First experience with nicotine products and transition to regular tobacco use: a secondary data analysis in 28 European countries

OBJECTIVE

The majority of tobacco users have had their first contact with nicotine at a young age. The aim of this study was to explore the association between the first tobacco or nicotine product tried and the transition to regular product use in 28 European countries.

METHODS

A secondary analysis of participants aged 15-40 years (n=8884) from 28 countries was conducted (Eurobarometer wave 93.2; August-September 2020). Participants who reported having ever tried tobacco or nicotine products were asked which product they tried first. Self-reported history of tobacco use determined whether they were established users (≥1 time weekly) of a range of products at any point in their life. Multilevel logistic regression was used to measure the association between first product tried and becoming a regular user of tobacco or nicotine products.

RESULTS

There was large variation between countries in the proportion of participants aged ≤40 years that ever tried tobacco or nicotine; Estonia had the highest proportion of ever users (85.8%) and Poland had the lowest (38.9%). Among those who had ever tried tobacco or nicotine, boxed cigarettes were the most common first product (72.3%) and pipe was the least common (0.4%). Compared with those who first tried e-cigarettes, the odds of ever becoming a regular user of any tobacco or nicotine product were higher among those who first had hand-rolled cigarettes (adjusted OR, aOR 2.23; 95% CI 1.43 to 3.48) or boxed cigarettes (aOR 2.08; 95% CI1.43 to 3.02) and lower among those who first tried waterpipe (aOR 0.22; 95% CI 0.14 to 0.34).

CONCLUSIONS

Although this study cannot infer causality, the findings show that odds of becoming a regular tobacco user differs widely depending on the first product used. Better understanding of the associations between first product use and regular tobacco use could be informative to tobacco control policy-makers and help tailor prevention programmes.

Effect of preoperative ibuprofen on pain after lower third molar removal: A randomized controlled trial

Aim

The aim of the study is to predict the effect of preemptive analgesics in the third molar surgery and to analyze whether the number and frequency of postoperative analgesics are reduced following the administration of preemptive analgesics.

Materials and Methods

The present study was carried out on 50 patients who reported to the Department of Oral and Maxillofacial Surgery for removal of their impacted mandibular third molar. The patients were randomly divided into two groups of 25 patients each - Group A (test group) patients receiving ibuprofen (400 mg) half an hour before the surgery and placebo half an hour after surgery and the Group B (control group) patients receiving placebo half an hour before the surgery and ibuprofen (400 mg) half an hour after surgery. Both groups of patients will be instructed to avoid any drug but those prescribed (ibuprofen 400 mg SOS and rescue medication of tramadol 50 mg SOS) and not to seek any medical help elsewhere for postoperative problems. The pain was recorded using a visual analog scale.

Results

Demographic data in the study show females (8%) and male (92%) patients. The average time taken for surgery was more in the control group (58.36 min) as compared to the test group (55.64 min) with no statistically significant difference. Values of pain score, medication score, number of rescue medication, and frequency at different time intervals (at baseline, after 3 h, 6 h, 24 h, and 7 days) are expressed in terms of mean and standard deviation, respectively, and the result shows the statistically significant difference for pain score at baseline and 7th-day time interval only. The distribution of different types of impaction and different types of elevation/odontotomy shows a significant association in test and control groups.

Conclusion

Preoperative ibuprofen decreases the frequency and intensity of the pain. We believe that since this preoperative ibuprofen seems to be beneficial without any adverse effects, it may be used routinely in the 3rd molar surgeries and even in routine extraction.

Computational Docking Studies of MAPK1 Target Protein Responsible for Heart Failure Using Catechin as Natural Inhibitor

Mitogen-activated protein kinases (MAPKs) are major thespians that have been the subject of in-depth research over the last few decades among the several intracellular signaling networks that regulate the pathophysiology and development of the heart. Heart failure is one of the most common reasons for hospitalization and is a serious public health issue. Heart failure mostly affects the elderly, and as life expectancy increases and chronic medical conditions are better managed, more people are expected to develop the condition. The thrust to investigate alternative traditional medicine has attracted much attention as there are many negative effects of the current pharmacological treatments that are being used to control the problem of heart failure. The protein's original configuration and the ligand combination both had binding energies of -5.62 kcal/mol, which may pave the way for future use of the knowledge about the responsible protein and optimization of their lead molecule for an alternative treatment for the cases of heart failure. But further research is needed, for the validation of the data in wet labs, larger trials and in-vitro studies, to establish its drug-likeliness and their applications.

A Novel IoT-based Monitoring Device for Effective Prediction of Heart Failure

Heart disease is the biggest cause of mortality worldwide. Approximately 80% of deaths happened in underdeveloped and middle-income countries. By 2030, it is projected that 23.6 million people would die from cardiovascular disease if present patterns are allowed to persist. An opportunity to offer an Internet of Things (IoT) solution has become more accessible as the use of smart wearable technology has grown. Furthermore, people who are disabled have a low likelihood of surviving after discharge from the hospital. The present research proposed an IoT-integrated model evaluating temperature, heart rate, and oxygen saturation for predicting the likelihood of the occurrence of heart failure. It has been noted that the proposed model or the hardware system is cost-effective as compared to other expensive sensors that are available in the market. The proposed system used heart rate, oxygen saturation, and temperature as parameters, thus it can make accurate and precise decisions on whether or not an individual has the chance to encounter heart failure and hence can be warned and managed beforehand.

Efficacy of bioresorbable plating system in the treatment of pediatric maxillary fractures: A short clinical study

Aim

The aim of this study was to evaluate the efficacy, stability, and clinical outcomes of a bioresorbable plating system in the treatment of pediatric maxillary fractures.

Materials and Methods

Twenty pediatric patients with maxillary fractures (13 males and 7 females) were included in this study. The 1.5- and 2.0-mm resorbable plates were used and secured with monocortical resorbable screws 6 mm and 7 mm in length. All patients were followed up for 6 months. Clinical parameters, such as pain, swelling, soft-tissue infection, malocclusion, nerve injury, and bite force for stability, were prospectively assessed.

Results

Fall from height (50%) was the most common cause of etiology, followed by road traffic accidents (35%). Maxillary alveolar # (40) was the most common fracture site, followed by nasal complex # (25%) and zygomatic complex # (25%). Appropriate fixation and adequate primary bone healing was achieved in 100% of the cases. Few minor complications were observed: (1) soft-tissue infection (5%) and (2) paresthesia (10%). There was a significant increase in bite force in the incisor and molar regions. Observation in clinical parameters shows that there was a significant reduction in postoperative pain and swelling at different follow-up periods.

Conclusion

Bioresorbable plating system is used as a load-sharing plate in a semirigid fixation technique after anatomic fracture reduction. Although its high costs limit its feasibility for use low infection rates, minimized second surgery for implant removal attracts its use. 1.5- and 2-mm resorbable plating system along is a good treatment modality for moderately displaced maxillary fractures in pediatric patients. Larger sample size and longer follow-up studies are required for conclusive results.

Adding MR Diffusion Imaging and T2 Signal Intensity to Neck Imaging Reporting and Data System Categories 2 and 3 in Primary Sites of Postsurgical Oral Cavity Carcinoma Provides Incremental Diagnostic Value

BACKGROUND AND PURPOSE

The NI-RADS lexicon doesn't use ADC parameters and T2 weighted signal for ascribing categories. We explored ADC, DWI, and T2WI to examine the diagnostic accuracy in primary sites of postsurgical oral cavity carcinoma in the Neck Imaging Reporting and Data System (NI-RADS) categories 2 and 3.

MATERIALS AND METHODS

We performed a retrospective analysis in clinically asymptomatic post-surgically treated patients with oral cavity squamous cell carcinoma who underwent contrast-enhanced MRI between January 2013 and January 2016. Histopathology and follow-up imaging were used to ascertain the presence or absence of malignancy in subjects with "new enhancing lesions," which were interpreted according to the NI-RADS lexicon by experienced readers, including NI-RADS 2 and 3 lesions in the primary site. NI-RADS that included T2WI and DWI (referred to as NI-RADS A) and ADC (using the best cutoff from receiver operating characteristic curve analysis, NI-RADS B) was documented in an Excel sheet to up- or downgrade existing classic American College of Radiology NI-RADS and calculate diagnostic accuracy.

RESULTS

Sixty-one malignant and 23 benign lesions included in the study were assigned American College of Radiology NI-RADS 2 (n = 33) and NI-RADS 3 (n = 51) categories. The recurrence rate was 90% (46/51) for NI-RADS three, 45% (15/33) for NI-RADS 2, and 73% (61/84) overall. T2WI signal morphology was intermediate in 45 subjects (53.5%) and restricted DWI in 54 (64.2%). Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the American College of Radiology NI-RADS were the following: NI-RADS (75.4%, 78.3%, 90.1%, 54.5%, and 76.1%); NI-RADS A (79.1%, 81.2%, 91.9%, 59.1%, and 79.6%); and NI-RADS B (88.9%, 72.7%, 91.4%, 66.7%, and 85.1%), respectively.

CONCLUSIONS

Adding MR imaging diagnostic characteristics like T2WI, DWI, and ADC to the American College of Radiology NI-RADS improved diagnostic accuracy and sensitivity.

Mesenchymal stem cells in SARS-CoV-2 infection: A hype or hope

COVID-19 is a serious viral infection that struck the world in December 2019 starting from Wuhan in China, spreading subsequently to all over the world. The disease has baffled scientists and doctors worldwide in terms of its presentation, behaviour, and treatment options till now. A low mortality rate is the only relief we get so far from COVID-19 in terms of numbers. Treatment options have gradually streamlined to steroids and very few FDA approved antiviral as well as plasma therapy and supportive treatment. Monoclonal antibodies are used to tide over any impending cytokine storm but are not equally effective in all patients. Ventilation support is invariably required for moderate to severe disease varying from a simple High Flow non-rebreathing mask to BiPAP (Bilevel Positive Airway Pressure) and HFNO (High-Flow Nasal Oxygen) extending to full-fledge ventilation via a Mechanical Ventilator. Because of the non-availability of satisfactory treatment so far, many researchers from different biomedical fields are looking for alternative therapeutic strategies to manage the pandemic. One such therapeutic approach showing a ray of hope to combat COVID-19 infection is Mesenchymal stem cell therapy. Mesenchymal cells have immunomodulatory, anti-inflammatory as well as regenerative properties and various preliminary studies have shown that MSCs can reverse the lung damage and overcome the cytokine storm incited by COVID-19 infection. Also, it has improved the recovery rate of critically ill patients on mechanical ventilation. In this review, we will discuss the possibility and relevance of MSCs in COVID-19 treatment and preview of various MSCs clinical trials.

Effect of second hand smoke on systemic, oral and psychological health of primary school children in western Uttar Pradesh. A biochemical analysis

BACKGROUND

Second Hand smoke (SHS) exposure to children causes several systemic problems like asthma, dental problems like caries and effects overall well being. This study was conducted to study impact of SHS on primary school children by associating it with dental caries, cotinine level, asthma severity and overall well being.

METHODS

Case control study was conducted amongst 200 children 9-15 years old that came to dental college in Muradnagar. Children who lived in smoking households were identified as SHS subjects-100 children and those who lived in non smoking households were identified as control group- 100 children. Parents completed questionnaire regarding their smoking status. In children's questionnaire severity of asthma was determined by using expert panel report (EPR3), dental caries was recorded by dmft index and psychological assessment of children was done using WHO- 5 well being index. Collection of unstimulated saliva of children was done in sterile plastic tubes and cotinine level was measured using enzyme-linked-immunosorbent assay (ELISA). Students t test and one way analysis of variance (ANOVA) was used for analysing data.

RESULTS

Mean number of children suffering from asthma was higher in SHS subjects in comparison to control group i.e. 348.9 ±166.509 and 247.3±15.86 respectively. dmft and WHO- well being scores increased as level of cotinine increased. Mean cotinine level was higher in SHS subjects than control group i.e. 348.9 ±166.509 and 247.3±15.86 respectively.

CONCLUSIONS

SHS has an adverse impact on young children reflected by poor dmft scores and psychological well being, increased cotinine levels and asthma severity in comparison to control group.

Staphylococcal Pyopericardium: A Rare and Fatal Complication Following a Common Viral Disease

How to cite this article: Sarma U, Mishra V, Aier I, et al. Staphylococcal Pyopericardium: A Rare and Fatal Complication Following a Common Viral Disease. Indian J Crit Care Med 2021;25(6):739–741.

Effectiveness of various health education methods amongst primary healthcare workers of western Uttar Pradesh, Delhi (National Capital Region), India: A promotive intervention study

Objectives:

The purpose of this study was to assess the effectiveness of various health education methods for improving oral health knowledge of accredited social health activists (ASHA) and Anganwadi workers of Muradnagar Block, Ghaziabad-Delhi NCR.

Methods:

A promotive interventional study was conducted amongst 301 ASHA and Anganwadi workers of Muradnagar block at three steps such as baseline, oral health education programme (OHEP), and reinforcement to assess their oral health knowledge using predesigned, close-ended, validated, questionnaire. Four different methods were used in OHEP to disseminate knowledge, namely, health talks, posters, and pamphlets, PowerPoint presentations, and a combination of all methods. Post-assessment was done one week after OHEP followed by reinforcement after 1 month which was followed by final post-assessment after 1 week. Students’ independent t-test and one-way ANOVA were used for analysing data.

Results:

At baseline, primary healthcare workers had mean knowledge scores as 14.67 ± 1.152 which was increased to 20.96 ± 1.053 after the intervention and 27.6 ± 0.762 after reinforcement. There was an increase of 7.6% and 14.3% of primary healthcare workers giving correct responses after OHEP and reinforcement, respectively.

Conclusions:

The combination method was the most effective in improving oral health knowledge of study population followed by posters and pamphlets and the least effective method was PowerPoint presentation. Dentists can play a vital role in mobilising the primary healthcare workers by consequently contributing towards improving the oral health status of the community.

Effectiveness of cognitive behavioral therapy and basic health education for tobacco cessation among adult tobacco users attending a private tobacco cessation center

Background:

India being major consumer of tobacco faces various problems involved for its cessation. Over the time enormous methods have been evolved which may aid in tobacco cessation.

Materials and Methods:

The present study was conducted among 100 adult tobacco users attending tobacco cessation clinic. The individuals where randomized into 2 counselling groups: Group A - Basic health education (BHE) and Group B Cognitive Behavioral Therapy (CBT). Baseline evaluation of demographic parameters, smoking/smokeless behavior was recorded and Fagerstrom's test for Nicotine Dependence (FTND) was utilized to assess subjects’ nicotine addiction levels. Follow up was done at intervals of 2 weeks and 4 weeks to assess the reduction in the mean FTND score. Appropriate statistical test was utilized to evaluate the results.

Results:

The majority of individuals in the study were male in age group of 41-60 years. The reduction in mean FTND score was found in both Group A and B on follow-up. But when both groups were compared, reductions in mean Fagerstrom scores were found to be more in CBT group than in BHE group at all time intervals.

Conclusion:

Individuals in both the group have quit the tobacco use by both the interventions followed by proper schematic follow up.

AgNOR as an effective diagnostic tool for determining the proliferative nature of different types of odontogenic cysts

Objective:

To determine the proliferative nature of different types of odontogenic cysts using silver-stained nucleolar organizer region (AgNOR) staining.

Materials and Methods:

Forty histopathological sections of each of odontogenic keratocyst, dentigerous, and radicular growth were taken into study. Two sections were produced using the paraffin block of separate cases, one was stained with hematoxylin and eosin and another segment was stained with silver nitrate method.

Results:

AgNOR staining shows black dots and other parts of nuclei show yellow-brown dots.

Conclusion:

AgNOR, which stain for NOR-related proteins, corresponds to cell multiplication. Their amount regarding the number of AgNORs per cyst can be a good marker of the proliferative action of the cell in aggressive cystic lesion having malignant potential.

Effect of gutkha chewing on periodontal health and oral hygiene of peoples in Delhi NCR region of North India: A cross-sectional multicentered study

Background

In India, gutkha is popular among all socioeconomic groups, since it is available easily and is of less cost. Various investigations have demonstrated the relationship of gutkha biting with periodontal status and oral hygiene.

Aim

The aim of this study is to assess the effect of gutkha chewing on periodontal health and oral hygiene of patients attending the dental department in India.

Materials and Methods

A cross-sectional investigation was directed among 200 patients going to dental camps. Among them, 100 were gutkha chewers and 100 were smokers. The oral hygiene status of selected patients was determined by using the Simplified Oral Hygiene Index. Various periodontal parameters like a gingival recession, clinical attachment loss, mobility, and furcation were used to evaluate the periodontal status. Data were collected and analyzed with the help of SPSS software version 20.

Result

Among the 200 subjects, 102 were males and 78 were females. In 100 gutkha chewers, 67% were male and 33% were females. About 68% gutkha chewers showed poor oral hygiene as compared to nonchewers (41%). The values of all the periodontal parameters were significantly higher in gutkha smokers compared to nonchewers.

Conclusion

Gutkha chewing has a strong effect on oral hygiene. The findings can contribute to the evidence of smokeless tobacco (gutkha) as a risk factor for periodontal disease.

Effect of orthodontic treatment needs on oral health related quality of life among the young population in Delhi NCR-region of North India

Aim:

To assess the effect of orthodontic treatment needs on oral health-related quality of life among the young people of Delhi NCR.

Methods:

The study was conducted on 12–15 years of individuals attending dental clinic/hospital in Delhi NCR region. Data were collected using Index of Orthodontic Treatment Need -Dental Component and oral health impact profile 14 questionnaire. The Chi-square test was used to analyze the qualitative data. SPSS software version 20 was used for statistical analysis.

Results:

Orthodontic treatment needs had an almost similar impact on the daily activities of both males and females. The sense of taste was not significantly affected by the need for orthodontic treatment in either males or females. The proportions of orthodontic patients found to have the painful arch, embarrassment, tension, and self-conscious both in males and females.

Conclusion:

There is a significant correlation of orthodontic treatment needs among oral health-related quality of life.

Association between maternal dental anxiety and its effect on the oral health status of their child: An institutional cross sectional study

Aim:

To assess the association between maternal dental anxiety and its effect on the oral health status of their child, in Murad nagar –An institutional cross-sectional study.

Materials and Methods:

Among the randomly selected 200 mother-child pairs, a cross-sectional study was done. The children of 2–5 years were selected for the study. A five-level Modified Dental Anxiety Scale (MDAS), Hindi edition, was used to assess dental anxiety among the mothers. Clinical examination of the wards was finished by using a modified gingival record and WHO dentition status (2013). The SPSS software version 20 was used for statistical analysis.

Results:

Approximately, 61% of the children were males, and 39% were females. The modified gingival index (MGI) score was high, if there should arise an occurrence of high MDAS values. The mean MGI score was most astounding in phobic class of MDAS and least in the not anxious classification. The MGI score expanded on increment in maternal anxiety. Dental caries expanded in kids, if there should be an occurrence of high maternal dental uneasiness. The MDAS demonstrated a critical association with clinical oral health results of the child. The children whose mothers were “extremely anxious” (phobic) had the highest mean decayed, missing, or filled teeth.

Conclusion:

Maternal dental anxiety significantly affects the oral health status of their ward.

Comparative study of risk indicators associated with tooth loss among adult population in urban and rural areas of Muradnagar, Ghaziabad, Uttar Pradesh, India

Background:

Oral health objectives prescribed by World Health Organization for the year 2020 have expressed that there ought to be an expansion in the quantity of people with functional dentitions (at least 21 common teeth) at ages of 35–44 and 65–74 years.

Aim:

The aim of this study is to examine the prevalence of tooth loss and to evaluate and compare the risk indicators associated with tooth loss among adult population in urban and rural areas of Muradnagar, Ghaziabad.

Materials and Methods:

A cross-sectional study was led among 1200 adults aged 35–74 years in urban and rural areas of Muradnagar, India. Information was assembled by an interview followed by clinical examination (number of missing teeth). Demographic and socioeconomic factors and self-perceived oral health were the independent variables assessed. One-way analysis of variance, post-hoc test (Bonferroni), Chi-square test, Student's t-test, and logistic regression analysis were used for statistical analysis.

Results:

Low educational status, no dental check-ups, low frequency of brushing, older age, and smoking habit were independent risk factors for tooth loss. The odds of tooth loss in older adults and illiterates were higher; the odds for tooth loss among those who expressed their desire for replacement of missing teeth were 1.3 times lower than their counterparts.

Conclusion:

The experiences gained up showed that tooth loss was very pervasive in Muradnagar populace and the critical hazard indicators identified were age, education, socioeconomic status, and cigarette smoking.

A retrospective cross-sectional study of maxillofacial trauma in Delhi-NCR Region

Aim and Objectives

To evaluate the pattern, prevalence, etiology, site of fractures, and their management in patients with maxillofacial injury in Delhi-NCR region.

Materials and Methods

A total of 1278 maxillofacial trauma patients visiting different registered hospitals from Delhi-NCR region from January 2012 to December 2017, treated by open reduction and internal fixation under general anesthesia (GA)/local anesthesia (LA) or closed reduction/conservatively, were taken into the study. The parameters considered in the study were age and sex distribution, etiological factors and incidence of maxillofacial trauma, pattern and site distribution of maxillofacial fractures, and management.

Results

From a total of 2250 trauma patients, 1278 patients (1053 males and 225 females) had maxillofacial injury. The average prevalence rate was 56.8%. Yearly incidence rate was 20.4%. Road traffic accident (RTA) was the most common cause of trauma in 1029 (80.5%) patients, followed by physical assault [158 (12.3%)] with significant male predominance in different age groups. Isolated mandibular fractures were the most common [48.6% (parasymphysis 31.6%, condyle 28.2%)], followed by midface with maxilla fracture [27.6% (zygomatic bone and arch 50.2% and Lefort II fractures 18%)]. Treatment modalities were conservative management, closed reduction, and open reduction with internal fixation under GA/LA.

Conclusion

RTA followed by physical assault is still the leading cause of maxillofacial trauma in young males in Delhi-NCR region. Mini plate osteosynthesis is the main treatment procedure for maxillofacial trauma. We need to enforce strict traffic rules, road safety law, and preventive measures along with improvement in education and socioeconomic status in the population to avoid maxillofacial injuries.

Prevalence of periodontal status among nicotine dependent individuals of 35-44 years attending community dental camps in Ghaziabad district, Uttar Pradesh

Background:

Tobacco is the second driving reasons for mortality worldwide and its broad utilization in the smoking and smokeless form have added to the expanding weight of non-communicable disease.

Aim:

To study the prevalence of periodontal status among nicotine dependent individuals of 35-44 years attending community dental camps in Ghaziabad District, Uttar Pradesh.

Methods:

A cross-sectional study was conducted on 800 individuals with the age range of 35-44 years. A pre-tested questionnaire was used to gather information about the sociodemographic profile and the pattern of substance use. Fagerstrom Test for Nicotine Dependence-Smokeless Tobacco (FTND-ST) and for smokers; Fagerstrom Test for Nicotine Dependence (FTND) for testing dependence. Periodontal status was assessed by Community Periodontal Index (Modified CPI WHO 2013) and loss of attachment (LOA). Statistical analysis was done by the Statistical Package for Social Sciences (SPSS) version 20.0.

Result:

The prevalence of periodontal disease was found to be 78.5% with maximum disease prevalence among males of 42-44 age. Majority of male consumed a smokeless form of tobacco (50.23%), followed by smoke (14.19%) form whereas females predominantly consumed smokeless form (37.36%). The mean number of teeth with pocket (3.37 ± 1.86) and mean of loss of attachment of more than 9 mm (0.67 ± 0.88) was higher among smokeless form of tobacco users as compared to other habit groups

Conclusion:

Higher prevalence of periodontal disease was seen among nicotine dependent individuals. A model for a comprehensive program in the dental office including the five A's and five R's for tobacco counseling must be applied at every institute.

QUAD fever: beware of non-infectious fever in high spinal cord injuries

A case of cervical spinal cord injury and quadriparesis with prolonged fever is being described. Initially, the patient received treatment for well-documented catheter-related bloodstream infection. High spiking fever returned and persisted with no obvious evidence of infection. The usual non-infectious causes too were carefully excluded. QUAD fever or fever due to spinal cord injury itself was considered. The pathogenetic basis of QUAD fever is unclear but could be attributed to autonomic dysfunction and temperature dysregulation. Awareness of this little known condition could help in avoiding unnecessary antimicrobial therapy and in more accurate prognostication. Unlike several previous reported cases that ended fatally, the present case ran a relatively benign course. The spectrum of presentations may therefore be broader than hitherto appreciated.

Use of a novel hemoadsorption device for cytokine removal as adjuvant therapy in a patient with septic shock with multi-organ dysfunction: A case study

CytoSorb(®) (CytoSorbents Corporation, USA) is a novel sorbent hemoadsorption device for cytokine removal. The aim of this study was to examine the clinical use of CytoSorb(®) in the management of patient with septic shock. We used this device as an adjuvant to stabilize a young patient with multi-organ failure and severe sepsis with septic shock. A 36-year-old female patient was hospitalized with the complaints of malaise, general body ache, and breathing difficulty and had a medical history of diabetes mellitus type II, hypertension, obstructive sleep apnea, hypothyroidism and morbid obesity. She was diagnosed to have septic shock with multi-organ dysfunction (MODS) and a low perfusion state. CytoSorb(®) hemoadsorption column was used as an attempt at blood purification. Acute physiology and chronic health evaluation score, MODS score, and sequential organ failure assessment score were measured before and after the device application. CytoSorb application as an adjuvant therapy could be considered in septic shock.

Efficacy and safety of parenteral omega 3 fatty acids in ventilated patients with acute lung injury

Objective:

To determine the effects of parenteral omega 3 fatty acids (10% fatty acids) on respiratory parameters and outcome in ventilated patients with acute lung injury.

Measurements and Main Results:

Patients were randomized into two groups – one receiving standard isonitrogenous isocaloric enteral diet and the second receiving standard diet supplemented with parenteral omega 3 fatty acids (Omegaven, Fresenius Kabi) for 14 days. Patients demographics, APACHE IV, Nutritional assessment and admission category was noted at the time of admission. No significant difference was found in nutritional variables (BMI, Albumin). Compared with baseline PaO²/FiO² ratio (control vs. drug group: 199 ± 124 vs. 145 ± 100; P = 0.06), by days 4, 7, and 14, patients receiving the drug did not show a significant improvement in oxygenation (PaO²/FiO²: 151.83 ± 80.19 vs. 177.19 ± 94.05; P = 0.26, 145.20 ± 109.5 vs. 159.48 ± 109.89; P = 0.61 and 95.97 ± 141.72 vs. 128.97 ± 140.35; P = 0.36). However, the change in oxygenation from baseline to day 14 was significantly better in the intervention as compared to control group (145/129 vs. 199/95; P < 0.0004). There was no significant difference in the length of ventilation (LOV) and length of ICU stay (LOS). There was no difference in survival at 28 days. Also, there was no significant difference in the length of ventilation and ICU stay in the survivors group as compared to the non survivors group.

Conclusions:

In ventilated patients with acute respiratory distress syndrome, intravenous Omega 3 fatty acids alone do not improve ventilation, length of ICU stay, or survival.

CpG methylation as a basis for breast tumor-specific loss of NES1/kallikrein 10 expression

The normal epithelial cell-specific-1 (NES1)/kallikrein 10 gene is expressed in normal mammary epithelial cells, but its expression is dramatically decreased in breast cancer cell lines. Now, we have cloned and characterized the active promoter region of NES1. Using a luciferase reporter system, we demonstrate that most tumor cell lines are able to support full or partial transcription from the NES1 promoter, suggesting a role for promoter-independent cis-acting mechanisms of loss of NES1 expression. We show that hypermethylation of the NES1 gene represents one such mechanism. Using methylation-specific PCR and sequence analysis of sodium bisulfite-treated genomic DNA, we demonstrate a strong correlation between exon 3 hypermethylation and loss of NES1 mRNA expression in a panel of breast cancer cell lines and in primary tumors. Treatment of NES1-nonexpressing cells with a demethylating agent led to reexpression of NES1, suggesting an important role of hypermethylation in the loss of NES1 expression. We suggest that hypermethylation is responsible for tumor-specific loss of NES1 gene expression. Our results also suggest that hypermethylation of the NES1 gene may serve as a potential marker for breast cancer.

Analysis of normal epithelial cell specific-1 (NES1)/kallikrein 10 mRNA expression by in situ hybridization, a novel marker for breast cancer

PURPOSE

Normal epithelial cell specific-1 (NES1)/kallikrein 10 gene is expressed in normal mammary and prostate epithelial cells, but the expression of NES1 mRNA and protein is markedly reduced in established breast and prostate cancer cell lines although the NES1 gene is intact. Here, we wished to assess whether NES1 expression is down-regulated in primary breast cancers.

EXPERIMENTAL DESIGN

We developed and used an in situ hybridization technique with an antisense NES1 probe to detect NES1 mRNA in sections of normal breast specimens, typical and atypical ductal hyperplasia, ductal carcinoma in situ, and infiltrating ductal carcinoma.

RESULTS

All of the 30 normal breast specimens showed high NES1 expression. Notably, 18 (75%) of 24 typical and atypical breast hyperplasia specimens showed high NES1 expression, with weak-to-moderate expression in 6 (25%). Significantly, 13 (46%) of 28 ductal carcinoma in situ specimens lacked NES1 expression, and the remaining 15 (54%) showed weak-to-moderate expression. Finally, 29 of 30 (97%) infiltrating ductal carcinoma grades I-III samples lacked NES1 mRNA, with weak expression in the remaining one sample.

CONCLUSIONS

Our results demonstrate that NES1 mRNA is expressed in normal breast tissue and benign lesions, with loss of NES1 expression during tumor progression. We suggest that NES1 expression may serve as a molecular tool in the study of breast cancer progression. Studies with larger series of specimens should help assess whether NES1 expression can be a diagnostic and/or prognostic marker in breast and other cancers.

Negative regulation of PYK2/related adhesion focal tyrosine kinase signal transduction by hematopoietic tyrosine phosphatase SHPTP1

Related adhesion focal tyrosine kinase (RAFTK) (also known as PYK2) is a cytoplasmic tyrosine kinase related to the focal adhesion kinase (FAK) p125(FAK). RAFTK is rapidly phosphorylated on tyrosine residues in response to various stimuli, such as tumor necrosis factor-alpha, changes in osmolarity, elevation in intracellular calcium concentration, lysophosphatidic acid, and bradykinin. Overexpression of RAFTK induces activation of c-Jun amino-terminal kinase (also known as stress-activated protein kinase), mitogen-activated protein kinase (MAPK), and p38 MAPK. The present studies demonstrate that RAFTK binds constitutively to the protein tyrosine phosphatase SHPTP1. In contrast to PTP1B, overexpression of wild-type SHPTP1 blocks tyrosine phosphorylation of RAFTK. The results further demonstrate that RAFTK is a direct substrate of SHPTP1 in vitro. Moreover, treatment of PC12 cells with bradykinin is associated with inhibition in tyrosine phosphorylation of RAFTK in the presence of SHPTP1. Furthermore, in contrast to the phosphatase-dead SHPTP1 C453S mutant, overexpression of wild-type SHPTP1 blocks interaction of RAFTK with the SH2-domain of c-Src and inhibits RAFTK-mediated MAPK activation. Significantly, cotransfection of RAFTK with SHPTP1 did not inhibit RAFTK-mediated c-Jun amino-terminal kinase activation. Taken together, these findings suggest that SHPTP1 plays a negative role in PYK2/RAFTK signaling by dephosphorylating RAFTK.

Role of lecithin-cholesterol acyltransferase in the metabolism of oxidized phospholipids in plasma: studies with platelet-activating factor-acetyl hydrolase-deficient plasma

To determine the relative importance of platelet-activating factor-acetylhydrolase (PAF-AH) and lecithin-cholesterol acyltransferase (LCAT) in the hydrolysis of oxidized phosphatidylcholines (OXPCs) to lyso-phosphatidylcholine (lyso-PC), we studied the formation and metabolism of OXPCs in the plasma of normal and PAF-AH-deficient subjects. Whereas the loss of PC following oxidation was similar in the deficient and normal plasmas, the formation of lyso-PC was significantly lower, and the accumulation of OXPC was higher in the deficient plasma. Isolated LDL from the PAF-AH-deficient subjects was more susceptible to oxidation, and stimulated adhesion molecule synthesis in endothelial cells, more than the normal LDL. Oxidation of 16:0-[1-14C]-18:2 PC, equilibrated with plasma PC, resulted in the accumulation of labeled short- and long-chain OXPCs, in addition to the labeled aqueous products. The formation of the aqueous products decreased by 80%, and the accumulation of short-chain OXPC increased by 110% in the deficient plasma, compared to the normal plasma, showing that PAF-AH is predominantly involved in the hydrolysis of the truncated OXPCs. Labeled sn-2-acyl group from the long-chain OXPC was not only hydrolyzed to free fatty acid, but was preferentially transferred to diacylglycerol, in both the normal and deficient plasmas. In contrast, the acyl group from unoxidized PC was transferred only to cholesterol, showing that the specificity of LCAT is altered by OXPC. It is concluded that, while PAF-AH carries out the hydrolysis of mainly truncated OXPCs, LCAT hydrolyzes and transesterifies the long-chain OXPCs.

Percutaneous suprapubic cystolithotripsy for vesical calculi in children

BACKGROUND

The majority of vesical calculi in adults can now be treated per-urethrally with the use of ultrasonic or pneumatic lithotripsy. However, the use of these devices is restricted in pediatric patients by the narrow caliber of the urethra. A percutaneous suprapubic approach to the bladder circumvents the problem of urethral caliber in these situations.

PATIENTS AND METHODS

Thirty-eight children presenting with bladder stones underwent percutaneous suprapubic cystolithotripsy (PCCL) between November 1989 and April 1996. The age ranged from 1.5 to 7 years. The stone size ranged from 0.8 to 2.4 cm. Seven of these were recurrent stones, and five of the patients were female. The procedure was done under general anesthesia, and the equipment was the same as for upper tract endourology. The bladder was distended with saline and a suprapubic puncture made. The nephroscope was introduced after tract dilation and the stone removed, intact if small or after fragmentation if >1 cm. The procedure was done without fluoroscopy. A suprapubic catheter was left in for 48 hours.

RESULTS

All patients had an uneventful recovery following stone removal. The average hospital stage was 3 days. Here, the access provided by percutaneous suprapubic cystostomy has been combined with the experience gained in upper-tract endourology to perform procedures that would otherwise require open operation because of nonavailability of urethral access.

CONCLUSION

Extension of endourologic procedures to the lower tract reduces morbidity and hospital stay and thus the cost of treatment. Percutaneous suprapubic cystolithotripsy, in our experience, is a safe and cost-effective alternative to open surgery in children.

The role for NES1 serine protease as a novel tumor suppressor

Previously (Liu et al, Cancer Res., 56: 3371-3379, 1996), we isolated a novel serine protease-like gene--Normal Epithelial Cell Specific-1 (NES1)--that is expressed in normal mammary epithelial cells but is down-regulated in most breast cancer cell lines. Here, we demonstrate that stable expression of NES1 in the NES1-negative MDA-MB-231 breast cancer cell line suppressed the oncogenicity as revealed by inhibition of the anchorage-independent growth and tumor formation in nude mice. Fluorescence in situ hybridization localized the NES1 gene to chromosome 19q13.3, a region that contains genes for related proteases (including the prostate-specific antigen) and is rearranged in human cancers. Similar to breast cancer cell lines, prostate cancer cell lines also lacked NES1 mRNA and protein expression. Together, these results strongly suggest a tumor-suppressor role for NES1 in breast and prostate cancer.

Novel function of lecithin-cholesterol acyltransferase. Hydrolysis of oxidized polar phospholipids generated during lipoprotein oxidation

Although the major function of lecithin-cholesterol acyltransferase (LCAT) is cholesterol esterification, our previous studies showed that it can also hydrolyze platelet-activating factor (PAF). Because of the structural similarities between PAF and the truncated phosphatidylcholines (polar PCs) generated during lipoprotein oxidation, we investigated the possibility that LCAT may also hydrolyze polar PCs to lyso-PC during the oxidation of plasma. PAF acetylhydrolase (PAF-AH), which is known to hydrolyze polar PCs in human plasma, was completely inhibited by 0.2 mM p-aminoethyl benzenesulfonyl fluoride (Pefabloc), a new serine esterase inhibitor, which had no effect on LCAT at this concentration. On the other hand, 1 mM diisopropylfluorophosphate (DFP) completely inhibited LCAT but had no effect on PAF-AH. Polar PC accumulation during the oxidation of plasma increased by 44% in the presence of 0.2 mM Pefabloc and by 30% in the presence of 1 mM DFP. The formation of lyso-PC was concomitantly inhibited by both of the inhibitors. The combination of the two inhibitors resulted in the maximum accumulation of polar PCs, suggesting that both PAF-AH and LCAT are involved in their breakdown. Oxidation of chicken plasma, which has no PAF-AH activity, also resulted in the formation of lyso-PC from the hydrolysis of polar PC, which was inhibited by DFP. Polar PCs, either isolated from oxidized plasma or by oxidation of labeled synthetic PCs, were hydrolyzed by purified LCAT, which had no detectable PAF-AH activity. These results demonstrate a novel function for LCAT in the detoxification of polar PCs generated during lipoprotein oxidation, especially when the PAF-AH is absent or inactivated.

Role of calcium and calmodulin in Giardia lamblia-induced diarrhoea in mice

The unidirectional fluxes of Na+, Cl- and Ca2+ across the small intestinal epithelium of normal and Giardia lamblia-infected mice were studied in vitro in short-circuited tissue. Net secretion of Na+ and Cl- was observed in infected animals, whereas in non-infected (control) animals there was net absorption of Na+ ions and marginal secretion of Cl- ions. In infected animals, net absorption of Ca2+ was observed as compared to little secretion observed in control animals. Although the presence of Ca(2+)-ionophore in the medium resulted in a net secretion of Na+ and Cl- in controls, it could not cause any change in the fluxes of these ions in infected animals. Verapamil, a calcium channel blocker, reversed the effects of infection and Ca(2+)-ionophore. Further W7 (n-(6-aminohexyl)-5 chloro-1-naphthalene sulphonamide), a calmodulin antagonist, also reversed the effects of infection. The addition of the neurotoxin, tetrodotoxin caused net absorption of Na+, Cl- and net secretion of Ca2+ in the control group, but it could not produce any effect on the fluxes of these ions in the infected group. These findings demonstrate that, in G. lamblia infection, the secretion of Na+ and Cl- is associated with an increase in absorption of Ca2+ and an increase in calmodulin activity in intestinal microvillar core. These findings further suggest that the enteric nervous system plays a marginal role in Giardia infection.

Cell density modulates the decrease of cytosolic free Ca2+ induced by atrial natriuretic hormone, S-nitroso-N-acetylpenicillamine and 8-bromo cyclic GMP in cultured rat mesangial cells

Cyclic GMP-elevating agents, including atrial natriuretic hormone and NO-generating vasodilators, decrease cytosolic free Ca2+ levels in mesangial cells. We have investigated the role of cell density as a modulator of the decrease in cytosolic free Ca2+ induced by the cyclic GMP (cGMP)-elevating vasodilators atrial natriuretic peptide (99-126) [ANP (99-126); 'atriopeptin 28'] and the NO-generating vasodilator S-nitroso-N-acetylpenicillamine (SNAP), in cultured rat mesangial cells. Increasing cell density was significantly correlated with the decrease in cytosolic free Ca2+ induced by ANP (99-126) or SNAP. Moreover, this effect was independent of the cells' proliferative status. ANP (99-126) and SNAP induced greater fold stimulation of cGMP accumulation in high-density cells, but the levels of cGMP elicited by high concentrations of ANP (99-126) or SNAP were similar in high- and low-density cells. 8-Bromo cGMP was more effective in decreasing cytosolic free Ca2+ in high- than in low-density cells, suggesting that the greater effectiveness of ANP (99-126) and SNAP was, in part, due to greater effectiveness of endogenous cGMP in high-density cells. The results document that cell density, but not proliferative status, plays an important role in the modulation of intracellular Ca2+ dynamics in rat mesangial cells by atriopeptins, NO-generating vasodilators and cGMP.

Differences between the mechanisms of action of heat-stable and heat-labile enterotoxins of Escherichia coli

The mucosal-to-serosal and serosal-to-mucosal fluxes of Na+ and Cl- were measured in control mice and mice treated with heat-stable (ST) and heat-labile (LT) enterotoxins in the presence or absence of: Ca2(+)-ionophore A23187, an activator of Ca2(+)-calmodulin; or phorbol-12-myristate-13-acetate (PMA), an activator of protein kinase C(PKC); or 1-(5-isoquinolinyl sulphonyl)-2-methyl piperazine (H-7), an inhibitor of PKC. There was net secretion of Na+ and CL- in both experimental groups in contrast to net absorption in the control group. The addition of ionophore or PMA or ionophore + PMA resulted in net secretion of Na+ and Cl- in the control group and the effect of ionophore and pMA was found to be additive. The addition of ionophore did not cause any change in electrolyte fluxes in the ST toxin treated group, however, it increased the net secretion of Na+ and Cl- in the LT toxin treated group. PMA increased the net secretion of Na+ and Cl- in the St toxin treated group, however, it did not cause any change in Na+ and Cl- fluxes in the LT toxin treated group. H-7 did not reverse the effect of ST toxin, however, it reversed the effect of LT toxin.(ABSTRACT TRUNCATED AT 250 WORDS)

Role of Ca2(+)-calmodulin and protein kinase C in the secretory action of heat-labile enterotoxin of Escherichia coli in mice

The mucosal-to-serosal and serosal-to-mucosal fluxes of Na+ and Cl- were carried out in control and heat-labile enterotoxin treated mice in the presence or absence of Ca2(+)-ionophore A23187, the activator of Ca2(+)-calmodulin or Phorbol-12-myristate-13-acetate (PMA), the activator of Protein kinase C (PKC) or 1-(5-isoquinolinyl sulphonyl)-2-methyl piperazine (H-7), an inhibitor of PKC. There was net secretion of Na+ and Cl- in experimental group in comparison to net absorption in control group. The addition of ionophore or PMA resulted in net secretion of Na+ and Cl- in control group. In experimental group ionophore increased the net secretion of Na+ and Cl- while, PMA could not cause any change in Na+ and Cl- fluxes in experimental group. Calmodulin activity remained unaltered in heat-labile enterotoxin treated mice as compared to control. H-7, reversed the effects of PMA and heat-labile enterotoxin. These studies demonstrate that heat-labile enterotoxin primarily involves PKC in its action.

Effect of heat-stable and heat-labile enterotoxins of Escherichia coli on intestinal brush border membrane enzymes of mice

The activities of intestinal brush border membrane (BBM) enzymes alkaline phosphatase, maltase, lactase, sucrase, gamma-glutamyl transpeptidase and leucine aminopeptidase were determined in intestinal homogenates and purified BBMs from control, heat-stable and heat-labile enterotoxin treated mice. The activities of all the enzymes except lactase were decreased significantly (p less than 0.01) in homogenates while increased significantly (p less than 0.001) in BBMs of experimental groups as compared to controls. Calmodulin activities were increased significantly (p less than 0.01) as compared to control in heat-stable enterotoxin treated mice but remained unaltered in heat-labile enterotoxin treated mice. DNA contents of intestinal homogenates were decreased in experimental groups demonstrating the decrease in cell number in these groups. The altered BBM enzyme activities could not be attributed to changes in calmodulin activities. The increase in enzyme activities in BBMs may reflect a compensatory phenomenon in the remaining cells.

Calcium calmodulin in altered NaCl transport by heat-labile enterotoxin of Escherichia coli

The mucosal-to-serosal and serosal-to-mucosal fluxes of Na+ and Cl- were carried out in control and experimental groups treated with different doses of heat-labile enterotoxin in the presence or absence of Ca2+-ionophore, Ca2+ channel blocker and calmodulin inhibitor. There was net secretion of Na+ and Cl- in 16 and 32 units of heat-labile enterotoxin treated groups in comparison to net absorption in control group, however, in animals treated with 8 units of heat-labile enterotoxin, no change in Na+ and Cl- fluxes was found when compared to control. Ca2+- ionophore increased net secretion of Na+ and Cl- in 16 and 32 units of heat-labile enterotoxin treated groups and also caused secretion in control group instead of net absorption. Ca2+ channel blocker and calmodulin inhibitor partially reversed the effect of heat-labile enterotoxin. The effect of Ca2+-ionophore was more pronounced in the control group while that of Ca2+ channel blocker and calmodulin inhibitor was more pronounced in 16 and 32 units of heat-labile enterotoxin treated groups. The findings suggest the involvement of Ca2+ and calmodulin in the action of heat-labile enterotoxin of Escherichia coli in mice.

Effect of excretory-secretory products of Giardia lamblia on glucose and phenylalanine transport in the small intestine of Swiss albino mice

The transport of D-glucose and L-phenylalanine was measured in intestinal brush border membrane (BBM) vesicles treated with Excretory-secretory (ES) products of Giardia lamblia. Uptake was found to be significantly lower (P/0.01) in the treated vesicles than in the controls. Exposure of intestinal tissue to ES products resulted in net secretion (P/0.01) of Na+, C1- and 3-O-methyl-D-glucose. Both observations indicate that alterations in the absorptive functions of the intestine might be attributed to interaction of ES products with the BBM.

Physiological and histopathological changes in the intestines of mice challenged with S. typhi

Transport of Na+, Cl-, Ca2+ and 3-0-methyl-D-glucose (a non-metabolizable analogue of D-glucose) was worked out in control, infected and immunized-infected animals along with histopathological studies of the intestines in these groups. There was significant decrease (p less than 0.01) in net absorption of Na+ and Cl- in the infected group as compared to that in the control group. There was also a significant decrease (p less than 0.01) in 3-0-methyl-D-glucose uptake in the infected group. However, no change was found in the immunized group in any of the electrolytes and non-metabolizable analogue of D-glucose. These findings correlated well with the histopathological studies as the infected intestines showed complete disorganization of mucosal tissues with loss of epithelial cells from the villi whereas the mucosal lining and epithelial cells from the intestines of immunized mice were normal looking.

Role of Ca2+/calmodulin in the regulation of sugar uptake in Escherichia coli heat-stable enterotoxin induced diarrhoea in mice

The mucosal-to-serosal fluxes of 3-O-methyl-D-glucose, a non-metabolizable analogue of D-glucose, were carried out in control and heat-stable enterotoxin treated mice in the presence or absence of Ca2+-ionophore, Ca2+-channel blocker, calmodulin inhibitor and Na+-K+-ATPase inhibitor. The transport of the sugar was significantly decreased (p less than 0.01) in the experimental animals. In the presence of Ca2+-ionophore, the uptake of the sugar decreased significantly (p less than 0.01) only in the control group while experimental group remained unaffected. Ca2+ channel blocker and calmodulin inhibitor significantly increased (p less than 0.01) the uptake of sugar in both the groups, however, the changes were more pronounced in the experimental group. Ouabain blocked the uptake of the sugar in both the groups. These studies indicated that heat-stable enterotoxin inhibit Na+-K+-ATPase by increasing Ca2+ uptake and calmodulin activity, thus resulting in decreased uptake of 3-O-methyl-D-glucose in heat-stable enterotoxin treated mice.

Studies on the mechanism of Escherichia coli heat-stable enterotoxin-induced diarrhoea in mice

The unidirectional fluxes of Na+, Cl- and Ca2+ and activities of calmodulin in the intestinal microvillar core were studied in Escherichia coli heat-stable enterotoxin-treated mice. There was net secretion of Na+ and Cl- in toxin-treated animals, while in control animals there was net absorption of these ions. In both control and experimental animals, there was net absorption of Ca2+; however, the absorption was significantly higher (P less than 0.01) in experimental animals when compared to controls. In the presence of Ca2+-ionophore, there was a net secretion of Na+ and Cl- in controls, while the Ca2+-ionophore could not cause any change in the fluxes of these ions in experimental animals. The activity of calmodulin was significantly higher (P less than 0.01) in experimental animals. Verapamil, a calcium channel blocker, and trifluoperazine, a calmodulin inhibitor, reversed the effects of Ca2+-ionophore and heat-stable enterotoxin. These studies demonstrate that the toxin acts through Ca2+-calmodulin, and secretion of Na+ and Cl- in experimental animals is due to an increase in calcium absorption and an increase in calmodulin activity in the intestinal microvillar core.

Gastric lesser curve superficial seromyotomy: an experimental study in dogs

Lesser curve superficial myotomy has been investigated in the dog. The anatomical basis for the operation is discussed. The operation has the advantage of being easily performed and the risk of damage to the nerve of Latarjet or ischemic necrosis of the lesser curvature is obviated. Acid studies in the dogs confirmed that the operation was capable of producing secretory inhibition in keeping with vagotomy of the parietal cell area. The experiment needs further investigation in animals and in man, for assessment of the potential of the operation to replace other forms of vagotomy in patients with duodenal ulcer.