A pre-vertebrate endodermal origin of calcitonin-producing neuroendocrine cells.

Vertebrate calcitonin-producing cells (C-cells) are neuroendocrine cells that secrete the small peptide hormone calcitonin in response to elevated blood calcium levels. Whereas mouse C-cells reside within the thyroid gland and derive from pharyngeal endoderm, avian C-cells are located within ultimobranchial glands and have been reported to derive from the neural crest. We use a comparative cell lineage tracing approach in a range of vertebrate model systems to resolve the ancestral embryonic origin of vertebrate C-cells. We find, contrary to previous studies, that chick C-cells derive from pharyngeal endoderm, with neural crest-derived cells instead contributing to connective tissue intimately associated with C-cells in the ultimobranchial gland. This endodermal origin of C-cells is conserved in a ray-finned bony fish (zebrafish) and a cartilaginous fish (the little skate, Leucoraja erinacea). Furthermore, we discover putative C-cell homologs within the endodermally-derived pharyngeal epithelium of the ascidian Ciona intestinalis and the amphioxus Branchiostoma lanceolatum, two invertebrate chordates that lack neural crest cells. Our findings point to a conserved endodermal origin of C-cells across vertebrates and to a pre-vertebrate origin of this cell type along the chordate stem.

Rare Lymphoma of the Breast: A Case Report.

Lymphoma of the breast is a rare malignancy of the breast lymphoid tissue. It can present as either a primary or a secondary malignancy due to metastasis from a systemic disease. Secondary breast lymphoma (SBL) is one of the most common malignancies to metastasize to the breast. Once present in the breast, these masses are often difficult to distinguish from primary breast carcinoma on both physical examination and diagnostic imaging modalities. Differentiating these tumors is imperative because each has a different management plan. This report presents a rare case of SBL in a 55-year-old Hispanic female and includes a review of its presentation, radiologic imaging findings, and management.

Donor-directed immunologic safety of COVID-19 vaccination in renal transplant recipients.

Infection risk and COVID-19 outcomes make SARS-CoV-2 vaccination essential forsolid-organ transplant recipients. Reports of immune activation after vaccination causing graft failure raise concerns, but data are limited. Here, we document graft function, donor-derived-cell-free-DNA(dd-cfDNA), and donor-specific antibodies (DSA) in solid-organ renal transplant recipients after vaccination. Retrospective demographics, graft function, and immunologic parameters were collected in 96 renal transplant patients one month after their second vaccine dose. For-cause biopsies were performed based on clinician judgment. Similar proportions of subjects experienced increases (39.6 %) and decreases (44.8 %) in serum creatinine in the post-vaccination period, p = 0.56. Similar proportions of subjects experienced increases (23 %) and decreases (25 %) in serum ddcfDNA in the post-vaccination period, p = 0.87. Post-vaccination changes in serum creatinine and ddcfDNA (r(95) = -0.04, p = 0.71), serum creatinine and cumulative DSA MFI (r(95) = 0.07, p = 0.56), and ddcfDNA and cumulative DSA MFI(r(95) = 0.13, p = 0.21) were not significantly correlated. Five subjects had increased cumulativeDSA MFI, but there were no de novo cases. Biopsies on three subjects confirmed pre-existing diagnoses. Our study found minimal evidence ofdonor-directed immunologic activity post-vaccination, and all immunologic changesdid not correlate to graft dysfunction. We believe these findings do not amount to evidence ofpost-vaccination deleterious donor-directed activation. SARS-CoV-2 vaccination is immunologically safe and should continue for renal transplant recipients.

Two Years Remission of Type 2 Diabetes Mellitus after Bariatric Surgery.

OBJECTIVE: To determine the influence of bariatric surgery on remission of type 2 diabetes mellitus (T2DM) in obese patients along with improvements in other obesity-associated comorbidities. STUDY DESIGN: Observational study. PLACE AND DURATION OF STUDY: Doncaster and Bassetlaw NHS Trust, UK, from August 2010 to August 2018. METHODOLOGY: All the cases of bariatric surgery in obese patients with T2DM who had completed 2 years of follow up were included in the study. Remission of T2DM was defined as glycated hemoglobin (HbA1C) <48 mmol/mol (<6.5%) or fasting blood sugar of <7.0 mmol/L, not on hypoglycemic agents 2 years after having bariatric surgery. Student's t-test was used to see any difference in baseline HbA1C, BMI, percentage of weight loss, and duration of diabetes between remitters and non-remitters. RESULTS: Two years follow-up data after bariatric surgery for remission of T2DM or otherwise was available for (n=121) patients. Majority (70.2%, n=85) were females and (29.8%, n=36) were males. Mean age was 48.21 ±9.77 years. Eightythree (68.6%) patients achieved remission of T2DM at 2 years and 31.4% (n=38) did not. Remission of other comorbidities was 33.3% (n=53 out of 159) for hypertension (HTN), 50.8% (n=60 out of 118) for dyslipidemia, 67.2% (n=43 out of 64) for obstructive sleep apnea (OSA), 52.1% (n=37 out of 71) for gastro esophageal reflux disease (GERD), 25.7% (n=18 out of 70) for asthma, and 23.3% (n=24 out of 103) for depression. CONCLUSION: Bariatric surgery effectively achieves remission of T2DM and other obesity associated comorbidities.

Obstructive Sleep Apnoea Screening Preoperatively with the Epworth Questionnaire: Is It Worth It ?

BACKGROUND: The prevalence of obstructive sleep apnoea (OSA) in the bariatric population has been reported to be as high as 60-83%. The Epworth Sleepiness Scale (ESS) is a validated, self-administrated eight-item questionnaire that measures subjective daytime sleepiness and thus helps to identify high-risk for OSA. OBJECTIVES: To find the prevalence of OSA in patients undergoing bariatric surgery who do not routinely undergo polysomnography (PSG) and are screened by the ESS. METHODS: All consecutive 425 patients who underwent bariatric surgery in our tercier referral centre from January 2012 to June 2017 were included in this prospective study. Patient demographics and ESS score were recorded prior to the bariatric surgery and patients were divided into low-risk (ESS < 11), high-risk (≥ 11) and "known-OSA" groups. RESULTS: The community-based OSA prevalence was 14% (59 patients). ESS-positive predictive value was 60%. There was no significant difference in BMI and excess body-weight, but patients with OSA were older and had a lower female ratio (75% vs 42%). The unplanned ICU admission rate was comparable amongst the low- and high-ESS group (2.2% and 2.1%, respectively); similarly, the respiratory and chest complication rate were similar. The median hospital stay for patients diagnosed with OSA was a half day longer; the high-score patients stayed significantly longer than the low-score patients (p = 0.017). CONCLUSION: In our study, the OSA prevalence was low (20%). We think that the ESS does not have significant predicting value before bariatric surgery and overall the OSA is "overhyped" in the bariatric pathway.

Etiology of Leaks Following Sleeve Gastrectomy: Current Evidence.

PURPOSE: The purpose of this paper is to study the causes of leaks following sleeve gastrectomy (SG). MATERIALS AND METHODS: Pubmed was searched during January 2016 for publications reporting leak after SG. A total of 205 publications were identified, of which 17 papers were selected. RESULTS: In about 3018 patients, reinforcement was used compared with 4595 patients, in whom no reinforcement was applied; both groups were representing matched bariatric populations. The use of reinforcement/buttressing has resulted in different rates of leaks ranging from 0% to 3.9%; whereas with no reinforcement/buttressing, the leak rate was 0.16% to 3.5%. The use of reinforcement/buttressing did not result in reduction of leak to a statistical significance although the trend was suggesting so (P=0.06), whereas no reinforcement/buttressing did not statistically increase the leak rate (P=0.10). CONCLUSIONS: No statistical significant difference of leak with or without reinforcement. This mean case complexity and surgical technique and experience are the sole factors for leaks following SG.