Lower esophageal sphincter injection of a biocompatible polymer: accuracy of implantation assessed by esophagectomy

BACKGROUND

Endoscopic lower esophageal sphincter (LES) implantation of a biocompatible polymer is undergoing clinical trial as an alternative to pharmacologic and laparoscopic treatments for gastroesophageal reflux disease. The safety and efficacy of LES augmentation depend on accurate placement of the implant into the wall of the esophagus. To date, no study has demonstrated the prevalence and location of the intended implant.

METHODS

The study group consisted of nine patients with underlying esophageal disease severe enough to warrant esophagectomy. Three or four implants of 1 or 2 cc of Enteryx (a biocompatible ethylene-vinyl alcohol copolymer dissolved in dimethyl sulfoxide with micronized tantalum as a radiopaque marker) were placed at the squamocolumnar junction of each patient via a 4-mm, 23-gauge needle under endoscopic guidance. Fluoroscopy was utilized in all patients to facilitate endoscopic placement. Outcome measures included the prevalence and location of successful implantation into the wall of the esophagus.

RESULTS

Thirty of 34 implants (88%) were successfully placed into the wall of the esophagus. The remaining 4 were found lying subserosally or attached to the exterior of the gastroesophageal junction (GEJ). Fluoroscopically, the implants often tended to coalesce, forming arcs or a ring around the GEJ. Histologic examination revealed implantation into the deep submucosa contiguous with the circular muscle and within the muscularis propria in all patients, with implants occasionally extending into the subserosa. There were no untoward reactions identified.

CONCLUSIONS

Endoscopically directed implantation of a biocompatible polymer into the esophageal wall can be accomplished with a high degree of accuracy. Injection via a 4-mm needle results in the placement of material along and within the muscular layers of the esophagus.

Children's representation of family mealtime in the context of maternal eating disorders

BACKGROUND

Recent research provides evidence for specific disturbance in feeding and growth in children of mothers with eating disorders.

AIM

To investigate the impact of maternal eating disorders during the post-natal year on the internal world of children, as expressed in children's representations of self and their mother in pretend mealtime play at 5 years of age.

METHODS

Children of mothers with eating disorders (n = 33) and a comparison group (n = 24) were videotaped enacting a family mealtime in pretend play. Specific classes of children's play representations were coded blind to group membership. Univariate analyses compared the groups on representations of mother and self. Logistic regression explored factors predicting pretend play representations.

RESULTS

Positive representations of the mother expressed as feeding, eating or body shape themes were more frequent in the index group. There were no other significant group differences in representations. In a logistic regression analysis, current maternal eating psychopathology was the principal predictor of these positive maternal representations. Marital criticism was associated with negative representations of the mother.

CONCLUSIONS

These findings suggest that maternal eating disorders may influence the development of a child's internal world, such that they are more preoccupied with maternal eating concerns. However, more extensive research on larger samples is required to replicate these preliminary findings.

Circle ligation of in vitro assembled chromatin indicates a highly flexible structure

Evidence is provided that some condensed linker histone-containing chromatin structures are highly flexible in solutions containing 2 mM Mg2+. Chromatin assembled in vitro +/- histone H5 on a 6.3 kb linear DNA fragment in 90 mM NaCl using the polyglutamic acid method sedimented fairly homogeneously. The H5-containing sample had s(20, w) values that were 58-69% greater than the sample lacking H5. Chromatin assembled on linear pUC19 plasmid DNA was treated with T4 DNA ligase in solutions containing 2 mM Mg2+ over a range of DNA concentrations. It was found that the intramolecular DNA ends of the chromatin could be joined together more efficiently than the intramolecular ends of the naked DNA at the higher DNA concentrations. This result could not be attributed to the effective reduction in DNA length by nucleosome formation. The chromatin structures formed did not have naked DNA tails extending from the ends as assessed by exonuclease III digestion. Chromatin assembled on DNA shortened by up to 420 bp gave very similar results, suggesting that the structure was a flexible one, rather than a rigid one having DNA ends that were fortuitously juxtaposed.

The mental health of refugee children

The UK is facing a major increase in the number of people seeking asylum each year, of whom approximately a quarter are children. The stressors to which refugees are exposed are described in three stages: (1) while in their country of origin; (2) during their flight to safety; and (3) when having to settle in a country of refuge. The evidence concerning the impact of displacement on children's mental health is reviewed and a framework for conceptualising the risk factors is proposed. The available literature shows consistently increased levels of psychological morbidity among refugee children, especially post-traumatic stress disorder, depression, and anxiety disorders. The principles underlying the delivery of mental health care for these children are also considered. It is argued that much primary prevention can be undertaken in the school context. Some key aspects of British immigration law are examined and the tension between the law and the best interests of the child principle is discussed. There is particular concern for the plight of unaccompanied children. Attention to the mental health needs of this vulnerable group is urgently required.

[Initial scleromyxedema. Successful treatment with melphalan]

Scleromyxedema is a rare mucinous disease without thyroid dysfunction, associated with a monoclonal gammopathy. The deposits of mucin in the skin and other organs such as the cardiovasculary system, determine the prognosis of the disease. A 74-year old patient with initial scleromyxedema is described, in whom a pulse therapy with melphalan was initiated already in the early stages of the disease. Four cycles of melphalan in combination with prednisolon led to a complete and sofar stable remission of the disease.

Combined calcitriol-pamidronate therapy for bone hyperresorption in spinal cord injury

OBJECTIVE

To determine the biochemical effects of combined calcitriol-pamidronate therapy on bone hyperresorption in patients with spinal cord injury (SCI).

METHODS

This was a retrospective study of 21 SCI inpatients (4 women and 17 men, mean age 34 years) treated for bone hyperresorption. Initial treatment was 0.5 microg oral calcitriol once daily and 1,250 mg CaCO3 twice a day (1000 mg elemental calcium/day). On days 4 through 6 following the initial treatment, patients received 30 mg pamidronate intravenously once daily (total of 3 doses). Urinary N-telopeptide (NTx) and calcium excretion rates, and serum parathyroid hormone (PTH), 25-hydroxyvitamin D (25-D), 1,25-dihydroxyvitamin D (1,25-D), calcium, and phosphorus levels were measured within 2 weeks prior to and 2 weeks following pamidronate therapy.

RESULTS

Patients demonstrated increased urinary NTx and calcium excretion, indicative of bone hyperresorption, and suppressed PTH and 1,25-D levels as early as 9 days post-SCI. Combined calcitriol-pamidronate therapy decreased urinary NTx and calcium excretion by 71% (P < .001) and 73% (P < .001), respectively. This therapy also increased serum levels of PTH (P <.05) and 1,25-D (P < .005). Post-pamidronate hypocalcemia or hypophosphatemia was observed in 44% (P < .01) or 53% (P < .01), respectively.

CONCLUSION

Combined calcitriol-pamidronate therapy significantly inhibited bone hyperresorption in SCI patients.

Cytotoxic phenotype of intra-epithelial lymphocytes in normal and cryptorchid human testicular excurrent ducts

BACKGROUND

Most testicular and epididymal lymphocytes express T-cell markers, but their cytotoxic potential and activation status have not been reported. In this study, distribution of the cytotoxic cells was compared between normal and cryptorchid testes stratified into two groups: the first with complete absence of germ cells [Sertoli cell-only (SCO)] and the second with arrested spermatogenesis (SCA).

METHODS

Immunohistochemistry for the T-lymphocyte marker CD3 and cytotoxic markers CD8, TIA-1 and granzyme B was performed on paraffin-embedded sections.

RESULTS

The number of CD8+ and CD3+ intra-epithelial lymphocytes (IELs) increased distally throughout the normal epididymis. TIA-1 immunostaining revealed that a significant proportion of IELs exhibited cytotoxic potential, whereas granzyme B staining disclosed a subpopulation of activated cytotoxic lymphocytes (CTLs). TIA-1/CD8 and granzyme B/CD8 double immunostaining revealed that the vast majority of TIA-1+ and granzyme B+ cells were CD8+. The proportion of activated granzyme B+ lymphocytes increased distally throughout the normal epididymis. The number of TIA-1+ and granzyme B+ intra-epithelial and stromal lymphocytes was significantly increased in the normal as opposed to the SCO cryptorchid epididymis and proximal vas deferens.

CONCLUSIONS

These results suggest that exposure of the testicular excurrent ducts to spermatozoa or immature germ cells triggers the activation and recruitment of CTLs. Cytotoxic granule effector mechanisms may contribute to the immunological barrier preventing the immune response to spermatozoa in testicular ducts.

Regioselective functionalization of starch: synthesis and 1H NMR characterization of 6-O-silyl ethers

A high regioselective 6-O silylation of starch by using thexyldimethylchlorosilane (TDSCl, chlorodimethyl-(2,3-dimethylbut-2-yl)silane) as bulky silylating agent in the reaction system N-methylpyrrolidone (NMP)/ammonia was carried out and investigated. The control of the degree of substitution (DSSi), the control of the regioselectivity, and the control of the reaction pathway are described in detail. After peracetylation of the silyl ethers of starch, the distribution of the silyl and acetyl substituents was characterized not only in the anhydroglucose repeating units (AGU) but also in the nonreducing end groups (NEG) by means of multidimensional 1H NMR techniques. In both cases, the silyl substituents were detected exclusively in the 6-O position, and the acetyl groups in the 2-O and 3-O positions of the AGU and in the 2-O, 3-O, and 4-O positions of the NEG, respectively. The described 6-O-thexyldimethylsilyl (TDS) units are potentially protecting groups of the primary OH position of starches.

Quantification of antigen-reactive T cells by a modified ELISPOT assay based on freshly isolated blood dendritic cells

The enzyme-linked immunospot (ELISPOT) assay has become a widely employed method for quantification of antigen-reactive T lymphocytes. In recent years, various types of antigen-presenting cells (APCs) have been tested as stimulator cells in ELISPOT protocols to achieve a highly sensitive and rapid assay which is not impaired by a marked nonspecific cytokine release. However, the currently available APCs still have disadvantages, such as significant background reactivities, limited sensitivity, and time-consuming preparation procedures. Recently, we succeeded in defining a novel subpopulation of circulating dendritic cells (DCs) that can easily be prepared from human blood. These M-DC8+ DCs proved to be very effective in the induction of antigen-specific T cell responses. In the present study we provide evidence that M-DC8+ DCs are particularly well suited as APCs for the detection of antigen-specific CD8+ T cells after challenge with viral or tumor peptides in ELISPOT assays. In addition, protein-loaded M-DC8+ DCs proved to be quite efficient in the presentation of MHC class II-bound peptides, thus allowing the determination of frequencies of antigen-reactive CD4+ T cells. The use of M-DC8+ DCs as stimulator cells can improve the ELISPOT assay by combining high sensitivity, rapidity, and low background reactivity.

[Multiple miliary osteomas of the face]

Osteoma cutis is a single or multiple ectope calcification with development of bony structures in the skin. We distinguish between primary and secondary ossification. Multiple miliary osteoma in the face has mostly been described secondary to preexisting acne vulgaris. We present a 62-year-old woman who developed multiple miliary osteoma in the face together with repeated doses of estrogen and discuss pathogenesis and therapeutic possibilities.

Improved sampling of wildlife populations using airborne surveys

Parameter estimates, obtained from airborne surveys of wildlife populations, often have large bias and large standard errors. Sampling error is one of the major causes of this imprecision and the occurrence of many animals in herds violates the common assumptions in traditional sampling designs like systematic or simple random sampling even when stratification is used. In this paper, we present an adaptive sampling design that uses criteria of observed animal counts to maximise sample information and that is independent of the usual assumption of a uniform distribution for wildlife populations. For illustration, the design is applied to data derived from a survey carried out in the Masai Mara ecosystem (Mara) of Kenya, with a focus on three species: elephant (Loxodonta africana), kongoni (Alcelaphus buselaphus) and wildebeest (Connochaetes taurinus). The sampling design's more efficient estimates show an improvement on those from conventional systematic design, with a greater than 10 times reduction in estimated bias and a 37% lowering of the standard error. The adaptive design, however, underestimates population totals for species in large herds, while a multivariate extension gives only marginal improvements.

Optimization of a monitoring network for sulfur dioxide

In this study, we develop and apply a methodology to reduce an existing monitoring network to find an optimal configuration of a smaller network. We use a criterion based on locally weighted regression with two different weight functions. The methodology is applied to the Dutch national SO2 network and offers the possibility to include different politically relevant options in the model by weight criteria. Because full enumeration of all monitoring networks is impossible, a combinatorial search algorithm is applied to find a (sub)optimal solution. If different (optimal) monitoring networks result from different criteria, then the best can be selected.

Synthesis and characterization of 2D and 3D structures from organic derivatives of polyoxometalate clusters: role of organic moiety, counterion, and solvent

New organic derivatives of "inverse-Keggin" polyoxometalate (POM) clusters, [Mo(12)O(46)(AsR)(4)](4-) (R = C(6)H(4)-4-COOH, C(6)H(3)-4-OH-3-NO(2), C(6)H(4)-4-OH), have been synthesized. Structures of the corresponding sodium or iron salts were elucidated by single-crystal X-ray diffraction and shown to be 3D structures connected through hydrogen bonds and/or O-Na-O linkages. Parameters which influence the final solid-state architecture, such as the crystallizing solvent, organic moiety, and counterions, have been examined. The hydrogen-bonding ability of the solvent affects the connectivity of the POM clusters through interactions with the organic group and the inorganic core. The organic groups influence the structure through hydrogen bonds to other organic groups, to neighboring clusters, and/or to solvent molecules. Hydrogen bonding between the organic groups and the solvent appears to inhibit some possible connectivity patterns, such as the hydrogen-bonded dimerization of carboxylic acid groups. Na(+) ions were found directly bonded to the cluster oxo ligands and provided linkages between clusters. Larger cations, such as transition metals, did not show this interaction, and other bonding methods dominated.

Trimethoprim-sulfamethoxazole (TMP-SMZ) dose escalation versus direct rechallenge for Pneumocystis Carinii pneumonia prophylaxis in human immunodeficiency virus-infected patients with previous adverse reaction to TMP-SMZ

Trimethoprim-sulfamethoxazole (TMP-SMZ) is the most effective Pneumocystis carinii pneumonia (PCP) prophylactic agent, but adverse reactions are common among human immunodeficiency virus (HIV)-infected patients and limit its use. This randomized, double-blind controlled trial compared 2 methods of TMP-SMZ reintroduction, 6-day dose escalation and direct rechallenge, for PCP prophylaxis in HIV-infected patients who had experienced previous treatment-limiting reactions. The primary end point was the ability to take single-strength TMP-SMZ daily for 6 months. Seventy-five percent of the dose-escalation group and 57% of the direct-rechallenge group continued to receive daily single-strength TMP-SMZ for 6 months (P= .014). Among premature discontinuations, 58% of the dose-escalation group and 70% of the direct-rechallenge group were due to adverse reactions. None of these reactions was serious. This study provides evidence that it is possible to successfully reintroduce TMP-SMZ to a significant proportion of HIV-infected patients who have experienced mild-to-moderate treatment-limiting adverse reactions.

New modality for treatment of resistant anastomotic strictures after radical prostatectomy: UroLume urethral stent

A new approach for the treatment of vesicourethral anastomotic stricture after radical retropubic prostatectomy is presented. The patient had failed treatment with bougies, balloon dilation, and cold-knife incision of the anastomotic area. Transurethral resection of the bladder neck resulted in a rapid recurrence of the stricture. He was successfully treated with insertion of a UroLume urethral stent. After 18 months of follow-up, the patient is symptom free.

Geochemistry of Bulgarian soils in villages affected and not affected by Balkan endemic nephropathy: a pilot study

Balkan endemic nephropathy (BEN) is a chronic tubulointerstitial disease whose mosaic-like distribution throughout the Balkans has not changed significantly since its initial description. In this study, we explored the hypothesis that the occurrence of BEN is linked with the environmental geochemistry of villages. Soil samples were collected from BEN and non-BEN villages in the Vratza region of Bulgaria. Samples were digested in nitric acid and analyzed for 22 elements by hexapole, inductively coupled plasma, and mass spectrometry. Selected results are that: 1) absolute concentrations from both types of villages were not enriched above "background" concentrations; and 2) copper, molybdenum, lead, and cadmium concentrations were higher in BEN than in non-BEN soils, while selenium concentrations were lower. Although geochemical differences between BEN and non-BEN villages were found, not all differences were statistically significant, in part due to a limited number of samples.

Telomerase activity and cytokeratin 20 as markers for the detection and followup of transitional cell carcinoma: an unfulfilled promise

PURPOSE

Telomerase activity compensates for the erosion of chromosomes and it has been detected in a wide variety of human tumors. Cytokeratin 20, an intermediate filament of epithelial cells, is expressed particularly in the urinary tract. These 2 molecules are candidates to become markers for the detection and followup of bladder carcinoma. We evaluate whether each molecule may serve as a potential marker and whether the 2 combined would improve the detection or followup of bladder carcinoma in a noninvasive manner.

MATERIALS AND METHODS

We obtained 44 morning urine samples from patients with transitional cell carcinoma patients and 26 from age matched patients with a wide variety of clinical disorders but no malignancy of any kind. A telomerase polymerase chain reaction-enzyme-linked immunosorbent assay kit was used to determine telomerase activity and cytokeratin 20 expression was determined by nested reverse transcriptase-polymerase chain reaction.

RESULTS

All samples tested positive for cytokeratin 8 expression, which verified epithelial cells in the urine samples. Of the 44 transitional cell carcinoma cases of all stages and grades 37 (84.1%) were positive for telomerase activity, 36 (81.8%) were positive for cytokeratin 20 expression and 65.9% were double positive. Of the 29 controls with various clinical conditions other that malignancy 22 (75.9%) were positive for telomerase activity, 13 (44.83%) were positive for cytokeratin 20 expression and 34.6% were double positive.

CONCLUSIONS

Telomerase activity and cytokeratin 20 expression are not specific for malignancy and may be detected in many nonmalignant pathological conditions. Therefore, their use as potential markers of bladder carcinoma should be carefully reevaluated.

Clinical and psychological course of diabetes from adolescence to young adulthood: a longitudinal cohort study

OBJECTIVE

To determine the clinical and psychological course of diabetes through adolescence and the relationship with glycemic control in young adulthood.

RESEARCH DESIGN AND METHODS

A longitudinal cohort study of adolescents recruited from the register of the outpatient pediatric diabetes clinic. A total of 76 individuals (43 male patients, 33 female patients) aged 11-18 years completed baseline assessments, and 65 individuals (86%) were reinterviewed as young adults (20-28 years of age). Longitudinal assessments were made of glycemic control (HbA(1c)), weight gain (BMI), and development of complications. Adolescents completed self-report questionnaires to assess emotional and behavioral problems as well as self-esteem. As young adults, psychological state was assessed by the Revised Clinical Interview Schedule and the self-report Brief Symptom Inventory.

RESULTS

Mean HbA(1c) levels peaked in late adolescence and were worse in female participants (average 11.1% at 18-19 years of age). The proportion of individuals who were overweight (BMI >25.0 kg/m(2)) increased during the 8-year period from 21 to 54% in female patients and from 2 to 28% in male patients. Serious diabetes-related events included death in one patient and cognitive impairment in two patients. Individuals in whom diabetic complications developed (25% of male patients and 38% of female patients) had significantly higher mean HbA(1c) levels than those without complications (difference 1.9%, 95% CI 1.1-2.7, P < 0.0001). Behavioral problems at baseline were related to higher mean HbA(1c) during the subsequent 8 years (beta = 0.15, SEM (beta) 0.04, P < 0.001, 95% CI 0.07-0.24).

CONCLUSIONS

The outcome for this cohort was generally poor. Behavioral problems in adolescence seem to be important in influencing later glycemic control.