An unusual presentation of a malignant jejunal tumor and a different management strategy

BACKGROUND: Malignant small bowel tumors are very rare and leiomyosarcoma accounts for less than 15% of the cases. Management of these tumors is challenging in view of nonspecific symptoms, unusual presentation and high incidence of metastasis. In this case report, an unusual presentation of jejunal sarcoma and management of liver metastasis with radiofrequency ablation (RFA) is discussed. CASE PRESENTATION: A 45-year-old male presented with anemia and features of small bowel obstruction. Operative findings revealed a mass lesion in jejunum with intussusception of proximal loop. Resection of bowel mass was performed. Histopathological findings were suggestive of leiomyosarcoma. After 3-years of follow-up, the patient developed recurrence in infracolic omentum and a liver metastasis. The omental mass was resected and liver lesion was managed with radiofrequency ablation. CONCLUSION: Jejunal leiomyosarcoma is a rare variety of malignant small bowel tumor and a clinical presentation with intussusception is unusual. We suggest that an aggressive management approach using a combination of surgery and a newer technique like RFA can be attempted in patients with limited metastatic spread to liver to prolong the long-term survival in a subset of patients.     

Effect of nutritionally enriched coffee consumption on aerobic and anaerobic exercise performance

The purpose of this study was to compare nutritionally enriched JavaFit coffee (JF) to commercially available decaffeinated coffee (P) with regard to impact on endurance and anaerobic power performance in a physically active, college-aged population. Ten subjects (8 men, 2 women) performed two 30-second Wingate anaerobic power tests and 2 cycle ergometer tests (75% VO2 max) to exhaustion. Mean VO2 was measured during each endurance exercise protocol. Excess postexercise oxygen consumption (EPOC) and respiratory exchange ratio (RER) were recorded for 30 minutes following all exercise sessions. Area under the curve analysis was used to compare EPOC between JF and P for all exercise sessions. No differences were seen between JF and P in any of the power performance measures. However, time to exhaustion was significantly (p = 0.05) higher in JF (35.3 +/- 15.2 minutes) compared with P (27.3 +/- 10.7 minutes). No difference between JF and P were seen in EPOC in either the aerobic or anaerobic exercise sessions. A significant (p < 0.05) difference in average 30-minute postanaerobic power exercise RER was seen between JF (0.87 +/- 0.04) and P (0.83 +/- 0.03), but not following endurance exercise. A nutritionally-enriched coffee beverage appears to enhance time to exhaustion during aerobic exercise, but does not provide an ergogenic benefit during anaerobic exercise.     

Vitamin C in premature and full-term human neonates

Summary

Plasma concentrations of vitamin C (ascorbic acid, AA) are known to be higher in full-term human neonates than their mothers. Immaturity of placental AA transport could result in low plasma AA concentrations in pre-term infants. We found that plasma AA concentrations in umbilical cord blood of 25 full-term neonates (38–42 weeks gestation) and 33 pre-term neonates (24–36 weeks gestation) were always significantly higher than in the corresponding maternal blood (P < 0.0001). However, plasma AA levels were significantly higher in pre-term than in full-term infants (146 ± 93 vs 102 ± 27 μM, respectively; P = 0.03). Furthermore, a rapid and sharp decrease in plasma AA concentrations from 229 ± 166 μM to 45 ± 18 μM (P < 0.0001) over the first 3 days of life was observed in eight very low birth weight infants (460–1090 g, 24–28 weeks gestation). These findings raise important questions about the in utero functions of AA in the developing fetus and the adequacy of postnatal vitamin C supplementation of the premature infant.     

IL-21-induced isotype switching to IgG and IgA by human naive B cells is differentially regulated by IL-4

Naive B cells can alter the effector function of their Ig molecule by isotype switching, thereby allowing them to secrete not only IgM, but also the switched isotypes IgG, IgA, and IgE. Different isotypes are elicited in response to specific pathogens. Similarly, dysregulated production of switched isotypes underlies the development of various diseases, such as autoimmunity and immunodeficiency. Thus, it is important to characterize mediators controlling isotype switching, as well as their contribution to the overall B cell response. Isotype switching in human naive B cells can be induced by CD40L together with IL-4, IL-10, IL-13, and/or TGF-beta. Recently, IL-21 was identified as a switch factor for IgG1 and IgG3. However, the effect of IL-21 on switching to IgA, as well as the interplay between IL-21 and other switch factors, remains unknown. We found that IL-4 and IL-21 individually induced CD40L-stimulated human naive B cells to undergo switching to IgG, with IL-4 predominantly inducing IgG1(+) cells and IL-21 inducing IgG3. Culture of naive B cells with CD40L and IL-21, but not IL-4, also yielded IgA(+) cells. Combining IL-4 and IL-21 had divergent effects on isotype switching. Specifically, while IL-4 and IL-21 synergistically increased the generation of IgG1(+) cells from CD40L-stimulated B cells, IL-4 concomitantly abolished IL-21-induced switching to IgA. Our findings demonstrate the dynamic interplay between IL-4 and IL-21 in regulating the production of IgG subclasses and IgA, and suggest temporal roles for these cytokines in humoral immune responses to specific pathogens.     

Cross-linking of phosphatidylethanolamine neighbors with dimethylsuberimidate is sensitive to the lipid phase

Dimethylsuberimidate was reacted with aqueous dispersions of dipalmitoylphosphatidylethanolamine, dimyristoylphosphatidylethanolamine, dilauroylphosphatidylethanolamine, and dielaidoylphosphatidylethanolamine at pH 10 and at pH 8. The amount of amidine dimer formation was about four times greater above the gel-to-fluid phase transition of each lipid than below the transition. The transition temperature of each phosphatidylethanolamine, measured by steady-state fluorescence anisotropy of cis-parinaric acid, was lower at pH 10 than at pH 8 or in water. The ability of dimethylsuberimidate to discriminate between phosphatidylethanolamines in the fluid and gel phases should allow use of this reagent to identify phosphatidylethanolamine species within the gel or fluid lipid phase.     

Ordering gene function: the interpretation of epistasis in regulatory hierarchies.

The order of action of genes in a regulatory hierarchy that is governed by a signal can often be determined by the method of epistasis analysis, in which the phenotype of a double mutant is compared with that of single mutants. The epistatic mutation may be in either the upstream or the downstream gene, depending on the nature of the two mutations and the type of regulation. Nevertheless, when the regulatory hierarchy satisfies certain conditions, simple rules allow the position of the epistatic locus in the pathway to be determined without detailed knowledge of the nature of the mutations, the pathway, or the molecular mechanism of regulation.