Endometrial polyps associated with endometrial hyperplasia in an obese bonnet monkey (Macaca radiata): a case report

BACKGROUND

A 10-year-old, female bonnet monkey (Macaca radiata) showed abnormal menstrual cycle length with heavy menstrual bleeding for 6-8 days.

METHODS

Uterine ultrasound and histological examinations of endometrium by endometrial biopsy.

RESULTS

An ultrasound examination of the uterine cavity showed presence of an enlarged polypoid mass. Further endometrial histology confirmed the presence of simple endometrial hyperplasia.

CONCLUSIONS

We report for the first time that endometrial polyp is associated with endometrial hyperplasia in obese bonnet monkey.

The predicted relative risk of premature ovarian failure for three radiotherapy modalities in a girl receiving craniospinal irradiation

In girls and young women, irradiation of the ovaries can reduce the number of viable ovarian primordial follicles, which may lead to premature ovarian failure (POF) and subsequently to sterility. One strategy to minimize this late effect is to reduce the radiation dose to the ovaries. A primary means of reducing dose is to choose a radiotherapy technique that avoids irradiating nearby normal tissue; however, the relative risk of POF (RRPOF) due to the various therapeutic options has not been assessed. This study compared the predicted RRPOF after craniospinal proton radiotherapy, conventional photon radiotherapy (CRT) and intensity-modulated photon radiotherapy (IMRT). We calculated the equivalent dose delivered to the ovaries of an 11-year-old girl from therapeutic and stray radiation. We then predicted the percentage of ovarian primordial follicles killed by radiation and used this as a measure of the RRPOF; we also calculated the ratio of the relative risk of POF (RRRPOF) among the three radiotherapies. Proton radiotherapy had a lower RRPOF than either of the other two types. We also tested the sensitivity of the RRRPOF between photon and proton therapies to the anatomic position of the ovaries, i.e., proximity to the treatment field (2 ≤ RRRPOF ≤ 10). We found that CRT and IMRT have higher risks of POF than passive-scattering proton radiotherapy (PRT) does, regardless of uncertainties in the ovarian location. Overall, PRT represents a lower RRPOF over the two other modalities.

Seroprevalence of Encephalitozoon cuniculi in wild rodents, foxes and domestic cats in three sites in the United Kingdom

Encephalitozoon cuniculi is an obligate intracellular microsporidian that is the causal agent of encephalitozoonosis, an important and emerging disease in both humans and animals. Little is known about its occurrence in wildlife. In this study, serum samples from 793 wild rodents [178 bank voles (BV), 312 field voles (FV) and 303 wood mice (WM)], 96 foxes and 27 domestic cats from three study areas in the UK were tested for the presence of antibodies to E. cuniculi using a direct agglutination test (DAT). Seroprevalence in the wild rodents ranged from 1.00% to 10.67% depending on species (overall 5.31%) and was significantly higher in foxes [49.50% (50/96)]. None of the 27 cats sampled were found to be seropositive. This is the first report of seroprevalence to E. cuniculi in BV, FV, WM, foxes and cats in the UK and provides some evidence that foxes could act as sentinels for the presence of E. cuniculi in rodents. The study demonstrates that wildlife species could be significant reservoirs of infection for both domestic animals and humans.

Abstract WP53: Can Attenuation Characteristics On Non Contrast CT Be Used In Place Of Diffusion FLAIR Mismatch In The Imaging Triage Of Acute Ischemic Stroke Patients?

Purpose: We aimed to determine if attenuation characteristics on NCCT can be used in place of DWI FLAIR“mismatch”as an imaging paradigmto detect patients within a recommended time window for thrombolysis.

Methods: Data is from consecutive acute stroke patients (2005-2009) from Keimyung University, South Korea analyzed at the University of Calgary. Only patients with visible anterior circulation occlusions on baseline CT-angio, known stroke symptom onset time and MRI within 60 minutes of baseline CT were included. All patients received revascularization therapy (IV tPA and/or IA). DWI FLAIR mismatch and CT changes at baseline were diagnosed by consensus. Ratio of ipsilateral vs. contralateral CT HU (rCT) within baseline DWI lesion was calculated. CT attenuation within DWI lesion was qualitatively graded into a) equal or more (subtle)or b) less than contralateral white matter (obvious). ROC analyses was used to compare the ability of models using DWI FLAIR mismatch vs. rCT in predicting onset to imaging time< 4.5 hrs and ICH at 24 hours.

Results: Of 136 patients included [mean age 67.6 yrs (SD 11.2 yrs), 55.1% male, median onset to MR time was 159.5 minutes (IQR 128-226 mins)], 131/136 (96.3%) had DWI changes on baseline MRI. DWI FLAIR mismatch was seen in 88/136 (64.7%) andNCCT hypo-attenuation in 93/136 (68.9%). A rCT>=0.85predicted DWI FLAIR mismatch with a sensitivity of 72.5%, specificity of 75.6% and PPV of 85.3%. No patient without baseline CT changes had rCT<0.9. DWI FLAIR mismatch was not better than rCT>=0.85 in predicting onset to MRtime<4.5 hrs (AUC 0.66 95% CI 0.57-0.75 vs. 0.61 95% CI 0.51-0.70, p=0.23). Subtle or no CT hypo-attenuation within DWI lesion measured qualitatively predicted presence of DWI FLAIR mismatch. (p=0.002)

Conclusion: CT hypo-attenuation is as good as DWI FLAIR mismatch in identifying patients who are good candidates for thrombolytic therapy.

Comparison of periosteal pedicle graft and subepithelial connective tissue graft for the treatment of gingival recession defects

BACKGROUND

The use of periosteum as a pedicle graft in the treatment of gingival recession defects is a recent advancement. The subepithelial connective tissue graft (SCTG) is considered the gold standard for the treatment of gingival recession defects. The present randomized controlled trial was done to compare periosteal pedicle graft (PPG) with SCTG for the treatment of gingival recession defects.

METHODS

10 males and 10 females between the ages of 16 and 40 years (mean age 25.2 years) with Miller's Class I and II recessions ≥3 mm participated in this one-year clinical study. They were assigned randomly to test group (PPG) and control group (SCTG). Results were evaluated based on parameters measuring patient satisfaction and clinical outcomes associated with two treatment procedures. Significance was set at p < 0.05.

RESULTS

At the end of the study, the defect coverage was 3.1 ± 0.13 mm or 92.6% in the test group compared to the control group in which the defect coverage was 2.70 ± 0.11 mm or 88.5%. The difference between the two groups was statistically significant (p < 0.0001). The average residual defect was comparable between the two groups, i.e. 0.3 ± 0.67 and 0.5 ± 0.84 in the PPG and SCTG group respectively. The test group was rated higher in terms of overall patient satisfaction (p < 0.02) and comfort during and after the procedure (p < 0.001).

CONCLUSIONS

PPG and SCTG have comparable clinical effectiveness, but PPG is superior to SCTG in terms of patient-centred outcomes, reflecting improved patient comfort and overall patient satisfaction.

Tyrosine kinase inhibitors and development of brain metastasis in metastatic renal cell carcinoma: A retrospective review

340

Background: Tyrosine kinase inhibitors (TKIs) have been shown to improve overall survival (OS) in metastatic renal cell carcinoma (mRCC) but their effect on brain metastasis (BM) development is unclear. The purpose of our study is to evaluate the impact of TKIs on incidence of BM and OS in patients with mRCC.

Methods: Searched the M. D. Anderson Cancer Center (MDACC) tumor registry for patients who presented with mRCC in 2002-2003 and 2006-2007 with no BM at initial staging. The following items were retrospectively collected: age, sex, Fuhrman grade, sites of disease, nephrectomy, systemic therapy including TKIs (sorafenib or sunitinib), MSKCC risk category, BM treatment, and vital status. Interaction between OS and incidence of BM and these variables was estimated using the Cox proportional hazards model. OS and incidence of BM were estimated using the Kaplan-Meier (K-M) method.

Results: 338 patients were identified; 154 (46%) were treated with a TKI prior to BM, and 184 (54%) were not. There were no significant differences in age, histology, involved sites of disease other than lung, nephrectomy, or MSKCC risk category between the groups. A higher proportion of the nonTKI group received other systemic agents and had lung metastasis at initial staging (p=0.03). Median OS was longer in the TKI-treated group (25 months versus 12.1 months, p<0.0001). In Cox multivariate analysis, TKI treatment (HR=0.53, 95% CI 0.38-0.74, p<0.001) was associated with improved OS and lung/mediastinal involvement and ECOG performance status > 2 (HR 1.87, 95% CI 1.28-2.71, p=0.001) were associated with poor OS. Median OS after BM was not significantly different between TKI treated and untreated groups. 44 patients (13%) developed a BM, including 29 (15.8%) of the nonTKI group and 15 (9.7%) of the TKI group. In K-M analysis, the 5-year incidence of BM was 40% versus 17% respectively (logrank p<0.001). In Cox multivariate analysis, TKI treatment was associated with lower incidence of BM (HR=0.39, 95% CI 0.21-0.73, p=0.003). Lung metastasis increased the risk of BM (HR=9.61, 95% CI 2.97-31.1, p<0.001).

Conclusions: Treatment with TKI agents reduces the incidence of BM in mRCC. Lung metastasis is a risk factor for BM development.

No significant financial relationships to disclose.

Isolation and characterization of a process impurity in tizanidine hydrochloride

A new process impurity was detected during the HPLC analysis of Tizanidine hydrochloride (I) batches. The impurity (II) was isolated by preparative HPLC and characterized by NMR and Mass spectral analysis as 5-S-ethyl-N-(4,5-dihydro-1H-imidazol-2-yl)-2,1,3-benzothiadiazol-4-amine hydrochloride.