Colorectal cancer in women: an equal opportunity disease

Colorectal cancer is the second leading cause of cancer-related deaths in developed countries. For women, it is the third leading cause of cancer-related deaths behind lung and breast cancers. Women have the same risk as men, and the lifetime risk of the development of colorectal cancer is 6%. One in 17 woman will have colorectal cancer diagnosed. There are risk factors unique to women, including gynecologic cancers, and treatment of gynecologic cancers, as well as delayed diagnosis in pregnancy. Fortunately, colorectal cancer is a preventable disease, as almost all colorectal cancers arise from premalignant polyps. Colorectal cancer screening is recommended in asymptomatic women aged 50 years and older who are at average risk. Screening and surveillance for colorectal cancer in women are important to improve the morbidity and mortality rates of this preventable disease.

Relative efficacy of DEPA and neem oil for repellent activity against Phlebotomus papatasi, the vector of leishmaniasis

The insect repellent N, N-diethylphenyl acetamide (DEPA) was compared with neem oil, a commercial preparation, for protection against 3 day old un-fed female of the sandfly, Phlebotomus papatasi, (Diptera: Psychodidae) under laboratory conditions on mouse. The percentage protection against sandfly bite provided by neem oil was significantly higher than DEPA when applied at 1% and 2% concentrations (p = 0.000, t = 21.474; df = 6 and p = 0.001, t = 5.960; df = 6 respectively). However, neem oil did not show any significant difference with DEPA at 5% (p = 0.1682, t = 0.15667; df = 6). This clearly indicates that at higher concentration (5%) both neem oil and DEPA exhibited similar repellent action against P. papatasi.

Alternative roles for interferon-gamma in the immune response to DNA vaccines encoding related melanosomal antigens

Tyrosinase-related proteins-1 and -2 (gp75/TRP-1 and TRP-2) are melanosomal membrane glycoproteins recognized by antibodies and T-cells from patients with melanoma. Xenogeneic DNA immunization against gp75/TRP-1 generates antibody-dependent tumor immunity and autoimmune depigmentation. In contrast xenogeneic TRP-2 DNA immunization induces immunity mediated by CD8+ T-cells. The role of IFN-gamma in the generation of tumor immunity and autoimmune depigmentation in these two models was investigated. No tumor protection and minimal depigmentation was observed after immunization with human TRP-2 DNA in mice deficient in IFN-gamma ligand. Repletion with recombinant murine IFN-gamma restored tumor immunity. Experiments using IL4 deficient mice demonstrated that tumor immunity was unaffected but that autoimmune depigmentation was potentially accelerated, consistent with down-modulation of autoimmunity against TRP-2 by IL4. In contrast, IFN-gamma was not required for the generation of immunity to gp75/TRP-1. In fact, exogenous IFN-gamma ablated autoantibody responses against gp75/TRP-1 after xenogeneic DNA immunization, consistent with a down-regulatory effect of IFN-gamma. These results show that immunity to TRP-2 following DNA immunization uses an IFN-gamma-dependent Th1 pathway, but immunity to gp75/TRP-1 is down-regulated by IFN-gamma.

Intracellular expression of the truncated extracellular domain of c-erbB-3/HER3

The ERBB3 gene is expressed as a 6.2- and a 1.4-kb transcript. The former encodes the full-length transmembrane protein and the latter a truncated extracellular fragment consisting of 140 amino acids of the c-erbB-3 protein followed by 43 unique residues. We have examined the expression of the two ERBB3 transcripts by Northern blotting in cancer cell lines and normal human fetal and adult tissues. We expressed the truncated receptor fragment and showed that it was glycosylated, probably with a single N-linked complex sugar chain, and that the protein was a 58-kDa disulphide-linked dimer. We were able to crosslink iodinated neuregulin (NRG)-1beta to the full-length solubilised receptor but not to the truncated dimeric protein. Using Western blot analysis, the truncated protein was shown to be present in cell lysates and, using immunoelectron microscopy, in vesicular structures within cells and associated with the plasma cell membrane.

Ultrafast diffraction and structural dynamics: the nature of complex molecules far from equilibrium

Studies of molecular structures at or near their equilibrium configurations have long provided information on their geometry in terms of bond distances and angles. Far-from-equilibrium structures are relatively unknown-especially for complex systems-and generally, neither their dynamics nor their average geometries can be extrapolated from equilibrium values. For such nonequilibrium structures, vibrational amplitudes and bond distances play a central role in phenomena such as energy redistribution and chemical reactivity. Ultrafast electron diffraction, which was developed to study transient molecular structures, provides a direct method for probing the nature of complex molecules far from equilibrium. Here we present our ultrafast electron diffraction observations of transient structures for two cyclic hydrocarbons. At high internal energies of approximately 4 eV, these molecules display markedly different behavior. For 1,3,5-cycloheptatriene, excitation results in the formation of hot ground-state structures with bond distances similar to those of the initial structure, but with nearly three times the average vibrational amplitude. Energy is redistributed within 5 ps, but with a negative temperature characterizing the nonequilibrium population. In contrast, the ring-opening reaction of 1,3-cyclohexadiene is shown to result in hot structures with a CC bond distance of over 1.7 A, which is 0.2 A away from any expected equilibrium value. Even up to 400 ps, energy remains trapped in large-amplitude motions comprised of torsion and asymmetric stretching. These studies promise a new direction for studying structural dynamics in nonequilibrium complex systems.

Simultaneous intraesophageal impedance and pH measurement of acid and nonacid gastroesophageal reflux: effect of omeprazole

BACKGROUND & AIMS

Nonacid reflux may explain symptoms in acid-suppressed patients. Simultaneous intraesophageal impedance and pH measurement was used to evaluate the frequencies of postprandial acid and nonacid reflux before and after omeprazole administration.

METHODS

Twelve heartburn patients underwent two 2-hour studies of intraesophageal impedance and pH in the right lateral decubitus position after a refluxogenic meal; session 1 without medication, session 2 after 7 days of omeprazole twice daily. Acid and nonacid reflux were quantified.

RESULTS

Two hundred seventeen reflux episodes were detected before and 261 after omeprazole treatment (P > 0.05). Percentage of acid reflux decreased (from 45% to 3%, P = 0.02) and nonacid reflux increased (from 55% to 97%, P = 0.03) after omeprazole. Heartburn and acid taste were more commonly linked to acid reflux but were also produced by nonacid reflux. Regurgitation was reported equally in acid and nonacid reflux. Delta(pH) > 1 did not help predict the presence of symptoms during nonacid reflux.

CONCLUSIONS

During treatment with omeprazole, postprandial reflux becomes predominantly nonacid. Symptoms are more common with acid reflux but are also produced by nonacid reflux. Simultaneous intraesophageal impedance and pH may be useful in evaluating the role of nonacid reflux in symptoms that persist despite adequate acid suppression.

Simultaneous occurrence of inflammatory bowel disease and thyroid disease

We report a case of simultaneous occurrence of inflammatory bowel disease (IBD) and Graves' disease. A review of reported cases of simultaneous onset of ulcerative colitis (UC) and autoimmune hyperthyroidism is presented. A discussion of the prevalence of thyroid disease in patients with UC and possible common autoimmune etiology is entertained. The concurrent presentation has implications for the diagnosis and treatment of both diseases. At the time of suspected initial presentation or exacerbation or preexisting IBD, we emphasize the need to consider both IBD and thyroid disease in the differential diagnosis for optimal patient management.

Maximal acid reflux control for Barrett's oesophagus: feasible and effective

The treatment of patients with Barrett's oesophagus is controversial. Debate exists regarding the use and value of high dose acid suppression as the standard of practice. Despite prolonged use of high dose proton pump inhibitors (40 mg omeprazole, 60 mg lansoprazole), most studies have shown no convincing evidence of significant regression of Barrett's length. These studies, however, have used fixed doses of proton pump inhibitors and did not regularly document control of oesophageal acid exposure.

AIM

To determine whether regression of Barrett's epithelium can be achieved with documented maximal acid suppression.

METHODS

We have prospectively followed nine patients with Barrett's oesophagus (eight male; mean age 60 years) for more than 1 year. They were all treated using medical therapy with pH monitoring documenting oesophageal acid exposure over 24 h < 1.6% of the time, and with two or more esophagogastroduodenoscopies performed by the same endoscopist.

RESULTS

Acid control was individually tailored and achieved with proton pump inhibitor b.d. (omeprazole 20 mg or lansoprazole 30 mg) and ranitidine at bedtime (HS) (Ran) if necessary. All nine patients (100%) showed some evidence of regression. All nine patients (100%) showed a decrease in Barrett's length (mean 2 cm, range 1-3 cm). Six out of nine (66.67%) patients showed evidence of squamous islands on the last oesophagogastroduodenoscopy. The mean total distal oesophageal acid exposure was 0.38% (range: 0-1.5%). The mean follow-up of patients was 54 months (range: 13-118 months).

CONCLUSIONS

Consistent and individually tailored maximal acid suppression documented by pH-metry is achievable and may result in decreased length and development of squamous islands in patients with Barrett's epithelium. This approach should be further evaluated as potentially the preferred medical treatment for these patients.

Autoimmune hemolytic anemia in treatment-naïve chronic hepatitis C infection

Extrahepatic immunologic abnormalities have been shown to occur in patients with chronic hepatitis C virus (HCV) infection. Induction of autoimmune hemolytic anemia has been reported, either during or after interferon treatment of HCV infection. I report a 48-year-old patient with HCV infection who developed Coombs-positive autoimmune hemolytic anemia in the absence of treatment with interferon, with a review of the available literature. Other potential etiologies of autoimmune hemolytic anemia were ruled out. Prednisone therapy was instituted because of the severity of the fall in the hemoglobin. There was resolution of the hemolytic anemia and the prednisone was tapered gradually. No deterioration of the underlying HCV liver disease was evident even though an increase in HCV viremia was noted. Coombs-positive autoimmune hemolytic anemia can occur as an extrahepatic immunologic abnormality in treatment-naïve patients with chronic HCV infection.

Esophageal function testing using multichannel intraluminal impedance

Multichannel intraluminal impedance (MII) is a new technique for evaluation of bolus transport. We evaluated esophageal function using bolus transport time (BTT) and contraction wave velocity (CWV) of liquid, semisolid, and solid boluses. Ten healthy subjects underwent MII swallow evaluation with various boluses of sterile water (pH 5), applesauce, three different sized marshmallows, and iced and 130 degrees F water. The effect of bethanechol was also studied. There was no difference in BTT or CWV for all water volumes from 1 to 20 ml. There was significant linear increase of BTT with progressively larger volumes of applesauce, and BTT of applesauce was longer than for water. BTT was significantly longer with large marshmallows vs. small and medium and was longer than for water. BTT for iced water was similar to 130 degrees F water. Applesauce showed a significant linear decrease of CWV with progressively larger volumes and was slower than water. Marshmallow showed significantly slower CWV with the large vs. small, and CWV for ice water was significantly slower than 130 degrees F water. Therefore, BTT of liquid is constant, whereas BTT of semisolid and solid are volume dependent and longer than liquids. CWV of semisolids and solids are slower than liquids. CWV of cold liquids is slower than warm liquids. MII can be used as a discriminating test of esophageal function.

Direct imaging of transient molecular structures with ultrafast diffraction

Ultrafast electron diffraction (UED) has been developed to study transient structures in complex chemical reactions initiated with femtosecond laser pulses. This direct imaging of reactions was achieved using our third-generation apparatus equipped with an electron pulse (1.07 +/- 0.27 picoseconds) source, a charge-coupled device camera, and a mass spectrometer. Two prototypical gas-phase reactions were studied: the nonconcerted elimination reaction of a haloethane, wherein the structure of the intermediate was determined, and the ring opening of a cyclic hydrocarbon containing no heavy atoms. These results demonstrate the vastly improved sensitivity, resolution, and versatility of UED for studying ultrafast structural dynamics in complex molecular systems.

Stiles-Crawford effect of the first kind: assessment of photoreceptor alignments following dark patching

Properties of presumed mechanisms controlling photoreceptor alignments are partially defined. A phototropic mechanism normally dominates alignment, but do modest changes in orientations occur with dark patching? Here, new photopic Stiles-Crawford (SCE-I) determinations were made before patching (pre-patch), just after 8-days of dark-patching (post-patch), and 3 days after patch removal (recovery test). We tested at 0, 11 and 22 degrees in the temporal retina of both eyes. Ten eyes of adult subjects were tested. SCE-I peak positions and Stile's parameter 'rho' were assessed. Dark-patching effects were small. Observations revealed meaningful corrective alignment overshoots with recovery in the light. Results suggest (1) the presence of multiple weak mechanisms affecting receptor alignments in the dark; (2) the phototropic mechanism to be dominant in the light; (3) the need for multiple test loci to be sampled in such studies, and (4) small changes in the SCE-I in the pupil plane can reflect meaningful events occurring at the retina.

The Flory isolated-pair hypothesis is not valid for polypeptide chains: implications for protein folding

Using an all-atom representation, we exhaustively enumerate all sterically allowed conformations for short polyalanyl chains. Only intrachain interactions are considered, including one adjustable parameter, a favorable backbone energy (e.g., a peptide hydrogen bond). The counting is used to reevaluate Flory's isolated-pair hypothesis, the simplifying assumption that each phi,psi pair is sterically independent. This hypothesis is a conceptual linchpin in helix-coil theories and protein folding. Contrary to the hypothesis, we find that systematic local steric effects can extend beyond nearest-chain neighbors and can restrict the size of accessible conformational space significantly. As a result, the entropy price that must be paid to adopt any specific conformation is far less than previously thought.