bluuebunny/crossref_metadata_2025 huggingface dataset:
Modification of adherence to plastic and to human buccal cells of Candida albicans and Candida dubliniensis by a subinhibitory concentration of itraconazole
Authors: Blanco M. T. , Morales J. J. , Lucio L. , Pérez‐Giraldo C. , Hurtado C. , Gómez‐García A. C.
Published: September 2010

Exposure to subinhibitory concentrations of antifungal agents can influence the adherence of Candida spp. to the host cell. In this study the adherence of Candida albicans ATCC 10231 and Candida dubliniensis CECT 11455 to plastic and to human buccal epithelial cells was evaluated following pre‐exposure to 0.5 × minimum inhibitory capacity (MIC) of itraconazole and compared with the corresponding cellular surface hydrophobicity. The yeasts were grown in Sabouraud broth or RPMI‐1640 with itraconazole (0.5 × MIC) for 24–26 h at 37°C and the drug was then removed. The adhesion capacity to plastic was studied by turbidimetry in a polystyrene microtiter plate. The adhesion of the yeast to buccal epithelial cells was determined using microscopy techniques. The cellular surface hydrophobicity levels were determined by the microbial adhesion hydrocarbons test. Pre‐exposure to itraconazole decreased plastic adherence and cellular surface hydrophobicity in both species when grown in RPMI. When C. albicans was grown in Sabouraud broth, it was nonhydrophobic and did not adhere and therefore no change was detected with the antibiotic. Itraconazole increased adherence to buccal epithelial cells in both species and media studied, as compared to controls without antifungal agents. To study the effects of these antifungal agents on pathogenicity mechanisms, it will be necessary to standardize the methodology for evaluation to determine their in vivo therapeutic efficacy.
Relationship between Campylobacter rectus and periodontal status during pregnancy
Authors: Yokoyama M. , Hinode D. , Yoshioka M. , Fukui M. , Tanabe S. , Grenier D. , Ito H.‐O.
Published: September 2010

Introduction:  In a previous study, we showed that the growth of Campylobacter rectus is stimulated by the presence of female sex hormones in the culture medium. In the present study, we examined the relationship between C. rectus levels in the saliva and the periodontal status of pregnant women.

Methods:  Unstimulated whole saliva was collected from 22 pregnant and 15 non‐pregnant women. Periodontal pocket depth (PD) and bleeding on probing (BOP) were recorded. A quantitative real‐time polymerase chain reaction was performed to determine the concentrations of suspected periodontopathogenic bacteria in the saliva samples. In addition, the concentration of estradiol in the saliva samples was measured by enzyme immunoassay.

Results:  The average age, number of teeth, and total number of bacteria in the saliva of subjects in both groups were similar. The percentage of sites with a PD = 4 mm and the salivary estradiol concentrations were significantly higher in pregnant women than in non‐pregnant women. In addition, the percentage of BOP sites and the C. rectus levels in the saliva of the pregnant women tended to be higher than in non‐pregnant women, although these differences were not statistically significant. There were positive correlations between C. rectus levels and estradiol concentrations, and between C. rectus levels and the percentage of sites with PD = 4 mm in the pregnant women.

Conclusion:  These results indicate that C. rectus levels are higher in the oral flora of pregnant women and that this may be associated with increased salivary estradiol concentrations. This may contribute to periodontal disease progression during pregnancy.
LuxS and expression of virulence factors in Streptococcus intermedius
Authors: Pecharki D. , Petersen F. C. , Scheie A. Aa.
Published: September 2010

Background/aims:  Autoinducer‐2 (AI‐2) is used by several bacteria in quorum‐sensing signaling and is a product of LuxS. The aim was to investigate the effect of LuxS mutation on expression of Streptococcus intermedius virulence factors.

Methods:  S. intermedius mutants were constructed by insertion inactivation or gene deletion. Real time RT‐PCR was used to assess transcription of pas, ily and hyl. Hyaluronidase and intermedilysin activities were measured biochemically.

Results:  The results indicated that disruption of luxS in S. intermedius may affect hyaluronidase and intermedilysin gene expressions. No difference in antigen I/II expression was observed. Biochemical methods showed a five‐fold decrease in hemolytic activity of the luxS mutant; however, secreted hyaluronidase activity was unaffected. The AI‐2 precursor 4,5‐dihydroxy‐2,3‐pentanedione complemented lack of AI‐2 production by the mutant thus restoring hemolytic activity.

Conclusions:  We suggest that AI‐2 communication is involved in intermedilysin expression.
Evaluation of the humoral immune response to the cytolethal distending toxin of Aggregatibacter actinomycetemcomitans Y4 in subjects with localized aggressive periodontitis
Authors: Xynogala I. , Volgina A. , DiRienzo J. M. , Korostoff J.
Published: September 2010

Introduction:  Cytolethal distending toxin (Cdt) is potentially one of several virulence factors of Aggregatibacter actinomycetemcomitans, the prime etiological agent of localized aggressive periodontitis (LAP). Little is known regarding the Cdt‐specific antibody response in humans. The current study is a quantitative and qualitative evaluation of the toxin‐specific antibody response in a cohort of LAP patients and age‐, race‐ and sex‐matched controls.

Methods:  Ninety‐five subjects provided a total of 692 serum samples. Sera were analysed by enzyme‐linked immunosorbent assays to determine the titers of antibody against the intact Cdt holotoxin as well as the individual subunit proteins (CdtA, CdtB, and CdtC). Neutralization of growth inhibition mediated by Cdt was evaluated in a modified colony‐forming assay using Chinese hamster ovary cells.

Results:  Fourteen of the 95 subjects exhibited significant serum Cdt‐binding activity. There were no differences in the percentages of seropositive individuals or in the mean antibody titers between the control and LAP groups. Binding activity was detected against each of the three Cdt subunit proteins in all of the positive samples. Neutralization of Cdt‐mediated growth inhibition was detected in samples from all of the seropositive subjects (range 20–75%).

Conclusions:  Cdt, a recently identified A. actinomycetemcomitans virulence factor, is capable of inducing a neutralizing antibody response indicating that the toxin is produced during natural infection of humans. The failure of a vast majority (20 of 23) of the LAP subjects to mount a significant anti‐Cdt response may in part explain their relative susceptibility to the disease.
Relationship of neutrophil phagocytosis and oxidative burst with the subgingival microbiota of generalized aggressive periodontitis
Authors: Carvalho R. P. M. , Mesquita J. S. , Bonomo A. , Elsas P. X. , Colombo A. P. V.
Published: September 2010

Introduction:  Polymorphonuclear neutrophil (PMN) dysfunctions have been associated with severe forms of periodontitis. This study evaluated the correlation between PMN phagocytosis and oxidative burst with the subgingival microbiota of patients with generalized aggressive periodontitis (GAgP).

Methods:  Heparinized peripheral blood samples were obtained from 18 GAgP patients and 11 periodontally healthy (PH) subjects, and PMNs were isolated on a Ficoll–Hypaque gradient. For phagocytosis analysis, PMNs were incubated with fluorescein‐labeled Staphylococcus aureus. The oxidative burst was evaluated by incubation of PMNs with dihydroethidium and activation by S. aureus. The assays were examined using flow cytometry. Subgingival biofilm samples were obtained from periodontal sites with and without periodontitis and 24 species were detected by checkerboard.

Results:  A significantly lower phagocytosis rate was observed for patients with GAgP compared with PH subjects over time (P < 0.05). No differences between groups were found for superoxide production. GAgP patients presented significantly higher prevalence and levels of Porphyromonas gingivalis, Tannerella forsythia, and Aggregatibacter actinomycetemcomitans serotype b than controls (P < 0.05). Significant negative correlations between T. forsythia and P. gingivalis and PMN functions were observed.

Conclusions:  GAgP subjects presented diminished phagocytic activity of peripheral PMNs and high prevalence and levels of classical periodontal pathogens.
Role of two component signaling response regulators in acid tolerance of Streptococcus mutans
Authors: Kawada‐Matsuo M. , Shibata Y. , Yamashita Y.
Published: September 2010

Introduction:  In bacteria, two‐component systems (TCS) involving the products of a histidine kinase gene (hk) and a response regulator gene (rr) play important roles in adaptation to environmental changes. Fourteen hk‐rr homologs and one orphan rr homolog were identified in the Streptococcus mutans UA159 genome database. There have been no comprehensive evaluations of the roles of rr homologs in the acid tolerance of S. mutans.

Methods:  The TCS genes (tcs) of S. mutans were designated smtcs01–15. Mutants of S. mutans UA159 with deletions of rr and hk‐rr were constructed. Acid tolerance was evaluated by comparing the doubling times at pH 7.2 and pH 5.5 between the wild‐type and mutant strains.

Results:  Excluding smtcs10 and 12, for which viable mutants could not be obtained, a total of 13 rr deletion mutants were constructed. The rr deletions in smtcs03, 05, 08, and 13 resulted in diminished acid tolerance in comparison with UA159. The hk‐rr double‐mutants exhibited acid sensitivity levels similar to those of the corresponding rr mutants. The results of the present study reveal the involvement of the rr genes of smtcs03 and 05 in acid tolerance. Deletion of hk and/or rr in smtcs03 generated an acid‐sensitive phenotype. In contrast, for smtcs05, while deletion of rr resulted in reduced acid tolerance, a single‐deletion of hk had no effect on acid tolerance.

Conclusions:  We implicated two rr genes in the acid tolerance of S. mutans. In particular, smtcs05 is a novel tcs, the sole rr of which is involved in the acid tolerance of S. mutans.
Porphyromonas gingivalis stimulates TACE production by T cells
Authors: Bostanci N. , Reddi D. , Rangarajan M. , Curtis M. A. , Belibasakis G. N.
Published: September 2010

Introduction:  Tumour necrosis factor‐α converting enzyme (TACE), also known as ADAM17, is a membrane‐bound metalloprotease and disintegrin. It is produced by a number of host cells and is known to shed and release cell‐bound cytokines, particularly members of the tumour necrosis factor family. The aim of this study was to investigate the effect of Porphyromonas gingivalis on TACE production by a human T‐cell line, to identify putative virulence factors involved in this process, and to investigate the effect of doxycycline.

Methods:  P. gingivalis 6‐day culture supernatants were used to challenge Jurkat T cells for 6 h. Secreted and cell‐associated TACE levels were measured by enzyme‐linked immunosorbent assay, whereas messenger RNA expression was investigated by quantitative real‐time polymerase chain reaction. To investigate the involvement of cysteine proteases or proteinaceous components in general, P. gingivalis culture supernatants were treated with the specific chemical inhibitor TLCK or heat‐inactivated, respectively. The effect of doxycycline on the regulation of TACE secretion by P. gingivalis was also investigated.

Results:  P. gingivalis challenge resulted in a concentration‐dependent enhancement of TACE messenger RNA expression and protein release by Jurkat cells. TLCK treatment or heat treatment of P. gingivalis culture supernatants decreased TACE release to control levels. Doxycycline inhibited TACE secretion dose dependently.

Conclusion:  The induction of TACE by T cells in response to P. gingivalis may in turn favour the shedding of host cell‐bound cytokines into the local microenvironment, potentially amplifying the inflammatory response. In the present experimental system, P. gingivalis cysteine proteases are involved in TACE release by T cells.
Clinical effects of pranlukast, an oral leukotriene receptor antagonist, in mild‐to‐moderate asthma: A 4 week randomized multicentre controlled trial
Authors: Yoo Se Hwa , Park Sung Hak , Song Jeong Sup , Kang Kyung Ho , Park Choon Sik , Yoo Jee Hong , Choi Byoung Whui , Hahn Myung Ho , Group Representing Korea Pranlukast Study
Published: September 2010

Objective: Leukotriene antagonists are increasingly used in asthma management. Pranlukast is a new, orally active, selective inhibitor of CysLt1 leukotriene receptor. The present clinical trial was performed to study the effect and safety of pranlukast in mild‐to‐moderate asthma.

Methodology: A randomized, double‐blind, placebo‐controlled, parallel group study was performed in eight medical centres in Korea. Mild‐to‐moderate asthma patients who had been treated with β2‐agonists and/or inhaled corticosteroids were studied. The patients' symptoms were evaluated by asthma diary and twice‐daily peak flow monitoring.

Results: Of the 206 patients enrolled, 197 were eligible for analysis. The pranlukast group (n = 98) showed statistically significant improvement in asthma symptoms, including asthma attack rate, daily living score, and morning and evening asthma scores. Pranlukast significantly reduced the consumption of β2‐agonist. Compared with the placebo group, forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1) were not significantly higher in the pranlukast group. Morning and evening peak expiratory flow (PEF) were significantly increased after pranlukast treatment at weeks 2 and 4 (380.8 ± 10.1 L/min at baseline, 394.5 ± 10.1 at week 2, 396.3 ± 10.4 at week 4). There were no serious adverse reactions.

Conclusion: Pranlukast, an oral leukotriene antagonist, was well tolerated and was effective for the management of mild‐to‐moderate asthma.
Case management may reduce length of hospital stay in patients with recurrent admissions for chronic obstructive pulmonary disease
Authors: Poole Phillippa J. , Chase Beth , Frankel Anthony , Black Peter N.
Published: September 2010

Objectives: The aim of the study was to determine whether the case management of patients with recurrent hospital admissions for chronic obstructive pulmonary disease (COPD) can reduce hospital days without reducing quality of life.

Methodology: Sixteen subjects (mean forced expiratory volume in 1 second; FEV1 0.64 L) with at least four admissions for COPD in the previous 2 years were case managed by a clinical nurse specialist. Admissions and hospital bed days were recorded before and after the introduction of case management, and compared with data for 16 controls at another hospital who received usual care. Quality of life was measured serially in the case‐managed group.

Results: In the first year of case management, the number of hospital bed days fell to eight per patient from 22 per patient in the previous year. This was mainly due to a reduction in the length of stay from 5.6 to 3.5 days. In the control group length of stay did not change. Admissions in both groups declined. Case‐managed patients had a significant improvement in their quality‐of‐life scores.

Conclusions: In a group of patients with severe COPD and recurrent admissions, case management reduced the number of days in hospital while improving the quality of life. These findings need to be confirmed in a randomized, controlled trial.
Enteral feeding in stable chronic obstructive pulmonary disease patients
Authors: Tanchoco Celeste C. , Castro Cecilia A. Ma , Villadolid Milagros F. , Casiño Gerardo , Rodriguez Marietta P. , Roa Camilo , Cruz Christine Marie A. De La , Tangcongco Fausto
Published: September 2010

Objective: The study aimed to compare the effectiveness of a defined formula diet with a blenderized diet on nutritional and respiratory function parameters and to determine the bacteriological load of the two formulations.

Methodology: Seventeen patients, aged 50–75 years, admitted to the University of the Philippines‐Philippine General Hospital for chronic bronchitis and/or emphysema, were studied. They were divided into two groups according to dietary regimens. Each group of patients received either the standardized commercial formula or the blenderized formula for 2 weeks. Evaluation of dietary intake, anthropometric measurements, laboratory examinations and lung function were assessed. Subjective evaluation (patient's and physician's assessment) was also sought. Microbiological examinations were performed on the prepared enteral formulas.

Results: There was a slight increase in weight and in pulmonary function in both groups but these results did not differ significantly. Possible formula contamination was confirmed. Furthermore, in the overall assessment, the physician and patients rated both formulas as comparable.
Indomethacin induced bulky lymphadenopathy and eosinophilic pneumonia
Authors: Oishi Yumiko , Sando Yoshichika , Tajima Syunji , Maeno Toshitaka , Maeno Yuri , Sato Mahito , Hosono Tatsuya , Suga Tatsuo , Kurabayashi Masahiko , Nagai Ryozo
Published: September 2010

Abstract: Indomethacin is one of the most popular non‐steroidal anti‐inflammatory drugs (NSAID). Although NSAID occasionally provoke bronchospasm and hypersensitivity pneumonia, they seldom cause lymphadenopathy. This is the first report in which NSAID induced both eosinophilic pneumonia and bulky intrathoracic lymphadenopathy simultaneously. A 76‐year‐old Japanese man experienced high fever and dyspnoea after using an indomethacin suppository. Computed tomography scan of his chest revealed massive mediastinal and hilar lymphadenopathy along with diffuse infiltration in both lungs. He was diagnosed to have eosinophilic pneumonia because of eosinophilia in his peripheral blood and bronchoalveolar lavage fluid (BALF). Without using glucocorticoids, the pulmonary infiltration and lymphadenopathy subsided spontaneously. As the blastoid transformation test using the lymphocytes in his BALF was positive to indomethacin, we judged that both his eosinophilic pneumonia and mediastinal lymphadenopathy were due to a hypersensitivity reaction to indomethacin. An allergic reaction to NSAID should be considered as a rare cause of mediastinal lymphadenopathy.
Tuberculosis in Thailand
Authors: Palwatwichai Apirak
Published: September 2010

Tuberculosis (TB) was expected to be eradicated by the end of this century. However, an increasing incidence of tuberculosis in many parts of the world has led to renewed interest in the disease. The pandemic of HIV infection has changed TB, an endemic disease, to an epidemic worldwide. In Thailand, tuberculosis cases and deaths reduced year after year, until 1992 when the cases began to increase as a result of HIV infection. The annual risk of infection in 1997 was estimated at 1.4%, with approximately 100 000 new TB cases developing each year. Fifteen per cent of tuberculosis patients are seropositive for HIV infection. Increasing antituberculosis drug resistance has been correlated with the high prevalence of HIV infection in some parts of the country. In 1995, cure rate of this disease was approximately 50% and, since 1996, in order to cope with the worsening situation, the National Tuberculosis Programme (NTP) has adopted Directly Observed Treatment, Short‐course (DOTS). Despite the current economic turmoil of the country, the programme has now been expanded to cover over 400 of the 810 districts of Thailand. Also, the economic effects of tuberculosis at the household level in Thailand were recently studied. Tuberculosis is a chronic disease that commonly affects the lower socioeconomic classes. Some patients were unable to follow the treatment regimens because of the financial burden. The low case detection and treatment completion rates are, in part, due to the inability of poor patients to cope with the expenditure.
Tuberculosis problems in the Asia–Pacific region
Authors: Shimouchi Akira
Published: September 2010

Abstract: Tuberculosis (TB) is the top killer of the productive age group in developing countries. More than half of cases in the world occur in Asia‐Pacific region. The number of cases will increase in the next decades due to increase in urban poor population and HIV incidence, and poor access to health services and poor TB programme. The mainstay of effective strategy is to promote DOTS. DOTS population coverage is high, 58% in the Western Pacific Region but low; 29% in the southeast Asia region. Even among intermediate TB‐burden countries in Asia, reduction of incidence has stagnated in recent years because of aging population, health problems in the urban poor population and influx of populations from high endemic areas. Indicators of successful TB programmes are high cure rate and low drug resistance rate. There is a strong correlation between the overall quality of TB control in the past and the current primary drug‐resistant rate. To solve these problems, priority should be given to nationwide implementation of DOTS in high TB‐burden countries with emphasis on ensuring availability of free anti‐TB drugs and strengthening primary health care. General hospitals and private sector should be involved in control programmes to prevent drug resistant cases.
Bullous lung disease due to marijuana
Authors: HII Su W. , TAM Jeff D. C. , THOMPSON Bruce R. , NAUGHTON Matthew T.
Published: September 2010

Background and objective:  In contrast to the well‐described effects of tobacco smoking upon pulmonary emphysema, with ∼15% of smokers being affected at the age of 65 years, the effects of marijuana smoking are rarely reported and poorly understood.

Methods:  We report a series of 10 patients (mean age 41 ± 9 years, eight male, two female), who presented over a period of 12 months to our respiratory unit with new respiratory symptoms, and who admitted to regular chronic marijuana smoking (>1 year continuously). Symptoms on presentation were dyspnoea (n = 4), pneumothorax (n = 4) and chest infection (n = 2).

Results:  High‐resolution CT revealed asymmetrical, variably sized, emphysematous bullae in the upper and mid zones. However, the CXR was normal in four patients and lung function was normal in five.

Conclusions:  Marijuana smoking leads to asymmetrical bullous disease, often in the setting of normal CXR and lung function. In subjects who smoke marijuana, these pathological changes occur at a younger age (approximately 20 years earlier) than in tobacco smokers.
Phase II study of uracil‐tegafur plus cisplatin in patients with previously untreated advanced non‐small cell lung cancer
Authors: TAKAYAMA Koichi , KAWASAKI Masayuki , NINOMIYA Kiyoshi , MOTOHIRO Akira , FUJITA Masaki , WATANABE Kentaro , KAJIKI Akira , IWAMI Fumiyuki , MIYAZAKI Naoki , IZUMI Miiru , HARA Nobuyuki , NAKANISHI Yoichi ,   FUKUOKA LUNG CANCER STUDY GROUP, JAPAN
Published: September 2010

Background and objective:  A multi‐institutional phase II trial combining uracil‐tegafur (UFT) and cisplatin (CDDP) was conducted in patients with previously untreated advanced non‐small cell lung cancer (NSCLC) to evaluate the safety and efficacy of this combined treatment regimen.

Methods:  The entry criteria for this study were previously untreated NSCLC, measurable disease, age <80 years, performance status <2, and adequate haematological, hepatic and renal function. Patients were treated with 400 mg/m2 oral UFT from day 1 to day 14 and 80 mg/m2 cisplatin on day 15. The treatment course was repeated every 3 weeks.

Results:  Of the 68 patients enrolled, 64 (27 with stage IIIB and 37 with stage IV disease) were eligible for treatment. Twenty of the 64 patients responded to the chemotherapy (response rate 31.3%; 95% CI 21.2–43.4%). The median survival time was 8.6 months, and the 1‐year survival was 41.5%. Haematological toxicity ≥WHO grade 3 was seen in 3 (4.7%) patients. For non‐haematological toxicities, anorexia with WHO grade 3 was seen in 8 (12.5%) patients, nausea and vomiting with WHO grade 3 in 4 (6.3%), diarrhoea with WHO grade 4 in 1 (1.6%), and liver dysfunction with WHO grade 4 in 1 (1.6%) patient.

Conclusions:  The combination of oral UFT plus cisplatin was found to be a safe and active treatment against advanced NSCLC. The observed low toxicity of this combined regimen may warrant its application to the treatment of elderly patients.
High levels of oxidative stress in patients with advanced lung cancer
Authors: ESME Hidir , CEMEK Mustafa , SEZER Murat , SAGLAM Hayrettin , DEMIR Adalet , MELEK Huseyin , UNLU Mehmet
Published: September 2010

Background and objective:  The aim of this study was to investigate oxidative stress status in different stages and histological types of lung cancer.

Methods:  Forty‐nine lung cancer patients, who had not received any therapy, and 20 healthy subjects were chosen for the study. Lung cancer patients were divided into those with early stage or advanced stage disease. The tumour type was adenocarcinoma in 24 patients, squamous cell carcinoma in 21 and large cell carcinoma in four. We measured serum nitrite, nitrate, ascorbic acid, retinol, β‐carotene and ceruloplasmin levels, and whole‐blood malondialdehyde, reduced glutathione levels and catalase activity in patients with non‐small cell lung carcinoma and healthy subjects.

Results:  Statistically significant differences between the patient group and the control group were detected for all biochemical parameters. Mean malondialdehyde, nitrite, nitrate and ceruloplasmin levels and catalase activity were significantly higher in the group with advanced stage disease than in the control group. Mean β‐carotene, ascorbic acid and reduced glutathione levels were significantly lower in the group with advanced stage disease than in the control group. Mean malondialdehyde and nitrite levels were significantly higher in the patients with squamous cell carcinoma than in those with adenocarcinoma, and mean malondialdehyde level was also significantly higher in patients with squamous cell carcinoma than in those with large cell carcinoma.

Conclusions:  These results suggest that with advancing stage of lung cancer, the levels of oxidative stress increase, while levels of antioxidant molecules decrease. Patients with squamous cell carcinoma have higher oxidative stress as reflected by higher levels of malondialdehyde and nitrite.
Macrolides attenuate mucus hypersecretion in rat airways through inactivation of NF‐κB
Authors: OU Xue‐Mei , FENG Yu‐Ling , WEN Fu‐Qiang , WANG Ke , YANG Jie , DENG Zhi‐Pin , LIU Dai‐Shun , LI Yan‐Ping
Published: September 2010

Background and objective:  To examine the effect of a 14‐membered ring macrolide on airway mucus hypersecretion in rats treated with LPS.

Methods:  Mucus hypersecretion in rat airways was induced by intratracheal instillation of LPS. Rats treated with or without LPS were administered roxithromycin (1–10 mg/kg), josamycin (10 mg/kg) or amoxicillin (40 mg/kg), orally for 4 days. Expression of Muc5ac, nuclear factor (NF)‐κB, and the mitogen‐activated protein (MAP) kinases p38 and ERK1/2 in bronchial epithelium were detected by RT‐PCR, immunohistochemistry or western blotting. Mucins, IL‐1β, IL‐8 and tumour necrosis factor (TNF)‐α in BAL fluid were assayed by enzyme‐linked lectin assay and ELISA.

Results:  LPS significantly induced the expression of Muc5ac mRNA and protein in bronchial epithelium, increased the release of mucins, IL‐1β, IL‐8 and TNF‐α, and increased neutrophil numbers in BAL. Moreover, LPS increased staining for NF‐κB in the cytoplasm as well as nuclear translocation of NF‐κB in airway epithelial cells. Upregulated expression of Muc5ac mRNA correlated positively with NF‐κB activation and the levels of cytokines (P < 0.05). Roxithromycin (5 and 10 mg/kg) significantly attenuated bronchial Muc5ac expression and NF‐κB nuclear translocation stimulated by LPS, and reduced neutrophil numbers, mucins and inflammatory cytokines in BAL (P < 0.05). However, LPS‐stimulated expression of p38 and ERK1/2 in airway epithelium was not affected by roxithromycin. Josamycin and amoxicillin had no effects on Muc5ac expression, NF‐κB activation or cytokine release.

Conclusions:  Roxithromycin inhibits the pulmonary inflammatory response and airway mucus hypersecretion induced by LPS. The inhibitory effect of roxithromycin on airway mucus hypersecretion may be mediated through reduction of NF‐κB activation, neutrophil infiltration and release of inflammatory cytokines in the lung.
De novo 7q deletion with a positive maternal serum triple test screening
Authors: Park In Yang , Jo Yoon Sung , Shin Jong Chul , Sung In‐Kyung , Kim Myungshin
Published: September 2010

A 32‐year‐old woman at 17 weeks of gestation had a high possibility (1:82) of having a child with Down syndrome. Fetal chromosome according to amniocentesis revealed 46,XX,del(7)(q11.23q21.2). The fetus' chromosomal defect was not inherent because the chromosome analysis of the parents did not have any abnormal findings. We were regularly monitoring the pregnant woman by routine prenatal schedule and she had a normal spontaneous delivery. The baby showed a typical facial malformation, epicanthal fold, decreased muscle tone, and cardiac abnormalities. This is the first patient prenatally diagnosed with de novo 7q deletion by positive triple marker screening test. We consider the triple test, which is the most popular examination used to clarify the risk of chromosome abnormality in obstetrics, will be used not only for trisomy 21 and 18, but also for any other chromosome abnormalities.
Isolated intrauterine femoral fracture in an otherwise normal fetus
Authors: Arioz Dagistan Tolga , Koken Gulengul Nadirgil , Koken Resit , Kose Kamil Cagri , Cevrioglu Arif Serhan
Published: September 2010

Multiple fractures of the long bones can be seen in the intrauterine period as a result of disorders such as skeletal dysplasias or maternal trauma, but isolated intrauterine femoral fracture is an extremely rare condition. Congenital short femur should be kept in mind, especially during the intrauterine period in the differential diagnosis. We report a case diagnosed as isolated femoral fracture in the 34th gestational week with post‐partum confirmation of the diagnosis by X‐rays and physical examination.
Intrapartum placement of an inferior vena cava filter for a woman with hereditary antithrombin III deficiency: Its role in the prevention of fatal pulmonary embolism
Authors: Hidaka Nobuhiro , Hachisuga Masahiro , Tsukimori Kiyomi , Onohara Toshihiro , Maehara Yoshihiko , Wake Norio
Published: September 2010

We present a case of a pregnant woman with hereditary antithrombin III deficiency and deep vein thrombosis of the left lower extremity managed by perinatal unfractionated heparin injection with antithrombin III replacement as well as by intrapartum placement of a temporary inferior vena cava filter. A massive thrombus of the right common iliac vein occurred during the intrapartum period despite antithrombin III replacement. An inserted filter could prevent fatal pulmonary embolism in this patient. Hereditary antithrombin III deficiency increases risk of thrombosis during pregnancy. However, discussion on intrapartum management, when anticoagulants are contraindicated due to possible hemorrhage, is minimal. Our experience suggests that thrombosis can occur and develop during the intrapartum period in an antithrombin III deficient woman despite antithrombin III replacement. It may be advisable to manage deliveries with temporary inferior vena cava filters to prevent fatal pulmonary embolism.
Staircase sign: A newly described uterine contraction pattern seen in rupture of unscarred gravid uterus
Authors: Matsuo Koji , Scanlon Jennifer T. , Atlas Robert O. , Kopelman Jerome N.
Published: September 2010

Although extremely rare, rupture of an unscarred gravid uterus poses significant morbidity and mortality to both fetus and mother. In the past, loss of uterine contraction was thought to be characteristic of uterine rupture, while recent evidence shows that uterine contraction pattern is not associated with uterine rupture. We report two cases of rupture in the unscarred term uterus. Both patients were multiparous and denied any past medical complications, previous cesarean delivery or myomectomy. Uterine rupture occurred in the latent phase of labor at 1 cm dilation (Case 1) and during an intravenous oxytocin infusion after three doses of intravaginal misoprostol (Case 2). Case 2 required cesarean hysterectomy and blood transfusion. Case 1 was monitored with an external tocodynamometer, while Case 2 was monitored with an internal pressure transducer. External monitoring demonstrated the classic sign of complete loss of uterine tone. In contrast, internal monitoring demonstrated an increase in uterine resting tone. Both techniques revealed a stepwise gradual decrease in contraction amplitude followed by sudden onset of profound and prolonged fetal bradycardia (staircase sign). In cases of uterine rupture, differing baseline characteristics between contraction patterns were dependant on uterine monitoring technique. In both techniques a stepwise gradual decrease in contraction amplitude was followed by prolonged fetal bradycardia.
Could birthweight prediction models be improved by adding fetal subcutaneous tissue thickness?
Authors: Larciprete Giovanni , Di Pierro Giuseppe , Barbati Giulia , Deaibess Therese , Jarvis Sheba , Valensise Herbert , Romanini Maria Elisabetta , Gioia Stefano , Arduini Domenico
Published: September 2010

Aim:  The aims of the study were to: (i) compare the accuracy of standard ultrasonic algorithms in the estimation of fetal weight and; (ii) test two new algorithms in order to improve the global performance of birthweight prediction by adding fetal subcutaneous tissue thickness.

Methods:  We enrolled 398 patients who were between 34 and 42 weeks' gestation. Routine ultrasonographic biometric parameters as well as subcutaneous tissue thickness ultrasound parameters were measured. Correlation matrices between ultrasound parameters, in order to evaluate the degree of multicollinearity between these parameters, were assessed to develop a stepwise multiple regression birthweight predictive model.

Results:  Contributions of single ultrasound measurements in predicting birthweight were examined, by fitting Log‐transformed birthweight versus single ultrasound measurements. We found that the mid‐thigh tissue area was able to significantly improve the performance of the birthweight prediction process when added to the other standard ultrasound measurements. We derived two new algorithms which appeared to be better at predicting birthweight. Furthermore there was a lower minimum absolute estimation error noted when compared to other reported formulae.

Conclusions:  Our algorithms showed that the addition of the mid‐thigh tissue evaluation in birthweight prediction was valuable in comparison to birthweight prediction models which are based on routine ultrasound parameters.
Laparoscopic vs transverse incision right colectomy for colon carcinoma
Authors: Veenhof A. A. F. A. , van der Pas M. H. G. M. , van der Peet D. L. , Bonjer H. J. , Meijerink W. J. H. J. , Cuesta M. A. , Engel A. F.
Published: September 2010

Aim  We investigated whether laparoscopic right colectomy has short‐term and/or oncological advantages compared with transverse incision right colectomy.

Method  Patients who underwent an elective laparoscopic right colectomy or an open right colectomy through a transverse incision at the VU University Medical Center or Zaans Medical Center from 2005 to 2009 were prospectively followed.

Results  Patient groups were comparable in terms of gender, body mass index and American Society of Anesthesiology classification. Patients in the transverse incision group were older (68 years vs 75 years, P = 0.07) and blood loss was greater during this procedure (60 ml vs 130 ml, P = 0.001), which cost less than the laparoscopic procedure (€6.033 vs€7.221, P = 0.03). Hospital stay for the laparoscopic group was shorter (8 days vs 9 days, P = 0.04), but laparoscopic procedures took longer (155 min vs 77 min, P < 0.001) and 8% of patients in the laparoscopic group were converted to a median laparotomy. Postoperative complications were comparable for both groups (28%vs 32%, P = 0.74), and in both groups a radical resection rate of 96% (P = 0.94) was achieved. At a median follow up of 20 months the incidence of incisional hernia was similar in both groups and no patient required additional surgery as a result. Overall survival at 60 months was 70% for the laparoscopic group and 67% for the transverse incision group (P = 0.84).

Conclusion  There are few clinically relevant differences between a laparoscopic right colectomy and a transverse incision right colectomy. Transverse incision right colectomy is cheaper. The study may be the first to compare these two techniques, but it is a nonrandomized trial and therefore has its limitations.
Randomized controlled, multicentre clinical trial comparing a dual‐probe ultrasonic lithotrite with a single‐probe lithotrite for percutaneous nephrolithotomy
Authors: Krambeck Amy E. , Miller Nicole L. , Humphreys Mitchell R. , Nakada Stephen Y. , Denstedt John D. , Razvi Hassan , Preminger Glenn M. , Nadler Robert B. , Matlaga Brian R. , Paterson Ryan F. , Chew Ben H. , Munch Larry C. , Handa Shelly E. , Lingeman James E.
Published: September 2010

Study Type – Therapy (case series)

Level of Evidence 4

What’s known on the subject? and What does the study add?

Studies have indicated that not all ultrasonic lithotripters are created equal when it comes to efficiency of stone fragmentation and removal. To improve the efficiency of stone fragmentation and removal, combination pneumatic and ultrasonic devices have been developed. This study demonstrates that one available combination device, the Cyberwand, did not decrease the time to removal of the target stone nor did it increase the stone free rate compared to a standard ultrasonic lithotripter.

OBJECTIVES

• To compare the Cyberwand (Gyrus/ACMI, Southborough, MA, USA), a dual‐probe ultrasonic lithotrite, with a single‐probe ultrasonic lithotrite.

• The Cyberwand incorporates coaxial high‐ and low‐frequency ultrasonic probes that work synergistically.

PATIENTS AND METHODS

• An institutional review board‐approved, multicentre, randomized controlled trial to compare the Cyberwand to the Olympus LUS‐II (Olympus America, Inc., Melville, NY, USA) single‐probe lithotrite was performed.

• Patients undergoing a percutaneous nephrolithotomy (PCNL) with a target stone >2 cm in diameter were eligible for the study.

• The primary outcome was the time to removal of the targeted stone.

RESULTS

• A total of 57 PCNLs were performed after randomization: 25 Cyberwand and 32 LUS‐II.

• There was no difference (P > 0.05) observed between the two devices for target stone surface area (Cyberwand 526.6 cm3 vs LUS‐II 540.1 cm3), time to clearance of target stone (Cyberwand 15.8 min vs LUS‐II 14.2 min) and target stone clearance rate (Cyberwand 61.9 mm2/min vs LUS‐II 75.8 mm2/min).

• Of the patients with stone analysis, hard stones (calcium oxalate monohydrate, brushite and cystine) were noted in 14 (56.0%) of the 25 Cyberwand and 18 (62.1%) of the 29 LUS‐II patients.

• Fifteen of the 25 (60.0%) Cyberwand and 20 of the 32 (62.5%) LUS‐II patients were stone‐free after the initial PCNL.

• Those patients not rendered stone‐free went on to receive a secondary PCNL.

• Device malfunction occurred in eight of 25(32.0%) Cyberwand and five of 32 (15.6%) LUS II patients.

• Complications were similar in both treatment groups.

CONCLUSION

• No appreciable difference between the dual‐probe Cyberwand and the standard ultrasonic Olympus LUS‐II lithotrites can be identified.
Laparoscopic high‐intensity focused ultrasound for renal tumours: a proof of concept study
Authors: Ritchie Robert W. , Leslie Tom A. , Turner Gareth D.H. , Roberts Ian S.D. , D’Urso Leonardo , Collura Devis , Demarchi Andrea , Muto Giovanni , Sullivan Mark E.
Published: September 2010

Study Type – Therapy (case series) Level of Evidence

What’s known on the subject? and What does the study add?

Renal cancer is increasingly diagnosed when tumours are small and asymptomatic, during routine abdominal imaging. Whilst surgery is an effective and potentially curative option, it carries a significant risk of complications. Recent work suggests that thermally ablative therapies (RFA, cryotherapy, HIFU) may be suitable minimally invasive treatment options in selected patients.

The success of extracorporeal HIFU has been limited by the abdominal wall and rib‐cage limiting energy delivery. For this study, a purpose‐built laparoscopic HIFU probe was designed to allow direct application of the transducer to the tumour surface, thus facilitating tumour destruction. Successful and accurate tumour destruction was demonstrated, paving the way for further clinical trials, subject to device modifications.

OBJECTIVE

To test and establish clinical proof of concept for a laparoscopic high‐intensity focused ultrasound (HIFU) device that facilitates delivery of ultrasound by direct application of a probe to the tumour surface.

PATIENTS AND METHODS

Twelve patients with renal tumours were treated with laparoscopic HIFU using a newly designed probe inserted via an 18‐mm laparoscopic port.

HIFU treatment was targeted at a pre‐defined proportion of the tumour and immediate laparoscopic partial or radical nephrectomy was then performed.

RESULTS

No tumour ablation was seen in the first five patients which made modifications in the treatment protocol necessary. After this, definite histological evidence of ablation was seen in the remaining seven patients.

The ablated zones were within the targeted area in all patients and no intra‐lesional skipping was seen.

Subcapsular skipping was seen at the probe–tumour interface in two patients with viable tumour cells seen at microscopy.

One patient did not undergo surgical extirpation; subsequent biopsy revealed no viable tumour cells.

There were no intraoperative or postoperative complications directly related to HIFU therapy and patients have reached a mean (range) follow‐up of 15 (8–24) months with no evidence of metastatic disease or late complications.

CONCLUSIONS

Tumour ablation with laparoscopic HIFU is feasible.

Homogenous ablation can be achieved with no vital tissue within the targeted zone.

The technique is associated with low morbidity and may have a role in the definitive management of small tumours.
Successful control of schistosomiasis and the changing epidemiology of bladder cancer in Egypt
Authors: Salem Shady , Mitchell Robert E. , El‐Alim El‐Dorey Abd , Smith Joseph A. , Barocas Daniel A.
Published: September 2010

What’s known on the subject? and What does the study add?

The association between squamous cell carcinoma of the bladder and schistosomal bladder infection is well‐known to most physicians. Less recognized is the remarkable cause and effect relationship between the eradication of schistosomiasis and the subsequent radical decline in squamous cell bladder cancer. Public health initiatives in Egypt have effectively eliminated the most common cause of death in young Egyptian men, and the result is a testament to how basic science, properly applied to public policy, can dramatically improve the health of an entire country.

Schistosomiasis is a parasitic disease caused by flatworms that live in snail‐infested fresh water. It is endemic to 74 countries and affects some 200 million people worldwide, causing an estimated 200 000 deaths annually [1]. Schistosomiasis can affect the gastrointestinal tract and liver (S. mansoni and S. japonicum species), resulting in diarrhoeal disease and hepatic fibrosis, or the urinary tract (S. haematobium) where it causes haematuria, strictures, obstruction, super‐infection and, ultimately, cancer. In children and vulnerable adults, systemic effects such as anaemia, malnutrition, stunted growth and impaired cognition can be profound.

The association between this parasitic infestation and the development of bladder cancer literally took millennia to uncover. It is unusual for a parasitic disease to result in a fatal neoplastic process, and rarer still to have public health efforts, aimed at eradication of the parasitic menace, to result in a dramatic shift in the epidemiology of the most common cancer in a nation.
Treatment of metastatic renal carcinoma patients with the combination of gemcitabine, capecitabine and bevacizumab at a tertiary cancer centre
Authors: Jonasch Eric , Lal Lincy S. , Atkinson Bradley J. , Byfield Stacey DaCosta , Miller Lesley Ann , Pagliaro Lance C. , Feng Chun , Tannir Nizar M.
Published: September 2010

Study Type – Therapy (case series)

Level of Evidence 4

What’s known on the subject? and What does the study add?

At this point there is very little known about the benefit of combining antiangiogenic therapy and chemotherapy in the treatment of advanced renal cell carcinoma. This retrospective study provides important preliminary data on combination therapy, and forms the basis of an ongoing clinical trial testing the combination of gemcitabine, capecitabine and bevacizumab in patients with sarcomatoid renal cell carcinoma.

OBJECTIVE

• To investigate the effect of combining gemcitabine plus capecitabine (GX) with bevacizumab (A) in patients with metastatic RCC previously treated with cytokines and targeted agents.

METHODS

• The combination of GX + A was evaluated in patients with metastatic RCC using institutional databases.

• Data included demographics, previous therapies, number of metastatic sites, Memorial Sloan‐Kettering Cancer Center risk stratification variables, and previous nephrectomy status.

• Descriptive statistics and survival analysis were employed for data analysis.

RESULTS

• Between January 2005 and October 2008, 28 patients were identified. Mean age was 55.7 years. Fifteen (53.57%) patients had been given tyrosine kinase inhibitor (TKI) previously. Nine (32.14%) patients had clear cell histology, 10 (35.71%) patients had sarcomatoid features on histopathology, and 19 patients (67.86%) had a prior nephrectomy.

• Initial treatment consisted of G (mean dose 786.07 mg/m2) every 2 weeks, X (mean dose 2.73 g/day), and A (mean dose 10 mg/kg) every 2 weeks. Median progression‐free survival (PFS) was 5.9 months and the median overall survival (OS) was 10.4 months.

• In patients with previous TKI therapy, median PFS was 6.2 months and median OS was 11.7 months.

• In patients with sarcomatoid features, median PFS was 3.9 months and OS was 9.0 months.

• Three patients discontinued one or more of the drugs because of adverse reactions.

CONCLUSIONS

• The combination of GX + A shows potential efficacy and acceptable tolerability in patients with intermediate and poor prognosis metastatic RCC.

• Based on these observations, a phase II trial is now underway assessing this combination in patients with sarcomatoid RCC.