Lymph node metastases and prognosis in oesophageal carcinoma--a systematic review

Oesophageal cancer is the 7th most common cause of cancer-related death in the developed world and the incidence of oesophageal adenocarcinoma is now the fastest growing of any gastrointestinal cancer. Lymph node involvement is the single most important prognostic factor in oesophageal cancer. Imaging to determine the extent of lymph node involvement and plan treatment often requires a combination of modalities to avoid under-staging. The 7th edition of the staging system released by the International Union Against Cancer (IUCC) has stratified lymph node involvement according to the number of lymph nodes involved and redefined its groupings for location of metastatic lymph node involvement. This review discusses the prognostic and treatment implications of these modifications and explores micrometastatic lymph node involvement, capsular infiltration and lymph node ratio as possible additions to the staging system.

The acute management of acid assault burns: A pragmatic approach

This case series comprises 31 patients who were victims of acid assault burns. They were admitted for acute or reconstructive care to a regional burns unit. Ten patients were admitted late with suboptimal acute care and needed a total of 50 reconstructive procedures. Of 13 patients admitted acutely, 7 had surgery performed after 48 hours of constant lavage while seven had urgent surgical debridement within 48 hours, followed by lavage. Although the number of reconstructive procedures performed in these two groups was similar, i.e., 20 and 19, respectively, the magnitude of the deformity in the urgent surgery group was significantly less than in the conventional surgery group. As in many cases of acute burns care, determining the evidence for best practice using a prospective, randomised, controlled comparison of conventional versus urgent surgery is difficult in view of the small number of cases involved. However, basing surgical practice on ethical principles, and in particular 'primum non nocere,' we propose that the urgent reduction of the chemical load on the skin by surgical debridement is appropriate in selected cases and should be considered in the acute management of these devastating injuries.

Maxillary sinusitis and fungal infection

This cross sectional study was done to identify the fungal etiology of maxillary sinusitis. This study was done in the department of Otolaryngology & Head-Neck Surgery, Shahid Suhrawardy Medical College Hospital, Dhaka, Bangladesh. The study period was 5 years (January 2003 to December 2007). Total 63 patients who were diagnosed clinically and radiologically as a maxillary sinusitis were enrolled in this study. All the patients were included randomly. Among 63 patients 8(12.69%) patients had laboratory proved fungal maxillary sinusitis. Collection of the laboratory specimen was done from antral wash out and biopsy for histopathology was taken by endoscopic surgery. By histopathological and fungal stain revealed noninvasive type of fungal infection in all cases. Post nasal drip (100%), Headache (100%), Nasal obstruction (65% cases) were the main presenting symptoms in case of fungal maxillary sinusitis. Anti fungal treatment along with systemic antibiotic was given in case of proven maxillary sinusitis and 100% cure rate was observed after treatment.

Diabetes resolution and hyperinsulinaemia after metabolic Roux-en-Y gastric bypass

The global prevalence of type 2 diabetes mellitus and impaired glucose metabolism continues to rise in conjunction with the pandemic of obesity. The metabolic Roux-en-Y gastric bypass operation offers the successful resolution of diabetes in addition to sustained weight loss and excellent long-term outcomes in morbidly obese individuals. The procedure consists of the physiological BRAVE effects: (i) Bile flow alteration; (ii) Reduction of gastric size; (iii) Anatomical gut rearrangement and altered flow of nutrients; (iv) Vagal manipulation and (v) Enteric gut hormone modulation. This operation provides anti-diabetic effects through decreasing insulin resistance and increasing the efficiency of insulin secretion. These metabolic outcomes are achieved through weight-independent and weight-dependent mechanisms. These include the foregut, midgut and hindgut mechanisms, decreased inflammation, fat, adipokine and bile metabolism, metabolic modulation, shifts in gut microbial composition and intestinal gluconeogenesis. In a small minority of patients, gastric bypass results in hyperinsulinaemic hypoglycaemia that may lead to nesidioblastosis (pancreatic beta-cell hypertrophy with islet hyperplasia). Elucidating the precise metabolic mechanisms of diabetes resolution and hyperinsulinaemia after surgery can lead to improved operations and disease-specific procedures including 'diabetes surgery'. It can also improve our understanding of diabetes pathogenesis that may provide novel strategies for the management of metabolic syndrome and impaired glucose metabolism.

Changes in chromatin fiber density as a marker for pluripotency

Extensive alterations in chromatin structure at the nucleosome level are linked to developmental potential. We hypothesize that such alterations in chromatin structure reflect and, to some extent, depend on the large-scale reorganization of the nuclear landscape. We have used electron spectroscopic imaging (ESI) to visualize chromatin organization at the mesoscale level of resolution in both pluripotent and differentiated cell types. Pluripotent cells are characterized by a highly dispersed mesh of 10-nm chromatin fibers that fill the nuclear volume. In contrast, differentiated cells display a propensity to form compact chromatin domains that lead to large regions of the nucleus devoid of DNA. Surprisingly, ESI combined with tomography methods reveals that the compact chromatin domains consist of 10-nm rather than 30-nm chromatin fibers. We propose that the transition between compact silent chromatin and open transcriptionally poised or active chromatin is based on the modulation of the packing density of 10-nm fibers rather than a transition between 10- and 30-nm fiber types.

Treatment of cultured human astrocytes and vascular endothelial cells with protein kinase CK2 inhibitors induces early changes in cell shape and cytoskeleton

Ubiquitous protein kinase CK2 is a key regulator of cell migration, proliferation and tumor growth. CK2 is abundant in retinal astrocytes, and its inhibition suppresses retinal neovascularization in a mouse retinopathy model. In human astrocytes, CK2 co-distributes with GFAP-containing intermediate filaments, which implies its association with cytoskeleton. Contrary to astrocytes, CK2 is co-localized in microvascular endothelial cells (HBMVEC) with microtubules and actin stress fibers, but not with vimentin-containing intermediate filaments. Specific CK2 inhibitors (TBB, TBI, TBCA and DMAT) and nine novel CK2 inhibiting compounds (TID43, TID46, Quinolone-7, Quinolone-39, FNH28, FNH62, FNH64, FNH68 and FNH74) were tested at 10-200 μM for their ability to induce morphological alterations in cultured human astrocytes (HAST-40), and HBMVEC (For explanation of the inhibitor names, see "Methods" section). CK2 inhibitors caused dramatic changes in shape of cultured cells with effective inhibitor concentrations between 50 and 100 μM. Attached cells retracted, acquired shortened processes, and eventually rounded up and detached. CK2 inhibitor-induced morphological alterations were completely reversible and were not blocked by caspase inhibition. However, longer treatment or higher inhibitor concentration did cause apoptosis. The speed and potency of the CK2 inhibitors effects on cell shape and adhesion were inversely correlated with serum concentration. Western analyses showed that TBB and TBCA elicited a significant (about twofold) increase in the activation of p38 and ERK1/2 MAP kinases that may be involved in cytoskeleton regulation. This novel early biological cell response to CK2 inhibition may underlie the anti-angiogenic effect of CK2 suppression in the retina.

Metabolic surgery: an evolution through bariatric animal models

Metabolic surgery was developed through the application and experience gained from bariatric or weight loss procedures. Much of our knowledge from the procedures comes from the study of animal models, where they have revealed anatomic feasibility, systemic physiological elements and cellular metabolic effects. The first generation of operation included the jejunoileal bypass and partial ileal bypass that led to the development of the current procedures including Roux-en-Y gastric bypass, biliopancreatic diversion, adjustable gastric banding and sleeve gastrectomy. These operations carry significant metabolic benefits and can reduce the risk of diabetes, heart disease and cancer. Further insights from these animal models can reveal genetic, molecular and systemic effects that can enhance and develop the next generation of metabolic operations.

Diabetes resolution and hyperinsulinaemia after metabolic Roux-en-Y gastric bypass

The global prevalence of type 2 diabetes mellitus and impaired glucose metabolism continues to rise in conjunction with the pandemic of obesity. The metabolic Roux-en-Y gastric bypass operation offers the successful resolution of diabetes in addition to sustained weight loss and excellent long-term outcomes in morbidly obese individuals. The procedure consists of the physiological BRAVE effects: (i) Bile flow alteration; (ii) Reduction of gastric size; (iii) Anatomical gut rearrangement and altered flow of nutrients; (iv) Vagal manipulation and (v) Enteric gut hormone modulation. This operation provides anti-diabetic effects through decreasing insulin resistance and increasing the efficiency of insulin secretion. These metabolic outcomes are achieved through weight-independent and weight-dependent mechanisms. These include the foregut, midgut and hindgut mechanisms, decreased inflammation, fat, adipokine and bile metabolism, metabolic modulation, shifts in gut microbial composition and intestinal gluconeogenesis. In a small minority of patients, gastric bypass results in hyperinsulinaemic hypoglycaemia that may lead to nesidioblastosis (pancreatic beta-cell hypertrophy with islet hyperplasia). Elucidating the precise metabolic mechanisms of diabetes resolution and hyperinsulinaemia after surgery can lead to improved operations and disease-specific procedures including 'diabetes surgery'. It can also improve our understanding of diabetes pathogenesis that may provide novel strategies for the management of metabolic syndrome and impaired glucose metabolism.

Classification of subtrochanteric femoral fractures

A review of the literature identified 15 different classification methods for subtrochanteric femoral fractures. Only eight of those classifications defined the area of bone, which constituted a subtrochanteric fracture. The actual length of femur defined as the subtrochanteric zone varied from 3 cm up to the level of the femoral isthmus. There was no agreement between the different classifications regarding the proximal and distal border or for those fractures, which traverse anatomical boundaries. In the various classifications, fractures were subdivided into 2-15 subgroups. The majority of the identified studies were unable to find the classifications useful in either determining treatment or predicting the outcome after treatment. We subdivided subtrochanteric fractures into three types based on the degree of fracture comminution. We examined the inter- and intra-observer agreement of our recommended classification. One orthopaedic consultant, one specialist hip fracture surgeon, two trainee registrar orthopaedic surgeons and one specialty trainee in orthopaedics, on two different occasions, 8 weeks apart, independently classified the radiographs of 20 patients with a subtrochanteric fracture. The mean kappa value for inter- and intra-observer variation was 0.71 and 0.79, respectively, with both showing substantial agreement and, therefore, this simpler classification is recommended. Based on the review of previous classification methods, we also recommend that the subtrochanteric zone be defined as the one in which the fracture line crossing the femur is predominantly within the area of bone extending 5 cm below the lower border of the lesser trochanter.

Blood pressure in relation to selected anthropometric measurements in senior citizens

This cross-sectional study was done to assess the blood pressure of the senior citizens in relation to the anthropometric measurements and indices. It was conducted among the Bangladeshi elderly citizens of selected areas of Dhaka city. Samples were selected by convenient technique. A pre-tested questionnaire and a check list were used for data collection. Data analysis was done by SPSS for Windows. Three areas of Dhaka city namely Nakhal Para, Badda and Mirpur were selected in this study. The study was conducted during January to June 2006. A total of 317 samples were studied. Mean age of the respondents was 67.1 years (+/-6.6 SD). Mean SBP and DBP measured were 126 mm of Hg (+/-20 SD) and 72 mm of Hg (+/-12 SD), respectively. Among them, 33.1% were hypertensive on BP measurement; amongst which 32.4% had both SBP and DBP raised; 55.2% had isolated systolic hypertension and 12.4% had DBP raised. Of them 44.8% were identified finally as hypertensive considering BP measurement and those taking antihypertensive medication. The majority were well nourished and at less health risk in terms of BMI, WC and WHR. There was a tendency of being hypertensive with overweight/obese (p<0.05), high WC (male p<0.05 and female p<0.01) and high WHR (female p<0.001). Percentage of hypertensive was higher among the seniors of the study areas especially among those who were overweight/obese or at health risk by WC/WHR.

The acute management of acid assault burns: A pragmatic approach

This case series comprises 31 patients who were victims of acid assault burns. They were admitted for acute or reconstructive care to a regional burns unit. Ten patients were admitted late with suboptimal acute care and needed a total of 50 reconstructive procedures. Of 13 patients admitted acutely, 7 had surgery performed after 48 hours of constant lavage while seven had urgent surgical debridement within 48 hours, followed by lavage. Although the number of reconstructive procedures performed in these two groups was similar, i.e., 20 and 19, respectively, the magnitude of the deformity in the urgent surgery group was significantly less than in the conventional surgery group. As in many cases of acute burns care, determining the evidence for best practice using a prospective, randomised, controlled comparison of conventional versus urgent surgery is difficult in view of the small number of cases involved. However, basing surgical practice on ethical principles, and in particular ‘primum non nocere,’ we propose that the urgent reduction of the chemical load on the skin by surgical debridement is appropriate in selected cases and should be considered in the acute management of these devastating injuries.

Enhancement of macrosphelide-induced apoptosis by mild hyperthermia

Hyperthermia is a useful adjunct in cancer therapy as it can increase the effectiveness and decrease the toxicity of currently available cancer treatments such as chemotherapy and radiation. In the present study, we investigated whether 41 degrees C hyperthermia (mild HT) for 20 min can enhance macrosphelide (MS5)-induced apoptosis in human lymphoma U937 cells. Our results revealed that, compared with MS5 (5 microM) and mild HT alone, the combined treatment exhibited significant enhancement in apoptosis at 6 h, which was evaluated by observing morphological changes and DNA fragmentation. Marked increase in the reactive oxygen species (ROS) generation was observed immediately after the combined treatment. Significant increase in Fas externalization, caspase-8 and caspase-3 activation, and loss of mitochondrial membrane potential (MMP) was found after the combined treatment compared with MS5 and mild HT alone. Moreover, this combination can also alter the expression of apoptosis-related proteins as evident by the cleavage of Bid and down-regulation of Bcl-2 while no change in the expression of Bax was observed. Furthermore, an immediate rise in the intracellular calcium ion ([Ca(2+)]i) concentration was observed after the combined treatment, which continuously increased in a time-dependent manner. In addition, mild HT treatment alone also increases [Ca(2+)]i concentration without inducing apoptosis. Our data indicate that early increase in ROS generation is mainly responsible for the enhancement of apoptosis after the combined treatment.

Protein kinase CK2 in health and disease: CK2: a key player in cancer biology

Elevated levels of protein kinase CK2 (formerly casein kinase 2 or II) have long been associated with increased cell growth and proliferation both in normal and cancer cells. The ability of CK2 to also act as a potent suppressor of apoptosis offers an important link to its involvement in cancer since deregulation of both cell proliferation and apoptosis are among the key features of cancer cell biology. Dysregulated CK2 may impact both of these processes in cancer cells. All cancers that have been examined show increased CK2 expression, which may also relate to prognosis. The extensive involvement of CK2 in cancer derives from its impact on diverse molecular pathways controlling cell proliferation and cell death. Downregulation of CK2 by various approaches results in induction of apoptosis in cultured cell and xenograft cancer models suggesting its potential as a therapeutic target.