No abstract

After 8 years, an update of central nervous system (CNS) tumors was published in 2016 after 2007. First time ever, molecular markers along with histology have been used in classification of any tumor. Major changes are seen in glioma and medulloblastoma groups. Few entities have been added such as diffuse midline glioma, H3 K27M-mutant, RELA fusion-positive ependymoma, embryonal tumor with multilayered rosettes, C19MC-altered, and hybrid nerve sheath tumors. Few variants and patterns that no longer have diagnostic and/or biological relevance and have been deleted such as glioblastoma cerebri, protoplasmic and fibrillary astrocytoma, and cellular ependymoma. Other changes include deletion of term “primitive neuroectodermal tumor,” addition of criterion of brain invasion in atypical meningioma, separation of melanotic schwannoma from other schwannoma, and combination of solitary fibrous tumors and hemangiopericytoma as one entity. There is also expansion of entities in nerve sheath tumors and hematopoietic/lymphoid tumors of the CNS. In this review article, we tried to review CNS tumors 2016 classification update in a simplified manner; comparing the differences between 2016 and 2007 CNS tumors classifications with brief description of important molecular markers and finally utility as well as challenges of this classification.

The offspring of high fat (HF) diet-fed rats display increased body weight during adulthood. However, it is not known whether the changes in appetite regulation in these animals occur in utero or postnatally. We investigated the effects of maternal obesity induced by a HF diet prior to and during pregnancy on leptin and insulin signaling and the expression of orexigenic and anorexigenic peptides in term fetal hypothalami. The consumption of a HF diet prior to and during pregnancy resulted in obesity in HF female rats; additionally, HF female rats exhibited hyperinsulinemia and hyperleptinemia which were exaggerated in late gestation compared with control female rats that were fed a standard rodent laboratory chow (LC). Term fetuses of HF female rats (FHF) also had significantly higher serum leptin and insulin levels compared with control fetuses (FLC) while there was no difference in average fetal weight between the two groups.FHF hypothalami showed elevated levels of mRNA and proteins for leptin long receptor and insulin receptor bsubunit. However, the protein levels of signal transducers and activators of transcription-3 and insulin receptor substrate-2, the downstream signaling components of leptin and insulin signaling respectively were decreased. Also, FHF hypothalami had increased mRNA levels of neuropeptide Y and agoutirelated polypeptide indicating that orexigenic neuropeptides in HF progeny are already upregulated by term fetal stage. Additionally, the mRNA levels of pro-opiatemelanocortin and melanocortin receptor-4 were also increased in the HF fetal hypothalami. These findings indicate potential programming effects of an altered intrauterine environment induced by HF diet consumption on appetite-regulating neuropeptides and leptin and insulin signaling in the late fetal period.

Diabetes technology has continually evolved over the years to improve quality of life and ease of care for affected patients. Frequent blood glucose (BG) checks and multiple daily insulin injections have become standard of care in Type 1 diabetes (T1DM) management. Continuous glucose monitors (CGM) allow patients to observe and discern trends in their glycemic control. These devices improve quality of life for parents and caregivers with preset alerts for hypoglycemia. Insulin pumps have continued to improve and innovate since their emergence into the market. Hybrid closed-loop systems have harnessed the data gathered with CGM use to aid in basal insulin dosing and hypoglycemia prevention. As technology continues to progress, patients will likely have to enter less and less information into their pump system manually. In the future, we will likely see a system that requires no manual patient input and allows users to eat throughout the day without counting carbohydrates or entering in any blood sugars. As technology continues to advance, endocrinologists and diabetes providers need to stay current to better guide their patients in optimal use of emerging management tools.

U. urealyticum can be considered as an etiological agent in unexplained infertility. It is suggested that culture for U. urealyticum should be carried out in patients with unexplained infertility.

Context:Arthritis is an important cause of morbidity, presenting as monoarticular or polyarticular lesion. Arthroscopic synovial aspiration and biopsy can help in arriving specific etiological diagnosis.Aim and Objectives:To evaluate the efficacy of arthroscopic synovial biopsy as a diagnostic aid and study the characteristics of synovial fluid in various joint diseases.Materials and Methods:Arthroscopic synovial biopsy along with synovial fluid analysis was studied in 30 of the 50 enrolled cases arthritis. The fluid was subjected to physical, biochemical, and cytological analysis.Results:Both rheumatoid (n = 14, 28%) and tubercular (n = 13, 26%) arthritis were found to be more common compared to other etiologies. Next common etiology observed was chronic nonspecific synovitis (n = 10, 20%). Clinicopathological correlation was seen in 34 out of 50 cases. As a diagnostic tool, synovial biopsy had a sensitivity of 85%, specificity of 100%, positive predictive value of 100%, and negative predictive value of 62%.Conclusion:Arthroscopic synovial biopsy is a simple and easy to perform technique and is an important useful investigative adjunct that may give conclusive diagnosis where clinical diagnosis is equivocal.

The rising incidence of obesity and metabolic diseases such as diabetes mellitus and cardiovascular disease in adolescents and young adults is of grave concern. Recent studies favor a role of lifestyle factors over genetics in the perpetuation of inflammation, insulin resistance and oxidative stress, which are pathophysiologic processes common to the above diseases; furthermore, the importance of dietary factors in addition to calories and physical activity in these processes is being increasingly recognized. Advanced glycation end products (AGEs) belong to a category of dietary oxidants which have been implicated in the pathogenesis of inflammation, oxidative stress, insulin resistance, β-cell failure and endothelial dysfunction. This paper reviews the studies of AGEs with a focus on their role in cardiometabolic disease in children. A Medline search was performed using the key words ‘childhood obesity', ‘metabolic syndrome' and ‘advanced glycation end products'. Articles published in English between 1975 and 2015 and their references were reviewed. While most studies were performed in adults, a few studies also demonstrated a role of AGEs in obesity and associated cardiometabolic comorbidities in the younger population. Available evidence suggests an involvement of AGEs in the pathogenesis of adiposity and β-cell failure in children. Potential areas for further research to investigate underlying mechanisms are proposed.

Angiomyolipoma is apparently a part of a family of neoplasms that derive from perivascular epitheloid cells. It is a rare mesenchymal tumor, usually found in the kidney. Extrarenal angiomyolipoma is uncommon and the most common extrarenal site is the liver. Only two cases of adrenal angiomyolipoma are reported in English literature. Authors wish to add one more case to world literature. Because of its large size and symptomatic presentation of extremely rare tumor merits documentation.