Identification of Two Eosinophil Subsets in Induced Sputum from Patients with Allergic Asthma According to CD15 and CD66b Expression.

Two subsets of eosinophils have been described: resident eosinophils with homeostatic functions (rEOS) in healthy subjects and in patients with nonallergic eosinophilic asthma, and inflammatory eosinophils (iEOS) in blood and lung samples from patients with allergic asthma. We explored if it would be possible to identify different subsets of eosinophils using flow cytometry and the gating strategy applied to induced sputum. We conducted an observational cross-sectional single-center study of 62 patients with persistent allergic asthma. Inflammatory cells from induced sputum samples were counted by light microscopy and flow cytometry, and cytokine levels in the supernatant were determined. Two subsets of eosinophils were defined that we call E1 (CD66b-high and CD15-high) and E2 (CD66b-low and CD15-low). Of the 62 patients, 24 were eosinophilic, 18 mixed, 10 paucigranulocytic, and 10 neutrophilic. E1 predominated over E2 in the eosinophilic and mixed patients (20.86% vs. 6.27% and 14.42% vs. 4.31%, respectively), while E1 and E2 were similar for neutrophilic and paucigranulocytic patients. E1 correlated with IL-5, fractional exhaled nitric oxide, and blood eosinophils. While eosinophil subsets have been identified for asthma in blood, we have shown that they can also be identified in induced sputum.

Guided implant surgery workflow in edentulous patients: A precise and rapid technique.

A new technique of guided implant surgery is presented. A conventional complete denture is converted into both tomographic and surgical guides and later into an interim implant-supported fixed prosthesis. A plate derived from a computed tomography scan becomes the physical link between the virtual planning and tube positioning device. Furthermore, the interim placement of mini-implants adjacent to the symphysis region stabilizes the guide throughout the guided surgery. This technique reduces treatment time and costs.

A review of the flightless genus Nanotermitodius Howden, 2003 (Coleoptera: Scarabaeidae: Aphodiinae: Rhyparini).

The genus Nanotermitodius Howden, 2003 (Coleoptera: Scarabaeidae: Aphodiinae: Rhyparini) is reviewed and a new species described. Only two species are presently known in the genus, Nanotermitodius andersoni Skelley, Smith, & Mora-Aguilar, new species, and Nanotermitodius peckorum Howden, 2003, which both occur in Oaxaca, Mexico. A key and distribution map for the species are presented.

Correction to: The natural course of pT2 prostate cancer with positive surgical margin: predicting biochemical recurrence.

In multivariate analysis, GS of the regular prostatectomy specimen was the only statistically significant parameter for pT2R1 prostate cancer.

A new Mexican species of Onthophagus Latreille (Coleoptera: Scarabaeidae: Scarabaeinae), with a revised key to the species of the O. dicranius species complex.

New World species of the genus Onthophagus Latreille (Coleoptera: Scarabaeidae: Scarabaeinae) have been classified in different ways, all of them without a phylogenetic framework. For instance, Boucomont (1932) separated them in 13 groups of species, but Zunino Halffter (1988; 1997) only recognize five species groups. Howden Gill (1993) add the O. dicranius Bates and O. mirabilis Bates species groups, and Kohlmann Solís (2001) added the O. gazellinus Bates species group. Also, over the years, groups, complexes, and sets of species have been defined using different criteria not even comparable each other. Two of these groupings are the O. dicranius and O. mirabilis species groups, which were firstly separated from the O. clypeatus Blanchard species group (sensu Zunino Halffter 1981, 1997) by Howden Gill (1993). After, Kohlmann Solís (2001) later merged both groups under the O. dicranius species group. Finally, Génier (2017) gives a conceptual framework for species groups and complexes, thus assigning the status of species complex to the two previous species groups, and integrating them in the O. dicranius species group. Herein, we describe a new species of the O. dicranius species complex, update the species list of this complex, and present a revised key to separate these species.

A new Mexican species of Rhyparus Westwood (Coleoptera: Scarabaeidae: Aphodiinae), with new records and a key to the Mexican and Guatemalan species.

In this paper we describe Rhyparus chimalapensis new species (Coleoptera: Scarabaeidae: Aphodiinae: Rhyparini), from the region of Chimalapas, Oaxaca, Mexico. New records are given for three species of Rhyparus Westwood from Mexico and Guatemala. A key to the Mexican and Guatemalan species of this genus is included.

A new Mexican species of Chrysina Kirby (Coleoptera: Scarabaeidae: Rutelinae), with nomenclatural changes, new records, and a key to the C. quiche species group.

Chrysina chimalapensis new species (Coleoptera: Scarabaeidae: Rutelinae: Rutelini), from the region of Chimalapas, Oaxaca, Mexico is described and illustrated. A key to the species of the C. quiche species group is included. Plusiotis neotenochca Morón Nogueira is placed as a new junior synonym of Chrysina paulseni Hawks, and C. aenigmatica (Morón) as a new junior synonym of C. modesta Sturm. Chrysina benesi from Guatemala, and C. quetzalcoatli from Nicaragua are recorded as new country records. Chrysina quetzalcoatli Morón and C. triumphalis Morón are also recorded for the first time for the state of Oaxaca, Mexico, and C. victorina (Hope) for the state of Veracruz, Mexico.

Acquired cryptorchidism: More harm than thought?

INTRODUCTION: Acquired cryptorchidism (AC) has been recognized as a subgroup of undescended testes (UDT). There is growing evidence that the compromising effect equals that of congenital UDT (cUDT). This prospective study included an extensive histological examination of biopsies taken from AC patients. PATIENTS AND METHODS: From August 2013 to December 2014, 21 boys (3-12 years of age) underwent testicular biopsy during orchiopexy for AC. Patient and family histories were taken. The amount of germ cells (GC) per tubule (T) and the amount of adult dark spermatogonia (Ad-S) per T were determined by resin semi-thin sections examination. The samples were also scanned for signs of malformation. Immunohistochemical stains were performed as markers for atypical germ cells. RESULTS: Four (19%) boys were born prematurely, two (9.5%) were small for gestational age (SGA), and nine (43%) had a positive family history of UDT. The median of GC/T was 1.06 in boys <9 years, and 0.60 in boys ≥9 years. The median of Ad-S/T was 0.02 in boys <9 years and 0.01 in boys ≥9 years. There were no signs for malformation and no atypical cells. The immunohistochemical stains were negative in all specimens. CONCLUSIONS: Prematurity, SGA, and a positive family history appeared to be predictors for AC. Extensive histopathological examination of AC revealed a significant reduction of germ cell count and fertility markers, comparable with that in cUDT. The alterations were more severe in boys aged ≥9 years. It is unclear as to whether or not this was possibly caused by a longer duration of inguinal position, but this finding suggests that routine checks of testicular position throughout childhood are needed, and that there is a cause for continued efforts in educating parents and primary care physicians regarding AC. Current data support the notion of surgical correction once the diagnosis is made.

Airway Mucin 2 Is Decreased in Patients with Severe Chronic Obstructive Pulmonary Disease with Bacterial Colonization.

RATIONALE: Mucins are essential for airway defense against bacteria. We hypothesized that abnormal secreted airway mucin levels would be associated with bacterial colonization in patients with severe chronic obstructive pulmonary disease (COPD) Objectives: To investigate the relationship between mucin levels and the presence of potentially pathogenic micro-organisms in the airways of stable patients with severe COPD Methods: Clinically stable patients with severe COPD were examined prospectively. All patients underwent a computerized tomography scan, lung function tests, induced sputum collection, and bronchoscopy with bronchoalveolar lavage (BAL) and protected specimen brush. Patients with bronchiectasis were excluded. Secreted mucins (MUC2, MUC5AC, and MUC5B) and inflammatory markers were assessed in BAL and sputum by ELISA. MEASUREMENTS AND MAIN RESULTS: We enrolled 45 patients, with mean age (±SD) of 67 (±8) years and mean FEV1 of 41 (±10) % predicted. A total of 31% (n = 14) of patients had potentially pathogenic micro-organisms in quantitative bacterial cultures of samples obtained by protected specimen brush. Patients with COPD with positive cultures had lower levels of MUC2 both in BAL (P = 0.02) and in sputum (P = 0.01). No differences in MUC5B or MUC5AC levels were observed among the groups. Lower MUC2 levels were correlated with lower FEV1 (r = 0.32, P = 0.04) and higher sputum IL-6 (r = -0.40, P = 0.01). CONCLUSIONS: Airway MUC2 levels are decreased in patients with severe COPD colonized by potentially pathogenic micro-organisms. These findings may indicate one of the mechanisms underlying airway colonization in patients with severe COPD. Clinical trial registered with www.clinicaltrials.gov (NCT01976117).

The natural course of pT2 prostate cancer with positive surgical margin: predicting biochemical recurrence.

PURPOSE: To predict biochemical recurrence respecting the natural course of pT2 prostate cancer with positive surgical margin (R1) and no adjuvant/neoadjuvant therapy. METHODS: A multicenter data analysis of 956 patients with pT2R1N0/Nx tumors was performed. Patients underwent radical prostatectomy between 1994 and 2009. No patients received neoadjuvant or adjuvant therapy. All prostate specimens were re-evaluated according to a well-defined protocol. The association of pathological and clinical features, in regard to BCR, was calculated using various statistical tests. RESULTS: With a mean follow-up of 48 months, BCR was found in 25.4 %. In univariate analysis, multiple parameters such as tumor volume, PSA, Gleason at positive margin were significantly associated with BCR. However, in multivariate analysis, Gleason score (GS) of the prostatectomy specimen was the only significant parameter for BCR. Median time to recurrence for GS ≤ 6 was not reached; 5-year BCR-free survival was 82 %; and they were 127 months and 72 % for GS 3+4, 56 months and 54 % for GS 4 + 3, and 27 months and 32 % for GS 8-10. The retrospective approach is a limitation of our study. CONCLUSIONS: Our study provides data on the BCR in pT2R1-PCa without adjuvant/neoadjuvant therapy and thus a rationale for an individual's risk stratification. The data support patients and physicians in estimating the individual risk and timing of BCR and thus serve to personalize the management in pT2R1-PCa.

Towards weighing individual atoms by high-angle scattering of electrons.

We consider theoretically the energy loss of electrons scattered to high angles when assuming that the primary beam can be limited to a single atom. We discuss the possibility of identifying the isotopes of light elements and of extracting information about phonons in this signal. The energy loss is related to the mass of the much heavier nucleus, and is spread out due to atomic vibrations. Importantly, while the width of the broadening is much larger than the energy separation of isotopes, only the shift in the peak positions must be detected if the beam is limited to a single atom. We conclude that the experimental case will be challenging but is not excluded by the physical principles as far as considered here. Moreover, the initial experiments demonstrate that the separation of gold and carbon based on a signal that is related to their mass, rather than their atomic number.

Potentially clinically relevant prostate cancer is found more frequently after complete than after partial histopathological processing of radical cystoprostatectomy specimens.

Incidental prostate cancer is often found in cystoprostatectomy specimens. The presence of a clinically significant tumour has an impact on follow-up strategies. In prostatectomy specimen for prostate cancer, whole-mount sections improve diagnostic accuracy. The present study compares detection of incidental prostate cancer in complete to routine processing. We included 295 consecutive patients who underwent radical cystoprostatectomy. Between 01/1995 and 12/2003 (period I), specimens of 129 patients were partially processed, whereas between 01/2004 and 03/2009 (period II), specimens of 166 patients were completely processed. Incidental prostate cancer was detected overall in 91 (30.8 %) patients. Prostate cancer was detected in 24 (18.6 %) patients in period 1 and in 67 (40.4 %) patients in period 2 (p < 0.001). Potentially clinically significant prostate cancer was detected in 12 (9.2 %) and 29 (17.5 %) patients, respectively (p = 0.044). Complete embedding and processing of cystoprostatectomy specimen yield significantly more potentially clinically relevant prostate cancers. The present data suggest that notably in younger men the specimens should be completely processed.

First results of endocavity evaluation of the microvascularization of malignant prostate tumors using contrast enhanced ultrasound (CEUS) including perfusion analysis: first results.

AIM: Detection of prostate cancer lesions using transrectal contrast enhanced ultrasound (CEUS) of the prostate utilizing quantitative perfusion analysis. METHOD: 20 patients (mean age 63 years, 47-71) with biopsy proven prostate cancer underwent transrectal ultrasound (TRUS) prior to radical prostatectomy by 2 experienced examiners using a multifrequency endocavitary probe (5-9 MHZ, LOGIQ E9, GE Healthcare, Chalfont St Giles, UK) to detect cancer-suspect lesions. CEUS was performed dynamically up to 3 Min after bolus injections of 2.4 ml SonoVue® (BRACCO, Italy). Digital cine loops were analyzed by an independent blinded examiner using perfusion quantification software with colour-coded parametric images in order to define suspect regions based on the perfusion-related parameters early wash in rate (WIR), mean transit time (MTT) and rise time (RT). The results of CEUS perfusion analysis were compared with the histopathology after surgery, obtained from whole mount sections. RESULTS: After prostatectomy and histopathology, 34 prostate cancer foci were found in 20 patients. In 30/34 cases an early enhancement within the tumor was detected by CEUS perfusion analysis without early wash out. By evaluating the MTT and RT tumor detection was possible in 29/34 and 25/34 cases. The highest detection rate of prostate cancers was obtained by analysis of early contrast enhancement (priot to the normal prostate parenchyma), with a sensitivity of 88%, specificity 100%, NPP 60%, PPV 90%, in clinically suspicious cases with good correlation to the postoperative histopathological findings (r = 0.728). CONCLUSION: This pilot study demonstrates, that quantitaive analysis of perfusion parameters obtained with transrectal CEUS could be helpful for characterization of neoplastic microcirculation of prostate cancer, for preoperative localization of cancer-suspect areas and for therapy guidance and management.

[Rare malignant tumor of the parotid gland. Myoepithelial carcinoma]. / Seltener maligner Tumor der Gl. parotis. Myoepitheliales Karzinom.

A parotid mass in a 62-year-old woman presented intraoperatively as a highly malignant tumor with facial nerve infiltration. Classification by means of rapid section histology was not possible. Immunohistochemical studies were necessary to diagnose this rare case of myoepithelial carcinoma of the parotid gland. We performed a total parotidectomy including partial nerve resection and neck dissection on the tumor side. The patient was referred to radiotherapy postoperatively.

[Hereditary and non-hereditary cutaneous amyloidoses]. / Hereditäre und nichthereditäre kutane Amyloidosen.

Amyloid and amyloidosis describes a heterogeneous group of diseases which are characterized by the pathological extracellular deposition of autologous proteins. Basically, amyloidoses can be divided into systemic or organ-limited (e.g. cutaneous) forms and can be acquired or hereditary in nature. The subclassification discriminates between primary amyloidosis (in the absence of an obvious predisposing disease) and secondary amyloidosis (if caused by a certain underlying disease). The subclassification of amyloidoses is based on the main protein constituent and therefore on the chemical composition of the amyloid fibrils. However, the exact etiopathogenesis of amyloid formation remains unclear. In addition to the clinical presentation, histology, electron microscopy and biochemical-immunological differentiation are also decisive for a proper diagnosis. In cutaneous amyloidosis the deposition of amyloid either occurs along reticulin fibers and the basal membrane (perireticulary amyloidoses) or along collagen fibers (pericollagenous amyloidosis). The purpose of this article is to provide an up-to-date overview on the different kinds of cutaneous amyloidoses.

[Antegrade aortomesenteric revascularisation originating from the supracoeliac aortic segment--a promising surgical option in chronic ischaemia of the visceral arteries]. / Die antegrade aortomesenteriale Revaskularisation von suprazöliakal--eine vielversprechende operative Option bei chronischer Viszeralarterienischämie.

INTRODUCTION: Ischaemia of the visceral arteries is considered to be an extraordinary challenge in the interdisciplinary therapeutic management. AIM AND METHOD: Using a case series of patients with chronic ischaemia of the visceral arteries, our diagnostic and therapeutic experience was analysed with regard to postoperative quality of life (increase of body weight, frequency in daily diarrhoea), perioperative morbidity and hospital mortality in dependence on the type of surgical reconstruction of the visceral arteries. RESULTS: During a time period of 2 years, 3 patients (male/female=1:2; mean age, 61.7 years) underwent surgical interventions on the visceral arteries from a total of 1118 vascular interventions (main indication revealed by colonoscopy and pathohistology of mucosal biopsy: ischaemic colitis). In all cases, symptomatology was affected by abdominal angina. Duplex sonography, angiography, and multislice CT scan revealed the combination of an occlusion of the coeliac trunk and of the superior mesenteric artery by atherosclerosis in 2 cases. In the remaining case, there was an isolated occlusion at the origin of the superior mesenteric artery. For revascularisation, the aortomesenteric reconstruction was subdivided according to the: i) target vessel: -combination of revascularised common hepatic artery and superior mesenteric artery (n=1) with an autologous Y-vein bypass ("reversed technique"), -exclusive revascularisation of the superior mesenteric artery (n=2)-prosthetic bypass; ii) origin of the bypass: -from the supracoeliac aortic segment (antegrade) n=3 (primarily in patients 1 and 3; as a redo operation in patient 2); -from the infrarenal segment (retrograde) n=1 (initial surgical intervention in patient 2) using an autologous venous bypass. In all cases, a significant improvement of the quality of life was observed as indicated by an increase of body weight (n=3; +no further abdominal angina) and primary wound healing in all 3 cases (hospital mortality, 0). CONCLUSION: Chronic ischaemia of the visceral arteries is characterised by an increasing incidence and a stealthy onset and requires an interdisciplinary approach to find the correct diagnosis using all available diagnostic procedures including sufficient periodic follow-up investigations. We favour the antegrade aortomesenteric revascularisation from the supracoeliac aortic segment as a promising surgical option in chronic ischaemia of visceral arteries.

Surgery of inferior vena cava associated malignant tumor lesions.

BACKGROUND: Tumor lesions of the inferior vena cava (IVC) can originate from the vein or can develop by malignant tumor infiltration from the surrounding tissue. In this context, particular attention should be paid to tumor lesions with pegs into or within the IVC. The aim of this series of a single surgical center was to analyze the perioperative management, the individual-specific and -adapted surgical technique, as well as the outcome including prognostic considerations in IVC-associated malignant tumor lesions. PATIENTS AND METHODS: Over a 6-year time period, all consecutive patients with IVC-associated malignant tumor lesions and their patient- and finding-specific characteristics were registered, data and parameters of the diagnostic and therapeutic management were documented, and both the short- and long-term outcomes (complication rate, perioperative morbidity/mortality, tumor recurrence rate, survival) were assessed with periodic follow-up investigations. RESULTS: Overall, 12 patients were enrolled in the study from 1/1/2001-31/12/2006:6 primary IVC-tumors (leiomyosarcomas, 50%) and 6 secondary IVC-tumors (2 retroperitoneal tumor lesions, 16.7%, 3 renal cell carcinomas 25% and 1 carcinoma of the adrenal gland, 8.3%). 4 of the secondary tumors had pegs into the IVC. The RO resection rate was 83%. The perioperative morbidity was 33%; whereas, the hospital mortality was 8.3% (n = 1). Surgical reconstruction of IVC was achieved in each case (100%). There was a mean postoperative observation period of 20 months (range, 1-58 months). Complete follow-up documentation was obtained for all of the patients (100%). Three patients experienced recurrent tumor growth (27.5% out of n = 11). While the overall mortality through the follow up observation period was 27.5%, the tumor-specific mortality was 16%. CONCLUSIONS: The primary surgical aim is RO resection to provide a long-term outcome with no tumor recurrence including the reconstruction of the IVC based on a reasonable risk-to-benefit ratio. The favorable outcome of this case series demonstrates that IVC-associated tumor lesions can be approached if there is an appropriate expertise of the surgical team, a sufficient perioperative management and an adequate financial background with a reasonable survival rate. The variable prognosis of the various tumor lesions depends on tumor entity, stage, resection status and individual risk factors.