Subdural Hematoma Mimickers: A Systematic Review

Publication date: September 2016
Source:World Neurosurgery, Volume 93
Author(s): Dragos Catana, Alex Koziarz, Aleksa Cenic, Siddharth Nath, Sheila Singh, Saleh A. Almenawer, Edward Kachur
BackgroundA variety of subdural pathologies that may mimic hematomas are reported in the literature. We aimed to identify the atypical clinical and radiologic presentations of subdural masses that may mimic subdural hematomas.MethodsA systematic review of MEDLINE and Embase was conducted independently by 2 reviewers to identify articles describing subdural hematoma mimickers. We also present a patient from our institution with a subdural pathology mimicking a subdural hematoma. We analyzed patient clinical presentations, underlying pathologies, radiologic findings, and clinical outcomes.ResultsWe included 43 articles totaling 48 patients. The mean ± SD patient age was 55.7 ± 16.8 years. Of the 45 cases describing patient history, 13 patients (27%) had a history of trauma. The underlying pathologies of the 48 subdural collections were 10 metastasis (21%), 14 lymphoma (29%), 7 sarcoma (15%), 4 infectious (8%), 4 autoimmune (8%), and 9 miscellaneous (19%). Findings on computed tomography (CT) scan were 18 hyperdense (41%), 11 hypodense (25%), 9 isodense (20%), 3 isodense/hyperdense (7%), and 3 hypodense/isodense (7%). Thirty-four patients (71%) were treated surgically; among these patients, 65% had symptom resolution. Neither the pathology (P = 0.337) nor the management strategy (P = 0.671) was correlated with improved functional outcomes.ConclusionsIdentification of atypical history and radiologic features should prompt further diagnostic tests, including magnetic resonance imaging (MRI), to elucidate the proper diagnosis, given that certain pathologies may be managed nonsurgically. A subdural collection that is hyperdense on CT scan and hyperintense on T2-weighted MRI, along with a history of progressive headache with no trauma, may raise the suspicion of an atypical subdural pathology.



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Clinical and Anatomic Insights From a Series of Ethmoidal Dural Arteriovenous Fistulas at Barrow Neurological Institute

Publication date: September 2016
Source:World Neurosurgery, Volume 93
Author(s): Bradley A. Gross, Karam Moon, M. Yashar S. Kalani, Felipe C. Albuquerque, Cameron G. McDougall, Peter Nakaji, Joseph M. Zabramski, Robert F. Spetzler
BackgroundEthmoidal dural arteriovenous fistulas (dAVFs) have a malignant natural history and an anatomy that make endovascular therapy challenging. Their uniqueness begs for stratified analyses, but this has largely been precluded by their rarity. We sought to summarize the anatomic, presentation, treatment approaches, and clinical outcomes of patients with these lesions.MethodsWe reviewed our prospectively maintained institutional database to identify patients diagnosed with ethmoidal dAVFs from January 1, 2000, to December 31, 2015. We evaluated demographic, presentation, angiographic, treatment, and follow-up data.ResultsIn total, 27 patients with ethmoidal dAVFs underwent endovascular and/or surgical treatment. Mean patient age was 62 years old and there was a male sex predilection (67% men; 2:1 male-female ratio). All dAVFs exhibited direct cortical venous drainage; venous ectasia was present in 59% of cases. Of the dAVFs, 30% drained posteriorly into the basal vein of Rosenthal or the sylvian veins. Embolization with casting of the draining vein was successful in 2 of 9 cases (22%), including 1 successful transvenous case. There were no clinical or permanent complications from embolization; specifically, no patients experienced visual loss after treatment. Surgical treatment with successful dAVF obliteration was carried out in 24 of 24 patients (100%). One patient declined surgical treatment after attempted endovascular embolization. There were no permanent complications after surgical treatment and no cases of wound infection or cerebrospinal fluid leakage.ConclusionsSurgical disconnection remains the gold standard in the treatment of ethmoidal dAVFs. Embolization is a consideration for well-selected cases with favorable arterial or venous access anatomy.



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Critical Age Affecting Functional Outcome after Decompressive Hemicraniectomy for Malignant Hemispheric Infarction

Publication date: September 2016
Source:World Neurosurgery, Volume 93
Author(s): Jaechan Park, Wonsoo Son, Joomi Lee
ObjectiveAlthough age already is known as a crucial factor affecting the functional outcome after a hemicraniectomy for malignant hemispheric infarction, previous studies have used arbitrary age cut-offs of 50, 60, or 70 years. Therefore, this study investigated predictors of the functional outcome after a hemicraniectomy and attempted to determine the critical age for an unfavorable functional outcome.MethodsA total of 38 patients with large hemispheric infarction were treated with a decompressive hemicraniectomy and the corresponding 1-year modified Rankin Scale (mRS) data obtained. An array of clinical variables was then investigated in relation to the functional outcomes.ResultsA multivariate analysis that used binary multiple logistic regression revealed that advanced age was a statistically significant predictor of an unfavorable 1-year functional outcome. In a receiver operating characteristic curve analysis for age, a patient age >58 years was determined as an appropriate cut-off value for predicting an unfavorable outcome. The patients aged >58 years showed an 82% positive predictive value (PPV) for an unfavorable outcome with mRS ≥4, and a 50% PPV for mRS ≥5. Moreover, a patient age cutoff value of >67 years exhibited a 100% PPV for predicting an unfavorable functional outcome with mRS ≥4.ConclusionsAdvanced age was identified as a significant predictor of an unfavorable outcome and functional dependency. The PPV of a patient age >58 years and >67 years for predicting an unfavorable outcome with functional dependency was 82% and 100%, respectively.



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Long Noncoding RNAs and Their Regulatory Network: Potential Therapeutic Targets for Adult Moyamoya Disease

Publication date: September 2016
Source:World Neurosurgery, Volume 93
Author(s): Faliang Gao, Lanbing Yu, Dong Zhang, Yan Zhang, Rong Wang, Jizong Zhao
ObjectiveTo investigate long noncoding ribonucleic acid (lncRNA) expression patterns in adult moyamoya disease (MMD) patients and explore their possible roles in the pathophysiology of MMD.MethodsA healthy control group (n = 10) and an MMD group (n = 15) were evaluated. RNA was extracted from peripheral blood samples and hybridized to microarray to get lncRNA expression profiles. Then predicted lncRNA target genes were identified, and bioinformatics analysis was performed to investigate their molecular functions.ResultsIn the MMD group, 3649 lncRNAs exhibited more than 2-fold expression than their counterparts in the healthy control group; of these, 1494 were upregulated, while 2155 were downregulated. Principal component analysis and Hclust analysis produced completely different clusters between the 2 groups. Gene ontology and KEGG pathway enrichment analysis suggested that the differentially expressed lncRNAs regulate multiple signaling pathways that were related with inflammation and vascular disease, and mitogen-activated protein kinase (MAPK) signaling pathway was the core regulatory pathway.ConclusionsLong noncoding RNA expression profiles were quite different between MMD and control groups. Multiple signaling pathways that were closely associated with immune response, vasculogenesis, and smooth muscle contraction were indicated to participate in lncRNAs regulatory mechanism; of these, MAPK signaling pathway, which has been well studied for the treatment of many other cardiovascular diseases, was the core of this regulatory network. Our findings could help further understand the pathophysiology of MMD and provide new potential therapeutic targets.



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Day of Surgery Impacts Outcome: Rehabilitation Utilization on Hospital Length of Stay in Patients Undergoing Elective Meningioma Resection

Publication date: September 2016
Source:World Neurosurgery, Volume 93
Author(s): Christopher A. Sarkiss, Joseph A. Papin, Amy Yao, James Lee, Roberta K. Sefcik, Eric K. Oermann, Errol L. Gordon, Kalmon D. Post, Joshua B. Bederson, Raj K. Shrivastava
Objective/BackgroundMeningiomas account for approximately one third of all brain tumors in the United States. In high-volume medical centers, the average length of stay (LOS) for a patient is 6.8 days compared with 8.8 days in low-volume centers with median total admission charges equaling approximately $55,000. To our knowledge, few studies have evaluated day of surgery and its effect on hospital LOS. Our primary goal was to analyze patient outcome as a direct result of surgical date, as well as to characterize the individual variables that may impact their hospital course, early access to rehabilitation, and long-term functional status.MethodsA retrospective database was generated for cranial meningioma patients who underwent elective surgical resection at our institution over a 3-year study period (2011–2014). Inclusion criteria included any patient who underwent elective meningioma resection and was discharged either home or to a rehabilitation facility with at least 6 months of follow-up. Exclusion criteria included any patient who was not discharged after resection (i.e., expired). Each patient's medical record was evaluated for a subset of demographics and clinical variables. Given that patients who undergo surgical resection of meningiomas have a national median LOS of 6 days, we subdivided the patients into 2 cohorts: early discharge (LOS < 3) and late discharge (LOS ≥ 3). Statistical analysis was performed using SPSS 21.0 to assess the significance of the results.ResultsWe identified 139 (25 male, 114 female) meningioma patients who underwent surgical resection. Seventy of these patients had surgery during the early week (defined as Monday–Wednesday), and 69 had surgery in the later week (Thursday–Friday). The median age for both early and late groups was 58, and the median diameter of the tumor was 3.1 cm and 3.3 cm, respectively. Overall, 55% of the patients had public insurance and 43% had private insurance, with no significant variation between the early and late groups. The median LOS for the early and late populations was 3 and 4 days, respectively. Physical therapy recommendations for rehabilitation facility were made in 26% of early-week patients and in 42% of late-week patients. Additionally, we found a statistically significant decreased LOS (<3 days) in those patients who underwent surgery during the early week (Monday–Wednesday), as opposed to those who received surgery in the later week (Thursday, Friday) (P = 0.045, Mann-Whitney test).ConclusionDay of surgery may play a significant role in LOS for meningioma patients. Clinicians should remain aware of those factors that may delay optimal patient discharge and early access to rehabilitation facilities. Further studies will need to be performed to assess the social variables that may affect LOS, as well as the financial implications for such extended hospital courses.



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The Outcome Predictors of Malignant Large Infarction and the Functional Outcome of Survivors Following Decompressive Craniectomy

Publication date: September 2016
Source:World Neurosurgery, Volume 93
Author(s): Tzu-Kang Lin, Shu-Mei Chen, Yin-Cheng Huang, Pin-Yuan Chen, Min-Chi Chen, Hong-Chieh Tsai, Tsong-Hai Lee, Ko-Ting Chen, Ming-Hsueh Lee, Jen-Tsung Yang, Kuo-Lun Huang
ObjectiveCerebral infarction is a common cause of disability. Malignant large infarction (MLI) is a catastrophic event, and there is no effective medical treatment. This study aimed to assess the outcome predictors of MLI and to analyze the impact of decompressive craniectomy (DC) on the functional outcome of survivors.MethodsThis study comprised 213 MLI cases. Outcome was evaluated with modified Rankin Scale (mRS) at 1-year follow-up, and various parameters were tested for MLI outcome predictors. The impact of DC on functional outcome was examined after being further stratified into good survival (mRS score = 0, 1, 2, 3), poor survival (mRS score = 4, 5), and mortality (mRS score = 6) groups.ResultsStandard medical treatment only was used in 106 cases, and both medical treatment and DC were used in 107 cases. With multiple logistic regression analysis, age, motor response at deterioration/operation, and DC were identified as independent outcome predictors of MLI (P = 0.027, P < 0.001, P < 0.001). Compared with the sole standard medical treatment, additional DC resulted in a better outcome (odds ratio [OR] =19.95; 95% confidence interval [CI], 7.61–52.27; P < 0.001). Further analysis of functional outcome revealed that DC significantly increased the chance of good survival as opposed to poor survival (OR = 20.04; 95% CI, 6.05–66.32; P < 0.001) and death (OR = 43.72; 95% CI, 13.21–144.72; P < 0.001).ConclusionsIn this study, DC performed on a young patient with motor response of localizing pain or better was linked with a better outcome. DC not only reduced mortality and increased the number of good survivals but also, most importantly, decreased the number of poor functional outcome survivals.



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Early atherosclerosis development in female apolipoprotein E-deficient mice is associated with an increased vascular oxidative stress

2016-07-03T15-29-41Z
Source: Oxidants and Antioxidants in Medical Science
Livan Delgado-Roche, Yanet Hernandez, Ivonilce Venturi, Irina Wilkins, Dalia Alvarez.
Objective: The mechanisms of atherosclerosis development in the apolipoprotein E-deficient (apoE−/−) mice have been clearly described. In this genetically modified strain, oxidative stress contributes with atherosclerotic lesion progression. However, there are controversial criteria on the vulnerability of female apoE−/− mouse to oxidative stress and atherosclerosis during the fertile period. Thus, the aim of the present work was to examine the implication of vascular oxidative stress during early atherosclerosis development in young apoE−/− female mice. Methods: AQ1 Please provide a brief methodology Results: Hematoxylin/eosin staining demonstrated the presence of early atherosclerotic lesions in the apoE−/− mice, which progressed with age. Dihydroethidium staining of aortic sections revealed a significant increase of superoxide anion generation in apoE−/− compared with the wild type mice. The increment of this reactive oxygen species was associated, at least, with the overexpression of Nox2 mRNA levels. In addition, the 8-week-old apoE−/− mice had a significant increment of lipid and protein damage, as well as a disruption of superoxide dismutase and catalase activity, together with a deprivation of reduced glutathione and an impairment of nitric oxide availability. Conclusion: The present study shows that early atherosclerotic lesion formation in young apoE−/− female mice is associated with an increment of Nox2-mediated reactive oxygen species generation with the subsequent redox disruption, suggesting a key role of oxidative stress during atherogenesis in fertile apoE−/− female mice.


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TWiV 396: Influenza viruses with Peter Palese

Vincent speaks with Peter Palese about his illustrious career in virology, from early work on neuraminidases to universal influenza virus vaccines.

Host: Vincent Racaniello 

Guest:&nbs...

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Size matters to function: Brain volume correlates with intrinsic brain activity across healthy individuals

Publication date: 1 October 2016
Source:NeuroImage, Volume 139
Author(s): Zhao Qing, Gaolang Gong
A fundamental issue in neuroscience is to understand the structural substrates of neural activities. Intrinsic brain activity has been increasingly recognized as an important functional activity mode and is tightly linked with various cognitive functions. Structurally, cognitive functions have also shown a relation with brain volume/size. Therefore, an association between intrinsic brain activities and brain volume/size can be hypothesized, and brain volume/size may impact intrinsic brain activity in human brains. The present study aimed to explicitly investigate this brain structure-function relationship using two large independent cohorts of 176 and 236 young adults. Structural-MRI was performed to estimate the brain volume, and resting-state functional-MRI was applied to extract the amplitude of low-frequency fluctuations (ALFF), an imaging measure of intrinsic brain activity. Intriguingly, our results revealed a robust linear correlation between whole-brain size and ALFF. Moreover, specific brain lobes/regions, including the frontal lobe, the left middle frontal gyrus, anterior cingulate gyrus, Rolandic operculum, and insula, also showed a reliable, positive volume-ALFF correlation in the two cohorts. These findings offer direct, empirical evidence of a strong association between brain size/volume and intrinsic brain activity, as well as provide novel insight into the structural substrates of the intrinsic brain activity of the human brain.



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Neural and behavioral correlates of selective stopping: Evidence for a different strategy adoption

Publication date: 1 October 2016
Source:NeuroImage, Volume 139
Author(s): Alberto J. Sánchez-Carmona, Jacobo Albert, José A. Hinojosa
The present study examined the neural and behavioral correlates of selective stopping, a form of inhibition that has scarcely been investigated. The selectivity of the inhibitory process is needed when individuals have to deal with an environment filled with multiple stimuli, some of which require inhibition and some of which do not. The stimulus-selective stop-signal task has been used to explore this issue assuming that all participants interrupt their ongoing responses selectively to stop but not to ignore signals. However, recent behavioral evidence suggests that some individuals do not carry out the task as experimenters expect, since they seemed to interrupt their response non-selectively to both signals. In the present study, we detected and controlled the cognitive strategy adopted by participants (n=57) when they performed a stimulus-selective stop-signal task before comparing brain activation between conditions. In order to determine both the onset and the end of the response cancellation process underlying each strategy and to fully take advantage of the precise temporal resolution of event-related potentials, we used a mass univariate approach. Source localization techniques were also employed to estimate the neural underpinnings of the effects observed at the scalp level. Our results from scalp and source level analysis support the behavioral-based strategy classification. Specific effects were observed depending on the strategy adopted by participants. Thus, when contrasting successful stop versus ignore conditions, increased activation was only evident for subjects who were classified as using a strategy whereby the response interruption process was selective to stop trials. This increased activity was observed during the P3 time window in several left-lateralized brain regions, including middle and inferior frontal gyri, as well as parietal and insular cortices. By contrast, in those participants who used a strategy characterized by stopping non-selectively, no activation differences between successful stop and ignore conditions were observed at the estimated time at which response interruption process occurs. Overall, results from the current study highlight the importance of controlling for the different strategies adopted by participants to perform selective stopping tasks before analyzing brain activation patterns.



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A Protocol for Functional Assessment of Whole-Protein Saturation Mutagenesis Libraries Utilizing High-Throughput Sequencing

We present a protocol for the functional assessment of comprehensive single-site saturation mutagenesis libraries of proteins utilizing high-throughput sequencing. Importantly, this approach uses orthogonal primer pairs to multiplex library construction and sequencing. Representative results using TEM-1 β-lactamase selected at a clinically relevant dosage of ampicillin are provided.

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Impact of genetic deletion of platform apolipoproteins on the size distribution of the murine lipoproteome

Publication date: Available online 3 July 2016
Source:Journal of Proteomics
Author(s): Scott M. Gordon, Hailong Li, Xiaoting Zhu, Patrick Tso, Catherine A. Reardon, Amy S. Shah, L. Jason Lu, W. Sean Davidson
Given their association with cardiovascular disease protection, there has been intense interest in understanding the biology of high density lipoproteins (HDL). HDL is actually a family of diverse particle types, each made up of discrete - but as yet undetermined – combinations of proteins drawn from up to 95 lipophilic plasma proteins. The abundant apolipoproteins (apo) of the A class (apoA-I, apoA-II and apoA-IV) have been proposed to act as organizing platforms for auxiliary proteins, but this concept has not been systematically evaluated. We assessed the impact of genetic knock down of each platform protein on the particle size distribution of auxiliary HDL proteins. Loss of apoA-I or apoA-II massively reduced HDL lipids and changed the plasma size pattern and/or abundance of several plasma proteins. Surprisingly though, many HDL proteins were not affected, suggesting they assemble on lipid particles in the absence of apoA-I or apoA-II. In contrast, apoA-IV ablation had minor effects on plasma lipids and proteins, suggesting that it forms particles that largely exclude other apolipoproteins. Overall, the data indicate that distinct HDL subpopulations exist that do not contain, nor depend on, apoA-I, apoA-II or apoA-IV and these contribute substantially to the proteomic diversity of HDL.Biological significancePlasma levels of high density lipoproteins (HDL) are inversely correlated with cardiovascular disease. These particles are becoming known as highly heterogeneous entities that have diverse compositions and functions that may impact disease. Unfortunately, we know little about the forces that maintain the composition of each particle in plasma. It has been suggested that certain 'scaffold' proteins, such as apolipoprotein (apo) A-I, apoA-II and apoA-IV, may act as organizing centers for the docking of myriad accessory proteins. To test this hypothesis, we took advantage of the genetic tractability of the mouse model and ablated these three proteins individually. We then tracked the abundance and size profile of the remaining HDL proteins by gel filtration chromatography combined with mass spectrometry. The results clearly show that certain cohorts of proteins depend on each scaffold molecule to assemble normal sized HDL particles under wild-type conditions. This work forms the basis for more detailed studies that will define the specific compositions of HDL subspecies with the possibility of connecting them to specific functions or roles in disease.

Graphical abstract

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Is Mandibular Third Molar's Angulation Associated with the Lingual Bone Thickness?

Publication date: Available online 2 July 2016
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): Len Tolstunov, Marshall Brickeen, Vladislav Kamanin, Srinivas M. Susarla, Firat Selvi
To find out whether the angulation of mandibular third molars is associated with the thickness of the bone at the site of impaction, and if so, which particular angulation affects the protective mechanism of the nerve, we retrospectively studied the thickness of lingual bone at the sites of impaction of 200 mandibular third molars in 149 patients using coronal, sagittal, and axial slices of cone-beam computed tomograms (CT). We measured the bone at the cementoenamel junction of the mandibular second molar, at the mid-root of the third molar, and at the apex of the root. Bone less than 1mm thick was defined as "thinning". We correlated these measurements with the angulation of the tooth based on the position of the second molar and the occlusal plane in 3 dimensions: vertical, mesiobuccal, and buccolingual. The primary outcome was the thickness of the bone around the third molar. A total of 102 teeth were on the left (51%), and 125 were angulated with an occlusal plane of <85° (63%). The mean (SD) thickness of bone at the cementoenamel junction of the second molar was 1.40 (0.87) mm, at mid-root 1.07 (1.03) mm, and at the apex 1.07 (1.30) mm. When the horizontal and mesioangular angulations of teeth were <85°, the thickness of bone at the mid-root differed significantly from that when the vertical and distoangular angulations were 85° or more (p<0.001). Correlations between the thickness of the bone and the buccolingual angulations were significantly associated with perforation of the bone at mid-root and apex (p<0.003). The bone around horizontal and mesioangular impactions was 3.6 times more likely to be "thin" than that at mid-root of vertical and distoangular third molars. A buccolingual angulation was also associated with perforation of the lingual cortex (p<0.003). As the bone was thinner at the mid-root of horizontally and mesioangularly impacted teeth, it seemed to compromise the integrity of the lingual plate, which is the natural protective barrier of the lingual nerve. These findings could be of prognostic value.



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Skin necrosis after self-removal of an artificial penile nodule in a Surinamese man

Maarten Jalink, Kelvin Harvey Kramp, Sarwan Baktawar, Anuska Jewbali<br />Jun 28, 2016; 2016:201521404-201521404<br />case-report

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Luftsichel sign

Sankar Neelakantan, Rakesh Anandarajan, Anil Kumar Swamy, Ravi Hoisala<br />Jun 23, 2016; 2016:201621655-201621655<br />case-report

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Asymmetric red-bluish foot due to acrodermatitis chronica atrophicans

Anh Ly Nguyen, Wim J A de Kort, Chantal C W Theunissen<br />Jun 22, 2016; 2016:201621603-201621603<br />case-report

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Congenital lobar emphysema: diagnostic and therapeutic challenges

James Jackson Mulvany, Andrew Weatherall, Amanda Charlton, Hiran Selvadurai<br />Jun 22, 2016; 2016:201621499-201621499<br />case-report

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Straddling interatrial embolus: a rare clinical dilemma

Elhosseyn Guella, Louis James Mitchell, Jolanta Sobolewska, Kamal Khan<br />Jun 21, 2016; 2016:201621513-201621513<br />case-report

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Pituitary apoplexy complicated by vasospasm and bilateral cerebral infarction

Giulio Gambaracci, Valeria Rondoni, Giorgio Guercini, Piero Floridi<br />Jun 21, 2016; 2016:201621618-201621618<br />case-report

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Disabling iatrogenic disorder

Mark Hughes, Bhathiya Wijeyekoon<br />Jun 16, 2016; 2016:201621480-201621480<br />case-report

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Abdominal pseudohernia: a manifestation of diabetic truncal radiculoneuropathy

Partha Pratim Chakraborty, Arijit Singha, Rana Bhattacharjee, Subhankar Chowdhury<br />Jun 16, 2016; 2016:201621560-201621560<br />case-report

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Reversible movement disorders due to toxoplasmosis as initial manifestation of HIV-AIDS, with sequential MR and video imaging

Antonio Jose Reyes, Kanterpersad Ramcharan, Samuel Aboh, Nathaniel Duke<br />Jun 16, 2016; 2016:201621567-201621567<br />case-report

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Cachexia and skin lesions in an acutely unwell man

Shilpa Manupati, Manju Krishnan, Tal Anjum<br />Jun 16, 2016; 2016:201621515-201621515<br />case-report

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Corpus callosum infarction presenting with anarchic hand syndrome

Karim Mahawish<br />Jun 15, 2016; 2016:201621607-201621607<br />case-report

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Left ovarian and renal vein thrombosis after emergency postpartum hysterectomy

Nuno Andre Barros, Maria Manuel Torrao, Manuela Ferreira, Angelina Pinheiro<br />Jun 15, 2016; 2016:201621629-201621629<br />case-report

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Xanthogranulomatous pyelonephritis

Tahmina Begum, Muhammad Ekramul Huq, Mashrafi Ahmed<br />Jun 15, 2016; 2016:201621602-201621602<br />case-report

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Learning to identify the benign thoracic manifestations of asbestosis from a single patient

Zahi Nachef, Pichapong Tunsupon, M Jeffery Mador<br />Jun 14, 2016; 2016:201621610-201621610<br />case-report

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Primary pulmonary plasmacytoma mimicking lung cancer diagnosed on endobronchial ultrasound (EBUS)-guided biopsy

Usman Maqsood, Hefin Jones, Daniel Gey van Pittius, Mohammed Haris<br />Jun 14, 2016; 2016:201621578-201621578<br />case-report

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Massive haemoptysis from a bougie intubating catheter in a patient with endobronchial sarcoid

Mark Alter, Benjamin Peake, Simon Grodski, Laurence Weinberg<br />Jun 14, 2016; 2016:201621593-201621593<br />case-report

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Young man with diabetic lipaemia

Manon G van der Meer, Gerben A J van Boekel, Lenneke E M Haas<br />Jun 13, 2016; 2016:201621559-201621559<br />case-report

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A febrile microbiologist

Simon Takada, Takeshi Andou, Kyouichi Yamaguchi, Yasuharu Tokuda<br />Jun 13, 2016; 2016:201621622-201621622<br />case-report

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Nevus sebaceous in a child caused by pregnancy with an intrauterine device (IUD) in situ

Lise Bangsgaard Fensby, Anne-Kathrine Reus Carstens, Luit Penninga<br />Jun 13, 2016; 2016:201621583-201621583<br />case-report

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Symptomatic anomalous vascular ring with right aortic arch

Arun Sharma, Amarinder Singh Malhi, Sanjeev Kumar, Sadisu M Ma'aji<br />Jun 10, 2016; 2016:201621626-201621626<br />case-report

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Obstruction and perforation of the small bowel caused by inadvertent ingestion of a blister pill pack in an elderly patient

Ghassan Al-Ramahi, Mohamed Mohamed, Kristin Kennedy, Michael McCann<br />Oct 16, 2015; 2015:201521282-201521282<br />case-report

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Human parvovirus B19 associated dilated cardiomyopathy

Parul Jain, Amita Jain, Danish Nasar Khan, Mala Kumar<br />Aug 5, 2013; 2013:201301041-201301041<br />case-report

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Congenital syphilis: remember to not forget

Roberta Onesimo, Danilo Buonsenso, Claudia Gioe, Piero Valetini<br />May 23, 2012; 2012:12012559-12012559<br />case-report

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Rapid-onset obesity with hypothalamic dysfunction, hypoventilation and autonomic dysregulation (ROHHAD): a case with additional features and review of the literature

H B Chew, L H Ngu, W T Keng<br />Jan 25, 2011; 2011:22010270-22010270<br />case-report

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Removal of Exogenous Materials from the Outer Portion of Frozen Cores to Investigate the Ancient Biological Communities Harbored Inside

The cryosphere offers access to preserved organisms that persisted under past environmental conditions. A protocol is presented to collect and decontaminate permafrost cores of soils and ice. The absence of exogenous colonies and DNA suggest that microorganisms detected represent the material, rather than contamination from drilling or processing.

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Isolation of Mouse Coronary Endothelial Cells

This protocol is prepared to share our method of isolating mouse coronary endothelial cells for the purpose of imaging or to conduct molecular biological experiments.

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New incision to harvest mandibular symphysis bone

After routine local anaesthesia we make a vertical incision in the midline of the mandibular labial mucosa just apical to the mucogingival junction, and close to the bone near the symphysis (Fig. 1). If the frenum is tightly attached we may first do a frenectomy before we extend a full-thickness subperiosteal dissection bilaterally to expose the whole area of the symphysis from canine to canine (Fig. 2). When we have exposed enough bone to place the trephine drills, we can harvest bony blocks the size of the diameter of the bit, or particles of bone, by overlapping the drilling (Fig.

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Is Mandibular Third Molar's Angulation Associated with the Lingual Bone Thickness?

To find out whether the angulation of mandibular third molars is associated with the thickness of the bone at the site of impaction, and if so, which particular angulation affects the protective mechanism of the nerve, we retrospectively studied the thickness of lingual bone at the sites of impaction of 200 mandibular third molars in 149 patients using coronal, sagittal, and axial slices of cone-beam computed tomograms (CT). We measured the bone at the cementoenamel junction of the mandibular second molar, at the mid-root of the third molar, and at the apex of the root.

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Patients with mild enteropathy have apoptotic injury of enterocytes similar to that in advanced enteropathy in celiac disease

Severity of villous atrophy in celiac disease (CeD) is the cumulative effect of enterocyte loss and cell regeneration. Gluten-free diet has been shown to benefit even in patients having a positive anti-tissue transglutaminase (tTG) antibody titre and mild enteropathy.

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Prescription drugs associated with false-positive results when using faecal immunochemical tests for colorectal cancer screening

The most common side effect in population screening programmes is a false-positive result which leads to unnecessary risks and costs.

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Low testosterone in non-responsive coeliac disease: A case series, case–control study with comparisons to the National Health and Nutrition Examination Survey

Adults with coeliac disease (CD) often report persistent fatigue, even when CD appears well controlled for unknown reasons.

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Predictive factors of poor response to therapy in Autoimmune Hepatitis

To evaluate "ex ante" the predictive factors of incomplete/absent response to the standard therapy in a well characterized series of Autoimmune Hepatitis (AIH) patients from Italy.

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Croton megalobotrys Müll Arg. and Vitex doniana (Sweet): Traditional medicinal plants in a three-step treatment regimen that inhibit in vitro replication of HIV-1

Publication date: 15 September 2016
Source:Journal of Ethnopharmacology, Volume 191
Author(s): Ian Tietjen, Teresia Gatonye, Barbara N. Ngwenya, Amos Namushe, Sundana Simonambanga, Mbaki Muzila, Philip Mwimanzi, Jianbo Xiao, David Fedida, Zabrina L. Brumme, Mark A. Brockman, Kerstin Andrae-Marobela
Ethnopharmacological relevanceHuman Immunodeficiency Virus (HIV) strains resistant to licensed anti-retroviral drugs (ARVs) continue to emerge. On the African continent, uneven access to ARVs combined with occurrence of side-effects after prolonged ARV therapy have led to searches for traditional medicines as alternative or complementary remedies to conventional HIV/AIDS management.Aim of the studyHere we characterize a specific three-step traditional HIV/AIDS treatment regimen consisting of Cassia sieberiana root, Vitex doniana root, and Croton megalobotrys bark by combining qualitative interviews of traditional medical knowledge users in Botswana with in vitro HIV replication studies.Materials and methodsCrude extracts from a total of seven medicinal plants were tested for in vitro cytotoxicity and inhibition of wild-type (NL4.3) and ARV-resistant HIV-1 replication in an immortalized GFP-reporter CD4+ T-cell line.ResultsC. sieberiana root, V. doniana root, and C. megalobotrys bark extracts inhibited HIV-1NL4.3 replication with dose-dependence and without concomitant cytotoxicity. C. sieberiana and V. doniana extracts inhibited HIV-1 replication by 50% at 84.8µg/mL and at 25µg/mL, respectively, while C. megalobotrys extracts inhibited HIV-1 replication by a maximum of 45% at concentrations as low as 0.05µg/mL. Extracts did not interfere with antiviral activities of licensed ARVs when applied in combination and exhibited comparable efficacies against viruses harboring major resistance mutations to licensed protease, reverse-transcriptase, or integrase inhibitors.ConclusionsWe report for the first time a three-step traditional HIV/AIDS regimen, used alone or in combination with standard ARV regimens, where each step exhibited more potent ability to inhibit HIV replication in vitro. Our observations support the "reverse pharmacology" model where documented clinical experiences are used to identify natural products of therapeutic value.

Graphical abstract

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Integrative traditional Chinese medicine therapy reduces the risk of diabetic ketoacidosis in patients with type 1 diabetes mellitus

Publication date: 15 September 2016
Source:Journal of Ethnopharmacology, Volume 191
Author(s): Angela Shin-Yu Lien, Yi-Der Jiang, Chih-Hsin Mou, Mao-Feng Sun, Bih-Shya Gau, Hung-Rong Yen
Ethnopharmacological relevanceLife-long insulin is the standard treatment for type 1 diabetes mellitus (T1DM). The role of traditional Chinese medicine (TCM) in T1DM is still not clear. The aim of this study is to explore the prescription pattern of TCM and its impact on the risk of diabetic ketoacidosis (DKA) in patients with T1DM.Materials and methodsWe retrieved samples from the registry for catastrophic illness patients from the National Health Insurance Research Database (NHIRD). Based on a frequency (1:4) matched case-control design, patients with T1DM in 2000–2011 were designated as cases (TCM users) and controls (non-TCM users). TCM treatment for patients with T1DM was analyzed. The incidence of DKA and the annual costs of emergency visits and hospitalizations were evaluated for all causes.ResultsOverall, 416 subjects were TCM users, whereas a total of 1608 matched subjects were classified as non-TCM users. The most common Chinese herbal formula and single herb is Liu-wei-di-huang-wan (Six-ingredient pill of Rehmannia) and Huang-qi (Radix Astragali; Astragalus membranaceus (Fisch.) Bunge, Astragalus membranaceus var. mongholicus (Bunge) P.K.Hsiao), respectively. Compared with non-TCM users, we found a 33% reduction in DKA incidence for all TCM users (aHR 0.67, 95% CI 0.56–0.81, p <0.000) and a 40% reduction for users receiving TCM treatment for more than 180 days (aHR 0.58, 95% CI 0.41–0.82, p <0.01). There were no significant differences between TCM users and non-users in the frequency and medical costs of emergency visits and hospitalizations.ConclusionsIntegrative TCM use may reduce the risk of DKA in patients with T1DM. Our results suggest that TCM may have a substantial positive impact on the management of TIDM.

Graphical abstract

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Oral cancer during pregnancy

Oral cavity cancers occurring during pregnancy are rare events, so that their management is controversial even over the past decades their incidence is increasing due to the higher number of women who become pregnant at a later age. In addition to possible secondary detrimental effects due to high basal metabolic rates associated with malignancy, oral cavity cancers also impact psychologically. Thus, there are different views about the most appropriate treatment approach, that in most cases is multimodal.

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Publishers' note

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Development of synaptic connectivity in the retinal direction selective circuit

Publication date: October 2016
Source:Current Opinion in Neurobiology, Volume 40
Author(s): Ryan D Morrie, Marla B Feller
Direction selectivity is a classic neuronal computation that has been described in many different sensory systems. The circuit basis of this computation is perhaps best understood in the retina, where direction selectivity is the result of asymmetric connectivity patterns between excitatory and inhibitory circuit components. Retinal direction selective circuits emerge before eye-opening, though components of the circuit undergo refinement after vision begins. These features make the direction selective circuit a rich model in which to investigate neuronal circuit assembly. In this Opinion, we highlight recent experiments investigating the contribution of various molecular cues, as well as neuronal activity, to the development of the retinal direction selective circuit.



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