An ectomesenchymal chondromyxoid tumour on the lateral border of the tongue.

Ectomesenchymal chondromyxoid tumour (ECT) is an extremely rare intraoral mesenchymal tumour. Most of these tumours have been identified on the anterior aspect of the dorsal surface of the tongue. ECT is difficult to diagnose because of its rarity. We report a case of ECT arising on the lateral border of the tongue in a 67-year-old woman. The tumour, measuring 20 × 10 mm in size, was surgically removed. Histopathologically, the tumour was composed of small polygonal cells arranged in sheets, with a myxoid or hyalinized stroma. The tumour boundary was clear; however, the tumour showed a multinodular structure expanding along the tongue surface without obvious capsule. Careful examination revealed the tumour nodule to be spreading in a skip lesion-like fashion away from the main part of the tumour in the striated muscle layer. Although there was no evidence of recurrence at 18 months after the surgery, our observations suggest that surgery for ECT resection with a safety margin is more appropriate than enucleation.

Preoperative intra-arterial chemotherapy with docetaxel, cisplatin, and peplomycin combined with intravenous chemotherapy using 5-fluorouracil for oral squamous cell carcinoma.

The objectives of this study were to evaluate survival in 141 patients with stage II-IV oral squamous cell carcinoma (OSCC) treated with preoperative intra-arterial chemotherapy with docetaxel, cisplatin, and peplomycin combined with intravenous chemotherapy using 5-fluorouracil (IADCPIVF) via the superficial temporal artery, and to clarify the prognostic factors. The study population included 59 patients with stage II OSCC, 34 with stage III, and 48 with stage IV. After IADCPIVF, 139 patients underwent surgery; minimally invasive surgeries (MIS) including excisional biopsy were performed on 96 patients with a remarkably good response to IADCPIVF. The primary tumour response rate was 99.3% (complete response rate 56.7%, good partial response rate 17.0%, fair partial response rate 25.5%). Additionally, there were no serious adverse events associated with IADCPIVF. The 5-year overall survival rate was 74.6% (stage II 83.6%, stage III 72.7%, stage IV 64.8%). In the multivariate analysis of survival, T classification and clinical tumour response were significant prognostic factors. Eight (8.3%) of the patients who received MIS had primary recurrence and six were salvaged. In conclusion, IADCPIVF is safe and efficacious for treating OSCC, and MIS could reduce the extent of primary tumour resection in the case of a remarkably good response.

The correlation between Salter's criteria for avascular necrosis of the femoral head and Kalamchi's prognostic classification following the treatment of developmental dysplasia of the hip.

AIMS: The aim of this study was to evaluate the correlation between Salter's criteria and Kalamchi's classification of avascular necrosis in patients treated for developmental dysphasia of the hip (DDH). PATIENTS AND METHODS: The study involved a retrospective analysis of 123 patients (123 hips) with DDH treated by operative and non-operative reduction before the age of two years, with a minimum follow-up of ten years. Salter's criteria (S1 to S4) were determined from radiographs obtained at one to two years post-reduction, whilst the Kalamchi grade was determined from radiographs obtained at ten or more years of age. Early post-reduction radiographs were also used to evaluate the centre-head distance discrepancy (CHDD) and the occurrence of a dome-shaped deformity of the proximal femoral metaphysis (D-shaped metaphysis). The prognosis was described as good (Kalamchi grade K0 or KI), fair (Kalamchi grade KII) or poor (Kalamchi grade KIII or KIV) for analysis and correlation with the early Salter criteria, CHDD and D-shaped metaphysis. RESULTS: S1 and S2 criteria were predictive of a poor prognosis. The outcome following S3, S4 and S3 + S4 varied; 18 (40%) had a good prognosis, 17 (38%) a fair prognosis and ten (22%) a poor prognosis. A CHDD ≥ 10% and a D-shaped metaphysis were also predictive of a poor prognosis. CONCLUSION: The Salter criteria were predictive of the Kalamchi grade of avascular necrosis in patients with DDH aged ten or more years after reduction of the hip. Cite this article: Bone Joint J 2017;99-B:1115-20.

The age, breed and sex pattern of diagnosis for veterinary care in insured cats in Japan.

OBJECTIVES: To estimate the annual prevalence of different diagnostic categories by age, breed and sex in insured cats in Japan for which veterinary care claims had been made, and to identify if there is a pattern in these host factors. MATERIALS AND METHODS: Data from 48,187 cats insured for veterinary care in Japan in the period from April 2012 to March 2013 comprising 26,003 males and 22,184 females were analysed to calculate the annual prevalence of 18 diagnostic categories of disease by age, breed and sex. RESULTS: The prevalence was highest for urinary system disorders (12·2% for males and 10·0% for females), followed by digestive disorders (11·6% for males and 10·7% for females) and dermatological diseases (8·7% for males and 9·0% for females). The male cats had a higher prevalence than female cats for most diagnostic categories. The prevalence of cardiovascular, urinary, endocrine and neoplastic disorders increased with age; infectious and parasitic diseases had high prevalence at young ages, and the prevalence of respiratory, musculoskeletal disorders and injuries had bimodal peaks. Dermatological disorders had a high prevalence at all ages. A large variation in prevalence was observed between breeds for otic, dermatological, dental and cardiovascular disorders. CLINICAL SIGNIFICANCE: The findings can be used to increase awareness of patterns of health disorders in different categories of cat.

Association of left atrial phasic volumes with systemic arterial stiffness and ankle-brachial index in hypertensive patients.

Left atrial (LA) phasic volumes consist of reservoir, conduit and booster pump volumes. Arterial stiffness is linked to lower systemic arterial compliance (SAC) contributing to cardiac afterload. Arterial stiffness may be a modulator of LA phasic volumes. Echocardiography was performed in 161 hypertensive patients and in 50 normotensive subjects in order to assess biplane LA volumes (maximum, before atrial contraction, minimum), early and late diastolic mitral annular velocity (e' and a'), and LV stroke volume. LA emptying volumes (total, passive, active) were calculated from these LA volumes. Blood pressures were measured using an automated oscillometric device simultaneously at the four limbs for evaluating pulse pressure (PP) and ankle-brachial index (ABI). SAC was estimated by the ratio of LV stroke volume indexed by body surface area (BSA) divided by PP. All three LA volumes, LA total volume and LA active emptying volume were greater in hypertensive patients than in normotensive subjects. A multiple linear regression analysis indicated that LA passive emptying volume (reservoir=early diastole)/BSA correlated positively with ABI after being adjusted for age, gender, BSA, LV mass, max LA volume, e' and SAC in hypertensive patients. LA active emptying volume (booster=late diastole)/BSA correlated positively with SAC after being adjusted for age, gender, BSA, LV mass, LA volume before atrial contraction, a' and ABI. LA reservoir volume was associated with ABI, and LA booster volume was related to systemic arterial stiffness in hypertensive patients, suggesting the LA-arterial coupling in this clinical setting.

De Novo Deep Transcriptome Analysis of Medicinal Plants for Gene Discovery in Biosynthesis of Plant Natural Products.

Study on transcriptome, the entire pool of transcripts in an organism or single cells at certain physiological or pathological stage, is indispensable in unraveling the connection and regulation between DNA and protein. Before the advent of deep sequencing, microarray was the main approach to handle transcripts. Despite obvious shortcomings, including limited dynamic range and difficulties to compare the results from distinct experiments, microarray was widely applied. During the past decade, next-generation sequencing (NGS) has revolutionized our understanding of genomics in a fast, high-throughput, cost-effective, and tractable manner. By adopting NGS, efficiency and fruitful outcomes concerning the efforts to elucidate genes responsible for producing active compounds in medicinal plants were profoundly enhanced. The whole process involves steps, from the plant material sampling, to cDNA library preparation, to deep sequencing, and then bioinformatics takes over to assemble enormous-yet fragmentary-data from which to comb and extract information. The unprecedentedly rapid development of such technologies provides so many choices to facilitate the task, which can cause confusion when choosing the suitable methodology for specific purposes. Here, we review the general approaches for deep transcriptome analysis and then focus on their application in discovering biosynthetic pathways of medicinal plants that produce important secondary metabolites.

Measurement of residual platelet thrombogenicity under arterial shear conditions in cerebrovascular disease patients receiving antiplatelet therapy.

UNLABELLED: Essentials A consensus methodology for assessing the effects of antiplatelet agents has not been established. Measuring platelet thrombus formation (PTF) for evaluating antiplatelet effects was assessed. PTF differentially reflected antiplatelet effects compared to other tests. PTF may be associated with the severity of carotid or intracranial arterial stenosis. Click to hear a presentation on platelet function testing in the clinic by Gresele and colleagues SUMMARY: Background A consensus methodology for assessing the effects of antiplatelet agents has not been established. Objective We investigated the usefulness of directly measuring platelet thrombus formation (PTF) using a microchip-based flow chamber system for evaluating antiplatelet therapy. Patients/Methods Platelet thrombus formation in the whole blood of 94 patients with ischemic cerebrovascular disease treated with clopidogrel and/or aspirin was measured in a flow chamber system at a shear rate of 1500 s(-1) and was compared with the results of assays for agonist-induced platelet aggregability, phosphorylation of vasodilator-stimulated phosphoprotein, platelet p-selectin expression (PS), and platelet-monocyte complexes. Results In all patients tested, area under the flow pressure curve (AUC10), which represents platelet thrombogenicity, showed weak correlation with platelet aggregation induced by either adenosine diphosphate or collagen. In addition, AUC10 was lower in patients treated with dual antiplatelet therapy (median 79.4) compared with patients treated with aspirin or clopidogrel alone (217.7 and 301.0, respectively), whereas the parameters evaluated by the other assays did not reflect the combined treatment efficacy. In clopidogrel monotherapy patients, AUC10 was associated with the severity of arterial stenosis (R(2) = 0.127, ß = 1.25), and AUC10 and PS were higher in patients with severe carotid or intracranial arterial stenosis than in those with mild stenosis. Conclusions Platelet thrombus formation measurement using a flow-chamber system was useful for evaluating the efficacy of treatment with aspirin and clopidogrel, both alone and in combination. The present findings indicate that high residual platelet thrombogenicity in patients treated with clopidogrel may be associated with the severity of carotid or intracranial arterial stenosis.

Impact of low-carbohydrate diet on body composition: meta-analysis of randomized controlled studies.

The effect of low-carbohydrate diet (LCD) on body composition, especially fat mass, in obese individuals remains to be elucidated. We performed a meta-analysis to provide quantitative summary estimates of the mean change of body weight (kg) and fat mass (kg) in LCD comparing to those in control diet. Literature searches were performed using EMBASE, MEDLINE and Cochrane Library until Dec 2014. Fourteen randomized controlled studies were included in this meta-analysis. Eight studies including very LCD (50 g carbohydrate or 10% calorie from carbohydrate) and seven studies including mild LCD (about 40% calorie from carbohydrate). Meta-analysis carried out on data of 1416 obese individuals, showed that LCD was associated with decrease in body weight (-0.70 kg [95% CI -1.07/-0.33]) or fat mass (-0.77 kg [-1.55/-0.32]). Subgroup meta-analysis of studies in over 12 months suggested that LCD was not associated with decrease in body weight (-0.44 kg [-0.94/0.07]), but LCD was associated with decrease in fat mass (-0.57 kg [-1.05/-0.09]). In addition, very LCD was associated with decrease in fat mass (-0.97 kg [-1.50/-0.44]), but mild LCD was not associated with decrease in fat mass (-0.43 kg [-1.15/0.33]). LCD, especially very LCD, might be effective for decrease in fat mass in obese individuals. © 2016 World Obesity.

Facilitation of bone resorption activities in synovial lavage fluid patients with mandibular condyle fractures.

The aim of this study was to investigate the bone resorption effect of the mediators delivered in joint cavity of patients with mandibular condyle fractures by detecting osteoclast markers using cellular biochemistry methods, and by analysing bone resorption activities via inducing osteoclast differentiation of the infiltrated cells from arthrocentesis. Sixteen joints in 10 patients with mandibular condyle fractures were evaluated. The control group consisted of synovial fluid (SF) samples from seven joints of four volunteers who had no clinical signs or symptoms involving the temporomandibular joint (TMJ) or disc displacement. We collected SF cells from all patients during therapeutic arthrocentesis. The infiltrating cells from TMJ SF were cultured, differentiated into tartrate-resistant acid phosphatase (TRAP)-positive osteoclast-like cells and examined bone resorption activities. We also investigated factors related to osteoclast induction of SF, using ELISA procedures. Osteoclast-like cells were induced from the SF cells obtained from all patients with condylar fractures. These multinucleated giant cells were positive for TRAP and actin, and had the ability to absorb dentin slices. The levels of macrophage colony-stimulating factor (M-CSF), prostaglandin E2 (PGE2), soluble form of receptor activator of nuclear factor kappa-B ligand (sRANKL) and osteoprotegerin (OPG), in SF samples from the patients, were significantly higher than in the controls. These findings indicate that bone resorption activities in SF from patients with mandibular condyle fractures were upregulated and may participate in the pathogenesis and wound healing.

Transient expression of neuropeptide W in postnatal mouse hypothalamus--a putative regulator of energy homeostasis.

Neuropeptide B and W (NPB and NPW) are cognate peptide ligands for NPBWR1 (GPR7), a G protein-coupled receptor. In rodents, they have been implicated in the regulation of energy homeostasis, neuroendocrine/autonomic responses, and social interactions. Although localization of these peptides and their receptors in adult rodent brain has been well documented, their expression in mouse brain during development is unknown. Here we demonstrate the transient expression of NPW mRNA in the dorsomedial hypothalamus (DMH) of postnatal mouse brain and its co-localization with neuropeptide Y (NPY) mRNA. Neurons expressing both NPW and NPY mRNAs begin to emerge in the DMH at about postnatal day 0 (P-0) through P-3. Their expression is highest around P-14, declines after P-21, and by P-28 only a faint expression of NPW and NPY mRNA remains. In P-18 brains, we detected NPW neurons in the region spanning the subincertal nucleus (SubI), the lateral hypothalamic (LH) perifornical (PF) areas, and the DMH, where the highest expression of NPW mRNA was observed. The majority of these postnatal hypothalamic NPW neurons co-express NPY mRNA. A cross of NPW-iCre knock-in mice with a Cre-dependent tdTomato reporter line revealed that more than half of the reporter-positive neurons in the adult DMH, which mature from the transiently NPW-expressing neurons, are sensitive to peripherally administrated leptin. These data suggest that the DMH neurons that transiently co-express NPW and NPY in the peri-weaning period might play a role in regulating energy homeostasis during postnatal development.

Heart rate-corrected QT interval is a novel risk marker for the progression of albuminuria in people with Type 2 diabetes.

AIMS: A close association between heart rate-corrected QT interval (QTc) and albuminuria in people with Type 2 diabetes has been reported in cross sectional studies. The aim of this study was to evaluate the relationship between QTc and change in urine albumin excretion (UAE) or progression of albuminuria in people with Type 2 diabetes. METHODS: We measured QTc in 251 consecutive people at baseline. We performed a 5-year follow-up cohort study to assess the relationship between QTc and change in UAE, defined as an increase of UAE/follow-up duration (year), or progression of albuminuria, defined as an increase in the category of diabetic nephropathy. RESULTS: During follow-up, 23 of 151 people with normoalbuminuria and 13 of 73 people with microalbuminuria at baseline had progression of albuminuria. Multiple regression analysis demonstrated that QTc was independently associated with change in UAE (ß = 0.176, P = 0.0104). Logistic regression analyses showed that QTc was a risk marker for progression of albuminuria [odds ratio per 0.01-s increase in QTc 1.35, 95% confidence interval (CI) 1.11-1.66, P = 0.0024] after adjusting for confounders. According to the receiver operator characteristic (ROC) analysis, the optimal cut-off point of QTc for progression of albuminuria was 0.418 s [area under the ROC curve 0.75 (95% CI 0.66-0.82), sensitivity = 0.86, specificity = 0.56, P < 0.0001]. CONCLUSIONS: Heart rate-corrected QT interval could be a novel risk marker for progression of albuminuria in people with Type 2 diabetes.

Low serum potassium concentration is a predictor of chronic kidney disease.

AIMS: The aim of this study was to examine whether low serum potassium concentration could be a predictor of chronic kidney disease (CKD) in a community-based cohort. MATERIALS AND METHODS: We enrolled 1001 subjects, median period of 5.7 years, and evaluated the risk factors for CKD, defined as estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73 m(2), and assessed whether low serum potassium concentration could predict CKD. RESULTS: Compared with the subjects without development of CKD, age, body mass index, fasting plasma glucose, uric acid (UA), creatinine and serum sodium concentration were higher, and serum potassium concentration was lower in subjects with development of CKD. Univariate Cox regression analyses demonstrated that age, body mass index, fasting plasma glucose, UA, creatinine, serum sodium concentration and serum potassium concentration were associated with progression of CKD. Multiple Cox regression analysis revealed that age, gender, creatinine and serum potassium concentration were independent predictors of CKD after adjustment for covariates. When serum potassium concentration was below 4.0 mmol/l at baseline, hazard ratio (95% confidence interval) of developing CKD was 2.65 (2.04-3.44; p < 0.0001). CONCLUSIONS: Serum potassium concentration could be a clinically relevant risk factor for the progression of CKD, defined as eGFR < 60 ml/min/1.73 m(2) , in healthy subjects.

Surface and intramural reentrant patterns during atrial fibrillation in the sheep.

INTRODUCTION: This article is part of the Focus Theme of Methods of Information in Medicine on "Biosignal Interpretation: Advanced Methods for Studying Cardiovascular and Respiratory Systems". BACKGROUND: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia in humans and is predicted to dramatically increase its prevalence in the future. High-resolution mapping data and Fourier power spectral analysis with its dominant frequency support the hypothesis that AF in the structurally normal sheep heart and in some patients often presents organized drivers in the form of periodic surface re-entries or breakthroughs. Nevertheless, the dynamics of those surface patterns of activity, as well as their intramural components are still poorly understood. OBJECTIVE: To present data on AF waves from the surface of isolated sheep hearts and discuss the interpretation of their intramural patterns. METHODS: We used a combination of endocardial-epicardial optical mapping with phase and spectral analysis as well as computer simulation of the re-entrant activity in the myocardial wall. RESULTS: Analysis of the surfaces' optical mapping data in the phase domain reveals that activation of the posterior left atrium (PLA) consisted of alternating patterns of breakthroughs and reentries. The patterns on the endocardial and epicardial PLA surface at any given moment of time of the AF could be either identical or not identical, and the activity in the thickness of the PLA wall is hypothesized to conform to either ectopic discharge or reentrant scroll waves, but a definite evidence for the presence of such mechanisms is currently lacking. A universal minimal-principle theory is shown in a computer model to result in a tendency of the axis of the scroll waves to align with the myocardial fibers inside the wall. CONCLUSION: The tendency of filaments of scroll waves to align with myocardial fibers may contribute to the variety and intermittency of surface rotors seen in AF.

Relationship between CT features and high preoperative serum carcinoembryonic antigen levels in early-stage lung adenocarcinoma.

AIM: To assess the relationship between thin-section computed tomography (CT) features of primary tumour and high preoperative serum carcinoembryonic antigen (CEA) levels that reportedly suggest poor prognoses in early-stage lung adenocarcinoma. MATERIALS AND METHODS: Two hundred and seventy-five consecutive patients who underwent resection of pathological stage I (T1-2aN0M0) adenocarcinomas with a maximum diameter of ≤ 3 cm (144 men, 131 women; mean age 67.8 years) were enrolled. CT features of the primary tumours and clinical characteristics of these patients were statistically evaluated to identify the factors associated with high serum CEA levels (>5 ng/ml). RESULTS: Eighty-one patients (29.5%) had high serum CEA levels. In univariate analysis, lower ground-glass opacity ratio (p < 0.001), lower tumour shadow disappearance rate (TDR: the ratio of tumour area in mediastinal window to that of lung window, p < 0.001), presence of notch (p = 0.015), and coexistence with bullae or honeycomb cysts (p < 0.001) were observed more frequently in the group with high serum CEA levels than that of the group with normal levels. TDR [odds ratio (OR) 0.984; 95% confidence interval (CI): 0.976-0.993; p < 0.001] and coexistence with bullae or honeycomb cysts (OR = 3.08; 95% CI: 1.55-6.12; p = 0.001) remained significant, even after adjusting patients' age, gender, and smoking status. CONCLUSIONS: Adenocarcinomas with lower TDR and coexisting with bullae or honeycomb cysts are associated with high preoperative serum CEA levels. Although some CEA elevations may be due to benign pulmonary diseases, such tumours are suspected to have poor prognoses, even for early-stage diseases.

Factors affecting variability in home blood pressure in patients with type 2 diabetes: post hoc analysis of a cross-sectional multicenter study.

Recent studies have shown that variability in home blood pressure has an important role in the progression of organ damage. The objective of this study was to investigate the factors that affect variability in home blood pressure in patients with type 2 diabetes. We assessed the relationship between home blood pressure variability, defined as coefficient of variation of mean of triplicate morning and evening blood pressure for 14 consecutive days, and various factors using univariate and multivariate linear regression analyses in 1114 patients with type 2 diabetes. Age (ß=0.149, P<0.001), female sex (ß=0.125, P=0.010), duration of diabetes mellitus (ß=0.103, P=0.005), heart rate (ß=0.136, P<0.001), current smoker (ß=0.118, P=0.005), white-coat hypertension (ß=0.136, P=0.002) and treatment with calcium channel blockers (ß=-0.094, P=0.024) were independently associated with coefficient of variation of morning systolic blood pressure. Our findings implicate that factors that might be intervened such as heart rate, smoking status, use of antihypertensive medication in addition to age, sex and duration of diabetes mellitus are associated with variability in home blood pressure in patients with type 2 diabetes.

Diagnostic performance of plasma biomarkers in patients with acute intestinal ischaemia.

BACKGROUND: The aim of this study was to evaluate the use of intestinal fatty acid binding protein (I-FABP) and traditional biomarkers in the early diagnosis of acute intestinal ischaemia of different causes. METHODS: I-FABP, white blood cell (WBC) count, C-reactive protein, base deficit, lactate, lactate dehydrogenase, aspartate aminotransferase, creatine kinase and D-dimer were measured prospectively in consecutive patients suspected of having acute intestinal ischaemia. Biomarker levels were compared in patients with vascular and non-vascular ischaemia. RESULTS: Two hundred and eight patients with a clinical suspicion of acute intestinal ischaemia were enrolled. Vascular intestinal ischaemia was diagnosed in 24 patients (11·5 per cent), non-vascular ischaemia in 62 (29·8 per cent) and non-ischaemic disease in 122 (58·7 per cent). The levels of most biomarkers (except WBC count and creatine kinase) were significantly higher in the vascular ischaemia group than in the other groups (P < 0·010). However, none of the biomarker levels differed between patients with non-vascular intestinal ischaemia and those with non-ischaemic disease. Receiver operating characteristic (ROC) curve analysis suggested that I-FABP was best at diagnosing vascular intestinal ischaemia (area under the curve 0·88). CONCLUSION: Serum biomarkers may be useful in the diagnosis of vascular, but not non-vascular, intestinal ischaemia. Among them, I-FABP shows promise for detecting vascular ischaemia.

Hiatal hernia following total gastrectomy with Roux-en-Y reconstruction.

Hiatal hernias after total gastrectomy for advanced gastric cancer are very rare. We review a case of a 44-year-old male who presented with dyspnea and chest pain 2 days after total gastrectomy, lower esophagectomy, and splenectomy with retrocolic Roux-en-Y reconstruction approached by a left thoracoabdominal incision for gastric cancer at the cardia. Plain and cross-sectional imaging identified a large hiatal hernia protruding into the right thorax containing left-sided transverse colon and small intestine. Our patient underwent a laparotomy, and after hernia reduction the hiatal defect was repaired by direct suturing. He experienced anastomotic leakage and right pyothorax, but recovered. The potential cause is discussed here and the published literature on this rare complication is reviewed briefly.