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Background: Vaccine-induced immune thrombocytopenia and thrombosis (VITT) is a new syndrome associated with the ChAdOx1 nCoV-19 adenoviral vector vaccine against severe acute respiratory syndrome coronavirus 2. Data are lacking on the clinical features of and the prognostic criteria for this disorder.Methods: We conducted a prospective cohort study involving patients with suspected VITT who presented to hospitals in the United Kingdom between March 22 and June 6, 2021. Data were collected with the use of an anonymized electronic form, and cases were identified as definite or probable VITT according to prespecified criteria. Baseline characteristics and clinicopathological features of the patients, risk factors, treatment, and markers of poor prognosis were determined.Results: Among 294 patients who were evaluated, we identified 170 definite and 50 probable cases of VITT. All the patients had received the first dose of ChAdOx1 nCoV-19 vaccine and presented 5 to 48 days (median, 14) after vaccination. The age range was 18 to 79 years (median, 48), with no sex preponderance and no identifiable medical risk factors. Overall mortality was 22%. The odds of death increased by a factor of 2.7 (95% confidence interval [CI], 1.4 to 5.2) among patients with cerebral venous sinus thrombosis, by a factor of 1.7 (95% CI, 1.3 to 2.3) for every 50% decrease in the baseline platelet count, by a factor of 1.2 (95% CI, 1.0 to 1.3) for every increase of 10,000 fibrinogen-equivalent units in the baseline d-dimer level, and by a factor of 1.7 (95% CI, 1.1 to 2.5) for every 50% decrease in the baseline fibrinogen level. Multivariate analysis identified the baseline platelet count and the presence of intracranial hemorrhage as being independently associated with death; the observed mortality was 73% among patients with platelet counts below 30,000 per cubic millimeter and intracranial hemorrhage.Conclusions: The high mortality associated with VITT was highest among patients with a low platelet count and intracranial hemorrhage. Treatment remains uncertain, but identification of prognostic markers may help guide effective management. (Funded by the Oxford University Hospitals NHS Foundation Trust.). [ABSTRACT FROM AUTHOR]

Several clinical series have reported successful closure of perimembranous ventricular septal defects using trancathether devices. This review presents the morphological aspects of ventricular septal defects focusing on perimembranous septal defects. By definition, a part of the margin of perimembranous septal defects is the area of fibrous continuity abutting the central fibrous body that bears the atrioventricular conduction bundle. Depending on the excursion of the remaining margin, these defects are in proximity to the aortic, tricuspid, or mitral valves. Defects that extend to be doubly committed and juxtaarterial are roofed by contiguity between pulmonary and aortic valves. Recognition of the proximity or distance of important structures is relevant in considering perimembranous defects for device closure. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Fast intestinal transit may be responsible for slow adaptation and unacceptable steady-state function after restorative proctocolectomy. Investigation of GI transit time may be valuable in such a setting. We hypothesized that postprandial hydrogen breath tests may yield transit data that correlate with technetium-labeled meal scintigrams. METHODS: This study compared intestinal transit after a lactulose and bean meal via the breath hydrogen and scintigraphy methods in 21 ileoanal pouch subjects. The meal consisted of baked beans (425 g), 30 ml (20 g) lactulose syrup, 1 mCi 99mtechnetium sulfur colloid in finely chopped liver and 170 ml tap water. The meal contained 120 Kcal (70% carbohydrate, 18% protein and 12% fat). RESULTS: Of 21 pouch subjects, 11 (53%) had breath tests and scintigrapby transit studies that differed by 5-21 min. Three of 21 (14%) scintigraphy mouth to pouch transit times were faster than breath test transits by 43-107 min. Seven of 21 (33%) subjects did not have breath test peaks > 10 ppm. Mouth to pouch transit for breath hydrogen (104 ± 16 min) and scintigraphy (98 ± 7 min) tests had significant correlation (r = 0.96, p < 0.0001) among subjects with alveolar hydrogen peaks and accurate scintigrams (n = II). Scintigrams were five times more expensive than breath tests. CONCLUSIONS: A peaking hydrogen breath test provides an alternative to scintigraphy for estimating intestinal transit after ileoanal pouch. [ABSTRACT FROM AUTHOR]

Tumors were induced in the HRA/Skh-1 hairless mouse by repeated irradiations of minimally erythemal and suberythemal doses of UV radiation. Aspects of tumor induction were recorded using a combined system of mapping and gross descriptive classification. Tumors of epithelial and dermal (mesenchymal) origin were confirmed histologically and their types correlated well with those reported by earlier investigators. Among those classified, however, appendage tumors and hemangiomas have rarely been described. The progression to malignancy of epithelial tumors was systematically characterized and was a consistent histogenic feature in our experiments. Squamous cell carcinomas represented a final stage for development arising ab initio or from other forms, in particular papillomas which commonly passed through intermediate forms toward definite malignancy. While confirming previous studies of UV-induced tumors, this report extends our knowledge of their dynamics as this bears upon any experimental objective which includes an assessment of tumorigenicity. [ABSTRACT FROM AUTHOR]

The sequelae of thrombus formation, both by shear forces and by collagen fiber, the subsequent coagulation, and the dislodgement of thrombi (thrombolysis) were measured from a small volume of nonanticoagulated blood sample, by a new instrument. Addition of streptokinase (SK) or tissue-type plasminogen activator (rt-PA) to the blood sample eliminated the need for anticoagulation for thrombolysis measurement: clot lysis preceded and allowed thrombolysis to occur. The test revealed activation of platelets and coagulation by SK and fl-PA. Apart from this general trend, platelet reactivity in response to plasminogen activator showed great individual variation. Whether the greatly enhanced (42 %) or prolonged hemostasis (13%), observed in different blood samples with rt-PA, could be used as a predictor of reocclusion or bleeding complications remains to be established. Thrombolysis did not occur in 12% of the samples tested. These thrombolysis models may be useful for developing new agents for the dissolution of platelet-rich thrombi. It is suggested that this technique be used for monitoring thrombolytic therapy. [ABSTRACT FROM AUTHOR]

Objectives and Methods: The outcome after liver transplantation for HBsAg-positive liver disease complicated by hepatocellular carcinoma is not clearly defined, and in the present study we analyzed the clinical course in 39 patients transplanted for hepatitis B virus (HBV)-related liver disease (group 1) compared with 16 patients with chronic HBV and hepatocellular carcinoma (group 2) and 52 patients with primary hepatocellular carcinoma seronegative for HBsAg (group 3). Results: Despite similar pretransplant viral serology, HBV recurred more often in patients with tumor (group 2) than in nontumor cases (group 1), with 1-yr actuarial cumulative reinfection rates of 85.4% versus 65.0%, respectively (p < 0.05). In group 2 cases, we observed a more aggressive pattern of HBV-related graft injury with a higher frequency of graft loss (56.3% vs. 12.8%, p< 0.001). Long-term outcome was worse in the group 2 cases, with 5-yr actuarial survival rates of 16.7% compared with 73.2% and 28.2% for groups 1 and 3, respectively. In group 2, recurrence of HBV in the graft, rather than tumor recurrence, was the principal cause of the high mortality observed (56.2% vs. 12.5%), which, in some cases, may have been potentiated by adjuvant chemotherapy. Conclusion: The poor outcome of patients transplanted for HBsAg-positive cirrhosis and hepatocellular carcinoma is due to HBV reinfection of the graft, rather than tumor recurrence. Antiviral agents in association with hepatitis B immunoglobulin would be the most promising approach to improving survival in this patient population. [ABSTRACT FROM AUTHOR]

Presents a summary of the surveillance conducted by the Working Party in identifying the factors which place an individual at a significantly greater risk of developing gastrointestinal cancer as of August 2, 1994. Reason the effectiveness and the potential risks of the surveillance protocol must be considered; Gene mutations that play a role in gastrointestinal carcinogenesis; Discussion on the pathology of premalignant lesions.

Hepatosplenic schistosomiasis is occasionally associated with cirrhosis and progressive hepatic decompensation. The aim of the present study was to determine the prevalence of antibody to hepatitis C virus in patients with schistosomiasis and cirrhosis. The prevalence of anti-HCV was studied in 12 consecutive cases of schistosomiasis associated with biopsy proven cirrhosis. All patients had a past history of schistosomiasis and high titers of schistosomal antibodies in serum (1:32 to 1:4096). Five of the 12 patients had hepatic cathe-terization and were found to have sinusoidal involvement with corrected sinusoidal pressures ranging from 19 to 23 mm Hg. Four had ascites, six had pedal edema, and eight had peripheral signs of chronic liver disease in the form of palmar crythema. spider nevi. and/or gynecomastia. Ten of the 12 cases (83%) were repeatedly positive for anti-HCV/ELISA. These results suggest that when patients with schistosomiasis develop cirrhosis, associated hepatitis C virus infection should be suspected. [ABSTRACT FROM AUTHOR]

Two cases of Caroli's disease confined to the left lobe of the liver are described. One patient is a 13-yr-old who presented with acute pancreatitis. The second patient presented with obstructive jaundice at age 60. In the latter case, the diagnosis was made by percutaneous transhepatic cbolangiography, in the former by post-operative T-tube cholangiography. The diseased bile ducts were not resected in either patient. Both remain well at 4 and 5.5 yr postoperatively. Monolobar involvement in Caroli's disease has been described previously in only 34 published cases, and these are reviewed in detail. [ABSTRACT FROM AUTHOR]

Four patients developed post-kala-azar dermal leishmaniasis and neuritis (PKDL) 1 to 6 months following apparently successful treatment of kala-azar. The duration of the lesion varied between 1 month and nearly 5 years. The lesions were macules, papules, or nodules affecting the face, extremities, and trunk. The diagnosis was made by demonstration of the parasite in slit smear and biopsies and by a positive direct agglutination test (DAT). Histologically, the patients were found to have neuritis affecting the cutaneous nerves in the lesion only. The nerves showed a lymphohistiocytic infiltration and occasionally parasites. There was no impairment of sensation. Response to sodium stibogluconate was good. PKDL may simulate leprosy both clinically and pathologically. [ABSTRACT FROM AUTHOR]

Three patients, aged 31, 26, and 22 years, had pemphigus vulgaris. A delay in diagnosis and appropriate treatment occurred because the initial presentation was confined to the oral mucosa. [ABSTRACT FROM AUTHOR]

The article focuses on the health risks of flooding, highlighting both immediate dangers like drowning and injury, and long-term effects such as disease spread and worsened health conditions. It emphasizes the increasing frequency of floods due to climate change and discusses strategies to reduce these risks through better preparedness and response.

The article discusses a phase 3 study which assessed the efficacy and safety of idelalisib, an oral inhibitor of the delta isoform of phosphatidylinositol 3-kinase, in combination with rituximab versus rituximab plus placebo in patients with relapsed chronic lymphocytic leukemia (CLL). It cites improvement in progression-free survival, overall response rate, and overall survival in patients receiving idelalisib and rituximab. It also mentions the occurrence of adverse events in some patients.

Interactions between dermatophyte fungi and staphylococci or brevibacteria on a new skin-based culture medium are described. Penicillin production by the fungus selects penicillin resistant S. aureus or B. epidermidis. Fungi are inhibited by brevibacteria but not by the staphylococci. "Keratolysis" by fungi may contribute to the growth nutrients of staphylococci. [ABSTRACT FROM AUTHOR]

Atherosclerosis affects the inner layers of human arteries, and causes major problems by blocking, directly or indirectly, the flow of blood. This paper concerns the growth of atherosclerotic lesions (atherogenesis), in particular potential factors that may allow a form of 'positive feedback' that drives the development of lesions, and considers the role of microvessels. The lesions of atherosclerosis have previously been compared to, or thought of as, sites of inflammation, and involve the accumulation of cells, including large lipid-containing macrophages, and extracellular elements. In tissues other than arteries inflammation may involve, amongst other phenomena, a resolution stage with the removal or departure of macrophages via lymphatics. However, the inner aspects of large arteries do not normally demonstrate lymphatics or other microvessels, and there is evidence from animal work that the lack of vessels effectively contributes to the development of atherosclerosis, as this limits the egress of macrophages and other elements. Conversely, in humans microvessels have been suggested to play a key role in the progress of atherosclerotic lesions. The importance of microvessels is herein considered, in particular the potentially paradoxical situation where as stated the lack of microvessels can be considered to allow atherosclerosis, but on the other hand these structures are involved in lesion development - the explanation can be seen to relate to the relatively short length of time which is assessable in animal models, compared to the lengthy period over which lesions appear to develop in humans. In addition, consideration is given to other factors, including haemodynamic factors related to the physical presence of lesions, which could lead to phenomena that can be regarded as a vicious cycle of events that lead to growth of the lesion. Specifically initial inflammation may lead to scarring and anatomical distortion, which through haemodynamic and physical factors leads to more damage, more inflammation and scarring, and so on., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Cancer development is driven by the accumulation of DNA changes in the approximately 40000 chromosomal genes. In solid tumours, chromosomal numerical/structural aberrations are common. DNA repair defects may lead to genome-wide genetic instability, which can drive further cancer progression. The genes code the actual players in the cellular processes, the 100000-10 million proteins, which in (pre)malignant cells can also be altered in a variety of ways. Over the past decade, our knowledge of the human genome and Genomics (the study of the human genome) in (pre)malignancies has increased enormously and Proteomics (the analysis of the protein complement of the genome) has taken off as well. Both will play an increasingly important role. In this article, a short description of the essential molecular biological cell processes is given. Important genomic and proteomic research methods are described and illustrated. Applications are still limited, but the evidence so far is exciting. Will genomics replace classical diagnostic or prognostic procedures? In breast cancers, the gene expression array is stronger than classical criteria, but in endometrial hyperplasia, quantitative morphological features are more cost-effective than genetic testing. It is still too early to make strong statements, the more so because it is expected that genomics and proteomics will expand rapidly. However, it is likely that they will take a central place in the understanding, diagnosis, monitoring and treatment of (pre)cancers of many different sites.