A guide to oral vaccination: Highlighting electrospraying as a promising manufacturing technique toward a successful oral vaccine development

Most vaccines approved by regulatory bodies are administered via intramuscular or subcutaneous injections and have shortcomings, such as the risk of needle-associated blood infections, pain and swelling at the injection site. Orally administered vaccines are of interest, as they elicit both systemic and mucosal immunities, in which mucosal immunity would neutralize the mucosa invading pathogen before the onset of an infection. Hence, oral vaccination can eliminate the injection associated adverse effects and enhance the person's compliance. Conventional approaches to manufacturing oral vaccines, such as coacervation, spray drying, and membrane emulsification, tend to alter the structural proteins in vaccines that result from high temperature, organic and toxic solvents during production. Electrohydrodynamic processes, specifically electrospraying, could solve these challenges, as it also modulates antigen release and has a high loading efficiency. This review will highlight the mucosal immunity and biological basis of the gastrointestinal immune system, different oral vaccine delivery approaches, and the application of electrospraying in vaccines development.     

Cervicofacial non-tuberculous mycobacterial lymphadenitis: clinical determinants of incomplete surgical removal

In patients with non-tuberculous mycobacterial cervicofacial lymphadenitis, incomplete surgical removal of infected lymph nodes leads to delayed healing and a higher recurrence rate, with eventual spontaneous drainage through the skin. However, complete surgical removal is not always achievable due to the extent of the infected tissue and proximity to vulnerable structures, such as the facial or accessory nerve. The aim of this study was to identify the clinical determinants of the (in)ability to perform complete surgical removal. The electronic health records of patients aged 0–15 years with bacteriologically proven non-tuberculous mycobacterial cervicofacial lymphadenitis, who underwent surgical treatment and preoperative sonographic imaging, were analysed. This was a case–control study. A total of 103 patients met the inclusion criteria. Most of the infections were unilateral, submandibular, and caused by Mycobacterium avium. Multiple logistic regression analysis revealed that higher age (odds ratio 1.24, 95% confidence interval 1.04–1.47) and fistulization (odds ratio 3.15, 95% confidence interval 1.13–8.75) were significantly associated with a limited ability to surgically remove all infected tissue. However, a larger sonographic lymph node size was not significantly associated. These findings could aid clinicians when informing the parent(s)/guardian(s) of the patient preoperatively and in properly estimating the intraoperative and postoperative course.     

Elevación del lactato en el postoperatorio como marcador de isquemia mesentérica aguda. Descripción de dos casos

Serum lactate is a non-specific marker of tissue hypoperfusion. Elevated serum lactate is used in the differential diagnosis of acute intestinal ischemia. Although this practice is controversial, in the absence of other validated markers lactate is still used because of its high sensitivity.We present the cases of two patients who developed acute mesenteric ischemia as a post-surgical complication. The patients reported moderate abdominal pain —a non-specific symptom in the postoperative context— and tests showed progressively increasing serum lactate levels, which facilitated suspicion and subsequent diagnostic confirmation through an imaging test.These cases highlight the physiopathological importance of lactate elevation in the perioperative context and of performing a differential diagnosis of its possible causes, including mesenteric ischemia. Although the outcome was negative in the first case, early suspicion allowed us to make an effective diagnosis and administer appropriate treatment in the second patient.     

Mesenteric and omental cysts: An ultrasonographic and clinical study of 15 patients

The clinical and ultrasonographic (US) features of 15 cases of mesenteric or omental cyst are herein described. This series included seven male and eight female patients, whose age ranged from 2–89 years. Correct clinical diagnosis was made in two children only, but preoperative US examination accurately demonstrated the lesion in 11 of 13 patients (85%). These cystic lesions usually had a thin wall, internal septations, and fluid content with sedimentation. Enteric duplication cysts had a relatively thick wall merging with the muscle layer of bowel loop, and multiloculation was noted mainly with cystic lymphangiomas or pseudocysts. The diagnostic and surgical management of these lesions are briefly reviewed and their US appearance is illustrated.     

组织细胞坏死性淋巴结炎29例临床病理分析

目的：探讨组织细胞坏死性淋巴结炎（HNL）的临床病理特征。方法：回顾性分析29例HNL的临床资料，观察描述其病理特征；用S-P免疫组化法检测细胞表型。结果：HNL多见于年轻女性，颈部淋巴结肿大．高热，外周血WBC降低。活检标本常呈破碎状．淋巴结皮质、副皮质区可见片状或融合的凝固性坏死灶，坏死灶内可见嗜础胜核碎片和嗜酸性颗粒辟屑，伴有T细胞和组织细胞的大量增生，无中性粒细胞浸润，B细胞少量散在分布。结论：淋巴结肿大、高热，淋巴结内不伴有中性粒细胞浸润的散在或片状凝固性坏死及大量组织细胞增生为HNL的临床病理特征。     

术后早期肠系膜静脉血栓形成的诊断与治疗

目的 分析腹部术后早期肠系膜静脉血栓形成的临床特点及诊断与治疗。方法 回顾性总结我院14年间7例腹部术后早期肠系膜静脉血栓形成患者的临床资料。结果 患者均体胖，主要临床表现为持续剧烈的腹痛和呕吐，腹部体征相比较轻；有2例甚至出现全身中毒症状。腹部X线检查均提示肠梗阻；4例腹部CT检查，其中3例提示本病；6例术前腹腔穿刺出血性液体。7例患者均予以手术探查，分别切除长度不一的坏死小肠段。2例术后出现短肠综合征，其中1例因严重营养不良，衰竭死亡。4例术后反复出现门静脉、肠系膜静脉和髂静脉血栓，需出院后长期服用肠溶阿斯匹林或华法令钠。结论 术后早期肠系膜静脉血栓形成在临床上无何特异性的症状和体征，极易误诊。治疗方面应强调及时地剖腹探查并配合使用全身性的抗凝溶栓药物。     

联合门静脉和/或肠系膜上静脉切除的扩大胰十二指肠切除术

目的探讨胰头癌侵犯门静脉和／或肠系膜上静脉（PV／SMV）时的根治切除的可行性。方法回顾分析包括受侵PV／SMV在内的扩大胰头十二指肠切除术16例的临床资料。16例均行胰头十二指肠切除术，其中9例行血管壁部分切除，5例行血管节段性切除及对端吻合，2例行受侵血管切除＋自体静脉移植。结果全组患者术后均未发生血管栓塞、肠坏死、肝衰竭等并发症。除1例并发多器官衰竭于术后2d死亡外，均康复出院。15例均随访。存活超过3年者3例，超过5年者1例，存活3～26个月4例。结论对单纯侵犯PV／SMV的胰头癌施行联合PV／SMV住内的胰头癌扩大根治术是可行的。     

Hepatic falciform artery

The hepatic falciform artery is an occasional terminal branch of the left or middle hepatic artery, and may provide an uncommon but important collateral route when the principal visceral arteries are occluded.