Limb Shaking Transient Ischemic Attacks with Normal Neurovascular Ultrasound may Herald Cardioembolic Stroke: A Case Report

Our objective is to highlight that the rare occurrence of limb shaking in transient ischemic attacks may be underpinned by etiologies other than critical internal carotid stenosis/occlusion. We describe a 74 year-old woman with abrupt left arm jerking and normal urgent computed tomography scan, electroencephalography (EEG) as well as carotid and transcranial ultrasound. Two days later she developed an overt ischemic stroke, with left mesencephalon and left cerebellar hemisphere lesions at brain magnetic resonance imaging and paroxysmal atrial fibrillation at Holter-EKG. Transient ischemic attacks should be considered in the differential diagnosis of limb shaking even in patients with normal carotid and transcranial ultrasonography.     

Efficacy of Cilostazol in Prevention of Delayed Cerebral Ischemia after Aneurysmal Subarachnoid Hemorrhage: A Meta-Analysis

Objectives

Cilostazol, a selective inhibitor of phosphodiesterase 3, may reduce symptomatic vasospasm and improve outcome in patients with aneurysmal subarachnoid hemorrhage considering its anti-platelet and vasodilatory effects. We aimed to analyze the effects of cilostazol on symptomatic vasospasm and clinical outcome among patients with aneurysmal subarachnoid hemorrhage (aSAH).

C-Reactive Protein and T3: New Prognostic Factors in Acute Ischemic Stroke

Background

Several studies have shown that high level of plasma C-reactive protein (CRP) is associated with stroke outcomes and future vascular events, and a decrease in serum triiodothyronine (T3) was reported to be associated with stroke severity and poor prognosis.

Ocular Neuromyotonia: Case Reports and Literature Review

Ocular neuromyotonia (ONM) is a rare eye movement disorder, presenting as a paroxysmal involuntary spasm of one or more extra-ocular muscles, that can persist for a few seconds up to several minutes. The phenomenon is caused by the contraction of an extra-ocular muscle, excited by a damaged nerve, which leads to delayed muscle relaxation.

We present eight patients with this rare condition together with an overview of the literature on all published ONM cases. One of the presented cases is possibly secondary to hypovitaminosis D. This association has not been reported previously in the literature. A possible underlying mechanism is given.     

Second-line treatment efficacy and toxicity in older vs. non-older patients with advanced gastric cancer: A multicentre real-world study

ObjectivesAlthough gastric cancer (GC) incidence rises with age, older patients are poorly represented in clinical trials, whose results are therefore difficult to translate into standard management of older patients. Purpose of this study was to compare clinico-pathological features and survival outcomes between older and non-older patients with advanced GC treated with at least two chemotherapy lines.Materials and MethodsClinico-pathological characteristics, basal values, and treatment data of older (≥70 years at second-line start) and non-older patients were compared using chi-square test or 2-tailed Fisher exact test. The Kaplan-Meier estimation was used to calculate progression-free survival (PFS) and overall survival (OS), which were examined by log-rank test.ResultsOlder patients represented 31.8% of the population (N = 868). Intestinal type was more frequent in older patients (P = .02). Poorly differentiated tumours were more often observed in non-older patients (P = .009). At stage IV diagnosis, the rate of liver metastases was higher in older patients (P = .02), while peritoneal spread was more represented in non-older patients (P = .002). Although older patients were more often treated with monotherapy (P = .001), they had similar PFS (HR 0.86, 95%CI 0.71–1.03, P = .102) and OS (HR 0.82, 95%CI 0.65–1.02, P = .08) compared to the non-older counterpart. No statistical differences were observed in treatment-related adverse events, hospital admissions, or further treatment lines between age groups.ConclusionIn our large cohort study, despite some differences in tumour characteristics and treatment intensity, no survival difference was found between older and non-older patients with advanced GC treated with at least two chemotherapy lines. Incidence of adverse events was similar between age groups.     

卡马西平血药浓度和临床用药的相关性研究

研究癫痫息儿卡马西平血药浓度与临床用药的相关性.对年龄1～19岁,服用卡马西平治疗的癫痫患儿185例血样进行检测,采用化学发光免疫分析法测定其稳态血药浓度,并对结果进行统计分析.结果表明,临床服药剂量和血药浓度没有明显的相关性,而年龄对血药浓度有明显的相关性(P<0.01).卡马西平血药浓度受多种因素影响,以年龄影响最明显,在持续血药浓度监测的情况下,提倡个体化给药.     

The effects of 2{5(4-chlorophenyl) pentyl}oxirane-2-carbonyl-CoA on mitochondrial oxidations

2{5(4-Chlorophenyl)pentyl}oxirane-2-carbonyl-CoA (POCA-CoA) was prepared from 2{5(4-chlorophenyl)pentyl}oxirane-2-carboxylate (POCA) and characterised chromatographically. POCA-CoA does not inhibit citrate cycle oxidations or effect oxidative phosphorylation by rat liver mitochondria. POCA-CoA at low (μM) concentrations, but not free POCA^?, specifically inhibits palmitoyl-CoA oxidation at the stage of carnitine palmitoyltransferase I (CPT I) situated on the outer face of the inner mitochondria membrane. Palmitoyl-carnitine oxidation was not inhibited by POCA-CoA. POCA-CoA inhibits palmitoyl-CoA oxidation in liver mitochondria from fed rats more strongly than it does in mitochondria from fasted rats, similarly to the inhibition by malonyl-CoA [E. D. Saggerson and C. A. Carpenter, FEBS Lett. 129, 225 (1981)]. Palmitoyl-CoA, by contrast with palmitoylcarnitine, is not quantitatively oxidised to acetoacetate by liver mitochondrial fractions, presumably due to competing palmitoyl-CoA hydrolase activity. In the presence of POCA-CoA the amount oxidised is decreased further because the slower rate of oxidation allows more palmitoyl-CoA to be hydrolysed to palmitate. The oxidation of palmitoyl-CoA, but not that of palmitoyl-carnitine, was strongly decreased in washed liver and muscle mitochondrial fractions from POCA-fed animals. POCA^? inhibited the oxidation of {U-¹⁴C}palmitate in cultured human fibroblasts, and caused small increases in ¹⁴CO₂ production from {1-¹⁴C}pyruvate and {U-¹⁴C}glucose. Inhibition of β-oxidation at the stage of CPT I by POCA-CoA can explain the powerful hypoketonaemic and hypoglycaemic effects of POCA in fasted normal and fasted diabetic animals [H. P. O. Wolf, K. Eistetter and G. Ludwig, Diabetologia22, 456 (1982)].     

Lithium-carbamazepine versus lithium-neuroleptic prophylaxis in bipolar illness

Fourteen DSM-III diagnosed patients with lithium-resistant bipolar affective disorder treated with a combination of lithium and carbamazepine were followed in a lithium clinic for one year to study the prophylactic benefit and side effects of this drug regimen. Comparison data for the previous year on lithium and neuroleptics showed that for the 9 patients who completed the study, the lithium-carbamazepine regimen was superior to lithium-neuroleptics in decreasing the number of affective episodes and side effects. Carbamazepine blood levels appeared to be a possible contributing factor in the development of side effects.     

Effects of Carbamazepine Therapy on Serum Sex Hormone Levels in Male Patients with Epilepsy

The effects of carbamazepine (CBZ) therapy and epilepsy on sex hormone plasma levels in male patients with epilepsy were evaluated by measuring the levels of testosterone (T), free testosterone (FT), sex hormone binding globulin (SHBG), estradiol (E2), luteinizing hormone (LH), follicle-stimulating hormone (FSH), prolactin (PRL), and dehydroepiandrosterone sulfate (DHEAS) and by calculating the free androgen index (FAI) in 23 male patients with epilepsy receiving CBZ medication, in 18 untreated male patients with epilepsy, and in 19 healthy age-matched control subjects. No significant differences in the mean T or FT levels were found between the three groups, but the CBZ-treated patients had significantly higher SHBG levels and their FAI values and DHEAS concentrations were lower. The LH, FSH, PRL, or E2 levels in CBZ-treated and untreated male patients with epilepsy did not differ from the controls. CBZ monotherapy does not significantly change the serum balance of sex hormones; however, CBZ clearly affects the serum levels of SHBG and DHEAS.