Oromandibular dystonia following dental treatment: case reports and discussion

Oromandibular dystonia (OMD) is a movement disorder characterised by involuntary, repetitive, and patterned muscle contractions of varying severity, affecting the jaws, tongue, face, and pharynx. It is most commonly idiopathic or medication-induced, but peripheral trauma sometimes precedes the condition. There have been several reports of OMD following dental treatment, and this paper discusses two cases which occurred following extractions and full dentures.

Prognostic significance of histological grade in clear-cell carcinoma of the ovary: a retrospective study of Korean Gynecologic Oncology Group

BACKGROUND

This study was to investigate the prognostic significance of clinicopathologic characteristics in patients with clear-cell carcinoma (CCC) of the ovary.

MATERIALS AND METHODS

Two hundred and one patients with CCC of the ovary were registered in the Korean Gynecologic Oncology Group. The Korean Gynecologic Pathology Study Group reviewed the pathological slides centrally, using a universal grading system. The prognostic significances of clinicopathologic factors were evaluated by multivariate analysis.

RESULTS

Most of the patients were diagnosed at an early stage (stage I, 61.3%), and the overall 5-year survival rate was 57%. Early-stage disease showed a favorable prognosis, but advanced diseases showed poor prognosis. Stage of disease was the only significant prognostic factor on multivariate analysis (P < 0.001). However, universal grade and residual tumor also showed prognostic significance on the forward stepwise likelihood ratio test. There was no survival difference observed between patients treated with paclitaxel-based and those treated with platinum-based combination chemotherapy.

CONCLUSIONS

The stage, residual tumor, and universal grade were significant prognostic factors in patients with CCC of the ovary. The universal grading system is applicable in determining prognosis of CCC of the ovary. Further clinical trials for optimal chemotherapy are in need.

A rare case of primary omental neuroblastoma and resection of the recurrent tumor by laparoscopy

Neuroblastoma is the most common extracranial solid tumor in children. Primary omental neuroblastoma has never been reported in the English literature. A 4-year-old girl presented with a mobile abdominal mass; primary omental neuroblastoma was diagnosed. There was tumor recurrence after complete tumor resection. She received chemotherapy and underwent laparoscopic resection of the recurrent tumor. There was no tumor recurrence after 1 year of follow-up.

How well do serum sTREM-1 measurements prognosticate in septic shock?

The soluble triggering receptor expressed on myeloid cells (sTREM)-1 has emerged as a potentially useful biomarker for the diagnosis of sepsis. This study aimed to evaluate the prognostic utility of serum sTREM-1 in septic shock, in comparison with that of procalcitonin measurements. Thirty-one consecutive patients in a tertiary medical intensive care unit with septic shock were studied. sTREM-1 levels in blood were measured using a modified immunoblot array technique on days one to three of intensive care unit admission. Serum procalcitonin and interleukin (IL)-1beta, IL-6, IL-IO and tumour necrosis factor-alpha levels were also measured. No significant difference was observed in the sTREM-1 levels on the first three days between survivors and nonsurvivors. sTREM-1 levels moderately correlated with the Acute Physiology and Chronic Health Evaluation II and Sequential Organ Failure Assessment scores on day three, but did not correlate with vasopressor requirements, cytokine levels and the presence of bacteraemia. In contrast, procalcitonin levels were significantly higher in nonsurvivors than in survivors on days two and three. A significant relationship also existed between procalcitonin levels and the other variables. In conclusion, this study found that the prognostic utility of serum sTREM-1 in septic shock is poor and that procalcitonin measurements perform better in this regard.

Phase II study and biomarker analysis of cetuximab combined with modified FOLFOX6 in advanced gastric cancer

This prospective study was conducted with the Korean Cancer Study Group to evaluate the efficacy and safety of cetuximab combined with modified FOLFOX6 (mFOLFOX6) as first-line treatment in recurrent or metastatic gastric cancer and to identify potential predictive biomarkers. Patients received cetuximab 400 mg m⁻² at week 1 and 250 mg m⁻² weekly thereafter until disease progression. Oxaliplatin (100 mg m⁻²) and leucovorin (100 mg m⁻²) were administered as a 2-h infusion followed by a 46-h continuous infusion of 5-fluorouracil (2400 mg m⁻²) every 2 weeks for a maximum of 12 cycles. Biomarkers potentially associated with efficacy were analysed. Among 38 evaluable patients, confirmed response rate (RR) was 50.0% (95% CI 34.1–65.9). Median time-to-progression (TTP) was 5.5 months (95% CI 4.5–6.5) and overall survival (OS) 9.9 months. Eleven patients having tumour EGFR expression by immunohistochemistry with low serum EGF and TGF-α levels showed a 100% RR compared to 37.0% in the remaining 27 patients (P<0.001). Moreover, ligand level increased when disease progressed in seven out of eight patients with EGFR expression and low baseline ligand level. No patient exhibited EGFR amplification or K-ras mutations. Gastric cancer patients with EGFR expression and low ligand levels had better outcomes with cetuximab/mFOLFOX6 treatment.

Effective cryopreservation of neural stem or progenitor cells without serum or proteins by vitrification

Development of effective cryopreservation protocols will be essential to realizing the potential for clinical application of neural stem and progenitor cells. Current cryopreservation protocols have been largely employed in research, which does not require as stringent consideration of viability and sterility. Therefore, these protocols involve the use of serum and protein additives, which can potentially introduce contaminants, and slow cooling with DMSO/glycerol-based cryopreservation solutions, which impairs cell survival. We investigated whether serum- and protein-free vitrification is effective for functional cryopreservation of neurosphere cultures of neural stem or progenitor cells. To protect the samples from introduction of other contaminants during handling and cryostorage, an original "straw-in-straw" method (250 microl sterile straw placed in 500 microl straw) for direct immersion into liquid nitrogen and storing the samples was also introduced. The protocol employed brief step-wise exposure to vitrification solution composed of ethylene glycol (EG) and sucrose (40% v/v EG, 0.6 M sucrose) and removal of vitrification solution at room temperature. Evaluation of the effects of vitrification revealed that there were no differences between control and vitrified neural stem or progenitor cells in expression of the neural stem or progenitor cell markers, proliferation, or multipotent differentiation. This sterile method for the xeno-free cryopreservation of murine neurospheres without animal or human proteins may have the potential to serve as a starting point for the development of cryopreservation protocols for human neural stem and progenitor cells for clinical use.

Prognostic factors in patients with acute liver failure undergoing live donor liver transplantation

Mortality from acute liver failure (ALF) is high. Live donor liver transplantation (LDLT) is the treatment of choice for ALF in Asia, because cadaveric donors are rare. We sought to review our results in ALF patients with undergoing LDLT at our center. One hundred two LDLTs were performed at our center from April 2002 to November 2007, 15 (14%) because of ALF. Mean (SEM; median, range) follow-up was 1,065 (189; 1400; 3-2046) days. Nine patients (60%) had acute exacerbation of chronic hepatitis B; and 6 (40%) had drug-induced liver injury. Age was 47 (3; 50; 27-65) years. Ten patients (67%) were men. At transplantation, laboratory values were included bilirubin, 449 (35) micromol/L; creatinine concentration, 182 (32) mmol/L. The international normalized ratio was 2.4 (0.2). The Model for End-Stage Liver Disease (MELD) score was 34 (2). Both inpatient and long-term mortality was 20% 3 of 15 patients died. The 5-year survival was 80%. Compared with survivors, patients who died had a significantly higher creatinine concentration 289 vs 155 micromol/L, international normalized ratio (3.4 vs 2.1), MELD score (47 vs 32). We conclude that despite being sick with median and mean MELD scores of 32 and 34, 80% of patients with ALF can achieve good long-term survival after LDLT.

Prognostic factors in patients with acute liver failure undergoing live donor liver transplantation

Mortality from acute liver failure (ALF) is high. Live donor liver transplantation (LDLT) is the treatment of choice for ALF in Asia, because cadaveric donors are rare. We sought to review our results in ALF patients with undergoing LDLT at our center. One hundred two LDLTs were performed at our center from April 2002 to November 2007, 15 (14%) because of ALF. Mean (SEM; median, range) follow-up was 1,065 (189; 1400; 3-2046) days. Nine patients (60%) had acute exacerbation of chronic hepatitis B; and 6 (40%) had drug-induced liver injury. Age was 47 (3; 50; 27-65) years. Ten patients (67%) were men. At transplantation, laboratory values were included bilirubin, 449 (35) micromol/L; creatinine concentration, 182 (32) mmol/L. The international normalized ratio was 2.4 (0.2). The Model for End-Stage Liver Disease (MELD) score was 34 (2). Both inpatient and long-term mortality was 20% 3 of 15 patients died. The 5-year survival was 80%. Compared with survivors, patients who died had a significantly higher creatinine concentration 289 vs 155 micromol/L, international normalized ratio (3.4 vs 2.1), MELD score (47 vs 32). We conclude that despite being sick with median and mean MELD scores of 32 and 34, 80% of patients with ALF can achieve good long-term survival after LDLT.

Towards registered single quantum dot photonic devices

We have registered the position and wavelength of a single InGaAs quantum dot using an innovative cryogenic laser lithography technique. This approach provides accurate marking of the location of self-organized dots and is particularly important for realizing any solid-state cavity quantum electrodynamics scheme where the overlap of the spectral and spatial characteristics of an emitter and a cavity is essential. We demonstrate progress in two key areas towards efficient single quantum dot photonic device implementation. Firstly, we show the registration and reacquisition of a single quantum dot with 50 and 150 nm accuracy, respectively. Secondly, we present data on the successful fabrication of a photonic crystal L3 cavity following the registration process.

Facial fractures in road cyclists

BACKGROUND

Despite the safety devices worn by bicycle riders and the road safety measures designed to protect them, road cycling is still associated with frequent traumas, notably to the extremities. Maxillofacial injuries are common, especially when road traffic accidents occur. There is a paucity of literature on the epidemiology of bicycle-related facial fractures in New Zealand.

METHODS

A retrospective database of patients presenting to the Oral and Maxillofacial Surgery Unit at Christchurch Hospital during an 11-year period was reviewed. Variables examined included demographics, types of fracture, mode of injury, and treatment delivered.

RESULTS

Sixty-three patients were identified as having road bicycle-related facial fractures, with no increase in prevalence over the study period. Male to female ratio was 3:1, with 76 per cent involving patients aged between their first and third decade. Fall was the most common mechanism of injury, followed by collision. Fifty-two per cent of patients were hospitalized and 40 per cent required surgical intervention. The highest incidence of injury was during January.

CONCLUSIONS

Road bicycle-related fractures accounted for a small proportion of the workload at our unit. They predominantly affected young male adults. More than half of the patients were hospitalized and a major proportion of these required surgery.

Incidence of chickenpox in young South Korean soldiers and correlation with atopic dermatitis

BACKGROUND

In South Korea, military service is compulsory for all healthy young men and provides specific environmental factors, with groups working and living together in specific places for several years making varicella more transmissible to susceptible individuals. Studies of people serving in the South Korean military may provide information about the young adult male population in Korea.

AIM

To determine the relationship between chickenpox and atopic dermatitis (AD) in young adults over a period of 3 years.

METHODS

The computerized database of the Armed Forces Medical Command was examined to identify the number of reported cases of chickenpox, AD, and AD associated with chickenpox.

RESULTS

In total, 588 cases of chickenpox (183, 182 and 223 in the periods November 2004 to October 2005, November 2005 to October 2006, and November 2006 to October 2007, respectively) were reported. A greater number of patients were found to be infected with chickenpox in January and November, with fewer patients in August and September (P < 0.0001). Within the same periods, 1890, 2417 and 2779 patients diagnosed with AD were recorded in the Defense Medical Information System. Only 3 of 588 patients with chickenpox also had AD (0.5%).

CONCLUSION

In this population-based study, the epidemiological trend of chickenpox and AD over a period of 3 years within the military personnel of South Korea is shown.

Association of TIMP-4 gene polymorphism with the risk of osteoarthritis in the Korean population

Due to an imbalance in the MMP:TIMP ratio determined a tissue damage in arthritis, it is hypothesized that polymorphic variations of the TIMP genes are associated with regulation of the MMP:TIMP balance. To test this hypothesis, the presence of single nucleotide polymorphisms (SNPs) located in the human TIMP-2 and TIMP-4 genes was confirmed in the Korean RA and OA patients. We performed a case-control study comprising 109 unrelated Korean OA patients, 177 unrelated Korean RA patients and 175 healthy subjects. There were statistically significant differences in the genotype distribution and allele frequencies of the C/T polymorphism of TIMP-4 gene between OA and control groups (P = 0.0002 and P = 0.001, respectively). However, no significant association between TIMP-2 polymorphisms and OA was observed. Also, no difference was observed when allele or genotype frequencies of both TIMP-2 and TIMP-4 gene polymorphisms were compared between RA and controls. We demonstrated that the C/T polymorphism which is located on the 3'-untranslational regions of the TIMP-4 gene might be associated with susceptibility to OA patients.

The use of laparoscopy in the management of Littre's hernia in children

Littre's hernia is a rare complication of Meckel's diverticulum. It was originally defined as 'the presence of a Meckel's diverticulum in any hernia sac' by Rieke in 1841. It is difficult to diagnose before surgery. With the advances in the development of laparoscopic surgery in children, diagnosis of this rare condition, together with subsequent repair of Littre's hernia and Meckel's diverticulectomy can be performed by laparoscopy. We herein report the use of laparoscopy in the management of two boys with Littre's hernia, including one with incarcerated hernia.

Elevated anti-alpha-enolase antibody levels in Kawasaki disease

OBJECTIVE

By functioning as a heat-shock protein (HSP), alpha-enolase has an important role in the pathophysiology of multivariant vasculitis. Kawasaki disease (KD) is a type of vasculitis occurring primarily in children. The role of alpha-enolase in KD was assessed by measuring anti-alpha-enolase antibody (Ab) titres in patients with KD and the usefulness of anti-alpha-enolase Ab as a diagnostic tool in atypical KD patients was evaluated.

METHODS

Anti-alpha-enolase Ab titres were measured by using an enzyme-linked immunosorbent assay (ELISA) in seven normal control patients, nine febrile control patients and 14 KD patients (10 typical KD, four atypical KD). A standard deviation (SD) of 3 above the mean of the normal control group was considered to be positive reactivity. Western blotting using recombinant human alpha-enolase was performed in four KD patients and three normal controls.

RESULTS

With the positive reactivity limited to +3 SD over the mean (>0.6), 10 out of 14 patients (71%) were positive at the acute onset and 12 out of 14 patients (85.7%) were positive before discharge. In total, 12 out of 14 patients (85.7%) were positive either at acute onset or before discharge. All four atypical KD patients showed positive reactivity. Specific positive bands against recombinant human alpha-enolase were detected by western blotting in all four KD patients, but no reactivity was seen in three patients with normal controls.

CONCLUSION

This is the first study to demonstrate that autoantibodies against the alpha-enolase are present in the sera of KD patients. We suggest that anti-alpha-enolase Ab should be a good candidate for a diagnostic tool in atypical KD.

Stable microwave coaxial cavity plasma system at atmospheric pressure

We present a systematic study of the development of a novel atmospheric microwave plasma system for material processing in the pressure range up to 760 torr and the microwave input power up to 6 kW. Atmospheric microwave plasma was reliably produced and sustained by using a cylindrical resonator with the TM(011) cavity mode. The applicator and the microwave cavity, which is a cylindrical resonator, are carefully designed and optimized with the time dependent finite element Maxwell equation solver. The azimuthal apertures are placed at the maximum magnetic field positions between the cavity and the applicator to maximize the coupling efficiency into the microwave plasma at a resonant frequency of 2.45 GHz. The system consists of a magnetron power supply, a circulator, a directional coupler, a three-stub tuner, a dummy load, a coaxial cavity, and a central cavity. Design and construction of the resonant structures and diagnostics of atmospheric plasma using optical experiments are discussed in various ranges of pressure and microwave input power for different types of gases.

Urinary bladder pheochromocytoma, an extremely rare tumor in children: case report and review of the literature

We report a case of pheochromocytoma in the urinary bladder of a 14-year-old girl who presented with headache and palpitation after voiding. This is an extremely rare condition in pediatric age group and thus can be missed easily. This case is the seventh case reported in the reviewed literature.

Minimal invasive surgery in pediatric solid tumors

BACKGROUND

There is only limited experience of using the minimally invasive surgery (MIS) technique in resecting pediatric solid tumors. In this paper, we report our experience of using the MIS technique in the management of pediatric solid tumors.

METHODS

A retrospective review was undertaken on all children who had undergone MIS for their solid tumors between 1995 and 2005.

RESULTS

Over a 10-year period, there were 38 patients who had undergone MIS for tumor resection. The mean age at the time of surgery was 7.5 years (range, 1 day to 15 years). There were 22 ovarian tumors, 4 sacrococcygeal tumors, 3 adrenal tumors, 3 retroperitoneal tumors, 1 kidney tumor, 1 liver mass, 1 intra-abdominal testicular tumor, and 3 intrathoracic masses. Thirty of 38 patients had undergone a successful resection using the MIS technique (78.9%). Eight patients required a conversion to the open procedure because of limited intraperitoneal space in 7 and excessive bleeding in 1. Of the 28 successfully MIS-resected intra-abdominal tumors, 18 required enlargement of the umbilical incision and 5 required an additional Pfannenstiel incision for tumor retrieval. Enlargement of the thoracic port site for specimen retrieval was required in the 2 successfully MIS-resected intrathoracic masses. The mean operation time was 171 minutes (range, 45-275). There was no postoperative complication encountered. On an average follow-up of 3.1 years, there was no recurrence observed, even in the 7 patients with malignant tumors, and all patients with successful MIS tumor excision had good cosmetic results.

CONCLUSIONS

With the advance of laparoscopic instruments and techniques, a variety of pediatric solid tumors can be resected safely by the MIS technique. This has the potential benefit of a more rapid postoperative recovery and better cosmetic results. The role of the MIS technique in resecting malignant tumors is uncertain, as the number of cases in the current series is too small to draw any conclusion.

Retrospective multicenter study of a clinicopathologic analysis of pseudomyxoma peritonei associated with ovarian tumors (KGOG 3005)

The purpose of this study is to assess clinicopathologic features of pseudomyxoma peritonei (PMP) that has ovarian pathology and its relationship with the prognosis. From 1995 to 2004, the clinical records and follow-up data of 35 patients with PMP, which had primarily originated from the ovary, were collected from 11 institutes of gynecologic oncology in Korea and retrospectively analyzed. All patients had ovarian lesion histologically confirmed with PMP. The mean age at diagnosis was 53.7 years (range: 16-82 years). There were 25 (71.4%) patients with disseminated peritoneal adenomucinosis, 5 (14.3%) with peritoneal mucinous carcinomatosis with intermediate group, and 5 (14.3%) with peritoneal mucinous carcinomatosis. The clinical stages at diagnosis were IA in 2 patients, IIIB in 4, IIIC in 23, IV in 1, and unknown in 5. In preoperative tumor markers, the positive rates were 72% (CA125), 47.4% (CA19-9), and 84.6% (CEA). Thirty-four patients underwent surgical staging or cytoreduction, and then 27 patients (77%) received adjuvant chemotherapy that was given to patients in a nonuniform fashion. The 5-year survival for 35 patients was 87%. Survival rate was significantly lower in patients >50 years of age (P = 0.002). Our data showed that age of the patient is the only significant prognostic factor in PMP that has ovarian lesion.

Effect of milk protein concentrate on lipid oxidation and formation of fishy volatiles in herring mince (Clupea harengus) during frozen storage

The effect of milk protein concentrate (MPC) at 0, 2, 4, and 6% on lipid oxidation and volatile formation in frozen stored herring mince (-18 degrees C) was evaluated by analyzing samples at 0, 2, and 4 months for fatty acid composition, volatiles, and thiobarbituric acid reactive substances (TBARS). Sensory evaluation was also conducted to assess the intensity of fishy odor, and the volatiles were analyzed using static headspace gas chromatography-mass spectrometry (SHGC-MS). The addition of 4 and 6% MPC to herring mince resulted in a 33% and 50% reduction of TBARS, respectively, at month 4 and lessened the intensity of fishy odor throughout storage. However, MPC did not protect fatty acids from enzymatic degradation unless it was added immediately after mincing. Volatile analysis using SHGC-MS showed that 4% MPC was able to reduce headspace volatiles associated with fishy odor. MPC is most effective for reducing 4-heptenal, 3-methyl-1-butanol, 2-hexenal, and 1-penten-3-ol, which are known to be potent odorants associated with lipid oxidation.

Methotrexate, vinblastine, doxorubicin and cisplatin combination regimen as salvage chemotherapy for patients with advanced or metastatic transitional cell carcinoma after failure of gemcitabine and cisplatin chemotherapy

We investigated the safety and efficacy of a methotrexate, vinblastine, doxorubicin and cisplatin (M-VAC) combination regimen as second-line chemotherapy for patients with advanced or metastatic transitional cell carcinoma who failed first-line gemcitabine and cisplatin (GC) chemotherapy. Thirty patients who had progressed or relapsed after GC chemotherapy as first-line treatment were enrolled in this study. The major toxicities were neutropaenia and thrombocytopaenia. A grade 3 or 4 neutropaenia occurred in 19 (63.3%) and a grade 3 or 4 thrombocytopaenia developed in nine patients (30.0%). There were no life-threatening complications during the study. The overall response was 30%. A complete response was achieved in two patients (6.7%) and a partial response in seven (23.3%). The overall disease control rate was 50%. Seven out of 16 patients who had responded previously to GC responded to M-VAC, while 2 out of 14 who had not responded to GC responded to M-VAC. The median response duration was 3.9 months and the median progression-free survival was 5.3 months. The median overall survival was 10.9 months. M-VAC showed encouraging efficacy and reversible toxicities in patients who had progressed after GC chemotherapy and, especially, M-VAC appears to be a reasonable option as a sequential treatment regimen in patients who responded previously to GC chemotherapy.

Lymphscintigraphy predicts response to complex physical therapy in patients with early stage extremity lymphedema

We investigated whether baseline lymphscintigraphic findings can predict long-term response to complex physical therapy (CPT) in patients with early stage extremity lymphedema. Twenty patients with unilateral extremity lymphedema of clinical stage I or II underwent CPT after baseline lymphscintigraphy. Therapeutic responses (good vs. poor) were evaluated at 1 year post-CPT based on changes in skin status and subjective symptoms, and percent volume reductions and compared with clinical factors and lymphscintigraphic findings. Eleven patients showed good response to CPT with significant volume reduction of edematous extremities, and no significant volume reduction was observed in the remaining 9. Patients with good or poor responses to CPT showed no significant differences in terms of clinical variables. However, significant differences were observed between the lymphscintigraphic findings of these patients. More specifically, a lymphscintigraphic finding of main lymphatic vessels without collateral lymphatic vessels was the best predictor for a good response to CPT; the sensitivity, specificity and accuracy of this lymphscintigraphic finding is 91% (10/11), 100% (9/9) and 95% (19/20), respectively. In patients with unilateral extremity lymphedema of early stage, baseline lymphscintigraphy may usefully predict long-term response to CPT.

Calorimetric investigation of phosphorylated and non-phosphorylated peptide ligand binding to the human Grb7-SH2 domain

Grb7 is a member of the Grb7 family of proteins, which also includes Grb10 and Grb14. All three proteins have been found to be overexpressed in certain cancers and cancer cell lines. In particular, Grb7 (along with the receptor tyrosine kinase erbB2) is overexpressed in 20-30% of breast cancers. In general, growth factor receptor bound (Grb) proteins bind to activated membrane-bound receptor tyrosine kinases (RTKs; e.g., the epidermal growth factor receptor, EGFR) through their Src homology 2 (SH2) domains. In particular, Grb7 binds to erbB2 (a.k.a. EGFR2) and may be involved in cell signaling pathways that promote the formation of metastases and inflammatory responses. In previous studies, we reported the solution structure and the backbone relaxation behavior of the Grb7-SH2/erbB2 peptide complex. In this study, isothermal titration calorimetry studies have been completed by measuring the thermodynamic binding parameters of several phosphorylated and non-phosphorylated peptides representative of natural Grb7 receptor ligands as well as ligands developed through combinatorial peptide screening methods. The entirety of these calorimetric studies is interpreted in an effort to describe the specific ligand binding characteristics of the Grb7 protein.

Association of the -2510A/G chemokine (C-C motif) ligand 2 polymorphism with knee osteoarthritis in a Korean population

OBJECTIVE

To investigate the possible association between polymorphisms [the -2510A/G promoter polymorphism (rs1024611) and the Cys35Cys coding polymorphism (rs4586) in exon 2] of the chemokine (C-C motif) ligand 2 (CCL2) gene and knee osteoarthritis (OA) in a Korean population.

METHODS

DNA was obtained from 153 Korean primary knee OA patients and 270 healthy controls. CCL2 genomic variants (-2510A/G and Cys35Cys polymorphisms) were detected by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). In additional, the effect of -2510A/G on CCL2 transcription was examined, using a luciferase reporter gene construct transfected into HMC-1 cells.

RESULTS

The -2510A/G promoter polymorphism was associated with OA [genotype frequency, p = 0.041; allele frequency, p = 0.017, odds ratio (OR) = 1.45, 95% confidence interval (CI) = 1.07-1.96]. Significant association was observed between the G carrier of the -2510A/G promoter polymorphism and primary knee OA patients (p = 0.021, OR = 2.25, 95% CI = 1.12-4.52). The G carrier of the -2510A/G promoter polymorphism was also associated with both clinically subtyped OA patients (OA patients with functionally poor index and radiographically severe OA patients). However, no significant difference was found in the Cys35Cys polymorphism. Haplotype frequency analysis revealed a significant difference (chi(2) = 8.98, p = 0.030). The CCL2 serum level of subjects with the G carrier (290.0+/-87.5 pg/mL) of the -2510A/G promoter polymorphism was statistically higher than that of subjects with the non-G carrier (161.5+/-48.3 pg/mL). The luciferase activity was significantly greater from interleukin (IL)-1beta-induced cells transfected with constructs containing G at position -2510.

CONCLUSIONS

The G carrier of the -2510A/G promoter polymorphism was found to be associated with primary knee OA, and could be a susceptibility factor in the development of primary knee OA in the Korean population.

Lentivirus-mediated carboxyl-terminal modulator protein gene transfection via aerosol in lungs of K-ras null mice

The low efficiency of conventional therapies in achieving long-term survival of lung cancer patients calls for development of novel options. Aerosol gene delivery may provide the alternative for safe and effective treatment for lung cancer. Therefore, current study was performed to elucidate the potential effects of C-terminal modulator protein (CTMP) via aerosol on lung tumorigenesis. Lentiviral vector-CTMP was delivered into K-ras null lung cancer mice through the nose-only inhalation system for 30 min. After 48 h, the potential effects of CTMP on Akt1-related signals and cell cycle regulation in the lungs were evaluated by western blot, immunohistochemistry and zymography. Lentivirus-based CTMP delivery inhibited the Akt1 activity through selective suppression of Akt1 phosphorylation at Ser473. Aerosol delivery of CTMP inhibited proteins important for Akt1 signals, cell cycle and tumor metastasis in lungs of K-ras null mice. Together, our results suggest that lentivirus-mediated aerosol delivery of CTMP may be compatible with noninvasive in vivo gene therapy. Our results emphasize the importance of noninvasive-targeted delivery of CTMP for lung cancer therapy in the future. While the studies are conducted in mice, it is envisioned that noninvasive targeting the specific genes responsible for cancer progression is an attractive strategy for effective anticancer therapeutics.

Preoperative endoscopic retrograde cholangiopancreatographic treatment of complicated choledochal cysts in children: a retrospective case series

We report our experience with endoscopic retrograde cholangiopancreatography-(ERCP-)based interventions in children with complicated choledochal cysts that are refractory to conservative management. Between 1999 and 2006, 42 children (12 boys, 30 girls; median age 3 years, range 2-14.5 years) were admitted for surgical treatment of choledochal cysts. Seven of these patients (16.7%; one boy, six girls; median age 3 years, range 2-12 years) showed signs of complicated choledochal cysts, and presented with pancreatitis/cholangitis (n = 4) and obstructive jaundice (n = 3). The anatomical classification of the cysts was type Ic (n = 3), type If (n = 3), and type IV (n = 1). ERCP was successfully performed in 6/7 patients, and therapeutic interventions included removal of debris (n = 3), sphincterotomy (n = 3), and stent placement (n = 4). One patient required blood transfusion for post-sphincterotomy bleeding. The patient in whom the ERCP failed underwent ultrasound-guided percutaneous transhepatic biliary drainage. Definitive surgery was performed after a median interval of 10 days (range 7-68 days) after the ERCP intervention.

Oral hairy leukoplakia arising in an oral lichen planus lesion in an otherwise immune-competent patient

Oral hairy leukoplakia (OHL) presents clinically as thickened white plaques which cannot be rubbed off, and is most often found on the lateral margin of the tongue. The name is derived from its often hairy appearance. OHL has clinical significance because of its association with HIV infection, and it is rare in immune-competent people. We report on a case of unilateral OHL which arose in an oral lichen planus lesion in an immune-competent patient.

Factors influencing pain during transrectal ultrasonography-guided prostate biopsy

We prospectively investigated the clinical parameters that influenced pain during prostate biopsies. From 12 hospitals 1781 patients were enrolled. The patients completed a visual analogue scale questionnaire for the pain during the procedure. Age, enema preparation, analgesia use and number of biopsy punctures influenced the level of pain during prostate biopsy in univariate linear regression analysis. However, multivariate analysis showed enema preparation, analgesia use and number of biopsy punctures were independent factors associated with the pain during the procedure. Our study confirmed enema preparation before biopsy and the number of biopsy punctures were associated with the pain during prostate biopsy.

Inflammatory myofibroblastic tumor of the bladder in children: what can be expected?

Inflammatory myofibroblastic tumor of the bladder is an uncommon condition of unknown neoplastic potential. In adults the tumor is seen in association with instrumentation of the lower genitourinary tract, while in children it appears to run an idiopathic course. Its clinical and radiological presentation in children resembles sarcoma. The case of a 10-year-old girl with inflammatory myofibroblastic tumor is presented, outlining the histological and immunhistochemical features to allow differentiation between sarcomas, the most important differential diagnosis. An outcome meta-analysis of the literature identified 35 cases of inflammatory myofibroblastic tumor in the bladder of children. Conservative surgery is the strategy of choice. There is no evidence of recurrence or metastasis at a median follow up of 1.5 years.

Adiponectin levels in patients with intracranial atherosclerosis

BACKGROUND

Adiponectin is a protein secreted by adipose cells that improves insulin sensitivity and possesses antiatherogenic properties. In this study, we investigated the relationship between adiponectin levels and ischemic stroke subtype.

METHODS

Using clinical, imaging, and laboratory data, 231 consecutive patients admitted to a university medical center over a 2-year period with acute cerebral infarcts were categorized into four subtypes: intracranial atherosclerosis (n = 67), extracranial atherosclerosis (n = 61), small arterial occlusion (n = 63), and cardioembolic (n = 40). Clinical features, risk factors including the presence of metabolic syndrome, and levels of s-adiponectin were compared between groups.

RESULTS

Patients with more severe metabolic abnormalities were more likely to have lower s-adiponectin levels (p = 0.002). S-adiponectin levels differed by stroke subtype: highest in the cardioembolic group and lowest in the intracranial atherosclerosis group (8.42 +/- 5.07 vs 5.60 +/- 2.79 microg/mL, p = 0.01). Extracranial atherosclerosis (6.45 +/- 4.10 microg/mL) and small arterial occlusion (6.07 +/- 3.44 microg/mL) groups were intermediate. Patients with advanced intracranial atherosclerosis (> or =1 additional lesion outside the symptomatic arterial territory) had lower s-adiponectin levels than those with isolated intracranial atherosclerosis (4.95 +/- 2.63 vs 6.13 +/- 2.84 microg/mL, p = 0.003). In multiple regression analysis, s-adiponectin levels, but not metabolic syndrome, were independently associated with intracranial atherosclerosis.

CONCLUSIONS

Symptomatic intracranial atherosclerosis is associated with lower s-adiponectin levels vs other ischemic stroke subtypes.

Aerosol-delivered programmed cell death 4 enhanced apoptosis, controlled cell cycle and suppressed AP-1 activity in the lungs of AP-1 luciferase reporter mice

The long-term survival of lung cancer patients treated with conventional therapies remains poor and therefore the need for novel approaches remains high. This has led to the re-emergence of aerosol delivery as a therapeutic intervention. In this study, glucosylated polyethylenimine (GPEI) was used as carrier to investigate programmed cell death 4 (PDCD4) and PDCD4 mutant (D418A), an eIF4A-binding mutant, on PDCD4-related signaling and activator protein-1 (AP-1) activity in the lungs of AP-1 luciferase reporter mice. After confirming the efficiency of GPEI as a carrier in lungs, the effects of aerosol-delivered PDCD4 were investigated in AP-1 luciferase reporter mice. Aerosol delivery of GPEI/PDCD4 through a nose-only inhalation facilitated the apoptosis of lungs whereas aerosol PDCD4 mutant did not. Also, such aerosol delivery regulated proteins relevant to cell-cycle control and suppressed AP-1 activity. Results obtained by western blot analysis, immunohistochemistry, luciferase assay and deoxynucleotidyl-transferase-mediated nick end labeling study suggest that combined actions such as facilitating apoptosis, controlling cell cycle and suppression of AP-1 activity by PDCD4 may provide useful tool for designing lung tumor prevention and treatment by which PDCD4 functions as a transformation suppressor in the future.

Ablation of paternal accessory sex glands imparts physical and behavioural abnormalities to the progeny: an in vivo study in the golden hamster

The functional significance of male accessory sex glands (ASG) remains unclear. This study explored their importance in reproduction. In previous investigations, embryos sired by males with ASG either totally or partially removed had a shift in the cell cycle and delayed cleavage during preimplantation development, higher incidence of apoptosis, early oviductal-uterine transit, higher proportion of embryo degeneration, lower implantation rate, and ultimately reduced fertility and fecundity. Some pups were born alive; but would they be normal? We hypothesized that the first generation offspring (F1) could also bear undesirable traits. To test our hypothesis, we raised and studied these F1 pups from birth to 8 weeks. We monitored physical growth and assessed behaviour such as nest patch odor preference, acoustic startle response (ASR) and exploratory activity. We detected deviations from the norm in physical growth, a premature cessation of nest patch odor preferences, accelerated acoustic startle habituation and more frequent rearing when exposed to a novel environment. In terms of structure, we found one incidence of diphallus with duplicated urethra. We concluded that sperm lacking contact with ASG secretions gave rise to progeny with abnormal traits.

Association of extracellular cleavage of E-cadherin mediated by MMP-7 with HGF-induced in vitro invasion in human stomach cancer cells

BACKGROUND

Proteolytic shedding of the ectodomain of a variety of transmembrane proteins, including cell-to-cell adhesion molecules, has been observed in solid cancers. We have investigated whether extracellular cleavage of E-cadherin mediated by matrix metalloproteinase-7 (MMP-7) is involved in hepatocyte growth factor (HGF) induced in vitro invasion in stomach cancer cells.

METHODS

The effects of HGF on the expression of E-cadherin/beta-catenin and MMP-7 at both the protein and mRNA levels were assessed in stomach cancer cells, NUGC-3 and MKN-28, and in cells in which the expression of MMP-7 was downregulated by transfection with a MMP-7 short hairpin RNA plasmid.

RESULTS

Treatment with HGF increased the extracellular cleavage of E-cadherin and the release of MMP-7 and reduced the level of E-cadherin in a dose- and time-dependent manner. HGF treatment repressed the phosphorylation of beta-catenin in a Triton-soluble fraction, but enhanced this phosphorylation in a Triton-insoluble fraction. The association of E-cadherin with beta-catenin was decreased by HGF treatment in the Triton-soluble fraction. In addition, treatment of MMP-7 short hairpin RNA transfected NUGC-3 cells with HGF resulted in no extracellular cleavage of E-cadherin and also decreased the in vitro cell invasion.

CONCLUSIONS

These results suggest that incubation with HGF mediated the release of MMP-7, resulting in extracellular cleavage of E-cadherin from stomach cancer cells. This might be a key mechanism in HGF-induced in vitro invasion and metastasis.

Investigation of the corticotropin-releasing hormone-proopiomelanocortin axis in various skin tumours

BACKGROUND

Various types of external stress cause the skin and central neuroendocrine system to express corticotropin-releasing hormone (CRH)-proopiomelanocortin (POMC) axis-related hormones. However, the precise role of the CRH-POMC axis-related hormones in various skin tumours is unclear.

OBJECTIVES

This study examined expression patterns of the CRH-POMC axis-related hormones in skin tumours.

METHODS

The production of CRH, adrenocorticotropic hormone (ACTH) and alpha-melanocyte-stimulating hormone (alpha-MSH) in various tumour cell lines including HaCaT and primary keratinocytes was examined using an enzyme-linked immunosorbent assay. Immunohistochemical analysis of the skin tumours was also performed.

RESULTS

CRH, ACTH and alpha-MSH were strongly expressed in malignant skin tumour cell lines such as G-361 and DX-3 (both malignant melanoma, MM). However, normal and haematological malignancy cell lines did not express the CRH-POMC axis-related hormones. Immunohistochemical analysis of the skin tumours showed that MM (80%), squamous cell carcinoma (SCC, 70%) and basal cell carcinoma (BCC, 10%) had strong immunoreactivity (++/+++) for CRH. Strong ACTH and alpha-MSH expression was observed in MM (70% and 50%, respectively), SCC (80% and 60%, respectively) and BCC (70% and 50%, respectively).

CONCLUSIONS

We report that an increase in the level of the CRH-POMC axis-related hormones is associated with malignant skin tumours such as MM. These results highlight the importance of the CRH-POMC axis-related hormones in the malignant tendency of skin tumours.

Polymeric nanofiber web-based artificial renal microfluidic chip

In this paper, we present a new method for the creation of a smaller dialyzer and do so by incorporating polymeric nanofiber web, which is known to have good filtration efficiency for broad particle sizes, into a poly (dimethylsiloxane)-based microplatform. We have developed a process that makes possible the efficient production of polyethersulfone and polyurethane nanofiber web and that, itself, incorporates an electrospinning method. We have combined the nanofiber web with the PDMS-based microfluidic platform to create a chip-based portable hemodialysis system. With the dialyzing chip, we evaluated the filtration capability of molecules in broad ranges of sizes and compared the filtration capability of nanofiber membranes with that of PES and polyvinylidene fluoride porous membranes (sheet type): we discovered that the nanofiber membranes have better filtration performance than the other membranes. Blood cells were not mechanically affected during their filtration and their transportation through the chip. In conclusion, we have demonstrated the feasibility of chip-based hemodialysis, and we expect that our method suggested in this paper will be applied to the development of small light-weight dialyzers for the realization of portable hemodialysis systems.

Mineral loss from bovine enamel by a 30% hydrogen peroxide solution

This study investigated the effect of a 30% hydrogen peroxide bleaching agent on bovine enamel in terms of mineral loss. Contents of mineral elements both in the teeth and bleaching agent were evaluated to estimate the effect of hydrogen peroxide on teeth. Finely polished non-carious bovine incisors (n = 5) were immersed in a 30% hydrogen peroxide solution for 120 h. The amounts of concentrated elements in the bleaching agent (5 mL) were measured using inductively coupled plasma-atomic emission spectrometer and ion chromatograph. The contents of mineral elements in the teeth were measured using an electron probe microanalyzer. The Ca/P ratio in the bleaching agent was approximately 1.99. The amount of Zn in the bleaching agent was below the detection limit. The total content of mineral elements of the unbleached enamel (90.75 +/- 1.58) was slightly greater than that of the bleached enamel (87.44 +/- 0.77). The Ca/P ratio of the bleached enamel was 2.06. The amount of Ca loss from the bleached enamels after 120 h was similar to the amount of Ca loss from teeth exposed to a soft drink or juice for a few minutes. Therefore, mineral loss caused by the bleaching process may not be a threatening factor to teeth.

A hepaticojejunostomy: technical errors with 'twists and turns'

Excision of a choledochal cyst followed by biliary reconstruction with a Roux-en-Y hepaticojejunostomy is the treatment of choice for type I and IV choledochal cysts. We present a rare complication which was identified 8 years after the original reconstructive surgery. Conventional imaging modalities failed to identify the pathology. Only a contrast enhanced CT scan supported by image rendering software allowed for the visualization of the underlying chronic obstruction of part of the mesentery.

Reversed discrepancy between CT and diffusion-weighted MR imaging in acute ischemic stroke

PURPOSE

We sought to determine whether an early CT ischemic lesion showing parenchymal hypoattenuation might be undetectable on diffusion-weighted imaging (DWI) in acute cerebral ischemia.

MATERIALS AND METHODS

We retrospectively evaluated CT and MR images of 70 consecutive patients with acute middle cerebral artery (MCA) infarction. All patients underwent CT and MR imaging within 6 hours of symptom onset. We determined the presence of reversed discrepancy (RD), defined as an early ischemic lesion showing parenchymal hypoattenuation on CT but no hyperintensity on DWI. CT Hounsfield units (HU), apparent diffusion coefficients (ADCs), and perfusion parameters were calculated for RD lesions.

RESULTS

RD was found in 9 (12.9%) patients and at basal ganglia (89%). The mean HU of RD lesion was lower than that of normal tissue (DeltaHU, 2.33 +/- 0.74, P < .001). RD lesions showed no significant decrease of ADC (ADC ratio, 0.97 +/- 0.07, P = .059) and cerebral blood flow (relative CBF, 0.87 +/- 0.20, P > 0.05). Delayed DWI hyperintensity occurred in 8 (88.8%) RD lesions, and all lesions progressed to infarction. In 6 (66%) of 9 patients with RD, Alberto Stroke Program Early CT scores of ischemic lesions were lower on CT than those on DWI.

CONCLUSION

RD was uncommonly found mainly in basal ganglia, and all RD lesions progressed to infarction at follow-up. Early CT ischemic lesion showing parenchymal hypoattenuation may be undetectable on DWI, and DWI may underestimate extent of severe ischemic tissue in patients with acute MCA infarction.

Seven-day is more effective than 4-day ranitidine bismuth citrate-based triple therapy in eradication of Helicobacter pylori in children: a prospective randomized study

BACKGROUND

Helicobacter pylori infection is common in paediatric population. To date, there is still no universally accepted recommendation on the treatment of this infection in children. Ranitidine bismuth citrate-based triple therapy has been shown to be effective in H. pylori eradication in adults but its use has rarely been validated in children.

AIM

To investigate the efficacy of ranitidine bismuth citrate-based triple therapy in eradication of H. pylori in children and to determine the shortest duration of treatment required.

PATIENTS AND METHODS

We conducted a prospective randomized study comparing ranitidine bismuth citrate plus amoxicillin plus clarithromycin given for 4 days vs. 7 days in H. pylori-infected children diagnosed by (13)C-urea breath test. Eradication was evaluated by repeat (13)C-urea breath test at 6 weeks after treatment.

RESULTS

A total of 206 children were recruited (median age 12 years, 97 boys and 109 girls). Ninety-eight (47.6%) and 108 (52.4%) children were randomized to receive 7-day and 4-day regimen respectively. The eradication rate of 4-day treatment arm was 77.8% (both intention-to-treat and per protocol) compared with 88.8% (intention-to-treat, P = 0.036) and 89.7% (per protocol, P = 0.022) of 7-day regimen. There was no statistical difference in terms of side effects between the two groups.

CONCLUSIONS

Seven-day ranitidine bismuth citrate-based triple therapy is an effective and well-tolerated treatment for eradication of H. pylori in children.

Referral patterns and waiting times for liver transplantation in Singapore

INTRODUCTION

Referral patterns, waiting times, waiting list, and mortality provide information on how effectively a transplant programme deals with referred patients. This paper aims to review these parameters in the Singapore National Liver Transplant Programme.

METHODS

Data of all patients referred to the Singapore National Liver Transplant Programme since its inception were captured and outcomes were retrieved and described.

RESULTS

562 patients were referred for liver transplant evaluation from 1990-2004, consisting of 457 adults and 105 children. The main indications for referral were hepatitis B liver disease and hepatocellular carcinoma in adults, and biliary atresia in children. Most patients were of United Network of Organ Sharing (UNOS) status 3 or 4 at the time of referral. 114 (20.28 percent) patients had transplants, consisting of 66 adults (14.44 percent) and 48 (45.71 percent) children. 138 adults and ten children were rejected for transplant, mainly for the reason of being "too early". The median waiting time for adults who had transplants was 3.3 months while adults still on the waiting list had been waiting for 16.2 months. The overall waiting list mortality was 44.3 percent, being 52.5 percent in adults and 23.2 percent in children.

CONCLUSION

The overall transplantation rate is low and the waiting list mortality is high as a result of low availability of organs, particularly in adults. Paediatric liver transplant appears to have been better at dealing with referred patients but this is probably due to availability of living-related liver transplant. Improvement in these may result from the Human Organ Transplant Act.

Long-term post-liver transplant complications of renal impairment and diabetes mellitus: data from Singapore

INTRODUCTION

Patients who survive the initial post-liver transplantation period face the development of chronic diseases in the long run. We studied two important complications of liver transplantation, namely: renal impairment and diabetes mellitus.

METHODS

We analysed adult patients followed-up for more than one year using data from our liver transplant clinical records. Long-term post-transplant renal impairment (RI) was defined as glomerular filtration rate (GFR) less than 60 ml/min/1.73 square metres and long-term post-transplant diabetes mellitus (DM) was defined as fasting blood glucose more than 7.8 mmol/L, that existed at least one year after liver transplantation. Pre- and post-transplant factors that could be associated with these conditions were examined.

RESULTS

Altogether, 35 patients were evaluated. Mean age at transplant was 50 years. Mean duration of follow-up was 58.4 months. There was 11.4 percent of pre-transplant RI and 17.0 percent of pre-transplant DM. Prevalence of post-transplant RI was 43.5 percent at one year and 45.0 percent at four years. Long-term post-transplant RI was associated with renal impairment at six months post-transplant (p-value is 0.033). Prevalence of severe post-transplant RI (GFR is less than 30 ml/min/1.73 square metres) at four years was 5.7 percent. Prevalence of post-transplant DM was 45.5 percent at two years but declined to 5.3 percent at four years.

CONCLUSION

Post-transplant renal impairment appears to be a potential long-term problem while post-transplant diabetes mellitus appears to improve with time.

MELD may not be the better system for organ allocation in liver transplantation patients in Singapore

INTRODUCTION

The Model for End-Stage Liver Disease (MELD) score is a good predictor of mortality on the liver transplant waiting list and is the current system of organ allocation in the USA. However, a higher MELD may be associated with poorer outcome post-liver transplantation. The aim of this study was to determine if MELD should be implemented as the system for organ allocation for liver transplantation in Singapore.

METHODS

There were 46 adult patients who underwent primary liver transplantation at the National University Hospital, Singapore from January 1996 to December 2002. We applied the MELD score to patients who were transplanted and looked for a correlation with survival post-transplant. Patients were followed-up until the most recent visit or death. Survival analysis was performed using Cox regression and Kaplan-Meier method.

RESULTS

The mean age at transplant was 52.7 (SD 2.34) years. The majority of the patients transplanted had Hepatitis B (43 percent). The median MELD score at transplantation was 17 (7-42) and the median Child's score was 11 (6-15). There was a significant correlation between pre-transplant MELD and survival at six months (p-value is 0.037, 95 percent confidence interval [CI] is 1.004-1.13) but not at one year (p-value is 0.065, 95 percent CI is 0.99-1.12). There were no differences in the pre-transplant MELD (odds-ratio [OR] 1, 95 percent CI 0.9-1) as well as survival for patients with and without Hepatitis B (OR 0.72, 95 percent CI 0.22-2.35).

CONCLUSION

MELD allows livers to be allocated to the patients with the greatest medical urgency but its influence on post-transplant survival should be further clarified so that post-transplant survival is not compromised.