Secondary Lesion Research Articles

A Bronze Age mandibular anomaly from Gansu, China

AbstractBone defect in the mandible due to developmental defects, trauma, or diseases is common. However, large scale of mandibular bone atrophy induced by long‐term pressure is rare. This study reported a mandibular anomaly, possibly a secondary lesion, from a Bronze Age adult male excavated from the Dunping cemetery during the Eastern Zhou Dynasty (770–256 BCE), Zhang County, Gansu Province, China. The defect presents as an absence of bone mass at the angle of inferior lingual aspect of the mandibular corpus, incorporating the gonial angle of the mandible on the left side. Overall profile of the defect was assessed using morphological observations of the mandible, accompanied by computed tomography (CT) imaging and panoramic dental X‐ray images of the jaws used to assist with the diagnosis. There were no signs of trauma, osteogenic neoplasms, or osteolytic lesions. Pressure resorption, a Stafne defect, was postulated as the primary cause of bone atrophy due to a long‐term lesion of the neighboring submandibular gland, namely, chronic sialadenitis or a benign neoplasm pleomorphic adenoma. This is for the first reported case of a mandible anomaly as such identified from ancient China. This reporting enriches the knowledge of long‐term effects of pressure resorption in the human mandible.

2019 novel coronavirus disease with secondary ischemic stroke: two case reports

BackgroundThe COVID-19 pandemic, which broke out in Wuhan in 2019, has become the global health crisis of our time. Elderly patients with certain fundamental diseases are more likely to develop severe cases. The secondary lesion following viral infection have only rarely been reported.Case presentationWe here report two cases of coronavirus-infected pneumonia with acute ischemic stroke in middle-aged patients. In both COVID-19 cases, neurological physical examinations showed normal results before infection. Lymphocytopenia, accompanied by elevated cytokines and D-dimers, were found from serum clinical laboratory examination at admission. Dysarthria and limb muscle weakness are initial manifestations, occurring one week after infect-causative pathogen, SARS-CoV-2. The head CT and head/neck arterial CTA showed small-vessel occlusion. The patients were diagnosed with coronavirus diseases with secondary acute ischemic stroke. They were treated with tirofiban and followed up with daily aspirin and atorvastatin.ConclusionsThese cases suggested that secondary ischemic stroke, mainly manifested as small-vessel occlusion, should be considered for COVID-19 patients and diagnosed and treated promptly.

Morphological features of jaw osteonecroses in injectable drug abuse

To determine the characteristic features in the structure of jaw bone sections in patients with jaw osteonecrosis caused by the use of homemade methamphetamine (HM) synthesized by the Nagai method. The investigation material was jaw sequesters and resected sections in 60 patients, which had been taken during sanitizing surgery for chronic odontogenic osteomyelitis (Group 1, n=30, a comparison group) and jaw osteonecrosis (Group 2, n=30). All the patients in Group 2 confirmed that they had been using HM for at least 2 years. The investigation material was selected only from the patients who had not been found to have congenital or acquired immunodeficiencies or multiple organ failure phenomena. The material was fixed according to the standard procedure; the sections obtained were stained with hematoxylin and eosin and Masson-Goldner. Morphometry used the indicators proposed by the American Society of Bone and Mineral Research Histomorphometry Nomenclature Committee, as well as 6 author parameters. The findings of the investigation were statistically processed using the Statistica 10.0 program (StatSoft, USA) by the nonparametric Mann-Whitney test. The histoarchitectonics of the mandible bone matrix represented a destructured devitalized tissue complex on the mandibular microspecimens taken from a group of patients with chronic odontogenic osteomyelitis of the jaws. The state of the bone matrix was characterized by the atypical rearrangement with the phenomena of sclerosis, the signs of primary aseptic inflammation with toxic vasculopathy and fibrinoid necrosis, as well as those of secondary pyonecrotic inflammation on the mandibular microspecimens taken in the HM group. The characteristic morphological pattern of jaw osteonecrotic injuries in persons with HM-induced drug abuse is the simultaneous identification of two types of lesions: a primary lesion as aseptic ossifying osteitis and a secondary lesion as pyonecrotic inflammation. The phenomena of toxic vasculopathy and fibrinoid osteonecrosis can serve as one of the criteria confirming the active regular intake of HM.

Putative periodontal pathogens in persisting periodontal pockets of endodontic origin.

Background:The microbial profile of endodontically treated teeth, presenting with a persisting deep periodontal pocket, secondary to a primary endodontic lesion, draining through the gingival crevice, has received very less attention. This observational study was done to evaluate if these sites with persisting pockets of endodontic origin persist because they have acquired bacteria which are considered as putative periodontal pathogens.Materials and Methods:Subgingival plaque samples were collected from fifty patients diagnosed with a primary endodontic and a secondary periodontal lesion that persisted even after completion of the root canal treatment. Clinical parameters such as probing pocket depth, clinical attachment level, plaque index, furcation, and tooth mobility were recorded. Real-time polymerase chain reaction was used to determine the possible association between six bacteria, which are frequently associated with periodontal and endodontic lesions.Results:The mean cycle threshold value for Treponema denticola (Td) was found to be 33.74, and for Enterococcus faecalis (Ef), it was 34.39. With regard to clinical attachment loss, Td (P < 0.04) and Parvimonas micra (P < 0.05) had a significant correlation.Conclusion:Ef (92%) and Td (86%) were found to be most prevalent. Porphyromonas gingivalis and Tannerella forsythia were in minimal to nonexistent levels.

Effect of Complete Revascularization vs. Staged PCI of Secondary Lesion on LV Systolic Function in Patient with STEMI

After a myocardial infarction, early restoration of normal coronary perfusion reduces infract size, preserves left ventricular function, and lowers mortality. Reperfusion therapy's major goal is to not only restore the culprit epicardial vessel's patency, but also to reperfuse tissue to preserve myocyte viability and hence LV function. The pathophysiology of myocardial infarction, on the other hand, is not limited to the culprit vessel. The treatment of non-culprit lesions in STEMI is a contentious issue. Previously published guidelines (the 2011 PCI and 2013 STEMI guidelines) recommended treating the culprit lesion only if the patient was in cardiogenic shock. These guidelines are based on expert opinions rather than randomized controlled trials, which take into account safety concerns such as complications from repeated intervention, a low technical success rate, a high incidence of coronary restenosis, and renal insufficiency after contrast agent use. The aim of this work is to Long-term outcomes Lt ventricular ejection fraction (6 months) between complete revascularization and culprit-only revascularization (followed by staged percutaneous coronary intervention of secondary lesions) in STEMI patients with multi vessel coronary disease undergoing primary angioplasty. This prospective analysis included 50 patients with acute ST elevation myocardial infarction who were amenable to primary coronary intervention and were admitted to the critical care unit. And was blindly randomized alternatively into 2 groups: Group A: Complete coronary revascularisation during primary percutaneous intervention. Group B: Culprit-only revascularization during primary PCI. This study enrolled 50 patients, 35 males (70%) and 15 females (30%); in G I, there were 18 males (72%) and 7 females (18%) while in G II there were 17 males (68%) and 8 females (32%). The age ranged from 34 yrs. to 82 yrs. with mean age: In G I was 61.6 (±8.9) In G II was 62.2 (±12.9) were enrolled in this study, pre-procedural EF% (Mean±St) there was no significant difference between both groups. In G I, patients had a mean EF% 49.9±10.1 Versus 48.0±11.3 seen in G II. (P=0.54) In G I, there was no a significant difference between pre- procedural versus post-procedural mean EF%. (P=0.53) In G II, there was no a significant difference between pre-procedural versus post-procedural mean EF%. (P=0.14) We concluded that There were no significant differences between infarct-related artery revascularization and multivessel revascularization in the rates of 6-month MACE, Also, there were no differences as regard in-hospital mortality, stroke, cardiogenic shock and reinfarction, ejection fraction.

Primary osteosarcoma of the breast

A 58-year-old female with a primary osteosarcoma of the breast (POB) is presented here. The diagnosis was based on the characteristic histological picture and on the immunohistochemical results. The possibility of the secondary lesion from a primary skeletal osteosarcoma or direct extension of an osteogenic sarcoma arising from nearby ribs or the sternum was excluded. Approximately, 150 cases of POB had been reported in the literature with tumor size affecting survival. The diagnosis needs to be made as early as possible to improve the survival of this disease.

Influence of biofilm removal from the tooth-restoration interface on the progression of secondary caries lesions: a preliminary in vitro model study

This study investigated the effects of biofilm removal from the tooth-restoration surface on secondary caries lesion progression. Biofilms were grown for up to 28 days on resin-restored enamel-dentin disks with an interfacial gap with DMM or DMM + 1% sucrose under five different protocols of Visible Biofilm Removal (V-BR; n = 7): (1) without V-BR, (2) with partial V-BR, (3) with total V-BR, (4) with total V-BR and saliva reinoculation, and (5) without V-BR under 9 h of cariogenic challenge. V-BR was performed at 7, 14 and 21 days. ΔS and CFU counts served as outcome variables. Linear regression models showed that ΔS values were higher for outer lesions than wall lesions, and outer lesion progression generally increased over time (p < 0.01). All protocols tested, except total V-BR, increased the lactobacilli count (p < 0.005). V-BR did not influence the progression of caries lesions on the cavity wall in this biofilm model.

Spectrum of rare splenic lesions

Introduction: The human spleen is the largest component of the reticuloendothelial system, having unique anatomic and functional importance. Spleen has been considered as mysterious organ with World population incidence of focal splenic lesions ranging from 0.103 to 0.20%. Aims and Objective: The aim of the present study was to study the pathological spectrum of rare lesions of spleen. Materials and Methods: The present study was conducted in the department of Pathology in a tertiary care centre, over a period of three years from Aug 2014 to July 2017. Results: Total 10 rare cases of splenic lesions were studied. Out of which eight were splenectomies and two were from fetal autopsies. Primary lesions were 9 and secondary lesion was 1. We found one case each of hemangiomatosis of spleen, small B cell lymphoma of spleen, Sickling of spleen, hydatid cyst of spleen, traumatic spleen avulsion, metastasis to spleen from lung and two case were of asplenia with right isomerism and situsambigus and two cases were of extra lymphatic filariasis of spleen. Conclusion: Morphological changes in splenic lesions are less discussed due to fewer number of splenectomy cases. We hereby analyzed rare splenic lesions which has contributed to the knowledge of splenic pathology. Keywords: Pathological spectrum, Splenic lesions, Splenectomy.

Cirugía reconstructiva en el tratamiento de lesiones causadas por miasis en la región oronasal en un canino: Reporte de caso

The present report described the treatment of a male, adult, uncastrated and mixed breed canine presenting dermal lesions in the oronasal region were identified, originating from myiasis infestation. After the larvae removal, treatment and cure, reconstructive surgical intervention it was necessary to correct secondary lesion defects, using the flap technique from subdermal plexus; where success was achieved in the choice of all adopted therapies. Myiasis refers to the presence of fly larvae (order: Diptera) in the tissues and mucous membranes of animals and humans. In Brazil, in addition to the species: Dermatobia hominis popularly known as “blowfly”, a Cochliomya hominivorax species, commonly known as 'flyworm', has great health importance. Considered a mandatory notification by the international organization of epizooties (OIE). Among the main causes that favor the appearance of myiasis, we have: lack of hygiene in the environment, ear infections and exposed wounds.

Secondary Tumor Arising in a Nevus Sebaceous

Abstract Introduction. Nevus sebaceous is a rare congenital hamartoma, composed of epidermis, sebaceous glands, sweat glands and hair follicles. It is possible to develop secondary tumors in the area of nevus sebaceous during the lifetime, most often after puberty. Secondary lesions are most often benign, while malignant lesions may occur but significantly less frequently. Case report. We present the case of a 21-year-old patient who came for an examination due to the appearance of a nodule in the area of a yellowish lesion on the head. The yellowish lesion was present since birth, and the nodule appeared about a year before. The dermoscopic examination of the lesion was nonspecific. The final diagnosis of eccrine poroma as a secondary lesion in nevus sebaceous was made by pathohisto-logical analysis. Conclusion. Every secondary tumor in nevus sebaceous deserves full attention, with either close follow up, or excision with pathohistological analysis.

Is there a requirement for a staging CT thorax in T1N0 and T2N0 oral squamous cell carcinomas?

Introduction: At the time of diagnosis 1 in 10 patients with oral squamous cell carcinoma has a secondary cancerous lesion or metastasis in the local lymph nodes. The incidence of occult metastasis in patients with T1 and T2 tumours has been 7–33% and 28–53% respectively. The 2016 NICE recommendation was that all people with cancer of the upper aero digestive tract should be offered systemic staging except those with T1N0 or T2N0 disease. In this study we review the staging scans for our T1N0 and T2N0 patients.

Clinical Observation of Zhuang Medicine Crystal Sugar Ye’An Decoction in Treating Senile Skin Pruritus and Its Effects on Serum IgE

Objective: To discuss the specific application of Zhuang Medicine Crystal Sugar Ye’An Decoction in senile skin pruritus and its effects on serum IgE detection level. Methods: 90 patients with senile skin pruritus admitted to our hospital from February 2019 to April 2020 were randomly grouped. The general treatment effect, itching, secondary skin lesion severity, serum IL-6, IgE level and adverse reactions between 45 patients treated with Chlorcyclizine Hydrochloride Tablets (The control group) and 45 patients treated with Crystal Sugar Ye’An Decoction were compared. Results: The total effective rate of the treatment in the observation group was 93.33%, much higher than that in the control group, 75.56%. The difference was verified and statistically significant (P&lt;0.05). Before the treatment, the itching area, frequency, duration and severity of secondary skin lesions were at the same level (P&gt;0.05). After the treatment, the above data were all reduced, and the reduction of the observation group was more significant than that of the control group, indicating the difference was statistically significant (P&lt;0.05). Before the treatment, there was no difference in serum IL-6 and IgE test data between the two groups (P&gt;0.05). After the treatment, the tendency all declined, and that of the observation group was more obvious, indicating the difference was statistically significant (P&lt;0.05). During the experiment, no obvious adverse reactions were observed in both groups. Conclusion: In the treatment of patients with senile pruritus, the application of Zhuang Medicine Crystal Sugar Ye’An Decoction is not only safe and reliable, but can promote the improvement of patients’ symptoms, adjust the level of inflammatory factors, and enhance clinical efficacy.

Skin lesion classification using decision trees and random forest algorithms

Any superficial skin growth that does not resemble the surrounding area is referred to as skin lesion. It can occur in the form of mole, bump, cyst, rash or other changes that can be classified either as primary or secondary lesion. While primary skin lesions correspond to those changes in color or texture, secondary lesions occur as a primary lesion progression. Skin lesion image segmentation and classification at the early stages can help the patients recover through proper medication and treatment. Many algorithms for segmentation and classification are available in the literature but they all fail to extract lesion boundaries perfectly and classify them with more accuracy. To improve the reliability of the skin image segmentation and classification, we propose to use decision trees and random forest algorithms in this works and compare them with different data sets. The proposed method can generate high-resolution feature maps that can help to preserve the spatial details of the image. While tested against the ISIC 2017 and HAM10000 dataset, we found that the proposed method is more accurate as compared to the existing algorithms in this domain and is also very robust to artifacts or hair fibers present in the skin images.

BILATERAL BREAST CANCER - CASE SERIES

This is a presentation of four rare and interesting cases of bilateral breast cancer. The cases vary from Synchronous double primary carcinoma breast, bilateral infiltrating ductal carcinoma, bilateral synchronous metastatic carcinoma and metachronous breast carcinoma. The incidence of developing either primary or metastatic carcinoma in the other breast is increased in patients who already have carcinoma in one side and mammography contributes greatly to the detection of these lesions. (1) It is of significant prognostic value and important in deciding the clinical management based on the classification whether it is a primary or a secondary lesion.

METASTATIC OVARIAN NEUROENDOCRINE TUMOR IN THE HEART FIRST PRESENTING ON EKG

SESSION TITLE: Medical Student/Resident Cardiovascular Disease Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Neuroendocrine tumors (NETs) of the gynecological tract are rare, they are most commonly seen in the lungs and gastrointestinal (GI) tracts. Cardiac metastasis in ovarian NETs is uncommon with only 7 such cases previously reported. We present a case of a right ventricular (RV) neuroendocrine cardiac tumor, initially noted due to EKG abnormalities, initiating from the right ovary. CASE PRESENTATION: A 70-year-old female with a history of uterine fibroids was evaluated preoperatively for an elective hysterectomy. Her EKG showed inferior and anteroseptal T wave changes. Cardiology then preformed an echocardiogram (TTE) showing a RV thrombus. Patient was admitted to the hospital where a repeated TTE demonstrated a 4x7cm mass arising from the RV apex with obstruction of the RV outflow tract. Cardiac MRI then demonstrated a right ventricular mass measuring 4.7x6.2cm extending from the apex to the base at the level of the outflow tract. The mass was invading the RV free wall and apical septum. Patient was then transferred to an outside hospital for cardiac biopsy, where pathology demonstrated a poorly differentiated carcinoma with neuroendocrine differentiation. A PET scan then demonstrated a hypermetabolic 7cm right ventricular mass, and a bulky uterus with a 6.6cm mass in the posterior aspect of the uterus arising form the right ovary. Repeat MRI showed an unchanged 7.1 cm mass in the cul-de-sac likely reflecting neoplastic involvement of the right ovary. She was initiated on chemotherapy with carboplatin and etoposide. Follow up TTE has shown a decrease in the size of the mass to 4.2x2.7cm. DISCUSSION: Secondary cardiac tumors are found in up to 8% of patients who died of metastatic cancer. Mesothelioma is the most common to metastasize to the heart with others being melanoma, lung, breast, renal, esophageal, and ovarian cancers. One study of 106 patients with primary ovarian tumors found that 10.3% had metastasis to the heart. The cause of such high levels of metastasis to the heart is likely the anatomy of the ovarian venous, which drain directly into the inferior venacava. Treatment options, depend on the stage of disease, including surgical removal of the ovarian tumor which is the mainstay of management, chemotherapy is typically reserved for advanced stage or recurrent disease. In the case above with a secondary cardiac metastatic lesion surgical resection was considered, but felt not to be a surgical candidate due to the extent of myocardial infiltration. CONCLUSIONS: Primary ovarian NETs are rare and metastasis to the heart is ever rarer. When discovered, it is important to ensure there is no GI metastatic primary tumor as this guides further treatment. An echocardiogram should be performed in all women with ovarian NETs as they can frequently metastasize to the heart. Finally the mainstay of treatment is surgical removal in isolated lesions and chemotherapy in more advanced disease. Reference #1: Damen N. Ovarian carcinoid presenting with right heart failure. BMJ Case Rep. 2014; bcr2014204518 Reference #2: Silvestri F, Bussani R, Pavletic N, Mannone T. Metastases of the heart and pericardium. G Ital Cardiol 1997; 27:1252. Reference #3: Bussani R, De-Giorgio F, Abbate A, Silvestri F. Cardiac metastases.J Clin Pathol. 2007; 60:27–34. DISCLOSURES: No relevant relationships by Chad Conner, source=Web Response No relevant relationships by Nikola Perosevic, source=Web Response No relevant relationships by Bryan Stringer, source=Web Response

Abstract 2711: Mechanism of natural progression from low grade glioma to glioblastoma: A case report

Abstract Introduction: Current studies about the progression mechanisms of gliomas mainly focus on the progression under treatment selection. Little is known about how low grade gliomas (LGG) progress to glioblastoma (GBM) under natural pressure, which remains to be elucidated. Methods: We reported a 67-years-old woman, whose intracranial lesion was diagnosed first in 2010 but without treatment. An enhanced peripheral lesion was detected around the primary lesion in 2018. Both the primary and secondary lesions were resected and diagnosed as diffuse astrocytoma(LGG) and glioblastoma (GBM), respectively. Both samples were subjected to whole exome sequencing, RNA sequencing, methylation array and TCR sequencing. Results: The results showed that both samples were IDH1 mutant, 1p/19q non-codel, TERT promoter wild-type, G-CIMP High and MGMT methylated. About 50% of the mutant genes were identical in both samples, suggesting that both samples had the same origin. Comparing with the primary glioma (LGG), the mutant allele fractions (MAFs) of these shared genes were increased in the secondary lesion (GBM). Furthermore, the MAFs of a novel mutation (p.N219K) in the gene NAF1 increased from 44% to 75%, and the ratio of the corresponding RNA reads increased from 37.5% to 75%, which indicating NAF1(p.N219K) maybe a novel driver mutation promoting tumor progression in LGG. The unique genes in the secondary lesion (GBM) with MAFs&amp;gt;15% were CIC, HMCN1, RPA4 and BRAC2. As it is well known, RPA4 and BRCA2 are involved in homologous recombination repair system. The ssGSEA analysis revealed that KRAS pathway and NF-kB pathway was activated in the secondary lesion (GBM). Mast cells were increased in the GBM, whereas CD4+ memory T cells and CD8+ T cells decreased, which suggesting potentiation of innate immune response and suppression of adaptive immune response. Surprisingly, although only 2.13% (n=14) of TCR sequences detected in the blood were shared in the LGG or the GBM, their reads accounted for 44% of all TCR sequences reads in blood, 71.10% in the LGG and 46.40% in the GBM, suggesting these T cells may play vital functions in the process of glioma progression. Conclusion: Here, we reported an IDHmut-1p/19q-noncodel glioma case with natural evolution. Several biological processes were identified in this progression including deficiency of DNA damage repair, activation of KRAS pathway and NF-kB pathway, excitation of innate immune response and suppression of adaptive immune response. We uncovered a novel driver mutation (NAF1, p.N219K), further analyses of its role in the natural progression of glioma are expected. We also found several significantly proliferated T cell clones in the development of gliomas, which suggesting the promise of T cells in clinical diagnosis and treatment of glioma. Citation Format: Long Wang, Xuegang Li, Tunan Chen, Feilong Zhao, Tonghui Ma, Hua Feng, Fei Li. Mechanism of natural progression from low grade glioma to glioblastoma: A case report [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 2711.

Overlapping Primary and Secondary Syphilis in Human Immunodeficiency Virus (HIV) Patient

ABSTRACTCoinfection between syphilis and Human Immunodeficiency Virus (HIV) could have varied clinical manifestations. Overlapping of syphilis stages is accounted for 25% of cases, attributable to the defect of the cellular and humoral immune response. We reported 55 years old man who was sexually active since 25 years ago via genito-genital, genito-anal, genito-oral routes, had multiple sexual partners both male and female, seldom used condom, and always being the insertive. Dermatological examination revealed alopecia non-scarring, a painless solitary ulcer on the collum penis, also multiple erythematous macules, patches, and plaques all over the body. Spirochaeta sp. was found from the base of the ulcer with a darkfield microscope. Histopathology examination revealed secondary syphilis lesion. Venereal Disease Research Laboratory (VDRL) 1:16, Treponema Pallidum Haemagglutination test (TPHA) reactive, HIV Determine rapid test reactive, and CD4 (Cluster of Differentiation 4) T-cell count 111 cells/ µL. He was treated with a single dose of benzathine penicillin G 2,4 million units intramuscular and antiretroviral drugs. On sixth month evaluation, VDRL was non-reactive, and CD4 T-cell count 325 cells/µL. This case shows that overlapping clinical manifestations of primary and secondary syphilis on HIV patients could occur with a good general condition. Immediate treatment of antibiotics for syphilis and antiretroviral could improve the clinical and serological conditions.Keyword: primary syphilis, secondary syphilis, HIVCorrespondence: nurul.laili.nahlia@gmail.com

Expression Patterns of Hypoxia-Inducible Factors, Proinflammatory, and Neuroprotective Cytokines in Neuroepithelial Tissues of Lumbar Spinal Lipomas–A Pilot Study

Lumbosacral lipomas (LSLs), one form of closed spinal dysraphism, are congenital disorders of the terminal spinal cord (SC). Delayed neurologic deterioration often occurs in the subsequent developmental course of the patient. Identifying the cellular and molecular factors underlying the progressive damage to neural structures is a prerequisite for developing treatment strategies for LSLs. Nine LSL specimens obtained from the SC/lipoma interface during surgical resection were examined. Normal SC tissue served as a control. Clinical characteristics were obtained, and spinal magnetic resonance imaging was re-evaluated. Cellular marker profiles were established. Immunoreactivity (IR) of hypoxia-inducible factor 1α (HIF-1α/-2α), erythropoietin (Epo)/erythropoietin receptor (EpoR), interleukin-1β (IL-1β)/IL-1R1, and tumor necrosis factor α/tumor necrosis factor receptor type 1 were analyzed qualitatively and semiquantitatively by densitometry. Colabeling with cellular markers was determined by multifluorescence labeling. Cytokines were further analyzed by real-time reverse transcription polymerase chain reaction. LSL specimens showed significant gliosis. HIF-1α/HIF-2α-IR and Epo/Epo-IR were found at significantly higher levels in the LSL specimens, as were IL-1β-/IL-1β receptor type 1 (IL1-R1) and tumor necrosis factor α/tumor necrosis factor receptor type 1 (P < 0.001), than were the controls. At the messenger RNA level, cytokines appeared partially induced. Double immunofluorescence labeling confirmed the costaining of these factors with inflammatory and glial markers. The expression of hypoxia-related and inflammatory mediators was shown for the first time in LSL specimens. These factors might play a role in multifactorial secondary lesion cascades underlying further damage to the neural placode in closed dysraphism.

T-cell and NK-cell lymphomas in the lung.

While the lung is frequently involved by systemic lymphoma, primary pulmonary lymphoma accounts for less than 1% of all extranodal ymphomas. In particular, T-cell lymphoma is very rare in the lung, as a primary or secondary lesion. Patients with pulmonary T-cell lymphoma usually present with cough, dyspnea, pain, fever, recurrent infections, and hemoptysis. Typical radiologic features include pulmonary nodules, consolidation, solid pulmonary opacities, cystic changes, hilar adenopathy, and pleural effusions. Patients with these clinical and radiologic findings are frequently presumed to have pneumonia and initially treated with empirical antibiotics. Therefore, CT-guided needle biopsy, bronchoscopic examination, or even wedge biopsy should be considered when clinical symptoms show deterioration despite adequate antibiotic therapy. Precise pathologic diagnosis and molecular characterization are recommended in all cases, following the World Health Organization (WHO) classification. Principles of treatment typically vary with the different histologic types of T-cell lymphoma.

The effect of occlusal loading on cervical gap deformation: A 3D finite element analysis

ObjectivesSecondary caries can be accelerated by hydrodynamic flow in a gap between the tooth and restorative material. This study investigated whether occlusal loading can lead to increased hydrodynamic flow by deforming a gap between tooth and restorative material. Methods3D finite element analysis was employed to model a molar containing a restoration with an interfacial gap. The model was loaded using direct cusp-to-restoration contact and using a rubber tube model simulating a food bolus. The object exerting pressure was moved across the molar from buccal to lingual side. The applied forces were 50, 100, 200 and 400N. The elastic modulus of the restoration material was varied between 5, 10, 15.9 and 25GPa to resemble different kinds of composite. The primary outcome parameter was the volume of the gap under occlusal pressure. ResultsOcclusal loading resulted in deformation of the gap area. Maximum deformation was seen when loading was applied in the middle of the restoration. Higher forces and lower restoration stiffness led to more deformation of the gap. Maximum deformation with a force of 100N and composite modulus of 15.9GPa was −0.0083mm3 (1.12%). SignificanceDeformation of the gap between tooth and restorative material could lead to increased hydrodynamic flow and faster secondary caries lesion formation. The measured deformation is small. Further research needs to show whether gap compression through occlusal loading affects secondary caries formation to a clinically relevant degree.