Risk of donor-site lymphatic vessel dysfunction after microvascular lymph node transfer

BACKGROUND: Microvascular lymph node transfer has been used to improve lymphatic function in patients with lymphoedema. We previously reported changes in the lymphatic function of the donor limb after lymph node transfer. For this reason, we modified our surgical method to be more conservative. SUBJECTS AND METHODS: Microvascular lymph node transfer was performed in 13 patients using the previously reported original method. Sixteen patients were operated upon using the more conservative modified method. Lymphatic function in the donor limb was evaluated using volumetry, lymphoscintigraphy and tissue water percentage. RESULTS: In the original method group, the donor-limb volume was on average greater (199 ± 540 ml) than in the non-operated control limb. The volume difference between the limbs was smaller (151 ± 463 ml) in the modified method group. Two patients in the original method group had abnormal transport index (Ti) values in lymphoscintigraphy indicating decreased lymphatic function of the donor limb. In the modified method group, the Ti-values remained normal. The tissue water percentage of the donor limb was on average 40% ± 4% in the original method group and 40% ± 3% in the modified method group. Importantly, none of the patients in either group developed clinical lymphoedema in the donor limb during the 11-84-month follow-up. CONCLUSIONS: Even with the more conservative lymph node transfer method, we can observe slight, subclinical signs of lymphatic dysfunction in the donor limb. These results highlight the importance of minimizing the surgical exploration in the inguinal area and avoiding damage to the lymphatic vessels or sentinel nodes draining the lower limb.</p

Lack of hybridization between Yersinia enterocolitica and HLA-B27 DNA

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Electromagnetic wave refraction at an interface of a double wire medium

Plane-wave reflection and refraction at an interface with a double wire medium is considered. The problem of additional boundary conditions (ABC) in application to wire media is discussed and an ABC-free approach, known in the solid state physics, is used. Expressions for the fields and Poynting vectors of the refracted waves are derived. Directions and values of the power density flow of the refracted waves are found and the conservation of the power flow through the interface is checked. The difference between the results, given by the conventional model of wire media and the model, properly taking into account spatial dispersion, is discussed.Comment: 17 pages, 11 figure

Polycythemia is uncommon in dogs with chronic hypoxic pulmonary disease

Background Prolonged tissue hypoxia caused by chronic pulmonary disease is commonly regarded as an important mechanism in the development of secondary polycythemia, but little clinical data are available to support this hypothesis. Objective To study the prevalence and severity of erythrocytosis accompanying chronic hypoxic pulmonary disease in dogs. Animals Forty-seven dogs with hypoxic chronic pulmonary disease, 27 dogs with nonhypoxic chronic pulmonary disease, and 60 healthy controls. Methods Dogs with chronic pulmonary disease and chronic hypoxemia (partial pressure of arterial oxygen [PaO2] = 65%) was noted in any of the dogs. Red blood cell parameters were not associated with the severity of hypoxemia (correlation to PaO2: Erytr, r = -.14; Hb, r = -.21; Hct, r = -.14; P > .05 for all). Conclusions and Clinical Importance Polycythemia is uncommon, and usually mild if present, in dogs with chronic hypoxia caused by pulmonary disease.Peer reviewe

Primary familial brain calcification linked to deletion of 5' noncoding region of SLC20A2

OBJECTIVES: Primary familial brain calcification (PFBC) is a rare neurological disease often inherited as a dominant trait. Mutations in four genes (SLC20A2, PDGFB, PDGFRB, and XPR1) have been reported in patients with PFBC. Of these, point mutations or small deletions in SLC20A2 are most common. Thus far, only one large deletion covering entire SLC20A2 and several smaller, exonic deletions of SLC20A2 have been reported. The aim of this study was to identify the causative gene defect in a Finnish PFBC family with three affected patients. MATERIALS AND METHODS: A Finnish family with three PFBC patients and five unaffected subjects was studied. Sanger sequencing was used to exclude mutations in the coding and splice site regions of SLC20A2, PDGFRB, and PDGFB. Whole-exome (WES) and whole-genome sequencing (WGS) were performed to identify the causative mutation. A SNP array was used in segregation analysis. RESULTS: Copy number analysis of the WGS data revealed a heterozygous deletion of ~578 kb on chromosome 8. The deletion removes the 5' UTR region, the noncoding exon 1 and the putative promoter region of SLC20A2 as well as the coding regions of six other genes. CONCLUSIONS: Our results support haploinsufficiency of SLC20A2 as a pathogenetic mechanism in PFBC. Analysis of copy number variations (CNVs) is emerging as a crucial step in the molecular genetic diagnostics of PFBC, and it should not be limited to coding regions, as causative variants may reside in the noncoding parts of known disease-associated genes

Co-infections with Respiratory Viruses in Dogs with Bacterial Pneumonia

BackgroundBacterial pneumonia (BP) is an inflammation of the lower airways and lung parenchyma secondary to bacterial infection. The pathogenesis of BP in dogs is complex and the role of canine respiratory viruses has not been fully evaluated. ObjectivesThe aim of this study was to investigate the occurrence of viral co-infections in dogs with BP and to assess demographic or clinical variables as well as disease severity associated with viral co-infections. AnimalsTwenty household dogs with BP caused by opportunistic bacteria and 13 dogs with chronic (>30days) tracheobronchitis caused by Bordetella bronchiseptica (BBTB). MethodsProspective cross-sectional observational study. Diagnosis was confirmed by clinical and laboratory findings, diagnostic imaging, and cytologic and microbiologic analysis of bronchoalveolar lavage or transtracheal wash fluid. Canine parainfluenza virus (CPIV), canine adenovirus, canine herpes virus, canine influenzavirus, canine distemper virus, canine respiratory coronavirus (CRCoV) and canine pneumovirus, as well as B.bronchiseptica and Mycoplasma spp. were analyzed in respiratory samples using PCR assays. ResultsCPIV was detected in 7/20 and CRCoV in 1/20 dogs with BP. Respiratory viruses were not detected in dogs with BBTB. There were no significant differences in clinical variables between BP dogs with and without a viral co-infection. Conclusion and Clinical ImportanceRespiratory viruses were found frequently in dogs with BP and may therefore play an important role in the etiology and pathogenesis of BP. Clinical variables and disease severity did not differ between BP dogs with and without viral co-infection.Peer reviewe

Phase 1 Lymfactin (R) Study : Short-term Safety of Combined Adenoviral VEGF-C and Lymph Node Transfer Treatment for Upper Extremity Lymphedema

Objective: To study the safety and tolerability of Lymfactin (R) treatment combined with microvascular lymph node transfer surgery in patients with upper limb lymphedema. Background: Upper limb lymphedema is a common clinical challenge after breast cancer surgery and/or radiotherapy. Lymfactin (R) is an adenovirus type 5-based gene therapy involving expression of human vascular endothelial growth factor C (VEGF-C) in the damaged tissue. It aims to correct deficient lymphatic flow by promoting the growth and repair of lymphatic vessels. Methods: In Phase I, Lymfactin (R) was combined with microvascular lymph node transfer surgery to study the safety and tolerability of Lymfactin (R) and the biodistribution of the viral vector in patients with upper limb lymphedema. Results: Fifteen patients with breast cancer-associated secondary lymphedema of the upper arm were recruited between December 2016 and February 2018. Three patients received a lower dose (1 x 10(10)) and 12 a higher dose (1 x 10(11)) of viral particles, respectively. No dose-limiting toxicities were observed, and the study was completed with the pre-determined maximum dose. Commonly reported adverse events during the 12-month follow-up were common cold, fever, gastroenteritis, pain in the operation area, headache, muscle ache and elevated liver enzymes. Serious adverse events consisted of two erysipelas infections in the lymphedema arm (requiring hospitalization) and one hematoma of the flap donor site. Conclusions: After 12 months' follow-up, results indicate that Lymfactin (R) is well tolerated. The study continues with a 36-months efficacy and 5 years safety follow-up of the patients. The oncological safety aspects of Lymfactin (R) will require a longer follow-up period. (c) 2020 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Pub-lished by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license. (http://creativecommons.org/licenses/by-nc-nd/4.0/)Peer reviewe

Self-rated health and objective health status as predictors of all-cause mortality among older people: a prospective study with a 5-, 10-, and 27-year follow-up

BackgroundDespite a non-specific nature of self-rated health (SRH), it seems to be a strong predictor of mortality. The aim of this study is to assess the association of SRH and objective health status (OH) with all-cause mortality in 70-year-old community-dwelling older people in Finland.MethodsA prospective study with 5-, 10- and 27-year follow-ups. SRH (n=1008) was assessed with a single question and OH (n=962) by the Rockwood's Frailty Index (FI). To assess the association of SRH and OH with mortality, Cox regression model was used.ResultsOf the 1008 participants, 138 (13.7%), 319 (31.6%), and 932 deceased (86.3%) during the 5-, 10- and 27-year follow-ups, respectively. In unadjusted models, subjects with poor SRH had almost eightfold risk for mortality compared to those with good SRH during the 5-year follow-up; among those with poor OH, the risk was fourfold compared to those with good OH. In the 10-year-follow up, both poor SRH and poor OH predicted about fourfold risk for mortality compared to those with good health. During the 27-year follow-up, OH was a stronger predictor of mortality than SRH. Poor SRH, compared to good SRH, showed 95% sensitivity and 34% specificity for 5-year mortality; corresponding figures for OH were 54 and 80%, respectively.ConclusionsSingle-item SRH seems to be able to capture almost the same as OH in predicting a short-term (less than 10years) mortality risk among older adults in clinical settings. The use of SHR may also enhance the focus on patient-centered care

Insuliiniresistenssi, aivot ja muistisairausriski

Tyypin 2 diabetes ja siihen liittyvä insuliiniresistenssi ovat muistisairauden riskitekijöitä. Insuliiniresistenssi ennustaa tiedonkäsittelytoimintojen heikentymistä jo henkilöillä, joille ei vielä ole kehittynyt diabetesta. Insuliinilla on useita tärkeitä säätelytehtäviä keskushermostossa. Se vaikuttaa esimerkiksi synapsien toimintaan ja niiden pitkäkestoiseen vahvistumiseen. Insuliiniresistenssiin liittyvään hyperinsulinemiaan on puolestaan yhdistetty paradoksaalisesti keskushermoston pienentynyt insuliinipitoisuus. Alzheimerin tautia sairastavilla insuliinin vaste keskushermostossa on heikentynyt. Insuliinilla ja Alzheimerin taudille tyypillisellä beeta-amyloidilla on aivoissa yhteinen hajottajaentsyymi. Muutokset tämän entsyymin toiminnassa ja määrässä voivat vaikuttaa beeta-amyloidin kertymään aivoissa. Insuliiniresistenssi voi altistaa kognition heikentymiselle myös aivojen pienten suonten muutosten kautta. Insuliiniresistenssi voi siis vaikuttaa tiedonkäsittelytoimintoihin ja Alzheimerin taudin neuropatologiaan useita eri reittejä.</p