Video-assisted thoracoscopic parenchymal sparing “rotational” bronchoplasty for managing bronchial carcinoid tumor

We present a modified bronchoplasty technique involving rotation of the bronchial structures. Our goal was to reconstruct the bronchus without using any foreign material while fully preserving the parenchyma. We used a biportal VATS approach. The centrally located bronchial tumor at the juncture between the right main bronchus, the right upper lobe bronchus, and the bronchus intermedius was first resected. The right upper lobe bronchus was rotated caudally, toward the bronchus intermedius, together with a slight clockwise rotation posteriorly to facilitate the approximation and tension-free closure of the bronchial defect. This video tutorial demonstrates the operative steps and explains how the rotational aspect is achieved.

Seizures 3 Months After Endarterectomy

A 57-year-old woman had development of acute-onset, right-sided weakness and sensory change (face, arm, and leg) when at a casino. She was brought to the emergency department, and her symptoms had essentially resolved upon her arrival. Brain magnetic resonance imaging showed no acute stroke, and a transient ischemic attack was diagnosed. She was transferred to an academic medical center. Investigations showed high-grade left internal carotid artery stenosis; the same day, a stent was placed via endovascular procedure by an interventional neuroradiologist. Magnetic resonance imaging of the head showed an enhancing lesion with surrounding edema in the left frontal and parietal lobes at the cortex, also involving the nearby leptomeninges. Electroencephalography showed potentially epileptogenic discharges over the left central head region. Brain biopsy was performed, which showed abundant CD68+ macrophages, granulomatous inflammation, and necrosis associated with foreign material. The associated lymphocytic infiltrates were predominantly composed of CD3+ T cells and only sparse CD20+ B cells. The foreign material seen was lamellated, amorphous, nonpolarizable, and nonrefractile, typical of hydrophilic polymers commonly used in intravascular medical devices. The patient was diagnosed with seizures caused by multifocal, intracranial, foreign-body, granulomatous reaction to polymers that had embolized to brain parenchyma during the prior endovascular procedure. To suppress this inflammatory reaction, corticosteroids were initiated—intravenous methylprednisolone, followed by an oral prednisone course, with a plan to gradually taper. Antiseizure medication was continued at the same doses. The patient’s seizures remitted initially but relapsed upon corticosteroid dose reduction despite a very slow prednisone taper. At that point, 18 months after the initial onset of seizures, the patient had cushingoid features, depression, and chronic insomnia. During the next year, 2 steroid-sparing strategies were employed sequentially. In patients who have received neurovascular medical device therapy and have subsequent development of seizures, focal neurologic deficit, headache, or encephalopathy, central nervous system inflammation triggered by retained foreign-body material should be considered as a potential cause.

The role of PMCT for the assessment of the cause of death in natural disaster (landslide and flood): a Sicilian experience

In this report, the authors provide a contribution of PMCT in assessing the cause of death due to natural disasters. Here, the PMCT findings of 43 subjects who died during both landslide and flood were described. The post-mortem imaging revealed, clearly, traumatic injuries and/or the presence of foreign material in airways allowing to assess the cause of death of each subject, together with external inspection and the collected circumstantial data. Particularly, the PMCT has been helpful for characterization and localization of the clogging substance in airways providing findings on bronchial branches involvement. Moreover, the investigation offered detailed data on skeletal injuries in all anatomic districts and put in evidence both the precise fracturing site and the characteristics of fracture stubs for each bone fracture. This report supports the recommendation of the virtual autopsy in a case with several victims, as in natural disasters, and its role as an alternative diagnostic investigation when the standard autopsy is not feasible.

Evaluation of the quality of commercial plant drugs with antidiabetic indications

The use of medicinal plants for the treatment of diseases is an old practice and is widely used. However, many products are still marketed without the necessary quality. This study aimed to evaluate the organoleptic characteristics, presence of foreign material, packaging and labeling of plant drugs marketed for the control of diabetes. Comercial samples of cavalinha, jambolão and pata-de-vaca sold in two municipalities in southeastern Brazil were acquired. The analyses of the packaging and labels were performed based on Resolutions of the Collegiate Board of Directors of the Brazilian National Health Surveillance Agency (RDC No. 26/2014 and RDC No. 66/2014). The Brazilian Pharmacopoeia VI was used to guide the preparation of a sensory evaluation questionnaire and analysis of foreign material. None of the samples complied with the packaging requirements. Approximately 69% of the samples failed the sensory analysis. Regarding the analysis for the presence of foreign material, only sample J1 of jambolão was within the 2% w/w limit, as established in the Brazilian Pharmacopoeia. Based on simple and primary quality control analyses, it is concluded that the analyzed plant drugs are not in accordance with Brazilian legislation, putting the health of consumers of these teas at risk.

Focal Palatitis (Previously Focal Palatine Erosions) in Captive Cheetahs (Acinonyx jubatus)

Focal palatine erosion (FPE) is a misleading term that is used in the literature to describe inflammatory lesions associated with depressions of the palatal mucosa in cheetah. Cheetahs have large cheek teeth and these depressions are formed to accommodate them. Previously FPE was only described as a mandibular molar tooth malocclusion on the hard palate due to suspected rotation and super eruption of the mandibular molar teeth of cheetahs aged 18 months and older. Two hundred and fifty six cheetahs (135 male, 121 female), originating from two independent facilities, had their oral cavities evaluated as part of an annual health visit over a decade. Ninety-nine cheetahs were seen once, 59 cheetahs were seen twice, 33 were seen three times, 43 on four occasions, 16 on five occasions, 5 on six occasions, and 1 cheetah was seen seven times. Apart from these clinical cases a prospective study on 5 cheetah cubs (3 male and 2 female) was conducted to document their skull development and mandibular molar tooth eruption over a period of 25 months. Of the 261 cheetahs observed none developed rotation or super eruption of their mandibular molar teeth. The term FPE is a misnomer as these inflammatory lesions were found in palatal depressions opposing any of the cusps of all of the cheetah mandibular cheek teeth. It consisted mainly of deep ulcerations, inflammation and oedema and also micro abscess formation. In severe cases oro-nasal fistulas were present. Of all the depressions present on the cheetah's palate, the large one palatal to the 4th maxillary premolar tooth was most commonly affected. In the five cubs evaluated prospectively, focal palatitis was evident from the 7 month evaluation, before all the permanent teeth erupted. Conservative treatment of the inflamed depressions by removing the foreign material through curettage and copious flushing reduced the grade of the inflammation when observed on follow-up. Focal palatine erosion is an incorrect term used to describe focal palatitis that occurs randomly in cheetahs. This focal palatitis is often associated with foreign material trapped in the palatal depressions. Conservative management is sufficient to treat these animals without odontoplasties.

The Four Pillars of Halal Crisis Management

This viewpoint paper is about how to prepare and respond to a halal crisis. Many companies are preparing for the wrong kind of crisis. Too many companies treat a halal issue and halal crisis as a foreign material problem, like finding metal or glass in food, for which a trade or public product recall is initiated with apology. Poorly managed halal crises hit the bottom line hard and can ultimately kill a company. Getting it right, on the other hand, can have its positive effects. Halal crises can also be an opportunity, although probably not experienced during a crisis itself, which could improve halal trust, Islamic values, and its network. This could strengthen a halal brand, sales, and company market share. However, this is only possible with the right actions and communication with a halal issue and crisis. Best practice halal crisis management is founded on four pillars: process, control, organisation, and information. This requires solid preparation and practice.

Improving Quality in the Process of Hot Rolling of Steel Sheets

The hot rolling of steel sheets is a highly energy-intensive process. There are technical and operational issues associated with this process, and the causes of these issues can be various. This study involved analysis of one issue that has a great influence on the resulting surface quality of rolled sheet metal: rolled foreign material. After the sheet cools, rolled foreign material tends to fall off and a hole then remain on the surface of the sheet. This paper focuses on the search for the root causes of the occurrence of foreign material rolling. The basic categorization of the causes of this issue was performed by experienced long-term operators. The 4M method (man, machine, method, and material) was used to categorize the causes. Pairwise comparison was used to verify the result. Using energy dispersive spectroscopy analysis, the origin of the foreign material was identified. The analysis confirmed that the foreign material was not derived from the primary material. Further research showed that the cause of the issue was the guide rulers, which are a structural part of the rolling mill. Measures were taken to significantly reduce the incidence of the problem, which also had the effect of reducing financial losses, which fell by a third in 18 weeks. In the future, it will be necessary to make design changes (modernization of the rolling mill), which will, however, require more financial investment.

Geophagia: A cause of distal large bowel obstruction in a Sudanese woman.

Objective: Geophagia is defined as the craving and deliberate consumption of dirt, soil, or clay that is practiced sometimes by pregnant ladies, mentally handicapped, or people with iron deficiency anemia. This disorder is seen frequently in people who are native to Africa all around the world. A grave surgical complication can result from the presence of this foreign material inside the intestine notably intestinal perforation, and obstruction Case: A 34 years old female present with features of distal large bowel obstruction three weeks post-delivery underwent exploratory laparotomy were obstructing piece of clay was found, the patient confirmed after surgery a heavy consumption of river shore clay during the pregnancy. Conclusions: The patient experienced an uneventful postoperative course, oral intake allowed by the third postoperative day, and the patient was discharged home on the fifth postoperative day. Follow-up at one month after surgery show a clean healed wound with no complaints.

Antiretroviral Drugs Impact Autophagy with Toxic Outcomes

Antiretroviral drugs have dramatically improved the morbidity and mortality of people living with HIV (PLWH). While current antiretroviral therapy (ART) regimens are generally well-tolerated, risks for side effects and toxicity remain as PLWH must take life-long medications. Antiretroviral drugs impact autophagy, an intracellular proteolytic process that eliminates debris and foreign material, provides nutrients for metabolism, and performs quality control to maintain cell homeostasis. Toxicity and adverse events associated with antiretrovirals may be due, in part, to their impacts on autophagy. A more complete understanding of the effects on autophagy is essential for developing antiretroviral drugs with decreased off target effects, meaning those unrelated to viral suppression, to minimize toxicity for PLWH. This review summarizes the findings and highlights the gaps in our knowledge of the impacts of antiretroviral drugs on autophagy.

Foreign Body Reaction to Implanted Biomaterials and Its Impact in Nerve Neuroprosthetics

The implantation of any foreign material into the body leads to the development of an inflammatory and fibrotic process—the foreign body reaction (FBR). Upon implantation into a tissue, cells of the immune system become attracted to the foreign material and attempt to degrade it. If this degradation fails, fibroblasts envelop the material and form a physical barrier to isolate it from the rest of the body. Long-term implantation of medical devices faces a great challenge presented by FBR, as the cellular response disrupts the interface between implant and its target tissue. This is particularly true for nerve neuroprosthetic implants—devices implanted into nerves to address conditions such as sensory loss, muscle paralysis, chronic pain, and epilepsy. Nerve neuroprosthetics rely on tight interfacing between nerve tissue and electrodes to detect the tiny electrical signals carried by axons, and/or electrically stimulate small subsets of axons within a nerve. Moreover, as advances in microfabrication drive the field to increasingly miniaturized nerve implants, the need for a stable, intimate implant-tissue interface is likely to quickly become a limiting factor for the development of new neuroprosthetic implant technologies. Here, we provide an overview of the material-cell interactions leading to the development of FBR. We review current nerve neuroprosthetic technologies (cuff, penetrating, and regenerative interfaces) and how long-term function of these is limited by FBR. Finally, we discuss how material properties (such as stiffness and size), pharmacological therapies, or use of biodegradable materials may be exploited to minimize FBR to nerve neuroprosthetic implants and improve their long-term stability.