Prognostic significance of bone marrow fibrosis in diffuse large B-cell lymphoma

INTRODUCTION

Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of non-Hodgkin lymphomas. The aim of this study is to determine the relationship between the increase in the degree of fibrosis in the bone marrow and prognosis and mortality in newly diagnosed DLBCL.

METHODS

Bone marrow biopsy of 153 newly diagnosed DLBCL patients was determined by staining with reticulin, Masson's trichrome histochemical stain, and the degree of fibrosis was determined.

RESULTS

In the bone marrow biopsy performed at the time of diagnosis, bone marrow fibrosis (BMF) was observed in 70 patients. While BMF-1 was detected in 42 patients (60%), BMF-2 was detected in 25 patients (35%) and BMF-3 was detected in 3 patients (4%). As the degree of BMF increased, the median overall survival and median progression-free survival times were significantly shorter (p: 0.008), (p < 0.001). In patients with an increased degree of BMF, a significant decrease in leukocyte and neutrophil counts was observed after chemotherapy (p: 0.004). According to the results of the multivariate Cox regression model, it was determined that high NCCN-IPI risk (HR: 8.25; %95 CI: 1.09-62.52; p = 0.041) and being BMF ≥ 2 (HR: 3.75; %95 CI: 1.65-8.51; p = 0.002), increased the risk of death (p = 0.002, -2 loglikelihood = 392,553).

CONCLUSION

When the literature was reviewed, it was seen that this study was the first to define that bone marrow fibrosis grade 2 and above in DLBCL is a prognostic marker associated with worse survival. In the bone marrow pathology, which is examined to detect advanced disease in DLBCL, besides lymphomatous involvement, the detection of fibrosis grade is very important.

COVID-19: booster(s) vs. hospitalization and Intensive Care Unit admission

OBJECTIVE

As the pandemic continues, different vaccine protocols have been implemented to maintain the protection of vaccines and to provide protection against new variants. The aim of this study was to assess hospitalized patients' vaccination status and document the efficacy of boosters.

PATIENTS AND METHODS

The patients that were hospitalized due to COVID-19 were enrolled from 28 hospitals in Turkey for five months from September 2021. 5,331 confirmed COVID-19 patients from collaborating centers were randomly enrolled to understand/estimate the distribution of vaccination status in hospitalized patients and to compare the efficacy of vaccination/booster protocols.

RESULTS

2,779 men and 2,552 women of which 2,408 (45.2%) were admitted to Intensive Care Units participated in this study. It was found that the highest risk reduction for all age groups was found in groups that received 4 doses. Four doses of vaccination for every 3.7 people under 50 years of age, for every 5.7 people in the 50-64 age group, and for every 4.3 people over 65 years of age will prevent 1 patient from being admitted to intensive care. Regardless of the type of vaccine, it was found that the risk of ICU hospitalization decreased in those who were vaccinated compared to those who were not vaccinated. Regardless of the type of vaccine, the ICU risk was found to decrease 1.25-fold in those who received 1 or 2 doses of vaccine, 1.18-fold in those who received 3 doses, and 3.26-fold in those who received 4 doses.

CONCLUSIONS

The results suggested that the addition of a fourth dose is more effective in preventing intensive unit care even in disadvantaged groups.

Shoulder tip pain after cesarean section: General versus spinal anesthesia

Background and Aim

Shoulder tip pain is a common but overlooked complication during the postoperative cesarean section. In this study, we aimed to investigate the relationship between the anesthesia method and the incidence of shoulder tip pain.

Patients and Methods

In this randomized clinical study, 117 patients who underwent cesarean section were divided into two groups as spinal anesthesia and general anesthesia. The demographic characteristics, the presence, the severity of shoulder tip pain, and also analgesic consumption in the first 24 hours were compared.

Results

The incidence of shoulder tip pain was significantly higher in the spinal anesthesia group than in the general anesthesia group (p = 0.032). While there was no statistically significant difference in terms of the number of patients who needed opioid treatment within the first 24 hours between patients with and without STP, a statistically significant difference was observed in terms of the use of nonsteroidal anti-inflammatory drugs (P < 0.001).

Conclusions

This study shows that the frequency and severity of shoulder pain are higher in women who have had cesarean section under spinal anesthesia, compared to those who had received general anesthesia.

A new COVID-19 prediction scoring model for in-hospital mortality: experiences from Turkey, single center retrospective cohort analysis

OBJECTIVE

Although many studies reported prognostic factors proceeding to severity of COVID-19 patients, in none of the article a prediction scoring model has been proposed. In this article a new prediction tool is presented in combination of Turkish experience during pandemic.

MATERIALS AND METHODS

Laboratory and clinical data of 397 over 798 confirmed COVID-19 patients from Gülhane Training and Research Hospital electronic medical record system were included into this retrospective cohort study between the dates of 23 March to 18 May 2020. Patient demographics, peripheral venous blood parameters, symptoms at admission, in hospital mortality data were collected. Non-survivor and survivor patients were compared to find out a prediction scoring model for mortality.

RESULTS

There was 34 [8.56% (95% CI:0.06-0.11)] mortality during study period. Mean age of patients was 57.1±16.7 years. Older age, comorbid diseases, symptoms, such as fever, dyspnea, fatigue and gastrointestinal and WBC, neutrophil, lymphocyte count, C-reactive protein, neutrophil-to-lymphocyte ratio of patients in non-survivors were significantly higher. Univariate analysis demonstrated that OR for prognostic nutritional index (PNI) tertile 1 was 18.57 (95% CI: 4.39-78.65, p<0.05) compared to tertile 2. Performance statistics of prediction scoring method showed 98% positive predictive value for criteria 1.

CONCLUSIONS

It is crucial to constitute prognostic clinical and laboratory parameters for faster delineation of patients who are prone to worse prognosis. Suggested prediction scoring method may guide healthcare professional to discriminate severe COVID-19 patients and provide prompt intensive therapies which is highly important due to rapid progression leading to mortality.

Macular capillary system and ganglion cell-layer complex of the amblyopic eye with optical cohorence tomography angiography and optical cohorence tomography

PURPOSE

To investigate the macular capillary system and ganglion cell-layer complex of the amblyopic eye with OCTA and OCT in comparison with fellow non-amblyopic eyes and a healthy control group and to examine their relationship with the severity of amblyopia.

METHODS

This prospective, cross-sectional comparative study enrolled 25 amblyopic patients and 25 healthy controls. All patients and controls underwent OCTA and OCT imagining. Macular vessel densities of the Superficial Capillary Plexus (SCP) and Deep Capillary Plexus (DCP) and retinal thickness were measured by OCTA and ganglion cell layer (GCL) by OCT.

RESULTS

SCP density at the fovea and parafovea was significantly lower in amblyopic eyes than in fellow eyes and control group. DCP density at the fovea was significantly lower in amblyopic eyes than fellow eyes and control group. Mean GCL thickness on OCT was 0.73 ± 0.07 μm in amblyopic eyes, 0.75 ± 0.06 μm in fellow eyes and 0.77 ± 0.06 μm in the control group. GCL volume was significantly lower in amblyopic eyes than the fellow eyes. The SCP and DCP and GCL thickness were not affected by the severity of amblyopia.

CONCLUSION

Macular vessel densities of the SCP and DCP of eyes with amblyopia is lower compared to the fellow non-amblyopic eyes and the control group. The thickness of GCL was lower in amblyopic eyes than fellow eyes while the severity of amblyopia did not have any impact on these structures. Microvascular retinal structures may have been affected in the course of amblyopia development.

Note: Effect of Some Spice Extracts on Bacterial Inhibition

Eighteen extracts of spices commonly consumed worldwide and grown naturally in Turkey were tested against twenty three bacterial strains to compare their antibacterial effects with eleven antibiotics. Eight pathogens and fifteen lactobacilli isolated from chick intestine were used as the test microorganisms. Pathogens (six different Staphylococcus aureus strains, Escherichia coli ATCC 25922 and Yersinia enterocolitica ATCC 1501) were grown in Nutrient broth and lactobacilli in MRS broth. Hop extracts formed inhibition zones against S. aureus strains of upto 36 mm. Inhibitory effects of hop extracts against S. aureuswere generally higher than that of erythromycin as antibiotic. Helichrysum compactum extract produced an inhibition zone of 23mm to E. coli ATCC 25922 and 26mm to Y. enterocolitica ATCC 1501. Helichrysum compactum extract inhibited the growth of Y. enterocolitica ATCC 1501 more than other spice extracts. While inhibition zones of these extracts against lactobacilli were found smaller than on S. aureus strains, inhibition zones of the same extracts against lactobacilli were found similar to those of E. coli ATCC 25922 and Y. enterocolitica ATCC 1501.

Polidocanol (Lauromacrogol 400) has anti-angiogenic effects in vitro and in vivo

OBJECTIVE

Polidocanol is the most frequently used sclerosant for sclerotherapy all around the world. Our experimental research aims to find out the angiogenic effects of Polidocanol.

MATERIALS AND METHODS

Angiogenic activity of polidocanol was examined in vivo in the chick chorioallantoic membrane (CAM) model, cell viability assay (human umbilical vein endothelial cells - HUVECs) and in vitro tube formation assay of HUVECs.

RESULTS

In CAM assay, a significant decrease on CAM vessel growth was observed after the application of polidocanol solutions. Vessel growth inhibition was strongly dose-dependent. There was a cytotoxic effect on HUVECs in the presence of polidocanol observed with MTT assay (p < 0.05). In the tube formation assay, statistically significant decrease in tube formation was observed in polidocanol group. It was found that polidocanol had an anti-angiogenic effect (p < 0.05). The results provide evidence that polidocanol decreases angiogenesis and has a cytotoxic effect on ECs.

CONCLUSIONS

These results provide evidence that Polidocanol (lauromacrogol 400) have strong anti-angiogenic effects in vitro and in vivo. Further researches needed to reveal early and long-term effects of polidocanol in the human vascular system and new treatment approach as an anti-angiogenic therapy.

Sedoanalgesia for cardioversion: comparison of alfentanil, remifentanil and fentanyl combined with propofol and midazolam: a prospective, randomized, double-blind study

OBJECTIVE

Electrical cardioversion (EC) is a short but painful procedure to restore sinus rhythm. The aim of this study is to compare the effect of fentanyl, remifentanil and alfentanil in association with propofol and midazolam for elective EC.

PATIENTS AND METHODS

Ninety-nine patients older than 18-years, American Society of Anesthesiologists I/II/III grades undergoing elective EC were randomized into 3 groups. All patients received 2 mg midazolam and propofol (0.5 mg/kg). Group A received alfentanil (5 µg/kg i.v. bolus), Group F received fentanyl (0.5 µg/kg i.v. bolus) and Group R received remifentanil (0.25 µg/kg i.v. bolus). Hemodynamics and respiratory variables [Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), SpO2, respiratory rate (RR)], and Modified Aldrete recovery score (MARS) were assessed at six different time points (baseline, right after EC, and 3rd min, 5th min, 10th min, 30th min following EC). Also, induction times (time to reach RSS to 5) and recovery times (time to reach MARS to 8) were recorded. The incidence of respiratory depression, bradycardia, hypotension and adverse effects were also recorded.

RESULTS

Hemodynamic variables were similar in all groups. SpO2 values in Group R were significantly lower at 3rd min (p = 0.005). Induction and recovery times were longest in Group F. There were significant differences at 3rd, 5th and 10th minute MARS values between groups. The incidence of hypotension and bradycardia were similar in all groups (p > 0.05) but respiratory depression was higher in Group R (p = 0.047).

CONCLUSIONS

Propofol alfentanil combination has more beneficial advantages in their rapid onset, early recovery time and less respiratory depression than remifentanil and fentanyl.

Comparison of angiogenic and proliferative effects of three commonly used agents for pulmonary artery hypertension (sildenafil, iloprost, bosentan): is angiogenesis always beneficial?

OBJECTIVE

Pulmonary artery hypertension (PAH) is devastating disease that has very serious outcomes. Dysregulated angiogenesis is one of the main responsible courses in pathophysiology of disease. Our experimental research intends to find out and compare the angiogenic effects of medications used sildenafil, iloprost, and bosentan in the treatment of PAH.

MATERIALS AND METHODS

This study was performed in Department of Biochemistry and Cancer and Stem Cell Research Laboratory of our institutes between August and October 2014. Angiogenic activity of sildenafil, iloprost, and bosentan were examined in vivo in chick chorioallantoic membrane (CAM) model and in vitro tube formation assay of human umbilical vein endothelial cells (HUVECs). Proliferative activity of these three agents was also determined through 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay on HUVECs.

RESULTS

In CAM assay, when compared to the control and drug groups, treatment with sildenafil solutions resulted in a significant dose-dependent increase (budding, sprouting, extravasation) on CAM vessel growth. While there was no significant proliferative effect with iloprost and bosentan, presence of sildenafil caused a statistically significant proliferation on HUVECs following 24 and 48 h incubation (p < 0.05) compared to the control group. Comparing the tube length/area ratio values, there was statistically significant increase in sildenafil group with respect to the other 2 groups (p < 0.05). Iloprost and bosentan did not show a significant effect.

CONCLUSIONS

The results provide evidence that sildenafil but not iloprost and bosentan induces angiogenesis in vitro and in vivo. Dysregulated angiogenesis, as an important pathophysiological part in the progression of PAH, may be triggered by the chronic ingestion of sildenafil in the long treatment period and may cause negative effects.

Acute high dose-fentanyl exposure produces hyperalgesia and tactile allodynia after coronary artery bypass surgery

OBJECTIVE

Opioid-induced hyperalgesia is well known complication of acute high dose and chronic opioid therapy. In this study, we evaluated development of opioid-induced hyperalgesia following intraoperative short-term use of µ-opioid agonist fentanyl after coronary artery bypass surgery.

PATIENTS AND METHODS

100 patients undergoing elective coronary artery bypass graft surgery is divided into two groups. In group I (low dose), anesthesia was induced with propofol 1-2.5 mg/kg and fentanyl 2 mcg/kg, in group II (high dose) fentanyl 40-70 mcg/kg was used. In group I, propofol 5-10 mg/kg/h, fentanyl 1-3 mcg/kg/h, in group II fentanyl 5-10 mcg/kg/h was used for maintenance of anesthesia. The tactile and thermal thresholds were measured before surgery and in 1st, 3rd and 7th postoperative days by using Von Frey filaments and a thermal source, respectively.

RESULTS

Tactile thresholds were significantly decreased at the first (6,08±0.21 and 3.76±0.13 g; p<0.001) and third (6.76±0.24 and 4.96±0.16 g; p<0.001) postoperative days compared to baseline preoperative values (7.72±0.26, and 7.60±0.21 g; p=816) in two groups. Postoperative 1st (13.45±0.33 and 10.05±0.24 sec; p<0.001) and 3rd day (14.77±0.28 and 13.17±0.26 sec; p<0.001) assessments showed a statistically significant thermal hyperalgesia compared to the preoperative baseline values (16.67±0.51 and 16.45±0.42 sec; p=0.997) in two groups. This decrease in both tactile and thermal thresholds returned to baseline control values at the 7th day of measurement.

CONCLUSIONS

Our results showed that patients undergoing coronary artery bypass surgery receiving fentanyl anesthesia developed postoperative tactile allodynia and thermal hyperalgesia and this was more prominent in high dose group.

[Occipital condyle fractures: a case report]

Occipital condyle fractures are rare, and conservative treatment is sufficient for many cases. Surgical treatment may be required if the condyle fracture is accompanied by atlantooccipital dislocation. Unfortunately, condyle fracture generally cannot be diagnosed with X-ray in the emergency department. Recently, computed tomography scans have been used more frequently, and enable easier diagnosis of these types of fractures. In this report, we describe a patient who admitted to our emergency department after a major trauma. She complained of neck pain, and maxillofacial trauma was more evident. Her cervical X-rays were normal, but cervical computed tomography revealed unilateral occipital condyle fracture.

Risk factors for peritonitis related to peritoneal dialysis

BACKGROUND

The aim of this study was to evaluate risk factors for peritonitis associated with peritoneal dialysis in our centre.

METHODS

Forty patients on chronic peritoneal dialysis between 2006-2010 were enrolled in this study. Nutritional, sociodemographical, psychological, dialysis related (peritoneal modality, characteristics and adequacy) possible risk factors associated with the development of peritonitis were recorded. Data of patients with and without peritonitis were compared using the Student's t-test and chi-square test.

RESULTS

There were 31 episodes of peritonitis among 21 patients, while other 19 patients had not experienced peritonitis resulting in a rate of 1 episode / 44 patient months. Staphylococcus aureus was the most frequent microorganism isolated (31 %). Hypoalbuminemia, technical problems, poor personal and environmental hygiene, low educational status, current or former smoking history and less urine output were observed significantly more in patients who had peritonitis.

CONCLUSIONS

Our results confirm that educational, psychological, nutritional, smoking and hygiene status and amount of urine output are closely associated with peritonitis among peritoneal dialysis patients. Measures to improve these factors may help prevent and control peritoneal dialysis related peritonitis (Tab. 4, Ref. 14).

Perspective on rhabdomyolysis-induced acute kidney injury and new treatment options

AIM

The purpose of this study was to assess the role of caspase-dependent apoptosis, caspase 1, calpain 1, inducible nitric oxide synthase (iNOS) and endothelial nitric oxide synthase (eNOS) and the protective effect of grape seed proanthocyanidin extract (GSPE) in the development of rhabdomyolysis-induced acute kidney injury (AKI).

MATERIALS AND METHODS

Twenty-one rats were divided into 3 groups - control, rhabdomyolysis and rhabdomyolysis + GSPE. Rhabdomyolysis was induced in the rhabdomyolysis and rhabdomyolysis + GSPE groups with the injection into both hind limbs of 10 ml/kg hypertonic (50%) glycerol following 24-hour dehydration on the 6th day. The rhabdomyolysis + GSPE group was given GSPE at 100 mg/kg by gavage for 7 days. The experiment was concluded 48 h after glycerol injection. Blood specimens were collected, and kidney tissues were extracted for histopathological examination.

RESULTS

We identified an increase in blood urea nitrogen, creatinine, histopathological score, iNOS, caspase 3, caspase 1 and calpain 1 expression in the rhabdomyolysis group compared to the controls and a decrease in eNOS expression. In the rhabdomyolysis + GSPE group, however, there was a decrease in these mediators, together with an increase in eNOS expression.

CONCLUSION

This study shows for the first time in the literature that calpain 1 is involved in the pathogenesis of rhabdomyolysis-induced AKI, and that GSPE may have a renoprotective effect.

Evaluation of nutritional parameters of hemodialysis patients

BACKGROUND

This study was performed to investigate nutritional parameters of hemodialysis patients by using anthropometric and biochemical measurements.

METHODS

Data from the last 6 months of 22 adult hemodialysis patients with a mean age of 61 ± 14 years were analyzed retrospectively. Dialysis vintage, normalized protein catabolic rate (nPCR), serum biochemical parameters, mid arm muscle circumference (MAMC) were determined as mean and standard deviation. Correlations between the variables were computed by coefficient p of Pearson.

RESULTS

We found significant positive correlations: age of patients versus C-reactive protein, MAMC versus LDL-Cholesterol, MAMC versus body mass index, albumin versus hemoglobin. There were also significant negative correlations: age versus serum creatinine, age versus albumin, age versus intact parathyroid hormone (iPTH), dialysis vintage versus MAMC.

CONCLUSION

In conclusion, age seem to be negatively associated with iPTH and albumin. As dialysis vintage increases, muscle mass seems to decrease.

A comparison of the effects of losartan and ramipril on blood pressure, renal volume and progression in polycystic kidney disease: A 5-Year follow-up

BACKGROUND

The major cause of hereditary renal failure is autosomal dominant polycystic kidney disease (ADPKD). Many factors affect renal progression in these patients. Among these, hypertension and an increase in renal volume are interrelated in terms of their effects on renal progression. We aimed to investigate the effects of losartan and ramipril on renal volume and progression in patients with ADPKD.

MATERIALS AND METHODS

Data from 18 hypertensive patients with ADPKD were evaluated. Eleven of the 18 hypertensive patients were on losartan and 7 on ramipril treatment. Demographic parameters, use of antihypertensives and other medications, the course of blood pressure (BP), biochemical parameters, creatinine clearance (CrCL), findings at computed tomography and renal volume were recorded at baseline and at 1 and 5 years.

RESULTS

Target BP values were maintained over 5 years. The annual decrease in CrCL was 1.33 mL/min in the losartan group compared with 6.59 mL/min in the ramipril group. There was no significant difference between the groups in terms of annual decrease in CrCL. Annual increase in renal volume was 252.04 cm³ in the losartan group and 167.36 cm³ in the ramipril group. There was no significant difference between the groups in terms of the increase in renal volumes at 1 and 5 years.

CONCLUSION

Our study demonstrated that losartan and ramipril provided effective BP control. In addition, the results of our study demonstrated that despite the increase in renal volume, losartan and ramipril may have regressed renal progression via other factors.

Bilateral asymptomatic giant renal artery aneurysm

The incidence of renal artery aneurysm is very low. Approximately in 20% of these patients hypertension is observed. The diameter of aneurysm increases with accompanying complication rates. The most feared complication is rupture. The risk of rupture also increases with the diameter of aneurysm. We report an aneurysm with the biggest diameter reported in the literature. The patient had a 12 cm-diameter of aneurysm in one kidney and did not show any symptoms including hypertension until she was seventy years old.

Management of glaucoma in patients with nanophthalmos

AIMS

In this retrospective study, we aimed to evaluate the results of glaucoma surgery in patients with nanophthalmos.

METHODS

Twenty-eight bilateral nanophthalmic patients, of whom 20 patients underwent trabeculectomy+Mitomycin-C (MMC)+inferior sclerotomy between 1996 and 2004, were included in this study. Records of patients with nanophthalmos were reviewed. Intraocular pressure (IOP), glaucoma medications, surgical success, visual acuity and complications were analyzed.

RESULTS

The mean IOP was 34.6+/-5.3 mm Hg preoperatively. At the final follow-up visit, the mean IOP dropped to 21.41+/-7.34 mm Hg (P<0.05). The cumulative probability of success was 85% at 1 year, 78.5% at 2 years, 76.9% at 3 years, 70.6% at 4 years and 47% at 5 years after surgery. Visual acuity decreased in 13 (65%) patients but no eye lost vision. Sequels of choroidal detachment (five patients 25%) and retinal folds (four patients 20%) were the most frequent reason for visual decrease. Uveal effusion (10 patients 50%) and cataract formation (seven patients 35%) were major late postoperative complications.

CONCLUSIONS

Results indicate that trabeculectomy+MMC+inferior sclerotomy procedure was effective and safe for glaucoma control in patients with nanophthalmos, but uveal effusion is a major problem and cataract surgery is expected in the long run.

The uncemented CLS expansion cup as a component of a hybrid system in primary total hip arthroplasty: A prospective study

The purpose of this prospective study is to present the results of 160 primary total hip replacements in 145 patients with a hybrid system composed of the uncemented CLS expansion cup and the cemented MS-30 femoral component. Included in this study were 109 women and 36 men with the mean age of 64.2 years (range 25 to 87) at the time of the surgery. The mean follow-up time was 7.5 years (range 6 to 12). The Harris Hip Score and radiographic analyses were used for the most recent assessment. Five patients died during the follow-up period. Two hips were dislocated and managed by open reduction. The mean Harris Hip Score before surgery was 38.4 (range 15 to 57) and 91.3 (range 64 to 100) at the last follow-up. Although a radiolucent line has been detected around the femoral component in four hips, no revision has been considered yet. No radiological evidence of loosening and detectable migration have been observed in any of the acetabular components. The hybrid replacement, consisting of the uncemented acetabular CLS expansion cup and the cemented MS-30 femoral stem, yielded overall good results after medium-term duration of follow-up. (Hip International 2004; 14: 223-8).

Prediction of chromatographic retention, pKa values and optimization of the separation of polyphenolic acids in strawberries

Polyphenolic acids are a complex group of compounds that have attracted enormous attention in the last few years because of their biological properties. In this work, the proportion of organic modifier and the pH of acetonitrile-water mixtures used as mobile phases were optimized in order to separate a series of polyphenolic compounds. The linear solvation energy relationship formalism based on the single solvent polarity parameter, E(T)N was used to predict their chromatographic behavior as a function of the percentage of acetonitrile in the eluent. Moreover, the correlation established between retention and the pH of the aqueous-organic mobile phase was used to optimize the pH of the mobile phase. The optimized mobile phase is composed of acetonitrile and formic acid buffer adjusted to pH 4.25, with 12% (v/v) acetonitrile. Also, the pKa values of polyphenolic acids in acetonitrile-water mixtures were determined using chromatographic data, and in order to validate the optimized conditions, a series of polyphenolic compounds was studied in strawberries.

A cephalometric investigation of the effects of the Elastic Bite-block in the treatment of Class II division 1 malocclusions

The purpose of this study was to investigate cephalometrically, the effects of a functional appliance-headgear combination, the Elastic Bite-block (EBB). Of 50 Class II division 1 subjects who participated in this study, 30 made up the treatment group and 20 the control group. All of the selected cases exhibited mandibular retrognathism, facial growth pattern either along the Y-axis or in the horizontal direction, and were all at the peak of the prepubertal growth spurt. Whilst the EBB was applied to the treatment group for 1 year, no treatment was performed on the control group. Measurements made on the lateral cephalograms, obtained at the beginning and end of the study were statistically evaluated. The following changes took place as a result of EBB treatment: sagittal growth of the maxilla was inhibited, the upper molars were distalized and intruded, sagittal growth of the mandible was stimulated and the lower molars erupted in a mesio-occlusal direction. As a result of downward and backward rotation of the mandible, the vertical dimension showed incremental changes. The upper and the lower incisors were both uprighted and intruded, and overjet and overbite decreased.

NMR spectroscopic studies of intermediary metabolites of cyclophosphamide. A comprehensive kinetic analysis of the interconversion of cis- and trans-4-hydroxycyclophosphamide with aldophosphamide and the concomitant partitioning of aldophosphamide between irreversible fragmentation and reversible conjugation pathways

Multinuclear (31P, 13C, 2H, and 1H) Fourier-transform NMR spectroscopy, with and without isotopically enriched materials, was used to identify and quantify, as a function of time, the following intermediary (short-lived) metabolites of the anticancer prodrug cyclophosphamide (1, Scheme I): cis-4-hydroxycyclophosphamide (cis-2), its trans isomer (trans-2), aldophosphamide (3), and its aldehyde-hydrate (5). Under a standard set of reaction conditions (1 M 2,6-dimethylpyridine buffer, pH 7.4, 37 degrees C), the stereospecific deoxygenation of synthetic cis-4-hydroperoxycyclophosphamide (cis-12, 20 mM) with 4 equiv of sodium thiosulfate (Na2S2O3) afforded, after approximately 20 min, a "pseudoequilibrium" distribution of cis-2, 3, 5, and trans-2, i.e., the relative proportions of these reactants (57:4:9:30, respectively) remained constant during their continual disappearance. NMR absorption signals indicative of "iminophosphamide" (8) and enol 6 were not detected (less than 0.5-1% of the synthetic metabolite mixture). A computerized least-squares fitting procedure was applied to the individual 31P NMR derived time courses for conversion of cis-2, 3 plus 5 (i.e., "3"), and trans-2 into acrolein and phosphoramide mustard (4), the latter of which gave an expected array of thiosulfate S-alkylation products (e.g., 16) and other phosphorus-containing materials derived from secondary decomposition reactions. This kinetic analysis gave the individual forward and reverse rate constants for the apparent tautomerization processes, viz., cis-2 in equilibrium "3" in equilibrium trans-2, as well as the rate constant (k3) for the irreversible fragmentation of 3. The values of k3 at pH 6.3, 7.4, and 7.8 were equal to 0.030 +/- 0.004, 0.090 +/- 0.008, and 0.169 +/- 0.006 min-1, respectively. Replacement of the HC(O)CH2 moiety n 3 with HC(O)CD2 led to a primary kinetic isotope effect (kH/kD = 5.6 +/- 0.4) for k3. The apparent half-lives (tau 1/2) for cis-2, "3", and trans-2 under the standard reaction conditions, at "pseudoequilibrium" (constant ratio of cis-2/"3"/trans-2), were each equal to approximately 38 min, which is considerably shorter than the widely cited colorimetrically derived half-lives reported by earlier investigators. The values of tau 1/2 for cis-2, "3", and trans-2 were affected by pH in the same manner as that found for k3 but were relatively insensitive to the presence of either K+, Na+, Ca2+, or Mg2+. The presence of certain primary amines led to marked decreases in tau 1/2 and, in some cases, the formation of acyclic adducts of aldehyde 3.(ABSTRACT TRUNCATED AT 400 WORDS)

Synthesis and evaluation of 3-halocyclophosphamides and analogous compounds as novel anticancer "pro-prodrugs"

3-Fluoro-, 3-chloro-, and 3-bromocyclophosphamide were prepared from the reaction of trifluoromethylhypofluorite, sodium hypochlorite, and bromine with the anticancer drug cyclophosphamide. Treatment of cis- and trans-4-phenylcyclophosphamide and 5,6-benzocyclophosphamide with sodium hypochlorite afforded cis- and trans-3-chloro-4-phenylcyclophosphamide and 3-chloro-5,6-benzocyclophosphamide, respectively. 31P-NMR spectroscopy was used to study the reactivity of these compounds: the fluoro derivative was reduced to cyclophosphamide on incubation with mouse liver slices, and the reactivity order for sulfhydryl-induced reduction of the 3-halocyclophosphamides was Br approximately equal to Cl much greater than F. Compared with the therapeutic efficacy of cyclophosphamide against L-1210 and P-388 cancers in mice, 3-fluoro- and 3-chlorocyclophosphamide were less active, although the fluoro derivative was more efficacious than the 3-chloro compound. The individual R and S enantiomers of 3-chlorocyclophosphamide, prepared from (S)- and (R)-cyclophosphamide, respectively, showed no significant difference in therapeutic activity in the P-388 test system.

Synthesis, hydrolytic reactivity, and anticancer evaluation of N- and O-triorganosilylated compounds as new types of potential prodrugs

N- and O-Triorganosilylated compounds related to various anticancer agents were synthesized for evaluation as potential anticancer prodrugs. 1H-NMR and UV kinetic measurements of hydrolytic desilylation were used to correlate relative rates of structural unmasking with steric bulk about the silicon reaction center. The tert-butyldimethylsilyl ester of chlorambucil and a number of O- triorganosilylated carbamate derivatives of nor-nitrogen mustard showed significant activity against P-388 lymphocytic leukemia in mice.