Biomechanics of the sarcolemma and costameres in single skeletal muscle fibers from normal and dystrophin-null mice

We studied the biomechanical properties of the sarcolemma and its links through costameres to the contractile apparatus in single mammalian myofibers of Extensor digitorum longus muscles isolated from wild (WT) and dystrophin-null (mdx) mice. Suction pressures (P) applied through a pipette to the sarcolemma generated a bleb, the height of which increased with increasing P. Larger increases in P broke the connections between the sarcolemma and myofibrils and eventually caused the sarcolemma to burst. We used the values of P at which these changes occurred to estimate the tensions and stiffness of the system and its individual elements. Tensions of the whole system and the sarcolemma, as well as the maximal tension sustained by the costameres, were all significantly lower (1.8-3.3 fold) in muscles of mdx mice compared to WT. Values of P at which separation and bursting occurred, as well as the stiffness of the whole system and of the isolated sarcolemma, were ~2-fold lower in mdx than in WT. Our results indicate that the absence of dystrophin reduces muscle stiffness, increases sarcolemmal deformability, and compromises the mechanical stability of costameres and their connections to nearby myofibrils.     

A randomized, naturalistic, parallel-group study for the long-term treatment of panic disorder with clonazepam or paroxetine

This long-term extension of an 8-week randomized, naturalistic study in patients with panic disorder with or without agoraphobia compared the efficacy and safety of clonazepam (n = 47) and paroxetine (n = 37) over a 3-year total treatment duration. Target doses for all patients were 2 mg/d clonazepam and 40 mg/d paroxetine (both taken at bedtime). This study reports data from the long-term period (34 months), following the initial 8-week treatment phase. Thus, total treatment duration was 36 months. Patients with a good primary outcome during acute treatment continued monotherapy with clonazepam or paroxetine, but patients with partial primary treatment success were switched to the combination therapy. At initiation of the long-term study, the mean doses of clonazepam and paroxetine were 1.9 (SD, 0.30) and 38.4 (SD, 3.74) mg/d, respectively. These doses were maintained until month 36 (clonazepam 1.9 [SD, 0.29] mg/d and paroxetine 38.2 [SD, 3.87] mg/d). Long-term treatment with clonazepam led to a small but significantly better Clinical Global Impression (CGI)-Improvement rating than treatment with paroxetine (mean difference: CGI-Severity scale -3.48 vs -3.24, respectively, P = 0.02; CGI-Improvement scale 1.06 vs 1.11, respectively, P = 0.04). Both treatments similarly reduced the number of panic attacks and severity of anxiety. Patients treated with clonazepam had significantly fewer adverse events than those treated with paroxetine (28.9% vs 70.6%, P < 0.001). The efficacy of clonazepam and paroxetine for the treatment of panic disorder was maintained over the long-term course. There was a significant advantage with clonazepam over paroxetine with respect to the frequency and nature of adverse events.     

The effect of montelukast in a model of gouty arthritis induced by sodium monourate crystals

Non-steroidal anti-inflammatory drugs (NSAIDS) are the first line of therapy in acute gouty arthritis. NSAIDs inhibit the cyclooxygenase pathway, but not the lipooxygenase activity and can have many adverse effects and thus have a limited effect on the control of inflammation in this disease. In this work we studied the effect of montelukast on the cellular inflammatory infiltrate in a model of murine arthritis induced by sodium monourate crystals (SMU), using a subcutaneous air cavity (air pouch) in BALB/c mice. Seven groups of BALB/c mice (n = 4) were distributed into five experimental groups and two inflammatory control groups, a positive and a negative one. Previous to SMU exposure, the experimental groups received montelukast (1 and 0.01 mg/Kg/w) and/or indomethacine (2.5 mg/Kg/w), followed by administration of SMU in the air pouch. The total and differential counts of inflammatory cells were analyzed after 2, 6, 12 and 24 hours. Montelukast, significantly reduced the total number of cells (p < 0.05), with a predominant impact on polymorphonuclear over mononuclear cells, especially after 12 hours of the medication. The montelukast/indometacine combination showed an additive effect. Our data show that montelukast has an anti-inflammatory effect in the model of gouty arthritis. Consequently, anti-leukotrienes could represent a new and effective therapy, either isolated or combined with conventional therapy of gouty arthritis.     

Ovarian clear cell carcinomas: RHO GTPases may contribute to explain their singular biologic behavior

Ovarian clear cell carcinoma is found more often confined to the ovary (stage I) than high-grade serous carcinoma. The RHO GTPase family of proteins is involved in tumor invasion and metastasis through regulation of the cytoskeleton. The expression of several RHO family genes, including RHOA, RHOC, CDC42, and 3 ARHGDIs (Rho GDP dissociation inhibitors), was studied by real-time polymerase chain reaction in 22 clear cell carcinomas and 31 high-grade serous carcinomas. Immunoreaction for p21-activated kinase 1 (a downstream effector of CDC42) was also investigated on 6 tissue microarrays containing 76 carcinomas (13 clear cell carcinomas and 63 high-grade serous carcinomas). Eight clear cell carcinomas (8/21; 38%) were at stage I, whereas only 3 high-grade serous carcinomas (3/31; 10%) were at stage I. Postoperatively, all patients were treated with taxane and cisplatinum or carboplatinum. ARHGDIA messenger RNA expression was higher in clear cell carcinomas than high-grade serous carcinomas (P = .07). In contrast, CDC42 messenger RNA levels were lower in clear cell carcinomas than high-grade serous carcinomas (P = .02). Immunoreaction for p21-activated kinase 1 was concordant with the results obtained by real-time polymerase chain reaction for CDC42. In clear cell carcinomas, RHOA and RHOC messenger RNA expression was lower in stage I than in advanced-stage tumors (P = .03 and P = .005, respectively). Furthermore, in high-grade serous carcinomas, RHOA expression was higher in patients who did not respond to chemotherapy (P = .04). ARHGDIA, CDC42, RHOA, and RHOC expression may contribute to explain the different stage at diagnosis of clear cell and high-grade serous carcinomas. RHOA may cause resistance of high-grade serous carcinoma to chemotherapy.     

Motor coordination: when two have to act as one

Trying to pass someone walking toward you in a narrow corridor is a familiar example of a two-person motor game that requires coordination. In this study, we investigate coordination in sensorimotor tasks that correspond to classic coordination games with multiple Nash equilibria, such as "choosing sides," "stag hunt," "chicken," and "battle of sexes". In these tasks, subjects made reaching movements reflecting their continuously evolving "decisions" while they received a continuous payoff in the form of a resistive force counteracting their movements. Successful coordination required two subjects to "choose" the same Nash equilibrium in this force-payoff landscape within a single reach. We found that on the majority of trials coordination was achieved. Compared to the proportion of trials in which miscoordination occurred, successful coordination was characterized by several distinct features: an increased mutual information between the players' movement endpoints, an increased joint entropy during the movements, and by differences in the timing of the players' responses. Moreover, we found that the probability of successful coordination depends on the players' initial distance from the Nash equilibria. Our results suggest that two-person coordination arises naturally in motor interactions and is facilitated by favorable initial positions, stereotypical motor pattern, and differences in response times.     

Surgical oncology: historical development and current status

The surgical oncology remains an essential part in the multidisciplinary management for patients with cancer, even though the current progress in field of radiotherapy, chemotherapy, systemic therapies, including therapies directed to molecular targets. Their role impact in several moments during the management of an oncological patient: prevention, diagnosis, assessment of the spread of the disease, curative treatment, management of the sequels, complications by the treatment and not less important, the palliation. The current state of the surgical oncology as a result of a constant development, inspired by skillful hands with creative and restless minds, have achieved to mark the history of the medicine in an area which currently has a great transcendence and an accelerated growth in a short period of time. Under this argument, we have decided to present an updated overview about the role of the surgical oncology, from the evolution through the history until all their applications in the different areas of the oncology.     

Utility of oligoclonal IgG band detection for MS diagnosis in daily clinical practice

An early and accurate diagnosis of multiple sclerosis (MS) is very important, since it allows early treatment initiation, which reduces the activity of the disease. Oligoclonal IgG band (OCGB) detection is a good ancillary tool for MS diagnosis. However, it was argued that its usefulness was limited by the high interlaboratory variability. In the last years, different techniques for OCGB detection have appeared. We performed a blinded aleatorized multicenter study in 19 Spanish hospitals to assess the accuracy and reproducibility of OCGB detection in this new scenario. We studied cerebrospinal fluid (CSF) and serum samples from 114 neurological patients. Every hospital contributed to the study with triplicated pairs of CSF and serum samples of six patients and analyzed 18 different samples. Global analysis rendered a sensitivity of 92.1%, a specificity of 95.1% and a Kappa value of 0.81. This shows that current techniques for OCGB detection have good accuracy and a high interlaboratory reproducibility and thus, represent a good tool for MS diagnosis. When we analyzed separately the different techniques used for OCGB detection, the highest concordance was observed in western blot with alkaline phosphatase detection (kappa=0.91). This indicates that high sensitivity techniques improve the reproducibility of this assay.     

Vaccine-derived poliomyelitis 12 years after infection in Minnesota

A 44-year-old woman with long-standing common variable immunodeficiency who was receiving intravenous immune globulin suddenly had paralysis of all four limbs and the respiratory muscles, resulting in death. Type 2 vaccine-derived poliovirus was isolated from stool. The viral capsid protein VP1 region had diverged from the vaccine strain at 12.3% of nucleotide positions, and the two attenuating substitutions had reverted to the wild-type sequence. Infection probably occurred 11.9 years earlier (95% confidence interval [CI], 10.9 to 13.2), when her child received the oral poliovirus vaccine. No secondary cases were identified among close contacts or 2038 screened health care workers. Patients with common variable immunodeficiency can be chronically infected with poliovirus, and poliomyelitis can develop despite treatment with intravenous immune globulin.