Ear Lesions Research Articles

Epidermal inclusion cyst of external auditory canal– A common lesion at a rare site diagnosed by FNAC

Epidermal inclusion cyst (EIC) is a benign condition that occurs rarely in the External auditory canal. EIC refers to cysts that result from the proliferation and implantation of epidermal elements within a circumscribed space in the dermis. Epidermal cysts occur anywhere in the body and are more common on the face, trunk, neck, extremities and scalp. The occurrence of EIC in the External auditory canal is rare. Lesions of such nature are frequently thought to be lesions like polyp, haematoma, haemangioma and are not included as one of the main differential diagnoses of lesions in External auditory canal. We report case of EIC of the External auditory canal in 4 years old child so that it should be kept as differential diagnosis of lumps in external auditory canal. The diagnosis was made on FNAC which is simple, OPD procedure and does not require any anaesthesia underlining the importance of FNAC in Ear lesions.

Clinical Predilection Features of Middle Ear Adenomatous Neuroendocrine Tumors: A Review of 10 Patients and a Special Case Is Attached.

Introduction: Middle ear adenomatous neuroendocrine tumors (MEANTs) are rare middle ear lesions characterized by nonspecific symptoms, signs, and imaging findings. Diagnosis typically relies on postoperative pathological assessment. This study investigated the diagnostic utility of the predilection sites and clinical characteristics of MEANTs. Methods: A retrospective analysis was conducted on clinical data from 10 patients with histologically confirmed MEANTs, admitted to Eye & ENT Hospital of Fudan University between March 2016 and March 2023. Results: The median age of the patients at diagnosis was 39.3 years. Hearing loss (n = 8) and ear pain (n = 6) were the most prevalent clinical symptoms in the patients diagnosed with MEANTs. Endoscopic examination revealed diverse symptoms, predominantly presenting as non-pulsatile masses with distinct boundaries and quasi-circular shapes within the external auditory canal, often accompanied by abundant blood vessels (n = 4). Tumors were typically confined to the middle/lower tympanic chambers or eustachian tube and were frequently associated with tympanic sclerosis, particularly around the pharyngeal tube (n = 3). Pathologically, MEANTs exhibited CD56 positivity or weak positivity, along with positive staining for CKpan and Syn, negativity for S100, and Ki67 ≤3%. Personalized surgical interventions were chosen by all the patients based on lesion severity, with no subsequent radiotherapy or chemotherapy administered postoperatively. No tumor progression was noted during the postoperative follow-up. In addition, a noteworthy case was presented in which MEANT initially manifested in the middle or lower tympanic cavity and eustachian tubes. Over 2 years, the tumor progressively grew, invading the middle tympanum and surrounding ossicles, ultimately achieving complete resection with no recurrence observed during subsequent follow-up. Conclusions: A possible diagnosis of middle ear adenoma should be considered when encountering non-pulsatile tumors with clearly demarcated inner boundaries within the external auditory canal accompanied by abundant quasi-circular vessels and the presence of new bone or neoplasm at the pharyngeal tympanic canal orifice observed during preoperative examinations or surgical procedures.

Testing for imbalance in the diabetics to presage inner ear lesions and stroke: Using Timed Up and Go test as a screening test

Background: Imbalance and impaired hearing are less known complications of diabetics. Very few studies have been conducted in this regard. A common reason for imbalance is insufficiency of cerebral vascular perfusion. This is dreaded because imbalance may presage stroke. Hence in every diabetic, clinicians must always ask for the presence of imbalance. Such self-report by the patient may be highly subjective and may lead several investigations, which are expensive and time-consuming. Hence, an objective screening test for the presence of imbalance is the need of the hour. One such test is the Timed Up and Go (TUG) test. Objectives: The objectives of the study were (i) to ascertain ‘whether self-reporting the absence of imbalance alone is robust enough to presume the absence of imbalance and (ii) to ascertain whether TUG test is feasible to use as a screening test. Method: The subjects of this study were 98 subjects in the age group of 41 to 50 years attending a large diabetic clinic, with confirmed diagnosis of Type 2 Diabetes Mellitus. Each subject was asked a simple question about whether they had ever felt any imbalance. Subsequently, all the subjects underwent the TUG test. The scores of the TUG test were analysed for association with the self-report of imbalance. Results: Among the 98 subjects, only 42 persons self-reported imbalance. The rest denied any imbalance. Among the 56 subjects (group A) who denied experiencing any imbalance, only 40 subjects had normal TUG scores i.e. 12 seconds or less. The remaining 16 subjects had prolonged scores i.e. 13 s or more. On the other hand, among the 42 subjects who admitted to having imbalance (group B), only 24 subjects had scores of 13 s or higher. The other 18 subjects had normal TUG scores. It is noteworthy that the self-reporting by 16 subjects of group A and 18 subjects group B were wrong, when we checked with the TUG test. With regard to the feasibility of the TUG test, we found it was inexpensive and required only two or three minutes. Even clinical assistants could learn and do it right. Conclusion: Because of the above reasons, TUG test is recommended for every diabetic patient. However, we should always keep in mind that TUG test is only a screening test and is not specific to any individual organ system.

Artificial Intelligence in CT Diagnosis: Current Status and Future Prospects for Ear Diseases

The human ear, with its complex structures like the ossicular chain, cochlea, and auditory nerve, plays a crucial role in hearing and balance. Common ear diseases, such as hearing loss, tinnitus, facial paralysis and vertigo, affect the quality of life of millions in China. Computed tomography (CT) has seen significant advancements since its introduction to China in 2000. The resolution improves from millimeter to sub-millimeter levels, and further, to 10 μm through bone-dedicated CT technology. The advancements have made CT the preferred method for diagnosing various ear conditions, including congenital malformations, trauma, inflammation, and neoplasm. Artificial intelligence (AI) has brought significant breakthroughs in CT diagnosis. Automatic segmentation of ear structures has dramatically improved with the advent of ultra-high-resolution computed tomography (U-HRCT). AI-driven measurement tools are enhancing the precision and personalization of surgical planning, while deep learning-based anomaly detection is utilized to address the challenges of detecting diverse ear lesions. Furthermore, AI-driven natural language processing and large language models are revolutionizing the generation of radiology reports, providing accurate and standardized diagnostic information. Despite ongoing challenges, the integration of AI into CT is expected to advance the otological field, leading to more precise and personalized treatment for ear diseases.

Prevalence of tail damage and ear lesions in docked and undocked pigs during trials to find alternatives to tail docking on Spanish commercial farms.

Tail docking is widely used to control tail biting in pigs, but it is a painful and stressful procedure. The impact of non-docking trials on tail damage (TD) and ear lesions (EL) from weaning to slaughter was assessed on four commercial farms. A total of 898 docked pigs (396 DP) or undocked pigs (502 UP) were assessed for tail damage and ear lesions at the beginning and end of the weaner stage, during fattening and at the abattoir during slaughter. The percentage of UP with shortened tails increased significantly from weaning to fattening, but the percentage of non-inflamed tails and tails without fresh lesions increased. In terms of severity of lesion, a lower percentage of pigs scored as 'no visible lesion' at the end of weaning compared to fattening, both for UP and DP (p<0.05). DP always had a lower percentage of TD, whereas UP had a lower percentage of EL at the end of weaning. It was not possible to statistically compare different preventive strategies trialed on farms as alternatives to docking. This study highlights that combining tail length and lesion score at slaughter could be a reliable on-farm welfare indicator.

Clinical analysis of cases of otogenic sigmoid sinus thrombosis in children

Objective:To analyze the clinical characteristics of middle ear mastoiditis combined with sigmoid sinus thrombophlebitis in children. Methods:Author retrospectively analyzed the clinical data of 6 children with middle ear mastoiditis combined with sigmoid sinus thrombophlebitis who were hospitalized in the Department of Infectious Diseases and Department of Neurology with first diagnosis of fever/headache, and subsequently underwent middle ear mastoidectomy in our department. All patients underwent comprehensive otoscopic, audiologic, imaging, and pathogenetic examinations. Clinical manifestations, pathogenetic features, treatment methods and prognosis were summarized, and the follow-up period was 3-6 months. Results:All 6 cases were first diagnosed with intracranial complications such as fever and headache in the internal medicine department. Within one month, all patients developed ear symptoms including pain, discharge, and hearing loss. Audiologic examination revealed conductive hearing loss in five cases and total deafness in one case. MRI, MRV and MRA examinations suggested that there were 6 cases of middle ear infection combined with thrombophlebitis of the ethmoid sinus, of which 3 cases had thrombus in the ethmoid sinus. 6 cases received surgical treatments: 2 cases of radical mastoidectomy+grommet Insertion, and 4 cases of radical mastoidectomy. Pathogenetic examination identified Streptococcus pneumoniae in three cases, Pseudomonas aeruginosa in one case, Enterobacter cloacae complex in one case, and no pathogens were detected in one case. Postoperative pathology was inflammatory granulation in all 6 cases. Follow-up was 3-6 months with no recurrence of intracranial and middle ear lesions on regular review. Conclusion:Children with recurrent fever, headache, and a recent history of acute and chronic otitis media should be evaluated for the possibility of sigmoid sinus thrombophlebitis, and imaging tests should be performed in a timely manner to clarify the diagnosis. Once diagnosed, surgery to remove the lesions around the ethmoid sinus, smooth drainage combined with antibiotic therapy is the most direct and effective treatment, and anticoagulation therapy is given when necessary. Timely diagnosis, multidisciplinary collaboration, and accurate timing of the management of primary foci and comorbidities are crucial to the treatment of the disease.

Description of patterns of ear and tail lesions during the grower-finisher period in a commercial pig farm

BackgroundEar and tail lesions are prevalent indicators of impaired welfare observed in pig production with different multifactorial causes. Understanding the progression of ear and tail lesions over time is important to implement preventative strategies on commercial pig farms. Therefore, this case study aimed to provide a detailed account of patterns of ear and tail lesions in pigs on a single commercial farm during the grower-finisher period.Case presentationA total of 1,676 12-week old pigs (n = 773 females and n = 903 males, all tail docked) were followed from arrival to the grower facilities until transferred to the finisher stage on a commercial pig farm in Ireland. Pigs were individually weighed and inspected for the severity of fresh ear and tail lesions (score 0–4) on transfer to the first grower (24.9 ± 5.33 kg, 12 weeks of age, n = 1,676 pigs), second grower (33.3 ± 7.04 kg, 14 weeks of age, n = 1,641 pigs), and finisher stage (60.2 ± 7.74 kg, 18 weeks of age, n = 1,626 pigs). Due to the low number of pigs with high scores, ear lesions were classified as no (score 0), mild (score 1), moderate (score 2) and severe (score ≥ 3) and tail lesions were classified as no (score 0), mild (score 1), and moderate-to-severe (score ≥ 2). Ear lesions were more prevalent than tail lesions at each inspection. There were approx. 19% of pigs with ear lesions at all three inspections but no pigs presented with tail lesions at all three inspections. When considering the specific severity categories, we observed 32 different ear lesion score combinations and 15 different tail lesion score combinations across the three inspections.ConclusionThe high number of observed patterns of ear and tail lesions suggest large individual variability in lesion progression. Ear lesions were more of an issue than tail lesions and little is known about this health and welfare problem indicating that further research into causes and management strategies is needed.

31 Effects of dietary standardized ileal digestible (SID) lysine (Lys) levels and dietary SID tryptophan to Lys ratios on growth performance and behavior of late-nursery to finish maternal barrows

Abstract The objective was to determine the effects of dietary standardized ileal digestible (SID) lysine (Lys) levels and SID tryptophan (Trp) to Lys ratios on growth performance and behavior of late-nursery to finish maternal barrows. A total of 2,293 barrows (PIC Camborough, initially 11.9 ± 0.35 kg) were used in this trial with 96 mixed-sex pens and 23 to 25 pigs/pen. There was a total of 6 dietary phases: P1:11.9-29.5 kg; P2:29.5-49.6 kg; P3:49.6-62.6 kg; P4:62.6-80.3 kg; P5:80.3-103.3 kg; and P6:103.3-137.8 kg. Pens were blocked by body weight and randomly allotted to 1 of 6 treatments:T1: 100% Lys (dietary SID Lys levels meet PIC SID Lys recommendation) and 21.0% of SID Trp:Lys ratio; T2: 100% Lys and 18.5% of SID Trp:Lys ratio; T3: 100% Lys and 16.0% of SID Trp:Lys ratio; T4: 80% Lys (dietary SID Lys levels meet 80% of PIC SID Lys recommendation) and 21.0% of SID Trp:Lys ratio; T5: 80% Lys and 18.5% of SID Trp:Lys ratio; and T6: 80% Lys and 16.0% of SID Trp:Lys ratio for P1-P2 and then 100% Lys and 18.5% of SID Trp:Lys ratio for P3-P6. Ear lesion (EL) was monitored during P2-P5. Data were analyzed using a linear mixed model in R Studio (Version 3.5.2, R Core Team; Vienna, Austria). Pigs fed T1 and T2 showed improved average daily gain than T6 (P &amp;lt; 0.05), with other treatments intermediate (Table 1). Pigs fed T2 showed improved average daily feed intake as compared with T6 (P &amp;lt; 0.05), with other treatments intermediate. There was no evidence for significant difference on feed-to-gain ratio or mortality. Removal was significantly greater for pigs fed T6 compared with all other treatments (P &amp;lt; 0.05). Pigs fed T2 had significantly greater hot carcass weight than T4, with other treatments intermediate. There was no evidence for significant differences on carcass yield or lean percentage. Pig fed T6 had significantly greater incidence of EL in P2 than all other treatments (P &amp;lt; 0.05). Pigs fed T4 and T6 had greater incidence of EL in P3 than T1 (P &amp;lt; 0.05), with other treatments intermediate. Pigs fed T5 and T6 had significantly greater incidence of EL in P4 than T1, T2, and T3 (P &amp;lt; 0.05), with T4 intermediate. During P5, pigs fed T4 and T5 had the greatest incidence of EL (P &amp;lt; 0.05), while pigs fed T6 had significant greater incidence of EL than T3 (P &amp;lt; 0.05), with T1 and T2 intermediate. In conclusion, dietary SID Lys and SID Trp:Lys ratio less than PIC recommendation during late-nursery-to-grower phase resulted in compromised overall growth performance of maternal barrows, even with restored dietary SID Lys and SID Trp:Lys levels in finish phase. Dietary SID Lys level and/or SID Trp:Lys ratios lower than PIC recommendation may result in greater incidence of aggression behavior in maternal barrows.

200 Effects of zinc oxide removal and different nutritional plans on the growth performance, health, and behavior of nursery pigs from different genetic lines

Abstract This study was conducted to investigate the impacts of the removal of zinc oxide (ZnO) supplemented at pharmaceutical levels and different nutritional plans on the growth performance, health, and behavior of nursery pigs from different genetic sire lines. A total of 1,440 newly weaned barrows and gilts were housed into nursery pens with 30 pigs/pen (0.25m2/pig). Pigs were assigned to eight groups following a randomized complete block design arranged on a 2 x 2 x 2 factorial arrangement [Genetic sire line: PIC 337 or PIC 800; ZnO supplementation: 0 or 2,500 ppm; nutritional plan: Control (PIC recommendation) or Treatment (TRT)]. Pigs were fed in three dietary phases (P1:7 d; P2: 21 d; P3: 21 d). The nutrient levels of the TRT for each phase consisted of reduced crude protein (P1: 21 vs. 18.43%; P2: 20.80 vs. 18.73%), SID Lys (P1: 1.40 vs. 1.20%; P2: 0.35 vs. 1.20%), net energy (P1: 2,450 vs. 2,352 kcal/kg; P2: 2,450 vs. 2,377 kcal/kg) and lactose levels (P1: 15 vs. 7%; P2: 7 vs. 5%), and use of calcium formate instead of calcium carbonate for both P1 and P2, and pigs receiving the same diet in P3. Health and behavior were assessed through ear lesion (weekly during P3) and fecal (weekly during P1 and P2) scoring, mortality/removals, and medication control. Growth performance was assessed by individually weighing pigs and recording feed disappearance every week throughout the experimental period. Data were analyzed using a generalized linear model considering pen as the experimental unit. Models included treatments and their interactions as fixed effects, and block and pen within block as the random terms. Pigs fed ZnO showed greater (P &amp;lt; 0.05) overall average daily gain (ADG; 495 vs. 456 g/d) and average daily feed intake (ADFI; 681 vs. 633 g/d); and decreased (P &amp;lt; 0.05) diarrhea incidence (DI; 3.64 vs 10.21%) at d 14 after weaning and mortality/removals (2.31 vs. 5.11%) compared with pigs fed no ZnO. No significant differences were detected between the nutritional plans for performance traits (P &amp;gt; 0.05); however, pigs fed the TRT had less (P &amp;lt; 0.05) DI (7.54 vs. 11.43%) at d 7 after weaning than pigs fed the control nutrition plan. Regarding the genetic sire lines, PIC 337 pigs showed greater (P &amp;lt; 0.05) overall body weight (26.1 vs. 25.4 kg), ADG (486 vs. 465 g/d) and ADFI (666 vs. 648 g/d); and decreased (P &amp;lt; 0.05) mortality/removals (2.54 vs. 4.66%) and DI (6.92 vs. 12.41%) at d 7 after weaning compared with PIC 800 pigs. In summary, PIC 337 pigs fed ZnO under the control nutritional program showed greater growth performance during the nursery period. This study reaffirmed the benefits of ZnO fed to nursery pigs during the post-weaning period; however, since different countries are banning or reducing the use of ZnO, nutritional strategies should be considered to not negatively impact the health and subsequent performance of nursery pigs.

Sesamin Enhances Apoptosis of Activated T cells by physically Interacting with MCL-1 and Shows Therapeutic Effect on Allergic Dermatitis

Sesamin is lignans mainly found in sesame seeds and oil. Previous studies have demonstrated that sesamin has potent pharmacological activities including anti-inflammatory, antioxidative, and cholesterol-and lipid-lowering. Detailed studies performed with sesamin revealed that it possesses anti-proliferative and pro-apoptotic properties that could potentially be used to kill tumors. Nevertheless T cell-mediated disorders usually occur when over-activated T cells are proliferative and less apoptotic, however, it is unknown whether sesamin suppresses T cell activation with underlying mechanism related to proliferation and apoptosis. In the present study, we evaluate whether sesamin upregulates apoptosis on activated T cells and improves T cell-mediated disease. First of all, we confirmed that sesamin suppresses IL-2 production and CD69 expression from activated T cells by quantitative PCR, ELISA and flow cytometry. In silico analysis showed that Myeloid cell leukemia 1 (MCL-1) is predicted to physically interact with sesamin in T cells. According to the in silico prediction, pulldown assay using sepharose4B beads and western blot results showed that treatment with sesamin physically binds to MCL-1 in T cells and regulates S56 phosphorylation level of MCL-1 which represents activity of MCL-1 in activated T cells. Moreover, inhibition of MCL-1 activity by sesamin blocked heterodimer interaction between MCL-1 and BAK in activated T cells by co-immunoprecipitation assay. These results led sesamin to selectively induce cell death pathway only in activated T cells. Oral administration of sesamin alleviated the symptoms of dinitrochlorobenzene (DNCB)/mite extract-induced AD, including ear thickness, mRNA levels of pro-atopic cytokines on the ear lesions of sesamin-treated AD mice. Therefore, these results suggest that sesamin has a therapeutic potential for treating T-cell mediated disease through modulating MCL-1 activity on activated T cells. This research was supported by Basic Science Research Program through the National Research Foundation of Korea(NRF) funded by the Ministry of Education(2021R1I1A1A01059119). This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Middle Ear Tophi: A Case Series of Two Unusual Lesions and a Report of Facial Weakness and Review of the Literature.

Tophaceous lesions of the middle ear from calcium pyrophosphate deposition disease (CPPD, or pseudogout) and gout are infrequently reported. Recognizing its characteristic findings will allow clinicians to accurately narrow the differential diagnosis of bony-appearing middle ear lesions and improve management. Two consecutive cases of tophaceous middle ear lesions presenting to a tertiary care center between January 2021 and December 2021. Neither with previous rheumatologic history. Surgical excision of tophaceous middle ear lesions. Improvements in facial weakness and conductive hearing loss. The first case was a 66-year-old gentleman with progressive conductive loss, ipsilateral progressive facial weakness over years, and an opaque, irregular-appearing tympanic membrane anterior to the malleus found to have CPPD on surgical pathology, with immediate postoperative improvement of facial function. The second was a 75-year-old gentleman with progressive conductive loss and similar appearing tympanic membrane as case 1, previously diagnosed with tympanosclerosis, found to have gout on surgical pathology. In both cases, the CT showed a heterogenous, bony-appearing lesion in the middle ear, and both tophaceous lesions were a of gritty, chalky consistency intraoperatively. Tophaceous lesions of the middle ear are rare but have similar findings. Notably, the tympanic membrane can appear opaque and irregular, and the CT demonstrates a radiopaque, heterogeneous appearance. Facial weakness is an unusual finding. Specimens of suspected tophi must be sent to pathology without formalin for accurate diagnosis.

Hypoxia-inducible factor-1α contributes to the proliferation of cholesteatoma keratinocytes through regulating endothelin converting enzyme 1 expression.

Cholesteatoma is a hyperproliferative, pseudoneoplastic lesion of the middle ear characterized by aggressive growth and bone destruction. Hypoxia-inducible factor-1α (HIF-1α, also known as HIF1A) is a key transcription factor that enters the nucleus and upregulates many genes involved in cancer progression in the oxygen-free environment. This study is designed to explore the role and mechanism of HIF1A in the progression of cholesteatoma. HIF1A and endothelin converting enzyme 1 (ECE1) levels were determined using real-time quantitative polymerase chain reaction. The protein levels of HIF1A, Cyclin D1, proliferating cell nuclear antigen, and ECE1 were measured using western blot. Cell viability, proliferation, and cell cycle progression were analyzed using cell counting kit-8, Colony formation, 5-ethynyl-2'-deoxyuridine, and flow cytometry assays. Binding between HIF-1α and ECE1 promoter was predicted by Jaspar and verified using Chromatin immunoprecipitation and dual-luciferase reporter assays. HIF1A and ECE1 were highly expressed in cholesteatoma patients and keratinocytes. Moreover, HIF1A knockdown might suppress the cell viability, proliferation, and cycle progression of cholesteatoma keratinocytes. Furthermore, HIF1A upregulated the transcription of ECE1 through binding to its promoter region. HIF1A might expedite cholesteatoma keratinocyte proliferation partly by increasing ECE1 expression, providing a possible therapeutic target for the cholesteatoma treatment.

Costimulatory Molecule CD226 Regulates Atopic Dermatitis in a Mouse Model

This study investigated the role of CD226 in a 2,4-dinitrochlorobenzene (DNCB)-induced mouse model of atopic dermatitis. The results showed that the lack of CD226 (global and CD4+ T-cell specific) significantly increased ear thickness, reddening, swelling, and scaling of the skin as well as inflammatory cell and mast cell infiltration. RT-qPCR results demonstrated that the mRNA expressions of atopic dermatitis-related inflammatory cytokines and chemokines were markedly increased in the draining lymph nodes and lesioned ear skin tissues of global and CD4+ T-cell-specific CD226-deficient mice compared with that in control mice. Invitro assessment revealed that CD226 directly modulates TGFβ-mediated regulatory T (Treg) cell differentiation and proliferation. Notably, Treg cell-specific deletion of CD226 (Cd226fl/flFoxp3cre mice) resulted in more severe dermatitis and epidermal thickening than those observed in littermate mice upon DNCB treatment. Subsequent analysis showed that the infiltration of Treg cells in ear lesions and the number of Tregs in the spleen were significantly reduced in Cd226fl/flFoxp3cre mice after DNCB treatment. In addition, the lack of CD226 induced apoptosis of Treg cells through the activation of caspase 3. Therefore, these results suggest that CD226 has potential efficacy in atopic dermatitis, correlating with Treg cell inhibition.

Endoscopic ear surgery -- Discipline establishment and technological innovation

The application of microscope is a milestone in the history of otosurgery, which makes otologists deal with middle ear lesions more clearly and finely, and helps otologists expand the scope of treatment to the lateral skull base area, which greatly promotes the development of otosurgery. In the past 20 years, with the continuous improvement of endoscopic equipment research and development and the gradual improvement of endoscopic technology, the application of endoscopic technology in China has shown an explosive development, and Chinese otolaryngologists have experienced from the initial attempts of endoscopic technology, to the widespread popularization of innovative and applicable technology, and then to the feasibility of exploring the future innovative concepts. Endoscopic technology is another revolutionary push for the development of otosurgery after the microscope.

Can we predict the risk of esophageal stricture after caustic injury?

Nonoperative management of severe caustic injuries has demonstrated its feasibility, avoiding the need for emergency esogastric resection and resulting in low mortality rates. However, leaving superficial necrosis in place could increase the risk of esophageal stricture development. Data on the risk factors of esophageal stricture secondary to caustic ingestion are scarce. The aim of our study was to identify the risk factors for esophageal strictures after caustic ingestion at admission. From February 2015 to March 2021, all consecutive patients with esophageal or gastric caustic injury score ≥ II according to the Zargar classification were retrospectively analyzed. For each patient, we collected over 50 criteria at admission to the emergency room and then selected among them 20 criteria with the best clinical relevance and limited missing data for risk factor analyses. Among the 184 patients included in this study, 37 developed esophageal strictures (cumulative rate 29.4%). All esophageal strictures occurred within 3months. In multivariate analyses, the risk factors for esophageal strictures were voluntary ingestion (cause-specific hazard ratio 5.92; 95% confidence interval 1.76-19.95, P = 0.004), Zargar's esophageal score ≥ III (cause-specific hazard ratio 14.30; 95% confidence interval 6.07-33.67, P < 0.001), and severe ear, nose, and throat lesions (cause-specific hazard ratio 2.15; 95% confidence interval 1.09-4.22, P = 0.027). Intentional ingestion, severe endoscopic grade, and severe ENT lesions were identified as risk factors for esophageal stricture following caustic ingestion. Preventive measures for this population require further evaluation.

Use of Integra® on avascular tissue

Integra® (Integra LifeSciences) is a well-known dermal regeneration template used in partial and full-thickness wound reconstruction. It can be applied directly on to vascular tissue to create a bed for a skin graft, which is often placed in a second surgery. We present our experience of its novel use in oral and maxillofacial surgery patients, using it directly on bone and cartilage (avascular tissue) without further skin grafting. Patients who required full-thickness excision of lesions down to bone or cartilage and who were treated using Integra® were included. After scalp or ear lesion resection, the collagenous dermal layer of Integra® was placed directly on to bone or cartilage and, along with its outer silicone epidermal layer, secured to the defect with absorbable sutures and a bolster dressing. The wounds were kept dry for 14 days, at which point the dressing and silicone were removed and patients continued regular wound care. Seventeen patients were included, 15 of whom had squamous cell carcinoma. One was lost to follow up. The rest achieved complete healing of the defect. Histology showed epidermis developing on the Integra® surface and at one year, the appearance of normal scarred skin. This novel approach could redefine the uses of Integra®, avoiding the need for free-flap surgery or skin grafting when reconstructing large defects. Further resection of close margins or recurrence is easier after reconstruction using dermal regeneration material than after reconstruction with a local or free flap.

Stress responses in pigs postweaning: Effect of heavier hybrid and weaning intact litters

Early and abrupt weaning of pigs is a stressful event. In addition, the use of hyperprolific sows with increasing numbers of live born piglets has decreased the average pig’s birth weight, colostrum intake and weaning weight. The aim of this study was to investigate whether behavioural (tail posture, agonistic and abnormal behaviour), clinical (ear and tail lesions) and physiological (saliva cortisol) indicators of stress postweaning can be minimised by 1) using a pig hybrid that is heavier at birth and weaning, and 2) trough specific-stress-free housing where intact litters of pigs stay in the pen of birth after removing the sow at weaning. The study was a 2 × 2 factorial design, with pigs from Topigs Norsvin TN70 (TN) sows as a heavier alternative to the lighter pigs from DanBred LY sows (DB), and the specific-stress-free (SSF) weaning strategy as an alternative to the conventional weaning strategy (CON) where pigs are regrouped and moved to weaner pens. Fiftyseven litters, on average 26 days of age, were included. Behaviour recordings on the day (d) of weaning (d0), showed that the rate of fights and attacks were 23 and 42 times higher in CON compared to SSF, respectively. Furthermore, on d+1 pig in CON had a 9 (in DB) to 13 (in TN) times higher odds of having clinical ear lesions compared to SSF. Only on d+2, saliva cortisol was lower in TN-SSF than TN-CON, but not lower that DB-SSF. A higher rate of high tail posture was seen in CON d+1, which may reflect higher arousal due to mixing and moving. The rate of belly nosing was 5 times higher in the lighter hybrid (DB compared to TN), but increased from d+7 to d+14 in both hybrids. On d+7 the rate of ear directed behaviour tended to be higher in DB than TN, but the rate increased from d+7 to d+14 in TN to a similar rate as in DB. The rate of tail directed behaviour increased from d+7 to d+14 and tended to be higher in CON than SSF. In conclusion, specific-stress-free weaning reduced agonistic behaviour and ear lesions and tended to reduce tail directed behaviour postweaning. Using the heaver hybrid TN reduced belly nosing postweaning. However, since belly nosing and tail directed behaviour increased over time for both hybrids and weaning strategies additional measures are needed to reduce stress associated with early and abrupt weaning.

Whole mount of adult ear skin as a model to study vascular malformations.

Genetic analysis in human patients has linked mutations in PIK3CA, the catalytic subunit of PI-3'Kinase, to sporadic incidences of vascular malformations. We have developed a mouse model with inducible and endothelial-specific expression of PIK3CAH1047R , resulting in the development of vascular malformations. Systemic induction of this mutation in adult mice results in rapid lethality, limiting our ability to track and study these lesions; therefore, we developed a topical and local induction protocol using the active metabolite of tamoxifen, 4OH-T, on the ear skin of adults. This approach allows us to successfully model the human disease in a mature and established vascular bed and track the development of vascular malformations. To validate the utility of this model, we applied a topical rapamycin ointment, as rapamycin is therapeutically beneficial to patients in clinical trials. We found that the induced ear lesions showed significant attenuation after treatment, which was easily quantified. These data collectively provide evidence of a new model to study vascular malformations in adult tissues, which should be particularly useful in environments lacking specialized small-animal imaging facilities.

Clinical case of diagnosis of generalized tuberculosis in a child with a positive result of an intradermal test

At present day, generalized forms are rarely found in the structure of tuberculosis in children. A significant risk factor for the development of generalized lesions is prolonged contact with a tuberculosis patient. The diagnosis of a specific etiology is often complicated by the absence of pathognomonic symptoms. Immunodiagnostics, microbiological and molecular genetic research play an important role in the diagnosis of tuberculosis infection in children. The purpose of this study was to analyze the case of the development and diagnosis of generalized tuberculosis in a child of primary school age (7 years and 11 months) with lesions of the lungs, larynx, middle ear. The examination methods included immunological intradermal tests (Mantoux test, RTA test), in vitro test (QuantiFERON-TB), multispiral computed tomography, bronchoscopy and laboratory methods of examination. The manifestation of the disease occurred gradually with the occurrence of hypochromic anemia with a further increase in symptoms of intoxication. A comprehensive examination established a disseminated process in the lungs, larynx and middle ear lesions. Family tuberculosis contact was established when the disease was detected in a child. During the examination, the evaluation result of the Mantoux test showed an increase in sensitivity to tuberculin. The hyperergic result of the RTA test indicated the activity of MBT in the body. At the same time, the irregular conduct of immunodiagnostics using the Mantoux test, the monotony of the test did not allow timely measures to be taken in relation to the in-depth examination of the child for tuberculosis. The specific etiology of the disease was reliably confirmed by cultural and molecular genetic research methods. The child was diagnosed with generalized tuberculosis, disseminated pulmonary tuberculosis in the infiltration phase, MBT (+) with drug resistance to isoniazid, streptomycin, paraaminosalicylic acid, tuberculosis of the larynx and vocal apparatus, PCR (+) with drug resistance to isoniazid, tuberculous right-sided otitis media, MBT (+) with drug resistance to isoniazid, streptomycin, paraaminosalicylic acid. The presented clinical case indicates the need for timely detection of tuberculosis contacts, regular immunodiagnostics, and compliance with phthisiological alertness of doctors of all specialties in relation to children with long-lasting symptoms of various diseases. The complete physical examination using an intradermal RTA test (Diaskintest), microbiological and molecular genetic research methods allows to establish the tuberculous etiology of the lesion.

Selection for social genetic effects in purebred pigs improves behaviour and handling of their crossbred progeny

BackgroundIn commercial pig production, reduction of harmful social behavioural traits, such as ear manipulation and tail biting, is of major interest. Moreover, farmers prefer animals that are easy to handle. The aim of this experiment was to determine whether selection on social breeding values (SBV) for growth rate in purebred pigs affects behaviour in a weighing crate, lesions from ear manipulation, and tail biting of their crossbred progeny. Data were collected on crossbred F1 pigs allocated to 274 pens, which were progeny of purebred Landrace sows and Yorkshire boars from a DanBred nucleus herd.ResultsBehaviour in the weighing crate scored on a three-level scale showed that groups of pigs with high SBV for growth rate were significantly calmer than groups of pigs with low SBV (P < 0.027). When the mean SBV in the group increased by 1 unit, the proportion of pigs that obtained a calmer score level was increased by 14%. A significant (p = 0.04), favourable effect of SBV was found on both the number of pigs with ear lesions in the group and the mean number of ear lesions per pig. For a 1 unit increase in mean SBV, the mean number of lesions per pig decreased by 0.06 from a mean of 0.98. Individual severity of ear lesions conditional upon the number of ear lesions was also significantly affected (p = 0.05) by the mean SBV in the group. In groups for which the mean SBV increased by 1 unit, the proportion of pigs that were observed with a lower severity score was increased by 20% on a three-level scale. Most pigs received no tail biting injuries and no effect of SBV was observed on the tail injury score.ConclusionsAfter 7 weeks in the finisher unit, crossbred progeny with high SBV were calmer in the weighing crate and had fewer ear lesions. These results indicate that selection of purebred parents for SBV for growth rate will increase welfare in their crossbred progeny by decreasing the number of ear lesions and making them easier to handle.