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Necrotizing fasciitis (NF) is an aggressive, necrotic, life-threatening infection of the soft tissues. The delay on treatment is generally accompanied by almost 90 % lethality according to the development of septic shock and its associated complications. Primary Necrotizing Fasciitis of the Breast (PNFB) is seen extremely rare. To date, breast necrotizing fasciitis have been reported only as a limited number of case reports in the literature. PNFB is commonly misdiagnosed as cellulitis, mastitis, abscess or inflammatory breast cancer. Although PNFB is a very rapid and aggressive disease, which can be fatal. Delayed cases were unfortunately resulted in mortality due to several consequential reasons. Therefore, careful and detailed evaluation of all cases irrespective of age, especially those with risk factors and comorbidities, could be life saving in respect of early diagnosis and timely treatment. Our aim is to to present the analysis and treatment modalities of five primarily seen PFNB, in this case series.

In this paper, we describe our design of an end- to-end Visible Light Communication (VLC) system prototype that is able to stream music and video. Our system is able to transmit and receive video and audio signals and is capable of communicating at a data rate of 7.14 Mbps at a distance of 6.7 cm at a much lower cost for the transmitter and the receiver circuitry compared with existing VLC designs. The channel attenuation and SNR tests that we have conducted on our design demonstrate the VLC channel characteristics. In order to assess the design for deployment in more realistic settings, we also compute the transmit power that will be required if our prototype system were scaled to transmit over the dimensions of a room and show that the required transmit power is reasonable. Furthermore, our audio and video fidelity tests quantify the user experience via the Mean Opinion Score (MOS) metric. Finally, alternative transmitter and receiver designs are discussed as possible improvements for future work. This prototype constitutes a first step towards wide-scale deployment of VLC technology for downlink video transmission in indoor spaces in the smart cities of the near future.

Introduction Tetracosactide is an engineered peptide that applies the same biological impacts as the endogenous adrenocorticotropic hormone. Previous studies indicated that tetracosactide has anti-inflammatory, antioxidant and neurotrophic activity. In this study, we hypothesized that tetracosactide may have protective effects in spinal cord ischemia-reperfusion injury. Material and methods Rabbits were randomized into the accompanying four groups of eight animals each: group 1 (control), group 2 (ischemia), group 3 (methylprednisolone) and group 4 (tetracosactide). In the control group, just a laparotomy was performed. In the various groups, the spinal cord ischemia model was made by the impediment of the aorta only caudal to the renal vein. Neurological assessment was conducted with the Tarlov scoring system. Levels of myeloperoxidase, malondialdehyde and catalase were analyzed, similar to the activities of xanthine oxidase and caspase-3. Histopathological and ultrastructural assessments were additionally performed. Results After ischemia-reperfusion injury, increments were found in the tissue myeloperoxidase levels (p < 0.001), malondialdehyde levels (p < 0.001), xanthine oxidase action (p < 0.001) and caspase-3 movement (p < 0.001). Conversely, both serum and tissue catalase levels were diminished (p < 0.001 for both). After the administration of tetracosactide, declines were seen in the tissue myeloperoxidase levels (p < 0.001), malondialdehyde levels (p = 0.003), xanthine oxidase action (p < 0.001) and caspase-3 movement (p < 0.001). Conversely, both the serum and tissue catalase levels were expanded (p < 0.001). Besides, tetracosactide treatment indicated enhanced results related to the histopathological scores (p < 0.001), the ultra-structural score (p = 0.008) and the Tarlov scores (p < 0.001). Conclusions The findings showed for the first time that tetracosactide shows significant neuroprotective activity against ischemia-reperfusion injury of the spinal cord.

De decentralisaties en hervormingen in het sociaal domein beogen een andere insteek van de ondersteuning van mensen. De meeste zorg en welzijn vindt meer plaats in de eigen kring van de bewoner, door mantelzorgers en vrijwilligers uit het netwerk van deze bewoner. Als dat niet meer gaat en te ingewikkeld wordt, is er kennis en kunde van beroepskrachten nodig. Vaak gaat het een en het ander in elkaar over, of spelen naast elkaar. Dan is het belangrijk dat er een goede samenwerking is en vertrouwen is, in elkaar en in de overtuiging dat samen goede oplossingen gevonden kunnen worden.

Aim This study was designed to assess the utility of calretinin immunohistochemistry in the diagnosis of Hirschsprung's disease. Material and methods Eleven definitive resection materials from 10 Hirschsprung's disease patients and 3 initial full-thickness rectal biopsies of these patients were retrieved from the pathology archives. Additionally, 15 distal colon and 13 proximal colon full-thickness samples from 23 non-Hirschsprung's disease patients were also evaluated as the control group. All material was reevaluated by light microscopy for the presence or absence of ganglion cells and immunostained with calretinin, including proximal surgical margins and aganglionic zone samples from each resection material. Results Immunohistochemistry for calretinin provided highly compatible results with hematoxylin-eosin findings in Hirschsprung's disease and non-Hirschsprung's disease patients, except in one Hirschsprung's disease patient with very rare nerve stainings at the distal surgical margin. Conclusions Calretinin immunohistochemistry was found to be highly sensitive and specific in detecting aganglionic segments. New research should be conducted in order to clarify calretinin staining patterns of the transitional zone, rare Hirschsprung's disease types, pure hypoganglionosis patients, and the anorectal junction, and for the mapping of fetal and neonatal colonic specimens. The technique seemed very effective for lowering the need for excessive sectioning and practical regarding the erratic nature of the acetylcholinesterase staining.

Basal cell adenoma (BCA) is a rare benign basaloid neoplasm of the salivary gland. There are four histopathological types of BCA: solid, tubular, trabecular, and membranous. It is known that focal squamous metaplasia may be seen in some BCAs, but it is rare to see extensive squamous metaplasia, especially with cellular atypia. Here, a 25-year-old male with right parotid swelling is presented. Ultrasonography revealed a 2-cm well defined mass in his parotid gland. Fine-needle aspiration (FNA), performed prior to surgical excision, showed a highly cellular tumor composed of basaloid cells, forming small duct-like or tubular structures containing basement membrane-like material, as well as squamous cells with hyperchromatic, enlarged, pleomorphic, and bizzare nuclei. We made a cytopathological diagnosis of "basaloid neoplasm" and also reported that the differential diagnosis included BCA, cellular pleomorphic adenoma, basal cell adenocarcinoma, and carcinoma ex pleomorphic adenoma. The patient underwent total parotidectomy. Both frozen and permanent sections showed a BCA with membranous, tubulotrabecular pattern, and extensive squamous metaplasia. Some of the squamous cells showed significant nuclear hyperchromasia, enlargement, and pleomorphism. As far as we know, this is the first case of BCA with extensive squamous metaplasia and prominent cellular atypia. This case has been presented to show that squamous metaplastic cells with hyperchromatic, enlarged, bizarre, and pleomorphic nuclei can be seen on FNA smears of a benign tumor like BCA. Also, the differential diagnosis of BCA of the salivary gland is discussed here.

Oncocytic parathyroid adenoma is a rarely seen benign neoplasm of the parathyroid and intrathyroidal location of this lesion is also uncommon. It can be easily misdiagnosed as Hürthle cell thyroid neoplasm on fine-needle aspiration (FNA). Here, an intrathyroidal oncocytic parathyroid adenoma in a 32-year-old male is reported. Ultrasonography showed a nodule 2 cm in largest diameter in the left thyroid lobe. FNA revealed cellular smears containing monotonous oncocytic cells arranged in monolayered sheets, pseudopapillary structures and clusters within a rich vascular network. The case was reported as "suspicious for Hürthle cell thyroid neoplasm" on FNA. Frozen section examination showed intrathyroidal oncocytic parathyroid adenoma with a rim of normal parathyroid tissue. The diagnosis was also confirmed with immunohistochemical stains (TTF-1, PTH, thyroglobulin) performed on permanent sections. Cytopathologic features of oncocytic parathyroid adenoma and Hürthle cell thyroid neoplasm are similar. It is important to keep oncocytic parathyroid adenoma in mind in the differential diagnosis of Hürthle cell thyroid neoplasm. Prior knowledge of clinical, radiological and laboratory data will avoid wrong cytopathologic diagnosis.

Background: Tumor necrosis factor-alpha is the key inflammatory cytokine in psoriasis vulgaris triggering abnormal differentiation and proliferation of keratinocytes. Etanercept as an antitumor necrosis factor-alpha agent is widely used for the treatment of psoriasis vulgaris. Objectives: To find out whether etanercept has an apoptotic effect on psoriatic keratinocytes. Methods: Biopsies from 13 untreated chronic plaque psoriasis patients and 10 control subjects were examined in the study. Immunohistochemical staining for Ki-67 and the terminal deoxynucleotidyl transferase (TdT)-mediated dUTP-biotin nick-end labeling (TUNEL) method for the detection of apoptosis were performed. Ki-67 and TUNEL indices were calculated. Results: The mean Ki-67 index of patients before treatment (34.20 +/- 10.30) was significantly higher than that of the control subjects (8.30 +/- 2.20) and of the treated patients (9.50 +/- 2.50); however, it did not differ between the treated patients and control subjects (p < 0.001, p = 0.001 and p = 0.208, respectively). Although the mean TUNEL index of patients before treatment (0.23 +/- 0.44) was significantly lower than the controls (1.1 +/- 0.99), it did not significantly differ after etanercept therapy (0.46 +/- 0.66) (p = 0.030 and p = 0.083, respectively). The mean TUNEL indices of treated patients and control subjects were not different (p = 0.131). Conclusion: Etanercept decreased epidermal thickness successfully without inducing apoptosis of psoriatic keratinocytes.

Gastrointestinal tract lymphangiomas are extremely rarely seen. Here, we present the first case of lymphangioma of the duodenal bulb diagnosed with a deep bite on a bite endoscopic biopsy and treated with polypectomy.

Liver biopsy is the gold standard for assessment of fibrosis in patients with hepatitis B. However, it has some disadvantages, including inter-observer and intra-observer variability in biopsy interpretation and specimen variation. A standard biopsy specimen represents only about 0.0002 % of the whole liver. It has been shown that two biopsy samples collected during a procedure have significant influence on the diagnostic performance of interpretation in patients with hepatitis C or non-alcoholic steatohepatitis. Therefore, we aimed to assess the influence of collecting two liver biopsy samples during a single procedure for staging and grading chronic hepatitis B.27 patients were included in the study. The median age of the patients was 43.51 ± 11.69. Fifteen patients were female, 12 patients were male. In the biopsy procedure, two samples of liver lobes were obtained. Grade and stage scores were compared between the two samples. Fibrosis staging and grading were assessed according to the Ishak scoring system.Numbers of portal tract and biopsy size were equal in the two samples. There was a significant difference between the samples in terms of histological activity index (p value = 0.04). However, the difference was not enough to distinguish the mild and moderate stages. On the other hand, no significant difference in fibrosis staging between the two samples was found.With this relatively small size of patients, in this study, we showed that a proper liver biopsy size is sufficient to predict treatment decisions in chronic hepatitis B patients. However, further studies are needed to show the association of sampling variability in patients with hepatitis B.

Introduction In this study, we tried to determine whether darbepoetin-α would protect the brain from oxidative stress and apoptosis in a rat traumatic brain injury model. Material and methods The animals were randomized into four groups; group 1 (sham), group 2 (trauma), group 3 (darbepoetin α), group 4 (methylprednisolone). In the sham group only the skin incision was performed. In all the other groups, a moderate traumatic brain injury modelwas applied. Results Following trauma both glutathione peroxidase, superoxide dismutase levels decreased (p < 0.001 for both); darbepoetin-α increased the activity of both antioxidant enzymes (p = 0.001 and p < 0.001 respectively). Trauma caused significant elevation in the nitric oxide synthetase and xanthine oxidase levels (p < 0.001 for both). Administration of darbepoetin-α significantly decreased the levels of nitric oxide synthetase and xanthine oxidase (p < 0.001 for both). Also, trauma caused significant elevation in the nitric oxide levels (p < 0.001); darbepoetin-α administration caused statistically significant reduction in the nitric oxide levels (p < 0.001). On the other hand, malondialdehyde levels were increased following trauma (p < 0.001), and darbepoetin α significantly reduced the malondialdehyde levels (p < 0.001). Due to the elevated apoptotic activity following the injury, caspase-3 activity increased significantly. Darbepoetin-α treatment significantly inhibited apoptosis by lowering the caspase-3 activity (p < 0.001). In the darbepoetin group, histopathological score was lower than the trauma group (p = 0.016). Conclusions In this study, darbepoetin-α was shown to be at least as effective as methylprednisolone in protecting brain from oxidative stress, lipid peroxidation and apoptosis.

Castleman disease is a rare disorder characterized by benign lymph node hyperplasia involving lymphatic tissue in the neck, mediastinum, abdomen and other areas. Disease was described for the first time in 1956 by Castleman. The etiopathogenesis of the disease is unknown. The disorder can be classified into three histopathological types: hyalin-vascular, plasma-cell and mixed. We report three cases of the Castleman's disease (hyaline-vascular type) in three female patients with unilateral swelling of the neck. None of the patients developed any local or distant recurrence in postoperative follow-up.