Controversy about the protective role of volume in the frontal sinus after severe head trauma: larger sinus equates with higher risk of death.

The "crumple zone" hypothesis suggests that the paranasal sinuses protect the brain as a zone to distribute and absorb energy after trauma to the head. We investigated the relation between the size of the frontal sinus and mortality in patients with cranial trauma. All patients with head trauma admitted to the ICU between 1 January 2016 and 20 December 2017 were reviewed retrospectively. They were divided into two groups (according to their outcome) : died and survived. The volumes of the frontal sinuses and other trauma-related variables were assessed on computed tomographs (CT) on admission. Admission CT of 33 patients (24 male, and nine female, aged between 18-92 years, mean 43) were obtained. Male patients had significantly larger frontal sinuses than female (10.24 compared with 6.6cm3). Larger sinuses were significantly associated with a worse outcome (p=0.005). The size of the frontal sinus correlates with mortality after cranial trauma. Our findings do not confirm the "crumple zone" hypothesis, and suggest that the larger the sinus, the greater the risk of death. To our knowledge this is a new finding that warrants further validation.

Medial olivocochlear reflex in ankylosing spondylitis patients.

OBJECTIVE: Ankylosing spondylitis (AS) is a chronic systemic inflammatory disease. Via autoimmune mediators, AS can damage the auditory system similar to other systems. Otoacoustic emission studies in AS patients showed that the damage that causes hearing loss was in the outer hair cells. The medial olivocochlear (MOC) reflex is used to evaluate the MOC efferent system (MOES), which includes the outer hair cells. The aim of this study was to evaluate the presence of subclinical damage in the inner ear with the aid of the MOC reflex test in AS patients with no hearing complaints. PATIENTS AND METHODS: Thirty-four patients with AS and a control group of 30 healthy volunteers with similar demographic characteristics were evaluated in the study. Otoacoustic emission responses, MOC reflex results, and frequency-specific and total suppression findings were compared between the groups. The relationship between clinical and laboratory findings for the AS patients, and the MOC reflex data were also investigated. RESULTS: Reduced MOC reflex response (p = 0.04) and suppression (p = 0.019) were detected in AS patients. When the clinical and laboratory findings for the AS patients and the MOC reflex test results were compared, a significant correlation was found only between the MOC reflex and the erythrocyte sedimentation rate. CONCLUSION: The results showed that AS can damage the inner ear, especially the MOES, and can reduce the MOC reflex response without clinical hearing loss.

Congenital B12 deficiency following maternal gastric bypass.

Here we present a case of severe B12 deficiency in an exclusively breastfed infant, born to a mother who had undergone gastric bypass 6 years earlier. At 4 months of age, the infant presented with pancytopenia and developmental delay. Our evaluation revealed physical and neurological developmental delay, pancytopenia with macrocytosis, with head imaging showing cortical and subcortical atrophy. Serum studies showed low B12, normal folate and iron. Treatment with parenteral B12 led to the resolution of the pancytopenia, steady weight gain and improved neurological status. The child is currently 16 months old with normal anthropometric and hematological parameters and normal B12 levels on a regular diet. Gross motor and speech developments are significantly delayed. This case illustrates that maternal B12 deficiency following gastric bypass surgery may lead to severe B12 deficiency with long-term neurological sequelae in their infants. Screening and prompt treatment of these deficiencies both during pregnancy and during infancy are important.

Inhibition of Wilms' tumor growth by intramuscular administration of tissue inhibitor of metalloproteinases-4 plasmid DNA.

Extracellular matrix (ECM) degrading matrix metalloproteinases (MMPs) lead to ECM turnover, a key event in cancer growth and progression. The tissue inhibitors of matrix metalloproteinases (TIMPs) limit the activity of MMPs, which suggests their use for cancer gene therapy. Here we report that systemic administration of naked TIMP-4 DNA significantly inhibited Wilms' tumor growth in nude mice. TIMP-4, whose expression was lost in Wilms' tumor, inhibited the growth of G401 Wilms' tumor cells at a concentration lower than those required for MMP inhibition. This inhibition was associated with internalization of exogenous recombinant TIMP-4. Electroporation-mediated intramuscular injection of TIMP-4 expression plasmid resulted in sustained plasma TIMP-4 levels and significant tumor suppression. Our data demonstrate a tumor suppressive effect of TIMP-4 against Wilms' tumor and the potential utility of intramuscular delivery of TIMP gene for treatment of kidney derived cancers.

Stimulation of mammary tumorigenesis by systemic tissue inhibitor of matrix metalloproteinase 4 gene delivery.

Tissue inhibitors of matrix metalloproteinase (TIMPs) are multifunctional proteins with both matrix metalloproteinase (MMP) inhibitory effects and growth-regulatory activity. TIMPs inhibit MMP activity, suggesting a use for cancer gene therapy. However, here we report that systemic administration of human TIMP-4 by electroporation-mediated i.m. injection of naked TIMP-4 DNA stimulates tumorigenesis of human breast cancer cells in nude mice. Consistent with tumor stimulation, TIMP-4 up-regulates Bcl-2 and Bcl-X(L) protein. TIMP-4 also inhibits apoptosis in human breast cancer cells in vitro and mammary tumors in vivo. A synthetic MMP inhibitor BB-94 did not have such antiapoptotic effect. Analysis of TIMP-4 expression in human mammary specimens indicates that TIMP-4 protein is increased in mammary carcinoma cells compared with normal mammary epithelial cells. These data indicate an antiapoptotic activity in breast cancer cells and a tumor-stimulating effect of TIMP-4 when administrated systemically.

Specific regulation of male rat liver cytosolic estrogen receptor by the modulator of the glucocorticoid receptor.

Modulator is a novel low-molecular-weight organic compound that regulates activities of glucocorticoid and mineralocorticoid receptors as well as protein kinase C. In this study we show that male rat liver cytosolic estrogen receptor activation is inhibited by modulator in a dose-dependent manner. Fifty percent inhibition is obtained with 1 unit/ml modulator purified from bovine liver which is within the physiological concentration for modulator. However, sheep uterine cytosolic estrogen and androgen receptors are insensitive to regulation by modulator. Exogenous sodium molybdate treatment inhibits activation of all of these receptors of liver or uterus origin in an identical manner, further differentiating the effects of modulator and the molybdate anion.