Objective and subjective assessment of Dupuytren's contracture.

This paper describes the evaluation options of Dupuytren's contracture by subjective and objective methods. There are various classification schemes named after their authors, including graphical representation for objective evaluation of the disease. Subjective assessment was performed in the form of a questionnaire for patients. The QuickDASH with a small specification for Dupuytren's contracture is the most commonly used questionnaire. The Southampton Dupuytren's Scoring Scheme questionnaire appears to be a higher specification. The classifications allow evaluation of treatment success to determine prognosis of the disease. The analysis of articles is based on PubMed search from the years 1967-2022, with 28 relevant articles were retrieved. Based on this analysis, the Tubiana classification appears to be the most appropriate one for patients with Dupuytren's contracture. Of patient questionnaires, the Southampton Dupuytren's Scoring Scheme meets these parameters.

Duodenal gastrinoma - case report.

INTRODUCTION: In our text, we want to highlight a rare diagnosis. CASE REPORT: A 54-year-old obese, hypertensive male smoker had been investigated for intermittent abdominal pain for 12 years. The first gastroscopy for a bleeding ulcer was conducted in 2010. In the subsequent years, repeated gastroscopies revealed variable involvement from the esophagus to the duodenum. Capsule enteroscopy did not provide further specification of the diagnosis. The patient underwent colonoscopy and MRI enterography multiple times, with no unequivocal pathological findings. In May 2022, he was admitted to our department for abdominal pain and vomiting. This time, gastroscopy revealed multiple small ulcers in the duodenum and jejunum with clots causing a mechanical obstruction. Chromogranin A was elevated, raising suspicion of gastrinoma. However, somatostatin receptor-based imaging (Octreoscan) was negative. Only the 68Ga-DOTATOC PET (positron emission tomography with the radiopharmaceutical DOTA, labeled with gallium-68) identified a lesion in the subhepatic region, which had no correlation on CT. We concluded the diagnosis as gastrinoma with the Zollinger-Ellison syndrome. Endoscopically, a 1cm tumor was found in the duodenum. In October 2022, the patient underwent an excision of the duodenal wall, and the pathology assessment confirmed our diagnosis of gastrinoma. CONCLUSION: With this case report, we want to emphasize the importance of taking into account neuroendocrine tumors in our differential diagnostic considerations. At the same time, we want to highlight that, according to ESMO recommendations, we should preferentially use 68Ga-DOTATOC PET/CT for the diagnosis instead of scintigraphic examination (111In-Octreoscan).

[From symptom to diagnosis-symptom checkers re-evaluated : Are symptom checkers finally sufficient and accurate to use? An update from the ENT perspective]. / Vom Symptom zur Diagnose ­ Tauglichkeit von Symptom-Checkern : Update aus Sicht der HNO.

BACKGROUND: Every seventh diagnosis is a misdiagnosis. Each year, 1.5 million lives could be saved worldwide with the correct diagnosis. Physicians have to consider over 20,000 diseases. A study from Harvard University published in 2015 tested 19 symptom checkers and found them to be insufficient, with only 29-71% accuracy in diagnosis. OBJECTIVE: The current study investigates the diagnostic accuracy of new symptom checkers from an ENT perspective. MATERIALS AND METHODS: The authors update the abovenamed diagnostic accuracy comparison by (1) including the five new symptom checkers Symptoma, Ada, FindZebra, Mediktor, and Babylon; and (2) normalizing results of the previously tested symptom checkers as to reflect each diagnostic accuracy based on the same set of patient vignettes. The winner is then compared to the two symptom checkers with the most scientific evidence, namely Isabel and FindZebra, on the basis of an ENT-specific test with patient vignettes sourced from the British Medical Journal. RESULTS: Most of the new symptom checkers demonstrated diagnostic accuracy rates within the previously established range, with the exception of Symptoma, which scored the right diagnosis in 82.2% of cases at the top of the list (+38% points), and in 100% of cases in the top 3 (+29% points) and the top 10 (+16% points), thus raising the bar in this field. The cross-validation with ENT cases resulted in a diagnostic accuracy of 64.3 vs. 21.4 vs. 26.2% (top 1), 92.9 vs. 40.5 vs. 42.9% (top 3), and 100 vs. 61.9 vs. 54.8% (top 10) for Symptoma vs. Isabel vs. FindZebra, respectively. CONCLUSIONS: Symptoma is the first and only viable solution in this market. Large-scale studies should be conducted to further validate these results as well as to assess the actual practical performance of the symptom checkers and their ability to diagnose rare diseases.

Efficacy and safety of pegylated full-length recombinant factor VIII with extended half-life for perioperative haemostasis in haemophilia A patients.

INTRODUCTION: BAX 855 is a pegylated full-length recombinant factor VIII (rFVIII) with an extended half-life, built on a licensed rFVIII (ADVATE(®) ). BAX 855 demonstrated efficacy and safety in prophylaxis and the treatment of bleeding episodes in previously treated patients (PTPs) with severe haemophilia A. AIM: This phase 3 surgery study evaluates the haemostatic efficacy and safety of BAX 855 for perioperative haemostasis in PTPs with severe haemophilia A undergoing surgery. METHODS: Elective procedures were prospectively classified as major or minor. The dose and frequency of BAX 855 administered perioperatively were to be guided by each patient's pharmacokinetic profile for major procedures or BAX 855 incremental recovery for minor procedures. Haemostatic efficacy was evaluated using a predefined scale. Blood loss was compared to the expected average and maximum blood loss predicted preoperatively. RESULTS: A total of 15 male patients (aged 19-52 years) underwent 15 procedures (11 major and four minor). The overall intra- and perioperative haemostatic efficacy of BAX 855 was 'excellent' in all 15 subjects (100%). Postoperatively, evaluated at postoperative Day 1, all treatments were 'excellent' except for one minor (dental) procedure which was rated 'good'. No related adverse events, allergic reactions, thrombotic events, nor signs of immunogenicity in terms of induction of binding antibodies to FVIII, PEG or PEG-VIII, or FVIII inhibitors were observed. CONCLUSION: These results demonstrate that BAX 855 is safe and haemostatically effective in patients with severe haemophilia A undergoing surgery.

Prorenin Receptor Homologue VHA-20 is Critical for Intestinal pH Regulation, Ion and Water Management and Larval Development in C. elegans.

The prorenin receptor (ATP6AP2) is a multifunctional transmembrane protein; it is a constituent of proton-translocating V-ATPase, a non-proteolytic activator of renin and an adaptor in the Wnt/ß-catenin pathway. Here, we studied vha-20, one of the two prorenin receptor homologues that are identified by sequence similarity in the C. elegans genome. We show that vha-20 (R03E1.2) is prominently expressed in the intestine, in the excretory cell and in amphid neurons, tissues critical for regulation of ion and water management. The expression of vha-20 in the intestine is dependent on NHR-31, a nuclear receptor related to HNF4. VHA-20 is indispensable for normal larval development, acidification of the intestine, and is required for nutrient uptake. Inhibition of vha-20 by RNAi leads to complex deterioration of water and pH gradients at the level of the whole organism including distention of pseudocoelome cavity. This suggests new roles of prorenin receptor in the regulation of body ion and water management and in acidification of intestinal lumen in nematodes.

Chelator-based catheter lock solutions in eradicating organisms in biofilm.

Two different chelator-based antimicrobial catheter lock solutions, methylene blue-citrate-parabens (MB-CIT) and minocycline-EDTA-25% ethanol (M-EDTA-25% ETOH), were compared in 2-h biofilm eradication experiments. Eradication of both mature and immature Gram-positive, Gram-negative, and fungal biofilms was assessed. M-EDTA-25% ETOH was able to fully eradicate all biofilms within 2 h. MB-CIT was only effective against immature biofilms but was unable to fully eradicate most of the mature biofilms tested.

Anti-adherence activity and antimicrobial durability of anti-infective-coated catheters against multidrug-resistant bacteria.

OBJECTIVES: To investigate the anti-adherence and antimicrobial durability of anti-infective catheters against multidrug-resistant (MDR) Staphylococcus aureus (resistant to vancomycin, rifampicin and methicillin) and MDR Gram-negative bacteria (Stenotrophomonas maltophilia, Acinetobacter baumannii/calcoaceticus and Enterobacter agglomerans) that are often associated with catheter-related bloodstream infections (CRBSIs). METHODS: Catheters impregnated with minocycline and rifampicin (M/R) or with silver-platinum and carbon (SPC) or with chlorhexidine and silver sulfadiazine (CHX/SS) were compared with non-coated catheters. Adherence of organisms was tested by using an established biofilm colonization model. All isolates were rifampicin-resistant. Antimicrobial durability was tested by soaking 1 cm segments of the catheter in serum and determining zones of inhibition against the tested organisms at weekly intervals. RESULTS: The M/R catheters showed significantly superior anti-adherence activity and more prolonged antimicrobial durability when compared with CHX/SS-central venous catheter (CVC), SPC-CVC and uncoated control catheters against MDR and vancomycin-resistant S. aureus (MDR VRSA) (all P values < or = 0.02), MDR S. maltophilia (all P values < 0.005) and MDR A. baumannii/calcoaceticus (all P values < 0.002), respectively. M/R-CVC and CHX/SS-CVC had comparable anti-adherence and antimicrobial durability against MDR E. agglomerans, and these two were superior to SPC-CVC and the uncoated control catheters (all P values < 0.001). CONCLUSIONS: M/R-CVC demonstrated superior anti-adherence activity and more prolonged antimicrobial durability when compared with other approved anti-infective catheters against MDR VRSA and/or MDR Gram-negative bacteria that are often associated with CRBSIs. This finding could explain their efficacy and better performance in clinical studies.

Effect of nixtamalization (Alkaline cooking) on fumonisin-contaminated corn for production of masa and tortillas.

Studies were undertaken to determine the fate of the mycotoxins, fumonisins, during the process of alkaline cooking (nixtamalization), using normal-appearing corn that was naturally contaminated with fumonisin B(1) (FB(1)) at 8.79 ppm. Corn was processed into tortillas, starting with raw corn that was cooked with lime and allowed to steep overnight; the steeped corn (nixtamal) was washed and ground into masa, which was used to make tortillas. Calculations to determine how much of the original fumonisin remained in the finished products took into consideration that FB(1) will be converted to hydrolyzed fumonisin B(1) (HFB(1)) by the process of alkaline cooking. All fractions, including steeping and washing water, were weighed, and percent moisture and fumonisin content were determined. Tortillas contained approximately 0.50 ppm of FB(1), plus 0.36 ppm of HFB(1), which represented 18.5% of the initial FB(1) concentration. Three-fourths of the original amount of fumonisin was present in the liquid fractions, primarily as HFB(1). Nixtamalization significantly reduced the amount of fumonisin in maize.

Fumonisin content in masa and tortillas from Mexico.

Fumonisins, a family of mycotoxins produced by Fusarium moniliforme and Fusarium proliferatum, are found in maize worldwide and have been associated with animal diseases. There is concern that high dietary intake of a maize-based diet may expose people in Mexico and Central America to fumonisins. Nixtamalized maize products from Mexico and the United States were examined to evaluate methods for quantitation of the different forms of fumonisins. The chelating reagent EDTA (exceeding the calcium concentration by a factor of 1. 36) was added to enhance extraction of fumonisins because calcium remained in the samples as a result of processing. It was expected that the majority of the fumonisin detected would be in the hydrolyzed form, yet the highest level of hydrolyzed fumonisin B(1) detected was 0.1 ppm. The amount of fumonisin B(1) was significantly higher in Mexican samples (mean = 0.79 ppm) than in samples purchased in the United States (mean = 0.16 ppm).

Mycotoxin production by Fusarium proliferatum isolates from rice with Fusarium sheath rot disease.

Twenty samples of unpolished (rough) rice collected in Arkansas and Texas during the 1995 harvesting season from fields exhibiting Fusarium sheath rot disease or panicle blight were previously shown to include 8 samples positive for fumonisin B1 (FB1) in the range 2.2-5.2 ppm, and moniliformin (MON), but no beauvericin (BEA), deoxynivalenol, its derivatives or zearalenone were detected. Fifteen cultures of F. proliferatum were established from the 20 rough rice samples. Single spore isolates of each culture were grown on rice and tested for the production of fumonisins (FB1, FB2, FB3, etc.), MON and BEA. All 15 isolates produced FB1, FB2, MON and BEA in culture on rice. No deoxynivalenol, its derivatives or zearalenone were detected. Seven cultures produced FB1 at > 50 ppm (range 80-230 ppm), with the rest producing FB1 in the range 14-43 ppm. FB2 was produced in the range 5-47 ppm, and those cultures which produced the most FB1 also produced the most FB2. Of the 15 cultures producing MON, 11 produced it at > 100 ppm in the range 188-6018 ppm, with the rest producing in the range 7-64 ppm. BEA was produced in the range 109-1350 ppm. Other derivatives of fumonisins, including FA1, FA2 and partially hydrolyzed FB1, as well as several unknown metabolites including a compound with MW 414, were identified in culture extracts by continuous flow fast atom bombardment with ion spray mass spectrometry (CF/FAB/MS). Further study is needed to identify the factors that control production of FB1, MON and BEA by F. proliferatum in culture and in field samples.

In-vitro activity of trovafloxacin against clinical bacterial isolates from patients with cancer.

The antibacterial activity of trovafloxacin was compared with that of ciprofloxacin, levofloxacin, ofloxacin, sparfloxacin and norfloxacin against bacterial isolates from patients with cancer. In general, the activity of trovafloxacin was comparable to that of ciprofloxacin, levofloxacin and sparfloxacin against most Gram-negative isolates tested (minor differences in the activity of each agent against individual species were seen) and it was the most active agent tested against Stenotrophomonas maltophilia, inhibiting 80% of these isolates at <2.0 mg/L. Trovafloxacin was also the most active agent tested against Gram-positive organisms, including ciprofloxacin-susceptible strains and most ciprofloxacin- and methicillin-resistant staphylococci and enterococci. It was much more active than ciprofloxacin against streptococci, including Streptococcus pneumoniae and the viridans streptococci, and was also active against Bacillus cereus and Listeria monocytogenes, inhibiting all isolates at a concentration of <0.5 mg/L.

In-vitro activity of ramoplanin (a novel lipoglycopeptide), vancomycin, and teicoplanin against gram-positive clinical isolates from cancer patients.

The in-vitro activities of ramoplanin, vancomycin, and teicoplanin against Gram-positive organisms isolated from cancer patients were determined. Ramoplanin was the most active agent tested inhibiting all isolates at a concentration of < or = 0.5 mg/L. Although all isolates were also susceptible to vancomycin and teicoplanin, their activities were surpassed by that of ramoplanin. The activity of teicoplanin was moderately better than that of vancomycin against Bacillus cereus, Enterococcus faecium, Listeria monocytogenes, methicillin-resistant Staphylococcus aureus, and most streptococcal isolates, and was comparable to vancomycin for the remainder of the isolates tested.

Natural occurrence of gliotoxin in turkeys infected with Aspergillus fumigatus, Fresenius.

Thirteen samples of infected turkey lung tissue from cases of 'airsacculitis' were collected either at the processing plant or from a local turkey farm and subjected to cultural and gliotoxin analysis. Aspergillus fumigatus was isolated from 6 of the 13 samples; all isolates were determined to be gliotoxin producers when grown in laboratory culture and assayed by HPLC procedures. Gliotoxin was isolated from 5 of the 13 tissue but was not isolated from all tissues that were infected with A. fumigatus. Gliotoxin was isolated from which no A. fumigatus was isolated and it was not detected in three tissues from which gliotoxin-producing isolates of A. fumigatus were obtained. The ability of this pathogenic fungs to produce this immunomodulating compound in naturally infected turkeys provides further evidence that gliotoxin may be involved in the pathogenesis of the disease, aspergillosis of turkeys.

In vitro activity of FK-037, a novel parenteral cephalosporin, against bacterial isolates from neutropenic cancer patients.

The in vitro activity of FK-037, a novel parenteral cephalosporin, was compared to that of ceftazidime, aztreonam and piperacillin (agents often used in empiric regimens in cancer patients) against recent bacterial isolates from patients with cancer. FK-037 was either equal to or 2 to 16-fold more active than the comparative agents against members of the Enterobacteriaceae. It was also active against Acinetobacter spp., Aeromonas spp., Pseudomonas aeruginosa, and other Pseudomonas spp. Xanthomonas maltophilia and Alcaligenes denitrificans were relatively resistant to all four agents. FK-037 was also 4 to 16-fold more active against most gram-positive organisms (including some methicillin-resistant staphylococci) than was ceftazidime. Enterococcus spp., Listeria monocytogenes and Staphylococcus haemolyticus were relatively resistant to FK-037 and ceftazidime. Overall, FK-037 has a broad antimicrobial spectrum that includes the majority of gram-positive and gram-negative isolates.