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Ligation of Patent Ductus Arteriosus via Anterior Thoracotomy in Preterm Infants: 10-...
Arif Selcuk
Murat Çiçek

Arif Selcuk

and 11 more

September 07, 2020
BACKGROUND The aim of this study is to describe the short-term and mid-term outcomes of the preterm infants who underwent patent ductus arteriosus (PDA) ligation in by anterior mini-thoracotomy. METHODS Data of 103 preterm infants who underwent PDA ligation by anterior mini-thoracotomy between 2009 and 2019 were retrospectively reviewed. PDA was clipped through an anterior mini-thoracotomy at the 2nd intercostal space. Outcomes were defined according to complications, morbidity and mortality rates within the postoperative 30 days and one year. RESULTS The median weight of the patients during the operation was 900 (IQR800–1125 g) grams and the lowest body weight was 460 grams. The median age at the operation was 21 (IQR14,5–29 days) days. In three patients (3%) there was intraoperative bleeding from the PDA that required transition to median sternotomy. In one patient (1%) residual PDA was seen and this patient was reoperated on the 4th postoperative day. One patient (1%) underwent surgical revision for chylothorax and chylomediastinum causing late cardiac tamponade on the 26th postoperative day. Twelve patients (12%) died in the first 30 days postoperatively. Six patients (6%) died between the thirtieth day and a year. CONCLUSIONS After a decade and over a hundred patients with PDA ligation through anterior mini-thoracotomy in preterm infants is still the main procedure of choice in this patient group in our clinic. Our outcomes demonstrate the safety of this approach and we believe that it can be reproducible.
Left Ventricular Pseudo-aneurysm with Ventricular Septal Perforation after Acute Myoc...
Muzheng Li
Na Liu

Muzheng Li

and 7 more

September 11, 2020
We report a case with left ventricular pseudo-aneurysm and ventricular septal perforation after acute myocardial infarction. A 77-year-old man was admitted because of repeated chest distress and chest pain for 1 week, which was diagnosed by an electrocardiogram with acute anteroseptal ST-segment elevation myocardial infarction and troponin T elevation. The transthoracic echocardiography and cardiac magnetic resonance showed the left ventricular apical pseudo-aneurysm and lower segment of ventricular septal perforation, and confirmed by left ventriculography. Surgical treatment was performed, with operation procedure successfully. In this article, we report a rare case in clinical and review the literatures of left ventricular pseudo-aneurysm.
Successful treatment of IgG4-related hypertrophic pachymeningitis with induction ritu...
Karan Seegobin
Muhamad Alhaj Moustafa

Karan Seegobin

and 7 more

September 07, 2020
IgG4-related disease (IgG4RD) with intracranial involvement is rare. We report a 56-year-old male who had an excellent response to rituximab and dexamethasone after going undiagnosed for 5 years. After 3 years of rituximab maintenance, he has no evidence of disease on brain MRI.
Mixed problem with dynamical transmission condition for a one-dimensional hyperbolic...
Akbar Aliyev
Gulshan Shafieva

Akbar Aliyev

and 1 more

September 11, 2020
In this paper, we study a mixed problem for the nonlinear hyperbolic equation with a strong dissipation and a dynamical transmission condition. The existence and uniqueness theorems of local and global solutions are proved
CodY, ComA, DegU and Spo0A Controlling Lipopeptides Biosynthesis in Bacillus amyloliq...
Jing Sun
Yanan Liu

Jing Sun

and 4 more

September 11, 2020
Bacillus amyloliquefaciens, as a biocontrol bacterium, mainly produces secondary metabolites to resist pathogenic microorganisms. In the study, B. amyloliquefaciens fmbJ could produce several antimicrobial lipopeptides (bacillomycin D, surfactin, and fengycin). In order to clarify the influence of transcriptional regulatory genes (codY, comA, degU, and spo0A) regulating the biosynthesis of lipopeptides, especially bacillomycin D, these genes in fmbJ were knocked out. The results showed that the productions of bacillomycin D were significantly reduced compared with that of fmbJ. The changes of lipopetides production in fmbJ with the genes deleted were then analyzed by comparative transcriptomics. Their deletion induced great changes in the levels of transcripts specifying metabolic pathways, quorum sensing system and substance transport system in fmbJ. Moreover, overexpression of these genes improved the productions of bacillomycin D. In particular, the overexpression of spo0A enhanced bacillomycin D yield up to 648.9 ± 60.9 mg/L from 277.3 ± 30.5 mg/L. On the contrary, the yields of surfactin in fmbJΔcodY and fmbJΔdegU were significantly improved. And, the regulatory factor CodY had no significant effect on the synthesis of fengycin. In addition, it was found that CodY had a concentration dependence on bacillomycin D synthesis. This study indicated the direction of genetic manipulation to improve the yields of antimicrobial lipopeptides and laid a theoretical foundation for the industrial production of lipopeptides.
Isolated Pulmonary Presentation of Childhood Goodpasture's Disease
Ketan  Kumar
Joseph L. Mathew

Ketan Kumar

and 5 more

September 11, 2020
Antiglomerular basement membrane disease is a small vessel vasculitis which affects the lungs and kidneys, causing diffuse alveolar haemorrhage and rapidly progressive glomerulonephritis respectively. It is extremely uncommon in children. Diagnosis requires the presence of specific anti-GBM autoantibodies. Presentation with renal involvement is much more common than pulmonary involvement. However, a small proportion of cases might have isolated pulmonary involvement. Minimal changes on renal biopsy could still be present in these patients. Treatment of antiglomerular basement membrane disease includes plasmapheresis and immunosuppression. We present a case where a 7 year old boy presented with a long history suggestive of pulmonary haemorrhage but no renal manifestations and was diagnosed on the basis of anti-GBM autoantibodies and renal biopsy. He responded well to immunosuppressive therapy alone.
Outcomes of Cardiac Surgery in Jehovah’s Witness Patients: A Review
Aimee-Louise Chambault
Louise Brown

Aimee-Louise Chambault

and 3 more

September 11, 2020
Objective: To review current literature evidence on outcomes of cardiac surgery in Jehovah’s Witness patients. Methods: A comprehensive electronic literature search was done from inception to 20th August 2020 identifying articles that discussed optimisation/outcomes of cardiac surgery in Jehovah’s Witness either as a solo cohort or as comparative to non-Jehovah’s Witnesses. No limit was placed on time and place of publication and the evidence has been summarized in a narrative manner within the manuscript. Results: The outcomes of cardiac surgery in Jehovah’s Witness patients has been described, and also compared, to non-Witness patients within a number of case reports, case series and comparative cohort studies. Many of these studies note no significant differences between outcomes of the two groups for a number of variables, including mortality. Pre-, intra- and post-operative optimisation of the patients by a multidisciplinary team is important to achieve good outcomes. Conclusion: The use of a bloodless protocol for Jehovah’s Witnesses does not appear to significantly impact upon clinical outcomes when compared to non-Witness patients, and it has even been suggested that a bloodless approach could provide advantages to all patients undergoing cardiac surgery. Larger cohorts and research across multiple centres into the long term outcomes of these patients is required.
INVESTIGATION OF EFFECTS OF DIFFERENT DRAINAGE METHODS ON POSTOPERATIVE PLEURAL COMPL...
FERHAT BORULU
Yusuf Velioglu

FERHAT BORULU

and 1 more

September 11, 2020
ABSTRACT Background The aim of this study was to investigate whether the need for thoracic tubes placed in the intercostal space, which cause severe pain in postoperative period and serious problems in pulmonary rehabilitation, could be eliminated by Jackson drains placed in mediastinum in patients who undergo off-pump surgery. Method A prospective analysis of 135 patients who underwent routine off-pump isolated CABG surgery in our clinic between January 2017 and June 2018 was performed. 65 patients had subxiphoid mediastinal drains and intercostal chest drains, and 64 patients had one subxiphoid mediastinal drain and one mediastinal Jackson drain. Postoperative pain scores, analgesic needs of patients, radiologically, effusion and pneumothorax assessments were recorded and pleural complications requiring invasive intervention were compared. Results There was no difference between the groups in terms of age, gender and comorbidities. In terms of pain scoring and analgesia requirement at the first hour after intubation, there was a significant superiority in all follow-up periods in group 2 (p˂0.001). In 2 patients in group 1 (3.1%) and in two patients in group 2 (3.07%) pleural effusion requiring intervention was detected. There was no significant difference between the two groups in terms of effusion pneumothorax, in terms of blood transfusion and other postoperative complications, postoperative whole blood replacement was higher in group 2 (P = 0.002). Conclusion Based on the results of the present study, we concluded that it was not necessary to insert intercostal chest tubes especially in off-pump surgery.
Mitral valve disease: A view on pathophysiology and management of the most common val...
Bianca  Botezatu
Sahil Kakar

Bianca Botezatu

and 6 more

September 11, 2020
Objectives: Mitral valve disease is increasingly prevalent. Timely diagnosis and the choice of the right intervention are very important in the early stages, as valvular dysfunction often leads to cardiac failure and even sudden death. The focus of this paper is on the various pathologies of the mitral valve, their etiology, and clinical management. Methods: Mitral regurgitation (MR) can be managed surgically, percutaneously or medically. Treatment methods for primary MR include percutaneous mitral valve (MV) repair, MV replacement, minimally invasive mitral valve surgery (MIMVS), and more recently, robotics. Additionally, conventional sternotomy has been used for both MR and mitral stenosis. Nonetheless, ongoing clinical trials are a clear indicator that the management of valve diseases is continuously evolving. Results: Multiple studies favour MV repair via MIMVS, over conventional sternotomy or percutaneous approach. However, more data is needed to optimize patient selection. Robot assisted repair is a new alternative, but attention should be given to the steep learning curve and medical training of professionals wishing to perform this intervention. Cost effectiveness and possible side effects should be explored by clinical trials as well. While guidelines are fairly straightforward for primary MR, there is insufficient evidence to suggest that surgical treatment is advantageous for secondary MR. Management is usually pharmaceutical and aims to treat symptoms rather than cause. Conclusion: Mitral valve disease remains a medical challenge, but numerous research and clinical trials have been embarked upon to refine old methods and discover new ones to improve treatment success and procedural safety.
Reply to a brief comment on the past and present of surgical treatment of cardiac wou...
Erwan Flecher
Alain Leguerrier

Erwan Flecher

and 2 more

September 11, 2020
Dear Editor, First we would like to thank Dr Lopez de la Cruz for her comments and interest about our recently published article “the odyssey of suturing cardiac wounds: lessons from the past”. We highly appreciated and agree with the complements she made especially about Larrey and Milton role in this field. One should also note Theodore Tuffier’s attempt at cardiac resuscitation in 1898 in a young man dying on the wards at La Pitié Hospital (Paris)¹. Although this act was performed on an unwounded heart it adds information about the history of surgical approach in such dramatic condition. We do recognize left anterolateral thoracotomy as the gold standard in an emergency room to treat a penetrating cardiac injury. However a median longitudinal sternotomy may be discussed in our opinion if the patient arrived directly in a cardiac surgery operating theater. The patent presented in our paper was directly brought in our operative theater of cardiac surgery and managed immediately by cardiac surgeons and cardiac anesthesiologists, with a cardiopulmonary bypass ready, dedicated scrub nurses and perfusionist. In such specific conditions a sternotomy may be discussed, depending on the context and the anatomical suspected lesions (it was the option retained in the presented case and the surgical procedure was safely performed with good outcome). Clearly, in a peripheral hospital or at the emergency room sternotomy is not an option to be considered and we agree with Dr Lopez de la Cruz.
Cardiogenic shock on 5-fluoruracile: a rare, fulminant and transient disease that des...
Tiphaine Lambert
Valérie Boige

Tiphaine Lambert

and 5 more

September 11, 2020
Five-fluorouracil (5-FU) and platins remain a first line treatment in oncology with a potential of cardiovascular toxicity. We identified two cases of acute severe cardiac toxicity treated with a combination of 5FU (different production batch) and platins at three months interval at two different institutions referred to our cardio-oncology services. Both cases had similar clinical presentation, favorable outcomes and identical cardiac magnetic imaging scans at follow-up. Mechanism was direct myocardial toxicity in the case with endomyocardial biopsy. Circulatory support as a bridge to recovery should be considered in the case of untreatable cardiogenic shock likely due to 5-FU.
Hinkson Creek Experimental Watershed, Missouri, USA: Findings, Information and the Fu...
Jason Hubbart
Sean Zeiger

Jason Hubbart

and 5 more

September 11, 2020
Managers are often inadequately informed to make decisions for municipal watersheds, in which sources of impairment are shifting due to the combined influences of land use change, rapid ongoing human population growth, and changing environmental conditions. To progressively pursue best-managed, science-based futures, municipal watersheds can be studied using an experimental watershed approach. To demonstrate this approach in a contemporary watershed, a nested-scale experimental watershed study design was implemented in a representative, mixed-use watershed located in the Midwestern USA. Results to date show that urban/suburban development and agriculture are primary (often combined) drivers of alterations to watershed hydrology, streamflow regimes, transport of multiple water quality constituents, and stream physical habitat. However, several natural processes and watershed characteristics, such as surficial geology and stream system evolution, are likely compounding observed water quality impairment and aquatic habitat degradation. Given the varied and complicated set of factors contributing to issues in the study watershed, watershed restoration is likely subject to physical limitations and should be conceptualized in the context of achievable goals/objectives. Results demonstrate the capacity of the experimental watershed approach to objectively identify causal factors, target critical source areas, and provide the science-based information, and shared data, necessary to make effective, collaborative, and adaptive management decisions. Results further demonstrate the immense, globally transferable value of the experimental watershed approach to address municipal watershed management challenges.
Comment on: “Team approach: Management of osteonecrosis in children with acute lympho...
Bruce Bostrom

Bruce Bostrom

September 11, 2020
Jones et al. have given us an excellent guide for the management of symptomatic osteonecrosis in children and young adults with ALL. (1) I would like to present our 10 year retrospective concurrent control evaluation of pamidronate for reducing the incidence of symptomatic osteonecrosis which may be of interest.Patients aged 10-28 years at time of ALL diagnosis were given intravenous pamidronate (1 mg/kg IV over 2 hours) monthly for one year at the discretion of the primary oncologist, starting as early as possible after diagnosis.Concurrent controls age 10-28 did not receive pamidronate. All were treated according to the concurrent COG protocols with intermittent dexamethasone during delayed intensification.(2) Imaging was performed if osteonecrosis was suspected based on symptoms. Patients with BCR-ABL ALL were excluded, as dasatinib may increase the risk of osteonecrosis. (3,4)Patients were diagnosed between January 2010 and March 2018. They were censored at relapse (n=4; 2 controls) bone marrow transplant (n=4; 3 controls) or at last follow up. Data was analyzed 6/1/2020. The median follow up is 3.3 years from diagnosis to event or censoring. This retrospective study was approved by Children’s Minnesota IRB. Data was entered into excel and transferred to SPSS version 23 for analysis.There were 65 patients, 38 males, 27 females, of which 49 had B-lineage and 16 T-lineage ALL. Pamidronate was started during induction in 63% of patients, and before delayed intensification in 85%. The mean, median and interquartile range for the number of pamidronate doses was 11.6, 12, 10.8 to 12. Pamidronate was used in 26 patients, with four subsequently developing symptomatic osteonecrosis. There were 39 concurrent controls who did not receive pamidronate with 14 developing osteonecrosis. Five from this group have since received joint replacements. There were no short or long term side-effects from pamidronate infusions including osteonecrosis of the jaw or hypocalcemia.The incidence of symptomatic osteonecrosis by Kaplan-Meier analysis with was 16% with pamidronate vs. 39% in controls (figure 1). P-value is significant at 0.043 (Breslow Generalized Wilcoxan). There was no significant difference in the leukemia lineage, gender distribution or Body Mass Index (BMI) at diagnosis between groups. For all patients the mean, median, and interquartile range for BMI was 25.8; 22.0; 14.2 to 28.8 Kg/m2.The age at diagnosis was significantly greater in the pamidronate group with a mean, median and Interquartile range 18.4; 18.6; 13.8 to 23.4 years for pamidronate patients vs. 15.6; 15.7; 11.5 to 19.9 in concurrent controls (independent means t-test p = 0.01). Age was not significant for osteonecrosis in Cox Proportional Hazard analysis (p=0.10).Study limitations include small numbers of patients from a single institution and lack of a randomized control group. Strengths of the study are the long duration of followup, as most of the patients are beyond the peak risk time for osteonecrosis. We hope these results even with its limitations would spark interest in a randomized trial of pamidronate in patients at high risk of symptomatic osteonecrosis.Author Contributions and Disclosures: Bruce Bostrom was the sole contributor to this submission and has no conflict-of-interest to disclose. Jack Knutson assisted with data collection as part of a high school senior mentor connection project. Char Bostrom provided invaluable editorial assistance.Figure 1 legend : Incidence of symptomatic osteonecrosis from time of ALL diagnosis in patients who received prophylactic pamidronate and concurrent controls.
Concurrent application of blinatumomab and haploidentical donor leukocyte infusions f...
Jasmine Smith
Abhijeet Kumar

Jasmine Smith

and 2 more

September 11, 2020
Primary mediastinal large B-cell lymphoma (PMBCL) is a rare hematologic malignancy with distinct clinical and immunopathological features. We report a case of a young adult male with disease refractory to multiple lines of therapy, including CAR-T cells, who achieved his first complete remission after haploidentical BMT, following donor leukocyte infusions (DLI) given concurrently with blinatumomab. While DLI has been used after T-replete haplo-BMT with PT-CY, there are no reports on its use for PMBCL. Similarly, blinatumomab is active against B-cell lymphomas, but literature is lacking in patients with PMBCL. Our experience illustrates that blinatumomab can be used concurrently with DLI in a haploidentical setting to achieve disease response in PMBCL. Despite our encouraging experience with this case, we would not recommend this approach outside of a clinical trial as blinatumomab may exacerbate the GvHD risks of DLI especially in a haploidentical setting.
Neonatal Fc receptor induces intravenous immunoglobulin growth suppression in Langerh...
Yuka Nabeshima
Tatsuki  Kataoka

Yuka Nabeshima

and 8 more

September 07, 2020
BACKGROUND: The neonatal Fc receptor (FcRn) plays a role in trafficking IgG and albumin and is thought to mediate intravenous immunoglobulin (IVIG) therapy for certain diseases. IVIG can be used for the treatment of human Langerhans cell histiocytosis (LCH); however, the mechanism remains unclear. The expression and function of FcRn have not been studied in LCH. METHODS: We evaluated the expression of FcRn in pathological samples with LCH by Immunohistochemistry, and did in LCH-like cell lines by RT-PCR and immunoblotting. Cell growth assay and immunocytochemistry were employed to evaluate the FcRn function in the LCH cell line in the presence or absence of albumin in the culture medium. RESULTS: We confirmed the expression of FcRn in 26 of 30 pathological cases (86.7%) diagnosed immunohistochemically as LCH. The expression was independent of age, gender, location, multi- or single-system, and the status of BRAFV600E immunostaining. We also confirmed the expression of FcRn mRNA and protein in the human LCH-like cell line ELD-1, but not in another LCH-like cell line PRU-1. IVIG administration suppressed albumin-dependent cell growth of mock ELD-1 cells, but not of FcRn-knockdown ELD-1 cells. FITC-conjugated albumin was taken into Rab11-positive recycle vesicles in mock ELD-1 cells, but not in FcRn-knockdown ELD-1 cells. IVIG prolonged this status in mock ELD-1 cells. CONCLUSION: ELD-1 recycled albumin via FcRn and albumin was disused for cell growth. Our results increase our understanding of the molecular mechanism of IVIG treatment of LCH.
Body weight and body composition among Japanese childhood leukemia/lymphoma survivors
Hideki Nakayama
Maiko Noguchi

Hideki Nakayama

and 8 more

September 11, 2020
Purpose: The study aimed to determine the body composition of Japanese adult survivors with childhood cancer. Methods: Between August 2018 and September 2019, we recruited adults aged ≥18 years who had childhood leukemia/lymphoma. Blood sampling, body composition measurement by bioelectrical impedance analysis (BIA), grip strength test, nutrition consultation, and screen viewing time survey were conducted. Results: We analyzed the data of 81 survivors with a median age of 25 years. The disease profile comprised 51 cases of acute lymphocytic leukemia, 20 acute myelocytic leukemias, and 10 lymphomas; 34 patients had undergone hematopoietic stem cell transplantation (HSCT). The average body mass index (BMI) was 21 kg/m2. Of the patients, 10 (12%) were obese and 18 (22%) were lean. Three patients had metabolic syndromes (MS) and 9 had sarcopenia. There was no significant difference in the frequency of obesity, sarcopenia, and MS in each disease; however, sarcopenia was significantly higher in the transplant group. Further, 30% of obese patients had MS, and 33% of lean patients had sarcopenia. Discussion: Leanness and sarcopenia are common in HSCT survivors, and the possible involvement of transplant-related complications is accordingly suspected. The effects of lifestyle cannot be ruled out, and more cases must be analyzed to examine risk factors. Conclusion: Some young adult survivors with childhood leukemia/lymphoma may have metabolic syndrome (MS) or sarcopenia. Assessments of body composition by BIA for childhood cancer survivors could benefit to detect MS or sarcopenia in their young adulthood.
Kinetics and Degradation Mechanism of Atmospheric Isoprene (2-methyl-1, 3-butadiene (...
Mohanapriya Subramani
Akilan Rajamani

Mohanapriya Subramani

and 2 more

September 11, 2020
Isoprene (2-methyl-1, 3-butadiene (C5H8)) is one of the most prominent and abundant non-methane hydrocarbon existing in the lower level of the troposphere. In this work, possible reaction mechanism of chlorine (Cl) radical initiated isoprene and its subsequent reactions are investigated using quantum chemical methods. The calculated thermodynamic result shows that the reaction of isoprene with the Cl radical at the terminal C=C bond position plays an important role to predict the end products. The calculated rate coefficient for the reaction between isoprene and Cl radicals (Cl addition at C1, C3, C4 and C5 positions) is found to be 4.89⨯10-11, 6.91⨯10-10, 1.63⨯10-10 and 8.12⨯10-10 cm3/molecule/sec at 298K. The branching ratio and atmospheric lifetime have been calculated from the reaction rate coefficient values of isoprene+Cl. The reaction force analysis predicts Cl radical addition at the terminal C=C bond position plays a dominant role by structural rearrangement. The kinetic and thermodynamic results reveal that the electrophilic addition of Cl radical to the terminal carbon atom plays the dominant role in the marine boundary. Further, the subsequent reaction of Cl-isoprene adduct radical helps for the development of ozone layer during daytime.
Cisplatin under oriented external electric fields: a deeper insight into electrochemo...
Li Zhang
Ya-Ling Ye

Li Zhang

and 6 more

September 07, 2020
Electrochemotherapy is an effective strategy for the treatment of solid tumors by exposing tumor cells to electric fields to enhance the bioactivity of non-permeable or low permeable anticancer drugs, such as cisplatin. To understand the improved efficiency of cisplatin in electrochemotherapy, the effects of oriented external electric fields (OEEFs) on the geometric structures and relevant electronic properties of cisplatin have been systemically investigated by density functional theory (DFT) computations in this work. Our results reveal that the presence of positive OEEFs on cisplatin can not only weaken its Pt-Cl bonds, but also enhance the intramolecular charge transfer in it, which effectively accelerates the critical hydrolysis step involved in the mechanism of its biological activity. Moreover, the positive OEEFs can facilitate the attack of the singly aquated cis-[Pt(NH3)2(H2O)Cl]+ on DNA, and enlarge the dipole moments and water solubility of cisplatin and its aquated product. Consequently, this work provides a deeper insight into the higher efficacy of electrochemotherapy than traditional chemotherapy from a molecular point of view.
Expression of CD4 and CD8 in head and neck mucosal melanoma
gaofei Yin
Wei Guo

gaofei Yin

and 5 more

September 11, 2020
Objectives: The expression of CD3, CD4, CD8, PD-1 and PD-L1 in mucosal malignant melanoma tumors was analyzed by immunohistochemical staining. The aim was to explore the characteristics of malignant melanoma in head and neck and its correlation with the expression of these factors, to further our understanding of the disease. Design:Retrospective clinical study. Setting: Otorhinolaryngology unit of a tertiary hospital. Participants: 36 patients underwent immunohistochemical staining. Main outcome measures: In total, 24 patients underwent immunohistochemical staining of CD4, CD8, PD-1, and PD-L1, and 12 patients underwent CD3 immunohistochemical staining. Results: There was no significant difference between the expression of CD3, CD4, or CD8 and the general clinical features of mucosal melanoma. However, (1) the high rate of expression of CD8 was significantly different in different lesion locations: 85.71% in the nasal cavity/sinus/nasal cavity and sinus, and 66.67% in the nasopharynx; (2) the expression of PD-L1 was statistically significantly correlated with the combined expression of CD4, CD8 and CD4/CD8 (r = 0.451, P < 0.05); (3) the median progression-free survival times of patients with high and low expression CD4 were 24 months and 4 months, respectively, and those of patients with high and low expression of CD8 were 24 months and 6 months, respectively. Conclusions: The correlation between the expression of CD8 and PD-L1 suggests the role of tumor infiltrating lymphocytes in anti-tumor immunity and their possible use as immunotherapy markers. In addition, the expression of CD4 and CD8 in tumor tissue may play a guiding role in the prognosis of patients.
Sialendoscopy combined with transoral sialodochoplasty for treatment of parotid duct...
Geun Cheol Shin
Jungghi Kim

Geun Cheol Shin

and 5 more

September 11, 2020
Objectives: Despite advances in the surgical treatment of parotid duct stenosis, it remains a surgical challenge. This study aimed to analyze the surgical outcomes of sialendoscopy combined with transoral sialodochoplasty for the treatment of patients with parotid duct stenosis with megaduct in parotid glands. Design: Retrospective cohort study Setting: Academic tertiary medical center Participants: This study included 13 patients with chronic obstructive sialadenitis caused by type 2 parotid duct stenosis who underwent sialendoscopy with transoral sialodochoplasty. Main Outcomes and Measures: All patients completed a three-point Likert-type rating scale 3 months postoperatively. Radiologic evaluation using magnetic resonance (MR) sialography was performed to evaluate megaduct diameter. Thirteen glands underwent sialendoscopy combined with transoral sialodochoplasty. Results: At 3 months after surgery, six (46.2%) glands showed complete resolution, and seven (53.8%) showed partial resolution of obstructive symptoms. Megaduct diameter between pre- and postoperative MR sialography significantly decreased after transoral sialodochoplasty (8.05 ± 2.675 vs. 4.15 ± 2.400, P = 0.028). Saliva excretion was improved after the transoral sialodochoplasty, as the distal ducts were visualized with sialagogues postoperatively. Conclusions: Type 2 parotid duct stenosis can be successfully treated with sialendoscopy combined with sialodochoplasty. In cases of large megaduct, transoral sialodochoplasty appears to offer benefits of reducing the diameter of dilated megaducts and improving salivary outflow.
Do patients correctly use steroid nose spray? A patient-reported survey of the nasal...
Waqas Jamil
Abdullah Alahwal

Waqas Jamil

and 4 more

September 11, 2020
Objectives; To investigate spray technique and compliance among patients using steroid nasal spray. Design: Patient-reported survey Setting; Single centre study- a tertiary care hospital Participants: 100 participants (1 excluded) Main outcome measures 1) Nasal spray technique 2) Patient compliance Results: Out of 99 participants included in this study only one patient used steroid nose spray with a completely correct spray technique. Only 40% of patients received guidance instructions from the prescriber about the spray technique. 70% of patients reported using their spray regularly while 14% and 16% reported using mostly and sometimes respectively. 53% of patients were found using the correct dosage of the spray while 34% of patients were using incorrect dose and 13% cases dosage was unknown. Conclusions: Wrong spray technique is extremely common and can be easily corrected. Patient compliance can also be improved further. This survey emphasizes the importance of giving written and verbal instructions about the use of spray to the patients. We recommend following the written instructions for the use of steroid nasal spray from “British Society for Allergy and Clinical Immunology” or/and video tutorial from “asthma.org.uk- how to use nasal spray”
Tectorigenin alleviates intrahepatic cholestasis by inhibiting hepatic inflammation a...
Jiaqing Xiang
Guangyan Yang

Jiaqing Xiang

and 9 more

September 11, 2020
Background and purpose: Increasing evidence has shown that human cholestasis is closely related to hepatic macrophage accumulation and activation. Research has indicated that peroxisome proliferator-activated receptor-g (PPARg) activation exerts liver protection in cholestatic liver disease (CLD), particularly by ameliorating inflammation and fibrosis, thus limiting disease progression. However, existing PPARg agonists, such as troglitazone and rosiglitazone, have significant side effects that impede their clinical application in the treatment of CLD. In this study, we found that tectorigenin (TEC) can alleviate intrahepatic cholestasis in mice by activating PPARg. Experimental approach: Wild-type mice received intragastric administration of a-naphthylisothiocyanate (ANIT) or were fed a diet containing 0.1% 3,5-diethoxycarbonyl-1,4-dihydrocollidine (DDC) to establish an experimental intrahepatic cholestasis model and TEC intervention simultaneously, followed by determination of intrahepatic cholestasis and the involved mechanisms. In addition, PPARg deficient mice were administered ANIT and/or TEC to determine whether TEC exerts its liver protection effect by activating PPARg. Key results: Our results demonstrated that TEC intervention alleviated intrahepatic cholestasis by inhibiting hepatic macrophage recruitment and activation as well as promoting the expression of bile transporters through activating PPARg. Furthermore, our results show that TEC increased bile salt export pump (Bsep) expression through enhanced PPARg binding to the Bsep promoter. We also demonstrated that PPARg deficiency blocked the hepatocyte protective effect of TEC during cholestasis. Conclusions and implications: In conclusion, TEC reduced hepatic macrophage recruitment and activation, and enhanced bile acid export by activating PPARg. Taken together, our results suggest that TEC is a potential drug for the prevention of CLD.
On the completeness of metric spaces with a \(w\)-distance
Aleksandar Kostic

Aleksandar Kostic

October 08, 2020
Abstract.  A \(w\)-distance on a metric space \(\left(X,d\right)\) is a function \(p:X\times X\to\left[0,\infty\right)\)  which is lower semicontinuous with respect to the second varibale, satisfies the triangle inequality and for all \(\varepsilon>0\) there exists a \(\delta>0\) such that \(p\left(z,x\right)\le\delta\) and \(p\left(z,y\right)\le\delta\) imply \(d\left(x,y\right)\le\varepsilon\) for all \(x,y,z\in X\). In this short note we prove that a metric space with a \(w\)-distance \(p\) is complete if and only if every sequence \(\ \left\{x_i\right\}\ \) such that \(\sum_{_{i=1}}^{\infty}p\left(x_i,x_{i+1}\right)<\infty\) converges.
Bridging diagnosis of a rare hematological disorder through genetic testing in a youn...
Himanshi
Sanjib Mondal

Himanshi Chaudhary

and 5 more

September 11, 2020
Title PageManuscript type: Letter to editorTitle: Bridging diagnosis of a rare hematological disorder through genetic testing in a young girl with persistent panleukopeniaRunning title: Young girl with persistent panleukopenia
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