Pneumocephalus and Brown‐Sequard syndrome caused by a stab wound to the back

This report describes a case of Brown‐Sequard syndrome in a man who presented to the ED after a stabbing to the left scapula region. The incidental finding of pneumocephalus found on CT scan during workup lead to cervical MRI that revealed the spinal cord pathology associated with Brown‐Sequard syndrome.     

Developing the role of public health in responding to mental health and wellbeing needs after mass casualty incidents: experience at London Bridge and Borough Market,June, 2017

Background

On Saturday, June 3, 2017, a terrorist attack at London Bridge and Borough Market in the London borough of Southwark resulted in the death of 11 individuals, including the three perpetrators. 48 people were injured. A mental health and wellbeing subgroup of the Humanitarian Assistance Steering Group was immediately formed, co-chaired by the Director of Public Health, to assess and respond to the mental health and wellbeing needs of those affected by the attack. We report on key aspects of this response.

Regulation of human peripheral blood BFU-E growth in vitro by leukaemic B-lymphocytes

We report a stimulating effect of leukaemic B-lymphocytes from anaemic and non-anaemic patients with CLL on the proliferation of normal peripheral blood BFU-E. Coculture of leukaemic B-cells at various concentrations (2.5 X 10(3)-10(6)) with 2.5 X 10(5) mononuclear cells from normal peripheral blood increased the number of BFU-E derived erythroid colonies. The same effect was observed when the number of target cells was varied in the presence of a fixed number of B-lymphocytes, with a clear linear relationship. B-cell conditioned medium gave a similar increase when added to the culture instead of B-cells. At high concentration of B-cells from anaemic patients, the size of the colonies was increased and a large number of macroscopic colonies was seen. The place of the B-cells in the regulation of erythroid progenitors in relation to monocytes and T-lymphocytes has still to be established.     

Endoscopist administered propofol for upper-GI EUS is safe and effective: a prospective study in 500 patients

BACKGROUND: The administration of propofol for endoscopic sedation by a qualified person, other than the endoscopist, is safe and effective. The aim of this study was to determine if propofol can be administered safely and effectively by the endoscopist performing the procedure. METHODS: All patients referred for upper-GI EUS were eligible for inclusion in the study. Exclusion criteria included the following: age less than 18 years, American Society of Anesthesiology physical status class greater than 2, a potential for difficulty in airway maintenance, and allergy to propofol constituents. The endoscopist administered propofol as an intravenous bolus followed by a constant infusion. Adverse events, drug dosage, complications, and patient/endoscopist satisfaction were recorded. RESULTS: A total of 500 patients (285 women, 215 men; mean age 53.4 [14.8 years]) were enrolled. Mean propofol dose was 301 mg (range 100-1000 mg). Mean procedure time was 19 minutes (range 3-70 minutes). The required examination was completed in all cases. There was no major adverse event. Oxygen desaturation (oxygen saturation < 95%) occurred in 16 (3%) patients. There were 4 (1%) cases of mild hypoxemia (saturation < 90%) but no case of severe hypoxemia (saturation <85%). The endoscopist rated the 92% of the procedures as "very smooth" or "smooth" and regarded administration of propofol as "easy" for 92%. All patients said they would prefer the same method of sedation if the procedure were repeated. CONCLUSIONS: Endoscopist-administered propofol is safe and effective in selected patients.     

Differential interferences of hemoglobin and hemolysis on insulin assay with the Abbott Architect®-Ci8200 immunoassay

Objectives

This paper evaluates the effect of hemoglobin (Hb) and hemolysis on insulin measurements with the Architect®-Ci8200 analyzer.

Design and methods

Insulin concentrations were measured using the Architect®-Ci8200. Interference studies were performed by spiking serum pools of defined insulin concentrations with increasing concentrations of either free Hb or hemolysate. A change of more than 10% was taken as evidence of significant interference.

Results

A significant negative bias in insulin results was observed only in samples spiked with hemolysate but not with free Hb. The bias was proportional to the degree of hemolysis and to the time elapsed before insulin assay. This interference was decreased when samples were kept at + 4 °C.

Conclusions

For all insulin requests, hemolysis must be systematically checked before biological interpretation of insulin results.     

Angiomyolipoma: Immunohistochemical and Ultrastructural Study of 14 Cases

Angiomyolipoma (AML) is a mesenchymal neoplasm of unclear histogenesis. In addition to varying amounts of smooth muscle, adipose tissue, and blood vessels, it contains a population of clear or pale eosinophilic epithelioid cells often arranged around blood vessels. Various phenotypes of AML have been described: leiomyoma-like, lipoma-like, epithelioid, and atypical. AMLs show consistent immunopositivity for HMB-45. This has been associated with the ultrastructural observation of melanosome-like structures in rare instances. In the present study, 14 AMLs from 13 patients were analyzed by electron microscopy and immunohistochemistry to determine the appearance and nature of cells composing AMLs. Overlap between cell types (spindle smooth muscle cells, epithelioid cells, and adipocytes) was found by both electron microscopy and immunohistochemistry. Melanosomes were found in 7 tumors. The cell of origin remains mysterious. Nevertheless, the study demonstrates that the AML is likely derived from a single cell that shares homology with the pericyte.     

PCR amplification and high throughput sequencing of immunoglobulin heavy chain genes from formalin-fixed paraffin-embedded human biopsies

The use of high throughput sequencing (HTS) technologies in biomedicine is expanding in a variety of fields in recent years. The 454 system is an HTS platform that is ideally suited to characterize B cell receptor (BCR) repertoires by sequencing of immunoglobulin (Ig) genes, as it is able to sequence stretches of several hundred nucleotides. Most studies that used this platform for antibody repertoire analyses have started from fresh or frozen tissues or peripheral blood samples, and rely on starting with optimal quality DNA. In this paper we demonstrate that BCR repertoire analysis can be done using DNA from formalin-fixed paraffin-embedded (FFPE) human tissue samples. The heterogeneity of BCR repertoires we obtained confirms the plausibility of HTS of DNA from FFPE specimens. The establishment of experimental protocols and computational tools that enable sequence data analysis from the low quality DNA of FFPE tissues is important for enabling research, as it would enable the use of the rich source of preserved samples in clinical biobanks and biopsy archives.     

Increased Serum GP88 (Progranulin) Concentrations in Rheumatoid Arthritis

GP88 (Progranulin; PGRN) is a secreted glycosylated protein with important functions in several processes, including immune response and cancer growth. Recent reports have shown that PGRN is a therapeutic target for rheumatoid arthritis (RA) because of its capability to bind with tumor necrosis factor receptor (TNFR). However, the serum PGRN level in RA patients has not been investigated. We used enzyme-linked immunosorbent assay (ELISA) to quantify the serum levels of PGRN in 417 healthy subjects, 56 patients with RA and 31 patients with osteoarthritis (OA). In RA patients, we also measured the serum TNF-α and sTNFR concentration. Immunohistochemical staining of PGRN was performed using synovectomy tissue of RA patients. The serum PGRN normal range was established as 40.1?±?8.7 ng/ml. PGRN levels were not influenced by sex or age. A significant increase in serum PGRN levels was observed in RA (50.2?±?11.1 ng/ml) and OA (45.4?±?6.6 ng/ml) groups compared to those in age-matched healthy controls (40.4?±?9.9 ng/ml) (p?TNF-α and sTNFR 2 concentration. Furthermore, PGRN/TNF-α ratio was correlated the stage of the disease in RA patients. The concentrations of serum PGRN in RA were found to be significantly higher than those in age-matched healthy controls, although it remains to be clarified how blood PGRN is related to the pathogenesis of RA. Our results showed that the serum PGRN may be a useful approach to monitor the disease activity in RA patients.     

A methodological comparison of the Porges algorithm,fast Fourier transform,and autoregressive spectral analysis for the estimation of heart rate variability in 5‐month‐old infants

Little empirical evidence exists on the comparability of heart rate variability (HRV) quantification methods commonly used in infants. The aim was to compare three methods of HRV estimation: (1) fast Fourier transform (FFT), (2) autoregressive (AR), and (3) the Porges methods. HRV was estimated in 63 healthy 5‐month‐old infants. HRV parameters were strongly correlated across methods (.92–.99) but yielded significantly different mean HRV estimates (Porges method > FFT > AR). There was no systematic bias over the whole range of values between the two spectral approaches, while differences between the Porges method and the spectral estimates were systematically greater for larger values. Additional comparative studies are needed to explore the between‐method agreement across a range of physiological conditions.