Effect of waterpipe tobacco smoking on airway inflammation in murine model of asthma

Objective: There has been an increase in the popularity of waterpipe tobacco smoking (WTS) worldwide, especially in the younger population, including asthma patients. In this study, we investigated the effects of waterpipe smoking on airway inflammation, cytokine levels and oxidative stress markers in an antigen-driven murine model of asthma.

Materials and methods: Balb/c mice were divided into four groups; (1) control (received fresh air, ovalbumin sensitization and saline challenge), (2) WTS (received WTS, ovalbumin sensitization and saline challenge), (3) Ova S/C (received fresh air, ovalbumin sensitization and ovalbumin challenge) and (4) simultaneous WTS and Ova S/C (received WTS, ovalbumin sensitization and ovalbumin challenge). Airway inflammatory cells were evaluated in the broncho-alveolar lavage fluid. Cytokines [interleukin (IL)-13, 10 and 18] and oxidative stress markers [superoxide dismutase (SOD), catalase and glutathione peroxidase (GPx)] were evaluated in the lung homogenates.

Results: Chronic exposure to WTS significantly increased the number of airway inflammatory cells in mice, specifically: eosinophils, neutrophils, macrophages and lymphocytes. The level of IL-13 in the lungs was increased and the level of IL-10 was reduced (p?Chronic WTS potentiated the increase in inflammatory cells induced by Ova S/C (p?p?Conclusions: Chronic WTS exposure induced airway inflammation in control mice and enhanced airway inflammation in murine model of asthma.     

The Stability and Solubility of Progabide and Its Related Metabolic Derivatives

The stability–pH profile of the -aminobutyric acid prodrug, Progabide, was found to be bell shaped, with maximum stability occurring at pH 6 to 7 with a t _1/2 of 126 min. Of its metabolic derivatives, the deamidated product PGA degraded in a similar fashion to Progabide, whereas the hydrolytic degradation product SL79.182 was, as expected, a stable compound. Progabide behaved as a typical weak base, with its solubility increasing with a decrease in pH. SL79.182 behaved as a typical phenolic weak acid, with its solubility increasing with an increase in pH. Both compounds displayed low intrinsic solubilities of 14.5 × 10^–5 M for Progabide and 33.4 × 10^–6 M for SL79.182. An increase in temperature resulted in an increase in the solubility but a decrease in the stability of Progabide. The data obtained indicate that the gastric pH and gastric emptying rate will have a profound effect on the oral bioavailability of Progabide.     

Skin adnexal neoplasms--part 2: an approach to tumours of cutaneous sweat glands

Tumours of cutaneous sweat glands are uncommon, with a wide histological spectrum, complex classification and many different terms often used to describe the same tumour. Furthermore, many eccrine/apocrine lesions coexist within hamartomas or within lesions with composite/mixed differentiation. In addition to the eccrine and apocrine glands, two other skin sweat glands have recently been described: the apoeccrine and the mammary-like glands of the anogenital area. In this review (the second of two articles on skin adnexal neoplasms), common as well as important benign and malignant lesions of cutaneous sweat glands are described, and a summary for differentiating primary adnexal neoplasms from metastatic carcinoma is outlined, striving to maintain a common and acceptable terminology in this complex subject. Composite/mixed adnexal tumours are also discussed briefly.     

Persistent Thebesian Vessels Involving the Right and Left Ventricles Leading to Coronary Steal Phenomena and Ischemia

We report an extremely rare case of thebesian vein microfistulae to both ventricles. A 65‐year‐old woman, with no major cardiovascular risk factors, presented with multiple episodes of chest pain. The resting electrocardiogram showed T‐wave inversion in leads V₁–V₄. A Dipyridamole myocardial perfusion imaging revealed large and severe inferior defect with complete reversibility. Coronary angiography showed no coronary artery disease. On contrast injection, an exaggerated capillary blush from the distal portions of the right and left coronary artery systems was seen in both ventricles, mimicking the image of ventriculography. This appearance suggests prominent thebesian vessels, a congenital communication between the coronaries and the two ventricles. The clinical relevance of these myocardial sinusoids is still not well established. Although the majority of these fistulas are small in size and with no clinical significance, they can rarely present with chest pain, cardiac arrhythmia, syncope, myocardial infarction, and/or pulmonary hypertension. These fistulae when excessive can cause significant shunting of blood to the ventricles, leading to coronary steal phenomena and ischemia. This phenomenon is facilitated by the low resistance in these microfistulae as opposed to the higher resistance in the normal coronary circulation. Due to the diffuse nature of these microfistulae, neither surgery nor transcatheter therapy is feasible. This condition can only be managed medically; however, it should be noted that vasodilator agents, such as nitrates, can worsen the coronary steal phenomenon. Our patient was treated with ranolazine with significant improvement in her symptoms, which was not reported previously. Multiple coronary artery microfistulae could be an underestimated condition of angina in patient with normal coronaries.     

Atrial fibrillation catheter ablation complications in obese and diabetic patients: Insights from the US Nationwide Inpatient Sample 2005–2013

BackgroundObesity and diabetes are risk factors for atrial fibrillation (AF) incidence and recurrence after catheter ablation. However, their impact on post‐ablation complications in real‐world practice is unknown.ObjectivesWe examine annual trends in AF ablations and procedural outcomes in obese and diabetic patients in the US and whether obesity and diabetes are independently associated with adverse outcomes.MethodsUsing the Nationwide Inpatient Sample (2005–2013), we identified obese and diabetic patients admitted for AF ablation. Common complications were identified using ICD‐9‐CM codes. The primary outcome included the composite of any in‐hospital complication or death. Annual trends of the primary outcome, length‐of‐stay (LOS) and total‐inflation adjusted hospital charges were examined. Multivariate analyses studied the association of obesity and diabetes with outcomes.ResultsAn estimated 106 462 AF ablations were performed in the US from 2005 to 2013. Annual trends revealed a gradual increase in ablations performed in obese and diabetic patients and in complication rates. The overall rate of the primary outcome in obese was 11.7% versus 8.2% in non‐obese and 10.7% in diabetic versus 8.2% in non‐diabetic patients (p < .001).ConclusionsObesity was independently associated with increased complications (adjusted OR, 95% CI:1.39, 1.20–1.62), longer LOS (1.36, 1.23–1.49), and higher charges (1.16, 1.12–1.19). Diabetes was only associated with longer LOS (1.27, 1.16–1.38). Obesity, but not diabetes, in patients undergoing AF ablation is an independent risk factor for immediate post‐ablation complications and higher costs. Future studies should investigate whether weight loss prior to ablation reduces complications and costs.     

Use of a jejunal pouch with ileal interposition in salvage surgery after restorative proctocolectomy

PURPOSE: A novel technique is described for pouch reconstruction after failed restorative proctocolectomy and pouch excision. METHODS: Surgery was undertaken in two patients who had undergone restorative proctocolectomy with subsequent excision of the ileal J-pouch after necrosis. At revisional surgery it was technically impossible to form a pouch using the terminal ileum because of mesenteric shortening. A new 18-cm J-pouch was formed with a jejunal segment. After selective division of axial vessels, adequate length was obtained to allow formation of a jejunal-pouchanal anastomosis. The small bowel distal to the pouch was interposed between the proximal jejunum and J-pouch and a defunctioning stoma was made. RESULTS: The postoperative course was uneventful in both cases. The functional results at 3 and 12 months after stoma closure were good, with five to seven bowel movements per day and complete continence. CONCLUSION: Shortening of the terminal ileal mesentery may preclude the formation of an ileal pouch in patients undergoing salvage surgery after failed restorative proctocolectomy. This novel technique of jejunal J-pouch formation and small-bowel interposition has value as an alternative to definitive ileostomy or Kock's pouch in such patients.     

Results of an aggressive surgical approach in the management of postoperative peritonitis

Background: Treatment of postoperative peritonitis (POP) necessitates adequate control of the source of peritoneal contamination. For most patients, a surgical approach to this requires reoperation to restore intestinal continuity. The aim of this study was to audit our results for the surgical treatment of POP. Methods: Medical records of patients treated for POP using a standardized surgical protocol in a dedicated intensive care unit at the Saint‐Antoine Hospital between 1995 and 2003 were reviewed. The aim of the study was to consider the effectiveness of our surgical protocol in the eradication of all sources of peritoneal contamination in patients presenting with POP. Results: There were 87 patients (34 women, mean age of 58.4 ± 14.7) with a mean Acute Physiology and Chronic Health Evaluation II score of 17.2 ± 4.7 (median 16.5, range 9–28). Eight patients died and there were complications in 60 patients. Nine patients of the 79 survivors either did not require or could not have an operation to restore intestinal continuity. Intestinal continuity was re‐established through a parastomal incision for 26 patients, whereas 44 patients required a further laparotomy. Two patients of the latter group died and 11 patients had a complication. It was not possible to restore intestinal continuity at laparotomy for one patient. Conclusion: An aggressive surgical approach, as reported in this series, including stoma formation whenever possible, diversion or intubation, provides effective control of the source of peritoneal contamination. Restoration of intestinal continuity is possible in most patients. The overall mortality rate for this treatment is 11.5%.     

Perilesional injections of human platelet lysate versus platelet poor plasma for the treatment of diabetic foot ulcers: A double-blinded prospective clinical trial

Diabetic foot ulcer (DFU) is a major cause of morbidity, non-traumatic lower limb amputation in diabetic patients and a high-cost burden on the healthcare system. New therapeutic products are increasingly tested. Platelet-rich plasma (PRP) and human platelet lysate (hPL) are reported to be useful. This trial was conducted to test whether the healing effect of hPL in chronic DFU was due to plasma or platelet lysates in a prospective double-blind design. Autologous PRP was obtained from citrated blood, lysed, and used as drug 1 (active product). The platelet-poor plasma (PPP) was used as a drug 2 (placebo). Ten patients were enrolled in arm 1 and 9 in arm 2. The drugs were injected perilesionally every 2 weeks for a total of sixinjections. Adverse events were recorded until Week 14. The DFUs were scored per the Texas and Wegner systems. No patient showed any major adverse events. Some reported local pain post-injection. Wound healing was achieved in the hPL group in 9/10 of patients at a mean of 35.1 days. In the PPP group, no patient had healed by Day 84. The difference was statistically significant at P < 0.00001. We conclude that autologous hPL is safe and highly effective in healing chronic DFU and is superior to autologous PPP.