bluuebunny/crossref_metadata_2025 huggingface dataset:
Nutrient Dietary Patterns and Gastric Cancer Risk in Italy
Authors: Bertuccio Paola , Edefonti Valeria , Bravi Francesca , Ferraroni Monica , Pelucchi Claudio , Negri Eva , Decarli Adriano , La Vecchia Carlo
Published: November 2009

Background: There have been several studies on diet and gastric cancer, but only a few investigations have considered the role of dietary patterns.

Methods: We investigated gastric cancer risk in relation to dietary patterns in a case-control study conducted in northern Italy between 1997 and 2007, including 230 patients with incident, histologically confirmed gastric cancer and 547 frequency-matched controls, admitted to the same hospitals as cases, with acute nonneoplastic conditions. Dietary habits were investigated through a validated food frequency questionnaire including 78 foods and beverages. We identified a posteriori dietary patterns on a selected set of 28 micro- and macro-nutrients through an exploratory principal component factor analysis. We estimated the odds ratios (OR) and the corresponding 95% confidence intervals (95% CI) using conditional logistic regression models on quartiles of factor scores.

Results: We identified four major dietary patterns, named “animal products”, “vitamins and fiber”, “vegetable unsaturated fatty acids”, and “starch-rich”. We observed a positive association between gastric cancer risk and the “animal products” (OR, 2.13; 95% CI, 1.34-3.40, for the highest versus the lowest score quartile) and the “starch-rich” (OR, 1.67; 95% CI, 1.01-2.77) dietary patterns. The “vitamins and fiber” pattern (OR, 0.60; 95% CI, 0.37-0.99) was inversely associated with gastric cancer, whereas no significant association emerged with the “vegetable unsaturated fatty acids” pattern (OR, 0.89; 95% CI, 0.56-1.42).

Conclusions: Our analysis suggests a protective effect against gastric cancer risk of dietary patterns rich in fruits and vegetables, and a positive association of dietary patterns rich in meats and animal fats and starchy foods. (Cancer Epidemiol Biomarkers Prev 2009;18(11):2882–6)
Solvent Exposure and Non-Hodgkin Lymphoma: No Risk in a Population-Based Study in the San Francisco Bay Area
Authors: Tranah Gregory J. , Holly Elizabeth A. , Bracci Paige M.
Published: November 2009

The literature on environmental exposures and risk of non-Hodgkin lymphoma (NHL) is inconsistent and no occupational exposures have been conclusively identified as causal factors. We used job exposure matrices to assess the association between occupational exposure to solvents in a population-based case-control study of NHL (n = 1,591 cases; n = 2,515 controls) in the San Francisco Bay Area between 1988 and 1995. Occupational histories were collected during in-person interviews and were coded according to the 1980 U.S. Department of Commerce Alphabetic Index of Industries and Occupations. Odds ratios and 95% confidence intervals were adjusted for potential confounders. Our results have provided no support for an association between NHL and occupational exposure to solvents. (Cancer Epidemiol Biomarkers Prev 2009;18(11):3130–2)
Mucosal Healing: Impact on the Natural Course or Therapeutic Strategies
Authors: Vatn Morten H.
Published: November 2009

Background: The treatment with anti-TNF in inflammatory bowel disease (IBD) has shown a much higher rate of mucosal healing (MH) compared to previous treatments. As MH after treatment also seemed to predict a positive outcome of disease regarding long-term outcome and reduced economic burden on the healthcare system, the question was if MH would have an impact on both the natural course of disease and treatment strategy. Areas of Experience: Literature search includes population-based cohort studies, such as the Norwegian IBSEN study, and hospital-based studies, such as the GETAID study from France, both referring to MH in prospective follow-up studies of treatment prior to the introduction of biologics. Additionally, experience is based on short- and long-term efficacy studies with anti-TNF treatment, especially infliximab. From all studies, predictability of MH on long-term outcome of disease, including surgery and hospitalization, was assessed. Results: MH predicts a generally favorable outcome of disease based on all types of treatment strategies, except glucocorticosteroids, and is related to treatment efficacy-reduced frequency of surgery and hospitalizations. Scheduled treatment with anti-TNF is superior to episodic treatment and a top-down strategy has a favorable effect on healing. A limitation of MH as a universal marker is the fact that less than 50% of patients with a clinical effect of treatment acquire complete healing and MH appears in less than 30% of all patients on anti-TNF. Conclusion: MH has become a valuable marker of efficacy in IBD, predicting a favorable disease outcome. In the future, additional markers of healing are expected to be combined with today’s endoscopic and histologic assessments.
Role of Matriptase-2 (TMPRSS6) in Iron Metabolism
Authors: Lee Pauline
Published: November 2009

Iron, an essential element for life, is regulated primarily at the level of uptake, storage, and transport in order to maintain sufficient availability for normal physiology. The key protein in iron homeostasis is a 25-amino-acid peptide, hepcidin, which modulates the amount of iron in the circulation by binding and promoting the degradation of the iron exporter ferroportin. Given the central importance of hepcidin, recent studies have focused on how iron is sensed and how the iron signal is transmitted to hepcidin. Mutations in a type II serine protease, matriptase-2/TMPRSS6, were recently identified to be associated with severe iron deficiency caused by inappropriately high levels of hepcidin expression. A key biologically relevant substrate for the proteolytic activity of matriptase-2/TMPRSS6 was found to be hemojuvelin, a cell surface protein that regulates hepcidin expression through a BMP/SMAD pathway. In this review, we discuss the putative role of matriptase-2/TMPRSS6 in iron homeostasis.
Anemia of Chronic Disease (Anemia of Inflammation)
Authors: Agarwal Neeraj , Prchal Josef T.
Published: November 2009

Mild-to-moderate anemia often develops in the setting of acute or chronic immune activation and is termed anemia of chronic disease (ACD) or anemia of inflammation. Anemia of chronic disease is the second most common type of anemia (after anemia of iron deficiency) and results in increased morbidity and mortality of the underlying disease. Anemia of chronic disease is mediated by inflammatory cytokines and is characterized by low serum iron (hypoferremia) and often increased reticuloendothelial stores of iron. Hepcidin is the master regulator of iron homeostasis and its synthesis is inhibited by iron deficiency and stimulated by inflammation. The serum hepcidin level is useful in identifying iron deficiency in patients with ACD. Successful treatment of the underlying disease improves ACD. If that is not possible and if anemia is symptomatic, treatment with erythropoietic agents, supplemented with iron if necessary, is helpful in many cases.
Deferiprone Chelation Therapy for Thalassemia Major
Authors: Galanello R. , Campus S.
Published: November 2009

Iron overload is one of the major causes of morbidity in patients with thalassemia major. Deferiprone (DFP), an orally active iron chelator, emerged from an extensive search for new drugs to treat iron overload. Comparative studies have shown that at comparable doses the efficacy of DFP in removing body iron is similar to that of desferoxamine (DFO). In retrospective and prospective studies, DFP monotherapy was significantly more effective than DFO in the treatment of myocardial siderosis in thalassemia major. DFP can be used in combination with DFO in the management of severe iron overload. This chelation regimen is tolerable and attractive for patients unable to comply with standard DFO infusions or with inadequate response to DFP monotherapy. DFP has a well-known long-term safety profile. Agranulocytosis is the most serious side effect associated with its use, occurring in about 1% of the patients. More common but less serious side effects are gastrointestinal symptoms, arthralgia, zinc deficiency, and fluctuating transaminase levels.
Deferasirox (Exjade®) for the Treatment of Iron Overload
Authors: Cappellini M.D. , Taher A.
Published: November 2009

Deferasirox is a once-daily oral iron chelator with established dose-dependent efficacy in both adult and pediatric patients with transfusional iron overload. The clinical development program has demonstrated the efficacy of deferasirox for up to 4.5 years of treatment in patients with various underlying anemias, including β-thalassemia, myelodysplastic syndromes, sickle cell disease, aplastic anemia, and other rare anemias. In addition to reducing key indicators of total body iron levels (serum ferritin, liver iron concentration, and toxic labile plasma iron), deferasirox has also demonstrated the ability to remove cardiac iron and prevent future cardiac iron accumulation. Emerging long-term data confirm the tolerability profile of deferasirox, and data on patient compliance render deferasirox a suitable therapeutic option for patients with chronic conditions requiring ongoing iron chelation therapy. Data continue to accumulate in a wide range of patient groups, including those with non-transfusion-dependent anemias such as hereditary hemochromatosis.
Double-Blind Comparison of the Efficacy, Toleration and Safety of Tioconazole Base 1% and Econazole Nitrate 1% Creams in the Treatment of Patients with Fungal Infections of the Skin or Erythrasma
Authors: Grigoriu D. , Grigoriu A.
Published: November 2009

A total of 61 patients with proven fungal infection of the skin or with erythrasma took part in a double-blind comparison of the efficacy, toleration and safety of tioconazole base 1% w/w and econazole nitrate 1% creams applied twice daily. Some patients had more than one site of infection and some were infected with more than one fungal/bacterial species. The mean duration of treatment in the tioconazole group of patients was 40 days (range: 12–68) and in the econazole group 38 days (range: 17–101). Clinical and mycologic cure was achieved in 27 of 29 (93.1%) tioconazole-treated and 29 of 31 (93.5%) econazole-treated patients. All but 1 of the cured patients in each treatment group were seen some 6 weeks after the end of treatment; all remained clinically and mycologically cured. Both creams were found to be generally acceptable in terms of ease of application. Some staining was reported in both treatment groups. One side effect of mild intermittent pruritus was reported in an econazole-treated patient. The minimum inhibitory concentrations were determined.
UV-Induced DNA Repair Synthesis in Patients with Epidermodysplasia verruciformis
Authors: Proniewska Maria , Jablonska Stefania
Published: November 2009

Autoradiographic technique was utilized to measure UV-induced DNA repair synthesis in 8 patients with epidermodysplasia verruciformis: 2 infected with human papillomavirus 3 (HPV 3), 4 with HPV 4, and 2 simultaneously with HPV 3 and HPV 4. Two cell populations were compared, i.e. epidermal cells derived from light-exposed and covered skin, and peripheral lymphocytes. A control group consisted of 10 healthy subjects. DNA repair was found to be normal both in the peripheral lymphocytes and in the epidermal cells from exposed and unexposed skin. The values for covered skin were even somewhat higher but this was not statistically significant. The type of HPV infection and malignant conversion had no apparent effect on DNA repair. A certain reduction of the UV-DNA repair synthesis was demonstrated in 2 patients infected with both types of viruses.
Pemphigus induit par la D-pénicillamine
Authors: Chouvet B. , Thivolet J. , Bathias J. , Forestier J.Y.
Published: November 2009

The authors describe a new original observation of a D-penicillamine-induced pemphigus in a patient with rheumatoid polyarthritis. It begins in two steps: the first crisis of blisters having subsided after withdrawal of D-penicillamine, there is a recurrence 7 months later. Clinical and histopathological aspects of pemphigus vulgaris are discussed. Existence of intercellular antisubstance antibody in the serum and in the skin. Evolution identical to that of a classical pemphigus requiring an important corticotherapy. Review of the literature on the previous cases of D-penicillamine-induced pemphigus and other pemphigus attributed to the action of other drugs, namely pyritinol, rifampicine and practolol. Discussion of the pathogenesis.
A Novel Association between HLA and Disease: Porphyria cutanea tarda and HLA-AW32
Authors: Santoianni P. , De Felice M. , Ayala F. , Budillon G. , Zappacosta S.
Published: November 2009

An association between porphyria cutanea tarda and HLA-AW32 has been put into evidence in a group of 28 unrelated patients. A relative risk of 3.09, with a χ2 of 4.55 (p < 0.05) was found, using a 148-member panel of controls.
Manifestation eines malignen Lymphoms von hohem Malignitätsgrad im Spätstadium der Mycosis fungoides
Authors: Büchner S. , Rufli T.
Published: November 2009

Report on a patient with mycosis fungoides, in whom after a long course the disease developed rapidly into a malignant lymphoma of high grade malignancy. The diagnosis was confirmed by cytomorphological and enzyme-cytochemical methods (demonstration of hydrolytic enzymes in cryostat sections, cutaneous smears and cell suspensions extracted from skin lesions), as well as by immunocytological methods (differentiation of lymphocyte sub-populations). In the tumour stage of mycosis fungoides, a polymorphous infiltrate composed of lymphocytoid and monocytoid cells prevailed, while a proliferation of lymphoblastic cells was present in the terminal stage of the disease. These cells showed no longer the properties of mature lymphocytes and differed also in their enzyme-cytochemical pattern.
Immunohistochemistry in Lichen Planus
Authors: Varelzidis A. , Tosca A. , Perissios A. , Capetanakis J.
Published: November 2009

An immunohistochemical study has been undertaken on 25 biopsy specimens taken from lichen planus lesions, using antisera against human fibrin, immunoglobulins IgG, IgA, IgM and C3 (BjC/BjA) complement component. The findings of the present research are discussed and evaluated in relation to the problem of the etiopathogenesis of the disease.
The Effect of Photochemotherapy on Epidermal-Glycogen and on Capillaries in Psoriatic Skin
Authors: Vukas Ante , Batistić Berislav , Velfl Duško
Published: November 2009

This study was undertaken to assess the amount of glycogen present in psoriasis vulgaris (PV), psoriasis erythrodermica (PE) and psoriasis pustulosa generalisata (PPG) lesions before and after photochemotherapy (PUVA). There were more deposits of glycogen in PPG than in PE and PV. With PUVA treatment, glycogen almost completely disappeared in PV and PE, but traces were still observed in PPG. After treatment, the epidermal layers returned to their normal structure but there was no significant improvement in the dilated and tortuous capillaries in the upper corium.
Serum Uric Acid Levels in Untreated and PUVA-Treated Patients with Psoriasis
Authors: Brenner W. , Gschnait F.
Published: November 2009

Hyperuricemia occurs frequently in patients with psoriasis. An increased purin breakdown due to the enhanced epidermal turnover was stressed as a reasonable explanation. To prove this theory serum uric acid, cholesterol, triglyceride levels and the average body overweight were determined in 318 untreated psoriatic patients and the parameters were correlated with the extent of psoriatic skin involvement. In more than 100 psoriatic patients treated by oral photochemotherapy (PUVA), uric acid serum levels were examined additionally after the PUVA clearing phase and during PUVA maintenance treatment. The present study demonstrates: (1) There is no relationship between the frequency of hyperuricemia and the extent of psoriatic skin involvement, indicating that the increased epidermal turn over may not play a role in psoriatic hyperuricemia. (2) The most reasonable explanation for elevated uric acid in psoriasis seems to be a combination of genetic predisposition and hyperalimentation. (3) No significant change was found in the incidence of hyperuricemia under the influence of photochemotherapy.
Two Types of Contact Urticaria and Immediate Reactions to Patch-Test Allergens
Authors: Rudzki Edward , Grzywa Zdzisława
Published: November 2009

3 patients with contact urticaria as the only pathological symptom are described, 2 with contact urticaria and other manifestations of hypersensitivity and 3 with immediate reaction to patch-test allergens.
Gibt es zirkumskripte Melanosen beim Melanomkranken?
Authors: Hoede N. , Bork K. , Korting G.W.
Published: November 2009

Regarding the rare phenomenon of diffuse melanosis of the skin secondary to widespread melanoma, the possibility of a circumscribed melanosis in melanoma patients is hypothetically discussed on the basis of a personal observation. Microscopically, such a circumscribed melanosis appears as clusters of melanin-laden macrophages.
Fixed Drug Eruption Due to Metronidazole
Authors: Naik R.P.C. , Singh Gurmohan
Published: November 2009

A case of fixed drug eruption due to metronidazole is presented. Such an eruption due to metronidazole has not been reported before.
Induction of Multinucleate Cells by 8-MOP and UV Treatment in vitro and in vivo
Authors: Omar A. , Wiesmann U.N. , Krebs A.
Published: November 2009

Fibroblast cells were treated with a single dose of 8-methoxypsoralen (8-MOP) and long-wave UV irradiation in vitro and the cytotoxic effects of the treatment followed up for 5 passages. During the first passage, there was an inhibition in cell proliferation, the induction of chromosomal aberrations and the production of macrocells as well as cells with more than one nucleus. In the subsequent passages, the proliferation rate of the cells gradually normalized but there was a concomitant increase in chromosomal aberrations and in the number of macrocells and multinucleate cells. Specimens, which were taken from the uninvolved skin of psoriatic patients who had been treated between 20 and 40 times with an oral dose of 8-MOP and black light irradiation (PUVA) also revealed the presence of binucleate, tetranucleate and multinucleate epidermal cells as well as binucleate and tetranucleate dermal fibroblasts.
Treatment of Keratoacanthomas with Curettage
Authors: Reymann Flemming
Published: November 2009

The present paper reports the results of a follow-up study of 47 patients with keratoacanthomas treated solely with curettage. Only one recurrence was seen, and the cosmetic results were much better than those obtained with other types of treatment. Curettage must be considered the treatment of choice for keratoacanthomas on the face.
Die therapeutische Harnstoffwirkung auf die Haut
Authors: Wohlrab W.
Published: November 2009

Long-term application up to 8 weeks of a 10% urea solution provokes an epidermal thinning expressed in a decreased number of DNA-synthetizing cells. This epidermal reaction cannot be established after topical use of HTH® emulsion. Even by daily application during 8 weeks no change was seen. The absence of epidermal thinning after HTH exposure can be explained as an additive effect of urea and the other constituents of the HTH emulsion. This opinion is supported by the results after application of urea together with Tween 60 in that the acanthogenic effect of Tween 60 is decreased by addition of urea. On the other side, the therapeutic efficiency of 10% 5-fluorouracil solution can be increased remarkably by preliminary treatment with HTH emulsion. These findings could reach importance in the topical therapy with regard to the possibility to improve the effectiveness of any drug by addition of, or preliminary treatment with, urea.
Epithelium of the Human Palatal Tonsil used for New Test Antigen in IIF Examination (for Pemphigus, Pemphigoid Antibodies and ANA)
Authors: Gligora M.
Published: November 2009

The author presents the results of IIF examinations for pemphigus, pemphigoid antibodies and antinuclear antibodies (ANA) on the epithelium of the human palatal tonsil obtained by tonsillectomy in patients with chronic hypertrophic tonsillitis. Tonsil epithelium is more sensitive to intercellular antibodies (IC Ab), and antibodies of the basal membrane zone (BMZ Ab) than sample tissue of the monkey esophagus, while its reaction to ANA is the same or even weaker than monkey esophagus.
Generalized Pruritus in Metastatic Adenocarcinoma of the Stomach
Authors: Shoenfeld Y. , Weiberger A. , Ben-Bassat M. , Pinkhas J.
Published: November 2009

Generalized pruritus appeared 2 years following resection of an adenocarcinoma of the stomach. The appearance of the pruritus was the presenting symptom of recurrence of the malignant process in the stomach as well as of its metastatic spread to the liver and to the lungs.
DNA and DNA + Histone Hydrolysis by Guinea Pig Epidermal Enzymes
Authors: Miyagawa Teruo , Urabe Harukuni
Published: November 2009

An acid deoxyribonuclease of guinea pig epidermis hydrolyzes chromatin DNA as well as histone-free DNA. The enzyme degrades approximately 50% of chromatin DNA, while it degrades 90% of histone-free DNA. Guinea pig epidermal extract contains proteolytic activity for histone or chromatin with a pH optimum at around 8.0.
Dégénérescence des muscles arrecteurs dans une observation de dermatomyosite
Authors: Dupré A. , Bonafé J.L. , Delsol G. , Oksman F.
Published: November 2009

We have observed great alterations of the arrector pili muscle in a case of dermatomyositis. These alterations were as follows: diminution and then loss of the staining properties of the smooth muscle fibres, perinuclear vacuolization, great heterogeneity in the degeneration of fibres, elective involvement of the cyto-fibrillary system with integrity of the other constituents of the arrector muscle and the surrounding dermis. This smooth myositis is nonspecific and similar to the one observed in other internal diseases (scleroderma, chronic alcoholism).
Nævus eccrine
Authors: Pippione M. , Depaoli M.A. , Sartoris S.
Published: November 2009

The eccrine nevus is an exceptional entity, formed by well-differentiated adnexa which can be classified as hamartoma or organoid nevus. It is characterized by a high degree of structural maturation. The authors report a case of eccrine nevus observed in a 32-year-old woman and compare clinical and histological features of the lesion with literature data.
Polychimiothérapie du mélanome métastatique
Authors: Laugier P. , Orusco M. , Wagenknecht L. , Jaccard M.A
Published: November 2009

It is still too early to draw valuable conclusions (only 8 months have elapsed) on the therapeutic value of these types of polychimiotherapies. This is only a preliminary notice. Regression was observed on three of our patients and this seems a good enough reason to carry on this clinical trial. Another important question comes up at once: How long does the anti-tumor effect last? We cannot as yet give a valuable answer. It is only by a careful follow-up of these patients that we will be able to determine it, more precisely.
Questions about Chemokine and Chemokine Receptor Antagonism in Renal Inflammation
Authors: Anders Hans-Joachim , Sayyed Sufyan Ali , Vielhauer Volker
Published: November 2009

Chemokines remain attractive therapeutic targets for modulating inflammatory diseases in all areas of medicine including acute and chronic kidney disease. Industry has launched huge programs for the development of chemokine antagonists, and clinical trials with chemokine and chemokine receptor antagonists are ongoing. However, chemokine biology remains an area of unexpected discoveries. Here we discuss a number of questions which need to be addressed to further explore the potential of chemokine antagonism in renal inflammation: Why does renal expression of chemokines and chemokine receptors not always correlate with their functional significance? Why does chemokine antagonism only partially reduce renal leukocyte counts? Will antagonist combinations be more effective in reducing renal inflammation? What are the functional roles of homeostatic chemokines and atypical, nonsignaling chemokine receptors in renal inflammation? And finally, what classes of chemokine antagonists are available to address these questions experimentally?
Cord Blood Cardiac Troponin T and Nonprotein-Bound Iron Levels in Newborns of Mild Pre-Eclamptic Mothers
Authors: Karadeniz Leyla , Coban Asuman , Ince Zeynep , Turkoglu Umit , Can Gulay
Published: November 2009

Background: In hypoxic newborns, cardiac troponin T (cTnT) was shown to be an indicator of cardiac damage and increased levels of nonprotein-bound iron (NPBI), an indicator of increased free radical production and perinatal brain damage. Objective: The aim of this study was to determine cord blood cTnT and NPBI levels in neonates of mild pre-eclamptic mothers. Methods: The study included 50 babies of mild pre-eclamptic mothers and 50 babies of healthy mothers. cTnT and NPBI levels were measured in cord blood. Results: The mean gestational age in the pre-eclamptic and healthy groups were 36.1 ± 3.5 and 38.1 ± 1.9 weeks, mean birth weights were 2,456 ± 945 and 3,059 ± 493 g. Cord blood median cTnT level was significantly higher in the pre-eclamptic group (0.024 vs. 0.015 ng/ml). Serum cTnT in the 95th percentile was 0.047 ng/ml in the healthy group. cTnT levels of preterm babies in the pre-eclamptic group was found to be significantly higher compared to term babies in the control group (0.038 vs. 0.013 ng/ml). It could not be demonstrated whether there is a statistically significant relation between cTnT levels and respiratory distress, gestation, type of delivery, sex and birth weight. The median NPBI level was higher in the control group (3.26 vs. 1.86 µmol/l). Conclusions: Increased levels of cTnT may be a biochemical marker of cardiac involvement in babies of mild pre-eclamptic mothers. In this study, no correlation was found between cTnT levels and NPBI levels.
Which Is More Valid for Stroke Patients: Generic or Stroke-Specific Quality of Life Measures?
Authors: Owolabi Mayowa Ojo
Published: November 2009

Background: It remains unclear whether a generic or specific health-related quality of life (HRQOL) measure is more valid for stroke. Aim: The aim of this study is to compare the validity of SF-36, a generic measure, and HRQOL in stroke patients (HRQOLISP), a stroke-specific measure, for assessing post-stroke HRQOL. Methods: The validity of HRQOLISP and SF-36 was compared in a cross-sectional study of 100 stroke survivors. The Stroke Levity Scale and modified Rankin Scale were applied to measure stroke severity and disability, respectively. Results: Both measures exhibited adequate ‘known-groups’ and construct validity. However, the SF-36 lacked content validity for the cognitive domain and personal constructs including spiritual functioning. Most SF-36 subscales had substantial floor or ceiling effects. The HRQOLISP demonstrated better content and internal consistency validity and no significant floor or ceiling effect. Conclusions: Like other stroke-specific measures, HRQOLISP was better than SF-36 in most parameters of validity considered. The SF-36 is designed for comparison among different diseases and may not be suitable for clinical trials or studies of internal adaptation, cognitive or spiritual functioning in stroke. This is because it lacks content validity for these domains and may underestimate health changes in most subscales.
Relationship between Blood Levels of Heavy Metals and Parkinson’s Disease in China
Authors: Fukushima Tetsuhito , Tan Xiaodong , Luo Yunwen , Kanda Hideyuki
Published: November 2009

Background: Idiopathic Parkinson’s disease (PD) and the Parkinsonian syndrome caused by manganese (Mn) poisoning are known to be indistinguishable in terms of symptoms. We thus suspect that many patients who have accumulated Mn in the body in daily life are diagnosed as having idiopathic PD. We examined the relationship between PD and blood levels of heavy metals, and the influence of intake from food in a general population. Methods: The subjects comprised PD patients and sex- and age-matched controls recruited from the outpatient clinic of Xiangfan No. 1 People’s Hospital in Hubei, China, between 2006 and 2008. Information was obtained on previous eating habits before diagnosis of PD and other factors. Morning blood samples were collected before breakfast and were used to measure concentrations of metals. Results: The whole-blood Mn and serum iron (Fe) levels were significantly higher in PD patients than in controls. However, no differences in intake of each metal from food or experience of Mn poisoning were seen between the groups. Conclusions: In China, accumulation of Mn and Fe via unknown routes might be involved in the etiology of PD in the general population.
Safety and Tolerability of Donepezil, Rivastigmine and Galantamine for Patients with Alzheimer’s Disease: Systematic Review of the ‘Real-World’ Evidence
Authors: Lockhart I.A. , Mitchell S.A. , Kelly S.
Published: November 2009

Background/Aims: The purpose of this systematic review was to compare the safety and tolerability of the cholinesterase inhibitors (ChEIs) donepezil, rivastigmine and galantamine for treating mild to moderate Alzheimer’s disease (AD) patients in routine clinical practice. Methods: Electronic databases (Cochrane Library, Medline, EMBASE; accessed October 2008) and manual bibliographic searches were conducted to identify head-to-head non-randomised studies examining ChEIs for the treatment of AD. Data were extracted by 2 independent reviewers. Results: Twelve head-to-head studies comparing ChEIs met the pre-specified inclusion criteria; 6 retrospective analyses and 6 prospective cohort studies. Donepezil was the most widely studied treatment and galantamine the least widely prescribed therapy. Fewer donepezil-treated subjects withdrew due to adverse events (AEs) compared with rivastigmine and galantamine-treated subjects. The incidence of gastrointestinal (GI) AEs was lower following treatment with donepezil compared with rivastigmine and galantamine. Non-GI (CNS and cardiovascular) AEs occurred at a low frequency, and had a similar incidence in subjects treated with the different ChEIs. Conclusions: Subjects with mild to moderate AD treated in routine clinical practice with donepezil were more adherent to pharmacotherapy, and had a lower risk of GI AEs compared with rivastigmine or galantamine. This finding accords with results reported in the randomised clinical trial literature.
Spared and Impaired Abilities in Community-Dwelling Patients Entering the Severe Stage of Alzheimer’s Disease
Authors: Gillioz Anne-Sophie , Villars Hélène , Voisin Thierry , Cortes Frédéric , Gillette-Guyonnet Sophie , Andrieu Sandrine , Gardette Virginie , Nourhashémi Fati , Ousset Pierre-Jean , Jouanny Pierre , Vellas Bruno
Published: November 2009

Background: Comprehensive geriatric assessments of patients entering the severe stage of Alzheimer’s disease (AD) are scarce. Methods: Cross-sectional study of 126 patients entering the severe stage of AD in the longitudinal study of REAL.FR cohort. Patients who had a first MMSE score <10 during follow-up underwent cognitive, behavioral, nutritional and functional assessment. Support requirements were also evaluated. Results: The best-preserved cognitive abilities were social interaction and response to own name, while praxis, orientation, memory and language showed the largest declines. Regarding independence in daily living, locomotion was best preserved (71% of patients independent) while personal hygiene deteriorated most (15.5%). Behavioral disorders were frequent, and consisted principally of apathy, aberrant motor behavior, and agitation. The Mini Nutritional Assessment showed that 68.5% of patients were malnourished or at risk of malnutrition. Caregiver burden remained mild to moderate in 69.8% of cases. In addition, 80% of patients still lived at home and 71.6% used at least 2 support services, consisting mainly of physician visits and home help. Conclusion: Assessment of remaining cognitive, functional abilities and behavioral disorders at entry to severe AD should help to improve targeted management aimed at preserving these abilities and treating complications, thereby optimizing these patients’ quality of life.
Rate of Change of Functional Abilities in Frontotemporal Dementia
Authors: Mioshi E. , Hodges J.R.
Published: November 2009

Background: Frontotemporal dementia (FTD) causes progressive change in activities of daily living (ADLs) and little is known about their rate of decline. This study aimed to examine changes in ADLs, including subcomponents of initiation, planning or execution. Methods: A total of 72 ADL and general cognitive assessments were analysed. The patients were subdivided into behavioural variant FTD (bvFTD) pathological and phenocopy subgroups, semantic dementia (SemDem) and progressive non-fluent aphasia (PNFA). Results: Pathological bvFTD, SemDem and PNFA groups showed significant decline on ADLs after 12 months, while the phenocopy subgroup did not. In terms of subcomponents of ADLs, each variant showed different profiles of decline. The decline in ADL and cognitive scores were significantly correlated. Conclusions: FTD variants show differential annual rates of functional decline. The rate of decline should be taken into consideration when discussing prognosis.
Stroke in Myopathies
Authors: Finsterer Josef , Stöllberger Claudia
Published: November 2009

Objectives: Only few data are available about the risk of myopathy patients experiencing a cerebral stroke. Aims: To review the current knowledge about the frequency, pathogenesis, and outcome of stroke in primary/secondary myopathies. Methods: Literature review of all human studies dealing with stroke in primary/secondary myopathies. Results: Stroke in myopathies may be either ischemic, metabolic, or cryptogenic. Ischemic stroke may be further classified as cardioembolic, angiopathic, hemodynamic, or thrombophilic. Cardioembolic stroke occurs if there is cardiac involvement in the form of atrial fibrillation/flutter, dilated cardiomyopathy, or non-compaction. Angiopathic stroke occurs if there is atherosclerosis (frequently associated with mitochondrial disorders (MIDs), vasculitis, or dissection in inflammatory myopathies) or MIDs. Thrombophilic stroke may occur in poly-/dermatomyositis if there is additional anti-phospholipid syndrome. Metabolic stroke usually manifests as stroke-like episode and is a distinct feature of various MIDs, particularly MELAS syndrome. The clinical manifestations are due to a vasogenic edema, showing up as hyperintensity on T2, DWI, and apparent diffusion coefficient mapping. Differentiation between ischemic and metabolic stroke is essential in terms of diagnosis, therapy, and prognosis. Conclusions: Ischemic stroke due to cardioembolism, arteriopathy, or thrombophilia are rare events in myopathies, but metabolic stroke is a frequent feature of MIDs, with distinct diagnostic and therapeutic implications.
Cerebral White Matter Hyperintensities Predict Functional Stroke Outcome
Authors: Liou Li-Min , Chen Chien-Fu , Guo Yuh-Cherng , Cheng Hsiu-Ling , Lee Hui-Lin , Hsu Jui-Sheng , Lin Ruey-Tay , Lin Hsiu-Fen
Published: November 2009

Background: Growing evidence suggests that white matter hyperintensities (WMHs) are implicated in stroke recurrence and mortality, and their location can be a critical factor. This study evaluated the impact of periventricular WMHs (PVWMHs) and subcortical WMHs (SWMHs) on poststroke functional outcomes. Methods: Brain MRI was performed on 187 acute ischemic stroke patients (57.8% male; mean age = 64.3 years) recruited from the Kaohsiung Municipal Hsiao-Kang Hospital from February 2007 to January 2008. A Fazekas score ≥2 in the periventrcular or subcortical white matter was taken as presence of WMHs. Demographic data and risk factors for stroke were assessed. Functional stroke outcomes were evaluated 30 days after stroke using the Barthel Index (BI) and the modifiedRankin Scale (mRS). Results: WMHs were inversely linked to favorable functional outcome measured by mRS (p = 0.001) and BI (p = 0.003). Evaluating different locations, PVWMHs were associated with unfavorable functional outcomes (p = 0.002, mRS; p = 0.001, BI). SWMHs were related to mRS (p = 0.026) but not BI (p = 0.069). After controlling other stroke risk factors, infarct volumes and initial stroke severity, PVWMHs were a significant indicator for both mRS (OR = 2.76; 95% CI = 1.03–7.40) and BI (OR = 3.07; 95% CI = 1.13–8.40), but SWMHs were not. Conclusions: Unfavorable functional stroke outcome is associated with MRI WMHs. In terms of location, PVWMHs but not SWMHs are related to functional stroke outcome.
Obstructive Sleep Apnea Is Frequent in Patients with Hypertensive Intracerebral Hemorrhage and Is Related to Perihematoma Edema
Authors: Pontes-Neto Octavio M. , Fernandes Regina M.F. , Sander Heidi H. , da Silva Larissa A.T. , Mariano Débora C. , Nobre Fernando , Simão Gustavo , de Araujo Draulio B. , dos Santos Antonio C. , Leite João P.
Published: November 2009

Background: Obstructive sleep apnea (OSA) is related to increased systemic inflammation and arterial hypertension. We hypothesize that OSA is frequent in patients with acute hypertensive intracerebral hemorrhage (ICH) and is related to the perihematoma edema. Methods: Thirty-two non-comatose patients with a hypertensive ICH underwent polysomnography in the acute phase. Perihematoma edema volume was measured on CT scans at admission, after 24 h (early control) and after 4–5 days (late control). The Spearman coefficient (rs) was used for correlations. Results: OSA occurred in 19 (59.4%) patients. The apnea-hypopnea index was correlated with relative edema at admission CT (rs = 0.40; p = 0.031), early CT (rs = 0.46; p = 0.011) and at late CT (rs = 0.59; p = 0.006). Conclusions: OSA is highly frequent during the acute phase of hypertensive ICH and is related to perihematoma edema.
Stroke Associated with Atrial Fibrillation – Incidence and Early Outcomes in the North Dublin Population Stroke Study
Authors: Hannon Niamh , Sheehan Orla , Kelly Lisa , Marnane Michael , Merwick Aine , Moore Alan , Kyne Lorraine , Duggan Joseph , Moroney Joan , McCormack Patricia M.E. , Daly Leslie , Fitz-Simon Nicola , Harris Dawn , Horgan Gillian , Williams Emma B. , Furie Karen L. , Kelly Peter J.
Published: November 2009

Background: Prospective population-based studies are important to accurately determine the incidence and characteristics of stroke associated with atrial fibrillation (AF), while avoiding selection bias which may complicate hospital-based studies. Methods: We investigated AF-associated stroke within the North Dublin Population Stroke Study, a prospective cohort study of stroke/transient ischaemic attack in 294,592 individuals, according to recommended criteria for rigorous stroke epidemiological studies. Results: Of 568 stroke patients ascertained in the first year, 31.2% (177/568) were associated with AF (90.4%, i.e. 160/177 ischaemic infarcts). The crude incidence rate of all AF-associated stroke was 60/100,000 person-years (95% CI = 52–70). Prior stroke was almost twice as common in AF compared to non-AF groups (21.9 vs. 12.8%, p = 0.01). The frequency of AF progressively increased across ischaemic stroke patients stratified by increasing stroke severity (NIHSS 0–4, 29.7%; 5–9, 38.1%; 10–14, 43.8%; ≥15, 53.3%, p < 0.0001). The 90-day trajectory of recovery of AF-associated stroke was identical to that of non-AF stroke, but Rankin scores in AF stroke remained higher at 7, 28 and 90 days (p < 0.001 for all). Discussion: AF-associated stroke occurred in one third of all patients and was associated with a distinct profile of recurrent, severe and disabling stroke. Targeted strategies to increase anticoagulation rates may provide a substantial benefit to prevent severe disabling stroke at a population level.
Transient Ischemic Attack after Tissue Plasminogen Activator: Aborted Stroke or Unnecessary Stroke Therapy?
Authors: Uchino Ken , Massaro Lori , Hammer Maxim D.
Published: November 2009

Background: The frequency with which intravenous thrombolysis for acute ischemic stroke results in normal clinical and radiographic status is currently unknown. Methods: Patients who received intravenous thrombolysis at community hospitals and a stroke center were retrospectively analyzed for occurrence of normal imaging after tissue plasminogen activator (tPA) treatment. The cases were classified as nonischemic process (stroke mimic), transient ischemic attack (TIA) or ischemic stroke. The occurrence rate and predictors of each condition were sought. Results: Of 254 patients who received tPA, 9 (3.5%) had a nonischemic process, 23 (9.1%) had TIA, and 222 (87%) were diagnosed with ischemic stroke. Nonischemic process patients were younger and were more likely to have received tPA at a community hospital than those with TIA or stroke. TIA was associated with lower pretreatment serum glucose, prevalence of coronary artery disease and stroke severity but not to time to treatment. Conclusion: Over 10% of patients who receive tPA for cerebral ischemia do not develop ischemic injury. tPA use for a nonischemic process is infrequent but is associated with community hospital use.
Relevant Category-Specific Effect on Naming in Alzheimer’s Disease
Authors: Martinaud Olivier , Opolczynski Gaëlle , Gaillard Marie-José , Hannequin Didier
Published: November 2009

Aim: To determine category effect on naming in Alzheimer’s disease (AD) and its relation with severity of the disease or naming deficit. Methods: A group of 50 patients suffering from probable AD was tested in a naming task involving 99 pictures of items belonging to living and non-living categories. Parameters relating to pictures (percentage of majority responses, familiarity, visual complexity and image agreement) were determined using a control group and parameters relating to words (frequency, age of acquisition, number of letters and syllables) were controlled. Results: A category-specific effect was demonstrated and individual stepwise logistic regression demonstrated a significant category effect in 9 cases (living items more failed than non-living). Conclusion: Our results suggest a categorical effect on naming in favor of the non-living items, especially for mild AD with predominant naming deficit.
Cortical Thickness Analysis to Detect Progressive Mild Cognitive Impairment: A Reference to Alzheimer’s Disease
Authors: Julkunen Valtteri , Niskanen Eini , Muehlboeck Sebastian , Pihlajamäki Maija , Könönen Mervi , Hallikainen Merja , Kivipelto Miia , Tervo Susanna , Vanninen Ritva , Evans Alan , Soininen Hilkka
Published: November 2009

Background/Aims: Mild cognitive impairment (MCI) is associated with an increased risk of Alzheimer’s disease (AD). It would be advantageous to be able to distinguish the characteristics of those MCI patients with a high probability to progress to AD if one wishes to monitor the disease development and treatment. Methods: We assessed the baseline MRI and maximum of 7 years clinical follow-up data of 60 MCI subjects in order to examine differences in cortical thickness (CTH) between the progressive MCI (P-MCI) and stable MCI (S-MCI) subjects. CTH was measured using an automatic computational surface-based method. During the follow-up, 15 MCI subjects converted to AD on average 1.9 ± 1.3 years after the baseline examination, while 45 MCI subjects remained stable. Results: The P-MCI group displayed significantly reduced CTH bilaterally in the superior and middle frontal, superior, middle and inferior temporal, fusiform and parahippocampal regions as well as the cingulate and retrosplenial cortices and also in the right precuneal and paracentral regions compared to S-MCI subjects. Conclusions: Analysis of CTH could be used in conjunction with neuropsychological testing to identify those subjects with imminent conversion from MCI to AD several years before dementia diagnosis.
T-Lymphocytes and Disease Mechanisms in Wegener’s Granulomatosis
Authors: Hua Fan , Wilde Benjamin , Dolff Sebastian , Witzke Oliver
Published: November 2009

The mechanisms underlying Wegener’s granulomatosis (WG) are not well understood. The role of T-cells in the pathogenesis of WG has only recently come into focus of research. This review presents recent developments regarding the role of T-cells in WG. The occurrence of anti-neutrophil-cytoplasmic antibodies (ANCA) directed against proteinase-3 (PR-3) is a hallmark of WG. ANCA seem to mediate vasculitic damage in WG. Apart from ANCA, T-cells are involved in disease mechanisms. T-cells might participate in ANCA formation. Furthermore, T-cells are observed in affected tissue and granulomatous lesions. T-cells are indispensable for granuloma formation in other diseases and this might apply to WG too. In line with this, several aberrations of T-cell populations and alterations of the T-cell response were recently discovered in patients suffering from WG. Therefore, the impact of T-cell polarization, genotypic alterations modifying T-cell function and specific T-cell subsets on disease pathogenesis is discussed. Moreover, the influence of Staphylococcus aureus on T-cells and self-tolerance in WG is further elucidated. Finally, therapeutic options and implications with regard to T-cell-mediated pathogenesis are highlighted.
The Hyperdense Anterior Cerebral Artery Sign (HACAS) as a Computed Tomography Marker for Acute Ischemia in the Anterior Cerebral Artery Territory
Authors: Jensen Ulf R. , Weiss Michael , Zimmermann Philip , Jansen Olav , Riedel Christian
Published: November 2009

Background: Hyperdense arteries in cranial CT of acute stroke patients have been described as a sign for acute ischemia in various brain-feeding arteries. However, only 1 case of a hyperdense anterior cerebral artery sign (HACAS) has been published to date. In this study, the frequency and association of HACAS with clinical symptoms and outcome are described. Methods: Our radiological databases were searched for patients with infarcts in the territory of the anterior cerebral artery (ACA). Only patients who received an initial CT and a follow-up CT or MRI were included. The presence of a HACAS was rated by 2 independent observers using the Cohen κ-statistics. Further data recorded were early ischemic signs, final size of infarct, symptoms, initial NIHSS (National Institute of Health Stroke Scale) score, latency between symptom onset and initial CT, etiology, modified Rankin Scale (mRS) score at discharge and secondary hemorrhage. Results: A HACAS could be visualized in 11/24 patients (46%). Interobserver agreement was substantial with Cohen’s κ = 0.66. Patients with a HACAS had a significantly higher NIHSS score (9.45 ± 8.41; median: 8) than those without (3.69 ± 2.09; median: 4). A HACAS was visible more frequently when the CT was performed early (<2.5 h after symptom onset). There was no correlation with single symptoms, size of infarct, etiology, mRS or the tendency to hemorrhage. Conclusions: HACAS is associated with a higher NIHSS score. It is an early sign of ischemia which can be reversible over time. It can be helpful in the detection of ischemia in the territory of the ACA.