Transcatheter coil embolization of an intercostal artery to pulmonary artery fistula

An 18-year-old asymptomatic male was found to have a high-flow systemic arterial to pulmonary arterial fistula fed by dilated lower intercostal arteries draining via pulmonary artery toward the left main pulmonary trunk. Transcatheter Guglielmi Detachable Coil (GDC; Target Ther, Fremont, Calif.) embolization was performed. Transcatheter embolization is a reasonable and less invasive mode in the treatment of systemic artery to pulmonary artery fistula, and GDC offers more precise coil placement over other conventional coils.     

Possible electrical stimulation on rostral ventrolateral medulla that causes significant hypertensive and tachycardic changes during endovascular treatment of a PICA aneurysm abutting the left medullary sulcus

We report the case of a 43-year-old man who underwent endovascular treatment for posterior inferior cerebellar aneurysm. Significant hemodynamic changes were observed as electric stimulation was applied during coil detachment for a PICA aneurysm. We postulate that changes in heart rate and blood pressure during coil detachment were due to the electric stimulation of the tonic vasomotor center located in the rostral ventrolateral medulla, which was very close to the PICA aneurysm.     

MR Imaging of pial melanosis secondary to a posterior fossa melanotic ependymoma

A 36-year-old man presented with trouble speaking and bilateral progressive hearing loss. MR imaging and histopathologic results revealed a posterior fossa melanotic ependymoma. Pial surfaces appeared hyperintense on T1-weighted images and hypointense on T2-weighted images. Histopathologic examination revealed that tumor cells and interstitial spaces had abundant melanin accumulation. There was no evidence of hemosiderin in tumor cells and in interstitial spaces. Pial melanin accumulation secondary to a posterior fossa melanotic ependymoma explained our MR findings.     

The cross-species A3 adenosine-receptor antagonist MRS 1292 inhibits adenosine-triggered human nonpigmented ciliary epithelial cell fluid release and reduces mouse intraocular pressure

PURPOSE: Antagonists to A3 adenosine receptors (ARs) lower mouse intraocular pressure (IOP), but extension to humans is limited by species variability. We tested whether the specific A3AR antagonist MRS 1292, designed to cross species, mimicks the effects of other A3AR antagonists on cultured human nonpigmented ciliary epithelial (NPE) cells and mouse IOP. METHODS: NPE cell volume was monitored by electronic cell sorting. Mouse IOP was measured with the Servo-Null Micropipette System. RESULTS: Adenosine triggered A3AR-mediated shrinkage of human NPE cells. Shrinkage was blocked by MRS 1292 (IC50 = 42 +/- 11 nM, p < 0.01) and by another A3AR antagonist effective in this system, MRS 1191. Topical application of the A3AR agonist IB-MECA increased mouse IOP. MRS 1292 reduced IOP by 4.0 +/- 0.8 mmHg at 25-microM droplet concentration (n = 10, p < 0.005). CONCLUSIONS: MRS 1292 inhibits A3AR-mediated shrinkage of human NPE cells and reduces mouse IOP, consistent with its putative action as a cross-species A3 antagonist.     

Do Anxiety and Depression Levels Affect the Inflammation Response in Patients Hospitalized for COVID-19

ObjectiveThe whole world is still struggling with the COVID-19 pandemic. Inflammation response, thought to be associated with severe illness and death, is an important research topic in COVID-19. Inflammation is also an essential condition explored in psychiatric illnesses. Our knowledge about the relationship between the inflammation response and psychiatric comorbidities in patients with COVID-19 is very limited. In this study, the relationship between anxiety and depression levels and inflammation response of patients with COVID-19 hospitalized in the hospital was examined. Methods175 patients were included in the study. Sociodemographic Data Form, Beck Depression Inventory and Beck Anxiety Inventory were applied to the patients. To evaluate the inflammation responses, blood sedimentation rate, C-reactive protein (CRP), procalcitonin, ferritin, neutrophil/lymphocyte ratio (NLR), and IL-6 levels were examined. ResultsIn our study, no relationship was found between anxiety and depression levels and inflammatory responses in patients hospitalized with a diagnosis of COVID-19. Anxiety and depression levels of women were higher than men, and NLR, ferritin, IL-6 levels were found to be lower than men. Anxiety levels increase with age. There is a positive correlation between NLR and ferritin levels and duration of hospitalization. ConclusionOur study examining the relationship of psychiatric comorbidities with the inflammation response and our increasing literature knowledge, together with studies evaluating the mental effects of COVID-19, suggest that determining the relationship between inflammation responses and psychiatric comorbidities in COVID-19, whose pathophysiology has not been clarified yet, maybe an essential step in interventions on the course of the disease.     

Genetic variations in colorectal cancer risk and clinical outcome

Colorectal cancer(CRC)has an apparent hereditary component,as evidenced by the well-characterized genetic syndromes and family history associated with the increased risk of this disease.However,in a large fraction of CRC cases,no known genetic syndrome or family history can be identified,suggesting the presence ofmissing heritabilityin CRC etiology.The genome-wide association study(GWAS)platform has led to the identification of multiple replicable common genetic variants associated with CRC risk.These newly discovered genetic variations might account for a portion of the missing heritability.Here,we summarize the recent GWASs related to newly identified genetic variants associated with CRC risk and clinical outcome.The findings from these studies suggest that there is a lack of understanding of the mechanism of many single nucleotide polymorphisms(SNPs)that are associated with CRC.In addition,the utility of SNPs as prognostic markers of CRC in clinical settings remains to be further assessed.Finally,the currently validated SNPs explain only a small fraction of total heritability in complex-trait diseases like CRC.Thus,themissing heritabilitystill needs to be explored further.Future epidemiological and functional investigations of these variants will add to our understanding of CRC pathogenesis,and may ultimately lead to individualized strategies for prevention and treatment of CRC.     

Erythropoiesis stimulating agents and clinical outcomes of invasive breast cancer patients receiving cytotoxic chemotherapy

The use of erythropoiesis stimulating agents (ESAs) to treat anemia in breast cancer patients who are treated with chemotherapy is a matter of ongoing debate. Several recent randomized trials challenged conventional wisdom, which holds that ESAs are contraindicated for breast cancer patients undergoing curative treatment. We aimed to perform the first large national population-based study to analyze the association between ESA use and breast cancer patient outcomes. Cytotoxic chemotherapy-treated invasive breast cancer patients were identified from the Surveillance, Epidemiology, and End Results (SEER)-Medicare database. Non-ESA users were sequentially 1:1 matched to 2,000 randomly sampled ESA users on demographics (age, diagnosis year, race, marital status, and socioeconomic status), tumor presentation (stage, grade, and status of hormone receptors), and treatments (surgery, radiation, and sub-types of chemotherapy) using a minimum distant strategy. Breast cancer-specific survival of ESA and matched non-ESA users was compared using Fine and Gray competing risk model. Compared to ESA users, non-ESA users exhibited dramatically different baseline characteristics such as less advanced tumor, and fewer co-morbidities. Non-ESA users had a significantly more favorable breast cancer-specific survival (subdistribution hazard ratio [sHR] = 0.75, p < 0.0001). This survival disparity was progressively diminished in the sequential matching of demographics (sHR = 0.74, p = 0.0004), presentation (sHR = 0.86, p = 0.06), and treatment (sHR = 0.89, p = 0.17) variables. Stratified analyses identified subgroups of patients whose breast cancer-specific survival were not different between ESA and non-ESA users. In the SEER-Medicare database, ESA usage does not seem to be associated with unfavorable breast cancer-specific survival in breast cancer patients receiving cytotoxic chemotherapy. The ESA-breast cancer prognosis association is complex and requires more intensive investigations.