All-cancer incidence in Tehranian adults: more than a decade of follow-up-results from the Tehran Lipid and Glucose Study

OBJECTIVES

To investigate the incidence rates for different malignancies and assess the risk factors for all-cancer incidence in Tehran.

STUDY DESIGN

Cohort study.

METHODS

This study consists of 8599 participants aged ≥ 30 years who were free of cancer (3935 men). Cancer diagnosis was based on pathology reports. Sex-stratified crude incidence rates and age-standardized incidence rates (ASRs) using Segi's method were calculated for all-cancers. Multivariate Poisson regression models were used to evaluate associations of potential risk factors, including sex, age, obesity status (body mass index [BMI]: 25-30 kg/m² as reference), education, smoking status, and diabetes mellitus with the incidence of cancers among the population. Incidence rate ratios (IRRs) with 95% confidence interval (CI) were also reported.

RESULTS

During a median follow-up of 13.9 years, there were 130 and 129 incident cancers for men and women, respectively; the corresponding ASRs were 356.1 and 243.6 per 100,000 person-years, respectively. The three most incident cancers among men were gastrointestinal (GI) (ASR = 127.5), hematopoietic (ASR = 99.5), and reproductive system malignancies (ASR = 46.3). The most common incident cancers in women were breast cancer (ASR = 92.1), GI (ASR = 65.4), and reproductive system malignancies (ASR = 16.8). Among risk factors for cancer incidence, age (IRR [95% CI]: 1.05 [1.03-1.06]) and having a BMI < 25 kg/m² (IRR [95% CI]: 1.38 [1.01-1.90]) had a statistically significant association with incident cancer.

CONCLUSIONS

The high rates of cancers in Tehran during more than a decade of follow-up calls for a need to define risk factors as well as to implement programs for early screening.

Upregulation of Helicoverpa armigera core RNA interference genes by bacterial infections and its effect on the insect-bacteria interaction

RNA interference (RNAi) is an extremely conserved defence mechanism. The antiviral role of the RNAi pathway in insects is well documented; however, the relevance of this pathway in other aspects of insect immunity is largely unknown. In this study, we questioned whether RNAi has any function during insect-bacteria interactions. For this, we assessed induction of the RNAi pathway in response to bacterial infections by monitoring the expression of dicer1/argonaute1 and dicer2/argonaute2, which are important genes in the microRNA and short interfering RNA sub-pathways respectively. Bacterial cells of Bacillus thuringiensis and Serratia marcescens were injected into the haemocoel of fifth-instar larvae of Helicoverpa armigera, whereas double-distilled water was injected into control insects. Expression levels of the RNAi-related genes increased in the bacteria-injected larvae compared with controls. Transcript knockdown of dicer1 reduced the replication of B. thuringiensis; as a consequence, larval mortality decreased compared with the control. However, replication of S. marcescens increased following dicer1 silencing, which led to higher rates of larval mortality when compared with the control. RNAi of dicer2 promoted replication of both bacteria in the larvae and also enhanced larval mortality. Therefore, dicer1 and dicer2 affected larval survival and the replication rates of the pathogenic bacteria, suggesting their roles in the interactions.

Involvement of microRNA miR-2b-3p in regulation of metabolic resistance to insecticides in Plutella xylostella

The diamondback moth, Plutella xylostella, has developed extremely high levels of resistance to chlorantraniliprole and other classes of insecticides in the field. As microRNAs (miRNAs) play important roles in various biological processes through gene regulation, we examined the miRNA profile of P. xylostella in response to chlorantraniliprole exposure. RNA sequencing analysis showed that insecticide treatment caused significant changes in the abundance of some miRNAs. Increasing exposure time and insecticide concentration induced more dysregulated miRNAs in P. xylostella larvae. We also screened potential target genes for some of the differentially expressed miRNAs (such as miR-2b-3p, miR-14b-5p and let-7-5p), which may play important roles in insecticide resistance development. Exposure of P. xylostella larvae to chlorantraniliprole caused considerable overexpression in the transcript levels of potential target genes cytochrome P450 9f2 (CYP9F2) and 307a1 (CYP307a1). Application of miR-2b-3p and miR-14b-5p mimics significantly suppressed the relative transcript levels of CYP9F2 and CYP307a1, respectively, in a P. xylostella cell line. Furthermore, enrichment of P. xylostella diet with miR-2b-3p mimics significantly increased mortality in deltamethrin-resistant larvae when exposed to deltamethrin. The results suggest that miR-2b-3p may suppress CYP9F2 transcript levels in P. xylostella and consequently inhibit larval detoxification pathways. The findings provide an insight into possible role of miRNAs in regulation of metabolic resistance of insects to insecticides.

Wolbachia-induced transcription factor GATA4 suppresses ovary-specific genes blastoderm-specific protein 25D and imaginal disc growth factor

The endosymbiotic bacterium Wolbachia infects a wide array of insect hosts and has been implicated in a range of biological modifications as a consequence of its infection. Previously, it was shown that the transcription factor GATA4 was significantly induced in Wolbachia wMelPop-CLA strain infected Aedes aegypti whole mosquitoes and cells. Here, we provide evidence that this induction also occurs in mosquito ovaries where the ovary-specific genes blastoderm-specific protein 25D (Bsg25D) and imaginal disc growth factor (Disc) are suppressed by Wolbachia. We further demonstrate that transcriptional depletion of GATA4 results in upregulation of both genes and conversely its overexpression leads to downregulation of the genes, suggesting that Wolbachia-induced GATA4 plays a suppressive regulatory role with regards to Bsg25D and Disc expression in mosquito ovaries. When the Disc gene was silenced in mosquitoes, we did not observe any difference in the number of mature ovarian follicles developed between treatment groups. However, we did find a significant delay in the hatching of eggs that had been laid by Disc knockdown mosquitoes.

Genomic innovations, transcriptional plasticity and gene loss underlying the evolution and divergence of two highly polyphagous and invasive Helicoverpa pest species

BACKGROUND

Helicoverpa armigera and Helicoverpa zea are major caterpillar pests of Old and New World agriculture, respectively. Both, particularly H. armigera, are extremely polyphagous, and H. armigera has developed resistance to many insecticides. Here we use comparative genomics, transcriptomics and resequencing to elucidate the genetic basis for their properties as pests.

RESULTS

We find that, prior to their divergence about 1.5 Mya, the H. armigera/H. zea lineage had accumulated up to more than 100 more members of specific detoxification and digestion gene families and more than 100 extra gustatory receptor genes, compared to other lepidopterans with narrower host ranges. The two genomes remain very similar in gene content and order, but H. armigera is more polymorphic overall, and H. zea has lost several detoxification genes, as well as about 50 gustatory receptor genes. It also lacks certain genes and alleles conferring insecticide resistance found in H. armigera. Non-synonymous sites in the expanded gene families above are rapidly diverging, both between paralogues and between orthologues in the two species. Whole genome transcriptomic analyses of H. armigera larvae show widely divergent responses to different host plants, including responses among many of the duplicated detoxification and digestion genes.

CONCLUSIONS

The extreme polyphagy of the two heliothines is associated with extensive amplification and neofunctionalisation of genes involved in host finding and use, coupled with versatile transcriptional responses on different hosts. H. armigera's invasion of the Americas in recent years means that hybridisation could generate populations that are both locally adapted and insecticide resistant.

Trends in outpatient cataract surgery in the Islamic Republic of Iran, 2006-2010

This study aimed to determine the trends in outpatient cataract surgery and its determinants in the Islamic Republic of Iran between 2006 and 2010. In this cross-sectional study, 106 cataract surgery centres were selected in all provinces by multistage randomized cluster sampling. The number of centres in each province was determined from the number of cataract operations and the number of patient charts examined in each centre was proportionate to the number of cataract operations in that centre. The prevalence of outpatient surgery increased from 46.0% (95% CI, 35.3-56.8) in 2006 to 51.4% (95% CI, 40.2-62.7) in 2010 (P = 0.549). Patients stayed in hospital for more than one night after 10.5% (95% CI, 6.9-14.1) of operations. Use of phacoemulsification and topical anaesthesia increased the prevalence of outpatient surgery and decreased intraoperative complications. Although outpatient cataract surgery increased by 11.7%, use of methods such as phacoemulsification is not widespread, and more attention should be paid to the barriers to outpatient cataract surgery in the Islamic Republic of Iran.

Revised annotation of Plutella xylostella microRNAs and their genome-wide target identification

The diamondback moth, Plutella xylostella, is the most devastating pest of brassica crops worldwide. Although 128 mature microRNAs (miRNAs) have been annotated from this species in miRBase, there is a need to extend and correct the current P. xylostella miRNA repertoire as a result of its recently improved genome assembly and more available small RNA sequence data. We used our new ultra-deep sequence data and bioinformatics to re-annotate the P. xylostella genome for high confidence miRNAs with the correct 5p and 3p arm features. Furthermore, all the P. xylostella annotated genes were also screened to identify potential miRNA binding sites using three target-predicting algorithms. In total, 203 mature miRNAs were annotated, including 33 novel miRNAs. We identified 7691 highly confident binding sites for 160 pxy-miRNAs. The data provided here will facilitate future studies involving functional analyses of P. xylostella miRNAs as a platform to introduce novel approaches for sustainable management of this destructive pest.

Contributions of public and private sectors to the Iranian cataract surgery output

This study determined trends in the contributions of the public and private sectors to the cataract surgery output in the Islamic Republic of Iran. Data about cataract surgeries performed at surgical centres throughout the nation were extracted from patient charts for a 5-year period from 2006 to 2010. Of the total 516 273 surgeries performed in 2010, more were done in public sector centres (61.7%) than private ones (38.3%). The total number of surgeries increased by 59.1% between 2006 and 2010. Analysis of the relative contributions of the public and private sectors showed a 41.0% increase in surgeries in public centres and 100.5% in private centres over the 5-year period. Thus the rate of growth of cataract surgery in the private sector was 2.7 times greater than that in the public sector. Despite a smaller contribution to the total number of cataract surgeries, the private sector has experienced a substantial rate of growth.

A comparative study on hypoglycemic properties, lipid profile and bioactive components of hydro-alcoholic extracts of cooked and raw Brassica napus

Introduction: Many plants with anti-oxidant properties proved to be effective on diabetes treatment. Brassica napus (turnip) is an anti-oxidant plant consumed raw or cooked. In this study, we examined and compared hypoglycemic and hypolipidemic properties of raw and cooked Brassica napus in diabetic rats. Objectives: Due to measuring bioactive component of Brassica napus as a rich source of flavonoid we investigate the hypoglycemic properties in raw and cooked type. Material and Methods: For this experimental study, 50 male Wistar rats weighing 200-250 g were designated into five groups of 10 consist of control, diabetic control, diabetic cooked turnip, diabetic raw turnip, and diabetic glibenclamide. The alloxan-induced diabetic rats received extracts orally for 4 weeks. Then, the serum biochemical factors were measured and compared statisticaly by analysis of variance (ANOVA) test. Results: Serum glucose, triglyceride (TG), cholesterol, and low density lipoprotein cholesterol (LDL-C) were significantly decreased in cooked and raw turnip rats compared to control ones. Cooked and raw Brassica napus extracts both helped high density lipoprotein cholesterol (HDL-C) increase; cooked turnip competency was superior in view of cholesterol and LDL-C decrease as well as HDL-C increase (P < 0.05). The mean difference in glucose and TG decrease was not significant between diabetic cooked turnip and diabetic raw turnip rats. Conclusion: Improving the blood glucose and lipid levels diabetic rats, in this study, may indicate that both raw and cooked Brassica napus extracts (especially the cooked one) may be beneficial in diabetic patients.

Matched optical quality comparison of 3-year results of PRK-MMC and phakic IOL implantation in the correction of high myopia

AIMS

To compare 3-year results of PRK-MMC and phakic intraocular lens (PIOL) implantation in patients with >8.0 diopters (D) of myopia.

METHODS

This study was conducted as a non-randomized clinical trial on 23 eyes treated with PIOL (Artiflex; group A) and 23 eyes treated with PRK-MMC (group B). This report compares 3-year treatment results in these two groups.

RESULTS

At 3 years after surgery, uncorrected visual acuity was 0.02±0.06 LogMAR in group A and 0.04±0.07 LogMAR in group B (P=0.639). Mean best corrected visual acuity in group A (0.004±0.02) was better than group B (0.03±0.07 LogMAR) (P=0.035). Mean manifest refraction spherical equivalent was -0.16±0.21 and -0.09±0.20D (P=0.190), respectively. Mesopic contrast sensitivity (CS) in the spatial frequency of three cycle/degree (CS3) significantly decreased in both groups, but the reduction was significantly higher in group B (P=0.024). CS6 decreased significantly only in group B (P=0.019). Changes in CS12 and CS18 showed no significant inter-group difference. In group A, the increase in C6 trefoil (0.16±0.18 μm, P=0.003) and reduction in spherical aberration (SA; 0.16±0.08 μm, P<0.001) were statistically significant. In group B, the reduction in vertical coma (P=0.052), and increases in horizontal coma (P=0.044), coma (P<0.001), SA (P<0.001), and total higher order aberrations (P<0.001) were significant after surgery.

CONCLUSION

Based on 3-year results, PIOL implantation is a better choice than PRK-MMC for treating patients with >8.0D myopia. However, for patients with an inadequate aqueous depth, PRK-MMC can be an acceptable treatment option with a potential for decreased quality of vision.

Reciprocal crosses between two populations of Trissolcus vassilievi (Mayr) (Hymenoptera: Scelionidae) reveal maternal effects on thermal phenotypes

The egg parasitoid Trissolcus vassilievi (Mayr) (Hymenoptera: Scelionidae) is a significant natural enemy of the sunn pest, Eurygaster integriceps Puton (Hemiptera: Scutelleridae), the most important pest of wheat in Iran. This study examined the developmental time and egg-to-adult survival of two geographically separate populations of T. vassilievi on two corresponding host populations at five constant temperatures ranging from 15.0 to 35.0 ± 1°C. No wasps of either population emerged at 15.0°C and the temperature threshold for development was similar between populations, ranging from 13.1 ± 0.3 to 13.8 ± 0.4°C for males and 12.2 ± 0.1 to 12.6 ± 0.1°C for females, but the thermal constant varied with gender and parasitoid population. Development of wasps from the colder Tabriz location was slower, with thermal constants for males and females of 172.6 ± 3.1 and 204.1 ± 1.2 degree-days, respectively, compared to Varamin wasps with 164.7 ± 3.0 and 195.6 ± 1.3 degree-days, respectively. Based on genetic inheritance patterns, reciprocal crosses between the two populations were expected to result in females with thermal phenotypes intermediate to their parental populations, and males that resembled their mothers. However, female progeny of crosses more closely resembled their maternal population, indicating a maternal effect on thermal phenotype. Furthermore, the magnitude of the maternal effect on the thermal constant was asymmetric and was more strongly expressed by Varmin than Tabriz females. These results suggest the possibility of using selective crosses between wasp populations, in combination with artificial selection in the laboratory, to tune the thermal phenotype of parasitoids to specific regions prior to augmentative releases.

White rice consumption and CVD risk factors among Iranian population

Association between white rice intake and risk factors of cardiovascular diseases remained uncertain. Most of the previous published studies have been done in western countries with different lifestyles, and scant data are available from the Middle East region, including Iran. This cross-sectional study was conducted in the structure of Isfahan Healthy Heart Program (IHHP) to assess the association between white rice consumption and risk factors of cardiovascular diseases. In the present study, 3,006 men were included from three counties of Isfahan, Najafabad, and Arak by multistage cluster random-sampling method. Dietary intake was assessed with a 49-item food frequency questionnaire (FFQ). Laboratory assessment was done in a standardized central laboratory. Outcome variables were fasting blood glucose, serum lipid levels, and anthropometric variables. Socioeconomic and demographic data, physical activity, and body mass index (BMI) were considered covariates and were adjusted in analysis. In this study, Student's t-test, chi-square test, and logistic regression were used for statistical analyses. Means of BMI among those subjects who consumed white rice less than 7 times per week and people who consumed 7-14 times per week were almost similar--24.8 +/- 4.3 vs 24.5 +/- 4.7 kg/m2. There was no significant association between white rice consumption and risk factors of cardiovascular diseases, such as fasting blood sugar arid serum lipid profiles. Although whole grain consumption has undeniable effect on preventing cardiovascular disease risk, white rice consumption was not associated with cardiovascular risks among Iranian men in the present study. Further prospective studies with a semi-quantitative FFQ or dietary record questionnaire, representing type and portion-size of rice intake as well as cooking methods and other foods consumed with rice that affect glycaemic index (GI) of rice, are required to support our finding and to illustrate the probable mechanism.

Antiviral activity of Quercus persica L.: High efficacy and low toxicity

Background:

Drug-resistant strain of Herpes simplex virus type 1 (HSV-I) has increased the interest in the use of natural substances.

Aims:

This study was aimed to determine minimum inhibitory concentration of hydroalchoholic extract of a traditionally used herbal plant, Quercus persica L., on HSV-1 replication on baby hamster kidney (BHK) cells.

Setting:

The study was conducted in Shahrekord University of Medical Sciences, Iran.

Design:

This was an experimental study.

Materials and Methods:

BHK cells were grown in monolayer culture with Dulbecco's modified Eagle's medium (DMEM) supplemented with 5% fetal calf serum and plated onto 48-well culture plates. Fifty percent cytotoxic concentration (CC50%) of Q. persica L. on BHK cells was determined. Subsequently, 50% inhibitory concentration (IC50%) of the extract on replication of HSV-1 both in interacellular and exteracellular cases was assessed.

Statistical Analysis:

Statistic Probit model was used for statistical analysis. The dose-dependent effect of antiviral activity of the extracts was determined by linear regression.

Results:

Q. persica L. had no cytotoxic effect on this cell line. There was significant relationship between the concentration of the extract and cell death (P<0.01). IC50s of Q. persica L. on HSV-1, before and after attachment to BHK cells were 1.02 and 0.257 μg/mL, respectively. There was significant relationship between the concentration of this extract and inhibition of cytopathic effect (CPE) (P<0.05). Antioxidant capacity of the extract was 67.5%.

Conclusions:

The hydroalchoholic extract of Q. persica L. is potentially an appropriate and promising anti herpetic herbal medicine.

Consumption of sugar-sweetened beverages in relation to the metabolic syndrome among Iranian adults

BACKGROUND

Few data are available linking intake of sugar-sweetened beverages (SSBs) with the metabolic syndrome. Furthermore, findings from these studies are inconsistent and most are from Western societies; no information is available in this regard from Middle Eastern populations.

OBJECTIVE

This study was conducted to assess the relationship between SSB consumption and metabolic syndrome in an Iranian adult population.

METHODS

In this cross-sectional study, data from 1,752 people (782 men and 970 women) that were selected with the multistage cluster random sampling method from three counties of Isfahan, Najafabad and Arak were used. A validated food frequency questionnaire was used to assess participants' usual dietary intakes. Consumption of SSBs was calculated by summing up the consumption of 'soft drinks' and 'artificially sweetened fruit juices'. To categorize participants, we used three levels of SSB consumption: <1 time/week, 1-3 times/week, and >3 times/week. Biochemical assessments were done after an overnight fasting. Metabolic syndrome was defined according to the guidelines of Adult Treatment Panel III.

RESULTS

Subjects with high consumption of SSBs (>3 times/week) were younger than those with low consumption (<1 time/week). Mean BMI was not significantly different across SSB categories. High consumption of SSBs was associated with greater intakes of energy and almost all food groups. We found a significant difference in serum triglyceride levels between men consuming SSBs 1-3 times/week and those consuming <1 time/week. However, after controlling for potential confounders, this association disappeared. In crude models, no significant associations were found between SSB intake and prevalence of the metabolic syndrome in either gender. After adjustment for potential confounders including BMI, we found that men in the top category of SSB intake were 17% more likely to have the metabolic syndrome (odds ratio (OR) 1.17; 95% confidence interval (95% CI) 0.56-2.46), while women in the highest category were 20% less likely to have the syndrome (OR 0.80; 95% CI 0.46-1.42) as compared with those in the bottom category. However, these associations were not significant in either men or women.

CONCLUSION

Our results do not support the previous findings on the association between SSB consumption and metabolic syndrome. Prospective studies are needed to further explore for this association.

HSV-2 Seroepidemiology and Risk Factors among Iranian Women: A Time to New Thinking

BACKGROUND

Genital herpes is a common sexually transmitted disease in many developed and developing countries mostly caused by Herpes simplex virus type 2 (HSV-2). This study determines the prevalence of HSV-2 infection between two groups of women with high and low risk behaviors.

METHODS

In this seroepidemiologic study, 362 women attending obstetrics and gynecology clinics as low risk group and 156 prisoners and drop in center resident women in Tehran as high risk group were enrolled. HSV infection was identified by serologic tests on blood samples.

RESULTS

The prevalence of IgG antibody in high risk group was significantly more than low risk women (26.3% vs. 2.5%). The prevalence of IgM antibody in high risk group was less than low risk group (3.8% vs. 7.1%) but the difference was not statistically significant. In high risk group, there was significant association between positive IgG and anal/oral sex, use of condom, smoking and drug addiction as well as genital pain, burning, itching, ulcer, dysuria, and history of genital infection. In low risk group, association between positive IgM and IgG test results and risky behaviors were not significant. There was significant association between IgM and genital itching, rash, and ulcer.

CONCLUSION

Relatively high seroprevalence of anti-HSV-2 IgG and high frequency of genital Herpes among high risk women necessitates regular screening and safe sex education programs. Moreover, risk of acute infection in this group should not be ignored and its distribution in Iranian population should be alarmingly concerned.

Venous air embolism during semi-sitting craniotomy evokes thrombocytopenia

Venous air embolism activates platelets in vitro and can evoke platelet dysfunction in swine. We tested the hypothesis that venous air embolism during semi-sitting craniotomy induces thrombocytopenia in humans. We analysed the charts of 799 patients who had an elective craniotomy in the semi-sitting position between 1990 and June 2009. Venous air embolism occurred in 52 patients (6.5%) and was associated with a decrease in mean (SD) in platelet count from 270 (75) × 10⁹ l⁻¹ to 194 (62) × 10⁹ l⁻¹ (p < 0.001). In age-matched controls without venous air embolism mean (SD) platelet count did not change (254 (82) × 10⁹ l⁻¹ vs. 250 (97) × 10⁹ l⁻¹ (NS). While mean (SD) haematocrit fell slightly in both groups (venous air embolism: 0.40 (0.05) to 0.32 (0.04), p <0.001; no venous air embolism: 0.41 (0.04) to 0.35 (0.05), p < 0.001), normalising platelet count to haematocrit did not alter the results.

Recovery of ophthalmoplegia after endovascular treatment of intracranial aneurysms

BACKGROUND AND PURPOSE

Recovery of aneurysm induced CNP after endosaccular coiling has been reported in the literature. The aim of this study was to assess in detail the parameters that affect the outcome after endovascular treatment of ophthalmoplegic aneurysms due CNP.

MATERIALS AND METHODS

Between November 1999 and March 2008, 30 consecutive patients (8 men, 22 women; mean age, 54.9 years) presenting with CNP underwent endosaccular coiling with or without additional use of stents in the parent artery. Subarachnoid hemorrhage was present in 10 patients, whereas 20 patients had unruptured aneurysms. The mean size of the aneurysms was 10 mm. Initial CNP was complete in 11 patients and partial in 19. Mean follow-up after coiling was 19 months.

RESULTS

The mean interval between the onset of CNP and aneurysm embolization was 48 days. Fifteen patients (50%) had complete recovery of oculomotor function, 12 had incomplete recovery (40%), and 3 (10%) remained unchanged after treatment. In 4 aneurysms (13.3%), 1 additional embolization was performed, whereas in 4 other aneurysms, 2 additional embolization procedures were necessary. Procedure-related permanent morbidity occurred in 2 patients (6.6%).

CONCLUSIONS

Endosaccular coiling is an effective and safe method for the treatment of ophthalmoplegic aneurysms. Age, neck size, and time of treatment do not seem to constitute prognostic factors with respect to CNP recovery, though patients with small aneurysms, unruptured status, and/or location in the posterior circulation showed a tendency for better outcome. The degree of initial CNP was the only statistically significant prognostic factor concerning the final outcome, resulting in better recovery, in case of incomplete initial CNP.

[The importance of CT angiography for screening supra-aortic vascular damage in severely injured patients]

PURPOSE

Traumatic injury of supra-aortic vessels remains a challenge in the initial diagnostics of severely injured patients. The presented prospective study analyzed the impact of multislice computed tomography angiography (CTA) as the primary diagnostic method.

METHODS

Patients with the following criteria were included and screened for a dissection of the supra-aortic vessels: a) admission directly from the scene, b) resuscitation room treatment indicated by the official criteria of the DGU (German Society for the Surgery of Trauma), c) suspected blunt trauma to head or trunk as well as d) age over 16 years.

RESULTS

During a period of 18 months 374 patients were treated for blunt trauma in the resuscitation room. In 176 cases CTA of the supra-aortic vessels was performed and pathological findings were observed in 16 patients. In 4 cases (2%) a traumatic dissection of supra-aortal vessels was diagnosed and confirmed by magnetic resonance imaging (MRI). All patients received heparin in a PTT effective dosage for 2 weeks and after rehabilitation there were no neurologic deficits.

CONCLUSION

Traumatic supra-aortic dissection was found in 2% of cases in the presented study group. The mechanisms of injury were not distinct in this group. Essentially MSCT angiography screening was demonstrated to be a safe diagnostic tool.

Ectopic expression of an endoparasitic wasp venom protein in Drosophila melanogaster affects immune function, larval development and oviposition

Endoparasitic hymenoptera inject maternal factors into the host, along with their eggs, to subvert the host immune system. The venom protein, Vn50, previously characterized from the wasp Cotesia rubecula inhibits prophenoloxidase activation in its host Pieris rapae and in another lepidopteran, Manduca sexta. We generated a stable line in the model insect, Drosophila melanogaster, which ectopically expresses Vn50. Results indicated that Vn50 expression accelerates larval development, increases oviposition and reduces melanization in the haemolymph of the transgenic flies. Since melanization is known to be an important facet of the insect immune response, we examined the impact of Vn50 expression on susceptibility to pathogens. Transgenic Vn50 flies challenged with the fungus Beauveria bassiana had increased mortality compared with control flies, but there was no significant change in survival in flies challenged with the pathogenic bacteria, Serratia marcescens. Interestingly, mortality induced by the natural pathogen Drosophila C virus was significantly delayed in Vn50 expressing flies. This indicates a wider range of potential hosts that may be affected by Vn50 and its potential for manipulation of immune system in insects.

Association of breast artery calcification with coronary artery disease and carotid intima-media thickness in premenopausal women

ABSTRACT This study investigated whether breast arterial calcification (BAC) has an association with coronary artery diseases (CAD) in young premenopausal women and evaluated the association of BAC with carotid intima-media thickness and standard CAD risk factors. Among 84 premenopausal women aged < 55 years who were referred for coronary angiography, 34 (40.5%) had abnormal angiographic findings and 6 (7.1%) showed BAC in their mammograms. The body mass index of patients with BAC was significantly higher than those without BAC. BAC had no significant association with angiography-confirmed CAD.

Embolization of intracranial arteriovenous malformations with ethylene-vinyl alcohol copolymer (Onyx)

BACKGROUND AND PURPOSE

Endovascular therapy of intracranial arteriovenous malformations (AVMs) is increasingly used. However, it is still under discussion which embolic material is optimal. We report our experience in the treatment of AVMs with ethylene-vinyl alcohol copolymer (Onyx).

MATERIALS AND METHODS

Between July 2002 and January 2008, brain AVMs were embolized with Onyx in 82 consecutive patients in our department. There were 41 females and 41 males with a mean age of 44.2 years (range, 15-85 years). Clinical presentation included symptoms due to intracerebral hemorrhage (n = 37), seizures (n = 18), nonhemorrhagic neurologic deficits (n = 8), headaches (n = 9), or incidental symptoms (n = 10). According to the Spetzler-Martin scale, 59 AVMs were grades I-II, 16 were grade III, and 7 were grades IV-V.

RESULTS

Complete obliteration at the end of all endovascular procedures was achieved in 20/82 patients (24.4%), with an average of 75% (range, 30%-100%) volume reduction. A mean of 2.9 (range, 1-10) feeding pedicles was embolized per patient, whereas an average of 2.6-mL Onyx was used per patient. Procedure-related permanent disabling morbidity was 3.8%, whereas mortality was 2.4%.

CONCLUSIONS

The overall initial complete obliteration rate of intracranial AVMs with Onyx embolization is relatively high, compared with other embolic agents, with evidence of stability with time. Morbidomortality rates due to AVM embolization as a single treatment method or as a part of a multimodality treatment should be further assessed regarding the natural course of the disease.

Extensive brain swelling with neurological deterioration after intracranial meningioma surgery - venous complication or 'unspecific' increase in tissue permeability

OBJECTIVE

We retrospectively analyzed a series of patients who deteriorated after resection of an intracranial meningioma due to extensive brain edema (EBE) with regard to etiology of the neurological worsening and outcome.

METHODS

Out of a series of 376 consecutive patients who underwent resection of an intracranial meningioma, 13 (3.5%) experienced postoperative deterioration due to EBE which necessitated prolonged artificial ventilation, tracheal reintubation, or decompressive craniectomy. Clinical data, radiological findings, operative records and follow-up data of these patients were retrospectively reviewed.

RESULTS

The study revealed two different patient groups: Patients in group A (n=7) demonstrated edema due to typical venous infarction (VI). A decompressive craniotomy was performed in all but one patient in this group; nonetheless, an acceptable neurological outcome (Glasgow Outcome Scale (GOS) 4) was achieved in only two cases. Patients in group B (n=6) deteriorated due to an EBE of unknown etiology. Mean tumor volume in this group was higher when compared to group A (75 ml vs. 30 ml). In addition, 83% of patients in group B displayed extensive preoperative peritumoral edema compared to only 14% in group A. Three patients in group B required decompressive surgery; however, neurological outcome was more favorable in this group as 83% achieved a GOS of 4 or 5.

CONCLUSION

Extensive brain swelling during or after intracranial meningioma surgery may be due to VI or possibly due to increased postoperative tissue permeability. It is recommended to preserve all venous structures as patients with VI had an unfavorable neurological outcome.

Intracranial Hemangiopericytoma: Treatment Outcomes in a Consecutive Series

OBJECTIVE

The purpose of this study was to analyse a series of patients harbouring an intracranial hemangiopericytoma (HPC) with respect to clinical presentation, treatment results and long-term follow-up outcomes.

PATIENTS AND METHODS

Clinical data were retrospectively obtained in a series of 12 patients who underwent microsurgical resection for HPC at two neurosurgical institutions between 1987 and 2004.

RESULTS

The main presenting symptoms in the seven men and five women (mean age 38 years) were headache in 50% and epileptic seizures in 33% of the patients. A Simpson grade I resection was achieved in seven patients (58%) and none of these patients developed local tumour recurrence after a mean follow-up period of 127 months (10.6 yrs). Only one of these patients received adjuvant radiotherapy. A recurrence of the HPC was observed in all patients (42%) who underwent subtotal tumour resection at first surgery (Simpson grade II or higher). Recurrences occurred after a mean period of 39 months (3.2 yrs) after primary surgery and were effectively controlled by surgical excision, radiotherapy and gamma knife radiosurgery. Two patients (17%) developed extraneural metastases which were treated by surgical excision, radiotherapy and salvage chemotherapy. Poly-chemotherapy was ineffective with respect to tumour control in this study.

CONCLUSIONS

The study emphasises the importance of total resection of HPC, defined as a Simpson grade I removal, at first surgery. Adjuvant radiotherapy is recommended after subtotal tumour resections. A life-long vigilant follow-up of these patients is mandatory.

Olfactory groove meningiomas: functional outcome in a series treated microsurgically

BACKGROUND

A systematic investigation of long-term follow-up results after microsurgical treatment of patients harbouring an olfactory groove meningioma, particularly with regard to postoperative olfactory and mental function, has rarely been performed. We reassessed a series of patients treated microsurgically for an olfactory groove meningioma in regard to clinical presentation, surgical approaches and long-term functional outcome.

METHOD

Clinical, radiological and surgical data in a consecutive series of 56 patients suffering from olfactory groove meningioma were retrospectively reviewed.

FINDINGS

Presenting symptoms of the 41 women and 15 men (mean age 51 years) were mental changes in 39.3%, visual impairment in 16.1% and anosmia in 14.3% of the patients. Preoperative neurological examination revealed deficits in olfaction in 71.7%, mental disturbances in 55.4% and reduced vision in 21.4% of the cases. The tumour was resected via a bifrontal craniotomy in 36, a pterional route in 13, a unilateral frontal approach in 4 and via a supraorbital approach in 3 patients. Extent of tumour resection according to Simpson's classification system was grade I in 42.9% and grade II in 57.1% of the cases. After a mean follow-up period of 5.6 years (range 1-13 years) by clinical examination and magnetic resonance imaging (MRI), 86.8% of the patients resumed normal life activity. Olfaction was preserved in 24.4% of patients in whom pre- and postoperative data were available. Mental and visual disturbances improved in 88 and 83.3% of cases, respectively. Five recurrences (8.9%) were observed and had to be reoperated.

CONCLUSIONS

Frontal approaches allowed better resection of tumours with gross infiltration of the anterior cranial base, tumours extending into the ethmoids or nasal cavity and in cases with deep olfactory grooves. Preservation of olfaction should be attempted in patients with normal or reduced smelling preoperatively.

Replication of Heliothis virescens ascovirus in insect cell lines

Ascoviruses (AVs) infect larvae of various insect pests belonging to the family Noctuidae. The result of AV infection in the hosts is cleavage of infected cells into vesicles, a unique feature of AV infection. Since insect cell lines facilitate the study of virus life cycles, attempts were made to analyze Heliothis virescens AV (HvAV3e) infection in several cell lines and compare cell pathology to larval infection. In this study, replication and cytopathological effects of HvAV3e on four different cell lines were investigated. HvAV3e replication was confirmed in three noctuid cell lines from Spodoptera frugiperda (Sf9) and Helicoverpa zea (BCIRL-Hz-AM1 and FB33). However, the virus did not replicate in the non-noctuid insect cell line from Pieris rapae (Pieridae). Despite replication of the virus in the three permissive cell lines, the cytopathological effects of the virus were significantly different from that of larval infection.

Functional outcome after surgical treatment of intramedullary spinal cord tumors: experience with 78 patients

OBJECTIVE

To analyze factors with impact on the functional outcome for patients with surgically treated intramedullary spinal cord tumors (IMSCT) and to point out characteristics of the different histological entities.

SETTING

Neurosurgical Department, University of Essen, Germany.

METHODS

Between 1990 and 2000, a consecutive series of 78 patients were referred to our institution and underwent surgical treatment. There were 46 (59%) male and 32 (41%) female patients. Mean age was 43.3 years. Functional outcome was analyzed depending on histological features, age, tumor localization and the extension of involved spinal segments. The mean follow-up period was 34.4 months. Operative removal of the IMSCT was performed under standard microsurgical conditions with intraoperative monitoring of somatosensory-evoked potentials (SSEP).

RESULTS

The most frequently involved localization was the cervical and cervicothoracic region (55%) followed by the thoracic region (32%) and the medullar conus (13%). The most frequent IMSCTs were neuroepithelial tumors in 44 patients (56.5%) including 32 patients with ependymomas, 15 astrocytomas, and two lesions without further histological classification. Non-neuroepithelial tumors included 10 metastases, nine cavernomas, eight hemangioblastomas, one dermoidal cyst and one enterogenetic cyst. Complete tumor removal was achieved in 65 cases (83.3%) and subtotal resection in nine cases. In four cases a biopsy was performed only. The overall postoperative neurological state was improved or unchanged in 51 patients (65.4%) and worsened in 27 patients (34.6%). A favorable functional outcome was observed in 94.1% of patients with vascular tumors, in 61.3% of patients with low-grade neuroepithelial tumors and in 53.3% of patients with malignant tumors.

CONCLUSIONS

The strongest predicting factor of functional outcome was the preoperative neurological condition beyond the histological differentiation of the IMSCT. Although there was no outcome difference with respect to the age and tumor extension, thoracically located IMSCTs proved to harbor an increased risk of postoperative surgical morbidity.

Comparison of neurotoxicity of root canal sealers on spontaneous bioelectrical activity in identified Helix neurones using an intracellular recording technique

AIM

To evaluate the neurotoxic effects of two endodontic sealers, AH-26 and Roth 801, on firing excitability and action potential configuration of F1 neural cells in the suboesophageal ganglia of Helix aspersa.

METHODOLOGY

A conventional intracellular current clamp technique was used to study the blocking effects of AH-26 and Roth 801 on ionic currents underlying the action potential of F1 nerve cells. The sealers were prepared according to the manufacturers' directions and were applied to the bathing media in two ways: invasive (0.05 mL of total mixture of each sealer was applied at a distance of 3 mm from the cell), or gradual (0.05 mL of the extract of each dissolved mixture of sealers in normal Ringers solution was perfused).

RESULTS

When applied in an invasive mode, both sealers reduced the duration, the amplitude of action potentials and the amplitude of after-hyperpolarization potentials significantly and led to dramatic changes in action potential configuration. In the gradual mode of application, AH-26 showed a biphasic action; it first increased the excitability and then decreased the action potential parameters, while Roth 801 exhibited solely blocking effects.

CONCLUSIONS

Both sealers had significant inhibitory effects on excitability of F1 neuronal cells.

Intra-operative characterization of gliomas by near-infrared spectroscopy: possible association with prognosis

BACKGROUND

Growth and expansion of gliomas are highly dependent on vascular neogenesis. An association of microvascular density and tumour energy metabolism is assumed in most human gliomas. The purpose of this investigation was to characterize a series of gliomas by intra-operative near-infrared spectroscopy (NIRS), and to elucidate the relationship between microvascular blood volume (BV), oxygen saturation (SaO(2)), histology and patient survival.

METHOD

The study included 13 patients with gliomas, in whom complete tumour resection according to postoperative magnetic resonance imaging criteria was achieved. Intra-operatively, one low grade astrocytoma, five anaplastic astrocytomas and seven glioblastomas with the ipsilateral cortex were investigated by NIRS revealing capillary BV (total haemoglobin) and SaO(2). Intratumoural BV (tBV) and SaO(2) (tSaO(2)) were additionally used in relation to histology and survival.

FINDINGS

The mean tBV of the astrocytomas was 4.96 mg/ml compared to 18.40 mg/ml in the glioblastoma group. Mean tSaO(2) was 36% in the astrocytoma group and 52% in the glioblastomas, respectively. Both tBV and tSaO(2) were significantly higher (p<0.01) in the glioblastoma group. Median survival time was shortest for patients with glioblastoma (12.5 months), with tBV >10/mg/ml (10 months), and tSaO(2) >50% (10 months). Longest median survival times were observed in the astrocytoma group (32.5 months), in patients with Tbv <10/mg/ml (30 months), and tSaO(2) <50% (27.5 months). The differences were highly significant (p<0.01).

INTERPRETATION

Intra-operative characterization of gliomas by NIRS is feasible. High tBV represents extensive angiogenetic activity of the tumour, whereas high tSaO(2) may be result of non-oxidative glucose metabolism with less oxygen extraction from the capillary bed of the tumour. However, the extent of tBV and tSaO(2) are both of possible prognostic value thus resulting in additional information about the tumour.

Is cell surface calreticulin involved in phagocytosis by insect hemocytes?

The innate immune system of insects consists of humoral and cellular components involved in the recognition of and responses to intruding foreign micro- or macroorganisms. Several molecules have been identified so far that recognize molecular patterns present on microorganisms, such as lipopolysaccharides, peptidoglycans and lipoteichonic acid. These molecules, acting as opsonins, trigger immune responses such as phagocytosis, nodule formation, melanization and encapsulation. Here, we investigated the role of calreticulin (CRT) present on the surface of Pieris rapae hemocytes in phagocytosis. Comparative phagocytosis assays using yeast cells showed that hemocytes from different insects exhibit significant variation in their phagocytosing potential and relative CRT involvement.

Persistence and expression of Cotesia congregata polydnavirus in host larvae of the tobacco hornworm, Manduca sexta

The gregarious braconid wasp Cotesia congregata parasitizes host larvae of Manduca sexta, and several other sphingid species. Parasitism induces host immunosuppression due to the disruptive action of the wasp's polydnavirus (PDV) on host blood cells. During the initial stages of parasitism, these cells undergo apoptosis followed by cell clumping, which clears the hemolymph of a large number of cells. In this study, the persistence and expression of Cotesia congregata PDV (CcPDV) were examined using Southern and Northern blots, respectively. Digoxygenin-labelled total polydnaviral DNA was used to probe genomic DNA isolated from fat body and brains of hosts with emerged wasps taken 6 days following egress of the parasitoids, and significant cross-hybridization between the host fat body genomic DNA with viral DNA was seen. Thus, the virus persists in the host for the duration of parasitism, even during the post-emergence period, and may even be integrated in the host caterpillar DNA. Viral gene expression was examined using Northern blots and probes to the Cotesia rubecula CrV1 homolog, and the CrV1-like mRNAs were expressed as early as 4 h post-parasitization for at least 72 h and faint hybrization is even seen at the time the wasps eclose. In contrast, in Pieris rapae larvae the CrV1 transcript is expressed only for a brief time, during which time hemocyte function is disrupted. The effect is transitory, and hemocytes regain their normal functions after the parasites emerge as first instars.The genome of CcPDV contains one copy of the CrV1-like homolog as shown on Southern blots of viral genomic DNA. In conjunction with our earlier studies of the PDV-encoded early protein 1, the current work suggests multiple viral transcripts are produced following parasitization of the host, and likely target host hemocytes to induce their apoptosis, thereby preventing encapsulation of the parasitoid's eggs. Whether viral DNAs are integrated in the host's genomic DNA remains to be proven, but our results provide preliminary evidence that viral DNAs are detected in the host's fat body cells examined at the time of wasp emergence and several days later.

[Dural arteriovenous fistulas with intracranial hemorrhage: diagnostic and therapeutic aspects]

Seven patients presented with intracranial hemorrhage due to arteriovenous dural fistula. Six patients showed intracerebral hemorrhage combined with subdural hematoma and intraventricular hemorrhage in one case respectively, and one patient had infratentorial subarachnoid hemorrhage. Location of the fistulae was frontobasal (n=2), tentorium (n=2), transverse sinus (n=2), and superior sagittal sinus (n=1). Angiography revealed reflux into cortical veins in all cases. Therapy was surgery in both cases with fistula of the anterior cranial fossa with good results. An endovascular intraarterial therapy was performed in a case with circumscribed fistula of the superior sagittal sinus, this patient developed a second dural fistula during follow-up. Two patients with tentorial fistulae had primary endovascular treatment complicated by infarction of both thalami in one case and a recurrence of the fistula in the other. In the last case the fistula was closed by surgery. Out of two patients with widespread fistulae of the transverse sinus one made a good clinical recovery and the other remained unchanged. In the first case definite closure of a remnant of the fistula was refused, in the second no further therapy was recommended.