Central nervous system regulation of adrenocorticotropin secretion: role of somatostatins

Somatostatin-28 (SS-28) and desAA1,2,4,5,12,13[D-Trp8]somatostatin (ODT8-SS), but not somatostatin-14, given intracerebroventricularly, but not when given iv, inhibit stress-induced pituitary ACTH and adrenomedullary epinephrine secretion in rats. The elevation of ACTH after tail-suspension stress is totally prevented by iv administration of antisera raised against corticotropin-releasing factor (CRF). SS-28 and ODT8-SS do not inhibit CRF-induced ACTH secretion in vivo or in vitro. These results are consistent with the hypothesis that SS-28 and ODT8-SS prevent stress-induced ACTH secretion by inhibition of CRF release.     

Prevalence and risk factors of sleep bruxism and wake-time tooth clenching in a 7- to 17-yr-old population

Carra MC, Huynh N, Morton P, Rompré PH, Papadakis A, Remise C, Lavigne GJ. Prevalence and risk factors of sleep bruxism and wake‐time tooth clenching in a 7‐ to 17‐yr‐old population.
Eur J Oral Sci 2011; 119: 386–394. © 2011 Eur J Oral Sci Sleep‐related bruxism (SB) and wake‐time tooth clenching (TC) have been associated with temporomandibular disorders (TMDs), headache, and sleep and behavioral complaints. This study aimed to assess the prevalence and risk factors of these signs and symptoms in a 7‐ to 17‐yr‐old population (n = 604) seeking orthodontic treatment. Data were collected by questionnaire and by a clinical examination assessing craniofacial morphology and dental status. Sleep‐related bruxism was reported by 15% of the population and TC was reported by 12.4%. The SB group (n = 58) was mainly composed of children (67.3% were ≤12 yr of age) and the TC group (n = 42) was mainly composed of adolescents (78.6% were ≥13 yr of age). The craniofacial morphology of over 60% of SB subjects was dental class II and 28.1% were a brachyfacial type. Compared with controls (n = 220), SB subjects were more at risk of experiencing jaw muscle fatigue [adjusted OR (AOR) = 10.5], headache (AOR = 4.3), and loud breathing during sleep (AOR = 3.1). Compared with controls, TC subjects reported more temporomandibular joint clicking (AOR = 5), jaw muscle fatigue (AOR = 13.5), and several sleep and behavioral complaints. Sleep‐ and wake‐time parafunctions are frequently associated with signs and symptoms suggestive of TMDs, and with sleep and behavioral problems. Their clinical assessment during the planning of orthodontic treatment is recommended.     

Hormonal responses to a potent gonadotropin hormone-releasing hormone antagonist in normal elderly men

GnRH analogs, both agonists and antagonists, have potential use in androgen-dependent diseases of older men, such as prostatic cancer and benign prostatic hyperplasia. Previous experience with agonists of GnRH has suggested that GnRH analogs may be more effective in aged men than in young men, but little is known about GnRH antagonists in older men. Therefore, we evaluated the hormonal effects of a single dose and a short course of a GnRH antagonist (Nal-Glu) in normal elderly men. Six young men (25-34 yr old) and six older men (66-76 yr) each received single morning injections of Nal-Glu (25, 75, and 250 micrograms/kg), separated by 2 weeks. Serum levels of testosterone (T), immunoreactive LH (LH RIA) and FSH (FSH RIA), and bioactive LH (LH BIO) were evaluated periodically for 7 days after each injection. In addition, six elderly men received 25 and 75 micrograms/kg.day Nal-Glu for 10 consecutive mornings each, and serum levels of T, inhibin, LH RIA, LH BIO, FSH RIA, and bioactive FSH were evaluated. Nal-Glu in all three single doses caused a significant (P less than 0.01) decline in serum levels of T and gonadotropins that was similar in extent in the elderly and young men. For example, T declined to a level of 19% of baseline after the 250 micrograms/kg dose of Nal-Glu in both age groups. For both the young and elderly men, the major effect of increasing the Nal-Glu dose was a prolongation of the period of suppression. Multiple Nal-Glu injections in the elderly men also resulted in a rapid decline in T, inhibin, and bioactive and immunoreactive gonadotropins. For both LH and FSH, bioactivity decreased to a greater extent than immunoreactivity. Local side-effects of Nal-Glu tended to be fewer and of less intensity in the elderly men compared to those in the young men. These results demonstrate that the response to Nal-Glu in healthy elderly men is similar to that in younger men, and extended administration of Nal-Glu in elderly men effectively suppresses gonadal and pituitary function. These results suggest that the role of GnRH antagonists in the effective treatment of androgen-dependent disease in the aging male needs to be explored further.     

Bariatric surgery and periodontal status: A systematic review with meta-analysis

Objective

To review and analyze periodontal clinical parameters after bariatric surgery.

Evaluation of a predictive model of end-stage kidney disease in a French-based cohort

Background

The risk of ESKD is highly heterogeneous among renal diseases, and risk scores were developed to account for multiple progression factors. Kidney failure risk equation (KFRE) is the most widely accepted, although external validation is scarce. The objective of this study was to evaluate the usefulness of this score in a French case–control cohort and test the pertinence of the proposed thresholds.

Methods

A retrospective case–control study comparing a group of patients starting renal replacement therapy (RRT) to a group of patients with CKD stages 3–5. Multivariate analysis to assess the predictors of ESKD risk. Discrimination of 4-, 6- and 8-variable scores using ROC curves and compared with eGFR alone and albumin/creatinine ratio (ACR) alone.

Results

314 patients with a ratio of 1 case for 1 control. In multivariate analysis, increasing age and higher eGFR were associated with a lower risk of ESKD (OR 0.62, 95% CI 0.48–0.79; and OR 0.72, 95% CI 0.59–0.86, respectively). The log-transformed ACR was associated with a higher risk of ESKD (OR 1.25 per log unit, 95% CI 1.02–1.55). The 4-variable score was significantly higher in the RRT group than in the CKD-ND group, and was more efficient than the eGFR (AUROC 0.66, 95% CI 0.60–0.72, p?=?0.018) and the log-transformed ACR (AUROC 0.63 95% CI 0.60–0.72, p?=?0.0087) to predict ESKD. The 6-variable score including BP metrics and diabetes was not more discriminant as the 4-variable score. The 8-variable score had similar performance compared with the 4-score (AUROC 8-variable score: 0.70, 95% CI 0.64–0.76, p?=?0.526). A 40% and 20% score thresholds were not superior to eGFR?<?15 and 20 mL/min/1.73 m², respectively. A 10% threshold was more specific than an eGFR?<?30 mL/min/1.73 m².

Conclusion

KFRE was highly discriminant between patients progressing to ESKD vs those non-progressing. The 4-variable score may help stratify renal risk and referral in the numerous patients with stage 3 CKD. Conversely, the proposed thresholds for creating vascular access or preemptive transplantation were not superior to eGFR alone.

     

Efectividad diagnóstica de la tomografía por emisión de positrones con 18fluorodeoxiglucosa asociada a tomografía axial en la discriminación de benignidad o malignidad de las lesiones suprarrenales

IntroductionThe usefulness of 18fluorodeoxyglucose positron emission tomography combined with axial tomography (PET-CT) in diagnosing whether adrenal tumours are benign or malignant is assessed.Material and methodsA retrospective study conducted between June 2005 and May 2009 on a consecutive series of patients on whom a PET-CT scan was performed to study suspected malignant adrenal disease. Focal uptakes were assessed, along with the maximum standard uptake value (SUV), and the ratio of the maximum adrenal/hepatic value. The sensitivity, specificity, positive and negative predictive value of the test, the maximum adrenal uptake values and the ratio for those where the diagnostic yield was maximum.ResultsFifteen patients were included. The final diagnosis showed malignancy in eight and seven were benign. Ten patients had adrenal uptake: three in benign lesions and seven in neoplasias, with a mean uptake value of 6.3 (3.2 in benign lesions and 9.0 in malignant lesions). The mean adrenal/hepatic ratio was 1.8 (0.9 in benign and 2.6 in malignant lesions). When the presence of adrenal uptake is associated with a final diagnosis of malignancy, we obtained a sensitivity of 87.5%, a specificity of 57.1%, and a positive and negative predictive value of 70% and 80%, respectively. An SUV cut-off value of 6, or an adrenal/hepatic uptake ratio of 2, gave a sensitivity of 75%, a specificity of 100%, and a positive and negative predictive value of 100% and 77.7%, respectively.ConclusionsPET-CT has a high ability to discriminate between benign and malignant lesions in the adrenal disease studied.     

Abdominal stab wounds: Self-inflicted wounds versus assault wounds

Intentional penetrating wounds, self inflicted or inflicted by others, are increasingly common. As a result, it can be difficult for the forensic examiner to determine whether the cause is self-inflicted or not. This type of trauma has been studied from a psychological perspective and from a surgical perspective but the literature concerning the forensic perspective is poorer. The objective of this study was to compare the epidemiology of abdominal stab wounds so as to distinguish specific features of each type. This could help the forensic scientist to determine the manner of infliction of the wound.We proposed a retrospective monocentric study that included all patients with an abdominal wound who were managed by the visceral surgery department at Angers University Hospital. Demographic criteria, patient history, circumstances and location of the wound were noted and compared. A comparison was drawn between group 1 (self inflicted wound) and group 2 (assault).This study showed that the only significant differences are represented by the patient's prior history and the circumstances surrounding the wound, i.e. the scene and time of day. In our study, neither the site, nor the injuries sustained reveal significant clues as to the origin of the wound. According to our findings, in order to determine the cause, the forensic examiner should thus carefully study the circumstances and any associated injuries.     

Atonic seizures in children with surgically remediable epilepsy: a motor system seizure phenotype?

Aim. Atonic seizures are common in some epileptic syndromes beginning in infancy or early childhood but they are rarely described in epilepsy with focal seizures of structural aetiology. We aimed to characterize the electroclinical features of atonic seizures in surgically remediable paediatric patients and to study the spatiotemporal organization of the underlying epileptogenic networks. Methods. We retrospectively analysed two consecutive, longitudinally evaluated and surgically treated paediatric patients presenting with atonic seizures as a manifestation of pharmacoresistant epilepsy of structural aetiology, evidenced by scalp‐ and stereotactic intracerebral video‐EEG‐recordings. A quantitative analysis of the epileptogenic zone organization was performed using the “epileptogenicity index”. Results. Long‐lasting generalized ictal atonia, occurring in infancy, was a predominant clinical feature in both patients, with some hints of focal origin present in one case. The seizure phenotype evolved at later age into subtle segmental atonia, associated with prominent positive motor signs. The epileptogenic zone was localized within the dorsolateral or mesiolateral premotor region. Its spatial organization was focal, matching the lesional cortex in one and distributed involving several lesional and non‐lesional structures in the other case. The emergence of atonic semiology temporally correlated with involvement of both lateral and mesial premotor, as well as primary motor areas. Conclusion. We hypothesize that atonic seizures may be considered as a motor system seizure phenotype in the setting of structural epilepsy. Complete removal of the epileptogenic area provided excellent seizure control.