Angiomatosis in the Head and Neck—3 Case Reports

Angiomatosis is a diffuse vascular lesion which involves a large segment of the body in a contiguous fashion involving multiple tissues (e.g. subcutis, muscle, bone, adipose tissue etc.) in different planes. Such lesions usually present in the first two decades of life with female predilection and are commonly seen in lower extremities. It clinically mimics hemangioma or vascular malformation and its surgical removal is difficult because of its infiltrative nature and thus has high recurrence rate (90%). Therefore a precise histopathological diagnosis of angiomatosis is important to achieve a curative resection. Histopathologically it consists of proliferating blood vessels of varying caliber, infiltrating into the soft tissues. Proliferating capillaries are seen within or adjacent to major vessels. Few cases are reported in head and neck region. This article highlights three unusual cases of angiomatosis reported as benign lesions, in rare sites such as the malar region (predominantly infiltrating the adipose tissue), within the masseter (predominantly infiltrating the muscle) and in the mandible (infiltrating the bone). Histopathological differential diagnosis is also discussed

Morphological docking of secretory vesicles

Calcium-dependent secretion of neurotransmitters and hormones is essential for brain function and neuroendocrine-signaling. Prior to exocytosis, neurotransmitter-containing vesicles dock to the target membrane. In electron micrographs of neurons and neuroendocrine cells, like chromaffin cells many synaptic vesicles (SVs) and large dense-core vesicles (LDCVs) are docked. For many years the molecular identity of the morphologically docked state was unknown. Recently, we resolved the minimal docking machinery in adrenal medullary chromaffin cells using embryonic mouse model systems together with electron-microscopic analyses and also found that docking is controlled by the sub-membrane filamentous (F-)actin. Currently it is unclear if the same docking machinery operates in synapses. Here, I will review our docking assay that led to the identification of the LDCV docking machinery in chromaffin cells and also discuss whether identical docking proteins are required for SV docking in synapses

Ebola: translational science considerations

We are currently in the midst of the most aggressive and fulminating outbreak of Ebola-related disease, commonly referred to as “Ebola”, ever recorded. In less than a year, the Ebola virus (EBOV, Zaire ebolavirus species) has infected over 10,000 people, indiscriminately of gender or age, with a fatality rate of about 50%. Whereas at its onset this Ebola outbreak was limited to three countries in West Africa (Guinea, where it was first reported in late March 2014, Liberia, where it has been most rampant in its capital city, Monrovia and other metropolitan cities, and Sierra Leone), cases were later reported in Nigeria, Mali and Senegal, as well as in Western Europe (i.e., Madrid, Spain) and the US (i.e., Dallas, Texas; New York City) by late October 2014. World and US health agencies declared that the current Ebola virus disease (EVD) outbreak has a strong likelihood of growing exponentially across the world before an effective vaccine, treatment or cure can be developed, tested, validated and distributed widely. In the meantime, the spread of the disease may rapidly evolve from an epidemics to a full-blown pandemic. The scientific and healthcare communities actively research and define an emerging kaleidoscope of knowledge about critical translational research parameters, including the virology of EBOV, the molecular biomarkers of the pathological manifestations of EVD, putative central nervous system involvement in EVD, and the cellular immune surveillance to EBOV, patient-centered anthropological and societal parameters of EVD, as well as translational effectiveness about novel putative patient-targeted vaccine and pharmaceutical interventions, which hold strong promise, if not hope, to curb this and future Ebola outbreaks. This work reviews and discusses the principal known facts about EBOV and EVD, and certain among the most interesting ongoing or future avenues of research in the field, including vaccination programs for the wild animal vectors of the virus and the disease from global translational science perspective

Evaluation of appendicitis risk prediction models in adults with suspected appendicitis

Background Appendicitis is the most common general surgical emergency worldwide, but its diagnosis remains challenging. The aim of this study was to determine whether existing risk prediction models can reliably identify patients presenting to hospital in the UK with acute right iliac fossa (RIF) pain who are at low risk of appendicitis. Methods A systematic search was completed to identify all existing appendicitis risk prediction models. Models were validated using UK data from an international prospective cohort study that captured consecutive patients aged 16–45 years presenting to hospital with acute RIF in March to June 2017. The main outcome was best achievable model specificity (proportion of patients who did not have appendicitis correctly classified as low risk) whilst maintaining a failure rate below 5 per cent (proportion of patients identified as low risk who actually had appendicitis). Results Some 5345 patients across 154 UK hospitals were identified, of which two‐thirds (3613 of 5345, 67·6 per cent) were women. Women were more than twice as likely to undergo surgery with removal of a histologically normal appendix (272 of 964, 28·2 per cent) than men (120 of 993, 12·1 per cent) (relative risk 2·33, 95 per cent c.i. 1·92 to 2·84; P < 0·001). Of 15 validated risk prediction models, the Adult Appendicitis Score performed best (cut‐off score 8 or less, specificity 63·1 per cent, failure rate 3·7 per cent). The Appendicitis Inflammatory Response Score performed best for men (cut‐off score 2 or less, specificity 24·7 per cent, failure rate 2·4 per cent). Conclusion Women in the UK had a disproportionate risk of admission without surgical intervention and had high rates of normal appendicectomy. Risk prediction models to support shared decision‐making by identifying adults in the UK at low risk of appendicitis were identified

Minimally invasive plate osteosynthesis for humerus diaphyseal fractures

Background: Minimally invasive plate osteosynthesis (MIPO) technique is reported as a satisfactory procedure for the treatment of humeral shaft fractures by the anterior approach by several authors. However, none of the published reports had a significant follow-up nor have they reported patient outcomes. We evaluated the clinical, radiographic, and functional outcome over a minimum follow-up of 2 years using the same MIPO technique to humeral shaft fracture. Materials and Methods: 32 adult patients with diaphyseal fractures of the humerus treated with MIPO between June 2007 and October 2008 were included in the study. Patients with metabolic bone disease, polytrauma, and Gustilo and Anderson type 3 open fractures with injury severity score >16 were excluded from the study. All cases were treated with closed indirect reduction and locking plate fixation using the MIPO technique. The surgery time, radiation exposure, and time for union was noted. The shoulder and elbow function was assessed using the UCLA shoulder and Mayo elbow performance scores, respectively. Results: Of the 32 patients in the study, 19 were males and 13 were females. The mean age was 39 years (range: 22-70 years). Twenty-seven of the thirty-two patients (84.3%) had the dominant side fractured. We had eight cases of C2 type; five cases of C1 and A2 type; four cases of B2 type; three cases each of B3, B1, and A1 type; and one case of A3 type of fracture. The mean surgical time was 91.5 minutes (range: 70-120 minutes) and mean radiation exposure was 160.3 seconds (range: 100-220 seconds). The mean radiological fracture union time was 12.9 weeks (range: 10-20 weeks). Shoulder function was excellent in 27 cases (84.3%) and good in remaining 5 cases (15.6%) on the UCLA score. Elbow function was excellent in 26 cases (81.2%), good in 5 cases (15.6%), and fair in 1 case (3.1%) who had an associated olecranon fracture that was fixed by tension band wire in the same sitting. Conclusion: MIPO of the humerus gives good functional and cosmetic results and should be considered one of the management options in the treatment of humeral diaphyseal fractures

Kisspeptin neurones in the posterodorsal medial amygdala modulate sexual partner preference and anxiety in male mice.

The posterodorsal medial amygdala (MePD) is a neural site in the limbic brain involved in regulating emotional and sexual behaviours. There is however limited information on the specific neuronal cell type in the MePD functionally mediating these behaviours in rodents. The recent discovery of a significant kisspeptin neurone population in the MePD has raised interest in the possible role of kisspeptin and its cognate receptor in sexual behaviour. This study therefore tested the hypothesis that the MePD kisspeptin neurone population is involved in regulating attraction towards opposite sex conspecifics, sexual behaviour, social interaction and anxiety response by selectively stimulating these neurones using the novel pharmacosynthetic DREADDs (designer receptors exclusively activated by designer drugs) technique. Adult male Kiss-Cre mice received bilateral stereotaxic injections of a stimulatory DREADD viral construct (AAV-hSyn-DIO-hM3D(Gq)-mCherry) targeted to the MePD which were activated by intraperitoneal (i.p.) injection of clozapine-N-oxide (CNO). Socio-sexual behaviours were assessed in a counter-balanced fashion after i.p. injection of either saline or CNO (5mg/kg). Selective activation of MePD kisspeptin neurones by CNO significantly increased the time spent by male mice in investigating an oestrous female as well as duration of social interaction. Additionally, after CNO injection the mice appeared less anxious; evidenced by longer exploratory time in the open arms of the elevated plus maze. However, levels of copulatory behaviour were comparable between CNO and saline treated controls. These data indicate that DREADD-induced activation of MePD kisspeptin neurones enhances sexual partner preference in males and social interaction and decreases anxiety, suggesting a key role played by MePD kisspeptin in sexual motivation and social behaviour. This article is protected by copyright. All rights reserved.This work was supported by the Medical Research Council, UK. DAA is a Commonwealth Scholar funded by the UK Government