Decreased Ankyrin Expression Is Associated with Repressed eNOS Signaling, Cell Proliferation, and Osteogenic Differentiation in Osteonecrosis of the Femoral Head

BACKGROUND

Reduced nitric oxide synthase (NOS) activity and decreased reparative potentials in stem cells may be involved in the pathogenesis of osteonecrosis of the femoral head (ONFH), but the underlying mechanism is not clear. Ankyrin, a cytoskeletal protein, can promote NOS expression and many cellular functions when it interacts with the CD44 receptors on the stem cells. This study investigated whether ankyrin is involved in the pathogenesis of ONFH.

MATERIALS AND METHODS

Bone marrow stem cells (BMSCs) from ONFH patients were compared with cells from patients with proximal femoral fracture and BMSC cell lines (PT-2501, Lonza, NC, USA). Differences in the expression levels and downstream signal pathway of ankyrin-Akt-eNOS in BMSCs were studied between ONFH and control. The involvement of ankyrin in the signal cascade, cell proliferation, and differentiation were further investigated by silencing ankyrin using small interfering (si)RNA.

RESULTS

We found the basal mRNA levels of ankyrin and CD44 in BMSCs from the ONFH group were significantly lower as compared with those from the control group. The signal transduction of CD44-ankyrin-Akt-eNOS was significantly repressed in the ONFH group as compared with the control group after hyaluronic acid treatment. Knockdown of ankyrin by siRNA could attenuate the eNOS signaling as well as the BMSCs proliferation and osteogenic differentiation. The proliferation ability and osteogenic differentiation potential of the BMSCs from the ONFH group were significantly reduced as compared with the control group, but they can be enhanced to the baseline levels of the control group by hyaluronic acid treatment.

CONCLUSION

The aberrant eNOS signaling, reduced cell proliferation, and osteogenic differentiation potential in BMSCs from ONFH patients are associated with the decreased ankyrin expression.

CLINICAL RELEVANCE

Altered signal transduction, proliferation, and osteogenic differentiation ability in BMSCs may be involved in the pathogenesis of ONFH. These need further studies especially in BMSC-based cell therapy.

Survival Analysis of Allografting and Antiprotrusio Cage in Treating Massive Acetabular Bone Defects

BACKGROUND

Massive acetabular bone defects reconstructed with allografting and antiprotrusio cage in revision hip arthroplasty is less reported in the literature. We here report a series of 84 antiprotrusio cages and analyze the risk factors associated with failure.

METHODS

All instances of use of an antiprotrusio cage for massive acetabular defect (Paprosky type IIc, III, and pelvic discontinuity) between 2002 and 2017 in the authors' institute were reviewed after institutional review board's approval. Survival analyses based on clinical data, bone defect (Paprosky system), type of allograft, size of cage, fixation quality, and position of cage were performed. Failure was defined as cage loosening or breakage, poor hip function, or cage revision for any reason.

RESULTS

A total of 84 cages in 77 patients (mean age, 62.9 years), with a mean follow-up period of 6.2 years, had a survival rate of 82.1%. Failure was noted in 15 hips, including mechanical failure in 8 hips, recurrent dislocation in 1 hip, poor hip function in 1 hip, and periprosthetic joint infection in 5 hips. Pelvic discontinuity, reconstruction with morselized allograft alone, and fewer than 4 fixation points to the host bone were associated with higher failure rates (hazard ratios, 4.02, 3.42, and 9.9, respectively).

CONCLUSION

We found that an antiprotrusio cage combined with strut allografts, fixed securely to the host bone (>4 fixation points), are beneficial for the management of massive acetabular bone defects. However, pelvic discontinuity remains a challenge that warrants the further study of technical or prosthetic innovations, such as triflange implants, cup cage, and 3D-printed implants.

Androgen deprivation therapy and the risk of subsequent keratitis

Objectives:

The objective of the study was to determine the risk of subsequent keratitis in prostate cancer (PCa) patients treated with androgen deprivation therapy (ADT).

Materials and Methods:

Three thousand three hundred and nine patients with PCa were identified using data from Taiwan’s National Health Insurance Research Database for 2001 through 2013. Among those patients, 856 treated with ADT comprised the study group, while 856 non-ADT-treated patients matched with 1:1 propensity-score-matched analysis comprised the control group. The demographic characteristics and comorbidities of all the patients were analyzed, and Cox proportional hazards regression was utilized to determine the hazard ratios (HRs) for subsequent keratitis.

Results:

A total of 157 (9.2%) patients had newly diagnosed keratitis. Compared to the non-ADT-treated patients, the ADT-treated patients had a reduced risk of subsequent keratitis, with an adjusted HR of 0.38 (95% confidence interval: 0.27–0.55; P < 0.001).

Conclusion:

ADT treatment apparently decreased the risk of subsequent keratitis in the investigated PCa patients, but the clinical significance of this finding should be further assessed in additional studies.

Dose escalation (81 Gy) with image-guided radiation therapy and volumetric-modulated arc therapy for localized prostate cancer: A retrospective preliminary result

Objectives:

The objective of the study is to report the acute and late toxicity and preliminary results of localized prostate cancer treated with high-dose radiation therapy (RT).

Materials and Methods:

Between March 2010 and October 2018, a total of 53 patients with clinically localized prostate cancer were treated with definitive RT at our institution. All patients were planned to receive a total dose of 81 Gy with the volumetric-modulated arc therapy technique. Patients were stratified by prognostic risk groups based on the National Comprehensive Cancer Network risk classification criteria. Acute and late toxicities were scored by the Radiation Therapy Oncology Group morbidity grading scales. The definition of biochemical failure was using the 2005 ASTRO Phoenix consensus definition. Median follow-up time was 46.5 months (range: 4.7–81.0 months).

Results:

The 3-year biochemical failure-free survival rates for low-, intermediate-, and high-risk group patients were 100%, 87.5%, and 84%, respectively. The 3- and 5-year overall survival rates were 83% and 62%, respectively. Three (5.6%) patients developed Grade II acute gastrointestinal (GI) toxicity. Four (7.5%) patients developed Grade II acute genitourinary (GU) toxicity, and none experienced Grade III or higher acute GI or GU symptoms. One (1.8%) patient developed Grade II or higher late GI toxicity. Six (11.3%) patients experienced Grade II late GU toxicity. No Grade III or higher late GI and GU complications have been observed.

Conclusions:

Data from the current study demonstrated the feasibility of dose escalation with image-guided and volumetric-modulated arc therapy techniques for the treatment of localized prostate cancer. Minimal acute and late toxicities were observed from patients in this study. Long-term prostate-specific antigen controls are comparable to previously published results of high-dose intensity-modulated RT for localized prostate cancer. Based on this favorable outcome, dose escalation (81 Gy) has become the standard treatment for localized prostate cancer at our institution.

Prospective evaluation of the setup errors and its impact on safety margin for cervical cancer pelvic conformal radiotherapy

Aim

The primary objective was to assess set-up errors (SE) and secondary objective was to determine optimal safety margin (SM).

Background

To evaluate the SE and its impact on the SM utilizing electronic portal imaging (EPI) for pelvic conformal radiotherapy.

Material and methods

20 cervical cancer patients were enrolled in this prospective study. Supine position with ankle and knee rest was used during CT simulation. The contouring was done using consensus guideline for intact uterus. 50 Gy in 25 fractions were delivered at the isocenter with ≥95% PTV coverage. Two orthogonal (Anterior and Lateral) digitally reconstructed radiograph (DRR) was constructed as a reference image. The pair of orthogonal [Anterior-Posterior and Right Lateral] single exposure EPIs during radiation was taken. The reference DRR and EPIs were compared for shifts, and SE was calculated in the X-axis, Y-axis, and Z-axis directions.

Results

320 images (40 DRRs and 280 EPIs) were assessed. The systematic error in the Z-axis (AP EPI), X-axis (AP EPI), and Y-axis (Lat EPI) ranged from -12.0 to 11.8 mm, -10.3 to 7.5 mm, and -8.50 to 9.70 mm, while the random error ranged from 1.60 to 6.15 mm, 0.59 to 4.93 mm, and 1.02 to -4.35 mm. The SM computed were 7.07, 6.36, and 7.79 mm in the Y-axis, X-axis, and Z-axis by Van Herk's equation, and 6.0, 5.51, and 6.74 mm by Stroom's equation.

Conclusion

The computed SE helps defining SM, and it may differ between institutions. In our study, the calculated SM was approximately 8 mm in the Z-axis, 7 mm in X and Y axis for pelvic conformal radiotherapy.

Aspirin decreases hepatocellular carcinoma risk in hepatitis C virus carriers: a nationwide cohort study

Background

Aspirin has been found to lower the occurrence rates of some cancers through the inhibition of the cyclooxygenase enzyme. For example, there is a well-known association between aspirin use and the occurrence of hepatocellular carcinoma (HCC) in hepatitis B virus (HBV) carriers. However, the association, if any, between aspirin use and HCC in hepatitis C virus (HCV) carriers is unknown. Therefore, this study compared the occurrence rates of HCC in HCV carriers treated with or without aspirin.

Methods

The participants in this retrospective cohort study consisted of people newly diagnosed with HCV in Taiwan from 2000 to 2012. Those who were treated with aspirin were defined as the control group, whereas those not treated with aspirin were defined as the comparison cohort. We used a 1:1 propensity score matching by age, sex, comorbidities, drugs, diagnosis year, and index year with covariate assessment.

Results

Our study sample consisted of 2980 aspirin-treated HCV carriers and 7771 non-aspirin-treated HCV carriers. After propensity score matching, each cohort consisted of 1911 HCV carriers. The adjusted hazard ratio (aHR) of HCC incidence in the aspirin users (aHR = 0.56, 95% CI = 0.43–0.72, p < 0.001) was significantly lower than that in the non-aspirin users. A Kaplan-Meier analysis showed that among the HCV carriers, the aspirin users had a lower cumulative incidence rate of HCC over the first 10 years of aspirin treatment (p < 0.0001).

Conclusions

The HCC incidence rate was lower in the aspirin-using HCV carriers than in the non- aspirin-using HCV carriers, indicating that the effects of aspirin might occur through inhibition of the cyclooxygenase enzyme pathway. Moreover, protection from HCC was provided by less than a year of aspirin treatment, while treatment with aspirin for 1 to 2 years exhibited the greatest protective effect. We therefore encourage aspirin treatment to prevent HCC in HCV carriers.

High-quality thulium iron garnet films with tunable perpendicular magnetic anisotropy by off-axis sputtering - correlation between magnetic properties and film strain

Thulium iron garnet (TmIG) films with perpendicular magnetic anisotropy (PMA) were grown on gadolinium gallium garnet (GGG) (111) substrates by off-axis sputtering. High-resolution synchrotron radiation X-ray diffraction studies and spherical aberration-corrected scanning transmission electron microscope (Cs-corrected STEM) images showed the excellent crystallinity of the films and their sharp interface with GGG. Damping constant of TmIG thin film was determined to be 0.0133 by frequency-dependent ferromagnetic resonance (FMR) measurements. The saturation magnetization (Ms) and the coercive field (Hc) were obtained systematically as a function of the longitudinal distance (L) between the sputtering target and the substrate. A 170% enhancement of PMA field (H⊥) was achieved by tuning the film composition to increase the tensile strain. Moreover, current-induced magnetization switching on a Pt/TmIG structure was demonstrated with an ultra-low critical current density (jc) of 2.5 × 106 A/cm2, an order of magnitude smaller than the previously reported value. We were able to tune Ms, Hc and H⊥ to obtain an ultra-low jc of switching the magnetization, showing the great potential of sputtered TmIG films for spintronics.

MicroRNA-mediated interacting circuits predict hypoxia and inhibited osteogenesis of stem cells, and dysregulated angiogenesis are involved in osteonecrosis of the femoral head

PURPOSE

MicroRNAs (miRNAs) are associated with various pathologic conditions and can serve as diagnostic or therapeutic biomarkers. This study tried to identify the differentially expressed miRNAs to predict the possible pathomechanisms involved in osteonecrosis of the femoral head (ONFH).

METHODS

We compared the peripheral blood miRNAs in 46 patients with ONFH and 85 healthy controls by microarray and droplet digital polymerase chain reaction (ddPCR). Putative interacted networks between the differentially responded miRNAs were analyzed by web-based bioinformatics prediction tools.

RESULTS

Microarray identified 51 differentially expressed miRNAs with at least twofold change (upregulation in 34 and downregulation in 17), and the results were validated by ddPCR using six selected miRNAs. Bioinformatics genetic network analysis focusing on the six miRNAs found the upregulated miR-18a and miR-19a are associated with angiogenesis after induction of ischemia; the upregulated miR-138-1 can inhibit osteogenic differentiation of mesenchymal stem cells; the most targeted genes, p53 and SERBP1, are associated with hypoxia and hypofibrinolysis.

CONCLUSIONS

This study combined the miRNA analysis with the bioinformatics and predicts that hypoxia, inhibited osteogenesis of stem cells, and dysregulated angiogenesis might be orchestrated through the miRNA interacting circuits in the pathogenesis of ONFH.

[Lung function influenced the prognosis of cardiac surgery in patients with chronic obstructive pulmonary disease]

Objective: To investigate the value of lung function for the prognosis of cardiac surgery in patients with chronic obstructive pulmonary disease(COPD). Methods: A retrospective analysis was conducted on the hospitalized patients with coronary heart disease or valvular heart disease in Beijing Anzhen hospital during Janury 2013 to December 2015. The relationship between lung function and extubation time, time of staying in ICU, second time tracheal incubation, tracheotomy and mortality rate were analyzed. Results: There were 355 patients without surgery in a total 1 729 of patients, of which 65 (18.31%)suffered from severe pulmonary dysfunction. There were 242 patients with obstructive ventilation dysfunction, 75 with mild, 127 with moderate, and 40 with severe and very severe obstructive ventilation dysfunction. There were significant differences in the rates of planned extubation and late extubation between patients with normal lung function (81.6% and 10.7%) and those with abnormal lung function(74.4% and 12.8%). In patients with different GOLD classification (Ⅰ, Ⅱ, and Ⅲ-Ⅳ), there were significant differences in the rates of early extubation 14.7%, 14.2% and 5%, planned extubation (80%, 74% and 65%) and late extubation (5.3%, 11.8% and 30%). By comparison with patients without COPD, the extubation time of COPD patients increased by 20.3%, the time of staying in ICU prolonged by 14.2%, and the mortality rate increased to 180%(P<0.05). However, there was no significant difference in the rate of second time tracheal incubation or tracheotomy. Conclusion: There was a close relationship between GOLD classification and prognosis of cardiac surgery patients with COPD. Cardiac surgery needs to be cautious because of increase in incidence of postoperative adverse events in patients with severe pulmonary dysfunction.

Dosimetric comparison between proton beam therapy and photon radiation therapy for locally advanced non-small cell lung cancer

OBJECTIVE

To assess the feasibility of proton beam therapy for the patients with locally advanced non-small lung cancer.

METHODS

The dosimetry was analyzed retrospectively to calculate the doses to organs at risk, such as the lung, heart, esophagus and spinal cord. A dosimetric comparison between proton beam therapy and dummy photon radiotherapy (three-dimensional conformal radiotherapy) plans was performed. Dummy intensity-modulated radiotherapy plans were also generated for the patients for whom curative three-dimensional conformal radiotherapy plans could not be generated.

RESULTS

Overall, 33 patients with stage III non-small cell lung cancer were treated with proton beam therapy between December 2011 and August 2014. The median age of the eligible patients was 67 years (range: 44-87 years). All the patients were treated with chemotherapy consisting of cisplatin/vinorelbine or carboplatin. The median prescribed dose was 60 GyE (range: 60-66 GyE). The mean normal lung V20 GyE was 23.6% (range: 14.9-32%), and the mean normal lung dose was 11.9 GyE (range: 6.0-19 GyE). The mean esophageal V50 GyE was 25.5% (range: 0.01-63.6%), the mean heart V40 GyE was 13.4% (range: 1.4-29.3%) and the mean maximum spinal cord dose was 40.7 GyE (range: 22.9-48 GyE). Based on dummy three-dimensional conformal radiotherapy planning, 12 patients were regarded as not being suitable for radical thoracic three-dimensional conformal radiotherapy. All the dose parameters of proton beam therapy, except for the esophageal dose, were lower than those for the dummy three-dimensional conformal radiotherapy plans. In comparison to the intensity-modulated radiotherapy plan, proton beam therapy also achieved dose reduction in the normal lung. None of the patients experienced grade 4 or worse non-hematological toxicities.

CONCLUSIONS

Proton beam therapy for patients with stage III non-small cell lung cancer was feasible and was superior to three-dimensional conformal radiotherapy for several dosimetric parameters.

Relationship between the G75A polymorphism in the apolipoprotein A1 (ApoA1) gene and the lipid regulatory effects of pravastatin in patients with hyperlipidemia

In this study, we investigated the relationship between the G75A polymorphism in the apolipoprotein A1 (ApoA1) gene and the lipid regulatory effect of pravastatin in patients with hyperlipidemia. A total of 179 patients were divided into two groups: the pravastatin (N = 97) and policosanol (N = 82) treatment groups. The total cholesterol (TC), triglyceride, low-density lipoprotein (LDL-c), high-density lipoprotein, ApoA, and ApoB concentrations in the serum were measured using an automatic biochemical analyzer before and after treatment for 12 weeks. The genotypes of the ApoA1 G75A SNP were detected by polymerase chain reaction-restriction fragment length polymorphism, and were subsequently statistically analyzed. Pravastatin treatment induced a significant decrease in the TC, LDL-c, and ApoB levels in patients expressing the ApoA1 AA+GA genotype (P < 0.05), and not in those expressing the GG genotype (P > 0.05). However, policosanol treatment induced a non-significant decrease in the serum TC levels (P > 0.05) and a significant decrease in the ApoB levels (P < 0.05), and did not induce a decrease in the LDL-c (P > 0.05) levels in patients with the AA+GA genotype. Policosanol also induced a significant decrease in the TC and LDL-c levels in patients with the GG genotype (P < 0.05). The various genotypes of the ApoA1 G75A SNP influence the efficacy of lipid regulation by pravastatin and policosanol in patients with hyperlipidemia.

Axillary lymph node dissection versus sentinel lymph node biopsy alone for early breast cancer with sentinel node metastasis: A meta-analysis

BACKGROUND

In early breast cancer patients with sentinel node metastasis, the effect of axillary lymph node dissection (ALND) is controversial. The purpose of this study is to compare the safety and efficacy of sentinel lymph node biopsy (SLNB) alone versus ALND in patients with early breast cancer and sentinel node metastasis.

METHODS

We searched PubMed, Embase, Web of Science, and Cochrane Library databases from 1965 to February 2014. All data were analyzed using Review Manager Software 5.2.

RESULTS

12 studies, which included 130,575 patients from five randomized controlled trials and seven observational studies, met our inclusion criteria. 26,870 early breast cancer patients underwent SLNB alone and 103,705 underwent ALND. Patients underwent ALND had more paresthesia (risk ratio [RR] 0.26, 95% confidence interval [CI] 0.20-0.33; p < 0.01) and lymphedema (RR 0.28, 95% CI 0.20-0.41; p < 0.01) than those had SLNB alone. There were no significant differences in overall survival (hazard ratio [HR] 0.95, 95% CI 0.85-1.06; p = 0.35), disease-free survival (HR 1.00, 95% CI 0.98-1.02, p = 0.96), and locoregional recurrence (RR 0.92, 95% CI 0.59-1.44; p = 0.73).

CONCLUSION

Current evidence indicates that axillary dissection may be omitted in early breast cancer patients with sentinel lymph metastasis.

Room temperature single-frequency output from a diode-pumped Tm,Ho:YAP laser

Single-frequency operation in the range of 2102.45-2102.54 nm and 2130.72-2130.82 nm is demonstrated from a Tm,Ho:YAP laser at room temperature. To our knowledge, this is the first time a room temperature single-frequency Tm,Ho:YAP laser of up to 72.6 mW at 2102.5 nm with Fabry-Perot etalons has been obtained. Regulating the elevation angle of the two etalons, 42.0 mW at 2130.8 nm was obtained. The single-longitudinal-mode laser can be used as a seed laser for coherent wind measurements and differential absorption lidar systems.

The growth and characterization of ZnO/ZnTe core-shell nanowires and the electrical properties of ZnO/ZnTe core-shell nanowire field effect transistor

Vertically aligned ZnO/ZnTe core-shell nanowires were grown on a-plane sapphire substrate by using chemical vapor deposition with gold as catalyst for the growth of ZnO core and then followed by growing ZnTe shell using metal-organic chemical vapor deposition (MOCVD). Transmission electron microscope (TEM) and Raman scattering indicate that the core-shell nanostructures have good crystalline quality. Three-dimensional fluorescence images obtained by using laser scanning confocal microscope demonstrate that the nanowires have good optical properties. The core-shell nanowire was then fabricated into single nanowire field effect transistor by standard e-beam photolithography. Electrical measurements reveals that the p-type ZnO/ZnTe FET device has a turn on voltage of -1.65 V and the hole mobility is 13.3 cm2/V s.

Alpinia pricei Hayata rhizome extracts have suppressive and preventive potencies against hypercholesterolemia

The aim of this study was to investigate the effects of 70% ethanol extracts of Alpinia pricei (APE) on lipid profiles and lipid peroxidation. Syrian hamsters were fed a chow-based hypercholesterolemic diet (HCD) for 2 weeks to induce hypercholesterolemia (>250 mg/dl). To evaluate the potency of APE in suppressing hypercholesterolemia, hamsters were then fed HCD plus a high dose (500 mg/kg body weight) or a low dose (250 mg/kg body weight) of APE, or only HCD for another 4 weeks. We found that hypercholesterolemic hamsters fed a high dose of APE had lower serum total cholesterol (TC) and low-density lipoprotein-cholesterol (LDL-C) levels, lower thiobarbituric acid reactive substances (TBARS) and alanine aminotransferase (ALT) activities, lower atherogenic indices (LDL-C/HDL-C and TC/HDL-C ratios), and lower hepatic protein expression of peroxisome proliferators activated receptor gamma (PPARgamma) than hamsters fed a HCD diet. In addition, we also determined the preventive effects of APE on hamsters fed a HCD for 6 weeks. The hypocholesterolemic effects were also found in hamsters co-fed a high dose of APE and HCD for 6weeks. These results suggest that APE has both suppressive and preventive potencies against hypercholesterolemia and has the potency to protect against lipid peroxidation.

Crystal orientation and thickness dependence of the superconducting transition temperature of tetragonal FeSe1-x thin films

Superconductivity was recently found in the tetragonal phase FeSe. A structural transformation from tetragonal to orthorhombic (or monoclinic, depending on point of view) was observed at low temperature, but was not accompanied by a magnetic ordering as commonly occurs in the parent compounds of FeAs-based superconductors. Here, we report the correlation between structural distortion and superconductivity in FeSe(1-x) thin films with different preferred growth orientations. The films with preferred growth along the c axis show a strong thickness dependent suppression of superconductivity and low temperature structural distortion. In contrast, both properties are less affected in the films with (101) preferred orientation. These results suggest that the low temperature structural distortion is closely associated with the superconductivity of this material.

Epitaxial Growth of InN Films by Molecular-Beam Epitaxy Using Hydrazoic Acid (HN3) as an Efficient Nitrogen Source

Epitaxial InN films have been successfully grown on c-plane GaN template by gas-source molecular-beam epitaxy with hydrazoic acid (HN3) as an efficient nitrogen source. Results in residual-gas analyzer show that the HN3 is highly dissociated to produce nitrogen radicals and can be controlled in the amounts of active nitrogen species by tuning HN3 pressure. A flat and high-purity InN epifilm has been realized at the temperature near 550 degrees C, and a growth rate of 200 nm/hr is also achieved. Moreover, the epitaxial relationship of the InN(002) on the GaN(002) is reflected in the X-ray diffraction, and the full-width at half-maximum of the InN(002) peak as narrow as 0.05 degrees is related to a high-quality crystallinity. An infrared photoluminescence (PL) emission peak at 0.705 eV and the integrated intensity increasing linearly with excitation power suggest that the observed PL can be attributed to a free-to-bound recombination.

Sphingosine kinase 1 participates in insulin signalling and regulates glucose metabolism and homeostasis in KK/Ay diabetic mice

AIMS/HYPOTHESIS

The aim of this study was to determine the potential role of sphingosine kinase 1 (SPHK1), a key sphingolipid metabolic enzyme, in glucose metabolism and homeostasis.

METHODS

SMMC-7721 hepatoma cells and C2C12 myotube cells were used to explore the role of SPHK1 in glucose uptake in vitro. KK/Ay type 2 diabetic mice, which were transfected with adenovirus harbouring the human SPHK1 gene by i.v. injection, were used to investigate the glucose-lowering effects of SPHK1 in vivo.

RESULTS

The basal glucose uptake and the insulin-stimulated glucose uptake in both 7721 cells and C2C12 cells were markedly enhanced when SPHK1 was overexpressed by adenovirus-mediated gene transfer, whereas they were substantially reduced when the expression of SPHK1 was inhibited or the activity of SPHK1 was blocked. Insulin could activate SPHK1 of both cell lines in a dose-dependent manner. SPHK1 gene delivery significantly reduced the blood glucose level of KK/Ay diabetic mice, but had no effect on that of normal animals. It also attenuated elevated levels of plasma insulin, NEFA, triacylglycerol, cholesterol and LDL, significantly ameliorated hyperglycaemia-induced injury of liver, heart and kidney, and enhanced phosphorylation of insulin-signalling kinases such as Akt and glycogen synthase kinase 3beta in livers of the diabetic animals.

CONCLUSIONS/INTERPRETATION

SPHK1 is involved in insulin signalling and plays an important role in the regulation of glucose and fat metabolism; adenovirus-mediated SPHK1 gene transfer might provide a novel strategy in the treatment of type 2 diabetes mellitus.

Comparison of the effects of thoracic epidural analgesia and i.v. infusion with lidocaine on cytokine response, postoperative pain and bowel function in patients undergoing colonic surgery

BACKGROUND

Both thoracic epidural analgesia (TEA) and i.v. lidocaine were able to decrease postoperative pain and duration of ileus. We compared TEA and i.v. lidocaine (IV) regarding their effects on cytokines, pain and bowel function after colonic surgery.

METHODS

Sixty patients were randomly allocated to one of the three groups. TEA group had lidocaine 2 mg kg(-1) followed by 3 mg kg(-1) h(-1) epidurally and an equal volume of i.v. normal saline. The IV group received the same amount of lidocaine i.v. and normal saline epidurally. The control group received normal saline via both routes. These regimens were started 30 min before surgery and were continued throughout. Blood cytokines were measured at scheduled times within 72 h.

RESULTS

Both TEA and IV groups had better pain relief. The total consumptions using patient-controlled epidural analgesia were 81.6 (6.5), 55.0 (5.3) and 45.6 (3.9) ml (P<0.01) and the times of flatus passage were 50.2 (4.9), 60.2 (5.8) and 71.7 (4.7) h (P<0.01) in the TEA, IV and control groups, respectively. The TEA group exhibited the best postoperative pain relief and the least cytokine surge. The IV group experienced better pain relief and less cytokine release than the control group.

CONCLUSIONS

The TEA lidocaine had better pain relief, lower opioid consumption, earlier return of bowel function and lesser production of cytokines than IV lidocaine during 72 h after colonic surgery; IV group was better than the control group.

Blue luminescence of Au nanoclusters embedded in silica matrix

Photoluminescence study using the 325 nm He-Cd excitation is reported for the Au nanoclusters embedded in SiO(2) matrix. Au clusters are grown by ion beam mixing with 100 KeV Ar(+) irradiation on Au [40 nm]/SiO(2) at various fluences and subsequent annealing at high temperature. The blue bands above approximately 3 eV match closely with reported values for colloidal Au nanoclusters and supported Au nanoislands. Radiative recombination of sp electrons above Fermi level to occupied d-band holes are assigned for observed luminescence peaks. Peaks at 3.1 and 3.4 eV are correlated to energy gaps at the X- and L-symmetry points, respectively, with possible involvement of relaxation mechanism. The blueshift of peak positions at 3.4 eV with decreasing cluster size is reported to be due to the compressive strain in small clusters. A first principle calculation based on density functional theory using the full potential linear augmented plane wave plus local orbitals formalism with generalized gradient approximation for the exchange correlation energy is used to estimate the band gaps at the X- and L-symmetry points by calculating the band structures and joint density of states for different strain values in order to explain the blueshift of approximately 0.1 eV with decreasing cluster size around L-symmetry point.

Effects of copper on wild and tolerant strains of the lichen photobiont Trebouxia erici (Chlorophyta) and possible tolerance mechanisms

The influence of copper was assessed on wild and tolerant strains of the lichen photobiont Trebouxia erici and shown to have multiple toxic effects. Addition of 4 mM copper chloride into Trebouxia media reduced growth rates of the wild type to less than 1% of control levels. It also injured cell membranes, inhibited dehydrogenase activity, altered pigment composition, and reduced activity of photosystem II. Membrane damage was assessed through measuring electrical conductivity and potassium content, dehydrogenase activity by degree of conversion of 2,3,5-triphenyl tetrazolium chloride to red triphenylformazan, and functioning of PS II by chlorophyll a fluorescence. In respect to most parameters the tolerant strain was usually less affected by copper than the wild strain and, in some cases, not at all. We demonstrated by inductively coupled plasma atomic emission spectrometry and energy-dispersive X-ray microanalysis that enriched copper in the medium resulted in increased uptake by both wild and tolerant photobiont cells, but extracellular concentrations were significantly higher in the tolerant strain. This suggested that, at least in vitro, extracellular deposition was a mechanism of copper tolerance.

Mapping the mesoscale interface structure in polycrystalline materials

A new experimental approach to the quantitative characterization of polycrystalline microstructure by scanning electron microscopy is described. Combining automated electron backscattering diffraction with conventional scanning contrast imaging and with calibrated serial sectioning, the new method (mesoscale interface mapping system) recovers precision estimates of the 3D idealized aggregate function G(x). This function embodies a description of lattice phase and orientation (limiting resolution approximately 1 degree) at each point x (limiting spatial resolution approximately 100 nm), and, therefore, contains a complete mesoscale description of the interfacial network. The principal challenges of the method, achieving precise spatial registry between adjacent images and adequate distortion correction, are described. A description algorithm for control of the various components of the system is also provided.

Pulmonary pleomorphic (spindle) cell carcinoma: peculiar clinicopathologic manifestations different from ordinary non-small cell carcinoma

Pleomorphic (spindle) cell carcinoma, also known as monophasic sarcomatoid carcinoma, is a rare primary pulmonary malignancy. This type of tumor shows concurrent presence of malignant epithelial and homologous sarcomatoid spindle cell components by co-expressing cytokeratin and vimentin in various degrees. Sixteen cases (four central endobronchial lesions and 12 peripheral parenchymal masses) were studied clinicopathologically. Men were affected far more frequently than women (13:3). The patients were between 56 and 80 years of age. The disease is strongly associated with smoking. Among seven of the patients who underwent surgical resection, four of them had mediastinum, pleura and chest wall invasions, and three of them had regional lymph node metastases. All of the patients succumbed to early distant metastases (range 2 weeks-5 months) in organs including brain, bone, adrenal gland, and unusual sites such as esophagus, jejunum, rectum and kidney. The remaining nine inoperable cases were late stage disease and treated with chemoradiotherapy with little effect. The median duration of survival was 3 months. All parenchymal masses appeared as cavities with marked central necrosis, and only peripheral rim of tumor cells was left. More definite diagnostic results will depend on further tissue sections and can be confirmed by immunohistochemical studies. Significantly fewer Ki-67, p53 and c-erb B-2 oncoprotein expressions were also noted.

Obstructive jaundice caused by hepatocellular carcinoma: detection by endoscopic sonography

Tumor thrombus in the extrahepatic biliary tree is a rare mechanism of obstructive jaundice. We present a patient with a minute hepatocellular carcinoma in the caudate lobe that invaded the common hepatic duct and caused biliary obstruction. Endoscopic sonography showed a tumor thrombus with central echogenicity and a "nodule-in-nodule" pattern and suggested the correct diagnosis.

Class I beta-1,3-glucanase and chitinase are expressed in the micropylar endosperm of tomato seeds prior to radicle emergence

beta-1,3-Glucanase (EC 3.2.1.39) and chitinase (EC 3.2.1.14) mRNAs, proteins, and enzyme activities were expressed specifically in the micropylar tissues of imbibed tomato (Lycopersicon esculentum Mill.) seeds prior to radicle emergence. RNA hybridization and immunoblotting demonstrated that both enzymes were class I basic isoforms. beta-1,3-Glucanase was expressed exclusively in the endosperm cap tissue, whereas chitinase localized to both endosperm cap and radicle tip tissues. beta-1,3-Glucanase and chitinase appeared in the micropylar tissues of gibberellin-deficient gib-1 tomato seeds only when supplied with gibberellin. Accumulation of beta-1,3-glucanase mRNA, protein and enzyme activity was reduced by 100 microM abscisic acid, which delayed or prevented radicle emergence but not endosperm cap weakening. In contrast, expression of chitinase mRNA, protein, and enzyme activity was not affected by abscisic acid. Neither of these enzymes significantly hydrolyzed isolated tomato endosperm cap cell walls. Although both beta-1,3-glucanase and chitinase were expressed in tomato endosperm cap tissue prior to radicle emergence, we found no evidence that they were directly involved in cell wall modification or tissue weakening. Possible functions of these hydrolases during tomato seed germination are discussed.

Surgical treatment of subluxation and dislocation of the hips in cerebral palsy patients

BACKGROUND AND PURPOSE

Progressive subluxation and dislocation of the hip are major complications in patients with cerebral palsy (CP), causing functional deterioration and difficulties in personal hygiene. Treatment of these problems is difficult and complicated. The purpose of this study was to describe the surgical results and long-term follow-up in a group of CP patients.

METHODS

Twenty-three CP patients with subluxated (15 hips) or dislocated hips (12 hips) underwent corrective surgery between 1985 and 1993. This included 11 quadriplegic, eight diplegic, and four hemiplegic patients. Before surgery, four patients were bed-ridden, eight were sitters, six were house-ambulators, and five were community-ambulators. The average age at surgery was 8 years and 5 months. The surgical procedures consisted of femoral varus derotational osteotomy in 21 patients (25 hips), selected soft tissue release in 18 patients (22 hips), and pelvic osteotomy in 18 patients (20 hips). The center-edge angle, acetabular index, and neck-shaft angle were used as parameters to evaluate preoperative and postoperative radiographic changes.

RESULTS

After an average follow-up of 4.8 years, 19 patients (22 hips) had gained hip stability, and also had improved functional status. The four bed-ridden patients all became sitters; six of the eight sitters became house-ambulators and one became a community-ambulator; all six house-ambulators became community-ambulators, and the five community-ambulators had functional improvement. Complications included nonunion at the femoral osteotomy site in one hip, redislocation in two hips, and resubluxation in one hip.

CONCLUSIONS

We conclude that subluxated or dislocated hips in patients with CP can be effectively treated with aggressive correction, which may include soft tissue release, femoral derotational osteotomy, and pelvic osteotomy for improvement of hip range of motion and functional status.

Bilateral pulmonary edema after endoscopic sympathectomy in a patient with glucose-6-phosphate dehydrogenase deficiency

Transaxillary endoscopic sympathectomy of thoracic ganglia (T2-T3) has recently gained wider acceptance as the treatment of choice for palmar hyperhidrosis. It requires one-lung ventilation to facilitate the surgery. One-lung ventilation, however, is not without complications, among which acute pulmonary edema has been reported. In this case report, we present a patient with palmar hyperhidrosis complicated by glucose-6-phosphate dehydrogenase (G-6-PD) deficiency, who received bilateral endoscopic sympathectomy under alternate one-lung anesthesia, and developed acute pulmonary edema immediately after recruitment of the successive collapsed lung. The effects of hypoxemia, G-6-PD deficiency and sympathectomy might all add to the development of acute pulmonary edema secondary to reexpansion of each individual lung after alternate one-lung ventilation. The possibilities of the inferred causes are herein discussed.

Absence of the preemptive analgesic effect of dextromethorphan in total knee replacement under epidural anesthesia

BACKGROUND

Previous studies have shown that dextromethorphan (DM), a N-methyl-D-aspartate (NMDA) receptor antagonist, produces a preemptive analgesic effect on post-operative pain. The aim of this study was to further examine the preemptive analgesic effect of intramuscular (i.m.) DM injection on unilateral total knee replacement (TKR).

METHODS

Sixty-four ASA I-III patients scheduled for unilateral TKR surgery were randomly allocated into three groups in a prospective double-blind manner. All patients received epidural anesthesia without any premedication. An initial bolus dose of 2% lidocaine (15-20 mL) followed by a maintenance dose of 8-10 mL/h was decided. Fentanyl (1.5 micrograms/kg) and diazepam (2 mg) were given i.v. before epidural catheter insertion. The epidural catheter was placed via the L2-L3 or L3-L4 interspace and advanced for 5 cm cephalad [corrected]. Patients received i.m. injection of 20 mg chlorpheniramine (CPM) before surgery as control (group C, n = 22). For the study groups, patients were given an i.m. injection containing 40 mg DM and 20 mg CPM, before (group B, n = 22) or after surgery (group A, n = 20), respectively. Postoperation, patients received intravenous morphine by means of a patient controlled analgesia (PCA) device for pain relief. The time to the first pull of PCA trigger, morphine consumption, worse pain scores (resting and incidental), and analgesics related side effects were recorded at 1, 2, 4, 8, 24, 48 and 72 h after surgery.

RESULTS

The time from the end of operation to the first PCA trigger were 31.2 +/- 5.2 min in group C, 67.3 +/- 11.1 min in group B (P < 0.05, compared with group C) and 61.8 +/- 7.2 min in group A (P < 0.05, compared with group C) respectively. The relevant pain score at resting, observed at the 8 h postoperatively was respectively 4.2 +/- 0.1 in group C, 3.7 +/- 0.2 in group B (P < 0.05, compared with group C) and 3.4 +/- 0.2 in group A (P < 0.05, compared with group C); and at the 24 h was 3.1 +/- 0.2 in group C, 2.4 +/- 0.2 in group B (P < 0.05, compared with group C) and 2.5 +/- 0.1 in group A (P < 0.05, compared with group C) respectively. There were no significant differences in actual morphine delivery and frequency of PCA triggering at all time among the three groups. Moreover, there was also no significant statistic difference in morphine-associated side effects among the three groups.

CONCLUSIONS

In the present study, we failed to observe any preemptive analgesic effect of DM (40 mg, i.m.) on postoperative pain in patients who received TKR under epidural anesthesia, however, DM given either before or after surgery augmented other analgesic (morphine) to offer a better pain relief.

Hepatic leiomyomatous neoplasm associated with Epstein Barr virus infection in an adult with acquired immunodeficiency syndrome

Focal lesions in the liver in patients with acquired immunodeficiency syndrome (AIDS) pose an important clinical problem. Hepatic smooth-muscle tumor is rare in AIDS patients and has been reported mostly in children. We describe a 32-year-old male AIDS patient, with previous disseminated tuberculosis, who developed a small tumor in the liver. Liver biopsy disclosed an unusual hepatic leiomyomatous neoplasm that was associated with Epstein Barr virus infection. It differed from the more common Kaposi's sarcoma and presented a relatively benign course.

E-cadherin expression in surgically-resected non-small cell lung cancers--a clinicopathological study

BACKGROUND

E-Cadherin is a subclass of the cadherin family that plays a major role in the maintenance of intercellular junctions in normal epithelium. Decreased expression of E-cadherin might be closely related to invasiveness and dedifferentiation in human cancers. This study is aimed at investigating the clinicopathological significance of E-cadherin expression and its impact on the prognosis in surgically resected non-small-cell lung cancer patients.

METHODS

Using immunohistochemical staining, the expression of E-cadherin was studied in 207 surgically resected lung cancer specimens from January 1990 through December 1994. The clinicopathological data and survival status were recorded and analysed against the E-cadherin expression level in each tumor.

RESULTS

E-cadherin expression was detected in 122 of the 207 lung tumors (59.0%), and the expression was significantly lower in tumors with poor differentiation (p < 0.001), in tumors with vascular invasion (p < 0.05), and in tumors with direct invasion into surrounding structures (p < 0.01). There was no correlation between E-cadherin expression, and tumor stage and regional lymph-node metastasis. There was no significant difference in survival rate between higher (> 40%) and lower (< 40%) E-cadherin expression groups; however, in tumors 3 cm or less, a significant difference was found between higher and lower E-cadherin expressions (p < 0.0001).

CONCLUSIONS

Underexpression of E-cadherin is associated with poor differentiation and invasiveness in NSCLC. In patients with small NSCLC (< or = 3 cm), higher E-cadherin expression (> 40%) significantly had a favorable prognosis.

Intracortical osteosarcoma: report of a case

Intracortical osteosarcoma is the rarest anatomic variation of osteosarcoma. There have been only 12 cases reported in the English-language literature. We present a case of osteosarcoma in an 18-year-old Taiwanese man that originated within the cortex of the tibial diaphysis. The initial radiograph revealed a lytic mass confined to the cortex, mimicking a benign bone lesion. Histopathologic examination of the biopsy specimen showed an osteoblastic osteosarcoma mingled with some fibroblastic foci. He underwent en bloc resection, and a metallic prosthetic intercalary stem was used to replace the larger bone defect. Adjuvant chemotherapy was administered before and after the operation. He was free of disease during 40 months of follow-up. A review of all reported cases of intracortical osteosarcoma revealed that the initial method of treatment plays an important role in local recurrence and distant metastasis. Local excision and curettage leads to the worst results. The outcomes of more recently reported cases have improved because of early awareness of the possibility of malignancy and advances in chemotherapy. However, whether patients with intracortical osteosarcoma have a different prognosis from those with conventional osteosarcoma cannot be determined, because of the small number of intracortical osteosarcoma cases available for analysis.

Preincisional dextromethorphan treatment for postoperative pain management after upper abdominal surgery

Previous studies showed that ketamine, an N-methyl-D-aspartate (NMDA) receptor antagonist, provides a preemptive analgesic effect and preemptive analgesia improves postoperative pain management. The aim of this study was to examine whether premedication with dextromethorphan (DM) improves postoperative pain management after upper abdominal surgery. Sixty (American Society of Anesthesiologists class 1 and 2 of either gender) patients scheduled for upper abdominal surgery were included in the study. Patients were randomly assigned to one of four groups: control, DM-10, DM-20, and DM-40. In the control group, chlorpheniramine maleate (CPM, 20 mg) was injected immediately before induction of anesthesia intramuscularly (IM). In the DM-10, DM-20, and DM-40 groups, patients were premedicated with DM 10 mg, 20 mg, and 40 mg IM, respectively. After operation, patient-controlled analgesia (PCA) with morphine was given for pain relief. The time to the first PCA trigger, morphine consumption, pain scores, and analgesic-related side effects were recorded at 1, 2, 4, 24, 48, and 72 hours after surgery. The time to first PCA trigger for the control group was 17.8 +/- 1.4 minutes, for group DM-10 20.2 +/- 1.6 minutes, for group DM-20 32.4 +/- 1.9 minutes, and for DM-40 77.9 +/- 6.5 minutes. The morphine delivered and PCA triggering frequency were 5.5 +/- 0.5/11.3 +/- 0.8 times for the controls, 5.5 +/- 0.4/ 14.1 +/- 1.3 times for DM-10, 3.1 +/- 0.3/6.3 +/- 1.2 times for DM-20, and 0.2 +/- 0.1/0.3 +/- 0.2 times for DM-40 during the first hour after operation. For the first day, the figures are 19.9 +/- 1.2/23.9 +/- 1.4 for the controls, 15.6 +/- 1.2/17.3 +/- 2.4 for DM-10, 12.6 +/- 0.7/15.9 +/- 1.6 for DM-20, and 5.0 +/- 0.21/5.6 +/- 0.9 for DM-40. On the first day, the cough pain scores were 6.67 +/- 0.23, 6.53 +/- 0.16, 6.67 +/- 0.23, and 5.73 +/- 0.18 for the controls, DM-10, DM-20, and DM-40 groups, respectively. All data showed dose-dependent better pain relief in DM-premedicated patients. We conclude that DM premedication offers preemptive analgesia and reduces postoperative pain and morphine requirement.

Premedication with dextromethorphan provides posthemorrhoidectomy pain relief

PURPOSE

Previous studies have shown that N-methyl-D-aspartate receptor antagonists provide a preemptive analgesic effect in humans. This study was designed to examine whether premedication with dextromethorphan, an N-methyl-D-aspartate antagonist, also provided a preemptive analgesic effect that improved postoperative pain management.

METHODS

Sixty patients who were American Society of Anesthesiologists status I and II scheduled for hemorrhoidectomy (modified Whitehead procedure) were included in the study. Patients were randomly assigned to the control and study groups. For the control group patients received chlorpheniramine maleate (20 mg), a component of the injection form of dextromethorphan, intramuscular injection 30 minutes before skin incision. In the study group dextromethorphan 40 mg containing 20 mg chlorpheniramine maleate (intramuscular) was given as premedication 30 minutes before skin incision. Pethidine (1 mg/kg, intramuscular) was given for pain relief as required postoperatively. The time to first pethidine injection, total pethidine consumption, worst pain score, and pethidine-related side effects were recorded for 48 hours postoperatively.

RESULTS

The times to first pethidine injection (mean +/- standard error of the mean) were 5.2 +/- 3 and 19.6 +/- 6 hours in the control and study groups, respectively. Total pethidine consumption was 140 +/- 11.3 and 63.5 +/- 11.8 mg in the control and study groups. The worst visual analog scale pain scores were 7.4 +/- 0.2 and 5.6 +/- 0.3 in the control and study groups during the two-day observation. The numbers of patients who required pethidine injection were 29 and 20 in the control and study groups, respectively. Two patients suffered pethidine-related side effects, such as nausea, vomiting, dizziness, and headache, in the control group, and no patient complained of any side effect in the study group.

CONCLUSION

We found that dextromethorphan premedication provided a preemptive analgesic effect, thus producing reduced postoperative pain and pethidine requirement and improved recovery from hemorrhoidectomy.

The role of free to total prostate-specific antigen ratio for prostate cancer in screening patients with total serum levels between 4 and 20 ng/ml

BACKGROUND

We retrospectively tried to determine if the free to total prostate-specific antigen (f/t PSA) ratio could improve the specificity of PSA in prostate cancer screening of patients with total serum levels between 4 and 20 ng/ml.

METHODS

Two hundred ninety-five patients with serum PSA levels from 4 to 20 ng/ml had undergone sextant prostate needle biopsy. Each patient had no prior history of prostate cancer, acute urine retention, or prostatitis. Prebiopsy free PSA values were measured in 155 patients. Total PSA levels were determined with the AxSYM enzyme-linked immunosorbent assay. Free PSA levels were measured with the AxSYM microparticle enzyme immunoassay.

RESULTS

Mean f/t PSA ratios were 0.114+/-0.004 in men of the cancer group and 0.161+/-0.008 in men of the benign group (p<0.002). Based on the analysis of sensitivity and specificity in relation to f/t PSA ratios, use of the 18% cutoff point could detect 89% of cancer cases, and at the same time could avoid 35% of unnecessary prostate biopsies. The areas under the receiver-of-characteristic curve for f/t PSA ratio and total PSA were 0.649 and 0.545, respectively.

CONCLUSION

Serum f/t PSA ratios were significantly lower in patients with prostate cancer than in patients with benign disease. The determination of an appropriate f/t PSA ratio should be based on the generated data such as that demonstrated in this study in order to improve diagnostic accuracy and specificity for patients with equivocal PSA values and to avoid conducting unnecessary prostate biopsies.

Anesthesia with deep hypothermic circulatory arrest for giant basilar aneurysm surgery

The application of deep hypothermic circulatory arrest (DHCA) as an adjutant technique in anesthetic management for surgery of giant and complex cerebral aneurysm has been clinically recognized with piling up experience in many institutes. DHCA provides the advantages such as a bloodless surgical field and protection of the brain, all of which make a precise clipping of the aneurysm possible and thus it lowers the mortality rate which could be extremely high without it. Nevertheless, in application, the disadvantages of this technique includes comparatively inefficient and uneven cooling or rewarming, severe physiological change, cardiac distension and arrhythmia during cardiopulmonary bypass (CPB), hemorrhage from systemic heparinization and brain damage due to inadequate protection, none of which has ever been stressed. Since many giant aneurysms are found inoperable during exploration with application of DHCA, it would change the fate of the patients, and the clinical value of DHCA in such an instance becomes contradictive and disputable. We would like to present our experience in a case who, because of a giant basilar aneurysm, underwent surgical correction under DHCA retrograde cerebral perfusion (RCP) with cerebral function monitoring including electroencephalography (EEG), brainstem auditory evoked potentials (BAEP), thermal diffusion cerebral blood flowmetry, study of the change of extracellular concentration of excitatory amino acid, glutamate and aspartate, and off-line neurochemical analysis with cerebral microdialysis technique.

Postoperative intramuscular dextromethorphan injection provides pain relief and decreases opioid requirement after modified radical mastectomy

BACKGROUND

Narcotics are still the therapeutic mainstay for postoperative pain relief. However, many unwanted side effects are accompanied. NMDA antagonists have been demonstrated to produce analgesic and antihyperalgesic effects, moreover, to possess potentiated effect of narcotics on postoperative pain management.

AIMS

To examine whether postoperative dextromethorphan (DM), an antitussive and also an NMDA antagonist, intramuscular injection (I.M.) reduced pain and analgesic requirement after modified radical mastectomy (MRM).

METHODS

Sixty-one patients scheduled for MRM were included and randomly allocated into two groups. For the control group (n=31), patients received chlorpheniramine maleate (CPM, 20 mg) I.M., while in the DM group (n = 30), 40 mg DM containing 20 mg CPM (I.M.) was given at the end of surgery. Meperidine (1 mg/kg, I.M.) was prescribed for postoperative pain relief, if ask. The time to first meperidine injection, total meperidine consumption, worst pain score, bed-rest time, and meperidine-related side effects were recorded for 48 hours postoperation.

RESULTS

A longer time to first meperidine injection (20.3 +/- 1.4 vs 1.5 +/- 0.2 hr, p < 0.001) and lower meperidine consumption (10.7 +/- 4.0 vs 70.7 +/- 8.9 mg, p < 0.001) were observed in the DM group than the control group. The average bed rest time was significantly shorter in the DM group than in the control group (18.9 +/- 1.5 vs 23.4 +/- 1.6 hr, p < 0.001). The number of patients who required meperidine injection (6 vs 27, p < 0.005) and meperidine-related side effects were significantly lower in the DM group than in the control group (1 vs 7, p < 0.025). No difference was noted in worst VAS pain score between the DM and the study groups.

CONCLUSION

Postoperative DM I.M. injection provided an analgesic effect and reduced meperidine requirement after MRM.

Pre-incisional epidural ketamine, morphine and bupivacaine combined with epidural and general anaesthesia provides pre-emptive analgesia for upper abdominal surgery

BACKGROUND

Previous studies have shown that N-methyl-D-asparate (NMDA) receptor antagonists provide a pre-emptive analgesic effect in humans. This study investigated the benefits of pre-emptive analgesia for upper abdominal surgery, using pre-incisional epidural ketamine + morphine + bupivacaine (K+M+B) treatment for achieving postoperative pain relief.

METHODS

Sixty ASA 1-2 patients scheduled for upper abdominal surgery were allocated to three groups in a randomized, single-blinded study. Patients in the control group (I) received general anaesthesia followed by an infusion of normal saline. Group II and III patients received general anaesthesia with a continuous epidural infusion of 2% lidocaine. Thirty minutes after the incision in groups I and II, an epidural pain control regimen was administered using ketamine (10 mg) and morphine (1 mg) in 10 ml of 0.085% bupivacaine (K+M+B). Group III patients also received K+M+B, but it was administered 10 min after the 2% lidocaine injection and 30 min before skin incision. All patients received an epidural pain control regimen (q12 h) for 3 days after their first injection. Patient-controlled analgesia (PCA) with morphine was used to control subsequent postoperative pain. During the 3-day period following surgery, duration to PCA trigger (h), morphine consumption (mg), pain intensity at rest and when coughing/moving, and analgesic-related adverse effects were recorded. The VAS scale (0-10) was used to assess pain intensity.

RESULTS

Median times to first PCA trigger were 1.2 (0.5-2.0) h, 3.0 (0.7-4.2) h, and 4.0 (2.5-7.5) h for groups I, II, and III, respectively. Both the incident and resting pain scores were consistently lower for group III patients than groups I and II. The number of PCA triggers (all attempts/successful triggers) during the day following surgery were 14.0 (3-30)/8.0 (3-24) times, 10.0 (3-23)/6.0 (2-20) times, and 7.0 (3-12)/4.5 (1-10) times for groups I, II, and III. Total morphine consumption for the 3-day observation period was 12.5 (3-42) mg, 10.5 (2-29) mg, and 6.0 (1-20) for groups I, II, and III, respectively.

CONCLUSION

Pre-incisional epidural K+M+B treatment combined with continuous epidural anaesthesia and general anaesthesia provides an ideal pre-emptive analgesic therapy, exhibiting better postoperative pain relief than general anaesthesia and post-incisional K+M+B treatment.

Postoperative intramuscular dextromethorphan injection provides postoperative pain relief and decreases opioid requirement after hemorrhoidectomy

BACKGROUND

Previous studies have shown that dextromethorphan (DM) produces an analgesic/antihyperalgesic effect. This study was designed to examine whether postoperative DM intramuscular (i.m.) injection could reduce post-hemorrhoidectomy pain.

METHODS

At the end of the surgery, patients in the study group (n = 30) were given an intramuscular injection of 40 mg DM and 20 mg chlorpheniramine (CPM) while in the study group (n = 30), the patients were given intramuscular 20 mg CPM only. Pethidine (1 mg/kg, i.m.) was prescribed for postoperative pain relief if required. The time to first pethidine injection, total pethidine consumption, worst pain score, and pethidine-related side effects were recorded for 48 h postoperatively.

RESULTS

The time from the end of operation to the first pethidine injection was 5.4 +/- 1.6 h and 17.8 +/- 3.7 h (P = 0.006) in the control group and the study group, respectively. Total pethidine consumption was 139.5 +/- 11.5 mg and 77.5 +/- 12.2 mg (P < 0.001) in the control group and the study group, respectively. The worst VAS score was 7.5 +/- 0.2 and 7.1 +/- 0.2 (P = 0.09) in the control and the study groups, respectively. The number of patients who required pethidine injection was 29 and 21 (P < 0.005) in the control and the study groups, respectively. The number of patients who suffered pethidine-related side effects was 7 and 1 (P < 0.025) in the control and the study groups, respectively.

CONCLUSIONS

We found that intramuscular DM given at the end of operation could provide good postoperative pain relief and decrease the pethidine requirement after hemorrhoidectomy.

Preincisional dextromethorphan decreases postoperative pain and opioid requirement after modified radical mastectomy

PURPOSE

To examine whether preincisional dextromethorphan (DM) improved analgesia after modified radical mastectomy (MRM).

METHODS

Sixty patients (ASA I-II) scheduled for MRM were included and randomly allocated into two groups. Patients in the treatment group (DM) received 40 mg DM and 20 mg chlorpheniramine maleate (CPM) i.m., and those in the control group received 20 mg CPM i.m. alone 30 min before skin incision. Meperidine, 1 mg x kg(-1) i.m., was given for postoperative pain relief as required. The time to first meperidine injection, total meperidine consumption, worst pain score, bed-rest time, and side effects were recorded every 24 hr for 48 hr after surgery by a resident anesthesiologist on a double-blind basis.

RESULTS

A longer time to first meperidine injection (19.2 +/- 1.6 vs 1.5 +/- 0.23 hr, P < 0.001) and lower meperidine consumption (0[10] vs 75[50] mg, median [interquartile range], P < 0.001) were observed in the DM group than in the control group. The bed-rest time was shorter in the DM than in the control group (18.0[4] vs 23.0[19] hr, P < 0.001). No difference was noted in worst VAS pain score. Meperidine-related side effects (nausea, vomiting, pruritus, dizziness, headache) were more frequent in the control (10/30) than in the DM group (3/30, P < 0.05). The number of patients who required meperidine injection for pain relief was lower in the DM (7/30) than in the control group (25/30, P < 0.005). No DM- or CPM-associated side effects were observed.

CONCLUSION

Preincisional IM. DM treatment decreased postoperative pain and opioid requirement after MRM surgery.

[Effects of basic fibroblast growth factor on repairing injury of intestinal mucosa in acute necrotic pancreatitis]

OBJECTIVE

To observe the effects of basic fibroblast growth factor (bFGF) on repairing injury of intestinal mucosa in acute necrotic pancreatitis (ANP).

METHODS

Sixteen dogs of ANP animal model were made by injection of 5% sodium taurocholate (0.5 ml/kg) with 3,000 U/kg trypsin into the pancreatic duct. The mucosa structure, content of protein, DNA and malondiethylaldehyde (MDA) were observed after ANP and treatment with bFGF, and the plasma lipopolysaccharide and endothelin-1 were detected. The organs of dogs were made to bacterial culture. Ileal mucosa was collected for histological and ultrastructural studies.

RESULTS

The results showed that after treatment with bFGF, the injury of intestinal mucosa in ANP was abated. The length, height and area of mucosa microvillus, the content of DNA and protein of ileal mucosa were significantly increased, while the plasma endothelin-1 and lipopolysaccharide were reduced. The organ bacterial translocation rate was also decreased in 50%.

CONCLUSION

bFGF has good effects on abating injury of intestinal mucosa, protecting gut barrier function, reducing the incidence of lipopolysaccharide and bacterial translocation after ANP.

Stabilization of chromatin structure by PRC1, a Polycomb complex

The Polycomb group (PcG) genes are required for maintenance of homeotic gene repression during development. Mutations in these genes can be suppressed by mutations in genes of the SWI/SNF family. We have purified a complex, termed PRC1 (Polycomb repressive complex 1), that contains the products of the PcG genes Polycomb, Posterior sex combs, polyhomeotic, Sex combs on midleg, and several other proteins. Preincubation of PRC1 with nucleosomal arrays blocked the ability of these arrays to be remodeled by SWI/SNF. Addition of PRC1 to arrays at the same time as SWI/SNF did not block remodeling. Thus, PRC1 and SWI/SNF might compete with each other for the nucleosomal template. Several different types of repressive complexes, including deacetylases, interact with histone tails. In contrast, PRC1 was active on nucleosomal arrays formed with tailless histones.

Preincisional dextromethorphan treatment decreases postoperative pain and opioid requirement after laparoscopic cholecystectomy

In the present study, we examined whether preincisional treatment with dextromethorphan (DM) provides preemptive analgesia. Ninety patients scheduled for laparoscopic cholecystectomy were included. Patients receiving chlorpheniramine maleate (CPM) 20 mg via an IM injection 30 min before skin incision were designated as the control group. Patients in Group A received DM 40 mg (containing CPM 20 mg) IM after removal of the gallbladder, whereas in Group B, DM 40 mg (containing CPM 20 mg) was administered IM 30 min before skin incision. Meperidine (1 mg/kg IM) was given for postoperative pain relief as required. Times to first meperidine injection, total meperidine consumption, worst pain score, bed rest time, and side effects were recorded for 48 h after surgery. Times to first meperidine injection were 9.3+/-15.9, 17.4+/-3.4, and 28.6+/-3.9 h for the control group and Groups A and B, respectively. The total meperidine consumption was 90.7+/-11.9, 77.5+/-12.7, and 20.0+/-4.4 mg for the control group and Groups A and B, respectively. The worst visual analog pain scores were 6.0+/-0.2, 6.0+/-0.2, and 4.0+/-0.4 for the control group and Groups A and B, respectively. The bed rest times were 21.0+/-0.5, 20.0+/-0.5, and 19.0+/-0.4 h for the control group and Groups A and B, respectively. The number of patients who required meperidine injection was 26, 22, and 12 for the control group and Groups A and B, respectively. We conclude that DM is more effective in producing postoperative analgesia when it is administered preincision rather than after the gallbladder removal treatment, which suggests a preemptive analgesic effect.

IMPLICATIONS

Preincisional dextromethorphan (40 mg IM) treatment offers a preemptive analgesic effect, thus improving the postoperative pain management.

Paget's disease of the tibia

Paget's disease of the bone is perceived to be rare in Asia. We report the first documented case of Paget's disease of the bones in Taiwan. A 66-year-old native Taiwanese woman was admitted to hospital with a 10-year history of pain and a bowing deformity of her left leg. Laboratory data disclosed elevated serum calcium and alkaline phosphatase levels, but no leukocytosis. A plain X-ray film of the left leg showed a curved tibia with thickening of the tibial cortex, while a technetium 99m bone scan revealed abnormal uptake in the left tibia. Elevated serum levels of bone-specific alkaline phosphatase and urinary collagen N-telopeptide were also noted. Histologic examination of a biopsy specimen of the left tibia lesion confirmed the diagnosis of Paget's disease in the bone. The patient received treatment with sodium chlodronate, and the symptoms improved rapidly. Laboratory data then revealed decreased levels of serum calcium, bone-specific alkaline phosphatase, and urinary collagen N-telopeptide after treatment.

Transvection and other homology effects

The presence of homologous nucleic acid sequences can exert profound effects on chromosomal and gene function in a wide range of organisms. These homology effects reveal remarkable forms of regulation as well as suggest possible avenues for the development of new technologies.

Delayed spontaneous tension pneumocephalus caused by radionecrosis of the skull base

We report a case of spontaneous tension pneumocephalus which occurred 6 years after radiotherapy for a nasopharyngeal carcinoma. A skull base defect and nasocranial fistula causing tension pneumocephalus was identified, and was repaired successfully. It proved to be due to skull base osteoradionecrosis.

Thoracic epidural anesthesia for pain relief and postoperation recovery with modified radical mastectomy

The purpose of this study was to investigate whether thoracic epidural anesthesia (TEA) provides better postoperative pain relief and recovery than general anesthesia (GA) for modified radical mastectomy (MRM) surgery. Sixty-four patients rated as American Society of Anesthesiologists (ASA) 1 to 3 who underwent MRM surgery were included in the study. In TEA group patients, 2% lidocaine (15-20 ml) was administered via the epidural route as primary anesthesia, in conjunction with midazolam (5-10 mg) and fentanyl (<250 microg) for amnesia. The GA patients were maintained with isoflurane and 50% nitrous oxide in oxygen. After operation the patients were given pethidine (1 mg/kg IM) as required for pain relief. The time to first pethidine requirement, total pethidine consumption, worst pain score, bed rest time, satisfaction score, and anesthesia-related side effects were recorded for 2 days after surgery. The results show that TEA provided a more prolonged analgesic effect than GA after operation. A longer time to first pethidine requirement (19.2 +/- 1.5 vs. 7.6 +/- 2.5 hours) (p < 0. 001) and decreased pethidine consumption (17.2 +/- 7.0 vs. 76.3 +/- 17.4 mg) (p < 0.001) were observed in the TEA group than in the GA group, respectively. A worse visual analog scale (VAS) pain score was observed in the GA group (5.7 +/- 0.6) than in TEA patients (4.3 +/- 0.4) (p < 0.01). The average bed rest time was significantly shorter in the TEA group (16.9 +/- 0.9 hours) (p < 0.01) than in the GA group (27.1 +/- 4.1 hours). Overall satisfaction scores were significantly higher in the TEA group (4.4 +/- 0.1) (p < 0.01) than in the GA group (3.5 +/- 0.2). Side effects were observed at a higher frequency in the GA group (16/32) (p < 0.0001) than in the TEA group (3/32). The frequency of pethidine injection for pain relief was significantly lower in the TEA group (8/32) (p < 0.0001) than in the GA group (24/32). The total hospital cost (NT 64,392 +/- 3,523 vs. NT 53,806 +/- 2,817) (p = 0.0342) and anesthesia cost (NT 7,968 +/- 246 vs. NT 5,268 +/- 262) (p < 0.0001) are also significantly lower in the TEA group than the GA group. In conclusion, TEA provided better postoperative pain relief and recovery and lower cost than GA for MRM surgery.

Ephedrine-induced complete atrioventricular block with ventricular asystole during rapid concomitant phenytoin infusion: a case report

Ephedrine is widely used to elevate blood pressure, however, one should be cautious to use it concomitantly with phenytoin infusion in neurosurgical procedures. A 59-year-old female was admitted for craniotomy with removal of metastatic brain tumor. During operation phenytoin infusion was given to forestall postoperative seizure. Hypotension, bradycardia and complete atrioventricular block followed by ventricular asystole suddenly occurred when the patient was given ephedrine to elevate the blood pressure to see the hemostatic effect close to the end of operation. We discontinued the phenytoin infusion and immediately injected 1.5 mg epinephrine. She was successfully resuscitated. We conclude that when phenytoin is used intraoperatively it should be administered by an infusion pump at a rate of less than 25 mg/min and under continuous monitoring of cardiac rhythm, heart rate, and blood pressure. When pressure support is required, the use of a pure alpha-agonist may minimize the risk of adverse reactions in the presence of phenytoin infusion.

Group B Streptococcal infection in neonates: an 11-year review

Group B Streptococcal (GBS) infection is an important cause of infant morbidity and mortality. The purpose of this study is to evaluate the incidence, clinical characteristics, mortality and complications of this infection. From 1985 through 1995, 66 infants with early onset disease (EOD) and 23 infants with late onset disease (LOD) were treated at Mackay Memorial Hospital (MMH). The occurrence rate of EOD was 3.26-10.08/1000 admissions. The incidence of the disease was 0.11-1.39/1000 live births. Of the 66 EOD infants, 24 (36%) were preterm infants. There were 33 (50%) infants in EOD category with respiratory distress and 40 (60%) infants with sepsis. Among the 23 LOD infants, 3 (13%) were preterm infants. There were 6 (13%) infants in LOD category with respiratory distress and 16 (69%) with sepsis. Nine (13%) EOD infants and 14 (60%) LOD infants had meningitis. Leukopenia occurred in 24 (36%) EOD infants and 5 (21%) LOD infants. Twelve (18%) EOD infants and 9 (39%) LOD infants had a history of prolonged rupture of membrane (PROM). The mortality rate was 14% in EOD and 4% in LOD infants. Four (17%) LOD infants developed neurological seguelae. Clinically, EOD infants were often premature and prone to develop sepsis, respiratory distress and leukopenia, while LOD often presented with meningitis and sepsis. Our estimated occurrence rate and incidence of EOD were similar to the European estimates. The influence of prenatal measures on EOD and the meaning of PROM on LOD need further evaluation.