ABSTRACT
Prion diseases are fatal neurologic disorders that can be transmitted by blood transfusion. The route for neuroinvasion following exposure to infected blood is not known. Carotid bodies (CBs) are specialized chemosensitive structures that detect the concentration of blood gasses and provide feedback for the neural control of respiration. Sensory cells of the CB are highly perfused and densely innervated by nerves that are synaptically connected to the brainstem and thoracic spinal cord, known to be areas of early prion deposition following oral infection. Given their direct exposure to blood and neural connections to central nervous system (CNS) areas involved in prion neuroinvasion, we sought to determine if there were cells in the human CB that express the cellular prion protein (PrPC), a characteristic that would support CBs serving as a route for prion neuroinvasion. We collected CBs from cadaver donor bodies and determined that mast cells located in the carotid bodies express PrPC and that these cells are in close proximity to blood vessels, nerves, and nerve terminals that are synaptically connected to the brainstem and spinal cord.
Subject(s)
Carotid Body , Prions , Humans , Prion Proteins/metabolism , Brain/metabolism , Carotid Body/metabolism , Mast Cells/metabolism , Prions/metabolismABSTRACT
Achalasia is a chronic gastrointestinal disorder characterized by increased esophageal sphincter tone and dysmotility that causes worsening dysphagia. While this condition usually affects the lower esophageal sphincter, we present a rare case of upper esophageal sphincter (UES) achalasia of unknown etiology in a female in her sixth decade of life. This was managed via UES myotomy but was complicated by esophageal perforation and severe post-operative stenosis. Consequently, the patient was referred to gastroenterology and treated over the course of two months with six endoscopic dilatations and glucocorticoid injections. Few cases of idiopathic UES achalasia have been described to date.
ABSTRACT
PURPOSE: To determine the utility of surgical videos published on YouTube (Google) as resources for trainee education in pediatric ophthalmology, the authors assessed the surgical proficiency, patient care, and video quality displayed in the published YouTube content. METHODS: The 10 most highly viewed pediatric and congenital cataract procedural videos published within the past 10 years were independently reviewed by three separate board-certified, fellowship-trained, practicing pediatric ophthalmologists. Videos were assessed for surgical competency on a 5-point Likert scale in six key areas as outlined in the American Academy of Ophthalmology's congenital cataract surgery guidelines. The teaching quality of the videos was also subjectively assessed based on multiple measures. RESULTS: The mean overall score was 3.93 ± 0.94 (range: 2.67 to 4.67). Only one video failed to receive an overall score of greater than 3, indicating incompetent overall surgical performance. No other video failed to have a mean competent score for any single individual technique. One video demonstrated potential patient safety concerns. Eighty percent of videos had adequate or better picture quality. CONCLUSIONS: Of the 10 most popular pediatric cataract surgical videos published on YouTube, all but one displayed competent overall surgical technique. Although viewers must always be wary because unvetted and potentially harmful videos may be published on the platform at any time, if used correctly, surgical content published on YouTube can be a helpful tool for ophthalmologic trainees. [J Pediatr Ophthalmol Strabismus. 2022;59(3):200-203.].
