Ex vivo Search for Sentinel Node in Postmastectomy Specimens: Should We Use a Transverse Incision for Mastectomy?

Background According to the concept of sentinel node (SN), the lymphatic pathway leading to SN should be regarded as the main and the most important lymphatic route from primary tumor to regional lymph nodes. We performed ex vivo blue-dye SN mapping in postmastectomy specimens to assess whether the main lymphatic tract leading to SN is completely removed during mastectomy. We assumed that ex vivo identification of SN may be possible only if the entire lymphatic tract leading to sentinel node is removed from within the postmastectomy specimen. Methods Blue dye (1 mL) was injected intracutaenously, periareolary into each of 28 postmastectomy specimens. In 13 cases mastectomy was performed with the use of transverse skin incision; in 15 cases oblique incision was used. Results The use of transverse skin incision during modified radical mastectomy allowed identification of the sentinel node and removal of the entire lymphatic pathway leading to sentinel node only in 4 of 15 cases (31%). Conversely, the use of oblique skin incision during modified radical mastectomy allowed identification of the sentinel node and removal of the entire lymphatic pathway leading to sentinel node in 12 of 15 cases (80%). Conclusions Our experiment revealed that the use of transverse skin incision during modified radical mastectomy may not be the best choice for breast cancer patients. In our opinion, this observation may be especially important for patients not irradiated postoperatively.     

Predicting Maximum Roux-en-Y Gastric Bypass-Induced Weight Reduction — Preoperative Plasma Leptin or Body Weight?

Background Weight loss after bariatric surgery varies between patients, and predicting the extent thereof is often inaccurate. The aim of this study was to assess the potential of preoperative plasma leptin and body weight in predicting the maximum weight loss within 2 years after Roux-en-Y gastric bypass (RYGBP). Methods The study comprised 68 subjects (39 women, 29 men; mean age 36.4 ± 10.2 years, body weight 130.3 ± 24.8 kg, BMI 44.4 ± 6.8 kg/m²) undergoing RYGBP who were followed for 2 years. Baseline and maximum follow-up plasma leptin and weight were assessed. Results Mean maximum weight reduction of 50.5 ± 19.1 kg (38.0 ± 9.0%, range 24 – 100 kg) was noted at 15 ± 4 months after RYGBP. Baseline plasma leptin was 37.9 ± 14.5 ng/ml, and decreased to 17.4 ± 8.1 ng/ml (P < 0.001) at maximum weight reduction. No significant correlation between baseline plasma leptin and absolute or relative weight reduction or minimum body weight achieved was noted. No significant plasma leptin threshold which would be predictive for any consistent extent of weight loss was found. However, baseline body weight was a strong determinant of minimum body weight attained (r = 0.67; P < 0.01) and of maximum absolute weight reduction (r = 0.81; P < 0.01). Conclusion Preoperative plasma leptin concentration cannot be used as a predictor of weight reduction following RYGBP. Preoperative body weight is a reliable predictor of post-RYGBP weight loss.     

Transient demineralization of the hip--case report]

Transient osteoporosis of the hip is an uncommon disorder of unclear etiology. It is often confused with other diagnosis including osteonecrosis of the femoral head. Authors describe a case of transient osteoporosis of the hip of 32 years woman. The symptoms occurred in third trimester of pregnancy. The primary symptoms were right hip pain and decreased range of motion of the right hip. In diagnostic process helpful were clinical examination, X-ray, ultrasonography, MRI and microscopic examination. As a treatment authors used walking on crutches, calcitonin and calcium preparate. After a few months remission of symptoms and normalization in accessory investigations were obtained.     

The influence of gender, weight, height and BMI on pentosidine concentrations in plasma of hemodialyzed patients

BACKGROUND/AIMS: Advanced glycation end-products (AGEs) such as pentosidine play an important role in complications associated with chronic renal failure (CRF) and hemodialysis (HD). This study was undertaken to determine the influence of anthropometric parameters and inflammation on plasma pentosidine concentrations. METHODS: We measured total and free pentosidine in the plasma of 49 patients on chronic HD. Acid hydrolysis of plasma and protein precipitation with trichloroacetic acid was done in the case of total and free pentosidine, respectively. Pentosidine was measured by high performance liquid chromatography (HPLC). C-reactive protein (CRP) was measured by the nephelometric method. RESULTS: A strong negative correlation between dry weight and mean concentration of total pentosidine before and after HD was found (R = -0.47, p < 0.001). This correlation was stronger in males (R = -0.47, p = 0.017) than females (R = -0.34, p = 0.10). Even stronger correlations were noted between body mass index (BMI) and total (R = -0.55, p < 0.001), as well as free (R = -0.39, p = 0.01) pentosidine. Multivariate analysis demonstrated that BMI and time on HD were two independent factors influencing total pentosidine concentrations. CRP did not correlate with pentosidine or BMI. CONCLUSIONS: Lower BMI values are associated with significantly higher plasma pentosidine concentrations in patients on HD. Presumably this relationship is mediated by hypercatabolism observed in these patients. Catabolism produces weight loss and reduces BMI concurrently with the induction of oxidative and carbonyl stresses that stimulate the generation of pentosidine and other harmful AGEs in dialyzed patients.     

Outcomes of endothelial keratoplasty with descemetorhexis (DSEK)

PURPOSE: Analysis of morphologic and functional outcomes of endothelial keratoplasty with descemetorhexis technique for recipient Descemet's membrane removal (DSEK). MATERIAL AND METHODS: We analyzed patients treated for chronic endothelial dysfunction with DSEK technique. For the study 12 patients (12 eyes) with follow up at least 9 months, were qualified. Study group consisted of 9 women and 3 men, in age from 53 to 83 years, mean 72.9 +/- 7.82 years. All surgery were performed by one surgeon (EW). Anterior chamber was opened through 5 mm wide and 3 mm long sclero-corneal tunnel. Before descemetorhexis incision points on the endothelial side of cornea were done with radio-frequency diathermy. Descemet's membrane stripping was done with the forceps. Endothelial grafts were fixed with anterior chamber by air tamponade. We analyzed postoperative visual acuity (on Snellen's charts), corneal transparency, endothelial cell density, total central corneal thickness and endothelial button (with OCT Visante), and complications of the surgery. RESULTS: 9 months postoperatively VA ranged from 0.1 to 0.5 (mean 0.28 +/- 0.15), BCVA ranged 0.1-0.9 (mean 0.43 +/- 0.30). Endothelial cell density ranged from 982 to 2781 cells per square millimeter (mean 1848.5 +/- 550.7). Total central corneal thickness ranged from 642 to 998 microm (mean 791.6 +/- 38.0 microm) before surgery and from 536 to 789 microm (mean 645 +/- 61.3 microm) 12 months postoperatively. Total central thickness of the endothelial graft 12 months postoperatively ranged from 42 to 163 microm (mean 89.1 +/- 38.2 microm). One penetrating keratoplasty was made for graft failure. Due to endothelial graft detachment or dislocation in anterior chamber, air tamponade was made in 5 cases with satisfactory final result. Only one case of the rejection was observed. CONCLUSIONS: Endothelial keratoplasty (DSEK) is safe and effective procedure in treatment of the endothelial cell dysfunction. Surgery supported by descemetorhrexis is easy and quick and results in smooth endothelial graft bed. The DSEK technique decreases surgery time and number of corneal graft dislocations.     

Correction: A novel biomass-based support (Starbon) for TiO2 hybrid photocatalysts: a versatile green tool for water purification

Correction for ‘A novel biomass-based support (Starbon) for TiO₂ hybrid photocatalysts: a versatile green tool for water purification’ by Juan Carlos Colmenares et al., RSC Adv., 2013, 3, 20186–20192.

The authors regret that the Experimental section (2.2 Preparation of hybrid TiO₂-based carbonaceous materials) of the original article requires a small correction. There was apparently some minor arithmetic error involved in the calculation of the nominal mass percentage of TiO₂ which was deposited on carbonaceous carbon materials. The nominal mass percentage of TiO₂ deposited on carbonaceous carbon materials was calculated incorrectly (should be 20.9 wt% TiO₂ instead of 25 wt% TiO₂). It should be recognized that this error does not affect any discussion and conclusions reported in this publication. However, this correction is necessary to determine the nominal mass percentage of TiO₂ which was deposited on carbon materials and improve the quality of this scientific publication.The Royal Society of Chemistry apologises for these errors and any consequent inconvenience to authors and readers.     

In‐Depth Analysis of Hyaline Fibromatosis Syndrome Frameshift Mutations at the Same Site Reveal the Necessity of Personalized Therapy

Hyaline fibromatosis syndrome is an autosomal recessive disease caused by mutations in ANTXR2, a gene involved in extracellular matrix homeostasis. Sixty percent of patients carry frameshift mutations at a mutational hotspot in exon 13. We show in patient cells that these mutations lead to low ANTXR2 mRNA and undetectable protein levels. Ectopic expression of the proteins encoded by the mutated genes reveals that a two base insertion leads to the synthesis of a protein that is rapidly targeted to the ER‐associated degradation pathway due to the modified structure of the cytosolic tail, which instead of being hydrophilic and highly disordered as in wild type ANTXR2, is folded and exposes hydrophobic patches. In contrast, one base insertion leads to a truncated protein that properly localizes to the plasma membrane and retains partial function. We next show that targeting the nonsense mediated mRNA decay pathway in patient cells leads to a rescue of ANTXR2 protein in patients carrying one base insertion but not in those carrying two base insertions. This study highlights the importance of in‐depth analysis of the molecular consequences of specific patient mutations, which even when they occur at the same site can have drastically different consequences.     

Cutting Edge Issues in the Churg–Strauss Syndrome

Churg–Strauss syndrome (CSS) is a rare systemic small-vessel vasculitis that develops in the background of bronchial asthma, which is characterized by eosinophilia and eosinophilic infiltration of various tissues. It belongs to the group of antineutrophil cytoplasmic autoantibody (ANCA)-associated vasculitides. The triggering factors and pathogenesis of CSS are still unknown. The possible role of eotaxin-3 and CCR4-related chemokines in selective recruitment of eosinophils to the target tissues in CSS has been recently suggested, but the role of eosinophilic inflammation in the development of vasculitic lesions is not completely understood. From the clinical view, two distinct phenotypes of the disease are slowly emerging depending on the ANCA-positivity status. Glucocorticoids are still the mainstay of treatment; however, data are accumulating regarding the beneficial role of novel immunosuppressants and biologic compounds, especially in patients with poorer prognosis.