Three-month treatment with pioglitazone reduces circulating levels of S100A8/A9 (MRP8/14) complex, a biomarker of inflammation, without changes in body mass index, in type 2 diabetics with abdominal obesity

We measured circulating S100A8/A9 (MRP8/14) complex levels before and after 3-month treatment with pioglitazone in type 2 diabetic patients. The results showed that pioglitazone reduced circulating S100A8/A9 complex levels, without changing body mass index, in type 2 diabetic patients with abdominal obesity.     

Migraine and Tension-Type Headache Reduction Through Pericranial Muscular Suppression: A Preliminary Report

Migraine and tension-type headaches have always plagued mankind. In spite of all the research dollars spent trying to determine the etiologies of these headaches, the neurology community still has not established a known cause of migraine and tension type headaches. This paper describes a study that was conducted for the U.S. Food and Drug Administration in which the efficacy of the Nociceptive Trigeminal Inhibition Tension Suppression System was evaluated and proved safe and efficacious in the reduction of medically diagnosed migraine and tension-type headache.     

Medullary and Odontogenic Disease in the Painful Jaw: Clinicopathologic Review of 500 Consecutive Lesions

Jaw-deviation dystonia is characterized by the lateral shift of the mandible due to involuntary masticatory muscle contraction, causing difficulties in speech or mastication. We evaluated a patient with jaw-deviation dystonia by recording movement-related cortical potentials (MRCPs) and treated with muscle afferent block (MAB). MRCP associated with mandibular movements (mouth opening, closing, and left and right lateral movements) was recorded in the patient and ten age-matched healthy subjects. In the control subjects, the amplitude of Bereitschaftspotential (BP)/negative slope (NS') was significantly higher for left lateral movements than for the mouth closing. The cortical map of BP/NS' prior to mouth opening and closing showed symmetric distribution, whereas those of lateral movements showed a slight predominance in the ipsilateral hemisphere. The patient showed lower amplitude as compared with control subjects. The right lateral movement (homonymous task) showed task-specific markedly reduced potentials. After MAB by intramuscular injection of lidocaine and ethanol to the inferior head of the left lateral pterygoid muscle, the deviation abolished and severity in speech and mastication was significantly improved. This study suggests that jaw-deviation dystonia might have the same etiology as other focal dystonias.     

Skeletal effects of zoledronic acid in an animal model of chronic kidney disease

Summary

Bisphosphonates reduce skeletal loss and fracture risk, but their use has been limited in patients with chronic kidney disease. This study shows skeletal benefits of zoledronic acid in an animal model of chronic kidney disease.

Introduction

Bisphosphonates are routinely used to reduce fractures but limited data exists concerning their efficacy in non-dialysis chronic kidney disease. The goal of this study was to test the hypothesis that zoledronic acid produces similar skeletal effects in normal animals and those with kidney disease.

Methods

At 25 weeks of age, normal rats were treated with a single dose of saline vehicle or 100 μg/kg of zoledronic acid while animals with kidney disease (approximately 30 % of normal kidney function) were treated with vehicle, low dose (20 μg/kg), or high dose (100 μg/kg) zoledronic acid, or calcium gluconate (3 % in the drinking water). Skeletal properties were assessed 5 weeks later using micro-computed tomography, dynamic histomorphometry, and mechanical testing.

Results

Animals with kidney disease had significantly higher trabecular bone remodeling compared to normal animals. Zoledronic acid significantly suppressed remodeling in both normal and diseased animals yet the remodeling response to zoledronic acid was no different in normal and animals with kidney disease. Animals with kidney disease had significantly lower cortical bone biomechanical properties; these were partially normalized by treatment.

Conclusions

Based on these results, we conclude that zoledronic acid produces similar amounts of remodeling suppression in animals with high turnover kidney disease as it does in normal animals, and has positive effects on select biomechanical properties that are similar in normal animals and those with chronic kidney disease.     

Practice patterns in high-risk bariatric venous thromboembolism prophylaxis

Background

In the morbidly obese population that undergoes bariatric surgery, venous thromboembolism (VTE) is the leading cause of morbidity and mortality. Certain factors place a patient at higher risk for VTE. No consensus exists on VTE screening or prophylaxis for the high-risk patient. This report describes the results of a survey on VTE screening and prophylaxis patterns in high-risk bariatric surgery.

Methods

Members of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) were queried on factors that identified bariatric patients as high risk for VTE and on routine screening and prophylaxis practices. This included mechanical and chemical prophylaxis, duration of therapy, and use of inferior vena cava (IVC) filters.

Results

Of the 385 surgeons who responded to the survey, 81 % were bariatric surgeons, and the majority managed more than 50 cases annually. One or more of the following risk factors qualified patients as high risk: history of VTE, hypercoagulable status, body mass index (BMI) exceeding 55 kg/m², partial pressure of arterial oxygen (PaO₂) lower than 60 mmHg, and severe immobility. Preoperative screening of patients for VTE was practiced routinely by 56 % of the surgeons, and 92.4 % used preoperative chemoprophylaxis. The most common agent used preoperatively was heparin (48 %), and Lovenox was most commonly used postoperatively (49 %). Whereas 48 % of the patients discontinued chemoprophylaxis at discharge, 43 % continued chemoprophylaxis as outpatients, and 47 % routinely screened for VTE postoperatively. Use of IVC filters was routine for 28 % of the patients, who most commonly removed them after 1–3 months.

Conclusions

This study describes current practice patterns of VTE screening and prophylaxis in high-risk bariatric surgery. Nearly all surgeons agree on risk factors that qualify patients as high risk, but only half routinely screen patients preoperatively. Preoperative VTE chemoprophylaxis is used by nearly all surgeons, but the duration of therapy varies. Use of IVC filters is not routine, and postoperative screening was performed by less than half of the respondents. An understanding of current practice patterns yields insight into the rates of VTE and shows variability in the need for evidence-based prophylaxis and standardized screening.     

Pure Erythroid Leukemia Mimicking Ewing Sarcoma/Primitive Neuroectodermal Tumor in an Infant

Pure erythroid leukemia (PEL) is a rare type of acute myeloid leukemia (AML) with a very aggressive clinical course. Presentation as a myeloid/erythroid sarcoma is exceedingly rare. We describe an infantile PEL presenting as a multifocal myeloid sarcoma, clinically and pathologically mimicking Ewing sarcoma/PNET family of tumors. The patient died 8 weeks after the initial presentation due to widespread disease. Our case shows that PEL needs to be considered in the differential diagnosis of small round blue cell tumors in infancy. A meticulous workup including immunohistochemistry, flow cytometry, molecular, and cytogenetic studies was required to reach the diagnosis.