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CHICAGO MEDICAL EXAMINER. N. S. DAVIS, MD, Editor. VOL. VIII. JANUARY, 1867. NO. 1. wnninat (iHtnmim ARTICLE I. THE MECHANICAL TREATMENT NECESSARY IN INFLAMMATION OF THE KNEE JOINT; WITH A DESCRIPTION OF A NEW APPARATUS FOR EXTENSION. By JULIEN S. SHERMAN, M.D., Chicago, Ill. The exposed position of this articulation, the thinness of the tissues surrounding, and the amount of labor performed by it, render it a very frequent seat of those diseases and deformities consequent upon injury. Inflammation of this joint is more severe and disastrous than of most others, on account of its large size and the extent of the synovial sack involved in the disease. The well-known pathological fact, that of joints is always followed by reflex contraction of the muscles in its vicinity, is well exemplified in the knee by the strong contraction of the powerful flexors, bending the leg to a right angle with the thigh. The injurious effect of pressure is also well shown, and the necessity for its removal as urgent as in hip-disease. Specific inflammations artf sometimes met with, but are not as frequent as generally supposed, most cases being traumatic in their . Yet inflammations occurring in constitutions either or syphilitic, are more prone to suppuration and caries than when this element is absent. Notwithstanding the advantages of medical treatment, there are indications which must be overcome by mechanical means. They are not only necessary for subduing disease in its early developement, but are indispensable for the correction and prevention of deformities following in severe cases. of this joint, even in its first stage, is always accompanied by contraction of the flexors, aggravating the pain and the pressure, thereby either wholly preventing, or greatly retarding, spontaneous recovery. This contraction increases with the violence of the inflammation, and should be overcome by tenotomy of all the tendons offering resistance to the of the limb. If ether is administered, the particular requiring division should be ascertained before anaesthesia is produced, as, when that stage is reached, the muscles become relaxed, and we may be at loss to determine where division is necessary. Special care must be taken to avoid wounding, the peroneal nerve, situated just internal to the biceps tendon. This tendon should be divided from without inwards, at the same time that extension is being made, the sheath and inner fibres of which will then be ruptured before the knife passes completely through, and all danger to the nerve avoided. The limb should then be placed upon an air-cushion, protected by oil-silk, in order that local dressings may be used without the bedding. The relief of pressure in inflamed joints is the most important part of the treatment; the diseased surfaces must be separated to allow of recovery or to prevent unfavorable results. The means for accomplishing this desired end are strictly . Adhesive straps may be applied to the leg, below the knee, and the surfaces of the joints separated by making with the pulley and weight, as in adhesive strap dressing for fractures of the thigh. The limb may be placed in the position or upon an inclined plane, as circumstances may indicate. This treatment will be found to greatly relieve the pain and entirely remove the pressure. If it be adopted at the outset of the attack, the flexing of the limb will be and division of the tendons rendered unnecessary. Should suppuration occur and the joint become greatly with pus, it should be carefully evacuated by means of a trochar, avoiding the admission of air into the synovial sack, and the extension persevered in. Moderate pressure upon the femoral artery is advised by good authority, as diminishing the flow of blood to the part, but it is difficult to maintain and adds to the discomfort of the patient. The accompanying cuts represent an apparatus for making extension. It consists of a wooden socket, constructed to fit the thigh and similar to those used for artificial legs, against this the counter-extension is made, and thus evenly over the thigh and tuberosity of the ischium. A steel rod is attached to each side of the socket, reaching to within a few inches of the ankle, and the two rods are joined behind by a broad band of sheet-iron, which is moulded to fit the posterior part of the leg; on the front, and joining the sheet-iron band, is a strap which, being buckled, holds the leg firmly in the . It is applied as follows: Six adhesive straps are cut, two inches in width at the top and tapering to one at the , and should be long enough to reach from about one inch below the knee to the ankle; they are then applied to the.leg, as represented in the cut, and secured by a bandage; the socket is then placed upon the thigh, the strap at the bottom of the instrument buckled, and the lower ends of the adhesive plaster turned over the bottom of the instrument and also attached to buckles upon its sides. The amount of extension is regulated by the degree of tightness to which the straps are drawn. The figure upon the right represents the same apparatus, with the exception that the side rods are extended and fastened to the sole of the shoe, while the adhesive straps are also to the buckles upon the sides. This will allow the patient to walk about and bear all his weight upon the socket and not any upon the knee-joint. This modification renders it more applicable to the chronic inflammations, when we desire the patient to have out-door exercise, which he can enjoy with as much ease as the wearer of an artificial leg. The advantages gained by this mode of extension are, the large surface to which the counter-extending force is applied, its security, and the ease with which the can tolerate it. When the socket is well fitted, there is no tendency for the instrument to rotate or twist upon the leg. This same principle can be used in the construction of instruments for the relief of deformities of the knee. |
ARTICLE III. CASE OF OVARIOTOMY. By D. MASON, M.D., Prairie du Chien, Wis. Was called to see Mrs. II., October 21st, 1865, and found her suffering from ovarian dropsy. The history she gave of herself is briefly as follows: She is now 52 years of age; first noticed a tumor in her right side, 26 years ago, which, at times, seemed to enlarge, and then recede, and so continued until October, 1864, about 25 years from its first appearance, when a decided and steady growth commenced. In February, 1865, the growth increased more rapidly, and continued until October, when the distress from distension became almost insupportable. She had been attended during the summer by various eclectics, galvanists, mesmerists, and homoeopaths, but without any benefit. On the 21st of October, 1865, as stated above, I first saw her, inviting my friend, Dr. Conant, to accompany me. The diagnosis was clearly established, and I tapped immediately, drawing off 14 tbs. of gray, turbid fluid, which reduced the tumor to about one-third its former size, very much to the of the patient. Her general health had been very much reduced by her suffering through the summer, but rapidly after the tapping. I then explained to her the of its refilling, and proposed its removal; at the same time explaining to her the danger, and probabilities of success of the operation. On the 10th of January, 1866, I was called to see her again, and found her much improved in health, and in good spirits. She expressed herself ready for, and anxious to have the done. I proposed the operation for the 18th. On the 17th, gave a full dose of castor oil, which thoroughly emptied the bowels. On the 18th, accompanied by Drs. Andros, Lowe, and IIazeltine, of McGregor, Iowa, and Dr. Conant, of Prairie du Chien, I proceeded to operate. Having the of the room at 70deg, gave the patient a mixture of equal parts of chloroform and sulphuric ether to complete anaesthesia; made, the incision on the linea alba, from about an inch above the pubis, upwards about 12 inches in length. The tumor itself covered by the omentum and with pretty firm adhesions, the most of which were broken up with the finger, but a few points, more firm, were dissected away. In breaking up these adhesions, a portion of the omentum was slightly torn, and was cut away. Two small arteries were divided in this procedure and threatened to be a little troublesome, but the hemorrhage was arrested by the application of a little of iron. Following the tumor down to its pedicle, it was found to be quite small, about four lines in diameter, two inches in length, and round. It was tied by one strong ligature, the pedicle severed and the tumor lifted out, and was found to weigh seven pounds. During this procedure, the exposed bowels were by? napkins dipped in warm water; they were now sponged, all little particles of clots removed, and returned to their natural position. The wound was now closed by eight silver wire sutures, the ligature of the pedicle being brought out of the lower angle of the wound; adhesive straps were placed between the sutures; a lint compress; and a broad pinned snugly around the whole. At this time, the effects of the chloroform had pretty wrell passed off; the pulse 98. Sulph. morph., J gr., was given immediately, and repeated in an hour, after which, gr. was given every two hours until the following day. 19th. Has had some vomiting; pulse 100. Sulph. morph. J gr. every four hours. 20th. Pulse 102; respiration 28; vomiting continues at ; not much pain. Suspend the morph. 21st. Restless; pulse 104; considerable tympanitis. Gave enema of tepid water; bowels moved, which greatly relieved the tympanitis. 22d. Has passed a comfortable night; pulse 104; pain slight. Dressed the wound, which is healing very kindly. 23d. Much tympanitis, though not much pain; pulse 110; tepid water enema relieves the tympanitis. 21flh. Has passed a comfortable night; pulse 108. 25th. Pulse 100; pain slight. R. Sp. vini Gallici SSij. every two hours. 26th. Considerable pain from distension of the bowels; moves the bowels and relieves all the symptoms. 28th. Has been very comfortable since the last record; remove the sutures; wound pretty firmly united. 30th. Pulse 94; give Rhine wine, SSj. every two hours, in place of brandy, and beef-tea ad libitum. I would here state, that, up to this date, the diet had been toast-water, farina gruel, with small particles of ice to allay thirst. Feb. 7th. Has been very comfortable since last record; pulse 80; ligature gave away upon a little traction to-day. 12th. Wound entirely healed; appetite good. 20th. Patient returned to her home, 10 miles in the country. 26th. Visited patient at her home. I found her moving about the house, and she expressed herself as feeling quite well, though a little weak. I would here tender my great obligations to Dr. Andros, for his assistance in conducting the after treatment. |
ARTICLE VI. CASE OF DEATH FROM CHLOROFORM. By. C. R. PARKE, M.D., Bloomington, Ill. Read to the Illinois State Medical Society, June, 1866. Mr. President: Permit me to report the following case of leath from the inhalation of chloroform: On Saturday, June 2d, I was called to administer chloroform to Miss , age about 20 years, apparently in good health. Object, the extraction of teeth. On the previous Wednesday, chloroform had been by a dentist, and six molar teeth extracted, without any deleterious effects. On Saturday, she seated herself in a regular dental chair, was quite cheerful, and anxious to get under the influence of chloroform. I placed about J of a drachm of chloroform on a sponge and applied it to the nose in the usual way, covered by a towel. This quantity not being sufficient to produce the result, an additional J of a drachm was poured upon the sponge, which, amount, in a few minutes, sufficiently affected her so as to enable the dentist to extract three molar teeth, with but little pain. She sat up and spit out the blood that in the mouth, after which she gave me to understand that I must give her more chloroform before she could submit to the further extraction of any more teeth. The remainder of the drachm of chloroform was then poured upon the sponge and given as before. In a few minutes, she wras considered under its influence, to have the remaining teeth (three) extracted. Just before the doctor succeeded in extracting the last tooth, I noticed a deathly pallor of the countenance; complete of respiration; pulse scarcely perceptible for a minute, when it ceased entirely. There was also considerable capillary congestion about the skin of the upper portion of the chest, also dilatation of the pupils. Prior to the appearance of the pallor of the face, there was not an unfavorable symptom present. Immediately upon the presentation of the above symptoms, 1 drew the tongue as far out of the mouth as was necessary to allow the air to enter freely, and, with the assistance of Dr. II. Luce, kept up artificial respiration. Applied aqua ammonia to the nostrils and introduced a small quantity of brandy into the mouth. A catheter was also introduced down into the pharynx, through which we blew, thinking the air might the more readily enter the lungs; at the same time we applied the electro-galvanic battery to the spine and muscles of respiration, all of which means were used diligently for three-quarters of an hour without avail, she only making three attempts at during the commencement of our efforts at artificial . The pulse acted as it commonly does, during the administration of chloroform, first being excited, then depressed, nothing indicating cardiac trouble of any kind. There was none of that lividity of countenance witnessed in asphyxia. The whole transaction, up to the fatal minute, was not over twenty-five minutes; and the amount of chloroform used, only one drachm. This is the first fatal case I ever witnessed from the of chloroform, and I suppose I have administered it, and seen it administered, in this country and in Europe, nearly a thousand times. Any suggestions thrown out by this Society, as to the action of the anaesthetic, and the cause of death in this case, will be thankfully received. My opinion is, it was of the heart, with congestion of lungs. |
QUINCY MEDICAL SOCIETY. The semi-annual meeting of the Quincy Medical Society was held-at the office of Dr. Zimmermann, in Quincy, Nov. 18th, 1866. A quorum being present, the President, Dr. C. A. W. , called the meeting to order. The proceedings of the annual meeting having been read and approved, the President proceeded to deliver his able and elaborate essay upon Bright's Diseasei The manner in which he treated the subject may be inferred from the following extract from the exordium: "I discharge this obligation with no inconsiderable degree of pleasure, inasmuch as this subject is classed among the most interesting in pathology; and I intend discussing it by strictly following the medical literature as far as it deals with facts, and particularly as far as it touches the anatomy of this , and eschews hypothesis; while I shall sometimes mention my own experience, which is naturally .enough based on in view of the sick couch, and the therapeutics of the disease, which are without exception open for discussion." The President entered at length into the consideration of the causes, pathology,- diagnosis, prognosis, and treatment of Bright's disease. On 'motion, resolved, that the thanks of this Society be to the President for his able essay, and that a copy is hereby requested for publication. rhe Secretary then read the history and treatment of two cases which had come under his observation since the annual meeting: Case I. June 21st, 1866. Was requested to visit Mrs. S., aged 25 years. I learned from her that she had been confined to the bed seven weeks, and had vomited, most of the time, every hour. The matter ejected is described as green and ; urine natural in quantity, specific gravity 1.011, acid, not albuminous. The last menstrual period occurred about four months since, as near as she recollects. She is greatly , very feeble, and takes but little nourishment. The mamma is flaccid and wasted, no change has occurred in the nipple or in the areola about it. On vaginal examination, the uterus was found enlarged, and the os hard and fissured. Prescribed one teaspoonful of Ellis' wine of pepsin in a wineglass of water three times a-day, and one tablespoonful of lime-water and two of milk every two hours, with beef-tea for nourishment. 22d. The symptoms not materially changed. Directed the treatment to be continued. 23d. Patient no better; has vomited every hour, anti has not slept during the night. A consultation was agreed, upon, and Dr. L. II. Baker of this city called. After a careful , it was decided that there is no evidence of a living foetus in the uterus, but even if there were, the dangerous of the mother demands interference. A speculum was introduced and the os brought to view, and a sound passed into the uterus three inches, no fluid followed its withdrawal. A sponge tent was then passed into the os and the patient directed to take the medicine as before. 21f,th. The patient has not vomited as much as formerly, and has taken more nourishment. The tent is not to be found in the vagina, and cannot be seen in the os through the speculum, and the supposition is entertained that it may have passed away unobserved. Introduced a larger tent, and directed treatment to be continued. 25th. The vomiting ceased during the day and returned at night. On examination, the tent cannot be found; introduced another with a small cord attached to it. 26th, 9 o'clock A.M. Has vomited less than formerly. the tent and introduced another. 2 o'clock P.M. Quite an offensive discharge has occurred, and the patient complains of pain in the back. Removed the tent and found the os dilated; on passing the finger, the two tents first used were found within the os and removed. 27. The patient is more quiet and vomits less. Continue the medicine. 28. The remains of a foetus passed away during the night; it is six inches in length, and weighs one ounce troy; it is much wasted; the skin is wanting; the head collapsed; the walls of the chest and abdomen wanting; no trace is found of the lungs, diaphragm, stomach, or intestines; the heart, liver, and kidneys were observed in their natural, positions. The foetus has, , been dead several weeks, and the placenta probably been absorbed, as it has not passed away, and cannot be discovered on examination. No flooding has occurred. Prescribed 5 grs. of pulvis ergot, to be taken every three hours, and a of a saturated solution of-sulphite of soda three times a-day. 30th. The vomiting continues frequently, and is supposed to be excited by the medicine, which was discontinued, and the Wine of pepsin and lime-water resumed, and milk freely taken for nourishment. July 1st. The vomiting has now ceased, and the patient's condition satisfactory in every respect. No unfavorable afterwards occurred, and the patient made a very rapid recovery. Remarks. The irritation of a dead foetus in the uterus has been referred to by authors as one of the causes of abortion; but it is evident does not always give rise to this result. Tyler Smith refers to a case, in which the foetus died at the fourth month, but was not expelled until the full term. As the sound of the foetal heart cannot ordinarily be heard until after the fourth month, we have no certain evidence by which we can infer the death of the foetus. In the cases which have come under my observation, I have found the mamma flaccid, the nipple and its areola without any of the ordinary indications of pregnancy, the neck of the uterus harder, and the os more than usual in that condition. It seems desirable that more careful and extended observations be made, as to the symptoms which indicate the presence of a blighted foetus in utero. In this case, if its presence had been known at an period, the patient might have been saved several w'eeks of distressing illness. Case II. Was called to visit Mr. B., aged 35, in with Dr. L. H. Baker, of this city, September 3d, 1866, and found the patient suffering from narcotism. The following is the history of the case, as given by the attendants: The attention of his wife was called to him by an unusual snoring, and, on going into his room, she found him quite , and nearly black in the face and neck. Supposing him to be in a fit, she attempted to give him some wine, spirits of camphor, and other restoratives, of which he swallowed but little, and that at the risk of strangling. Just at that time, she found in his pocket an empty bottle, labelled laudanum. Dr. Baker was called immediately, and gave him, 10 minutes before 4 o'clock, 20 grs. of sulphate of zinc, and repeated the dose in 5 minutes, without effect. I arrived 25 minutes after the emetic had been given. Not having had its effect, it was thought best to use the stomach pump. About one quart of warm water was thrown by it into the stomach and immediately pumped out with the whole of its contents, which gave a strong odor of laudanum. This was repeated three times, and about a gallon of water, in all, was used, the last of which was nearly clean and devoid of smell of laudanum. During this time, the patient remained entirely insensible, with the eyes closed, the pupils contracted, respiration slow and , pulse slow, with other symptoms of narcotism. After thoroughly emptying the stomach, a galvanic' battery was used for nearly two hours, one pole applied to the upper part of the spine and the other to the front of the chest. About one hour after the stomach was evacuated, and while using the battery, the patient began to sink, the respiration became to four in a minute. Dr. Baker resorted to artificial JL Uopi 1 cLLlUlL cltlvlltlUll LU L11C UcLLLtH J ) WHICH Wd>>0 KLj/L Lip Uj by Hall's method, about a-quarter of an hour, until an occurred in the respiration, which continued until the patient was fully restored. No unpleasant symptoms followed excepting vomiting, which occurred at intervals during the night. It was subsequently ascertained that the patient took two ounces of tincture of opium at 10 o'clock A.M., and also two ounces at 1 o'clock P.M; and that he was not in the habit of taking opium or laudanum; that he took it for a diarrhoea, which he had for three or four days. The apothecary says the tincture of opium sold the patient contained just one-half the officinal quantity of opium. On motion, Dr. J. F. McCormic was appointed essayist for the next meeting. On motion, Dr. A. Niles was appointed delegate to the State Society. On motion, resolved, that the proceedings of this meeting be published in the Chicago Medical Examiner, and an abstract of them in our city papers. ADDISON NILES, Secy. |
Cancers (Basel) Cancers (Basel) cancers Cancers 2072-6694 MDPI 10.3390/cancers15051359 cancers-15-01359 Correction Correction: van de Velde et al. Vincristine-Induced Peripheral Neuropathy in Pediatric Oncology: A Randomized Controlled Trial Comparing Push Injections with One-Hour Infusions (The VINCA Trial). Cancers 2020, 12, 3745 van de Velde Mirjam Esther 1* Kaspers Gertjan J. L. 12 Abbink Floor C. H. 3 Twisk Jos W. R. 4 van der Sluis Inge M. 25 van den Bos Cor 23 van den Heuvel-Eibrink Marry M. 2 Segers Heidi 6 Chantrain Christophe 7 van der Werff ten Bosch Jutte 8 Willems Leen 9 van den Berg Marleen H. 1 1 Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Pediatric Oncology, 1081 HV Amsterdam, The Netherlands 2 Princess Maxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands 3 Emma Children's Hospital, Amsterdam UMC, Amsterdam Medical Center, Pediatric Oncology, 1105 AZ Amsterdam, The Netherlands 4 Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands 5 Department of Pediatric Oncology, Erasmus Medical Center Rotterdam/Sophia Children's Hospital, 3000 CB Rotterdam, The Netherlands 6 Department of Pediatric Hemato-Oncology, University Hospitals Leuven, 3000 Leuven, Belgium 7 Department of Pediatrics, Clinique du MontLegia, CHC, 4000 Liege, Belgium 8 Department of Pediatric Onco-Hematology, Universitair Ziekenhuis Brussel, 1090 Brussels, Belgium 9 Department of Paediatric Haematology-Oncology and Stem Cell Transplantation, Ghent University Hospital, 9000 Ghent, Belgium * Correspondence: [email protected]; Tel.: +31-(0)20-444-6206; Fax: +31-(0)20-444-5122 21 2 2023 3 2023 21 2 2023 15 5 135921 9 2022 29 11 2022 (c) 2023 by the authors. 2023 Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ). pmcError in Table In the original publication, there was a mistake in Table 1 as published . The number of patients with death was swapped between the one-hour administration group and the push administration group. The corrected Table 1 appears below. The authors state that the scientific conclusions are unaffected. This correction was approved by the Academic Editor. The original publication has also been updated. cancers-15-01359-t001_Table 1 Table 1 Demographic and clinical characteristics of the participants at baseline. One-Hour Administration Group (n = 45) Push Administration Group (n = 45) Sex Male 26 (58) 24 (53) Female 19 (42) 21 (47) Age, years (mean(SD)) 9.06 (5.11) 9.29 (5.25) Age >= 5 years and included for ped-mTNS assessment 32 (71) 34 (76) Disease Acute lymphoblastic leukemia 29 (64) 29 (64) Hodgkin lymphoma 7 (16) 11 (24) Nephroblastoma 6 (13) 2 (4) Medulloblastoma 1 (2) 1 (2) Rhabdomyosarcoma 2 (4) 0 (0) Low-grade glioma 0 (0) 2 (4) Ancestry a Europe 36 (80) 37 (82) Eastern Asia 1 (2) 0 (0) Latin-America (including Caribbean) 1 (2) 2 (4) Middle-East (including Northern Africa) 3 (7) 3 (7) Sub-Saharan Africa 1 (2) 0 (0) Combination 2 (4) 3 (7) Missing 1 (2) 0 (0) No. (%) of patients needing VCR dose reductions or omissions 1 (3) 0 (0) No. (%) of patients using analgesics for neuropathic pain 9 (20) 11 (24) Relapse (No. (%)) 2 (4) 1 (2) Death (No. (%)) 3 (7) 1 (2) Values represent the number (%) of participants, unless indicated otherwise. SD: standard deviation; ped-mTNS: pediatric modified Total Neuropathy Score; VCR: vincristine, a: Ancestry was parent-reported; participants could only be included in one category. Disclaimer/Publisher's Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. Reference 1. Van de Velde M.E. Kaspers G.J.L. Abbink F.C.H. Twisk J.W.R. van der Sluis I.M. van den Bos C. van den Heuvel-Eibrink M.M. Segers H. Chantrain C. van der Werff Ten Bosch J. Vincristine-Induced Peripheral Neuropathy in Pediatric Oncology: A Randomized Controlled Trial Comparing Push Injections with One-Hour Infusions (The VINCA Trial) Cancers 2020 12 3745 10.3390/cancers12123745 33322788 |
Cancers (Basel) Cancers (Basel) cancers Cancers 2072-6694 MDPI 10.3390/cancers15051403 cancers-15-01403 Correction Correction: Zhu et al. A Feedback Loop Formed by ATG7/Autophagy, FOXO3a/miR-145 and PD-L1 Regulates Stem-like Properties and Invasion in Human Bladder Cancer. Cancers 2019, 11, 349 Zhu Junlan Li Yang Luo Yisi Xu Jiheng Liufu Huating Tian Zhongxian Huang Chao Li Jingxia Huang Chuanshu * Nelson Institute of Environmental Medicine, New York University School of Medicine, New York, NY 10010, USA * Correspondence: [email protected]; Tel.: +1-646-754-9457; Fax: +1-646-754-9471 23 2 2023 3 2023 23 2 2023 15 5 140319 9 2022 02 11 2022 (c) 2023 by the authors. 2023 Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ). pmcError in Figure In the original article , there was a mistake in Figure 1E (right panel) as published. A sphere image was incorrectly used in Figure 1E (right panel). The corrected Figure 1E is shown below. The authors apologize for any inconvenience caused and state that the scientific conclusions are unaffected. The original article has been updated. Figure 1 PD-L1 acted as an ATG7 downstream mediator being responsible for ATG7-promoted stem-like property, invasion, and anchorage-independent growth in human high invasive BC cells. (A-C) T24T, UMUC3, T24 cells were stably transfected with ATG7 knockdown constructs (#1 & #2), respectively. Western Blot was used to assess the ATG7 protein knockdown efficiency and its effects on other protein expression. (D) The GFP-tagged PD-L1 overexpression plasmid was stably transfected into T24T(shATG7#1) cells. (E,F) The indicated cells were subjected to determination of sphere formation abilities according to the manufacturer's instruction, the number of spheroid formed cells were counted as described in the section of "Materials and Methods". The asterisk (*) indicates a significant decrease in comparison to scramble nonsense transfectant (* p < 0.05), while the symbol (**) indicates a significant increase in comparison to T24T(shATG7#1/pEGFPc1) cells (** p < 0.05). (G,H) The indicated cells were subjected to anchorage-independent soft agar assay using the protocol described in the section of "Materials and Methods". Representative images of colonies of indicated cells were photographed under an Olympus DP71 (G). The number of colonies was counted with more than 32 cells of each colony and the results were presented as colonies per 104 cells, and the bars show mean +- SD from three independent experiments (H). The asterisk (*) indicates a significant decrease in comparison to scramble nonsense transfectant (* p < 0.05), while the symbol (**) indicates a significant increase in comparison to T24T(shATG7#1/pEGFPc1) cells (** p < 0.05). (I) Invasion abilities of the indicated cells were determined using BD BiocoatTM matrigelTM invasion chamber. The migration ability was determined using the empty insert membrane without the matrigel, while the invasion ability was evaluated using the same system except that the matrigel was applied. (J) The invasion ability was normalized to the insert control according to the manufacturer's instruction. The asterisk (*) indicates a significant inhibition in comparison to T24T(Nonsense) cells (* p < 0.05), while the symbol (**) indicates a significant increase in comparison to T24T(shATG7#1/pEGFPc1) (** p < 0.05). Scale bars in (E,I) = 200 mm, Scale bars in (G) = 500 mm. Disclaimer/Publisher's Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. Reference 1. Zhu J. Li Y. Luo Y. Xu J. Liufu H. Tian Z. Huang C. Li J. Huang C. A Feedback Loop Formed by ATG7/Autophagy, FOXO3a/miR-145 and PD-L1 Regulates Stem-like Properties and Invasion in Human Bladder Cancer Cancers 2019 11 349 10.3390/cancers11030349 30871066 |
J Gen Fam Med J Gen Fam Med 10.1002/(ISSN)2189-7948 JGF2 Journal of General and Family Medicine 2189-6577 2189-7948 John Wiley and Sons Inc. Hoboken 10.1002/jgf2.603 JGF2603 JGF2-2022-0153.R1 Letter to the Editor Letters to the Editor Five strategies on writing research papers for beginners and young general medicine doctors Miyagami Taiju MD, PhD 1 [email protected] Ishizuka Kosuke MD, PhD 2 Harada Taku MD 3 Nagano Hiroyuki MD 4 Otsuka Yuki MD, PhD 5 Kumakawa Tomoko MD 6 Yamashita Shun MD, PhD 7 1 Department of General Medicine, Faculty of Medicine Juntendo University Tokyo Japan 2 Division of General Internal Medicine, Department of Internal Medicine St. Marianna University School of Medicine Kanagawa Japan 3 General Medicine Nerima Hikarigaoka Hospital Tokyo Japan 4 Department of Healthcare Economics and Quality Management, Graduate School of Medicine Kyoto University Kyoto Japan 5 Department of General Medicine Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Okayama Japan 6 School of Public Health University of California Berkeley California USA 7 Department of General Medicine Saga University Hospital Saga Japan * Correspondence Taiju Miyagami, Department of General Medicine, Juntendo University Faculty of Medicine, 2-1-1, Bunkyo-Ku, Tokyo, Japan. Email: [email protected] 18 1 2023 3 2023 24 2 10.1002/jgf2.v24.2 141142 15 12 2022 02 11 2022 25 12 2022 (c) 2023 The Authors. Journal of General and Family Medicine published by John Wiley & Sons Australia, Ltd on behalf of Japan Primary Care Association. This is an open access article under the terms of the License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. We propose five important strategies for young generalists to write original research and papers. We hope that even beginners will understand and practice these five strategies, and help young generalist to write research papers based on clinical questions that arise in their daily practice. source-schema-version-number2.0 cover-dateMarch 2023 details-of-publishers-convertorConverter:WILEY_ML3GV2_TO_JATSPMC version:6.2.6 mode:remove_FC converted:10.03.2023 pmc To the Editor: Japanese general medicine doctors (GMs) tend not to conduct research and place importance on it compared with clinical practice and education. 1 Tips for GMs to publish case reports emphasize the importance of clarifying the blueprint of the writing process in advance. 2 However, there are no reports on methods for publishing clinical research papers, except for case reports. We consider that for GMs to conduct research, strategies should be clarified, including those aspects which they share with specialists. Seven GMs (median years since graduation: 10 years), who have actively published original papers in international peer reviewed journals, completed interactive interviews and a narrative literature review about the likely stumbling blocks for beginners (who have never written a paper before) while writing their first online research paper. Hence, we propose five important strategies to help young GMs author original research papers. (Table 1). TABLE 1 Five strategies for becoming an academic generalist Strategy 1. Keeping the motivation. Strategy 2. Connecting clinical question to research question on a daily basis. Strategy 3. Reviewing previous research. Strategy 4. Conducting descriptive studies first. Strategy 5. Assigning a mentor and forming a project team. STRATEGY 1: KEEPING THE MOTIVATION First, being motivated in any situation and challenging daily practice makes the emergence of a clinical question more likely. The joy we experience when our products are published and by knowing that having a research perspective improves our clinical skills is motivation in itself. We encourage GMs who have not yet taken the plunge to take the first step. STRATEGY 2: CONNECTING CLINICAL QUESTIONS TO RESEARCH QUESTIONS ON A DAILY BASIS To conduct research, it is crucial to link clinical questions questions that occur in the clinical setting to research issues by considering their ethics, novelty, and viability. Eventually, we may be able to form GMs' original research team. STRATEGY 3: REVIEWING PREVIOUS RESEARCH We regret not conducting a thorough review of previous studies during the planning stage, either due to a lack of research items after beginning research or to previously published reports on the subject. Conducting a generic, yet comprehensive search of previous studies and setting survey items and inclusion criteria are critical. STRATEGY 4: CONDUCTING DESCRIPTIVE STUDIES FIRST This strategy is particularly important among these five strategies. Descriptive studies are able to summarize study data efficiently and logically, without a control group, intervention, or complex statistical calculations. 3 Investigating epidemiological frequencies enables answering questions in clinical practice. In addition, GMs have a high affinity for descriptive research because they have conducted several studies on diagnosis and epidemiology. 4 In our experience, we recommend that beginners start with descriptive studies. STRATEGY 5: ASSIGNING A MENTOR AND FORMING A PROJECT TEAM Hospitalists in the U.S. report that the lack of a mentor interferes with their research work. 5 Therefore, finding a mentor to discuss team building in detail and determining the division of roles between the mentor and the team are crucial. Mentors may not be easily available at GMs' own institutions; thus, it is important to find one at academic conferences or social network services and actively seek advice. We hope that these five strategies will help beginners and young GMs author research papers. AUTHOR CONTRIBUTIONS All authors had access to the data and a role in writing the manuscript. CONFLICT OF INTEREST None. REFERENCES 1 Miyagami T , Yamada T , Kanzawa Y , Kosugi S , Nagasaki K , Nagano H , et al. Large-scale observational study on the current status and challenges of general medicine in Japan: job description and required skills. Int J Gen Med. 2022;15 :975-84.35125887 2 Shikino K , Watari T , Tago M , Sasaki Y , Takahashi H , Shimizu T . Five tips on writing case reports for Japanese generalists. J Gen Fam Med. 2020;22 :111-2.33717791 3 Vetter TR . Descriptive statistics: reporting the answers to the 5 basic questions of who, what, why, when, where, and a sixth, so what? Anesth Analg. 2017;125 :1797-802.28891910 4 Tago M , Hirata R , Watari T , Shikino K , Sasaki Y , Takahashi H , et al. Future research in general medicine has diverse topics and is highly promising: opinions based on a questionnaire survey. Int J Gen Med. 2022;15 :6381-6.35942291 5 Dugani SB , Geyer HL , Maniaci MJ , Burton MC . Perception of barriers to research among internal medicine physician hospitalists by career stage. Hosp Pract. 1995;2020 (48 ):206-12. |
We report a case of spontaneous remission of hepatocellular carcinoma in an 84-year-old woman who was managed in our best supportive care clinic. The tumor, once relapsed regardless of the application of conventional transcatheter arterial chemoembolization and radiofrequency ablation, regressed spontaneously within 4 months. The presence of an occlusive thrombus in the portal vein feeding to the site of the tumor suggests that the reduced blood supply might have caused tumor necrosis. Furthermore, the successful eradication of hepatitis C virus maintained performance status, and good nutrition might play other roles on it. We report a case of spontaneous remission of hepatocellular carcinoma in an 84-year-old woman who was managed in our best supportive care clinic. hepatocellular carcinoma palliative care spontaneous regression source-schema-version-number2.0 cover-dateMarch 2023 details-of-publishers-convertorConverter:WILEY_ML3GV2_TO_JATSPMC version:6.2.6 mode:remove_FC converted:10.03.2023 Yamamoto N , Yamamoto C , Tajitsu T . Spontaneous regression of hepatocellular carcinoma in a pure palliative care setting. J Gen Fam Med. 2023;24 :126-128. 10.1002/jgf2.588 pmc1 INTRODUCTION Spontaneous regression of hepatocellular carcinoma (HCC) is very rare. 1 It is estimated to occur in 1 in 140,000 cases worldwide. 1 By 2019, only 106 cases were reported in the English written literature. 1 We report a case of spontaneous regression of HCC in a woman with liver cirrhosis caused by hepatitis C virus (HCV) infection. The patient agreed to the publication of her case by providing informed consent. The project was approved by an institutional ethics committee. For human subjects, the investigation was conducted in accordance with the Declaration of Helsinki of 1975. 2 CASE PRESENTATION An 84-year-old native Japanese woman presented to our clinic for the best supportive care (BSC) of HCC. She had been diagnosed with HCV-related liver cirrhosis since 2008. A tumor 30 mm in diameter in segment 3 (S3) and a tumor in 10 mm in diameter in S8 developed as a complication of liver cirrhosis in 2017. She initially refused treatment, but she was treated with conventional transcatheter arterial chemoembolization (c-TACE) of the tumor in S3 using a gelatin sponge and lipiodol combined with 20 mg of epirubicin on November 26, 2019. Subsequent c-TACE of tumor in S8 was abandoned due to the patient's distress during the procedure. It was treated with radiofrequency ablation (RFA) on April 3, 2020. Ledipasvir 90 mg and sofosbuvir 400 mg were administered for 12 weeks in parallel with the tumor treatment resulting in the eradication of her HCV infection. Her serum alpha-fetoprotein (AFP) and protein induced by vitamin K absence or antagonist-II (PIVKA-II) dropped once following the RFA, but they rose again persistently , and on June 29, 2020, a recurrent tumor with a diameter of about 30 mm was found in S8, accompanied with an occlusive portal vein thrombus in P8 again . She was referred to our clinic on July 29, 2020, because she refused any more active anti-tumor treatment. At the initial presentation, her Karnofsky Performance Status remained at 90. Laboratory examination showed serum albumin of 4.1 g/dL and total lymphocyte counts of 1615/mm3. On the contrary, serum AFP value had declined to 5261.8 ng/mL from 16962.3 ng/mL in 3 months. It continued to decline to 12 ng/mL 2 months later . When her PIVKA-II was measured using the stored serum, it was found to have decreased simultaneously . Persistent eradication of HCV was confirmed using real-time polymerase chain reaction. Contrast enhancement triple-phase computed tomography was performed to confirm the spontaneous remission of her HCC. The previously affected area of S8 enhanced in the arterial phase with an early washout pattern in the portal phase was almost disappeared in the present computed tomography (CT). In addition, the portal occlusion on P8 had resolved . Giving the information about the spontaneous regression definitely pleased her and her caregivers. Her serum values of AFP and PIVKA-II are gradually rising, but they remained still low over a further 1 year of follow-up (AFP, 26.3 ng/mL; PIVKA-II, 24 mAU/mL on December 13, 2021) . Throughout the entire time in the care of our BSC practice, she received neither curative treatment for cancer nor any specific treatment for symptoms due to the absence of discomfort. FIGURE 1 The patient's serum alpha-fetoprotein and protein induced by vitamin K absence or antagonist-II levels show a marked decline after discontinuing anti-cancer therapy. FIGURE 2 Axial image of contrast-enhanced computed tomography shows a hypodense tumor with a diameter of about 3 cm in S8 (white arrow) (A) accompanied by portal vein thrombosis in P8 (black allow) (B) before regression in June 2020 and markedly decreased in size with the resolution of the portal vein thrombosis after regression in September 2020 (C, D). 3 DISCUSSION The patient's clinical course is compatible with the definition of "spontaneous regression of cancer." 2 Tumor regression may be a delayed effect of RFA, but it is inconsistent with persistent elevation of tumor markers and CT findings for 2 months after RFA. Several hypotheses have been advocated to explain the mechanism of the spontaneous regression of HCC, but it has not been confirmed yet. 1 Diminished blood supply by the thrombus in the portal vein should have caused our patient's tumor to become necrotic as previously reported. 1 Six of the 24 spontaneous regression of HCC cases had impaired blood flow in the portal vein. 3 Besides, one case of complete histopathological necrosis after preoperative portal vein embolization was reported. 4 Recently, advances in molecular biology have led to the development of angiogenesis inhibitors that block the blood flow that cancer cells need to grow. 5 Sorafenib, one of the angiogenesis inhibitors, has been used currently as a standard regimen for advanced HCC in Japan. 5 Additionally, the successful eradication of persistent hepatitis viral infection which accelerates the carcinogenic process, maintenance of Karnofsky Performance Status, and good nutrition may have played other roles. 6 With the accumulation of similar cases and integration of knowledge, we can expect to establish new treatment strategies for HCC. 1 , 3 A major limitation of this report is that we diagnosed the tumor as HCC based on laboratory data and imaging features 7 without histopathological confirmation. However, it is well-known that HCV infection is a major cause of cirrhosis, significantly increasing the risk of HCC. 8 Given that similar cases have been reported previously, 1 , 9 we consider the clinical evidence to be sufficient. In our case, further close follow-up is required, as there have been some evidences that show once spontaneously regressed HCC cases recurred and resulted in death after few years. 1 , 6 We encountered spontaneous regression of HCC in the clinical setting of BSC. Spontaneous regression of cancer is a recognized verifiable phenomenon, even though it is quite rare. 2 When caring for patients with advanced cancer, we must be more careful, not just obsessed with conventional concepts. AUTHOR CONTRIBUTIONS All authors meet the ICMJE criteria for authorship. ETHICAL APPROVAL None. PATIENT CONSENT The patient has provided free written informed consent for the publication of this manuscript. CLINICAL TRIAL REGISTRATION None. INFORMED CONSENT The patient provided written informed consent. CONFLICT OF INTEREST The authors declare no conflicts of interest for this article. PERMISSION TO PUBLISH The patient has provided consent for the publication of this report. ACKNOWLEDGMENTS We thank Dr. Sadayoshi Ohubu, Dr. Satoshi Monno, Dr. Yukou Ikezawa, Dr. Mari Katsuno, and Dr. Sho Komada for their kind advice. |
J Belg Soc Radiol J Belg Soc Radiol 2514-8281 Journal of the Belgian Society of Radiology 2514-8281 Ubiquity Press 10.5334/jbsr.3006 VoR Case Report Intracranial Arteriovenous Malformation Combined with Multiple Aneurysms Diagnosed by CTA: A Case Report Zhang Qin 1 Hou Yongzhe 1 Wang Qiong 2 Chen Xilong [email protected] 13 1 Gansu University of Traditional Chinese Medicine, CN 2 The Third People's Hospital of Bijie City, Radiology Department, CN 3 Department of PICU, Gansu Provincial Maternity and Child-Care Hospital, CN CORRESPONDING AUTHOR: Xilong Chen Gansu University of Traditional Chinese Medicine, CN [email protected] 06 3 2023 2023 107 1 1604 11 2022 13 2 2023 Copyright: (c) 2023 The Author(s) 2023 This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC-BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. See Arteriovenous malformation (AVM) combined with aneurysms is not uncommon, but AVM of the basilar artery, brainstem, and right middle cerebral artery combined with multiple intracranial aneurysms (IAs) is rare. Cases of aneurysm protrusion into the optic canal are also rare. We report a distinctive case of intracranial AVM combined with multiple IAs and partial protrusion of a cavernous segment aneurysm of the right internal carotid artery into the optic nerve canal. Teaching Point: Cases of partial protrusion of a cavernous segment aneurysm of the right internal carotid artery into the optic canal, resulting in widening of the optic canal compared to the contralateral side, compression, thickening and swelling of the subocular veins, and obstruction of venous drainage warrant the clinician's attention. arteriovenous malformation aneurysm computed tomography angiography intracranial cerebral Education Department of Gansu Province 10.13039/501100009590 lccx2021001 The 2022 project of innovation foundation of outstanding graduate students of Gansu Province; the graduate innovation foundation of major project of Education Department of Gansu Province, No. lccx2021001. pmcIntroduction Intracranial arteriovenous malformation (AVM) combined with multiple intracranial aneurysms (IAs) is a complicated and specific cerebrovascular disease, with an incidence ranging from 2.7% to 16.7% and is a common risk factor for hemorrhage, with a high mortality rate . Case History A 57-year-old man was rushed to the emergency room with intermittent convulsions. The patient had a five-year history of hypertension and a single seizure one year earlier. Axial computed tomography angiography (CTA) image showed a vascular mass (red arrow) and thickened, swollen inferior ophthalmic vein (white arrow). The bone window axial CTA image demonstrated a right internal cavernous sinus aneurysm locally protruding into the optic canal (red arrow) and optic canal enlargement compared to the contralateral side (white arrow). A basilar artery aneurysm was present . Multiplanar reformation sagittal image shows saccular aneurysm (red arrow) approximately 2.4 cm x 1.3 cm in size with a narrow neck originating from the cavernous segment of the right internal carotid artery. The bone window coronal CTA image demonstrates the feeding artery (white arrow) and the malformed vascular mass (red arrow), while the volume rendering illustrates the draining vein (white arrow) and the basilar artery aneurysm (red arrow). Figure 1 CTA presentation of intracranial arteriovenous malformation combined with multiple aneurysms. CTA presentation of intracranial arteriovenous malformation combined with multiple aneurysms The final diagnosis was intracranial AVM combined with multiple IAs and a right internal carotid artery aneurysm. The patient was given antiepileptic, vasospasm-relieving, and blood pressure-controlling medication after being admitted to the hospital. When the patient had stabilized, the patient was transferred to another hospital. However, due to financial constraints, the patient and his family declined the further therapy and were self-discharged from the hospital. Comments The mechanism of AVM combined with IA is complicated. IA mostly occurs in the supplying arteries of AVM and there is a blood flow correlation between IA and AVM. Moreover, fibrous degeneration and thinning of the AVM-supplying arterial walls, disruption of the intima, and alterations in the vascular musculature lead to a significant increase in pressure in the AVM-supplying vessel. These hemodynamic mechanisms may explain the development of AVM combined with IA. Given the patient's imaging data, this case of AVM combined with IA is difficult to handle because of the following characteristics: IA occurred in the supplying artery of the AVM, which is different from the vascular structure of an ordinary IA and is clinically rare. Besides the IA in the intracranial arteriovenous malformation mass, IA was also present in the distal basilar artery and the right internal carotid artery. The IA of the cavernous segment of the right internal carotid artery partially protruded into the optic canal, resulting in widening of the optic canal compared to the contralateral side and compression, thickening, and swelling of the inferior ophthalmic vein by obstruction of venous outflow. The arteriovenous malformation vascular mass was supplied by the C5-6 segment of the internal carotid artery and the basilar artery, and several drainage veins were seen converging into the superior sagittal sinus. And IA predominantly occurred in vessels other than ordinary IA vessels (e.g., anterior and posterior communicating arteries). Digital subtraction angiography (DSA), which is the gold standard for the clinical diagnosis of AVM and IA, its use is restricted because it is an invasive examination and more likely to cause cerebrovascular accidents than CTA (e.g., aneurysm rupture and transient cerebral ischemia due to vasospasm). However, because CTA is a noninvasive, inexpensive, and quick imaging technique, it can be utilized as a reliable alternative to DSA in emergencies demanding immediate operation . CTA and its multiple reconstruction modalities (e.g., volume rendering, maximal-intensity projection, multiplane reconstruction) are of great value in the diagnosis of AVM and IA. The clinical significance of CTA is that it can reveal the blood supply arteries and drainage veins of AVM, as well as the location, size, morphology, thrombi, and calcification of AVM, allowing physicians to more precisely assess AVM and IA. CTA may also display the architecture of the lesion and its relationship with neighboring tissues in numerous angles and planes. Additionally, the CTA technique can save examination time, accurately localize bleeding, and help with disease characterization when acute rupture of IA occurs, guiding the development of treatment plans. Furthermore, patients prefer to select less expensive CTA in some poor areas of developing countries. Therefore, diagnoses of AVM combined with IA can be made using CTA as an alternate imaging technique to DSA. Conclusion We reported a rare case of intracranial AVM combined with multiple IAs and partial protrusion of a cavernous segment aneurysm of the right internal carotid artery into the optic nerve canal, to increase awareness of this rare cerebrovascular disease. Funding Information The 2022 project of innovation foundation of outstanding graduate students of Gansu Province; the graduate innovation foundation of major project of Education Department of Gansu Province, No. lccx2021001. Competing Interests The authors have no competing interests to declare. 1 Jha V, Behari S, Jaiswal AK, Bhaisora KS, Shende YP, Phadke RV. The 'focus on aneurysm' principle: Classification and surgical principles of management of concurrent arterial aneurysm with arteriovenous malformation causing intracranial hemorrhage. Asian J Neurosurg. 2016; 11 (03 ): 240-254. DOI: 10.4103/1793-5482.145340 27366251 2 Kouskouras C, Charitanti A, Giavroglou C, et al. Intracranial aneurysms: Evaluation using CTA and MRA. Correlation with DSA and intraoperative findings. Neuroradiology. 2004; 46 (10 ): 842-850. PMID: 15448952. DOI: 10.1007/s00234-004-1259-2 15448952 |
Methodist Debakey Cardiovasc J Methodist Debakey Cardiovasc J 1947-6108 Methodist DeBakey Cardiovascular Journal 1947-6094 1947-6108 Houston Methodist DeBakey Heart & Vascular Center 10.14797/mdcvj.1213 VoR Multimodality Museum Image Atypical Left Ventricular False Chordae Tendineae Darwish Amr MD [email protected] 1 Wessly Priscilla MD 1 Faza Nadeen MD 1 1 Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas, US CORRESPONDING AUTHOR: Amr Darwish, MD Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas, US [email protected] 07 3 2023 2023 19 2 100102 01 2 2023 03 2 2023 Copyright: (c) 2023 The Author(s) 2023 This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC-BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. See An 81-year-old female patient with a history of severe secondary mitral regurgitation, hypertension, and paroxysmal atrial fibrillation was seen by the valve team to determine candidacy for transcatheter edge-to-edge repair of the mitral valve. Two-dimensional biplane imaging showed a transverse basal left ventricle false tendon attached to papillary muscles. The position was concerning for interference during deployment of the mitral clip. LV false tendon chordae tendineae LV false chord 3-dimensional transesophageal echocardiography mitraclip pmcLeft ventricular false chordae tendineae are fibromuscular structures in the ventricular cavity without connection to mitral valve leaflets. Although first described more than 100 years ago, the pathophysiological significance of these structures remains unclear.1 Some studies have suggested that false tendons reduce the severity of functional mitral regurgitation by stabilizing the position of the papillary muscles as the left ventricle enlarges.2 Transverse false tendons also are associated with early repolarization, which could be a substrate for ventricular arrythmias.3 Figure 1 and Videos 1-3 show cardiac images of an 81-year-old female patient with a history of severe secondary mitral regurgitation, hypertension, and paroxysmal atrial fibrillation. She was seen by the valve team to determine candidacy for transcatheter edge-to-edge repair of the mitral valve. Two-dimensional biplane imaging showed a transverse (localized to one zone) basal left ventricle (LV) false tendon attached to papillary muscles. The position was concerning for interference during deployment of the mitral clip. Video 1 Two-dimensional biplane transesophageal echocardiography, two chamber mid-esophageal view, showing transverse chord-like structure close to mitral valve connecting the papillary muscles; see also at Video 2 Three-dimensional transesophageal echocardiography showing atypical left ventricular false tendon; see also at Video 3 Two-dimensional transesophageal echocardiography showing successful MitraClip implantation with residual mitral regurgitation and the tendon remained intact; see also at Figure 1 (A) Two-dimensional transesophageal echocardiography (TEE) (mid-esophageal 2-chamber view) shows a transverse chord-like structure (blue arrow) connecting the papillary muscles. (B) Three-dimensional TEE of the mitral valve highlights the transverse tendon (blue arrow). The procedure was successful with (C) residual mild mitral regurgitation, and (D) the tendon remained intact. LA: left atrium; LV: left ventricle. 2D and 3D TEE imaging of a transverse basal LV false tendon during MitraClip implantation Competing Interests The authors have no competing interests to declare. 1 Silbiger JJ. Left ventricular false tendons: anatomic, echocardiographic, and pathophysiologic insights. J Am Soc Echocardiogr. 2013 Jun;26 (6 ):582-8. doi: 10.1016/j.echo.2013.03.005 23602169 2 Bhatt MR, Alfonso CE, Bhatt AM, et al. Effects and mechanisms of left ventricular false tendons on functional mitral regurgitation in patients with severe cardiomyopathy. J Thorac Cardiovasc Surg. 2009 Nov;138 (5 ):1123-8. doi: 10.1016/j.jtcvs.2008.10.056 19660373 3 Liu Y, Mi N, Zhou Y, et al. Transverse false tendons in the left ventricular cavity are associated with early repolarization. PLoS One. 2015 May 1;10 (5 ):e0125173. doi: 10.1371/journal.pone.0125173 25933440 |
J Belg Soc Radiol J Belg Soc Radiol 2514-8281 Journal of the Belgian Society of Radiology 2514-8281 Ubiquity Press 10.5334/jbsr.3040 VoR Images in Clinical Radiology Pulmonary Artery Sling Blurs the Distal Trachea on Frontal Chest Radiography Jacquemin Quentin [email protected] 1 Nchimi Alain 1 1 Centre Hospitalier de Luxembourg, LU CORRESPONDING AUTHOR: Quentin Jacquemin Centre Hospitalier de Luxembourg, LU [email protected] 06 3 2023 2023 107 1 1821 12 2022 13 2 2023 Copyright: (c) 2023 The Author(s) 2023 This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC-BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. See Teaching Point: The pulmonary artery sling can be suspected on frontal chest radiography, not only by ancillary findings like lobe/lung emphysema or persisting atelectasis, but also blurring of the distal trachea or carina. Lung pediatrics bronchus trachea artery sling pmcCase History We report the case of a premature newborn, 30 weeks of gestation, without any noticeable birth event. On day one, he experienced respiratory stridor, polypnea, and intercostal retractions. Anteroposterior chest radiograph (CRX) showed right upper lobe atelectasis with air bronchogram. As his condition did not improve, an endotracheal tube was placed on day two. On control CRX , the tube was in an abnormally high position (asterisk), approximately 10mm under the vocal cords. The trachea was displaced to the right due to the right upper lobe atelectasis. Both the carina and the left main bronchus were not clearly depicted (arrow). Figure 1 Figure 1 Following axial computed tomography (CT) angiography , an aberrant origin of the left pulmonary artery (LPA) from the right pulmonary artery (RPA) was seen, with a subsequent posterior compression of the trachea on sagittal reformation , causing a tight stenosis of the pre-carinal trachea. The carina is located at the level of the seventh thoracic vertebral body. Coronal reformation shows an abnormal origin of the right upper lobe bronchus on the right, with abnormal narrowing of the tracheal segment below this origin, due to the abnormal origin and course of the LPA. Figure 2 Figure 2 Comments The term LPA 'sling' comes from the fact that it originates from the RPA and crosses the sagittal midline in between the trachea and esophagus to reach the left lung hilum. This causes a tracheal stenosis. A posterior mass effect on the lateral CRX is the most widely acknowledged finding related to this vascular anomaly. Nevertheless, lateral CRX is being progressively abandoned in neonates because of technical difficulties and radiation burden. Common but nonspecific findings for LPA sling on anteroposterior CRX include a lobar emphysema/atelectasis (most often the right upper lobe) persisting over time despite therapeutic measures. Herein we reported that undepictable trachea could be added in combination to these findings, to help raise the suspicion index for LPA sling for two reasons. First, the double superimposition of the pulmonary vasculature on the anteroposterior projection causes increased opacity and blurring of the right stripe of the distal trachea or the carina (depending on the level of the sling). Second, congenital bronchial malformations, potentially associated with pulmonary artery sling, such as displaced carina in this case, also contribute to a failure of depiction on anteroposterior CRX. Though valuable in terms of specificity for a mediastinal vascular ring, the identification of a blurred distal trachea (or carina) may lack sensitivity, given the common presence of nasogastric and/or endotracheal tubes and the displacement of the trachea over the lateral vertebral elements. According to the Wells and Landing's classification, there are two types of LPA sling depending on the position of the artery in relation to the carina. In Type 1, the carina is at its usual level (i.e., the fourth and fifth thoracic vertebral bodies), and the tracheobronchial anatomy is normal. In Type 2, the carina is located lower, at the level of the sixth and seventh thoracic vertebral bodies, the angle of the bronchial bifurcation is widened, and the bronchial anatomy can be altered, as in our patient, who had a type 2A malformation, as he additionally had a right tracheal bronchus . Competing Interests The authors have no competing interests to declare. 1 Newman B, Cho YA. Left pulmonary artery sling-anatomy and imaging. Semin Ultrasound CT MR. 2010; 31 (2 ): 158-70. DOI: 10.1053/j.sult.2010.01.004 20304323 |
J Belg Soc Radiol J Belg Soc Radiol 2514-8281 Journal of the Belgian Society of Radiology 2514-8281 Ubiquity Press 10.5334/jbsr.3012 VoR Case Report Giant Cell Tumor of Lumbar Vertebrae on MR and PET/CT: A Case Report and Literature Review Liu Xiangxiang 1 Lou Cen 1 Huang Zhongke [email protected] 1 1 Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, CN CORRESPONDING AUTHOR: Zhongke Huang Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, CN [email protected] 06 3 2023 2023 107 1 1712 11 2022 15 2 2023 Copyright: (c) 2023 The Author(s) 2023 This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC-BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. See Teaching Point: Giant cell tumor of bone may show a moderate to high FDG uptake, and attention should be paid to differentiate from malignant tumors. giant cell tumor vertebral tumors PET/CT MRI benign fibrous histiocytoma pmcIntroduction Giant cell tumor (GCT) is a common benign bone tumor, accounting for 5% of all primary bone tumors . Vertebral giant cell tumor is a very rare tumor, and imaging studies are challenging because it shares features with some other spinal lesions. There are not many reports on giant cell tumor of the lumbar spine, and even fewer reports on PET/CT of spinal GCT . Herein, we present a case of GCT of lumbar vertebrae on magnetic resonance imaging (MRI) and PET/CT, as well as review the literature. Case History A 45-year-old man with pain and numbness in the right lower limb for more than one year was referred for magnetic resonance imaging (MRI). MRI showed a large expansile lesion of the second lumbar vertebra . The right pedicle was involved, and part of the mass protruded into the spinal canal. The lesion was uniformly enhancing on contrast-enhanced MRI images . 18F-FDG PET/CT scan showed the expansile bone destruction of the second lumbar vertebra with increased FDG uptake (SUVmax: 11.8) . The cortex was eroded, with a residual bone crest. Figure 1 MRI. MRI Figure 2 PET/CT. PET/CT The patient underwent vertebral resection. Pathological diagnosis was a benign fibrous histiocytoma (BFH) (now considered GCT) . Light microscopy showed that spindle cells were arranged in a swirled structure . Osteoclast-type giant cells and foamy cells were scattered in the stroma. Figure 3 Pathological result. Pathological result Comments BFH shares common clinical symptoms, location, radiological characteristics, and histological features with GCT , causing difficulties in diagnosis. According to the latest WHO Classification of Tumors of Bone (2020), BFH of the spine is now classified as a heterogeneous GCT . GCTs are rare benign tumors, but with aggressive behavior. Spinal GCTs are even rarer, reported in less than 3% of cases . Despite benign in nature, GCTs generally exhibit high FDG uptake. A retrospective study of 20 patients from a single center showed that the SUVmax of spinal GCT ranged between 7.6 and 13.7, and the mean SUVmax was 10.4 +- 2.7 , consistent with our results (SUVmax: 11.8). Previous studies indicated that the high SUVmax of GCT was caused by overexpression of glucose transporter type 1 (GLUT-1) and hexokinase-2 in macrophages and giant cells, reactive fibroblast proliferation or enhanced angiogenesis . High FDG uptake may cause a misdiagnosis of malignancy. Conclusion GCT is a rare benign skeletal tumor. It shares features with some other malignant bone lesions on MRI and PET-CT and should be included in the differential diagnosis. Competing Interests The authors have no competing interests to declare. 1 Lin P, Lin N, Teng W, et al. Recurrence of giant cell tumor of the spine after resection: A report of 10 cases. Orthop Surg. 2018; 10 (2 ): 107-14. DOI: 10.1111/os.12375 29878714 2 Chakarun CJ, Forrester DM, Gottsegen CJ, Patel DB, White EA, Matcuk GR. Giant cell tumor of bone: Review, mimics, and new developments in treatment. Radiographics. 2013; 33 (1 ): 197-211. DOI: 10.1148/rg.331125089 23322837 3 Dejust S, Jallerat P, Soibinet-Oudot P, Jouannaud C, Morland D. Multimodality imaging features of a misleading sacral giant cell tumor in 18F-FDG PET/CT, bone scan, and MRI. Clin Nucl Med. 2020; 45 (10 ): 800-1. DOI: 10.1097/RLU.0000000000003148 32604109 4 Muheremu A, Ma Y, Huang Z, Shan H, Li Y, Niu X. Diagnosing giant cell tumor of the bone using positron emission tomography/computed tomography: A retrospective study of 20 patients from a single center. Oncol Lett. 2017; 14 (2 ): 1985-8. DOI: 10.3892/ol.2017.6379 28781642 5 Hoshi M, Takada J, Oebisu N, Hata K, Ieguchi M, Nakamura H. Overexpression of hexokinase-2 in giant cell tumor of bone is associated with false positive in bone tumor on FDG-PET/CT. Arch Orthop Trauma Surg. 2012; 132 (11 ): 1561-8. DOI: 10.1007/s00402-012-1588-2 22825642 6 McKinney AM, Reichert P, Short J, et al. Metachronous, multicentric giant cell tumor of the sphenoid bone with histologic, CT, MR imaging, and positron-emission tomography/CT correlation. AJNR Am J Neuroradiol. 2006; 27 (10 ): 2199-201.17110693 7 Ezgu MC, Cicek AF, Yasar S. Benign fibrous histiocytoma of the cervical vertebra: A rare case. Neurol India. 2019; 67 (1 ): 306-8.30860146 8 Mondal SK. Cytodiagnosis of benign fibrous histiocytoma of rib and diagnostic dilemma: A case report. Diagn Cytopathol. 2010; 38 (6 ): 457-60. DOI: 10.1002/dc.21245 20014125 9 Hattori T, Matsumine A, Uchida K, Nojima T, Sudo A. Benign fibrous histiocytoma of the talus: A case report. J Foot Ankle Surg. 2019; 58 (4 ): 762-5. DOI: 10.1053/j.jfas.2018.11.009 30962105 10 Ventura L, Petrella E, Piciucchi S, et al. Giant cell tumor of bone in an eighteenth-century Italian mummy. Virchows Arch. 2021; 479 (6 ): 1255-61. DOI: 10.1007/s00428-021-03192-5 34462806 11 Choi JH, Ro JY. The 2020 WHO classification of tumors of soft tissue: Selected changes and new entities. Adv Anat Pathol. 2021; 28 (1 ): 44-58. DOI: 10.1097/PAP.0000000000000284 32960834 12 Montgomery C, Couch C, Emory CL, Nicholas R. Giant cell tumor of bone: Review of current literature, evaluation, and treatment options. J Knee Surg. 2019; 32 (4 ): 331-6. DOI: 10.1055/s-0038-1675815 30449024 13 Park HL, Yoo IR, Lee Y, Park SY, Jung CK. Giant cell tumor of the rib: Two cases of F-18 FDG PET/CT findings. Nucl Med Mol Imaging. 2017; 51 (2 ): 182-5. DOI: 10.1007/s13139-016-0442-9 28559944 |
Methodist Debakey Cardiovasc J Methodist Debakey Cardiovasc J 1947-6108 Methodist DeBakey Cardiovascular Journal 1947-6094 1947-6108 Houston Methodist DeBakey Heart & Vascular Center 10.14797/mdcvj.1217 VoR Issue Introduction The Spectrum of Care for Aortic Disease Lumsden Alan B. MD [email protected] 1 1 Methodist DeBakey Heart & Vascular Center, Houston Methodist, Houston, Texas, US CORRESPONDING AUTHOR: Alan B. Lumsden, MD Methodist DeBakey Heart & Vascular Center, Houston Methodist, Houston, Texas, US [email protected] 07 3 2023 2023 19 2 13 08 2 2023 08 2 2023 Copyright: (c) 2023 The Author(s) 2023 This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC-BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. See aortic disease endograft graft explantation abdominal aortic aneurysm Alan B. Lumsden receives research support from W. L. Gore & Associates, CorMatrix Cardiovascular, Silk Road Medical, and Cook Medical. He also consults with Boston Scientific, W. L. Gore & Associates, Siemens, Medical Metrics, Nova Signal, Intact Vascular, Karl Storz, Avail Medsystems, AneuMed, Silk Road Medical, Hemostemix, and KOL BioMedical and is a shareholder in Hatch Medical. pmcAortic diseases have varied pathologies and, increasingly, new options for treatment. The causes of aortic disease may vary from congenital or genetic conditions to infection, traumatic accidents, degenerative or inflammatory disorders. Environmental influences clearly contribute to increased occurrence, with known risk factors including hypertension, aging, smoking, and trauma. While preventive and pharmacological interventions have been explored in recent years, surgery or Endovascular intervention continues as the recommended solution when treating most cases. This issue of the Methodist DeBakey Cardiovascular Journal explores the major types of aortic disease and their various options for treatment and repair. We open with a review of dynamic imaging of aortic pathologies by Drs. Dipan J. Shah, Alan B. Lumsden, Peter Osztrogonacz, and colleagues, who note that today's vascular surgeons can choose from a wide array of imaging modalities to evaluate different aortic pathologies. Despite the fact that newer dynamic imaging techniques provide time-resolved information in various aortic pathologies compared to the standard imaging modalities of vascular ultrasound and aortography, these newer techniques have not seen widespread adoption. To help readers decipher the role of emerging modalities, the authors provide an overview of dynamic imaging techniques for aortic pathologies and describe various dynamic computed tomography and magnetic resonance imaging protocols, clinical applications, and potential future directions. Next, we explore the topic of branched and fenestrated aortic endovascular grafts with Dr. Marvin D. Atkins and coauthor Aidan D. Atkins. Although improvements in morbidity and mortality have made endovascular repair of abdominal and descending thoracic aortic aneurysms the standard of care, late durability is problematic due to persistent endoleaks that may lead to aneurysm expansion and eventual rupture. The authors explore the current state of branched, fenestrated, and physician-modified endografts used in complex aortic pathologies including early results of such technologies that show at least similar short-term outcomes compared with open repair as well as issues such as late branch endograft failure and acute periprocedural stroke. From here, Drs. Valeria Duarte, Michael Singh, and Raman Yousefzai discuss the increase in genetically triggered thoracic aortic disease. Up to 25% of patients with thoracic aortic disease have an underlying genetic predisposition, which makes diagnosis critical from both a medical management perspective and to identify at-risk family members. The authors explain the genetic etiology of thoracic aortic disease, identify aortic diseases associated with genetic syndromes, review the recent ACC/AHA guidelines, and discuss specific testing protocols for patients predisposed with heritable thoracic aortic disease. Authors Michael Reardon, Marvin Atkins, and Aidan Atkins then delve into endovascular management of the ascending aorta. Thoracic endovascular aortic stent graft repair (TEVAR) has revolutionized the management of descending aortic pathologies, showing significant improvements in mortality, morbidity, and recovery time. However, devices designed specifically for the ascending aorta are desperately needed for those patients unfit for open surgical repair. The authors update readers on the unique challenges of endovascular management of the ascending aorta and look at the future technologies that will define this space. The dramatic increase in the number of aneurysms treated with abdominal aortic endografts has spurred more interest in graft explantation. Open procedures can be particularly challenging, especially in patients with nonremedial type 1 endoleaks or graft infections. With up to 70% of primary repairs performed with an abdominal aortic endograft, an overwhelming number of explants continue to be performed in the abdomen. In the article titled "Explant of the Aortic Endograft: Today's Solutions, Tomorrow's Problems," I address some of the technical challenges and management of these patients and focus on practical challenges associated with removing these devices. From here, Drs. Anthony Estrera, Akiko Tanaka, and colleagues review open treatments for thoracoabdominal aortic aneurysm repair (TAAA), for which Michael E. DeBakey and colleagues developed a Dacron graft to shunt between the descending thoracic aorta and infrarenal abdominal aorta to minimize visceral and renal ischemia. The current standard practice of TAAA repair includes myriad techniques, such as left heart bypass with mild hypothermia or cardiopulmonary bypass with moderate/deep hypothermia, among others, and the authors explore these techniques in detail. They also explain how their use of distal aortic perfusion and cerebrospinal fluid drainage combined with moderate passive hypothermia has reduced the overall spinal cord ischemia rate after extent I TAAA. Drs. John F. Eidt and Javier Vasquez then shift focus to the changing management of type B aortic dissections (TBAD). Despite contemporary advances in medical and surgical care, acute aortic dissection remains a highly lethal and morbid condition, with almost one-third of patients never reaching the hospital. The authors explore four significant trends in the management of type B aortic dissection, including (1) the adoption of a new classification system that resolves deficiencies of the DeBakey and Stanford systems; (2) recognition that thoracic endovascular aortic repair (TEVAR) fails to effectively prevent aneurysmal degeneration in the untreated aortic segments; (3) increasing use of TEVAR in uncomplicated TBAD despite the absence of definitive proof of efficacy; and (4) the emergence of a variety of techniques and devices designed to improve the long-term outcomes of TBAD. We then step back to look at the medical management of aortic disease. While surgery is the cornerstone of management for most aortic conditions, medical therapy is now an important adjunctive therapy in most if not all aortic patients. A preemptive diagnostic approach with a multidisciplinary team and shared decision-making has led to improved clinical outcomes. Control of blood pressure, cholesterol, lifestyle factors, and comorbidities are all important and meaningful targets to optimize outcomes in aortic disease patients. In their review, Drs. Maan Malahfji and Mujtaba Saeed review the role and evidence behind medical management of patients with aortic disease. Ruptured abdominal aortic aneurysm is an acute aortic condition that requires immediate action and appropriate continuity of care to optimize patient outcomes. A systematic standardized protocol-driven approach is essential to improve the management of aortic emergencies as well as perioperative morbidity, mortality, and long-term survival. In their review, authors Maham Rahimi, Peter J. Osztrogonacz, Vy C. Dang, and colleagues summarize the internal protocol of the Houston Methodist Hospital Acute Aortic Treatment Center to provide guidance to vascular surgeons in training and also to low-volume aortic centers, following the five phases of surgical care outlined by the American College of Surgeons (ACS): preoperative, perioperative, intraoperative, postoperative, and post-discharge. The quality of any cardiovascular program depends in large part on the competency and care of its nursing staff. Having specialty trained and certified cardiovascular nurses has been shown to help decrease delays in cardiac referral and treatment, reduce hospital stays in patients with cardiac disease, and prevent rehospitalization. Against the backdrop of an ongoing nurse shortage, healthcare organizations need strategic plans to support, build, and retain a strong team of CV nurses. Gail M. Vozzella, DNP, RN, NEA-BC, and Michelle C. Hehman, PhD, RN, close this issue describing the numerous forces driving the current nursing shortage and the impact of the coronavirus-19 pandemic on nurse job satisfaction and turnover. They also present a reinvented model of nursing care as a framework for healthcare organizations to address nurse staffing challenges. The articles presented here are shared in the spirit of offering useful insights and approaches for treating aortic diseases and repairing the damage they have caused. To learn more about aortic disease treatment and see additional video clips of aortic procedures, I include links to the extensive video library of DeBakey Cardiovascular Education. More videos, in addition to those shared in the articles included here, can be found on the DeBakey Cardiovascular Education YouTube channel at Guest Editor Biography The editors of the Methodist DeBakey Cardiovascular Journal express our appreciation to Dr. Alan B. Lumsden for his knowledge and insight in developing this issue on aortic disease. Alan B. Lumsden, MD Dr. Lumsden's academic career began in 1989 at Emory University in Atlanta, Georgia, where he completed his postdoctoral training and served as a Collaborative Scientist in the Division of Pathobiology and Immunology at the renowned Yerkes Primate Center. He remained at Emory for several years, rising to the rank of associate professor and chief of the Division of Vascular Surgery. In 2002, Dr. Lumsden joined the faculty at the Baylor College of Medicine in Houston, Texas, as professor and chief of the Division of Vascular Surgery and Endovascular Therapy. He assumed his current positions at Houston Methodist in 2008. Dr. Lumsden has developed an international reputation as a leader in the field of endovascular surgery. He has clinical and research expertise in stent graft treatment of thoracic and abdominal aortic aneurysms, stenting and endarterectomy in carotid arterial disease, renovascular hypertension, aortoiliac occlusive disease, and mesenteric vascular and minimally invasive therapy in venous disease. Dr. Lumsden also conducts FDA-mandated training for surgeons nationwide in a carotid stenting simulator housed at the Houston Methodist DeBakey Heart & Vascular Center. Dr. Lumsden's research interests include developing novel minimally invasive methods of therapy and preventing restenosis. His research has been funded by the National Institutes of Health, and he has contributed more than 200 papers to the medical literature, as well as numerous abstracts, books, and book chapters. Competing Interests Alan B. Lumsden receives research support from W. L. Gore & Associates, CorMatrix Cardiovascular, Silk Road Medical, and Cook Medical. He also consults with Boston Scientific, W. L. Gore & Associates, Siemens, Medical Metrics, Nova Signal, Intact Vascular, Karl Storz, Avail Medsystems, AneuMed, Silk Road Medical, Hemostemix, and KOL BioMedical and is a shareholder in Hatch Medical. |
Methodist Debakey Cardiovasc J Methodist Debakey Cardiovasc J 1947-6108 Methodist DeBakey Cardiovascular Journal 1947-6094 1947-6108 Houston Methodist DeBakey Heart & Vascular Center 10.14797/mdcvj.1214 VoR Poet's Pen Old Ironsides Young James B. MD [email protected] 12 1 Emeritus Executive Director of Academic Affairs, Cleveland Clinic and Professor Emeritus of Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, US 2 Section Editor, Poet's Pen, Methodist DeBakey Cardiovascular Journal CORRESPONDING AUTHOR: James B. Young, MD Emeritus Executive Director of Academic Affairs, Cleveland Clinic, Professor of Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, US [email protected] 07 3 2023 2023 19 2 103106 03 2 2023 08 2 2023 Copyright: (c) 2023 The Author(s) 2023 This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC-BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. See Dr. Oliver Wendell Holmes Sr. was a 19th century elite physician, curmudgeon, essayist, and poet. His works were numerous, insightful, entertaining, and characteristic of the pre-Civil War, Civil War, and Gilded age eras. Many of his shorter poems are taught in high school as examples of late 19th century works, as they are relatively easy to memorize and understand. Holmes and the Fireside Poets (Emerson, Longfellow, and Lowell, among others) created works that, in their time, were read aloud by fathers and mothers to their family because the poems often centered around values, morals, and historic events. "Old Ironsides" is characteristic of the type of work for which the Fireside Poets became famous. It is an entertaining poem to read, study, and hear, particularly when linking it to the oldest ship in the world, still afloat and sailing around Boston Bay. pmcOld Ironsides Ay, tear her tattered ensign down! Long has it waved on high. And many an eye has danced to see That banner in the sky; Beneath it rung the battle shout, And burst the cannon's roar; The meteor of the ocean air Shall sweep the clouds no more! Her deck, once red with heroes' blood Where knelt the vanquished foe, When winds were hurrying o'er the flood And waves were white below, No more shall feel the victor's tread, Or know the conquered knee; The harpies of the shore shall pluck The eagle of the sea! O, better that her shattered hulk Should sink beneath the wave; Her thunders shook the mighty deep, And there should be her grave; Nail to the mast her holy flag, Set every thread-bare sail, And give her to the god of storms, The lightning and the gale! Oliver Wendell Holmes Sr, MD Uss Constitution as "Old Ironsides" "Old Ironsides"1,2 is an iconic poem written by the physician, curmudgeon, and poet Oliver Wendell Holmes Sr (1804-1894). Holmes Sr should not be confused with his son, Oliver Wendell Holmes Jr (1841-1934), associate justice of the Supreme Court, nicknamed "the Great Dissenter." The poem has been a staple for youthful classes of literature and poetry because of its catchy tone, cadence, and important reference to American history. Its style is old school and short enough to be easily memorized (three eight-line stanzas), with a catchy rhyming pattern as each stanza has its own distinct rhyming scheme.1,2,3 It was written in 1830, on the eve of the warship USS Constitution being decommissioned from the United States Navy, and very early in the career of Holmes as a poet and curmudgeon. The poem was published in the Boston Daily Adviser in response to an article in the New York Journal of Commerce, detailing the fact that the USS Constitution was to be decommissioned and sundered for scrap. This was after an extraordinary history of protecting democracy and the United States of America. Particularly notable was its defense during the War of 1812. Figure 1 USS Constitution port broadside. [Between 1900 and 1920] Photograph. Detroit Publishing Co., Publisher. Retrieved from the Library of Congress, <www.loc.gov/item/2016817278/> USS Constitution port broadside. [Between 1900 and 1920] Photograph. Detroit Publishing Co., Publisher. Retrieved from the Library of Congress, <www.loc.gov/item/2016817278/> This is the first poem in Holmes' poetry compendium after his solicitous introduction to his readers.2 At the beginning of the poem, Holmes seems to take the position of endorsing decommissioning of this glorious warship. The poem suggests that the distinctive ensign, that was flown high, should be torn down and permanently fixed to the ship's mast. The author had other ideas about how to honor the glory of the historic USS Constitution by putting it on display, albeit that "...her shattered hulk/should sink beneath the wave" but only after nailing "to the mast her holy flag" and setting "every thread-bare sail" while giving her to the god of storms. The history of the USS Constitution goes back to the beginning of our republic. She is a three-masted heavy frigate with an impenetrable oak hull (thus the name "Ironsides"), launched in 1797 as part of the Naval Act of 1794. She was the third of six commissioned warships. George Washington himself approved the name "Constitution." She protected merchant shipping during conflicts with France and the First Barbary War. Her actions in the War of 1812 were particularly significant and important, prompting public adoration that saved her from the scrap heap on several occasions. The oldest ship in the world still floating, and intermittently sailing, she currently is on "active duty," moored in Boston Harbor near the Boston Freedom Trail with a Navy crew of around 75 sailors. My attachment to the ship is the name of the Ohio Township, Bainbridge, in which I live. When my wife and I recently toured the USS Constitution, I discovered that Captain William Bainbridge was the frigate's commander during the War of 1812. Several other municipalities, many streets, and a few warships carry the name "Bainbridge" as well. I have yet to come across any neighbors who know the history of our township's name or know much about the War of 1812 and how our Ohio "Western Reserve" got the name and why. Figure 2 Oliver Wendell Holmes Sr, by Jacques Reich, 1899. National Portrait Gallery, Smithsonian Institution; gift of Oswald D. Reich. Oliver Wendell Holmes Sr, by Jacques Reich, 1899. National Portrait Gallery, Smithsonian Institution; gift of Oswald D. Reich Oliver Wendell Holmes Sr studied medicine in Paris at first, then returned to Boston and Harvard School of Medicine, where he received his medicine degree in 1836 after he penned "Old Ironsides."4 He taught at Dartmouth School of Medicine before returning to Boston and Harvard, where he had a long and distinguished career. He championed the unpopular concept of puerperal fever being an infection transmitted by doctor's carrying the scourge from patient to patient via filthy hands, clothing, and instruments. Holmes also was part of a literary group of prominence that included Henry Wadsworth Longfellow, William Cullen Bryant, John Greenleaf Whittier, and James Russell Lowell, collectively known as the Fireside Poets. His works were often published in The Atlantic Monthly, and he continued his literary career throughout his medical career, earning him the label of a literary physician writer (William Carlos Williams was of the same ilk almost a century later). With respect to the profession of medicine, Holmes was a reformer. In addition to his attention to puerperal fever, he focused on the poor hygienic conditions of the Boston Dispensary. He railed against many contemporary practices with the quote, "If all contemporary medicine was tossed into the sea it would be all the better for mankind and all the worse for the fishes."5 He also demeaned quackeries and homeopathy, labeling the later "the pretended science...mingled with a mass of perverse ingenuity, of tinsel erudition, of imbecile credulity, and of artful misrepresentation, too often mingled in practice."6 Holmes traveled extensively throughout New England, wrote poetry, essays, and novels, saw patients, and at one time was critical of the abolitionists. In the end, he was a passionate supporter of the Union side of the Civil War. Later in life, Holmes slowed as he aged but also traveled to Europe, received numerous honorary degrees, kept up his association with his literary friends, and died peacefully in 1894. He seems better known for his literary adventures than his medical work. Though his poetry and other writings might be labeled stilted and old fashioned, careful reading uncovers his wit and wisdom. Competing Interests The author has no competing interests to declare. 1 PoetryFoundation.org [Internet]. Chicago, IL: Poetry Foundation; c2023. Oliver Wendell Holmes Sr. Old Ironsides; 2023 [cited 2023 Feb 6]. Available from: https/old-ironsides//www.poetryfoundation.org/poems/46547/old-ironsides 2 Holmes OW. The Poetical Works of Oliver Wendell Holmes. Boston, MA: Houghton, Osgood and Co; 1879. 324 p. 3 PoemAnalysis.com [Internet]. London, United Kingdom: Poem Solutions Limited; 2023. Oliver Wendell Holmes; 2023 [cited 2023 Feb 6]. Available from: 4 Hoyt EP. The Improper Bostonian: Dr. Oliver Wendell Holmes. New York, NY: William Morrow & Co; 1979. 319 p. 5 Sullivan W. New England Men of Letters. New York, NY: Atheneum Books/Simon & Schuster; 1972. 256 p. 6 Homeoint.org [Internet]. Sylvain Cazalet, publisher; 2006. Homeopathy and its Kindred Delusions by Dr. Oliver Wendell Holmes; 2023 [cited 2023 Feb 6]. Available from: |
Cells Cells cells Cells 2073-4409 MDPI 10.3390/cells12050781 cells-12-00781 Editorial Advances in the Understanding of Frontotemporal Dementia Bandopadhyay Rina 1* Gatt Ariana 2 Lashley Tammaryn 2 1 Reta Lila Weston Institute of Neurological Studies, Department of Clinical and Movement Neuroscience, UCL Institute of Neurology, 1 Wakefield Street, London WC1N 1PJ, UK 2 Queen Square Brain Bank, Department of Neurodegenerative Diseases, UCL Institute of Neurology, 1 Wakefield Street, London WC1N 1PJ, UK * Correspondence: [email protected] 01 3 2023 3 2023 12 5 78122 2 2023 27 2 2023 (c) 2023 by the authors. 2023 Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ). pmcFrontotemporal dementia (FTD) encompasses a group of clinically, genetically and pathologically heterogeneous neurodegenerative disorders that mainly affect people under the age of 64 years. However, around 25% of those affected have a later age of onset. FTD represents 10-20% of all dementia cases . It is predominantly characterized by the progressive atrophy of the frontal and temporal lobes . Disease duration ranges between 2 and 20 years, with 8 years being the mean following the onset of symptoms. FTD treatment is restricted to symptom control, and no disease-modifying treatments are available. The clinical hallmarks of FTD include gradual yet progressive deficits in behaviour and/or language with the relative preservation of memory. Subtypes of FTD are identified clinically according to the symptoms that appear prominently at presentation. Clinical diagnoses include behavioral variant FTD (bVFTD), which accounts for nearly 60% of cases; primary progressive aphasia (PPA), which affects language; and the movement disorders progressive supranuclear palsy (PSP) and corticobasal syndrome (CBS) . With disease progression, the debilitating symptoms cause marked impairments of social and/or occupational functioning. Early and accurate diagnosis is crucial for the streamlining and development of any disease-modifying treatment therapies. A third of FTD cases are genetically linked with mutations occurring in C9orf72, progranulin (GRN) and MAPT, with C9orf72 repeat expansions being the most common. Neuropathologically, TAR DNA binding protein-43 (TDP-43), fused in sarcoma (FUS) and tau are three major proteins that cause pathological deposits in FTD post-mortem brains . Those with C9orf72 expansions also have an additional pathology where di-peptide repeat proteins are also found deposited in patients. It is thought that disease pathogenesis is caused either by a gain of toxic function or a loss of nuclear function associated with protein dislocation from the nucleus, which in turn may lead to neuronal degeneration. FUS regulates the transcription of multiple genes, including the MAPT gene . Recent studies have highlighted the molecular pathways associated with lysosomal dysfunction, lipid dysregulation, RNA splicing aberrations, synaptic loss and neuroinflammation as putative causes of sporadic forms of FTD. The disease mechanisms are far from understood in FTD, especially the cellular changes occurring in the early disease stages. Continued research with improved animal models, iPS technologies, clinicopathological correlations with donated human brain tissue and the discovery of early biomarkers of disease progression should enable us to rationalize the mechanisms involved in these neurodegenerative diseases and identify much-needed therapeutic targets. This Special Issue will collect articles relating to all advances in FTD research, both clinical and non-clinical. Conflicts of Interest The authors declare no conflict of interest. Disclaimer/Publisher's Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. References 1. Olney N.T. Spina S. Miller B.I. Frontotemporal dementia Neurol. Clin. 2017 35 339 374 10.1016/j.ncl.2017.01.008 28410663 2. Lashley T. Rohrer J.D. Mead S. Revesz T. An update on clinical, genetic and pathological aspects of frontotemporal lobar degenerations Neuropathol. Appl. Neurobiol. 2015 41 858 881 10.1111/nan.12250 26041104 3. Ishigaki S. Fujioka Y. Okada Y. Riku Y. Udagawa T. Honda D. Yokoi S. Endo K. Ikenaka K. Takagi S. Altered trau isoforms ratio caused by Loss of FUS and SFPQ function leads to FTLD-like phenotypes Cell Rep. 2017 18 1118 1131 10.1016/j.celrep.2017.01.013 28147269 4. Sobue G. Ishigaki S. Watanabe H. Pathogenesis of frontotemporal lobar degeneration: Insights from loss of function theory and early involvement of the caudate nucleus Front. Neurosci. 2018 12 473 10.3389/fnins.2018.00473 30050404 |
Diagnostics (Basel) Diagnostics (Basel) diagnostics Diagnostics 2075-4418 MDPI 10.3390/diagnostics13050901 diagnostics-13-00901 Interesting Images Finger Pain as an Uncommon Primary Manifestation of Lung Carcinoma Holzgreve Adrien 1* Durr Hans Roland 2 Stabler Axel 3 Kaemmerer Mathias 3 Unterrainer Lena M. 1 Tufman Amanda 4 Manapov Farkhad 5 Kunz Wolfgang G. 6 Unterrainer Marcus 17 Grenier Philippe A. Academic Editor 1 Department of Nuclear Medicine, University Hospital, LMU Munich, 81377 Munich, Germany 2 Musculoskeletal Oncology, Department of Orthopaedics and Trauma Surgery, University Hospital, LMU Munich, 81377 Munich, Germany 3 Radiologische Praxis Munchen Grosshadern, 81377 Munich, Germany 4 Department of Internal Medicine V, University Hospital, LMU Munich, 81377 Munich, Germany 5 Department of Radiation Oncology, University Hospital, LMU Munich, 81377 Munich, Germany 6 Department of Radiology, University Hospital, LMU Munich, 81377 Munich, Germany 7 DIE RADIOLOGIE, 80331 Munich, Germany * Correspondence: [email protected]; Tel.: +49-89-4400-74665 27 2 2023 3 2023 13 5 90113 1 2023 24 2 2023 25 2 2023 (c) 2023 by the authors. 2023 Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ). A 54-year-old patient presented with progressive pain for one month in the second finger of the right hand with an emphasis on the proximal interphalangeal (PIP) joint. Subsequent magnetic resonance imaging (MRI) showed a diffuse intraosseous lesion at the base of the middle phalanx with destruction of the cortical bone and extraosseous soft tissue. An expansively growing chondromatous bone tumor, e.g., a chondrosarcoma, was suspected. After incisional biopsy, the pathologic findings finally revealed, surprisingly, a metastasis of a poorly differentiated non-small cell adenocarcinoma of the lung. This case illustrates a rare but important differential diagnosis for painful finger lesions. magnetic resonance imaging (MRI) non-small cell lung carcinoma (NSCLC) rare symptom unusual presentation Munich-Clinician-Scientist-Program (LMU Munich)L.M.U. was funded by the Munich-Clinician-Scientist-Program (LMU Munich). pmcDetailed Figure Legend A 54-year-old patient presented with progressive pain for one month and mild swelling in the second finger of the right hand with an emphasis on the proximal interphalangeal (PIP) joint. Subsequent 3T magnetic resonance imaging (MRI) of the right hand in T1-weighted fat-saturated sequence after administration of 20 mL Gd-DOTA showed a contrast-enhancing diffuse intraosseous lesion at the base of the middle phalanx with destruction of the cortical bone and surrounding extraosseous soft tissue . The axial view revealed ulnar infiltration of the ligaments of the articular capsule (arrow). Based on the imaging findings, an expansively growing chondromatous bone tumor, e.g., a chondrosarcoma, was suspected. After incisional biopsy, the pathologic findings finally revealed, surprisingly, a metastasis of a poorly differentiated non-small cell adenocarcinoma of the lung. The patient stopped smoking 12 years ago (after 20-30 pack years); there was no positive family history, no B symptoms (i.e., fever, night sweats, unintentional weight loss), occasional cough, no sputum, and no hemoptysis. Staging by positron emission tomography/computed tomography (PET/CT) with 316 MBq [18F]FDG revealed a primary tumor in the upper lobe of the right lung and multiple lymph node, soft tissue, and bone metastases ; cranial MRI revealed a brain metastasis. In contrast to this case, typical initial symptoms of lung carcinoma are respiratory symptoms including cough, dyspnoea or haemoptysis, but not bone pain . Overall, the occurrence of metastases in the acral parts of the body is a rare condition . Amongst acro-metastases, lung cancer was reported to be the most common cause, with one third of cases . The imaging findings of peripheral bone metastases, however, are variable and a robust differentiation from chondrosarcoma or other malignant bone and soft tissue tumors is not regularly possible using MRI alone . Typically, medullary chondrosarcomas present with a lobular growth pattern at the margins and display a heterogeneous signal behavior across the sequences in MRI, partly due to diverse matrix mineralization and areas of entrapped yellow marrow . These images illustrate the findings in a rare but important differential diagnosis for painful finger lesions and underline the value of timely histological confirmation, especially in the case of inconclusive imaging findings. Further, they recall that patients with advanced stage cancer may be either asymptomatic or symptomatic with an unusual pattern. Author Contributions A.H.: clinical management, manuscript draft. H.R.D. and L.M.U.: clinical management, revision of the manuscript, increased intellectual content. A.S. and M.K.: provision of the MR images, increased intellectual content. A.T., F.M. and W.G.K.: revision of the manuscript, increased intellectual content. M.U.: manuscript draft, supervision. All authors have read and agreed to the published version of the manuscript. Informed Consent Statement The Ethics Committee waived additional approval for case reports. Conflicts of Interest The authors declare no conflict of interest. Figure 1 T1-weighted fat-saturated, contrast-enhanced MRI. (a) coronal view. (b) axial view. Figure 2 [18F]FDG PET/CT. (a) axial view. (b) maximum intensity projection (MIP). Disclaimer/Publisher's Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. References 1. Rudin C.M. Brambilla E. Faivre-Finn C. Sage J. Small-cell lung cancer Nat. Rev. Dis. Prim. 2021 7 3 10.1038/s41572-020-00235-0 33446664 2. Afshar A. Farhadnia P. Khalkhali H. Metastases to the hand and wrist: An analysis of 221 cases J. Hand Surg. 2014 39 923 932 10.1016/j.jhsa.2014.01.016 24612837 3. Sur Y.J. Kang Y.K. Bahk W.J. Chang D.K. Rhee S.K. Metastatic malignant tumour in the hand J. Plast. Surg. Hand Surg. 2011 45 90 95 10.3109/2000656X.2011.556224 21504279 4. Stomeo D. Tulli A. Ziranu A. Perisano C. De Santis V. Maccauro G. Acrometastasis: A literature review Eur. Rev. Med. Pharmacol. Sci. 2015 19 2906 2915 26241547 5. Ma L.D. Magnetic resonance imaging of musculoskeletal tumors: Skeletal and soft tissue masses Curr. Probl. Diagn. Radiol. 1999 28 29 62 10.1016/S0363-0188(99)90009-9 10088064 6. Douis H. Saifuddin A. The imaging of cartilaginous bone tumours. II. Chondrosarcoma Skelet. Radiol. 2013 42 611 626 10.1007/s00256-012-1521-3 |
Cancers (Basel) Cancers (Basel) cancers Cancers 2072-6694 MDPI 10.3390/cancers15051485 cancers-15-01485 Correction Correction: Wind et al. Topical Bimiralisib Shows Meaningful Cutaneous Drug Levels in Healthy Volunteers and Mycosis Fungoides Patients but No Clinical Activity in a First-in-Human, Randomized Controlled Trial. Cancers 2022, 14, 1510 Wind Selinde S. 12 Jansen Manon A. A. 1 Rijsbergen Melanie 1 van Esdonk Michiel J. 1 Ziagkos Dimitrios 1 Cheng Wing C. 1 Niemeyer-van der Kolk Tessa 1 Korsten John 3 Gruszka Agnieszka 3 Schmitz-Rohmer Debora 4 Bonnel David 5 Legouffe Raphael 5 Barre Florian 5 Bekkenk Marcel W. 6 de Haas Ellen R. M. 7 Quint Koen D. 2 Schnidar Harald 8 Rolli Melanie 4 Streefkerk Henk Johan 4 Burggraaf Jacobus 129 Vermeer Maarten H. 2 Rissmann Robert 129* 1 Centre for Human Drug Research, 2333 CL Leiden, The Netherlands 2 Department of Dermatology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands 3 Charles River Laboratories Den Bosch B.V., 5231 DD Den Bosch, The Netherlands 4 PIQUR Therapeutics AG, 4057 Basel, Switzerland 5 MS Imaging Department, ImaBiotech, 59120 Lille, France 6 Amsterdam University Medical Centers, 1105 AZ Amsterdam, The Netherlands 7 Erasmus Medical Center, 3015 GD Rotterdam, The Netherlands 8 SCARLETRED Holding GmbH, 1030 Vienna, Austria 9 Leiden Academic Centre for Drug Research, Leiden University, 2333 CC Leiden, The Netherlands * Correspondence: [email protected] 27 2 2023 3 2023 27 2 2023 15 5 148524 10 2022 07 11 2022 (c) 2023 by the authors. 2023 Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ). pmcThe authors wish to make the following corrections to this paper : 1. 'Harald Schnidar' was not included as an author in the published article and he was added as the co-author including his affiliation 8. The corrected Author Contributions Statement was updated as follows: The author contributed to this research in the development, supply and read-out of software for this clinical trial. His contribution was added to 'Author Contributions' sections: 'conceptualization', 'software', 'writing review and editing' and 'visualization' of the manuscript. 2. The medical device product name and the regarding sentence were changed to 'For standardized daily photo documentation and objective erythema quantification of a single target lesion, the CE medical device certified mobile app Scarletred(r)Vision (SCARLETRED, Vienna, Austria) was used by patients at home and investigators on site' in Section 2.3. 3. The caption of Figure 3C was updated to 'SCARLETRED imaging'. For Figure 5I caption, 'by SCARLETRED imaging' was added and the statement was corrected to: '(I) Clinical picture by SCARLETRED imaging'. 4. Furthermore, a new reference was added as 23th reference for completeness regarding the objective quantification of erythema by SCARLETRED imaging. All subsequent after reference were numbered sequentially. Finally, to be consistent with the cited references, the 'intravenous' administration of bimiralisib was removed from the Introduction on page 2 and Section 4.1 of the Discussion on page 12. The corrected sentences reads now: 'Multiple clinical studies, including studies on 233 patients with various malignancies (including lymphomas), demonstrated potential clinical activity of oral bimiralisib' and 'This is a major improvement compared to the severe adverse events that were seen with oral administration of bimiralisib [11,16-20].' respectively. The authors apologize for any inconvenience caused and state that the scientific conclusions are unaffected. The original article has been updated. The original version will remain online on the article webpage, with a reference to this erratum. Disclaimer/Publisher's Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. References 1. Wind S.S. Jansen M.A.A. Rijsbergen M. van Esdonk M.J. Ziagkos D. Cheng W.C. Niemeyer-van der Kolk T. Korsten J. Gruszka A. Schmitz-Rohmer D. Topical Bimiralisib Shows Meaningful Cutaneous Drug Levels in Healthy Volunteers and Mycosis Fungoides Patients but No Clinical Activity in a First-in-Human, Randomized Controlled Trial Cancers 2022 14 1510 10.3390/cancers14061510 35326659 2. Ranjan R. Partl R. Erhart R. Kurup N. Schnidar H. The mathematics of erythema: Development of machine learning models for artificial intelligence assisted measurement and severity scoring of radiation induced dermatitis Comput. Biol. Med. 2021 139 104952 10.1016/j.compbiomed.2021.104952 34739967 |
Int J Environ Res Public Health Int J Environ Res Public Health ijerph International Journal of Environmental Research and Public Health 1661-7827 1660-4601 MDPI 10.3390/ijerph20054673 ijerph-20-04673 Editorial Stand Up for Yourself: Tackling Sedentary Behavior through Exercise and Lifestyle Fermino Rogerio Cesar 12* Guerra Paulo Henrique 3 1 Research Group on Environment, Physical Activity, and Health, Postgraduate Program in Physical Education, Federal University of Technology-Parana, Curitiba 81310-900, Brazil 2 Postgraduate Program in Physical Education, Federal University of Parana, Curitiba 81531-980, Brazil 3 School of Medicine, Federal University of Fronteira Sul, Chapeco 89815-899, Brazil * Correspondence: [email protected] 06 3 2023 3 2023 20 5 467301 3 2023 02 3 2023 (c) 2023 by the authors. 2023 Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ). pmcBecause of their direct relations to the process of health and disease throughout life, physical activity and sedentary behavior emerge as priorities in the global public health agenda . If there is no reduction in physical inactivity worldwide, around 500 million new non-communicable chronic diseases could occur by 2030, with most of these in middle-income countries . The available evidence supports the understanding that a lack of physical activity and substantial periods of sedentary behavior is associated with an increased risk of cardiovascular disease, cancer, and premature mortality . Non-communicable chronic diseases show increasing trends globally, resulting in high morbidity and mortality rates and high costs to health systems . The COVID-19 pandemic decreased physical activity and increased sedentary behavior . Most people were confined to their homes for months and exposed to less energy-intensive activities . From a global perspective, the research contributes to the broad understanding of developing interventions that reduce physical inactivity and sedentary behavior . How can we make it easier for people to move around in their leisure time, during commutes, when attending work/school/university, or staying at home? Physical activity and sedentary behavior are multidetermined and require complex approaches and efforts for confrontation . Thus, this IJERPH Special Issue, "Stand Up For Yourself! Tackling Sedentary Behavior Through Exercise and Lifestyle Change", invites researchers worldwide to share evidence and discuss the main determinants and strategies of interventions from an interdisciplinary perspective. Author Contributions Conceptualization and writing, R.C.F. and P.H.G. All authors have read and agreed to the published version of the manuscript. Conflicts of Interest The authors declare no conflict of interest. Disclaimer/Publisher's Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. References 1. Guidelines on Physical Activity and Sedentary Behaviour WHO Geneva, Switzerland 2020 Available online: (accessed on 28 February 2023) 2. Ding D. Ramirez-Varela A. Bauman A.E. Ekelund U. Lee I.M. Heath G. Katzmarzyk P.T. Reis R. Pratt M. Towards better evidence-informed global action: Lessons learnt from the Lancet series and recent developments in physical activity and public health Br. J. Sports Med. 2020 54 462 468 10.1136/bjsports-2019-101001 31562122 3. Santos A.C. Willumsen J. Meheus F. Ilbawi A. Bull F.C. The cost of inaction on physical inactivity to public health-care systems: A population-attributable fraction analysis Lancet Glob. Health 2023 11 e32 e39 10.1016/S2214-109X(22)00464-8 36480931 4. Ekelund U. Steene-Johannessen J. Brown W.J. Fagerland M.W. Owen N. Powell K.E. Bauman A. Lee I.M. Series L.P.A. Lancet Sedentary Behaviour Working Group Does physical activity attenuate, or even eliminate, the detrimental association of sitting time with mortality? a harmonised meta-analysis of data from more than 1 million men and women Lancet 2016 388 1302 1310 10.1016/S0140-6736(16)30370-1 27475271 5. Nguyen P. Le L.K.D. Ananthapavan J. Gao L. Dunstan D.W. Moodie M. Economics of sedentary behaviour: A systematic review of cost of illness, cost-effectiveness, and return on investment studies Prev. Med. 2022 156 106964 10.1016/j.ypmed.2022.106964 35085596 6. Murray C.J.L. Aravkin A.Y. Zheng P. Abbafati C. Abbas K.M. Abbasi-Kangevari M. Abd-Allah F. Abdelalim A. Abdollahi M. Abdollahpour I. Global burden of 87 risk factors in 204 countries and territories, 1990-2019: A systematic analysis for the Global Burden of Disease Study 2019 Lancet 2020 396 1223 1249 10.1016/S0140-6736(20)30752-2 33069327 7. Stockwell S. Trott M. Tully M. Shin J. Barnett Y. Butler L. McDermott D. Schuch F. Smith L. Changes in physical activity and sedentary behaviours from before to during the COVID-19 pandemic lockdown: A systematic review BMJ Open Sport Exerc. Med. 2021 7 e000960 10.1136/bmjsem-2020-000960 34192010 8. Sallis J.F. Bull F. Guthold R. Heath G.W. Inoue S. Kelly P. Oyeyemi A.L. Perez L.G. Richards J. Hallal P.C. Progress in physical activity over the Olympic quadrennium Lancet 2016 388 1325 1336 10.1016/S0140-6736(16)30581-5 27475270 9. Global Action Plan on Physical Activity 2018-2030: More Active People for a Healthier World WHO Geneva, Switzerland 2018 Available online: (accessed on 28 February 2023) |
]) AND Clinical Trial[ptyp])) AND ((((multiple sclerosis [Title/Abstract])) AND Clinical Trial[ptyp])) Cochrane "gut microbiota" or microbiome and "multiple sclerosis" ProQuest "gut microbiota" or microbiome and "multiple sclerosis" CINAHL "gut microbiota" or microbiome and "multiple sclerosis" ScienceDirect "gut microbiota" or microbiome and "multiple sclerosis" Scopus (TITLE-ABS-KEY ("gut microbiota") OR TITLE-ABS-KEY (microbiome) AND TITLE-ABS-KEY ("multiple sclerosis")) AND PUBYEAR > 2017 AND (LIMIT-TO (DOCTYPE, "ar")) ijerph-20-04624-t002_Table 2 Table 2 Summary of the articles included in the study. Reference Participants Cases/Control / / Microbial Dysbiosis and SCFAs Metabolome 24 RRMS/25 3/21 3/22 No diversity a | Clostridium leptum and Bacteroides thetaiotaomicron | Faecalibacterium, Prevotella, Lachnospiraceae anaerostipias, Bifidobacterium longum, Faecalibacterium prausnitzii, Parabacteroides and Escherichia | +SCFAs 30 RRMS/14 9/21 7/7 No diversity a | Firmicutes and Actinobacteria | Proteobacteria and Lentisphaerae 30 RRMS/20 13/17 8/12 | Bacteroides fragilis | Bacteroide fragilis with 30 years old | Bacteroides relapse rate >= 1.4 129 MS/58 36/93 29/29 | butyrate 18 RRMS/18 2/16 2/16 No diversity a | Bacteroides and | Actinobacteria | Bacteroides, Flavobacterium and Parabacteroides | Bifidobacteria and Streptococcus 22 MS/33 8/14 12/21 No diversity a | Faecalibacterium, Roseburia, Haemophilus, Bilophila, Dorea, Butyricicoccus, Gemella, Clostridium XIVb and Granulicatella 95 RRMS/54 30/65 21/33 | plasmatic acetate No propionate nor butyrate 26 RRMS 12 SPMS/38 18/20 18/20 No diversity a | Lachnospiraceae | Akkermansia, Collinsella, Eubacterium and Prevotella | Parabacteroides, Roseburia, Coprococcus and Blautia 26 RRMS/39 4/22 12/27 | diversity a | Bacteroidetes | Coprococo, Clostridium, nc. Ruminococcaceae, Paraprevotella and Methanobrevibacter 15 PPMS/15 9/6 8/7 | diversity a | Verrucomicrobia | Actinomycetaceae, Verrucomicrobiaceae, Desulfovibrionaceae, nc. Firmicutes, Acidaminococcaceae, nc. Clostridia, Eubacteriaceae, Verrucomicrobiaceae, Oxalobacteraceae, Christensenellaceae and Corynebacteriaceae | Gemmiger and nc. Ruminococcaceae 45 MS/44 15AC 16AH 14AA 11/34 16/28 MS vs. control: | Clostridia MS AC vs. control: | Verrucomicrobia and | Akkermansia MS AH and AA vs. control: | Adlercreutzia MS AH vs. control: | Blautia, Holdemania and Dorea | Prevotella, Slackia, Lachnospira and Dialister MS AA vs. control: | Butyricococcus 98 (52 RRMS o 26 PPMS o 20 BMS)/120 39/59 48/72 No diversity | Alistipes, Anaerotruncus, Clostridium cluster IV, Lactobacillus, Methanobrevibacter, Olsenella, Parabacteroides, Ruminococcus, Sporobacter | Butyricicoccus, Faecalicoccus, Gemmiger, Intestinibacter y Roseburia MS: Multiple Sclerosis; RRMS: Remittent Recurrent; PPMS: Primary Progressive; VS: versus; SCFAs: short chain fatty acids; AC: American Caucasian; AH: American Hispanic; AA: Afroamerican; a: Alpha; b: Beta; Diversity a: measures the variety of species present in a sample; Diversity b: measures differences in the composition of microbial communities between samples; : men; : women; +: Marginal; nc: non classified; |: decrease in MS vs. control; |: increase in MS vs. control. ijerph-20-04624-t003_Table 3 Table 3 NOS risk of bias evaluation. Reference Selection Comparability Exposition Conclusion Low risk Low risk Low risk Low risk Low risk Low risk Low risk Low risk Low risk Low risk Low risk Low risk indicates the quality of the studies, when the sum of the is <4: low-quality study; 4-6 : moderate-quality study and >=7 : high-quality study. ijerph-20-04624-t004_Table 4 Table 4 Clue findings of relative abundances regarding taxon levels: MS vs. control group cases. Taxon/Reference Phylum Firmicutes Actinobacteria Proteobacteria Lentisphaerae Bacteroidetes Verrumicrobia Class Clostridio Family Lachnospiraceae Ruminococcaceae Genre Bifidobacterium Roseburia Coprococcus Butyricicoccus Lachnospira Akkermansia Blautia Parabacteroides Dorea Ruminococcus Faecalibacterium Prevotella Methanobrevibacter Dialister Decrease in relative abundance MS/vs/Control, Increase in relative abundance MS/vs/Control. Disclaimer/Publisher's Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
Int J Environ Res Public Health Int J Environ Res Public Health ijerph International Journal of Environmental Research and Public Health 1661-7827 1660-4601 MDPI 10.3390/ijerph20054629 ijerph-20-04629 Comment Comment on Vazquez-Gandullo et al. Inspiratory Muscle Training in Patients with Chronic Obstructive Pulmonary Disease (COPD) as Part of a Respiratory Rehabilitation Program Implementation of Mechanical Devices: A Systematic Review. Int. J. Environ. Res. Public Health 2022, 19, 5564 Yigit Safak 1* Akinci Buket 2 Dharmage Shyamali Academic Editor 1 Department of Therapy and Rehabilitation, Vocational School, Istanbul Galata University, Istanbul 34425, Turkey 2 Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Biruni University, Istanbul 34010, Turkey * Correspondence: [email protected] 06 3 2023 3 2023 20 5 462924 1 2023 02 3 2023 (c) 2023 by the authors. 2023 Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ). pmcIn May 2022, the paper "Inspiratory Muscle Training in Patients with Chronic Obstructive Pulmonary Disease (COPD) as Part of a Respiratory Rehabilitation Program Implementation of Mechanical Devices: A Systematic Review" was published in the International Journal of Environmental Research and Public Health. Sixteen studies were included in the review, and it was concluded that in the pulmonary rehabilitation program in which the inspiratory muscles were trained by using the Inspiratory Muscle Training (IMT) devices benefited the quality of life in patients with COPD . We have read with great interest the systematic review which gives broad information about types of IMT and current devices used for the training. We would like to share our views and ask questions about the review. First, the authors stated that studies with low quality evidence were excluded from the review. According to the PRISMA guideline, most methods for assessing the quality of studies to be included in the systematic review include components such as the suitability of the research design, the risk of bias, the choice of measurement method, and the quality of the intervention administered . However, we could not read about a cut-off point for the quality of the studies or information about quality assessment in this review. Therefore, it is difficult to discuss the quality, integrity and homogeneity of the included studies. Secondly, in the training of respiratory muscles, the principles of loading, specialization and reversibility are taken into account, as in peripheral muscles. To provide response in inspiratory muscle training, muscle fibers must be loaded. For the loading principle of respiratory muscle training, the training should be applied at a certain intensity, duration and frequency . Although device-specific information is given in detail for the 16 studies, enough information is not provided about the usage regime of IMT protocol. As a result of the review, do authors suggest a specific IMT protocol for the COPD patients? Additionally, which type of training is better for COPD patients in terms of patient compliance? Finally, a systematic review and meta-analysis conducted in 2018 examined the effects of inspiratory muscle training in COPD patients. The review included 37 studies in the meta-analysis which all evaluated quality of life, and it was reported that IMT using threshold improves quality of life . In the current review, only three out of the 16 included studies evaluated quality of life; however, the authors concluded that IMT devices provided a wide benefit in terms of quality of life. Can we think that the increased quality of life is a result of other clinical improvements achieved with the IMT, or was the methodological quality of these three studies significantly high? There is increasing evidence of the benefits of IMT even applied alone for patients with COPD . Therefore, we believe that this review is an important guide for clinicians, and further suggestions according to our questions can bring us a different perspective on the rehabilitation program of patients with COPD. We look forward to your answers and thank you in advance. Conflicts of Interest The authors declare no conflict of interest. Disclaimer/Publisher's Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. References 1. Vazquez-Gandullo E. Hidalgo-Molina A. Montoro-Ballesteros F. Morales-Gonzalez M. Munoz-Ramirez I. Arnedillo-Munoz A. Inspiratory Muscle Training in Patients with Chronic Obstructive Pulmonary Disease (COPD) as Part of a Respiratory Rehabilitation Program Implementation of Mechanical Devices: A Systematic Review Int. J. Environ. Res. Public Health 2022 19 5564 10.3390/ijerph19095564 35564959 2. Page M.J. McKenzie J.E. Bossuyt P.M. Boutron I. Hoffmann T.C. Mulrow C.D. Shamseer L. Tetzlaff J.M. Akl E.A. Brennan S.E. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews Syst. Rev. 2021 10 372 10.1186/s13643-021-01626-4 3. Sanderson S. Tatt I.D. Higgins J. Tools for assessing quality and susceptibility to bias in observational studies in epidemiology: A systematic review and annotated bibliography Int. J. Epidemiol. 2007 36 666 676 10.1093/ije/dym018 17470488 4. Ramirez-Sarmiento A. Orozco-Levi M. Guell R. Barreiro E. Hernandez N. Mota S. Sangenis M. Broquetas J.M. Casan P. Gea J. Inspiratory muscle training in patients with chronic obstructive pulmonary disease: Structural adaptation and physiologic outcomes Am. J. Respir. Crit. Care Med. 2002 166 1491 1497 10.1164/rccm.200202-075OC 12406842 5. Beaumont M. Forget P. Couturaud F. Reychler G. Effects of inspiratory muscle training in COPD patients: A systematic review and meta-analysis Clin. Respir. J. 2018 12 2178 2188 10.1111/crj.12905 29665262 6. Ammous O. Feki W. Lotfi T. Khamis A.M. Gosselink R. Rebai A. Kammoun S. Inspiratory muscle training, with or without concomitant pulmonary rehabilitation, for chronic obstructive pulmonary disease (COPD) Cochrane Database Syst. Rev. 2023 1 CD013778 10.1002/14651858.CD013778 36606682 |
ALLOPATHIC SUPPRESSION OF LOCHIA. D. C. McLaren, M. D., Ottawa, Can. This case is that of a lady about thirty-five years of age, whose second child was born on August 1st, 1885. Up to this date she had always been a strong, healthy woman, but, after a 'few days, the foul condition of the lochia excited the combined animosity of physician and nurse, and an intra-uterine injection of Iodine was ordered and faithfully administered. This promptly dried up the discharge, but was immediately followed by a sense of fullness in the abdomen ; this sensation soon became reality, and for some months she was as much distended as if again pregnant. Severe headaches came on in November, for which she was treated by the allopathic methods in vain. Finally, a specialist discovered a lacerated cervix, and operated. The headaches left, but in place of them came a most distressing across the chest; this was so bad at one time that she was almost out of her mind. This trouble was at its height in March, 1890, when she had a miscarriage. She came to me in October, 1890, weeping bitterly as she described her symptoms, saying she surely had heart disease, that she was possessed by the devil, etc. She complained so much about her heart that it was examined, but found to be sound ; there was, however, a decided throbbing at the pit of the stomach, which was at times visible externally. This spot was exceedingly tender on , and there seemed to be a lump beneath. I hesitate, , to declarethat it was an aneurism, because, in our provings of Iodine, there occurs the symptom : " Violent throbbing of the abdominal aorta." I tried several apparently indicated remedies, but Lycopodium was the first to do any real good ; its principal indication was the formation of flatulence in the stomach and relief from eructation. The course of the was interrupted in March, 1891, by another miscarriage, for which the lady's husband, in his haste, called in the former physician. During the summer I gave one dose of Iodum high, but cannot record any great improvement from it. I became convinced that pregnancy would do this case much good, and when she was again threatened with miscarriage, in October, I was promptly on hand, and stopped the manifestation with a single dose of Sabina200. Subsequent symptoms required, from time to time, a dose of Belladonna, but during the last three months of pregnancy she was left under the influence of . Her baby was born on Good Friday, 1892, and the lochial discharge for a week was most astonishingly profuse. She well, and the pulsation at the stomach pit has entirely disappeared. Ido not claim to have cured a case of aneurism, but to have in some degree overcome the results of the original suppression. Discussion. Dr. Farley The trouble in that case suggests to me a case ' I had last week. A physician in my town asked me to see a case for him, which he called asthma. He had given several remedies. She had long been a sufferer from hemorrhoids, and,. I judge, also a fissure. She had been operated on for rectal trouble, and soon after had the asthma. I gave Kali-bichrom.200, in water, at intervals of two hours for twenty-four hours. The respiration was better, and she was sittingerecton the next day. It was a marked improvement, but her rectum was getting sore,, and in a short time her asthma was gone, but her rectum was again the seat of much suffering. The character of the drew my attention to the remedy. The following amendment to the By-Laws was presented by Dr. Bell to be acted upon at the next meeting : " The order of business may be changed at any annual by a unanimous vote." The following amendment to the By-Laws was presented by Dr. Custis to be acted upon at the next meeting : " The Association shall meet annually at such time and place as may be fixed upon by ballot at the annual meeting. If arrangements cannot be made in accordance with the given, the Executive Committee may, with the of a majority of the members, change the place of . The ballot to be taken by mail, the members to have the choice of two places named by the committee." The motion was made and carried that the Executive have charge of the publication of the Transactions. A vote of thanks was passed to the proprietor of the hotel. The minutes of the meeting were read by the Secretary and were approved. Adjourned sine die at 11.30 a. m. |
PUERPERAL CONVULSIONS. R. E. Jameson, M. D., Jamaica Plain, Boston, Mass. Mrs. A., aged thirty-two, of a decidedly psoric constitution. Mother at climacteric season for four years and died of insanity. Her aunt, sister to her mother, died of puerperal convulsions at thirty-two. When eighteen was thrown from a carriage and spine injured. Suffered for several years with uterine disease, and received all kinds of local treatment at the hands of homoeopathic physicians. In January, 1882, gave birth to a daughter, and was in poor health for several years. the birth of her daughter and 1890, when I first became acquainted with her, had two miscarriages. In 1890 became pregnant again and called me in to relieve her of various incident to her condition, if possible another miscarriage. She had a good deal of leucorrhoea, constipation, headaches, and indigestion, with vomiting. Her headache and the gastric symptoms were aggravated by motion, and I gave her Bryonia(r)"1, which relieved all the symptoms but the leucorrhoea. For that I gave her Puls, and Sepia, which helped it very much but did not entirely cure it. She went to term and was delivered of a girl, that lived only twenty-four hours. She became pregnant again, as she was very anxious to have , and had a much more comfortable time than at any pregnancy. April 4th last I was called about half-past twelve a. m. As she had previously had tedious labors her husband, who summoned me, did not hurry very much, and when I arrived I was very much surprised on being told that the baby had arrived. She had had a very easy labor, and was feeling very happy over the advent of the boy. I visited her again at half-past nine and found her comfortable with the of headache, which she said was not very bad and which did not alarm me, as she was so subject to headache. I left a remedy for it, however. At eleven o'clock I called at my house and was told by my wife that I was wanted at once at Mrs. A.'s, that she was in convulsions. I drove at once to her and found her in a violent spasm, the fourth that she had had. Her face was of a bluish color, there were twitchings of the muscles, of the face and eyelids; with great restlessness, tossing from one side of the bed to the other, with constant delirium. I gave her Hyoscyamus. In two hours there was apparently a little improvement in that she became conscious, and said she felt very uncomfortable and wanted to pass water. The did not last, however, and I sent for Dr. Wesselhoeft. The symptoms changed, there were now stupor, stertorous breathing, rigidity of limbs, head turned to right, eyes turned up, pupils dilated, and nearly insensible to light; pulse rapid ; throws arms out at right angles with body, frothing at mouth, face livid and bloated, tongue swollen and abdomen very much distended and tympanitic. Hot sweat. I gave Opium, which was approved by Dr. Wesselhoeft. Dr. Kimball came out at night, and remained till morning. We went over the symptoms together very carefully, and could find nothing better indicated than the Opium. In the night, however, the changed again. The stertor gave place to a constant between the spasms. The spasm began in the right eyelid, and the right side was convulsed, while the left was motionless, as though paralyzed. The hot sweat continued, and there was rolling of the head on the pillow. Dr. Kimball gave Bell.om. The spasms were not quite so frequent, and from 5.30 to 8.30 she had none; between that and 11.30 she had five. I repeated the Bell, at 8.30 and at 10.30. At 11.30 she had the last one. Then respiration ceased and the pulse could scarcely be felt, and I thought she was gone. She remained unconscious till Wednesday night, about thirty hours after the convulsion ceased, when a violent delirium set in, and it was difficult to keep her in bed. Her screams could be heard over the neighborhood. I gave Coffea, Hyoscyamus, and Stramonium, as they seemed indicated. On Saturday her husband said her mental condition seemed like anger, real ugliness. I did not wonder that he thought so, for she struck him several times in the face. I asked him if she had shown any such disposition during her or during labor. I had never seen anything of it, and had not been told of any such symptoms. He answered, " Oh I yes." The little daughter came to him one day and wanted him to take her somewhere because mamma treated her so, and sometimes it seemed impossible to do anything to please her. Saturday night or Sunday morning I gave her Chamomilla. Sunday P. M. I called, and found her in a quiet sleep. In the evening I called again, and she was still sleeping, though she had awakened once or twice and taken nourishment. From that time she improved, and is now perfectly well. Mastitis. Mrs. F., about two weeks after confinement, called me in to see her breast, which was somewhat inflamed, but not very painful. It was on the right side, and the inflammation was of a pale red. I gave Bryonia, and in a few days called again and found it worse; the inflammation had increased and extended in area. She said the pains were pricking in character. It looked very much as though an abscess was inevitable. But she had another symptom. She said she was lame when she sat down, and it hurt her to rise from her seat. She was also constipated, had no stool without an enema. I gave her Lycopodium'"1, two doses. The abscess was averted, the constipation relieved, and the ischiatic lameness disappeared with the rest. Discussion. Dr. Plummer I had a case of convulsions strikingly similar to the one Dr. Jameson has reported, and occurred at very nearly the same time. In my case as in his, Hyoscyamus seemed indicated, yet did not help; but Opium gave marked relief. It was, however, insufficient, and had to be followed by Belladonna. My patient had paralysis of the right side following the , which cleared up in the course of ten days or two weeks under Phosphorus, and at the end of four weeks she was entirely cured. Dr. Carr Does the doctor recall the character of the pulse at the time of the first headache, whether it had the globular described by Dr. Gregg? The headache which preceded the convulsions, I mean. It has been my experience that when on the second or third day such a pulse and headache occurs, it is almost a characteristic indication for Belladonna. I think that probably Bell, would have averted the first convulsion if given as soon as indicated by that pulse. Dr. Kimball During the night I frequently took the pulse, and often could not find it at all. She would have a ; then in an hour another one; then one in fifteen minutes; then in forty-five minutes. There would be, in other words, a long interval and then a short one. After the Opium she moaned, instead of being in a stertorous sleep. After the dose of Bell, the intervals began to increase, and by morning she was having two hours between the convulsions. Dr. Long There is one part of that paper which impresses me very deeply, and makes me feel sad to know that in such extreme cases I stand entirely alone. I have no Dr. or Kimball to help me out. There are many who have to meet the severe strain of their terrible cases alone, unhelped by the friendly hands of their professional brethren. Some of you who are more fortunate do not realize how awful it may sometimes be to stand before a terrible case of sickness, unhelped save by your God and your materia medica. |
FIBROID TUMOR OF THE UTERUS. E. T. Adams, M. D., Toronto, Can. Mr. President and Members : I have briefly to mention some peculiarities occurring in the case of a patient suffering from fibroid tumor of the uterus, and which I reported in extenso at our last meeting. Perhaps some of you will remember the very satisfactory results obtained by the use of Lil-tig.em in checking the floodings. Monthly discharge became as natural as for many years every three weeks and lasting four days. The tumor ceased to grow then began to diminish and continued to . The woman became natural and normal in her mental condition. In fact, patient like, a common remark with her was : " I doubt whether I ever had a tumorand as went on " I don't believe I ever had a tumor." Such was the happy state of affairs till the middle of November last, when one midnight a messenger delivered a telegram stating that an only and much loved sister had died very suddenly. The shock from the sudden news and grief at its cause affected her very severely. In three days you would scarcely have the woman. She returned from the funeral and in about two week called on me. She was in a most despondent state, similar to that of the year before. Thought she was going mad was confident would notice that there was something wrong with her mentally. Was sure some fearful misfortune was about to happen. Was confused, forgetful, no life or energy, no for business love of which, when well, was as the breath in her nostrils anxious and given to spells of weeping. Was much bloated, and felt sure that the tumor was again growing. I gave her Lil-tig.(r)"1 again, and at the end of two weeks found but little improvement possibly a slight relief mentally. At this visit she was sure the tumor was again growing, and she was confident the growth now was on the opposite side of womb. On examination this proved correct. The tumor was rapidly developing, while on the side originally affected, I could no enlargement. At this time she also complained of numbers of small warts over her upper abdomen, and on upper left chest and shoulder. Lil-tig. had evidently done all it could, and after careful comparison, I gave Calc-carb.20, three doses, two hours apart, and Placebo. In a couple of weeks she returned and mentally was much better, brighter, and more cheerful, with desire to attend to her business returning. Quite a satisfactory change, and she a supply of Placebo. The improvement continued gradually and all round. Two weeks later she felt sure that growth in tumor had ceased, and she began again to expect to be a well woman. Some time in February improvement seemed to cease, after a severe cold. By the way, disposition to take cold easily was a prominent in the beginning of this her second attack, and I gave her Calc-carb.om, one dose. This was the last active medicine she received. She has been comparatively well all the past spring,, and as she begins to " wonder whether she had a tumor at all," I regard her prospects as favorable though uncertain, but that this may prove a perennial root and thus afford me an annual branch on which to address you. To me this case has been very peculiar. No doubt could exist as to the presence of a tumor in 1890 and early part of 1891. It was so diagnosed by several gynecologists the hemorrhages, etc. And no doubt can exist that she was on the road to health if not cured prior to the shock, grief, etc. Then the sudden return, and on the opposite side of womb. I cannot account for this. It's peculiar. But one thing prevents my hoping too much from past in this case, and that is that rheumatism (muscular), from which she has suffered for years, has not been to any appreciable extent even relieved by the treatment. On the other hand, she keeps a medicine chest with remedies in low potencies with which she doses herself for cold and slight attacks, only sending for the doctor when either she or her friends get alarmed. But the drugs she took did not in any way seem to interfere with the action of the CM potency. Possibly they did with the 2c. I neglected to say that the crop of warts is disappearing rapidly. Discussion. Dr. Johnson One point Dr. Adams brought out which I think is important, namely, that remedies in lower potencies do not afiect the action of a higher potency. I have noticed it in several cases. When a patient who is under the action of a constitutional remedy has an acute attack we may give an remedy in a lower potency without affecting or the action of the higher. Dr. W. L. Morgan I have observed the same thing, that the lower potencies do not interfere with the higher. This case reminds me of one I had five years ago, a fibroid tumor. The patient had had a large one taken away nine years before, and this was still larger than the one taken away. It was so large that when it came down in the pelvis I could not get my finger in the vagina above it. It interfered with the flow of urine. It was exceedingly hard and very tender to touch. Her called for Sepia. I gave the 200th. In three months it removed the entire tumor, and it remained absent for a long time. Returning again in six months Sepialm removed it again. An old laceration of the cervix only remained, until last fall she went into a hospital and had an operation. After that came prolapse without return of tumor, for which she came to my office a few days ago. She had been wearing a pessary. I gave her Sepiacm, and have not seen her since. That was just before leaving home for this place. She was much improved two months later. |
CLINICAL CONTRIBUTION. T. D. Stow, M. D., Mexico, N. Y. Psorinumcm. Arthur D , an alumnus of Middletown College, Conn., to his home in Mexico, N. Y., to spend the holidays of'91. Soon after his return his father came to me and stated as : "Arthur is in his twenty-first year, and has been away some ten months. For the last sixty days has had a papular *eruption on his hands, forearms, between the fingers, in the and elbow flexures, with much intolerable itching, , and burning after scratching. Has much thirst for cold water, taking much at a time. Itching worse at night and when warm in bed ; sweats easily; feels very weak and grows thin ; has much anxiety regarding his condition." I sent him one dose of Psorinurndegm (Swan). At the of thirty-six hours there was marked amelioration of all the symptoms. At the end of three days no more itching or burning ; less perspiration and less debility. In a week's time his hands, wrists, and skin were free from any eruption, and he was cured. He has remained well ever since. Earle Mentor, a lad of eight years, had a papulo-vesicular ^eruption over the entire surface, but more in the flexures of joints, on hands, between fingers, on the wrists, and in the palms, where it closely resembled eczema. The itching was so intolerable that he scratched until blood flowed, after which the itching ceased and he would fall asleep. Aggravation at night on undressing, and in bed ; general perspiration at night, during sleep, but giving no relief; his face looked sallow; he was pale also; tongue coated a dirty white; he had great thirst for cold water ; odor from body offensive. I first saw him in September, '91. He then also had of the right tibia just below the tuberosity, with abscess, much tumefaction, much inflammation, and temperature 101deg. The right leg was studded with the eruption mbre thickly than any other part. The boy's temper was morose. After opening and irrigating the abscess and limb, and dressing the same, gave him two doses of Merc-sol.500, and awaited its action. Some improvement followed, but it was not satisfactory. Carefully reviewing his case, I gave him (Swan), three powders, a powder to be taken every twelve hours. Great aggravation of all his symptoms followed, but in the course of a week improvement commenced. Meantime it became necessary to cut down upon the tibia, drill into its cavity, and remove a small sequestrum. From that day the boy rapidly recovered without further medication. Myrna Fellows, aged fourteen, bright and active, had herpes on his arms, wrists, hands, between fingers, on body, legs, feet. Intolerable itching, worse when warm, and at night; skin of hands cracks and bleeds ; the skin inflames. Gave (Swan), one dose. Improvement immediately followed, and in one week he was well. Has remained so up to date. Pneumonia-vera . J. D. H , a retired lawyer, some fifty-eight years old, is addicted to inebriety. Last October he had a short but sharp attack of pneumonia. When I saw him for the first time during his attack, he had short, sharp pain in both lungs; dull, full pain in same, more in the right side, with dry, hard cough, increasing the pain ; much thirst; chilliness on stirring in bed; great anxiety, with restlessness. His head ached hard in forehead. Circumscribed flush on both cheeks rather purple flush. Preferred the dorsal decubitus. Pulse full, sharp, quick, frequent, 120 to 130 per minute. Respiration short, frequent, constricted, 30 per minute. Gave Aconite30 in water, repeating every hour. Profuse perspiration followed in the course of an hour, so that his linen and bed-sheets and one blanket were wet. Discontinued the Aeon., and gave nothing more for one day. All his symptoms gradually disappeared, leaving but little more than a blood-streaked, free, quite abundant , with great thirst for large quantities of cold water; some pain in right side when coughing and when turning in bed, for which Bry.00 was given with speedy relief. He rapidly. I gave him Aeon, not more than four times, and he had but one prescription of Bry. I report this case as more than has been seen by most any homoeopathic , but as illustrative of the effect of homoeopathic remedies, in treating pneumonia, pleurisy, etc., as compared with the slow-coach and death-dealing processes of old-school . Grippe and pneumonia were with us last winter in forms, and the mortality and wrecks of humanity were simply appalling. The case also illustrates the benefits of Homoeopathy among the dissipated and enfeebled. I had many cases of bronchitis and pneumonia some of them grave and all speedily and remain well. |
HEMORRHAGE FOLLOWING ABORTION READILY CONTROLLED BY THE INDICATED REMEDY. J. A. Tomhagen, M. D., Philadelphia, Pa. Case I. Mrs. E. H., set. twenty-four. Menses absent two months and positive she was pregnant. Has taken many drugs and teas to rid herself of the foetus. March 4th, 1889, she rode a horse about three miles, and noticed that she was flooding before she reached her destination. She was put to bed, and after several severe pains the foetus was extruded. The hemorrhage was profuse and painless and bright red. When I arrived her face was blanched, and she frequently gasped for breath. The slightest motion would cause a gush of blood, which was by a deathly sinking at the epigastrium. Ipec.200 controlled the hemorrhage at once. The woman a peculiar, indescribable sensation pass over her in a few seconds. The gushes then came at longer intervals and the fainting ceased immediately. The one dose was all-. Case II. Mrs.' F. G., set. twenty-eight. Blonde. This woman maintained that the " miscarriage " came on ; she could account for it in no way except that carrying a bucket of water caused it. She had been flooding in spells for several days, when I saw her, May 13th, 1889. Blood dark and clotted. As soon as she saw me, she began to weep, but could say nothing; moreover, she was as patient as a lamb; her mouth was parched, and yet she desired no water. The foetus of a few weeks must have been buried with the clots since I could find none. Puls.2m. In five minutes a sensation as if the whole external genitals were drawn up into the pelvis followed. (Puls.10m has produced this several times. In fact, one girl remarked that I had given her dynamite, the action was so violent.) With this sensation the hemorrhage ceased and returned only slightly in six hours. No more medicine. Case III. Mrs. J. S., set. twenty. Married a short time; got into an altercation with another of the fair sex. Both being typical brunettes, they well-nigh demolished each other. My patient tore and swore, fumed and stamped, when separated, because she was not permitted to annihilate her adversary; she retired very disconcerted, and during the night was taken with violent cramps and vomiting of bile; intense bearing-down pains and sharp, excruciating pain in the left ovarian region ; she could not lie still a moment, and the only relief was obtained from hard pressure and hot fomentation on abdomen. The hemorrhage was slight, two A. M., Coloc.3m. In twenty minutes the pains abated and hemorrhage stopped. Six a. M., very comfortable, but face as yellow as a lemon ; no more pain and carried child to full term. Remarks. The single dose of the appropriate remedy was in these cases. Some maintain that it is criminal to rely on medicine in abortion. It is criminal to do other than give the indicated remedy. The above cases I regard as typical of abortion. Am., Gels., Sabina, Apis, etc., do the work as effectually, when called for. China often removes membranes that have kept up flooding for weeks, and then the hemorrhage ceases. Pyrogen, cured several cases where symptoms of septicaemia supervened. The China and Pyrogen, cases come from the scientific doctors. Dynamics supersede mechanics. |
HYDRO-SALPINGITIS. A CASE CURED WITH GELSEMINUM. J. H. Allen, M. D., Logansport, Ind. Case. Mrs. E., aged twenty-seven, light blonde, above medium height, and weight about one hundred and forty, came to me one year ago for an examination and treatment for a large growth in the left abdominal region. Pregnancy had been diagnosed, with advice to rest as much as possible, especially during the menstrual period, which function had kept up with clock-like regularity every month. During the inter-menstrual period she suffered very little pain with exception of an dragging or bearing-down feeling in the region of the uterus. As the usual period of gestation had passed she became very anxious to know what the trouble was. After examining her case carefully I made a diagnosis of some tubular trouble, and that of cystic nature and in all probability hydro-. Though it is hard to diagnose these cases, yet by taking into consideration that the case had a gonorrhoeal history, together with the location of tumor, the consistency of the walls of the growth and by the aid of percussion and the bimanual , together with the large amount of serum that passed at the close of each menstrual period I made it pretty conculsive. The tumor was then the size of a child's head or larger, mobile and fluctuating, the os was patulous, the genital organs showed marked signs of pregnancy and in an advanced stage, morning sickness had continued all through her illness, the breasts had increased in size and were fully as large as in the eighth month. She was now suffering considerable pain in the region of the left ovary, which was probably due to pressure or distention caused by the accumulated fluid, as it was worse just before the menses and better after the profuse flow of serum that came on at the close of the menstrual period. I called in an eminent surgeon from a distant city in , who advised an operation for removal of the ovary as well as the diseased tube. I did not agree with him as to his mode of procedure, and my patient would not listen to it for a moment. I therefore concluded to try my remedies and await results. On examination of the symptomatology of her case the following symptoms were noted: A feeling of fullness and heaviness in the uterine region, spasmodic, cramp-like pains during the menses, sharp pains running from uterus to back and hips. A languid aching in back and hips a day or so before the menses, great weakness and loss of power in the lower extremities, very little pain after the menses begin ; she says that her pains resemble false labor pains, when she gets tired she has a lump in the throat which she cannot swallow. After the menses suffers with pains in back of head and spine, pains running up the back of the neck, with a feeling of in the brain, she is irritable and easily angered. There is considerable fever in the afternoons and evenings accompanied with twitching of the muscles. The menses last eight days, for the first three days they seem quite natural, but during the rest of the flow it is very light-colored and resembles serum. Gelseminum was given in the one thousandth potency, which relieved her menstrual pains, and as she continued to improve and feel better generally I did not change the prescription. In ten days after receiving the remedy the flow of serum increased to almost a pint per day for a week, when it gradually decreased and finally ceased entirely. The next menstrual period only lasted five days, she experiencing very little pain and no return of the flow of serum. In all six powders of the remedy were given during the period of two months, usually a powder was prepared in water and given every hour until she found relief when it was discontinued. Since then she has received no medicine, though it is nine months since I discharged the case. At the end of the third month all symptoms of the tumor had disappeared, and the menses resumed the normal again, and she has been in perfect health since. |
PATHOGENETIC, OR TOXIC EFFECT OF TOBACCO. S. Seward, M. D., Syracuse, N. Y. The first severe case of tobacco poisoning I ever treated was in a woman, from smoking a clay pipe. Her tongue was coated as with thick, white velvet, and had been so eight years, from a severe sickness. No red color on the tongue or its edges. She smoked almost constantly day and night. There came a crease across the middle of her tongue, as though made with the edge of a knife, and in the centre of the crease there came up an oval poiflt, which increased quite fast until it became as large as the cup of an acorn from an oak, the oval up, then it fell in and disappeared, leaving a cavity covered with a substance like cigar ashes. The tongue was gradually all eaten away into the throat. She suffered severe pain for months, emaciated, and died. The next severe case I met with and treated was a physician, who had smoked for nearly fifty years. His worst suffering was in the stomach. He had a " sinking sensation in the stomach which obliged him to lie down," which is both pathogenetic and clinical. He would suffer with the sinking sensation for several hours, then it would pass away. He was weak in body and mind. Constipation was the next most severe trouble; there was q loss of power in the colon and rectum to pass the faeces downward, one to three or four injections of warm water would not always bring a stool. He had suffered in this way for several years, becoming worse, and died. On post mortem, a malignant tumor was found back of the stomach, and attached to the spine and one kidney, which was doubtless caused by tobacco. An English workingman came to me with a swelling on bis under lip as large as half a butternut, on the place where he rested his clay pipe. I told him it was a tobacco cancer, and could not be cured. He replied, "So all the doctors say." He died in consequence of the accumulated poison of tobacco. A man with a good constitution and otherwise of good habits, except in the use of tobacco; had been in a business office for about forty years, where himself or some one else was smoking nearly all the time. His whole body suffered, he was bloated and dropsical the abdomen the most so face of an earthly-pale color; his liver was enlarged, not sensitive; the urine half albumen. Left side of head was numb, ear deaf, tongue foul, and taste bad, no appetite, quite weak. Many of these symptoms were removed by Apis the albumen from the urine and the dropsy. Of course he left off the use of tobacco. He was quite well for over four years. He then thought he would like to taste tobacco. He took a little in his mouth. It soon awoke all the old tobacco symptoms, and they could not be removed; the force of the renewed trouble was in the abdomen, and the efforts and wisdom of four physicians could not remove the very painful disease. One of our eclectic homoeopaths cut the Gordian knot by a dose of Morphine, which 6oon ended his sufferings and life. This patient, a man, smoked excessively, and was up nights, a gambler. He was paralyzed on the right side nervous ; his expression of a thought was obstructed; he could only speak the first word of the sentence he had in mind, and after a few days he could only speak the first letter of the first word. He improved under treatment, and went to business again. I cautioned him to keep clear of tobacco, not even to smell it. He felt so well be did not believe it would hurt him to smoke a cigar occasionally. He did so, and was paralyzed, and died suddenly. |
CLINICAL MEDICINE. J. A. Tomhagen, M. D., Philadelphia, Pa. Case I. Was called to see Mrs. E. P., aet. fifty-one, and mother of thirteen children. Had itch nine years ago, suppressed with ointment, and measles eight years ago. At present, life is a burden to her. Says she does not care to live, if this urinary trouble can't be cured. Burning in the feet at night; this is merely a sensation, since her husband says they are actually cold. She has a , alternately, for sweet and sour things. Lies on right side with legs drawn up ; this is the only position in which she can obtain any sleep. Chilly sensation at times. Leucorrhoea and again whitish, flowing profusely during the day. Great burning after urinating. Shooting pain in the tongue, which looks red and angry; burning down centre of tongue. Cannot eat fat meat because it brings on diarrhoea. Her menses always delayed a week, lasted six days, but were scanty, flowing in fits and starts. During the week before menses she had sour vomiting and diarrhoea; drawing up and down sensation in abdomen * hot feet and legs when walking. At present, she has frequent urination and passes only a teaspoonful at a time with great bearing down. Urine high colored. Sept. 20th, 1888. Puls.10m, six powders, one every night and morning for three days. Nov. 6th. Considerably better, but I still have the drawing in my stomach (?), and burning in my feet and legs. CM. Dec. 15th, she writes : "Am almost well, but think I had better continue taking medicine awhile longer." Remarks. This woman had been in bed for months, off and on, and utterly unable to supervise her domestic affairs. The strangury was intense, and the chief difficulty for which I was summoned. The patient, however, living twenty miles from my office, could not have me come often, so I thought it advisable to prescribe on the constitutional symptoms, trusting that the remedy selected on these, would also cure the strangury. The changeability of the symptom: the symptom she had during her menstrual epoch ; the burning sensation down centre of tongue ; the aggravations and ameliorations all pointed to Puls. One prescription was sufficient to cause the vicegerent of the soul to re-establish order out of chaos. Case II. Mrs. E. T., set. fifty-seven. Brunette. Migraine seven years. Heavy sore feeling over right eye; sleepy and languid all day ; bitter taste in morning and sick at stomach ; pain in occiput and moves forward to right supra-orbital region ; wants to go into a dark room, away from everything and ; does not want to hear nor see anything; pain in head relieved by \omiting, which is watery and bilious; yellow on base of tongue; " bowels regularno appetite during attacks; skin gets yellow when about to have an attack ; urine, high colored ; dark coffee-ground sediment in urine during ; generally feels better in cold weather ; can sit down any time of day and go to sleep ; very thirsty; photophobia of right eye during attack. These headaches last from one to seven days, beginning about eight or nine a. m. and leaving at seven p. m. Urine becomes clear as headache improves. * Oct. 5th, 1891. Sang.1600. Oct. 12th. General improvement. Last Wednesday, was giddy after dinner, and again slightly this morning, but no headache. CM. Nov. 4th. Soreness and stiffness in palate in morning. Scratching and scraping in throat. Chilly sensation ; dull in forehead. Watery discharge from nose and eyes. Dry cough worse in room. Discharge worse in room. General improvement in open air. CM. Dec. 20th. No headache till December 17th, which was slight and of same nature as old ones. Sang.Bm. Dec. 31st. " I have so much wind in stomach and only after a few mouthfuls." No appetite ; thirstless; mouth and throat dry in morning ; sensation of load in pit of stomach ; chilly ; costive; left eye waters ; tired, heavy feeling; worse from coffee; better in open air; sleeps lying on right side; feet cold ; wants head uncovered always, and thinks she takes cold that way ; urine high colored. Lyc.1400. March 2d. Was all right till last few days; some of old symptoms returning. Lyc.71m. March 20th. On the 17th inst., her right foot was very cold, while left was normal (she thought this very strange). Also had the full feeling in stomach, and a pain in left supra-orbital extending through to back of head. CM. March 30th. Reports herself well. Remarks. The second dose of Sang, produced no change. Gradually symptoms developed calling for Lyc., which finished the cure. I searched all the books to ascertain whether Lyc. followed Sang., because the symptoms so loudly called for it, but I could not find a single confirmation. |
Int J Mol Sci Int J Mol Sci ijms International Journal of Molecular Sciences 1422-0067 MDPI 10.3390/ijms24054310 ijms-24-04310 Editorial Molecular Research on Huntington's Disease Valor Luis M. Unidad de Investigacion, Hospital General Universitario Dr. Balmis, ISABIAL, 03010 Alicante, Spain; [email protected]; Tel.: +34-965-913-988 21 2 2023 3 2023 24 5 431009 2 2023 17 2 2023 (c) 2023 by the author. 2023 Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ). pmcHuntington's disease (HD) is a devastating neurodegenerative disorder caused by an aberrant expansion of CAG triplets in the HTT (Huntingtin) gene. This mutation leads to the production of a toxic peptide (mHTT) and the loss of a functional allele that is behind pleiotropic symptomatology that progressively compromises the motor, cognitive, affective and mental capabilities of patients until final decease. Apart from the nervous system impairment, the HTT protein is ubiquitously expressed and, despite not being fully acknowledged until recent times, peripheral organs (e.g., liver, pancreas, heart, spleen) and cells (e.g., myeloid and lymphoid lineages) also exhibit certain malfunction, contributing to the plethora of pathological signs and potentially providing general principles regarding the molecular pathogenesis in the disease, as reviewed by Ana I. Arroba and colleagues . Despite knowing the cause of the disease more than thirty years ago, neither a cure nor an effective treatment is available, and this is due to the complex alterations (and interactions) between multiple cellular processes. This is well exemplified in in which Hoon Ryu and collaborators provide a succinct overview of the molecular alterations provoked by the CAG expansion in the HTT gene at the level of epigenetics, vesicle trafficking and axonal transport, mitochondria and mitophagy. This review also reminds us that not only neurons but also astrocytes and oligodendocytes can be affected by the ubiquitous expression of mHTT, interfering with their roles in neuronal homeostasis and synapse transmission and exacerbating neuronal dysfunction. Meanwhile improved formulations of antisense oligonucleotides targeting HTT are still under development, it is worth exploring alternative therapeutic approaches aimed at restoring defective gene expression, mitochondrial function and autophagy or at preventing mHTT aggregation and accumulation and neuronal death, among others . Interestingly, the use of the invertebrate model can accelerate the identification of potential therapeutic targets in systematic screens, for example, by examining the effects of RNA interference assays in a C. elegans model for HD, as documented by Jeremy M. Van Raamsdonk's team. In this example, targeting genes involved in mitochondrial fission can rescue mitochondrial fragmentation in neurons and can restore movement and life span in HD worms . As a complementary approach consisting of the application of novel bioinformatics tools, deciphering and understanding the network of protein-protein interactions surrounding the scaffolding protein HTT can open new lines of research by providing modulators of HD as potential drug targets for future studies . Therapeutic administration requires the use of biomarkers to discern the real stage and rate of progression of the disease in each patient. We reviewed that HTT and its mutant form, markers of neuronal injury (e.g., NF-L), the phosphodiesterase PDE10A, the neuropeptide Y, oxidative stress markers, transcriptional deregulated genes in blood cells, inflammatory markers, genetic modifiers (polymorphisms), etc., are prominent biomarkers which suggest that their potential applicability into clinics is promising but still challenging . Genetic modifiers deserve further attention due to their special relevance in the modulation of the HD ethiopathogeny, and Jakob von Engelhardt and coworkers illustrate this fact in HD mouse strains, as they can exhibit different pathophenotypical traits, including neuronal electrophysiology properties, as a result of the still obscure interplay between HTT mutation and the genetic background . In this Special Issue, we provide some glimpses of the molecular research that is being conducted in HD but several fronts of research are simultaneously open. Despite the vast cumulated knowledge and recent advances, we still need in-depth characterizations of the mechanisms involved in this pathology, as patients are still orphans for biomarkers and therapies in their clinical management. We hope that the advent of new technologies that are increasingly accessible to worldwide researchers, fueled by current policies for data sharing and open access, will provide effective solutions in the next future. Conflicts of Interest The author declares no conflict of interest. Disclaimer/Publisher's Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. References 1. Gomez-Jaramillo L. Cano-Cano F. Gonzalez-Montelongo M.C. Campos-Caro A. Aguilar-Diosdado M. Arroba A.I. A New Perspective on Huntington's Disease: How a Neurological Disorder Influences the Peripheral Tissues Int. J. Mol. Sci. 2022 23 6089 10.3390/ijms23116089 35682773 2. Kim C. Yousefian-Jazi A. Choi S.H. Chang I. Lee J. Ryu H. Non-Cell Autonomous and Epigenetic Mechanisms of Huntington's Disease Int. J. Mol. Sci. 2021 22 12499 10.3390/ijms222212499 34830381 3. Traa A. Machiela E. Rudich P.D. Soo S.K. Senchuk M.M. Van Raamsdonk J.M. Identification of Novel Therapeutic Targets for Polyglutamine Diseases That Target Mitochondrial Fragmentation Int. J. Mol. Sci. 2021 22 13447 10.3390/ijms222413447 34948242 4. Vagiona A.C. Mier P. Petrakis S. Andrade-Navarro M.A. Analysis of Huntington's Disease Modifiers Using the Hyperbolic Mapping of the Protein Interaction Network Int. J. Mol. Sci. 2022 23 5853 10.3390/ijms23105853 35628660 5. Marti-Martinez S. Valor L.M. A Glimpse of Molecular Biomarkers in Huntington's Disease Int. J. Mol. Sci. 2022 23 5411 10.3390/ijms23105411 35628221 6. Back M.K. Kurzawa J. Ruggieri S. von Engelhardt J. C57BL/6 Background Attenuates mHTT Toxicity in the Striatum of YAC128 Mice Int. J. Mol. Sci. 2021 22 12664 10.3390/ijms222312664 34884469 |
Int J Mol Sci Int J Mol Sci ijms International Journal of Molecular Sciences 1422-0067 MDPI 10.3390/ijms24054386 ijms-24-04386 Editorial Editorial of Special Issue "Protective and Detrimental Role of Heme Oxygenase-1": 2021 Sorrenti Valeria Department of Drug and Health Sciences, Biochemistry Section, University of Catania, 95125 Catania, Italy; [email protected]; Tel.: +39-0947384115 23 2 2023 3 2023 24 5 438624 11 2022 09 1 2023 (c) 2023 by the author. 2023 Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ). This research received no external funding. pmcThe Special Issue "Protective and detrimental role of heme oxygenase-1"(2021), in the International Journal of Molecular Sciences, includes original research papers and reviews aiming to understand the protective or detrimental role of HO-1 and the signaling pathway involved. Heme oxygenase (HO) is the enzyme that catalyzes heme degradation with the simultaneous release of carbon monoxide (CO), ferrous iron (Fe2+), and biliverdin, which is then reduced to bilirubin. Two main isoforms of heme oxygenase are present in humans: HO-1 (inducible) and HO-2 (constitutive). HO-1 may be induced in many organs and tissues in various stress-related conditions in order to obtain a cytoprotective effect. Due to its cytoprotective effects, HO-1 upregulation may be useful in many stress-related diseases. However, HO-1 overexpression may contribute to tissue injury under certain unfavorable conditions, such as neurodegeneration and carcinogenesis. Therefore, original research papers and reviews aiming to identify natural molecules or new synthetic compounds able to modulate HO-1 activity/expression will assist the use of HO-1 as a potential therapeutic target for the amelioration of various diseases. The modulation of heme content by heme oxygenase activity can affect other heme proteins, such as Indoleamine 2,3-dioxygenase 1 (IDO1), a heme enzyme considered attractive for its significant function in cancer immunotherapy. Yan et al. performed a systematic study of analogs of SAR405838, a spiro-oxindole skeleton compound able to selectively inhibit murine double minute 2 (MDM2) protein, and also evaluated its capacity to inhibit IDO1 activity. The authors, by screening all synthesized compounds with a structural similarity to tryptophan, demonstrated that one synthesized compound exhibited the highest IDO1 inhibitory activity and was found to have the most effective inhibition of IDO1 in MCF-7 cancer cells without toxic effects. Therefore, this study provides valuable insights into the screening of more potent IDO1 inhibitors for cancer immunotherapy . Recently, particular research interest has been focused on identifying the role played by heme oxygenase in the ferroptosis process. The term ferroptosis refers to a peculiar type of programmed cell death (PCD) mainly characterized by extensive iron-dependent lipid peroxidation. Ferroptosis has been suggested as a potential new strategy for the treatment of several cancers, including breast cancer (BC). In particular, among the BC subtypes, triple-negative breast cancer (TNBC) is considered the most aggressive, and conventional drugs fail to provide long-term efficacy. In this context, the purpose of Consoli et al.'s study was to investigate the mechanism of ferroptosis in breast cancer cell lines and reveal the significance of heme oxygenase (HO) modulation in the process, providing new biochemical approaches. HO's effect on BC was evaluated using MTT tests, gene silencing, Western blot analysis, and measurement of reactive oxygen species (ROS), glutathione (GSH) and lipid hydroperoxide (LOOH) levels. In order to assess the implications of HO effects, different approaches were exploited, using two distinct HO-1 inducers (hemin and curcumin), a well-known HO inhibitor (SnMP) and a selective HO-2 inhibitor. The data obtained showed HO's contribution to the onset of ferroptosis; in particular, HO-1 induction seemed to accelerate the process. Moreover, the results obtained by Consoli et al. suggest a potential role of HO-2 in erastin-induced ferroptosis. In view of the above, HO modulation in ferroptosis can offer a novel approach for breast cancer treatment . It has been reported that HO-1 induction may ameliorate various inflammatory diseases. However, few studies have investigated the role of HO-1 in cholestatic liver diseases, which can progress to end-stage liver disease and reduce patients' quality of life. To this end, Kim et al. examined whether pharmacological induction of HO-1 by cobalt protoporphyrin (CoPP) ameliorates cholestatic liver injury. A murine model of 3,5-diethoxycarbonyl-1,4-dihydrocollidine (DDC) diet feeding was used. The administration of CoPP ameliorated liver damage and cholestasis with HO-1 upregulation in DDC-diet-fed mice. Induction of HO-1 by CoPP suppressed the DDC-diet-induced oxidative stress and hepatocyte apoptosis. In addition, CoPP attenuated cytokine production and inflammatory cell infiltration. Furthermore, the deposition of the extracellular matrix and expression of fibrosis-related genes after DDC feeding were also decreased by CoPP. HO-1 induction decreased the number of myofibroblasts and inhibited the transforming growth factor-b pathway. Altogether, these data suggest that the pharmacological induction of HO-1 ameliorates cholestatic liver disease by suppressing oxidative stress, hepatocyte apoptosis, and inflammation . Choi et al.'s review discusses the dual roles of HO-1 and its metabolites in various neurovascular diseases, including age-related macular degeneration, ischemia-reperfusion injury, traumatic brain injury, Gilbert's syndrome, and AD. Heme oxygenase (HO) has both beneficial and detrimental effects via its metabolites, including carbon monoxide (CO), biliverdin or bilirubin, and ferrous iron. In brains injured by trauma, ischemia reperfusion, or Alzheimer's disease (AD), the long-term expression of HO-1 can be detected, which can lead to cytotoxic ferroptosis via iron accumulation. In contrast, the transient induction of HO-1 in the peri-injured region may have regenerative potential (e.g., angiogenesis, neurogenesis, and mitochondrial biogenesis) and neurovascular protective effects through the CO-mediated signaling pathway, the antioxidant properties of bilirubin, and iron-mediated ferritin synthesis . Today, natural products play increasingly important roles, especially in early drug development . Natural molecules or new synthetic compounds may be able to modulate HO-1 activity. Natural molecules can be extracted from vegetable matrices or can be obtained by the chemical synthesis of different enzymes. Deng et al.'s review summarizes the most important enzymes, such as flavin adenine dinucleotide (FAD)-dependent monooxygenases (FMOs), which are involved in the synthesis of many natural products. The authors introduce the mechanisms for different FMOs and summarize the difference between FMOs and cytochrome P450 (CYP450) mono-oxygenases, emphasizing the advantages of FMOs and their specificity for substrates. Finally, the authors present examples of FMO-catalyzed synthesis of natural products . Overall, the contributions published in this Special Issue highlight the protective and detrimental role of HO-1 and the signaling pathway involved. Natural molecules or new synthetic compounds able to modulate HO-1 activity/expression may represent a therapeutic strategy against various diseases. In particular, HO-1 may represent a potential target for the amelioration of inflammatory diseases or cancer. Conflicts of Interest The authors declare no conflict of interest. Disclaimer/Publisher's Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. References 1. Yan D. Xu J. Wang X. Zhang J. Zhao G. Lin Y. Tan X. Spiro-oxindole skeleton compounds are efficient inhibitors for indoleamine 2,3-dioxygenase 1: An attractive target for tumor immunotherapy Int. J. Mol. Sci. 2022 23 4668 10.3390/ijms23094668 35563059 2. Consoli V. Sorrenti V. Pittala V. Greish K. D'Amico A.G. Romeo G. Intagliata S. Salerno L. Heme oxygenase modulation drives ferroptosis in TNBC cells Int. J. Mol. Sci. 2022 23 5709 10.3390/ijms23105709 35628518 3. Kim J.Y. Choi J. Leem J. Song J.E. Heme Oxygenase-1 induction by cobalt protoporphyrin ameliorates cholestatic liver disease in a xenobiotic-induced murine model Int. J. Mol. Sci. 2021 22 8253 10.3390/ijms22158253 34361019 4. Choi J.K. Kim J.M. Beneficial and detrimental roles of heme oxygenase-1 in the neurovascular system Int. J. Mol. Sci. 2022 23 7041 10.3390/ijms23137041 35806040 5. De Gonzalo G. Mihovilovic M.D. Fraaije M.W. Recent developments in the application of Baeyer-Villiger monooxygenases as biocatalysts Chembiochem 2010 11 2208 2231 10.1002/cbic.201000395 20936617 6. Weatherall M. Search of a Cure: A History of Pharmaceutical Discovery Oxford University Press Oxford, UK 1992 Volume 24 493 504 7. Deng J. Zhou Q. Wu Y. Chen X. Zhong F. Properties and mechanisms of flavin-dependent monooxygenases and their applications in natural product synthesis Int. J. Mol. Sci. 2022 23 2622 10.3390/ijms23052622 35269764 |
of the research on dynamic monitoring of TRHR grassland. Study Area Dataset Source (Periods) Main Method Results Reference Grassland Monitoring and Simulation Based on NDVI TRHR 1. GIMMS 3g. v1 (1982-2015) 2. Institute of Remote Sensing and Digital Earth, Chinese Academy of Sciences (2000-2015) 3. Landsat NDVI date (1982-2015) - 1982-2015, NDVI increased slightly; 2000-2015, >70% NDVI increase Bai, Guo, Degen, Ahmad, Wang, Zhang, Li, Ma, Huang, Zeng, Qi, Long and Shang TRHR MODIS VI (MOD13Q1) (2001-2016) - Increased NDVI in most grasslands Ge, Meng, Liang, Feng, Gao, Yang, Huang and Xie TRHR Pathfinder database (Pathfinder Data Sets) of U.S. Earth Resources Observation Systems Data Center (1982-2006) - 1994-2004, NDVI increased; 2004-2006, especially substantial Qian, Fu and Pan TRHR Ten-day MODND1T NDVI product DBEST Vegetation generally recovered, although the progressive fluctuations of trend observed Shen, An, Feng, Ye, Zhu and Li TRHR GIMMS 3g. v1 (1982-2015) - No remarkable change in NDVI, and it increased in the west and decreased in the east Gillespie, Madson, Cusack and Xue TRHR GIMMS AVHRR NDVI datasets (2000-2013) - From 2000 to 2013, NDVI decreased slightly. Projected to increase by 2100 under RCP4.5 climate change scenario Zheng, Han, Huang, Fassnacht, Xie, Lv and Chen TRHR MODIS (MOD09GA) (2003-2014) - NDVI gradually increases from northwest to southeast Liang, Yang, Feng, Liu, Zhang, Huang and Xie Monitoring and Modeling of Grassland Cover and Grassland Aboveground Biomass TRHR MODIS (2001-2016), the measured grassland cover data collected by unmanned aerial vehicle (2014-2016) SVM The average annual maximum grassland coverage increases from west to east and from north to south; 59.9% annual maximum grassland coverage increases Ge, Meng, Liang, Feng, Gao, Yang, Huang and Xie Qumalai, Gande, Henan, Xinghai, Tongde Fields observation (1994-2006) - Grass height increased from 1994 to 2006; dry biomass of Qumalai, Gande, Xinghai increased, and Henan decreased, and all four sites increased substantially from 2004 to 2006; Gande, Qumalai grassland coverage increased, Xinghai changed slightiy, and Henan decreased Qian, Fu and Pan Zhiduo, Qumalai HJ-1A/HIS and Landsat 8 (16 September 2013), Fields observation (August 2017) RF, SVM Native plant coverage was generally higher than noxious weeds Ai, An, Chen and Huang TRHR Fields Observation (2003-2014), MODIS (MOD09GA) (2001-2016) BP-ANN The largest AGB appeared in the easternmost and north-central regions; 2001-2006, TRHR had more AGB increasing areas than decreasing (44.4% and 29.2%, respectively), and 26.4% stable areas. AGB in the far east (Zeku, Henan) and far southwest (part of Golmud and Yushu) increased substantially (16.5%), while AGB in the northwest of Zhiduo County decreased significantly (3.8%) Yang, Feng, Liang, Liu, Zhang and Xie TRHR MODIS (MOD09GA) (2003-2014), Field Observation (2003-2014) Multifactor regression analysis AG-AGB gradually increases from northwest to southeast Liang, Yang, Feng, Liu, Zhang, Huang and Xie Headwater of the Yellow River MODIS (MOD13Q1) (2001-2020), Field Observation (2005, 5006, 2015, 2018, and 2020) RF Headwater of the Yellow River AGB decreased from southeast to northwest; 2001-2020, 69.51% area increased, 30.14% area decreased Tang, Zhao and Lin TRHR Field Observation (2005-2016), MOD13Q1 (V006, NDVI and EVI included) (2000-2018) RF, Cubist, ANN, SVM, and Bayesian model averaging (BMA) AGB was higher in the southeast and lower in the northwest; 2000-2018, the interannual variation trend of grassland in most areas was not evident Zeng, Ren, He, Zhang, Li and Niu Note: TRHR: Three-Rivers Headwaters Region, NDVI: normalized difference vegetation index, AG-AGB: aboveground biomass of alpine grassland, HYR: Headwater of the Yellow River, DBEST: Detecting Breakpoints and Estimating Segments in Trend. Disclaimer/Publisher's Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
Front Endocrinol (Lausanne) Front Endocrinol (Lausanne) Front. Endocrinol. Frontiers in Endocrinology 1664-2392 Frontiers Media S.A. 10.3389/fendo.2023.1154170 Endocrinology Correction Corrigendum: Genetically predicted C-reactive protein mediates the association between rheumatoid arthritis and atlantoaxial subluxation Yuan Jiaqin 1 2 + Xiong Xiaoqin 3 + Zhang Bin 4 + Feng Qingyuan 5 Zhang Jinglin 6 Wang Wenting 7 * Tang Jia 8 * 1 Department of Orthopedics, The Second People's Hospital of Yibin, Yibin, Sichuan, China 2 Department of Orthopedics, Yibin Hospital, West China Hospital of Sichuan University, Yibin, Sichuan, China 3 Department of Pediatrics, The Affiliated Hospital of Southwest Medical University, Luzhou, China 4 Rheumatism Immunity Branch, Weifang People's Hospital, Weifang, Shandong, China 5 Wuxi School of Medicine, Jiangnan University, Wuxi, Jiangsu, China 6 Department of Occupational Disease, Yibin Center for Disease Control and Prevention, Yibin, Sichuan, China 7 Department of Anesthesiology, The Second Affiliated Hospital of Hainan Medical University, Haikou, China 8 Department of Pediatrics, Daping Hospital, Army Medical University, Chongqing, China Approved by: Frontiers Editorial Office, Frontiers Media SA, Switzerland *Correspondence: Jia Tang, [email protected]; Wenting Wang, [email protected] +These authors have contributed equally to this work This article was submitted to Bone Research, a section of the journal Frontiers in Endocrinology 23 2 2023 2023 23 2 2023 14 115417030 1 2023 09 2 2023 Copyright (c) 2023 Yuan, Xiong, Zhang, Feng, Zhang, Wang and Tang 2023 Yuan, Xiong, Zhang, Feng, Zhang, Wang and Tang This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. A Corrigendum on Genetically predicted C-reactive protein mediates the association between rheumatoid arthritis and atlantoaxial subluxation by Yuan J, Xiong X, Zhang B, Feng Q, Zhang J, Wang W and Tang J (2022) Front. Endocrinol. 13:1054206. doi: 10.3389/fendo.2022.1054206 Mendelian randomization rheumatoid arthritis C-reactive protein atlantoaxial subluxation upper cervical instability pmc Incorrect Author Name In the published article, an author name was incorrectly written as Wengting Wang. The correct spelling is Wenting Wang. The authors apologize for this error and state that this does not change the scientific conclusions of the article in any way. The original article has been updated. Publisher's note All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher. |
Front Endocrinol (Lausanne) Front Endocrinol (Lausanne) Front. Endocrinol. Frontiers in Endocrinology 1664-2392 Frontiers Media S.A. 10.3389/fendo.2023.1163996 Endocrinology Editorial Editorial: Parathyroid atypical adenomas and carcinoma: An update on clinical management Gianotti Laura 1 * Cetani Filomena 2 1 Division of Endocrinology, Department Internal Medicine, S.Croce & Carle Hopsital, Cuneo, Italy 2 Unit of Endocrinology, University Hospital of Pisa, Pisa, Italy Edited and Reviewed by: Terry Francis Davies, Icahn School of Medicine at Mount Sinai, United States *Correspondence: Laura Gianotti, [email protected] This article was submitted to Thyroid Endocrinology, a section of the journal Frontiers in Endocrinology 24 2 2023 2023 14 116399611 2 2023 20 2 2023 Copyright (c) 2023 Gianotti and Cetani 2023 Gianotti and Cetani This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. Editorial on the Research Topic Parathyroid atypical adenomas and carcinoma: An update on clinical management parathyroid carcinoma atypical adenoma long non-coding RNAs CDC73 mutations ectopic localization pmcAtypical parathyroid adenomas and parathyroid carcinomas are rare among parathyroid tumors that commonly are benign. They share some histological features namely trabecular growth pattern, fibrous bands, and cellular atypia but parathyroid carcinoma shows unequivocal features of neoplastic infiltration of adjacent tissues, lympho-vascular invasion, or perineural invasion (1, 2). Atypical parathyroid adenomas represent a challenge for the differential diagnosis with parathyroid carcinomas (2). Recently, the new classification of the 2022 WHO Classification of Parathyroid Tumors no longer endorses the use of "atypical parathyroid adenoma". This entity has now been labeled as "atypical parathyroid tumor" to reflect a parathyroid neoplasm of uncertain malignant potential (3). The prognosis of patients with parathyroid carcinoma mainly depends on early detection and a radical surgical treatment. A strict and continued follow-up is mandatory to detect relapse or metastasis (1, 3). The diagnosis of parathyroid carcinoma is quite difficult due to the lack of reliable clinical diagnostic criteria, and in most cases is made postoperatively at histological examination (1). The clinical manifestations are primarily due to the excessive secretion of PTH by the tumor rather than spread to local or distant organs. Over the past few decades there has been no significant trend toward detecting the disease at an earlier stage, with no significant change in patient survival. No specific guidelines addressed to the clinical management of patients with parathyroid carcinomas are present in literature. The Research Topic on Parathyroid Atypical Adenomas and Carcinoma has given attention to these aspects and underlines the need of more studies in parathyroid tumor research. Accordingly, the interesting application of the bibliometric analysis by a machine learning-based method in primary hyperparathyroidism (PHPT) proposed by Zhang et al. showed that the annual scientific publications on parathyroid tumors have scarcely changed during the last two decades. On the other hand, some novel aspects on the molecular profile and genetics of parathyroid tumours are emerging and new evidence from imaging studies or medical treatment and surgical techniques have also appeared in recent years. In the Research topic an extensive review by Marini et al. summarized the genetic and molecular pathways of parathyroid carcinogenesis. The Authors focused their attention on the germline heterozygote inactivating mutations of the CDC73 tumor suppressor gene that accounts for about 50-75% of familial cases; over 75% of sporadic parathyroid carcinomas harbor biallelic somatic inactivation/loss of CDC73 and one-third of them are germline (1). Other novel gene mutations, alterations of the PI3K/AKT/mTOR signaling pathway as well as modifications of microRNA expression profile and gene promoter methylation pattern have been detected in parathyroid carcinoma (4). The role of Long non-coding RNAs (lncRNAs) as prognostic and diagnostic biomarkers in parathyroid cancer has also been explored by Morotti et al. suggesting that human parathyroid tumors are characterized by a different lncRNAs signature, with the lncRNA BC200/BCYRN1 representing a candidate biomarker for parathyroid carcinoma and its possible use in the post-operative setting for patient's follow-up. Clinical aspects and new therapeutical approaches of parathyroid carcinomas have been extensively revised by Zelano et al. that reported a life-threatening case of parathyroid carcinoma, associated with several systemic manifestations. Furthermore, some clinical challenge due to ectopic localization of parathyroid tumours has been raised, as in the paper by Validazeh et al. in whom the first case of parathyroid adenoma in the lung has been reported and successfully resected with video-assisted thoracoscopic surgery. In the setting of parathyroid tumors, atypical parathyroid adenomas are considered a distinct clinical entity often associated with more severe form of the disease. Accordingly, Bhan et al. presented five cases of PHPT with osteitis fibrosa cystica, an uncommon manifestation of contemporary PHPT associated with larger parathyroid adenomas. Lastly, it is worth mentioning the contribute of Tzikos et al. on the evaluation of quality of life (QoL) in patients with PHPT. Through the Pasieka's parathyroid assessment of symptoms Questionnaire (PAS-Q) and the validation of this tool in Greek speaking population, they applied PAS-Q - a self-administered questionnaire, which was developed in Canada specifically to assess the symptoms of PHPT and the impact on patients' lives. PAS-Q may be considered a useful method to evaluate PHPT patients' QoL and should be encouraged for dissemination in European and Eastern countries. In conclusion, new aspects are emerging on the pathogenesis and clinical aspects of parathyroid tumors. More attention needs to be given to the parathyroid disease including molecular and genetic aspects, the disease expression, and the influence on the QoL of the patients. All these aspects appear to be very important to optimize the diagnostic workout and individualize the therapeutic strategy of the patients. Author contributions LG and FC equally contributed to conceptualization and writing the manuscript. All authors contributed to the article and approved the submitted version. Conflict of interest The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Publisher's note All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher. References 1 Cetani F Pardi E Marcocci C . Parathyroid carcinoma. Front Horm Res (2019) 51 :63-76. doi: 10.1159/000491039 30641523 2 Cetani F Marcocci C Torregrossa L Pardi E . Atypical parathyroid adenomas: challenging lesions in the differential diagnosis of endocrine tumors. Endocr Relat Cancer (2019) 26 (7 ):R441-64. doi: 10.1530/ERC-19-0135 3 Erickson LA Mete O Juhlin CC Perren A Gill AJ . Overview of the 2022 WHO classification of parathyroid tumors. Endocr Pathol (2022) 33 (1 ):64-89. doi: 10.1007/s12022-022-09709-1 35175514 4 Pandya C Uzilov AV Bellizzi J Lau CY Moe AS Strahl M . Genomic profiling reveals mutational landscape in parathyroid carcinomas. JCI Insight (2017) 2 (6 ):e92061. doi: 10.1172/jci.insight.92061 28352668 |
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