Adiponectin differentially affects gene expression in human mammary epithelial and breast cancer cells

Serum levels of adiponectin are inversely associated with breast cancer risk. In this study, its effect on growth and gene expression of MCF-7 breast cancer cells and MCF-10A human mammary epithelial cells was compared. The antiproliferative effect of adiponectin on MCF-10A cells was more pronounced and was accompanied by elevated transcript levels of caspase 1, ERbeta2, ERbeta5, TR2 and USP2. Our data suggest that upregulation of genes with known growth inhibitory or apoptotic functions in mammary epithelial cells might contribute to the protective action of this adipocytokine.

Counting the cost: markers of endothelial damage in hematopoietic stem cell transplantation

During hematopoietic stem cell transplantation (HSCT), endothelial damage is the pathological hallmark of veno-occlusive disease of the liver, thrombotic microangiopathy, capillary leak syndrome and graft-versus-host disease. Events prior to conditioning, the conditioning regimen itself as well as calcineurin inhibitors may all induce endothelial damage. Unfortunately, the relative importance of these factors and their interactions, the time frame of endothelial damage and individual susceptibility remain unknown. Moreover, it is conceivable that conditioning regimens differ markedly in their propensity to initiate endothelial damage. Monitoring endothelial damage and response to treatment is hampered by the current lack of suitable markers. In this regard, an ideal marker should be sensitive and specific and indicate the development of an endothelial disorder prior to the onset of symptoms and organ dysfunction. Soluble markers, such as thrombomodulin, are easily amenable with immunoassays; yet, the interpretation of their levels is hampered by the influence of comorbidity. Evaluation of circulating endothelial cells in HSCT demonstrated a marked and dose-dependent increase in cell numbers after conditioning. The challenge ahead is to establish and evaluate novel markers of endothelial damage to permit early detection of disease, monitor response to treatment and evaluate different conditioning regimens.

Doppler echocardiographic findings in 2 identical variants of a rare cardiac anomaly, "subtotal" cor triatriatum: a critical review of the literature

Improved diagnostic procedures of echocardiography and better awareness of the anomaly and its possible variants lead the examiner to the right diagnosis of the rare cor triatriatum sinister. We describe two cases of a variant of "subtotal" cor triatriatum sinister. A uniform classification system is desirable to compare cases, treatment, and outcome.

Hypertension outcomes in an urban nurse-managed center

PURPOSE

To assess the quality of hypertension (HTN) care in an urban nurse-managed center (NMC) by chart audits of insured and uninsured (N = 52) African Americans who were managed by nurse practitioners.

DATA SOURCES

A chart audit form was developed by the authors that merged Health Plan Employer Data and Information Set (HEDIS) criteria with the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI) criteria.

CONCLUSIONS

There was near comparable hypertension control among the two groups. No difference was found in systolic blood pressure (BP) control; however, the uninsured group had a slightly greater average diastolic BP compared with the insured group. There was no significant difference in the number of HTN medications or the number of risk factors. A significant difference was found in the number of NP visits per year between the two groups; the uninsured group averaged 3.2 more visits per year.

IMPLICATIONS FOR PRACTICE

Nurse practitioners in this NMC were able to manage HTN in a high-risk population despite a lack of insurance coverage for anti-hypertensive prescriptions. The finding that the uninsured group had more clinic visits per year than the insured group is significant in that it increases the cost of providing care for these patients and the health care system. The patient cost in time, transportation and burden needs further assessment.

Ebstein's anomaly in adults: Doppler-echocardiographic evaluation

A systematic approach and segmental analysis are required for comprehensive assessment including both morphologic and functional abnormalities associated with Ebstein's anomaly. The essence of the disease is an apical displacement of both the septal and the posterior tricuspid leaflets, exceeding 20 mm or 8 mm/m2 in adults. As a consequence, the right heart consists of three components including the true right atrium, the functional right ventricle (RV) and an intervening zone that is anatomically ventricular but functionally right atrial (atrialized RV). The thin wall of the atrialized RV may result in an aneurysm between the anatomic tricuspid annulus and the apically displaced posterior leaflet. The annular attachment of the anterior leaflet is normal, which may be dysplastic and adherent to the RV wall. Tricuspid regurgitation is usually moderate to severe. Size, shape and function of the functional RV must be described. The paradoxical motion of the interventricular septum causes alterations in left ventricular geometry and function. An interatrial communication is frequently present. Echocardiography is the method of choice to diagnose Ebstein's anomaly on its own or in association with other heart defects.

[Tubercular psoas abscess]

HISTORY AND ADMISSION FINDINGS

A 43-year-old patient suffered from fatigue, nocturnal sweating, rigor and a weight loss of 5 kg over the last 4 weeks. A year before he had been anaemic and he was treated with omeprazole and iron. On admission physical examination was unremarkable, except for the known swelling in the right flank. His general condition was good.

INVESTIGATIONS

Computed tomography showed an extensive abscess of the right psoas muscle with deplacement of the right ureter, causing hydronephrosis, and infiltration of the abdominal wall. Cytological and bacteriological tests of the abscess aspirate indicated tuberculosis.

TREATMENT AND COURSE

The abscess markedly shrank within 2 months of starting antituberculosis treatment, which was continued for another 4 months. A catheter, which had been inserted into the right ureter to relieve hydronephrosis, was remowed without further complications.

CONCLUSION

Because of an increase in the number of immigrants from countries with a high incidence of tuberculosis or HIV infection, extrapulmonary tuberculosis should be included in the differential diagnosis, such as in this case of a psoas muscle abscess. Despite the size of the abscess surgical intervention is rarely required because it will heal under appropriate antituberculosis treatment.