P3641Matrix Metalloproteinase-2 polymorphisms are associated with prognosis of patients with symptomatic coronary artery disease

Background

Matrix Metalloproteinase-2 (MMP-2) is involved in regulation and proliferation of vascular and endothelial cells and is therefore an important component of atherosclerotic vessels. Inhibition of MMP-2 activity is associated with improvement of cardiac function in animal models after myocardial infarction. MMP-2 single nucleotide polymorphisms (SNPs) might alter MMP-2 expression and therefore influence prognosis in patients with symptomatic coronary artery disease (CAD).

Methods and results

Genotyping for selected MMP-2 SNPs variants (rs2241145, rs2285053, rs2287076, rs243865, rs7201) was performed in 943 consecutive patients with symptomatic CAD. All patients were followed-up for all-cause death (ACD), myocardial infarction (MI) and ischemic stroke (IS) for 360 days. The primary combined endpoint (CE) consisted of either first occurrence of ACD, and/or MI, and/or IS. Secondary endpoints were defined as the single events of ACD or MI. Homozygous carriers of major allele (rs2241145, rs2287076) showed significantly better event-free survival than carriers of the minor allele for CE (Log rank = 0.022 and Log rank= 0.015, respectively). Furthermore, homozygous carriers of major allele (rs2241145, rs2285053, rs2287076) showed significantly better event-free survival for ACD (Log rank= 0.047, Log rank= 0.006 and Log rank= 0.023, respectively). In multivariate analysis, MMP-2 rs2241145, rs2287076 and rs2285053 were significantly and independently associated with CE and ACD.

Figure 1

Conclusions

MMP-2 rs2241145, rs2287076 and rs2285053 are associated with prognosis and might be valuable for further risk stratification in CAD patients.

Acknowledgement/Funding

DFG, KFO 274, CRC TR 240

DNA barcoding Brooklyn (New York): A first assessment of biodiversity in Marine Park by citizen scientists

DNA barcoding is both an important research and science education tool. The technique allows for quick and accurate species identification using only minimal amounts of tissue samples taken from any organism at any developmental phase. DNA barcoding has many practical applications including furthering the study of taxonomy and monitoring biodiversity. In addition to these uses, DNA barcoding is a powerful tool to empower, engage, and educate students in the scientific method while conducting productive and creative research. The study presented here provides the first assessment of Marine Park (Brooklyn, New York, USA) biodiversity using DNA barcoding. New York City citizen scientists (high school students and their teachers) were trained to identify species using DNA barcoding during a two-week long institute. By performing NCBI GenBank BLAST searches, students taxonomically identified 187 samples (1 fungus, 70 animals and 116 plants) and also published 12 novel DNA barcodes on GenBank. Students also identified 7 ant species and demonstrated the potential of DNA barcoding for identification of this especially diverse group when coupled with traditional taxonomy using morphology. Here we outline how DNA barcoding allows citizen scientists to make preliminary taxonomic identifications and contribute to modern biodiversity research.

Calprotectin and neutrophil gelatinase-associated lipocalin in the differentiation of pre-renal and intrinsic acute kidney injury

BACKGROUND

Urinary calprotectin has recently been identified as a promising biomarker for the differentiation of pre-renal and intrinsic acute kidney injury (AKI). This study compares the diagnostic performance of calprotectin and neutrophil gelatinase-associated lipocalin (NGAL) in this differential diagnosis.

METHODS

Urinary calprotectin and NGAL concentrations were assessed in a study population of 87 subjects including 38 cases of intrinsic AKI, 24 cases of pre-renal AKI and 25 healthy controls. Urinary tract obstruction, renal transplantation and metastatic cancer were defined as exclusion criteria.

RESULTS

Mean calprotectin concentrations were significantly lower in pre-renal (190.2 ± 205.7 ng mL(-1) ) than in intrinsic AKI (6250.1 ± 7167.2 ng mL(-1) , P < 0.001). Receiver-operating characteristic (ROC) analysis provided an AUC of 0.99. Mean NGAL concentrations were significantly higher in intrinsic than in pre-renal AKI as well (458.1 ± 695.3 vs. 64.8 ± 62.1 ng mL(-1) , P = 0.001) providing an AUC of 0.82. A combination of the present study population with the cohort of the proof of concept study led to a population of 188 subjects (58 pre-renal AKI, 90 intrinsic AKI, 40 healthy controls). ROC analyses provided an AUC of 0.97 for calprotectin and 0.76 for NGAL yielding sensitivity and specificity values of 93.3 and 94.8% (calprotectin) vs. 75.3 and 72.4% (NGAL). Optimal cut-off values were 440 ng mL(-1) (calprotectin) and 52 ng mL(-1) (NGAL). Pyuria increased calprotectin concentrations independent of renal failure.

CONCLUSION

This study shows that both calprotectin and NGAL are able to differentiate between pre-renal and intrinsic AKI after exclusion of pyuria. In the present population, calprotectin presents a higher sensitivity and specificity than NGAL.

Genetics/genomics and drug effects

Differences in response to medications both in terms of clinical activity and side-effects have long been recognised by physicians. Genetics has been recently considered as a potential factor to explain part of this variability. Pharmacogenetics focuses on the variants within one or more candidate genes while pharmacogenomics evaluates the entire genome for associations with pharmacologic phenotypes. Genetic variants can effect drug metabolism, drug transport or drug targets. Drug metabolism is responsible 1. for the conversion of prodrugs into active compounds or conversion of drug to toxic or inactive metabolites mostly through reactions mostly catalysed by cytochromes (CYP) P450 (phase reactions) and 2. for transforming drugs to compounds that are more water soluble and more easily excreted (phase type II reactions). Genetic polymorphisms can modify the activity of several CYPs such as CYPs, 2D6, 2C9, 2C19 with altered responses to codeine, tamoxifen, clopidogrel, warfarin, ... or of enzymes of the phase II reactions with abnormal responses to drugs like irinotecan, 5-fluorouracil, azathioprine, ... Proteins involved in the transport of drugs in or out the cells such as chemiotherapeutic agenrs, simvastatin, ... can also be affected by genetics. Genetics can also modify drug targets by mutations affecting tumour cells rending these later more or less responsive to drugs. Genetic tests have been launched for screening polymorphisms before giving drugs such as warfarin and several biomarkers are available in oncology. However, many challenges exist. For example, we need more prospective studies to have a better knowledge of the clinical impact and the cost-effectiveness of these tests. It remains that in the future pharmacogenetics/genomics will probably help to personalise medicine by conferring to the clinician the possibility of giving the right drug to the right patients and by this way improving efficacy and safety of medications.

Country of origin predicts nutrition risk among community living older people

OBJECTIVES

To assess the nutrition risk status of community living older people and to identify associated risk factors.

DESIGN

A cross-sectional study using convenience sampling.

SETTING

North Shore City, Auckland, New Zealand. Data collection was carried out by a research nutritionist using computer assisted personal interviewing in the participant's own home.

PARTICIPANTS

Fifty-one independently living people aged between 80 and 85 years.

MEASUREMENT

A survey using three validated questionnaires: Practitioner Assessment of Network Type (PANT) to evaluate social networks; Elderly Assessment System (EASY-Care) to evaluate physical and mental wellbeing and Seniors in the Community: Risk Evaluation for Eating and Nutrition Version II (SCREEN II) to assess nutrition risk.

RESULTS

A third of the participants (31%) were at high risk of malnutrition (SCREEN II score <50; range 29-58 out of maximum score of 64). The majority of participants (82%) lived alone and nearly half (47%) had supportive social networks including close relationships with local family, friends and neighbours. Low self-rated health, disability and social factors (being born outside of New Zealand, losing a spouse and loneliness) were key underlying factors associated with being at nutrition risk.

CONCLUSION

Nutrition risk is common among aged individuals living in the community. Health and social factors that shape eating behaviours place older people at increased nutrition risk. Strategies are needed for the early identification of risk factors to prevent nutrition problems. Engaging older people at risk to share meal preparation and dining experiences may foster better outcomes.

Are ACE-inhibitors or ARB's still needed for cardiovascular prevention in high risk patients? Insights from profess and transcend

The HOPE and EUROPA clinical studies have shown that treatment with the angiotensin-converting enzyme (ACE) inhibitors, ramipril and perindopril, may reduce the occurrence of major cardiovascular events in patients with proven atherosclerotic disease. The recently published results of the PRoFESS and TRANSCEND trials completed the much needed information concerning the use of an angiotensin receptor blocker for patients at high risk of cardiovascular events. PROFESS compared a therapy of telmisartan 80 mg daily with placebo in patients with a recent ischemic stroke. The difference in the primary outcome of first recurrent stroke was not statistically significant between telmisartan and placebo. The secondary outcome of major cardiovascular events showed a relative risk reduction (RRR) of 7% in favour of telmisartan. This tended to be significant (p = 0.06) despite a rather short follow-up period of only 28 months. In TRANSCEND 5926 patients at high risk for cardiovascular events were randomized to a treatment with telmisartan 80 mg daily or placebo for a mean duration of follow-up of 56 months. The primary composite outcome of cardiovascular death, myocardial infarction, stroke or hospitalization for heart failure showed a non-significant 8% RRR in favour of the telmisartan treated patients. The main secondary outcome of cardiovascular death and myocardial infarction or stroke as used in the HOPE trial showed a non-significant RRR of 13% in favour of telmisartan treated patients (p = 0.068 adjusted for multiplicity of comparisons). In comparing the Kaplan-Meier curves for the endpoint of major cardiovascular events used in HOPE, EUROPA, TRANSCEND and PRoFESS, the trends are similar. Results of most of the recently published trials have been neutral.This could partly be explained by major improvements in the optimal background therapy of the patients included. Nevertheless, the results of PRoFESS and TRANSCEND do not contradict the results from previous studies with theACE inhibitors ramipril and perindopril and the ARB telmisartan.

Diagnostic value of confocal endomicroscopy in celiac disease

BACKGROUND

Improved endoscopic screening with targeted biopsies might enhance diagnostic yield in celiac disease. Confocal endomicroscopy (CEM) allows high-resolution in vivo histological analysis. We compared the endomicroscopic findings during ongoing endoscopy with the histological findings graded according to the Marsh classification.

METHODS

Twenty-four patients with celiac disease and six patients with celiac disease that was refractory on a gluten-free diet were examined using CEM. The duodenal mucosa was evaluated by CEM and by conventional histological analysis in respect of villous atrophy, crypt hyperplasia, and increased numbers of intraepithelial lymphocytes (IELs > 40 / 100 enterocytes). The CEM results were assessed as to sensitivity, specificity, and interobserver variability. A Marsh classification score determined by CEM was compared to that obtained by histology. Thirty patients undergoing routine upper gastrointestinal endoscopy were used as controls.

RESULTS

Conventional histology showed villous atrophy and crypt hyperplasia in 23 and increased numbers of IELs in 27 of the 30 patients with celiac disease. With CEM, villous atrophy, crypt hyperplasia, and increased IELs were respectively identified in 17, 12, and 22 of the 30 patients. The agreement of the findings on CEM with those of conventional histology was good in relation to villous atrophy (sensitivity 74 %) and increased numbers of IELs (sensitivity 81 %), but inadequate in relation to crypt hyperplasia (sensitivity 52 %). The kappa values for determination of interobserver variability were 0.90 for villous atrophy, 1.00 for crypt hyperplasia, and 0.84 for IEL detection. In the 30 control patients, normal duodenal architecture was found by both histology and endomicroscopy, indicating an overall specificity of 100 %.

CONCLUSION

The assessment of duodenal histology by CEM in patients with celiac disease is sensitive and specific in determining increased numbers of IELs and villous atrophy, but insufficient in respect of crypt hyperplasia. For routine use of CEM in patients with celiac disease, the technique would need to be improved.

Generics and cost-effective prescribing in Belgium: does bioequivalence always translate in therapeutic equivalence?

As many other countries, Belgium has a policy to promote the use of generic pharmaceutical products. In order to protect consumers, these generic products must be demonstrated to be essentially similar to the previously approved product, typically an innovator product. The therapeutic equivalence of a generic and an innovator product is most commonly based on the demonstration of bioequivalence, i.e. clinically insignificant differences in the rate and extent of drug absorption usually assessed from pharmacokinetic measurements, in a normal and healthy population. This article reviews the bioequivalence requirements for generic products and examines whether bioequivalence always adequately substantiates therapeutic equivalence and interchangeability. Clinical practice has identified a number of drug classes for which generic substitution should be approached with caution. Current bioequivalence requirements are based on a measure of average bioequivalence. There are fears that use of this measure may be inappropriate in the case of a drug with a narrow therapeutic range or high intrasubject or intersubject variability. Under these circumstances, measures of individual and population bioequivalence are proposed to be more accurate than measures of average bioequivalence. Bioequivalence issues are discussed together more general concerns about generic drug substitution, such as differences in product and packaging appearance and differences in excipients.

In vivo diagnosis of acute intestinal graft-versus-host disease by confocal endomicroscopy

BACKGROUND AND STUDY AIMS

Conventional histology with hematoxylin and eosin (H&E) staining is the accepted standard for diagnosing acute intestinal graft-versus-host disease (GvHD). Confocal endomicroscopy (CEM) is a noninvasive method that allows in vivo histology to be performed during endoscopy. The aim of this study was to evaluate CEM for the diagnosis of acute intestinal GvHD.

PATIENTS AND METHODS

This observational pilot study conducted between September 2006 and August 2008 included patients with acute diarrhea after stem cell transplantation, infectious diarrhea, or active ulcerative colitis. CEM (EC-3870CIFK, Pentax, Tokyo, Japan) was performed after intravenous injection of fluorescein 10% and topical application of acriflavine 0.05%.

RESULTS

A total of 35 patients with acute diarrhea after stem cell transplantation were examined. In 16 patients, CEM and histology showed no evidence of GvHD. In 14/19 patients with histologically confirmed GvHD, the diagnosis could already be established by CEM during ongoing endoscopy. In GvHD grade IV, near complete destruction of the colonic crypts ("flat mucosa") was visible. Control patients with infectious colitis (N = 15) or ulcerative colitis (N = 15) displayed inflammatory changes but no evidence of GvHD. Altogether, sensitivity of CEM was 74% and specificity was 100 %.

CONCLUSIONS

CEM improves rapid diagnosis of acute intestinal GvHD with high accuracy while performing endoscopy. Platelet transfusions and unnecessary biopsy acquisition can be avoided once acute intestinal GvHD has been diagnosed in vivo.

Lessons from ONTARGET

The recently published results of the ONTARGET trial shed a new light on the cardiovascular protection of patients at high risk of a cardiovascular event. Despite a number of trials looking at the efficacy of Angiotensin Converting Enzyme inhibitors (ACEis) or Angiotensin Receptor Blockers (ARBs) in the prevention of cardiovascular events in patients with specific high risk profiles, the question of the equivalence of ACEis and ARBs remained unanswered. The ONTARGET trial has shown that telmisartan 80 mg administered for a median duration of 4.5 years to patients at high risk of developing a major cardiovascular event, is equally effective to ramipril 10 mg. In addition, telmisartan was slightly better tolerated. The comparator ramipril has been chosen as it is currently the gold standard ACEi since the results of the HOPE study, in terms of the composite outcome of cardiovascular death, myocardial infarction and stroke. Moreover, ONTARGET is the first trial to test the hypothesis of superiority of adding an ARB (telmisartan 80 mg) to an ACEi (ramipril 10 mg) over the ACEi ramipril monotherapy in cardiovascular protection of the same broad range of high-risk patients. Surprisingly, despite a more pronounced blood pressure lowering, the combination of the two agents did not lead to an additional decrease in the number of events, but had significantly more side-effects compared to ramipril monotherapy. ONTARGET is a landmark study, performed according to the highest statistical and clinical standards, providing compelling evidence and clear answers to two important clinical questions.

[Measuring the contrast-enhancement in the skin and subcutaneous fatty tissue with the NMR-MOUSE: a feasibility study]

PURPOSE

The NMR-MOUSE is an open and mobile sensor for measuring NMR relaxation parameters in organic matters. T1-measurements of the subcutaneous fatty tissue and the skin are reported.

MATERIAL AND METHOD

For the first time, the NMR-MOUSE was employed to measure the signal recovery following saturation of the skin and the subcutaneous fatty tissue of three patients, before and after administering a contrast agent.

RESULTS

Despite a low signal-to-noise ratio, changes in the relaxation behaviour of the skin could be detected. Malignant tissue exhibits faster signal recovery than scar tissue and healthy tissue, which only show a small difference.

CONCLUSIONS

Changes in the relaxation behavior can be monitored with the NMR-MOUSE. Before the clinical use of the NMR-MOUSE, sensitivity, sensor mounting device, and sensor tuning must be improved. Further investigations need to be performed on a statistically relevant number of patients.

Barobiofeedback et rééducation de la marche de l'hémiplégique

AIMS

To compare, in post-acute hemiparetic patients, gait improvement after conventional physical therapy alone or with a specialised balance retraining program.

PATIENTS

Twenty-six patients within 3 months of onset of stroke were randomised to receive physical therapy (control group) or therapy and retraining (experimental group), most of the patients in both groups with left hemiplegia. The experimental group was significantly older than the control group.

METHOD

Thirteen patients received early conventional therapy, and 13 received therapy combined with standing balance training by biofeedback (BPM Monitor). Clinical measures were collected at entry (J0), once when subjects began to walk (JM) and 30 days later (JM + 30). Gait spatiotemporal parameters were collected by use of the Vicon system at JM and JM + 30.

RESULTS

Whatever the method of rehabilitation, the clinical scores improved significantly between J0 and JM + 30, except for spasticity. The time between stroke and the beginning of walking was not significantly different between both groups. Gait velocity increased significantly between JM and JM + 30 in both groups, with no difference between groups. The walking pattern was improved for both groups, with a significant increase of the duration of the paretic limb single stance. The experimental group significantly improved the duration of the reception double stance on the paretic limb between JM and JM + 30 compared with the control group (P = 0.03).

CONCLUSION

Both groups demonstrated improvement in the rehabilitation unit. The benefits of visual biofeedback by forceplate system training suggest particular improvement of anticipation equilibrium with conventional therapy.

Impact of hepatitis C virus infection on the aetiology of cirrhosis and hepatocarcinoma in three affiliated hospitals in southern Belgium

In a consecutive series of 411 patients with cirrhosis attending the outpatient liver clinics of 3 general hospitals located in the southern part of Belgium, hepatitis C virus infection accounted for 20% of the cases, far behind alcohol (63%). However, in a consecutive series of 57 hepatocarcinoma superimposed on cirrhosis, hepatitis C virus infection was the main aetiological factor accounting for 44% of the cases.

Isolate KAV: a new genotype of the TT-virus family

A novel DNA sequence belonging to a new genotype of TT virus (TTV) was detected by long-distance PCR in the serum of a chronically HCV-infected patient. The isolate was designated KAV according to the patient's initials. Extending the sequence to full length revealed a 3705-nt viral genome, which is about 100 nucleotides shorter than the other TT-viruses. KAV showed common features with the TTV family, such as the organization of open reading frames and conserved noncoding regions. The largest open reading frame of KAV (ORF 1) was about 40 aa shorter than that of other TT-viruses. Overall sequence homology with known TTV isolates was less than 66%. Phylogenetic analysis poses KAV in one major group with three recently published TTV sequences. So KAV can be considered as a new genotype of the TTV family (provisionally designated genotype 28).

The efficacy of atorvastatin in treating patients with hypercholesterolaemia to target LDL-cholesterol goals: the LIPI-GOAL trial

OBJECTIVE

LIPI-GOAL is a multicentre, open-label, non-comparative treat-to-target study, conducted from March 1998 to May 1999, that assessed the percentage of patients reaching 1992 European Atherosclerosis Society (EAS) low-density lipoprotein cholesterol (LDL-C) targets with atorvastatin 10-80 mg/day in subjects with hypercholesterolaemia, defined as LDL-C > 160 mg/dl after a 12-week step I diet.

METHODS AND RESULTS

Patients were treated towards the following LDL-C goals: < 135 mg/dl in patients with atherosclerotic disease present and/or coronary heart disease (CHD) risk >40%/10 years, or LDL-C < 155 mg/dl in all others. All subjects started treatment with atorvastatin 10 mg/day for 6 weeks. The dose was doubled every 6 weeks, to 20, 40, or 80 mg/day at weeks 12, 18, and 24, respectively, if targets were not reached. Of 587 patients screened for participation, 473 were enrolled and 419 (59% male; mean age 61 years) were available for efficacy evaluation. Fifty-five percent had atherosclerotic disease and/or CHD risk >40%/10 years. Dose titration was not needed in 303 patients (72%) who reached LDL-C target with atorvastatin 10 mg/day. Among 116 patients who were subsequently treated with higher atorvastatin dosages, 47 reached LDL-C target with 20 mg/day, 15 with 40 mg/day, and 6 with 80 mg/day. Therefore, 88.5% of subjects reached LDL-C goal in an intention-to-treat analysis. In general, atorvastatin was well tolerated.

CONCLUSIONS

Most patients at high risk for CHD reached LDL-C goals with atorvastatin 10-80 mg/day. Seventy-two % of patients reached target with atorvastatin 10 mg/day, which may simplify clinical management and should encourage better adherence to recommendations.

Differential expression of utrophin and dystrophin in CNS neurons: an in situ hybridization and immunohistochemical study

The cellular distribution of utrophin, the autosomal homologue of dystrophin, was investigated in developing and adult rat and mouse brain by in situ hybridization and immunohistochemistry. Digoxigenin-labeled cRNA probes complementary to N-terminal, rod-domain, and C-terminal encoding sequences of utrophin were used to differentiate between full-length and short C-terminal isoforms. Largely overlapping distribution patterns were seen for the three probes in neurons of cerebral cortex, accessory olfactory bulb, and several sensory and motor brainstem nuclei as well as in blood vessels, pia mater, and choroid plexus. The C-terminal probe was detected in addition in the main olfactory bulb, striatum, thalamic reticular nucleus, and hypothalamus, suggesting a selective expression of G-utrophin in these neurons. Western blot analysis with isoform-specific antisera confirmed the expression of both full-length and G-utrophin in brain. Immunohistochemically, only full-length utrophin was detected in neurons, in close association with the plasma membrane. In addition, intense staining was seen in blood vessels, meninges, and choroid plexus, selectively localized in the basolateral membrane of immunopositive epithelial cells. The expression pattern of utrophin was already established at early postnatal stages and did not change thereafter. Double-labeling analysis revealed that utrophin and dystrophin are differentially expressed on the cellular and subcellular levels in juvenile and adult brain. Likewise, in mice lacking full-length dystrophin isoforms (mdx mice), no change in utrophin expression and distribution could be detected in brain, although utrophin was markedly up-regulated in muscle cells. These results suggest that utrophin and dystrophin are independently regulated and have distinct functional roles in CNS neurons.

Identification and characterisation of transcript and protein of a new short N-terminal utrophin isoform

Dystrophin and utrophin are known to link the intracellular cytoskeleton to the extracellular matrix via a transmembraneous glycoprotein complex. Four short C-terminal isoforms (Dp71, Dp116, Dp140, and Dp260) are described for dystrophin and three for utrophin (Up71, Up113, and Up140). We describe here for the first time the existence of a 3.7-kb transcript and a 62-kDa protein in C6 glioma cells representing a short N-terminal isoform unique for utrophin (N-utrophin). More than 20 clones covering the entire coding region of utrophin were isolated from a rat C6 glioma cell cDNA library. Two clones were found to code for a protein with 539 amino acids. Its sequence is identical to that of the full-length utrophin, except for the last residue where Cys is replaced by Val. This isoform contains the actin binding domain (consisting of two calponin homology subdomains), followed by two spectrin-like repeats. A recombinant fragment corresponding to N-utrophin binds to F-actin in vitro with an equilibrium constant (affinity) K of 4.5 x 10(5) M(-1) and a stoichiometry of one fragment per around five actin monomers. Immunocytochemical staining of C6 glioma cells with antisera specific for different utrophin regions localised full-length utrophin in the submembraneous cortical actin layer as revealed by confocal microscopy. A distinct staining pattern for the N-utrophin was not detectable, although it was expected to localise at the actin stress fibers. It is assumed that it co-localises via the two spectrin-like repeats with the full-length utrophin at the cell membrane.

Thromboembolism in inflammatory bowel disease

Thromboembolism represents a severe complication of inflammatory bowel disease occurring in young patient, with active disease. Deep venous thrombosis and pulmonary embolism are the most frequent thromboembolism manifestations. Arterial complications and unusual sites for thromboembolism are more rare. Overall, inflammatory bowel disease is a real prothrombotic state as almost all parameters of coagulation are enhanced. Anticoagulation during the episode of thromboembolism is mandatory, and sometimes may ameliorate the course of inflammatory bowel disease.

[Pelvic wall recurrence of cervix carcinomas. Combined surgical-radio-chemotherapeutic procedure (CORCT)]

PURPOSE

The prognosis of patients with pelvic wall recurrences after primary therapy of cervical cancer is bad. In selected patients treated exclusively by surgery as primary therapy the 5-year survival rate was between 5 and 25%. Additionally the combination of operation and radiotherapy (CORT) improved the survival so far. We developed a new concept for the treatment of pelvic wall recurrences. This concept includes the combination of radical surgery, interstitial radiation and chemotheray--CORCT (combined operative- and radiochemotherapy).

PATIENTS AND METHODS

After radical surgery, interstitial HDR (Ir-192) brachytherapy in afterloading technique (2.5 Gy, 2 fractions/day in 5 days) was performed. Additionally a chemotherapy with cisplatin 25 mg/m2/day in 5 days and 5-fluorouracil 1000 mg/day in 5 days was applicated.

RESULTS

After combined operative- and radiotherapy 3 of 3 patients died after treatment within 8 months (median) because of distant metastases. After additive radiochemotherapy 3 of 4 patients had no evidence of disease (NED) after a follow-up period of 14 (12 to 30) months.

CONCLUSION

The first treatment results of the new designed combined operative- and radiochemotherapy concept (CORCT) led us to expect an improvement of the prognosis of patients with recurrences of cervical cancer at the pelvic wall.

Developmental expression and localization of the catalytic subunit of protein phosphatase 2A in rat lung

Protein phosphatase type-2A (PP2A) is a highly conserved serine/threonine phosphatase known to play a key role in cell proliferation and differentiation in vitro, but the role of PP2A in mammalian embryogenesis remains unexplored. No particular information exists as to the tissue or cell specific expression of PP2A or the relevance of PP2A expression to mammalian development in vivo. To examine expression of PP2A during mammalian lung development, we studied fetal rats from day 14 of gestation (the lung bud is formed on day 12 of gestation) to parturition. Western analysis with a specific PP2A catalytic subunit antibody identified a single 36 kDa protein, with protein levels two-fold higher in the 17 and 19 day embryonic lung as compared to the adult. With in situ hybridization and immunohistochemistry, both mRNA and protein for PP2A were localized equally to the epithelial lining of the embryonic lung airway and the surrounding mesenchyme in the 14 day embryonic lung. With maturation of the lung, PP2A becomes highly expressed in respiratory epithelium. The highest level of expression was in the earliest developing airways with columnar epithelium (the pseudoglandular stage, 15-18 days of gestation). There was a decrease in expression with the transformation to cuboidal epithelium by day 20 of gestation. This was most noticeable in the developing bronchial epithelium of the 19 and 20 day gestation lungs where only an occasional cell continues to express PP2A. Mesenchymal hybridization was most obvious in early endothelial cells of forming vascular channels at 17-19 days of gestation. PP2A respiratory epithelial expression mimicked the centrifugal development of the respiratory tree where the highest expression was in the peripheral columnar epithelium (15-18 days gestation) with only an occasional central bronchiolar cell continuing to express PP2A at 19 and 20 days gestation. Endothelial hybridization decreased with muscularization of large pulmonary arteries with low levels of expression detected in bronchial or vascular smooth muscle. In the newborn lung PP2A expression was decreased, but detectable in alveolar epithelium and vascular endothelium. In summary; 1) PP2A mRNA and protein exhibit cell specific expression during rat lung development; 2) PP2A is highly expressed in the respiratory epithelium of the fetal rat lung and is temporally related to the maturation of the bronchial epithelium; 3) and the PP2A subunit is highly expressed in early vascular endothelium, but not smooth muscle of the rat lung.

Analysis of magnetic material in the human heart, spleen and liver

Isothermal remanent magnetization (IRM) acquisition and alternating field (A.F.) demagnetization analyses were performed on human heart, spleen and liver samples resected from cadavers. The magnetic properties of the samples were measured both at 77K and at 273K. A.F. demagnetization was performed at 273K. Results from the analyses of the tissue indicate the presence of ferromagnetic, fine-grained, magnetically interacting particles which, due primarily to magnetic properties, are thought to be magnetite and/or maghemite. The presence of superparamagnetic particles can be inferred from the increase in saturation IRM values when measured at 77K compared with measurements at 273K and the decay of remanent magnetization upon warming from 77K. The concentration of magnetic material (assuming it is magnetite or maghemite) in the samples varies from 13.7 ng g-1 to 343 ng g-1, with the heart tissue generally having the highest concentration. The presence of magnetic material in these organs may have implications for the function of biogenic magnetite in the human body.

AT1 receptor gene regulation in cardiac myocytes and fibroblasts

The regulation of the AT1 receptor gene was studied in neonatal cardiomyocytes and fibroblasts in vitro. Incubation with angiotensin II (Ang II) resulted in a time-dependent and dose-dependent decrease in AT1 mRNA levels in both cardiomyocytes and fibroblasts. Coincubation with Ang II and the specific AT1 antagonist losartan prevented the decrease in AT1 mRNA whereas the AT2 antagonist PD123319 was ineffective in preventing the decrease in AT1 mRNA. Because Ang II is known to decrease cAMP levels in cardiomyocytes, the role of cAMP in the regulation of the AT1 gene was examined. Treatment with the adenylyl cyclase stimulant forskolin or the cAMP stereoisomer Sp-cAMPS increased AT1 mRNA levels or prevented the Ang II mediated decrease in AT1 mRNA levels. The role of calcium in the regulation of the AT1 gene was determined by incubation with the calcium ionophores A23187 and ionomycin (0.0625-1 microM) which resulted in a profound, dose-dependent decrease in AT1 mRNA levels. Treatment with BAPTA, an intracellular chelator of calcium, prevented the Ang II-mediated decrease in AT1 mRNA. Therefore Ang II is a potent negative regulator of the AT1 gene in cardiomyocytes and fibroblasts via the AT1 receptor. This Ang II mediated decrease in AT1 mRNA is mediated by two complementary mechanisms involving cAMP and intracellular calcium.

Severe nontyphoidal salmonellosis probably in relation with omeprazole treatment: report of 2 cases

We report 2 cases of severe nontyphoidal salmonellosis (Salmonella enteritidis), occurring 4 and 5 weeks after starting a treatment with Omeprazole (20 mg a day). No other member of the families was sick, and none of the 2 patients took any meals outside home during the two weeks preceding the first symptoms. Gastric hypochlorhydria is a major risk factor for Salmonella enteritidis, and several cases of severe infection have been described with this condition. After a review of the literature we conclude that patients with diminished gastric acid run an increased risk of developing Salmonella infection and often with a more serious clinical course.

Magnetic material in the human hippocampus

Magnetic analyses of hippocampal material from deceased normal and epileptic subjects, and from the surgically removed epileptogenic zone of a living patient have been carried out. All had magnetic characteristics similar to those reported for other parts of the brain [6]. These characteristics along with low temperature analysis indicate that the magnetic material is present in a wide range of grain sizes. The low temperature analysis also revealed the presence of magnetite through manifestation of its low temperature transition. The wide range of grain sizes is similar to magnetite produced extracellularly by the GS-15 strain of bacteria and unlike that found in magnetotactic bacteria MV-1, which has a restricted grain size range. Optical microscopy of slices revealed rare 5-10 micron clusters of finer opaque particles, which were demonstrated with Magnetic Force Microscopy to be magnetic. One of these was shown with EDAX to contain AI, Ca, Fe, and K, with approximate weight percentages of 55, 19, 19, and 5, respectively.

Hypoxic hepatitis in patients with cardiac failure: incidence in a coronary care unit and measurement of hepatic blood flow

The incidence of hypoxic hepatitis was prospectively studied for 1 year in a group of high-risk patients suffering from low cardiac output in a coronary care unit. Hypoxic hepatitis, defined as an increase in serum aminotransferase activity of at least 20 times the upper limit of normal without any other cause for hepatic necrosis, was observed in 20 patients. This represents 2.6% of the 766 patients admitted to the unit during this period and 21.9% of the 91 patients suffering from low cardiac output. Clinical, biological and hemodynamic data were compared between 20 patients with low cardiac output and hypoxic hepatitis, and 48 patients with low cardiac output but without hypoxic hepatitis who survived more than 24 h. In these two groups of patients, hepatic blood flow was measured by galactose clearance at low concentration. Patients with hypoxic hepatitis exhibited a higher central venous pressure (90% versus 38%-p < 0.001) as well as a lower hepatic blood flow (867 +/- 377 ml/min versus 1429 +/- 644 ml/min-p = 0.001). In conclusion, although it is considered a rare hepatic disorder, hypoxic hepatitis is frequent in patients with low cardiac output admitted to the coronary care unit, and is associated with a decrease in hepatic blood flow and passive hepatic venous congestion.

Ludwig's angina and mediastinitis due to Streptococcus milleri: usefulness of computed tomography

Despite intensive use of antibiotics, Ludwig's angina remains a potentially lethal infection because of the risk of upper airway obstruction and spread into the mediastinum. We present two patients who survived mediastinitis complicating Ludwig's angina due to Streptococcus milleri. Computed tomography performed early in the course of the disease detected pus collections and directed appropriate drainage procedures.

Ludwig's angina and mediastinitis due to Streptococcus milleri: usefulness of computed tomography

Despite intensive use of antibiotics, Ludwig's angina remains a potentially lethal infection because of the risk of upper airway obstruction and spread into the mediastinum. We present two patients who survived mediastinitis complicating Ludwig's angina due to Streptococcus milleri. Computed tomography performed early in the course of the disease detected pus collections and directed appropriate drainage procedures.