Thermographic visualization of facial vasoconstriction is associated with 30-day all-cause mortality in medical patients; prospective observational two-site cohort study

INTRODUCTION

Quick and reliable assessment of acute patients is required for accurate triage. The temperature gradient between core and peripheral temperature could possibly instantly provide information on circulatory status.

METHODS

Adult medical patients, who did not receive supplementary oxygen, attending two emergency departments, had a thermographic image taken on arrival. The association between 30-day mortality and gradients was tested using logistic regression.

RESULTS

726 patients were studied, median age was 64 years and 14 (1.9%) died within 30 days. There was a significant association between mortality and temperature gradient, comparable to vital signs, age, and clinical intuition.

CONCLUSION

Temperature gradient between nose and eye had an acceptable discriminatory power for 30-day all-cause mortality.

Long-term efficacy and safety of biosimilar infliximab (CT-P13) after switching from originator infliximab: open-label extension of the NOR-SWITCH trial

BACKGROUND AND OBJECTIVES

The 52-week, randomized, double-blind, noninferiority, government-funded NOR-SWITCH trial demonstrated that switching from infliximab originator to less expensive biosimilar CT-P13 was not inferior to continued treatment with infliximab originator. The NOR-SWITCH extension trial aimed to assess efficacy, safety and immunogenicity in patients on CT-P13 throughout the 78-week study period (maintenance group) versus patients switched to CT-P13 at week 52 (switch group). The primary outcome was disease worsening during follow-up based on disease-specific composite measures.

METHODS

Patients were recruited from 24 Norwegian hospitals, 380 of 438 patients who completed the main study: 197 in the maintenance group and 183 in the switch group. In the full analysis set, 127 (33%) had Crohn's disease, 80 (21%) ulcerative colitis, 67 (18%) spondyloarthritis, 55 (15%) rheumatoid arthritis, 20 (5%) psoriatic arthritis and 31 (8%) chronic plaque psoriasis.

RESULTS

Baseline characteristics were similar in the two groups at the time of switching (week 52). Disease worsening occurred in 32 (16.8%) patients in the maintenance group vs. 20 (11.6%) in the switch group (per-protocol set). Adjusted risk difference was 5.9% (95% CI -1.1 to 12.9). Frequency of adverse events, anti-drug antibodies, changes in generic disease variables and disease-specific composite measures were comparable between arms. The study was inadequately powered to detect noninferiority within individual diseases.

CONCLUSION

The NOR-SWITCH extension showed no difference in safety and efficacy between patients who maintained CT-P13 and patients who switched from originator infliximab to CT-P13, supporting that switching from originator infliximab to CT-P13 is safe and efficacious.

Spatial and temporal changes in the morphology of preosteoblastic cells seeded on microstructured tantalum surfaces

It has been widely reported that surface morphology on the micrometer scale affects cell function as well as cell shape. In this study, we have systematically compared the influence of 13 topographically micropatterned tantalum surfaces on the temporal development of morphology, including spreading, and length of preosteoblastic cells (MC3T3-E1). Cells were examined after 0.5, 1, 4, and 24 h on different Ta microstructures with vertical dimensions (heights) of 0.25 and 1.6 mum. Cell morphologies depended upon the underlying surface topography, and the length and spreading of cells varied as a function of time with regard to the two-dimensional pattern and vertical dimension of the structure. Microstructures of parallel grooves/ridges caused elongated cell growth after 1 and 4 h in comparison to a flat, nonstructured, reference surface. For microstructures consisting of pillars, cell spreading was found to depend on the distance between the pillars with one specific pillar structure exhibiting a decreased spreading combined with a radical change in morphology of the cells. Interestingly, this morphology on the particular pillar structure was associated with a markedly different distribution of the actin cytoskeleton. Our results provide a basis for further work toward topographical guiding of cell function.

Nanomechanical sensing of DNA sequences using piezoresistive cantilevers

A microfabricated cantilever with an internal piezoresistive component has been sensitized with thiol tethered ss-DNA strands and utilized for an in situ, label-free, highly specific, and rapid DNA detection assay. The generation of a differential surface stress onto the functionalized cantilever surface upon target recognition has allowed nanomechanical identification of 12-nucleotide complementary DNA probes with single base mismatch discrimination (sensitivity of 0.2 microM). Interestingly, utilization of an overhang extension distal to the surface enhanced the sensitivity to the 0.01 microM level. The cantilever was functionalized by inkjet printing technology. Replacing the capture probe with locked nucleic acid (LNA) resulted in a faster target probe capture kinetics compared to DNA-DNA hybridization. The capabilities of the piezoresistive cantilever indicate future ergonomic convenience via miniaturization alternative to the conventional laser-based detection method for portable on-site applications.

Bioavailability of selenium from fish, yeast and selenate: a comparative study in humans using stable isotopes

OBJECTIVE

To measure the bioavailability of selenium from cooked and raw fish in humans by estimating and comparing apparent absorption and retention of selenium in biosynthetically labelled fish with labelled selenate and biosynthetically labelled selenium in brewers yeast.

DESIGN

The intervention study was a parallel, randomised, reference substance controlled design carried out at two different centres in Europe.

SETTING

The human study was carried out at the Institute of Food Research, Norwich, UK and at TNO Nutrition and Food Research, Zeist, The Netherlands.

SUBJECTS

In all, 35 male volunteers aged 18-50 y were recruited; 17 subjects were studied in Norwich (UK) and 18 in Zeist (Netherlands). All of the recruited subjects completed the study.

INTERVENTIONS

Biosynthetically labelled trout fish (processed by two different methods), biosynthetically labelled brewers yeast and isotopically labelled selenate were used to estimate selenium apparent absorption and retention by quantitative analysis of stable isotope labels recovered in faeces and urine. Subjects consumed the labelled foods in four meals over two consecutive days and absorption was measured by the luminal disappearance method over 10 days. Urinary clearance of isotopic labels was measured over 7 days to enable retention to be calculated.

RESULTS

Apparent absorption of selenium from fish was similar to selenate and there was no difference between the two processing methods used. However, retention of fish selenium was significantly higher than selenate (P<0.001). Apparent absorption and retention of yeast selenium was significantly different (P<0.001) from both fish selenium and selenate.

CONCLUSION

Fish selenium is a highly bioavailable source of dietary selenium. Cooking did not affect selenium apparent absorption or retention from fish. Selenium from yeast is less bioavailable.

Decreased concentration of hemoglobin, accumulation of lipid oxidation products and unchanged skeletal muscle in Atlantic salmon (Salmo salar) fed low dietary vitamin E

Atlantic salmon (Salmo salar) fry, initial weight 0.16 g, were fed a semipurified diet with 0, 15, 30, 60 or 120 mg dl-α-tocopheryl acetate/kg. After 24 weeks, the first two of these groups were extinct, and the fish receiving 30 mg/kg were clearly vitamin E deficient. Vitamin E deficient fish had low hemoglobin levels, characterized by a combination of reduced cellular hemoglobin concentration, red cell volume and red cell number, and an increased number and fraction of immature red blood cells. The hemoglobin concentration decreased over the decreasing range of experimental dl-ga-tocopheryl acetate levels. Therefore, even if 60 mg dl-α-tocopheryl acetate/kg gave good survival, this level was clearly physiologically suboptimal. Ceroid accumulated in the liver of fish fed 30 mg vitamin E/kg, and autofluorescent inclusions were found in the red blood cells of fish fed 30 and 60 mg vitamin E/kg. Degeneration of skeletal muscle was not observed in the present study.

Xanthogranulomatous cholecystitis. A clinicopathological study of 20 cases and review of the literature

Xanthogranulomatous cholecystitis (XGC) is a focal or diffuse destructive inflammatory process of the gall bladder, characterized macroscopically by yellowish tumour-like masses in the wall of the gall bladder. Microscopically, it is characterized in the early stages by a large number of foamy histiocytes and acute inflammatory cells. Later stages demonstrate increasing fibrosis. The gall bladder from 20 of 352 consecutive patients subjected to cholecystectomy showed XGC. Gall stones were found in the gall bladder of all 20 patients and in the ductus choledochus in 3 cases. Perforation of the gall bladder was observed at operation in six cases; in one case there was also a fistula to the colon. A perivesical abscess was found in five other cases. Adhesions to the surrounding structures were seen in a total of 16 cases. Pathogenetically, XGC is probably due to an interplay between obstruction of the gall flow, infection with subsequent inflammation, and leakage of gall fluid to the tissue, where histiocytes accumulate and phagocytize the bile pigment, haemosiderin and cholesterol, resulting in the formation of xanthoma cells. The correct diagnosis of XGC is important for several reasons, first and foremost due to the high frequency of complications, but not least because the condition may give rise peroperatively to the suspicion of malignancy. The new laparoscopic method for cholecystectomies further stresses the necessity of correct preoperative diagnosis of complicating disease.

Phaeochromocytoma--an unusual cause of haematuria

A patient was admitted to hospital because of haematuria. A papillomatous bladder tumor was removed. Histological examination revealed a phaeochromocytoma. Fourteen days postoperatively the urinary excretion rates of catecholamines were elevated but normalized afterwards. Abdominal computed tomography and metaiodobenzylguanidine scintigraphy were normal. No hypertension or characteristic micturitional attacks preceded removal of the tumor.

Anorectal dysfunction in patients with urologic disturbance due to multiple sclerosis

Anorectal function was evaluated in 11 patients with voiding dysfunction due to multiple sclerosis. In six patients with constipation, three also had symptoms of obstructed defecation and one patient was incontinent due to stercoral diarrhea. One patient was only fecal incontinent and one patient had obstructed defecation as the only symptom. Three patients had no anorectal symptoms. Anal manometry in the women compared with a control group revealed significant lower anal resting and squeeze pressures, although no significant difference of rectal sensation to distention with air was found. Pudendal nerve terminal latencies were obtained in seven patients and were all normal. In four patients latency could not be demonstrated due to poor contraction of the sphincter on stimulation of the pudendal nerve. Two of these patients were incontinent and two had both constipation and obstructed defecation. It is concluded that patients with voiding symptoms due to multiple sclerosis often reveal anorectal symptoms or motility disorders. Although anal sphincter function is reduced, fecal incontinence is not prevalent in this group. The reason for this lies probably in the fact that many of the patients are constipated, thus securing fecal continence.

Influence of peptides on anorectal function

Immunohistochemical and immunochemical studies on biopsies from the human rectum and anal canal have shown several regulatory peptides present in the muscle layers and the mucosa, suggesting a regulatory action on defecation. This view has been supported by studies of anorectal function in man during administration of different peptides. The physiological implications of these observations remain obscure.

Implantation of artificial sphincter for anal incontinence. Report of five cases

The implantation of an artificial anal sphincter in five patients with anal incontinence of neuromuscular origin is described. The prosthesis, an AMS 800 artificial urinary sphincter (American Medical Systems), worked well with solid or semisolid stool, but less satisfactorily when diarrhea was present. Manometric and defecographic studies seem to indicate that the effect of the prosthesis may be ascribed partly to maintenance of an acute anorectal angle even during straining.

Influence of gastrointestinal neuropeptides on the anal canal

To evaluate the possible effect of gastrointestinal neuropeptides on anal function, the effect of somatostatin, enkephalin, VIP, and substance P on anal canal pressure and electromyographic response of the external anal sphincter was studied in healthy subjects. Enkephalin and somatostatin elicited a significant decrease in anal canal pressure after a bolus injection of 1 microgram/kg body weight whereas VIP and substance P had no effect. Future studies must show whether these effects are of pharmacologic importance and if these peptides participate in the physiologic regulation of anorectal function.

Xanthogranulomatous inflammation of the female genital tract

We describe three cases of xanthogranulomatous inflammation in the female genital tract--one affecting endometrium, tube and ovary, one affecting tube, ovary and parametrium and one confined to the endometrium. To date, xanthogranulomatous inflammation in the female genital tract has been reported in a total of 19 cases including the present three. The inflammation most often affects the endometrium but involvement of the vagina, cervix, fallopian tube and ovary may also occur.

Implantation of artificial sphincter for anal incontinence

The implantation of an artificial anal sphincter in a man with severe anal incontinence an myasthenia gravis is described. The prosthesis used, an "AMS 800' artificial urinary sphincter, gave the patient complete control of defecation. The technique offers the possibility of curing anal incontinence of neuromuscular origin, for which there has been no treatment until know.

Effect of sham-feeding on glucose tolerance and insulin secretion

Glucose, 25 g, was infused iv with or without sham-feeding in seven normal males. Sham-feeding improved glucose tolerance, incremental area of blood glucose being 63% (P less than 0.05) of that during iv glucose without sham-feeding. The actual insulin secretion evaluated from the total area under the C-peptide and insulin curves did not differ during iv glucose with or without sham-feeding. These results suggest that the cephalic-vagal reflex improves glucose tolerance during iv glucose, independent of changes in beta-cell function.

Comparative studies of the function and morphology of 111In- and 51Cr-labelled human platelets

Comparative studies of the aggregability in vitro and ex vivo, and of the surface/volume ratio of 111In- and 51Cr-labelled human platelets were carried out. The ADP-induced aggregation in vitro of 111In-platelets was superior to that of 51Cr-platelets, as was that of 51Cr-platelets labelled in plasma as compared to 51Cr-platelets labelled in buffer. These differences seemed to be reversed in vivo, as identical collagen-induced aggregation responses were observed ex vivo when comparisons were made between 111In- and 51Cr-platelets, and between labelled and unmanipulated platelets. Morphometric determination of the surface/volume ratios of the labelled platelets indicated a higher degree of platelet activation of 51Cr-platelets labelled in buffer as compared to those labelled in plasma. In this respect, no difference seemed to be present between 111In- and 51Cr-platelets. The results of the ex vivo aggregation studies were unaffected by the time spent by the platelets in the circulation within 24 h post-injection, by platelet isolation yield, and by the medium used in 51Cr-labelling. Our results indicate that it will be possible to conduct comparative studies of simultaneously induced aggregation ex vivo of different platelet populations labelled with 111In and 51Cr.

Histological findings following oestrogen treatment of hereditary haemorrhagic telangiectasia. A controlled double-blind investigation

In a controlled investigation of 22 patients with hereditary haemorrhagic telangiectasia, an evaluation has been carried out of the connective tissue content of muco-substances prior to and after treatment with oral oestrogen (oestradiol valerate 4 mg. daily). The clinical condition of the patients, all of whom had haemorrhagic anaemia, was evaluated by the frequency of epistaxis and by blood analyses. No effect of treatment could be demonstrated by means of histochemical, clinical or laboratory methods.

Function and morphology of 111-In-labelled platelets. In vitro, in vivo and ex vivo studies

111In-labelled human platelets were aggregated with ADP and subjected to ultrastructural morphometric analysis. In addition, the hemostatic function in vivo and the ultrastructural morphology ex vivo of rabbit platelets were examined. The platelet isolation and labelling procedures exerted no certain influence on the aggregation response, and platelet surface/volume calculations did not indicate that platelet activation had taken place. Bleeding time experiments in rabbits indicated that the hemostatic effectiveness of the labelled platelets was unimpaired. Transfused 111In-labelled platelets isolated from the recipient rabbits exhibited fewer electromicroscopic signs of platelet activation than the same platelets prior to transfusion. Our results indicate that the described procedure for isolation and 111In-labelling of platelets induces only insignificant damage to the platelets.

Metastases to the breast from extramammary carcinomas

Metastases to the breast from extramammary carcinomas are rare. Only about 200 cases are reported in the literature. Fifteen additional cases are presented here and the literature is reviewed. Two of the patients has primary thyroid carcinoma, two adenocarcinoma of the colon, three bronchogenic carcinoma, four malignant melanoma, one a squamous cell carcinoma of the oesophagus, one an adenocarcinoma of the stomach, one a renal cell carcinoma and one a carcinoid of the terminal ileum. In three cases the breast lesion was the first manifestation of an extramammary cancer. Six of the patients died of disseminated cancer shortly after the breast metastasis was diagnosed. Although breast metastasis may be suspected clinically, exact histological diagnosis is important in order to avoid unnecessary surgical treatment and to guide further therapy.

Xanthogranulomatous pyelonephritis. An immunohistochemical and ultrastructural study on the occurrence of bacteria and bacterial antigen

Nine kidneys with typical xanthogranulomatous pyelonephritis (XP) involvement were investigated on the occurrence of bacteria, bacterial fragments and antigen, in light microscopy using Gram staining and immunohistochemistry, and by electron microscopy. The present study did not reveal any occurrence of bacteria, bacterial fragments or antigen. It is concluded that the xanthogranulomatous reaction in man represents a resorption phenomenon, and not an immunological reaction to bacteria or bacterial antigen.

Giant cell tumor of the ovary

A 31 year old woman with primary sterility was found, at operation, to have endometriosis of the Fallopian tubes and a giant cell tumor of the ovary, histologically indistinguishable from giant cell tumor of bone. The tumor is considered to be primary and benign, with a follow-up period of 4 1/2 years and no signs of recurrence or malignancy.

Quantitative studies of the gastrin-producing cells of the human antrum. A methodological study

The antral gastrin-producing cells (G-cells) have been identified by the indirect immunoperoxidase technique in two antrum preparations removed due to a recurrent duodenal and gastric ulcer. Morphometric principles were applied to the G-cells with determination of their volume density, numerical density, and mean cell volume. The study showed that within-observer variation, between-observer variation and within-patient variation were negligible, provided at least 200 G-cells were counted. A biopsy material can be used, as well as larger tissue blocks, when this minimum sample size is respected. A method for estimating the total G-cell population and the total G-cell volume in the antrum was developed. In the antrum removed due to a gastric ulcer the number of G-cells was 190 x 10(6) and their total volume 176 mm3.

Congenital ependymoblastoma

An ependymoblastoma with widespread dissemination within the central nervous system of a stillborn, premature male infant is reported.

Xanthogranulomatous pyelonephritis

Evaluation of clinical, radiological and pathological data from 10 adult patients with xanthogranulomatous pyelonephritis has been carried out. There are no pathognomonic diagnostic features, but the majority of patients present with a previous history of recurrent urinary tract disorders. Obstruction and infection are essential pathogenetic factors, but it is suggested that immunologic factors are also play a part. The treatment is nephrectomy, as correct diagnosis cannot be established preoperatively, and as the condition is often misinterpreted as renal carcinoma. A definite diagnosis can only be obtained from pathologic examination with demonstration of the characteristic inflammatory xanthogranulomatous reaction.

Urinary bladder tumours in children. Case report of inverted papilloma

A short review is given of tumours of the urinary bladder in children, and the first case of an inverted papilloma in a child is reported. The tumour was situated in the trigone of the bladder and was successfully extirpated, with no recurrence at follow-up 9 months later. It was histologically typical of these tumours. The 105 patients described in the literature had an average age of 55 years, whereas the present case is the first to be described arising during the first two decades of life. The most frequent symptoms of such tumours are haematuria and urinary obstruction. It is suggested that the treatment of choice is transurethral excision. The term Brunnian adenoma is recommended for use with this tumour, in order to avoid the impression given by the name papilloma of the bladder, that the tumour is malignant.

Rhabdomyosarcoma of the larynx. Report of two cases and a review of the literature

The rhabdomyosarcoma is a relatively rare tumour form. Two cases in the larynx--a site which is extremely rare--are reported. So far, only 9 cases have been described and documented, and of one of our cases seems to be the first of the alveolar type found at this site. Diagnostic and differential-diagnostic considerations are discussed. Hoarseness is the commonest and earliest symptom. As stated by most authors, the treatment should be radical operation, often with laryngectomy, supplemented by irradiation and chemotherapy.

The incidence of malignant transformation in giant pigmented nevi

151 patients with benign giant pigmented nevi registered in the Danish Health system during the 60-year period 1915-75 were retrieved via the national register. A questionnaire was sent to all surviving patients asking for information about their health and especially whether they had had any treatment or had observed any changes in the nevus. All of the patients replied to the questionnaire. No patients had been cured from malignancy or were alive with known malignancy. Three patients had died from malignant melanoma during the period of observation. These case histories are reported. It is calculated that 4.6% of the patients with congenital giant nevi should be expected to develop malignant melanoma provided the incidence is the same in all age groups. Some uncertainty remains on account of the limited number of cases and an unsettled question about a higher incidence in childhood.