Treatment of acute middle cerebral artery occlusion with a Solitaire AB stent: preliminary experience

We report our initial experience with a Solitaire AB neurovascular remodeling stent device in performing cerebral embolectomy in seven patients presenting to our institution with acute stroke who were resistant to iv thrombolytic drug treatment. The main inclusion criteria were: National Institutes of Health Stroke Scale (NIHSS) score ≥10; treatment performed within 8 h from the onset of symptoms and no large hypodensity on CT; and occlusion of a major cerebral artery on the CT angiogram. An admission and a post-interventional NIHSS score were calculated for all patients by two different neurologists. Efficacy was assessed radiologically by post-treatment thrombolysis in myocardial infarction (TIMI) scores and clinically by a 30-day Modified Rankin Scale (MRS) score. The mean duration of neurointerventional treatment was 84 min. All interventions were successful, with TIMI scores of 2 or 3 achieved in 100% of patients. There was one procedural complication in our series owing to a self-detached stent and one patient had a small asymptomatic basal ganglia haemorrhage. There was improvement of more than 4 points on the NIHSS score in 5 (72%) of the patients following treatment, of whom 4 (57%) had a 30-day MRS score of ≤2. The use of a Solitaire stent in acute stroke was safe, time-efficient and encouraging; however, a larger sample size will be required to further evaluate the use of this device, which could benefit a significant number of stroke patients.

Neoadjuvant and adjuvant therapy with imatinib for locally advanced gastrointestinal stromal tumors in eastern Indian patients

BACKGROUND

Imatinib mesylate is able to at least modify the course of gastrointestinal stromal tumours (GISTs). Neoadjuvant use for locally advanced lesions is evolving as a new treatment paradigm in this hitherto universally fatal disease.

METHODS AND RESULTS

The study patients with locally advanced GIST received neoadjuvant and adjuvant imatinib mesylate. Response was noted as per the RECIST protocol and overall progression free survival was reported. Of 19 patients (mean age 38.5 years, range 26 yrs to 64 yrs) studied, 13 achieved partial response (PR) and 6 a stationary disease (SD) on preoperative imatinib. Histopathological evaluation and grading of responses revealed only moderate and low grade pathological response after imatinib. R0 resection was possible in 13/19 and R1 in 6/19. Imatinib was well tolerated and adverse reactions were minimal. Post operative complications of surgery were not out of the ordinary for a surgical series featuring extensive abdominal surgery.

CONCLUSION

Preoperative imatinib in locally advanced GIST seems to be a reasonable option for locally advanced GIST patients and enough downstaging to allow a resection with microscopically negative margins can be expected in a fairly good proportion of patients.

Learning and memory-enhancing effect of Bacopa monniera in neonatal rats

OBJECTIVE

The aim of this study was to evaluate the learning and memory-enhancing effect of Bacopa monniera in neonatal rats.

BACKGROUND

Learning is an acquisition and storage of information as a consequence of experience. Memory is a relatively permanent storage form of the learned information. In the process of 'learning', activation of neurons occurs in specific areas or specific memory systems of the brain concerned with the processing of the specific modality of sensory information. Rasayana plants are said to prevent ageing, re-establish youth, strengthen life, brain power and prevent diseases. Bacopa monniera (BM) is shown to be very useful in improving learning and memory.

METHODS

In the present study neonatal rat pups (10 days old) were given different doses of BM extract orally for different periods of time. These rats were then subjected to spatial learning (T- Maze) and passive avoidance tests along with the age matched normal and gum acacia control rats. The data were compared with those of control rats.

RESULTS

The results showed improvement in spatial learning performance and enhanced memory retention in neonatal rats treated with extract of BM.

CONCLUSION

We conclude that treatment with BM extract during growth spurt period of neonatal rats enhances learning and memory (Tab. 3, Fig. 3, Ref. 45). Full Text in free PDF www.bmj.sk.

Can the skin smear examination in NLEP be reconsidered?

Slit and skin smear examination is an important laboratory test which was made optional in the NLEP. In a laboratory managed by LEPRA Society, this test was provided to voluntary reporting cases and those referred by the general health service institutions of the area. Total cases tested were 1180, out of which 152 (12.9%) were positive. Of the 152 smear reports, 121 were from Koraput district and constitute the sample for this study. Regarding the spread of site wise highest BI, 56% cases had BI of 3.1+ to 6+. Of the 121 cases, 112 (92.6%) cases completed 12 doses of MDT. Seventy patients, from whom detailed information was collected by personal contact, responded well to MDT resulting in regression of lesions. Out of them, 46 cases had repeat smear showing negative smear in 39% and decline of 81 in the rest of cases. There are 16 contact cases with 2 family clusters. A rough block-wise mapping showed 4 strata with a dense clustering in the urban area where the laboratory facility is available. The probable reasons for uneven distribution of cases and causes for late diagnosis were discussed. The study reflects the leprosy problem in urban pockets which high infection pool. Together these two factors remain unexposed due to winding up of smear labs and pose a potential threat to elimination. The paper also emphasized on the reasons for past failure of the test along with suggestions to revive this facility with minor modifications.

Anomalous branching pattern of the aortic arch and its clinical applications

The aortic arch gives rise to three classical branches, namely the brachiocephalic trunk, the left common carotid artery and the left subclavian artery. We report a rare variation of the left common carotid artery and the right vertebral arteries originating from the brachiocephalic trunk, and the left vertebral artery that was arising from the arch of the aorta, proximal to the origin of the left subclavian artery. Variations in the branching pattern of the arch of aorta can alter the cerebral haemodynamics that leads to cerebral abnormalities. Knowledge of the variations in the classical branches of the arch of aorta is important in the diagnosis of intracranial aneurysm after subarachnoid haemorrhage.

Isolation and characterization of NBS-LRR- resistance gene candidates in turmeric (Curcuma longa cv. surama)

Turmeric (Curcuma longa), an important asexually reproducing spice crop of the family Zingiberaceae is highly susceptible to bacterial and fungal pathogens. The identification of resistance gene analogs holds great promise for development of resistant turmeric cultivars. Degenerate primers designed based on known resistance genes (R-genes) were used in combinations to elucidate resistance gene analogs from Curcuma longa cultivar surama. The three primers resulted in amplicons with expected sizes of 450-600 bp. The nucleotide sequence of these amplicons was obtained through sequencing; their predicted amino acid sequences compared to each other and to the amino acid sequences of known R-genes revealed significant sequence similarity. The finding of conserved domains, viz., kinase-1a, kinase-2 and hydrophobic motif, provided evidence that the sequences belong to the NBS-LRR class gene family. The presence of tryptophan as the last residue of kinase-2 motif further qualified them to be in the non-TIR-NBS-LRR subfamily of resistance genes. A cluster analysis based on the neighbor-joining method was carried out using Curcuma NBS analogs together with several resistance gene analogs and known R-genes, which classified them into two distinct subclasses, corresponding to clades N3 and N4 of non-TIR-NBS sequences described in plants. The NBS analogs that we isolated can be used as guidelines to eventually isolate numerous R-genes in turmeric.

Identification of upregulated immune-related genes in Vibrio harveyi challenged Penaeus monodon postlarvae

A subtracted cDNA library was constructed and analyzed to elucidate the response of Penaeus monodon postlarvae challenged with Vibrio harveyi. As many as 960 randomly selected cDNA fragments generated through suppression subtractive hybridization were single pass sequenced. Forty five genes and 20 hypothetical proteins were identified, a few being first reports from shrimps. The most abundant immune relevant genes were ferritin, hemocyanin, and TCTP (translationally controlled tumor protein) indicating their upregulation as also confirmed through qPCR. Post-infection qPCR analyses confirmed 2.04, 2.09, 3.28, 5.49, 6.47, and 11.63 fold rise respectively in ferritin, penaeidin, MnSOD, lysozyme, TCTP, and hemocyanin genes. These genes may be involved in the regulation of the host defense against V. harveyi.

Rediscovering cyanobacteria as valuable sources of bioactive compounds

Cyanobacteria are a simple, but primitive and diverse group of microorganisms, with characteristics in common to both bacteria and algae. Their success as a group in a wide range of habitats has been attributed to their unique physiological characters and high adaptive ability under a wide range of environmental conditions. The potential of cyanobacteria as a source of a variety of compounds such as polysaccharides, lipids, proteins, vitamins, sterols, enzymes, pharmaceuticals and other fine chemicals is well recognized, and their demand is now on an increasing trend. This compilation reviews the salient advances in the discovery of bioactive compounds from cyanobacteria and their significance in agriculture and industry.

Results of Treatment of Squamous Cell Carcinoma of Maxillary Sinus: A 26-Year Experience

BACKGROUND

Five-year survival in squamous cell carcinoma of maxillary antrum is low. This article examines the results of various approaches to treatment as given in our hospital in past 26 years.

METHODS

From 1979 to 2005, 379 patients with squamous cell carcinoma of maxillary antrum managed with curative intent were studied. Twenty-eight patients had T2, 237 patients had T3, and 114 had T4 tumors. The N classification was N0 in 316 patients, N1 in 21 patients, N2a in 28 patients and N2b in 14 patients. Treatment to the primary site comprised of surgery (Sx) and radiation therapy (RT) in 284 patients, RT alone in 57 patients and chemotherapy (CTx) with radiotherapy in 38 patients.

RESULTS

There was a difference in survival between patients who underwent Sx with RT compared with patients who received RT alone or CTx with RT. The most common pattern of recurrence was in the primary site, 187 (49.3%) patients. Local control at 3 and 5 years was 71% and 63.8% respectively in Sx with RT, 31.6% and 28% respectively in RT, and 28.9% and 26% in CTx with RT group.

CONCLUSIONS

The type of treatment to the primary site is an important determinant of survival and local control. Surgery with radiation is a better treatment option.

Factors associated with diagnosis and treatment of osteoporosis in older adults

Osteoporosis is often undiagnosed and untreated. We surveyed 1,830 adults and identified factors associated with osteoporosis diagnosis and treatment. Individuals with several risk factors, including older age, were not more likely to be diagnosed or treated. Measures should be taken to improve osteoporosis identification and treatment in high-risk patients.

INTRODUCTION

We aimed to identify patient characteristics associated with osteoporosis diagnosis and treatment.

METHODS

Survey was mailed to 1,830 women and men > or =60 years old in Pennsylvania. Multivariable logistic regression analyses were performed to determine odds ratios for osteoporosis diagnosis and treatment for individuals with established osteoporosis risk factors.

RESULTS

Surveys were completed by 1,268 adults (69.3%). Osteoporosis diagnosis was more commonly reported by participants with risk factors of female sex (OR, 3.60; 95% CI 2.31-5.61), prolonged oral steroid use (OR, 3.76, 95% CI 2.06-6.84), low-trauma fracture (OR, 2.14, 95% CI 1.44-3.17), height loss (OR, 1.83, 95% CI 1.28-2.64), and lower weight (OR, 1.35 per 11.4 kg decrease in weight; 95% CI, 1.16-1.56). Age and family history of osteoporosis were not predictive of osteoporosis diagnosis, when adjusting for other risk factors. Osteoporosis treatment was more commonly reported by participants with risk factors of female sex (OR, 5.19; 95% CI, 3.31-8.13), family history (OR, 2.18; 95% CI, 1.55-3.06), height loss (OR, 1.79; 95% CI 1.29-2.49), low-trauma fracture (OR, 1.66; 95% CI, 1.14-2.42), and lower weight (OR, 1.45 per 11.4 kg decrease in weight; 95% CI, 1.27-1.67). Osteoporosis treatment was not significantly associated with age or prolonged oral steroid use.

CONCLUSIONS

Individuals with several established osteoporosis risk factors are more likely to be underdiagnosed or undertreated.

Tamoxifen use in Indian women--adverse effects revisited

BACKGROUND

Tamoxifen is generally considered a safe drug for Indian women with breast cancer. Indian women seem to tolerate tamoxifen therapy better than western women, but there are no data regarding safety and local adverse effect profiles in typical Indian populations.

METHODS AND RESULTS

A total of 3,000 case records of patients who had received tamoxifen daily for any period of time, between January 1988 and December 2007, were identified for study. Hot flashes were reported by 800 (26%), mild vaginal dryness by 450 (15%) and vaginal discharge by 300 (10%), with vaginal bleeding experienced by 40 (1.3%) patients. A total of 1,100 (36.6%) asymptomatic patients had a thickened endometrium(defined as >8mm in thickness) on ultrasonography. Endometrial curettage was performed in all of these. None of the patients developed endometrial carcinoma. Fatty infiltration of liver was found in 1,440 (48%) patients with a mean time interval for development of 7 months (range 6-30 months).

CONCLUSIONS

Fatty infiltration of liver is found in almost half of the Eastern Indian women who receive tamoxifen. Increased endometrial thickness, which remains asymptomatic, was documented in more than one third of patients on ultrasound examination. Tamoxifen seems to have a negligible potential for causation of uterine malignancies in eastern Indian women. Rates of hysterectomies in Indian patients on tamoxifen are substantially lower than those of western patients on tamoxifen.

Prophylactic immune tolerance induced by changing the ratio of antigen-specific effector to regulatory T cells

BACKGROUND

Gene and protein replacement therapies for inherited protein deficiencies such as hemophilia or lysosomal storage disorders are limited by deleterious immune responses directed against their respective therapeutic proteins. Therefore, the development of protocols preventing such responses is key to providing successful long-term therapy.

OBJECTIVES

We sought to develop a protocol, utilizing a drug/peptide cocktail, that would effectively shift the antigen-specific CD4+ T-cell population, tipping the balance from effector T cells (Teffs) towards regulatory T cells (Tregs).

METHODS

Treg-deficient (DO11.10-tg Rag2(-/-)) BALB/c mice were used to screen for an optimal protocol addressing the aforementioned goal and to study the mechanisms underlying in vivo changes in T-cell populations. Muscle-directed gene transfer to hemophilia B mice was also performed in order to test the optimal protocol in a therapeutically relevant setting.

RESULTS

Specific antigen administration (4-week repeated dosing) combined with rapamycin and interleukin-10 led to substantial reductions in Teffs, via activation-induced cell death, and induced CD4+CD25+FoxP3+ Tregs to a large extent in multiple organs. The proportion of apoptotic T cells also increased over time, whereas Teffs and Tregs were differentially affected. When applied to a model of protein deficiency (gene therapy for hemophilia B), the protocol successfully prevented inhibitor formation, whereas non-specific immunosuppression was only marginally effective.

CONCLUSIONS

It is feasible to provide a short-term, prophylactic protocol allowing for the induction of immune tolerance. This protocol may provide a marked advance in efforts seeking to improve clinical outcomes in disorders involving therapeutic protein replacement.

Prevalence of myofascial temporomandibular disorder in US community women

This study estimates the prevalence of the myofascial subtype of temporomandibular disorders (M-TMD) defined by Research Diagnostic Criteria (RDC), and relates that prevalence to the surveyed report of facial pain. From among 20 000 women selected at random in the NY metropolitan area who completed a telephone survey of facial pain, 2000 were invited for an RDC/TMD examination; 782 examinations were completed. Prevalence was estimated in analyses that were weighted to correct sampling biases. Differences among demographic strata were evaluated with logistic regression. The prevalence of M-TMD was estimated to be 10.5% (95% CL = 8.5-13.0%). Prevalence was significantly higher among younger women, among women of lower socio-economic status, among Black women, and among non-Hispanic women. The report of facial pain in the telephone survey (10.1%) had high specificity for M-TMD diagnosis (94.7%), but low sensitivity (42.7%). M-TMD is a fairly common disorder among American women. Among those reporting facial pain during the last month, half met RDC palpation criteria for M-TMD; thus, a formal physical examination is imperative to establish this diagnosis. Prevalence varies with age, socio-economic status, race and Hispanic ethnicity. A substantial number of RDC-diagnosed cases of M-TMD did not report facial pain in the survey; the reason for this requires further study.

Cystogastrocolic fold and associated atrophy of the gallbladder

Peritoneal anomalies are common in humans. We report the presence of a cystogastrocolic fold associated with an abnormally small gallbladder in a 50-year-old male cadaver. Presence of this fold is one of the clinically important anomalies, which can result in atrophy of the gallbladder or congenital obstruction of the duodenum.

Twisted renal vessels producing an abnormal shape of the right kidney

The kidneys and the renal vessels are subject to a wide variety of variations. We report a rare variation of the right kidney and right renal vessels in a 60-year-old male cadaver. The right kidney was pyramidal in shape and the hilum was directed anteriorly. The right renal vessels were twisted against each other, and the inferior vena cava had a kink to the right side. Knowledge of this variation may be useful for the nephrologists, radiologists and surgeons.