Polymerase chain reaction diagnosis of Helicobacter pylori in gastroduodenal diseases: comparison with culture and histopathological examinations

Helicobacter pylori has been associated with a variety of upper gastrointestinal diseases. Histopathological examination and culture are considered to be the more specific tests in the diagnosis of H. pylori infection. In the present study, we evaluated the efficiency of a polymerase chain reaction (PCR) assay of the H. pylori urease A gene as a procedure in the diagnosis of gastric H. pylori infection in various gastroduodenal diseases. Biopsy specimens were obtained from the antral mucosa of 83 patients during endoscopic examination and were submitted to three tests for the detection of H. pylori infection. The detection rates of H. pylori using PCR, histopathological examination and culture were 84, 77 and 63%, respectively. When the infection was defined, by the agreement of culture and histopathological examination or by positive culture, the PCR assay had a sensitivity of 98.1% and a specificity of 84.6%. When the infection was defined by a positive result of either two of the three tests or by positive culture, the PCR assay had a sensitivity of 98.6% and a specificity of 85.7%. We conclude that the PCR assay is a valuable test for the diagnosis of H. pylori infection in gastroduodenal diseases.

Extrapyramidal effects of methanandamide, an analog of anandamide, the endogenous CB1 receptor ligand

Recent evidence has demonstrated that arachidonylethanolamide ("anandamide", AEA), the major endogenous ligand of CB1 receptors, inhibits motor behavior in rats, as does (-)delta 9-tetrahydrocannabinol (THC), the prototypical tricyclic cannabinoid derived from Cannabis sativa preparations. However, its effects were of shorter duration, as compared to THC, likely due to its rapid breakdown by an amidase activity. The present work has been designed to examine the motor effects of AM356(R-methanandamide), an analog of AEA that possesses higher metabolic stability to amidase hydrolysis. We have studied the dose-response and time-course effects of R-methanandamide, i.p. administered, on ambulatory activity, frequency of stereotypy and time spent in inactivity measured in an open-field test. Results were as follows. R-Methanandamide, as THC and AEA, inhibited motor behavior. Thus, it decreased ambulation and stereotypy and increased the time spent in inactivity, usually in a dose-related manner, 10 min after administration. However, the motor deficit caused by the highest dose of R-methanandamide was usually more pronounced than that caused by a similar dose of AEA. These inhibitory effects persisted 30 min after the administration of R-methanandamide, as occurred with AEA and THC. Interestingly, at 60 min after administration, the effects of AEA disappeared, likely because of its breakdown to arachidonic acid and ethanolamine, but this did not occur with R-methanandamide whose effects persisted even until 180 min after treatment as occurred with THC. In summary, R-methanandamide inhibits motor behavior in a manner (its effects were persistent) that resembles the effects of THC rather than the effects of AEA (its effects were of rapid onset but shorter duration). This fact supports the use of R-methanandamide as a valuable tool for studying the physiological roles of the anandamidergic system.

The role of labetalol and propofol in the management of HELLP syndrome--a case report

The acronym HELLP describes a syndrome of (H) hemolysis, (EL) elevated liver enzymes, and (LP) low platelets, which symptomatically defines a unique group of preeclamptic/eclamptic women. Pregnancies complicated by this syndrome are associated with poor maternal and fetal outcome. This poses a considerable challenge to the anesthesiologists as many of these patients require emergent Cesarean section. We reported a 30-year-old woman with gestation of 32 wk who sustained Cesarean section under the impression of pregnancy with HELLP syndrome. General anesthesia was performed for this patient. The preoperative evaluation, general management, and intraoperative monitoring system were described. The individual role and use of labetalol and propofol were also discussed in this report.

Total knee arthroplasty in tuberculous arthritis

Sixteen cases of tuberculosis of the knee treated by total knee arthroplasty with followup of 3.4 to 11 years were reviewed. Eight cases were treated with antituberculous chemotherapy for 2 to 20 months before and 1 year after the arthroplasty. Another 8 cases were not diagnosed primarily and therefore received only postoperative antituberculous chemotherapy. Five cases had a recurrence of tuberculosis. Four of these 5 cases did not receive preoperative antituberculous treatment. The infection in 1 case was controlled satisfactorily with chemotherapy alone, and for the other 3 cases, chemotherapy was supported by surgical debridements. The last case of recurrent infection occurred in a patient who had received long- standing corticosteroid therapy. He required an excisional arthroplasty to control the infection. The mean functional knee score was 30.5 points before surgery and 82.6 points at the time of the last followup. These results suggest that arthroplasty may be formed for knees badly damaged with tuberculous infection, and good results may be expected for those patients who have received effective antituberculous chemotherapy both before and after surgery. There is a substantial risk of reactivation of tuberculous infection for those patients not treated before surgery or for patients dependent on corticosteroids.

Mandibular position and head posture as a function of eye dominance

A recent study conducted at Tufts University, School of Dental Medicine has confirmed the relationship between head posture, mandibular position and eye dominance. The purpose of this study is to assess the temporary eye dominance of children and the change relative to head posture and mandibular position. Twenty children were included in this study after the completion of the ophthalmological exclusion screening. All subjects had the sign of eye dominance screened with eye dominance tests. The mandibular position and the 3-dimensional posture of head were recorded. The eye patches were applied over the dominant eye for one hour to achieve the effect of temporary eye dominance change for 10 children. Ten children had the same procedures except for the eye patch procedure. The reexaminations were performed at the end of one hour visit for both groups. Mandibular midline data revealed no change in both control and experimental group. Statistically significant difference in the transverse plane of head posture was observed by means of Student's t test in experimental group. The mean transverse measurement difference was 14.7 degrees, with a standard deviation of 6.4265 degrees. The T value was 5.66, with a probability of p=0.0003 at DF=9. The differences of positions were not statistically significant (P=0.05) on horizontal and vertical planes. The transverse head postural change has been demonstrated by means of temporary eye dominance change. This study highlights several areas: the importance of clinical intervention in young children, the difference on transverse dimensional change, and the importance of role of pediatric dentistry among interdisciplinary cooperation. Further investigation and early clinical intervention is encouraged.

Mechanical property analysis of small bone fixators

The purpose of this study is to establish a database and to compare mechanical properties between various types of small bone fixators. Hollow maple dowels are uniformly produced to simulate small bones in this study. Furthermore, transverse osteotomy, transverse osteotomy with 2 mm gap, and 45 degrees oblique osteotomies are created to simulate stable, unstable, and spiral fractures. Each fracture pattern is then approximated with four types of fixators: (1) Aesculap mini external fixator, (2) mini A-O plate and screw, (3) cross pin, and (4) self-assembled mini external fixator. Finally, tension, torsion, and bending tests are performed with INSTRON. In three different fracture patterns, dorsal plating has the strongest tensile rigidity and lateral bending rigidity. In stable and unstable fractures, Aesculap mini external fixator has the strongest torsional rigidity. However, mini A-O plate has the strongest torsional rigidity in 45 degrees oblique fractures. In stable fractures, dorsal plating, lateral plating, and mini external fixator all have good anterior bending rigidity without significant differences. Nevertheless, only lateral plating and mini external fixator show good anterior bending rigidity in unstable and 45 degrees oblique fractures. Except in torsional rigidity, Aesculap mini external fixator is not significantly stiffer than the self-assembled external fixator. As expected, cross pin is the weakest fixator. Differences in mechanical stiffiness between the four types of small bone fixators are provided in this study. Additionally, one should also consider the indication when choosing a proper fixator. Complication rate can then be lowered to achieve successful surgery in treating small bone fractures.

Sequence variation in the capsid protein genes of human papillomavirus type 16 and type 31

The sequences of the capsid genes of a human papillomavirus type 16 (HPV 16) DNA and an HPV 31 DNA were determined. The HPV 16 DNA contained genes coding for the most variable HPV 16 capsid proteins yet identified (17 variable amino acids). Three of six coding changes in the HPV 31 DNA occurred at positions equivalent to ones where variable amino acids in HPV 16 have been observed. Variable amino acids in both viruses occurred predominantly in regions which showed amino acid variation when closely related types of HPV were compared; thus, most of the factors which determined the intratypic variation in the capsid proteins of the viruses described here were likely the same as those which determined differences between the capsid proteins of different HPV types.

Arthroscopic debridement for osteoarthritis of the knee: a seven years follow-up study

We reviewed 32 knees with osteoarthritis of the knee treated by either arthroscopic debridement in association with drilling the subchondral bone or arthroscopic debridement alone and followed for 2.5 to 11 years. Eighteen knees had arthroscopic debridement and drilling the subchondral bone, and 14 knees had arthroscopic debridement alone. In the group treated with arthroscopic debridement and drilling the subchondral bone, 55.6% had good to excellent results, 22.2% had fair results, and 22.2% had poor results. In the group that had arthroscopic debridement alone, 57.2% had good to excellent results, 35.7% had fair results, and 7.1% had poor results. There was better relief of pain in the group with arthroscopic debridement alone.

Comparison of antihypertensive effects of nicardipine with nitroglycerin for perioperative hypertension

BACKGROUND

To compare the efficacy of intravenous (iv) nicardipine with nitroglycerin for the treatment for patients with perioperative hypertension.

METHODS

Forty patients with perioperative hypertension randomly divided into two groups were treated with intravenous calcium entry blocker, nicardipine, or vasodilator, nitroglycerin. Haemodynamic measurements including mean arterial and pulmonary arterial pressure, central venous and pulmonary capillary wedge pressure, and cardiac output were recorded; peripheral and pulmonary vascular resistance were calculated.

RESULTS

Both medications were effective in reducing blood pressure and controlling haemodynamics. During the maintenance by continuous iv infusion, nicardipine controlled hypertension more rapidly than nitroglycerin (nicardipine 10.5 +/- 2.5 min and nitroglycerin 18.7 +/- 2.8 min, p < 0.05) without significant alteration in heart rate. The total frequency of dose adjustments required to achieve therapeutic response was significantly less in the nicardipine-treated group (2.5 +/- 0.3 for nicardipine and 6.2 +/- 1.4 for nitroglycerin, p < 0.05). Incidence of hypotensive episodes during the infusion were observed in both groups [nicardipine 5% (1/20) and nitroglycerin 30% (6/20), p < 0.05].

CONCLUSIONS

Intravenous nicardipine is as effective as nitroglycerin in the treatment of perioperative hypertension. Specific advantages have been identified such as stable dose-response effect, less hypotensive and tachycardial effects during the use of iv nicardipine in treatment of hypertensive patients.

Effect of diabetic duration on the secondary structures of the human lens capsules in diabetic cataracts

The decrease in triple helix content from 16% to 9% and in beta-turn content from 45% to 33%, combined with markedly increased random coil structure (16%) can be found in the secondary structure contents of lens capsule of the premature cataractous patients with longer diabetic history. However, almost the same peak position and secondary structure content are observed in the curve-fitted IR amide I band of lens capsules of both non-diabetic controls and premature cataractous patients with shorter diabetic history, even if the cataracts are senile. The present study emphasizes the duration of diabetes as a major cause to alter the secondary conformation of the cataractous human lens capsules in diabetic patients.

Congenital tracheal cartilaginous sleeve

The congenital tracheal cartilaginous sleeve (TCS) results from a vertical fusion of the tracheal cartilages. This rare malformation is usually associated with one of the craniosynostosis syndromes, such as Crouzon's disease, Pfeiffer's syndrome, or Goldenhar's syndrome. Three new cases of TCS are reported, two with autopsy findings including the histopathology of horizontal tracheal sections. Salient features of the clinical presentation, diagnostic evaluation, endoscopic findings, histopathology, treatment, and prognosis for TCS are summarized from the perspective of the otolaryngologist. In addition, the literature is reviewed, and previously reported cases are discussed. Although infants with TCS often have multiple abnormalities, this tracheal malformation is not incompatible with life. Since multiple lesions of the larynx and trachea may be present, endoscopic evaluation is recommended for infants with TCS who experience airway distress. A smooth trachea lacking the normal ridges of tracheal arches suggests the diagnosis of TCS. With early recognition and appropriate management (including tracheotomy, if necessary, and aggressive management of pulmonary hygiene), patients may survive into childhood.

[Effects of Shenmai injection on immune function in stomach cancer patients after chemotherapy]

Sixty-three cases with stomach cancer were randomized and observed, the results showed that the count of T lymphocytes in chemotherapy combined with Shenmai injection (SMI) group increased, while in control group it decreased, the difference was significant (P < 0.05). The results also indicated that the count of OKT4 cells and the ratio of OKT4/OKT8 decreased after chemotherapy, but in SMI group both parameters increased in advence which were higher in the 4th week after chemotherapy than that before chemotherapy. However, the count of OKT1 cells and the ratio of OKT4/OKT8 were still in low level. Serum interleukin-2 receptor (sIL-2R) level also decreased (P < 0.05), while activities of natural killer cell (NK) and lymphokine activated killer cell (LAK) level increased (P < 0.05) in SMI group. Although the sIL-2R level had no change, both NK and LAK level decreased in control group. In addition, the difference of IgA, IgM, IgG level were not significant between these two groups. This suggested that SMI might improve human immune function to facilitate the chemotherapy of patients with stomach cancer.

Non-destructive analysis of the protein conformational structure of human pituitary adenomas using reflectance FT-IR microspectroscopy

Reflectance Fourier-transform infrared microspectroscopy was used to determine the secondary structure and composition of the different human pituitary adenomas. Non-functioning pituitary adenomas exhibited similar protein secondary structure and conformational composition, but active pituitary adenomas revealed different behavior. The differences in secondary structure for the different human pituitary adenomas might possibly be due to the different protein conformations of the proliferated adenoma tissues and various hormones shared.

Effect of ethanol on the protein secondary structure of the human gastric mucosa, in vitro

The effect of ethanol on the secondary conformational structure of proteins of the human gastric mucosa was investigated by attenuated total reflection/Fourier transform infrared (ATR/FT-IR) spectroscopy. The IR peak intensity and position of each structural component of gastric mucosa was found to change significantly with the ethanol concentration and length of exposure. The peak intensity due to the beta-sheet and/or beta-turn conformational structure in amide I and II bands of gastric mucosa clearly increased after treatment with ethanol. Moreover, the peak at 1635 cm-1 shifted to 1630 cm-1 after treatment with 40% ethanol for 3 h, or 80% ethanol for 1 h, and a distinct shoulder also appeared at 1643 cm-1. This shift occurred more rapidly and was more pronounced after exposure of mucosa to 80% ethanol, compared with the effect of 40% ethanol, but the alpha-helical structure at the amide I and II bands was not influenced by either concentration of ethanol. Ethanol treatment might also transform the secondary structure of amide III in gastric mucosa from an alpha-helix to a mainly random coil with extensive unfolding. The absorption between 1180 and 980 cm-1, which is assigned to glycoprotein structure, was also reduced after treatment with ethanol. This strongly indicates that ethanol influences the conformation of the lipids and proteins of human gastric mucosa, leading to their deformation.

Priming reversal of profound atracurium blockade by edrophonium and neostigmine

Accelerated reversal of moderate neuromuscular blockade has been reported to be effective by giving anticholinesterase in divided doses (priming reversal). To evaluate its effectiveness in profound blockade, forty ASA physical status I or II patients were studied. After receiving 0.5mg/kg of atracurium during N2O-O2-halothane anesthesia, they were reversed at 5% spontaneous recovery of first twitch height (T1) measured by train-of-four (TOF) stimulation. Edrophonium 1mg/kg was administered intravenously either in a single bolus dose (Group I, n = 10) or in an initial priming dose of 0.2mg/kg followed one minute later by 0.8mg/kg (Group II, n = 10). Neostigmine 0.05mg/kg was administered in a single bolus dose (Group III, n = 10) or in divided priming dose of 0.01 mg/kg followed one minute later by 0.04mg/kg (Group IV, n = 10). The recovery time from the first injection of the reversal agents until the TOF ratio reached 75% was significantly longer (p < 0.05) in Group III (681.5 +/- 77.5 sec) compared to Groups I, II, and IV (451.3 +/- 72.3 sec, 470.6 +/- 39.8 sec, and 448.1 +/- 42.5 sec, respectively; no statistical difference among these three groups). It is concluded that priming reversal by neostigmine, but not edrophonium, produced a significantly faster recovery of profound atracurium blockade. Using the priming method, neostigmine may reach a similar recovery time as edrophonium in profound blockade under equipotent doses.

Drug-induced liver disease--a review of 14 cases

The clinical and pathological features of 14 cases of acute drug-induced liver disease (DILD) were analyzed using the French group method for drug reaction assessment. Among them, 8 were of the cytotoxic type, 4 were of the cholestatic type and 2 were of the mixed type. Serum alkaline phosphatase (ALP) levels of the cytotoxic type DILD were all < 1.8 times the normal value, while those of the cholestatic type DILD > 1.8 times (P < 0.05). The alanine aminotransaminase and aspartate aminotransaminase (ALT and AST) levels of the cholestatic type were all < 13.1 times the normal value, while those of the cytotoxic type varied from 2.2 to 118 times the normal value. We found that steatosis was the major feature in the cytotoxic type with ALT and AST < 2.5 times the normal value. Piecemeal necrosis was noted only in all the cases with ALT and AST > 20 times the normal value. In the cholestatic type, the pathological features of the oral contraceptive-related DILD showed mainly cholestasis, whereas chlorpromazine-related DILD revealed additional portal inflammation. Meticulous taking of patient history and clinical assessment are mandatory for the diagnosis of DILD. The ALP levels were helpful in distinguishing different types of DILD. There are some correlations between biochemical changes and pathological features, and both are helpful in distinguishing different etiologies of DILD when the inciting drug is in doubt.

Preparation and evaluation of sodium diclofenac controlled-release tablets. II. Dibasic calcium phosphate as a retardant in mixtures for direct compression

The dissolution behaviour of a direct compression compact prepared with sodium diclofenac and dibasic calcium phosphate (DCP) in different weight ratios with or without Biosoluble polymer (acrylic-based resin) was investigated in distilled water and in a medium with changing pH. The results indicate that the amount of sodium diclofenac released from the compact was dependent on the amount of drug and DCP used in the compact, and was also controlled by the amount of Biosoluble polymer added. A chemical reaction forming diclofenac acid might occur on the surface of the sodium diclofenac compact during exposure to the acidic medium, which was confirmed by diffuse-reflectance spectroscopy. The tablet with a 1:2 weight ratio of sodium diclofenac to DCP exhibited a sustained-release behaviour, similar to commercial sustained-release products (Voltaren SR-100 and Grofenac Retard), but a lower release rate was found as compared to the commercial products. The dissolution behaviour of the study tablet and the commercial products was found to be dependent on the dissolution medium and the rotating speeds. Glass beads were added to the dissolution assembly to simulate the influence of food, and the enhanced friction between tablet and glass beads might result in a higher dissolution rate of the tablet and the commercial products.

Thermal analyser and micro FT-IR/DSC system used to determine the protective ability of microencapsulated squid oil

Squid oil was microencapsulated by spray drying method. Gelatin, sodium caseinate, maltodextrin were contained in spray drying formulation with or without lecithin and microcrystalline cellulose (Avicel). The thermal stability of the unencapsulated and encapsulated squid oils was determined by pressure differential scanning calorimetry (PDSC), Fourier transform infrared (FT-IR) microscopic photometer with DSC system and themogravimetric analysis (TGA). The results indicate that the above analytical apparatus is an easy and reliable method to investigate the samples and that the microcapsule prepared by spray-dried formulation with lecithin as an emulsifier and Avicel as a stabilizer exhibits more stable thermal stability and longer shelf-life.

An urgent technique of applying high frequency jet ventilation in patients with extreme periglottic stenosis

Applying high frequency jet ventilation (HFJV) to patients with extreme periglottic stenosis (EPS) carries high risk of barotrauma or severe circulatory depression, since the stenotic airway will result in inadequate outflow tract obstructing the passage of the expired gas. We encountered with emergent obstruction of the outflow tract in 13 patients with EPS during HFJV in endolaryngeal microsurgery (ELM) procedures. The phenomenon of progressive gas trapping occurred within seconds in all patients. Barotrauma and disastrous circulatory depression would occur if we had not recognized them and then taken some measures immediately. We surmounted these potentially lethal events without interrupting the surgical procedures and found neither hypoxia nor barotrauma in all these patients. This may attribute to an urgent technique, i.e., intermittent disconnecting the jet conduit at the junction of the proximal end of the insufflation catheter and the distal end of the patient connecting tube of jet ventilator during HFJV.

Ras oncogene and p53 gene hotspot mutations in colorectal cancers

Ras oncogene and p53 gene mutations are frequently observed in colorectal cancers. The role of co-operation between these two genes in the tumorigenesis of colorectal cancer was evaluated. Point mutations in K-ras oncogene and hotspot codons of p53 gene of colorectal cancers were evaluated by naturally created or amplified created restriction site method. Nine of 42 cases (21.4%) of colorectal cancer showed K-ras oncogene mutations. Six of 42 cases (14.3%) of colorectal cancer showed p53 gene hotspot point mutations. The low frequency of p53 gene mutation in this series may be due to racial difference or different hotspot codons. When six cases with mutated p53 gene were examined, only one (16.7%) showed concurrent K-ras oncogene codon 12 and p53 gene codon 248 mutations. We concluded that the co-operation between ras oncogene and p53 gene hotspot point mutations in the tumorigenesis of colorectal cancer in Chinese was not common. Other factors such as adenomatous polyposis coli gene mutations, oncogene activation or tumour suppression gene inactivation may be involved.

Phylogenetic relationships among two species of golden monkey and three species of leaf monkey inferred from rDNA variation

Restriction maps of rDNA repeats of five species of Colobinae and three outgroup taxa, Hylobates leucogenys, Macaca mulatta, and Macaca irus, were constructed using 15 restriction endonucleases and cloned 18S and 28S rRNA gene probes. The site variation between Rhinopithecus roxellana and Rhinopithecus bieti is comparable to that between Presbytis françoisi and Preshytis phayrei, implying that R. bieti is a valid species rather than a subspecies of R. roxellana. Phylogenetic analysis on the 47 informative sites supports the case for Rhinopithecus being an independent genus and closely related to Presbytis. Furthermore, branch lengths of the tree seem to support the hypothesis that the leaf monkeys share some ancestral traits as well as some automorphic characters.