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Objective This study investigated the impact of a single piezocision in the maxillary alveolar process on the speed of tooth movement. The null hypothesis was that the speed of tooth movement will be equal with and without piezocision. Methods All maxillary molars on one side were moved against the combined incisors in 10 ten-week-old male Wistar rats. Under general anesthesia, a force of 25 cN was applied on either side using a Sentalloy closed coil spring. After placing the orthodontic appliance, vertical corticision was performed using a piezotome under local anesthesia, 2 mm mesial from the mesial root of the first molar on a randomly selected side; the other side served as the control. At the beginning of the treatment, and 2 and 4 weeks later, skull micro-computed tomography was performed. After image reconstruction, the distance between the mesial root of the first molar and the incisive canal, and the length of the mesial root of the first maxillary molar were measured. Moreover, the root resorption score was determined as described by Lu et al. Results Significantly higher speed of tooth movement was observed on the corticision side; thus, the null hypothesis was rejected. The loss of root length and root resorption score were significantly more pronounced after piezocision than before. A strong correlation was observed between the speed of tooth movement and root resorption on the surgical side, but the control side only showed a weak correlation. Conclusions Piezocision accelerates orthodontic tooth movement and causes increased root resorption.

Cardiovascular risk is increased in patients with autoimmune rheumatic diseases. Endothelial, erythrocyte and platelet microvesicles (MVs) are elevated in patients with cardiovascular diseases and represent novel markers of endothelial dysfunction and thromboinflammation. We tested whether their levels are increased in patients with autoimmune rheumatic diseases (ARDs) in the absence of disease flare and cardiovascular comorbidities. Well-controlled patients with rheumatoid arthritis or systemic lupus erythematosus were studied, provided they were free from cardiovascular comorbidities and established cardiovascular disease. We additionally studied (a) a control group consisting of healthy volunteers and (b) a reference group including patients with stable coronary artery disease (CAD). MVs were measured using a standardized flow cytometry protocol. In a population of 74 participants, patients with ARDs (n = 17) presented increased levels of both endothelial (283.3 ± 195.0/μL vs 168.5 ± 54.8/μL, p = 0.029) and platelet MVs (374.0 ± 275.3/μL vs 225.7 ± 101.1/μL, p = 0.046) compared to controls (n = 34), whereas erythrocyte MVs did not significantly differ. In addition, patients with ARDs showed similar levels of endothelial MVs compared to CAD patients (n = 23) (283.3 ± 195.0/μL vs 297.0 ± 211.8/μL, p = 0.846). Platelet MVs were significantly associated with disease duration, and erythrocyte MVs with patients' perceived disease activity. In conclusion, increased levels of endothelial and platelet MVs may be evident in patients with ARDs, even in the absence of disease flares and before the establishment of cardiovascular complications. Levels of endothelial MVs resemble those of patients with profound atherothrombotic profile. The prognostic potential of MVs in terms of cardiovascular disease prevention warrants further investigation in patients with ARDs.

The objectives of this experimental work were the evaluation of the potential role of Salmonella enterica subsp. diarizonae in diarrhoeic syndrome in lambs and the investigation of facets of the pathogenesis of the infection. In total, 12 lambs were challenged orally on the first day of life, with a S. enterica subsp. diarizonae isolate from a clinical case of diarrhoeic syndrome. Sequential blood, faecal and buccal samples were collected from lambs and faecal and milk samples were taken from their dams. Lambs were euthanised 1, 2, 4, 7, 10, 14 and 21 days after challenge. Samples were processed for recovery of the challenge organism, they were also subjected to examination by PCR for detection of the invA gene. Tissue samples from lambs were also examined as above and histopathologically. S. enterica subsp. diarizonae was recovered from faecal samples of all lambs, in total, from 45/77 samples (median duration: 2.4 days post-inoculation). It was also recovered from buccal samples (10/77) from seven lambs (median duration: 0.8 days), and from tissue samples (small intestine, abomasum, liver, gallbladder) of nine lambs. It was recovered from two consecutive milk samples from the same ewe, but not from any faecal sample from ewes. The invA gene was detected in samples from all lambs (median duration: 5.5 days in faecal and 1.3 days in buccal samples), as well as in milk samples from three ewes. Histopathological findings included abomasitis with subepithelial presence of eosinophils, lymphocytes and plasma cells, consistently observed in all lambs. In the small intestine, salient lesions initially included distension and oedema of intestinal villi, leucocytic infiltration and hyperplasia of lymphoid nodules with apparent germinal centres, this was followed at later stages by atrophy and/or degeneration of the lymphoid tissue of the intestine with marked subepithelial infiltration of lymphocytes, plasma cells and eosinophils.

Background/aim The incidence of hepatocellular carcinoma (HCC) in patients with transfusion dependent thalassemia (TDT) has been increasing, where viral hepatitis and iron overload are the two established HCC risk factors. The aim of this study was to investigate the etiological factors of HCC development and to evaluate the possible factors associated with survival in our cohort of TDT patients with HCC. Methods Records of patients with TDT diagnosed with HCC from 2008 to 2018 were reviewed. Liver iron concentration (LIC) has been assessed by the signal-intensity-ratio MRI. The diagnosis of HCC was made by a 3-phase contrast magnetic resonance imaging (MRI) and patients were staged and treated for HCC according to Barcelona Clinic Liver Cancer (BCLC) grading system. Results Forty-two TDT patients with HCC have been included. Most of them (78.5%) were anti-HCV positive, 59.5% HCV-RNA positive, and 16.5% had serological markers of resolved HBV infection. Patients with HCV infection have been treated successfully with either Peg-IFNa±Ribavirin or with the new direct antivirals (DAAs). At the time of HCC diagnosis, all patients with chronic HCV infection were HCV-RNA negative, 78.5% had underlying cirrhosis, and the vast majority (98%) had average or mild elevated LIC values. According to the BCLC system, patients were classified as 0-A: 28.5%, B: 57% and C-D: 14.5%. HCC has been treated with loco-regional treatment in 78.5% of our patients, while the rest have received sorafenib. Twenty-eight patients (66.5%) died due to HCC with a median survival time of 6 months (range: 2-60). Using the Cox proportional hazard model, the only factors associated with poor survival were BCLC stages C and D. Conclusions In conclusion, BCLC staging is the main prognostic factor of survival in patients with TDT who develop HCC.

The objectives of the study were (a) to study the characteristics of uterine involution in ewes that had developed subclinical uterine infection in the immediately post-partum period and (b) to evaluate effects of the infection in the subsequent reproductive performance of ewes. Uterine infection was induced in ewes (I, n = 10) by intrauterine inoculation of Escherichia coli, uninoculated controls were included (C, n = 12). Animals were examined at regular intervals before and post-inoculation. Clinical and ultrasonographic examinations were performed. Vaginal swab samples and biopsy uterine tissue samples were collected for bacteriological, cytological and histological examination. Finally, ewes were put to rams and reproductive performance was monitored. After challenge, it was ultrasonographically found that caruncular dimensions, myometrial thickness and diameter of uterine lumen were greater in I ewes. In these ewes, particular reduction of dimensions occurred during the second week post-partum, whilst in C ewes during the first week. The uterine artery diameter and the blood flow into the uterus were also greater in I than in C ewes. E. coli infection was more frequent and of longer duration in I than in C ewes: in 68.1% and 50.0% of ewes and 19.5 and 14 days, respectively. There was lower proportion of neutrophils and higher of lymphocytes in group I than in C. In inoculated ewes, there was histological evidence of uterine epithelial destruction, increased cellular infiltration, hyperaemia and extracasation, which persisted up to 42 days post-partum. During the subsequent reproductive season, all ewes in group I lambed normally and produced healthy and viable lambs. No significant difference in reproductive performance parameters were seen in I comparison to C ewes. It is concluded that the innate immunity of the uterus sufficed to counteract the bacterial infection, although the process of involution took longer than in healthy animals, moreover, the ultrasonographic examination is a useful means for assessment of the genital tract of ewes post-partum, finally, no adverse effects were noted in the subsequent reproductive performance of ewes.

Objectives were to evaluate characteristics of uterine involution in ewes with pregnancy toxaemia during gestation and to study effects on subsequent reproductive performance. Pregnancy toxaemia was induced in ewes (A) by feeding an energy-deficient diet as confirmed by detecting β-hydroxybutyrate concentrations in blood indicative of this disorder. There was also a control group (C). Animals were evaluated until the 60th day post-partum using clinical and ultrasonographic examinations. Vaginal swab samples and uterine biopsy tissue samples were collected for bacteriological and cytological examination; biopsy samples were prepared for histological examination. Ewes were subsequently placed with rams and reproductive performance was ascertained. Post-partum, during the ultrasonographic examination of the uterus, ewes of Group A had caruncle and uterine lumen diameters, as well as a uterine thickness greater than ewes of Group C. Post-partum uterine blood flow volume was greater in ewes of the A than C group. Neutrophils predominated in vaginal samples, with the neutrophil proportion being less in ewes of Group A than C. There were no differences in the uterine involution process between groups. During the subsequent reproductive season, all the ewes of Group A lambed normally and produced viable lambs. It is concluded that there were no adverse effects on subsequent reproductive performance of ewes previously affected with pregnancy toxaemia, when appropriate health management was performed.

Lifestyle interventions remain the cornerstone therapy for non-alcoholic fatty liver disease (NAFLD). This randomised controlled single-blind clinical trial investigated the effect of Mediterranean diet (MD) or Mediterranean lifestyle, along with weight loss, in NAFLD patients. In all, sixty-three overweight/obese patients (50 (sd11) years, BMI=31·8 (sd4·5) kg/m2, 68 % men) with ultrasonography-proven NAFLD (and elevated alanine aminotransferase (ALT) and/or γ-glutamyl transpeptidase (GGT) levels) were randomised to the following groups: (A) control group (CG), (B) Mediterranean diet group (MDG) or (C) Mediterranean lifestyle group (MLG). Participants of MDG and MLG attended seven 60-min group sessions for 6 months, aiming at weight loss and increasing adherence to MD. In the MLG, additional guidance for increasing physical activity and improving sleep habits were given. Patients in CG received only written information for a healthy lifestyle. At the end of 6 months, 88·8 % of participants completed the study. On the basis of intention-to-treat analysis, both MDG and MLG showed greater weight reduction and higher adherence to MD compared with the CG (allPPP=0·04). MLG showed significant improvements in ALT levels (i.e. ALTP=0·03) and 50 % reduction of ALT levels (P=0·009)) and liver stiffness (P=0·004) compared with CG after adjusting for % weight loss and baseline values. MDG improved only liver stiffness compared with CG (P

Malnutrition risk screening in cirrhotic patients is crucial, as poor nutritional status negatively affects disease prognosis and survival. Given that a variety of malnutrition screening tools is usually used in routine clinical practice, the effectiveness of eight screening tools in detecting malnutrition risk in cirrhotic patients was sought. A total of 170 patients (57·1 % male, 59·4 (sd 10·5) years, 50·6 % decompensated ones) with cirrhosis of various aetiologies were enrolled. Nutritional screening was performed using the Malnutrition Universal Screening Tool, Nutritional Risk Index, Malnutrition Screening Tool, Nutritional Risk Screening (NRS-2002), Birmingham Nutritional Risk Score, Short Nutritional Assessment Questionnaire, Royal Free Hospital Nutritional Prioritizing Tool (RFH-NPT) and Liver Disease Undernutrition Screening Tool (LDUST). Malnutrition diagnosis was defined using the Subjective Global Assessment (SGA). Data on 1-year survival were available for 145 patients. The prevalence of malnutrition risk varied according to the screening tools used, with a range of 13·5–54·1 %. RFH-NPT and LDUST were the most accurate in detecting malnutrition (AUC = 0·885 and 0·892, respectively) with a high sensitivity (97·4 and 94·9 %, respectively) and fair specificity (73·3 and 58 %, respectively). Malnutrition according to SGA was an independent prognostic factor of within 1-year mortality (relative risk was 2·17 (95 % CI 1·0, 4·7), P = 0·049) after adjustment for sex, age, disease aetiology and Model for End-stage Liver Disease score, whereas nutrition risk according to RFH-NPT, LDUST and NRS-2002 showed no association. RFH-NPT and LDUST were the only screening tools that proved to be accurate in detecting malnutrition in cirrhotic patients.

Background Accurate assessments of muscle mass in patients with cirrhosis are necessary in clinical practice. Computed tomography (CT) of the upper abdomen has been proposed as a useful method for quantifying muscle mass. Recently, Carey et al developed specific cutoffs for muscle wasting based on the skeletal muscle index at the L3 vertebra (L3-SMI) for cirrhotic patients. The aim of the present study was to assess the concurrent validity of the newly proposed cutoffs of Carey et al, along with others widely used in several clinical contexts, using dual energy X-ray absorptiometry (DXA) as the reference method. Methods Data were evaluated from 97 Caucasian patients (59.8% male, 59.1±11.6 years old, 45.4% decompensated) with cirrhosis of various etiologies. Muscle mass was assessed using the appendicular lean mass index (ALMI) by DXA and the L3-SMI by CT. Low L3-SMI was defined in relation to 5 different cutoffs. Results Low muscle mass prevalence was 13.4% according to ALMI and 26.8-45.4% according to the different cutoffs applied for L3-SMI. The Carey et al, Prado et al and Montano-Loza et al cutoffs showed similar sensitivity (all 69.2%) and specificity (79.8%, 76.2% and 75.0%, respectively) and high accuracy (78.4%, 75.3% and 74.2%). The Carey et al cutoffs showed the highest diagnostic validity against DXA the multivariate odds ratio adjusted for age, sex, body mass index category, disease etiology and model for end-stage liver disease score (95% confidence interval) was 5.88 (1.36-25.4), P=0.018. Conclusion Compared to DXA, the cutoffs for identifying muscle wasting proposed by Carey et al were proven to be the most accurate.

Background Liver disease severity must be determined before treatment of chronic hepatitis C (CHC). We evaluated the diagnostic performance of the APRI and FIB-4 scores compared to transient elastography liver stiffness (TE-LS) in detecting significant fibrosis (F3) or cirrhosis (F4). Methods We retrospectively enrolled 575 patients with CHC who underwent TE-LS between May 2014 and September 2018: 365 (63.5%) male, mean age 51.54±12.4 years. APRI and FIB-4 scores were compared to TE-LS. Results One hundred patients (17.5%) had TE-LS values between 9 and 11.9 kPa, and were classified as F3, while 265 (46%) were classified as F4 (TE-LS ≥12 kPa). APRI and FIB-4 scores predicted F4 patients adequately using cutoff values of 0.65 (sensitivity 85.5%, specificity 77%) and 1.63 (sensitivity 91%, specificity 77%), respectively. Cutoff values of 0.64 for APRI and 1.46 for FIB-4 predicted F3/F4 patients (sensitivity 72% and 81.5%; specificity 83% and 79%, respectively). The use of these cutoff values with APRI and FIB-4 in combination adequately predicted patients with significant fibrosis or cirrhosis (positive predictive value 91.5%), while cutoff values of 0.3 and 0.98, respectively, predicted F1/F2 patients with specificity 94.5% and sensitivity 26.5%, suggesting that in 58.5% of patients TE-LS could possibly be avoided. Conclusions The APRI/FIB-4 combination performed well in predicting significant fibrosis, while FIB-4 performed well in predicting cirrhosis. These noninvasive biochemical markers could be used as screening tools instead of LS measurement, which is not widely available. Further prospective validation studies are required to confirm this finding.

Type 2 diabetes mellitus (T2DM) is evolving to an epidemic of the modern world. T2DM is associated with a number of pathological complications, including cardiovascular disease that is mostly promoted by the increased oxidative stress in type 2 diabetic patients. We performed a randomized double-blind placebo-controlled trial to investigate the effectiveness of an individualized oral supplementation with α-lipoic acid (ALA), carnosine, and thiamine. For that purpose, 82 obese type 2 diabetic patients were randomly assigned to 2 groups, and were either supplemented daily with 7 mg ALA/kg body weight, 6 mg carnosine/kg body weight, and 1 mg thiamine/kg body weight or placebo for 8 weeks. An array of biochemical tests including the estimation of oxidative stress and platelet aggregation were performed at baseline and at follow-up. Moreover, the antiplatelet activity of each of the supplement's components was determined ex vivo at human and washed rabbit platelets. Glucose and HbA

Background Only limited data concerning hepatitis B (HBV) and C viruses (HCV) coinfection are available. Direct-acting antivirals (DAAs) may be more effective for HCV clearance than interferon (IFN)-based regimens with a risk of HBV reactivation. Methods We retrospectively enrolled 40 HBV/HCV-coinfected patients to evaluate their clinical profile and treatment outcomes. Results Chronic dual infection was present in 25/40 (62.5%) patients, acute HCV superinfection in 5/40 (12.5%) patients and acute HBV superinfection in 10/40 (25%). Twenty-five patients (62.5%) were treated: 16/25 (64%) with IFN, 4/25 (16%) with nucleot(s)ide analogs (NUCs) and 5/25 (20%) with DAAs. Of the 16 patients treated with IFN-based therapy, 6 (37.5%) achieved both sustained virological response (SVR) and HBsAg clearance. Of the 4 patients treated with NUCs, one (25%) achieved both SVR and HBsAg clearance. All five patients treated with DAAs (100%) achieved SVR, while one case of HBV reactivation was recorded. Fifteen of the 40 patients (37.5%) did not receive any treatment. Eight of them (53.5%) presented with acute HBV superinfection: spontaneous HCV clearance was recorded in 5/8 (62.5%), while HBsAg clearance occurred in 6/8 (75%). Three of them (20%) presented with acute HCV superinfection; spontaneous HCV clearance was recorded in one of the three (33.5%). The other four patients (26.5%) presented with dual HBV/HCV infection. Conclusions A significant proportion of patients presented with active HBV replication. Treatment with DAAs seems to be efficacious for HCV eradication. However, clinicians should be aware of HBV reactivation. HBV superinfection may lead to both HBsAg and HCV clearance.

Parkinson's disease (PD) is a progressive neurodegenerative movement disorder where motor dysfunction gradually increases as the disease progress. In addition to administering dopaminergic PD-specific drugs, attending neurologists strongly recommend regular exercise combined with physiotherapy. However, because of the long-term nature of the disease, patients following traditional rehabilitation programs may get bored, lose interest and eventually drop out as a direct result of the repeatability and predictability of the prescribed exercises. Technology supported opportunities to liven up a daily exercise schedule have appeared in the form of character-based, virtual reality games which promote physical training in a non-linear and looser fashion and provide an experience that varies from one game loop the next. Such "exergames", a word that results from the amalgamation of the words "exercise" and "game" challenge patients into performing movements of varying complexity in a playful and immersive virtual environment. Today's game consoles such as Nintendo's Wii, Sony PlayStation Eye and Microsoft's Kinect sensor present new opportunities to infuse motivation and variety to an otherwise mundane physiotherapy routine. In this paper we present some of these approaches, discuss their suitability for these PD patients, mainly on the basis of demands made on balance, agility and gesture precision, and present design principles that exergame platforms must comply with in order to be suitable for PD patients., 12 pages, 3 figures

Our Kinect-based physiotherapy platform tailored to Parkinson’s disease (PD) patients employs a Kinect sensor to extract 3D skeletal data in real-time from an exercising patient. The initial collection of five exercises served by the platform has now been enriched with an additional five exercises which are also based on traditional PD-specific physiotherapy. Each exercise has been implemented in the Unity 3d game engine and employs either a linear or a circular movement pattern with very light-weight processing demands for real-time computations. During each exercise, a trainer demonstrates correct execution and patient-provided 3D joint data obtained via the Kinect sensor are compared to exercise-specific control routines in real time, in order to assess proper posture and body control. Following completion of an exercise, performance metrics appropriate for that exercise are computed and displayed on screen as feedback to the patient. In addition, they are stored to provide a historical progress record to, e.g., enable the attending physiotherapist to fine-tune the exercise to the abilities/needs of an individual patient.

Hereditary bleeding disorders include a group of diseases with abnormalities of coagulation. Prior to 1990, infection with hepatitis C virus (HCV) was mainly transmitted via pooled plasma products as a treatment for hereditary bleeding disorders. Anti-HCV positivity in these patients may be as high as >70% in some areas, while some of them have also been coinfected with human immunodeficiency virus. Since about 20% of HCV-infected patients clear the infection naturally, chronic HCV infection represents a significant health problem in this group of patients. Mortality due to chronic HCV infection is estimated to be >10 times higher in patients with hemophilia than in the general population, and is mainly due to liver cirrhosis and hepatocellular carcinoma. The antiviral treatment of HCV in patients with hereditary bleeding disorders is not different from that of any other infected patients. Nevertheless, many patients with hereditary bleeding disorders have declined (Peg)interferon-based treatment because of side effects. In recent years, multiple orally administrated direct-acting antivirals (DAAs) have been approved for HCV treatment. Unfortunately, there is not much experience from treating these patients with DAA regimens, as major studies and real-life data did not include adequate numbers of patients with inherited hemorrhagic disorders. However, the available data indicate that DAAs have an excellent safety profile with a sustained virological response rate of >90%.

Parkinson's Disease patients attending traditional long-term rehabilitation programs may lose interest and eventually drop out, as a direct result of the repeatability of the prescribed exercises. Technology-supported opportunities in the form of character-based, virtual reality exercise games (called “exergames”) can engage players to train in a non-linear fashion by providing an experience which varies from one game loop the next. The present work reports on a Kinect-based Unity3D exergame tailored to PD patients with mild to moderate symptoms which can be used in both clinical and home settings. The game supports a collection of gestures drawn from existing PD-specific training programs which advocate big and purposeful movements, intended to improve postural stability and reflexes as well as increase the overall mobility of upper and lower limbs. When a patient's movements “match” a programmed gesture, a 3D cartoon avatar responds accordingly. Finally, in-game decision-making purports to improve the patient's cognitive reaction.

Hyperbilirubinemia is an adverse reaction of simeprevir (SMV). The majority of these patients were taking concurrent ribavirin presenting elevated unconjugated hyperbilirubinemia due to hemolysis. However, cases of hepatic failure with elevated bilirubin level have also been reported in patients with decompensated cirrhosis. We describe a 51-year-old female patient with HbS beta 0-thalassemia and recently diagnosed compensated cirrhosis due to chronic hepatitis C infection. Laboratory evaluation revealed total bilirubin: 2.7 mg/dL and serum HCV-RNA 137.204 IU/mL. HCV was genotyped as 4. A FibroScan revealed 35.3 kPa. She was considered as illegible for pegylated-interferon-free treatment with direct acting antivirals and a course with simeprevir and sofosbuvir (SOF) combination for twelve weeks was planned. Hyperbilirubinemia developed from the beginning with peak values during the 3rd month of treatment. However, no findings of liver decompensation were noticed. Hyperbilirubinemia was benign and fully reversible and our patient finally achieved sustained virological response 24 weeks after the end of treatment.

We report on a Kinect-based, augmented reality, real-time physiotherapy platform tailored to Parkinson’s disease (PD) patients. The platform employs a Kinect sensor to extract real-time 3D skeletal data (joint information) from a patient facing the sensor (at 30 frames per second). In addition, a small collection of exercises practiced in traditional physiotherapy for PD patients has been implemented in the Unity 3D game engine. Each exercise employs linear or circular movement patterns and poses very light-weight processing demands on real-time computations. During an exercise, trainer instruction demonstrates correct execution and Kinect-provided 3D joint data are fed to the game engine and compared to exercise-specific control routines to assess proper posture and body control in real time. When an exercise is complete, performance metrics appropriate for that exercise are computed and displayed on screen to enable the attending physiotherapist to fine-tune the exercise to the abilities/needs of an individual patient as well as to provide performance feedback to the patient. The platform can operate in a physiotherapist’s office and, following appropriate validation, in a home environment. Finally, exercises can be parameterized meaningfully, depending on the intended purpose (motor assessment versus plain exercise at home).

Introduction The low and incomplete recanalization performance of thrombolytic therapy in patients with acute ischemic stroke has created the need to use focused ultrasound (FUS) energy as a way to enhance thrombolysis efficiency (sonothrombolysis). Using an in vitro flow model, the role of various parameters involved in FUS-enhanced tenecteplase (TNK-tPA [tissue plasminogen activator])-mediated thrombolysis was evaluated. Materials and methods Fully retracted porcine blood clots were used for the proposed parametric studies. A spherically FUS transducer (4 cm diameter), focusing at 10 cm and operating at 1 MHz, was used. Pulsed ultrasound protocols were applied that maintained temperature elevation at the focus that never exceeded 1°C. Thrombolysis efficiency was measured as the relative reduction in the mass of the clot. Results The role of various properties on thrombolysis efficacy was examined. These various properties are the acoustic power, the TNK-tPA concentration, the flow rate, the exposure time, the pulse length, the pulse repetition frequency, the duty factor, the formation of standing waves, the acoustic medium, and the administration of microbubbles. Study results have demonstrated that the parameters examined influenced thrombolysis efficacy and the degree of thrombolysis achieved by each parameter was measured. Conclusions Study findings helped us to optimize the treatment protocol for 1 MHz pulsed FUS that maximizes the thrombolytic efficacy of TNK-tPA, which potentially could be applied for therapeutic purposes. The outcome of the study showed poor thrombolysis efficacy, as with 30 minutes of FUS treatment only 370 mg of clot was removed.

Endometrial cancer is the sixth most common cancer in women. Galectin-3 (GAL-3) and CRIP-1 are multifunctional proteins which seem to be involved in many neoplasias. This study aims to point out correlations between clinicopathological findings and endometrial cancer patient survival to GAL-3 and CRIP-1 expression in order to enfold their diagnostic/prognostic potential. Tissues from 46 patients diagnosed with endometrial cancer were studied by immunohistochemistry, using monoclonal antibodies for GAL-3 and CRIP-1, and expression levels were correlated with clinicopathological findings and survival. Analysis was performed at single protein level or as co-expression. High expression of GAL-3 and CRIP-1 was independently associated with tumor depth and histological grade, respectively. Also, there was a significant correlation between high co-expression of the two proteins and the histological grade (aOR 2.66), the tumor depth (aOR 0.32) and the histological type (aOR 1.32), but not with the patients' age. Moreover, high expression of both proteins was observed in patients with shorter survival times. Interestingly, the co-expression of the two proteins exhibited some degree of monotony (Spearman's ρ = 0.768), indicating a common molecular pathway. This study provides evidence for a prognostic clinical potential of the combined study of GAL-3 and CRIP-1 in endometrial cancer. These factors are poorly studied in endometrium, and their role in the carcinogenetic process and on effective therapy awaits further elucidation.

Goals: Comparison of nitric oxide (NO) levels in cirrhotic patients with and without hepatic encephalopathy (HE), evaluation of possible correlation between HE and other clinical or laboratory characteristics, and estimation of utilization of NO levels in clinical practice. Background: HE is a neuropsychiatric complication of cirrhosis. The exact pathogenetic mechanisms underlying the presence of HE are not known. However, dysfunction of the NO pathway and ammonia detoxification are thought to play a major role. Study: Sixty-seven cirrhotic patients, 36 (53.7%) without HE, and 31 (46.3%) with HE were included in the study. Eighteen healthy individuals were used as control group. Clinical and laboratory data, including ammonia and stable end products of NO using Griess reaction, were collected. Results: NOx levels were statistically significantly higher in cirrhotic patients (225.5 μmol/L) than in control group [(67.94 μmol/L) (P = 0.000)]. NOx levels were, also, statistically significantly higher in patients with HE compared with patients without HE (324.67 μmol/L vs. 141.96 μmol/L, P = 0.000). Significant correlation between the presence of HE and NOx, ammonia, C-reactive protein, albumin, Model for End-Stage Liver Disease score, and Child-Pugh classification revealed. NOx levels also correlated with severity of HE. NOx and ammonia are independent factors predicting HE according to regression analysis. Diagnostic accuracy for the diagnosis of HE using a combination of NOx and ammonia was superior compared with standalone NOx or ammonia utilization. Conclusions: NOx levels are correlated with the presence and severity of HE. NOx levels determination, in addition to ammonia levels, could contribute in diagnosis of HE.

Apoptosis-related proteins play an important role in lymphoma cell death during chemotherapy. In our study, we investigated the prognostic significance of CD95, BCL2, and P53 expression in extranodal non-Hodgkin's lymphoma (NHL). We examined 71 patients with extranodal NHL [45 diffuse large B-cell lymphomas (DLBCLs) and 26 mucosa-associated lymphoid tissue lymphomas (MALTLs)], 35 male and 36 female, with a median age of 65.8 years. The most common site of origin was the stomach (N = 31). Paraffin-embedded specimens were analyzed immunohistochemically for CD95, BCL2, and P53 expression. Multivariate analysis revealed that in DLBCLs, positive CD95 and negative BCL2 expression were independent prognostic factors for overall survival. We reached the same conclusion for MALTLs, with positive CD95 and negative P53 expression. In DLBCLs, the 5-year overall survival rate was 71.5% for the CD95-positive cases and 35% for the CD95-negative cases (p = 0.004) and the 5-year overall survival was significantly better in BCL2-negative cases (70.8%) when compared to BCL2-positive cases (37%; p = 0.009). In MALTLs, the 5-year overall survival rate for the CD95-positive and CD95-negative groups was 89.5% and 42.9%, respectively (p = 0.004) and the 5-year overall survival rate was 50% for the P53-positive cases and 88.9% for the P53-negative cases (p = 0.016). In conclusion, positive CD95 expression proved to be a good prognostic factor of overall survival in both extranodal DLBCLs and MALTLs. In contrast, positive expression of BCL2 and P53 was found to be unfavorably associated with survival in extranodal DLBCLs and MALTLs, respectively.

The purpose of this study was to investigate the co-expression of survivin, c-erbB2, and COX-2 in endometrial cancer tissues and evaluate its prognostic significance in endometrial cancerTumor tissue biopsies from 110 patients with primary untreated endometrial carcinomas were studied by immunohistochemistry. Statistical analysis evaluated correlation of antigen expression with tumor stage, grade, myometrial invasion, and histologic type. Association with disease outcome was also investigatedThe results showed that expression of the three antigens was independently associated with histological grade, disease stage, and myometrial invasion. Clinicopathological parameters were also associated with the number of antigens expressed by each tumor, the expression of more antigens correlating with advanced stage disease and deep myometrial invasion. In a 10-year follow-up, patients with tumors expressing more of these three antigens had significantly lower survival rate that those with smaller expression scoreOur results indicate that the co-expression score has independent prognostic value for endometrial cancer.

Background and aim We investigated the role of the prophylactic administration of the antioxidant 2-mercaptoethane sulfonate (mesna) on the hepatocyte-regenerating capacity following partial hepatectomy (PH) with concurrent Pringle maneuver. Methods Wistar rats were subjected to PH (70% hepatectomy), 30 min Pringle maneuver, PH plus Pringle with or without mesna pretreatment (400 mg/kg, per os, 3 h before Pringle), or sham operation. At 24 h, 48 h, 72 h, and 1 week after operation, relative liver weight, hepatocyte mitotic activity (mitotic index), the histopathological score and serum aspartate aminotransferase, and alanine aminotransferase concentrations were assessed. At 1 h after operation, oxidative stress markers (glutathione to glutathione disulfide ratio, malondialdehyde concentration, and superoxide dismutase activity) and nuclear factor-kappaB (NF-kappaB) activity were assessed. Results Hepatectomy stimulated the regenerating process and induced mild oxidative stress and the activation of NF-kappaB in hepatocytes, while causing tissue injury in the remnant liver. When PH was performed under Pringle maneuver, hepatocyte mitotic activity was substantially suppressed, although Pringle alone initiated a delayed regenerating response. Furthermore, Pringle maneuver deteriorated oxidative stress markers, markedly increased NF-kappaB activity, and aggravated tissue injury, as compared to hepatectomy alone. Mesna pretreatment prevented the Pringle-induced antimitotic effect and the induction of oxidative stress, inhibited the activation of NF-kappaB, while attenuating liver injury after PH under Pringle. Conclusion The excessive activation of NF-kappaB is related to the suppression of hepatocyte-regenerating activity following PH with concurrent liver ischemia. Mesna pretreatment protects the liver against the Pringle-induced antimitotic effect after PH via the prevention of oxidative stress and the inhibition of NF-kappaB activation.

Hearing impairment is a well-known consequence of closed head injury (CHI). The aim of this study was to elucidate the pathogenesis of CHI-induced hearing loss, using a rabbit model. Twelve New Zealand white rabbits were divided into two groups of 6. In the first group, CHI was induced mechanically, whereas the rabbits of the second group served as controls. Baseline distortion product otoacoustic emissions (DPOAEs), contralateral suppression (CS) of the DPOAEs and auditory brainstem response (ABR) were obtained. The same measurements were performed in the first group after CHI. Three hours later, the animals were sacrificed and their brain was excised and subjected to histopathologic examination. Mean I–III ABR latencies were increased and DPOAE amplitudes and CS values were reduced in the trauma group after CHI, at a statistically significant level. Histopathologic examination of the temporal lobe and brainstem showed multiple hemorrhagic and necrotic areas, with edema in the surrounding region. The vestibulocochlear nerve was severely damaged at its emerging site at the brainstem. In conclusion, both peripheral and central involvement of the auditory pathway was found after CHI. Otoacoustic emissions in conjunction with ABR may provide significant information on both peripheral and central auditory function.

AIM The effectiveness and safety of ibutilide (IB) use in patients receiving amiodarone or propafenone for atrial flutter (AFL) and atrial fibrillation (AF) were compared to IB alone. METHODS AND RESULTS In 104 consecutive patients with AF (65%) or AFL (35%), receiving amiodarone (n = 46), propafenone (n = 30), or no specific antiarrhythmic drug (n = 28), IB was given for cardioversion. Fifteen patients in amiodarone group were loaded with 1.2 g intravenously before IB administration. The mean duration of arrhythmia episode was 23 +/- 65 days, while 85% of patients had structural heart disease. The left ventricle ejection fraction was 57 +/- 10% and the left atrium size was 4.2 +/- 0.6 cm. The conversion efficacy did not differ among groups (62% for amiodarone vs 55% for propafenone vs 64% for IB alone). The QTc intervals were significantly prolonged, at 10 minutes and 30 minutes after IB administration, in amiodarone group (from 449 +/- 88 to 496 +/- 92 ms, 508 +/- 52 ms; P = 0.001) and in the group where IB was used alone (from 434 +/- 45 to 517 +/- 74 ms, 492 +/- 65 ms; P < 0.001), while it remained unchanged in propafenone group (from 464 +/- 52 to 471 +/- 80 ms, 489 +/- 93 ms; P = 0.536). The only predictor of conversion was the presence of AFL (P = 0.009). Five patients developed ventricular tachycardias after IB administration (two in propafenone, one in amiodarone, and two in IB group). CONCLUSIONS The use of IB in patients receiving amiodarone or propafenone for AFL or AF is equally effective and safe as the use of IB alone. The presence of AFL is the stronger predictor factor for cardioversion.

Coexistence of B- and T-cell lymphoid malignancies has been reported sporadically.A 68-year-old woman developed a lymphoid neoplasm in the large intestine and a second lymphoid neoplasm in the esophagus, 24 months after the diagnosis of the first lymphoma. Immunophenotypic analyses were consistent with extranodal marginal zone B-cell mucosa-associated lymphoid tissue type (MALT type) and peripheral T-cell unspecified lymphomas in the large intestine and the esophagus, respectively. The molecular analysis confirmed the B-clonal genotype of the first lymphoma, and disclosed a biclonal genotype of the second one (composite T- and B-cell lymphoma). No evidence of Epstein-Barr virus (EBV) association was shown in either tumor.B- and T-cell neoplasms represent two distinct malignancies rather than progression of the same neoplastic clone.

Aim: Polymorphous low grade adenocarcinoma of the salivary glands (PLGA) is a low grade neoplasm that predominantly occurs in the minor salivary glands. In this site is amenable to biopsy and histologic diagnosis. However, experience with cytological findings in these tumors is limited. We describe the cytology of this entity. Experimental design: Touch imprint cytology of a primary parotid PLGA is specified and correlated with histology. Results: Smears were hypercellular showing branching papillae, sheets and clusters of uniform cells with bland nuclei, dispersed chromatin and no nucleoli. The cells had a scant to moderate amount of eosinophilic cytoplasm. They formed tubular structures containing hyaline globules. Conclusions. The cytologic differential diagnosis of PLGA includes adenoid cystic carcinoma, pleomorphic adenoma, and monomorphic adenoma. PLGA should be considered in the differential diagnosis of head and neck tumors, where the cytology suggests on of the above mentioned tumors, even when the clinical findings (involvement of a major salivary gland, lymph node metastasis) is not typical of PLGA.

Aim: To determine the immunoreactivity of pancreatic-polypeptide (PP) during the development of the human fetal pancreas and ductal pancreatic adenocarcinoma, given that, PP positive cells were demonstrated either into its embryonic anlage or into pancreatic cancer. Methods: Tissue sections from 15 pancreatic fetal specimens, and equal number of ductal adenocarcinoma specimens, were assessed. Results: The density of positive cells in the primitive exocrine ductal epithelium and endocrine epithelium was significantly higher than the relevant density in the neoplastic pancreatic tissue of mixed (ductal – endocrine) and pure ductal type (p1=0.001, p2

Brucellosis is a zoonotic infection with a worldwide distribution, endemic in the Mediterranean region, and is associated with high morbidity in humans [1,2]. Osteoarticular complications are the most common focal complications of Brucella spp. infection [3]. These complications commonly affect the axial skeleton, with vertebral spondylitis accounting for 35%–50% of all osteoarticular complications [4–6]. Estimates of the incidence of spondylitis range from 9% to 31% [4,5]. While lumbar spine involvement is the most common, cervical involvement is a rare, but more severe, complication, accounting for 8.3% of cases of vertebral osteomyelitis in a recent study [4]. We present a case of brucellar spondylitis with paravertebral mass in the cervical segment that resulted in neurological deficits.

Background Acute exercise may exert deleterious effects on the cardiovascular system through a variety of pathophysiological mechanisms, including increased platelet activation. However, the degree of exercise-induced platelet activation in untreated hypertensive (UH) individuals as compared with normotensive (NT) individuals has yet to be established. Furthermore, the effect of antihypertensive treatment on exercise-induced platelet activation in essential hypertension (EH) remains unknown. Methods Study 1 consisted of 30 UH and 15 NT subjects. UH subjects who received treatment were included in study 2 and were followed-up after a 3-month treatment period with an angiotensin II receptor blocker (ARB; valsartan). Circulating monocyte-platelet aggregates (MPA) and platelet P-selectin were measured as platelet activation markers at baseline, immediately after a treadmill exercise test, and 10, 30, and 90 minutes later. Results Maximal platelet activation was observed at 10 minutes after peak exercise in both groups. In UH subjects, MPA levels remained increased at 30 minutes after peak exercise, despite BP fall to baseline levels. MPA levels were significantly higher in UH subjects than NT subjects at maximal exercise and at 10 and 30 minutes of recovery. Post-treatment MPA levels increased significantly only at 10 minutes into recovery and were similar to those of NT subjects. Conclusions Acute high-intensity exercise exaggerates platelet activation in untreated patients with EH compared with NT individuals. Angiotensin II receptor blockade with adequate BP control greatly improves exercise-induced platelet activation in EH. Further studies are needed to clarify whether this phenomenon depends purely on BP lowering or benefits also from the pleiotropic effects of ARBs.

Background Spontaneous bacterial peritonitis (SBP) is historically caused by Gram-negative bacteria (GNB) almost exclusively Enterobacteriaceae. Recently, an increasing rate of infections with Gram-positive cocci (GPC) and multidrug-resistant (MDR) microorganisms was demonstrated. Aims To assess possible recent changes of the bacteria causing SBP in cirrhotic patients. Methods We retrospectively recorded 47 cases (66% males) during a 4-year-period (2008–2011). Results Twenty-eight (60%) patients had healthcare-associated infections while 15 (32%) received prophylactic quinolone treatment. GPC were found to be the most frequent cause (55%). The most prevalent organisms in a descending order were Streptococcus spp (n = 10), Enterococcus spp (n = 9), Escherichia coli (n = 8), Klebsiella pneumonia (n = 5), methicillin-sensitive Staphylococcus aureus (n = 4) and coagulase-negative Staphylococcus spp (n = 3). Nine of the isolated bacteria (19%) were MDR, including carbapenemase-producing K. pneumonia (n = 4), followed by extended-spectrum beta-lactamase-producing E. coli (n = 3) and Pseudomonas aeruginosa (n = 2). MDR bacteria were more frequently isolated in healthcare-associated than in community-acquired infections (100% vs 50%, P = 0.006), in patients receiving long-term quinolone prophylaxis (67% vs 24%, P = 0.013) and in those with advanced liver disease as suggested by higher MELD score (28 vs 19, P = 0.012). More infections with GNB than GPC were healthcare-associated (81% vs 42%, P = 0.007). Third-generation cephalosporin resistance was observed in 49% and quinolone resistance in 47%. Conclusions GPC were the most frequent bacteria in culture-positive SBP and a variety of drug-resistant microorganisms have emerged. As a result of high rates of resistance in currently recommended therapy and prophylaxis, the choice of optimal antibiotic therapy is vital in the individual patient.

OBJECTIVE To report a case of hyperchloremic metabolic acidosis in a patient with beta thalassemia major secondary to treatment with deferasirox due to iron overload. CASE SUMMARY A 58-year-old white female with beta thalassemia major was admitted with fever, fatigue, abnormal liver function test results, and hyperchloremic metabolic acidosis (lactate dehydrogenase 494 U/L, aspartate aminotransferase 167 U/L, alanine aminotransferase 250 U/L, γ-glutamyl transferase 102 U/L, total bilirubin 3.79 mg/dL, direct bilrubin 2.37, potassium 3.3 mEq/L, PO2 81.4 mm Hg, PCO2 29.4 mm Hg, HCO3 16 mEq/L, pH 7.35, chloride 116 mEq/L, anion gap 7.5 mEq/L). Twenty-five days before admission the patient decided to discontinue treatment with deferoxamine for chronic iron overload and continue treatment with oral deferasirox 1500 mg/day. Despite extended clinical and laboratory examination, no obvious cause of fever, hepatitis, or hyperchloremic metabolic acidosis was revealed. Diagnosis was compatible with tubular dysfunction, drug-induced hepatitis, and hypersensitivity reaction due to deferasirox. All pathological findings were fully reversible and our patient had an excellent outcome. DISCUSSION The presence of tubular dysfunction should be considered in any patient with otherwise unexplained hyperchloremic metabolic acidosis. In our patient, other potential causes of metabolic hyperchloremic acidosis were ruled out. Toxic effects of deferasirox are probably caused by chelation of mitochondrial iron, leading to adenosine triphosphate depletion in tubular epithelial cells. Use of the Naranjo probability scale revealed that the adverse reaction was probable. CONCLUSIONS Kidney toxicity may be a major issue in the management of patients receiving deferasirox. Our case indicates a potential risk of renal toxicity with the presence of tubular dysfunction and hyperchloremic metabolic acidosis in patients undergoing treatment with deferasirox.

Background Prolonged sedation with propofol at high doses may lead to fatal multi-organ dysfunction, know as propofol infusion syndrome. We tested the hypothesis that propofol plus remifentanil co-administration attenuates propofol tolerance to its sedative effect and assessed if such an effect has an impact on propofol toxicity in rabbits under prolonged mechanical ventilation. Materials and Methods Eighteen healthy male rabbits were mechanically ventilated and received propofol (group P, n = 6), propofol plus remifentanil (group PR, n = 6), or remifentanil plus sevoflurane (group RS, n = 6) in order to be kept under sedation (group P) or sedation/analgesia (groups PR and RS) for up to 48h. Initial propofol and remifentanil infusion rates (IRs) were adjusted, if needed, to maintain the desired level of sedation and analgesia, respectively (groups P and PR). In group RS, remifentanil was infused at IRs equivalent to those of group PR. Propofol IRs were recorded, propofol concentrations were measured in the arterial plasma, and blood biochemical parameters and organ histopathology were assessed. Results Animals survived for 29-36h in group P and 22-38h in group PR (100% mortality rate). Tolerance was developed to propofol's sedative effect. The onset of tolerance was delayed and its magnitude was decreased in group PR compared with group P. Propofol was accumulated in the systemic circulation. Propofol clearance rate was gradually decreased. Arterial lactate, and serum aspartate aminotransferase (AST), lactate dehydrogenase (LDH), bilirubin, cholesterol, triglycerides, and creatine kinase (CK) levels were increased. The heart, lungs, liver, gallbladder, kidneys, urinary bladder, and skeletal muscles were seriously injured in groups P and PR. In group RS, mortality was 0%, while there was only mild injury of the lungs, liver, gallbladder, kidneys, and urinary bladder. Conclusions Although propofol tolerance is attenuated in propofol plus remifentanil receiving rabbits under prolonged mechanical ventilation, fatal multi-organ injury occurs resembling human propofol infusion syndrome.

Summary Background Results of several studies published since 1999 suggest that primary hyperaldosteronism (also known as Conn's syndrome) affects more than 10% of people with hypertension; however, such a high prevalence has also been disputed. Experts generally agree that resistant hypertension has the highest prevalence of primary hyperaldosteronism, on the basis of small studies. We aimed to assess the prevalence of primary hyperaldosteronism in a large group of patients with resistant hypertension. Methods Patients with resistant hypertension (blood pressure >140/90 mm Hg despite a three drug regimen, including a diuretic) who attended our outpatient clinic were assessed for primary hyperaldosteronism. Serum aldosterone and plasma renin activity were determined and their ratio was calculated. Patients with a positive test (ratio >65·16 and aldosterone concentrations >416 pmol/L) underwent salt suppression tests with intravenous saline and fludrocortisone. Diagnosis of primary hyperaldosteronism was further confirmed by the response to treatment with spironolactone. Findings Over 20 years, we studied 1616 patients with resistant hypertension. 338 patients (20·9%) had a ratio of more than 65·16 and aldosterone concentrations of more than 416 pmol/L. On the basis of salt suppression tests, 182 (11·3%) patients had primary hyperaldosteronism, and response to spironolactone treatment further confirmed this diagnosis. Hypokalaemia was seen only in 83 patients with primary hyperaldosteronism (45·6%). Interpretation Although the prevalence of primary hyperaldosteronism in patients with resistant hypertension was high, it was substantially lower than previously reported. On the basis of this finding, we could assume that the prevalence of primary hyperaldosteronism in the general unselected hypertensive population is much lower than currently reported. Thus, the notion of an epidemic of primary hyperaldosteronism is not supported. Funding None.

The aim of the study was to determine the importance of genetic polymorphisms of glutathione-S-transferase T1 and M1 and cytochrome P1A1 genes in the development of cervical intraepithelial neoplasia in Greek women. This was a prospective, case-control study conducted by the Cervical Pathology and Colposcopy Unit of a University Ob/Gyn Department from 1999 to 2003. Cervical smears from 114 controls without any cytological and/or colposcopical evidence of cervical pathology and from 166 women with history of cervical intraepithelial neoplasia (56 CIN I, 54 CIN II and 56 CIN III) were examined with polymerase chain reaction for the above-mentioned genetic polymorphisms, taking also in mind their smoking attitudes. Statistical analysis was performed to detect any association between the null genotype of GSTM1 and GSTT1 genes and the CYP1A1 m1 polymorphism and the severity of cervical intraepithelial neoplasia. The distributions of the GSTT1 and GSTM1 wild-type genotypes were 57.48 and 39.75%, respectively. No woman with homozygous GSTT1 and GSTM1 null/null genotype was identified. CYP1A1 m1 polymorphism frequency was 24.49%. No woman with homozygous CYP1A1 m1/m1 genotype was detected as well. No significant difference in the frequencies of the GSTM1 and GSTT1 null alleles, and the CYP1A1 m1 polymorphism, was found between cases and controls. After application of Mantel-Haenszel chi procedure, there was no linear severity of the lesion and the frequency of these polymorphisms. According to our results, glutathione-S-transferase T1 and M1 and cytochrome P1A1 genetic polymporphisms do not appear to be a risk factor for cervical disease irrespective of smoking habits.

A S L D A b st ra ct s diagnosed with chronic hepatitis B (ICD-9-CM codes 070.2 and 070.3) at our institution during 2011-2014. In addition to patient demographics, characteristics of chronic hepatitis B and treatment patterns were examined. The chi-square test and multivariate logistic model were used in statistical analysis. Results: Our study sample of 111 chronic hepatitis B patients included 66 Asians, 18 African Americans, and 27 other races, with mean age of 46.7 (standard deviation 12.6), 61.3% female, 2.7% with family history of HCC, and 3.6% cirrhotic. Eighteen patients (16.2%) reported at least occasional alcohol use and 49 patients (44.1%) were treated with an anti-HBV medication, mainly tenofovir (n=36) followed by entecavir (n=9). Fifty two patients (46.8%) were deemed at high risk for HCC per the AASLD guideline, of which 51 patients (98.1%) underwent or were recommended to undergo an imaging study (ultrasound, CT or MRI) at their most recent visit. Use of anti-HBV medication was positively associated with age and cirrhosis (both p

Imprint cytology may provide a fast and accurate method for intraoperative screening of sentinel lymph nodes, so a decision can be made regarding whether to perform axillary clearance during primary surgery. If the findings are negative, in many cases axillary dissection can be omitted.128 sentinel nodes from a cohort of 87 patients that had been identified using technetium-99m nanocolloid as a radioactive tracer and Patent blue dye were dissected for rapid Diff-Quick stained touch preparations. Intraoperative evaluation of sentinel node status by imprint cytology was correlated with histopathological results of permanent sections. Tumor-negative nodes in routine paraffin sections were further investigated with the employment of an anti-cytokeratin antibody.36 of all sentinel nodes harbored metastases in the paraffin sections, of which 32 were identified by imprint cytology (sensitivity 88.8%). 3 sentinel nodes were positive by imprint cytology and negative by histopathology of the paraffin sections. Comparison of the results of the touch preparations with the final histopathology (hematoxylin-eosin and anticytokeratin antibody stains) demonstrated a sensitivity of 83.3% and a negative predictive value of 92.5%. The specificity and positive predictive value were 100% each.Touch imprint cytology is potentially useful for intraoperative evaluation of sentinel lymph nodes in breast cancer patients.

To evaluate the efficacy of customized surface ablation in cases of forme fruste keratoconus.Prospective noncomparative case series.Eleven eyes of 8 contact lens-intolerant patients with forme fruste keratoconus treated at the Institute of Refractive and Ophthalmic Surgery and the University Eye Clinic Zurich.Topography-guided customized surface ablation by means of a scanning spot excimer laser.Visual acuity, refraction, quality of vision (ghosting), corneal topography including the Zernike parameter Z3.Statistically significant reduction of manifest refractive error, corneal irregularity, and ghosting. The spherical equivalent was reduced by -2.8+/-0.62 diopters (D) (P = 0.0007), the cylinder by 1.34 +/- 0.18 D (P = 0.015), Z3 was reduced by 41% (P0.001), and all patients had less ghosting compared to their preoperative status. No eye lostor =1 lines in best spectacle-corrected visual acuity; however, 7 of 11 eyes gainedor = 1 line.Topography-guided surface ablation is a promising option to rehabilitate vision in contact lens-intolerant patients with forme fruste keratoconus.

Background: Poland’s syndrome, a rare congenital anomaly characterized by a defect of the pectoralis muscles, has been reported in association with lymphoreticular malignancies and some solid tumors. Case report: We report the case of a 53-year-old woman with Poland’s syndrome who developed breast cancer in the afflicted ipsilateral hypoplastic breast. FNA cytology revealed a moderately differentiated carcinoma and histology was consistent with a well differentiated invasive ductal carcinoma. Conclusion: Poland’s syndrome can be associated with breast cancer so all females with the syndrome should be thoroughly examined for early detection of neoplasia.

Chronic hepatitis C has been implicated in the pathogenesis of sarcoidosis in several cases of patients treated with interferon-alpha. On the other hand, only in a few cases previously has a possible link between sarcoidosis and untreated chronic hepatitis C virus infection been demonstrated. We report on a patient with chronic hepatitis C who developed cutaneous sarcoidosis without prior interferon-alpha treatment. We hypothesize that viral persistence seen in chronic hepatitis C virus infection might be one of the potential factors that trigger cellular immune response in granulomatous reactions as seen in sarcoidosis, in genetically predisposed patients.

Extramedullary hematopoiesis (EMH) is associated with a number of diseases in which the normal function of the bone marrow is disturbed. While organs with hemopoietic capacity like the liver and spleen are most commonly involved, EMH has also occasionally been found in other organs like the adrenal gland, lymph nodes, breast, thymus, small bowel and central nervous system. However, presentation of a myeloproliferative disorder, such as EMH in these organs is a rare event.We report clinical and fine-needle aspiration (FNA) findings in a patient who presented with intrahepatic EMH which mimicked metastatic carcinoma from a colonic primary.Ultrasound-guided FNA of the intrahepatic mass revealed megakaryocytes and myelocytes thus establishing the diagnosis of EMH.EMH is an unusual condition that can mimic other solid masses of the liver. Because radiologic findings are not specific, EMH should be considered in the differential diagnosis, especially in patients with a myeloproliferative disorder. FNA and subsequent cytopathological interpretation of the aspirates enables avoidance of unnecessary potentially hazardous surgery.

Skin prick testing (SPT) is the standard method for diagnosing allergic sensitization. Correct diagnosis of inhalant allergies, requires knowledge of the most important inhalant allergen sensitizations. Few data are available regarding the prevalence of these sensitizations in Greece.