Clinical and pathological examination of mycotoxicosis as an associated risk factor for colic in equine.

A retrospective cohort study was conducted on two Egyptian horse farms with most of horses were suffered from abdominal pain to describe the associations between the occurrence of mycotoxicosis and equine colic. The farms owner complain was an unexpected increase in number of colic cases and deaths among horses. The association between colic and risk factors (sex, type of food either dry or mixed with roughages and hematobiochemical parameters) was compared using independent sample T-test. The associations between possible prognostic indicators for colic caused by mycotoxicosis was estimated using logistic regression analysis model. The cumulative incidence, incidence rates for colic attacks, survival rate among diseased horses were additionally estimated. Our results showed that a total of 24 out of the 132 horses suffered from colic due to feeding of ration contaminated with high percent of mycotoxin including Aflatoxins, Ochratoxins and or fusarium mycotoxins. The total cumulative incidence of colic due to mycotoxicosis was 19.7%. The horses fed on dry rations had more chance of developing colic than horses fed on mixed rations (P < 0.05). The overall incidence rate of colic due to mycotoxicosis was estimated at 18 colic attack/1000 horse/month. The mortality rate of horses suffered from colic due to mycotoxicosis was estimated at 5.9% (5/85), while the case fatality rate was estimated at 25% (n = 5/20). Inconclusion, our results showed that mycotoxicosis are considered an important risks factor for colic cases development in equine practice.

Long-term (>10-year) clinical follow-up after young embolic stroke/TIA of undetermined source.

BACKGROUND: To date, the pathophysiology of first-ever and recurrent stroke/TIA still remains unclear in young patients with embolic stroke/TIA of undetermined source (ESUS). Clinical studies with long-term follow-up in young ESUS patients are necessary to investigate the underlying pathophysiology of first-ever and recurrent stroke/TIA in this patient population, in particular the role of new-onset atrial fibrillation. AIMS: Our aim was to study the long-term (>10-year) clinical outcome of young patients (<50 years) with ESUS. METHODS: This cohort study included all patients aged ≤ 50 years who underwent transoesophageal echocardiography for diagnostic work-up of ESUS during 1996-2008 from one tertiary center. All patients were contacted by telephone between September-November 2018 to update clinical information from medical records. The clinical outcomes of this study were incidence rates of all-cause and cardiovascular mortality, recurrent stroke/TIA, new-onset clinical AF, and ischemic vascular events. RESULTS: In total, 108 patients (57% female, mean age 40 ± 7.2 years [range 19-50 years], n = 72 stroke) were included. Across clinical follow-up (median 13[IQR 10-16] years), 24 patients died (n = 14 cardiovascular). The 15-year incidence rate of recurrent stroke/TIA was 15% (incidence rate = 1.09[95%CI 0.54-1.65]/100 patient-years) and a 5.5% incidence of new-onset clinical AF (incidence rate = 0.44[95%CI 0.09-0.79]/100 patient-years) following ESUS. CONCLUSIONS: The incidence of recurrent stroke/TIA is relatively high during long-term clinical follow-up of young patients with ESUS. In contrast, new-onset clinical AF is relatively low and therefore may not play an important part in the pathophysiology of first-ever and recurrent stroke/TIA of these patients.

Computer-assisted surgery for replacement of the temporomandibular joint with customized prostheses: can we validate the results?

PURPOSE: Replacing the temporomandibular joint poses an important challenge to maxillofacial surgeons, and for certain disorders, it represents the treatment's gold standard. Computer-assisted surgery (comprising preoperative virtual planning, virtual intraoperative navigation and 3D printing) is a useful tool for this type of surgery. However, we do not know if and how much the final position of the prosthesis differs, in absolute values, from what was planned virtually in the preoperative phase. We propose a comparative result validation system for temporomandibular joint replacement METHODS: In the present study, we propose a comparative validation system using overlapping images, between the model obtained with preoperative virtual planning and the postoperative result. RESULTS: The mean difference for all screws of the glenoid prosthesis was 2.08 mm (range, 1.20-3.03) and for all screws of the condylar prosthesis it was 2.33 mm (range, 1.16-3.56). Mean overall difference between both prostheses in all patients was 2.21 mm (range, 1.16-3.56). CONCLUSIONS: The validation system proposed by overlapping pre- and postoperative images in temporomandibular joint replacement allowed us to establish differences in absolute values between the virtual preoperative model and the actual postoperative result expressed in millimeters.

Network approach identifies Pacer as an autophagy protein involved in ALS pathogenesis.

BACKGROUND: Amyotrophic lateral sclerosis (ALS) is a multifactorial fatal motoneuron disease without a cure. Ten percent of ALS cases can be pointed to a clear genetic cause, while the remaining 90% is classified as sporadic. Our study was aimed to uncover new connections within the ALS network through a bioinformatic approach, by which we identified C13orf18, recently named Pacer, as a new component of the autophagic machinery and potentially involved in ALS pathogenesis. METHODS: Initially, we identified Pacer using a network-based bioinformatic analysis. Expression of Pacer was then investigated in vivo using spinal cord tissue from two ALS mouse models (SOD1G93A and TDP43A315T) and sporadic ALS patients. Mechanistic studies were performed in cell culture using the mouse motoneuron cell line NSC34. Loss of function of Pacer was achieved by knockdown using short-hairpin constructs. The effect of Pacer repression was investigated in the context of autophagy, SOD1 aggregation, and neuronal death. RESULTS: Using an unbiased network-based approach, we integrated all available ALS data to identify new functional interactions involved in ALS pathogenesis. We found that Pacer associates to an ALS-specific subnetwork composed of components of the autophagy pathway, one of the main cellular processes affected in the disease. Interestingly, we found that Pacer levels are significantly reduced in spinal cord tissue from sporadic ALS patients and in tissues from two ALS mouse models. In vitro, Pacer deficiency lead to impaired autophagy and accumulation of ALS-associated protein aggregates, which correlated with the induction of cell death. CONCLUSIONS: This study, therefore, identifies Pacer as a new regulator of proteostasis associated with ALS pathology.

Can stress echocardiography identify patients who will benefit from percutaneous mitral valve repair?

The aim of the current study was to investigate whether stress echocardiography improves selection of patients who might have clinical benefit from percutaneous mitral valve repair with the MitraClip. In total, 39 patients selected for MitraClip implantation underwent preprocedural low-dose stress (dobutamine or handgrip) echocardiography from which stroke volume, ejection fraction and MR grade were measured. Outcome after MitraClip implantation was determined by New York Heart Association classification and Quality of Life questionnaires. Clinical benefit from MitraClip treatment was defined as survival and NYHA class I-II at 6 months follow-up. In total, 36 patients with a technically successful procedure were included in the analysis (mean age 79 ± 8 years, 47% male, 50% functional MR). Clinical benefit was achieved in 18 patients. All seven patients with MR decreasing during stress remained in NYHA III-IV or died within 6 months, while 62% (18 out of 29) of the patients with stable or increased MR during stress had clinical benefit (p = 0.008). Significant increase in Quality of Life on 4/8 subscales of the RAND Short Form-36 questionnaire was observed: Physical Functioning (p < 0.001), Social Functioning (p < 0.001), Mental Health (p = 0.022) and Vitality (p = 0.026) was seen in patients with an increase in stroke volume during stress echocardiography. Patients with a decreased MR during preprocedural stress echocardiography remained more symptomatic than patients with a stable or increased MR during stress. Stress echocardiography may support patient selection for percutaneous mitral valve repair.

Reduction of bilateral dislocation of TMJ and Rendu Osler Weber syndrome: case report and physiopathological model.

Temporomandibular joint dislocation (TMJ) is an infrequent clinical situation, representing 3% of all the human body's dislocations. The etiological factors reported are associated to alterations typical of the joint or of the muscular-ligament apparatus, or to clinical conditions that may cause dislocation. We present the case of a 46-year-old patient with hereditary hemorrhagic telangiectasia with bilateral dislocation of the TMJ. There are several potential causes (antipsychotics, intubation, etc.) although the deposit of manganese in the basal ganglia that produce extrapyramidal symptoms could be the most consistent cause.

Adenocarcinoma of the Colon Disguised as Abdominal Wall Abscess: Case Report and Review of the Literature.

INTRODUCTION: Abdominal wall invasion by cancerous cells arising from the colon with an overlying secondary infection that presents as an abdominal wall abscess has been encountered previously, but such a symptom is rarely the first presentation of colon cancer. There are very few cases reported in the literature. CASE PRESENTATION: In this case report, we present a case of a 66-year-old male presenting with abdominal wall abscess that was refractory to treatment. The patient later was found to have an abdominal wall invasion by an underlying colonic carcinoma. CONCLUSION: The purpose of this review is to set forth the proper approach when encountering such cases and emphasize on the significance of keeping a high index of suspicion. We also highlight the need for utilizing proper diagnostic imaging modalities prior to invasive intervention.

Relationship between atrial septal defects and asthma-like dyspnoea: the impact of transcatheter closure.

BACKGROUND: Patients with atrial septal defects (ASD) are often misdiagnosed as asthma patients and accordingly receive erroneous bronchodilator treatment. In order to characterise their symptoms of dyspnoea to explain this clinical observation, we investigated the prevalence of asthma-like symptoms in patients with secundum ASD who then underwent successful percutaneous closure. METHODS: A total of 80 ASD patients (74 % female, mean age 46.7 ± 16.8 years, median follow-up 3.0 [2.0-5.0] years) retrospectively completed dyspnoea questionnaires determining the presence and extent of cough, wheezing, chest tightness, effort dyspnoea and bronchodilator use on a 7-point scale (0 = none, 6 = maximum) before and after ASD closure. The Mini Asthma Quality of Life (Mini-AQLQ) and Asthma Control Questionnaire with bronchodilator use (ACQ6) were administered. RESULTS: A total of 48 (60 %) patients reported cough, 27 (34 %) wheezing, 26 (33 %) chest tightness and 62 (78 %) effort dyspnoea. Symptom resolution or reduction was found in 64 (80 %) patients after ASD closure. Asthma symptom scores decreased significantly on the Mini-AQLQ and ACQ6 (both p < 0.001). The number of patients using bronchodilators decreased from 16 (20 %) to 8 (10 %) patients after ASD closure (p = 0.039) with less frequent use of bronchodilators (p = 0.015). CONCLUSIONS: A high prevalence of asthma-like symptoms and bronchodilator use is present in ASD patients, which exceeds the low prevalence of bronchial asthma in this study population. Future prospective research is required to confirm this phenomenon. The presence of an ASD should be considered in the differential diagnosis of patients with asthma-like symptoms, after which significant symptom relief can be achieved by ASD closure.

Platypnoea-orthodeoxia syndrome, an underdiagnosed cause of hypoxaemia: four cases and the possible underlying mechanisms.

Cardiac platypnoea-orthodeoxia syndrome (POS) is a position-dependent condition of dyspnoea and hypoxaemia due to right-to-left shunting. It often remains unrecognised in clinical practice, possibly because of its complex underlying pathophysiology. We present four consecutive patients with POS and patent foramen ovale (PFO) who underwent a successful percutaneous PFO closure, describe the mechanism of their POS and provide a review of the literature.

Measurement of autophagy flux in the nervous system in vivo.

Accurate methods to measure autophagic activity in vivo in neurons are not available, and most of the studies are based on correlative and static measurements of autophagy markers, leading to conflicting interpretations. Autophagy is an essential homeostatic process involved in the degradation of diverse cellular components including organelles and protein aggregates. Autophagy impairment is emerging as a relevant factor driving neurodegeneration in many diseases. Moreover, strategies to modulate autophagy have been shown to provide protection against neurodegeneration. Here we describe a novel and simple strategy to express an autophagy flux reporter in the nervous system of adult animals by the intraventricular delivery of adeno-associated viruses (AAV) into newborn mice. Using this approach we efficiently expressed a monomeric tandem mCherry-GFP-LC3 construct in neurons of the peripheral and central nervous system, allowing the measurement of autophagy activity in pharmacological and disease settings.

Hyperthermic isolated limb perfusion for extremity soft tissue sarcomas: systematic review of clinical efficacy and quality assessment of reported trials.

BACKGROUND AND OBJECTIVES: Extremity soft tissue sarcomas (STS) are managed with radiotherapy and limb-sparing surgery however aggressive or recurrent cases require amputation. Hyperthermic isolated limb perfusion (HILP) has been proposed as an alternative. Our aim was to systematically review phase II HILP trials, assess tumor response, limb salvage (LS), and quality of scientific publications on this technique. METHODS: We conducted a literature search of electronic databases (MEDLINE, EMBASE, Scopus, Cochrane Library) and clinical trial registries for phase II HILP trials on non-resectable extremity STS. Outcomes of interest were complete response (CR), partial response (PR), and LS rates. Quality of published trials was assessed using a quality checklist. RESULTS: Of 518 patients across 12 studies, 408 had some response (CR or PR), and 428 had the limb spared. Median CR, PR, and LS rates were 31%, 53.5%, and 82.5%, respectively. Median Wieberdink loco-regional toxicity rates were 3.8%, 45.5%, 17%, 1%, and 0% for levels 1-5, respectively. No trial fulfilled either all ideal or essential quality criteria. Seven trials did not include statistical methodology. CONCLUSION: HILP seems effective in treating advanced extremity STS. However, poor publication quality hinders results validity. Technical and methodological standardization, well-designed, multi-institutional trials are warranted.

Bonding nano-filled resin-modified glass ionomer to dentin using different self-etch adhesives.

OBJECTIVE: To investigate the shear bond strength of the nano-filled resin-modified glass ionomer (RMGI) to dentin using different self-etch adhesives. MATERIALS AND METHODS: Two resin-based restorative materials, a nano-filled RMGI (Ketac Nano-100, 3M ESPE) and a restorative composite (Grandio, VOCO) were bonded to bovine dentin using four self-etch adhesives (Futurabond M, VOCO; Adper Easy Bond, 3M ESPE; G Bond, GC Corp; and One Coat, Coltène). One hundred bovine anterior teeth were used in this study. Subsequent to labial enamel removal, each adhesive was applied according to manufacturer instructions. Fifty teeth were restored with the nano-filled RMGI and the other 50 were restored with the resin composite. Cylinders of 3×2 mm from the two restorative materials were bonded to dentin, and the specimens were stored in distilled water for 24 hours. Shear bond strength testing was performed in a universal testing machine at a crosshead speed of 0.5 mm/min. Two randomly selected specimens from each group were chosen for evaluation by scanning electron microscopy (SEM). Failure modes were evaluated using the stereomicroscope. All data for shear bond strength in MPa were expressed as mean ± standard deviation (SD). Statistical analysis was carried out using SAS program (SAS, 1988). RESULTS: Two-way analysis of variance revealed that the adhesives, the restorative materials, and their interactions (adhesives and restorative materials) had a significant effect on the shear bond strength to bovine dentin. CONCLUSIONS: Self-etch adhesives used in this study can adequately bond the nano-filled RMGI to dentin.

Material properties of Thera-Band Tubing.

BACKGROUND AND PURPOSE: Thera-Band Tubing has been used in rehabilitation to provide resistance for exercise and splinting. However, the forces required to stretch the tubing have not been thoroughly quantified. Therefore, the therapist cannot assess, with certainty, how much force is applied when using a given length and type of Thera-Band Tubing. The purpose of this study was to quantify the material properties of Thera-Band Tubing. METHODS: Force versus percentage of strain for all types of Thera-Band Tubing was measured during elongation in a mechanical testing machine. RESULTS: The material is very compliant and displays nonlinear behavior in the initial stretching phase and linear behavior after 50% elongation. DISCUSSION AND CONCLUSION: From the data obtained in this project, plots that can provide the therapist with information about the forces needed for exercises with Thera-Band Tubing were generated. These data should allow therapists to make better choices about which size of tubing to use for each patient.