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Background and purpose: Acquired neuromyotonia can occur in patients with thymoma, alone or in association with myasthenia gravis (MG), but the clinical prognostic significance of such comorbidity is largely unknown. The clinico‐pathological features were investigated along with the occurrence of neuromyotonia as predictors of tumour recurrence in patients with thymoma‐associated myasthenia. Methods: A total number of 268 patients with thymomatous MG were studied retrospectively. Patients with symptoms of spontaneous muscle overactivity were selected for autoantibody testing using immunohistology for neuronal cell‐surface proteins and cell‐based assays for contactin‐associated protein 2 (CASPR2), leucine‐rich glioma inactivated 1 (LGI1), glycine receptor and Netrin‐1 receptor antibodies. Neuromyotonia was diagnosed according to the presence of typical electromyography abnormalities and/or autoantibodies against LGI1/CASPR2. Results: Overall, 33/268 (12%) MG patients had a thymoma recurrence. Five/268 (2%) had neuromyotonia, four with typical autoantibodies, including LGI1 (n = 1), CASPR2 (n = 1) or both (n = 2). Three patients had Netrin‐1 receptor antibodies, two with neuromyotonia and concomitant CASPR2+LGI1 antibodies and one with spontaneous muscle overactivity without electromyography evidence of neuromyotonia. Thymoma recurrence was more frequent in those with (4/5, 80%) than in those without (28/263, 10%, P < 0.001) neuromyotonia. Neuromyotonia preceded the recurrence in 4/5 patients. In univariate analysis, predictors of thymoma recurrence were age at thymectomy [odds ratio (OR) 0.95, 95% confidence interval (CI) 0.93–0.97], Masaoka stage ≥IIb (OR 10.73, 95% CI 2.38–48.36) and neuromyotonia (OR 41.78, 95% CI 4.71–370.58). Conclusions: De novo occurrence of neuromyotonia in MG patients with previous thymomas is a rare event and may herald tumour recurrence. Neuronal autoantibodies can be helpful to assess the diagnosis. These observations provide pragmatic risk stratification for tumour vigilance in patients with thymomatous MG. [ABSTRACT FROM AUTHOR]

Abstract: Aim: An airtight anastomosis on intra‐operative leak testing has been previously demonstrated to be associated with a lower risk of clinically significant postoperative anastomotic leak following left‐sided colorectal anastomosis. However, to date, there is no consistently agreed upon method for management of an intra‐operative anastomotic leak. Therefore, we powered a noninferiority study to determine whether suture repair alone was an appropriate strategy for the management of an intra‐operative air leak. Method: This is a retrospective cohort analysis of prospectively collected data from a tertiary care referral centre. We included all consecutive patients with left‐sided colorectal or ileorectal anastomoses and evidence of air leak during intra‐operative leak testing. Patients were excluded if proximal diversion was planned preoperatively, a pre‐existing proximal diversion was present at the time of surgery or an anastomosis was ultimately unable to be completed. The primary outcome measure was clinically significant anastomotic leak, as defined by the Surgical Infection Study Group at 30 days. Results: From a sample of 2360 patients, 119 had an intra‐operative air leak during leak testing. Sixty‐eight patients underwent suture repair alone and 51 underwent proximal diversion or anastomotic reconstruction. The clinically significant leak rate was 9% (6/68; 95% CI: 2–15%) in the suture repair alone arm and 0% (0/51) in the diversion or reconstruction arm. Conclusion: Suture repair alone does not meet the criteria for noninferiority for the management of intra‐operative air leak during left‐sided colorectal anastomosis. Further repair of intra‐operative air leak by suture repair alone should be reconsidered given these findings. [ABSTRACT FROM AUTHOR]

Background: The incidence of type 1 diabetes mellitus (T1DM) in Sardinia is among the highest in the world (44.8 cases/100,000 person-years). Recommendations of the Immunology of Diabetes Society advise evaluating autoantibody positivity in first-degree relatives (FDRs) of patients with T1DM, for their higher risk to develop the disease. The aim of this study was to determine the prevalence of beta-cell autoimmunity in FDRs of T1DM patients in Sardinia.Methods: A total of 188 Sardinian families were recruited in collaboration between diabetes and pediatric units of university and district hospitals in Sardinia. The recruitment involved 188 patients with diagnosed T1DM and all their available FDRs (n = 447). Autoantibodies (Aabs) against GAD, IA2, insulin, and ZnT8 were measured in all subjects. Human leukocyte antigen (HLA) risk genotypes (HLA-DR and DQ loci) were analyzed in 43 Aabs-positive FDR.Results: The prevalence of Aabs (any type of autoantibody, single or multiple) in FDR was 11.9% (53/447). Of those with autoantibodies, 62.3% (33/53) were positive to only 1 autoantibody, 22.6% (12/53) had 2 autoantibodies, 7.55% (4/53) had 3 autoantibodies, and 7.55% (4/53) had all 4 autoantibodies. Typing of HLA-DR and DQ loci showed that 89% of FDR carried moderate- to high-risk genotypes, with only 5 FDR with low-risk genotypes.Conclusions: The prevalence of T1DM autoantibodies in FDRs of T1DM patients was very high (11.9%) in the Sardinian population, higher than in other populations from the United States and Europe, and similar to that observed in Finland. Autoantibody positivity strongly associated with HLA risk. This study provides evidence of the high risk of T1DM in FDR of T1DM patients in Sardinia and warrants longitudinal follow-up to estimate the risk of progression to T1DM in high-risk populations. [ABSTRACT FROM AUTHOR]

In this work, highly conductive and transparent films based on poly(3,4 ethylenedioxythiophene):poly(styrene sulfonate) (PEDOT:PSS) doped with dimethyl sulfoxide (DMSO) were printed onto a flexible substrate, the polyethylene naphthalate (PEN), using the gravure printing method. Gravure-printed DMSO-PEDOT:PSS ink suitably modified with isopropanol was developed and used as anode in flexible solar cells replacing the commonly used anode, that is, Indium Tin Oxide (ITO). Several inks were prepared and characterized in terms of viscosity and surface energy and tested by gravure printing. The wettability of the PEN substrate was investigated through contact angle measurements. For comparison, the anodic conductive polymer was also spin coated on the PEN substrate using an ink suitable for this technique. The films produced with both the techniques, gravure printing and spin coating, each using a proper ink, were characterized in terms of structure and physical-chemical properties. The printed layers were employed as anodes into ITO free-polymer solar cells based on a bulk heterojunction of Poly({4,8-bis[(2-ethylhexyl)oxy]benzo[1,2- b:4,5-b′]dithiophene-2,6-diyl}{3-fluoro-2-[(2-ethylhexyl)carbonyl]thieno [3,4- b]thiophenediyl}) (PTB7) and [6,6]-phenyl C70-butyric acid methyl ester ([70]PCBM). The performances of the devices with printed and spin coated polymeric anode were compared. The cell with the spin-coated anode reached a power conversion efficiency of 3% while the corresponding device with the printed anode a value around 2%. POLYM. COMPOS., 36:1104-1109, 2015. © 2015 Society of Plastics Engineers [ABSTRACT FROM AUTHOR]

Uracil-DNA glycosylases (UDGs) are evolutionarily conserved DNA repair enzymes that initiate the base excision repair pathway and remove uracil from DNA. The UDG superfamily is classified into six families based on their substrate specificity. This review focuses on the family I enzymes since these are the most extensively studied members of the superfamily. The structural basis for substrate specificity and base recognition as well as for DNA binding, nucleotide flipping and catalytic mechanism is discussed in detail. Other topics include the mechanism of lesion search and molecular mimicry through interaction with uracil-DNA glycosylase inhibitors. The latest studies and findings detailing structure and function in the UDG superfamily are presented. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to determine whether mobilization of the splenic flexure during anterior resection is associated with an increased number of complications. Methods: This is a retrospective cohort analysis of all non-emergent anterior resections with anastomosis (open and laparoscopic) between January 2005 and December 2009 from the American College of Surgeons National Surgical Quality Improvement Program. Infectious, renal, and pulmonary adverse events as well as operative times were analyzed for cases with splenic flexure mobilization as compared to no mobilization. We then constructed multivariate models to identify risk factors for postsurgical adverse events. Results: During the 5-year study period, 6,324 (57 %) open resections and 4,788 (43 %) laparoscopic resections were performed. Mobilization of the splenic flexure was associated with an increase in operating room time (204 vs 172 min, p < 0.0001). Although anastomotic leaks were not recorded, there was no difference in organ space infections (3.9 vs 3.7 %, p = 0.7) or return to operating room events between the two groups. However, patients who underwent splenic flexure mobilization had significantly more superficial surgical site infections (10.6 vs 8.4 %, p < 0.0002). Multivariate analysis accounting for laparoscopic or open surgery and standard preoperative and intraoperative variables demonstrated a persistent increase in superficial surgical site infections for patients with splenic flexure mobilization. Conclusions: Operating room times are longer and superficial surgical site infections are more common when the splenic flexure is mobilized. The absolute indications for splenic flexure mobilization should be addressed in further research. [ABSTRACT FROM AUTHOR]

Poxvirus uracil DNA glycosylases are the most diverse members of the family I uracil DNA glycosylases (UNGs). The crystal structure of the uracil complex of Vaccinia virus uracil DNA glycosylase (D4) was determined at 2.03 Å resolution. One uracil molecule was located in the active-site pocket in each of the 12 noncrystallographic symmetry-related D4 subunits. Although the UNGs of the poxviruses (including D4) feature significant differences in the characteristic motifs designated for uracil recognition and in the base-excision mechanism, the architecture of the active-site pocket in D4 is very similar to that in UNGs of other organisms. Overall, the interactions of the bound uracil with the active-site residues are also similar to the interactions previously observed in the structures of human and Escherichia coli UNG. [ABSTRACT FROM AUTHOR]

Aim We sought to identify the rate of re-operation after an index colorectal surgical procedure and potential contributing risk factors. Method This is a retrospective cohort study from the American College of Surgeons National Surgical Quality Improvement Program. We identified all patients who either returned or did not return to the operating room after any colorectal resection from January 2005 to December 2008. Results From a total cohort of 635 265 patients included in the National Surgical Quality Improvement Program over the 4-year study period, we identified 54 237 patients who underwent colorectal operations. A return to the operating room was coded in 5.4 ± 0.1% of non colorectal resection patients and 7.6 ± 0.2% of colorectal resection patients ( P < 0.001). The multivariate model identified patients with postoperative diagnostic codes for abdominal cavity hernia or colostomy complication as having the highest odds of return to the operating room within 30 days. Patients returning to the operating room had longer length of stay and higher overall mortality compared with those patients who did not return to the operating room. Conclusion Return to the operating room is a relatively common occurrence after colorectal resections, with an associated high rate of mortality. Given the association between return to the operating room and adverse patient outcomes, emphasis should be placed on determining strategies to reduce the need for return to the operating room. [ABSTRACT FROM AUTHOR]

Scanning electron microscopy coupled with an energy dispersive X-ray detector (SEM-EDS) has been used to study samples of Sasanian glazed pottery. Analysis of ceramic bodies revealed a general homogeneity in composition among the studied samples and the use of calcareous clay for their manufacture. Glazes are typically alkaline in composition, with sodium and potassium oxide contents between 8 and 13%, and between 3 and 5%, respectively; calcium and magnesium oxide contents are between 7 and 10%, and between 3 and 5%, respectively. These data suggest the use of plant ash together with a silica source for glaze production. Coating thickness is highly variable among different samples, from some 400 up to 1200 µm, but it is generally uniform when a single sample is concerned. Glazes are mostly coloured blue or blue-green; copper and iron are the colouring agents detected; abundance of bubbles, silicate crystals and relics of unmelted material are responsible for their generally opaque appearance, together with the presence of weathering products. The characteristics of the body to glaze contact zone, together with the widespread presence of bubbles, would not rule out production by a single firing process. A few samples feature a peculiar gritty coating on one side of their surface; SEM images show that they are actually partially vitrified, and EDS data denote a rather heterogeneous composition. It seems possible that they result from mixing clay together with the frit used for glaze development. [ABSTRACT FROM AUTHOR]

Isolated fungal infections of the perianal skin are rare and their diagnosis is frequently overlooked. We report a case of a 78-year-old male patient who presented with a friable, violaceous, papulopustular lesion, with heaped-up edges along the anal verge. Biopsy revealed unicellular yeast consistent with blastomycosis. The patient was treated with itraconazole with resolution of this lesion. An extensive MEDLINE literature review from 1958 to the present indicates that this is an uncommon manifestation of cutaneous blastomycosis. A summary of the medical literature is presented with a review of the characteristics, diagnosis, and management of blastomycosis. [ABSTRACT FROM AUTHOR]

Summary Background : The urea breath test is routinely used for diagnosing or confirming the eradication of Helicobacter pylori . Aim : To evaluate the appropriateness of urea breath test referrals. Methods : The age, sex, symptoms, endoscopic findings, use of non-steroidal anti-inflammatory drugs, family history of gastric cancer or H. pylori infection and concomitant diseases of patients referred for urea breath testing in a 1-year period were recorded. The appropriateness of urea breath test referrals was judged according to Maastricht guidelines. Results : One thousand, three hundred and twenty subjects (47 ± 16 years) were referred in 2001: 578 (43.8%) for the diagnosis and 742 (56.2%) for confirmation of the eradication of H. pylori . The urea breath test was considered to be appropriate in 836 (63.3%) patients, inappropriate in 192 (14.5%) and appropriate but avoidable in 292 (22.1%). The appropriateness ratios of urea breath test referrals were 4.6 and 9.0 ( P < 0.0001) for general practitioners and gastroenterologists, respectively. Of the patients ( n =230) with uninvestigated dyspepsia, who underwent urea breath testing according to a ‘test and treat’ strategy, 98 (42.6%) presented at least one risk factor for organic disease. Conclusions : In Italy, nearly 36% of urea breath test referrals are inappropriate or could be avoided if all dyspeptic patients with risk factors were referred for endoscopy or all dyspeptic patients undergoing endoscopy were tested for H. pylori infection with biopsy methods. Both general practitioners and, to a lesser extent, gastroenterologists require educational programmes to deal effectively with H. pylori . [ABSTRACT FROM AUTHOR]

Background: As new techniques are emerging for laparoscopic liver resections, concerns have been raised about the development of gas embolus related to the CO2 pneumoperitoneum. We hypothesized that elevated intrahepatic vascular pressures and decreased hepatic tissue blood flow (LQB) would prevent gas embolus during laparoscopic liver resections under conventional pneumoperitoneum. Methods: Intrahepatic vascular pressures and LQB were measured in nine pigs with varying CO2 pneumoperitoneum. Gas embolus was determined after hepatic incision by monitoring pulmonary arterial pressure (PAP), hepatic venous PCO2, systemic blood pressure (SBP), and suprahepatic vena cava ultrasound. Results: As the pneumoperitoneum was increased from 0 to 15 mmHg, intrahepatic vascular pressures increased significantly (p < 0.05), while LQB decreased significantly (p < 0.05). A 2.0-cm hepatic incision at 4, 8, 15, and 20mmHg produced no ultrasound evidence of gas embolus and no changes in PAP, SBP, or hepatic venous PCO2 (p = NS). Conclusion: These data suggest that the risk of significant embolus under conventional pneumoperitoneum is minimal during laparoscopic liver resections. [ABSTRACT FROM AUTHOR]

Background: Urea breath test (UBT) is the most accurate non invasive test for either diagnosing (Dx) or confirming the successful eradication (Cx) of H. pylori infection. Aim: To evaluate the appropriateness of UBT referrals in one Italian Center. Methods: Patients consecutively referred for UBT (1-year period). Age, sex, symptoms, endoscopic findings, NSAIDs use, family history of gastric cancer or H. pylori infection, and concomitant diseases were recorded. Reasons for UBT referral were carefully examined and judged as appropriate or not according to the guidelines of the Maastricht 2-2000 Consensus Meeting. Patients were asked whether they had been referred by GP or gastroenterologist. Results: 1320 subjects (47±16 years) were referred for UBT to our Unit during 2001:578 (43.8%) for Dx and 742 (56.2%) for Cx of infection. The UBT was considered appropriate in 836 (63.3%) patients, inappropriate in 192 (14.5%), and still appropriate but avoidable in 292 (22.1%) patients who should have been tested with a biopsy-based method during prior endoscopy. In the subgroup of patients (n = 230) with uninvestigated dyspepsia, who underwent UBT according to the "test and treat" strategy proposed in Maastricht, 98 (42.6%) were > 45 years or presented at least one risk factor for organic disease. Overall, the appropriateness ratio of UBT referrals (appropriate UBT/inappropriate UBT) was 4.64 and 9.02 (p < 0.01) for GPs and gastroenterologists, respectively. Conclusion: In Italy, nearly 36% of UBT referrals are inappropriate or could be avoided if all dyspeptic patients with risk factors would be correctly referred to endoscopy or all dyspeptic patients undergoing endoscopy would be tested for H. pylori infection with a biopsy-based method. Although the European guidelines on the management strategies of H. pylori infection clearly indicate who to test and how to test, both GPs and, to a lesser extent, gastroenterologists still need educational programs to... [ABSTRACT FROM AUTHOR]

The effectiveness of intranasal neostigmine (9.3-13.8 mg) was tested in 20 subjects with myasthenia gravis, classified as Osserman grades 2A and 2B. In all cases the drug produced significant clinical and electromyographic improvement. No side effects were reported during the treatment. [ABSTRACT FROM AUTHOR]

This article presents information on contact dermatitis to acupuncture needles. A 65-year-old female developed an itchy red vesicular dermatitis of the neck in 1985. Chronic and painful cervical and scapular arthrapathy treated for a long time by non-steroidal anti-inflammatory drugs, with poor tolerance and then for a few weeks by acupuncture. It was examined that 3 types of needles were used by the rheumatologist, all supposed to be gold metal made. The diphenyl carbazide spot test demonstrated the presence of chromium in the oldest type, but not in the 2 more recent types. Discontinuation of the chromium-containing needles allowed fast healing, even while using the 2 other types.