Conspicuous Findings Research Articles

Arthroplasty and oral health-an overview

Despite limited evidence for a preoperative dental screening examination and needs-based focal rehabilitation, as well as the need for antibiotic prophylaxis prior to invasive dental procedures, oral health is and remains a relevant topic in arthroplasty. The aspect of oral health should not be neglected in the future in connection with periprosthetic infections and should continue to be the subject of intensive research. The frequency of conspicuous dental findings in middle and old age underlines the importance of this problem. A dental examination prior to arthroplasty implantation can generally contribute to minimizing the risk of arthroplasty infection. It would be desirable for further studies to provide evidence on this topic in order to make recommendations for action. Independently of this, the development of an interdisciplinary guideline (arthroplasty and dentistry) on this topic should be encouraged.This could help to ensure that standardized treatment procedures are integrated into everyday clinical practice across the board.

The Benefit of Detecting Reduced Intracellular B12 Activity through Newborn Screening Remains Unclear.

Vitamin B12 (B12) deficiency (B12D) can have detrimental effects on early growth and development. The Austrian newborn screening (NBS) program targets inborn errors of cobalamin metabolism and also detects B12D. Of 59 included neonates with B12D suspected by NBS, B12D was not further investigated in 16 (27%) retrospectively identified cases, not confirmed in 28 (48%), and confirmed in 15 (25%) cases. NBS and recall biomarkers were recorded. Age at sampling of the dried blood spots for NBS and the 1st-tier methionine/phenylalanine ratio were the strongest parameters to predict B12D (67.4% correct allocations). No differences between cases with confirmed, unconfirmed, or unknown B12D or differences to norms were observed for growth and psychomotor development (Vineland III scales, phone interviews with parents of children between months 10 and 14 of life). B12 intake was below recommendations in most mothers. NBS can detect reduced intracellular B12 activity. No advantage of NBS detection and treatment regarding infant cognitive development or growth could be proven. Since conspicuous NBS findings cannot be ignored, and to prevent exposing newborns to invasive diagnostics, assessment of maternal B12 status during pregnancy seems advisable.

Prominent black esophagus, Wischnewsky spots, and black duodenum in a fatal hypothermia case with an underlying diabetic ketoacidosis.

Hypothermia can occur in patients with diabetic ketoacidosis (DKA), and these two conditions can exacerbate each other. Fatal hypothermia and DKA have overlapping features and findings such as Wischnewsky spots (WS), black esophagus, basal subnuclear vacuolization in the renal tubule, dehydration, and increased acetone levels. Therefore, it may be challenging to differentiate or clarify the context of these two conditions. Herein, we report a case of a 49-year-old man with type 1 diabetes who was found lying in his house in mid-winter. He experienced cardiopulmonary arrest 10h after the initial discovery and died at the hospital. On autopsy, florid left cardiac blood was observed. Black discoloration of the distal part of the esophageal mucosa, widespread WS in the gastric mucosa, and black discoloration of the duodenal mucosa were observed. Histologically, neutrophil infiltration in the esophageal mucosa, neutrophil infiltration and bleeding in the gastric mucosa, basal subnuclear vacuolization and Armanni-Ebstein lesion in the renal tubule epithelium in the kidney, and hyalinization of the islets of Langerhans were observed in the pancreas. Blood acetone and β-hydroxybutyrate levels were 538µg/mL and 8947 µmol/L, respectively. Glycated hemoglobin A1c and glucose levels were 16.2% and 883mg/dL, respectively, while C-reactive protein level was 3.64mg/dL. In conclusion, obnubilation due to DKA was assumed to be the underlying cause of hypothermia, and the combination of these two conditions led to the outcome of death. The concurrent presence of these conditions likely contributed to the conspicuous mucosal findings in the upper gastrointestinal tract.

Conspicuous cardiac findings in the context of a hypereosinophilic syndrome

Das hypereosinophile Sydrom ist eine Systemerkrankung, die mit einer Eosinophilie im peripheren Blut (von ≥1500/mm3) einhergeht [Ganss F et al. Hypereosinophiles Syndrom: Löffler-Endomyokarditis. RoFO 2017; 189: 874–876]. Nach der Definition von Chusid sollte dies über einen Zeitraum von mehr als 6 Monaten vorliegen und mit Zeichen einer Organbeteiligung einhergehen [Hellmich B et al, Hypereosinophilic syndrome and Churg-Strauss syndrome: is it clinically relevant to differentiate these syndromes ? Internist (Berl) 2008 Mar;49(3):286–96]. Alternative Ursachen für die Eosinophilie müssen per definitionem ausgeschlossen sein wie z.B. ein parasitärer Befall. Diverse Organsysteme können betroffen sein, neben Lunge und dem Herzen auch peripheres und zentrales ZNS [Ganss F et al. Hypereosinophiles Syndrom: Löffler-Endomyokarditis. RoFO 2017; 189: 874–876]. In etwa 50–60 % der Fälle ist eine kardiale Beteiligung beschrieben in Form einer Endo-/Myokardfibrose [Ganss F et al. Hypereosinophiles Syndrom: Löffler-Endomyokarditis. RoFO 2017; 189: 874–876].

All-Body-Cavity (ABC)-scopy-An approach for a feasible method of minimally invasive autopsy to allow for postmortem tissue sampling in cases where a conventional autopsy is denied.

The decreasing autopsy numbers in many western countries have been partially attributed to the invasiveness of the autopsy, which causes relatives to decline postmortem examination. This issue has been addressed by developing methods of minimally or non-invasive autopsy, which could be shown to increase acceptance for autopsies. The aim of this study is to compare the All-Body-Cavity-scopy (ABC-scopy) to conventional autopsies for diagnostic accuracy. The ABC-scopy is an endoscopic approach for minimally invasive autopsy involving laparoscopic and thoracoscopic evaluation of the accessible organs, followed by excision biopsies of relevant organs and conspicuous findings. The method was performed in 10 cases on deceased patients scheduled for autopsy, each followed by a conventional autopsy. The results gathered from ABC-scopy through observation and histopathological evaluation provided an acceptable diagnostic accuracy in 9 out of 10 autopsies when compared to those of the conventional autopsy for diagnostic findings. The ABC-scopy is a feasible approach for minimally invasive autopsy that provides acceptable diagnostic value. Despite its minimally invasive nature, the procedure enables representative histology through providing large size excision biopsies from intraabdominal and thoracic organs, which is especially useful for examining disseminated diseases such as metastasized tumors.

Co-Test im Zervixkarzinom-Screening: Die erste Runde

BackgroundIn 2020 guidelines for an organized screening program for cervical cancer with changes in primary screening and clinical management of conspicuous findings were introduced in Germany.ObjectiveDue to the data deficit, which stems from the central documentation only beginning after a 9-month delay, the results of the complete first screening round from a routine laboratory are evaluated.MaterialIn 2020 all co-test results of women aged 35 years and over were recorded in a pathology practice. The cytological control findings, human papillomavirus (HPV) tests, colposcopy and histological findings were documented.ResultsIn the primary screening a co-test was carried out for 63,615 women. Cytology findings requiring clarification by colposcopy (groups IIp–V of the Munich nomenclature III) were found in 1.96% and the HPV positive rate was 5.82% (1.28% HPV 16, 0.42% HPV 18). When cytologically negative and HPV positive women were examined by the required co-test 12 months later, these findings persisted in 40.6%, in 19.7% positive cytology findings were found. For 973 of the 1378 women positive for co-test, the results of colposcopy are known: 10.2% cervical intraepithelial neoplasia (CIN) 1, 7.8% CIN2, 8.5% CIN3 and 0.21% carcinoma. Of the 1081 women with positive cytology findings in primary screening 979 underwent colposcopy and 19.9% CIN1, 17% CIN2, 25.1% CIN3, 0.41% adenocarcinoma in situ (AIS) and 1.43% invasive carcinoma were diagnosed. Referral for colposcopy solely on persistent positive HPV test yielded CIN3 in 3.6% and for low-risk cytology a total of 6.6%.ConclusionOur data indicate an unfavorable benefit-cost ratio for negative and low-risk cytology. The central program evaluation will show to what extent algorithms should be adapted.

Optical coherence tomography in the differential diagnostics of important neuro-ophthalmological disease patterns

There are many disease patterns that are treated jointly by neurologists and ophthalmologists, for which optical coherence tomography (OCT) is of important differential diagnostic significance. In this context neurologists are mainly confronted by two patient collectives: patients with an acute ischemic event, who present with an acute but painless monocular visual deterioration (for central retinal artery occlusion) or with a monocular visual field defect (for arterial branch occlusion or anterior ischemic optic neuropathy). The second collective is patients without ophthalmological symptoms but with conspicuous optic nerve findings (papilledema or optic disc drusen). In this overview article both patient collectives are considered separately. In addition, the most important OCT findings for optic neuritis are presented. Before the disease patterns are described in detail, the normal OCT findings and the diagnostic possibilities of OCT are explained.

The Influence of Chest-Knee Position on the Appearance of anal Physical Findings in Comparison with other Clinical Positions during the Examination of Sexual anal Assault Victim

Background: Sexual anal assault is an important and critical issue worldwide. Usually the clinical examinationreveals subtle findings to prove the incident of sexual anal assault. Thus for approaching a proper diagnosis, thevictim needs to be examined by a trained and experienced forensic physician who is officially involved in dealingwith such issues.Methods: Prospective study of 82 victims of sexual anal assault transferred by the local prosecutor to the forensicmedicine department.Results: The majority of victims were females (82%), most of them were younger than 18 years (53.8%). Thefindings obtained by other clinical positions regarding the distribution of anal cutaneous folds revealed that(82%) of victims showed normal distribution, and (18%) showed abnormal distribution of the folds. While afterchest-knee positioning (33.3%) of victims showed normal distribution of the anal cutaneous folds and (38.5%)showed abnormal distribution along with (28.2%) of victims showed absence of folds. Regarding inspection ofanal sphincter by other clinical positions; (84.6%) of victims showed normally contracted sphincter and (15.4%)showed less contractility of the sphincter, whilst by chest-knee positioning (35.9%) of victims showed normallycontracted sphincter with the majority of victims (64.1%) showed abnormal contraction. Concerning injuries in theanal region represented mainly by contusions and abrasions; they were noticed only in (12.8%) of victims by otherclinical positions, while were present in (29%) of victims examined with chest-knee position.Conclusions: During the clinical examination of victims of sexual anal assault, and in comparison with otherclinical positions used, the application of chest-knee position showed overall more conspicuous physical findings,especially regarding the distribution of anal cutaneous folds, the inspected degree of contractility of anal sphincter,and the presence of injuries in the anal region represented mainly by contusions and abrasions.

Patient reported experience and adherence to remote patient management in chronic heart failure patients: a posthoc analysis of the TIM-HF2 trial

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): German Federal Ministry of Education and Research Background Remote Patient Management (RPM) enables early detection and prevention of cardiac deterioration in heart failure (HF) patients by measuring vital signs. Clinical trials reported inconsistent results. Patient adherence was suggested to be one of the main reasons for inconsistent results in previous trials (2-4). The "Telemedical interventional management in heart failure II (TIM-HF2)" study showed the superiority of non-invasive RPM compared to usual care (UC) in terms of mortality and unplanned cardiovascular (CV) hospitalisation (1). Purpose The objective of the analysis is to assess the patient experience with RPM, the adherence to daily measurements and outline factors affecting both aspects. Methods TIM-HF2 was conducted 2013-2018 with 1,538 HF patients in a 12-month follow-up (5). Inclusion criteria were HF in NYHA class II or III with either LVEF ≤45% or, if LVEF >45%, patients had been treated with oral diuretics; and HF hospitalisation within the last 12 months. Patients with major depression were excluded. Patients were randomly assigned (1:1) to RPM or UC. RPM-Patients had to measure daily weight, blood pressure, ECG and self-rated health status. Data were sent automatically to the telemedical centre (TMC). In case of conspicuous findings, the TMC contacted the patient or GP for therapy adjustment. At the study end, RPM-patients were asked to evaluate the program through a 9-question survey. Adherence was distinguished between measurement of at least one (incomplete adherence- IA) and all vital parameters (complete adherence- CA) and defined as ratio of the number of days of measurements taken divided by the number of days of possible measurements. All data were analysed descriptively (mean ± standard deviation). Differences between groups were analysed by ANOVA and T-Test. Results The survey was answered by n=564 patients (response rate: 79.7%). The patients were satisfied with the program and device usability. CA was 89.1±14.1% and consistently high over the study course (table 1). Reasons for dropouts (n=37) were e.g. frustration with the devices and physical inability to complete the measurement protocol. Patients <70 years and living in rural areas had lower IA rates. The mean adherence was independent of severe of disease (LVEF, NTproBNP, NYHA). Patients (n=244) had significantly lower IA the week prior to an unplanned CV hospitalisation (difference by -5.2±20.5%) compared to the entire study period. IA was significantly lower by -12.8±24.7% in the week after an unplanned CV hospitalisation compared to the entire study period. Conclusions In a setting with user-friendly devices, pre-interventional patient training, regular TMC-patient contact and close cooperation between primary physicians and TMC a long-lasting and high adherence and satisfaction regarding RPM could be achieved. A change in adherence might detect deterioration in health status and indicate the need to intensify telemedical care.

Whole body magnetic resonance imaging in healthy children and adolescents. Bone marrow appearances of the axial skeleton

ObjectiveTo describe the findings of focal high signal on T2 weighted (T2W) images of the bone marrow in the axial skeleton as assessed by whole-body MRI in healthy and asymptomatic children and adolescents. Material and methodsWe assessed the bone marrow of the mandible, shoulder girdle, thorax, spine, and pelvis on water-only Dixon T2W sequences as part of a whole-body MRI protocol in 196 healthy and asymptomatic children aged 5–19 years. Intensity (0–2 scale) and extension (1–4 scale) of focal high signal areas in the bone marrow were scored and divided into minor or major findings, based on intensity and extension to identify the potentially conspicuous lesions in a clinical setting. ResultsWe registered 415 areas of increased signal in the axial skeleton whereof 75 (38.3%) were major findings. Fifty-eight (29.6%) individuals had at least one major finding, mainly located in the pelvis (54, 72%). We found no differences according to gender. The number of minor findings increased with age (p = 0.020), but there were no significant differences in the number of major findings. The most conspicuous findings were in the pelvis, spine and sternum. ConclusionNon-specific bone marrow T2W hyperintensities in the axial skeleton are frequently detected on whole-body MRI in healthy, asymptomatic children. Awareness of this is important as some findings may resemble clinically silent lesions in children with suspected multifocal skeletal disease.

Optical coherence tomography in the differential diagnostics of important neuro-ophthalmological disease patterns

There are many disease patterns that are treated jointly by neurologists and ophthalmologists, for which optical coherence tomography (OCT) is of important differential diagnostic significance. In this context neurologists are mainly confronted by two patient collectives: patients with an acute ischemic event, who present with an acute but painless monocular visual deterioration (for central retinal artery occlusion) or with a monocular visual field defect (for arterial branch occlusion or anterior ischemic optic neuropathy). The second collective is patients without ophthalmological symptoms but with conspicuous optic nerve findings (papilledema or optic disc drusen). In this overview article both patient collectives are considered separately. In addition, the most important OCT findings for optic neuritis are presented. Before the disease patterns are described in detail, the normal OCT findings and the diagnostic possibilities of OCT are explained.

Effects of denosumab treatment on the expression of receptor activator of nuclear kappa-B ligand (RANKL) and TNF-receptor TNFRSF9 after total hip arthroplasty—results from a randomized placebo-controlled clinical trial

SummaryWe investigated whether the drug denosumab modulates the inflammatory response after total hip arthroplasty in a randomized controlled trial. Significantly increased expression of RANKL was found in patients treated with denosumab. This could provide an explanation for the rebound effect with rapid loss of BMD seen after discontinuation of denosumab treatment.PurposeTo evaluate whether denosumab, a human monoclonal antibody directed against receptor activator of nuclear factor kappa-B ligand (RANKL), modulates the inflammatory response after cementless total hip arthroplasty (THA) in patients with osteoarthritis of the hip.MethodsSixty-four patients operated with cementless THA were randomized to two doses of 60-mg denosumab or placebo 1–3 days and 6 months postoperatively. Serum samples were analyzed by a multiplex extension assay detecting 92 inflammation-related proteins. Bone turnover markers were assessed. Proteins were analyzed using linear mixed effect models. Validation of conspicuous findings was performed with ELISA.ResultsTwo proteins were significantly affected by denosumab treatment: RANKL and tumor necrosis factor receptor super family member 9 (TNFRSF9). Serum levels of RANKL were more than twice as high in the denosumab than in the placebo group 3 months after surgery (ratio 2.10, p<0.001). Six and 12 months after surgery, the expression of RANKL was still elevated in the denosumab-treated group (ratios 1.50, p < 0.001; 1.47, p =0.002). The expression of TNFRSF9 was lower in the denosumab group at 3 months (ratio 0.68, p<0.001). In the denosumab group, concentrations of bone turnover markers were substantially reduced after 3 months, remained suppressed after 6 and 12 months, but increased above baseline at 24 months after surgery.ConclusionTwo subcutaneous denosumab injections 6 months apart increase RANKL and depress TNFRSF9 after THA. This provides a possible explanation for the rebound effect on bone turnover markers as well as bone mineral density (BMD) upon withdrawal of denosumab. None of the other measured markers of inflammation was influenced by denosumab treatment.

Assessing the Influence of Land Use/Land Cover Alteration on Climate Variability: An Analysis in the Aurangabad District of Maharashtra State, India

Examining the influence of land use/land cover transformation on meteorological variables has become imperative for maintaining long-term climate sustainability. Rapid growth and haphazard expansion have caused the conversion of prime agricultural land into a built-up area. This study used multitemporal Landsat data to analyze land use/land cover (LULC) changes, and Terra Climate monthly data to examine the impact of land transformation on precipitation, minimum and maximum temperature, wind speed, and soil moisture in the Aurangabad district of Maharashtra state in India during 1999–2019. Multiple linear regression and correlation analysis were performed to determine the association among LULC classes and climatic variables. This study revealed rapid urbanization in the study area over the years. The built-up area, water bodies, and barren lands have recorded a steep rise, while the agricultural area has decreased in the district. Drastic changes were observed in the climatic variables over the years. The precipitation and wind speed have shown decreasing trends during the study period. A positive relationship between soil moisture and agricultural land was found through a correlation analysis. Conspicuous findings about the positive relationship between the agricultural land and maximum temperature need further investigation. A multiple linear regression analysis demonstrated a negative relationship between the built-up area and precipitation. The intensity of the precipitation has reduced as a consequence of the developmental activities in the study area. Moreover, a positive relationship was observed between the built-up area and maximum temperature. Thus, this study calls for policy implications to formulate a futuristic land-use plan considering climate change projection in the district.

Treatment with an intravaginal gel containing siliceous dioxide, selenite, and citric acid to promote regression of ASC-US, LSIL, ASC-H, HSIL, p16/Ki67 status and improve clearance of hr-HPV in cervical specimens

Objective: An intravaginal gel containing highly dispersed silicon dioxide (SiO2) and an anti-oxidative combination of citric acid and sodium selenite was tested for its ability to promote regression of abnormal cytological findings and its influence on hr-HPV status and tumor markers p16/Ki67 (CINtec® PLUS test).Patients and methods: A control study was performed, including women (n=100) diagnosed with conspicuous cervical smears (ASC-US, LSIL, ASC-H, or HSIL). The gel was applied for 3x28 days. After three months, participants were analyzed for Pap status, hr-HPV strains, and expression of tumor markers p16/Ki67. Three months later, Pap testing and p16/Ki67 analysis were repeated. The results were compared to those of 106 women who met the same inclusion criteria but did not obtain any treatment.Results: After six months, cytological Pap findings were improved in 80.9% of the participants in the treated group, and the clearing of hr-HPV was observed in 53% of cases. Only 5.3% were tested p16/Ki67 positive after six months in comparison to 75.0% at baseline. In the comparison group, 37.1% of the Pap smears and 18.6% of the CinTec results were improved, but no hr-HPV clearance was observed. The improvements were highly significant for the treatment. Conclutions: The vaginal gel containing SiO2 sodium selenite, and citric acid may support the healing of conspicuous cytological findings and clearance of hr-HPV.

\u201cGuboow\u201d\u2014child abuse or traditional medical treatment? a case report

The examination of children suspected of being abused poses a great challenge for forensic pathologists. The risk of misjudgment is high and can have serious consequences for the child and the family. In unclear cases, an assessment should always be carried out on an interdisciplinary basis with the involvement of the relevant disciplines such as pediatrics, dermatology, or radiology. We present the case of a 2.5-year-old boy who was presented by his parents at the Pediatric Emergency Department of a Swiss University Hospital due to fever and weight loss. During the physical examination, conspicuous findings on the abdomen were present, and the responsible emergency physicians informed the child protective services. A clinical forensic examination occurred on behalf of the child protection services. The abdomen of the child showed several symmetrical scars. The initial questioning of the parents did not provide clear information about the origin of the injuries. Further professional questioning of the family by the child protective services concluded that the injuries were the result of a traditional medical treatment in Somalia, which occurred several weeks before.

Human papillomavirus persistence or clearance after infection in reproductive age. What is the status? Review of the literature and new data of a vaginal gel containing silicate dioxide, citric acid, and selenite.

Cervical cancer, the third most common cancer in women, is caused in nearly all cases by a persistent infection with high-risk types of the human papillomavirus. Although human papillomavirus infections are 80%–90% transient and disappear spontaneously within 24 months, human papillomavirus infections that remain are at risk of developing cervical lesions. Different therapeutical approaches have been tested to promote the regression of low-grade lesions or prevent progression. They include the application of 5-fluorouracil, curcumin, imiquimod, interferons, Vitamin D, and others. Also, the effect of probiotics and vaginal therapy with carboxy-methyl-beta glucan was assessed. Review of the literature and presentation of the last study data are presented. Clearance of high-risk human papillomavirus seemed to be promoted by treatment with a new vaginal gel containing a highly disperse SiO2 and an anti-oxidative combination of citric acid and sodium. This gel showed, after 6 months, an improvement of cytological Pap findings (ASC-US, LSIL, ASC-H, or HSIL) in 80.9% of the participants. Similarly, there was a clearing of hr-human papillomavirus in 53% of cases after 3 months of gel administration. The percentage increased slightly in the non-treated control group from 78.3% at baseline to 83% after 3 months. The percentage of patients who were tested positive for p16/Ki67 reduced from 75% at baseline to 5.3% in the treatment group after 6 months, while the percentage decreased only slightly in the non-treated group (baseline: 91.5%; 6 months: 75.2%). The examined vaginal gel may support the healing of conspicuous cytological findings (ASC-US, LSIL, ASC-H, or HSIL) and clearance of hr-human papillomavirus positive results.

Do Organisational Circumstances in the Birth Ward Influence Perinatal Outcome? A Retrospective Analysis of Over 43.000 Deliveries

Background: Birth can be a high-risk situation requiring identification of potential complications and decisive action. Identifying times of increased risk with respect to working patterns is important to optimise quality and safety. The umbilical cord pH and the 1-minute APGAR score are evaluated predictive parameters for the neonatal outcome. Aberrant values may be related to many factors, including special circumstances during birth. Objectives: In this study, we checked the data of our hospital to find out, whether the day, the time of birth, as well as the Hand Over Times (HOT), may be correlated to conspicuous findings. Methods: This retrospective cohort study included deliveries of 20 years. The impaired fetal outcome was defined as pH values 6. Conclusion: These results demonstrate a high standard of care during the different days, times, and HOT over the last decades despite an increased workload. As the neonatal outcome depends on various factors, further studies are necessary to improve the working environment

Clinical signs of paraproteinemic keratopathy

AbstractMonoclonal gammopathies are much more common than previously known in Ophthalmology. In the so‐called benign form or MGUS (Monoclonal Gammopathy of Undetermined Significance) different corneal opacities can be observed, in which the patients having no subjective symptoms or conspicuous systemic findings other than corneal opacities which were summarized as Paraproteinemic Keratopathy (PPK). It is therefore to be demanded that in all elderly patients with bilateral unclear corneal findings, Serum Protein Electrophoresis (SPE) should be performed to include or exclude monoclonal gammopathy.

The demographic and clinicopathological features of salivary gland tumors in Turkey

Aim: Salivary gland tumors (SGTs) are rare neoplasms thus, the local records are valuable to obtain the epidemiological overview. This study aimed to determine the demographic and clinicopathological features of SGTs in our clinic and compare the findings with the studies from Turkey and all over the world.Material and methods: The data of 185 patients who underwent surgery for SGT in The Department of Otorhinolaryngology-Head and Neck Surgery of a tertiary referral center between 2012 and 2017 were studied retrospectively. The demographic and clinicopathological features of the patients were recorded.Results: Among all patients with primary and secondary SGTs, the median age was 53 years, 54.6% of the patients were men. Patients with primary tumor constituted 96.8% of all cases. Malignancy rate was 14. Parotid gland was the most common location (90%). Nearly half of all primary tumors were diagnosed as pleomorphic adenoma (n=84, 46.9%). Mucoepidermoid carcinoma was the most common malign neoplasm of the parotid gland. There were only six patients (3.2%) that had secondary SGT.Conclusion: Pleomorphic adenoma and mucoepidermoid carcinoma were the most common benign and malign pathologies, respectively. The lowest malignancy rate and the highest rate of warthin tumor of the existing literature were the most conspicuous findings of our study. Although the frequency of the secondary SGTs is low, the possibility of metastasis should be considered especially for the patients above 65 years of age.

Rapid Atrial Pacing Promotes Atrial Fibrillation Substrate in Unanesthetized Instrumented Rats.

AimThe self-perpetuating nature of atrial fibrillation (AF) has been a subject of intense research in large mammalian models exposed to rapid atrial pacing (RAP). Recently, rodents are increasingly used to gain insight into the pathophysiology of AF. However, little is known regarding the effects of RAP on the atria of rats and mice. Using an implantable device for electrophysiological studies in rodents, we examined on a daily basis, the effects of continuous RAP on the developed AF substrate of unanesthetized rats and mice.Methods and ResultsAggressive burst pacing did not induce AF at baseline in the large majority of rodents, but repeatedly induced AF episodes in rats exposed to RAP for more than 2 days. A microarray study of left atrial tissue from rats exposed to RAP for 2 days vs. control pacing identified 304 differentially expressed genes. Enrichment analysis and comparison with a dataset of atrial tissue from AF patients revealed indications of increased carbohydrate metabolism and changes in pathways that are thought to play critical roles in human AF, including TGF-beta and IL-6 signaling. Among 19 commonly affected genes in comparison with human AF, downregulation of FOXP1 and upregulation of the KCNK2 gene encoding the Kir2.1 potassium channel were conspicuous findings, suggesting NFAT activation. Further results included reduced expression of MIR-26 and MIR-101, which is in line with NFAT activation.ConclusionOur results demonstrate electrophysiological evidence for AF promoting effects of RAP in rats and several molecular similarities between the effects of RAP in large and small mammalian models.