Risk factor analysis and model construction for fish bone foreign body in children's pharynx.

OBJECTIVES: This study aimed to assess the risk factors for predicting the presence of fish bone foreign bodies and to develop a risk prediction model. METHODS: Data of 1405 children who underwent video-guided laryngoscope for suspected fish bone foreign body ingestion were retrospectively analyzed. Multi-factor logistic regression analyses were performed to analyze the risk factors for the presence of fish bone foreign body in patients, and a risk prediction model was established based on the results of the logistic regression analysis. RESULTS: The results of the statistical analysis showed the presence of an ulcerated surface increased the risk of having a fishbone foreign body in the pharynx by approximately 55.36-fold (95 % confidence interval (CI): 15.78-194.24), followed by a clear chief complaint site, which increased the risk of having a fishbone foreign body in the pharynx by approximately 7.963-fold (95 % CI: 4.820-13.15), and a tingling sensation, which increased the risk of having a fishbone foreign body by approximately 7-fold (95 % CI: 3.483, 14.233). A clinical prediction model (nomogram) was developed and its validation was performed using receiver operating characteristic (ROC) curve analysis, in which an area under the curve (AUC) value of 0.808 indicated that the model had a great prediction capability. CONCLUSION: The predictive capability of a logistic regression model for the detection of fish bone foreign bodies following ingestion is significant. Clinicians can concentrate on monitoring these risk factors and implementing appropriate interventions to reduce the risks of patients presenting with fish bone foreign bodies.

Ensuring that ingested fishbones that migrate to the neck are located, diagnosed, and removed early.

OBJECTIVES: The aim of this retrospective study was to explore the clinical characteristics of and diagnostic and therapeutic strategies for the removal of fish bones that migrate to the neck. METHODS: We reviewed the clinical data of 30 patients over the past 12 years who underwent neck surgery in our otorhinolaryngology department for the migration of fish bones from the throat. The location of fish bones and the positivity rate of different examination methods (neck CT and B-ultrasound) were evaluated statistically. The diagnosis and treatment strategy for fish bone migration to the neck was also summarized. RESULTS: A total of 24 patients had a history of foreign body ingestion. The duration from foreign body ingestion to the appearance of symptoms in the neck ranged from 26 to 151 days, with a median of 50 days (interquartile range, 32-86 days). Among the 24 patients with fish bones located in the front or side of the neck, 50% (12/24) and 100% (24/24) of whom had positive neck CT and B-ultrasound results, respectively. Additionally, for 6 patients with fish bones in the retropharyngeal space, the positive rate for neck CT was 100%, whereas neck B-ultrasound showed negative results due to the air and depth in the trachea and esophagus. A strong correlation was observed between the length of fish bones detected by B-ultrasound and CT and the actual length. Indeed, no significant difference was observed between the length of fish bone determined by B-ultrasound and the actual length. In patients with fish bones located in the anterior and lateral neck regions, the foreign bodies were successfully removed by a lateral cervical approach operation (23/24). For the 6 cases with fish bones located in the retropharyngeal space, all (6/6) were removed by incising the posterior pharyngeal wall with assistance from transoral endoscopy. CONCLUSIONS: The techniques of B-ultrasound and CT have advantages for the diagnosis of migratory foreign bodies in the neck. Although B-ultrasound is more accurate for estimating the length of migratory fish bones in the neck, a combination of both methods can improve the preoperative positive rate of diagnosis. Therefore, a variety of surgical approaches should be employed to manage the different locations of cervical foreign bodies.

Preparation, Characterization, and Biological Properties of Hydroxyapatite from Bigeye Snapper (Priancanthus tayenus) Bone.

The optimum condition of acid hydrolysis for hydroxyapatite extraction from bigeye snapper (Priancanthus tayenus) bone and the effects of extraction time (10-60 min) and HCl concentration (2.0-5.0% w/v) on yield and hydroxyapatite properties were determined. The optimum extracted condition was found using 5% HCl for 60 min, which was 13.4% yield; 19.8 g/100 g Ca content; 9.6 g/100 g P content; 2.1 Ca/P ratio; L*, a*, b*; and ΔE as 84.5, 2.8, 16.5, and 15.6, respectively. The using of 5% NaOH solution was optimum for hydroxyapatite precipitation from the extracted solution. The characteristic and biological properties of the obtained hydroxyapatite were studied. Fourier transform infrared spectroscopy and X-ray diffraction results showed a good comparison between the extracted and commercial hydroxyapatite. The microstructure of the extracted hydroxyapatite from a scanning electron microscope showed an irregular and flat-plate shape, large surface area, and roughness. The extracted hydroxyapatite was non- and low-cytotoxicity at a concentration of 50 and 100-400 µg/mL, respectively. Bovine serum albumin (BSA) adsorption and desorption of hydroxyapatite was studied. An increasing BSA concentration, hydroxyapatite amount, and adsorption time significantly increased protein adsorption on hydroxyapatite. Protein desorption from BSA-loaded hydroxyapatite showed an increase of release initially in the first 4 days and became a steady release rate until 14 days.

Isotopic life-history signatures are retained in modern and ancient Atlantic bluefin tuna vertebrae.

Isotopic, tagging and diet studies of modern-day teleosts lacked the ability to contextualise life-history and trophic dynamics with a historical perspective, when exploitation rates were lower and climatic conditions differed. Isotopic analysis of vertebrae, the most plentiful hard-part in archaeological and museum collections, can potentially fill this data-gap. Chemical signatures of habitat and diet use during growth are retained by vertebrae during bone formation. Nonetheless, to fulfil their potential to reveal life-history and trophic dynamics, we need a better understanding of the time frame recorded by vertebrae, currently lacking due to a poor understanding of fish bone remodelling. To address this issue, the authors serially-sectioned four vertebral centra of the highly migratory Atlantic bluefin tuna (Thunnus thynnus; BFT) captured off Sardinia (Italy) and analysed their isotopic composition. They show how carbon (δ13 C), nitrogen (δ15 N) and sulphur (δ34 S) isotope values can vary significantly across BFT vertebrae growth-axes, revealing patterning in dietary life histories. Further, they find that similar patterns are revealed through incremental isotopic analysis of inner and outer vertebrae centra samples from 13 archaeological BFT vertebrae dating between the 9th and13th centuries CE. The results indicate that multi-year foraging signatures are retained in vertebrae and allow for the study of life histories in both modern and paleo-environments. These novel methods can be extended across teleost taxa owing to their potential to inform management and conservation on how teleost trophic dynamics change over time and what their long-term environmental, ecological and anthropological drivers are.

Exploring the Anti-Cancer Effects of Fish Bone Fermented Using Monascus purpureus: Induction of Apoptosis and Autophagy in Human Colorectal Cancer Cells.

Fish bone fermented using Monascus purpureus (FBF) has total phenols and functional amino acids that contribute to its anti-oxidant and anti-inflammatory properties. Colorectal cancer, one of the most prevalent cancers and the third largest cause of death worldwide, has become a serious threat to global health. This study investigates the anti-cancer effects of FBF (1, 2.5 or 5 mg/mL) on the cell growth and molecular mechanism of HCT-116 cells. The HCT-116 cell treatment with 2.5 or 5 mg/mL of FBF for 24 h significantly decreased cell viability (p < 0.05). The S and G2/M phases significantly increased by 88-105% and 25-43%, respectively (p < 0.05). Additionally, FBF increased the mRNA expression of caspase 8 (38-77%), protein expression of caspase 3 (34-94%), poly (ADP-ribose) polymerase (PARP) (31-34%) and induced apoptosis (236-773%) of HCT-116 cells (p < 0.05). FBF also increased microtubule-associated protein 1B light chain 3 (LC3) (38-48%) and phosphoinositide 3 kinase class III (PI3K III) (32-53%) protein expression, thereby inducing autophagy (26-52%) of HCT-116 cells (p < 0.05). These results showed that FBF could inhibit HCT-116 cell growth by inducing S and G2/M phase arrest of the cell cycle, apoptosis and autophagy. Thus, FBF has the potential to treat colorectal cancer.

Anti-inflammatory effects of fish bone fermented using Monascus purpureus in LPS-induced RAW264.7 cells by regulating NF-κB pathway.

Fish bones are the by-products of aquatic and fishery processing, which are often discarded. However, it has been considered having health-promoting by containing many essential nutrients. This study investigates the anti-inflammatory effect of fish bone fermented by Monascus purpureus (FBF) and the NF-κB pathway regulation mechanism in lipopolysaccharides (LPS)-induced RAW 264.7 cells. FBF has inhibited the production of PGE2 (prostaglandin E2), interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) in LPS-induced RAW264.7 cells. The FBF has significantly inhibited mRNA expression of inducible nitric oxide synthase (iNOS) and cyclooxygenase-2 (COX-2). Moreover, FBF has suppressed activation of NF-κB (nuclear factor kappa-B) by increasing IκB mRNA expression and reduced of p65, p50 mRNA expression, as well as nuclear NF-κB DNA binding activity in LPS-induced RAW 246.7 cells. These findings demonstrate that FBF has inhibited LPS-induced inflammation by subsiding the activation of NF-κB in RAW 246.7 cells, implying that FBF could be employed as a promising natural product.

An extremely dangerous case of acute massive upper gastrointestinal bleeding: a case report.

BACKGROUND: Upper gastrointestinal (GI) bleeding is a severe acute disease of gastroenterology department. Fish bone is the most common food-related foreign body. However, fish bone piercing the esophagus, causing the mediastinal abscess that corroded the left subclavian artery, resulting delayed but high-risk massive upper gastrointestinal bleeding is very rare. CASE PRESENTATION: We report a 54-year-old man who was diagnosed with delayed but high-risk massive upper GI bleeding that was the result of a fish bone piercing the esophagus, causing a mediastinal abscess that corroded the left subclavian artery. He was saved effectively by early and timely multidisciplinary collaboration. CONCLUSION: A fish bone-caused mediastinal abscess that corrodes the left subclavian artery and induces delayed but high-risk massive upper GI bleeding is very rare. In addition to routine consideration of upper GI bleeding, medical history, endoscopy and CT are helpful for achieving a diagnosis. Importantly, early and timely multidisciplinary collaboration can effectively save critically ill patients.

Suppurative thyroiditis caused by ingested fish bone in the thyroid gland: a case report on its diagnostics and surgical therapy.

BACKGROUND: Accidental ingestion of fish bone is a common cause of otolaryngological emergency. Migration of the ingested bone into the thyroid gland, however, occurs very rarely. The associated clinical presentation, symptoms and duration of discomfort are also highly variable between patients and can be diagnostically challenging. CASE PRESENTATION: Here, we report the case of a 71-year-old female patient presenting with an ingested fish bone that migrated into the right thyroid lobe as a rare cause of suppurative thyroiditis with the clinical features of sepsis. We outline the diagnostic approach, peri- and intraoperative management as well as complications. It is proposed that besides endoscopy, imaging methods such as ultrasound or computed tomography may be necessary to verify the diagnosis and location of an ingested fish bone. Prompt surgical removal of the foreign body and resection of the infectious focus is recommended to minimize the risk of local inflammation, recurrent nerve lesions and septic complications arising from the spread of infection. CONCLUSION: Fish bone migration into the thyroid gland is an extremely rare event, the successful detection and surgical management of which can be achieved through a careful interdisciplinary approach.

Learning Curve of Upper Aerodigestive Tract Foreign Body Management for Otorhinolaryngology Residents.

INTRODUCTION: Foreign body ingestion is the most common reason for otolaryngology specialist consultations in emergency departments. Among the different types of foreign bodies, fish bones are the most common, particularly in Asian populations. In Taiwan, upper aerodigestive tract foreign bodies (UADT-FBs) are mostly managed by residents in the otorhinolaryngology (ORL) department. Considering the learning curve required for all procedures, different management types between residents, and possible resulting safety issues, this study explored the outcomes of UADT-FB management by residents in different years of ORL training. MATERIALS AND METHODS: The medical records of 2,283 patients who visited Kaohsiung Veterans General Hospital's Emergency Department for UADT-FB during June 2013-August 2019 were retrospectively reviewed. The reviewed data included the demographic data of enrolled patients, outcomes of foreign body management, and follow-up chart records of the patients. RESULTS: Among the 2,283 patients, 1,324 (58%) were found to be negative for foreign bodies, and foreign bodies in 951 (41.7%) were removed immediately. In the negative finding (NF) group, 2 (4.9%) patients were later found to be positive for foreign bodies during follow-up in the outpatient department. One (2.4%) patient developed a deep neck infection and esophageal perforation. The percentage of NFs decreased from 62.58% in residents in the first half of their first year (R1a) to 54% for third-year residents (R3). Comparing R1a with R3, the number needed to harm for retained UADT-FBs after patients visited the emergency department was 12.2. DISCUSSION/CONCLUSION: This study provides data from 1 referral center regarding the management of UADT-FBs. With increasing resident training, the percentage of NFs declined from 62.58 to 54%. Young residents, especially those in the first 6 months of their training, should have senior residents perform a second examination if UADT-FBs are not found in suspected cases.

[Perforation of Meckel's diverticulum by a fishbone]. / Perforatsiya divertikula Mekkelya ryb'ei kost'yu.

Meckel's diverticulum is the most common congenital defect of the gastrointestinal tract. It is most often silent or asymptomatic. However, acute abdominal signs of obstruction, inflammation, hemorrhage and perforation are possible in other cases. Different foreign bodies can cause perforation of Meckel's diverticulum. We present an 18-year-old male who presented to the emergency department with abdominal pain within 48 previous hours. After evaluation, acute appendicitis was diagnosed and he underwent laparoscopic appendectomy. Meckel's diverticulum perforated by a fish bone was intraoperatively discovered. Incidental appendectomy and segmental resection of the ileum were performed.

Migration of fish bones into abdominal para-aortic tissue from the duodenum after leading to duodenal perforation: a case report.

BACKGROUND: Migration of fish bones into abdominal para-aortic tissue after penetrating the junction of 3rd and 4th part of duodenum is incredibly rare. CASE PRESENTATION: A 68-year-old man was admitted to our hospital with persistent colic in the lower abdomen after eating fish two weeks ago. Abdominal computed tomography (CT) scan showed High density streaks along the anterior and lower edges of the 3rd part of duodenum with peripheral exudation and localized peritonitis. Esophagogastroduodenoscopy didn't find foreign bodies and perforations in the digestive tract. Laparoscopic surgery and intraoperative endoscopy were made to detect foreign bodies and perforation site was found. After transition to open surgery, the fish bone was found in abdominal para-aortic tissue and removed without complications. Postoperative recovery is smooth, and the patient resumed normal diet and was discharged. CONCLUSIONS: It is difficult to choose a treatment plan for foreign bodies at the 3rd part of the duodenum, because it is difficult to judge the damage caused by the foreign body to the intestine and the positional relationship with the surrounding important organs. Conservative treatment or surgical treatment both have huge risks. The handling of this situation will extremely test the psychology, physical strength and professional experience of the surgeon.

Unusual Biliary Complication following Christmas Eve Dinner.

We present a case of a fish bone impacted in the papilla of Vater resulting in dyspepsia and mild elevation in liver function tests, which was subsequently treated endoscopically. Fish bones are one of the most commonly encountered swallowed foreign bodies. However, involvement of the biliary tract, such as the one described by us, represents an extremely rare complication of fish bone ingestion. The diagnosis of a foreign body in the biliary tract can be difficult, and early endoscopic or surgical extraction may be required to avoid complications such as biliary stone formation, obstructive jaundice, cholangitis or cholecystitis, and/or biliary sepsis. Prompt endoscopic treatment can avoid severe biliary complications or surgical therapy.

Fishbone double-layer barbed suture in cesarean section: a help in preventing long-term obstetric sequelae?

Due to the high number of cesarean sections over the last two decades, there has been a growing awareness of the post-surgical obstetric long-term sequelae (i.e., uterine scar defects and abnormal placentation) following this surgical procedure. Knotless barbed suture is an absorbable bidirectional and unidirectional monofilament, characterized by the presence of "barbs" along its length. After being introduced in gynecology, the favorable features of the knotless barbed suture, such as the uniform distribution of tensile force, provide the rationale for studying its benefits in obstetric surgery. Recently, our research group has investigated a double-layer barbed suture ("fishbone" suture) for closing the uterine wall during cesarean section by a case-control study, reporting a low incidence of uterine scar defects and a reduced size of defects in women who had developed them (NCT04825821). In the near future, large prospective studies are strongly awaited to investigate reproductive outcomes and long-term sequelae after cesarean section performed with knotless barbed suture.

Emergency CT of abdominal complications of ingested fish bones: what not to miss.

Fish bones are the most commonly ingested structures and the most common cause of foreign body perforation of the gastrointestinal tract (GIT). Clinical presentation of foreign body GIT perforation is nonspecific, in many cases with clinical signs of acute abdomen, which can mimic appendicitis, diverticulitis, ulcer peptic disease, and other common inflammatory conditions. Besides, patients commonly do not refer that a fish bone was swallowed. Since this condition is usually not suspected by referring physicians of the emergency department (ED), radiologists play a key role in this diagnosis; the spectrum of these imaging features must be known in order to be accurately reported in the ED.

Does plain radiography still have a role in cases of fish bone ingestion in emergency rooms? A retrospective analysis.

BACKGROUND: Fish bones are the most common aerodigestive foreign bodies found in adults. Most cases of fish bone impaction improve after primary management by emergency physicians with a mirror laryngoscopy using a tongue depressor, before otolaryngologists perform a fiberoptic nasendoscopy. A computed tomography scan usually follows to determine the next step. Studies have recently been concerned about overdoses of radiation from computed tomography. However, clear algorithms remain unavailable for fish bone ingestion management to date. METHODS: A retrospective review was conducted on 180 patients who visited the emergency department with complaints of fish bone impaction between January 2017 and January 2019. RESULTS: A total of 81.6% of patients with fish bone impaction got symptomatic relief after primary management by emergency physicians and otolaryngologists. Out of 180 patients, 33 (18.3%) needed an endoscopic procedure due to persistent symptoms. Only one (0.56%) required an operation due to perforation. In the group failing primary management, the plain radiography of eight patients showed a positive finding and an esophagogastroscopy was done to remove the fish bones. CONCLUSION: Lateral neck radiography is still beneficial to patients with fish bone ingestion failure from primary management. Positive lateral soft tissue radiography in cases with persistent symptoms post primary management may directly suggest esophagogastroscopy without confirmation from a computed tomography, unless complications are suspected. For patients aged below 40, following up on their conditions after post management radiography shows negative results may increase their safety.

Evaluation of Chemical Compositions, Antioxidant Capacity and Intracellular Antioxidant Action in Fish Bone Fermented with Monascus purpureus.

Fish bones (FBs) are aquatic by-products that are sources of antioxidant-active peptides, calcium dietary supplements, and biomedical materials. Usually, fermentation of these by-products via microorganisms brings desirable changes, enhancing their value. This study investigates the value addition of FB when fermented with Monascus purpureus (MP) for different time intervals, such as 3 days (F3) and 6 days (F6). The results indicate that the soluble protein, peptide, amino acid and total phenol content, as well as the antioxidant capacity (DPPH, ABTS+ radical scavenging activity, and relative reducing power), of F3 and F6 were significantly increased after fermentation. Furthermore, the ROS contents of F3 and F6 were reduced to a greater extent than that of hydrogen peroxide (H2O2) in Clone-9 cells. The MMP integrity, as well as the SOD, CAT, and GPx activity, of F3 and F6 were also increased significantly compared to the H2O2 in Clone-9 cells. Notably, F3 and F6 displayed significant reductions in ROS content, as well as elevate, SOD activity and MMP integrity in Clone-9 cells, when compared with the native FB. These results indicate that the FBs fermented with MP for 3 days (F3), and 6 days (F6) have antioxidant capacity, with possible applications as natural food supplements.

Computed Tomography Findings of Emergency Cases Resulting From Fish Bone Ingestion.

Fish bones are some of the most commonly ingested foreign bodies. In most cases, fish bone ingestion is asymptomatic, and the bones are expelled from the body spontaneously. Otherwise, patients with fish bone ingestion can present to the emergency department with nonspecific symptoms. Fish bones can become impacted in various part of the body. Even in cases that are initially asymptomatic after ingestion, serious complications may develop at a later stage. Computed tomography (CT) plays an important role in the diagnosis of fish bone ingestion because it is the most sensitive modality for detecting these foreign bodies. It is important to be familiar with CT findings to detect ingested fish bones and the related complications and to direct further management of the condition.

Successful laparoscopic management of a hepatic abscess caused by a fish bone.

BACKGROUND: Hepatic abscess is a rare condition but comes with heavy consequences if not diagnosed and managed properly. Early detection of this pathology is challenging because of the variety and lack of specificity of symptoms but is necessary for accurate management. CASE REPORT: We report a case of pyogenic liver abscess secondary to the migration of an ingested fish bone in a 74-year-old female. We used laparoscopic surgery to drain the abscess, remove the foreign body responsible and look for the perforation site. Parenteral antibiotherapy was added to the surgical treatment. CONCLUSION: Early diagnosis of hepatic abscess caused by the migration of a foreign body remains a challenge. In our opinion, laparoscopic surgery associated with antibiotics is the safest and most effective therapeutic option.

Evaluation of Sigma-Metric and Application of Quality Tools in Clinical Laboratory of a Tertiary Care Hospital.

Variability in analytical performance of some analyte indicated the need of evaluation of quality plan of our laboratory. We tried to put the same degree of effort into our quality metrics as we put into the laboratory processes themselves. Application of six sigma methodologies improve the quality by focusing on the root causes of the problems in performance and analyzing by flowcharts, fishbone diagrams and other quality tools. Sigma metric was calculated for laboratory parameters for a period of 8 months during 2018-19. The analytes with poor sigma metric were free Thyroxine (FT3, FT4), Sodium, Calcium and Magnesium. Sigma metric of free Thyroxine (FT3, FT4), Sodium, Calcium and Magnesium were below 3. A road map for process improvement was designed with DMAIC (Define-Measure-Analyze-Improve-Control) model to solve the issue. Possible causes for low analytical performance of the particular analytes were depicted in Fishbone diagram. The Fishbone analysis identified the water quality issues with electrolyte analysis while high ambient temperature was culprit for poor assay performance of free Thyroxine. Sigma metric of the analytical performance was assessed once again after root cause analysis. Sigmametric showed marked improvement in control phase. Identification of problems led to reduction in non value added work leading to adequate resource utilization by addressing the priority issue. Therefore, DMAIC tool with Fish bone model analysis can be recommended as a well suited method for troubleshooting in poor performance of laboratory parameter.

Minimally invasive approach for retrieval of retropharyngeal foreign body.

Ingested fish bone at times can migrate extraluminally into the surrounding soft tissue, leading to complications. Conventionally, these migrated fish bones are retrieved by open procedures, which could add to the morbidity. We successfully retrieved one such foreign body by a minimally invasive transcervical approach in a 64-year-old female patient. The method offered an easy identification of the foreign body with minimal soft-tissue dissection, which ultimately aided in the early post-operative recovery. This is the first report of a minimally invasive approach to explore the retropharyngeal space, and we propose the technique even for sampling retropharyngeal lymph node.