Steroid injection in chronic inflammatory vocal fold disorders, literature review

Os corticosteróides são potentes inibidores da inflamação e da cicatrização. Administração local de esteróides diretamente na laringe tem sido relatada em diversas patologias laríngeas. OBJETIVO: O objetivo desse estudo é realizar uma revisão da literatura sobre o uso de infiltração de corticosteróide em pregas vocais, em pacientes com patologias vocais benignas, inflamatórias e crônicas de laringe. METODOLOGIA: Realizou-se uma busca eletrônica na base de dados Medline, selecionando-se estudos clínicos que utilizavam corticosteróides em patologias benignas da laringe. RESULTADOS: Os corticosteróides são indicados nas seguintes situações: 1) doenças inflamatórias agudas, principalmente naquelas relacionadas a edema que comprometa a via aérea; 2) doenças auto-imunes com alterações laríngeas; 3) estenose laríngea; 4) em lesões benignas inflamatórias das pregas vocais, como nódulos, pólipos e edema de Reinke, para diminuir o processo inflamatório pré-cirúrgico ou na tentativa de se evitar uma intervenção cirúrgica; 5) em fonocirurgia, com o objetivo de reduzir a formação de cicatriz. Seu uso pode ser profilático, visando à prevenção da formação de cicatriz ou terapêutico em uma cicatriz já formada. CONCLUSÃO: Os corticosteróides podem ser considerados uma opção terapêutica importante no manejo de várias patologias, principalmente aquelas de origem inflamatória que causam alterações vocais.Steroids are potent inhibitors of inflammation and wound repair. Local administration of steroids directly into the larynx has been reported in many laryngeal diseases. AIM: The purpose of this study is to review related literature about the use of steroid injection in patients with benign, inflammatory and chronic vocal disease. METHODOLOGY: We performed an electronic survey in Medline database and selected clinical trials regarding steroid use in benign laryngeal diseases. RESULTS: Steroids are indicated in these situations: 1) acute inflammatory diseases, mainly when edema compromises the airways; 2) auto- immune disease with laryngeal involvement; 3) laryngeal stenosis; 4) benign lesions of the vocal folds, e.g., nodules, polyps and Reinke's edema, to reduce the inflammatory reactions before phonosurgery or in an attempt to avoid surgery; 5) In phonosurgery, aiming to reduce scarring. In this case, it could be used as a preventive measure in vocal fold scarring, or for scar treatment. CONCLUSION: Steroids may be considered an important therapeutic option in the management of many diseases, specially the inflammatory ones, associated with vocal changes

Supranormal orientation selectivity of visual neurons in orientation-restricted animals

Altered sensory experience in early life often leads to remarkable adaptations so that humans and animals can make the best use of the available information in a particular environment. By restricting visual input to a limited range of orientations in young animals, this investigation shows that stimulus selectivity, e.g., the sharpness of tuning of single neurons in the primary visual cortex, is modified to match a particular environment. Specifically, neurons tuned to an experienced orientation in orientation-restricted animals show sharper orientation tuning than neurons in normal animals, whereas the opposite was true for neurons tuned to non-experienced orientations. This sharpened tuning appears to be due to elongated receptive fields. Our results demonstrate that restricted sensory experiences can sculpt the supranormal functions of single neurons tailored for a particular environment. The above findings, in addition to the minimal population response to orientations close to the experienced one, agree with the predictions of a sparse coding hypothesis in which information is represented efficiently by a small number of activated neurons. This suggests that early brain areas adopt an efficient strategy for coding information even when animals are raised in a severely limited visual environment where sensory inputs have an unnatural statistical structure

Coronarin D induces apoptotic cell death and cell cycle arrest in human glioblastoma cell line

Glioblastoma (GBM) is the most frequent and highest–grade brain tumor in adults. The prognosis is still poor despite the use of combined therapy involving maximal surgical resection, radiotherapy, and chemotherapy. The development of more efficient drugs without noticeable side effects is urgent. Coronarin D is a diterpene obtained from the rhizome extract of Hedychium coronarium, classified as a labdane with several biological activities, principally anticancer potential. The aim of the present study was to determine the anti–cancer properties of Coronarin D in the glioblastoma cell line and further elucidate the underlying molecular mechanisms. Coronarin D potently suppressed cell viability in glioblastoma U–251 cell line, and also induced G1 arrest by reducing p21 protein and histone H2AX phosphorylation, leading to DNA damage and apoptosis. Further studies showed that Coronarin D increased the production of reactive oxygen species, lead to mitochondrial membrane potential depolarization, and subsequently activated caspases and ERK phosphorylation, major mechanisms involved in apoptosis. To our knowledge, this is the first analysis referring to this compound on the glioma cell line. These findings highlight the antiproliferative activity of Coronarin D against glioblastoma cell line U–251 and provide a basis for further investigation on its antineoplastic activity on brain cancer.This research was funded by grants from the Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP 2014/06636–7 and 2016/06137–6), financiadora de Estudos e Projetos FINEP (MCTI/FINEP/MS/SCTIE/DECIT–01/2013–FPXII–BIOPLAT)

Comparison with Magnetic Resonance Three-Dimensional Sequence for Lumbar Nerve Root with Intervertebral Foramen

Study DesignProspective study based on magnetic resonance (MR) imaging of the lumbar spinal root of the intervertebral foramen.PurposeThis study was to compare MR three-dimensional (3D) sequences for the evaluation of the lumbar spinal root of the intervertebral foramen.Overview of LiteratureThe diagnosis of spinal disorders by MR imaging is commonly performed using two-dimensional T1- and T2-weighted images, whereas 3D MR images can be used for acquiring further detailed data using thin slices with multi-planar reconstruction.MethodsOn twenty healthy volunteers, we investigated the contrast-to-noise ratio (CNR) of the lumbar spinal root of the intervertebral foramen with a 3D balanced sequence. The sequences used were the fast imaging employing steady state acquisition and the coherent oscillatory state acquisition for the manipulation of image contrast (COSMIC). COSMIC can be used with or without fat suppression (FS). We compared these sequence to determine the optimized visualization sequence for the lumbar spinal root of the intervertebral foramen.ResultsFor the CNR between the nerve root and the peripheral tissue, these were no significant differences between the sequences at the entry of foramen. There was a significant difference and the highest CNR was seen with COSMIC-FS for the intra- and extra-foramen.ConclusionsIn this study, the findings suggest that the COSMIC-FS sequences should be used for the internal or external foramen for spinal root disorders

当院におけるPoint-of-Care Ultrasonography（POCUS）の現状 : ICU におけるベッドサイド腹部超音波症例での検討

　近年point-of-care 超音波（以下POCUS）の有用性が注目されている．しかし，その定義，対象臓器や疾患，必要とされる手技などは明らかとなっていない．当施設でICU（intensive-careunit）入院患者に対しベッドサイドで腹部超音波検査（abdominal ultrasound: AUS）を施行した症例をPOCUS 症例とし，当院のPOCUS の現状をretrospective に検討した．POCUS 施行例245例で，検査依頼領域は肝胆膵領域が最多で次に消化管領域が続いた．検査依頼領域に何らかの所見が認められた症例は47.8％であった．POCUS の正診率については94.5％であった．診断困難例は全例が消化管疾患でその中でも消化管出血とくに出血性直腸潰瘍が多く，いずれも内視鏡検査で診断されていた．POCUS で緊急対応が必要と指摘した症例は28例あり，その28.6％は検査依頼領域以外の部位に病変を認めた．28例の内訳では消化管領域（60.7％）と循環器領域（17.9％）であった．POCUS では検査依頼領域以外の領域に所見を認める事もあり，腹部全体の検索が重要である．また消化管領域はPOCUS による診断が困難なこともあり，AUS 所見で症状が説明できない場合には、内視鏡検査なども検討すべきである．以上のことから，緊急疾患は消化管領域と循環器領域に多く，特に消化管領域については慎重な検索が重要と考えられた．また，AUS を用いて適切なPOCUS を行うためには，急性腹症を含めた腹部疾患の横断的かつ総合的な病態判断が必要である．　The usefulness of point-of-care ultrasonography (POCUS) has been attracting attention in recent years, but its definition, target organs and diseases, procedures required, etc., have not been clarified. We considered cases in which abdominal ultrasound (AUS) had been performed at the bedside of patients admitted to the intensive-care unit (ICU) in our institution to be POCUS cases and assessed its current status retrospectively. There were 245 POCUS cases, and the location of abdominal area from which the greatest number of requests for the examination had been received was the hepato-biliary-pancreatology area, which was followed by the gastrointestinal area. Some sort of finding in the area from which the examination had been requested was detected in 47.8% of the cases. The diagnostic accuracy rate of POCUS was 94.5%. All difficult diagnosis cases were gastrointestinal diseases, many of which were gastrointestinal bleeding cases, especially bleeding hemorrhagic rectal ulcers, and all were diagnosed by endoscopy. There were 28 cases in which emergency management was indicated based on the POCUS findings, and in 28.6% of them the findings were detected at other area that had requested the examination. The breakdown of the emergency 28 cases showed that they included cases in the gastrointestinal area (60.7%) and cardiovascular area (17.9%). Since some of the findings detected by POCUS were in other area than the field that requested the examination, it is important to search the entire abdomen. Also, sometimes diagnosis by POCUS in the gastrointestinal area is difficult, and when the symptoms cannot be explained by the AUS findings, other examinations, such as endoscopy, should be examined. Based on the above, it appeared that diseases that require emergency management are most common in the gastrointestinal and cardiovascular area, and that very careful searches are important, especially in the gastrointestinal area. The most important, in order to perform appropriate POCUS with AUS, it is necessary to judge cross-sectional and comprehensive pathophysiological conditions of abdominal disease include acute abdomen

A dialysis patient with multiple intestinal diverticula in whom partial penetration was recognized.

　小腸憩室は比較的稀な疾患で，多くが無症状で経過するが，穿孔した場合は腸間膜内に穿通し膿瘍形成をきたす．高齢者に多く，その診断および治療の遅れから重篤な経過をたどることも少なくない．その診断にはコンピュータ断層撮影（CT）が有用とされているが，穿孔部位や憩室の特定は困難とされ，術前に指摘できるものは決して多くない．透析患者では高リン血症に対し陰イオン交換樹脂剤などが一般的に使用されるが，消化管穿孔の注意が記載されている．今回我々は，透析患者の腸管穿孔の原因検索に体外式超音波（US）が有用であった１例を経験したので，文献的考察を含めて報告する．症例は70歳台男性，18年前から血液透析を行っている．10日前に発熱で近医を受診し，保存的に経過を見ていたが炎症反応の上昇を認め当院紹介受診した．身体所見は心窩部付近に軽度の圧痛を認めたが腹膜刺激兆候は明らかでなかった．単純 CT で消化管外の free air が疑われ，精査目的に US が行われた．US では空腸に多発している憩室と，憩室周囲の膿瘍形成およびその内部の free air と思われる点状高エコーが認められ，小腸憩室穿通と診断した．同日小腸切除術が行われ，病理組織学的検索の結果，US と同様の所見であった．また穿通した憩室にセベラマー結節が認められ，憩室穿通に関与した可能性が示唆された．US は透析患者における憩室穿通の診断に有用である．　Jejunal diverticula (JD) are considered to be rare and are asymptomatic in most cases. However, they are potentially associated with serious complications, such as diverticulitis and perforation/penetration, especially in the elderly. In the event of perforation/ penetration, JD usually penetrates the mesentery, resulting in the formation of an abscess in the mesentery, which is difficult to diagnose, because there are no specific signs. Anion exchange resin agents, such as sevelamer hydrochloride (SH), are often used for hyperphosphatemia in dialysis patients, but the package insert cautions against the development of the adverse effect of gastrointestinal perforation. Herein, we report a case in which abdominal ultrasonography (US) was useful for the diagnosis of jejunal diverticular penetration in a hemodialysis patient. The patient was a male in his 70s who had been on hemodialysis for 18 years and was receiving SH 2.25g/day. He presented to a neighborhood hospital with a 10-days’history of fever. The fever did not improve with conservative therapy, and the patient was referred to our hospital. Physical examination revealed mild epigastric tenderness, but there were no signs of peritoneal irritation. Computed tomography (CT) was performed, and the presence of free air was suspected. Abdominal US performed subsequently showed multiple jejunal diverticula and abscess formation around the diverticulum. Furthermore, free air was recognized in the abscess, which was finally diagnosed as a mesenteric abscess complicating JD penetration. On the same day, jejunal resection was performed and histopathological examination of the surgical specimen revealed findings consistent with the US findings. Histopathology revealed sevelamer crystals in the penetrated diverticulum. US is useful for the diagnosis of penetration of JD in dialysis patients

The Double-stranded RNA–dependent Protein Kinase Differentially Regulates Insulin Receptor Substrates 1 and 2 in HepG2 Cells

The RNA-dependent protein kinase (PKR), initially known as a virus infection response protein, is found to differentially regulate two major players in the insulin signaling pathway, IRS1 and IRS2. PKR up-regulates the inhibitory phosphorylation of IRS1 and the expression of IRS2 at the transcriptional level