Necrotic mediastinal lymphadenopathy: Tuberculosis or Sarcoidosis, a diagnostic conundrum - A case report and review of the literature.

Sarcoidosis is an uncommon disease involving pulmonary parenchyma and lymph nodes. Non-necrotizing, bilaterally symmetric hilar, and right paratracheal lymph nodes are the pathognomonic imaging features of sarcoidosis. Rarely, atypical radiological findings of sarcoidosis may mimic mycobacterial infections, posing a diagnostic dilemma, especially in tuberculosis endemic countries. In this report, we have discussed the case of a 61-year-old female presenting with multiple conglomerated necrotic mediastinal lymph nodes on computed tomography that looked tubercular but eventually turned out to be sarcoidosis. It is important for primary care physicians, who are the first point of contact for patients, to keep in mind the atypical radiologic manifestations of sarcoidosis, in order to reach a timely diagnosis and help reduce the associated morbidity and mortality.

Bridging Barriers to Cervical Cancer Screening in Transgender Men: A Scoping Review.

Estimates of high-risk human papillomavirus (HPV) infection and susceptibility to HPV-related cancer in transgender men (TM) are comparable to prevalence rates found in cisgender women. Regular and thorough screening for cervical cancer is equally as crucial for TM as for cisgender women; however, despite continued risk for cervical cancer in TM and associated recommendations for screening, studies indicate disparities in rates of cervical cancer screening (CCS) in TM compared to cisgender women. The current scoping review explores TM's knowledge and experiences of CCS and barriers to screening uptake in this population. A range of barriers were identified including the need for health-care services to provide care for TM within the context of a nonbinary approach to gender identity and health. Findings synthesized from relevant research studies (n = 15; published 2008-2019) are presented, and recommendations are drawn from these findings to inform primary health-care providers' clinical practice and care of TM.

Critical heat flux maxima during boiling crisis on textured surfaces.

Enhancing the critical heat flux (CHF) of industrial boilers by surface texturing can lead to substantial energy savings and global reduction in greenhouse gas emissions, but fundamentally this phenomenon is not well understood. Prior studies on boiling crisis indicate that CHF monotonically increases with increasing texture density. Here we report on the existence of maxima in CHF enhancement at intermediate texture density using measurements on parametrically designed plain and nano-textured micropillar surfaces. Using high-speed optical and infrared imaging, we study the dynamics of dry spot heating and rewetting phenomena and reveal that the dry spot heating timescale is of the same order as that of the gravity and liquid imbibition-induced dry spot rewetting timescale. Based on these insights, we develop a coupled thermal-hydraulic model that relates CHF enhancement to rewetting of a hot dry spot on the boiling surface, thereby revealing the mechanism governing the hitherto unknown CHF enhancement maxima.

Racial differences in outcomes of the evaluation of potential live kidney donors: a retrospective cohort study.

BACKGROUND: In the USA, the lower rate of live donor kidney transplant among Black transplant candidates may stem from lower rates of donation among potential live donors who are Black. We determined whether outcomes of the evaluation of potential live kidney donors varied according to the potential donors' demographic characteristics. METHODS: We performed a single-center, retrospective observational cohort study of 1,179 potential live kidney donors, who came forward between 2000 and 2007. Potential donors' intended recipients were first-time transplant recipients who were evaluated between 2000 and 2005. RESULTS: There were 268 (22.7%) potential live kidney donors who were Black, of whom 93.7% were recruited by Black transplant candidates. Donor outcomes included actual donation (38.3%), exclusion due to blood group or crossmatch incompatibility (20.4%), exclusion due to medical contraindication to donation (13.7%), and lack of further donor interest (11.2%). Black (vs. non-Black) potential donors were less likely to actually donate (27.2 vs. 41.6%, p < 0.001). Black potential donors were more likely to stop pursuing live donation (p = 0.047) or be excluded from donation for medical reasons (p = 0.008) or blood group or crossmatch incompatibility (p = 0.01). These racial differences persisted in a multivariable multinomial logistic regression model of factors associated with outcomes of the donor evaluation. CONCLUSIONS: Potential live kidney donors who are Black are less likely to actually donate. Future studies should determine whether paired exchange and desensitization programs decrease these racial differences and why Black potential donors appear more likely to stop pursuing live donation.

A single nucleotide polymorphism of Toll-like receptor 4 identifies the risk of developing graft failure after liver transplantation.

BACKGROUND & AIMS: While studies in animal models have linked Toll-like receptor (TLR) 4 signaling to the pathophysiology of ischemia/reperfusion (IR) injury and liver fibrosis, the relevance of TLR4 activation after human liver transplantation is unknown. The TLR4 single nucleotide polymorphism (SNP) D299G is situated within the extracellular domain and diminishes receptor binding to danger-associated molecular patterns. METHODS: We studied the influence of TLR4 D299G on IR injury and graft survival in 430 deceased donor LT recipients. Compared with livers expressing wild-type (WT) alleles, livers with a TLR4 loss-of-function allele were significantly more likely to have initial good graft function (IGGF) (OR 2.20, p=0.01). In contrast, there was no effect of recipient TLR4 genotype on the rate of IGGF. RESULTS: The effect of TLR4 D299G on long-term graft survival was analyzed based on hepatitis C virus (HCV) serostatus. In HCV infected recipients, multivariate Cox regression analysis demonstrated a significant association between the presence of recipient, but not donor TLR4 D299G and long-term graft failure (HR 2.48, CI 1.28-4.81; p=0.007). There was no difference in graft survival between TLR4 mutant and WT recipients among non-HCV infected recipients. CONCLUSIONS: Collectively, these results demonstrate the differential effects of donor and recipient TLR4 signaling in human liver transplantation. Donor TLR4 contributed to sterile injury following cold preservation and the recipient TLR4 genotype was linked with poor allograft survival among HCV infected recipients.

Complement component C3 allotypes and outcomes in liver transplantation.

The complement system has been implicated in the pathogenesis of liver diseases. Human complement component C3 (C3) exists as 2 allotypes, fast (F) and slow (S). We conducted a study to address the influence of these alleles on ischemia-reperfusion (IR) injury and graft survival in liver transplant recipients. Four hundred thirty patients receiving liver transplants from 2000 to 2004 were included. C3 allotypes of 296 donor-recipient pairs were determined and correlated with clinical outcomes. Four groups were analyzed according to the C3 genotype: C3 SS donor and recipient, C3 FS or C3 FF donor and C3 SS recipient, C3 SS donor and C3 FS or C3 FF recipient, and C3 FS or C3 FF donor and recipient. Baseline characteristics of the 4 groups were similar. The mean follow-up time was 4.3 +/- 2.2 years. The 4 groups had similar rates of IR injury (P = 0.16). The hazard ratios for liver allograft survival in the C3 SS donor and recipient group in comparison with the other 3 groups (C3 FS or C3 FF donor and C3 SS recipient, C3 SS donor and C3 FS or C3 FF recipient, and C3 FS or C3 FF donor and recipient) were not significantly different: 1.13 (P = 0.60), 0.99 (P = 0.97), and 1.02 (P = 0.95), respectively. In conclusion, donor and recipient C3 genotypes are not associated with liver transplantation outcomes.

Donor Toll-like receptor 4 contributes to ischemia and reperfusion injury following human kidney transplantation.

While studies in animal models have linked Toll-like receptor (TLR) 4 signaling to kidney injury induced by ischemia and reperfusion, the relevance of TLR4 activation to allograft injury in human kidney transplants is unknown. Here we show that TLR4 is constitutively expressed within all donor kidneys but is significantly higher in deceased-, compared with living-donor organs. Tubules from deceased- but not living-donor kidneys also stained positively for high-mobility group box-1 (HMGB1), a known endogenous TLR4 ligand. In vitro stimulation of human tubular cells with HMGB1, in a TLR4-dependent system, confirmed that HMGB1 can stimulate proinflammatory responses through TLR4. To assess the functional significance of TLR4 in human kidney transplantation, we determined whether TLR4 mutations that confer diminished affinity for HMGB1 influence intragraft gene-expression profiles and immediate graft function. Compared with kidneys expressing WT alleles, kidneys with a TLR4 loss-of-function allele contained less TNFalpha, MCP-1, and more heme oxygenase 1 (HO-1), and exhibited a higher rate of immediate graft function. These results represent previously undetected evidence that donor TLR4 contributes to graft inflammation and sterile injury following cold preservation and transplantation in humans. Targeting TLR4 signaling may have value in preventing or treating postischemic acute kidney injury after transplantation.

Cyclin E both regulates and is regulated by calpain 2, a protease associated with metastatic breast cancer phenotype.

Overexpression of cyclin E in breast tumors is associated with a poor response to tamoxifen therapy, greater genomic instability, more aggressive behavior, and a poor clinical prognosis. These tumors also express low molecular weight isoforms of cyclin E that are associated with higher kinase activity and increased metastatic potential. In the current study, we show that cyclin E overexpression in MCF7 cells transactivates the expression of calpain 2, leading to proteolysis of cyclin E as well as several known calpain substrates including focal adhesion kinase (FAK), calpastatin, pp60src, and p53. In vivo inhibition of calpain activity in MCF7-cyclin E cells impedes cyclin E proteolysis, whereas in vivo induction of calpain activity promotes cyclin E proteolysis. An analysis of human breast tumors shows that high levels of cyclin E are coincident with the expression of the low molecular weight isoforms, high levels of calpain 2 protein, and proteolysis of FAK. Lastly, studies using a mouse model of metastasis reveal that highly metastatic tumors express proteolyzed cyclin E and FAK when compared to tumors with a low metastatic potential. Our results suggest that cyclin E-dependent deregulation of calpain may be pivotal in modifying multiple cellular processes that are instrumental in the etiology and progression of breast cancer.

Ectopic expression of cyclin E in estrogen responsive cells abrogates antiestrogen mediated growth arrest.

Estrogens stimulate proliferation of estrogen receptor positive MCF7 breast cancer cells while antiestrogens signal a G0/G1 growth arrest. In MCF7 cells, arrest is mediated through the CDK inhibitors p21 and p27 and through a decrease in cyclin E/CDK2 kinase activity. We found that in MCF7 cells, overexpression of cyclin E partially abrogates a tamoxifen mediated growth arrest. Overexpression of cyclin E is accompanied by a decrease in the levels of RB and CDK inhibitor p21 but an increase in CDK inhibitor p27. Cyclin E overexpression also alters the composition of E2F transcription factor complexes. The E2F4/p107/cyclin E/CDK2 complex, a minor component in proliferating control cells that is absent in growth-arrested cells, is more abundant in both proliferating and tamoxifen treated cyclin E overexpressing cells. Conversely, levels of the quiescence associated E2F/p130 complex is not detected in these cells. Expression from the E2F dependant promoter is elevated in proliferating and tamoxifen treated cyclin E overexpressing cells. This study suggests that a modest overexpression of cyclin E abrogates the tamoxifen mediated growth arrest through modification of the RB/E2F pathway. Moreover, these results provide one explanation of why some cells that express the estrogen receptor may be unresponsive to antiestrogens.

Simian immunodeficiency virus Nef protein delays the progression of CD4+ T cells through G1/S phase of the cell cycle.

Human and simian immunodeficiency virus (HIV and SIV, respectively) infections are characterized by gradual depletion of CD4+ T cells. The underlying mechanisms of CD4+ T-cell depletion and HIV and SIV persistence are not fully determined. The Nef protein is expressed early in infection and is necessary for pathogenesis. Nef can cause T-cell activation and downmodulates cell surface signaling molecules. However, the effect of Nef on the cell cycle has not been well characterized. To determine the role of Nef in the cell cycle, we investigated whether the SIV Nef protein can modulate cell proliferation and apoptosis in CD4+ Jurkat T cells. We developed a CD4+ Jurkat T-cell line that stably expresses SIV Nef under the control of an inducible promoter. Alterations in cell proliferation were determined by flow cytometry using stable intracytoplasmic fluorescent dye 5- and 6-carboxyfluorescein diacetate succinimidyl ester and bromodeoxyuridine incorporation. Apoptotic cell death was measured by annexin V and propidium iodide staining. Our results demonstrated that SIV Nef inhibited Fas-induced apoptosis in these cells and that the mechanism involved upregulation of the Bcl-2 protein. SIV Nef suppressed CD4+ T-cell proliferation by inhibiting the progression of cells into S phase of the cell cycle. Suppression involved an upregulation of cyclin-dependent kinase inhibitors p21 and p27 and the downregulation of cyclin D1 and cyclin A. In summary, inhibition of apoptosis by Nef can lead to persistence of infected cells and can support viral replication. In addition, a Nef-mediated delay in cell cycle progression may contribute to CD4+ T-cell anergy/depletion seen in HIV and SIV disease.