Objective: The public use of electronic-cigarettes (e-cigs) is rapidly growing. When heated, e-cigs produce a vapor that is inhaled. The vocal folds are among the first tissues exposed to this insult. However, the impact of e-cigs on vocal fold health is almost entirely unknown. Our objective was to evaluate the effects of e-cig vapor on cultured human vocal fold fibroblasts (hVFFs), the primary cell type of the lamina propria. We compared the cellular effects of e-cig vapor without and with nicotine and conventional cigarette smoke.Study Design: In vitro.Methods: E-cig vapor extract (EVE) and cigarette smoke extract (CSE) were created by bubbling vapor and smoke, respectively, into the cell culture medium. hVFFs were exposed to EVE without or with nicotine or CSE for 24 hours. Untreated cells were used as a control group. Cells were harvested, and cytotoxicity, extracellular matrix and inflammatory gene expression, and DNA damage were assessed.Results: Undiluted EVE without and with nicotine reduced the viability of hVFFs to a cytotoxic level. CSE reduced hVFFs viability to a greater extent than EVE and induced DNA damage as measured by DNA double-strand breaks. No changes in gene expression were observed following EVE or CSE exposure.Conclusion: EVE induces cytotoxicity in hVFFs. However, cellular responses were greater following exposure to CSE, suggesting cigarette smoke may induce more harm, at least in the short term. Findings from this investigation improve our understanding of responses of hVFFs to e-cigs and form the basis for an in vitro methodology to study the vocal fold responses to these products.
In this report, a pregnant patient exhibited cytarabine induced isolated hyperbilirubinemia during induction chemotherapy without any other evidence of liver dysfunction; in addition, decreasing cytarabine dosage during the consolidation phase resulted in lower elevations of bilirubin. Our findings add to the existing literature on cytarabine induced hyperbilirubinemia by highlighting its effects in pregnancy, while also showing that dose adjustments can be utilized not only to prevent high bilirubin levels but to achieve clinically significant outcomes.[2957] Figure 1. Laboratory trends during chemotherapeutic induction phase with Cytarabine and Daunorubicin. Peak elevation in total and direct bilirubin can be seen on Day 14.
Introduction: Multifocal adult intussusceptions (AI) are rare with challenging diagnostic workup. Etiology of most adult intussusceptions are structural lesions, such as surgical adhesions or malignant neoplasm. Case Description/Methods: A 54-year-old man presented with severe abdominal pain. His medical history included diverticulosis and pulmonary histoplasmosis, but no prior abdominal surgeries. He works in construction, and he denied international travel. Vital signs were normal and labs notable for leukocytosis (17 x10 9 /L). Physical examination revealed abdominal distension and tenderness to palpation of the left abdomen. Contrast CT of the abdomen showed multiple proximal small bowel intussusceptions without identifiable lead points or obstruction (a, arrows). HIV, histoplasmosis, tuberculosis, and celiac serologies were negative. He underwent exploratory laparoscopy with reduction of 9 segments of intussuscepted bowel involving the jejunum and proximal ileum, all without identifiable lead point (b). CT enterography post-operatively was normal. Antegrade double balloon-assisted enteroscopy showed no mucosal abnormality and jejunal biopsies were unremarkable. Patient was discharged with symptom resolution. He represented 2 months later with recurrent left-sided abdominal pain. Laboratory investigation showed leukocytosis (10.7 x10 9 /L) with mild eosinophilia (0.63 x10 9 /L). CT enterography showed a possible shortsegment intussusception at the proximal jejunum without lead point. Comprehensive autoinflammatory and infectious workup revealed positive Strongyloides Antibody, IgG. Patient was treated with ivermectin and has remained symptom free without further events. (Figure ) Discussion: AI is unusual and requires a high index of clinical suspicion combined with appropriate imaging to establish an early diagnosis. 1 More than 90% are caused by a lead point or structural abnormality (e.g., tumor) and CT is best modality for diagnosis. 1,2 Helminth infection is a well-recognized cause of pediatric intussusception, but few cases of helminth-related AI have been reported, and none secondary to Strongyloides have been documented. Our patient's peripheral eosinophilia, abdominal pain, recurrent multifocal intussusceptions, and resolution of these symptoms after treatment of Strongyloides infection suggest Strongyloides as the etiology of his multifocal AI. This case highlights the importance of a risk factor driven differential in the workup of AI.[3498] Figure 1. CT abdomen showing multifocal small bowel intussusceptions (a) and exploratory laparoscopy demonstrating segment of intussuscepted bowel (b).
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