Intact Capsule Research Articles

Is there enough evidence to support hip capsular reconstruction? A systematic review of biomechanical studies.

ABSTRACTThe aim of this study was to review and summarize the available biomechanical data on hip capsular reconstruction to guide clinical decision-making. A literature search was completed in December 2020 using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to identify biomechanical cadaver studies on hip capsular reconstruction, hip capsulectomy or hip capsular defect. The investigated parameters included maximum distraction force, capsular state affecting range of motion (ROM), rotation and translation. Four studies met al. the inclusion–exclusion criteria. The median effective force for resisting maximum distraction for the reconstruction state, capsular defect state and the intact state was 171, 111 and 206 N, respectively. The defect capsule force was significantly lower (P = 0.00438) than the intact capsule force. The reconstruction state had a higher distraction force than that of the capsular defect, but due to heterogeneity, the overall effect size was not statistically significant. The capsular reconstruction state reduced excess motion and the degree of instability compared to the capsular defect state but restored the hip close to its native capsular state in the cadaveric model. When compared to capsulectomy/defect state, hip capsular reconstruction significantly improved the rotational stability and effective force at maximum distraction and minimized translation. However, no conclusions can be made regarding the most effective protocol due to the high heterogeneity between the four studies. Further biomechanical studies are needed to test various types of grafts under the same protocol.

Study to Compare Capsule and Liquid Formulations of Enzalutamide After Single-Dose Administration Under Fasting Conditions in Prostate Cancer.

Limited evidence suggests an acceptable pharmacokinetic profile when enzalutamide is administered via a liquid formulation extracted from the commercially available liquid-filled soft-gelatin capsules. Tolerability may limit use in clinical practice. Enzalutamide is an established standard-of-care treatment for advanced prostate cancer with a commercially available formulation that may be inconvenient for some patients. We proposed a study to evaluate the bioequivalence of a liquid formulation to provide an alternative method of administration. This was a single-dose, randomized, open-label, two-way crossover pilot bioequivalence study to compare two oral formulations of enzalutamide: four enzalutamide 40 mg liquid-filled soft-gelatin capsules (commercially available) administered whole versus enzalutamide 160 mg liquid (extracted from capsules) administered via oral syringe. To assess bioequivalence, patients were randomized to receive a single dose of one formulation, then cross over to receive the alternative formulation following a 42-day washout period; serial plasma samples were collected over the course of 24 hours, followed by collections at 3, 8, and 42 days after the dose for both formulations. Bioequivalence of the formulations was assessed via comparisons of area under the plasma concentration-time curve (AUC) calculations per U.S. Food and Drug Administration (FDA) guidance. The study also assessed the safety and tolerability of the formulations. The study failed to meet proposed accrual, with only one patient enrolled, thus limiting the bioequivalence evaluation. Based on the data from a single patient, the drug exposure (measured by AUC) of enzalutamide and N-desmethyl enzalutamide (primary active metabolite) for the liquid formulation was 112% and 117%, respectively, compared with the capsule formulation. Although both formulations appeared well tolerated with no adverse events reported, the tolerability assessment questionnaire revealed an unpleasant taste of the liquid formulation. Preliminary evidence suggests a similar pharmacokinetic profile when administering liquid extracted from enzalutamide soft-gelatin capsules compared with intact capsules in patients with prostate cancer.

A Case Presentation of Gastrointestinal Stromal Tumor of Duodenum

A gastrointestinal stromal tumor (GIST) is the most common mesenchymal tumor of the gastrointestinal tract. It is caused by the mutation in KIT and PDGFRα genes. It constitutes <1% of all gastrointestinal tumors. Duodenal GISTs constitute 4.5% of all GISTs. We report a 61-year-old lady, presented with generalized abdominal pain, vomiting, abdominal distension, and nausea for the last 3 years. Physical exam-ination showed a pallor and on abdominal examination, a large palpable mass was extending from the pelvis to the right upper quadrant of the abdomen. The CT scan showed a large heterogeneously echogenic mass in the abdomen and pelvis with no lymphadenopathy and distant metastasis in this region. Laparotomy showed a large globular mass extending from the pelvis to the right upper quadrant of the abdomen adherent to the wall of a third part of the duodenum. Complete surgical resection of tumor done with an intact capsule. Microscopic examination showed neoplastic spindle cells with tumor necrosis. An immunohistochemical study confirmed GIST.

TWO PEAS IN A POD: AN INCIDENTAL FINDING OF SCLEROSING POLYCYSTIC ADENOSIS WITHIN A PLEOMORPHIC ADENOMA

<h3>Background</h3> A 55-year-old male patient was urgently referred to the local ear, nose, and throat surgery department with a 1-cm left parotid lump. Initial core biopsy was suggestive of a pleomorphic adenoma with some atypical features. The patient underwent a left parotidectomy. <h3>Case Description</h3> Macroscopic examination showed an intact capsule. Histology showed a small well-defined and encapsulated tumor showing the classical appearance of a pleomorphic adenoma for the most part exhibiting bilayered ducts and mucomyxoid stroma. Toward the periphery, a microcystic pattern was seen with luminal secretory material, prominent apocrine changes, and focal stromal sclerosis with some nuclear and cellular atypia but no evidence of frank malignancy. Immunohistochemistry for p63, SMA, and S100 highlighted the myoepithelial cells and Cam5.2 decorated the luminal cells. Ki67 showed a very low perforation index (<1%). Staining for GCDFP and AR was strong and diffuse within the apocrine and sclerotic areas but lacking within the background pleomorphic adenoma. A final diagnosis of sclerosing polycystic adenosis (SPA) within a pleomorphic adenoma was made. <h3>Conclusions</h3> The present case is the first of its kind to show a discrete SPA within a pleomorphic adenoma. SPA is an uncommon recently described salivary gland condition that was initially presumed to be inflammatory in nature and resembles fibrocystic breast disease. It appears to harbor human androgen receptor monoclonality with recent reports suggesting that it should be reclassified as a benign neoplasm. The atypia usually present within an SPA can be easily mistaken for a malignancy, requiring careful histopathologic examination.

In Vitro Assessment for Dose Preparation and Simulated Administration of Azithromycin Suspensions via Enteral Feeding Tubes.

Administration of medication via enteral feeding tubes (EFT) is common in cases where patients are unable to swallow the dosage form or a patient is intubated. The SARS-CoV-2 (COVID-19, coronavirus disease 2019) epidemic created a need to rapidly evaluate potential treatment options to address the global pandemic including evaluation of azithromycin (AZM) as a mono or combination therapy. Due to the complicating medical conditions of COVID-19, in some cases patients may be unable to take medication orally and could require medication administration by alternate routes such as an EFT. The aim of this study was an in vitro assessment for the dose preparation and simulated administration of AZM suspensions, prepared from tablets and capsules, via nasogastric feeding tubes (NGT). AZM tablets and capsules were used to prepare aqueous suspensions from 250 to 2000 mg for administration via NGT. NGT between 8 and 12 French (Fr), from common materials of construction and typical lengths were evaluated. About 20 mL syringes were used with water as the diluent. The preparation and simulated NGT administration steps for AZM suspensions were evaluated in the laboratory studies and included assessment of in-use stability of the aqueous suspensions, chemical compatibility of prepared aqueous suspensions with the syringe and NGT, ease of delivery and accuracy of simulated administration. Analysis of the prepared sample solutions for assay/impurities was performed using chromatographic conditions based on the USP-NF monograph. Verification of dose preparation and simulated administration was performed for intact tablets, crushed tablets, and capsules. Aqueous suspensions prepared from intact tablets and capsules were exposed to dosing materials (enteral syringe and NGT) for a period of up to 4 hours at ambient conditions. Assessment of the ease of dose delivery and analyses of the resulting samples for assay, purity and total degradation products were performed. The laboratory studies verified a procedure to reliably prepare suspensions from AZM tablets and capsules, over a range of 250 to 2000 mg, that can be accurately administered through NGT in sizes of 8 to 12 Fr. No incompatibilities of the prepared aqueous AZM suspension with dosing materials were observed and acceptable stability was demonstrated for up to 4 hours.

Abstract P-34: Cryo-EM Study of Submicrocapsules with a Shell of Nanoparticle Heteroaggregates and Polyelectrolyte Layers

Background: Currently, different approaches of active and passive targeted drug delivery are being developed. One of the most promising methods of targeted drug delivery is the use of capsules. For instance, colloidosomes—capsules consisting of the shell formed by colloidal particles at the interface of the emulsion—can be used for targeted delivery of antitumor drugs or any other drugs in liquid form. Here we present results of cryo-EM study of submicrocapsules with the soybean oil core and with the shell consisting of SiO2 nanoparticles and detonation nanodiamonds (DNDs) stabilized with chitosan and alginate. Methods: Сryo-electron tomography (Cryo-ET) was used to identify the morphological features of the submicrocapsules. Preliminary screening of samples and cryo-ET data collection were performed using Titan Krios cryo-EM (ThermoFisher Scientific, US) equipped with Falcon 2 direct electron detector. The restoration of the tomographic series was carried out using IMOD software. Eman2 was used for segmentation and UCSF Chimera was used for visualization of the 3D model. Submicron capsules were obtained by stabilizing oil droplets with a mixture of SiO2 nanoparticles and DNDs. To form a stable shell, an additional layer of silica particles and polyelectrolyte layers of alginate/chitosan were applied to the droplets of the dispersed phase of the emulsion by physical adsorption. Results: Cryo-EM data showed the presence of submicrocapsules with a diameter in the range of 200-900 nm. Although a significant fraction of submicrocapsules was found to be partially destroyed, results of cryo-ET study of intact capsules demonstrated that silicon dioxide nanoparticles form a net, while DNDs form clusters. Conclusion: Here we demonstrate the results of the study of submicron capsules with a shell of silica nanoparticles and DNDs. It was found that a uniform distribution of DNDs is not a prerequisite for the creation of submicron capsules that contradicts the theoretical model.

Load-to-failure characteristics of patellar tendon allograft superior capsule reconstruction compared with the native superior capsule.

BackgroundThe potential use of a patellar tendon allograft for superior capsular reconstruction has been demonstrated biomechanically; however, there are concerns regarding compromised fixation strength owing to the longitudinal orientation of the fibers in the patellar tendon. Therefore, the purpose of this study was to compare the fixation strength of superior capsule reconstruction using a patellar tendon allograft to the intact superior capsule.MethodsThe structural properties of the intact native superior capsule (NSC) followed by superior capsular reconstruction using a patellar tendon allograft (PT-SCR) were tested in eight cadaveric specimens. The scapula and humerus were potted and mounted onto an Instron testing machine in 20 degrees of glenohumeral abduction. Humeral rotation was set to achieve uniform loading across the reconstruction. Specimens were preloaded to 10 N followed by cyclic loading from 10 N to 50 N for 30 cycles, then load to failure at a rate of 60 mm/min. Video digitizing software was used to quantify the regional deformation characteristics.ResultsDuring cyclic loading, there was no difference found in stiffness between PT-SCR and NSC (cycle 1 – PT-SCR: 12.9 ± 3.6 N/mm vs. NSC: 22.5 ± 1.6 N/mm; P = .055 and cycle 30 – PT-SCR: 27.3 ± 1.4 N/mm vs. NSC: 25.4 ± 1.7 N/mm; P = .510). Displacement at the yield load was not significantly different between the two groups (PT-SCR: 7.0 ± 1.0 mm vs. NSC: 6.5 ± 0.3 mm; P = .636); however, at the ultimate load, there was a difference in displacement (PT-SCR: 20.7 ± 1.1 mm vs. NSC: 8.1 ± 0.5 mm; P < .001). There was a significant difference at both the yield load (PT-SCR: 71.4 ± 2.2 N vs. NSC: 331.6 ± 56.6 N; P = .004) and the ultimate load (PT-SCR: 217.1 ± 26.9 N vs. NSC: 397.7 ± 62.4 N; P = .019). At the yield load, there was a difference found in the energy absorbed (PT-SCR: 84.4 ± 8.9 N-mm vs. NSC: 722.6 ± 156.8 N-mm; P = .005), but no difference in energy absorbed was found at the ultimate load.ConclusionsPT-SCR resulted in similar stiffness to NSC at lower loads, yield displacement, and energy absorbed to ultimate load. The ultimate load of the PT-SCR was approximately 54% of the NSC, which is comparable with the percent of the ultimate load in rotator cuff repair and the intact supraspinatus at time zero.

English

BACKGROUND Posterior capsule opacification (PCO) is the most common delayed complication of cataract surgery. Nd:YAG (Neodymium yttrium aluminium garnet) laser posterior capsulotomy presents the advantages of a non-invasive, effective, relatively safe technique to manage intact posterior capsule that opacifies postoperatively. With this background we want to study the visual outcome and complications following Nd-YAG laser posterior capsulotomy in posterior capsular opacification following small incision cataract surgery (SICS). METHODS The study includes 64 patients attending outpatient department of a tertiary eye care hospital at Latur from June 2018 to May 2019 who have undergone SICS with PMMA PC IOL (polymethyl methacrylate posterior chamber intraocular lens) implantation and clinically diagnosed with posterior capsular opacification. 64 eyes with PCO were subjected to Nd:YAG laser posterior capsulotomy after detailed slit lamp bio microscopic examination pre- and post-capsulotomy. Follow-up was done at 1 hour, 1 week, 2 weeks and 4 weeks and patients were examined for visual outcome and any complications at each visit. RESULTS There were 16 males (25 %) and 48 females (75 %) with a mean age of 65 years. Posterior capsule opacification occurs within 3 years accounting for 46.9 % of the cases. Elschnig pearls type of PCO was more common when compared to fibrous type of PCO. Best corrected visual acuity (BCVA) before Nd:YAG laser capsulotomy was less than 6 / 60 in 35 patients (54.7 %) and within 6 / 60 to 6 / 24 in 23 patients (35. 9 %) with 6 patients (9.4 %) accounting for visual acuity between 6 / 24 to 6 / 18. After Nd - YAG Laser Capsulotomy, 46.9 % gained best corrected visual acuity of 6 / 18 or better, 39.1 % cases improved 6 / 12 and better and BCVA of 6 / 9, 6 / 6 was observed in 11 cases and 1 case respectively. Only 12 out of 64 patients had complications. Raised intraocular pressure (IOP) was found in 4 patients. Intraocular lens (IOL) pitting was found in 8 patients. CONCLUSIONS Nd:YAG laser capsulotomy is a safe, effective and a non-invasive procedure which avoids all the complications of surgical capsulotomy in patients of posterior capsule opacification. KEYWORDS Posterior capsule opacification (PCO), Nd:Yag Laser Capsulotomy, Best Corrected Visual Acuity (BCVA), Central Subfield Macular Thickness (CSMT)

Silicone oil obscuring vision by migrating behind an intraocular lens in an intact capsular bag after previous retinal detachment surgery

Silicone oil is used on a regular basis during vitrectomy for the surgical management of complex or recurrent retinal detachment. Incomplete removal of particles can cause postoperative complications. A 68-year-old pseudophakic patient with previous retinal detachment surgery presented with reduced vision. On examination, silicone oil could be visualized lodged between the hydrophobic intraocular lens (IOL) and intact posterior capsule. YAG laser capsulotomy was performed to clear the visual axis and disperse the oil droplets into the vitreous cavity. Corrected distance visual acuity improved to 6/6 and symptoms resolved. Silicone oil can accumulate in the capsular bag after vitrectomy even in patients with an intact posterior capsule. It is important to ascertain the type of IOL material used during cataract surgery and to properly identify the positioning of the oil droplets to safely treat the patient and avoid unnecessary complications.

Unexpected but Not Uncommon - a Case of Adrenal Insufficiency

Abstract Background: Herbal remedies are widely available and whilst portrayed as generally harmless, they may contain a variety of potent medications that can cause unintended and potentially serious consequences. This danger is further amplified as their use is typically inadvertently not divulged to clinicians, such as in this case. Clinical Case: A 65-year-old gentleman was referred to Endocrinology for assessment of adrenal insufficiency (AI) as a cause of his lethargy. He was found to have serum cortisol levels of 38 nmol/L and 68 nmol/L (150 – 700 nmol/L) on two separate mornings. No identified recent use of inhaled, topical, intra-articular or oral exogenous steroid therapy was noted. He had an inadequate response to Synacthen stimulation with peak serum cortisol of 150 pmol/L at 60-minutes (Adequate response – Post-Synacthen cortisol &amp;gt;430 pmol/L). Baseline plasma ACTH was low - 1.1 pmol/L(2.0 – 10 pmol/L) and secondary (pituitary) AI was suspected. He had normal thyroid function and prolactin. The patient subsequently admitted to taking an herbal medication, “Montalin” for a few months. It was obtained over-the-counter in Indonesia for symptomatic relief of “muscle pains”. The tablet underwent analysis to investigate for presence of corticosteroid components. An intact Montalin capsule was partly dissolved and the soluble content was diluted and analysed via LCMS/MS. Presence of dexamethasone/betamethasone was confirmed at an approximate concentration of 69.8 nmol/L constituting 0.548mg and 0.81% of the tablet. At the time, betamethasone and dexamethasone could not be distinguished due to stereoisomerism, but since has been confirmed to be dexamethasone. The patient likely had suppression of the hypothalamic-pituitary-adrenal axis from unintended exogenous corticosteroid use, causing a picture of secondary AI. He requires ongoing corticosteroid replacement pending recovery of endogenous production. Although Montalin is marketed as an herbal over-the-counter medication it was confirmed to be adulterated with a potent corticosteroid. An alert issued by the Singaporean government details two further cases of adverse effects from Montalin and warns against its use. Conclusion: Herbal remedies with undisclosed potent ingredients may unknowingly cause serious adverse effects. With advances in LCMS/MS technology, laboratory analysis of either the tablets or the patient’s serum could be utilised to identify potential exogenous corticosteroid exposure.

Histopathological comparison of pleomorphic adenomas of the parotid and submandibular gland.

The aim of this study was to investigate and compare the histopathological findings in pleomorphic adenomas (PA) of the parotid and submandibular gland with emphasis on the histological subtype and capsular characteristics. The histopathological specimens of all patients with PAs of the parotid and submandibular gland between 2000 and 2020 were re-examined by an experienced head and neck pathologist. Patients without representative slides allowing evaluation of the whole periphery of the PA were excluded from our study sample. Nine hundred and thirty-four patients formed our study sample (327 men, 607 women, male-to-female ratio: 0.53:1). Eight hundred and forty-four cases had a PA in the parotid gland and the remaining 90 in the submandibular gland. Our comparative analysis showed that submandibular PAs are characterized by the consistent presence of an intact anatomical capsule, infrequent occurrence of pseudopodia and satellite nodules, and a low proportion of the high-risk myxoid subtype. Our study highlights significant differences between PAs of the parotid and submandibular glands in their histopathological characteristics. Their differences likely underlie the favorable surgical outcome observed in PAs of the submandibular glands and may explain the propensity of PAs of the parotid glands for local recurrences.

Masson tumor of the lingual tongue: a case report

<h3>Background</h3> Intravascular papillary endothelial hyperplasia, or Masson tumor, is a benign lesion of the head and neck region. The etiology of the lesion arises within a blood vessel and is thought to be reactive and associated with vascular injury. Masson tumors comprise approximately 2% of all vascular tumors of skin and subcutaneous tissues; however, this is rarely seen intraorally. It is important to consider at the time of differential diagnosis to distinguish from malignancy and avoid aggressive surgery or unnecessary treatment. <h3>Case Summary</h3> We describe a case of a patient who presented to the Erie County Medical Center Department of Oral Oncology for evaluation of a soft, nontender, mobile mass in the right side of the ventral tongue. The patient first presented in June 2019 with an approximately 5-mm round mobile mass on the right side of the ventral tongue of 6 days' duration. The patient opted for no treatment in June 2019 and returned in December 2019 after the mass had grown in size and had begun to affect his everyday activities. Treatment options included excisional biopsy under general anesthesia or under local anesthesia. The patient opted for excision under local anesthesia. The vascular component was identified and tied off, and the tumor was removed in total. The tumor was a bluish lesion with a thick intact capsule. The final pathology revealed a thrombosed blood vessel with papillary endothelial hyperplasia consistent with Masson tumor. Immunostains for CD31 and D2-40 supported this diagnosis. The patient has some residual tethering of the right side of the tongue resulting from establishing primary closure. <h3>Conclusions</h3> The majority of tumors with this diagnosis have an excellent prognosis with complete excision. Malignant transformation and metastasis have not been reported.

Nondestructive qualitative and quantitative analysis of Yaobitong capsule using near-infrared spectroscopy in tandem with chemometrics

The purpose of the study is to present a nondestructive qualitative and quantitative approach of hard-shell capsule using near-infrared (NIR) spectroscopy combined with chemometrics. The Yaobitong capsule (YBTC) was used for demonstration of the proposed approach and the NIR spectra were collected using a handheld fiber probe (FP) without the damage of capsule shell. By comparing the differences and similarities of the NIR spectra of capsule shells, contents and intact capsules, a preliminary conclusion can be drawn that the NIR spectra contained the information of the contents. Characteristic variables were selected by competitive adaptive weighted resampling (CARS) method, and least squares support vector machine (LSSVM) method based on particle swarm optimization (PSO) algorithm was applied to the construction of quantitative models. The relative standard error of prediction (RSEP) values of five saponins including notoginsenoside R1, ginsenoside Rg1, Re, Rb1, and Rd were 3.240%, 5.468%, 5.303%, 5.043%, and 3.745%, respectively. In addition, for qualitative model, three different types of adulterated capsules were designed. The model established by data driven version of soft independent modeling of class analogy (DD-SIMCA) demonstrated a satisfactory result that all adulterated capsules were identified accurately after an appropriate number of principal components (PCs) were chosen. The results indicated that although the NIR spectra collection was affected by capsule shell, sufficient content information can be obtained for quantitative and qualitative analysis after combining with chemometrics. It further proved that acquired NIR spectra do contain the effective component information of the capsule. This study provided a reference for the rapid nondestructive quality analysis of traditional Chinese medicine (TCM) capsule without damaging capsule shell.

A glycan FRET assay for detection and characterization of catalytic antibodies to the Cryptococcus neoformans capsule

Classic antibody functions include opsonization, complement activation, and enhancement of cellular antimicrobial function. Antibodies can also have catalytic activity, although the contribution of catalysis to their biological functions has been more difficult to establish. With the ubiquity of catalytic antibodies against glycans virtually unknown, we sought to advance this knowledge. The use of a glycan microarray allowed epitope mapping of several monoclonal antibodies (mAbs) against the capsule of Cryptococcus neoformans From this, we designed and synthesized two glycan-based FRET probes, which we used to discover antibodies with innate glycosidase activity and analyze their enzyme kinetics, including mAb 2H1, the most efficient identified to date. The validity of the FRET assay was confirmed by demonstrating that the mAbs mediate glycosidase activity on intact cryptococcal capsules, as observed by a reduction in capsule diameter. Furthermore, the mAb 18B7, a glycosidase hydrolase, resulted in the appearance of reducing ends in the capsule as labeled by a hydroxylamine-armed fluorescent (HAAF) probe. Finally, we demonstrate that exposing C. neoformans cells to catalytic antibodies results in changes in complement deposition and increased phagocytosis by macrophages, suggesting that the antiphagocytic properties of the capsule have been impaired. Our results raise questions over the ubiquity of antibodies with catalytic activity against glycans and establish the utility of glycan-based FRET and HAAF probes as tools for investigating this activity.

Strumal Carcinoid of the Ovary: A Report of Two Cases

We describe two cases of strumal carcinoid of ovary, which is an extremely rare ovarian germ cell tumor composed of an intimate mixture of thyroid and carcinoid tissues. The first case involved a 63-year-old woman, who presented with a 1-month history of abdominal distension and unintentional weight loss (5 kg). Abdominal and chest computed tomography revealed right ovarian tumor and bilateral pleural effusion. Her thyroid-stimulating hormone level was slightly lower 0.475 μIU/mL (normal range: 0.55 - 4.78 μIU/mL); however, the levels of FT3 and FT4 were normal. Intraoperatively, the right ovary was enlarged (8.0 cm × 7.0 cm), with a smooth surface and intact capsule. Bilateral salpingo-oophorectomy with a total abdominal hysterectomy and an appendectomy was performed. The second case was a 54-year-old woman, in whom pelvic mass was recognized 2 months before. Intraoperatively, the left ovary was dumbbell-shaped (20.0 cm × 9.0 cm × 9.0 cm) and connected to two masses (9.0 cm × 8.0 cm and 8.0 cm × 7.0 cm, respectively). Her thyroid function test was normal (0.70 μIU/mL). Total abdominal hysterectomy, partial omentectomy, and pelvic adhesion lysis were performed. In both patients, intraoperative frozen section suggested strumal carcinoid of the ovary (stage IA). Ovarian strumal carcinoid should be included in a differential diagnosis of adnexal masses. The prognosis is considered good.

Preserving posterior capsular integrity in post-endothelial keratoplasty posterior capsular opacification.

Endothelial keratoplasty (EK) with pseudophakia often presents with late-onset proliferative after-cataract with posterior capsule distension. We performed a modified technique of capsular bag lavage in 11 eyes with late-onset PCO after EK (4 cases: post-DSAEK, 7 cases: post-DMEK). Anterior capsular rim was separated from the underlying IOL optic using MVR blade. Circumferential relaxing radial nicks were made on the capsular rim to create space for the passage of irrigation-aspiration (IA) probes behind the IOL. Bimanual IA of the flocculent cortical material was performed without damaging the posterior capsule. Air was injected at end of surgery to ensure graft apposition. All cases gained 1-3 lines of Snellen’s acuity and no case developed graft failure, rejection, or endothelial decompensation. An intact posterior capsule is associated with better outcomes post a repeat graft, if required. Our technique helps avoid complications related to a disturbed anterior hyaloid phase and minimizes postoperative inflammation.

1303. Characterization of Isavuconazole Serum Concentrations with Various Administration Routes in a Hospitalized Cohort

BackgroundPatients with invasive fungal infections are often critically ill and immunosuppressed with multiple comorbidities that may impact drug absorption and exposure. This study sought to characterize isavuconazole serum concentrations (ISCs) in a cohort of real-world hospitalized patients when administered by intravenous solution (IV), enteral as intact capsules, or tube as opened capsule contents.MethodsThis retrospective cohort analysis included all hospitalized patients who received isavuconazole as prophylaxis or treatment between September 2017 and September 2018 and had therapeutic drug monitoring performed. For patients receiving isavuconazole by tube, the capsules were opened and contents were diluted with 10-30 mL of sterile water. Administration was per package insert for intact capsules and IV solution. ISCs were obtained as part of routine care and were quantified by high-performance liquid chromatography. An appropriate trough was defined as within 4 hours of the next scheduled dose. Currently, there is a lack of correlation between isavuconazole exposure and efficacy or toxicity; thus, ISCs were compared between administration routes.Results93 ISCs were obtained during 65 encounters from 55 unique patients. The majority of patients were post-transplant (69.1%) and death occurred during 12 (18.5%) encounters. ISCs based on different characteristics of the cohort are shown in Table 1. All ISC assessments were detectable, median 2.3 mg/dL (Q1: 1.5 mg/dL, Q3: 3.3 mg/dL). Administration via tube achieved similar ISCs compared with IV therapy (1.6 mg/dL vs. 1.9 mg/dL, respectively). However, administration of intact capsules resulted in higher median ISCs, 3 mg/dL (Q1: 1.9 mg/dL, Q3: 4.1 mg/dL). All 14 patients with administration via tube were post-transplant, which was not shown to have a significant impact on ISCs (median, transplant 2.2 mg/dL vs. non-transplant 2.7 mg/dL).Table 1. Characterization of Isavuconazole Concentrations ConclusionISCs were detectable in all patients regardless of transplant status or location at the time of assessment. Administration of isavuconazole via an enteral feeding tube achieved comparable serum concentrations compared with FDA-approved routes of administration and may represent an important alternative for select patients.Disclosures All Authors: No reported disclosures

Reliability of the application of transvaginal color Doppler ultrasound in the identification of pelvic tumors in women of childbearing age.

BackgroundRecently, transvaginal color Doppler ultrasound (TVCDU) has been widely used in the diagnosis of pelvic tumors. This study aimed to assess the reliability of the application of TVCDU in the identification of pelvic tumors in women of childbearing age.MethodsThe clinical data of 209 patients with pelvic tumors at childbearing age admitted to our hospital from January 2016 to December 2019 were retrospectively analyzed. The ultrasound signs, color Doppler ultrasound score (CDUS), and resistance index (RI) of benign and malignant pelvic tumors diagnosed by TVCDU were analyzed. The value of transabdominal color Doppler ultrasound (TACDU) and TVCDU in the diagnosis of benign and malignant pelvic tumors was calculated.ResultsThere were 150 cases with benign pelvic tumors and 59 cases with malignant tumors. Most benign tumors had an intact capsule and regular shape, were mainly cystic, and were rarely accompanied by ascites; meanwhile, malignant tumors were mostly non-capsular and irregular in shape, mainly solid or cystic, and were often accompanied by ascites. There were significant differences in the above-mentioned ultrasound signs between benign and malignant tumors (P<0.05). The CDUS score of benign pelvic tumors was significantly lower than that of malignant tumors, and the RI value was significantly higher than that of the malignant tumors (P<0.05). The sensitivity, specificity, and accuracy of TACDU in the diagnosis of benign pelvic and malignant tumors were 83.33%, 84.75%, and 83.73%, respectively; and the sensitivity, specificity, and the accuracy of TVCDU in the diagnosis of benign pelvic and malignant tumors were 95.33%, 88.14%, and 93.30%, respectively; thus TVCDU had a superior performance compared to TACDU, especially in sensitivity and accuracy (P<0.05).ConclusionsThe sensitivity and accuracy of TVCDU in the differential diagnosis of benign pelvic and malignant tumors in women at childbearing age were significantly higher than those of TACDU. The combined application of CDUS and RI can further improve the accuracy in the diagnosis of pelvic tumors.

In Vitro Bioeffects of Polyelectrolyte Multilayer Microcapsules Post-Loaded with Water-Soluble Cationic Photosensitizer.

Microencapsulation and targeted delivery of cytotoxic and antibacterial agents of photodynamic therapy (PDT) improve the treatment outcomes for infectious diseases and cancer. In many cases, the loss of activity, poor encapsulation efficiency, and inadequate drug dosing hamper the success of this strategy. Therefore, the development of novel and reliable microencapsulated drug formulations granting high efficacy is of paramount importance. Here we report the in vitro delivery of a water-soluble cationic PDT drug, zinc phthalocyanine choline derivative (Cholosens), by biodegradable microcapsules assembled from dextran sulfate (DS) and poly-l-arginine (PArg). A photosensitizer was loaded in pre-formed [DS/PArg]4 hollow microcapsules with or without exposure to heat. Loading efficacy and drug release were quantitatively studied depending on the capsule concentration to emphasize the interactions between the DS/PArg multilayer network and Cholosens. The loading data were used to determine the dosage for heated and intact capsules to measure their PDT activity in vitro. The capsules were tested using human cervical adenocarcinoma (HeLa) and normal human dermal fibroblast (NHDF) cell lines, and two bacterial strains, Gram-positive Staphylococcus aureus and Gram-negative Escherichia coli. Our results provide compelling evidence that encapsulated forms of Cholosens are efficient as PDT drugs for both eukaryotic cells and bacteria at specified capsule-to-cell ratios.

Giant Retroperitoneal Sarcoma: A Case Report and Review of Literature

AbstractLiposarcomas are neoplasms of mesodermal origin derived from adipose tissue representing 10 to 14% of all soft tissue sarcomas, with the most frequent subtype being liposarcoma. Given that the retroperitoneum is a large space in which the retroperitoneal liposarcoma can grow asymptomatically up until a mass effect develop. Hence, patients usually present late with symptoms with possible invasion to nearby structures. These tumors are known to reach significantly large dimension, despite their poor vascularization and can grow to enormous size, the average diameter of the tumor is 20 to 25 cm with a weight of 15 to 20 kg. Surgery with en-bloc resection of the tumor and adherent nearby structures, with intact capsule, remains the gold standard in surgical management of retroperitoneal sarcomas. Herein, we present a case of 52 year old male patient with a huge 48 cm right-sided retroperitoneal liposarcoma, managed surgically by en bloc excision of the tumor, right kidney, right ureter, right adrenal gland, and the right colon.