Novel treatment for glance necrosis due to priapism; presentation and review of literature

Introduction: Glans necrosis in association with priapism is very rare and its appropriate treatment is not known. There is a secondary cause in most cases. Case description: We treated a 65-year-old man with priapism and glans necrosis using a closed shunt (Winter), continuous penile irrigation with normal saline, and heparin for 48 h and waited for the necrotic area to resolve spontaneously. The treatment outcome was much better compared to previous cases in whom open surgery, irrigation with pure normal saline, and/or resection of the necrotic area were performed. Conclusion: In cases with priapism and glans ischemia, we recommend treating the condition with continuous covernose irrigation with heparinized saline and avoiding open surgery.

Imaging features of intrahepatic cholangiocarcinoma mimicking a liver abscess: an analysis of 8 cases

Background In rare cases, intrahepatic cholangiocarcinoma can present as a pyogenic liver abscess and are often misdiagnosed. This study aimed to analyze the imaging features of intrahepatic cholangiocarcinoma mimicking a pyogenic liver abscess. Methods The clinical data and imaging results of eight patients with pathologically confirmed intrahepatic cholangiocarcinoma mimicking a liver abscess were retrospectively collected. Results The mean age was 58 years with a range of 46–68 years. Fever and leukocytosis were present in six patients. All the eight lesions were a single mass. Air–liquid levels were present in two patients. Only one patient showed hepatic lobar atrophy and hepatic capsule retraction. The double target sign of liver abscess was not noticed in the CT/MRI images of all eight patients. The inner wall of the lesion was rough and irregular, with multiple dot/patchy and wall nodule enhancements. The abscess wall and the marginal parenchyma were supplied by the hepatic artery in four patients, and the intralesional arteries were rough and disrupted. Bile duct dilatation was seen adjacent to the lesion. In seven patients, diffusion-weighted images showed irregular patchy restricted diffusion in the marginal parenchyma of the necrotic area in addition to the prominent restricted diffusion in the necrotic area. Two patients with cholangiolithiasis showed patchy slight CT hypodensity, slight T1 hypointensity, slight T2 hyperintensity, and patchy delayed enhancement. Multiple lymph nodes enlargement in the hepatic hilar area and the retroperitoneal space were seen in five patients. Conclusion Intrahepatic cholangiocarcinoma mimicking a pyogenic liver abscess have unique imaging features and require careful image examination to avoid misdiagnosis.

PARK7 promotes repair in early steroid-induced osteonecrosis of the femoral head by enhancing resistance to stress-induced apoptosis in bone marrow mesenchymal stem cells via regulation of the Nrf2 signaling pathway

Novel therapies for the treatment of early steroid-induced osteonecrosis of the femoral head (SONFH) are urgently needed in orthopedics. Transplantation of bone marrow mesenchymal stem cells (BMSCs) provides new strategies for treating this condition at the early stage. However, stress-induced apoptosis of BMSCs transplanted into the femoral head necrotic area limits the efficacy of BMSC transplantation. Inhibiting BMSC apoptosis is key to improving the efficacy of this procedure. In our previous studies, we confirmed that Parkinson disease protein 7 (PARK7) is active in antioxidant defense and can clear reactive oxygen species (ROS), protect the mitochondria, and impart resistance to stress-induced apoptosis in BMSCs. In this study, we investigated the mechanism driving this PARK7-mediated resistance to apoptosis in BMSCs. Our results indicate that PARK7 promoted the disintegration of nuclear factor (erythroid-derived 2)–like 2 (Nrf2)/Kelch-like echinacoside–associated protein 1 (Keap1) complex. The free Nrf2 then entered the nucleus and activated the genetic expression of manganese superoxide dismutase (MnSOD), catalase (CAT), glutathione peroxidase (GPx), and other antioxidant enzymes that clear excessive ROS, thereby protecting BMSCs from stress-induced apoptosis. To further explore whether PARK7-mediated resistance to stress-induced apoptosis could improve the efficacy of BMSC transplantation in early-stage SONFH, we transplanted BMSCs-overexpressing PARK7 into rats with early-stage SONFH. We then evaluated the survival of transplanted BMSCs and bone regeneration in the femoral head necrotic area of these rats. The results indicated that PARK7 promoted the survival of BMSCs in the osteonecrotic area and improved the transplantation efficacy of BMSCs on early-stage SONFH. This study provides new ideas and methods for resisting the stress-induced apoptosis of BMSCs and improving the transplantation effect of BMSCs on early-stage SONFH.

Effect of Femoral Head Necrosis Cystic Area on Femoral Head Collapse and Stress Distribution in Femoral Head

Objective:Osteonecrosis of the femoral head (ONFH) is a common and difficult disease. The effect of cystic area on femoral head mechanics in patients with ONFH is unknown. The purpose of this study was to investigate the effect of cystic areas of osteonecrosis of the femoral head on stress distribution and disease progression in the femoral head.Methods:A total of 85 patients (106 hips) diagnosed with ARCO stage II non-traumatic and non-surgical treatment of ONFH from February 2017 to November 2018 were retrospectively analyzed. All patients were followed up for an average of more than 2 years. According to whether the femoral head collapsed during the follow-up, they were divided into collapse group and non-collapse group. The age, gender, etiology, height, weight, BMI, JIC classification, presence of cystic areas and diameter of cystic areas were compared between the two groups. In addition, five spherical cystic areas of different diameters of 0, 5, 10, 15, and 20 mm were constructed to simulate the hip joint load of a person during standing by finite element methods, and the maximum stress, mean stress, and maximum stress values in the necrotic area of the femoral head without cystic areas and in the area 1 mm around the cystic areas with different diameters were observed and analyzed.Results:All 85 patients (106 hips) completed the follow-up, with an average age of 37.4 ± 8.12 years. The mean follow-up time was 2.8 ± 0.6 years. Forty-five patients (57 hips) with ONFH who had femoral head collapse were included in the collapse group, and the remaining 40 patients (49 hips) were included in the non-collapse group. There was significant difference in JIC classification between the two groups (P < 0.05), most of which were C2 type in the collapse group and B type in the non-collapse group. There was a difference between the two groups in whether cystic areas appeared in the femoral head, with 49.1% in the collapse group showing cystic areas, which was significantly higher than that in the non-collapse group (18.4%) (P < 0.05). In addition, the diameter of the cystic areas was significantly larger in the collapsed group than in the non-collapsed group (P < 0.05). The maximum von Mises stress value and mean von Mises stress value around the cortical bone, necrotic area and around the cystic area of the femoral head increased with the increase of the cystic diameter. Furthermore, linear regression analysis showed a linear positive correlation between the maximum stress, mean stress in the necrotic area in the femoral head, and the maximum stress value in the 1 mm area around the cystic area and the diameter of the cystic area.Conclusion:The maximum stress and average stress of necrotic area can be increased in cystic area, and the increase of stress in cystic area is more obvious. Stress concentration areas can be generated around the cystic areas. The presence and increased diameter of the cystic areas accelerates the collapse of the ONFH femoral head.

Forest and Plantation Soil Microbiomes Differ in Their Capacity to Suppress Feedback Between Geosmithia morbida and Rhizosphere Pathogens of J. nigra Seedlings

Thousand cankers disease (TCD) is hypothesized to have a greater impact on eastern black walnut (Juglans nigra) in urban forests and plantations compared to natural forest stands. Along with other factors, such as resource availability, the phytobiome could partly account for observed differences in disease severity across management regimes. We investigated the extent to which J. nigra-associated soil microbiomes from plantations and natural forests modulate a) the amount of necrosis caused by Geosmithia morbida Kolařík, Freeland, Utley and Tisserat in one-year-old seedlings, and b) relative abundance of rhizosphere endophytes and opportunistic pathogens Fusarium and Rhizoctonia in response to aboveground inoculation with G. morbida. Our results suggest that the microbiome from natural forest soil in central Indiana suppresses Fusarium and is indirectly suppressive of G. morbida. Natural forest soil had a greater ability to reduce the size of necrotic area caused by G. morbida compared to steam-treated soil. Inoculating stems of seedlings with G. morbida induced a shift in fungal community composition in the rhizosphere, including Fusarium and Rhizoctonia, but the direction and magnitude of the shift depended on whether seedlings were amended with forest, plantation, or steam-treated soil. In a companion experiment, necrotic area in G. morbida-inoculated seedlings was twice as high in seedlings grown from seeds that were treated with Fusarium solani relative to those grown from seeds treated with water. Our findings support the hypothesis that TCD severity can be modulated by host-mediated feedback between above- and belowground pathogens, as well as by microbial interactions in the rhizosphere.

Effect of Femoral Head Necrosis Cystic Area on Femoral Head Collapse and Stress Distribution in Femoral Head

Objective: Osteonecrosis of the femoral head (ONFH) is a common and difficult disease. The effect of cystic area on femoral head mechanics in patients with ONFH is unknown. The purpose of this study was to investigate the effect of cystic areas of osteonecrosis of the femoral head on stress distribution and disease progression in the femoral head.Methods: A total of 85 patients (106 hips) diagnosed with ARCO stage II non-traumatic and non-surgical treatment of ONFH from February 2017 to November 2018 were retrospectively analyzed. All patients were followed up for an average of more than 2 years. According to whether the femoral head collapsed during the follow-up, they were divided into collapse group and non-collapse group. The age, gender, etiology, height, weight, BMI, JIC classification, presence of cystic areas and diameter of cystic areas were compared between the two groups. In addition, five spherical cystic areas of different diameters of 0, 5, 10, 15, and 20 mm were constructed to simulate the hip joint load of a person during standing by finite element methods, and the maximum stress, mean stress, and maximum stress values in the necrotic area of the femoral head without cystic areas and in the area 1 mm around the cystic areas with different diameters were observed and analyzed.Results: All 85 patients (106 hips) completed the follow-up, with an average age of 37.4 ± 8.12 years. The mean follow-up time was 2.8 ± 0.6 years. Forty-five patients (57 hips) with ONFH who had femoral head collapse were included in the collapse group, and the remaining 40 patients (49 hips) were included in the non-collapse group. There was significant difference in JIC classification between the two groups (P < 0.05), most of which were C2 type in the collapse group and B type in the non-collapse group. There was a difference between the two groups in whether cystic areas appeared in the femoral head, with 49.1% in the collapse group showing cystic areas, which was significantly higher than that in the non-collapse group (18.4%) (P < 0.05). In addition, the diameter of the cystic areas was significantly larger in the collapsed group than in the non-collapsed group (P < 0.05). The maximum von Mises stress value and mean von Mises stress value around the cortical bone, necrotic area and around the cystic area of the femoral head increased with the increase of the cystic diameter. Furthermore, linear regression analysis showed a linear positive correlation between the maximum stress, mean stress in the necrotic area in the femoral head, and the maximum stress value in the 1 mm area around the cystic area and the diameter of the cystic area.Conclusion: The maximum stress and average stress of necrotic area can be increased in cystic area, and the increase of stress in cystic area is more obvious. Stress concentration areas can be generated around the cystic areas. The presence and increased diameter of the cystic areas accelerates the collapse of the ONFH femoral head.

Ultrastructural mitral valve abnormalities in infective endocarditis

Aim. Using an original method based on backscattered scanning electron microscopy, to study the structural features of the mitral valve leaflets in infective endocarditis.Material and methods. We examined 9 mitral valves extracted during surgical interventions due to structural malfunction in patients with infective endocarditis (IE). The samples were fixed in buffered paraformaldehyde with osmium tetraoxide postfixation. After dehydration by increasing alcohol concentration and acetone, the samples were placed in epoxy resin. After the resin has polymerized, the samples were ground and then polished to the desired depth. To increase the electronic contrast, the samples were treated with a uranyl acetate alcohol solution during dehydration and with Reynolds' lead citrate after polishing the epoxy blocks. The samples were visualized by backscattered scanning electron microscopy at an accelerating 15-kV voltage.Results. Structural leaflet injuries caused by IE were most pronounced in the central part and the base. Necrotic areas were extensive electron-dense formations located in the central leaflet layers, or displaced towards the ventricular surface. The electron-dense material in the necrotic area was poorly structured and contained individual cells and bacteria. Bacteria were also present outside the necrotic area. Necrotic areas were surrounded by a layer of a modified extracellular matrix, usually covered with a fibrin layer. Among the extracellular matrix fibers, the macrophages, smooth myocytes and fibroblasts was noted. The fibrin layer, in addition to these cells, contained a large number of blood vessels and was often covered with endothelium.Conclusion. Infection of the mitral valve leaflets causes a simultaneous inflammatory response and regeneration activation. Without adequate regulatory factors, the processes of inflammation and connective tissue creation lead to structural and functional leaflet failure. Specific causes may be overgrowth of necrotic and inflammatory areas, edema and fiber orientation disorder, as well as leaflet rupture.

Control and translocation of saflufenacil in fleabane (Conyza spp.) according to plant integrity

Efficient herbicide absorption and translocation, and satisfactory weed control can be affected by the site of herbicide application. However, during harvesting of crops of previous soybean sowing, the cutting process made by harvesters on the fleabane may generate a difficult management in pre sowing of the crop by limiting the leaf area of the absorption of the herbicide. Experiments were conducted to evaluate the control efficiency and translocation potential of saflufenacil in fleabane plants with different leaf and stem conditions. Experiment I was arranged in a 2x10 factorial scheme, with factor A corresponding to leaf integrity, and factor B corresponding to different levels of injury and saflufenacil application. Weed control was evaluated at 7, 14, and 21 days after herbicide treatment (DAT), and dry matter was evaluated at 21 DAT. Experiment II consisted of applying saflufenacil to different fleabane structures, where the percentage of necrotic area was evaluated at 1, 3, 5, and 7 DAT. Fleabane control was higher than 75% in all treatments with saflufenacil application, with greater control in plants previously defoliated. Saflufenacil application on 10 and 20 cm hairy fleabane plants was also efficient in all treatments. Saflufenacil application in old stem showed a larger necrotic area, while application in the site of the cutting resulted in a lower necrotic area. The main pathway for translocation of saflufenacil is via xylem and the stem proved to be the absorption element of the herbicide when leaf area is limited.

A biological agent modulates the physiology of barley infected with Drechslera teres

Recognized as the causal agent of net blotch, Drechslera teres is responsible for major losses of barley crop yield. The consequences of this leaf disease are due to the impact of the infection on the photosynthetic performance of barley leaves. To limit the symptoms of this ascomycete, the use of beneficial bacteria known as “Plant Growth Promoting Rhizobacteria” constitutes an innovative and environmentally friendly strategy. A bacterium named as strain B25 belonging to the genus Burkholderia showed a strong antifungal activity against D. teres. The bacterium was able to limit the development of the fungus by 95% in detached leaves of bacterized plants compared to the non-bacterized control. In this study, in-depth analyses of the photosynthetic performance of young barley leaves infected with D. teres and/or in the presence of the strain B25 were carried out both in and close to the necrotic area. In addition, gas exchange measurements were performed only near the necrotic area. Our results showed that the presence of the beneficial bacterium reduced the negative impact of the fungus on the photosynthetic performance and modified only the net carbon assimilation rate close to the necrotic area. Indeed, the presence of the strain B25 decreased the quantum yield of regulated non-photochemical energy loss in PSII noted as Y(NPQ) and allowed to maintain the values stable of maximum quantum yield of PSII photochemistry known as Fv/Fm and close to those of the control in the presence of D. teres. To the best of our knowledge, these data constitute the first study focusing on the impact of net blotch fungus and a beneficial bacterium on photosynthesis and respiratory parameters in barley leaves.

The perforator-centralizing technique for super-thin anterolateral thigh perforator flaps: Minimizing the partial necrosis rate

Background Despite the wide demand for thin flaps for various types of extremity reconstruction, the thin elevation technique for anterolateral thigh (ALT) flaps is not very popular because of its technical difficulty and safety concerns. This study proposes a novel perforatorcentralizing technique for super-thin ALT flaps and analyzes its effects in comparison with a skewed-perforator group.Methods From June 2018 to January 2020, 41 patients who required coverage of various types of defects with a single perforator-based super-thin ALT free flap were enrolled. The incidence of partial necrosis and proportion of the necrotic area were analyzed on postoperative day 20 according to the location of superficial penetrating perforators along the flap. The centralized-perforator group was defined as having a perforator anchored to the middle third of the x- and y-axes of the flap, while the skewed-perforator group was defined as having a perforator anchored outside of the middle third of the x- and y-axes of the flap.Results No statistically significant difference in flap thickness and dimension was found between the two groups. The arterial and venous anastomosis patterns of patients in both groups were not significantly different. Only the mean partial necrotic area showed a statistically significant difference between the two groups (centralized-perforator group, 3.4%±2.2%; skewed-perforator group, 15.8%±8.6%; P=0.022).Conclusions The present study demonstrated that super-thin ALT perforator flaps can be elevated safely, with minimal partial necrosis, using the perforator-centralizing technique.