Unusual cause of lower extremity wounds: Cobb syndrome

Cobb syndrome (Cutaneomeningospinal Angiomatosis) is a rare segmental neurocutaneous syndrome associated with metameric cutaneous and spinal cord arteriovenous malformations (AVMs). In this syndrome, capillary malformation or angiokeratoma‐like lesions are formed in a dermatomal distribution, with an AVM in the corresponding segment of the spinal cord. The spinal cord lesions can cause neurological disorder and paraplegia, which typically develop during young adulthood. We report a 32‐year‐old male with the Cobb syndrome associated with lower extremity painful wounds and acute‐onset paraplegia due to metameric vascular malformations.     

Purification and characterization of α-amylase in Moroccan locust,Dociostaurus maroccanus Thunberg (Orthoptera: Acrididae) and its inhibition by inhibitors from Phaseolus vulgaris L.

An α-amylase with molecular weight of 73?kDa was purified from midgut of Dociostaurus maroccanus using ammonium sulfate precipitation, gel filtration, and ion exchange chromatography. The optimal pH and temperature were 6 and 45?°C, respectively. As calculated using Lineweaver–Burk plots, the Km was about 0.62?mM and the Vmax was 1.113 (μmol/min/mg protein). Mn²⁺, Hg⁺, Zn²⁺ and ethylene diamine tetraacetic acid (EDTA) decreased α-amylase activity of D. maroccanus, whereas the addition of K⁺, Na⁺, Fe²⁺, Ba⁺, Mg²⁺, Ca²⁺ and Co²⁺ increased enzyme activity. Alpha-amylase inhibitors (AI1, AI2) with molecular weights of 43?kDa and 29?kDa, respectively, were purified from the seeds of Phaseolus vulgaris and its inhibitory effect on purified α-amylase of D. maroccanus was investigated. These inhibitors inhibited the D. maroccanus gut α-amylase activity significantly.     

Hsa-miR-625 Upregulation Promotes Apoptosis in Acute Myeloid Leukemia Cell Line by Targeting Integrin-linked Kinase Pathway

Background: Growing evidence has demonstrated that microRNAs have a major effect on development of different types of cancer including AML. The overexpression of miR-625 could decrease tumorgenesis of acute myeloid leukemia cell lines through Integrin-linked kinase signaling pathway and reducing the associated oncogenes.  The aim of this study is to evaluate the effect of hsa-miR-625 upregulation on apoptosis and proliferation of KG1 cell line via ILK signaling pathway. Methods: The KG-1 cell line was transfected with pLenti-III-premir625-GFP through viral method. Then, expression of miR-625 and genes were analyzed by quantitative PCR. Western blotting was used to evaluate for the protein level. Apoptosis was investigated by flow cytometry. Cell cycle analysis with PI and CCK-8 assay were performed to evaluate proliferation. Results: KG-1 cells transfected with pLenti-III-pre mir625-GFP construct showed a significant increase in cell apoptosis. Gene expression of ILK and NF-κB were downregulated and AKT, c-fos, Caspase3, cyclin D1, KLF-4, OCT-4 and Nanog were upregulated but no alteration in GSK3 expression profile was observed. Downregulation of NF-κB and upregulation of Caspase 3 and p-β-catenin protein levels were indicated (p<0.05). Conclusion: MiR-625 can be a promising approach to aid in the treatment of AML. However, further studies are required in this respect.     

A comparison of the effect of short-term aromatase inhibitor (letrozole) and GnRH agonist (triptorelin) versus case control on pregnancy rate and symptom and sign recurrence after laparoscopic treatment of endometriosis

Purpose  

To compare the role of an aromatase inhibitor (letrozole) with a GnRH agonist (triptorelin) versus case control on the pregnancy rate and recurrence of symptoms and signs in patients with endometriosis.     

Top-Cited Articles in Rehabilitation

Shadgan B, Roig M, HajGhanbari B, Reid WD. Top-cited articles in rehabilitation.

Objective

To identify the 100 top-cited articles ever published in rehabilitation journals and to analyze their characteristics as a quantitative approach to investigating the quality and evolution of rehabilitation research.

Data Sources

The Institute for Scientific Information Web of Knowledge Database and the 2007 and 2008 Journal Citation Report Science Editions were used to retrieve the 100 top-cited articles from 30 rehabilitation dedicated journals.

Study Selection

The 100 top-cited articles included randomized controlled trials, case-control studies, case series studies, case reports, methodologic studies, systematic reviews, narrative reviews, and expert opinions.

Data Extraction

Two independent reviewers performed data extraction from the retrieved articles and compared their results. The Sackett's initial rules of evidence were used to categorize the type of study design as well as to evaluate the level of evidence provided by the results of the 100 top-cited articles.

Data Synthesis

Among the 45,700 articles published in these journals, the 100 top-cited articles were published between 1959 and 2002 with an average of 200 citations an article (range, 131-1109). Top-cited articles were all English-language, primarily from North America (United States=67%; Canada=11%) and published in 11 journals led by the Archives of Physical Medicine and Rehabilitation. Eighty-four percent of the articles were original publications and were most commonly prospective (76%) case series studies (67%) that used human subjects (96%) providing level 4 evidence. Neurorehabilitation (41%), disability (19%), and biomechanics (18%) were the most common fields of study.

Conclusions

We demonstrated that methodologic observational studies performed in North America and published in English have had the highest citations in rehabilitation journals.     

Weight retention from early pregnancy to three years postpartum: a study in Iranian women

Objectives

to examine weight retention from early pregnancy to three years postpartum in Iranian women.

Design

a prospective cohort study.

Setting

12 health centres selected at random in urban and rural areas in Guilan.

Participants

1315 pregnant women (705 in urban areas and 610 in rural areas) who regularly attended health centres for antenatal care and growth monitoring of their babies.

Measurements

details of weight, height, pregnancy weight gain, body weight at one to three years postpartum, mother's age, parity, duration of any breast feeding, education and employment status of women who carried singleton fetuses and delivered at term were collected at the first antenatal visit. The women were categorised based on their pre-pregnancy body mass index, weight retention at one to three years postpartum, employment status and educational levels.

Findings

women who gained more weight than recommended during pregnancy tended to be heavier at three years postpartum than women who gained weight within the recommended ranges during pregnancy (7.0±5.3 versus 4.8±6.7 kg; p<0.0001). Less-educated women were at greater risk for inadequate pregnancy weight gain than other educational groups, and they had less weight retention at three years postpartum than other educational groups. Also, weight retention for primiparous women was higher than that for multiparous women (5.4±6.6 versus 3.8±6.3 kg; p<0.0001). The results of logistic regression analysis revealed that only total pregnancy weight gain was independently related to major weight retention (?4 kg) at three years postpartum (odds ratio 1.34, 95% confidence intervals 1.03–1.74; p=0.02).

Conclusion

a high body mass index before pregnancy is not associated with increased risk of retaining more weight after pregnancy. On the other hand, total pregnancy weight gain was the most important determinant of weight retention at three years postpartum in this population of Iranian women.     

Term delivery following successful treatment of choriocarcinoma with brain metastases, a case report and review of literature

Background  Cerebral metastases from choriocarcinoma are a poor prognostic indicator of outcome in both the World Health Organization and FIGO classification systems. Although gestational trophoblastic neoplasia has become the most curable of gynecological malignancies, failure rate among “high-risk” patients is still high despite of the use of aggressive multidrug regimens. Case  A 27-year-old woman (G₄P₂Ab₁) presented with hemiplegia due to brain metastases of choriocarcinoma 1 year after spontaneous abortion. She underwent craniotomy and was treated with nine courses of multiple agent etoposide, methotrexate, actinomycin- etoposide, and cisplatinum (EMA-EP) regimen combined with whole brain irradiation. She delivered a term healthy child 2 years after termination of treatment. Conclusion  Multiagent EMA-EP chemotherapy and whole brain irradiation with craniotomy in selected patients preserves fertility and may improve a patient overall prognosis.     

Secondary chemotherapy for high-risk gestational trophoblastic neoplasia

OBJECTIVE: To determine the efficacy of secondary chemotherapy after failure of initial treatment for high-risk gestational trophoblastic neoplasia. METHODS: Twenty-six patients with high-risk gestational trophoblastic neoplasia based on WHO criteria who failed primary treatment or relapsed from remission and received secondary chemotherapy were identified from the records of the Brewer Trophoblastic Disease Center. Initial chemotherapy consisted of etoposide, high-dose methotrexate with folinic acid, actinomycin D, cyclophosphamide and vincristine (EMA-CO) in 10 patients and methotrexate/actinomycin D-based chemotherapy without etoposide in 16 patients. Secondary chemotherapy consisted mainly of platinum-etoposide combinations with methotrexate and actinomycin D (EMA-EP), bleomycin (BEP), or ifosfamide (VIP, ICE). Adjuvant surgery and radiotherapy were used in selected patients. Clinical response and survival as well as factors affecting survival were analyzed retrospectively. RESULTS: The overall survival has 61.5% (16/26). Of the 10 patients who failed primary treatment with EMA-CO, 9 (90%) had complete clinical responses to secondary chemotherapy with EMA-EP (3) or BEP (6), and 6 (60%) were placed into lasting remission. Of the 16 patients who failed primary treatment with methotrexate/actinomycin D-based chemotherapy without etoposide, 10 (63%) had complete clinical responses to BEP (8), VIP (1) and ICE (1), and 10 (63%) achieved long-term remission. Adjuvant surgical procedures were performed on 15 patients as a component of their therapy; eight (73%) of 11 patients who underwent hysterectomy, five (62%) of eight patients who had pulmonary resections, and one patient who had wedge resection of resistant choriocarcinoma from the uterus survived. Survival was significantly influenced by both hCG level at the start of secondary therapy and sites of metastases. CONCLUSION: Patients with persistent or recurrent high-risk gestational trophoblastic neoplasia who develop resistance to methotrexate-containing treatment protocols should be treated with drug combinations employing a platinum agent and etoposide with or without bleomycin or ifosfamide.     

18F-FDG PET for staging breast cancer in patients with inner-quadrant versus outer-quadrant tumors: comparison with long-term clinical outcome.

Extraaxillary metastases (i.e., in the absence of axillary involvement) are more likely to develop in patients with inner-quadrant (IQ) breast cancer than in patients with outer-quadrant (OQ) primary tumors. The relative difficulty of identifying extraaxillary metastases may lead to understaging of cancer in these patients. This study examined whether (18)F-FDG PET findings were differentially associated with the location of primary tumors, and with long-term prognosis, in IQ and OQ patients. METHODS: Follow-up data were obtained for 141 patients whose breast cancer was staged by PET and who were documented to have IQ (n = 42) or OQ (n = 99) primaries. Results were stratified according to PET findings consistent with different metastatic patterns. Data were further analyzed with respect to disease outcome after a mean 3-y follow-up period. RESULTS: Among IQ patients, progressive disease was identified in 26.1%, compared with 13.1% of OQ patients, for a relative risk (RR) of 2.0. Of patients with PET findings of isolated extraaxillary metastases, 36.1% had progressive disease, compared with 10.7% of other patients (RR = 3.4), and 61.9% of IQ patients had isolated extraaxillary metastases identified on PET, compared with 10.1% of OQ patients (RR = 6.1). CONCLUSION: IQ patients demonstrated a 6-fold greater frequency of PET findings of isolated extraaxillary metastasis, and such findings were associated with triple the risk for disease progression. Patients with IQ tumors could be vulnerable to understaging with conventional staging approaches and may particularly benefit from PET during the staging process.