Intracranial thrombosed anastomosing hemangioma: Case report

An anastomosing hemangioma is a relatively new diagnosis of a benign vascular lesion that is typically found in the genitourinary tract. On imaging, anastomosing hemangiomas have a broad differential diagnosis and can resemble malignant lesions such as angiosarcoma. Here we present a case of a 33-year-old male with seizures who on imaging was found to have a presumed recurrent intracranial meningioma. After surgical resection of his lesion, this case was pathologically diagnosed as having anastomosing hemangioma. To our knowledge, this is the first report of a case of a thrombosed anastomosing hemangioma located at intracranial and intradural region.     

Screening in the Prenatal Period for Intimate Partner Violence and History of Abuse: A Survey of Edmonton Obstetrician/Gynaecologists

Objective

This study sought to understand how obstetrician gynaecologists (OB/GYNs) in Edmonton, Alberta screen prenatal patients for intimate partner violence (IPV). It also aimed to explore attitudes, beliefs, and perceptions regarding IPV and identify barriers to screening for IPV. Institutional protocols, resources, and support available to clinicians and patients were also reviewed.

When to consider targeted therapies in thrombotic microangiopathies in the modern era: walking the tightrope between cost,safety, and efficacy

Journal of Thrombosis and Thrombolysis - Thrombotic Microangiopathy (TMA) is a heterogeneous collection of syndromes that encompasses TTP, HUS, and other processes characterized by...     

Humanized C3 Mouse: A Novel Accelerated Model of C3 Glomerulopathy

Open in a separate window     

Analysis of the Pediatric Health Information System Database as a Surveillance Tool for Travel-Associated Infectious Diseases

The Pediatric Health Information System (PHIS) database collects admission, diagnostic, and treatment data among 44 children''s hospitals across the United States (U.S.) and presents an opportunity for travel-associated infectious disease (TAID) surveillance. We calculated cumulative incidence rates among children admitted to 16 PHIS hospitals for dengue, malaria, and typhoid, and pooled TAID using discharge codes from 1999 to 2012. We compared incidence rates before, during, and after the 2007–2009 economic recession. Among 16 PHIS hospitals during the study period (1999–2012), incidence of dengue and pooled TAID (malaria, dengue, typhoid fever) increased significantly, and rates of malaria and typhoid trended upward. Admissions for dengue and pooled TAIDs increased significantly among 16 children''s hospitals across the United States from 1999 to 2012. The PHIS database may provide a useful surveillance tool for TAIDs among children in the United States.International travel to other countries has increased 5% in the United States and 48% worldwide in the last decade, and more travelers visit low- and middle-income countries (LMICs) than ever before.¹ As many as 8% of U.S. travelers seek medical care, and many more suffer from milder illness while abroad.^2–4 A significant proportion of the 62 million annual U.S. international travelers develops illness after returning to the United States with infections that may be unfamiliar to local health-care providers.^5–7 Estimating incidence rates of non-endemic diseases may help public health officials direct educational resources and raise awareness among local practitioners.Currently, surveillance systems for travel-associated infectious diseases (TAIDs) in the United States are limited. Many TAIDs are reportable to state health departments, but reporting is often unreliable.⁸ The GeoSentinel Surveillance Network (GSSN) is a system of 57 travel disease clinics worldwide, including 15 clinics in the United States. Although the GSSN obtains robust clinical and diagnostic information, it surveys only those seeking care at specialty travel clinics, and only 7% of GSSN patients are children.¹The Pediatric Health Information System (PHIS) database was established to collect administrative and financial data from pediatric hospitals across the Unites States. More recently, the database has been augmented (PHIS+) to also collect clinical, laboratory, treatment, and outcome data at multiple health-care settings (inpatient, outpatient, and emergency departments [EDs]) among 44 freestanding children''s hospitals across the United States.^9,10 It offers an opportunity for objective hospitalized TAID surveillance among the greater than 5 million children hospitalized annually at these institutions.¹¹ We evaluated the PHIS database as a potential TAID surveillance tool by determining cumulative incidence rates of three TAIDs (malaria, dengue, and typhoid fever) among PHIS hospitals over a 14-year period.A total of 16 PHIS hospitals from geographically diverse metropolitan areas (median population 426,001 people, interquartile range 247,026–757,907 people)¹² had non-missing data available during the study period (1999–2012). The metropolitan areas include San Diego, CA; Norfolk, VA; St. Petersberg, FL; Orange County, CA; Corpus Christi, TX; Miami, FL; Denver, CO; Memphis, TN; Chicago, IL; Akron, OH; Little Rock, AR; Columbus, OH; Fort Worth, TX; Omaha, NE; Milwaukee, WI; and St. Louis, MO. All inpatient discharges from these sites with a principal discharge diagnosis (International Classification of Diseases 9 [ICD-9]) code¹³ for malaria (0840, 0841, 0842, 0843, 0846, 0849), typhoid (0020), and dengue (061) were identified within the PHIS database. Readmissions for the same ICD-9 diagnosis were excluded from the analysis. Cumulative incidence rates of malaria, typhoid, and dengue as well as pooled TAID incidence rates for all three diseases were determined by dividing hospitalized cases by total hospital discharges per year. Individual disease and pooled incidence rates were compared over the study period (1999–2012). We hypothesized that TAID incidence rates may have decreased during the 2007–2009 economic recession due to decreased international travel, and thus, rates for before (1999–2006), during (2007–2009), and after the U.S. economic recession were compared.^7,14,15 Categorical variables were compared using χ² with Fisher''s exact testing when appropriate.The 16 PHIS hospitals represented 2,203,063 pediatric hospital admissions during the study period. Individual and pooled cumulative TAID incidence trended upward from 1999 to 2012, though the trend did not achieve statistical significance (r² = 0.158). When comparing cumulative incidence rates from before (1999–2006), during, and after (2010–2012) the 2007–2009 economic recession, there was a significant change in incidence rates for dengue (P = 0.016) and pooled TAID (p = 0.009), though all diseases studied showed a similar trend with decreases during the recession and highest rates after (Figure 1 ).Open in a separate windowFigure 1.Comparison of pooled and individual travel-associated infectious diseases (TAIDs) in the Pediatric Health Information System (PHIS) database, 1999–2012.

Table 1

Hospital admission incidence rates of travel-associated infectious diseases (TAIDs) in children before, during, and after the 2007–2009 economic recession.

Phenotype-Genotype Correlations and Estimated Carrier Frequencies of Primary Hyperoxaluria

Primary hyperoxaluria (PH) is a rare autosomal recessive disease characterized by oxalate accumulation in the kidneys and other organs. Three loci have been identified: AGXT (PH1), GRHPR (PH2), and HOGA1 (PH3). Here, we compared genotype to phenotype in 355 patients in the Rare Kidney Stone Consortium PH registry and calculated prevalence using publicly available whole-exome data. PH1 (68.4% of families) was the most severe PH type, whereas PH3 (11.0% of families) showed the slowest decline in renal function but the earliest symptoms. A group of patients with disease progression similar to that of PH3, but for whom no mutation was detected (11.3% of families), suggested further genetic heterogeneity. We confirmed that the AGXT p.G170R mistargeting allele resulted in a milder PH1 phenotype; however, other potential AGXT mistargeting alleles caused more severe (fully penetrant) disease. We identified the first PH3 patient with ESRD; a homozygote for two linked, novel missense mutations. Population analysis suggested that PH is an order of magnitude more common than determined from clinical cohorts (prevalence, approximately 1:58,000; carrier frequency, approximately 1:70). We estimated PH to be approximately three times less prevalent among African Americans than among European Americans because of a limited number of common European origin alleles. PH3 was predicted to be as prevalent as PH1 and twice as common as PH2, indicating that PH3 (and PH2) cases are underdiagnosed and/or incompletely penetrant. These results highlight a role for molecular analyses in PH diagnostics and prognostics and suggest that wider analysis of the idiopathic stone-forming population may be beneficial.     

Stress-dependent cardiac remodeling occurs in the absence of microRNA-21 in mice

MicroRNAs inhibit mRNA translation or promote mRNA degradation by binding complementary sequences in 3' untranslated regions of target mRNAs. MicroRNA-21 (miR-21) is upregulated in response to cardiac stress, and its inhibition by a cholesterol-modified antagomir has been reported to prevent cardiac hypertrophy and fibrosis in rodents in response to pressure overload. In contrast, we have shown here that miR-21-null mice are normal and, in response to a variety of cardiac stresses, display cardiac hypertrophy, fibrosis, upregulation of stress-responsive cardiac genes, and loss of cardiac contractility comparable to wild-type littermates. Similarly, inhibition of miR-21 through intravenous delivery of a locked nucleic acid-modified (LNA-modified) antimiR oligonucleotide also failed to block the remodeling response of the heart to stress. We therefore conclude that miR-21 is not essential for pathological cardiac remodeling.     

Host response in experimental periodontal disease

Experiments were performed to determine the role of the immune response in rat periodontal disease. Germ-free rats were fed defined antigen-free liquid diets or a diet containing ovalbumin(OVA) as a prototype antigen. The OVA-fed rats demonstrated increased gingival lymphocytes (mainly T at early times), OVA-sensitized spleen cells, and increased periodontal bone loss. In further studies, rats pre-sensitized with OVA, and receiving OVA in the diet, showed elevated IgG antibody, sensitized spleen cells, and elevated periodontal bone loss scores. The concept that bone loss was due to mixed hypersensitivity reaction is consistent with the periodontal pathology. The effects of pre-immunization with A. actinomycetemcomitans (Aa) on periodontal bone loss in Actinobacillus (Aa) - infected rats was examined. Delayed hypersensitivity (DTH) was present in immunized rats throughout the experimental period. Sham-immunized rats showed DTH after 30 days of infection. In addition, immunized rats showed elevated bone loss scores. These experiments support the contention that a combination of hypersensitivity reactions (i.e., mixed hypersensitivity to Aa) could give rise to the periodontal pathology observed. Congenitally athymic rats (nude) were shown to have more periodontal bone loss than did normal littermates. However, bone loss in thymus-cell reconstituted nude rats was not different from that in control rats. Normal rats receiving Aa-sensitized T lymphocytes prior to infection with Aa demonstrated increased DTH and periodontal bone loss. These studies support the concept that T-cell functions and thymic regulation of immune responses can exert protective and/or destructive effects in periodontal disease. In order to modify disease, it will be necessary to enhance the protective aspects of the immune response and to minimize the detrimental aspects.     

Quantitation of blood flow after anterior maxillary osteotomy: investigation of three surgical approaches.

The radioactive microsphere method was used to quantitate preoperative and postoperative blood flows in macaque monkeys when three different surgical approaches for anterior maxillary osteotomy were performed. Despite distinct variations in flap designs among the experimental groups, preoperative and postoperative determinations of blood flow were essentially unchanged. Results of the study suggest that a palatal, labial, or combined mucoperiosteal pedicle should be adequate to preserve the flow of blood to tissues in the osteotomized segment.