Severe tinnitus and migraine headache in a 37-year-old woman treated with trastuzumab for breast cancer: A case report.

BACKGROUND: Trastuzumab is a generally safe agent prescribed in the systemic treatment of breast cancer. Tinnitus is not a currently known adverse event related to trastuzumab. Here, we describe a rare case of severe tinnitus and a migraine headache induced by trastuzumab used for adjuvant therapy. CASE SUMMARY: A 37-year-old woman was diagnosed with hormone receptor-positive and human epidermal growth factor receptor 2-positive breast cancer. After surgery, she was treated with four cycles of epirubicin and cyclophosphamide; she then received docetaxel and a loading dose of trastuzumab plus pertuzumab. Less than half an hour after trastuzumab infusion, the patient complained of severe tinnitus and left-sided migraine headache. Trastuzumab monotherapy was discontinued immediately, and symptoms disappeared after 10 min. Trastuzumab was readministered, and severe tinnitus and migraine headache recurred. Trastuzumab was stopped, and severe tinnitus diminished after 10 min. Pertuzumab and docetaxel therapy was then administered, and no adverse events were observed. Subsequent infusions of trastuzumab every three weeks did not show the same symptoms. CONCLUSION: Although trastuzumab is well-tolerated in most patients, we should pay attention to the risk of severe tinnitus and migraine.

Photosystem Disorder Could be the Key Cause for the Formation of Albino Leaf Phenotype in Pecan.

Pecan is one of the most famous nut species in the world. The phenotype of mutants with albino leaves was found in the process of seeding pecan, providing ideal material for the study of the molecular mechanisms leading to the chlorina phenotype in plants. Both chlorophyll a and chlorophyll b contents in albino leaves (ALs) were significantly lower than those in green leaves (GLs). A total of 5171 differentially expression genes (DEGs) were identified in the comparison of ALs vs. GLs using high-throughput transcriptome sequencing; 2216 DEGs (42.85%) were upregulated and 2955 DEGs (57.15%) were downregulated. The expressions of genes related to chlorophyll biosynthesis (HEMA1, encoding glutamyl-tRNA reductase; ChlH, encoding Mg-protoporphyrin IX chelatase (Mg-chelatase) H subunit; CRD, encoding Mg-protoporphyrin IX monomethylester cyclase; POR, encoding protochlorophyllide reductase) in ALs were significantly lower than those in GLs. However, the expressions of genes related to chlorophyll degradation (PAO, encoding pheophorbide a oxygenase) in ALs were significantly higher than those in GLs, indicating that disturbance of chlorophyll a biosynthesis and intensification of chlorophyll degradation lead to the absence of chlorophyll in ALs of pecan. A total of 72 DEGs associated with photosynthesis pathway were identified in ALs compared to GLs, including photosystem I (15), photosystem II (19), cytochrome b6-f complex (3), photosynthetic electron transport (6), F-type ATPase (7), and photosynthesis-antenna proteins (22). Moreover, almost all the genes (68) mapped in the photosynthesis pathway showed decreased expression in ALs compared to GLs, declaring that the photosynthetic system embedded within the thylakoid membrane of chloroplast was disturbed in ALs of pecan. This study provides a theoretical basis for elucidating the molecular mechanism underlying the phenotype of chlorina seedlings of pecan.

[Study on Salt Tolerance of Echinacea purpurea].

OBJECTIVE: To explore the salt tolerance of Echiancea purpurea and its mechanism. METHODS: Echiancea purpurea was used as test material in this study and six salinity levels (0, 30, 60, 90, 120 and 150 mmol/L NaCl) were set. Effects on seed germination and salt tolerance relevant physiological and biochemical indexes of Echiancea purpurea were studied. RESULTS: Salt stress suppressed the germination of Echiancea purpurea seeds, induced osmotic adjustment substances proline, soluble sugar and K+ to increase, and activities of POD and SOD to rise, and meanwhile resulted in accumulation of Na+ and decrease of K+/Na+. CONCLUSION: Echiancea purpurea can tolerant salt stress to a certain degree, but in case of high salt concentrations, severe salt injury would remarkably suppress the growth of Echinacea purpurea.

Anti-inflammatory and anti-proliferative effects of CBS3830 in arterialized vein grafts in rats.

OBJECTIVE: To investigated whether CBS3830, a highly selectively inhibitor of p38MAPK, could ameliorate inflammation and intimal hyperplasia in arterialized vein grafts (AVGs). METHODS: Sixty male Sprague-Dawley rats underwent a reversed right jugular vein to common carotid artery interposition graft and were randomly treatment with vehicle (control) or single-dose (3 mg/kg, preoperative) or double-dose (3 mg/kg, preoperative and 4 d postoperative) CBS3830. Twenty rats underwent sham operation. The levels of tumor necrosis factor-α (TNF-α), interleukin-1ß (IL-1ß), and interleukin-6 (IL-6) were determined by ELISA. Vein grafts were analyzed by intimal/medial morphometry, proliferating cell nuclear antigen (PCNA) expression, and p38MAPK phosphorylation. RESULTS: TNF-α, IL-1ß, and IL-6 gradually increased then slowly decreased in AVG rats. However, at 4 d and 7 d, TNF-α levels decreased by 37.5% and 29.5% (p = 0.003, 0.05, respectively) in the single-dose CBS3830 group, and by 37.6% and 32.5%, respectively (both p = 0.003) in the double-dose group compared with those of control. IL-1ß levels significantly reduced at 4 d and 14 d in both dosage groups. IL-6 levels significantly reduced at 7 d in both groups. Intima and medial thickening were significantly reduced in both dosage treated groups at 7, 14, and 28 d (all p = 0.000) compared to the controls. Further study showed CBS3830 inhibited p38MAPK phosphorylation and decreased PCNA expression. CONCLUSIONS: CBS3830 significantly decreases inflammation and intimal hyperplasia in AVGs.

Decreasing pancreatic leak after distal pancreatectomy: bovine pericardium wrapping stump in a porcine model.

BACKGROUND: Despite marked improvements in pancreatic surgery, the high incidence and morbidity of pancreatic leak after resection has remained unchanged. The current study investigated the safety and efficacy of bovine pericardium wrapping stump after distal pancreatectomy in a porcine model. METHODS: Thirty-two swine were randomly assigned to control and experiment groups to undergo conventional scalpel transection with single hand-sewn closure of the pancreatic remnant (control) or bovine pericardium wrapping stump combined with hand-sewn closure (experiment). Closed-suction drainage was collected and measured daily. Animals were necropsied at 3 weeks postoperatively, and the pancreatic remnants were examined for histology. Primary end points were the development of a pancreatic fistula defined as greater than threefold drain/serum amylase after the 3rd postoperative day, and the presence of undrained amylase-rich fluid collections/abscess. RESULTS: The incidence of pancreatic leak in the wrapping group was 6.3 versus 46.7% in the control group (p < 0.05). The amount of drainage fluid was higher in the control group than the experiment group during the postoperative days. There were no differences in operative time or other clinical parameters measured. No other significant differences were found in macroscopic changes between groups at reexploration. Histological examination demonstrated focal, chronic inflammation with necrosis in all animals. CONCLUSIONS: Bovine pericardium wrapping stump effectively reduced the incidence of pancreatic leakage after the distal pancreatectomy.

Auditory pre-attentive processing of Chinese tones.

BACKGROUND: Chinese tones are considered important in Chinese discrimination. However, the relevant reports on auditory central mechanisms concerning Chinese tones are limited. In this study, mismatch negativity (MMN), one of the event related potentials (ERP), was used to investigate pre-attentive processing of Chinese tones, and the differences between the function of oddball MMN and that of control MMN are discussed. METHODS: Ten subjects (six men and four women) with normal hearing participated in the study. A sequence was presented to these subjects through a loudspeaker, the sequence included four blocks, a control block and three oddball blocks. The control block was made up of five components (one pure tone and four Chinese tones) with equiprobability. The oddball blocks were made up of two components, one was a standard stimulus (tone 1) and the other was a deviant stimulus (tone 2 or tone 3 or tone 4). Electroencephalogram (EEG) data were recorded when the sequence was presented and MMNs were obtained from the analysis of the EEG data. RESULTS: Two kinds of MMNs were obtained, oddball MMN and control MMN. Oddball MMN was obtained by subtracting the ERP elicited by standard stimulation (tone 1) from that elicited by deviant stimulation (tone 2 or tone 3 or tone 4) in the oddball block; control MMN was obtained by subtracting the ERP elicited by the tone in control block, which was the same tone as the deviant stimulation in the oddball block, from the ERP elicited by deviant stimulation (tone 2 or tone 3 or tone 4) in the oddball block. There were two negative waves in oddball MMN, one appeared around 150 ms (oddball MMN 1), the other around 300 ms (oddball MMN 2). Only one negative wave appeared around 300 ms in control MMN, which was corresponding to the oddball MMN 2. We performed the statistical analyses in each paradigm for latencies and amplitudes for oddball MMN 2 in discriminating the three Chinese tones and reported no significant differences. But the latencies and amplitudes for control MMN in discriminating the three tones all were significantly different. CONCLUSIONS: There are evident waveforms for oddball and control MMN obtained in normal hearing persons, indicating that the change of Chinese tones could be detected in the pre-attentive stage. Because control MMN can eliminate reflects for physical characteristics of sound, it is the genuine memory-based pre-attentive processing. Since control MMN can reflect the differences of Chinese tones processing better than oddball MMN, it is more sensitive in evaluating pre-attentive processing in Chinese tones discrimination.

[Local response caused by implant after cochlear implantation].

OBJECTIVE: To approach the incidence rate, symptoms, etiologies, correlating reasons, consequences and treatments of local responses caused by implant after cochlear implantation and to provide reference for the future works. METHODS: From 1995 to 2007 there were 997 cases adopted cochlear implantation in Peding Union Medical College Hospital. Ten cases experienced local responses were analyzed retrospectively. RESULTS: The incidence of local response was 1.003%. There were 6 males and 4 females. The ages were between 13 months to 8 years old. The average age was 34 months. The devices mainly were made by Cochlear and Med-EL companies. The mainly symptoms and signs were local swellings, complaint of pruritus after ear, decrease of sound legibility and so on. Onset frequencies of this disease was 1 to 8 times. The bacterium cultured of displacing liquids was negative. But the IgE was detected in 2 cases. Results showed the patients were midrange status of hypersensitivity. Positive conservative treatments must be done including antibiotics, antihistamines, necessarily using immunotherapy. CONCLUSIONS: Besides local infection of bacteria, the allergy caused by silicone of implant coupled be a reason. Although the diagnose of this disease was difficult, but the screening of source of hypersensitivity was necessary before operation. It was recurrent attacks and maybe liable by kindred patients. Onset age was more below 4 years old. The patch test should be done again when the symptoms were occurrence after operation. If severe secondary infection was occurred and the states could not be well controlled the devices in the body must be explanted immediately. When the conditions were stable reimplantation could be experienced by non-sensibilisinogen devices.