Oral and ocular manifestations in Sjögren's syndrome

OBJECTIVE: Little is known about the relationship between lachrymal and salivary gland involvement in Sj?gren's syndrome (SS). It is also of interest to know which eye test contributes most to the diagnosis of SS. We investigated the performance of different tear tests and how these tests relate to common serologic and salivary tests in SS. METHODS: In patients suspected of SS, the tear breakup time and the tear mucus score were evaluated in addition to the routine tests. Eighty consecutive patients were included, categorized into primary SS (pSS), secondary SS (sSS), and negative for SS. RESULTS: The tear breakup time and mucus score both performed insufficiently in diagnosing SS, in contrast to the Rose Bengal score. In pSS and sSS patients, a clear correlation was noted between tear and saliva quality and secretion rate, and between the Rose Bengal score and parotid sialography. Increased Rose Bengal scores also correlated significantly with hyperglobulinemia and presence of SSB antibodies in serum, with duration of subjective eye dryness, and with decreased tear gland function. CONCLUSION: The Rose Bengal score remains the eye test of choice having the highest specificity for SS. Hyperglobulinemia and especially positive SSB serology may warrant close monitoring of the eyes, since these serum findings appear to relate to the severity of ocular surface damage. Theoretically, a positive evaluation of either the ocular or oral component, in addition to positive serology or histopathology, could be sufficient to diagnose the syndrome for clinical purposes.     

Ectopic prolactinoma of the sphenoidal sinus: case report

A 34-year-old woman was hospitalized for exploration of amenorrhea and galactorrhea. She had experienced primary sterility, diagnosed 11 years earlier. Endocrine tests demonstrated hyperprolactinemia (serum prolactin 594 ng/ml). Magnetic resonance imaging (MRI) showed a soft tissue mass located within the posterior part of the sphenoidal sinus. The pituitary gland appeared normal. Medical treatment with bromocriptine was unsuccessful. Transsphenoidal tumor resection was performed. Histology reported adenoma, which was consistent with prolactin-producing tumor demonstrated by immunohistochemical staining for prolactin. Because of the persistence of hyperprolactinemia related to an intra-sphenoidal tumor remnant, bromocriptine (15 mg/d) was initiated. Menses ensued and prolactin level declined (49 ng/ml). One year later, the tumor remnant had disappeared on the MRI and the patient became pregnant. Ectopic adenomas of the sphenoidal sinus are of particular interest due to the diagnostic difficulties encountered. Nevertheless, the nature of the lesion can be determined from the endocrine manifestations. Some of these tumors respond to medical treatment, similar to intra sellar tumors. Surgery remains however the only means of obtaining definitive diagnosis and cure.     

Cloning and pharmacological characterization of a rat kappa opioid receptor.

A full-length cDNA was isolated from a rat striatal library by using low-stringency screening with two PCR fragments, one spanning transmembrane domains 3-6 of the mouse delta opioid receptor and the other unidentified but homologous to the mouse delta receptor from rat brain. The novel cDNA had a long open reading frame encoding a protein of 380 residues with 59% identity to the mouse delta receptor and topography consistent with a seven-helix guanine nucleotide-binding protein-coupled receptor. COS-1 cells transfected with the coding region of this clone showed high-affinity binding to kappa opioid receptor-selective ligands such as dynorphin A and U-50,488 and also nonselective opioid ligands such as bremazocine, ethylketocyclazocine, and naloxone. Not bound at all (or bound with low affinity) were dynorphin A-(2-13), enantiomers of naloxone and levophanol [i.e., (+)-naloxone and dextrorphan], and selective mu and delta opioid receptor ligands. Activation of the expressed receptor by kappa receptor agonists led to inhibition of cAMP. Finally, in situ hybridization revealed a mRNA distribution in rat brain that corresponded well to the distribution of binding sites labeled with kappa-selective ligands. These observations indicate that we have cloned a cDNA encoding a rat kappa receptor of the kappa 1 subtype.     

Preliminary results of Zenith Fenestrated abdominal aortic aneurysm endovascular grafts

Background

Patients with juxtarenal aortic aneurysms who are unfit for open repair may be considered for fenestrated endovascular repair (fenEVAR). We report our initial experience with fenEVAR.

Methods

We reviewed the data on all our patients receiving fenEVAR for juxtarenal aortic aneurysms.

Results

Eight patients, average age 75 years, underwent fenEVAR. Endografts were designed from details obtained from preoperative computed tomography angiography. There were 6 grafts with superior mesenteric scallops and bilateral renal fenestrations, 1 with bilateral renal scallops, and 1 with a single renal fenestration. All patients survived 30 days. There was no renal failure requiring dialysis. At 10 weeks, 1 patient died from acute intestinal ischemia and multisystem organ failure, and another died from respiratory failure.

Conclusions

It is feasible to offer fenEVAR to patients who are poor candidates for open repair. However, these procedures are technically challenging. Early outcomes are less favorable than other aortic endovascular procedures.     

Sensitivity of Crosswise Model to Simplistic Selection of Nonsensitive Questions: An Application to Estimate Substance Use,Alcohol Consumption and Extramarital Sex Among Iranian College Students

Background: Nonrandomized response (NRR) models are a new generation of surveys for sensitive issues. This study aims to evaluate the validity of estimates from the crosswise model (as one of the efficient models) through employing different response probabilities of nonsensitive questions. Methods: This cross-sectional study was conducted during October and November 2015 among 1777 students of Tabriz University of Medical Sciences. Estimates of monthly alcohol consumption, and at least one instance of illicit drug use and extramarital sex over the last year were determined using direct questioning (DQ) and the Crosswise model (CM). In the last model, the probability of positive response to the nonsensitive questions was determined by using five different methods: uniform distribution (I), Benford’s law (II), and estimations based on data from three other studies (III, IV, V). Results: Crosswise estimates of sensitive behaviors with different probabilities of a positive response to nonsensitive questions differed significantly. For example, estimates of history of using illegal opioids at least once in the last year among men varied significantly from 5.0% to 16.1% with different crosswise models based on the probability of being born in Spring using method I (0.250), III (0.287), IV (0.248), and V (0.310). The model based on Benford’s law (II) was applied to estimate alcohol and cannabis consumption, and its estimates showed significant discrepancy with results of crosswise models I and V. Conclusion: Estimates from crosswise model is highly sensitive to the response probability of nonsensitive questions. It seems that if this question is not selected carefully, the mentioned models will provide overestimates or underestimates, and the more-is-better hypothesis is not always valid. To achieve valid estimates, the exact probability of a positive response to the nonsensitive question must be known for the studied population.     

Modulatory effects of Saussurea lappa root aqueous extract against ethephon‐induced kidney toxicity in male rats

Ethephon (2‐chloroethyl phosphonic acid) is a plant growth promoter used to control the plant growth process by liberating ethylene and stimulating the production of endogenous ethylene. Medicinal plants are sources of novel drug discovery targets. Costus (Saussurea lappa) has been used as traditional Chinese medicine. The current study was conducted to examine the possible modifying effects of costus (S. lappa) root aqueous extract against kidney toxicity induced by ethephon in male rats. A total of 50 adult male rats were divided into five groups (first, control; second, costus; third, ethephon; fourth, posttreated ethephon with costus; fifth, ethephon self‐healing). There is a significant increase in the serum levels of urea, creatinine, potassium ions, chloride ions, kidney injury, DNA damage, and proliferating cell nuclear antigen expressions in treated rats with ethephon when compared to the control group. In contrast, the treated rats with ethephon revealed a significant decrease in the levels of sodium ions and an insignificant decrease in the calcium ions. Saussurea lappa extract modified these alterations when compared to the control group. As a result, costus root extract significantly reduced rat kidney toxicity after ethephon administration. We recommend costus to be included in diet for its valuable effects, and also producers and consumers should become more aware about the toxic effects of ethephon.     

Correlates of Obstructive Apnea Duration

Purpose

The duration of an obstructive apnea is dependent on gender, age, body position, and state. Termination of an obstructive respiratory event is attributed as the end result of an achieved specific negative inspiratory force, sufficient to result in cortical arousal. We used polysomnographic measures of tendency for arousal, hypothesizing that long apnea would be associated with a smaller tendency for arousal.

Methods

From a clinical sleep laboratory sample, 140 subjects (82 men) with an obstructive apnea index >5 were selected. Subjects were split into those with long and short apnea by stratifying around median obstructive apnea duration. Those with long duration apnea were compared to short apnea for age, gender, apnea-hypopnea index (AHI), and a measure of tendency to arouse, respiratory event-related arousal to AHI ratio (RespArI:AHI).

Results

Obstructive apnea duration (mean ± SD) was 20.7 ± 5.6. Apnea duration trended toward being longer in men than women and was significantly longer in supine than nonsupine sleep (19.2 ± 7.3 vs. 16.1 ± 10; p = 0.001) and REM than NREM sleep (24.3 ± 9.0 vs. 19.7 ± 5.1; p < 0.001). Those with long compared with short apnea were significantly older; AHI was similar. RespArI:AHI was significantly higher for those with long compared with short apnea (0.58 ± 0.24 and 0.43 ± 0.19; p < 0.0001). This difference was most apparent for women in whom RespArI:AHI for those with long and short apnea was 0.6 ± 0.24 and 0.41 ± 0.17 (p = 0.001). For men, RespArI:AHI for those with long and short obstructive apnea was 0.56 ± 0.24 and 0.44 ± 0.2 (p = 0.02).

Conclusions

Long obstructive apnea duration occurs to a greater degree in older individuals, in supine, and REM sleep. Women more than men with long apnea had a greater tendency toward arousal.     

Neuroprotective effect of Crocus sativus against cerebral ischemia in rats

Metabolic Brain Disease - The present study aimed to investigate the role of vascular endothelial growth factor (VEGF) in the neuroprotective effect of Crocus sativus (saffron) against cerebral...