Newly diagnosed cirrhosis secondary to gastrointestinal bleed due to portal hypertensive colopathy

Portal hypertensive colopathy (PHC) is a colonic phenomenon commonly causing chronic gastrointestinal bleeding or less commonly a life-threatening acute colonic hemorrhage. An otherwise well, 58-year-old female presents general surgeons a diagnostic dilemma for symptomatic anemia. An interesting case where the rare and elusive PHC was diagnosed on colonoscopy, which led to the diagnosis of liver cirrhosis without evidence of oesophageal varices. Although PHC is most common in patients with cirrhosis, it is likely still underdiagnosed, given the current stepwise treatment approach of these cirrhotic patients often leads to treatment of the PHC alongside PHG without establishing a diagnosis. Instead, this case presents a generalised approach to patients with underlying portal and sinusoidal hypertension due to a variety of causes, and the endoscopic and radiological findings, which lead to their successful diagnosis and medical management of the gastrointestinal bleeding.

Testicular ischemia as a result of an incarcerated inguinal hernia containing omentum: a two-case series

Acute scrotal pain is a very common presentation to the emergency room. The most important pathology we must exclude is testicular infarction or testicular ischemia. Here we describe two rare cases of acute scrotum where incarcerated inguinal hernias containing omentum resulted in testicular ischemia/infarction. In Case 1, we describe a rare case in an adult where a large, incarcerated hernia containing omentum along with direct trauma to the testicle resulted in testicular infarction. In Case 2, we describe a 2-year-old boy who presented with left scrotal tenderness due to a left inguinal hernia containing omentum resulting in compromised testicular blood flow. Both patients underwent scrotal exploration. This article also explores the possible pathophysiology of how omentum containing hernias may result in an increased risk of testicular ischemia.

A case of spontaneous idiopathic tension pneumoperitoneum successfully managed with bedside pig-tail catheter

We present a 67-year-old gentleman with a high perioperative mortality and morbidity risk who presented with spontaneous idiopathic tension pneumoperitoneum that was successfully managed with bedside pig-tail catheter insertion. Here we also discuss other potential non-surgical aetiologies of pneumoperitoneum.

Combined flow cytometry and high-throughput image analysis for the study of essential genes in Caenorhabditis elegans

Background

Advances in automated image-based microscopy platforms coupled with high-throughput liquid workflows have facilitated the design of large-scale screens utilising multicellular model organisms such as Caenorhabditis elegans to identify genetic interactions, therapeutic drugs or disease modifiers. However, the analysis of essential genes has lagged behind because lethal or sterile mutations pose a bottleneck for high-throughput approaches, and a systematic way to analyse genetic interactions of essential genes in multicellular organisms has been lacking.

Results

In C. elegans, non-conditional lethal mutations can be maintained in heterozygosity using chromosome balancers, commonly expressing green fluorescent protein (GFP) in the pharynx. However, gene expression or function is typically monitored by the use of fluorescent reporters marked with the same fluorophore, presenting a challenge to sort worm populations of interest, particularly at early larval stages. Here, we develop a sorting strategy capable of selecting homozygous mutants carrying a GFP stress reporter from GFP-balanced animals at the second larval stage. Because sorting is not completely error-free, we develop an automated high-throughput image analysis protocol that identifies and discards animals carrying the chromosome balancer. We demonstrate the experimental usefulness of combining sorting of homozygous lethal mutants and automated image analysis in a functional genomic RNA interference (RNAi) screen for genes that genetically interact with mitochondrial prohibitin (PHB). Lack of PHB results in embryonic lethality, while homozygous PHB deletion mutants develop into sterile adults due to maternal contribution and strongly induce the mitochondrial unfolded protein response (UPR^mt). In a chromosome-wide RNAi screen for C. elegans genes having human orthologues, we uncover both known and new PHB genetic interactors affecting the UPR^mt and growth.

Conclusions

The method presented here allows the study of balanced lethal mutations in a high-throughput manner. It can be easily adapted depending on the user’s requirements and should serve as a useful resource for the C. elegans community for probing new biological aspects of essential nematode genes as well as the generation of more comprehensive genetic networks.

Electronic supplementary material

The online version of this article (10.1186/s12915-018-0496-5) contains supplementary material, which is available to authorized users.

Einflußnahme von Rontgenkontrastmitteln auf Schilddrüsenhormonparameter als Soforteffekt

Untersuchungen einer Reihe von Funktionsparametern der Schilddru-senhormone direkt im Anschluß nach Gabe verschiedener Kontrastmittel ergaben insbesondere nach Applikation von Biliscopin®, das als gallegängiges Kontrastmittel eine starke Eiweißbindung aufweist, signifikante Anstiege der freien Schilddrüsenhor-monfraktionen, eine signifikante Zunahme der Bindungskapazität der spezifischen Transportproteine und eine Abnahme der Gesamtschilddrüsen-hormonkonzentration. Die letztgenannte Änderung dürfte Folge eines Dilutionseffektes sein, während die Anstiege des FT3 und des FT4 im Serum moglicherweise durch eine Änderung der Bindungsaffinität der Zell-membranrezeptoren fur Schilddrüsen-hormone erklärt werden können. Daher sollte Blut zur Bestimmung von thyreoidalen Funktionsparametern weder in der Frühphase, innerhalb von einer Stunde, noch in der Spät-phase, innerhalb von 10 Tagen nach Gabe von Kontrastmittel entnommen werden, da andernfalls Fehlinterpretationen der erhaltenen Ergebnisse zu befiirchten sind.

Floral colours in a world without birds and bees: the plants of Macquarie Island

We studied biotically pollinated angiosperms on Macquarie Island, a remote site in the Southern Ocean with a predominately or exclusively dipteran pollinator fauna, in an effort to understand how flower colour affects community assembly. We compared a distinctive group of cream-green Macquarie Island flowers to the flora of likely source pools of immigrants and to a continental flora from a high latitude in the northern hemisphere. We used both dipteran and hymenopteran colour models and phylogenetically informed analyses to explore the chromatic component of community assembly. The species with cream-green flowers are very restricted in colour space models of both fly vision and bee vision and represent a distinct group that plays a very minor role in other communities. It is unlikely that such a community could form through random immigration from continental source pools. Our findings suggest that fly pollination has imposed a strong ecological filter on Macquarie Island, favouring floral colours that are rare in continental floras. This is one of the strongest demonstrations that plant-pollinator interactions play an important role in plant community assembly. Future work exploring colour choices by dipteran flower visitors would be valuable.

Radiosensitization by BRAF inhibitor therapy-mechanism and frequency of toxicity in melanoma patients

BACKGROUND

Recent evidence suggests that ionizing radiation may be associated with unexpected side-effects in melanoma patients treated with concomitant BRAF inhibitors. A large multicenter analysis was carried out to generate reliable safety data and elucidate the mechanism.

METHODS

A total of 161 melanoma patients from 11 European skin cancer centers were evaluated for acute and late toxicity, of whom 70 consecutive patients received 86 series of radiotherapy with concomitant BRAF inhibitor therapy. To further characterize and quantify a possible radiosensitization by BRAF inhibitors, blood samples of 35 melanoma patients were used for individual radiosensitivity testing by fluorescence in situ hybridization of chromosomal breaks after ex vivo irradiation.

RESULTS

With radiotherapy and concomitant BRAF inhibitor therapy the rate of acute radiodermatitis ≥2° was 36% and follicular cystic proliferation was seen in 13% of all radiotherapies. Non-skin toxicities included hearing disorders (4%) and dysphagia (2%). Following whole-brain radiotherapy, rates of radiodermatitis ≥2° were 44% and 8% (P < 0.001) for patients with and without BRAF inhibitor therapy, respectively. Concomitant treatment with vemurafenib induced acute radiodermatitis ≥2° more frequently than treatment with dabrafenib (40% versus 26%, P = 0.07). In line with these findings, analysis of chromosomal breaks ex vivo indicated significantly increased radiosensitivity for patients under vemurafenib (P = 0.004) and for patients switched from vemurafenib to dabrafenib (P = 0.002), but not for patients on dabrafenib only. No toxicities were reported after stereotactic treatment.

CONCLUSION

Radiotherapy with concomitant BRAF inhibitor therapy is feasible with an acceptable increase in toxicity. Vemurafenib is a more potent radiosensitizer than dabrafenib.

Prohibitin-mediated lifespan and mitochondrial stress implicate SGK-1, insulin/IGF and mTORC2 in C. elegans

Lifespan regulation by mitochondrial proteins has been well described, however, the mechanism of this regulation is not fully understood. Amongst the mitochondrial proteins profoundly affecting ageing are prohibitins (PHB-1 and PHB-2). Paradoxically, in C. elegans prohibitin depletion shortens the lifespan of wild type animals while dramatically extending that of metabolically compromised animals, such as daf-2-insulin-receptor mutants. Here we show that amongst the three kinases known to act downstream of daf-2, only loss of function of sgk-1 recapitulates the ageing phenotype observed in daf-2 mutants upon prohibitin depletion. Interestingly, signalling through SGK-1 receives input from an additional pathway, parallel to DAF-2, for the prohibitin-mediated lifespan phenotype. We investigated the effect of prohibitin depletion on the mitochondrial unfolded protein response (UPRmt). Remarkably, the lifespan extension upon prohibitin elimination, of both daf-2 and sgk-1 mutants, is accompanied by suppression of the UPRmt induced by lack of prohibitin. On the contrary, gain of function of SGK-1 results in further shortening of lifespan and a further increase of the UPRmt in prohibitin depleted animals. Moreover, SGK-1 interacts with RICT-1 for the regulation of the UPRmt in a parallel pathway to DAF-2. Interestingly, prohibitin depletion in rict-1 loss of function mutant animals also causes lifespan extension. Finally, we reveal an unprecedented role for mTORC2-SGK-1 in the regulation of mitochodrial homeostasis. Together, these results give further insight into the mechanism of lifespan regulation by mitochondrial function and reveal a cross-talk of mitochondria with two key pathways, Insulin/IGF and mTORC2, for the regulation of ageing and stress response.

PDR-1/hParkin negatively regulates the phagocytosis of apoptotic cell corpses in Caenorhabditis elegans

Apoptotic cell death is an integral part of cell turnover in many tissues, and proper corpse clearance is vital to maintaining tissue homeostasis in all multicellular organisms. Even in tissues with high cellular turnover, apoptotic cells are rarely seen because of efficient clearance mechanisms in healthy individuals. In Caenorhabditis elegans, two parallel and partly redundant conserved pathways act in cell corpse engulfment. The pathway for cytoskeletal rearrangement requires the small GTPase CED-10 Rac1 acting for an efficient surround of the dead cell. The CED-10 Rac pathway is also required for the proper migration of the distal tip cells (DTCs) during the development of the C. elegans gonad. Parkin, the mammalian homolog of the C. elegans PDR-1, interacts with Rac1 in aged human brain and it is also implicated with actin dynamics and cytoskeletal rearrangements in Parkinsons's disease, suggesting that it might act on engulfment. Our genetic and biochemical studies indicate that PDR-1 inhibits apoptotic cell engulfment and DTC migration by ubiquitylating CED-10 for degradation.

An etiologic profile of anemia in 405 geriatric patients

Background. Anemia is a common condition in the elderly and a significant risk factor for increased morbidity and mortality, reducing not only functional capacity and mobility but also quality of life. Currently, few data are available regarding anemia in hospitalized geriatric patients. Our retrospective study investigated epidemiology and causes of anemia in 405 hospitalized geriatric patients. Methods. Data analysis was performed using laboratory parameters determined during routine hospital admission procedures (hemoglobin, ferritin, transferrin saturation, C-reactive protein, vitamin B12, folic acid, and creatinine) in addition to medical history and demographics. Results. Anemia affected approximately two-thirds of subjects. Of 386 patients with recorded hemoglobin values, 66.3% were anemic according to WHO criteria, mostly (85.1%) in a mild form. Anemia was primarily due to iron deficiency (65%), frequently due to underlying chronic infection (62.1%), or of mixed etiology involving a combination of chronic disease and iron deficiency, with absolute iron deficiency playing a comparatively minor role. Conclusion. Greater awareness of anemia in the elderly is warranted due to its high prevalence and negative effect on outcomes, hospitalization duration, and mortality. Geriatric patients should be routinely screened for anemia and etiological causes of anemia individually assessed to allow timely initiation of appropriate therapy.

Ligation of intersphincteric fistula tract compared with advancement flap for complex anorectal fistulas requiring initial seton drainage

BACKGROUND

The ligation of intersphincteric fistula tract (LIFT) is a relatively new surgical technique for treating complex anorectal fistulas.

METHODS

LIFT was compared with anorectal advancement flap management (ARAF) of complex anorectal fistulas requiring previous seton drainage. Crohn's patients were excluded. Patients with no confirmed recurrent sepsis after 6 months were randomized to day surgery performance of LIFT (25; 17 male) or ARAF (14; 10 male) with removal of the seton. Outcome measures included recurrences, surgical time, complications, hospital readmissions, and fecal incontinence.

RESULTS

LIFT was 32.5 minutes shorter than ARAF (P < .001). Complications were similar, with no hospital readmissions. Return to normal activities was 1 week for LIFT patients, 2 weeks for ARAF patients (P = .016). At 19 months there were 3 recurrences (2 in the LIFT group). One ARAF patient had minor incontinence.

CONCLUSIONS

The LIFT procedure was simple, safe, shorter, and patients returned to work earlier. All patients had preliminary seton drainage, possibly contributing to the low recurrence rates.

[Solitary extramedullary plasmocytoma of the conjunctiva]

There is a wide variety of conjunctival tumors. A good diagnosis can be reached by discussing the case history with the patient in conjunction with a slit-lamp examination. Presented here is the case of a 39-year-old patient with a rapidly growing conjunctival tumor on his left eye. After tumor resection and histological analysis, a plasmacytoma was found. The completed hemato-oncological analysis gave no further suspicious pathological results, leading to the diagnosis of a solitary extramedullary plasmacytoma. Percutaneous radiotherapy was carried out.

Location and type of mutation in the LIS1 gene do not predict phenotypic severity

BACKGROUND

Lissencephaly is a neuronal migration disorder leading to absent or reduced gyration and a broadened but poorly organized cortex. The most common form of lissencephaly is isolated, referred as classic or type 1 lissencephaly. Type 1 lissencephaly is mostly associated with a heterozygous deletion of the entire LIS1 gene, whereas intragenic heterozygous LIS1 mutations or hemizygous DCX mutations in males are less common.

METHODS

Eighteen unrelated patients with type 1 lissencephaly were clinically and genetically assessed. In addition, patients with subcortical band heterotopia (n = 1) or lissencephaly with cerebellar hypoplasia (n = 2) were included.

RESULTS

Fourteen new and seven previously described LIS1 mutations were identified. We observed nine truncating mutations (nonsense, n = 2; frameshift, n = 7), six splice site mutations, five missense mutations, and one in-frame deletion. Somatic mosaicism was assumed in three patients with partial subcortical band heterotopia in the occipital-parietal lobes or mild pachygyria. We report three mutations in exon 11, including a frameshift which extends the LIS1 protein, leading to type 1 lissencephaly and illustrating the functional importance of the WD domains at the C terminus. Furthermore, we present two patients with novel LIS1 mutations in exon 10 associated with lissencephaly with cerebellar hypoplasia type a.

CONCLUSION

In contrast to previous reports, our data suggest that neither type nor position of intragenic mutations in the LIS1 gene allows an unambiguous prediction of the phenotypic severity. Furthermore, patients presenting with mild cerebral malformations such as subcortical band heterotopia or cerebellar hypoplasia should be considered for genetic analysis of the LIS1 gene.

Relationship quality in agri-food chains: Supplier management in the German pork and dairy sector

In this paper we develop a measurement scale for relationship quality in procurement which provides a management tool for agribusiness companies to evaluate their supply chain basis. In agribusiness, processors are often confronted with thousands of small farmer-suppliers. According to findings from several research streams, we argue that relationship quality must be conceptualised as a construct comprising satisfaction, trust, and commitment. We test our model for the German dairy and pork chains, thereby providing new insights into the critical success factors of initiating and maintaining relationships with agricultural suppliers. Relationship quality is determined by a number of factors. Though there are differences between the industries in question, we find some parallels in the factors explaining relationship quality. It is surprising that farmer orientation of the processor and perception of management competence by the farmer are more important than price satisfaction. Thus, understanding farmers' problems as well as better communication with the supplier are more relevant than the perceived price. Moreover, the data show that relationship quality affects willingness to co-operate more closely with the processor. Buyer-switching-behaviour can be reduced significantly. From these findings we draw some advice for processors to improve collaboration by means of supplier relationship management.

Chromosom-1q-Syndrom und Innenohrschwerhörigkeit: ein ungewöhnlicher Fall

INTRODUCTION

The interstitial deletion of chromosome 1q is a disease of rare incidence, which might be hereditary or caused by spontaneous changes within the chromosome respectively. The phenotype in most cases is based on the loss of macrochromosomal material within the long arm of chromosome 1. The characteristics of this syndrome include pre- and postnatal growth retardation, severe psychomotor retardation, microbrachycephaly, sparse fine scalp hair and eyebrows, deformity of skull with cleft of lips and palate, scoliosis, small hands and feet hernias, genital defects, clinodactyly of the fifth fingers and campylodactyly. Other morphological characteristics that have been reported are mainly kidney and cardiac abnormalities. The number of symptoms are related to the loss of genetic material. To our knowledge this is the first description of a patient with interstitial deletion of chromosome 1 (q23-q31).

PATIENT

We report an eleven year old boy with interstitial deletion of chromosome 1(q23-q31). In addition to the known skeletal, orofacial disorders, hypothrophia and retardation we discovered a unilateral high-graded and contralateral middle-graded hearing loss.

CONCLUSION

In infants with chromosome 1q syndrome adequate diagnostic procedures have to be employed to unveil sensineural hearing losses that might be overseen because of mental retardation. In particular a brainstem electric response audiometry should be considered for early diagnosis and treatment of a possible hearing-loss.

Piperacillin/tazobactam vs ceftazidime in the treatment of neutropenic fever in patients with acute leukemia or following autologous peripheral blood stem cell transplantation: a prospective randomized trial

Piperacillin/tazobactam was compared with ceftazidime for the empirical treatment of febrile neutropenia in patients with acute leukemia or following autologous peripheral blood stem cell transplantation. Owing to inclusion criteria, it was possible for the same patient to be randomized several times. A total of 219 individual patients were admitted to a prospective randomized clinical study: 24 patients were included twice. Patients (23.5%) remained afebrile. Patients who developed febrile neutropenia were randomized to receive intravenous ceftazidime (n = 74 patients, group I) or piperacillin/tazobactam (n = 87 patients, group II). Response to first-line antibiotic treatment was seen in 55% (group I) and 53% (group II). After the addition of vancomycin, a further 19% (group I) and 24% (group II) of the patients became afebrile. Causes of fever were: microbiologically documented infection in 36 and 34 patients of group I and II; Clostridium difficile in eight and 12 patients of group I and II, and fever of unknown origin in 30 and 41 patients of group I and II. One patient died in each group. Single-agent therapy with piperacillin/tazobactam is as effective as ceftazidime in the treatment of neutropenic fever and is well tolerated. Direct and indirect costs of both treatment regimes are equivalent.