A unique case of tachycardia‐mediated cardiomyopathy in a patient misusing anabolic steroids

A 54‐year‐old male patient with history of anabolic androgenic steroid (AAS) misuse presented to the emergency department with new‐onset atrial fibrillation and severely reduced ejection fraction. Cardiac catheterization revealed normal coronaries. He underwent cryo‐balloon ablation with subsequent conversion to sinus rhythm. After appropriate guideline‐directed medical management, ejection fraction improved on follow‐up.     

Neural basis of single-word reading in Spanish-English bilinguals

Brain imaging studies have identified a left-lateralized network of regions that are engaged when monolinguals read. However, for individuals who are native speakers of two languages, it is unclear whether this pattern of activity is maintained across both languages or if it deviates according to language-specific properties. We used functional magnetic resonance imaging to investigate single-word processing in Spanish and in English in 12 proficient early Spanish-English bilinguals matched in skill level in both languages. Word processing in Spanish engaged the left inferior frontal and left middle temporal gyri. Word processing in English activated the left inferior frontal, middle frontal, and fusiform gyri extending to inferior temporal gyrus and the right middle temporal gyrus extending into superior temporal sulcus. The comparison of reading in Spanish greater than reading in English revealed involvement of the left middle temporal gyrus extending into the superior temporal sulcus. English greater than Spanish, however, demonstrated greater engagement of the left middle frontal gyrus extending into the superior frontal gyrus. We conclude that although word processing in either language activates classical areas associated with reading, there are language-specific differences, which can be attributed to the disparity in orthographic transparency. English, an orthographically deep language, may require greater engagement of the frontal regions for phonological coding, whereas Spanish allows increased access to semantic processing via the left middle temporal areas. Together, these results suggest that bilinguals will show adjustments to the typical neural representation of reading as necessitated by the demands of the orthography.     

Experimental gastrocystoplasty in rats: risk of developing ECLoma

ObjectiveThere are no clinical reports on the risk of carcinoids in the gastric segment following gastrocystoplasty. The aim of the present study was to examine whether gastric carcinoids could develop in a rat model of gastrocystoplasty.Materials and methodsRats were subjected to gastrocystoplasty in which 10% of the oxyntic part of the stomach was removed (i.e. 10% fundectomy), gastrocystoplasty with 90% fundectomy (known to induce hypergastrinemia), sham operation, or no operation, and were followed up for 6 months. Tissue specimens of bladder and stomach were analyzed by means of pathology and immunohistochemistry.ResultsAtrophy of gastric glands in the augmented bladders was found after gastrocystoplasty with either 10% or 90% fundectomy. Gastrocystoplasty with 90% fundectomy resulted in hyperplasia of the oxyntic mucosa, enterochromaffin-like (ECL) cell hyperplasia and ECLoma in the remnant stomach, and atrophy of the oxyntic mucosa and ECLoma in the gastric segment of the bladder.ConclusionsECLoma could develop in the gastric segment of the bladder after gastrocystoplasty, particularly in the setting of hypergastrinemia. The tumorigenesis of ECLoma seems to follow the same pathological pathway regardless of whether the oxyntic mucosa is located in the stomach or the bladder.     

The impact of Epstein-Barr virus status on clinical outcome in diffuse large B-cell lymphoma

To define prognostic impact of Epstein-Barr virus (EBV) infection in diffuse large B-cell lymphoma (DLBCL), we investigated EBV status in patients with DLBCL. In all, 380 slides from paraffin-embedded tissue were available for analysis by EBV-encoded RNA-1 (EBER) in situ hybridization, and 34 cases (9.0%) were identified as EBER-positive. EBER positivity was significantly associated with age greater than 60 years (P = .005), more advanced stage (P < .001), more than one extranodal involvement (P = .009), higher International Prognostic Index (IPI) risk group (P = .015), presence of B symptom (P = .004), and poorer outcome to initial treatment (P = .006). The EBER(+) patients with DLBCL demonstrated substantially poorer overall survival (EBER(+) vs EBER(-) 35.8 months [95% confidence interval (CI), 0-114.1 months] vs not reached, P = .026) and progression-free survival (EBER(+) vs EBER(-) 12.8 months [95% CI, 0-31.8 months] vs 35.8 months [95% CI, 0-114.1 months], respectively (P = .018). In nongerminal center B-cell-like subtype, EBER in situ hybridization positivity retained its statistical significance at the multivariate level (P = .045). Nongerminal center B-cell-like patients with DLBCL with EBER positivity showed substantially poorer overall survival with 2.9-fold (95% CI, 1.1-8.1) risk for death. Taken together, DLBCL patients with EBER in situ hybridization+ pursued more rapidly deteriorating clinical course with poorer treatment response, survival, and progression-free survival.     

Gastric Bypass Surgery Causes Body Weight Loss Without Reducing Food Intake in Rats

Background It is a common dogma that gastric bypass (GB) induces early satiety and consequent reductions in food intake and nutrient absorption. The aim of the present study was to analyze feeding behavioral and metabolic changes in rats after GB. Methods Male Sprague–Dawley rats at the ages of 23 and 42 weeks were placed in metabolic cages connected with a comprehensive laboratory animal monitoring system. At the age of 48 weeks they were subjected to either GB or sham operation, and then placed in metabolic cages at 51 and 62 weeks (or 3 and 14 weeks postoperatively). Results GB rats lost 20% of the body weight within 2–3 weeks and remained at this lower level until the end of the study at 14 weeks postoperatively. Satiety ratio was higher during daytime than nighttime in both sham-operated and GB rats, but was not significantly different between the two groups. Neither daily accumulated food intake nor food intake per 100 g of body weight was different between sham-operated and GB rats. Apparently, GB rats ate more frequently during daytime and had smaller meal size during nighttime at 3 weeks postoperatively. These changes were not present at 14 weeks postoperatively. Energy density in the feces was the same in GB and sham-operated rats postoperatively. Energy expenditure declined with age, but increased in GB rats compared with age-matched sham-operated rats. Conclusions GB reduced the body weight without causing early satiety, reducing food intake or inducing malabsorption. It did, however, increase energy expenditure.     

Isoniazid,Rifampin, and Pyrazinamide Plasma Concentrations in Relation to Treatment Response in Indonesian Pulmonary Tuberculosis Patients

Numerous studies have reported low concentrations of antituberculosis drugs in tuberculosis (TB) patients, but few studies have examined whether low drug concentrations affect TB treatment response. We examined steady-state plasma concentrations of isoniazid, rifampin, and pyrazinamide at 2 h after the administration of drugs (C_{2 h}) among 181 patients with pulmonary tuberculosis in Indonesia and related these to bacteriological response during treatment. C_{2 h} values below reference values for either isoniazid, rifampin, or pyrazinamide were found in 91% of patients; 60% had at least two low C_{2 h} concentrations. The isoniazid C_{2 h} was noticeably lower in fast versus slow acetylators (0.9 mg/liter versus 2.2 mg/liter, P < 0.001). At the end of treatment, 82% of the patients were cured, whereas 30 patients (17%) had dropped out during the study, and 2 patients (1%) failed treatment. No association was found between C_{2 h} concentrations and sputum culture results at 8 weeks of treatment. Post hoc analysis showed that patients with low pyrazinamide C_{2 h} (P = 0.01) and patients with large extensive lung lesions (P = 0.01) were at risk of at least one positive culture at week 4, 8, or 24/32. Antituberculosis drug concentrations were often low, but treatment response was nevertheless good. No association was found between drug concentrations and 8 weeks culture conversion, but low pyrazinamide drug concentrations may be associated with a less favorable bacteriological response. The use of higher doses of pyrazinamide may warrant further investigation.     

Female PAPP-A knockout mice are resistant to metabolic dysfunction induced by high-fat/high-sucrose feeding at middle age

Longevity and aging are influenced by common intracellular signals of the insulin/insulin-like growth factor (IGF)-1 pathway. Abnormally high levels of bioactive IGF-1 increase the development of various cancers and may contribute to metabolic diseases such as insulin resistance. Enhanced availability of IGF-1 is promoted by cleavage of IGF binding proteins (IGFBPs) by proteases, including the pregnancy-associated plasma protein-A (PAPPA). In vitro, PAPP-A is regulated by pro-inflammatory cytokines (PICs) such as interleukin (IL)-6 and tumor necrosis factor (TNF). Mice born with deficiency of the Papp-a gene (PAPP-A knockout (KO) mice) live ∼30–40 % longer than their normal littermates and have decreased bioactive IGF-1 on standard diets. Our objective was to elucidate how the effects of high-fat, high-sucrose diet (HFHS) promote obesity, induce metabolic dysfunction, and alter systemic cytokine expression in PAPP-A KO and normal mice. PAPP-A KO mice fed HFHS diet for 10 weeks were more glucose tolerant and had enhanced insulin sensitivity compared to normal mice fed HFHS diet. PAPP-A KO mice fed HFHS diet had lower levels of pro-inflammatory cytokines (IL-2, IL-6, and TNF-α) compared to normal mice fed the same diet. However, anti-inflammatory cytokine levels (IL-4 and adiponectin) were higher in PAPP-A KO mice fed HFHS diet compared to normal mice fed HFHS. Circulating PAPP-A levels were elevated in normal mice fed an HFHS diet compared to normal mice fed a standard, low-fat, low-sucrose (LFLS) diet. Indirect calorimetry showed, at 10 weeks of feeding HFHS diet, significantly increased oxygen consumption (VO₂) in PAPP-A KO mice fed HFHS diet compared to normal mice fed the same diet. Furthermore, respiratory quotient (RQ) was significantly lower in PAPP-A KO mice fed HFHS diet compared to normal (N) mice fed HFHS diet indicating PAPP-A KO mice fed HFHS diet are able to rely on fat as their primary source of energy more so than normal controls. We conclude that PAPP-A KO mice are resistant to the HFHS diet induction of metabolic dysfunction associated with higher levels of anti-inflammatory cytokines and a remarkably metabolic flexible phenotype and that some of the effects of HFHS diet in normal animals may be due to increased levels of PAPP-A.

Electronic supplementary material

The online version of this article (doi:10.1007/s11357-015-9765-1) contains supplementary material, which is available to authorized users.