Postoperative pulmonary complications in older patients undergoing elective surgery with a supraglottic airway device or tracheal intubation

The two most commonly used airway management techniques during general anaesthesia are supraglottic airway devices and tracheal tubes. In older patients undergoing elective non-cardiothoracic surgery under general anaesthesia with positive pressure ventilation, we hypothesised that a composite measure of in-hospital postoperative pulmonary complications would be less frequent when a supraglottic airway device was used compared with a tracheal tube. We studied patients aged ≥ 70 years in 17 clinical centres. Patients were allocated randomly to airway management with a supraglottic airway device or a tracheal tube. Between August 2016 and April 2020, 2900 patients were studied, of whom 2751 were included in the primary analysis (1387 with supraglottic airway device and 1364 with a tracheal tube). Pre-operatively, 2431 (88.4%) patients were estimated to have a postoperative pulmonary complication risk index of 1-2. Postoperative pulmonary complications, mostly coughing, occurred in 270 of 1387 patients (19.5%) allocated to a supraglottic airway device and 342 of 1364 patients (25.1%) assigned to a tracheal tube (absolute difference -5.6% (95%CI -8.7 to -2.5), risk ratio 0.78 (95%CI 0.67-0.89); p < 0.001). Among otherwise healthy older patients undergoing elective surgery under general anaesthesia with intra-operative positive pressure ventilation of their lungs, there were fewer postoperative pulmonary complications when the airway was managed with a supraglottic airway device compared with a tracheal tube.

[Effect of plumbagin on epithelial-mesenchymal transition and underlying mechanisms in human tongue squamous cell carcinoma cells]

Objective: To study the effect of plumbagin on epithelial-mesenchymal transition (EMT) and underlying mechanisms in human tongue squamous cell carcinoma (TSCC) cells. Methods: Methyl thiazolyl tetrazolium assay was apllied to examine the proliferation inhibition effect and half maximal inhibitory concentration (IC(50)) of plumbagin (0.1, 1.0, 5.0, 10.0, 20.0 μmol/L) in 12, 24, 48 h in TSCC cells. Transwell assay was used to count the number of transmembrane cells and scratch test was performed to examine cells mobility. The flow cytometry was applied to measure intracellular reactive oxygen species (ROS) level in control group, plumbagin group (1.0 μmol/L, 24 h) and glutathione (GSH)+plumbagin group. The expression of E-cadherin, vimentin, Slug, p38 mitogen activated protein kinases (p38MAPK) and phospho-p38MAPK (p-p38MAPK) proteins were determined by Western blotting. The expression of E-cadherin, vimentin and Slug were detected by Western blotting in control group, plumbagin group, activator combined group (p38MAPK activator+plumbagin) and inhibitor combined group (p38MAPK inhibitor+plumbagin). Results: After the treatment of plumbagin for 12, 24, and 48 h, the IC(50) of TSCC cells were 10.3, 3.1, 1.5 μmol/L. After treated by 1.0 μmol/L plumbagin for 24 h, the number of transmembrane cells were significantly reduced ([50±13], P<0.05) in comparison to control group (204±6), as well as the cells mobility ([18.2±2.3]%, P<0.05) in comparison to control group ([49.3±1.2]%). Compared to control group (2.32±0.52), the ROS level was increased in plumbagin group (902.20±10.69), while compared to plumbagin group, the ROS level was reduced in GSH combined group (2.18±0.15). In comparison to control group, the expression of E-cadherin was up-regulated (P<0.05), and vimentin, Slug, p-p38MAPK/p38MAPK were down-regulated in plumbagin group (P<0.05). In comparison to plumbagin group, the expression of E-cadherin was down-regulated (P<0.05), and vimentin, Slug, p-p38MAPK/p38MAPK were up-regulated in GSH combined group (P<0.05). Treatment of cells with p38MAPK activator could decrease the expression of E-cadherin significantly (P<0.05) and increase the expression of vimentin (P<0.05) and Slug (P<0.05) in comparison to plumbagin group. Treatment of cells with p38MAPK inhibitor could increase the expression of E-cadherin significantly (P<0.05) and decrease the expression of vimentin (P<0.05) and Slug (P<0.05) in comparison to plumbagin group. Conclusions: Plumbagin inhibits EMT via ROS/p38MAPK-mediated pathway in human TSCC cells.

3-D imaging, illustration, and quantitation of enteric glial network in transparent human colon mucosa

BACKGROUND

Enteric glia form a network in the intestinal mucosa and have been suggested to engage in multidirectional interactions with the epithelium, blood vessels, nerves, and immune system. However, due to the dispersed nature of the glial network, standard histology cannot provide a global view of the network architecture. We prepared transparent human colon mucosa for three-dimensional (3-D) confocal microscopy with S100B immunostaining to reveal the location-dependent glial network for qualitative and quantitative analyses.

METHODS

Full-thickness human colons were acquired from colectomies performed for colorectal cancer. We targeted the mucosa away from the tumor site to characterize the glial network morphology. Optical clearing (use of immersion solution to reduce scattering) was applied to generate transparent specimens for deep-tissue microscopy.

KEY RESULTS

Two features of the glial network were seen: (i) A dense glial population resides at the crypt base/mucosal boundary in contact with the lymphatic vessels, and (ii) from the base, the glial network elongates along the crypt axis with peri-cryptic and peri-vascular connections toward the opening. We quantified the mucosal glia as the S100B-positive cells with at least two processes extending from the cell body. Examples of the global and in-depth imaging of adenoma were given to illustrate the morphological correlation between the loss of glial fibers and the aberrant crypts.

CONCLUSIONS & INFERENCES

We have established a useful approach for 3-D imaging, panoramic illustration, and quantitation of the enteric glia in the human colon mucosa to help characterize their roles with mucosal components in health and disease.

Leptomeningeal malignant melanoma arising in neurocutaneous melanocytosis: a case report

A rare case of histology-proved giant congenital melanocytic nevus (GCMN) with symptomatic leptomeningeal melanocytosis is reported. A 26-year-old man had had a large patch of pigmented nevus over his back and left arm since birth. He had begun to have seizures as well as symptoms and signs of increased intracranial pressure about six months before admission. Serial computed tomography of brain showed hydrocephalus, diffuse leptomeningeal enhancement and multiple well-enhanced, rapid-growing nodules on the surface of the cerebellum and left parietal lobe. Magnetic resonance imaging (MRI) revealed T1 shortening of leptomeninges on precontrast T1 weighted imaging. Skin biopsy was done twice and showed intradermal nevus. Biopsy on one of the intracranial nodules revealed malignant melanoma arising in the melanocytosis. He died one year after the onset of neurologic symptoms. For early diagnosis of neurocutaneous melanocytosis, we suggest 1) MRI, and 2) leptomeningeal biopsy in patients with suspected leptomeningeal malignant melanoma.

Pleural non-Hodgkin's lymphoma arising in a patient with a chronic pyothorax

A 69 year old man with a chronic left pyothorax was treated by decortication. Although the treatment rapidly improved respiratory function, histopathological examination revealed a diffuse large B cell non-Hodgkin's lymphoma. Subsequent bone marrow biopsy samples disclosed bone marrow involvement. It is possible that non-Hodgkin's lymphoma may develop from a chronic pyothorax.

Thin basement membrane nephropathy: a report of two cases

Two cases of thin basement membrane nephropathy were collected from 233 renal biopsies which contained adequate material for diagnosis. Both patients had presented with persistent hematuria. Thin glomerular basement membrane was the sole significant abnormality found in their renal biopsies. A complete workup of renal biopsy including light microscopy, immunofluorescence study and electron microscopy is mandatory for patients with unexplained hematuria.

A retrospective study of DNA ploidy of transitional cell carcinoma of urinary bladder using flow cytometry

Transitional cell carcinoma is the most common malignancy of urothelial origin in urinary bladder. Its aggressive potential cannot be reliably predicted from the histologic appearance alone. Recently, there has been extensive studies of DNA ploidy using flow cytometry in prospective analysis of bladder tumors with fresh tissue. Techniques for the preparation of paraffin embedded tissue have been developed and successfully applied in retrospective evaluation of bladder tumors. These studies had demonstrated the correlation between histological grading and DNA ploidy, and between clinical staging and DNA ploidy. Our retrospective study showed that the cytometric method is superior to histologic grading in the predictability of patient's survival, especially in the low grade (grades 1 and 2) group. In the preparation of paraffin embedded tissue, the high background debris and wide range of coefficients of variation had some interference in the interpretation for the histogram of FCM (only 80% of the cases studied are interpretable). This interference might be due to the variation of conditions of tissue processing and fixation. The evaluation of S phase fraction and G2/M fraction is also difficult to perform because of the same problem. There was an encouraging result in the evaluation of DNA ploidy using flow cytometry with paraffin embedded tissue, although a relatively small number of patients were included in this study. The value of this technique application in clinical evaluation of the prognosticity was obvious.

Malignant peritoneal mesothelioma: a case report

Malignant peritoneal mesothelioma is a rare disease, not previously reported in Taiwan. The reported case concerns a 64-year-old veteran who had suffered from abdominal pain and distension for several days. After exploratory laparotomy, segmental resection of the small intestine, excised a mesenteric mass. A characteristic biphasic pattern resulting from the admixture of gland-like area and a sarcomatous stroma presented in the histologic section. A series of histochemical, immunohistochemical and ultrastructural studies proved this to be a malignant peritoneal mesothelioma. The patient died after a course of post-operative chemotherapy. History of asbestos exposure, with which the tumor is usually intimately associated, could not be traced with certainty. Poor prognosis is the rule of the disease; almost all patients die within two years of diagnosis. An effective therapeutic modality is still unavailable. Here the clinical and pathologic characteristics of the tumor are described, with a brief review and discussion of the pathogenesis as well as the obscured therapeutic problem.

Single-laboratory validation of EPA Method 8150 for determination of chlorinated herbicides in hazardous waste

Method 8150, published in the second edition of Test Methods for Evaluating Solid Waste, Manual SW-846, required optimization, ruggedness testing, linearity determinations, precision tests, bias testing, gas chromatographic/mass spectrometric confirmation, and quality control guidelines for validation of the protocol. This single-laboratory validation, which is applicable to the determination of the herbicides dicamba, silvex, 2,4-D, 2,4-DB, 2,4,5-T, dinoseb, MCPP, MCPA, and dichlorprop in hazardous waste extracts, was completed and is described in this report. Final ruggedness testing of the optimized procedure gave a mean recovery of 89.3% with a standard deviation of 4.3%. Percent relative standard deviations are less than 10 (n = 20, each analyte) over a 10(2) linear range of concentration for MCPP and MCPA and over a 10(3) linear range of concentration for the other target herbicide esters. Instrumental detection limits for electron capture detection and mass spectrometric identity confirmation were determined and found to be matrix-dependent.