Biologic excipients: Importance of clinical awareness of inactive ingredients

Spinal metastases are the most common of spinal neoplasms and occur predominantly in an extradural location. Their appearance in an intradural location is uncommon and is associated with a poor prognosis. Cerebrospinal fluid dissemination accounts for a significant number of intradural spinal metastases mostly manifesting as leptomeningeal carcinomatoses or drop metastases from intracranial tumors. The occurrence of local tumor dissemination intradurally following surgery for an extradural spinal metastasis has not been reported previously. The authors describe 2 cases in which local intradural and intramedullary tumor recurrences occurred following resection of extradural metastases that were complicated by unintended durotomy. To heighten clinical awareness of this unusual form of local tumor recurrence, the authors discuss the possible etiology and clinical consequences of this entity.

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Evolution of Internal Stress in Heterogeneous Electrode Composite during the Drying Process

Energies ◽

10.3390/en14061683 ◽

2021 ◽

Vol 14 (6) ◽

pp. 1683

Author(s):

Zuoquan Zhu ◽

Yaolong He ◽

Hongjiu Hu ◽

Fangzhou Zhang

Keyword(s):

Internal Stress ◽

Vinylidene Fluoride ◽

Influence Factors ◽

Lithium Ion ◽

Integrated Analysis ◽

Drying Time ◽

Component Distribution ◽

Poly Vinylidene Fluoride ◽

Inactive Ingredients ◽

Main Influence

The mechanical behavior of electrode composite during the drying preparation has played a crucial role in the electrochemical performance of lithium-ion batteries (LIBs). Our work aimed at developing an integrated analysis method to study the component distribution, mechanical properties, and internal stress of composite coating in the process of electrode drying. The main influence factors of drying stress were thoroughly investigated. It was found that this present model could capture not only the heterogeneity effect of inactive ingredients but also the porosity-dependent viscoelasticity of electrode composite. Meanwhile, the calculated effective modulus and stress evolution upon drying time were in acceptable accord with the experimental data. Furthermore, the rapid solidification markedly increased the drying stress in electrodes and significantly impaired the tensile strength of electrode composite due to the highly gradient distributed constituents. However, the stress level at high drying temperature could be significantly reduced by an aqueous sodium alginate binder instead of poly(vinylidene fluoride). The obtained results will be a great help in efficiently manufacturing LIB electrodes with adequate mechanical integrity.

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Myocarditis Presenting as Sudden Death in Infants and Children: A Single Centre Analysis by ESGFOR Study Group

Pediatric and Developmental Pathology ◽

10.1177/10935266211007262 ◽

2021 ◽

pp. 109352662110072

Author(s):

Oana Neagu ◽

Amparo Fernández Rodríguez ◽

Domitille Callon ◽

Laurent Andréoletti ◽

Marta C Cohen

Keyword(s):

Sudden Death ◽

Influenza A ◽

Group A Streptococcus ◽

Acute Myocarditis ◽

Clinical History ◽

Infants And Children ◽

Group A ◽

Clinical Awareness ◽

Type 3 ◽

In Infants And Children

Background Acute myocarditis is an inflammatory disease of the heart mostly diagnosed in young people, which can present as sudden death. The etiology includes infectious agents (mostly viruses), systemic diseases and toxins. We aim to characterize infants and children with myocarditis at post-mortem presenting as sudden deaths. Methods Retrospective evaluation of 813 post-mortems in infants and children dying suddenly and unexpectedly between 2009–2019. Data retrieved included histological features, microbiology and clinical history. Results 23 of 813 post-mortems reviewed corresponded to acute myocarditis and 1 to dilated cardiomyopathy related to remote Parvovirus infection. PCR identified enterovirus (7), parvovirus (7 cases, 2 also with HHV6 and 1 case with EVB), Influenza A (1), Parainfluenza type 3 (1). Two cases corresponded to hypersensitivity myocarditis, 1 was Group A Streptococcus and 5 idiopathic myocarditis. Enterovirus was frequent in infants (7/10), and in newborns was associated with meningoencephalitis or congenital myocarditis. More than 50% were less than 2 years of age and all remained clinically unsuspected. Conclusion Myocarditis represents almost 3% of all sudden pediatric deaths. Enterovirus and parvovirus were the most common viruses. This retrospective analysis showed that patients experienced viral symptoms but remained unsuspected, highlighting the need for more clinical awareness of myocarditis.

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Ovarian epithelioid angiosarcoma complicating pregnancy: a case report and review of the literature

Journal of International Medical Research ◽

10.1177/03000605211019641 ◽

2021 ◽

Vol 49 (5) ◽

pp. 030006052110196

Author(s):

Xiaotong Peng ◽

Zhi Duan ◽

Hongling Yin ◽

Furong Dai ◽

Huining Liu

Keyword(s):

Adverse Events ◽

Soft Tissues ◽

Malignant Tumors ◽

Cystic Teratoma ◽

Abdominal Distension ◽

Epithelioid Angiosarcoma ◽

History Of ◽

New Ideas ◽

The Right ◽

Clinical Awareness

Epithelioid angiosarcoma is a rare and highly aggressive soft tissue angiosarcoma most commonly arising in the deep soft tissues. Given that abundant vascular cavities anastomose with each other, most angiosarcomas prone to metastasis recur quickly, and the overall prognosis is poor. We report a 25-year-old woman at 24 weeks’ gestation who presented with a 1-month history of abdominal distension. Ultrasonography suggested a mass in the right adnexa, and she underwent two operations owing to uncontrolled intraperitoneal bleeding with progressive anemia. The right ovarian tumor and right adnexa were removed successively. Biopsy yielded a diagnosis of primary epithelioid angiosarcoma with mature cystic teratoma. The patient died from uncontrolled progressive bleeding 1 week after the second operation. This case revealed that epithelial angiosarcoma is a highly malignant endothelial cell tumor. The results of surgery and chemoradiotherapy tend to be poor, and the recurrence rate is high. The purpose of this study is to raise clinical awareness of epithelial angiosarcoma and its adverse events and to provide new ideas for the treatment of these adverse events. Immunohistochemical staining of pathological specimens can facilitate diagnosis. Pregnancy with malignant tumors may lead to rapid disease progression, extensive lesions, and a poor prognosis.

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The Challenge of Diagnosing Constitutional Mismatch Repair Deficiency Syndrome in Brain Malignancies from Young Individuals

International Journal of Molecular Sciences ◽

10.3390/ijms22094629 ◽

2021 ◽

Vol 22 (9) ◽

pp. 4629

Author(s):

Cristina Carrato ◽

Carolina Sanz ◽

Ana María Muñoz-Mármol ◽

Ignacio Blanco ◽

Marta Pineda ◽

...

Keyword(s):

Brain Tumors ◽

Mismatch Repair ◽

Rare Event ◽

Deficiency Syndrome ◽

Mismatch Repair Deficiency ◽

Malignant Brain Tumors ◽

Repair Deficiency ◽

Clinical Awareness ◽

High Degree ◽

Constitutional Mismatch Repair Deficiency

Biallelic germline mismatch repair (MMR) gene (MLH1, MSH2, MSH6, and PMS2) mutations are an extremely rare event that causes constitutional mismatch repair deficiency (CMMRD) syndrome. CMMRD is underdiagnosed and often debuts with pediatric malignant brain tumors. A high degree of clinical awareness of the CMMRD phenotype is needed to identify new cases. Immunohistochemical (IHC) assessment of MMR protein expression and analysis of microsatellite instability (MSI) are the first tools with which to initiate the study of this syndrome in solid malignancies. MMR IHC shows a hallmark pattern with absence of staining in both neoplastic and non-neoplastic cells for the biallelic mutated gene. However, MSI often fails in brain malignancies. The aim of this report is to draw attention to the peculiar IHC profile that characterizes CMMRD syndrome and to review the difficulties in reaching an accurate diagnosis by describing the case of two siblings with biallelic MSH6 germline mutations and brain tumors. Given the difficulties involved in early diagnosis of CMMRD we propose the use of the IHC of MMR proteins in all malignant brain tumors diagnosed in individuals younger than 25 years-old to facilitate the diagnosis of CMMRD and to select those neoplasms that will benefit from immunotherapy treatment.

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Fatal cutaneous anthrax in a heroin user

The Journal of Laryngology & Otology ◽

10.1017/s0022215112003210 ◽

2013 ◽

Vol 127 (4) ◽

pp. 423-425 ◽

Cited By ~ 4

Author(s):

S Meghji ◽

O Judd ◽

E Carr

Keyword(s):

Case Report ◽

Mortality Rate ◽

Drug Users ◽

Heroin User ◽

Intravenous Drug Users ◽

Cutaneous Anthrax ◽

The Uk ◽

Clinical Awareness ◽

Symptoms And Signs ◽

Typical Picture

AbstractBackground and objective:Cutaneous anthrax usually has a mortality rate of less than 1 per cent. However, since December 2009 there have been more than 13 deaths in the UK due to anthrax-contaminated heroin. We therefore wish to raise clinical awareness of this treatable disease.Case report:We describe the case of a heroin user with an equivocal presentation of cellulitis in the neck. Within 36 hours, this led to death due to cutaneous anthrax.Conclusion:Whilst cutaneous anthrax remains rare, this case report aims to raise awareness of the fact that the symptoms and signs of this condition in intravenous drug users may not always fit the typical picture.

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LIMB-GIRDLE MUSCULAR DYSTROPHY: ITS LARGER SIGNIFICANCE

PEDIATRICS ◽

10.1542/peds.41.2.382 ◽

1968 ◽

Vol 41 (2) ◽

pp. 382-384

Author(s):

S. C.

Keyword(s):

Peripheral Nerves ◽

Neuromuscular Disorders ◽

Serum Enzymes ◽

Muscle Disease ◽

Muscular Dystrophies ◽

Muscular Weakness ◽

Conduction Velocities ◽

Clinical Awareness ◽

Muscle Biopsies

The current literature reflects the interest of pediatricians, neurologists, and internists in the neuromuscular disorders of childhood.1-5 Clinical awareness and the availability and refinement of ancillary procedures, such as electromyography, measurement of nerve conduction velocities, determination of serum enzymes and muscle biopsies, have made it possible to differentiate many of these conditions and correctly localize the pathology of these lower motor neuron disorders to the anterior horn cells, the peripheral nerves, and/or the muscles.1 Primary muscle disease is the most frequent cause of progressive muscular weakness in children with neuromuscular disorders.2 The primary myopathies are either hereditary or acquired. The muscular dystrophies and the myotonic syndrome are representative of the genetic variety, while the acquired disorders are recognized clinically as polymyositis and dermatomyositis.

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Comparative assessment of the dynamics of the incidence of pulmonary and etraulmonary tuberculosis in St. Petersburg for half a century of observation

MedAlliance ◽

10.36422//23076348-2020-8-3-6-14 ◽

2020 ◽

Vol 8 (3) ◽

pp. 6-14

Keyword(s):

Control System ◽

Incidence Rate ◽

Extrapulmonary Tuberculosis ◽

High Rate ◽

Tb Control ◽

Complete Restoration ◽

Third Stage ◽

High Level ◽

Clinical Awareness ◽

Positive Effect

This article describes the results of comparative analysis of the dynamics of incidence of pulmonary tuberculo-sis (TBP), extrapulmonary extrarespiratory tuberculo-sis (TBER) and respiratory extrapulmonary tuberculosis (TBREP) in St. Petersburg (Leningrad) from 1970 to 2019. Throughout the 50 years of observation, epidemiological situation for TBP, especially for TBER, hasmuch improved, with incidence of the latter going down 30 times. Five stages (decades) were identified, within which the factors demonstrate practically the same impact, the growth rate of indicators was calculated for each stage (the value of indicators at the beginning of each stage taken as 100%).The first stage was a simultaneous reduction in the inci-dence rate in all categories of TB localization against the background of socio-economic factors positive effect and organization of effective and comprehensive an-ti-TB measures. In the second stage (1980ies, a period of growing socio-economic problems), the positive dynam-ics of TB incidence stopped and switched to stabilization at a low level. Indicators became more volatile, while TB dynamics by localization more and more desynchro-nized. Тhe third stage (1990iеs, a period of social and economic crisis) was char-acterised by a sharp increase of TB incidence, especially TBREP, with a switch to stabi-lization at a high level. The fourth stage (2000 through 2009, the beginning of TB control system restoration) demonstrated the indicators’ dynamics desynchroniza-tion: the incidence of TBP and TBREP has stabilized, and TBER continued to decline. The fifth stage (2009 through 2019, complete restoration of TB control system) showed a steady trend of incidence rate reduction and return of uniformity in incidence rate of various localizations.There is no increase in the proportion of extrapulmonary TB expected for the incidence decline. TBER incidence had been declining in most stages, with the exception of the 90ies, which could be explained by substandard work in identifying patients, and the rarity of TBER etiological verification. It is necessary to raise the clinical awareness of narrow specialists and general practitioners in the di-agnostic problems associated with TBER.The coincidence of the rate of TB incidence decrease in main localizations in the 1970ies and 2010s proves that a comprehensive state strategy to combat tuberculosis can provide a high rate of TB incidence decrease in various social layers with positive social and economic conditions of life of the population.

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Appendiceal hernia: an extremely rare condition

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2020.7000 ◽

2021 ◽

Vol 103 (2) ◽

pp. e50-e52

Author(s):

GA Molina ◽

CL Rojas ◽

WG Aguayo ◽

MA Moyon ◽

P Gálvez ◽

...

Keyword(s):

Acute Appendicitis ◽

Incisional Hernia ◽

Rare Condition ◽

Full Recovery ◽

Incisional Hernias ◽

Inguinal Hernias ◽

Clinical Awareness

Appendix-associated hernias are extremely rare. They have been described sporadically in the literature, mostly as inguinal hernias. Appendix-associated incisional hernias are even more unusual. High clinical awareness is needed as complications can arise if misdiagnosis or delay occurs. We present an 80-year-old man with acute appendicitis in an incisional hernia. After successful surgery, the patient made a full recovery.

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Prevalence and Clinical Implications of Incidentally Detected Parotid Lesions as Blind Spot on Brain MRI: A Single-Center Experience

Medicina ◽

10.3390/medicina57080836 ◽

2021 ◽

Vol 57 (8) ◽

pp. 836

Author(s):

In-Chul Nam ◽

Hye-Jin Baek ◽

Kyeong-Hwa Ryu ◽

Jin-Il Moon ◽

Eun Cho ◽

...

Keyword(s):

Brain Mri ◽

Brain Magnetic Resonance Imaging ◽

Blind Spot ◽

Clinical Implications ◽

Single Center Experience ◽

Superficial Lobe ◽

Mean Size ◽

Magnetic Resonance Imaging Mri ◽

Clinical Awareness ◽

Low Prevalence

Background and objective: This study was conducted to assess the prevalence and clinical implications of parotid lesions detected incidentally during brain magnetic resonance imaging (MRI) examination. Materials and Methods: Between February 2016 and February 2021, we identified 86 lesions in the brain MRI reports of 84 patients that contained the words “parotid gland” or “PG”. Of these, we finally included 49 lesions involving 45 patients following histopathological confirmation. Results: Based on the laboratory, radiological or histopathological findings, the prevalence of incidental parotid lesions was low (1.2%). Among the 45 study patients, 41 (91.1%) had unilateral lesions, and the majority of the lesions were located in the superficial lobe (40/49, 81.6%). The mean size of the parotid lesions was 1.3 cm ± 0.4 cm (range, 0.5 cm–2.8 cm). Of these, 46 parotid lesions (93.9%) were benign, whereas the remaining three lesions were malignant (6.1%). Conclusions: Despite the low prevalence and incidence of malignancy associated with incidental parotid lesions detected on brain MRI, the clinical implications are potentially significant. Therefore, clinical awareness and appropriate imaging work-up of these lesions are important for accurate diagnosis and timely management.

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