Effect of aromatase inhibition on serum levels of sclerostin and dickkopf-1, bone turnover markers and bone mineral density in women with breast cancer

Purpose

While their negative impact on bone health is well established, the effects of aromatase inhibition (AI) on Wnt inhibitors and osteoprotegerin (OPG) are unknown. The aim of the study was to investigate the effects of AI on serum levels of sclerostin, DKK-1 and OPG, as well as their associations with PINP and CTX as markers of bone turnover and bone mineral density (BMD) assessed by DXA.

Methods

We conducted a prospective longitudinal analysis of 70 postmenopausal women with hormone receptor-positive early breast cancer (BC) treated with anastrozole. All measurements were performed at baseline, 12 and 24 months of treatment. We measured the association of the investigated variables with circulating bone turnover markers, as well as with the BMD.

Results

After 24 months of AI therapy, sclerostin and OPG concentrations increased from 29.5 pmol/l (SD = 15.1) and 6.8 pmol/l (SD = 2.2) at baseline to 43.2 pmol/l (SD = 20.6) (p < 0.001) and 7.4 pmol/l (SD = 2.2) (p = 0.028), respectively. DKK-1 levels decreased from 34.3 pmol/l (SD = 13.5) at baseline to 29.7 pmol/l (SD = 12.3) at the 24-month visit (p = 0.005). Sclerostin levels significantly correlated with PTH, OPG and BMD of the lumbar spine, while DKK-1 correlated with the BMD of the femoral neck and of the total hip.

Conclusions

The observed increase in sclerostin levels indicates a central role of osteocytes in bone turnover in women with BC.     

Intracranial hemorrhage pattern in the patients with factor XIII deficiency

Intracranial hemorrhage (ICH) is one of the most severe and life-threatening manifestations occurring in the patients with factor XIII (F XIII) deficiency. The aim of this study was to describe the ICH pattern in the patients suffering from F XIII deficiency. In this case series, we investigated 38 patients with severe F XIII deficiency in south of Iran from January to May 2012. ICH pattern, neurologic complications, efficacy of treatment, and incidence of recurrence were reported. The site of ICH was intraparenchymal in 35 patients (92.1 %), subdural in 2 patients (5.2 %), and epidural hemorrhage in 1 patient (2.6 %). Besides, neurologic complications occurred in 21 patients (55.2 %), including locomotor disability in 8, psychological impairment in 7, mental disorders in 5, speech impairment in 4, and visual impairment in 2. Prophylaxis was started with a dose of 10 IU/kg Fibrogammin every 4–6 weeks for all the patients, except for one. All the patients on prophylaxis showed good response without any episodes of recurrence, except for one. The most frequent site of ICH in our patients was intraparenchymal. It seems that long-term prophylactic treatment with a dose of 10 IU/kg Fibrogammin could be effective in the prevention of CNS bleeding in the patients with F XIII deficiency. Moreover, all the patients with severe F XIII deficiency even without severe bleeding symptoms are recommended to undergo prophylactic treatment.     

Intracranial artery dissection

The aim of this narrative review is to evaluate the pathogenesis, clinical features, diagnosis, treatment and prognosis of intracranial artery dissection (IAD). IAD is a rare and often unrecognized cause of stroke or subarachnoid haemorrhage (SAH), especially in young adults. Two types of IAD can be identified: a subintimal or subadventitial dissection. It is suggested that a subintimal dissection results in luminal stenosis, thromboembolism and subsequently cerebral ischaemia, whilst a subadventitial IAD could result in the formation of a pseudo‐aneurysm and compression on brainstem or cranial nerves. Rupture of such a dissecting aneurysm causes SAH. The exact cause of IAD remains unknown but several factors are associated with its development. Diagnosis is based on clinical presentation and specific features seen on multimodal neuroimaging. The management of IAD depends on the clinical presentation. In the case of cerebral ischaemia, anticoagulants or antiplatelet agents are used, whilst in the case of SAH endovascular treatment is primarily advocated. Prognosis depends on clinical presentation. Presentation with SAH has a worse prognosis.     

Antioxidant effects of oleuropein versus oxidative stress induced by ethanol in the rat intestine

Purified oleuropein from olive leaf extract indicated antioxidant properties in our previous reports. The recent study demonstrated that the lesions of absolute ethanol could be attributed to the increasing reactive oxygen species, subsequently lipid peroxidation and gastric ulcers. Therefore, the antioxidant effects of oleuropein as a natural antioxidant agent on intestine mucosal damages induced by absolute ethanol were investigated in the present study. The 42 adult male rats were divided into four (control, oleuropein, ethanol, and oleuropein plus ethanol) groups. Oleuropein at a dosage of 12 mg/kg was used for 10 consecutive days in oleuropein and oleuropein plus ethanol groups, thereafter absolute ethanol (once, 1 ml/rat) was administrated orally in ethanol and oleuropein plus ethanol groups at fasting state by gavage. The duodena of rats were removed for histopathology and antioxidant assay. Histological evidence of severe mucosal damages were confirmed by histopathology findings in ethanol group and prevented in oleuropein plus ethanol group. In this setting, glutathione peroxidase and catalase activities were significantly higher in oleuropein and oleuropein plus ethanol groups than the ethanol-treated rats. In contrast, thiobarbituric acid reactive substances concentration (as a lipid peroxidation marker) significantly increased in ethanol-treated rats when compared to the other groups. Our results suggest that olive leaf extract (containing oleuropein) exerts a potent antioxidant agent against oxidative stress. These findings allow us to exploit the advantages of oleuropein treatment in various diseases induced by oxidative stress in humans.     

Extended,virtual and augmented reality in thoracic surgery: a systematic review

 Open in a separate windowOBJECTIVESExtended reality (XR), encompassing both virtual reality (VR) and augmented reality, allows the user to interact with a computer-generated environment based on reality. In essence, the immersive nature of VR and augmented reality technology has been warmly welcomed in all aspects of medicine, gradually becoming increasingly feasible to incorporate into everyday practice. In recent years, XR has become increasingly adopted in thoracic surgery, although the extent of its applications is unclear. Here, we aim to review the current applications of XR in thoracic surgery.METHODSA systematic database search was conducted of original articles that explored the use of VR and/or augmented reality in thoracic surgery in EMBASE, MEDLINE, Cochrane database and Google Scholar, from inception to December 2020.RESULTSOur search yielded 1494 citations, of which 21 studies published from 2007 to 2019 were included in this review. Three main areas were identified: (i) the application of XR in thoracic surgery training; (ii) preoperative planning of thoracic procedures; and (iii) intraoperative assistance. Overall, XR could produce progression along the learning curve, enabling trainees to reach acceptable standards before performing in the operating theatre. Preoperatively, through the generation of 3D-renderings of the thoracic cavity and lung anatomy, VR increases procedural accuracy and surgical confidence through familiarization of the patient’s anatomy. XR-assisted surgery may have therapeutic use particularly for complex cases, where conventional methods would yield inadequate outcomes due to inferior accuracy.CONCLUSIONXR represents a salient step towards improving thoracic surgical training, as well as enhancing preoperative planning and intraoperative guidance.     

Application of microwave tissue coagulation in partial nephrectomy

Microwave tissue coagulation was used during partial nephrectomy in 10 mongrel dogs, without clamping the renal artery. There were no major complications, such as retroperitoneal hematoma, abscess formation, or macroscopic infarction of the kidney tissue related to this new procedure. The advantages of microwave coagulation are reduced blood loss, shorter operative time, and minimal risk of vascular injury.     

Cardiac Papillary Fibroelastoma: case report and review of the literature

Primary cardiac tumors are very rare. Cardiac Papillary Fibroelastoma (CPF) is the third most common primary tumor of the heart and most commonly affects cardiac valves. Those tumors appear like a "sea anemone" with multiple papillary fronds attached to the endocardium by a short stalk. It generally occurs as a single structure and is typically found on the atrial aspect of atrioventricular valves or either side of the semilunar valves. We report a case of aortic valve papillary fibroelastoma which was found on autopsy in a patient with normal coronary artery with evidence of myocardial and cerebral ischemic damage and sudden death.     

Gene expression changes associated with Barrett's esophagus and Barrett's-associated adenocarcinoma cell lines after acid or bile salt exposure

Background  

Esophageal reflux and Barrett's esophagus represent two major risk factors for the development of esophageal adenocarcinoma. Previous studies have shown that brief exposure of the Barrett's-associated adenocarcinoma cell line, SEG-1, or primary cultures of Barrett's esophageal tissues to acid or bile results in changes consistent with cell proliferation. In this study, we determined whether similar exposure to acid or bile salts results in gene expression changes that provide insights into malignant transformation.