Epiretinal membrane vitrectomy: outcomes with or without cataract surgery and a novel prognostic factor for cystoid macular edema

Graefe's Archive for Clinical and Experimental Ophthalmology - To assess the outcomes of vitrectomy with or without cataract surgery for the treatment of idiopathic ERM in phakic eyes and...     

Comparison of thyroid fine-needle aspiration and core needle biopsy

We compared the adequacy and accuracy of fineneedle aspiration (FNA) with core needle aspiration in a total of 377 patients who underwent both tests.The adequacy rate for core needle biopsy (82.2%) was significantly higher than that of FNA (70.3%; P < .001), but the combined adequacy was significantly higher than that for either test alone (88.9%; P < .001). Overall concordance between the tests was 67.9%. In 70 cases, the core was adequate and negative (55 cases) or atypical (15 cases) and the aspirate was nondiagnostic; in 25 cases, the aspirate was adequate and negative (15 cases) or atypical (10 cases) and the core was nondiagnostic. In 21 cases, the FNA diagnosis was atypical and the core was negative; histologic follow-up supported the FNA diagnosis in all 14 cases with resection, of which 9 were malignant, and 8 of the 9 were papillary carcinoma. On review, it seemed that the core biopsy missed the lesion.Core needle biopsy has a higher adequacy rate than FNA but seems less sensitive, especially for papillary carcinoma. The combination of FNA with core needle biopsy seems to have the highest adequacy rate and sensitivity.     

Use of the Patient State Index (PSI) to Assist in the Diagnosis of Perioperative Neurological Injury and Brain Death

We present a series of three postoperative cases that were admitted to a cardiothoracic intensive care unit (ICU) after major surgery. Due to the possible presence of residual postoperative neuromuscular blockade after surgery, a processed electroencephalograph (EEG) was applied prior to starting sedation. This was markedly abnormal in all three cases, and not in keeping with the residual anesthesia. The patients were immediately transported for a CT scan. In all three cases there was severe neurological injury incompatible with survival and end of life decisions were made. Although the utility of quantitative EEG technology, like the Bispectral index (BIS) or Patient State Analyzer (PSA), is becoming better defined in the operating room, the role in the ICU is less clear. We propose that the ICU use of the PSA 4000 may have affected our decision weighing the risk versus benefit of transporting a fresh postoperative case to the radiology suite, expedited the neurological diagnosis, and may have reduced overall ICU resource utilization.     

Discovery of New Sites for Drug Binding to the Hypertension‐Related Renin–Angiotensinogen Complex

Renin (REN) is a key drug target to stop the hypertension cascade, but thus far only one direct inhibitor has been made commercially available. In this study, we assess an innovative REN inhibition strategy, by targeting the interface of the renin:angiotensinogen (REN:ANG) complex. We characterized the energetic role of interfacial residues of REN:ANG and identified the ones responsible for protein:protein binding, which can serve as drug targets for disruption of the REN:ANG association. For this purpose, we applied a computational alanine scanning mutagenesis protocol, which measures the contribution of each side chain for the protein:protein binding free energy with an accuracy of ≈ 1 kcal/mol. As a result, in REN and ANG, six and eight residues were found to be critical for binding, respectively. The leading force behind REN:ANG complexation was found to be the hydrophobic effect. The binding free energy per residue was found to be proportional to the buried area. Residues responsible for binding were occluded from water at the complex, which promotes an efficient pairing between the two proteins. Two druggable pockets involving critical residues for binding were found on the surface of REN, where small drug‐like molecules can bind and disrupt the ANG:REN association that may provide an efficient way to achieve REN inhibition and control hypertension.