Chyle leak following total colectomy for ulcerative colitis: a case report and review of the literature.

Chyle leak is a rare complication in colorectal surgery. It occurs due to disruption of the lymphatic drainage network in the abdomen or retroperitoneum. We describe the first reported case of chyle leak following total colectomy for inflammatory bowel disease. Our patient underwent total colectomy for severe ulcerative colitis not responsive to medical treatment. Four days postoperatively, a milky fluid was noted in the drainage bag. Analysis of the fluid confirmed chyle. The patient remained well and was successfully managed conservatively with a fat-free elemental diet and was discharged from hospital on day 12 postoperatively. A review of the literature suggests that conservative management with dietary modification is a common and effective management strategy; however, medical and surgical options exist for refractory cases.

The haptoglobin beta subunit sequesters HMGB1 toxicity in sterile and infectious inflammation.

BACKGROUND: Extra-corpuscular haemoglobin is an endogenous factor enhancing inflammatory tissue damage, a process counteracted by the haemoglobin-binding plasma protein haptoglobin composed of alpha and beta subunits connected by disulfide bridges. Recent studies established that haptoglobin also binds and sequesters another pro-inflammatory mediator, HMGB1, via triggering CD163 receptor-mediated anti-inflammatory responses involving heme oxygenase-1 expression and IL-10 release. The molecular mechanism underlying haptoglobin-HMGB1 interaction remains poorly elucidated. METHODS: Haptoglobin ß subunits were tested for HMGB1-binding properties, as well as efficacy in animal models of sterile liver injury (induced by intraperitoneal acetaminophen administration) or infectious peritonitis (induced by cecal ligation and puncture, CLP, surgery) using wild-type (C57BL/6) or haptoglobin gene-deficient mice. RESULTS: Structural-functional analysis demonstrated that the haptoglobin ß subunit recapitulates the HMGB1-binding properties of full-length haptoglobin. Similar to HMGB1-haptoglobin complexes, the HMGB1-haptoglobin ß complexes also elicited anti-inflammatory effects via CD163-mediated IL-10 release and heme oxygenase-1 expression. Treatment with haptoglobin ß protein conferred significant protection in mouse models of polymicrobial sepsis as well as acetaminophen-induced liver injury, two HMGB1-dependent inflammatory conditions. CONCLUSIONS: Haptoglobin ß protein offers a novel therapeutic approach to fight against various inflammatory diseases caused by excessive HMGB1 release.

Novel strategies for targeting innate immune responses to influenza.

We previously reported that TLR4(-/-) mice are refractory to mouse-adapted A/PR/8/34 (PR8) influenza-induced lethality and that therapeutic administration of the TLR4 antagonist Eritoran blocked PR8-induced lethality and acute lung injury (ALI) when given starting 2 days post infection. Herein we extend these findings: anti-TLR4- or -TLR2-specific IgG therapy also conferred significant protection of wild-type (WT) mice from lethal PR8 infection. If treatment is initiated 3 h before PR8 infection and continued daily for 4 days, Eritoran failed to protect WT and TLR4(-/-) mice, implying that Eritoran must block a virus-induced, non-TLR4 signal that is required for protection. Mechanistically, we determined that (i) Eritoran blocks high-mobility group B1 (HMGB1)-mediated, TLR4-dependent signaling in vitro and circulating HMGB1 in vivo, and an HMGB1 inhibitor protects against PR8; (ii) Eritoran inhibits pulmonary lung edema associated with ALI; (iii) interleukin (IL)-1ß contributes significantly to PR8-induced lethality, as evidenced by partial protection by IL-1 receptor antagonist (IL-1Ra) therapy. Synergistic protection against PR8-induced lethality was achieved when Eritoran and the antiviral drug oseltamivir were administered starting 4 days post infection. Eritoran treatment does not prevent development of an adaptive immune response to subsequent PR8 challenge. Overall, our data support the potential of a host-targeted therapeutic approach to influenza infection.

A review of the effectiveness of stress management skills training on academic vitality and psychological well-being of college students.

Objective: Carrying out the appropriate psychological interventions to improve vitality and mental well-being is critical. The study was carried out to review the effectiveness of stress management training on the academic life and mental well-being of the students of Shahed University. Methodology: The method used was quasi-experimental with a pretest-posttest plan and control group. Therefore, a total of 40 students of Shahed University of Tehran were selected by a convenience sampling method and were organized into two groups: experimental and control group. Both groups were pretested by using an academic vitality inventory and an 84-question psychological well-being inventory. Then, the experimental group received stress management skills training for ten sessions, and the control group did not receive any intervention. Next, both groups were post-tested, and the data were analyzed with SPSS-21 software by using descriptive and inferential statistical methods. Findings: The findings showed that the stress management skills training significantly contributed to promoting the academic vitality and psychological well-being of students (p < 0.001). Conclusions: It was concluded from this research that teaching the methods for dealing with stress was an effective strategy to help students exposed to high stress and pressure, and this was due to its high efficiency, especially when it was held in groups, had a small cost, and it was accepted by the individuals.

Pharmacological inhibition of MIF interferes with trophoblast cell migration and invasiveness.

INTRODUCTION: Macrophage migration inhibitory factor (MIF) is expressed by villous and extravillous cytotrophoblast. This study was aimed to investigate functional relevance of MIF for human trophoblast. METHODS: MIF mRNA and protein were documented in cytotrophoblast (CT) and extravillous trophoblast cell line HTR-8/SVneo by RT-PCR, Western blot (WB), and immunocytochemistry. Recombinant human MIF (rhMIF), or its specific inhibitor (S,R)-3-(4-hydroxyphenyl)-4,5-dihydro-5-isoxazole acetic acid methyl ester (ISO-1) were used in Wound healing migration and Matrigel invasion tests. Potential effectors, integrin subunits and matrix metalloproteinases (MMP) were studied using WB and gelatin zymography, respectively. RESULTS: Blocking endogenous MIF by ISO-1 decreased HTR-8/SVneo cell migration dose dependently, most significantly with 200 µg/ml to 65% of control. Supplementation with rhMIF induced a significant stimulation to 129% of control with 200 ng/ml. In CT cell invasion test, ISO-1 at 200 µg/ml reduced invasion to 59% of control, while rhMIF (200 ng/ml) induced stimulation to 159% of control. In HTR-8/SVneo cells, invasion was significantly inhibited by ISO-1 to 40%, and increased to 150% of control by rhMIF (200 ng/ml). Integrin α1 was reduced by ISO-1 in both cell types, while integrins α5 and ß1 were not changed. Addition of rhMIF increased integrin α1. In the presence of ISO-1, levels of MMP-2 and MMP-9 were reduced in CT and HTR-8/SVneo, while rhMIF stimulated MMP-2 in CT and MMP-9 in HTR-8/SVneo cells. CONCLUSION: Reported findings provide the first insight into the cellular effects of MIF in human trophoblast, which acts to promote cell migration and invasion.

Dietary behaviours and dental fluorosis among Gaza Strip children.

A high prevalence of dental fluorosis has been identified among children in the Gaza Strip. This study aimed to determine the history of breastfeeding and dietary behaviours among children in the Gaza Strip and to examine potential associations with the prevalence and severity of dental fluorosis. A cross-sectional study recruited a stratified cluster random sample of 350 children aged 12-18 years and their mothers. Data about dietary behaviours in the first 7 years of life were collected by interview questionnaire. Dental fluorosis was determined using the Thyllstrup-Fejerskov index. A majority of children were breastfed exclusively in the first 6 months (82.9%) but 98.1% were given tea in the first year of life. The prevalence of dental fluorosis was 78.0%. Both intake of animal proteins and plant proteins were negatively associated with the prevalence and severity of dental fluorosis. Further studies to investigate fluoride intake is required to plan preventive interventions.

Dietary behaviours and dental fluorosis among Gaza Strip children

A high prevalence of dental fluorosis has been identified among children in the Gaza Strip. This study aimed to determine the history of breastfeeding and dietary behaviours among children in the Gaza Strip and to examine potential associations with the prevalence and severity of dental fluorosis. A cross-sectional study recruited a stratified cluster random sample of 350 children aged 12-18 years and their mothers. Data about dietary behaviours in the first 7 years of life were collected by interview questionnaire. Dental fluorosis was determined using the Thyllstrup-Fejerskov index. A majority of children were breastfed exclusively in the first 6 months [82.9%] but 98.1% were given tea in the first year of life. The prevalence of dental fluorosis was 78.0%. Both intake of animal proteins and plant proteins were negatively associated with the prevalence and severity of dental fluorosis. Further studies to investigate fluoride intake is required to plan preventive interventions

Appendicular abscess with appendicolith in a Spigelian hernia masquerading caecal volvulus-A case report.

INTRODUCTION: Spigelian hernias are rare hernias of the anterior abdominal wall named after Adrian van den Spiegel, the anatomist who first described them in the 16th century. They represent around 2% of all hernias. PRESENTATION OF CASE: We present an 83-year-old female with one week history of a painful right iliac fossa swelling, her examination revealed a tender lump with no cough impulse and non-reducible and her computed tomography (CT) scan showed a mass anterior to ileocaecal valve suggestive of a caecal volvulus. Intra-operative the finding was a Spigelian hernia containing an appendicular abscess and an appendicolith. DISCUSSION: The diagnosis of Spigelian hernias represents a challenge for the surgeons principally due to their rarity but also due to their anatomy and the variety of their contents. Searching the literature we found many different intra-abdominal structures presenting within a Spigelian hernia but we did not encounter a case similar to this. CONCLUSION: Clinicians need to be aware of these hernias when dealing with lower abdominal swellings and have a high index of suspicion even in the presence of negative clinical and CT findings.

Diet, nutritional status and school performance among adolescents in Gaza Strip.

The associations between dietary intake, nutritional status and school performance among 932 adolescents aged 12-15 years were examined in a cross-sectional survey in 2002 in north Gaza Strip. School performance was obtained from school records and height and weight were measured for body mass index (BMI). Self-administered questionnaires included sociodemographic characteristics and food frequency intakes. Adolescents consuming fruit and vegetables more than 3 times per week were more likely to have good school performance (72.6% versus 59.9%). When adjusting for sociodemographic variables and BMI, fruit and vegetables intake was positively associated with school performance (OR = 1.61, 95% CI: 1.11-2.32) and stunting was negatively associated (OR = 0.53, 95% CI: 0.31-0.90). The findings support a broader implementation of school nutrition programmes.

Moving towards a cure: blocking pathogenic antibodies in systemic lupus erythematosus.

Systemic lupus erythematosus (SLE) is characterized by the presence of autoantibodies that can mediate tissue damage in multiple organs. The underlying aetiology of SLE autoantibodies remains unknown, and treatments aimed at eliminating B cells, or limiting their function, have demonstrated limited therapeutic benefit. Thus, the current therapies for SLE are based on the concept of nonspecific immunosuppression and consist of nonsteroidal anti-inflammatory drugs (NSAIDS), corticosteroids, anti-malarials and cytotoxic drugs, all of which have serious adverse side effects including organ damage. The major auto-specificity in SLE is double-stranded (ds) DNA. Many anti-dsDNA antibodies cross-react with non-DNA antigens that may be the direct targets for their pathogenic activity. Studying anti-dsDNA antibodies present in SLE patients and in animal models of lupus, we have identified a subset of anti-dsDNA antibodies which is pathogenic in the brain as well as in the kidney. We have recently demonstrated that specific peptides, or small molecules, can protect target organs from antibody-mediated damage. Thus, it might be possible to treat the aspects of autoimmune disease without inducing major immunosuppression and ensuing infectious complications.

Diet, nutritional status and school performance t among adolescents in Gaza Strip

The associations between dietary intake, nutritional status and school performance among 932 adolescents aged 12-15 years were examined in a cross-sectional survey in 2002 in north Gaza Strip. School performance was obtained from school records and height and weight were measured for body mass index [BMI]. Self-administered questionnaires included sociodemographic characteristics and food frequency intakes. Adolescents consuming fruit and vegetables more than 3 times per week were more likely to have good school performance [72.6% versus 59.9%]. When adjusting for sociodemographic variables and BMI, fruit and vegetables intake was positively associated with school performance [OR = 1.61, 95% Cl: 1.11-2.32] and stunting was negatively associated [OR = 0.53, 95% Cl: 0.31-0.90]. The findings support a broader implementation of school nutrition programmes

Biological reconstruction after resection of bone tumours around the knee: long-term follow-up.

We reviewed 25 patients who had undergone resection of a primary bone sarcoma which extended to within 5 cm of the knee with reconstruction by a combination of a free vascularised fibular graft and a massive allograft bone shell. The distal femur was affected in four patients and the proximal tibia in 21. Their mean age at the time of operation was 19.7 years (5 to 52) and the mean follow-up period 140 months (28 to 213). Three vascularised transfers failed. The mean time to union of the fibula was 5.6 months (3 to 10) and of the allograft 19.6 months (10 to 34). Full weight-bearing was allowed at a mean of 21.4 months (14 to 36). The mean functional score at final follow-up was 27.4 (18 to 30) using a modified 30-point Musculoskeletal Tumour Society rating system. The overall limb-salvage rate was 88%. The results of our study suggest that the combined use of a vascularised fibular graft and allograft is of value as a limb-salvage procedure for intercalary reconstruction after resection of bone tumours around the knee, especially in skeletally immature patients.

Hyperamylasaemia in ureteric colic.

Hyperamylasaemia is classically associated with acute pancreatitis. Hyperamylasaemia may be associated with many other clinical conditions. However, ureteric colic has never been reported to cause hyperamylasaemia. We describe a 47-year-old woman who presented with an atypical history of left ureteric colic. Radiological investigations confirmed an upper ureteric stone with urinary extravasation. At presentation, the serum amylase was elevated but normalised after 24 h. In conclusion, ureteric colic may cause hyperamylasaemia and this is likely a result of pancreatic irritation due to urinary extravasation. Patients presenting with ureteric colic and elevated concentrations of serum amylase should raise the clinical suspicion of urinary extravasation.

Change in the z-axis location of the sternal notch in an arms-raised vs arms-down position on CT examinations.

The aim of the study was to determine whether the sternal notch changes in its z-axis position in the arms raised vs arms down position on CT scans. A retrospective study was made of 132 consecutive CT scans of the neck and chest. We recorded the table position of the sternal notch and the most inferior slice through the thyroid gland on both scans, and the table position on the chest CT where the configuration of the head and neck vessels most closely corresponded to their configuration on the sternal notch slice of the neck CT. The sternal notch moved up an average of 8.4 mm (p<0.0001) when the arms were raised. In 44 cases (33.3%), the sternal notch moved up by > or =10 mm. In 6% of cases, the sternal notch moved upwards > or =20 mm. There was a slightly greater upward movement of the sternum in males of 2.57 mm (p = 0.0208). Mean upward motion of the sternal notch relative to the vessels was 7.74 mm (p<0.0001). Mean upward motion of the sternal notch relative to the thyroid was 8.98 mm (p<0.0001). In conclusion, the sternal notch moves upwards relative to the CT table and soft tissues in the neck and upper mediastinum when the arms are raised; the degree of upward motion is greater in males. This may have implications when categorizing nodes at the cervicothoracic junction on staging CT examinations, when deciding if nodes might be accessible to ultrasound-guided biopsy, and in classifying goitres.

A new system for scanning, measuring and analyzing dental casts based on a 3D holographic sensor.

OBJECTIVES: To evaluate the reliability of a new technique for measuring 3D-scanned orthodontic cast models with cross-section planes using teledent, a new software, developed at Technion - for the purpose of this research. EXPERIMENTAL VARIABLE: Thirty orthodontic plaster models were divided into three equal groups according to severity of teeth crowding. Measurements of mesio-distal tooth width and the arch length were performed manually on the casts using a conventional caliper. Thereafter, the models were scanned and processed into the software using a 3-D measuring scanner with a holographic sensor 'ConoProbe' (by Optimet, Jerusalem, Israel). teledent used two types of digital measurements; linear and cross-section planes to perform a space analysis on the scanned teeth. Significance was determined by the paired Wilcoxon rank sum test. RESULTS: Results show that 3D measurements of tooth width and arch length obtained by cross-section planes were generally similar to manual caliper measurements, while linear measurements were statistically smaller. When comparing space analysis, both digital measurements were statistically smaller than the caliper (p < 0.05). The difference in space analysis between the caliper and the cross-section plane measurements was very small (0.38-0.74 mm) and can be considered clinically acceptable. However, a difference of 1.19-3 mm between the linear measurements and the caliper might have clinical implications especially in severely crowded dentition. CONCLUSIONS: This study suggests that measurements performed by cross-section planes are as accurate as the manual caliper and can be employed clinically while the accuracy of linear measurements is sometimes questionable.

Risk factors associated with preterm birth in the Gaza Strip: hospital-based case-control study.

This study aimed to assess the main maternal risk factors associated with preterm birth in the Gaza Strip. A hospital-based case-control study was carried out at El-Shifa and Khan-Younis hospitals with 200 women with preterm births and 200 control women. Significant risk factors for preterm birth were: maternal age > or = 35 years, being a refugee, inadequate antenatal care, failure to gain adequate weight during pregnancy and previous history of preterm birth. Other significant risk factors included: short stature, short interval between the last 2 pregnancies, presence of congenital gynaecological abnormalities, previous history of caesarean delivery and previous history of stillbirth.

Risk factors associated with preterm birth in the Gaza Strip: hospital-based case-control study

This study aimed to assess the main maternal risk factors associated with preterm birth in the Gaza Strip. A hospital-based case-control study was carried out at El-Shifa and Khan-Younis hospitals with 200 women with preterm births and 200 control women. Significant risk factors for preterm birth were: maternal age >/= 35 years, being a refugee, inadequate antenatal care, failure to gain adequate weight during pregnancy and previous history of preterm birth. Other significant risk factors included: short stature, short interval between the last 2 pregnancies, presence of congenital gynaecological abnormalities, previous history of caesarean delivery and previous history of stillbirth

[Localized aggressive periodontitis: a possible site-specific rather than tooth-specific disease?].

The diagnosis of localized aggressive periodontitis includes first molar attachment loss as an obligatory criterion. This tooth-specific based diagnosis has never been questioned or tested previously. We present a rare case of aggressive periodontitis that developed during orthodontic treatment, which included extraction of right lower first molar and bodily movement of the second molar to the original first molar site. At the end of the orthodontic therapy, localized periodontal disease was diagnosed at the site of the lower left first molar and the second lower right molar that was now occupying the site of the former first lower molar. The patient's periodontal condition was stabilized, and the bony defects were filled following periodontal treatment. This report shows that bacterial induced aggressive periodontitis developed during orthodontic treatment in a site-specific manner and suggest the hypothesis that localized aggressive periodontitis was targeted to a specific alveolar site rather than a tooth-specific site.

The bovine immunodeficiency virus: cloning of a tat/rev cDNA encoding a novel Tat protein with enhanced transactivation activity.

Previous studies have shown that BIV may encode two types of Tat proteins of 103 and 108 amino acids, respectively. Here, we report the characterization of a new BIV Tat protein (Tat236) derived from a tat/rev cDNA. The tat/rev cDNA was obtained by reverse transcription-PCR from RNA extracted from cells infected with BIV. BIV was rescued by cell co-cultivation from the spleen of rabbits exposed for 3 years to the R29 isolate of BIV. Sequence analysis indicated that BIV Tat236 contains the first 98 amino acids of Tat103 and the 3' end 138 amino acids of Rev. Reporter gene assays indicated that transactivation of BIV long terminal repeat (LTR) by Tat236 is higher than by the original BIV Tat proteins in several cell types. By using overlapping deletion mutants, evidence was given that the predicted basic domain of Rev within Tat236 plays a major role in the observed enhanced transactivation activity of the protein. However, the intact functional domain of the original BIV Tat is required for efficient transactivation. This is the first report of a hybrid Tat protein from BIV or any lentiviruses that shows higher transactivation than the original transactivator Tat proteins.

Prediction of premolar tooth lengths based on their panoramic radiographic lengths.

OBJECTIVE: Establishing a linear regression model for the determination of first premolar lengths based on panoramic radiographs. MATERIALS AND METHODS: The real lengths of 112 first premolars extracted for orthodontic reasons were measured and compared with their panoramic lengths. The teeth were divided into four groups according to their intraoral quadrant locations (T14, T24, T34, T44) and regression analysis was conducted for each group. RESULTS: A linear regression model for the prediction of tooth length (mm) based on the panoramic length was established (P < 0.0001): For group T14 the predicted length = (panoramic length x 0.698) + 2.61. For group T24 the predicted length = (panoramic length x 0.5056) + 7.844. For group T34 the predicted length = (panoramic length x 0.5075) + 9.282. For group T44 the predicted length = (panoramic length x 0.436) + 11.298. CONCLUSION: Prediction of all first premolar lengths using their panoramic images is both feasible and reliable.