Severe hypercalcemia and a pelvic brown tumor in an adolescent with primary hyperparathyroidism: a case report.

BACKGROUND: Primary hyperparathyroidism may present in a myriad of manners, varying from an incidental asymptomatic biochemical finding to gastrointestinal, psychiatric, renal, and bone manifestations. While hyperparathyroidism remains a rare diagnosis in the pediatric population, the initial approach to diagnosis and management of hypercalcemia in children is imperative for the general pediatrician. Herein, we describe an adolescent who presented with a lytic bone lesion and severe, symptomatic hypercalcemia due to primary hyperparathyroidism. CASE PRESENTATION: A 14-year-old male presented with vomiting, constipation, abdominal pain, and lethargy. He had an elevated total corrected calcium of 4.3 mmol/L. He was found to have a large pelvic lytic tumor consistent with a brown tumor due to primary hyperparathyroidism. He received pharmacologic therapy for stabilization of his hypercalcemia, including intravenous saline, intravenous bisphosphonates, and calcitonin. He subsequently received definitive therapy via parathyroidectomy and his post-operative course was complicated by hungry bone syndrome. Long-term follow-up has found full resolution of the lytic lesion and restored calcium homeostasis. CONCLUSIONS: We present this case to highlight the possible presentations of hypercalcemia and hyperparathyroidism that are essential for a general pediatrician to recognize to ensure prompt diagnosis and management. Evaluation for hypercalcemia should be considered in patients with suggestive symptoms and physical exam findings. To our knowledge, this patient represents the first reported pediatric case of a pelvic brown tumor in an adolescent. While the multi-systemic complications of hyperparathyroidism may be quite severe, swift and appropriate management may mitigate these clinical outcomes.

Biosecurity in endemic foot and mouth disease settings: a case study of foot and mouth disease vaccination in South-East Asia.

Foot and mouth disease (FMD) is a highly contagious viral infection affecting cloven-hoofed animals including cattle, buffalo, sheep, goats and pigs. The disease is endemic in several parts of Asia, as well as most of Africa and the Middle East. In 1997, the World Organisation for Animal Health (OIE) established the South-East Asia Foot and Mouth Disease Campaign with the aim of increasing livestock sector productivity and economic output through the control and eradication of FMD in South-East Asia. Large-scale vaccination of livestock against FMD has in the past led to the successful eradication (or control) of the disease, for example in the Philippines. However, despite the benefit associated with large-scale vaccination, biosecurity risks can be created by vaccination teams moving between locations. It is therefore recommended that biosecurity measures are used by vaccination teams to prevent inadvertent disease spread. The majority of existing guidelines are focused on high-risk situations such as exotic animal disease outbreaks in developed countries, or agents posing a risk to human health. This paper describes the development of novel biosecurity guidelines for vaccination teams in South-East Asia. To achieve this, available literature was scanned followed by in-country workshops and field-testing of draft materials. Entry and exit procedures are laid out within the context of five core rules that follow the biosecurity principles of situational awareness, segregation, cleaning and disinfection. Guidelines and accompanying fact sheets were translated into local languages and included in a comprehensive vaccination training programme for all vaccination teams undertaking cattle FMD vaccination programmes in the New Zealand OIE FMD control project target countries (Myanmar and Laos). The material developed has wide practical relevance to veterinarians, traditional healers and village or community animal health workers, who all pose a heightened risk of spreading infectious agents.

La fièvre aphteuse est une maladie virale extrêmement contagieuse affectant les artiodactyles (dont les bovins, les buffles, les ovins, les caprins et les porcins). La maladie est présente à l'état endémique dans plusieurs régions d'Asie, dans presque toute l'Afrique et au Moyen-Orient. En 1997, l'Organisation mondiale de la santé animale (OIE) a lancé la Campagne de lutte contre la fièvre aphteuse en Asie du Sud-Est afin d'améliorer la productivité et la rentabilité économique du secteur de l'élevage à travers la lutte contre la fièvre aphteuse voire son éradication de la sous-région. Grâce à la vaccination à grande échelle du bétail, certains pays ont pu éradiquer (ou du moins contrôler) la fièvre aphteuse dans le passé, par exemple les Philippines. Si la vaccination à grande échelle est en soi bénéfique, elle comporte certains risques de biosécurité, liés aux déplacements des équipes de vaccination d'un site à l'autre. Il est donc recommandé que ces équipes appliquent des mesures de biosécurité visant à prévenir toute propagation accidentelle de la maladie. La plupart des lignes directrices existantes sont axées sur les situations présentant un niveau de risque élevé, par exemple la survenue de foyers de maladies animales exotiques dans les pays développés, ou d'agents pathogènes qui constituent un risque pour la santé publique. Dans cet article, les auteurs décrivent la méthodologie suivie pour élaborer des lignes directrices innovantes de biosécurité en Asie du Sud-Est, destinées aux équipes de vaccination. Ces lignes directrices ont été rédigées en passant en revue la littérature sur le sujet lors d'ateliers nationaux et en testant sur le terrain les projets de documents. Les procédures d'entrée et de sortie ont été établies en suivant cinq règles fondamentales fondées sur les grands principes de la biosécurité, à savoir la connaissance de la situation, la ségrégation, le nettoyage et la désinfection. Les lignes directrices et les fiches explicatives qui les accompagnent ont été traduites en langues locales et utilisées dans le cadre d'un programme complet de formation à la vaccination destiné à l'ensemble des équipes de vaccination participant aux programmes de vaccination du cheptel bovin contre la fièvre aphteuse dans les pays couverts par le projet Nouvelle-Zélande­OIE de lutte contre la fièvre aphteuse (Myanmar et Laos). Les matériels proposés présentent une utilité concrète pour les vétérinaires, les guérisseurs traditionnels et les auxiliaires communautaires ou villageois de santé animale, qui sont tous particulièrement exposés au risque de propager involontairement des agents de maladies infectieuses.

La fiebre aftosa es una infección vírica muy contagiosa que afecta a animales biungulados como el ganado vacuno, el búfalo, la oveja, la cabra o el cerdo. La enfermedad es endémica en varias zonas de Asia y en la mayor parte de África y Oriente Medio. En 1997, la Organización Mundial de Sanidad Animal (OIE) instituyó la «Campaña de lucha contra la fiebre aftosa en el Sudeste asiático¼ con el objetivo de que el control y la erradicación de la enfermedad en la región se tradujeran en un aumento de la productividad y la rentabilidad económica del sector ganadero. En ocasiones anteriores la vacunación a gran escala del ganado ya ha resultado eficaz para erradicar (o controlar) la fiebre aftosa, por ejemplo en Filipinas. Sin embargo, pese a los beneficios que depara la vacunación a gran escala, los equipos que la llevan a cabo, al desplazarse de una a otra localidad, también pueden vehicular nuevos riesgos biológicos. Por ello se recomienda que esos equipos apliquen medidas de seguridad biológica destinadas a impedir la propagación accidental de la enfermedad. La mayoría de las directrices existentes al respecto están centradas en situaciones de gran riesgo, como brotes de enfermedades animales exóticas en países desarrollados o presencia de agentes infecciosos que entrañan peligro para la salud pública. Los autores describen la elaboración de nuevas directrices de seguridad biológica dirigidas a los equipos de vacunación que operan en el Sudeste asiático. Para empezar se hizo un repaso de la bibliografía existente, tras lo cual se celebraron talleres nacionales y se ensayaron sobre el terreno las medidas preconizadas en un primer borrador. Como parte de las directrices se instauran procedimientos de entrada y salida encuadrados en cinco reglas básicas que se ajustan a los grandes principios de seguridad biológica: conocimiento de la situación, segregación, limpieza y desinfección. Las directrices y las fichas descriptivas que las acompañan, una vez traducidas a los idiomas locales, fueron incluidas en un programa integral de formación en vacunaciones dirigido a todos los equipos que se disponían a intervenir en programas de vacunación antiaftosa del ganado en Myanmar y Laos, países beneficiarios del proyecto Nueva Zelanda­OIE de lucha contra la fiebre aftosa. El material elaborado reviste gran utilidad práctica para los veterinarios, curanderos tradicionales y trabajadores zoosanitarios de aldeas y comunidades, todos ellos portadores de un riesgo especialmente importante de propagar agentes infecciosos.

High-grade glioma management and response assessment-recent advances and current challenges.

The management of high-grade gliomas (hggs) is complex and ever-evolving. The standard of care for the treatment of hggs consists of surgery, chemotherapy, and radiotherapy. However, treatment options are influenced by multiple factors such as patient age and performance status, extent of tumour resection, biomarker profile, and tumour histology and grade. Follow-up cranial magnetic resonance imaging (mri) to differentiate treatment response from treatment effect can be challenging and affects clinical decision-making. An assortment of advanced radiologic techniques-including perfusion imaging with dynamic susceptibility contrast mri, dynamic contrast-enhanced mri, diffusion-weighted imaging, proton spectroscopy, mri subtraction imaging, and amino acid radiotracer imaging-can now incorporate novel physiologic data, providing new methods to help characterize tumour progression, pseudoprogression, and pseudoresponse. In the present review, we provide an overview of current treatment options for hgg and summarize recent advances and challenges in imaging technology.

Socioeconomic position during childhood and physical activity during adulthood: a systematic review.

OBJECTIVES: A growing body of evidence links socioeconomic position early in life and physical activity during adulthood. This systematic review aimed to summarize this evidence. METHODS: Medline and EMBASE were searched for studies that assessed socioeconomic position before age 18 years and physical activity at age ≥18 years. Studies were rated according to three key methodological quality criteria: (1) was childhood socioeconomic position assessed prospectively? (2) Was socioeconomic position during adulthood included in the statistical analysis? (3) Was a validated instrument used to measure of physical activity? RESULTS: Forty-two publications were included. Twenty-six (61.9 %) found a significant association between socioeconomic position early in life and physical activity during adulthood. Twenty-one studies met at least two methodological quality criteria. Among those, the proportion was higher: 15/21 (71.4 %). Associations were of weak to moderate strength, positive for physical activity during leisure time, and negative for transports and work. CONCLUSIONS: The bulk of the evidence supports the notion that there is a life course association between socioeconomic position early in life and physical activity during adulthood. Studies using more rigorous methodology supported this conclusion more consistently.

Palatable high-energy diet decreases the expression of cannabinoid type 1 receptor messenger RNA in specific brain regions in the rat.

In laboratory rodents, a palatable high-energy diet (PHED) is usually consumed in a higher quantity than a standard laboratory diet, leading to the development of an obese phenotype. The central effects of PHED are not fully understood. Nonetheless, the long-term consumption of PHED can decrease cannabinoid type 1 receptor (CB1R) protein density in particular brain regions. However, little is known about the diet-dependent regulation of the brain expression of CB1R mRNA. The present study aimed to investigate the effects of the long-term consumption of PHED and short-term (12 h) food deprivation on the brain expression of CB1R mRNA. For 13 weeks, rats were fed a standard laboratory chow or PHED presented as a free choice of chow, shortcake biscuits and pork spread. In total, the food intake of PHED rats was higher than that of chow-fed animals. Expectedly, PHED rats demonstrated higher body weight than chow-fed animals. The difference in body weight between PHED- and chow-fed rats was as result of the fat but not the lean mass. PHED-fed rats had significantly higher plasma levels of leptin and insulin and significantly higher levels of expression of suppressor of cytokine signalling 3 (SOCS-3) in the arcuate hypothalamic nucleus. The long-term consumption of PHED significantly decreased the levels of CB1R mRNA expression in the cingulate (Cg) cortex, ventromedial hypothalamic nucleus and the descending/autonomic divisions of the parvocellular hypothalamic nucleus (PVH), the ventrolateral parvocellular PVH and, to a lesser extent, the dorsomedial parvocellular PVH. Acute food deprivation decreased the levels of CB1R transcript in the Cg and ventrolateral parvocellular PVH. Altogether, the present results demonstrate that long-term PHED leads to an increase in the hypothalamic expression of SOCS-3 mRNA and a decrease in expression of CB1R mRNA in the Cg cortex and specific hypothalamic regions.

Troglitazone reduces leptinemia during experimental dexamethasone-induced stress.

BACKGROUND AND AIMS: Recently, we found that profound anorexia observed in a catabolic model induced by chronic glucocorticoid (dexamethasone, Dex) injection could be associated with strong hyperleptinemia. To investigate the implication of leptin in this catabolic stress response, we used a model whereby leptin secretion was inhibited using troglitazone (Trg) concomitantly with a Dex-induced-stress injection. METHODS: Adult rats (3 months, n=12) were stressed with a Dex injection (1.5 mg/kg/day ip, 5 days) and either treated (DXTG+, n=6) or not (DXTG-, n=6) with Trg (60 mg/kg/day sc, 5 days). These DXTG+ and DXTG- groups were compared with an untreated ad libitum group and a pair-fed group receiving saline ip instead of the Dex injection. The effects of troglitazone treatment on leptin gene expression in adipose tissue, blood glucose, insulin, and on hepatic parameters under stress conditions were determined. RESULTS: Trg treatment specifically diminished leptinemia (30%, DXTG+ vs DXTG-, p<0.05). Insulinemia and glycemia remained unchanged, as did leptin gene expression; food intake improved, but hepatic capacities did not show any alteration. CONCLUSION: Trg is a useful agent in exploring certain potential effects of leptin on metabolic and immune disorders occurring during aggression.

Leptin regulates functional capacities of polymorphonuclear neutrophils.

Recent studies report that leptin may be able to modulate some functions of cells involved in non-specific immune response. We recently found that a functional leptin receptor is present on polymorphonuclear neutrophils (PMNs) and may be able to influence their oxidative capacities. We demonstrate here for the first time that leptin is also able to stimulate chemotaxis of PMNs and exerts by itself a chemoattractive effect comparable to that of well-known formyl-methionyl-leucyl-phenylalanine, and a stimulating effect on intracellular hydrogen peroxide production, without modification of phagocytosis.

Leptin: a potential regulator of polymorphonuclear neutrophil bactericidal action?

It is well known that leptin, the ob gene product, is involved in the regulation of food intake and thermogenesis. Recent studies also demonstrate that leptin may be able to modulate functions of cells involved in nonspecific immune response such as phagocytosis and secretion of cytokines by macrophages. This and the prominent implication of polymorphonuclear neutrophils (PMNs) in infectious response suggested a possible role of leptin as a modulator of PMN functions. We detected a leptin receptor on the PMN membrane by immunocytochemistry with an anti-leptin receptor. Using chemiluminescence we then demonstrated that leptin enhances oxidative species production by stimulated PMNs. These results show for the first time that a functional leptin receptor is present on PMNs and that leptin may be able to influence their oxidative capacity.

Optical bandpass filter from a curved segment of a detuned two-core fiber.

We present the use of a dual-core fiber as a bandpass filter. Our device is based on the fact that intrinsic detuning between the propagation constants of the two cores can be compensated for in a controlled manner by use of a loop. This compensation is made to occur for a specific frequency band, so that the resulting device acts as a bandpass filter.