The direct determination of aldosterone in human saliva

A method is described for the direct radioimmunoassay of aldosterone in human saliva without preliminary extraction or chromatographic purification. The method has been validated with respect to sensitivity, accuracy, precision, specificity and other criteria. Under basal conditions concentrations of aldosterone in saliva ranged from 10-63% those of plasma (mean +/- SD = 32.5 +/- 13.1%). When plasma aldosterone responded to such acute stimuli as postural change, exercise or ACTH infusion, this was promptly reflected in corresponding changes in saliva aldosterone concentration. In subjects going about their normal daily business saliva aldosterone concentration fluctuated markedly during the day. It is therefore difficult to define a normal range for saliva aldosterone concentration but present observations suggest an upper limit of 150 pmol/l under basal conditions.

Modulation of smooth muscle phenotype in vitro by homologous cell substrate

We have developed a novel cell culture system that supports the shortening of smooth muscle cells. Primary rat airway smooth muscle cells were plated on an ethanol-fixed, confluent monolayer of homologous smooth muscle cells (homologous cell substrate, HCS). Cells grown on HCS exhibited morphological and functional characteristics consistent with a differentiated phenotype. Cells on HCS were spindle shaped with a well-defined long axis, whereas cells grown on glass were larger and irregularly shaped. Smooth muscle-specific alpha-actin immunostained diffusely in cells on HCS, whereas it appeared as stress fibers in cells on glass. Agonists recruited a greater fraction of HCS cells to contract, resulting in greater changes in cell area or length on average, but the maximal capacity of shortening of individual cells was similar between the groups. Unlike cells on glass, cells on HCS shortened to methacholine. HCS was reversible and persisted over several passages. Agonists stimulated intracellular Ca(2+) oscillations in cells on HCS, whereas they elicited biphasic peak and plateau transients in cells on glass. HCS modulates smooth muscle cell phenotype in vitro.

Long-Term Toxicity and Efficacy of Intensity-Modulated Radiation Therapy in Cervical Cancers: Experience of a Cancer Hospital in Pakistan

PURPOSE

To report the chronic toxicity and disease outcomes attributable to intensity-modulated radiation therapy (IMRT) in patients with cervical cancer.

METHODS AND MATERIALS

Between January 2014 and December 2018, a retrospective review of medical records of patients with cervical cancer who received radiation therapy with IMRT was performed. Disease and treatment-related details were documented. Follow-up notes were reviewed, and severity of late toxicities was recorded. Overall survival (OS) and disease-free survival (DFS) at 3 years were estimated.

RESULTS

A total of 222 patients’ records were reviewed. Mean age was 50.7 years. Median follow-up duration was 33 months (range, 2-70 months). The most common toxicity was vaginal stricture (grade 2, n = 59, 26.6%; grade 3, n = 4, 1.80%), followed by proctitis (grade 2, n = 24; 10.8%; grade 3, n = 7; 3.20%). Seven patients (grade 2, n = 5, 2.3%; grade 3, n = 2; 0.90%) developed cystitis, and only 5 (grade 2; 2.3%) were found to have colitis. None of the patients had grade 4 or grade 5 toxicities. There was a significant difference in late complications in patients with nodal disease or those who underwent prior surgery (P < .05). Three-year OS and DFS rates were 79.7% and 81.9%, respectively. Patients with tumor size > 5 cm and those with pelvic lymph node metastasis had poor survival rates (P < .05).

CONCLUSION

IMRT is an effective and well-tolerated technique that should be considered in patients with lymph node disease and in postoperative patients. There is an inverse relationship between tumor size and nodal involvement with respect to OS and DFS.

Thermographic assessment of the immediate and short term-effects of blood flow restriction exercise on Achilles tendon skin temperature

OBJECTIVES

To determine the thermal patterning of the Achilles tendon following bodyweight resistance exercise with and without blood-flow restriction (BFR).

DESIGN

Cross-sectional.

SETTING

Research laboratory.

PARTICIPANTS

Twelve asymptomatic recreational runners (Age: 37 ± 10, Height: 169 ± 20, Mass: 73.8 ± 13.4).

MAIN OUTCOME MEASURES

Thermograms were taken pre and post exercise with and without a BFR cuff on separate legs. BFR cuff pressure was set at 80% maximal arterial occlusion pressure determined using doppler via the tibial artery. Linear mixed-effects models were used to assess the effect of BFR and time post-exercise on skin-temperature (Tskin).

RESULTS

A lower Tskin was seen following BFR exercise at the tendon insertion (P = 0.002), but not at the free tendon (P = 0.234), or the musculotendinous junction (P = 0.933). A significant effect of time upon changes in Tskin was observed in both BFR and non-BFR groups (P = 0.002). No interaction of time and BFR were observed on changes in Tskin (P = 0.726).

CONCLUSION

Region specific changes in Tskin were found, with greater and longer reductions observed at the insertion of the Achilles following BFR exercise before returning to baseline. These findings could have implications for the programming of BFR exercise on tendon health. Future research should observe for differences between symptomatic and healthy tendons.

A Rare Occurrence of Scalp Metastasis in Hepatocellular Carcinoma: Case Report

Hepatocellular carcinoma (HCC) is the most prevalent primary liver malignancy and the fifth most common cancer worldwide. Extrahepatic spread in this type of cancer is most commonly seen in the lungs and lymph nodes and less commonly in the skeletal system. Skull metastases are exceedingly rare, with an incidence of 0.5 to 1.6% reported to date. We report a similar case of a middle-aged Asian male patient with parietal scalp swelling that was initially diagnosed as meningioma. Surgical resection was performed at a local facility. The abdominal computed tomography scan did not reveal any primary or metastatic lesion. After much deliberation, multiparametric magnetic resonance imaging was requested that showed multiple lesions in the liver. Metastatic scalp lesion should be considered a differential diagnosis in HCC regardless of liver symptoms.

Neoadjuvant Capecitabine and Oxaliplatin Before Concurrent Capecitabine and Radiation in Locally Advanced Rectal Cancers: Experience of a Cancer Hospital in Pakistan

To report the toxicity and pathologic response rates after adding neoadjuvant capecitabine and oxaliplatin (CAPOX) followed by concurrent radiation and capecitabine (CAPRT) and surgery in patients with locally advanced rectal cancer.

GABA expression dominates neuronal lineage progression in the embryonic rat neocortex and facilitates neurite outgrowth via GABA(A) autoreceptor/Cl- channels

GABA emerges as a trophic signal during rat neocortical development in which it modulates proliferation of neuronal progenitors in the ventricular/subventricular zone (VZ/SVZ) and mediates radial migration of neurons from the VZ/SVZ to the cortical plate/subplate (CP/SP) region. In this study we investigated the role of GABA in the earliest phases of neuronal differentiation in the CP/SP. GABAergic-signaling components emerging during neuronal lineage progression were comprehensively characterized using flow cytometry and immunophenotyping together with physiological indicator dyes. During migration from the VZ/SVZ to the CP/SP, differentiating cortical neurons became predominantly GABAergic, and their dominant GABA(A) receptor subunit expression pattern changed from alpha4beta1gamma1 to alpha3beta3gamma2gamma3 coincident with an increasing potency of GABA on GABA(A) receptor-mediated depolarization. GABA(A) autoreceptor/Cl(-) channel activity in cultured CP/SP neurons dominated their baseline potential and indirectly their cytosolic Ca(2+) (Ca(2+)c) levels via Ca(2+) entry through L-type Ca(2+) channels. Block of this autocrine circuit at the level of GABA synthesis, GABA(A) receptor activation, intracellular Cl(-) ion homeostasis, or L-type Ca(2+) channels attenuated neurite outgrowth in most GABAergic CP/SP neurons. In the absence of autocrine GABAergic signaling, neuritogenesis could be preserved by depolarizing cells and elevating Ca(2+)c. These results reveal a morphogenic role for GABA during embryonic neocortical neuron development that involves GABA(A) autoreceptors and L-type Ca(2+) channels.

Response variability in the visual field: comparison of optic neuritis, glaucoma, ocular hypertension, and normal eyes

PURPOSE

To compare the relationship between sensitivity and response variability in the visual field of normal eyes and eyes with optic neuritis (ON), glaucoma (POAG), and ocular hypertension (OHT).

METHODS

Frequency-of-seeing (FOS) data were collected from four visual field locations in one eye of 71 subjects (12 ON, 25 POAG, 11 OHT, and 23 normal), using a constant stimulus method on an Henson 4000 perimeter (Tinsley Instruments, Croydon, UK). At each location, at least 20 stimuli (subtending 0.5 degrees) were presented for 200 ms at six or more intensities above and below the estimated threshold. The mean and SD of the probit fitted cumulative Normal function were used to estimate sensitivity and response variability. Cluster regression analysis was carried out to determine whether there were differences in the sensitivity-log (variability) relationship between the four groups.

RESULTS

Variability was found to increase with decreased sensitivity for all four groups. The combined data from the four groups was well represented (R2 = 0.57) by the function log(e)(SD) = A.sensitivity (dB) + B, where the constants A and B were -0.081 (SE, +/-0.005) and 3.27 (SE, +/-0.15), respectively. Including other statistically significant covariates (false-negative errors, P = 0.004) and factors (diagnosis, P = 0.005) into the model increased the proportion of explained variance to 62% (R2 = 0.62). Stimulus eccentricity (P = 0.34), patient age (P = 0.33), fixation loss rate (P = 0.10), and false-positive rate (P = 0.66) did not reach statistical significance as additional predictors of response variability.

CONCLUSIONS

The relationship between response variability and sensitivity is similar for ON, POAG, OHT, and normal eyes. These results provide supporting evidence for the hypothesis that response variability is dependent on functional ganglion cell density.

What happens when a baby dies: stillbirth investigations for infection and other aetiologies

Infections in stillbirths are common, often clinically silent and need to be screened. The microbiology laboratory needs to have the appropriate culture techniques and expertise. The results of the clinical features, the pathology findings of the fetus and the placenta and the microbiological and serological features need to be interpreted together; individual results should not be considered in isolation.