Unusual presentation of vertebral endplate Modic changes in congenital scoliosis associated with pain: a report of two cases

Congenital scoliosis is not normally associated with pain in young children. We are presenting two cases of young patients with congenital scoliosis and moderate to severe pain. There were no spinal cord abnormalities found in these patients. The magnetic resonance imaging and CT scan revealed disc degeneration with Modic changes at the apex of the congenital scoliosis. We hypothesized that the mechanical instability resulting from poor spinal element formations associated with congenital scoliosis was responsible for causing the disc degeneration and endplate changes. Modic changes have been reported to be associated with pain in degenerative conditions of the spine. Both patients underwent a posterior spinal fusion and instrumentation, which relieved their pain immediately.     

Developing and validating of Ramathibodi Appendicitis Score (RAMA-AS) for diagnosis of appendicitis in suspected appendicitis patients

Background

Diagnosis of appendicitis is still clinically challenging where resources are limited. The purpose of this study was to develop and externally validate Ramathibodi Appendicitis Score (RAMA-AS) in aiding diagnosis of appendicitis.

Methods

A two-phase cross-sectional study (i.e., derivation and validation) was conducted at Ramathibodi Hospital (for derivation) and at Thammasat University Hospital and Chaiyaphum Hospital (for validation). Patients with abdominal pain and suspected of having appendicitis were enrolled. Multiple logistic regression was applied to develop a parsimonious model. Calibration and discrimination performances were assessed. In addition, our RAMA-AS was compared with Alvarado’s score performances using ROC curve analysis.

Results

The RAMA-AS consisted of three domains with seven predictors including symptoms (i.e., progression of pain, aggravation of pain, and migration of pain), signs (i.e., fever and rebound tenderness), and laboratory tests (i.e., white blood cell count (WBC) and neutrophil). The model fitted well with data, and it performed better discrimination than the Alvarado score with C-statistics of 0.842 (95% CI 0.804, 0.881) versus 0.760 (0.710, 0.810). Internal validation by bootstrap yielded Sommer’s D of 0.686 (0.608, 0.763) and C-statistics of 0.848 (0.846, 0.849). The C-statistics of two external validations were 0.853 (0.791, 0.915) and 0.813 (0.736, 0.892) with fair calibrations.

Conclusion

RAMA-AS should be a useful tool for aiding diagnosis of appendicitis with good calibration and discrimination performances.

     

Hepatitis B virus X (HBX) protein upregulates β-catenin in a human hepatic cell line by sequestering SIRT1 deacetylase

Hepatitis B virus X (HBX) protein has been reported to induce upregulation of β-catenin, a known proto-oncogene, in p53-knockout and p53-mutant hepatic cell lines both in a GSK-3β-dependent manner and via interaction with adenomatous polyposis coli, which results in protection from β-catenin degradation. In this study, we describe a novel mechanism for HBX-mediated upregulation of β-catenin. We observed that HBX interacts with SIRT1, a class III histone deacetylase. Furthermore, the presence of HBX attenuated the interaction between SIRT1 and β-catenin, leading to protection of β-catenin from the inhibitory action of SIRT1. Reduction of SIRT1 with siRNA or suppression of SIRT1 activity with nicotinamide upregulated β-catenin protein levels. In contrast, enhancement of SIRT1 activity with resveratrol reduced β-catenin protein levels. Furthermore, in Hep3B cells stably expressing HBX, overexpression of SIRT1 or treatment with resveratrol enhanced sensitivity to doxorubicin-induced apoptosis, indicating that upregulation of SIRT1 could be a therapeutic strategy for HBV-related hepatocellular carcinoma. Based on these results, we propose that HBX upregulates β-catenin by sequestering SIRT1, which leads to anticancer drug treatment resistance.     

Comparison of multiple statistical models for the development of clinical prediction scores to detect advanced colorectal neoplasms in asymptomatic Thai patients

A good clinical prediction score can help in the risk stratification of patients with colorectal cancer (CRC) undergoing colonoscopy screening. The aim of our study was to compare model performance of binary logistic regression (BLR), polytomous logistic regression (PLR), and classification and regression tree (CART) between the clinical prediction scores of advanced colorectal neoplasia (ACN) in asymptomatic Thai patients.We conducted a cross-sectional study of 1311 asymptomatic Thai patients to develop a clinical prediction model. The possible predictive variables included sex, age, body mass index, family history of CRC in first-degree relatives, smoking, diabetes mellitus, and the fecal immunochemical test in the univariate analysis. Variables with a P value of .1 were included in the multivariable analysis, using the BLR, CART, and PLR models. Model performance, including the area under the receiver operator characteristic curve (AUROC), was compared between the model types.ACN was diagnosed in 53 patients (4.04%). The AUROCs were not significantly different between the BLR and CART models for ACN prediction with an AUROC of 0.774 (95% confidence interval [95% CI]: 0.706–0.842) and 0.765 (95% CI: 0.698–0.832), respectively (P = .712). A significant difference was observed between the PLR and CART models in predicting average to moderate ACN risk with an AUROC of 0.767 (95% CI: 0.695–0.839 vs AUROC 0.675 [95% CI: 0.599–0.751], respectively; P = .009).The BLR and CART models yielded similar accuracies for the prediction of ACN in Thai patients. The PLR model provided higher accuracy for ACN prediction than the CART model.     

Stimulant Methamphetamine and Dextromethorphan Use Among Thai Adolescents: Implications for Health of Women and Children

For over a decade, amphetamine-type stimulants have made their way into the adolescent culture of Thailand. Coupled with the more recent emergence of the legal, over-the-counter cough medicine dextromethorphan (DM), they represent the most commonly abused substances among Thai youths today. Methamphetamine is the second most popular drug of abuse in Thailand, the first being cannabis. It is available in the crystalline version, ICE, and the less pure methamphetamine tablets. The tablets are frequently crushed and smoked. Its use has gained enormous popularity among teenagers and young adults, including women of child-bearing age. As such, it has become the most common drug being detected in the urine of peripartum women, resulting in peripartum and postpartum complications for both mother and child. DM is a newer drug which has gained popularity among middle school and high school students due to its easy availability as a single product over the counter. It is usually taken with soft drinks at parties and gathering. It is metabolized by CYP4502D6 to dextrorphan, the substance responsible for the feeling of euphoria. Consequently, those who are poor metabolizers often experience the ??negative?? effects associated with the drug. The recreational use of methamphetamine and dextromethorphan in teenagers and young adults in Thailand is a serious problem. Recognizing not only the toxicological but also the emotional and psychosocial impacts of these drugs on Thai youth is an integral part of approaching the problem.     

Effect of Single-Dose Preemptive Systemic Dexamethasone on Postoperative Dysphagia and Odynophagia Following Anterior Cervical Spine Surgery: A Double-Blinded,Prospective, Randomized Controlled Trial

BackgroundThe efficacy of preoperative dexamethasone in anterior cervical discectomy and fusion (ACDF) to reduce dysphagia and odynophagia remains controversial. This study evaluated the effect of a single dose of intravenous dexamethasone given as preemptive analgesia in the ACDF procedure.MethodsA total of 64 patients aged 18 years or over were randomized into two groups. The experimental group received dexamethasone 10 mg intravenously before surgery for 60 minutes, and the control group received normal saline. One surgeon operated on all patients. The Bazaz score and visual analog scale (VAS) for odynophagia were measured at 0 hour, 24 hours, 48 hours, 72 hours, and 2 weeks postoperatively. Prevertebral soft-tissue swelling (PSTS) and the modified Japanese orthopedic association (mJOA) score were measured preoperatively and 2 weeks postoperatively.ResultsThe Bazaz scores at 0, 24, 48, and 72 hours after operation were significantly lower in the dexamethasone group than in the placebo group (p < 0.001, p < 0.001, p < 0.001, and p = 0.004, respectively). The VAS scores of the dexamethasone group were significantly lower than those of the placebo group at 0, 24, 48, and 72 hours after surgery (all p < 0.001), but there was no significant reduction in the Bazaz score and VAS score at 2 weeks postoperatively. There was no difference in PSTS and mJOA preoperatively and 2 weeks postoperatively.ConclusionsA single dose of intravenous dexamethasone used preoperatively in single-level and multilevel ACDF can significantly improve symptoms of dysphagia and odynophagia early on postoperatively.