Sonoelastographic lesion stiffness: preoperative predictor of the presence of an invasive focus in nonpalpable DCIS diagnosed at US-guided needle biopsy

Objectives  

To retrospectively evaluate whether sonoelastographic evaluation could help predict the presence of an invasive focus in nonpalpable DCIS diagnosed at US-guided needle biopsy.     

Intracranial transthecal subarachnoid fat emboli and subarachnoid haemorrhage arising from a sacral fracture and dural tear

We present the case of a 28-year-old man with an unusual aetiology of lipid-dense material in the subarachnoid space. CT of the head at presentation was normal. MRI of the spine revealed a defect in the dura at L5/S1, with avulsed left L5 and S1 nerve roots. Haematoma and marrow fat were observed in close relation to the dural tear adjacent to the sacral fracture. Head CT and MRI subsequently demonstrated new lipid-dense material and haemorrhage in the subarachnoid space after sacral instrumentation, presumably owing to transthecal displacement of fatty marrow.The presence of fat droplets within the subarachnoid space is an unusual finding and is most commonly the sequelae of a ruptured dermoid. We present a unique case with CT and MRI that demonstrates the development of subarachnoid fat emboli and subarachnoid haemorrhage secondary to pelvic trauma. A sacral fracture with an adjacent dural tear and nerve root avulsion is the putative source of the subarachnoid fat and blood.     

A Prospective Study on the Association Between Lower Urinary Tract Symptoms (LUTS) and Erectile Dysfunction: Results from a Large Study in Elderly Chinese in Southern China

IntroductionAlthough many cross-sectional studies have been conducted on the association between lower urinary tract symptoms (LUTS) and erectile dysfucntion (ED), no studies were prospective in Asia.AimThe relationship between LUTS and ED is examined using a prospective cohort of 2000 Chinese men.MethodsBaseline and 4-year data from a large prospective cohort study of 2000 Chinese elderly men were analyzed. A total of 1,736 subjects were included in the current analysis after excluding those with history of bladder or prostate cancer, or urological surgery, and those who used alpha blockers or anti-androgen.Main Outcome MeasuresLUTS were measured at baseline by the International Prostatic Symptom Score and ED was measured using one question on impotence at the end of 4 years.ResultsA dose–response relationship was observed for the relationship between baseline severity of LUTS and severity of ED at follow-up with those who had more severe LUTS at baseline with an increased odds of having more severe ED (odd ratio [OR] = 1.86, confidence interval [CI]: 1.16–2.97 for mild LUTS at baseline; OR = 2.95, CI: 1.81–4.81 for moderate LUTS at baseline; and OR = 3.82, CI: 2.00–7.27 for severe LUTS at baseline). Other baseline factors that were statistically significantly associated with ED included body mass index (OR = 1.13, CI: 1.01–1.26), hypertension (OR = 1.30, CI: 1.02–1.65) and diabetes (OR = 1.44, CI: 1.07–1.93).ConclusionThe presence of LUTS is associated with ED with more severe LUTS being associated with higher degree of ED in men. Wong SY, Leung JC, and Woo J. A prospective study on the association between lower urinary tract symptoms (LUTS) and erectile dysfunction: Results from a large study in elderly chinese in southern China. J Sex Med 2009;6:2024–2031.     

Change in cross‐sectional area of esophageal muscle does not correlate with the outcome of achalasia after pneumatic balloon dilatation

Background and Aim: Patients with achalasia have a thicker muscularis propria compared to normal patients. Because pneumatic balloon dilatation (PD) is an effective treatment for achalasia, the changes in the esophageal muscles after PD may predict treatment outcomes, if muscular change is of primary importance. In the present study, we aimed to observe the changes in esophageal muscle thickness following PD and assessed whether symptom relapse can be predicted on the basis of the esophageal muscle cross‐sectional area (CSA), as measured by high‐frequency intraluminal ultrasound (HFIUS). Methods: Fifteen patients treated by PD were studied and followed up for a median of 3.6 years. An HFIUS was done before PD and 6 months after PD. The esophageal muscle CSA measured at the lower esophageal sphincter (LES), and 3 and 6 cm above the LES, was used to see whether any association was present between symptom recurrence and the esophageal muscle CSA. Results: A single PD resulted in a 2‐year remission rate of 66%. A significance variance in change (?65%–248%) was noticed in the muscle CSA after PD. The predilation muscle CSA, post‐dilation muscle CSA, and change in the muscle CSA after PD was not associated with symptom recurrence. Conclusion: Our findings suggest that measuring the muscle CSA does not help to predict treatment outcome. Muscular changes in achalasia might be just reactive changes.     

PEST family phosphatases in immunity, autoimmunity, and autoinflammatory disorders

Summary:  The proline-, glutamic acid-, serine- and threonine-rich (PEST) family of protein tyrosine phosphatases (PTPs) includes proline-enriched phosphatase (PEP)/lymphoid tyrosine phosphatase (LYP), PTP-PEST, and PTP-hematopoietic stem cell fraction (HSCF). PEP/LYP is a potent inhibitor of T-cell activation, principally by suppressing the activity of Src family protein tyrosine kinases (PTKs). This function seems to be dependent, at least in part, on the ability of PEP to bind C-terminal Src kinase (Csk), a PTK also involved in inactivating Src kinases. Interestingly, a polymorphism of LYP in humans (R620W) is a significant risk factor for autoimmune diseases including type 1 diabetes, rheumatoid arthritis, and lupus. The R620W mutation may be a 'gain-of-function' mutation. In non-hematopoietic cells, PTP-PEST is a critical regulator of adhesion and migration. This effect correlates with the aptitude of PTP-PEST to dephosphorylate cytoskeletal proteins such as Cas, focal adhesion associated-kinase (FAK), Pyk2, and PSTPIP. While not established, a similar function may also exist in immune cells. Additionally, overexpression studies provided an indication that PTP-PEST may be a negative regulator of lymphocyte activation. Interestingly, mutations in a PTP-PEST- and PTP-HSCF-interacting protein, PSTPIP1, were identified in humans with pyogenic sterile arthritis, pyoderma gangrenosum, and acne (PAPA) syndrome and familial recurrent arthritis, two autoinflammatory diseases. These mutations abrogate the ability of PSTPIP1 to bind PTP-PEST and PTP-HSCF, suggesting that these two PTPs may be negative regulators of inflammation.