A rare case of isolated duodenal metastases from hepatocellular carcinoma associated with p53 and ki-67 expression: a case report

Hepatocellular carcinoma (HCC) is the most common primary tumor of the liver worldwide. The incidence of HCC is increasing in North America secondary to rises in chronic liver disease from alcohol abuse and viral hepatitis. HCC most commonly metastasizes hematogenously or through lymphatics to the lungs and regional lymph nodes. Involvement of small bowel is rare and typically results from direct invasion and extension. We examined the molecular features related to this extremely rare case of isolated duodenal metastasis of HCC and noted p53 and Ki-67 positive staining. Here, we review the possible molecular and immunohistochemical studies that may aid definitive diagnosis and the evidence for the management of metastatic hepatocellular carcinoma

Optical coherence tomography angiography indicates subclinical retinal disease in neuromyelitis optica spectrum disorders

Background: Neuromyelitis optica spectrum disorders (NMOSD) are neuroinflammatory diseases of the central nervous system. Patients suffer from recurring relapses and it is unclear whether relapse-independent disease activity occurs and whether this is of clinical relevance. Objective: To detect disease-specific alterations of the retinal vasculature that reflect disease activity during NMOSD. Methods: Cross-sectional analysis of 16 patients with NMOSD, 21 patients with relapsing-remitting multiple sclerosis, and 21 healthy controls using retinal optical coherence tomography (OCT), optical coherence tomography angiography (OCT-A), measurement of glial fibrillary acidic protein (GFAP) serum levels, and assessment of visual acuity. Results: Patients with NMOSD but not multiple sclerosis revealed lower foveal thickness (FT) (p = 0.02) measures and an increase of the foveal avascular zone (FAZ) (p = 0.02) compared to healthy controls independent to optic neuritis. Reduced FT (p = 0.01), enlarged FAZ areas (p = 0.0001), and vessel loss of the superficial vascular complex (p = 0.01) were linked to higher serum GFAP levels and superficial vessel loss was associated with worse visual performance in patients with NMOSD irrespective of optic neuritis. Conclusion: Subclinical parafoveal retinal vessel loss might occur during NMOSD and might be linked to astrocyte damage and poor visual performance. OCT-A may be a tool to study subclinical disease activity during NMOSD

Displacement of the Greater Tuberosity in Humeral Head Fractures Does Not only Depend on Rotator Cuff Status

It is assumed that dorsocranial displacement of the greater tuberosity in humeral head fractures is caused by rotator cuff traction. The purpose of this study was to investigate the association between rotator cuff status and displacement characteristics of the greater tuberosity in four-part humeral head fractures. Computed tomography scans of 121 patients with Neer type 4 fractures were analyzed. Fatty infiltration of the supra- and infraspinatus muscles was classified according to Goutallier. Position determination of the greater tuberosity fragment was performed in both coronary and axial planes to assess the extent of dorsocranial displacement. Considering non-varus displaced fractures, the extent of the dorsocranial displacement was significantly higher in patients with mostly inconspicuous posterosuperior rotator cuff status compared to advanced fatty degenerated cuffs (cranial displacement: Goutallier 0–1: 6.4 mm ± 4.6 mm vs. Goutallier 2–4: 4.2 mm ± 3.5 mm, p = 0.020; dorsal displacement: Goutallier 0–1: 28.4° ± 32.3° vs. Goutallier 2–4: 13.1° ± 16.1°, p = 0.010). In varus displaced humeral head fractures, no correlation between the displacement of the greater tuberosity and the condition of the posterosuperior rotator cuff could be detected (p ≥ 0.05). The commonly accepted theory of greater tuberosity displacement in humeral head fractures by rotator cuff traction cannot be applied to all fracture types

Clavicle Elevation or Shoulder Girdle Depression in Acromioclavicular Joint Dislocation: A Radiological Investigation

Background: The side-comparative coracoclavicular (CC) distance is used to describe the vertical instability component of acute acromioclavicular (AC) joint dislocations. Elevation of the clavicle or a depression of the shoulder girdle can lead to an increased CC distance. The dislocation direction has not yet been investigated and is not included in common classification systems. Hypothesis: Clavicle elevation is primarily responsible for vertical dislocation in AC joint separation. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Weighted and nonweighted bilateral plain anteroposterior views of the shoulder girdles of patients with AC joint dislocations (Rockwood [RW] types III and V), diagnosed in our trauma department between 2001 and 2018, were included in this study. After determining the CC distance, a side-comparative determination of the positions of both the clavicle and shoulder girdle, with reference to the spinal column, was conducted. Results: In total, 245 bilateral plain anteroposterior views were evaluated (RW III, n = 116; RW V, n = 129). All patients showed a side-comparative clavicle elevation (mean +/- SD: RW III, 5 +/- 14 mm; RW V, 11 +/- 17 mm) in weighted and nonweighted views. While no depression of the shoulder girdle was measured in RW III injuries (weighted and nonweighted views, 0 +/- 11 mm), dropping of the shoulder girdle in RW V lesions on nonweighted views was observed (-5 +/- 11 mm). Conclusion: Vertical dislocation is mostly associated with clavicle elevation in RW III injures, while in high-grade AC joint dislocations (RW V), a combination of clavicle elevation and shoulder girdle depression is present. A significantly greater superior displacement of the clavicle in RW V injuries was seen in weighted views, while a depression of the shoulder girdle could be detected in nonweighted views. For the first time, these results include the dislocation direction in the classification of an AC joint injury. Further studies are needed to investigate the extent to which dislocation types differ in optimal therapy and outcome

The Loop Tenodesis Procedure—From Biomechanics to First Clinical Results

(1) Introduction: Several surgical therapy options for the treatment of pathologies of the long biceps tendon (LHB) have been established. However, tenotomy, as well as established tenodesis techniques, has disadvantages, such as cosmetic deformities, functional impairments and residual shoulder pain. This study presents the first clinical and structural results of the recently introduced loop tenodesis procedure for the LHB, developed to overcome these issues. (2) Methods: 37 patients (11 women, 26 men, mean age 52 years), who underwent loop tenodesis of the LHB were examined six months after surgery. For the clinical evaluation the Constant score, as well as the LHB score, were used, complemented by elbow flexion and supination strength measurements. The integrity of the tenodesis construct was evaluated indirectly by sonographic detection of the LHB in the bicipital groove. (3) Results: Both, the overall Constant score as well as the LHB score showed significant improvements six months postoperatively, as compared to the preoperative value. Fourteen patients (38%) presented an examiner-dependent upper arm deformity, although only five patients (13%) reported subjective cosmetic deformities. Both, flexion and supination strength were preserved compared to the preoperative level. In 35 patients (95%), the tenodesis in the bicipital groove was proofed sonographically. (4) Conclusion: The loop tenodesis of the LHB provides good-to-excellent overall clinical results after a short-term follow-up of six month. The incidence of cosmetic deformities was inferior compared to conventional therapy options (tenotomy and anchor tenodesis)

Efficiency and accuracy of different ovulation inducers after progesterone device removal in crossbred multiparous cows

The aim of this study was to verify the efficiency and ovulation time after the administration of different inducers for synchronization of ovulation in beef cows. One hundred and eight non-lactating cows were distributed into the control group (CG; untreated; n=28), estradiol benzoate (EB) group (EBG; n=28); 17 beta-estradiol (17ßE) group (17ßEG; n=28), and deslorelin (DES) group (DESG; n=24). On day minus 11 (D-11) of the protocol, the CG underwent application of cloprostenol and ultrasound examination (US); on D0, progesterone (P4) was inserted plus EB; on D7, cloprostenol was applied; on D9, P4 was removed and cloprostenol plus 400 IU of equine chorionic gonadotropin (eCG) was injected. The EBG was subjected to treatment identical to that of the CG, except on D10, when the cows received EB. The 17ßE was subjected to the same protocol used in the CG except for the administration of 17ßE on D10. And, the DESG was subjected to the same treatment as the CG, except on D10, when the group received DES acetate. Twelve hours after the administration of EB, 17ßE and DES, ovarian US were performed every 6 hours. The preovulatory follicle (POF) diameters measured before ovulation were 19.5; 14.7; 18.7 and 19.8 mm respectively for CG, EBG, 17ßEG and DESG; and the time intervals between inducer application and ovulation were 20.2; 18.9; 21.0 and 22.5 hours respectively. In conclusion, all ovulation inducers were efficient in promoting ovulation; the inducers caused ovulation between 18.9 and 22.5 hours; EB promoted ovulation in a shorter time (P<0.05); 17ßE and DES showed greater variation in application/ovulation time between groups. Keywords: Ovulation inductors; Deslorelin acetate; Cows; Ovulation synchronization; 17 beta-estradiol

Molecular epidemiology of a hepatitis C virus epidemic in a haemodialysis unit: outbreak investigation and infection outcome

<p>Abstract</p> <p>Background</p> <p>HCV is a leading cause of liver chronic diseases all over the world. In developed countries the highest prevalence of infection is reported among intravenous drug users and haemodialysis (HD) patients. The present report is to identify the pathway of HCV transmission during an outbreak of HCV infection in a privately run haemodialysis (HD) unit in Italy in 2005.</p> <p>Methods</p> <p>Dynamics of the outbreak and infection clinical outcomes were defined through an ambi-directional cohort study. Molecular epidemiology techniques were used to define the relationships between the viral variants infecting the patients and confirm the outbreak. Risk analysis and auditing procedures were carried out to define the transmission pathway(s).</p> <p>Results</p> <p>Of the 50 patients treated in the HD unit 5 were already anti-HCV positive and 13 became positive during the study period (AR = 28.9%). Phylogenic analysis identified that, all the molecularly characterized incident cases (10 out of 13), were infected with the same viral variant of one of the prevalent cases. The multivariate analysis and the auditing procedure disclosed a single event of multi-dose vials heparin contamination as the cause of transmission of the infection in 11 out of the 13 incident cases; 2 additional incident cases occurred possibly as a result of inappropriate risk management.</p> <p>Discussion</p> <p>More than 30% of all HCV infections in developed countries results from poor application of standard precautions during percutaneous procedures. Comprehensive strategy which included: educational programmes, periodical auditing on standard precaution, use of single-dose vials whenever possible, prospective surveillance for blood-borne infections (including a system of prompt notification) and risk assessment/management dedicated staff are the cornerstone to contain and prevent outbreaks in HD</p> <p>Conclusions</p> <p>The outbreak described should serve as a reminder to HD providers that patients undergoing dialysis are at risk for HCV infection and that HCV may be easily transmitted whenever standard precautions are not strictly applied.</p

Social partners going digital: using digital tools and adapting social dialogue processes

Aquesta publicació s'elabora a partir de les contribucions de cadascú dels membres nacionals que integren la Network of Eufound Correspondent. Pel cas d'Espanya la contribució ha estat realitzada per l'Alejandro GodinoDigital transformation is changing the world of work. This report looks at how social partners - the actors involved in the regulation of employment relationships - are increasingly adopting technological solutions to improve the services that they provide to their members and facilitate collective bargaining processes. Technological tools offer social partners the opportunity to enhance consultation, engage with their members through digitised processes, improve services and increase networking activities, as well as addressing the issue of membership decline. The findings of this report show that the extent to which the social partners use digital technologies varies greatly across the EU Member States, Norway and the United Kingdom. Provisions in collective agreements on several aspects of digitalisation have been identified in about half of the countries. Through these provisions, social partners encourage their members to boost training on digital skills, ensure fair and safe working conditions and take account of data protection and employee monitoring practices. The European social partners' autonomous framework agreement on digitalisation has provided inspiration to national-level organisations, and follow-up actions in this regard have the potential to greatly benefit their members

Social partners going digital: using digital tools and adapting social dialogue processes

La xarxa de corresponsals d'Eurofound ha contribuït a aquest informe i en concret l'Alejandro Godino com així s'expressa a l'Annex 3: Network of Eurofound CorrespondentsDigital transformation is changing the world of work. This report looks at how social partners - the actors involved in the regulation of employment relationships - are increasingly adopting technological solutions to improve the services that they provide to their members and facilitate collective bargaining processes. Technological tools offer social partners the opportunity to enhance consultation, engage with their members through digitised processes, improve services and increase networking activities, as well as addressing the issue of membership decline. The findings of this report show that the extent to which the social partners use digital technologies varies greatly across the EU Member States, Norway and the United Kingdom. Provisions in collective agreements on several aspects of digitalisation have been identified in about half of the countries. Through these provisions, social partners encourage their members to boost training on digital skills, ensure fair and safe working conditions and take account of data protection and employee monitoring practices. The European social partners' autonomous framework agreement on digitalisation has provided inspiration to national-level organisations, and follow-up actions in this regard have the potential to greatly benefit their members

Democratic research: Setting up a research commons for a qualitative, comparative, longitudinal interview study during the COVID-19 pandemic

The sudden and dramatic advent of the COVID-19 pandemic led to urgent demands for timely, relevant, yet rigorous research. This paper discusses the origin, design, and execution of the SolPan research commons, a large-scale, international, comparative, qualitative research project that sought to respond to the need for knowledge among researchers and policymakers in times of crisis. The form of organization as a research commons is characterized by an underlying solidaristic attitude of its members and its intrinsic organizational features in which research data and knowledge in the study is shared and jointly owned. As such, the project is peer-governed, rooted in (idealist) social values of academia, and aims at providing tools and benefits for its members. In this paper, we discuss challenges and solutions for qualitative studies that seek to operate as research commons