Protective effects of resveratrol on sepsis-induced DNA damage in the lymphocytes of rats

Sepsis, often initiated by an infection, is a state of disrupted inflammatory homeostasis. There is increasing evidence that oxidative stress has an important role in the development of sepsis-induced multiorgan failure. Resveratrol (RV) is a polyphenolic compound found in the skin of red fruits, such as mulberries and red grapes, and in peanuts. RV has been reported to have an antioxidant, antiproliferative, and anti-inflammatory properties in various models. It has also been found to inhibit the proliferation of a variety of human cancer cell lines, including breast, prostate, colon, pancreatic, and thyroid. This study has been undertaken to assess the role of RV on the sepsis-induced oxidative DNA damage in the lymphocytes of Wistar albino rats by the standard and formamidopyrimidine DNA glycosylase (Fpg)-modified comet assays. The parameters of tail length, tail intensity, and tail moment were evaluated for the determination of DNA damage. According to the study, the DNA damage was found to be significantly higher in the sepsis-induced rats when compared with the control rats (p < 0.05). The parameters were significantly decreased in the RV-treated sepsis-induced group when compared with the sepsis-induced group. The parameters in the sepsis-induced rats were found to be significantly higher in the Fpg-modified comet assay when compared with the standard comet assay (p < 0.05), and RV treatment decreases the DNA damage in the sepsis-induced rats, suggesting that the oxidative stress is likely to be responsible for DNA damage and RV might have a role in the prevention of sepsis-induced oxidative DNA damage.

Fatty acid, cholesterol and fat-soluble vitamin composition of wild and captive freshwater crayfish (Astacus leptodactylus)

The proximate analysis (dry matter, protein, fat and ash), cholesterol, fatty acid and fat-soluble vitamin compositions of the tail muscle of wild caught and captive crayfish (Astacus leptodactylus) were investigated. Captive crayfish contained higher moisture and fat content than wild crayfish. In contrast, wild crayfish contained a higher level of crude protein, ash and n-3 polyunsaturated fatty acids (PUFA), particularly eicosapentaenoic (EPA) and docosahexaenoic acid (DHA) than captive crayfish. Arachidonic acid (C20:4 n-6) was the major n-6 PUFA in wild A. leptodactylus, and linoleic acid (C18:2 n-6) was the major n-6 PUFA in captive A. leptodactylus. The percentages of total saturated fatty acids (SFA), PUFA, and n-3/n-6 ratio were higher in wild crayfish and total monounsaturated fatty acids (MUFA) were lower. Although differences existed between wild and captive crayfish in vitamins A (p < 0.001), δ-Tocopherol (p < 0.001), α-Tocopherol acetate (p < 0.05), no differences were found in vitamins D(2), D(3), α- Tocopherol and K (p > 0.05). The differences may be originated from the diet provided to captive crayfish. Since wild A. leptodactylus contained higher n-3/n-6 ratio than captive A. leptodactylus, crayfish farms can potentially produce a better quality of crayfish meat by increasing the PUFA n-3 (especially DHA and EPA) in the diets of A. leptodactylus.

Coexistence of blaOXA48 and aac(6′)-Ib-cr Genes in Klebsiella Pneumoniae Isolates from Istanbul, Turkey

This study evaluated the presence of carbapenem hydrolysing β-lactamase genes and plasmid-mediated quinolone resistance (PMQR) determinants in 22 Klebsiella pneumoniae isolates collected from the Istanbul Medical Faculty, Turkey, which reduced the susceptibility or resistance to carbapenem. The VITEK® 2 system and E-tests were used to determine the minimum inhibitory concentrations needed to inhibit bacterial growth. Genes were screened by polymerase chain reaction, and gene transferability was evaluated by transconjugation. Strain clonality was investigated by pulsed-field gel electrophoresis (PFGE). All strains were OXA-48 β-lactamase producers and three (13.6%) were also positive for the aac(6′)-Ib-cr gene. Most of the strains harboured other b-lactamase (bla) genes such as blaTEM, blaSHV, blaCTX-M and blaVEB-1. The transconjugants mostly harboured blaOXA-48 and other β-lactamases separately. PFGE revealed eight pulsotypes among the isolates. The coexistence of blaOXA-48 and PMQR in K. pneumoniae isolates may present a significant threat to health, especially in the nosocomial setting.

Use of Cervical Spinal Cord Stimulation in Treatment and Prevention of Arterial Vasospasm after Aneurysmal Subarachnoid Hemorrhage

Based on past laboratory and anecdotal clinical experience, we hypothesized that prolonged cervical spinal cord stimulation (SCS) in the acute settings of aneurysmal subarachnoid hemorrhage (aSAH) would be both safe and feasible, and that 2-week stimulation will reduce incidence of cerebral arterial vasospasm. The goal of our clinical study was to establish feasibility and safety of cervical SCS in a small group of selected aSAH patients. Single-arm non-randomized prospective study of cSCS in aSAH patients involved percutaneous implantation of 8-contact electrode in 12 consecutive aSAH patients that satisfied strict inclusion criteria. The electrode insertion was performed immediately upon surgical or endovascular securing of the ruptured aneurysm while the patient was still under general anesthesia. Patients were stimulated for 14 consecutive days or until discharge. There were no complications related to the electrode insertion or to SCS during the study and no long-term side effects of SCS during 1-year follow-up. There was 1 unrelated death and two electrode pullouts. This article summarizes technical details of SCS electrode insertion and the stimulation parameters used in the research study. Our study of SCS for prevention of vasospasm after aSAH conclusively shows both safety and feasibility of this promising treatment approach. Despite high level of acuity in aSAH patients, impaired level of consciousness, frequent patient repositioning, need in multiple tests and variety of monitors, SCS electrodes may be safely implanted and maintained for the two-week period. Long-term follow up shows no adverse effects of cervical SCS in this patient category.

Acute formation of lumbar discal cyst: what is the mechanism?

Lumbar discal cysts are extremely rare pathologies, with only few reports describing these lesions in the literature. Moreover, their definite pathogenesis is still unknown, with proposed theories based on radialogic and histologic findings. In this report, the authors present an acute formation of a discal cyst, which is reported for the first time. Also, we center our case on the discussion of the possible pathogenesis. Also, this is the first case of discal cyst reported in Turkey. A 67-year-old woman, whose complaints, and clinical and radiological findings demonstrated lumbar disc herniation with acute Modic 1 degererative changes of the adjacent end plates of L3-4 level. After medical and physical therapies, follow-up lumbar MRI has been taken to demonstrate a discal cyst formation on the adjacent intervertebral disc, showed cranially migrated cyst superior posterior on herniated disc, in 2 weeks period. The patient was treated by microsurgical resection of the cyst, and her complaints resolved completely.

Effectiveness of erdosteine, a second generation mucolytic agent, in children with acute rhinosinusitis: a randomized, placebo controlled, double-blinded clinical study

AIM

To evaluate whether mucolytic agents have an adjuvant role with antibiotics in the treatment of children with rhinosinusitis.

METHODS

Ninety-two children with rhinosinusitis were recruited for this randomized, placebo controlled, double-blinded clinical trial. Mean age was 8.5 +/- 3.2 years. Erdosteine (5-8 mg/kg/day) was administered to 49 children, and 43 children received placebo. Changes in symptoms were recorded with the standard S5 scoring for 14 days. Complete resolution of symptoms on day 14 was considered to be clinical improvement.

RESULTS

Eighty-one participants completed the study. Forty-one were in the treatment group and 40 in the placebo group. The average S5 scoring value at the onset of study was 11.0 in treatment group and 12.1 in placebo group. On day 14, mean scores were 3.1 in the treatment group and 2.8 in the placebo group. Complete improvement was 78% in the treatment group and 74.4% in the placebo group. There was no significant difference between the groups. There were no clinically detected serious side effects or complications in both groups.

CONCLUSION

Use of erdosteine as a mucolytic agent in children with acute rhinosinusitis does not directly affect the success of treatment.

Effect of orlistat on the total ghrelin and leptin levels in obese patients

Obesity, characterized by hyperleptinemia and hypoghrelinemia, has become a major health problem all over the world and is associated with an increased risk of complications including insulin resistance, hypertension, dyslipidemia, diabetes mellitus and atherosclerosis. The use of the pancreatic lipase inhibitor Orlistat can help seriously overweight people to achieve and maintain weight loss. The aim of our study was to compare the serum leptin and ghrelin levels in obese subjects who take orlistat with those receiving only dietary treatment. Twenty-one obese patients and 10 control subjects participated. The obese patients were divided into two groups; one group (n=11) took orlistat (120 mg, 3 times daily) and received dietary treatment and the other (n=10) only received the dietary treatment. The study lasted twelve weeks. The concentrations of serum ghrelin, leptin, insulin and C-peptide, and routine biochemical parameters, were measured in both groups. The serum ghrelin level was higher in control (183+/-62 fmol/ml) than obese (59+/-30 fmol/ml) subjects while the plasma leptin level was lower in control (8.7+/-12 microg/L) than obese (36.7+/-19 microg/L) subjects (all p<0.001). BMI and the total blood cholesterol, LDL and triglyceride levels fell significantly after both orlistat and dietary treatment in the obese subjects (all p<0.01), and the plasma ghrelin level rose (p<0.01). The leptin level demonstrated the opposite trend in both groups but only the patients taking orlistat showed a significant change (p<0.05).Taken together, these results show that orlistat has no effect on body weight in obese subjects additional to that conferred by a non-pharmacological life-style intervention. We therefore conclude that weight lost rather than type of treatment might be more valuable in obesity.

CD38 increases CXCL12-mediated signals and homing of chronic lymphocytic leukemia cells

Homing of chronic lymphocytic leukemia (CLL) cells to sites favoring growth, a critical step in disease progression, is principally coordinated by the CXCL12/CXCR4 axis. A cohort of 62 CLL patients was divided into migrating and nonmigrating subsets according to chemotaxis toward CXCL12. Migrating patients phosphorylated extracellular signal-regulated kinase 1/2 (ERK1/2) proteins more than nonmigrating patients (P<0.0002). CD38 expression was the parameter most strongly associated with heightened CXCL12 signaling (P<0.0001), confirmed by independent statistical approaches. Consistent with this observation, CD38(-) CLL cells in samples with bimodal CD38 expression responded less to CXCL12 than the intact clone (P=0.003). Furthermore, lentivirus-induced de novo expression of CD38 was paralleled by increased responses to CXCL12, as compared with cells infected with a control virus. CD38 ligation with agonistic monoclonal antibodies (mAbs) enhanced CXCL12 signaling, whereas blocking anti-CD38 mAbs inhibited chemokine effects in vitro. This is attributed to physical proximity on the membrane between CD38 and CXCR4 (the CXCL12 receptor), as shown by (i) coimmunoprecipitation and (ii) confocal microscopy experiments. Blocking anti-CD38 mAbs significantly compromised homing of CLL cells from blood to lymphoid organs in a mouse model. These results indicate that CD38 synergizes with the CXCR4 pathway and support the working hypothesis that migration is a central step in disease progression.

Methotrexate: can it be a choice for nasal polyposis in aspirin exacerbated respiratory disease?

Nasal polyposis (NP) is considered a subgroup of chronic rhinosinusitis and is commonly associated with asthma, bronchiectasis, and cystic fibrosis. A certain subgroup of nasal polyposis is known as Aspirin Exacerbated Respiratory Disease (AERD), previously called Samter's Triad or aspirin triad, comprising polyposis, asthma, and aspirin hypersensitivity and makes up almost 10% of cases of NP. Therapy of NP involves a combination of medical and surgical treatments. However, recurrences are common, particularly in patients with asthma and aspirin hypersensitivity. Both topical and systemic corticosteroids form the mainstay of conservative therapy for NP as well as a primary treatment and prevention for recurrences. They have been shown to improve nasal breathing, rhinitis symptoms, and reduce the size of NP, along with the rate of recurrence. There is great concern about the adverse effects of systemic steroids, especially when long-term usage is necessary to maintain improvement. So far, no knowledge exists about the effects of methotrexate (MTX) on NP of the patients with asthma. We report two patients whose NP dramatically reduced in size after a course of MTX therapy administered as an additional treatment for their steroid- dependent asthma.

Ghrelin and obestatin levels in end-stage renal disease

Malnutrition is fairly common in end-stage renal disease (ESRD) patients, persistent lack of appetite being a major symptom. Ghrelin and obestatin are two hormones that are involved in appetite and energy homeostasis. The present study examined ghrelin and obestatin levels in 24 ESRD patients undergoing haemodialysis and 24 age-matched healthy controls. Serum and saliva ghrelin and obestatin levels in the ESRD patients were significantly higher compared with controls, while saliva ghrelin and obestatin levels in all study participants were significantly higher than serum levels. Saliva ghrelin correlated with serum ghrelin and saliva obestatin correlated with serum obestatin in all study participants, although there was no correlation between ghrelin and obestatin levels. In conclusion, the results suggest that the kidneys may have a role in the metabolism and/or clearance of obestatin, as they do for ghrelin. Further studies are needed to determine if elevated levels of these hormones in ESRD patients contribute to the malnutrition that is common in these patients.

Ghrelin immunohistochemistry of gastric adenocarcinoma and mucoepidermoid carcinoma of salivary gland

Ghrelin (G-HH) synthesized in several tissues including salivary and stomach glands stimulates appetite in humans by modulating neuropeptide Y neurons in the hypothalamic arcuate nucleus. Loss of appetite is one of the most important symptoms of stomach cancer. We conducted a study using immunohistochemistry to determine whether salivary glands and stomach cancer tissues produce ghrelin. We determined that negative ghrelin immunohistochemistry discriminates tumors from normal tissues and may therefore further our understanding of the clinically important problem of reduced food intake and anorexia in cancer patients. Radioimmunoassay analyses confirmed that cancer cells do not produce a G-HH peptide, whereas normal cells yield this peptide.

Effects of estrogens on oxidative protein damage in plasma and tissues in ovariectomised rats

Purpose: To assess estrogen-related changes in the redox status of the brain and liver proteins as well as the systemic oxidative stress in ovarectomised (OVX) rats Methods: Twelve-week-old, sexually mature female Sprague–Dawley rats (200-250g) were randomly divided into four groups: The following treatment combinations were administrated daily to all in 0.05 ml 96% ethanol solution by gastric gavage. (1) Sham operation (2) OVX rats (3) OVX rats [0.02 mg/kg/day of 17?-estradiol (E2) and 0.01 mg/kg/day of norethisterone acetate] (4) OVX rats [E2 (0.01 mg/kg/day) and drospirenon (0.02 mg/kg/day)]. Estrogen levels were determined using routine clinical-chemistry methods. We also measured protein oxidation parameters such as protein carbonyl (PCO), total thiol (T-SH) and the other oxidative stress markers malondialdehyde (MDA) and glutathione (GSH). Results: Ovariectomy resulted in abnormal elevation of plasma and tissue oxidative stress markers and changes in redox status of the proteins in tissue dependent manner. Supplementation of various estrogens combinations partially alleviated these abnormalities and restored redox homeostasis of proteins after the ovariectomy. Among the studied protein oxidation parameters, plasma and tissue PCO levels of the OVX rats were higher than those of the control groups (P < 0.01). Hormone replacement therapies (HRT) caused a decrease in PCO and MDA in both plasma and tissue of the OVX rats (P < 0.01). HRT in OVX rats decreased plasma MDA and increased liver and brain GSH (P < 0.01). Liver MDA levels of the Drospirenon-treated rats were lower than in the norethisterone acetate group (P < 0.01). On the other hand, Drospirenon increases brain GSH s more effectively than norethisterone acetate (P < 0.01). After bilateral oopherectomy, plasma and tissue T-SH levels decreased in the OVX group compared with control (P < 0.01). Norethisterone acetate increased plasma T-SH more effectively than Drospirenon (P < 0.05) Conclusions: The study showed the extent of oxidative protein damage (OPD) in this model of estrogen deficiency. The protective effect of estrogens against tissue specific OPD suggests that estrogens play an important role within the antioxidant defense systems in plasma, liver and brain. The exact molecular mechanisms leading to these findings are not yet completely known. Meanwhile, hormone replacement therapy for the prevention of OPD in a tissue specific manner may be required.

An objective method to determinme corneal changes during menopause

OBJECTIVE

We hypothesized that menopause has a measurable effect on corneal thickness. The aim of this study was to evaluate central corneal thickness (CCT) differences between women in the premenopausal and postmenopausal period.

METHODS

A prospective, case-control, single-blind study was designed. Two groups were included: Group I (premenopausal period) and Group II (postmenopausal period). Forty women were recruited in each group. The correlation between CCT with age, estradiol (E2) and follicle stimulating hormone (FSH) levels were evaluated.

RESULTS

CCT was significantly decreased in postmenopausal women compared to premenopausal women (521.18 +/- 37.97 microm 561 +/- 42.84 microm, respectively, p < 0.005). Similarly, there was a linear correlation between CCT and serum E2 levels of patients overall (p < 0.01).

CONCLUSION

The data presented in this study suggest that menopause causes corneal changes, which may be documented by central corneal thickness measurement.

The WHO global alliance against chronic respiratory diseases in Turkey (GARD Turkey)

In order to prevent and control non-communicable diseases (NCDs), the 61st World Health Assembly has endorsed an NCD action plan (WHA resolution 61.14). A package for essential NCDs including chronic respiratory diseases (CRDs) has also been developed. The Global Alliance against Chronic Respiratory Diseases (GARD) is a new but rapidly developing voluntary alliance that is assisting World Health Organization (WHO) in the task of addressing NCDs at country level. The GARD approach was initiated in 2006. GARD Turkey is the first comprehensive programme developed by a government with all stakeholders of the country. This paper provides a summary of indicators of the prevalence and severity of chronic respiratory diseases in Turkey and the formation of GARD Turkey.

Dynamic MR dacryocystography in patients with epiphora

OBJECTIVE

The purpose of this study was to investigate the diagnostic value of dynamic MRI dacryocystography (dMR-DCG) for the assessment of nasolacrimal drainage system (NLDS).

METHODS

The study population consisted of 35 patients with a history of epiphora. Each patient underwent bilateral dMR-DCG and conventional dacryocystography (DCG) to assess the NLDS. Two radiologists, who were unaware of the clinical data, evaluated the images separately for the level of obstruction at the nasolacrimal passage and the presence or absence of lacrimal sac dilatation. The findings from the dMRI-DCG and DCG images were compared. DCG was considered to be the gold standard imaging technique.

RESULTS

dMRI-DCG had a sensitivity of 90.5% and a specificity of 89.3% to detect nasolacrimal passage. In 24 out of 70 NLDS that were assessed, there was 100% agreement between the dMRI-DCG and DCG images in the detection of the obstructed level in the nasolacrimal pathway. The lacrimal sac dilatation finding detected by DCG was not observed by dMRI-DCG in only two patients, in whom there was a prior history of dacryocystorhinostomy (DCR) operation. These findings suggest that dMRI-DCG has 94.3% sensitivity and 100% specificity for the diagnosis of lacrimal sac dilatation.

CONCLUSION

dMRI-DCG is an easily performed, minimally invasive imaging technique to identify the presence or absence of obstruction and its level, and lacrimal sac dilatation in the evaluation of NLDS. dMRI-DCG does not require the use of contrast material and ionizing radiation and provides functional information by depicting dynamic behaviour. Thus, dMRI-DCG could be useful as a reliable diagnostic imaging technique in many patients prior to surgery.

The relationship of inflammatory cytokines with asthma and obesity

OBJECTIVES

Obesity is considered a risk factor for asthma. However, the mechanism that connects the two is not well understood. In this study we investigated the relationship between inflammatory cytokines and acute phase reactants in obesity, and asthma.

METHOD

Asthmatic and control subjects were divided into 2 sub-groups: obese and non-obese. Anthropomorphic parameters, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), leptin, tumour necrosis factor-alpha (TNF-alpha), and interleukin-6 (IL-6) were compared between obese, asthmatics and control subjects of normal weight. Respiratory function tests and allergy skin tests were also performed in the patients with asthma.

RESULTS

ESR, CRP, TNF-alpha, IL-6, and leptin levels in obese asthma patients were higher than in the healthy controls (P < 0.01). TNF-alpha, IL-6, and leptin levels were higher in obese asthma patients than in non-obese asthma patients (P < 0.01). Inflammatory markers were related to parameters of obesity. No association was found between allergy test results and obesity (P > 0.05).

CONCLUSION

We identified a relationship between acute phase reactants and inflammatory cytokines, and the criteria for obesity in obese asthma patients. Inflammation markers were at their highest levels in obese asthma patients. Leptin levels were considerably higher in obese patients than in normal weight controls. Like obesity, leptin is suggested to play a role in the pathogenesis of asthma.

Ghrelin and orotic acid increased in subclinical mastitis

Hormone ghrelin and orotic acid accelerate wound healing as well as controlling inflammation and immunity. We have, therefore, investigated the serum and milk levels of ghrelin and orotic acid in dairy cows with (n = 21) or without (n = 21) subclinical mastitis. Acylated and des-acylated ghrelin as well as orotic acid concentration were detected by using high performance liquid chromatography (HPLC). The results revealed that ghrelin level in milk and serum was significantly higher in dairy cows with subclinical mastitis than that of dairy cows without subclinical mastitis. This was also the case when the orotic acid concentrations in dairy cows with subclinical mastitis were compared with those dairy cows without subclinical mastitis. In conclusion, ghrelin and orotic acid occur in particularly high concentrations in subclinical mastitis, and might, therefore, be required in greater amounts for tissue repair and may be also used as a indicator for subclinical mastitis.

The endoscopic endonasal trans-sphenoidal approach to the sellar and suprasellar area. Anatomic study

AIM

The microscopic trans-sphenoidal approach has been the treatment of choice of different sellar lesions over the last thirty years. However, due to several advantages brought by the endoscope, which provides a panoramic and close up view of all the anatomic landmarks either in the sphenoid sinus and in the sellar region, an increasing interest for the trans-sphenoidal approach to the sellar and suprasellar region is being noticed in the recent past years. Since the endoscopic approach drives the surgeon through a corridor whose walls were previously hidden by the nasal speculum, the precise knowledge of the endoscopic anatomy and the anatomical landmarks of the surgical approach are essential to better explore the mentioned advantages.

METHODS

The endoscopic endonasal approach to the sellar region was performed in 40 adult fresh cadavers, with the aim of describing the anatomical landmarks for a safe realization of the surgical approach.

RESULTS

The anatomic features and the variations of the sphenoid ostia, sphenoid sinus and septae, sella turcica, optic and carotid protuberances and their relationships have been described, as well as supra and parasellar neurovascular structures.

CONCLUSION

The endoscopic endonasal trans-sphenoidal approach provides a straight approach to the sellar region, where it offers a multiangled and close-up view of all the relevant neurovascular structures.

Venous graft perforation leading to cardiac tamponade

We describe a cardiac tamponade after venous graft perforation due to stent inflation. The complications and therapeutic options are discussed.

Clinical, biochemical and histological correlations in a group of non-drinker subjects with non-alcoholic fatty liver disease

The correlation between biochemistry, imaging-studies and histology is a matter of controversy in non-alcoholic fatty liver disease (NAFLD) and the major pathophysiology of non-alcoholic steatohepatitis (NASH) is still unknown. We aimed to perform a comparative analysis between clinical, biochemical and histological variables of NAFLD. One-hundred and five NAFLD patients (F/M: 51/54), were studied, all with no-alcohol intake. The groups were followed-up for six months. Necroinflammation and fibrosis were more severe in patients with diabetes (p = 0.002, and p = 0.0001, respectively). In comparing NAFL to NASH, plasma nitric-oxide and malondialdehyde levels were significantly higher (p = 0.05, for-both), and vitamin-E and-C levels were significantly lower in NASH (p = 0.002, and 0.001, respectively). The serum ferritin levels were higher in NASH patients (p = 0.016). While the ultrasonographic grade was significantly higher, the liver-spleen density gradient was significantly lower in NASH group (p = 0.017, and 0.005, respectively). Within a six month period, serum ALT levels dropped into the normal range in 23/76 (30.3%) patients and serum ALT in the 6th month correlated significantly with the severity of steatosis, inflammation and fibrosis in initial biopsy (p = 0.023, 0.035, 0.011, respectively). In conclusion, the probability of severe liver disease is higher in patients with elevated-ALT in NAFLD. Serum ferritin levels have some prognostic significance in liver damage and fibrosis. Overt diabetes is predictive of advanced fibrosis and inflammation. However impaired glucose-tolerance is not. The advice on diet and exercise for six months after diagnosis may be a good strategy in NAFLD. The patients with normal-ALT without hepatomegaly, morbid-obesity and diabetes seem to have a good prognosis, however some of these patients may still require liver biopsy.

Response to SDF-1 defines a subset of CD38+/ZAP-70+ CLL patients with a common genetic signature and aggressive behavior (96.23)

Chronic lymphocytic leukemia (CLL), traditionally considered a disease of failed apoptosis, is now seen as characterized by a different propensity to grow according to microenvironmental signals. CD38 (surface receptor) and ZAP-70 (cytoplasmic molecule) independently predict unfavorable outcome in CLL patients. We reported that CD38 is a receptor mediating interactions with nurse-like cells (NLC) and transducing proliferation signals. The production by NLC of the attractant SDF-1α and the presence of ZAP-70 in CXCR4 pathway suggested that CD38 and ZAP-70 control CLL cell migration. We show that CD38+/ZAP-70+ patients feature enhanced ability to respond to SDF-1α. The functional link between the two molecules was confirmed by showing that i) CD38 engagement leads to ZAP-70 phosphorylation in CLL cells and in ad hoc modified B line expressing a ZAP-70-myc construct. Further, ii) CD38 signals are effective only in presence of ZAP-70, as seen in 22 molecularly characterized patients.

Lastly, a separation of the patient cohort based on migration, brought to the identification of 23 differentially expressed genes: 12 are involved in cell motility, migration and neoplastic transformation.

This work provides biological evidence explaining why the combination of CD38 and ZAP-70 in routine clinics results in a more efficient identification of CLL patients with aggressive disease.

Sponsors: CLL-GRF, AIRC, FIRMS.

Phase I/II study of preoperative cetuximab, capecitabine, and external beam radiotherapy in patients with rectal cancer

BACKGROUND

To assess the safety and preliminary efficacy of concurrent radiotherapy, capecitabine, and cetuximab in the preoperative treatment of patients with rectal cancer.

PATIENTS AND METHODS

Forty patients with rectal cancer (T3-T4, and/or N+, endorectal ultrasound) received preoperative radiotherapy (1.8 Gy, 5 days/week for 5 weeks, total dose 45 Gy, three-dimensional conformal technique) in combination with cetuximab [initial dose 400 mg/m(2) intravenous given 1 week before the beginning of radiation followed by 250 mg/m(2)/week for 5 weeks] and capecitabine for the duration of radiotherapy (650 mg/m(2) orally twice daily, first dose level; 825 mg/m(2) twice daily, second dose level).

RESULTS

Four and six patients were treated at the first and second dose level of capecitabine, respectively. No dose-limiting toxicity occurred. Thirty additional patients were treated with capecitabine at 825 mg/m(2) twice daily. The most frequent grade 1/2 side-effects were acneiform rash (87%), diarrhea (65%), and fatigue (57%). Grade 3 diarrhea was found in 15%. Three grade 4 toxic effects were recorded: one myocardial infarction, one pulmonary embolism, and one pulmonary infection with sepsis. Two patients (5%) had a pathological complete response.

CONCLUSIONS

Preoperative radiotherapy in combination with capecitabine and cetuximab is feasible with some patients achieving pathological downstaging.

Identification of oxalotrophic bacteria by neural network analysis of numerical phenetic data

A new approach with artificial neural network (ANN) was applied to numerical taxonomy of bacteria using the oxalate as carbon and energy source. For this aim the characters effective in differentiating separate groups were selected from morphological, physiological and biochemical test results. Fourteen aerobic, Gram-negative, oxalate-utilizing isolates and four oxalate-utilizing reference strains (Ralstonia eutropha DSM 428, Methylobacterium extorquens DSM 1337T, Ralstonia oxalatica DSM 1105T, Oxalicibacterium flavum DSM 15506T) were included in the study. ANN program used here was developed in Borland C++ language. Iterations were performed on an IBM compatible PC computer. ANN architecture having feed-forward backpropagation algorithm was used for teaching generalized delta rule. The results show that ANN can have a large potential in solving the taxonomic problems of oxalate-utilizing bacteria.

Pathological effects of Arcobacter cryaerophilus infection in rainbow trout (Oncorhynchus mykiss Walbaum)

Arcobacter cryaerophilus was isolated from naturally infected rainbow trout (Oncorhynchus mykiss Walbaum), and its pathogenicity was tested by intramuscular injection into 40 healthy 1-year-old rainbow trout at 16 degrees C. The lethal dosage of 50% end point (LD50) for A. cryaerophilus was calculated 2.25 x 10(4) viable cells. Experimental infection caused deaths with gross clinical abnormalities such as degenerated opercula and gills, liver damage, haemorrhagic kidney and serous fluid in swollen intestines. The counts of A. cryaerophilus in kidney, liver and gills of experimentally infected fish ranged from 1.59 x 10(10) colony forming units (cfu)/g to 7.41 x 10(12) cfu/g. The means of erythrocyte (RBC) count, haematocrit level, serum cholesterol, triglyceride, albumin and total protein concentrations in the blood of the experimentally infected rainbow trout group were significantly lower than in the healthy fish. Leukocyte (WBC) counts of the experimentally infected rainbow trout were significantly higher than those of healthy fish. The present work shows that the selected blood characteristics may be good indicators of response to infections in rainbow trout.

Adult intramedullary mature teratoma of the spinal cord: review of the literature illustrated with an unusual example

Intramedullary mature teratomas particularly in adults are rarely encountered. In this manuscript the authors have reviewed the adult intramedullary lesions of the spinal cord published in the literature that are harbouring the characteristics of a mature teratoma and analysed the results with respect to histopathology, epidemiology, diagnostic methods and treatment. An illustrative case of an extremely unusual localization is also presented.

Effects of curcumin on tumour necrosis factor-alpha and interleukin-6 in the late phase of experimental acute pancreatitis

Summary Inflammatory cytokines have been demonstrated to play an important role in the induction and severity of acute pancreatitis (AP) in the recent studies. The aim of this study was to investigate the effects of curcumin on inflammatory cytokines, such as tumour necrosis factor (TNF)-alpha and interleukin (IL)-6 in the late phase of AP. The study was conducted on 40 male Wistar Albino rats. The animals were divided randomly into four equal groups. AP was induced by the infusion of 3% sodium taurocholate into the biliopancreatic duct (in groups I and II). Starting on day 20 prior to the induction of AP, rats in group I received daily dose of 100 mg/kg of curcumin, dissolved in 9% ethanol via an intragastric tube. The same procedure was repeated for 6 days following the onset of AP. Group III was infused only on saline solution. Group IV (curcumin control group) received 9% ethanol via an intragastric tube, during the experimental period (totally 26 days). All the animals were sacrificed on day 6 after the collection of blood samples and serum TNF-alpha and IL-6 levels were determined. Tissue samples were taken from pancreas, mesenteric lymph nodes, liver, lungs, spleen and the kidneys for histopathological evaluation. Serum TNF-alpha and IL-6 levels in the group, which received curcumin (group I), were determined to be significantly lower than those of the untreated group (group II) (P<0.05). No statistically significant difference was detected in terms of total histopathological scores in the treatment group versus untreated group. Curcumin has been shown to markedly reduce serum TNF-alpha and IL-6 levels in the late phase of AP, but failed in the prevention of tissue injury.

Carcinoid tmour of the common bile duct: report of a case and a review of the literature

Carcinoid tumours of the common bile duct are extremely rare lesions. In this article we report a case with an extrahepatic bile duct carcinoid tumour. A 40-year-old woman suffered from biliary colic and jaundice. Pre-operative computed tomography demonstrated a tumour in the biliary tract. At laparotomy there was a tumour invading the common bile duct. Common bile duct resection was performed. Carcinoid tumour of the common bile duct was diagnosed histopathologically. For extrahepatic bile duct carcinoid tumours surgical resection is the only treatment modality that offers a chance to provide a cure and prolonged disease-free survival. The favourable histopathological and biological features of these tumours encouraged the surgeons to use more aggressive approaches for advanced disease.

CYP2C19 Polymorphisms in Patients with Gastric and Colorectal Carcinoma

BACKGROUND

It has been reported that up to 80% of human cancers arise as a consequence of environmental exposure and host susceptibility factors. Environmental carcinogens are predominantly metabolized by the cytochrome P450 (CYP) superfamily of drug- or xenobiotic-metabolizing enzymes. Genetic variations in these enzymes affect individuals' susceptibility to carcinogens.

AIM OF THE STUDY

The aim of this study was to evaluate the relationship between CYP2C19 polymorphism and susceptibility to these cancers by means of CYP2C19 genotyping among Turkish subjects.

METHODS

DNAof subjects were isolated from leukocytes by high pure template preparation kit (Roche Diagnostics, GmbH, Mannheim, Germany) and genotypes were detected by LightCycler CYP2C19 Mutation Detection Kit by real-time PCR with LightCycler instrument (Roche Diagnostics, cat. no. 3113914).

RESULTS

Being male was associated with a 3.5-fold (OR: 4.27, CI: 2.27-8.05) and 4.27-fold (OR: 3.50, CI: 1.948-6.301) risk for colorectal and gastric carcinoma, respectively. The CYP2C19*3 heterozygote genotype was not found in either gastric or colorectal carcinoma patients. Although the frequency of CYP2C19*2 heterozygote genotype is high in patients with gastric and colorectal carcinoma, it is not significantly associated with cancer (OR: 1.79, CI: 0.829-3.865 and OR: 1.998, CI: 0.961-4.154, respectively).

CONCLUSION

Although the frequency of CYP2C19*2 heterozygote genotype is high in our patients with gastric and colorectal carcinoma, there is no the relationship between CYP2C19 polymorphism and susceptibility to these cancer.

Antioxidant Status, α-Amylase Production, Growth, and Survival of Hemoglobin Bearing Escherichia coli Exposed to Hypochlorous Acid

In the present work, two matched strains of E. coli that bear a recombinant R-amylase gene (MK57) or the R-amylase gene and vgb (MK79-hemoglobin expressing strain) were exposed to HOCl. In these cells, glutathione (GSH), superoxide dismutase (SOD), catalase (CAT), alpha-amylase production, growth and lethality were assessed in the presence and absence of HOCl. It was observed that the hemoglobin makes cells highly susceptible to killing by HOCl. The maximum survival for both strains was with stationary phase cells at any concentration of HOCl. Both strains grown in the presence of 0.0125-0.075 mg/liter HOCl showed a substantial increase in SOD activity and GSH level, with MK79 being the most increased strain in this respect, while the level of CAT activity was decreased in a dose depended manner. Growth of MK57 and MK79 strains decreased as HOCl concentration increased. However, HOCl at concentration above zero enhanced alpha-amylase production (about 2-fold) in both MK79 and MK57. Furthermore, total amylase production (at all HOCl concentrations) by MK79 was always greater than that by MK57. The results indicate that except for survival, the hemoglobin helps cells to grow better and produces more recombinant products and activates general defense systems more in response to oxidative stress when compared with the non-hemoglobin-containing counterpart.

Serum and cerebrospinal fluid concentrations of E-selectin in patients with aneurysmal subarachnoid hemorrhage

The goal of the present study was to determine concentrations of E-selectin in both cerebrospinal fluid (CSF) and serum of patients with aneurysmal subarachnoid hemorrhage (SAH) and to evaluate the correlation between the clinical parameters and E-selectin levels. Both CSF and serum samples obtained from 12 patients with aneurysmal SAH and 8 patients with hydrocephalus (control group) without any other known central nervous system disease were assayed for E-selectin by quantitative enzyme-linked immunosorbent assay and the results were compared between the two groups. Mean levels of soluble forms of E-selectin within the first 3 days and on the 5th and 7th days of SAH were 4.0 +/- 7.9, 2.8 +/- 5.2, and 3.1 +/- 4.9 ng/ml in the patient's CSF, and 33.7 +/- 9.2, 35.1 +/- 7.0, and 35.2 +/- 8.7 ng/ml in serum, respectively. In contrast, mean E-selectin levels were 0.1 +/- 0.2 ng/ml in CSF and 8.7 +/- 5.0 ng/ml in serum of control patients. The difference between groups was statistically significant regarding both CSF and serum E-selectin levels (P < 0.05). Thus, we have demonstrated a marked increase of E-selectin concentration in both CSF and serum of patients with aneurysmal SAH compared with control and suggest that blocking the interaction between E-selectin and vascular endothelium may have a beneficial effect on vasospasms.

Phase II study of preoperative oxaliplatin, capecitabine and external beam radiotherapy in patients with rectal cancer: the RadiOxCape study

BACKGROUND

Preoperative radiotherapy has been shown to decrease the local recurrence rate of patients with locally advanced rectal cancer. Capecitabine and oxaliplatin are both active anticancer agents in the treatment of patients with advanced colorectal cancer and have radiosensitizing properties. Therefore, these drugs would be expected to improve effectiveness of preoperative radiotherapy in terms of local control and prevention of distant metastases.

PATIENTS AND METHODS

Forty patients with rectal cancer (T3-T4 and/or N+) received radiotherapy (1.8 Gy, 5 days a week over 5 weeks, total dose 45 Gy, 3D conformational technique) in combination with intravenous oxaliplatin 50 mg/m2 once weekly for 5 weeks and oral capecitabine 825 mg/m2 twice daily on each day of radiation. Surgery was performed 6-8 weeks after completion of radiotherapy. The main end points were safety and efficacy as assessed by the pathological complete response (pCR).

RESULTS

The most frequent grade 3/4 adverse event was diarrhea, occurring in 30% of patients. pCR was found in five (14%) patients. According to Dworak's classification, good regression was found in six (18%) additional patients.

CONCLUSIONS

Combination of preoperative radiotherapy with capecitabine and oxaliplatin is feasible for downstaging rectal cancer.