAR) of HCC remains poorly defined. We sought to evaluate the available evidence on oncologic outcomes, as well as the clinical efficacy and safety of AR versus NAR performed as the primary treatment for HCC patients.Material and methodsA systematic review and meta-analysis was conducted using Medline, ClinicalTrials.gov and Cochrane library through April 15th, 2017. Only clinical studies comparing AR versus NAR were deemed eligible.ResultsA total of 43 studies were considered eligible (total 12,429 patients: AR, n = 6839 (55%) versus NAR, n = 5590 (45%)). Blood loss was higher among patients undergoing AR (mean difference: +229.74 ml, 95% CI: 97.09–362.38, p = 0.0007), whereas resection margin was slightly wider following AR versus NAR (mean difference: +0.29 cm, 95% CI: 0.15–0.44, p < 0.0001). No difference was noted for perioperative complications (RR: 0.95, 95% CI: 0.81–1.11, p = 0.49) and perioperative mortality (RR: 0.91, 95% CI: 0.43–1.95, p = 0.82). AR was associated with a disease-free survival (DFS) benefit at 1- (HR: 0.79, 95% CI: 0.68–0.92, p = 0.002), 3- (HR: 0.87, 95% CI: 0.78–0.95, p = 0.004) and 5-years (HR: 0.87, 95% CI: 0.82–0.93, p < 0.0001). AR also was associated with a decreased risk of death at 5-years (HR: 0.88, 95% CI: 0.79–0.97, p = 0.01).ConclusionDespite the high heterogeneity among studies, the data demonstrated that AR had comparable perioperative morbidity and mortality versus NAR. AR seemed to offer an advantage versus NAR in terms of DFS and OS among patients undergoing resection of HCC – especially among patients without cirrhosis. Thus, AR should be considered the preferred surgical option for patients with HCC when feasible.



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Routine portal vein resection for pancreatic adenocarcinoma shows no benefit in overall survival

Publication date: July 2018
Source:European Journal of Surgical Oncology, Volume 44, Issue 7
Author(s): Fritz Klein, Finja Berresheim, Matthäus Felsenstein, Thomas Malinka, Uwe Pelzer, Timm Denecke, Johann Pratschke, Marcus Bahra
BackgroundExtended pancreatic resections including resections of the portal (PV) may nowadays be performed safely. Limitations in distinguishing tumor involvement from inflammatory adhesions however lead to portal vein resections (PVR) without evidence of tumor infiltration in the final histopathological examination. The aim of this study was to analyze the impact of these "false negative" resections on operative outcome and long-term survival.Methods40 patients who underwent pancreatic resection with PVR for pancreatic adenocarcinoma (PA) without tumor infiltration of the PV (PVR-group) were identified. In a 1:3 match these patients were compared to 120 patients after standard pancreatic resection without PVR (SPR-group) with regard to operative outcome and overall survival.ResultsSurvival analysis revealed that median survival was significantly shorter in the PVR group (311 days) as compared to the SPR group (558 days), (p = 0.0011, hazard ratio 1.98, 95% CI: 1.31–2.98). Also postoperative complications ≥ Clavien III occurred significantly more often in the PVR group (37.5% vs. 20.8%).ConclusionsRadical resection affords the best chance for long-term survival in patients with PA. Based on the results of this study a routine resection of the PV as recently proposed may however not be recommended.



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Announcements

Publication date: July 2018
Source:European Journal of Surgical Oncology, Volume 44, Issue 7





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Editorial Board

Publication date: July 2018
Source:European Journal of Surgical Oncology, Volume 44, Issue 7





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Oncoplastic breast surgery for the management of ductal carcinoma in situ (DCIS): is it oncologically safe? A retrospective cohort analysis

Publication date: July 2018
Source:European Journal of Surgical Oncology, Volume 44, Issue 7
Author(s): Francesca De Lorenzi, Julien Di Bella, Patrick Maisonneuve, Nicole Rotmensz, Giovanni Corso, Roberto Orecchia, Marco Colleoni, Giovanni Mazzarol, Mario Rietjens, Pietro Loschi, Stefano Marcelli, Paolo Veronesi, Viviana Galimberti
BackgroundFew data exist in literature regarding oncoplastic surgery (ONC) and ductal carcinoma in situ (DCIS). The role of ONC in the treatment of DCIS has not been elucidated yet: no case-control study has yet been published on the issue and no long-term oncologic results are reported.MethodsUsing the European Institute of Oncology (IEO) institutional breast cancer data base we investigated the oncologic safety of ONC for DCIS comparing a consecutive series of 44 patients who have underwent ONC followed by external irradiation for DCIS (Group A-study group) with 375 patients who received conservation alone followed by external irradiation for DCIS (Group B control group) in the same period. We excluded patients presenting with secondary tumors or local relapses and those requiring re-excision or completion mastectomy for positive margins. Primary endpoints were disease-free survival (DFS) and ipsilateral breast tumor recurrence (IBTR) within the study group and comparison with the control group.ResultsEvents rates and death rates were similar in the two groups. The average annual rate of invasive IBTR in group A and B was 1.6% and 1.0% respectively. No difference in the rate of lymphnode metastasis, distant metastasis, contralateral breast cancer, other primary cancer or death was observed across the two groups.ConclusionsOur findings suggest the safety of ONC and irradiation for the management of DCIS extending the indications for conservation in DCIS patients otherwise treated with mastectomy. It provides the best available evidence supporting ONC as a valid treatment option for the management of DCIS.



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Patient reported outcome measures in breast cancer patients

Publication date: July 2018
Source:European Journal of Surgical Oncology, Volume 44, Issue 7
Author(s): M. Lagendijk, L.S.E. van Egdom, C. Richel, N. van Leeuwen, C. Verhoef, H.F. Lingsma, L.B. Koppert
IntroductionIn the International Consortium for Health Outcome Measures (ICHOM) breast cancer outcome set Patient Reported Outcome Measurements (PROMs) form an important but rather innovative part. Few data exist on scores per type of breast surgery and how to use scores in surgical practice. We evaluated PROM scores as well as satisfaction with and expectations of the use of PROMs in breast cancer patients using the national and local patient advocate society.MethodsThrough an online survey patients were asked to report age, type of breast cancer surgery (whether Breast Conserving Therapy (BCT), mastectomy, autologous or implant breast reconstruction) and time since surgery. PROMs (EORTC-QLQ-C30/BR23 and BREAST-Q postoperative modules) were compared for the different surgeries. Additional comparison was made with literature normative and reference scores. Three questions evaluated satisfaction with PROMs and expectations.Results496 patients completed all PROMs and 487 the satisfaction/expectation-questions. Significantly reduced physical functioning was reported following BCT as compared to other surgeries and literature reference values. Satisfaction scores were higher following autologous reconstruction and lower following implant reconstruction as compared to BCT. PRO scores were comparable to normative and references scores except for the 'physical functioning' (BREAST-Q) scores that reported lower in the present study. Ninety-four percent of the participants was (highly) satisfied with future PROM use.ConclusionsStatistical significant differences were found for PROMs following different types of breast surgery. The significance of these results should become clearer trough collection of future data. The great majority of participants considered PROMs as (highly) acceptable and reacted positively on their proposed future use.



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In-hospital length of stay after major surgical oncological procedures

Publication date: July 2018
Source:European Journal of Surgical Oncology, Volume 44, Issue 7
Author(s): Sebastiano Nazzani, Felix Preisser, Elio Mazzone, Zhe Tian, Francesco A. Mistretta, Shahrokh F. Shariat, Fred Saad, Markus Graefen, Derya Tilki, Emanuele Montanari, Stefano Luzzago, Alberto Briganti, Luca Carmignani, Pierre I. Karakiewicz
Background and objectivesEnhanced recovery after surgery protocols (ERAS) have been developed and implemented as of 2001. However, no previous analyses targeted length of stay (LOS) changes over time after major surgical oncological procedures (MSOPs).MethodsBetween 2003 and 2013, we retrospectively identified patients, who underwent prostatectomy, colectomy, cystectomy, mastectomy, gastrectomy, hysterectomy, nephrectomy, oophorectomy, lung resection or pancreatectomy within the Nationwide Inpatient Sample. A total of 3 431 602 assessable patients were identified. We examined temporal trends of LOS after ten MSOPs, as well as LOS determinants and the impact of LOS on total hospital charges (THCGs). Univariable and multivariable linear, log-linear, logistic (MLR) and Poisson regression (MPR) analyses were used.ResultsMean and median LOS were respectively 6 and 4 days (IQR 2–7). During the study span, LOS decreased [Estimated annual percentage change (EAPC): −1.89%, p = 0.0002]. Of the ten examined MSOPs, nine showed a decrease that ranged from −4.47% in prostatectomy to −0.7% in mastectomy. Conversely, no decrease in LOS was recorded for colectomy (EAPC:+0.37, p = 0.015). In MPR analyses, robotic [Relative risk (RR):0.68, p = 0.0003] and laparoscopic (RR: 0.90, p < 0.0001) surgical approaches were associated with shorter LOS. LOS was directly related to THCGs.ConclusionsSince the implementation of ERAS protocols, LOS has decreased for nine out of ten MSOPs in a significant fashion. Although these gains may appear marginal on an annual basis, their cumulative effect, over the study span, ranges for 7.7%–49.2%, which can hardly be interpreted as marginal. LOS decrease directly translates in THCGs savings.



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Outcomes of open versus laparoscopic surgery in patients with colon cancer

Publication date: Available online 6 June 2018
Source:European Journal of Surgical Oncology
Author(s): José M. Quintana, Ane Antón-Ladislao, Nerea González, Santiago Lázaro, Marisa Baré, Nerea Fernández de Larrea, Maximino Redondo, Eduardo Briones, Antonio Escobar, Cristina Sarasqueta, Susana García-Gutierrez
ObjectiveThere is limited information on health service use or patient-reported outcomes when comparing the effectiveness of laparoscopic with that of open surgery. The aim was to compare the effectiveness of laparoscopic with that of open surgery up to 2 years after intervention in patients with colon cancer.MethodsProspective cohort study of patients with colon cancer who underwent surgery (laparoscopic or open surgery) between June 2010 and December 2012, at 22 hospitals. Main outcomes of the study were mortality, complications, reoperation, readmission, and patient-reported outcome measures (PROMs), as measured using the Hospital Anxiety and Depression Scale, Duke-UNC, EuroQol-5D, and European Organisation for Research and Treatment of Cancer-Q30 and Q29 at baseline, and 30 days and 1 and 2 years after surgery. Multivariable multilevel logistic regression and generalized linear models were used in analyses after adjusting for specific propensity scores developed for each outcome and time point.ResultsIn the multivariable analysis, the complication rates up to 30 days (infectious, surgical, and medical) and 1 year (surgical), and readmission rate at 30 days and at 2 years were higher among patients who underwent open surgery than among those who underwent laparoscopic surgery. There were no differences between the two surgical approaches in all other parameters assessed and in changes of all PROMs.ConclusionsThough in most outcomes both surgical approaches provide similar results up to 2 years after intervention, still the rates of some complications and readmission, mainly up to 30 days, are higher in open surgery.



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Evaluation of liquid biopsies for detection of emerging mutated genes in metastatic colorectal cancer

Publication date: July 2018
Source:European Journal of Surgical Oncology, Volume 44, Issue 7
Author(s): Hiroyasu Furuki, Takeshi Yamada, Goro Takahashi, Takuma Iwai, Michihiro Koizumi, Seiichi Shinji, Yasuyuki Yokoyama, Kohki Takeda, Nobuhiko Taniai, Eiji Uchida
BackgroundDetection of gene mutations is important for planning molecular targeted therapy. Although most gene mutations are concordant between primary colon cancers and their liver metastases, new mutations can emerge in metastases. The liquid biopsy is a newly developed, gene analytic method to detect mutations in metastatic tumors. In this prospective study, we evaluated the applicability of liquid biopsies in the detection of mutations in primary and metastatic tumors.MethodsWe included 22 patients with liver metastases from colorectal cancer and extracted DNA from primary colorectal tumors, metastatic liver tumors, and peripheral blood (liquid biopsy). Next-generation sequencing (NGS) and digital PCR were performed to detect mutations in these three sample types.ResultsWe found a total of 36 different mutations in samples from primary tumors, liver metastases, and liquid biopsies using NGS. Twenty-eight of these mutations were found in all three types of samples, whereas liquid biopsy did not identify four mutations that had been found in both primary tumors and liver metastases, but did identify four mutations that were found in liver tumors but not in primary tumors. The sensitivity of liquid biopsies for detecting mutations in liver metastases was 64% (23/36) using NGS and 89% (32/36, P = 0.02) using dPCR. The specificities of NGS and dPCR were 100% (23/23) and 100% (32/32), respectively.ConclusionsEmerging mutations, which are not found in primary tumors, can be detected in their metastases and liquid biopsies.



https://ift.tt/2Jgd8AK

Quality of life and cost effectiveness in a randomized trial of patients with colorectal cancer and peritoneal metastases

Publication date: July 2018
Source:European Journal of Surgical Oncology, Volume 44, Issue 7
Author(s): P.H. Cashin, H. Mahteme, I. Syk, J.E. Frödin, B. Glimelius, W. Graf
BackgroundThe aim was to compare health-related quality-of-life (HRQOL) and cost-effectiveness between cytoreductive surgery with intraperitoneal chemotherapy (CRS + IPC) and systemic chemotherapy for patients with colorectal peritoneal metastases.MethodsPatients included in the Swedish Peritoneal Trial comparing CRS + IPC and systemic chemotherapy completed the EORTC QLQ-C30 and SF-36 questionnaires at baseline, 2, 4, 6, 12, 18, and 24 months. HRQOL at 24 months was the primary endpoint. EORTC sum score, SF-36 physical and mental component scores at 24 months were calculated and compared for each arm and then referenced against general population values. Two quality-adjusted life-year (QALY) indices were applied (EORTC-8D and SF-6D) and an incremental cost-effectiveness ratio (ICER) per QALY gained was calculated. A projected life-time ICER per QALY gained was calculated using predicted survival according to Swedish population statistics.ResultsNo statistical differences in HRQOL between the arms were noted at 24 months. Descriptively, survivors in the surgery arm had higher summary scores than the general population at 24 months, whereas survivors in the chemotherapy arm had lower scores. The projected life-time QALY benefit was 3.8 QALYs in favor of the surgery arm (p=0.06) with an ICER per QALY gained at 310,000 SEK (EORTC-8D) or 362,000 SEK (SF-6D) corresponding to 26,700–31,200 GBP.ConclusionThe HRQOL in patients with colorectal peritoneal metastases undergoing CRS + IPC appear similar to those receiving systemic chemotherapy. Two-year survivors in the CRS + IPC arm have comparable HRQOL to a general population reference. The treatment is cost-effective according to NICE guidelines.

Teaser

Synopsis: This study reports the health-related quality-of-life and cost-effectiveness between surgical treatment and systemic chemotherapy treatment in a randomized setting for patients with colorectal cancer and peritoneal metastases. The surgical treatment has good quality-of-life and is cost-effective.


https://ift.tt/2xQukXX

Multicenter comprehensive methodological and technical analysis of 832 pressurized intraperitoneal aerosol chemotherapy (PIPAC) interventions performed in 349 patients for peritoneal carcinomatosis treatment: An international survey study

Publication date: July 2018
Source:European Journal of Surgical Oncology, Volume 44, Issue 7
Author(s): Maciej Nowacki, Mohammad Alyami, Laurent Villeneuve, Frederic Mercier, Martin Hubner, Wouter Willaert, Wim Ceelen, Marc Reymond, Denis Pezet, Catherine Arvieux, Vladimir Khomyakov, Laura Lay, Sergio Gianni, Wojciech Zegarski, Naoual Bakrin, Olivier Glehen
BackgroundPressurized intraperitoneal aerosol chemotherapy (PIPAC) is a new drug delivery method offered in selected patients suffering from non-resectable peritoneal carcinomatosis (PC). As reported experience is still limited, we conducted a survey among active PIPAC centers aiming to report their technical approach and clinical findings.MethodsAn online survey was sent to active PIPAC centers worldwide. The questionnaire consisted of 34 closed questions and was conducted over a period of 3 months beginning in March 2017.ResultsNine out of 15 contacted centers completed the questionnaire totaling 832 PIPAC procedures in 349 patients. Most common indications for PIPAC were PC from gastric, ovarian and colorectal origin. The mean time between each PIPAC procedure was 6–8 weeks. Seven of nine (77.8%) centers evaluate the PCI at every PIPAC procedure. At least four tissue samples for histopathology analysis were retrieved in 5 (55.6%). All centers (100%) use the same chemotherapy protocol: oxaliplatin at a dosage of 92mg/m² for PC of colorectal origin and a combination of cisplatin and doxorubicin at a dosage of 7.5mg/m² and 1.5mg/m², respectively, for other types of PC. Eight centers (88.9%) perform routine radiological evaluation before first PIPAC and after third PIPAC.ConclusionThese data confirm that PIPAC procedures are homogeneously performed in established centers. Standardization of the procedure will facilitate future international multicenter prospective clinical trials.



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Downregulation of RFX1 predicts poor prognosis of patients with small hepatocellular carcinoma

Publication date: July 2018
Source:European Journal of Surgical Oncology, Volume 44, Issue 7
Author(s): Yingjun Liu, Peng Jiang, Gangcheng Wang, Xiaonyong Liu, Suxia Luo
ObjectiveRegulatory factor X1 (RFX1) deletion has been reported to be correlated with poor prognosis of some types of cancer. The present study aimed to investigate the prognostic value of RFX1 in HCC, especially in small hepatocellular carcinoma.MethodsImmunohistochemical assay was used to investigate RFX1 expression in 221 HCC tissues and another validation cohort of 71 small HCC samples. We also performed in vitro experiments to investigate if RFX1 regulated invasive capacity of HCC cells and expression of epithelial-mesenchymal transition (EMT) markers.ResultsWe found that RFX1 expression was significantly lower in HCC tissues compared to the corresponding non-tumor tissues. Further survival analysis suggested that the downregulation of RFX1 correlated with poor prognosis and a high recurrence risk in HCC patients, particularly in small HCC patients. Furthermore, another validation cohort of small HCC samples confirmed that downregulation of RFX1 in HCC tissues predicted high recurrence risk and poor prognosis for early stage HCC patients. In vitro studies suggested that knocking down RFX1 facilitated HCC cell invasion, while overexpression of RFX1 reduced the invasion of HCC cells. Western blot assays also indicated that RFX1 regulated expression of some EMT markers. Knocking down RFX1 decreased E-cadherin and increased vimentin expression, while RFX1 overexpression enhanced E-cadherin and decreased vimentin expression.ConclusionsOur study demonstrated that RFX1 downregulation is a new predictive marker of high recurrence risk and poor prognosis of HCC; It has potential to help guide treatment for postoperative HCC patients, especially for small HCC patients.



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Human Immunodeficiency Virus Infection: Does Highly Active Antiretroviral Therapy Influence Ear Nose Throat Manifestations?

Abstract

To study the change in trend of ear, nose and throat (ENT) manifestations in patients who were on treatment, before and after availability of highly active antiretroviral therapy (HAART). To find out the prevalence of ENT manifestations in human immunodeficiency virus (HIV) infected people who were on treatment, in the year of 2004 (before the availability of HAART) and in 2014 (after the availability of HAART). Design A combination of a retrospective and prospective study. Setting Anti Retroviral Therapy (ART) Center at Our Hospital. Subjects Patients with HIV infection on ART. Methods Retrospective review of case records of the patients visiting the center in the year 2004 and prospective study of the patients visiting in the year 2014 was conducted. Sample size was calculated as 200 in each group based on 95% confidence and 96% power. Convenience sampling was used in our study. The prevalence of ENT manifestations in HIV patients were found to be 86% in 2004 and 93% in 2014. Among ENT manifestations oropharyngeal manifestations were most common. Lesser the CD4 count more was the prevalence of disorders in oropharynx. Our study showed a high prevalence of ENT manifestations in HIV patients who were on treatment, irrespective of the gap of 10 years and introduction of HAART therapy. Most common ENT manifestation both in 2004 and 2014 was oropharyngeal candidiasis. Lesser the CD4 count more was the prevalence of disorders in oropharynx.

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A Perspective of Clinical Behaviour and Management of Deep Neck Space Infections (DNSI): The Clinical Conundrum

Abstract

The diagnosis and management of deep neck space infections remain a challenging task for otolaryngologists. A retrospective observational analysis of 137 cases of deep neck infections at a tertiary care centre was reviewed. We present 137 treated cases of DNSIs in a retrospective 5 years clinical study conducted in the department of otolaryngology at a tertiary care center from January 2012 to December 2016. Demographic information, Socio-economic data, etiopathogenesis, clinical presentation, spaces involved, diagnosis, and treatment strategies, associated morbidities, course and complications were analysed and compared with past experiences. Odontogenic and salivary gland infections causes were the most common source of DNIs. Major complication observed was skin defect. In this study, submandibular space infection was found to be the most common space involved in DNSI. Pain (100%) was the most common clinical complaint followed by neck swelling (65.69%). Staphylococcus aureus (38 cases) was the most common micro-organism isolated. Surgical intervention was the main modality of treatment and there was one mortality. DNSIs are fairly common challenging and potentially lethal entities which can lead to severe complications in a very short time, should there be delay in its prompt diagnosis and management. Computerized Tomography Scan (CT scan) with contrast is the investigation of choice in diagnosing DNSIs. Assessment of airway control must take precedence.

https://ift.tt/2sM5Ucp

Miringoplastia con injerto doble medial y lateral

Publication date: Available online 7 June 2018
Source:Acta Otorrinolaringológica Española
Author(s): Francisco Javier Olarieta Soto, Francisco Antolí-Candela Cano, Alejandro Harguindey Antolí-Candela
ObjetivosSe describe la técnica quirúrgica del injerto doble medial y lateral de fascia autóloga, sus indicaciones y resultados.Material y métodoSe estudian las características preoperatorias y al año de la intervención de 100 casos intervenidos de miringoplastia con la técnica de injerto doble medial y lateral de fascia autóloga. Se analizan los resultados anatómicos y funcionales.ResultadosLos resultados se valoran al año de la intervención. En el 95% de los casos conseguimos el cierre de la perforación. La incidencia de persistencia de las perforaciones es del 12,5% en los niños menores de 10 años y del 2,5% en niños mayores de 10 años y adultos. Las complicaciones son un 4% de perlas epiteliales con engrosamiento del neotímpano, un 1% de retracciones del neotímpano y un 3% de epitelitis que se resuelven con tratamiento médico tópico. La recuperación auditiva es del 85% de cierres del UDA medio a menos de 20dB (el 38% a menos de 10dB y el 47% entre 10 y 20dB). Se analizan las posibles causas del cierre incompleto del UDA, posiblemente relacionados con fibrosis y esclerosis de los restos timpánicos y/o la cadena osicular.ConclusionesSe concluye que esta metodología nos proporciona los mejores resultados en comparación con otras que hemos utilizado y hemos relegado a situaciones muy específicas atendiendo al tamaño y localización de la perforación.ObjectivesA surgical technique for a double medial and lateral overlay autologous fascia graft myringoplasty is described in this paper along with its indications and results.Material and methodThe presurgical and one year post surgery characteristics are analyzed for 100 cases with the double medial and lateral overlay autologous fascia graft technique. The anatomical and functional results are analyzed.ResultsThe results are analyzed one year post surgery. The probabilities of obtaining a graft take using this methodology are 95%. The incidence of persistence of the perforations is 12.5% in children under 10 and 2.5% in children over ten years of age and adults. The complications are 4% of epithelial pearls with blunting of the neo-tympanum, 1% of retractions and 3% of epithelitis which is resolved with a topical medical treatment. The average residual air/bone gap is less than 20dB in 85% of the cases. Less than 10dB in 38%, and between 10 and 20dB in 47%. The causes for incomplete closure of the gap are analyzed; possibly related to fibrosis and sclerosis of the tympanic remnants and/or the ossicular chain.ConclusionsIt is concluded that this methodology provides the best results in comparison with other methods we have used and have set aside for very specific situations related to the size and location of the perforation.



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Anthropometric factors and non-Hodgkin’s lymphoma risk: Systematic review and meta-analysis of prospective studies

Publication date: Available online 6 June 2018
Source:Critical Reviews in Oncology/Hematology
Author(s): Khemayanto Hidayat, Hui-Juan Li, Bi-Min Shi
The associations between anthropometric factors and non-Hodgkin's lymphoma (NHL) risk remain inconclusive. A meta-analysis was performed to clarify these associations. PubMed and Web of Science were searched for relevant prospective observational studies. A random-effects model was used to generate the summary relative risks (RRs) with 95% confidence intervals (CIs). A total of 22 prospective cohort studies, with over 20,000 NHL cases, were included in the present meta-analysis. The summary RRs of NHL risk were 1.06 (95% CI 1.03, 1.09) for each 5 kg/m² increase in body mass index (BMI), 1.11 (95% CI 1.07, 1.16) for each 5 kg/m² increase in BMI in early adulthood (aged 18-21 years), 1.05 (95% CI 1.01, 1.09) for each 10 kg increase in weight, 1.21 (95% CI 1.15, 1.28) for each 10 kg increase in weight in early adulthood (aged 18-21 years), and 1.13 (95% CI 1.10, 1.17) for each 10 cm increase in height. No association was found for waist circumference (WC) and waist-to-hip ratio. By subtypes, all anthropometric factors (but not WC) were associated with an increased risk of diffuse large B-cell lymphoma. Chronic lymphocytic leukemia/small lymphocytic lymphoma was positively associated with BMI in early adulthood and with height, whereas follicular lymphoma was only positively associated with height. In summary, BMI and weight in early adulthood may be more relevant to NHL development than current BMI and weight. These findings emphasize the importance of maintaining a healthy weight throughout the life-course, starting from early life, for NHL prevention. Increased NHL risk with taller stature, which may reflect cumulative exposure to hormones/growth factors and nutrition status in early life, further supports the relevance of early life exposure in the etiology of NHL.



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A revisited concept. Tumors: Wounds that do not heal

Publication date: Available online 6 June 2018
Source:Critical Reviews in Oncology/Hematology
Author(s): Domenico Ribatti, Roberto Tamma
In 1986, Harold F. Dvorak, Professor of Pathology at Harvard Medical School Boston, published an essay in the New England Journal of Medicine entitled "Tumors: Wounds that do not heal" pointed out that similarities exist between tumor stroma generation and wound healing. Cancers share many features in common with tissue regeneration, including immune response, cell proliferation, cell migration, tissue remodeling, and cell death. In this review article, I analyzed the importance and the limits of this important concept, which confirm the close relationship between apparently different biological processes.



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TAFRO SYNDROME: CRITICAL REVIEW FOR CLINICIANS AND PATHOLOGISTS

Publication date: Available online 6 June 2018
Source:Critical Reviews in Oncology/Hematology
Author(s): Paydas Semra
TAFRO is an acrostic and includes thrombocytopenia (T), anasarca (A), fever (F), reticulin fibrosis (R) and organomegaly (O) (Takai et al., 2013). TAFRO syndrome has been described firstly by Takai in Japanese patients. However TAFRO cases have been reported from US, Europe and other countries (Takai et al., 2010; Iwaki et al., 2016; Abdo et al., 2014). Three major and at least one minor criteria and exclusion of infectious, rheumatologic and neoplastic diseases are required for the diagnosis of TAFRO. In fact TAFRO must be thought in clinically undiagnosed and unsolved problemmatic cases.



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MicroRNA-21 down-regulates inflammation and inhibits periodontitis

Publication date: Available online 6 June 2018
Source:Molecular Immunology
Author(s): Wei Zhou, Li Su, Xingyu Duan, Xi Chen, Aislinn Hays, Satya Upadhyayula, Juili Shivde, Huizhi Wang, Yong Li, Dingming Huang, Shuang Liang
Periodontitis is one of the most prevalent inflammatory diseases, characterized by gingival inflammation and alveolar bone loss. MicroRNAs (MiRNAs) are important regulators of inflammation and involved in periodontitis pathogenesis. In this work, we studied the roles of microRNA-21 (miR-21) in periodontitis. MiR-21 is up-regulated in both periodontitis patients and the mice that induced with periodontitis. We tested the roles of miR-21 in the macrophages challenged by periodontitis pathogen Porphyromonas gingivalis (P. gingivalis) lipopolysaccharide (LPS). MiR-21 expression is up-regulated in P. gingivalis LPS-stimulated macrophages. MiR-21 mimic inhibits the pro-inflammatory cytokine production by macrophages, while miR-21 deficiency elevates the production of pro-inflammatory cytokines. Moreover, absence of miR-21 promotes activation of nuclear factor-κB (NF-κB) in P. gingivalis LPS- stimulated cells. In a murine periodontitis model, ligation induced exacerbated gingival inflammation and alveolar bone loss in miR-21 deficient mice than their wild-type littermates. These results demonstrated the anti-inflammatory function of miR-21 in vitro and in vivo, indicating miR-21 could be an interventional target for the control of periodontitis.



https://ift.tt/2JkVxn6

MicroRNA-21 down-regulates inflammation and inhibits periodontitis

Publication date: Available online 6 June 2018
Source:Molecular Immunology
Author(s): Wei Zhou, Li Su, Xingyu Duan, Xi Chen, Aislinn Hays, Satya Upadhyayula, Juili Shivde, Huizhi Wang, Yong Li, Dingming Huang, Shuang Liang
Periodontitis is one of the most prevalent inflammatory diseases, characterized by gingival inflammation and alveolar bone loss. MicroRNAs (MiRNAs) are important regulators of inflammation and involved in periodontitis pathogenesis. In this work, we studied the roles of microRNA-21 (miR-21) in periodontitis. MiR-21 is up-regulated in both periodontitis patients and the mice that induced with periodontitis. We tested the roles of miR-21 in the macrophages challenged by periodontitis pathogen Porphyromonas gingivalis (P. gingivalis) lipopolysaccharide (LPS). MiR-21 expression is up-regulated in P. gingivalis LPS-stimulated macrophages. MiR-21 mimic inhibits the pro-inflammatory cytokine production by macrophages, while miR-21 deficiency elevates the production of pro-inflammatory cytokines. Moreover, absence of miR-21 promotes activation of nuclear factor-κB (NF-κB) in P. gingivalis LPS- stimulated cells. In a murine periodontitis model, ligation induced exacerbated gingival inflammation and alveolar bone loss in miR-21 deficient mice than their wild-type littermates. These results demonstrated the anti-inflammatory function of miR-21 in vitro and in vivo, indicating miR-21 could be an interventional target for the control of periodontitis.



https://ift.tt/2JkVxn6

Potential application of selected metal resistant phosphate solubilizing bacteria isolated from the gut of earthworm (Metaphire posthuma) in plant growth promotion

Publication date: 15 November 2018
Source:Geoderma, Volume 330
Author(s): Jayanta Kumar Biswas, Anurupa Banerjee, Mahendra Rai, Ravi Naidu, Bhabananda Biswas, Meththika Vithanage, Madhab Chandra Dash, Santosh Kumar Sarkar, Erik Meers
The present study focuses on the isolation of three phosphate solubilizing bacteria (PSB), PSB1, PSB2 and PSB3 from the gut of earthworm Metaphire posthuma. The three stains were identified as Bacillus megaterium (MF 589715), Staphylococcus haemolyticus (MF 589716) and Bacillus licheniformis (MF 589720) through 16 S rRNA gene sequencing and biochemical characterization. The strains showed resistance to the metals Cu and Zn at significant concentrations and could solubilize phosphate even in the presence of metals. Maximum phosphate was solubilized by strain PSB3 with a production of 222 ± 2.0 mg L⁻¹ soluble phosphate followed by PSB1 (213.7 ± 1.3 mg L⁻¹) and PSB2 (193.5 ± 1.5 mg L⁻¹) at 96 h of incubation. The strains were able to produce indole acetic acid (IAA) in presence of l-tryptophan and possessed ammonium ion production potential in the order PSB3 > PSB1 > PSB2 (P < 0.05). The sterilized seeds of mung beans (Vigna radiata) displayed greater germination rate and higher growth under bacterium-enriched conditions. The effect on seed germination traits by the isolated strains followed the order of PSB3 > PSB1 > PSB2 (P < 0.05). Our results suggest that the three isolated PSB strains from earthworm gut possess intrinsic abilities of growth promotion, metal resistance and solubilization of phosphate which could be exploited for plant growth promotion and bioremediation even under metal-stress conditions.

Graphical abstract

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Impacts of dam draining on the mobility of heavy metals and arsenic in water and basin bottom sediments of three studied dams in Germany

Publication date: 1 November 2018
Source:Science of The Total Environment, Volumes 640–641
Author(s): Jens Hahn, Christian Opp, Alevtina Evgrafova, Michael Groll, Nina Zitzer, Gabriela Laufenberg
The draining of a dam is a relatively rare event, however, it can have severe consequences for a watercourse connected to that reservoir. In order to understand the effects of the draining on the mobility of pollutants stored in the bottom sediments, the concentrations of heavy metals and arsenic were measured in pore water, river water, and sediments sampled from three emptied reservoirs in Germany. Two of these sites were analyzed immediately after the draining, while the third reservoir was studied one and a half years after the complete discharge of the stored water. Heavy metal and arsenic concentrations within the sediments varied among the studied dams as a result of different geological characteristics and the degree of anthropogenic impacts. Based on the analysis of pore water samples, the concentrations of heavy metals and arsenic were not significantly altered shortly after the draining. However, increased concentrations of As, Fe, Cd, Ni, and Zn were measured in pore water samples after a longer duration of sediment exposure, which altered the redox conditions and sediment properties. The changes in Cu, Cr, Mn, and Pb concentrations in pore water samples were less pronounced. As a result of the pore water drainage increased dissolved heavy metal concentrations were found in the discharge water immediately after draining. At the third site, which had been emptied for one and a half years, only for Mn, a concentration increase was detected in the reservoir discharge water, which emphasizes the strong temporal dynamic of the mobilization of the analyzed elements.

Graphical abstract

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Impact of age on breast cancer mortality and competing causes of death at 10 years follow-up in the adjuvant TEAM trial

Publication date: August 2018
Source:European Journal of Cancer, Volume 99
Author(s): M.G.M. Derks, E. Bastiaannet, W. van de Water, N.A. de Glas, C. Seynaeve, H. Putter, J.W.R. Nortier, D. Rea, A. Hasenburg, C. Markopoulos, L.Y. Dirix, J.E.A. Portielje, C.J.H. van de Velde, G.J. Liefers
AimDue to increasing life expectancy, patients with breast cancer remain at risk of dying due to breast cancer over a long time. This study aims to assess the impact of age on breast cancer mortality and other cause mortality 10 years after diagnosis.MethodsPostmenopausal patients with hormone-receptor positive breast cancer were included in the Tamoxifen and Exemestane Adjuvant Multinational (TEAM) trial between 2001 and 2006. Age at diagnosis was categorised as <65 years (n = 3369), 65–74 years (n = 1896) and ≥75 years (n = 854). Breast cancer mortality was assessed considering other cause mortality as competing event using competing risk analysis.ResultsAfter a median follow-up of 9.8 years (interquartile range 8.0–10.3), cumulative incidence of breast cancer mortality increased with increasing age (age <65 years, 11.7% [95% confidence interval {CI}: 10.2–13.2]; 65–74 years, 12.7% (11.2–14.2) and ≥75 years, 15.6% (13.1–18.0)). Univariate subdistribution hazard ratio (sHR) increased with increasing age (age: 65–74 years, sHR: 1.08, 95% CI: 0.92–1.27 and ≥75 years sHR: 1.30, 95% CI: 1.06–1.58, P = 0.013). Multivariable sHR adjusted for tumour and treatment characteristics increased with age but did not reach significance (age 65–74 years, sHR: 1.11, 95% CI: 0.94–1.31; ≥75 years, sHR: 1.18, 95% CI: 0.94–1.48, P = 0.055).ConclusionTen years after diagnosis, older age at diagnosis is associated with increasing breast cancer mortality in univariate analysis, but it did not reach significance in multivariable analysis. This is not outweighed by a substantially higher other cause mortality with older age. This underlines the need to improve the balance between undertreatment and overtreatment in older patients with breast cancer. The trial was registered in International Trial Databases (ClinicalTrials.govNCT00279448, NCT00032136, and NCT00036270; the Netherlands Trial Registry NTR267).



https://ift.tt/2LtoGx2

A revisited concept. Tumors: Wounds that do not heal

Publication date: Available online 6 June 2018
Source:Critical Reviews in Oncology/Hematology
Author(s): Domenico Ribatti, Roberto Tamma
In 1986, Harold F. Dvorak, Professor of Pathology at Harvard Medical School Boston, published an essay in the New England Journal of Medicine entitled "Tumors: Wounds that do not heal" pointed out that similarities exist between tumor stroma generation and wound healing. Cancers share many features in common with tissue regeneration, including immune response, cell proliferation, cell migration, tissue remodeling, and cell death. In this review article, I analyzed the importance and the limits of this important concept, which confirm the close relationship between apparently different biological processes.



https://ift.tt/2Ltm9Ty

Acellular vascular matrix grafts from human placenta chorion: Impact of ECM preservation on graft characteristics, protein composition and in vivo performance

Publication date: September 2018
Source:Biomaterials, Volume 177
Author(s): Karl H. Schneider, Marjan Enayati, Christian Grasl, Ingrid Walter, Lubos Budinsky, Gabriel Zebic, Christoph Kaun, Anja Wagner, Klaus Kratochwill, Heinz Redl, Andreas H. Teuschl, Bruno K. Podesser, Helga Bergmeister
Small diameter vascular grafts from human placenta, decellularized with either Triton X-100 (Triton) or SDS and crosslinked with heparin were constructed and characterized. Graft biochemical properties, residual DNA, and protein composition were evaluated to compare the effect of the two detergents on graft matrix composition and structural alterations. Biocompatibility was tested in vitro by culturing the grafts with primary human macrophages and in vivo by subcutaneous implantation of graft conduits (n = 7 per group) into the flanks of nude rats. Subsequently, graft performance was evaluated using an aortic implantation model in Sprague Dawley rats (one month, n = 14). In situ graft imaging was performed using MRI angiography. Retrieved specimens were analyzed by electromyography, scanning electron microscopy, histology and immunohistochemistry to evaluate cell migration and the degree of functional tissue remodeling.Both decellularization methods resulted in grafts of excellent biocompatibility in vitro and in vivo, with low immunogenic potential. Proteomic data revealed removal of cytoplasmic proteins with relative enrichment of ECM proteins in decelluarized specimens of both groups. Noteworthy, LC-Mass Spectrometry analysis revealed that 16 proteins were exclusively preserved in Triton decellularized specimens in comparison to SDS-treated specimens. Aortic grafts showed high patency rates, no signs of thrombus formation, aneurysms or rupture. Conduits of both groups revealed tissue-specific cell migration indicative of functional remodeling.This study strongly suggests that decellularized allogenic grafts from the human placenta have the potential to be used as vascular replacement materials. Both detergents produced grafts with low residual immunogenicity and appropriate mechanical properties. Observed differences in graft characteristics due to preservation method had no impact on successful in vivo performance in the rodent model.

Graphical abstract

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A novel bioscaffold with naturally-occurring extracellular matrix promotes hepatocyte survival and vessel patency in mouse models of heterologous transplantation

Publication date: September 2018
Source:Biomaterials, Volume 177
Author(s): Wei Yang, Quanyu Chen, Renpei Xia, Yujun Zhang, Ling Shuai, Jiejuan Lai, Xiaolin You, Yan Jiang, Ping Bie, Leida Zhang, Hongyu Zhang, Lianhua Bai
BackgroundNaïve decellularized liver scaffold (nDLS)-based tissue engineering has been impaired by the lack of a suitable extracellular matrix (ECM) to provide "active micro-environmental" support.AimThe present study aimed to examine whether a novel, regenerative DLS (rDLS) with an active ECM improves primary hepatocyte survival and prevents thrombosis.Methods: rDLS was obtained from a 30–55% partial hepatectomy that was maintained in vivo for 3–5 days and then perfused with detergent in vitro. Compared to nDLS generated from normal livers, rDLS possesses bioactive molecules due to the regenerative period in vivo. Primary mouse hepatocyte survival was evaluated by staining for Ki-67 and Trypan blue exclusion. Thrombosis was assessed by immunohistochemistry and ex vivo diluted whole-blood perfusion. Hemocompatibility was determined by near-infrared laser-Doppler flowmetry and heterotopic transplantation.ResultsAfter recellularization, rDLS contained more Ki-67-positive primary hepatocytes than nDLS. rDLS had a higher oxygen saturation and blood flow velocity and a lower expression of integrin αIIb and α4 than nDLS. Tumor necrosis factor-α, hepatocyte growth factor, interleukin-10, interleukin-6 and interleukin-1β were highly expressed throughout the rDLS, whereas expression of collagen-I, collagen-IV and thrombopoietin were lower in rDLS than in nDLS. Improved blood vessel patency was observed in rDLS both in vitro and in vivo. The results in mice were confirmed in large animals (pigs).Conclusion: rDLS is an effective DLS with an "active microenvironment" that supports primary hepatocyte survival and promotes blood vessel patency. This is the first study to demonstrate a rDLS with a blood microvessel network that promotes hepatocyte survival and resists thrombosis.



https://ift.tt/2JjKgaR

Platinum(IV) complex-based two-in-one polyprodrug for a combinatorial chemo-photodynamic therapy

Publication date: September 2018
Source:Biomaterials, Volume 177
Author(s): Dongbo Guo, Shuting Xu, Yu Huang, Huangyong Jiang, Wumaier Yasen, Nan Wang, Yue Su, Jiwen Qian, Jing Li, Chuan Zhang, Xinyuan Zhu
A combinatorial therapy that utilizes two or more therapeutic modalities is more effective in overcoming the limitations than each individual method used alone. Despite great advances have been achieved, the combination of chemotherapy and photodynamic therapy (PDT) still cannot satisfy the clinic requirements as the antitumor efficacy could be severely affected by tumor-associated hypoxia. Herein, for the first time, we reported a platinum(IV) complex-based polyprodrug that can in situ generate the highly toxic platinum(II) species as chemotherapeutics and simultaneously induce a high level of reactive oxygen species (ROS) in a PDT-like process without the use of photosensitizer and consumption of oxygen. By in situ polymerizing the platinum(IV) complex-based prodrug monomer (PPM) and 2-methacryloyloxy ethyl phosphorylcholine (MPC), nanosized hydrogel-like polyprodrug could be synthesized. Upon being exposed to light, Pt(IV) moieties in this photoactivable polyprodrug were reduced to generate Pt(II) species. At the meantime, a high level of ROS was generated without the presence of endogenous oxygen, which was confirmed by electron spin resonance (ESR) and fluorescence probes. With the unique nanosized architecture and photoresponsive feature, the as-synthesized polyprodrug exhibited the advantages of sustained drug release, long-term circulation, preferable tumor accumulation, and reversing drug resistance by downregulating the expression of multidrug resistance-associated protein 1 (MRP1) in the anticancer treatment.

Graphical abstract

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Differentiating RNA from DNA by a molecular fluorescent probe based on the “door-bolt” mechanism biomaterials

Publication date: September 2018
Source:Biomaterials, Volume 177
Author(s): Qichao Yao, Haidong Li, Liman Xian, Feng Xu, Jing Xia, Jiangli Fan, Jianjun Du, Jingyun Wang, Xiaojun Peng
Although excellent florescent probes have been developed for DNA, good probes for RNA remain lacking. The shortage of reported and commercial RNA probes is attributable to their severe interference from DNA. As DNA and RNA have similar structures but different functions, it has been an imperative challenge to develop RNA probes that differentiate from DNA. In this study, an NIR fluorescent probe, NBE, is described, which contains a bulky julolidine group that can fit in a spacious RNA pocket and emit intense fluorescence. However, NBE has no response to DNA, as it cannot intercalate into the double strands or even in the DNA minor groove. The sensing mechanism is similar to the effect of a door-bolt. NBE shows excellent performance in RNA sensing (outstanding photostability, high selectivity and fast response), whether in aqueous buffers, fixed cells or living cells. These findings might provide not only a potential imaging tool but also a new design strategy for the recognition of RNA while avoiding interference from DNA.

Graphical abstract

https://ift.tt/2JhyM7B

SERPING1 and F12 combined variants in a hereditary angioedema family,,✰✰✰,✰✰✰✰

Publication date: Available online 6 June 2018
Source:Annals of Allergy, Asthma & Immunology
Author(s): Delphine Charignon, Denise Ponard, Christian De Gennes, Christian Drouet, Arije Ghannam




https://ift.tt/2JEmuW2

Olfactory dysfunction out of season in seasonal allergic rhinitis

Publication date: Available online 6 June 2018
Source:Annals of Allergy, Asthma & Immunology
Author(s): Motohiko Suzuki, Makoto Yokota, Shinya Ozaki, Yoshihisa Nakamura




https://ift.tt/2Lrrcnq

Adverse drug reactions attributed to fondaparinux and unfractionated heparin in cardiovascular care unit: An observational prospective pilot study in a tertiary care hospital

Sahithi Sharma, Shubhatara Swamy, Anupam Bhambhani, Pratibha Nadig

Journal of Pharmacy And Bioallied Sciences 2018 10(2):90-95

Introduction: This study was carried out to collect and analyze the adverse drug reactions (ADRs) reported with use of anticoagulants, heparin and fondaparinux. These drugs are vital in the treatment of unstable coronary artery diseases and emergencies. Materials and Methods: A cross-sectional study with active reporting of ADRs from cardiology and medicine department was conducted. The type of reaction was assessed by Rawlins and Thomson criteria, causality by Naranjo probability scale, severity by modified Hartwig criteria, and preventability by Schumock and Thornton criteria. Result: Of the 67 patients observed, 16 showed ADRs. Fifteen reactions were attributable to unfractionated heparin and one to fondaparinux following assessment by the Naranjo causality scale. Severity of the ADRs assessed by modified Hartwig criteria showed that although 12 of 16 (75%) were mild, 4 (25%) were moderate in severity. Modified Schumock and Thornton criteria showed that 9 of 16 (56.25%) reactions could not have been prevented whereas 5 (31.25%) were probably preventable and 2 (12.5%) were definitely preventable. Conclusion: Incidence of ADRs with fondaparinux was lower than with heparin, hence emphasizing its better safety profile. The study also highlights the need for nurses and other caretakers in the coronary care unit to enquire for and report ADRs, particularly with high-potency medicines that are associated with an equally high potential to induce ADRs.

https://ift.tt/2xOhSYN

Polycystic ovarian syndrome–related depression in adolescent girls: A Review

Saleha Sadeeqa, Tehreem Mustafa, Sumaira Latif

Journal of Pharmacy And Bioallied Sciences 2018 10(2):55-59

Polycystic ovarian syndrome (PCOS), a common endocrinal disorder of reproductive age characterized by heterogeneous complications, is nowadays prevailing among females at adolescent stage. Infrequent or prolonged menstrual periods, excess hair growth, acne, and obesity can occur in women with PCOS. In adolescents, infrequent or absence of menstruation may raise chances for this condition. The increased prevalence of PCOS among general population throughout the world is found to be 5%–10% in the women of reproductive age, and about 40% women with PCOS experience depression, particularly young girls. The exact cause of PCOS is unknown. Early diagnosis and treatment along with weight loss may reduce the risk of long-term complications. Depression and anxiety are common in women with PCOS but are often overlooked and therefore left untreated. Along with the physical disturbances, many mental problems are also associated with PCOS. Therefore, PCOS not only has problems associated with reproduction but also has associated crucial metabolic and psychological health risks with increasing age of the patients. Because of the increased number of cases with PCOS around the world in present times, with prominent symptom of, specifically, depression at the adolescent stage, it is important to highlight the disease.

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Electrochemical oxidability of antioxidants: Synergism and antagonism in mixes

Natalia Sazhina, Evgenii Plotnikov, Elena Korotkova, Elena Dorozhko, Olesya Voronova

Journal of Pharmacy And Bioallied Sciences 2018 10(2):60-65

Aims: To investigate electrochemical oxidability of antioxidants to reveal synergistic and antagonistic effects in mixes. Materials and Methods: Electrochemical oxidability of some widely used antioxidants, including uric acid, glutathione, trolox, ascorbic acid, gallic acid, Mexidol, and potassium fenozan, was investigated by the amperometric approach. Results: All obtained electrochemical oxidability values correlate well with antioxidant activity parameters of the same compounds measured by other methods. The measurements of the electrochemical oxidability for binary mixes of substances were tested to reveal any synergistic actions. The experimental results and calculated values overlap for various combinations of tested mixes. It testifies to the absence of interaction between them (both synergism and antagonism) in the oxidation process. Conclusions: The constants of oxidation were defined for different antioxidants and mixes by amperometric approach. Most mixes of probed compounds revealed absence of interaction between them in oxidation process. In some cases (mainly with glutathione and ascorbic acid), antagonism takes place, deteriorating effects of their joint application. Apparently, a partial reduction of glutathione by ascorbic acid leads to excess of the measured value over calculated value.

https://ift.tt/2xRdpVm

Eosinophilia in advanced HIV infection with hyperinfection syndrome: A case report

Pratima Gupta, Ruchi Dua, Mohit Bhatia, Puneet K Gupta, Neelam Kaistha

Journal of Pharmacy And Bioallied Sciences 2018 10(2):102-105

Strongyloides stercoralis is a soil-transmitted helminth that occurs almost worldwide, yet estimates about its prevalence are not well documented. The spectrum of clinical manifestations of strongyloidiasis is wide, ranging from asymptomatic disease to hyperinfection or dissemination of larvae involving multiple organ systems. Immunosuppression can increase the risk of hyperinfection syndrome in patients with strongyloidiasis. Strongyloidiasis continues to remain a neglected tropical disease, the diagnosis of which is often overlooked by clinicians and diagnosticians alike. The paucity of published literature from India further accentuates this problem. We hereby present a case report with the aim of elucidating this relatively underreported infection.

https://ift.tt/2JgK38g

Protective effect of Rheum turkestanicum against cisplatin by reducing oxidative stress in kidney tissue

Azar Hosseini, Sahar Fanoudi, Hamid Mollazadeh, Azita Aghaei, Mohammad Taher Boroushaki

Journal of Pharmacy And Bioallied Sciences 2018 10(2):66-71

Background: Cisplatin is used as chemotherapeutic drug in the treatment of some solid tumors. It causes different side effects such as nephrotoxicity because of increasing oxidative stress and reactive oxygen species production. This study was designed to investigate the effect of Rheum turkestanicum on cisplatin-induced nephrotoxicity in rat. Materials and Methods: Animals were randomly divided into four groups (six each). Group I received normal saline (1mL/day, intraperitoneally [i.p.]). Group II received a single dose of cisplatin (8mg/kg, i.p.). Groups III and IV received extract at doses of 100mg/kg and 200mg/kg, i.p., respectively, for 3 consecutive days, 1h before a single dose of cisplatin only at the first day. Blood samples were taken for measuring the level of urea and creatinine. Furthermore, 24-h urinary factors such as glucose and protein were measured. Histopathological observation was carried out on kidney sections. Statistical analysis was performed using one-way analysis of variance followed by Tukey–Kramer post hoc test for multiple comparisons. Results: Cisplatin increased the lipid peroxidation, serum creatinine, serum urea, urinary glucose, and urinary protein, whereas decreased the content of thiol in kidney. The extract reduced serum creatinine, serum urea, urinary glucose, urinary protein, lipid peroxidation, and increased thiol following cisplatin administration. Histological studies revealed lower lesions in kidney in the extract-treated groups compared to cisplatin-treated one. Conclusion: This research showed the extract has protective effect against cisplatin-induced nephrotoxicity. This observation may be related to antioxidant properties of the extract.

https://ift.tt/2Jkqo3e

In vitro antilithiatic potential of Kalanchoe pinnata, Emblica officinalis, Bambusa nutans, and Cynodon dactylon

Atul K Sohgaura, Papiya Bigoniya, B Shrivastava

Journal of Pharmacy And Bioallied Sciences 2018 10(2):83-89

Objective: The study aims at the exploration of calcium oxalate (CaOx) crystal growth inhibition potential of Cynodon dactylon, Emblica officinalis, Kalanchoe pinnata, and Bambusa nutans ethyl acetate fraction rich in polyphenol and flavonoid. Materials and Methods: Ethyl acetate fraction was separated from the hydromethanolic extract of C. dactylon, E. officinalis, K. pinnata, and B. nutans followed by quantitative analysis for total polyphenol and flavonoid content. Ethyl acetate fraction of all the plants were subjected to in vitro screening for the inhibition of CaOx crystals growth induced by sodium oxalate. Results: The results signify rich presence of polyphenols and flavonoids in K. pinnata and E. officinalis ethyl acetate fractions followed by C. dactylon and B. nutans. Ethyl acetate fractions of B. nutans shoot, E. officinalis fruit, and K. pinnata leaf have excellent in vitro CaOx crystal growth inhibition potential based on both the comparative concentration and the time level to achieve IC50. Conclusion: The study outcome substantiates potential in vitro CaOx crystal dissolution and crystal growth inhibition properties of E. officinalis, B. nutans, C. dactylon, and K. pinnata. Rich presence of caffeic acid, ferulic acid, and luteolin in ethyl acetate fraction of B. nutans leaf, and chebulinic acid, chebulagic acid, gallic acid, ellagic acid, and quercetin of E. officinalis may have produced prominent crystal aggregation inhibition response.

https://ift.tt/2sDdvL7

Emerging biocide resistance among multidrug-resistant bacteria: Myth or reality? A pilot study

Priyanka Gupta, Mohit Bhatia, Pratima Gupta, Balram J Omar

Journal of Pharmacy And Bioallied Sciences 2018 10(2):96-101

Context: Possible linkage between biocide and antibiotic resistance in bacteria is a major area of concern. Aim: To evaluate the susceptibility of multidrug-resistant (MDR) bacteria to four commonly used biocides. Settings and Design: A pilot study was conducted in a tertiary care hospital from April to November 2017. Materials and Methods: Fifty-four MDR bacterial isolates, namely Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Staphylococcus aureus, were obtained from various clinical samples of inpatients. These isolates were subjected to tube dilution method for determining minimum inhibitory concentration (MIC) of four commonly used biocides in our hospital, namely 5% w/v povidone iodine, absolute ethanol (99.9%), sodium hypochlorite (4% available chlorine), and quaternary ammonium compounds (QACs) (3.39%). Minimum bactericidal concentration (MBC) of these biocides was determined as per standard guidelines. Similar tests were also performed on corresponding American Type Culture Collection (ATCC) bacterial strains. Statistical Analysis: The Fisher exact test. Results: Twenty-two MDR bacterial isolates had higher MIC values for QACs than their corresponding ATCC strains. Statistically significant difference in proportion of test isolates exhibiting higher MIC values for QACs and absolute ethanol was observed (P-value = 0.02). Twenty-four MDR bacterial isolates exhibited higher MBC values for sodium hypochlorite than their corresponding ATCC strains. The difference in proportion of test isolates exhibiting higher MBC values for sodium hypochlorite and absolute ethanol, respectively, was statistically significant (P-value <0.0001). The difference in proportion of test isolates exhibiting higher MBC values for absolute ethanol versus QACs and povidone iodine, respectively, was statistically significant (P-values = 0.0003 and 0.0076). Statistically significant differences in susceptibility to biocides among test isolates were also observed. Conclusion: Emergence of biocide resistance among MDR bacteria poses a serious threat to our efforts in containing outbreaks of nosocomial infections.

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Assessment of knowledge, attitude, and practice of dental and medical interns toward toothbrush maintenance and replacement in Bhubaneswar city, Odisha, India

Gunjan Kumar, Alok Kumar Sethi, Ranjan Mani Tripathi, Pratik , Diplina Barman

Journal of Pharmacy And Bioallied Sciences 2018 10(2):77-82

Background: Toothbrushes are an important medium for maintaining good oral hygiene, and hence there arises a need to maintain and replace toothbrushes at a regular interval. Assessing the knowledge, attitude, and practice (KAP) of the medical and dental interns would help the society in promoting oral hygiene in a broader aspect. Materials and Methods: A cross-sectional questionnaire study was conducted among 759 medical and dental interns residing in Bhubaneswar, Odisha, India. The data on oral health KAP were collected using a self-structured questionnaire. Descriptive statistics was evaluated using SPSS software package, version 19. Results: Of 759 participants, 445 were dental interns and 314 were medical interns. Knowledge about toothbrush maintenance was seen to be more in the dental interns. The attitude toward maintenance was seen to be better among the dental interns compared with the medical interns. The practice of toothbrush maintenance was seen in both the groups but more dominantly in the dental interns. Conclusion: Education regarding the effective use and maintenance of the toothbrush would help improve the KAP toward toothbrush maintenance and replacement. The lack of knowledge holds back the attitude of properly maintaining the toothbrush in a regular basis.

https://ift.tt/2Jo8Kvx

Lab on a Chip: Conquer disease at the earliest

Gibson S T Daniel, Manigandan Thiruppathy, Nalini Aswath, Sankar R Narayanan

Journal of Pharmacy And Bioallied Sciences 2018 10(2):106-108

Oral cancer is the fifth most common cancer in the world, accounting for numerous deaths annually. The 5-year survival rate remains approximately 50% for oral squamous cell carcinoma (OSCC) in the past several decades. Early detection plays a vital role in the survival rate of the patients. There is no accurate, cost-effective, and reliable method for the screening of patients with OSCC. Hence, many patients are diagnosed at advanced stages. Early detection would, therefore, help to identify patients and modify treatment with close monitoring. Lab on a Chip or micro-total-analysis systems are one of the microfluidics technologies that are defined as adaptation, miniaturization, integration, and automation of analytical laboratory procedures into a single device or "chip." This technology assures the replacement of complicated techniques with miniaturized, integrated, programmed, and economical diagnostic devices. Hence, this system provides a means for rapid, automated, molecular analysis of cancer cells.

https://ift.tt/2sDdoPH

A simple cleanup method for the removal of humic substances from soil protein extracts using aluminum coagulation

Abstract

Soil proteomics, the large-scale characterization of the entire protein complement in soils, provides a promising approach for deciphering the role of microbial functioning in terrestrial ecosystems. However, the extraction of soil proteins in sufficient quantities and of adequate purity remains a challenging task mainly due to the co-extraction of interfering humic substances. Up to now, the treatment of soil extracts with liquid phenol has been the "gold standard" for reducing humics, while the NoviPure cleanup kit was recently launched as a non-toxic approach. The present study describes an alternative method for delivering high-purity proteins based on humic coagulation with trivalent aluminum ions (Al³⁺). Various experimental parameters were optimized individually in order to maximize protein yield and diminish co-extracted humics. The optimized method was applied on a set of soil samples with diverse physicochemical characteristics and a comparison with the other two techniques was conducted. The amount of residual humics resulting from Al³⁺-based method was 26 and 35% higher than that from phenol treatment and NoviPure Kit, respectively, but these differences were of marginal statistical significance. With regard to extracted proteins, the average yields of the three methods were comparable, without showing any statistically significant differences. Overall, humic coagulation with Al³⁺ offers comparable cleanup performance in terms of protein yield and purity, but it is less toxic and less complex than the phenol-partitioning method, whereas it is far less expensive than the NoviPure Kit. The new technique is expected to facilitate the implementation of proteomic studies in soils.

https://ift.tt/2sM5pz1

Uninformative Contexts Support Word Learning for High-Skill Spellers.

Author: Eskenazi, Michael A.; Swischuk, Natascha K.; Folk, Jocelyn R.; Abraham, Ashley N.

DOI: 10.1037/xlm0000568

Publication Date: POST AUTHOR CORRECTIONS, 30 April 2018

https://ift.tt/2Hr5iOL

Automaticity of Access to Numerical Magnitude and Its Spatial Associations: The Role of Task and Number Representation.

Author: Cleland, Alexandra A.; Bull, Rebecca

DOI: 10.1037/xlm0000590

Publication Date: POST AUTHOR CORRECTIONS, 30 April 2018

https://ift.tt/2kVOIxI

Time in Causal Structure Learning.

Author: Bramley, Neil R.; Gerstenberg, Tobias; Mayrhofer, Ralf; Lagnado, David A.

DOI: 10.1037/xlm0000548

Publication Date: POST AUTHOR CORRECTIONS, 10 May 2018

https://ift.tt/2sI1D9O

Consequences of short sleep duration on the dietary intake in children: a systematic review and metanalysis

During the last years, a decline in the amount of hours of sleep has been observed in children. Sleep deficiency has been linked to an increase in calories, snacks, and fat intake. The objective of this study was to review the evidence between sleep duration and eating habits in children.We performed an electronic search in MEDLINE, The Cochrane Central Register, BIREME, EMBASE, LILACS, and Epistemonikos. Study selection criteria was: children aged 2 - 18 years within studies that aimed to associate sleep duration and eating habits.

https://ift.tt/2JqeiFT

Social Media Ratings of Minimally Invasive Fat Reduction Procedures: Benchmarking Against Traditional Liposuction

BACKGROUND Minimally invasive fat reduction procedures are rapidly growing in popularity. OBJECTIVE Evaluate online patient reviews to inform practice management. MATERIALS AND METHODS Data from RealSelf.com, a popular online aesthetics platform, were reviewed for all minimally invasive fat reduction procedures. Reviews were also aggregated based on the primary method of action (e.g., laser, radiofrequency, ultrasound, etc.) and compared with liposuction. A chi-square test was used to assess for differences with the Marascuilo procedure for pairwise comparisons. RESULTS A total of 13 minimally invasive fat reduction procedures were identified encompassing 11,871 total reviews. Liposuction had 4,645 total reviews and a 66% patient satisfaction rate. Minimally invasive fat reduction procedures had 7,170 aggregate reviews and a global patient satisfaction of 58%. Liposuction had statistically significantly higher patient satisfaction than cryolipolysis (55% satisfied, n = 2,707 reviews), laser therapies (61% satisfied, n = 3,565 reviews), and injectables (49% satisfied, n = 319 reviews) (p

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Platelet-Rich Plasma Therapy in the Treatment of Recalcitrant Melasma

No abstract available

https://ift.tt/2JfkWTk

To Form a More Perfect Dermatologic Union

No abstract available

https://ift.tt/2xQEtUG

Sustained Benefit After Treatment of Acne Vulgaris Using Only a Novel Combination of Long-Pulsed and Q-Switched 1064-nm Nd: YAG Lasers

BACKGROUND Acne vulgaris remains a challenging disease to treat in many patients. Traditional therapies may have limited successes with potential side effects. Laser and light energy devices may offer a desirable alternative. OBJECTIVE To evaluate the effectiveness and safety in using a combination laser approach with both long-pulsed (LP) and Q-switched (QS) Nd:YAG lasers in the treatment of active acne. METHODS Twenty patients with moderate to severe inflammatory acne were treated with LP YAG laser followed immediately with QS YAG laser. Patients received at least 8 treatments. Follow-up evaluation occurred at a minimum of 12 months. Pre- and post-treatment photographs were graded by blinded physicians. All topical acne medications and oral antibiotics were discontinued throughout the therapy and follow-up period. RESULTS There was a 81% reduction in acne lesions, with 60% of patients having 90% or greater reduction. Overall appearance was graded at 84% improvement at follow-up. Follow-up occurred at a mean of 22.7 months after completion of therapy. Aside from transient erythema, there were no other adverse effects. CONCLUSION Active acne can be treated successfully with a combination of LP and QS YAG lasers with patients remaining off acne medications throughout laser therapy and the follow-up period. Address correspondence and reprint requests to: Jerome M. Garden, MD, Physicians Laser and Dermatology Institute, 150 E. Huron, Suite 1050, Chicago, IL 60645, or e-mail: j-garden@northwestern.edu The authors have indicated no significant interest with commercial supporters. © 2018 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2JpNdm5

Standardised pain management decreases expenses on analgesics: results from a 5-year programme at a university hospital

No abstract available

https://ift.tt/2szOfFO

Severe and persistent morphine-induced respiratory depression associated with ATP-Binding Cassette Subfamily B Member 1 and catechol-O-methyltransferase genetic defects: A case report

No abstract available

https://ift.tt/2xVk15g

Does goal-directed haemodynamic and fluid therapy improve peri-operative outcomes?: A systematic review and meta-analysis

BACKGROUND Much uncertainty exists as to whether peri-operative goal-directed therapy is of benefit. OBJECTIVES To discover if peri-operative goal-directed therapy decreases mortality and morbidity in adult surgical patients. DESIGN An updated systematic review and random effects meta-analysis of randomised controlled trials. DATA SOURCES Medline, Embase and the Cochrane Library were searched up to 31 December 2016. ELIGIBILITY CRITERIA Randomised controlled trials enrolling adult surgical patients allocated to receive goal-directed therapy or standard care were eligible for inclusion. Trauma patients and parturients were excluded. Goal-directed therapy was defined as fluid and/or vasopressor therapy titrated to haemodynamic goals [e.g. cardiac output (CO)]. Outcomes included mortality, morbidity and hospital length of stay. Risk of bias was assessed using Cochrane methodology. RESULTS Ninety-five randomised trials (11 659 patients) were included. Only four studies were at low risk of bias. Modern goal-directed therapy reduced mortality compared with standard care [odds ratio (OR) 0.66; 95% confidence interval (CI) 0.50 to 0.87; number needed to treat = 59; N = 52; I2 = 0.0%]. In subgroup analysis, there was no mortality benefit for fluid-only goal-directed therapy, cardiac surgery patients or nonelective surgery. Contemporary goal-directed therapy also reduced pneumonia (OR 0.69; 95% CI, 0.51 to 0. 92; number needed to treat = 38), acute kidney injury (OR 0. 73; 95% CI, 0.58 to 0.92; number needed to treat = 29), wound infection (OR 0.48; 95% CI, 0.37 to 0.63; number needed to treat = 19) and hospital length of stay (days) (−0.90; 95% CI, −1.32 to −0.48; I2 = 81. 2%). No important differences in outcomes were found for the pulmonary artery catheter studies, after accounting for advances in the standard of care. CONCLUSION Peri-operative modern goal-directed therapy reduces morbidity and mortality. Importantly, the quality of evidence was low to very low (e.g. Grading of Recommendations, Assessment, Development and Evaluation scoring), and there was much clinical heterogeneity among the goal-directed therapy devices and protocols. Additional well designed and adequately powered trials on peri-operative goal-directed therapy are necessary.

https://ift.tt/2sD6JoA