Drainage of pancreatic fluid collections using a lumen-apposing metal stent with an electrocautery-enhanced delivery system.

BACKGROUND AND AIM: Our aim was to evaluate the efficacy and safety of a lumen-apposing metal stent with an electrocautery-enhanced delivery system (EDS-LAMS) for endoscopic ultrasound (EUS)-guided drainage of pancreatic fluid collections (PFCs) in regular clinical practice. METHODS: A retrospective and subsequent prospective analysis was undertaken of all patients who underwent EUS-guided drainage of their PFCs using the EDS-LAMS at 17 tertiary therapeutic endoscopy centers. RESULTS: Two hundred eight cases of EDS-LAMS deployment were attempted in 202 patients (mean age 52.9 years) at time of evaluation. Ninety-seven patients had pancreatic pseudocysts (PPs), 75 walled-off pancreatic necrosis (WOPN), 10 acute peripancreatic fluid collections (APFCs), 6 acute necrotic collections (ANCs), and 14 postoperative collections (POCs). Procedural technical success was achieved in 202/208 cases (97.1%). Maldeployment occurred in 7/208 cases (3.4%). Clinical success was achieved in 142/160 (88.8%) patients (PP 90%, WOPN 85.2%, APFC 100%, ANC 75%, POC 100%). Delayed adverse events included stent migration in 15/202 (7.4%), stent occlusion and infection in 16/202 (7.9%), major bleeding in 4/202 (2%), and buried EDS-LAMS in 2/202 (1%). PFC recurrence occurred in 13/142 (9.2%) patients; 9/202 (4.5%) required surgical or radiological intervention for PFC management after EDS-LAMS insertion. CONCLUSIONS: This large international multicenter study evaluating the EDS-LAMS for drainage of PFCs in routine clinical practice suggests that the EDS-LAMS are safe and effective for drainage of all types of PFCs; however, further endoscopic therapy is often required for WOPN. Major bleeding was a rare complication in our cohort.

Combination of pulsed dye laser and verapamil in comparison with verapamil alone in the treatment of keloid.

Background and objective: Many modalities of treatment have been advocated for Keloid ,but the success rates of these have been variable. The present study is an attempt to evaluate and compare the efficacy of a combination of pulsed dye laser (PDL) and intralesional verapamil against intralesional verapamil alone in the treatment of keloids.Methods: 40 Patients with keloids were divided into two groups randomly of 20 each receiving four sessions of therapy. Group A intralesional verapamil alone 2.5mg/ml. Group B received a combination of PDL and intralesional verapamil alone 2.5mg/ml. Pretreatment measurements and photographs were taken.Results: Statistically significant improvement was seen in the height and length of the lesions. Overall appearance criteria of modified MQS showed an improvement of more than 50% in 43.3% of the lesions by the end of four sessions. The improvement of these parameters in the verampil only group was significantly lower than the improvement seen in the PDL+ intralesional verapamil group.Conclusion: Combination therapy with PDL+ intralesional verapamil was superior in efficacy when compared to intralesional verapamil alone, in the treatment of keloids.

Analysis of the Trichuris suis excretory/secretory proteins as a function of life cycle stage and their immunomodulatory properties.

Parasitic worms have a remarkable ability to modulate host immune responses through several mechanisms including excreted/secreted proteins (ESP), yet the exact nature of these proteins and their targets often remains elusive. Here, we performed mass spectrometry analyses of ESP (TsESP) from larval and adult stages of the pig whipworm Trichuris suis (Ts) and identified ~350 proteins. Transcriptomic analyses revealed large subsets of differentially expressed genes in the various life cycle stages of the parasite. Exposure of bone marrow-derived macrophages and dendritic cells to TsESP markedly diminished secretion of the pro-inflammatory cytokines TNFα and IL-12p70. Conversely, TsESP exposure strongly induced release of the anti-inflammatory cytokine IL-10, and also induced high levels of nitric oxide (NO) and upregulated arginase activity in macrophages. Interestingly, TsESP failed to directly induce CD4+ CD25+ FoxP3+ regulatory T cells (Treg cells), while OVA-pulsed TsESP-treated dendritic cells suppressed antigen-specific OT-II CD4+ T cell proliferation. Fractionation of TsESP identified a subset of proteins that promoted anti-inflammatory functions, an activity that was recapitulated using recombinant T. suis triosephosphate isomerase (TPI) and nucleoside diphosphate kinase (NDK). Our study helps illuminate the intricate balance that is characteristic of parasite-host interactions at the immunological interface, and further establishes the principle that specific parasite-derived proteins can modulate immune cell functions.

Serum prolactin level in chronic urticaria: Is bromocriptine inducing remission in chronic urticaria?

BACKGROUND: Chronic urticaria (CU) is a disturbing disease with a negative impact on quality of life. Despite of several clinical studies on CU patients, its pathogenesis is poorly understood. Prolactin (PRL) is peptide hormone has immunomodulatory effects in some immune inflammatory skin diseases. AIM: To elucidate any possible relationship between the immunomodulatory effects of PRL and CU. Besides, the study aims to investigate the crucial role of antiprolactin drugs in the management of CU patients. PATIENTS AND METHODS: The serum PRL level of 40 female patients with CU was measured using the electrochemiluminescence immunoassay. The activity of CU was assessed by European Academy of Allergology and Clinical Immunology; Global Allergy and Asthma European Network; European Dermatology Forum (EAACI/GA2LEN/EDF) activity score. Patients with high PRL level had been given anti prolactin therapy to normalize their PRL levels. Then, the disease activity was reassessed in these patients. RESULTS: The serum PRL level was high in 8 of 40 (20%) patients (43.18 ± 12.81). Half of patients with high PRL level had remission after treatment of hyperprolactinemia (p = .001). CONCLUSIONS: Serum PRL levels could not be considered as a marker of the disease activity in CU patients.

Bacillus Calmette-Guerin, polysaccharide nucleic acid in the treatment of cutaneous and oral lichen planus.

The aim of this study was to evaluate the safety and efficacy of Bacillus Calmette-Guerin, polysaccharide nucleic acid (BCG-PSN) therapy in the treatment of oral and cutaneous LP. Twenty-four LP patients were included in this study and classified randomly into; Oral LP group (OLP), 11 patients and Cutaneous LP group (CLP), 13 patients. All patients received intradermal injections of BCG-PSN, twice weekly for three weeks. Patients with complete response were followed up for 3 months. The assessment in OLP was based on the reduction in the treated area, (Reticulation/Erythema/Ulceration) REU scoring system and numerical rating scale (NRS). CLP evaluated by the response to treatment as (complete, partial and no response) and visual analogue scale (VAS). There were highly significant differences in the diminution of lesion areas (p < .006), NRS scores (p < .001), REU score (p < .011), and VAS (p < .001) after treatment. The majority of patients achieved complete response after 3-week management. The BCG-PNS is safe and effective in the treatment of oral and cutaneous LP.

Amplify-and-forward cooperative diversity for green UWB-based WBSNs.

This paper proposes a novel green cooperative diversity technique based on suboptimal template-based ultra-wideband (UWB) wireless body sensor networks (WBSNs) using amplify-and-forward (AF) relays. In addition, it analyzes the bit-error-rate (BER) performance of the proposed nodes. The analysis is based on the moment-generating function (MGF) of the total signal-to-noise ratio (SNR) at the destination. It also provides an approximate value for the total SNR. The analysis studies the performance of equally correlated binary pulse position modulation (EC-BPPM) assuming the sinusoidal and square suboptimal template pulses. Numerical results are provided for the performance evaluation of optimal and suboptimal template-based nodes with and without relay cooperation. Results show that one relay node provides ~23 dB performance enhancement at 1e - 3 BER, which mitigates the effect of the nondesirable non-line-of-sight (NLOS) links in WBSNs.

Toward a highly accurate ambulatory system for clinical gait analysis via UWB radios.

In this paper, we propose and investigate a low-cost and low-complexity wireless ambulatory human locomotion tracking system that provides a high ranging accuracy (intersensor distance) suitable for the assessment of clinical gait analysis using wearable ultra wideband (UWB) transceivers. The system design and transceiver performance are presented in additive-white-gaussian noise and realistic channels, using industry accepted channel models for body area networks. The proposed system is theoretically capable of providing a ranging accuracy of 0.11 cm error at distances equivalent to interarker distances, at an 18 dB SNR in realistic on-body UWB channels. Based on real measurements, it provides the target ranging accuracy at an SNR = 20 dB. The achievable accuracy is ten times better than the accuracy reported in the literature for the intermarker-distance measurement. This makes it suitable for use in clinical gait analysis, and for the characterization and assessment of unstable mobility diseases, such as Parkinson's disease.