Peripheral stent technology and current status for endovascular treatment of femoropopliteal artery disease: a clinical review

Over the past decade, the treatment of peripheral artery disease poses a number of technical challenges for the physician. The primary rationale of this article is to review the available literature on the current practices involved in the treatment of peripheral artery disease (PAD), particularly the femoropopliteal lesions. It is evident from the landmark clinical trials that the use of self-expanding drug-eluting stents (DES) has become the most favored clinical strategy for treating peripheral lesions above the knee. It is chiefly due to higher patency rates, and minimal in-stent restenosis and stent fracture rates associated with the use of DES. The technical evolution in the endovascular approach from the use of bare nitinol stents to DES for treating PAD and the factors responsible for this transformation have also been reviewed with their respective justification. Presently there is a need of DES technology for the treatment of femoropopliteal lesions, which can reduce the risk of stent fracture and in-stent restenosis for longer lesions while maintaining patency during long-term follow-up. To conclude, this review establishes that self-expanding DES and drug coated balloons using anti-proliferative drugs like sirolimus and paclitaxel are currently the most effective method of treating the femoropopliteal lesions in PAD

Impressive journey of TAVI so far, but miles to go

Valve replacement is mandatory for AS patients owing to its progressive nature leading to continuous valve degeneration. However, surgical replacement cannot be opted for majority of patients due to old age and affiliated co-morbidities. Over the recent years, AS treatment in high-risk patient population favors a newer, less-invasive method of transcatheter aortic valve implantation (TAVI). The main objective of this review is to revisit all the relevant aspects of TAVI to treat AS in high-risk patients and to assess its possibility as a first-line treatment approach even for low-risk AS patients. We searched PubMed, Google Scholar, Medline and ClinicalTrials.gov to identify all the relevant randomized controlled trials (RCTs) assessing the outcomes of TAVI vs. surgical mode of valve replacement. This method is found to be very safe and reproducible in many landmark clinical trials involving high-risk patients, demonstrating superior or, at least, comparable outcomes vs. surgical mode of treatment. This led to a trend of testing TAVI in lower-risk patient population as well to expand its treatment indication profile

Two patients with an anti-N-methyl-D-aspartate receptor antibody syndrome-like presentation and negative results of testing for autoantibodies. Pediatr Neurol

abstract We describe two boys whose distinct and remarkable clinical pictures suggested the possibility of anti-Nmethyl-D-aspartate receptor antibody encephalitis. Both patients responded to immunotherapy, but neither manifested that antibody. Patient 1 exhibited florid encephalopathy with psychotic manifestations including inappropriate affect, intermittent delirium, visual hallucinations, severe anorexia, agitation, paranoid ideation, and abnormal electroencephalogram results. He responded to intravenous immunoglobulin, with steady improvement over 3 months to almost complete remission for 1 year, followed by a relapse that again responded, more quickly, to intravenous immunoglobulin. A second relapse occurred 1 month later, and again responded to intravenous immunoglobulin. Patient 2 exhibited progressive, severely debilitating limb dystonia that worsened over 1.5 years, with milder psychiatric symptoms including mood instability, aggressiveness, impulsivity, and depression. When he developed thymic hyperplasia 1.5 years into his illness, he underwent a thymectomy, and improved significantly on a regimen of plasmapheresis and intravenous immunoglobulin. Patients presenting with symptoms suggestive of autoimmune encephalitis, but without antibodies, may still respond to immunotherapy

Impressive journey of TAVI so far, but miles to go

Valve replacement is mandatory for AS patients owing to its progressive nature leading to continuous valve degeneration. However, surgical replacement cannot be opted for majority of patients due to old age and affiliated co-morbidities. Over the recent years, AS treatment in high-risk patient population favors a newer, less-invasive method of transcatheter aortic valve implantation (TAVI). The main objective of this review is to revisit all the relevant aspects of TAVI to treat AS in high-risk patients and to assess its possibility as a first-line treatment approach even for low-risk AS patients. We searched PubMed, Google Scholar, Medline and ClinicalTrials.gov to identify all the relevant randomized controlled trials (RCTs) assessing the outcomes of TAVI vs. surgical mode of valve replacement. This method is found to be very safe and reproducible in many landmark clinical trials involving high-risk patients, demonstrating superior or, at least, comparable outcomes vs. surgical mode of treatment. This led to a trend of testing TAVI in lower-risk patient population as well to expand its treatment indication profile

Peripheral stent technology and current status for endovascular treatment of femoropopliteal artery disease: a clinical review

Over the past decade, the treatment of peripheral artery disease poses a number of technical challenges for the physician. The primary rationale of this article is to review the available literature on the current practices involved in the treatment of peripheral artery disease (PAD), particularly the femoropopliteal lesions. It is evident from the landmark clinical trials that the use of self-expanding drug-eluting stents (DES) has become the most favored clinical strategy for treating peripheral lesions above the knee. It is chiefly due to higher patency rates, and minimal in-stent restenosis and stent fracture rates associated with the use of DES. The technical evolution in the endovascular approach from the use of bare nitinol stents to DES for treating PAD and the factors responsible for this transformation have also been reviewed with their respective justification. Presently there is a need of DES technology for the treatment of femoropopliteal lesions, which can reduce the risk of stent fracture and in-stent restenosis for longer lesions while maintaining patency during long-term follow-up. To conclude, this review establishes that self-expanding DES and drug coated balloons using anti-proliferative drugs like sirolimus and paclitaxel are currently the most effective method of treating the femoropopliteal lesions in PAD

Contact Lens Induced Corneal Ulcer Management in a Tertiary Eye Unit in Oman - A descriptive study

Objectives: The corneal disease is a priority problem in Oman. We present patients with contact lens (CL) induced severe keratitis, admitted in the corneal unit of Al Nahdha Hospital in Oman. Methods: The study was conducted in 2005-2006. Ophthalmologists examined the eyes using slit lamp bio-microscope. Visual acuity was noted using Snellen’s distance vision chart. Specimens of corneal scraping and CLs were sent for culture and sensitivity tests. Patients with severe keratitis were admitted and treated with medicines. Corneal and visual statuses were noted at the time of discharge from hospital and after six weeks. Numbers, percentages and their 95% confidence intervals were calculated. Pre- and post-treatment vision were compared using a scattergram. Results: The 52 eyes of 15 males and 37 female patients with corneal ulcers were examined. Thirty-two patients were between 20 to 30 years of age. Only 13 (25%) patients had visited an ophthalmologist within 24 hours of developing severe keratitis. Seventeen (33%) had central ulcers and six (11.5%) had ulcer ≥5 mm in size. Pseudomonas was found in 29 (55.8%) of CL and corneal material scraped from the eyes of 15 (28.8%) patients. Vision was <6/60 (legally blind) in 12 (23.1%) eyes before and in five (9.6%) eyes after treatment. Twenty-six (50%) patients were lost to follow up. Conclusion: CL related severe keratitis causes visual disabilities. Prevention and proper records are essential. Treatment improves vision and hence facilities for management should be strengthened

Conjunctival keratoacanthoma

An 83-year-old man presented with a 1-month history of a rapidly enlarging conjunctival mass. On examination, slit lamp biomicroscopy revealed a leukoplakic tumour at the temporal limbus. The lesion was excised with cryotherapy application to the limbus and conjunctival margins. Histopathology revealed a keratoacanthoma (KA). KA typically occurs on sun-exposed areas of the skin. Conjunctival KA is very rare, and differentiation between conventional squamous cell carcinoma (SCCA) and KA can be challenging. The present case highlights the indication for excisional surgery in patients with conjunctival KA using the no touch technique, cryotherapy, amniotic membrane and the histopathological differentiation between KA and SCCA

Type 2 innate lymphoid cells from Id1 transgenic mice alleviate skin manifestations of graft-versus-host disease

Abstract Background Acute graft-versus-host disease (aGVHD) is one of the most common causes of morbidity for patients undergoing allogeneic stem cell transplantation. There is preliminary evidence that activated Group 2 innate lymphoid cells (ILC2s) from wild type (WT) mice reduces the lethality of aGVHD and is effective in treating lower gastrointestinal (GI) tract manifestations of aGVHD. This raises the prospect that ILC2s may be used for cell-based therapy of aGVHD but vigorous investigation is necessary to assess their impacts on different aspects of aGVHD. Genetically engineered mice which either express Id1 protein (Id1tg/tg), an inhibitor of E protein transcription factors or have E protein genes knocked out (dKO) in the thymus produce massive numbers of ILC2s, thus allowing extensive evaluation of ILC2s. We investigated whether these ILC2s have protective effects in aGVHD as WT ILC2s do using an established mouse model of aGVHD. Results bone marrow transplant was performed by irradiating BALB/c strain of recipient mice and transplanting with bone marrow and T cells from the MHC-disparate C57BL/6 strain. We isolated ILC2s from Id1tg/tg and dKO mice and co-transplanted them to study their effects. Our results confirm that activated ILC2s have a protective role in aGVHD, but the effects varied depending on the origin of ILC2s. Co-transplantation of ILC2s from Id1tg/tg mice were beneficial in aGVHD and are especially helpful in ameliorating the skin manifestations of aGVHD. However, ILC2s from dKO mice were less effective at the protection and behaved differently depending on if the cells were isolated from dKO mice were pre-treated with IL-25 in vivo. Conclusion These findings support the notion that thymus-derived ILC2s from Id1tg/tg mice are protective against aGVHD, with a significant improvement of skin lesions and they behave differently from dKO mice in the setting of aGVHD

A novel homozygous VPS45 p.P468L mutation leading to severe congenital neutropenia with myelofibrosis

VPS45-associated severe congenital neutropenia (SCN) is a rare disorder characterized by life-threating infections, neutropenia, neutrophil and platelet dysfunction, poor response to filgrastim, and myelofibrosis with extramedullary hematopoiesis. We present a patient with SCN due to a homozygous c.1403C\u3eT (p.P468L) mutation in VPS45, critical regulator of SNARE-dependent membrane fusion. Structural modeling indicates that P468, like the T224 and E238 residues affected by previously reported mutations, cluster in a VPS45 hinge region, indicating its critical role in membrane fusion and VPS45-associated SCN. Bone marrow transplantation, complicated by early graft failure rescued with stem cell boost, led to resolution of the hematopoietic phenotype