Risk factors for device-associated infection related to organisational characteristics of intensive care units: findings from the Korean Nosocomial Infections Surveillance System

Device-associated infections (DAIs) have been the major causes of morbidity and mortality of patients in intensive care units (ICUs). This study evaluated the risk factors for DAIs in ICUs. Ninety-six medical or surgical ICUs of 56 hospitals participated in the Korean Nosocomial Infections Surveillance System between July 2007 and June 2008. The occurrence of catheter-associated urinary tract infection (CAUTI), central line-associated bloodstream infection (CABSI), and ventilator-associated pneumonia (VAP) were monitored and DAI rates were calculated. Data associated with ICU characteristics were collected and Poisson regression was used for statistical analysis. Rates of CAUTI, CABSI, and VAP were 3.87 per 1000 urinary catheter days, 2.23 per 1000 central line days, and 1.89 per 1000 mechanical ventilator days, respectively. Rates of CAUTI were higher in ICUs in Seoul (P=0.032) and ICUs of major teaching hospitals (P=0.010). The ICUs of university-affiliated hospitals showed lower CAUTI rates (P=0.013). CABSI rates were higher in Seoul (P=0.001) and in medical ICUs (P=0.026). VAP rates were lower in ICUs of hospitals with more than 900 beds compared with hospitals with 400-699 beds (P=0.026). VAP rates were higher in surgical ICUs (P<0.0001) and increased 1.13-fold with each 100-unit increase in beds per infection control professional (P=0.003). The organisational and institutional characteristics of ICUs may influence DAI rates and there is a need for improvement in the incidence of VAP, CAUTI or CABSI.

A case of systemic polyarteritis nodosa involving bronchial artery

Polyarteritis nodosa (PAN) is a systemic necrotizing vasculitis involving predominantly medium-sized muscular arteries. It commonly involves skin, kidney, cardiovascular system, gastrointestinal system, and neurological system. But bronchial artery involvement of PAN is rarely identified. We report a case of PAN with initial presentation of hemoptysis. On admission, chest radiograph and chest CT angiography revealed no focus of bleeding. Angiography showed a bronchial artery aneurysm and multiple arterial aneurysms in both renal, hepatic, mesenteric and branches of small bowel arteries. These findings were compatible with the diagnosis of PAN. The patient was started on steroid and cyclophosphamide.

Effect and sustainability of part-time occlusion therapy for patients with anisometropic amblyopia aged > or =8 years

AIMS

To study the effect and long-term sustainability of part-time occlusion therapy for anisometropic amblyopia after 8 years of age.

METHODS

A total of 41 anisometropic amblyopes aged > or =8 years were analysed. In six patients, best-corrected visual acuity (BCVA) of amblyopic eye improved more than two lines within 2 weeks of full-time spectacle wear. The remaining patients were assigned to perform part-time patching during out-of-school hours. Long-term results were assessed in patients who were observed over 1 year after the end of the treatment.

RESULTS

Among 35 patients, four dropped out, refusing further treatment, and one changed to atropine penalisation. The part-time patching schedule was completed in 30 patients. 90% of patients (27/30) complied well. Mean BCVA in the amblyopic eye improved significantly (p<0.001), and 96.7% of patients (29/30) achieved the final BCVA of 0.1 logMAR or better. In long-term results, 87% preserved the BCVA of 0.1 logMAR or better. None of four dropouts achieved the BCVA of 0.1 logMAR or better in long-term results even on the continuous spectacle wear.

CONCLUSIONS

The part-time occlusion treatment in school-aged amblyopes, which had been carried out after school hours, was successful and the effect was sustained in most cases.

Orientational relationships and atomic arrangements of GaN nanorods grown on Al2O3 (0001) substrates by using hydride vapor phase epitaxy

Scanning electron microscopy (SEM) images and transmission electron microscopy (TEM) images showed that the one-dimensional GaN nanorods were formed on Al2O3 (0001) substrates by using hydride vapor phase epitaxy without a catalyst. Selected area electron diffraction (SAED) pattern and high-resolution TEM (HRTEM) results showed that GaN nanorods grown on Al2O3 (0001) substrates had crystalline wurzite structures and (0001) preferential orientation. The morphologies of GaN nanorods were affected by the flow rates of the source materials. The orientational relationships between the GaN nanorods and the Al2O3 substrates were (0001)GaN perpendicular (0001) Al2O3 and [0110]GaN perpendicular [1120] Al2O3. Cross-sectional and plan-view atomic arrangements of the fully relaxed interfacial region are described on the basis of the TEM, the SAED pattern, and the HRTEM results.

The impact of insulin sensitisers on lung function in patients with chronic obstructive pulmonary disease and diabetes

SETTING

It has been reported that diabetes mellitus (DM) is associated with poor pulmonary function, which could be explained by insulin resistance.

OBJECTIVE

To evaluate whether insulin sensitisers (ISs) have beneficial effects on lung function in patients with chronic obstructive pulmonary disease (COPD) and DM.

DESIGN

This retrospective study included patients with both COPD and DM who attended Seoul National University Hospital for treatment between 1 January 2000 and 31 August 2007. They were treated with inhalers for COPD and oral hypoglycaemia agents, including ISs or insulin, for DM. The primary outcome was a change in lung function in spirometric examinations.

RESULTS

Among 61 patients enrolled, 32 were in the no IS group, while 29 were in the IS group. On multivariable regression analysis, the IS group showed a significantly greater change in forced vital capacity (FVC) than the no IS group (adjusted beta-coefficient 131.9, 95%CI 8.5-255.4, P = 0.04).

CONCLUSIONS

Treatment with an IS was independently associated with improvements in FVC in patients with both COPD and DM, compared with treatment without IS.

An open, non-comparative, multicentre study on the impact of alfuzosin on sexual function using the Male Sexual Health Questionnaire in patients with benign prostate hyperplasia

OBJECTIVES

To determine the effect of alfuzosin on sexual function by using the Male Sexual Health Questionnaire (MSHQ) in men with lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH).

PATIENTS AND METHODS

In this multicentre, open-label and non-comparative study, a total of 135 sexually active patients with LUTS were enrolled in Korea to receive alfuzosin 10 mg once daily for 12 weeks. International Prostate Symptom Score (IPSS) and a 25-item MSHQ exploring erection ejaculation and satisfaction with sex life were evaluated at baseline after 4 and 12 weeks of treatment.

RESULTS

Of 135 patients (age 58.8 years, duration of LUTS 2.6 years, mean values), 110 (81.5%) completed the study. The ejaculatory domain of the MSHQ significantly improved at the end-point in the intent-to-treat population (score difference of 2.24, p < or = 0.0001, n = 120). The domains of erection and sexual satisfaction improved at the end-point, but the score differences were not statistically significant. After the 12 weeks treatment, the total IPSS score significantly decreased from 17.9 to 12.1 (p < 0.0001), bother score decreased from 3.8 to 2.85 (p < 0.0001) and peak flow rate increased from 11.0 to 14.3 ml/s (p < 0.0001). A significant relationship between ejaculatory domains of MSHQ and IPSS was found. Four patients (2.9%) discontinued the trial for adverse event.

CONCLUSIONS

Based on the analysis of MSHQ scores before and after alfuzosin treatment, improvement was significant on ejaculatory function, in addition to improvement on LUTS and quality of life. MSHQ is a useful tool to evaluate the male sexual dysfunction.

Relationship between land use and water quality in a small watershed in South Korea

Recent research and monitoring undertaken by various institutions have emphasized measurements of river-water quality. Based on the results, government agencies have set guidelines to improve river-water quality management. However, the relationship between water quality and land use/land cover (LULC) has not been examined closely in South Korea to date. This study investigated this relationship in the Imgok River watershed. For this study, the relationship between water quality parameters, e.g. metallic ions, biological oxygen demand and chemical oxygen demand (BOD and COD), NH₃, NO₃ and PO₄ levels and land-use types (abandoned mine land, forest/grassland, agricultural, livestock and residential areas) was examined by correlation analysis with significant level (p<0.05) and principal component analysis (PCA). Applying PCA to water quality parameters according to land-use coverage, the principal component impacting river water quality were found to be the pH, metallic ions, BOD, PO₄, COD and total suspended solids (TSS) for abandoned mine land (AML) coverage; BOD, NO₃ and PO₄ for forest/grassland areas; TSS, NO₃, and PO₄ for agricultural land; BOD, COD, NH₃ and NO₃ for livestock coverage; and BOD, COD, NH₃ and PO₄ for residential areas. For the AML, the pH exhibited a significant negative correlation with other water quality parameters at the significant level (p<0.05). Grassland showed significant positive correlations of BOD with values of 0.837 NO₃ and 0.514 PO₄. In agricultural land, TSS had a significant negative correlation with value of -0.772 PO₄. For livestock coverage, BOD had significant positive correlations with values of 0.865 COD, 0.629 NH₃, 0.709 NO₃ and 0.472 TSS. In residential areas, COD was significantly positively correlated with values of 0.988 BOD and 0.856 PO₄, and TSS was highly positively correlated with value of 0.810 NO₃ but highly negatively correlated with value of -0.702 PO₄. Based on the above, LULC is a significant factor to influence on river water quality and this relationship should be based on the management plan for river water quality control. Future work will be conducted to take more samples in the entire river and season, to run water quality model and to choose a new method for better analysis and more accurate relationship between land-use and water quality.

Characteristics of DOC concentration with storm density flows in a stratified dam reservoir

Among natural organic matter (NOM) defined as the complex matrix of organic materials abundant in natural waters, a gradual accumulation of recalcitrant organic matter (ROM) has been observed in impounded water bodies such as a lake or dam reservoir in spite of extensive efforts made to curtail organic pollutant loadings generated in their catchment areas. This paper aims to identify the effect of diffuse pollution resulting from allochthonous organic matters on the temporal and spatial characteristics of organic matters in a stratified dam reservoir, Daecheong Dam, using both intensive observation and CE-QUAL-W2 model simulation. With the limitation of observation data in terms of organic matters of inflow waters from boundary tributaries and impounded water in the reservoir, organic matter was represented by organic carbon including labile particular organic carbon (LPOC), refractory organic carbon (RPOC), labile dissolved organic carbon (LDOC), and refractory organic carbon (RDOC). Both autochthonous and allochthonous origins of organic carbon were considered in the modeling of eutrophication of the reservoir water using CE-QUAL-W2. The result of simulation during the period from 2001 to 2005 was observed to be a gradual accumulation of particular organic carbon (POC). It is clear that the model calculation results enable the explanation of the internal and external movement of constituents in the reservoir. In particular turbidity and NOM were well related in the upper region of the reservoir according to flow distance, gradually changing to dissolved form of organic matter, DOC affected organic matter concentration of reservoir water quality compared to turbidity.

Mathematical models for biomass in membrane-BNR process for wastewater treatment

The equation of biomass is related to the mass-balance equation of substrate. This equation of substrate is expressed according to a model using the Monod equation, which indicates some limits for calculating the amounts of VSS in the MBR process. Some degradation of biomass which is caused by long SRT might result in the generation of substrate based on COD. Research was conducted by lab-scale tests with two membrane-BNR (Biological Nutrients Removal) processes. These were composed of multi-reactors as anaerobic, anoxic, aerobic tank and oxygen exhauster. The aerobic tank was also divided into 3 reactors, which were oxic for nitrification, oxic-media containing fluidized sponge typed media for simultaneous nitrification and denitrification, and oxic-membrane for submerged membrane. This membrane-BNR process could remove most of the organics, suspended solids and nutrient substances like nitrogen thus satisfying the reuse guidelines issued by the Korean Ministry of Environment. The value measured of VSS (X(v)) through the experiment with SRT of 35 days was similar to the biomass using the conventional equation while the one with SRT of 60 days was close to the concentration of VSS calculated by a revised equation which considered the biomass degraded with long SRT.

Identification of a novel HLA-DRB1 allele, HLA-DRB1*1217, in a Korean individual

We report a new DRB1 allele, DRB1*1217, identified by direct sequencing of a bacterial artificial chromosome (BAC) clone originated from genomic DNA of a Korean donor. DRB1*1217 differs from previously reported DRB1*120201 by a single nucleotide substitution, which results in an amino acid change at codon 67 [TTC-->ATC (F>I)].

The Glu346Lys polymorphism and frameshift mutations of the Methyl-CpG Binding Domain 4 gene in gastrointestinal cancer

MBD4 (Methyl-CpG Binding Domain 4) is a human DNA repair protein that may be involved in DNA mismatch repair. The polymorphisms and frameshift mutations in MBD4 may influence cancer susceptibility and the development of cancer. The specific aim of this study was to investigate whether frameshift mutations of the MBD4 gene and the codon 346 polymorphism were associated with microsatellite instability (MSI) and the risk for gastrointestinal cancer. We examined the MSI, frameshift mutations and polymorphisms of the MBD4 gene in 84 patients with gastric cancers, 82 colorectal cancers and 299 healthy controls. MSI was found in 19 (22.6%) and 26 (31.7%) of the gastric and colorectal cancer samples, respectively. The mutation analysis revealed no frameshift mutations in the MBD4 gene among the gastrointestinal cancers. The frequencies of genotypes: Glu/Glu, Glu/Lys and Lys/Lys were 41.7% (35/84), 41.7% (35/84) and 16.6% (14/84), respectively, in the gastric cancer cases, and 42.7% (35/82), 36.6% (30/82) and 20.7% (17/82), respectively, in the colorectal cancers. MSI was not associated with the MBD4 codon 346 polymorphism and there was no significant difference in the frequency of the genotypes between healthy controls and gastric cancer patients (P=0.2748). However, the MBD4 codon 346 polymorphism was significantly associated with the risk of colorectal cancer (P=0.0315). Our findings suggest that microsatellite instability may not be associated with frameshift mutations in the MBD4 gene, and that the MBD4 codon 346 polymorphism may play arole in colorectal cancer susceptibility in the Korean population.

Low frequency mutation of the Ephrin receptor A3 gene in hepatocellular carcinoma

EphA3 is a component of the Eph/ephrin tyrosine kinase system, which participates in vasculature development. This receptor/ligand system is associated with various signaling pathways related to cell growth and viability, cytoskeletal organization, cell migration, and anti-apoptosis. Accumulated evidence suggests that aberrant regulation of EphA3 and its genetic alterations are implicated in the development and progression of various cancers. However, despite a high incidence of EphA3 over-expression, no such investigation has been performed in hepatocellular carcinoma. Thus, we investigated genetic alterations of the EphA3 gene in 73 cases of hepatocellular carcinoma by single-strand conformational polymorphism and sequencing. One novel D219V missense mutation was found in the extracellular domain of EphA3, and two genetic alterations in the intracellular sterile-alpha-motif (SAM) domain of EphA3 appeared to be polymorphisms. Although the functional assessments of this mutant are incomplete, it is believed that this novel EphA3 mutation may contribute to the development of hepatocellular carcinoma.

Effect of reinforcement particle size on the tribological properties of nano-diamond filled polytetrafluoroethylene based coating

The tribological properties of PTFE composite coatings reinforced by nano-diamonds were investigated. Mechanical particle size reduction and dispersion of nano-diamond aggregates were performed by milling with ceramic beads in an organic solvent. Particle size was controlled by the milling time. Pastes comprising a PTFE solution mixed with nano-diamond having various sizes were coated on the aluminum substrate. Ball-on-plate type wear test was performed to investigate the friction and wear behavior. The results indicated that the addition of nano-diamonds effectively improved tribological performance of the PTFE coating. The reduction in nano-diamond sizes were not always improved the wear resistance of PTFE coating. This unexpected behavior was explained by observation on the worn surfaces and wear debris.

The p53 codon 72 polymorphism and susceptibility to colorectal cancer in Korean patients

TP53 is a major gene involved in the determination of proliferation or growth arrest at the cellular level. The polymorphism of p53 at codon 72 has been widely studied; this variation has been associated with cancer susceptibility and disease outcome. The specific aim of this study was to investigate whether the p53 codon 72 polymorphism is associated with individual susceptibility to colorectal cancer in Korean patients. The frequency of the polymorphism was examined in 156 patients with colorectal cancer and in 293 healthy controls. The polymorphism analysis was performed by amplifying exon 4 of p53 and digesting the products with restriction enzyme. The frequencies of genotypes: Arg/Arg, Arg/Pro and Pro/Pro were 34.6% (54/156), 43.0% (67/156) and 22.4% (35/156), respectively, in the cases with colorectal cancer, and 28.9% (114/293), 47.8% (140/293) and 13.3% (39/293), respectively, in the healthy controls. Statistically, there was a significant difference in the frequency of the genotypes when the healthy controls were compared to the patients with colorectal cancer (<em>p</em>=0.0459). The specific allele frequencies showed borderline significance (<em>p</em>=0.0502). Our findings suggest that the p53 Pro72 variant is associated with an increased risk for colorectal cancer in the Korean population.

KEYWORDS

p53, colorectal cancer, polymorphism, susceptibility, metastasis.

Overexpression of Wnt-2 in colorectal cancers

The binding of the Wnt ligand to its receptor Frizzled, activates the Wnt canonical signaling pathway in carcinogenesis as well as many cellular processes, including cellular proliferation and differentiation. Wnt-2, one of 19 members of the <em>Wnt</em> gene family, is frequently overexpressed in malignant tissues. Here, in order to investigate the role of Wnt-2 in colorectal carcinogenesis, we examined the expression of the Wnt-2 protein in 120 colorectal cancers by immunohistochemistry. Wnt-2 protein was expressed in the cell membrane and cytoplasm and up-regulated in 74 (61.7%) of 120 colorectal cancers. Statistically, overexpression of Wnt-2 protein was not associated with the clinical and pathological parameters studied, including tumor location, tumor size, clinical stage, lymph node metastasis, and 5-year survival (<em>P > </em>0.05). These results indicate that up-regulation of the Wnt-2 protein might play a role in the development of colorectal cancers, as an early event of carcinogenesis.

KEYWORDS

Wnt-2 protein, expression, immunohistochemistry, tissue microarray, colon cancer.

Mutational analysis of JAK1 gene in human hepatocellular carcinoma

The <em>Janus kinase 1</em> (JAK1) gene encodes a cytoplasmic tyrosine kinase that is noncovalently associated with a variety of cytokine receptors and plays a nonredundant role in cell proliferation, survival, and differentiation. The mutated forms of JAK1 often altered the activation of JAK1 and then changed the activation of JAK1/STAT pathways, and this may contribute to cancer development and progression. Thus, to investigate whether genetic mutations of JAK1 gene are associated in hepatocellular carcinoma (HCC) progression, we analyzed genetic alterations of JAK1 gene in 84 human HCCs by single-strand conformational polymorphism (SSCP) and direct sequencing. Of 24 exons of JAK1 gene, 12 exons were previously reported to have mutations, we searched genetic alteration of JAK1 in these exons. Overall, one missense mutation (1.2%) was found. In addition, 12 cases (14%) were found to have single nucleotide polymorphism (14%) in exon 14. Taken together, we found one novel missense mutation of JAK1 gene in hepatocellular carcinomas with some polymorphisms. Although the functional assessment of this novel mutant remains to be completed, JAK1 mutation may contribute to the tumor development in liver cancer.

KEYWORDS

JAK1 gene, hepatocellular carcinoma, mutation.

Post-induction alfentanil reduces sevoflurane-associated emergence agitation in children undergoing an adenotonsillectomy

BACKGROUND

Emergence agitation is a common problem in paediatric anaesthesia, especially after volatile induction and maintenance anaesthesia (VIMA) with sevoflurane. The purpose of this study was to investigate the effect of alfentanil to prevent emergence agitation without delayed recovery after VIMA with sevoflurane in children undergoing an adenotonsillectomy.

METHODS

One hundred and five children, aged 3-10 years, were randomly allocated to receive normal saline (control group), alfentanil 10 microg/kg (A10) or 20 microg/kg (A20) 1 min after loss of the eyelash reflex. Anaesthesia was induced and maintained with sevoflurane. Time to tracheal extubation, recovery time, Paediatric Anaesthesia Emergence Delirium (PAED) scale and emergence behaviour were assessed.

RESULTS

The incidence of severe agitation was significantly lower in the A10 and A20 groups compared with those in the control group (11/32 and 12/34 vs. 24/34, respectively) (P=0.007, 0.006, respectively). PAED scales were significantly different between the three groups (P=0.008), and lower in the A10 and A20 groups than that in the control group (P=0.044, 0.013, respectively). However, the incidence of severe agitation and PAED scale was not different between the A10 and the A20 groups. Time to tracheal extubation and recovery time were similar in all three groups.

CONCLUSION

The administration of alfentanil 10 microg/kg after induction of anaesthesia for children undergoing an adenotonsillectomy under VIMA reduced the incidence of emergence agitation without delaying the recovery time or causing significant hypotension.

5,7-dihydroxy-3,4,6-trimethoxyflavone inhibits the inflammatory effects induced by Bacteroides fragilis enterotoxin via dissociating the complex of heat shock protein 90 and I kappaB alpha and I kappaB kinase-gamma in intestinal epithelial cell culture

Enterotoxin produced by enterotoxigenic Bacteroides fragilis (BFT) has been associated with mucosal inflammation and diarrhoeal diseases. In this study, the anti-inflammatory molecular mechanism of 5,7-dihydroxy-3,4,6-trimethoxyflavone (eupatilin) was characterized in an HT-29 intestinal epithelial cell line stimulated with BFT. Pre-treatment of HT-29 cells with eupatilin decreased the production significantly of both interleukin (IL)-8 and prostaglandin E(2) induced by BFT in a dose-dependent manner. BFT-activated nuclear factor-kappaB (NF-kappaB) signals in HT-29 cells and pretreatment with eupatilin suppressed NF-kappaB activation that resulted in the significant inhibition of IL-8 and cyclo-oxygenase-2 expression. BFT-induced phosphorylation of both I kappaB alpha and I kappaB kinase (IKK) signals was prevented in eupatilin-pretreated HT-29 cells. Transfection of siRNA for IKK-alpha and IKK-beta decreased the production of IL-8 and prostaglandin E(2); however, the transfection of IKK-beta siRNA showed a more significant reduction of BFT-induced I kappaB alpha phosphorylation compared with that of IKK-alpha siRNA. In addition, herbimycin A, a specific inhibitor of heat shock protein 90 (Hsp90), decreased the BFT-induced activation of IKK and NF-kappaB, suggesting that Hsp90 is associated with a pathway of IKK-NF-kappaB-IL-8/cyclo-oxygenase-2 gene signalling. Furthermore, eupatilin dissociated the complex between Hsp90 and IKK-gamma in BFT-stimulated HT-29 cells. These results suggest that eupatilin can suppress the NF-kappaB signalling pathway by targeting the Hsp90-IKK-gamma complex in intestinal epithelial cells and may attenuate BFT-induced inflammatory responses.

Impact of a fall prevention programme in acute hospital settings in Singapore

INTRODUCTION

This study aimed to develop a multifaceted strategy using tailored interventions to implement a fall prevention programme, and to achieve a change in fall prevention practices and a reduction in fall incidence at an acute care hospital in Singapore.

METHODS

A comparative study was conducted at two acute care hospitals (intervention and control) in Singapore. Pre-intervention, post-intervention and six-month follow-up knowledge assessments of 641 nursing staff, and audits of fall rates and fall prevention practices were performed to determine the effectiveness of a multifaceted strategy with targeted interventions in supporting the implementation of a fall prevention programme.

RESULTS

The mean post-knowledge test scores at six months were statistically significantly higher (t[516] is -3.3, p-value is less than 0.01) at the intervention hospital (10.3 +/- 2.3) compared to the scores at the control hospital (9.8 +/- 1.8). Increased compliance with the use of fall risk assessment tools was evident in 99.4 percent and 99.3 percent of all patient records at the control and intervention hospitals, respectively. Following the implementation strategy for a fall prevention programme, there was a non-significant reduction in fall rates from 1.44 to 1.09 per 1,000 patient days at the intervention hospital. No reduction in the fall rate was observed at the control hospital.

CONCLUSION

A multifaceted strategy for the implementation of a fall prevention programme was effective in increasing nurses' knowledge and the use of the fall risk assessment, but did not have a statistically significant impact on a reduction in the fall rate. The increase in nurses' knowledge and change in nursing practice were important markers of success in terms of fall prevention at the acute hospitals.

Irradiation-induced shrinkage and expansion mechanisms of SiO2 circle membrane nanopores

20 nm diameter SiO(2) nanopore arrays on gradient-thickness membranes were formed by a focused electron beam with in situ transmission electron microscopy (TEM). Nanopore shrinkage was seen in nanopores on thicker membranes, with the rate of diameter change remaining constant during the shrinkage process. In contrast, pore expansion was observed in thinner membranes, with the expansion rate being constant at the initial stage but with a slight increase at the later stage. The geometry model of shrinkage and expansion of the nanopores in relation to the electron irradiation time was investigated by utilizing the TEM tilting method.

Learning curve for identification of sentinel lymph node based on a cumulative sum analysis in gastric cancer

BACKGROUND/AIMS

Lymph node metastasis is the most important point to consider when deciding on the modality of resection in patients with early gastric cancer. This study was conducted to evaluate the learning curve for identification of sentinel lymph nodes in patients with gastric cancer.

METHODS

The investigators included the results from 2 prospective series of sentinel lymph node mapping. Cumulative sum (CUSUM) analysis was performed to assess the learning curves for identification of sentinel lymph nodes at CUSUM target success rates of 95%.

RESULTS

One surgeon performed 135 sentinel lymph node mappings for 2 prospective series. The success rate exceeded 90%. The learning period for gastric cancer sentinel node mapping was calculated to be 26 cases for achieving a 95% success rate. Multiple logistic regression analysis for successful detection of sentinel nodes showed that surgical experience of sentinel lymph node mapping was an independent factor for successful detection of sentinel nodes.

CONCLUSIONS

This study suggests that the learning period for identification of sentinel lymph nodes in gastric cancer would be 26 cases. In clinical trials for gastric cancer with sentinel lymph node mapping, the learning curve should be considered to minimize bias due to surgical factors.

Maple syrup urine disease (MSUD)--clinical profile of 47 Filipino patients

Maple syrup urine disease (MSUD) is a very rare disorder of branched-chain amino acid metabolism. However, it is the most common inborn error of metabolism in the Philippines. We present a retrospective review of 21 patients diagnosed with MSUD between 1999 and 2004. The patients presented clinically between 2 and 14 days of life (mean 5 days) and the diagnosis of MSUD was established between 6 days and 11 months of age (mean 39 days). The classical burnt sugar odour was noted in the majority of patients (81%). The diagnosis of MSUD was initially based on clinical suspicion and confirmed biochemically by measurement of leucine/isoleucine levels by thin-layer chromatography. The acute management included removal of accumulated branched-chain amino acids by peritoneal dialysis in 62% of the patients. Mortality rate of this group of patients was 24% and follow-up rate was 87%. We compared this series with a previously reported series of 26 patients to determine whether diagnosis and the management of MSUD improved over the two periods. Four cases have been diagnosed early since 1992, the majority of whom had the classic form of MSUD with the onset of symptoms in the first two weeks of life. A small subset of patients with early nonspecific symptoms was diagnosed much later owing to a low-level clinical suspicion among clinicians. Overall, however, there appears to be a small but general trend towards earlier diagnosis, reduced mortality and long-term follow up in the later series. Although we are able to diagnose and manage MSUD in the Philippines, we recognize that the clinical outcome remains poor and is due mainly to late referral of cases and inadequate long-term management. In the Philippines, we recommend that all newborns who are considered to be septic, have feeding difficulties, fail to regain their birth weight or present with any other symptoms suggestive of MSUD be evaluated in the first instance by analysis of urine for ketones and if they are positive have blood collected and sent to our laboratory for leucine/isoleucine measurement.

Generation of intense proton beams from plastic targets irradiated by an ultraintense laser pulse

Proton beams generated from thin aluminum and Mylar foil targets that are irradiated by a 30fs Ti:sapphire laser pulse with an intensity of 2.2x10;{18}Wcm;{2} were investigated. Protons from the Mylar targets were observed to have an energy higher by a factor of 2 and were higher in number by an order of magnitude as compared with those generated from the aluminum targets. The maximum proton energy of 1.3+/-0.12MeV obtained from the Mylar target was found to be similar with previous observations that used laser pulses with different intensities. To address the anomalous behavior of the maximum proton energy for plastic targets, an acceleration model is proposed. In this model, the protons are accelerated by a resistively induced electric field in the front of the target, which can account for the experimental observations.

Pharmacokinetics and tissue distribution of 3-((5-(6-methylpyridin-2-yl)-4-(quinoxalin-6-yl)-1H-imidazol-2-yl)methyl)benzamide; a novel ALK5 inhibitor and a potential anti-fibrosis drug

The authors investigated the pharmacokinetics and metabolism of 3-((5-(6-methylpyridin-2-yl)-4-(quinoxalin-6-yl)-1H-imidazol-2-yl)methyl)benzamide (IN-1130), a novel ALK5 inhibitor, which suppresses renal and hepatic fibrosis, and also exerts anti-metastatic effects on breast cancer-bearing MMTV-cNeu mice model. Plasma half-lives of orally administered IN-1130 were 62.6 min in mice, 76.6 +/- 10.6 min in dogs, 156.1 +/- 19.3 min in rats, and 159.9 +/- 59.9 min in monkeys. IN-1130 showed a high apparent permeability coefficient (P(app)) of (45.0 +/- 2.3) x 10(-6) cm s(-1) in in vitro permeability tests in a Caco-2 cell monolayer model. The bioavailability of orally administered IN-1130 was 84.9% in dogs and 34.4% in monkeys (oral dose, 5.5 mg kg(-1)), 11.4% in rats and 8.95% in mice (oral dose, 50.3 mg kg(-1)), respectively. Orally given IN-1130 was readily distributed into liver, kidneys and lungs. The major metabolite of IN-1130 (M1) was detected in the systemic circulation of rat and mouse and was purified and tentatively identified as 3-((4-(3-hydroxyquinoxaline-6-yl)-5-(6-methylpyridine-2-yl)-1H-imidazol-2-yl)methyl)benzamide or 3-((4-(2-hydroxyquinoxalin-6-yl)-5-(6-methylpyridine-2-yl)-1H-imidazol-2-yl)methyl)benzamide. The highest levels of M1 were found in liver. The results of this study suggest that IN-1130 has the potential to serve as an effective oral anti-fibrotic drug.

Iron monosulfide as a scavenger for dissolved hexavalent chromium and cadmium

Iron sulfide minerals are common components of soil/sedimentary environments. Reactions near the surfaces of iron sulfides play important roles in metal retention, mobility, and bioavailability. A series of batch experiments was conducted to study the removal of aqueous chromium and cadmium by iron monosulfide. Hexavalent chromium was reduced to Cr(III) by iron monosulfide with simultaneous precipitation of chromium and iron oxyhydroxide. In contrast to chromium, the primary retention mechanism of cadmium by iron monosulfide was lattice exchange. Surface adsorption to iron monosulfide and precipitation with sulfide on the iron monosulfide surface also contributed to the removal of aqueous cadmium. New phases of both chromium and cadmium were confirmed with transmission electron microscopy. The solution pH was an important factor in this research; it can change particle surface charge and metal species, hence affecting the removal of chromium, but not cadmium. Ferrous ions without FeS exhibited less Cr(VI) removal than with FeS, which might be owing to sulfides from FeS and the existence of the solid phase. Iron monosulfide exhibited higher removal efficiency for chromium and cadmium than zero valent iron and other iron oxide minerals, and the synergistic effect of ferrous iron and sulfide appeared to cause this result.

The formation mechanism of periodic Zn nanocrystal arrays embedded in an amorphous layer by rapid electron beam irradiation

A periodic nano-island array of ∼7 nm diameter Zn single crystals embedded in an amorphous Zn(2x)Si(1-x)O(2) layer was created by using rapid electron beam irradiation for 50 s. A sequential process of 900 °C thermal annealing followed by electron beam irradiation induces the formation of an amorphous Zn(2x)Si(1-x)O(2) layer containing periodic Zn nanocrystals. It is shown that the periodic Zn crystal array can be produced with good control of their size and spacing. Possible formation mechanisms for the Zn crystal nano-islands are described on the basis of the experimental results.

Hyperglycaemia, hypercholesterolaemia and the risk for developing gastric dysplasia

BACKGROUND/GOALS

Gastric dysplasia is believed to be the penultimate stage of gastric carcinogenesis. Few studies have evaluated whether there is a relationship between such risk factors and gastric dysplasia. This case-control study was conducted to investigate the associations between obesity, serum glucose, lipids and gastric dysplasia.

STUDY

Endoscopic findings and pathology specimens were reviewed from 1 July 1997 to 31 December 2006 in the Health Promotion Center. One hundred thirty patients have the dysplasia in the stomach during screening endoscopy. The same number of controls was evaluated and matched to the gastric dysplasia group for age and gender.

RESULT

The univariate analysis showed that the dysplasia risk was slightly increased among persons with a higher low-density lipoprotein, lower high-density lipoprotein, impaired fasting glucose and higher total cholesterol. However, a higher body mass index and higher triglyceride level were not associated with the diagnosis of gastric dysplasia. In the multivariate-adjusted model, a higher low-density lipoprotein cholesterol and glucose were strongly associated with an increased risk of dysplasia compared to the controls. However, the body mass index, triglyceride and total cholesterol were not associated with the risk for dysplasia.

CONCLUSION

Hyperglycaemia and low-density lipoprotein cholesterol appear to be associated with the risk for gastric dysplasia. Further epidemiologic studies including a large cohort of patients with gastric dysplasia and adenocarcinoma are needed to clarify the association of low-density lipoprotein cholesterol, serum glucose and gastric carcinogenesis.

Down-regulation of ATBF1 is a major inactivating mechanism in hepatocellular carcinoma

AIMS

alpha-Fetoprotein (AFP) is frequently detected in hepatocellular carcinomas (HCCs) and AT motif binding factor 1 (ATBF1) down-regulates AFP gene expression in hepatic cells. The ATBF1 gene also inhibits cell growth and differentiation, and altered gene expression is associated with malignant transformation. The aim was to investigate the potential role of the ATBF1 gene in HCCs.

METHODS AND RESULTS

Somatic mutations, allelic loss and hypermethylation of the ATBF1 gene were analysed in 76 sporadic HCCs. The level of ATBF-1 mRNA expression was analysed using quantitative real-time reverse transcriptase-polymerase chain reaction. Genetic studies of the ATBF1 gene revealed absence of somatic mutation in the hotspot region and 15 (25%) of 60 informative cases showed allelic loss at the ATBF1 locus. Hypermethylation in the intron 1 region of the ATBF1 gene was detected in only one case. Interestingly, ATBF1 mRNA expression in HCCs was significantly reduced in 55 (72.4%) samples compared with the corresponding surrounding liver tissues. Reduced expression was not statistically associated with clinicopathological parameters including stage, histological grade, infective virus type, and serum alpha-fetoprotein level.

CONCLUSIONS

The ATBF1 gene may contribute to the development of HCCs via transcriptional down-regulation of mRNA expression, but not by genetic or epigenetic alterations.

Low coherent hybrid detection technique for differential mode delay in a multimode optical fiber

We present a low coherent hybrid detection technique for the differential model delay (DMD) measurement of a conventional optical multimode fiber with a modified Mach-Zehnder interferometer. A low coherent hybrid detection technique enhances mode coupling between guided modes and the reference mode to easily resolve the modal distribution. An optical spectrum analyzer and a broadband source were used to obtain time-resolved optical beat signals. The measured interference signal was Fourier transformed to obtain time-delay information. A scanning offset launching method was used to excite every available mode in a multimode fiber (MMF). Measurements of a conventional 8-m-long MMF demonstrated the validity of our proposed method. The experimental results of our proposed method agree well with results obtained using a conventional time domain measurement method. Our proposed method can be used to measure the DMD in a short length of optical MMF with a temporal resolution better than 0.72 ps when using an 8-m-long single-mode fiber as a reference.

No association of MDM2 T309G polymorphism with susceptibility to Korean gastric cancer patients

Mouse double minute 2 (Mdm2) acts as a negative regulator of p53 by binding to the amino-terminus of p53. The common T309G polymorphism of Mdm2 has been the most frequently investigated, which can influence in cancer susceptibility and disease outcome. The specific aim of this study is to investigate whether the T309G polymorphism of Mdm2 was associated with individual susceptibility to gastric cancer in Korea. The frequency of the polymorphism was examined in 239 gastric cancer patients and 299 healthy controls. Polymorphism analysis was performed by amplifying the first intron of the Mdm2 and digesting with restriction enzyme and sequencing the products. The frequencies of genotypes: T/T, T/G and G/G were 26.8% (64/239), 46.0% (110/239) and 27.2% (65/239), respectively, in gastric cancer cases and 20.4% (61/299), 50.8% (152/ 299) and 28.8% (86/299), respectively, in healthy controls. Statistically, there was no significant difference in the frequency of genotype and allele between healthy control and gastric cancer patients. Finally, the polymorphism was not associated with increased risk of gastric cancer in this population. When stratified by histological subtype of gastric cancer, the risk was also not statistically significant. Our findings suggested that the T309G polymorphism of Mdm2 was not associated with an increased risk for gastric cancer in Korean population.

KLF6 IVS1 -27G/A polymorphism with susceptibility to gastric cancers in Korean

KLF6 is a key cell cycle regulator that is downregulated in several kinds of human cancers, including gastric cancer. The IVS1 -27G/A polymorphism of KLF6 has been investigated, which can influence susceptibility to gastric cancer and disease outcome. In order to investigate whether the IVS1 -27G/A polymorphism of KLF6 is associated with individual susceptibility to gastric cancer in Korea, the frequency of the polymorphism was examined in 264 gastric cancer patients and 299 healthy controls. Single nucleotide polymorphism (SNP) analysis was performed by amplifying intron 1 of KLF6 and sequencing the products. The frequencies of genotypes: G/G, G/A and A/A were 91.7% (242/264), 5.7% (15/264) and 2.6%, respectively, in gastric cancer cases and 91.9%, 7.0% and 1.1%, respectively, in healthy controls. Genotype frequencies in Korean population were very similar to those of Caucasian population. Interestingly, the male gastric cancer patients showed a significantly higher proportion of the G allele (Chi-Square test, P=0.005) compared to female gastric cancer patients. However, the polymorphism was statistically not associated with increased risk of gastric cancer in Korea. When stratified by histological subtype of gastric cancer, the risk was also not statistically significant. Thus, our results suggested that the IVS1 -27G/A polymorphism of KLF6 is not associated with an increased risk for gastric cancer in Korean population.

The 21st century role of Piver type II hysterectomy in FIGO stage IA, IB cervical cancer: a personal perspective

Class II modified radical hysterectomy reported in 1974 by Piver, Rutledge and Smith for cervical cancer is an extended hysterectomy that has less dissection of the ureter from the paracervical tissues, ligation of the uterine vessels just medial to the ureter to ensure preservation of the distal ureteral blood supply, and less radical parametrectomy preserving the lateral parametrium. The authors present a 21st century personal perspective on the use of a type II hysterectomy based on the 1994 FIGO changes in classification of Stage IAI, IA2, IBI and IB2.

Effects of nitrate on the UV photolysis of H2O2 for VOCs degradation in an aqueous solution

The major objective of this study was to delineate the effect of nitrate on the UV oxidation of benzene and toluene, dissolved in less than 100 microg l(-1), by conducting a bench-scale operation at various reaction times and with various initial concentrations of H2O2 and NO3-. The oxidation of benzene and toluene can be expected to be only about 10% and 18%, respectively, through the photolysis of H2O2 (initial conc. of 50 mg l(-1)), where the reactor was operated at a reaction time of 2 min, with an initial NO(3-)-N concentration of 5 mg l(-1). Nitrate clearly hindered UV oxidation when the initial H2O2 concentration in the reactor was less than 50 mg l(-1). Even if approximately 40% removal could be achieved under the conditions mentioned above (an initial H2O2 concentration of 200 mg l(-1) at a reaction time of 9 min, with a high UV dose), the operating conditions for the 40% removal might be beyond the practical limits applied for effluents discharged from wastewater treatment plants. The results of the experiment also indicate that benzene and toluene can be oxidized in very limited amounts through direct photolysis, without additional oxidation by hydroxyl radicals.

Lymphscintigraphy predicts response to complex physical therapy in patients with early stage extremity lymphedema

We investigated whether baseline lymphscintigraphic findings can predict long-term response to complex physical therapy (CPT) in patients with early stage extremity lymphedema. Twenty patients with unilateral extremity lymphedema of clinical stage I or II underwent CPT after baseline lymphscintigraphy. Therapeutic responses (good vs. poor) were evaluated at 1 year post-CPT based on changes in skin status and subjective symptoms, and percent volume reductions and compared with clinical factors and lymphscintigraphic findings. Eleven patients showed good response to CPT with significant volume reduction of edematous extremities, and no significant volume reduction was observed in the remaining 9. Patients with good or poor responses to CPT showed no significant differences in terms of clinical variables. However, significant differences were observed between the lymphscintigraphic findings of these patients. More specifically, a lymphscintigraphic finding of main lymphatic vessels without collateral lymphatic vessels was the best predictor for a good response to CPT; the sensitivity, specificity and accuracy of this lymphscintigraphic finding is 91% (10/11), 100% (9/9) and 95% (19/20), respectively. In patients with unilateral extremity lymphedema of early stage, baseline lymphscintigraphy may usefully predict long-term response to CPT.

Dependence of the energies of fusion on the intermembrane separation: optimal and constrained

We calculate the characteristic energies of fusion between planar bilayers as a function of the distance between them, measured from the hydrophobic/hydrophilic interface of one of the two nearest, cis, leaves to the other. The two leaves of each bilayer are of equal composition: 0.6 volume fraction of a lamellar-forming amphiphile, such as dioleoylphosphatidylcholine, and 0.4 volume fraction of a hexagonal-forming amphiphile, such as dioleoylphosphatidylethanolamine. Self-consistent field theory is employed to solve the model. We find that the largest barrier to fusion is that to create the metastable stalk. This barrier is the smallest, about 14.6k(B)T, when the bilayers are at a distance about 20% greater than the thickness of a single leaf, a distance which would correspond to between 2 and 3 nm for typical bilayers. The very size of the protein machinery which brings the membranes together can prevent them from reaching this optimum separation. For even modestly larger separations, we find a linear rate of increase of the free energy with distance between bilayers for the metastable stalk itself and for the barrier to the creation of this stalk. We estimate these rates for biological membranes to be about 7.1k(B)Tnm and 16.7 k(B)Tnm, respectively. The major contribution to this rate comes from the increased packing energy associated with the hydrophobic tails. From this we estimate, for the case of hemagglutinin, a free energy of 38k(B)T for the metastable stalk itself and a barrier to create it of 73 k(B)T. Such a large barrier would require that more than a single hemagglutinin molecule be involved in the fusion process, as is observed.

CT evaluation of shock viscera: a pictorial review

The purpose of this article is to review both the pathophysiology and the computed tomography features of the hypoperfusion complex and shock viscera. The main findings include dilated fluid-filled loops of bowel with hyperenhancing mucosa, intensely enhancing kidneys and mesenteric vasculature, and small caliber, dense aorta and collapsed, slit-like inferior vena cava. Variable features include increased enhancement of the adrenals, decreased enhancement of the spleen, and altered enhancement of the pancreas with both hypo- and hyperenhancement described. This complex of findings indicates a tenuous hemodynamic status and has been associated with a poor prognosis. In addition, it is important to discern this collection of findings from direct injury to the viscera to aid in appropriate triage and management of the patients' injuries.

Spectrum-sliced Fourier-domain low-coherence interferometry for measuring the chromatic dispersion of an optical fiber

We present a novel spectrum-slicing method for measuring the chromatic dispersion of an optical fiber in Fourier-domain low-coherence interferometry. Broadband spectral interference data obtained from a low-coherence interferometer is sliced with Gaussian window functions. Each sliced spectral datum is used to calculate a relative group delay with Fourier transformation at the peak wavelength of a narrow window function. We have demonstrated that our proposed method is very powerful and simple for measuring chromatic dispersion and second-order dispersion in optical fibers and optical devices. Comparison of the proposed method with a conventional measurement method agrees within 0.5%.

Secondary malignant lymphoedema after mastectomy in two dogs

This case report describes the diagnosis of secondary malignant lymphoedema in two dogs that had undergone a mastectomy. A remarkable severe oedematous lesion associated with lameness in the right hindlimb was observed in both cases. Diagnostic imaging examinations, including direct pedal lymphangiography (case 1) and lymphoscintigraphy (case 2), showed obstruction of lymph flow in the lymphatics of the right hindlimbs. Although the recommended medical management and physiotherapy had been applied to resolve the problems, oedema did not improve in the damaged region in both cases. Results of histopathological examinations suggested that the cause of the obstructed lymph flow was neoplastic cells in the lymphatics of the right hindlimb in both dogs.

Stromelysin-3 expression in the differential diagnosis of dermatofibroma and dermatofibrosarcoma protuberans: comparison with factor XIIIa and CD34

BACKGROUND

The distinction between dermatofibroma (DF) and dermatofibrosarcoma protuberans (DFSP) is a well-known challenge for dermatopathologists. Immunohistochemical stains have been used to augment routine histological examination to aid in differentiating DF from DFSP. Stromelysin-3 (ST3) is a member of the matrix metalloproteinase (MMP) family, MMP-11, which is expressed in the skin during wound healing and in the stroma of basal cell carcinoma. Recent studies demonstrated that DFs expressed ST3, whereas DFSPs were only rarely ST3 positive.

OBJECTIVES

To assess the expression of ST3 in DF and DFSP and to ascertain whether ST3 is superior to factor XIIIa or CD34 in differentiating DF from DFSP, by comparison with factor XIIIa and CD34 expression.

METHODS

Immunohistochemical staining was performed on 23 cases of DF and 17 cases of DFSP, using antibodies to ST3, factor XIIIa and CD34.

RESULTS

ST3 was expressed in all cases of DF (23 of 23) but only one case showed weakly positive staining in DFSP (one of 17). The mean +/- SD ST3 immunohistochemistry (IHC) score in DF was 4.52 +/- 0.67. The sensitivity of ST3 was 100% and the specificity was 94%. Factor XIIIa was expressed in all cases of DF (23 of 23) and in five of the 17 DFSPs. The mean +/- SD factor XIIIa IHC score in the DFs was 4.43 +/- 0.73. The sensitivity of factor XIIIa was 100% and the specificity was 71%. CD34 was expressed in four of the 23 DFs and 16 of the 17 DFSPs. The mean +/- SD CD34 IHC score in the DFSPs was 4.41 +/- 1.37. The sensitivity of CD34 was 94% and the specificity was 83%.

CONCLUSIONS

Immunohistochemical staining with a commercial anti-ST3 antibody can be successfully carried out in routine dermatopathology. We confirmed that ST3 is a positive marker for DF and that ST3 staining might be more reliable than factor XIIIa staining in differential diagnosis of DF and DFSP. As the present study showed that ST3 was not absolutely negative in all cases of DFSP, the combination with CD34 immunostaining could make the distinction more reliable.

Field theoretic study of bilayer membrane fusion III: membranes with leaves of different composition

We extend previous work on homogeneous bilayers to calculate the barriers to fusion of planar bilayers that contain two different amphiphiles, a lamellar former and a hexagonal former, with different compositions of the two in each leaf. Self-consistent field theory is employed, and both standard and alternative pathways are explored. We first calculate these barriers as the amount of hexagonal former is increased equally in both leaves to levels appropriate to the plasma membrane of human red blood cells. We follow these barriers as the composition of hexagonal formers is then increased in the cis layer and decreased in the trans layer, again to an extent comparable to the biological system. We find that, while the fusion pathway exhibits two barriers in both the standard and alternative pathways, in both cases the magnitudes of these barriers are comparable to one another, and small, on the order of 13 k(B)T. As a consequence, one expects that once the bilayers are brought sufficiently close to one another to initiate the process, fusion should occur rapidly.

Patients with IgA nephropathy have increased serum galactose-deficient IgA1 levels

Immunoglobulin A (IgA) nephropathy is the most prevalent form of glomerulonephritis worldwide. A renal biopsy is required for an accurate diagnosis, as no convenient biomarker is currently available. We developed a serological test based upon the observation that this nephropathy is characterized by undergalactosylated IgA1 in the circulation and in mesangial immune deposits. In the absence of galactose, the terminal saccharide of O-linked chains in the hinge region of IgA1 is terminal or sialylated N-acetylgalactosamine. A lectin from Helix aspersa, recognizing N-acetylgalactosamine, was used to develop an enzyme-linked immunosorbent assay that measures galactose-deficient IgA1 in serum. The median serum lectin-binding IgA1 level was significantly higher for 153 Caucasian adult patients with IgA nephropathy without progression to end-stage renal disease as compared with that for 150 healthy Caucasian adult controls. As the lectin-binding IgA1 levels for the controls were not normally distributed, the 90th percentile was used for determination of significant elevation. Using a value of 1076 U/ml as the upper limit of normal, 117 of the 153 patients with IgA nephropathy had an elevated serum lectin-binding IgA1 level. The sensitivity as a diagnostic test was 76.5%, with specificity 94%; the positive predictive value was 88.6% and the negative predictive value was 78.9%. We conclude that this lectin-binding assay may have potential as a noninvasive diagnostic test for IgA nephropathy.

A dual-design expandable colorectal stent for malignant colorectal obstruction: results of a multicenter study

BACKGROUND AND STUDY AIMS

It is known that metal stent placement is safe, easy, and effective for the treatment of malignant colorectal obstruction, but these stents are associated with delayed complications of tumor ingrowth and stent migration. The aim of this study was to prospectively investigate the technical feasibility, clinical effectiveness, and safety of a dual-design colorectal stent (consisting of an outer stent and an inner bare nitinol stent) in patients with malignant colorectal obstruction.

PATIENTS AND METHODS

Placement of the dual stent using a 4.5-mm stent delivery system was attempted in 151 patients with malignant colorectal obstruction, either before surgery (n = 50) or for palliation (n = 101). Multivariate logistic regression analysis was used to identify risk factors associated with complications.

RESULTS

Stent placement was technically successful in 145/151 patients (96%). Of the patients who had a technically successful placement, bowel obstruction resolved within 2 days after stent placement in 48/50 (96%) of the patients in the bridge-to-surgery group and in 87/95 (92%) of the patients in the palliative group. Perforation occurred in 16 patients, incomplete stent expansion in eight patients, stent migration in four patients, tumor overgrowth in five patients, severe rectal pain in five patients, and bleeding in eight patients. Complete obstruction was the only significant risk factor for perforation (odds ratio 6.88, 95% CI 2.04-23.17, P = 0.002). In the palliative group, the median survival was 152.0 days and the mean survival was 263.8 days.

CONCLUSIONS

The dual stent with a 4.5-mm stent delivery system is easy to insert, safe, and reasonably effective for the palliative treatment of malignant colorectal obstruction. However, a great deal of care is needed in its deployment because of the high rate of perforation.