Correlation of cervical endplate strength with CT measured subchondral bone density

Cervical interbody device subsidence can result in screw breakage, plate dislodgement, and/or kyphosis. Preoperative bone density measurement may be helpful in predicting the complications associated with anterior cervical surgery. This is especially important when a motion preserving device is implanted given the detrimental effect of subsidence on the postoperative segmental motion following disc replacement. To evaluate the structural properties of the cervical endplate and examine the correlation with CT measured trabecular bone density. Eight fresh human cadaver cervical spines (C2-T1) were CT scanned and the average trabecular bone densities of the vertebral bodies (C3-C7) were measured. Each endplate surface was biomechanically tested for regional yield load and stiffness using an indentation test method. Overall average density of the cervical vertebral body trabecular bone was 270 +/- 74 mg/cm3. There was no significant difference between levels. The yield load and stiffness from the indentation test of the endplate averaged 139 +/- 99 N and 156 +/- 52 N/mm across all cervical levels, endplate surfaces, and regional locations. The posterior aspect of the endplate had significantly higher yield load and stiffness in comparison to the anterior aspect and the lateral aspect had significantly higher yield load in comparison to the midline aspect. There was a significant correlation between the average yield load and stiffness of the cervical endplate and the trabecular bone density on regression analysis. Although there are significant regional variations in the endplate structural properties, the average of the endplate yield loads and stiffnesses correlated with the trabecular bone density. Given the morbidity associated with subsidence of interbody devices, a reliable and predictive method of measuring endplate strength in the cervical spine is required. Bone density measures may be used preoperatively to assist in the prediction of the strength of the vertebral endplate. A threshold density measure has yet to be established where the probability of endplate fracture outweighs the benefit of anterior cervical procedure.

Loss of cervical endplate integrity following minimal surface preparation

STUDY DESIGN

In vitro biomechanical study.

OBJECTIVES

This biomechanical study was designed to evaluate the loss of endplate integrity with incremental removal of the endplate.

SUMMARY OF BACKGROUND DATA

The position of the anterior cervical motion preserving prosthesis is very important. Unlike interbody bone graft, where a certain amount of settling is tolerable and potentially advantageous with respect to the fusion rate, a settled total disc replacement will not function properly and may dislodge. Partial or aggressive endplate removal may be a factor resulting in subsidence of an interbody device. This study was designed to precisely examine the change of endplate strength following precise burring of the surface.

METHODS

Eight human cadaver cervical spines (C3-C7) were dissected and 6 locations on the endplates from each vertebra were biomechanically tested using an indentation test protocol. Pairs of locations were randomly assigned to be burred to the depth of 0 mm (intact), 1 mm, or 2 mm before the testing using a flat 3-mm end mill. Strength of the endplate was statistically analyzed to examine the effect of the depth of the burr and any regional variations.

RESULTS

Significant differences (P < 0.0001) in endplate strength was noted between the intact endplate (106 +/- 86 N) and burred endplates (1 mm depth, 59 +/- 49 N; 2 mm depth, 51 +/- 46 N). No significant differences existed between the burr depths of 1 and 2 mm (P = 0.21). The posterior endplate was significantly stronger than the anterior endplate irrespective of depth of burr.

CONCLUSION

There is a significant loss of endplate integrity when 1 mm of endplate (44% loss) or 2 mm of endplate (52% loss) is removed. Although the implant interface plays an important role in the magnitude of the subsidence of a device, this study in general shows that the endplate is important in terms of maximizing the strength of a construct.

Estimations of fiber Bragg grating parameters and strain gauge factor using optical spectrum and strain distribution information

An inverse approach based on an optimization technique is proposed to characterize a fiber Bragg grating (FBG) and the strain gauge factor (GF) when the FBG is bonded on a structure. By bonding an FBG on a substrate and simply straining this FBG into a chirped fiber Bragg grating with a predesignated strain, the proposed method, based on an optimization technique, can be used to reconstruct seven parameters of the FBG from the corresponding reflective spectrum. The parameters identified are the length of an FBG, the grating period, the average refractive index, the index modulation, the apodization coefficient, the starting point bonded on the plate, and the strain GF. The information from the predesignated strain, as well as the measured reflective spectrum, is used as the objective function during the optimal search. As a result, the design sensitivity for the optimal search is much improved compared with the design sensitivity when only the reflective spectrum is used. In particular, the strain GF, which depends on the adhesive, the bonding layer characteristics, etc., can be determined in order to provide a reference for an FBG used as a strain sensor. Results from numerical simulations and experiments show that seven parameters of an FBG can be obtained accurately and efficiently.

Contralateral neurologic deficits following microendoscopic lumbar surgery. Can it happen?

A contralateral neurologic deficit following microendoscopic discectomy (MED) or laminectomy (MEL) had not previously been reported. Between September 1999 and April 2004, 60 patients with symptomatic lumbar disc herniations or spinal stenotic syndrome received MED or MEL at the authors' institution. Three out of 60 patients were found to exhibit a contralateral neurologic deficit following unilateral microendoscopic surgery. All three patients complained of a newly developed, contralateral neurologic deficit following their operations. One MED patient with a concomitant contralateral disc herniation developed contralateral motor and sensory deficits and required immediate open surgery. At the two-year follow-up, a residual motor deficit was noted. The other two patients (1 MED, 1MEL) with temporary sensory deficits were only treated conservatively and experienced complete recovery one week and six weeks following the operation, respectively. Surgeons should pay close attention to the possibility that contralateral neurologic deficits may occur following MED or MEL. Our reports indicate that caution should be exercised when performing microendoscopic procedures on patients with substantial dural compromise, a concomitant contralateral disc herniation, or a lateral spinal stenosis, which may be etiologies.

Minimal access spinal surgery (MASS) in treating thoracic spine metastasis

STUDY DESIGN

A retrospective study was conducted.

OBJECTIVE

This study aims to analyze the feasibility and efficacy of using minimal access spinal surgery (MASS) for managing thoracic spine metastasis.

SUMMARY OF BACKGROUND DATA

Literature regarding minimally invasive surgical treatment for thoracic spine metastasis is sparse. In the past decade, the role of minimally invasive or endoscopic technique in managing metastatic thoracic disease has evolved.

METHODS

From February 1997 to March 2003, 46 patients with spine metastases, from T3-T12, were enrolled in this study. There were 29 patients undergoing MASS. Seventeen patients received standard thoracotomy (ST) in the early study period served as the control group. The indications for MASS include intractable back pain and/or neurologic deficits or neurologic deterioration during or after radiotherapy. Inclusion criteria for this study included tumor limited to one or two vertebral segments.

RESULTS

In the MASS and ST groups, no patient died as a result of an immediate intraoperative event. The mean operative blood loss was 1,110 versus 1,162 mL (P = 0.63), and the mean operative length was 179 versus 180 minutes (P = 0.54). Complication rates and 1-year, 2-year, and overall survival rates were comparable and the mean grade of neurologic recovery was 1.2 on the Frankel scale in both groups. Only 6.9% of MASS patients required a 2-day postoperative ICU stay compared with 88% of ST patients (P < 0.0001).

CONCLUSIONS

The MASS technique is safe and effective and has proved to be an excellent alternative in managing thoracic spine metastasis. Surgeons may use progressively smaller incisions (5-6 cm in length) for the procedure. The learning curve for performing MASS procedures was not steep.

Less systemic cytokine response in patients following microendoscopic versus open lumbar discectomy

The magnitude of the tissue damage from surgery impacts the trauma response. This response is proportional to the severity of surgical stress. Systemic cytokines are recognized as markers of postoperative tissue trauma. Microendoscopic discectomy (MED) recently has become popular for treating lumbar disc herniations, and is associated with favorable clinical outcomes compared with open discectomy (OD). This study postulates that MED is a less traumatic procedure, and therefore has a lower surgical stress response compared to OD. In this study, a quantitative comparison of the overall effects of surgical trauma resulting from MED and OD was performed through analyzing patient systemic cytokines response. From April, 2002 to June, 2003, 22 consecutive patients who had symptomatic lumbar disc herniations were prospectively randomized to undergo either intracanalicular MED (N=10) or OD (N=12). In this study, the Vertebroscope System (Zeppelin, Pullach, Germany) was used to perform the endoscopic discectomy procedure in all MED patients. Serum levels of tumor necrosis factor-alpha (TNF-alpha), Interleukin-1beta (IL-1beta), Interleukin-6 (IL-6), and Interleukin-8 (IL-8) were measured before surgery and at 1, 2, 4, 8 and 24h after surgery using an enzyme-linked immunosorbent assay. Serum C-reactive protein (CRP) was measured at the same time interval. The results showed the MED patients had shorter postoperative hospital stay (mean, 3.57+/-0.98 vs. 5.92+/-2.39 days, p=0.025) and less intraoperative blood loss (mean, 87.5+/-69.4 vs. 190+/-115 ml, p=0.042). The operating length, including the set-up time, was longer in the MED group (mean, 109+/-35.9 vs. 72.1+/-17.8 min, p=0.01). The mean size of skin incision made for the MED patients was 1.86+/-0.13 cm (range 1.7-2.0 cm); and 6.3+/-0.98 cm for the OD patients (range 5.5-8 cm), p=0.001. The patients' pain severity of the involved limbs on 10-point Visual Analog Scale before operation in MED group was 7.5+/-0.3 (range 6-9) and 8+/-0.2 (range 7-9) in OD group, p=0.17; and after surgery, 1.5+/-0.2 (range 1-2) in MED group and 1.4+/-0.1 (range 1-3) in OD group, p=0.91. CRP levels peaked at 24h in both groups, and OD patients displayed a significantly greater postoperative rise in serum CRP (mean, 27.78+/-15.02 vs. 13.84+/-6.25mg/l, p=0.026). Concentrations of TNF-alpha, IL-1beta, and IL-8 were detected only sporadically. Serum IL-6 increased less significantly following MED than after OD. In the MED group, IL-6 level peaked 8h after surgery, with the response statistically less than in the open group (mean, 6.27+/-5.96 vs. 17.18+/-11.60 pg/ml, p=0.025). A statistically significant correlation was identified between IL-6 and CRP values (r=0.79). Using the modified MacNab criteria, the clinical outcomes were 90% satisfactory (9/10) in MED patients and 91.6% satisfactory (11/12) in OD patients at a mean 18.9 months (range 10-25) follow-up. Based on the current data, surgical trauma, as reflected by systemic IL-6 and CRP response, was significantly less following MED than following OD. The difference in the systemic cytokine response may support that the MED procedure is less traumatic. Moreover, our MED patients had achieved satisfactory clinical outcomes as the OD patients at a mean 18.9 months follow-up after surgery.

Systemic Vibrio infection presenting as necrotizing fasciitis and sepsis. A series of thirteen cases

BACKGROUND

Vibrio species are an uncommon cause of necrotizing fasciitis and primary septicemia, which are likely to occur in patients with hepatic disease, diabetes mellitus, adrenal insufficiency, and immunocompromised conditions. These organisms are found in warm sea waters and are often present in raw oysters, shellfish, and other seafood. The purposes of the present report were to describe a series of patients who had this potentially lethal infection and to identify clinical features associated with a poor prognosis.

METHODS

We retrospectively reviewed the records of thirteen patients (ten men and three women) who had necrotizing fasciitis and sepsis caused by Vibrio species. All patients had a history of contact with seawater or raw seafood. Eight patients had a hepatic disease such as hepatitis or cirrhosis of the liver, three had diabetes mellitus (without hepatic disease), and two had chronic renal or adrenal insufficiency (without hepatic disease).

RESULTS

Twelve patients underwent fasciotomy or limb amputation. Five patients (38%) died within two to six days after admission, and eight patients survived. Patients with a systolic blood pressure of < or =90 mm Hg and leukopenia in the emergency room had a significantly higher mortality rate (p < 0.05).

CONCLUSIONS

The diagnosis of Vibrio necrotizing fasciitis should be suspected when a patient has the appropriate clinical findings and a history of contact with seawater or raw seafood. The treatment should begin as early as possible, essentially when the patient has symptoms of sepsis. Although emergency fasciotomy or limb amputation did not reduce the mortality rate in this series, we consider such operations to be an important aspect of treatment.

Iatrogenic esophagobronchial fistula arising in irradiated Barrett's esophagus

A 47-yr-old male underwent a right upper lobectomy for stage IIB bronchoalveolar carcinoma followed by 4600 Gy of irradiation. One year later a fistula formed from an ulcerated region of Barrett's esophagus into the left main bronchus. Bronchotomy repair with onlay patch intercostal muscle flap and esophageal repair with serratus anterior muscle flap plus postoperative esophageal stent placement for stricture resulted in good functional results.

Pathological and biochemical analysis of dilated cardiomyopathy of broiler chickens--an animal model

Forty-seven birds (M/F = 33/14) with natural outbreak dilated cardiomyopathy (DCM) of right ventricle (RV) and 33 birds with artificially cool-induced DCM hearts were studied. Clinically, 20 severe and 13 mild DCM cases were induced during five weeks and the peak morbidity was in the 2nd week. The progressive dilatation of RV and hypokinesis of septum was shown by echocardiography. At autopsy, the ratio of heart weights to the body weights was increased, the ratio of RV weight to the total ventricle significantly increased, especially in the severe DCM cases (P < 0.05). The RV was dilated and the wall thickness was increased and finally both RV and left ventricle (LV) were markedly dilated and the septum became thinner. The struts, weave and coil demonstrated by silver impregnation stain were fragmented, dissociated and overstretched. The promatrix metalloproteinases (MMP)-2, -9 and active MMP-2 were markedly increased in natural outbreak DCM cases, especially in the RV (P < 0.05). The proMMP-2 and active MMP-2 was increased in the cool induced DCM cases, especially in the RV of severe DCM (P < 0.05). These indicated that both the natural outbreak and the artificially induced DCM of broiler chickens are ideal DCM animal models.

Design of antineoplastic agents based on the '2-phenylnaphthalene-type' structural pattern--synthesis and biological activity studies of 11H-indolo[3.2-c]quinoline derivatives

Designed as a new group of planar molecule containing the proposed 2-phenylnaphthalene-type structure, a number of 11H-indolo[3.2-c]quinoline derivatives were synthesized and evaluated biologically. Several compounds were found to possess cytotoxic activity against the growth of human promyelocytic leukemia cells (HL-60), against the small cell lung cancer (SCLC), and showed good response in the National Cancer Institute preclinical antitumor drug discovery 60-cell line panel.

Generation of electromagnetic pulses from plasma channels induced by femtosecond light strings

We present a model that elucidates the physics underlying the generation of an electromagnetic pulse from a femtosecond laser induced plasma channel. The radiation pressure force from the laser pulse spatially separates the ionized electrons from the heavier ions and the induced dipole moment subsequently oscillates at the plasma frequency and radiates an electromagnetic pulse.

CAPD-associated peritonitis caused by Alcaligenes xylosoxidans sp. xylosoxidans

Alcaligenes xylosoxidans is an uncommon cause of peritonitis in patients on maintenance continuous ambulatory peritoneal dialysis (CAPD). Peritonitis caused by A. xylosoxidans usually carries a poor prognosis because of the pathogen's virulence and its universal resistance to most antimicrobial agents. Even after early Tenckhoff catheter removal, the transport property of the peritoneum is often irreversibly damaged, leading to permanent technique failure. We report 2 patients with CAPD-associated peritonitis due to A. xylosoxidans sp. xylosoxidans who were successfully cured with a combination of piperacillin and tazobactam. One of them subsequently returned uneventfully to CAPD.

Long-term follow-up of interferon alfa treatment in Chinese patients with chronic hepatitis B infection: The effect on hepatitis B e antigen seroconversion and the development of cirrhosis-related complications

The long-term effect of interferon alfa (IFN-alpha) in Chinese patients with chronic hepatitis B infection is unknown. A total of 411 chronic hepatitis B patients (208 treated with IFN-alpha and 203 as control) were followed up for hepatitis B serology and the development of hepatoma and other cirrhosis-related complications. The hepatitis B e antigen (HBeAg) seroconversion rate in the IFN-alpha-treated group, though significantly greater at 6 and 24 months, was comparable with the control group on subsequent follow-up, irrespective of pretreatment alanine transaminase (ALT) levels. HBeAg seroreversion rate was higher in the IFN-alpha group compared with the control group (21.1% vs. 2.2%; P =.001). Loss of hepatitis B surface antigen (HBsAg) occurred in 2.4% of the IFN-alpha-treated patients and 0.49% of the control patients (P = NS). Around 90% of the anti-HBe-positive patients in both groups were still hepatitis B virus (HBV)-DNA-positive by polymerase chain reaction (PCR) assay. Two patients suffered from hepatic reactivation during the course of treatment. Nine (4.3%) patients in the IFN-alpha group and 2 (1.0%) in the control group developed complications of cirrhosis and hepatoma (P =.062). In Chinese HBsAg carriers, IFN-alpha was of no long-term benefit in inducing HBeAg seroconversion or in the prevention of hepatoma and other cirrhosis-related complications.

Poly(2-hydroxyethyl methacrylate) film as a drug delivery system for pilocarpine

This work investigates pilocarpine trapped in a matrix diffusion-controlled drug delivery system using hydrophilic inserts of Poly(2-hydroxyethyl methacrylate) (pHEMA) to ensure an increased bioavailability of pilocarpine and prolong the length of time in which the medication remains in the eyes of the test subjects. The physical and chemical properties of pilocarpine were investigated to elucidate the mechanism of drug-polymer interaction and the effect on drug release behavior of controlled release polymeric devices. In vitro release studies indicated that pilocarpine continued to be released from the inserts for a 24 h period. The results of intraocular pressure tests performed on albino rabbits were consistent with the observed in vitro behavior. The pressure decrease was significant for a period longer than 48 h. It confirms that the inserts, as sustainable releasing devices, are promising carriers for ophthalmic drug delivery systems.

Proteolysis of integrin α5 and β1 subunits involved in retinoic acid-induced apoptosis in human hepatoma Hep3B cells

Our previous report demonstrated that all-trans-retinoic acid (ATRA) induces detachment and death under serum starvation in several human tumor cell lines. In this study, we examined the influence of cell-extracellular matrix interaction on the ability of ATRA to induce apoptosis. Plating of human hepatoma Hep3B cells onto poly-hydroxyethylmethacrylate-coated plates in the absence of serum resulted in the acceleration of ATRA-induced apoptosis. In contrast, ATRA-induced apoptosis was significantly suppressed by plating cells onto Matrigel-coated plates but not suppressed by culturing onto collagen-, laminin-, vitronectin-, or fibronectin-coated plates. Exogenously added soluble collagen, laminin, fibronectin, vitronectin or Matrigel failed to suppress ATRA-induced apoptosis. Results from the adhesion assay indicated that the cell attachment to fibronectin was significantly inhibited by ATRA. Treatment with perturbing antibody against integrin alpha5 or beta1 subunits resulted in promotion of ATRA-induced apoptosis. Moreover, the proteolytic cleavage of alpha5beta1 integrin and focal adhesion kinase (FAK) proteins is linked to the early phase of the ATRA-induced apoptotic process. Furthermore, ATRA-induced detachment, death, and cleavage of alpha5beta1 integrin and FAK were drastically suppressed by plating cells onto Matrigel-coated plates. These findings provide evidence that abrogation of cell adhesion, through proteolysis of alpha5beta1 integrin and FAK, is closely linked to ATRA-induced apoptosis in Hep3B cells.

Combined measurement of fetal nuchal translucency, maternal serum free beta-hCG, and pregnancy-associated plasma protein A for first-trimester Down's syndrome screening

PURPOSE

It has been proposed that first-trimester Down's syndrome screening has a higher detection rate compared to second-trimester biochemical screening. This study investigated the accuracy of Down's syndrome screening during gestational weeks 10 to 13 using the combination of fetal nuchal translucency (NT) measurement with maternal serum concentrations of free beta-human chorionic gonadotropin (beta-hCG) and pregnancy-associated plasma protein-A (PAPP-A).

METHODS

A total of 1,514 women with singleton pregnancies were enrolled in this study. Fetal NT was measured using the criteria published by the Fetal Medicine Foundation. Maternal serum concentrations of free beta-hCG and PAPP-A were determined by microtiter-plate ELISA. Down's syndrome risk was calculated using multivariate Gaussian distribution and Alpha software.

RESULTS

Seventeen (1.12%) of the 1514 screened pregnancies had a fetal NT of at least 3 mm, and 41.2% of these had a poor pregnancy outcome, including four fetal aneuploidies. The odds of a fetal aneuploidy when the NT was greater than 2.0 multiples of median (MoM) was 90, when serum PAPP-A concentration was less than 0.45 MoM, it was 8.6, and when serum free beta-hCG concentration was greater than 2.2 MoM, it was 4.7. Using a risk cut-off level of 1 in 400, nine of 10 fetal aneuploidies were identified with a 4.7% false-positive rate, including two with trisomy 21, one with trisomy 18, and three with Turner's syndrome.

CONCLUSIONS

This study demonstrated that Down's syndrome screening using the combined test in the first trimester had a higher detection rate than that of serum screening in the second trimester. Implementation of NT measurement in the first trimester provides substantial advantages for Down's syndrome detection and early diagnosis of fetal structural abnormalities.

Formation and properties of proton-exchanged and annealed LiNbO3 waveguides for surface acoustic wave

The proton-exchanged (PE) and annealed PE (APE) z-cut LiNbO3 waveguides were fabricated using H4P2O7. The positive strain, c-axis lattice constant change (delta C/C), was calculated to be about +0.43%, which was almost independent of the exchanged conditions. The penetration depth of H measured by secondary ion mass spectrometry (SIMS) exhibited a step-like profile, which was assumed to be equal to the waveguide depth (d). The surface acoustic wave (SAW) properties of PE and APE z-cut LiNbO3 samples were investigated. The phase velocity (Vp) and electromechanical coupling coefficient (K2) of PE samples were significantly decreased by the increase of kd, where k was the wavenumber (2 pi/lambda). The insertion loss (IL) of PE samples was increased by the increase of kd and became nearly constant at kd > 0.064. The temperature coefficient of frequency (TCF) of PE samples showed an apparent increase with kd, reaching a maximum at kd = 0.292, then slightly decreased at higher kd. The effects of annealing resulted in a restoration of Vp and an improvement of IL.

Absence of nasal mucosal atrophy with fluticasone aqueous nasal spray

OBJECTIVE

To evaluate whether 1 year of continuous treatment with intranasal fluticasone propionate would lead to atrophy in the nasal mucosa compared with an active control, oral terfenadine.

DESIGN

Prospective, randomized, multicenter, open-label, parallel-group study.

SETTING

Two tertiary care academic institutions.

PATIENTS

Seventy-five subjects older than 18 years with perennial allergic rhinitis.

INTERVENTIONS

Patients received either fluticasone propionate aqueous nasal spray, 200 microg once daily, or terfenadine, 60 mg twice daily, for 1 year. Nasal biopsy specimens were obtained before and after 1 year of treatment and were evaluated for evidence of atrophy.

MAIN OUTCOME MEASURES

Epithelial and collagen layer thickness of the nasal mucosa as assessed by light microscopy and the presence and degree of edema, and regularity of collagen fibrils as assessed by electron microscopy. Analyses were performed without knowledge of subject identity or treatment assignment.

RESULTS

Neither fluticasone nor terfenadine treatment led to atrophy in the nasal mucosa by clinical or histologic observation. No significant changes from baseline were observed for any assessment of atrophy. In contrast to what would have been expected if atrophy were to occur, mean epithelial layer thickness in the fluticasone group significantly increased compared with terfenadine treatment (P = .03).

CONCLUSIONS

Treatment with intranasal fluticasone for 1 year increases the thickness of the nasal epithelium as compared with a year's treatment with terfenadine and does not lead to atrophy in the nasal mucosa. The increased thickness in the fluticasone treatment may represent repair from epithelial damage caused by chronic allergic inflammation.

An interesting observation of the position of some electronegative atoms in the taxol molecule

A study of the absolute energy-minimized configuration of the taxol molecule revealed that many oxygen atoms in this molecule and a nitrogen atom on the side chain are located on the same plane. A comparison of these electronegative atoms with information provided from existing literature indicated that most of these noted atoms conform with the reported structure--activity relationship (cytotoxicity, antineoplastic activity, tubulin assembly property, etc.). This observation may assist investigators in their future design of simpler, possibly clinically efficacious molecules related to taxol.

Early detection of hepatocellular carcinoma increases the chance of treatment: Hong Kong experience

The prognosis for patients with hepatocellular carcinoma (HCC) is poor because of the low chance of curative treatment. To increase the chance of intervention and to improve survival, early detection of subclinical HCC (SCHCC) by alpha-fetoprotein (AFP) and/or ultrasonography (USG) screening is implemented in many countries. Three hundred six Chinese patients with HCC diagnosed between January 1995 and December 1997 were recruited. They were categorized into two groups: 142 patients (group 1) had SCHCC diagnosed by screening (AFP and/or USG), and 164 patients (group 2) presented with symptomatic HCC. The tumor size was significantly smaller in group 1 compared with that of group 2 (3.5 cm vs. 8.1 cm; P <.0001). A significantly higher proportion of patients had bilobar involvement, multifocal HCC, diffuse-type HCC, portal vein infiltration, and distant metastasis in group 2 when compared with group 1. Operability and feasibility of treatment by transcatheter intra-arterial chemoembolization (TACE) in group 1 patients (26.8% and 45.1%, respectively) were significantly better than in group 2 patients (7.9% and 32.3%, P <.0001 and P =.03, respectively). The cumulative survival rate was significantly higher in group 1 than in group 2 (P <.0001). For those who had surgical resection and those who had TACE, group 1 patients had a higher cumulative survival rate compared with that of group 2 patients (P =.04 and P =.0003, respectively). Screening for HCC by AFP and/or USG can identify tumors at an early stage, resulting in a higher chance of receiving treatment. Whether it can improve survival requires a further prospective, randomized study.

Antituberculosis drug-related liver dysfunction in chronic hepatitis B infection

Liver toxicity is a common side effect of antituberculosis (anti-TB) drugs. We studied the differences in liver dysfunction observed during anti-TB treatment between hepatitis B virus carriers (HBV) and noncarriers. Three hundred twenty-four patients on anti-TB drugs were recruited and followed up for 1 year. Forty-three patients with HBV and 276 non-HBV patients were included for analysis. Liver function tests and viral markers were monitored monthly. Liver biopsy was requested whenever the alanine transaminase (ALT) was persistently abnormal. Eighty-six HBV carriers who were not given anti-TB drugs were chosen as a second control and evaluated prospectively. The incidence of liver dysfunction was significantly higher in HBV carriers given anti-TB drugs (34.9%) when compared to noncarriers (9.4%, P <.001) and with HBV carriers not given anti-TB drugs (8.1%, P <.001). For patients given anti-TB drugs, HBV carriers who developed liver dysfunction were younger (P =.011) and had more severe liver injury compared with noncarriers (P =.008). By multiple logistic regression analysis, age (P =.002) and hepatitis B infection (P <.001) were the only 2 significant risk factors for hepatotoxicity related to anti-TB therapy.

T1762/A1764 variants of the basal core promoter of hepatitis B virus; serological and clinical correlations in Chinese patients

BACKGROUND

A double variant in the basal core promoter, converting nucleotide 1762 from A to T (T1762) and nucleotide 1764 from G to A (A[764), has been described in patients with chronic hepatitis B infection. Its prevalence and significance in Chinese chronic HBV carriers are unknown.

METHODS

We studied 177 Chinese patients with chronic HBV infection (chronic hepatitis/asymptomatic: 89/88; hepatitis B e antigen positive/negative: 84/93). The double variant was detected by mismatched polymerase chain reaction and restriction fragment length polymorphism analysis. The reliability of this method was verified by sequencing in 41 serum samples with 100% matching.

RESULTS

The double variant T1762/ A1764 was found in 52 of 89 patients with chronic hepatitis, but in only 6 of 59 asymptomatic carriers (p<0.001). The prevalence was significantly lower in hepatitis B e antigen positive patients (23/84) than in hepatitis B e antigen negative patients (35/64) (p<0.005). Precore variant, A1896 was detected in 40 individuals; 31 of them suffered from chronic hepatitis and 9 were asymptomatic (p<0.001). A combination of both variants T1762/A1764 and A1896 was seen in 3 of 59 asymptomatic and 22 of 89 patients with chronic hepatitis (p<0.005).

CONCLUSIONS

Mismatched polymerase chain reaction with restriction fragment length polymorphism provides a reliable, easy and fast method for detection of the presence of the T1762/A1764 variant. In Chinese chronic hepatitis B carriers, T1762/A1764 variant was associated with both active liver disease and hepatitis B e antigen negativity.

Random X chromosome methylation patterns in the carriers with clinical phenotypic expressions of X-linked recessive bulbospinal neuronopathy

OBJECTIVES

We report the unusual phenotypic expression in 2 female carriers of a family with X-linked recessive bulbospinal neuronopathy (X-BSN). We analyze the methylation pattern of the androgen receptor (AR) gene to inspect the possibility of non-random X chromosome inactivation to be the underlying mechanism.

MATERIAL AND METHODS

Twenty-three members in 3 generations of a Taiwanese family were examined and studied for genomic DNA analysis. We analyzed the sequence of the first exon of the AR gene to identify the numbers of CAG repeats, and to determine the methylation pattern by using the restriction enzymes HpaII and HhaI.

RESULTS

There were 3 probands and 5 carriers and 2 of the carriers manifested clinical symptoms. Sequence analysis revealed that the numbers of trinucleotide repeats ranged from 42 to 45 in one allele of the X-chromosome in the 5 female carriers. The restriction pattern of the HpaII and HhaI recognizable sites of the X-chromosome indicated a random methylation.

CONCLUSION

Our data suggest that molecular genetic studies are important in confirming the diagnosis of X-BSN and early detection of female carriers, and the random or non-random methylation pattern of the X-chromosome is not a determining factor for partial expression of the abnormal AR gene in some carriers.

Mannose binding lectin gene mutations are associated with progression of liver disease in chronic hepatitis B infection

Mannose-binding lectin (MBL) plays an important role in immune defense. We examined the MBL gene mutations and MBL levels in Chinese hepatitis B and hepatitis C patients with and without symptomatic cirrhosis. We recruited 190 hepatitis B and C patients, and 117 normal Chinese as controls. Serum MBL levels were measured by enzyme-linked immunosorbent assay. MBL gene mutation at codons 52, 54, and 57 was detected by polymerase chain reaction (PCR) assay. In asymptomatic hepatitis B and C patients, there was no increase in codons 52, 54, and 57 mutation, but the MBL levels were significantly lower than those in the controls. Codon 54 mutation rate was increased to 44.4% (P =.007) in symptomatic hepatitis B cirrhosis and 64.3% (P =.0026) in patients with spontaneous bacterial peritonitis (SBP). There was no increase in codon 54 mutation rate in hepatitis B-related hepatocellular carcinoma (HCC). In chronic hepatitis B infection, the odds ratio for an individual with codon 54 mutation to develop cirrhosis was 1.84 (95% CI: 1.21-2. 81) and to develop SBP was 4.58 (95% CI: 1.73-12.16). Chronic hepatitis B and hepatitis C infection lowered the MBL levels, probably by suppressing MBL production. Codon 54 mutation of MBL was associated with progression of disease in chronic hepatitis B infection.