Acute Subarachnoid Hemorrhage and Cardiac Abnormalities: Takotsubo Cardiomyopathy or Neurogenic Stunned Myocardium? a case report

Abstract Introduction Cardiac abnormalities can be seen with subarachnoid hemorrhage. To date, there have been isolated case reports of transient left ventricular apical ballooning cardiomyopathy, also known as Takotsubo cardiomyopathy in patients suffering from subarachnoid hemorrhage. Case presentation An adult female was brought to the emergency department with somnolence. A 3 × 3 mm ruptured basilar aneurysm was found and successfully embolized. Two days after the patient developed acute heart failure. Troponin-I was elevated to 4.2 (normal \u3c0.4). On ECG, new symmetric T wave inversion in V3, V4, V5 with prolonged QT were evident. Transthoracic echocardiogram showed severe systolic dysfunction with an ejection fraction of 20% and akinetic apex along with the distal left ventricular segments, consistent with Takotsubo cardiomyopathy. Myocardial contrast echocardiography showed a decrease in capillary blood flow and volume in the akinetic areas with delayed contrast replenishment, sparing the basal segments. A repeat study 2 weeks later showed near normalization of the perfusion parameters. The patient improved with medical management. A repeat echocardiogram, a month later revealed an ejection fraction of 45% with no identifiable wall motion abnormality. Conclusion Our case, as well as others reported previously, supports the diagnosis of Takotsubo cardiomyopathy in patients with Subarachnoid Hemorrhage who fulfill the clinical and imaging description of this syndrome

Pengaruh Gaya Mengajar Inkuiri dan Komando terhadap Keterampilan Gerak Dasar

Berdasarkan pengamatan peneliti di lapangan terlihat bahwa peserta didik Sekolah Dasar Negeri 159/III Semumu Kecamatan Devati VII Kabupaten Kerinci memiliki keterampilan gerak dasar yang masih kurang. Penelitian ini bertujuan untuk melihat pengaruh gaya mengajar terhadap keterampilan gerak dasar Peserta didik Sekolah Dasar Negeri 159/III Semumu Kecamatan Devati VII Kabupaten Kerinci. Secara khusus untuk mengungkap efektifitas antara gaya mengajar inkuiri dan komando pada keterampilan gerak dasar kelas V dan VI. Jenis penelitian ini menggunakan metode eksperimen dengan rancangan the two group pretest-posttest. Populasi penelitian ini adalah seluruh Peserta didik yang berada pada tahun ajaran 2016/2017 di Sekolah Dasar Negeri 159/III Semumu Kecamatan Devati VII Kabupaten Kerinci. Teknik pengambilan sampel dalam penelitian ini digunakan teknik Stratafied Sampling sehingga 34 Peserta didik di tetapkan sebagai sampel penelitian. Instrumen yang digunakan adalah tes keterampilan. Data dianalisis menggunakan Uji t. Hasil temuan menyimpulkan, (1) gaya mengajar inkuiri berpengaruh signifikan terhadap keterampilan gerak dasar Peserta didik dengan thitung = 8,46 > t tabel = 2,12, (2) gaya mengajar komando berpengaruh signifikan terhadap keterampilan gerak dasar Peserta didik dengan thitung = 8,90 > t tabel = 2,12, dan (3) gaya mengajar inkuiri lebih efektif dari gaya mengajar komando terhadap gerak dasar Peserta didik dengan thitung  = 2,46 > t tabel 2,12

Prospect of the use of checkpoint inhibitors in hepatocellular cancer treatments

Ali Raufi, Maria Tria Tirona Division of Hematology/Oncology, Department of Medicine, Joan C. Edwards School of Medicine at Marshall University, Edward Comprehensive Care Center, Huntington, WV, USA Abstract: Hepatocellular cancer (HCC) is a very fatal disease due to limited therapeutic options as well as due to its association with underlying chronic liver disease in the majority of cases. The immune evasion in HCC signifies a major barrier to the delivery of effective immunotherapy. Sorafenib is the only Food and Drug Administration-approved drug available with an overall response rate of 2%–3% and overall survival of 2.8 months. Chemotherapy has not been used routinely because of the relative refractoriness of advanced HCC. The introduction of immune checkpoint inhibitors (cytotoxic T-lymphocyte antigen 4, programmed death 1, and programmed death-ligand 1) has opened a new horizon for cancer immunotherapy. Future direction in immunotherapy for HCC is to rationally combine it with other treatment modalities, including surgery, radiofrequency ablation, and cytotoxic agents, to maximize its therapeutic efficacy. Keywords: hepatocellular cancer, immune checkpoint inhibitors, cancer immunotherap

Cognitive impairment induced by permanent bilateral common carotid occlusion exacerbates depression-related behavioral, biochemical, immunological and neuronal markers

Item does not contain fulltextThere is a strong link between cognitive impairment and depression, but up to date it is not clear whether cognitive impairment is 'cause' or 'consequence' of depression. Therefore, we here examined the effect of cognitive impairment induced by permanent occlusion of common carotid arteries, a model known as two-vessel occlusion (2VO), on chronic unpredictable stress (CUS)-induced depression-related markers in rats. Male Sprague-Dawley rats underwent 2VO or sham surgery. Sixty days after the surgery, the cognitive function of the rats was tested using the radial arm maze task measuring working and reference memory. Subsequently, the animals were randomly assigned to undergo 21 days of CUS or to stay non-stressed. One week after the last stressor, psychomotor retardation, a feature of depression-like behavior, was assessed using the forced swim test (FST) by measuring time spent on immobility. Plasma amino acid (glutamine, glutamate and glycine) and serum pro-inflammatory cytokine (interleukin 6) levels, and hippocampus CA1 neuronal damage were measured 24h after FST exposure. Results show that 2VO increased immobility in the FST only when rats had been exposed to CUS. In addition, 2VO surgery intensified the effect of CUS on IL-6, glutamate and glycine levels and increased CA1 hippocampal damage. In conclusion, our findings show that cognitive impairment may predispose to depression by intensifying the effect of stress on depression-related behavioral, biochemical, immunological and neuronal markers

Advances in Liquid Biopsy Technology and Implications for Pancreatic Cancer

Pancreatic cancer is a highly aggressive malignancy with a climbing incidence. The majority of cases are detected late, with incurable locally advanced or metastatic disease. Even in individuals who undergo resection, recurrence is unfortunately very common. There is no universally accepted screening modality for the general population and diagnosis, evaluation of treatment response, and detection of recurrence relies primarily on the use of imaging. Identification of minimally invasive techniques to help diagnose, prognosticate, predict response or resistance to therapy, and detect recurrence are desperately needed. Liquid biopsies represent an emerging group of technologies which allow for non-invasive serial sampling of tumor material. Although not yet approved for routine use in pancreatic cancer, the increasing sensitivity and specificity of contemporary liquid biopsy platforms will likely change clinical practice in the near future. In this review, we discuss the recent technological advances in liquid biopsy, focusing on circulating tumor DNA, exosomes, microRNAs, and circulating tumor cells

Primary Retroperitoneal Melanoma Presented in a Rare Extracutaneous Site for Malignant Melanoma

Malignant melanoma, as the name implies, is a malignant tumor of melanocytes, found in the skin, eyes, meningeal lining and the mucosal epithelium of the aero-digestive and genitourinary tracts. Malignant melanoma is typically skin malignancy, which rarely presents at extracutaneous site. Here we present a rare case of primary retroperitoneal melanoma and review the findings in comparison with other cases described in literature