Doege-Potter syndrome: hypoglycemia associated with malignant solitary fibrous tumor

We report a case of recurrent solitary fibrous tumor with associated hypoglycemia, the "Doege-Potter syndrome." These are rare tumors with a 12-13% rate of malignancy. The syndrome of hypoglycemia is seen in less than 5% of the cases, and the associated tumors are large with a high mitotic rate. The cause of hypoglycemia is related to insulin-like growth factors produced by these tumors. Resection in many cases is curable with resolution of the hypoglycemia. We discuss the different signs and symptoms and literature evidence of treatment options and follow-up.     

Effectiveness of supplemental grasp-force feedback in the presence of vision

Previous studies have shown that supplemental grasp-force feedback can improve control for users of a hand prosthesis or neuroprosthesis under conditions where vision provides little force information. Visual cues of force are widely available in everyday use, however, and may obviate the utility of supplemental force information. The purpose of the present study was to use a video-based hand neuroprosthesis simulator to determine whether grasp-force feedback can improve control in the presence of realistic visual information. Seven able-bodied subjects used the simulator to complete a simple grasp-and-hold task while controlling and viewing pre-recorded, digitised video clips of a neuroprosthesis user's hand squeezing a compliant object. The task was performed with and without supplemental force feedback presented via electrocutaneous stimulation. Subjects had to achieve and maintain the (simulated) grasp force within a target window of variable size (±10–40% of full scale). Force feedback improved the success rate significantly for all target window sizes (8–16%, on average), and improved the success rate at all window sizes for six of the seven subjects. Overall, the improvement was equivalent functionally to a 35% increase in the window size. Feedback also allowed subjects to identify the direction of grasp errors more accurately, on average by 10–15%. In some cases, feedback improved the failure identification rate even if success rates were unchanged. It is thus concluded that supplemental grasp-force feedback can improve grasp control even with access to rich visual information from the hand and object.     

口服维生素C对人眼房水中抗坏血酸盐浓度的影响(英文)

AIM: To study oral administration of vitamin C onhuman aqueous humour ascorbate concentration.METHODS: High performance liquid chromatography(HPLC) coupled with electrochemical detector (ECD)was used. The effect of oral administraion of variousdoses of ascorbic acid, 0 (control), 1.0, 1.5., 2.0,3.0, and 5.0 g, on its concentration in aqueoushumour, obtained from volunteer cataract patients wasstudied. RESULTS: The concentration of ascorbicacid in aqueous humour of control group (without     

Postoperative thyroid hormone supplementation rates following thyroid lobectomy

BackgroundThyroid lobectomy is performed for symptomatic benign nodules, indeterminate nodules, or low-risk well differentiated thyroid cancer. We aimed to determine factors associated with thyroid stimulating hormone over goal (TH) following lobectomy.MethodsWe performed a retrospective single-institution cohort study of patients undergoing thyroid lobectomy from January 2016 to December 2017. TH was defined as need for thyroid hormone in accordance with guidelines. Univariate and multivariate logistic regression analysis was performed.ResultsOne hundred patients were included and 47% developed.TH73% of those with cancer, 38% with benign pathology (p = 0.002). Patients with TH were more likely to have thyroiditis 26% versus 3.8% (p = 0.002); higher preoperativeTSHmean 1.88mIU/L (SD 1.17) versus 1.16mIU/L (SD 0.77) (p = 0.0002), and smaller remnant thyroid lobe adjusted for body surface area 2.99ml/m2 versus 3.72ml/m2 (p = 0.003).ConclusionsAfter thyroid lobectomy, TH is associated with preoperative TSH level, thyroiditis, remnant thyroid volume, and malignancy. The majority of patients with final pathology of carcinoma will require thyroid hormone supplementation to achieve TSH goal.     

Identifying Trends of Percutaneous Injuries at an Australian Dental School

ObjectivesThe aim of this study was to retrospectively examine trends in percutaneous exposure incidences (PEIs) at the School of Dentistry (SoD) from 2009 to 2019 and to report on the underreporting rate of PEIs, current attitudes, and awareness of PEI safety protocols from clinical staff and students at the SoD in 2019.MethodsRetrospective data were collected from deidentified archival incident reports from 2009 to 2019 from the SoD's incident reporting system (UQSafe and Legacy Database). Additionally, cross-sectional data were collected via the validated Percutaneous Exposure Incident Questionnaires (PEIQ) completed by clinical staff and students of the SoD in 2019.ResultsFrom the archival data, the majority (79.9%) of the 618 reported PEIs involved students. Local anaesthetic-related procedures were the most common cause in the archival (31.5%) and survey data (23.7%), whereas the needle-prick was the most common causative instrument in both data sets. Additionally, the finger was the most common site of injury found in the archival (53.0%) and survey data (52.8%). From 345 responses to the survey, 42.1% of PEIs sustained were not reported.ConclusionsStudents were at a higher risk of sustaining a PEI than staff members between 2009 and 2019. The reported knowledge on PEI classification and preventative measures is inadequate, suggesting that further PEI education is necessary. The study provides evidence of the trends in PEIs as well as data on the attitudes and awareness of student and staff at a dental teaching faculty to support the development of PEI safety management protocols.     

Randomized Trial of Empagliflozin in Nondiabetic Patients With Heart Failure and Reduced Ejection Fraction

BackgroundLarge clinical trials established the benefits of sodium-glucose cotransporter 2 inhibitors in patients with diabetes and with heart failure with reduced ejection fraction (HFrEF). The early and significant improvement in clinical outcomes is likely explained by effects beyond a reduction in hyperglycemia.ObjectivesThe purpose of this study was to assess the effect of empagliflozin on left ventricular (LV) function and volumes, functional capacity, and quality of life (QoL) in nondiabetic HFrEF patients.MethodsIn this double-blind, placebo-controlled trial, nondiabetic HFrEF patients (n = 84) were randomized to empagliflozin 10 mg daily or placebo for 6 months. The primary endpoint was change in LV end-diastolic and -systolic volume assessed by cardiac magnetic resonance. Secondary endpoints included changes in LV mass, LV ejection fraction, peak oxygen consumption in the cardiopulmonary exercise test, 6-min walk test, and quality of life.ResultsEmpagliflozin was associated with a significant reduction of LV end-diastolic volume (?25.1 ± 26.0 ml vs. ?1.5 ± 25.4 ml for empagliflozin vs. placebo, respectively; p < 0.001) and LV end-systolic volume (?26.6 ± 20.5 ml vs. ?0.5 ± 21.9 ml for empagliflozin vs. placebo; p < 0.001). Empagliflozin was associated with reductions in LV mass (?17.8 ± 31.9 g vs. 4.1 ± 13.4 g, for empagliflozin vs. placebo, respectively; p < 0.001) and LV sphericity, and improvements in LV ejection fraction (6.0 ± 4.2 vs. ?0.1 ± 3.9; p < 0.001). Patients who received empagliflozin had significant improvements in peak O₂ consumption (1.1 ± 2.6 ml/min/kg vs. ?0.5 ± 1.9 ml/min/kg for empagliflozin vs. placebo, respectively; p = 0.017), oxygen uptake efficiency slope (111 ± 267 vs. ?145 ± 318; p < 0.001), as well as in 6-min walk test (81 ± 64 m vs. ?35 ± 68 m; p < 0.001) and quality of life (Kansas City Cardiomyopathy Questionnaire-12: 21 ± 18 vs. 2 ± 15; p < 0.001).ConclusionsEmpagliflozin administration to nondiabetic HFrEF patients significantly improves LV volumes, LV mass, LV systolic function, functional capacity, and quality of life when compared with placebo. Our observations strongly support a role for sodium-glucose cotransporter 2 inhibitors in the treatment of HFrEF patients independently of their glycemic status. (Are the “Cardiac Benefits” of Empagliflozin Independent of Its Hypoglycemic Activity? [ATRU-4] [EMPA-TROPISM]; NCT03485222)     

Mutational analysis of the CYP1B1 gene in Pakistani primary congenital glaucoma patients: Identification of four known and a novel causative variant at the 3′ splice acceptor site of intron 2

Primary congenital glaucoma (PCG) causes blindness in early age. It has an autosomal recessive pattern of inheritance, hence is more prevalent in populations with frequent consanguineous marriages that occur in the Pakistani population. Mutations in the CYP1B1 gene are commonly associated with PCG. The aim of the present study was to identify genetic mutations in the CYP1B1 gene in PCG cases belonging to 38 Pakistani families. DNA was extracted using blood samples collected from all enrolled patients, their available unaffected family members and controls. Direct sequencing of the CYP1B1 gene revealed a novel 3' splice acceptor site causative variant segregating in an autosomal recessive manner in a large consanguineous family with four PCG‐affected individuals. The novel variant was not detected in 93 ethnically matched controls. Furthermore, four already reported mutations, including p.G61E, p.R355X, p.R368H, and p.R390H were also detected in patients belonging to nine different families. All identified causative variants were evaluated by computational programs, that is, SIFT, PolyPhen‐2, and MutationTaster. Pathogenicity of the novel splice site variant identified in this study was analyzed by Human Splicing Finder and MaxEntScan. Ten out of 38 families with PCG had the disease due to CYP1B1 mutations, suggesting CYP1B1 was contributing to PCG in these Pakistani patients. Identification of this novel 3' splice acceptor site variant in intron 2 is the first report for the CYP1B1 gene contributing to genetic heterogeneity of disease.     

Acute and chronic toxicity of a lyophilised aqueous extract of Tanacetum vulgare leaves in rodents

AIM OF THE STUDY: The present investigation was carried out to evaluate the safety of an aqueous extract of tansy (Tanacetum vulgare L.) leaves by determining its potential toxicity after acute and chronic administration in rodents. MATERIALS AND METHODS: For the acute study, a lyophilized aqueous extract of tansy leaves was administered to mice in single doses of 0-13 g/kg given by gavage as well as intraperitoneal doses of 0-4.5 g/kg. General behavior adverse effects and mortality were determined for up to 14 days. In the chronic dose study, the extract was administered orally at doses of 0, 100, 300 and 600 mg/kg daily for 90 days to rats. Biochemical and hematological parameters were determined after 30 and 60 days, and then at the end of 90 days of daily administration. RESULTS: In the acute study in mice, the crude aqueous extract of tansy leaves caused dose-dependent general behavior adverse effects and mortality. The no-observed adverse effect levels (NOAEL) of the tansy extract were 7.0 g/kg and 1.0 g/kg, and the lowest-observed adverse effect levels (LOAEL) were 9.0 g/kg and 1.5 g/kg, when given by the oral and intraperitoneal routes, respectively. Mortality increased with increasing doses, with LD(50) of 9.9 g/kg and 2.8 g/kg for the oral and intraperitonal modes of administration, respectively. In the chronic study in rats, daily oral administration of the crude aqueous extract of tansy leaves for up to 90 days did not result in death or significant changes in the biological (except for hypoglycemia) and hematological parameters. CONCLUSIONS: Because of the relatively high NOAEL values in the acute study in mice, and lack of significant effect on biological and hematological parameters in rats after 90 days of daily doses, the tansy extract does not appear to have significant toxicity. In view of the dose of tansy consumed in traditional medicine, there is a wide margin of safety for the therapeutic use of the aqueous extract of Tanacetum vulgare leaves.