An HIV-Infected Woman with Choriocarcinoma Presenting with a Nasal Mass

Gestational choriocarcinoma metastasized to the nasal mucosa is extremely rare. An HIV-infected woman with choriocarcinoma presenting with a nasal mass is reported. The clinical findings are compared with a previous reported case. She responded to multiagent chemotherapy and has obtained complete remission. The role of HIV infection is also discussed.     

Combined nerve transfers for C5 and C6 brachial plexus avulsion injury

PURPOSE: To report the results of combined nerve transfer in C5 and C6 brachial plexus avulsion injury. METHODS: Fifteen patients had nerve transfers: spinal accessory nerve to the suprascapular nerve, a part of the ulnar nerve to the biceps motor branch, and the nerve to the long head of the triceps to the anterior branch of the axillary nerve. Patients were evaluated with regard to elbow flexion, shoulder abduction, and shoulder external rotation. RESULTS: All patients had recovered full elbow flexion: 13 scored M4 and 2 scored M3. Thirteen of the 15 patients obtained good results. The weight the patients could lift ranged from 0 to 7 kg. All patients had recovery of the deltoid function: 13 scored M4 and 2 scored M3. All 15 patients achieved useful functional recovery. Ten patients experienced excellent recoveries and 5 were classified as having good results. The mean shoulder abduction was 115 degrees . Shoulder external rotation strength was scored as M4 in 9 patients, M3 in 4 patients, and M2 in 2 patients. The range of motion of external rotation that was measured from full internal rotation averaged 97 degrees . No clinical donor nerve deficits were observed. CONCLUSIONS: We recommend combined nerve transfers for C5 and C6 avulsion root injuries. These nerve transfers have the advantage of a quick recovery time as a result of the short regeneration distance without nerve graft. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic, Level IV.     

Transformation of temporomandibular joint disc configuration in internal derangement patients using magnetic resonance imaging

PurposeThe normal disc configuration is biconcave; however, the deformed disc can be found in internal derangement (ID) of the temporomandibular joint (TMJ). The purpose of this study was to evaluate the relationship between the transformation patterns of TMJ disc configuration during mouth opening and disc displacement status, disc reduction ability and TMJ clinical symptoms.MethodsTMJ MR images from volunteers and ID patients were analyzed for closed and open mouth positions. MR images of ID patients were classified into 4 groups: symptomatic joint with anterior disc displacement with or without reduction (ADW or ADWo) and asymptomatic joint with ADW or ADWo. The disc configurations in both positions were categorized as biconcave, biplanar, convex or folded; then the patterns of transformation were observed.ResultsFor the ADW group, the most common disc configuration for closed and open mouth positions were biplanar (66.7%) and biconcave (86.3%). The transformation pattern was significantly related to disc reduction ability (p < 0.05).ConclusionsThe transformation patterns of disc configuration during opening were related to anterior disc displacement and disc reduction ability.     

Factors correlating quality of life in patients with myasthenia gravis

We studied factors associated with quality of life (QOL) among myasthenia gravis (MG) patients in two university hospitals in Thailand: Thammasat University (TU) and Khon Kaen University (KKU). Consecutive MG patients from an outpatient neurology clinic of both sites were enrolled and their clinical variables and QOL by the Short-Form 36 questionnaire were assessed. There were 31 and 40 subjects enrolled at TU and KKU, respectively. The mean values of the SF-36 score in seven dimensions were higher at the TU site. The significant factors between both sites were mean age, and numbers of participants with myasthenic symptoms and steroid treatment. The frequency of MG symptoms was the only factor associated with the SF-36 score (correlation coefficient −0.66, p value < 0.01). In conclusion, the frequency of MG symptoms might be the main factor that lowers QOL in MG patients in both physical and mental aspects.     

Pneumonia and Risk of Serious Adverse Outcomes in Hospitalized Strokes in Thailand

Background: The impact of stroke associated pneumonia (SAP) on stroke complications is not well understood; we aimed to study the association between SAP and adverse outcomes including in-hospital mortality, prolonged length of stay and the risk of developing common serious complications (sepsis, respiratory failure, and convulsions). Methods: We retrospectively analyzed data from a cohort of 610,668 stroke patients drawn from the Universal Coverage Health Security Scheme (a national insurance database) in Thailand which covers ～80% of the Thai population. Patients were hospitalized between October 2004 and January 2013. Results: Pneumonia was present in 9.6 % (n = 58,586) of patients. Aspiration pneumonia was present in 6.2% (n = 38,060) and nonaspiration pneumonia in 3.4% (n = 20,526). After adjusting for age, sex, stroke type, and comorbidities, patients with SAP had significantly higher odds of in-hospital mortality (odds ratio [OR] 2.90: 2.83-2.96), long length of stay (OR 13.11: 12.83-13.40), sepsis (OR 8.49: 8.22-8.76), respiratory failure (OR 4.37: 4.27-4.48), and convulsions (OR 2.09: 2.00-2.17). On subanalysis, patients with nonaspiration pneumonia were found to have higher odds of adverse outcomes compared to aspiration pneumonia; the corresponding ORs (95% confidence interval) for above outcomes were 1.25 (1.21-1.30), 2.40 (2.32-2.49), 1.34 (1.28-1.40), 1.80 (1.73-1.88), and 1.19 (1.11-1.28), respectively. Conclusions: SAP is associated with higher odds of inpatient mortality, long length of stay, and risk of developing serious stroke complications. Nonaspiration pneumonia is associated with significantly higher likelihood of adverse outcomes compared to aspiration pneumonia in this patient population. Early identification and treatment of SAP is vital in reducing adverse outcomes in acute stroke.     

Meteorin is a chemokinetic factor in neuroblast migration and promotes stroke-induced striatal neurogenesis

Ischemic stroke affecting the adult brain causes increased progenitor proliferation in the subventricular zone (SVZ) and generation of neuroblasts, which migrate into the damaged striatum and differentiate to mature neurons. Meteorin (METRN), a newly discovered neurotrophic factor, is highly expressed in neural progenitor cells and immature neurons during development, suggesting that it may be involved in neurogenesis. Here, we show that METRN promotes migration of neuroblasts from SVZ explants of postnatal rats and stroke-subjected adult rats via a chemokinetic mechanism, and reduces N-methyl-D-asparate-induced apoptotic cell death in SVZ cells in vitro. Stroke induced by middle cerebral artery occlusion upregulates the expression of endogenous METRN in cells with neuronal phenotype in striatum. Recombinant METRN infused into the stroke-damaged brain stimulates cell proliferation in SVZ, promotes neuroblast migration, and increases the number of immature and mature neurons in the ischemic striatum. Our findings identify METRN as a new factor promoting neurogenesis both in vitro and in vivo by multiple mechanisms. Further work will be needed to translate METRN's actions on endogenous neurogenesis into improved recovery after stroke.     

Synthesis of Benzoazepine Derivatives via Azide Rearrangement and Evaluation of Their Antianxiety Activities

A new synthetic method for the construction of benzoazepine analogues has been developed employing ortho-arylmethylbenzyl azide derivatives as precursors using an azide rearrangement reaction. In this work, 14 benzoazepine compounds were successfully synthesized in moderate to excellent yields. All synthetic benzoazepines were evaluated for their cytotoxicity against normal human kidney cell line (HEK cell). The results showed that compound 18c had the lowest cytotoxicity (IC₅₀ = 65.68 μM) among tested compounds, which was comparable with the antianxiety drug diazepam (IC₅₀ = 87.90 μM). Based on the cytotoxicity results, five benzoazepine analogues (compounds 18c, 18h, 18j, 18n, and 18p) were selected to determine the antianxiety effect on stressed rats using elevated plus maze (EPM) and open field test (OFT) methods. Interestingly, compound 18c showed better anxiolytic activity than diazepam without a sedative effect by showing superior hyperlocomotor activity. Therefore, this discovery could pave the way for drug development to treat patients with anxiety disorder.