A case of slipped capital femoral epiphysis results from hypophosphatemic rickets： treatment and midterm follow-up

In this case, a male patient presented with a clinically and radiographieally unstable slipped capital femoral epiphysis （SCFE） as well as slipped calcaneal epiphysis years. Subsequent thorough at the age of 23 work-up revealed that he had some features of rickets and labo- ratory test demonstrated he had hypophos- phatemia （2.3mg/dl）, normocalcemia, normal vi- tamin D metabolite levels, and secondary hy- perparathyroidism.     

Comparison of the subacute toxicity and efficacy of 3-hydroxypyridin-4- one iron chelators in overloaded and nonoverloaded mice

Five orally effective iron chelators of the 3-hydroxypyridin-4-one series have been administered intraperitoneally to iron-overloaded and nonoverloaded male mice at a dose of 200 mg/kg/24 h for a total of 60 days to investigate the effect on iron loading and toxicity. There was a significant reduction in hepatic iron at the end of the study in the iron-overloaded mice with all compounds studied using chemical iron quantitation (P less than .001) and with Perls' stain (P less than .01). Liver iron removal with the hydroxypyridinones ranged from 37% with CP20 to 63% with CP51, compared with 46% removal for desferrioxamine (DFO). There was no significant reduction in splenic or cardiac iron with any chelator. There were no deaths in iron-overloaded animals receiving any of the hydroxypyridin-4-ones, but significantly more deaths in the nonoverloaded groups as a whole (P less than .03). No weight loss was observed with any chelator. Significant reductions in hemoglobin and white cell count were observed with CP20(L1). No histologic abnormalities of kidney, spleen, bone marrow, or stifle joints were observed. Intracytoplasmic inclusion bodies were observed in the centrilobular hepatocytes of animals administered each of the hydroxypyridin-4-ones, while the DFO-treated and control groups showed no such changes.     

Detection of anti-HTLV-I Tax antibodies in HTLV-I enzyme-linked immunosorbent assay-negative individuals

The HTLV-I tax gene protein (Tax) is not packaged within the mature viral particle from which the proteins for the commercially available enzyme-linked immunosorbent assay (ELISA) are derived. Screening of 162 individuals within a cohort of white intravenous (IV) drug abusers, previously identified as having an increased incidence of HTLV-I infection, demonstrated that seven of them had antibodies to the HTLV-I Tax protein but tested negative in HTLV-I ELISAs and Western blots prepared from purified virion proteins. Three out of 35 individuals in other behaviorally defined high-risk groups also displayed this limited pattern of reactivity to HTLV-I proteins. The presence of the anti-HTLV- I p40/Tax antibodies was determined by radioimmunoprecipitation assay (RIPA), which also revealed low levels of anti-env reactivity. The specificity of the anti-p40 reactivity was confirmed on specific Tax ELISAs and Western blots prepared from recombinantly produced Tax. In vitro gene amplification by the polymerase chain reaction (PCR) was used to establish the presence of sequences homologous to HTLV-I proviral DNA in four/four of these HTLV-I ELISA negative, Tax ELISA/Tax western blot/RIPA positive individuals. These data suggest that the true incidence of HTLV-I infection within high-risk cohorts is greater than previously reported.     

Myxoid glioneuronal tumor,PDGFRA p.K385‐mutant: clinical,radiologic, and histopathologic features

“Myxoid glioneuronal tumor, PDGFRA p.K385‐mutant” is a recently described tumor entity of the central nervous system with a predilection for origin in the septum pellucidum and a defining dinucleotide mutation at codon 385 of the PDGFRA oncogene replacing lysine with either leucine or isoleucine (p.K385L/I). Clinical outcomes and optimal treatment for this new tumor entity have yet to be defined. Here, we report a comprehensive clinical, radiologic, and histopathologic assessment of eight cases. In addition to its stereotypic location in the septum pellucidum, we identify that this tumor can also occur in the corpus callosum and periventricular white matter of the lateral ventricle. Tumors centered in the septum pellucidum uniformly were associated with obstructive hydrocephalus, whereas tumors centered in the corpus callosum and periventricular white matter did not demonstrate hydrocephalus. While multiple patients were found to have ventricular dissemination or local recurrence/progression, all patients in this series remain alive at last clinical follow‐up despite only biopsy or subtotal resection without adjuvant therapy in most cases. Our study further supports “myxoid glioneuronal tumor, PDGFRA p.K385‐mutant” as a distinct CNS tumor entity and expands the spectrum of clinicopathologic and radiologic features of this neoplasm.     

Similar Influence of Stabilized Alkaline and Neutral Sodium Hypochlorite Solutions on the Fracture Resistance of Root Canal–treated Bovine Teeth

Introduction

Stabilizing sodium hypochlorite (NaOCl) at an alkaline pH is proposed to increase solution stability and tissue dissolution ability; however, a reduction on the flexural strength of dentin discs has been found to be a side effect. This study sought to determine whether a stabilized alkaline NaOCl reduces the fracture resistance of root canal–treated bovine teeth after root canal preparation compared with a neutral solution counterpart.

Methods

The 4 anterior incisors were removed from 20 mandibular bovine jaws, and each 1 was randomly assigned to 1 of 4 groups (20 teeth each). Teeth were prepared with a sequence of 6 K-type files. The following experimental groups received a different irrigation regimen: G1: distilled water (negative control), G2: 5% NaOCl at a pH of 7.2, and G3: 5% NaOCl at a pH of 12.8; in the positive control group (G4), teeth remained untreated. The time of contact and volume of solution were carefully standardized. After bone and periodontal ligament simulation, teeth were subjected to a fracture resistance test.

Results

A significant difference was observed among the 4 groups tested (analysis of variance, P < .05). The 5% NaOCl groups (G2 and G3) presented significantly lower resistance to fracture than the control (G1 and G4) (Tukey test, P < .05). Both NaOCl solutions similarly reduced the fracture resistance at approximately 30% (Tukey test, P > .05). No differences were observed between positive and negative control groups (Tukey test, P > .05).

Conclusions

Stabilized alkaline and neutral NaOCl solutions similarly reduced the fracture resistance of root canal–treated bovine teeth by about 30%.     

Jatrophone Inhibits Platelet Rich Plasma Aggregation from Man,Rat and Guinea-pig Induced by Different Agents

The effect of jatrophone (2.5–100 μM ), a diterpene isolated from Jatropha elliptica , upon the aggregation (platelet rich plasma) induced by several agents in different animal species was examined. At the same range of inhibitory concentrations (24.0–43.0 μM ) previously shown to inhibit contractions triggered by different agents in isolated muscle preparations, jatrophone markedly inhibited platelet aggregation. This effect was dose-dependent and it was reversible for up to 30 min. It is concluded that this nonspecific effect could reflect an action of jatrophone either at an intracellular step in the signal transduction process, which is common to different agonists, or at the level of extracellular and/or intracellular Ca²⁺ mobilization.     

The provision of a time-critical elective surgical service during the COVID-19 Crisis: a UK experience

IntroductionWith the emergence of the COVID-19 pandemic, all elective surgery was temporarily suspended in the UK, allowing for diversion of resource to manage the anticipated surge of critically unwell patients. Continuing to deliver time-critical surgical care is important to avoid excess morbidity and mortality from pathologies unrelated to COVID-19. We describe the implementation and short-term surgical outcomes from a system to deliver time-critical elective surgical care to patients during the COVID-19 pandemic.Materials and methodsA protocol for the prioritisation and safe delivery of time-critical surgery at a COVID-19 ‘clean’ site was implemented at the Nuffield Health Exeter Hospital, an independent sector hospital in the southwest of England. Outcomes to 30 days postoperatively were recorded, including unplanned admissions after daycase surgery, readmissions and complications, as well as the incidence of perioperative COVID-19 infection in patients and staff.ResultsA total of 128 surgical procedures were performed during a 31-day period by a range of specialties including breast, plastics, urology, gynaecology, vascular and cardiology. There was one unplanned admission and and two readmissions. Six complications were identified, and all were Clavien-Dindo grade 1 or 2. All 128 patients had preoperative COVID-19 swabs, one of which was positive and the patient had their surgery delayed. Ten patients were tested for COVID-19 postoperatively, with none testing positive.ConclusionThis study has demonstrated the implementation of a safe system for delivery of time-critical elective surgical care at a COVID-19 clean site. Other healthcare providers may benefit from implementation of similar methodology as hospitals plan to restart elective surgery.     

Nonselective cation channels as effectors of free radical-induced rat liver cell necrosis

Necrosis, as opposed to apoptosis, is recognized as a nonspecific cell death that induces tissue inflammation and is preceded by cell edema. In non-neuronal cells, the latter has been explained by defective outward pumping of Na(+) caused by metabolic depletion or by increased Na(+) influx via membrane transporters. Here we describe a novel mechanism of swelling and necrosis; namely the influx of Na(+) through oxidative stress-activated nonselective cation channels. Exposure of liver epithelial Clone 9 cells to the free-radical donors calphostin C or menadione induced the rapid activation of an approximately 16-pS nonselective cation channel (NSCC). Blockage of this conductance with flufenamic acid protected the cells against swelling, calcium overload, and necrosis. Protection was also achieved by Gd(3+), an inhibitor of stretch-activated cation channels, or by isosmotic replacement of extracellular Na(+) with N-methyl-D-glucamine. It is proposed that NSCCs, which are ubiquitous although largely inactive in healthy cells, become activated under severe oxidative stress. The ensuing influx of Na(+) initiates a positive feedback of metabolic and electrolytic disturbances leading cells to their necrotic demise.     

Interactions between forskolin, calcium and Bay K 8644 in K+-depolarized rat uterine muscle

1. Forskolin (FORS) (0.03 to 10 microM) caused a concentration-dependent rightward shifts of the dose-response curves to CaCl2 in the isolated K+-depolarized rat uterus, with apparent, pA2 value of 8.3, but the slope was different from unity (0.55). 2. In presence of Bay K 8644 (10 and 100 nM), the pA2 values for FORS against CaCl2 contractions were reduced in a concentration-dependent manner and increased the slopes of Schild plots to values no longer different from unity. 3. In presence of low Ca2+ concentration (0.22 nM), the potency of FORS in antagonizing CaCl2 contractions was reduced in about 2-fold. 4. FORS (0.3-3 microM) caused a dose- and time-dependent relaxation of sustained contraction induced by CaCl2 (0.5 mM). 5. FORS (0.3 microM) like nifedipine (NIF, 30 pM) caused a concentration-dependent displacement to the right of the dose-response curve to Bay K 8644 (0.1-100 nM) in K+-depolarized preparations. 6. Higher concentration of both FORS (1 and 3 microM) and NIF (0.01 and 0.03 nM) also reduced the maximal response of Bay K 8644. 7. Both drugs caused a concentration-dependent relaxation of uterine muscle contracted by Bay K 8644 (100 nM) and K+ (80 nM), but neither FORS nor NIF discriminated the two types of contraction.     

18F‐fluorodeoxyglucose positron emission tomography imaging in brain tumours: The Western Australia positron emission tomography/cyclotron service experience

¹⁸F‐fluorodeoxyglucose positron emission tomography (FDG‐PET) scans in the first 49 patients referred with either possible brain tumour or brain tumour recurrence were reviewed. FDG‐PET imaging was reported with reference to anatomical imaging. Based on the report the FDG study was classified as either positive or negative for the presence of tumour. Thirty‐eight cases were included in the analysis, 21 having pathological data and 17 with diagnostic clinical follow up. Eleven were excluded, as they had inadequate follow‐up data. Of the 21 cases with pathology, 18 were shown to have tumour. In this group there were five false‐negative scans and two false‐positive PET scans. Seventeen cases were assessed by clinical follow up, nine were considered to have been tumour. There were two false negatives with one false positive. The overall sensitivity, specificity and positive and negative predictive values were 74, 73, 87 and 53% respectively. This is similar to figures previously quoted in published work. Despite relatively limited numbers, the utility of FDG PET imaging in our hands is similar to published reports. With a positive predictive value of 87%, a positive FDG study indicates a high likelihood that there is brain tumour present. A negative study does not exclude the presence of tumour.