Ascher syndrome

AbstractAscher syndrome is a rare, benign skin disorder characterized by a double upper lip, blepharochalasis, and nontoxic enlargement of the thyroid gland. The exact cause is unknown, but it is considered to be a hereditary disease with an autosomal dominant trait. We report here a case of forme fruste Ascher syndrome in a 29-year-old man

Primary localized histoplasmosis with lesions restricted to the mouth in a Chinese HIV-negative patient

SummaryHistoplasmosis is a deep mycosis caused by Histoplasma capsulatum, which is endemic in many areas of the world but is relatively rare in China. Although the majority of cases present as a mild to moderate flu-like disease requiring only supportive therapy, approximately 1% of patients experience more serious pulmonary and extrapulmonary disease, which can be life-threatening if diagnosis is delayed or the treatment is not initiated rapidly. Definitive diagnosis is usually made by a combination of culture, detection of the organism in tissues, measurement of antibodies, and detection of antigen. We present the case of a 51-year-old patient who presented with histoplasmosis only, with several ulcerated lesions in the oral cavity and without HIV infection, who did not show any detectable signs and symptoms of systemic disease or extra-oral manifestations. Histopathological analysis indicated a chronic inflammatory process with granulomas with yeast-like organisms. Isolation of H. capsulatum and molecular identification provided the definitive diagnosis. Treatment with oral itraconazole led to remission of the oral lesions. This is the first Chinese case report of localized histoplasmosis with lesions restricted to the mouth in an HIV-negative patient

Numerical Simulation of Bridging Ball Plugging Mechanism in Fractured-Vuggy Carbonate Reservoirs

Pores, fractures, caves, and other storage spaces are commonly distributed in fractured-vuggy carbonate reservoirs. During the drilling process, more than half of all drill-in fluid loss issues are caused by developed caves. Cave scales range from centimeters to meters, making leak prevention increasingly difficult through the use of traditional technologies. Currently, there is still high demand for the understanding of feasible loss control techniques, especially in fractured-vuggy carbonate reservoirs. Multistage Bridge Plugging (MBP) technology has facilitated pioneering experiments in many oilfields, but the success rate of plugging is less than 50%, and the effects of plugging are uncontrollable and difficult to predict. This is due to a lack of clarity regarding the plugging mechanism and the key controlling factors. In this study, we used the Discrete Element Method (DEM) simulation method to investigate the controlling factors of MBP technology, and analyzed its applicable conditions. We found that the prerequisite for the success of MBP is the presence of a constricted throat near the wellbore when drilling the well hole; the first-stage bridging ball is the key to the success of MBP. Larger ball radius, cave inclination and initial flow rate, and lower ball velocity are beneficial to the first-stage bridging. All discussion in this research is based on the ideal situation. However, the cave pattern is difficult to describe using several models, let alone by one ideal model. With the progress of seismic fine description technology and mud logging, more accurate characterization of caves in carbonate reservoirs will help to accurately formulate the plugging scheme and greatly improve the success rate of plugging technology. Additionally, the engineering risks of this technology, such as plugging the coiled tubing, need to be further studied

Numerical Simulation of Bridging Ball Plugging Mechanism in Fractured-Vuggy Carbonate Reservoirs

Pores, fractures, caves, and other storage spaces are commonly distributed in fractured-vuggy carbonate reservoirs. During the drilling process, more than half of all drill-in fluid loss issues are caused by developed caves. Cave scales range from centimeters to meters, making leak prevention increasingly difficult through the use of traditional technologies. Currently, there is still high demand for the understanding of feasible loss control techniques, especially in fractured-vuggy carbonate reservoirs. Multistage Bridge Plugging (MBP) technology has facilitated pioneering experiments in many oilfields, but the success rate of plugging is less than 50%, and the effects of plugging are uncontrollable and difficult to predict. This is due to a lack of clarity regarding the plugging mechanism and the key controlling factors. In this study, we used the Discrete Element Method (DEM) simulation method to investigate the controlling factors of MBP technology, and analyzed its applicable conditions. We found that the prerequisite for the success of MBP is the presence of a constricted throat near the wellbore when drilling the well hole; the first-stage bridging ball is the key to the success of MBP. Larger ball radius, cave inclination and initial flow rate, and lower ball velocity are beneficial to the first-stage bridging. All discussion in this research is based on the ideal situation. However, the cave pattern is difficult to describe using several models, let alone by one ideal model. With the progress of seismic fine description technology and mud logging, more accurate characterization of caves in carbonate reservoirs will help to accurately formulate the plugging scheme and greatly improve the success rate of plugging technology. Additionally, the engineering risks of this technology, such as plugging the coiled tubing, need to be further studied

Intracranial peak pressure as a predictor for perioperative mortality after spontaneous intracerebral hemorrhage evacuation and decompressive craniectomy

Abstract Background An optimal intracranial pressure (ICP) management target is not well defined in patients with spontaneous intracerebral hemorrhage. The aim of this study was to explore the association between perioperative ICP monitoring parameters and mortality of patients with spontaneous intracerebral hematoma undergoing emergency hematoma removal and decompressive craniectomy (DC), to provide evidence for a target-oriented ICP management. Methods The clinical and radiological features of 176 consecutive patients with spontaneous intracerebral hemorrhage that underwent emergent hematoma evacuation and DC were reviewed. The Glasgow Coma Scale (GCS) and Glasgow Outcome Scale (GOS) scores were assessed 2 weeks after surgery. Multivariate logistic regression analysis was performed to identify predictors for perioperative death. Results Forty-four cases (25.0%) were assigned to the ICP group. In patients with an ICP monitor, the median peak ICP value was 25.5 mmHg; 50% of them had a peak ICP value of more than 25 mmHg. The median duration of ICP > 25 mmHg was 2 days. Without a target-specific ICP management, the mortality at 2 weeks after surgery was similar between patients with or without an ICP monitor (27.3% versus 18.2%, p = 0.20). In multivariable analysis, the peak ICP value (OR 1.11, 95% CI 1.004–1.234, p = 0.04) was significantly associated with perioperative death in the ICP group. The area under ROC curve of peak ICP value was 0.78 (95%CI 0.62–0.94) for predicting mortality, with a cut-off value of 31 mmHg. Conclusion Compared with a persistent hyperintracranial pressure, a high ICP peak value might provide a better prediction for the mortality of patients with spontaneous intracerebral hemorrhage evacuation and DC, suggesting a tailored ICP management protocol to decrease ICP peak value

Downregulation of TNIP1 Expression Leads to Increased Proliferation of Human Keratinocytes and Severer Psoriasis-Like Conditions in an Imiquimod-Induced Mouse Model of Dermatitis.

Psoriasis is a chronic, inflammatory skin disease involving both environmental and genetic factors. According to genome-wide association studies (GWAS), the TNIP1 gene, which encodes the TNF-α-induced protein 3-interacting protein 1 (TNIP1), is strongly linked to the susceptibility of psoriasis. TNIP1 is a widely expressed ubiquitin sensor that binds to the ubiquitin-editing protein A20 and restricts TNF- and TLR-induced signals. In our study, TNIP1 expression decreased in specimens of epidermis affected by psoriasis. Based on previous studies suggesting a role for TNIP1 in modulating cancer cell growth, we investigated its role in keratinocyte proliferation, which is clearly abnormal in psoriasis. To mimic the downregulation or upregulation of TNIP1 in HaCaT cells and primary human keratinocytes (PHKs), we used a TNIP1 specific small interfering hairpin RNA (TNIP1 shRNA) lentiviral vector or a recombinant TNIP1 (rTNIP1) lentiviral vector, respectively. Blocking TNIP1 expression increased keratinocyte proliferation, while overexpression of TNIP1 decreased keratinocyte proliferation. Furthermore, we showed that TNIP1 signaling might involve extracellular signal-regulated kinase1/2 (Erk1/2) and CCAAT/enhancer-binding protein β (C/EBPβ) activity. Intradermal injection of TNIP1 shRNA in BALB/c mice led to exaggerated psoriatic conditions in imiquimod (IMQ)-induced psoriasis-like dermatitis. These findings indicate that TNIP1 has a protective role in psoriasis and therefore could be a promising therapeutic target

<i>TNIP1</i>/TNIP1 and CK6 expression in psoriatic lesions.

<p>(A) Expression of <i>TNIP1</i> and CK6 mRNA levels based on qRT-PCR in the epidermis of psoriatic plaque of patients with moderate to severe plaque psoriasis (n = 12) and the epidermis of normal controls (n = 12). Data shown represent mean ± SD; (B) Expression of TNIP1 and CK6 protein levels based on Western blotting in psoriatic plaque (n = 4) and controls (n = 4) skin. Data shown represent mean ± SD. (C) Tissue sections obtained from patients with psoriasis (n = 8; panel b and panel c) or from healthy controls (n = 8; panel a) were stained with mice anti-TNIP1 antibody and counterstained with hematoxylin. Bar = 100 μm. Staining intensity was scored in a semiquantitative manner by two independent observers. Data are presented as mean staining intensity grade ± SEM. (D) The distribution of TNIP1 in HaCaT cells identified by immunofluorescence staining. Bar = 30 μm. *, p<0.05; **, p<0.01.</p

Alteration of TNIP1 expression in PHKs and the anti-proliferative effect of TNIP1 on PHKs.

<p>(A) Green fluorescence observed in PHKs stably infected by lentiviral particles respectively encoding rTNIP1, TNIP1 shRNA or a non-specific shRNA (control shRNA). Bar = 100 μm. (B) Alteration of TNIP1 in PHKs is confirmed by Western blotting. PHKs stably infected with rTNIP1, TNIP1 shRNA, or control shRNA were assessed using (C) the CCK-8 assay, (D) the BrdU assay and (E) Western blotting (for CK6 protein level). Data are presented as mean ± SD of three independent experiments (*P<0.05 or **P<0.01 compared with control cells).</p