Primary Uterine NK-Cell Lymphoma,Nasal-Type: A Unique Malignancy of a Prominent Cell Type of the Endometrium

Natural killer (NK) cells host in the human endometrium with dedicated role in reproductive physiology. Interestingly, malignant transformation of these specialized cells has not been presented thus far. Here we report a primary endometrial NK-cell lymphoma of a 48 year-old patient presenting with irregular bleeding. The endometrial curetting showed a dense lymphomatous infiltrate demonstrating highly infiltrative aggressive features with characteristic angiocentric, partially angiodestructive growth pattern and accompanying focal necroses. The lymphoma cells displayed a CD3ε/CD56/TIA-1/granzyme-B-positive and CD5/CD4/CD8/TCRγδ-negative immunophenotype, proved to be positive for Epstein-Barr virus by EBER in situ hybridization, and revealed no clonal T-cell receptor gene rearrangement. The diagnosis of uterine extranodal NK-cell lymphoma, nasal-type was made. Clinically, the disease was limited to the uterus at diagnosis, but progressed rapidly, and the patient died within 5 months due disseminated lymphoma, irrespective of intensive chemotherapy. Genuine NK-cell lymphomas occurring in the uterus as primary site seem to be rare making the therapeutic decisions extremely complicated.     

Pituitary adenylate cyclase activating polypeptide is protective in bilateral carotid occlusion-induced retinal lesion in rats

Pituitary adenylate cyclase activating popypeptide (PACAP) is a pleiotropic neuropeptide, exerting neurotrophic and neuroprotective effects in numerous models of in vitro and in vivo nervous injuries. The aim of the present study was to investigate whether PACAP is neuroprotective in ischemic retinal damage. Adult male Wistar rats underwent bilateral carotid occlusion and PACAP was administered unilaterally into the vitreous body immediately following carotid occlusion. Retinas were analyzed three weeks after the injury. It was found that bilateral carotid occlusion led to a severe degeneration of all retinal layers. PACAP treatment significantly ameliorated the carotid occlusion-induced retinal damage: the overall thickness of the retina was significantly more than in control carotid occluded animals and the morphological characteristics of the photoreceptors showed nearly normal appearance. The outer plexiform layer remained discernible and the inner and outer nuclear layers were significantly thicker than in control animals. In summary, our present study provides evidence, for the first time, that PACAP attenuates ischemic retinal degeneration.     

Prospective memory in adults with traumatic brain injury: an analysis of perceived reasons for remembering and forgetting

Reasons for prospective remembering and forgetting after traumatic brain injury (TBI) were investigated using Ellis' (1996) five phases of prospective memory as a framework. Participants were 38 individuals with severe TBI and 34 controls. Participants self-rated their perceived reasons for prospective remembering and forgetting using section C of the Comprehensive Assessment of Prospective Memory (CAPM). Significant others also rated participants using the same scale. Analyses were conducted to examine the effect of group membership (TBI or control) on reported reasons for prospective remembering and forgetting. Findings highlighted the TBI group's difficulties with encoding, performance interval, and execution phases of prospective remembering.     

Improved Glycemic Control through Continuous Glucose Sensor-Augmented Insulin Pump Therapy: Prospective Results from a Community and Academic Practice Patient Registry

Background

Conducted by highly experienced investigators with abundant time and resources, phase III studies of continuous glucose sensing (CGS) may lack generalizability to everyday clinical practice.

Method

Community or academic practices in six Central and Eastern European or Mediterranean countries prospectively established an anonymized registry of consecutive patients with type 1 insulin-dependent diabetes mellitus starting CGS-augmented insulin pump therapy with the Paradigm^® X22 (Medtronic MiniMed, Northridge, CA) under everyday conditions, without prior CGS with another device. We compared glycosylated hemoglobin (GHb) values before and after 3 months of CGS and assessed relationships between insulin therapy variables and glycemia-related variables at weeks 1, 4, and 12 of CGS.

Results

Of 102 enrolled patients, 85 (83%) with complete weeks 1, 4, and 12 sensor data and baseline/3-month GHb data were evaluable. Evaluable patients were ∼54% male and ∼75% adult (mean age, 33.2 ± 16.9 years) with longstanding diabetes and high personal/family education levels. Mean GHb declined significantly after 3 months of CGS (7.55 ± 1.33% at baseline to 6.81 ± 1.08% after 12 weeks, 0.74% absolute decrease, P < 0.001). The absolute GHb reduction correlated significantly (P < 0.0005) with baseline GHb: larger absolute reductions tended to occur when baseline levels were higher. An increased basal insulin dose as a percentage of the total daily insulin dose and a decreased daily bolus count from week 1 to week 12 of CGS predicted GHb improvement from baseline to week 12.

Conclusions

CGS-augmented insulin pump therapy appears to improve glycemic control in type 1 diabetes in varied everyday practice settings.     

Interactions between the Endocrine and Exocrine Pancreas and Their Clinical Relevance

In consequence of the close anatomical and functional links between the exocrine and endocrine pancreas, any disease affecting one of these parts will inevitably affect the other. Pancreatic conditions which might cause diabetes mellitus include acute and chronic pancreatitis, pancreatic surgery, cystic fibrosis and pancreatic cancer. The development of diabetes greatly influences the prognosis and quality of life of patients with exocrine pancreatic diseases. It may cause life-threatening com plications, such as hypoglycemia, due to the lack of glucagon and the impaired absorption of nutrients, or the micro- and macrovascular complications may impair the organ functions. Diabetes mellitus is an independent risk factor of mortality in those with exocrine pancreatic diseases. The treatment of pancreatic diabetes, a distinct metabolic and clinical form of diabetes, requires special knowledge. Diet and pancreatic enzyme replacement therapy may be sufficient in the early stages. Oral antidiabetic drugs are not recommended. If the diet proves inadequate to reach the glycemic goals, insulin treatment with multiple injections is required. Impairments of the exocrine pancreatic function and morphology in diabetic patients are frequent and well known. Atrophy of the exocrine tissue may be caused by the lack of trophic insulin, whereas pancreatic fibrosis can result from activation of stellate cells by hyperglycemia, or from microangiopathy and neuropathy. The regulation of the exocrine pancreaticfunction isal so damaged because of theim-paired effect of islet hormones. In the event of a proven impairment of the pancreatic exocrine function in diabetes meliitus, pancreatic enzyme replacement therapy is indicated. This may improve the nutritional condition of the patient and decrease the metabolic instability.     

Reactions of young children to the MRI scanner environment

Seventy children aged 2 to 7 years were exposed to the MRI environment through a series of steps typical of a research study. Their willingness to proceed through the process was used to estimate the prevalence of fear. Thirty‐seven children (53%; 95% confidence interval [41%, 65%]) completed the approach sequence. Although the correlation of child age in months (Mean (M) = 60.1, standard deviation = 16.5, N = 70) and highest successful step (M = 5.8, standard deviation = 2.6, 95% confidence interval [5.2, 6.4]) completed was not statistically significant at the 0.05 level, r (68) = 0.21, P = 0.08, 95% confidence interval [?0.03, 0.42], the proportion of children aged 6‐7 years who successfully completed all steps (14 of 21, 67%, 95% confidence interval [50%, 84%]) was significantly different from the proportion of children aged 2‐3 years who completed all steps (six of 23, 26%, 95% confidence interval [11%, 41%]) (Fisher's exact test, two‐tailed P = 0.0148). A failure rate of at least 50% should be included into group size calculations when performing studies with young children (2‐7 years), in addition to motion and other experimental factors. Magn Reson Med, 2010. © 2010 Wiley‐Liss, Inc.