Novel role for RGS1 in melanoma progression

RGS1 (regulator of G protein signaling 1) encodes a member of the regulator of G protein family. Recently, RGS1 was found to be overexpressed in gene expression-profiling studies of melanoma. However, no analyses have been reported of its expression at the protein level in melanoma. In this study, the potential impact of RGS1 as a molecular prognostic marker for melanoma was assessed using immunohistochemical analysis of a melanoma tissue microarray containing primary cutaneous melanomas from 301 patients. High RGS1 expression was significantly correlated with increased tumor thickness (P=0.0083), mitotic rate (P=0.04), and presence of vascular involvement (P<0.02). Kaplan-Meier analysis demonstrated a significant association between increasing RGS1 expression and reduced relapse-free survival (P=0.0032) as well as disease-specific survival (DSS) (P=0.018) survival. Logistic regression analysis showed RGS1 overexpression to be significantly correlated to sentinel lymph node metastasis (P=0.04). Multivariate Cox regression analysis showed that increasing RGS1 immunostaining had an independent impact on the relapse-free survival (P=0.0069) and DSS (P=0.0077) of this melanoma cohort. In the analysis of DSS, RGS1 expression level was the most powerful factor predicting DSS. RGS1 immunostaining retained independent prognostic impact even when sentinel lymph node status was included in the prognostic model (P=0.0039). These results validate the role of RGS1 as a novel prognostic marker for melanoma given its impact on the survival associated with melanoma.     

Dose-independent occurrence of seizure with tramadol

Introduction

Tramadol, as a centrally-acting, opioid-like analgesic with serotonin reuptake inhibition property, is one of the most prescribed analgesics in the world. We assessed the incidence of seizure, as it is one of the most important adverse effects.

Methods

In a cross-sectional study, 215 cases of tramadol users or abusers who were admitted to Loghman-Hakim Hospital Poisoning Center (LHHPC) in Tehran during a 5-month period, from April 2007 to September 2007, were assessed to evaluate the occurrence of seizure. Patients with positive history of co-ingestion of other drugs, addiction, convulsive disorders, renal diseases, or head trauma with abnormal electroencephalography (EEG) or computerized tomography (CT) scan of the brain were excluded, thus 132 patients were included in the study. For patients who had seizure, CT scan of the brain and EEG were performed, and frequency and type of seizure were identified. Mean tramadol dose was compared between patients with and without seizure.

Results

Among the patients, 97 (73.5%) were male. Seizure occurred in 61 patients (46.2%) within 24 hours after tramadol ingestion. The majority of patients who had seizure were male (male, 83.6% vs. female, 16.4%). Mean tramadol dose was lower among females than males (males, 2413 mg vs. females, 1706 mg), but the difference was not statistically significant. Of 35 patients with documented seizure type, all showed generalized tonic-clonic seizure and 12 patients had abnormal EEG (35.3%). No statistically significant difference was observed in mean tramadol intake between patients with or without seizure. Analysis of patients with seizure, according to tramadol intake, indicated that most patients used tramadol in the dose range of 500–1000 mg followed in occurrence by 1500–2000 mg, then 100–500 mg, 2500–3000 mg, and 3500–4000 mg.

Conclusions

Mean tramadol intake does not differ between patients with and without seizure, and the most common dose range in those with seizure is 500–1000 mg. We thus conclude that the incidence of seizure with tramadol is not dose dependent.     

Response of salivary peroxidase to exercise intensity

Oral peroxidase, one of the most important salivary antioxidant enzymes, is subjected to alternation due to various body conditions. The aim of this study was to assess the effect of exercise intensity on salivary peroxidase activity. Using a randomized design, ten healthy male university students (mean age, 23.22; s _x = 2.34 years) completed treadmill runs with initial velocity 6.73 km/h at the rate of 1.58 km/h increase every 3 min until exhaustion. Unstimulated whole saliva collected over a 5-min period in pre-weighed tubes before, immediately after exercise, and 1 h after exercise was analyzed for total protein and saliva peroxidase activity. The saliva flow rate ranged from 0.08 to 1.40 ml min⁻¹ at rest and was not significantly affected by the exercise. Peroxidase activity in each sample was measured using 4-amino antipyrine as substrate. In the incremental exhaustion run and also at 75% VO_2max, the secretion rates of peroxidase increased. No significant changes in saliva flow rate were observed in any treadmill run. Treadmill runs at 75% VO_2max and to exhaustion increased the activity of peroxidase immediately after exercise which decreased after 1 h. It was concluded that short-duration, high-intensity exercise increases the activity rate of peroxidase despite no change in the saliva flow rate. These effects appear to be associated with changes in sympathetic activity and not the hypothalamic pituitary adrenal axis.     

The Potential Role of Combined Highly Sensitive Troponin and Coronary Computed Tomography Angiography in the Evaluation of Patients with Suspected Acute Coronary Syndrome in the Emergency Department

The evaluation and triage of patients presenting to the emergency department (ED) with suspected acute coronary syndrome (ACS) remains to be challenging despite available guidelines and clinical evidence. The current guidelines in the USA recommend clinical risk assessment based on cardiovascular risk factors followed by serial electrocardiograms and conventional cardiac troponin measurements, which are supplemented by advanced non-invasive cardiac testing in the majority of patients. This approach is safe, but leads to a lengthy work-up and high cost of care. There is clinical need for diagnostic strategies that will lead to rapid and reliable triage of patients with suspected ACS. In this review, we will summarize the experience and evidence for the use of highly sensitive troponin (hsTn) in the rapid and efficient evaluation of patients with suspected ACS. We will also review the available literature on the use of coronary computed tomography angiography (CTA) in the rapid evaluation of patients with suspected ACS. We will discuss the opportunities for the combined use of hsTn and coronary CTA in this population. Finally, we will outline the possible implementation of combined use of hsTn and coronary CTA in the evaluation of patients with suspected ACS in the ED.     

A Comparative Study of the Effect of Prednisolone and Celecoxib on MMO (Maximum Mouth Opening) and Pain Following Removal of Impacted Mandibular Third Molars

Objective

The purpose of this study was to compare the effects of prednisolone and celecoxib on pain and maximum mouth opening (MMO) after surgical removal of mandibular third molars.

Methods and Materials

This double-blind clinical study was conducted upon 60 subjects. These patients received 4 tablets of either 100 mg celecocxib or 5 mg prednisolone: one tablet before surgery and the rest for every 8 h post-operation. The subjects were asked to take acetaminophen codeine as rescue dose. Interincisal distance of upper and lower central teeth and pain measurements (according to Visual Analogue Scale) were taken before surgery, 24 h, 48 h and 7 days after surgery.

Results

Average pain intensity in 24 h after surgery in patients receiving celecoxib was 3.6 ± 2.5 with significant difference to the other group (p = 0.041), but in subsequent evaluations prednisolone group reported less pain intensity, but the differences were not significant. MMO in 48 h after surgery was lower in prednisolone group (p = 0.640) and in further evaluations the groups were almost similar. Analyzing the data revealed no significant difference between groups in MMO.

Conclusion

According to this study there is no significant difference in the effects of prednisolone or celecoxib upon MMO, while celecoxib had better results for pain relief in 24 h after surgery in comparison to prednisolone.     

Correction to: Risk factors associated with intensive care unit (ICU) admission and in-hospital death among adults hospitalized with COVID-19: a two-center retrospective observational study in tertiary care hospitals

Emergency Radiology - A correction to this paper has been published: https://doi.org/10.1007/s10140-021-01943-0     

NF-kappa B in the vascular progression of melanoma.

PURPOSE: To examine a model of melanoma progression based on vascular factors and the role of NF-kappa B in the vascular progression of melanoma. PATIENTS AND METHODS: A data set of 526 patients from the University of California San Francisco Melanoma Center with 2 years of follow-up or first relapse was studied. The impact of the presence or absence of various prognostic factors on overall survival of melanoma patients was assessed using Cox regression and Kaplan-Meier analysis. A matched-pair analysis of NF-kappa B expression was performed in cases with vascular involvement and increased tumor vascularity versus matched controls lacking these factors. RESULTS: Cox regression analysis of factors evaluated by the American Joint Committee on Cancer Melanoma Staging Committee reproduced the powerful impact of tumor thickness and ulceration in this data set. With the inclusion of vascular factors such as tumor vascularity and vascular involvement, ulceration was no longer significant in predicting overall survival. By multivariate analysis, vascular involvement and tumor vascularity were the strongest predictors of melanoma outcome. Tumor vascularity seems to be a precursor of both vascular involvement and ulceration. A matched-pair tissue array analysis demonstrated the significant correlation between overexpression of NF-kappa B-p65 and the development of vascular factors. CONCLUSION: Vascular factors play an important role in the progression of malignant melanoma. Ulceration may be a surrogate marker for the interactions between melanoma and the tumor vasculature. NF-kappa B seems to play an important role in the development of these factors.