Top 10 Myths Regarding the Diagnosis and Treatment of Cellulitis

Publication date: Available online 3 July 2017
Source:The Journal of Emergency Medicine
Author(s): Erin K. McCreary, Melissa E. Heim, Lucas T Schulz, Robert Hoffman, Jeffrey Pothof, Barry Fox
BackgroundCellulitis is commonly treated in the emergency department (ED). Patients who present with cellulitis incur significant health care costs and may be overtreated with antibiotics. The accurate diagnosis and treatment of cellulitis plays an important role in cost-effective, high-quality medical care, as well as appropriate antibiotic utilization.ObjectiveWe aim to describe common fallacies regarding cellulitis. We present 10 myths that result in misdiagnosis, overtreatment, or inappropriate empiric management of cellulitis. Clinical presentation, including swelling and redness, is explored in depth, along with incidence of community-acquired methicillin-resistance Staphylococcus aureus, management of tick bites, and effective antibiotic therapy for cellulitis.DiscussionPatients are often treated for cellulitis unnecessarily or inappropriately. Awareness of these myths will help guide providers in clinical decision making in order to effectively tailor treatment for these infections.ConclusionsCellulitis is not as simple as it might seem, and is commonly misdiagnosed in the ED. Noninfectious causes of local symptoms, including lymphedema, venous stasis, and deep vein thrombosis need to be considered. Cellulitis should be treated with empiric antimicrobial therapy based on patient risk factors and regional susceptibility patterns. This review will assist providers in managing cellulitis and avoiding treatment errors that lead to high costs, unwanted side effects for patients, and overuse of antibiotics.



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Back Pain in a Healthy Teenager

Publication date: Available online 4 July 2017
Source:The Journal of Emergency Medicine
Author(s): Kelly Gardner, Sigmund Kharasch, Ali Raja, Rene Balza, Kriti Bhatia, Emily S. Miller




http://ift.tt/2tflpuV

Physicochemical properties, in vitro cytotoxic and genotoxic effects of PM 1.0 and PM 2.5 from Shanghai, China

Abstract

Exposure to ambient particulate matter (PM) links with a variety of respiratory diseases. However, compared with coarse particles (PM₁₀) and fine particles (PM_2.5), submicrometer particles (PM_1.0) may be a more important indicator of human health risks. In this study, the cytotoxic and genotoxic effects of PM_1.0 samples from Shanghai were examined using A549 cells, and compared with the effects of PM_2.5, to better understand the health effects of PM_1.0 in this area. The PM_1.0 and PM_2.5 samples were characterized for morphology, water-soluble inorganic ions, organic and elemental carbon, and metal elements. The cytotoxicity of PMs was measured using cell viability and cell membrane damage assays. The genotoxic effects of PMs were determined using the comet assay, and DNA damage was quantified using olive tail moment (OTM) values. The physicochemical characterization indicated that PM_1.0 was enriched in carbonaceous elements and hazardous metals (Al, Zn, Pb, Mn, Cu, and V), whereas PM_2.5 was more abundant in large, irregular mineral particles. The biological results revealed that both PM_1.0 and PM_2.5 could induce significant cytotoxicity and genotoxicity in A549 cells, and that exposure to PM_1.0 caused more extensive toxic effects than exposure to PM_2.5. The greater cytotoxic effects of PM_1.0 can be attributed to the combined effects of size and chemical composition, whereas the genotoxic effects of PM_1.0 may be mainly associated with chemical species.

http://ift.tt/2sE1jfi

Interpositional Lateral Thoracic Vein Graft for DIEP Flap Salvage in Setting of Superficial Venous System Dominance

No abstract available

http://ift.tt/2solkCb

Contextual fear conditioning is enhanced in mice lacking functional sphingosine kinase 2

Publication date: 30 August 2017
Source:Behavioural Brain Research, Volume 333
Author(s): Mona Lei, Adeena Shafique, Kani Shang, Timothy A. Couttas, Hua Zhao, Anthony S. Don, Tim Karl
The lipid sphingosine 1-phosphate (S1P) is a potent neuroprotective signalling molecule that signals through its own family of five G-protein coupled receptors. S1P signalling enhances presynaptic glutamate release and is essential for neural development. S1P is synthesized by the enzymes sphingosine kinases 1 and 2 (SPHK1 and SPHK2), of which SPHK2 mRNA and activity is more abundant in the brain. In this study we investigated the consequences of global SphK2 knockout (SphK2^−/−) on basic motor capabilities, anxiety, learning, and memory in mice, using a range of tests including the elevated plus maze, the cheeseboard, contextual and cued fear conditioning, and fear extinction. Loss of SphK2 resulted in an 85–90% reduction in brain S1P levels, and was associated with a notably higher freezing response in a novel context. SphK2 knockout mice also exhibited increased contextual fear conditioning but the extinction of contextual fear memory was similar to control mice. SphK2^−/− mice, contrary to their control littermates, did not respond to cue presentation with increased freezing. Anxiety measures in the elevated plus maze were not different between SphK2^−/− mice and control littermates. Also, knockout mice showed no deficits in neurological reflexes or motor functions, and performed as well as their control littermates in the spatial memory test. Our findings demonstrate that SphK2 is responsible for the vast majority of S1P synthesis in the mouse brain, and plays a role in freezing responses as evaluated in the fear conditioning paradigm.



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The lateral parabrachial nucleus and central angiotensinergic mechanisms in the control of sodium intake induced by different stimuli

Publication date: 30 August 2017
Source:Behavioural Brain Research, Volume 333
Author(s): Camila F. Roncari, Richard B. David, Patrícia M. De Paula, Débora S.A. Colombari, Laurival A. De Luca Jr., Eduardo Colombari, José V. Menani
Angiotensin II (ANG II) is a typical facilitatory stimulus for sodium appetite. Surprisingly, hyperosmolarity and central cholinergic stimulation, two classical antinatriorexigenic stimuli, also facilitate NaCl intake when they are combined with injections of the α2-adrenoceptor/imidazoline agonist moxonidine into the lateral parabrachial nucleus (LPBN). In the present study, we tested the relative importance of central angiotensinergic and cholinergic mechanisms for the control of water and NaCl intake by combining different dipsogenic or natriorexigenic stimuli with moxonidine injection into the LPBN. Adult male Holtzman rats (n=9–10/group) with stainless steel cannulas implanted in the lateral ventricle and LPBN were used. Bilateral injections of moxonidine (0.5 nmol) into the LPBN increased water and 0.3M NaCl intake in rats that received furosemide+captopril injected subcutaneously, ANG II (50ng) or carbachol (cholinergic agonist, 4 nmol) injected intracerebroventricularly (icv) or 2M NaCl infused intragastrically (2ml/rat). Losartan (AT1 antagonist, 100μg) or atropine (muscarinic antagonist, 20 nmol) injected icv abolished the effects on water and 0.3M NaCl of moxonidine combined to either 2M NaCl intragastrically or carbachol icv. However, atropine icv did not change 0.3M NaCl intake produced by direct central action of ANG II like that induced by ANG II icv or furosemide+captopril combined with moxonidine into the LPBN. The results suggest that different stimuli, including hyperosmolarity and central cholinergic stimulation, share central angiotensinergic activation as a common mechanism to facilitate sodium intake, particularly when they are combined with deactivation of the LPBN inhibitory mechanisms.



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Hypoxic postconditioning improves behavioural deficits at 6 weeks following hypoxic-ischemic brain injury in neonatal rats

Publication date: 30 August 2017
Source:Behavioural Brain Research, Volume 333
Author(s): Jonathan D. Teo, Margaret J. Morris, Nicole M. Jones
Hypoxic-ischemic (HI) brain injury in newborns is associated with high morbidity and mortality, with many babies suffering neurological deficits. Recently, we showed that hypoxic postconditioning (PostC) immediately post injury can protect against HI up to one week in neonatal rats. Here, we aimed to examine whether long term functional deficits were also improved by PostC. Sprague-Dawley rats were assigned to control (C) or HI group on postnatal day 7 (P7). The HI group underwent unilateral carotid artery occlusion followed by hypoxia (7% oxygen, 3h). Half of each group were randomly assigned to the PostC group (8% oxygen, 1h/day for 5days post-injury), or normoxic group, where animals were kept under ambient conditions. Righting reflex and negative geotaxis tests were performed on P8 and P14. On P42, rats underwent further behavioural tests of motor function and memory (forelimb grip strength, grid walking and novel object recognition tasks). Brain injury was assessed using histological scoring of brain sections. At P14, PostC reduced the righting reflex deficit compared to HI alone. Long-term (6 weeks) behavioural deficits were observed in grid walking and novel object recognition tests after HI alone, with both functions improved following PostC. Following HI, there was an increase in brain injury assessed by histological scoring compared to control, and this damage was reduced by PostC. This novel finding of long-term histological neuroprotection accompanied by functional improvements by PostC further demonstrates the clinical potential of mild hypoxia for the treatment of HI brain injury.



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Effect of a change in housing conditions on body weight, behavior and brain neurotransmitters in male C57BL/6J mice

Publication date: 30 August 2017
Source:Behavioural Brain Research, Volume 333
Author(s): Noemi Pasquarelli, Patrizia Voehringer, Julia Henke, Boris Ferger
The development of modern housing regimes such as individually ventilated cage (IVC) systems has become very popular and attractive in order to reduce spreading of pathogenic organisms and to lower the risk to develop a laboratory animal allergy for staff members. Additionally, optimal housing of laboratory animals contributes to improve animal health status and ensures high and comparable experimental and animal welfare standards. However, it has not been clearly elucidated whether 1) a change to IVC systems have an impact on various physiological phenotypic parameters of mice when compared to conventional, standard cages and 2) if this is further affected by changing from social to single housing. Therefore, we investigated the influence of a change in housing conditions (standard cages with social housing changed to standard or IVC cages combined with social or single housing) on body weight, behavior and a neurochemical fingerprint of male C57BL/6J mice. Body weight progression was significantly reduced when changing mice to single or social IVC cages as well as in single standard cages when compared to social standard housing. Automated motor activity measurement in the open field showed that mice maintained in social husbandry with standard cages displayed the lowest exploratory behavior but the highest activity difference upon amphetamine treatment. Elevated plus maze test revealed that a change to IVC single and social housing as well as single standard housing produced anxiety-related behavior when compared to maintenance in social standard housing. Additionally, postmortem neurochemical analysis of the striatum using high-performance liquid chromatography coupled to electrochemical detection showed significant differences in striatal dopamine and serotonin turnover levels. In summary, our data indicate a crucial influence of a change in housing conditions on several mouse phenotype parameters. We propose that the maintenance of well-defined housing conditions is mandatory to ensure reproducible and comparable results and contributes to the application of the 3R refinement principle in animal studies by contributing to welfare and hygienical standards.



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Chronic mild stress impairs latent inhibition and induces region-specific neural activation in CHL1-deficient mice, a mouse model of schizophrenia

Publication date: 30 August 2017
Source:Behavioural Brain Research, Volume 333
Author(s): Mona Buhusi, Daniel Obray, Bret Guercio, Mitchell J. Bartlett, Catalin V. Buhusi
Schizophrenia is a neurodevelopmental disorder characterized by abnormal processing of information and attentional deficits. Schizophrenia has a high genetic component but is precipitated by environmental factors, as proposed by the 'two-hit' theory of schizophrenia. Here we compared latent inhibition as a measure of learning and attention, in CHL1-deficient mice, an animal model of schizophrenia, and their wild-type littermates, under no-stress and chronic mild stress conditions. All unstressed mice as well as the stressed wild-type mice showed latent inhibition. In contrast, CHL1-deficient mice did not show latent inhibition after exposure to chronic stress. Differences in neuronal activation (c-Fos-positive cell counts) were noted in brain regions associated with latent inhibition: Neuronal activation in the prelimbic/infralimbic cortices and the nucleus accumbens shell was affected solely by stress. Neuronal activation in basolateral amygdala and ventral hippocampus was affected independently by stress and genotype. Most importantly, neural activation in nucleus accumbens core was affected by the interaction between stress and genotype. These results provide strong support for a 'two-hit' (genes x environment) effect on latent inhibition in CHL1-deficient mice, and identify CHL1-deficient mice as a model of schizophrenia-like learning and attention impairments.



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Observational fear learning in degus is correlated with temporal vocalization patterns

Publication date: 14 August 2017
Source:Behavioural Brain Research, Volume 332
Author(s): Navdeep K. Lidhar, Nathan Insel, June Yue Dong, Kaori Takehara-Nishiuchi
Some animals learn to fear a situation after observing another individual come to harm, and this learning is influenced by the animals' social relationship and history. An important but sometimes overlooked factor in studies of observational fear learning is that social context not only affects observers, but may also influence the behavior and communications expressed by those being observed. Here we sought to investigate whether observational fear learning in the degu (Octodon degus) is affected by social familiarity, and the degree to which vocal expressions of alarm or distress contribute. 'Demonstrator' degus underwent contextual fear conditioning in the presence of a cagemate or stranger observer. Among the 15 male pairs, observers of familiar demonstrators exhibited higher freezing rates than observers of strangers when returned to the conditioning environment one day later. Observer freezing during testing was, however, also related to the proportion of short- versus long- inter-call-intervals (ICIs) in vocalizations recorded during prior conditioning. In a regression model that included both social relationship and ICI patterns, only the latter was significant. Further investigation of vocalizations, including use of a novel, directed k-means clustering approach, suggested that temporal structure rather than tonal variations may have been responsible for communicating danger. These data offer insight into how different expressions of distress or fear may impact an observer, adding to the complexity of social context effects in studies of empathy and social cognition. The experiments also offer new data on degu alarm calls and a potentially novel methodological approach to complex vocalizations.



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Adjuvant intensity-modulated whole abdominal radiotherapy for high-risk patients with ovarian cancer FIGO stage III– first results of a prospective phase-II-study

Publication date: Available online 4 July 2017
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): N. Arians, M. Kieser, L. Benner, N. Rochet, S. Katayama, F. Sterzing, K. Herfarth, K. Schubert, L. Schröder, Ch. Leitzen, A. Schneeweiss, Ch. Sohn, J. Debus, K. Lindel
PurposeTo assess treatment tolerance and toxicity rates of consolidative whole abdominal radiotherapy (WART) following cytoreductive surgery and carboplatin/paclitaxel chemotherapy in high risk patients with advanced ovarian cancer FIGO stage III using IMRT.Methods/Design: The xxx study is a multicenter single-arm phase-II-trial. 20 patients with optimally debulked ovarian cancer FIGO stage III with complete remission after chemotherapy were treated with intensity-modulated WART as a consolidation therapy. A total dose of 30 Gy in 20 fractions of 1.5 Gy was applied to the entire peritoneal cavity. Primary endpoint was treatment tolerability defined as lack of any CTC AE Grade 4 toxicity within 10 weeks after start of treatment; secondary objectives were acute and chronic toxicity, quality of life, rates of therapy disruption and abortion, progression-free and overall survival.ResultsIntensity-modulated WART resulted in excellent coverage of the whole peritoneal cavity with effective sparing of all organs at risk. The primary analysis included all 20 enrolled patients of which 19 did not experience CTC Grade 4 toxicity. Only one patient experienced acute Grade 4 hematological toxicity. Thus, the tolerability rate of intensity-modulated WART was significantly higher than 70%. No gastrointestinal acute toxicities > Grade 2 have been observed. During WART mean global health status decreased for 18.1 points (95%-CI: 7.1-29.0). 6 weeks after WART global health status already increased with a no lower difference of 4.6 (-11.1-20.4), compared to baseline. Similar characteristics were observed for all function scale scores.ConclusionIntensity-modulated WART after aggressive surgery and carboplatin/paclitaxel chemotherapy is associated with an acceptable risk of acute toxicity and a treatment tolerability rate significantly higher than 70%. Together with our knowledge about clinical feasibility meaning excellent coverage of the PTV and effective sparing of OARs, intensity-modulated WART could offer a new therapeutic option for consolidation treatment of patients with advanced ovarian cancer.

Teaser

Patients with advanced stage ovarian cancer have a poor prognosis with intraperitoneally disease recurrence being a common pattern of relapse. This prospective multicenter phase-II-study tested treatment tolerability of whole abdominal radiotherapy using IMRT as one possible treatment option to improve survival. Results show excellent treatment tolerability rates of 95% (lower limit of the one-sided 95% CI 80.4%), thus making IMRT a promising treatment option in addition to established chemotherapy regimens.


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Topical timolol for treatment of penile Kaposi sarcoma in HIV-negative patient

http://ift.tt/2tfi6DT

Riga-Fede disease in the upper jaw in an infant

Abstract

Riga-Fede disease is a benign and uncommon mucosal disorder. This illness is an ulceration of the oral mucosa and arises from repetitive traumatic injuries. The disease is usually caused by the sharp edges of new erupted teeth. The aim of the present case report is to present Riga-Fede disease and its treatment. We reported a 11-month-old healthy female infant diagnosed as Riga-Fede disease based on clinical features. After the conservative treatment that focused on eliminating the source of trauma, total healing was observed. Riga-Fede disease is rare. This illness can be confused with malignancies. Therefore, the diagnosis and treatment of this disease are very important for physicians and patients.

http://ift.tt/2sKJ3Mz

Superiority of a vitamin B12-barrier cream compared with standard glycerol-petrolatum-based emollient cream in the treatment of atopic dermatitis: A randomized, left-to-right comparative trial

Abstract

Atopic dermatitis (AD) is a result of complex genetic, epigenetic, environmental, and immunological interactions with an overlapping epidermal barrier defect. The study evaluates the efficacy and tolerability of topical Vitamin B12-barrier cream (MB12) compared with standard glycerol-petrolatum-based emollient cream (GPC) used three times a day for mild AD. The study was conducted as a on one hemi-body randomized, controlled, single-blind, intra-patient left-to-right comparative trial by patients with clinical diagnosis of mild AD measured with total SCORAD index over 4 months. MB12 was compared on one hemi-body treated (GPC). The comparisons of score values were performed primarily by using non-parametric procedures: Mann–Whitney-U test (for independent samples) and Wilcoxon test (for dependent samples). All 22 patients were randomized (left or right side treated with MB12 or GPC). At week 12 a reduction from baseline in SCORAD index was assessed in both body sites with 77.6% SCORAD index reduction in the MB12 treated body sites versus 33.5% in the GPC treated body sites. These results suggest that MB12 could represent a new option in the treatment of mild AD.

http://ift.tt/2tfcGJo

Prevention of 5-fluorouracil-induced early severe toxicity by pre-therapeutic dihydropyrimidine dehydrogenase (DPD) deficiency screening: The multiparametric approach is not convincing

Publication date: Available online 4 July 2017
Source:Seminars in Oncology
Author(s): Marie-Christine Etienne-Grimaldi, Chantal Barin Le Guellec, Jean-Christophe Boyer, Etienne Chatelut, Alexandre Evrard, Marie-Anne Loriot, Angelo Paci, Bernard Royer, Fabienne Thomas, Joseph Ciccolini




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Biomarker-Driven and Molecular Targeted Therapies for Colorectal Cancers

Publication date: Available online 4 July 2017
Source:Seminars in Oncology
Author(s): Marta Schirripa, Stacey A. Cohen, Francesca Battaglin, Heinz-Josef Lenz
The improved clinical selection and the identification of new molecules and innovative strategies widened treatment options and increased overall survival in metastatic colorectal cancer patients in recent years. Biomarker-driven therapies represent an emerging issue in this field and new targeted treatments are under investigation and will be probably soon adopted in the daily clinical practice. In the present review the role RAS, BRAF mutations, Her2 amplification, microsatellite instability and CpG Island Methylator Phenotype are reviewed and discussed according to their possible role as prognostic, predictive markers as well as possible biomarker-driven treatment options.



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In vitro and in vivo antimicrobial activity of a synthetic peptide derived from the C-terminal region of human chemokine CCL13 against Pseudomonas aeruginosa

Publication date: Available online 4 July 2017
Source:Peptides
Author(s): Mayte Cossio-Ayala, Mariana Domínguez-López, Erika Mendez-Enriquez, María del Carmen Portillo-Téllez, Enrique García-Hernández
Chemokines are important mediators of immunological responses during inflammation and under steady-state conditions. In addition to regulating cell migration, some chemotactic cytokines have direct effects on bacteria. Here, we characterized the antibacterial ability of the synthetic oligopeptide CCL1357-75, which corresponds to the carboxyl-terminal region of the human chemokine CCL13. In vitro measurements indicated that CCL1357-75 disrupts the cell membrane of Pseudomonas aeruginosa through a mechanism coupled to an unordered-helicoidal conformational transition. In a murine pneumonic model, CCL1357-75 improved mouse survival and bacterial clearance and decreased neutrophil recruitment, proinflammatory cytokines and lung pathology compared with that observed in untreated infected animals. Overall, our study supports the ability of chemokines and/or chemokine-derived oligopeptides to act as direct defense agents against pathogenic bacteria and suggests their potential use as alternative antibiotics.



http://ift.tt/2uI6OGo

Endogenous hydrogen sulfide-mediated MAPK inhibition preserves endothelial function through TXNIP signaling

Publication date: September 2017
Source:Free Radical Biology and Medicine, Volume 110
Author(s): Danyang Tian, Jinghui Dong, Sheng Jin, Xu Teng, Yuming Wu
Mounting evidence demonstrated deficient cystathionine-γ-lyase (CSE)/H2S implicated the development of cardiovascular disease. The present study aimed to evaluating the favorable action of CSE derived H2S on endothelial function in CSE^-/- mice. CSE^-/- mice exhibited attenuated endothelium-dependent relaxations, coupled with reduction of endothelial nitric oxide synthase (eNOS) phosphorylation at site of Ser1177, increase of thioredoxin interacting protein (TXNIP) level and MAPK phosphorylation, which were corrected by sodium hydrosulfide chronic treatment for 8 weeks. Impaired relaxations to ACh and upregulated TXNIP of CSE^-/- mice aorta were partially corrected by p38 inhibitor, extracellular regulated protein kinase (ERK) inhibitor and c-Jun N-terminal kinase (JNK) inhibitor and totally corrected by combined treatment. Pharmacological inhibition of CSE with DL-propargylglycine (PPG) in vivo and ex vivo induced endothelial dysfunction. PPG stimulated the phosphorylation of p38, JNK and ERK in human umbilical vein endothelial cells (HUVECs). MAPK inhibition by combined treatment of p38, JNK and ERK inhibitors normalized the endothelial changes of eNOS phosphorylation and TXNIP protein level in CSE^-/- mice aorta and PPG-treated HUVECs. NaHS offered similar effect with MAKP inhibitors. TXNIP siRNA prevented against endothelial function by PPG and TXNIP overexpression mimics the detrimental effect of PPG treatment on endothelial function, whereas MAPK inhibitor or NaHS has no beneficial effect. In a word, Endogenous CSE/H2S benefits against endothelial dysfunction through suppressing MAPK/TXNIP cascade. CSE deficiency and consequently lowered endogenous H2S level should be considered as risk factors and biomarkers for endothelial dysfunction.

Graphical abstract

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EphB2 signaling-mediated Sirt3 expression reduces MSC senescence by maintaining mitochondrial ROS homeostasis

Publication date: Available online 4 July 2017
Source:Free Radical Biology and Medicine
Author(s): Young Hyun Jung, Hyun Jik Lee, Jun Sung Kim, Sei-Jung Lee, Ho Jae Han
Disruption of mitochondrial reactive oxygen species (mtROS) homeostasis is a key factor inducing UCB-MSC senescence. Accordingly, preventing mtROS accumulation will help in suppressing the UCB-MSC senescence. In this study, we observed that the expressions of EphrinB2 and EphB2 were inversely regulated by UCB-MSC passage-dependent manner. EphB2 signaling induced mitochondrial translocation of Sirt3. The knockdown of SIRT3 inhibited the effect of EphB2 signaling in UCB-MSCs. Subsequently, EphrinB2-Fc induced the nuclear translocation of Nrf-2 via c-Src phosphorylation dependent manner, and Sirt3 expression was regulated by Nrf-2. Among Sirt3 target genes, EphB2 signaling increased MnSOD and reduced the mtROS level of UCB-MSCs. Furthermore, the deacetylase effect of Sirt3 enhanced the MnSOD activity by deacetylation at the lysine 68 residue and therapeutic effect of UCB-MSCs on skin-wound healing was increased by EphB2 activation. In conclusion, the EphB2 can serve as a novel target for the optimizing the therapeutic use of UCB-MSCs in wound repair by MnSOD-mediated mtROS scavenging through EphB2/c-Src signaling pathway and Nrf-2-dependent Sirt3 expression.

Graphical abstract

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Long sleep duration and health outcomes: A systematic review, meta-analysis and meta-regression

We examined the dose-response relationship between long sleep duration and health outcomes including mortality and the incidence of diabetes mellitus, hypertension, cardiovascular diseases, stroke, coronary heart diseases, obesity, depression and dyslipidemia. We collected data from 5,134,036 participants from 137 prospective cohort studies. For the independent variable, we categorized participants at baseline as having long sleep duration or normal sleep duration. Risk ratios (RRs) for mortality and incident health conditions during follow-up were calculated through meta-analyses of adjusted data from individual studies.

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Chemical constituents and pharmacological actions of carob pods and leaves (Ceratonia siliqua L.) on the gastrointestinal tract: A review

Publication date: September 2017
Source:Biomedicine & Pharmacotherapy, Volume 93
Author(s): Kaïs Rtibi, Slimen Selmi, Dhekra Grami, Mohamed Amri, Bruno Eto, Jamel El-benna, Hichem Sebai, Lamjed Marzouki
Carob tree, Ceratonia siliqua L., is a medicinal plant used in Tunisian traditional medicine for the treatment of the gastro-intestinal (GI) disorders. In this respect, a relatively large number of scientific publications on the carob tree have been published in recent years. Therefore, the present review was aimed to analyze the traditional uses, phytochemical constituents and pharmacological activities of Ceratonia siliqua on the GI tract. Indeed, previous investigations on the carob pods and leaves have revealed the presence of a number of compounds including high amounts of carbohydrates, dietary fibers, minerals, polyphenols, flavonoids and low amounts of protein and lipids. This plant possesses anti-inflammatory, antimicrobial, anti-diarrheique, antioxidant, anti-ulcer, anti-constipation and anti-absorptive of glucose activities in the gastrointestinal tract. Based on the chemical and pharmacological characteristics of C. siliqua, we concluded that this species has beneficial preventive and therapeutic properties, especially, in digestive tract.



http://ift.tt/2ungSFb

Phytotherapeutic potential of natural herbal medicines for the treatment of mild-to-severe atopic dermatitis: A review of human clinical studies

Publication date: September 2017
Source:Biomedicine & Pharmacotherapy, Volume 93
Author(s): Zahid Hussain, Hnin Ei Thu, Ahmad Nazrun Shuid, Prashant Kesharwani, Shahzeb Khan, Fahad Hussain
For many decades, natural herbal medicines, polyherbal formulations and/or decoctions of plant-derived materials have widely been accepted as alternative complementary therapies for the treatment, cure or prevention of a wide range of acute and chronic skin diseases including chronic herpes, prurigo, acute and chronic wounds, psoriasis and atopic dermatitis (AD). This review was aimed to summarize and critically discuss about the therapeutic viability and clinical applicability of natural herbal medicines for the treatment of AD in human. The critical analysis of the literature revealed that oral (in the form of capsules, syrup or granules) and/or topical application (alone or in conjunction with wet-wrap dressing and/or acupuncture) of natural herbal medicines exhibit remarkable potential for the treatment of mild-to-severe AD in adults, children, infants and in the pregnant women. In this review, the clinical efficacy of various herbal formulations such as Chinese herbal therapies, Korean medicines, Iranian medicines, honey, natural herbal oils (coconut oil, olive oil and mineral oil), beeswax, dodder seeds and whey for the treatment of AD has been discussed. The clinical anti-AD efficacy of these complementary therapies has been observed in terms of down-regulation in Scoring Atopic Dermatitis (SCORAD) index, erythematic intensity, Children's Dermatology Life Quality Index (CDLQI), Dermatology Life Quality Index (DLQI), pruritus and itching frequency, transepidermal water loss (TEWL) and expression of AD-mediated chemokines. Conclusively, we recognized that natural herbal medicines demonstrate remarkable clinical efficacy when used alone or in conjunction with other complementary therapies for the treatment of AD in patients of all ages as well as pregnant women.

Graphical abstract

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Oral Lymphomatoid papulosis type C: A diagnostic pitfall, often confused with T-cell lymphoma

Publication date: Available online 16 June 2017
Source:Annals of Diagnostic Pathology
Author(s): Ziv Schwartz, Morton Coleman, Jennifer P. Toyohara, Paul D. Freedman, Cynthia M. Magro
Eosinophilic ulcer of the oral mucosa (EUOM) is a rare, benign, self-resolving lymphoproliferative disorder, which typically presents with asymptomatic to mildly tender ulcers. Histological findings of EUOM are characterized by a polymorphic infiltrate with many eosinophils often extending into the underlying muscle. Although this entity is well documented within the dental literature, it is not well known to physicians. The pathogenesis of the condition is unclear, although reports dating back to 1997 suggest that at least a subset of EUOM represents CD30 positive lymphoproliferative disorder (LPD30). More specifically the original report and subsequent authors suggest that the patients fall on the spectrum of LPD30 most reminiscent of Lymphomatoid papulosis (LyP) seen in the skin. This oral variant of LyP would be expected to have the same diverse morphologic spectrum as that seen in cutaneous LyP. We present five EUOM patients whose biopsies showed an atypical lymphocytic infiltrate most compatible with Type C LyP, a histologically unique subset of LyP, reminiscent of the biopsy findings encountered in the reported case by Ficarra and co-workers. (Ficarra, et al., 1997) In four of the five cases, the biopsies were interpreted by expert hematopathologists as an aggressive form of peripheral T cell lymphoma resulting in recommendations to administer systemic chemotherapy to four of the patients, the scheduling of one patient for induction therapy and transplantation before revision of the diagnosis, and administration of chemotherapy to one of the patients. The natural clinical course of spontaneous regression refuted the original diagnoses as a form of aggressive peripheral T cell lymphoma. Recognition of oral LyP is critical to avoid inadvertent exposure to potentially toxic chemotherapeutic regimens intended for the treatment of high grade lymphoma.



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Distribution of lymphoid neoplasms in Northwest China: Analysis of 3244 cases according to WHO classification in a single institution

Publication date: Available online 12 May 2017
Source:Annals of Diagnostic Pathology
Author(s): Chun Cao, Juan Feng, Hongtao Gu, Hailong Tang, Li Xu, Hongjuan Dong, Baoxia Dong, Mimi Shu, Qingxian Bai, Rong Liang, Tao Zhang, Lan Yang, Zhe Wang, Xiequn Chen, Guangxun Gao
To explore the distribution of lymphoid neoplasms in Northwest China, the clinical and pathological data of lymphoma patients from 2006 to 2014 were analyzed according to the WHO classification in Xijing Hospital. Of the 3244 cases, mature B-cell neoplasms occupied 60.7%, while mature T/NK-cell neoplasms and Hodgkin's lymphomas (HL) occupied 26.2% and 8.1%, respectively. The most common subtype of lymphoma was diffuse large B-cell lymphoma (35.0%), followed by extranodal NK/T-cell lymphoma, nasal type (ENKTCL) (12.9%) and marginal zone B-cell lymphoma (7.8%). Mixed cellularity (34.0%) was the most common subtype of HL. The especially high proportion of ENKTCL was the most outstanding feature of our study in comparison to previous reports. The mean age of all lymphoid neoplasms cases was 51years and most subtypes showed male predominance, with an average male-female ratio of 1.6. Extranodal lymphomas took up about 60% of all cases and gastrointestinal tract was the most frequently involved site. In conclusion, the distribution of lymphoid neoplasms of Northwest China showed some features similar to previous reports of China and other countries, but some subtypes presented distinct features.



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Three cases of adrenocortical tumors mistaken for hepatocellular carcinomas/diagnostic pitfalls and differential diagnosis

Publication date: December 2017
Source:Annals of Diagnostic Pathology, Volume 31
Author(s): Won Young Park, Hyung Il Seo, Kyung Un Choi, Ahrong Kim, Young Keum Kim, So Jeong Lee, Chang Hun Lee, Gi Yeong Huh, Do Youn Park
Adrenocortical adenomas and carcinomas in other parenchyma are extremely rare, with few cases reported and because of the rarity of these tumors, they occasionally cause problems during diagnosis. Adrenal cortical neoplasms in liver parenchyma can be present in 3 forms, including direct invasion or adhesion to liver parenchyma, tumors arising in adrenohepatic fusion tissue or in ectopic adrenal gland tissue. We report 3 cases of adrenal cortical tumors that were misdiagnosed as hepatocellular carcinoma in the preoperative state. The first case involved an adrenocortical adenoma arising in adrenohepatic fusion tissue. The remaining 2 cases involved an adrenocortical carcinoma and an adrenocortical oncocytoma arising in ectopic adrenal tissue in the liver. We describe the clinical presentations, gross, microscopic findings, immunohistochemical findings with respect to each case, with emphasis on differential diagnosis from hepatocellular carcinoma.



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Phenotypic alterations in breast cancer associated with neoadjuvant chemotherapy: A comparison with baseline rates of change

Publication date: December 2017
Source:Annals of Diagnostic Pathology, Volume 31
Author(s): Nosaibah Hariri, Andres A. Roma, Farnaz Hasteh, Vighnesh Walavalkar, Oluwole Fadare
Several studies have documented phenotypic alterations in breast cancer associated with neoadjuvant chemotherapy [NACT], but many of these studies are limited by the fact that they did not account for the baseline rate of expected phenotypic change between biopsies and resections in the absence of NACT. Herein, we assess whether the NACT-associated rate of phenotypic change is significantly different than would be expected in a control population of patients that did not receive NACT. From a pathologic database, we documented the estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor-2 (HER2/neu) phenotypes of consecutive invasive breast carcinomas (n=826), as well as the subset in which at least one of these tests was assessed in both the biopsy and resection (n=340). We then compared the rates of phenotypic change in the patients that did (n=65) and did not (n=275) receive NACT. Respectively, 49.2% and 36% of the NACT and non-NACT groups showed a biopsy-to-resection change in status for at least one biomarker (p=0.0005). The NACT and non-NACT groups showed the following respective rates of a biopsy-to-resection change in phenotype: ER (9.2% vs 2.5%, p=0.02); PR (30.7% vs 8%, p=0.000006); Her2/neu-IHC (25% vs 22.3%, p=0.7), Her2/neu-FISH (7% vs 3%, p=0.6). The direction of change in the NACT group was positive in the biopsy to negative in the resection in >70% of cases for all markers. For ER and PR, there was no statistically significant difference between cases that showed a biopsy-to-excision change in phenotype and those that were more phenotypically stable regarding a wide array of clinicopathologic variables. The average percentage of ER/PR-immunoreactive tumor cells in the pre-NACT biopsies was significantly lower in the phenotypically altered cases as compared to the phenotypically stable cases. Our findings confirm that phenotypic alterations in breast cancer occur after NACT, and that these changes are more pronounced for hormone receptors (especially PR); Significant NACT-associated alterations were not apparent for HER2/neu. A distinct pathologic profile for cases displaying a phenotypic change within the NACT group was not demonstrable. The pre-NACT levels of ER and PR may affect the likelihood of a phenotypic change. These results highlight the need for repeat testing in residual tumors after NACT.



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Accuracy and interobserver agreement of retroareolar frozen sections in nipple-sparing mastectomies

Publication date: August 2017
Source:Annals of Diagnostic Pathology, Volume 29
Author(s): David A. Suarez-Zamora, Luis E. Barrera-Herrera, Mauricio A. Palau-Lazaro, Fabio Torres-Franco, Alejandro Orozco-Plazas, Lisette Barreto-Hauzeur, Paula A. Rodriguez-Urrego
In the last decades, surgical treatment of breast cancer has enormously changed. As a result, nipple-sparing mastectomy (NSM) has evolved as an oncologically safe and cosmetic approach. NSM includes a subareolar frozen section to evaluate malignancy. We determined the accuracy of subareolar frozen section diagnosis, analyzed the discrepancy factor, and estimated the interobserver agreement of frozen section in NSM. A retrospective review of all NSMs at our institution from 2009 to 2015 was performed. Frozen sections were compared to the final diagnoses to analyze the accuracy of subareolar frozen sections. Discordant results were rigorously evaluated to identify discrepancy factors. Some cases were randomly chosen to assess the interobserver agreement (kappa) among pathologists. The agreement results were evaluated with and without knowledge of the tumor morphology. Among 34 NSMs, the frozen section false-negative and false-positive rate was 5.9% and 8.8%, respectively. The sensitivity and specificity was 77.8% and 88.0%, respectively. Sampling errors and diathermy artifacts explained our false-negative diagnoses. Freezing artifacts and an intraductal papilloma explained our false-positive diagnoses. The interobserver agreement between breast and general pathologists was 0.87 (p<0.0001) and 0.31 (p=0.0001), respectively. The interobserver agreement increased to 0.35 (p<0.0001) in general pathologists with knowledge of the tumor morphology. Subareolar frozen section showed to be a specific test with moderate sensitivity. Papillary lesions can mimic atypical cells and influence the frozen section interpretation. Frozen section in NSM had a better performance in breast pathologists (almost perfect) versus general pathologists (fair). Interobserver agreement may improve with knowledge of tumor morphology.



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Usefulness of a direct immunofluorescence in the diagnosis of plaque type oral lichen planus

Publication date: December 2017
Source:Annals of Diagnostic Pathology, Volume 31
Author(s): Patricia Alejandra Masquijo-Bisio, Mariana Silvia Gandolfo, Alicia Keszler, Maria Elina Itoiz, María Luisa Paparella




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Lymphocytic thrombophilic arteritis: A distinct inflammatory type I interferon and C5b-9 mediated subcutaneous endovasculitis

Publication date: December 2017
Source:Annals of Diagnostic Pathology, Volume 31
Author(s): Cynthia M. Magro, Jad Saab
BackgroundLymphocytic thrombophilic arteritis is a recently recognized subcuticular larger vessel vasculitis characterized by striking vascular luminal thrombosis.MethodsThe clinical features, histopathology and phenotypic profile of ten patients with lymphocytic thrombophilic arteritis were explored in an attempt to better define the entity from a clinical and pathophysiologic perspective.ResultsThe patients were all female (mean age of 43) presenting with generally asymptomatic lower and upper extremity hyperpigmented macules. A consistent picture diagnostic of a connective tissue disease syndrome was not seen. The disease was not progressive although it was typically persistent.The morphology was characterized by a temporally heterogeneous subcutaneous arteritis targeting the endothelium and intima with changes ranging from incipient intimal expansion by hyaluronic acid to concentric intimal fibrin deposition to one of an end stage acellular intraluminal obliterative fibrous arteriopathy. The infiltrate was predominated by lymphocytes and histiocytes. The intimal elastic lamina was intact in most cases. All tested cases showed intimal and endothelial C5b-9 deposition, an upregulated type I interferon microenvironment and marked upregulation of the inducible interferon gamma 16 protein.ConclusionsLymphocytic thrombophilic arteritis is a unique form of C5b-9 mediated arteritic endotheliopathy where the brunt of the changes involves the endothelium and intima and that is morphologically distinct from the transmural arteritis of benign cutaneous polyarteritis nodosa.



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Low-grade fibromyxoid sarcoma: Clinical, morphologic and genetic features

Publication date: June 2017
Source:Annals of Diagnostic Pathology, Volume 28
Author(s): Mustafa Mohamed, Cyril Fisher, Khin Thway
Low-grade fibromyxoid sarcoma (LGFMS) is a bland spindle cell neoplasm that typically arises in the deep soft tissues of the proximal extremities or trunk of young adults. The majority of LGFMS are characterized by a recurrent (7;16)(q34;p11) translocation, resulting in the FUS-CREB3L2 fusion gene, which generates a chimeric protein with transcriptional regulatory activity. Small numbers harbor a FUS-CREB3L1 fusion resulting from t(11;16)(p11;p11), whilst rare cases harbor the EWSR1-CREB3L1 fusion. LGFMS is of low to moderate cellularity and consists of bland spindle cells with small, angulated nuclei and scant, wispy cytoplasm, arranged in a whorled growth pattern and typically showing abrupt transition from myxoid to fibrous areas. Immunohistochemical expression of MUC4 is a consistent finding. Hyalinized spindle cell tumor with giant rosettes (HSCTGR) is a morphological variant of LGFMS that shares the same balanced translocation, and is also immunoreactive for MUC4. A potential relationship between LGFMS and sclerosing epithelioid fibrosarcoma (SEF), a rare fibroblastic neoplasm that most commonly arises in the deep soft tissues of the lower extremities, limb girdles or trunk, has also been suggested. SEF is classically composed of nests and cords of epithelioid cells with clear or eosinophilic cytoplasm embedded within densely sclerotic stroma. In some cases, areas indistinguishable from LGFMS are present, and these have been shown to contain FUS-CREB3L2 fusion transcripts. The majority of pure SEF tumors harbor EWSR1 rearrangements, with EWSR1-CREB3L1 and more rarely EWSR1-CREB3L2 gene fusions more common than those involving FUS. MUC4 immunoreactivity is also seen in approximately 70% of SEF. Surgical resection of these tumors with clear margins is the treatment of choice. Correct diagnosis is important because of the significant potential for recurrence and late metastatic spread. We review LGFMS and SEF, discussing morphology and immunohistochemistry, genetics and molecular findings, and the differential diagnosis.



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IMP3 contributes to poor prognosis of patients with metaplastic breast carcinoma: A clinicopathological study

Publication date: December 2017
Source:Annals of Diagnostic Pathology, Volume 31
Author(s): Ryuji Ohashi, Maoka Sangen, Shigeki Namimatsu, Hiroyuki Takei, Zenya Naito
Metaplastic breast carcinoma (MBC) is a rare type of tumor with heterogenous histological patterns. We investigated the immunohistochemical expression of IMP3, an oncofetal protein, in 31 MBC patients in association with histological subtypes and clinical outcomes. The cohort consisted of spindle cell carcinoma (SPC) (n=11), squamous cell carcinoma (SCC) (n=14), matrix-producing carcinoma (MPC) (n=4), carcinoma with osteocartilaginous elements (COC) (n=1), and low grade adenosquamous cell carcinoma (ASC) (n=1). IMP3 expression was identified in 7 cases of SPC (64%) and 6 patients of all the other subtypes (p=0.051). In comparison between IMP3 high (n=13) and low (n=18) groups, a large-sized tumor (≥4.0cm) was identified in 9 IMP3 high patients, and 14 IMP3 low patients had a small-sized tumor (p=0.01). High Ki67 positivity was detected in all of the IMP3 high patients and in 7 of the IMP3 low patients (p=0.002). During the follow-up period, 9 IMP3 high patients died, whereas 15 of the 18 IMP3 low patients remained alive (p=0.004). A univariate analysis revealed that IMP3 expression and tumor size were significantly associated with poor clinical outcomes (p=0.03 and <0.001, respectively). The IMP3 high group was likely to be associated with reduced overall survival compared to the IMP3 low group (p=0.06). These findings indicate that IMP3 may contribute to the aggressive behavior of MBC, and that this expression could potentially be a prognostic marker of MBC.



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Beta-catenin and p53 expression in topographic compartments of colorectal cancer and its prognostic value following surgery

Publication date: December 2017
Source:Annals of Diagnostic Pathology, Volume 31
Author(s): Juan Daniel Prieto, Martina Álvarez, María Isabel Hierro, Isabel García, Luis Vicioso
Colorectal cancer (CRC) is the third most prevalent neoplasm worldwide and the fourth cause of cancer-related death. From Vogelstein's initial model, new molecular knowledge has been incorporated which includes an elevated number of genetic mutations, many of them located in the Wnt pathway, which affect its principle effector: β-catenin. Additionally, it is necessary to keep the heterogeneity of CRCs in mind, both in terms of morphology and biology. The aim of this work is to study the interaction between the Wnt molecular pathway, by means of immunoexpression of β-catenin, in CRC and other molecular mechanisms, such as the p53 pathway, in order to determine the pattern - if one exists - of different immunohistochemical expression of β-catenin and p53 in the superficial and deep tumor components, and lastly, to determine the impact of these markers on prognosis.Our cases showed an increasing gradient of β-catenin immunoexpression that parallels depth in the tumor, with a greater degree of nuclear immunoexpression in the deep compartment. We observe that in those cases with positivity for nuclear p53 and an absence of immunostaining of β-catenin show higher rates of survival, whereas one of the lowest rates was observed in patients who co-expressed p53 and β-catenin. We conclude that a combined analysis of β-catenin and p53 could have prognostic importance as markers for predicting the disease's progression and contribute to the identification of patients with a high risk of mortality.



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Comparison of HER2 status determination methods in HER2 (2+) patients: Manual fluorescent in situ hybridization (FISH) vs. dual silver enhanced in situ hybridization (SISH)

Publication date: December 2017
Source:Annals of Diagnostic Pathology, Volume 31
Author(s): Burcin Pehlivanoglu, Gurdeniz Serin, Levent Yeniay, Osman Zekioglu, Erhan Gokmen, Necmettin Ozdemir
HER2 amplification has been demonstrated in 15–25% of invasive breast carcinomas and can be assessed using immunohistochemical and in situ hybridization methods. Here, we compared the accuracy of dual SISH to manual FISH in HER2 (2+) breast carcinoma and evaluated the feasibility of dual SISH method in routine practice. Sixty HER2 (2+) consecutive tumor samples diagnosed between January 2009 and February 2013 were selected. Demographic, histological and immunohistochemical features and FISH results were recruited from patient records and compared to dual SISH results. Nine (15%) of the 60 tumor samples were excluded from statistical analysis due to lack of interpretable SISH signals. HER2 staining percentages by immunohistochemistry differed between 20 and 80%. HER2 amplification was shown in 7 (13.7%) and 8 (15.7%) patients by FISH and SISH, respectively. Very good agreement was observed between FISH and SISH methods (kappa value: 0.92). Significant correlation was found between HER2 staining percentage and FISH positivity, in contrast to SISH positivity (p=0.012 vs. p=0.069). Our results are consistent with previously reported literature, indicating SISH can be used to determine HER2 status. However, preanalytical and analytical problems may cause inadequate or uncountable signals, making interpretation impossible for the pathologist and highlighting the importance of standardization and quality control programs.



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AMPK expression patterns are significantly associated with poor prognosis in breast cancer patients

Publication date: August 2017
Source:Annals of Diagnostic Pathology, Volume 29
Author(s): Jaudah Al-Maghrabi, Kaltoom Al-Sakkaf, Imtiaz Ahmad Qureshi, Nadeem Shafique Butt, Lila Damnhory, Mohamed Elshal, Basim Al-Maghrabi, Alia Aldahlawi, Sawsan Ashoor, Barry Brown, Pauline Dobson, Mohamad Nidal Khabaz
Many investigators have examined the functions of AMP-activated protein kinase (AMPK) in cancer biology and its anti-neoplastic features in cancer models. The goal of this research is to assess the association of the immunohistochemical expression of AMPK in human mammary tumours with the clinical data of breast cancer patients. 449 cases of previously diagnosed breast cancer, and 27 tissue samples of fibroadenomas and normal breast were utilized for detection of AMPK expression using tissue microarrays and immunohistochemistry. Brownish nuclear and cytoplasmic staining were present in epithelial cells and stromal cells in 333 (74.16%) and 348 (77.5%) cancer cases respectively indicating AMPK expression. Twenty two (81.48%) control cases showed AMPK immunoexpression in both epithelial and stromal cells. Significant statistical association has been found between advanced stages of breast cancer and increased intensity of AMPK immunostaining only in epithelial cells (p-value=0.0001). Histotypes have been correlated with AMPK immunostaining in epithelial cells only (p-value=0.029). Low AMPK immunostaining scores were more dominant in DCIS, ductal and mixed type's ductal and mucinous histotypes, while high intense staining was more common in the lobular type. Furthermore, breast tumour cases with lymph node metastases showed significant AMPK expression in both epithelial and stromal cells (p-value=0.0001 and p-value=0.026). Low scores of AMPK immunostaining were common in breast cancer cases with positive vascular invasion (p-value=0.007) and disease recurrence (p-value=0.008). No significant differences in survival behavior distributions were observed for the different categories of AMPK immunostaining in epithelial and stromal cells.In conclusion, our results showed decreased AMPK expression in breast cancer in comparison with the control group. AMPK expression was significantly correlated with some clinicopathological factors like advanced stage, lymph node involvement, vascular invasion and disease recurrence which give indications for poor clinical outcomes. Immunohistochemical staining of AMPK protein is a valuable method which could predict cases of breast cancer with poor prognosis.



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Expression of pRb, Ki67 and HER 2/neu in gastric carcinomas: Relation to different histopathological grades and stages

Publication date: October 2017
Source:Annals of Diagnostic Pathology, Volume 30
Author(s): Azza Abdel-Aziz, Rehab Allah Ahmed, Afaf Taha Ibrahiem




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Editorial Board

Publication date: June 2017
Source:Annals of Diagnostic Pathology, Volume 28





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Expression of dog1 in low-grade fibromyxoid sarcoma: A study of 19 cases and review of the literature

Publication date: October 2017
Source:Annals of Diagnostic Pathology, Volume 30
Author(s): Ana Vallejo-Benítez, Enrique Rodríguez-Zarco, Sara Pabón Carrasco, Sofia Pereira-Gallardo, Javier Brugal Molina, Antonio García-Escudero, Antonio Robles Frías, David Marcilla, Ricardo González-Cámpora
DOG1 is a highly-sensitive marker often included in the immunohistochemical panel for the diagnosis of gastrointestinal stromal tumors (GISTs). Recent research has shown that DOG1 may also be expressed by low-grade fibromyxoid sarcomas (LGFMSs); this may give rise to diagnostic error when the sarcoma is located in the abdominal cavity. This paper reports on immnohistochemical expression of DOG1 in 19 LGFMSs using two different monoclonal antibodies: K9 (Leica, Novocastra Laboratories, Newcastle upon Tyne, UK) and SP31 (Thermo Scientific, Freemont, USA). All LGFMSs displayed the standard histological pattern of alternating myxoid and fibrous areas, low cellularity and bland spindle-cell morphology. Positive staining for MUC4 was observed in 18/19 cases (94.7%), while there was rearrangement of the FUS gene in 14/19 (73.7%) cases and of the EWR1 gene in 2/19 (10.5%). The sarcoma staining negative for MUC4 displayed FUS gene rearrangement. Whole-section immunohistochemistry revealed positive staining for DOG1 in 8/19 cases (42.1%), though only with clone K9. Cytoplasmic as well as membrane staining was observed in all cases; staining was focal (10–30%) and of varying intensity (1+ to 2+).In conclusion, DOG1 clone K9 exhibited low sensitivity (42.1%) for the diagnosis of LGFMS, although higher than clone SP31. Since the two clones display similar sensitivity and specificity for GIST diagnosis, SP31 would appear to be more specific for this purpose, since no reaction was observed here with LGFMS, a GIST-mimicking lesion.



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Histological, immunohistochemical features and pathogenesis of pseudoangiosarcomatous urothelial carcinoma

Publication date: October 2017
Source:Annals of Diagnostic Pathology, Volume 30
Author(s): Pelin Yıldız, Kemal Behzatoğlu, Ezgi Hacıhasanoğlu, Oğuzhan Okcu, Haydar Durak, Uğur Yücetaş




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Chronic inflammation in refractory hippocampal sclerosis-related temporal lobe epilepsy

Publication date: October 2017
Source:Annals of Diagnostic Pathology, Volume 30
Author(s): Jordan M. Gales, Richard A. Prayson
Emerging evidence suggests chronic inflammation may play a role in hippocampal sclerosis-associated temporal lobe epilepsy. We sought to systematically evaluate for its presence in a group of 315 patients who underwent surgery for medically-refractory epilepsy and who had hippocampal sclerosis. Upon histologic review of hematoxylin and eosin stained tissue sections, 95 (41%) cases demonstrated the presence of lymphocytes within the perivascular region and diffusely within the brain parenchyma. Those cases with chronic inflammation evident on hematoxylin and eosin staining were significantly more likely to experience a post-operative seizure recurrence than those without it (p=0.03). In 9 cases of hippocampi with chronic inflammation observed on hematoxylin and eosin stained sections, there was a mixture of both T (CD3+) and B (CD20+) lymphocytes located around blood vessels and interspersed within the brain parenchyma and a predominance of CD4 positive T cells versus CD8 positive cells. Ten hippocampi, apparently devoid of chronic inflammation upon inspection with hematoxylin and eosin stained sections, were stained with the lymphocyte common antigen CD45. In all 10 cases, scattered lymphoid cells were observed in the brain parenchyma, suggesting some level of chronic inflammation may be present in more cases than casual inspection might suggest. This study was the first to evaluate the incidence of chronic inflammation within a large temporal lobe epilepsy population. The study findings suggest chronic inflammation may be a more common component of hippocampal sclerosis -associated temporal lobe epilepsy than previously believed.



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Table of Contents

Publication date: June 2017
Source:Annals of Diagnostic Pathology, Volume 28





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Utility of different immunostains for diagnosis of metastatic breast carcinomas in both surgical and cytological specimens

Publication date: October 2017
Source:Annals of Diagnostic Pathology, Volume 30
Author(s): Yanjun Hou, Rulong Shen, Shweta Chaudhary, Dena Tonkovich, Zaibo Li
ObjectiveA panel of immunostains is usually performed to confirm a metastatic carcinoma origin. GATA3 is a transcription factor and has been proven to be a useful marker for breast carcinoma. Other immunostains including mammaglobin (MGB), gross cystic disease fluid protein 15 (GCDFP-15), estrogen receptor (ER) and progesterone receptor (PR) are also used in diagnosing metastatic breast cancer. In this study, we aimed to compare the performance of these immunostains in the work up of metastatic breast carcinoma in both surgical and cytological specimens.Study designThis study cohort was composed of 242 metastatic breast carcinomas (142 surgical and 100 cytological specimens) during a study period from October 2013 to December 2015. Immunostain results of GATA3, CK7, MGB, GCDFP-15, ER and PR and their correlations were examined.ResultsIn surgical specimens, GATA3 and CK7 were highly expressed (88% and 87%), but MGB and GCDFP-15 showed much lower positivity rates (43% and 29%). In cytological specimens, GATA3, CK7 and MGB showed similar positivity rates to those in surgical specimens; but GCDFP-15, ER and PR showed significantly lower positivity rates than those in surgical specimens. All ER-positive cases were positive for GATA3 in both surgical and cytological specimens; however, GATA3 positivity showed a significantly stronger correlation with ER positivity in surgical specimens than in cytological specimens.ConclusionsGATA3 and CK7 performed better than other immunostains to detect metastatic breast carcinoma in both surgical and cytological specimens. GATA3 expression was positively correlated with ER expression, and the correlation was stronger in surgical specimens than in cytological specimens.



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Editorial Board

Publication date: April 2017
Source:Annals of Diagnostic Pathology, Volume 27





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A simple technique for the correction of maxillonasal dysplasia using customized expanded polytetrafluoroethylene (ePTFE) implants

The treatment of maxillonasal dysplasia in Binder's syndrome using autologous costal bone and cartilage is well established, but postoperative results may be compromised by scarring, unpredictable absorption of transferred autologous tissue, and donor site morbidity. Here, we propose a simple surgical technique to improve maxillonasal dysplasia using an expanded polytetrafluoroethylene (ePTFE) implant.

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High resolution residual stress gradient characterization in W/TiN-stack on Si(100): Correlating in-plane stress and grain size distributions in W sublayer

Publication date: 15 October 2017
Source:Materials & Design, Volume 132
Author(s): René Hammer, Juraj Todt, Jozef Keckes, Bernhard Sartory, Georg Parteder, Jochen Kraft, Stefan Defregger
Residual stress gradient characterization by the ion beam layer removal method (ILR), using a milling step of 10nm, was applied to W/TiN stacks processed on thermal SiO2-insulated standard silicon wafers. The stress profiles indicate a pronounced stress gradient with high tensile, as well as compressive stress concentrations in polycrystalline W and amorphous TiN sublayers ranging between 3.5 and −4GPa. Electron backscatter diffraction shows that the W sublayer exhibits zone T microstructure with nano-sized crystallites in the nucleation region at the interface to TiN and above that columnar or V-shaped grain morphology typical for competitive grain growth. In the W sublayer, the stress distributions correlate well with this in-plane crystallite size distribution on the base of a Hall-Petch mechanism, reaching a tensile maximum in the transition region between the nucleation layer and the region with columnar microstructure.

Graphical abstract

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Plasmatic and Intracellular Markers of Oxidative Stress in Normal Weight and Obese Patients with Polycystic Ovary Syndrome

Exp Clin Endocrinol Diabetes
DOI: 10.1055/s-0043-111241

Introduction Insulin resistance (IR) is associated with polycystic ovary syndrome (PCOS). Oxidative stress (OS) is, in turn, related to IR. Studies in PCOS evidenced an increase in OS markers, but they are mainly performed in obese patients, while the complex picture of normal weight PCOS is still poorly investigated. Matherials and Methods To investigate OS in PCOS and relationship with hormonal and metabolic picture, we performed a case-control study in 2 PCOS groups: normal weight (N-PCOS, n=21, age 18–25 ys, mean±SEM BMI 20.7±0.2 kg/m2) and obese (OB-PCOS, n=15, 20–30 ys, BMI 32.8±1.1), compared with control groups matched for BMI: normal (N-C, n=10, 20–30 ys, BMI 21.6±0.9) and obese (OB-C, n=20, 21–31ys, BMI 36.8±1.0). Malondialdehyde (MDA) in blood plasma and peripheral mononuclear cells, obtained by density-gradient centrifugation, was assayed spectrophotometrically by TBARS assay. CoenzymeQ10 (CoQ10) in plasma and cells was assayed by HPLC. Plasma Total Antioxidant Capacity (TAC) was also measured by spectrophotometric method. Results PCOS patients exhibited higher Testosterone levels than controls, but OB-PCOS had highest HOMA (Homeostasis Model Assessment) index, suggesting marked insulin resistance. Despite plasma MDA levels were not significantly different (N-PCOS 3380±346.94 vs. N-C 7 120±541.66; OB-PCOS 5 517.5±853.9 vs. OB. 3 939.66±311.2 pmol/ml), intracellular MDA levels were significantly higher in N-PCOS than controls (mean 3 259±821.5 vs. 458±43.2 pmol/106/cells) and higher than OB-PCOS, although not significantly (1363.1±412.8 pmol/106/cells). Intracellular CoenzymeQ10 was higher in N-PCOS than in N-C, but the highest levels were found in OB-C. Conclusions Our data, while confirming the presence of OS in obese PCOS patients in agreement with literature, suggest that OS could be present also in normal weight PCOS, but it can be revealed in tissue rather than in plasma. The relationship with metabolic status remains to be established, but could be a physiopathological basis for antioxidant treatment in such patients.
[...]

© Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
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Risk Factors for Premature Death in Diabetes Patients who Undergo Amputations below Ankle Level

Exp Clin Endocrinol Diabetes
DOI: 10.1055/s-0043-109700

Aim To identify risk factors for early death in diabetes patients who undergo amputations below the ankle. Methods A retrospective study, where all hospital records of all diabetes patients who had undergone minimum one amputation below the ankle at the CWHC Bispebjerg Hospital, Denmark, in the period 1996–2013, were examined. The amputations were mainly trans-metatarsal amputations and partial amputations of toes. The participants were found via ICD10-codes. The included patients were followed from their first contact to the last registered contact. The statistical analysis in this article is performed on patients with a of minimum 5-year follow-up. Results The 5 year mortality was 42% for patients with type 2 diabetes, and 29% for patients with type 1 diabetes. For patients with type 2 diabetes, multivariable analysis showed that high age, peripheral arterial insufficiency and short time from first admission to amputation were independently statistically significantly associated with increased 5-years mortality. Use of statins was associated with decreased mortality. 35% died as a result of their diabetes, mostly due to cardiovascular causes. Conclusion Short time from first admission to amputation is a risk factor for early death. Arterial insufficiency and high age is also associated with increased mortality, whereas use of statin is associated with decreased mortality, in patients with type 2 diabetes.
[...]

© Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

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Heavy metals and minerals contents in pikeperch ( Sander lucioperca ), carp ( Cyprinus carpio ) and flathead grey mullet ( Mugil cephalus ) from Sidi Salem Reservoir (Tunisia): health risk assessment related to fish consumption

Abstract

The aim of this study was to investigate heavy metals and selected minerals contents in filets of pikeperch (Sander lucioperca), carp (Cyprinus carpio) and flathead grey mullet (Mugil cephalus), the major fish species produced in Sidi-Salem reservoir; the largest Tunisian freshwater ecosystem. Concentrations of Ca, Mg, Fe, Zn, Cd, Pb and Hg were determined by inductively coupled plasma-optical emission spectrometry, while concentrations of Na and P were determined by flame photometry and spectrophotometry, respectively. Results concerning heavy metals are considered quantitatively reliable for Hg and Cd but must be taken with precautions concerning Pb levels as the LOD (limit of detection) of the analytical process was higher than acceptable limit. They showed greater accumulations of both Hg and Cd in filets of pikeperch than in filets of carp and mullet, but none of the values exceeded the normative maximum levels (0.500 and 0.050 mg kg⁻¹ w.w., respectively). Considering provisional intakes, target hazard quotient and hazard index, estimated for a fish portion per week, consumption of any of the species did not appear to be potentially hazardous for the health as they were far below threshold values. A fish portion would provide substantial amounts (>15% of daily requirements) in essential mineral nutrients (P, Mg and Fe) and thus should be considered an interesting contribution to a healthy diet. It is strongly advocated to authorities including freshwater fish in the official national annual control survey of contaminants in fishery products, which in addition to guaranteeing security of consumers, would also allow diversifying valorisation opportunities and thus increase the economic value of this fish production.

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Suppression of a cancer stem-like phenotype mediated by alpha-lipoic acid in human lung cancer cells through down-regulation of β-catenin and Oct-4

Abstract

Purpose

Cancer stem cells (CSCs) that possess the ability of self-renewal and multi-potency have been shown to drive tumor progression and metastasis. The majority of recent studies has focused on potential molecules targeting CSCs so as to develop novel strategies for efficient cancer treatment or protection. Here, we show how alpha-lipoic acid (LA), an endogenous mitochondrial anti-oxidant, affects the CSC-like phenotypes of human non-small cell lung cancer-derived H23, H292 and H460 cells.

Methods

CSC-like phenotypes were verified by anchorage-independent growth, three-dimensional (3D) spheroid formation and the expression of CSC markers. Enriched CSC populations were used to confirm the effects of LA. Protein ubiquitination and degradation were assessed using immunoprecipitation.

Results

We found that treatment with LA reduced the CSC-like phenotype, as indicated by a decreased expression of known CSC markers (CD133, CD44, ALDH1A1, Oct-4 and Nanog) in H460 cells. In addition, we found that LA reduced the CSC-related abilities of anchorage-independent growth and 3D spheroid formation, and suppressed factors related to epithelial-mesenchymal transition, such as E-cadherin, Vimentin, Slug and Snail. Mechanistically, we found that LA suppresses CSC through depletion of the cellular stemness proteins β-catenin and Oct-4 via decreasing the level of active (phosphorylated) Akt. This resulted in the induction of GSK3β-dependent β-catenin ubiquitin-proteasomal degradation and a decrease in the stabilized (phosphorylated) form of Oct-4. The effects of LA on the CSC-like phenotypes were confirmed in CSC enriched H460, H292 and H23 non-small cell lung cancer-derived cells.

Conclusion

Our data are indicative for a novel regulatory role and underlying mechanism of LA in the negative regulation of a CSC-like phenotype in non-small cell lung cancer-derived cells.

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Institutional Outcomes of Leech Therapy for Venous Congestion in 87 Patients

J reconstr Microsurg
DOI: 10.1055/s-0037-1604082

Background We aimed to report the outcomes associated with leech therapy and to identify risk factors associated with reconstructive failure. Methods We retrospectively reviewed cases of flap reconstruction or replanted appendages that required leech therapy over an 8-year period at the Duke University Medical Center. Using logistic regression, we assessed the association of risk factors with reconstructive failure. Results The study cohort included 87 patients which correspond to 2.1% of 4,115 cases done during the study period. The most common flap recipient site was the lower extremity (n = 33, 37.9%) followed by the upper extremity (n = 30, 34.5%), head and neck (n = 13, 14.9%), and trunk (n = 11, 12.6%). Flap types were pedicled in 44 (50.5%) cases and free in 24 (27.5%) cases. Fifteen (17.2%) were digital replantation, and four (4.5%) were replanted appendages. The average duration of therapy was 4.6 days (range: 1–11). The overall leech therapy success rate was 60.9% (53/87) and accounted for cases without flap loss (n = 45, 51.7%) and with partial flap loss in which the original reconstructive goal was achieved without further reconstructive procedures (n = 8, 9.2%). Postoperative blood transfusion was administered in 32 (36.7%) cases, and infectious complications occurred in 7 cases in spite of the administration of prophylactic antibiotics (8%). Conclusions This study represents the largest single-institution series evaluating the outcomes after leech therapy. Our data support the use of leeches as an adjunct for the management of venous congestion after reconstructive surgery. However, the morbidity associated with it should be considered, particularly the need for a blood transfusion.
[...]

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Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

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Automaticity of Force Application During Simulated Brain Tumor Resection: Testing the Fitts and Posner Model

Publication date: Available online 3 July 2017
Source:Journal of Surgical Education
Author(s): Abdulgadir Bugdadi, Robin Sawaya, Duaa Olwi, Gmaan Al-Zhrani, Hamed Azarnoush, Abdulrahman Jafar Sabbagh, Ghusn Alsideiri, Khalid Bajunaid, Fahad E. Alotaibi, Alexander Winkler-Schwartz, Rolando Del Maestro
ObjectiveThe Fitts and Posner model of motor learning hypothesized that with deliberate practice, learners progress through stages to an autonomous phase of motor ability. To test this model, we assessed the automaticity of neurosurgeons, senior residents, and junior residents when operating on 2 identical tumors using the NeuroVR virtual reality simulation platform.DesignParticipants resected 9 identical simulated tumors on 2 occasions (total = 18 resections). These resections were separated by the removal of a variable number of tumors with different visual and haptic complexities to mirror neurosurgical practice. Consistency of force application was used as a metric to assess automaticity and was defined as applying forces 1 standard deviation above or below a specific mean force application. Amount and specific location of force application during second identical tumor resection was compared to that used for the initial tumor.SettingThis study was conducted at the McGill Neurosurgical Simulation Research and Training Center, Montreal Neurologic Institute and Hospital, Montreal, Canada.ParticipantsNine neurosurgeons, 10 senior residents, and 8 junior residents.ResultsNeurosurgeons display statistically significant increased consistency of force application when compared to resident groups when results from all tumor resections were assessed. Assessing individual tumor types demonstrates significant differences between the neurosurgeon and resident groups when resecting hard stiffness similar-to-background (white) tumors and medium-stiffness tumors. No statistical difference in consistency of force application was found when junior and senior residents were compared.Conclusion"Experts" display significantly more automaticity when operating on identical simulated tumors separated by a series of different tumors using the NeuroVR platform. These results support the Fitts and Posner model of motor learning and are consistent with the concept that automaticity improves after completing residency training. The potential educational application of our findings is outlined related to neurosurgical resident training.



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An Analysis of the Most Commonly Tested Topics and Their Taxonomy From Recent Self-Assessment Examinations

Publication date: Available online 3 July 2017
Source:Journal of Surgical Education
Author(s): Chad A. Krueger, Sean Moroze, Andrew S. Murtha, Jessica C. Rivera
ObjectiveThe purpose of this study is to determine the most commonly tested topics and the question taxonomy of the American Academy of Orthopaedic Surgeons Self-Assessment Examinations (SAE) from 2009 through 2014.DesignAll SAEs were analyzed from 2009 through 2014. The SAEs were separated by subject and the questions of each SAE were analyzed for topic, taxonomic classification, and question type.ResultsA total of 2107 questions were reviewed from 10 different subjects. In all, 6 of the 9 subjects had roughly 1/3 of their questions composed of the 3 most commonly tested topics. Each subject had at least 1 trauma-related question within its top 5 most commonly tested topics. Almost half (47%) of all questions were of taxonomy 1 classification and 29% were taxonomy 3. The Basic Science SAEs had the greatest percentage of taxonomy 1 questions of any subject (83%) whereas Trauma contained the highest percentage of taxonomy 3 questions (47%).ConclusionsCertain topics within each subject are consistently tested more often than other topics. In general, the 3 most commonly tested topics comprise about one-third of total questions and orthopedic surgeons should be very familiar with these topics in order to best prepare for standardized examinations.



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Diagnostic yield of percutaneous biopsy for sclerotic bone lesions: Influence of mean Hounsfield units

Publication date: Available online 4 July 2017
Source:Clinical Imaging
Author(s): Jennifer Ní Mhuircheartaigh, Colm McMahon, Yu-Ching Lin, Jim Wu
PurposeTo identify whether there was an association between Hounsfield units of sclerotic bone lesions and diagnostic yield of biopsy.MethodAll core needle biopsies of sclerotic bone lesion were identified from a database. Pathology reports were reviewed to determine whether the biopsy was diagnostic or non-diagnostic.Results91 patients were included in the study group. The yield for lesions with mean HU≥500 was significantly lower than those with a mean HU≤500 (40% vs. 69.6%, p<0.05).ConclusionLesions with a mean HU>500 are more likely to have a non-diagnostic biopsy than a diagnostic biopsy.



http://ift.tt/2tJC76a

Differentiating parotid tumors by quantitative signal intensity evaluation on MR imaging

Publication date: Available online 4 July 2017
Source:Clinical Imaging
Author(s): Eiji Matsusue, Yoshio Fujihara, Eiken Matsuda, Yusuke Tokuyasu, Shu Nakamoto, Kazuhiko Nakamura, Toshihide Ogawa
BackgroundThere have been no reports about quantitative evaluations of enhancing components of parotid tumors on conventional MR imaging.PurposeTo evaluate the signal intensity of the enhancing components of tumors, including pleomorphic adenomas (PAs), Warthin tumors (WTs) and malignant tumors (MTs), on various MR sequences and to assess the usefulness of quantitative evaluations for differentiation among the three groups of tumors.Material and methodsA total of 39 histologically proven tumors, including 15 PAs, 17 WTs and 7 MTs, were enrolled in this study. The tumor-to-spinal cord contrast ratio (TSc-CR) was calculated by dividing the signal intensity of the lesion by that of the spinal cord on MR sequences, including T1-weighted imaging (T1WI), T2-weighted imaging (T2WI) and postcontrast gadolinium-enhanced T1WI (CE-T1WI). The mean apparent diffusion coefficient (ADC) value was selected in each tumor. Furthermore, the differences in the TSc-CRs and the ADC values among the three groups of tumors were statistically evaluated. Cutoff values were determined for the prediction of tumor histology.ResultsThe TSc-CRs of PAs were significantly higher than those of WTs and MTs on T2WI and CE-T1WI. The sensitivities and specificities were 100% and 87.5%, respectively, at a cutoff value of 1.31 for the TSc-CR of T2WI; and 83.3% and 100%, respectively, at a cutoff value of 2.00 for the TSc-CR of CE-T1WI. For the ADC values, sensitivity and specificity for discriminating PAs from WTs or MTs were both 100% when the cutoff value of the ADC was set at 1.40×10⁻³mm²/s.ConclusionADC maps and the quantitative evaluations using the TSc-CRs on T2WI and CE-T1WI were useful for discriminating WTs or MTs from PAs. However, discrimination between WTs and MTs was difficult using any MR sequence.



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Anaesthesia for laryngo-tracheal surgery, including tubeless field techniques

1C012A013A02

http://ift.tt/2sD68oV

Regional anaesthesia for ophthalmic surgery

1A011A022G012G023A093A12

http://ift.tt/2tn0ggV

Diagnosis and management of malignant hyperthermia

1A012A063I00

http://ift.tt/2sDmeiy

Critical care management of pulmonary hypertension

Abstract

Patients with pulmonary hypertension (PH) can be extremely challenging to manage in the critical care setting. In this article we review the classification, diagnosis, and chronic management of PH. An approach to the management of the critically unwell PH patient is discussed. Initial management involves treating underlying precipitants of deterioration and optimizing right ventricular (RV) preload. Reduction of RV afterload with pulmonary vasodilators is also required. Augmentation of cardiac function and perfusion pressures with inotropes and vasopressors may additionally be needed. Advanced renal and respiratory support may be appropriate depending on the clinical context. Patients with known PH who have undergone major surgery or who are in the immediate postpartum period are also at significant risk of deterioration and require management in the critical care setting. Although pulmonary vasodilators are associated with improvements in pulmonary haemodynamics and oxygenation in patients with acute respiratory distress syndrome or after cardiac surgery, there is currently no evidence demonstrating improved outcomes.

http://ift.tt/2tmUvQa

Postoperative management of the difficult airway

1C012A013A01

http://ift.tt/2sDkGow

Scholar : These new articles for Addiction Research & Theory are available online

The online platform for Taylor & Francis Online content New for Addiction Research & Theory and online now on Taylor & Francis Online: Original Article Athletes' perceptions of their head coach's alcohol management strategies and athlete alcohol use Michelle Pitts, Graig M. Chow & Yanyun Yang Pages: 1-9 | DOI: 10.1080/16066359.2017.1341976 FREE ACCESS: Health Care for Women International: Research on Women's Health in Africa: Issues, Challenges & Opportunities To update which email alerts you receive, manage your alerts within the My Account area. You can also unsubscribe from this alert with one click. If you need any further help, please contact us at support@tandfonline.com Please do not reply to this email. To ensure that you receive your alerts and information from Taylor & Francis Online, please add "alerts@tandfonline.com" and "info@tandfonline.com" to your safe senders list. Taylor & Francis, an Informa business. Taylor & Francis is a trading name of Informa UK Limited, registered in England under no. 1072954. Registered office: 5 Howick Place, London, SW1P 1WG.

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The online platform for Taylor & Francis Online content New for International Journal of Performance Arts and Digital Media and online now on Taylor & Francis Online: Original Articles Choreography for One, Two, and Three Legs (A phenomenological meditation in movements) Vivian Sobchack Pages: 1-16 | DOI: 10.1080/14794713.2017.1345583 To update which email alerts you receive, manage your alerts within the My Account area. You can also unsubscribe from this alert with one click. If you need any further help, please contact us at support@tandfonline.com Please do not reply to this email. To ensure that you receive your alerts and information from Taylor & Francis Online, please add "alerts@tandfonline.com" and "info@tandfonline.com" to your safe senders list. Taylor & Francis, an Informa business. Taylor & Francis is a trading name of Informa UK Limited, registered in England under no. 1072954. Registered office: 5 Howick Place, London, SW1P 1WG.

Scholar : These new articles for Comedy Studies are available online

The online platform for Taylor & Francis Online content New for Comedy Studies and online now on Taylor & Francis Online: Original Articles No laughing matter: film advisory boards' evaluations of award-considered comedies Alon Lazar & Tal Litvak Hirsch Pages: 1-10 | DOI: 10.1080/2040610X.2017.1343997 The stations of the fool Olly Crick Pages: 1-15 | DOI: 10.1080/2040610X.2017.1343273 Hell gigs: the stand-up comic as outlaw hero Eric Shouse Pages: 1-11 | DOI: 10.1080/2040610X.2017.1343970 Listening Leaders Free Accessarticles from International Listening Association Lifetime Achievement AwardeesFind out more To update which email alerts you receive, manage your alerts within the My Account area. You can also unsubscribe from this alert with one click. If you need any further help, please contact us at support@tandfonline.com Please do not reply to this email. To ensure that you receive your alerts and information from Taylor & Francis Online, please add "alerts@tandfonline.com" and "info@tandfonline.com" to your safe senders list. Taylor & Francis, an Informa business. Taylor & Francis is a trading name of Informa UK Limited, registered in England under no. 1072954. Registered office: 5 Howick Place, London, SW1P 1WG.

Scholar : These new articles for Asia Pacific Translation and Intercultural Studies are available online

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