Acute Esophageal Necrosis Syndrome (Black Esophagus): A Case Report of Rare Presentation.

Acute esophageal necrosis (AEN) is a rare clinical finding due to multifocal factors consisting of an ischemic insult to the esophagus, corrosive injury from gastric content, and diminished mucosal defense. It is also referred to as "black esophagus" or acute necrotizing esophagitis. The clinical presentation mainly consists of upper gastrointestinal bleed and abdominal pain. Associated symptoms include nausea, vomiting, and dysphagia. AEN can be diagnosed by esophagogastroduodenoscopy (EGD) with findings of diffuse circumferential black pigmentation in the distal esophagus that classically extends to the gastroesophageal junction. A diagnostic biopsy is not required but recommended. Treatment of AEN is conservative management to maintain hemodynamic stability and treat coexisting medical conditions. Herein, we present the case of a 78-year-old male who initially presented with hematemesis and abdominal discomfort of five-day duration and was subsequently found to have AEN.

Metastasis-Induced Acute Pancreatitis Secondary to Small Cell Lung Carcinoma: A Case Report.

Description Metastasis-induced acute pancreatitis (MIAP) is a condition that occurs when patients develop acute pancreatitis secondary to metastatic malignancy. Most pancreatic cancers are adenocarcinomas that are primary malignancies. On the other hand, metastatic pancreatic lesions are rare, especially from primary pulmonary malignancies. Acute pancreatitis caused by metastatic carcinoma of the pancreas is a very rare presentation. Herein, we present the case of a 63-year-old male with a history of small-cell lung carcinoma presenting to the hospital due to recurrent episodes of acute pancreatitis who was found to have metastatic pancreatic carcinoma. The patient was treated conservatively for his recurrent acute pancreatitis, had a stent placed in the common bile duct to relieve an obstruction and planned for outpatient palliative chemotherapy.

From DNA Damage to Cancer Progression: Potential Effects of Cytolethal Distending Toxin.

Cytolethal distending toxin (CDT), one of the most important genotoxins, is produced by several gram-negative bacteria and is involved in bacterial pathogenesis. Recent studies have shown that bacteria producing this peculiar genotoxin target host DNA, which potentially contributes to development of cancer. In this review, we highlighted the recent studies focusing on the idea that CDT leads to DNA damage, and the cells with inappropriately repaired DNA continue cycling, resulting in cancer development. Understanding the detailed mechanisms of genotoxins that cause DNA damage might be useful for targeting potential markers that drive cancer progression and help to discover new therapeutic strategies to prevent diseases caused by pathogens.

Berberine Inhibits Pro-inflammatory Cytokine-induced IL-6 and CCL11 Production via Modulation of STAT6 Pathway in Human Bronchial Epithelial Cells.

Berberine is an isoquinoline alkaloid isolated from various Chinese herbs that has potential of anti-inflammatory, anti-lipidemic, anti-neoplastic, and anti-diabetic activity. In this study, we evaluated the anti-inflammatory efficacy of berberine on allergic airway inflammation by targeting epithelial cells. Allergic airway inflammation driven by T helper 2 (Th2)-type immunity is characterized by airway hyperresponsiveness, elevated IgE production, and eosinophilic infiltration. For eosinophil recruitment, major chemoattractant CCL11 (eotaxin-1) was secreted by lung epithelial cells. BEAS-2B cells, a human bronchial epithelial cell line, were pre-treated with berberine and then activated by IL-4 plus TNF-α. The viability of BEAS-2B cells was assessed. Expression levels of IL-6 and CCL11 were determined using ELISA and real-time PCR. The signaling pathways of MAP kinases, NF-κB, and STAT6 were analyzed by western blot. Berberine treatment (≤1 µM) didn't significantly affect the viability of BEAS-2B cells with or without IL-4 plus TNF-stimulation. Berberine significantly inhibited the secretion of IL-6 and CCL11 from pro-inflammatory cytokine-activated BEAS-2B cells. NF-κB and MAP kinase pathways were seemingly unaffected in BEAS-2B cells with berberine treatment. Significant reduction of nuclear STAT6 protein expression in activated BEAS-2B cells with berberine treatment was observed. Current study reveals that berberine has inhibitory effect in pro-inflammatory cytokine-activated BEAS-2B cells through reducing IL-6 and CCL11 production, which is possibly modulated by suppressing STAT6 signaling pathway.

DNA methyltransferase inhibitor alleviates bleomycin-induced pulmonary inflammation.

Acute lung injury (ALI) is a severe disease characterized by several inflammatory responses in the lung with high mortality. We applied a mouse model of the pulmonary inflammation induced by the intratracheal instillation of bleomycin which is widely used to induce ALI and fibrosis in animal models. We hypothesized that DNA methyltransferase inhibitor, 5-azacytidine (5-Aza), with its anti-inflammatory benefits, might attenuate bleomycin-induced ALI through the alleviation of inflammation in the lung. We quantified white blood cells with cell blood count (CBC) test, lung inflammation by analyzing cells in the collected bronchoalveolar lavage fluid (BALF) and histological analysis of the lung tissues, and gene expression levels by real-time PCR. Intratracheal administration of bleomycin in mice induced pulmonary inflammation, characterized by increased neutrophil infiltration and inflammatory cytokine expression in the lungs. Mice treated with 5-Aza showed a significant reduction of lung neutrophilia, together with lower expressions of CXCL2 and MCP-1. Furthermore, 5-Aza treatment decreased the expression of proinflammatory cytokines in the lung tissue. Collectively, our data show that DNA methyltransferase inhibitor can alleviate the lung inflammation of bleomycin-induced ALI, indicating an alternative treatment option for the inflammation-triggered lung injury.

Using patient self-checklist to improve the documentation of risk of postoperative nausea and vomiting: an implementation project.

BACKGROUND AND AIMS: Postoperative nausea and vomiting (PONV) is a common surgical complication, affecting 30-50% of patients and 80% in high risk populations. Successful prevention and management of PONV relies on accurately assessing individual risk prior to surgery. A valid and reliable Apfel score is commonly used to assess patients' risk. It is however challenging to translate this evidence into clinical practice. This evidence-based project aimed to identify the current practice of assessing and documenting the risk factors of PONV prior to surgery, and to develop strategies to improve the practice. METHODS: The project had three phrases, including forming a team and conducting the baseline audit; identifying problems and developing strategies; and conducting a follow-up tool to assess the impact on compliance with best practice. A research team was formed. A baseline audit was conducted at a public hospital in Victoria in June 2016 to examine PONV risk assessment practice through checking medical files of surgical patients. A getting research into practice audit and feedback tool was used to identify barriers, implementation strategies, stakeholders and resources. After implementation, a second audit was conducted between June and October 2017. Audit criteria were based on a reliable and valid Apfel score. RESULTS: At baseline, accurate PONV risk could only be calculated from 8% of patient files with no file formally recording the risk factors. The proportion of patients with three risk factors preoperatively, indicating high PONV risk, was 5.3%. Barriers identified were the perceived lack of necessity to record the risk, time constraint and too much paperwork. A self-checklist for risk assessment was developed to enable patients to check their own level of risk. Its face validity, construct validity and accuracy were examined. The checklist was then implemented for patients to complete prior to surgery. A number of strategies were used to improve the implementation. The second audit of 1308 files showed that at the end of audit period, 74% of patients had risk assessment conducted and documented postimplementation. 16.8% of the patients were identified as having high PONV risk, nearly triple the number identified at baseline. CONCLUSION: A simple self-checklist of PONV risk was implemented. It greatly improved PONV risk assessment and documentation in a public hospital in Australia and enabled the identification of patients at high risk.

Pediatric musculoskeletal nuclear medicine.

This article reviews the current role of nuclear medicine in common benign and malignant pediatric musculoskeletal conditions and discusses future applications.