Differential effects of voluntary and forced exercise on stress responses after traumatic brain injury

Voluntary exercise increases levels of brain-derived neurotrophic factor (BDNF) after traumatic brain injury (TBI) when it occurs during a delayed time window. In contrast, acute post-TBI exercise does not increase BDNF. It is well known that increases in glucocorticoids suppress levels of BDNF. Moreover, recent work from our laboratory showed that there is a heightened stress response after fluid percussion injury (FPI). In order to determine if a heightened stress response is also observed with acute exercise, at post-injury days 0-4 and 7-11, corticosterone (CORT) and adrenocorticotropic hormone (ACTH) release were measured in rats running voluntarily or exposed to two daily 20-min periods of forced running wheel exercise. Forced, but not voluntary exercise, continuously elevated CORT. ACTH levels were initially elevated with forced exercise, but decreased by post-injury day 7 in the control, but not the FPI animals. As previously reported, voluntary exercise did not increase BDNF in the FPI group as it did in the control animals. Forced exercise did not increase levels of BDNF in any group. It did, however, decrease hippocampal glucocorticoid receptors in the control group. The results suggest that exercise regimens with strong stress responses may not be beneficial during the early post-injury period.     

Ovarian undifferentiated carcinoma with voluminous mesenteric presentation

INTRODUCTIONAbout 5% of ovarian cancers are so poorly differentiated and difficult to classify that they are called undifferentiated carcinomas and usually have disseminated disease at presentation. Extra pelvic debulking it is difficult to complete.PRESENTATION OF CASEWe report a case of a rare ovarian tumor presented as a large mesenteric tumor of 14 cm diameter in a 73 years old woman.DISCUSSIONUndifferentiated carcinomas are usually large, solid with hemorrhage and necrosis, bilateral and most are difficult to classify histologically. Rarely are pure, generally identified through the extensive sampling of lesions, some other components of surface epithelial carcinoma and usually the predominant element is the latter. Cases with predominantly undifferentiated component are rare.CONCLUSIONThe treatment and diagnostic approach is the same as for other high-grade epithelial tumors of the ovary, but in this particular case the differential diagnosis and diagnostic approach is that of a mesenteric tumor.     

A comparative non randomized study of narrow-band (NB) (312 +/- 2 nm) UVB phototherapy versus sequential therapy with oral administration of low-dose Cyclosporin A and NB-UVB phototherapy in patients with severe psoriasis vulgaris

Sequential therapy may improve the efficacy and safety of single treatments for severe psoriasis. We compared sequential Cyclosporin A and narrow-band UVB phototherapy versus narrow-band UVB phototherapy alone. A group of 30 patients with severe psoriasis received 3 mg/kg/day Cyclosporin A for 4 weeks. Afterwards, Cyclosporin A was rapidly tapered and phototherapy begun. An additional 30 patients received phototherapy alone. Treatments were given until psoriasis cleared or until partial improvement was achieved without further amelioration despite another week of treatment. Both treatments were highly effective and well tolerated but sequential therapy was more effective in lesions of UV-shielded body areas; itching disappeared more quickly. The cumulative narrow-band UVB dosages and number of exposures were lower. No difference was seen at follow-up extended up to 9 months. Sequential therapy was well tolerated and allowed for the reduction of narrow-band UVB dosage and exposures, quick relief of itching and improvement of UV-shielded lesions.     

Perinatal dengue infection

Dengue is a mosquito-borne viral disease, with worldwide distribution in tropical and subtropical areas. Argentina was certified free of Aedes aegypti in the sixties, however the vector reappered in 1984. In the nineties, small dengue outbreaks occurred with autocthonus diseases at first limited to the northern provinces. In the summer of 2008-2009, autocthonus cases were reported in other parts of the country. Vertical dengue virus transmission has been infrequently described, and the effect on pregnant women and newborn has not been well documented. We review this condition and present a case of perinatal dengue infection in a newborn infant from Salta, Argentina.     

Families and elder care in the twenty-first century

Although most Americans know that the U.S. population is aging, they are far less informed about the reality of providing elders with personal care, health care, and social support. Families-particularly women-have always been critical in providing elder care, but the entry of so many women into the paid labor force has made elder care increasingly difficult. Ann Bookman and Delia Kimbrel show how changes in both work and family life are complicating families' efforts to care for elderly relatives. Because almost 60 percent of elder caregivers today are employed, many forms of caregiving must now be "outsourced" to nonfamily members. And because elders are widely diverse by race and socioeconomic status, their families attach differing cultural meanings to care and have widely different resources with which to accomplish their care goals. Although the poorest elders have access to some subsidized services, and the wealthiest can pay for services, many middle-class families cannot afford services that allow elders to age in their homes and avoid even more costly institutional care. Six key groups--health care providers, nongovernmental community-based service providers, employers, government, families, and elders themselves--are engaged in elder care, but their efforts are often fragmented and uncoordinated. All six groups must be able to work in concert and to receive the resources they need. Both employer and government policies must be improved. Although large businesses have taken up the elder care challenge, most small and mid-sized firms still do not offer flexible work arrangements. Social Security and Medicare have provided critical support to families caring for elders, yet both face significant financial shortfalls. The Older American Act and the National Family Caregiver Support Program have broadened access to elder services, but need updating to address the needs of today's employed caregivers and elders who want to "age in place." And just over half of the nation's workforce is eligible for the unpaid leave benefits provided by the Family and Medical Leave Act. The authors close by reflecting on the need for a coordinated, cross-sector movement to create an "aging-friendly" society in the United States-a society that values well-being across the life span and supports citizens from diverse cultures and income levels as they age.     

Cardiac syndrome X: Relation to microvascular angina and other conditions

Cardiac syndrome X (CSX) describes patients with angina-like chest pain, positive stress ischemia, and nonobstructive coronary angiograms. Microvascular angina (MVA) is an etiologic mechanism in women with cardiac symptoms and abnormal vascular dysfunction without obstructive coronary artery disease, although not all patients with MVA show detectable ischemia. CSX is more prevalent in women than men, with an average age in the mid-to-late 50s. Many additional cardiac and noncardiac mechanisms have been proposed for CSX over the past three decades. The uncertainty and inconsistency of data for determining diagnosis and causality along with the unusual response to traditional antianginal treatment hinder the development of effective treatment strategies. Many researchers believe that women with MVA do not have a benign prognosis and may be better classified as intermediate risk. Better understanding of the disease characteristics; its relation to traditional and novel risk factors, especially in women; identification of reliable, accurate diagnostic procedures; and a comprehensive preventive therapeutic approach are all important for optimizing management strategy for MVA and CSX.     

Leaving the Welfare Rolls: The Health and Mental Health Status of Current and Former Welfare Recipients

This paper summarizes the mail survey findings of 1,634 respondents examining the impact of welfare reform, namely the Work and Gain Economic Self Sufficiency (WAGES) program, in two urban areas of Florida. The health and mental health status, quality of life, and service needs of adults and children who had left WAGES were compared with those of current recipients. Findings indicate that 60% of the respondents had left WAGES during a 14-month period. Compared to former WAGES recipients, current recipients reported significantly poorer health and mental health status. Additionally, the children of current recipients had significantly greater health needs compared to those of former WAGES recipients. Although no group difference existed regarding the children's mental health status, the percentage of children scoring above the criterion suggesting a need for further psychosocial evaluation was twice the rate that would be expected in a general pediatric sample. Transportation was the only service need in which a significant group difference was found, with current recipients reporting significantly greater need compared to former recipients. Compared to former WAGES recipients, current recipients reported significantly lower levels of satisfaction with their leisure opportunities, employment or educational status, financial condition, legal and safety, family's health, and with their overall quality of their lives.     

Integration of MRI and MRS approaches to monitor molecular imaging and metabolomic effects of trabectedin on a preclinical ovarian cancer model

Although several drugs are available to treat recurrences of human epithelial ovarian cancer (EOC), clinical responses often remain short lived and lead to only marginal improvements in patients' survival. One of the new drugs proposed for recurrent platinum‐resistant EOC patients is trabectedin (Trab), a marine‐derived antitumor agent initially isolated from the tunicate Ecteinascidia turbinata and currently produced synthetically. Predictive biomarkers of therapy response to this drug and the potential use of non‐invasive functional MRI and MRS approaches for an early assessment of Trab efficacy have not yet been evaluated, although they might be relevant for improving the clinical management of EOC patients. In the present work we combined functional and spectroscopic magnetic resonance technologies, such as in vivo diffusion‐weighted MRI and ¹H MRS, with ex vivo high resolution MRS (HR‐MRS) metabolomic analyses, with the aim of identifying new pharmacodynamic markers of Trab effectiveness on well characterized, highly aggressive human SKOV3.ip (a HER2‐enriched cell variant derived from SKOV3 cells) EOC xenografts. In vivo treatment with Trab (three consecutive weekly 0.2 mg/kg i.v. injections) resulted in the following: (1) a significant reduction of in vivo tumor growth, along with the formation in cancer lesions of diffuse hyper‐intense areas detected by T₂‐weighted MRI and attributed to necrosis, in agreement with histopathology findings; (2) significant increases in the apparent diffusion coefficient mean and median values versus saline‐treated control tumors; and (3) a significant reduction in the choline‐containing metabolites' signal detected by quantitative in vivo MRS. Multivariate and quantitative HR‐MRS analyses on ex vivo tissue samples revealed Trab‐induced alterations in phospholipid and glucose metabolism identified as a decrease in phosphocholine and an increase in lactate. Collectively, these data identify Trab‐induced functional MRI and MRS alterations in EOC models as a possible basis for further developments of these non‐invasive imaging methods to improve the clinical management of EOC patients.