bluuebunny/crossref_metadata_2025 huggingface dataset:
Natural Progression of an Unresected Supratentorial Ependymoma
Authors: Wang Helen C. , Hertzog James H. , O’Donnell Hugh D. , Walter Andrew W.
Published: December 2007

Ependymomas are rare gliomas that have been associated with a poor outcome despite aggressive therapy including surgery, chemotherapy and radiation therapy. We present a case report of a 16-year-old male with an untreated supratentorial ependymoma that lay dormant for 15 years without significant morbidity. Supratentorial ependymomas are thought to have a better outcome than infratentorial ependymomas, primarily because of the increased likelihood of achieving a gross total resection in the supratentorial space. Our case report suggests that the improved outcome may be due in part to the biologically benign nature of some supratentorial ependymomas. This highly unusual case illustrates the unpredictable heterogeneity of pediatric ependymomas.
Clear Cell Ependymoma of the Temporal Lobe in a Child: A Case Report
Authors: Seyithanoglu Hakan , Karagoz Guzey Feyza , Emel Erhan , Alatas Ibrahim , Acarbas Arsal , Ozkan Nezih
Published: December 2007

A 12-year-old boy with a left temporal tumor diagnosed as clear cell ependymoma (CCE) was reported. CCE is an uncommon central variant of ependymomas with a predilection for the supratentorial region in children. Brain tumors with a honeycomb pattern with clear cells having round nuclei and perinuclear halos could pose a problem in the differential diagnosis with the other tumors with clear cells. There were 41 reported cases of CCE in the literature. In 61% of these cases, tumors were located in the supratentorial region, and in the others in the posterior fossa and spinal cord. However, there was none located in the temporal lobe except in the case presented here.
Long-Term Effects of Interferon-Based Therapy for Chronic Hepatitis C
Authors: Yu Ming-Lung , Huang Chung-Feng , Dai Chia-Yen , Huang Jee-Fu , Chuang Wan-Long
Published: December 2007

Hepatitis C virus infection frequently causes chronic liver disease leading to cirrhosis and hepatocellular carcinoma (HCC) and has become the main indication for liver transplantation. Interferon (IFN)-based therapy has been used in the treatment of chronic hepatitis C (CHC) for viral clearance. Several earlier studies showed long-term beneficial effects of IFN monotherapy in reducing the progression of cirrhosis, hindering HCC development, and prolonging survival among both sustained virological responders and nonresponders. However, the benefits of preventing disease progression in CHC patients without sustained virological response (SVR) no longer existed over a longer observation period. Both IFN monotherapy and IFN-ribavirin combination therapy were shown to reduce significantly the complications of liver disease, in terms of development of cirrhosis, HCC and liver-related mortality. The significance disappeared after response to antiviral treatment was taken into account. The benefits were obtained mainly from successful antiviral treatment but were not related to the antiviral regimens, suggesting that the magnitude of this preventive effect could increase through the significant improvement of SVR rate by using a more effective regimen, such as interferon-ribavirin or peginterferon-ribavirin combination therapy. Nevertheless, about one-third of patients remain resistant to the current recommended antiviral regimens. More effective treatment is needed for the population.
From Molecular Biology to Targeted Therapies for Hepatocellular Carcinoma: The Future Is Now
Authors: Pang Roberta W.C. , Poon Ronnie T.P.
Published: December 2007

Hepatocellular carcinoma (HCC) is characterized as a highly chemoresistant cancer with no effective systemic therapy. Despite surgical or locoregional therapies, prognosis remains poor because of high tumor recurrence or tumor progression, and currently there are no well-established effective adjuvant therapies. The molecular biology of carcinogenesis and tumor progression of HCC has been increasingly understood with intense research in recent years. Several important intracellular signaling pathways such as the Ras/Raf/Mek/Erk pathway and PI3k/Akt/mTOR pathway have been recognized, and the role of several growth factors and angiogenic factors such as EGF and VEGF has been confirmed. Effective agents targeting these molecular abnormalities have been developed and widely tested in preclinical studies of HCC cell lines or xenograft models. Several agents have entered clinical trials in HCC patients, and recent data indicated that a multikinase inhibitor targeting Ras kinase and VEGFR-2, sorafenib, is effective in prolonging survival of patients with advanced HCC. The management of advanced HCC is entering the era of molecular targeting therapy, which is of particular significance for HCC in view of the lack of existing effective systemic therapy for this cancer.
Development of a Novel Assay to Quantify Serum Human Telomerase Reverse Transcriptase Messenger RNA and Its Significance as a Tumor Marker for Hepatocellular Carcinoma
Authors: Miura Norimasa , Maruyama Shigeo , Oyama Kenji , Horie Yutaka , Kohno Michimori , Noma Eijiro , Sakaguchi Seigo , Nagashima Miki , Kudo Masatoshi , Kishimoto Yukihiro , Kawasaki Hironaka , Hasegawa Junichi , Shiota Goshi
Published: December 2007

Currently available tumor markers for hepatocellular carcinoma (HCC) are α-fetoprotein (AFP), lens culinaris agglutinin-reactive AFP (AFP-L3), and Des-γ-carboxy prothrombin (DCP). However, their positive rate can not surpass abdominal ultrasonography (US) as modalities to detect small HCC at early stage, resulting in a possible delay of its diagnosis. There is a need to develop an additional sensitive marker to improve the early detection of HCC. We here introduced a newly developed quantitative detection method for serum hTERT mRNA, which has a clinical significance in HCC diagnosis. Briefly, we examined its sensitivity and specificity in HCC diagnosis, clinical significance in comparison with other tumor markers, and its correlations with the clinical parameters. Serum hTERT mRNA showed higher values in patients with HCC than those with chronic liver diseases. hTERT mRNA expression independently correlated with clinical parameters such as differentiation degree (p < 0.001). The sensitivity/specificity of hTERT mRNA in HCC diagnosis showed 88.2/70.0%. hTERT mRNA proved to be expectedly superior to AFP mRNA , AFP and DCP in HCC diagnosis. Importantly, hTERT mRNA in serum correlated with that in HCC tissue. Thus, we report that serum hTERT mRNA is a novel and available marker for HCC diagnosis.
PIVKA-II Is a Useful Tumor Marker for Recurrent Hepatocellular Carcinoma after Surgical Resection
Authors: Kim Do Young , Paik Yong Han , Ahn Sang Hoon , Youn Young Jun , Choi Jong Won , Kim Ja Kyung , Lee Kwan Sik , Chon Chae Yoon , Han Kwang Hyub
Published: December 2007

Objectives: The aim of this study is to assess the usefulness of prothrombin induced by vitamin K absence or antagonist-II (PIVKA-II) in monitoring of recurrent hepatocellular carcinoma (HCC) after curative resection. Methods: From April 2001 to March 2004, a total of 245 patients with histologically proven HCC and 267 non-HCC patients were recruited. Serial follow-up measurements of both alpha-fetoprotein (AFP) and PIVKA-II were performed in 27 patients who had recurrent HCC after resection. Results: In the initial HCC diagnosis, the sensitivity of AFP and PIVKA-II was 48.6% (119/245) and 75.1% (184/245), respectively, at the cutoff of 20 ng/ml for AFP and 40 mAU/ml for PIVKA-II (p < 0.01). The specificity was 81.3% (217/267) and 94.8% (253/267), respectively. When AFP and PIVKA-II were combined, the sensitivity and specificity was 83.3% (204/245) and 77.2% (206/267), respectively. In 27 patients developing recurrent HCC after curative surgical resection, the sensitivity of AFP and PIVKA-II was 40.7% (11/27) and 74.1% (20/27), respectively. Several fluctuating patterns of AFP and PIVKA-II were observed from initial diagnosis to recurrence. Conclusion: Our data suggest that PIVKA-II is a useful tumor marker for HCC, complementary to AFP. Serial measurements of both markers after resection might be helpful for early diagnosis of tumor recurrence.
Efficacy and Tolerability of Low-Dose Thalidomide as First-Line Systemic Treatment of Patients with Advanced Hepatocellular Carcinoma
Authors: Yau Thomas , Chan Pierre , Wong Hilda , Ng Kelvin K. , Chok Siu-Ho , Cheung Tan-To , Lam Vincent , Epstein Richard J. , Fan Sheung-Tat , Poon Ronnie T.P.
Published: December 2007

Objective: The systemic treatment of advanced hepatocellular carcinoma (HCC) has produced disappointing results thus far. HCC is a hypervascular tumor with over-expression of angiogenic factors such as vascular endothelial growth factor. Thalidomide is an anti-neoplastic agent with anti-angiogenic and other mechanisms of action. We aim to evaluate the efficacy and toxicity of low-dose (100 mg) thalidomide as the first-line treatment of advanced HCC. Methods: Between August 2003 and March 2007, 45 patients who had received thalidomide 100 mg daily as first-line treatment of advanced HCC were reviewed retrospectively. Advanced HCC was defined as either metastatic or not amenable to surgical or locoregional therapies. Diagnosis of HCC was based on clinical, biochemical and radiological grounds. Survival was analyzed by the Kaplan-Meier method. Results: Thirty-eight patients were evaluable for response and toxicity. Two (5%) patients had partial response and 8 (21%) had stable disease. The overall median survival of patients in this cohort was 3.2 months (95% CI: 2.8–3.7 months). The common toxicities were somnolence (13%), peripheral neuropathy (11%) and ankle edema (8%), with no grade 3 or 4 toxicities and treatment-related deaths. Conclusion: Our study shows that a single agent, low-dose thalidomide has a modest clinical activity with good tolerability in treating advanced HCC patients.
Severe Complications of Radiofrequency Ablation Therapy for Hepatocellular Carcinoma: An Analysis of 3,891 Ablations in 2,614 Patients
Authors: Kasugai Hiroshi , Osaki Yukio , Oka Hiroko , Kudo Masatoshi , Seki Toshihito
Published: December 2007

Objective: To clarify information on and frequency of complications as well as mortality rate after radiofrequency ablation (RFA) for hepatocellular carcinoma.Methods: The results of a questionnaire obtained mainly from members of the Osaka Liver Cancer Study Group at 43 departments of 38 facilities were analyzed in order to clarify the current status of RFA, and information on and frequency of complications and death occurring after RFA. Results: Between January 1999 and May 2002, a total of 3,891 RFA therapies were performed percutaneously in 2,542 patients, laparoscopically in 23, and operatively in 49 (2,614 patients in total). Complications were observed in 207 of 2,614 patients (7.9%), and 9 (0.3%) died within 3 months after RFA. Among these 9 nonsurvivors, 3 had liver failure, 3 rapid progression and sarcomatous changes, 1 biliary injury, 1 gastrointestinal bleeding, and 1 acute myocardial infarction. The departments that treated larger numbers of patients per month had a smaller number of complications and deaths. Conclusion: It is possible that complications of RFA can be reduced by gathering experience.
CT Imaging of Early Hepatocellular Carcinoma and the Natural Outcome of Hypoattenuating Nodular Lesions in Chronic Liver Disease
Authors: Takayasu Kenichi , Muramatsu Yukio , Mizuguchi Yasunori , Ojima Hidenori
Published: December 2007

Background: The Liver Cancer Study Group of Japan has designated early hepatocellular carcinoma (HCC) a clinically early-stage HCC corresponding to a high-grade dysplastic nodule as proposed by the International Working Party. Methods: The majority of resected early HCCs were demonstrated as having hypo- or isoattenuation in the arterial and delayed phases of dynamic CT. Results: Only 5% of early HCCs were hyperattenuated on dynamic CT, whereas 94% of advanced small HCC were hyperattenuated. CT arterial portography (CTAP) showed that 66% of early HCCs were hypo- and 34% were isoattenuated. CT hepatic arteriography (CTHA) demonstrated that 55% of them were hypo-, 30% were iso- and the remaining 15% were hyperattenuated. Conclusions: These findings suggest that most early HCCs receive equal or decreased blood supply from both portal and arterial blood flow compared with surrounding hepatic parenchyma. In contrast, 97% of small advanced HCCs were hypoattenuated on CTAP, and 93% were hyperattenuated on CTHA. For nodule-in-nodule type HCC, the central portion of the lesion was hyperattenuating and the peripheral portion was hypoattenuating in the arterial phase of dynamic CT, and both areas became hypoattenuated in the delayed phase. Sixty hypoattenuating nodular lesions in chronic liver disease were followed periodically with helical CT. Thirty-six (60%) of them developed to the hyperattenuating type (attenuation conversion), 21 were unchanged, and 3 disappeared spontaneously. The hyper-in-hypo-attenuating lesions showed rapid progression to entirely enhanced lesions, i.e. overt HCC. Dynamic CT is recommended as one of the low-invasive imaging modalities to follow the hypoattenuating nodules and to determine the optimal treatment with careful attention being given to intratumoral attenuation conversion.
Evaluating Patients with Cirrhosis for Hepatocellular Carcinoma: Value of Clinical Symptomatology, Imaging and Alpha-Fetoprotein
Authors: Paul Shashi Bala , Gulati Manpreet Singh , Sreenivas Vishnubhatla , Madan Kaushal , Gupta Arun Kumar , Mukhopadhyay Sima , Acharya Subrat Kumar
Published: December 2007

Objective: This study was undertaken to assess the value of clinical symptomatology, abdominal ultrasound (US), triple-phase CT (TPCT) and serum alpha-fetoprotein (AFP) estimation in predicting presence of hepatocellular carcinoma (HCC) among patients with cirrhosis. Materials and Methods: In this cross-sectional study, Child’s A/B cirrhosis patients were subjected to clinical evaluation, US, TPCT and serum AFP estimation. Sensitivity and specificity of clinical symptoms and of AFP at different cut-off levels were determined. Detection rate of HCC and agreement between US and TPCT was estimated. Results: A high proportion of enrolled subjects had HCC at first presentation (40.7%). Significantly higher prevalence of abdominal pain, weight loss, and anorexia was seen in patients with cirrhosis with HCC compared to those without HCC. Sensitivity and specificity of any of these symptoms was 73 and 79%, respectively (positive and negative predictive values of 65 and 85%, respectively). A 100% agreement between TPCT and US was observed for diagnosing HCC cases. However, TPCT detected a greater number of smaller HCCs. Sensitivity of AFP at 400 ng/ml cut-off was only 25.7%, too low to be useful. Best mix of sensitivity (77.2%) and specificity (78.1%) of AFP was found to be at 10.7 ng/ml cut-off which falls within the conventional limits of normalcy. Conclusion: The study highlights the importance of symptomatology of weight loss, abdominal pain or anorexia as markers for HCC in patients with cirrhosis. AFP was not found to be a useful screening test. TPCT should be undertaken in all cirrhotics presenting to the hospital for the first time.
Microwave Ablation of Hepatocellular Carcinoma
Authors: Liang Ping , Wang Yang
Published: December 2007

Objective: This article reviews the basic principles, equipment, current therapeutic status and future trends of microwave ablation (MWA) in the treatment of hepatocellular carcinoma (HCC). Methods: All articles published in English on MWA or MWA as a treatment for HCC were identified with a PubMed search from the 1990s through June 2007. Papers were reviewed on the technical advances of MWA equipment and the clinical applications of MWA including indications, techniques, therapeutic outcomes, complications and combination therapies. Results: MWA has several advantages, including high thermal efficiency, higher capability of coagulating blood vessels, faster ablation time, and an improved convention profile. MWA can induce large ablation volumes and yield good local tumor control, especially for small HCC. Larger HCC can also be completely ablated by using more effective antenna or simultaneous application of multiple antennae. Long-term survival comparable to that of surgery was obtained for tumors measuring 4 cm or less. Associated complications appear to be low. Conclusions: MWA is a promising minimally invasive technique for the treatment of HCC. Future advances are warranted to improve the therapeutic efficacy.
Long-Term Interferon Maintenance Therapy Improves Survival in Patients with HCV-Related Hepatocellular Carcinoma after Curative Radiofrequency Ablation
Authors: Kudo Masatoshi , Sakaguchi Yasuhiro , Chung Hobyung , Hatanaka Kinuyo , Hagiwara Satoru , Ishikawa Emi , Takahashi Shunsuke , Kitai Satoshi , Inoue Tatsuo , Minami Yasunori , Ueshima Kazuomi
Published: December 2007

Objective: To assess whether low-dose, long-term maintenance interferon (IFN) therapy inhibits recurrence after complete ablation of hepatocellular carcinoma (HCC) and improves patient survival. Methods and Patients: From June 1999 through May 2006, a total of 127 HCC cases that met the requirements of both tumor diameter 3 cm or less, and number of tumors three or fewer, were curatively treated by radiofrequency ablation therapy (RFA). Among them, 43 patients received three million IU of IFN-α2b twice per week or pegylated IFN-α2a 90 µg once per week or once per 2 weeks without discontinuation (IFN maintenance group). The remaining 84 patients, whose sex, age, and platelet counts were randomly matched to those of the IFN maintenance group, did not receive IFN treatment (control group). Results: Cumulative first, second, and third recurrence rates were significantly reduced in the IFN maintenance group compared with the control group by Kaplan-Meier estimate. The 5-year survival rate was 66% for the control group and 83% for the IFN maintenance group (p = 0.004). Multivariate analysis using the Cox proportional hazards model identified IFN maintenance therapy as an independent risk factor for survival, and the risk ratio was 0.21 (95% CI: 0.05–0.73). In conclusion, low-dose, long-term maintenance IFN therapy after curative RFA therapy of HCC significantly inhibits recurrence, and consequently improves patient survival.
Study of the Relationship between Gene Polymorphisms of Paraoxonase 2 and Stroke in a Chinese Population
Authors: Xu Hong-Wei , Yuan Ning , Zhao Zhen , Zhang Le , Xia Jian , Zeng Kai-Min , Xiao Bo , Yang Xiao-Su , Tang Bei-Sha
Published: December 2007

Background and Purpose: The paraoxonase (PON) gene family has been demonstrated to be capable of preventing lipid peroxidation and could consequently exert antiatherosclerotic effects. Alteration of enzyme activity due to polymorphisms in the PON genes may influence the development of atheroma and thus affect stroke risk. PON2, the second member of this family, has twopolymorphisms, C311S and G148A. Our study explores the relationship between the two polymorphisms of PON2 and stroke. Methods: 120 healthy individuals, 150 patients with primary cerebral hemorrhage and 180 patients with cerebral infarction were included in this study. The genotypes of PON2 were detected with polymerase chain reaction and digested by specific restriction enzymes. Results: C311S and G148A polymorphisms of PON2 exist in Chinese people, with the allele frequencies 0.273/0.727 for C/S and 0.567/0.433 for G/A. No significant differences were observed in genotype and allele frequency between stroke patients and controls (p > 0.05). Conclusions: There was no significant correlation between the two tested polymorphisms of PON2 and stroke in the Chinese population. Allele C/S and G/A might not be independent risk factors for stroke.
Stress/Aggressiveness-Induced Immune Changes Are Altered in Adult Rats Submitted to Neonatal Malnutrition
Authors: Barreto-Medeiros Jairza , Queiros-Santos Adenilda , Cabral-Filho José Eulálio , Ferreira e Silva Wylla Tatiana , Leandro Carol Góis , Deiró Tereza Cristina , Manhaes-de-Castro Raul , Machado Barbosa de-Castro Célia Maria
Published: December 2007

Background/Aims: Neonatal malnutrition induces metabolic and endocrine changes that have beneficial effects on the neonatal in the short term but, in the longer term, these alterations lead to maladaptations. We investigated the effect of neonatal malnutrition on immune responses in adult rats submitted or not to an aggressiveness test. Methods: Male Wistar rats were distributed to one of two groups according to their mothers’ diet during lactation: the well-nourished group (group C, n = 42, receiving 23% of protein) and the malnourished group (group MN, n = 42, receiving 8% of protein). After weaning, all rats received normoproteic diet. Ninety days after birth, each group was subdivided into three subgroups: control rats (n = 14, respectively), aggressive rats (n = 14, respectively) and rats receiving foot shock (FS; n = 14, respectively). Plasma corticosterone concentration was measured after FS sessions. Leukocyte counts and humoral immunity were evaluated. Results: In neonatal malnourished animals, FS-induced stress reduced plasma corticosterone concentration. Intraspecific aggressiveness induced alterations in leukocyte counts and antibody titers 7 and 15 days after immunization. Neonatal malnourished animals showed no changes in the immune parameters evaluated. Conclusions: Expression of intraspecific aggressiveness activates the immune system. Neonatal malnutrition seems to have a long-lasting effect on components of both neuroendocrine and immune functions.
Alexithymia and Interleukin Variations in Somatoform Disorder
Authors: Pedrosa Gil Francisco , Nickel Marius , Ridout Nathan , Schwarz Markus J. , Schoechlin Claudia , Schmidmaier Ralf
Published: December 2007

Objective: The aim of the present study was to investigate if somatoform disorders (SFD) are associated with changes in the normal serum levels of important interleukins, and further, to establish if these changes are related to the presence and severity of alexithymia in patients with SFD. Methods: Twenty-four unmedicated patients who met the International Classification of Diseases (ICD-10) diagnostic criteria for SFD completed the psychological questionnaire to assess alexithymia (Toronto Alexithymia Scale), symptom reporting (SCL-90-R) and diagnostic criteria for SFD (Screening for Somatoform Symptoms scale). Serum concentrations of soluble interleukin 2 receptor α (sIL-2 Rα), IL-4, IL-6, IL-10 and IL-12 were determined in patients with SFD and in 9 healthy subjects. Results: In patients with SFD, serum levels of IL-6 (p < 0.001), IL-10 (p = 0.047) and immunoglobulin E (p = 0.045) were significantly increased in comparison with healthy controls. Additionally, a negative correlation was observed between the level of alexithymia (‘total’ Toronto Alexithymia Scale score) and the serum levels of sIL-2 Rα (r = –0.538) in SFD. Conclusions: Taken together, these results suggest that SFD, with clinically significant alexithymia, are associated with a reduction in Th1-mediated immune function and an increase in the activation of the Th2 immune function, indicated by the augmented serum levels of IL-6 and IL-10 and elevated immunoglobulin E.
Thyroid Function Changes and Cytokine Alterations following Major Surgery
Authors: Ilias Ioannis , Tzanela Marinella , Mavrou Irini , Douka Evangelia , Kopterides Petros , Armaganidis Apostolos , Orfanos Stylianos , Kostopanagiotou Georgia , Macheras Anastasios , Tsagarakis Stylianos , Dimopoulou Ioanna
Published: December 2007

To establish whether cytokine release is implicated in thyroid hormone changes during surgical stress we studied 36 adult patients (20 men; mean age ± SD: 68.5 ± 10.5 years) undergoing elective major abdominal operations. We measured tumor necrosis factor (TNF)-α, interleukin (IL)-6, IL-8 and IL-10 and thyrotropin (TSH), free thyroxine (FT4) and triiodothyronine (T3) before scheduled non-emergency surgery, immediately postoperatively, on the 1st postoperative day (post-1) and on the 2nd postoperative day (post-2). TNF-α, IL-6 and IL-8 peaked on day post-1 whereas IL-10 peaked immediately postoperatively. Fourteen of 36 patients had low T3 levels after surgery, indicating non-thyroidal illness (NTI). Significant negative correlations were noted among TNF-α, IL-6 and IL-8 against T3 and FT4. Cytokines are responsible, at least in part, for NTI following major operations.
An Apolipoprotein A-I Gene Promoter Polymorphism Associated with Cognitive Decline, but Not with Alzheimer’s Disease
Authors: Helbecque Nicole , Codron Valérie , Cottel Dominique , Amouyel Philippe
Published: December 2007

Background/Aims: Accumulating biological and epidemiological evidence suggests a close link between cholesterol metabolism and the pathophysiology of Alzheimer’s disease (AD). The observation that the use of statins reduces the risk of AD sustains this hypothesis. Apolipoprotein A-I (APOA1) is the major component of the high-density lipoproteins, particles involved in reverse cholesterol transport. Therefore, genetic polymorphisms in the gene encoding APOA1 might influence cholesterol metabolism and be a risk factor for AD. A previous study suggested an impact of a G→A polymorphism at position –75 bp in the APOA1 gene on the risk for early-onset AD and on the age at onset of the disease. We studied this polymorphism in 3 independent European population samples. Methods: Genotyping was conducted asdescribed in the previous study. Results: We were unable to show any impact of this polymorphism on the risk of AD. Conversely, subjects bearing the A allele of this polymorphism were at risk of cognitive decline. Conclusion: Our resultssuggest an impact of the G→A polymorphism at position –75 bp in the APOA1 gene on cognitive impairment, but not on the risk of AD.
Investigation of Lipopolysaccharide Receptor Expression on Human Monocytes after Major Orthopaedic Surgery
Authors: Bastian D. , Shegarfi H. , Rolstad B. , Naper C. , Lyngstadaas S.P. , Reikerås O.
Published: December 2007

Background: The innate immune system is suppressed after major orthopaedic surgery, implicating a risk of septic complications. Whole-blood ex vivo testing with lipopolysaccharide (LPS) has shown a depression of the tumour necrosis factor alpha (TNF-α) production until 12 days postoperatively. As part of the innate immune system, the Toll-like receptors TLR2 and TLR4 recognize antigens from Gram-positive and Gram-negative bacteria, respectively. The receptors CD14 and CD11b are involved in the LPS receptor complex, whereas human lymphocyte antigen (HLA)-DR binds endotoxin peptides. It is still uncertain whether the expression of all these receptors changes after major surgery. Methods: In 6 patients undergoing hip arthroplasty, we investigated three times the display of TLR4, TLR2, CD14, CD11b, and HLA-DR on monocytes by fluorescence-activated cell sorting and white blood cell counts during 12 days postoperatively. At the same time, the plasma levels of interleukin (IL)-1β, IL-4, IL-6, IL-10, IL-13, and TNF-α were measured. Results: There was no significant change in the expression of TLR4, CD14, CD11b, HLA-DR, and TLR2. Monocyte count and cytokine analysis did not differ from the ones pre-operatively taken. Conclusions: After aseptic orthopaedic surgery, there is no change in the display of the LPS receptor complex on monocytes. Other mechanisms have to be investigated to gain insight into the decrease of the TNF-α production capacity postoperatively.
Lower Erythrocyte Glutathione Peroxidase Activity in Bronchopulmonary Dysplasia in the First Week of Neonatal Life
Authors: Fu Ren-Huei , Chiu Tsung-Hong , Chiang Ming-Chou , Lien Reyin , Chou Yi-Hung , Chiang Chiao-Ching , Cho Yu-Hsueh , Yang Peng-Hong
Published: December 2007

Background: Bronchopulmonary dysplasia (BPD) is a major pulmonary complication in premature infants and is considered a free radical disorder. Erythrocyte catalase (CAT) and cellular glutathione peroxidase (c-GPx) are antioxidant enzymes that detoxify peroxides generated from dismutation of superoxide anion. The study goal was to measure enzyme activity for preterm infants during the first week of life. Methods: Blood samples were collected from umbilical arterial lines or the radial artery of 44 preterm infants (gestational age range: 25–30 weeks) on days 0, 2, and 5 after delivery. Erythrocyte CAT and c-GPx activities were evaluated, while clinical data were obtained and the correlations of enzyme activity and BPD status were examined. Results: There was no correlation between enzyme activity and gestational age or birth weight. Packed red cell transfusion did not affect enzyme activity and there was no difference in CAT activity between the patient groups. C-GPx activity from preterm infants with BPD was significantly lower than those of preterm infants without BPD on day 5. Conclusions: Erythrocyte c-GPx may play an important role in the development of BPD. Lower c-GPx activity in early post-natal life might be a risk factor of BPD.
Prevalence of Neuropsychiatric Symptoms in Elderly Patients with Dementia in Mungialde County (Basque Country, Spain)
Authors: Fernández Martínez Manuel , Castro Flores Jéssica , Pérez de las Heras Susana , Mandaluniz Lekumberri Aitxiber , Gordejuela Menocal María , Zarranz Imirizaldu Juan José
Published: December 2007

Background: Determination of the prevalence of neuropsychiatric symptoms in elderly patients with dementia inMungialde. Methods: 108 subjects with dementia, who participated in a door-to-door epidemiological study, were included. The 12-item Spanish version of the Neuropsychiatric Inventory was used to evaluate these symptoms. Results: The prevalence of at least 1 neuropsychiatric symptom was found to be 76.90% for all dementia types, 73.50% in patients with Alzheimer’s disease (AD), 80% for the Parkinson-Lewy body dementia complex (PLBD), 78.60% for vascular dementia (VD) and 100% for frontotemporal dementia (FTD). Apathy was found to be the most prevalent symptom for all dementia types and in patients with AD (53.70 and 54.30%, respectively). The next most prevalent symptoms were anxiety, depression and sleep disturbances (35.20, 32.40 and 30.60%) for all dementia types, and anxiety and depression (32.10 and 30.90%) in patients with AD. The most prevalent symptoms in patients with PLBD were apathy, appetite changes, sleep disturbances and agitation (50% each); in patients with VD they were apathy, depression and anxiety (42.90% each), and in patients with FTD they were apathy, anxiety and aberrant motor activity (100% each). Conclusions: Neuropsychiatric symptoms were found to be prevalent in patients with dementia, irrespective of dementia type.
Influence of a Standard Electropalatography Artificial Palate Upon Articulation
Authors: McAuliffe Megan J. , Lin Emily , Robb Michael P. , Murdoch Bruce E.
Published: December 2007

Objective: This study investigated the influence of a standard electropalatography (EPG) palate upon speech articulation in 3 normal speakers under standard EPG testing conditions. Patients and Methods: Three adult females aged 26, 31 and 34 years read the experimental phrase ‘say CV again’ 5 times under 3 experimental conditions: normal speech (without a palate in situ), 45 min after EPG palate insertion and 3 h after EPG palate insertion. Consonants and vowels commonly used in EPG research were studied and included /t/, /s/ and /∫/ in the /i/, /a/ and /u/ vowel environments. Perceptual and acoustic analysis of the data was completed. Results: The results revealed varied patterns of adaptation across the 3 participants. Perceptual analysis suggested that 2 of the participants adapted to the presence of the palate; however, 1 did not. The presence of the palate resulted in significant changes to consonant duration for all 3 participants. Spectrally, production of /t/ was unaffected by the presence of the palate, while articulation of fricatives varied across the participants. Conclusion: Paired with a previous study examining the effects of an EPG palate upon speech articulation [McLeod S, Searl J: Am J Speech Lang Pathol 2006;15:192–206], the present data suggest that researchers and clinicians alike should be aware of the potential perturbing effects of the palate.
Approximal Caries Diagnosis after Data Import from Different Digital Radiography Systems: Interobserver Agreement and Comparison to Histological Hard-Tissue Sections
Authors: Schulte A.G. , Wittchen A. , Stachniss V. , Jacquet W. , Bottenberg P.
Published: December 2007

Aims: To evaluate the agreement of approximal caries diagnosis obtained with different types of digital radiography systems after image import into a reference system. Methods: Digital radiographs were taken from 30 extracted human premolars with 60 diagnostic surfaces using a reference and two test systems from which images were imported as TIFF files. Four observers evaluated the radiographs using the reference software. Teeth were sectioned for histology. Agreement between histology and each technique was calculated using receiver operating characteristic (ROC) statistics. Results: The areas under the ROC curves were not significantly different between reference and test systems. Conclusions: Importing files from different programs did not affect diagnostic accuracy.
Acute Fulminant Colitis Caused by Idiopathic Mesenteric Inflammatory Veno-Occlusive Disease
Authors: Canavan James B. , Coss Alan , Leader Mary , Patchett Stephen E.
Published: December 2007

Mesenteric inflammatory veno-occlusive disease (MIVOD) is an uncommon but important cause of bowel inflammation. MIVOD is characterised by lymphocytic inflammation and non-thrombotic occlusion of the mesenteric venules and veins. We present the case of a young man who presented with acute fulminant colitis, requiring colectomy. The differential diagnosis, pathogenesis and treatment are discussed. This case illustrates the rapid progression from ‘well’ to ‘colectomy’ that can occur with MIVOD. MIVOD should be considered in the differential diagnosis of colitis that does not respond to conventional medical treatment.
Obstetric Characteristics for a Prolonged Third Stage of Labor and Risk for Postpartum Hemorrhage
Authors: Magann Everett F. , Doherty Dorota A. , Briery Christian M. , Niederhauser Amy , Chauhan Suneet P. , Morrison John C.
Published: December 2007

Aim: To determine the obstetric characteristics associated with a prolonged third stage of labor and risk factors for a postpartum hemorrhage (PPH) in women undergoing vaginal delivery. Method: Secondary analysis of a prospective randomized investigation comparing placental removal at 20 versus 30 min to prevent PPH. Results: Between 1 March 2004 and 1 March 2005, 1,607 women were recruited. Eighty-nine percent of the placentas had delivered by 10 min (n = 1,430) and 10.5% (n = 168) had delivered between 10 and 20 min, leaving 8 retained placentas (0.5%) >20 min. Simultaneous factors predictive of longer duration of third stage of labor included maternal age ≧35 years (hazard ratio HR = 0.990, 95% CI 0.981–0.999, p = 0.030) and duration of second stage of labor >2 h (HR = 0.745, 95% CI 0.628–0.883, p = 0.001) relative to second stage of labor <1 h. Significant risk factors for PPH included chorioamnionitis (odds ratio OR = 6.45, 95% CI 2.37–17.64, p < 0.001), nulliparity (OR = 2.38, 95% CI 1.19–4.77, p = 0.014), overdistended uterus (OR = 2.81, 95% CI 1.02–7.76, p = 0.047) and third stage of labor >10 min (OR = 6.45 95%, CI 2.73–22.84, p < 0.001 compared with third stage ≤5 min). Conclusions: Prolonged third stage of labor is correlated with an older maternal age and a prolonged second stage of labor. Significant risk factors for PPH include chorioamnionitis, an overdistended uterus and a third stage of labor >10 min.
Spontaneous Regression of a Breast Carcinoma: A Case Report
Authors: Dussan Carlos , Zubor Pavol , Fernandez Manuel , Yabar Alejandro , Szunyogh Norbert , Visnovsky Jozef
Published: December 2007

Spontaneous regression of malignant tumors is a rare event. It is defined as partial or total disappearance of a proven malignant tumor without adequate medical treatment. The causes of this phenomenon are various. Nevertheless, malignant tumors do regress occasionally for no apparent reason, as evidenced by many clinical observations. We report a case of a 68-year-old woman, who was presented with a several-month history of a painless firm lump, initially of 1 cm in diameter and growing to a large solid regular tumor of 2.5 × 2.5 cm in size, in the upper outer quadrant of her right breast. Preoperative histopathological diagnosis revealed ductal invasive carcinoma. Later on, while awaiting surgical treatment, she suffered an arm injury requiring a 1-month delay of surgery. After recovery, on the date of surgery the tumor disappeared, and, in addition, it was not found in tissue specimens obtained from quadrantectomy. After 78 months of follow-up there was no evidence of relapse. In this report, we discuss clinical and histopathological findings, patient management and possible mechanisms of cancer regression.
Rationale for Combination Angiotensin Receptor Blocker and Angiotensin-Converting Enzyme Inhibitor Treatment and End-Organ Protection in Patients with Chronic Kidney Disease
Authors: Toto Robert , Palmer Biff F.
Published: December 2007

Chronic kidney disease (CKD) is a major public health problem that has received increasing attention because of the high rate of associated cardiovascular morbidity and mortality. Mounting evidence indicates that angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs), drugs that inhibit the renin-angiotensin-aldosterone system (RAAS) safely slow down progression of CKD. There is also growing evidence supporting combination treatment of nephropathies with an ACE inhibitor plus an ARB to more completely block the RAAS and provide greater renoprotection than either an ACE inhibitor-based or ARB-based regimen. The National Kidney Foundation suggests that ACE inhibitors and ARBs may be used in combination to reduce proteinuria in patients with kidney disease; however, larger outcomes trials are needed.
Supratherapeutic Doses of Angiotensin Receptor Blockers to Decrease Proteinuria in Patients with Chronic Kidney Disease
Authors: Palmer Biff F.
Published: December 2007

An important endpoint in treating chronic kidney disease, a prevalent disease that can lead to kidney failure and cardiovascular disease, is reducing proteinuria. Proteinuria is an independent risk factor for disease progression and the development of cardiovascular disease and is a key factor that can be used to guide therapy designed to maximize kidney protection. Proteinuria is targeted by using pharmacologic agents that suppress the renin-angiotensin-aldosterone system (RAAS), a regulator of intravascular volume and blood pressure; this has been shown to decrease proteinuria, slow disease progression, and improve coronary disease outcome, independent of effects on blood pressure. The efficacy of RAAS blockers, including angiotensin receptor blockers and angiotensin-converting enzyme inhibitors, may be limited by currently recommended doses, which are based on treatment of hypertension. Data are now emerging from clinical trials demonstrating that use of ‘supratherapeutic doses’ (doses greater than those approved for lowering blood pressure), compared with standard doses, has favorable safety, tolerability, and efficacy in reducing proteinuria in both diabetic and nondiabetic patients with chronic kidney disease. Supratherapeutic dosing may be a valuable approach for optimizing RAAS blockade and providing renoprotection.
Uric Acid Excretion and Dopamine-Induced Glomerular Filtration Response in Patients with IgA Glomerulonephritis
Authors: Sulikowska Beata , Manitius Jacek , Odrowąż-Sypniewska Grażyna , Łysiak-Szydłowska Wiesława , Rutkowski Bolesław
Published: December 2007

Background/Aim: It is unknown to what extent uric acid (UA) may affect vessel function and participate in tubulointerstitial damage. We examined the relationship between intrarenal vessel function and serum UA and its excretion in association with urinary N-acetyl-β-D-glucosaminidase (NAG). Methods: In 50 IgA patients (mean age 34.7 ± 9.3 years) and 15 controls (mean age 33.5 ± 6.9 years) with a creatinine clearance of 99.4 ± 21.6 and 118.1 ± 17.2 ml/min, respectively, the renal vascular function was estimated based on the dopamine-induced glomerular filtration response (DIR; see text). The DIR was measured using two 120-min creatinine clearance values (before and after intravenous administration of 2 g/kg/min dopamine). Serum UA, triglycerides and cholesterol and urinary NAG (24 h) and protein and UA excretion were measured. Results: Patients with IgA nephropathy versus controls: DIR 8.80 ± 6.6 vs. 12.83% (p < 0.01), NAG 7.25 ± 3.30 vs. 4.69 ± 1.12 U/g creatinine (p < 0.01), and fractional UA excretion 7.80 ± 2.20 versus 6.29 ± 1.80% (p < 0.01). A negative correlation between DIR and NAG was found; regression analysis showed a more prominent relationship in the patients (NAG = 9.99 – 0.29x DIR) than in the controls (NAG = 5.50 – 0.06x DIR). UA and urate excretion and NAG in the patients correlated with DIR (r = –0.39, p < 0.02; r = –0.29, p < 0.04, and r = 0.59, p < 0.001, respectively). Multivariate analysis showed an association of DIR (R2 = 0.39) with NAG but not with proteinuria and UA and UA excretion; the NAG excretion (R2 = 0.56) correlated significantly with UA and DIR. Conclusion: It is suggested that UA plays a role, associated with tubular dysfunction, in the regulation of intrarenal vessel function.
A High Glycemic Meal Suppresses the Postprandial Leptin Response in Normal Healthy Adults
Authors: Barkoukis Hope , Marchetti Christine M. , Nolan Brian , Sistrun Sakita N. , Krishnan Raj K. , Kirwan John P.
Published: December 2007

Background/Aims: To evaluate the metabolic effects of meals with varying glycemic index (GI). Methods: We measured the glucose, insulin and leptin responses to two contrasting breakfast cereals in a group of 10 young healthy volunteers. Meals were provided on two separate occasions in random order after a 12-hour overnight fast, and consisted of 50 g of available carbohydrate from either Corn Flakes (Kellogg’s), or Fiber One® (General Mills). Blood samples were obtained at rest, and 30, 60, 90 and 120 min after eating. The GI was calculated from the glucose response to the test meal normalized against a 50 g oral glucose load. Results: The GI for Corn Flakes was 125 ± 17 units and 49 ± 8 units for Fiber One®. These meals were classified as high GI and low GI, respectively, and were significantly different from each other (p < 0.0003). The area under the insulin response curve (AUC) following the low glycemic meal was significantly attenuated compared to the high glycemic meal (14,064 ± 2,694 vs. 6,828 ± 1,182 pmol/l·min, p < 0.02). The leptin AUC revealed that circulating leptin was suppressed by the high glycemic meal compared to the low (3.1 ± 1.5 vs. 9.6 ± 3.6 ng/ml·min, p < 0.04). Conclusions: Lower insulin and higher leptin suggests that low glycemic meals promote a postprandial metabolic milieu that is favorable for reduced food consumption; this may be advantageous in the control of obesity and related disorders including insulin resistance and type 2 diabetes.
The Potential Role of Pemetrexed in Gastrointestinal Cancer
Authors: Meriggi F. , Di Biasi B. , Caliolo C. , Zaniboni A.
Published: December 2007

In 2004, the new-generation multitargeted antifolate pemetrexed was approved by the US Food and Drug Administration for the treatment of malignant pleural mesothelioma and as second-line monochemotherapy for advanced non-small cell lung cancer. However, pemetrexed as a single agent showed activity in preclinical and clinical studies, as well as in many other neoplasms such as gastrointestinal tumors, breast, head and neck, bladder and cervix cancer. Its tolerability profile is very favorable since the introduction of oral folic acid and vitamin B12 supplementation in December 1999, and therefore, the maximum tolerated dose as single agent is probably higher than the dose actually utilized in clinical practice. Gastrointestinal tumors are the most common malignancies in the world, accounting for more than 25% of all cancers. In phase II studies exploring this multitargeted antifolate in advanced gastrointestinal tumors, pemetrexed showed an interesting degree of clinical activity, encouraging further trials evaluating the synergism with other drugs such as oxaliplatin, irinotecan and gemcitabine.
Intranasal Mupirocin Prophylaxis in Elective Surgery
Authors: Trautmann M. , Stecher J. , Hemmer W. , Luz K. , Panknin H.T.
Published: December 2007

Background: Mupirocin is a natural antibiotic from Pseudomonas fluorescens which is available as a 2% ointment. The drug has been used mainly for topical treatment of the nasal vestibulum in patients carrying methicillin-resistant Staphylococcus aureus (MRSA). However, mupirocin is also active against methicillin-sensitive S. aureus. Nasal colonization with S. aureus has been identified as a significant risk factor for surgical site infection (SSI). Methods: Randomized trials and sequential cohort studies investigating mupirocin nasal treatment for prophylaxis of SSI in elective surgery in comparison with placebo or no treatment were found by Medline review and additional manual search. Evaluable studies were analyzed regarding the influence of mupirocin on the rate of all SSIs and, specifically, of SSIs due to S. aureus. The effect in cardiosurgical patients was analyzed in detail. Results: Four randomized and seven sequential open cohort studies were analyzed. Study design and mupirocin application schemes varied considerably. Three out of 5 studies carried out in cardiac surgery patients showed a significant reduction in sternotomy site infections. However, all three studies were open sequential cohort studies. By contrast, the only prospective, randomized, double-blind study in cardiosurgical patients showed no benefit of mupirocin. In other surgical disciplines, results were inconclusive or negative. Two studies specifically addressing the prevention of SSIs due to MRSA showed a significant effect of mupirocin on postsurgical infections due to this organism. Conclusions: Because of the heterogeneity of the studies and the variability of results, no recommendation can be given for the general use of mupirocin in elective surgical patients. Specifically, because of the negative result of a recently published high-quality study, no recommendation can be made for the use of mupirocin in cardiosurgical patients. By contrast, eradication of MRSA before surgery appears to lower SSI rates due to MRSA and is therefore recommended.
An Analysis of Therapeutic, Adult Antibiotic Prescriptions Issued by Dental Practitioners in Jordan
Authors: Dar-Odeh Najla Saeed , Abu-Hammad Osama Abdalla , Khraisat Ameen Sameh , El Maaytah Mohamed Ali , Shehabi Asem
Published: December 2007

Objective: The aim of this study was to determine the therapeutic adult antibiotics prescribed by dental practitioners working in the Jordan University Hospital. Methods: Adult dental prescriptions for therapeutic antibiotics issued between 1 January 2003 and 31 May 2004 by dental specialists working in the Jordan University Hospital were included in this study. Data included the name of the antibiotic as well as the dose, quantity and presentation of the drug. Descriptive statistical analysis was carried out. Results: Amoxycillin and metronidazole were the most commonly prescribed antibiotics, with 60% of the prescriptions containing amoxycillin and 39.4% containing metronidazole. 20.4% of the prescriptions were combination prescriptions containing metronidazole. In this study, long courses were observed for amoxycillin (60.5%), cephalosporins (21%) and metronidazole (59.7%). Conclusions: It seems that in the sample studied, Jordanian dental specialists have a tendency towards overprescribing antibiotics both in quantity and duration. This may constitute a problem particularly when considering the remaining sectors of less well-educated dental practitioners. The results will be used to increase awareness among dental practitioners in the field of antibiotic prescribing throughout the University of Jordan and the Jordanian Dental Association.