bluuebunny/crossref_metadata_2025 huggingface dataset:
A “case control” study on the rôle of HLA DR4 in severe periodontitis and rapidly progressive periodontitis
Authors: Bonfil J. J. , Dillier F. L. , Mercier P. , Reviron D. , Foti B. , Sambuc R. , Brodeur J. M. , Sedarat C.
Published: October 2003

Abstract. HLA DR4 antigens have been considered as a risk factor in periodontal disease. The aim of this “case control” study was to verify and to provide fuller clarification of such data. “Cases” or patients had to be aged between 20 and 48 years. They presented at least 5 sites spread over several teeth with an attachment loss equal or greater than 6 mm, and 10 sites spread over several teeth with periodontal pockets equal to or greater than 5 mm. Verification with a WHO probe showed an individual CPITN score of 4. Moreover, subjects whose average CPITN score for the 6 sextants was less than 3 were excluded from the study. Among these “severe periodontitis” patients, a subgroup was distinguished composed of subjects aged 20–35 years who presented, in accordance with the cases by Katz and co‐workers, 5 or more teeth showing pocket depths of 6 mm or more. The dental chartings of these subjects showed an attachment loss of more than 3 mm on certain teeth over an inter‐exam period of 1–3 years. They all displayed obvious loss of bony support in the affected sites. This constituted the “rapidly progressive periodontitis” subgroup. The “controls” were all over 20 years of age, and it was clinicically verified that they were free of periodontal disease. There were 48 “cases” and 55 “controls”. HLA typing of patients and controls was performed using “sequence oligoprobe hybridization after polymerase chain reaction” in accordance with the 11th International Workshop. This method allowed the detection of DR4 alleles as well as DR4 subtypes. The ethno‐geographic origin of the subjects, considered as a confounding variable, was neutralized by stratified analysis. Subtypes 0401, 0404, 0405 and 0408 tended to be more frequent (p=0.08) in the cases (Severe Periodontitis). Focusing on analysis of “rapidly progressive periodontitis” in subjects aged 20–35 years, a very significant Mantel‐Haenszel c2 was obtained (p=0.0058) which led to a Mantel‐Haenszel standardized odds ratio (OR) equal to 17. The 95% confidence interval was 1.03<0.R.<180.10. In conclusion, this supports previous reports and gives further clarification: in particular subtypes 0401, 0404, 0405 and 0408 considered as a risk factor for “rapidly progressive periodontitis”. It should be noted that these determinants have been implicated in rheumatoid arthritis.
Long‐term monitoring of adult periodontitis patients in supportive periodontal therapy: correlation of gingival crevicular fluid proteases with probing attachment loss
Authors: Bader H. I. , Boyd R. L.
Published: October 2003

Abstract. The aim of this retrospective study was to determine if a chairside assay for neutral protease activity in gingival crevicular fluid (GCF) could provide an early indication of site‐specific disease activity, as defined by probing attachment loss. Clinical measures and assay data were collected at 6‐month intervals over an average period of 26 months (range from 24 to 36 months). 38 subjects were selected from a pool of previously‐treated chronic adult periodontitis patients who were in periodontal maintenance at intervals of 3 to 6 months. GCF samples were collected from a total of 71 tooth sites exhibiting prior attachment loss, and analyzed for neutral protease activity (NPA). Positive BOP and positive NPA scores were classified as true positives if sites subsequently lost at least 1 mm of attachment over the next 12 months, as confirmed by linear regression analysis. As a predictor of breakdown, the NPA assay had an accuracy of 94% and a risk ratio of 37.6 as compared to values of 58% and 1.5 for BOP. When only the subset of sites ≥7 mm were considered, the NPA assay had a calculated accuracy of 92% versus a value of 50% for BOP. These results indicate that the assay appears to differentiate between bleeding at sites exhibiting only chronic inflammation with no attachment loss and bleeding at sites undergoing active attachment loss.
Etiologic models for incident periodontal attachment loss in older adults
Authors: Elter John R. , Beck James D. , Slade Gary D. , Offenbacher Steven
Published: October 2003

Abstract. Etiologic factors for incident periodontal attachment loss (ALOSS) have not been conclusively identified. The purpose of this study was to develop etiologic models for ALOSS in older adults. Data on 697 older blacks and whites were obtained from 5 sequential examinations over 7 years in the Piedmont 65+ dental study, a complex random sample of older adults in North Carolina. Multivariable Poisson regression models were fit for average number of ALOSS events per person or site month at risk. In models for whites, molar sites, sites with adjacent caries, sites in persons who had: Porphyromonas gingivalis (P.g.) at least 2% of total microbial count (TMC), never had a dental checkup, more depression symptoms, fewer than 12 years of education, higher BANA score, or smoked, had significantly higher rates of ALOSS. In a separate model for blacks, interproximal and molar sites, sites in blacks who had: P.g. at least 2% of TMC, higher BANA score, never had a dental checkup, lower socioeconomic status (SES), or smoked, had significantly higher rates of ALOSS. These results confirm a multifactorial etiology for ALOSS in older adults and indicate that interventions aimed at infection, smoking, and preventive dental care utilization, may be most useful.
Synthesis and absorption markers of cholesterol in serum and lipoproteins during a large dose of statin treatment
Authors: Miettinen T. A. , Gylling H.
Published: October 2003

Background  Serum contains noncholesterol sterols, which are reliable markers of cholesterol metabolism, but their presence and importance in different lipoproteins have been insufficiently studied.

Materials and methods  Serum and lipoprotein cholesterol precursors squalene, cholestenol, desmosterol and lathosterol (markers of cholesterol synthesis) and cholestanol and plant sterols (markers of cholesterol absorption), and absorption efficacy and absolute synthesis of cholesterol were studied at baseline and during 6‐month atorvastatin (80 mg day−1) treatment by the sterol balance technique in men with type 2 diabetes.

Results  At baseline, approximately 14% of serum squalene was transported by VLDL, 12% by IDL, 40% by LDL and 30% by HDL. The respective values for the noncholesterol sterols were approximately 8, 4, 61 and 26%. The squalene to cholesterol ratios were highest in VLDL and IDL, those of cholestenol, desmosterol and absorption marker sterols were gradually higher, and that of lathosterol lower from VLDL to HDL. Atorvastatin reduced LDL cholesterol by approximately 50%, decreased the absolute cholesterol synthesis and turnover by approximately 40%, but increased significantly the fractional and mass absorption of cholesterol. In accordance with the fecal data, the ratios of the precursor sterols to cholesterol were reduced (−50%), but those of squalene (+48%) and the absorption sterols increased (e.g. 2·6‐fold for sitosterol) similarly in each lipoprotein, but progressively from VLDL to HDL.

Conclusions  Effective lowering of LDL cholesterol by large dose of statin is associated with decreased synthesis and turnover of cholesterol and increased fractional and mass absorption of cholesterol. These changes are detectable by noncholesterol sterols in serum and in different lipoprotein fractions.
Inhibition of intracellular tumour necrosis factor (TNF)‐α and interleukin (IL)‐6 production in human monocytes by iloprost
Authors: Czeslick E. G. , Simm A. , Grond S. , Silber R.‐E. , Sablotzki A.
Published: October 2003

Background  To investigate the effects of iloprost as a stable prostacyclin analogue on intracellular expression of IL‐6 and TNF‐α of lipopolysaccharide (LPS)‐stimulated human monocytes in a whole blood system assessed by flow cytometry.

Material and methods  Whole blood of six healthy volunteers processed immediately after withdrawal and twice on different days (six measurements per experiment) was stimulated in two different settings with LPS (final concentrations 0·2 ng mL−1 and 10 ng mL−1) and incubated with iloprost (final concentrations in each experiment were 0·01 nm, 0·1 nm, 0·3 nm, 1 nm, 3 nm, 10 nm, 30 nm and 100 nm) for 3 h at 37 °C and 5% CO2. Intracellular expression of IL‐6 and TNF‐α was assessed by flow cytometry.

Results  Our investigations showed, for the first time, that iloprost (0·1 nm up to 100 nm) caused a dose‐dependent inhibitory effect of IL‐6 production in human monocytes stimulated with LPS (10 ng mL−1), which was even more obvious in monocytes stimulated with lower concentrated LPS (0·2 ng mL−1). Iloprost (0·1 nm up to 100 nm) was found to inhibit TNF‐α production of LPS‐stimulated monocytes in a dose‐dependent fashion not influenced by LPS concentration.

Conclusions  Apart from the vasodilatory and antithrombotic effects, iloprost may also down‐regulate the intracellular expression of IL‐6 and TNF‐α in human monocytes.
Prognostic value of interleukin‐6, plasma viscosity, fibrinogen, von Willebrand factor, tissue factor and vascular endothelial growth factor levels in congestive heart failure
Authors: Chin B. S. P. , Blann A. D. , Gibbs C. R. , Chung N. A. Y. , Conway D. G. , Lip G. Y. H.
Published: October 2003

Background  Congestive heart failure (CHF) carries a poor prognosis with a high mortality rate, frequent hospitalizations and increased risk of thrombotic complications such as stroke. Cytokines may contribute to the progression and prothrombotic state of CHF, including the pro‐inflammatory interleukin‐6 (IL‐6) and the pro‐angiogenic vascular endothelial growth factor (VEGF), both of which are raised in CHF. The procoagulant properties of both cytokines may be mediated via tissue factor (TF), a potent clotting activator. We hypothesized that plasma levels of these markers, as well as levels of plasma viscosity, fibrinogen, soluble P‐selectin and von Willebrand factor (markers of abnormal rheology, clotting, platelet activation, and endothelial damage, respectively) will be useful in predicting morbidity and mortality in chronic stable CHF.

Methods and results  One hundred and twenty consecutive out‐patients with chronic stable CHF (92 males; mean [SD] age 64 [11] years, mean [SD] left ventricular ejection fraction of 29 [6]%) were recruited and followed for 2 years during which 42 patients reached a clinical end‐point of all‐cause mortality and cardiovascular hospitalizations, including stroke and myocardial infarction. Plasma IL‐6 (P = 0·003) and TF (P = 0·013) levels, but not other research indices, were higher in those who suffered events compared with those without events. Predictors of end‐points were high (≥ median) TF (P = 0·011), and IL‐6 (P = 0·023) levels, as well as the lowest quartile of a left ventricular ejection fraction (P = 0·007). A strong correlation was present between TF and IL‐6 levels (r = 0·59; P < 0·0001) and with VEGF levels (r = 0·43; P < 0·0001).

Conclusion  IL‐6 and TF are predictors of poor prognosis in chronic CHF, raising the hypothesis that IL‐6 may contribute to the progression and thrombotic complications of CHF via its actions on TF expression. Although VEGF did not independently predict outcome in chronic CHF, the possibility arises that it may act with IL‐6 to induce TF expression.
Aortic stiffness and carotid intima‐media thickness: two independent markers of subclinical vascular damage in young adults?
Authors: Oren A. , Vos L. E. , Uiterwaal C. S. P. M. , Grobbee D. E. , Bots M. L.
Published: October 2003

Background  Previous reports have shown that carotid intima‐media thickness (CIMT) and arterial stiffness are strong predictors of subsequent cardiovascular disease (CVD) morbidity and mortality, and are well related to an unfavourable cardiovascular risk profile in middle‐aged and older subjects. These similarities suggest that arterial stiffness may play a role in the development of atherosclerosis or vice versa. However, studies show conflicting results and are limited to elderly subjects. To study this issue further, we evaluated the relation of arterial stiffness to subclinical atherosclerosis in 524 healthy young adults, aged 27–30 years.

Methods and Results  Aortic stiffness was assessed using pulse wave velocity (PWV) and CIMT was used as measure of subclinical atherosclerosis. The positive crude correlation between for mean arterial pressure adjusted PWV and CIMT (Pearson's correlation coefficient: 0·11; P = 0·016) attenuated after adjustment for common determinants of both measurements like gender and age (partial correlation coefficient: 0·03; P = 0·512). Furthermore, multivariate linear regression models showed that male gender, age and blood pressure were independent determinants of both CIMT and PWV while body mass index and LDL‐cholesterol were independent determinants of CIMT only.

Conclusions  These observations suggest that in healthy young adults arterial stiffness and CIMT reflect two separate entities of vascular damage.
Significant dominance of fibrinogen over immunoglobulins, C‐reactive protein, cholesterol and triglycerides in maintaining increased red blood cell adhesiveness/aggregation in the peripheral venous blood: a model in hypercholesterolaemic patients
Authors: Schechner V. , Shapira I. , Berliner S. , Comaneshter D. , Hershcovici T. , Orlin J. , Zeltser D. , Rozenblat M. , Lachmi K. , Hirsch M. , Beigel Y.
Published: October 2003

Background  It is not clear what is the relative importance of fibrinogen, immunoglobulins, highly sensitive C‐reactive protein (hs‐CRP), cholesterol and triglyceride concentrations on the appearance of aggregated red blood cells in the peripheral blood.

Design  Six hypercholesterolaemic patients undergoing regular LDL apheresis that were examined repeatedly before and following the procedure.

Results  We determined the degree of erythrocyte adhesiveness/aggregation in relation to the concentration of the above‐mentioned macromolecules in 80 samples. In a linear logistic regression the respective R2 values for fibrinogen, total cholesterol, triglycerides, hs‐CRP, IgG, IgM and IgA were 0·45 (P < 0·0001), 0·2 (P < 0·0001), 0·02 (P = 0·02), 0·001 (P = NS) and 0·002 (P = NS), respectively. We further analyzed the potential of ApoA, ApoB and Lpa to participate in red cell adhesiveness/aggregation and found them to be not significant.

Conclusions  In a milieu of adhesive macromolecules, lipids and inflammation‐sensitive proteins including fibrinogen, total cholesterol, triglycerides, hs‐CRP and immunoglobins G, M and A, fibrinogen has a dominant role in maintaining the red blood cell adhesiveness/aggregation in the peripheral venous blood. These findings are relevant for the research directed at finding new apheretic modalities to reduce the degree of red blood cell adhesiveness/aggregation in the peripheral blood.
Adventures in the origin of modern operative laparoscopy
Authors: Clarke H. Courtenay
Published: October 2003

Objective  Development of instruments and methods for surgery through small incisions, which allowed indigent patients to leave hospital early, in Port of Spain, Trinidad.

Methods  At the State University of New York at Buffalo, these methods and instruments were combined with laparoscopy to open this era of modern operative laparoscopy.

Interventions  Frenzy of marketing for the highest profit margin; useless and dangerous technology; ravishing of patents; surgeon adventurers for fame and fortune; clip, cut and burn surgery; complications, and laparoscopic surgery at the point of disrepute.

Results  Regulation; criteria; cost‐effectiveness; suturing and tying; training; fewer complications; application to most organs and cavities of the body, and acceptance of minimal access surgery.
Temporary ovarian suspension
Authors: Trehan A. K.
Published: October 2003

Background  Following the division of adhesions, ovarian cystectomys, and/or the excision or coagulation of endometriosis, pelvic pain may continue because of re‐formation of adhesions between the posterior surface of the ovary and the ovarian fossa. Various methods of adhesion prevention, such as the use of Interceed, Intergel or heparinized saline etc., have proved unsuccessful. Temporary ovarian suspension is a simple technique of suspending the ovary, for 5–7days, by attachment to the anterior abdominal wall. This allows separation of the raw area on the ovary and the ovarian fossa until surface epithelialization has occurred. When the suture is removed, the ovary falls back to its anatomical position.

Objective  To describe and discuss this simple technique of suspending the ovaries.

Intervention  The anterior abdominal wall is transilluminated with the laporoscope to demonstrate any major blood vessels, especially the inferior epigastric vessels. The junction of the lateral one‐quarter and the medial three‐quarters, approximately 1 inch above the inguinal ligament is the site on the anterior abdominal wall used for ovarian suspension. Non‐absorbable number 0 Prolene on a straight needle is used for suturing. The needle is pushed into the abdominal cavity at the abovementioned site; it picks up the ovary and comes out of the abdominal wall at the same site. The thread is tied on the anterior abdominal wall, with appropriate adjustment of the tension. The stitch is covered with a transparent dressing which is left in position until the day of removal of the stitch.
Transcervical resection of the endometrium and myometrium: a review of 111 patients after 6 years
Authors: Lupton Martin , Coltart T.
Published: October 2003

Objective  To determine the medium‐ to long‐term amenorrhoea rate and patient satisfaction following transcervical resection of both the endometrium and inner myometrium (TCREM).

Design  A prospective audit of 111 patients.

Subjects  111 patients referred with menorrhagia, and concomitant dysmenorrhoea in 74% of cases.

Setting  Queen Charlotte's and Chelsea Hospital for Women, London.

Methods  Data relating to patient history, operational details, subsequent bleeding and pain, satisfaction and complications, were obtained from a pro forma, case notes and an annual questionnaire with a menstrual calendar. The patients were followed up for six full years.

Results  103 women (93%) completed the audit. By the sixth year of follow up 78% of the women were satisfied with the result of their TCREM, 64% being amenorrhoeic.

Conclusion  Resection of both the endometrium and inner myometrium appears to offer an improved amenorrhoea rate compared with resection of the endometrium alone. Patient satisfaction is high and there was no apparent increase in morbidity. This applied to women with both menorrhagia and dysmenorrhoea.
Laparoscopic management of cystic adnexal masses
Authors: Mettler Liselotte , Schollmyer Thoralf , Doshi Praful , Lehmann‐Willenbrock Enrique , Hohn Andre , Moharram Ahmed E.
Published: October 2003

Objective  To analyse all laparoscopic treatment of cystic adnexal tumours in the period 1998–2000.

Design  Retrospective evaluation of surgical procedures (Canadian Task Force classification III).

Setting  University department of obstetrics and gynaecology.

Patients  427 patients with cystic adnexal masses.

Interventions  141 patients underwent an adnectomy/ovariectomy and 286 an ovariectomy, ovarian cyst enucleation or biopsy by operative laparoscopy.

Results  Laparoscopic treatment was possible in 97% of patients with adnexal masses. In 10 patients (2.3%) a conversion to laparotomy was necessary.

Conclusions  After careful evaluation, most cases of adnexal mass can be managed laparoscopically. The risk of missing a malignancy is very low. Proper attention to techniques and training reduces complications and the risk of spillage.
Laparoscopy or laparotomy in the management of benign adnexal cysts in premenopausal women
Authors: Badawy A. M. , Allakkany N. S. , El‐Gohary A. S. , Youssef H. M. , Nazar M.
Published: October 2003

Objective  To compare the outcome of laparoscopy and laparotomy in the management, in premenopausal women, of adnexal cysts which were not suspected to be malignant.

Patients and methods  In a prospective study, 98 premenopausal patients requiring surgical management for adnexal cystic swellings were assigned to receive laparoscopy (n = 48), or laparotomy (n = 50), at Mansoura University Hospital between April 1997 and July 2001. Inclusion criteria were the presence of adnexal cysts, not suspected to be malignant, with a maximum diameter ≤15 cm by ultrasonography, in non‐pregnant women, aged ≤40 years. Statistical analysis included the t test and the χ2 test.

Results  There were no differences in patient characteristics between the two groups including the size of adnexal cysts, adnexal adhesion score or the frequency of bilateral disease. All the cysts were benign. Endometriotic cyst, dermoid cyst and ovarian cystademoma were the most common disorders in the two groups. Cystectomy was performed in the majority of cases (87.5% of laparoscopies and 70% of laparotomies). The laparoscopic approach was associated with significantly less operative morbidity and postoperative analgesic requirement, and shorter hospital stay and recovery period. The percentage of patients who achieved pregnancy was higher after laparoscopy than after laparotomy. There was no adverse effect caused by the spillage of cyst contents during laparoscopic open cystectomy.

Conclusions  Operative laparoscopy could replace laparotomy in the management of premenopausal adnexal cysts which are not suspected to be malignant.
Postmenopausal bleeding: management by transvaginal ultrasound scan or outpatient hysteroscopy?
Authors: Böttcher Bettina , Brown Valerie A.
Published: October 2003

Objective  The aim of this study was to determine whether transvaginal ultrasound scan or outpatient hysteroscopy represents a more efficient way to investigate postmenopausal bleeding.

Design  This was a retrospective study by case note review of women with postmenopausal bleeding (PMB), investigated in clinic A by transvaginal ultrasound scan (TVS) and endometrial biopsy, and in clinic B by outpatient hysteroscopy, between April and October 2000. Women on hormone replacement therapy were excluded.

Setting  Two teaching hospital gynaecological units in one city.

Results  During the study period 166 women were referred to the clinics; case notes for 10 patients were missing; 84 patients underwent TVS, and 72 outpatient hysteroscopy. The number of visits was significantly lower in the hysteroscopy group, with 13.8% of women making two or more visits compared with 44% in the TVS group (P = 0.01). Of the women investigated by hysteroscopy, 72.2% were discharged after the first visit compared with 61.9% in the TVS group (P ≤ 0.01). Therefore the time from first visit to clinic to clinical diagnosis was significantly shorter after hysteroscopy, with a mean of 2.3 days compared with 8.8 days in the TVS group (P ≤ 0.01). Fewer investigations were required in the hysteroscopy group, with seven women (9.7%) needing more than two investigations compared with 24 (28.6%) in the TVS group. TVS identified other pelvic pathology in five women (6%).

Conclusions  Hysteroscopy appears more efficient than TVS for the investigation of postmenopausal bleeding. This results in fewer clinic visits and investigations, a reduction in waiting time for patients and possibly less wasting of resources.
Experience in office mini‐hysteroscopy
Authors: Sadik Salih , Önoğlu Ahmet S. , İnal M. Murat , Güler Ahmet , Arici Azra , İspahi Çiğdem
Published: October 2003

Objective  To evaluate the usefulness of and necessity for diagnostic office mini‐hysteroscopy, and to review its indications and results with regard to patients who were admitted to the gynaecology and infertility outpatient clinics of the SSK Aegean Maternity and Women's Health Teaching Hospital.

Study design  A retrospective review was carried out of 344 women admitted with various gynaecological and reproductive complaints, who underwent office mini‐hysteroscopy.

Results  A mini‐hysteroscope with an operating channel of outer diameter (OD) 4 mm was used successfully in 344 patients, to evaluate abnormal and postmenopausal bleeding, endometrial thickness, intrauterine device dislocation, secondary amenorrhoea, severe dysmenorrhoea, infertility, tubal integrity and endometrial biopsy. In 219 patients (63.7%), the procedure was carried out without local anaesthesia and in 131 patients (38%) without cervical dilation. Local anaesthesia was used in 124 patients (36%) and only one patient (0.2%) had general anaesthesia. When indicated, endometrial biopsies were performed without any complication or difficulty. In 62.5% of patients intrauterine pathology was identified and 28% required further operative procedures.

Conclusion  Mini‐hysteroscopy can be used in office conditions for more than 60% of women without the requirement for general or local anaesthesia. The experience of the operator is the most important factor in correct evaluation of the endometrium and for thus reducing the failure rate of endometrial biopsy. Office mini‐hysteroscopy is a safe, fast and effective method of intrauterine evaluation, allowing the operator to take direct biopsies from suspected focal lesions and thus giving the opportunity of curing some intrauterine pathologies during the same session. It is very effective in clarification of indefinite results obtained from ultrasonography, magnetic resonance imaging, blind biopsy and hysterosalpingography.
Feasibility of laparoscopic abdominal cerclage in the second trimester
Authors: Darwish Atef M. , Hassan Zein Z.
Published: October 2003

Objective  To describe a simplified laparoscopic approach to cervical cerclage in the early second trimester.

Design  A case study.

Setting  Gynaecological Endoscopy Unit, Assiut University Hospital, Assiut, Egypt.

Subject  A 31‐year‐old‐patient, para 5, gravida 11, with a history of eight cervical cerclage operations performed using Shirodkar and McDonald techniques.

Interventions  A laparoscopic abdominal cerclage procedure was carried out by fixation of a Mersilene tape into the cervical isthmus at the 12 o’clock position. The stitch was advanced at each side and passed underneath the round ligament after freeing of the bladder. The stitch was tightened posteriorly after appropriate visualization using a fan‐shaped retractor.

Main outcome measures  Continuation of the pregnancy after 36 weeks.

Results  The patient delivered a healthy 3150‐g female baby at 37 weeks by repeat Caesarean section and the stitch was left in place.

Conclusions  Laparoscopic abdominal cerclage in the early second trimester is technically feasible without deleterious effects on the mother or the fetus. Randomized studies are required to compare the cost‐effectiveness, fetal and maternal safety, feasibility and success of laparoscopic vs. open abdominal cerclage.
The uterine and tubal effects of laparoscopy in intra‐abdominal infection: a rat model
Authors: Ergin Tolga , Tarim Ebru , Zeyneloglu Hulusi B. , Ergin Funda , Kuscu Esra , Haberal Ali
Published: October 2003

Objective  To assess the severity of uterine and tubal infection and bacteraemia incidence in CO2 pneumoperitoneum vs. laparotomy, in a rat model of intra‐abdominal infection.

Design  Experimental study.

Setting  Experimental research laboratory at Başkent University.

Subjects  A total of 30 Wistar albino rats.

Interventions  Rats were given an intraperitoneal injection of 108 colony‐forming units of Escherichia coli and underwent laparotomy (n = 10), laparoscopy (n = 10) or no further manipulation (control group, n= 10) At 60 min after bacterial injection, a blood sample was collected from each rat, and the fallopian tubes and uterine horns were removed bilaterally. Each blood sample was cultured, and quantitative bacterial cultures were done for each organ.

Main outcome measurements  Bacterial counts in uterine horns, fallopian tubes and blood.

Results  The mean bacterial counts in the uterine and fallopian tissues from the laparoscopy group were higher than the counts in the laparotomy group, but this difference was not statistically significant. None of the uterine horns or fallopian tubes from the control animals showed bacterial growth. There was no statistically significant difference in bacteraemia incidence among the control, laparotomy and laparoscopy groups at 60 min after bacterial inoculation.

Conclusions  Uterine/tubal infection rates and bacteraemia incidence were similar in the laparoscopy and laparotomy groups. The exact mechanism is still unclear, but this finding indicates that, under both these conditions, bacterial biology is modified by mechanical bacterial clearance, peritoneal immunity, elevated intra‐abdominal pressure, CO2 atmosphere and exposure of the peritoneum to air. In addition to many advantages, laparoscopic surgery causes no more deleterious effects than laparotomy in cases of intra‐abdominal infection.
Fallopian tube detorsion in near‐term pregnancy: a laparoscopic approach
Authors: Romano Shabtai , Bustan Moshe , Shalev Eliezer
Published: October 2003

Objective  Torsion of the fallopian tube during pregnancy is infrequent and difficult to diagnose. Prompt diagnosis and treatment can avoid not only permanent damage to the tube but also obstetric complications. We report on a laparoscopic technique for the treatment of fallopian tube torsion in the third trimester of pregnancy.

Conclusion  Open laparoscopy, with lateral tilting of the patient can be considered as an additional method for treatment of twisted fallopian tube or adnexa up until near‐term pregnancy.
Missed ovarian pregnancy in early laparoscopic management
Authors: Wu Chun‐Hsing , Wang Chin‐Jung , Yen Chih‐Feng , Lee Chyi‐Long , Hsu Jenn‐Jeih
Published: October 2003

Objective  To report a case of repeat hemoperitoneum which was later proved to be a missed ovarian pregnancy in early laparoscopic management.

Design  Case report.

Setting  University hospital.

Subject and intervention  A 31‐year‐old women who presented with haemoperitoneum was thought to have an ectopic pregnancy, but no substantial lesion was found at early laparoscopy. Haemoperitoneum recurred 10 days later, and repeat laparosopy revealed a ruptured ovarian pseudogestational sac at a site previously thought to be a corpus luteum.

Main Outcome  Measure intraoperative transvagianl doppler ultrasonography confirmed the presence of pseudogestational sac. Postoperative histopathology proved the diagnosis of ovarian pregnancy.

Result and Conclusion  The lesson learned from this case was the need to remove all suspicious ovarian masses, including the corpus luteum cysts, in early laparoscopic management in patients with otherwise ‘negative’ findings, in order to avoid missing an ovarian pregnancy.
Hysteroscopic myomectomy using the Versapoint system in a normal saline field: report of 94 cases
Authors: Shi Yong Peng , Xie Hui Liang , Feng Zuan Chong , Wang Yu Bao
Published: October 2003

Objectives  To document clinical and surgical experience in a large series of hysteroscopic myomectomies performed using the Versapoint system in a normal saline field, and to determine the outcomes with regard to excessive uterine bleeding.

Design  Prospective clinical study.

Setting  Jiading Hospital for Maternal and Infant Health, Shanghai, China.

Subjects  94 women, mainly with a complaint of heavy bleeding, who underwent hysteroscopic resection of submucous myomas.

Result  All the scheduled procedures were completed using the new device. No complications occurred. The mean operating time was 26.12 ± 12.40 min. The mean amount of distension fluid used was 2511.90 ± 2145.65 ml. The time in the operating room and the amount of distension fluid used were related to fibroid size. After a mean follow‐up of 16.60 ± 10.29 months, there was recurrence of myoma in four women. The effectiveness rate was 93.94% at 24 months after operation.

Conclusion  The Versapoint system is safe, effective and easy to use for removal of fibroids whose greatest diameter is within the uterine cavity and which are of size less than or equal to 3 cm.
MHC‐dependent and ‐independent modulation of endogenous Ly49 receptors on NK1.1+ T lymphocytes directed by T‐cell receptor type
Authors: Sköld Markus , Stenström Martin , Sidobre Stephane , Höglund Petter , Kronenberg Mitchell , Cardell Susanna
Published: October 2003

Natural killer (NK) T lymphocytes are thought to act as regulatory cells directing early events during immune responses. Murine NKT cells express inhibitory receptors of the Ly49 family. These receptors have a well‐established and crucial role in modulating NK cell activities, but their physiological role in regulating NKT cells is not well understood, nor is the influence of major histocompatibility (MHC) ligands on endogenous Ly49 expression. We have further investigated how the expression of inhibitory NK receptors is regulated on NKT cells, and demonstrate a non‐random expression of ligated Ly49 molecules on CD1d‐restricted NKT cells. The nature of the T‐cell receptor on the NKT cell crucially determines the profile of expressed Ly49 isoforms. Further, we show that MHC class I ligands efficiently modulate the expression levels of the inhibitory receptors, and the frequencies of cells positive for the Ly49 members. In addition, we find a several‐fold increase in Ly49C/I‐expressing NKT cells in adult thymus, apparently independent of MHC class I molecules. Abundant expression of Ly49 receptors on NKT cells, and the striking differences found in Ly49 isoform patterns on NKT‐cell subsets differing in T‐cell receptor expression, suggest that the pattern of Ly49 expression is tuned to fit the T‐cell receptor and to emphasize further a role for these receptors in NKT immunity.
Glycosylation of FcγRIII in N163 as mechanism of regulating receptor affinity
Authors: Drescher Bettina , Witte Torsten , Schmidt Reinhold E.
Published: October 2003

Human FcγRIII (CD16) is a low‐affinity receptor for immunoglobulin G (IgG). There are two different isoforms of this protein: CD16a (transmembranous, expressed on natural killer cells and on macrophages) and CD16b (glycosylphosphatidylinositol‐linked, expressed on neutrophilic granulocytes in two allelic forms NA1 and NA2). Both forms of the protein have a variable glycosylation pattern. The NA1 allele of CD16B has four asparagine (N)‐linked glycosylation sites. One of them (N163) is localized in the ligand‐binding site of domain II. This site is shared by the NA2 allele and CD16A. To examine the functional role of the glycosylation we mutated the four glycosylation sites of the NA1 allele (N39, N75, N163, N170) into glutamine (Q). HEK293 cells were stably transfected with the single mutants and wild‐type CD16 as control. We determined binding of human IgG to transfected cells using immunofluorescence studies with anti‐human IgG antibody. Monomeric IgG bound to N163Q transfectants with higher affinity than to other transfectants, showing that glycosylation in N163 influences the affinity of CD16 to its ligand. In addition, preincubation of WT‐CD16‐transfected cells with Tunicamycin (an inhibitor of N‐glycosylation) resulted in an increased binding of monomeric IgG whereas N163Q‐CD16‐transfected cells remained unaffected. Therefore, glycosylation in N163 is a mechanism of regulating affinity of FcγRIII to its ligand IgG.
Role of early‐ or late‐phase activation of p38 mitogen‐activated protein kinase induced by tumour necrosis factor‐α or 2,4‐dinitrochlorobenzene during maturation of murine dendritic cells
Authors: Iijima Norifumi , Yanagawa Yoshiki , Onoé Kazunori
Published: October 2003

Dendritic cells (DCs) are maturated by a variety of stimuli. However, the precise mechanisms underlying the maturation of DCs are not fully understood. In the present study, we analysed the effects of tumour necrosis factor‐α (TNF‐α) and 2,4‐dinitrochlorobenzene (DNCB) on phenotypic maturation and p38 mitogen activated protein kinase (MAPK) activity, using a murine DC line. TNF‐α markedly increased the surface expression of major histocompatibility complex (MHC) and costimulatory molecules, CD86 and CD80, on DCs. DNCB more markedly enhanced the surface expression of costimulatory molecules, but showed less stimulatory capability on MHC molecules, compared with TNF‐α. Simultaneous treatment of DCs with TNF‐α and DNCB showed additive enhancement of costimulatory molecule expression. TNF‐α activated p38 MAPK in DCs only at an early time‐point (15 min). In contrast, DNCB activated p38 MAPK at later time‐points (3–6 hr). SB203580, a specific inhibitor of p38 MAPK, partially or markedly inhibited the phenotypic changes of DCs induced by TNF‐α or DNCB, respectively. In addition, N‐acetyl‐l‐cysteine, a reducing supplier, completely inhibited the DNCB‐induced expression of MHC and costimulatory molecules, but not those induced by TNF‐α. These findings demonstrate that TNF‐α and DNCB activate the p38 MAPK pathway at an early and a late phase, respectively, and thereby induce DC maturation through different signal pathways.
Selective regulation of intercellular adhesion molecule‐1 expression by interleukin‐18 and interleukin‐12 on human monocytes
Authors: Stuyt Rogier J. L. , Netea Mihai G. , Geijtenbeek Teunis B. H. , Kullberg Bart Jan , Dinarello Charles A. , Van Der Meer Jos W. M.
Published: October 2003

Induction of expression of adhesion molecules is a crucial step in inflammation. The role of interleukin‐18 (IL‐18) in induction of various adhesion molecules was investigated in freshly isolated peripheral blood mononuclear cells and human monocyte and T‐cell lines. IL‐18 selectively up‐regulated intercellular adhesion molecule‐1 (ICAM‐1) expression on freshly isolated human monocytes, but not on lymphocytes. The expression of other adhesion molecules was not influenced. Induction of ICAM‐1 by IL‐18 was dependent on endogenous tumour necrosis factor‐α (TNF‐α), and IL‐12 had an additive effect on that of IL‐18. No changes in adhesion molecule expression were observed on the monocytic cell line THP‐1 and on the T‐cell lines HSB‐2 and Jurkat J16. In addition, induction of ICAM‐1 on monocytes by lipopolysaccharide was slightly, but significantly, inhibited by blockade of either endogenous IL‐18 or TNF‐α with IL‐18 binding protein or TNF binding protein, respectively. Blocking IL‐1 effects with IL‐1 receptor antagonist did not influence ICAM‐1 levels. In conclusion, IL‐18 selectively up‐regulates the expression of ICAM‐1 on monocytes, and this contributes to the proinflammatory effects of this cytokine.
Dihomo‐γ‐linolenic acid inhibits tumour necrosis factor‐α production by human leucocytes independently of cyclooxygenase activity
Authors: Dooper Maaike M. B. W. , Van Riel Boet , Graus Yvo M. F. , M'Rabet Laura
Published: October 2003

Dietary oils (such as borage oil), which are rich in γ‐linolenic acid (GLA), have been shown to be beneficial under inflammatory conditions. Dihomo‐GLA (DGLA) is synthesized directly from GLA and forms a substrate for cyclooxygenase (COX) enzymes, resulting in the synthesis of lipid mediators (eicosanoids). In the present study, the immunomodulatory effects of DGLA were investigated and compared with those of other relevant fatty acids. Freshly isolated human peripheral blood mononuclear cells (PBMC) were cultured in fatty acid (100 µm)‐enriched medium for 48 hr. Subsequently, cells were stimulated with lipopolysaccharide (LPS) for 20 hr and the cytokine levels were measured, in supernatants, by enzyme‐linked immunosorbent assay (ELISA). Phospholipids were analysed by gas chromatography. Fatty acids were readily taken up, metabolized and incorporated into cellular phospholipids. Compared with the other fatty acids tested, DGLA exerted pronounced modulatory effects on cytokine production. Tumour necrosis factor‐α (TNF‐α) and interleukin (IL)‐10 levels were reduced to 60% of control levels, whereas IL‐6 levels were not affected by DGLA. Kinetic studies showed that peak levels of TNF‐α, occurring early after LPS addition, were inhibited strongly, whereas IL‐10 levels were not affected until 15 hr after stimulation. Both the reduction of cytokine levels and the decrease in arachidonic acid levels in these cells, induced by DGLA, were dose dependent, suggesting a shift in eicosanoid‐subtype synthesis. However, although some DGLA‐derived eicosanoids similarly reduced TNF‐α levels, the effects of DGLA were probably not mediated by COX products, as the addition of indomethacin did not alter the effects of DGLA. In conclusion, these results suggest that DGLA affects cytokine production by human PBMC independently of COX activation.
Allergen‐specific immunosuppression by mucosal treatment with recombinant Ves v 5, a major allergen of Vespula vulgaris venom, in a murine model of wasp venom allergy
Authors: Winkler Birgit , Bolwig Caroline , Seppälä Ulla , Spangfort Michael D. , Ebner Christof , Wiedermann Ursula
Published: October 2003

Up to 5% of the population suffer from systemic, 19% from local allergic hypersensitivity reactions to stinging insects. Even though specific immunotherapy is very effective in treating allergy to insect venom, new concepts of treatment strategies with only the disease eliciting allergen in recombinant form, along with antigen application via a less invasive route might be suggested for enhanced treatment efficacy and compliance. In the present study we aimed (i) to establish a mouse model of wasp venom allergy, mimicking the natural mode of sensitization, and (ii) to develop a prophylactic treatment strategy based on mucosal tolerance induction, using one major wasp venom allergen in recombinant form, i.e. recombinant (r)Ves v 5. Immunization with wasp venom – with or without the use of the adjuvant aluminium hydroxide – led to comparable T helper 2‐like immune responses in vivo and in vitro. Intranasal administration of rVes v 5 prior to sensitization with wasp venom resulted in a significant reduction of wasp venom‐specific antibody levels (immunoglobulin E (IgE)/IgG2a), type I hypersensitivity reactions in vivo and cytokine production in vitro. Pretreatment with the whole venom was less effective and caused toxic side reactions in higher concentrations, suggesting a favourable use of the recombinant venom allergen for mucosal application. Increased mRNA levels of transforming growth factor‐β and interleukin‐10, along with adoptive cell transfer experiments indicated that the immunosuppression after intranasal rVes v 5‐application has been mediated by regulatory mechanisms. This is further supported by the fact that the immunosuppression to rVes v 5 was associated with a bystander suppression to the unrelated aero‐allergen Bet v 1. In conclusion, we demonstrated that the intranasal application of recombinant Ves v 5 prevented subsequent allergic sensitization to all components of the whole wasp venom. As allergy to insect venom develops in dependence of the frequency of insect stings, a prophylactic treatment based on mucosal tolerance induction with recombinant allergens might be of interest for people at high risk to frequent exposure to the stinging insects.
Leptin receptor‐mediated regulation of cholinergic neurotransmitter phenotype in cells of central nervous system origin
Authors: Di Marco Annalise , Demartis Anna , Gloaguen Isabelle , Lazzaro Domenico , Delmastro Paola , Ciliberto Gennaro , Laufer Ralph
Published: October 2003

Leptin is an adipocyte‐secreted hormone that regulates body weight and exerts effects on hematopoiesis, reproduction, and immunity. The leptin receptor (OBR) shares sequence similarity and signaling capabilities with receptors for cytokines of the ciliary neurotrophic factor (CNTF) family. Our previous finding that CNTF and leptin exert similar anti‐obesity effects and activate common neuronal signaling pathways, prompted us to investigate whether leptin may share with CNTF the ability to regulate the expression of specific neuronal genes. To this end, we established a cell line, derived from the murine septal cholinergic neuronal cell line SN‐56, which stably expresses OBR. In this cell line, termed SN‐56/OBR, leptin induces STAT transcription factor activation and STAT‐dependent reporter gene expression in a manner similar to that of CNTF. Furthermore, in SN‐56/OBR cells both CNTF and leptin produce changes in neurotransmitter and neuropeptide phenotype characteristic of cholinergic neurons, such as an increase in choline acetyltransferase and vasoactive intestinal polypeptide, and a decrease in neuropeptide Y expression. SN‐56/OBR cells thus constitute an interesting new model system to investigate leptin action in cells of central nervous system origin. Possible physiological implications of OBR's intrinsic ability to regulate cholinergic phenotypic markers are discussed.
Polypeptide binding properties of the chaperone calreticulin
Authors: Jørgensen Charlotte S. , Heegaard Niels H. H. , Holm Arne , Højrup Peter , Houen Gunnar
Published: October 2003

Calreticulin is a highly conserved eukaryotic ubiquitious protein located mainly in the endoplasmic reticulum. Two major characteristics of calreticulin are its chaperone activity and its lectin properties, but its precise function in intracellular protein and peptide processing remains to be elucidated. We have investigated the interactions of human calreticulin with denatured ovalbumin, proteolytic digests of ovalbumin, and different available peptides by solid phase assays, size‐exclusion chromatography, capillary electrophoresis, and MS. The results show that calreticulin interacts better with unfolded ovalbumin than with native ovalbumin, that calreticulin strongly binds components in proteolytic digests of denatured ovalbumin, and that calreticulin interacts strongly with certain synthetic peptides.
Oxidized galectin‐1 promotes axonal regeneration in peripheral nerves but does not possess lectin properties
Authors: Inagaki Yoshimasa , Sohma Yoshiaki , Horie Hidenori , Nozawa Risa , Kadoya Toshihiko
Published: October 2003

Galectin‐1 has recently been identified as a factor that regulates initial axonal growth in peripheral nerves after axotomy. Although galectin‐1 is a well‐known β‐galactoside‐binding lectin, its potential to promote axonal regeneration as a lectin has not been reported. It is essential that the process of initial repair in peripheral nerves after axotomy is well clarified. We therefore undertook to investigate the relation between the structure and axonal regeneration‐promoting activity of galectin‐1. Recombinant human galectin‐1 secreted into the culture supernatant of transfected COS1 cells (rhGAL‐1/COS1) was purified under nonreducing conditions and subjected to structural analysis. Mass spectrometric analysis of peptide fragments from rhGAL‐1/COS1 revealed that the secreted protein exists as an oxidized form containing three intramolecular disulfide bonds (Cys2–Cys130, Cys16–Cys88 and Cys42–Cys60). Recombinant human galectin‐1 (rhGAL‐1) and a galectin‐1 mutant in which all six cysteine residues were replaced by serine (CSGAL‐1) were expressed in and purified from Escherichia coli for further analysis; the purified rhGAL‐1 was subjected to oxidation, which induced the same pattern of disulfide linkages as that observed in rhGAL‐1/COS1. Oxidized rhGAL‐1 enhanced axonal regeneration from the transected nerve sites of adult rat dorsal root ganglion explants with associated nerve stumps (5.0–5000 pg·mL−1), but it lacked lectin activity. In contrast, CSGAL‐1 induced hemagglutination of rabbit erythrocytes but lacked axonal regeneration‐promoting activity. These results indicate that galectin‐1 promotes axonal regeneration only in the oxidized form containing three intramolecular disulfide bonds, not in the reduced form which exhibits lectin activity.