Risk factors for colonic diverticular bleeding:A Westernized community based hospital study

AIM： To evaluate the risk factors-other than nonsteroidal anti-inflammatory drugs-for colonic diverticular bleeding in a westernized population. METHODS： One hundred and forty patients, treated for symptomatic diverticular disease in a community based hospital, were included. Thirty （21%） had signs of diverticular bleeding. Age, gender, and the results of colonoscopy were collected and compared to a group of patients with nonbleeding symptomatic diverticulosis. Records were reviewed for comorbidities, such as obesity, alcohol consumption, smoking habits and metabolic diseases. Special emphasis was put on arterial hypertension, cardiovascular events, diabetes mellitus, hyperuricemia and hypercholesterinemia. RESULTS： There was no difference between patients with diverticular hemorrhage and those with nonbleeding symptomatic diverticulosis regarding gender ratio （male/female 9/21 vs 47/63） and diverticular Iocalisation. Bleeding patients differed in respect to age （73.4± 9.9 vs 67. 8± 13.0, P 〈 0.013）. Significant differences were found between both groups regarding the presence of hyperuricemia and use of steroids and nonsteroidal anti-inflammatory drugs. Patients with three concomitant metabolic diseases were also identified as being at risk of bleeding. A forward stepwise logistic regression analysis revealed steroids, hyperuricemia and the use of calcium-channel blockers as independent risk factors of bleeding.CONCLUSION： Beside nonsteroidal anti-inflammatory steroid drug use, antihypertensive medication and concomitant arteriosclerotic diseases are risk factors for colonic diverticular hemorrhage. Our results support the hypothesis of an altered arteriosclerotic vessel as the source of bleeding.

Necrosis zone depth after bipolar plasma vaporization and resection in the human prostate

Objectives:To compare the depth of thermal necrosis after use of bipolar resection and vaporization technique comparing intra-individually bipolar loop and bipolar button electrodes.Methods:Transurethral resection and vaporization of the prostate was performed in 55 male patients(260 specimens in total).In a standardized procedure,a bipolar resection loop was used for resection,and a bipolar button electrode was used for vaporization.Both electrodes were applied in each patient,either in the left or in the right lateral lobe.The depth of necrotic zones in the resected or vaporized tissue of each patient was measured in a standardized way by light microscopy.Results:The mean depth with standard deviation of thermal injury caused by the loop electrode was 0.0495±0.0274 mm.The vaporization electrode caused a mean thermal depth with standard deviation of 0.0477±0.0276 mm.The mean difference of necrosis zone depths between the two types of electrodes(PlasmaButtoneresection loop)was 0.0018 mm(p=0.691).Conclusion:For the first time,we present directly measured values of the absolute necrosis zone depth after application of plasma in the transurethral treatment of benign prostatic hyperplasia.The measured values were lower than in all other transurethral procedures.Standardized procedures of measurement and evaluation allow a statistically significant statement that the low necrosis depth in bipolar procedures is independent of the applied electrodes.

Supporting smoking cessation in healthcare: obstacles in scientific understanding and tobacco addiction management

Despite ongoing efforts to reduce tobacco smoking, the smoking prevalence in many countries has remained stable for years. This may be a consequence of either lack of knowledge about effective ways to reduce smoking, or failing treatment of tobacco addiction in healthcare. This study explored gaps in the current understanding of smoking cessation and the challenges facing tobacco addiction management in order to formulate recommendations for future research and healthcare practice. A narrative review was written to determine areas in which more research is needed as well as areas in which sufficient knowledge is already available. Recommendations for future research were prioritised using a Delphi-procedure. Recommendations for healthcare practice were confirmed by expert’s assessment. Smoking is not widely acknowledged as an addiction and a relatively small number of smokers ask help from a healthcare professional when trying to stop smoking. Most healthcare professionals recognise the importance of advising patients to stop smoking, but experience certain barriers to actually do this. Overall, healthcare professionals need to be convinced that tobacco smoking is an addiction and should be treated likewise. If all healthcare professionals systematically advise their patients to give up smoking, eventually more smokers will successfully stop smoking.

Alternative Exposure Parameters and Post Process Noise Reduction Expect Considerable Dose Reduction in Single Mammography Views—Initial Experience on Mastectomy Specimens

Objective: To experimentally indicate a lower limit of dose in mammographic imaging yielding adequate image quality for complementary diagnostic views, by evaluation of image series with different exposure parameters and additional image processing on mastectomy specimens with diverse pathology. Methods: Image series were obtained on seven specimens with different target-filter combinations at different exposure values. Three experienced radiologists assessed the lowest acceptable dose level per specimen using a relative grading technique. With the standard image as reference, fibroglandular tissue and pathological structures, including microcalcifications, were evaluated. Subsequently, a series of pixel binning processes was tested and subjectively assessed on the selected images. Results: The lowest dose level at which image quality was acceptable, and achieved with a W/Ag target-filter combination at 32 kV and 4 mAs. These images can be acquired with 10.4% to 22.4% of the average glandular dose in standard images. Post process pixel binning added to the interpretability of such low dose images. Conclusion: This specimen study suggests that dose level of mammography images might be reduced substantially by general application of a W/Ag spectrum, particularly when combined with post process noise reduction. Future studies should focus on the feasibility of this technique in clinical mammography.

Serum levels of soluble Fas, nitric oxide and cytokines in acute decompensated cirrhotic patients

AIM： To evaluate plasma levels of nitrite/nitrate （NOx）, soluble Pas （spas） antigen, tumor necrosis factor alpha （TNF-α） and interleukin-6 （IL-6） in patients with compensated and acute decompensated cirrhosis and to evaluate mediators causing acute decompensation in liver cirrhosis, METHODS： This prospective study was conducted in the medical intensive care unit of an academic tertiary center, Fifty-five patients with acute decompensation （gastrointestinal hemorrhage, encephalopathy, hydropic decompensation） and twenty-five patients with compensated liver drrhosis were included, Blood samples were taken for analyses of spas, Nox, IL-6, TNF-α, Liver enzymes and kidney functions were also tested, RESULTS： In patients with acute decompensation, plasma spas levels were higher than in non-decompensated patients （15305 ± 4646 vs 12458± 4322 pg/mL, P 〈 0.05）. This was also true for the subgroup of patients with alcoholic liver cirrhosis （P 〈 0.05）. The other mediators were not different and none of the parameters predicted survival, except for ALT （alanine-aminotransferase）. In patients with portal-hypertension-induced acute hemorrhage, NOx levels were significantly lower than in patients with other forms of decompensation （70.8 ± 48.3 vs 112.9 ± 74.9 pg/mL, P 〈 0.05）. When NOx levels were normalized to creatinine levels, the difference disappeared. IL-6, TNF-α and spas were not different between bleeders and non-bleeders. In decompensated patients spas, IL-6 and NOx levels correlated positively with creatinine levels, while IL-6 levels were dependent on Child class. CONCLUSION： In acute decompensated cirrhotic patients sPas is increased, suggesting a role of apoptosis in this process and patients with acute bleeding have lower NOx levels, However, in this acute complex clinical situation, kidney function seems to have a predominant influence on mediator levels,

Computer-aided clinical image analysis as a predictor of sentinel lymph node positivity in cutaneous melanoma

BACKGROUND Delays in sentinel lymph node(SLN)biopsy may affect the positivity of non-SLNs.For these reasons,effort is being directed at obtaining reliable information regarding SLN positivity prior to surgical excision.However,the existing tools,e.g.,dermoscopy,do not recognize statistically significant predictive criteria for SLN positivity in melanomas.AIM To investigate the possible association of computer-assisted objectively obtained color,color texture,sharpness and geometry variables with SLN positivity.METHODS We retrospectively reviewed and analyzed the computerized medical records of all patients diagnosed with cutaneous melanoma in a tertiary hospital in Germany during a 3-year period.The study included patients with histologically confirmed melanomas with Breslow>0.75 mm who underwent lesion excision and SLN biopsy during the study period and who had clinical images shot with a digital camera and a handheld ruler aligned beside the lesion.RESULTS Ninety-nine patients with an equal number of lesions met the inclusion criteria and were included in the analysis.Overall mean(±standard deviation)age was 66(15)years.The study group consisted of 20 patients with tumor-positive SLN(SLN+)biopsy,who were compared to 79 patients with tumor-negative SLN biopsy specimen(control group).The two groups differed significantly in terms of age(61 years vs 68 years)and histological subtype,with the SLN+patients being younger and presenting more often with nodular or secondary nodular tumors(P<0.05).The study group patients showed significantly higher eccentricity(i.e.distance between color and geometrical midpoint)as well as higher sharpness(i.e.these lesions were more discrete from the surrounding normal skin,P<0.05).Regarding color variables,SLN+patients demonstrated higher range in all four color intensities(gray,red,green,blue)and significantly higher skewness in three color intensities(gray,red,blue),P<0.05.Color texture variables,i.e.lacunarity,were comparable in both groups.CONCLUSION SLN+patients demonstrated significantly higher eccentricity,higher sharpness,higher range in all four color intensities(gray,red,green,blue)and significantly higher skewness in three color intensities(gray,red,blue).Further prospective studies are needed to better understand the effectiveness of clinical image processing in SLN+melanoma patients.

肘部尺神经病的临床、电生理诊断及超声研究

The aim of this study was to determine possible correlations between the clinical characteristics, electrophysiological features, and sonographic ulnar nerve diameter in patients with ulnar neuropathy at the elbow (UNE). We prospectively performed clinical, electrodiagnostic, and sonographic studies in 102 patients having either purely sensory signs (35% ) or sensorimotor signs (65% ) of UNE. Nerve conduction studies had a sensitivity of 78% , and the addition of sonography increased this to 98% . The diagnostic value of both tests was not different among cases with and without motor deficit. Motor studies with recording from the abductor digiti minimi and first dorsal interosseousmuscles were equally sensitive for the detection of conduction block or velocity slowing across the elbow, but the combination yielded more positive cases than when only one study was performed. There were modest negative correlations between the electrodiagnostic parameters and the sonographic ulnar nerve diameter. Electrodiagnostically and sonographically, there were no significant differences between clinically pure sensory and mixed sensorimotor cases of UNE, except for electrodiagnostic findings suggesting loss of motor axons in cases with motor signs. Almost half the patients with only sensory signs had electromyographic evidence of motor axonal loss. We conclude that, although UNE is clinically heterogeneous, the electrophysiological and sonographic findings are fairly consistent despite the clinical manifestations.

More bricks in the wall against SARS-CoV-2 infection:involvement of γ9δ2 T cells

The SARS-CoV-2 virus which emerged in late December 2019 had reached pandemic proportions by March 2020.1 Host defence mechanisms against this new member of the corona virus family will include innate immunity,humoral,and cellular immune responses,of yet unknown relative importance.Conventional CD8^(+) αβTCR cytotoxic T cells and natural killer cells are mainly responsible for detection and elimination of virus infected cells,with a special role for the CD94/NK group 2 member A(NKG2A)receptor as reported by Zheng et al.in this journal.2,3 We want to report yet another brick in the wall against SARS-CoV-2 infection,made of a subset of γδTCR T cells.