Artichoke leave extract for chronic hepatitis C - a pilot study

BACKGROUND

Artichoke leave extracts (ALE) have hepatoprotektive properties and are used by patients with chronic liver disease. Effects in patients with chronic hepatitis C are unclear.

METHODS

17 patients with chronic hepatitis C and persistently elevated aminotransferase levels were treated for 12 weeks with 3200mg standardized ALE per day. Primary outcome parameter was the rate of alanine aminotransferase (ALT) normalisation after 12 weeks. Secondary parameters were the course of ALT, aspartate aminotransferase and gamma glutamyltransferase levels, quantitative HCV RNA, subjective symptoms frequently associated with chronic hepatitis C (fatigue, discomfort upper abdomen, joint problems) and safety.

RESULTS

None of the patients had normalized ALT levels after 12 weeks of treatment. There was no significant change of aminotransferase levels or viral load compared to baseline levels. Fatigue and joint problems significantly improved after 4 weeks of treatment. However, after 12 weeks, there was no significant difference to baseline. Tolerability of ALE was rated as good to excellent. Severe side effects did not occur.

CONCLUSION

ALE seem not to be effective to improve aminotransferase levels in patients with chronic hepatitis C.

Intra- and Inter-individual Variation of Background and Radiation-induced Micronucleus Frequencies in Human Lymphocytes

Serial blood samples were taken from four healthy individuals (three males, one female, aged between 26 and 51 years) in 3-monthly intervals during 1 year. Leucocyte suspensions were prepared and exposed to 3 Gy of 137Cs gamma-rays or left unirradiated as controls. In a cytokinesis-blocked (CB) micronucleus (MN) assay significant inter- and intra-donor variations of background and radiation-induced MN incidences became apparent. The two sources of variation lead to an extra variance sigma I2, in addition to the sample variance sigma e2 of MN incidences. The contributions of the different components to the total variance were estimated by means of a variance component model. The deviation sigma I for the mean background MN level of 1.53 x 10(-2) MN/CB cell was +/- 0.67 x 10(-2) and for the mean radiation-induced MN level of 0.53 MN/CB cell it was +/- 0.10. The contribution of the intra-individual variance to sigma I2 was about 50% for background MN levels and 75% for radiation-induced MN frequencies. With respect to the application of the CB-MN assay as a biological dosimetry system, the consequences of the present findings for calibration purposes and low-dose estimation are discussed. The calculation of the variance components is explained in an appendix, which serves also as an example for the adaptation of analysis of variance techniques to the evaluation of data derived from scoring of MN, as well as from scoring of metaphase chromosomal aberrations.

Quantitative muscle ultrasound in neuromuscular disorders using the parameters 'intensity', 'entropy', and 'fractal dimension'

BACKGROUND AND PURPOSE

Ultrasound is a useful non-invasive instrument in visualizing physiological and pathological morphology in skeletal muscle. Here, we evaluate the possibility that quantitative muscle ultrasound using the parameters 'intensity', 'entropy', and 'fractal dimension' is a feasible method to distinguish between dystrophic myopathies (DM), inflammatory myopathies (IM), and motor neuron disorders.

METHODS

Seven patients with IM, 12 patients with DM, nine patients with motor neuron diseases, and 24 healthy subjects underwent an identical ultrasound examination protocol, applied on gastrocnemius and tibialis anterior muscle. Analysis parameters were applied on grey scale images as well as on gradient images.

RESULTS

Statistical evaluation revealed no significant differences in the evaluated parameters for differentiation of the distinct disease groups. Compared with healthy controls however we found statistically significant differences between almost of all the investigated parameters, even in disease cases with clinically unaffected distal musculature.

CONCLUSION

The parameters are able to distinguish between healthy and affected musculature but not between distinct disease entities. Studies are needed to establish whether or not the parameters are helpful to monitor muscle involvement and disease progression in neuromuscular diseases.

Slow waves, synaptic plasticity and information processing: insights from transcranial magnetic stimulation and high-density EEG experiments

Sleep slow waves are the main phenomenon underlying NREM sleep. They are homeostatically regulated, they are thought to be linked to learning and plasticity processes and, at the same time, they are associated with marked changes in cortical information processing. Using transcranial magnetic stimulation (TMS) and high-density (hd) EEG we can measure slow waves, induce and measure plastic changes in the cerebral cortex and directly assess corticocortical information transmission. In this manuscript we review the results of recent experiments in which TMS with hd-EEG is used to demonstrate (i) a causal link between cortical plastic changes and sleep slow waves and (ii) a causal link between slow waves and the decreased ability of thalamocortical circuits to integrate information and to generate conscious experience during NREM sleep. The data presented here suggest a unifying mechanism linking slow waves, plasticity and cortical information integration; moreover, they suggest that TMS can be used as a nonpharmacological means to controllably induce slow waves in the human cerebral cortex.

Laser ultrasonic inspection of the microstructural state of thin metal foils

A laser-based ultrasonic technique suitable for characterization of the microstructural state of metal foils is presented. The technique relies on the measurement of the intrinsic attenuation of laser-generated longitudinal waves at frequencies reaching 1 GHz resulting from ultrasonic interaction with the sample microstructure. In order to facilitate accurate measurement of the attenuation, a theoretical model-based signal analysis approach is used. The signal analysis approach isolates aspects of the measured attenuation that depend strictly on the microstructure from geometrical effects. Experimental results obtained in commercially cold worked tungsten foils show excellent agreement with theoretical predictions. Furthermore, the experimental results show that the longitudinal wave attenuation at gigahertz frequencies is strongly influenced by the dislocation content of the foils and may find potential application in the characterization of the microstructure of micron thick metal foils.

Terahertz coherent control of optically dark paraexcitons in Cu2O

Intense multiterahertz fields of order megavolts per centimeter are used to coherently promote optically dark and dense paraexcitons in Cu2O from the 1s into the 2p state. The nonlinear field response of the intraexcitonic degrees of freedom is directly monitored in the time domain via ultrabroadband electro-optic sampling. The experimental results are analyzed with a microscopic many-body theory, identifying up to two internal Rabi cycles. The effects of population inversion and ponderomotive contributions are disentangled.

[Fast-track rehabilitation after open aorto-iliac vascular procedures]

BACKGROUND

Fast-track rehabilitation programs have resulted in a decrease in mortality and morbidity after major surgical procedures, e. g., in colorectal surgery. It is not known whether fast-track rehabilitation can safely be applied in major vascular surgery.

METHOD

35 patients (mainly ASA III) who underwent open aorto-iliac reconstruction (21 for abdominal aneurysm, 14 for aorto iliac occlusive disease) between May 2005 and June 2006 were treated with a fast-track protocol including PDA, early postoperative oral fluid and food supply, early postoperative mobilisation, all starting on the day of operation. The average daily oral fluid amount, duration of mobilisation, step of oral nutrition, day of first defecation, PONV, pain levels while resting, under effort and mobilisation, and fatigue were monitored.

RESULTS

The 30-day mortality was 0%, overall morbidity was 14.8% with 9% pulmonary, 2.9% cardiac and 2.9% renal complications. Mobility was safely achieved. The oral fluid consumption was 329 mL on the day of operation and 1160 mL on the second day after operation. 33 patients (94%) achieved total oral nutrition on day four after operation. The average pain level in all categories and the fatigue were below 4 on the VAS.

CONCLUSION

Fast-track rehabilitation can safely be applied to patients undergoing conventional aorto-iliac reconstruction. Early onset of oral nutrition and mobilisation influence the fatigue in a positive way. Thoracal PDA leads to acceptable pain levels.

[Vascular surgery in a vascular centre--the different way--2 years of the Karlsbad model]

BACKGROUND

The G-DRG system will lead from specialty-bound to process-bound pathways to guarantee efficient patient treatment in specialised units. Innovative concepts will have a trend-setting character. Certified vascular centres are currently cooperating in an interdisciplinary manner but on a specialty- and department-based background.

PROJECT

In the "Karlsbad Model", the vascular surgery was integrated into existing medical departments like internal medicine/angiology, neurology and radiology in 2004. Treatment takes place in a department-overlapping, guide-line equitable and process-orientated manner with shared treatment competence. Clinical pathways, interdisciplinary case discussion and consultation hours guarantee a target-oriented pathway. The Karlsbad Model was certified by the German Society of Angiology. The internal (patients, staff) and external (cooperating doctors) contentment was augmented. The (preoperative) and overall length of stay was reduced from (6.47) 11.73 days in 2004 to (3.49) 9.32 days in 2005 for all vascular surgery G-DRGs.

CONCLUSION

The Karlsbad Model with its process- and case-orientated cooperation has a trend-setting character with a positive influence on internal and external contentment.

Differential expression of GHRH receptor and its splice variant 1 in human normal and malignant mucosa of the oesophagus and colon

Recent evidence indicates that growth hormone-releasing hormone (GHRH) functions as a growth factor for gastrointestinal (GI) tumours. The tumourigenic effects of GHRH appear to be mediated by the splice variant 1 (SV-1) of GHRH receptor as well as the full length pituitary type receptor for GHRH (GHRH-R). We examined the protein and mRNA expression of GHRH-R and SV-1 in normal human tissues and tumours of the gastrointestinal (GI-) tract by immunohistochemical staining and reverse transcriptase (RT)-PCR. Squamous cells and squamous cell carcinoma of the oesophagus were negative for GHRH-R and SV-1, while Barrett's mucosa and adenocarcinomas of the oesophagus showed a strong expression of both receptors. The expression of GHRH-R was absent in normal colonic mucosa other than neuroendocrine cells (NE) and lining epithelium (LE) but strong in tubular adenomas of the colon, while the staining for SV-1 was absent in cells other than NE. However, the expression of both receptors was significantly increased in tubulovillous adenomas and colorectal cancers. No differences were seen in protein levels for both receptors between normal and neoplastic tissues of the stomach, pancreas and liver. Because of low mRNA levels for both receptors in all samples tested, only a qualitative assessment could be made. However, mRNA for GHRH-R and SV-1 showed a near-perfect correlation with the assessment of receptor proteins by immunostaining. Our study shows that in contrast to normal mucosa, transformed mucosa of the oesophagus and the colon expresses GHRH-R and SV-1. This aberrant expression of GHRH-R and SV-1 in oesophageal and colorectal malignancies may provide a molecular target for a therapeutic approach based on GHRH antagonists.

Bilateral internal carotid artery dissections related to pregnancy and childbirth

We illustrate a 35 years old woman presenting with acute left hemiplegia three weeks after caesarean section. Cerebral MRI demonstrated acute right frontoparietal ischemic stroke, while angiographic investigations provided acute occlusion of the proximal right internal carotid artery due to a dissection and two additional dissections of the proximal and distal contralateral internal carotid artery. A skin biopsy revealed alterations like in some types of Ehlers-Danlos syndrome. Pregnancy, caesarean section, and possibly hormonal implicated connective tissue changes may have contributed to the dissections. Remarkably a second pregnancy with a close ultrasonographic vascular monitoring two years later succeeded upon caesarean section without complications, which gives an important input in the gestational guidance of risk patients.

Mistletoe therapy in oncology

BACKGROUND

Mistletoe extracts are commonly used in cancer patients. It is claimed that they improve survival and quality of life (QOL) in cancer patients.

OBJECTIVES

To determine the effectiveness, tolerability and safety of mistletoe extracts given either as monotherapy or adjunct therapy for patients with cancer.

SEARCH STRATEGY

Search sources included the Cochrane Central Register of Controlled Trials (CENTRAL, Issue 3, 2007) Cochrane Complementary Medicine Field Registry of randomized clinical trials (RCTs) and controlled clinical trials, MEDLINE, EMBASE, HEALTHSTAR, INT. HEALTH TECHNOLOGY ASSESSMENT, SOMED, AMED, BIOETHICSLINE, BIOSIS, CancerLit, CATLINE, CISCOM (August 2007). For the search the Standard Operating Procedures of the Information System in Health Economics at the German Institute for Medical Documentation and Information (DIMDI) were utilized. Reference lists of relevant articles and authors extensive files were searched for additional studies. Manufacturers of mistletoe preparations were contacted.

SELECTION CRITERIA

We included RCTs of adults with cancer of any type. The interventions were mistletoe extracts as sole treatments or given concomitantly with chemo- or radiotherapy. The outcome measures were survival times, tumor response, QOL, psychological distress, adverse effects from antineoplastic treatment and safety of mistletoe extracts.

DATA COLLECTION AND ANALYSIS

Three review authors independently assessed trials for inclusion in the review. All review authors independently took part in the extraction of data and assessment of study quality and clinical relevance. Disagreements were resolved by consensus. Study authors were contacted where information was unclear. Methodological quality was narratively described and additionally assessed with the Delphi list and the Jadad score. High methodological quality was defined if six out of nine Delphi criteria, or four out of five Jadad criteria were fulfilled. Results were presented qualitatively.

MAIN RESULTS

Eighty studies were identified. Fifty-eight were excluded for various reasons, usually as there was no prospective trial design with randomised treatment allocation. Of the 21 included studies 13 provided data on survival, 7 on tumour response, 16 on measures of QOL or psychological outcomes, or prevalence of chemotherapy-related adverse effects and 12 on side effects of mistletoe treatment; overall comprising 3484 randomised cancer patients. Interventions evaluated were 5 preparations of mistletoe extracts from 5 manufacturers and one commercially not available preparation. The general reporting of RCTs was poor. Of the 13 trials investigating survival, 6 showed some evidence of a benefit, but none of them was of high methodological quality. The results of two trials in patients with melanoma and head and neck cancer gave some evidence that the used mistletoe extracts are not effective for improving survival. Of the 16 trials investigating the efficacy of mistletoe extracts for either improving QOL, psychological measures, performance index, symptom scales or the reduction of adverse effects of chemotherapy, 14 showed some evidence of a benefit, but only 2 of them including breast cancer patients during chemotherapy were of higher methodological quality. Data on side effects indicated that, depending on the dose, mistletoe extracts were usually well tolerated and had few side effects.

AUTHORS' CONCLUSIONS

The evidence from RCTs to support the view that the application of mistletoe extracts has impact on survival or leads to an improved ability to fight cancer or to withstand anticancer treatments is weak. Nevertheless, there is some evidence that mistletoe extracts may offer benefits on measures of QOL during chemotherapy for breast cancer, but these results need replication. Overall, more high quality, independent clinical research is needed to truly assess the safety and effectiveness of mistletoe extracts. Patients receiving mistletoe therapy should be encouraged to take part in future trails.