Obesity surgery makes patients healthier and more functional: real world results from the United Kingdom National Bariatric Surgery Registry

Background

The National Bariatric Surgery Registry (NBSR) is the largest bespoke database in the field in the United Kingdom.

Intrarater and interrater reliability of a hand-held dynamometric technique to quantify palmar thumb abduction strength in individuals with and without carpal tunnel syndrome

Study Design

Clinical measurement.

Evolving trends in aortic valve replacement: A statewide experience

Background

Transcatheter aortic valve replacement (TAVR) is an alternative to surgical aortic valve replacement (SAVR) for the treatment of aortic stenosis in patients at intermediate, high, and extreme risk for mortality from SAVR. We examined recent trends in aortic valve replacement (AVR) in Michigan.

Methods

The Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative (MSTCVS‐QC) database was used to determine the number of SAVR and TAVR cases performed from January 2012 through June 2017. Patients were divided into low, intermediate, high, and extreme risk groups based on STS predicted risk of mortality (PROM). TAVR patients in the MSTCVS‐QC database were also matched with those in the Transcatheter Valve Therapy Registry to determine their Heart Team‐designated risk category.

Results

During the study period 9517 SAVR and 4470 TAVR cases were performed. Total annual AVR volume increased by 40.0% (from 2086 to 2920), with a 13.3% decrease in number of SAVR cases (from 1892 to 1640) and a 560% increase in number of TAVR cases (from 194 to 1280). Greater than 90% of SAVR patients had PROM ≤8%. While >70% of TAVR patients had PROM ≤ 8%, they were mostly designated as high or extreme risk by a Heart Team.

Conclusions

During the study period, SAVR volume gradually declined and TAVR volume dramatically increased. This was mostly due to a new group of patients with lower STS PROM who were designated as higher risk by a Heart Team due to characteristics not completely captured by the STS PROM score.     

Management of Periocular Granuloma Annulare Using Topical Dapsone

Granuloma annulare is a disease characterized by granulomatous inflammation of the dermis. Localized granuloma annulare may resolve spontaneously, while generalized granuloma annulare may persist for decades. The authors present the case of a 41-year-old Hispanic man with a two-week history of periocular granuloma annulare. Due to previously reported success in the use of systemic dapsone for the treatment of granuloma annulare, and the periocular proximity of the patient’s lesion, topical dapsone was used for treatment. Various additional therapies for the management of granuloma annulare have been reported, such as topical and systemic steroids, isotretinoin, pentoxifylline, cyclosporine, Interferon gamma, potassium iodide, nicotinamide, niacinamide, salicylic acid, fumaric acid ester, etanercept, infliximab, and hydroxychloroquine. Additional clinical trials are necessary to further evaluate the effectiveness of topical dapsone in the management of granuloma annulare.Granuloma annulare (GA) was first identified in 1985 by Fox1 and has since been well-described in the literature as benign, firm, skin-colored, and solitary or grouped papules or nodules arranged in an annular pattern.2 When the nodules increase in size the annular ring arrangement can become obscured.3 GA most commonly occurs in women in the first three decades of life.2 The estimated distribution of GA lesions per the literature is 60 percent on the hands or arms, 20 percent on the feet and legs, seven percent involving both upper and lower extremities, five percent on the trunk, and five percent involving any other areas, such as the face and scalp.4 It is rare to see GA on the face and scalp especially in adults as it usually occurs in children.3 There have however been some instances of GA occurring on the face in adults as reported by Coskey in 1979 who studied the literature and found 44 reported cases of facial GA of which 25 were adults.5 There are four subtypes of GA: localized, perforating, subcutaneous, and generalized.3 The most common subtype is localized GA, which occurs in children and presents clinically as small, firm, asymptomatic, skin-colored or red papules or nodules in an arciform pattern and is histologically consistent with no epidermal change. This type runs the course of enlargement and later regression.3 The second type is the perforating type, which appears as umbilicated lesions. The third type is subcutaneous GA, which appears clinically as subcutaneous nodules either mobile or fixed to the periosteum or bone located most commonly on the extremities.3 The fourth type is generalized/disseminated GA, which occurs primarily in adults and presents as widespread flesh-colored to violaceous papules or plaques. Although there is some controversy over this relationship, generalized GA has been accepted to be significantly associated with diabetes mellitus.3     

Loss of N‐WASP drives early progression in an Apc model of intestinal tumourigenesis

N‐WASP (WASL) is a widely expressed cytoskeletal signalling and scaffold protein also implicated in regulation of Wnt signalling and homeostatic maintenance of skin epithelial architecture. N‐WASP mediates invasion of cancer cells in vitro and its depletion reduces invasion and metastatic dissemination of breast cancer. Given this role in cancer invasion and universal expression in the gastrointestinal tract, we explored a role for N‐WASP in the initiation and progression of colorectal cancer. While deletion of N‐wasp is not detectably harmful in the murine intestinal tract, numbers of Paneth cells increased, indicating potential changes in the stem cell niche, and migration up the crypt–villus axis was enhanced. Loss of N‐wasp promoted adenoma formation in an adenomatous polyposis coli (Apc) deletion model of intestinal tumourigenesis. Thus, we establish a tumour suppressive role of N‐WASP in early intestinal carcinogenesis despite its later pro‐invasive role in other cancers. Our study highlights that while the actin cytoskeletal machinery promotes invasion of cancer cells, it also maintains normal epithelial tissue function and thus may have tumour suppressive roles in pre‐neoplastic tissues. © 2018 The Authors. The Journal of Pathology published by John Wiley & Sons Ltd on behalf of Pathological Society of Great Britain and Ireland.