Anabolic effect of prostaglandins

Prostaglandins, particularly PGE₂, have been shown to stimulate bone formation in a number of circumstances. Endogenous prostaglandins may be important in heterotopic ossification and fracture healing. The major source of prostaglandins in bone is the inducible form of cyclooxygenase (COX)-2 and inhibition of COX-2 may impair bone formation. Recent studies using selective agonists for the prostaglandin EP2 and EP4 receptors, which stimulate cAMP in bone cells, have suggested that these might be used clinically to accelerate bone formation, particularly when used locally.     

Newer antiviral agents and therapeutic approaches for chronic hepatitis b

A new era in the treatment of chronic hepatitis B began approximately a decade ago. Three oral nucleoside or nucleotide analogues—lamivudine, adefovir dipivoxil, and entecavir—are now approved in the United States for the treatment of chronic hepatitis B. Other new oral agents, including telbivudine, clevudine, and emtricitabine, are in various stages of clinical investigation. This article reviews the efficacy and resistance data of these oral antiviral agents, and the preliminary results of combination therapy for chronic hepatitis B.     

Novel pore mutation in SCN5A manifests as a spectrum of phenotypes ranging from atrial flutter, conduction disease, and Brugada syndrome to sudden cardiac death

OBJECTIVES: The purpose of this study was to determine the clinical and biophysical characteristics of a novel SCN5A mutation. BACKGROUND: Brugada syndrome and isolated cardiac conduction defect have been linked to SCN5A mutations. METHODS: Eleven members of a western European family underwent electrophysiologic investigations and mutation analysis of the SCN5A gene. Wild-type and mutant SCN5A channels were expressed in HEK293 cells, and whole cell currents were studied using patch clamp procedures. RESULTS: A novel mutation, R376H, in the first pore segment of SCN5A variably causes Brugada syndrome and/or conduction disease in a single family. Biophysical analysis demonstrated a significant current reduction for the mutant, a pathophysiologic profile consistent with Brugada syndrome and isolated cardiac conduction defect. Among 11 family members, 9 were carriers of the mutation. The proband's initial presentation was a saddleback Brugada ECG, atrial flutter, and diffuse conduction disturbances. He had no inducible ventricular arrhythmias but experienced sudden cardiac death. His brother was affected by atrial flutter and had a clear conduction disorder, but he did not display baseline or evocable ECG signs of Brugada syndrome. He received an implantable cardioverter-defibrillator that delivered one appropriate shock after 1 year of follow-up. The phenotype in the family members was highly variable and ranged from noninducible and inducible asymptomatic carriers of the mutations to isolated conduction disease and to symptomatic Brugada syndrome. CONCLUSIONS: We describe the functional characterization of a novel SCN5A pore mutation, R376H, with variable clinical expression in the same family. Differentiating between electrophysiologic entities (Brugada syndrome-isolated cardiac conduction defect) is more challenging. Recognition of factors modifying the clinical presentation may be important for clinical decision making.