Brain metastases from cholangiocarcinoma: a first case series in Thailand

Background: Brain metastasis from cholangiocarcinoma (CCA) is a rare but fatal event. To the best of ourknowledge, only few cases have been reported. Herein, we report the incident rate and a first case series of brainmetastases from CCA. Methods: Between January 2006 and December 2010 5,164 patients were treated atSrinagarind hospital, Khon Kaen University; of those, 8 patients developed brain metastasis. Here we reviewedclinical data and survival times. Results: The incident rate of brain metastases from CCA was 0.15%. The medianage of the patients was 60 years. Tumor subtypes were intrahepatic in 6 and hilar in 2 patients. All suffered fromsymptoms related to brain metastasis. Three patients were treated with whole-brain radiation therapy (WBRT),one of whom also underwent surgery. The median survival after the diagnosis of brain metastasis was 9.5 weeks(1-28 weeks). The longest survival observed in a patient in RPA class I with two brain lesions and received WBRT.Conclusion: This is a first case series of brain metastases from CCA with the incident rate of 0.15%. It is rareand associated with short survival time.     

Assessing the performance of a methyl methacrylate-based resin cement with self-etching primer for bonding orthodontic brackets

Questions over the usefulness of a self-etching primer with resin adhesive in the bonding of orthodontic brackets remain unsolved. The purpose of this study was to determine the effects of using Multibond, a new methyl methacrylate (MMA)-based resin cement with self-etching primer, on the shear bond strength of orthodontic brackets compared with Superbond C&B, which is a well-known MMA-based resin cement containing phosphoric acid etching. Metal or plastic brackets were bonded to etched or self-etching primed bovine teeth using Superbond C&B or Multibond. The shear bond strengths were measured after immersion in water at 37 degrees C for 24 hours. Data were analyzed by two-way analysis of variance and Scheffe's test. The surface appearances of the teeth after phosphoric acid etching or self-etching priming were observed by field-emission scanning electron microscopy (FE-SEM). Metal brackets bonded with Multibond had a significantly lower shear bond strength than metal brackets bonded with Superbond C&B. No significant differences in shear bond strength were observed between Multibond and Superbond C&B when plastic brackets were bonded to the enamel. The shear bond strength of metal brackets bonded with Multibond was comparable with that of plastic brackets bonded with Superbond C&B. Adhesive remnant index score showed a tendency of more residual resin cement remaining on the teeth when metal brackets were bonded with Multibond. FE-SEM observation revealed less dissolution of the enamel surface resulting from treatment with Multibond self-etching primer as compared with phosphoric acid. Thus, the Multibond system may be a candidate for bonding orthodontic brackets with the advantage of minimizing enamel loss.     

Bonding durability between orthodontic brackets and human enamel treated with megabond self-etching primer using 4-META/MMA-TBB resin cement

The purpose of this study was to determine the bonding durability when a Megabond self-etching primer is used with 4-META/MMA-TBB resin to bond metal orthodontic brackets to human premolar enamel. Three conditions of enamel were prepared: Megabond self-etching primer without saliva contamination, Megabond self-etching primer with saliva contamination, and repeat Megabond self-etching priming after saliva contamination. Shear bond strengths were measured after immersion in water at 37 degrees C for 24 hours, or after 2000 or 5000 cycles of thermal cycling between 5 degrees C and 55 degrees C. There were no significant differences in shear bond strength among the three groups not only before thermal cycling, but also after thermal cycling. FE-SEM observation revealed the presence of saliva and reduced amount of resin tag formation after saliva contamination. The present study provided the evidence in human teeth that when using 4-META/MMA-TBB resin, Megabond self-etching primer treatment produced tight bonding even when surface was contaminated with saliva.     

Anti-HIV-1 integrase compounds from Dioscorea bulbifera and molecular docking study

Context Dioscorea bulbifera L. (Dioscoreaceae) has been used in a traditional Thai longevity medicine preparation. Isolation of inhibitors from natural products is a potential source for continuous development of new HIV-1 integrase (IN) inhibitors.

Objective The objective of this study is to isolate the compounds and evaluate their anti-HIV-1 IN activity, as well as to predict the potential interactions of the compounds with an IN.

Materials and methods The ethyl acetate and water fractions (1–100?μg/mL) of Dioscorea bulbifera bulbils were isolated and tested for their anti-HIV-1 IN activity using the multiplate integration assay (MIA). The interactions of the active compounds with IN were investigated using a molecular docking method.

Results and discussions The ethyl acetate and water fractions of Dioscorea bulbifera bulbils afforded seven compounds. Among these, allantoin (1), 2,4,3′,5′-tetrahydroxybibenzyl (2), and 5,7,4′-trihydroxy-2-styrylchromone (5) were isolated for the first time from this plant. Myricetin (4) exhibited the most potent activity with an IC₅₀ value of 3.15?μM, followed by 2,4,6,7-tetrahydroxy-9,10-dihydrophenanthrene (3, IC₅₀ value=?14.20?μM), quercetin-3-O-β-d-glucopyranoside (6, IC₅₀ value?=?19.39?μM) and quercetin-3-O-β-d-galactopyranoside (7, IC₅₀ value?=?21.80?μM). Potential interactions of the active compounds (3, 4, 6, and 7) with the IN active site were additionally investigated. Compound 4 showed the best binding affinity to IN and formed strong interactions with various amino acid residues. These compounds interacted with Asp64, Thr66, His67, Glu92, Asp116, Gln148, Glu152, Asn155, and Lys159, which are involved in both the 3′-processing and strand transfer reactions of IN. In particular, galloyl, catechol, and sugar moieties were successful inhibitors for HIV-1 IN.     

Meigs’ Syndrome with Elevated Serum CA125: Case Report and Review of the Literature

An elevated serum CA125 level in association with a pelvic mass, pleural effusion, and massive ascites usually signifies a dismal prognosis in a postmenopausal woman. However, surgery and histopathological examination are required for the correct diagnosis and treatment, since an elevated CA125 level can be falsely positive for ovarian malignancy. We present a case of Meigs’ syndrome due to right ovarian fibroma with elevated CA125 level in a postmenopausal woman.Key Words: Meigs’ syndrome, Ascites, Pleural effusion, Serum CA125     

Anti‐SARS‐CoV‐2 IgG antibody levels among Thai healthcare providers receiving homologous and heterologous COVID‐19 vaccination regimens

BackgroundWe examined SARS‐CoV‐2 anti‐spike 1 IgG antibody levels following COVID‐19 vaccination (AstraZeneca [AZ], Sinovac [SV], Pfizer‐BioNTech [PZ]) among Thai healthcare providers.MethodsBlood specimens were tested using enzyme‐linked immunosorbent assay. We analyzed seven vaccination regimens: (1) one dose of AZ or SV, (2) two doses of homologous (2AZ, 2SV) or heterologous (1AZ + 1PZ) vaccines, and (3) three doses of heterologous vaccines (2SV + 1AZ, 2SV + 1PZ). Differences in antibody levels were assessed using Kruskal–Wallis statistic, Mann–Whitney test, or Wilcoxon matched‐pairs signed‐rank test. Antibody kinetics were predicted using fractional polynomial regression.ResultsThe 563 participants had median age of 39 years; 92% were female; 74% reported no underlying medical condition. Antibody levels peaked at 22–23 days in both 1AZ and 2SV vaccinees and dropped below assay''s cutoff for positive (35.2 binding antibody units/ml [BAU/ml]) in 55 days among 1AZ vaccinees compared with 117 days among 2SV vaccinees. 1AZ + 1PZ vaccination regimen was highly immunogenic (median 2279 BAU/ml) 1–4 weeks post vaccination. 2SV + 1PZ vaccinees had significantly higher antibody levels than 2SV + 1AZ vaccinees 4 weeks post vaccination (3423 vs. 2105 BAU/ml; p‐value < 0.01), and during weeks 5–8 (3656 vs. 1072 BAU/ml; p‐value < 0.01). Antibodies peaked at 12–15 days in both 2SV + 1PZ and 2SV + 1AZ vaccinees, but those of 2SV + 1AZ declined more rapidly and dropped below assay''s cutoff in 228 days while those of 2SV + 1PZ remained detectable.Conclusions1AZ + 1PZ, 2SV + 1AZ, and 2SV + 1PZ vaccinees had substantial IgG levels, suggesting that these individuals likely mounted sufficient anti‐S1 IgG antibodies for possible protection against SARS‐CoV‐2 infection.     

Hepatitis B virus strains in Thailand: Genomic variants in chronic carriers

Genetic heterogeneity of the hepatitis B virus (HBV) has been shown to influence the serological pattern and clinical picture in HBV infection. Thailand has a high transmission rate of HBV, but the molecular epidemiology of HBV strains circulating in this region was hitherto unknown. In this study, the HBV strains from 34 Thai HBsAg-positive patients were investigated. In a proportion of these samples, an antigenically important region of the S gene (n = 181, and the pre-S2 and precore genes (n = 15) were sequenced after PCR amplification. Four strains had in-frame deletions of an upstream region of the pre-S2 gene, with all deletions ending at the same nucleotide. In one of three anti-HBe positive strains without a translational stop at codon 28 of the precore gene, there was a one nucleotide insertion in the precore gene. This insertion would cause a frame shift and result in a nonsense protein being expressed, thus providing one explanation for the lack of HBeAg in this patient. Several rare or unique amino acid changes in the region between residues 120 and 161 of the S protein were found. Glycine 145 was changed to alanine in one strain, and this position showed an apparent mixture of glycine and arginine in another. In total, 10 strains displayed unexpected changes that were not related to the normal variability between subtypes or genetic subgroups. It is concluded that there is considerable heterogeneity in HBV strains in Thailand and that this could have clinical and epidemiological importance in a region with high HBV transmission rates. © Wiley-Liss, Inc.     

Cannabinoid receptor 1 (CB1R) expression in rat dental pulp

Purpose of the researchAccumulating evidence supports the role of the cannabinoid system in providing an antinociceptive effect in various painful conditions. This effect is mediated through the Cannabinoid receptor 1 (CB1R) expressed on nociceptive afferent nerve terminals. To investigate whether this receptor plays a similar role in dental pain, we studied the presence and distribution of CB1R in rat dental pulp. Pulps from 28 maxillary molars were immunohistochemically stained with an antibody against CB1R.Principal resultsOf all tooth specimens, CB1R immunoreactivity (CB1R-ir) was observed to be associated with nerve fibers in radicular pulp and was seen as a continuous network in the subodontoblastic layer.Major conclusionCB1R was present on nerve fibers in rat dental pulp and possibly plays a role in dental pain mechanisms.     

MRI findings in acute disseminated encephalomyelitis following varicella infection in an adult

There are no abnormal magnetic resonance imaging (MRI) findings in children with acute disseminated encephalomyelitis (ADEM) after varicella infection. Here, we report abnormal MRI findings in an adult, namely: hyperintense signal in the right medullary olive, the right side of the pons, the left middle cerebellar peduncle, the dorsal aspect of both thalami and the periventricular white matter of both cerebral hemispheres. The patient's condition improved after 1 week of corticosteroid treatment. Four months later, MRI of the brain showed almost complete resolution and there were no further attacks of motor weakness at 18-months follow-up.