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Endometriosis may contribute to Mullerian adenosarcoma development but makes diagnosis challenging given similar symptoms. Survival benefit has not been definitively shown for chemotherapy, hormonal therapy, or radiotherapy, consolidating surgery as the mainstay treatment. Local excision may be a treatment option for patients with confined tumors wishing to preserve their fertility., Competing Interests: The authors declare no conflicts of interest., (© 2024 The Author(s). Clinical Case Reports published by John Wiley & Sons Ltd.)

Over the past decades, the main techniques used to visualize bacteria in tissue have improved but are still mainly based on indirect recognition of bacteria. Both microscopy and molecular recognition are being improved, but most procedures for bacteria detection in tissue involve extensive damage. Here, we describe a method to visualize bacteria in tissue slices from an in vivo model of breast cancer. This method allows examining trafficking and colonization of fluorescein-5-isothiocyanate (FITC)-stained bacteria in various tissues. The protocol provides direct visualization of fusobacterial colonization in breast cancer tissue. Rather than processing the tissue or confirming bacterial colonization by PCR or culture, the tissue is directly imaged using multiphoton microscopy. This direct visualization protocol causes no damage to the tissue; therefore, all structures can be identified. This method can be combined with others to co-visualize bacteria, types of cells, or protein expression in cells., Competing Interests: Competing interestsThe authors declare no competing interests., (Copyright © 2023 The Authors; exclusive licensee Bio-protocol LLC.)

Pneumothorax is one of the most frequent complications of computed tomography (CT)-guided lung biopsies. We aim to identify the safe zone of the needle-pleura angle during a CT-guided lung biopsy. Fifty-two patients underwent CT-guided lung biopsies between January 2020 and September 2022 (27 males, 25 females, median age 70 years). Right and left needle angles were measured and correlated to the incidence of pneumothorax. The minimum delta (δ min ) was calculated as the absolute value of the difference between a 90° angle and the right and left angles. t -test p -values for δ min were conducted. We recorded 29 patients with pneumothorax, including intraprocedural and transient, postprocedural with minimal symptoms, or postprocedural requiring a chest tube insertion. Thirty-two patients had a δ min ≥ 10°, while 20 had a δ min < 10°. Of the patients with a δ min < 10°, 30% experienced pneumothorax compared to 71.8% in patients with δ min ≥ 10° ( p = 0.0023). The study results show that as the needle's angle deviates from the perpendicular, with an absolute value of more than 10°, the likelihood of pneumothorax increases significantly. A needle-pleura angle between 80° and 100° gives the operator a safe zone to reduce the risk of pneumothorax., Competing Interests: The authors declare no conflict of interest.

Bladder cancer is the 4 th leading cancer in men. Tumor resection followed by bladder instillation of Bacillus Calmette-Guérin (BCG) is the primary treatment for high-risk patients with Non-Muscle Invasive Bladder Cancer (NMIBC) to prevent recurrence and progression to muscle-invasive disease. This treatment, however, lacks efficiency and causes severe adverse effects. Mannose residues are expressed on bladder surfaces and their levels were indicated to be higher in bladder cancer. Intravesical instillations of a recombinant Pseudomonas aeruginosa (PA) overexpressing the mannose-sensitive hemagglutination fimbriae (PA-MSHA), and of a mannose-specific lectin-drug conjugate showed efficiency against NMIBC in murine models of bladder cancer. Urothelial mannosylation facilitates bladder colonization by Uropathogenic E. coli (UPEC) via the interaction with the FimH mannose lectin, positioned at the tip of type 1 fimbria. A recombinant BCG strain overexpressing FimH on its outer surface, exhibited higher attachment and internalization to bladder cancer cells and increased effectivity in treating bladder cancer in mice. Investigating the pattern of mannose expression in NMIBC is important for improving treatment. Here, using tissue microarrays containing multiple normal and cancerous bladder samples, and lectins, we confirm that human bladder cancer cells express high mannose levels. Using UPEC mutants lacking or overexpressing type 1 fimbria, we also demonstrate that tumor-induced hypermannosylation increases type 1 fimbria mediated UPEC attachment to human and mouse bladder cancer. Our results provide an explanation for the effectiveness of PA-MSHA and the FimH-overexpressing BCG and support the hypothesis that mannose-targeted therapy holds potential for improving bladder cancer treatment., Competing Interests: CG, VY, OM and GB are the inventors on a patent application (No. 10,918,677 B2: entitled “Attenuated or inactivated pathogenic Escherichia coli for treating urogenital cancer”) by the Hebrew University of Jerusalem, and the Hadassah Medical Organization. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Maalouf, Gur, Yutkin, Scaiewicz, Mandelboim and Bachrach.)

Background: COVID-19 digital contact-tracing apps were created to assist public health authorities in curbing the pandemic. These apps require users' permission to access specific functions on their mobile phones, such as geolocation, Bluetooth or Wi-Fi connections, or personal data, to work correctly. As these functions have privacy repercussions, it is essential to establish how contact-tracing apps respect users' privacy., Objective: This study aimed to systematically map existing contact-tracing apps and evaluate the permissions required and their privacy policies. Specifically, we evaluated the type of permissions, the privacy policies' readability, and the information included in them., Methods: We used custom Google searches and existing lists of contact-tracing apps to identify potentially eligible apps between May 2020 and November 2021. We included contact-tracing or exposure notification apps with a Google Play webpage from which we extracted app characteristics (eg, sponsor, number of installs, and ratings). We used Exodus Privacy to systematically extract the number of permissions and classify them as dangerous or normal. We computed a Permission Accumulated Risk Score representing the threat level to the user's privacy. We assessed the privacy policies' readability and evaluated their content using a 13-item checklist, which generated a Privacy Transparency Index. We explored the relationships between app characteristics, Permission Accumulated Risk Score, and Privacy Transparency Index using correlations, chi-square tests, or ANOVAs., Results: We identified 180 contact-tracing apps across 152 countries, states, or territories. We included 85.6% (154/180) of apps with a working Google Play page, most of which (132/154, 85.7%) had a privacy policy document. Most apps were developed by governments (116/154, 75.3%) and totaled 264.5 million installs. The average rating on Google Play was 3.5 (SD 0.7). Across the 154 apps, we identified 94 unique permissions, 18% (17/94) of which were dangerous, and 30 trackers. The average Permission Accumulated Risk Score was 22.7 (SD 17.7; range 4-74, median 16) and the average Privacy Transparency Index was 55.8 (SD 21.7; range 5-95, median 55). Overall, the privacy documents were difficult to read (median grade level 12, range 7-23); 67% (88/132) of these mentioned that the apps collected personal identifiers. The Permission Accumulated Risk Score was negatively associated with the average App Store ratings (r=-0.20; P=.03; 120/154, 77.9%) and Privacy Transparency Index (r=-0.25; P<.001; 132/154, 85.7%), suggesting that the higher the risk to one's data, the lower the apps' ratings and transparency index., Conclusions: Many contact-tracing apps were developed covering most of the planet but with a relatively low number of installs. Privacy-preserving apps scored high in transparency and App Store ratings, suggesting that some users appreciate these apps. Nevertheless, privacy policy documents were difficult to read for an average audience. Therefore, we recommend following privacy-preserving and transparency principles to improve contact-tracing uptake while making privacy documents more readable for a wider public., (©Marco Bardus, Melodie Al Daccache, Noel Maalouf, Rayan Al Sarih, Imad H Elhajj. Originally published in JMIR mHealth and uHealth (https://mhealth.jmir.org), 12.07.2022.)

The purpose of this study is to assess the effect of nine covariates on the occurrence or absence of stable or symptomatic pneumothorax. Forty-three patients underwent CT-guided lung biopsies from January 2020 to January 2022 (24 m, 19 f, median age 70 years). All the interventions were carried out with a semi-automatic 18G needle and a 17G trocar in a prone or supine position. Different covariates were measured and correlated to the rate and severity of the pneumothoraces observed. Nominal two-sided t -test p -values for the continuous variables and Fisher's exact test results for the categorical variables were conducted. The data included the lesion size, distance to the pleura, needle-pleura angle, age, gender, position during the procedure, and the presence of chronic obstructive pulmonary disease. Patients with an observed pneumothorax had an average angle between the needle and the pleura of 74.00° compared to 94.68° in patients with no pneumothorax ( p -value = 0.028). A smaller angle measurement correlated with a higher risk of pneumothorax development. The needle-pleural angle plays a vital role in the outcome of a CT-guided lung biopsy. Correctly adjusting the needle-pleural angle can diminish the pneumothorax risk associated with a CT-guided lung biopsy. The study results show that as the needle's angle deviates from the perpendicular, the pleural surface area experiencing trauma increases, and pneumothorax is more likely to occur.

Autoimmune brainstem encephalitis (BSE) is a rare neurological condition with a wide range of underlying etiologies. It can be subdivided into two broad groups: a primary inflammatory disease of the central nervous system (CNS) or a brainstem disorder secondary to systemic diseases where the CNS is only one of many affected organs. Symptoms range from mild to life-threatening manifestations. Most cases respond well to immunotherapy. Therefore, broad and in-depth knowledge of the various inflammatory disorders that target the brainstem is essential for guiding the diagnostic approach and assisting in early initiation of appropriate therapy. We herein report on a case of BSE and provide an overview of the various causes of autoimmune BSE with an emphasis on the clinical manifestations and diagnostic approach.

Electrophysiology plays a determinant role in Guillain-Barré syndrome (GBS) diagnosis, classification, and prognostication. However, traditional electrodiagnostic (EDX) criteria for GBS rely on motor nerve conduction studies (NCS) and are suboptimal early in the course of the disease or in the setting of GBS variants. Sensory nerve conduction studies, including the sural-sparing pattern and the sensory ratio are not yet included in EDX criteria despite their well-established role in GBS diagnosis. The aim of this review is to discuss the diagnostic value of sensory NCS in GBS, their role in establishing the diagnosis and predicting the outcome according to the various subtypes of the disease., Competing Interests: Conflict of Interest MAC declares having received compensation from Janssen Global Services LLC. SSA declares having received travel grants or compensation from Genzyme, Biogen, Novartis, and Roche. The remaining authors do not have potential conflicts of interest to be disclosed., (Copyright © 2021 International Federation of Clinical Neurophysiology. Published by Elsevier B.V. All rights reserved.)

Hemodialysis (HD) is the most common method of renal replacement therapy. Besides toxins, it eliminates nutrients from the circulation, such as ascorbic acid (AA). HD-patients present AA deficiency more often than representatives of the general population, also due to dietary restrictions. This condition aggravates oxidative stress and inflammation related to uremia and extracorporeal circulation and increases cardiovascular risk followed by mortality. Supplementation of AA seems to be a promising approach in the treatment of hemodialysis patients. Many successful interventions restored plasma AA concentration in HD patients by enteral or intravenous supplementation, concomitantly inhibiting oxidative stress and inflammation. A significant number of studies reported opposite, serious pro-oxidant effects of AA. In this narrative review, we present studies, commenting on their limitations; on AA plasma or serum concentration and the influence of its supplementation on protein and lipid peroxidation, DNA damage, reactive oxygen species generation, paraoxonase activity, advanced glycation endproducts, and C-reactive protein (CRP) concentration. Moreover, in terms of safety, the possible development of oxalosis in HD patients regarding the intravenous or enteral route of AA administration is discussed. Unequivocal clinical results of recent studies on hemodialysis patients are displayed.

Fusobacterium nucleatum is a common oral bacterium that is enriched in colorectal adenomas and adenocarcinomas (CRC). In humans, high fusobacterial CRC abundance is associated with chemoresistance and poor prognosis. In animal models, fusobacteria accelerate CRC progression. Targeting F. nucleatum may reduce fusobacteria cancer progression and therefore determining the origin of CRC F. nucleatum and the route by which it reaches colon tumors is of biologic and therapeutic importance. Arbitrarily primed PCR performed previously on matched same-patients CRC and saliva F. nucleatum isolates, suggested that CRC F. nucleatum may originate from the oral cavity. However, the origin of CRC fusobacteria as well as the route of their arrival to the tumor have not been well-established. Herein, we performed and analyzed whole genome sequencing of paired, same-patient oral, and CRC F. nucleatum isolates and confirmed that CRC-fusobacteria originate from the oral microbial reservoir. Oral fusobacteria may translocate to CRC by descending via the digestive tract or using the hematogenous route during frequent transient bacteremia caused by chewing, daily hygiene activities, or dental procedures. Using the orthotropic CT26 mouse model we previously showed that IV injected F. nucleatum colonize CRC. Here, we compared CRC colonization by gavage vs. intravenous inoculated F. nucleatum in the MC38 and CT26 mouse orthotropic CRC models. Under the tested conditions, hematogenous fusobacteria were more successful in CRC colonization than gavaged ones. Our results therefore provide evidence that the hematogenous route may be the preferred way by which oral fusobacteria reach colon tumors., (Copyright © 2020 Abed, Maalouf, Manson, Earl, Parhi, Emgård, Klutstein, Tayeb, Almogy, Atlan, Chaushu, Israeli, Mandelboim, Garrett and Bachrach.)

Fusobacterium nucleatum is an oral anaerobe recently found to be prevalent in human colorectal cancer (CRC) where it is associated with poor treatment outcome. In mice, hematogenous F. nucleatum can colonize CRC tissue using its lectin Fap2, which attaches to tumor-displayed Gal-GalNAc. Here, we show that Gal-GalNAc levels increase as human breast cancer progresses, and that occurrence of F. nucleatum gDNA in breast cancer samples correlates with high Gal-GalNAc levels. We demonstrate Fap2-dependent binding of the bacterium to breast cancer samples, which is inhibited by GalNAc. Intravascularly inoculated Fap2-expressing F. nucleatum ATCC 23726 specifically colonize mice mammary tumors, whereas Fap2-deficient bacteria are impaired in tumor colonization. Inoculation with F. nucleatum suppresses accumulation of tumor infiltrating T cells and promotes tumor growth and metastatic progression, the latter two of which can be counteracted by antibiotic treatment. Thus, targeting F. nucleatum or Fap2 might be beneficial during treatment of breast cancer.

Background: Controversy surrounds the cause of the pressure gradient in patients with hypertrophic obstructive cardiomyopathy (HOCM). Left ventricular cavity obliteration (LVCO) was first described as the cause of the gradient but subsequently systolic anterior motion (SAM) of the mitral valve has been established as the cause. Nevertheless, the two gradients, though different in origin and significance, share similar characteristics. They both have a similar "dagger" profile, are obtained from the cardiac apex, are associated with a hyperdynamic left ventricle, and the gradients are worsened by Valsalva. The distinction has clinical relevance, because treating the intracavitary gradient (ICG) of LVCO as if it were a SAM-associated gradient associated with HOCM would be inappropriate and possibly harmful., Materials and Methods: To clarify the cause and characteristics of the ICG in patients with LVCO in patients without HOCM, we assessed the extent and duration of cavity obliteration, and for differentiation, we compared the spectral profiles with patients with HOCM and severe aortic stenosis (AS)., Results: Higher ICG is associated with a greater extent and more prolonged apposition of LV walls, and smaller left ventricular cavity size. The spectral profile of patients with AS, HOCM, and LVCO is differentiated by the peak/mean gradient ratios of 2 or less, 2-3, and 3 or greater, respectively, in >90% of patients. Most patients with LVCO without HOCM or severe LVH have an ICG < 36 mm Hg., Conclusion: The magnitude of ICG is quantitatively associated with the extent and duration of LVCO. Spectral profiles of severe AS, HOCM, and LVCO can be differentiated by the peak/mean gradient ratio., (© 2020 The Authors. Echocardiography published by Wiley Periodicals LLC.)