Surfer's myelopathy: A rare presentation in a teenage gymnast and review of the literature.

This article describes a novel setting for a rare nontraumatic spinal cord injury referred to as Surfer's myelopathy. The patient is a 16 year-old female cheerleader who presented following a gymnastics practice where she was repeatedly performing back handsprings. She demonstrated progressively worsening midthoracic back pain and evolving paraplegia and hypesthesia of the lower extremities. Magnetic resonance imaging findings were consistent with T5-T7 spinal cord ischemia at 8 h and 16 h after symptom onset. The clinical and radiologic findings for this patient are consistent with previous case reports of Surfer's myelopathy. The authors also provide a summary of the current literature describing Surfer's myelopathy, which to date includes 64 reported cases. The diagnosis of nontraumatic spinal cord injury, referred to as Surfer's myelopathy, in a gymnast highlights the importance of greater physician and patient awareness of this rare condition.

Predicting the likelihood of an isocitrate dehydrogenase 1 or 2 mutation in diagnoses of infiltrative glioma.

BACKGROUND: Several variables are associated with the likelihood of isocitrate dehydrogenase 1 or 2 (IDH1/2) mutation in gliomas, though no guidelines yet exist for when testing is warranted, especially when an R132H IDH1 immunostain is negative. METHODS: A cohort of 89 patients was used to build IDH1/2 mutation prediction models in World Health Organization grades II-IV gliomas, and an external cohort of 100 patients was used for validation. Logistic regression and backward model selection with the Akaike information criterion were used to develop prediction models. RESULTS: A multivariable model, incorporating patient age, glioblastoma multiforme diagnosis, and prior history of grade II or III glioma, was developed to predict IDH1/2 mutation probability. This model generated an area under the curve (AUC) of 0.934 (95% CI: 0.878, 0.978) in the external validation cohort and 0.941 (95% CI: 0.918, 0.962) in the cohort of The Cancer Genome Atlas. When R132H IDH1 immunostain information was added, AUC increased to 0.986 (95% CI: 0.967, 0.998). This model had an AUC of 0.947 (95% CI: 0.891, 0.995) in predicting whether an R132H IDH1 immunonegative case harbored a less common IDH1 or IDH2 mutation. The models were also 94% accurate in predicting IDH1/2 mutation status in gliomas from The Cancer Genome Atlas. An interactive web-based application for calculating the probability of an IDH1/2 mutation is now available using these models. CONCLUSIONS: We have integrated multiple variables to generate a probability of an IDH1/2 mutation. The associated web-based application can help triage diffuse gliomas that would benefit from mutation testing in both clinical and research settings.

Long-term treatment with temozolomide in malignant glioma.

Six months of maintenance temozolomide (TMZ) following concurrent TMZ chemotherapy and radiation therapy has become the standard of care in the treatment of glioblastoma. In addition, TMZ has also been used to treat other forms of glioma although less evidence of efficacy exists. TMZ administration longer than 6months is common in clinical practice, but it is unusual for the drug to be administered longer than 1 to 2years. We report five patients who received long-term treatment with TMZ chemotherapy at normal dosing levels. One of these patients was diagnosed with glioblastoma, two with anaplastic astrocytoma, one with gliosarcoma, and one with oligo-astrocytoma. The length of treatment in our group of patients ranged from 45 to 85 cycles of TMZ. Common Terminology Criteria for Adverse Events (CTCAE) developed by The National Cancer Institute was used to classify toxicity. Two patients experienced no toxicity per CTCAE guidelines. One patient experienced grade I thrombocytopenia, one developed grade I leukopenia, and one experienced both grade I thrombocytopenia and grade I nausea, all which resolved with either withholding TMZ for 1month or supportive treatment. Our report provides evidence that long-term TMZ chemotherapy is a therapeutic option when appropriately monitored.

Virus infection improves drought tolerance.

Viruses are obligate intracellular symbionts. Plant viruses are often discovered and studied as pathogenic parasites that cause diseases in agricultural plants. However, here it is shown that viruses can extend survival of their hosts under conditions of abiotic stress that could benefit hosts if they subsequently recover and reproduce. Various plant species were inoculated with four different RNA viruses, Brome mosaic virus (BMV), Cucumber mosaic virus (CMV), Tobacco mosaic virus and Tobacco rattle virus. The inoculated plants were stressed by withholding water. The onset of drought symptoms in virus-infected plants was compared with that in the plants that were inoculated with buffer (mock-inoculated plants). Metabolite profiling analysis was conducted and compared between mock-inoculated and virus-infected plants before and after being subjected to drought stress. In all cases, virus infection delayed the appearance of drought symptoms. Beet plants infected with CMV also exhibited significantly improved tolerance to freezing. Metabolite profiling analysis showed an increase in several osmoprotectants and antioxidants in BMV-infected rice and CMV-infected beet plants before and after drought stress. These results indicate that virus infection improves plant tolerance to abiotic stress, which correlates with increased osmoprotectant and antioxidant levels in infected plants.