镰孢菌属镰刀菌致与接触镜有关的真菌性角膜炎1例(英文)

目的:报道1例罕见的被确诊为由镰孢菌属镰刀菌引起的与接触镜有关的严重的真菌性角膜炎,该病例最后通过治疗性穿透性角膜移植术成功治疗。方法:病例报告。结果:一位39岁的马来西亚女士,私企职员,配戴长戴性软性接触镜18a。感右眼剧痛、眼红10d。眼部检查见多个长有伪足的圆形旁中心角膜溃疡,前房少许积脓,临床诊断为真菌性角膜炎。经重复角膜刮片检查真菌和细菌结果均阴性后给予局部广谱抗生素和抗真菌治疗,但患者右眼角膜炎病情进一步加重,又给予其他的局部和全身抗真菌药物治疗,患者右眼角膜溃疡进一步加深。最后,为保留眼球,限制感染,在发病1.5mo后,给予患者治疗性的穿透性角膜移植术。术后,角膜组织病理学检查和PCR检查证实为镰孢菌属镰刀菌感染所致。结论:这是1例罕见的由镰孢菌属镰刀菌感染引起的严重的与接触镜有关的真菌性角膜炎。这也说明了在真菌性角膜炎的治疗上存在挑战性。为控制真菌性角膜炎进一步发展,并保护眼球,治疗性的穿透性角膜移植术应该是最后的选择。     

Organochlorine Pesticide Residues in Blood Samples of Agriculture and Sheep Wool Workers in Bangalore (Rural), India

To describe exposure level of organochlorine pesticides (OCP) among workers occupationally engaged in agriculture and sheep wool associated jobs, the present study was carried out in rural neighborhood of Bangalore city, India. Thirty participants were interviewed and obtained informed consent before blood sample collection. The maximum concentrations of OCP were detected in blood samples of agriculture workers than sheep wool workers. Among the metabolites of HCH and DDT, lindane (γ-HCH) and p,p’-DDE were the most contributed to the total OCP. There were no differences in pesticide residues found between sex and work groups. It was observed that about 30% of samples exceeded the tolerance limits of 10 μg/L prescribed for HCH under the prevention of food adulteration act. Therefore, the present study recommends continuous monitoring with larger sample size.     

Aldose reductase: a novel target for cardioprotective interventions

Recanalization therapy remains the most effective way for treatment of evolving myocardial infarction and thereby salvaging jeopardized tissue. However, the efficacy of reperfusion in limiting infarction and improving recovery of contractile function depends on the amount of irreversible damage occurring prior to initiating reperfusion and is related to failure of energy production to meet the basal needs of the injured myocardium. In recent years, a variety of metabolic therapies that enhance myocardial metabolism and attenuate changes in sodium and calcium homeostasis during ischemia have been proposed. They focus on (a) increasing myocardial glucose metabolism during ischemia or (b) inhibiting fatty acid metabolism to increase glucose use, and (c) inhibiting sodium and calcium influx pathways that deplete high energy phosphates. Recent studies from our laboratory showed that inhibition of aldose reductase, a key regulatory enzyme in the substrate flux via polyol pathway, reduces ischemic injury and improves functional and metabolic recovery after ischemia-reperfusion in hearts. These and subsequent studies have generated considerable interest in the use of aldose reductase inhibitors as potential therapeutic adjuncts in treating evolving myocardial infarction in patients. This review will discuss the mechanisms by which aldose reductase inhibitors protect ischemic myocardium and provide rationale for their use as cardioprotective drugs.     

Ultrasound and fine needle aspiration cytology of the axilla in the pre-operative identification of axillary nodal involvement in breast cancer

Aims

Pre-operative diagnosis of axillary nodal involvement in breast cancer allows one-stage axillary surgery. We evaluated the efficacy of axillary ultrasound (US) with US guided fine needle aspiration cytology (FNAC) in the diagnosis of axillary nodal involvement.

Methods

Over a 13-month period, we performed US of 369 axillae in patients with screen-detected (n = 278) and symptomatic (n = 91) invasive carcinoma of the breast, at the same time as US of the primary tumour. If abnormal lymph nodes were demonstrated, a single US guided FNAC of the most abnormal node was performed. US and FNAC results were compared with the final histology of the surgically excised lymph nodes.

Results

Among the 369 axillae studied, 102 had nodal macrometastases and 38 (37%) were identified by US guided FNAC. The rate was 33% in screen-detected and 44% in symptomatic patients. Sensitivity increased with increasing numbers of positive axillary nodes, and the more abnormal the appearances of the nodes on US.

Conclusion

US with FNAC of the most abnormal node allows pre-operative detection of a third of node positive axillae in screen-detected and over 40% of those with symptomatic breast cancer, allowing one-stage axillary surgery avoiding the sentinel node biopsy step in these patients.     

Screen-detected breast lesions with an indeterminate (B3) core needle biopsy should be excised

Background

Screen-detected breast lesions in the National Health Service Breast Screening Programme (NHSBSP) are assessed by core needle biopsy (CB) or fine needle aspiration cytology (FNAC). Most core biopsies are diagnostic and representative, but a small proportion is indeterminate (coded “B3” in the NHSBSP). We studied the surgical outcome of screen-detected breast lesions with indeterminate (B3) CB.

Methods

We retrieved and analysed the data on women who were recalled for assessment of a screen-detected abnormality in whom the initial CB was reported as B3 over a six-year period from a prospectively collected database in one breast screening centre. The main outcome measure was final histology following surgical excision.

Results

Among 4080 CB performed, 220 (5.4%) were B3. Mammographically 127 lesions were microcalcifications and 88 were soft tissue lesions. On surgical excision (n = 199, 90%), 67 (34%) were malignant. In patients with malignancy, clinical examination, US and concurrent FNAC were either suspicious or definitive of malignancy only in 2%, 4% and 7%, respectively.

Conclusion

A third of screen-detected breast lesions with indeterminate CB are malignant on excision. Clinical examination, US, and FNAC may identify some of these carcinomas pre-operatively but most malignancies would not be picked up. Thus, these lesions should undergo surgical excision.     

Functional outcome after total knee arthroplasty revision: a meta-analysis

The objective of this study was to perform a systematic literature review to describe patient outcome after total knee arthroplasty revision procedures using various global knee score ratings. English language articles published from 1966 through 2000 were identified through a computerized literature search and bibliography review. A multistage assessment was used to determine the articles containing data that could meet our objective. Meta-analyses of global knee scores were undertaken using a fixed effects model with the assumption that the variances of each individual measurement were identical across studies. The initial inclusion criteria were met by 58 articles with a total of 1965 patients. There were 42 articles comprising 45 unique patient cohorts and a total of 1515 patients that had sufficient global knee score data for analysis and were used in the meta-analyses. Revision total knee arthroplasty is an effective procedure for failed knee arthroplasties based on global knee rating scales.     

Advances in the diagnosis of herpes simplex stromal necrotising keratitis: A feasibility study on deep learning approach

Purpose:Infectious keratitis, especially viral keratitis (VK), in resource-limited settings, can be a challenge to diagnose and carries a high risk of misdiagnosis contributing to significant ocular morbidity. We aimed to employ and study the application of artificial intelligence-based deep learning (DL) algorithms to diagnose VK.Methods:A single-center retrospective study was conducted in a tertiary care center from January 2017 to December 2019 employing DL algorithm to diagnose VK from slit-lamp (SL) photographs. Three hundred and seven diffusely illuminated SL photographs from 285 eyes with polymerase chain reaction–proven herpes simplex viral stromal necrotizing keratitis (HSVNK) and culture-proven nonviral keratitis (NVK) were included. Patients having only HSV epithelial dendrites, endothelitis, mixed infection, and those with no SL photographs were excluded. DenseNet is a convolutional neural network, and the two main image datasets were divided into two subsets, one for training and the other for testing the algorithm. The performance of DenseNet was also compared with ResNet and Inception. Sensitivity, specificity, receiver operating characteristic (ROC) curve, and the area under the curve (AUC) were calculated.Results:The accuracy of DenseNet on the test dataset was 72%, and it performed better than ResNet and Inception in the given task. The AUC for HSVNK was 0.73 with a sensitivity of 69.6% and specificity of 76.5%. The results were also validated using gradient-weighted class activation mapping (Grad-CAM), which successfully visualized the regions of input, which are significant for accurate predictions from these DL-based models.Conclusion:DL algorithm can be a positive aid to diagnose VK, especially in primary care centers where appropriate laboratory facilities or expert manpower are not available.     

Growth hormone directly stimulates testosterone and oestradiol secretion by rat Leydig cells in vitro and modulates the effects of LH and T3

The modulatory effect of GH on basal, LH and T3 mediated secretion of testosterone and oestradiol by purified rat (60 day old) Leydig cells was studied in vitro. Percoll gradient purified Leydig cells (1 x 10(3)) were cultured for 48 hours at 34 degrees C in a medium containing different concentrations of rat GH (5-400 ng/mL), after an initial culture for 24 hours at 37 degrees C. GH increased testosterone and oestradiol secretions in a dose dependent manner. While testosterone secretion reached the saturation point with 50 ng GH, oestradiol secretion reached the saturation point with 150 ng GH, followed by diminished secretions. Co-administration of minimum (10 ng) effective does of GH with minimum (25 ng) or maximum (100 ng) effective doses of oLH significantly decreased the testosterone secretion. However, an increased secretion of testosterone was observed when maximum effective doses of rGH (50 ng) and oLH (100 ng) were co-administered. Minimum effective (25 ng) or maximum effective (50 ng) doses of T3 inhibited GH mediated secretion of testosterone in vitro. Oestradiol concentration in the culture medium increased when either dose of rGH was co-administered with the minimum or maximum effective doses of oLH. T3 50 ng augmented the secretion of oestradiol by Leydig cells in the presence of GH. These results indicate that GH acts as a gonadotrophin to stimulate testosterone and oestradiol secretions by Leydig cells, and that it modulates LH or T3 induced secretion of these steroids, depending on the intensity of their stimulation.