Effect of epidermal growth factor receptor status on the outcomes of patients with metastatic gastric cancer: A pilot study

The expression of epidermal growth factor receptor (EGFR) has been linked to clinical outcome in several solid tumors. However, the clinical significance of EGFR (c-erbB1) in gastric cancer remains unclear. The present study was designed to detect the clinical implications of EGFR in the Turkish population. Paraffin-embedded tissue microarrays containing gastric cancer tissue were obtained from 30 patients. EGFR expression was detected using immunohistochemistry. The correlation of this biomarker to the clinicopathological features and survival of patients with gastric cancer was studied. The overall positivity rate of EGFR was 63.3%. EGFR expression was significantly correlated with an improved progression-free survival (PFS) and overall survival (OS) rate (P=0.039 and 0.01, respectively). EGFR expression is a good prognostic marker for patients with gastric cancer.

Pretransplant serum ferritin level may be a predictive marker for outcomes in patients having undergone allogeneic hematopoietic stem cell transplantation

Iron overload increases the risk of infections, veno-occlusive disease and hepatic dysfunction in post-transplant period. Our objective was to investigate the association of pre-transplant ferritin levels with complications and survival after allogeneic hematopoietic stem cell transplantation (alloHSCT).We retrospectively analysed 84 patients' data who had undergone allogeneic HSCT into two groups: patients with a serum ferritin level ≥ 1000 ng/ml, and patients with <1000 ng/ml at the time of HSCT.Cox-regression analysis showed that pre-transplant serum ferritin levels were significantly higher in patients who had at least one infectious event compared with those who had no any infectious event in the post-transplant 100 days (p<0.023). Overall survival (OS) and disease-free survival (DFS) rates were significantly higher in patients with a time-to-tx interval 12 months (p=0.002 and p=0.008 respectively). A higher risk of death was observed in high-ferritin group (hazard ratio=2.27, CI:1.01-5.09, p=0.023 for OS and hazard ratio=2.49, CI:1.12-5.53 p=0.039 for DFS). No significant effect on OS and DFS among groups was observed for variables conditioning regimen, gender and diagnosis. Acute GVHD was more common in patients with a ferritin level ≥ 1000 ng /mL, but this was not statistically significant (p>0.05). There was no statistical significance in both groups (ferritin ≥ 1000 ng /mL and ferritin <1000 ng/mL) for relapse rates (p>0.05). Platelet and neutrophil engaftment day was not found statistically significant compared with both groups (p=0.273 and p=0.882, respectively). Pre-transplant ferritin levels may predict poor outcomes in patients who had undergone allogeneic hematopoietic stem cell transplantation.

Analytic performance of bacteriuria and leukocyturia obtained by UriSed in culture positive urinary tract infections

BACKGROUND

Urine analysis is one of the most common tests for assessing urinary-tract infections, which are the most frequently occurring infectious diseases in community populations. Urine culture is still the 'gold standard' for the detection of urinary tract infection, however, it is time- and labor-intensive and and has a high number of unnecessary cultures. The aim of this study was to evaluate the analytical and diagnostic performance of a new urinalysis system LabUMat with UriSed (77 Elektronika, Budapest, Hungary) in comparison to urine culture as the reference method.

METHODS

By comparing the test results for 965 urine samples with quantitative urine cultures, we established cutoff criteria for the UriSed. The cut-off values by the receiver operating characteristic (ROC) curve technique, sensitivity, and specificity were calculated for bacteria (BACT) and white blood cells (WBCs).

RESULTS

A bacterial cutoff value of 375/microL provided the best discrimination for community-acquired urinary tract infection, with a sensitivity of 96.5% and a specificity of 82.1% compared with 182 urine culture positive samples (AUC: 0.939). It was possible to forgo 62.6% of cultures with only 8 false-negative results. The best cut-off value for WBCs was 13/microL. When we used an algorithm in which the combination with the positivity for 85 BACT/microL and for 13 WBCs/microL count, the sensitivity and NPV improved to 99.8% and 100%, respectively, but the specificity declined from 78.8% to 52.0%.

CONCLUSIONS

When screening with the UriSed for community-acquired urinary tract infection, a cut-off value of 85 bacteria/microL and 13 WBCs/microL should be adopted. Diagnostic performance of UriSed is satisfactory and use of this instrument is a reliable method for screening out a major part of the culture negative samples. It would improve the efficiency of microbiology laboratory, and unnecessary antibiotic prescriptions could be reduced.

Tecto-cerebellar dysraphism with occipital encephalocele: not a distinct disorder, but part of the Joubert syndrome spectrum?

Magnetic resonance imaging (MRI) and diffusion tensor imaging (DTI) findings in a 4-year-old child with occipital encephalocele, cerebellar vermis hypogenesis, and tectal malformation are presented. The neuroimaging findings are reminiscent of tectocerebellar dysraphism with an occipital encephalocele (TCD-OE). Additionally, elongated, thickened, and horizontally orientated superior cerebellar peduncles, an abnormally deepened interpeduncular fossa, subependymal heterotopia, and focal cortical dysplasia were noted. Color-coded fractional anisotropy (FA) maps revealed an absence of the decussation of the superior cerebellar peduncles. These findings are highly suggestive of Joubert syndrome and related disorders (JSRD). Our report and the review of the published cases suggest that TCD-OE is not a nosological entity, but may represent the structural manifestation of heterogeneous disorders such as the JSRD spectrum. DTI may be very helpful to differentiate between similar midbrain-hindbrain malformations.

The antimicrobial peptide DEFB1 is associated with caries

Genetics is an important component in the determination of individual susceptibility to caries and periodontal diseases. Since beta defensin 1 (DEFB1) localizes in the oral cavity, we tested if variation in DEFB1 is associated with caries and periodontitis. We analyzed 3 single-nucleotide polymorphisms in DEFB1 in DNA samples from unrelated individuals. Carrying a copy of the variant allele of the DEFB1 marker rs11362 (G-20A) increased the DMFT and DMFS scores more than five-fold. Also, carrying a copy of the variant allele of the DEFB1 marker rs179946 (G-52A) correlated with low DMFT scores. We found a high-caries-experience haplotype (GCA), which increased DMFT scores two-fold, and a low- caries-experience haplotype (ACG), which decreased DMFT scores two-fold, in the DEFB1 promoter. No association between DEFB1 genetic markers and periodontal disease was found. Our results suggest that functional polymorphisms of DEFB1 are potential markers for caries.

MRI of the corpus callosum in multiple sclerosis: association with disability

Inflammatory demyelination and axon damage in the corpus callosum are prominent features of multiple sclerosis (MS) and may partially account for impaired performance on complex tasks. The objective of this article was to characterize quantitative callosal MRI abnormalities and their association with disability. In 69 participants with MS and 29 healthy volunteers, lesional and extralesional callosal MRI indices were estimated via diffusion tensor tractography. expanded disability status scale (EDSS) and MS functional composite (MSFC) scores were recorded in 53 of the participants with MS. All tested callosal MRI indices were diffusely abnormal in MS. EDSS score was correlated only with age (r = 0.51). Scores on the overall MSFC and its paced serial auditory addition test (PASAT) and 9-hole peg test components were correlated with callosal fractional anisotropy (r = 0.27, 0.35, and 0.31, respectively) and perpendicular diffusivity (r = -0.29, -0.30, and -0.31) but not with overall callosal volume or callosal lesion volume; the PASAT score was more weakly correlated with callosal magnetization-transfer ratio (r = 0.21). Anterior callosal abnormalities were associated with impaired PASAT performance and posterior abnormalities with slow performance on the 9-hole peg test. In conclusion, abnormalities in the corpus callosum can be assessed with quantitative MRI and are associated with cognitive and complex upper-extremity dysfunction in MS.

Proton MR spectroscopy correlates of frontal lobe function in healthy children

BACKGROUND AND PURPOSE

Neuroimaging methods have been used to improve our understanding of the topographic organization of the brain. In our study, proton (1)H-MR spectroscopic imaging was used to evaluate frontal lobe function. The goal was to determine the relationship between neuropsychological measures of frontal lobe function and levels of a surrogate neuronal marker, N-acetylaspartate (NAA), in typically developing healthy children and adolescents.

MATERIALS AND METHODS

Fifty-one healthy children (25 girls; 6.2-18.3 years of age; mean age, 12.3 +/- 3.6 years) were examined. All children completed a neuropsychological assessment including measures of attention, executive function, memory, language, and visual and motor skills. (1)H-MR spectroscopic imaging was performed by using a multisection spin-echo sequence at 1.5T. General linear model analysis of covariance was used to examine the relationship between the neuropsychological test scores and NAA/creatine (Cr) ratios, controlling for age and sex.

RESULTS

A positive relationship between frontal lobe white matter NAA/Cr ratio and performance on 2 neuropsychological tests associated with frontal lobe function was detected. The Purdue Pegboard right-hand scores were higher with increasing NAA/Cr in the left frontal white matter (P = .047), and Stanford-Binet-IV "Bead Memory" scores improved with increasing NAA/Cr ratio in the right frontal white matter (P = .032).

CONCLUSIONS

An association between frontal white matter NAA/Cr ratios and 1) measures of manual speed and dexterity, and 2) visual working memory was detected. Our data may provide a quantitative basis for assessment of frontal lobe impairments in disease states.

The relationship between sleep duration and obesity in Turkish children and adolescents

AIM

To determine the relationship between sleep duration and obesity in Turkish children and adolescents.

METHODS

This study was conducted in Turkey with 5358 children aged 6 to 17 years. Height, weight, waist circumference (WC), mid-upper arm circumference (MUAC), triceps skinfold thickness were measured. Body mass index (BMI), arm fat area were calculated. Self-reported sleep duration by parents were obtained.

RESULTS

As sleep duration increased, BMI, which was significantly higher in girls sleeping < or =8 h, decreased (p < 0.05). WC, MUAC, BMI were significantly higher in boys sleeping < or =8 h versus males sleeping > or =10 h. Boys sleeping < or =10 h in 6.0-17.0-years had significantly higher risk of overweight/obesity. In 6.0 to 17.0 years, the risk of overweight/obesity in boys sleeping 9-10 h, 8-9 h and < or =8 h were 1.86-, 1.74- and 2.06-times higher respectively, versus children sleeping > or =10 h (p < 0.05).

CONCLUSION

Sleep duration may be an important factor for obesity and providing > or =10 h of sleep is recommended as a prevention strategy for obesity.

Third metatarsal brown tumor with secondary hyperparathyroidism: an atypical localization

Brown tumors represent the terminal stage of the remodeling process during primary or secondary hyperparathyroidism. We report the first case of brown tumor on the third metatarsal associated with secondary hyperparathyroidism caused by vitamin D deficiency. Radiography showed an expansile tissue mass in the third metatarsal bone. The diagnosis was suggested by the clinical history and was confirmed by biochemical, radiologic, and histopathologic determinations. After intravenous therapy with calcidiol, 1g/d, her symptoms were relieved. The brown tumor showed regression and ossification during the 3 months after therapy.

Decreased thymus size in full-term newborn infants of smoking mothers

BACKGROUND

Prenatal exposure to tobacco can have significant effects on infants. The objective was to investigate whether maternal smoking affects the size of the thymus.

MATERIAL/METHODS

A group of 50 pregnant women who smoked throughout pregnancy and a control group of 92 non-smoking pregnant women were studied. The full-term newborn babies' length, weight, and head circumference were measured. The size of the thymus was assessed by sonography during the first six hours of life in both the study group and the control group newborns.

RESULTS

The results of the anthropometric measurements in respect of length (50.36+/-2.27, 50.15+/-1.40 cm, p=0.51), weight (3.43+/-5.13, 3.57+/-4.38 kg, p=0.07), head circumference (34.47+/-1.22, 34.57+/-0.93 cm, p=0.62), and head circumference/weight ratio ((9.94+/-1.40, 9.79+/-1.16 cm/kg, p=0.50) were not significantly different between the patient and control groups, respectively. The thymic index (Ti) and thymic index/weight ratio (Ti/w) of the newborns of the smoking group were lower than in the controls (8.70+/-5.80 vs. 13.26+/-5.46, p<0.001 and 2.47+/-1.55 vs. 3.69+/-1.43, p<0.001, respectively). Moreover, the birth weight, head circumference/weight ratio, Ti, and Ti/w of the newborns of those smoking more than 10 cigarettes per day were significantly lower than those smoking less than 10 (3.08+/-0.55 vs. 3.58+/-0.45, p<0.001; 10.65+/-1.84 vs. 9.67+/-1.11, p=0.03; 5.95+/-4 vs. 10.25+/-6.12, p=0.01; and 1.82+/-1.08 vs. 2.84+/-1.66, p=0.02, respectively).

CONCLUSIONS

These results show that smoking while pregnant has a significant effect on the general involution of the newborn and size of the thymus, which plays an important role in the immune system.

Oesophageal aspergillosis in a case of acute lymphoblastic leukaemia successfully treated with caspofungin alone due to liposomal amphotericin B induced severe hepatotoxicity

Aspergillosis is one of the most common invasive fungal infections in immunocompromised patients. Sinonasal region and upper respiratory tract are commonly involved regions whereas oesophagus is seldom involved. We present an 18-year-old male with acute lymphoblastic leukaemia with aspergillosis of oesophagus which is a rare region of involvement. The diagnosis was confirmed by the examination of the cultures of endoscopic biopsy material. The patient was already receiving empirical liposomal amphotericin B, due to severe hepatotoxicity the therapy was switched to another antifungal (caspofungin). Here we report a case of successful treatment of invasive oesophageal aspergillosis by caspofungin.

Initial temporary misdiagnosis of bronchiectasis following pumpkin seed aspiration

Undiagnosed and retained foreign bodies may result in serious complications such as pneumonia, atelectasis, or bronchiectasis. In this report, the authors present a rare case of temporary bronchiectasis of the left lung due to a long-standing retained foreign body in a child. Interestingly, the whole left lung was affected due to the check valve type of obstruction of the main bronchus. Unexpected, unilateral findings on a chest x-ray or a CT scan could be related to an inhaled foreign body, and any delay in making the diagnosis may result in serious complications.

Regional differences in diffusion tensor imaging measurements: assessment of intrarater and interrater variability

BACKGROUND AND PURPOSE

Diffusion tensor imaging (DTI) has become a valuable tool in both the research and clinical evaluation of subjects. We sought to quantify interobserver and intraobserver variability of diffusivity and diffusion anisotropy measurements with regard to specific regions of interest (ROIs).

MATERIALS AND METHODS

The subject group consisted of 5 healthy control subjects and 7 study subjects (all males; 16-19 years old; mean age = 17.5 years), as part of a protocol for closed head injury. Two whole-brain DTI scans were acquired on a 3T scanner for each subject. Analysis was performed using a ROI approach. Two independent observers analyzed the apparent diffusion coefficient (ADC) and fractional anisotropy (FA) indices in the corpus callosum, cortical spinal tract, internal capsules (ICs), basal ganglia, and centrum semiovale (CSO). Intraobserver and interobserver variability were calculated for the mean ADC, FA, and ordered eigenvalues of the diffusion tensor (lambda(1), lambda(2), and lambda(3)).

RESULTS

The overall kappa statistic for intraobserver variability for both observers showed slight-to-substantial agreement (kappa = 0.02-0.69), however FA values in the CSO showed only slight agreement. Interobserver agreement was also slight to substantial for these DTI measurements with high variability in FA values in the IC and CSO.

CONCLUSIONS

When one is comparing 2 DTI measurements, it is important to assess intraobserver and interobserver variability. We recommend caution in the analysis of DTI contrasts in the IC and CSO, because we have found the widest range of variability in measurements within these structures.

Effect of ongoing inflammation in rheumatoid arthritis on P-wave dispersion

It has been emphasized recently that there is a strong association between atrial fibrillation and inflammation. Rheumatoid arthritis (RA), characterized by ongoing inflammatory activity, can increase the risk of atrial arrhythmia. P-wave dispersion has been encountered as a risk factor for atrial fibrillation and the effect of inflammation on P-wave dispersion has not been studied thoroughly. The aim of this study was to examine the effect of ongoing inflammatory activity in RA on P-wave dispersion. The study comprised 82 patients diagnosed with RA and 41 healthy volunteers as controls. Systolic functions of all participants were evaluated by echocardiography. Maximum P-wave duration and dispersion were calculated and found to be significantly increased in the RA group compared with the healthy controls. These parameters were also significantly correlated with C-reactive protein levels. The findings of this study suggest that RA may be associated with increases in P-wave dispersion and maximum P-wave duration, and that this association may result from ongoing inflammation.