Development of a nomogram to predict the clinical impact of a postexcision preirradiation mammogram

We aimed to better quantify the impact of a postexcision preirradiation mammogram (PPM), first by identifying factors associated with abnormal results and then incorporating these findings into a nomogram. Beginning February 2011, our institution made a practice change to obtain a PPM on all patients with any calcifications identified. A total of 530 patients underwent a PPM. Suspicious abnormalities were reported in 61 patients (11.5%), with the PPM leading to a change in management in 47 instances (8.9%). A nomogram was created based on patient and tumor characteristics to identify patients most likely to have an abnormal PPM.     

Impaired CCR7 expression on plasmacytoid dendritic cells of HIV-infected children and adolescents with immunologic and virologic failure

BACKGROUND: Defects of plasmacytoid (p) and myeloid (m) dendritic cells (DCs) occur in HIV infection. The aim of this study was to evaluate the maturation and function of DCs in children with perinatal HIV infection who were on antiretroviral therapy. MATERIALS AND METHODS: Twenty HIV-infected children (median age = 12.9 years) classified as immunologic/virologic responders and failures were evaluated in a whole-blood assay with resiquimod (RSQ), a potent agonist to Toll-like receptors 7 and 8, as the DC stimulant. RESULTS: In comparison to controls, pDC and mDC numbers were decreased in patients, but RSQ stimulation resulted in upregulation of CD83, CD80, and tumor necrosis factor-alpha in both DC subsets and upregulation of interferon (IFN)-alpha in pDCs. Patients with immunologic and virologic failure demonstrated a selective impairment in upregulation of lymph node homing marker CCR7 in pDCs. Plasma virus load was negatively correlated with IFNalpha and CCR7 expression, whereas CD4 percentage correlated only with CCR7 expression in pDCs. CONCLUSIONS: A novel defect of pDCs, impaired CCR7 upregulation, is described in association with immunologic or virologic failure. This deficiency could impair homing of pDCs to lymph nodes, leading to secondary defects of mDC maturation and poor T-cell activation.     

Interactions of bacterial effector proteins with host proteins

Pathogenic bacteria have evolved several clever survival strategies for manipulating host cell signaling pathways to establish beneficial replicative niches within the host. Recent literature has revealed novel mechanisms adopted by bacteria to manipulate host responses. For instance, host signaling pathways that were traditionally thought to be regulated by phosphorylation events have now been shown to be irreversibly blocked by bacterially-mediated acetylation, beta-elimination, and lytic modifications. This review highlights some of the common host proteins and signaling cascades targeted by such pathogens.     

Comparative effect of topical application of lindane and permethrin on oxidative stress parameters in adult scabies patients

OBJECTIVES: The insecticides lindane and permethrin are commonly used for treatment of scabies. Animal studies have shown the presence of insecticide induced oxidative stress. Hence, this study was undertaken to assess and compare the effects of topical application of lindane and permethrin on oxidative stress parameters in scabies patients. DESIGN AND METHODS: Patients were alternatively assigned to treatment by either 1% lindane lotion or 5% permethrin cream. Blood samples were collected before and 12-14 h after the application of the drugs and evaluated for oxidative stress parameters and compared with healthy controls. RESULTS: Serum malondialdehyde (MDA) levels, erythrocyte superoxide dismutase (SOD) and catalase (CAT) activity were significantly increased while blood glutathione (GSH) levels were significantly decreased in the lindane group as compared to controls and the permethrin group. The permethrin treated group showed a non significant alteration in the oxidative stress parameters. CONCLUSION: Topical application of lindane induced significant oxidative stress as compared to permethrin which appears to be a safer option for the treatment of scabies.     

Assessment of faculty perception of content validity of PerioSim, a haptic-3D virtual reality dental training simulator

Haptic technology (sense of touch) along with 3D-virtual reality (VR) graphics, creating lifelike training simulations, was used to develop a dental training simulator system (PerioSim). This preliminary study was designed to evaluate whether faculty considered PerioSim realistic and useful for training and evaluating basic procedural skills of students. The haptic device employed was a PHANToM and the simulator a Dell Xeon 530 workstation with 3D, VR oral models and instruments viewed on a stereoscopic monitor. An onscreen VR periodontal probe or explorer was manipulated by operating the PHANToM for sensing lifelike contact and interactions with the teeth and gingiva. Thirty experienced clinical dental and dental hygiene faculty judged the realism of the system. A PowerPoint presentation on one screen provided instructions for the simulator use with the 3D, VR simulator on a second stereoscopic monitor viewed with 3D goggles. Faculty/practitioners found the images very realistic for teeth and instruments, but less so for gingiva. Tactile sensation was realistic for teeth but not so for gingiva. The onscreen instructions were very useful with high potential for teaching. Faculty members anticipated incorporating this device into teaching and were enthusiastic about its potential for evaluating students' basic procedural skills. This study suggests that the preliminary "evidence-of-concept" was successful and PerioSim may aid students in developing necessary dental tactile skills.     

Jejunojejunal Intussusception with Internal Herniation in the Stomach

Jejunojejunal intussusception with internal herniation of the stomach through a gastrojejunostomy stoma is one of the rarest complications of the previous gastric surgery. The incidence is reported to be less than 0.1 %. An elderly male presented to the emergency room with signs of intestinal obstruction for 1 day. There was also history of appearance of a lump in the mid-abdomen. A primarily healed midline scar of the previous surgery was present; the details of which were not known. X ray abdomen in the erect posture showed multiple air fluid levels. Ultrasonography (USG) revealed dilated stomach with central hyperechogenicity with a peripheral rim of decreased echogenecity. Contrast-enhanced computed tomography (CECT) scan showed jejunojejunal intussusception with internal herniation of the stomach. On laparotomy, it was found that there was a previous gastrojejunostomy with jejunal invagination leading to gangrene of a segment. Resection anastomosis was done. The postoperative period was uneventful.     

Morphometric analysis of fovea with spectral-domain optical coherence tomography and visual outcome postsurgery for retinal detachment

Purpose:

The purpose of this study was to correlate the postoperative best-corrected visual acuity (BCVA) with spectral-domain optical coherence tomography (SD-OCT) findings in fovea involving rhegmatogenous retinal detachment (RRD) surgery.

Materials and Methods:

Thirty eyes with preoperative fovea-involving RRD, who underwent scleral buckling (SB) (6 eyes) and pars plana vitrectomy (PPV) (19 eyes) and combined SB and PPV (5 eyes) were recruited. Patients underwent clinical examination and SD-OCT scan of fovea preoperatively and at 30 days and 90 days postoperatively. The correlations between SD-OCT findings and BCVA were analyzed.

Results:

Inner segment/outer segment (IS/OS) junction integrity was the indicator of better BCVA at 30 days and 90 days (P = 0.0002 and P = 0.0003, respectively) whereas outer retinal corrugation (ORC) was related to worse BCVA at 30 days and 90 days (P = 0.001). External limiting membrane did not have a co-relation with visual outcome, but cystoid macular edema showed co-relation at 90 days (P = 0.047). All eyes of SB and 3 eyes of PPV had a minimal subfoveal fluid at 30 days follow-up that had no effect on visual acuity. All retinas were attached at final follow-up.

Conclusion:

IS/OS junction integrity and ORC may be important predictors of postoperative visual outcome after anatomically successful RRD surgery.     

Mitochondrial respiratory abnormalities in patients with end-stage congenital heart disease.

BACKGROUND: Nitric oxide (NO) binds to mitochondrial cytochrome oxidase to decrease myocardial oxygen consumption (MVO(2)). This regulation is disrupted in heart failure (HF) due to reduced NO. The present objective was to evaluate NO-mediated regulation of mitochondrial respiration in the myocardium of patients with congenital heart disease (CHD) and cardiomyopathy (CMP). METHODS: MVO(2) was measured in vitro in explanted human myocardium obtained at transplantation. Seven patients had CHD (5 cyanotic, 2 acyanotic), and 11 had non-ischemic CMP. The effects of the following on MVO(2) were measured: kinin-dependent endothelial NO synthase (eNOS) agonists, bradykinin, ramiprilat and amlodipine; NO donors, nitroglycerin and S-nitroso-N-acetylpenicillamine (SNAP) (10(-7) to 10(-4) mol/liter); and NOS inhibitor, N(omega)-nitro-L-arginine methylester (L-NAME). RESULTS: eNOS agonists caused a smaller decrease in MVO(2) in CHD compared with CMP patients. Changes in MVO(2) at the highest dose in CHD vs CMP were, respectively: bradykinin, -22 +/- 7% vs: -30 +/- 5% (p < 0.05); ramiprilat, -17 +/- 8% vs -26 +/- 2%, (p < 0.001); and amlodipine, -5 +/- 7% vs -29 +/- 6% (p < 0.001). L-NAME attenuated the effect of bradykinin, ramiprilat and amlodipine in both groups, confirming that the drug effect was secondary to eNOS activation. Nitroglycerin and SNAP also caused smaller decreases in MVO(2) in CHD vs CMP (NTG -16 +/- 6% vs -37 +/- 4%, SNAP -37 +/- 4% vs -49 +/- 3%, [p < 0.01]), suggesting altered mitochondrial function in CHD. CONCLUSIONS: Abnormal regulation of MVO(2) in end-stage CMP may be secondary to reduced endogenous NO availability and can be reversed by the use of NO agonists. In end-stage CHD, this abnormality may be related in part to abnormal mitochondrial function.