Combined Direct Tumoral Puncture Embolization with Onyx and Trans-arterial Embolization for JNA.

Onyx is a safe and effective embolic agent to utilize in the treatment paradigm of JNA. We present a tandem approach that combines trans-arterial embolization (TAE) with direct puncture embolization (DPE) with Onyx to limit blood loss and facilitate safe resection. Laryngoscope, 134:3568-3571, 2024.

Recurrence rates of de-novo versus inverted papilloma-transformed sinonasal squamous cell carcinoma: a meta-analysis.

BACKGROUND: There is a paucity of reporting on recurrence patterns of de-novo sinonasal squamous cell carcinoma (DN-SCC) and inverted-papilloma-transformed sinonasal squamous cell carcinoma (IP-SCC). METHOD: A systematic literature review queried studies comparing recurrence patterns in patients with both DN-SCC and IP-SCC. Primary outcomes included local and regional recurrence and rates of distant metastasis. Of the 595 studies screened, eight were included. RESULTS: Patients with DN-SCC had significantly higher rates of positive margins, advanced T classification (T3/T4), treatment with chemotherapy and radiotherapy. There were no significant differences in local recurrence or regional recurrence. Overall risk of distant metastasis was lower in IP-SCC. DN-SCC, compared to IP-SCC, is more likely to present with advanced TNM classification and have positive margins after surgical resection, which may affect rates of distant metastasis and recurrence. CONCLUSIONS: The findings in this study suggest IP-SCC may be a less aggressive malignancy compared to DN-SCC, with the possibility of a reduced role for adjuvant therapy in IP-SCC. Further studies are required to better understand differences in tumor biology and treatments strategies between IP-SCC and DN-SCC.

CD28 deficiency attenuates primary blast-induced renal injury in mice via the PI3K/Akt signalling pathway.

INTRODUCTION: Primary blast affects the kidneys due to direct shock wave damage and the production of proinflammatory cytokines without effective treatment. CD28 has been reported to be involved in regulating T cell activation and secretion of inflammatory cytokines. The aim of this study was to investigate the influence of primary blast on the kidney and the effect of CD28 in mice. METHODS: A mouse model of primary blast-induced kidney injury was established using a custom-made explosive device. The severity of kidney injury was investigated by H&E staining. ELISA was applied to study serum inflammation factors' expression. Western blot assays were used to analyse the primary blast-induced inflammatory factors' expression in the kidney. Immunofluorescence analysis was used to examine the PI3K/Akt signalling pathway. RESULTS: Histological examination demonstrated that compared with the primary blast group, CD28 deficiency caused a significant decrease in the severity of the primary blast-induced renal injury. Moreover, ELISA and western blotting revealed that CD28 deficiency significantly reduced the levels of interleukin (IL)-1ß, IL-4 and IL-6, and increased the IL-10 level (p<0.05). Finally, immunofluorescence analysis indicated that PI3K/Akt expression also changed. CONCLUSIONS: CD28 deficiency had protective effects on primary blast-induced kidney injury via the PI3K/Akt signalling pathway. These findings improve the knowledge on primary blast injury and provide theoretical basis for primary blast injury treatment.

Advancing Care for Head and Neck Cancers in a Multidisciplinary Tumour Board in the East.

Managing head and neck cancers is an excellent example of the importance of teamwork, with head and neck surgeons, clinical oncologists, radiologists, pathologists and other allied health professionals specialised in this disease site working together. The reliable imaging and dedicated pretreatment work-up entailing the comprehensive anatomical description of tumour involvement by the radiologists, the expertise of surgeons in performing en-bloc gross tumour resection, the uneventful speedy postoperative rehabilitation and recovery by the speech therapists and nutritionists, as well as the dedicated treatment planning of clinical oncologists in delivering precise preoperative or postoperative (chemo)radiotherapy to maximise the therapeutic potentials are the pillars of treatment success. A multidisciplinary tumour board involving all of these key players is essential to provide the highest level of recommendation based on evidence-based medicine and to bring patients new hopes and the best chance of cure. This review illustrates the seamless collaborative teamwork within a well-established multidisciplinary tumour board in managing one of the most intractable cancers in the East, taking enlightenment and inspiration from the West.

Outcomes of externalized pyeloureteral versus internal ureteral stent in pediatric robotic-assisted laparoscopic pyeloplasty.

INTRODUCTION: After pyeloplasty, urinary drainage options include internal double-J (DJ) ureteral stents or externalized pyeloureteral (EPU) stents, which can avoid bladder symptoms and additional anesthetic exposure from stent removal. Comparative outcome studies, however, are lacking following primary pediatric robotic-assisted laparoscopic pyeloplasty (RALP). OBJECTIVE: To compare operative success, operative time, hospitalization, and postoperative complications of EPU versus DJ stents following RALP. STUDY DESIGN: Consecutive children undergoing primary RALP from 10/2013 to 9/2015 were retrospectively identified. Data collected included patient demographics, stent type and duration, postoperative complications, and operative success. To control for confounding by indication for EPU stent, propensity score weighting was used to balance baseline covariates. Weighted regression analyses compared between-group differences in study outcomes. RESULTS: At median follow-up of 12.3 months, 44 and 17 patients underwent DJ and EPU stenting, respectively. At baseline, DJ stent patients were older than EPU stent patients (median 7.7 vs 1.2 years, P = 0.01) and were less likely to be on postoperative antibiotic prophylaxis (25 vs 76%, P < 0.001). After weighting, these differences disappeared. All EPU stents were removed in the outpatient clinic; all DJ stents were removed under anesthesia. On weighted regression analyses (Summary Fig.), EPU stents had no different associations than DJ stents with operative success (95 vs 94%, between-group difference 1%, 95% CI -11, 13; P = 0.86), complications, or operative time, but did have 0.6 of a day more hospitalization (95% CI 0.04, 1.2; P = 0.04). DISCUSSION: Patients receiving EPU stents were different at baseline from those receiving DJ stents. After propensity score weighting balanced these covariates, EPU stents were associated with similar operative success, complications, and operative time to DJ stents. Further study is warranted in larger prospective cohorts. CONCLUSION: Use of EPU stents provided a viable alternative, particularly in younger patients, to DJ stenting with comparable success and complications, while avoiding the need for an additional anesthetic.

Personnel dose reduction in 90Y microspheres liver-directed radioembolization: from interventional radiology suite to patient ward.

OBJECTIVE: To describe a method to reduce the external radiation exposure emitted from the patient after liver-directed radioembolization using 90Y glass microspheres, to quantitatively estimate the occupational dose of medical personnel providing patient care to the patient radioembolized with the use of the method and to discuss radiation exposure to patients who are adjacent if the patient radioembolized needs hospitalization. METHODS: A lead-lined blanket of lead equivalence of 0.5 mm was used to cover the patient abdomen immediately after the 90Y radioembolization procedure, in order to reduce the radiation emitted from the patient. The interventional radiologist used a rod-type puncture site compressor for haemostasis to avoid direct contact with possible residual radioactivity at the puncture site. Dose rates were measured at the interventional radiologist chest and hand positions during puncture site pressing for haemostasis with and without the use of the blanket. The measurement results were applied to estimate the occupational dose of colleagues performing patient care to the patient radioembolized. The exposure to patients adjacent in the ward was estimated if the patient radioembolized was hospitalized. RESULTS: The radiation exposures measured at the radiologist chest and hand positions have been significantly reduced with the lead-lined blanket in place. The radiologist, performing puncture site pressing at the end of radioembolization procedure, would receive an average hand dose of 1.95 µSv and body dose under his own lead apron of 0.30 µSv for an average 90Y microsphere radioactivity of 2.54 GBq. Other medical personnel, nurses and porters, would receive occupational doses corresponding to an hour of background radiation. If the patient radioembolized using 90Y needs hospitalization in a common ward, using the lead-lined blanket to cover the abdomen of the patient and keeping a distance of 2 m from the patient who is adjacent would reduce the exposure by 0.42% of dose limit for the general public. CONCLUSION: By placing a lead-lined blanket on the patient abdominal region after 90Y radioembolization, hospital staff receive minimal radiation exposure in order to comply with the radiation protection "as low as reasonably achievable" principle. There will be no increase in radiation level in ward if the patient radioembolized using 90Y needs to be hospitalized. Therefore, the patient radioembolized can be accommodated alternatively at a corner bed of a common ward if an isolation room with private toilet facility is not available. Advances in knowledge: To reduce exposure to personnel providing patient care to patients radioembolized using 90Y.

Insight into gene evolution within Cervidae and Bovidae through genetic variation in MHC-DQA in the black muntjac (Muntiacus crinifrons).

The critical role that the major histocompatibility complex plays in the immune recognition of parasites and pathogens makes its evolutionary dynamics exceptionally relevant to ecology, population biology, and conservation studies. The black muntjac is a rare deer endemic to a small mountainous region in eastern China. We found that this species has two DQA loci through cDNA expression and sequence variation analysis. The level of variation at both DQA loci was found to be extremely low (three alleles for DQA1 and four alleles for DQA2), possibly because of past bottlenecks and the species' relatively solitary behavior pattern. The ratio of d(N)/d(S) in the putative peptide binding region of the DQA2 locus (13.36, P = 0.012) was significantly larger than one but not that of DQA1 (0.94, P = 0.95), suggesting strong positive selection at the DQA2 but not at the DQA1 locus. This difference might reflect different sets of evolutionary selection pressures acting on the two loci. The phylogenetic tree showed that DQA1 alleles from two species of Cervidae and two of Bovidae grouped together, as did the DQA2 alleles. However, different genes from the four species were located in separate branches. These results lead us to suggest that these DQA alleles are derived from primordial DQA genes from a common ancestor and are maintained in Cervidae and Bovidae since their divergence around 25.5-27.8 million years ago.

The lack of genotoxicity of sodium fluoride in a battery of cellular tests.

In a comprehensive assessment of genotoxicity, sodium fluoride was evaluated in a battery of cellular tests providing different genetic end points and biotransformation capabilities. The tests included the following: rat hepatocyte primary culture/DNA repair assay, Salmonella typhimurium histidine locus reversion assay, adult rat liver epithelial cell/hypoxanthine guanine phosphoribosyl transferase mutation assay, and sister chromatid exchange in two target cell types, human peripheral blood lymphocytes and Chinese hamster ovary cells. Negative findings were made in all assays, indicating that sodium fluoride is not genotoxic in these assays.

Concentration multiplicity in a draft tube fluidized-bed bioreactor involving two limiting substrates.

Concentration multiplicity in a two-phase or three-phase draft tube fluidized-bed bioreactor containing biofloc particles is studied. The kinetics of biological reactions considered involve two limiting substrates. The necessary and sufficient conditions for concentration multiplicity in both the biofilm and bioreactor are examined in terms of effectiveness factor, inlet and bulk concentration of substrates, and liquid flow rate. Hysteresis behavior in both the biofilm and bioreactor and multiplicity of concentration profiles in the biofilm are also discussed.

Substrate specificity and mode of action of the cellulases from the thermophilic fungus Thermoascus aurantiacus.

The substrate specificities of three cellulases and a beta-glucosidase purified from Thermoascus aurantiacus were examined. All three cellulases partially degraded native cellulose. Cellulase I, but not cellulase II and cellulase III, readily hydrolyzed the mixed beta-1,3; beta-1,6-polysaccharides such as carboxymethyl-pachyman, yeast glucan and laminarin. Both cellulase I and the beta-glucosidase degraded xylan, and it is proposed that the xylanase activity is an inherent feature of these two enzymes. Lichenin (beta-1,4; beta-1,3) was degraded by all three cellulases. Cellulase II cannot degrade carboxymethyl-cellulose, and with filter paper as substrate the end product was cellobiose, which indicates that cellulase II is an exo-beta-1,4-glucan cellobiosylhydrolase. Degradation of cellulose (filter paper) can be catalysed independently by each of the three cellulases; there was no synergistic effect between any of the cellulases, and cellobiose was the principal product of degradation. The mode of action of one cellulase (cellulase III) was examined by using reduced cellulodextrins. The central linkages of the cellulodextrins were the preferred points of cleavage, which, with the rapid decrease in viscosity of carboxymethyl-cellulose, confirmed that cellulase III was an endocellulase. The rate of hydrolysis increased with chain length of the reduced cellulodextrins, and these kinetic data indicated that the specificity region of cellulase III was five or six glucose units in length.

Purification and properties of the cellulases from the thermophilic fungus Thermoascus aurantiacus.

Three cellulases and a beta-glucosidase were purified from the culture filtrate of the thermophilic fungus Thermoascus aurantiacus. The isolated enzymes were all homogeneous on polyacrylamide-disc-gel electrophoresis. Data from chromatography on Bio-Gel P-60 and sodium dodecyl sulphate/polyacrylamide-gel electrophoresis indicated mol.wts. of 87000 (beta-glucosidase), 78000 (cellulase I), 49000 (cellulase II) and 34000 (cellulase III); the carbohydrate contents of the enzymes were 33.0, 5.5, 2.6 and 1.8% (w/w) respectively. Although the three purified cellulases were active towards filter paper, only cellulases I and III were active towards CM(carboxymethyl)-cellulose. Cellulase I was also active towards yeast glucan. The Km and catalytic-centre-activity values for the enzymes were as follows; 0.52 mumol/ml and 6.5 X 10(4) for beta-glucosidase on p-nitrophenyl beta-D-glucoside, 3.9 mg/ml and 6.3 for cellulase I on CM-cellulose, 1.2 mg/ml and 1.1 for cellulase I on yeast glucan, 35.5 mg/ml and 0.34 for cellulase II on filter paper, and 1.9 mg/ml and 33 for cellulase III on CM-cellulose.