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Πέμπτη 26 Αυγούστου 2021

A multidisciplinary approach in the diagnostic challenge of GIST

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Exp Ther Med. 2021 Oct;22(4):1063. doi: 10.3892/etm.2021.10497. Epub 2021 Jul 27.

ABSTRACT

Gastrointestinal stromal tumors (GISTs) are the most common malignant mesenchymal lesions of the gastrointestinal tract. They originate from the interstitial cells of Cajal and are characterized by overexpression of the tyrosine kinase receptor, protein product of c-KIT gene (KIT). In this retrospective study, conducted over a period of 10 years, we retrieved from our database, a total number of 57 patients, admitted and operated in the surgical department of 'Sf. Pantelimon' Emergency Clinical Hospital, Bucharest, for digestive tumors, histopathologically confirmed as GISTs. More than half of the cases presented as surgical emergencies and the tumors found during the surgical procedures, which proved to be GISTs, were sometimes difficult to differentiate from other mesenchymal tumors, both for the clinician and the pathologist. The diagnosis of GIST relies mostly on pathology and immunohistochemistry, but also on clinical and imagistic data. The most common emergencies were digestive hemorrhage (associated with gastric location), followed by intestinal obstruction (especially for the ileal localization). The largest dimensions corresponded to gastric location. For selected indications (upper digestive sites), upper digestive endoscopy approaches 100% sensitivity. This study focuses on diagnosis of GISTs sustained by both clinical and imagistic methods, along with histopathology and immunohistochemistry techniques, according to the World Health Organization 2019 criteria. Even though the differential diagnosis of these tumors is challenging, an interdisciplinary cooperation with a multiple approach increases the odds of a correct positive diagnosis.

PMID:34434277 | PMC:PMC8353641 | DOI:10.3892/etm.2021.10497

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Inhibition of autophagy promotes human RSV NS1-induced inflammation and apoptosis in vitro

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Exp Ther Med. 2021 Oct;22(4):1054. doi: 10.3892/etm.2021.10488. Epub 2021 Jul 23.

ABSTRACT

Human respiratory syncytial virus (RSV) is a major health challenge due to the lack of a safe and effective vaccine and antiviral drugs. RSV non-structural protein 1 (NS1) is the main inhibitor of antiviral signaling pathways in RSV infection; however, the underlying mechanism is unclear. The aim of the present study was to investigate of the role of NS1 and its relationship with autophagy. NS1-Flag plasmid was transfected into A549 cells and the levels of inflammatory cytokines, autophagy markers and apoptosis were detected. In addition, the cells were treated with an autophagy inhibitor, 3-methyladenine for 12 h prior to transfection with the NS1 plasmid to explore the role of autophagy in NS1-transfected cells. The results showed that the production of inflammatory cytokines and autophagy was induced in NS1-transfected cells, and indicated tha t autophagy prevents the production of cytokines and the activation of apoptosis. Furthermore, the results demonstrated that NS1 activated autophagy partly through the mTOR-p70 S6 kinase signaling pathway. The results suggest that autophagy induced by NS1 transfection through the mTOR pathway can hinder the production of inflammatory cytokines and interferon-α and inhibit cell apoptosis, which may help to explain why autophagy has been shown to be beneficial to viral replication in most studies.

PMID:34434268 | PMC:PMC8353648 | DOI:10.3892/etm.2021.10488

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Omega plate for the treatment of acetabular fractures involving the quadrilateral plate

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Exp Ther Med. 2021 Oct;22(4):1064. doi: 10.3892/etm.2021.10498. Epub 2021 Jul 27.

ABSTRACT

This retrospective study aimed to assess the outcome of a modified Stoppa approach using an anatomically precontoured plate for the treatment of acetabular fractures. In total, 30 patients (mean age 50.3 years; 25 men and 5 women) with acetabular fractures were treated between January 1, 2018 and December 31, 2019. In all 30 cases, fracture reduction was performed through a modified Stoppa approach and fixed with the omega plate. In specific fracture patterns, additional approaches were needed (lateral window in 4 cases and posterior Kocher-Langenbeck approach in 7 cases). Patients were assessed for restoration of the hip joint congruency, complications, and overall fracture reduction. Quality of reduction was categorized based on Matta's radiological principles and to assess functional outcome the Merle d'Aubigné-Postel and Harris hip score was used. The average anesthesia time was 253.6 min, the mean intraoperative blood lost was 266.6 ml and the mean intraoperative fluoroscopy dose was 3.21 mGy. According to Matta criteria for reduction quality, anatomical reduction was recorded in 22 cases, imperfect reduction in 6 cases and 2 cases had poor reduction. The average follow-up was 22.5 months. Malunion, loss of reduction or implant loosening were not recorded. Late complications included one case of avascular necrosis of the femoral head and post-traumatic arthritis changes in 5 cases. At the final follow-up, a mean Merle d'Aubigné-Postel score of 13.26±4.46 and a mean Harris score of 86.03±13.37 were recorded. The possibility of an anatomically precontoured plate with subsequent lower operative time combined with stable fixation of the primary acetabular fracture fragments and the quadrilateral plate makes the omega plate a viable option for treating acetabular fractures with a very low complication rate and good to e xcellent results in 89% of the cases.

PMID:34434278 | PMC:PMC8353621 | DOI:10.3892/etm.2021.10498

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CGFe and TGF-β1 enhance viability and osteogenic differentiation of human dental pulp stem cells through the MAPK pathway

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Exp Ther Med. 2021 Oct;22(4):1048. doi: 10.3892/etm.2021.10482. Epub 2021 Jul 23.

ABSTRACT

The present study aimed to evaluate the effects of concentrated growth factor exudate (CGFe) and TGF-β1 on the viability and osteogenic differentiation of human dental pulp stem cells (hDPSCs). CGFe was prepared from the peripheral blood of healthy donors (obtained with informed consent). STRO-1+ hDPSCs were isolated from dental pulp tissues and treated in four groups: i) Control; ii) TGF-β1 (1 ng/ml); iii) 100% CGFe; and iv) TGF-β1 (1 ng/ml) + 100% CGFe group. hDPSC viability was measured via MTT assay. The osteogenic differentiation of hDPSCs was quantified via alkaline phosphatase (ALP) activity, western blotting and reverse transcription-quantitative PCR assays. CGFe and TGF-β1 enhanced hDPSC viability, upregulated ALP activity, upregulated the expression of phosphorylated (p)-ERK1/2, p-JNK and p-p38 in hDPSCs, and promoted tra nscription and protein expression of osteogenic-related genes (bone sialoprotein, Runt-related transcription factor 2 and osteocalcin) in hDPSCs. The present study demonstrated that CGFe and TGF-β1 facilitated the viability and osteogenic differentiation of hDPSCs potentially through activation of the MAPK signaling pathway.

PMID:34434262 | PMC:PMC8353646 | DOI:10.3 892/etm.2021.10482

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External cervical resorption: Radiological diagnosis and literature (Review)

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Exp Ther Med. 2021 Oct;22(4):1065. doi: 10.3892/etm.2021.10499. Epub 2021 Jul 27.

ABSTRACT

External cervical resorption (ECR) is a relatively unknown and insidious pathology characterized by the loss of hard dental tissues such as: Enamel, cementum and dentine due to clastic function. It begins as a localized resorptive process that initiates on the area of the root beneath the epithelial attachment and the coronal part of the alveolar process, involving vital and non-vital tissues. Despite the fact that there are several potential predisposing factors related to ECR, its aetiology still remains poorly understood and more research is needed to establish the cause-and-effect relationship of all the etiological factors. Improved radiographic detection using cone-beam computed tomography (CBCT) is required in order to correctly classify and assess this entity. This provides a three-dimensional insight into the lesion, regarding the locati on, the size, the depth and the circumferential spread of the ECR defect. It also allows establishment of the most efficacious treatment plan and management. The purpose of this literature review is to cover the relevant literature concerning the etiology, pathogenesis, clinical and radiological presentation and management of ECRs (based on the CBCT findings).

PMID:34434279 | PMC:PMC8353645 | DOI:10.3892/etm.2021.10499

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Bilirubin is a specific marker for the diagnosis of acute appendicitis

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Exp Ther Med. 2021 Oct;22(4):1056. doi: 10.3892/etm.2021.10490. Epub 2021 Jul 23.

ABSTRACT

Total serum bilirubin and other biochemical parameters have been associated with acute appendicitis, mainly in complicated cases. The present study aimed to evaluate the role of biochemical parameters in the diagnosis of acute appendicitis, and to further investigate the role of bilirubin as a diagnostic marker irrespective of the severity of the pathology. All recorded cases of appendicectomies in a 1-year period in a single institution were reviewed. The median values of white cell count, C-reactive protein and total serum bilirubin on admission were associated with final histology, and their respective rates of abnormal and normal values were compared between patients who were proven to have negative histology and patients who were proven to have acute appendicitis. A total of 300 patients were studied. Median total serum bilirubin, white cell count and C-reactive protein on admission were significantly associated with acute appendicitis (P<0.001). Respective rates of normal and abnormal values were significantly associated with final histology (P<0.001). Total serum bilirubin demonstrated higher specificity (0.88) but lower sensitivity (0.26) and diagnostic accuracy (0.40) for acute appendicitis. In conclusion, total serum bilirubin on admission should be considered in the diagnostic workup to confirm rather than exclude appendicitis, without focusing on subgroups of specific severity of the disease. White cell count and C-reactive protein may also contribute to the diagnostic work-up, although with limited accuracy.

PMID:34434270 | PMC:PMC8353631 | DOI:10.3892/etm.2021.10490

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IL-17F promotes osteoblastic osteogenesis via the MAPK/ERK1/2 signaling pathway

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Exp Ther Med. 2021 Oct;22(4):1052. doi: 10.3892/etm.2021.10486. Epub 2021 Jul 23.

ABSTRACT

Osteoimmunology is a field that focuses on the interactions between the skeletal and immune systems, and has become a focus of research over the years. The role of interleukin (IL)-17F, a proinflammatory cytokine, in bone regeneration and its signal transduction are not completely understood. The aim of the present study was to evaluate the function of IL-17F and the possible mechanisms underlying IL-17F in osteoblasts in vitro. Osteoblasts derived from newborn rats were treated with various concentrations of IL-17F. The pro-osteogenic effects of IL-17F were assessed at the cellular and molecular level. The results demonstrated that IL-17F promoted osteoblast proliferation, differentiation and mineralization. Reverse transcription-quantitative PCR and western blotting indicated that IL-17F treatment upregulated osteogenesis-related factors , including bone morphogenetic protein-2, Runt-related transcription factor-2 (Runx2) and Osterix, and downregulated Noggin compared with the control group. Subsequently, whether the IL-17F receptors, IL-17 receptor (IL-17R) A and IL-17RC, served a role in the effects of IL-17F on osteoblasts was investigated. The mRNA expression levels of IL-17RA and IL-17RC were upregulated in IL-17F-treated osteoblasts compared with control osteoblasts. Furthermore, U0126, a MAPK/ERK1/2 inhibitor, was utilized to investigate the mechanisms underlying IL-17F. The results indicated that compared with the control group, IL-17F increased the protein expression of phosphorylated-ERK1/2, Runx2 and Osterix, whereas U0126 reversed IL-17F-mediated effects. Collectively, the results of the present study suggested that IL-17F promoted osteoblastic osteogenesis via the MAPK/ERK1/2-mediated signaling pathway. IL-17F promoted osteogenesis, including proliferation, differentiation and mineralization activity, i ndicating that IL-17F may serve as a potential therapeutic target for osteoblast-mediated bone loss disease.

PMID:34434266 | PMC:PMC8353634 | DOI:10.3892/etm.2021.10486

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Association between obstructive sleep apnea and thyroid cancer incidence: a national health insurance data study

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Eur Arch Otorhinolaryngol. 2021 Aug 25. doi: 10.1007/s00405-021-07050-7. Online ahead of print.

NO ABSTRACT

PMID:34435245 | DOI:10.1007/s00405-021-07050-7

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Metastatic Follicular Thyroid Carcinoma Presenting as Thoracic Cord Compression

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J Med Cases. 2021 May;12(5):177-180. doi: 10.14740/jmc3658. Epub 2021 Mar 5.

ABSTRACT

Follicular thyroid carcinoma (FTC) is an uncommon cancer and the incidence of FTC is higher in endemic areas of iodine deficiency or endemic goiter. Up until the 1990s Fiji was listed as an iodine deficient country. We report a rare case of a 53-year-old native Fijian man who presented to our hospital with spinal cord compression due to a metastatic deposit of an undiagnosed FTC. He underwent emer gent neurosurgical treatment for his cord compression, with histology of the lesion at the level of T5 identifying metastatic FTC. Despite the emergent surgery, he did not have any neurological recovery. Total thyroidectomy confirmed the presence of a large left-sided FTC and the patient was assessed for radioactive iodine treatment. Nuclear medicine imaging revealed extensive distant bony metastatic disease. Unfortunately due to his significant distant disease burden, he was unable to undergo radioactive iodine ablation therapy. After significant allied health input he was discharged home with community palliative care input.

PMID:34434453 | PMC:PMC8383535 | DOI:10.14740/jmc3658

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Acute Vision Loss From IgG4-Related and Bacterial Rhinosinusitis After COVID-19

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This case report describes a man in his 70s who presented to the emergency department with a headache for 2 weeks and vision loss in the right eye for 2 days and was subsequently diagnosed with IgG4-related and Streptococcus constellatus rhinosinusitis.
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Continuous Local Anesthetic Wound Infusions as Postoperative Standard of Care in Patients With Head and Neck Cancer

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To the Editor We thank Gostian et al for their study demonstrating a reduction in postoperative pain when continuous wound infusion (CWI) was used after head and neck oncological resections. The authors call for CWI to be assimilated into the multimodal postoperative analgesic concept in patients. However, prior to widespread implementation, we find it prudent to draw attention to a few caveats to the study's conclusions.
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