Does the training of mentors increase the contact frequency and the quality of support in a portfolio-based teaching module?

Introduction: All over the world, mentors are employed more and more for portfolio-based training modules in order to support the learner’s learning- and reflection process.

Within the final year of medical education, tertial internal medicine, the University Hospital of Erlangen, Department of Medicine 1 offered trainings for mentors.

In the framework of the student’s evaluation of this training period it was asked whether and what kind of effect the mentor training has had on the contact frequency between mentor and student and whether it affects how students experience the mentor’s support.

Methods: Since spring 2005, the Medizinische Klinik 1 held one-day-long mentor trainings, and in the following two years, about half of the medical staff attended. During the following four years, both trained and untrained mentors participated.

At the end of the training section the students evaluated the contact to their mentor with a structured question form. The questions on the contact frequency and how the students experienced the support through the mentor were evaluated for the present study.

186 question forms were evaluated; 67 of them related to trained mentors.

Result: One year after the first training, the students rated the trained mentor’s support significantly higher than the support by untrained mentors. There was a tendency noted, though not significant, for a higher contact frequency with the trained mentors.

During the following three years, the measurable difference between the trained and untrained mentors regarding both items was not significant. In those years, a tendency towards a more intensive support of the students through all mentors was shown.

Discussion: The evaluation results one year after the intervention imply that trained mentors can intensify their support for the students without requiring more time. The positive development of the evaluation results for both mentor groups during the following three years can be interpreted as a result of the process of exchange between trained and untrained mentors and readjustment among staff.

The Virtual Family--development of surface-based anatomical models of two adults and two children for dosimetric simulations

The objective of this study was to develop anatomically correct whole body human models of an adult male (34 years old), an adult female (26 years old) and two children (an 11-year-old girl and a six-year-old boy) for the optimized evaluation of electromagnetic exposure. These four models are referred to as the Virtual Family. They are based on high resolution magnetic resonance (MR) images of healthy volunteers. More than 80 different tissue types were distinguished during the segmentation. To improve the accuracy and the effectiveness of the segmentation, a novel semi-automated tool was used to analyze and segment the data. All tissues and organs were reconstructed as three-dimensional (3D) unstructured triangulated surface objects, yielding high precision images of individual features of the body. This greatly enhances the meshing flexibility and the accuracy with respect to thin tissue layers and small organs in comparison with the traditional voxel-based representation of anatomical models. Conformal computational techniques were also applied. The techniques and tools developed in this study can be used to more effectively develop future models and further improve the accuracy of the models for various applications. For research purposes, the four models are provided for free to the scientific community.

Gender-based differences in drug prescription: relation to adverse drug reactions

BACKGROUND/AIM

The female gender appears to suffer from more adverse drug reactions (ADRs) than the male gender. So far, there has been no epidemiologic study analyzing gender-based differences in drug prescribing and its ADR risks. The aim of the present study was to establish a drug risk stratification adjusted to age, number of prescriptions and drug classes with respect to gender differences based on intensive data acquisition methods.

METHOD

A prospective multicenter study was conducted in several departments in Germany and Israel (pediatrics, medicine and geriatrics) enclosing 2,371 inpatients.

RESULTS

A total of 25,532 drug prescriptions during hospitalization were evaluated. At least 1 ADR was found in 774 patients (32.6%). Drugs for the cardiovascular system, nervous system, alimentary tract and musculoskeletal system were prescribed most often in females. The following drug classes led significantly more often to ADRs in women as compared to men: alimentary tract (OR 0.5; p = 0.0002), cardiovascular system (OR 0.72; p = 0.0140), musculoskeletal system (OR 0.31; p = 0.0004) and nervous system (OR 0.62; p = 0.0023). After adjustment to age, total number of prescriptions and drug class, only anti-infectives (antibacterials) and musculoskeletal system (anti-inflammatory) drugs stand out as causing more ADRs in women.

CONCLUSION

Antibacterials and anti-inflammatory agents cause more ADRs in females as compared to males.

Characteristics of metachronous colorectal adenomas found during long-term follow-up: analysis of four subsequent generations of adenoma recurrence

OBJECTIVE

Because of the high recurrence rates of colorectal adenomas, regular surveillance by colonoscopy has been recommended, but there is still a dearth of information on the long-term results of follow-up colonoscopy after polypectomy. The aims of this study were to determine the differences between initial adenomas and metachronous lesions, to evaluate the effect of long-term surveillance and to describe the hypothetical origin of the colorectal adenoma-carcinoma sequence.

MATERIAL AND METHODS

Between 1978 and 2003 a total of 1091 patients undergoing periodic surveillance examinations were prospectively documented at the Erlangen Registry of Colorectal Polyps. Differences between initial and metachronous lesions found during long-term follow-up were studied. Statistical analysis using chi(2) testing of adenoma characteristics found in four subsequent recurrence periods was carried out, and the relative risk (RR) for the development of metachronous adenomas of advanced pathology was calculated.

RESULTS

In comparison with the initial findings, metachronous adenomas are generally significantly smaller lesions (p<0.00001), usually tubular in shape (p<0.00001) and bearing high-grade dysplasia less often (p<0.00001) and are usually located in the right colon (p<0.00001). These differences are found between the initial and four subsequent generations of metachronous adenomas. The number of synchronous adenomas is reduced only in the first recurrence (p<0.001); in the further generations equal proportions of multiplicity are found, as in the baseline examination. Patients with adenomas of advanced pathology, i.e. large, tubulovillous or villous adenomas at baseline, have a significantly higher risk for large (RR 2.73; 95% CI 1.77-4.20), tubulovillous or villous (RR 1.55; 95% CI 1.06-2.25) or multiple (RR 2.45; 95% CI 1.83-3.29) metachronous adenomas at the first recurrence.

CONCLUSIONS

Metachronous adenomas show the uniform characteristics of being small tubular lesions rarely bearing high-grade dysplasia, usually located in the right colon. Thus regular follow-up colonoscopy can provide sufficient colorectal carcinoma prevention.

Activation of tumor-specific T lymphocytes after laser-induced thermotherapy in patients with colorectal liver metastases

PURPOSE

To asses if laser-induced thermotherapy (LITT) induces a specific cytotoxic T cell response in patients treated with LITT for colorectal cancer liver metastases.

METHODS

Eleven patients with liver metastases of colorectal cancer underwent LITT. Blood was sampled before and after LITT. Peripheral T cell activation was assessed by an interferon gamma (IFNg) secretion assay and flow cytometry. Test antigens were autologous liver and tumor lysate obtained from each patient by biopsy. T cells were stained for CD3/CD4/CD8 and IFNg to detect activated T cells. The ratio of IFNg positive to IFNg negative T cells was determined as the stimulation index (SI). To assess cytolytic activity, T cells were co-incubated with human colorectal cancer cells (CaCo) and cytosolic adenylate kinase release was measured by a luciferase assay.

RESULTS

IFNg secretion assay: before LITT SI was 12.73 (+/-4.83) for CD3+, 4.36 (+/-3.32) for CD4+ and 3.64 (+/-1.77) for CD8+ T cells against autologous tumor tissue. Four weeks after LITT SI had increased to 92.09 (+/-12.04) for CD3+ (P < 0.001), 42.92 (+/-16.68) for CD4+ (P < 0.001) and 47.54 (+/-15.68) for CD8+ T cells (P < 0.001) against autologous tumor tissue. No increased SI was observed with normal liver tissue at any time point. Cytotoxicity assay: before LITT activity against the respective cancer cells was low, with RLU = 1,493 (+/-1,954.68), whereas after LITT cytolytic activity had increased to RLU = 7,260 [+/-3,929.76 (P < 0.001)].

CONCLUSION

Patients with liver metastases of colorectal cancer show a tumor-specific cytotoxic T cell stimulation and a significantly increased cytolytic activity of CD3+, CD4+ and CD8+ T cells after LITT against an allogenic tumor (CaCo cell line).

Cellular plasticity of trans- and dedifferentiation markers in human hepatoma cells in vitro and in vivo

Tumor cells have the capability to trans- and to dedifferentiate, for example by reactivating embryonic development genes and stem cell characteristics. The aim of our study was to show the differential expression of stem- and progenitor cell markers in human hepatocellular carcinoma cell lines (HCC). Different human HCC cell lines (HUH7, HUH7 5-15, HUH7 pcDNA3.1, Hep3B and HepG2) were cultured under standard conditions in vitro or implanted subcutaneously (5x10(6) cells) in male NMRI mice. Specimens were characterized by quantitative real-time PCR, Western blotting, methylation-specific PCR and immunohistochemistry for markers of differentiation (cytokeratins, vimentin), embryonic development or stem cells (PTC, PDX-1, SHH, Thy1, c-kit, CD34, beta-catenin, Ki-67). The investigated HCC cell lines showed different patterns of marker expression allowing to distinguish four distinct groups: the classical cholangiocellular type (Huh-7, Huh-7 pcDNA3.1, Hep3B) with expression of CK7/19, beta-catenin and CD34; a dedifferentiated mesenchymal-proliferative type (Huh-7 5-15) characterized by CK19, Vimentin and Ki-67; a dedifferentiated embryonic-development type (Hep3B implanted in matrigel) with expression of CK19, beta-catenin and PTC and a classical HCC type (HepG2) showing CK18/19 and beta-catenin expression. HCC cell lines showed significantly different expression patterns of differentiation markers in a xenograft model. Furthermore, direct association of some markers was observed. The groups differ from each other in expression patterns, but also show that environmental factors play an important role in the behaviour of cells.

Percutaneous endoscopic jejunostomy and jejunal extension tube through percutaneous endoscopic gastrostomy: a retrospective analysis of success, complications and outcome

BACKGROUND

Percutaneous access to the jejunum is an important approach if gastrostomy feeding is not possible.

OBJECTIVE

To analyze success, short- and long-term complications (STCs, LTCs) in patients with percutaneous endoscopic jejunostomy (PEJ) and jejunal access through percutaneous endoscopic gastrostomy (Jet-PEG).

METHODS

A retrospective analysis of endoscopically placed PEJs and Jet-PEGs. Success rates, mortality, STCs and LTCs were investigated for risk factors comprising demographic data, underlying disease, previous surgery and experience of the endoscopist.

RESULTS

205 PEJ and 58 Jet-PEG placements were included in the study. PEJs and Jet-PEGs were successfully placed in 65.4 and 89.7%, respectively. Billroth II surgery predisposed in favor of a significantly higher success rate for PEJ placement (p = 0.014, OR = 2.27). Inexperienced examiners have a significantly (p = 0.040) lower success rate for tube insertion than examiners with a medium level of experience. STCs and LTCs occurred evenly in PEJ and Jet-PEG patients. Dislocation of the tube occurred significantly more frequently in Jet-PEG patients (33.3%, p = 0.005). Aspiration was most common for bedridden patients.

CONCLUSION

PEJ has a significantly lower success rate for insertions, but fewer LTCs. The experience of the endoscopist correlates with the success rate of tube insertion.

Lung volumes and mean apnea duration in obstructive sleep apnea

Former studies suggested that lung volumes might play a role in pathomechanisms of obstructive sleep apnea (OSA). Mean apnea duration (MAD) is a rarely investigated parameter in OSA but is possibly a surrogate of arousal threshold. The aim of this study was to evaluate the influence of lung volumes to MAD in OSA. In 69 patients with obstructive sleep apnea (51 male und 18 female, BMI 34.2+/-6.0 kg/m(2), age 53.6+/-9.7 years, AHI 43.1+/-21.1/h) we performed a polysomnography and pulmonary function testing in daytime. There was a significant correlation between MAD and residual volume (RV) (r=0.51; p<0.001), which was the highest correlation we found. In linear regression analysis RV remained the only independent variable with significant influence on MAD (p<0.001). We could show that RV seems to play a role in the mechanisms of apnea termination in terms of MAD. MAD reflects the time until a specific negative intrathoracic pressure is reached to induce an arousal. In this process dependency on RV could explain our results. Despite some limitations these results provide some new aspects in understanding pathophysiology of OSA.

Night eating, binge eating and related features in patients with obstructive sleep apnea syndrome

The aim of the study was to explore the nature and extent of the association between night eating, other forms of disordered eating and obstructive sleep apnea (OSAS).Eighty-one participants (20 women and 61 men), mean age 53.7 years diagnosed with OSAS were assessed prior to starting treatment. Using a cut-off of > or =25 on the Night Eating Questionnaire (NEQ), 8.6% of the participants screened positive for night eating syndrome (NES). In addition, 7.5% met criteria for a daytime eating disorder. NES was significantly associated with diagnoses of depression, anxiety and eating disorders and was significantly correlated with an impairment of mental quality of life. No associations were found between NES and gender, BMI and the severity of the OSAS. NES does not appear to be closely linked to OSAS; however, in patients with OSAS and NES a significant co-morbidity with psychiatric disorders can be expected which might require additional treatment.

Peginterferon alfa-2a relapse rates depend on weight-based ribavirin dosage in HCV-infected patients with genotype 1: results of a retrospective evaluation

OBJECTIVE

The cumulative dosage of ribavirin per kilogram of body-weight prevents relapse and thus is a significant predictor of sustained virological response (SVR). Comparison of peginterferon (peg-IFN) alfa-2b/ribavirin and peg-IFN alfa-2a/ribavirin shows that the rates of SVR are similar, but the rates of relapse are significantly lower under the peg-IFN alfa-2b regimen. Depending on the weight-based ribavirin dose, patients with >105 kg reach a maximum of 13.2 mg/kg body-weight ribavirin in the peg-IFN alfa-2b regimen as opposed to only 11.3 mg/kg in the peg-IFN alfa-2a regimen. The aim of these investigations was to determine relapse rates in a retrospective analysis of 98 patients chronically infected with hepatitis C virus (HCV) genotype (GT) 1 in relation to the weight-based ribavirin dose.

MATERIAL AND METHODS

All patients completed treatment with peg-IFN alfa-2a/ribavirin (1000 mg/d or 1200 mg/d for patients weighing <75 kg or > or =75 kg) for 48 weeks. Classification of a low ribavirin dose with <13.2 mg/kg body-weight was used. Patients with a ribavirin dose > or =13.2 mg/kg were compared with those with a dose <13.2 mg/kg.

RESULTS

Patients with a ribavirin dose > or = 13.2 mg/kg (n=84) showed a relapse rate of 19.0% in contrast to 71.4% in patients with a ribavirin dose of <13.2 mg/kg (n=14) (p=0.0013). The SVR rate was significantly higher in the > or =13.2 mg/kg ribavirin dosed group (59.5% versus 28.6%).

CONCLUSIONS

Weight-adapted ribavirin dosing in combination with peg-IFN alfa-2a to avoid giving low doses of ribavirin should be evaluated. This will minimize relapse, especially in HCV GT 1 patients.

The differential diagnosis of food intolerance

INTRODUCTION

More than 20% of the population in industrialized countries suffer from food intolerance or food allergy.

METHODS

Selective literature search for relevant publications in PubMed and the Cochrane Library combined with further data from the interdisciplinary database on chronic inflammatory and allergic diseases of the Erlangen University Hospital.

RESULTS

The majority of cases of food intolerance (15% to 20%) are due to non-immunological causes. These causes range from pseudoallergic reactions to enzymopathies, chronic infections, and psychosomatic reactions that are associated with food intolerance. The prevalence of true food allergy, i.e., immunologically mediated intolerance reactions, is only 2% to 5%.

CONCLUSIONS

The differential diagnosis of food intolerance is broad. Therefore, a structured diagnostic algorithm with input from multiple clinical disciplines should be applied. The treatment consists of eliminating the offending substance from the diet as well as medications and psychosomatic support, when indicated.

Long-term partial remission of autoimmune thrombocytopenia in a patient treated with the anti-tumor necrosis factor-alpha antibody infliximab for refractory fistulizing Crohn's disease

BACKGROUND

Up to the present date, the treatment of recurrent chronic fistulas occurring with Crohn's disease represents a challenging task for both internists and surgeons alike.

METHODS

Conservative methods of treatment using steroids, dietotherapy, antibiotics or immunosuppressive agents are not particularly effective in treating fistulas. Treatment with anti-tumor necrosis factor-alpha (TNFalpha) antibodies results in more remissions of fistulas. However, its use requires appropriate medical experience and causes substantial costs. Surgical procedures such as fistula sanitation or protective ileostomy are often obfuscated by the recurrence of the condition. The efficiency of anti-TNFalpha antibodies for the treatment of active Crohn's disease has been evidenced through several multicenter, double-blind, placebo-controlled studies.

RESULTS

Here we report the successful anti-TNFalpha treatment of a patient suffering from chronic, fistulizing, therapy-resistant Crohn's disease and a concomitant chronic autoimmune thrombocytopenia. The chimeric anti-TNFalpha antibody infliximab markedly reduced the disease activity of Crohn's disease, and, in addition, substantially increased the platelet counts. After infliximab application, no other treatment of autoimmune thrombocytopenia was required. After infliximab therapy, autoantibodies to dsDNS could be observed. However, there were no signs of a lupus-like disease.

CONCLUSION

This report indicates a favorable therapeutic response of autoimmune thrombocytopenia associated to Crohn's disease.

[Spectrum and bleeding complications of sonographically guided interventions of the liver and pancreas]

PURPOSE

Sonographically guided fine-needle punctures (p.) are considered to be a low risk procedure. Interventions with needles with a larger diameter seem to cause more complications. In search of potential complications, we examined 1923 sonographically guided interventions of the liver and pancreas in a retrospective analysis.

MATERIALS AND METHODS

We examined the coherence of the kind of intervention and complications. We considered bleeding with a need for transfusion and/or a need for surgical treatment as complications. Diseases and medication increasing the probability of post-interventional bleeding were also detected.

RESULTS

1923 sonographically guided interventions in the abdomen (1800 in the liver, 123 in the pancreas) were analyzed (n = 1696 diagnostic interventions, n = 227 therapeutic interventions). Needles with diameters > 1 mm were primarily used. Drainage and radiofrequency ablation (RFA) (12 % of all interventions) were performed with devices with diameters between 2 - 3.96 mm. A need for transfusion was found in 8 / 1923 patients (0.4 %), predominantly in the first 24 h. There was no significant correlation between coagulation preventing drugs (heparin, NSAIDs, antiaggregants) and bleeding events. Patients who suffered from liver cirrhosis with a thromboplastin time of < 50 % had a higher risk of post-interventional bleeding than patients with liver cirrhosis and a thromboplastin time > 50 %. Furthermore, therapeutic interventions showed higher complication rates than diagnostic procedures.

CONCLUSION

Severe bleeding complications with a need for transfusion in sonographically guided procedures are rare (0.4 %). Our results showed that liver cirrhosis with a low thromboplastin time (< 50 %) seems to be the most important risk factor for patients. Overall, sonographically guided interventions are safe and have low complication rates considering careful performance and contraindications.

Liver function under interferon/ribavirin therapy of chronic hepatitis C

BACKGROUND

Quantitative testing of liver function (QTLF) is one way to show the efficacy of antiviral treatment of Hepatitis C. Data on liver function in patients with chronic Hepatitis C during antiviral therapy are lacking. We therefore investigated if and to what extent antiviral therapy influenced quantitative testing of liver function (QTLF).

METHODOLOGY

One hundrend seven patients with chronic Hepatitis C (genotype 1) were treated with pegylated-interferon 2alpha/ribavirin for 48 weeks. Quantitative testing of liver function, including aminopyrine breath test (ABT), galactose elimination capacity (GEC), sorbitol clearance (SCl) and indocyanine green clearance (ICG) was performed before and 12 weeks after initiation of antiviral therapy. QTLF was repeated at the end of the therapy (week 48) and 6 months after therapy.

RESULTS

After 3 months of treatment, 97 patients showed normal transaminases and were negative for HCV-RNA. ABT and GEC as parameters of microsomal and cytosolic liver function were reduced in all patients before therapy initiation and returned to normal values in the therapy responders after 3 months. Parameters of liver perfusion (SCl and ICG) require one year of treatment before returning to normal levels. In non-responders, QTLF did not change during therapy, in relapsers, QTLF results deteriorated after ending the therapy.

CONCLUSION

All liver tests return to normal within one year after eradication of the Hepatitis C virus. Parameters measuring the liver plasma flow (SCI and ICG) require more time to become normal, most likely due to tissue remodelling processes.

Localization of the polyol pathway in the human kidney

Sorbitol plays an important role in the osmotic regulation of the mammalian kidney. Sorbitol synthesis is regulated by the enzyme aldose reductase (AR) and its degradation to fructose is catalyzed by the enzyme sorbitol dehydrogenase (SDH). Various data exist on the polyol pathway on the rat kidney, but little is known about the distribution of the polyol pathway enzymes in the human kidney. Determination of enzyme activities and a semiquantitative determination of mRNA expression, immunohistochemistry and in-situ hybridisation in healthy human kidney tissue was carried out. The enzyme activity of AR showed a fourfold increase from cortex to papilla, while SDH-activity dropped from cortex to papilla by a factor of four. Corresponding data was obtained at the mRNA level from the semiquantitative polymerase chain reaction (PCR). Additional differentiation at the cellular level reveals both enzymes in cells of the proximal and distal tubules, thick ascending loop, thin loop and collecting duct. Studies of enzyme activity and expression by immunohistochemistry, PCR and in-situ hybridization presented corresponding results with respect to the localization of the enzymes, which match the experimental data obtained from rats very well. Thus, the established rat model might well represent the situation in the human kidney, too.

[Renal cell cancer does not show a typical perfusion pattern in contrast-enhanced ultrasound]

PURPOSE

Grayscale ultrasound has improved the outcome of renal cell cancer (RCC), since most significant RCCs are discovered coincidently during routine abdominal ultrasound examinations. The CT scan is currently the method of choice for further evaluation. The therapeutic approach depends on the results of the CT scan. The purpose of this study was to evaluate whether RCCs would show typical vascularization patterns in contrast-enhanced ultrasonography (CEUS).

METHODS AND MATERIALS

We examined 30 patients with solid renal tumors before surgery with CEUS using the microbubble contrast agent SonoVue (Bracco, Italy). All patients had suspected malignant lesions on a CT scan. The examination was performed with an Acuson Sequoia (Siemens, Erlangen, Germany) with a low mechanical index (low MI) using the contrast agent imaging method "contrast pulsed sequencing" (CPS). We looked at the vascularization in the early phase (< 30 s) and the late phase (60 - 120 s). These findings were compared to the histopathological results.

RESULTS

25 (83 %) had an RCC, and two (7 %) patients showed an urothelial carcinoma. Benign tumors were diagnosed in three (10 %) patients. All of them were oncocytomas. In grayscale ultrasound 52 % of the RCCs were hypoechoic, 36 % isoechoic, and 12 % hyperechoic. After the application of the contrast agent, all RCCs showed a chaotic vascularization pattern. In the early phase (< 30 s), 12 tumors showed hyperperfusion, three showed isoperfusion, and nine showed hypoperfusion. During the late phase (60 - 120 s), five tumors showed hyperperfusion, nine showed isoperfusion, and ten showed hypoperfusion. One small cystic tumor did not indicate contrast enhancement at any time.

CONCLUSION

In our study RCC showed chaotic vascularization in CEUS without typical vascularization patterns.

Differences in the gene expression profile of matrix metalloproteinases (MMPs) and their inhibitors (TIMPs) in primary colorectal tumors and their synchronous liver metastases

BACKGROUND

Matrix metalloproteinases (MMPs) and their tissue inhibitors (TIMPs) have been strongly implicated in the pathogenesis of many types of human cancer. We wanted to specifically define their role in established colorectal cancer liver metastases.

PATIENTS AND METHODS

The MMP/TIMP expression profiles of N=9 colorectal primary tumour liver metastasis tissue pairs were determined using oligonucleotide-based arrays. Expression levels for the most relevant MMPs were confirmed by reverse-transcriptase polymerase chain reaction (RT-PCR). Additionally, unsupervised clustering using the MMP/TIMP profile of N=25 colorectal cancer liver metastases was performed and the response to palliative 5-fluorouracil (5-FU)-based chemotherapy was assessed using radiological response criteria.

RESULTS

When comparing the primary tumors to their synchronous liver metastases, a statistically significant (p < 0.05) down-regulation of MMP1, -2, -3 and -12 was found in the metastases. Unsupervised clustering using the MMP/TIMP profiles of 25 liver metastases revealed two distinct subgroups with different responses to palliative, 5-FU-based chemotherapy (response rates: 22% vs. 56%, respectively). In particular, higher MMP7, TIMP1 and TIMP2 levels were found in the unfavourable group, while higher expression of MMP2, -9, -11 and -14 was associated with a more favourable response to chemotherapy.

CONCLUSION

Colorectal cancer liver metastases show a distinctive MMP/TIMP profile with predictive implications.

BRAVO wireless 48 hour pH-metric system

The monitoring pH exposition in the esophagus plays an important role in the diagnosis of gastro-esophageal reflux disease (GERD). Recently, a new wireless method for intraesophageal pH measurement called the BRAVO system has been introduced for clinical application. This wireless system provides data on pH exposure of the esophagus through a small capsule clipped at the oesophageal mucosa. Since clinical introduction several studies have been published about safety, reliability, patient comfort and different clinical applications. This article provides an overview of different methods of capsule placement, complications, quality of the recorded data as well as future applications of the BRAVO system.

In vitro differentiation of human monocytes into dendritic cells by peptic-tryptic digest of gliadin is independent of genetic predisposition and the presence of celiac disease

INTRODUCTION

This study was done to further reveal the role of the innate immune system in celiac disease.

METHODS

Dendritic cells were matured from venous blood of patients with active or treated celiac disease and DQ2-DQ8-positive or negative controls. Dendritic cells were treated with a peptic-tryptic digest of gliadin (500 microg/ml) and their activation was analyzed by fluorescent-activated cell sorting analysis, cytokine secretion, and their ability to elicit T cell proliferation.

RESULTS AND DISCUSSION

Gliadin upregulated interleukin (IL)-6, IL-8, and IL-12 (p40) secretion in dendritic cells and induced strong expression of the maturation markers human leukocyte antigen (HLA)-DR, CD25, CD83, and CD86 of all subjects irrespective of their genotype or the presence of disease, whereas the digest of bovine serum albumin showed no effect. However, gliadin-stimulated dendritic cells from active celiac showed enhanced stimulation of autologous T cells compared to the other groups.

CONCLUSION

Further research should be aimed at identifying the mechanisms that control inflammation in healthy individuals.

The expression pattern of PDX-1, SHH, Patched and Gli-1 is associated with pathological and clinical features in human pancreatic cancer

BACKGROUND AND AIMS

Pancreatic cancer cells have been shown to possess stem-cell-like properties, especially by reactivating embryonic transcription factors involved in tissue differentiation. We therefore investigated if and to what extent developmental genes of the human pancreas are expressed in pancreatic ductal adenocarcinomas and precursor lesions, pancreatic intraepithelial neoplasia (PanIN), and if this correlates or predicts response to treatment and overall survival.

MATERIAL AND METHODS

Invasive ductal adenocarcinomas of the pancreas [UICC pT3pN0 (n = 13) vs. pT3pN1 (n = 25)] and tumors after neoadjuvant chemotherapy [5-fluorouracil (FU)/folic-acid and gemcitabine; UICC ypN0 (n = 7) vs. ypN1 (n = 6)] resected between 1997 and 2003 were characterized histochemically and immunohistochemically [pancreas duodenum homeobox 1 (PDX-1), Sonic hedgehog protein (SHH), Patched (Ptc) and Gli-1]. Gene distribution was compared with morphological patterns of the pancreatic carcinoma and PanIN as well as with peritumorous reactions of normal pancreas.

RESULTS

The overall expression of PDX-1, SHH, Ptc and Gli-1 was low, but showed a distinctive and topographic linkage inside pancreatic carcinomas as well as inside PanINs. Additionally, a topographic and significant association of these markers with nodal status (PDX-1, Ptc, Gli-1), tumor size (PDX-1, Gli-1) and R status (PDX-1) was found. After stratification with the strongest outcome predictor, grading, survival analysis revealed that Ptc expression in grade 2 and PDX-1 expression in grade 3 carcinomas are independent survival factors.

CONCLUSIONS

Markers of pancreas development are reexpressed in invasive ductal adenocarcinomas and their expression is essentially associated with general clinical and pathological features such as survival or nodal status.