Case report: Retroperitoneal bronchogenic cyst as a diagnostic dilemma after colon cancer diagnosis.

A 52 year-old obese male presented with a moderately differentiated adenocarcinoma of the sigmoid colon. On staging CT, the patient was found to have a cystic lesion in the left retroperitoneum.

A new highly penetrant form of obesity due to deletions on chromosome 16p11.2.

Obesity has become a major worldwide challenge to public health, owing to an interaction between the Western 'obesogenic' environment and a strong genetic contribution. Recent extensive genome-wide association studies (GWASs) have identified numerous single nucleotide polymorphisms associated with obesity, but these loci together account for only a small fraction of the known heritable component. Thus, the 'common disease, common variant' hypothesis is increasingly coming under challenge. Here we report a highly penetrant form of obesity, initially observed in 31 subjects who were heterozygous for deletions of at least 593 kilobases at 16p11.2 and whose ascertainment included cognitive deficits. Nineteen similar deletions were identified from GWAS data in 16,053 individuals from eight European cohorts. These deletions were absent from healthy non-obese controls and accounted for 0.7% of our morbid obesity cases (body mass index (BMI) >or= 40 kg m(-2) or BMI standard deviation score >or= 4; P = 6.4 x 10(-8), odds ratio 43.0), demonstrating the potential importance in common disease of rare variants with strong effects. This highlights a promising strategy for identifying missing heritability in obesity and other complex traits: cohorts with extreme phenotypes are likely to be enriched for rare variants, thereby improving power for their discovery. Subsequent analysis of the loci so identified may well reveal additional rare variants that further contribute to the missing heritability, as recently reported for SIM1 (ref. 3). The most productive approach may therefore be to combine the 'power of the extreme' in small, well-phenotyped cohorts, with targeted follow-up in case-control and population cohorts.

Water demand profile before and during COVID-19 pandemic in a Brazilian social housing complex.

The COVID-19 pandemic has changed the way resources are consumed around the world. The relationship between the pandemic and water consumption has important implications for the management of water use and must be evaluated in depth. The main goal of this research paper is to establish a comparison between pre-pandemic and pandemic water consumption profiles for 14 social-housing buildings located in Joinville, Southern Brazil. Telemetry data from each apartment were collected on an hourly basis before and during the COVID-19 pandemic. The analysis was based on descriptive statistics on the hourly and daily water consumption in addition to its profile plots. The best probability distribution fitting was also determined. To assess the differences in water consumption due to de pandemic, the Wilcoxon-Mann-Whitney test was employed and a Generalized Linear Model with mixed effects was fitted to the data. The Lognormal distribution was shown to be the most appropriate to model the water consumption data. Due to the COVID-19 pandemic, the two daily peak consumption periods changed from 12 h to 15 h and from 19 h to 21 h. The COVID-19 pandemic also impacted daily water consumption, leading to a small, yet significant, increase in demand in the first quarter of the pandemic period.

Adjustment of Anti-Hyperglycaemic Agents During Bowel Preparation for Colonoscopy in Patients with Diabetes.

OBJECTIVE: Due to the growing diabetes pandemic, the number of colonoscopies performed in patients with diabetes is steadily rising. However, recommendations on adjustments of anti-hyperglycaemic agents (AHG) during bowel preparation for colonoscopy are limited. METHODS: A total of nine articles were revealed on a PubMed search using the search terms "diabetes" and "colonoscopy", "sigmoidoscopy", "endoscopy", "endoscopic intervention", "endoscopic invasive diagnostics", "endoscopic surgery", or "diabetes care in the hospital" and manual screening of the references of the articles reporting on AHG adjustment during bowel preparation. RESULTS: Regular glucose measurements and the opportunity to contact the diabetes team were commonly advised. Recommendations also agreed that all oral AHG and short-acting insulin should be omitted when patients are on clear fluids. Recent studies suggest discontinuation of sodium-glucose cotransporter-2 (SGLT2) inhibitors even three days before the colonoscopy. In contrast, recommendations differed regarding adjustment of basal insulin depending on diabetes type and time point in relation to the intervention. CONCLUSIONS: While discontinuation of oral AHG and short-acting insulin during bowel preparation for colonoscopy is generally accepted, recommendations on the adaptation of basal insulin follow different approaches.

Football - Novel Approaches to Tackle Diabetes.

Balanced diet and regular physical activity are of key importance to the prevention of the development and progression of non-communicable diseases. In 2050, 50% of the European population is expected to be obese. Cardiovascular diseases, diabetes mellitus, cancer, as well as joint impairments, will further increase. Therefore, programmes are critical to the improvement of the population's health status in the long run. New ways have to be found that allow addressing more people than with the current approaches. Football has a great potential to attract people at risk for or with already existing non-communicable diseases, such as type 2 diabetes, to participate in health-promoting programmes. The novel football version, walking football was developed for elderly players, aiming at avoiding injuries and physical overload. The present article gives a brief overview on the metabolic effects of recreational football, particularly walking football, as well as health-promoting programmes offered by professional football clubs in humans at risk for or with already existing non-communicable diseases.

Football as a Health Promotion Strategy.

BACKGROUND: Football training can be a primary prevention strategy to reach people who otherwise would not be physically active. This systematic review summarizes the evidence on the health effects of controlled recreational football training as an intervention in children, adolescents, adults and the elderly. METHODS: A systematic review (PROSPERO record CRD42018083665) of the literature was carried out in MEDLINE, Cochrane, Scopus, and SPORTDiscus databases to identify randomized and non-randomized intervention studies in which healthy individuals of any age participated in controlled football training and were investigated for health outcomes related to prevention of obesity, hypertension, diabetes mellitus, and cardiovascular disease. RESULTS: The studies included-14 randomized and three non-randomized intervention studies-have sample sizes too small for reliable statistical analysis and bear a considerable risk of systematic bias. The evidence of positive effects of playing football is limited to short-term loss of body fat and improvement in aerobic fitness. For all other health outcomes, no conclusive results were found. CONCLUSION: A considerable number of intervention studies reporting on football-based intervention programs have been published, and there is a widespread assumption that such programs have positive health effects. However, this systematic review shows that the empirical evidence is insufficient to permit such a conclusion.

HIPK2 restricts SIRT1 activity upon severe DNA damage by a phosphorylation-controlled mechanism.

Upon severe DNA damage a cellular signalling network initiates a cell death response through activating tumour suppressor p53 in association with promyelocytic leukaemia (PML) nuclear bodies. The deacetylase Sirtuin 1 (SIRT1) suppresses cell death after DNA damage by antagonizing p53 acetylation. To facilitate efficient p53 acetylation, SIRT1 function needs to be restricted. How SIRT1 activity is regulated under these conditions remains largely unclear. Here we provide evidence that SIRT1 activity is limited upon severe DNA damage through phosphorylation by the DNA damage-responsive kinase HIPK2. We found that DNA damage provokes interaction of SIRT1 and HIPK2, which phosphorylates SIRT1 at Serine 682 upon lethal damage. Furthermore, upon DNA damage SIRT1 and HIPK2 colocalize at PML nuclear bodies, and PML depletion abrogates DNA damage-induced SIRT1 Ser682 phosphorylation. We show that Ser682 phosphorylation inhibits SIRT1 activity and impacts on p53 acetylation, apoptotic p53 target gene expression and cell death. Mechanistically, we found that DNA damage-induced SIRT1 Ser682 phosphorylation provokes disruption of the complex between SIRT1 and its activator AROS. Our findings indicate that phosphorylation-dependent restriction of SIRT1 activity by HIPK2 shapes the p53 response.

Tibial shock measured with bone and skin mounted transducers.

The purpose of this study was to assess the value of superficial transducer mounting to measure tibial shock during locomotion. Surface (SMT) and bone mounted transducers (BMT) simultaneously recorded axial tibial acceleration in five subjects who ran at 4.5 m s-1. SMT produced inconsistent recording across the subjects both in the time and frequency domains. In two subjects, SMT signals provided close approximation of BMT signals, some distortion occurred in one subject while severe distortions were observed in the other two subjects. The present results established that SMT could not be used directly to quantify the shock transmitted through the tibia during running. However, frequency transformation of SMT recordings produced encouraging results; the transformed SMT signals mimicked the signals recorded with the bone mounted transducer.

[Dose dependent effects of the combined beta-gamma-emitter 188Rhenium on the growth of human vessel wall cells]. / Dosisabhängige Auswirkungen des kombinierten beta-gamma-Emitters 188Rhenium auf humane Endothelzellen und humane vaskuläre glatte Muskelzellen.

PURPOSE: To evaluate the dose of (188)Re that completely suppresses growth and clonogenic activity of human aortic smooth muscle cells (haSMC) since these cells are mainly responsible for restenosis occurring after PTA. For comparison, growth and clonogenic activity of endothelial cells (EC) were investigated with corresponding doses. MATERIALS AND METHODS: Two days after plating, haSMC and EC were incubated with (188)Re for five days. The doses applied ranged from 4 to 16 Gy. Cell growth was observed for a period of 20 days (EC) or 30 days (haSMC), respectively. Clonogenic activity was monitored over a period of 20 days for both cell lines. RESULTS: Irradiation caused dose-depend-ent inhibition of cell growth and clonogenic activity both in haSMC and in EC. HaSMC growth was completely blocked with 8 Gy, while EC still showed some proliferation even with 16 Gy. The clonal activity of haSMC was also completely blocked with 8 Gy while EC still showed little clonal activity even with 16 Gy. CONCLUSION: Cell growth of both haSMC and EC can be effectively suppressed in a dose-dependent manner. Only haSMC showed a complete growth arrest with 8 Gy while EC were able to proliferate even with 16 Gy. HaSMC colony formation was completely suppressed after application of 8 Gy, while the EC still showed colony formation activity with 16 Gy. (188)Re has some advantageous properties for intravascular irradiation in comparison to other radionuclides making it an interesting radionuclide for stent coating to prevent restenosis.

[Microvascular denudation of the femoral artery of the mouse as a model for restenosis]. / Mikrovaskuläre Denudation der Arteria femoralis der Maus--ein Restenosemodell für die Experimentelle Radiologie.

OBJECTIVE: To present technique and results of a microvascular denudation of the common femoral artery of the mouse as a model for inducing intimal hyperplasia in interventional radiology. MATERIALS AND METHODS: Under general anesthesia introduced by intraperitoneal injection, 14 B6129F1 hybrid mice (7 females and 7 males) at a mean age of 12.1 +/- 1.8 weeks and a mean weight of 28 +/- 2.8 grams had a groin incision of the vascular bundle directly distal to the inguinal ligament in preparation of placing a vascular clamp. Thereafter, the femoral artery was dissected distal to the origin of the epigastric artery and a loop prepared for a ligation proximal to the planned arteriotomy. Through an arteriotomy performed free-hand with a pair of micro scissors, a 0.010" (= 0.25 mm) guidewire was introduced into the vessel and advanced to the aortic bifurcation. The guide-wire was moved back and forth three times. The same procedure was performed on the other side as sham-operation, i.e., without introduction and passage of a guidewire. The resulting changes of the vessel wall were evaluated by histology and morphometry. RESULTS: Four weeks after intervention, the mean intima-to-media-ratio (IMR) was 1.80 +/- 0.28. A significant difference was observed between the sexes, with an IMR of 1.41 +/- 0.29 in females and an IMR of 2.24 +/- 0.45 in males (p = 0.0173). The neointima led to an overall luminal loss of 50.2% +/- 8.3% without significant sex difference (p = 0.09), but the average luminal loss was still more severe in females, amounting to 43.9% in comparison to 56.1% in males. This technique induces a significant neointima formation in a reproducible manner. The internal elastic membrane was preserved in all vessels. CONCLUSION: This technique is an excellent model to examine the differences between genetically modified mice to clarify the role of putative key molecules in the pathophysiology of restenosis.

Postoperative course of plasma protein binding of lignocaine, ropivacaine and bupivacaine in sheep.

The plasma protein binding of the 2,6-xylidide local anaesthetic agents lignocaine, ropivacaine and bupivacaine enantiomers was determined by equilibrium dialysis in plasma obtained from chronically catheterized sheep before and up to 21 days after surgery. Three concentrations (1, 5 and 10 mg L-1), were used for each agent. Concentration-dependent binding was evident for each agent throughout the study period. R(+)-Bupivacaine was more extensively bound than S(-)-bupivacaine at the higher concentrations. Compared with pre-surgery, binding of each agent was less on the first postoperative day but did not differ significantly from days 8 to 21.

Prolonged successful therapy for hyperinsulinaemic hypoglycaemia after gastric bypass: the pathophysiological role of GLP1 and its response to a somatostatin analogue.

BACKGROUND: Spontaneous hyperinsulinaemic hypoglycaemia following gastric bypass surgery (GBS) is increasingly recognised. However, its pathophysiology remains unclear. Some patients require pancreatectomy. Medical therapy with calcium channel blockers, acarbose and diazoxide has been reported to be beneficial but has variable adherence and response. METHOD: We demonstrate the role of GLP1, counter-regulatory hormones and the subsequent response of GLP1 to somatostatin analogue therapy in a 42-year-old woman with persistent neuroglycopaenia 6 years after GBS. Plasma GLP1, insulin and glucose were measured for 5  h on three settings: i) a 75  g oral glucose tolerance test (OGTT); ii) a standard liquid test meal (LTM); and iii) an OGTT 30  min after a s.c. injection of 100  µg octreotide. RESULTS: In comparison with obese non-diabetic controls, the patient had an elevated fasting and a markedly enhanced GLP1 response during the OGTT, followed by an exaggerated insulin response and a subsequent low glucose level. The GLP1 response to a LTM was similar but greater. Octreotide given prior to the OGTT attenuated both the GLP1 and insulin responses and abolished hypoglycaemia. Octreotide therapy significantly improved the patient's neuroglycopaenic symptoms. The hormone profile was reassessed after 6 months following the LTM preceded by octreotide injection. Peak GLP1 and insulin responses were less pronounced than pretreatment responses and without hypoglycaemia. The patient was treated with lanreotide and had remained symptom-free and euglycaemic for 4 years. CONCLUSION: An exaggerated incretin response following altered gastrointestinal anatomy was the likely cause of hypoglycaemia in our GBS patient. Somatostatin successfully suppressed this response acutely and in the long term, thereby avoiding pancreatectomy and its sequelae.

Colorectal polyps: detection with dark-lumen MR colonography versus conventional colonoscopy.

PURPOSE: To prospectively compare dark-lumen magnetic resonance (MR) colonography with conventional colonoscopy in the detection of colorectal polyps. MATERIALS AND METHODS: Local ethical committee approval and informed consent were obtained. One hundred consecutive patients (56 men, 44 women; mean age +/- standard deviation, 67.7 years +/- 14.7; range, 25-82 years) who were referred for conventional colonoscopy from January 2003 to January 2004 underwent MR colonography and conventional colonoscopy after standard precolonoscopic bowel cleansing. Colonoscopy was performed immediately after MR colonography. For MR colonography, the colon was filled with approximately 2000 mL of tap water. Imaging was performed with a 1.5-T MR unit with patients in the prone position. A T1-weighted three-dimensional volumetric interpolated breath-hold sequence was performed before and 75 seconds after intravenous administration of 0.2 mmol gadobenate dimeglumine per kilogram of body weight. Results of MR colonography were analyzed on a per-polyp and per-patient basis. Findings at colonoscopy were used as the reference for determining accuracy, sensitivity, specificity, and positive and negative predictive values of MR colonography. RESULTS: Of 100 patients recruited for study, 92 (52 men, 40 women; mean age, 61.5 years +/- 14.5; range, 25-82 years) underwent complete MR and conventional colonoscopy examinations. Forty-three of the 92 patients (47%) had normal findings at conventional colonoscopy. In the other 49 patients (53%), conventional colonoscopy depicted 107 polyps (82 adenomas, 25 hyperplastic polyps) and seven carcinomas. At per-polyp analysis, sensitivity of MR colonography in the detection of adenomatous polyps was 100% for polyps at least 10 mm in diameter and 84.2% for polyps 6-9 mm in diameter. At per-patient analysis, the accuracy of MR colonography was 93.1% (sensitivity, 89%; specificity, 96%) if detection of adenomatous polyps of all sizes was considered. CONCLUSION: Dark-lumen MR colonography is a promising modality with high accuracy for detecting colorectal polyps larger than 5 mm in diameter.

[Cysts of second branchial cleft: review of 32 operated cases]. / Quistes de la segunda hendidura branquial: revisión de 32 casos operados.

The aim of this work was to analyze retrospectively the clinical features of 32 patients aged 23.9 years (21 female) with the histological diagnosis of second branchial cleft cyst. In 28 patients, the cyst was localized below the mandibular angle. The presenting symptom was a cervical tumor in 30 patients and pain in eight. Fourteen aspiration punctures was performed obtaining 8 purulent and 6 straw colored aspirates. The preoperative diagnosis was correctly made in only 19 patients; the principal confounding diagnosis was tuberculous adenitis. All patients were operated performing a complete cystectomy in 30 and partial cystectomy in two. Three patients had a surgical wound infection and the cysts recurred 5 months and 4 years after operation in the two patients subjected to partial cystectomy. The histological study revealed squamous epithelial with underlying lymphoid tissue. It is concluded that aspiration puncture is useful for the correct diagnosis and that the cyst must be completely eradicated to avoid recurrences.

Psychomotor development in preschool children exposed to antiepileptic drugs in utero.

UNLABELLED: The aim of this study was to assess psychomotor development with the Griffiths' test in preschool children exposed to antiepileptic drugs (AED) in utero. The study sample consisted of 76 children exposed to AED in utero and 71 unexposed children. The children (exposed and unexposed) have since birth been included in a population-based longitudinal follow-up study of children born to women with meticulously treated epilepsy during pregnancy, initiated in 1985. In total, 67 exposed and 66 unexposed children were tested with the Griffiths' test, which consists of 6 subsets: locomotor function, personal and social behaviour, hearing and speech, eye and hand coordination, performance, and practical reasoning. There was no significant difference in the global scores of the Griffiths' test between the two groups of children. Children exposed to phenytoin in utero (n = 16) showed a significant but subtle reduction in the scores for locomotor development compared with the unexposed children (mean scores: 98 vs 106: 95% confidence interval for the difference in mean scores: -14.0 to -0.4). There was no such difference for the children exposed to carbamazepine in utero (n = 35). The exposed children had significantly fewer siblings (p < 0.01). A significant number of the mothers with AED treatment had no higher level of education than compulsory school (p < 0.01). No other differences in socioeconomic status were observed between the groups. CONCLUSION: The subtle delay in locomotor development evaluated with the Griffiths' test at 4.5-5 y of age in children exposed to phenytoin may indicate a subtle influence on psychomotor development, which may be more obvious at school age: thus, larger studies and further follow-up are warranted.

[Breast hydatid cyst. A case report]. / Quiste hidatídico de la mama. Comunicación de un caso.

We report the case of a 63 years old woman with a left mammary hydatid cyst. The patient presented with a left painless mammary mass of four months evolution. Mammography showed a dense image of 9 cm phi in the left breast. Ultrasound showed a solid and heterogeneous lesion. The tumor was excised under general anesthesia. The initial macroscopic inspection showed a tumor with a well defined fibrous capsule filled with a grayish material that contained membrane debris. The pathological study confirmed the diagnosis of a hydatid cyst.