Desmocollin switching in colorectal cancer

The desmocollins are members of the desmosomal cadherin family of cell-cell adhesion molecules. They are essential constituents of desmosomes, intercellular junctions that play a critical role in the maintenance of tissue integrity in epithelia and cardiac muscle. In humans, three desmocollins (Dsc1, Dsc2 and Dsc3) have been described. The desmocollins exhibit tissue-specific patterns of expression; only Dsc2 is expressed in normal colonic epithelium. We have found switching between desmocollins in sporadic colorectal adenocarcinoma with a reduction in Dsc2 protein (in 8/16 samples analysed by immunohistochemistry) being accompanied by de novo expression of Dsc1 (16/16) and Dsc3 (7/16). Similar results were obtained by western blotting of a further 16 samples. No change was found in Dsc2 mRNA, but de novo expression of Dscs 1 and 3 was accompanied by increased message levels. Loss of Dsc2 (8/19) and de novo expression of Dsc1 (11/19) and Dsc3 (6/19) was also found in colorectal adenocarcinomas on a background of colitis. The data raise the possibility that switching of desmocollins could play an important role in the development of colorectal cancer.

Bone Mineral Density in Adults Transplanted in Childhood for Liver Disease

INTRODUCTION

It remains unclear whether bone mineral density (BMD) is compromised in adult life after liver transplantation (LT) during childhood.

METHODS

This was a cross-sectional study of total body (TB) and lumbar spine (LS) dual-energy X-ray absorptiometry, anthropometry, and data collected, which included a physical activity questionnaire.

RESULTS

Fifteen patients were enrolled. Mean age at LT was 10.6 (4.5) years (range 1.6 to 18.4). The mean posttransplant period was 12.0 (4.1) years (range 4.4 to 16.7); six were men. The mean TB BMD, 1.11 (0.12) g/cm2, was similar to LS BMD, 1.15 (0.17) g/cm2 (P=.82). The Z-score mean was lower for TB BMD, -0.92 (1.2), and LS BMD, -0.41 (1.2) (P=.22). There was no effect from gender, pretransplant cholestasis (9/15 cases), age at LT, and time since LT. BMD (Z-score) was better for those on corticosteroids (9/15 cases): TB BMD -0.42 (1.20) versus -1.77 (0.86) (P=.04); LS BMD 0.14 (1.00) versus -1.54 (1.03) (P=.03). Anthropometry Z-scores were height -0.04 (0.70), weight -0.33 (0.39), and BMI -0.32 (0.37). There was no correlation between Z-scores for BMD and any of the anthropometry parameters.

CONCLUSION

Although the mean TB BMD was lower in transplanted patients than would be expected for the general population, overall BMD and anthropometry were with the normal adult ranges for adults who had undergone LT in childhood.

CCK2 gastrin receptor as a potential target for therapy in leukaemia cell lines

The gastrin CCK2 pathway has been implicated in the development of various cancers including leukaemia. An autocrine or intracrine pathway may exist in the leukaemia cell that is involved in stimulating proliferation. We tested four leukaemia cell lines, KU812, ML-1, MOLT-4 and U937 for the existence of the CCK2 receptor and gastrin precursor protein using immunoblotting. We also assessed the effect of CCK2 antagonist PD 135 and both gastrin 17 and glycine-extended gastrin on the proliferation of the cell lines. We found immunoreactive CCK2 and gastrin precursors present in all 4 cell lines. We also observed a stimulatory effect on proliferation by gastrin and glycine-extended gastrin on 2 and 3 of the cell lines respectively and an inhibitory effect of PD 135 on all 4 cell lines. These results demonstrate that the gastrin-gastrin receptor axis is a potential target for new therapeutic strategies.

The cost-effectiveness of ivermectin vs. albendazole in the presumptive treatment of strongyloidiasis in immigrants to the United States

The presumptive treatment of parasitosis among immigrants with albendazole has been shown to save both money and lives, primarily via a reduction in the burden of Strongyloides stercoralis. Ivermectin is more effective than albendazole, but is also more expensive. This coupled with confusion surrounding the cost-effectiveness of guiding therapy based on eosinophil counts has led to disparate practices. We used the newly arrived year 2000 immigrant population as a hypothetical cohort in a decision analysis model to examine the cost-effectiveness of various interventions to reduce parasitosis among immigrants. When the prevalence of S. stercoralis is greater than 2%, the incremental cost-effectiveness ratios of all presumptive treatment strategies were similar. Ivermectin is associated with an incremental cost-effectiveness ratio of 1700 dollars per QALY gained for treatment with 12 mg ivermectin relative to 5 days of albendazole when the prevalence is 10%. Any presumptive treatment strategy is cost-effective when compared with most common medical interventions.

Breast necrosis following harvest of internal mammary artery

The use of internal mammary artery is well established not only in cardiac surgery for coronary artery bypass grafting but also in plastic surgery for breast reconstruction with free autologus tissue. The complications that follow harvest of internal mammary artery for heart surgery usually relate to the wound. This case report documents the first case of complete breast infarction following such a procedure in a patient who had no prior history of breast pathology. The histology of the breast showed extensive calcification of the intima and media of small to medium sized vessels, a condition called calciphylaxis, which is largely unknown outside the fields of nephrology and dermatology.

Chromosomal location of genes for novel glutenin subunits and gliadins in wild emmer wheat (Triticum turgidum L. var. dicoccoides)

The glutenin and gliadin proteins of wild emmer wheat, Triticum turgidum L. var. dicoccoides, have potential for improvement of durum wheat ( T. turgidum L. var. durum) quality. The objective of this study was to determine the chromosomes controlling the high molecular weight (HMW) glutenin subunits and gliadin proteins present in three T. turgidum var. dicoccoides accessions (Israel-A, PI-481521, and PI-478742), which were used as chromosome donors in Langdon durum- T. turgidum var. dicoccoides (LDN-DIC) chromosome substitution lines. The three T. turgidum var. dicoccoides accessions, their respective LDN-DIC substitution lines, and a number of controls with known HMW glutenin subunits were analyzed by sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE), urea/SDS-PAGE, and acid polyacrylamide gel electrophoresis (A-PAGE). The results revealed that all three T. turgidum var. dicoccoides accessions possess Glu-A1 alleles that are the same as or similar to those reported previously. However, each T. turgidum var. dicoccoides accession had a unique Glu-B1 allele. PI-478742 had an unusual 1Bx subunit, which had mobility slightly slower than the 1Ax subunit in 12% SDS-PAGE gels. The subunits controlled by chromosome 1B of PI-481521 were slightly faster in mobility than the subunits of the Glu-B1n allele, and the 1By subunit was identified as band 8. The 1B subunits of Israel-A had similar mobility to subunits 14 and 16. The new Glu-B1 alleles were designated as Glu-B1be in Israel-A, Glu-B1bf in PI-481521, and Glu-B1bg in PI-478742. Results from A-PAGE revealed that PI-481521, PI-478742, and Israel-A had eight, 12, and nine unique gliadin bands, respectively, that were assigned to specific chromosomes. The identified glutenin subunits and gliadin proteins in the LDN-DIC substitution lines provide the basis for evaluating their effects on end-use quality, and they are also useful biochemical markers for identifying specific chromosomes or chromosome segments of T. turgidum var. dicoccoides.

Fast-tracking revisited: routine cardiac surgical patients need minimal intensive care

OBJECTIVE

Following cardiac surgery, patients are transferred from the operating theatre to intensive care. This clinical environment has one nurse per patient and facilities for mechanical ventilation. Patients are kept in this setting until the following day. This practice has been challenged with early extubation of patients. At our institution we have established a fast-track policy including the following features: (1) patient selection; (2) operating list scheduling with fast-track patients first; (3) anaesthetic tailored to early extubation; (4) methodical procedure with warm cardiopulmonary bypass; (5) removal of the arterial line; (6) transfer from intensive care to a separate high dependency unit ('step-down') on the day of operation, where the ratio of nurse to patient is one to three and there are no ventilatory facilities and no invasive monitoring; or (7) to keep these patients on ICU but decrease the nurse to patient ratio.

METHOD

The case notes of 572 patients who predominantly had myocardial revascularisation, undergoing this process from July 1996 to July 2000 at our institution were reviewed.

RESULTS

Mean EUROSCORE for the study group was 1.42. The 30-day mortality rate for the study group was 0.34%, mean intensive care time was 5 h 52 min, mean time to extubation was 3 h 10 min, mean readmission rate to intensive care was 0.34% and mean hospital stay from day of operation (inclusive) was 5.65 days. This process increased our throughput by 14.6% (compared to standard practices).

COMMENT

This study demonstrates that transfer of appropriate patients to a high dependency area from intensive care following cardiac surgery is safe. It allows intensive care beds to be used by more than one patient each day and allows significant cost savings by reducing the nursing ratio per patient.

Low-cost failure sensor design and development for water pipeline distribution systems

This paper describes the design and development of a new sensor which is low cost to manufacture and install and is reliable in operation with sufficient accuracy, resolution and repeatability for use in newly developed systems for pipeline monitoring and leakage detection. To provide an appropriate signal, the concept of a "failure" sensor is introduced, in which the output is not necessarily proportional to the input, but is unmistakably affected when an unusual event occurs. The design of this failure sensor is based on the water opacity which can be indicative of an unusual event in a water distribution network. The laboratory work and field trials necessary to design and prove out this type of failure sensor are described here. It is concluded that a low-cost failure sensor of this type has good potential for use in a comprehensive water monitoring and management system based on Artificial Neural Networks (ANN).

Cost-effectiveness of vaccination versus treatment of influenza in healthy adolescents and adults

At present time, there is uncertainty regarding whether influenza-like illness in healthy adults is best managed by preventive efforts that use the trivalent influenza vaccine, administration of neuraminidase inhibitors at the onset of illness, or recommendation of supportive care alone at the onset of illness. We conducted a cost-effectiveness analysis that examined these 3 strategies for managing influenza-like illness. Vaccination with inactivated trivalent vaccine would save approximately 25 dollars per person while resulting in a net gain of approximately 3.2 quality-adjusted hours relative to providing treatment with the neuraminidase inhibitor oseltamivir. A quality-adjusted hour is a fraction of a quality-adjusted life-year, which is the equivalent of 1 year lived in perfect health. Treatment with oseltamivir was associated with an incremental cost-effectiveness of approximately 27,619 dollars per quality-adjusted life-year gained relative to providing supportive care. Vaccination is cost-saving relative to providing either treatment with oseltamivir or providing supportive care alone.

Patient handling of a dry-powder inhaler in clinical practice

BACKGROUND

Multi-dose dry-powder inhalers are perceived as being easier for patients to use than conventional pressurized aerosol inhalers; however, no study has determined whether patients handle such devices adequately and whether there is a need for patient education in this area.

METHOD

We used trained observers to assess the handling of a specific multi-dose dry powder inhaler (Turbuhaler; AstraZeneca Canada; Mississauga, ON) by patients currently using the device for the management of their asthma. Fourteen discrete steps were scored independently by two observers simultaneously. Patients were divided into two groups for analysis: those who had received formal instruction in the use of the inhaler at The Asthma Centre and those who had received no formal instruction in the community.

RESULTS

There was no significant difference between the formally trained groups and control groups in the percentage of handling steps performed correctly (79% vs 78%, respectively; p > 0.05). Fewer than 50% of patients in both groups demonstrated optimal breath-holding when using the device.

CONCLUSION

Patient handling of Turbuhaler was generally good, with no evidence that a structured education intervention offered an advantage over the usual education incidental to the prescribing or dispensing process. The most common handling flaw, suboptimal breath-holding, is not specific to this device and is of uncertain clinical significance.

Increased formation of S-nitrothiols and nitrotyrosine in cirrhotic rats during endotoxemia

Plasma S-nitrosothiols are believed to function as a circulating form of nitric oxide that affects both vascular function and platelet aggregation. However, the formation of circulating S-nitrosothiols in relation to acute and chronic disease is largely unknown. Plasma S-nitrosothiols were measured by chemiluminescence in rats with biliary cirrhosis or controls, and the effect of lipopolysaccharide (LPS) on their formation was determined. Plasma S-nitrosothiols were increased in rats with cirrhosis (206 +/- 59 nM) compared to controls (51 +/- 6 nM, p <.001). Two hours following injection of LPS (0.5 mg/kg) plasma S-nitrosothiols increased to 108 +/- 23 nM in controls (p <.01) and to 1335 +/- 423 nM in cirrhotic rats (p <.001). The plasma clearance and half-life of S-nitrosoalbumin, the predominant circulating S-nitrosothiol, were similar in control and cirrhotic rats, confirming that the increased plasma concentrations were due to increased synthesis. Because reactive nitrogen species, such as peroxynitrite, may cause the formation of S-nitrosothiols in vivo, we determined the levels of nitrotyrosine by gas chromatography/mass spectrometry as an index for these nitrating and nitrosating radicals. Hepatic nitrotyrosine levels were increased at 7.0 +/- 1.2 ng/mg in cirrhotic rats compared to controls (2.0 +/- 0.2 ng/mg, p <.01). Hepatic nitrotyrosine levels increased by 2.3-fold and 1.5-fold in control and cirrhotic rats, respectively, at 2 h following injection of LPS (p <.01). Strong positive staining for nitrotyrosine was shown by immunohistochemistry in all the livers of the rats with cirrhosis. We conclude that there is increased formation of S-nitrosothiols and nitrotyrosine in biliary cirrhosis, and this is markedly upregulated during endotoxemia.

Effect of gastrin and anti-gastrin antibodies on proliferation of hepatocyte cell lines

Gastrin (G-17) and its precursor glycine-extended gastrin (G-17-gly) have been shown to be trophic to some gastrointestinal tumors. This in vitro study assessed the effect of G-17, G-17-gly, anti-gastrin antibodies (anti-G-17), and the CCK-B receptor antagonist PD135,158 on three hepatoma cell lines (PLC/PRF/5, HepG2 and MCA-RH7777) and an embryonic liver cell line (WRL68). The pancreatic adenocarcinoma cell line AR42J was used as a positive control. G-17 and G-17-gly caused significant proliferation of AR42J and WRL68 cell lines. G-17-gly but not G-17 induced significant proliferation of the PLC/PRF/5 cell line. Anti-G-17 and PD135,158 significantly inhibited unstimulated AR42J and WRL68 cell lines. Anti-G-17 also inhibited the proliferative effects of G-17 and G-17-gly on AR42J, WRL68, and PLC/PRF/5 cell lines, whereas PD135,158 inhibited the proliferative effect of G-17 only. G-17 and G-17-gly as well as anti-G-17 and PD135,158 had no effect on HepG2 and MCA-RH77777 cell lines. It is concluded that G-17-stimulated proliferation is mediated via the CCK-B receptor and G-17-gly via a separate, as yet uncharacterized, receptor. There may therefore be a role for gastrin in embryonic hepatocellular proliferation and perhaps also in the proliferation of some hepatocellular tumors.

Development and validation of a questionnaire to evaluate the effectiveness of evidence-based practice teaching

AIM

The aim of this study was to develop and validate a questionnaire to evaluate the effectiveness of evidence-based practice (EBP) teaching.

METHODS

The 152 questionnaires completed by health care professionals with a range of EBP experience were used in this study. Cronbach's alpha for the knowledge and attitude questions indicated a satisfactory level of internal consistency (i.e. >0.60).

RESULTS

The discriminative validity was evidenced by a statistically significant difference in the knowledge and attitude scores of 'novices' (i.e. little or no prior EBP education) compared with 'experts' (i.e. health care professionals and academics currently teaching EBP). Moderate to good (> or =0.4) sensitivity index scores were observed for both knowledge and attitude scores as the result of comparing individuals before and after an EBP intervention.

CONCLUSIONS

The results of this validation study indicate that the developed questionnaire is a satisfactory tool with which to evaluate the effectiveness of EBP teaching interventions.

A double-blind, placebo-controlled crossover study investigating the effect of porcine secretin in children with autism

A recent patient series reported the incidental findings of improved social and language skills in 3 children with autistic spectrum disorders after the administration of secretin, a peptide hormone. However, a subsequent study did not find evidence for a drug effect. Parents are seeking treatment with secretin despite the absence of empirical investigations demonstrating amelioration in autism symptomology. In order to more precisely measure the effects of secretin, this study investigated the effect of a single intravenous dose of porcine secretin on 12 autistic children through a randomized, double-blind, placebo-controlled, crossover study. Children were assessed on objective language and on social, neuropsychological, and gastrointestinal measures to evaluate drug effects. The study was conducted over a 16-week trial. The results indicated that significant differences were not observed on the majority of the dependent variables. Statistically significant differences were observed on measures of positive affect and activity level following secretin infusion. In general, the autistic children did not demonstrate the improvements described in the initial retrospective report.

Natural gamma-emiting radionuclides in Pakistani Portland cement

Studies of the natural gamma-emitting radionuclides in Portland cement manufactured in the North West Frontier Province (NWFP) of Pakistan and the various raw materials which compose the product have been carried out using gamma-spectrometric techniques. For data acquisition a high-purity germanium detector (HPGe) was used. The range of the total specific activity (minimum and maximum values) due to all the three radionuclides (40K, 226Ra and 232Th) were found to be 187.8+/-63.5-573.2+/-73.1 Bq kg(-1) (Portland cement); 54.5+/-16.1-183.9+/-31.4 Bq kg(-1) (limestone); 87.1+/-30.7-297.1+/-64.4 Bq kg(-1) (gypsum); 696.4+/-79.1-1043.9+/-85.0 Bq kg(-1) (slate); and 490.9+/-54.5-570.2+/-59.8 Bq kg(-1) (latrite). The average specific activities due to 40K in Portland cement and all the raw materials were found to be higher when compared with 226Ra and 232Th. Such materials do not pose any excess radiological health problem.

Lactation, breast-feeding supplementation and nutrition

BACKGROUND

Breast-feeding and proper weaning methods are very important to cover the milestones of life and to achieve good nutritional status under five. The proper lactation, feeding and supplementation methods must be adopted to achieve this goal. In Pakistan a lot of agencies have been working on this. It is included in the daily effort of every doctor and medic to achieve this goal.

METHODS

This study was done to know the results of our efforts in Oghi Pakistan. A Hospital based study on 10 children/mothers was conducted. The children were randomly selected from the best E.P.I. center of Oghi. The mothers were interviewed after explaining them the purpose of the study. The questionnaire was filled and questions were explained in local language for the convenience of mother. The parameters studied and questions asked included age, sex, weight, height, first feed, age at weaning, type of milk, and type of weaning food.

RESULTS

The results were found satisfactory due to the hard work of workers of UNICEF, Health department of NWFP and better when compared to other areas of the province.

Recurrent metastatic fallopian tube carcinoma in pregnancy

BACKGROUND

Fallopian tube cancer is the rarest of all gynecologic cancers. An extensive literature search on Medline reveals no previous case reports of fallopian tube carcinoma in association with a term pregnancy.

CASE

A woman with surgical stage IIB fallopian tube carcinoma was treated with limited staging laparotomy, as per the patient's fertility wishes, followed by adjuvant cis-platinum and paclitaxel (Taxol). One year following chemotherapy, she conceived. She was noted to have an asymptomatic intraabdominal recurrence at 16 weeks. The patient completed 37 weeks of pregnancy without further therapy according to her wishes. She subsequently underwent a cesarean section with optimal tumor reduction surgery. Carboplatin and paclitaxel were reinstituted, achieving partial response. She is presently alive with stable disease status 6 months after completing her salvage chemotherapy.

CONCLUSION

This is the first case report of recurrent fallopian tube cancer in pregnancy.

Prevention and reduction of AD-type pathology in PDAPP mice immunized with A beta 1-42

In AD certain brain structures contain a pathological density of A beta protein deposited into plaques. The effect of genetic mutations found in early onset AD patients was an overproduction of A beta 42, strongly suggesting that overproduction of A beta 42 is associated with AD. We hypothesized that an immunological response to A beta 42 might alter its turnover and metabolism. Young PDAPP transgenic mice were immunized with A beta 1-42, which essentially prevented amyloid deposition; astrocytosis was dramatically reduced and there was reduction in A beta-induced inflammatory response as well. A beta 1-42 immunization also appeared to arrest the progression of amyloidosis in older PDAPP mice. A beta immunization appears to increase clearance of amyloid plaques, and may therefore be a novel and effective approach for the treatment of AD.

Radiological significance of building bricks in Pakistan

Baked clay bricks samples were collected from both urban and rural areas of the North West Frontier Province of Pakistan and natural radioactivity due to 40K, 226Ra and 232Th has been measured in these samples. The specific absorbed dose rates due to natural radioactivity emanating from the walls, floors and ceilings of the typical model rooms made of these building bricks have been calculated applying the mesh size adaptive volume integral methodology. The occupancy factor, representing the weighted average of all the population in the country, was taken to be 0.3 in this study. The values of estimated annual effective dose rates for whole body were found to be 0.38 and 0.35 mSv.y(-1) for the two types of model rooms. These values are smaller than those predicted by UNSCEAR for normal background areas. Thus the building bricks analysed in this study do not pose any significant health problem to the population.

The role of physiotherapy in the prevention and treatment of osteoporosis

Osteoporosis is an increasing public health problem that causes loss of life and reduced quality of life in sufferers. Strategies to improve bone density and reduce the likelihood of falls are important in the prevention of osteoporosis. Physiotherapists have a role to play in this condition through exercise prescription, therapeutic modalities, specific techniques and education. Appropriate treatment goals can be established following a thorough assessment of signs and symptoms, risk factors for osteoporosis and functional status. Levels of bone density measured from dual energy X-ray absorptiometry can help guide patient management. Since the aim is to maximize peak bone mass in children and adolescents, participation in a variety of high-impact activities should be encouraged. In the middle adult years, small increases in bone mass may be achieved by structured weight-training and weight-bearing exercise. In the older adult years, particularly if osteopenia or osteoporosis is present, the aim is to conserve bone mass, reduce the risk of falls, promote extended posture, reduce pain, and improve mobility and function.

Outcome of reduction mammaplasty--a patients' perspective

There have been several studies analysing the outcome of reduction mammaplasty in the literature. Our study is condition specific, with emphasis placed on the patients' subjective experience of treatment. Following a successful pilot study, data were obtained from 74 patients' charts and an anonymous postal questionnaire over a 1-year period. Sixty-six returned the questionnaire complete (89%). Overall satisfaction with the procedure was high (94%). The outcome of surgery with respect to breast size, shape, nipple position, sensation and scarring is documented. All patients expressed marked improvement regarding neck pain, back pain, submammary rash, breast pain and shoulder grooving. Other parameters including psychological wellbeing, quality of life, time on the waiting list, weight of tissue removed and complication rates are analysed. The findings of this study demonstrate overwhelming physical and psychological benefits from surgery. This supports the suggestion that reduction mammaplasty is not primarily cosmetic, producing significant improvement in symptoms.