Motor cortex injury has different behavioral and anatomical effects in early and late adolescence

Although there are many studies investigating the effects of early cortical injury on brain and behavioral development in laboratory animals, there are virtually no studies examining the effects of cortical injury in adolescence. The purpose of present study was to investigate the effects of unilateral motor cortex lesion received in early and late adolescence periods (Postnatal days 35 and 55 [P35, P55]) on spontaneous neural reorganization and behavioral recovery in adulthood. Rats were given unilateral motor cortex lesions at P35 or P55 and their motor behaviors were compared to sham controls in adulthood. The results of behavioral tests (skilled reaching, postural asymmetry, sunflower seed manipulation, forepaw inhibition in swimming) revealed that rats with P35 lesions had significant functional deficits whereas the rats with P55 lesions showed nearly complete recovery. Golgi-Cox analysis of pyramidal neurons showed bilateral hypertrophy of dendritic fields in the remaining sensorimotor cortex in P55 but not P35 rat brains. Thus, there appears to be an age-related pattern of morphological and behavioral changes in response to cortical injury in the early and late adolescent periods leading to better functional recovery from later injuries, much as is seen in human children.     

Treatment of pemphigus vulgaris with mycophenolate mofetil as a steroid-sparing agent

Pemphigus vulgaris is a rare autoimmune blistering disease. Estimation of the incidence in Iran is one patient per 100,000 of the population per year. Mycophenolate mofetil is an immunosuppressive drug and successful treatment of pemphigus vulgaris and bullous pemphigoid has been reported with it, in combination with high dose prednisone, or as monotherapy. The present study describes our experience of the adjuvant use of mycophenolate mofetil in the management of 31 patients with pemphigus vulgaris as an initial treatment. We evaluated the efficacy and safety of mycophenolate mofetil combined with prednisolone in this cohort. We also assessed the relationship between the demographic indices/disease severity factors, and the failure of this treatment. In this study, mycophenolate mofetil was of definite benefit in 21 cases (67.7%). Generalized forms; patients with higher sum of the clinical scores at presentation; severe involvement of the groin; chest; face and limbs and those who had nail dystrophy also appeared to have poorer responses. When we excluded patients with generalized forms, only four patients were included in the failure group and the response rate reached 83.3%. It can be concluded that, except for generalized diseases, mycophenolate mofetil can be used safely and effectively in patients with pemphigus vulgaris as a first line, steroid sparing agent.     

Low serum leptin serves as a biomarker of malnutrition in elderly patients

Anthropometric and classical biologic markers of malnutrition, such as serum albumin, are limited because they are influenced by nonnutritional factors. We propose that a biologic parameter that both predicts nutritional status and is unaffected by nonnutritional factors would facilitate the diagnosis of malnutrition in the elderly. This cross-sectional study included 179 randomized elderly patients. Nutritional status was assessed by the Mini-Nutritional Assessment (MNA) instrument; other end points included anthropometric measures and biologic parameters. Subjects were divided into 3 groups based on MNA-defined nutritional status, and end point means were compared using 2-way analyses of variance adjusted by sex. Correlations between the most accurate biologic marker in predicting malnutrition and other biologic and clinical variables were assessed using Pearson correlation test. Multiple linear regressions were then performed to relate the best biomarker of malnutrition to specific parameters. Finally, leptin levels that predict malnutrition were determined using receiver operating characteristic curve cutoff values. The well-nourished group had significantly higher leptin (P = .001), weight, body mass index, mid-arm circumference, and calf circumference (all, P < .001) compared with the malnourished group and the at risk of malnutrition group. Serum leptin was the optimal biomarker of MNA-defined malnutrition and had significant positive correlations with weight (P = .003) and with all anthropometric values (all P < .001), but no significant correlation with C-reactive protein. Sex, weight, and triglyceride were the best predictors of serum leptin (all P < .001). The optimal cutoff value of serum leptin to detect malnutrition was 4.3 ng/mL in men and 25.7 ng/mL in women. Serum leptin may be a good predictor of nutritional status in elderly patients.     

Metformin‐associated lactic acidosis (MALA): Moving towards a new paradigm

Although metformin has been used for over 60 years, the balance between the drug's beneficial and adverse effects is still subject to debate. Following an analysis of how cases of so‐called “metformin‐associated lactic acidosis” (MALA) are reported in the literature, the present article reviews the pitfalls to be avoided when assessing the purported association between metformin and lactic acidosis. By starting from pathophysiological considerations, we propose a new paradigm for lactic acidosis in metformin‐treated patients. Metformin therapy does not necessarily induce metformin accumulation, just as metformin accumulation does not necessarily induce hyperlactatemia, and hyperlactatemia does not necessarily induce lactic acidosis. In contrast to the conventional view, MALA probably accounts for a smaller proportion of cases than either metformin‐unrelated lactic acidosis or metformin‐induced lactic acidosis. Lastly, this review highlights the need for substantial improvements in the reporting of cases of lactic acidosis in metformin‐treated patients. Accordingly, we propose a check‐list as a guide to clinical practice.     

Chronic Administration of Daidzein,a Soybean Isoflavone,Improves Endothelial Dysfunction and Attenuates Oxidative Stress in Streptozotocin‐induced Diabetic Rats

The effect of chronic daidzein, a soybean isoflavone, on aortic reactivity of streptozotocin‐diabetic rats was studied. Male diabetic rats received daidzein for 7 weeks a week after diabetes induction. Contractile responses to KCl and phenylephrine (PE) and relaxation response to acetylcholine (ACh) were obtained from aortic rings. Maximum contractile response of endothelium‐intact rings to PE was significantly lower in daidzein‐treated diabetic rats relative to untreated diabetic rats, and endothelium removal abolished this difference. Endothelium‐dependent relaxation to ACh was significantly higher in daidzein‐treated diabetic rats as compared with diabetic rats and pretreatment of rings with nitric oxide synthase inhibitor N(G)‐nitro‐l‐arginine methyl ester and/or indomethacin attenuated it. Two‐month diabetes also resulted in an elevation of malondialdehyde (MDA) and decreased superoxide dismutase (SOD) activity, and daidzein treatment significantly reversed the increased MDA content and reduced activity of SOD. Therefore, chronic treatment of diabetic rats with daidzein could prevent some abnormal changes in vascular reactivity in diabetic rats through nitric oxide and prostaglandin‐related pathways, and via attenuation of oxidative stress in aortic tissue and endothelium integrity seems essential for this effect. Copyright © 2012 John Wiley & Sons, Ltd.     

The utility of e-Learning to support training for a multicentre bladder online adaptive radiotherapy trial (TROG 10.01-BOLART)

Background and purpose

An e-Learning programme appeared useful for providing training and information regarding a multi-centre image guided radiotherapy trial. The aim of this study is to demonstrate the utility of this e-Learning programme.

Materials and methods

Modules were created on relevant pelvic anatomy, Cone Beam CT soft tissue recognition and trial details. Radiation therapist participants’ knowledge and confidence were evaluated before, at the end of, and after at least 6 weeks of e-Learning (long term).

Results

One hundred and eighty-five participants were recruited from 12 centres, with 118 in the first, and 67 in the second cohort. One hundred and forty-six participants had two tests (pre and post e-Learning) and 39 of these had three tests (pre, post, and long term). There was an increase confidence after completion of modules (p < 0.001). The first cohort pre scores increased from 67 ± 11 to 79 ± 8 (p < 0.001) post. The long term same question score was 73 ± 14 (p = 0.025, comparing to pre-test), and different questions’ score was 77 ± 13 (p = 0.014). In the second cohort, pre-test scores were 64 ± 10, post-test same question score 78 ± 9 (p < 0.001) and different questions’ score 81 ± 11 (p < 0.001).

Conclusions

e-Learning for a multi-centre clinical trial was feasible and improved confidence and knowledge.     

Is the iliolumbar ligament a reliable identifier of the L5 vertebra in lumbosacral transitional anomalies?

Objective

Sufficiently sized studies to determine the value of the iliolumbar ligament (ILL) as an identifier of the L5 vertebra in cases of a lumbosacral transitional vertebra (LSTV) are lacking.

Methods

Seventy-one of 770 patients with LSTV (case group) and 62 of 611 subjects without LSTV with confirmed L5 level were included. Two independent radiologists using coronal MR images documented the level(s) of origin of the ILL. The interobserver agreement was analysed using weighted kappa/kappa (wκ/κ) and a Fischer’s exact test to assess the value of the ILL as an identifier of the L5 vertebra.

Results

The ILL identified the L5 vertebra by originating solely from L5 in 95 % of the controls; additional origins were observed in 5 %. In the case group, the ILL was able to identify the L5 vertebra by originating solely from L5 in 25–38 %. Partial origin from L5, including origins from other vertebra was observed in 39–59 % and no origin from L5 at all in 15–23 % (wκ?=?0.69). Both readers agreed that an ILL was always present and its origin always involved the last lumbar vertebra.

Conclusion

The level of the origin of the ILL is unreliable for identification of the L5 vertebra in the setting of an LSTV or segmentation anomalies.

Key Points

? The origin of the ILL is evaluated in subjects with an LSTV. ? The origin of the ILL is anatomically highly variable in LSTV. ? The ILL is not a reliable landmark of the L5 vertebra in LSTV.