We report a 12-month-old boy with a skin eruption that developed 15 days after receiving the measles, mumps, rubella (MMR), pneumococcal, and meningococcal vaccines, consistent with the diagnosis of Wells syndrome. Patch testing showed a positive reaction to gelatin, which is used as a stabilizer for both live and inactivated vaccines. Gelatin was only present in the MMR vaccine.

BACKGROUND: Papilledema is a common sign of various diseases in the eye. It could result from any conditions of increased intracranial pressure (ICP). Underlying the etiology of papilledema and appropriate treatment in time is essential.
METHODS: We present a case of severe bilateral papilledema after sigmoid sinus constriction surgery. A 25-year-old female presented with a 1-month history of bilateral blurred vision, headache, and vomiting. The patient had a history of right-side sigmoid sinus constriction surgery for pulsatile tinnitus (PT) one month before in another hospital. Fundus examination showed severe bilateral papilledema. Lumbar puncture showed an elevated cerebrospinal fluid (CSF) opening pressure of 29 cm H2O. Neuroimaging examination demonstrated the right sigmoid sinus filling defect as changes after surgery. We referred the patient to the initial surgeon, who repaired the sigmoid sinus on the right side by removing the implanted gelatin sponge, as diuretic treatment could not be effective. Intracranial hypertension symptoms and signs improved soon after eliminating sigmoid sinus stenosis. Neuroimaging showed resolved right sigmoid sinus stenosis after the second surgery. CSF opening pressure was 14.5 cm H2O at the 1-month follow-up. Fundus examination showed entirely resolved papilledema. Three years of follow-up showed no recurrence.
CONCLUSIONS: This is the first clinical report of intracranial hypertension associated with sigmoid sinus constriction surgery. Although rare, rapid detection and adequate etiology management could lead to a good prognosis. It highlights the need for ophthalmologists to be aware of the diagnostic approach to papilledema and enhance cooperation with multidisciplinary departments. The most likely cause of the intracranial hypertension was dominant sinus surgical constriction by mechanical external compression, as confirmed by the complete clinical remission following the second operation to remove the implanted gelatin sponge. Thus, this case also highlights the importance of selecting the appropriate therapeutic option for PT. Surgical sinus constriction should no longer be considered a viable option for PT treatment.

暂无摘要。

Computed tomography (CT) may have a crucial role in the forensic documentation and analysis of firearm injuries. The aim of this forensic ballistics case study was to explore whether two types of expanding bullets and a full metal-jacketed bullet could be differentiated by inspecting bullet fragments and fragmentation pattern in CT. Three types of .30 caliber bullets (full metal-jacketed Norma Jaktmatch, expanding full-copper Norma Ecostrike, and expanding soft-point Norma Oryx) were test fired from a distance of 5 m to blocks of 10% ballistic gelatine. CT scans of the blocks were obtained with clinical equipment and metal artifact reduction. Radiopaque fragments were identified and fragmentation parameters were obtained from the scans (total number of fragments, maximum diameter of the largest fragment, distance between entrance and the closest fragment, length of the fragment cloud, and maximum diameters of the fragment cloud). The fragmentation patterns were additionally visualized by means of 3D reconstruction. In CT, the bullet types differed in several fragmentation parameters. While the expanding full-copper bullet Ecostrike left behind only a single fragment near the end of the bullet channel, the soft-point Oryx had hundreds of fragments deposited throughout the channel. For both expanding bullets Ecostrike and Oryx, the fragments were clearly smaller than those left behind by the full metal-jacketed Jaktmatch. This was surprising as the full metal-jacketed bullet was expected to remain intact. The fragment cloud of Jaktmatch had similar mediolateral and superoinferior diameters to that of Oryx; however, fragments were deposited in the second half of the gelatine block, and not throughout the block. This case study provides a basis and potential methodology for further experiments. The findings are expected to benefit forensic practitioners with limited background information on gunshot injury cases, for example, those that involve several potential firearms or atypical gunshot wounds. The findings may prove beneficial for both human and wildlife forensics.

The TD-NMR technique mostly involves the use of T1 (spin-lattice) and T2 (spin-spin) relaxation times to explain the changes occurring in food systems. However, these relaxation times are affected by many factors and might not always be the best indicators to work with in food-related TD-NMR studies. In this study, the non-conventional TD-NMR approaches of Solid Echo (SE)/Magic Sandwich Echo (MSE) and Spin Diffusion in food systems were used for the first time. Soft confectionary gelatin gels were formulated and conventional (T1) and non-conventional (SE, MSE and Spin Diffusion) TD-NMR experiments were performed. Corn syrups with different glucose/fructose compositions were used to prepare the soft candies. Hardness, °Brix (°Bx), and water activity (aw) measurements were also conducted complementary to NMR experiments. Relaxation times changed (p < 0.05) with respect to syrup type with no obvious trend. SE/MSE experiments were performed to calculate the crystallinity of the samples. Samples prepared with fructose had the lowest crystallinity values (p < 0.05). Spin Diffusion experiments were performed by using Goldman−Shen pulse sequence and the interface thickness (d) was calculated. Interface thickness values showed a wide range of variation (p < 0.05). Results showed that non-conventional NMR approaches had high potential to be utilized in food systems for quality control purposes.

OBJECTIVE: The purpose of this article was to describe the successful diagnosis and management of clinically atypical, unilateral, gelatinous drop-like corneal dystrophy (GDLD) in a pediatric patient.
METHODS: This study was a case report.
RESULTS: A 7-year-old Japanese girl was referred to our clinic with right corneal opacity for over 3 years. Slitlamp examination revealed a white, protruding, paracentral corneal opacity with an irregular surface and tiny stromal lattice figures with subepithelial opacities. No trichiasis or epiblepharon was observed, and the patient\'s right corrected distance visual acuity (CDVA) was 18/20. The contralateral cornea was intact but demonstrated fluorescein uptake. After 8 months, the right CDVA worsened from 18/20 to 6/20, and corneal epithelial scraping was performed. Histopathological analysis revealed amyloid nodules in the subepithelial layer and in the anterior corneal stroma stained with Congo red, which reoccurred 2 months after the procedure, and corneal dystrophy was suspected. Isolation and sequencing of the genomic DNA revealed a homozygous p.Gln118Ter. mutation in TACSTD2 in the patient and heterozygous p.Gln118Ter. mutations in both parents. GDLD was diagnosed; bilateral use of therapeutic soft contact lenses was prescribed after the first corneal scraping. No additional surgical intervention was required for the right eye for 4.5 years. CDVA of the contralateral left eye has been successfully maintained at 30/20 over this period, without emergence of nodular lesions or corneal opacities.
CONCLUSIONS: We encountered a patient with early, atypical GDLD, who was definitively diagnosed using genomic DNA sequencing. GDLD should be a part of the differential diagnosis in patients presenting with unilateral, recurrent amyloid deposition.

暂无摘要。

Amyloids are a group of proteins that are capable of forming aggregated amyloid fibrils, which is responsible for many neurodegenerative diseases including Alzheimer\'s disease (AD). In our previous study, synthesis and characterization of star-shaped poly(D,L-lactide)-b-gelatin (ss-pLG) have been reported. In the present work, we have extended our work to study ss-pLG against protein aggregation. To the best of our knowledge, this is the first report on the inhibition of amyloid fibrillation by protein grafted poly(D,L-lactide). Bovine serum albumin (BSA) was chosen as the model protein, which readily forms fibril under high temperature. We found that ss-pLG efficiently suppressed the fibril formation of BSA compared with gelatin (Gel), which was supported by Thioflavin T assay, circular dichroism (CD) spectroscopy and atomic force microscopy (AFM). In addition, ss-pLG significantly curtailed amyloid-induced hemolysis. We also found that incubation of ss-pLG with neuroblastoma cells (MC65) protected the cells from fibril-induced toxicity. The rescuing efficiency of ss-pLG was better than Gel, which could be attributed to the reduced lamella thickness in branched ss-pLG. These results suggest the significance of gelatin grafting, which probably allows gelatin to interact with the key residues of the amyloidogenic core of BSA effectively.

Primary hyperparathyroidism (PHPT) is the most common cause of hypercalcemia in the clinical setting and affects 0.3% of the population. Parathyroidectomy is the only definitive cure. Unfortunately, even in the most experienced hands, persistent primary hyperparathyroidism (P-PHPT) occurs in 4.7% of the patients. Ectopic adenomas are difficult to localize before and during operation and usually end up with P-PHPT. Herein, we presented a case with P-PHPT due to mediastinal parathyroid adenoma that was successfully ablated with selective arterial embolization. A 57-year-old female patient was admitted to our endocrinology clinic with persistent hypercalcemia 4 months after the initial surgery for PHPT that had been performed in another center. The patient did not accept the second operation, and serum calcium and parathyroid hormone (PTH) remained high despite medical treatment with cinacalcet and IV zoledronate. In the 99-m Tc-MIBI scintigraphy with SPECT, a 18 × 12-mm-sized lesion in the mediastinum at the paratracheal region was detected which was confirmed to be a possible parathyroid adenoma with fluorocholine PET and chest computed tomography (CT). The right bronchial artery that was detected to supply the mediastinal mass in CT angiography was selectively catheterized and embolized with embosphere. Right after the procedure, serum PTH and calcium levels were normalized and remained normal in 23 months of follow-up. Selective arterial embolization is a treatment option for ectopically located adenomas which are difficult to resect and in cases with certain comorbidities which constitute a contraindication for surgery.

Percutaneous endoscopic lumbar discectomy (PELD) can only relieve mechanical compression but cannot directly reduce the inflammatory reaction of the adjacent nerve root, which contributes to persistent pain and physical disabilities postoperatively. Numerous studies have explored the application of epidural steroids after an open lumbar discectomy in relieving pain by reducing local inflammatory reactions and further peridural scar formation.
To explore that whether \"cocktail treatment\" in which a gelatin sponge was impregnated with ropivacaine, dexamethasone, and vitamin B12 promoted early postoperative recovery after PELD.
Retrospective, case-controlled study.
All data were from Hong-Hui Hospital in Xi\'an.
Between January 2016 and January 2017, 100 patients of single-level lumbar disc herniation were treated with PELD in our hospitals. The cocktail treatment was applied in the first 50 patients (group cocktail), and an equal size gelatin sponge without drugs was used in the other 50 patients as control (group noncocktail). The clinical outcome evaluation included the Visual Analog Scale (VAS) score for back and leg pain and Oswestry Disability Index (ODI) score.
There was a significant difference in the mean periods of return to work (4.25 ± 1.88 weeks in the cocktail group and 5.18 ± 2.19 weeks in the noncocktail group) (P < 0.01). Compared with the preoperative data, a significant improvement in VAS scores of back pain and sciatica and ODI were observed in each follow-up interval (P < 0.05, respectively). In the noncocktail group, there were visible fluctuations in the 3 indicators within the first week after surgery. This phenomenon was not observed in the cocktail group, a difference that was statistically significant (P < 0.05, respectively). In further follow-up, no significant differences were observed between the 2 groups (P > 0.05, respectively).
The nonrandomized, single-center, retrospective design is a major limitation of this study.
The \"cocktail treatment\" with a gelatin sponge impregnated with ropivacaine, dexamethasone, and vitamin B12 promotes early and satisfactory back and leg pain relief and fast functional recovery after PELD.
Endoscopic lumbar discectomy, lumbar disc herniation, steroids, nerve root block, gelatin sponge.