Expression of nuclear factor-kappaB in human astrocytomas: relation to pI kappa Ba, vascular endothelial growth factor, Cox-2, microvascular characteristics, and survival

Although NF-kappaB has been reported to be constitutively activated in various neoplasms, little information is available about its clinical significance in astrocytomas. In this study, we investigated the association of NF kappa B1/p50 and pI kappa Ba immunohistochemical expression with clinicopathologic features, vascular endothelial growth factor, Cox-2, and microvascular parameters in paraffin-embedded tissue from 82 patients with astrocytomas. pI kappa Ba expression was positively correlated with nuclear (P = .0010) and negatively with cytoplasmic (P = .0008) NF kappa B1/p50 expression. Nuclear NF kappa B1/p50 and pI kappa Ba expression increased with tumor grade (P = .0001 and P < .0001). Nuclear NF kappa B1/p50 was associated with vascular endothelial growth factor (P = .0079), Cox-2 (P = .0500), and total vascular surface area (P = .0430), although the latter was significant only in grades II and III. pI kappa Ba was also positively correlated with microvessel caliber (pI kappa Ba/area; P = .0087). Multivariate analysis selected NF kappa B/p50 expression as an independent prognosticator not only for the entire cohort (P = .0220), but also for grades II and III (P = .0029) and grade IV cases (P = .0310). Our results suggest that nuclear NF kappa B1/p50 expression is dictated by its interaction with I kappa Ba in astrocytomas and is associated with tumor grade and angiogenic factors, denoting the importance of nuclear NF kappa B/p50 expression in patients' prognosis.     

Shape covariation between the craniofacial complex and first molars in humans

The occurrence of mutual genetic loci in morphogenesis of the face and teeth implies shape covariation between these structures. However, teeth finalize their shape at an early age, whereas the face grows and is subjected to environmental influences for a prolonged period; it is therefore conceivable that covariation might modulate with age. Here we investigate the extent of this covariation in humans by measuring the 3D shape of the occlusal surface of the permanent first molars and the shape of the craniofacial complex from lateral radiographs, at two maturations stages. A sample of Greek subjects was divided into two groups (110 adult, 110 prepubertal) with equally distributed gender. The occlusal surfaces of the right first molars were 3D scanned from dental casts; 265 and 274 landmarks (including surface and curve semilandmarks) were digitized on the maxillary and mandibular molars, respectively. The corresponding lateral cephalometric radiographs were digitized with 71 landmarks. Geometric morphometric methods were used to assess shape variation and covariation. The vertical dimension of the craniofacial complex was the main parameter of shape variation, followed by anteroposterior deviations. The male craniofacial complex was larger (4.0–5.7%) and was characterized by a prominent chin and clockwise rotation of the cranial base (adult group only). Allometry was weak and statistically significant only when examined for the sample as a whole (percent variance explained: 2.1%, P = 0.0002). Covariation was statistically significant only between the lower first molar and the craniofacial complex (RV = 14.05%, P = 0.0099, and RV = 12.31%, P = 0.0162, for the prepubertal and adult groups, respectively). Subtle age‐related covariation differences were noted, indicating that environmental factors may influence the pattern and strength of covariation. However, the main pattern was similar in both groups: a class III skeletal pattern (relative maxillary retrusion and mandibular protrusion), hyperdivergency, forward rotation of the posterior cranial base and upward rotation of the anterior cranial base were associated with mesiodistal elongation of the lower molars and height reduction of their distal cusps. This pattern mimics phylogeny in humans, where flexion and counterclockwise rotation of the cranial base, considered advantageous to survival, co‐occur with tooth reductions that cannot be easily explained in evolutionary terms. The similarity of the phylogenetic and covariation patterns seems to support the pleiotropic gene hypothesis.     

<Emphasis Type="SmallCaps">D</Emphasis>-dimer concentrations in dogs with kidney disease with or without protein-losing nephropathy

Limited information is currently available regarding the range of D-dimer concentrations in dogs with kidney disease (KD). The objective of the present cross-sectional study was to investigate the concentration of D-dimers in dogs with KD irrelevant of the underlying cause or the time course of the KD and the potential association of D-dimers elevation with serum creatinine concentration, concurrent protein-losing nephropathy (PLN) or the age of the animals. D-dimers were measured by a semi-quantitative plasma latex agglutination assay in 31 healthy dogs (group A) and in 30 dogs with KD (group B), without evidence of concurrent extra-renal disease that may precipitate hypercoagulation. Significantly higher median D-dimer concentrations (p?=?0.0133) and a higher prevalence of increased D-dimers (≥250 μg/L) (p?=?0.011) were documented in dogs with KD as compared to healthy dogs, and the increased D-dimers were not associated with the serum creatinine concentration, the coexistent PLN or the age of the dogs. In conclusion, the detection of increased D-dimers in the context of impaired kidney function should be cautiously interpreted in the dog and should not be invariably assumed to imply the presence of a state of hypercoagulability.     

Non-vitamin K oral anticoagulants in nonvalvular atrial fibrillation: a network meta-analysis

Objectives. We conducted a systematic review and network meta-analysis of randomized controlled trials (RCTs) including the comparison of non-vitamin K antagonist oral anticoagulants (NOACs) with warfarin for patients with atrial fibrillation (AF). Design. Network meta-analysis. Two authors independently extracted data. All authors evaluated overall confidence in the evidence. Results. Eighteen RCTs included in our review, a total of 78,796 patients with AF, with sample sizes from 90 to 21,105 patients. Apixaban 5?mg (OR: 0.79, 95% CI: 0.66 to 0.95), dabigatran 110?mg (0.91, 0.74–1.12), dabigatran 150?mg (0.66, 0.53–0.82), edoxaban 60?mg (0.87, 0.74–1.02), and rivaroxaban 20?mg (0.88, 0.74–1.03) reduced the risk of stroke or systemic embolism compared with warfarin. Dabigatran 150?mg had the highest P-score for reducing stroke or systemic embolic events. The risk of haemorhagic stroke and all-cause mortality was lower with all NOACs than with warfarin. Apixaban 5?mg (0.69, 0.60–0.80), dabigatran 110?mg (0.80, 0.69–0.93), dabigatran 150?mg (0.93, 0.80–1.08), edoxaban 30?mg (0.46, 0.40–0.54), and edoxaban 60?mg (0.78, 0.69–0.90) reduced the risk of major bleeding compared with warfarin. Edoxaban 30?mg had the highest P-score for reducing major bleeding. The plots of P-scores rank showed that apixaban offered the most favorable balance of efficacy and safety. Conclusions. This study adds an attempt for treatment ranking of both efficacy and safety outcomes. Future trials comparing directly NOACs are needed in order to provide conclusive proofs for these results and not only circumstantial evidence offered by a network meta-analysis.     

Sustained ventricular tachycardia as a first manifestation of hypertrophic cardiomyopathy with mid‐ventricular obstruction and apical aneurysm in an elderly female patient

Sustained ventricular tachycardia complicating left ventricular apical aneurysms has been reported previously solely in middle‐aged patients with hypertrophic cardiomyopathy and mid‐cavity obstruction. We report a case of an elderly female patient who presented with incessant ventricular tachycardia as the first clinical manifestation of hypertrophic cardiomyopathy with mid‐ventricular obstruction and apical aneurysm.     

Malignant mixed tumor of the nasal cavity

Parotid gland is the most common location of malignant mixed tumors. Three different subtypes of these tumors exist: carcinoma ex pleomorphic adenoma, carcinosarcoma, and metastasizing mixed tumor. Carcinoma ex-pleomorphic adenoma is by far the most common subtype. Although unusual sites of these tumors have been published, we report an extremely rare case of a malignant mixed tumor located in the nasal cavity.