OtoLaryngology New Articles

An Update on the Role of Immunotherapy and Vaccine Strategies for Primary Brain Tumors Opinion statement Existing therapies for glioblastoma (GBM), the most common malignant primary brain tumor in adults, have fallen short of improving the dismal patient outcomes, with an average 14–16-month median overall survival. The biological complexity and adaptability of GBM, redundancy of dysregulated signaling pathways, and poor penetration of therapies through the blood–brain barrier contribute to poor therapeutic progress. The current standard of care for newly diagnosed GBM consists of maximal safe resection, followed by fractionated radiotherapy combined with concurrent temozolomide (TMZ) and 6–12 cycles of adjuvant TMZ. At progression, bevacizumab with or without additional chemotherapy is an option for salvage therapy. The recent FDA approval of sipuleucel-T for prostate cancer and ipilumimab, nivolumab, and pembrolizumab for select solid tumors and the ongoing trials showing clinical efficacy and response durability herald a new era of cancer treatment with the potential to change standard-of-care treatment across multiple cancers. The evaluation of various immunotherapeutics is advancing for GBM, putting into question the dogma of the CNS as an immuno-privileged site. While the field is yet young, both active immunotherapy involving vaccine strategies and cellular therapy as well as reversal of GBM-induced global immune-suppression through immune checkpoint blockade are showing promising results and revealing essential immunological insights regarding kinetics of the immune response, immune evasion, and correlative biomarkers. The future holds exciting promise in establishing new treatment options for GBM that harness the patients' own immune system by activating it with immune checkpoint inhibitors, providing specificity using vaccine therapy, and allowing for modulation and enhancement by combinatorial approaches. Read More » An Update on the Role of Immunotherapy and Vaccine Strategies for Primary Brain Tumors Opinion statement Existing therapies for glioblastoma (GBM), the most common malignant primary brain tumor in adults, have fallen short of improving the dismal patient outcomes, with an average 14–16-month median overall survival. The biological complexity and adaptability of GBM, redundancy of dysregulated signaling pathways, and poor penetration of therapies through the blood–brain barrier contribute to poor therapeutic progress. The current standard of care for newly diagnosed GBM consists of maximal safe resection, followed by fractionated radiotherapy combined with concurrent temozolomide (TMZ) and 6–12 cycles of adjuvant TMZ. At progression, bevacizumab with or without additional chemotherapy is an option for salvage therapy. The recent FDA approval of sipuleucel-T for prostate cancer and ipilumimab, nivolumab, and pembrolizumab for select solid tumors and the ongoing trials showing clinical efficacy and response durability herald a new era of cancer treatment with the potential to change standard-of-care treatment across multiple cancers. The evaluation of various immunotherapeutics is advancing for GBM, putting into question the dogma of the CNS as an immuno-privileged site. While the field is yet young, both active immunotherapy involving vaccine strategies and cellular therapy as well as reversal of GBM-induced global immune-suppression through immune checkpoint blockade are showing promising results and revealing essential immunological insights regarding kinetics of the immune response, immune evasion, and correlative biomarkers. The future holds exciting promise in establishing new treatment options for GBM that harness the patients' own immune system by activating it with immune checkpoint inhibitors, providing specificity using vaccine therapy, and allowing for modulation and enhancement by combinatorial approaches. Read More » An empirical study of lay comprehension of Chinese legal reference texts in Hong Kong This socio-legal study empirically assesses the use of plain language in improving comprehension of legal reference texts by laypeople in Hong Kong, where common-law Chinese was newly engineered. Our study shows that native Chinese speakers have problems understanding the materials, but simple modifications of the texts can significantly improve their comprehension. The results suggest that the seeming incapability of expressing law in a language may not be related to the choice of code, but to how it is written. Based on the data, this study contributes to the improvement of legal communication by identifying features of common-law Chinese that make these materials difficult to understand, and proposes language-specific plain-language strategies that can improve comprehensibility. Read More » Impact of mobile phone usage on speech spectral features: some preliminary findings The manner of using a mobile phone in voice communications can significantly affect the spectral characteristics of the speech signal. This article presents preliminary results of the analysis of the long-term average speech spectrum (LTASS), the long-term formant distribution (LTF) in voiced sounds, and vowel formants F1, F2 and F3 of six speakers in five modes of mobile phone usage. These modes are: normal holding of a mobile phone (NOR), with a bonbon (sweet) in the mouth (BON), with a cigarette between the lips (CIG), with the mobile phone between cheek and shoulder (SHO) and with the hand covering the mobile phone and mouth (HAN). The results show that each mode has an impact on spectral features and that the modes HAN and SHO have the greatest impact. The most striking results are the relative displacement of F1, which can reach 30% (e.g. vowel /a/ in HAN mode for males), formant F2, near 15% (vowel /i/ in SHO mode for males), and formant F3, about 5% (vowel /u/ in CIG mode for females). These findings suggest that forensic practitioners should exercise caution in interpreting formant measurements in speaker identification cases involving mobile phone transmission. Read More » The Language of Bribery Cases Roger W. Shuy (2013) Oxford University Press 276pp Read More » The law of England and Wales: translation in transition This article considers the role of the legal translator/interpreter in bilingual court proceedings. This is not, however, a situation where a non-English speaker gives oral evidence which is translated for the benefit of the court, but rather a situation where a court – the court in question being the Supreme Court of England and Wales – is unable to comprehend the bilingual text of the legislation. The interpreter is therefore called upon to explain the possible differences in meaning between the two versions. This article questions the extent to which the legal system is aware of the significance of these issues, and advocates re-evaluating the training requirements of legal interpreters. Read More » Disfluencies in the speech of intoxicated speakers Our hypothesis is that speakers under the influence of alcohol produce more linguistic/phonetic errors because of the negative effect of ethanol on cognitive processes and speech motor control. We examined the speech of 150 German speakers of both genders with regard to rates of 6 types of disfluencies and 2 durational measures. The intoxication of speakers ranged from 0.050% to 0.175% blood alcohol concentration; other factors investigated are speaker gender and speaking style (read, spontaneous, command&control). We found that most rates of disfluencies as well as durations increase with intoxication – but not for command&control speech; gender has no influence; individual speakers deviate from the general trend frequently. We conclude that for forensic investigations disfluency rates should be applied with greatest care (i.e. individual speaker only), and command&control speech as typically used in automotive systems is not suitable for the automatic detection of intoxication on the basis of disfluency rates. Read More » Bilingual speaker identification: Chinese and English Very few studies have examined voice memory and speaker identification in bilingual contexts. This study investigated how well bilingual listeners could identify bilingual voices in different language conditions. 89 Cantonese-English and 89 Mandarin-English listeners participated in voice line-ups with Cantonese-English voices in the same-language and cross-language conditions. Results show that the overall identification accuracy was low. Cantonese-English listeners performed significantly better in the same-language than cross-language conditions, similar to previous findings based on monolingual subjects. However, there was no language effect for the Mandarin-English listeners, possibly due to their unfamiliarity with the languages concerned. Confidence ratings showed that all listeners were more confident in the same-language condition with their most familiar language, although the relationship between confident and accuracy was not reliable. The results suggest that some indexical information about speaker identity is language-dependent. Different articulatory settings may explain the better performance of Cantonese-English listeners in the same-language conditions. Read More » Ens queda la paraula: Estudis de lingüística aplicada en honor a M. Teresa Turell Raquel Casesnoves, Montserrat Forcadell and Núria Gavaldà eds (2014) Institut Universitari de Lingüística Aplicada, Universitat Pompeu Fabra Read More » Book announcements Read More » Jury Instructions in Hong Kong: A Gricean Perspective Most previous studies on jury instructions have been confined to legalese such as the lexical and syntactic features of jury instructions. This study, drawing on reported cases on jury instructions from the Hong Kong judiciary, aims to examine jury instructions in Hong Kong to better explore how jury instructions are given in Hong Kong, being a common-law jurisdiction, and to argue that Grice's Cooperative Principle can be usefully adopted to examine jury instructions in order to shed some light on the drafting of jury instructions. The study argues that the principle of rationality, a deeper-level of observance of Gricean maxims, which underlies the Cooperative Principle, has interpretative force on jury instructions in the case of non-observance of conversational maxims, and that, in the court judgments examined, non-observance of the fundamental communicative principle usually constitutes a good ground for appeal, although the opposite is also true. It therefore provides a pertinent demonstration of the differences of the operation of Gricean maxims in lay and legal contexts. Read More » Inhibition of autophagy induced by quercetin at a late stage enhances cytotoxic effects on glioma cells Abstract Glioma is the most common primary brain tumor in the central nervous system (CNS) with high morbidity and mortality in adults. Although standardized comprehensive therapy has been adapted, the prognosis of glioma patients is still frustrating and thus novel therapeutic strategies are urgently in need. Quercetin (Quer), an important flavonoid compound found in many herbs, is shown to be effective in some tumor models including glioma. Recently, it is reported that adequate regulation of autophagy can strengthen cytotoxic effect of anticancer drugs. However, it is not yet fully clear how we should modulate autophagy to achieve a satisfactory therapeutic effect. 3-Methyladenine (3-MA) and Beclin1 short hairpin RNA (shRNA) were used to inhibit the early stage of autophage while chloroquine (CQ) to inhibit the late stage. MTT assay was implemented to determine cell viability. Transmission electron microscopy, western blot, and immunohistochemistry were adopted to evaluate autophagy. Western blot, flow cytometry, and immunohistochemistry were used to detect apoptosis. C6 glioma xenograft models were established to assess the therapeutic effect (the body weight change, the median survival time, and tumor volume) in vivo. Quercetin can inhibit cell viability and induce autophagy of U87 and U251 glioma cells in a dose-dependent manner. Inhibition of early-stage autophagy by 3-MA or shRNA against Beclin1 attenuated the quercetin-induced cytotoxicity. In contrast, suppression of autophagy at a late stage by CQ enhanced the anti-glioma efficiency of quercetin. Therapeutic effect of quercetin for malignant glioma can be strengthened by inhibition of autophagy at a late stage, not initial stage, which may provide a novel opportunity for glioma therapy. Read More » CRITERIA FOR CYTOLOGICAL DIAGNOSIS OF THYROID LESIONS 2015-10-10T17-44-30Z Source: Online Journal of Otolaryngology Chandramouleeswari Kathirvel. Palpable thyroid nodules are more common in women, and male/female ratio ranged from 1.2 to 4.3.[1,3] Thyroid nodules may cause hypothy-roidism, hyperthyroidism, cosmetic issues, and problems in other organs such as compression, and they also have the potential for malignancy.[4] Therefore, the accurate evaluation of thyroid nodules is crucial. In recent years, the role of fine-needle aspiration cytology (FNAC) is increasing regarding the management methods as well as its role in detection of malignancy potentials of thyroid nodules. No single diagnostic methods used for the definitive diagnosis of thyroid cancers, such as radiographs, US, scintigraphy and suppression therapy, is effective enough to make a benign/malignant differentiation alone. FNAC has been used since the 1950s, and is one of the effective methods in the diagnosis of thyroid nodules.[5].In this article, a retrospective study of FNAC of thyroid lesions over a period of three years is analysed with reiew of literature. Read More » Recurrent Laryngeal Nerve: Anatomical perspective 2015-10-10T17-44-30Z Source: Online Journal of Otolaryngology Lalruatkimi khiangte, Balasubramanian Thiagarajan. The recurrent laryngeal nerve can be a real challenge to the surgeon operating in its area. This article highlights the normal anatomy, anatomical variants and ways to identify the nerve as the consequences of its injury can have a life changing impact on both the patient and the surgeon. It should be borne in mind that the anatomy of recurrent laryngeal nerve differs between both sides. These anatomical differences between the course of the nerve on both sides could be attributed to the embryological development which varies between sides. Read More » ESOPHAGEAL PERFORATION AND CHICKEN BONE MIGRATION INDUCED VOCAL CORD HYPOMOBILITY, SURGICAL EMPHYSEMA,PNEUMOTHORAX , PNEUMOMEDIASTINUM, HYPOTHYROIDISM AND THYROID ABSCESS AND SEPTICEMIC SHOCK : CASE REPORT AND REVIEW OF THE LITERATURE 2015-10-10T17-44-30Z Source: Online Journal of Otolaryngology PRADIP KUMAR TIWARI, JOYDEEP DEY, PINPO TERON, BHUYAN UT, DEBAJIT DAS. Hypothyroidism along with thyroid abscess is a very rare condition and not frequently encountered. It is an emergency as indicated with surgical emphysema and hypothyroidism along with pneumothorax and pneumomediastinum. Esophageal abscess and perforation along with pneumothorax ,pneumomediastinum and surgical cervical emphysema was diagnosed by HRCT NECK AND THORAX. The foreign body extruded after rupture of esophageal abscess and patient treated for the underlying complications. Read More » Post-thyroidectomy hematoma : a rare but potentially fatal complication 2015-10-10T17-44-30Z Source: Online Journal of Otolaryngology Sudhir M Naik, Ravishankara S, Mohan Appaji, MK Gautham, Pinky Devi, Sarika S Naik. Background/ objectives: Post-thyroidectomy hematoma is a rare but fatal complication of thy-roidectomy. The incidence of hematoma has dropped to less than 2-3% due to better preoper-ative preparation & major refinements in surgical techniques. Setting: Department of ENT, Head & Neck Sur-gery, KVG Medical College, Sullia. Case report: We report a case of post- thyroidec-tomy hematoma in an elective surgery done for a large thyroid. The hematoma occurred 15 minutes after surgery & was managed success-fully under general anaesthesia. Intervention: Urgent evacuation of the hemato-ma was done under general anaesthesia & bleeders were re-ligated. 2 pints of A+ blood was transfused. Conclusion: Post-thyroidectomy hematoma leading to airway obstruction is a fatal complication which needs emergency management. Post-operative care include attention to the drain, careful monitoring in the recovery room & appreciation of subtle signs of respiratory distress. So every thyroidectomy case can bleed & cause hematoma complication. Prevention & early intervention can avoid fatal complications. Read More » THYROID TISSUE IN BUCCAL MUCOSA: A RARE PRESENTATION OF THYROID ECTOPIA 2015-10-10T17-44-30Z Source: Online Journal of Otolaryngology ANUJ JAULKAR, NUDRAT PARVEZ KAMAL. Ectopic thyroid tissue is a rare entity resulting from developmental defects at early stages of thyroid gland embryogenesis, during its passage from the floor of the primitive foregut to its final pre-tracheal position. It is frequently found along the course of the thyroglossal duct or laterally in the neck, as well as in distant places such as me-diastinum and subdiaphragmatic organs. Presence of thyroid tissue in buccal mucosa is a rare presentation of thyroid ectopia. No such case has been reported in the world literature. We report a case of ectopic thyroid tissue in buccal mucosa in a seven years old male child who presented with a gradually increasing swelling in the right buccal mucosa. Aspiration cytology was suggestive of squamous papilloma. This also protects the recurrent laryngeal nerve from damage. Capsular dissection helps in pro-tecting the recurrent laryngeal nerve and also protects the blood supply of parathyroid glands. Minimally invasive transoral excision with CO2 laser was done and the tissue was sent for histo-pathology which revealed heterotopic thyroid tissue with follicular adenoma. Thyroid function tests suggested euthyroidism. Ultrasonography of the neck showed a normal thyroid gland in its normal location. Read More » HASIMOTO'S THYROIDITIS A REVIEW 2015-10-10T17-44-30Z Source: Online Journal of Otolaryngology Ramya Ranganathan, Balasubramanian Thiagarajan. Hashimoto thyroditis is an organ specific autoimmune disorder. Initially described Hakaru Hashimotoa century ago is now the most common cause of hypothyroidism in iodine sufficient are-as of the world. But still the pathogenesis is not fully understood. With higher incidence among female population HT develops as a result of in-teraction between the genetic factors and environmental factors in susceptible individuals. HT is associated with other autoimmune disorders. Now many variants of HT have been identified: classical form, fibrous variant, IgG4 variant, juve-nile form, hashitoxicosis and silent thyroiditis (sporadic or postpartum). All variants of HT are characterized by lymphocytic infiltration, distruction and atropy of thyroid gland ultimately thyroid failure though each entity has specific other features. Clinically HT can also present as euthyroid or even hyperthyroid state with or without goiter. Diagnosis is based on the clinical features, demonstration of antibodies against thyroid antigen, sonography and cytological findings. Treatment is mainly supplementing Levothyroixin for correction of hypo-thyroidism. Surgery is reserved for patients with large goiter causing mechanical compression of cervical structures, painful HT and suspicion of malignancy. Read More » ROLE OF ULTRASOUND IN THYROID DISORDERS 2015-10-10T17-44-30Z Source: Online Journal of Otolaryngology Janani Parkkunam, Balasubramanian Thiagarajan. Ultrasonography has established itself has a useful tool in evaluating and managing thyroid disorders. This article provides an overview of basic principles of ultrasound, how it is used in different thyroid disorders, different sonographic pattern of thyroid disorders, comparative features of malignant and benign nodule, ultra-sound features of diffuse thyroid disorders and congenital thyroid disorders, ultrasound guided FNAC, advanced techniques of ultrasound in thyroid imaging. Read More » Anatomy of thyroid gland Surgeon's perspective 2015-10-10T17-44-30Z Source: Online Journal of Otolaryngology Balasubramanian Thiagarajan. Thyroid surgery can give rise to complications if performed without adequate knowledge of anatomy. With adequate knowledge of its anatomy, its variations and optimal operative technique complications can be reduced. Structures that should be protected at all costs include the re-current laryngeal nerves, external branches of superior laryngeal nerves and parathyroid glands. Safe surgery involves meticulous hemostasis, and performing the dissection in a meticulous and step wise pattern. Thyroid gland if pulled medially will help in lateral dissection, securing middle thyroid vein (which may cause troublesome bleed in some patients as it is a branch from internal jugular vein). This also protects the recurrent laryngeal nerve from damage. Capsular dissection helps in protecting the recurrent laryngeal nerve and also protects the blood supply of parathyroid glands. Read More » Patient age and breast resection weight affect immediate post mastectomy breast reconstruction in ductal carcinoma in situ Mastectomy is still necessary for 40% of the ductal carcinoma in situ. If Immediate Breast Reconstruction (IBR) is systematically proposed, 81% of the patients would choose immediate versus delayed breast reconstruction, but actual IBR rate is only around 50% of these patients. Therefore, the aim of this study was to identify objective characteristics that distinguish the patients who actually underwent IBR from those who do not. Read More » CXCL13 blockade attenuates lupus nephritis of MRL/lpr mice Publication date: Available online 9 October 2015 Source:Acta Histochemica Author(s): Xiaobei Wu, Jialong Guo, Rui Ding, Bin Lv, Liqi Bi The chemokine CXC ligand 13 protein (CXCL13) is reported to closely related to the disease activity and severity of systemic lupus erythematosus (SLE), moreover, the level of CXCL13 was markedly raised in kidney tissues of lupus nephritis (LN) patients. The aim of the present study was to explore whether the blockade of CXCL13 has therapeutic effects on murine LN. MRL/lpr mice received 50μg anti-CXCL13 neutralizing antibody or isotype IgG by intraperitoneal injection everyday for six weeks, and renal damage of each group was determined. Our results showed that the blockade of CXCL13 significantly reduced urine protein, serum creatinine, and dramatically attenuated renal pathology injury. Treatment with anti-CXCL13Ab also reduced serum anti-dsDNA level, renal immune complex deposition as well as inflammatory cytokines secretion. Meanwhile, Th17/Treg ratio in spleens of MRL/lpr mice was significantly decreased by the blocking of CXCL13. These findings suggested that CXCL13 may be a promising target for the therapy of LN. Read More » Serum prolidase levels in Graves' disease without ophthalmopathy and its association with oxidative status Abstract Objective The aim of this study was to evaluate serum prolidase levels and its association with oxidative stress in autoimmune thyroid disease (AITD). Materials and methods 25 with Hashimoto thyroiditis (HT) and 25 patients Graves' disease (GD), and 27 healthy controls were enrolled in the study. The patients with signs of Graves' ophthalmopathy were excluded from the study. Serum samples were obtained in euthyroid period at the third month of treatment. Serum prolidase, total antioxidant status (TAS), total oxidative stress (TOS), and total free sulfhydryl (–SH) levels were measured. Results Serum prolidase levels were significantly higher in the patients with GD compared to the HT and the healthy control group. Oxidative stress index (OSI) and TOS levels of the patients with both GD and HT were significantly higher compared to those of the control group (p < 0.001, for each), while –SH levels were significantly lower (p < 0.001, for each). There was no significant difference between the patients with HT and healthy control group in terms of prolidase levels (p = 0.580). Prolidase levels were positively correlated with TOS and OSI and negatively correlated with –SH (r = 0.565, p = 0.003; r = 0.604, p = 0.001; r = −0.532, p = 0.006). Conclusion Serum prolidase activity is increased in GD patients without signs of ophthalmopathy, and showed a positive correlation with oxidative stress parameters. Read More » Telomere length and telomerase expression in pituitary tumors Abstract Purpose Telomere dysfunction and telomerase activation underlie cancer transformation. This study aims to investigate the contribution of telomere biology to pituitary tumor behavior. Subjects and methods Samples from 50 patients with pituitary tumors (11 ACTH-secreting, 18 GH-secreting, and 21 non-secreting tumors) and 7 subjects without pituitary lesions were collected. The expressions of telomerase essential components TERT and TERC and tumor telomere content were measured by quantitative PCR techniques. Results Telomerase (TERT) expression was detected in 36 % of tumors. No correlation was observed between TERT and TERC expression level and tumor size in any tumor type. There was no association between gene expression and clinical findings. Telomere content (T/S ratio) was similar between pituitary adenomas (0.39 ± 0.16) and normal pituitaries (0.47 ± 0.12; p = 0.24) and also was between the different adenoma types: ACTH-secreting (0.43 ± 0.08), GH-secreting (0.31 ± 0.12), and non-secreting (0.42 ± 0.20; p = 0.10) tumors. Conclusions The telomere content and expression of telomerase components are comparable between normal pituitary glands and tumor tissues, suggesting that telomere biology does not play an important role in pituitary tumor development. Read More » Papillary thyroid carcinoma and multiple endocrine neoplasia type 2 Abstract Introduction Papillary thyroid carcinoma (PTC) is exceptional in MEN 2. Results The analysis in 135 patients revealed two PTC, without C-cell pathology; both being positive for V804M mutation (RET proto-oncogene). Conclusions Few data are available about PTC in MEN 2, and without C-cell pathology is even less common. More studies are needed to correlate genetics and histology, and even for assessing PTC as only manifestation of MEN 2. Read More » Effects of a high-protein/low-carbohydrate versus a standard hypocaloric diet on adipocytokine levels and cardiovascular risk factors during 9 months, role of rs6923761 gene variant of glucagon-like peptide 1 receptor Abstract Background The role of GLP-1 R variants on body weight response after dietary intervention is unclear. Objective The aim was to investigate the role of this polymorphism on cardiovascular risk factors, adipokine levels and weight loss secondary to a high-protein/low-carbohydrate vs. standard hypocaloric diets during 9 months. Design 211 obese subjects were randomly allocated to one of these two diets for a period of 9 months; diet HP (high protein/low carbohydrate) and diet S (standard). Results Ninety-four patients (44.5 %) had the genotype GG (wild group) and 117 (55.5 %) patients had the next genotypes; GA (89 patients, 42.2 %) or AA (28 patients, 13.3 %) (mutant group). With both diets and in both genotype groups, body mass index, weight, fat mass, waist circumference and systolic blood pressure decreased. Anthropometric parameters were higher in non-A allele carriers than A allele carriers. With diet HP in both genotypes, LDL cholesterol, total cholesterol, leptin, insulin levels and HOMA-R decreased. With the diet S and only in wild genotype, the same parameters decreased, too. Conclusion Our data showed a lack of association of rs6923761 GLP-1 R polymorphism with weight loss. Better anthropometric parameters in obese subjects with the mutant allele (A) of rs6923761 GLP-1 R polymorphism were observed. Total cholesterol, LDL cholesterol, insulin levels and HOMA-R decreased in all patients with both diets, although A allele carriers treated with standard diet did not show these changes. Read More » TP53 polymorphism may contribute to genetic susceptibility to develop Hashimoto's thyroiditis Abstract Purpose p53, which is encoded by the tumor suppressor gene TP53, plays a crucial role in the regulation of mechanisms of cell cycle arrest and apoptosis. Some SNPs of TP53, involving a different apoptotic ability of p53, have been associated with increased susceptibility to develop autoimmune diseases as well as cancer. We investigated the genotypic distribution of TP53 exon 4 SNPs in a cohort of Caucasian patients affected by Hashimoto's thyroiditis (HT). Methods Peripheral blood for DNA extraction was collected from 109 Caucasian unrelated subjects, 79 HT patients and 30 healthy controls. SNPs analysis was carried out by amplification and sequencing of exon 4 TP53. Results For the Pro72Arg (rs 1042522) SNP we found these rates in HT patients: 11.4 % wild-type C/C (Pro72Pro), 24.0 % heterozygous G/C (Pro72Arg), 64.6 % homozygous G/G (Arg72Arg). The corresponding rates in healthy controls were 10, 46.7 and 43.3 %, respectively. Thus, significantly different were G/C heterozygosity (24.0 vs 46.7 %, p = 0.039) and G/G homozygosity (64.6 vs 43.3 %, p = 0.042). These differences were also confirmed when comparing our study population to published Caucasian control groups. The other described SNPs (Pro34Pro rs 11575998, Pro36Pro rs1800370, Pro47Ser rs1800371, and Arg110Leu rs 11540654) were absent or very rare in our study population. Conclusions Our preliminary data, the first on a Caucasian population, indicate an increased prevalence of the homozygous genotype Arg/Arg and a decreased prevalence of heterozygous genotype Arg/Pro of rs 1042522 in HT patients compared to controls, suggesting that such SNP may contribute to confer susceptibility to HT. Read More » A review on the effects of Allium sativum (Garlic) in metabolic syndrome Abstract The metabolic syndrome is a common problem world-wide and includes abdominal obesity, hypertension, dyslipidemia, and hyperglycemia disorders. It leads to insulin resistance and the development of diabetes mellitus or cardiovascular disease. Allium sativum (garlic) has been documented to exhibit anti-diabetic, hypotensive, and hypolipidemic properties. This suggests a potential role of A. sativum in the management of metabolic syndrome; however, more studies should be conducted to evaluate its effectiveness. In this review, we discussed the most relevant articles to find out the role of A. sativum in different components of metabolic syndrome and cardiovascular disease risk factors. Because human reports are rare, further studies are required to establish the clinical value of A. sativum in metabolic syndrome. Read More » Ipilimumab-induced hypophysitis: review of the literature Abstract Purpose Ipilimumab is a human monoclonal antibody against cytotoxic T-lymphocyte antigen 4 available as an immunotherapy mainly for advanced melanoma. It induces an activation of T cells, resulting in an immune-mediated anti-tumor response and also immune-related adverse events, including hypophysitis. The aim of this review is to identify and discuss features concerning ipilimumab-induced hypophysitis (IIH). Design A MEDLINE research of all years of publication of IIH was conducted. We gathered information regarding clinical, radiologic and laboratory features of 71 cases recorded in the literature. Results In our review, IIH was more frequent among older and male patients. Fatigue and headache were the most frequent initial clinical manifestations of IIH and enlargement of the pituitary gland at MRI was present in the majority of patients. Those who received more than 3 cycles of ipilimumab had more fatigue (p = 0.04) and arthritis (p = 0.04). Adrenal insufficiency was more prevalent in men (p = 0.007). Glucocorticoid therapy and hormone replacement were required in most patients and pituitary function recovery was uncommon. Low prolactin at diagnosis tended to predict permanent pituitary dysfunction (p = 0.07). Conclusion Hypopituitarism as a consequence of IIH, if not promptly recognized, can lead to potentially fatal events, such as adrenal insufficiency. IIH can be easily managed with glucocorticoids and hormonal replacement; therefore, physicians should be familiar with the key aspects of this condition. More studies to develop screening protocols and therapeutic intervention algorithms should be performed to decrease morbidity related to IIH. Read More »