Lateral ectopic thyroid mimics carotid body tumor on Indium-111 pentetreotide scintigraphy.

A 34-year old woman with past history of anxiety, depression, and hypothyroidism resulting from prior total thyroidectomy for multinodular goiter presented with complaints of palpitations, sweating, and tachycardia. Clinical examination revealed a painless right lateral neck mass. USG/CT of the neck revealed the soft tissue mass located at the right carotid bifurcation. A subsequent Indium-111 pentetreotide somatostatin receptor scintigraphy (SRS) demonstrated tracer uptake in the mass. Hence, secretory carotid body tumor/paraganglioma was strongly suspected. However, post-surgical histopathological specimen revealed only benign thyroid follicles indicative of lateral ectopic thyroid with no evidence of neuroendocrine cells or malignancy. This case highlights the importance of considering lateral ectopic thyroid, a very rare entity, in the differential diagnosis for carotid bifurcation masses. Also highlighted is the false positivity from normal but ectopic thyroid tissue on Indium-111 pentetreotide SRS mimicking a paraganglioma.

Ensuring healthy skin as part of wound prevention: an integrative review of health professionals' actions.

OBJECTIVE: To provide a synthesis of the best available, recent primary or secondary research evidence on early preventative activities taken to increase skin health, and reduce the incidence of facility-acquired skin tears and pressure ulcers (PUs) in community, residential and health-care institutions. METHOD: An integrative review focusing on a 10-year period, 2007-2017. A literature search of health databases was carried out, as well as a search of grey literature in relevant skin, wound care and nursing association journals. A second search was also conducted focused on literature from policy and guideline development organisations. Primary outcomes of interest were reduction in dry skin (xerosis), friable skin, or increases in healthy skin maintenance activities. Secondary outcomes of interest were reductions in PU or skin tear occurrences. Opinion, non-systematic literature reviews and discussion papers were excluded. RESULTS: Of the 4932 references obtained from the searches, a total of 33 articles were included in the review: 27 peer-reviewed journal articles and six articles from the grey literature search. No guideline was found that focused on maintaining skin health as a person ages. Studies identified the main factors for maintaining skin health as nutrition, hydration and skin care regimen. CONCLUSION: Skin care regimens, including a focus on good nutrition and pH balance, should start immediately on arrival in institutions such as hospitals or residential aged care, and continue throughout the stay.

Simplifying wound dressing selection for residential aged care.

OBJECTIVE: To demonstrate the effectiveness of a simplified wound dressing regimen and develop a decision tree tool for wound management, for use by nurses in a residential aged care setting. METHOD: A three-phase process was used. Firstly, practice was audited, including a cost analysis of existing wound treatment. Secondly, staff were educated on wounds, wound care products and a simplified wound management protocol. In the final phase, the new wound care products and protocol used for skin tears and other wounds (as assessed by a nurse practitioner) were evaluated and ongoing education provided as required. RESULTS: A total of 93 residents from two residential aged care facilities participated in the study. Overall, 178 wounds were identified, of which 121 were considered eligible for treatment under the new protocol. The majority of residents were aged >85 years and the major wound type was skin tears 72.7% (n=88). The mean healing time for skin tears was significantly shorter than for other wounds (19.7±14.2 days versus 30.9±25.2 days, p=0.0359). Most wounds were suitable for the simplified dressing selection regimen. Data collected from a survey of nursing staff demonstrated that the simplified protocol products were easy to apply, conformed well, were easy to remove and stayed in place. In addition, patient satisfaction was positive and removal of dressings was generally pain free. CONCLUSION: In summary, data collected from this project showed that the dressings were effective, performed well and simplified wound dressing selection for nursing staff.

Education and process change to improve skin health in a residential aged care facility.

We report on an intervention and evaluation in relation to changes in staff knowledge, time spent on healing and wound prevention and proportion of wounds in the facilities before and after. A rapid review of recent peer-reviewed literature (2006-2016) found 14 education-based intervention articles and provided the background and context for this intervention. A cohort of 164 nurses and personal care workers and 261 residents at two aged care-approved facilities contributed to this intervention on the effect of education, mentoring and practice change on staff knowledge and wound prevalence between 2015 and 2016. There was a significant decrease in pressure injury prevalence and an increase in the early identification of potential wounds between phase 1 and 3 across the two facilities. Overall, registered nurses and enrolled nurses showed significant increase in mean knowledge scores. There was a reorganisation of time spent on various wound care and prevention strategies that better represented education and knowledge. Wound management or prevention education alone is not enough; this study, using an educational intervention in conjunction with resident engagement, practice change, mentorship, onsite champions for healthy skin and product choice suggestions, supported by an organisation that focuses on a healthy ageing approach, showed improvement across two residential sites.

Improved wound management at lower cost: a sensible goal for Australia.

Chronic wounds cost the Australian health system at least US$2·85 billion per year. Wound care services in Australia involve a complex mix of treatment options, health care sectors and funding mechanisms. It is clear that implementation of evidence-based wound care coincides with large health improvements and cost savings, yet the majority of Australians with chronic wounds do not receive evidence-based treatment. High initial treatment costs, inadequate reimbursement, poor financial incentives to invest in optimal care and limitations in clinical skills are major barriers to the adoption of evidence-based wound care. Enhanced education and appropriate financial incentives in primary care will improve uptake of evidence-based practice. Secondary-level wound specialty clinics to fill referral gaps in the community, boosted by appropriate credentialing, will improve access to specialist care. In order to secure funding for better services in a competitive environment, evidence of cost-effectiveness is required. Future effort to generate evidence on the cost-effectiveness of wound management interventions should provide evidence that decision makers find easy to interpret. If this happens, and it will require a large effort of health services research, it could be used to inform future policy and decision-making activities, reduce health care costs and improve patient outcomes.

Adenocarcinoma of the urethra with mucinous features.

Primary adenocarcinoma of the female urethra is a rare malignancy. Previous studies hypothesize multiple origins, including periurethral glands or intestinal metaplasia. We report a case of a 60-year-old white woman with adenocarcinoma of the urethra who initially presented with obstructive voiding complaints secondary to a urethral mass. Wide local excision revealed invasive adenocarcinoma of the urethra with mucinous features. There was intestinal metaplasia adjacent to the tumor, as well as separate identification of intestinal metaplasia along the urethra. Ultimately, the patient underwent radical cystectomy with ileal conduit urinary diversion with no evidence of recurrence, indicating the role of early identification and surgical intervention for such cases.

Immunoglobulin G4-related Retroperitoneal Fibrosis of the Pelvis.

Retroperitoneal fibrosis (RPF) is a rare disease characterized by the replacement of normal tissue with fibrosis and/or inflammation. In this case, a 68-year-old man presented with RPF in the pelvis, a rare location for this disease. Biopsies were performed, which showed elevated levels of C-reactive protein, erythrocyte sedimentation rate, and, most importantly, immunoglobulin G4 (IgG4). It has been postulated that IgG4-related sclerosing disease is a systemic disease. Treatment has been successful with systemic corticosteroids.

Painful bladder syndrome: an update and review of current management strategies.

Interstitial cystitis/painful bladder syndrome (IC/PBS) remains a prevalent, but untreated disease with a poorly understood pathophysiology. Nonetheless, four main processes currently appear to be involved in producing IC/PBS symptoms: (1) disruption of the bladder GAG/proteoglycan layer, (2) upregulated immune/inflammatory response, (3) neural upregulation, and (4) pelvic floor dysfunction. Current and emerging therapies aimed at these potential targets will be the focus of this review with an update on IC/PBS therapy.

Factors influencing fluid intake behavior among kidney stone formers.

PURPOSE: We determined factors influencing the behavior of patients with kidney stones in the prevention of recurrent stones. MATERIALS AND METHODS: Patients with stones from an academic and a community practice were recruited for key informant interviews and focus groups. Groups were guided based on the framework of the health belief model. Content analysis was done on transcriptions using qualitative data analysis software. RESULTS: Key informant interviews were completed with 16 patients and with a total of 29 subjects in 5 focus groups. Content analysis revealed that patients were highly motivated to prevent stones. The minimum level of perceived benefit for adopting the behavior change varied among patients and the behaviors proposed. An important strategy to increase fluid intake was insuring availability with containers. Patients were more consistently confident in the ability to increase fluid, in contrast to ingesting medicine or changing the diet. While barriers to increasing fluid were multifactorial among individuals, the barriers aligned into 3 progressive stages that were associated with distinct patient characteristics. Stage 1 barriers included not knowing the benefits of fluid or not remembering to drink. Stage 2 barriers included disliking the taste of water, lack of thirst and lack of availability. Stage 3 barriers included the need to void frequently and related workplace disruptions. CONCLUSIONS: Patients with kidney stones are highly motivated to prevent recurrence and were more amenable to fluid intake change than to another dietary or pharmaceutical intervention. Barriers preventing fluid intake success aligned into 3 progressive stages. Tailoring fluid intake counseling based on patient stage may improve fluid intake behavior.

In vitro and in vivo safety studies of a proprietary whey extract.

A proprietary whey growth factor extract (WGFE) or Lactermin (Lact milk; ermin growth factors) is a whey fraction of milk containing the major proteins lactoperoxidase and lactoferrin, together with a variety of minor proteins and peptides such as the growth factors IGF-I, IGF-II, PDGF, FGF, TGF-ss and betacellulin. This growth factor component of milk has been suggested to possess biological properties such as the promotion of tissue repair and anti-inflammatory activity. In this study the safety of Lactermin has been evaluated using genotoxicity assays (Ames, mouse lymphoma and micronucleus assay) and in a subchronic (13 week) rat oral toxicity study. In vitro Lactermin did not show any mutagenic properties in the Ames or mouse lymphoma assay and in vivo did not show any adverse clinical effects or in the bone marrow of male or female mice. In the subchronic oral toxicity study in which 10 rats per sex were fed Lactermin mixed with rat diet to deliver doses of 300, 1000 and 3000 mg/kg/day for 13 weeks, male and female rats did not show any test article-related clinical observations or effects on body weight, food consumption, ophthalmic effects, functional observational battery, organ weights, locomotor activity, hematology, serum chemistry, urinalysis or macroscopic or microscopic pathology. The results from the genotoxicity studies and the subchronic oral toxicity study suggest Lactermin is safe for consumption with a no-observed-adverse-effect level (NOAEL) of 3000 mg/kg/day.

GPCR screening via ERK 1/2: a novel platform for screening G protein-coupled receptors.

Discovery of novel agonists and antagonists for G protein-coupled receptors (GPCRs) relies heavily on cell-based assays because determination of functional consequences of receptor engagement is often desirable. Currently, there are several key parameters measured to achieve this, including mobilization of intracellular Ca2+ and formation of cyclic adenosine monophosphate or inositol triphosphate. However, no single assay platform is suitable for all situations, and all of the assays have limitations. The authors have developed a new high-throughput homogeneous assay platform for GPCR discovery as an alternative to current assays, which employs detection of phosphorylation of the key signaling molecule p42/44 MAP kinase (ERK 1/2). The authors show that ERK 1/2 is consistently activated in cells stimulated by Gq-coupled GPCRs and provides a new high-throughput platform for screening GPCR drug candidates. The activation of ERK 1/2 in Gq-coupled GPCR systems generates comparable pharmacological data for receptor agonist and antagonist data obtained by other GPCR activation measurement techniques.

Development and validation of a radioimmunoassay for fish insulin-like growth factor I (IGF-I) and the effect of aquaculture related stressors on circulating IGF-I levels.

This paper describes the development and validation of a commercially available radioimmunoassay (RIA) for the detection of fish insulin-like growth factor-I (IGF-I). The assay was developed using recombinant barramundi IGF-I as antigen and recombinant tuna IGF-I as radiolabelled tracer and standard. Assay sensitivity was 0.15 ng/ml, inter-assay variation was 16% (n = 9) and intra-assay variation was 3% (n = 10). Cross reactivity of less than 0.01% was found with salmon insulin, salmon IGF-II and barramundi IGF-II, less than 0.5% with human IGF-I and less than 1% with human IGF-II. Parallel dose-response inhibition curves were shown for barramundi (Lates calcarifer), coho salmon (Oncorhynchus kisutch), Southern Bluefin tuna (Thunnus maccoyii), tilapia (Oreochromis mossambicus), and seabream (Pagrus auratus) IGF-I. The assay was then used to measure stress related changes in different aquacultured fish species. Salt water acclimated Atlantic salmon smolts (Salmo salar) bathed for 2 h in fresh water showed significantly lower IGF-I concentrations than control smolts two days after the bath (53.1 compared to 32.1 ng/ml), with levels of IGF-I also lower in smolts exhibiting stunted growth (stunts). Capture and confinement of wild tuna in sea-cages resulted in a significant decrease in IGF-I levels (28 ng/ml) when compared to tuna captured and sampled immediately (48 ng/ml), but had recovered to starting levels after 3 weeks (43 ng/ml). Handling and isolation in silver perch (Bidyanus bidyanus) led to a gradual decline in IGF-I over a 12 h period (36-19 ng/ml) but showed signs of recovery by 24 h (24 ng/ml) and had recovered fully 72 h after treatment (40 ng/ml). A similar trial in black bream (Acanthopagrus butcherii) showed comparable results with IGF-I levels gradually decreasing (40-26 ng/ml) over 24 h, results that were mirrored by cortisol concentrations which increased during this time (1-26 ng/ml). In the studies presented here changes in IGF-I levels were not observed for at least 3 h after exposure to the stressor. We suggest this is due to the endocrine nature of IGF-I regulation and the clearance rate of IGF-I in vivo.