Comparison of smear cytology with histopathology of the CT guided stereotactic brain biopsy

The study was undertaken to determine the accuracy of cytological diagnosis of CNS lesions by comparing it with the final histopathological diagnosis of CT guided stereotactic brain biopsy. Squash preparations were prepared from 25 cases of CNS lesions operated in two years. These included 18 astrocytomas, 1 metastatic deposits, 1 epidermoid cyst, 1 Toxoplasmosis, 1 granulomatous inflammation and 3 cases showing normal brain parenchyma. The cytological diagnosis was available to the neurosurgeon within 10 minutes. The cytohistological correlation with paraffin block sections worked out to be 92%. Thus, this proved to be a fairly reliable and rapid method for immediate intra-operative diagnosis.     

Calcitonin receptor-stimulated migration of prostate cancer cells is mediated by urokinase receptor-integrin signaling

Abundance of calcitonin (CT) and calcitonin receptor (CTR) mRNA in primary prostate tumors positively correlates with tumor grade, and exogenously added CT increases the invasion of prostate cancer cell lines. We examined acute and chronic actions of CT on migration of highly metastatic PC-3M cells and poorly invasive LNCaP cells on several extracellular matrices in a spheroid disaggregation/migration assay. While PC-3M spheroids displayed maximum disaggregation/migration on vitronectin (VN), LNCaP spheroids preferred collagen but also migrated significantly on VN. Up-regulation of CT significantly enhanced disaggregation/migration of PC-3M spheroids on VN, but not on fibronectin. In contrast, down-regulation of CT, CTR, protein kinase A or urokinase-type plasminogen activator receptor (uPAR) led to amelioration of PC-3M spheroid disaggregation/migration. CT selectively increased surface activity of αvβ3 or α6β5 integrins in PC-3M and LNCaP cell lines, respectively, and uPAR-integrin association. Finally, either CT or urokinase could completely restore migration of CT-knock-down PC-3M spheroids. But, only forced expression of urokinase receptor coupled with exogenous addition of urokinase restored migration of CTR-knock-down spheroids. These results support our hypothesis that up-regulation of CT biosynthesis and activation of CT–CTR axis in primary prostate tumors may have direct relevance in their progression to the metastatic phenotype.     

Endophthalmitis associated with intravenous drug use

Infectious complications related to i.v. drug use represent an important source of morbidity and mortality among this population. We report an informative case of endogenous endophthalmitis related to injection of cocaine mixed with lemon juice. Clinicians should remember that any visual change among patients using injection drugs warrants aggressive workup, including empiric antifungal therapy. Once the disease is identified, early vitrectomy should be considered.     

ASO Visual Abstract: Time to Surgical Treatment and Facility Characteristics as Potential Drivers of Racial Disparities in Breast Cancer Mortality: Delay,Facilities, and Breast Cancer Mortality

Annals of Surgical Oncology -     

Influence of beta-blocker therapy on aortic blood flow in patients with bicuspid aortic valve

In patients with bicuspid aortic valve (BAV), beta-blockers (BB) are assumed to slow ascending aorta (AAo) dilation by reducing wall shear stress (WSS) on the aneurysmal segment. The aim of this study was to assess differences in AAo peak velocity and WSS in BAV patients with and without BB therapy. BAV patients receiving BB (BB+, n = 30, age: 47 ± 11 years) or not on BB (BB?, n = 30, age: 46 ± 13 years) and healthy controls (n = 15, age: 43 ± 11 years) underwent 4D flow MRI for the assessment of in vivo aortic 3D blood flow. Peak systolic velocities and 3D WSS were calculated at the anterior and posterior walls of the AAo. Both patient groups had higher maximum and mean WSS relative to the control group (p = 0.001 to p = 0.04). WSS was not reduced in the BB+ group compared to BB? patients in the anterior AAo (maximum: 1.49 ± 0.47 vs. 1.38 ± 0.49 N/m², p = 0.99, mean: 0.76 ± 0.2 vs. 0.74 ± 0.18 N/m², p = 1.00) or posterior AAo (maximum: 1.45 ± 0.42 vs. 1.39 ± 0.58 N/m², p = 1.00; mean: 0.65 ± 0.16 vs. 0.63 ± 0.16 N/m², p = 1.00). AAo peak velocity was elevated in patients compared to controls (p < 0.01) but similar for BB+ and BB? groups (p = 0.42). Linear models identified significant relationships between aortic stenosis severity and increased maximum WSS (β = 0.186, p = 0.007) and between diameter at the sinus of Valsalva and reduced mean WSS (β = ?0.151, p = 0.045). Peak velocity and systolic WSS were similar for BAV patients irrespective of BB therapy. Further prospective studies are needed to investigate the impact of dosage and duration of BB therapy on aortic hemodynamics and development of aortopathy.     

Cost-effectiveness analysis of baclofen and chlordiazepoxide in uncomplicated alcohol-withdrawal syndrome

Objectives:

Benzodiazepines (BZDs) are the first-line drugs in alcohol-withdrawal syndrome (AWS). Baclofen, a gamma-aminobutyric acid_B (GABA_B) agonist, controls withdrawal symptoms without causing significant adverse effects. The objective of this study was to compare the cost-effectiveness of baclofen and chlordiazepoxide in the management of uncomplicated AWS.

Materials and Methods:

This was a randomized, open label, standard controlled, parallel group study of cost-effectiveness analysis (CEA) of baclofen and chlordiazepoxide in 60 participants with uncomplicated AWS. Clinical efficacy was measured by the Clinical Institute Withdrawal Assessment for alcohol (CIWA-Ar) scores. Lorazepam was used as supplement medication if withdrawal symptoms could not be controlled effectively by the study drugs alone. Both direct and indirect medical costs were considered and the CEA was analyzed in both patient''s perspective and third-party perspective.

Results:

The average cost-effectiveness ratio (ACER) in patient''s perspective of baclofen and chlordiazepoxide was Rs. 5,308.61 and Rs. 2,951.95 per symptom-free day, respectively. The ACER in third-party perspective of baclofen and chlordiazepoxide was Rs. 895.01 and Rs. 476.29 per symptom-free day, respectively. Participants on chlordiazepoxide had more number of symptom-free days when compared with the baclofen group on analysis by Mann-Whitney test (U = 253.50, P = 0.03).

Conclusion:

Both study drugs provided relief of withdrawal symptoms. Chlordiazepoxide was more cost-effective than baclofen. Baclofen was relatively less effective and more expensive than chlordiazepoxide.KEY WORDS: Alcohol-withdrawal syndrome, baclofen, chlordiazepoxide, clinical institute withdrawal assessment for alcohol, cost-effectiveness analysis