[Debridement combined with negative-pressure wound therapy and local flap for treating a case of stingray sting]

On January 10, 2018, a 35-year-old male patient with a 3 day stingray stinger injury in his left thigh was admitted to Xuzhou Central Hospital. At the time of admission, the patient's left thigh was red, swollen, and painful. On the day of admission, the patient underwent emergency operation in the outpatient operating room for local debridement to remove the infected and necrotic tissue. After the routine dressing change and the wound got better, surgical debridement and negative-pressure wound therapy were performed, and finally local flap was used to repair the wound. On the 14th day after the flap repair operation, the suture was removed and the patient was discharged. After half a year follow-up, the appearance of the operation area recovered well. This case suggests that the timely and correct pre-hospital treatment, thorough and timely debridement, and systemic antibiotic application are important means to reduce further injury of toxin. The local flap can achieve satisfactory result on wound healing after the wound bed is prepared by negative-pressure wound therapy.

Efficacy and Safety of Flow-Diverter Therapy for Recurrent Aneurysms after Stent-Assisted Coiling

BACKGROUND AND PURPOSE

Flow-diverter treatment for previously stented aneurysms has been reported to be less effective and prone to complications. In this study, we evaluated the effectiveness and safety of flow diverters for recurrent aneurysms after stent-assisted coiling.

MATERIALS AND METHODS

Patients who underwent flow-diverter placement for recurrent aneurysms after stent-assisted coiling between March 2015 and March 2019 were recruited. Clinical and radiographic characteristics and clinical and angiographic outcomes were retrospectively evaluated.

RESULTS

Among 133 patients who underwent flow-diverter insertion, 17 (male/female ratio = 5:12; mean age, 53.8 years) were treated for recurrent aneurysms after stent placement with (n = 16) or without (n = 1) coiling. Eight patients initially presented with subarachnoid hemorrhage; 7, with headache; and 2, with visual field defects. Angiographic morphology included large/giant saccular in 12 patients, dissecting in 2, fusiform in 1, traumatic pseudoaneurysm in 1, and ruptured blood blister-like aneurysm in 1. The duration between the first treatment and flow-diverter placement ranged from 2 weeks to 15 months (median, 6 months). Flow-diverter placement was successful in all cases without any complications. All patients had favorable outcomes (mRS, 0-2), without any newly appearing symptoms. Aneurysms were followed up with conventional angiography at least once in 6-18 months. Sixteen aneurysms showed complete occlusion, and 1 aneurysm was enlarged.

CONCLUSIONS

Results from this case series investigating flow-diverter placement for recurrent aneurysms after stent-assisted coiling suggested that the procedure is safe and effective. Further study in a larger population may be warranted.

Impacts of pre-rigor salting with KCl on technological properties of ground chicken breast

The objective of this study was to determine the impact of pre-rigor salting using KCl on the technological properties of ground chicken breast. Chicken breast muscle (M. pectoralis major and minor) was hot-debonded and salted with 2% NaCl (w/w), 1% NaCl+1% KCl mixture, or 2% KCl, respectively, within 30 min after slaughter. Post-rigor salting treatment was prepared with 2% NaCl at 24 h postmortem. All pre-rigor salting treatments showed higher ultimate pH, protein solubility, and final yield than post-rigor salting treatment (P < 0.05). However, the positive effects of pre-rigor salting on chicken breast differed by salt type. Pre-rigor salting with KCl resulted in higher ultimate pH and R-values of chicken breast than pre-rigor salting with NaCl (P < 0.05). Despite the high ultimate pH, pre-rigor salting with KCl resulted in lower protein solubility, final yield, and hardness of chicken breast than pre-rigor salting with NaCl (P < 0.05). These results indicate that pre-rigor salting with KCl could contribute to the maintenance of relatively excellent technological properties of pre-rigor chicken breasts compared to post-rigor salted chicken breast. However, this current study also suggests that the impact of KCl on technological properties in pre-rigor chicken breast, such as water-holding capacity, protein solubility, and texture, could be less effective than pre-rigor salting with NaCl at an identical percentage concentration.

Solution-Processed Organic Photodetector Using Hafnium Oxide as an Electron Blocking Layer

Organic photodetector (OPD) performance is affected significantly by leakage current. In this study, to decrease OPD leakage current, we introduced hafnium oxide as an electron blocking material, using a solution fabrication process. We fabricated an OPD consisting of ITO/HfO₂/PCHT:PC₆₀BM/Yb/Al, and measured its J-V characteristics, external quantum efficiency, and transient photocurrents. We found that the thickness of the hafnium oxide layer affected the detectivity of the prepared OPD. In particular, a device having an ultrathin hafnium oxide film (5.5 nm thick) exhibited a high on-off current ratio of up to 2.26 × 10⁵ at -1 V, which is two times higher than that of a device having a PEDOT:PSS electron blocking layer.

Serous cystic neoplasm of the pancreas: a multinational study of 2622 patients under the auspices of the International Association of Pancreatology and European Pancreatic Club (European Study Group on Cystic Tumors of the Pancreas)

OBJECTIVES

Serous cystic neoplasm (SCN) is a cystic neoplasm of the pancreas whose natural history is poorly known. The purpose of the study was to attempt to describe the natural history of SCN, including the specific mortality.

DESIGN

Retrospective multinational study including SCN diagnosed between 1990 and 2014.

RESULTS

2622 patients were included. Seventy-four per cent were women, and median age at diagnosis was 58 years (16-99). Patients presented with non-specific abdominal pain (27%), pancreaticobiliary symptoms (9%), diabetes mellitus (5%), other symptoms (4%) and/or were asymptomatic (61%). Fifty-two per cent of patients were operated on during the first year after diagnosis (median size: 40 mm (2-200)), 9% had resection beyond 1 year of follow-up (3 years (1-20), size at diagnosis: 25 mm (4-140)) and 39% had no surgery (3.6 years (1-23), 25.5 mm (1-200)). Surgical indications were (not exclusive) uncertain diagnosis (60%), symptoms (23%), size increase (12%), large size (6%) and adjacent organ compression (5%). In patients followed beyond 1 year (n=1271), size increased in 37% (growth rate: 4 mm/year), was stable in 57% and decreased in 6%. Three serous cystadenocarcinomas were recorded. Postoperative mortality was 0.6% (n=10), and SCN's related mortality was 0.1% (n=1).

CONCLUSIONS

After a 3-year follow-up, clinical relevant symptoms occurred in a very small proportion of patients and size slowly increased in less than half. Surgical treatment should be proposed only for diagnosis remaining uncertain after complete workup, significant and related symptoms or exceptionally when exists concern with malignancy. This study supports an initial conservative management in the majority of patients with SCN.

TRIAL REGISTRATION NUMBER

IRB 00006477.

Effects of soy sauce on physicochemical and textural properties of tumbled chicken breast

The objective of this study was to evaluate the effects of soy sauce on the physicochemical and textural properties of tumbled chicken breasts. Chicken breasts marinated with distilled water (Con), 4% NaCl solution, 4% NaCl and lactic acid solution (pH 4.9), and soy sauce solution (4% salt concentration and pH 4.9) were vacuum tumbled at 3°C for 60 min. The chicken breast marinated with soy sauce solution showed lower lightness and higher redness and yellowness due to the color of the soy sauce. The acidic marinades led to a decrease in pH value of tumbled chicken breast. The acidic marinades increased collagen solubility of sample compared with 4% NaCl solution, resulting in decreased shear force. Water-holding capacity, marination and cooking yields, and solubility of myofibrillar proteins were mainly affected by the presence of salt in the marinade, rather than by pH alternation. Our results suggested that soy sauce marination can improve the tenderness of tumbled chicken breast.

Effects of rigor state, thawing temperature, and processing on the physicochemical properties of frozen duck breast muscle

The objectives of this study were to evaluate effects of rigor state, thawing temperature, and processing on the physicochemical properties of intact frozen duck breast muscle and homogenates prepared with the frozen-thawed muscles. Prerigor breast muscle was frozen at -25°C and thawed at 4 and 15°C, and the physicochemical properties of duck breast frozen prerigor compared with those in frozen postrigor and 4°C chilled postrigor muscles. The homogenates prepared with duck breast frozen prerigor showed similar physicochemical properties as the frozen-thawed postrigor muscle homogenate. The thawing temperature did not affect the physicochemical properties of homogenates prepared with duck breast muscle frozen prerigor. Also, no significant differences (P > 0.05) in the ultimate pH value and color parameters were observed among the frozen-thawed treatments despite the differences in rigor state and thawing temperature. However, a higher thawing temperature of the intact frozen prerigor muscle resulted in an increase in thawing loss and shear force due to excessive muscle shortening. In this study, the intact duck breast that has undergone thaw-rigor showed main problems associated with thaw-rigor, such as higher thawing loss and shear force, regardless of thawing temperature. However, the processing (grinding and salting) decreased the difference in physicochemical properties due to rigor state before freezing and thawing temperature. Therefore, the frozen-thawed duck breast muscle used to manufacture ground-type meat product may be frozen before rigor onset.

Microemulsion polymerized polyaniline/montmorillonite nanocomposite and its electrorheology

Conducting polyaniline (PANI) and inorganic Na+-Montmorillonite (Na+-MMT) nanocomposite material was prepared via a microemulsion polymerization method. To observe the morphology of the as-synthesized PANI/Na+-MMT nanocomposite, SEM images were employed. D-spacing of the PANI/Na+-MMT nanocomposite obtained from the XRD was found to become wider than that of pure Na+-MMT particles due to the successful intercalation of PANI into Na+-MMT layers. The fabricated PANI/Na+-MMT nanocomposite based electrorheological (ER) fluid was prepared by dispersing the particles in insulating silicone oil. Dynamic mechanical properties of the ER fluid were investigated via an oscillatory testing method using a vertical oscillation rheometer under an applied electric field, showing typical ER behavior.

Gastrin stabilises beta-catenin protein in mouse colorectal cancer cells

As gastrin may play a role in the pathophysiology of gastrointestinal (GI) malignancies, the elucidation of the mechanisms governing gastrin-induced proliferation has recently gained considerable interest. Several studies have reported that a large percentage of colorectal tumours overexpress or stabilise the β-catenin oncoprotein. We thus sought to determine whether gastrin might regulate β-catenin expression in colorectal tumour cells. Amidated gastrin-17 (G-17), one of the major circulating forms of gastrin, not only enhanced β-catenin protein expression, but also one of its target genes, cyclin D1. Furthermore, activation of β-catenin-dependent transcription by gastrin was confirmed by an increase in LEF-1 reporter activity, as well as enhanced cyclin D1 promoter activity. Finally, G-17 prolonged the τ_1/2 of β-catenin protein, demonstrating that gastrin appears to exert its mitogenic effects on colorectal tumour cells, at least in part, by stabilising β-catenin.

COX-2 selective inhibition reverses the trophic properties of gastrin in colorectal cancer

Gastrin is a gastrointestinal peptide that possesses potent trophic properties on both normal and neoplastic cells of gastrointestinal origin. Previous studies have indicated that chronic hypergastrinaemia increases the risk of colorectal cancer and cancer growth and that interruption of the effects of gastrin could be a potential target in the treatment of colorectal cancer. Here we demonstrate that gastrin leads to a dose-dependent increase in colon cancer cell proliferation and tumour growth in vitro and in vivo, and that this increment is progressively reversed by pretreatment with the cyclo-oxygenase-2 inhibitor NS-398. Gastrin was able to induce cyclo-oxygenase-2 protein expression, as well as the synthesis of prostaglandin E2, the major product of cyclo-oxygenase. Moreover, gastrin leads to approximately a two-fold induction of cyclo-oxygenase-2 promoter activity in transiently transfected cells. The results of these studies demonstrate that cyclo-oxygenase-2 appears to represent one of the downstream targets of gastrin and that selective cyclo-oxygenase-2 inhibition is capable of reversing the trophic properties of gastrin and presumably might prevent the growth of colorectal cancer induced by hypergastrinaemia.

Vinorelbine-associated myelopathy in a patient who previously received paclitaxel: a case report

Vinorelbine seems to cause less neurotoxicity than other vinca alkaloids because of its selective activity on mitotic cells over axonal microtubules. Clinical trials report very mild peripheral neurotoxicity with distal paresthesiae and there are no reports of myelopathy in these series of patients. The authors describe a patient who developed a rare event of myelopathy while on vinorelbine for non-small-cell lung cancer.

Protein kinase CK2: signaling and tumorigenesis in the mammary gland

Breast cancer is a major cause of cancer death in women, and the genetic abnormalities leading to the common sporadic forms of the disease are still under active investigation. CK2 has been reported to be upregulated in human breast cancer, which these studies confirm; CK2 is also upregulated in rat carcinogen-induced breast tumors. Transgenic mice overexpressing CK2alpha in the mammary gland develop mammary hyperplasia, dysplasia, and eventually adenocarcinomas, demonstrating that dysregulated expression of CK2 can contribute to transformation of the mammary epithelium. These mammary tumors have evidence of activation of the Wnt and NFkappaB pathways and upregulation of c-Myc. CK2 is capable of phosphorylating the key signaling molecule in the Wnt pathway, the transcriptional cofactor beta-catenin, and regulating its turnover. CK2 is known to phosphorylate IkappaB and thereby regulate basal NFkappaB levels; in the mammary cell lines and tumors, CK2 activity correlates with NFkappaB levels and inhibition of CK2 downregulates NFkappaB. Thus, CK2 may promote breast cancer through dysregulation of key pathways of transcriptional control in the mammary epithelium, and inhibition of CK2 has a potential role in the treatment of breast and other cancers.

Protein kinase CK2 in mammary gland tumorigenesis

Protein kinase CK2 is a ubiquitous and evolutionarily conserved serine/threonine kinase that is upregulated in many human cancers and can serve as an oncogene in lymphocytes. Recently, we have demonstrated that CK2 potentiates Wnt/beta-catenin signaling in mammary epithelial cells. To determine whether CK2 overexpression contributes to mammary tumorigenesis, we have performed comparative studies of human and rat breast cancer specimens and we have engineered transgenic mice with dysregulated expression of CK2alpha in the mammary gland. We find that CK2 is highly expressed in human breast tumor specimens and in carcinogen-induced rat mammary tumors. Overexpression of CK2alpha in the mammary gland of transgenic mice, under control of the MMTV-LTR, causes hyperplasia and dysplasia of the female mammary gland. Thirty per cent of the female MMTV-CK2alpha transgenic mice develop mammary adenocarcinomas at a median of 23 months of age, often associated with Wnt pathway activation, as evidenced by upregulation of beta-catenin protein. NF-kappaB activation and upregulation of c-Myc also occur frequently. Thus, in mice, rats, and humans, dysregulated expression of CK2 is associated with and is capable of contributing to mammary tumorigenesis. Targeted inhibition of CK2 could be useful in the treatment of breast cancer.

The clinical significance of upper gastrointestinal endoscopy in gastrointestinal vasculitis related to scrub typhus

BACKGROUND AND STUDY AIMS

Scrub typhus is an acute febrile illness caused by Rickettsia tsutsugamushi-induced vasculitis, which is common in Asia and the Pacific islands and is sometimes encountered in Western countries because of increased travel and economic changes spurred by world globalization. Skin rash and eschar are typical physical findings on the trunk and extremities, but endoscopic mucosal changes have not been described in the gastrointestinal tract until now. We aimed to describe different endoscopic characteristics of the gastrointestinal manifestation of scrub typhus, to ascertain the necessity for endoscopy, and to determine correlations between the degrees of endoscopic lesion and clinical severity, including cutaneous manifestation.

PATIENTS AND METHODS

Between January 1993 and October 1998, out of 256 scrub typhus patients, we applied esophagogastroduodenoscopy to 58 patients who complained of gastrointestinal symptoms but had no past history of these symptoms. We categorized clinical severity into four grades according to the degree of six clinical indicators of systemic complications, and endoscopic findings were graded from I to IV (I, normal, nonspecific hyperemia; II, distinct hyperemia, petechiae, purpura; II, superficial hemorrhage, erosion; IV, ulcer, active bleeding).

RESULTS

Endoscopic findings of scrub typhus were characterized by petechiae, superficial hemorrhage, erosion, ulcers, and vascular bleeding (grade I, 14 patients; grade II, 11 patients; grade III, 16 patients; grade IV, 17 patients). In 83.3% of patients there was multiple occurrence of lesions without any predilection sites. Clinical severity was graded (grade I, 7 patients; grade II, 23 patients; grade III, 22 patients; grade IV, 6 patients). There was a correlation between clinical severity and endoscopic findings (P < 0.01). The grade of lesion was high in patients with cutaneous lesions (r(s) 0.359, P < 0.01). In two cases of gastric vascular bleeding, complete hemostasis was achieved by endoscopic hemoclipping.

CONCLUSIONS

The major endoscopic features that can develop in scrub typhus are superficial mucosal hemorrhage, multiple erosions and ulcers without any predilection sites, and unusual vascular bleeding. The endoscopic features are related to cutaneous lesions and severity of the disease. Endoscopy is useful for diagnosis and management of gastrointestinal vasculitis related to scrub typhus.

Endogenous protein kinase CK2 participates in Wnt signaling in mammary epithelial cells

Protein kinase CK2 (formerly casein kinase II) is a serine/threonine kinase overexpressed in many human tumors, transformed cell lines, and rapidly proliferating tissues. Recent data have shown that many cancers involve inappropriate reactivation of Wnt signaling through ectopic expression of Wnts themselves, as has been seen in a number of human breast cancers, or through mutation of intermediates in the Wnt pathway, such as adenomatous polyposis coli or beta-catenin, as described in colon and other cancers. Wnts are secreted factors that are important in embryonic development, but overexpression of certain Wnts, such as Wnt-1, leads to proliferation and transformation of cells. We report that upon stable transfection of Wnt-1 into the mouse mammary epithelial cell line C57MG, morphological changes and increased proliferation are accompanied by increased levels of CK2, as well as of beta-catenin. CK2 and beta-catenin co-precipitate with the Dvl proteins, which are Wnt signaling intermediates. A major phosphoprotein of the size of beta-catenin appears in in vitro kinase reactions performed on the Dvl immunoprecipitates. In vitro translated beta-catenin, Dvl-2, and Dvl-3 are phosphorylated by CK2. The selective CK2 inhibitor apigenin blocks proliferation of Wnt-1-transfected cells, abrogates phosphorylation of beta-catenin, and reduces beta-catenin and Dvl protein levels. These results demonstrate that endogenous CK2 is a positive regulator of Wnt signaling and growth of mammary epithelial cells.

[18F]fluoromethylbenzylsulfonate ester: a rapid and efficient synthetic method for the N-[18F]fluoromethylbenzylation of amides and amines

We have prepared 4-[18F]fluoromethylbenzylsulfonate esters as fluoromethylbenzylating agents. These agents are readily prepared by an [18F]fluoride ion displacement of the corresponding bissulfonate esters. The application of these 4-[18F]fluoromethylbenzylsulfonate esters to N-alkylation reaction of spiperone and 1-phenylpiperazine shows that the products 3-N-(4-[18F]fluoromethylbenzyl)spiperone and 1-N-(4-[18F]fluoromethylbenzyl)-4-phenylpiperazine are rapidly produced with high radiochemical yields under a no-carrier-added condition.

An open clinical trial of fluoxetine in the treatment of premature ejaculation

There have been an increased number of recent reports on orgasm-related sexual dysfunction coincident with selective serotonin reuptake inhibitor (SSRI) treatment. In contrast, it has also been reported that SSRIs improve sexual dysfunction. Low doses of clomipramine and paroxetine, potent 5-hydroxytryptamine reuptake blockers, have been found to retard ejaculation time. We hypothesized that the SSRI fluoxetine might be effective in treating premature ejaculation. In an 8-week open-label clinical study, 11 male patients with premature ejaculation were treated with fluoxetine. After a washout period of 2 weeks, each patient was assigned to receive fluoxetine, 20 mg/day for 2 weeks, and then titrated to 60 mg/day, depending on the patient's tolerability and clinical response. A within-subjects comparison of pre- and posttreatment intravaginal ejaculation latency time revealed a significant improvement. Fluoxetine treatment produced significant improvements in self-visual analogue scale scores for sexual desire, anxiety for rapid ejaculation, and partner's satisfaction with ejaculation and overall sexual function. These data suggest that serotonergic antidepressants may be effective in treating rapid ejaculation in men and underline the need to carry out a double-blind, placebo-controlled trial to confirm these results.

Gang warfare: the medical repercussions

Gang related violence in Los Angeles County has increased, with homicides increasing from 205 in 1982 to 803 in 1992. This study examines the medical and financial consequences of such violence on a level I trauma center. Of 856 gunshot injuries over a 29-month period, 272 were gang related. There were 55 pediatric and 217 adult patients. Eighty-nine percent were male and 11% were female. Trauma Score averaged 14.7 +/- 3.1, Glasgow Coma Scale average score was 13.7 +/- 3.4, and the mean Injury Severity Score was 10.8 +/- 14. Twenty-two percent of the gunshots were to the head and neck, 20% to the chest, 20% to the abdomen, 6% had a peripheral vascular injury, and 33% sustained an extremity musculoskeletal injury. Emergency surgery was performed on 43%, including laparotomy 58 (49%), craniotomy 16 (13%), laparoscopy 14 (12%), vascular procedures 10 (8%), orthopedic procedures 6 (5%), head and neck endoscopies 4 (3%), thoracotomies 2 (2%), and 10 (8%) unspecified. There were 25 deaths (9%), primarily caused by head injuries and exsanguinating hemorrhage. Eighty-six percent entered the hospital during the hours of minimal staffing that preempted the use of facilities for other emergent patients. Charges totaled $4,828,828 (emergency room, surgical procedures, intensive care, and surgical ward stay) which equated to $5,550 per patient per day. Fifty-eight percent had no third party reimbursement, 22% had Medi-Cal, and 20% had medical insurance. Because of dismal reimbursement rates, the costs of gang violence are passed on to the tax payer. The cost of gang related violence cannot be derived from hospital charges only, because death, disability, and pain are not entered into the calculation. Education, increased social programs, and strict criminal justice laws and enforcement may decrease gang related violence and the drain it has on financial and medical resources.

Cyproheptadine augmentation of haloperidol in chronic schizophrenic patients: a double-blind placebo-controlled study

A 6 week double-blind placebo-controlled trial of cyproheptadine augmentation of ongoing haloperidol treatment was conducted in 40 chronic schizophrenic in-patients. Cyproheptadine augmentation, compared to administration of haloperidol with placebo, did not produce a statistically significant improvement in psychotic symptoms. Cyproheptadine augmentation caused significant reduction in the extrapyramidal symptoms, which supports the atypical profile of antipsychotics. As to the neuroendocrinological effect, cyproheptadine augmentation did not reduce the plasma prolactin level but did induce a decrease in the plasma cortisol level. Although long-term follow-up studies are needed to confirm the results, this study suggests that cyproheptadine augmentation may be effective in treating chronic schizophrenic patients who are intolerant of extrapyramidal side effects of conventional antipsychotics.

Idiopathic calcinosis of the scrotum: histopathologic observations of fifty-one nodules

A 29-year-old man had a 2-year history of multiple, asymptomatic, firm, subcutaneous nodules on the scrotal skin, which sometimes discharged a chalky material. Fifty-one nodules were observed in the histopathologic examination, which revealed, in addition to the typical findings of idiopathic calcinosis of the scrotum, various forms of intact cysts: epidermal (some calcified), pilar (calcified), hybrid (calcified), and indeterminate cysts with diffusely calcified keratinous content and attenuated walls. A mixture of calcified keratinous material and inflammatory infiltrates was detected, with or without remnants of the cyst wall. These findings suggest that idiopathic calcinosis of the scrotum derives from the dystrophic calcification of cysts.

Detection of circulating antibodies to purified keratinolytic proteinase in sera from guinea pigs infected with Microsporum canis by enzyme-linked immunosorbent assay

A keratinolytic proteinase (KPase) which is regarded as an important factor in the pathogenesis of dermatophytosis was isolated and purified from Microsporum (M.) canis culture filtrates. Enzyme-linked immunosorbent assay (ELISA) was used to determine the occurrence of circulating antibodies to this enzyme in sera samples from guinea pigs with superficial fungal infections caused by M. canis. Of sera samples from guinea pigs infected with M. canis, 75% were reactive within 10 weeks, however, those ELISA values were relatively low compared with those from guinea pigs immunized with KPase. The presence of circulating antibodies was first detected 2 weeks post inoculation with M. canis, corresponding to the period when the lesions were most severe. The titers of the ELISA antibodies reached a peak at 4 weeks; at that time the lesions had disappeared completely.