Initial effects of the tongue crib on tongue movements during deglutition: a Cine-Magnetic resonance imaging study

The objective of this study was to investigate the initial effects of a tongue crib on tongue movements during deglutition by using real time balanced turbo field echo (B-TFE) Cine-MR imaging. A total of 21 patients were evaluated in this study. The open-bite group (OBG) consisted of 11 patients (seven girls, four boys) who had a mean age of 11.09 +/- 2.02 years and a mean overbite of -5.14 +/- 1.83 mm. These patients were evaluated initially (T1) and while wearing a tongue crib (T2). A total of 10 patients (five girls, five boys) with a mean age of 14.5 +/- 2.6 years and with a mean overbite of 1.6 +/- 0.5 mm served as controls (CG), and only initial records were obtained from these patients. T2 was compared with T1 and CG. T1 was also compared with CG. We evaluated deglutition during three stages matching oral (1), pharyngeal (2), and esophageal (3) stages. Our results indicated that the tongue's tip positioned more posteriorly when the crib was in place (T2) compared with both T1 and CG; the anterior portion of the tongue's dorsum was at a lower position in T2 compared with both T1 and CG at stage 3; the midportion of the tongue's dorsum was at a lower position in T2 than in T1 and CG at stages 1 and 2. To compensate for the posterior position of the tongue's tip (caused by the tongue crib), adaptive changes occurred in the anterior and midportions of the dorsum of the tongue.     

Primary Resection With Anastomosis vs. Hartmann’s Procedure in Nonelective Surgery for Acute Colonic Diverticulitis: A Systematic Review

Purpose This study compares primary resection with anastomosis and Hartmann's procedure in an adult population with acute colonic diverticulitis. Methods Comparative studies published between 1984 and 2004 of primary resection with anastomosis vs. Hartmann's procedure were included. The primary end point was postoperative mortality. Secondary end points included surgical and medical morbidity, operative time, and length of postoperative hospitalization. Random effects model was used and sensitivity analysis was performed. Results Fifteen studies, including 963 patients (57 percent primary resection with anastomoses, 43 percent Hartmann's procedures), were analyzed. Overall mortality was significantly reduced with primary resection and anastomosis (4.9 vs. 15.1 percent; odds ratio = 0.41). Subgroup analysis of trials matched for emergency operations showed significantly decreased mortality with primary resection and anastomosis (7.4 vs. 15.6 percent; odds ratio = 0.44). No significant difference in mortality was observed in trials matched for severity of peritonitis Hinchey > 2 (14.1 vs. 14.4 percent; odds ratio = 0.85). Sensitivity analysis did not reveal significant heterogeneity between the studies for the primary outcome. Conclusions Patients selected for primary resection and anastomosis have a lower mortality than those treated by Hartmann's procedure in the emergency setting and comparable mortality under conditions of generalized peritonitis (Hinchey > 2). The retrospective nature of the included studies allows for a considerable degree of selection bias that limits robust and clinically sound conclusions. This analysis highlights the need for high-quality randomized trials comparing the two techniques.     

An extremely rare bifurcation pattern of the caudal abdominal aorta: case report demonstrated by angiography

An extremely rare bifurcation pattern at the caudal abdominal aorta was encountered on the pelvic angiography and MR angiography of a male patient. Instead of dividing into two common iliac arteries, the caudal abdominal aorta first gave the right external iliac artery at the level of the last lumbar arteries, then bifurcated into a right internal iliac artery and a left common iliac artery. The median sacral artery originated at this anomalous bifurcation. This high origin of the right external iliac artery and separate branching of these right iliac vessels from the abdominal aorta are important during the interventions in the region. We present the angiography findings and discuss the embryological origin of this unusual and unreported congenital anomaly.     

Susceptibilities of Cryptococcus neoformans strains to platelet binding in vivo and to the fungicidal activity of thrombin-induced platelet microbicidal proteins in vitro

In this study we investigated the interactions between capsular and acapsular strains of Cryptococcus neoformans and blood platelets. In vivo microscopic observation of blood samples from mice inoculated with C. neoformans yeast cells demonstrated that encapsulated and nonencapsulated yeast cells disappeared quickly from the bloodstream and that platelets were attached solely to yeast cells of the nonencapsulated strains. In vitro we observed that only the acapsular strains were susceptible to the fungicidal activity of thrombin-induced platelet microbicidal proteins.     

Drugs in early clinical development for Systemic Lupus Erythematosus

Introduction: While immunosuppressive therapy has positively impacted the prognosis of systemic lupus erythematosus (SLE), many patients still do not respond to traditional therapy. Thus, active SLE disease remains a significant problem. Furthermore, conventional immunosuppressive treatments for SLE are associated a high risk of side effects. These issues call for improvement in our current therapeutic armamentarium.

Areas covered: In this review, the authors highlight the recent developments in therapies for SLE, and present an overview of drugs which are in early clinical development for SLE. There are many new therapeutic approaches being developed, including those focused on B-cell targets, T-cell downregulation, co-stimulatory blockade, anti-cytokine agents, and kinase inhibition, and Toll-like receptor inhibition. They also discuss peptide therapy as a potential method to re-establish immune tolerance, and some of the challenges ahead in developing and testing novel agents for SLE.

Expert opinion: Many novel agents are currently in development for SLE, but this encouraging news is tempered by several disappointments in clinical trials and provides a timely moment to reflect on the future of therapeutic development in SLE. It seems likely that biological heterogeneity between patients is a major contributor to difficulty in drug design in SLE.     

2-Amino-3,5-dicarbonitrile-6-sulfanylpyridines: synthesis and multiple biological activity – a review

This review integrates the published data of the last decade (from 2010 to 2020) on the synthesis of the 2-amino-3,5-dicarbonitrile-6-sulfanylpyridine scaffold, the derivatives of which are widely used in the synthesis of biologically active compounds. Currently, no systematic accounts of synthetic routes towards this class of heterocyclic compounds can be found in the literature. The present-day trends in the catalytic synthesis of 2-amino-3,5-dicarbonitrile-6-sulfanylpyridines are considered using pseudo-four-component reaction (pseudo-4CR) by condensation of malononitrile molecules with thiols and aldehydes, and alternative three-component (3CR) condensations of malononitrile with 2-arylidenemalononitrile and S-nucleophiles.

The latest advances in the catalytic synthesis of biologically active compounds with 2-amino-3,5-dicarbonitrile-6-sulfanylpyridine scaffold via the multicomponent reactions of malononitrile have been discussed.     

Prevalence and features of metabolic syndrome in childhood-onset systemic lupus erythematosus

To estimate the prevalence and features of metabolic syndrome (MetS) in childhood-onset systemic lupus erythematosus (cSLE), we performed a cross-sectional study of 76 consecutive cSLE patients and 54 healthy controls, age and sex matched. All individuals were assessed for anthropometric and MetS features according to World Health Organization (WHO), NCEP Adult Treatment Panel III (NCEP-ATP III), and International Diabetes Federation (IDF) criteria. The cSLE patients were further assessed for clinical and laboratory manifestations, disease activity (Systemic Lupus Erythematosus Disease Activity Index), cumulative damage (Systemic Lupus International Collaborating Clinics (SLICC)), and current and cumulative drug exposures. Sixty-nine (90.8%) patients were female with mean age of 16.8 years [standard deviation (SD) ±4.0 years]. Mean disease duration was 4.8 years (SD ± 4.1). Based on the WHO MetS criteria, MetS was observed in two (2.6%) cSLE patients. We observed high prevalence of the MetS in cSLE patients according to NCEP-ATP III MetS criteria (18.4%) (p = 0.002) and according to IDF MetS criteria (17.1%) (p = 0.003). We did not observe MetS in the control group. No difference in cSLE patients <18 and ≥18 years was observed. We observed an association between the presence of MetS and SLICC scores in cSLE <18 years and cumulative corticosteroid dose adjusted by weight in cSLE ≥18 years. This study showed that MetS is frequently observed in cSLE using NCEP-ATP III MetS criteria and IDF MetS criteria. The identification of MetS is important to indicate cardiovascular morbidity and mortality in cSLE.