[Coronary artery bypass grafting in patients with severe left ventricular systolic dysfunction: Short- and long-term outcomes]

BACKGROUND

Ischemic heart disease with severe left ventricular systolic dysfunction is a poor prognosis. Coronary artery bypass grafting is the gold treatment in this population, despite high surgical risk.

AIM

The aim of our study is to evaluate the short- and long-term outcomes of coronary artery bypass grafting in patients with ischemic heart disease and severe left ventricular systolic dysfunction (LVEF≤35%).

METHODS

Between May 1995 and December 2010, 171 patients with ischemic heart disease and severe left ventricular systolic dysfunction (LVEF≤35%) underwent isolated coronary artery bypass grafting. Hospital mortality, postoperative morbidity, all-cause death, cardiovascular death, and major adverse cardiovascular events (heart failure, recurrent angina, myocardial infarction, stroke) were evaluated. The mean follow-up was 9.3±5 years.

RESULTS

Hospital mortality was 9.9%. Postoperative morbidity was 36.9%. Overall survival at 1-, 5- and 10-years was 97.4%, 90.5% and 43.4%, respectively. Freedom from cardiovascular death at 1-, 5- and 10-years was 98.1%, 91.8% and 55.4%, respectively. Freedom from recurrent angina at 1-, 5- and 10-years was 95.5%, 84.8% and 44.9%, respectively. Freedom from heart failure at 1-, 5- and 10-years was 89.9%, 86,8% and 53.3%, respectively. Freedom from major adverse cardiovascular events at 1-, 5- and 10-years was 88%, 82.1% and 38.2%, respectively.

CONCLUSION

Based on our findings, coronary artery bypass grafting can be performed in patients with ischemic heart disease and severe left ventricular systolic dysfunction with acceptable hospital morbidity and mortality and long-term survival.

Epidemiology of breast cancer in women based on diagnosis data from oncologists and senologists in Algeria

BACKGROUND

Breast cancer (BC) is a major health issue threatening women's life. No reliable epidemiological data on BC diagnosed by oncologists/senologists are available in Algeria.

METHODS

The BreCaReAl study, a non-interventional prospective cohort study, included adult women with confirmed BC in Algeria. Disease incidence, patients and disease characteristics, treatment patterns, and mortality rate were recorded up to 12 months of follow-up.

RESULTS

Overall, 1,437 patients were analysed: median age was 48 [41;57] years and 337 (23.5%) women had a family history of BC. BC incidence was 22.3 (95% CI: 21.5; 23.2) cases per 100,000 inhabitants over 8 months. Delayed diagnosis was reported in 400 (29.2%) patients. First line of treatments were mainly chemotherapy and surgery. Twenty-eight serious adverse events were reported including 10 (37.0%) events which led to death. Mortality rate reached 3.2% at 12 months CONCLUSION: A delayed diagnosis highlights the importance of implementing more effective screening strategies.

Adsorption of pharmaceutical residues on adsorbents prepared from olive stones using mixture design of experiments model

In this work, inexpensive and easily available olive stone (OS) waste was used as the source material to prepare activated carbons (ACs) by chemical activation with phosphoric acid and zinc chloride. The mixture design of experiments (MDOE) method was applied to study the effect of the composition of the mixture of unmodified olive stones (UOS) and ACs prepared from olive stones activated with ZnCl₂ (ACOS ZnCl₂) and H₃PO₄ (ACOS H₃PO₄) on the absorption of pharmaceutical residues. The adsorbed tetracycline (TC) amounts at equilibrium predicted from the model equation developed using Microsoft Excel were found to be in good agreement with the experimental values (R² = 0.999). Based on the results of the model, the amount of TC removed increased as the proportion of ACOS H₃PO₄ in the adsorbent mixture increased and the highest amount of TC adsorbed was obtained with an adsorbent made up entirely of ACOS H₃PO₄. Separate adsorption tests for sulfamethazine (SMT) and amoxicillin (AMX) on ACOS H₃PO₄ showed that SMT was adsorbed best (189.81 mg/g), followed by TC (183.11 mg/g) then AMX (155.69 mg/g). However, when these molecules were present together in the same solution, it was TC that adsorbed best, followed by SMT then AMX. In addition to this, the sorption process studied was best described by a pseudo-first-order model and it was the Langmuir model that satisfactorily described the equilibrium data.

Valorisation of tuna processing waste biomass: isolation, purification and characterisation of four novel antioxidant peptides from tuna by-product hydrolysate

Tuna protein hydrolysate (TPH) was prepared by hydrolysis with Prolyve BS and fractionated by membranes process. The antioxidant activities of recovered peptide fractions were evaluated. Four novel antioxidant peptides that were isolated from nanofiltration retentate exhibited the highest antioxidant activity, using gel chromatography and reversed phase high-performance liquid chromatography. The amino acid sequences of isolated peptides were identified as Tyr-Glu-Asn-Gly-Gly (P2), Glu-Gly-Tyr-Pro-Trp-Asn (P4), Tyr-Ile-Val-Tyr-Pro-Gly (P7) and Trp-Gly-Asp-Ala-Gly-Gly-Tyr-Tyr (P8) with molecular weights of 538.46, 764.75, 710.78 and 887.85 Da, respectively. P2, P4, P7 and P8 exhibited good scavenging activities on hydroxyl radical (IC₅₀ 0.41, 0.327, 0.17 and 0.042 mg/ml), DPPH radical (IC₅₀ 0.666, 0.326, 0.451 and 0.377 mg/ml) and superoxide radical (IC₅₀ 0.536, 0.307, 0.357 and 0.115 mg/ml). P7 was effective against lipid peroxidation in the model system. The isolated peptides might be useful used as natural food additive in food industry and formulation of nutritional products.

One pot flame retardant and weathering resistant coatings for plastics: a novel approach

The first epoxy/fluoropolymer/iron oxide self-stratified coatings (thickness < 100 μm) with outstanding fireproofing performances were designed for polycarbonate substrates.

Valorisation of tuna processing waste biomass for recovery of functional and antioxidant peptides using enzymatic hydrolysis and membrane fractionation process

The enzymatic hydrolysis using Prolyve BS coupled to membrane process (Ultrafiltration (UF) and nanofiltration (NF)) is a means of biotransformation of tuna protein waste to Tuna protein hydrolysate (TPH) with higher added values. This method could be an effective solution for the production of bioactive compounds used in various biotechnological applications and minimizing the pollution problems generated by the seafood processing industries. The amino acid composition, functional and antioxidant properties of produced TPH were evaluated. The results show that the glutamic acid, aspartic acid, glycine, alaline, valine and leucine were the major amino acids detected in the TPH profile. After membrane fractionation process, those major amino acids were concentrated in the NF retentate (NFR). The NFR and NF permeate (NFP) have a higher protein solubility (>95 %) when compared to TPH (80 %). Higher oil and water binding capacity were observed in TPH and higher emulsifying and foam stability was found in UF retentate. The NFP showed the highest DPPH radical scavenging activity (65 %). The NFR contained antioxidant amino acid (30.3 %) showed the highest superoxide radical and reducing power activities. The TPH showed the highest iron chelating activity (75 %) compared to other peptide fractions. The effect of the membrane fractionation on the molecular weight distribution of the peptide and their bioactivities was underlined. We concluded that the TPH is a valuable source of bioactive peptides and their peptide fractions may serve as useful ingredients for application in food industry and formulation of nutritional products.

Alterations of microsatellite loci GSN and D18S51 in urinary bladder cancer

BACKGROUND

Transitional cell carcinoma (TCC) of urinary bladder cancer is the most common malignancy in the urinary system. Genetic instability is an essential property of malignant neoplasms and could be evaluated by microsatellite analysis. Alterations in numerous microsatellite loci are already described in urinary bladder TCC. The aim of this study was to investigate the usefulness of only two microsatellite loci for the detection of bladder TCC, and their correlation with the major clinicopathological parameters.

METHODS

We analyzed the tissue samples derived from 70 patients with histopathologically confirmed TCC of the urinary bladder, collected by transurethral resection, and samples of normal bladder mucosa derived from 40 patients with nonmalignant diseases. Microsatellite alleles GSN and D18S51 were amplified in paired samples of tissue and leukocyte DNA from each patient, and were analyzed by electrophoresis.

RESULTS

Microsatellite alterations at either GSN or D18S51locus, or in both, were detected in 46 out of the 70 patients (65.71 %) with TCC, but not in the patients of the control group. We found a significant statistical correlation between the frequencies of patients with microsatellite alterations in the examined loci and all three grades of histopathological T-classification. No significant correlation was found regarding the stages or the occurrence of recidivism, metastasis or cancer-related death within the two-year follow-up period.

CONCLUSIONS

This study indicates that two selected microsatellite markers could have a potential value in clinical and pathological evaluation of urinary bladder TCC, especially regarding the prediction of tumor differentiation. Additional studies and further validation of the method are needed. Hippokratia 2015; 19 (3): 200-204.

Digital quantitative immunofluorescent detection of p53 protein in urinary bladder cancer tissue samples

Bladder cancer is a significant health problem and is the fourth most common malignancy in the Western world. Histologically, transitional cell carcinoma (TCC) is the most common subtype and represents nearly 90% of all bladder cancers. Mutations of the tumour suppressor gene p53 are the most frequent genetic alteration found in human cancers, including urinary bladder carcinoma. Numerous studies have attempted to define p53 as a molecular marker with clinicopathological and predictive values. In this study we have investigated tissue samples of histopathologically confirmed TCC of the urinary bladder from 70 patients. Normal urinary bladder mucosa obtained from 40 patients with nonmalignant diseases were used as a negative control group. Immunofluorescence detection was performed using double-sandwich antibody technique, the microscope images were captured by digital camera and analyzed by ImageJ software. Corrected fluorescent intensity values corresponding to average malignant cells' nuclear p53 staining were calculated from each patient sample. We found that the mean corrected fluorescence intensity values of TCC samples grade I and II did not differ statistically significantly. On the contrary, those values were significant between the TCC grades II and III, as well as between grade I and III. In addition, a high correlation of p53 fluorescence intensity values from superficial TCC samples with the invasive TCC samples was found. However, the data showed no predictive value of p53 nuclear accumulation in TCC samples in terms of recidive, metastasis or cancer-related death, at least within the 2-years follow-up period. Given the relatively small size and heterogeneity of our patient groups, however, further studies are needed to demonstrate the clinicopathological value of digital quantitative immunofluorescent detection of nuclear p53 in TCC samples.

Evaluation of the value of p53 protein expression in the extra-capsular extension of prostate cancer

INTRODUCTION AND OBJECTIVES

The objective of this study is to identify the nuclear expression of the p53 protein in prostate cancer and to determine its relationship with clinico-pathological variables.

MATERIAL AND METHODS

The research included 83 patients, 43 of whom are patients with prostate cancer who underwent radical prostatectomy and a control group of 40 patients with benign hyperplasia of the prostate in whom a transurethral resection or a transvesical prostatectomy was undertaken. In all cases the nuclear expression of p53 protein was evaluated. A hystopatological evaluation of the tumour characteristics and the data of the local progression of the cancer were undertaken in the research group.

RESULTS

The results show that the expression of the p53 protein does not have an important correlation with the preoperative PSA, but that it is in direct correlation with the malign potential of the cancer (Gleason score, Gleason sum, primary tumour) and with the features of the disease (metastatic lymph nodes, stage of the disease).

CONCLUSION

p53 protein could be used as a valid biomarker in determining the malignant potential of the tumour and the prognosis of the disease. There is no practical use in predicting the extraprostatic extension.

IL-33 is expressed in human osteoblasts, but has no direct effect on bone remodeling

The aim of the present study was to investigate the potential role of the recently discovered IL-1 family member IL-33 in bone remodeling. Our results indicate that IL-33 mRNA is expressed in osteocytes in non-inflammatory human bone. Moreover, IL-33 levels are increased by TNF-α and IL-1β in human bone marrow stromal cells, osteoblasts and adipocytes obtained from three healthy donors. Experiments with the inhibitor GW-9662 suggested that expression of IL-33, in contrast to that of IL-1β, is not repressed by PPARγ likely explaining why IL-33, but not IL-1β, is expressed in adipocytes. The IL-33 receptor ST2L is not constitutively expressed in human bone marrow stromal cells, osteoblasts or CD14-positive monocytes, and IL-33 has no effect on these cells. In addition, although ST2L mRNA is induced by TNF-α and IL-1β in bone marrow stromal cells, IL-33 has the same effects as TNF-α and IL-1β, and, therefore, the biological activity of IL-33 may be redundant in this system. In agreement with this hypothesis, MC3T3-E1 osteoblast-like cells constitutively express ST2L mRNA, and IL-33 and TNF-α/IL-1β similarly decrease osteocalcin RNA levels in these cells. In conclusion, our results suggest that IL-33 has no direct effects on normal bone remodeling.

Screening for prostate cancer: a controversy or fact

BACKGROUND

Adenocarcinoma of the prostate is the most frequent malignancy in men and the second leading cause of death in the male population worldwide. The screening for prostate cancer allows early diagnosis of prostate malignancy before the individual presents with symptoms. The early stage of the disease is easier to manage by different therapeutic modalities.

AIM

The aim of this review is to evaluate the reasons and facts for enthusiasm and positive approach towards the clinical decision about whether to screen or not male patients for early detection of prostate cancer.

METHODS

We performed a computerized MEDLINE search followed by a manual bibliographic review of cross-references. These reports were analyzed and the important findings were summarized. We analyzed the methods and schedule of screening, as well as advantages and disadvantages of the prostate cancer screening.

RESULTS

There were more than a hundred studies on prostate cancer screening performed but only a few are eligible for a decisive conclusion concerning the prostate cancer screening issue. We reviewed the screening methods, the schedule of screening, the advantages and disadvantages of prostate cancer screening.

CONCLUSION

The role for prostate cancer screening is not established yet. Definite proof of screening should be assumed as a decrease in the death rate of that cancer due to screening activity.

Endothelial nitric oxide synthase Glu298Asp, 4b/a, and -786T>C gene polymorphisms and the risk of ischemic stroke

BACKGROUND AND PURPOSE

Endothelial nitric oxide synthase (eNOS) gene polymorphisms were associated with reduced NO production, and were evaluated as risk factors for ischemic stroke (IS). We investigated the association between eNOS gene -786T>C (promoter), 27-bp repeat 4b/4a (intron 4), and Glu298Asp (exon 7) polymorphisms with IS in 329 IS patients and 444 controls.

MATERIALS AND METHODS

Glu298Asp and -786T>C genotyping was done by PCR-RFLP, 4b/4a was assessed by PCR-ASA. The contribution of eNOS polymorphisms to IS was analyzed by haplotype and multivariate regression analysis.

RESULTS

Higher frequency of 298Asp allele was seen in IS patients (P = 1.2 x 10(-10)), which remained independently associated with IS on multivariate analysis after controlling for traditional cerebrovascular risk factors. Allele and genotype distribution of 4b/4a and -786T>C polymorphisms were comparable between patient and controls. Significantly higher prevalence of 298Asp/4b/-786T and 298Asp/4b/-786C haplotypes were seen in IS cases, thus conferring a disease susceptibility nature to these haplotypes. Multivariate regression analysis confirmed the association of 298Asp/4b/-786T and 298Asp/4b/-786C haplotypes, and in addition identified 298Asp/4a/-786T haplotype to be independently associated with IS, after controlling for traditional cerebrovascular risk factors.

CONCLUSIONS

Genetic variation at the eNOS locus represent genetic risk factor for increased susceptibility to IS.

Does prostate specific antigen density correlates with aggressiveness of the prostate cancer?

BACKGROUND

As already documented, a high prostate specific antigen in men with normal size of prostate gland is more likely to be associated with an aggressive cancer as compared to others with the same prostate specific antigen and a large gland size. In this retrospective study we tested the association between Prostate Specific Antigen Density (PSAD) and tumor aggressiveness in patients with clinically localized Prostate Cancer (PCa) surgically treated by radical prostatectomy.

METHODS

We evaluated data from patients records in a cohort of 72 patients who underwent radical prostatectomy between January 2000 and June 2007. PSAD was calculated as ratio between the preoperative total prostatic specific antigen (PSA) in nanograms per milliliter with the prostate weight (PW) of prostatectomized specimen in grams or prostate volume measured with ultrasound (US). The patients were stratified into four PSAD categories: 0.1-0.15, 0.16- 0.20, 0.21-0.5 and greater than 0.51 ng/ml/gr. Parameters that were included into analysis were: PSA, measurement of the prostate volume by ultrasound (preoperatively) and prostate weight, pathological tumor stage, Gleason sum, Gleason grade, metastatic lymph nodes, seminal vesicle involvement and organ confine disease (postoperatively). Worsening of the clinicopathological properties was defined as aggressiveness.

RESULTS

There was a significant correlation between US-PSAD and PW-PSAD (p<0.001). In US-PSAD categories the statistic tests found significant correlation with the primary tumor (R=0.303, p<0.01), metastatic lymph nodes (R=0.331, p<0.01), and the organ confine disease (R=0.296, p<0.05). The PW-PSAD categories correlated significantly with the pathologic findings from other parameters. Hence, a statistically significant correlation was found with Gleason sum (R=0.246, p<0.05), Gleason grade (R=0.234, p<0.05), primary tumor (R=0.285, p<0.05), metastatic lymph node (R=0.287, p<0.05) and organ confine disease (R=0.303, p<0.01).

CONCLUSIONS

Prostate specific antigen density measurement is useful tool for the assessment of the degree of aggressiveness in clinically localized prostate cancer, and further investigation regarding its possible use as a prediction marker is justified.

Lupus anticoagulants and anti-phospholipid antibodies as risk factors for a first episode of ischemic stroke

BACKGROUND

Antiphospholipid antibodies (aPLA) and lupus anticoagulant (LAC) were shown to precipitate thromboembolic events. Their association with ischemic stroke remains to be seen.

OBJECTIVES

We investigated the contribution of LAC, and antibodies directed against the phospholipids cardiolipin (aCL), phosphatidylserine (aPS), and the phospholipid-dependent cofactors beta2-glycoprotein I and annexin V, to the risk for ischemic stroke.

PATIENTS/METHODS

LAC and antibody levels were measured in 208 stroke patients and 203 age- and gender-matched control subjects.

RESULTS

Positive LAC resulted in an increased risk for stroke [OR (95% CI) = 8.1 (2.4-27.5)]. Significant elevation in aPS IgG, aCL IgM and aCL IgG titers, and increased prevalence of elevated aPS IgG, aCL IgM and aCL IgG (based on P95 cutoff values of healthy individuals) were seen in patients. aPS IgG was associated with cardioembolic, whereas aCL IgG and IgM were elevated in lacunar, atherosclerotic and cardioembolic, and LAC positivity was documented only in lacunar stroke subtypes. The co-presence of LAC with a positive aCL IgM/IgG or aPS IgG did not affect the overall risk for stroke. Multivariate analysis confirmed the association of positive LAC with stroke [aOR (95% CI) = 9.7 (1.8-52.5)], and demonstrated a clear gradation of increasing risk of stroke associated with the four categories of aCL IgG and aPS IgG, and identified aCL IgM P95 as independent predictors of stroke after adjusting for potentially confounding covariates.

CONCLUSIONS

Our study demonstrates that the presence of LAC, and elevated aCL IgG and aPS IgG antibodies are risk factors for stroke.

Association between renin-angiotensin-aldosterone system genotypes and haplotypes and risk of ischemic stroke of atherosclerotic etiology

OBJECTIVE

The association of renin C-4063T and angiotensinogen (AGT) T174M, AGT M235T and AGT A-6G polymorphisms with ischemic stroke of atherosclerotic etiology was investigated in 329 Tunisian patients with stroke and 444 controls.

MATERIALS AND METHODS

Genotyping was performed using PCR-RFLP and the contributions of polymorphisms to the risk of stroke were analyzed using haplotype and multivariate regression analysis.

RESULTS

AGT 235T and AGT-6G allele and AGT 235T/T, AGT-6A/G and AGT-6G/G genotype frequencies were higher in patients. Linkage disequilibrium (LD) was noted for AGT174T with AGT235M and AGT(-6)A in patients, while AGT235M was in LD with AGT(-6)A in controls and AGT235T was in LD with AGT(-6)G in both groups. The AGT 174T/235T/-6A and AGT 174T/235M/-6G haplotypes were positively and negatively associated with stroke respectively. Multivariate regression analysis identified AGT 174T/235M/-6A, AGT 174T/235T/-6G, AGT 174T/235T/-6A and AGT 174M/235T/-6A haplotypes to be significantly associated with an increased risk of stroke.

CONCLUSIONS

Renin-angiotensin-aldosterone system polymorphisms influence the risk of atherosclerotic stroke in Tunisians.

Lower urinary tract reconstruction following a cystectomy: experience and results in 20 patients using the "Studer" orthotopic ileal bladder substitution

INTRODUCTION AND OBJECTIVE

To analyze the outcome, complications and functional results in patients undergoing bladder substitution with the Studer continent urinary pouch.

MATERIALS AND METHODS

At our Clinic, between January 2005 and December 2006, 20 male patients underwent a radical cystoprostatectomy followed by the Studer orthotopic bladder substitution.

RESULTS

The transitional cell carcinoma was found to be the most frequent histopathological type. The distribution by grade and pathological stage showed all were high grade infiltrating tumors localized in the bladder. We observed 3 patients with neobladder-unrelated complications: one patient with a wound infection and 2 patients with a prolonged ileus.

CONCLUSION

In conclusion, our results with urinary diversion are promising in patients recquiring a radical cystoprostatectomy. We believe that the Studer's orthotopic neobladder is an excellent alternative for patients suffering a radical cystectomy and offers a sufficient protection of the upper urinary tract with a low complication rate, good voiding function and continence (Tab. 1, Ref. 25). Full Text (Free, PDF) www.bmj.sk.

Development of an engineering autologous palatal mucosa-like tissue for potential clinical applications

The goal of this study was to optimize key processes in recreating functional and viable palatal mucosa-like tissue that would be easy to handle and would promote wound healing. Normal human gingival fibroblasts and epithelial cells and a clinically useful biomaterial, CollaTape, were used. Structural and ultrastructural analyses showed that the gingival fibroblasts and epithelial cells adhered to the biomaterial and proliferated. Following a 6-day culture, using 10(5) fibroblasts and 10(6) epithelial cells, a well-organized palatal mucosa-like tissue was engineered. The engineered epithelium displayed various layers, including a stratum corneum, and contained cytokeratin 16-positive cells located in the supra-basal layer. This palatal mucosa-like engineered tissue was designed to meet a variety of surgical needs. The biodegradable collagen membrane (CollaTape) contributed to the flexibility of the engineered tissue. This engineered innovative tissue may contribute to the reconstruction of oral soft-tissue defects secondary to trauma, congenital defects, and acquired diseases.

Methylenetetrahydrofolate reductase C677T and A1298C polymorphism and changes in homocysteine concentrations in women with idiopathic recurrent pregnancy losses

Because they have been described as strong risk factors for idiopathic recurrent pregnancy losses (RPLs), we assessed the association between the methylenetetrahydrofolate reductase (MTHFR) single-nucleotide polymorphisms (SNPs) C677T and A1298C and hyperhomocysteinemia in Tunisian women with idiopathic RPL. Study subjects comprised 200 patients with more than three consecutive RPLs, and 200 age-matched parous control women. C677T and A1298C SNPs were analyzed by PCR-RFLP analysis, and fasting serum homocysteine was measured with ELISA. The frequency of MTHFR 677T/T (30.0 vs 7.0%) and 1298C/C (13.5 vs 4.0%) genotypes was significantly higher in patients. While it was similar among patients and controls (P = 0.095), higher homocysteine was seen with the T/T (but not 1298A/C and 1298C/C) genotype among patients and controls compared with non-T/T carriers (P < 0.05), and in patients vs controls. Higher prevalence of MTHFR 677T/T was seen in late (P < 0.05) and early-late (P < 0.001) RPL, while higher prevalence of 1298C/C genotype was seen only in early-late RPL (P < 0.001), and the prevalence of double heterozygotes was statistically not significant between patients and controls (P = 0.10; odds ratio = 2.73). Logistic regression analysis showed that, after adjusting for all variables, homozygosity for MTHFR C677T was associated with late (P < 0.001), and combined early-late (P < 0.001), while homozygosity for A1298C was associated only with combined early-late (P = 0.026), as was secondary-level education, which was associated with early (P = 0.005), late (P = 0.026) and combined early-late (P = 0.004) abortions. Homozygosity for MTHFR C677T (late and early-late) and A1298C (early-late) are risk factor for RPLs, irrespectively of total homocysteine levels.

Radical retropubic prostatectomy for prostate carcinoma; first results of the Clinic of Urology in Skopje

OBJECTIVES

The aim of this retrospective study is to present our experience and results in the management of prostate carcinoma, with radical retropubic prostatectomy, for a period of seven years.

MATERIAL AND METHODS

From December 1997 to April 2005, 61 radical retropubic prostatectomies for prostate carcinoma were performed at the Clinic of Urology in Skopje. Mean age of the treated patients was 66.4 years. Mean serum PSA level was 32.75 ng/ml. None of the patients had distant or bone metastases. Mean operative time was 160 minutes and from 2 to 4 units of blood were transfused intra and postoperatively. Mean follow up time was 39 months.

RESULTS

In all of 61 patients, the RRP was performed for adenocarcinoma of the prostate. The pathological findings postoperatively showed the following pTNM grade: pT2a in 8, pT2b in 10, pT3a in 10, pT3b in 27and pT4 in 6 patients. Positive lymph nodes were found in 14 cases. Intraoperative complications occurred in 6 patients. Early postoperative complications were seen in 12 patients. Urine leakage was seen in 2 patients, incontinence (day and night) in 8 and pulmonary embolia in 2 patients. Late postoperative complications occurred in 11 patients. Stenosis of the vesicourethral anasthomosis was seen in 3 patients and incontinence (during the night only) in 8 patients. The rate of potency was not evaluated but in the last 30 cases we insisted on preservation of the neurovascular bundles in the cases that it was possible.

CONCLUSION

Radical retropubic prostatectomy is the method of choice and the golden standard for treatment of organ confined prostate carcinoma in patients with long life expectancy, no neither local nor distant metastases and good overall status. With this technique complication rates are minimal, the cure rate is very big and the patients have high quality of life. The experience of the surgeon is very important since the learning curve is crucial for diminishing operative time, postoperative complications and blood transfusions.

Impact of Newly Available Drugs on Clinical Progression in Patients with Virological Failure after Exposure to Three Classes of Antiretrovirals

Objective

To study the prognosis of HIV-infected patients with virological failure after exposure to three classes of antiretroviral drugs (ARVs).

Design

Cohort study. Setting: French Hospital Database on HIV.

Patients

Patients previously exposed to at least two nucleoside reverse transcriptase inhibitors (NRTIs), two protease inhibitors and one non-NRTI, with viral load (VL) values of >5000 copies/ml after the exposure criteria were met and a new treatment initiated between 1998 and 2001 with VL >5000 copies/ml.

Main outcome measures

Risk of new AIDS-defining-events (ADEs) or death from first introduction of a drug never used before occurring between 1998 and 2001 defined as baseline.

Results

The main baseline characteristics of the 1092 patients were: previous ADE in 49% of cases, median CD4 cell count 181 μl, median VL 4.9 log10 copies/ml, median duration of ARV therapy 5.0 years and previous exposure to a median of nine ARVs. The crude progression rates were 20.1/100 patient-years among patients included in 1998, 15.1 in 1999, 11.1 in 2000 and 8.6 in 2001. After adjustment for baseline characteristics, the calendar year of inclusion was associated with the risk of clinical progression ( P<0.001). When the types of newly available drugs used at baseline or during follow-up were introduced into the model, year of inclusion was no longer associated with the risk of clinical progression ( P=0.42), while exposure to amprenavir/r, lopinavir/r, abacavir or tenofovir was associated with a lower risk.

Conclusions

The clinical prognosis of heavily pretreated patients experiencing virological failure improved between 1998 and 2001, mainly thanks to the use of newly available drugs with more favourable resistance profiles.

The effect of RU486 on the gene expression profile in an endometrial explant model

Administration of RU486 in vivo during the receptive phase rapidly renders the endometrium non-receptive to the implanting embryo. In order to identify key pathways responsible for endometrial receptivity we have used cDNA arrays to monitor gene expression changes in short-term endometrial explants in response to RU486. Endometrial biopsies from five normal fertile women at mid-secretory phase were cultured in the presence of estradiol and progesterone with or without RU486 for 12 h. cDNA arrays were produced containing approximately 1000 sequence-verified clones which included genes known to be important in angiogenesis, apoptosis, cell signalling, extracellular matrix remodelling and cell cycle regulation. cDNA probes from the paired endometrial samples were hybridized to the arrays and hybridization signals were quantified. A total of 12 genes displayed significant changes in expression; six were up-regulated and six down-regulated following RU486 treatment. For five of these genes this is the first report suggesting that they are regulated by steroids in the endometrium. JAK1 and JNK1 were two of the genes shown by the arrays to be down-regulated in RU486-treated endometrial explants. This was confirmed by real time RT-PCR. JAK1 immunoreactivity was localized to both glandular epithelium and the stroma of normal endometrium and staining was much stronger in the luteal phase of the cycle. These results show that components of two important signalling pathways in endometrium-the JAK/STAT pathway, and the JNK pathway-are altered by RU486. Genes whose expression is controlled by these pathways are likely to be involved in the mechanism by which steroids render the endometrium receptive to the implanting embryo.

Thermophysical properties of fluorinated acrylate homopolymers: mixing and phase separation

The thermophysical properties of fluorinated acrylate homopolymers are investigated by differential scanning calorimetry (DSC) and optical microscopy and discussed in terms of relative lengths of the fluorinated chain and the hydrocarbon spacer between the acrylate moiety and the fluorinated chain. These compounds exhibit an intrinsic microphase-separation (Isotropic+Isotropic morphology) occurring between the fluorinated chains and the acrylate polymer backbone. It is shown that the enthalpy of mixing is a function of the length of the lateral fluorocarbon chains. The thermophysical behaviour of these materials may be regarded as demixed systems exhibiting an Upper Critical Solution Temperature. The photopolymerization process of one of the monomer is studied by isothermal photocalorimetry. High acrylate double-bond conversion and fast curing rates were obtained thus demonstrating the promising use of these materials for coating and film processing applications using UV-curing techniques.

Studies on the epidemiology of sandfly fever in Iran. III. Host-feeding patterns of Phlebotomus papatasi in an endemic area of the disease

Blood meals from 575 Phlebotomus papatasi collected in an Iranian village were identified by precipitin test. The majority of sandfly feedings (57.5%) were on birds, mainly chickens and pigeons. The remaining 42.5% were on mammals (humans, cows, mules, sheep, and goats) or were non-reactive. Calculation of forage ratios of each host species indicated that chickens, equines, and bovines were the preferred hosts of P. papatasi in the village. Results of this study demonstrate that P. papatasi has a much wider natural host range than indicated previously and suggest that this species is an opporunistic feeder and is not strongly anthropophilic. Observations on the diurnal activity of P. papatasi are also presented.

Studies on the epidemiology of sandfly fever in Iran. II. The prevalence of human and animal infection with five phlebotomus fever virus serotypes in Isfahan province

Human and animal sera from an endemic area of sandfly fever in Iran were tested by plaque reduction neutralization method against five different Phlebotomus fever virus serotypes (Naples, Sicilian, Karimabad, Salehabad, and I-47). The overall prevalence of Naples, Sicilian, and Karimabad virus antibodies among the human population was 17%, 25%, and 66%, respectively. All sera were negative against Salehabad and I-47 viruses. Age-specific antibody rates suggested that Sicilian and Karimabad viruses were endemic in the study area but that Naples virus activity was sporadic. These observations were confirmed by isolations of Sicilian and Karimabad viruses from sandflies collected in the study area. Among the animal sera tested, evidence of Phlebotomus fever virus infection was detected only in gerbils. Of 38 Rhombomys opimus tested, 34% had neutralizing antibodies against Sicilian virus and 32% against Karimabad. These results indicate that gerbils are infected with these two viruses and possibly might serve as reservoirs or amplifying hosts. The serologic studies also suggest that the ecology of Sicilian and Karimabad viruses involves chiefly sandflies, gerbils, and man, an epidemiologic pattern previously demonstrated for cutaneous leishmaniasis in the same region of Iran.

Isfahan virus, a new vesiculovirus infecting humans, gerbils, and sandflies in Iran

The characteristics and ecology of Isfahan virus, a new vesicular stomatitis virus (VSV) serotype, are described. Two strains of the agent were isolated from pools of Phlebotomus papatasi collected in Iran in 1975. Its animal pathogenicity, growth rate, cytopathic effect, and plaque morphology are similar to those of the other VSV serotypes. Electron microscopic examination of the virus demonstrated a bullet shape, the presence of truncated particles and maturation at plasma membranes. Antigenic relationships between Isfahan virus and three other VSV serotypes (Cocal, Piry, and Chandipura) were demonstrated by complement fixation or neutralization tests. A high prevalence of Isfahan neutralizing antibodies was found in human sera from several regions of Iran, suggesting that the virus may be of some public health importance. All of the residents over 5 years of age in the village where the virus was isolated had been infected. Neutralizing antibodies to Isfahan virus were also found in sera of Iranian gerbils but not in domestic animals. Results of this study suggest that the ecology of Isfahan virus is distinct from the other VSV serotypes and involves chiefly humans, gerbils, and sandflies, a pattern also observed with cutaneous leishmaniasis and sandfly fever in Iran.

Studies on the epidemiology of sandfly fever in Iran. I. Virus isolates obtained from Phlebotomus

A total of 62 virus isolates was obtained from 12,485 male and female sandflies (predominately Phlebotomus papatasi) collected in a village in central Iran during the summer of 1975. The overall virus isolation rate from female sandflies was 1 per 177 insects processed. Of the 62 virus strains obtained, 49 were identified as Sicilian virus, 11 as Karimabad, and 2 as a new member of the vesicular stomatitis serogroup. One isolate each of Sicilian and Karimabad virus was made from pools of male sandflies. The three virus types were active in the sandfly population simultaneously. Sicilian virus isolation rates showed little variation during the study period, suggesting continuous virus activity during the sandfly season. The implications of these findings for the epidemiology of sandfly fever are discussed.

Serological studies on the epidemiology of sandfly fever in the Old World

Selected human sera from 59 different localities in Africa, the Mediterranean littoral, eastern Europe and Asia were examined by plaque reduction neutralization test against eight sandfly (Phlebotomus) fever virus serotypes (Sicilian, Naples, Arumowot, SudAn 754-61, Karimabad, Salehabad, Gordil and Saint Floris) known to occur in the Old World. Results of these studies provide new information on the geographic distribution and prevalence of human infection with each of the viruses. Specific neutralizing antibodies were detected against all of the agents except Salehabad. Naples and Sicilian antibodies were encountered most frequently and had the widest geographic range; moreover they were found only in areas where Phlebotomus papatasi occurs. Age-specific antibody rates for several of the viruses are presented. These data and the epidemiology of sandfly fever are discussed.

Crimean hemorrhagic fever-Congo (CHF-C) virus antibodies in man, and in domestic and small mammals, in Iran

A Crimean hemorrhagic fever-Congo (CHF-C) virus antibody survey was carried out in Iran with sera from man and several animal species; this survey was done by means of agar gel diffusion precipitation (AGDP) test with the following results (percent positive of number tested): men, 13% of 351; sheep, 38% of 728; goats, 36% of 135; cattle, 18% of 130; camels, 0% of 157; small mammals, 3% of 274. A number of sera were tested by complement-fixation (CF), neutralization (N), and hemagglutination-inhibition (HI) tests in addition to the AGDP test. A good correlation was found in the results with 105 sera tested by AGDP, HI, and N, with approximately 70% to 75% positive in all three tests; by CF, only 20% were positive. Of 55 human sera, of which 15 could be tested by N test, about half were positive by AGDP and only 10% by HI at low titers; none was positive by N and CF tests. These results suggest that any one of the three serological tests (N, HI, and AGDP) can be used to survey the antibody prevalence in sera from domestic animals; the CF test, not unexpectedly, was less suitable. Our results, however, are inconclusive in regard to the human sera.

First detection of tularaemia in domestic and wild mammals in Iran

During a study on the ecology of small-mammal-borne infections in Iran, over 4 600 wild mammals were collected at 47 localities. Attempts were made to isolate Francisella tularensis from the spleens of 3 548 of these animals. All were found to be negative. In addition, sera from 200 sheep and cattle and from 39 wild mammals were tested: 8 sheep, 3 oxen, and 1 hedgehog showed evidence of recent infection. This is the first report of tularaemia in Iran. The relationship of these findings to the potential distribution of natural foci in Iran and adjacent countries indicates that the infection in Asia may be more widespread than was previously thought.