Identified higher-order neurons controlling the feeding motor program of helisoma

A bilaterally symmetrical pair of neurons in the anterior region of the cerebral ganglia of the snail Helisoma trivolvis were found to have excitatory input to the feeding motor program contained in the buccal ganglia. Intracellular microelectrodes were used to stimulate and record from these cells while the motor output of the buccal ganglia was monitored with a combination of intracellular and extracellular recordings. Experimentally evoked tonic activity in an individual cerebral cell could initiate and maintain the patterned motor output from buccal ganglia, characteristic of the activity underlying buccal mass feeding movements. The rate of buccal motor output could be modified directly by varying the firing frequency of the cerebral cell. Cobaltous chloride backfills of cerebrobuccal connectives revealed that these higher-order neurons were the only large cells in the anterior portion of the ganglia to send processes into the connectives. Furthermore, they are the only cells in this region to fluoresce when processed with a sucrose-phosphate-glyoxylic acid solution, indicating that they contain an indoleamine, probably serotonin. Application of low concentrations of serotonin to isolated buccal ganglia or buccal ganglia-buccal mass preparations mimics the effects of the cerebral cells' activity on the buccal motor output, implying that serotonin is a putative transmitter for these cerebral cells.     

More than skin deep

We present the case of a woman in her 50s with past medical history significant for psoriasis treated with methotrexate on a stable dose for the past 20?years, diabetes mellitus and chronic kidney disease. In the setting of a long flight, dehydration and non steroidal anti-inflammatory drug consumption, the patient presented to the emergency department with oral mucositis and cutaneous erosions and ulcers of the psoriasis plaques. MTX levels were normal corroborated by three different measurements in 24?h. Initially the complete blood count tests were significant for macrocytic, thrombocytopenia (82.000 10³/L) and impaired kidney function. The patient was diagnosed of acute methotrexate toxicity and started on intravenous folinic acid. In 24?h the patient developed severe pancytopenia. She required treatment with colony-stimulating factors, platelet and blood transfusions. After 10?days, the CBC improved to normal levels and the cutaneous lesions resolved.     

Pharmacotherapy Approaches in Nontuberculous Mycobacteria Infections

Nontuberculous mycobacteria (NTM) comprise a heterogeneous group of organisms, with only a small subset known to cause disease in humans. Although NTM infection is not a reportable disease, both the increasing clinical recognition and recent advancements in laboratory diagnostic capabilities of NTM infections in immunocompromised and immunocompetent patients are rapidly evolving. We reviewed antimicrobial agents used to treat the most frequently encountered NTM infections and examined optimized drug dosing strategies, toxicity profiles, drug-drug interactions, and the role of therapeutic drug monitoring. Antimicrobial susceptibility testing and patient monitoring on therapy were also examined. We used PubMed to review the published literature on the management of select NTM pathogens, the common syndromes encountered since 2000, and select pharmacokinetic principles of select antimicrobial agents used since 1990. We included select clinical trials, systematic reviews, published guidelines, and observational studies when applicable. The prolonged duration and the necessity for combination therapy for most forms of NTM disease can be problematic for many patients. A multidisciplinary care team that includes pharmacy engagement may help increase rates of optimal patient tolerability and successful treatment completion.     

Mean platelet volume and coronary artery disease: a systematic review and meta-analysis

Background

Platelets with high hemostatic activity play an important role in the pathophysiology of coronary artery disease(CAD) and mean platelet volume(MPV) has been proposed as an indicator of platelet reactivity. Thus, MPV may emerge as a potential marker of CAD risk. The aim of this study was to conduct a systematic review and meta-analysis comparing mean difference in MPV between patients with CAD and controls and pooling the odds ratio of CAD in those with high versus low MPV.

Methods

Medline and Scopus databases were searched up to 12 March 2013. All observational studies that considered MPV as a study's factor and measured CAD as an outcome were included. Two reviewers independently selected the studies and extracted the data.

Results

Forty studies were included in this meta-analysis. The MPV was significantly larger in patients with CAD than controls with the unstandardized mean difference of 0.70 fL (95% CI: 0.55, 0.85). The unstandardized mean difference of MPV in patients with acute coronary event and in patients with chronic stable angina was 0.84 fL (95% CI: 0.63, 1.04) and 0.46 fL (95% CI: 0.11, 0.81) respectively. Patients with larger MPV (≥ 7.3 fL) also had a greater odds of having CAD than patients with smaller MPV with a pooled odds ratio of 2.28 (95% CI: 1.46, 3.58).

Conclusion

Larger MPV was associated with CAD. Thus, it might be helpful in risk stratification, or improvement of risk prediction if combining it with other risk factors in risk prediction models.     

Cumulative risk of second primary contralateral breast cancer in BRCA1/BRCA2 mutation carriers with a first breast cancer: A systematic review and meta-analysis

BRCA1/2 mutation carriers are at a higher risk of breast cancer and of subsequent contralateral breast cancer (CBC). This study aims to evaluate the evidence of the effect of the BRCA1/2-carriership on CBC cumulative risk in female breast cancer patients.The literature was searched in Pubmed and Embase up to June 2013 for studies on CBC risk after a first primary invasive breast cancer in female BRCA1/2 mutation carriers. A qualitative synthesis was carried out and the methodological quality of the studies evaluated. Cumulative risks of CBC after 5, 10 and 15 years since the first breast cancer diagnosis were pooled by BRCA1/2 mutation status.A total number of 20 articles, out of 1324 retrieved through the search, met the inclusion criteria: 18 retrospective and 2 prospective cohort studies. Cumulative risks of up to five studies were pooled. The cumulative 5-years risk of CBC for BRCA1 and BRCA2 mutation carriers was 15% (95% CI: 9.5%–20%) and 9% (95% CI: 5%–14%), respectively. This risk increases with time since diagnosis of the first breast cancer; the 10-years risk increased up to 27% and 19%, respectively. The 5-years cumulative risk was remarkably lower in non-BRCA carriers (3%; 95% CI: 2%–5%) and remained so over subsequent years (5%; 95% CI: 3%–7%).In conclusion, risk of CBC increases with length of time after the first breast cancer diagnosis in BRCA1/2 mutation carriers. Studies addressing the impact of treatment-related factors and clinical characteristics of the first breast cancer on this risk are warranted.     

Predicción del número de linfocitos T CD4 en sangre periférica a partir de teoría de conjuntos y probabilidad en pacientes con VIH/SIDA

Previously a refinement of a methodology was developed based on set theory and probability, with the aim of improving the predictive ability of CD4 T cells (LT-CD4) for HIV/AIDS from the total number of leukocytes and lymphocytes. In this work the clinical applicability of the method was shown by refining prediction in 150 samples. Taking data of leukocytes/mm³, lymphocytes/mm³, and LT-CD4 cells/mm³ of each patient, called triples, they were organized from highest to lowest based on the number of leukocytes, to evaluate ranges of 1,000 leukocytes. The membership of the triples to the set A∪C, B∪D was established, as well as the intersection between the two sets (A∪B)∩(B∪D), in which a prediction of the number of CD4 associated with specific values of leukocytes and lymphocytes is established. The number of elements belonging to each set was counted and the probability of belonging to each of the ranges tested was determined. A total of 7 out of the 9 ranges of leukocytes measured showed a probability of success equal to or greater than 0,76, achieving a probability of 1 in the ranks lower than 4.000/mm³ and 3.000/mm³, respectively. The ability of the methodology for determining the value of the LT-CD4 was demonstrated, achieving a higher predictive capacity than the unrefined methodology. The evidence shows that the applied methodology is effective for clinical use, thus leading to a reduction of costs and resources.     

Diana-5全自动血液分析仪测定参数的临床研究

目的　对Diana 5全自动血液分析仪的测定参数及临床应用价值进行研究与评价。方法　根据国际临床实验室标准化委员会 (NCCLS)颁布的《定量临床实验室方法初步评定试行准则 (EP1 0 T2 )》的要求 ,用Diana 5血液分析仪进行全血细胞计数和白细胞五分类测定 ,MicrosoftExcel2 0 0 0及SAS软件进行统计学处理。结果　中、高值WBC、RBC、HGB的批内CV<2 % ,低值 <3% ,批间CV <3% ;MCV的批内和批间CV <2 % ;PLT的批内CV <4 .5 % ,批间CV <5 .2 %。WBC、RBC、HGB、MCV的总不精密度 <2 .5 % ,PLT <5 %。WBC、RBC、HGB、HCT、PLT的线性相关系数分别为 0 .999、0 .999、0 .999、0 .998和 0 .995。PLT的最大偏差为3% ,WBC、RBC、HGB、HCT的实测值均等于或接近于靶值。WBC的携带污染率为 1 % ,RBC、PLT <1 % ,HGB、MCV为 0。Neu、Lym、Mon、Eos、Bas与镜检结果的相关系数分别为 0 .982、0 .95 6、0 .84 2、0 .5 36和 0 .32 8。结论　Diana 5血液分析仪主要测定参数的线性好 ,精密度和准确度高 ,携带污染率低 ;白细胞五分类结果的重复性好 ,准确性较高 ,能有效发挥仪器的过筛作用     

Peroxisome proliferator-activated receptor alpha regulates B lymphocyte development via an indirect pathway in mice

Peroxisome proliferator-activator receptor alpha (PPARalpha), a member of the nuclear receptor superfamily, has been implicated in the regulation of inflammation and immune response. Adaptive immune responses are suppressed by exposure to PPARalpha agonists, resulting in severe thymus and spleen atrophy. In addition, the decline in both T and B cells is due in part to the loss of splenocytes upon exposure to PPARalpha agonists. Thus, the current study was designed to examine the effect of Wy-14,643, a potent PPARalpha agonist, on B cell development in bone marrow from wild-type and PPARalpha-null mice. Significantly decrease in pro/pre-B cell and total B220(+) cell was observed in wild-type mice in bone marrow upon Wy-14,643 treatment, but not in PPARalpha-null mice. Immature and mature B cell populations are not affected. This suggests that PPARalpha is involved in the development of B cell during lymphoid lineage. However, surprisingly, PPARalpha mRNA was absent in bone marrow as revealed by RT-PCR. Therefore, the effect of PPARalpha on B cell development is by an indirect mechanism.