Usefulness of single-channel amplitude-integrated electroencephalography for continuous seizure monitoring in infancy: A case report

We continuously monitored clustered seizures using single-channel amplitude-integrated electroencephalography (aEEG) in a 6-month-old girl with probable benign partial epilepsy in infancy (BPEI). The patient was admitted with clustered seizures, and aEEG using three disposable electrodes was started by a non-expert pediatrician. During the recording, seven seizures were detected. The last seizure was nearly overlooked on clinical observation, but was later confirmed on the basis of aEEG findings. The efficacy of antiepileptic drugs could also be objectively assessed from aEEG findings. Our results show that aEEG is useful for the continuous monitoring of seizures even in older children.     

Simplified staging system for predicting the prognosis of patients with resectable liver metastasis: development and validation

HYPOTHESIS: Although several staging systems for colorectal liver metastasis have been proposed, simple and generally accepted staging systems are not available for this disease. We hypothesized that more detailed analysis of primary colorectal cancer may make it possible to develop a simple staging system and that its stratification ability may be demonstrated by validation against data from unrelated patients. DESIGN: Retrospective analysis of prospectively documented data, development of a stage, and validation against an unrelated cohort. SETTING: Four tertiary referral centers. PATIENTS: Twenty-two clinicopathologic factors were examined in 369 consecutive patients who underwent curative resection for liver metastasis from colorectal cancer (original cohort). Using the independent prognostic factors, a simplified staging system was developed and was validated by data from 229 unrelated patients (validation cohort). MAIN OUTCOME MEASURES: Kaplan-Meier survival curve analyses between different prognostic groups in the cohorts. RESULTS: Multivariate analysis revealed several independent prognostic variables, including hepatic lymph node metastasis (relative risk 4.39), 4 or more colorectal lymph node metastases (RR 1.50), carcinoembryonic antigen level of 50 ng/mL or higher (RR 1.29), and multiple hepatic metastases (RR 1.27). Patients with hepatic lymph node metastasis were assigned to stage 4, and the remaining patients were divided according to number of factors: none, stage 1; 1, stage 2; 2 or 3, stage 3. In the original cohort, median survival in stages 1, 2, 3, and 4 was 7.2, 3.5, 2.0, and 1.3 years, respectively. In the validation cohort, these values were 9.6, 4.1, 2.8, and 1.6 years, respectively. CONCLUSIONS: The proposed simplified staging system was easy to use, was highly predictive of patient outcome, and permitted categorization of patients into treatment groups. Although we validated this staging system, further validation and improvements are needed.     

Characterization of chronic glutamate-mediated motor neuron toxicity in organotypic spinal cord culture prepared from ALS model mice

Amyotrophic lateral sclerosis (ALS) is a devastating neurodegenerative disease characterized by selective loss of motor neurons. Although organotypic spinal slice cultures (OSCs) exposed to inhibitors of glutamate uptake have been used as a model of ALS for screening of potentially therapeutic drugs, little development of such drugs has been achieved. In the present study we attempted to establish OSCs from G93A SOD1 transgenic mice (G93A) and to characterize the specific cell death pathway in motoneurons using glial cell line-derived neurotrophic factor (GDNF) in these mice. In the presence of GDNF, the number of surviving neurons in the OSCs was dramatically increased in both G93A and control mice. Exposure to threo-hydroxyaspartate (THA), a glutamate transport inhibitor, for 14 days induced loss of motoneurons in OSCs in G93A and control mice. In OSCs cultured with GDNF, THA-induced motoneuronal death was significantly inhibited in G93A mice, whereas that in control mice was not significantly affected. Moreover, the cleaved form of caspase-12 was increased after THA in the OSCs in G93A but not in control mice, and the activation of caspase-12 was attenuated by OSCs cultured with GDNF. These results suggest that the pathway responsible for motoneuronal death induced by THA in OSCs in G93A mice involves not only in excitotoxicity but also other mechanisms, and that the caspase-12-dependent ER stress pathway plays a role in spinal neuronal death in G93A mice. Moreover, OSCs prepared from the G93A mouse model of ALS may provide a suitable in vitro drug screening model for ALS.     

Surgery for hepatic neuroendocrine tumors: a single institutional experience in Japan

BACKGROUND: Surgical resection has been advocated as an effective treatment for hepatic neuroendocrine tumors (HNETs) in Western countries, but few data are available to define its indications. We evaluated the results of Japanese patients to determine the prognostic factors and the feasibility of our aggressive surgical approach. METHODS: The records of all consecutive patients who underwent surgical resection for HNETs at our institution were retrospectively reviewed. Patients were selected for surgery if all tumors were deemed resectable, regardless of their extent. RESULTS: A total of 21 patients were identified. Bilobar disease was present in 13 patients (62%). Eleven patients (52%) underwent major hepatectomy, which included right trisectionectomy, extended right or left hepatectomy and right hepatectomy. No in-hospital death occurred. The overall 1-, 3- and 5-year survival rates were 95, 68 and 41%, respectively, with a median follow-up of 34 months. Metastatic HNETs from bronchopulmonary primaries exhibited significantly poor outcome compared with other primary sites (P = 0.04). Patients who underwent curative resection had an improved overall 5-year survival rate of 73% compared with palliative resection (0%, P = 0.01). The longest survival in the latter group was 57 months. Complete symptom resolution rate was 92%. CONCLUSIONS: This is the first study from Asia demonstrating the safety of aggressive hepatic resection for HNETs. Significant symptom relief and long-term survival were achieved irrespective of the extent of disease or the magnitude of operation. Metastatic HNETs from bronchopulmonary primaries may represent a more lethal subset of tumors.     

N-terminus of Etanercept is Proteolytically Processed by Dipeptidyl Peptidase-4

Pharmaceutical Research - Biologics are structurally heterogeneous and can undergo biotransformation in the body. Etanercept (ETN) is a fusion protein composed of a soluble tumor necrosis factor...     

HHV-6, 7 and their related diseases

Human herpesvirus 6 (HHV-6) and human herpesvirus 7 (HHV-7) are relatively recently discovered beta-herpesvirus. They are prevalent in the human population. Primary infection of HHV-6 has been associated with exanthem subitum and febrile illness. Little information is known about the clinical characteristics of primary infection with HHV-7, although some cases of exanthem subitum have been linked to it. HHV-6 has been recently recognized as an opportunistic pathogen in patients with HIV infection and in transplant recipients. The techniques now available to detect these two viruses remain limited, though putative roles for HHV-6 and HHV-7 in several diseases linked to viral infection have been reported. This report reviews the current knowledge of HHV-6 and HHV-7 biology and their pathogenesis.