A prospective study on the efficacy of oral estrogen in female patients with acromegaly.

PURPOSE: To evaluate the efficacy and safety of oral estrogen therapy in female patients of childbearing age with uncontrolled acromegaly and to verify the significance of the presence of estrogen receptor α (ER-α) in somatotropinomas. METHODS: Prospective study in which biochemical and radiological evaluations were performed at baseline and after six months of treatment with an oral formulation of ethinyl-estradiol 0.03 mg and levonorgestrel 0.15 mg. ER-α was assessed by immunohistochemistry and immunopositivity was considered when it was present in ≥ 1% of cells. RESULTS: Eight patients with uncontrolled acromegaly were selected. All patients underwent surgery. Four patients were on octreotide LAR 30 mg, two patients were on lanreotide autogel 120 mg, and two patients had active disease after surgery. At the end of follow-up, IGF-I normalized in 3/8 (37%), 2/8 (25%) patients presented with mean IGF-I reduction of 25% but without IGF-I normalization, and 2/8 (25%) did not respond-one had a 13% increase in IGF-I and IGF-I level remained unchanged after treatment in the other. In one patient, treatment was discontinued after 3 months due to side effects (headache), with an IGF-I reduction of 28% but without normalization. Tumor volume increase (41%) was observed in only one patient (the only tumor with positive ER-α expression). CONCLUSIONS: In uncontrolled patients with acromegaly, a trial with oral estrogen can be an option for young women. Oral estrogen was well tolerated, but the somatotropinoma that presented ER-α expression was the only somatotropinoma that presented growth during treatment.

Osmotic demyelination syndrome diagnosed radiologically during Wilson's disease investigation.

Wilson's disease (WD), also known as hepatolenticular degeneration, is a rare autosomal recessive disorder that results from abnormal ceruloplasmin metabolism, with copper deposition affecting multiple systems. Osmotic demyelination syndrome (ODS) refers to acute demyelination seen in the setting of osmotic changes, typically with the rapid correction of electrolyte disturbance. We present a 29-year-old male patient diagnosed with WD 1 year after the onset of extrapyramidal symptoms. Magnetic resonance imaging performed during hospitalization showed two patterns of pons involvement, which allowed the diagnosis of ODS in addition to WD. Classic imaging findings were observed and illustrate perfectly these two conditions.

Evaluation of deep gray matter volume, cortical thickness and white matter integrity in patients with typical absence epilepsy: a study using voxelwise-based techniques.

INTRODUCTION: The objective of this study was to evaluate the cortical thickness and the volume of deep gray matter structures, measured from 3D T1-weighted gradient echo imaging, and white matter integrity, by diffusion tensor imaging (DTI) in patients with typical absence epilepsy (AE). METHODS: Patients (n = 19) with typical childhood AE and juvenile AE, currently taking antiepileptic medication, were compared with control subjects (n = 19), matched for gender and age. 3D T1 magnetization-prepared rapid gradient echo-weighted imaging and DTI along 30 noncolinear directions were performed using a 1.5-T MR scanner. FreeSurfer was used to perform cortical volumetric reconstruction and segmentation of deep gray matter structures. For tract-based spatial statistics analysis of DTI, a white matter skeleton was created, along with a permutation-based inference with 5000 permutations. A threshold of p < 0.05 was used to identify abnormalities in fractional anisotropy (FA). The mean, radial, and axial diffusivities were also projected onto the mean FA skeleton. RESULTS: Patients with AE presented decreased FA and increased mean diffusivity and radial diffusivity values in the genu and the body of the corpus callosum and right anterior corona radiata, as well as decreased axial diffusivity in the left posterior thalamic radiation, inferior cerebellar peduncle, right cerebral peduncle, and right corticospinal tract. However, there were no significant differences in cortical thickness or deep gray matter structure volumes between patients with AE and controls. CONCLUSION: Abnormalities found in white matter integrity may help to better understand the pathophysiology of AE and optimize diagnosis and treatment strategies.

Healthy aging: what can we learn from Caenorhabditis elegans?

The microscopic worm Caenorhabditis elegans (C. elegans) is one of the most prominent animal models for aging studies. This is underscored by the fact that most of the genes and interventions that modulate the aging process, such as the insulin/IGF pathway, caloric restriction and mitochondrial signalling, were first identified in this organism. Remarkably, many features of the mammalian aging process are recapitulated in C. elegans: over time, damage to macromolecule accumulates, structural cellular components progressively deteriorate, physiological functions decline, resistance to stress and infections decreases, while morbidity and mortality rates increase. In humans, age represents risk factor number one for most diseases ultimately leading to death in industrialized countries, namely cardiovascular diseases, cancer and neurodegenerative disorders. Genes regulating aging in C. elegans are evolutionarily conserved and their deregulation is often involved in the development of age-associated diseases in humans. It is therefore likely that any intervention that extends C. elegans lifespan will indicate strategies to positively impact on healthy human longevity.

Femoral tunnel length: accessory anteromedial portal drilling versus transtibial drilling.

PURPOSE: To determine whether drilling using an anteromedial portal technique during single-bundle anterior cruciate ligament (ACL) reconstruction risks creating femoral tunnels less than 25 mm long in the clinical setting. METHODS: Intraoperative measurements of femoral tunnel length in a group of 35 consecutive patients undergoing single-bundle primary ACL reconstruction with transtibial (TT) femoral drilling were compared with a subsequent group of 80 consecutive patients undergoing the same procedure with accessory anteromedial portal (AAMP) femoral drilling. The length of femoral tunnels created through the AAMP in male patients was compared with that in female patients, and the expected likelihood of obtaining tunnels shorter than 25 mm was determined for either gender. RESULTS: The mean femoral tunnel length in the AAMP group was significantly shorter than that in the TT group (35.6 mm and 40.7 mm, respectively; P < .0001). In male patients in the AAMP group, the femoral tunnel length was significantly greater on average than that in female patients in the same group (36.8 mm and 33.5 mm, respectively; P = .0001). The shortest measured femoral tunnel was 28 mm long. The statistical likelihood of femoral tunnels created by AAMP drilling being less than 25 mm in length was 0.47% for female patients and 0.1% for male patients. CONCLUSIONS: Although femoral tunnel length with AAMP drilling is, on average, approximately 5 mm (12.5%) shorter than with TT drilling, the likelihood of the tunnel being too short to allow for suspensory fixation with adequate graft placed within the femoral tunnel is very low. Female patients undergoing single-bundle ACL reconstruction with AAMP drilling have a femoral tunnel length that is approximately 3 mm (9%) shorter than that in male patients on average, but the expected likelihood of obtaining a tunnel shorter than 25 mm in female patients is still less than 1:200, compared with 1:1,000 for male patients. LEVEL OF EVIDENCE: Level III, retrospective comparative study.

Gut microbiota as a candidate for lifespan extension: an ecological/evolutionary perspective targeted on living organisms as metaorganisms.

An emerging central concept in evolutionary biology suggests that symbiosis is a universal characteristic of living organisms that can help in understanding complex traits and phenotypes. During evolution, an integrative circuitry fundamental for survival has been established between commensal gut microbiota and host. On the basis of recent knowledge in worms, flies, and humans, an important role of the gut microbiota in aging and longevity is emerging. The complex bacterial community that populates the gut and that represents an evolutionary adapted ecosystem correlated with nutrition appears to limit the accumulation of pathobionts and infections in all taxa, being able of affecting the efficiency of the host immune system and exerting systemic metabolic effects. There is an urgent need to disentangle the underpinning molecular mechanisms, which could shed light on the basic mechanisms of aging in an ecological perspective. Thus, it appears possible to extend healthy aging and lifespan by targeting the host as a metaorganism by manipulating the complex symbiotic ecosystem of gut microbiota, as well as other possible ecosystems of the body.

What information do patients recall from the third molar surgical consultation?

The aim of this study was to determine whether the use of a professionally prepared educational video on third molar extraction enhances comprehension and retention of general and informed consent information. A prospective cohort study of adult patients undergoing consultation followed by extraction of third molars in the Oral and Maxillofacial Surgery Clinic, University of Illinois at Chicago was completed. At the initial consultation, the subjects viewed an educational video and received specific verbal individual information about their case. A written examination (group 1) was then completed; a subgroup of the subjects (group 2) was selected randomly to complete the same examination at the next visit prior to the procedure. The primary predictor variable was utilization of the video. The primary outcome variable was comprehension of information regarding third molars, assessed by examination scores. The secondary outcome variable was retention of the information, assessed by repeat examination scores. One hundred adults (34 male, 66 female; group 1) completed the examination at least once; 54 (19 male, 35 female) completed both examinations (group 2). Correct responses ranged from 64% to 100% in group 1 and from 37% to 100% in group 2. In group 2, all questions answered incorrectly at the first visit were answered correctly at the second visit, without any additional information being provided. Patient comprehension and retention of pertinent pre-surgical information is poor, despite use of an educational video to supplement the usual verbal consultation. These results confirm those of prior studies and may have medico-legal implications regarding the informed consent process for third molar surgery.

Influence of different periods of pre-slaughter fasting on microbiological quality of bullfrog carcasses (Lithobates catesbeianus) / [Influência de diferentes períodos de jejum pré-abate na qualidade microbiológica de carcaças de rã-touro (Lithobates catesbeianus)]

The aim of this study was to evaluate the influence of different periods of pre-slaughter fasting (F1: 2 to 24 hours and F2: 48 to 72 hours) on the counts of hygiene indicator microorganisms and the presence of Salmonella spp. in carcasses of bullfrogs. Two different stages of the slaughter process were analyzed: after bleeding (A) and after the final carcasses cleaning (B). Samples from each fasting period were analyzed to count hygiene indicator microorganisms (n=30) and Salmonella spp. (n=140). For aerobic mesophilic microorganisms, the variation in fasting periods caused a reduction of 0.69 log10 CFU / g (P<0.05) in F2 when compared to F1 at point B of the slaughter. Coliforms at 35º C and Escherichia coli showed no differences (P >0.05) between the fasting analyzed periods. Considering the presence of E. coli, it was observed that F2 resulted in a reduction of 30% (P<0.05) positivity on point B. For Salmonella spp., the results showed that F2 contributed to an 11.5% reduction in the presence of this bacteria at point B. (P<0.05). Therefore, it is concluded that 48 to 72 hours of pre-slaughter fasting resulted in a positive impact on the microbiological quality of bullfrog carcasses.(AU)

O objetivo deste estudo foi avaliar a influência de diferentes períodos de jejum pré-abate (F1: duas a 24 horas e F2: 48 a 72 horas) nas contagens de micro-organismos indicadores de higiene e na presença de Salmonella spp. em carcaças de rãs-touro. Foram analisadas duas etapas do processo de abate: após a sangria (A) e após a toalete final da carcaça (B). As amostras de cada período de jejum foram utilizadas para contagem de indicadores de higiene (n = 30) e Salmonella spp. (n = 140). Para aeróbios mesófilos, a variação no tempo de jejum causou uma redução de 0,69 log10 UFC/g (P<0,05) em F2 quando comparado a F1 na etapa B do abate. Os coliformes a 35ºC e Escherichia coli não apresentaram diferenças (P>0,05) entre os dois períodos de jejum analisados. Considerando a presença de E. coli, F2 resultou em uma redução de 30% (P<0,05) de positividade na etapa B. Para Salmonella spp., os resultados mostraram que F2 contribuiu para uma redução de 11,5% na presença desse micro-organismo na etapa B. Portanto, conclui-se que 48 a 72 horas de jejum pré-abate tiveram um impacto positivo na qualidade microbiológica das carcaças de rã-touro.(AU)

Neural bases of language switching in high and early proficient bilinguals.

The left inferior frontal cortex, the caudate and the anterior cingulate have been proposed as the neural origin of language switching, but most of the studies were conducted in low proficient bilinguals. In the present study, we investigated brain areas involved in language switching in a sample of 19 early, high-proficient Spanish-Catalan bilinguals using a picture naming task that allowed contrasting switch and non-switch trials. Compared to the non-switching condition, language switching elicited greater activation in the head of the left caudate and the pre-SMA/ACC. When the direction of the switching was considered, the left caudate was more associated with forward switching and the pre-SMA/ACC with backward switching. The discussion is focused on the relevance of these brain structures in language control in early, high-proficient bilinguals, and the comparison with previous results in late bilinguals.

Frataxin participates to the hypoxia-induced response in tumors.

Defective expression of frataxin is responsible for the degenerative disease Friedreich's ataxia. Frataxin is a protein required for cell survival since complete knockout is lethal. Frataxin protects tumor cells against oxidative stress and apoptosis but also acts as a tumor suppressor. The molecular bases of this apparent paradox are missing. We therefore sought to investigate the pathways through which frataxin enhances stress resistance in tumor cells. We found that frataxin expression is upregulated in several tumor cell lines in response to hypoxic stress, a condition often associated with tumor progression. Moreover, frataxin upregulation in response to hypoxia is dependent on hypoxia-inducible factors expression and modulates the activation of the tumor-suppressor p53. Importantly, we show for the first time that frataxin is in fact increased in human tumors in vivo. These results show that frataxin participates to the hypoxia-induced stress response in tumors, thus implying that modulation of its expression could have a critical role in tumor cell survival and/or progression.

Intervertebral disc calcification in childhood.

Nine children with calcified intervertebral discs are described. Seven were boys and 2 were girls. The average age at diagnosis was 8.6 years (range 5 to 14 years). Follow up was from 2 to 10 years. Only one child gave a history of trauma. In all twelve discs were involved with more than one disc being affected in 2 children; there were 7 in the cervical spine, 4 in the thoracic and one in the lumbar spine. Every child with cervical calcification had an acute onset with pain and limited movement, and disappeared during the following months. The calcified discs in the thoracic and lumbar regions did not cause symptoms and did not change. Calcification of cervical discs is self-limiting and has an excellent prognosis.

Infantile idiopathic scoliosis in the newborn.

We have reviewed 7 patients (5 boys and 2 girls) with infantile idiopathic scoliosis which was present at birth and was diagnosed at ages from 1 day to 1 month. The mean follow up was 16 years. The objectives were to discover whether intrauterine forces play a role in the aetiology and to determine whether early treatment of a potentially progressive curve can induce resolution. Two infants were male conjoined twins and were united by skin over the posterior sacrum. Six infants had a rib vertebral angle difference greater than 20 degrees in the first radiograph and 5 had stiff curves. In 2 with flexible curves, the deformity disappeared by the end of the first year. The 5 with stiff curves were treated conservatively for 6 to 24 months. Growth has now been completed in 5; 4 have a straight spine and one developed an adolescent curve of 26 degrees. The 2 who are still growing have no scoliosis. Intrauterine moulding was only demonstrated in the conjoined twins. There was a correlation between the rib vertebral angle difference above 20 degrees and the rigidity of the curve. Early treatment of a potentially progressive curve can lead to resolution.

Intervertebral discitis in children: a review of 12 cases.

Twelve children with lumbar discitis were reviewed. The average age at diagnosis was 2.5 years. Seven were girls, and the follow-up varied between 2 and 10 years (average 5 years). The clinical signs were general irritability, abdominal or hip pain and refusal to walk or to sit. The erythrosedimentation rate was elevated in all but two. Radiographic narrowing of the disc space was seen in seven patients. Needle disc aspiration was done in five cases with two being positive for Staphylococcus aureus. Blood culture was positive in one case. Magnetic resonance imaging helped to diagnose the condition in three. Treatment consisted of bed rest and immobilisation of the spine; intravenous antibiotics were given to nine children. The natural course of the disease was benign in all our twelve cases.

The response of trained athletes to six weeks of endurance training in hypoxia or normoxia.

This study was performed to investigate the effect of training under simulated hypoxic conditions. Hypoxia training was integrated into the normal training schedule of 12 endurance trained cyclists. Athletes were randomly assigned to two groups and performed three additional training bouts per week for six weeks on a bicycle ergometer. One group (HG) trained at the anaerobic threshold under hypoxic conditions (corresponding to an altitude of 3200 m) while the control group (NG) trained at the same relative intensity at 560 m. Preceding and following the six training weeks, performance tests were performed under normoxic and hypoxic conditions. Normoxic and hypoxic .VO2max, maximal power output as well as hypoxic work-capacity were not improved after the training period. Testing under hypoxic conditions revealed a significant increase in oxygen saturation (SpO 2, from 67.1 +/- 2.3 % to 70.0 +/- 1.7 %) and in maximal blood lactate concentration (from 7.0 to 9.1 mM) in HG only. Ferritin levels were decreased from 67.4 +/- 16.3 to 42.2 +/- 9.5 microg/l (p < 0.05) in the HG and from 54.3 +/- 6.9 to 31.4+/- 8.0 microg/l (p = 0.17) in the NG. Reticulocytes were significantly increased in both groups by a factor of two. In conclusion, the integration of six weeks of high intensity endurance training did not lead to improved performance in endurance trained athletes whether this training was carried out in hypoxic or normoxic conditions.

Descolamento prematuro de placenta iterativo. / Repetitive premature placental dislocation

Os autores apresentam o caso de uma paciente com historia obstetrica relevando dois episodios previos de descolamento prematuro de placenta.A conduta tomada foi de se internar a paciente na 27a. semana de gestacao. Quando a gestacao contava com 37 semanas, repetiu-se o episodio de DPP, e foi possivel estabelecer uma conduta adequada e precoce. Comentarios sao tecidos a respeito dos fatores etiologicos e predisponentes ao DPP em geral e ao DPP recorrente. Comenta-se ainda a conduta face a uma gestante com historia previa de DPP