Un-FASN-ing cancer's seat belt: Linking lipid metabolism and antigen presentation.

MHC-II expression on cancer cells is associated with improved treatment outcome. In this issue, Huang et al. report a panel of small molecules that selectively upregulate MHC-II on cancer cells through suppression of fatty acid synthase (FASN), resulting in inhibition of tumor growth.

A Zebrafish Model of Metastatic Colonization Pinpoints Cellular Mechanisms of Circulating Tumor Cell Extravasation.

Metastasis is a multistep process in which cells must detach, migrate/invade local structures, intravasate, circulate, extravasate, and colonize. A full understanding of the complexity of this process has been limited by the lack of ability to study these steps in isolation with detailed molecular analyses. Leveraging a comparative oncology approach, we injected canine osteosarcoma cells into the circulation of transgenic zebrafish with fluorescent blood vessels in a biologically dynamic metastasis extravasation model.

Consciousness after split-brain surgery: The recent challenge to the classical picture.

In a recent series of experiments, Pinto and colleagues found that the split-brain patient D.D.C.

A safe and comparable alternative to BIPP packing following tympanoplasty for tympanic membrane perforation.

Purpose: To compare two post-operative ear packing methods following tympanoplasty for tympanic membrane perforation.

Methods: A prospective study of patients undergoing tympanoplasty for tympanic membrane perforation over a 2-year period was undertaken across two district general hospitals. Data, including demographics, pre-operative ear state, and graft type used for repair were recorded.

Split-Brain: What We Know Now and Why This is Important for Understanding Consciousness.

Recently, the discussion regarding the consequences of cutting the corpus callosum ("split-brain") has regained momentum (Corballis, Corballis, Berlucchi, & Marzi, Brain, 141(6), e46, 2018; Pinto et al., Brain, 140(5), 1231-1237, 2017a; Pinto, Lamme, & de Haan, Brain, 140(11), e68, 2017; Volz & Gazzaniga, Brain, 140(7), 2051-2060, 2017; Volz, Hillyard, Miller, & Gazzaniga, Brain, 141(3), e15, 2018). This collective review paper aims to summarize the empirical common ground, to delineate the different interpretations, and to identify the remaining questions.

Fungal malignant otitis externa.

An 89-year-old man presented to the outpatient clinic with a 2-month history of persistent unilateral left-sided otalgia, otorrhoea and reduced hearing despite oral and topical antibiotics. Treatment was protracted, requiring a 4-month hospital admission for intravenous antifungal medication as well as 3 further months of oral antifungal treatment. We describe the clinical presentation, complications and treatment of this potentially fatal condition in the context of an unusual, and easily missed, causative organism.

Haemostatic property of cyanoacrylate in pedicled flaps.

We present a technique that can, in principle, be applied to any pedicled flap that is routinely used for reconstructions of the forehead. In our experience, cyanoacrylate glue applied to the pedicle before the flap is inserted decreases postoperative bleeding and wound exudate.

Chimeric Upper Eyelid--Supraorbital Flap Reconstruction.

Wide local excision of a lesion that encompasses several facial subunits including medial canthus, nasal sidewall, and cheek provides multiple aesthetic and reconstructive challenges to restore both orbital function as well as appearance. We report the first successful use of a chimeric upper eyelid--supraorbital flap to reconstruct a facial defect, secondary to a wide local excision of the lower eyelid, entire nasal sidewall, and infraorbital cheek in a patient with a biopsy-proven diagnosis of malignant melanoma. Chimeric upper eyelid--supraorbital flap provides simultaneous reconstruction of lower eyelid, nasal sidewall, and infraorbital areas, therefore replacing multiple facial aesthetic subunits at the same time providing unparalleled tissue quality match to all areas as well as excellent functional and aesthetic outcomes.

Is risk factor control and guideline-based medical therapy optimal in patients with nonobstructive coronary artery disease? A Veterans Affairs study.

Background: Aggressive risk factor modification using evidence-based secondary prevention strategies is recommended in coronary artery disease (CAD). Utilization of such strategies was compared in patients with nonobstructive CAD (NOCAD) and obstructive CAD (OCAD).

Methods: Patients undergoing coronary angiography (excluding normal coronary angiograms), between January 2006 and June 2006, at the Veterans Affairs Medical Center were included.

Coronary slow flow--prevalence and clinical correlations.

Background: Coronary slow flow phenomenon (CSFP) is defined as delayed coronary opacification in the absence of obstructive coronary artery disease. In the present study, we sought to define its prevalence and clinical features.

Methods And Results: The 1,741 consecutive patients who underwent coronary angiography (CAG) were identified.

Sertraline-induced ventricular tachycardia.

Sertraline is a selective serotonin reuptake inhibitor, which is a commonly used drug for major depressive disorder. Most frequently reported adverse effects of sertraline in patients receiving 50-150 mg/d are dry mouth, headache, diarrhea, nausea, vomiting, sweating, and dizziness. We hereby report one of the few cases of sertraline-induced ventricular tachycardia, which has been for the first time objectively assessed by the Naranjo scale.

Screening for cervical neoplasia: a community-based trial comparing Pap staining, human papilloma virus testing, and the new bi-functional Celldetect® stain.

Although cytological screening for cervical neoplasia has lowered mortality rates, current screening methods are plagued by sub-optimal sensitivity and/or specificity. The purpose of this study was to compare the performance of the new CellDetect® staining technology as a potential screening tool. This initial, non-blinded study, utilized samples are taken at a community-based clinic.

Fluoroscopy vs. traditional guided femoral arterial access and the use of closure devices: a randomized controlled trial.

Objective: To compare the effectiveness of accessing the common femoral artery (CFA) using fluoroscopic guidance (FG) versus traditional anatomic landmark guidance (TALG) during cardiac catheterization and to determine the effect of the two modalities on the appropriateness for use of vascular closure devices (VCDs).

Background: Previous studies have shown a consistent relationship between the head of the femur and the CFA, yet there is no prospective data validating the superiority of fluoroscopy-assisted CFA access.

Methods: A total of 972 patients were randomized to either FG or TALG access.

Clopidogrel attenuates coated-platelet production in patients undergoing elective coronary catheterization.

Introduction: Coated-platelets are a subclass of highly thrombotic activated platelets with an enhanced ability to generate thrombin. Excessive numbers of coated-platelets are believed to increase thrombotic risk. A previous report demonstrated that P2Y12 inhibition in vitro attenuates coated-platelet formation.

Identification of subcutaneous myiasis using bedside emergency physician performed ultrasound.

Background: Subcutaneous myiasis, a maggot infiltration of human tissue, is common in tropical countries. However, physicians in the United States may be unlikely to consider this etiology of dermatologic abnormalities even when a travel history suggests the diagnosis should be included in the differential.

Case Report: We report the case of a patient who returned from Sierra Leone with an infestation of a maggot of Cordylobia anthropophaga (tumbu fly) that was diagnosed and appropriately treated based on ultrasound findings.

HFE mutations in heart disease.

Given the reported association of cardiac complications with hereditary hemochromatosis and the high carrier frequency of HFE gene mutations in the natural population, it seems reasonable that such mutations might appear more frequently than expected among symptomatic cardiac patients. Thus, H63D, C282Y, and S65C mutations and their possible associations were examined in 477 Caucasian males undergoing coronary angiography. Genotypes were analyzed for differences between ferritin and transferrin levels, coronary artery disease (CAD), cardiomyopathy (CM), and cardiovascular disease (CVD) mortality.

Coronary slow flow phenomenon and risk for sudden cardiac death due to ventricular arrhythmias: a case report and review of literature.

We report a case of coronary slow flow phenomenon (CSFP) in a patient who underwent coronary angiography due to anginal chest pain and recurrent syncope with complete normalization of flow after intracoronary adenosine. He was noted to have multiple episodes of nonsustained ventricular tachycardia on holter monitor and increased QTc dispersion on surface electrocardiogram (EKG). He responded very well to oral dipyridamole therapy with complete resolution of his symptoms and no episodes of ventricular tachycardia on the event recorder at 3 months.

Dose indices of radiation to skin in fluoroscopically guided invasive cardiology procedures.

Tissue injury depends on the extent as well as the intensity of the assault. It would be helpful to develop skin dose indices that are more descriptive of the skin area receiving radiation above a threshold value of potential injury. For monitoring radiation exposure to patients, radiochromic film was placed close to the skin of a patient undergoing cardiac catheterization procedures.

Relationship of the 1793G-A and 677C-T polymorphisms of the 5,10-methylenetetrahydrofolate reductase gene to coronary artery disease.

Numerous studies have investigated the relationship between polymorphisms, in particular 677C-T and 1298A-C, of the methylene-tetrahydrofolate reductase (MTHFR) gene and coronary artery disease (CAD) with conflicting results. This study investigates the potential association of two point mutations in MTHFR, 677C-T and 1793G-A, along with other risk factors, with CAD. This is the first hospital-based study to investigate 1793G-A in this context.

Transfemoral venous access through inferior vena cava filters for interventions requiring large sheaths.

The presence of a filter in the inferior vena cava (IVC) to prevent pulmonary embolism from lower extremity deep vein thrombosis has traditionally been a contraindication for venous catheterization from the femoral vein. Certain interventional procedures require femoral access and occasionally, patients with IVC filters require these procedures. The authors report two such patients, one with a Greenfield filter requiring balloon mitral valvuloplasty and one with a Trapease filter requiring atrial septostomy.

A new approach to office hysteroscopy compared with traditional hysteroscopy: a randomized controlled trial.

Objective: To compare a "no touch" approach to diagnostic hysteroscopy without anesthesia with traditional diagnostic hysteroscopy after intracervical injection of mepivacaine hydrochloride 3%.

Methods: A total of 130 women undergoing diagnostic hysteroscopy were included in the study and were randomized, using a computer-generated randomization list to one of two treatment groups in a ratio of 2:1. Eighty-three women underwent hysteroscopy without speculum, tenaculum, or anesthesia.