Invasive lobular carcinoma with extracellular mucin as a distinct variant of lobular carcinoma: a case report

ABSTRACT: The differences between invasive lobular and ductal carcinomas affect the diagnostic and therapeutic management for patients with breast cancer. In most cases, this can be accomplished because of distinct histomorphologic features. However, occasionally, this task may become quite difficult, in particular when dealing with the variants of infiltrating lobular carcinoma. Lobular carcinoma has been considered a variant of mucin-secreting carcinoma with only intracytoplasmic mucin. The presence of extracellular mucin is a feature of ductal carcinoma. Herein is presented a case of lobular carcinoma with extracellular and intracellular mucin in a 43-year-old female patient, and confirmed by immunohistochemistry. Up to the present, infiltrating lobular carcinoma displaying extracellular mucin has not been described in the literature except two case. Virtual slides The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1839906067716744.     

The Effects of Chronomodulated Therapy with 5-Fluorouracil (5-Fu) and Folinic Acid (Fa) on the Toxicity and Quality of Life in Patients with Advanced Gastric Cancer

This study was designed to assess the tolerability of chronomodulated infusion chemotherapy, individualized by the rhythm of peripheral blood cells. Twenty patients with metastatic gastric cancer were randomized to chronotherapy or day-time arms of 5-fluorouracil (FU) (600 mg/m², 8 h inf.d1-5) and folinic acid (FA) (20 mg/m², iv, d1-5) in the first cycle and crossed-over to the other arm in the following cycles. Ten of 18 evaluable patients were assigned to chronotherapy arm and eight to day-time in the first cycle. Although there was no significant difference between two arms on enrollment, chronotherapy arm yielded an improvement of 45% of QLQ-C30 scores (p = 0.021) and the day-time arm had 11% improvement (p = 0.575). After the crossing-over, chronotherapy arm, again, had a significant improvement in QLQ-C30 scores, compared to the day-time arm (14% vs. -18%, p = 0.001, respectively). Mucositis/diarrhea was significantly higher in the day-time arm compared to chronotherapy arm (p = 0.015). In conclusion, chronomodulated infusion of 5-FU might improve the quality of life.     

Mutations in NALCN Cause an Autosomal-Recessive Syndrome with Severe Hypotonia,Speech Impairment,and Cognitive Delay

Sodium leak channel, nonselective (NALCN) is a voltage-independent and cation-nonselective channel that is mainly responsible for the leaky sodium transport across neuronal membranes and controls neuronal excitability. Although NALCN variants have been conflictingly reported to be in linkage disequilibrium with schizophrenia and bipolar disorder, to our knowledge, no mutations have been reported to date for any inherited disorders. Using linkage, SNP-based homozygosity mapping, targeted sequencing, and confirmatory exome sequencing, we identified two mutations, one missense and one nonsense, in NALCN in two unrelated families. The mutations cause an autosomal-recessive syndrome characterized by subtle facial dysmorphism, variable degrees of hypotonia, speech impairment, chronic constipation, and intellectual disability. Furthermore, one of the families pursued preimplantation genetic diagnosis on the basis of the results from this study, and the mother recently delivered healthy twins, a boy and a girl, with no symptoms of hypotonia, which was present in all the affected children at birth. Hence, the two families we describe here represent instances of loss of function in human NALCN.     

Assessment of the risk of perforation of the mandibular canal by implant drill using density and thickness parameters

Gerodontology 2009; doi: 10.1111/j.1741‐2358.2009.00362.x
Assessment of the risk of perforation of the mandibular canal by implant drill using density and thickness parameters Objective: The objective of this study was to investigate whether the resistance of the bone surrounding the mandibular canal had sufficient density and thickness to avoid perforation by drills when preparing the bed of the implant. Background: Damage to the inferior alveolar nerve (IAN) is more common than expected. This injury may lead to serious complications ranging from mild paresthesia to total anaesthesia of the lower jaw. Materials and methods: The CT images of 99 patients, whose ages ranged between 20 and 79 years, and who applied for an implant application to the posterior aspect of the mandible were included in this study. Results: The overall average bone thickness in the premolar and molar regions was 0.8717 ± 0.1818 and 0.8556 ± 0.1756 mm, respectively, whereas the bone density in the premolar and molar regions was 649.18 ± 241.42 and 584.44 ± 222.73 Hounsfield Units (HU), respectively (p < 0.001). Conclusion: It was determined that the average density and thickness of the bone that surrounds the mandibular canal was not sufficient to resist the implant drill. It can be concluded that the risk of injury to the IAN may be minimised by accurately determining the bone mass on the canal prior to the implant procedure, and avoiding excessive force when approaching the canal.     

Terbinafine hydrochloride loaded liposome film formulation for treatment of onychomycosis: in vitro and in vivo evaluation

Onychomycosis is a fungal infection of nail unit that is caused by dermatophytes. Oral Terbinafine hydrochloride (TBF-HCl) is being used for the treatment of onychomycosis since 24 years. The side effects caused by the systemic application and limitations of topical administration of this drug regarding the diffusion through nail lead to the development of a new formulation based on, TBF-HCl-loaded liposome. The newly obtained film formulations were prepared and characterized via several parameters, such as physical appearance, drug content, thickness, bioadhesive properties and tensile strength. In vitro and ex vivo permeation studies were performed to select an optimum film formulation for antifungal activity to show the efficiency of formulations regarding the treatment of onychomycosis. The in vitro release percentages of drug were found 71.6?±?3.28, 54.4?±?4.26, 56.1?±?7.48 and 46.0?±?2.43 for liposome loaded pullulan films (LI-P, LII-P) and liposome loaded Eudragit films (LI-E, LII-E), respectively. The accumulated drug in the nail plates were found 31.16?±?4.22, 24.81?±?5.35, 8.17?±?1.81 and 8.92?±?3.37 for LI-P, LII-P, LI-E and LII-E, respectively, which within therapeutic range for all film formulations. The accumulated drug in the nail plate was found within therapeutic range for all film formulations. The efficacy of the selected TBF-HCl-loaded liposome film formulation was compared with TBF-HCl-loaded liposome, ethosome, liposome poloxamer gel and ethosome chitosan gel formulations. It was found that TBF-HCl-loaded liposome film formulation had better antifungal activity on fungal nails which make this liposome film formulation promising for ungual therapy of fungal nail infection.     

Thermoluminescence in pumice stone collected from the Mediterranean coast

Pumice is a low-density, light-coloured volcanic rock (igneous rock) formed when the magma from a volcanic eruption is suddenly cooled. It has a porous structure and can be different colours and have different densities. Pumice stone, unlike other rock, does not sink in water because it has a low density. In the present study, the thermoluminescent (TL) dosimetric characteristics, such as the dose–response, TL signal fading as a function of storage time, heating rate, and reusability of pumice collected on the Mediterranean coast were investigated. From this study, it was concluded that the pumice stone showed TL properties with a TL glow curve including an obviously wide peak at ∼200°C. A wide linear dose–response region up to 144 Gy, low fading of the TL signal when it was kept in a dark room for a long time, and poor reusability properties were observed for dosimetry use.     

Cold acclimation of SnRK2.2 kinases mutant Chlamydomonas reinhardtii

In Chlamydomonas reinhardtii, plant‐specific serine/threonine kinases (SnRK2 kinases) play a central role in sulfur metabolism. However, their role in environmental stress has not been clearly understood. Cold stress is one of the most important factors that limit the growth, productivity, and development of photosynthetic organisms. In this report, the effect of cold stress on some physiological parameters were investigated in SnRK2.2 mutant and wild type C. reinhardtii culture. Our results showed that cold stress had significantly enhanced lipid peroxidation rate in wild type, while no significant change was observed in SnRK2.2 mutant culture. Our data also indicated a decline in Rubisco protein amount of wild type culture under low temperature exposure. Low temperature reduced glutathione reductase (GR) activity in the wild type, while GR activity was enhanced in SnRK2.2 mutant. This result indicated the potential of SnRK2 kinase in cold acclimation process.     

The prognostic importance of a history of hypertension in patients with symptomatic heart failure is substantially worsened by a short mitral inflow deceleration time

ABSTRACT: BACKGROUND: Hypertension is a common comorbidity in patients with heart failure and may contribute to development and course of disease, but the importance of a history of hypertension in patients with prevalent heart failure remains uncertain. METHODS: 3078 consecutively hospitalized heart failure patients (NYHA classes II-IV) were screened for the EchoCardiography and Heart Outcome Study (ECHOS). The left ventricular ejection fraction (LVEF) was estimated by 2 dimensional transthoracic echocardiography in all patients and a subgroup of 878 patients had additional data on pulsed wave Doppler assessment of transmitral flow available. A restrictive filling (RF) was defined as a mitral inflow deceleration time [less than or equal to]140 ms. Patients were followed for a median of 6.8 (Inter Quartile Range 6.6-7.0) years and multivariable Cox regression models were used to assess the risk of all-cause mortality associated with hypertension. RESULTS: The study population had a mean age of 73 +/- 11 years. 39% were female, 27% had a history of hypertension and 48% had a RF. Over the study period, 64% of the population died. Hypertension was not associated with increased risk of mortality, hazard ratio (HR) 0.95 (0.85-1.05). LVEF did not modify this relationship (p for interaction = 0.7), but RF pattern substantially influenced the outcomes associated with hypertension (p for interaction < 0.001); HR 0.75 (0.57-0.99) and 1.41 (1.08-1.84) in patients without and with RF, respectively. CONCLUSIONS: In patients with symptomatic heart failure, a history of hypertension is associated with a substantially increased relative risk of mortality among patients with a restrictive transmitral filling pattern.     

Relationship between eutrophication reference conditions and boundary settings considering OSPAR recommendations and the Water Framework Directive—examples from the German Bight

In order to allow for natural variability, the original OSPAR assessment procedure for eutrophication (Comprehensive Procedure) sets the threshold between Non-Problem/Problem Area (elevated levels) at 50% above natural background concentrations, which is equivalent to the boundary setting good/moderate for the EU Water Framework Directive (WFD). The 50% level corresponds to the recent natural variability of nutrient gradients in coastal and estuarine waters in the German Bight. Based on this threshold, a proposal is given for the additional boundary settings required for the WFD assessments. Examples, based on concentrations of total nitrogen and other correlated eutrophication components, are presented. However, for eutrophication effects such as oxygen deficiency, reduced transparency and increased transboundary loads, especially for offshore regions, 50% exceedance of the natural background surpasses ‘slight differences’ as recommended by the boundary good/moderate for the WFD. For this reason, 15% is proposed as the boundary setting for good/moderate and discussed for different parameters. Overlapping between recent means and their standard deviations and the four boundary settings for the WFD cannot be avoided, thereby causing weak assessments. Since the part of the variability of recent data is caused by hydrodynamics, coupled with salinity variation, the variability could be reduced to some degree by relating the data to mean salinities. By doing this, the significance of classifications could be improved. The application of this procedure is discussed for examples from the German Bight.     

Bacterial Spectrum and Antimicrobial Susceptibility Pattern of Bloodstream Infections in Children with Febrile Neutropenia: Experience of Single Center in Southeast of Turkey

Empirical antimicrobial therapy is usually started in febrile neutropenic patients without having culture results. The aim of this study was to help determine the policies of empirical antibiotic usage in febrile neutropenic children by detecting the antimicrobial susceptibility profile in this group of patients. In this study 811 blood cultures taken from neutropenic children hospitalized at the Department of Oncology of Gaziantep Children Hospital November 2007 and February 2010 were retrospectively evaluated. Blood cultures were routinely collected in aerobic and anaerobic media and incubated using the BACTEC system. Identification and antimicrobial susceptibility testing of the isolates to antimicrobial agents was performed using the Vitek2^® system according to the recommendations of the Clinical and Laboratory Standards Institute. Of 811 isolates analyzed, 128 (56.4%) were gram positive cocci, 43 (18.9%) were gram negative bacilli and fungi accounted for 56 (24.7%). The main isolated Gram-positive bacteria from blood were coagulase-negative staphylococcus (56.7%), followed by methicillin-resistant Staphylococcus aureus (14.1%). S. aureus and Streptococcus spp. were all susceptible to linezolid, vancomycin and teicoplanin. S aureus was still susceptible to few other antimicrobial agents such as tetracycline (82.4%), chloramphenicol (55.6%). Seven E. faecium, 7 E. fecalis and 1 E. hirae was isolated from blood cultures. Vancomycin resistance was detected in 6 out of 15 (40%) Enterococcus spp. isolates. Among gram-negative bacteria E. coli (30.2%) was followed by Klebsiella pneumoniae (20.9%) and Proteus spp. (18.6%). Imipenem (89.2%), meropenem (86.6%), chloramphenicol (88.9%), amicasin (82.4%) and fosfomycin (81.3%) showed highest susceptibility in vitro activity against all Gram-negative isolates. To know the antimicrobial susceptibility profile of the pathogens frequently isolated from febrile neutropenic children and to consider this profile before starting an empirical antibiotic therapy would help the clinics which have any role in the treatment of these patients to determine the empirical antibiotic usage policies.