B Cells Participate in Thymic Negative Selection of Murine Auto-reactive CD4+ T Cells

It is well documented that thymic epithelial cells participate in the process of negative selection in the thymus. In recent years it was reported that also dendritic cells enter the thymus and contribute to this process, thus allowing for the depletion of thymocytes that are specific to peripherally expressed self-antigens. Here we report that also B cells may take part in the elimination of auto-reactive thymocytes. Using a unique mouse model we show that B cells induce negative selection of self-reactive thymocytes in a process that leads to the deletion of these cells whereas regulatory T cells are spared. These findings have direct implication in autoimmunity, as expression of a myelin antigen by B cells in the thymus renders the mice resistant to autoimmune inflammation of the CNS

Infected pancreatic necrosis: outcomes and clinical predictors of mortality. A post hoc analysis of the MANCTRA-1 international study

: The identification of high-risk patients in the early stages of infected pancreatic necrosis (IPN) is critical, because it could help the clinicians to adopt more effective management strategies. We conducted a post hoc analysis of the MANCTRA-1 international study to assess the association between clinical risk factors and mortality among adult patients with IPN. Univariable and multivariable logistic regression models were used to identify prognostic factors of mortality. We identified 247 consecutive patients with IPN hospitalised between January 2019 and December 2020. History of uncontrolled arterial hypertension (p = 0.032; 95% CI 1.135-15.882; aOR 4.245), qSOFA (p = 0.005; 95% CI 1.359-5.879; aOR 2.828), renal failure (p = 0.022; 95% CI 1.138-5.442; aOR 2.489), and haemodynamic failure (p = 0.018; 95% CI 1.184-5.978; aOR 2.661), were identified as independent predictors of mortality in IPN patients. Cholangitis (p = 0.003; 95% CI 1.598-9.930; aOR 3.983), abdominal compartment syndrome (p = 0.032; 95% CI 1.090-6.967; aOR 2.735), and gastrointestinal/intra-abdominal bleeding (p = 0.009; 95% CI 1.286-5.712; aOR 2.710) were independently associated with the risk of mortality. Upfront open surgical necrosectomy was strongly associated with the risk of mortality (p < 0.001; 95% CI 1.912-7.442; aOR 3.772), whereas endoscopic drainage of pancreatic necrosis (p = 0.018; 95% CI 0.138-0.834; aOR 0.339) and enteral nutrition (p = 0.003; 95% CI 0.143-0.716; aOR 0.320) were found as protective factors. Organ failure, acute cholangitis, and upfront open surgical necrosectomy were the most significant predictors of mortality. Our study confirmed that, even in a subgroup of particularly ill patients such as those with IPN, upfront open surgery should be avoided as much as possible. Study protocol registered in ClinicalTrials.Gov (I.D. Number NCT04747990)

Neurological disorders in liver transplantation = Neurológiai kórképek májátültetett betegekben

Liver transplantation is the only curative treatment in patients with end-stage liver failure. It has been associated with neurological disorders more frequently than other solid organ transplantations. We aimed to detect neurological disorders in liver transplantation patients and determine those that affect mortality. One hundred eighty-five patients, 105 with and 80 without neurological disorders, were included in this study. The follow-up was categorized into three periods: preoperative, early postoperative and late postoperative. We analyzed all medical records, including demographic, laboratory, radiological, and clinical data. Neurological disorders were observed in 52 (28.1%) patients in the preoperative period, in 45 (24.3%) in the early postoperative, and in 42 (22.7%) in the late postoperative period. Hepatic encephalopathy in the preoperative and altered mental state in the post­operative period were the most common neurological disorders. Both hepatic encephalopathy (37.5%) and altered mental state (57.7%) caused high mortality (p=0.019 and 0.001) and were determined as indepen­dent risk factors for mortality. Living donor transplantation caused less frequent mental deterioration (p=0.049). The mortality rate (53.8%) was high in patients with seizures (p=0.019). While mortality was 28.6% in Wilson’s disease patients with neurological disorders, no death was observed in patients without neurological disorders. We identified a wide variety of neurological disorders in liver transplantation patients. We also demonstrated that serious neurological disorders, including hepatic encephalopathy and seizures, are associated with high morbidity and mortality. Therefore, in order to avoid poor outcomes, hepatic encephalopathy should be considered as a prioritization criterion for liver transplantation

Endoscopic Treatment of the Zenker Diverticulum With Flexible Endoscopic Myotomy: A Single Tertiary Center Experience

Introduction:The Zenker diverticulum (ZD) is the most common type of esophageal diverticula. Management of ZD has different options; however, there is a recent increase in treatment with flexible endoscopic myotomy (FEM). In our study, we aimed to investigate the efficacy and safety of FEM among patients with ZD.Materials and Methods:The data of patients who underwent FEM for ZD in our clinic between January 2008 and May 2016 were retrospectively analyzed. Myotomy was performed with a needle-knife sphincterotome by using pulse-cut or forced coagulation electrocautery mode. Myotomy was performed on the common wall of the diverticulum up to 0.5 to 1cm of the distal end. A handmade diverticuloscope, which was modified from an overtube, was used in most of the patients to focus more carefully on the septum. Dysphagia scores of the patients before and after the procedure were compared and complications were evaluated.Results:A total of 17 patients were enrolled in the study. The mean age was 65.3 years, and mean diverticular diameter was 3.2cm. The most common symptoms were dysphagia and regurgitation. The mean in-hospital stay was 5 days. The dysphagia score was significantly decreased after FEM among the patients (0.170.39 vs. 2 +/- 0.79; P=0.0001). Complications were observed in 3 patients (17.6%); however, there was no procedure-related mortality.Discussion:FEM is an efficient and safe procedure as a treatment modality for ZD. However, lack of a standard algorithm is a remarkable disadvantage

Covid-19 in Liver Transplant Recipients: A National Cohort

[No Abstract Available

Traumatic lung pathologies confused with COVID-19

While the COVID-19 pandemic affected the whole world, lung radiologic imaging has become widely used for diagnosis. Ground glass opacity is the most detected radiologic findings in pulmonary tomography. However, in the first 6-8 hours of CT scans of patients admitted to the hospital with injuries affecting the chest cavity, single or multiple patchy and/or diffuse ground-glass parenchymal infiltrates can be seen usually. Due to these appearances, it is necessary to eliminate COVID-19 in cases with a lung contusion. This study aims to evaluate the clinical and laboratory characteristics of patients who presented with pulmonary trauma and were suspected of COVID-19 due to lung images. Between the March 2020 and December 2020 pandemic period, patients who applied to our hospital in emergency services due to trauma and who were discharged or hospitalized in COVID services or followed in intensive care units because COVID-19 could not be excluded due to lung tomography findings were included in the study. It was evaluated retrospectively with laboratory tests and thoracic CTs in patients over 18 years old. Fourteen cases were included in the study, seven of them were males (50%), with a mean age of 45 (19-74). The COVID-19 PCR result was negative for all patients except one patient (case 11) with lymphopenia. Peripherally located ground-glass opacity (GGO) (92.9%), subpleural line (85.7%), air bronchogram (64.3%), pleural thickening (64.3%), atelectasis (% 64.3), consolidation (50%), ground glass mixed consolidation (42.9%) was detected in chest CT cases. Eleven cases (78.6%) were hospitalized to the COVID service or intensive care unit. Thoracic CT images of patients with lung trauma may be confused with COVID-19. It is appropriate to evaluate the cases together with epidemiological data, clinical and laboratory findings. Lymphopenia may help physicians to consider the diagnosis of COVID-19 in trauma patients. [Med-Science 2022; 11(2.000): 712-6

Distinguishing Between Migraine and Cervicogenic Headache: Key Factors for Differential Diagnosis

International Headache Congress (IHC