Dedifferentiated liposarcoma arising from the sigmoid mesocolon： A case report

Dedifferentiated liposarcoma is a variant of liposarcoma with a more aggressive course. It occurs most commonly in the retroperitoneum and rarely in other anatomic locations. In the present report, we describe a case of dedifferentiated liposarcoma that occurred in an unusual location, sigmoid mesocolon, which has not yet been documented.     

Attainment of Normal Lipid Levels Among Patients on Lipid-Modifying Therapy in Hong Kong

Introduction

Although low-density lipoprotein cholesterol (LDL-C) is the primary lipid target for coronary heart disease (CHD) risk reduction, high-density lipoprotein cholesterol (HDL-C) and triglycerides (TG) have also emerged as CHD risk factors. The objective of this study was to evaluate attainment of lipid goals and normal levels following lipid-modifying therapy (LMT) and its predictors in a representative sample of Chinese patients from Hong Kong.

Methods

Using longitudinal data collected from patient medical records, the study identified 706 patients who initiated LMT from January 2004 to December 2006 and had full lipid panels 12 months before and after therapy. LDL-C goals and normal levels of HDL-C and TG were defined according to the National Cholesterol Education Program Adult Treatment Panel 3 guidelines. Patients with previous CHD, diabetes, and 10-year CHD risk > 20% were classified as high risk. Multiple logistic regressions evaluated predictors of normal lipid-level attainment.

Results

Among 706 patients (mean age 64.6 years, 58.6% male), 71.7% had elevated LDL-C, 32.4% had low HDL-C, and 24.9% had elevated TG before LMT. Despite therapy (91.2% statins only), 22.7% had elevated LDL-C, 31.9% had low HDL-C, 12.3% had elevated TG, and 13.9% had multiple abnormal lipid levels. The strongest predictors of attaining ?? 2 normal lipid levels included male gender (odds ratio [OR]: 2.11 [1.12 to 4.01]), diabetes (OR: 0.43 [0.23 to 0.78]), obesity (OR: 0.91 [0.86 to 0.97]), and CHD risk > 20% (OR: 0.33 [0.15 to 0.71]).

Conclusions

Current approaches to lipid management in Hong Kong, primarily using statins, considerably improve attainment of LDL-C goal. However, a large proportion of patients do not achieve normal HDL-C levels and control of multiple lipid parameters remains poor. Patients could benefit from a more comprehensive approach to lipid management that treats all three lipid risk factors, as suggested in clinical guidelines.     

RELATIONSHIPS BETWEEN CORE ENDURANCE,HIP STRENGTH,AND BALANCE IN COLLEGIATE FEMALE ATHLETES

Purpose/Background:

Lower extremity injuries such as Anterior Cruciate Ligament (ACL) tears remain a concern in collegiate female athletes. Core endurance and hip strength reportedly influence ACL and lower extremity injury risk. Good neuromuscular control, as measured by the Star Excursion Balance Test (SEBT) test is associated with decreased lower extremity injuries. The exact relationships between core endurance, hip strength, and balance (SEBT scores), and how they impact one another in the female collegiate athlete remain unclear. Thus, the purpose of this study was to investigate relationships between core endurance, hip strength, and balance in collegiate female athletes.

Methods:

Forty collegiate female athletes (19.6±1.1yrs, 163.1±7.8cm, 61.3±6.5kgs) performed the SEBT in anterior, posterolateral, and posteromedial directions bilaterally (% leg length), McGill''s anterior, posterior, and left and right plank core endurance tests (seconds), and hip abductor, flexor, extensor, and external rotator isometric strength tests bilaterally (N) using handheld dynamometry. Pearson''s product moment correlations examined relationships between core endurance, hip strength, and balance. A linear regression analysis examined whether core endurance and hip strength influenced balance (p≤0.05).

Results:

Anterior SEBT scores were fairly positively correlated with hip flexor and extensor strength. Posterolateral SEBT scores were fairly positively correlated with hip abductor, extensor, and flexor strength (p=0.02‐to‐0.004; r=0.26‐to‐0.45). Fair positive correlations existed between posterior core endurance and hip extensor strength bilaterally (right: p=0.02, r=0.37; left: p=0.003, r=0.47). Core endurance and SEBT scores were not correlated (p>0.05). Core endurance and hip strength did not influence SEBT scores (p=0.47).

Conclusions:

Overall, hip strength, but not core endurance was related to SEBT scores in collegiate female athletes. Females with greater hip flexor, extensor, and abductor strength also had better anterior and posterolateral SEBT scores. Having females participate in hip muscle strengthening programs may help improve their SEBT balance scores, as a measure of their neuromuscular control and influence their ACL and lower extremity injury risk.

Level of Evidence:

2b     

Temporal assessment of Candida risk factors in the surgical intensive care unit.

HYPOTHESIS: Risk factors for Candida infection in surgical intensive care units (SICUs) change over time. Risk factor progression may influence Candida colonization and infection. DESIGN: Multicenter cohort survey. SETTING: Three urban teaching institutions. PATIENTS: A total of 301 consecutively admitted patients in SICUs for 5 or more days. MAIN OUTCOME MEASURES: Assessment of patients on SICU days 1, 3, 4, 6, and 8 and SICU discharge for risk factors, Candida colonization, and antifungal use. Candida colonization status was categorized as noncolonized (NC), locally colonized (LC) if 1 site was involved, and disseminated infection (DI) if 2 or more sites or candidemia were involved. RESULTS: The most frequent risk factors in the 301 patients enrolled were presence of peripheral and central intravenous catheters, bladder catheters, mechanical ventilation, and lack of enteral or intravenous nutrition. Early risk factors included total parenteral nutrition or central catheter at SICU day 1 and previous SICU admissions or surgical procedures. Peak number of risk factors (mean +/- SD) were as follows: 7.2 +/- 2.6 in NC (n = 229), 9.2 +/- 2.3 in LC (n = 45), and 9.2 +/- 2.6 in DI (n = 27). These numbers were reached at day 8 in the NC and LC groups and day 4 in the DI group. The LC and DI groups had more risk factors on each SICU day than the NC group and longer median SICU length of stay (28 days in the DI group vs 11 and 19 days in the NC and LC groups, respectively). Antifungal therapy, while used most frequently in the DI group, was initiated later for this group than in NC and LC groups. CONCLUSIONS: Risk factors for Candida infection in SICU patients change over time. Patients with DI demonstrate a greater number of and more rapid increase in risk factors than patients in the LC and NC groups. Presence of early risk factors at the time of SICU admission, a high incidence of risk factors, or a rapid increase in risk factors should prompt clinicians to obtain surveillance fungal cultures and consider empirical antifungal therapy.     

GABRB3 mutations: a new and emerging cause of early infantile epileptic encephalopathy

The gamma‐aminobutyric acid type A receptor β3 gene (GABRB3) encodes the β3‐subunit of the gamma‐aminobutyric acid type A (GABA_A) receptor, which mediates inhibitory signalling within the central nervous system. Recently, GABRB3 mutations have been identified in a few patients with infantile spasms and Lennox–Gastaut syndrome. We report the clinical and electrographic features of a novel case of GABRB3‐related early‐onset epileptic encephalopathy. Our patient presented with neonatal hypotonia and feeding difficulties, then developed pharmacoresistant epileptic encephalopathy, characterized by multiple seizure types from 3 months of age. Electroencephalography demonstrated ictal generalized and interictal multifocal epileptiform abnormalities. Using a SureSelectXT custom multiple gene panel covering 48 early infantile epileptic encephalopathy/developmental delay genes, a novel de novo GABRB3 heterozygous missense mutation, c.860C>T (p.Thr287Ile), was identified and confirmed on Sanger sequencing. GABRB3 is an emerging cause of early‐onset epilepsy. Novel genetic technologies, such as whole‐exome/genome sequencing and multiple gene panels, will undoubtedly identify further cases, allowing more detailed electroclinical delineation of the GABRB3‐related genotypic and phenotypic spectra.     

A new tool for predicting erectile dysfunction

The Sexual Health Inventory for Men (SHIM) is an effective way to assess erectile difficulty (ED). Despite documented efficacy, however, many physicians may be reluctant to incorporate it into clinical practice because of the intimate nature of the questionnaire. In an attempt to devise and test an easy-to-use computer-based SHIM score indicator for office use, more than 30,000 SHIM questionnaires were administered to men visiting physicians’ offices in 2000. Information about age, current smoking status, diabetes, depression, hypertension, prostate disease, and cholesterol levels was also collected. A logistic regression model with a sensitivity of 81.8% and a specificity of 57.7% was created to predict the likelihood of ED in a patient scoring below 21 (SHIM definition). This model was built into a highly graphic Windows®-based program. The SHIM score indicator is a convenient way to rapidly identify patients at high risk for ED who should be further assessed.