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Urology Oct 2018Translabial ultrasound (TUS) can provide an inexpensive alternative imaging modality for evaluating pelvic floor structures and synthetic slings as mesh can be difficult...
BACKGROUND
Translabial ultrasound (TUS) can provide an inexpensive alternative imaging modality for evaluating pelvic floor structures and synthetic slings as mesh can be difficult to identify on pelvic exam or cystoscopy, patients may be unable to provide an accurate history of previous pelvic surgery, and cross-sectional imaging with computed tomography and magnetic resonance imaging can be inadequate for evaluating synthetic slings.
OBJECTIVE
To demonstrate the use of TUS in the evaluation of female pelvic floor structures and mesh.
METHODS
Translabial ultrasound can be used in the Urology clinic or intraoperative setting using a curvilinear transducer. Following identification of anatomic landmarks in the various planes of the pelvic floor, TUS can evaluate for pelvic floor disorders and the type and location of synthetic mesh material. Artifacts, such as air pockets in the vagina or rectum and the hypoechoic pubic symphysis, are also considered.
RESULTS
Real-time imaging allows for dynamic examination of pelvic organ prolapse and urethral hypermobility that can contribute to pelvic exam findings. Bladder ultrasound can help evaluate for lesions, calculi, and even mesh erosion. Translabial ultrasound can also be used to differentiate hyperechoic retropubic and transobturator slings by identifying the position of sling arms and the appearance of the sling at different planes. Evaluation with TUS can demonstrate sling disruption, folding, urethral impingement, and erosion into pelvic floor structures. This can be particularly useful in patients presenting with pain, recurrent infections, or voiding dysfunction in which problems with mesh may not be easily identified on pelvic exam or cystoscopy. This imaging modality can complement a patient's history, aid in preoperative planning, and enable intraoperative identification of mesh slings.
CONCLUSION
Translabial ultrasound provides a quick, readily available, and easy-to-learn imaging modality for evaluating pelvic floor structures and mesh in the office or intraoperative setting.
PubMed: 30031831
DOI: 10.1016/j.urology.2018.07.004 -
Journal of Cardiology Cases Aug 2018The number of implantations of cardiac implantable electrophysiological devices (CIEDs) has increased over the past several years. However, the aging population and...
The number of implantations of cardiac implantable electrophysiological devices (CIEDs) has increased over the past several years. However, the aging population and expansion of indications for CIEDs have led to an increase in associated infections. We experienced a case of a 99-year-old man presenting with skin erosion at the pocket site, where a 6-month-old implantable pacemaker was replaced. He was referred for pacemaker pocket infection and presented with fever accompanied by pain and swelling around pacemaker generator. We could not explant 7-year-old pacemaker leads and the patient refused to undergo either laser lead extraction or surgical removal. We planned to re-implant in the contralateral chest. However, the patient was emaciated with low body-mass-index (15.2 kg/m), thus concerns arose about the possibility of tissue disruption and re-infection owing to thin skin and absence of sufficient subcutaneous tissue in contralateral subclavian region. Axillary placement of CIEDs has been adopted in patients with limited venous access. We applied a mid-axillary pacemaker implant procedure to this elderly and emaciated patient. Postoperative clinical course was uneventful. After discharge, no history of unexplained fever or illness was recorded. Mid-axillary pacemaker pocket could be an alternative approach for re-implantation in patients with emaciated, cachexic, or limited pocket preparation. < We apply the mid-axillary pacemaker implant procedure to a nonagenarian with contralateral pacemaker infection to minimize the risk of skin disruption after implantation. This implies that implantation is possible in patients with emaciated or cachexic or infection of the contralateral subclavian pocket. Mid-axillary pacemaker pocket could be an alternative approach for re-implantation in patients with emaciated, cachexic, or limited pocket preparation.> .
PubMed: 30279914
DOI: 10.1016/j.jccase.2018.04.008 -
Acta Biochimica Et Biophysica Sinica May 2024Rheumatoid arthritis (RA) is an idiopathic and chronic autoimmune disease for which there are currently no effective treatments. Oxypeucedanin hydrate (OXH) is a natural...
Rheumatoid arthritis (RA) is an idiopathic and chronic autoimmune disease for which there are currently no effective treatments. Oxypeucedanin hydrate (OXH) is a natural coumarin known for its potent anti-inflammatory properties. However, further investigations are needed to determine its therapeutic efficacy in treating RA. In this study, we evaluate the anti-inflammatory activity of OXH by treating LPS-induced RAW264.7 macrophages. Our results show that OXH treatment reverses the changes in iNOS, COX-2, IL-1β, IL-6, and TNF-α levels. Additionally, OXH reduces ROS production. Further analysis reveals that OXH suppresses the activation of the NF-κB/MAPK pathway. CETSA results show that OXH competes with LPS for binding to the TLR4/MD2 complex. MST experiments demonstrate the specific affinity of OXH for the TLR4/MD2 complex, with a Kd value of 33.7 μM. Molecular docking analysis suggests that OXH binds to the pocket of the TLR4/MD2 complex and interacts with specific amino acids, such as GLY-343, LYS-388, and PHE-345. Molecular dynamics simulations further confirm this conclusion. Finally, we investigate the potential of OXH in treating RA using a collagen-induced arthritis (CIA) model in rats. OXH effectively ameliorates the symptoms of CIA, including improving body weight, reducing swelling and redness, increasing talus volume, and decreasing bone erosion. OXH also decreases the mRNA levels of pro-inflammatory factors in synovial tissue. Transcriptome enrichment analysis and western blot analysis confirm that OXH suppresses the NF-κB/MAPK pathway, which is consistent with our findings.
PubMed: 38734936
DOI: 10.3724/abbs.2024076 -
Polymers Sep 2018The objective of this study was to develop the metronidazole loaded high and low methoxyl pectin films (HM-G-MZ and LM-G-MZ) for the treatment of periodontal disease....
The objective of this study was to develop the metronidazole loaded high and low methoxyl pectin films (HM-G-MZ and LM-G-MZ) for the treatment of periodontal disease. The films were prepared by pectin 3% /, glycerin 40% /, and metronidazole 5% / The developed films were characterized by scanning electron microscope and evaluated for thickness, weight variation, and elasticity. The developed films showing optimal mechanical properties were selected to evaluate radial swelling properties, in vitro release of metronidazole and the antimicrobial activity against and by the disc diffusion method. The results demonstrated that LM-MZ and HM-G-MZ films were colorless and yellowish color, respectively, with the film thickness around 0.36⁻0.38 mm. Furthermore, both films exhibited good elasticity with low puncture strength (1.63 ± 0.37 and 0.84 ± 0.03 N/mm², respectively) and also showed slight increase in radial swelling, so that they could be easily inserted and fitted into the periodontal pocket during a clinical use. However, HM-G-MZ showed a decrease in radial swelling after 1 h due to the film erosion. The in vitro release study of LM-G-MZ showed a burst release that was initially followed by a slow release rate profile, capable to maintain the therapeutic level in periodontal pocket for seven days, whereas HM-G-MZ showed an immediate release profile. The cumulative percentage of metronidazole release from HM-G-MZ was less than LM-G-MZ during the first 5 min as metronidazole was in a crystalline form inside HM-G-MZ film. For antimicrobial activity test, both films showed the inhibitory effect against and , and there was no difference in the inhibition zone between LM-G-MZ and HM-G-MZ. The present study showed, for the first time, that low methoxyl pectin film containing glycerin and metronidazole could be potentially considered as a promising clinical tool for the drug delivery via intra-periodontal pocket to target an oral disease that is associated with polymicrobial infection.
PubMed: 30960947
DOI: 10.3390/polym10091021 -
Pacing and Clinical Electrophysiology :... Jul 2018Methodology specific for moving superficial chronically implanted transvenous pacing leads to a subpectoral pocket is not described in the literature. Relocation of...
BACKGROUND
Methodology specific for moving superficial chronically implanted transvenous pacing leads to a subpectoral pocket is not described in the literature. Relocation of prepectoral leads and generator to a submuscular pocket for relief of erosion and pain with minimal pectoral trauma is possible by applying a variant of a previously described submammary tunneling technique.
METHODS
All patients presenting for device follow-up, elective battery replacement, or system upgrade over an 8-month period were considered for relocation if experiencing significant thinning or pain over their prepectoral implant. Those selected for relocation then had their system moved subpectorally via the tunneling technique. Patients were followed for 6 months postoperatively for procedurally related complications and resolution of preprocedure symptoms.
RESULTS
Thirty-two leads in 14 patients were all successfully relocated. Of the relocated leads, five (16%) were a three-pin connector implantable cardioverter defibrillator lead. Three patients (21%) in the group required short-term prescription analgesia in the immediate postdischarge period. Pain and erosion concerns abated in the study group by the 3-month follow-up.
CONCLUSIONS
Relocation of superficial pacing leads with CIED generator to a subpectoral pocket facilitated by this tunneling method is successful, safe, and can accommodate single and multipin leads with minimal pectoral trauma and no nerve damage.
Topics: Defibrillators, Implantable; Humans; Pacemaker, Artificial; Pain; Pectoralis Muscles; Postoperative Complications; Prosthesis Implantation
PubMed: 29745977
DOI: 10.1111/pace.13366 -
Bioorganic & Medicinal Chemistry Dec 2023Bromodomain and PHD finger-containing (BRPF) proteins function as epigenetic readers that specifically recognize acetylated lysine residues on histone tails. The...
Bromodomain and PHD finger-containing (BRPF) proteins function as epigenetic readers that specifically recognize acetylated lysine residues on histone tails. The acetyl-lysine binding pocket of BRPF has emerged as an attractive target for the development of protein interaction inhibitors owing to its potential druggability. In this study, we identified 3-acetylindoles as bone antiresorptive agents with a novel scaffold by performing structure-based virtual screening and hit optimization. Among those derivatives, compound 18 exhibited potent and selective inhibitory activities against BRPF1B (IC = 102 nM) as well as outstanding inhibitory activity against osteoclastogenesis (73.8% @ 1 μM) and differentiation (IC = 0.19 μM) without cytotoxicity. Besides, cellular mechanism assays demonstrated that compound 18 exhibited a strong bone antiresorptive effect by modulating the RANKL/RANK/NFATc1 pathway. Structural and functional studies on BRPF1 inhibitors aid in making advances to understand the epigenetic mechanisms of bone cell development and create innovative therapeutics for treating bone metastases from solid tumors and other bone erosive diseases.
Topics: Osteogenesis; Osteoclasts; NF-kappa B; Receptor Activator of Nuclear Factor-kappa B; Bone Density Conservation Agents; Ligands; Lysine; Cell Differentiation; RANK Ligand; NFATC Transcription Factors
PubMed: 37951134
DOI: 10.1016/j.bmc.2023.117440 -
Artificial Cells, Nanomedicine, and... Sep 2018Periodontal disease is chronic, highly prevalent infectious disease that requires prolonged and controlled delivery of antimicrobial agents into pockets. To achieve this...
Periodontal disease is chronic, highly prevalent infectious disease that requires prolonged and controlled delivery of antimicrobial agents into pockets. To achieve this objective, dual antimicrobials encapsulated chitosan fortified calcium alginate (CS-Ca-SA) microspheres were formulated by application of Plackett-Burman factorial design. The microspheres were optimized for particle size (PS), entrapment efficiency (EE) and drug release. The optimized microspheres presented average PS of 74-461 µm and EE of 62.45-86.20% with controlled drug delivery for 120 hours. FTIR disclosed successful complexation between SA and CS. DSC and XRD studies showed changes in the crystallinity of drugs in microspheres. Shape factor and SEM demonstrated spherical to pear-shaped microspheres. Release exponent >0.43 and high diffusion coefficients revealed non-Fickian-based diffusion-limited drug release. CS-Ca-SA microspheres exhibited surface pH of 6.5 ± 0.5, moderate swelling, less erosion and improved mucoadhesion over Ca-SA microspheres. Also, significant antimicrobial activity against Escherichia coli and Staphylococcus aureus and cytocompatibility with L929 cell lines were observed. Further, microspheres exhibited long-term stability on refrigeration. The outcomes of study supported the potential of dual polymer and dual drug-based biodegradable, stable, non-toxic, mucoadhesive, controlled and prolonged drug release microspheres as more patient compliant by administration into periodontal pockets for the management of periodontal disease.
Topics: Alginates; Anti-Infective Agents; Chitosan; Delayed-Action Preparations; Diffusion; Doxycycline; Drug Carriers; Drug Combinations; Drug Delivery Systems; Drug Liberation; Glucuronic Acid; Hexuronic Acids; Microbial Sensitivity Tests; Microbial Viability; Microspheres; Models, Chemical; Ornidazole; Particle Size
PubMed: 28830256
DOI: 10.1080/21691401.2017.1366331 -
British Dental Journal Oct 2019Aims To determine patient awareness of periodontal health, dentine hypersensitivity and tooth wear, and their impact on oral health quality of life in patients attending...
Aims To determine patient awareness of periodontal health, dentine hypersensitivity and tooth wear, and their impact on oral health quality of life in patients attending NHS practices in South West England.Method In this cross-sectional, multi-centre epidemiological study 814 adult NHS patients completed an oral health questionnaire and then underwent a clinical examination. Pocket probing depths (mm), gingival recession (mm), gingival bleeding (yes/no), dentine hypersensitivity (Schiff score, and yes/no) and tooth wear (basic erosive wear examination score) were measured.Results Participants were regular dental attenders, with good oral hygiene practices and a low prevalence of periodontal disease (probing depth of 4 mm or more) (25%). For all conditions assessed, self-reported data and clinical indices were significantly positively associated, with the strongest associations being seen for dentine hypersensitivity and the weakest for tooth wear. Periodontal disease and dentine hypersensitivity were significantly associated with all four patient-reported measures of oral health quality of life studied.Conclusion This NHS patient population is well cared for and educated with respect to their oral health. The findings confirm the negative impact of periodontal disease and dentine hypersensitivity, and identifies the need to increase awareness of the signs and symptoms of tooth wear.
Topics: Adult; Cross-Sectional Studies; Dentin Sensitivity; England; Humans; Quality of Life; State Medicine
PubMed: 31605067
DOI: 10.1038/s41415-019-0721-9 -
Auris, Nasus, Larynx Apr 2015This clinical study was performed to analyze the characteristics of attic cholesteatoma occurring behind a tiny retraction of the pars flaccida, which was classified as...
OBJECTIVE
This clinical study was performed to analyze the characteristics of attic cholesteatoma occurring behind a tiny retraction of the pars flaccida, which was classified as Tos type I or II and had an intact pars tensa of the tympanic membrane.
METHODS
The clinical records of patients who underwent tympanomastoidectomy for attic cholesteatoma at a tertiary care referral center (Kangdong Sacred Heart Hospital of Seoul, Korea) between March 2004 and December 2012 were retrospectively reviewed. Eleven patients (five men and six women) who underwent tympanomastoidectomy between March 2004 and December 2012 for attic cholesteatoma occurring behind a tiny attic retraction were included. The mean age of patients was 41.1 years (range 20-58 years) and the mean duration of follow-up was 29.5 months (range 13-52 months).
RESULTS
Every patient had a unilateral cholesteatoma, and the opposite side was normal except in one patient. Hearing loss was the most common symptom, followed by earfullness and otalgia. Five patients had type I attic retraction, and six patients had type II attic retraction. No patient had definite scutum erosion. Interestingly, during regular postoperative checkup, one patient was found incidentally for the opposite ear. Six patients had a cholesteatoma sac that was separated from the pars flaccida, whereas in five patients it was in contact with the pars flaccida but was easily separated. Six patients had a limited cholesteatoma within the epitympanum, and five patients had extension beyond the epitympanum. The average air-bone gap was 24.3±10.1dB before the operation and 14.2±6.6dB after the operation. Every patient had an intact tympanic membrane without retraction pocket postoperatively. There was no recurrence of cholesteatoma during follow-up.
CONCLUSION
The rate of attic cholesteatomas occurring behind a tiny retraction of the pars flaccida was 7.7% (11 of 142 patients with attic cholesteatoma). Attic retractions must be followed closely using endoscopy, microscopy, and temporal bone Computed tomography, even though the patient has a tiny retraction of the pars flaccida or a normal hearing level.
Topics: Adult; Cholesteatoma, Middle Ear; Cohort Studies; Female; Humans; Male; Mastoid; Middle Aged; Otologic Surgical Procedures; Retrospective Studies; Tomography, X-Ray Computed; Tympanic Membrane; Young Adult
PubMed: 25199742
DOI: 10.1016/j.anl.2014.08.006 -
World Neurosurgery Sep 2018Skin complications are a frequent type of complication of deep brain stimulation (DBS) neurosurgical procedure and are always observed in the postauricular area, scalp...
BACKGROUND
Skin complications are a frequent type of complication of deep brain stimulation (DBS) neurosurgical procedure and are always observed in the postauricular area, scalp area, and implantable pulse generator pocket. Modifications to the surgical techniques for DBS have been proposed as therapeutic options. To prevent skin complications, we modified the surgical incisions.
METHODS
At our center, we retrospectively analyzed the complications associated with traditional surgical incisions and then adjusted the double C-shaped incision and changed the postauricular incision from vertical to horizontal in patients undergoing DBS for movement disorders.
RESULTS
Skin complications were observed in 4 patients among 30 patients who underwent traditional surgical incisions. In 102 consecutive patients who underwent operations with modified surgical incisions, we did not encounter any skin complications such as skin infection or erosion related to our modified incision. A single patient experienced pain and was cured after a week of local antiinflammatory treatment.
CONCLUSION
By trying to avoid placing hardware directly under the suture line, our modified surgical incision successfully reduces the incidence of skin complications.
Topics: Adult; Aged; Aged, 80 and over; Deep Brain Stimulation; Dystonia; Female; Humans; Incidence; Male; Middle Aged; Parkinson Disease; Postoperative Complications; Retrospective Studies; Skin Diseases; Surgical Wound; Time Factors; Young Adult
PubMed: 29886304
DOI: 10.1016/j.wneu.2018.05.224