Hereditary hemochromatosis restores the virulence of plague vaccine strains

Nonpigmented Yersinia pestis (pgm) strains are defective in scavenging host iron and have been used in live-attenuated vaccines to combat plague epidemics. Recently, a Y. pestis pgm strain was isolated from a researcher with hereditary hemochromatosis who died from laboratory-acquired plague. We used hemojuvelin-knockout (Hjv(-/-)) mice to examine whether iron-storage disease restores the virulence defects of nonpigmented Y. pestis. Unlike wild-type mice, Hjv(-/-) mice developed lethal plague when challenged with Y. pestis pgm strains. Immunization of Hjv(-/-) mice with a subunit vaccine that blocks Y. pestis type III secretion generated protection against plague. Thus, individuals with hereditary hemochromatosis may be protected with subunit vaccines but should not be exposed to live-attenuated plague vaccines.     

Continuous apex to left ventricle blood flow pattern in hypertrophic cardiomyopathy with apical aneurysm and midventricular obstruction

A 42-year-old female presented with chest pain, noted to have systolic and diastolic murmurs on physical examination and left ventricular hypertrophy on the electrocardiogram. Echocardiography with contrast enhancement revealed hypertrophic cardiomyopathy (HCM) with apical aneurysm and mid left ventricular cavity obstruction. Doppler interrogation showed continuous systolic and diastolic flow from the apex to left ventricle (LV) with a transient deceleration giving rise to a notched pattern. Myocardial ischemia of the apex was demonstrated on adenosine nuclear scintigraphy without epicardial coronary obstruction on angiography. This case demonstrates a novel Doppler pattern with continuous apex to LV flow in HCM in the setting of apical ischemia that may account for the formation of the aneurysm.     

Healing responses following transverse root fracture: a historical review and case reports showing healing with (a) calcified tissue and (b) dense fibrous connective tissue

Background

The understanding and management of transverse intra‐alveolar root fractures has evolved to its current high level of sophistication and clinical success from foundations laid down by histological studies as early as the mid‐nineteenth century.

Significance

The aim of the review was to highlight those earlier histological reports and studies that have contributed to the current understanding of the biological processes involved in the healing of transverse root fractures. Healing of a transverse root fracture by calcified tissue was demonstrated histologically by Howe in 1926, while Boulger in 1928 showed the two other patterns of root fracture healing, namely the interposition of fibrous connective tissue and the interposition of bone and periodontal ligament around both fractured segments. Other major histological reports around that time came from members of the so‐called ‘The Vienna group of Illinois’, who had a significant influence in the development of oral biology worldwide. Other important reports and an experimental study emanated from Germany and Switzerland in the late 30s and early 40s, followed in the 1950s and early 1960s by histological material principally from Sweden, Denmark, France, the USA and Britain. Jens Andreasen and Erik Hjörting‐Hansen's landmark paper in 1967 included new histological reports and a classification of healing responses following transverse root fractures. The expansion of knowledge related to root fractures since that time has been exponential, with major contributions from Scandinavia and several other countries.

Case reports

Accompanying the historical review are two case reports with histology of root fracture healing by (a) calcified tissue and (b) dense fibrous connective tissue. The role of the pulp and the periodontal ligament in the repair process is described and the clinical significance discussed with particular emphasis to diagnosis and orthodontic management.     

The Global Lung Initiative 2012 reference values reflect contemporary Australasian spirometry

We aimed to ascertain the fit of the European Respiratory Society Global Lung Initiative 2012 reference ranges to contemporary Australasian spirometric data. Z‐scores for spirometry from Caucasian subjects aged 4–80 years were calculated. The mean (SD) Z‐scores were 0.23 (1.00) for forced expirtory volume in 1 s (FEV₁), 0.23 (1.00) for forced vital capacity (FVC), ?0.03 (0.87) for FEV₁/FVC and 0.07 (0.95) for forced expiratory flows between 25% and 75% of FVC. These results support the use of the Global Lung Initiative 2012 reference ranges to interpret spirometry in Caucasian Australasians.     

Agreement and reproducibility of gray‐scale intravascular ultrasound and optical coherence tomography for the analysis of the bioresorbable vascular scaffold

Objective : To report the agreement between gray‐scale intravascular ultrasound (GS‐IVUS) and optical coherence tomography (OCT) in assessing the bioresorbable vascular scaffolds (BVS) structures and their respective reproducibility. Background : BVS are composed of an erodible polymer. Ultrasound and light signals backscattered from polymeric material differs from metallic stents using GS‐IVUS and OCT. Methods : Forty‐five patients included in the ABSORB trial were treated with a 3.0 × 18 mm BVS and imaged with GS‐IVUS 20 MHz and OCT post‐implantation. Qualitative (ISA, side‐branch struts, protrusion, and dissections) and quantitative (number of struts, lumen, and scaffold area) measurements were assessed by two investigators. The agreement and the inter‐ and intraobserver reproducibility were investigated using the kappa (κ) and the interclass correlation coefficient (ICC). Results : GS‐IVUS and OCT agreement was predominantly poor at a lesion, frame, and strut level analysis (κ and ICC <0.4) for qualitative measurements. GS‐IVUS demonstrated a reduced ability to detect cross‐sections with ISA (4.5% vs. 20.6%), side‐branch (SB) struts (6.3% vs. 7.8%), protrusions (3.2% vs. 9.6%), and dissections (0.2% vs. 9.0%) compared with OCT. GS‐IVUS reproducibility was poor–moderate (κ and ICC <0.6) except for ISA and SB‐struts (κ and ICC between 0.2 and 0.75). OCT showed an excellent reproducibility (κ and ICC > 0.75) except for the assessment of tissue protrusion (κ and ICC between 0.47 and 0.94). GS‐IVUS reproducibility was poor–moderate (ICC ≤ 0.5) in assessing the number of struts but excellent with OCT (ICC > 0.85). The reproducibility to assess lumen and scaffold areas was excellent using both techniques (ICC > 0.85). Conclusions : GS‐IVUS has a poor capacity to detect qualitative findings post‐BVS implantation and its reproducibility is low compared with OCT. The use of GS‐IVUS should be limited when assessing lumen and scaffold areas. © 2011 Wiley Periodicals, Inc.     

The Effects of Pre- and Post-Exercise Whey vs. Casein Protein Consumption on Body Composition and Performance Measures in Collegiate Female Athletes

Two of the most popular forms of protein on the market are whey and casein. Both proteins are derived from milk but each protein differs in absorption rate and bioavailability, thus it is possible that each type of protein may contribute differently to the adaptations elicited through resistance training. Therefore, the purpose of this study was to investigate the potential effects of ingestion of two types of protein in conjunction with a controlled resistance training program in collegiate female basketball players. Sixteen NCAA Division III female basketball players were matched according to body mass and randomly assigned in a double-blind manner to consume 24 g whey protein (WP) (N = 8, 20.0 ± 1.9 years, 1.58 ± 0.27 m, 66. 0 ± 4.9 kg, 27.0 ± 4.9 %BF) or 24 g casein protein (CP) (N = 8, 21.0 ± 2.8 years, 1.53 ± 0.29 m, 68.0 ± 2.9 kg, 25.0 ± 5.7 %BF) immediately pre- and post-exercise for eight weeks. Subjects participated in a supervised 4-day per week undulating periodized training program. At 0 and 8 weeks, subjects underwent DXA body composition analysis, and at 0 and 8 weeks underwent one repetition maximum (1RM) strength, muscle endurance, vertical jump, 5-10-5 agility run, and broad jump testing sessions. Data were analyzed using repeated measures ANOVA, and presented as mean ± SD changes from baseline after 60 days. No significant group x time interaction effects were observed among groups in changes in any variable (p > 0.05). A significant time effect was observed for body fat (WP: -2.0 ± 1.1 %BF; CP: -1.0 ± 1.6 %BF, p < 0.001), lean mass (WP: 1.5 ± 1.0 kg; CP: 1. 4 ± 1.0 kg, p < 0.001), fat mass (WP: -1.3 ± 1.2 kg; CP: -0.6 ± 1.4 kg, p < 0.001), leg press 1RM (WP: 88.7 ± 43.9 kg; CP: 90.0 ± 48.5 kg, p < 0.001), bench press 1RM (WP: 7.5 ± 4.6 kg; CP: 4.3 ± 4.5 kg, p = 0.01), vertical jump (WP: 4.1 ± 1.8 cm; CP: 3.5 ± 7.6 cm, p < 0.001), 5-10-5 (WP: -0.3 ± 0.2 sec; CP: -0.09 ± 0.42 sec, p < 0.001), and broad jump (WP: 10.4 ± 6.6 cm; CP: 12. 9 ± 7.1 cm, p < 0.001). The combination of a controlled undulating resistance training program with pre- and post-exercise protein supplementation is capable of inducing significant changes in performance and body composition. There does not appear to be a difference in the performance- enhancing effects between whey and casein proteins.

Key points

• Females can experience and increase in performance makers from consuming protein after resistance training.
• Females can have a decreased body fat composition when ingesting protein with daily resistance training and conditioning.
• There was no significant difference in performance markers between whey and casein.

Key words: whey, casein, protein, females, body composition, performance     

Thoracoscopic lobectomy: is a training program feasible with low postoperative morbidity?

Objective

To evaluate the feasibility of training program in video assisted thoracic surgery (VATS) lobectomy comparing intraoperative and postoperative data of patients operated on by an established consultant and trainees.

Methods

Retrospective analysis of 100 consecutive patients who underwent VATS lobectomies between May 2008 and May 2012. 66 patients were operated on by an established consultant (Group A) and 34 by trainees (Group B).

Results

The groups were comparable for clinical characteristics and pathological staging. The mean operating time in Group A was 125 ± 30 min and in Group B was 133 ± 26 min (p = 0.18). The rate of conversion was similar in both groups: 9.1 % in Group A and 8.8 % in Group B (p = 0.6). The complication rate was comparable (p = 0.4): 36.3 % in Group A and 32.3 % in Group B. Median time to drain removal and median length of hospital stay was 3 and 5.5 days in Group A and 3 and 5 days in Group B, showing no statistical differences between the two groups (p = 0.3 and 0.5). There were no differences in term of long-term complications between the two groups.

Conclusion

Our study showed that a training program in VATS lobectomy is feasible, without increasing the operative time, conversion rate, postoperative complication, time to drain removal, and length of hospital stay.     

Transvenous Biopsy in the Diagnosis of Intravascular or Perivascular Neoplasm: A Single-Center Retrospective Analysis of 36 Patients

Between September 2008 and August 2017, 36 patients (mean age 56 y; range, 30–89 y) underwent transvenous biopsy of suspected tumor thrombus or perivascular tumor. Intravascular biopsy was pursued because of inaccessible percutaneous access in 9 patients (25%) and as part of a planned revascularization procedure in 27 patients (75%). Histopathologic results showed malignancy in 26 patients (72%) and benign etiologies in 10 patients (28%). No patients required repeat biopsy. There were no complications related to the biopsy procedure. The present series suggests that transvenous biopsy is a safe and accurate method of intravascular and perivascular mass tissue sampling.     

Standards for Instrument Migration When Implementing Paper Patient-Reported Outcome Instruments Electronically: Recommendations from a Qualitative Synthesis of Cognitive Interview and Usability Studies

Objectives

To synthesize the findings of cognitive interview and usability studies performed to assess the measurement equivalence of patient-reported outcome (PRO) instruments migrated from paper to electronic formats (ePRO), and make recommendations regarding future migration validation requirements and ePRO design best practice.