Coronary artery dissection in the postpartum period--a case study

Spontaneous coronary dissection is a rare condition occurring more often in women, with a higher frequency during the peripartum period. No specific aetiology has been defined to this uncommon, but often fatal disease. We describe the case of a young woman admitted to our intensive care unit with ECG-findings of acute anterior myocardial infarction presented one week after delivery. The acute coronary angiography didn't show significant stenoses or occlusion, therefore angioplasty was not done. Cardiogenic shock developed, which could be reverted by mechanical circulatory support and the condition of our patient stabilized. Later, new-onset cardiac ischemic signs presented warranting a repeated coronary angiography, which detected dissection on the distal part of the left main coronary artery with signs of flow-limiting even in the circumflex artery. Therefore, urgent coronary bypass surgery was performed with good results. Spontaneous coronary dissection must be considered when evaluating a patient in the peripartum period with signs of acute coronary syndrome, given its high overall mortality. The treatment holds specific points of consideration.     

Acceleration of cerebral noradrenaline turnover after morphine withdrawal and its retardation by acute morphine administration in rats

Summary To clarify the effects of withdrawal from chronic morphine treatment on cerebral noradrenaline (NA) turnover, we have measured the -methyl-p-tyrosine (MT)-induced depletion of NA in five brain areas of male Wistar rats given morphine twice daily for 40 or 60 days. After the last morphine dose (50 or 70 mg/kg) the rats were withdrawn for 1, 2 or 4 days. In order to study the development of tolerance a challenge dose of 10 mg/kg of morphine was given to some of the rats.Withdrawal of morphine accelerated the MT-induced NA depletion clearly in the hemispheres and the lower brain stem and slightly in the diencephalon. The acceleration was more pronounced in the brains of rats treated for 60 days than of those treated for 40 days. In the hemispheres the acceleration of NA depletion occurred at 1 and 2 days, in the diencephalon at 2 days, and in the lower brain stem at 2 and 4 days after morphine withdrawal. The most pronounced acceleration of NA depletion coincided with the maximum withdrawal-induced weight loss. The challenge dose of morphine clearly retarded the MT-induced NA depletion in the hemispheres of control rats treated chronically with saline. This retardation was even more pronounced in rats withdrawn from chronic morphine treatment for 1 or 2 days. The challenge dose slightly accelerated the MT-induced NA depletion in the lower brain stem of control rats. However, in rats withdrawn from chronic morphine treatment for 1 or 2 days the challenge dose instead of accelerating, clearly retarded, the NA depletion in the lower brain stem.Our results show that cerebral NA turnover is accelerated in rats withdrawn from morphine. The degree of this acceleration is proportional to the duration of chronic treatment. Tolerance does not seem to develop towards the NA release-inhibiting effect of morphine in the hemispheres, but develops towards the NA release-accelerating effect of morphine in the lower brain stem.     

Saliva concentrations of isosorbide dinitrate, isosorbide 2-mononitrate and isosorbide 5-mononitrate.

Correlations between saliva and plasma concentrations of isosorbide dinitrate (ISDN), and its active metabolites, isosorbide 2-mononitrate (2-ISMN) and isosorbide 5-mononitrate (5-ISMN) were examined. In the case of 5-ISMN (r = 0.98, P less than 0.01), saliva concentrations are probably reliable indices of the plasma concentrations of this drug and their measurement should provide a useful non-invasive procedure to assess compliance during the clinical use of products containing either ISDN or 5-ISMN: it may also be helpful in assessing the clinical pharmacokinetics of 5-ISMN. Less satisfactory correlations were obtained for ISDN (r = 0.84) and 2-ISMN (r = 0.83).     

In vitro Anti‐diabetic Activity and Chemical Characterization of an Apolar Fraction of Morus alba Leaf Water Extract

The tea from the white mulberry (Morus alba L.) leaf is a worldwide known traditional medicine of type II diabetes. Here, we report the investigation of the dichloromethane‐soluble fraction obtained in a 0.24% m/m yield from the hot water extract of mulberry leaves. A significant, dose‐dependent activity was found by means of the 24‐h glucose consumption of fully differentiated adipocytes both in the absence and presence of insulin. The fraction was characterized by HPLC‐DAD, GC‐MS and GC‐FID. The main constituent (40.3% by means of GC‐FID) was isolated and identified as loliolide by EIMS, HRESIMS and NMR spectroscopy. In the active fraction benzyl alcohol, ethyl benzoate, t‐cinnamic acid, p‐hydroxyacetophenone, t‐coniferyl alcohol and synapil alcohol were also identified by GC‐MS and quantified by GC‐FID (0.7, 1.3, 1.5, 2.9, 7.5 and 2.6%, respectively). Copyright © 2012 John Wiley & Sons, Ltd.     

In vivo migration of lymphocytes in chronically rejecting rat kidney allografts

Histological analyses have identified lymphocytes and macrophages as the predominant leukocyte populations that infiltrate organs undergoing chronic rejection. In order to define the time frame of this infiltration, we investigated the in vivo migration pattern of lymphocytes in a well-established rat model of chronic kidney allograft rejection. F344 kidneys were orthotopically transplanted into bilaterally nephrectomized Lewis rats. Recipients were treated with cyclosporin A (1.5 mg/kg/per day) for the first 10 days. After anti-CD18 or vehicle pretreatment, peripheral blood lymphocytes obtained from naive Lewis rats and labeled with 3H-uridine were injected into transplanted rats 12 and 16 weeks after transplantation. Organs were harvested 4, 8, and 12 h thereafter. After 12 weeks, proteinuria developed, accompanied by all signs of chronic rejection including glomerular sclerosis. Labeled lymphocytes rapidly infiltrated grafted kidneys 4 h after injection. Even more lymphocytes had accumulated in the grafts 12 h after injection. After 16 weeks, few lymphocytes had emigrated into the graft at 4 h, while infiltration was most pronounced by 12 h. Pretreatment with anti-CD18 inhibited the influx of lymphocytes. There was no difference between the patterns of lymphocytes derived from naive and transplanted rats. Our results emphasize the importance of endothelial cells in chronically rejecting kidneys for the control of leukocyte influx. β2-integrins may play a central role in determining the transendothelial migration during this process. Received: 26 May 1998 Received after revision: 28 July 1998 Accepted: 25 September 1998     

Evaluation of an online case-based learning module that integrates basic and clinical sciences

ObjectiveCase-based online modules can be created to integrate basic science and clinical science knowledge. An integrated module was designed, implemented, and evaluated for student performance and perception.MethodsFive faculty members from both basic science and clinical education departments developed an integrative, online, case-based learning module. The case involved a patient with facial asymmetry, and the student was led to a diagnosis of Bell''s palsy. Material on Bell''s palsy was presented in an integrated module in addition to traditional lecture for a fall cohort of students and was presented only in traditional lecture format to a winter cohort of students. Both cohorts were given the same 5 multiple-choice questions on Bell''s palsy as part of a midterm exam, and the scores of these test questions were compared between cohorts. A 13-question, mixed-methods survey was given to the fall cohort to determine their perceptions of the module and their learning.ResultsMultiple-choice test question performance was equivalent between cohorts for the Bell''s palsy questions (fall 2018: mean = 3.68, SD = 0.99; winter 2019: mean = 3.51, SD = 0.92). Perception survey responses indicated that students felt positively about the integrated module and that it was applicable and helpful with improving, reinforcing, and integrating basic science and clinical knowledge.ConclusionThis study provides evidence that case-based integrated modules are perceived favorably by students and result in similar exam question performance. They can be a useful tool to help students connect information throughout the chiropractic curriculum.     

The influence of expertise of the surgical pathologist to undergrading,upgrading, and understaging of prostate cancer in patients undergoing subsequent radical prostatectomy

Purpose

The main objective of this retrospective study was to evaluate the influence of pathological experience in histological examination of prostate cancer (PCa) on preoperative understaging (UNS), undergrading (UNG), and upgrading (UPG).

Methods

Histopathological data of prostate biopsy (PB) and radical prostatectomy (RP) specimens of patients undergoing subsequent radical prostatectomy (n = 430) in our center were compared. Histological diagnoses of PB were provided either by corresponding academic pathology institute (Group 1: 322 patients) or by external (nonacademic) departments which had a lower number (≤100/year) of PCa histopathological evaluations (Group 2 108 patients). The rate of UNG, UPG, and UNS in both groups and also the effects of institutional learning curve were analyzed in terms of grading and staging.

Results

Significant difference was detected between Group 1 and Group 2 in average preoperative Gleason score (GS) values and in the rate of well, moderately, and poorly differentiated cancers as well. There was also a significant difference in the rate of UNG (29.1 vs. 56.5 %, p < 0.0001). The mean preoperative and postoperative GS in Group 1 was significantly lower in the first 50 than in the last 50 patients, but the rates of UNG, UPG, and UNS did not differ significantly between the groups.

Conclusions

The experience of pathologists has direct influence on grading concordance and on UNG and UPG, between PB and RP specimen; however, it has no significant effect on complete preoperative understaging. The bigger pathological experience improves the sensitivity of the histological diagnostic process.     

Malignant astrocyte swelling and impaired glutamate clearance drive the expansion of injurious spreading depolarization foci

Spreading depolarizations (SDs) indicate injury progression and predict worse clinical outcome in acute brain injury. We demonstrate in rodents that acute brain swelling upon cerebral ischemia impairs astroglial glutamate clearance and increases the tissue area invaded by SD. The cytotoxic extracellular glutamate accumulation (>15 µM) predisposes an extensive bulk of tissue (4–5 mm²) for a yet undescribed simultaneous depolarization (SiD). We confirm in rat brain slices exposed to osmotic stress that SiD is the pathological expansion of prior punctual SD foci (0.5–1 mm²), is associated with astrocyte swelling, and triggers oncotic neuron death. The blockade of astrocytic aquaporin-4 channels and Na⁺/K⁺/Cl⁻ co-transporters, or volume-regulated anion channels mitigated slice edema, extracellular glutamate accumulation (<10 µM) and SiD occurrence. Reversal of slice swelling by hyperosmotic mannitol counteracted glutamate accumulation and prevented SiD. In contrast, inhibition of glial metabolism or inhibition of astrocyte glutamate transporters reproduced the SiD phenotype. Finally, we show in the rodent water intoxication model of cytotoxic edema that astrocyte swelling and altered astrocyte calcium waves are central in the evolution of SiD. We discuss our results in the light of evidence for SiD in the human cortex. Our results emphasize the need of preventive osmotherapy in acute brain injury.