Long-term results of Ahmed glaucoma valve implantation with/without intravitreal anti-VEGF injection in neovascular glaucoma patients.

PURPOSE: This study aimed to evaluate the efficacy of Ahmed glaucoma valve (AGV) implantation with or without anti-VEGF injections in neovascular glaucoma patients. MATERIALS AND METHODS: This single-center retrospective study assessed NVG patients who underwent AGV implantation with or without anti-VEGF injections. Demographic and clinical data, including ocular findings, intraocular pressure (IOP), visual acuity, and glaucoma medication count, were recorded preoperatively and postoperatively at one day, one month, and one year. The study included 35 patients. Group 1 consisted of 23 patients who received anti-VEGF injections before AGV surgery. Group 2, with 12 patients, had no anti-VEGF injections prior to surgery. Successful surgery was defined as IOP values between 6 and 21mmHg. The primary outcome was a 30% or more reduction in IOP. RESULTS: The groups displayed no significant difference in their demographic or clinical profiles (P>0.05). The visual acuity before and one year after surgery did not differ significantly between the groups. However, IOP values significantly decreased by the end of the one-year follow-up for both groups. No significant differences were found between the groups regarding visual acuity, IOP, or the number of medications during the one-year follow-up (P>0.05). Success rates were 95.7% for Group 1 and 91.7% for Group 2. No significant difference in complications between the groups was observed (P>0.05). CONCLUSION: Anti-VEGF injections prior to AGV implantation did not significantly impact visual acuity, IOP values, or medication count during the one-year follow-up.

Evaluation of the Effect of Vitamin D Treatment on Cardiac Function in Non-Obese Female Adolescents with Vitamin D Deficiency in Türkiye: A Cross-Sectional Study.

BACKGROUND: Vitamin D deficiency may cause adverse effects on the cardiovascular system as well as many other systems. The risk of vitamin D deficiency increases during adolescence, when the growth rate is high, due to reasons such as limited sun exposure, inadequate dietary calcium, and vitamin D intake. AIM: To evaluate the effect of daily 2000 IU vitamin D supplementation for 12 weeks on cardiac function in non-obese adolescent girls with vitamin D deficiency. METHODS: This cross-sectional study was carried out between September 2021 and June 2022. A total of 108 non-obese adolescent girls having 25-hydroxyvitamin D [25(OH)D] levels below 12 ng/mL were given daily 2000 IU vitamin D orally for 12 weeks. Serum levels of 25(OH)D, alkaline phosphatase, parathormone, calcium, phosphate, and cardiac function were determined before and after treatment. RESULTS: After treatment, the 25(OH)D levels were above 20 ng/mL in 90.8% of the adolescents. The parathormone and alkaline phosphatase levels decreased, while the phosphate levels increased. Echocardiographic tissue Doppler studies showed positive changes in some systolic and diastolic function indicators. In addition, the myocardial performance index decreased from 0.42 ± 0.03 to 0.40 ± 0.03 (P < 0.001) in the left ventricle, from 0.43 ± 0.03 to 0.38 ± 0.03 (P < 0.001) in the right ventricle, and from 0.41 ± 0.04 to 0.38 ± 0.02 (P < 0.001) in the interventricular septum after vitamin D treatment as compared to pretreatment. CONCLUSION: It was observed that administration of 2000 IU vitamin D treatment for a period of 12 weeks to non-obese adolescent girls with vitamin D deficiency contributed positively to cardiac systolic and diastolic function.

Evaluation of cell morphology and adhesion capacity of human gingival fibroblasts on titanium discs with different roughened surfaces: an in vitro scanning electron microscope analysis and cell culture study.

BACKGROUND: Implantoplasty is an option in peri-implantitis treatment. What is known about the effects of implantoplasty on peri-implant soft tissue adhesion and cell behaviours is limited. This study aimed to evaluate the morphological features and adhesion capacity of human gingival fibroblast (HGF) cells onto sand-blasted, large-grit, acid-etched (SLA®) titanium (Ti) discs surfaces roughened with different implantoplasty protocols. MATERIALS AND METHODS: The study included a total of 48 Ti discs divided into four groups (n = 12 per group): Group I: machined, smooth surface discs; Group II: SLA® surface discs; Group III: SLA® surface discs roughened with diamond bur sequence (40 and 15-µm grit); Group IV: SLA® surface discs roughened with diamond bur sequence (125 and 40-µm grit). Following polishing procedure, the surface roughness value of discs was assessed by a profilometer and scanning electron microscope. HGFs were cultured on Ti discs and cell adhesion was examined after the 24th, 48th, and 72nd hours. Statistical significance was set at the p ≤ 0.05 level. RESULTS: Scanning electron microscope analyses of the discs revealed that fibroblasts exhibited well-dispersion and a firm attachment in all groups. The cells in group I and II had thin and long radial extensions from the areas where the nucleus was located to the periphery; however, attached cells in group III and IV showed more spindle-shaped morphology. The surface roughness parameters of the test groups were lower than those of the SLA®. The SLA® group showed the highest HGF adhesion (group II) (p ≤ 0.05). HGF adhesion in group IV was greater compared to group III, but less than group I. CONCLUSIONS: This study showed that the characteristics of the burs applied in the implantoplasty protocol are determinant for the surface roughness and fibroblast adhesion occurs on surfaces with decreased roughness following implantoplasty. Consequently, it should be kept in mind that the surface properties of the implant may affect the adherent cell morphology and adhesion.

Hemopressin increases penicillin-induced epileptiform activity in rats.

OBJECTIVE: Hemopressin (Hp) is the first peptide ligand described for the CB1 cannabinoid receptor. Therefore, we aimed to investigate the effect of hemopressin on pencillin-induced epileptiform activity by using electrophysiological recording (ECoG) technique. METHODS: Male Wistar rats were anesthetized with urethane (1.25 g/kg), and epileptiform activity was induced by intracortical injection of penicillin (500 IU). Animals were randomly divided into eight groups. Subsequently, the rats were administered with saline or hemopressin as follows: saline control group (Group I: 2 µl/i.c.v/saline), hemopressin groups (Group II: 0.025 µg/i.c.v; Group III: 0.075 µg/i.c.v; Group IV: 0.15 µg/i.c.v; Group V: 0.3 µg/i.c.v; Group VI: 0.6 µg/i.c.v; Group VII: 1.2 µg/i.c.v; Group VIII: 2.4 µg/i.c.v). The various doses of hemopressin were injected intracerebroventricularly (i.c.v) 30 minutes after penicillin (2.5µl) injection. After hemopressin injection, ECoGs were recorded for three hours. RESULTS: Hp at doses of 0.075, 0.15, 0.3, 0.6, 1.2 and 2.4 µg/kg significantly increased the frequency of epileptiform ECoG activity compared to penicillin-injected group without changing the amplitude. The 0.6 µg hemopressin was the most effective dose to increase the epileptiform activity (p 0.05). CONCLUSIONS: The results of this study provided electrophysiological evidence for hemopressin to be modulating penicillin-induced epileptiform activity by acting as CB1 receptor antagonist. Further studies are required to elucidate the involved mechanism underlying this effect (Fig. 3, Ref. 40).

Efficacy of pamidronate in children with chronic non-bacterial osteitis using whole body MRI as a marker of disease activity.

BACKGROUND: To study the response to pamidronate using whole body magnetic resonance imaging (WB-MRI) in children with chronic non-bacterial osteitis (CNO) in a tertiary health centre. METHODS: The medical records of children under the age of sixteen with a diagnosis of chronic non-bacterial osteitis between 2005 and 2018 were reviewed. All those who were treated with pamidronate were included and relevant data was collected. Response to therapy was determined based on the status of lesions on WB- MRI. RESULTS: Forty six patients were included in the study. Pre- and post-treatment WB-MRI was available in forty patients. Cumulative lesions pre-treatment were 150 and reduced to 45 (30%) post-treatment. Seventeen patients (42.5%) had a good response with complete resolution of all lesions and nine patients (22.5%) worsened during or following treatment with pamidronate. Vertebral disease had a good response and 82.3% of the lesions resolved completely. CONCLUSION: Our study describes the experience with pamidronate in a tertiary health centre using WB-MRI as a marker of disease activity. Pamidronate was well tolerated in our cohort and treatment response was fairly good. SIGNIFICANCE AND INNOVATION: 1. Bisphosphonates can be used in the treatment of CNO when response to NSAIDs is suboptimal. 2. In the presence of spinal or mandibular lesions bisphosphonates were used as first line. 3. Treatment was escalated to a TNF blocker when response to bisphosphonates was suboptimal.

Maintenance of the parturient in the left lateral position after spinal anesthesia with plain levobupivacaine for cesarean section reduces hypotension: a randomized study.

PURPOSE OF INVESTIGATION: Hypotension during spinal anesthesia is a main concern in cesarean delivery. The authors hypothesized that keeping parturients in a prolonged left lateral position before turning them to a supine position with left lateral tilt would reduce the incidence of hypotension without jeopardizing the quality of anesthesia. MATERIALS AND METHODS: Randomized comparative unblinded prospective study. This randomized comparative prospective study was conducted at Gaziantep University Hospital between June and December 2011. Sixty parturients undergoing cesarean section were included. Patients were randomized to two groups: turning to the supine position with left lateral tilt immediately or 15 minutes after subarachnoid injection of 2.5 ml 0.5% plain levobupivacaine in the left lateral position. Loss of pinprick sensation to T6 was accepted as adequate for cesarean section, and surgery proceeded. Characteristics of anesthesia; incidences of hypotension, bradycardia, and other adverse events, and ephedrine use were assessed. RESULTS: Compared with the supine group, parturients kept in a lateral position for 15 minutes showed marked reductions in the incidence of hypotension (33.3% vs. 83.3%, p < 0.001) and adverse events related to hypotension, such as nausea and vomiting (16.7% vs. 57.3%, p <0.001). In addition, ephedrine consumption per hypotension case was significantly reduced in the lateral group (5.4 ± 4.7 vs. 8.9 ± 5.8 mg; p < 0.00 1). CONCLUSIONS: Keeping parturients in the lateral position for 15 minutes before turning them to the supine position for cesarean section can provide reliable spinal anesthesia with a lower incidence and severity of hypotension and nausea/vomiting.

Nrf2-driven TERT regulates pentose phosphate pathway in glioblastoma.

Given the involvement of telomerase activation and dysregulated metabolism in glioma progression, the connection between these two critical players was investigated. Pharmacological inhibition of human Telomerase reverse transcriptase (hTERT) by Costunolide induced glioma cell apoptosis in a reactive oxygen species (ROS)-dependent manner. Costunolide induced an ROS-dependent increase in p53 abrogated telomerase activity. Costunolide decreased Nrf2 level; and ectopic Nrf2 expression decreased Costunolide-induced ROS generation. While TERT knock-down abrogated Nrf2 levels, overexpression of Nrf2 increased TERT expression. Inhibition of hTERT either by Costunolide, or by siRNA or dominant-negative hTERT (DN-hTERT) abrogated (i) expression of Glucose-6-phosphate dehydrogenase (G6PD) and Transketolase (TKT) - two major nodes in the pentose phosphate (PPP) pathway; and (ii) phosphorylation of glycogen synthase (GS). hTERT knock-down decreased TKT activity and increased glycogen accumulation. Interestingly, siRNA-mediated knock-down of TKT elevated glycogen accumulation. Coherent with the in vitro findings, Costunolide reduced tumor burden in heterotypic xenograft glioma mouse model. Costunolide-treated tumors exhibited diminished TKT activity, heightened glycogen accumulation, and increased senescence. Importantly, glioblastoma multiforme (GBM) patient tumors bearing TERT promoter mutations (C228T and C250T) known to be associated with increased telomerase activity; exhibited elevated Nrf2 and TKT expression and decreased glycogen accumulation. Taken together, our findings highlight the previously unknown (i) role of telomerase in the regulation of PPP and glycogen accumulation and (ii) the involvement of Nrf2-TERT loop in maintaining oxidative defense responses in glioma cells.

Evaluation of observational research reports published in Turkish nursing journals.

AIM: The aim of this literature-based descriptive study was to examine the reporting of the observational research studies published in peer-reviewed nursing journals in Turkey. METHODS: Eleven peer-reviewed nursing journals printed on a regular basis in Turkey between 2007 and 2012 were selected. These journals were searched for observational research studies, and 502 studies were selected and examined by using the Strengthening the Reporting of Observational Studies in Epidemiology Statement. RESULTS: Of the 502 studies, 495 were cross-sectional, 3 were cohort, and 4 were case controlled. Summary and introduction and aim sections were sufficient in most of the studies. The methods sections of the reports were mostly not reported: 64.3% of the reports did not indicate eligibility/inclusion criteria; sampling method, 67.0%; possible sources of bias, 99.2%; ways to reach sample size, 92.6%. In the results section, the number of individuals participating in each stage of the studies (44.0%) and in other analyses made (39.2%) was not reported. In the discussion section, a main comment about research findings was partly made (97.4%), and limitations of the studies and possible sources of bias were not written in 99.0% of the studies. CONCLUSIONS: This study clearly revealed that the observational research studies published in nursing journals in Turkey did not fulfil the important criteria and needed to be improved. IMPLICATIONS FOR NURSING AND HEALTH POLICY: Information obtained from this study can contribute to improvement of the quality of reporting observational studies in nursing and thus using obtained findings in practice.

Testicular development of male mice offsprings exposed to acrylamide and alcohol during the gestation and lactation period.

Acrylamide (Ac) in the foods and alcohol (Al) in the drinks are unavoidable. Several previous studies demonstrated that these substances which are taken into the body via diet may cause adverse effects in the cells. However, there is no study about how Ac and Al may affect the male reproductive system of the offspring when consumed by the mother during pregnancy and lactation. For this purpose, sexual development in male mice was evaluated after intake of 14 mg/kg Ac and 2 g/kg Al from gestation day 6 to postnatal day (PND) 21. The weight of the offspring was reduced at birth and PND 21 for those exposed to Ac and/or Al. The gonadosomatic index of male offsprings was reduced except for the Ac-treated lactation group. Both substances induced multinuclear giant cells, degenerative cells, atrophic tubules, and maturation-arrested tubules, while decreased Leydig, Sertoli, and spermatogenic cell numbers. Lipid peroxidation level and superoxide dismutase enzyme activity increased in both Al-treated and Ac and Al-treated groups. There was only reduction in the catalase activity during the gestation and lactation periods. These findings suggest that consumption of Ac together with Al may induce impairments on testicular spermatogenesis in male offsprings.

PPARγ regulated CIDEA affects pro-apoptotic responses in glioblastoma.

Refractoriness of glioblastoma multiforme (GBM) to current treatment paradigms has necessitated identification of new targets to better the existing therapeutic strategies. One such target is peroxisome proliferator-activated receptor gamma (PPARγ) - a transcription factor involved in regulation of lipid metabolism and inflammation. Expression of PPARγ, a known regulator of cell death-inducing DFFA-like effector (CIDEA), is modulated by hypoxia inducible factor (HIF-1α). While the involvement of CIDEA in lipid metabolism is known, its role in malignancies remains largely unknown. An elevated PPARγ and low CIDEA level was observed in GBM tumors as compared with surrounding non-neoplastic tissue. As reciprocal relation exists between PPAR and HIF-1α: and as HIF-1α is a key component in glioma progression, their role in regulating CIDEA expression in glioblastoma was investigated. Although HIF-1α inhibition had no effect on CIDEA expression, pharmacological inhibition of PPARγ elevated CIDEA levels. PPARγ mediated upregulation of CIDEA was accompanied by decreased recruitment of NFκB and SP1 to their predicted binding sites on CIDEA promoter. Ectopic expression of CIDEA triggered apoptosis, activated JNK, decreased HIF-1α activation and increased PPARγ levels in glioma cells. While CIDEA overexpression induced actin cytoskeletal disruption, cell cycle arrest, release of pro-inflammatory cytokine IL-6 in a JNK-dependent manner; CIDEA mediated apoptotic cell death, decreased STAT3 phosphorylation and increased p53 acetylation was JNK independent. This study highlights for the first time the existence of (i) PPARγ-CIDEA regulatory loop in glioma and (ii) novel function of CIDEA as regulator of glioma cell survival.

Chaetocin-induced ROS-mediated apoptosis involves ATM-YAP1 axis and JNK-dependent inhibition of glucose metabolism.

Oxidative stress serves as an important regulator of both apoptosis and metabolic reprogramming in tumor cells. Chaetocin, a histone methyltransferase inhibitor, is known to induce ROS generation. As elevating basal ROS level sensitizes glioma cells to apoptosis, the ability of Chaetocin in regulating apoptotic and metabolic adaptive responses in glioma was investigated. Chaetocin induced glioma cell apoptosis in a ROS-dependent manner. Increased intracellular ROS induced (i) Yes-associated protein 1 (YAP1) expression independent of the canonical Hippo pathway as well as (ii) ATM and JNK activation. Increased interaction of YAP1 with p73 and p300 induced apoptosis in an ATM-dependent manner. Chaetocin induced JNK modulated several metabolic parameters like glucose uptake, lactate production, ATP generation, and activity of glycolytic enzymes hexokinase and pyruvate kinase. However, JNK had no effect on ATM or YAP1 expression. Coherent with the in vitro findings, Chaetocin reduced tumor burden in heterotypic xenograft glioma mouse model. Chaetocin-treated tumors exhibited heightened ROS, pATM, YAP1 and pJNK levels. Our study highlights the coordinated control of glioma cell proliferation and metabolism by ROS through (i) ATM-YAP1-driven apoptotic pathway and (ii) JNK-regulated metabolic adaptation. The elucidation of these newfound connections and the roles played by ROS to simultaneously shift metabolic program and induce apoptosis could provide insights toward the development of new anti-glioma strategies.

How to use antistreptolysin O titre.

Group A streptococcus (GAS) is the cause of a wide range of acute suppurative and, following a latent period, non-suppurative diseases such as rheumatic fever and poststreptococcal glomerulonephritis. Diagnosis of the latter group requires evidence of preceding GAS infection. The bacteria produce a range of extracellular antigens, including streptolysin O, which induce an antibody response in the host. A rise in antistreptolysin O titre (ASOT) is indicative of preceding GAS infection. In clinical practice, often only a single ASOT measurement is available and its timing in relation to a possible GAS infection is unknown. Interpretation of the result in this context is liable to misdiagnosis. In order to optimise diagnosis of preceding GAS infection, at least two sequential ASOT measurements, together with simultaneous assay for anti-DNase B, a second antistreptococcal antibody, is recommended.

The child with joint pain in primary care.

Joint pains are a common reason for children to present to primary care. The differential diagnosis is large including some diseases that do not primarily affect the musculoskeletal system. Although the cause for many patients will be benign and self-resolving, in rare cases the diagnosis is associated with long-term morbidity and mortality if not detected early and appropriately treated. These include primary and secondary malignancies, septic arthritis, osteomyelitis, inflammatory arthritis, slipped upper femoral epiphysis (SUFE) and non-accidental injury. We highlight the importance of a thorough history and directed yet comprehensive examination. A diagnostic algorithm is provided to direct primary care physicians' clinical assessment and investigation with the evidence base where available. In many cases, tests are not required, but if there is suspicion of malignancy, infection or inflammatory conditions, laboratory tests including full blood count, blood film, erythrocyte sedimentation rate, C-reactive protein and lactate dehydrogenase help to support or exclude the diagnosis. Autoimmune tests, such as antinuclear antibodies and rheumatoid factor, have no diagnostic role in juvenile idiopathic arthritis; therefore, we advise against any form of 'rheumatological/autoimmune disease screen' in primary care. Imaging does have a place in the diagnosis of joint pains in children, with plain radiographs being most appropriate for suspected fractures and SUFE, whilst ultrasound is better for the detection of inflammatory or infective effusions. The appropriate referral of children to paediatric rheumatologists, oncologists, orthopaedic surgeons and the emergency department are discussed.

Does the weather really affect epistaxis?

OBJECTIVES: The aim of this study was to determine the incidence and severity of epistaxis under different air conditions. METHODS: This prospective study of 310 patients was conducted between January 2010 and December 2010 in the Diyarbakir State Hospital. Epistaxis rates were examined in under conditions of mean temperature (MT; degrees Celsius), mean humidity (MH; (%), air pressure (AP; atmosphere bar), sunlight duration (SD; hours), rainfall (kg/m2), and wind speed (km/hour). RESULTS: A positive correlation between epistaxis rates and temperature was found, but the correlation between epistaxis rates and humidity, air pressure, and rainfall were negative. Additionally, no correlation was seen between epistaxis rates and either wind speed or sunlight duration. CONCLUSION: This clinical study provides evidence to support the idea that meteorological factors should be considered risk factors of epistaxis rates.

[Hhigh-frequency ultrasound research on the normal adult sciatic nerve].

OBJECTIVE: To explore the application value of the high-frequency ultrasound examination of the normal adult sciatic nerve. METHODS: The high frequency ultrasound was used to examine 60 cases ,a total of 120 normal adult sciatic nerve (28 males and 32 females ranging in age from 19 to 38 years old, averaged 23.8 years old). The age between men and women, height and weight showed no significant difference. The cross-sectional scanning and longitudinal scanning, if necessary, Panoramic Imaging were conducted. The cross section area of sciatic nerve was measured at the hip line, the middle of the thigh, the edge of the popliteal fossa, and the relationship betwen the sciatic nerve and surrounding muscle group was observed in each cross-section. Probe was rotated 90 degree to display the long axis of sciatic nerve, to get the longitudinal section along the long axis from top to bottom. So the sciatic nerve in the vertical axis and the surrouunding muscles was displayed by above method combined with panoramic imaging. The data of coss-sectional area of sciatic nerve were obtained at the central of hip line, the middle of the thigh, the edge of the popliteal fossa, and then were divided into different groups by gender and sides to do statistical analysis. RESULTS: The applicatic nerve in thigh can be clearly displayed by high-frequency ultrasound in this group of 60 people with 120 nerves, but low display rate of sciatic nerve in hip, approximatley 31.4% (21/66). The longitudinal section of the sciatic nerve displayed as the banded isoechoic or slightly hyperechoic, parallel partial hyperechoic line could be seen in it; in the cross-section, it showed a clear edge of the sieve-like isoechoic or slightly hyperechnie, which could be oval ,trapezoidal, triangular and irregular in shape; the sciatic nerve bad visible passive movement and shape change when muscle contracted. There were statistically significant differences of cross-sectional area of sciatic nerves at the hip line ,the middle of thigh and edge of the popliteal fossa between 56 sciatic nerves in 28 males and 64 sciatic nerves in 32 females (P< 0.05); but there were no significant differences between left and right sides (P>0.05). CONCLUSION: High frequency ultrasound can be used as the first choice of the sciatic nerve when an imaging method preferred.

ATM-NFκB axis-driven TIGAR regulates sensitivity of glioma cells to radiomimetics in the presence of TNFα.

Gliomas are resistant to radiation therapy, as well as to TNFα induced killing. Radiation-induced TNFα triggers Nuclear factor κB (NFκB)-mediated radioresistance. As inhibition of NFκB activation sensitizes glioma cells to TNFα-induced apoptosis, we investigated whether TNFα modulates the responsiveness of glioma cells to ionizing radiation-mimetic Neocarzinostatin (NCS). TNFα enhanced the ability of NCS to induce glioma cell apoptosis. NCS-mediated death involved caspase-9 activation, reduction of mitochondrial copy number and lactate production. Death was concurrent with NFκB, Akt and Erk activation. Abrogation of Akt and NFκB activation further potentiated the death inducing ability of NCS in TNFα cotreated cells. NCS-induced p53 expression was accompanied by increase in TP53-induced glycolysis and apoptosis regulator (TIGAR) levels and ATM phosphorylation. siRNA-mediated knockdown of TIGAR abrogated NCS-induced apoptosis. While DN-IκB abrogated NCS-induced TIGAR both in the presence and absence of TNFα, TIGAR had no effect on NFκB activation. Transfection with TIGAR mutant (i) decreased apoptosis and γH2AX foci formation (ii) decreased p53 (iii) elevated ROS and (iv) increased Akt/Erk activation in cells cotreated with NCS and TNFα. Heightened TIGAR expression was observed in GBM tumors. While NCS induced ATM phosphorylation in a NFκB independent manner, ATM inhibition abrogated TIGAR and NFκB activation. Metabolic gene profiling indicated that TNFα affects NCS-mediated regulation of several genes associated with glycolysis. The existence of ATM-NFκB axis that regulate metabolic modeler TIGAR to overcome prosurvival response in NCS and TNFα cotreated cells, suggests mechanisms through which inflammation could affect resistance and adaptation to radiomimetics despite concurrent induction of death.

Precoccygeal epidermal inclusion cyst: ultrasound and MR imaging features.

In this case report, we are presenting a 33 year-old pregnant woman who suffered from pelvic and coccygeal pain. Her medical examination and laboratory tests were found within normal limits. In order to explain her pain, initially a pelvic ultrasound was performed which revealed a huge hypoechoic cystic mass in the precoccygeal-presacral region. She then underwent a pelvic magnetic resonance imaging (MRI) examination in order to better delineate the characteristics and extension of this huge mass. On these images the mass was hypointense on T1 weighted images and extremely hyperintense on T2 weighted images. We also performed a diffusion weighted sequence which exhibited high signal intensity for the mass. We thought that this finding could be suggestive of an epidermal inclusion cyst similar to that of a brain epidermoid cyst which shows bright signal intensity on diffusion weighted images. The patient was operated and the cystic mass removed from the precoccygeal region. Histopathological examination confirmed the diagnosis of epidermal inclusion cyst. This case report suggests that an epidermal inclusion cyst should be considered in the differential diagnosis of intractable pelvic and coccygeal pain. MRI can help to establish the correct diagnosis.

Inhibition of Casein kinase-2 induces p53-dependent cell cycle arrest and sensitizes glioblastoma cells to tumor necrosis factor (TNFα)-induced apoptosis through SIRT1 inhibition.

Glioblastoma multiforme (GBM) are resistant to TNFα-induced apoptosis and blockade of TNFα-induced NF-κB activation sensitizes glioma cells to apoptosis. As Casein kinase-2 (CK2) induces aberrant NF-κB activation and as we observed elevated CK2 levels in GBM tumors, we investigated the potential of CK2 inhibitors (CK2-Is) - DRB and Apigenin in sensitizing glioma cells to TNFα-induced apoptosis. CK2-Is and CK2 small interfering RNA (siRNA) reduced glioma cell viability, inhibited TNFα-mediated NF-κB activation, and sensitized cell to TNFα-induced apoptosis. Importantly, CK2-Is activated p53 function in wild-type but not in p53 mutant cells. Activation of p53 function involved its increased transcriptional activation, DNA-binding ability, increased expression of p53 target genes associated with cell cycle progression and apoptosis. Moreover, CK2-Is decreased telomerase activity and increased senescence in a p53-dependent manner. Apoptotic gene profiling indicated that CK2-Is differentially affect p53 and TNFα targets in p53 wild-type and mutant glioma cells. CK2-I decreased MDM2-p53 association and p53 ubiquitination to enhance p53 levels. Interestingly, CK2-Is downregulated SIRT1 activity and over-expression of SIRT1 decreased p53 transcriptional activity and rescued cells from CK2-I-induced apoptosis. This ability of CK2-Is to sensitize glioma to TNFα-induced death via multiple mechanisms involving abrogation of NF-κB activation, reactivation of wild-type p53 function and SIRT1 inhibition warrants investigation.

Too cold for comfort: a neonate with severe hypothermia.

Severe neonatal hypothermia is an infrequent presentation to the Emergency Department. This case report describes the successful resuscitation and rapid rewarming of a newborn baby who presented to the Emergency Department with a core temperature of 14.8°C. This is the lowest temperature documented in the literature to date from which an infant has been successfully resuscitated.

Effects of safety warnings on prescription rates of cough and cold medicines in children below 2 years of age.

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT: • Cough and cold medicines are frequently used in children to treat upper respiratory tract infections without solid proof of benefits. • Safety issues have been raised about the use of these drugs in young children. • In 2007 international warnings were issued advising against use of these drugs in young children. WHAT THIS STUDY ADDS: • Cough and cold medicines prescribing by primary care physicians has not really been influenced by international warnings in the Netherlands, where no additional national warnings were made and only partially in Italy. • A concerted action should be taken in Europe to advise strongly against the OTC use and prescription of cough and cold medicines in young children. AIM: The aim of the study was to assess the influence of national and international warnings on the prescription rates of cough and cold medicines (CCMs) in the youngest children (<2 years) in the Netherlands and Italy. METHODS: Analysis of outpatient electronic medical records of children <2 years in Italy and the Netherlands was carried out. Age and country specific prescription prevalence rates were calculated for the period 2005-08. Comparisons of prescription rates in 2005 (pre) and 2008 (post) warnings were done by means of a chi-square test. RESULTS: The cohort consisted of 99,176 children <2 years of age. After international warnings, overall prescription rates for CCMs decreased slightly from 83 to 77/1000 person years (P= 0.05) in Italy and increased in the Netherlands from 74 to 92/1000 children per year. Despite the international warnings, prescription rates for nasal sympathomimetics and opium alkaloids increased in the Netherlands (P < 0.01). In Italy a significant decrease in the prescription rates of opium alkaloids and other cough suppressants (P < 0.01) was observed, and also a significant reduction in use of combinations of nasal sympathomimetics. CONCLUSION: Despite the international safety warnings and negative benefit-risk profiles, prescription rates of cough and cold medicines remain substantial and were hardly affected by the warnings, especially in the Netherlands where no warning was issued. The hazards of use of these medicines in young children should be explicitly stipulated by the European Medicines Agency and all national agencies, in order to increase awareness amongst physicians and caretakers and reduce heterogeneity across the EU.