Chest wall and intrathoracic desmoid tumors: surgical experience and review of the literature

Desmoid tumors are fibroblastic/myofibroblastic neoplasms, which originate from musculo-aponeurotic structures and are classified as deep fibromatoses. Despite their benign histologic appearance and lack of metastatic potential, desmoid tumors may cause aggres?sive local infiltrations and compression of surrounding structures. They are often associated with female gender, familial adenomatous polyposis (FAP) and sporadically may occur at sites of previous trauma, scars or irradiation. Molecular studies have demonstrated that these patients are associated with a bi-allelic APC mutation in the affected tissue. Radical tumor resection with free margins remains the first therapy of choice. In cases with anatomical or technical limitations for a wide excision, radiation therapy represents a proven and effective alternative or supplementary treatment.

Is obesity becoming a public health problem in India? Examine the shift from under- to overnutrition problems over time

This study aimed to examine the prevalence and trends of overweight, obesity and undernutrition in recent decades in India. Based on a systematic literature search on PubMed and other data sources, most published studies were regional or local surveys in urban areas, while good representative data from the India National Family Health Surveys (NFHS, 1992-1993, 1998-1999 and 2005-2006) allowed for examining the trends at the national level. Overall, the available data showed that in India, prevalence of overweight was low while that of undernutrition remained high. Overweight was more prevalent among female, urban and high-socioeconomic-status (SES) groups. NFHS data showed that the prevalence of overweight in women and pre-school children did not increase much in the last decade: 10.6% and 1.6% in 1998-1999 to 12.6% and 1.5% in 2005-2006 respectively. As for underweight, NFHS 2005-2006 showed high prevalence among ever-married women (about 35%) and pre-school children (about 42%). The prevalence of overweight and obesity had increased slightly over the past decade in India, but in some urban and high-SES groups it reached a relatively high level. Factors associated with undernutrition need closer examination, and prevention of obesity should be targeted at the high-risk groups simultaneously.

Synthesis and Characterization of Styrene-Butadiene Rubber-Clay Nanocomposites with Enhanced Mechanical and Gas Barrier Properties

Five styrene-butadiene rubber (SBR)/clay nanocomposite or hybrid systems were synthesized via mechanical mixing of SBR using a Brabender mixer and a 2-roll mill in the presence of unmodified sodium montmorillonite (Na-MMT) clay, MMT modified with octadecylamine (C18amine), MMT modified with a zwitterionic surfactant, octadecyldimethyl betaine (C18DMB), and MMT modified with a polymerizable cationic surfactant, vinylbenzyl octadecyldimethyl ammonium chloride (VODAC) or vinylbenzyl dodecyldimethyl ammonium chloride (VDAC). The surfactant chain length and functional groups affected the dispersion of clay nanolayers in the matrix and the overall properties of the nanocomposites. X-ray diffraction (XRD) revealed peaks corresponding to intercalated structures; transmission electron microscopy (TEM) observations agreed well with XRD assessment of the composites. SBR/VODAC-MMT system exhibited the best dispersion among the nanocomposites studied. VODAC-MMT was partially exfoliated in SBR matrix and the average aspect ratio of the nanolayer stacks or aggregates was high (20). Depending on the amount of clay, considerable mechanical reinforcement and gas barrier enhancement were achieved in nanocomposites over pure rubber. Tensile strength in excess of 18MPa was observed in SBR nanocomposites with 30 phr C18 organoclays. The storage modulus at 25C increased by a factor of four by incorporating 10 phr VODAC-MMT in SBR. The most pronounced oxygen barrier enhancement was again observed in SBR/VODAC-MMT nanocomposite with the reduction of permeability by 60% at silicate volume fraction of 0.06. The superior performance of nanocomposites containing VODAC-MMT is attributed to the presence of the vinyl-benzyl group and 18 carbon-atom tail in the surfactant leading to high compatibility with SBR and nano-scale dispersion in the SBR matrix.

Outcome of a conservative policy for managing acute sigmoid diverticulitis

Background

A conservative policy for patients presenting with acute sigmoid diverticulitis is associated with a low operation rate, and low overall and operative mortality rates. The long-term consequences of such a policy were investigated.

Methods

Data were collected prospectively for 232 patients with acute sigmoid diverticulitis between 1990 and 2004. Details of all subsequent readmissions were obtained and survival to August 2005 was analysed.

Results

Of the 232 patients admitted, 60 (25·9 per cent) were known to have diverticulosis; in 172 patients it was a new diagnosis. Thirty-eight patients (16·4 per cent) underwent sigmoid resection, with one death. Three elderly patients in whom a decision was made not to operate had perforated diverticulitis at autopsy. Of 191 patients discharged without resection, 35 (18·3 per cent) subsequently underwent sigmoid resection: 26 (13·6 per cent) elective and nine (4·7 per cent) emergency, with one death.

Conclusion

A conservative policy is safe in both the short term and the long term.

Endoscopic trans-anal resection of rectal tumours: critical appraisal of an interdisciplinary approach

OBJECTIVE

Endoscopic trans-anal resection (ETAR) is an accepted technique for treating benign rectal adenomas that relies on technical expertise with the urological resectoscope. We present our experience with ETAR in an interdisciplinary setting combining the decision-making of the colorectal surgeon with the technical skill of the urologist.

METHOD

Assessment of all patients with adenomas and their subsequent care was organized by the colorectal team. Those with carpet-like rectal adenomas were referred to the urologist for ETAR performed using a Storz-Olympus 27/28Ch resectoscope, with roller-ball for haemostasis and glycine for irrigation.

RESULTS

Twenty-four patients (43-93 years, median 71 years; 14 men and 10 women) underwent 51 ETAR procedures from 1999 to 2005, with a median of two (range 1-6) procedures per patient. Complete clearance was achieved on 25 occasions. Two intra-operative extra-peritoneal perforations occurred which were managed conservatively. There were four cases of postoperative haemorrhage, two of which required a repeat procedure to secure haemostasis. Four patients had postoperative pyrexia that settled with oral antibiotics. Mean tumour distance from the anal verge was 7 cm (range 2-12 cm); the mean tumour area was 8 cm(2) (range 3-20 cm(2)); the mean operating time was 34 min (range 15-60 min) and the mean hospital stay was 32 h (range 24-120 h).

CONCLUSION

An interdisciplinary approach to ETAR uses available clinical resources efficiently as the colorectal surgeon does need to acquire the technical skills of endoscopic resection. Our results compare favourably with other published series and this approach can be adopted by any centre where colorectal and urological surgeons work together.

Sleep duration and its correlates in a sample of Saudi elementary school children

INTRODUCTION

This study was conducted to estimate sleep duration in Saudi elementary school children, sleep habits and practices that may affect it, and compare our results to published data in other societies.

METHODS

Parents of elementary school children were surveyed regarding their children's bedtime, rise time, sleep duration at night and daytime nap duration during weekdays and weekends. A questionnaire inquiring about demographical data, specific sleep problems and habits, and home environment was completed by the parents.

RESULTS

The study comprised 511 (50.5 percent) boys and 501 (49.5 percent) girls. During weekdays, bedtime for the whole group was 21.3 +/- 1.8 hours, rise time was 5.9 +/- 0.5 hours, total sleep time (TST) was 8.4 +/- 1.1 hours, and TST and nap was 9.98 +/- 1.3 hours. Multivariate analysis revealed that TST was affected by regularity of bedtime, mother's level of education, daytime naps, and the habits of watching television (TV) and playing computer games after 20.00 hours.

CONCLUSION

Nighttime sleep duration is shorter in Saudi school children compared to published data. Several factors appeared to affect sleep duration, including mother's educational level, daytime naps and watching TV at night.

Mechanical devices for urinary incontinence in women

BACKGROUND

Incontinence can have a devastating effect on the lives of sufferers with significant economic implications. Non-surgical treatments such as pelvic floor muscle training and the use of mechanical devices are usually the first line of management. The latter more so when a person did not want surgery or when considered unfit for surgery. Mechanical devices are inexpensive and do not compromise future surgical treatment.

OBJECTIVES

To determine the effects of mechanical devices in the management of adult female urinary incontinence.

SEARCH STRATEGY

We searched the Cochrane Incontinence Group Specialised Trials Register (7 December 2005). The register contains trials identified from MEDLINE, the Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL and handsearching of journals and conference proceedings.

SELECTION CRITERIA

All randomised or quasi-randomised controlled trials of mechanical devices in the management of adult female urinary incontinence determined either by symptom classification or by urodynamic diagnosis.

DATA COLLECTION AND ANALYSIS

Three reviewers assessed the identified studies for eligibility and methodological quality and independently extracted data from the included studies. Data analysis was performed using RevMan software (version 4.2).

MAIN RESULTS

There were six trials involving a total of 286 women. Two small trials compared a mechanical device with no treatment and although they suggested that use of a mechanical device might be better than no treatment, the evidence for this was inconclusive. Five trials compared one mechanical device with another. Quantitative synthesis of data from these trials was not possible because different mechanical devices were compared in each trial using different outcome measures. Data from the individual trials showed no clear difference between devices, but with wide confidence intervals. There were no trials comparing a mechanical device with another type of treatment.

AUTHORS' CONCLUSIONS

The place of mechanical devices in the management of urinary incontinence remains in question. Currently there is little evidence from controlled trials on which to judge whether their use is better than no treatment and a large well-conducted trial is required for clarification. There was also insufficient evidence in favour of one device over another and no evidence to compare mechanical devices with other forms of treatment.

Mechanical devices for urinary incontinence in women

BACKGROUND

Incontinence can have a devastating effect on the lives of sufferers with significant economic implications. Non-surgical treatments such as pelvic floor muscle training and the use of mechanical devices are usually the first line of management. The latter more so when a person did not want surgery or when considered unfit for surgery. Mechanical devices are inexpensive and do not compromise future surgical treatment.

OBJECTIVES

To determine the effects of mechanical devices in the management of adult female urinary incontinence.

SEARCH STRATEGY

We searched the Cochrane Incontinence Group Specialised Trials Register (7 December 2005). The register contains trials identified from MEDLINE, the Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL and handsearching of journals and conference proceedings.

SELECTION CRITERIA

All randomised or quasi-randomised controlled trials of mechanical devices in the management of adult female urinary incontinence determined either by symptom classification or by urodynamic diagnosis.

DATA COLLECTION AND ANALYSIS

Three reviewers assessed the identified studies for eligibility and methodological quality and independently extracted data from the included studies. Data analysis was performed using RevMan software (version 4.2).

MAIN RESULTS

There were six trials involving a total of 286 women. Two small trials compared a mechanical device with no treatment and although they suggested that use of a mechanical device might be better than no treatment, the evidence for this was inconclusive. Five trials compared one mechanical device with another. Quantitative synthesis of data from these trials was not possible because different mechanical devices were compared in each trial using different outcome measures. Data from the individual trials showed no clear difference between devices, but with wide confidence intervals. There were no trials comparing a mechanical device with another type of treatment.

AUTHORS' CONCLUSIONS

The place of mechanical devices in the management of urinary incontinence remains in question. Currently there is little evidence from controlled trials on which to judge whether their use is better than no treatment and a large well-conducted trial is required for clarification. There was also insufficient evidence in favour of one device over another and no evidence to compare mechanical devices with other forms of treatment.

Cell viability effects of triamcinolone acetonide and preservative vehicle formulations

AIM

To assess the effect of triamcinolone acetonide and preservative vehicle formulations on human retinal pigment epithelium (ARPE19) cells over a range of concentrations.

METHODS

Triamcinolone acetonide, in its trade and preservative free formulations, along with the preservative vehicle were added to ARPE19 cell cultures in various concentrations (0.01-1.0 mg/ml). Cell viability was assessed using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay at day 5 after exposure. Functionality of the cultured ARPE19 cell line was confirmed by exposure to a previously characterised toxic agent, tamoxifen.

RESULTS

The ARPE19 cell line behaved as predicted with exposure to tamoxifen. All formulations caused significant reductions in ARPE19 cell viability at the highest concentrations (1.0 mg/ml for triamcinolone preparations and undiluted vehicle). Cell viability was reduced to the greatest degree in trade formulation triamcinolone, less so by the vehicle, and least by preservative free triamcinolone. At lower concentrations no significant effect on cell viability was observed, although cell viability was found to be inversely proportional to increasing concentration of all tested reagents

CONCLUSIONS

Both the trade and preservative free formulations of triamcinolone acetonide as well as the vehicle result in cell loss at in vitro concentrations of 1 mg/ml. Although this represents theoretical vitreous concentrations achieved with current widespread therapeutic use it probably does not indicate the actual exposure of cells in their biological milieu. That cell viability was reduced most in the trade formulation suggests a possible potentiated inhibitory toxic effect of triamcinolone acetonide and vehicle at higher concentrations.

Antioxidant vitamins E and C as adjunct therapy of severe acute lower-respiratory infection in infants and young children: a randomized controlled trial

OBJECTIVE

To evaluate the effect of antioxidant Vitamins E and C as adjunct therapy of severe acute lower respiratory infection (ALRI) in children.

DESIGN

Randomized double-blind placebo-controlled clinical trial.

SETTING

A large childrens' hospital serving the urban poor in Kolkata, India.

SUBJECTS

Children aged 2-35 months admitted with severe ALRI.

INTERVENTION

In total, 174 children were randomly assigned to receive alpha-tocopherol 200 mg and ascorbic acid 100 mg twice daily or placebo for 5 days. All children received standard treatment for severe ALRI. Outcome measures were: time taken to recover from a very ill status, fever, tachypnoea, and feeding difficulty; and improvement in oxidative stress and immune response indicated by thiobarbituric acid reacting substances (TBARS) and response to skin antigens, respectively.

RESULTS

Recovery rate ratios (95% CI) using proportional hazards model were 0.89 (0.64-1.25), 1.01 (0.72-1.41), 0.86 (0.57-1.29), and 1.12 (0.77-1.64) for very ill status, feeding difficulty, fever, and tachypnoea, respectively. TBARS values were high and similar in the two groups at admission, discharge, and at 2 weeks follow-up. Serum alpha-tocopherol significantly increased in treated group at discharge. Immune response to skin antigens were very poor at admission and after 2 weeks, in both groups.

CONCLUSION

Infants with severe ALRI failed to benefit from two antioxidant nutrients as adjunct therapy. Severe ALRI in infants may cause cell-mediated immune dysfunction. We need a better understanding of oxidative processes in growing infants to help us better design interventions with antioxidant therapy.

Brain-derived neurotrophic factor variants are associated with childhood-onset mood disorder: confirmation in a Hungarian sample

Brain-derived neurotrophic factor (BDNF) is a nerve growth factor that has been implicated in the neurobiology of depression. Our group has previously reported an association between a BDNF variant and childhood-onset mood disorder (COMD) in an adult sample from Pittsburgh. We hypothesize that variants at the BDNF locus are associated with COMD. Six BDNF polymorphisms were genotyped in 258 trios having juvenile probands with childhood-onset DSM-IV major depressive or dysthymic disorder. BDNF markers included the (GT)n microsatellite, Val66Met and four other single-nucleotide polymorphisms (SNPs) distributed across the BDNF gene. Family-based association and evolutionary haplotype analysis methods were used. Analysis of linkage disequilibrium (LD) revealed substantial LD among all six polymorphisms. Analyses of the Val66Met polymorphism demonstrated significant overtransmission of the val allele (chi2=7.12, d.f.=1, P=0.0076). Consistent with the pattern of LD, all other SNPs showed significant biased transmission. The (GT)n microsatellite alleles also indicated a trend towards biased transmission (170 bp: Z=2.095, P=0.036). Significant haplotypes involved Val66Met and BDNF2 (P=0.0029). In this Hungarian sample, we found all five BDNF SNPs tested and a haplotype containing the BDNF Val66Met Val allele to be associated with COMD. These results provide evidence that BDNF variants affect liability to juvenile-onset mood disorders, supported by data from two independent samples.

Amniotic IGF-I supplementation of growth-restricted fetal sheep alters IGF-I and IGF receptor type 1 mRNA and protein levels in placental and fetal tissues

We have previously reported that chronic intra-amniotic supplementation of the late gestation growth-restricted (IUGR) ovine fetus with IGF-I (20 microg/day) increased gut growth but reduced liver weight and circulating IGF-I concentrations. Here we report mRNA and protein levels of IGF-I, the type 1 IGF receptor (IGF-1R) and IGF-binding proteins (IGFBP)-1, -2 and -3 in fetal gut, liver, muscle and placenta from fetuses in that earlier study in an attempt to explain these contrasting results. mRNA and protein were extracted from tissues obtained at post mortem at 131 days of gestation (term, 145 days) from three groups of fetuses (control, IUGR+saline and IUGR+IGF-I, n=9 per group). Control fetuses were unembolised and untreated. In the IUGR groups, growth restriction was induced from 113 to 120 days by placental embolisation; from 120 to 130 days fetuses were treated with daily intra-amniotic injections of either saline or 20 microg IGF-I. mRNA was measured by RT-PCR or real-time RT-PCR, and protein by Western blot. In liver, muscle and placenta, IGF-I mRNA and protein levels were reduced by between 8 and 30% in IGF-I-treated fetuses compared with saline-treated fetuses and controls with no change in IGF-1R mRNA or protein levels. In contrast, in the gut, IGF-I mRNA and protein levels were not significantly altered with IGF-I treatment, but IGF-1R levels were increased, especially in the jejunum. Immunolocalisation demonstrated that IGF-1R expression was confined to the luminal aspect of the gut. mRNA levels of all three IGFBPs were reduced in the gut of IGF-I-treated fetuses, but hepatic expression was significantly increased. These data demonstrated tissue-specific regulation of IGF-I, IGF-1R and IGFBPs-1, -2 and -3 in response to intra-amniotic IGF-I supplementation, though the underlying mechanisms remain obscure.

Association study of brain-derived neurotrophic factor in adults with a history of childhood onset mood disorder

Brain-derived neurotrophic factor (BDNF) is a nerve growth factor that has antidepressant-like effects in animals. BDNF gene polymorphisms have been associated with bipolar disorder. We tested two genetic polymorphisms of BDNF for their association with childhood-onset mood disorders (COMD) within the context of a case-control design. Two BDNF polymorphisms, a dinucleotide repeat (GT)(n), and a single nucleotide polymorphism (SNP) in the coding region, val66met, were genotyped in 99 adults with a history of COMD and matched psychiatrically healthy controls. A genomic control (GC) method was used to evaluate population substructure. Alleles at (GT)(n) were highly associated with COMD in this sample (chi(2) = 17.8; d.f. = 5; P = 0.0032). The odds of carrying the 168 bp allele were 3.94 times greater for cases than controls (CI = 1.72-9.04). Alleles of val66met were not significantly associated with COMD. GC analysis suggested population substructure was not a confounder of association. Analysis of haplotypes, in which (GT)(n) was treated as a binary variable (long vs. short alleles), provided significant evidence that the haplotype val/short contributes to liability to COMD. The BDNF (GT)(n) marker and the val/short haplotype are associated with COMD in this sample, in accordance with the previously described neurotrophic hypothesis of depression and some previous studies of association for bipolar disorder and neuroticism.

Frequency of food items among households in a low socioeconomic area of Karachi

OBJECTIVE

To describe the frequency of certain food items among families in a low socioeconomic area of Karachi and their association with socioeconomic variables.

METHOD

A cross sectional survey of houses selected through random sampling using a pre-tested structured questionnaire.

RESULTS

A total of 294 houses were surveyed, 23% households consumed meat almost daily, 55% consumed vegetables almost daily.

CONCLUSION

The survey showed that the consumption of food items in our study population is less as compared to what is recommended.

Association study of serotonin-2A receptor gene polymorphism and panic disorder in patients from Canada and Germany

The T102C serotonin-2A (5-HT2A) receptor gene polymorphism has been studied extensively in a number of complex psychiatric conditions with mixed results. Recently a genetic association has been described between this polymorphism and panic disorder in a Japanese sample. To evaluate the impact of the T102C polymorphism in panic disorder we genotyped triad families (panic disorder patient and parents), and cases with controls in Canadian and German samples. No significant transmission disequilibrium was observed between the alleles of the T102C 5-HT2A receptor gene polymorphism and panic disorder, nor was a significant excess of either allele found in the case control analysis. Our data suggest thus that this polymorphism is unlikely to play a major role in the pathogenesis of panic disorder.

BDNF and COMT Polymorphisms: Relation to Memory Phenotypes in Young Adults With Childhood-Onset Mood Disorder

Recent investigations in several species have suggested a role for brain-derived neurotrophic factor (BDNF) in memory, which may be mediated by the influence of BDNF on neuronal plasticity in the hippocampus. BDNF polymorphisms have also been associated with mood disorders. Catechol-O-methyltransferase (COMT) metabolizes dopamine and has been implicated in prefrontal function, another area of the brain relevant for memory. In a sample of 63 young adults with a history of childhood-onset mood disorder, we typed three BDNF polymorphisms, including the BDNF Val66Met single nucleotide polymorphism (SNP), and the COMT Val108/158Met SNP. Multivariate analysis of variance was used to test the association between BDNF and COMT markers and measures of declarative memory. Variants at the three BDNF markers and one COMT marker were not associated with declarative memory function p-values ranged from 0.25 to 0.98. Higher IQ (F = 6.18, df = 4, 58, p = 0.0003) and female gender (F = 4.41, df = 4, 58, p = 0.0035) were associated with more optimal performance on the memory tasks. This study did not provide evidence supporting an association between BDNF and COMT genes and declarative memory phenotypes.

Postnatal development and testosterone dependence of a rat epididymal protein identified by neonatal tolerization

A rat epididymal protein of 27 kDa was identified using neonatal tolerization. This study reports the production and characterization of a polyclonal antiserum to this protein. ELISA was used to demonstrate that this antiserum reacts strongly with epididymal sperm proteins, but has little or no reactivity with testicular proteins. Western blot analysis revealed that this polyclonal antiserum recognized a 27 kDa protein extracted from the corpus epididymidis as well as from spermatozoa from the corpus and cauda epididymides, and immunostaining revealed the presence of the protein in the corpus to cauda epididymides. Stronger reactivity was observed in the supranuclear region and stereocilla of principal cells of the corpus epididymidis and in the luminal content of the corpus and cauda epididymides. The testicular section showed no reactivity. Treatment with the antiserum resulted in time- and dose-dependent agglutination of rat spermatozoa. By indirect immunofluorescence, the antiserum localized proteins in the mid-piece region of rat spermatozoa. Studies were carried out to determine the age at which the protein first became apparent during postnatal development. The protein was expressed from day 40 onwards, as demonstrated by western blot analysis. The androgen regulation of this protein was ascertained by castration and supplementation studies. Expression of this protein showed a decline starting at day 14 after castration and by day 21 the protein was absent; however, androgen replacement resulted in the reappearance of the protein. The results of these studies indicate that the protein identified is specific to the epididymis, and is regulated by development and androgens. The importance of epididymis-specific proteins that are regulated by androgens in sperm maturation is discussed, and the need to ascertain the sequence of the protein and clone the cognate gene is indicated.