Natural resolution or intervention for fluid collections in acute severe pancreatitis

BACKGROUND

Revisions in terminology of fluid collections in acute pancreatitis have necessitated reanalysis of their evolution and outcome. The course of fluid collections in patients with acute pancreatitis was evaluated prospectively.

METHODS

Consecutive adults with acute pancreatitis, who had contrast-enhanced CT (CECT) within 5-7 days of symptom onset, were enrolled in a prospective cohort study in a tertiary-care centre. Patients were treated according to standard guidelines. Follow-up transabdominal ultrasonography was done at 4-week intervals for at least 6 months. CECT was repeated at 6-10 weeks, or at any time if there were new or persistent symptoms. Asymptomatic collections were followed until spontaneous resolution. Risk factors for pancreatic pseudocysts or walled-off necrosis (WON) were assessed in multivariable analyses.

RESULTS

Of 122 patients with acute pancreatitis, 109 were analysed. Some 91 patients (83·5 per cent) had fluid collections at baseline. Eleven of 29 with interstitial oedematous pancreatitis had acute peripancreatic fluid collections, none of which evolved into pseudocysts. All 80 patients with acute necrotizing pancreatitis had at least one acute necrotizing collection (ANC); of these, five patients died (2 after drainage), three underwent successful drainage within 5 weeks, and collections resolved spontaneously in 33 and evolved into WON in 39. By 6 months' follow-up, WON had required drainage in eight patients, resolved spontaneously in 23 and was persistent but asymptomatic in seven. Factors associated with increased risk of WON were blood urea nitrogen 20 mg/dl or more (odds ratio (OR) 10·96, 95 per cent c.i. 2·57 to 46·73; P = 0·001) and baseline ANC diameter greater than 6 cm (OR 14·57, 1·60 to 132·35; P = 0·017). Baseline ANC diameter over 6 cm was the only independent predictor of either the need for drainage or persistence of such collections beyond 6 months (hazard ratio 6·61, 1·77 to 24·59; P = 0·005).

CONCLUSION

Pancreatic pseudocysts develop infrequently in oedematous acute pancreatitis. Only one-quarter of ANCs either require intervention or persist beyond 6 months, whereas more than one-half of WONs resolve without any intervention within 6 months of onset. Baseline diameter of ANC(s) is an important predictor of outcome.

An analysis of response to neo-adjuvant chemotherapy in patients with locally advanced breast cancer with emphasis on pathological complete response

CONTEXT

In India, most breast cancer women present at a locally advanced stage. Routine practice in majority of the cancer centers is to administer neo-adjuvant chemotherapy (NACT) followed by loco-regional treatment. Surgery is scheduled after 3 or 4 cycles. The patients who achieve pathological complete response (pCR) are expected do well.

AIMS

The present study was conducted to analyze our results with NACT, to know pCR rate, to compare pCR rates among various subgroups and to determine the factors which predict pCR.

SETTINGS AND DESIGN

The study was conducted in a tertiary care university affiliated cancer hospital in South India.

SUBJECTS AND METHODS

All patients with non-metastatic locally advanced breast cancer and agreed by the hospital tumor board to receive NACT were included. At each visit, response was assessed according to RECIST criteria. Re-staging work up and mammography was done prior to surgery.

STATISTICAL ANALYSIS USED

Chi square test was used to analyze categorical variables and uni and multivariate analysis were performed to determine the factors predicting pCR rates.

RESULTS

A total of 84 patients received NACT. Median age was 46 years (ranged from 28 to 66), 46 patients were premenopausal. Totally 72 patients completed the full course before surgery. Clinical response was complete in 26, partial in 52 and 3 had local progression, one stable and two patient developed distant metastasis. Forty-eight patients underwent modified radical mastectomy and breast could be conserved in 34 patients, pCR rate was 36%.

CONCLUSIONS

Compared with historical controls particularly from India, we could achieve higher pCR rates.

Malignant Leiomyoblastoma: An Incidental Diagnosis

DOI: http://www.dx.doi.org/10.3126/njog.v7i2.11147   Nepal Journal of Obstetrics and Gynaecology / Vol 7 / No. 2 / Issue 14 / July-Dec, 2012 / 55-56

Assessment of vascular and endothelial dysfunction in nutritional studies

Vascular and endothelial dysfunction (VED) is emerging as a potential set of early markers of cardiovascular disease risk and tests for its measurement have been widely used in clinical research. The aim of this viewpoint is to describe and discuss the current usage of these measures in well-designed nutritional trials, using the potential relationship between fruit juice intake and VED as example. A search was conducted using the NHS evidence portal including studies published in English between January 1980 and October 2013. Only 10 suitable studies were selected, which investigated the effect of fruit juice intake on VED, among which 4 interventions used flow-mediated dilatation, 2 arterial stiffness, 2 a combination of arterial stiffness and flow-mediated dilatation, 2 carotid intimal media thickness and 1 iontophoresis with laser Doppler. Despite minimal effects reported on classical CVD markers, such as lipids, 8 out of the 10 identified studies reported an effect on endothelial function following juice consumption, indicating that VED tests can be effectively used in human dietary interventions to identify relationships between bioactive compounds from fruit and CVD risk. However, paucity of available data, scarcity of compound bioavailability and metabolism information, strong heterogeneity among experimental methodologies and a number of limitations to study designs, still limit the interpretation of the results obtained through these measures. Future, well-designed studies with greater attention to consider use of VED measures are needed to strengthen the utility of VED tests in nutrition research such as those investigating the impact of polyphenol-rich juices and CVD risk.

Cholinergic nerve fibers in bone defects of a rat osteoporosis model and their regulation by implantation of bone substitution materials

OBJECTIVES

Bone is innervated by autonomic nervous system that consists of sympathetic and parasympathetic nerves that were recently identified in bone. Thus we asked whether parasympathetic nerves occur in bone defects and at the interface of substitution materials that were implanted for stabilization and improvement of healing in an osteoporosis animal model.

METHODS

Osteoporosis was induced in rats by ovariectomy and deficiency diet. A wedge-shaped osteotomy was performed in the metaphyseal area of femur. Eight different implants were inserted that were based on calcium phosphate cement, iron, silica-mineralized collagen, and modifications with strontium. Nerves were identified by immunohistochemistry with antibodies against vesicular acetylcholine transporter (VAChT), tyrosine hydroxylase (TH) and protein gene product 9.5 (PGP 9.5) as neuronal marker.

RESULTS

Cholinergic nerves identified with VAChT immunostaining were detected in defects filled with granulation tissue and in surrounding mast cells. No immunolabeling of cholinergic nerves was found after implantation. The general presence of nerves was reduced after implantation as shown by PGP 9.5. Sympathetic nerves identified by TH immunolabeling were increased in strontium functionalized materials.

CONCLUSION

Since cholinergic innervation was diminished after implantation a further increase in the compatibility of substitution materials to nerves could improve defect healing especially in osteoporotic bone.

PKCλ/ι signaling promotes triple-negative breast cancer growth and metastasis

Triple-negative breast cancer (TNBC) is a distinct breast cancer subtype defined by the absence of estrogen receptor (ER), progesterone receptor (PR) and epidermal growth factor receptor 2 (HER2/neu), and the patients with TNBC are often diagnosed with higher rates of recurrence and metastasis. Because of the absence of ER, PR and HER2/neu expressions, TNBC patients are insensitive to HER2-directed and endocrine therapies available for breast cancer treatment. Here, we report that expression of atypical protein kinase C isoform, PKCλ/ι, significantly increased and activated in all invasive breast cancer (invasive ductal carcinoma or IDC) subtypes including the TNBC subtype. Because of the lack of targeted therapies for TNBC, we choose to study PKCλ/ι signaling as a potential therapeutic target for TNBC. Our observations indicated that PKCλ/ι signaling is highly active during breast cancer invasive progression, and metastatic breast cancers, the advanced stages of breast cancer disease that developed more frequently in TNBC patients, are also characterized with high levels of PKCλ/ι expression and activation. Functional analysis in experimental mouse models revealed that depletion of PKCλ/ι significantly reduces TNBC growth as well as lung metastatic colonization. Furthermore, we have identified a PKCλ/ι-regulated gene signature consisting of 110 genes, which are significantly associated with indolent to invasive progression of human breast cancer and poor prognosis. Mechanistically, cytokines such as TGFβ and IL1β could activate PKCλ/ι signaling in TNBC cells and depletion of PKCλ/ι impairs NF-κB p65 (RelA) nuclear localization. We observed that cytokine-PKCλ/ι-RelA signaling axis, at least in part, involved in modulating gene expression to regulate invasion of TNBC cells. Overall, our results indicate that induction and activation of PKCλ/ι promote TNBC growth, invasion and metastasis. Thus, targeting PKCλ/ι signaling could be a therapeutic option for breast cancer, including the TNBC subtype.

Menopause-specific quality of life of a group of urban women, West Bengal, India

OBJECTIVE

To find out the association of menopause-specific quality of life of women with menopausal status.

METHODS

In this cross-sectional study, we involved 250 Bengali-speaking women of Hindu ethnic group (118 perimenopausal and 132 postmenopausal), aged 40-65 years from urban areas of North 24 Paraganas, a district of West Bengal, India. The Menopause-Specific Quality of Life questionnaire (MENQOL) consisting of 29 menopausal symptoms, grouped under four menopausal domains (vasomotor, psychosocial, physical and sexual), was used to assess menopause-specific quality of life. Scores of four menopausal domains generated a composite score of 'Quality of Life'. Additionally, participants were also interviewed for their sociodemographic characteristics.

RESULTS

Bivariate analyses showed significant difference in all the domains of menopause-specific quality of life (barring vasomotor domain) when compared for menopausal status. Results of ANCOVA showed that menopausal status was significantly associated only with the physical domain after removing the effects of sociodemographic characteristics.

CONCLUSION

Menopausal status had a significant association with the physical domain of menopause-specific quality of life of women.

Bioaccumulation of resveratrol metabolites in myocardial tissue is dose-time dependent and related to cardiac hemodynamics in diabetic rats

BACKGROUND AND AIMS

Trans-resveratrol (RSV) is a natural compound occurring in different foods and plants, which in vivo is rapidly conjugated with glucuronic acid and sulfate. Despite its demonstrated cardioprotective activity, the bioaccumulation of RSV or its metabolites in cardiac tissue is still unknown.

METHODS AND RESULTS

Diabetic rats were randomized to 1, 3 or 6 weeks of RSV treatment at two different doses (1 or 5 mg/kg/day). A dose and time-dependent accumulation was observed, with no detectable levels of RSV metabolites found in heart tissues after 1 week and significant concentrations of RSV-3-sulfate and RSV-3-glucuronide after 6 weeks of treatment (0.05 nmol/g of tissue and 0.01 nmol/g of tissue, respectively). Tissue accumulation of RSV metabolites was accompanied by an improvement of cardiac function in long-term diabetes, when myocardial morpho-functional damage is more evident, with an almost complete recovery of all hemodynamic parameters, at the highest RSV dose.

CONCLUSION

Even if a higher concentration of RSV in tissues cannot be ruled out after constant oral administration, an accumulation coherent with what is usually evaluated in cell based mechanistic studies is largely unattainable and the RSV unconjugated form would not be present in this paradigm. The current investigation provides data on myocardial tissue concentrations of RSV metabolites, after short/medium term RSV treatment. This knowledge constitutes a basic requirement for future studies aimed at reliably defining the molecular pathways underlying RSV-mediated cardioprotective effects and opens up new perspectives for research focused on testing phenolic compounds as adjuvants in degenerative heart diseases.

Perpendicular fibre tracking for neural fibre bundle analysis using diffusion MRI

Information on the directionality and structure of axonal fibres in neural tissue can be obtained by analysing diffusion-weighted MRI data sets. Several fibre tracking algorithms have been presented in the literature that trace the underlying field of principal orientations of water diffusion, which correspond to the local primary eigenvectors of the diffusion tensor field. However, the majority of the existing techniques ignore the secondary and tertiary orientations of diffusion, which contain significant information on the local patterns of diffusion. In this paper, we introduce the idea of perpendicular fibre tracking and present a novel dynamic programming method that traces surfaces, which are locally perpendicular to the axonal fibres. This is achieved by using a cost function, with geometric and fibre orientation constraints, that is evaluated dynamically for every voxel in the image domain starting from a given seed point. The proposed method is tested using synthetic and real DW-MRI data sets. The results conclusively demonstrate the accuracy and effectiveness of our method.

Simulation Study of Thermotropic LCPs and Prediction of Normal Stress Difference at High Shear Rate

The shear viscosity and normal stress difference of two filled and two unfilled thermotropic liquid crystal polymer (TLCPs) were studied. The rigid and rod like molecules of TLCPs orientate differently at different shear rates. Under low shear rate, the molecules tend to align in the direction of the flow but also tumble and wagging on their own axis. The abnormal orientation of the molecules also depends upon temperature, fillers contents, aspect ratio and elastic nature of LCP molecules. These behaviors lead to unusual rheological properties of LCPs, such as negative first normal stress difference for filled LCPs at low shear rates. But with the increase of shear rate, the molecules are oriented in the direction of flow, which lead to isotropic flow at high shear rates. The complicated rheological properties and characteristic anisotropic properties of LCPs are modelled by recently developed Leonov's viscoselastic constitutive equations. Simulation has been carried out using Mathematica software and the characteristic anisotropic properties of LCPs have been identified. The experimentally measured viscosities at high shear rate have been compared with model predictions. Moreover, the normal stress differences using at high shear rates have been estimated using Leonov's model, which is experimentally not accessible.

Alcohol Consumption by workers in automobile repair shops of a slum of Kolkata: An assessment with AUDIT instrument

Background   National Household Survey of Drug Use in the India in its systematic effort to document the nationwide prevalence of drug use including alcohol consumption reported that almost 21% of the adult male Indian consume alcohol in a year. To find out prevalence, pattern and consequences of drinking and determine the relationship of  alcohol use with demographic and socio-economic factors among auto-mobile repair workers. Materials and Methods A cross-sectional study was conducted among auto-mobile repair workers in the urban field practice area of All India Institute of Hygiene and Public Health, Kolkata. Results Prevalence of alcoholism in the community of automobile repair workers was found to be as high as 79%.  More than 50% of the alcoholics belonged to the hazardous and dependent variety according to the WHO developed AUDIT instrument.53.01% of the alcoholics consumed foreign liquor predominantly and 87.95% bought them from licensed liquor shops. Mean age of initiation of drinking was 18.67 years. Taking loan OR (95% CI) 3.51(1.56-7.92), gambling OR (95% CI) 3.38(1.48-7.69) and clinical signs of alcoholism OR (95% CI) 5.52 (2.13 - 14.29) were significantly associated with chronic alcohol abuse. A multivariate logistic regression model was created for socio-economic variables which showed education AOR (95%CI) 4.65(1.34- 16.31) and total number of family members AOR (95%CI) 5.33(1.31-25.02) were significantly associated with drinking status (Nagelkerke R2 for this model is 0.2585). ConclusionThe prevalence of alcoholism is high in the automobile repair workers and therefore all efforts must be made to reduce, if not eliminate, alcohol consumption among the workers of auto-mobile service centres.DOI: http://dx.doi.org/10.3126/nje.v3i3.9188 Nepal Journal of Epidemiology 2013;3(3): 269-274