Contribution of edema and cerebral blood volume to traumatic brain swelling in head-injured patients

OBJECT: The pathogenesis of traumatic brain swelling remains unclear. The generally held view is that brain swelling is caused primarily by vascular engorgement and that edema plays a relatively minor role in the swelling process. The goal of this study was to examine the roles of cerebral blood volume (CBV) and edema in traumatic brain swelling. METHODS: Both brain-tissue water and CBV were measured in 76 head-injured patients, and the relative contribution of edema and blood to total brain swelling was determined. Comparable measures of brain-tissue water were obtained in 30 healthy volunteers and CBV in seven volunteers. Brain edema was measured using magnetic resonance imaging, implementing a new technique for accurate measurement of total tissue water. Measurements of CBV in a subgroup of 31 head-injured patients were based on consecutive measures of cerebral blood flow (CBF) obtained using stable xenon and calculation of mean transit time by dynamic computerized tomography scanning after a rapid bolus injection of iodinated contrast material. The mean (+/- standard deviation) percentage of swelling due to water was 9.37+/-8.7%, whereas that due to blood was -0.8+/-1.32%. CONCLUSIONS: The results of this study showed that brain edema is the major fluid component contributing to traumatic brain swelling. Moreover, CBV is reduced in proportion to CBF reduction following severe brain injury.     

Reduction of oocyte lipid droplets and meiotic failure due to biotin deficiency was not rescued by restoring the biotin nutritional status

BACKGROUND/OBJECTIVESOocyte lipid droplets play a crucial role in meiosis and embryo development. Biotin is associated with fatty acid synthesis and is the coenzyme for acetyl-CoA carboxylase (ACC). The effects of a biotin deficiency on the oocyte lipid metabolism remain unknown. This study examined the effects of a biotin deficiency and its replenishment on murine 1) oocyte lipid droplet levels, 2) ovary lipid metabolism, and 3) oocyte meiosis.MATERIALS/METHODSMice were divided into 3 groups: control, biotin deficient (BD), and recovery groups. The control and BD groups were fed a control diet or BD diet (0.004 or 0 g biotin/kg), respectively. The recovery group mice were fed a BD diet until day 21, and were then fed the control diet from days 22 to 64. This study then quantified the oocyte lipid droplet levels, assessed the oocyte mitochondrial function, and examined the ability of oocytes to undergo meiosis. Ovarian phosphorylated ACC (p-ACC), lipogenesis, β-oxidation, and ATP production-related genes were evaluated.RESULTSThe BD group showed a decrease in lipid droplets and mitochondrial membrane potential and increased p-ACC levels. In the recovery group, the hepatic biotin concentration, ovarian p-ACC levels, and mitochondrial membrane potential were restored to the control group levels. On the other hand, the quantity of lipid droplets in the recovery group was not restored to the control levels. Furthermore, the percentage of oocytes with meiotic abnormalities was higher in the recovery group than in the control group.CONCLUSIONSA biotin deficiency reduced the oocyte lipid droplet levels by downregulating lipogenesis. The decreased lipid droplets and increased oocyte meiosis failure were not fully restored, even though the biotin nutrition status and gene expression of lipid metabolism was resumed. These results suggest that a biotin deficiency remains robust and can be long-lasting. Biotin might play a crucial role in maintaining the oocyte quality.     

Inhibition of autophagy by chloroquine makes chemotherapy in nasopharyngeal carcinoma more efficient

Objectives

A combination of platinum-based chemotherapy and radiotherapy is the standard treatment for nasopharyngeal carcinoma (NPC). However, the efficacy of chemotherapy has reached a plateau. Many autophagy studies suggest that autophagy can either promote or suppress to cancer progression. Thus, a role of autophagy in the acquisition of chemoradioresistance has recently been a notable event. Therefore, we examined the relationship between autophagy and chemotherapy in NPC.

Torsion of the normal ovary and oviduct in a pre-pubertal girl

We encountered a 10-year-old prepubertal girl with a normal ovary and oviduct torsion. Hemorrhagic infarction of the ovary and oviduct occurred, and these structures were laparoscopically removed. Torsion of the normal ovary and oviduct in a prepubertal girl is discussed.     

Dissolution of Lead Pellets in Saliva: A Source of Lead Exposure in Children

Lead is a nonessential element, being a toxic metal that can adversely affect humans exposed to it, even at low levels of exposure. Indeed, children have been especially susceptible to lead toxicity with numerous epidemiological studies reporting neurocognitive functions to be inversely correlated with lead levels (blood or tooth-lead levels), even when confounding variables were controlled. Further, evidence is accumulating supporting the suggestion that there may be no threshold to the detrimental effects of lead. Thus, exposure to sources of lead should be kept to a minimum, especially for children (United States Centers for Disease Control [USCDC] 1991; Bellinger 1997).

In the past, lead was ubiquitous in the environment; however, over the last three decades a concerted effort has been made to decrease or eliminate sources of environmental lead. In North America, the virtual elimination of unleaded gasoline, the use of lead-free solder in the canning industry and mechanical trades, and the decrease in lead content of new paint have all contributed to the decrease in environmental lead. Although the USCDC has identified paint with a high lead content used in housing units prior to 1950, as the major source (reservoir) of lead for children (USCDC 1991), other sources of lead exposure must be considered.

In the western James Bay region of northern Ontario (Mushkegowuk Territory), Canada, elevated lead levels have been reported for adults (Tsuji et al. 1997), children (Ontario Ministries of Health and the Environment [OMHE] 1989; Ontario Ministry of Health [OMH] 1993), and newborns (Hanning et al. 1997). These findings were surprising because the Mushkegowuk Territory is a remote area, where water and soil-lead levels have been found to be very low, and air-lead levels well under the established safety guidelines (OMHE 1989). The source of lead exposure in this region appears to be related to the use of leaded ammunition in the harvesting of wild game (Tsuji and Nieboer 1997). Several studies have shown that any animal harvested with leaded ammunition risks being contaminated with lead pellets and/or fragments, to the extent where the meat was not fit for human consumption (Scheuhammer et al. 1998; Tsuji et al. 1999). Further, two recent studies in northern Quebec, Canada, have found supporting evidence for the hypothesis relating elevated lead levels in humans to the use of leaded ammunition in the harvesting of wild game. Sex-adjusted data for First Nation Cree revealed elevation in blood-lead levels, compared to baseline data, two months after the goose harvest (Kosatsky 1998). Moreover, in a study by Levesque et al. (1998) leaded ammunition was reported as the source of lead for Inuit newborns, as determined by the stable isotope ratio technique. Even though these studies are suggestive that the use of leaded ammunition is a significant source of lead exposure, other sources of lead exposure must be considered.

Considering other sources of lead exposure for children of the Mushkegowuk Territory is important, because observations and discussions with First Nation children and their parents revealed that it is common practice to place lead pellets in the mouth as a place of temporary storage prior to discharge in air-pellet guns. We hypothesized that dissolution of pellets in saliva could be a significant source of lead exposure. Boxes of Copperhead® pellets (abrand commonly used in this region) have the following warning clearly displayed: “Warning: Lead pellets. Do not inhale pellet dust or put pellets in mouth. Wash hands after handling. Lead is a toxic substance listed under CA. Prop 65 as causing reproductive toxicity.” A literature search revealed several articles concerning the risk of lead poisoning from the accidental (Greensher et al. 1974) or intentional (Hitchings and Sloan 1914) swallowing of lead pellets, but none regarding oral exposure through the above-mentioned practice. In this paper, we measured the degree of lead dissolution in saliva samples obtained from children in the James Bay area, as well as the prevalence of the behaviour of storing lead pellets in the mouth, prior to discharge in air-pellet guns.

     

An economic evaluation of Japanese telemedicine, focusing on teleradiology and telepathology

We collected information by postal survey from 622 medical institutions reported to be using telemedicine in Japan. The questionnaire asked about willingness to pay (WTP) for telemedicine and willingness to undertake (WTU) it. The Kernel Estimation Method was used to obtain WTP for teleradiology (4379 yen), telepathology (9526 yen), teleconferencing (2084 yen) and teleconsultation (633 yen). The estimated WTU were teleradiology (3875 yen), telepathology (17,918 yen), teleconferencing (3230 yen) and teleconsultation (3643 yen). These values are larger than the current charges that customers actually pay or providers receive. Multiplying these values by the number of medical institutions that had implemented telemedicine allows the total annual benefits of telemedicine to be estimated, e.g. for teleradiology, the annual benefit in terms of WTP and WTU (millions of yen per year) were 140.20 and 1101.75, respectively. Based on the results of the survey, specific policy measures to promote telemedicine further include improvement of quality and reimbursement.     

Endoscopic Treatment of Superficial Gastric Cancer: Present Status and Future

Although the mortality rates of gastric cancer (GC) are gradually declining, gastric cancer is still the fourth leading cause of cancer-related death worldwide. This may be due to the high rate of patients who are diagnosed with GC at advanced stages. However, in countries such as Japan with endoscopic screening systems, more than half of GCs are discovered at an early stage, enabling endoscopic resection (ER). Especially after the introduction of endoscopic submucosal dissection (ESD) in Japan around 2000, a high en bloc resection rate allowing pathological assessment of margin and depth has become possible. While ER is a diagnostic method of treatment and may not always be curative, it is widely accepted as standard treatment because it is less invasive than surgery and can provide an accurate diagnosis for deciding whether additional surgery is necessary. The curability of ER is currently assessed by the completeness of primary tumor removal and the possibility of lymph node metastasis. This review introduces methods, indications, and curability criteria for ER of EGC. Despite recent advances, several problems remain unsolved. This review will also outline the latest evidence concerning future issues.     

Vertebral derotation in adolescent idiopathic scoliosis causes hypokyphosis of the thoracic spine

The underlying purpose of this commentary and position paper is to achieve evidence-based recommendations on prevention of work-related musculoskeletal disorders (MSDs). Such prevention can take different forms (primary, secondary and tertiary), occur at different levels (i.e. in a clinical setting, at the workplace, at national level) and involve several types of activities. Members of the Scientific Committee (SC) on MSDs of the International Commission on Occupational Health (ICOH) and other interested scientists and members of the public recently discussed the scientific and clinical future of prevention of (work-related) MSDs during five round-table sessions at two ICOH conferences (in Cape Town, South Africa, in 2009, and in Angers, France, in 2010). Approximately 50 researchers participated in each of the sessions. More specifically, the sessions aimed to discuss new developments since 1996 in measures and classification systems used both in research and in practice, and agree on future needs in the field. The discussion focused on three questions: At what degree of severity does musculoskeletal ill health, and do health problems related to MSDs, in an individual worker or in a group of workers justify preventive action in occupational health? What reliable and valid instruments do we have in research to distinguish ??normal musculoskeletal symptoms?? from ??serious musculoskeletal symptoms?? in workers? What measures or classification system of musculoskeletal health will we need in the near future to address musculoskeletal health and related work ability? Four new, agreed-upon statements were extrapolated from the discussions: 1. Musculoskeletal discomfort that is at risk of worsening with work activities, and that affects work ability or quality of life, needs to be identified. 2. We need to know our options of actions before identifying workers at risk (providing evidence-based medicine and applying the principle of best practice). 3. Classification systems and measures must include aspects such as the severity, frequency, and intensity of pain, as well as measures of impairment of functioning, which can help in prevention, treatment and prognosis. 4. We need to be aware of economic and/or socio-cultural consequences of classification systems and measures.