Idiopathic granulomatous mastitis: Long-discussed but yet-to-be-known

Idiopathic granulomatous mastitis (IGM) is a chronic benign inflammatory disease of the breast with unknown etiology. It is an important diagnostic and therapeutic challenge, as most patients were initially misdiagnosed by their primary care physicians, leading to diagnostic confusion and heightened anxiety. Although several triggers have been proposed for development of IGM, the etiologic association of neither of them has been documented. Three main hypotheses about the possible causes of IGM have been suggested, including autoimmune response, infectious disease, and hormonal disruption. Here, we discuss a hypothetical perspective of IGM to explain the possible role of autoinflammation in the pathogenesis of the disease. We also reviewed the previously published literature on pathogenesis of IGM.

Adipose Derived Stromal Cell (ADSC) Injections for Pain Management of Osteoarthritis in the Human Knee Joint

BACKGROUND

This safety and feasibility study used autologous adipose-derived stromal vascular cells (the stromal vascular fraction [SVF] of adipose tissue), to treat 8 osteoarthritic knees in 6 patients of grade I to III (K-L scale) with initial pain of 4 or greater on a 10-point Visual Analog Scale (VAS).

OBJECTIVES

The primary objective of the study was evaluation of the safety of intra-articular injection of SVF. The secondary objective was to assess initial feasibility for reduction of pain in osteoarthritic knees.

METHODS

Adipose-derived SVF cells were obtained through enzymatic disaggregation of lipoaspirate, resuspension in 3 mL of Lactated Ringer's Solution, and injection directly into the intra-articular space of the knee, with a mean of 14.1 million viable, nucleated SVF cells per knee. Metrics included monitoring of adverse events and preoperative to postoperative changes in the Western Ontario and McMaster Universities Arthritis Index (WOMAC), the VAS pain scale, range of motion (ROM), timed up-and-go (TUG), and MRI.

RESULTS

No infections, acute pain flares, or other adverse events were reported. At 3-months postoperative, there was a statistically significant improvement in WOMAC and VAS scores (P < .02 and P < .001, respectively), which was maintained at 1 year. Physical therapy measurements for ROM and TUG both improved from preoperative to 3-months postoperative. Standard MRI assessment from preoperative to 3-months postoperative showed no detectable structural differences. All patients attained full activity with decreased knee pain.

CONCLUSIONS

Autologous SVF was shown to be safe and to present a new potential therapy for reduction of pain for osteoarthritis of the knee. LEVEL OF EVIDENCE 4: Therapeutic.

Open Versus Closed Laparoscopy: Yet an Unresolved Controversy

INTRODUCTION

Safe placement of the Verres needle or the primary trocar for establishment of pneumoperitoneum is the most critical step in laparoscopic procedure as it is associated with bowel, bladder and life threatening vascular injuries and embolism. In the last few decades many techniques and guidelines have been introduced to eliminate complications in creation of pneumoperitoneum. Classical closed technique (Verres needle) and the open classic technique (Hasson) are the most commonly used techniques for creation of pneumoperitoneum.

AIM

To compare the rate of occurrence and nature of complications in open and closed laparoscopy during establishment of pneumoperitoneum in different surgical and gynaecological procedures.

MATERIALS AND METHODS

This was a comparative study conducted at three hospitals in Dibrugarh district, Assam, India from January 2012 to December 2014. Total 3000 cases were included in the study with 1500 cases of open laparoscopy and 1500 cases of closed laparoscopy. Complications occurring in both the groups were compared by using Fisher's-exact test.

RESULTS

In closed laparoscopy group minor complications occurred in 80 (5.33%) and major complications in 20 (1.33%) cases. In open laparoscopy group minor complications were observed in 60 (4%) and major complications in 2 (0.13%). The p-value of the difference between the two groups for minor complications was 0.0834 and for major complications was 0.0001(significant).

CONCLUSION

Open laparoscopy was seen to be better than closed laparoscopy in terms of not only the rate of occurrence of complications but also the nature and severity of the complications. This study is clinically relevant as there is no consensus for a particular method of safe entry in to the peritoneal cavity warranting the need for more research. Open technique can be performed in all cases irrespective of previous operative scar, suspected intra peritoneal adhesions or obesity. Favourable outcome may be achieved in closed technique in cases of normal BMI, absence of postoperative scar in the abdomen, absence of abdominal and genital tuberculosis and pelvic inflammatory disease.

New perspectives on management of idiopathic pulmonary fibrosis

Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive parenchymal lung disease characterized by a median survival of 3-5 years following diagnosis. The diagnosis is based on clinical, radiological and histopathological evaluation. Therefore, a multidisciplinary team is needed to reach the correct diagnosis. For a long time, supportive care and lung transplantation in selected cases, have been considered the only possible treatments for IPF. In the last decade many studies have investigated IPF pathogenesis, leading to an improved knowledge of the mechanisms underlying the disease and to the approval of two new drugs for IPF treatment (pirfenidone and nintedanib). The therapeutic approach of IPF cannot be limited to the administration of antifibrotic drugs, but it is necessary for improving the quality of life of patients and for facilitating, as far as possible, the performance of normal daily activities and relationships. IPF patients are also afflicted by disease-related complications such as gastroesophageal reflux, pulmonary hypertension, acute exacerbations and an increased risk of developing lung cancer. The clinician who treats IPF patients, should also treat these possible complications to slow disease progression, thus maintaining the possibility of a pulmonary transplantation.

Metabolomics-Based Discovery of Small Molecule Biomarkers in Serum Associated with Dengue Virus Infections and Disease Outcomes

BACKGROUND

Epidemic dengue fever (DF) and dengue hemorrhagic fever/dengue shock syndrome (DHF/DSS) are overwhelming public health capacity for diagnosis and clinical care of dengue patients throughout the tropical and subtropical world. The ability to predict severe dengue disease outcomes (DHF/DSS) using acute phase clinical specimens would be of enormous value to physicians and health care workers for appropriate triaging of patients for clinical management. Advances in the field of metabolomics and analytic software provide new opportunities to identify host small molecule biomarkers (SMBs) in acute phase clinical specimens that differentiate dengue disease outcomes.

METHODOLOGY/PRINCIPAL FINDINGS

Exploratory metabolomic studies were conducted to characterize the serum metabolome of patients who experienced different dengue disease outcomes. Serum samples from dengue patients from Nicaragua and Mexico were retrospectively obtained, and hydrophilic interaction liquid chromatography (HILIC)-mass spectrometry (MS) identified small molecule metabolites that were associated with and statistically differentiated DHF/DSS, DF, and non-dengue (ND) diagnosis groups. In the Nicaraguan samples, 191 metabolites differentiated DF from ND outcomes and 83 differentiated DHF/DSS and DF outcomes. In the Mexican samples, 306 metabolites differentiated DF from ND and 37 differentiated DHF/DSS and DF outcomes. The structural identities of 13 metabolites were confirmed using tandem mass spectrometry (MS/MS). Metabolomic analysis of serum samples from patients diagnosed as DF who progressed to DHF/DSS identified 65 metabolites that predicted dengue disease outcomes. Differential perturbation of the serum metabolome was demonstrated following infection with different DENV serotypes and following primary and secondary DENV infections.

CONCLUSIONS/SIGNIFICANCE

These results provide proof-of-concept that a metabolomics approach can be used to identify metabolites or SMBs in serum specimens that are associated with distinct DENV infections and disease outcomes. The differentiating metabolites also provide insights into metabolic pathways and pathogenic and immunologic mechanisms associated with dengue disease severity.

Biosurveillance in Central Asia: Successes and Challenges of Tick-Borne Disease Research in Kazakhstan and Kyrgyzstan

Central Asia is a vast geographic region that includes five former Soviet Union republics: Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan, and Uzbekistan. The region has a unique infectious disease burden, and a history that includes Silk Road trade routes and networks that were part of the anti-plague and biowarfare programs in the former Soviet Union. Post-Soviet Union biosurveillance research in this unique area of the world has met with several challenges, including lack of funding and resources to independently conduct hypothesis driven, peer-review quality research. Strides have been made, however, to increase scientific engagement and capability. Kazakhstan and Kyrgyzstan are examples of countries where biosurveillance research has been successfully conducted, particularly with respect to especially dangerous pathogens. In this review, we describe in detail the successes, challenges, and opportunities of conducting biosurveillance in Central Asia as exemplified by our recent research activities on ticks and tick-borne diseases in Kazakhstan and Kyrgyzstan.

Femoroacetabular impingement in children and adolescents

PURPOSE OF REVIEW

The present review discusses the etiology, clinical presentation, and management of femoroacetabular impingement (FAI) in the pediatric population, including etiologic and diagnostic controversies, management options, and outcomes.

RECENT FINDINGS

New evidence demonstrates conflicting results regarding how and when primary FAI develops in relation to skeletal maturity. Recent studies also discuss the effects of sex, race, and sports on FAI development and radiographic considerations in the pediatric population. Recent literature demonstrates good to excellent outcomes in the operative management of FAI in children and adolescents.

SUMMARY

FAI is a source of pediatric hip pain and can occur primarily or secondarily. It is characterized by anterior hip pain, made worse with flexion activities, decreased hip internal rotation, and a positive impingement sign. Pathologic values for radiographic measures of FAI are not clearly defined in the pediatric population. As FAI is a risk factor for osteoarthritis, early intervention in specific patients may be indicated. Hip arthroscopy, surgical hip dislocation, or combined mini-open and arthroscopic approaches are utilized, with good to excellent short, and mid-term functional results. Further study is required in the pediatric population to identify potential preventive strategies, to delineate the pathologic radiographic values of FAI, to define specific indications for operative management, and to examine long-term outcomes to determine optimal management.

Genetic Susceptibility to Vitiligo: GWAS Approaches for Identifying Vitiligo Susceptibility Genes and Loci

Vitiligo is an autoimmune disease with a strong genetic component, characterized by areas of depigmented skin resulting from loss of epidermal melanocytes. Genetic factors are known to play key roles in vitiligo through discoveries in association studies and family studies. Previously, vitiligo susceptibility genes were mainly revealed through linkage analysis and candidate gene studies. Recently, our understanding of the genetic basis of vitiligo has been rapidly advancing through genome-wide association study (GWAS). More than 40 robust susceptible loci have been identified and confirmed to be associated with vitiligo by using GWAS. Most of these associated genes participate in important pathways involved in the pathogenesis of vitiligo. Many susceptible loci with unknown functions in the pathogenesis of vitiligo have also been identified, indicating that additional molecular mechanisms may contribute to the risk of developing vitiligo. In this review, we summarize the key loci that are of genome-wide significance, which have been shown to influence vitiligo risk. These genetic loci may help build the foundation for genetic diagnosis and personalize treatment for patients with vitiligo in the future. However, substantial additional studies, including gene-targeted and functional studies, are required to confirm the causality of the genetic variants and their biological relevance in the development of vitiligo.

The Coagulation Factor XIIa Inhibitor rHA-Infestin-4 Improves Outcome after Cerebral Ischemia/Reperfusion Injury in Rats

Background and Purpose

Ischemic stroke provokes severe brain damage and remains a predominant disease in industrialized countries. The coagulation factor XII (FXII)-driven contact activation system plays a central, but not yet fully defined pathogenic role in stroke development. Here, we investigated the efficacy of the FXIIa inhibitor rHA-Infestin-4 in a rat model of ischemic stroke using both a prophylactic and a therapeutic approach.

Methods

For prophylactic treatment, animals were treated intravenously with 100 mg/kg rHA-Infestin-4 or an equal volume of saline 15 min prior to transient middle cerebral artery occlusion (tMCAO) of 90 min. For therapeutic treatment, 100 mg/kg rHA-Infestin-4, or an equal volume of saline, was administered directly after the start of reperfusion. At 24 h after tMCAO, rats were tested for neurological deficits and blood was drawn for coagulation assays. Finally, brains were removed and analyzed for infarct area and edema formation.

Results

Within prophylactic rHA-Infestin-4 treatment, infarct areas and brain edema formation were reduced accompanied by better neurological scores and survival compared to controls. Following therapeutic treatment, neurological outcome and survival were still improved although overall effects were less pronounced compared to prophylaxis.

Conclusions

With regard to the central role of the FXII-driven contact activation system in ischemic stroke, inhibition of FXIIa may represent a new and promising treatment approach to prevent cerebral ischemia/reperfusion injury.

Diving medicine in clinical practice

BACKGROUND

Diving is a popular sport, and some recreational divers have medical risk factors. Their health can be endangered by high extracorporeal (ambient) pressure and its many systemic effects.

METHODS

We review relevant publications on free (breath-hold) diving, scuba diving, medical evaluation for diving, barotrauma, decompression sickness, and diving with medical risk factors, which were retrieved by a selective search of PubMed.

RESULTS

Free diving or scuba diving, even at seemingly innocuous depths, puts considerable stress on the cardio - vascular system, ears, and lungs. Unexpected events while diving, diminished functional reserve, and pre-existing medical illnesses increase the risk of a diving accident. An international survey revealed that minor incidents occur in 1.3% of all dives, and decompression accidents in 2 of every 10 000 dives. A properly conducted medical examination to determine diving fitness, followed by appropriate counseling, can make a life-threatening diving accident less likely.

CONCLUSION

To be able to certify diving fitness and give competent medical advice about diving, physicians must be well informed about the physical and physiological changes of diving and the associated risks to health, and they need to know how to perform a medical evaluation of prospective divers. In Germany, any licensed physician may judge a person fit to dive. It is recommended that this be done in adherence to the relevant evaluation standards and recommendations of the medical specialty associations. Randomized controlled trials on the effect of preventive behavior would be desirable, as would a central registry of diving accidents.

Association between allergic rhinitis and metabolic conditions: a nationwide survey in Korea

Background

Accumulating evidence indicates a strong correlation between allergic disease and cardiovascular risks. In spite of this, the data concerning the association between allergic rhinitis (AR) and cardiovascular risks is sparse and conflicting. This study aimed to investigate the association between AR prevalence and metabolic syndrome (MetS) in a large-scale, population-based survey, while considering the relevant risk factors.

Methods

A nationwide cross-sectional study was conducted based on data from 30,590 subjects aged 19 years and older, from the Korean National Health and Nutrition Survey 2007–2013. The odds ratios (ORs) and 95 % confidence intervals (CIs) of AR prevalence, based on MetS status and the presence of any MetS component, were calculated using multiple logistic regression analyses.

Results

Regarding the characteristics of patients with AR and/or MetS, some variables had significant associations with disease in inverse directions for AR and MetS. Multivariate logistic analysis, with adjustments for demographic variables and health habits, indicated that AR prevalence was significantly lower in subjects with MetS (OR 0.84; 95 % CI 0.76–0.93), high blood pressure (OR 0.85; 95 % CI 0.77–0.94), or impaired fasting glucose (OR 0.81; 95 % CI 0.73–0.89). Furthermore, high blood pressure and impaired fasting glucose were significant predictors for reduced AR prevalence, independently of other MetS components.

Conclusion

In this population, AR was diagnosed less frequently in subjects with metabolic conditions. Well-designed prospective studies allowing for medical service utilization and collaborative basic research are warranted to elucidate the mechanism responsible for this inverse relationship.

Baastrup's Disease: An Often Missed Etiology for Back Pain

Baastrup's disease is a relatively common disorder of the vertebral column, characterized by low back pain arising from the close approximation of adjacent posterior spinous processes and resultant degenerative changes, most commonly at L4-L5. Though fairly common, Baastrup's disease is overwhelmingly underdiagnosed and often missed due to a lack of knowledge and/or improper diagnostic techniques, leading to frequent mistreatment. We present a case of a 56-year-old man who presented with chronic, ongoing low back pain of several years duration. His pain was relieved by flexion of the spine, and aggravated by extension. Imaging studies revealed "kissing" posterior spinous processes, consistent with a diagnosis of Baastrup's Disease. He was treated with subcutaneous steroid injections and showed considerable clinical improvement.

Diet and nutritional factors in inflammatory bowel diseases

Inflammatory bowel disease (IBD) development is affected by complex interactions between environmental factors, changes in intestinal flora, various predisposing genetic properties and changes in the immune system. Dietary factors seem to play an underestimated role in the etiopathogenesis and course of the disease. However, research about food and IBD is conflicting. An excessive consumption of sugar, animal fat and linoleic acid is considered a risk factor for IBD development, whereas a high fiber diet and citrus fruit consumption may play a protective role. Also, appropriate nutrition in particular periods of the disease may facilitate achieving or prolonging remissions and most of all, improve the quality of life for patients. During disease exacerbation, a low fiber diet is recommended for most patients. In the remission time, an excessive consumption of alcohol and sulfur products may have a negative effect on the disease course. Attempts are also made at employing diets composed in detail in order to supplement IBD therapy. A diet with a modified carbohydrate composition, a semi-vegetarian diet and a diet low in fermentable oligosaccharides, disaccharides, monosaccharides and polyols are under investigation. Due to chronic inflammation as well as side effects of chronically used medications, patients with IBD are also at increased risk of nutritional factor deficiencies, including iron, calcium, vitamin D, vitamin B12, folic acid, zinc, magnesium and vitamin A. It should also be remembered that there is no single common diet suitable for all IBD patients; each of them is unique and dietary recommendations must be individually developed for each patient, depending on the course of the disease, past surgical procedures and type of pharmacotherapy.

Biophysical regulation of Chlamydia pneumoniae-infected monocyte recruitment to atherosclerotic foci

Chlamydia pneumoniae infection is implicated in atherosclerosis although the contributory mechanisms are poorly understood. We hypothesize that C. pneumoniae infection favors the recruitment of monocytes to atherosclerotic foci by altering monocyte biophysics. Primary, fresh human monocytes were infected with C. pneumoniae for 8 h, and the interactions between monocytes and E-selectin or aortic endothelium under flow were characterized by video microscopy and image analysis. The distribution of membrane lipid rafts and adhesion receptors were analyzed by imaging flow cytometry. Infected cells rolled on E-selectin and endothelial surfaces, and this rolling was slower, steady and uniform compared to uninfected cells. Infection decreases cholesterol levels, increases membrane fluidity, disrupts lipid rafts, and redistributes CD44, which is the primary mediator of rolling interactions. Together, these changes translate to higher firm adhesion of infected monocytes on endothelium, which is enhanced in the presence of LDL. Uninfected monocytes treated with LDL or left untreated were used as baseline control. Our results demonstrate that the membrane biophysical changes due to infection and hyperlipidemia are one of the key mechanisms by which C. pneumoniae can exacerbate atherosclerotic pathology. These findings provide a framework to characterize the role of ‘infectious burden’ in the development and progression of atherosclerosis.

Cannabinoid hyperemesis syndrome

The antiemetic properties of marijuana are well known, but there is increasing evidence of its paradoxical hyperemetic effects on the gastrointestinal tract and central nervous system, known as 'cannabinoid hyperemesis syndrome' (CHS). We report a case of CHS encountered in our outpatient clinic. We also completed a review of the literature using PubMed in patients over 18 years of age with CHS. Understanding the diagnostic criteria and risk factors associated with CHS may reduce the ordering of unnecessary and expensive investigations, and pursuing inappropriate medical and surgical treatments. Ultimately, abstaining from cannabis use leads to resolution of symptoms in the majority of patients.

Galectin-9: An anticancer molecule for gallbladder carcinoma

Gallbladder cancer (GBC) is the most common and aggressive type of biliary tract cancer. There are various histological types of GBC, and the vast majority of GBC cases are adenocarcinomas. Squamous and adenosquamous carcinomas are rare GBC subtypes that are traditionally considered to be more aggressive and to be associated with a poorer prognosis than adenocarcinoma. Galectin-9 (Gal-9), a tandem-repeat-type galectin, has been reported to induce apoptosis-mediated elimination of various cancers, including hepatocellular carcinoma, cholangiocarcinoma, and hematologic malignancies. Therefore, we investigated the antitumor effects of Gal-9 on GBC in vitro and in vivo. In our in vitro experiments, Gal-9 suppressed cell proliferation in various GBC cell lines but not in the OCUG-1 cell line, which represents a poorly differentiated type of adenosquamous carcinoma. Gal-9 induced the apoptosis of Gal-9-sensitive GBC cells by increasing the levels of caspase-cleaved keratin 18 and phosphorylated p53. However, Gal-9 did not affect the expression of various cell cycle-related proteins. In addition, Gal-9 suppressed tumor growth by implanted human GBC cells in a xenograft model. Furthermore, Gal-9 induced the phosphorylation of the Ephrin type-B receptor, and the microRNA (miRNA) expression profile was markedly altered by Gal-9. Based on these results, various miRNAs might contribute to the suppression of tumor growth. Our data reveal that Gal-9 suppresses the growth of GBC, possibly by inducing apoptosis and altering miRNA expression. Thus, Gal-9 might serve as a therapeutic agent for the treatment of GBC.

Antimicrobial resistance profiles and genetic elements involved in carbapenem resistance in Acinetobacter baumannii isolates from a referral hospital in Southern Iran

In this study, antimicrobial resistance patterns, carbapenemase production, carbapenem-hydrolysing class D OXA-type β-lactamase (CHDL)-encoding genes and ISAba insertion elements were characterised in Acinetobacter baumannii isolates from Southern Iran. A total of 85 A. baumannii isolates from patients in a tertiary care hospital were isolated. Antibiotic susceptibility profiles to 14 antimicrobials were determined by disc diffusion assay. Minimum inhibitory concentrations (MICs) to colistin and tigecycline were determined by the broth microdilution method. Isolates were analysed for OXA-type carbapenemase-encoding genes, ISAba elements upstream of blaOXA genes, and carbapenemase production by the CarbAcineto NP test. Of the 85 A. baumannii isolates, 73 (86%) were non-susceptible to imipenem. The MIC50 and MIC90 values for imipenem were 16mg/L and 64mg/L, respectively. Fourteen isolates (16%) were resistant to colistin. Among the 79 carbapenem-non-susceptible A. baumannii isolates, 77 (97%) were carbapenemase-producers as determined by the CarbAcineto NP test. The most frequently identified OXA-type carbapenemase gene was blaOXA-23-like, which was identified in 44 isolates (52%), followed by blaOXA-24-like with 13 isolates (15%). Statistical analysis showed that ISAba elements upstream of the blaOXA gene were significantly related to imipenem-non-susceptible isolates. The presence of blaOXA genes and ISAba1 and ISAba4 elements can explain the resistance of the isolates to carbapenems. The concerns raised following the emergence of colistin-resistant A. baumannii isolates highlight the need for a comprehensive national programme to collect and examine A. baumannii isolates from different parts of Iran.

Biomedical Applications of Biodegradable Polyesters

The focus in the field of biomedical engineering has shifted in recent years to biodegradable polymers and, in particular, polyesters. Dozens of polyester-based medical devices are commercially available, and every year more are introduced to the market. The mechanical performance and wide range of biodegradation properties of this class of polymers allow for high degrees of selectivity for targeted clinical applications. Recent research endeavors to expand the application of polymers have been driven by a need to target the general hydrophobic nature of polyesters and their limited cell motif sites. This review provides a comprehensive investigation into advanced strategies to modify polyesters and their clinical potential for future biomedical applications.

Is endoscopic resection a correct treatment for atypical gastrointestinal lipomas?

We would like offering our experience about a very rare and underestimated type of gastrointestinal lipoma, which is the lipoma with precancerous or frankly malignant features of the mucosal epithelium, the so-called atypical lipoma. So far, only few cases have been described in the world literature. Recently, we grappled with what we think the first case of atypical colonic lipoma presenting with adenocarcinomatous transformation of the overlying epithelium, as discussed in more detail below. We propose a new definition and classification for this kind of lesions and discuss about their diagnosis, treatment and prognosis.

Papillary carcinoma of breast: Minireview

The term “intracystic papillary ductal carcinoma in situ” constitutes only 0.5% to 1% of all breast cancers. It is usually seen in postmenopausal age group. Herein, we are presenting a minireview about this unusual breast malignancy usually difficult to diagnose on clinical grounds and highlighting modalities of diagnosis and management.

Dual-Energy Computed Tomography Gemstone Spectral Imaging: A Novel Technique to Determine Human Cardiac Calculus Composition

OBJECTIVE

Understanding the chemical composition of any calculus in different human organs is essential for choosing the best treatment strategy for patients. The purpose of this study was to assess the capability of determining the chemical composition of a human cardiac calculus using gemstone spectral imaging (GSI) mode on a single-source dual-energy computed tomography (DECT) in vitro.

METHODS

The cardiac calculus was directly scanned on the Discovery CT750 HD FREEdom Edition using GSI mode, in vitro. A portable fiber-optic Raman spectroscopy was also applied to verify the quantitative accuracy of the DECT measurements.

RESULTS

The results of spectral DECT measurements indicate that effective Z values in 3 designated positions located in this calculus were 15.02 to 15.47, which are close to values of 15.74 to 15.86, corresponding to the effective Z values of calcium apatite and hydroxyapatite. The Raman spectral data were also reflected by the predominant Raman peak at 960 cm for hydroxyapatite and the minor peak at 875 cm for calcium apatite.

CONCLUSIONS

A potential single-source DECT with GSI mode was first used to examine the morphological characteristics and chemical compositions of a giant human cardiac calculus, in vitro. The CT results were consistent with the Raman spectral data, suggesting that spectral CT imaging techniques could be accurately used to diagnose and characterize the compositional materials in the cardiac calculus.

Prospective evaluation of radiation-induced skin toxicity in a race/ethnically diverse breast cancer population

We evaluated predictors of radiation‐induced skin toxicity in a prospective study of a tri‐racial/ethnic breast cancer population. We evaluated patient demographics, tumor characteristics, and treatment variables in the first 392 patients in a prospective study assessing radiation‐induced skin toxicity. Logistic regression analyses were conducted to evaluate potential predictors of skin toxicity. The study consists of 59 non‐Hispanic whites (NHW; 15%), 241 Hispanic Whites (HW; 62%), 79 black or African Americans (AA; 20%), and 13 others (3%). Overall, 48% developed grade 0–1 skin toxicity, 49.8% grade 2, and 2.2% grade 3 by the National Cancer Institute's Common Toxicity Criteria for Adverse Events (CTCAE) scale. Twenty‐one percent developed moist desquamation. In multivariate analysis, higher body mass index (BMI; OR = 2.09; 95%CI = 1.15, 3.82), higher disease stage (OR = 1.82; 95%CI = 1.06, 3.11), ER‐positive/PR‐negative status (OR = 2.74; 95%CI = 1.26, 5.98), and conventionally fractionated regimens (OR = 3.25; 95%CI = 1.76, 6.01) were significantly associated with higher skin toxicity grade after adjustment for age, race, ethnicity, ER status, and breast volume. BMI specifically predicted for moist desquamation, but not degree of erythema. In this racially and ethnically diverse cohort of breast cancer patients receiving radiation to the intact breast, risk factors including BMI, disease stage, and conventionally fractionated radiation predicted for higher skin toxicity grade, whereas age, race, ethnicity, and breast volume did not. BMI specifically predicted for moist desquamation, suggesting that preventive measures to address this particular outcome should be investigated.

Auricular ossification: A newly recognized feature of osteoprotegerin-deficiency juvenile Paget disease

We report auricular ossification (AO) affecting the elastic cartilage of the ear as a newly recognized feature of osteoprotegerin (OPG)-deficiency juvenile Paget disease (JPD). AO and auricular calcification refer interchangeably to rigid pinnae, sparing the ear lobe, from various etiologies. JPD is a rare Mendelian disorder characterized by elevated serum alkaline phosphatase activity accompanied by skeletal pain and deformity from rapid bone turnover. Autosomal recessive transmission of loss-of-function mutations within TNFRSF11B encoding OPG accounts for most JPD (JPD1). JPD2 results from heterozygous constitutive activation of TNFRSF11A encoding RANK. Other causes of JPD remain unknown. In 2007, we reported a 60-year-old man with JPD1 who described hardening of his external ears at age 45 years, after 4 years of treatment with bisphosphonates (BPs). Subsequently, we noted rigid pinnae in a 17-year-old boy and 14-year-old girl, yet pliable pinnae in a 12-year-old boy, each with JPD1 and several years of BP treatment. Cranial imaging indicated cortical bone within the pinnae of both teenagers. Radiologic studies of our three JPD patients without mutations in TNFRSF11B showed normal auricles. Review of the JPD literature revealed possible AO in several reports. Two of our JPD1 patients had experienced difficult tracheal intubation, raising concern for mineralization of laryngeal elastic cartilage. Thus, AO is a newly recognized feature of JPD1, possibly exacerbated by BP treatment. Elastic cartilage at other sites in JPD1 might also ossify, and warrants investigation.

Genome-editing Technologies for Gene and Cell Therapy

Gene therapy has historically been defined as the addition of new genes to human cells. However, the recent advent of genome-editing technologies has enabled a new paradigm in which the sequence of the human genome can be precisely manipulated to achieve a therapeutic effect. This includes the correction of mutations that cause disease, the addition of therapeutic genes to specific sites in the genome, and the removal of deleterious genes or genome sequences. This review presents the mechanisms of different genome-editing strategies and describes each of the common nuclease-based platforms, including zinc finger nucleases, transcription activator-like effector nucleases (TALENs), meganucleases, and the CRISPR/Cas9 system. We then summarize the progress made in applying genome editing to various areas of gene and cell therapy, including antiviral strategies, immunotherapies, and the treatment of monogenic hereditary disorders. The current challenges and future prospects for genome editing as a transformative technology for gene and cell therapy are also discussed.

Role of phosphatase of regenerating liver 3 in gastric carcinoma

Gastric carcinoma is one of the most common malignancies worldwide and remains the third leading cause of cancer death in both sexes worldwide. Phosphatase of regenerating liver 3 (PRL-3) is a tyrosine phosphatase that has been reported to be overexpressed in gastric tissues and play an important role in lymphatic metastasis and peritoneal metastasis of gastric carcinoma. It has also been reported that PRL-3 has a negative relationship with the prognosis of gastric carcinoma patients. More and more researchers have focused on the regulatory mechanism of PRL-3 in gastric carcinoma, aiming to elucidate the possible pathway and influencing factors. However, the exact mechanism of PRL-3 in promoting lymphatic metastasis, peritoneal metastasis and recurrence of gastric cancer is unknown. This paper will review the role of PRL-3 in gastric carcinoma with regard to its structure, function and possible mechanism in gastric carcinoma development.

Omental torsion, a rare cause of acute abdomen

Omental torsion is a rare cause of acute abdominal pain. We report a case of omental torsion in a 7-year-old girl, who presented with right iliac fossa pain. The patient underwent an open appendicectomy, during which a normal appendix was identified and a diagnosis of omental torsion was made. The affected segment of omentum was resected along with the appendix. The patient made an uncomplicated recovery and was discharged on day 1 postoperatively. A normal appendix in the presence of omental torsion is found in 0.1% of all appendicectomies in children. We suggest routine visualisation of the omentum in the presence of a normal appendix during appendicectomy.

Mechanistic analysis of aliphatic β-lactones in Vibrio harveyi reveals a quorum sensing independent mode of action

β-Lactone analogs of autoinducers potently inhibitVibrio harveyibioluminescence using a quorum sensing independent mechanism interfering with fatty acid biosynthesis.

Immunopathogenesis of Chlamydial Infections

Chlamydial infections lead to a number of clinically relevant diseases and induce significant morbidity in human populations. It is generally understood that certain components of the host immune response to infection also mediate such disease pathologies. A clear understanding of pathogenic mechanisms will enable us to devise better preventive and/or intervention strategies to mitigate the morbidity caused by these infections. Over the years, numerous studies have been conducted to explore the immunopathogenic mechanisms of Chlamydia-induced diseases of the eye, reproductive tract, respiratory tract, and cardiovascular systems. In this article, we provide an overview of the diseases caused by Chlamydia, animal models used to study disease pathology, and a historical context to the efforts to understand chlamydial pathogenesis. Furthermore, we discuss recent findings regarding pathogenesis, with an emphasis on the role of the adaptive immune response in the development of chlamydial disease sequelae. Finally, we summarize the key insights obtained from studies of chlamydial pathogenesis and avenues that remain to be explored in order to inform the next steps of vaccine development against chlamydial infections.

Chlamydia pneumoniae Infection and Inflammatory Diseases

Chlamydia pneumoniae, an obligate intracellular bacterial pathogen, has long been investigated as a potential developmental or exacerbating factor in various pathologies. Its unique lifestyle and ability to disseminate throughout the host while persisting in relative safety from the immune response has placed this obligate intracellular pathogen in the crosshairs as a potentially mitigating factor in chronic inflammatory diseases. Many animal model and human correlative studies have been performed to confirm or deny a role for C. pneumoniae infection in these disorders. In some cases, antibiotic clinical trials were conducted to prove a link between bacterial infections and atherosclerosis. In this review, we detail the latest information regarding the potential role that C. pneumoniae infection may have in chronic inflammatory diseases.

Olfactory functioning in early multiple sclerosis: Sniffin' Sticks Test study

INTRODUCTION

Previous studies have shown that olfactory functioning is affected by multiple sclerosis (MS). This study assessed the level of the olfactory impairment in early MS by using the Sniffin' Sticks Test.

METHODS

This study included 30 patients with MS and 30 healthy controls. We collected demographic and clinical data from participants and administered the Sniffin' Sticks Test.

RESULTS

We found no differences between the MS and control groups in odor discrimination, odor identification, and threshold discrimination identification scores, but odor threshold (OT) scores were higher in the control group than in the MS group (P=0.49). In addition, we did not find any correlation between MS patients' olfactory test scores and their scores on the Mini-Mental State Examination (MMSE), Expanded Disability Status Scale (EDSS), disease duration, history of optic neuritis, or being on immunomodulatory therapy.

CONCLUSION

In recent studies, odor threshold impairment seemed to be the most striking finding in patients with MS. Although the present study found a mild alteration in odor threshold, olfactory dysfunction appears to be a consequence of neurodegeneration in the higher order olfactory brain regions, which is thought to be a time-dependent process.

Improving proprioceptive deficits after stroke through robot-assisted training of the upper limb: a pilot case report study

The purpose of this study was to determine whether a conventional robot-assisted therapy of the upper limb was able to improve proprioception and motor recovery of an individual after stroke who exhibited proprioceptive deficits. After robotic sensorimotor training, significant changes were observed in kinematic performance variables. Two quantitative parameters evaluating position sense improved after training. Range of motion during shoulder and wrist flexion improved, but only wrist flexion remained improved at 3-month follow-up. These preliminary results suggest that intensive robot-aided rehabilitation may play an important role in the recovery of sensory function. However, further studies are required to confirm these data.

Peripheral ossifying fibroma: A rare case affecting maxillary region

Focal gingival enlargements are a diverse group of lesions with almost similar clinical presentation but varied etiology and histopathology. The actual cause of peripheral ossifying fibroma (POF) has been debated over many years. POFs are usually seen in childhood and younger ages. There is a slight female predilection. It is usually localized, rarely generalized. Usually, the treatment option is only surgical excision with minimal chances of recurrence. Here, we report a case of POF of the right maxillary posterior region with a review of literature.

Krill oil reduces intestinal inflammation by improving epithelial integrity and impairing adherent-invasive Escherichia coli pathogenicity

BACKGROUND

Krill oil is a marine derived oil rich in phospholipids, astaxanthin and omega-3 fatty acids. Several studies have found benefits of krill oil against oxidative and inflammatory damage.

AIMS

We aimed at assessing the ability of krill oil to reduce intestinal inflammation by improving epithelial barrier integrity, increasing cell survival and reducing pathogenicity of adherent-invasive Escherichia coli.

METHODS

CACO2 and HT29 cells were exposed to cytomix (TNFα and IFNγ) to induce inflammation and co-exposed to cytomix and krill oil. E-cadherin, ZO-1 and F-actin levels were analyzed by immunofluorescence to assess barrier integrity. Scratch test was performed to measure wound healing. Cell survival was analyzed by flow cytometry. Adherent-invasive Escherichia coli LF82 was used for adhesion/invasion assay.

RESULTS

In inflamed cells E-cadherin and ZO-1 decreased, with loss of cell-cell adhesion, and F-actin polymerization increased stress fibres; krill oil restored initial conditions and improved wound healing, reduced bacterial adhesion/invasion in epithelial cells and survival within macrophages; krill oil reduced LF82-induced mRNA expression of pro-inflammatory cytokines.

CONCLUSIONS

Krill oil improves intestinal barrier integrity and epithelial restitution during inflammation and controls bacterial adhesion and invasion to epithelial cells. Thus, krill oil may represent an innovative tool to reduce intestinal inflammation.

Cuff-Induced Neointimal Formation in Mouse Models

Ischemic heart failure caused by atherosclerosis is a major cause of death worldwide. Although remarkable technological advances have been made in the treatment of coronary heart disease, there is as yet no treatment that can sufficiently suppress the progression of atherosclerosis, including neointimal thickening. Therefore, a precise understanding of the mechanism of neointimal hyperplasia will provide the development of new technologies. Both ApoE-KO and LDLR-KO mice have been employed to generate other relevant mouse models of cardiovascular disease through breeding strategies. Although these mice are effective tools for the investigation of atherosclerosis, development of a progressive atherosclerotic lesion takes a long time, resulting in increase of both the costs and the space needed for the research. Thus, it is necessary to develop simpler tools that would allow easy evaluation of atherosclerosis in mouse models. In this review, we discuss our experience in generating mouse models of cuff-induced injury of the femoral artery and attempt to provide a better understanding of cuff-induced neointimal formation.

Oropharyngeal dysphagia: manifestations and diagnosis

Swallowing disorders (dysphagia) have been recognized by the WHO as a medical disability associated with increased morbidity, mortality and costs of care. With increasing survival rates and ageing of the population, swallowing disorders and their role in causing pulmonary and nutritional pathologies are becoming exceedingly important. Over the past two decades, the study of oropharyngeal dysphagia has been approached from various disciplines with considerable progress in understanding its pathophysiology. This Review describes the most frequent manifestations of oropharyngeal dysphagia and the clinical as well as instrumental techniques that are available to diagnose patients with dysphagia. However, the clinical value of these diagnostic tests and their sensitivity to predict outcomes is limited. Despite considerable clinical research efforts, conventional diagnostic methods for oropharyngeal dysphagia have limited proven accuracy in predicting aspiration and respiratory disease. We contend that incorporation of measurable objective assessments into clinical diagnosis is needed and might be key in developing novel therapeutic strategies.

[Impact of obesity on response to therapy and pulmonary function in children with asthma]

OBJECTIVE

To investigate the effects of obesity on response to therapy and pulmonary function in children with asthma who receive inhaled corticosteroid (ICS) treatment.

METHODS

A total of 129 children with asthma were divided into two groups according to their body mass index: normal weight group (n=64) and obese group (n=65). The asthma control status and pulmonary function were compared between the two groups after one year of ICS treatment. The pulmonary function was expressed as percent forced expiratory volume in 1 second (FEV1%), percent predicted forced vital capacity (FVC%), peak expiratory flow (PEF), peak expiratory flow at 25% of vital capacity (PEF25), and peak expiratory flow at 50% of vital capacity (PEF50). The asthma control status was expressed as complete control rate, partial control rate, and uncontrolled rate. Sixty-eight healthy children were selected as the healthy control group.

RESULTS

There were significant differences in the indices of pulmonary function between the three groups before treatment (P<0.01); the healthy control group had the best values of pulmonary function, while the obese group had the worst values. After 1 year of treatment, the normal weight group showed significantly more improvements in FEV1% and FVC% than the obese group (P<0.01). However, there were no significant differences in improvements in PEF, PEF25, and PEF50 between the two groups. The complete control rate, partial control rate, and uncontrolled rate in the normal weight group were 72%, 19%, and 9%, respectively, while the rates in the obese group were 28%, 51%, and 22%, respectively; the normal weight group had a significantly better asthma control status than the obese group (P<0.01).

CONCLUSIONS

The asthmatic children with obesity have a significantly less improvement in large airway function and a poorer asthma control status after ICS treatment than those with the normal weight.