Review old bone,new tricks

Despite the significant progress made over the past decade with combination of molecular profiling data and the development of new clinical strategies, our understanding of metastasis remains elusive. Bone metastasis is a complex process and a major cause of mortality in breast and prostate cancer patients, for which there is no effective treatment to-date. The current review summarizes the routes taken by the metastatic cells and the interactions between them and the bone microenvironment. We emphasize the role of the specified niches and cues that promote cellular adhesion, colonization, prolonged dormancy, and reactivation. Understanding these mechanisms will provide better insights for future studies and treatment strategies for bone metastatic conditions.

     

Effect of the characteristics of family physicians on their utilisation of laboratory tests

BACKGROUND: The use of laboratory tests by family physicians has increased in recent years. AIMS: To evaluate the relationship between family physicians' characteristics and the number and type of laboratory tests requested, taking into account chronic diseases. DESIGN OF STUDY: Retrospective, cross-sectional study. SETTING: One hundred and sixty-two physicians treating 230 123 patients in one district of a health management organisation in Israel. METHOD: Physicians' use of 16 common types of laboratory tests was assessed in relation to physicians' demographic, professional, and clinic characteristics. The utilisation rate over 1 year was divided into quintiles for each laboratory test, and each physician was given a global laboratory score (for each test the physician got a score from 1 (utilisation in the lower quintile) to 5 (higher quintile). The global score was the sum of scores of the individual tests. RESULTS: On logistic regression analysis, four background characteristics were associated with the global score for the utilisation of laboratory tests. The highest hazard ratios were for being a female doctor (3.2, 95% confidence interval [CI] = 1.5 to 6.5), working in an urban clinic (3.2, 95% CI = 1.1 to 9.8), and having a greater workload than doctors in rural clinics (1.4, 95% CI = 1.1 to 1.8). Being a graduate of a Western country or Israel had a negative association with the global score (0.4, 95% CI = 0.1 to 0.99). CONCLUSION: Female sex and working in a urban clinic were major factors in the use of laboratory tests in clinical practice. As more women enter the medical profession, an improved understanding of the sex differences in ordering medical tests is important.     

Widespread functional connectivity and fMRI fluctuations in human visual cortex in the absence of visual stimulation

To what extent does the visual system's activity fluctuate when no sensory stimulation is present? Here, we studied this issue by examining spontaneous fluctuations in BOLD signal in the human visual system, while subjects were placed in complete darkness. Our results reveal widespread slow fluctuations during such rest periods. In contrast to stimulus-driven activity, during darkness, functionally distinct object areas were fluctuating in unison. These fMRI fluctuations became rapidly spatially de-correlated (39% drop in correlation level, P < 0.008) during visual stimulation. Functional connectivity analysis revealed that the slow spontaneous fluctuations during rest had consistent and specific neuro-anatomical distribution which argued against purely hemodynamic noise sources. Control experiments ruled out eye closure, low luminance and mental imagery as the underlying sources of the spontaneous fluctuations. These results demonstrate that, when no stimulus is present, sensory systems manifest a robust level of slow organized fluctuation patterns.     

Parental occupational exposure and the risk of acute lymphoblastic leukemia in offspring in Israel

OBJECTIVE: Parental employment in occupations that have potential exposures to organic solvents or pesticides could be associated with the risk of childhood acute lymphoblastic leukemia (ALL) in their offspring. METHODS: We explored this hypothesis by studying the association with respect to exposure time windows. Our case-control study included 224 children, 112 diagnosed with ALL and 112 matched controls. RESULTS: A significantly higher odds ratio (OR) was found between childhood ALL and reported parental occupational exposures. Analysis of exposures of both parents by exposure time windows revealed significant OR during the preconception and postnatal periods separately. CONCLUSIONS: The results provide support to the association between parental occupational exposures and ALL in their children. These results should be interpreted cautiously because of the small numbers, biases characterizing case-control studies, and the use of hospital-based controls.     

Role of the R92Q TNFRSF1A mutation in patients with familial Mediterranean Fever

Objective

To define the frequency of the R92Q tumor necrosis factor receptor–associated periodic syndrome (TRAPS) mutation in patients with familial Mediterranean fever (FMF) and to study the role of this mutation in FMF.

Methods

Ninety‐two FMF patients and 250 controls were genotyped for the R92Q mutation. The frequency of R92Q was assessed among 5 groups of FMF patients.

Results

R92Q was found in 6% of the controls, with an especially high carrier rate among Moroccan Jews (8%). R92Q was found in 3 (3.2%) of the 92 FMF patients, 1 homozygous for the MEFV M694V mutation and 2 heterozygous for M694V. All 3 patients showed partial response to colchicine. R92Q was not found in patients unresponsive to colchicine, nor was it found in patients with amyloidosis or in patients with FMF‐like disease without MEFV mutations.

Conclusion

The frequency of the R92Q mutation in FMF patients is comparable with that of controls. Despite the fact that TRAPS and FMF share common biochemical pathways, we found no evidence for an interaction between these two genes.     

Crohn��s Disease: A Surgeon��s Perspective

Crohn’s disease (CD) is known for wide anatomic distribution, different presentations, life-threatening complications, and multiple modalities of management. Its multiple implications are still unaddressed. Since all the patients do not show a good response to medical modalities of treatment, a significant percentage of these patients are referred to the surgeon for the palliation of complications or for the ultimate curative treatment. Since most surgeons come across such patients only rarely, it is sometimes difficult for them to choose the appropriate procedure at the time of need. Moreover, the various surgical modalities available for the different presentations and complications of the disease have not been adequately discussed. The aim of this review is to offer insight and a detailed account of the management of CD from a surgical perspective. This review offers an overview of the various surgical options available, their utility in context, and an approach to various scenarios of complicated CD.