Atypical meningioma presenting as a nasal mass-multidisciplinary management

ObjectiveTo report a case of recurrent extracranial atypical meningioma successfully managed by a multidisciplinary team.MethodsCase report and literature review concerning successful management of recurrent extracranial meningioma based on pathology and extent of resection.ResultsA 48-year-old woman who presented with a nasal mass, anosmia and headaches. Physical exam and imaging showed recurrent meningioma involving the entire anterior frontal meninges extending into the frontal bone and down into the nasal cavity via the anterior ethmoid. Combined modality surgical intervention was successful and the patient recovered suffering no neurological sequelae.ConclusionThis is a very rare presentation of meningioma that the craniomaxillofacial surgeon should consider when formulating a differential diagnosis for a nasal mass. Long-term surveillance is crucial as recurrence can have devastating consequences. Aggressive multidisciplinary care is needed to prevent future recurrences and to improve survival.     

Recovery after AKI: Effects on outcomes over 15 years

PurposeTo examine the effect of kidney recovery on mortality, dialysis and kidney transplantation up to 15 years after AKI.Materials and methodsWe studied 29,726 survivors of critical illness and compared these outcomes stratified by AKI and recovery status at hospital discharge. Kidney recovery was defined as a return of serum creatinine to ≤150% of baseline without dialysis prior to hospital discharge.ResultsOverall AKI occurred in 59.2% in which two thirds developed stage 2–3 AKI. Recovery rate of AKI at hospital discharge was 80.8%. Patients who did not recover experienced the worst 15-year mortality compared to those who recovered and those without AKI (57.8% vs 45.2% vs 30.3%, p < 0.001). This pattern was also found in subgroups of patients with suspected sepsis-associated (57.1% vs 47.9% vs 36.5%, p < 0.001) and cardiac surgery-associated AKI (60.1% vs 41.8% vs 25.9%, p < 0.001). The rates of dialysis and transplantation at 15 years were low and not associated with recovery status.ConclusionsRecovery of AKI in critically ill patients at hospital discharge had an effect on long-term mortality for up to 15 years. These results have implications for acute care, follow-up and choice of endpoints for clinical trials.     

Prognostic significance of CRLF2 overexpression and JAK2 mutation in Egyptian pediatric patients with B-precursor acute lymphoblastic leukemia

BackgroundThe prognostic significance of cytokine receptor-like factor 2 (CRLF2) overexpression in pediatric B-cell precursor (BCP) acute lymphoblastic leukemia (ALL) is still controversial. We aimed to investigate the role of CRLF2 overexpression and JAK2 mutation in the diagnosis and prognosis of newly diagnosed pediatric B-ALL patients.MethodsCRLF2 expression was assessed by real-time quantitative polymerase chain reaction (PCR) in 115 pediatric patients newly diagnosed with precursor B-ALL patients compared with 24 age- and sex-matched controls. JAK2 R683G mutation status was performed by the qBiomarker Somatic Mutation PCR Assay.ResultsCRLF2 overexpression was identified in 21 patients (18.3%), while the JAK2 R683G mutant type was found in only in 7 patients (6.1%). There was a significant CRLF2 overexpression in patients with high initial TLC, high blast count in blood, and organomegaly (P .04, 0.005 & 0.05 respectively). No patients with CRLF2 overexpression expressed any recurrent cytogenetic translocations. 4 patients with CRLF2 overexpression showed JAK2 R683G mutation. CRLF2 levels and JAK2 R683G mutation status did not have a significant impact on either overall survival or disease-free survival.ConclusionCRLF2 expression was significantly higher in Egyptian precursor B-ALL pediatric patients. CRLF2 overexpression was associated with a number of unfavorable prognostic factors with high tumor load, but was not an adverse independent parameter in pediatric BCP-ALL patients. Some patients with CRLF2 overexpression display JAK2 mutation, which may benefit from targeted therapy by kinase inhibitors.     

Effect of Saikokeishito,a Kampo medicine,on hydrogen peroxide-induced premature senescence of normal human dermal fibroblasts

OBJECTIVE: Saikokeishito(TJ-10) is a Kampo(traditional Japanese herbal) medicine, clinically used for hundreds of years in East Asia. Among its various mechanisms elucidated so far, TJ-10 inhibits the production of transforming growth factor-β1(TGF-β1) and development of pancreatic fi brosis in vivo. Oxidative damage of normal human dermal fi broblasts(NHDFs) in the corium is a cause of human dermal senescence. Our aim was to determine whether TJ-10 protects NHDFs from premature senescence by hydrogen peroxide(H2O2). METHODS: Premature senescence was induced in NHDFs by 200 μmol/L H2O2 for 4 h. Cell viability and the expressions of p53, AMP-activated protein kinase α1(AMPKα1), AMPKα2, and 14-3-3 protein sigma(14-3-3 σ) were measured in NHDFs treated with TJ-10 for 48 h before exposure to H2O2 for 4 h. RESULTS: Cell viability after treatment with 200 μmol/L H2O2 for 4 h was similar(about 80%) to after pre-treatment with TJ-10. Ascorbic acid as a control did not protect NHDFs from damage by 200 μmol/L H2O2. Treatment with 200 μmol/L H2O2 tended to up-regulate p53 and to down-regulate SIRT1 and AMPKα1, but had no effect on AMPKα2 and 14-3-3 σ expression. Pretreatment with TJ-10 inhibited H2O2-induced up-regulation of p53 and enhanced AMPKα1 expression. CONCLUSION: It is suggested that Saikokeishito has a protective effect on oxidative stressinduced senescence of NHDFs.