Utility of duct-washing cytology for detection of early breast cancer in patients with pathological nipple discharge: A comparative study with fine-needle aspiration cytology.

BACKGROUND: Pathological nipple discharge (PND) is a relatively common symptom of breast cancer affecting the nipple. Mammary ductscopy (MD) allows direct visualization of the ductal lumen and collection of a cytological specimen using duct-washing cytology (DWC). Herein, we clarified the diagnostic efficacy of DWC for the detection of breast cancers with PND, compared with fine-needle aspiration cytology (FNAC). METHODS: We retrospectively examined 48 patients with PND who underwent DWC by MD (ductosccopy group; histologically determined by intraductal biopsy [IDB] or surgical specimen). The results of sensitivity and specificity of DWC were compared with that of FNAC (conventional group; histologically determined by core needle biopsy). Clinicopathological factors were compared between the ductoscopy and the conventional groups. RESULTS: Of eight histologically malignant cases in the ductoscopy group, one case was cytologically judged as malignant and three as indeterminate. Sensitivity and specificity of DWC were 50.0% and 82.5%, respectively. Malignant cases were mostly solid papillary carcinomas (SPCs), and benign cases were intraductal papillomas (IDPs). In the conventional group, sensitivity and specificity of FNAC were 88.0% and 38.2%, respectively, and malignant cases were mainly invasive carcinomas of no special type. Tumors in the ductocsopy group had more favorable prognostic features than those in the conventional group. CONCLUSION: DWC has limited diagnostic value due to the high incidence of SPC, whose cytological features are indistinguishable from IDP. As DWC alone may be unreliable, comprehensive examination with IDB and MD findings is recommended.

Is current age related macular degeneration self-monitoring a good tool for detecting exudative recurrence?

PURPOSE: To assess the ability of patients with exudative AMD to detect exudative recurrence. Another objective was to assess if self-monitoring, as currently taught, improves this ability. MATERIALS AND METHODS: An observational cross-sectional study was carried out in the ophthalmology center of BeauSoleil clinic in Montpellier between March 1 and April 1 2016. Inclusion criteria were presence of neovascular age related macular degeneration treated with the loading dose of three monthly intravitreal anti-VEGF injections, with at least one injection in the past 12 months and at least one exudative recurrence. All patients underwent a visual acuity measurement with ETDRS charts at 4 meters. A questionnaire assessed familiarity with the Amsler grid and its proper use, performance of and type of self-monitoring at home and the subjective feeling of an exudative recurrence at the visit with a 5-level Likert scale. RESULTS: A total of 94 eyes of 70 patients were included in this study with 69.0 % women and a median (interquartile range) age of 83 (77-96) years. Among them, 81 % performed regular self-monitoring, mostly with environmental Amsler tests (70 %). Only 63 % of the patients knew of the Amsler grid, among which 52 % used it correctly. Sensitivity (95 % confidence interval, 95 % CI) and specificity (95 % CI) of the subjective sensation of exudative recurrence were 0.32 (0.14-0.55) and 0.85 (0.74-0.92), respectively, for the entire population. Sensitivity (95 % CI) and specificity (95 % CI) were 0.33 (0.13-0.59) and 0.85 (0.74-0.93); 0.25 (0.0063-0.81) and 0.82 (0.48-0.98), respectively, in patients performing and not performing self-monitoring. CONCLUSION: Patients' prediction in wet AMD is insufficient in detecting exudative recurrences, even if regular self-monitoring with Amsler grid or environmental Amsler is performed.

Novel mediators and mechanisms in the resolution of infectious inflammation: evidence for vagus regulation.

Excessive chronic inflammation is linked to many diseases and considered a stress factor in humans (Robbins Pathologic Basis of Disease. Philadelphia: W.B. Saunders Co., 1999, Proc Natl Acad Sci USA, 2008, 105: 17949, Immunity, 44, 2016, 44: 463, N Engl J Med, 2011, 364: 656). Today, the resolution of inflammation is widely recognized as a cellular biochemically active process involving biosynthesis of a novel superfamily of endogenous chemical signals coined specialized pro-resolving mediators (SPMs; Nature, 2014, 510:92). Herein, we review recent evidence, indicating a role for the vagus nerve and vagotomy in the regulation of lipid mediators. Vagotomy reduces pro-resolving mediators, including the lipoxins, resolvins, protectins and maresins, delaying resolution in mouse peritonitis. Vagotomy also delays resolution of Escherichia coli infection in mice. Specifically, right vagus regulates peritoneal Group 3 innate lymphoid cell (ILC-3) number and peritoneal macrophage responses with lipid mediator profile signatures with elevated pro-inflammatory eicosanoids and reduced resolvins, including the novel protective immunoresolvent agonist protectin conjugate in tissue regeneration1 (PCTR1). Acetylcholine upregulates PCTR biosynthesis, and administration of PCTR1 to vagotomized mice restores tissue resolution and host responses to E. coli infections. Results obtained with human vagus ex vivo indicate that vagus can produce both pro-inflammatory eicosanoids, such as prostaglandins and leukotrienes, as well as the SPM. Electrical stimulation of human vagus in vitro reduces both prostaglandins and leukotrienes and enhances resolvins and the other SPM. These results elucidate a host protective mechanism mediated by vagus stimulation of SPM that includes resolvins and PCTR1 to regulate myeloid antimicrobial functions and resolution of infection. Moreover, they define a new pro-resolution of inflammation reflex operative in mice and human tissue that involves a vagus SPM circuit.

Eosinophilic effusions: A clinicocytologic study of 12 cases.

OBJECTIVES: Our aim is to study the prevalence of eosinophilic effusions (EEs) in our institution, to highlight their cytologic patterns, potential interpretation pitfalls, diagnostic importance, and to investigate their possible causes and clinical associations. MATERIALS AND METHODS: We conducted a retrospective review study for over 13 years. We retrieved all of the cytology reports of pleural, pericardial, and peritoneal effusions with eosinophils. We reviewed and screened the cytology slides looking for eosinophils that constitute >10% of the cells. We extracted the clinical, radiologic, and laboratory findings and follow-up data for each patient. RESULTS: We found 12 patients (0.7%) with EEs. They included five pleural, five peritoneal, and two pericardial fluids. The age range was between 16 and 75 with a mean age of 36.5 years. The male to female ratio was 3:1. We have recognized three cytomorphologic patterns; purely eosinophilic, dominantly eosinophilic, and mixed inflammatory infiltrate that correlated with peripheral blood eosinophilia. Two cases demonstrated extracellular and intracellular Charcot-Leyden crystals. Certain cellular and crystal features are potential cytologic pitfalls. EEs were associated with miscellaneous specific and non-specific medical conditions. None was associated with tuberculosis, malignancy, drugs, or parasites. CONCLUSIONS: EEs are uncommon. They mostly occur in young adult males. There are three cytomorphologic patterns that correlate with peripheral eosinophilia. Etiologies are diverse or obscure. EEs with a very high eosinophilia are less likely malignant, tuberculous, parasitic, and seldom associated with drugs. Cytopathologists should be aware of certain potential diagnostic pitfalls. Correct cytologic recognition is clinically important since some causes are treatable.

Abordaje de una herida por roce o fricción de categoría III, con presencia de biofilm, tras contención mecánica / Approach of a category III rub injury, with the presence of biofilm, after mechanical containment

Objetivo: Reforzar y demostrar lo importante que es identificar, conocer y atender todos los factores relacionados con las biopelículas que nos encontramos en, prácticamente, todas las heridas crónicas. Metodología: Se trata del caso de una paciente de intensivos, con ventilación mecánica invasiva. Durante el destete, presenta cuadro de delirio exacerbado que precisa contención mecánica, que produjo una lesión por fricción de categoría III, que evolucionó de manera muy agresiva hacia la presentación reiterada de biofilm. Resultados: Tras un primer abordaje poco eficaz, instauramos cura en ambiente húmedo y procedimos a aplicar todos los cuidados más actuales indicados en el manejo de heridas con presencia de biofilm. Conseguimos cierre completo en 4 semanas. Conclusiones: Se hace necesario entender qué significa una biopelícula para una herida y para un paciente. Si esto no se consigue, jamás podremos abordarla de manera categórica y eficaz

Objective: Reinforce and demonstrate the importance of identifying, knowing and attending to all the factors related to biofilms, which we find in practically all chronic wounds. Methodology: It is a case of a Intensive Care Unit patient with invasive mechanical ventilation. During weaning, he presents exacerbated delirium that requires mechanical restraint, which produced a category III friction lesion, evolving in a very aggressive way towards the repeated presentation of biofilm. Results: After an ineffective first approach, we established a cure in a humid environment and proceeded to apply all the most current care indicated in the management of wounds with the presence of biofilm. We got complete closure in four weeks. Conclusions: It is necessary to understand what a biofilm means for a wound and for a patient. If this is not achieved, we can never address it categorically and effectively

Assessing the Effects of ILeVO and VOTiVO Seed Treatments on Reproduction, Hatching, Motility, and Root Penetration of the Soybean Cyst Nematode, Heterodera glycines.

Successful management of the soybean cyst nematode Heterodera glycines is limited by increased virulence of nematode populations on resistant soybean cultivars and persistence of the nematode in the soil in the absence of hosts. Seed treatments are now available for H. glycines management. However, it is unclear how these treatments affect specific life stages of the nematode. The objectives of this study were to assess the effects of ILeVO (with active ingredient fluopyram) and VOTiVO (with active ingredient Bacillus firmus I-1582) seed treatments on H. glycines reproduction and important processes in the nematode life cycle, such as second-stage juvenile (J2) hatching, motility, and root penetration. The effects of seed treated with formulated (ILeVO and VOTiVO) and nonformulated active ingredient (fluopyram and B. firmus I-1582) on H. glycines reproduction were conducted in a greenhouse. Nematode reproduction on plants grown from seed treated with ILeVO or technical fluopyram (active ingredient only) was reduced by 35 to 97% relative to the nontreated control, suggesting that the fluopyram active ingredient was affecting H. glycines directly and was not an inert ingredient in the seed treatment formulation. Hatching, motility, and root penetration experiments also were conducted using only the formulated seed treatments. Exudates collected from ILeVO-treated seed reduced J2 hatching and motility by more than 95% in laboratory assays. Exudates from radicles grown from ILeVO-treated seed reduced hatching in vitro by 48% in one run but had no significant effect in the second run compared with the nontreated control exudates. There also were no consistent effects of radicle exudates, regardless of treatment, on hatching and motility of the J2. ILeVO reduced root penetration of H. glycines J2 at different inoculation densities in a growth chamber experiment. VOTiVO did not affect any of the processes or life stages of the nematode studied. The results of this study indicate that the use of nematode-protectant seed treatments may be useful in controlling H. glycines; however, additional investigations into the precise effects of ILeVO and VOTiVO on H. glycines life processes and in different parts of the soil profile are necessary.

Potassium, not lepidimoide, is the principal 'allelochemical' of cress-seed exudate that promotes amaranth hypocotyl elongation.

Background and Aims: Imbibed cress ( Lepidium sativum L.) seeds exude 'allelochemicals' that promote excessive hypocotyl elongation and inhibit root growth in neighbouring competitors, e.g. amaranth ( Amaranthus caudatus L.) seedlings. The major hypocotyl promoter has recently been shown not to be the previously suggested acidic disaccharide, lepidimoic acid (LMA), a fragment of the pectic polysaccharide domain rhamnogalacturonan-I. The nature of the hypocotyl promoter has now been re-assessed. Methods: Low-molecular weight cress-seed exudate (LCSE) was fractionated by high-voltage electrophoresis, and components with different charge:mass ratios were tested for effects on dark-grown amaranth seedlings. Further samples of LCSE were size-fractionated by gel permeation chromatography, and active fractions were analysed electrophoretically. Key Results: The LCSE strongly promoted amaranth hypocotyl elongation. The active principle was hydrophilic and, unlike LMA, stable to hot acid. After electrophoresis at pH 6·5, the only fractions that strongly promoted hypocotyl elongation were those with a very high positive charge:mass ratio, migrating towards the cathode 3-4 times faster than glucosamine. Among numerous naturally occurring cations tested, the only one with such a high mobility was potassium. K + was present in LCSE at approx. 4 m m , and pure KCl (1-10 m m ) strongly promoted amaranth hypocotyl elongation. No other cation tested (including Na + , spermidine and putrescine) had this effect. The peak of bioactivity from a gel permeation chromatography column exactly coincided with the peak of K + . Conclusions: The major 'allelopathic' substance present in cress-seed exudate that stimulates hypocotyl elongation in neighbouring seedlings is the inorganic cation, K + , not the oligosaccharin LMA.

First Insights into Human Fingertip Regeneration by Echo-Doppler Imaging and Wound Microenvironment Assessment.

Fingertip response to trauma represents a fascinating example of tissue regeneration. Regeneration derives from proliferative mesenchymal cells (blastema) that subsequently differentiate into soft and skeletal tissues. Clinically, conservative treatment of the amputated fingertip under occlusive dressing can shift the response to tissue loss from a wound repair process towards regeneration. When analyzing by Immunoassay the wound exudate from occlusive dressings, the concentrations of brain-derived neurotrophic factor (BDNF) and leukemia inhibitory factor (LIF) were higher in fingertip exudates than in burn wounds (used as controls for wound repair versus regeneration). Vascular endothelial growth factor A (VEGF-A) and platelet-derived growth factor (PDGF) were highly expressed in both samples in comparable levels. In our study, pro-inflammatory cytokines were relatively higher expressed in regenerative fingertips than in the burn wound exudates while chemokines were present in lower levels. Functional, vascular and mechanical properties of the regenerated fingertips were analyzed three months after trauma and the data were compared to the corresponding fingertip on the collateral uninjured side. While sensory recovery and morphology (pulp thickness and texture) were similar to uninjured sides, mechanical parameters (elasticity, vascularization) were increased in the regenerated fingertips. Further studies should be done to clarify the importance of inflammatory cells, immunity and growth factors in determining the outcome of the regenerative process and its influence on the clinical outcome.

Comparative evaluation of the functional properties of superabsorbent dressings and their effect on exudate management.

A range of wound dressings currently available in the UK and elsewhere, each claiming to possess different performance characteristics, can make dressing selection difficult. This report concentrates on the superabsorbent polymer dressings (SAPs) - which are designed to absorb medium to high levels of exudate and to maintain an 'ideal moist wound healing environment'. What do these dressings achieve, what are they suitable/not suitable for, and are all super-absorbent dressings equal in terms of performance and quality? When assessing the key performance characteristics of absorbency, moisture vapour transmission rate (MVTR), strikethrough and structural integrity, results show that SAPs are not all the same-in fact each of them varies considerably and may lend themselves to different wound aetiologies and usage conditions. While performance data is often presented from non-standard tests or modifications, it is proposed that to provide clarity over dressing selection, all SAPs were measured using International Standards for the key performance characteristics. This will aid clinical staff in selecting the most appropriate dressing for each wound.

A D-optimal design to model the performances of dressings and devices for negative pressure wound therapy.

A D-optimal design was used to identify and model variables that affect the transit time of wound exudate through an illustrative dressing used for negative pressure wound therapy. Many authors have addressed the clinical benefits of negative pressure wound therapy, but limited information is available on how to assess performances of dressings. In this paper, the transit time of wound exudate through a dressing was chosen as a model parameter to show how experimental design (DOE) can be used for this purpose. Results demonstrated that rate of exudate production, temperature and dressing thickness were the variables with the largest impact on transit time. The DOE approach could be used to model other dressing properties, like for example capability of absorbing excess exudate or breathability.

Acute and chronic wound fluids inversely influence adipose-derived stem cell function: molecular insights into impaired wound healing.

Wound healing is a complex biological process that requires a well-orchestrated interaction of mediators as well as resident and infiltrating cells. In this context, mesenchymal stem cells play a crucial role as they are attracted to the wound site and influence tissue regeneration by various mechanisms. In chronic wounds, these processes are disturbed. In a comparative approach, adipose-derived stem cells (ASC) were treated with acute and chronic wound fluids (AWF and CWF, respectively). Proliferation and migration were investigated using 3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) test and transwell migration assay. Gene expression changes were analysed using quantitative real time-polymerase chain reaction. AWF had a significantly stronger chemotactic impact on ASC than CWF (77·5% versus 59·8% migrated cells). While proliferation was stimulated by AWF up to 136·3%, CWF had a negative effect on proliferation over time (80·3%). Expression of b-FGF, vascular endothelial growth factor (VEGF) and matrix metalloproteinase-9 was strongly induced by CWF compared with a mild induction by AWF. These results give an insight into impaired ASC function in chronic wounds. The detected effect of CWF on proliferation and migration of ASC might be one reason for an insufficient healing process in chronic wounds.

Tissue viability nurses' experiences of managing wound exudate.

Wound exudate presents several challenges for patients and nurses. The description of exudate volume, colour and viscosity varies greatly, often depending on the personal preference of the nurse. When the nature and volume of exudate has been described, management of exudate presents its own issues in terms of ensuring that the appropriate dressing or intervention is selected and used effectively. This article reports on the outcomes of a series of discussion groups held to explore the difficulties tissue viability nurse specialists experience in relation to advising non-specialist nurses about wound exudate in the practice setting.

Exudate: friend or foe?

Wound exudate is an essential component in the normal process of wound healing. However, excess exudate has always been a major challenge for clinicians and a source of embarrassment and discomfort for the patient. The challenge for healthcare staff is to provide a wound healing environment that offers the optimal amount of exudate to promote healing. This article provides the reader with an understanding of the benefits and problems associated with exudate.

Automated detection of exudates and macula for grading of diabetic macular edema.

Medical systems based on state of the art image processing and pattern recognition techniques are very common now a day. These systems are of prime interest to provide basic health care facilities to patients and support to doctors. Diabetic macular edema is one of the retinal abnormalities in which diabetic patient suffers from severe vision loss due to affected macula. It affects the central vision of the person and causes total blindness in severe cases. In this article, we propose an intelligent system for detection and grading of macular edema to assist the ophthalmologists in early and automated detection of the disease. The proposed system consists of a novel method for accurate detection of macula using a detailed feature set and Gaussian mixtures model based classifier. We also present a new hybrid classifier as an ensemble of Gaussian mixture model and support vector machine for improved exudate detection even in the presence of other bright lesions which eventually leads to reliable classification of input retinal image in different stages of macular edema. The statistical analysis and comparative evaluation of proposed system with existing methods are performed on publicly available standard retinal image databases. The proposed system has achieved average value of 97.3%, 95.9% and 96.8% for sensitivity, specificity and accuracy respectively on both databases.

Ilizarov fixator pin site care: the role of crusts in the prevention of infection.

Pin site infection is one of the most common local complications after procedures using the Ilizarov fine wire fixator. In this study, the rate of infection was investigated in two groups of patients, representing two consecutive case series, undergoing fracture stabilisation or lower limb reconstruction using an Ilizarov fine wire fixator. Both groups received identical Russian-style pin site care, except in the first Group A where the crusts of dried exudate were removed at the time of pin site cleaning; while in the subsequent Group B, the adherent crusts were retained during cleaning. Pin site infection was diagnosed if the site was painful and inflamed or discharging. The first infected pin site while the fixator remained in situ was considered the outcome of interest. Group A consisted of 59 patients and Group B of 33 patients. A lower proportion of patients in Group B (12/33 - 36%) developed a pin site infection compared to Group A (36/59 - 61%) (p=0.023). However, once infection had developed, a greater proportion of patients in Group B required more than one course of antibiotics to treat the infection when compared to patients in Group A (p=0.005). No patient required hospitalisation for intravenous antibiotics or wire change in Group B (0/33), whereas 3/59 patients required hospitalisation in Group A; but this did not reach statistical significance (Chi-squared test, p=0.18). Retention of adherent crusts during Ilizarov fixator pin site care significantly protects against the development of pin site infection, but renders subsequently infected pin sites more refractory to treatment. This study therefore suggests that crusts should be retained as long as a pin site remains uninfected. Retained crusts may act as a physical barrier to bacterial contamination ('biological dressing').