Harnessing the supremacy of MEG3 LncRNA to defeat gastrointestinal malignancies

Evidence suggests that long non-coding RNAs (lncRNAs) play a pivotal role in the carcinogenesis and progression of various human malignancies including gastrointestinal malignancies. This comprehensive review reports the functions and mechanisms of the lncRNA maternally expressed gene 3 (MEG3) involved in gastrointestinal malignancies. It summarizes its roles in mediating the regulation of cellular proliferation, apoptosis, migration, invasiveness, epithelial-to-mesenchymal transition, and drug resistance in several gastrointestinal cancers such as colorectal cancer, gall bladder cancer, pancreatic cancer, gastric cancer, esophageal cancer, cholangiocarcinoma, gastrointestinal stromal tumors and most importantly, hepatocellular carcinoma. In addition, the authors briefly highlight its implicated mechanistic role and interactions with different non-coding RNAs and oncogenic signaling cascades. This review presents the rationale for developing non coding RNA-based anticancer therapy via harnessing the power of MEG3 in gastrointestinal malignancies.

Evaluation of circulating insulin-like growth factor-1, heart-type fatty acid-binding protein, and endotrophin levels as prognostic markers of COVID-19 infection severity

BACKGROUND

Coronavirus Disease 2019 (COVID-19) is a worldwide pandemic challenge spreading enormously within a few months. COVID-19 is characterized by the over-activation of the immune system causing cytokine storm. Insulin-like growth factor-1 (IGF-1) pathway can regulate the immune response via interaction with various implicated cytokines. Heart-type fatty acid-binding protein (H-FABP) has been shown to promote inflammation. Given the fact that coronavirus infections induce cytokines secretion leading to inflammatory lung injury, it has been suggested that H-FABP levels are affected by COVID-19 severity. Moreover, endotrophin (ETP), the cleavage product of collagen VI, may be an indicator of an overactive repair process and fibrosis, considering that viral infection may predispose or exacerbate existing respiratory conditions, including pulmonary fibrosis. This study aims to assess the prognostic capacity of circulating IGF-1, HFABP, and ETP, levels for COVID-19 severity progression in Egyptian patients.

METHODS

The study cohort included 107 viral RNA-positive patients and an equivalent number of control individuals with no clinical signs of infection. Clinical assessments included profiling of CBC; serum iron; liver and kidney functions; inflammatory markers. Circulating levels of IGF-1; H-FABP, and ETP were estimated using the corresponding ELISA kits.

RESULTS

No statistical difference in the body mass index was detected between the healthy and control groups, while the mean age of infected patients was significantly higher (P = 0.0162) than the control. Patients generally showed elevated levels of inflammatory markers including CRP and ESR concomitant with elevated serum ferritin; D dimer and procalcitonin levels, besides the COVID-19 characteristic lymphopenia and hypoxemia were also frequent. Logistic regression analysis revealed that oxygen saturation; serum IGF-1, and H-FABP can significantly predict the infection progression (P < 0.001 each). Both serum IGF-1 and H-FABP as well as O₂ saturation showed remarkable prognostic potentials in terms of large AUC values, high sensitivity/specificity values, and wide confidence interval. The calculated threshold for severity prognosis was 25.5 ng/mL; 19.5 ng/mL, 94.5, % and for IGF-1, H-FABP, and O₂ saturation; respectively. The calculated thresholds of serum IGF-1; H-FABP, and O₂ saturation showed positive and negative value ranges of 79-91% and 72-97%; respectively, with 66-95%, 83-94% sensitivity, and specificity; respectively.

CONCLUSION

The calculated cut-off values of serum IGF-1 and H-FABP represent a promising non-invasive prognostic tool that would facilitate the risk stratification in COVID-19 patients, and control the morbidity/mortality associated with progressive infection.

Impact of COVID-19 on endoscopic follow-up of gastroesophageal varices

Background

Portal hypertension is considered as a major complication of liver cirrhosis. Endoscopy plays a main role in managing of gastrointestinal complications of portal hypertension. Endoscopists are at increased risk for COVID-19 infection because upper gastrointestinal (GI) endoscopy is a high-risk aerosol-generating procedure and may be a potential route for COVID-19.

Objectives

To compare the outcome between cirrhotic patients who underwent classic regular endoscopic variceal ligation after primary bleeding episode every 2–4 weeks, and those presented during the era of COVID-19 and their follow-up were postponed 2 months later.

Methods

This retrospective study included cross-matched 238 cirrhotic patients with portal hypertension presented with upper GI bleeding, 112 cirrhotic patients presented during the era of COVID19 (group A) underwent endoscopic variceal ligation, another session after 2 weeks and their subsequent follow-up was postponed 2 months later, and 126 cirrhotic patients as control (group B) underwent regular endoscopic variceal band ligation after primary bleeding episode every 2–4 weeks.

Results

Eradication of varices was achieved in 32% of cases in group A, and 46% in group was not any statistically significant (p > 0.05); also, there was no any statistical significant difference between both groups regarding occurrence of rebleeding, post endoscopic symptoms, and mortality rate (p > 0.05).

Conclusion

Band ligation and injection of esophageal and gastric vary every 2 months were as effective and safe as doing it every 2 to 4 weeks after primary bleeding episode for further studies and validation.

Down-regulation of hepatic expression of GHR/STAT5/IGF-1 signaling pathway fosters development and aggressiveness of HCV-related hepatocellular carcinoma: Crosstalk with Snail-1 and type 2 transforming growth factor-beta receptor

Background and aims

So far, few clinical trials are available concerning the role of growth hormone receptor (GHR)/signal transducer and activator of transcription 5 (STAT5)/insulin like growth factor-1 (IGF-1) axis in hepatocarcinogenesis. The aim of this study was to evaluate the hepatic expression of GHR/STAT5/IGF-1 signaling pathway in hepatocellular carcinoma (HCC) patients and to correlate the results with the clinico-pathological features and disease outcome. The interaction between this signaling pathway and some inducers of epithelial-mesenchymal transition (EMT), namely Snail-1 and type 2 transforming growth factor-beta receptor (TGFBR2) was studied too.

Material and methods

A total of 40 patients with HCV-associated HCC were included in this study. They were compared to 40 patients with HCV-related cirrhosis without HCC, and 20 healthy controls. The hepatic expression of GHR, STAT5, IGF-1, Snail-1 and TGFBR2 proteins were assessed by immunohistochemistry.

Results

Compared with cirrhotic patients without HCC and healthy controls, cirrhotic patients with HCC had significantly lower hepatic expression of GHR, STAT5, and IGF-1proteins. They also displayed significantly lower hepatic expression of TGFBR2, but higher expression of Snail-1 versus the non-HCC cirrhotic patients and controls. Serum levels of alpha-fetoprotein (AFP) showed significant negative correlations with hepatic expression of GHR (r = -0.31; p = 0.029) and STAT5 (r = -0.29; p = 0.04). Hepatic expression of Snail-1 also showed negative correlations with GHR, STAT5, and IGF-1 expression (r = -0.55, p = 0.02; r = -0.472, p = 0.035, and r = -0.51, p = 0.009, respectively), whereas, hepatic expression of TGFBR2 was correlated positively with the expression of all these proteins (r = 0.47, p = 0.034; 0.49, p = 0.023, and r = 0.57, p<0.001, respectively). Moreover, we reported that decreased expression of GHR was significantly associated with serum AFP level>100 ng/ml (p = 0.048), increased tumor size (p = 0.02), vascular invasion (p = 0.002), and advanced pathological stage (p = 0.01). Similar significant associations were found between down-regulation of STAT5 expression and AFP level > 100 ng/ml (p = 0.006), vascular invasion (p = 0.009), and advanced tumor stage (p = 0.007). Also, attenuated expression of IGF-1 showed a significant association with vascular invasion (p < 0.001). Intriguingly, we detected that lower expression of GHR, STAT5 and IGF-1 were considered independent predictors for worse outcome in HCC.

Conclusion

Decreased expression of GHR/STAT5/IGF-1 signaling pathway may have a role in development, aggressiveness, and worse outcome of HCV-associated HCC irrespective of the liver functional status. Snail-1 and TGFBR2 as inducers of EMT may be key players. However, large prospective multicenter studies are needed to validate these results.

Dosimetric response of fabricated Ge-doped optical fibres in computed tomography RQT beam quality x-ray beams

Novel germanium (Ge)-doped silica glass fibres tailor-made in Malaysia are fast gaining recognition as potential media for thermoluminescence (TL) dosimetry, with active research ongoing into exploitation of their various beneficial characteristics. Investigation is made herein of the capability of these media for use in diagnostic imaging dosimetry, specifically at the radiation dose levels typically obtained in conduct of Computed Tomography (CT). As a first step within such efforts, there is need to investigate the performance of the fibres using tightly defined spectra, use being made of a Philips constant potential industrial x-ray facility, Model MG165, located at the Malaysian Nuclear Agency Secondary Standards Dosimetry Lab (SSDL). Standard radiation beam qualities (termed RQT) have been established for CT, in accord with IEC 61267: 2003 and IAEA Technical Reports Series No. 457: 2007. A calibrated ionisation chamber has also been utilised, forming a component part of the SSDL equipment. The fabricated fibres used in this study are 2.3 mol% flat fibre (FF) of dimensions 643 × 356 μm² and 2.3 mol% cylindrical fibre (CF) of 481 μm diameter, while the commercial fibre used is 4 mol% with core diameter of 50 μm. The dopant concentrations are nominal preform values. The fibres have been irradiated to doses of 20, 30 and 40 milligray (mGy) for each of the beam qualities RQT 8, RQT 9 and RQT 10. For x-rays generated at constant potential values from 100 to 150 kV, a discernible energy-dependent response is seen, comparisons being made with that of lithium fluoride (LiF) thermoluminescence dosimeters (TLD-100). TL yield versus dose has also been investigated for x-ray doses from 2 to 40 mGy, all exhibiting linearity. Compared to TLD-100, greater sensitivity is observed for the fibres.

Diagnostic value of early postoperative MRI and diffusion-weighted imaging following trans-sphenoidal resection of non-functioning pituitary macroadenomas

AIM

To establish the value of early contrast-enhanced magnetic resonance imaging (MRI) and diffusion-weighted imaging (DWI) in differentiating residual pituitary adenoma from postoperative surgical changes.

MATERIALS AND METHODS

Thirty patients with non-functioning pituitary macroadenomas, who were undergoing trans-sphenoidal adenomectomy, were prospectively studied. Patients were imaged with both MRI and DWI in the early postoperative period, as well as 6-months post-surgery. Patterns of postoperative contrast enhancement were described (non-enhancement, peripheral enhancement, and nodular enhancement). Apparent diffusion coefficient (ADC) maps were utilised to select the region of interest (ROI) for ADC calculations.

RESULTS

Seventeen patients had postoperative surgical granulation tissue and 13 had residual adenoma based on the 6 months follow-up imaging. Mean ADC values of postoperative granulation tissue and residual adenoma were 1.476±0.476×10^-3 mm²/s and 0.855±0.190×10^-3 mm²/s, respectively, in the early postoperative period, and 1.357±0.416×10^-3 mm²/s and 0.829±0.201×10^-3 mm²/s, respectively, at the 6-month follow-up. ADC values of granulation tissue were significantly different from that of residual adenoma at both time points (p<0.001). Sensitivity, specificity, positive and negative predictive values of early MRI were 84.6%, 94.1%, 91.7%, and 88.9% respectively, and of early DWI were 91%, 97%, 94.3%, and 93%, respectively.

CONCLUSION

Early postoperative DWI after trans-sphenoidal resection of pituitary macroadenomas may be more helpful than early MRI in differentiating residual adenoma from post-surgical changes.

Health and safety implications of recruitment payments in migrant construction workers

BACKGROUND

The Middle East construction sector is heavily reliant on a migrant workforce that predominantly originates from South Asia. It is common practice for migrant construction workers to pay a local labour recruiter the equivalent of one or more years' prospective overseas salary to secure employment, work and travel permits and transportation. The occupational health and safety implications of these financial arrangements remain unexplored.

AIMS

To examine associations between payment to a labour recruiter, perceived general health and worksite accidents among migrant construction workers in the Middle East.

METHODS

A questionnaire was completed by a convenience sample of predominantly Indian migrant construction workers drawn from a large construction project. The relationship between payment and risk of poor health and workplace accidents was assessed using multivariate logistic regression models (crude and adjusted for socio-demographic and occupational factors).

RESULTS

There were 651 participants. The majority (58%) of migrant construction workers had paid a labour recruiter and ~40% had experienced a worksite accident. Between 3% (labourers) and 9% (foremen) perceived their health to be poor. Labourers and skilled workers who had paid a labour recruiter were significantly more likely to have experienced a worksite accident in the previous 12 months. Skilled workers, but not labourers and foremen, who had paid a labour recruiter were at increased risk of poor health.

CONCLUSIONS

The mechanisms linking labour recruiter payments to adverse safety and health outcomes warrant investigation with a view to developing interventions to erode these links.

Unique karyotype: mos 46,X,dic(X;Y)(p22.33;p11.32)/ 45,X/45,dic(X;Y)(p22.33;p11.32) in an Egyptian patient with Ovotesticular disorder of sexual development

Ovotesticular disorder of sexual development (OT-DSD) is an unusual form of DSD, characterized by the coexistence of testicular and ovarian tissue in the same individual. In this report, we present clinical, cytogenetic and molecular data of an Egyptian patient with ambiguous genitalia and OT-DSD, who had a unique karyotype comprising 3 different cell lines: mos 46,X,dic(X;Y)(p22.33;p11.32)/45,X/ 45,dic(X;Y)(p22.33;p11.32). This mosaic karyotype probably represents 2 different events: abnormal recombination between the X and Y chromosomes during paternal meiosis and postzygotic abnormality in mitotic segregation of the dic(X;Y) chromosome, resulting in a mosaic karyotype. The presence of the sex-determining region Y (SRY) gene explains the development of testicular tissue. On the other hand, other factors, including the presence of a 45,X cell line, partial SRY deletion, X inactivation pattern, and position effect, could be contributed to genital ambiguity. Explanation of the patient's phenotype in relation to the genotype is discussed with a literature review. We conclude that FISH analysis with X- and Y-specific probes and molecular analysis of the SRY gene are highly recommended and allow accurate diagnosis for optimal management of cases with ambiguous genitalia.

Optimal use of topical agents for allergic conjunctivitis

In recent years, there has been renewed interest in the topical treatment of allergic conjunctivitis, a disorder that is involved in the common red-eye syndrome. Topical treatment for rapid relief of symptoms is most often preferred by the patient, although physicians are more cautious with the choice of an agent that might worsen symptoms due to contact irritation induced by the substance or its preservative. Theoretical advantages of topical over oral administration include a more rapid onset of action, since the active agent is applied directly to the affected tissue, and a reduced potential for systemic adverse effects. The range of topical agents currently available for the treatment of allergic conjunctivitis varies widely. The 4 primary aims when considering local drug application are: rapid symptomatic relief (particularly applicable to local vasoconstrictors and histamine antagonists);prophylactic therapy (mast cell stabilisers);avoidance of systemic adverse reactions (eye drops containing corticosteroids); anddirect route of administration (specific ocular immunotherapy). In this article we review the underlying pathological mechanisms, present a clinical and diagnostic overview and discuss the available therapeutic options. Finally, we present our treatment strategy, which is based on the nature of the disorder and the patient's expectations. In seasonal or perennial conjunctivitis the combination of decongestants and antihistamines should be first choice for palliative treatment. Mast cell stabilisers should be used as prophylaxis, while immunotherapy can provide a cure. In vernal and atopic keratoconjunctivitis, the decongestant/antihistamine combination can be used for long-term treatment, while courses of topical corticosteroids may prevent flares. Mast cell stabilisers, with lodoxamide in the first place, are used for prophylactic therapy. Surgery may be useful in handling complications. In giant papillary conjunctivitis, hygienic measures regarding contact lenses are mandatory, and sodium cromoglycate (cromolyn sodium) may provide rapid relief. In contact conjunctivitis, removal or avoidance of the sensitiser is most important. Topical use of corticosteroids should be limited to severe cases.

Profile of sudden death in an adult population (1999-2008)

Sudden death is the sudden and unexpected death of an individual within 24 hours of symptom onset. The vast majority of these cases are found, at autopsy, to be due to underlying ischaemic cardiac disease. We retrospectively reviewed all adult post mortems performed at Beaumont Hospital over a decade (1999-2008). Our aim was to identify all sudden death cases (natural and accidental) and subclassify them according to age profile and organ system involved. We identified 1230 sudden death cases in the review period with 775 (63%) deaths attributable to ischaemic heart disease. The rate of sudden death remained constant over the decade with 663 (54%) deaths occurring in the first five years. Our negative autopsy rate was 2.8% corresponding to 35 cases. This is the first Irish study to retrospectively review all adult sudden deaths within a defined catchment area and analyse them as outlined above.

Performance and optical characteristic of InGaN MQWs laser diodes

The performance of the InGaN multi-quantum wells (MQWs) laser diode structures has been numerically investigated by using ISE TCAD software. We investigated the effect of well numbers, barrier thickness and barrier doping on the output power, threshold current, and slope efficiency. All material parameters used in the model are evaluated based on the recent literature values. We observed the maximum output power and lower threshold current when the well number was two. Effective change in the output power and threshold current was observed with the variations in barriers thickness and doping level. Our results are in agreement with the experimental results observed by [S. Nakamura et al. Jpn. J. Appl. Phys. Part 2, 37, L1020 (1998) and S. Nakamura et al. Appl. Phys. Lett. 76, 22 (2000)].

Cumulus cell contribution to cytoplasmic maturation and oocyte developmental competence in vitro

OBJECTIVE

Although several reports indicated the bidirectional communication between the oocyte and granulosa cell, and the potential negative impact of premature cumulus removal, clinical data are controversial. The present analysis report the results of a prospective randomized study done on sibling oocytes to evaluate whether or not preincubation with intact cumulus is needed in ICSI.

METHODS

It was a prospective randomized study, and conducted at Alexandria IVF-ICSI center. This study was performed using 926 M2 oocytes from 141 cycles of patients undergoing ICSI. Oocytes were randomized between three protocols: protocol A (immediate denudation, immediate injection), protocol B (delayed denudation, delayed injection), and protocol C (early denudation, delayed injection). Main outcome measure(s) were maturation, fertilization, and cleavage rate after ICSI.

RESULTS

Aspects of nuclear, cytoplasmic maturation and oolemma properties were improved when oocytes were preincubated with intact cumulus before ICSI.

CONCLUSIONS

Preincubation, before ICSI improved results. Duration of preincubation should be program specific.

Effects of growth hormone on in vitro maturation of germinal vesicle of human oocytes retrieved from small antral follicles

PURPOSE

Evaluation of the effect of GH, administered in vivo, on in vitro maturation of human GV oocytes obtained from small follicles.

METHODS

The study included 88 ICSI women stimulated with long agonist protocol. They were randomly allocated to two groups (Group 1, 44 women with 86 GV oocytes), were cotreated with GH (Group 2, no GH: 44 women with 67 GV oocytes). GV oocytes from small follicles were matured in vitro, injected, and their development observed.

RESULTS

Resumption of meiosis was significantly higher in Group 1 compared to Group 2 (60 and 37.3% respectively). Significantly more M2 oocytes were obtained in Group 1 than in Group 2 (45.5 and 23.9% respectively). Fertilization rates were also significantly higher (51.9 and 18.8% respectively). No embryos were obtained in Group 2, whereas 21.1% of fertilized oocytes in Group 1 cleaved into class A embryos.

CONCLUSION

In vivo administration of GH enhanced in vitro maturation and fertilization of human GV oocytes retrieved from small antral follicles.

Effect of treatment with Ginkgo biloba extract EGb 761 (oral) on unilateral idiopathic sudden hearing loss in a prospective randomized double-blind study of 106 outpatients

OBJECTIVE

Test of dose-response relationship for Ginkgo biloba extract EGb 761 (oral) in outpatients with acute idiopathic sudden sensorineural hearing loss (ISSHL) of at least 15 dB at one frequency within the speech range occurring less than 10 days before study inclusion.

DESIGN

Multicentre, randomized, double-blind phase III study comparing dosages of 120 mg twice daily and 12 mg twice daily over 8 weeks. MAIN ENDPOINT: Recovery (in dB) of the auditory threshold from the initial measurement to the value on the last day of treatment, averaged over those frequencies from 0.25, 0.5, 1, 2, and 3 kHz for which the initial hearing loss amounted to 15 dB or more compared to the level on the opposite side.

PATIENTS

106 patients with an average age of 44+/-16 years and with hearing loss at affected frequencies 26 dB +/- 9 dB included between December 1995 and July 1997.

RESULTS

Large majorities of both treatment groups recovered completely. In exploratory analyses of the 96 patients included according to the protocol, patients given the higher dose had less risk of not recovering well (< or =10 dB residual hearing loss) (one-sided Fisher test: P = 0.0061), especially if they had no tinnitus (n = 44, P = 0.00702).

CONCLUSION

A higher dosage of EGb 761 (oral) appears to speed up and secure the recovery of ISSHL patients, with a good chance that they will recover completely, even with little treatment. This was already observed after one week of treatment. We find it justified to treat patients who have unilateral ISSHL of less than 75 dB and neither tinnitus nor vertigo with 120 mg oral EGb 761 twice daily.

Biological activities of two porcine growth hormone-releasing hormone receptor isoforms

Binding of growth hormone-releasing hormone (GHRH) to two isoforms (G3R and G5R) of the porcine GHRH receptor was studied. Both G3R- and G5R-cDNA were isolated from a porcine anterior pituitary cDNA library and have an identical primary structure from aa 1 to 418 and a different aa sequence from aa 419 to 423. In addition, the G5R isoform contains an extra C-terminal tail of 28 aa. The G3R and G5R mRNAs arise from alternative splicing of a single precursor mRNA for GHRH receptors. A mammalian cell expression vector containing either G3R or G5R cDNA under the regulation of a strong human cytomegalovirus promoter was constructed and used to transfect a human embryonic kidney 293 cell line. Two stable transfectants (293/G3R-4 and 293/G5R-12) were isolated on the basis of high expression of the receptor mRNAs. Both G3R and G5R mRNAs were expressed at similarly high levels in 293/G3R-4 and 293/G5R-12 cells; however, GHRH binding to 293/G3R-4 cells was much greater than that observed for 293/G5R-12 cells. Basal as well as GHRH-stimulated GTPase activity and intracellular cAMP concentration are also significantly greater in 293/G3R-4 cells as compared to 293/G5R-12 cells. We conclude that the modification of GHRH receptor at the C-terminal region hindered GHRH binding to the receptor and thus attenuates its biological activities.

Pregnene derivatives from Solenostemma argel leaves

Two new pregnene derivatives 14beta-15alpha-dihydroxy-delta4pregnene-3,20 dione and 3beta-14beta,15alpha-16alpha hydroxy-20-oxo-delta5pregnene-tetra-ol, in addition to alpha- and beta-amyrin and beta-sitosterol, were isolated from Solenostemma argel leaves. The structures were established by extensive spectral analysis as well as comparison with reference materials.

Estrogen and androgen elicit growth hormone release via dissimilar patterns of hypothalamic neuropeptide secretion

The dimorphic pattern of growth hormone (GH) secretion and somatic growth in male and female mammals is attributable to the gonadal steroids. Whether these hormones mediate their effects solely on hypothalamic neurons, on somatotropes or on both to evoke the gender-specific GH secretory patterns has not been fully elucidated. The purpose of this study was to determine the effects of 17beta-estradiol, testosterone and its metabolites on release of GH, GH-releasing hormone (GHRH) and somatostatin (SRIF) from bovine anterior pituitary cells and hypothalamic slices in an in vitro perifusion system. Physiological concentrations of testosterone and estradiol perifused directly to anterior pituitary cells did not affect GH releases; whereas, dihydrotestosterone and 5alpha-androstane-3alpha, 17beta-diol increased GH. Perifusion of testosterone at a pulsatile rate, and its metabolites and estradiol at a constant rate to hypothalamic slices in series with anterior pituitary cells increased GH release. The androgenic hormones increased GHRH and SRIF release from hypothalamus; whereas, estradiol increased GHRH but decreased SRIF release. Our data show that estradiol and the androgens generated distinctly different patterns of GHRH and SRIF release, which in turn established gender-specific GH patterns.

Changing trends in gastric carcinoma at a university medical center: a twelve-year retrospective analysis

Over the past 60 years, the epidemiology of gastric adenocarcinoma has changed considerably. The most striking change in the epidemiology of gastric adenocarcinoma has been the rapid increase in cancers of the proximal stomach. We performed a retrospective analysis of all gastric adenocarcinomas diagnosed at two hospitals in Little Rock, Arkansas, U.S.A., between 1985 and 1996. Two hundred seventeen patients were diagnosed with gastric adenocarcinoma. Patients were divided into three 4-year cohorts. We found that the proportions of gastric cardia adenocarcinoma in cohorts 1, 2, and 3 were 31%, 36%, and 42%, respectively (p = 0.52). Median survival in the three cohorts was 5, 8, and 8 months, respectively (p = 0.22). Median survival (stages 1-4) was 41.5, 11.5, 10, and 3 months, respectively (p < 0.0001). Well-, moderately-, and poorly- differentiated adenocarcinoma had median survivals of 18, 7.5, and 6 months, respectively (p = 0.07). We concluded that patients with gastric adenocarcinoma continue to be diagnosed at late stages. There has been a trend toward an increasing proportion of cardia adenocarcinoma. Stage at presentation was the only significant predictor of survival.

Diagnosis and staging of head and neck cancer: a comparison of modern imaging modalities (positron emission tomography, computed tomography, color-coded duplex sonography) with panendoscopic and histopathologic findings

OBJECTIVE

To compare the clinical value of positron emission tomography (PET) using fludeoxyglucose F 18, computed tomography (CT), color-coded duplex sonography (CCDS), and panendoscopy in the detection and staging of head and neck cancer.

DESIGN

Prospective nonrandomized controlled study.

SETTING

Medical school.

PATIENTS

Convenience sample of 50 patients with suspected primary or recurrent head and neck cancer.

INTERVENTION

Biopsy, tumor surgery.

MAIN OUTCOME MEASURES

Information of diagnostic procedures compared with histopathologic features.

RESULTS

Both PET and panendoscopy had a sensitivity of 95% and 100% for detection of primary tumor or recurrent carcinomas, respectively. Specificity for PET and panendoscopy was 92% and 85% in primary tumors and 100% and 80% in recurrent carcinoma, respectively. Sensitivity of CCDS and CT was 74% and 68% in primary tumors and 67% and 63% in recurrent carcinomas, respectively. Specificity was 75% and 69% in primary tumors and 100% and 80% in recurrent neoplasms. When assessing neck nodes, all imaging procedures exhibited identical sensitivity (84%). Specificity was 90%, 96%, and 88% in PET, CT, and CCDS, respectively. In recurrent lymph node metastases, sensitivity was 100%, 67%, and 67% and specificity was 87%, 91%, and 87% for PET, CT, and CCDS, respectively.

CONCLUSIONS

Positron emission tomography was the most reliable imaging procedure in the detection of primary tumor and recurrent carcinomas localized in the head and neck region. Owing to its limited anatomical depiction, it cannot as yet replace other diagnostic procedures in preoperative planning but does contribute valuable complementary diagnostic information. Computed tomograpy may have difficulties in identifying recurrent carcinomas. For routine diagnosis of nodal spread in the neck, CCDS is recommended. Panendoscopy is a valuable diagnostic procedure that can provide key information in cases of superficial mucosal tumor involvement. Arch Otolaryngol Head Neck Surg. 2000;126:1457-1461

[Multiple primary carcinomas in patients with head and neck malignancies]

BACKGROUND

Multiple primary tumors can lead to diagnostic and therapeutical problems. In this study we surveyed frequency, localisation, diagnostic, chronologic and therapeutic aspects of multiple primary carcinomas in patients with head and neck tumors.

PATIENTS AND METHODS

The data of 843 patients from the tumor registry of the ENT-clinic Aachen were retrospectively studied.

RESULTS

Larynx (41.87%) and oropharynx (12.57%) were the main localisation of the first primary neoplasma. In 65 patients (7.71%) multiple primary tumors were observed. 24.6% of these tumors occurred synchronously. Preferential localisation of a second tumor were lung (20%), oral cavity (15.3%) and larynx (13.8%). 28.57% of the metachronous tumors were observed after more than five years. In 46.15% clinical complaints led to the suspicion of a second tumor. Panendoscopy was the most reliable diagnostic procedure. The survival rate and time was significantly reduced in patients with synchronous tumors. 3-year survival rate was 15% compared to 81% in patients with metachronous tumor appearance (p < 0.0001).

CONCLUSION

Patients with head and neck tumors have a high incidence of multiple primary malignomas varying from the region of the first presentation of a malignant tumor. Concepts comprising surgery provide the highest survival rates. Because of the high incidence of metachronous carcinomas after five years found in this study, the authors regard a prolonged follow-up period as necessary.

Zinc-induced copper deficiency in a coin swallower

In humans, acquired copper deficiency anemia is rare. This report describes a 58-yr-old man with metal pica, especially coins, who presented with symptomatic anemia. His workup led to the diagnosis of zinc-induced copper deficiency. We believe that, in this man, leaching of zinc from pennies explained the clinical and laboratory findings. This case demonstrates that health care workers should consider the possibility of zinc-induced copper deficiency when confronted with patients with unexplained anemia who have ingested coins or other zinc-containing metals.

Degradation of the Photosystem II D1 and D2 proteins in different strains of the cyanobacterium Synechocytis PCC 6803 varying with respect to the type and level of psbA transcript

The turnover of the D1 and D2 proteins of Photosystem II (PSII) has been investigated by pulse-chase radiolabeling in several strains of the cyanobacterium Synechocystis PCC 6803 containing different types and levels of the psbA transcript. Strains lacking psbA1 and psbA3 gene and containing high levels of the psbA2 transcript showed the selective synthesis of D1 whose degradation could be slowed down by the protein synthesis inhibitor lincomycin. In contrast, in strains containing just the psbA3 gene, the intensity of the D1 protein labeling was lower and labeling of the D2 and CP43 proteins was stimulated in comparison to the psbA2-containing strains. In addition, the rate and selectivity of the D1 degradation and its dependence on the presence of lincomycin was proportional to the level of the psbA3 transcript in the particular strain. Consequently, there was parallel, lincomycin-independent and slowed-down breakdown of the D1 and D2 proteins in strains with the lowest level of psbA3 transcript. These results are discussed in terms of a model in which the rate of D1 and D2 degradation in cyanobacteria is affected not only by the rate of PSII photodamage, but also by the availability of newly synthesized D1 protein. Moreover, the comparison of the non-oxygen-evolving D1 mutants D170A** and Y161F*** differing by the presence of tyrosine Z has indicated a minor role of the oxidized form of this secondary PSII electron donor in the donor side mechanism of D1 and D2 protein breakdown.

Salmonella speticemia resistant to 3rd generation cephalosporins in a child with sickle crisis

Full text is available as a scanned copy of the original print version.

Oral contraceptive-induced mesenteric venous thrombosis with resultant intestinal ischemia

The author reports a case of oral contraceptive-induced mesenteric venous thrombosis with resultant intestinal ischemia in a young woman. The relationship between mesenteric venous thrombosis and oral contraceptives is discussed. Twenty-six other cases of oral contraceptive-related mesenteric venous thrombosis reported in the English literature are reviewed.

Mesenteric venous thrombosis

BACKGROUND

Mesenteric venous thrombosis is an uncommon but often lethal form of intestinal ischemia.

METHODS

We reviewed pertinent literature on mesenteric venous thrombosis using MEDLINE search.

RESULTS

We found that previous abdominal surgery and hypercoagulable states are the most common conditions associated with mesenteric venous thrombosis. The symptoms and signs related to mesenteric venous thrombosis are not specific. In the majority of cases, the diagnosis is established by a high index of clinical suspicion and noninvasive imaging techniques. Immediate operation is indicated if signs of peritonitis or intestinal infarction are present. Administration of heparin is beneficial for reducing recurrence and mortality.

CONCLUSION

Clinicians should consider the possibility of acute mesenteric venous thrombosis when faced with a patient having abdominal pain out of proportion to the physical findings and with a negative workup for the common causes of abdominal pain.

Double oocyte aspiration may be a solution for empty follicle syndrome: case report

OBJECTIVE

To assess the possibility of salvaging the cycle in a case of empty follicle syndrome by scheduling a second retrieval.

SETTING

Miami IVF/Intracytoplasmic Sperm Injection Center, Alexandria, Egypt. It is a private center.

PATIENT(S)

A 24-year-old female with a 6-year history of primary infertility. Intracytoplasmic sperm injection was performed because of her partner's obstructive azoospermia. No oocytes could be retrieved despite normal ultrasonic and hormonal responses and the presence of 25 mature follicles.

INTERVENTION(S)

Serum hCG on the day of the first retrieval. A second dose of hCG was given after the first retrieval, and a second retrieval was scheduled 24 hours later.

MAIN OUTCOME MEASURE(S)

Number of oocytes retrieved, fertilization and cleavage rates, and pregnancy outcome.

RESULT(S)

Serum beta-hCG level on the day of the first retrieval was 300 IU/mL. Eleven oocytes were retrieved, (7 were metaphase II, 3 fertilized, and 2 cleaved) and two embryos were transferred. No pregnancy resulted.

CONCLUSION(S)

In a variant of empty follicle syndrome, the cycle could be salvaged by giving another dose of hCG and scheduling another retrieval 24 hours later.

Peripheral neuropathy in burn patients

Neuropathy in burn patients is frequently overlooked. This study aimed at looking for neuropathies among burn patients. It included 55 burn patients, whether symptomatic or asymptomatic, with variable depths of burn at different stages. Their ages ranged from 8 to 55 years with a mean age of 23.6 +/- 11.1 years. All patients were submitted to clinical examination, electromyographic and motor conduction velocities of burned and unburned limbs. Serum electrolyte, blood urea and creatinine were measured for all patients. Sixteen patients (29 per cent) had peripheral neuropathy. Only six had symptoms and signs of peripheral neuropathy. The most frequently diagnosed neuropathy in this study was mononeuritis multiplex in nine patients (56 per cent), then generalized distal axonal neuropathy in five patients (31 per cent) and entrapment neuropathy in two patients (13 per cent). In patients with mononeuritis, 29 nerves were affected, 24 nerves related to the site of the burn and five nerves were away from the site of the burn. All the entrapment neuropathy developed after wound healing. Age above 20 years, electric burns burns involving full thickness of the skin and a surface area of more than 20 per cent were associated with a significantly higher prevalence of neuropathy. Other parameters were not found to be significant in the development of neuropathy.

Oral or vaginal misoprostol for induction of labor

OBJECTIVE

To compare vaginal versus oral misoprostol for induction of labor.

METHOD

Induction of labor was carried out in 40 women near term in two equal and randomized groups (according to a computer generated table) using misoprostol. Group I received vaginal misoprostol (100 micrograms) every 3 h while group II patients were given the same dose via the oral route. The dose was doubled if no response was detected under continuous cardiotocographic (CTG) tracings.

RESULT

The vaginal route of administration induced a higher success rate in a shorter time interval using a lower dose but was associated with more abnormal FHR patterns and instances of uterine hyperstimulation.

CONCLUSION

It is recommended to use the vaginal approach with cardiotocographic monitoring.

Endometrial unresponsiveness: a novel approach to assessment and prognosis in in vitro fertilization cycles

OBJECTIVE

To categorize endometrial responsiveness to orally administered estriol in natural cycles of patients with thin endometrium. The value of endometrial responsiveness in predicting the outcome of subsequent IVF-ET cycles was evaluated.

DESIGN

Prospective clinical study.

SETTING

Miami IVF-ICSI Center, Alexandria, Egypt, a private center.

PATIENTS

Forty-two patients undergoing IVF-ET. All had endometrial thickness < or = 7 mm at the time of maximal follicular diameter in natural cycle.

INTERVENTION

Estriol was orally administered in subsequent unstimulated cycle. Patients were categorized into responsive and unresponsive groups (those with improved and unimproved endometrial thickness, respectively). Lastly, controlled ovarian hyperstimulation (COH) with or without estriol was started in the IVF-ET cycles.

MAIN OUTCOME MEASURES

The endometrial thickness during COH with or without estriol, fertilization, pregnancy, and abortion rates.

RESULTS

The responsive group compared with the unresponsive group had a significantly higher rate of improved endometrial thickness, a similar number of oocytes retrieved, a similar fertilization rate, and a significantly higher pregnancy rate.

CONCLUSION

Patients with endometrial unresponsiveness to estriol in their natural cycles rarely improve by COH and have a poor pregnancy rate in IVF cycles.

Characterization of growth hormone-releasing hormone (GHRH) binding to cloned porcine GHRH receptor

To study structure-activity relationships of growth hormone-releasing hormone (GHRH), a competitive binding assay was developed using cloned porcine adenopituitary GHRH receptors expressed in human kidney 293 cells. Specific binding of [His1, 125I-Tyr10,Nle27]hGHRH(1-32)-NH2 increased linearly with protein concentration (10-45 micrograms protein/ tube). Binding reached equilibrium after 90 min at 30 degrees C and remained constant for at least 240 min. Binding was reversible to one class of high-affinity sites (Kd = 1.04 +/- 0.19 nM, Bmax = 3.9 +/- 0.53 pmol/mg protein). Binding was selective with a rank order of affinity (IC50) for porcine GHRH (2.8 +/- 0.51 nM), rat GHRH (3.1 +/- 0.69 nM), [N-Ac-Tyr1, D-Arg2]hGHRH(3-29)-NH2 (3.9 +/- 0.58 nM), and [D-Thr7]GHRH(1-29)-NH2 (189.7 +/- 14.3 nM), consistent with their binding to a GHRH receptor. Nonhydrolyzable guanine nucleotides inhibited binding. These data describe a selective and reliable method for a competitive GHRH binding assay that for the first time utilizes rapid filtration to terminate the binding assay.

Comparative study of the karyotypes of two Egyptian species of bats, Taphozous perforatus and Taphozous nudiventris (Chiroptera: Mammalia)

A detailed karyotypic analysis of two Egyptian species of bats, Taphozous perforatus and Taphozous nudiventris, was made on the basis of conventional data and G-band patterns. No detectable karyotypic difference was found between the two species (2n = 42, F. N. 64). By comparison of G-band patterns, some differences between the two species were seen in the corresponding autosomal pairs. These results are reported for the first time in Egypt.

Perifusion model system to culture bovine hypothalamic slices in series with dispersed anterior pituitary cells

Dispersed bovine anterior pituitary cells were incubated either in static or perifusion cultures to assess basal growth hormone release as well as stimulatory and inhibitory effects of growth hormone-releasing hormone and somatostatin, respectively, on growth hormone release. Total concentrations of growth hormones over a 12-hour incubation period were fivefold greater in perifused than in static cultures (2034 +/- 160 vs. 387 +/- 33 ng/12 h). A dose-dependent increase in growth hormone secretion in response to challenge with growth hormone-releasing hormone (10(-12) to 10(-8) M) for 1 h was observed in both static and perifusion cultures; however, perifused cells were more responsive to the same concentration of neuropeptide than those in static culture. Concentrations of somatostatin (10(-12) to 10(-8) M) for 1 h did not inhibit basal growth hormone secretion in either static or perifusion cultures. To establish the hypothalamic-pituitary in series-perifusion model, slices of the hypothalamus, immediately adjacent to the sagittal midline, were perifused in series with anterior pituitary cells, and media effluent was assayed for growth hormone concentrations. Release of growth hormone was pulsatile and seemed to mimic the episodic pattern of bovine secretion. Hypothalamic slices were placed in one chamber of the perifusion system, and basal secretion of growth hormone-releasing hormone and somatostatin was pulsatile in media effluent. Tissue viability of hypothalamic slices and anterior pituitary cells was evaluated by KCl depolarization. Tissues were viable for at least 120 h. Thus, this hypothalamo-pituitary dual chamber perifusion system is a valid in vitro model to study regulation of growth hormone secretion.

Androgens modulate growth hormone-releasing factor-induced GH release from bovine anterior pituitary cells in static culture

Static primary cultures of bovine anterior pituitary (AP) cells were utilized to study the effect of sex steroids on basal growth hormone (GH) and GH-releasing hormone (GRF)-stimulated release of GH. The AP cells (5 x 10(5) cells/well) were allowed to attach for 72 hr and become confluent before treatments were imposed. Cells were incubated for an additional 24, 48 or 72 hr with either estradiol-17 beta (E2, 10(-11) to 10(-8) M), testosterone (T, 10(-8) to 10(-5) M), dihydrotestosterone (DHT, 10(-9) to 10(-6) M) or 5 alpha-androstane-3 alpha, 17 beta-diol (3 alpha-diol, 10(-11) to 10(-8) M). Media were collected every 24 hr and GH concentrations determined by RIA. Incubation of calf AP cells with gonadal steroids did not affect (P > 0.05) basal GH released at 24, 48, or 72 hr. In another experiment, calf AP cells were incubated with the same concentrations of the steroids for 24 hr, media harvested, cells washed and challenged in serum-free media for 1 hr with bovine GRF 1-44-NH2 (10(-8) M). In non-steroid treated wells, GRF increased (P < 0.05) GH from 58 to 134 ng/ml. Incubation with E2 or 3 alpha-diol did not affect (P > 0.05) GRF-induced GH release; however, preincubation with T (10(-5) M) and DHT (10(-9), 10(-8) and 10(-7) M) increased (P < 0.05) GRF-induced GH release above control concentrations (195, 235, 190 and 185 ng/ml, respectively). At the doses tested, sex steroids did not affect basal release of GH, but androgens increased responsiveness of somatotropes to GRF.

Effect of aspirin and indomethacin on the serum and urinary calcium, magnesium and phosphate

Recent data have shown that administration of prostaglandin inhibitors to patients with hypercalciuric nephrolithiasis decreased urinary calcium excretion, implying a possible role for prostaglandins in calcium excretion. To explore this hypothesis, we investigated the effect of single dose or 7 days' administrations of aspirin (100 mg/kg orally) or indomethacin (20 mg/kg, orally) on the urinary and serum concentrations of calcium, magnesium and inorganic phosphate. Experiments were performed in normocalcaemic and hypercalcaemic rats. Hypercalcaemia and hypercalciuria were induced in male Wistar albino rats by administration of vitamin D3 (20,000 IU/daily) for 7 days. Aspirin and indomethacin both significantly lowered the urinary calcium excretion in normocalciuric and hypercalciuric rats. The acute administration of indomethacin caused greater reduction of calcium excretion than that produced by the acute administration of aspirin, whereas aspirin showed greater activity than indomethacin after the long-term use of each. Aspirin induced hypocalcaemia in normocalcaemic rats and abolished the hypercalcaemia in hypercalcaemic rats. On the contrary, indomethacin, a specific prostaglandin biosynthesis inhibitor, increased serum levels of calcium. Hypophosphataemia was observed only after the administration of a single dose of aspirin in normocalcaemic rats, while the reduction of urinary phosphate excretion was investigated in hypercalciuric rats after the acute and chronic administration of indomethacin. Serum levels of phosphate were not altered significantly by acute or chronic administration of indomethacin. A single dose of indomethacin significantly reduced urinary excretion of magnesium in both groups of rats. However, the acute and chronic administration of aspirin resulted in non-significant changes in serum and urinary concentrations of magnesium. These data suggest that aspirin has hypocalcaemic and hypocalciuric actions while indomethacin has only a hypocalciuric effect. Aspirin may produce these actions by two mechanisms, one of them like that of indomethacin which is dependent on the inhibition of biosynthesis of prostaglandins, and another possible mechanism that is not related to the inhibition of prostaglandin biosynthesis. This suggestion may be supported by the discrepancy between the effects of aspirin and indomethacin on the renal handling and serum concentrations of magnesium and inorganic phosphate.

Some tetracycline drugs suppress mitogen-stimulated lymphocyte growth but others do not

Eight tetracycline drugs were tested for inhibitory effect on phytohaemagglutinin (PHA) stimulated growth (measured by [3H]-TdR uptake) of peripheral blood mononuclear cells: at least 26 normal subjects were tested with each drug. Doxycycline reduced DNA synthesis appreciably at concentrations within and just above the therapeutic range of blood levels: it was the most potent inhibitor, but demeclocycline, methacycline and minocycline had similar, if less potent, effects. Tetracycline, oxytetracycline, chlortetracycline and clomocycline did not inhibit DNA synthesis of 3-day cultures even at concentrations five to ten times greater than the therapeutic blood level. Volume spectroscopy measurements showed that none of the eight tetracycline drugs interfered with the recruitment of cells into G1-phase growth of the first cell cycle after PHA stimulation.

In vitro effects of doxycycline and tetracycline on mitogen stimulated lymphocyte growth

Doxycycline and tetracycline were tested for inhibitory effect on PHA stimulated growth (measured by [3H]-TdR uptake) of peripheral blood mononuclear cells from 26 normal subjects. Doxycycline reduced DNA synthesis appreciably at concentrations within and just above the therapeutic range of blood levels: tetracycline did not inhibit DNA synthesis of 3 day cultures even at concentrations five-10 times greater than the therapeutic blood level. Detailed studies on the action of doxycycline by volume spectroscopy and RNA flow cytofluorimetry indicated that this drug did not influence the recruitment of cells into the first G1-phase. Cell counts, DNA flow cytofluorimetry and autoradiography after pulsed exposure to [3H]-TdR showed a reduction in the numbers of growing cells in 2 and 3 day cultures in the presence of doxycycline compared with those containing tetracycline at the same concentration.