Central calcifying epithelial odontogenic tumour in the posterior maxilla: a case report

The calcifying epithelial odontogenic tumour (CEOT), or Pindborg tumour, is a rare, benign odontogenic tumour. CEOT is usually asymptomatic and an incidental radiological finding, often presenting as a mandibular radiolucency with flecks of calcific material. We report an unusual case of CEOT in the left posterior maxilla of a 46‐year‐old male that was associated with an unerupted tooth. The tumour in this case caused non‐specific sinus symptoms and appeared radiographically similar to an odontoma or ossifying fibroma due to its dense calcific contents. Diagnosis was confirmed histologically following surgical removal of the lesion, which showed classic CEOT histomorphology. We report this case to highlight the unusual clinico‐radiologic presentation and illustrate the diagnostic difficulties that can occur with radiolucent and/or radiopaque lesions in the jaws.     

Prevention and control of neglected tropical diseases: overview of randomized trials,systematic reviews and meta-analyses

Objective

To analyse evidence from randomized controlled trials (RCTs) on the prevention and control of neglected tropical diseases (NTDs) and to identify areas where evidence is lacking.

Methods

The Cochrane Central Register of Controlled Trials and PubMed were searched for RCTs and the Cochrane Database of Systematic Reviews and PubMed were searched for meta-analyses and systematic reviews, both from inception to 31 December 2012.

Findings

Overall, 258 RCTs were found on American trypanosomiasis, Buruli ulcer, dengue, geohelminth infection, leishmaniasis, leprosy, lymphatic filariasis, onchocerciasis, rabies, schistosomiasis or trachoma. No RCTs were found on cysticercosis, dracunculiasis, echinococcosis, foodborne trematodes, or human African trypanosomiasis. The most studied diseases were geohelminth infection (51 RCTs) and leishmaniasis (46 RCTs). Vaccines, chemoprophylaxis and interventions targeting insect vectors were evaluated in 113, 99 and 39 RCTs, respectively. Few addressed how best to deliver preventive chemotherapy, such as the choice of dosing interval (10) or target population (4), the population coverage needed to reduce transmission (2) or the method of drug distribution (1). Thirty-one publications containing 32 systematic reviews (16 with and 16 without meta-analyses) were found on American trypanosomiasis, dengue, geohelminths, leishmaniasis, leprosy, lymphatic filariasis, onchocerciasis, schistosomiasis or trachoma. Together, they included only 79 of the 258 published RCTs (30.6%). Of 36 interventions assessed, 8 were judged effective in more than one review.

Conclusion

Few RCTs on the prevention or control of the principal NTDs were found. Trials on how best to deliver preventive chemotherapy were particularly rare.     

MDR1、CYP3A 基因多态性对维吾尔族、汉族心力衰竭患者地高辛血药浓度的影响

目的：观察多药耐药基因1（MDR1） C3435T、细胞色素P450（CYP）3A4*18B对维吾尔族、汉族充血性心力衰竭（简称心衰）患者地高辛血药浓度的影响。方法选择维吾尔族、汉族心衰患者各40例,均口服地高辛0．125 mg/（次· d）至少1周。抽取清晨空腹静脉血后,采用PCR-RFLP法检测患者MDR1 C3435T、CYP3A4*18B基因型,日立741-0050全自动生化分析仪检测地高辛血药浓度。结果汉族MDR1 C3435T基因CT、TT型患者地高辛血药浓度均高于 CC 型和维吾尔族同基因型, P 均＜0．05;维吾尔族 MDR1 C3435T 各基因型及两民族CYP3A4*18B各基因型患者地高辛血药浓度比较,P均＞0．05。结论 MDR1 C3435T基因多态性可能会提高汉族心衰患者的地高辛血药浓度,但对维吾尔族患者则无影响;而CYP3A4*18B基因多态性对两民族心衰患者的地高辛血药浓度均没有明显影响。     

Improvement in Obesity-associated Medical Conditions following Vertical Banded Gastroplasty and Gastrointestinal Bypass

Thirty-nine patients undergoing either Silastictrade mark ring vertical banded gastroplasty (SRVG, n = 23) or Roux-en-Y gastrointestinal bypass (RGB, n = 16) over a 1-year period were analyzed retrospectively. Weight loss averaged 40 kg (89 lb). Clinical diabetes mellitus was markedly improved in seven out of nine patients (p = 0.023). Shortness of breath resolved in all 26 patients who had this condition preoperatively (p < 0.001). Orthopedic problems, high blood pressure, and self-assessment of general health and quality of life were also dramatically improved. We conclude that bariatric surgery serves as an effective method to alleviate a multitude of conditions associated with morbid obesity.     

人源抗HIV—1整合酶单链抗体基因的构建及表达

获得人源抗ＨＩＶ－１整合酶单链抗体基因并在大肠杆菌及细胞中进行表达。方法：从人的抗ＨＩＶ－１整合酶的Ｆａｂ抗体基因片段中通过ＰＣＲ扩出此抗体的重链可变区和轻链可变区基因,经一弹性连接肽连接构建成人源抗ＨＩＶ－１整合酶的单链抗体基因。     

Physical and mental development in 4-6-year-old triplets

A total of 21 families with complete sets of triplets, born within 200 km of Stockholm, were invited to participate in a follow-up study with the aim of assessing the physical and mental development of their triplets at 4-6 years of age. Four families declined to participate in the study and thus the study group consisted of 17 sets of triplets who were born at 33-36 gestational weeks from 1986 to 1989. Mean birth weight was 2104g (range 1310-2670g) for the boys and 1882g (range 1290-2590g) for the girls. At birth, none of the 51 triplets showed any malformations. No asphyxia or other major complications were noted to have occurred at delivery. The children were examined in their homes with a neurological examination and the Griffiths mental development scales (GMDS). No major physical disabilities were found. In a group of triplets born small for dates, the total GMDS score and most of the subscale scores were significantly lower than for their siblings. In contrast to what has been found in singletons and twins, the differences in mental development between triplet boys and girls were not significant. On the whole, physical and mental development did not differ from what has been found in twins and singletons of the same age and with the same birth weight.     

Plasma cytokine levels in necrotizing enterocolitis

Plasma concentrations of tumour necrosis factor (TNF) and interleukin-6 (IL-6) were measured by ELISA in samples taken from 24 infants with necrotizing enterocolitis (NEC) between 0 and 306 h from diagnosis. TNF was detected (>10pg/ml) in 71% samples with a mean of 48pg/ml (95% CI 42 to 55 pg/ml) and did not vary with either time from diagnosis or severity of disease. IL-6 was raised during the first 48 h with a significant difference between stage II (mean 127 pg/ml, 95% CI 10 to 329 pg/ml) and stage HI (mean 3127 pg/ml, 95% CI 1809 to 4445 pg/ml, p = 0.001). Postoperative plasma IL-6 concentration fell to similar levels seen in stage II (mean 150 pg/ml, 95% CI 37 to 283 pg/ ml, p = 0.79). We conclude that plasma concentration of IL-6 rather than TNF reflects the clinical severity of necrotizing enterocolitis and that the relative level of these cytokines has important implications for the use of anti-cytokine therapy in NEC.     

Necrotizing enterocolitis—multisystem organ failure of the newborn?

Evidence of failure of organ system other than the gastrointestinal tract was reviewed in a series of 46 infants treated for necrotizing enterocolitis (NEC) at a regional combined medical and surgical neonatal unit. Respiratory failure was identified in 42 infants (91%), renal failure in 39 (85%), cardiovascular failure in 15 (33%) and hepatic failure in 7 (15%). The number of systems involved correlated with both severity of disease and outcome. Onset of failure in the above systems was closely related to the diagnosis of NEC and 29 cases predated the clinical onset. We conclude that NEC is part of a syndrome of multisystem failure and that this has important implications for the treatment of NEC.     

Intrastate Variation in Treatment and Outcomes of Out-of-Hospital Cardiac Arrest

Objective: Our objective was to analyze and compare out-of-hospital cardiac arrest (OHCA) system of care performance and outcomes at the Medical Control Authority (MCA) level in the state of Michigan. We hypothesized that clinically and statistically significant variations in treatment and outcomes of OHCA exists within a single U.S. state. Methods: We performed a retrospective, observational study of all non-traumatic EMS-treated OHCA from the state of Michigan CARES registry for 2014–2015. Geocoding of the OHCA incident address was used to assign records to individual MCAs. MCA-based demographics, arrest characteristics, system of care performance and outcomes were quantified and compared. Associations between demographics, system of care parameters, and outcomes were examined at the MCA level. Results: A total of 8,115 records with complete data were available for analysis. Eleven MCAs met study inclusion criteria of >100 cases, producing a final sample size of 7,788 records (96%). Statistically significant variations in survival to hospital discharge ranged from 4.5% to 15% (p < 0.001) (Adjusted odds ratio [AOR] range 0.6–2.0) and survival with good neurologic outcome 2.7–12.5% (p < 0.001; AOR range 0.5–2.2,) were observed across MCAs. Bystander CPR ranged from 32% to 53% (p < 0.001) and bystander AED application ranged from 3.5% 11.5% (p < 0.05). Of patients admitted to the hospital alive, 29–68% received targeted temperature management. In hospital mortality ranged from 53.1% to 73.9% (p < 0.05). Conclusion: Significant intrastate variability in OHCA system of care performance and outcomes currently exist and are similar to what has been previously reported across North America almost a decade ago. This degree of variability highlights the opportunity to optimize modifiable factors within local systems of care to improve OHCA outcomes.