Prolonged remission in a patient with transitional cell carcinoma of the bladder developing brain metastases after systemic chemotherapy: a case report

We report a case of an excellent response to M-VAC chemotherapy in a patient with pulmonary metastases from transitional cell carcinoma of the bladder. He subsequently presented with acute neurological symptoms seven weeks after the completion of chemotherapy. Computed tomography of the brain revealed a solitary 24 mm x 26 mm lesion in the frontal lobe. The brain metastasis was resected. The patient was closely followed for disease progression and showed no evidence of disease up to 42 months after surgery. The presentation and treatment policy are discussed. This case suggests that long-term remission may be obtained after surgical resection of a single brain metastasis in patients with disseminated urothelial cancer who completely responded to systemic chemotherapy.     

Hemodynamic results of acute thoracic aortomyoplasty in a canine model: comparison of stimulation regimens

Our previous investigations in a sheep model demonstrated that when electrical stimulation (ES) was applied to a newly mobilized latissimus dorsi muscle (LDM) in a work-rest regimen and at a rate of 15 contractions per minute, it did not damage this muscle. This regimen was used twice during a 60 minute period, once a day for 16 days, with no LDM damage. The goal of our current investigation was to apply this regimen in studies of acute thoracic aortomyoplasty. In two experimental groups, we mobilized the LDM but left it in situ. Two hours later, contractile force (CF) testing (20 g/kg preload, six impulses per burst) was performed until CF dropped to 50% of baseline. Recovery time needed to completely restore CF was calculated. In one group (six sheep), we applied continuous ES; in another (six sheep), we applied ES in a work-rest regimen (1 min work, 1 min rest). In two other groups of six dogs each, aortomyoplasty was performed; the LDM flap was subjected to ES immediately postoperatively (six impulses per burst; ventricular-LDM delay, 290 ms). Again, one group received continuous ES, and the other received work-rest ES. In the mobilized LDM under continuous ES, CF decreased to 50% of baseline values after 52 +/- 8 minutes, and returned to baseline after 84 +/- 16 minutes of rest. Under the work-rest regimen, this decrease took 105 +/- 8 minutes, and the return to baseline took 25 +/- 6 minutes (p < 0.05). In LDM subjected to work-rest ES, light microscopy revealed no additional damage to LDM tissue than was seen immediately after mobilization. However, LDM subjected to continuous ES had evidence of increased basophilic degeneration and wavy fibers. After acute thoracic aortomyoplasty, assisted hemodynamic values under the continuous ES exceeded unassisted values for only 40 minutes, compared with 100 minutes for work-rest ES (p < 0.05). When counterpulsation was completed, for continuous ES, recovery time to baseline was 96 +/- 9 minutes; for work-rest ES, it was only 43 +/- 6 minutes. In conclusion, a work-rest regimen of ES can be started safely immediately postprocedure.     

Effects of β-1.3/1.6 glucan on cytokines production by leukocytes in vitro

Background

The aim of the study was to investigate the immunomodulating effect of ??-1,3/1,6 glucan from yeast on the production of interleukin-4 (IL-4), interleukin-5 (IL-5) in a medium of peripheral venous blood leukocytes from patients with periodontitis.

Material/Methods

The study was performed using venous blood of 22 patients, aged 20 to 45 years, suffering from untreated severe chronic generalized periodontitis confirmed by clinical and radiological examination, and 22 periodontally healthy subjects. The effects of ??-1,3/1,6 glucan on the production of the cytokines IL-4 (pg/ml) and IL-5 (pg/ml) levels by unstimulated and stimulated leukocyte incubation medium with unopsonized E. coli were determined using the Enzymes Linked Immunosorbent Assay (ELISA) method.

Results

We found that the incubation medium of stimulated leukocytes by unopsonized E. coli and treated with 0.2 mg and 0.4 mg of ? -1,3/1,6-glucan of patients with periodontitis produced significantly higher (P<0,001; P<0,001) levels of IL-4 and IL-5 than the analogous medium of healthy subjects.

Conclusion

This study indicates that ??-1,3/1,6-glucan may significantly increase production of IL-4 and IL-5 cytokine levels in a stimulated peripheral blood leukocytes incubation medium from periodontitis patients.     

Simultaneous nephrectomy and coronary artery bypass grafting through extended sternotomy

A 37-year-old man with end-stage idiopathic dilated cardiomyopathy underwent an orthotopic heart transplant followed by a reoperation with mitral annuloplasty for severe mitral regurgitation. Shortly thereafter, he developed severe tricuspid regurgitation and severe recurrent mitral regurgitation due to annuloplasty ring dehiscence. The dehisced annuloplasty ring was refixated, followed by tricuspid annuloplasty through a right anterolateral thoracotomy. After four years of follow-up, there are no signs of recurrent mitral or tricupid regurgitation and the patient remains in NYHA class II. Pushing the envelope on conventional surgical procedures in marginal donor hearts (both before and after transplantation) may not only improve the patient??s functional status and reduce the need for retransplantation, but it may ultimately alleviate the chronic shortage of donor hearts.     

Initial neonatal resuscitation: skill retention after the implementation of the novel 24/7 HybridLab® learning system

Background: Ensuring long-term retention of the acquired practical skills is one of the major aims of a medical school. This depends on the application of training techniques and their combinations. In order to standardize the teaching process, to acquire and maintain a broad array of technical, professional, and interpersonal skills and competencies, and to improve the retention of practical skills, we developed a new training technique – the HybridLab^® learning method. It consists of an e-learning platform, hands-on simulation, carefully elaborated learning algorithms (DRAKON), peer-to-peer teaching, and assessment and feedback by peers, and later – by a remote instructor.

Summary of the work: The subjects of the study were fifth-year students of the Lithuanian University of Health Sciences Medical Academy who during 2014–2015 were studying the obstetrics and gynecology module in the neonatology cycle. We analyzed the retention of practical skills in the initial neonatal resuscitation among students who were training with the use of our developed HybridLab^® technique at 6 and 12 months after the completion of the cycle.

Summary of results: After 6 and 12 months, mean changes in the subjects’ evaluation scores (percentage drop-off between the first and the second total score) dropped by, respectively, 31.8% (SD: 27.5) and 7.7% (SD: 25.6), and did not differ statistically significantly (p?=?.2). In the group of subjects who were not given a possibility to remember the skills and the course of initial neonatal resuscitation, the mean change between the first and the second total evaluation scores was 42.5% (SD: 26.7). In students who were given such possibility, the mean change between the first and the second total evaluation scores was significantly smaller ?12.7% (SD: 13.8) (p?p?Discussion: The HybridLab^® learning method is a novel technique, and thus more studies are required to evaluate the significance of the HybridLab^® technique for long-time retention of practical skills.

Conclusion: As a result of the application of the HybridLab^® training technique, practical skill retention among medical students after 6 and 12 months dropped by only about 13%. A recall system significantly improved practical skill retention.     

SCARB1 rs5888 is associated with the risk of age-related macular degeneration susceptibility and an impaired macular area

Background: Age-related macular degeneration (ARMD), a progressive retinal disease, is responsible for an impaired central vision in about 180 million people worldwide. Current options for ARMD prevention and treatment are limited due to an incomplete understanding of disease etiopathogenesis. We aimed to test the hypothesis that the single nucleotide polymorphism rs5888 of SCARB1 gene reflecting lipid and antioxidant micronutrient metabolism pathways is associated with ARMD susceptibility and to evaluate if there is any relation between SCARB1 rs5888 and the macular lesion area.

Materials and methods: The prospective case-control study included patients with ARMD (n = 215) and the reference group (n = 238) drawn from a random sample of the Lithuanian population (n = 1436). The genotyping test of SCARB1 rs5888 was carried out using the real-time polymerase chain reaction method.

Results: Regression analysis adjusted by gender and age demonstrated that SCARB1 rs5888 TT genotype significantly decreased the odds for ARMD development (OR: 0.61, 95%; CI: 0.380–0.981, p = 0.04). A smoking habit and leading an outdoor life are associated with larger macular lesion areas in ARMD patients (0.54 (0.00–39.06) vs. 3.09 (0.02–19.30) and 0.27 (0.00–34.57) vs. 0.75 (0.00–39.06), respectively). In late stage ARMD subjects with CT genotype, the macular lesion area was larger than in TT carriers (7.64 (0.49–39.06) mm² vs. 5.02 (0.03–37.06) mm², p = 0.006).

Conclusions: SCARB1 rs5888 and environmental oxidative stress have a prominent role in ARMD susceptibility, early ARMD progression to advanced stage disease and even in the outcome of the disease—an area of macular lesion.     

Small Aβ1–42 oligomer‐induced membrane depolarization of neuronal and microglial cells: Role of N‐methyl‐D‐aspartate receptors

Although it is well documented that soluble beta amyloid (Aβ) oligomers are critical factors in the pathogenesis of Alzheimer's disease (AD) by causing synaptic dysfunction and neuronal death, the primary mechanisms by which Aβ oligomers trigger neurodegeneration are not entirely understood. We sought to investigate whether toxic small Aβ_1–42 oligomers induce changes in plasma membrane potential of cultured neurons and glial cells in rat cerebellar granule cell cultures leading to neuronal death and whether these effects are sensitive to the N‐methyl‐D‐aspartate receptor (NMDA‐R) antagonist MK801. We found that small Aβ_1–42 oligomers induced rapid, protracted membrane depolarization of both neurons and microglia, whereas there was no change in membrane potential of astrocytes. MK801 did not modulate Aβ‐induced neuronal depolarization. In contrast, Aβ_1?42 oligomer‐induced decrease in plasma membrane potential of microglia was prevented by MK801. Small Aβ_1–42 oligomers significantly elevated extracellular glutamate and caused neuronal necrosis, and both were prevented by MK801. Also, small Aβ_1–42 oligomers decreased resistance of isolated brain mitochondria to calcium‐induced opening of mitochondrial permeability transition pore. In conclusion, the results suggest that the primary effect of toxic small Aβ oligomers on neurons is rapid, NMDA‐R‐independent plasma membrane depolarization, which leads to neuronal death. Aβ oligomers‐induced depolarization of microglial cells is NMDA‐R dependent. © 2014 Wiley Periodicals, Inc.     

Shell-Isolated Nanoparticle-Enhanced Raman Spectroscopy for Probing Riboflavin on Graphene

Graphene research and technology development requires to reveal adsorption processes and understand how the defects change the physicochemical properties of the graphene-based systems. In this study, shell-isolated nanoparticle-enhanced Raman spectroscopy (SHINERS) and graphene-enhanced Raman spectroscopy (GERS) coupled with density functional theory (DFT) modeling were applied for probing the structure of riboflavin adsorbed on single-layer graphene substrate grown on copper. Intense and detailed vibrational signatures of the adsorbed riboflavin were revealed by SHINERS method. Based on DFT modeling and detected downshift of prominent riboflavin band at 1349 cm⁻¹ comparing with the solution Raman spectrum, π-stacking interaction between the adsorbate and graphene was confirmed. Different spectral patterns from graphene-riboflavin surface were revealed by SHINERS and GERS techniques. Contrary to GERS method, SHINERS spectra revealed not only ring stretching bands but also vibrational features associated with ribityl group of riboflavin and D-band of graphene. Based on DFT modeling it was suggested that activation of D-band took place due to riboflavin induced tilt and distortion of graphene plane. The ability to explore local perturbations by the SHINERS method was highlighted. We demonstrated that SHINERS spectroscopy has a great potential to probe adsorbed molecules at graphene.     

A three-dimensional model of the human masticatory system, including the mandible, the dentition and the temporomandibular joints

The objective of this study was to create a three-dimensional mathematical model of a human masticatory system, including the mandible, the dentition and the temporomandibular joints. Object of research was one 20 year old dead man. The research was approved by Committee of bioethics (Kaunas University of Medicine). Required extent of computed tomography scanning and required high amount and high resolution of images increased X-ray radiation for the object and made this research impossible to perform on alive human. Spiral computed tomography scanning was performed to achieve two-dimensional images, necessary for creating three-dimensional model. The 3D modeling was done using the "Image pro plus" and "Imageware"software. A three-dimensional physiological (normal) model of a human masticatory system, simulating the mandible, the dentition and the temporomandibular joints was generated. This model system will be used subsequently in stress analysis comparison for the physiological and pathological systems after improvement of its physical properties. We suggest that computer simulation is a promising way to study musculoskeletal biomechanics of masticatory system.