CT findings of plastic bronchitis in children after a Fontan operation

BACKGROUND: Plastic bronchitis is a rare cause of acute obstructive respiratory failure in children. Life-threatening events are much more frequent in patients with repaired cyanotic congenital heart disease, and most frequent following a Fontan operation. Commonly, the diagnosis is not made until bronchial casts are expectorated. Detailed CT findings in plastic bronchitis have not been described. OBJECTIVE: To describe the CT findings in plastic bronchitis in children after a Fontan operation. MATERIALS AND METHODS: Three children with plastic bronchitis after a Fontan operation were evaluated by chest CT. Bronchial casts were spontaneously expectorated and/or extracted by bronchoscopy. Airway and lung abnormalities seen on CT were analyzed in the three children. RESULTS: CT demonstrated bronchial casts in the central airways with associated atelectasis and consolidation in all children. The affected airways were completely or partially obstructed by the bronchial casts without associated bronchiectasis. The airway and lung abnormalities rapidly improved after removal of the bronchial casts. CONCLUSION: CT can identify airway and lung abnormalities in children with plastic bronchitis after a Fontan operation. In addition, CT can be used to guide bronchoscopy and to monitor treatment responses, and thereby may improve clinical outcomes.     

Loss of cell invasiveness through PKC‐mediated syndecan‐1 downregulation in melanoma cells under anchorage independency

Anchorage‐independent survival is one of the key features for malignant tumor cells. Whether specific gene alterations contributed by anchorage independency would further affect metastatic phenotypes of melanoma cells was unclear. We adapted suspension culture of melanoma cells to establish anchorage independency. The suspended melanoma cells lost their invasive abilities in vitro. Specific loss of laminin‐binding ability in suspended melanoma cells was observed, which was correlated with downregulation of syndecan‐1 as revealed by microarray and validated by qPCR and Western blot. Modulation of syndecan‐1 expression level affected laminin binding, transwell migration and matrix metalloproteinase‐2 secretion in melanoma cells. SDC1 expression and transwell migration were correlated with activity or level of protein kinase Cδ as evidence by specific inhibitors and shRNA transfection. In this study, we compared metastatic phenotypes and gene expressions of adherent and suspended melanoma cells. The anchorage independency led to protein kinase Cδ‐mediated syndecan‐1 downregulation, which contributed to loss of laminin‐binding ability, reduced metalloproteinase‐2 secretion and loss of invasiveness.     

Vascular fibrinoid necrosis in the urinary bladder of ketamine abusers: A new finding that may provide a clue to the pathogenesis of ketamine‐induced vesicopathy

Two 31‐year‐old women who had abused ketamine, 1 for 8 years and 1 for 5 years, presented with ketamine‐induced vesicopathy with urinary frequency, decreased bladder capacity, and detrusor overactivity. An enterocystoplasty was performed in both cases. The pathology of the urinary bladders in both women showed ulcerative cystitis and fibrinoid necrosis of vessels; the latter was confirmed by Masson trichrome staining. Fibrinoid necrosis of vessels is a kind of immune complex‐mediated vasculitis that induces the release of inflammatory mediators, with subsequent thrombosis, ischemic injury, and eventual tissue necrosis in localized areas, the so‐called Arthus reaction. The new finding of fibrinoid necrosis in the urinary bladders of ketamine abusers may provide a new clue to the pathogenesis of ketamine‐induced vesicopathy.     

The CCR5 (−2135C/T) Polymorphism may be Associated with the Development of Kawasaki Disease in Korean Children

Background  Kawasaki disease (KD) is an acute vasculitis syndrome of unknown etiology that frequently affects small to medium size arteries. C-C chemokine receptor 5 (CCR5) is a chemokine receptor that binds C-C chemokines. This study investigated the association of the CCR5 (−2135C/T) polymorphism with KD in Korean children. Methods  The study population consisted 189 Korean children with KD and 194 Korean children with congenital heart disease (CHD). CCR5 (−2135C/T) polymorphism genotypes were determined using the single-base extension method. Results  The allele frequencies of the CCR5 (−2135C/T) polymorphism differed significantly between CHD children and KD children (−2135T/T, 16.75% vs. 30.05%, aOR 2.14, 95% CI 1.31–3.51). The tested laboratory parameters differed significantly between the KD and CHD groups. The development of coronary artery aneurysm in KD patients was not associated with the CCR5 polymorphism. Conclusions  Our findings suggest that the T allele at the CCR5 (−2135C/T) polymorphism might be associated with the development of KD in Korean children but does not appear to be associated with the development of coronary artery aneurysm.     

Mitomycin C inhibits recurrent Avellino dystrophy after phototherapeutic keratectomy

PURPOSE: To report 4 patients with Avellino corneal dystrophy (ACD) who were treated with 0.02% mitomycin C (MMC) during phototherapeutic keratectomy (PTK). METHODS: ACD was confirmed by polymorphism of the exon region in the BIGH3 gene using polymerase chain reaction followed by DNA sequencing analysis. Three patients with recurrent ACD and 1 patient with primary ACD underwent PTK. Intraoperative 0.02% MMC was applied topically with a soaked microsponge. RESULTS: There was no recurrence of ACD in the heterozygotes, but there were recurrences with best-corrected visual acuity of 20/30 in the 2 homozygotes. CONCLUSION: Intraoperative use of topical 0.02% MMC in conjunction with PTK may prevent or delay the recurrence of ACD for at least for 1 year.     

自杀事件的媒体报道对人群自杀行为的影响(综述)

自杀是一个重大的公共健康问题，据世界卫生组织报道全世界每年自杀死亡人数超过百万，自杀未遂者则是它的10—20倍，自杀带来的损失占全球疾病负担的1．4％。有学者发现自杀事件的媒体报道对人群自杀行为产生一定的影响。如1998年经香港报纸图文并茂地在头版大量报导了一名妇女用一种当时特殊的“烧炭”方法自杀后，     

Interobserver Variability of Left Ventricular Measurements in a Population of Predominantly Obese Hypertensives Using Simultaneously Acquired and Displayed M-Mode and 2-D Cine Echocardiography

Achieving low interobserver variability is a goal of echocardiographic determined left ventricular (LV) mass measurements. In a group of hypertensives, we evaluated interobserver variation using a method of simultaneously acquired two-dimensional (2-D) cine and M-mode images displayed in a split screen format. Sixty echocardiographic images from ongoing hypertension trials, including serial studies of the same patients, were obtained with an UltraMark^TM 6 Ultrasound System (Advanced Technology Laboratories, Inc., Bothell, WA, USA). Images were digitized online, coded with a random number, and pooled prior to the analysis to minimize observer bias. Studies were read by two independent observers in a blinded fashion and in a random order using a Color Vue II Nova MicroSonics^TM analyzer (Nova Microsonics, Mahwah, NJ, USA). The M-mode tracing and cine of three consecutive frames of 2-D parasternal short-axis views of the LV were simultaneously displayed in a split screen format. The 2-D cine was used as a reference image during M-mode measurements of LV dimensions. Measurements were obtained and the LV mass estimated according to the Penn convention. Interobserver variability for left ventricular internal dimension (LVID), inter-ventricular septal thickness (IVS), posterior wall thickness (PWT), and left ventricular mass (LV mass) is low when either correlated (Pearson correlation coefficients of 0.94, 0.82, 0.75, and 0.93, respectively) or expressed as a percent of the mean (3.0%, 10.0%, 10.2%, and 8.9%, respectively). When read in a blinded fashion, interobserver variability (especially for LV mass) is small using digitized, simultaneously acquired and displayed cines of 2-D and M-mode echocardiograms. This is likely due to the ability to discriminate myocardial wall edges (endocardium) from other associated structures such as tricuspid and mitral apparatus. This method may prove useful in studies of LV mass.     

A workable model for the management of hyperglycemia in non-critically ill patients in an Asian population

Objective: The clinical efficacy of applying a western model for managing hyperglycemia in hospitalized patients in Asia has not been studied. Methods: For this observational case-control study, we divided six medical wards into two groups, an intervention group and a control group. The intervention group, consisting three medical wards on the same floor, received care under a computer-assisted consulting model in which special care was automatically indicated for patients who had two successive high glucose measurements in 1 day. The control group, consisting of another three medical wards distributed on different floors, received regular care. Outcome measures were baseline and post-intervention patient-day weighted mean glucose, percentage of patient-day weighted glucose ≥180 mg/dL, proportion of glucose level 100–180 mg/dL, and prevalence of inpatient hyperglycemia (>180 mg/dL) and hypoglycemia (individual measurement <70 mg/dL and patient-day with any measurement <70 mg/dL). Results: At baseline, the patient-day weighted mean glucose level was 181.6 mg/dL. All parameters were comparable between the intervention and control groups with the exception of prevalence of hypoglycemia, which was found to be higher in the intervention group. After intervention, patient-day weighted mean glucose levels for intervention and control groups were 169.9 mg/dL and 176.7 mg/dL, respectively (p < 0.001). The intervention group had a reduction in hypoglycemia and the control group an increase. Conclusion: This computer-assisted consulting model was found to be potentially very workable for the management of inpatient hyperglycemia in hospitals with high patient volumes in Asia.