Forearm pain secondary to compression syndrome of the lateral cutaneous nerve of the forearm

This report describes a syndrome of compression of the lateral cutaneous nerve of the forearm (LCNF), the distal termination of the musculocutaneous nerve. Three patients presented with pain or numbness along the radial aspect of the distal forearm. There was a history of vigorous upper extremity exercise with elbow extension and arm pronation or resisted elbow flexion. Signs included: decreased sensation to pin and light touch in the distal forearm over the cutaneous distribution of the nerve; tenderness to palpation over the nerve where it pierces the deep fascia of the arm lateral to the bicipital tendon and proximal to the elbow crease; and decreased elbow extension with arm fully pronated. Electrodiagnostic studies revealed either a prolonged distal latency or decrease in amplitude of the evoked response of the lateral cutaneous nerve of the forearm in the symptomatic arm. Patients responded to treatment directed to the site of the lesion where the nerve pierces the deep fascia of the arm. Treatment methods included: restriction of upper extremity activity, use of a posterior splint to restrict elbow extension, transcutaneous electrical nerve stimulation (TENS), ultrasound, and surgical decompression. This syndrome may be readily differentiated from other causes of pain along the distal radial aspect of the forearm, making accurate diagnosis and treatment possible.     

AHNS Series: Do you know your guidelines? AHNS Endocrine Section Consensus Statement: State‐of‐the‐art thyroid surgical recommendations in the era of noninvasive follicular thyroid neoplasm with papillary‐like nuclear features

The newly introduced pathologic diagnosis of noninvasive follicular thyroid neoplasm with papillary‐like nuclear features (NIFTP) will result in less bilateral thyroid surgery as well as deescalation in T4 suppressive and radioactive iodine treatment. Although, NIFTP is a nonmalignant lesion that has nuclear features of some papillary malignancies, the challenge for the surgeon is to identify a lesion as possibly NIFTP before the pathologic diagnosis. NIFTP, due to its reduction of overall rates of malignancy, will result in the initial surgical pendulum swinging toward lobectomy instead of initial total thyroidectomy. This American Head and Neck Society endocrine section consensus statement is intended to inform preoperative evaluation to attempt to identify those patients whose final pathology report may ultimately harbor NIFTP and can be offered a conservative surgical plan to assist in cost‐effective, optimal management of patients with NIFTP.     

NON-CONVULSIVE STATUS EPILEPTICUS AS A COMPLICATION OF Mycoplasma pneumoniae INFECTION

SUMMARY Described is a confirmed case of non-convulsive status epilepticus, an unusual presentation of M. pneumoniae infection. The postulated pathological mechanisms in this infection are reviewed.     

β-巯基乙醇诱导大鼠骨髓基质细胞神经细胞蛋白的表达

目的:骨髓基质细胞具有向神经细胞分化的能力,观察化学诱导剂β-巯基乙醇体外诱导大鼠骨髓基质细胞后神经细胞标志蛋白的表达率。方法:实验于2006-09-01/2006-10-20在辽宁医学院中心实验室完成。①实验材料:选取清洁级2月龄SD大鼠12只,由辽宁医学院实验动物中心提供,体质量200g左右,雌雄不拘。②实验方法:采用贴壁培养与传代的方法分离纯化SD大鼠骨髓基质细胞,将第2代细胞置于含有4mol/Lβ-巯基乙醇诱导剂的培养基中诱导6h。③实验评估:应用倒置显微镜观察骨髓基质细胞与诱导后细胞形态,采用免疫组织化学法检测巢蛋白,胶质纤维酸性蛋白,神经丝蛋白的表达率。结果:诱导前大鼠骨髓基质细胞以长梭形细胞为主,诱导后可见细胞体积缩小,胞体伸出较多突起并有分枝出现,个别细胞形态类似神经细胞。诱导6h后,细胞中巢蛋白、神经丝蛋白、胶质纤维酸性蛋白均有表达,表现为胞浆呈棕黄色,免疫组织化学检测神经细胞标志蛋白神巢蛋白、胶质纤维酸性蛋白、神经丝蛋白表达率分别为85.12%,6.56%,80.17%。结论:大鼠骨髓基质细胞体外分离纯化方法简单易行,在β-巯基乙醇诱导下,较高的表达了神经细胞标志物。     

Does “Physiologic” mitral valve prolapse occur with acute blood loss?

Intravascular volume changes are reported to affect the clinical and echocardiographic spectrum of patients with known mitral valve prolapse syndrome (MVPS). We tested whether acute blood loss can produce MVP in normal adults. Twenty-one subjects were studied with Doppler echocardiography before and after donating 550 ml whole blood. Two subjects demonstrated minimal (1+) prolapse postphlebotomy, but in only one echocardiographic view, and without mitral regurgitation by Doppler. Three subjects demonstrated slight, early (not late or pansystolic) mitral regurgitation after phlebotomy, but without prolapse. Left atrial dimensions decreased significantly after the blood donation but the left ventricular size was not significantly smaller. The 1+ MVP is within the range of superior systolic motion found in 35% of a normal population, free of heart disease, and without intervention. We find no evidence in our study or in the literature that pathologic degrees of MVP can be produced in normal subjects by physiologic alteration in blood volume.     

Effects of neuraminidase on the regulation of erythropoiesis

In this article, we present evidence that sialic acid-containing surface components play a role in the regulation of erythropoiesis. A 1- hr exposure of mouse bone marrow cells to high concentrations of neuraminidase reduced erythroid colony formation. Coculture of 10(6) untreated thymocytes with neuraminidase-treated bone marrow cells restored erythroid colony growth. Neuraminidase-treated thymocytes retained their ability to suppress erythroid colony formation by untreated marrow cells, but lost their ability to enhance erythroid colony formation. Continuous exposure to low concentrations of neuraminidase enhanced erythroid bone marrow cell colony growth in response to a suboptimal dose of erythropoietin.     

Hemoglobin stimulates mononuclear leukocytes to release interleukin-8 and tumor necrosis factor alpha

Incubation of human mononuclear leukocytes (MNL) with human stroma-free hemolysate (SFH), purified adult hemoglobin Ao (HbAo), and oxidized HbAo (METHb) caused MNL to release compounds into the supernate that mediated neutrophil (polymorphonuclear leukocytes, PMN) chemotaxis and PMN adherence to human umbilical vein endothelial cells (HUVEC). Chemotaxis and PMN adherence to HUVEC were reduced significantly when supernates were preincubated with neutralizing antibodies to interleukin-8 (IL-8) and tumor necrosis factor alpha (TNF-alpha), respectively, suggesting that IL-8 and TNF-alpha played significant roles in mediating these activities. Greatest chemotactic activity was observed in supernates of MNL treated with HbAo; while greatest PMN/endothelial cell (EC) adherence activity was observed in supernates of MNL treated with METHb. Furthermore, PMN/EC adherence activity was a function of METHb content in each hemoglobin solution. PMN chemotaxis, PMN adherence to HUVEC, and cytokine release increased as a function of increasing incubation time. Chemotactic activity was detected in HbAo- treated and METHb-treated MNL supernates after incubation for 6 hours and was maximal by 10 hours. IL-8 was detected in both HbAo and METHb- MNL supernates by 4 hours. PMN/EC adherence activity was detected in HbAo-MNL supernates at 10 hours and in METHb-MNL supernates at 4 hours. TNF-alpha was detected in METHb and HbAo-MNL supernates at 4 and 12 hours, respectively. These results suggest that hemoglobin solutions stimulate MNL to release IL-8 and TNF-alpha in quantities sufficient to induce PMN chemotaxis and PMN adherence to HUVEC. This is a US government work. There are no restrictions on its use.     

Transduction of primitive human hematopoietic cells with recombinant adenovirus vectors

We have examined the ability of recombinant adenoviral vectors to transduce human hematopoietic cells. Our findings indicate that adenovirus readily infects a large proportion of CD34+ cells. Using adenovirus vectors that transduce either a lacZ or an alkaline phosphatase reporter gene, we observed up to 45% of total CD34+ cells infected. Upon more detailed analysis, we observed comparable levels of transduction for CD34+/CD38- cells and for CD34+ cells in G(zero) phase of the cell cycle. Importantly, exposure to adenovirus resulted in negligible levels of toxicity as assayed by propidium iodide staining and colony-forming ability. Using adenovirus vectors, we also describe a model system for regulated gene expression in early hematopoietic tissues. CD34+ cells were simultaneously infected with two viruses, one carrying a TetR/VP16 transactivator (tTA) and the second carrying a tTA- dependent lacZ reporter gene. Using this approach, beta-gal expression was only observed upon coinfection with the transactivator vector. In addition, as shown previously (Gossen and Bujard, Proc Natl Acad Sci USA 89:5547, 1992), tetracycline was able to inhibit tTA mediated induction, thereby providing an effective means to regulate expression of the reporter gene. We conclude that recombinant adenovirus is an effective vehicle for transiently expressing genes in primitive human hematopoietic cells.     

DNA sequence recognition in the minor groove by crosslinked polyamides: The effect of N-terminal head group and linker length on binding affinity and specificity

Development of sequence-reading polyamides or "lexitropsins" with comparable DNA-binding affinities to cellular proteins raises the possibility of artificially regulated gene expression. Covalent linkage of polyamide ligands, with either a hairpin motif or crosslinking methylene bridge, has greatly improved binding affinity by ensuring their side-by-side register. Whereas hairpin polyamides have been investigated extensively, the optimized structure of crosslinked polyamides remains to be determined. This study examines a series of thiazole-imidazole-pyrrole (TIP) monomers and crosslinked dimers to evaluate the effects on selectivity and binding affinity of different N-terminal head groups attached to the leading thiazole ring and differing methylene linker lengths. Quantitative footprinting of a DNA sequence, containing potential match and mismatch sites for both maximum overlap and one-residue stagger binding modes, allowed measurement of binding constants at each putative site. Within an N-terminal amino TIP series, C7 and C8-linked compounds bound most strongly to these sites, whereas maximum binding affinity was observed for a C6 linker with a formyl head group. A C5 linker gave weak binding with either head group. A hydrogen or acetyl head group abrogated binding. Binding was confirmed by gel shift analyses. The highest specificity for the maximum overlap site over the one-residue stagger was observed with TIP-C7-amino. Selectivity of the leading thiazole was modulated by the head group, with N-terminal formyl TIP exhibiting up to 3-fold specificity for AGT over TGT, suggesting that N-formyl-thiazole may provide sequence discrimination of adenine over thymine. Moreover, the leading head group and methylene linker length significantly influences the binding characteristics of crosslinked polyamides.