Molecular Identification of Spirometra erinaceieuropaei Tapeworm in Cases of Human Sparganosis, Hong Kong.

Human sparganosis is a foodborne zoonosis endemic in Asia. We report a series of 9 histologically confirmed human sparganosis cases in Hong Kong, China. All parasites were retrospectively identified as Spirometra erinaceieuropaei. Skin and soft tissue swelling was the most common symptom, followed by central nervous system lesions.

The Electronic CardioMetabolic Program (eCMP) for Patients With Cardiometabolic Risk: A Randomized Controlled Trial.

BACKGROUND: Effective lifestyle interventions targeting high-risk adults that are both practical for use in ambulatory care settings and scalable at a population management level are needed. OBJECTIVE: Our aim was to examine the potential effectiveness, feasibility, and acceptability of delivering an evidence-based Electronic Cardio-Metabolic Program (eCMP) for improving health-related quality of life, improving health behaviors, and reducing cardiometabolic risk factors in ambulatory care high-risk adults. METHODS: We conducted a randomized, wait-list controlled trial with 74 adults aged ≥18 years recruited from a large multispecialty health care organization. Inclusion criteria were (1) BMI ≥35 kg/m(2) and prediabetes, previous gestational diabetes and/or metabolic syndrome, or (2) BMI ≥30 kg/m(2) and type 2 diabetes and/or cardiovascular disease. Participants had a mean age of 59.7 years (SD 11.2), BMI 37.1 kg/m(2) (SD 5.4) and were 59.5% female, 82.4% white. Participants were randomized to participate in eCMP immediately (n=37) or 3 months later (n=37). eCMP is a 6-month program utilizing video conferencing, online tools, and pre-recorded didactic videos to deliver evidence-based curricula. Blinded outcome assessments were conducted at 3 and 6 months postbaseline. Data were collected and analyzed between 2014 and 2015. The primary outcome was health-related quality of life. Secondary outcomes included biometric cardiometabolic risk factors (eg, body weight), self-reported diet and physical activity, mental health status, retention, session attendance, and participant satisfaction. RESULTS: Change in quality of life was not significant in both immediate and delayed participants. Both groups significantly lost weight and reduced waist circumference at 6 months, with some cardiometabolic factors trending accordingly. Significant reduction in self-reported anxiety and perceived stress was seen in the immediate intervention group at 6 months. Retention rate was 93% at 3 months and 86% at 6 months post-baseline. Overall eCMP attendance was high with 59.5-83.8% of immediate and delayed intervention participants attending 50% of the virtual stress management and behavioral lifestyle sessions and 37.8-62.2% attending at least 4 out of 7 in-person physical activity sessions. The intervention received high ratings for satisfaction. CONCLUSIONS: The technology-assisted eCMP is a feasible and well-accepted intervention and may significantly decrease cardiometabolic risk among high-risk individuals. TRIAL REGISTRATION: Clinicaltrials.gov NCT02246400; https://clinicaltrials.gov/ct2/show/NCT02246400 (Archived by WebCite at http://www.webcitation.org/6h6mWWokP).

Utilization, surgical populations, centers, coverages, regional balance, and their influential factors of deep brain stimulation for Parkinson's disease: a large-scale multicenter cross-sectional study from 1997 to 2021.

BACKGROUND: Deep brain stimulation (DBS) is an emerging and effective therapy for Parkinson's disease (PD). However, little is known about its utilization, surgical populations, centers, coverages, regional balance, and influential factors. MATERIALS AND METHODS: This large-scale multicenter cross-sectional study was conducted using a national census involving 74 Chinese centers. National DBS populations and centers for PD were investigated in 1997-2021, and regional sociodemographic features, surgical populations, related resources, and insurance policies in 2020 were explored. RESULTS: Since the first DBS surgery in 1997, a total of 38 122 PD patients from 349 centers underwent DBS by 2021, which covered 1.118% (1.108-1.129) of patients and 0.954% (0.933-0.976) of centers. Significant upward trends in the annual surgical population and coverages were observed with rapid climbing rates, while the annual surgical centers and their coverage showed two growth peaks in 2002-2006 and 2010-2018, correlating with clinical approvals and new technologies. A total of 103 070 (51 165-154 975) PD patients [2.088% (1.351-2.825) coverage] and 603 (72-1134) centers [1.356% (1.126-1.586) coverage] are predicted to conduct DBS by 2030. The new remotely programmed DBS technology was recoded as the first application in 2015 and rapidly increased to 2771 (47.39%, 46.11-48.67) patients with 10 507 remote programming sessions annually in 2021. Provinces in the eastern and central regions had better economic status, more surgical patients, higher insurance affordability, and more related resources than those in the western and northeastern regions. Higher gross domestic product per capita ( ß =5.041, 3.324-6.758 and ß =0.008, 0.004-0.012; all P <0.001) and more functional neurosurgery doctors ( ß =3.596, 0.353-6.839; P =0.031 and ß =0.010, 0.002-0.017; P =0.013) positively influenced surgical populations and coverages, while higher insurance levels ( ß =128.888, 64.702-193.075; P <0.001) positively influenced surgical coverages. CONCLUSION: Although surgical populations, centers, and coverages of DBS for PD have rapidly improved and are predicted to show future increases, this is still insufficient to cover potential eligible patients. Regionally imbalanced health coverage should be given attention to promote coordinated development.

Indocyanine Green-Assisted Endoscopic Transorbital Excision of Lateral Orbital Apex Cavernous Hemangioma.

Orbital apex lesions posed operative difficulties to neurosurgeons and ophthalmologists due to limited surgical corridor and close vicinity to cranial nerves and arteries. Lateral orbital apex lesions were traditionally operated via the transcranial route by neurosurgeons. Recently, only a handful of reports have described the use of endoscope alone for excision of lateral orbital apex lesion. Our group, with both endoscopic skull base neurosurgeons and oculoplastic surgeons, has adopted the endoscopic transorbital approach for orbital apex lesions. We also used an indocyanine green (ICG) endoscope to aid identification and dissection of orbital apex cavernous hemangioma, which otherwise can be difficult to differentiate from surrounding intraconal recti muscles. Video 1 captured the first reported case of excision of lateral orbital apex cavernous hemangioma via endoscopic transorbital approach, using a zero-degree ICG endoscope. This was a 64-year-old Chinese woman who presented with right eye painless blurring of vision with visual acuity of 0.6 and right relative afferent pupillary defect. Fundoscopic examination showed absence of right optic disc swelling, and automated visual field testing confirmed a superior and infratemporal visual field defect in the right eye. On magnetic resonance imaging, there was a 1-cm oval mass that was hypointense on T1-weighted and hyperintense on T2-weighted images, with slow enhancement, suggestive of cavernous hemangioma. Optical coherence tomography of the retinal nerve fiber layer showed evidence of subtle right nerve fiber layer thinning. Right endoscopic transorbital excision of the tumor was performed with an ICG-assisted endoscope. Lateral skin crease incision was followed by crescent-shaped superolateral orbital rim removal. Superior and inferior orbital fissures were identified after stripping off the periorbita. The meningoorbital band was divided to release the orbital apex from the middle fossa dura. The greater wing of sphenoid bone was drilled with a 3-mm high-speed diamond burr under irrigation to create space for dissection. Injection of ICG resulted in delayed enhancement of the lesion at around 1 minute and 30 seconds, in contrast to rapid enhancement of surrounding recti muscles at around 30 seconds. Incision of periorbita was guided by ICG enhancement of lesion. The tumor was dissected from the lateral rectus and superior division of oculomotor nerve and was excised en bloc. The supraorbital rim was reconstructed with 2 miniplates. Pathology confirmed the diagnosis of cavernous hemangioma. Postoperatively, the patient had good recovery, with right eye visual acuity of 0.8 and resolution of the relative afferent pupillary defect.

Silver Nanoparticle (AgNP) Technology applications in trauma and orthopaedics.

Recently Nanotechnology advances continue to accelerate with development of incredible new materials and products in the field of science. The Nanotechnology has evolved in the domains of prevention, diagnosis and treatment in the field of trauma and orthopaedics. It provides a spectrum of new tools such as drug delivery (chemotherapy in orthopaedic oncology), diagnosis (bone diseases, osteoporosis, metastatic osteosarcoma), improving osteointegration of implant materials (implants & total joint replacements), combating infection (trauma implants and prosthesis), tissue engineering (hydroxyapatite scaffolds, cartilage defects, stem cell regeneration) and prevention of osteoporosis. The current article highlights the role of Silver Nanoparticle (AgNP) Technology applications in Trauma and Orthopaedics.

The Incidence, Distribution and Clinicopathology of Missed Colorectal Cancer After Diagnostic Colonoscopy.

BACKGROUND: Colonoscopy does miss some lesions that may be later diagnosed as post-colonoscopy colorectal cancers (PCCRCs). We evaluated the rate of PCCRCs in a cohort of our patients. METHODS: The data of patients diagnosed with first primary colorectal cancers (CRCs) between July 2014 and June 2017 were analyzed. Colorectal cancers were considered to be missed if they occurred among patients who have had an index colonoscopy between 7 and 36 months prior to their diagnosis. The incidence of missed lesions and the distribution of such lesions in the large bowel are presented. RESULTS: In the study, 399 of the total 541 patients whose CRCs were diagnosed by colonoscopy were included. The median age of the patients (213 males and 186 females) was 75.3 (32.4-82.1) years. Seven patients with diagnosis of primary CRCs had undergone index colonoscopy between 7 and 36 months prior to their diagnostic colonoscopy. Therefore, the PCCRC rate in this cohort was 1.8% (7/399 × 100). The mean time interval between the false negative colonoscopy (index colonoscopy) and diagnostic colonoscopy was 18.7 (9.1- 34.9) months. Missed CRCs were located in the ascending (2), transverse (1), descending (1), and sigmoid colon (2) and in the rectum (1). CONCLUSION: Our PCCRC rate was 1.8%, which is lower than the usually reported rate.

'Hemispherical asymmetry in the Meyer's Loop': a prospective study of visual-field deficits in 105 cases undergoing anterior temporal lobe resection for epilepsy.

OBJECTIVES: Visual-field deficits following temporal lobe surgery have been reported in the literature. In this prospective study, the authors analyse their experience of visual-field deficits in 105 consecutive cases undergoing temporal-lobe surgery performed by a single surgeon, with particular consideration to the laterality of the deficit and its functional implications. METHODS: 105 consecutive patients undergoing an anterior temporal lobe resection for epilepsy, between March 1998 and June 2004, were selected. The patient population had a mean age of 35 years (range 19-60 years); 53 had a left-sided resection and 52 a right-sided resection. 91 patients had mesial temporal sclerosis, three gangliogliomas, four dysembryoplastic neuroepithelial tumours (DNETs), two neurocytomas and two cavernomas, and in three cases the histology was inconclusive. Pre- and postoperative visual-field tests were obtained using the Humphrey Esterman binocular functional test for all cases. The test was set to stimulus white III, with a single intensity of 10 DB on the background of 31.5 ASB for all patients. A minimum follow-up period of 12 months postsurgery was employed. Postoperative MRI scans were carried out on all patients. 60 scans were randomly selected, and the extent of temporal lobe resection calculated manually for each. RESULTS: Of the 105 cases, 16 patients had a visual-field deficit postoperatively which was not present preoperatively: 12 following a left and four following a right-sided resection. The OR for incurring a postoperative visual-field defect following left versus right-sided surgery was 3.51 (95% CI 1.05 to 11.73, p=0.04). In four patients, the deficit was severe enough to preclude them from driving in the UK (three left- and one right-sided resection). There was no association between the extent of tissue resection and the incidence of postoperative visual-field deficits. CONCLUSIONS: This study suggests left-/right-hemispherical asymmetry in the Geniculocalcarine tracts with field deficits being 3.5 times more likely following left-sided anterior temporal lobe resections compared with right-sided resections. This has significant implications on counselling patients for these procedures. MR tractography may provide an anatomical substrate for these clinical findings, perhaps revealing a more anterior course of the optic radiations within the temporal lobe in one hemisphere versus the other.

Enteroviral Infection Inhibits Autophagic Flux via Disruption of the SNARE Complex to Enhance Viral Replication.

Picornaviruses have evolved to hijack host cellular machinery, including the autophagic pathway. However, the mechanisms remain largely unclear. We use coxsackievirus B3 (CVB3) as a model organism to explore the possible role of picornavirus subversion of the autophagic pathway in viral infection. Our in vivo and in vitro experiments demonstrate that CVB3 infection causes a significant, albeit incomplete, inhibition of autophagic flux by limiting the fusion of autophagosomes with lysosomes and/or late endosomes. Furthermore, we show that CVB3 specifically targets SNARE protein SNAP29 and adaptor protein PLEKHM1, two critical proteins known to regulate autophagosome fusion, for cleavage through the catalytic activity of viral proteinase 3C, ultimately impairing the formation of SNARE complexes. Finally, we demonstrate that loss of SNAP29/PLEKHM1 inhibits autophagic flux, resulting in increased viral replication. Collectively, our study reveals a mechanism that supports an emerging model whereby CVB3 hijacks the autophagic machinery to facilitate its own propagation.

Systematic identification of genes involved in metabolic acid stress resistance in yeast and their potential as cancer targets.

A hallmark of all primary and metastatic tumours is their high rate of glucose uptake and glycolysis. A consequence of the glycolytic phenotype is the accumulation of metabolic acid; hence, tumour cells experience considerable intracellular acid stress. To compensate, tumour cells upregulate acid pumps, which expel the metabolic acid into the surrounding tumour environment, resulting in alkalization of intracellular pH and acidification of the tumour microenvironment. Nevertheless, we have only a limited understanding of the consequences of altered intracellular pH on cell physiology, or of the genes and pathways that respond to metabolic acid stress. We have used yeast as a genetic model for metabolic acid stress with the rationale that the metabolic changes that occur in cancer that lead to intracellular acid stress are likely fundamental. Using a quantitative systems biology approach we identified 129 genes required for optimal growth under conditions of metabolic acid stress. We identified six highly conserved protein complexes with functions related to oxidative phosphorylation (mitochondrial respiratory chain complex III and IV), mitochondrial tRNA biosynthesis [glutamyl-tRNA(Gln) amidotransferase complex], histone methylation (Set1C-COMPASS), lysosome biogenesis (AP-3 adapter complex), and mRNA processing and P-body formation (PAN complex). We tested roles for two of these, AP-3 adapter complex and PAN deadenylase complex, in resistance to acid stress using a myeloid leukaemia-derived human cell line that we determined to be acid stress resistant. Loss of either complex inhibited growth of Hap1 cells at neutral pH and caused sensitivity to acid stress, indicating that AP-3 and PAN complexes are promising new targets in the treatment of cancer. Additionally, our data suggests that tumours may be genetically sensitized to acid stress and hence susceptible to acid stress-directed therapies, as many tumours accumulate mutations in mitochondrial respiratory chain complexes required for their proliferation.

Subthalamic Nucleus Deep Brain Stimulation for Parkinson Disease in Hong Kong: A Prospective Territory-Wide 2-Year Follow-Up Study.

OBJECTIVE: We assessed the effects of bilateral subthalamic nucleus (STN) deep brain stimulation (DBS) in patients with Parkinson disease at the 1-year and 2-year follow-up evaluations. Unified Parkinson's Disease Rating Scale (UPDRS) motor score at "off" medication ("on" DBS) and quality-of-life assessments (39-item Parkinson's Disease Questionnaire [PDQ-39]) were conducted. The percentage of awake "on" time and awake "off" time and levodopa requirement were also assessed. METHODS: A 2-year prospective study was conducted of 25 consecutive patients from 3 DBS referral centers in Hong Kong. The patients were treated with bilateral stimulation of the STN. Assessments were performed at 1 year and 2 years after DBS and were compared with the baseline. RESULTS: The 2-year outcome assessments were completed by 18 patients. The mean UPDRS motor score improvement was 57% in the first year and 45% in the second year. PDQ-39 showed significant improvement in quality of life for 2 consecutive years. The levodopa requirement decreased 63% in the first year and 55.9% in the second year. The awake "on" time was doubled in the first year and sustained in the second year. Awake "off" time was reduced from 28.1% to 5.9% in the first year and returned to 10.6% in the second year. Improvement of UPDRS motor score, reduction in awake "off" time, and decrease of daily levodopa dosage all were main factors correlated with the improvement in PDQ-39 summary index. CONCLUSIONS: The effects of STN DBS in patients with Parkinson disease in Hong Kong were satisfactory. The results showed that reduction in UPDRS motor score, awake "off"-time, and daily levodopa dosage were the major drivers of overall improvement in PDQ-39.

The anti-adhesive mucin podocalyxin may help initiate the transperitoneal metastasis of high grade serous ovarian carcinoma.

High grade serous ovarian tumors often metastasize transperitoneally, a process that begins when small tumor nodules de-adhere and are released into the fluid of the abdominal cavity where they float freely to reach new sites on the peritoneal wall. Podocalyxin, a small anti-adhesive sialomucin, has been shown to contribute to non-adhesive membrane domain formation in some epithelia and is overexpressed in a variety of cancers. We therefore assessed podocalyxin expression on a previously characterized tissue microarray and found that 87% (169/194) of high grade serous epithelial ovarian carcinomas were positive for podocalyxin. In addition, cell surface localization of podocalyxin was associated with a significant decrease in disease-free survival in these tumors. When podocalyxin was force-expressed in serous ovarian carcinoma-derived OVCAR-3 cells it was targeted to the cell surface and it decreased the adhesion of these cells to mesothelial monolayers, fibronectin and immobilized ß1 integrin-binding antibodies. This decrease in adhesion was associated with a modest decrease in cell surface ß1 integrin. In monolayer culture, podocalyxin was targeted to the free, apical domains of OVCAR-3 cells and it appeared to decrease ß1 integrin levels on the attached basolateral domains of the same cells. Furthermore, in 3-dimensional basement membrane gel culture, the cells formed small, cohesive nodules and podocalyxin localized to membrane domains at the cell-basement membrane interface. Therefore, podocalyxin's ability to facilitate the formation of non-adhesive membrane domains may contribute to the formation of free-floating high grade serous tumor nodules during the initial steps of transperitoneal metastasis.

Predictors of outcome following Gamma Knife surgery for acromegaly.

OBJECT: Gamma Knife surgery (GKS) is gaining popularity in the treatment of patients with acromegaly after transsphenoidal tumor excision. In this paper, the authors examine the efficacy of GKS and predictors for biochemical remission. METHODS: The authors retrospectively reviewed data spanning the period 1997­2008 in their hospital Gamma Knife statistics database. Forty patients with a mean age of 64 years (range 19­73 years) underwent GKS for acromegaly during that period. Transsphenoidal subtotal tumor excision had been performed prior to GKS in all these patients, except for 3 deemed to be at high surgical risk. All GKS treatment plans were formulated by the same team that performed the microsurgical procedures. Biochemical remission was defined as a growth hormone (GH) level <2 ng/ml and an insulin-like growth factor­I level that was considered normal with reference to the patient's age and sex. The mean follow-up period after radiosurgery was 73.8 months (range 12­132 months). RESULTS: Three patients died during the study period of causes unrelated to surgery or GKS. Twenty-nine patients (72.5%) underwent 1 radiosurgery session, and 11 patients (27.5%) required 2 radiosurgery sessions. Among the patients who underwent 1 radiosurgery session, excellent responses (76%­100% reductions in tumor size, GH level, and insulin-like growth factor­I level) were observed in 18 (62%; p < 0.0001), 20 (69%; p < 0.0001), and 5 patients (17%; p = 0.21), respectively. Tumors < 1 cm³ and those with no evidence of cavernous sinus extension were statistically significantly related to a good response in tumor size reduction (p = 0.029 and p = 0.0016, respectively). Subgroup analyses were performed in patients who attained biochemical remission in GH levels; the subgroups included patient sex, patient age, target volume, isodose volume, prescribed dose and isodose, pre-GKS GH level, and evidence of cavernous sinus extension. Only male sex was found to be a statistically significant predictor of good hormone regulation (p = 0.0124). The presence of a cavernous sinus extension was the statistically significant predictor of poor hormone control (p = 0.0011) in our study. CONCLUSIONS: Subtotal tumor excision followed by GKS was an effective treatment for acromegaly. Tumors < 1 cm³ and those with no evidence of cavernous sinus extension responded well to treatment. Male sex and absence of cavernous sinus involvement can be regarded as predictors of biochemical remission. (DOI: 10.3171/2010.7.GKS10