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Spinal cord injury (SCI) is one of the most devastating injuries which causes either complete or partial loss of movement, balance, muscular coordination and endurance. Electromagnetic field (EMF) stimulation has been shown to reduce muscle atrophy and fiber-type switching and improves muscle function in a hindlimb suspension model. The present study aims to elucidate the therapeutic potential of EMF stimulation on motor neuron excitability, soleus muscle morphology and function in complete SCI rats. Thirty-six adult male Wistar rats were randomly divided into Sham, SCI and SCI+EMF groups. Complete transection was done at the T13 spinal level, followed by whole-body EMF exposure for 7 or 14 days. Hyper-reflexia, muscle atrophy, reduction in twitch and tetanic force with earlier onset of fatigue was evident in the SCI group. EMF stimulation showed significant improvement in H and M wave parameters, H/M ratio, muscle twitch and tetanic force, fusion frequency and fatigability. A significant increase in regenerating myofibers and reduction in muscle degeneration following EMF was evident on histopathological examination. Further, EMF significantly increased myogenic protein levels responsible for muscle regeneration. Our study demonstrates for the first time the potential of EMF to modulate motor neuron excitability and muscle contractile function in SCI rats through activity-dependent mechanisms.

Elevated serum interleukin-6 (IL-6) in Hodgkin lymphoma (HL) is reported to correlate with B symptoms, response rate and survival in adult patients. The authors studied prognostic significance of IL-6 expression by immunohistochemistry on Hodgkin-Reed Sternberg cells and background reactive cells in a retrospective cohort of pediatric HL patients treated with doxorubicin, bleomycin, vinblastine and dacarbazine (ABVD) from January 2009 through December 2013. Of 142 patients, tissue blocks were retrieved in 110 patients. On logistic regression analysis, IL-6 expression on background cells alone was among the factors associated with inferior response rate (OR-9.9, 95%CI-1.2, 78.3; p = 0.03). On multivariate analysis, IL-6 expression on background cells alone had significant impact on 5 y freedom from treatment failure (FFTF) (HR-7.7, 95% CI-1.2, 48.6; p = 0.03). IL-6 expression by immunohistochemistry in the background cells is an independent poor predictor of response and FFTF in pediatric HL. Further prospective studies in children are needed to confirm the current findings and whether IL-6 expression can be used to stratify treatment.

To determine the agreement between transcutaneous bilirubin (TcB) measured from shielded skin and serum total bilirubin (STB) in infants (34 to 41 weeks of gestation) with hyperbilirubinemia receiving phototherapy (PT).In this prospective cohort study, we shielded a small area of skin on sternum using a commercial photo-opaque patch (BilEclipseTM, Philips Respironics, Murrysville, PA, USA). The TcB from the shielded skin (TcBs) and STB were measured at four time points-before initiation, 12 and 24 h during and once after (12 h) cessation of PT. TcB was measured using multiwavelength transcutaneous bilirubinometer (BiliChek, Philips Children's Medical Ventures, Monroeville, PA, USA). The STB was measured in triplicate by spectrophotometry (Apel BR 5100, APEL, Japan). Bland and Altman plots were drawn to determine agreement between the TcBs and STB.The gestation and birth weight of enrolled neonates were 37.0 (1.0) weeks and 2750 (458) g, respectively. The age at initiation and duration of PT were 75 (27 to 312) and 25.3 (4.4) h, respectively. Bland and Altman plot showed poor agreement between TcBs and STB at all time points. The gradient (median, range) between TcBs and STB at 0, 12, 24 h and 12 h after cessation of PT were -0.2 (-4.9 to 3.5), 1.4 (-4.7 to 4.0), 1.5 (-3.8 to 9.4) and 2 (-2.9 to 5.8) mg dlTcBs does not appear to be reliable for estimating serum bilirubin in late preterm and term neonates receiving PT.

Data on prognostic factors in patients with metastatic osteosarcoma treated with uniform chemotherapy protocol are lacking. The objective of this study was to analyze demographic data, treatment outcome and prognostic factors for patients with metastatic osteosarcoma at our center treated with a uniform chemotherapy protocol without high dose methotrexate.This is a single-institutional data review of patients treated between June 2003 and December 2012 with neoadjuvant chemotherapy, local site surgery followed by adjuvant chemotherapy and metastasectomy at completion of adjuvant chemotherapy.102 patients of metastatic osteosarcoma were treated with a median age of 18 years (range 8-48 years), male to female ratio of 3.3:1 and median symptom duration of 4 months. EFS and OS at 5 years were 12.7 ± 0.1 and 28.1 ± 0.1 %, respectively. On multivariate analysis, elevated serum alkaline phosphatase (p 0.001) and number of metastasis3 (p = 0.04) were predictive of lower EFS, whereas elevated serum alkaline phosphatase (p = 0.01), number of metastasis3 (p = 0.05), and margin positivity (p 0.001) were predictive of lower OS.This is the largest data on metastatic osteosarcoma treated with a uniform chemotherapy protocol without high dose methotrexate. The data showed prognostic factors similar to what have been observed previously such as elevated serum alkaline phosphatase and3 metastatic lesions in lung predicting inferior outcome. Notably our survival was comparable to data from other studies despite our practice of delaying metastasectomy to completion of chemotherapy rather than performing the same along with local site surgery.

Extrahepatic portal vein obstruction (EHPVO) is a common cause of paediatric portal hypertension and the only permanent treatment is shunt surgery. The inferior mesenteric vein (IMV) is a portal venous channel that can be used for the shunt when the splenic vein/superior mesenteric vein is thrombosed or when a lienorenal shunt is not possible.To compare MDCT venography (MDCTV) and contrast-enhanced MR venography (CEMRV) for visualisation of the IMV in children with EHPVO.This was a prospective study of 26 children (4-12 years, median 10 years) who underwent MDCTV and CEMRV. The IMV visualisation was graded using 4- and 2-point scales and the difference in visualisation was assessed by calculating the exact significance probability (P).The IMV was visualised in all children on MDCTV and 25/26 children on CEMRV (96%). The images were diagnostic in 23/26 children (88%) on MDCTV and in 18/26 (69%) children on CEMRV (P=0.063).MDCTV and CEMRV are comparable for IMV visualisation with a tendency toward MDCTV being superior.

A majority of patients with esophageal cancer present with inoperable disease and require rapid and long-lasting palliation of dysphagia.To compare the duration of relief of dysphagia in patients with inoperable esophageal cancer treated with esophageal stenting alone or a combination of esophageal stenting and external beam radiotherapy (EBRT), and to assess overall survival, treatment-related complications, and quality of life (QOL) in the two groups.Patients with inoperable esophageal cancer and with high grade dysphagia were randomized to receive esophageal stenting with self-expandable metal stent (Ultraflex) alone (Group I), versus a combination of stenting followed by EBRT (30 gray in ten divided fractions over 2 weeks) (Group II). Dysphagia relief, overall survival, QOL (using European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-C30, version 3), and treatment-related complications were assessed in the two groups.From April 2007 to March 2009, 84 patients were randomized to receive esophageal stent alone (42 patients) or a combination of stent and EBRT (42 patients). The two groups were comparable in demographics, tumor characteristics, indications for palliative treatment, and pretreatment dysphagia score. Dysphagia scores improved significantly in both groups following stent insertion. However, dysphagia relief was more sustained in Group II than in Group I (7 vs. 3 months, p = 0.002). Overall median survival was significantly higher in Group II than in Group I (180 vs. 120 days, p = 0.009). Addition of radiotherapy following stenting prolonged the mean dysphagia-free survival (118.6 ± 55.8 vs. 96.8 ± 43.0 days, p = 0.054). There was significant improvement in all QOL parameters at 1 week after stenting. The QOL, however, significantly declined immediately after radiotherapy. There was no treatment-related mortality, and the incidence of complications was similar in the two groups.Post-stenting EBRT effectively prolongs duration of dysphagia relief and improves overall survival in inoperable esophageal cancer.