Electrocardiographic criteria of left ventricular hypertrophy in the presence of left bundle branch block

When left bundle branch block (LBBB) is present on the electrocardiogram, the diagnosis of left ventricular hypertrophy (LVH) may be difficult. The left ventricular mass in 70 patients with LBBB was estimated by echocardiography, and was compared to the QRS configuration on the electrocardiogram. We found that there was agreement between a monophasic R pattern in lead 1 or V6 (sensitivity 79.3%, 70.7%) and left ventricular hypertrophy. We suggest that a monophasic R pattern in L1 and V6 may provide a useful simple index of left ventricular hypertrophy in the presence of left bundle branch block.     

Misdiagnosed fibrosarcoma of the mandible mimicking temporomandibular disorder: a rare condition.

The jawbones can be sites of various neoplastic conditions. Given the variety of processes affecting this particular anatomical area, formulation of a precise diagnosis can be challenging to clinicians. Limited jaw movement, pain, and facial asymmetry are common signs among patients, especially those with temporomandibular disorder (TMD). This paper reports a case of primary fibrosarcoma affecting the mandible and surrounding structures in a 14-year-old girl presenting signs and symptoms similar to TMD. Her condition was misdiagnosed, and she was treated for TMD over an extended period before the correct diagnosis was made for fibrosarcoma. The patient underwent surgical resection with postsurgical radiotherapy and chemotherapy and now is being followed up. Although malignant lesions are rare in the temporomandibular joint (TMJ) region, dentists are advised to be aware of the condition and to keep in mind that patients who are admitting for TMD can also possibly be affected from neoplasms. Hence, those patients have to be examined meticulously to avoid misdiagnosis and mistreatment.     

Human Milk Virome Analysis: Changing Pattern Regarding Mode of Delivery,Birth Weight,and Lactational Stage

The human milk (HM) microbiota is a significant source of microbes that colonize the infant gut early in life. The aim of this study was to compare transient and mature HM virome compositions, and also possible changes related to the mode of delivery, gestational age, and weight for gestational age. Overall, in the 81 samples analyzed in this study, reads matching bacteriophages accounted for 79.5% (mainly Podoviridae, Myoviridae, and Siphoviridae) of the reads, far more abundant than those classified as eukaryotic viruses (20.5%, mainly Herpesviridae). In the whole study group of transient human milk, the most abundant families were Podoviridae and Myoviridae. In mature human milk, Podoviridae decreased, and Siphoviridae became the most abundant family. Bacteriophages were predominant in transient HM samples (98.4% in the normal spontaneous vaginal delivery group, 92.1% in the premature group, 89.9% in the C-section group, and 68.3% in the large for gestational age group), except in the small for gestational age group (only ~45% bacteriophages in transient HM samples). Bacteriophages were also predominant in mature HM; however, they were lower in mature HM than in transient HM (71.7% in the normal spontaneous vaginal delivery group, 60.8% in the C-section group, 56% in the premature group, and 80.6% in the large for gestational age group). Bacteriophages still represented 45% of mature HM in the small for gestational age group. In the transient HM of the normal spontaneous vaginal delivery group, the most abundant family was Podoviridae; however, in mature HM, Podoviridae became less prominent than Siphoviridae. Myoviridae was predominant in both transient and mature HM in the premature group (all C-section), and Podoviridae was predominant in transient HM, while Siphoviridae and Herpesviridae were predominant in mature HM. In the small for gestational age group, the most abundant taxa in transient HM were the family Herpesviridae and a species of the genus Roseolovirus. Bacteriophages constituted the major component of the HM virome, and we showed changes regarding the lactation period, preterm birth, delivery mode, and birth weight. Early in life, the HM virome may influence the composition of an infant’s gut microbiome, which could have short- and long-term health implications. Further longitudinal mother–newborn pair studies are required to understand the effects of these variations on the composition of the HM and the infant gut virome.     

The evaluation of acute kidney injury due to ischemia by urinary neutrophil gelatinase-induced lipocalin (uNGAL) measurement in patients who underwent partial nephrectomy

International Urology and Nephrology - To investigate the role of urinary neutrophil gelatinase-induced lipocalin (uNGAL) measurement in the early diagnosis of acute kidney injury that may occur...     

The effect of renal artery-only or renal artery–vein clamping during partial nephrectomy on short and long-term functional results: Is clamping technique important?

Purpose

To evaluate the effect of artery-only (AO) and artery–vein (AV) clamping during partial nephrectomy (PN) on short- and long-term renal function outcome.

Methods

Medical records of 154 patients in the AO group and 192 patients in the AV group who underwent open and minimally invasive (laparoscopic/robotic) PN between January 2011 and January 2018 were retrospectively assessed. Preoperative patient and tumor-specific characteristics in addition to perioperative factors and renal function outcomes were compared. The change in the estimated glomerular filtration rate (eGFR) from postoperative 1–3 days, 12 and 24 months after surgery was calculated. Acute kidney injury (AKI) was defined a as a?>?25% reduction in eGFR.

Results

There were no statistically significant differences between the clamping techniques in terms of postoperative 1–3 days, 12 and 24 months eGFR change percentage and risk of progression to chronic kidney disease (CKD). No significant difference in short- and long-term renal functions was found between the minimally invasive or open AO and AV clamping subgroups at any time point. In multivariate analysis, the R.E.N.A.L score (AO group p?=?0.026, AV group p?<?0.001) and preoperative eGFR (AO group p?<?0.001, AV group p?=?0.010) were strong predictors of the acute kidney injury in both groups. Older age (AO group p?=?0.045, AV group p?=?0.010) and preoperative eGFR (AO group p?=?0.008, AV group p?=?0.002) were significantly associated with CKD progression at 2-year follow-up in both groups.

Conclusion

AV clamping does not adversely affect postoperative renal function compared to AO clamping. Preoperative patient- and tumor-related factors are more important for renal function regardless of the clamping technique.

     

Profiles of faecal output of rare earth elements and stable isotopic tracers of iron and zinc after oral administration

The objectives of this study were to confirm the non-absorbability and the reproducibility of faecal excretion kinetics of orally administered rare earth elements, and to investigate the excretion profiles of rare earth elements and stable isotopic tracers of Fe and Zn to establish the extent to which rare earth element markers duplicate the behaviour of isotopic tracers. Two investigations were performed: (1) six healthy subjects consumed a solution containing five rare earth elements in amounts varying from 1 to 10 mg; (2) seven healthy subjects were given a standard solution labelled with Sm marker and (57)Fe tracer, and a meal labelled with Yb marker and (58)Fe and (70)Zn tracers. Individual faecal samples were collected and analysed to determine recoveries of rare earth elements and unabsorbed isotopic tracers. The mean values for recoveries were 94.1 (sd 4.5) % for the five rare earth elements, and 103 (sd 3.0) % and 99.8 (sd 2.8) % for Sm and Yb respectively. For Fe consumed with the solution, excretion kinetics of the rare earth element marker and unabsorbed tracers with cumulative collections of the first two and three faecal samples were identical, but endogenous excretion of Fe was significant in stools collected after the third. For Fe and Zn consumed with the meal, the excretion kinetics for the first two individual faecal samples and composites of sequential outputs were identical. Rare earth elements can be used as markers in studies of measurement of absorption. The dose of tracer required for the measurement of absorption would be reduced proportionally to the reduction of the period of faecal sampling, so that studies with stable isotopes would be more economical, thus enabling epidemiological investigations.     

Fibrodysplasia ossificans progressiva without characteristic skeletal anomalies

Fibrodysplasia ossificans progressiva (FOP) is a rare but extremely disabling genetic disease of the skeletal system. This disease is characterized by progression of heterotopic ossification within skeletal muscles, ligaments and tendons. Most patients with FOP are misdiagnosed early in life before the appearance of heterotopic ossification and undergo diagnostic procedures such as biopsy that can cause lifelong disability. Almost all of the patients have some peculiar congenital anomalies, including short great toes, hallux valgus, short thumbs and hypoplasia of digital phalanges. These congenital defects support the diagnosis of FOP, but are not constantly observed in the totality of patients. If necessary, genetic studies can be performed to confirm the diagnosis. Once diagnosed, patients should be advised in order to avoid unnecessary traumas, surgical procedures, biopsies, intramuscular injections and vaccinations. Here, we describe a patient with FOP without characteristic congenital skeletal anomalies.