Improving the Results of Endonasal Dacryocystorhinostomy with Mitomycin C Application: A Prospective Case–Control Study

Abstract

Many surgical advancement paved to surgical success in endonasal endoscopic dacryocystorhinostomy. Mitomycin C is a systemic chemotherapeutic agent derived from Streptomyces caespitosus that inhibits the synthesis of DNA, cellular RNA, and protein by inhibiting the synthesis of collagen by fibroblasts. The objective of the study was to evaluate the advantage of mitomycin C in primary endoscopic endonasal dacryocystorhinostomy without stenting. Randomised case control design. Tertiary academic centre in central India. 112 patients who presented with epiphora and diagnosed as chronic dacryocystitis after syringing by ophthalmologist, were selected and randomised into two groups with or without mitomycin C intraoperative application. 112 eyes underwent endoscopic-dacryocystorhinostomy. Additional surgeries were done according to necessity. Mitomycin C was applied in concentration of 0.4 mg/dl for 5 min. Patients were followed up on OPD-basis at the end of 1st week, 1st month, 3rd month and over phone call at end of 1 year. Symptomatic improvement assessed by verbal enquiry and clinically by syringing by ophthalmologist. 8 patients underwent septal surgery in case group and 4 in control group along with 1 concha bullosa correction in the case group (p < 0.05). Nil intraoperative complications (p < 0.05) and nil postoperative complication noted (p < 0.05). Functional and anatomical patency found to be 100% at the end of 1st week in both groups, 96.5% at 3rd month in case group and 96.4% and 92.9% at 1 month and 3 month respectively in control group. Nasal endoscopy of all surgical failures showed restenosis in both case group and control group except 1 patient with granulation in control group. Eventhough intraoperative mitomycin C application is effective in increasing the success rate of endonasal DCR surgery in standard nasolacrimal duct obstruction, and with no significant complications from its use, the study did not show added benefit in the primary endoscopic endoscopic dacryocystorhinostomy without stenting.

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Mitomycin-C in Post-endoscopic Septoplasty Synechiae: Does it Really Helps?

Abstract

Endoscopic septoplasty has advantage of magnified image and access to posterior part of the septum. Synechiae formation is a common complication of this procedure. The incidence of adhesions rises particularly in cases of submucosal flap tears which is sometimes unavoidable during spurectomy. Various procedures like septal splints, nasal packings have been tried to reduce the incidence of adhesions. Recently mitomycin-C is being tried to decrease post operative adhesions after Functional Endoscopic Sinus Surgery, endoscopic Dacrocystorhinostomy, with varying degree of success. Mitomycin-C has got anti fibroblastic activity, which inhibits the fibroblasts without hampering epithelization. Eighty (80) Patients undergoing septoplasty and spurectomy were observed for any submucosal flap tear, and those developing flap tear were included in the study. The patients were divided into 2 groups of 40 each. In group-1 topical mitomycin (0.4 mg/ml) was applied at the raw area for 5 min, similarly normal saline was applied in group-2 (control).The aim of study was to evaluate the role of mitomycin-C in preventing post operative adhesions in Endoscopic septoplasty. Adhesion rate was calculated at 1 month, and compared using Chi square test. P value < 0.05 was considered significant. The adhesion rate at 1 month was 17.5% in group-1 and 45% in group-2 (P = 0.008). Incidence of adhesion decreased significantly in mitomycin-C treated group. Mitomycin-C can routinely be used in septoplasty to prevent post op adhesions, particularly in cases of submucosal flap tears/concurrent turbinate reduction procedures.

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Survival percentages of atraumatic restorative treatment (ART) restorations and sealants in posterior teeth: an updated systematic review and meta-analysis

Abstract

Objective

The aim of the present study is to update the results of two previous meta-analyses, published in 2006 and 2012, on the survival percentages of atraumatic restorative treatment (ART) restorations and ART sealants. The current meta-analysis includes Chinese publications not investigated before.

Materials and methods

Until February 2017, six databases were interrogated (two English, one Portuguese, one Spanish and two Chinese). Using six exclusion criteria, a group of six independent reviewers selected 43 publications from a total of 1958 potentially relevant studies retrieved. Confidence intervals and/or standard errors were calculated and the heterogeneity variance of the survival rates was estimated.

Results

The survival percentages and standard errors of single-surface and multiple-surface ART restorations in primary posterior teeth over the first 2 years were 94.3% (± 1.5) and 65.4% (± 3.9), respectively; for single-surface ART restorations in permanent posterior teeth over the first 3 years, they were 87.1% (± 3.2); and for multiple-surface ART restorations in permanent posterior teeth over the first 5 years, they were 77% (± 9.0). The mean annual dentine-carious-lesion-failure percentages in previously sealed pits and fissures using ART sealants in permanent posterior teeth over the first 3 and 5 years were 0.9 and 1.9%, respectively.

Conclusions

ART single-surface restorations presented high survival percentages in both primary and permanent posterior teeth, whilst ART multiple-surface restorations presented lower survival percentages. ART sealants presented a high-caries-preventive effect.

Clinical relevance

ART is an effective evidence-based option for treating and preventing carious lesions in primary and permanent posterior teeth.

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Cutaneous angioleiomyoma of the auricle: a painless variant of a painful tumour

Cutaneous angioleiomyomas (ALMs) are uncommon benign tumours of the skin which derive from the smooth muscle layer of dermal blood vessels. They usually present as tender nodules in the fifth or sixth decade of life, predominantly in the legs of females. These tumours rarely present on the head and neck, especially the ear. Head and neck ALMs differ from their more common leg counterparts in that they are painless. Additionally, they do not manifest with a female predominance. Herein, a new case of a painless auricular ALM in a 63-year-old man is reported.

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Genitalia self-mutilation commanded by hallucinations: a psychointensive case of Klingsor syndrome

Description 

One of the world's rarest cases recorded up to date stands a case of hallucination influenced genitalia self-mutilation (GSM). There are just 13 cases recorded on PubMed till date. What and who is Klingsor? It was derived from the name of a character in Parsifal (a German opera) who had engaged in the act of self-castration for gaining entry into the prestige brotherhood of the Knights of the Holy Grail. In one of the first recorded cases in 1990, the author argued that the term 'Klingsor' be applied to all cases of GSM to patients of psychotic illness and not just religious conflicts.1 Some literatures call this syndrome as Skoptic syndrome.

Various surveys done by psychologists found psychosis beneath the cases of men carrying out autocastration. One of the most famous cases documented of Thomas Corbett, the man behind the assassination of John Wilkes Booth and...

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Primary intratracheal schwannoma resected during bronchoscopy using argon plasma coagulation

A 63-year-old man presented with intermittent, progressively worsening dyspnoea associated with cough and blood-tinged sputum. Initial work-up showed left axis deviation on ECG, chest X-ray with an elevated left hemidiaphragm and a non-contrast CT chest that showed a multilobulated mass in the proximal trachea. Bronchoscopy showed a whitish-appearing lesion, which was then sampled and partially resected with pathology showing a schwannoma with no malignant cells. He felt partial relief post procedure; however, he presented a month later with similar symptoms of dyspnoea and a repeat CT scan showed enlargement of the mass in the same location. The patient underwent another flexible bronchoscopy and resection with argon plasma coagulation (APC)/electrocautery snare. APC/electrocautery is an effective interventional bronchoscopy technique that can be used to resect endoluminal lesions or extraluminal lesions that have infiltrated into the airway using flexible/rigid bronchoscopy. It is more cost-effective, safe, works well with vascular lesions and achieves excellent haemostasis as compared with Nd:YAG lasers.

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A rare cause of ascites in a renal transplant recipient

Thirty-five-year-old man, underwent renal transplantation 4 years back and was doing well. He now presented with complaints of ascites with engorged neck veins and dyspnoea on exertion for last 6 months. Examination showed elevated jugular venous pressure with two prominent descents, high pitched diastolic heart sound (pericardial knock). Echocardiography showed characteristic features of thickened pericardium, septal bounce, expiratory flow reversal in hepatic veins and phasic variation of mitral inflow, suggestive of constrictive pericarditis. The patient was started on empirical antitubercular therapy and diuretics. The patient symptomatically improved, but in view of persisting constrictive physiology he was planned for pericardiectomy.

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Dental management of a patient with 22q11.2 deletion syndrome (22q11.2DS)

22q11.2 deletion syndrome (22q11.2DS) is one of the most common microdeletion syndromes, with an incidence of approximately 1/2000–1/4000 live births; it is thought to be mainly attributable to a de novo deletion. The clinical phenotype of this syndrome is highly variable. Certain craniofacial and oral features are common to most patients with 22q11.2DS, including a high prevalence of dental caries; abnormalities of tooth shape, eruption and number; and enamel defects such as hypomineralisation and hypoplasia. This report focuses on the dental features and management of an 8-year-old boy with 22q11.2DS. Dental treatments were carried out under general anaesthesia. In summary, facial dysmorphism and common dental manifestations are typically noticeable in patients with this syndrome. Therefore, dentists need to be aware of the dental features of this condition in order to refer them to the adequate specialists. Cooperation among and experience with different specialties are mandatory to improve quality of life for patients with 22q11.2DS.

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Mid-ventricular takotsubo cardiomyopathy triggered by major depressive disorder after abortion

Description 

A 28-year-old gravida 7 para 5 woman presented from an outlying facility with non-radiating, crushing, severe left-sided chest pain. She was initially treated for a non-ST elevation myocardial infarction with ECG evidence of T wave inversions in leads II, III, aVF, V5, V6 and an abnormal troponin level at 0.56 ng/mL. Accordingly, left heart catheterisation was performed emergently and revealed normal coronary arteries without any obstruction (figure 1). Left ventriculography showed mid-ventricular hypokinesis with hyperdynamic apical and basal wall contraction, consistent with a mid-ventricular takotsubo cardiomyopathy (TCM) (video 1). The ejection fraction was estimated at 30%–35%.

Figure 1

Coronary angiogram showing normal coronary arteries. (A) Left anterior oblique 30 view. (B) Right anterior oblique 10 cranial 40 view. (C) Left anterior oblique 45 caudal 25 view.

Video 1

Left ventriculogram.

Medical history was significant for an elective abortion...

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A case of young diabetes and parasuicide

Wolfram syndrome is a rare monogenic cause of juvenile onset diabetes mellitus. It is a non-autoimmune, insulin-deficient state with concurrent or consequent optic atrophy. Here we depict the case of a 16-year-old young girl afflicted with this condition, who presented with parasuicide on a background of depressive disorder. The aetiology of this presentation was attributable to multiple physical ailments and a genetic predisposition conferred by the disease-causing mutation for which she tested positive. She was managed with intensive insulin therapy and specific psychotherapy. Her case highlights the importance of recognising and addressing these comorbidities associated with Wolfram syndrome, so as to curtail disastrous consequences.

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Subperiosteal haematoma of the orbit secondary to frontal sinusitis

Reported is the case of a 79-year-old woman initially diagnosed with periorbital abscess on the background of a recent upper respiratory tract infection. Unexpectedly, intraoperative findings were that of a haematoma rather than an abscess. Subperiosteal orbital haematoma (SOH) is an extremely rare complication of rhinosinusitis. In contrast to the more common periorbital abscess, it is seldom listed as a complication of sinusitis. A review of reported cases suggests an older patient demographic are affected by SOH in contrast to periorbital abscess which typically affects paediatric patients. Given current demographic trends toward an older patient population with multiple comorbidities, failure to consider SOH as a differential will have important implications on preoperative workup, perioperative care and final outcome for patients. We present this case as a reminder of a rare but important complication of a common disease.

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Custom 3D-printed finger proximal phalanx as salvage of limb function after aggressive recurrence of giant cell tumour

Giant cell tumours (GCT) of the finger phalanges are extremely rare but have a high rate of recurrence. This report details the case of a GCT of the proximal phalanx of the fourth finger in a 64-year-old man. The patient was initially subjected to systemic neoadjuvant denosumab treatment, and subsequent aggressive curettage, sparing of the articular joints, local cryotherapy and autologous intercalary fibular bone graft. Finger function after surgery was considered satisfactory, despite limited proximal interphalangeal (PIP) joint motion. Aggressive local GCT recurrence was noted at the 32-month follow-up, with entire articular and diaphyseal phalangeal destruction. The patient refused amputation and, after analysing several reconstruction options, he was treated by entire en bloc resection and reconstruction employing a 3D-printed custom titanium implant. At the 24-month follow-up, the patient is free of disease and pain, and has a stable finger, good metacarpal–phalangeal joint motion, fusion of the PIP joint, a good Musculoskeletal Tumour Society score, and functional ability.

https://ift.tt/2QMO98e

Suspicious breast pseudocalcifications

Description 

We present a follow-up case of an invasive right ductal breast carcinoma in a 72-year-old woman.

A follow-up mammography study (figure 1) performed 1 year after right lumpectomy (wide local excision) shows postsurgical changes in the right breast and reveals 'de novo' coarse/amorphous microcalcifications in the left breast axis. Some of these calcifications show radiolucent centre, and can only be depicted in the craniocaudal mammographic images, raising concern for hypothetic cutaneous location, although presenting suspicious features.

Figure 1

Mammographic images showing postlumpectomy (wide local excision) changes in the right upper outer quadrant and coarse and amorphous calcifications in the left breast. Blue square shows the magnification of the calcifications, revealing some calcifications with radiolucent centre.

Cancer biomarkers and clinical status were unremarkable.

An ultrasound (US) evaluation was further advised. The patient was told not to apply any cream, lotion or deodorant on...

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Severe pulmonary hypertension associated with hepatic arteriovenous malformation in a patient with hereditary haemorrhagic telangiectasia

We report a case of 46-year-old Asian woman with a history of recurrent epistaxis who presented with dyspnoea on exertion. Physical examination revealed mucocutaneous telangiectasias and signs of heart failure. Further evaluation showed huge hepatic arteriovenous malformation and severe pulmonary hypertension. This case demonstrates an uncommon manifestation of hereditary haemorrhagic telangiectasia presented with severe pulmonary hypertension.

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Primary peritoneal hepatoid adenocarcinoma: a diagnostic and therapeutic conundrum in patients with gastrointestinal bleeding

Description 

A 50-year-old man with a history of iron-deficiency anaemia and fatty liver disease presented to the emergency department complaining of black tarry stools with associated weakness and shortness of breath for 1 week. At presentation, contrast-enhanced CT revealed multiple hypervascular masses in the abdomen and pelvis with the largest lesion located in the right lower quadrant, abutting the right psoas muscle (figure 1). Laboratory evaluation demonstrated a haemoglobin level of 5.5 g/dL (normal, 13.5–17.5 g/dL). Upper endoscopy showed a mass, which was making an extrinsic impression into the stomach (figure 2). Colonoscopy was unremarkable for abnormalities. Endoscopic ultrasound-guided fine-needle aspiration (FNA) of the lesion adjacent to the stomach was performed using a 22-gauge needle (Expect Slimline; Boston Scientific, Natick, Massachusetts, USA). The FNA was positive for metastatic carcinoma with hepatic features. Furthermore, capsule endoscopy identified blood clots surrounding the multiple, small intestinal masses. These lesions were...

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Endogenous bacterial endophthalmitis and subretinal abscess complicating diabetic ketoacidosis

Description 

A 26-year-old Lithuanian man with type 1 diabetes, diagnosed at aged 14, presented to the emergency department with shortness of breath as well as left flank pain. The patient was taking a basal-bolus (Actrapid/Lantus) regimen of insulin and had no other medical conditions. The patient was found to be in diabetic ketoacidosis (blood glucose level 21 mmol/L, pH 7.10) and diagnosed with chest sepsis based on bilateral consolidation on a chest X-ray. The patient was admitted to the high dependency unit and treated empirically with intravenous flucloxacillin and ceftriaxone. Blood cultures grew a fully sensitive Staphylococcus aureus. The patient's flank pain failed to improve and on day 3 of admission CT of the abdomen and pelvis demonstrated a left 4.9 cm intermedius muscle abscess (figure 1). There were additional small focal collections in the left psoas, right psoas and right erector spinae muscle. Radiologically guided aspiration of the left intermedius...

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MRI SPACE sequence confirmation of occluded MCA M2 dissection stump masquerading as a ruptured MCA aneurysm

Intracranial vascular pathologies often have overlapping clinical presentations. Dissected vessel occlusions and bifurcation aneurysms can appear similar on pretherapeutic imaging. The medical management of these two entities is drastically different. The patient is a 51-year-old man who presented with severe, sudden-onset headache. Initial presentation was consistent with a ruptured middle cerebral artery (MCA) aneurysm and surgical clipping was recommended. However, further review of radiographic findings could not definitively differentiate an aneurysmal origin of the symptoms as opposed to intracranial dissection followed by occlusion of the M2 branch of the MCA. MRI sampling perfection with application optimised contrasts using different flip angle evolution (SPACE) was performed and showed thin flow signalling distal to the dissected vessel stump confirming the diagnosis. Accurate diagnosis is a crucial step in directing treatment for intracranial vascular lesions. MRI SPACE is a simple tool in the diagnostic armamentarium to adequately direct treatment and avoid the potential for unnecessary interventions.

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Significant bleeding from Meckel’s diverticulum after blunt abdominal trauma: a case report

Meckel's diverticulum, with an incidence of 2%, is the most common congenital anomaly in the gastrointestinal tract. Its main complications are perforation, obstruction, and bleeding. A few studies have report...

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Reduced CD8 + T cells infiltration can be associated to a malignant transformation in potentially malignant oral epithelial lesions

Abstract

Objective

The aim of this study was to evaluate the immunohistochemical expressions of PD1, CD4⁺, and CD8⁺ in premalignant lesions (OPML) that were transformed into oral squamous cell carcinoma OSCC (OPML-OSCC), in OSCC and also in premalignant lesions that were not transformed into OSCC (OPML-NOSSC).

Materials and methods

Retrospective analyses were performed in order to verify the demographic characteristics of the patients. CD4, CD8, and PD1 IMH studies were carried out on OPML and OSCC samples from 11 patients with OPML-OSCC and OPML, together with samples from 14 patients with OPML-NOSCC. The differences between OPML-OSCC and OPML-NOSCC were analyzed.

Results

Non-homogenous leukoplakia, together with the related oral subsite, and the lack of an exposure to tobacco, were all associated with malignant transformations. There were no statistical differences in the PD1 expression and the CD4⁺ cells in OPML-OSCC and OPML-NOSCC. A significant increment in the CD8⁺ cells was noted in the OPML that evolved into carcinomas when compared with OPML-NOSCC (p = 0.05), whereas there were higher CD8⁺ cells levels in the carcinomas when compared with the OPML that evolved into carcinomas (p = 0.027).

Conclusions

CD8⁺ cells infiltrate more in OPML-NOSCC than in OPML-OSCC. Carcinoma is more infiltrated by CD8⁺ cells than its associated OPML.

Clinical relevance

Understanding immunological factors associated with malignant transformation of oral premalignant lesions can open a new way to treat this disease.

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CME examination

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Answers to CME examination

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Editorial Board

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Table of Contents

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Dermatology Calendar

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Urticaria: A comprehensive review

Urticaria is a common clinical condition presenting with wheals (hives), angioedema, or both. Urticaria has a complex pathogenesis, along with a high disease burden, a significant impact on quality of life, and high health care costs. The first article in this continuing medical education series covers the definition, classification, epidemiology, diagnosis, and work-up of urticaria, taking into account the recent literature and the best available evidence.

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Quick note from your Editors

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The case of the dog and the blue light

Over the past decade, as the number of emotional support animals has increased dramatically, more requests for accommodation have occurred in medical practices.1 While clinicians frequently will accommodate an emotional support animal, there are important differences between service animals and emotional support animals in the United States under the Americans with Disabilities Act (ADA). The ADA defines a service animal as an animal that has been individually trained to do work or perform tasks for an individual with a disability.

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JAAD Case Reports Article List

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CME examination

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Answers to CME examination

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October Iotaderma (#296)

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Urticaria: A comprehensive review

Second-generation antihistamines are considered first-line agents in the treatment of chronic urticaria because of their safety and efficacy profile. Some patients require higher doses of H1 antihistamines alone or in combination with other classes of medications, including H2 antihistamines, leukotriene receptor antagonists, or first-generation H1 antihistamines. One major therapeutic advance has been omalizumab, a humanized monoclonal anti–immunoglobulin E that was recently approved by the US Food and Drug Administration for the treatment of chronic urticaria that is unresponsive to H1 antagonists.

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Clinically amelanotic or hypomelanotic melanoma: Anatomic distribution, risk factors, and survival

The recognition and diagnosis of clinically amelanotic or hypomelanotic melanoma is a challenge.

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Information for Readers

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September iotaderma (#295)

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Journal Based CME Instructions and Information

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Camp Discovery: Changing lives for 25 years

The first session of Camp Discovery was held in Minnesota in 1993. Then and each year since, children age 8 to 16 years with "significant skin diseases" have attended the American Academy of Dermatology's (AAD's) Camp Discovery program free of charge (Figs 1 and 2). Each camper has been nominated by an AAD member dermatologist. Counselors with skin disease serve as role models and sympathetic supporters. Details of the Camp Discovery program, its founding, and its early evolution were reviewed in 2 previous publications in the Journal of the American Academy of Dermatology.

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Stigmatizing Attitudes Toward Persons with Psoriasis Among Laypersons and Medical Students

Perceived stigma among patients with psoriasis contributes to poor health. Stigmatizing attitudes toward persons with psoriasis are prevalent among laypersons. Medical students and people who have heard of/know someone with psoriasis report less stigmatizing attitudes. Educational campaigns for the public and medical trainees may reduce stigma toward patients with psoriasis.

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The Clinical Spectrum of Cutaneous Melanoma Morphology

Melanoma can mimic many cutaneous lesions, impairing correct diagnosis. By clustering of diagnostic assignments, five common melanoma morphological groupings were identified: typical, nevus-like, amelanotic/NMSC-like, SK-like, and lentigo/lentigo maligna-like. Awareness of the diversity of melanoma appearances and their associated clinical factors may help dermatologists improve their diagnostic accuracy.

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The Extended Purse-String Rhytidectomy

Facial plast Surg
DOI: 10.1055/s-0038-1672176

Facelifts remain a critical part of a facial plastic surgeon's cosmetic practice. Techniques continue to evolve, while at the same time patients demand less invasive procedures with less morbidity. The authors present a facelift plication technique using wide purse-string sutures placed into the superficial musculoaponeurotic system and platysma. This is a retrospective review with a level of evidence 3 set at a medical spa and tertiary referral center designed to assess a purse-string suture technique using an inner followed by an outer purse-string, with refinements being made during the timeframe of the review. One hundred and eighteen patients were reviewed and 95 were included in the study given the inclusion criteria of a minimum of 1-year follow-up. Based on the subjective judgment of the primary surgeon, 37 patients were found to have excellent results, while 43 patients were judged as having good results. The judgment was based on the physical exam improvement of the aging aspects of the patient, and patient satisfaction. Ten patients displayed fair results (the patients were marginally happy), and five patients were noted to have poor results (they were notably unhappy). Complications included eight hematomas, five patients with prominent scars, and one patient with skin loss in the temple region. There were no cases of facial nerve injury. The extended purse-string rhytidectomy is a good alternative to traditional facelift techniques. This offers a plication method that results in the vertical vector that is now considered of paramount importance with all facelifts. The authors feel that it is a valuable tool that can be considered in most patients presenting for aging face surgery.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

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A 2-Year Follow-up Study of an Absorbable Implant to Treat Nasal Valve Collapse

Facial plast Surg
DOI: 10.1055/s-0038-1672213

The safety and effectiveness of an absorbable implant for lateral cartilage support have been recently demonstrated in subjects with nasal valve collapse (NVC) at 12 months postprocedure. This follow-up study aimed to assess whether the safety and effectiveness of the implant persist in these patients for 24 months after the procedure. Thirty subjects with Nasal Obstruction Symptom Evaluation (NOSE) score ≥ 55 and isolated NVC were treated; 14 cases were performed in an operating suite under general anesthesia and 16 cases were performed in a clinic-based setting under local anesthesia. The implant, a polylactic acid copolymer, was placed with a delivery tool within the nasal wall to provide lateral cartilage support. Subjects were followed up through 24 months postprocedure. Fifty-six implants were placed in 30 subjects. The mean preoperative NOSE score was 76.7 ± 14.8, with a range of 55 to 100. At 24 months, the mean score was 32.0 ± 29.3, reflecting an average within-patient reduction of −44.0 ± 31.1 points. There were no device-related adverse events in the 12 to 24 months period. There were five subjects who exited the study prior to the 24-month follow-up. Four of the five subjects who exited were elected for further intervention and one subject was lost to follow-up. This study demonstrates safety of an absorbable implant for lateral nasal wall support and symptom improvement in some subjects with NVC at 24 months postprocedure.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

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A Bayesian modeling approach for phosphorus load apportionment in a reservoir with high water transfer disturbance

Abstract

Phosphorus loading from external and internal sources poses a potential risk to eutrophication of lakes or reservoirs. However, the relative contribution of external and internal sources to eutrophication is still unclear especially for reservoirs with water transfer disturbance. The objective of this paper is to estimate the phosphorus loading from external (water transfer and diffusing emission) and internal sources (sediment release) in Yuqiao Reservoir (YQR) and compare their relative contribution of external and internal sources. In this study, we estimated the phosphorus loading considering both external (water transfer and diffusing source emission) and internal (release from sediment) sources of YQR. The phosphorus loading from water transfer was estimated by total phosphorus (TP) concentration × monthly flow of inflow. The phosphorus loading from nonpoint source emission was estimated using a generalized watershed loading function (GWLF). The phosphorus loading from internal sources was estimated with a Bayesian phosphorus budget model. Our result showed that water transfer TP load is the biggest (45.2%) source of TP load in YQR and internal TP load (20.5%) accounts for a comparable proportion of TP load as nonpoint source (34.3%) in YQR and dominates the total loading in some months. Analysis of seasonal total phosphorus load apportionment indicated that water transfer TP load takes the largest proportion in winter (60.8%), spring (60.2%), and autumn (47.8%). Nonpoint source TP load takes the largest proportion in summer (60.1%), and internal TP load is the second source of YQR in summer (22.4%). Our study indicates that water transfer may be the major driver of eutrophication for some reservoir systems, and sediment release may prevent recovery of many eutrophic lakes and reservoirs. Our analysis suggests that TP pollution control strategies in YQR should be preferentially focused on the improvement of water quality in the upstream reservoir, and nonpoint source TP load reductions should be focused on summer. Compared with conventional nutrient apportionment model applications, this paper provides a new approach to estimate external and internal TP loads simultaneously.

Graphical abstract

ᅟ

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Drosophila melanogaster as model organism for monitoring and analyzing genotoxicity associated with city air pollution

Abstract

This study evaluated the genotoxic potential of atmospheric pollution associated with urbanization using the model organism Drosophila melanogaster and the Comet assay with hemolymph cells. Larvae were exposed to atmospheric compounds in an urban and a rural area in the municipality of Vitória de Santo Antão, Pernambuco, Brazil, for 6 days (from the embryo stage to the third larval stage) in April 2015 and April 2017. The results were compared to a negative environmental control group exposed to a preserved area (Catimbau National Park) and to a negative control exposed to the laboratory room conditions. The Comet assay demonstrated significant genetic damage in the organisms exposed to the urban area compared with those exposed to the rural area and negative control groups. The evidences were supported by particulate matter analysis showing higher photopeaks of chemical elements such as aluminum, silicon, sulfur, potassium, calcium, titanium, and iron, associated to road dust fraction in urban environment. Once again, the results confirm D. melanogaster an ideal bioindicator organism to monitor genotoxic hazard associated with atmospheric pollution.

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Seasonality of month of birth in children and adolescents with autoimmune thyroiditis: a continuing conundrum

Journal Name: Journal of Pediatric Endocrinology and Metabolism
Issue: Ahead of print


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A case of Graves’ disease associated with membranoproliferative glomerulonephritis and leukocytoclastic vasculitis

Journal Name: Journal of Pediatric Endocrinology and Metabolism
Issue: Ahead of print


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Adipocyte aquaporin 7 (AQP7) expression in lean children and children with obesity. Possible involvement in molecular mechanisms of childhood obesity

Journal Name: Journal of Pediatric Endocrinology and Metabolism
Issue: Ahead of print


https://ift.tt/2PHV80O

In vitro assessment of the toxicity of small silver nanoparticles and silver ions to the red blood cells

Abstract

This work reports the toxicity of small silver nanoparticles (nanoAg, 20 nm) and silver ions (Ag⁺) to the red blood cells with the silver concentration level of 10⁻⁶ g/mL. Results show that red blood cells (RBCs) start hemolysis when treated by nanoAg of 1.5 × 10⁻⁵ g/mL or Ag⁺ of 2.9 × 10⁻⁷ g/mL. A low ATPase activity of 30% has been observed after RBCs being treated with Ag⁺ of 2.6 × 10⁻⁷ g/mL, while the nanoAg does not obviously affect the ATPase activity. In molecular level, Ag⁺ is more toxic to the amino acid residues than nanoAg according to the change of fluorescence characteristics of hemoglobin (Hb). However, the nanoAg has been found to be more toxic than Ag⁺ to the secondary structure of Hb in terms of the loss of α-helix content.

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Long-term postoperative control of eosinophilic chronic rhinosinusitis recurrence by inserting a steroid-eluting, sinus-bioabsorbable device reduces the dosage of oral steroid

We employed a steroid-eluting, sinus-bioabsorbable device for local treatment after surgery for eosinophilic chronic rhinosinusitis (ECRS). One year later, we investigated its efficacy in suppressing recurrence and reducing the use of oral steroids.

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Screening indices for cadmium-contaminated soil using earthworm as bioindicator

Abstract

Artificial soil simulation tests were conducted to study the response of oxidative stress in different parts of Eisenia fetida under cadmium Cd) stress. Factor analysis and analytic hierarchy process were used to establish a comprehensive mathematical model to screen key monitoring indices of the Cd-contaminated soil early warning system. This paper sets the short-term group and the long-term group. The former lasted 10 days, and the latter was 30 days. Gradient solution of 0, 50, 100, 125, 250, and 500 mg kg⁻¹ Cd²⁺ was used in each test group. The earthworm was cut into two parts from its clitellum to determine oxidative stress indices. Results showed that during the short-term stress, TP (total protein) in the head tissues of the earthworm was the key monitoring index for 3–4 and 8–9 days of Cd stress. In addition, the TP in tail tissues was the key index for 2, 4, 6, and 8–10 days of stress. On the first and second days, the key monitoring indices in the tail tissues were both the CAT (catalase), while in the head, they were CAT and TP, respectively. On the 5th, the 7th, and the 9th days, the focus should be on monitoring POD (peroxidase) in the tail tissues, while in the head tissues, they were POD, CAT, and TP, respectively. In the long-term test after 10 days of Cd stress, the key monitoring index in head tissues was GPX (glutathione peroxidase), and in the tail, it was TP. At 20–30 days, the key monitoring indices were TP in the head and MDA (malondialdehyde) in the tail.

https://ift.tt/2NYHqtm

Chemical characteristics, source apportionment, and regional transport of marine fine particles toward offshore islands near the coastline of northwestern Taiwan Strait

Abstract

This study aims to investigate the spatiotemporal variation, chemical composition, and source apportionment of marine fine particles (PM_2.5) as well as their regional transport toward the Matsu Islands located near the coastline of northwestern Taiwan Strait. Four offshore island sites located at the Matsu Islands were selected to conduct both regular and intensive sampling of marine PM_2.5. Water-soluble ionic species, metallic elements, and carbonaceous contents were then analyzed to characterize the chemical characteristics of marine PM_2.5. In order to identify the potential sources and their contributions to marine PM_2.5, chemical mass balance (CMB) receptor model was employed along with the backward trajectory simulation to resolve the source apportionment of marine PM_2.5 and to explore their transport routes in different seasons. The results showed that high PM_2.5 concentrations were commonly observed during the northeastern monsoon periods. Additionally, marine PM_2.5 concentration decreased from the west to the east with the highest PM_2.5 at the Nankang Island and the lowest PM_2.5 at the Donyin Island in all seasons, indicating an obvious concentration gradient of PM_2.5 transported from the continental areas to the offshore islands. In terms of chemical characteristics of PM_2.5, the most abundant water-soluble ions of PM_2.5 were secondary inorganic aerosols (SO₄²⁻, NO₃⁻, and NH₄⁺) which accounted for 55–81% of water-soluble ions and 29–52% of marine PM_2.5. The neutralization ratios of PM_2.5 were always less than unity, indicating that NH₄⁺ cannot solely neutralize nss-SO₄²⁺ and NO₃⁻ in marine PM_2.5 at the Matsu Islands. Although crustal elements (Al, Ca, Fe, K, and Mg) dominated the metallic content of marine PM_2.5, trace anthropogenic metals (Cd, As, Ni, and Cr) increased significantly during the northeastern monsoon periods, particularly in winter. Organic carbons (OCs) were always higher than elemental carbons (ECs), and the mass ratios of OC and EC were generally higher than 2.2 in all seasons, implying that PM_2.5 was likely to be aged particles. During the poor air quality periods, major air mass transport routes were the northern transport and the anti-cyclonic circulation routes. Source apportionment results indicated that fugitive soil dusts and secondary aerosols were the major sources of marine PM_2.5 at the Matsu Islands, while, in winter, biomass burning contributed up to 15% of marine PM_2.5. This study revealed that cross-boundary transport accounted for 66~84% of PM_2.5 at the Matsu Islands, suggesting that marine PM_2.5 at the Matsu Islands has been highly influenced by anthropogenic emissions from neighboring Fuzhou City as well as long-range transport from Northeast Asia.

https://ift.tt/2OC4meQ

Unsubstituted metallophthalocyanine catalysts for the removal of endocrine disrupting compounds using H 2 O 2 as oxidant

Abstract

Advanced oxidation processes have become increasingly important to treat non-biodegradable compounds entering environmental waters. In recent decades, water-soluble metallophthalocyanines have been shown to catalyse H₂O₂-containing oxidation reactions through the production of unique reactive species, nucleophilic metal-peroxo complexes. Few reports in the literature have examined water insoluble metallophthalocyanines (MPc). The oxidative catalytic activity of water insoluble manganese- and iron-phthalocyanine (MnPc, FePc) at pH 7 has been shown through the decolourisation of methylene blue and removal of bisphenol A. These studies expand on this previous study, exploring the catalytic activity of a range of metallophthalocyanines catalysts under both acidic and neutral conditions. FePc, while only active under neutral conditions, was the best performing catalyst. This activity was significantly improved upon by the addition of acetonitrile as a co-solvent, as well as increasing the ratio of H₂O₂ to catalyst. MnPc was catalytically active at both pH 3 and 7. FePc and MnPc catalysts showed the ability to remove bisphenol A in the presence of dam water. Reaction rates were reduced for bisphenol A removal with FePc as a catalyst but were unchanged in the presence of MnPc. The removal of 17β-estradiol, estrone, and coumestrol was successfully demonstrated, with greater than 96% removal of all tested EDC's achieved. This is the first reported study showing the removal of the phytoestrogen, coumestrol. Even though considerably lower concentrations of costly catalysts and oxidation reagents were used in our work, the removal extent of EDC's by the MPc-catalysed oxidation reactions achieved here compares favourably with literature.

https://ift.tt/2NYHlG4

Predictors of Sentinel Lymph Node Positivity in Thin Melanoma Using the National Cancer Database

Presence of dermal mitoses and invasion to Clark level IV-V are important factors in predicting SLN positivity, even when accounting for ulceration and Breslow thickness. Continued evaluation of possible predictors of SLN positivity is necessary to establish clear guidelines when to proceed with SLNB in thin melanoma.

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Barriers to Compounding in Physician Offices: The Future is Now!

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Drug-induced hypersensitivity syndrome (DiHS)/drug reaction with eosinophilia and systemic symptoms (DRESS) severity score: A useful tool for assessing disease severity and predicting fatal cytomegalovirus disease

The clinical course of drug-induced hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms is unpredictable. We developed a scoring system to predict development of cytomegalovirus disease and complications. Using this scoring system, cytomegalovirus disease and complications could be preventable by prompt treatment with anti- cytomegalovirus agents.

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Prevention of Thermal Burns from Magnetic Resonance Imaging in Patients with Tattoos

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Mineral sunscreens not recommended by Consumer Reports: What lies beneath the surface?

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Reply

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Sirolimus for the treatment of “verrucous” venous malformation: are we missing the lymphatic malformation component?

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Global Epidemiology and Clinical Spectrum of Rosacea, Highlighting Skin of Color: Review and Clinical Practice Experience

Rosacea is infrequently reported among nonwhite populations worldwide, but difficulty detecting its characteristics in darker skin may lead to underdiagnosis. This paper provides strategies for recognizing and treating rosacea in skin of color. This information may help reduce disparities in managing rosacea across diverse populations with the disease.

https://ift.tt/2xxz8ht

Cutaneous angioimmunoblastic T-cell lymphoma: Epstein–Barr Virus positivity and its effects on clinicopathological features

1. Epstein–Barr virus in situ hybridization is positive in 19 of 42 (45.2%) patients with cutaneous angioimmunoblastic T-cell lymphoma. 2. Epstein–Barr virus-positive cutaneous angioimmunoblastic T-cell lymphoma is associated with distinctive clinicopathological features but shows no significant differences in survivals compared to Epstein–Barr virus-negative cutaneous angioimmunoblastic T-cell lymphoma.

https://ift.tt/2QDK7Pk

Resident and Fellow Engagement in Safety and Quality

Beyond educational and institutional requirements, there is a need for trainees (residents and fellows) to learn patient safety and quality improvement skills in order to achieve the ultimate goal of providing better patient care. Key steps to engagement include creating a safety and quality culture, supporting faculty development, and selecting appropriate curricular resources. Efforts to align the goals and processes of the graduate medical education institution and teaching hospital can foster a unified mission. Faculty must be prepared to teach and reinforce these topics on a regular basis. Both didactic instruction and experiential learning are necessary components for trainee education.

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Preventing and Managing Operating Room Fires in Otolaryngology—Head and Neck Surgery

Otolaryngologists are at high risk of surgical fire. During surgery in the head and neck region there is close proximity of 3 essential elements: an ignition source, a fuel, and an oxidizing agent. In this article, the authors highlight the scenarios where fire may occur and offer steps that surgeons can take to minimize risk for their patients. By understanding the elements of the fire triad, otolaryngologists can decrease the risk of surgical fire, through careful control of oxidizers, ignition sources, and potential fuels in the operating room.

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Evaluation and Management of Facial Nerve Schwannoma

Facial nerve schwannomas are benign peripheral nerve sheath tumors that arise from Schwann cells, and most commonly present with facial paresis and/or hearing loss. Computed tomography and MRI are critical to diagnosis. Management decisions are based on tumor size, facial function, and hearing status. Observation is usually the best option in patients with good facial function. For patients with poor facial function, the authors favor surgical resection with facial reanimation. There is growing evidence to support radiation treatment in patients with progressively worsening moderate facial paresis and growing tumors.

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Research Analysis: Key takeaways from PART and Airways-2 Trials

Comparing endotracheal, laryngeal tube and supraglottic airway device intubation during out of hospital cardiac arrest

https://ift.tt/2DaxU22

Assessment of heavy metal in coal gangue: distribution, leaching characteristic and potential ecological risk

Abstract

In the process of excavation and utilization of the coal gangue hill, gangue at different weathering degree was exposed to the environment, which can be harmful to the surroundings. In order to find the law of heavy metal release and to evaluate the potential ecological risk, five kinds of coal gangue at different weathering degrees were collected from a coal mine named Suncun, an over 100-year-old mine of Xinwen coal mining field located in Tai'an city, Shandong Province of China. Samples were processed with microwave digestion for total content determination of heavy metals, and another part of samples was processed by Tessier sequential extraction for chemical forms analysis. Leaching tests at various pH were carried out to investigate the release of heavy metal. The laws of transformation and release of heavy metals were discussed and potential ecological risk was evaluated. The results indicated that the weathering degree had a significant impact on the content of heavy metal. Exchangeable and carbonate fractions of Cr and Pb were a large proportion of the total and should attract great attention. Potential ecological risk was at strong level (light black) and was up to very strong level (deep black) because of Cd. But Cr had contributed the most for gray gangue, which was 71% of the total. The species of heavy metal in gangue changed due to weathering and lead to the difference of the leaching characteristic and risk.

https://ift.tt/2QCG06h

Modulation of Associative Learning in the Hippocampal-Striatal Circuit Based on Item-Set Similarity

Publication date: Available online 18 September 2018

Source: Cortex

Author(s): Shauna M. Stark, Amy Frithsen, Aaron T. Mattfeld, Craig E.L. Stark

Abstract

Mounting evidence suggests that the medial temporal lobe (MTL) and striatal learning systems support different forms of learning, which can be competitive or cooperative depending on task demands. We have previously shown how activity in these regions can be modulated in a conditional visuomotor associative learning task based on the consistency of response mappings or reward feedback (Mattfeld & Stark, 2015). Here, we examined the shift in learning towards the MTL and away from the striatum by placing strong demands on pattern separation, a process of orthogonalizing similar inputs into distinct representations. Mnemonically, pattern separation processes have been shown to rely heavily on processing in the hippocampus. Therefore, we predicted modulation of hippocampal activity by pattern separation demands, but no such modulation of striatal activity. Using a variant of the conditional visuomotor associative learning task that we have used previously, we presented participants with two blocked conditions: items with high and low perceptual overlap during functional magnetic resonance imaging (fMRI). As predicted, we observed learning-related activity in the hippocampus, which was greater in the high than the low overlap condition, particularly in the dentate gyrus. In contrast, the associative striatum also showed learning related activity, but it was not modulated by overlap condition. Using functional connectivity analyses, we showed that the correlation between the hippocampus and dentate gyrus with the associative striatum was differentially modulated by high vs. low overlap, suggesting that the coordination between these regions was affected when pattern separation demands were high. These findings contribute to a growing literature that suggests that the hippocampus and striatal network both contribute to the learning of arbitrary associations that are computationally distinct and can be altered by task demands.

https://ift.tt/2xtK4wI

Utilization of high FFA landfill waste (leachates) as a feedstock for sustainable biodiesel production: its characterization and engine performance evaluation

Abstract

In present study, biodiesel was produced from landfill waste-derived oil by chemical transesterification process, to evaluate its potential as a renewable energy source for the first time. The free fatty acid percentage (FFA) in landfill waste oil is considered to be high, which was reduced by treating it with two different acids as catalyst, muriatic acid and phosphoric acid, in order to build a comparison between fatty acid methyl ester (FAME) contents. Further, it was treated with a base catalyst potassium hydroxide (KOH) to produce the final product. The FAME value of landfill oil when treated with muriatic acid was found to be 92.59%. The quality of biodiesel produced was analyzed by gas chromatography (GC), which indicated above 25.7% of conversion of oil into biodiesel when muriatic acid was used as a catalyst. The properties of the produced biodiesel were found to be in good agreement with ASTM D 6751 and EN 14214 standards. Various test fuels were prepared for the engine test by blending 10%, 20%, and 100% of landfill waste biodiesel in diesel on volumetric basis and designated as B10, B20, and B100, respectively. The brake thermal efficiency (BTE) of the engine was more while the exhaust emission was less except NOx with biodiesel and its blend (B10 and B20). Thus, landfill waste is a potential source of biodiesel, and blends of landfill waste up to 20% can be used for realizing better performance from the engine.

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ESSFN Mission

Stereotact Funct Neurosurg 2018;96:279–280

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ASSFN Society News

Stereotact Funct Neurosurg 2018;96:278–278

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WSSFN Society News

Stereotact Funct Neurosurg 2018;96:277–277

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Leserbrief zu Steger et al. Methadon gegen Krebs

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Increased ischemic stroke, acute coronary artery disease and mortality in patients with granulomatosis with polyangiitis and microscopic polyangiitis

Publication date: Available online 17 September 2018

Source: Journal of Autoimmunity

Author(s): M. Mourguet, D. Chauveau, S. Faguer, J.B. Ruidavets, Y. Béjot, D. Ribes, A. Huart, L. Alric, L. Balardy, L. Astudillo, D. Adoue, L. Sailler, G. Pugnet

Abstract

Objective

The aim of our study was to assess major cardiovascular event incidence, predictors, and mortality in ANCA-associated vasculitis (AAV).

Methods

We conducted a retrospective cohort study of all GPA or MPA, according to Chapel Hill Consensus Conference classification criteria, diagnosed between 1981 and 2015. Major cardiovascular event was defined as acute coronary artery disease, or ischemic stroke, or peripheral vascular disease requiring a revascularization procedure. We calculated the comparative morbidity/mortality figure (CMF) and we used Cox proportional hazards regression models to assess the risk of coronary artery disease, ischemic stroke associated with AAV, after adjusting for covariates.

Results

125 patients, 99 GPA (79,2%) and 26 MPA (20,8%), were followed 88.4 ± 78.3 months. Ischemic stroke incidence was four times higher than in the general population (CMF 4,65; 95% CI 4,06-5,31). Coronary artery disease incidence was four times higher than in the general population (CMF 4,22; 95% CI 1,52-11,68). Smoking habits and history of coronary artery disease were strongly associated with coronary artery disease occurrence (adjusted HR 8.8; 95% CI 2.12–36.56, and adjusted HR 10.3; 95% CI 1.02–104.5, respectively). ENT flare-up was an independent protective factor for coronary artery disease occurrence. We did not identify factors significantly associated with stroke occurrence. The age-adjusted mortality rate was 22.5 per 1000 person-years. Mortality in AAV was 1.5 times higher than in the general population (CMF 1.56; 95% CI 1.34–1.83).

Conclusion

AAV have a significantly increased risk of mortality, ischemic stroke, and coronary artery disease.

https://ift.tt/2NQGTJI

Use of 99m Tc-sestamibi SPECT/CT when conventional imaging studies are negative for localizing suspected recurrence in differentiated thyroid cancer: a method and a lesson for clinical management

Abstract

Purpose

The detection of recurrent disease in differentiated thyroid cancer (DTC) patients with elevated or rising serum thyroglobulin (Tg) levels and multiple negative conventional imaging studies can be challenging, especially when ¹⁸F-FDG PET/CT scan is also negative. We report a patient and review the literature on the diagnostic use of ^99mTc-sestamibi scans to identify the source of elevated or rising Tg in patients with negative conventional imaging including negative ¹⁸F-FDG PET/CT scans.

Patient and methods

A 73-year-old woman was referred for widely-invasive metastatic follicular thyroid cancer with bone metastasis to her left mandible. She had a total thyroidectomy, left mandibular resection, and ¹³¹I therapy of 145 mCi (5.4 GBq) and her subsequent unstimulated serum Tg level was 29 ng/ml (TgAb negative). At six months' follow-up, her stimulated Tg was 527 ng/ml (TSH 188 mIU/L, TgAb negative). All imaging studies performed within the prior 12 months were reported as negative for recurrence or metastasis; this included neck ultrasound, diagnostic radioiodine scan, chest CT and, ¹⁸F-FDG PET/CT. The patient was injected with 24.6 mCi (910 MBq) of ^99mTc-sestamibi intravenously, and whole-body and SPECT/CT images were acquired.

Results

The ^99mTc-sestamibi whole-body posterior image demonstrated abnormal focal uptake in the right posterior calvarium and corresponded to an occipital lytic bone lesion on the SPECT/CT. The patient underwent surgical resection of the skull metastasis, and pathology confirmed metastatic follicular thyroid cancer. Five months post-surgery, the suppressed Tg was markedly reduced and remained stable at ~3.2 ng/ml. With the knowledge of the DTC recurrence location, the two sets of ¹⁸F-FDG images were re-evaluated. The more thorough and targeted interpretation underscored the importance of structured image reporting. The current literature on the utility of ^99mTc-sestamibi scans when radioiodine, ¹⁸F-FDG PET/CT, and other imaging studies are negative is sparse and inconsistent.

Conclusions

^99mTc-sestamibi may have a role in thyroid cancer localization when physical exam, neck ultrasound, radioiodine scan, chest/abdomen CT, and ¹⁸F-FDG PET/CT does not identify the source of elevated Tg levels in DTC.

https://ift.tt/2Nnr5yw

Evaluation of melatonin and AFMK levels in women with breast cancer

Abstract

Purpose

Changes in the circadian rhythm may contribute to the development of cancer and are correlated with the high risk of breast cancer (BC) in night workers. Melatonin is a hormone synthesized by the pineal gland at night in the absence of light. Levels of melatonin and the metabolite of oxidative metabolism AFMK (acetyl-N-formyl-5-methoxykynurenamine), are suggested as potential biomarkers of BC risk. The aims of this study were to evaluate levels of melatonin and AFMK in women recently diagnosed with BC, women under adjuvant chemotherapy, and night-shift nurses, and compare them with healthy women to evaluate the relation of these compounds with BC risk.

Methods

Blood samples were collected from 47 women with BC, 9 healthy women, 10 healthy night shift nurses, and 6 patients under adjuvant chemotherapy. Compound levels were measured by mass spectrometry.

Results and conclusions

Our results showed that women with BC had lower levels of melatonin compared to control group women, and even lower in night-shift nurses and in patients under adjuvant chemotherapy. There was no significant difference of AFMK levels between the groups. In addition to this, high levels of melatonin and AFMK were related to patients with metastasis, and high levels of AFMK were related to the presence of lymph node-positive, tumor > 20 mm and patients who sleep with light at night. Our results showed a reduction of melatonin levels in BC patients, suggesting a relation with the disease, and in addition, point to the importance of melatonin supplementation in women that work at night to reduce the BC risk.

https://ift.tt/2D6xvNN

Clinical outcomes of childhood craniopharyngioma: can we do better?

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Primary hyperparathyroidism: findings from the retrospective evaluation of cases over a 6-year period from a regional UK centre

Abstract

Background

Although there are international guidelines on diagnosis and management of primary hyperparathyroidism (PHPT), clinical practice varies in different centres. Periodic review of diagnostic work-up, surgical treatment by parathyroidectomy (PTX) and clinical surveillance in nonsurgical treatment group among patients with PHPT is expected to improve the quality of care. We report a retrospective study of cases with PHPT managed at a regional centre in the United Kingdom.

Methods

Clinical data of cases with calcium ≥2.6 mmol/L and parathyroid hormone (PTH) ≥9.0 pmol/L was procured from biochemistry database from January 2011 to December 2016. Laboratory parameters, imaging studies for renal stones, osteoporosis and localisation of parathyroid adenomas, type of treatment received (PTX or nonsurgical), complications of treatment, other medical co-morbidities and mortality during follow-up was recorded in each case to examine the outcomes of care of patients with PHPT.

Results

The study included 160 patients: 127 (79%) females and 33 (21%) males. Median age was 70 years in females and 74 in males. Thirty cases (19% of 159) had renal stones and 47 (37.3% of 126) had osteoporosis. Eighty-one cases (51%) received PTX. Logistic regression analysis showed that higher calcium levels (odds ratio (OR) = 73.991; p < 0.001), peak PTH (OR = 1.023; p = 0.025), peak alkaline phosphatase (OR = 0.985, p < 0.001), lower age (OR = 0.985, p < 0.001) and male gender (OR = 0.209, p < 0.002) as statistically significant predictors for patients receiving PTX. Higher age at diagnosis of PHPT was associated with increased risk of co-existent hypertension (OR = 10.904, p = 0.001) and fractures (OR = 1.067, p = 0.004). Higher peak calcium concentration was an independent predictor of acute kidney injury (OR = 9.631, p = 0.011). PTX cured 76 cases (94%) with only 7 (9%) postoperative complications. Twenty-four cases (15%) died from the entire cohort (only one from PTX group) during a median follow-up period of 3.6 years (interquartile range = 1.5).

Conclusions

PTX treatment is associated with cure of disease in patients with PHPT with acceptable risk of complications. Improvements in diagnostic work-up and follow-up care should improve the morbidity from PHPT.

https://ift.tt/2D98bH1

Putative endothelial progenitor cells predict long-term mortality in type-2 diabetes

https://ift.tt/2Nmo55O

Ghrelin knockout mice display defective skeletal muscle regeneration and impaired satellite cell self-renewal

Abstract

Purpose

Muscle regeneration depends on satellite cells (SCs), quiescent precursors that, in consequence of injury or pathological states such as muscular dystrophies, activate, proliferate, and differentiate to repair the damaged tissue. A subset of SCs undergoes self-renewal, thus preserving the SC pool and its regenerative potential. The peptides produced by the ghrelin gene, i.e., acylated ghrelin (AG), unacylated ghrelin (UnAG), and obestatin (Ob), affect skeletal muscle biology in several ways, not always with overlapping effects. In particular, UnAG and Ob promote SC self-renewal and myoblast differentiation, thus fostering muscle regeneration.

Methods

To delineate the endogenous contribution of preproghrelin in muscle regeneration, we evaluated the repair process in Ghrl^−/− mice upon CTX-induced injury.

Results

Although muscles from Ghrl^−/− mice do not visibly differ from WT muscles in term of weight, structure, and SCs content, muscle regeneration after CTX-induced injury is impaired in Ghrl^−/− mice, indicating that ghrelin-derived peptides actively participate in muscle repair. Remarkably, the lack of ghrelin gene impacts SC self-renewal during regeneration.

Conclusions

Although we cannot discern the specific Ghrl-derived peptide responsible for such activities, these data indicate that Ghrl contributes to a proper muscle regeneration.

https://ift.tt/2D981zp

Low trabecular bone score in postmenopausal women with differentiated thyroid carcinoma after long-term TSH suppressive therapy

Abstract

The effect of thyroid suppression therapy (TST) on trabecular bone scores (TBS) and bone mineral density (BMD) in thyroidectomized women with differentiated thyroid carcinoma (DTC) on long-term follow-up is presently not conclusive. Patients and Methods. We carried out a study in 61 premenopausal and 84 postmenopausal Caucasian women with DTC. Serum biochemistry, bone markers, TBS, BMD, and bone fractures were evaluated 1–3 months post surgery and after a median follow-up of 10 years. Results. In the final study, patients belonged to Group I Premenopausal (n = 14) who remained in this status; Group II Premenopausal who became postmenopausal (n = 47); Group III patients who were and continued as postmenopausal (n = 84). Baseline premenopausal patients had a normal TBS mean value of 1.39 ± 0.14 significantly higher than that found in postmenopausal 1.31 ± 0.12 (p = 001). In the final study, premenopausal patients continued to have a normal TBS of 1.46 ± 0.08 compared to the significantly lower value of postmenopausal patients 1.25 ± 0.11 (p = 0.0009). Lumbar BMD (L-BMD) loss after the long-term study was significant in Group II (0.99 g/cm² ± 0.13 vs. 0.91 ± 0.12 g/cm², p < 0.0001) and there was a slight, but not significant, bone loss in Group I (1.00 ± 0.12 vs. 0.98 ± 0.11, p = 0.1936) and in Group III (0.86 ± 0.12 vs. 0.84 ± 0.15, p = 0.1924) compared with baseline values. Conclusion: Longer-term suppression therapy in female patients with DTC did not increase significantly the risk of bone loss, although we found in postmenopausal patients deterioration of bone microarchitecture. TBS study should be considered in the evaluation of postmenopausal DTC patients on long-term DTC for the evaluation of the risk of fractures.

https://ift.tt/2NmoAgc

Statins as potential agents for the prevention and treatment of osteoporosis

https://ift.tt/2D8NU4w

Risk factors for central neck lymph node metastases in follicular variant vs. classic papillary thyroid carcinoma

Abstract

Purpose

Histological variants of papillary thyroid carcinoma (PTC) have been advocated as possible risk factors for central neck nodal metastases (CNM). A lower incidence of CNM in follicular variant of papillary thyroid carcinoma (fvPTC) when compared with classic PTC (cPTC) has been observed. We aimed to compare risk factors for CNM in patients with fvPTC and cPTC.

Methods

The medical records of 1737 patients with a diagnosis of cPTC or fvPTC were reviewed. Demographic, clinical and pathological findings were prospectively registered. Risk factors for CNM were evaluated by univariate and multivariate analysis in cPTC vs. fvPTC patients.

Results

Six hundred and fifty-two patients (37.5%) had fvPTC. The diagnosis was incidental in 69.5% of the fvPTC and in 29.4% of the cPTC patients. Overall, 26.3% cPTC and 8.3% fvPTC patients showed CNM (p < 0.001). In both cPTC and fvPTC patients at univariate analysis age <45 years, nonincidental diagnosis, tumor size >5 mm, multifocality, angioinvasion and extracapsular invasion were risk factors for CNM. At multivariate analysis independent risk factors for CNM in both cPTC and fvPTC patients were age <45 years (p < 0.01), nonincidental diagnosis (p < 0.001), multifocality (p < 0.001) and extracapsular invasion (p < 0.001).

Conclusions

No differences were observed between cPTC and fvPTC with regard to risk factors of CNM. fvPTC seems associated with a lower incidence of CNM, presumably because of the higher rate of incidental diagnosis. With the exception of age, in patients with a preoperative diagnosis of PTC, no preoperatively available clinical parameter is a reliable predictor of CNM.

https://ift.tt/2Nos9Ci

Long-term follow-up of female prolactinoma patients at child-bearing age after transsphenoidal surgery

Abstract

Context:

Prolactinoma is the most common subtype of functional pituitary adenoma. Effective therapy is required for women of child-bearing age to achieve remission at serum prolactin level and regain reproductive function.

Purpose

To evaluate long-term outcomes, including menstrual recovery, after transsphenoidal surgery on female prolactinoma patients by experienced neurosurgeons.

Design

Observational study.

Patients

Consecutive female prolactinoma patients aged from 16 to 45 years were included. Histological analysis after surgery revealed adenoma with positive staining for prolactin. Plurihormonal cell adenomas were excluded.

Main measurements

Clinical manifestations, surgical indications, serum prolactin level before and after surgery, surgical complications, pituitary fuctions, drug maintenance, the status of menstruation, and pregnancy.

Results

Sixty-three consecutive female patients with a mean age of 29.5 ± 1.1 years were included. Based on magnetic resonance imaging findings before surgery, 31 (49.2%) patients had microadenoma, and the remaining 32 (50.8%) had macroadenoma. The median follow-up after transsphenoidal surgery was 53 (33–74) months, and long-term surgical remission was achieved in 50 (79.37%) patients with 28 (90.32%) microadenomas and 22 (68.75%) macroadenomas. No meningitis or persistent cerebrospinal fluid leaks occurred. Only one case suffered from persistent diabetes insipidus at follow-up. No severe pituitary dysfunction was observed in microprolactinoma patients. Of patients with menstrual disorders, 85% regained regular menstrual cycles after surgery. Nineteen patients in this cohort desired pregnancy and 15 of them successfully gave birth after surgery. All 17 microadenoma patients with modern surgical indications achieved normal prolactin levels and regular menstrual cycles with only one patient on drug therapy at follow-up.

Conclusion

Long-term follow-up showed a high remission rate in female prolactinoma patients, especially in microadenoma patients, after surgery. Transsphenoidal surgery performed by experienced neurosurgeons may offer a valuable approach to treat female microprolactinoma patients of child-bearing age with modern indications for surgery.

https://ift.tt/2D97H3F

Correction to: Multiple endocrine neoplasia type 1: analysis of germline MEN1 mutations in the Italian multicenter MEN1 patient database

The original version of this article unfortunately contained a mistake in Table 2. The table 2 was truncated in the original publication. The full table 2 is given below.

https://ift.tt/2NlAYwQ

Great veins invasion in follicular thyroid cancer: single-centre study assessing prevalence and clinical outcome

Abstract

Purpose

Great veins invasion is considered as a rare and prognostically unfavourable event in thyroid cancer. However, current knowledge about this issue is mainly based on single case reports. Follicular thyroid cancer (FTC) represents the histotype with the most pronounced angioinvasive feature. This study is aimed at assessing the actual prevalence of great veins invasion in FTC and providing information about prognosis and the proper clinical management of these patients.

Methods

Clinico-pathological and radiological data of patients with thyroid cancer undergoing thyroidectomy in our institution were retrospectively retrieved. Inclusion criteria were as follows: (a) histological diagnosis of FTC; (b) instrumental and histological evidence of great veins invasion and (c) documented follow-up entirely performed at our institution. Pre-surgical assessment of great veins status was performed in all patients by means of Doppler ultrasonography.

Results

Out of 637 patients operated from 2003 to 2013, four subjects, all affected with FTC, showed great veins involvement (0.62% of the overall cohort and 7.85% of the FTC group). One of them was lost at follow-up. All three patients with available follow-up were subjected to aggressive surgery obtaining a complete eradication of neck disease. All of them achieved the 5-year survival target (60, 63 and 96 months of survival for patients 1, 2 and 3, respectively).

Conclusions

Great veins invasion may not be uncommon in FTC and preoperative detection and characterisation of such condition may optimise surgical approach and improve survival.

https://ift.tt/2D8NEm4

Sildenafil normalizes MALAT1 level in diabetic cardiomyopathy

https://ift.tt/2NlAR4o

Inhibition of endoplasmic reticulum stress by intermedin1-53 attenuates angiotensin II–induced abdominal aortic aneurysm in ApoE KO Mice

Abstract

Endoplasmic reticulum stress (ERS) is involved in the development of abdominal aortic aneurysm (AAA). Since bioactive peptide intermedin (IMD)1-53 protects against AAA formation, here we investigated whether IMD1–53 attenuates AAA by inhibiting ERS. AAA model was induced by angiotensin II (AngII) in ApoE KO mouse background. AngII-treated mouse aortas showed increased ERS gene transcription of caspase12, eukaryotic translation initiation factor 2a (eIf2a) and activating transcription factor 4(ATF4).The protein level of ERS marker glucose regulated protein 94(GRP94), ATF4 and C/EBP homologous protein 10(CHOP) was also up-regulated by AngII. Increased ERS levels were accompanied by severe VSMC apoptosis in human AAA aorta. In vivo administration of IMD1-53 greatly reduced AngII-induced AAA and abrogated the activation of ERS. To determine whether IMD inhibited AAA by ameliorating ERS, we used 2 non-selective ERS inhibitors phenyl butyrate (4-PBA) and taurine (TAU). Similar to IMD, PBA, and TAU significantly reduced the incidence of AAA and AAA-related pathological disorders. In vitro, AngII infusion up-regulated CHOP, caspase12 expression and led to VSMC apoptosis. IMD siRNA aggravated the CHOP, caspase12-mediated VSMC apoptosis, which was abolished by ATF4 silencing. IMD infusion promoted the phosphorylation of adenosine 5'-monophosphate (AMP)-activated protein kinase (AMPK) in aortas in ApoE KO mice, and the AMPK inhibitor compound C abolished the protective effect of IMD on VSMC ERS and apoptosis induced by AngII. In conclusion, IMD may protect against AAA formation by inhibiting ERS via activating AMPK phosphorylation.

https://ift.tt/2D6UOHk

Acute pancreatitis as the first manifestation in a young boy with primary hyperparathyroidism

https://ift.tt/2NmkTHh

FKBP5 expression in human adipose tissue: potential role in glucose and lipid metabolism, adipogenesis and type 2 diabetes

Abstract

Purpose

Here, we explore the involvement of FKBP51 in glucocorticoid-induced insulin resistance (IR) in human subcutaneous adipose tissue (SAT), including its potential role in type 2 diabetes (T2D). Moreover, we assess the metabolic effects of reducing the activity of FKBP51 using the specific inhibitor SAFit1.

Methods

Human SAT was obtained by needle biopsies of the lower abdominal region. FKBP5 gene expression was assessed in fresh SAT explants from a cohort of 20 T2D subjects group-wise matched by gender, age and BMI to 20 non-diabetic subjects. In addition, human SAT was obtained from non-diabetic volunteers (20F/9M). SAT was incubated for 24 h with or without the synthetic glucocorticoid dexamethasone and SAFit1. Incubated SAT was used to measure the glucose uptake rate in isolated adipocytes.

Results

FKBP5 gene expression levels in SAT positively correlated with several indices of IR as well as glucose area under the curve during oral glucose tolerance test (r = 0.33, p < 0.05). FKBP5 gene expression levels tended to be higher in T2D subjects compared to non-diabetic subjects (p = 0.088). Moreover, FKBP5 gene expression levels were found to inversely correlate with lipolytic, lipogenic and adipogenic genes. SAFit1 partly prevented the inhibitory effects of dexamethasone on glucose uptake.

Conclusions

FKBP5 gene expression in human SAT tends to be increased in T2D subjects and is related to elevated glucose levels. Moreover, FKBP5 gene expression is inversely associated with the expression of lipolytic, lipogenic and adipogenic genes. SAFit1 can partly prevent glucose uptake impairment by glucocorticoids, suggesting that FKBP51 might be a key factor in glucocorticoid-induced IR.

https://ift.tt/2D6y76j

A kinetic study for the Fenton and photo-Fenton paracetamol degradation in an annular photoreactor

Abstract

A kinetic model describing Fenton and photo-Fenton degradation of paracetamol (PCT) and consumption of hydrogen peroxide (H₂O₂) was proposed. A set of Fenton and photo-Fenton experiments (18 runs in total) was performed by fixing the initial concentration of PCT to 40 mg L⁻¹ and varying the initial concentrations of H₂O₂ and ferrous ion, Fe²⁺. The experimental set-up was a well-stirred annular photoreactor equipped with an actinic BL TL-DK 36 W/10 1SL lamp. Experimental results highlighted that PCT is no more detected by HPLC analysis within a minimum reaction time of 2.5 and a maximum reaction time of 15.0 min. Besides, a maximum conversion of total organic carbon (TOC) of 68.5% was observed after 75 min of reaction in case of using UV radiation and the highest concentrations of the Fenton reagents. The experimental data were used to fit the kinetic model. The radiation field inside the reactor was taken into account through the local volumetric rate of photon absorption, evaluated by assuming a line source model with spherical and isotropic emission. The kinetic parameters were estimated by using a non-linear least-squares regression procedure and root mean square errors (RMSE) were calculated in order to validate the feasibility of the proposed model. A good agreement between experimental and predicted data was observed and the lowest values of RMSE resulted in 5.84 and 9.59% for PCT and H₂O₂ normalized concentrations, respectively.

https://ift.tt/2Dfi7Pc

Use of 99m Tc-sestamibi SPECT/CT when conventional imaging studies are negative for localizing suspected recurrence in differentiated thyroid cancer: a method and a lesson for clinical management

Abstract

Purpose

The detection of recurrent disease in differentiated thyroid cancer (DTC) patients with elevated or rising serum thyroglobulin (Tg) levels and multiple negative conventional imaging studies can be challenging, especially when ¹⁸F-FDG PET/CT scan is also negative. We report a patient and review the literature on the diagnostic use of ^99mTc-sestamibi scans to identify the source of elevated or rising Tg in patients with negative conventional imaging including negative ¹⁸F-FDG PET/CT scans.

Patient and methods

A 73-year-old woman was referred for widely-invasive metastatic follicular thyroid cancer with bone metastasis to her left mandible. She had a total thyroidectomy, left mandibular resection, and ¹³¹I therapy of 145 mCi (5.4 GBq) and her subsequent unstimulated serum Tg level was 29 ng/ml (TgAb negative). At six months' follow-up, her stimulated Tg was 527 ng/ml (TSH 188 mIU/L, TgAb negative). All imaging studies performed within the prior 12 months were reported as negative for recurrence or metastasis; this included neck ultrasound, diagnostic radioiodine scan, chest CT and, ¹⁸F-FDG PET/CT. The patient was injected with 24.6 mCi (910 MBq) of ^99mTc-sestamibi intravenously, and whole-body and SPECT/CT images were acquired.

Results

The ^99mTc-sestamibi whole-body posterior image demonstrated abnormal focal uptake in the right posterior calvarium and corresponded to an occipital lytic bone lesion on the SPECT/CT. The patient underwent surgical resection of the skull metastasis, and pathology confirmed metastatic follicular thyroid cancer. Five months post-surgery, the suppressed Tg was markedly reduced and remained stable at ~3.2 ng/ml. With the knowledge of the DTC recurrence location, the two sets of ¹⁸F-FDG images were re-evaluated. The more thorough and targeted interpretation underscored the importance of structured image reporting. The current literature on the utility of ^99mTc-sestamibi scans when radioiodine, ¹⁸F-FDG PET/CT, and other imaging studies are negative is sparse and inconsistent.

Conclusions

^99mTc-sestamibi may have a role in thyroid cancer localization when physical exam, neck ultrasound, radioiodine scan, chest/abdomen CT, and ¹⁸F-FDG PET/CT does not identify the source of elevated Tg levels in DTC.

https://ift.tt/2Nnr5yw

Evaluation of melatonin and AFMK levels in women with breast cancer

Abstract

Purpose

Changes in the circadian rhythm may contribute to the development of cancer and are correlated with the high risk of breast cancer (BC) in night workers. Melatonin is a hormone synthesized by the pineal gland at night in the absence of light. Levels of melatonin and the metabolite of oxidative metabolism AFMK (acetyl-N-formyl-5-methoxykynurenamine), are suggested as potential biomarkers of BC risk. The aims of this study were to evaluate levels of melatonin and AFMK in women recently diagnosed with BC, women under adjuvant chemotherapy, and night-shift nurses, and compare them with healthy women to evaluate the relation of these compounds with BC risk.

Methods

Blood samples were collected from 47 women with BC, 9 healthy women, 10 healthy night shift nurses, and 6 patients under adjuvant chemotherapy. Compound levels were measured by mass spectrometry.

Results and conclusions

Our results showed that women with BC had lower levels of melatonin compared to control group women, and even lower in night-shift nurses and in patients under adjuvant chemotherapy. There was no significant difference of AFMK levels between the groups. In addition to this, high levels of melatonin and AFMK were related to patients with metastasis, and high levels of AFMK were related to the presence of lymph node-positive, tumor > 20 mm and patients who sleep with light at night. Our results showed a reduction of melatonin levels in BC patients, suggesting a relation with the disease, and in addition, point to the importance of melatonin supplementation in women that work at night to reduce the BC risk.

https://ift.tt/2D6xvNN

Clinical outcomes of childhood craniopharyngioma: can we do better?

https://ift.tt/2Ni2tHD

Primary hyperparathyroidism: findings from the retrospective evaluation of cases over a 6-year period from a regional UK centre

Abstract

Background

Although there are international guidelines on diagnosis and management of primary hyperparathyroidism (PHPT), clinical practice varies in different centres. Periodic review of diagnostic work-up, surgical treatment by parathyroidectomy (PTX) and clinical surveillance in nonsurgical treatment group among patients with PHPT is expected to improve the quality of care. We report a retrospective study of cases with PHPT managed at a regional centre in the United Kingdom.

Methods

Clinical data of cases with calcium ≥2.6 mmol/L and parathyroid hormone (PTH) ≥9.0 pmol/L was procured from biochemistry database from January 2011 to December 2016. Laboratory parameters, imaging studies for renal stones, osteoporosis and localisation of parathyroid adenomas, type of treatment received (PTX or nonsurgical), complications of treatment, other medical co-morbidities and mortality during follow-up was recorded in each case to examine the outcomes of care of patients with PHPT.

Results

The study included 160 patients: 127 (79%) females and 33 (21%) males. Median age was 70 years in females and 74 in males. Thirty cases (19% of 159) had renal stones and 47 (37.3% of 126) had osteoporosis. Eighty-one cases (51%) received PTX. Logistic regression analysis showed that higher calcium levels (odds ratio (OR) = 73.991; p < 0.001), peak PTH (OR = 1.023; p = 0.025), peak alkaline phosphatase (OR = 0.985, p < 0.001), lower age (OR = 0.985, p < 0.001) and male gender (OR = 0.209, p < 0.002) as statistically significant predictors for patients receiving PTX. Higher age at diagnosis of PHPT was associated with increased risk of co-existent hypertension (OR = 10.904, p = 0.001) and fractures (OR = 1.067, p = 0.004). Higher peak calcium concentration was an independent predictor of acute kidney injury (OR = 9.631, p = 0.011). PTX cured 76 cases (94%) with only 7 (9%) postoperative complications. Twenty-four cases (15%) died from the entire cohort (only one from PTX group) during a median follow-up period of 3.6 years (interquartile range = 1.5).

Conclusions

PTX treatment is associated with cure of disease in patients with PHPT with acceptable risk of complications. Improvements in diagnostic work-up and follow-up care should improve the morbidity from PHPT.

https://ift.tt/2D98bH1

Putative endothelial progenitor cells predict long-term mortality in type-2 diabetes

https://ift.tt/2Nmo55O

Ghrelin knockout mice display defective skeletal muscle regeneration and impaired satellite cell self-renewal

Abstract

Purpose

Muscle regeneration depends on satellite cells (SCs), quiescent precursors that, in consequence of injury or pathological states such as muscular dystrophies, activate, proliferate, and differentiate to repair the damaged tissue. A subset of SCs undergoes self-renewal, thus preserving the SC pool and its regenerative potential. The peptides produced by the ghrelin gene, i.e., acylated ghrelin (AG), unacylated ghrelin (UnAG), and obestatin (Ob), affect skeletal muscle biology in several ways, not always with overlapping effects. In particular, UnAG and Ob promote SC self-renewal and myoblast differentiation, thus fostering muscle regeneration.

Methods

To delineate the endogenous contribution of preproghrelin in muscle regeneration, we evaluated the repair process in Ghrl^−/− mice upon CTX-induced injury.

Results

Although muscles from Ghrl^−/− mice do not visibly differ from WT muscles in term of weight, structure, and SCs content, muscle regeneration after CTX-induced injury is impaired in Ghrl^−/− mice, indicating that ghrelin-derived peptides actively participate in muscle repair. Remarkably, the lack of ghrelin gene impacts SC self-renewal during regeneration.

Conclusions

Although we cannot discern the specific Ghrl-derived peptide responsible for such activities, these data indicate that Ghrl contributes to a proper muscle regeneration.

https://ift.tt/2D981zp

Low trabecular bone score in postmenopausal women with differentiated thyroid carcinoma after long-term TSH suppressive therapy

Abstract

The effect of thyroid suppression therapy (TST) on trabecular bone scores (TBS) and bone mineral density (BMD) in thyroidectomized women with differentiated thyroid carcinoma (DTC) on long-term follow-up is presently not conclusive. Patients and Methods. We carried out a study in 61 premenopausal and 84 postmenopausal Caucasian women with DTC. Serum biochemistry, bone markers, TBS, BMD, and bone fractures were evaluated 1–3 months post surgery and after a median follow-up of 10 years. Results. In the final study, patients belonged to Group I Premenopausal (n = 14) who remained in this status; Group II Premenopausal who became postmenopausal (n = 47); Group III patients who were and continued as postmenopausal (n = 84). Baseline premenopausal patients had a normal TBS mean value of 1.39 ± 0.14 significantly higher than that found in postmenopausal 1.31 ± 0.12 (p = 001). In the final study, premenopausal patients continued to have a normal TBS of 1.46 ± 0.08 compared to the significantly lower value of postmenopausal patients 1.25 ± 0.11 (p = 0.0009). Lumbar BMD (L-BMD) loss after the long-term study was significant in Group II (0.99 g/cm² ± 0.13 vs. 0.91 ± 0.12 g/cm², p < 0.0001) and there was a slight, but not significant, bone loss in Group I (1.00 ± 0.12 vs. 0.98 ± 0.11, p = 0.1936) and in Group III (0.86 ± 0.12 vs. 0.84 ± 0.15, p = 0.1924) compared with baseline values. Conclusion: Longer-term suppression therapy in female patients with DTC did not increase significantly the risk of bone loss, although we found in postmenopausal patients deterioration of bone microarchitecture. TBS study should be considered in the evaluation of postmenopausal DTC patients on long-term DTC for the evaluation of the risk of fractures.

https://ift.tt/2NmoAgc

Statins as potential agents for the prevention and treatment of osteoporosis

https://ift.tt/2D8NU4w

Risk factors for central neck lymph node metastases in follicular variant vs. classic papillary thyroid carcinoma

Abstract

Purpose

Histological variants of papillary thyroid carcinoma (PTC) have been advocated as possible risk factors for central neck nodal metastases (CNM). A lower incidence of CNM in follicular variant of papillary thyroid carcinoma (fvPTC) when compared with classic PTC (cPTC) has been observed. We aimed to compare risk factors for CNM in patients with fvPTC and cPTC.

Methods

The medical records of 1737 patients with a diagnosis of cPTC or fvPTC were reviewed. Demographic, clinical and pathological findings were prospectively registered. Risk factors for CNM were evaluated by univariate and multivariate analysis in cPTC vs. fvPTC patients.

Results

Six hundred and fifty-two patients (37.5%) had fvPTC. The diagnosis was incidental in 69.5% of the fvPTC and in 29.4% of the cPTC patients. Overall, 26.3% cPTC and 8.3% fvPTC patients showed CNM (p < 0.001). In both cPTC and fvPTC patients at univariate analysis age <45 years, nonincidental diagnosis, tumor size >5 mm, multifocality, angioinvasion and extracapsular invasion were risk factors for CNM. At multivariate analysis independent risk factors for CNM in both cPTC and fvPTC patients were age <45 years (p < 0.01), nonincidental diagnosis (p < 0.001), multifocality (p < 0.001) and extracapsular invasion (p < 0.001).

Conclusions

No differences were observed between cPTC and fvPTC with regard to risk factors of CNM. fvPTC seems associated with a lower incidence of CNM, presumably because of the higher rate of incidental diagnosis. With the exception of age, in patients with a preoperative diagnosis of PTC, no preoperatively available clinical parameter is a reliable predictor of CNM.

https://ift.tt/2Nos9Ci

Long-term follow-up of female prolactinoma patients at child-bearing age after transsphenoidal surgery

Abstract

Context:

Prolactinoma is the most common subtype of functional pituitary adenoma. Effective therapy is required for women of child-bearing age to achieve remission at serum prolactin level and regain reproductive function.

Purpose

To evaluate long-term outcomes, including menstrual recovery, after transsphenoidal surgery on female prolactinoma patients by experienced neurosurgeons.

Design

Observational study.

Patients

Consecutive female prolactinoma patients aged from 16 to 45 years were included. Histological analysis after surgery revealed adenoma with positive staining for prolactin. Plurihormonal cell adenomas were excluded.

Main measurements

Clinical manifestations, surgical indications, serum prolactin level before and after surgery, surgical complications, pituitary fuctions, drug maintenance, the status of menstruation, and pregnancy.

Results

Sixty-three consecutive female patients with a mean age of 29.5 ± 1.1 years were included. Based on magnetic resonance imaging findings before surgery, 31 (49.2%) patients had microadenoma, and the remaining 32 (50.8%) had macroadenoma. The median follow-up after transsphenoidal surgery was 53 (33–74) months, and long-term surgical remission was achieved in 50 (79.37%) patients with 28 (90.32%) microadenomas and 22 (68.75%) macroadenomas. No meningitis or persistent cerebrospinal fluid leaks occurred. Only one case suffered from persistent diabetes insipidus at follow-up. No severe pituitary dysfunction was observed in microprolactinoma patients. Of patients with menstrual disorders, 85% regained regular menstrual cycles after surgery. Nineteen patients in this cohort desired pregnancy and 15 of them successfully gave birth after surgery. All 17 microadenoma patients with modern surgical indications achieved normal prolactin levels and regular menstrual cycles with only one patient on drug therapy at follow-up.

Conclusion

Long-term follow-up showed a high remission rate in female prolactinoma patients, especially in microadenoma patients, after surgery. Transsphenoidal surgery performed by experienced neurosurgeons may offer a valuable approach to treat female microprolactinoma patients of child-bearing age with modern indications for surgery.

https://ift.tt/2D97H3F

Correction to: Multiple endocrine neoplasia type 1: analysis of germline MEN1 mutations in the Italian multicenter MEN1 patient database

The original version of this article unfortunately contained a mistake in Table 2. The table 2 was truncated in the original publication. The full table 2 is given below.

https://ift.tt/2NlAYwQ

Great veins invasion in follicular thyroid cancer: single-centre study assessing prevalence and clinical outcome

Abstract

Purpose

Great veins invasion is considered as a rare and prognostically unfavourable event in thyroid cancer. However, current knowledge about this issue is mainly based on single case reports. Follicular thyroid cancer (FTC) represents the histotype with the most pronounced angioinvasive feature. This study is aimed at assessing the actual prevalence of great veins invasion in FTC and providing information about prognosis and the proper clinical management of these patients.

Methods

Clinico-pathological and radiological data of patients with thyroid cancer undergoing thyroidectomy in our institution were retrospectively retrieved. Inclusion criteria were as follows: (a) histological diagnosis of FTC; (b) instrumental and histological evidence of great veins invasion and (c) documented follow-up entirely performed at our institution. Pre-surgical assessment of great veins status was performed in all patients by means of Doppler ultrasonography.

Results

Out of 637 patients operated from 2003 to 2013, four subjects, all affected with FTC, showed great veins involvement (0.62% of the overall cohort and 7.85% of the FTC group). One of them was lost at follow-up. All three patients with available follow-up were subjected to aggressive surgery obtaining a complete eradication of neck disease. All of them achieved the 5-year survival target (60, 63 and 96 months of survival for patients 1, 2 and 3, respectively).

Conclusions

Great veins invasion may not be uncommon in FTC and preoperative detection and characterisation of such condition may optimise surgical approach and improve survival.

https://ift.tt/2D8NEm4

Sildenafil normalizes MALAT1 level in diabetic cardiomyopathy

https://ift.tt/2NlAR4o

Inhibition of endoplasmic reticulum stress by intermedin1-53 attenuates angiotensin II–induced abdominal aortic aneurysm in ApoE KO Mice

Abstract

Endoplasmic reticulum stress (ERS) is involved in the development of abdominal aortic aneurysm (AAA). Since bioactive peptide intermedin (IMD)1-53 protects against AAA formation, here we investigated whether IMD1–53 attenuates AAA by inhibiting ERS. AAA model was induced by angiotensin II (AngII) in ApoE KO mouse background. AngII-treated mouse aortas showed increased ERS gene transcription of caspase12, eukaryotic translation initiation factor 2a (eIf2a) and activating transcription factor 4(ATF4).The protein level of ERS marker glucose regulated protein 94(GRP94), ATF4 and C/EBP homologous protein 10(CHOP) was also up-regulated by AngII. Increased ERS levels were accompanied by severe VSMC apoptosis in human AAA aorta. In vivo administration of IMD1-53 greatly reduced AngII-induced AAA and abrogated the activation of ERS. To determine whether IMD inhibited AAA by ameliorating ERS, we used 2 non-selective ERS inhibitors phenyl butyrate (4-PBA) and taurine (TAU). Similar to IMD, PBA, and TAU significantly reduced the incidence of AAA and AAA-related pathological disorders. In vitro, AngII infusion up-regulated CHOP, caspase12 expression and led to VSMC apoptosis. IMD siRNA aggravated the CHOP, caspase12-mediated VSMC apoptosis, which was abolished by ATF4 silencing. IMD infusion promoted the phosphorylation of adenosine 5'-monophosphate (AMP)-activated protein kinase (AMPK) in aortas in ApoE KO mice, and the AMPK inhibitor compound C abolished the protective effect of IMD on VSMC ERS and apoptosis induced by AngII. In conclusion, IMD may protect against AAA formation by inhibiting ERS via activating AMPK phosphorylation.

https://ift.tt/2D6UOHk

Acute pancreatitis as the first manifestation in a young boy with primary hyperparathyroidism

https://ift.tt/2NmkTHh

FKBP5 expression in human adipose tissue: potential role in glucose and lipid metabolism, adipogenesis and type 2 diabetes

Abstract

Purpose

Here, we explore the involvement of FKBP51 in glucocorticoid-induced insulin resistance (IR) in human subcutaneous adipose tissue (SAT), including its potential role in type 2 diabetes (T2D). Moreover, we assess the metabolic effects of reducing the activity of FKBP51 using the specific inhibitor SAFit1.

Methods

Human SAT was obtained by needle biopsies of the lower abdominal region. FKBP5 gene expression was assessed in fresh SAT explants from a cohort of 20 T2D subjects group-wise matched by gender, age and BMI to 20 non-diabetic subjects. In addition, human SAT was obtained from non-diabetic volunteers (20F/9M). SAT was incubated for 24 h with or without the synthetic glucocorticoid dexamethasone and SAFit1. Incubated SAT was used to measure the glucose uptake rate in isolated adipocytes.

Results

FKBP5 gene expression levels in SAT positively correlated with several indices of IR as well as glucose area under the curve during oral glucose tolerance test (r = 0.33, p < 0.05). FKBP5 gene expression levels tended to be higher in T2D subjects compared to non-diabetic subjects (p = 0.088). Moreover, FKBP5 gene expression levels were found to inversely correlate with lipolytic, lipogenic and adipogenic genes. SAFit1 partly prevented the inhibitory effects of dexamethasone on glucose uptake.

Conclusions

FKBP5 gene expression in human SAT tends to be increased in T2D subjects and is related to elevated glucose levels. Moreover, FKBP5 gene expression is inversely associated with the expression of lipolytic, lipogenic and adipogenic genes. SAFit1 can partly prevent glucose uptake impairment by glucocorticoids, suggesting that FKBP51 might be a key factor in glucocorticoid-induced IR.

https://ift.tt/2D6y76j

Impaired Skin Barrier Function and Downregulated Expression of Caspase-14 in Moderate to Severe Chronic Hand Eczema

Aim: To investigate whether the skin barrier function is impaired with regard to the pH value, water content, transepidermal water loss (TEWL), and the integrity of the stratum corneum, and whether the expression of caspase-14 is altered in moderate to severe chronic hand eczema (CHE). Methods: Thirty patients with moderate to severe CHE treated at our institute and 30 healthy volunteers were included in this study. The pH value, water content, TEWL, and the integrity of the stratum corneum were measured in all subjects. Results: Significantly increased pH value, decreased water content, elevated TEWL, and impaired integrity of the stratum corneum were observed in the lesional skin of CHE patients compared with the nonlesional skin of CHE patients and the normal skin of healthy volunteers. The expression of caspase-14 decreased in the lesional and nonlesional skin of CHE patients compared with the normal skin of healthy volunteers, especially prominent in the nonlesional skin. The mean optical density (OD) value of immunohistochemical staining for caspase-14 was significantly lower in the nonlesional skin than in the lesional skin and normal skin (p #x3c; 0.01 for both). Although the mean OD value was lower in the lesional skin than in the normal skin, the difference was not statistically significant (p #x3e; 0.05). Conclusion: Skin barrier dysfunction indeed occurs in CHE patients, which may be related to mechanisms associated with a downregulated expression of caspase-14.
Dermatology

https://ift.tt/2NSGeHB

Combined Unilateral Posteroventral Pallidotomy and Ventral Intermediate Nucleus Thalamotomy in Tremor-Dominant Parkinson's Disease versus Posteroventral Pallidotomy Alone: A Prospective Comparative Study

Background: The optimum target in surgery for Parkinson's disease (PD) is still controversial, especially in patients with tremor-dominant PD. We aim to compare results in tremor-dominant patients undergoing pallidotomy vs. those undergoing simultaneous posteroventral pallidotomy (PVP) and ventral intermediate nucleus (VIM) thalamotomy. Methods: Twenty-four patients with tremor-dominant PD were included in this study. Twelve patients received unilateral PVP contralateral to the most affected side. The other 12 patients received simultaneous unilateral PVP and VIM thalamotomy contralateral to the most affected side. Assessment of results in both groups was achieved using both UPDRS "off" motor scores and UPDRS rest tremor subscores. Results: The mean UPDRS off motor score improved in the pallidotomy group from 61.3 preoperatively to 36.8 at 12 months. In the combined group, it improved from 59.6 to 35.2 at 12 months, with no statistically significant difference between both groups. On the other hand, while the mean tremor subscore in the pallidotomy group improved from a mean of 2.3–0.8, the tremors were abolished in all of the patients in the combined group except for 1 patient who showed slight infrequent tremors at 12 months. Conclusion: Patients with tremor-dominant PD achieve more improvement in tremor control after combined PVP and VIM thalamotomy.
Stereotact Funct Neurosurg 2018;96:1–6

https://ift.tt/2xpvshU

Effects and parameters of the photobiomodulation in experimental models of third-degree burn: systematic review

Abstract

This systematic review was performed to identify the role of photobiomodulation therapy in experimental models of third-degree burns used to induce oxidative stress. EMBASE, PubMed, and CINAHL databases were searched for studies published between January 2003 and January 2018 on the topics of photobiomodulation therapy and third-degree burns. Any study that assessed the effects of photobiomodulation therapy in animal models of third-degree burns was included in the analysis. A total of 17 studies were selected from 1182 original articles targeted on photobiomodulation therapy and third-degree burns. Two independent raters with a structured tool for rating the research quality critically assessed the articles. Although the small number of studies limits the conclusions, the current literature research indicates that photobiomodulation therapy can be an effective short-term approach to accelerate the healing process of third-degree burns, to increase and modulate the inflammatory process, to accelerate the proliferation of fibroblasts, and to enhance the quality of the collagen network. However, differences still exist in the terminology used to describe the parameters and the dose of photobiomodulation therapy.

https://ift.tt/2NSPNGH