MalignancyCase Report: Systemic Sarcoidosis Preceeding Acute Myeloid Leukemia

The authors report the case of a 59-year-old woman who developed acute myeloid leukemia nine months after the resolution of systemic sarcoidosis treated by corticosteroid therapy. This rare case poses the questions of the physiopathogenic mechanisms, particularly a granulomatous reaction to leukemic antigens or to cytokines or of the role of an infectious agent.     

The role of UV-B light in skin carcinogenesis through the analysis of p53 mutations in squamous cell carcinomas of hairless mice

Mutation spectra of the p53 gene from human skin carcinomas have been connected to solar UV radiation. For comparison we have characterized the mutation spectrum of the p53 gene in a very large sample of squamous cell carcinomas from hairless mice induced with UV of wavelength 280-320 nm (UV-B), which have substantiated the mutagenic effects of UV-B radiation in vivo. Tumors from hairless mice, random bred SKH:HR1 as well as inbred SKH:HRA strains, which are analyzed for mutations in the conserved domains of the p53 protein present a very specific mutation spectrum. The observed mutation frequency after chronic UV-B radiation in the p53 gene ranged from 54% (SKH-HRA) to 73% (SKH-HR1) among the 160 tumors analyzed. Over 95% of the mutations were found at dipyrimidine sites located in the non-transcribed strand, the majority were C-->T transitions and 5% were CC-->TT tandem double mutations. Four distinct UV-B mutation hot spots have been identified for the first time: two major ones at codons 267 (33%) and 272 (19%) and two minor ones at codons 146 (10%) and 173 (4%). The codon 267 hot spot consists of a CpG preceded by a pyrimidine, which confirms in vivo an important role for this UV-B mutable site in UV-B-induced skin tumors that is not found in other types of mouse tumors. Comparison with mutation spectra from human skin carcinomas fully validates the merits of the hairless mouse model for studying the molecular mechanisms of skin carcinogenesis. For example, the murine hot spot at codon 272 does have a full equivalent in human skin carcinomas. In contrast, the human equivalent of the murine codon 267 lacks the dipyrimidine site and therefore fails to be a pronounced hot spot in human skin carcinomas; however, this site is one of the major hot spots in human internal cancers (evidently not induced by UV radiation but probably by deamination of the 5 methyl cytosine).      

天然牛黄与培育牛黄的扫描电镜观察

天然牛黄(natural ox gallstone)为牛的胆结石,由于产量极少,供求困难,国内于1956年参照天然牛黄的主要成分制成人工牛黄(artificial ox gallstone),作为天然牛黄的代用品。从1974年以来,很多省区如吉林、广东、内蒙古等都先后进行了人工培育牛黄的试验,并试验成功培育牛黄(cultured ox gallstone)。其方法是用手术在牛胆囊内植入异物为核,促使胆汁成分的沉积与结石的形成,经过一段时间后,将异物取出,上面的沉积物即为培育牛黄。本文目的是探讨天然牛黄与培育牛黄的结构特征。     

Review article: percutaneous endoscopic gastrostomy in infants and children

Aliment Pharmacol Ther 31 , 788–801

Summary

Background Percutaneous endoscopic gastrostomy (PEG) placement is widely accepted in children needing long‐term gastrostomy feeding and clinical experience has been accumulated using PEG in children for nearly three decades. Aim To discuss the current knowledge about clinical application of percutaneous endoscopic gastrostomy in children as well as associated complications and special aspects. Methods We reviewed literature on PEG, primarily in children, with a focus on complications, gastro‐oesophageal reflux, potential benefits and parental perceptions. In addition to reviewing scientific literature, we considered clinical experience and judgment in developing recommendations for special aspects concerning PEG in children. Results Since its introduction in 1980, the use of PEG in paediatric patients has become widely accepted. With expanded experience, the number of medical conditions for which PEG is indicated, as well as the use of new techniques has increased. Published reports have helped improve expertise in dealing with associated complications; however, several key issues remain unresolved such as the implications of gastro‐oesophageal reflux associated with PEG placement. Conclusions Percutaneous endoscopic gastrostomy insertion for enteral nutrition in children and adolescents is an efficient and safe technique, even in small children, and is associated with a tolerable complication rate.     

Rapid cognitive decline: searching for a definition and predictive factors among elderly with Alzheimer's disease

The pattern and rate of cognitive decline in AD patients is far from uniform. In clinical practice, certain patients present episodes of rapid cognitive loss, whereas others deteriorate more progressively. At present time, there is little known about rapid decline in cognitive function in patients with AD, and moreover among older population. The main objective of this review was to elaborate a proposal of definition of rapid cognitive decline in order to facilitate its applicability into ordinary medical practice and to be relevant for clinical-decision making in old patients with AD. After the literature review, our results from longitudinal prospective studies and our clinical practice experience, we propose the following definition of rapid cognitive decline: a four-point or greater loss on the MMSE within six months and the loss of at least one point on the MMSE during the following six months. After ELSA cohort's results, 11% of an AD population of 312 patients were rapid cognitive decliners, complying with our proposed definition. They represent a non-negligible proportion of the population afflicted by AD.     

Cervical Cancer Prevention on Instagram: Content and Social Interaction Analysis of Brazilian Accounts

Abstract: Objective: The aim of the present study was to analyse the content of posts on Instagram about cervical cancer. Methods: It was conducted a qualitative analysis using the 50 most popular publicly available Portuguese-language Instagram posts, containing the hashtags #cervicalcancer, #papsmear, #hpv, #papillomavirus, and #hpvvac-cine, during the Brazilian national cervical cancer prevention campaign in March 2018. Results: Posts recruited using #cervicalcancer provided 60% of posts with contents related to secondary prevention; the #papsmear provided 46% of posts with irrelevant contents; the #hpv and #papillomavirus provided 50% and 64% of posts with informative content, respectively; and the #hpvvaccine provided 58% of posts with content related to primary prevention. The posts that received the highest number of likes were those from the hashtags #hpv and #papillomavirus with 151.33 and 78.00 likes/post, respectively. The majority of posts presented less than 05 comments/post, except for the #hpv, which had 64.76 comments/post. According to the users’ profiles, the majority of the posts, regardless of the hashtag used, were made by health professionals. Conclusion: The focus of Instagram posts about cervical cancer is on secondary prevention, which can contribute to the promotion of health behaviours not directed to aspects of primary prevention of the disease.     

Vitamin K status of lactating mothers and their infants

Vitamin K deficiency remains a world-wide problem in the newborn. Vitamin K traverses the placenta from mother to infant very poorly and is present only in very low concentrations in human milk. Thus, it is not surprising that the newborn infant has undetectable vitamin K serum levels with abnormal amounts of the coagulation proteins and undercarboxylated prothrombin. Hemorrhagic disease of the newborn, secondary to vitamin K deficiency, remains largely a disease of breastfed infants. Lactating mothers easily achieve the recommended dietary allowance for vitamin K (1 μg kg⁻¹ d⁻¹) and the breast milk concentration is readily increased by increasing maternal vitamin K intake. Breastfed infants do not receive the recommended vitamin K intake via human milk. To prevent vitamin K deficiency in the newborn, intramuscular or oral vitamin K prophylaxis is necessary.