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Κυριακή 7 Νοεμβρίου 2021

miR-199b-5p mediates adriamycin-induced podocyte apoptosis by inhibiting the expression of RGS10

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Exp Ther Med. 2021 Dec;22(6):1469. doi: 10.3892/etm.2021.10904. Epub 2021 Oct 21.

ABSTRACT

Podocyte apoptosis is a key risk factor for the progression of kidney diseases. MicroRNA (miR)-199b-5p has been shown to be involved in cell apoptosis. However, the molecular mechanisms of miR-199b-5p in podocyte apoptosis remain uncertain. Thus, the present study aimed to investigate whether miR-199b-5p participates in the regulation of podocyte apoptosis and to elucidate the involved mechanisms of this process. A podocyte apoptosis model was constructed using adriamycin (ADR) in vitro. miR-199b-5p mimic and inhibitor were transfected in podocytes to change the expression level of miR-199b-5p. RNA expression was examined by reverse transcription-quantitative PCR. Western blotting was used to measure protein expression. Apoptosis was monitored via flow cytometry and detection of apoptosis-associated proteins. The results from the present s tudy demonstrated that miR-199b-5p was upregulated and that regulator of G-protein signaling 10 (RGS10) was downregulated in ADR-stimulated podocytes. Overexpression of miR-199b-5p could inhibit RGS10 expression and stimulate podocyte apoptosis, whereas miR-199b-5p knockdown restored the levels of RGS10 and ameliorated podocyte apoptosis in ADR-induced podocytes. Furthermore, the effects of miR-199b-5p overexpression could be significantly reversed by RGS10 overexpression. In addition, podocyte transfection of miR-199b-5p activated the AKT/mechanistic target of rapamycin (mTOR) signaling, which was blocked following RGS10 overexpression. Taken together, the present study demonstrated that miR-199b-5p upregulation could promote podocyte apoptosis by inhibiting the expression of RGS10 through the activation of AKT/mTOR signaling.

PMID:34737809 | PMC:PMC8561778 | DOI:10.3892/etm.2021.10904

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Anagliptin alleviates lipopolysaccharide-induced inflammation, apoptosis and endothelial dysfunction of lung microvascular endothelial cells

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Exp Ther Med. 2021 Dec;22(6):1472. doi: 10.3892/etm.2021.10907. Epub 2021 Oct 22.

ABSTRACT

It has been reported that dipeptidyl peptidase-4 (DPP4) inhibition protects against acute lung injury (ALI). Anagliptin is a novel selective inhibitor of DPP4 but its role in ALI has not been studied. The present study aimed to investigate the effects of anagliptin on lipopolysaccharide (LPS)-induced human pulmonary microvascular endothelial cell (HPMVEC) injury, as well as its underlying mechanism. HPMVECs were exposed to LPS in the presence or absence of anagliptin co-treatment. MTT assay was used to evaluate cell viability and nitric oxide (NO) production was detected using a commercial kit. DPP4 and pro-inflammatory cytokine expression levels, apoptosis and migration were assessed via reverse transcription-quantitative PCR, western blotting, TUNEL staining and wound healing assay, respectively. Western blot analysis was performed to assess ex pression levels of proteins involved in NF-κB signaling, cell apoptosis and migration, as well as high mobility group box 1 (HMGB1)/receptor for advanced glycation end products (RAGE). LPS decreased cell viability and NO production, but elevated expression of DPP4 in HPMVECs. LPS promoted pro-inflammatory cytokine expression, NF-κB activation and cell apoptosis, but inhibited cell migration and phosphorylated-AKT/endothelial NO synthase expression. Anagliptin co-treatment significantly restored all of these effects. Mechanistically, the upregulation of HMGB1/RAGE expression induced by LPS was markedly blocked by anagliptin. In conclusion, anagliptin alleviated inflammation, apoptosis and endothelial dysfunction in LPS-induced HPMVECs via modulating HMGB1/RAGE expression. These data provide a basis for use of anagliptin in ALI treatment.

PMID:34737812 | PMC:PMC8561766 | DOI:10.3892/etm.2021.10907

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Relationship between inferior fascicle of anterior talofibular ligament and articular capsule in lateral ankle ligament complex

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Surg Radiol Anat. 2021 Nov 5. doi: 10.1007/s00276-021-02851-1. Online ahead of print.

ABSTRACT

PURPOSE: The lateral ankle ligament complex (LALC) is composed of anterior talofibular (ATFL), calcaneofibular (CFL), and posterior talofibular (PTFL) ligaments, all of which have a connection/continuous fiber. However, the structural link between the LALC and the articular capsule remains unknown. The goal of our study was to determine the connection between ATFL's inferior fascic le and the articular capsule.

METHODS: In this study, we utilized 84 formalin-fixed ankles to elucidate the structure of LALC. Between ATFL and CFL, the bundle number of ATFL and arciform fiber was investigated. The specimens were decalcified and sectioned coronally using a freezing microtome, in the case of double bundles of ATFL, to study the connection between the inferior fascicle of ATFL and the articular capsule.

RESULTS: ATFL had a single (25%), double (74%), and triple (1%) bundle number, respectively. The arciform fiber connecting the ATFL and the CFL was found in the superficial layer of all ankles (100%). There were two types of relationships between the inferior fascicle of ATFL and the articular capsule: 36 ankles (58%) were extracapsular, and 26 of 62 ankles (42%) were integrated with the inferior-lateral articular capsule. There are two kinds of relationships between the inferior fascicle of the ATFL and the articular capsule: extracapsular and integrated- capsular.

CONCLUSIONS: The inferior fascicle of ATFL has a variant and integrated-capsular type is reinforced inferior-lateral articular capsule and enters the joint to form continuous fibers with PTFL, making LALC. These anatomical findings are helpful in ultrasonography diagnosis and arthroscopic ankle surgery.

PMID:34738180 | DOI:10.1007/s00276-021-02851-1

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Impact of the COVID-19 pandemic on head and neck cancer diagnosis: data from a single referral center, South Tyrol, northern Italy

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Eur Arch Otorhinolaryngol. 2021 Nov 5. doi: 10.1007/s00405-021-07164-y. Online ahead of print.

ABSTRACT

OBJECTIVE: The aim of the study was to evaluate the impact of the COVID-19 pandemic on new diagnoses of head and neck cancer (HNC) in South Tyrol, northern Italy in terms of the number of new diagnoses and worsening disease stage due to diagnostic delay.

METHODS: Patients were divided into two groups: the control group with a first diagnosis of HNC in 10 months before the national lockdown (March 9th, 2020) and the study group with a first diagnosis of HNC in 10 months after lockdown.

RESULTS: A total of 124 patients were included in the study. Before the spread of COVID-19, 79 new diagnoses of HNCs were registered, while in the period after the lockdown, 45 new cancers cases were diagnosed and the difference was statistically significant (p = 0.01278). Early clinical T-stage results showed 52 cases in the control group a nd 21 in the study group, again with a significant difference (p = 0.03711). Advanced T-stage results showed 27 cases in the control group and 24 in the study group.

CONCLUSIONS: This study highlights the impact of the COVID-19 pandemic on HNCs, showing a statistically significant difference in the number of diagnoses before and after the lockdown which was related to the spread of the SARS-CoV-2 virus, and with a relevant decrease in early cT-staged HNCs.

PMID:34739577 | DOI:10.1007/s00405-021-07164-y

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A hitchhiking approach to reconstruct the finger pulp and the subsequent 1st toe hemi-pulp donor site defect

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J Plast Reconstr Aesthet Surg. 2021 Oct 7:S1748-6815(21)00451-4. doi: 10.1016/j.bjps.2021.09.008. Online ahead of print.

ABSTRACT

BACKGROUND: The free 1st toe hemi-pulp transfer for finger pulp reconstruction was acknowledged as the optimal one. However, the treatment of the 1st toe donor defect, owning to the impossibility of primary closure, was frequently oversimplified. This study presented a "hitchhiking" approach to resurface finger pulp and the subsequent 1st toe donor site defect in a one-stage procedure.

METHODS: From 2014 to 2019, finger pulp amputations (13 digits in 12 patients) were reconstructed with free 1st toe pulp flaps, and the donor site was resurfaced by the 2nd toe pedicled flap with the 2nd toe's primary closure. Therapeutic evaluation of repaired fingers and toes was based on cold intolerance, two-point discrimination (2PD), and gait disturbance.

RESULTS: All finger and toe pulp flaps survived uneven tfully. The average size of free 1st toe and pedicled 2nd toe flap was 3.1 cm × 2.0 cm (3.5 cm × 1.4 cm to 4.2 cm × 2.5 cm) and 3.0 cm × 1.1 cm (2.0 cm × 0.9 cm to 3.8 cm × 1.5 cm), respectively. The regained average static 2PD on the finger and 1st toe pulps was 6 mm (ranged 5-10 mm) and 4 mm (ranged 2-6 mm), respectively. All reconstructed 1st toe pulps were qualified for normal gait. One patient complained the mild cold intolerance, and hammer-toe deformities were involved in two cases.

CONCLUSION: To fulfill donor site care and cost-effective rule, the toe-to-finger pulp reconstruction can't underestimate the morbidity on 1st toe donor site due to inappropriate intervention. Equally importantly, the hitchhiking pedicled 2nd toe flap should be recruited in the reconstructive scheme.

PMID:34740566 | DOI:10.1016/j.bjps.2021.09.008

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BRAF V600E mutation is associated with aggressive features in papillary thyroid carcinomas ≤ 1.5 cm

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While some studies suggest that the BRAF V600E mutation correlates with a high-risk phenotype in papillary thyroid microcarcinoma (PTMC), more evidence is necessary before this mutation can be used to help guide ...
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Πέμπτη 4 Νοεμβρίου 2021

Airway injury from transoral endoscopic thyroidectomy vestibular approach

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Abstract

Background

The transoral endoscopic thyroidectomy vestibular approach (TOETVA) is a novel technique that eliminates a cervical scar. This procedure carries unique risks, and data on outcomes are needed as more cases are performed.

Methods

We describe two cases of airway injury during the TOETVA. A description of the procedure and management of the injuries is outlined.

Results

In one case, a 3-mm injury in the thyrohyoid membrane was identified. The TOETVA was converted to an open approach due to significant inflammation in the setting of Graves' and the repair was performed while open. In the second case, a fracture occurred from the thyroid notch to Broyle's ligament without avulsion. A primary repair was endoscopically performed.

Conclusions

Airway injury is a possible complication of both open thyroidectomy and TOETVA. For TOETVA, trauma is most likely to occur in the midline during Hegar dilation and trocar placement through the central incision.

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Perfusion-Decellularized Larynx as a Natural 3D Scaffold in a Rabbit Model

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Introduction: Decellularized larynges could be used as scaffolds to regenerate the larynx. The purpose of this study was to establish a perfusion decellularization protocol to produce a 3-dimensional whole laryngeal extracellular matrix (ECM) scaffold in a rabbit model. Methods: The larynges of 20 rabbits assigned to the study group were harvested and decellularized using a perfusion decellularization protocol, while the larynges of 10 rabbits in the control group were harvested and untreated. Macroscopic and microscopic morphological analyses, a molecular analysis, a cellular content analysis, and scanning electron microscopy were performed. Results: A histological analysis showed the absence of cellular components, the presence of the ECM, and an intact cartilage structure filled with chondrocytes. The mean total DNA amounts of the native larynx, decellularized larynx, and decellularized cartilage-free larynx were 1,826.40, 434.70, and 41.40 μg/µL, respectively; those for the decellularized larynx and decellularized cartilage-free larynx were significantly lower (p #x3c; 0.001 and p #x3c; 0.001, respectively). The total amount of DNA in the decellularized sample was significantly lower compared to that in the native sample, at 57.2% in cartilage (p #x3c; 0.001), 2.4% in the thyroid gland (p #x3c; 0.001), 2.7% in muscle (p #x3c; 0.001), 1.6% in vessels (p #x3c; 0.001), and 4.8% in the vocal cords (p #x3c; 0.001). Conclusion: Our perfusion decellularization protocol is feasible and reproducible to produce a 3-dimensional whole laryngeal ECM scaffold in a rabbit.
ORL
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Safety and Predictors of 30‐Day Adverse Events of Laryngeal Framework Surgery: An Analysis of ACS‐NSQIP data

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Objectives/Hypothesis

To characterize and identify predictors of 30-day adverse events in patients undergoing laryngeal framework surgery (LFS).

Study Design

This study is a retrospective analysis of the National Surgical Quality Improvement dataset.

Methods

LFS cases were identified from the American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) database from 2008 to 2018. Demographic variables, patient comorbidities, and perioperative outcomes (any adverse event, 30-day readmission, 30-day reoperation, and unplanned intubation) were extracted. Patient-specific and surgery-specific factors associated with perioperative adverse events were examined using descriptive statistics and univariate logistic regression (LR).

Results

Of 283 patients who underwent LFS, 225 underwent laryngoplasty medialization, 56 underwent laryngoplasty medialization with arytenoidectomy or arytenoidopexy via an external approach, and 2 underwent local myocutaneous or fasciocutaneous advancement flap along with laryngoplasty. Medical comorbidities were present in 33.6% of patients and 57.9% were American Society of Anesthesiologists (ASA) Class III/IV (57.9%). LFS was performed as same-day surgery in 30.7% of cases. Fourteen patients (4.9%) suffered an adverse condition within 30 days following surgery. In univariate LR, ASA Class III or IV (odds ratio [OR] 4.6, 95% confidence interval [CI] 1.2–30.1) was the only predictor associated with any adverse event. Arytenoid adduction (AA) was associated with increased risk of reoperation within 30 days of the initial surgery (OR 6.4, 95% CI 1.0–49).

Conclusions

LFS is a generally safe procedure with infrequent perioperative adverse events. In the ACS-NSQIP database, ASA classification of III or IV was associated with a higher risk for any 30-day adverse event and AA was associated with a higher risk for 30-day reoperation.

Level of Evidence

4 Laryngoscope, 2021

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Ear, nose and throat manifestations of autoimmune and autoinflammatory diseases: a rheumatology perspective

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Ear involvement
Nose and sinus involvement
Oral involvement
Throat involvement
Fundings
Conflicts of interest
References
Brazilian Journal of Otorhinolaryngology
Brazilian Journal of Otorhinolaryngology
Available online 22 October 2021
In Press, Corrected ProofWhat are Corrected Proof articles?
Brazilian Journal of Otorhinolaryngology
Editorial
Ear, nose and throat manifestations of autoimmune and autoinflammatory diseases: a rheumatology perspective
Author links open overlay panelSamuel de OliveiraAndradeaSimoneAppenzellerb
https://doi.org/10.1016/j.bjorl.2021.05.015Get rights and content
Under a Creative Commons licenseopen access
Ear, nose and throat (ENT) manifestations are an important hallmark of inflammatory rheumatic diseases, varying from mild to life-threatening manifestations. They can be the first symptoms or occur during the course of the disease. The correct identification of the underlying physiopathology (inflammation, thrombosis or infection) and proper treatment of ENT symptoms are therefore of importance in diagnosis and followup of patients with inflammatory rheumatic disease. Many classification criteria include ENT manifestations, such as granulomatosis with polyangiitis (GPA), Behçet disease (BD), relapsing polychondritis (RP), eosinophilic granulomatosis with polyangiitis (EGPA) and Cogan syndrome (GS). Other autoimmune/autoinflammatory diseases are characterized by widespread inflammation and may present with ENT symptoms, such as sarcoidosis, rheumatoid arthritis (RA), Sjogren syndrome (SS), systemic lupus erythematosus (SLE) and systemic sclerosis (SSc).1, 2, 3, 4, 5

In this editorial, we will review on the main ENT manifestations that have been described in inflammatory rheumatic diseases.

Ear involvement
Outer ear
Auricular chondritis is present in 20% at the onset of RP and 90% during the course of the disease. The entire ear is swollen, red and painful at contact. The continuous inflammation can result in pinna cauliflower deformity or ossification of the connective tissue. RP is characterized by a rare multisystem disease accepted as a complex autoimmune disorder affecting proteoglycan-rich structures and cartilaginous tissues, especially the auricular pinna, cartilage of the nose, tracheobronchial tree and various organ's connective components. Auricular chondritis can also be observed in GPA. It is a rare autoimmune disorder characterized by granulomatous inflammation and small-vessel vasculitis associated with antineutrophil cytoplasmic antibodies (ANCA). GPA has a broad clinical spectrum that ranges from predominantly granulomatous manifestations restricted to the respiratory tract to severe, life-threatening necrotizing vasculitis.1, 2, 3

Middle ear
Otalgia, secretory otitis media and otorrhea can be observed in GPA and imunoglobulin G4 related disease (IgG4-RD). IgG4-RD is a chronic inflammatory disease that involves many tissues such as pancreas, lacrimal and salivary glands. Ear manifestations are more common in the middle ear, and the inner ear is rarely affected. Recurrent mastoiditis and facial numbness can also be observed.4

Inner ear
Sensorineural hearing loss (SNHL) can be observed in a variety of systemic autoimmune/autoinflammatory diseases, having a prevalence of 21-69% for RA, 8-28% for SLE, 21-46% for SS and 20-77% for systemic sclerosis. Possible mechanisms include disease related (vasculitis, thrombosis or antibody-mediated) and medication related (ototoxic effect). The presence of vestibuloauditory symptoms, as sudden onset tinnitus and vertigo that can present with nausea, vomiting, ataxia and nystagmus in association especially with non-infectious interstitial keratitis, but also other symptoms (conjunctivitis, uveitis, episcleritis, scleritis, optic neuritis) should raise the suspicion of Cogan Syndrome (CS).1, 2

SNHL in association with increased inflammatory markers and the presence of recurrent fever in the absence of infection should alert otolaryngologists to the possibility of autoinflammatory diseases. Systemic autoinflammatory diseases (SIAD) are a group of disorders caused by a dysregulation of the innate immune system. One of most common monogenic SIAD associated with hearing loss is mutation of NOD- like receptor gene (NLRP3), a condition known as NLRP3-associated autoinflammatory disease (NLRP3-AID), formerly known as Cryopyrin-associated periodic syndrome (CAPS). Muckle Wells syndrome (MWS) is the intermediate form of CAPS and can develop to progressive SNHL, secondary to chronic inflammation of the internal ear. SNHL in MWS often rapidly progresses from mild high tone deficits to complete deafness. Early hearing loss primarily affects high frequencies of > 6 kHz reflecting the characteristic high sensitivity pattern of hair cells to injury as described in other systemic condit ions. Cochlear enhancement on fluid attenuation inversion recovery MRI (FLAIR- MRI) is more frequent in patients with a higher prevalence of hearing loss, providing some insight into the mechanisms of SNHL in MWS.5

Nose and sinus involvement
Nasal involvement in GPA is present in approximately 42% of patients. Other associated symptoms related to GPA activity are nasal inflammation, chronic sinusitis, and nasal crusting with or without bloody rhinorrhea.

Nasal chondritis can affect up to 15% of patients of RP. The inflammation involves the bridge of the nose, causing nasal pain, redness and swelling, being less marked than the ears. Nasal obstruction is rare. Both RP and GPA can progress to permanent damage, such as characteristic 'saddle-nose' deformity or septal perforation.1

EGPA is a rare necrotizing ANCA-associated vasculitis. EGPA is characterized by the presence of asthma, peak blood eosinophilia and small-size vessel vasculitis. There are many nasal manifestations associated with the disease, such as chronic sinusitis, nasal crusting, allergic rhinitis and bilateral diffuse polyposis. The presence of these manifestations associated with vasculitis in biopsy or ANCA positivity should rise the suspicion of EGPA.

Oral involvement
Sicca syndrome is by far the most frequent oral manifestation in autoimmune diseases, being present in more than 95% of patients with SS. Xerostomia may lead to secondary problems like oral candidiasis, dental caries and periodontal disease. In addition to that, sicca symptoms can lead to hoarseness and non-productive cough. Recurrent parotitis is present in 30-50% of patients and is characterized by a firm, diffuse, non-tender swelling. It is important in differentiate it from recurrent juvenile parotitis, where ANA antibodies are generally absent.

BD is a systemic vasculitis, affecting vessels of variable sizes. It is characterized by a myriad of systemic manifestations, including mucocutaneous, arthritis, vascular, neurological and gastrointestinal. Recurrent oral ulceration is the most frequent presenting ENT symptom (95% of patients), typically being multiple and variable size (2-20 mm) and occur extensively on the buccal membrane, tongue, palate and in the oropharynx. The ulcers are classically painful, surrounded by erythema and the larger ones heal with scarring. Six or more painful, recurrent ulcers, of variable size with surrounding erythema occurring on the soft palate or oropharynx should heighten suspicion of BD.1, 2

SLE mucous membrane involvement is characterized by oral ulcers. Classical lesions are asymptomatic, occur at the hard palate and are characterized by whitish plaques with erythema in the center and keratotic striae in the periphery with areas of telangiectasia.1, 2

Throat involvement
Laryngeal chondritis is an important symptom of RP and it manifests as pain above the thyroid gland and dysphonia, causing laryngomalacia or stenosis in more severe cases. Hypoglottic stenosis, due to granulomatous inflammation of GPA occurs in 2-20% and is a potential life-threatening complication and is associated with systemic involvement. Dyspnea, voice changes and cough are the most common symptoms, and audible stridor is present in most severe cases.1

RA is a chronic inflammatory disease characterized by symmetrical inflammatory joint disease that may evolve to joint damage and bone destruction. Laryngeal manifestations of RA involve cricoarytenoid joint (CJ) arthritis and rheumatoid nodules. The symptoms of CJ arthritis in the acute stage are often fullness in the throat or a feeling of tension, in addition to hoarseness, odynophagia or dysphagia, as well as pain worsening by speaking. Chronic disease can be manifest by a husky voice and stridor.1, 2

In summary, inflammatory rheumatic are rare diseases that present with a wide spectrum of ENT manifestations. A high index of suspicion is necessary for timely diagnosis. ENT specialists have a crucial role in referring patients with possible inflammatory diseases to rheumatologists.

Fundings
National Council for Scientific and Technological Development (CNPQ): 306723/2019-0.

Coordination of Superior Level Staff Improvement (CAPES): 001.

Conflicts of interest
The authors declare no conflicts of interest.

References
1
C. Gera, N. Kumar
Otolaryngologic Manifestations of Various Rheumatic Diseases: Awareness and Practice Among Otolaryngologists
Indian J Otolaryngol Head Neck Surg, 67 (2015), pp. 366-369
CrossRefView Record in ScopusGoogle Scholar
2
R.J. Gusmão, F.L. Fernandes, A.C. Guimarães, L. Scaramussa, Z. Sachetto, H.F. Pauna, et al.
Otorhinolaryngological findings in a group of patients with rheumatic diseases
Rev Bras Reumatol, 54 (2014), pp. 172-178
ArticleDownload PDFCrossRefView Record in ScopusGoogle Scholar
3
M. Felicetti, D. Cazzador, R. Padoan, A.L. Pendolino, C. Faccioli, E. Nardello, et al.
Ear, nose and throat involvement in granulomatosis with polyangiitis: how it presents and how it determines disease severity and long-term outcomes
Clin Rheumatol, 37 (2018), pp. 1075-1083
CrossRefView Record in ScopusGoogle Scholar
4
Q. Ren, J. Su, D. Zhang, X. Ding
Otological IgG4-Related Disease With Inner Ear Involvement: A Case Report and Review of Literature
Ear Nose Throat J (2020), 10.1177/0145561320976411
Online ahead of print
Google Scholar
5
T. Welzel, J.B. Kuemmerle-Deschner
Diagnosis and Management of the Cryopyrin-Associated Periodic Syndromes (CAPS): What Do We Know Today?
J Clin Med, 10 (2021), p. 128
CrossRefGoogle Scholar
© 2021 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda.

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Braz J Otorhinolaryngol. 2021 Oct 22:S1808-8694(21)00168-3. doi: 10.1016/j.bjorl.2021.05.015. Online ahead of print.

NO ABSTRACT

PMID:34732358 | DOI:10.1016/j.bjorl.2021.05.015

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