Anatomical classification of canine congenital extrahepatic portosystemic shunts based on CT angiography: A SVSTS and VIRIES multi-institutional study in 1082 dogs.

Canine congenital extrahepatic portosystemic shunt (EHPSS) morphologies have not been fully elucidated. The goal of this retrospective, multi-institutional study was to use CT angiography to create an anatomical-based nomenclature system for canine congenital EHPSS. These shunt morphologies were then evaluated to identify any significant association with patient age, sex, breed, weight, or subjective portal perfusion score. Data collected respectively from the SVSTS and VIRIES list-serves included patient DOB, sex, breed, weight, CT date, and reported diagnosis. A single author (C.W.) viewed all CT scans and classified shunts based on the shunt portal vessel(s) of origin, the shunt systemic vessel(s) of insertion, and any substantial portal vessels contributing to the shunt. Additionally, hepatic portal perfusion was subjectively scored between one (poor/none) and five (good/normal) based on the caliber of the intrahepatic portal veins. A total of 1182 CT scans were submitted from 13 different institutions. Due to exclusion criteria, 100 (8.5%) were removed, leaving 1082 CT scans to be included. Forty-five different EHPSS anatomies were identified with five classifications accounting for 85% of all shunts (left gastric-phrenic [27%], left gastric-azygos [19%], left gastric-caval [15%], aberrant left gastric-caval with right gastric vein [12%], and aberrant left gastric-caval with right gastric vein and short gastric vein [11%]). Shunt origin involved the left gastric vein in 95% of the described classifications. Significant differences were identified among the five most common shunt types with respect to age at the time of the CT scan (P < .001), sex (P = .009), breed (P < .001), weight (P < .001), and subjective portal perfusion score (P < .001). An anatomical classification system for canine EHPSS may enable improved understanding, treatment comparisons, and outcome prediction for these patients.

Description and evaluation of a novel transoral endoscopic arytenopexy in canine cadavers.

OBJECTIVE: To describe the transoral endoscopic arytenopexy (TEA) and evaluate its effects on the rima glottis area (RGA) and laryngeal epiglottic-glottic seal (LEGS). We hypothesize the TEA will be a feasible surgical technique and the TEA will provide a significant increase in RGA with minimal change to the LEGS. STUDY DESIGN: Canine cadaveric model. ANIMALS: Fifteen medium- to large-breed canine cadavers. METHODS: Endoscopic photos of the larynx were taken with the epiglottis open for baseline RGA measurement and closed for baseline measurement of exposed RGA and LEGS. A custom endoscopic gag port (EGP) facilitated the TEA, performed by suturing the lateral aspect of the left arytenoid soft tissues to adjacent pharyngeal wall across the piriform recess. Endoscopic photos were repeated to measure changes in RGA and LEGS. A computerized planimetric analysis program was used to calculate baseline RGA and LEGS. The RGA was reported in % change from baseline. The LEGS was reported as intact or altered. A nonparametric Wilcoxon signed-rank test was used to compare baseline to post-TEA RGA. RESULTS: The mean baseline RGA was 0.52 ± 0.28 cm3 and mean post-TEA RGA was 0.78 ± 0.37 cm3 (p-value < .0001). The LEGS remained intact post-TEA in all cadavers. CONCLUSIONS: The TEA was technically feasible and resulted in an increase in RGA while maintaining the LEGS. CLINICAL SIGNIFICANCE: The TEA may provide a minimally invasive addition to the established techniques for reducing airway resistance while minimizing the impact on the LEGS.

Prospective evaluation of lymphatic embolization as part of the treatment in dogs with presumptive idiopathic chylothorax.

OBJECTIVE: To describe the embolization technique and short-term clinical outcome in dogs undergoing lymphatic embolization (LE) as part of treatment for presumptive idiopathic chylothorax (IC). Additionally, to document findings in computed tomography lymphangiography (CTLa) following embolization. STUDY DESIGN: Prospective case series. ANIMALS: Eight client-owned dogs. METHODS: Dogs underwent CTLa followed by thoracic duct ligation (TDL), pericardiectomy (PC) and LE. A mixture of 3:1 lipiodol: n-butyl cyanoacrylate embolic solution was injected through a catheterized mesenteric lymphatic vessel via limited abdominal approach using intraoperative fluoroscopy. CTLa was scheduled for 12 weeks postoperatively, and long-term follow-up was obtained via telephone contact. RESULTS: LE was technically successful in six of the eight dogs; and clinically successful in five of the six dogs. In the unsuccessful dog, a diagnosis of lymphangiosarcoma was determined, and the owners elected for euthanasia. Five dogs who underwent successful LE underwent CTLa at 12 weeks. Complete resolution of pleural effusion occurred in three dogs and scant pleural effusion in two dogs. A robust lymphatic embolus preventing antegrade continuation of radiocontrast was documented in all five dogs. Five of the six dogs that underwent LE, were alive and clinically normal at 358-960 days postoperatively. CONCLUSIONS: LE is a feasible part of treatment for dogs with IC. Additionally, a robust lymphatic embolus and lack of radiocontrast flow past the embolus was documented at 12 weeks following surgery. CLINICAL SIGNIFICANCE: LE has the potential to reduce surgical failure by reducing efferent lymphatic chyle flow, occluding missed lymphatic branches and preventing the development of collateral branches.

Long-term outcome and quality of life of dogs that developed neurologic signs after surgical treatment of a congenital portosystemic shunt: 50 cases (2005-2020).

OBJECTIVE: To determine survival time and quality of life of dogs that developed postattenuation neurologic signs (PANS) after surgical treatment of a single congenital portosystemic shunt and survived at least 30 days and identify whether neurologic signs present at the time of discharge would resolve or reoccur. ANIMALS: 50 client-owned dogs. PROCEDURES: Medical records were retrospectively reviewed, and follow-up data relating to neurologic signs and seizure activity were obtained. Owners were asked to complete a questionnaire related to the presence of neurologic signs, including seizures, and their dog's quality of life. RESULTS: Thirty of the 50 (60%) dogs had postattenuation seizures with or without other nonseizure neurologic signs, and 20 (40%) had neurologic signs other than seizures. Neurologic signs had fully resolved by the time of discharge in 24 (48%) dogs. Signs resolved in 18 of the remaining 26 (69%) dogs that still had PANS other than seizures at the time of discharge. Seizures reoccurred in 15 of the 30 dogs that had postattenuation seizures. Twenty-seven of 33 (82%) owners graded their dog's long-term (> 30 days after surgery) quality-of-life as high. Forty-five (90%) dogs survived > 6 months. Most (29/43 [67%]) neurologic signs (other than seizures) present at the time of hospital discharge resolved. CLINICAL RELEVANCE: Findings highlighted that survival times of > 6 months and a high QOL can be achieved in most dogs with PANS that survive at least 30 days. Most neurologic signs other than seizures resolved within 1 month postoperatively. Half of the dogs with postattenuation seizures had a reoccurrence.

WEScover: selection between clinical whole exome sequencing and gene panel testing.

BACKGROUND: Whole exome sequencing (WES) is widely adopted in clinical and research settings; however, one of the practical concerns is the potential false negatives due to incomplete breadth and depth of coverage for several exons in clinically implicated genes. In some cases, a targeted gene panel testing may be a dependable option to ascertain true negatives for genomic variants in known disease-associated genes. We developed a web-based tool to quickly gauge whether all genes of interest would be reliably covered by WES or whether targeted gene panel testing should be considered instead to minimize false negatives in candidate genes. RESULTS: WEScover is a novel web application that provides an intuitive user interface for discovering breadth and depth of coverage across population-scale WES datasets, searching either by phenotype, by targeted gene panel(s) or by gene(s). Moreover, the application shows metrics from the Genome Aggregation Database to provide gene-centric view on breadth of coverage. CONCLUSIONS: WEScover allows users to efficiently query genes and phenotypes for the coverage of associated exons by WES and recommends use of panel tests for the genes with potential incomplete coverage by WES.

Evaluation of intraoperative leak testing of small intestinal anastomoses performed by hand-sewn and stapled techniques in dogs: 131 cases (2008-2019).

OBJECTIVE: To compare the rate of postoperative dehiscence on the basis of intraoperative anastomotic leak test results (ie, positive or negative for leakage or testing not performed) between dogs that underwent hand-sewn anastomosis (HSA) or functional end-to-end stapled anastomosis (FEESA) of the small intestine. ANIMALS: 131 client-owned dogs that underwent 144 small intestinal anastomoses (94 FEESA and 50 HSA). PROCEDURES: Medical records were searched to identify dogs that had undergone a small intestinal anastomosis (HSA or FEESA) from January 2008 through October 2019. Data were collected regarding signalment, indication for surgery, location of the anastomosis, surgical technique, the presence of preoperative septic peritonitis, performance of intraoperative leak testing, development of postoperative dehiscence, and duration of follow-up. RESULTS: Intraoperative leak testing was performed during 62 of 144 (43.1%) small intestinal anastomoses, which included 26 of 94 (27.7%) FEESAs and 36 of 50 (72.0%) HSAs. Thirteen of 144 (9.0%) anastomoses underwent dehiscence after surgery (median, 4 days; range, 2 to 17 days), with subsequent septic peritonitis, including 10 of 94 (10.6%) FEESAs and 3 of 50 (6.0%) HSAs. The incidence of postoperative dehiscence was not significantly different between FEESAs and HSAs; between anastomoses that underwent intraoperative leak testing and those that did not, regardless of anastomotic technique; or between anastomoses with positive and negative leak test results. Hand-sewn anastomoses were significantly more likely to undergo leak testing than FEESAs. Preoperative septic peritonitis, use of omental or serosal reinforcement, preoperative serum albumin concentration, and surgical indication were not significantly different between anastomotic techniques. CONCLUSIONS AND CLINICAL RELEVANCE: Performance of intraoperative anastomotic leak testing, regardless of the anastomotic technique, was not associated with a reduction in the incidence of postoperative anastomotic dehiscence.

Transperiferismo, necropolítica y sufrimiento social. Etnografía experimental sobre las condiciones de vida de inmigrantes venezolanos en el Caribe colombiano / Transperiferism, Necropolitics and social suffering. Experimental ethnography on the living conditions of Venezuelan immigrants in the Colombian Caribbean

RESUMEN Objetivos En este trabajo exploramos la crueldad y el sufrimiento que experimentan inmigrantes venezolanos que habitan en un asentamiento irregular llamado Villa Caracas, en la periferia de Barranquilla. Nuestro objetivo principal se centró en analizar desde una perspectiva antropológica y filosófica la condición de lo humano, el dolor que toma forma a raíz de la extrema precariedad material manifiesta en el flujo transnacional migratorio entre Venezuela y Colombia. Método A través de una etnografía extendida por cerca de 6 meses, hecha mediante observación participante, entrevistas semiestructuradas y relatos de vida, describimos el sufrimiento social del inmigrante en su tránsito, asentamiento y supervivencia cotidiana. Resultados Los resultados preliminares de esta investigación nos llevaron a formular el concepto de transperiferismo como una categoría que engloba transversalmente el fenómeno migratorio con una perspectiva urbana.

ABSTRACT Objective In this research we explore the cruelty and suffering experienced by a high percentage of Venezuelan immigrants who live in an irregular settlement called Villa Caracas on the outskirts of Barranquilla. Our main objective focused on analyzing from an anthropological and philosophical perspective the condition of the human, the pain that takes shape because of the extreme material precariousness manifested in the transnational migratory flow between Venezuela and Colombia. Method Through an ethnography extended for about 6 months applying participant observation, semi-structured interviews and life stories, we describe the social suffering that the immigrant experiences in their transit, settlement and daily survival. Result Based on the research, we formulate the concept of trans-periphery as a cate-gory that transversally encompasses the migratory phenomenon in cities.

The Clinical Genome and Ancestry Report: An interactive web application for prioritizing clinically implicated variants from genome sequencing data with ancestry composition.

Genome sequencing is positioned as a routine clinical work-up for diverse clinical conditions. A commonly used approach to highlight candidate variants with potential clinical implication is to search over locus- and gene-centric knowledge databases. Most web-based applications allow a federated query across diverse databases for a single variant; however, sifting through a large number of genomic variants with combination of filtering criteria is a substantial challenge. Here we describe the Clinical Genome and Ancestry Report (CGAR), an interactive web application developed to follow clinical interpretation workflows by organizing variants into seven categories: (1) reported disease-associated variants, (2) rare- and high-impact variants in putative disease-associated genes, (3) secondary findings that the American College of Medical Genetics and Genomics recommends reporting back to patients, (4) actionable pharmacogenomic variants, (5) focused reports for candidate genes, (6) de novo variant candidates for trio analysis, and (7) germline and somatic variants implicated in cancer risk, diagnosis, treatment and prognosis. For each variant, a comprehensive list of external links to variant-centric and phenotype databases are provided. Furthermore, genotype-derived ancestral composition is used to highlight allele frequencies from a matched population since some disease-associated variants show a wide variation between populations. CGAR is an open-source software and is available at https://tom.tch.harvard.edu/apps/cgar/.

Prevalence and impact of cholecystitis on outcome in dogs with gallbladder mucocele.

BACKGROUND: Gallbladder mucocele is a potentially life-threatening extrahepatic biliary disease in dogs. The primary aims of this study were to evaluate the prevalence of cholecystitis in dogs with gross and histopathologically confirmed gallbladder mucocele and to investigate if there is an association between cholecystitis, including its subtypes (eg, acute, acute on chronic, with necrosis, chronic), and survival. Our secondary objective was to evaluate if there is an association between cholecystitis and intraoperative bacteriological culture positivity. KEY FINDINGS: Two hundred nineteen dogs with gallbladder mucocele were included in this multi-institutional retrospective study, of which 63 (28.8%) dogs had histopathological evidence of cholecystitis. The most common forms of cholecystitis were acute on chronic (n = 22/63, 34.9%) and with necrosis (n = 20, 31.7%). Thirty-one (14.1%) dogs had growth of at least 1 bacterial isolate; however, 88.7% had antimicrobials administered within the 48 hours before surgery or intraoperatively. There was not an association between cholecystitis or its subtypes and survival. Furthermore, there was not an association between cholecystitis and intraoperative bacteriological culture positivity. A total of 38 (17.4%) dogs either died or were euthanized during hospitalization. SIGNIFICANCE: Cholecystitis is a common comorbidity in dogs with gallbladder mucocele but was not associated with decreased survival.

Softepigen: Primers Design Web-Based Tool for MS-HRM Technique.

Polymerase Chain Reaction (PCR) based techniques for DNA methylation techniques includes the MS-HRM technique. Methylation Sensitive High-Resolution Melting (MS-HRM) primer-design requires a set of necessary recommendations for such DNA methylation assessment. However, there were not any available software that allows an automatic design of this kind primers. We present Softepigen, the first complete MS-HRM primer design software. Softepigen allows to search for primers in a genomic region following Wojdacz's recommendations and targets primer binding regions with high linguistic complexity sequences that increase the specificity of the converted sequence of the human genome. We performed in-silico PCR analysis through BiSearch ePCR tool to validate the specificity of the of the primers designed using Softepigen. Softepigen for MS-HRM performance in our genomic regions of interest show satisfactory specificity measurements, and we implemented it for freely available use in the web-based interface at www.soft-epigen.com.

Burkitt lymphoma of the maxilla in a HIV positive male - Presentation and review of diagnostic laboratory tests.

Burkitt lymphoma (BL) is a highly aggressive, B cell non-Hodgkin lymphoma (NHL) that is rare outside Africa. We report a case of HIV-associated BL originating in the right maxillary sinus in a 31-year-old Hispanic male living in Washington, USA. We also highlight the diagnostic challenges in arriving at the diagnosis when the patient initially presented with a painless right facial swelling. Rapid diagnosis and treatment are critical because BL is one of the fastest-growing tumors. Treatment involves brief duration of high intensity chemotherapy and central nervous system prophylaxis. It is important for oral and maxillofacial surgeons to recognize this disease and understand the necessary steps to treat this aggressive tumor.

Química prebiótica y carcinoma nasal reporte de caso revisión de la literatura y propuesta del cáncer como adaptación evolutiva a la unicelularidad / Prebiotic Chemistry and nasal carcinoma a case report literature review and proposal of cancer as evolutionary adaptation to unicellularity

La contaminación actual ha impregnado no sólo cuanto nicho ecológico existe, sino nuestros tejidos, a tal punto que puede llevar a las células más sensibles, vía activación de genes atávicos, a la cancerización. La patogénesis del cáncer aún no está elucidada. En este trabajo, valiéndonos de un caso clínico y una perspectiva evolutiva, exploramos el potencial de la fisicoquímica prebiótica (originadora de la vida) en el esclarecimiento etiológico del cáncer. Por tanto, nuestro objetivo es correlacionar cáncer, unicelularidad y elementos afines a la química prebiótica entre sí.

The current contamination has impregnated not only what ecological niche exists, but our tissues, to the point that it can lead to the most sensitive cells, via the activation of atavistic genes, to cancerization. The pathogenesis of cancer is not yet elucidated. In this work, using a clinical case and an evolutionary perspective, we explore the potential of prebiotic physicochemistry (originator of life) in the etiological clarification of cancer. Therefore, our objective is to correlate cancer, unicellularity and elements related to prebiotic chemistry.

γ-Aminobutyric acid type A receptor inhibition triggers a nicotinic neuroprotective mechanism.

Nicotinic acetylcholine receptor (nAChR)-mediated neuroprotection has been implicated in the treatment of neurodegenerative disorders such as Alzheimer's and Parkinson's diseases and hypoxic ischemic events as well as other diseases hallmarked by excitotoxic and apoptotic neuronal death. Several modalities of nicotinic neuroprotection have been reported. However, although this process generally involves α4ß2 and α7 subtypes, the underlying mechanisms are largely unknown. Interestingly, both activation and inhibition of α7 nAChRs have been reported to be neuroprotective. We have shown that inhibition of α7 nAChRs protects the function of acute hippocampal slices against excitotoxicity in an α4ß2-dependent manner. Neuroprotection was assessed as the prevention of the N-methyl-D-aspartate-dependent loss of the area of population spikes (PSs) in the CA1 area of acute hippocampal slices. Our results support a model in which α7 AChRs control the release of γ-aminobutyric acid (GABA). Blocking either α7 or GABA(A) receptors reduces the inhibitory tone on cholinergic terminals, thereby promoting α4ß2 activation, which in turn mediates neuroprotection. These results shed light on how α7 nAChR inhibition can be neuroprotective through a mechanism mediated by activation of α4ß2 nAChRs.

Mucocele nasofacial: una presentación inusual de un quiste común nasofacial / Mucocele: an unusual presentation of a common cyst

Objetivo: reportamos un caso raro de mucocele nasofacial, correspondiente a una presentación primaria en una anciana con historia de carcinoma de cabeza y cuello, el cual fue tratado con radioterapia. Reporte de caso: mujer de 90 años de edad, que presenta masa subcutánea indolora en vestíbulo nasal y ángulo nasofacial, de crecimiento progresivo lento, de diez años de evolución. La CT muestra una masa en el vestíbulo nasal, con extensión facial. Tratamiento: la escisión quirúrgica de la masa confi rmó el diagnóstico. Luego de un año no hay recurrencia del mucocele. Conclusión: los mucoceles en el vestíbulo nasal son extremadamente raros, pero pueden presentarse en pacientes con antecedentes de radioterapia. Una masa nasofacial de tejido blando subcutánea puede ser signo positivo de un mucocele nasal. El caso es discutido, por lo cual se revisa la literatura pertinente.

Objective: To report a rare case of nasofacial mucocele which was the initial presentation of a head and neck carcinoma occurring in old woman who had been treated with radiotherapy. Case Report: A 90 year-old woman presented to the outpatient clinic with a painless slowly progressive subcutaneous swelling that had been growing over the previous 10 years and located in the nasal vestibule and the nasofacial angle. CT showed a mass in the nasal vestibule with facial extension. Treatment: Surgical excision of the mass was performed and histopathological examination confi rmed the diagnosis. At one year follow up, there was no recurrence.

Cáncer de pene: presentación de un caso en Gambia / Cancer of the penis: a case in Gambia

Se presenta un caso de 65 años de edad que acude a consulta de Urología por presentar lesión microscópica (úlcera indolora), de más o menos 3 cm, situada en el glande. Se le realiza biopsia y se estadio en un T1N0M0, de acuerdo al sistema de estadiaje propuesto por Jackson en 1966. El estadio I es el tumor confirmado a glande o prepucio. Se practica amputación parcial del pene con evaluación favorable (AU)

Rabdomiosarcoma paratesticular en pediatria: informe de un caso / Paratesticular rhabdomyosarcoma in pediatrics: a case report

Los rabdomiosarcomas paratesticulares son tumores agresivos, raros, aparentemente de buen pronóstico cuando se presentan en niños y malo en adultos. se presenta el caso de un niño de 15 años, que cursó con dolor durante la marcha en el miembro pélvico izquierdo con irradiación al testículo, aumento de volumen en la región escrotal y testicular izquierdas, y sin adenomegalias inguinales, de cuatro meses de evolución. La tomografía axial computada y el ultrasonido evidenciaron tumor testicular. Se realizó orquiectomía. El diagnóstico histológico fue de rabdomiosarcoma embrionario con áreas alveolares. Se discute la presentación en adultos (AU)

Nefroma mesoblastico congenito: informe de un caso / Congenital mesoblastic nephroma: a case report

Se informa el primer caso de nefroma mesoblástico reportado en la literatura médica guantanamera. Se trata de un lactante de seis meses remitido a la consulta urológica especializada por orinas hematúricas. En la evaluación clínica e Imageneológica se establece el diagnóstico de tumoración renal sólida, siendo intervenido quirúrgicamente a las 72 horas con excelentes resultados, patología confirmó el diagnóstico preoperatorio de nefroma mesoblástico congénito. El nefroma mesoblástico es una tumoración renal congénita benigna sumamente rara, existen menos de 200 casos en el mundo (AU)

Tratamiento quirurgico de Hipospadias: estudio de 5 años / Surgical tratement of hypospadias: 5 years study

El hipospadias es una patología congénita en la que el meato o apertura de la uretra se encuentra en la cara ventral del pene en lugar de localizarse en la punta. Su frecuencia va en aumento en los últimos años a nivel mundial. En nuestro servicio de urología infantil del hospital pediátrico docente Pedro A Pérez se han realizado en los últimos cinco años 60 intervenciones correctoras. Se evalúa la incidencia y el tratamiento quirúrgico del hipospadias entre 2002 y 2006, caracterizándose algunas variables epidemiológicas y las técnicas quirúrgicas y sus complicaciones. Se concluye que el hipospadias del tipo peneano distal fue el más incidente, con un 43,3 por ciento, al tiempo que la edad al momento de la intervención estuvo entre el 1er y el 5to año de vida en casi dos tercios de la casuística. La técnica más utilizada fue el adelantamiento meatal y glanuloplastia (magpi), y todos los pacientes con hipospadias del tipo distales fueron intervenidos mediante esta técnica. Las complicaciones mas frecuentes fueron las fístulas y las dehiscencias de las suturas. Los resultados se presentan en cuadros (AU)