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11/03/2024


Bacteria known to be causal in pneumonia are present and colonize the dental plaque of non-ventilated adults with a neuro-disability. Daily toothbrushing with 0.2 % CHX gel did not produce a sustained reduction in intra-oral respiratory pathogen counts after 48 weeks.Honey is a natural product with many beneficial properties including antimicrobial action. Production of hydrogen peroxide (H2O2) in diluted honey is central to this action. Here, we describe an optimized method for measuring levels of H2O2 in honey. This method is based on established methods, with the level of dilution, the time between dilution and reading the assay, and aeration of the samples during the assay identified as critical points for ensuring reliability and reproducibility. The method is cost-effective and easy to perform using common laboratory equipment. Using this method, we quantified the hydrogen peroxide content of five different, unprocessed polyfloral honeys collected in NC, USA. Our results show that H2O2 production by these honeys varies greatly, with some samples producing negligible levels of H2O2. We assessed the effect of colour on the assay by measuring the recovery of spiked H2O2 from light and dark honey and from serially diluted dark corn syrup, and found the amount of H2O2 that could be detected was lower in dark corn syrup and darker honey samples.
species are increasingly recognized as agents of culture-negative endocarditis. However, to date, almost all human cases have been associated with two members of the genus,
and
infections are zoonotic, with domestic cats serving as reservoir hosts for the pathogen.
also exploits cats as reservoir hosts, but its zoonotic potential is far less established.

A 34-year-old male presented with palpitations after a history of aortic incompetence. During surgery for an aortic valve replacement, two vegetations were found on the aortic valve. PCR analysis of the vegetation demonstrated the presence of
species and so the patient was treated post-operatively with ceftriaxone and doxycycline, making a good recovery. Further PCR-based analysis of the patient's aortic vegetation confirmed the presence of
.

This report expands the number of
species associated with endocarditis and provides clear evidence that
should be considered a zoonotic pathogen.
This report expands the number of Bartonella species associated with endocarditis and provides clear evidence that B. clarridgeiae should be considered a zoonotic pathogen.
Resistant and uncontrolled hypertension prominently amplifies the risk of end-stage renal disease and fatal cardiovascular events. Therapeutic inertia, despite maximum tolerated anti-hypertensive medications, puts patients at high risk, thus non-pharmacologic therapies have been proposed. The ROX arteriovenous coupler (ROX, Medical Inc., San Clemente, CA, USA), initially developed for treatment of chronic obstructive pulmonary disease, exploits the biomechanical effects of diverting arterial blood into a low-resistance, high-compliance venous segment, thereby decreasing arterial vascular resistance and blood pressure (BP).

A 76-year-old male, non-smoker and non-diabetic with resistant primary hypertension presented to our institution with disabling claudication, lower limb swelling and right hip pain. He had concomitant saccular abdominal aortic and right iliac aneurysms. He had previously undergone renal denervation on two separate occasions yet continued to require increasing anti-hypertensive medications. He subsequently had an insertion of an ROX coupler device between his right external iliac artery and vein after failure of insertion into his left iliac system. He developed right hip and buttock pain and consequently underwent a total hip replacement and subsequent revision, which did not alleviate his symptoms. Ankle-brachial indices were reduced to 0.70 on the right limb and normal on the left. Insertion of the ROX coupler device was reversed with concomitant endovascular aortic repair.

There is no clear consensus on reversal of the ROX coupler device. Endovascular aortic repair reversal of the ROX coupler device in this case was safe, effective, and improved symptoms including patient's BP control and limb symptoms.
There is no clear consensus on reversal of the ROX coupler device. Endovascular aortic repair reversal of the ROX coupler device in this case was safe, effective, and improved symptoms including patient's BP control and limb symptoms.
Mitral annular disjunction (MAD) is an under-recognized cause of arrhythmic sudden cardiac death, especially in young women. The relation between MAD and the occurrence of arrhythmia during pregnancy has not yet been explored. We would like to stress the importance of careful echocardiographic examination and the vulnerable peripartum period.

A 29-year-old woman survived an out of hospital cardiac arrest 4 months after delivery of her first child. The diagnosis was not clear and an implantable cardioverter-defibrillator (ICD) as secondary prevention was implanted. Her second pregnancy and delivery were uneventful. The 12-lead electrocardiogram demonstrated sinus rhythm with right bundle branch block, ventricular extra systoles (premature ventricular contractions), and a right superior axis, i.e. origin in the inferolateral basal left ventricle. https://www.selleckchem.com/products/GDC-0449.html Transthoracic 2D echocardiography showed myxomatous mitral valve disease with moderate mitral valve insufficiency with normal left and right heart dimensions and fisk stratification and sudden cardiac death prevention. Careful follow-up is necessary especially during pregnancy and the postpartum period.
Transcatheter left atrial appendage occlusion (LAAO) using Watchman device has been demonstrated to be efficacious in decreasing stroke risk in patients with atrial fibrillation who are not suitable for long-term anticoagulation. Residual leaks are frequently encountered following LAAO procedures and their clinical implications and optimal management remain controversial.

In this report, we describe a case of peri-Watchman device leak treated successfully with percutaneous device closure using an Amplatzer Vascular Plug II device.

The clinical implications of peri-device leaks remain controversial with general consensus to continue anticoagulation along with serial imaging for larger leaks (>5 mm). As an alternative strategy, percutaneous closure of these leaks has been attempted in hope of avoiding anticoagulation and minimizing the risk of stroke and should be studied further.
5 mm). As an alternative strategy, percutaneous closure of these leaks has been attempted in hope of avoiding anticoagulation and minimizing the risk of stroke and should be studied further.

11/01/2024


In the animal model, the expression of ECM components and inflammatory genes was significantly upregulated. The expression of IL-6 was increased at both the mRNA level and the protein level in BOO rats. In vitro, hydrostatic pressure, and mechanical stretching both promoted MMP7 and MMP11 expression. https://www.selleckchem.com/products/fr180204.html Additionally, downregulation of collagen III occurred in both the hydrostatic pressure group and the mechanical stretch group. However, the expression of fibronectin exhibited opposing patterns between the hydrostatic pressure and mechanical stretch groups. The application of targeted siRNA transfection and an inhibitor (SC144) that targeted IL-6 significantly reversed the changes in MMP7 and MMP11 under mechanical stress and partially increased the expression of collagen III and fibronectin. In summary, IL-6 participated in the ECM remodeling of HBSMCs under mechanical stress, indicating that IL-6 may play an essential role in BOO.
.Histoplasma capsulatum is an ascomyceteous fungus and a human lung pathogen, which is present in river valleys of the Americas and other continents. H. capsulatum and two related human pathogens, Blasmomyces dermatitidis and Paracoccidioides brasiliensis, belongs to the Ajellomycetaceae family. The genomes of all three species code for three homologous and tentative enzymes of the linoleate diol synthase (LDS) family of fusion enzymes with dioxygenase (DOX) and cytochrome P450 domains. One group aligned closely with 8R-DOX-5,8-LDS of Aspergilli, which oxidizes linoleic acid to 5S,8R-dihydroxylinoleic acid; this group was not further investigated. The second group aligned with 10R-DOX-epoxy alcohol synthase (EAS) of plant pathogens. Expression of this enzyme from B. dermatitidis revealed only 10R-DOX activities, i.e., oxidation of linoleic acid to 10R-hydroperoxy-8E,12Z-octadecadienoic acid. The third group aligned in a separate entity. Expression of these enzymes of H. capsulatum and B. dermatitidis revealed no DOX activities, but both enzymes transformed 13S-hydroperoxy-9Z,11E-octadecadienoic acid efficiently to 12(13S)epoxy-11-hydroperoxy-9Z-octadecenoic acid. Other 13-hydroperoxides of linoleic and α-linolenic acids were transformed with less efficiency and the 9-hydroperoxides of linoleic acid were not transformed. In conclusion, a novel EAS has been found in H. capsulatum and B. dermititidis with 13S-hydroperoxy-9Z,11E-octadecadienoic acid as the likely physiological substrate.
This study sought to compare radiographic outcomes and resource utilization between recombinant human bone morphogenetic protein-2 (rhBMP-2) and anterior iliac crest bone graft (AICBG) when used for secondary alveolar grafting.

This is a 14-year retrospective study of patients with alveolar clefts treated at the Morgan Stanley Children's Hospital of New York-Presbyterian/Columbia University Irving Medical Center between January 2006 and January 2020. Patients who had alveolar grafting with either rhBMP-2 or AICBG were included in this study. The primary study predictor was the graft material. The study outcomes were bone height, operating room time, and the number of scrubbed personnel (surgeon and assistants). Graft survival was measured at a minimum of 6months postoperatively. Bone height was scored according to the Bergland scale, and radiographic success was defined as Bergland types 1 or2.

The study sample included a total of 115 patients with 130 alveolar clefts. Overall, 13.0% of patients had bilired less hospital resources. The decision to use harvested ilium or rhBMP-2 is not limited by outcome data at this time. More studies will need to be performed to identify the particular advantages of each graft material. The choice of material is currently both surgeon specific and patient specific and requires thorough informed consent.
The objective of this study was to examine the diagnostic value of cutting labial salivary gland (LSG) biopsies at 2 levels in the histological evaluation for Sjögren's syndrome (SS).

This retrospective study included LSG biopsy specimens from 112 consecutive patients evaluated for SS from 2007 to 2019. Three observers, blinded with regard to patient data, independently scored the degree of focal lymphocytic infiltration (foci) and calculated the focus score in specimens cut at 2 levels 60 µm apart.

Unblinded analysis revealed that the LSG specimens derived from 107 women and 5 men, aged 49.2 ± 22.3 years. Seventy-six patients had SS (70 primary SS and 6 secondary SS) according to the American-European Consensus Group and American College of Rheumatology/European League Against Rheumatism criteria. The average number of LSGs was 5.0 ± 1.4 and the focus scoring area was 16.1 ± 7.6 mm
. Compared to baseline, the average number of foci (4.4 vs 5.1, P < .001), focus score (1.7 vs 1.9, P = .01), and cases with focus score >1.0 (61 vs 74%; P=.03) were higher in the second level. Subsequently, an additional 11 cases of SS were confirmed (14%), and 8 non-SS cases were reclassified as SS (22%).

Histological assessment of an additional section level improves the diagnostic accuracy of the labial salivary gland biopsy to detect histopathological changes consistent with the diagnosis of SS.
Histological assessment of an additional section level improves the diagnostic accuracy of the labial salivary gland biopsy to detect histopathological changes consistent with the diagnosis of SS.
This study sought to report early experience with the new-generation Watchman FLX device (Boston Scientific, Marlborough, Massachusetts).

The new-generation Watchman FLX features a reduced height, improved anchoring and fabric coverage, and a closed distal end. These design modifications aim to simplify implantation, allow full recapture and repositioning, and reduce peridevice leak and device-related thrombosis.

A total of 165 patients undergoing left atrial appendage (LAA) occlusion (LAAO) with Watchman FLX were enrolled in a prospective, multicenter registry at 12 centers participating in the European limited market release program.

Mean age was 75.4 ± 8.9 years, and CHA
DS
-VASc score 4.4 ± 1.4. A total of 128 patients (77.6%) had a history of major bleeding, including previous intracranial hemorrhage in 55 cases (33.3%). LAA landing zone minimal and maximal mean diameters were 19.1 ± 3.6mm and 22.3 ± 3.7mm, and 24.2% of LAA were considered complex by dimensions. Technical success was achieved in all patients.

10/31/2024


This narrative review critically evaluates the evidence for risk of anemia and red blood cell (RBC) transfusion. For this purpose, it assesses large prospective randomized-controlled trials (RCTs) in medical, surgical, and critical care patient populations in which the impact of specific hemoglobin transfusion thresholds are compared. In these trials, the risks of anemia relative to those of RBC transfusion are assessed. The results of published systematic reviews and meta-analyses are also discussed. Lastly, recommendations for patient blood management and treatment of anemia are explored. The main conclusion of this review emphasizes that the decision to transfuse RBCs is complex and depends on the interaction between multiple factors including the balance between the risk of anemia and the risk of RBC transfusion, existing patient comorbidities, and medical and surgical exposures. The transfusion thresholds recommended by current guidelines vary for medical and surgical patient populations. Guidelines suggesting specific transfusion thresholds for different patient populations should be viewed as a starting point for making an informed decision about RBC transfusion. Alternatives to transfusion (i.e., patient blood management), biomarkers of anemia-induced tissue hypoxia, and transfusion alternatives should continue to be evaluated in large RCTs, with the goal of improving event-free survival in critically ill and perioperative patients.Anticoagulation increases the risk of intracerebral hemorrhage (ICH) in patients with cerebral amyloid angiopathy (CAA), so the management of stroke-risk in patients with both atrial fibrillation (AF) and CAA is controversial. Advances in left atrial appendage closure (LAAC) techniques provide a stroke-risk-reduction option which avoids long-term oral anticoagulation (OAC). We aimed to evaluate the safety of this intervention in patients with CAA. This is an observational cohort study of patients with severe CAA (with or without ICH) and AF who were treated with LAA closure. The Watchman™ and Amulet® LAAC devices and Lariat procedure or open surgical closure of the LAA were all considered acceptable means of closure. https://www.selleckchem.com/products/salinomycin.html Patients with symptomatic ICH and those naïve to anticoagulation were placed on clopidogrel and/or aspirin for 6 weeks after the procedure; patients who previously tolerated anticoagulation remained on warfarin or a DOAC for 6 weeks post-procedure. All anticoagulation therapy was discontinued aftging. LAA closure may be a good alternative to anticoagulation in patients with CAA and atrial fibrillation.The "face of medicine" is a term commonly used to describe the leaders and decision-makers of medicine. Medical ethics often discuss past historical atrocities committed by the "face of medicine," such as the American eugenics movement and medical experimentation. However, a great irony persists the "faces of medicine" do not resemble the faces of the oppressed populations. Nevertheless, the discussion of white supremacy and systemic racism, structures which fueled historical medical atrocities, is often omitted. This reflection discusses the need for education, conversation, and action surrounding these topics to adequately combat racial and ethnic health disparities. We also argue that the decision-makers of medicine should be a diverse group of stakeholders, thereby representative of and personally invested in a diverse group of populations.Tubulointerstitial nephritis and renal tubular acidosis are well-known renal involvements with primary Sjögren's syndrome. However, several types of glomerulonephritis such as membranoproliferative glomerulonephritis and membranous nephropathy are also known to develop in patients with this syndrome. We here report a case of membranous nephropathy that developed 8 years after a diagnosis of primary Sjögren's syndrome in a female patient. Interestingly, the deposition was not identified by routine immunofluorescence using snap frozen tissue, but was revealed by immunofluorescence on formalin-fixed paraffin-embedded sections treated with proteinase K. We further performed immunofluorescence analysis on the treated paraffin-embedded sections with the identified antigen but found that the deposited IgG was not monoclonal and that serum amyloid P, a sensitive marker for membranous-like glomerulopathy with masked IgG κ deposits, was not evident in the glomeruli. To the best of our knowledge, this report depicted the first case of masked polyclonal IgG deposits and further analysis is needed to clarify the underlying mechanisms of IgG masking and possible association with autoantibodies.
Medial patellofemoral ligament (MPFL) reconstruction using the hamstring tendon is widely performed to treat recurrent patellar dislocation. MPFL reconstruction includes a post-operative process of necrosis and reperfusion of the hamstring tendon graft. We hypothesise that the patella gradually shifts laterally because of this process, ultimately affecting the patellofemoral joint alignment. This study aimed to analyse the chronological changes in the patellofemoral joint alignment and the outcomes of MPFL reconstruction.

In this retrospective case-series study, the Knee Society, Lysholm, and Kujala scores were evaluated in 24 consecutive patients (27 knees). To evaluate patellar tracking defects, radiographic indices including the tilting angle, the lateral shift ratio, and the congruence angle were measured before, immediately after, and three, 12, and 36 months after MPFL reconstruction.

Post-operative Kujala, KneeSociety, and Lysholm scores for the study population significantly improved relative to joint within three months after the operation. Therefore, we believe it is necessary to refrain from knee rotation that places lateral stress on the patella until three months after the operation.
Hepatitis B virus (HBV) X gene (HBx) mutants can develop during the natural course of chronic HBV infection. However, little is known about whether the emergence of HBx mutants during long-term antiviral therapy is an adaptation of HBV to antiviral stress. This study was to identify HBx mutants that emerged in patients experiencing Lamivudine resistance or suboptimal treatment.

Forty-six Lamivudine-resistant patients and 46 patients with suboptimal treatment responses to Entecavir were enrolled in this study. HBx mutants were identified by sequence analysis and their roles in the HBV replication cycle were characterized.

We show that deletion/truncation/insertion mutations were only detected in the Lamivudine resistance group, while synonymous mutations were found in both groups. Follow-up analyses revealed that five patients in the Lamivudine group developed hepatocellular carcinoma, while patients in the Entecavir group did not. These mutants were characterized by a significant decrease in transactivation of the pre-S1 promoter, and varying effects on transactivation of the X promoter.

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Posts

11/03/2024


Bacteria known to be causal in pneumonia are present and colonize the dental plaque of non-ventilated adults with a neuro-disability. Daily toothbrushing with 0.2 % CHX gel did not produce a sustained reduction in intra-oral respiratory pathogen counts after 48 weeks.Honey is a natural product with many beneficial properties including antimicrobial action. Production of hydrogen peroxide (H2O2) in diluted honey is central to this action. Here, we describe an optimized method for measuring levels of H2O2 in honey. This method is based on established methods, with the level of dilution, the time between dilution and reading the assay, and aeration of the samples during the assay identified as critical points for ensuring reliability and reproducibility. The method is cost-effective and easy to perform using common laboratory equipment. Using this method, we quantified the hydrogen peroxide content of five different, unprocessed polyfloral honeys collected in NC, USA. Our results show that H2O2 production by these honeys varies greatly, with some samples producing negligible levels of H2O2. We assessed the effect of colour on the assay by measuring the recovery of spiked H2O2 from light and dark honey and from serially diluted dark corn syrup, and found the amount of H2O2 that could be detected was lower in dark corn syrup and darker honey samples.
species are increasingly recognized as agents of culture-negative endocarditis. However, to date, almost all human cases have been associated with two members of the genus,
and
infections are zoonotic, with domestic cats serving as reservoir hosts for the pathogen.
also exploits cats as reservoir hosts, but its zoonotic potential is far less established.

A 34-year-old male presented with palpitations after a history of aortic incompetence. During surgery for an aortic valve replacement, two vegetations were found on the aortic valve. PCR analysis of the vegetation demonstrated the presence of
species and so the patient was treated post-operatively with ceftriaxone and doxycycline, making a good recovery. Further PCR-based analysis of the patient's aortic vegetation confirmed the presence of
.

This report expands the number of
species associated with endocarditis and provides clear evidence that
should be considered a zoonotic pathogen.
This report expands the number of Bartonella species associated with endocarditis and provides clear evidence that B. clarridgeiae should be considered a zoonotic pathogen.
Resistant and uncontrolled hypertension prominently amplifies the risk of end-stage renal disease and fatal cardiovascular events. Therapeutic inertia, despite maximum tolerated anti-hypertensive medications, puts patients at high risk, thus non-pharmacologic therapies have been proposed. The ROX arteriovenous coupler (ROX, Medical Inc., San Clemente, CA, USA), initially developed for treatment of chronic obstructive pulmonary disease, exploits the biomechanical effects of diverting arterial blood into a low-resistance, high-compliance venous segment, thereby decreasing arterial vascular resistance and blood pressure (BP).

A 76-year-old male, non-smoker and non-diabetic with resistant primary hypertension presented to our institution with disabling claudication, lower limb swelling and right hip pain. He had concomitant saccular abdominal aortic and right iliac aneurysms. He had previously undergone renal denervation on two separate occasions yet continued to require increasing anti-hypertensive medications. He subsequently had an insertion of an ROX coupler device between his right external iliac artery and vein after failure of insertion into his left iliac system. He developed right hip and buttock pain and consequently underwent a total hip replacement and subsequent revision, which did not alleviate his symptoms. Ankle-brachial indices were reduced to 0.70 on the right limb and normal on the left. Insertion of the ROX coupler device was reversed with concomitant endovascular aortic repair.

There is no clear consensus on reversal of the ROX coupler device. Endovascular aortic repair reversal of the ROX coupler device in this case was safe, effective, and improved symptoms including patient's BP control and limb symptoms.
There is no clear consensus on reversal of the ROX coupler device. Endovascular aortic repair reversal of the ROX coupler device in this case was safe, effective, and improved symptoms including patient's BP control and limb symptoms.
Mitral annular disjunction (MAD) is an under-recognized cause of arrhythmic sudden cardiac death, especially in young women. The relation between MAD and the occurrence of arrhythmia during pregnancy has not yet been explored. We would like to stress the importance of careful echocardiographic examination and the vulnerable peripartum period.

A 29-year-old woman survived an out of hospital cardiac arrest 4 months after delivery of her first child. The diagnosis was not clear and an implantable cardioverter-defibrillator (ICD) as secondary prevention was implanted. Her second pregnancy and delivery were uneventful. The 12-lead electrocardiogram demonstrated sinus rhythm with right bundle branch block, ventricular extra systoles (premature ventricular contractions), and a right superior axis, i.e. origin in the inferolateral basal left ventricle. https://www.selleckchem.com/products/GDC-0449.html Transthoracic 2D echocardiography showed myxomatous mitral valve disease with moderate mitral valve insufficiency with normal left and right heart dimensions and fisk stratification and sudden cardiac death prevention. Careful follow-up is necessary especially during pregnancy and the postpartum period.
Transcatheter left atrial appendage occlusion (LAAO) using Watchman device has been demonstrated to be efficacious in decreasing stroke risk in patients with atrial fibrillation who are not suitable for long-term anticoagulation. Residual leaks are frequently encountered following LAAO procedures and their clinical implications and optimal management remain controversial.

In this report, we describe a case of peri-Watchman device leak treated successfully with percutaneous device closure using an Amplatzer Vascular Plug II device.

The clinical implications of peri-device leaks remain controversial with general consensus to continue anticoagulation along with serial imaging for larger leaks (>5 mm). As an alternative strategy, percutaneous closure of these leaks has been attempted in hope of avoiding anticoagulation and minimizing the risk of stroke and should be studied further.
5 mm). As an alternative strategy, percutaneous closure of these leaks has been attempted in hope of avoiding anticoagulation and minimizing the risk of stroke and should be studied further.

11/01/2024


In the animal model, the expression of ECM components and inflammatory genes was significantly upregulated. The expression of IL-6 was increased at both the mRNA level and the protein level in BOO rats. In vitro, hydrostatic pressure, and mechanical stretching both promoted MMP7 and MMP11 expression. https://www.selleckchem.com/products/fr180204.html Additionally, downregulation of collagen III occurred in both the hydrostatic pressure group and the mechanical stretch group. However, the expression of fibronectin exhibited opposing patterns between the hydrostatic pressure and mechanical stretch groups. The application of targeted siRNA transfection and an inhibitor (SC144) that targeted IL-6 significantly reversed the changes in MMP7 and MMP11 under mechanical stress and partially increased the expression of collagen III and fibronectin. In summary, IL-6 participated in the ECM remodeling of HBSMCs under mechanical stress, indicating that IL-6 may play an essential role in BOO.
.Histoplasma capsulatum is an ascomyceteous fungus and a human lung pathogen, which is present in river valleys of the Americas and other continents. H. capsulatum and two related human pathogens, Blasmomyces dermatitidis and Paracoccidioides brasiliensis, belongs to the Ajellomycetaceae family. The genomes of all three species code for three homologous and tentative enzymes of the linoleate diol synthase (LDS) family of fusion enzymes with dioxygenase (DOX) and cytochrome P450 domains. One group aligned closely with 8R-DOX-5,8-LDS of Aspergilli, which oxidizes linoleic acid to 5S,8R-dihydroxylinoleic acid; this group was not further investigated. The second group aligned with 10R-DOX-epoxy alcohol synthase (EAS) of plant pathogens. Expression of this enzyme from B. dermatitidis revealed only 10R-DOX activities, i.e., oxidation of linoleic acid to 10R-hydroperoxy-8E,12Z-octadecadienoic acid. The third group aligned in a separate entity. Expression of these enzymes of H. capsulatum and B. dermatitidis revealed no DOX activities, but both enzymes transformed 13S-hydroperoxy-9Z,11E-octadecadienoic acid efficiently to 12(13S)epoxy-11-hydroperoxy-9Z-octadecenoic acid. Other 13-hydroperoxides of linoleic and α-linolenic acids were transformed with less efficiency and the 9-hydroperoxides of linoleic acid were not transformed. In conclusion, a novel EAS has been found in H. capsulatum and B. dermititidis with 13S-hydroperoxy-9Z,11E-octadecadienoic acid as the likely physiological substrate.
This study sought to compare radiographic outcomes and resource utilization between recombinant human bone morphogenetic protein-2 (rhBMP-2) and anterior iliac crest bone graft (AICBG) when used for secondary alveolar grafting.

This is a 14-year retrospective study of patients with alveolar clefts treated at the Morgan Stanley Children's Hospital of New York-Presbyterian/Columbia University Irving Medical Center between January 2006 and January 2020. Patients who had alveolar grafting with either rhBMP-2 or AICBG were included in this study. The primary study predictor was the graft material. The study outcomes were bone height, operating room time, and the number of scrubbed personnel (surgeon and assistants). Graft survival was measured at a minimum of 6months postoperatively. Bone height was scored according to the Bergland scale, and radiographic success was defined as Bergland types 1 or2.

The study sample included a total of 115 patients with 130 alveolar clefts. Overall, 13.0% of patients had bilired less hospital resources. The decision to use harvested ilium or rhBMP-2 is not limited by outcome data at this time. More studies will need to be performed to identify the particular advantages of each graft material. The choice of material is currently both surgeon specific and patient specific and requires thorough informed consent.
The objective of this study was to examine the diagnostic value of cutting labial salivary gland (LSG) biopsies at 2 levels in the histological evaluation for Sjögren's syndrome (SS).

This retrospective study included LSG biopsy specimens from 112 consecutive patients evaluated for SS from 2007 to 2019. Three observers, blinded with regard to patient data, independently scored the degree of focal lymphocytic infiltration (foci) and calculated the focus score in specimens cut at 2 levels 60 µm apart.

Unblinded analysis revealed that the LSG specimens derived from 107 women and 5 men, aged 49.2 ± 22.3 years. Seventy-six patients had SS (70 primary SS and 6 secondary SS) according to the American-European Consensus Group and American College of Rheumatology/European League Against Rheumatism criteria. The average number of LSGs was 5.0 ± 1.4 and the focus scoring area was 16.1 ± 7.6 mm
. Compared to baseline, the average number of foci (4.4 vs 5.1, P < .001), focus score (1.7 vs 1.9, P = .01), and cases with focus score >1.0 (61 vs 74%; P=.03) were higher in the second level. Subsequently, an additional 11 cases of SS were confirmed (14%), and 8 non-SS cases were reclassified as SS (22%).

Histological assessment of an additional section level improves the diagnostic accuracy of the labial salivary gland biopsy to detect histopathological changes consistent with the diagnosis of SS.
Histological assessment of an additional section level improves the diagnostic accuracy of the labial salivary gland biopsy to detect histopathological changes consistent with the diagnosis of SS.
This study sought to report early experience with the new-generation Watchman FLX device (Boston Scientific, Marlborough, Massachusetts).

The new-generation Watchman FLX features a reduced height, improved anchoring and fabric coverage, and a closed distal end. These design modifications aim to simplify implantation, allow full recapture and repositioning, and reduce peridevice leak and device-related thrombosis.

A total of 165 patients undergoing left atrial appendage (LAA) occlusion (LAAO) with Watchman FLX were enrolled in a prospective, multicenter registry at 12 centers participating in the European limited market release program.

Mean age was 75.4 ± 8.9 years, and CHA
DS
-VASc score 4.4 ± 1.4. A total of 128 patients (77.6%) had a history of major bleeding, including previous intracranial hemorrhage in 55 cases (33.3%). LAA landing zone minimal and maximal mean diameters were 19.1 ± 3.6mm and 22.3 ± 3.7mm, and 24.2% of LAA were considered complex by dimensions. Technical success was achieved in all patients.

10/31/2024


This narrative review critically evaluates the evidence for risk of anemia and red blood cell (RBC) transfusion. For this purpose, it assesses large prospective randomized-controlled trials (RCTs) in medical, surgical, and critical care patient populations in which the impact of specific hemoglobin transfusion thresholds are compared. In these trials, the risks of anemia relative to those of RBC transfusion are assessed. The results of published systematic reviews and meta-analyses are also discussed. Lastly, recommendations for patient blood management and treatment of anemia are explored. The main conclusion of this review emphasizes that the decision to transfuse RBCs is complex and depends on the interaction between multiple factors including the balance between the risk of anemia and the risk of RBC transfusion, existing patient comorbidities, and medical and surgical exposures. The transfusion thresholds recommended by current guidelines vary for medical and surgical patient populations. Guidelines suggesting specific transfusion thresholds for different patient populations should be viewed as a starting point for making an informed decision about RBC transfusion. Alternatives to transfusion (i.e., patient blood management), biomarkers of anemia-induced tissue hypoxia, and transfusion alternatives should continue to be evaluated in large RCTs, with the goal of improving event-free survival in critically ill and perioperative patients.Anticoagulation increases the risk of intracerebral hemorrhage (ICH) in patients with cerebral amyloid angiopathy (CAA), so the management of stroke-risk in patients with both atrial fibrillation (AF) and CAA is controversial. Advances in left atrial appendage closure (LAAC) techniques provide a stroke-risk-reduction option which avoids long-term oral anticoagulation (OAC). We aimed to evaluate the safety of this intervention in patients with CAA. This is an observational cohort study of patients with severe CAA (with or without ICH) and AF who were treated with LAA closure. The Watchman™ and Amulet® LAAC devices and Lariat procedure or open surgical closure of the LAA were all considered acceptable means of closure. https://www.selleckchem.com/products/salinomycin.html Patients with symptomatic ICH and those naïve to anticoagulation were placed on clopidogrel and/or aspirin for 6 weeks after the procedure; patients who previously tolerated anticoagulation remained on warfarin or a DOAC for 6 weeks post-procedure. All anticoagulation therapy was discontinued aftging. LAA closure may be a good alternative to anticoagulation in patients with CAA and atrial fibrillation.The "face of medicine" is a term commonly used to describe the leaders and decision-makers of medicine. Medical ethics often discuss past historical atrocities committed by the "face of medicine," such as the American eugenics movement and medical experimentation. However, a great irony persists the "faces of medicine" do not resemble the faces of the oppressed populations. Nevertheless, the discussion of white supremacy and systemic racism, structures which fueled historical medical atrocities, is often omitted. This reflection discusses the need for education, conversation, and action surrounding these topics to adequately combat racial and ethnic health disparities. We also argue that the decision-makers of medicine should be a diverse group of stakeholders, thereby representative of and personally invested in a diverse group of populations.Tubulointerstitial nephritis and renal tubular acidosis are well-known renal involvements with primary Sjögren's syndrome. However, several types of glomerulonephritis such as membranoproliferative glomerulonephritis and membranous nephropathy are also known to develop in patients with this syndrome. We here report a case of membranous nephropathy that developed 8 years after a diagnosis of primary Sjögren's syndrome in a female patient. Interestingly, the deposition was not identified by routine immunofluorescence using snap frozen tissue, but was revealed by immunofluorescence on formalin-fixed paraffin-embedded sections treated with proteinase K. We further performed immunofluorescence analysis on the treated paraffin-embedded sections with the identified antigen but found that the deposited IgG was not monoclonal and that serum amyloid P, a sensitive marker for membranous-like glomerulopathy with masked IgG κ deposits, was not evident in the glomeruli. To the best of our knowledge, this report depicted the first case of masked polyclonal IgG deposits and further analysis is needed to clarify the underlying mechanisms of IgG masking and possible association with autoantibodies.
Medial patellofemoral ligament (MPFL) reconstruction using the hamstring tendon is widely performed to treat recurrent patellar dislocation. MPFL reconstruction includes a post-operative process of necrosis and reperfusion of the hamstring tendon graft. We hypothesise that the patella gradually shifts laterally because of this process, ultimately affecting the patellofemoral joint alignment. This study aimed to analyse the chronological changes in the patellofemoral joint alignment and the outcomes of MPFL reconstruction.

In this retrospective case-series study, the Knee Society, Lysholm, and Kujala scores were evaluated in 24 consecutive patients (27 knees). To evaluate patellar tracking defects, radiographic indices including the tilting angle, the lateral shift ratio, and the congruence angle were measured before, immediately after, and three, 12, and 36 months after MPFL reconstruction.

Post-operative Kujala, KneeSociety, and Lysholm scores for the study population significantly improved relative to joint within three months after the operation. Therefore, we believe it is necessary to refrain from knee rotation that places lateral stress on the patella until three months after the operation.
Hepatitis B virus (HBV) X gene (HBx) mutants can develop during the natural course of chronic HBV infection. However, little is known about whether the emergence of HBx mutants during long-term antiviral therapy is an adaptation of HBV to antiviral stress. This study was to identify HBx mutants that emerged in patients experiencing Lamivudine resistance or suboptimal treatment.

Forty-six Lamivudine-resistant patients and 46 patients with suboptimal treatment responses to Entecavir were enrolled in this study. HBx mutants were identified by sequence analysis and their roles in the HBV replication cycle were characterized.

We show that deletion/truncation/insertion mutations were only detected in the Lamivudine resistance group, while synonymous mutations were found in both groups. Follow-up analyses revealed that five patients in the Lamivudine group developed hepatocellular carcinoma, while patients in the Entecavir group did not. These mutants were characterized by a significant decrease in transactivation of the pre-S1 promoter, and varying effects on transactivation of the X promoter.

10/30/2024


AIMS This study compares clinical outcomes of Watchman vs. Amplatzer devices for left atrial appendage closure (LAAC). METHODS AND RESULTS Of two real-world registries, the Watchman registry Lichtenfels, Germany, and the Amplatzer registry Bern-Zurich, Switzerland, 303 and 333 consecutive patients, respectively, were included. After a 11 propensity score matching, 266 vs. 266 patients were compared by use of the predefined primary efficacy endpoint of stroke, systemic embolism and cardiovascular/unexplained death, the primary safety endpoint of major peri-procedural complications and major bleeding events at follow-up, and the combined hazard endpoint, a composite of all above-mentioned hazards. Mean age was 75.3 ± 7.8 (Watchman) vs. 75.1 ± 9.9 (Amplatzer) years, CHA2DS2-VASc score 4.5 ± 1.7 vs. 4.5 ± 1.5, and HAS-BLED score 3.2 ± 1.0 vs. 3.2 ± 1.0. At a mean follow-up of 2.4 ± 1.3 vs. 2.5 ± 1.5 years and 1.322 patient-years, the primary endpoints of efficacy [40/646, 6.2% [Watchman] vs. 43/676, 6.4% [Amplatzer]; hazard ratio (HR), 1.02; 95% confidence interval (CI), 0.66-1.58; P = 0.92] and safety (33/646, 5.1% vs. 30/676, 4.4%; HR, 0.57; 95% CI, 0.29-1.11; P = 0.10), as well as the combined hazard endpoint (69/646, 10.7% vs. 66/676, 9.8%; HR, 0.80; 95% CI, 0.55-1.12; P = 0.26) were similar for both groups. CONCLUSION This study suggests comparable efficacy and safety of the Watchman and Amplatzer devices. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2020. For permissions, please email journals.permissions@oup.com.MOTIVATION RNA-sequencing (RNA-seq) enables global identification of RNA editing sites in biological systems and disease. A salient step in many studies is to identify editing sites that statistically associate with treatment (e.g. case vs. control) or covary with biological factors such as age. However, RNA-seq has technical features that incumbent tests (e.g. t-test, linear regression) do not consider, which can lead to false positives and false negatives. RESULTS In this study we demonstrate the limitations of currently used tests and introduce the method, REDITs (RNA editing tests), a suite of tests that employ beta-binomial models to identify differential RNA editing. The tests in REDITs have higher sensitivity than other tests, while also maintaining the type I error (false positive) rate at the nominal level. Applied to the GTEx dataset, we unveil RNA editing changes associated with age and gender, and differential recoding profiles between brain regions. AVAILABILITY AND IMPLEMENTATION REDITs are implemented as functions in R and freely available for download at https//github.com/gxiaolab/REDITs. The repository also provides a code example for leveraging parallelization using multiple cores. SUPPLEMENTARY INFORMATION Supplementary data are available at Bioinformatics online. © The Author(s) (2020). https://www.selleckchem.com/products/KU-0063794.html Published by Oxford University Press. All rights reserved. For Permissions, please email journals.permissions@oup.com.MOTIVATION LINCS L1000 dataset contains numerous cellular expression data induced by large sets of perturbagens. Although it provides invaluable resources for drug discovery as well as understanding of disease mechanisms, the existing peak deconvolution algorithms cannot recover the accurate expression level of genes in many cases, inducing severe noise in the dataset and limiting its applications in biomedical studies. RESULTS Here, we present a novel Bayesian-based peak deconvolution algorithm that gives unbiased likelihood estimations for peak locations and characterize the peaks with probability based z-scores. Based on the above algorithm, we build a pipeline to process raw data from L1000 assay into signatures that represent the features of perturbagen. The performance of the proposed pipeline is evaluated using similarity between the signatures of bio-replicates and the drugs with shared targets, and the results show that signatures derived from our pipeline gives a substantially more reliable and informative representation for perturbagens than existing methods. Thus, the new pipeline may significantly boost the performance of L1000 data in the down-stream applications such as drug repurposing, disease modeling, and gene function prediction. AVAILABILITY The code and the precomputed data for LINCS L1000 Phase II (GSE 70138) are available at https//github.com/njpipeorgan/L1000-bayesian. SUPPLEMENTARY INFORMATION Supplementary data are available at Bioinformatics online. © The Author(s) 2020. Published by Oxford University Press.Cellular protrusions create complex cell surface topographies, but biomechanical mechanisms regulating their formation and arrangement are largely unknown. To study how protrusions form, we focused on the morphogenesis of microridges, elongated actin-based structures that are arranged in maze-like patterns on the apical surfaces of zebrafish skin cells. Microridges form by accreting simple finger-like precursors. Live imaging demonstrated that microridge morphogenesis is linked to apical constriction. A nonmuscle myosin II (NMII) reporter revealed pulsatile contractions of the actomyosin cortex, and inhibiting NMII blocked apical constriction and microridge formation. A biomechanical model suggested that contraction reduces surface tension to permit the fusion of precursors into microridges. Indeed, reducing surface tension with hyperosmolar media promoted microridge formation. In anisotropically stretched cells, microridges formed by precursor fusion along the stretch axis, which computational modeling explained as a consequence of stretch-induced cortical flow. Collectively, our results demonstrate how contraction within the 2D plane of the cortex can pattern 3D cell surfaces. © 2020 van Loon et al.In this paper, the geometric and electronic properties of heterojunctions constructed using a graphene sheet and an MASnI3 surface were investigated by performing first-principles calculations based on the density functional theory. Our results show that the interaction between graphene and the MASnI3 surface is in the scope of van der Waals interactions. In the heterojunctions, electrons transfer from graphene to the MASnI3 surface, resulting in the formation of a built-in electric field in the interface, which is favorable for the separation of electrons and holes. The absorption spectra showed that the absorption intensity of the heterojunction in the visible region is slightly smaller than that of the pristine MASnI3 surface. The energy barriers of water molecules diffusing through MASnI3 surfaces are relatively low, but when a water molecule penetrates the graphene sheet into the interior of the MASnI3 it has to overcome an energy barrier of as high as 9 eV. It is found that the water diffusions through the surfaces cause very severe damage to the structures of the graphene sheet and MASnI3 surface.

10/30/2024


Fournier's gangrene (FG) is a rapidly progressive necrotizing bacterial dermo-hypodermitis of the perineum and external genitalia. It represents a real medical and surgical emergency requiring multidisciplinary care. Our study was based on the retrospective analysis of 18 cases of FG, collected in the Department of General and Visceral Surgery of Fattouma Bourguiba University Hospital in Monastir over an 18-year period extending from January 2000 to December 2018. Our series included 18 cases of FG collected over an 18-year period, an annual incidence of one case per year. The average age of our patients was 58 years (36 to 77). The male prevalence was clear. Diabetes and old age were found to be the major risk factors. The treatment was based on an aggressive surgical debridement remains to be the cornerstone of therapy and is commonly preceded by patient preparation for the surgical act by perioperative resuscitation and broad-spectrum antibiotic therapy, possibly accompanied by hyperbaric oxygen therapy (Hergency.
all women, including those living with HIV, have the right to choose the timing, spacing, and number of their births and need access to family planning services. This study aimed at assessing the prevalence and factors associated with an unmet need for family planning among women receiving Antiretroviral Therapy (ART) services.

a facility-based cross-sectional study was conducted from March to April 2018 in Gondar city, Ethiopia. A systematic random sampling technique was used to recruit 441 reproductive-age women on ART. The data were collected using a pretested structured questionnaire. The bivariate and backward multivariable logistic regression model was fitted to identify factors associated with the unmet need for family planning.

the prevalence of the unmet need for family planning among women living with HIV was 24.5%. Increase in women´s age (AOR 0.90, 95% CI (0.85, 0.95)), having more than three children (AOR 0.13, 95% CI (0.04, 0.38)), intention to have more children (AOR 0.09, 95% CI (0.03, 0.23)), not disclosing sero-status to partner (AOR 0.40, 95% CI (0.20, 0.82)) and having no experience of contraception use (AOR 0.43, 95% CI (0.21, 0.90)) were protective factors against unmet need for family planning. https://www.selleckchem.com/products/abr-238901.html Rural residence (AOR 2.17, 95% CI (1.05, 4.46)) was associated with increased odds of unmet need for family planning.

one in every four women living with HIV had an unmet need for family planning. So, continuous awareness-raising activities on family planning for women on ART should be given by emphasizing the rural and younger age women.
one in every four women living with HIV had an unmet need for family planning. So, continuous awareness-raising activities on family planning for women on ART should be given by emphasizing the rural and younger age women.
the aim of this study was to correlate the metabolic syndrome with the level of the physical activity in a population from Marrakech, Morocco.

the study was conducted at Ibn Zohr Regional Hospital in Marrakech. The body mass index (BMI) was calculated to assess the degree of obesity of each subject. To determine the level of physical activity, we used the short version of the IPAQ (International Physical Activity Questionnaire); Blood parameters were measured by a Biochemistry Automaton. All statistical analyzes were performed using SPSS software.

a total of 300 subjects participated in the study, which 57.3% were female and 42.7% were male with a sex ratio of 0.74. The average age of our population was 51.6± 13.42 years old. Seventy-nine of the participants (26.3%) had a metabolic syndrome, with a predominance of female 60 women (34.9%) and 19 men (14.8%). There is a significant relationship between level of physical activity and the presence of metabolic syndrome (P = 0.002), between physical activity level and BMI and waist circumference (p < 0.001) and (p = 0.003) respectively.

the result shows a significant association between obesity, metabolic syndrome and the level of the physical activity, which would encourage us to encourage the application of lifestyle rules, including physical activity, which remains one of the best preventive actions against this pathology.
the result shows a significant association between obesity, metabolic syndrome and the level of the physical activity, which would encourage us to encourage the application of lifestyle rules, including physical activity, which remains one of the best preventive actions against this pathology.
To evaluate feasibility of MRI in patients with non-pacemaker (PM)/ Implantable cardioverter defibrillator (ICD) metallic devices and abandoned leads.

Relative safety of MRI performed using specified protocol has been established in MR non-conditional PM/ICDs. With limited safety data, many non-PM/ICD metallic devices and abandoned leads continue to be a contraindication for MRI.

We retrospectively analyzed consecutive patients with extra-cardiac devices, non-programmable cardiac devices, and abandoned leads, who underwent MRI (GE 1.5 Tesla, WI) at a single tertiary care center over a span of 13 years. Scan protocol was designed to maintain specific absorption rate (SAR) < 4.0 W/kg and scan time < 60 minutes.

The cohort comprised 127 MRI exams representing 94 patients, with 13 patients having two or more scans. The devices consisted of 23 vagal nerve stimulators (VNS), 22 implantable loop recorders, 16 spinal stimulators, 5 peripheral nerve stimulators, 3 bladder stimulators, 2 deep brain stimulators, 1 gastric stimulator, 1 bone stimulator, 1 WATCHMAN device, 22 abandoned PM/lCD leads and 1 VNS lead. There was no immediate (peri-MRI exam) morbidity or mortality. Patients did not report any discomfort, palpitations, heating, or sensation of device migration during the exam. Local follow-up data was available in 65% (100% for thoracic imaging) with a mean of 190±475 days (median 13 days). No device malfunction reported during follow-up.

With appropriate precautions, MRI is feasible in patients with extracardiac devices, nonprogrammable cardiac devices, and abandoned leads.
With appropriate precautions, MRI is feasible in patients with extracardiac devices, nonprogrammable cardiac devices, and abandoned leads.