A case of extensive hyperostosis frontalis interna in an 87-year-old female human cadaver

Hyperostosis frontalis interna (HFI) is a condition that involves thickening of the inner surface of the frontal bone with sparing of the midline. Little is known about the etiology and clinical presentation of HFI. We report unusual findings in a woman with extensive Type D hyperostosis of the frontal bone and a large hyperostotic nodule in the parietal bone with impingement on the precentral gyrus, distinguishing this from the common form of HFI. The scalp was dissected from the cranial vault, and the calvaria and brain were removed and digitally imaged. Bone specimens were embedded in methyl methacrylate plastic, sectioned, and stained using the Von Kossa Method with MacNeal's tetrachrome. Medical records were reviewed, and additional history was obtained through interviews with the donor's family. The calvaria had extensive, bilateral thickening of the frontal bone with irregular topography and clearly demarcated borders. The dura was adherent to all hyperostotic regions. A 3.5-cm nodule was visible on the inner table of the left parietal bone. The dura and cerebrum showed compression in this region, but it was unclear if this resulted in clinical ramifications. Microscopic analysis revealed a larger proportion of cancellous bone was present in regions of macroscopic hyperostosis. Quantitative analysis of sections through areas of gross hyperostosis demonstrated a lower proportion of lamellar bone than in the control. The patient exhibited symptoms that have been correlated to HFI in previous studies. We suggest that the HFI disease process was responsible for the manifestation of these symptoms in this patient.     

Articulation development in preschool children: consistency of productions

The purpose of this study was to describe the consistency of productions of /theta, r, l, s, t, f, t, k/ in releasing and arresting position for 2 1/2- to 5-year-old children. The Coarticulation Assessment in Meaningful Language (Kenney & Prather, 1984) was given to 360 children, 60 at each of six age levels. A four-way multivariate analysis of variance with repeated measures on the last two factors was used to test for main effects and interactions among age, sex, phoneme, and position. These children produced /theta, t, l, f/with greater accuracy in the releasing position, but articulated /k, s, t/ at similar levels of accuracy in both positions. They produced /r/ with greater accuracy as a vocalic allophone. Further patterns and interactions are discussed.     

Anxiogenic behavior in rats during acute and protracted ethanol withdrawal: reversal by buspirone.

This study investigated the effectiveness of buspirone in reversing the anxiogenic behaviors occurring during ethanol withdrawal as measured in the elevated plus-maze. In response to anxiogenic drugs, rats spend less time in and make fewer entries onto the open arms of an elevated plus-maze, whereas anxiolytic drugs produce opposite effects. In this study, rats were fed a liquid diet containing 4.5% ethanol for 7 days. Twelve h (acute withdrawal) and 7 days (protracted withdrawal) following cessation of the ethanol diet, rats were tested on the elevated plus-maze. During these withdrawal periods, the percent open-arm entries and time spent on the open arms were significantly reduced relative to animals fed an ethanol-free diet, suggestive of anxiogenic-like symptoms. Buspirone (0.32-1.25 mg/kg) dose dependently reversed the withdrawal-induced decreases in open-arm activity. The anxiolytic-like activity of buspirone observed during ethanol withdrawal may be due to a reduction in serotonergic neurotransmission through activation of presynaptic 5-HT1A autoreceptors. The results obtained in this study suggest that pharmacotherapy with selective 5-HT1A agonists may be beneficial in alleviation of anxiety during ethanol withdrawal.     

Mineral balances of men and women consuming high fiber diets with complex or simple carbohydrate

Calcium, copper, iron, magnesium, manganese, and zinc balances of 20 men, 19 premenopausal women, and 12 postmenopausal women were determined while they consumed self-selected diets or high fiber diets with either complex or simple carbohydrate. Self-selected intakes of calcium, magnesium, copper and zinc were generally below RDA levels. Iron intakes of premenopausal women were less than two-thirds RDA. Balances during the self-selected intake period of calcium in men and women and of magnesium and zinc in women were negative, but lower-than-usual intakes could have contributed to this. High fiber diets did not adversely affect zinc, copper, manganese or iron balances. Calcium and magnesium balances were generally negative, especially in women, even though intakes were adequate. Excretion of copper was increased in premenopausal women consuming the simple carbohydrate diet. The levels of magnesium and especially calcium needed to maintain balance when consuming a high fiber diet may be above present RDA levels.     

检查前用药可降低乳腺钼钯X线检查中的不适

目的验证乳腺钼钯X线检查前给予对乙酰氨基酚、布洛酚和(或)4%利多卡因凝胶能否减轻检查不适或提高普查中有恐惧感妇女的满意度。方法本前瞻性研究为     

A Systematic Review and Network Meta-Analysis to Evaluate the Comparative Efficacy of Interventions for Unfit Patients with Chronic Lymphocytic Leukemia

Introduction

Rituximab plus fludarabine and cyclophosphamide (RFC) is the standard of care for fit patients with untreated chronic lymphocytic leukemia (CLL); however, its use is limited in ‘unfit’ (co-morbid and/or full-dose F-ineligible) patients due to its toxicity profile. We conducted a systematic review and Bayesian network meta-analysis (NMA) to determine the relative efficacy of commercially available interventions for the first-line treatment of unfit CLL patients.

Methods

For inclusion in the NMA, studies had to be linked via common treatment comparators, report progression-free survival (PFS), and/or overall survival (OS), and meet at least one of the five inclusion criteria: median cumulative illness score >6, median creatinine clearance ≤70 mL/min, existing co-morbidities, median age ≥70 years, and no full-dose F in the comparator arm. A manual review, validated by external experts, of all studies that met at least one of these criteria was also performed to confirm that they evaluated first-line therapeutic options for unfit patients with CLL.

Results

In unfit patients, the main NMA (five studies for PFS and four for OS) demonstrated clear preference in terms of PFS for obinutuzumab + chlorambucil (G-Clb) versus rituximab + chlorambucil (R-Clb), ofatumumab + chlorambucil (O-Clb), fludarabine and chlorambucil (median hazard ratios [HRs] 0.43, 0.33, 0.20, and 0.19, respectively), and a trend for better efficacy versus rituximab + bendamustine (R-Benda) and RFC-Lite (median HR 0.81 and 0.88, respectively). OS results were generally consistent with PFS data, (median HR 0.48, 0.53, and 0.81, respectively) for G-Clb versus Clb, O-Clb, and R-Clb 0.35 and 0.81 versus F and R-Benda, respectively); however, the OS findings were associated with higher uncertainty. Treatment ranking reflected improved PFS and OS with G-Clb over other treatment strategies (median rank of one for both endpoints).

Conclusion

G-Clb is likely to show superior efficacy to other treatment options selected in our NMA for unfit treatment-naïve patients with CLL.

Funding

F. Hoffmann-La Roche Ltd.