Betaxolol,a beta1-adrenoceptor antagonist,protects a transient ischemic injury of the retina

In the present study, we investigated the protective effects of the topical beta-adrenoceptor antagonist Betoptic((R)) (0.25% betaxolol) in the rat retina following the ischemic injury induced by a transient increase of intraocular pressure (IOP). Like other areas of the central nervous system, the retina is highly vulnerable to ischemic-induced injury. Ischemia was induced in the rat retina by raising the IOP above the systolic blood pressure for 60min. After an ischemia/reperfusion, the thickness of the retinal layers and the immunoreactivities of choline acetyltransferase (ChAT), gamma-amino butyric acid (GABA) and tyrosine hydroxylase (TH) were examined. After a reperfusion period of 7 days, the thickness of both the inner plexiform layer and inner nuclear layer was much decreased. After a reperfusion period of 14-28 days, the thickness of the outer nuclear layer decreased markedly. Moreover, the ChAT and TH immunoreactivity had almost completely disappeared in the retinas after 7 days, while GABA immunoreactivity remained for 28 days. These results suggest that the inner retinal layers are more susceptible to ischemic-induced injury than the outer retinal layer.Histological examination demonstrated protective effects of betaxolol on ischemic-induced retinal damage, which was more substantial in the inner retinal layer. When two drops of betaxolol, once before ischemic injury and twice daily for 28 days after ischemia, were continuously administered, the reductions in the retinal ChAT, GABA and TH immunoreactivities were significantly attenuated. The present study suggests that topically applied betaxolol is an efficient neuroprotective agent and prevents the retinal cell damage induced by ischemic injury in rats.     

Closed reduction of fractured anterior wall of the frontal sinus using threaded K-wires

Classic approach of the anterior wall of frontal sinus fracture involves bicoronal or direct forehead incisions. However, these methods have some disadvantages, for example, paresthesia, scarring, and even alopecia. The purpose of this study was to introduce the simple and effective method of reduction of the anterior wall of frontal sinus fracture with threaded K-wires. Thirteen patients with fracture of the anterior wall of the frontal sinus underwent our method from December 2005 to September 2011. The distance of threaded K-wires was measured by facial computed tomography, and those marks were made directly on the threaded K-wires with an aseptic pencil. Closed reduction with these K-wires was tried carefully until a tolerable level was attained with digital palpation. Facial computed tomography was performed the following day for comparison. On postoperative day 7, following disappearance of swelling, the patient and the doctor mutually evaluated the outcome; both were satisfied with the results. The postoperative course was uneventful, without any complications. Unlike other methods, this method can guarantee a short operating time, effective reduction, and inconspicuous scar.     

Clinical characteristics,risk factors and outcomes of asymptomatic rectal neuroendocrine tumors

Background

Rectal neuroendocrine tumors (NET) are often asymptomatic and frequently discovered during health examinations. However, data on the risk factors of asymptomatic rectal NETs are lacking. We investigated the risk factors, clinical characteristics and outcomes of asymptomatic rectal NETs discovered during health screening.

Materials and methods

Asymptomatic subjects who underwent colonoscopy during routine health screening at a tertiary hospital from March 2009 to July 2014 were reviewed. Subjects with histologically confirmed rectal NETs were compared with healthy controls from the same population. Risk factors for rectal NETs were analyzed by multivariable analysis. Clinical outcomes of the resected NETs were also analyzed.

Results

A total of 21,706 Subjects underwent screening colonoscopy during the study period. 3417 were excluded from the study, and 180 rectal NET subjects were compared with 18,109 controls. Multivariable analysis showed that a previous history of malignancy (OR 2.960, 95% CI 1.673–5.237, p < 0.001), hypertriglyceridemia (OR 1.482, 95% CI 1.046–2.100, p = 0.027), higher fasting plasma glucose levels (OR 1.008, 95% CI 1.003–1.014, p = 0.001) and higher carcinoembryonic antigen levels (OR 1.019, 95% CI 1.003–1.035, p = 0.021) were significant risk factors while older age (OR 0.964, 95% CI 0.951–0.977, p < 0.001) was a preventive factor. One hundred and sixty nine subjects had endoscopic resection, five were treated by local surgery and six by radical surgery. Complete resection was achieved in 152 subjects. There were three cases of positive lymph nodes and one metastasis. Histology revealed four lymphatic, five vascular and two cases of perineural invasion. One hundred and fifty seven subjects were followed up for at least 1 year (median 38.6 months, 12–84 months). There were no recurrences during the follow-up period.

Conclusions

Younger age, previous history of malignancy, higher fasting plasma glucose levels and hypertriglyceridemia are significantly associated with rectal NET risk.

     

Communicating <Emphasis Type="Italic">BRCA</Emphasis> research results to patients enrolled in international clinical trials: lessons learnt from the AGO-OVAR 16 study

Background

The focus on translational research in clinical trials has the potential to generate clinically relevant genetic data that could have importance to patients. This raises challenging questions about communicating relevant genetic research results to individual patients.

Methods

An exploratory pharmacogenetic analysis was conducted in the international ovarian cancer phase III trial, AGO-OVAR 16, which found that patients with clinically important germ-line BRCA1/2 mutations had improved progression-free survival prognosis. Mechanisms to communicate BRCA results were evaluated, because these findings may be beneficial to patients and their families.

Results

Communicating individual BRCA results was not anticipated during clinical trial design. Consequently, options were not available for patients to indicate their preference for receiving their individual results when they signed pharmacogenetic informed consent. Differences in local requirements, clinical practice, and opinion regarding the ethical aspects of how to convey genetic results to patients are all potential barriers to returning individual BRCA results to patients. Communicating the aggregate BRCA result from this study provided clinical investigators with a mechanism to disseminate the overall study finding to patients while taking individual circumstances, local guidelines and clinical practice into account.

Conclusion

This study illustrates the importance of increasing the clarity and scope of informed consent and the need for patient engagement to ensure clinical trial participants can indicate their preference regarding receipt of potentially important individual pharmacogenetic results.

Trial registration

This study was registered in the NCT Clinical Trial Registry under NCT00866697 on March 19, 2009, following approval from participating ethics committees (Additional file 1).

     

Endobronchial enchondroma: Unusual bronchial tumor

Bronchial chondromas are very rare pulmonary benign tumors. Despite their rarity, clinicians should be aware of the possibility of endobronchial tumors in patients with unexplained respiratory symptoms. Treatment modalities for the complete excision of the tumor should be initiated to prevent further complications based on the individual tumor situation.