Number of erythrocyte transfusions is more predictive than serum ferritin in estimation of cardiac iron loading in pediatric patients with acute lymphoblastic leukemia

Background

Transfusions with packed erythrocytes is a common practice in pediatric patients with acute lymphoblastic leukemia (ALL) who are on chemotherapy. Since there is no physiological excretion mechanism for iron, the iron related to erythrocyte transfusions accumulates and may contribute to late cardiac, hepatic and endocrine complications in these patients.

Procedure

In order to evaluate the iron burden among pediatric patients with ALL and define the risk factors associated with higher iron loading, we evaluated 79 pediatric patients with ALL (36 were off-therapy). Cardiac and hepatic T2* were ordered to a total of 22 (28%) patients who were either transfused with erythrocytes ≥10 times (n = 11; 50%), had serum ferritin (SF) ≥1000 ng/ml (n = 2; 9.1%) or both (n = 9; 40.9%).

Results

Half of the patients who were screened by T2* MRI had hepatic T2* < 7 ms and six (27%) of the patients had cardiac T2* < 20 ms, indicating iron loading. Patients who had serum ferritin <1000 vs ≥1000 ng/ml had median cardiac T2* values of 28.3 ms (15–40) vs 21 (7.9–36), (p = 0.324); whereas hepatic T2* of 10.8 (5.32–27) vs 4.7 (2.2–36), (p = 0.017). Patients who had erythrocyte transfusion <10 vs ≥10 times had median cardiac T2* values of 34 ms (28–38) vs 23 (7.93–40), (p = 0.021); whereas hepatic T2* of 13.6 (6.6–36) vs 5.32 (2.2–27), (p = 0.046).

Conclusions

Our results indicate that pediatric patients with ALL should be screened for transfusional iron load and the amount of erythrocyte transfusions seems to be a more reliable indication than serum ferritin levels to detect cardiac iron loading in these patients.     

Fatal cranial shot by blank cartridge gun: Two suicide cases

Blank firing pistols are generally considered to be harmless and these guns are not accepted as being firearms in most countries. Due to lack of legal regulations these guns are easily purchased by anyone aged over 18 years. Reports of serious injuries and even fatalities due to these guns are increasing in the literature.These guns when modified or even unmodified can cause serious and potentially fatal injuries. Without doing any changes to the barrel, using blank or tear gas cartridges, firing at contact range can cause penetration of gas into the body including bone originated from gunpowder.We report two suicide cases shooting themselves at temporal region with a blank cartridge gun at contact range. There was no foreign body on radiological examination and there was no trajectory of a bullet inside the brain. In both cases the wound was at the right temporal region and there was defect at temporal bone. There was circular soot around this bone defect. The injury of the brain tissue was localized at the level of the defect but there was widespread subarachnoidal bleeding.We discussed the potential danger of these guns and stressed the need of legal regulations concerning these guns.     

Further delineation of interstitial chromosome 6 deletion syndrome and review of the literature

Interstitial deletions of chromosome 6q are a relatively rare finding. Deletions have ranged from the loss of a single band to larger deletions spanning multiple bands. The clinical phenotype varies, but some features commonly seen include cardiac anomalies, hypotonia, facial dysmorphism and mental retardation. To further delineate the syndrome, we report an infant with facial dysmorphism, ectrodactyly and tetralogy of Fallot owing to interstitial deletion 6q16.1-6q22.32. On array comparative genomic hybridization analysis, the deletion spanned from the 93 377 323rd base to the 127 650 582nd base on chromosome 6 [coordinates are based on Human Mar. 2006 (hg18) assembly of International Human Genome Sequencing Consortium]. A literature review identified 16 additional cases with overlapping interstitial deletions of chromosome 6q between q13 and q23.1. Genotype-phenotype correlations are considered.     

Expression of periostin according to endometrial cancer grade

While various molecular profiling methods have been described for the early diagnosis and prognostic process of endometrial cancer, the most common gynaecological cancer, the data obtained remain insufficient. The present study aimed to investigate the protein and gene expression of periostin and its role as a new biomarker in the diagnosis, treatment and prognosis of endometrial cancer. A total of 15 patients diagnosed with endometrial cancer at the Department of Pathology, Zeynep Kamil Training and Research Hospital (Istanbul, Turkey) and 15 patients who were operated on for non-tumour-related reasons, between December 2019 and May 2020, were included in the study. The cases diagnosed with endometrial cancer were divided into three groups: International Federation of Gynaecology and Obstetrics grades I, II and III. Pathology tumour blocks were selected for enzyme-linked immunosorbent assay and PCR studies in which periostin gene expression and protein levels were measured, respectively. A significant increase in periostin gene expression was observed in the endometrial cancer samples compared with that in the controls (3.40±0.66 vs. 2.23±0.47). The protein level of periostin in the tissues was found to be higher in the endometrial cancer samples than that in the control group (1.59±0.31 vs. 0.94±0.22). The levels of periostin protein and gene expression detected in the endometrial cancer samples increased as the grade increased. To the best of our knowledge, the current study is the first to determine the levels of periostin protein and gene expression in endometrial cancer. The results suggested that periostin may be used as a biomarker in the determination of higher histological grade in endometrial cancer.     

Functional Characterization of Nonadrenergic Noncholinergic Neurotransmitter Release via Endocannabinoids: An in Vitro Study in Rabbit Corpus Cavernosum

IntroductionCorporal smooth muscle relaxation is mediated mainly but not completely by nitric oxide. Endocannabinoids modulate the various neurotransmitter systems.AimIn the present study, a possible role of endocannabinoids on non-nitrergic nonadrenergic noncholinergic (NANC)-mediated relaxations was investigated.MethodsIn precontracted tissues, control electrical field stimulation (EFS)-induced NANC relaxation responses were obtained using varying frequencies of stimulation in the presence of L-arginine methyl ester (L-NAME), guanethidine, and atropine. To investigate the effects of cannabinoids on EFS-evoked non-nitrergic NANC relaxation responses, a similar experimental procedure was applied in the presence of cannabinoid receptor antagonists AM251 or AM630; vanilloid receptor antagonist capsazepine; or cannabinoid receptor agonists anandamide, arachidonyl-2-chloroethylamide (ACEA), or JHW015.Main Outcome MeasuresEffects of cannabinoid receptor antagonists and agonists on EFS-evoked non-nitrergic NANC relaxation responses.ResultsL-NAME abolished EFS-induced relaxation responses at lower frequencies (2–4 Hz) and inhibited the relaxation responses at higher frequencies (8–32 Hz). AM251 and AM630 either together or separately inhibited, whereas anandamide, ACEA, and JHW015 enhanced non-nitrergic NANC relaxation responses. Anandamide did not alter EFS-induced non-nitrergic NANC relaxations in the presence of AM251 and AM630. Capsazepine enhanced non-nitrergic NANC relaxation responses.ConclusionThese results suggest that non-nitrergic NANC relaxations may be mediated partially by cannabinoid-like neuronal factors acting at both cannabinoid CB₁ and cannabinoid CB₂ receptors. Vural IM, Ozturk GS, and Sarioglu Y. Functional characterization of nonadrenergic noncholinergic neurotransmitter release via endocannabinoids: An in vitro study in rabbit corpus cavernosum. J Sex Med 2009;6:717–729.     

Ehrlichia (Cytoecetes) phagocytophila predisposes to severe contagious ecthyma (Orf ) in lambs.

Eight lambs experimentally infected with Ehrlichia (Cytoecetes) phagocytophila 7 days before exposure to orf virus were compared with control lambs infected with orf virus alone. The dually infected animals differed from the controls in showing skin lesions of greater severity, prolonged viral shedding, and lower antibody titres. Infection with E. phagocytophila had no significant effect on virus-specific lymphocyte proliferation. Such proliferation was detected in the peripheral blood of all lambs as early as 7 days after exposure to orf virus.     

Giant pedunculated liposarcoma of the esophagus

European Surgery - Liposarcoma is a&nbsp;common soft tissue neoplasm but its presence within the gastrointestinal system, especially the esophagus, is quite rare. It usually presents as an...     

Virtual morphometric method using seven cervical vertebrae for sex estimation on the Turkish population

International Journal of Legal Medicine - Sex estimation from skeletal remains is crucial for the estimation of the biological profile of an individual. Although the most commonly used bones for...     

The impact of lipid accumulation product (LAP) and visceral adiposity index (VAI) on clinical,hormonal and metabolic parameters in lean women with polycystic ovary syndrome

This study was performed to assess the impact of lipid accumulation product (LAP) and visceral adiposity index (VAI) on clinical, hormonal, and metabolic parameters in lean women with PCOS. Retrospective analysis of 120 consecutive lean PCOS subjects was performed. Subjects were divided into two groups according to HOMA-IR, as IR?+?and IR?. A HOMA-IR value above 2.5 was used to indicate IR. Clinical, hormonal and metabolic parameters were compared between the two groups. Correlations between LAP and VAI and clinical, hormonal, metabolic features in women PCOS were analyzed. One hundred twenty lean PCOS subjects were enrolled, of which 39 were insulin resistant. Comparison of group means showed significantly higher values for TG levels, FAI, FGS, TG/HDL-c, TyG, LAP, and VAI indexes and lower values for glucose/insulin ratio and QUICKI in the IR?+?group. LAP and VAI were both found to be positively correlated with each other and with WC, FAI, FGS, TG, TC levels, lipid ratios, TyG index, and HOMA-IR and negatively correlated with Glucose/Insulin ratio, QUICKI, and HDL-c in lean women with PCOS. LAP and VAI may be promising in early identification of IR and cardiometabolic risk and may be useful for the assessment of hyperandrogenism in lean women with PCOS.