Budd-Chiari syndrome in myeloproliferative neoplasms:A review of literature

Myeloproliferative neoplasms(MPNs)are defined as clonal disorders of the hematopoietic stem cell in which an exaggerated production of terminally differentiated myeloid cells occurs.Classical,Philadelphia-negative MPNs,i.e.,polycythemia vera,essential thrombocythemia and primary myelofibrosis,exhibit a propensity towards the development of thrombotic complications that can occur in unusual sites,e.g.,portal,splanchnic or hepatic veins,the placenta or cerebral sinuses.The pathogenesis of thrombotic events in MPNs is complex and requires an intricate mechanism involving endothelial injury,stasis,elevated leukocyte adhesion,integrins,neutrophil extracellular traps,somatic mutations(e.g.,the V617F point mutation in the JAK2 gene),microparticles,circulating endothelial cells,and other factors,to name a few.Herein,we review the available data on Budd-Chiari syndrome in Philadelphia-negative MPNs,with a particular focus on its epidemiology,pathogenesis,histopathology,risk factors,classification,clinical presentation,diagnosis,and management.

Emergency department procedural sedation for primary electrical cardioversion — a comparison with procedural sedations for other reasons

BACKGROUND: Atrial fibrillation(AF) is the most common arrhythmia treated in the emergency department(ED), with primary electrical cardioversion(PEC) the preferred method of rhythm control. Anecdotally, patients undergoing ED procedural sedation(EDPS) for PEC differ from those requiring EDPS for other procedures: they are at higher risk of adverse events, and require fewer drugs and lower doses. We attempt to verify this using an EDPS registry at a Canadian, tertiary care teaching hospital.METHODS: This is a retrospective review of patients that underwent EDPS for the period of June 2006 to September 2014. We compared demographics, medication use and intra-procedural adverse events between those receiving EDPS for PEC for AF compared to that for other indications. We report the asssociation between AEs and predictors using logistic regression.RESULTS: A total of 4 867 patients were included, 714 for PEC for AF and 4 153 for other indications. PEC patients were more likely male(58.5% vs. 47.1%), older(59.5 years vs. 48.1 years), and less likely to be ASA I(46.6% vs. 69.0%). PEC patients received smaller doses of propofol and less likely to receive adjuvant analgesic therapy(11.5% vs. 78.2%). PEC patients were more likely to experience hypotension(27.6% vs. 16.5%) but respiratory AEs(apnea, hypoxia and airway intervention) were not different.CONCLUSION: EDPS for PEC differs from that conducted for other purposes: patients tend to be less healthy, receive smaller doses of medication and more likely to suffer hypotension without an increase in respiratory AEs. These factors should be considered when performing EDPS.

Acute appendicitis–advances and controversies

Being one of the most common causes of the acute abdomen,acute appendicitis(AA)forms the bread and butter of any general surgeon’s practice.With the recent advancements in AA’s management,much controversy in diagnostic algorithms,possible differential diagnoses,and weighing the management options has been generated,with no absolute consensus in the literature.Since Alvarado described his eponymous clinical scoring system in 1986 to stratify AA risk,there has been a burgeoning of additional scores for guiding downstream management and mortality assessment.Furthermore,advancing literature on the role of antibiotics,variations in appendicectomy,and its adjuncts have expanded the surgeon’s repertoire of management options.Owing to the varied presentation,diagnostic tools,and management of AA have also been proposed in special groups such as pregnant patients,the elderly,and the immunocompromised.This article seeks to raise the critical debates about what is currently known about the above aspects of AA and explore the latest controversies in the field.Considering the ever-evolving coronavirus disease 2019 situation worldwide,we also discuss the pandemic’s repercussions on patients and how surgeons’practices have evolved in the context of AA.

Cyanidin 3-glucoside modulated cell cycle progression in liver precancerous lesion,in vivo study

BACKGROUND Cyanidin-3-O-glucoside(cyan)exhibits antioxidant and anticancer properties.The cell cycle proteins and antimitotic drugs might be promising therapeutic targets in hepatocellular carcinoma.AIM To investigate the effect of cyan administration on cell cycle in hepatic precancerous lesion(PCL)induced by diethylnitrosamine/2-acetylaminofluorene(DEN/2-AAF)in Wistar rats.METHODS In vivo,DEN/2-AAF-induced hepatic PCL,rats were treated with three doses of cyan(10,15,and 20 mg/kg/d,for four consecutive days per week for 16 wk).Blood and liver tissue samples were collected for measurement of the followings;alpha fetoprotein(AFP)liver function and RNA panel differential expression was evaluated via real time polymerase chain reaction.Histopathological examination of liver sections stained with H&E and immunohistochemical study using glutathione S-transferase placental(GSTP)and proliferating cell nuclear antigen(PCNA)antibodies were assessed.RESULTS Cyan administration mitigated the effect of DEN/2-AFF induced PCL,decreased AFP levels,and improved liver function.Remarkably,treatment with cyan dose dependently decreased the long non-coding RNA MALAT1 and tubulin gamma 1 mRNA expressions and increased the levels of miR-125b,all of which are involved in cell cycle and mitotic spindle assembly.Of note,cyan decreased GSTP foci percent area and PCNA positively stained nuclei.CONCLUSION Our results indicated that cyan could be used as a potential therapeutic agent to inhibit liver carcinogenesis in rat model via modulation of cell cycle.