Haemobilia due to hepatic artery pseudoaneurysm

An 83-year-old woman with a history of hepaticoduodenostomy 20 years ago was admitted with upper gastrointestinal bleeding. Emergency upper gastrointestinal endoscopy revealed multiple blood clots over the stomach and first and second parts of the duodenum. The cannulation of the biliary tree with a flexible end-viewing endoscope exposed the presence of blood clot inside biliary lumen and a semipedunculated polyp which, at first, appeared to be the cause of haemorrhage. A few days after polypectomy, patient was discharged home, however, was admitted again with massive bleeding and selective angiography demonstrated a pseudoaneurysm of left hepatic artery. Angioembolisation was performed and haemorrhage was stopped afterwards.

http://ift.tt/2s8OIwB

Giant cell tumor in the sphenoid sinus and ethmoid sinus during childhood, and it is thought that optic atrophy was caused by compressive optic neuropathy.

http://orlhealth.blogspot.com/2017/05/giant-cell-tumor-in-sphenoid-sinus-and.html

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com

Involvement of M2 macrophages in the pathomechanisms of multicentric reticulohistiocytosis

http://ift.tt/2rhWoyQ

Comments regarding “Four cases of mucous membrane pemphigoid with clinical features of oral lichen planus” and on the utility of immunofluorescence

http://ift.tt/2sg4Ziu

“Influence of possible predictor variables on the outcome of primary oral squamous cell carcinoma: a retrospective study of 392 consecutive cases at a single centre”— methodological issues

We read the paper by Loeffelbein and colleagues, published online in the International Journal of Oral and Maxillofacial Surgery in December 2016, with enthusiasm1. The authors aimed to examine tumour-specific and patient-related risk factors in a large single-centre cohort, i.e., factors that have a considerable effect on postoperative survival following ablative tumour surgery with elective neck dissection and immediate microvascular reconstruction in oral squamous cell carcinoma. It was concluded that postoperative survival does not depend only on tumour-related characteristics.

http://ift.tt/2s8G01s

Detection of gastric atrophy by circulating pepsinogens: A comparison of three assays

Abstract

Background

Circulating levels of pepsinogens have been used in high gastric cancer-risk Asian and European populations to triage endoscopic evaluation for more severe pathology. There are different analytic methods with uncertain correlations. We therefore compared diagnostic performance of three commonly used pepsinogen assays to detect histologically confirmed gastric atrophy.

Methods

We tested plasma samples from adult patients with (n=50) and without (n=755) moderate or severe gastric corpus atrophy, as determined histologically by consensus of three expert pathologists. A single laboratory measured pepsinogens I (PgI) and II (PgII) using commercially available assays: two ELISA assays produced by Biohit (Finland) and Vector Best (Russia), and a latex agglutination assay from Eiken (Japan). Quantitative correlations were assessed by Spearman statistics. Receiver operating characteristic (ROC) curves vs histological diagnosis were calculated using both the manufacturers' and optimized cutoffs.

Results

Pepsinogen levels were highly correlated among the assays (pairwise Rhos: PgI≥0.84, PgII≥0.87; all P-values<.01). Based on manufacturers' cutoffs, sensitivities, specificities and areas under the ROC curve for detecting moderate to severe histological corpus atrophy by PgI/PgII were 44%/91%/0.70, 56%/84%/0.76, and 52%/90%/0.77 for Biohit, Vector Best and Eiken, respectively. Cutoffs optimized by ROC or data mining analyses did not substantially improve test performance.

Conclusions

Commercial assays for pepsinogen have good relative agreement but are imperfect tests for clinical diagnosis of gastric atrophy.

Impact

Pepsinogen testing alone does not provide sufficient information for gastric cancer risk stratification. Future investigations should focus on other potential markers, in combination with pepsinogens.

http://ift.tt/2rhxjEd

Gillies temporal incision: an alternate approach to superficial temporal artery biopsy

The main complications of a biopsy of the superficial temporal artery using a standard preauricular approach include scars on the face, weakness of the temporal branch of the facial nerve, and the possible harvest of a disease-free segment of artery. We describe a modification of the Gillies temporal approach, which when placed at the junction of the frontal and parietal branch can be easily modified to harvest either branch. It avoids scarring to the face as it is hidden within the hairline. The incision placed with specific measurements and palpation is easily reproducible.

http://ift.tt/2ryZNdq

Re: Wrong tooth extraction: an examination of ‘Never Event’ data

I read with interest the recent study by Pemberton et al concerning wrong tooth extractions.1 In many ways it is surprising that extraction of a wrong tooth is the most common wrong site event, given that many of these procedures are done under local anaesthesia and the patient often knows which tooth or teeth are to be removed. Although the authors were not able to comment on the causes, as with many cases of human error, they are likely to be multifactorial. Ineffective communication is widely regarded as one of the highest causes of error.

http://ift.tt/2s8fa9O

Local effects of epidermal growth factor on the wound healing in esophageal anastomosis: An experimental study

Publication date: August 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 99
Author(s): Ayşe Bülbül Adam, Mustafa Yaşar Özdamar, Hacı Hasan Esen, Engin Günel
ObjectiveIn this study with the experimental model of primary repair of esophageal atresia(EA), we investigated the effects of the epidermal growth factor(EGF) on wound healing in the anastomosis of EA.Materials and methodsForty rabbits that were performed a resection of a 1-cm segment of the cervical esophagus followed by the end-to-end anastomosis were divided into four groups. Group I (7-day group) and III (21-day group), the control groups, had no EGF applied to the anastomosis. In group II (7-day group) and group III (21-day group), all around the anastomoses were locally covered with 100 μg/kg EGF. Group 1, 2 and 3, 4 were sacrificed on the 7th and 21st day, respectively. We investigated and compared with bursting pressure, vascularization around the anastomotic line by histopathology, inflammation, and fibroblast granulation as well as hydroxyproline level by biochemical.ResultsNo significant difference was found at vascularization and inflammation between all of the groups (p > 0.05). Considering the critical parameters of the groups, at bursting pressure difference was found between group 1 and 2 as well as 3 and (p < 0.05). At fibroblast granulation and hydroxyproline level, no difference was found between group 1 and 2 (p > 0.05) but the difference between group 3 and 4 (p < 0.05).ConclusionEGF might be useful in preventing anastomotic leakage of esophageal atresia in primary anastomosis of esophageal atresia by accelerating wound healing process and increasing the stability of the anastomotic line.



http://ift.tt/2sfeyP1

An evaluation of oxidative and nitrosative stress in children-who-stutter and its relationship to severity

Publication date: August 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 99
Author(s): Nagihan Bilal, Selman Sarica, Ergül Belge Kurutas, Ebru Findikli, İsrafil Orhan, Erkan Oner, Adem Doganer, Saime Sagiroglu, Mehmet Akif Kilic
ObjectivesAlthough there has been much research into the cause of stuttering, it has not yet been fully clarified. There is known to be a close relationship between stress severity and stuttering. The aim of this study was to evaluate the levels of oxidative and nitrosative stress by comparing a stuttering group and a control group. It was also aimed to evaluate the relationship between the oxidative and nitrosative stress levels and the severity of the stutter.MethodsThe study included a total of 80 individuals, comprising a study group of 40 and a control group of 40. The severity of the stutter in the patient group was evaluated with the Stuttering Severity Instrument 3 (SSI). Blood samples were taken from both the patient and control groups and malondialdehyde (MDA), 3 nitrotyrosine (3-NT), nitric oxide (NO), catalase (CAT), and superoxide dismutase (SOD) concentrations were examined.ResultsIn the stuttering patients, MDA, 3-NT, NO, CAT, and SOD activity were determined to be statistically significantly higher than those of the control group (all p:0.001). In the ROC analysis, there was good diagnostic value for NO, with the area under the curve as 1.0. A direct, positive, statistically significant correlation was determined between SSI points and MDA values (r = 0.317, p = 0.046).ConclusionThe results of the study showed that the oxidative and nitrosative stress levels of the stuttering patients were higher than those of the control group. With 100% sensitivity and specificity, it is thought that NO in particular could be important for the diagnosis and treatment of these patients. As the severity of the stutter increased, so there was an increase in MDA, suggesting that MDA is important in stuttering.



http://ift.tt/2rhoZEd

Airway stenting in a child with spondyloepiphyseal dysplasia congenita: 13-Year survival

Publication date: August 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 99
Author(s): Raffaella Nenna, Fabio Midulla, Laura Masi, Giacomo Maria Bacci, Antonella Frassanito, Roberto Baggi, Maria Luisa Brandi, Stefano Avenali, Lorenzo Mirabile, Paola Serio
We describe the case of a boy with spondyloepiphyseal dysplasia congenita. At birth, he experienced severe respiratory distress necessitating tracheotomy. Endoscopy done because mechanical ventilation failed to resolve desaturations disclosed severe tracheo-bronchomalacia. A Polyflex silicone stent was placed in the trachea (replaced by Y-Dumon stent) and 2 Palmaz metallic stents in the mainstem bronchi (overlapped with 2 Jomed stents 5 years later). Airway stenting guaranteed a suitable respiratory status and allowed a child who was expected to die at birth, to reach 13.5 years old in good conditions.



http://ift.tt/2sf7yS0

Evolving Concepts in Atopic Dermatitis

Abstract

Purpose of Review

Tremendous advances have been made in the field of atopic dermatitis in the past 5 years. We will explore developments in burden of disease, co-morbidities, pathogenesis, prevention, and management.

Recent Findings

The tremendous burden moderate to severe atopic dermatitis (AD) places on families from a medical, psychosocial, and financial perspective has been characterized. Epidemiologic studies have identified intriguing new associations beyond the well-characterized "atopic march" of food allergies, asthma, and hay fever. Studies of primary prevention have gained traction including the remarkable impacts of early emollient therapy. Basic advances have simultaneously elucidated the nature of atopic inflammation, setting the stage for an explosion of new potential therapeutic targets. After a fallow period of nearly 15 years without a substantial therapeutic advance, this year has already seen two new FDA-approved treatments for AD.

Summary

AD has a tremendous impact on quality of life with an underappreciated burden of disease; there are important newly described co-morbidities including ADHD and anemia; new insights into etio-pathogenesis have paved the way for novel topical therapies like crisaborole, and new systemic interventions like dupilumab.

http://ift.tt/2qu0j8t

T Cells in Allergic Asthma: Key Players Beyond the Th2 Pathway

Abstract

Asthma is a common chronic lung disease that affects 300 million people worldwide. It causes the airways of the lungs to swell and narrow due to inflammation (swelling and excess mucus build-up in the airways) and airway constriction (tightening of the muscles surrounding the airways). Atopic asthma is the most common form of asthma, and is triggered by inhaled allergens that ultimately promote the activation of the Th2-like T cells and the development of Th2-mediated chronic inflammation. Different subsets of T cells, including T follicular helper cells, tissue-resident T, cells and Th2 effector cells, play different functions during allergic immune response. Dendritic cells (DCs) are known to play a central role in initiating allergic Th2-type immune responses and in the development of the T cell phenotype. However, this function depends on the complex interaction with other cells of the immune system and determines whether the response to environmental allergens will be one of tolerance or allergic inflammation. This review discusses cell interactions leading to the initiation and maintenance of allergic Th2-type immune responses, particularly those associated with allergic asthma.

http://ift.tt/2rNRr15

Evolving Concepts in Atopic Dermatitis

Abstract

Purpose of Review

Tremendous advances have been made in the field of atopic dermatitis in the past 5 years. We will explore developments in burden of disease, co-morbidities, pathogenesis, prevention, and management.

Recent Findings

The tremendous burden moderate to severe atopic dermatitis (AD) places on families from a medical, psychosocial, and financial perspective has been characterized. Epidemiologic studies have identified intriguing new associations beyond the well-characterized "atopic march" of food allergies, asthma, and hay fever. Studies of primary prevention have gained traction including the remarkable impacts of early emollient therapy. Basic advances have simultaneously elucidated the nature of atopic inflammation, setting the stage for an explosion of new potential therapeutic targets. After a fallow period of nearly 15 years without a substantial therapeutic advance, this year has already seen two new FDA-approved treatments for AD.

Summary

AD has a tremendous impact on quality of life with an underappreciated burden of disease; there are important newly described co-morbidities including ADHD and anemia; new insights into etio-pathogenesis have paved the way for novel topical therapies like crisaborole, and new systemic interventions like dupilumab.

http://ift.tt/2qu0j8t

T Cells in Allergic Asthma: Key Players Beyond the Th2 Pathway

Abstract

Asthma is a common chronic lung disease that affects 300 million people worldwide. It causes the airways of the lungs to swell and narrow due to inflammation (swelling and excess mucus build-up in the airways) and airway constriction (tightening of the muscles surrounding the airways). Atopic asthma is the most common form of asthma, and is triggered by inhaled allergens that ultimately promote the activation of the Th2-like T cells and the development of Th2-mediated chronic inflammation. Different subsets of T cells, including T follicular helper cells, tissue-resident T, cells and Th2 effector cells, play different functions during allergic immune response. Dendritic cells (DCs) are known to play a central role in initiating allergic Th2-type immune responses and in the development of the T cell phenotype. However, this function depends on the complex interaction with other cells of the immune system and determines whether the response to environmental allergens will be one of tolerance or allergic inflammation. This review discusses cell interactions leading to the initiation and maintenance of allergic Th2-type immune responses, particularly those associated with allergic asthma.

http://ift.tt/2rNRr15

Cytokine storm and sepsis disease pathogenesis

Abstract

Infectious diseases are a leading cause of death worldwide. Sepsis is a severe clinical syndrome related to the host response to infection. The severity of infections is due to an activation cascade that will lead to an autoamplifying cytokine production: the cytokine storm. Cytokines are a broad category of relatively small proteins (<40 kDa) that are produced and released with the aim of cell signaling. Our understanding of the processes that trigger this tremendous amount of cytokine production has made dramatic progress over the last decades, but unfortunately, these findings could not translate yet into effective treatments; so far, all clinical trials targeting cytokine production or effects failed. This review aims to summarize the pathophysiology of the cytokine storm; to describe the type, effects, and kinetics of cytokine production; and to discuss the therapeutic challenges of targeting cytokines. New promising therapeutic strategies focusing on the endothelium, as a source and a target of cytokines, are described.

http://ift.tt/2rdrzJr

Molecular pathogenesis of viral hemorrhagic fever

Abstract

The clinical syndrome referred to as viral hemorrhagic fever (VHF) can be caused by several different families of RNA viruses, including select members of the arenaviruses, bunyaviruses, filoviruses, and flaviviruses. VHF is characterized by malaise, fever, vascular permeability, decreased plasma volume, coagulation abnormalities, and varying degrees of hemorrhage. Study of the filovirus Ebola virus has demonstrated a critical role for suppression of innate antiviral defenses in viral pathogenesis. Additionally, antigen-presenting cells are targets of productive infection and immune dysregulation. Among these cell populations, monocytes and macrophages are proposed to produce damaging inflammatory cytokines, while infected dendritic cells fail to undergo proper maturation, potentially impairing adaptive immunity. Uncontrolled virus replication and accompanying inflammatory responses are thought to promote vascular leakage and coagulopathy. However, the specific molecular pathways that underlie these features of VHF remain poorly understood. The arenavirus Lassa virus and the flavivirus yellow fever virus exhibit similar molecular pathogenesis suggesting common underlying mechanisms. Because non-human primate models that closely mimic VHF are available for Ebola, Lassa, and yellow fever viruses, we propose that comparative molecular studies using these models will yield new insights into the molecular underpinnings of VHF and suggest new therapeutic approaches.

http://ift.tt/2qt0J2W

Genetics of rheumatoid arthritis susceptibility, severity, and treatment response

Abstract

A decade after the first genome-wide association study in rheumatoid arthritis (RA), a plethora of genetic association studies have been published on RA and its clinical or serological subtypes. We review the major milestones in the study of the genetic architecture of RA susceptibility, severity, and response to treatment. We set the scientific context necessary for non-geneticists to understand the potential clinical applications of human genetics and its significance for a stratified approach to the management of RA in the future.

http://ift.tt/2rdomts

New fronts emerge in the influenza cytokine storm

Abstract

Influenza virus is a significant pathogen in humans and animals with the ability to cause extensive morbidity and mortality. Exuberant immune responses induced following infection have been described as a "cytokine storm," associated with excessive levels of proinflammatory cytokines and widespread tissue damage. Recent studies have painted a more complex picture of cytokine networks and their contributions to clinical outcomes. While many cytokines clearly inflict immunopathology, others have non-pathological delimited roles in sending alarm signals, facilitating viral clearance, and promoting tissue repair, such as the IL-33—amphiregulin axis, which plays a key role in resolving some types of lung damage. Recent literature suggests that type 2 cytokines, traditionally thought of as not involved in anti-influenza immunity, may play an important regulatory role. Here, we discuss the diverse roles played by cytokines after influenza infection and highlight new, serene features of the cytokine storm, while highlighting the specific functions of relevant cytokines that perform unique immune functions and may have applications for influenza therapy.

http://ift.tt/2qsC5j0

In vitro differentiated plasmacytoid dendritic cells as a tool to induce anti-leukemia activity of natural killer cells

Abstract

Acute lymphoblastic leukemia (ALL) is believed to be resistant to NK cell-mediated killing. To overcome this resistance, we developed an innovative approach based on NK cell stimulation with Toll-like receptor (TLR)-activated plasmacytoid dendritic cells (pDC). The translation of this approach into the clinic requires the production of high numbers of human pDC. Herein, we show that in vitro differentiation of cord blood CD34⁺ progenitors in the presence of aryl hydrocarbon receptor antagonists gives rise to clinically relevant numbers of pDC, as about 10⁸ pDC can be produced from a typical cord blood unit. Blocking the aryl hydrocarbon receptor (AHR) pathway significantly increased the yield of pDC. When compared to pDC isolated from peripheral blood, in vitro differentiated pDC (ivD-pDC) exhibited an increased capacity to induce NK cell-mediated killing of ALL. Although ivD-pDC produced lower amounts of IFN-α than peripheral blood pDC upon TLR activation, they produced more IFN-λ2, known to play a critical role in the induction of anti-tumoral NK cell functions. Both TLR-9 and TLR-7 ligands triggered pDC-induced NK cell activation, offering the possibility to use any clinical-grade TLR-7 or TLR-9 ligands in future clinical trials. Finally, adoptive transfer of ivD-pDC cultured in the presence of an AHR antagonist cured humanized mice with minimal ALL disease. Collectively, our results pave the way to clinical-grade production of sufficient numbers of human pDC for innate immunotherapy against ALL and other refractory malignancies.

http://ift.tt/2rOmVV5

The critical amino acids of a nephritogenic epitope on human Goodpasture autoantigen for binding to HLA-DRB1*1501

Publication date: August 2017
Source:Molecular Immunology, Volume 88
Author(s): Qiu-hua Gu, Xiao-yu Jia, Jian-nan Li, Fang-jin Chen, Zhao Cui, Ming-hui Zhao
BackgroundAnti-GBM disease is caused by autoimmunity to Goodpasture antigen on α3(IV)NC1 and had strong associations with HLA-DRB1*1501. Previous studies identified α3127-148 (P14: TDIPPCPHGWISLWKGFSFIMF) as a T cell epitope. The present study was aimed to investigate the binding capacity of P14 to HLA-DRB1*1501 and the critical amino acids for this binding.MethodsA line of EBV-transformed human B cells homozygous for HLA-DRB1*1501 was used to detect the binding capacity of peptides to HLA-DRB1*1501 using flow cytometry analysis. P14 was sequentially truncated into 8 peptides with 15 amino acids to identify the core binding motif. A set of alanine substituted peptides of P14-2 was then synthesized to identify its critical residues for binding to HLA-DRB1*1501. The structure of HLA-DR2b-Peptide-TCR complex was constructed by modeling to analyze the interaction of each amino acids of P14-2 with the HLA-DR2b molecule.ResultsP14 could bind to HLA-DRB1*1501 expressed on B cell surface. The N-terminus of P14 was the core binding motif and the truncated peptide P14-2 (DIPPCPHGWISLWKG) 128-142 had the strongest binding capacity. After sequential amino acid substitution, we found the binding capacity of P14-2 was completely lost by the substitution of cysteine (C) 132 and significantly decreased by the substitution of tryptophan (W) 136, lysine (K) 141, or glycine (G) 142, but still at a high level. The modeling showed that (C) 132 had a strong interaction with pocket 4 on the β chain of DR2b. Thus, C132, W 136, K141, and G142 were defined as the critical amino acid residues for the binding capacity of P14 to HLA-DRB1*1501.ConclusionWe identified α3128-142 (DIPPCPHGWISLWKG) as the core binding motif of P14 to HLA-DRB1*1501 molecule. And the critical amino acid residues for this binding were further defined as C132, W 136, K 141, and G 142.



http://ift.tt/2rda77H

Gillies temporal incision: an alternate approach to superficial temporal artery biopsy

Publication date: Available online 29 May 2017
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): G. Markose, R.M. Graham
The main complications of a biopsy of the superficial temporal artery using a standard preauricular approach include scars on the face, weakness of the temporal branch of the facial nerve, and the possible harvest of a disease-free segment of artery. We describe a modification of the Gillies temporal approach, which when placed at the junction of the frontal and parietal branch can be easily modified to harvest either branch. It avoids scarring to the face as it is hidden within the hairline. The incision placed with specific measurements and palpation is easily reproducible. In patients with giant cell arteritis, arterial wall thickening, and narrowing of the lumen, reduced blood flow makes it harder to identify the artery with a Doppler scan. A procedure based on measurements and palpation is therefore likely to yield better results.



http://ift.tt/2rOMFAD

Re: Wrong tooth extraction: an examination of ‘Never Event’ data

Publication date: Available online 29 May 2017
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): P.A. Brennan




http://ift.tt/2qvjSNm

Rapid Cataract Progression after Nd:YAG Vitreolysis for Vitreous Floaters: A Case Report and Literature Review

Purpose: We report a case of rapid cataract progression after Nd:YAG vitreolysis for vitreous floaters. Case Report: A 55-year-old man presented with acute onset of blurred vision following Nd:YAG vitreolysis for symptomatic floaters in the left eye. His initial best corrected visual acuity (BCVA) was 20/1,000 in the left eye. Ocular examinations showed frost-like opacities of the lens and a suspected break of the posterior capsule in the left eye. There were no detectable retinal lesions. Cataract surgery was then arranged. Posterior capsular rupture and vitreous loss occurred during surgery, which required a subsequent pars plana vitrectomy. After the surgery, BCVA in the left eye gradually improved to 20/20 and was maintained during a 1-year follow-up period. Conclusion: Crystalline lens injuries and rapid cataract progression may occur following Nd:YAG vitreolysis. While dealing with this type of complicated cataract, clinicians should be aware of the possibility of posterior lens capsule rupture during surgery and the need for combined vitrectomy.
Case Rep Ophthalmol 2017;8:321–325

http://ift.tt/2quCPjC

Spironolactone as an Adjunctive Treatment in Neovascular Age-Related Macular Degeneration

Neovascular age-related macular degeneration (AMD) is a potentially sight-threatening condition. The current standard-of-care treatment regimen is serial intravitreal antivascular endothelial growth factor injections. While these typically have great success, they do carry exceptional treatment burden on the patient, cost burden due to their required frequency of use, and the risk of endophthalmitis, which can be devastating. This case report explores an alternative potential option as a treatment adjunct for neovascular AMD (nAMD), and identifies some of the overlap between nAMD and central serous chorioretionpathy. Future research is needed to better understand the role of mineralocorticoid receptor antagonist treatment in this disease spectrum.
Case Rep Ophthalmol 2017;8:314–320

http://ift.tt/2rOAxzx

Multiquadrant Subtenon Triamcinolone Injection for Acute Corneal Graft Rejection: A Case Report

Background: We report a case of reversal of an acute corneal graft rejection following multiquadrant subtenon triamcinolone injection. Case Presentation: A 19-year-old woman who had acute corneal graft rejection failed to show resolution of the graft rejection after standard treatment with systemic, intravenous, and topical steroids. The graft rejection, however, responded to injection of triamcinolone in multiple subtenon quadrants. Conclusions: For corneal graft rejection, multiquadrant subtenon triamcinolone injections may be a safe adjunct to systemic treatment.
Case Rep Ophthalmol 2017;8:308–313

http://ift.tt/2quVbAX

A Case of Childhood-Onset Giant Cell Tumor that Caused Optic Nerve Atrophy in Both Eyes

Purpose: The purpose of this study was to report the case of a female patient who had a giant cell tumor in the paranasal sinus during childhood, and while undergoing multiple resection surgeries experienced optic atrophy in both eyes. Case Presentation: This study involved a 35-year-old woman who was previously diagnosed with a giant cell tumor of the paranasal sinus bone at age 13. A CT scan revealed a large tumor extending from the sphenoid sinus to the ethmoid sinus. At age 14, a tumor resection was performed in conjunction with radiation therapy. However, after resection and radiation therapy there were repeated recurrences, and additional resections were performed. Ophthalmically, there was marked optical atrophy in both eyes, and Goldmann visual field perimetry revealed that only the arcuate peripheral area remained on the nasal side of the right eye, and that there were dark spots in the paracentral area of the left eye. Conclusions: In this case, a large giant cell tumor occurred in the sphenoid sinus and ethmoid sinus during childhood, and it is thought that optic atrophy was caused by compressive optic neuropathy. The sphenoid sinus and ethmoid sinuses are anatomically close to the optic nerve, and when a tumor grows larger at this site it can easily put pressure on the optic nerve. Therefore, early detection and treatment are important.
Case Rep Ophthalmol 2017;8:301–307

http://ift.tt/2rOJed3

Professor Enrico Mihich, 1928–2016

http://ift.tt/2rd78wm

Peripheral blood T cell alterations in newly diagnosed diffuse large B cell lymphoma patients and their long-term dynamics upon rituximab-based chemoimmunotherapy

Abstract

The importance of T cell-dependent immune responses in achieving long-term cure of chemoimmunotherapy-treated cancer patients is underscored by the recently described "vaccinal effect" exerted by therapeutic mAbs. In accordance, pre- and post-therapy peripheral blood lymphopenia represents a well-established negative prognostic factor in DLBCL. We analyzed the phenotypic and functional (IFNγ production, and Granzyme B (GrzB) cytotoxic granule marker expression) profile of peripheral blood T lymphocyte subsets ("conventional" CD4⁺ and CD8⁺, FOXP3⁺CD25^bright Treg, and "innate-like" CD56⁺) in DLBCL patients at diagnosis, and assessed the long-term impact of R-CHOP chemoimmunotherapy, in a prospective study. At diagnosis, DLBCL patients showed lower lymphocyte counts, due to selective decrement of CD4⁺ T (including Treg) and B lymphocytes. While all T cell subsets transiently decreased during therapy, CD4⁺ T cell and Treg remained significantly lower than controls, up to 1 year after R-CHOP. Phenotypically skewed profile of CD4⁺ and CD8⁺ T cell subsets associated with higher frequencies of IFNγ⁺ and GrzB⁺ cells at diagnosis, that transiently decreased during therapy, and re-attained persistently elevated levels, till up to 1 year after therapy. Differently, the pre-therapy elevated levels of circulating monocytes, and of plasma IL-6 and IL-10 rapidly normalized upon R-CHOP. In sum, we describe a quantitatively and functionally altered status of the peripheral blood T cell compartment in DLBCL patients at diagnosis, that persists long-term after tumor eradication, and it is only transiently perturbed by R-CHOP chemoimmunotherapy. Moreover, data suggest the association of selected T cell functional features with DLBCL phenotype, and with therapy outcome.

http://ift.tt/2rOq6vY

The cellular character of liquefaction degeneration in oral lichen planus and the role of Interferon gamma

Abstract

Background

Oral lichen planus (OLP) is a T-cell-mediated chronic inflammatory oral mucosal disease of unknown etiology, liquefaction degeneration in the basal keratinocytes is one of the specific histological changes. However, the understanding of liquefaction degeneration is still very limited, and how does it affect the prognosis of LP is largely unknown. Therefore, the objective of this study is to clarify the intrinsic change behind the liquefaction degeneration in lichen planus, and evaluate the effect of the OLP typical cytokines IFN-γon these changes.

Materials And Methods

Biopsies were collected from OLP patients, immunochemistry staining was performed to analysed E-cadherin, vimentin, CK19, β1 integrin, nestin, STAT1 and STAT3 expression. Primary oral epithelial cells were cultured in vitro, 20ng/ml IFN-γwas applied to assay the effect on epithelial cells.

Results

E-cadherin expression was decreased but vimentin expression was increased in the OLP epithelial cells undergo liquefaction degeneration, showing the typical epithelial-mesenchymal transition (EMT) alteration. In vitro research showed that OLP typical cytokine, IFN-γpossesses EMT inducing ability, and the primary oral epithelial cells stimulated by IFN-γacquired some properties of cancer stem cells, expressing moreβ1 integrin,α6 integrin and nestin. In addition, the major downstream mediator of IFN-γreceptors, STAT1 was expressed more intensive and extensive with the malignant transition of OLP.

Conclusion

Liquefaction degeneration in oral lichen planus is an EMT phenomenon, the IFN-γ may be the main inducer, and IFN-γsignaling might be implicated in malignant transition of OLP.

This article is protected by copyright. All rights reserved.

http://ift.tt/2s6AfBg

Effects of comorbidity and medication use on the haemodynamic status during office-based laryngeal procedures: a prospective cohort study

Abstract

Objective

Office-based laryngeal procedures are emerging as effective alternative modalities for vocal disorders. This study systematically investigates the haemodynamic status of patients, specifically focusing on the potential effects of underlying comorbidity and medication use.

Design

Prospective cohort study.

Setting

Tertiary referral center.

Participants

We prospectively recruited 214 consecutive patients who received office-based laryngeal procedures during January–December 2015. All procedures were performed under local anaesthesia without sedation, in an upright (sitting) position.

Main outcome measures

We measured heart rate, systolic and diastolic blood pressure, and oxygen saturations at baseline (before procedure), immediately after local anaesthesia to the pharynx and larynx, immediately after completing of procedure, and 20 min after the procedure.

Results

Systolic, diastolic blood pressures and heart rate all significantly increased after local anaesthesia, and gradually decreased after the procedure (p<0.01). Oxygen concentration remained unchanged. Patients with comorbidity and those receiving vasoactive medications showed significantly higher perioperative blood pressures than the other patients (p<0.05), but the trend remained similar. Prominent hypertension (systolic ≥160 mmHg or diastolic ≥ 100 mmHg) were noted in 17 patients, more commonly in patients with older age, higher baseline blood pressures, and receiving vasoactive medications. Only 2% of patients with normal baseline measurements developed prominent hypertension perioperatively. Tachycardia (heart rate ≥ 100 bpm) developed in 22 patients, more frequently in patients with higher baseline heart rates, and perceiving greater discomforts.

Conclusion

This study revealed that routine haemodynamic monitoring may not be necessary for all the office-based laryngeal procedures, but should be considered for older patients, those with higher baseline blood pressure or heart rate, sensitive patients who might be more susceptible to perioperative discomfort, and those receiving vasoactive medications.

This article is protected by copyright. All rights reserved.

http://ift.tt/2rfksCa

An Exceptional Case of Intraparotid Plexiform Neurofibroma Originating from Autonomic Fibers of the Auriculotemporal Nerve

Plexiform neurofibromas are benign tumors that tend to occur in patients suffering from neurofibromatosis type 1 (NF-1). This report addresses a rare case where the tumor affected the parotid gland, deriving almost exclusively from the peripheral portion of the facial nerve. A 6-year-old male was referred to us complaining about a gradually enlarging swelling over the right parotid area. Imaging localized the lesion to the superficial lobe of the parotid gland, suggesting a neurofibroma. Cosmetic disfigurement and a functional deficit led us to perform complete surgical resection. Meticulous surgical dissection as well as auriculotemporal nerve origin made complete extirpation possible with almost zero morbidity and ensured alleviation of both aesthetic impairment and pain. This is the first case of an intraparotid PN in a pediatric NF-1 patient, which originated from branches of the auriculotemporal nerve and particularly from fibers of the autonomic nervous system. Radical surgical excision was decided according to established decision-making algorithms.

http://ift.tt/2qz2JBE

Psychological impact of a genetic diagnosis on hearing impairment – an exploratory study

Abstract

Objective

Genetic testing for hereditary hearing impairment has become more routinely available as a diagnostic tool in the outpatient clinic. However, little is known about the psychological impact of a genetic diagnosis. To evaluate this impact, an exploratory study was conducted.

Design

Prospectively, 48 individuals who underwent genetic testing for hereditary hearing impairment were included in this study. Study participants were asked to fill out the following questionnaires: Hospital Anxiety Depression Scale, Impact of Event Scale, Self-Efficacy 24, Illness Cognition Questionnaire and the Inventory for Social Reliance. Questionnaires were filled out on three occasions: before genetic testing, directly after counselling on either positive or negative test results, and six weeks thereafter.

Results

No significant differences were found between the group that received a genetic diagnosis for their hearing impairment and the group that did not.

Conclusion

This study did not demonstrate differences between receiving a genetic diagnosis or not, however, special attention to psychological well-being should be offered to hearing-impaired patients who seek a genetic diagnosis for their hearing impairment. Additionally, the psychological impact of sensorineural hearing impairment might be greater than the impact of a genetic diagnosis itself. Based on the current exploratory study, there are no psychological reasons in favour of or against genetic testing for hereditary hearing impairment.

This article is protected by copyright. All rights reserved.

http://ift.tt/2rcg457

Portomesenteric venous thrombosis complicated by a haemorrhagic shock: a rare complication of laparoscopic gastrectomy

Portomesenteric venous thrombosis is a rare complication reported in only a few cases involving laparoscopic bariatric surgery. We report a case of a 44-year-old woman who presented 14 days after recent laparoscopic sleeve gastrectomy with the chief complaint of abdominal pain and associated nausea. Abdominal CT demonstrated thrombi in her superior mesenteric, portal and splenic veins. She was initiated on therapeutic heparin but developed haemorrhagic shock shortly afterwards. Subsequent CT angiogram failed to localise the source of her haemorrhage. Her haemodynamic instability improved following a 6-day intensive care unit stay requiring vasopressive agents and blood transfusions. Further hypercoagulable workup revealed that she was a heterozygous carrier of the prothrombin gene mutation, and thus started on lifelong oral anticoagulation.

http://ift.tt/2r3BpPC

A review of the role of sebum in the mechanism of acne pathogenesis

Summary

Acne is one of the most common skin disorders, and its occurrence is closely related to many factors, including sebum secretion, hormone levels, bacterial infection, and inflammatory reactions. Among these, changes in sebum secretion are believed to be one important factor of acne. Increased sebum secretion can induce acne occurrence, and increasing evidence indicates sebum component changes are also strongly related to acne occurrence. Recently, developments in lipidomics have provided effective lipid analysis methods. These can help elucidate the effects of different types of sebum on acne occurrence and provide a theoretical basis for research on the mechanisms of acne pathogenesis and treatment.

http://ift.tt/2r3PgoX

Evaluation of the safety and efficacy of a monopolar nonablative radiofrequency device for the improvement of vulvo-vaginal laxity and urinary incontinence

Summary

Background and objective

Vaginal childbirth, natural process of aging, congenital factors, and surgical interventions are considered the main causes of vulvo-vaginal laxity driven by changes in collagen and elastin fibers. This causes a loss of strength and flexibility within the vaginal wall. As a result, women may experience lack of sensation and stress urinary incontinence (SUI)—the condition of involuntary loss of urine associated with activities that cause an increase in intra-abdominal pressure (eg, sneezing, coughing, and lifting). Both vaginal laxity and urinary incontinence significantly affect patients' quality of life (QoL).

The aim of this study was to evaluate efficacy and safety of a noninvasive radiofrequency device when used to treat SUI and vulvo-vaginal laxity through its heating effect which stimulates collagen and elastin fibers.

Methods

Twenty-seven women (average age 44.78±10.04 years) with indications of mild/moderate SUI as well as vulvo-vaginal laxity were treated with a monopolar radiofrequency device. The treatment course consisted of three once-a-week sessions. Each session included intravaginal treatment followed by treatment of labia majora and the perineum.

Improvement in the SUI condition was evaluated by applying the International Consultation on Incontinence Questionnaire - Urinary Incontinence Short Form (ICIQ-UI SF). Data were collected at the baseline, after the last treatment and at 1-month follow-up visit.

Vaginal laxity was assessed by subjective vulvo-vaginal laxity questionnaire (VVLQ). Data were collected before the 1st treatment and during the 1-month follow-up visit.

Patient's satisfaction was recorded using a satisfaction questionnaire. Data were collected after the last treatment and at the 1-month follow-up visit. Any adverse events related to the treatments were monitored.

Results

On a scale of 0 to 5, the average frequency of urine leak improved from "2-3 times a week" (2.15±1.03 points prior to treatment) to "once a week" (1.00±0.78 points post-treatment), and on to "never" (0.44±0.51 points at the 1-month follow-up visit). Sixteen subjects (59.3%) reported decrease in the amount of leakage, with 15 women (55.6%) becoming completely leak-free at the 1-month follow-up. At the 1-month follow-up visit, 24 subjects (88.9%) expressed their condition's interference with everyday life decreased and 17 patients (62.9%) said the condition did not interfere with their everyday life at all as a result of the treatment. All results are statistically significant (P<.05). No adverse events were recorded.

All subjects reported improvement in vaginal laxity, from average perception of "very loose" (2.19±1.08 points prior to treatment) to "moderately tight" (5.74±0.76 points at the 1-month follow-up visit).

During the follow-up visit, 89% of the patients "agreed" or "strongly agreed" that their SUI condition improved, and 93% of the patients "agreed" or "strongly agreed" that their gratification during intercourse improved. None of the subjects reported dissatisfaction.

Conclusion

The study confirmed the monopolar radiofrequency method as an effective and safe treatment of SUI and vulvo-vaginal laxity. The treatments were well tolerated by all subjects with no adverse effects.

http://ift.tt/2qyXSRa

A rare complication of topical atropine for treatment of eccrine hidrocystoma: Pharmacological fixed dilated pupils

Summary

Multiple eccrine hidrocystoma (EH) has been treated with topical atropine with variable results. However, in rare cases, anticholinergic side effects have been seen after the use of the topical form of this drug. We presented a 50-year-old woman who developed recent onset of visual disturbance and photophobia from 2 weeks prior. The diagnosis of topical atropine-induced bilateral mydriasis was made. We reported a recognized but often overlooked case of bilateral mydriasis caused by application of topical 1% atropine for treatment of multiple EH.

http://ift.tt/2r3VJ3j

Altered molecular profile in thyroid cancers from patients affected by the Three Mile Island nuclear accident

Objectives/Hypothesis

In 1979, Three Mile Island (TMI) nuclear power plant experienced a partial meltdown with release of radioactive material. The effects of the accident on thyroid cancer (TC) in the surrounding population remain unclear. Radiation-induced TCs have a lower incidence of single nucleotide oncogenic driver mutations and higher incidence of gene fusions. We used next generation sequencing (NGS) to identify molecular signatures of radiation-induced TC in a cohort of TC patients residing near TMI during the time of the accident.

Study Design

Case series.

Methods

We identified 44 patients who developed papillary thyroid carcinoma between 1974 and 2014. Patients who developed TC between 1984 and 1996 were at risk for radiation-induced TC, patients who developed TC before 1984 or after 1996 were the control group. We used targeted NGS of paired tumor and normal tissue from each patient to identify single nucleotide oncogenic driver mutations. Oncogenic gene fusions were identified using quantitative reverse transcription polymerase chain reaction.

Results

We identified 15 patients in the at-risk group and 29 patients in the control group. BRAF_V600E mutations were identified in 53% patients in the at-risk group and 83% patients in the control group. The proportion of patients with BRAF mutations in the at-risk group was significantly lower than predicted by the The Cancer Genome Atlas cohort. Gene fusion or somatic copy number alteration drivers were identified in 33% tumors in the at-risk group and 14% of tumors in the control group.

Conclusions

Findings were consistent with observations from other radiation-exposed populations. These data raise the possibility that radiation released from TMI may have altered the molecular profile of TC in the population surrounding TMI.

Level of Evidence

4 Laryngoscope, 2017

http://ift.tt/2rf1sUl

Impact of liver disease on outcomes of patients hospitalized for epistaxis

Objectives

Liver disease (LD) often results in coagulation abnormalities that may predispose to more severe epistaxis. The purpose of this analysis was to examine characteristics of patients hospitalized for epistaxis with LD and explore the impact of LD on patient outcomes.

Methods

The 2002 to 2013 National Inpatient Sample was queried for cases with a primary diagnosis of epistaxis. Cases with additional codes meeting the Agency for Healthcare Research and Quality's definition of LD were identified and compared to the non-LD cohort.

Results

Out of 39,879 cases meeting inclusion criteria, 3.6% had LD. LD was associated with younger age (55.7 years vs. 67.5 years; P < 0.001), longer hospital stay (3.9 days vs. 3.2 days; P < 0.001), and greater hospital charges ($26,141 vs. $18,200; P < 0.001) compared to the non-LD cohort. LD patients had higher rates of alcohol abuse, coagulopathy, chronic blood loss anemia, and renal failure. LD patients also had higher rates of sepsis, urinary/renal complications, respiratory failure, and infectious pneumonia. LD was associated with decreased rates of aggressive management (defined as ligation or embolization) (6.6%–9.0%; P < 0.002) and anterior or posterior nasal packing. In our multivariate logistic regression model correcting for age, gender, race, and significant comorbidities, LD was associated with 1.520 (1.336–1.729; P < 0.001) greater odds of transfusion and 2.264 (1.372–3.736; P = 0.001) greater odds of in-hospital mortality.

Conclusion

Among patients hospitalized for epistaxis, LD resulted in greater morbidity and mortality. Clinicians should be aware of the particular risk that LD bears on the hospitalized epistaxis patient.

Level of Evidence

2C. Laryngoscope, 2017

http://ift.tt/2sd5oCh

Postinfectious olfactory loss: A retrospective study on 791 patients

Objectives/Hypothesis

Postinfectious olfactory loss is among the most common causes of olfactory impairment and has substantial negative impact on patients' quality of life. Recovery rates have been shown to spontaneously improve in most of patients, usually within 2 to 3 years. However, existing studies are limited by small sample sizes and short follow-up. We aimed to assess the prognostic factors for recovery in a large sample of 791 patients with postinfectious olfactory disorders.

Study Design

Retrospective cohort.

Methods

We performed a retrospective analysis of 791 patients with postinfectious olfactory loss. Olfactory functions were assessed using the Sniffin' Sticks test at the first and final visits (mean follow-up = 1.94 years).

Results

Smell test scores improved over time. In particular, patient's age and the odor threshold (T), odor discrimination (D), and odor identification (I) (TDI) score at first visit were significant predictors of the extent of change. The percentage of anosmic and hyposmic patients exhibiting clinically significant improvement was 46% and 35%, respectively.

Conclusions

This study provides new evidence within the postinfectious olfactory loss literature, shedding light on the prognostic factors and showing that recovery of olfactory function is very frequent, even many years after the infection.

Level of Evidence

4 Laryngoscope, 2017

http://ift.tt/2rf1r2J

Computer-assisted orthognathic surgery: evaluation of mandible registration accuracy and report of the first clinical cases of navigated sagittal split ramus osteotomy

Publication date: Available online 28 May 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): H. Naujokat, M. Rohnen, J. Lichtenstein, F. Birkenfeld, M. Gerle, C. Flörke, J. Wiltfang
Intraoperative navigation is a helpful tool in complex anatomical regions or procedures. The mobility of the mandible in relation to the skull base limits the use of navigation tools on the lower jaw if the reference device is installed on the forehead. A new workflow that allows navigation-assisted sagittal split osteotomy in orthognathic surgery using a separate non-invasive mandibular registration technique has been developed. An evaluation of accuracy in different anatomical regions and with different registration techniques was performed on skull models and skulls with movable mandibles. The mean inaccuracy was 1.51mm, with no significant difference between anatomical sites. Using a splint-based reference device allows the movable mandible to be registered independently from the midface. Registration using metal points in the splint provides higher accuracy than using interdental anatomical landmarks. The workflow could be transferred successfully to patient treatment. Navigation-assisted osteotomy by Obwegeser–Dal Pont technique was performed without any complication in six patients. The mean deviation from the planned osteotomy line was 1.52mm. The navigated sagittal split ramus osteotomy seems to be a suitable technique to increase patient safety.



http://ift.tt/2rc7J18

Journal of Antibiotics

Alexandros Sfakianakis

Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com

TABLE OF CONTENTS Volume 70, Issue 6 (June 2017) In this issue Original Articles Notes Also new  AOP   Sign up for e-alerts   Recommend to your library   Web feed    Subscribe ORIGINAL ARTICLES Top Trienylfuranol A and trienylfuranone A–B: metabolites isolated from an endophytic fungus, Hypoxylon submoniticulosum, in the raspberry Rubus idaeus Kevin M N Burgess, Ashraf Ibrahim, Dan Sørensen and Mark W Sumarah J Antibiot 2017 70: 721-725; advance online publication, March 1, 2017; 10.1038/ja.2017.18 Abstract | Full Text OSMAC approach leads to new fusarielin metabolites from Fusarium tricinctum Catalina F Pérez Hemphill, Parichat Sureechatchaiyan, Matthias U Kassack, Raha S Orfali, Wenhan Lin, Georgios Daletos and Peter Proksch J Antibiot 2017 70: 726-732; advance online publication, March 8, 2017; 10.1038/ja.2017.21 Abstract | Full Text Ghanamycins A and B, two novel γ-butyrolactones from marine-derivedstreptomyces ghanaensis TXC6-16 Jia-hui Xu, Kang-bo Gu, Dao-Jing Zhang, Yuan-Guang Li and Li Tian J Antibiot 2017 70: 733-736; advance online publication, March 15, 2017; 10.1038/ja.2017.37 Abstract | Full Text Bioactive secondary metabolites produced by an endophytic fungusGaeumannomyces sp. JS0464 from a maritime halophyte Phragmites communis Changyeol Lee, Soonok Kim, Wei Li, Sunghee Bang, Hanna Lee, Hyun-Jung Lee, Eun-Young Noh, Jung-Eun Park, Woo Young Bang and Sang Hee Shim J Antibiot 2017 70: 737-742; advance online publication, March 29, 2017; 10.1038/ja.2017.39 Abstract | Full Text Two new polyketides from the ascomycete fungus Leptosphaeria sp. Jie Lin, Renlei Wang, Guohua Xu, Zhengfeng Ding, Xueshen Zhu, Erwei Li and Ling Liu J Antibiot 2017 70: 743-746; advance online publication, February 15, 2017; 10.1038/ja.2017.5 Abstract | Full Text Streptomyces euryhalinus sp. nov., a new actinomycete isolated from a mangrove forest Kaushik Biswas, Jayanta D Choudhury, Riddhi Mahansaria, Malay Saha and Joydeep Mukherjee J Antibiot 2017 70: 747-753; advance online publication, February 8, 2017; 10.1038/ja.2017.3 Abstract | Full Text In vitro antibacterial activity of MGDG-palmitoyl from Oscillatoria acuminataNTAPC05 against extended-spectrum β-lactamase producers Abdul Azees Parveez Ahamed, Mohammed Uddin Rasheed, Kalilurrahuman Peer Muhamed Noorani, Nazar Reehana, Subramanian Santhoshkumar, Yousuff Mohamed Mohamed Imran, Naiyf S Alharbi, Chinnathambi Arunachalam, Sulaiman Ali Alharbi, Mohammad Abdulkader Akbarsha and Nooruddin Thajuddin J Antibiot 2017 70: 754-762; advance online publication, April 5, 2017; 10.1038/ja.2017.40 Abstract | Full Text Penicillenols from a deep-sea fungus Aspergillus restrictus inhibit Candidaalbicans biofilm formation and hyphal growth Jie Wang, Qi-Feng Yao, Muhammad Amin, Xu-Hua Nong, Xiao-Yong Zhang and Shu-Hua Qi J Antibiot 2017 70: 763-770; advance online publication, April 5, 2017; 10.1038/ja.2017.45 Abstract | Full Text Synergistic effects of vancomycin and β-lactams against vancomycin highly resistant Staphylococcus aureus Fumiaki Tabuchi, Yasuhiko Matsumoto, Masaki Ishii, Keita Tatsuno, Mitsuhiro Okazaki, Tomoaki Sato, Kyoji Moriya and Kazuhisa Sekimizu J Antibiot 2017 70: 771-774; advance online publication, February 15, 2017; 10.1038/ja.2017.7 Abstract | Full Text The efficacy of different anti-microbial metals at preventing the formation of, and eradicating bacterial biofilms of pathogenic indicator strains Natalie Gugala, Joe A Lemire and Raymond J Turner J Antibiot 2017 70: 775-780; advance online publication, February 15, 2017; 10.1038/ja.2017.10 Abstract | Full Text Formal synthesis of Thienamycin Michał Pieczykolan, Bartłomiej Furman and Marek Chmielewski J Antibiot 2017 70: 781-787; advance online publication, April 5, 2017; 10.1038/ja.2017.44 Abstract | Full Text NOTES Top Aspergone, a new chromanone derivative from fungus Aspergillus sp. SCSIO41002 derived of mangrove soil sample Bin Yang, Huaming Tao, Xiao-Chu Qin, Zhen Wang, Junde Dong, Xiuping Lin, Xuefeng Zhou, Jian-Lin Li, Zheng-Chao Tu and Yonghong Liu J Antibiot 2017 70: 788-790; advance online publication, January 25, 2017; 10.1038/ja.2016.169 Full Text Acremopeptin, a new peptaibol from Acremonium sp. PF1450 Masatomi Iijima, Masahide Amemiya, Ryuichi Sawa, Yumiko Kubota, Takao Kunisada, Isao Momose, Manabu Kawada and Masakatsu Shibasaki J Antibiot 2017 70: 791-794; advance online publication, February 15, 2017; 10.1038/ja.2017.15 Full Text New diketopiperazine derivatives with cytotoxicity from Nocardiopsis sp. YIM M13066 Mingwei Sun, Xiaotong Chen, Wenjun Li, Chunhua Lu and Yuemao Shen J Antibiot 2017 70: 795-797; advance online publication, April 5, 2017; 10.1038/ja.2017.46 Full Text Identification of tirandamycins as specific inhibitors of the futalosine pathway Yasushi Ogasawara, Kensuke Kondo, Ayumi Ikeda, Rikako Harada and Tohru Dairi J Antibiot 2017 70: 798-800; advance online publication, March 1, 2017; 10.1038/ja.2017.22 Full Text Molecular epigenetic approach activates silent gene cluster producing dimeric bis-spiro-azaphilones in Chaetomium globosum CBS148.51 Meng-Hua Wang, Tao Jiang, Gang Ding, Shu-Bin Niu, Xue-Wei Wang, Meng Yu, Yu-Cheng Gu, Qiu-Bo Zhang, Jia-Huan Chen, Hong-Mei Jia and Zhong-Mei Zou J Antibiot 2017 70: 801-804; advance online publication, March 1, 2017; 10.1038/ja.2017.4 Full Text Conjugative ESBL plasmids differ in their potential to rescue susceptible bacteria via horizontal gene transfer in lethal antibiotic concentrations Sari Mattila, Pilvi Ruotsalainen, Ville Ojala, Timo Tuononen, Teppo Hiltunen and Matti Jalasvuori J Antibiot 2017 70: 805-808; advance online publication, March 29, 2017; 10.1038/ja.2017.41 Full Text Biochemical characterization of CTX-M-166, a new CTX-M β-lactamase produced by a commensal Escherichia coli isolate Vera Manageiro, Rafael Graça, Eugénia Ferreira, Lurdes Clemente, Richard Bonnet and Manuela Caniça J Antibiot 2017 70: 809-810; advance online publication, April 5, 2017; 10.1038/ja.2017.42 Full Text Natureevents is a fully searchable, multi-disciplinary database designed to maximise exposure for events organisers. 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