Body Lesions Research Articles

Radiation‐induced osteosarcoma involving the mandible—Report of a rare diagnosis

AbstractBackgroundRadiation‐induced osteosarcomas of the jaws are a rare but often fatal consequence of radiation therapy in the head and neck region. Here we present a case of radiation‐induced osteosarcoma of the mandible.Case PresentationA male presented with severe trismus and marked left lingual alveolus expansion 1 year following extractions in the lower left quadrant. Four years previously, he had radical radiotherapy (70Gy) and chemotherapy for a p16‐positive T1N2cM0 squamous cell carcinoma of the left tonsil with a positive left level II node. Initial bone biopsies of the left mandible showed a bony sequestrum suggestive of osteoradionecrosis with the presence of abnormal osteoid suspicious of osteosarcoma. Imaging demonstrated an abnormal exophytic bone‐forming lesion in the left mandibular body and parasymphysis and ruled out a metastatic lesion. The patient underwent bilateral neck dissection, left mandibulectomy with fibula flap reconstruction and full‐thickness skin graft.ConclusionsOsteosarcoma should be considered if changes are seen in previously stable irradiated bone with bony destruction and a soft tissue mass. This case highlights the importance of synthesis of clinical, radiological and pathological findings in the diagnosis of such lesions, especially where the histology initially suggested a benign process.

Hematologi dan Histopatologi Insang Ikan Lele Hasil Budidaya Pembudidaya Lokal di Noekele, Kabupaten Kupang Timur

The aim of this study was to determine the haematological and histopathological of the Catfish gills cultured in Noekele, East Kupang, East Nusa Tenggara. The fish samples used were catfish taken randomly as many as 80 individuals from the rearing pond owned by local farmers in Noekele, then taken to the laboratory for measurement of length and weight, morphological abnormalities observation, preparation of fish blood smears and collection of gills for histological preparation. The observation of morphological abnormalities showed body lesion (90%), one ventral fins (31.3%), one pectoral fins (28.8%), dull and pale body colors (100%). Erythrocyte cell damage on haematological observation on blood smear were tear drop shaped, fusion, lacerated membrane, nuclear extrusion, blebbed nuclei, sperocytes (deformed cells), lysis and shrinking erythrocytes. Based on histopathological analysis, gill’s damage were secondary lamella edema, primary lamella vacuoles, secondary lamella necrosis, epithelium lifting, secondary lamella fusion. Loss of lamella structure, hyperplasia and presence of parasites.

Detection of "Incidentalomas" on Brain and Body 68Ga-DOTATOC-PET Scans: A Retrospective Study and Case Illustration.

One of the main limitations of standard imaging modalities is microscopic tumor extension, which is often difficult to detect on magnetic resonance imaging (MRI) and computer tomography (CT) in the early stages of the tumor. (68)Ga-DOTA(0)-Phe(1)-Tyr(3)-octreotide positron-emission tomography/computed tomography (68Ga-DOTATOC PET/CT) has shown efficacy in detecting lesions previously undiagnosed by neuroimaging modalities, such as MRI or CT, and has enabled the detection of multiple benign tumors (like multiple meningiomas in a patient presenting with a single lesion on MRI) or additional secondary metastatic locations. We retrospectively reviewed data from the Cannizzaro Hospital on brain and body 68Ga-DOTATOC PET/CT "incidentalomas", defined as tumors missed on CT or MRI scans, but detected on 68Ga-DOTATOC PET/CT scans. "Incidentalomas" were classified into "brain" and "body" groups based on their location. The standardized uptake values (SUVs) were compared between the two groups. A total of 61 patients with "incidentalomas" documented on the 68Ga-DOTATOC PET/CT were identified: 18 patients with 25 brain lesions and 43 patients with 85 body lesions. The mean SUV at baseline was 9.01±7.66 in the brain group and 14.8±14.63 in the body group. We present the first series on brain and body "incidentalomas" detected on 68Ga-DOTATOC PET/CT. Whole-body 68Ga-DOTATOC PET/CT may be considered in selected patients with brain tumors with high expression of somatostatin receptors to assist radiosurgical or surgical planning and, simultaneously, provide accurate follow-up with early detection of potential metastases.

Tumor-induced osteomalacia treated with T12 tumor resection

Tumor-induced osteomalacia (TIO) is a rare form of osteomalacia caused by fibroblast growth factor-23 (FGF23)-secreting tumors. Most of these tumors are phosphaturic mesenchymal tumors (PMTs) typically involving soft tissue in the extremities and bone of the appendicular skeleton and cranium. We report the case of a 60-year-old woman with about 3 years of persistent bone pain and multiple fractures, initially diagnosed as osteoporosis, who was found to have hypophosphatemia with low 1,25-dihydroxyvitamin D and elevated alkaline phosphatase and inappropriately normal FGF23 consistent with TIO. Her symptoms improved with phosphate supplementation, vitamin D and calcitriol. 68Ga-DOTATATE imaging revealed a T12 vertebral body lesion confirmed on biopsy to be a PMT. She underwent resection of the PMT with resolution of TIO and increased bone density. This rare case of TIO secondary to a PMT of the thoracic spine highlights some of the common features of PMT-associated TIO and draws attention to PMT-associated TIO as a possible cause of unexplained persistent bone pain, a disease entity that often goes undiagnosed and untreated for years. Tumor-induced osteomalacia (TIO) is typically caused by phosphaturic mesenchymal tumors (PMTs) that are usually found in the soft tissue of the extremities and bone of the appendicular skeleton/cranium and rarely in the spine. TIO may be misdiagnosed as osteoporosis or spondyloarthritis, and the correct diagnosis is often delayed for years. However, osteoporosis, in the absence of fracture, is not associated with bone pain. The hallmark of TIO is hypophosphatemia with inappropriately normal or low 1,25-dihydroxyvitamin D and elevated or inappropriately normal fibroblast growth factor-23 (FGF23) levels. In patients with unexplained persistent bone pain, a serum phosphate should be measured. Consider PMT-associated TIO as a potential cause of unexplained persistent bone pain and hypophosphatemia. PMTs express somatostatin receptors and may be identified with 68Ga-DOTATATE imaging. Complete surgical resection is the preferred treatment for spinal PMTs associated with TIO.

“Growing fibroadenoma”: Are there clinical and pathological features predicting a phyllodes tumor on surgical excision?

In cases of growth of FA on imaging, core needle biopsies (CNB) are often performed to rule out phyllodes tumor (PT). We aim to focus on “growing FAs” and to identify clinical and histopathologic features that are likely to predict a PT on excision. Thirty-four FAs with radiologic documentation of growth were included. Various clinical and pathological features such as age, body mass index (BMI), lesion size, and growth rate were recorded. On excision, 17 cases (50 %) were FAs, whereas 16 (47 %) were re-classified as benign PT despite only 19 % being suspicious for PT on CNB. PT patients were older (mean age 42.6) than those with FAs (mean age 28.2), p = 0.0002. All false negative cases demonstrated intracanalicular growth. Mitotic rate was the most significant histologic feature in PT on excision compared to others, such as lesion circumscription and stromal cellularity. Recognition and careful counting of mitotic rate, especially with intracanalicular patterns in growing FAs, can potentially prevent missing a PT on CNB. In patients with “growing FAs” who are ≥40 years of age, excision may be recommended due to the high likelihood of PT diagnosis on excision and high false negative rate on CNB.

The role of the bed nucleus of the stria terminalis in the motivational control of instrumental action.

We review recent studies assessing the role of the bed nucleus of the stria terminalis (BNST) in the motivational control of instrumental conditioning. This evidence suggests that the BNST and central nucleus of the amygdala (CeA) form a circuit that modulates the ventral tegmental area (VTA) input to the nucleus accumbens core (NAc core) to control the influence of Pavlovian cues on instrumental performance. In support of these claims, we found that activity in the oval region of BNST was increased by instrumental conditioning, as indexed by phosphorylated ERK activity (Experiment 1), but that this increase was not due to exposure to the instrumental contingency or to the instrumental outcome per se (Experiment 2). Instead, BNST activity was most significantly incremented in a test conducted when the instrumental outcome was anticipated but not delivered, suggesting a role for BNST in the motivational effects of anticipated outcomes on instrumental performance. To test this claim, we examined the effect of NMDA-induced cell body lesions of the BNST on general Pavlovian-to-instrumental transfer (Experiment 3). These lesions had no effect on instrumental performance or on conditioned responding during Pavlovian conditioning to either an excitory conditioned stimulus (CS) or a neutral CS (CS0) but significantly attenuated the excitatory effect of the Pavlovian CS on instrumental performance. These data are consistent with the claim that the BNST mediates the general excitatory influence of Pavlovian cues on instrumental performance and suggest BNST activity may be central to CeA-BNST modulation of a VTA-NAc core circuit in incentive motivation.

Rupture of the extensor digitorum communis tendon in extensor zone V due to plant thorn injuries: a report of two cases

Penetrating injuries due to a plant thorn in the hand may occur during outdoor activities. We experienced two patients with rupture of the extensor digitorum communis (EDC) tendon in extensor zone V caused by plant thorn injuries. Both patients, presenting with pain and swelling around the third metacarpophalangeal joint, had a history of penetrating injuries due to plant thorns. The injuries had been ineffectively treated with oral antibiotics. Plain radiographs showed soft tissue swelling without a foreign body and bony lesions. Enhanced magnetic resonance imaging confirmed a rupture of the EDC tendon at the third extensor zone V. Tendon ruptures were diagnosed 27 and 60 days after injury, respectively. A plant thorn injury in the hand can cause persistent synovitis around the tendon, and as a result, progress to tendon rupture. A magnetic resonance imaging examination may be helpful if symptoms do not improve for a prolonged period after plant thorn injury.

Hepar-1 Positive Prostatic Adenocarcinoma: A Case Report and Review of Literature

Abstract Introduction/Objective Poorly differentiated metastatic malignancy in patients with a history of more than one known primary tumor, such as a history of both hepatocellular and prostatic carcinoma as seen in our case, can be challenging. Both tumors are CK7/CK20 positive, and both can be reactive for hepar-1, as has been demonstrated in the current case, and rarely described in the literature. Methods/Case Report Herein we present a sixty-three-year-old male who presented for follow-up of his lower back pain in the setting of hepatocellular carcinoma. MRI of the spine was suggestive of an expansile metastatic lesion in the C2 vertebral body with extraosseous soft tissue extension resulting in moderate to severe central canal and left foraminal narrowing at C2-3. Multiple additional metastatic lesions were visualized throughout the cervical upper thoracic spine as detailed above. Vertebral body biopsy showed metastatic adenocarcinoma with sheets of neoplastic cells infiltrating the medullary spaces. The patient’s history of hepatocellular carcinoma was noted, and immunohistochemical staining for HepPar1 with appropriate control was performed and found to be diffusely reactive in the tumor cells. However, tumor cells were also positive for PSA, PSAP, and NKX3.1 (Fig-1-A-D, H&E, Hepar-1, PSAP, PAP). This immunoprofile is consistent with a prostatic origin of the tumor cells, and a diagnosis of metastatic prostatic adenocarcinoma was given. Results (if a Case Study enter NA) NA. Conclusion Hepar-1 and even arginase-1 have been observed in rare subsets of prostatic acinar adenocarcinoma. Even in the setting of PSA and PSAP negative metastatic disease in patients with a history of hepatocellular carcinoma, we suggest utilizing additional stains suggestive of a prostatic origin, such as NKX3.1, and even molecular studies. This could be useful diagnostic approach to help differentiate between the two neoplasms in such patients.

Multifocal Paraganglioma Including the Cervical Sympathetic Chain.

Multifocal head and neck paragangliomas are exceptionally rare. We present a patient with 4 synchronous tumors including a sympathetic chain lesion. This is a case report and literature review conducted from September 2021 to the present. Our 69-year-old male patient presented to the clinic with multifocal paraganglioma involving the right carotid body, right cervical sympathetic trunk, right glomus jugulare, and left glomus tympanicum. After preoperative embolization, successful surgical resection was performed for the right sympathetic trunk and right carotid body tumor. Postoperatively, the patient had a right Horner's syndrome but a strong voice and intact recurrent laryngeal nerve function. He also had first-bite syndrome and right cranial nerve XII weakness which resolved. Of interest, patient also has a strong family history of paragangliomas: his sister has malignant paragangliomas with lymph node involvement and his mother and nephew have non-malignant paragangliomas. To our knowledge, multifocal tumors including synchronous carotid body, sympathetic chain, glomus jugulare, and glomus tympanicum lesions occurring in 1 person have not been reported until now. As a result of this study, there is new light shed on the treatment and evaluation of patients who present with multifocal paraganglioma involving the sympathetic chain.

Clinical Analysis of Extrapulmonary Neuroendocrine Carcinoma: A Retrospective and Single Institution Experience

Introduction: Extrapulmonary neuroendocrine carcinoma (EPNEC) is a clinicopathological entity distinct from neuroendocrine carcinoma of the lung. Here, we reviewed the clinical features, treatment modalities, and prognosis of EPNEC patients in a single-institution series. Methods: We retrospectively reviewed the medical records of EPNEC patients and examined the clinical profiles and treatment outcomes at our hospital between 2013 and 2021. Results: Thirty-one EPNEC patients (21 men and 10 women) with a median age of 65 years were included. The primary sites were as follows: stomach (n = 7); rectum and bladder (n = 3 each); prostate, esophagus, cervix, and pancreas (n = 2 each); maxillary sinus, parotid gland, gallbladder, anal canal, larynx, uterine body, ovary, appendix, anterior mediastinum, and unknown primary lesion (n = 1 each). Thirteen patients had locally advanced stage and 18 cases had distant metastases. Chemotherapy using platinum-combined CPT-11 or VP-16 was mainly performed. Various therapeutic modalities were used, especially in locally advanced cases. Ten patients underwent surgery, including initial surgery in 5 and conversion in 5 after chemotherapy. The response rate to initial chemotherapy was 56.5%, and the median overall survival in all patients was 12.8 (95% CI: 9.6–34.5) months. Survival was significantly longer in patients with locally advanced stage (80.3 months) and receiving surgery (not reached) than in those with metastatic disease (9.9 months) and without surgery (9.6 months). Conclusion: EPNEC occurs in various organs and has poor prognosis. Long-term survival may be possible with surgical resection in cases with early-stage disease or tumor shrinkage due to chemotherapy.

Meta-Analysis of the Use of Eimeria Lesion Scores and Oocyst Counts in Floor-Pen Studies.

The success of treatments for, or prophylaxis of, coccidiosis with classical anticoccidial feed additives or alternative treatments can be measured with a variety of metrics. Three important metrics are body weight or body weight gain (BW or BWG), lesion scores (LS), and oocyst shedding (OS). A meta-analysis of floor-pen experiments was performed to determine if using LS and OS would lead to systematically different assessments compared to the use of BW at the end of the experiment, and to what degree changes in LS and OS are correlated with BW. We also investigated if there were days postinfection on which one could expect larger ratios between untreated control groups and treated groups for LS and OS as an aid to selecting sampling days. A total of 38 experiments from 37 articles in peer-reviewed journals were included. Data sets containing experiments that investigated LS or OS in addition to BW or BWG to assess anticoccidial feed additives or alternative treatment were tested for the effectiveness of the intervention either by univariate meta-analyses for each metric or by robust variance estimation multivariate meta-analysis combining BW with LS or BW with OS. The results did not show evidence that the inclusion of LS and OS in experimental designs to assess the effect of conventional and alternative feed additives with assumed anticoccidial activity systematically changed the conclusions drawn from an experiment, but there was no significant correlation between the LS and OS ratios of untreated and treated groups determined during the experiments with the ratios of the BW at the end of the experiment for each experiment. There was also no discernible relationship between LS or OS ratios and days postinfection.

Impact of two commercial weaning and transport strategies on piglet behaviour, body weight change, lesions and lameness following transport

The impact of transport on weaned piglet welfare has been evaluated under experimental conditions, but data generated from studies conducted under commercial conditions and incorporating variation in time between weaning and transport are lacking. The purpose of this research was to describe the behaviour patterns, changes in weight and signs of injury observed in a subset of piglets from two Canadian commercial swine systems employing different weaning and transport practices. The Western system (W) weaned piglets up to six days prior to long (>30 h) transport, while the Eastern system (E) weaned piglets immediately prior to short (<3 h) transport. Four transport events for both systems were observed under summer conditions. Behaviour of the first pen of piglets placed after transport was recorded at arrival (T1a), while a subset of the transported piglets enrolled prior to transport (E: n = 200, W: n = 240) had weights collected, injury assessments completed, and behaviour video recorded on the day of arrival (T1b) and 3–4 days later (T2). A greater percentage of W piglets were observed feeding at T1a (35.8% vs 0.0%; P < 0.001), and piglets exposed to W system practices had a greater likelihood of being observed feeding compared to piglets exposed to E system practices at T1b (IRR: 9.2, 95% CI: 4.3–19.9, P < 0.001) and T2 (IRR: 2.1, 95% CI: 1.8–2.4, P < 0.001). Similarly, a greater percentage of W piglets were observed drinking at T1a (13.9% vs 9.2%; P = 0.005) and piglets exposed to W system practices had a greater likelihood of being observed drinking at T1b (IRR: 2.0, 95% CI: 1.3–2.9, P = 0.001). Sitting was performed more by E piglets at T1a (P = 0.01), but piglets exposed to W system practices had a greater likelihood of being observed sitting at T1b (IRR: 2.5, 95% CI: 1.4–4.6, P = 0.003). Eastern system piglets lay down more at T1a (20.0% vs 0.0%; P < 0.001) and piglets exposed to E system practices had a greater likelihood of being observed lying at T2 (IRR: 1.4, 95% CI: 1.4–1.5, P < 0.001). Between T1b and T2, lesion severity (scratches, wounds) increased in E piglets compared to W piglets in the ear, skin and tail regions assessed, likely due to weaning timeline and associated aggression. This study observed impacts of both proximity to weaning and transport duration on piglet welfare indicators and supports further investigation of the interaction between weaning and transport departure times. Piglets undergoing long transport days after weaning may benefit from having access to feed and water during transport.

Management factors affecting gestating sows' welfare in group housing systems - A review.

Public concern on the methods of raising food-producing animals has increased, especially in the last two decades, leading to voluntary and mandated changes in the animal production methods. The primary objective of these changes is to improve the welfare of farm animals. The use of gestational stalls is currently a major welfare issue in swine production. Several studies assessed the welfare of alternative housing systems for gestating sows. A comparative study was performed with gestating sows housed in either individual stalls or in groups in a pen with an electronic sow feeder. This review assessed the welfare of each housing system using physiological, behavioral, and reproductive performance criteria. The current review identified clear advantages and disadvantages of each housing system. Individual stall housing allowed each sow to be given an individually tailored diet without competition, but the sows had behavioral restrictions and showed stereotypical behaviors (e.g., bar biting, nosing, palate grinding, etc.). Group-housed sows had increased opportunities to display such behavior (e.g., ability to move around and social interactions); however, a higher prevalence of aggressive behavior, especially first mixing in static group type, caused a negative impact on longevity (more body lesions, scratch and bite injuries, and lameness, especially in subordinate sows). Conclusively, a more segmented and diversified welfare assessment could be beneficial for a precise evaluation of each housing system for sows. Further efforts should be made to reduce aggression-driven injuries and design housing systems (feeding regimen, floor, bedding, etc.) to improve the welfare of group-housed sows.

S3657 Primary Gastric Adenocarcinoma With Clear Cell Differentiation Presenting With Melena: A Rare Cancer Treated With Hybrid Endoscopic Mucosal Resection and Endoscopic Submucosal Dissection

Introduction: Primary gastric clear cell carcinoma (GCCC) is an exceedingly rare type of adenocarcinoma. It can often be misdiagnosed as metastatic clear cell cancer with primary lesions in other body organs. We hereby present an interesting case of primary GCCC, successfully removed with hybrid endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD). Case Description/Methods: A 91-year-old male had ongoing anemia and melena due to intermittent oozing from a gastric body nodule. Previous EGD showed an oozing, nodular lesion in the gastric body (Figure 1A). On EUS, it was a benign, mucosal-based, friable lesion. Pathology revealed gastric intestinal metaplasia. His past history included hyperlipidemia, hypertension, skin cancer, transient ischemic attack, prior colon polyps, and sigmoid resection for diverticulosis. Home medications included cardizem, iron and vitamin C supplements, allopurinol, aspirin, and PPI. He denied recent weight loss, nausea, vomiting, early satiety, chest pain, dyspnea, fever, or dysphagia. He then came to our hospital for endoscopic removal of the gastric lesion. EGD showed a 3-cm sessile polyp on the posterior wall of the gastric body, located along the lesser curvature (Figure 1B, C). The polyp was completely removed by the hybrid EMR and ESD technique. Pathology revealed invasive adenocarcinoma of the intestinal type with clear cell features, arising in a background of extensive intestinal metaplasia (Figure 1; D, E, F). He developed post-procedure urinary retention and underwent temporary Foley's catheter placement, which was removed shortly after. No fever or GI bleeding was noted. After diagnosis, his oncologist recommended concurrent chemoradiotherapy. His most recent PET scan was unremarkable. No melena was reported at the follow-up after 3 months. Discussion: We herein presented a rare and interesting case of primary GCCC. In these patients, it is imperative for endoscopists to differentiate between primary GCCC and metastatic lesions to deliberate upon best therapeutic choice. Pathology with immunohistochemistry is the cornerstone of accurate diagnosis for primary GCCC. Given the extremely rare occurrence, no standard treatment guidelines exist for GCCC. Therefore, the therapeutic approach varies on a case-by-case basis, which largely depends on its localization. For instance, the 3-cm lesion in our patient was located along the lesser curvature and was successfully removed by hybrid EMR and ESD. Therefore, it did not necessitate total gastrectomy.Figure 1.: A: Previous EGD showing an actively oozing, nodular lesion in the gastric body. B and C: EGD showing a 3-cm sessile polyp on the posterior wall of the gastric body, located along the lesser curvature. D, E, and F: Pathologic examination of the polypectomy specimen showing invasive adenocarcinoma of the intestinal type with clear cell features, arising in a background of extensive intestinal metaplasia.

Arthroscopic-Assisted Minimal Invasive Surgery for Weber C Ankle Fractures: Comparation to Open Reduction Internal Fixation

Category: Trauma; Arthroscopy Introduction/Purpose: After acceptable reduction and internal fixation for ankle fractures, some patients regularly suffer from residual symptoms, presumably due to occult intra-articular injuries. Recently, arthroscopic-assisted technique for ankle fractures was introduced. However, there was no previous study that investigate the outcomes of arthroscopic-assisted minimal invasive surgery (MIS) for pronation type ankle fractures. The aim of this study was to compare the clinical outcomes after arthroscopic- assisted MIS surgery to conventional open reduction internal fixation (ORIF) for Weber C ankle fractures. Methods: Between 2016 and 2019, 86 patients with Weber C type ankle fractures with minimum 2 years follow up were included. Patients were sorted to 2 groups according to operation technique (MIS group (n=34): arthroscopic-assisted MIS, ORIF group (n=52): conventional ORIF). In MIS group, fibula fractures were fixed using fibula nail. Medial and posterior malleolus fractures were fixed using cannulated screw arthroscopically assisted with pin point wound. Syndesmosis injury was treated with arthroscopic reduction and screw fixation. Intraarticular lesions such as loose body or osteochondral lesion of talus were removed or debrided arthroscopically. Clinical outcomes were compared using a visual analog scale (VAS), Foot and Ankle Outcome Score (FAOS). In addition, postoperative complications including posttraumatic arthritis were evaluated. Results: There were no significant differences between 2 groups in VAS, FAOS. There were 2 cases of postoperative infections and 4 cases of wound problems in ORIF group, but there was no complication in MIS group. There were 1 cases of obvious advanced posttraumatic arthritis in MIS group and 3 cases in ORIF group. Conclusion: Arthroscopic-assisted minimal invasive surgery was effective treatment option with low rate of wound problem in for Weber C ankle fractures.

Image-guided percutaneous biopsy and pathological diagnosis in atypical tuberculous spondylitis: a case series and clinical outcomes.

Tuberculous spondylitis can be difficult to distinguish from alternative spinal pathologies such as malignancy, particularly if the imaging features are not typical. Biopsy and histopathological analysis are facilitative to the early and accurate diagnosis of atypical tuberculous spondylitis and the clinical management. The purpose of this study is to describe some of the atypical imaging features of tuberculous spondylitis diagnosed by image-guided percutaneous biopsy, as well as associated treatment outcomes. We performed a retrospective analysis of all patients diagnosed with tuberculous spondylitis after image-guided percutaneous biopsy at The Third Affiliated Hospital of Southern Medical University between 2013 and 2020. Of the patients identified, those with atypical imaging features were selected for case review. All patients were given anti-tuberculous medication treatment with or without surgery. The imaging features, histological and microbiological results, and clinical presentations and outcomes were evaluated. Neurological function was evaluated according to the Frankel grading system. The clinical outcomes were evaluated by Visual Analogic Scale (VAS) scores for pain, imaging [X-ray, computed tomography (CT), and magnetic resonance imaging (MRI)] results, and laboratory examinations. Comparison of VAS scores was made by Student t-test. Of the 102 patients identified with tuberculous spondylitis between 2013 and 2020, eight patients (two females and six males) with a mean age of 41.6 years (range, 18-61 years) demonstrated atypical imaging findings, including central vertebral body lesion, multiple skip vertebral lesions, extradural mass lesion and anterior subperiosteal lesion. All eight patients received anti-tuberculous medication treatment, and six underwent surgery. One patient developed a pleural effusion after debridement of the thoracic lesion. The mean follow-up period was 16.2 months (6-37 months). The VAS scores before treatment and at the final follow-up showed significant differences (7.25±1.49 and 0.0±0.0, respectively, P<0.01). Improved neurological function were observed in all patients. Solid fusion and osteogenic osteosclerosis were observed at the final follow-up, and no recurrence was observed in any cases. All eight patients had a good prognosis. Image-guided biopsy and histopathological analysis are helpful for the early diagnosis of tuberculous spondylitis, especially when imaging features are not typical for this condition.

Consequences of timing of organic enrichment provision on pig performance, health and stress resilience after weaning and regrouping

Most pigs in slatted systems are provided with enrichment meeting only minimum legal requirements. We aimed to explore the effects of a novel enrichment treatment consisting of daily provided fodder beet and jute bags for pigs in slatted systems, and investigate the timing of enrichment provision on performance, health and stress resilience. We used 280 weaners allocated into standard (S, meeting only legal requirements consisting of a plastic toy and softwood) or enriched (E) treatment (n = 14 groups/treatment). At regrouping during the grower to finisher transition, pigs were either kept in the same treatment (EE, SS) or switched from enriched to standard (ES) and vice versa (SE); each treatment was replicated on five groups. Pigs were weighted at the start and end of weaner, and finisher stage, and feed intake was recorded. Occurrence of scouring, respiratory problems, locomotor disorders, tail, ear, and body lesions were recorded twice a week. Ten males per treatment were sampled for saliva on days 1, 2 and 4, either postweaning or after the housing switch. Saliva samples were analysed for cortisol, alpha-amylase, haptoglobin (Hp), and adenosine deaminase. Additionally, these pigs were sampled for hair at the start and end of weaner, and end of finisher stage to analyse for hair cortisol and cortisone. We found that E weaners consumed less feed (P = 0.04), had better FCR (feed conversion ratio, P = 0.03) and less ear lesions for two weeks postweaning (P = 0.04), and tended to have lower occurrence of scouring (P = 0.07) and higher salivary cortisol concentrations (P = 0.09) than S weaners. Effects of enrichment treatment during weaner stage on performance were carried through to finisher stage, with EE and ES pigs having better FCR (P = 0.0009) and higher BW (P = 0.0001) compared to SS and SE pigs. E treatment during finisher stage decreased feed intake (P = 0.04) and tended to decrease Hp levels (P = 0.07). There was a significant interaction between enrichment treatments during weaner and finisher stages on finisher body lesions: EE finishers had less lesions than SS, ES, and SE finishers (P = 0.04). There were no other significant differences caused either by enrichment treatment during weaner/finisher stage or their interaction. We conclude that the novel enrichment applied at weaner stage had positive effects on ear lesions and performance, which were carried through to finisher stage. Body lesions were affected by its application during both stages, with finishers receiving the enrichment treatment throughout (EE) having reduced body lesions than the rest of the finishers.

Monkeypox and the dental team

Monkeypox (MPX), a rare zoonotic disease, endemic to some African countries is now spreading in non-endemic regions, including the UK. So far, it has been reported in 93 countries with over 38,000 global cases, although the signs are that the disease may be plateauing in UK. The outbreak was declared a public health emergency of international concern by the World Health Organization (WHO). Monkeypox virus (MPXV), belongs to the family Orthopoxviridae, the same family as the smallpox (variola) virus. Although some features of MPX resemble smallpox, a disease that has been eradicated, the former is far milder with a very few associated fatalities. Usually, the initial signs of MPX appear during its prodrome, as single or multiple macular lesions on the oral mucosa, accompanied by generalized lymphadenopathy, followed by the characteristic macular, papular vesicular rash on the skin that heals with scarring. The major mode of spread of MPX is generally through direct or indirect contact with body fluids or lesion material. Its transmission in the dental clinic environment is unlikely if the standard infection prevention and control (IPC) precautions recommended in the National IPC Manual (NHS England) are adhered to. These include wearing N95 masks, fluid-resistant attire and eye protection. Here, the virology, clinical manifestations, diagnosis, management and prevention strategies of MPX, with particular reference to dentistry are reviewed. CPD/Clinical Relevance: To describe the epidemiology of the re-emergent monkeypox outbreak, and discuss the management of dental patients who may present with it.

Diagnostic Yield of Serial Pancreatic Juice Aspiration Cytologic Examination With Brush Cytology for Pancreatic Ductal Stenosis.

Serial pancreatic-juice aspiration cytologic examination (SPACE) is useful for diagnosis of pancreatic ductal stenosis. This study investigates the utility of adding brush cytology to SPACE during the same procedure. We retrospectively analyzed consecutive patients who underwent SPACE with brush cytology for pancreatic ductal stenosis between February 2014 and July 2020 in our hospital. Thirty-four patients were included. Eleven had lesions in the pancreatic head lesions, and 23 had lesions in the pancreatic body or tail. Malignancies were found in 22 patients. Endoscopic ultrasound, computed tomography, and magnetic resonance imaging showed distal pancreatic duct dilation in 81.8% to 90.6% of cases, with a sensitivity of 63.0% to 65.5%. The sensitivity and diagnostic accuracy of SPACE, brush cytology, and SPACE with brush cytology were 63.6%, 50.0%, and 77.3% (P = 0.19) and 73.5%, 67.6%, and 82.4% (P = 0.42), respectively. No significant differences in diagnostic yield were observed for either pancreatic head lesions or pancreatic body/tail lesions. Post-endoscopic retrograde cholangiopancreatography pancreatitis was observed in 4 cases (11.8%). The utility of adding brush cytology to SPACE was limited.

Invasion and Metastasis Suppression by Anti-Neonatal Nav1.5 Antibodies in Breast Cancer.

Detectable neonatal Nav1.5 (nNav1.5) expression in tumour breast tissue positive for lymph node metastasis and triple-negative subtype serves as a valid tumour-associated antigen to target and prevent breast cancer invasion and metastasis. Therapeutic antibodies against tumour antigens have become the predominant class of new drugs in cancer therapy because of their fewer adverse effects and high specificity. This study was designed to investigate the therapeutic and anti-metastatic potential of the two newly obtained anti-nNav1.5 antibodies, polyclonal anti-nNav1.5 (pAb-nNav1.5) and monoclonal anti-nNav1.5 (mAb-nNav1.5), on breast cancer invasion and metastasis. MDA-MB-231 and 4T1 cells were used as in vitro models to study the effect of pAb-nNav1.5 (59.2 µg/ml) and mAb-nNav1.5 (10 µg/ml) (24 hours treatment) on cell invasion. 4T1-induced mammary tumours in BALB/c female mice were used as an in vivo model to study the effect of a single dose of intravenous pAb-nNav1.5 (1 mg/ml) and mAb-nNav1.5 (1 mg/ml) on the occurrence of metastasis. Real-time PCR and immunofluorescence staining were conducted to assess the effect of antibody treatment on nNav1.5 mRNA and protein expression, respectively. The animals' body weight, organs, lesions, and tumour mass were also measured and compared. pAb-nNav1.5 and mAb-nNav1.5 treatments effectively suppressed the invasion of MDA-MB-231 and 4T1 cells in the 3D spheroid invasion assay. Both antibodies significantly reduced nNav1.5 gene and protein expression in these cell lines. Treatment with pAb-nNav1.5 and mAb-nNav1.5 successfully reduced mammary tumour tissue size and mass and prevented lesions in vital organs of the mammary tumour animal model whilst maintaining the animal's healthy weight. mRNA expression of nNav1.5 in mammary tumour tissues was only reduced by mAb-nNav1.5. Overall, this work verifies the uniqueness of targeting nNav1.5 in breast cancer invasion and metastasis prevention, but more importantly, humanised versions of mAb-nNav1.5 may be valuable passive immunotherapeutic agents to target nNav1.5 in breast cancer.