Reciprocal regulatory interaction between human herpesvirus 8 and human immunodeficiency virus type 1

Human herpesvirus 8 (HHV8) is the primary viral etiologic agent in Kaposi's sarcoma (KS). However, individuals dually infected with both HHV8 and human immunodeficiency virus type 1 (HIV-1) show an enhanced prevalence of KS when compared with those singularly infected with HHV8. Host immune suppression conferred by HIV infection cannot wholly explain this increased presentation of KS. To better understand how HHV8 and HIV-1 might interact directly in the pathogenesis of KS, we queried for potential regulatory interactions between the two viruses. Here, we report that HHV8 and HIV-1 reciprocally up-regulate the gene expression of each other. We found that the KIE2 immediate-early gene product of HHV8 interacted synergistically with Tat in activating expression from the HIV-1 long terminal repeat. On the other hand, HIV-1 encoded Tat and Vpr proteins increased intracellular HHV8-specific expression. These results provide molecular insights correlating coinfection with HHV8 and HIV-1 with an unusually high incidence of KS.

Enteral feeding tubes: placement by using fluoroscopy and endoscopy

Fluoroscopy and endoscopy are both effective for guiding placement of enteral feeding tubes, but the relative advantages and limitations of the two methods are less clear. Consequently, we studied 104 consecutive patients referred for primary fluoroscopic placement of a Frederick-Miller feeding catheter. Success rate, fluoroscopic and room times, and tube position were determined. Unsuccessful fluoroscopic placement was followed immediately by an endoscopic attempt. The success rate for fluoroscopic placement was 90% (94/104), with the tube placed into the jejunum in 53% and into the duodenum in 47%. The fluoroscopic and room times for successful fluoroscopic placements were 8.6 +/- 5.6 min (mean +/- SD) and 21.7 +/- 8.4 min, respectively. For the 10 unsuccessful placements, the fluoroscopic and room times were 16.2 +/- 5.4 min (mean +/- SD) and 45.6 +/- 18.4 min, respectively. Both time differences were significant statistically. Endoscopic placement was successful in all seven patients in whom it was attempted, with a mean time of 13.4 min. The tubes placed endoscopically were in the jejunum in 29% and in the duodenum in 71%. Our results show that fluoroscopic and endoscopic placement of enteral feeding tubes is highly effective. Fluoroscopic time in successful cases is usually less than 15 min. Endoscopic placement of feeding tubes is successful after fluoroscopic failure.

Interpretation of abdominal CT: analysis of errors and their causes

PURPOSE

Our goal was to analyze those factors contributing to the error rate in the interpretation of abdominal CT scans at an academic medical center.

METHOD

From a total of 694 consecutive patients (329 male, 365 female), we evaluated the error rates of interpreting abdominal CT studies. The average patient age was 54 years. All abdominal CT studies were reviewed by three to five CT faculty radiologists on the morning after the studies were performed. The error rate was correlated with reader variability, the number of cases read per day, the presence of a resident, inpatient versus outpatient, organ systems, etc. The chi 2-test was used for statistical analysis.

RESULTS

A total of 56 errors were found in the reports of 53 patients (overall error rate = 7.6%). Of these errors, 19 were judged to be clinically significant and 7 affected patient management. A statistically significant difference in error rates was noted among the five faculty radiologists (3.6-16.1%, p = 0.00062). No significant correlates between error rates and any of the other variables could be established.

CONCLUSION

The primary determinant of error rates in body CT is the skill of the interpreting radiologist.

Acoustic correlates of English and French nasalized vowels

Acoustic analysis of nasalized vowels in the frequency domain indicates the presence of extra peaks: one between the first two formants with amplitude P1 and one at lower frequencies, often below the first formant, with amplitude P0. The first-formant amplitude A1 is also reduced relative to its amplitude for an oral vowel. These acoustic characteristics can be explained by speech production theory. The objective of this study was to determine the values for the acoustic correlates A1-P1 and A1-P0 (dB) for quantifying nasalization. They were tested as measures of nasalization by comparing vowels between nasal consonants and those between stop consonants for English speakers. Also, portions of nasal vowels following a stop consonant were compared for speakers of French, which makes a linguistic distinction between oral and nasal vowels. In the analysis of English, the mean difference of A1-P1 measured in oral vowels and nasalized vowels had a range of 10 dB-15 dB; the difference of A1-P0 had a range of 6 dB-8 dB. In the study of French, the difference of A1-P1 measured between the least-nasalized portion and the most-nasalized portion of the vowel had a range of 9 dB-12 dB; for A1-P0, the difference ranged between 3 dB and 9 dB. In order to obtain an absolute acoustic measure of nasalization that was independent of vowel type, normalized parameters were calculated by adjusting for the influence of the vowel formant frequencies.

Validation of the World Health Organization quality of life instrument in patients with HIV infection

We studied the reliability and validity of the World Health Organization quality of life (WHOQOL) assessment instrument in patients with human immunodeficiency virus (HIV) infection. WHOQOL-BREF was used to assess 136 HIV-infected outpatients. The results were analyzed and compared with data from 213 healthy persons. The Cronbach's alpha for internal consistency ranged from 0.74 to 0.85 across domains in HIV-infected patients. The test-retest reliability ranged from 0.64 to 0.79 across domains at average 4-week retest interval. Factor analysis identified four major factors: social, psychological, environment, and physical, consistent with the four domains of the instrument. The scores of all four domains correlated positively with self-evaluated health status and happiness (r range: 0.52-0.60 and 0.55-0.73 across domains, respectively), and correlated negatively with the number and severity of symptoms (r range: -0.40 to -0.47 and -0.41 to -0.52, respectively). The scores of physical, psychological and social domains, but not the environment domain, discriminated between healthy persons and HIV-infected patients (all p < 0.01). We conclude that the WHOQOL-BREF can be a useful quality-of-life instrument in patients with HIV infection.

Invasive amoebiasis: an emerging parasitic disease in patients infected with HIV in an area endemic for amoebic infection

OBJECTIVES

To describe the incidence and presentations of invasive amoebiasis (IA) in patients with HIV infection in an area endemic for amoebic infection and to assess the role of the indirect haemagglutination (IHA) assay in the diagnosis of IA in HIV-infected patients.

DESIGN

Retrospective study of 18 cases of IA and HIV infection.

SETTING

A university hospital, the largest centre for management of HIV-associated complications in Taiwan.

METHODS

Medical, microbiological and histopathological records of 296 HIV-infected patients and serological data of IHA assay of 126 HIV-infected patients were reviewed to identify cases of IA from 23 June 1994 to 31 March 1999. An IHA titre > or = 1 : 128 was considered positive. Clinical characteristics of HIV-infected patients with IA and without IA were compared.

RESULTS

Eighteen of the 296 patients (6.1%) with HIV infection were diagnosed with IA: 12 patients were diagnosed with definite IA and six with probable IA. The clinical manifestations included amoebic colitis (13 patients), amoebic liver abscess (nine), both colitis and abscess (four), and pleural effusion (two). IA was the initial presentation of HIV infection in nine patients. Co-infection with other enteric pathogens was diagnosed in six patients with IA. Compared with the 161 patients without IA who were newly diagnosed with HIV infection, the nine patients with IA had a higher median CD4+ lymphocyte count (202 x 10(6)/l versus 33 x 10(6)/l; P = 0.0017), were less likely to be diagnosed with AIDS (55.6% versus 85.4%; P = 0.039), and had fewer concurrent AIDS-defining illnesses (median number 0 versus 2; P = 0.003). Estimated mean survival duration was not significantly different between the two groups (597 days versus 611 days). Fourteen out of 126 patients (11.1%) had an IHA titre > or = 1 : 128. Of the 18 patients diagnosed with IA, 13 had a titre > or = 1 : 128. The sensitivity of IHA assay in the diagnosis of IA was 72.2% (13 out of 18) and the specificity was 99.1% (107 out of 108). The positive predictive value of IHA test for IA of this patient population was 92.9% (13 out of 14) whereas the negative predictive value was 95.5% (107 out of 112).

CONCLUSION

IA is an increasingly important parasitic disease among patients with HIV infection in Taiwan. IHA assay has a good specificity and high negative predictive value in diagnosis of IA.

Assessment of rectal tumor infiltration utilizing endorectal MR imaging and comparison with endoscopic rectal sonography

BACKGROUND

The preoperative assessment of depth of invasion of rectal carcinoma is increasingly important as new treatment methodologies are developed. Accuracy of preoperative endorectal MR imaging was therefore compared with that of the endoscopic rectal sonography in determining depth of invasion of rectal carcinomas.

METHOD

From March 1993 to April 1994, 10 consecutive patients with biopsy-proven rectal carcinomas were imaged with both endorectal MR imaging and endoscopic rectal sonography. These two studies were performed an average of 2.7 days apart in each patient. All 10 patients had surgical resection of the rectal carcinoma within days of imaging studies. TNM staging of each malignant lesion was correlated with the imaging reports.

RESULT

Staging accuracy was 80% for endorectal MR imaging and 70% for endoscopic rectal sonography. With MR imaging, one T2 lesion was overstaged and one T3 lesion was understaged. With sonography, two T2 lesions were overstaged and one T3 lesion was understaged. One MR error resulted from misinterpretation. All other staging errors occurred in patients with tumor spread into, but not through, the muscularis propria or with microscopic spread through this layer.

CONCLUSIONS

Endorectal MR imaging and endoscopic rectal sonography have similar accuracy for assessing depth of invasion of rectal carcinoma.

Validity of CT classification on management of occult pneumothorax: a prospective study

OBJECTIVE

In the setting of blunt trauma, abdominal CT, which routinely includes images of the lower thorax, frequently reveals pneumothoraces that have not been detected on routine supine chest radiographs. Proper management of these occult pneumothoraces remains controversial. The purpose of this study was to test the hypothesis that small (minuscule) to moderate (anterior) radiographically occult pneumothoraces can be safely managed without chest tube placement for patients in whom the need for positive pressure ventilation is not anticipated.

SUBJECTS AND METHODS

We undertook a prospective study in which 44 occult pneumothoraces were classified into three groups, minuscule, anterior, or anterolateral, according to size and location on CT scans. Choice of initial management (tube thoracostomy versus close observation) was based in part on this classification system and in part on individual circumstances of a surgeon's decision.

RESULTS

Of the 44 pneumothoraces found in 36 patients, 16 pneumothoraces were minuscule, 20 were anterior, and eight were anterolateral. Thirteen minuscule pneumothoraces and 11 anterior pneumothoraces initially managed with observation did not require subsequent tube thoracostomy. All eight patients with anterolateral pneumothoraces underwent tube thoracostomy.

CONCLUSION

Most small (minuscule) occult pneumothoraces can successfully be managed with close observation. The risk that the pneumothorax will progress is slight. Moderate-sized (anterior) pneumothoraces may also be successfully managed without initial placement of a chest tube if the patient is not to undergo positive pressure ventilation.

Pharmacological exploitation of the phenothiazine antipsychotics to develop novel antitumor agents-A drug repurposing strategy

Phenothiazines (PTZs) have been used for the antipsychotic drugs for centuries. However, some of these PTZs have been reported to exhibit antitumor effects by targeting various signaling pathways in vitro and in vivo. Thus, this study was aimed at exploiting trifluoperazine, one of PTZs, to develop potent antitumor agents. This effort culminated in A4 [10-(3-(piperazin-1-yl)propyl)-2-(trifluoromethyl)-10H-phenothiazine] which exhibited multi-fold higher apoptosis-inducing activity than the parent compound in oral cancer cells. Compared to trifluoperazine, A4 demonstrated similar regulation on the phosphorylation or expression of multiple molecular targets including Akt, p38, and ERK. In addition, A4 induced autophagy, as evidenced by increased expression of the autophagy biomarkers LC3B-II and Atg5, and autophagosomes formation. The antitumor activity of A4 also related to production of reactive oxygen species and adenosine monophosphate-activated protein kinase. Importantly, the antitumor utility of A4 was extended in vivo as it, administrated at 10 and 20 mg/kg intraperitoneally, suppressed the growth of Ca922 xenograft tumors. In conclusion, the ability of A4 to target diverse aspects of cancer cell growth suggests its value in oral cancer therapy.

Heat shock protein 72 overexpression protects against hyperthermia, circulatory shock, and cerebral ischemia during heatstroke

This study extends our earlier studies in rats by applying our heatstroke model to a new species. Additionally, transgenic mice are used to examine the role of heat shock protein (HSP) 72 in experimental heatstroke. Transgenic mice that were heterozygous for a porcine HSP70i gene ([+]HSP72), transgene-negative littermate controls ([−]HSP72), and normal Institute of Cancer Research strain mice (ICR) under pentobarbital sodium anesthesia were subjected to heat stress (40°C) to induce heatstroke. In [−]HSP72 or ICR, the values for mean arterial pressure, the striatal blood flow, and the striatal Po2after the onset of heatstroke were significantly lower than those in preheat controls. The core and brain temperatures, the extracellular concentrations of ischemic and injury markers in the striatum, and the striatal neuronal damage scores were significantly greater than those in the preheat controls. In [−]HSP72 or ICR, the body temperatures, cell ischemia content, and injury marker in the striatum were significantly higher, and the mean arterial pressure, striatal blood flow, and striatal Po2concentration were significantly lower during heatstroke than in [+]HSP72. Accordingly, the latency and the survival times for [+]HSP72 significantly exceeded those of [−]HSP72 or ICR. These results demonstrate that the overexpression of HSP72 in multiple organs improves survival during heatstroke by reducing hyperthermia, circulatory shock, and cerebral ischemia and damage in mice.

Measurement of synovial tumor necrosis factor-alpha in diagnosing emergency patients with bacterial arthritis

Because of the high morbidity and mortality in patients with bacterial arthritis, rapidly and correctly diagnosing this critical condition is a challenge to emergency clinicians. Synovial fluid samples were obtained from 75 patients with arthritis disorders who presented to an emergency service, and levels of tumor necrosis factor-alpha (TNF-alpha), interleukin-1 beta (IL-1 beta), and interleukin-6 (IL-6) were measured. Twenty patients with culture-proven bacterial arthritis had higher levels of synovial TNF-alpha than patients with osteoarthritis or with inflammatory arthritis, including gouty arthritis, rheumatoid arthritis, reactive arthritis, and lupus arthritis. There was a good sensitivity for synovial TNF-alpha level in diagnosing patients with bacterial arthritis. Nearly 100% of patients with bacterial arthritis had elevated synovial TNF-alpha levels. However, synovial IL-1 beta and IL-6 levels failed to discriminate bacterial arthritis from other inflammatory arthritis. Measurement of synovial TNF-alpha level may be useful as a diagnostic aid in emergency patients with bacterial arthritis disorders.

Functional abnormalities of the esophagus: a prospective analysis of radiographic findings relative to age and symptoms

OBJECTIVE

The prevalence and severity of functional abnormalities of the esophagus seen on fluoroscopic examination were compared with the age and symptoms of the patients.

SUBJECTS AND METHODS

The esophagus was examined radiographically in 139 consecutive outpatients 19-84 years old. All patients completed a data sheet about their symptoms, and medical records were reviewed to determine the main indication for the examination. Videofluoroscopy was used to evaluate primary peristalsis, proximal escape, and tertiary activity in the esophagus. The severity of proximal escape and activity was classified.

RESULTS

Patients were categorized into three age groups: 39 years old or younger (n = 33); from 40 to 60 years old (n = 55); and 61 years old or older (n = 51). Abnormal esophageal motility, defined as disruption of peristalsis on two or more of five swallows, was found in 24% of patients 39 years old or younger, 36% of patients from 40 to 60 years old, and in 49% of patients 61 years old or older (p > .05). However, evaluation of the number of disrupted peristaltic swallows by age revealed 18% abnormal swallows in patients 39 years old or older, 27% in patients from 40 to 60 years old, and 37% in patients 61 years old or older (p < .01). Proximal escape and tertiary contractions increased significantly with the age of the patient. Regardless of age, proximal escape was seen in 79% of swallows and tertiary contractions were seen in 48% of swallows with disrupted peristalsis. The prevalence and severity of proximal escape and tertiary contractions increased in the older patients. Symptoms had no correlation with status of esophageal motility (p > .05). In 22 patients with secondary diseases, including rheumatoid arthritis and diabetes mellitus, those diseases showed no correlation with the status of esophageal motility.

CONCLUSION

The prevalence of functional abnormalities of the esophagus increased with age. Most patients with abnormal swallows showed proximal escape with or without tertiary activity. Patients' symptoms and other diseases did not correlate with the status of their esophageal motility.

Oropharynx in patients with cerebrovascular disease: evaluation with videofluoroscopy

Forty-six patients with cerebrovascular disease underwent videofluoroscopic examination of the oropharynx to assess location and severity of swallowing dysfunction with use of boluses of various consistencies. Low- and high-viscosity barium suspensions, a barium paste, and a paste-coated cookie were used; not all patients were given all materials. Thirty-nine patients had abnormalities of both oral and pharyngeal function. Two patients had oral dysfunction only, and five had pharyngeal abnormalities only. Mild swallowing difficulties occurred in 18 patients (39%), moderate dysfunction in 23 (50%), and severe dysfunction in five (11%). Thirty-one patients had pharyngeal stasis, which was symmetric in 25 patients (81%), right-sided in three, and left-sided in three. Asymmetric stasis did not correlate to the site of cerebrovascular disease. Twenty-four episodes of aspiration occurred, half of them with the low-viscosity barium suspension. Thus, video-fluoroscopy can be used to define the location and severity of oropharyngeal abnormalities, which is critical for feeding recommendations. The abnormalities present, however, were not useful in predicting the type of cerebrovascular disease.

Radiation exposure during ERCP: effect of a protective shield

OBJECTIVES

To measure the radiation exposure to endoscopists, patients, and assistants during diagnostic and therapeutic ERCP and to assess the effect of a protective lead shield. Radiation dose with and without the protective lead shield was mapped in our standard fluoroscopy room.

MATERIALS AND METHODS

Twenty patients undergoing ERCP were selected for this study. Radiation exposure of endoscopists with and without a protective shield was monitored by digital dosimeter. Radiation exposure for diagnostic procedures was correlated with that of therapeutic procedures.

RESULTS

Endoscopists were exposed to 2.5 mR without the protective shield, but exposure was reduced to an average of 0.27 mR per procedure with the shield. Endoscopists received an average of 1.5 mR per diagnostic ERCP and 3.17 mR per therapeutic ERCP without the shield. When using the protective shield, however, those numbers were reduced to an average of 0.25 mR per diagnostic procedure and 0.28 mR per therapeutic procedure. Radiation exposure to endoscopic assistants, who were not shielded, averaged 0.56 mR per procedure.

CONCLUSION

Amount of radiation exposure to occupational personnel during ERCP was related to duration of fluoroscopy and type of procedure. Radiation exposure to endoscopists can be significantly reduced by the use of a protective shield. Medical assistants received less radiation than did endoscopists because the assistant's position was more distant from x-ray sources.

Human papillomavirus genotyping by a polymerase chain reaction-based genechip method in cervical carcinoma treated with neoadjuvant chemotherapy plus radical surgery

The aim of this study was to evaluate the accuracy of human papillomavirus (HPV) genotyping by a polymerase chain reaction (PCR)-based genechip method and to determine the prognostic value of HPV genotype in bulky stage IB or IIA cervical carcinoma treated with neoadjuvant chemotherapy (NAC) and radical surgery. A total of 149 patients had adequate tissue for the study. The SPF1/GP6+ primers were used to amplify a 184 bp fragment. The amplimers were submitted for direct sequencing and hybridization with a genechip using revert-blot detection of 39 types of HPV DNA in a single reaction. Two runs of PCR with respective hybridization were performed for each tumor. The complete concordance of HPV genotyping was 80.5% (120/149) of the paired genechip results. The kappa coefficient was 0.634 (P < 0.0001). HPV DNA sequences were detected in 100% of the specimens, among which 67.8% harbored single type and 32.2% contained multiple types. HPV-16 was detected in 98.7%, HPV-18 in 22.8%, HPV-31 in 0.7%, HPV-45 in 1.3%, HPV-52 in 2.0%, HPV-58 in 6.7%, HPV-59 in 4.7%, and HPV-67 in 0.7%. In multivariate analyses, the HPV genotype [HPV-18 or HPV-16 and HPV-18 only versus all others: relative risk (RR), 2.33; 95% CI, 1.17-4.64; P = 0.016] and pre-NAC tumor size (>5 versus </=5 cm: RR, 2.25; 95% CI, 1.13-4.48; P = 0.021) were significantly related to overall survival. This PCR-based genechip method is sensitive and reproducible for HPV genotyping. The association of HPV-18 or HPV-16 and HPV-18 with poor outcome in cervical carcinoma treated with NAC plus radical surgery is confirmed.

Lower esophageal mucosal ring: correlation of referred symptoms with radiographic findings using a marshmallow bolus

OBJECTIVE

The purpose of this investigation was to determine the prevalence of lower esophageal mucosal rings and to correlate the relationship between these mucosal rings and the presence and anatomic level of symptoms evoked using a marshmallow bolus.

SUBJECTS AND METHODS

Our prospective study included 130 patients who underwent barium examination of the esophagus. All patients completed a questionnaire regarding the anatomic location of their symptoms of dysphagia. In addition to a multiphasic examination of the esophagus, all patients also underwent fluoroscopic observation and videotaping while swallowing a marshmallow bolus; any symptoms that were provoked were recorded.

RESULTS

Lower esophageal mucosal rings were shown in 26 (20%) of the 130 patients. The diameter of the rings was 9-12 mm in six patients, 13-20 mm in 18 patients, and larger than 20 mm in two patients. In 16 (62%) of the 26 patients, a marshmallow bolus became impacted at the ring; the impaction caused dysphagia in 12 (75%) of the 16 patients. In these 12 patients, dysphagia was referred to the neck in seven, the sternal angle in two, the mid chest in two, and the lower chest in one patient. None of the 12 patients had a pharyngeal or cervical esophageal abnormality that would account for their symptoms.

CONCLUSION

Because proximal referral of symptoms is common in patients with lower esophageal mucosal rings, a thorough radiographic examination of the entire esophagus and esophagogastric region is required regardless of the level of their swallowing complaints.

A randomised controlled trial comparing computer-assisted with face-to-face sexual history taking in a clinical setting

AIM

To compare computer-assisted self-interview (CASI) with routine face-to-face interview (FTFI) for sexual history taking from patients in a clinical setting.

METHODS

A randomised controlled trial was undertaken at the Melbourne Sexual Health Centre, Melbourne, Victoria, Australia, in 2005. New, walk-in patients triaged into the centre were eligible for the study. Those who consented to the study were randomly allocated (initially at a ratio of 2:1, then 1:1) to either CASI or FTFI. Those randomised to CASI also subsequently undertook FTFI.

RESULTS

During the study period, of 713 patients approached, 611 agreed to participate in the study; 356 were randomised to FTFI and 255 to CASI. Overall, the responses to questioning using CASI and FTFI were similar except that women undertaking the CASI reported a significantly higher median number of male partners for the preceding 12 months (3 v 2, p = 0.05) and the CASI participants reported previous hepatitis B vaccination more often (50% v 37%, p = 0.01). Most participants found the CASI either easy (31; 13%) or very easy (193; 82%) to complete; 83 (35%) were comfortable and 121 (51%) were very comfortable with it.

CONCLUSIONS

CASI may be a reliable, efficient and highly acceptable method for the screening of sexual risk in clinical sexual health settings and could be used routinely to improve the efficiency of clinical services.

Epigallocatechin gallate sensitizes CAL-27 human oral squamous cell carcinoma cells to the anti-metastatic effects of gefitinib (Iressa) via synergistic suppression of epidermal growth factor receptor and matrix metalloproteinase-2

Human head and neck squamous cell carcinoma (HNSCC) is a major cause of cancer-related death during the last decade due to its related metastasis and poor treatment outcomes. Gefitinib (Iressa), a tyrosine kinase inhibitor has been reported to reduce the metastatic abilities of oral cancer. Previous studies have shown that epigallocatechin gallate (EGCG), a green tea polyphenol, possesses cancer chemopreventive and anticancer activity. However, the mechanisms involved in the suppression of invasion and metastasis of human oral cancer cells following co-incubation with gefitinib and EGCG remain poorly understood. In the present study, we attempted to investigate the synergistic effects of a combined treatment of gefitinib and EGCG in CAL-27 cells in vitro and to elucidate the underlying molecular mechanisms associated with the supression of cell migration and invasion. In the present study, we found that the individual treatments or the combined treatment of gefitinib and EGCG synergistically inhibited the invasion and migration of CAL-27 cells using Transwell invasion and wound-healing scratch assays, respectively. Similarly, gefitinib in combination with EGCG synergistically attenuated enzymatic activity and the protein expression of MMP-2 in CAL-27 cells. Furthermore, individual or combined treatment with EGCG and gefitinib suppressed the protein expression of p-EGFR and the phosphorylated protein levels of ERK, JNK, p38 and AKT and displayed inhibitory effects on metastatic ability of CAL-27 cells. Combined effects of EGCG and gefitinib-altered anti-metastatic actions for related gene expression were observed using DNA microarray analysis. Importantly, EGCG sensitizes CAL-27 cells to gefitinib-suppressed phosphorylation of epidermal growth factor receptor (EGFR in vitro. Taken together, our results suggest that the synergistic suppression of the metastatic ability of CAL-27 cells after EGCG and gefitinib individual or combined treatment are mediated through mitogen-activated protein kinase (MAPK) signaling. Our novel findings provide potential insights into the mechanism involved with synergistic responses of gefitinib and EGCG against the progression of oral cancer.

Australian men who have sex with men prefer rapid oral HIV testing over conventional blood testing for HIV

This study examined the views of 172 community-based Australian men who have sex with men (MSM) on the acceptability and potential uptake of rapid oral testing for HIV in clinic and home-based settings. Men were asked to complete a questionnaire that sought their views on rapid testing for HIV. When asked about which HIV test they would prefer in a clinic setting, 64% indicated a preference for rapid oral HIV testing and 74% indicated that if rapid oral HIV testing was available at a clinic they would test for HIV more frequently. If rapid oral HIV testing was available for home testing, 63% of men indicated it would be likely they would test themselves for HIV and 61% indicated they would test more frequently. Overall, MSM expressed a preference for rapid oral HIV testing and would test more frequently if testing was available for clinic or home use in Australia.

Evaluation of the Antibacterial Potential of Liquid and Vapor Phase Phenolic Essential Oil Compounds against Oral Microorganisms

The aim of the present study was to determine the antibacterial activities of the phenolic essential oil (EO) compounds hinokitiol, carvacrol, thymol, and menthol against oral pathogens. Aggregatibacter actinomycetemcomitans, Streptococcus mutans, Methicillin-resistant Staphylococcus aureus (MRSA), and Escherichia. coli were used in this study. The minimum inhibitory concentrations (MICs), minimum bactericidal concentrations (MBCs), bacterial growth curves, temperature and pH stabilities, and synergistic effects of the liquid and vapor EO compounds were tested. The MIC/MBC of the EO compounds, ranging from the strongest to weakest, were hinokitiol (40-60 μg/mL/40-100 μg/mL), thymol (100-200 μg/mL/200-400 μg/mL), carvacrol (200-400 μg/mL/200-600 μg/mL), and menthol (500-more than 2500 μg/mL/1000-more than 2500 μg/mL). The antibacterial activities of the four EO phenolic compound based on the agar diffusion test and bacterial growth curves showed that the four EO phenolic compounds were stable under different temperatures for 24 h, but the thymol activity decreased when the temperature was higher than 80°C. The combination of liquid carvacrol with thymol did not show any synergistic effects. The activities of the vaporous carvacrol and thymol were inhibited by the presence of water. Continual violent shaking during culture enhanced the activity of menthol. Both liquid and vaporous hinokitiol were stable at different temperatures and pH conditions. The combination of vaporous hinokitiol with zinc oxide did not show synergistic effects. These results showed that the liquid and vapor phases of hinokitiol have strong anti-oral bacteria abilities. Hinokitiol has the potential to be applied in oral health care products, dental materials, and infection controls to exert antimicrobial activity.

Isoliquiritigenin as a cause of DNA damage and inhibitor of ataxia-telangiectasia mutated expression leading to G2/M phase arrest and apoptosis in oral squamous cell carcinoma

BACKGROUND

Isoliquiritigenin (ISL), a natural compound extracted from licorice, has chemopreventive and antitumor activities. The purpose of this study was to investigate the anticancer effect of ISL on human oral squamous cell carcinoma (OSCC).

METHODS

The anti-OSCC effects of ISL were evaluated using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide test, flow cytometry, reverse transcription-polymerase chain reaction, Western blotting, promoter activity, terminal deoxynucleotidyl transferase dUTP nick-end labeling assay, malignant phenotype analysis, microRNA, and xenografting.

RESULTS

ISL induced OSCC cell cycle G2/M phase arrest, apoptosis, and DNA damage. However, the DNA repair-associated ataxia telangiectasia mutated (ATM) and phospho-ATM were downregulated, ATM mRNA remained unchanged, and the downstream signals were inhibited. ATM recovered when the caspase activity was blocked by Z-DVED-FMK. A low dose of ISL inhibited OSCC malignancy in vitro and reduced the tumor size in vivo.

CONCLUSION

ATM was cleaved by ISL-activated caspase, thus inhibiting DNA repair in OSCC cells. Therefore, ISL is a promising chemopreventive agent against oral cancer. © 2015 Wiley Periodicals, Inc. Head Neck 38: E360-E371, 2016.

Cranial imaging in autosomal recessive osteopetrosis. Part I. Facial bones and calvarium

Cranial imaging studies (radiographs, computed tomographic [CT] scans, magnetic resonance [MR] images, and bone marrow scintigrams) in 13 infants and children with autosomally recessive osteopetrosis were reviewed to characterize patterns of facial and calvarial involvement at presentation and with progression of disease. In the mandible, a characteristic triangular opacity representing calcification within the secondary condylar cartilage ossification center was seen in 10 of the 13 patients. Defective dentition with incomplete enamel formation and/or caries was encountered in all patients. The paranasal sinuses were poorly pneumatized in all patients, but the ethmoid sinuses tended to be the least severely affected. Hypertelorism was present in five of the 13 patients, with a characteristic "space-alien" appearance on frontal radiographs. In younger patients, the calvarium demonstrated a high-attenuation inner table, a broad, low-attenuation diploic space, and a less high-attenuation outer table at CT. In three older children, a "hair-on-end" appearance was seen, which, at bone marrow scintigraphy, corresponded to areas of marked hematopoietic activity. Regions of sclerotic bone demonstrated low signal intensity on both T1- and T2-weighted MR images; areas containing marrow had intermediate signal intensity. These many new radiologic features of osteopetrosis are related to its pathophysiologic characteristics.

Globus pharyngeus: radiographic evaluation and 24-hour pH monitoring of the pharynx and esophagus in 22 patients

PURPOSE

The authors correlated the radiographic evaluation and 24-hour pH monitoring of the pharynx and the esophagus in patients with globus pharyngeus.

MATERIALS AND METHODS

Radiographic examination of the pharynx of 22 patients (13 women and nine men, aged 23-73 years [mean, 47 years]) included videofluoroscopy and static radiography. Twenty-four-hour double-probe pH monitoring of the pharynx (abnormal, pH < 4) and esophagus (abnormal, 6% or more total acid exposure) was performed in all patients.

RESULTS

Radiographic results were normal in 17 patients; results were abnormal in five, with four having pharyngeal dysfunction and one showing a persistent cricopharyngeal impression. Zenker diverticulum was not seen. Results at pH monitoring of the pharynx and esophagus were normal in 20 and 18 of the 22 patients, respectively. In four of five patients with abnormal radiographic studies of the pharynx, results of pharyngeal pH monitoring were normal.

CONCLUSION

Most patients with globus pharyngeus had normal results at pH monitoring and radiographic examination of the pharynx.