Fabrication of hydroxyapatite-based nano-gold and nano-silver-doped bioceramic bone grafts: Enhanced mechanostructure, cell viability, and nuclear abnormality properties

In this study, nano-gold (nAu) and nano-silver (nAg) were doped at the molar ratios of Molar5-Molar30 to the Hydroxyapatite (HAp)-based bioceramic bone graft synthesized by the sol-gel method. The effects of nAu and nAg on structural, mechanical, cell viability, and nuclear abnormality of the synthesized bioceramic grafts were evaluated. The chemical and morphological properties of the bone grafts after production were examined through XRD and SEM-EDX analyses and mechanical tests. To determine the biocompatibility of the bone grafts, cell viability tests were performed using human fibroblast cells. In the cytotoxicity analyses, only HAp and HAp-nAu5 grafts did not show toxicological properties at any concentration, while HAp-nAg5 among the nAg-containing grafts gave the best results at the 200-100 μg/mL concentrations and showed significant cytotoxicity in human fibroblast cells. The other nAu-containing grafts showed toxicological properties in the concentration range of 200-50 μg/mL and nAg-containing grafts in the concentration range of 200-100 μg/mL against the negative control. The micronucleus (MN) analyses showed that the lowest total MN and L (lobbed) amounts, while the lowest total N (notched) amount, was obtained from the only HAp graft. It was found that the nAg-doped bone grafts gave higher total MN, L, and N amounts compared to the nAu-doped bone grafts. Furthermore, while the mean nuclear abnormality (NA) values of all grafts gave close results, the highest values were again obtained from the nAg-doped bone grafts.

Efficacy and safety of endoscopic ultrasound guided drainage of pseudocysts and walled-off necrosis after failure of percutaneous drainage

BACKGROUND

Endoscopic Ultrasound (EUS) represents the gold standard for initial drainage of pancreatic fluid collections (PFC) due to various etiologies. However, data concerning salvage EUS drainage after initial percutaneous drainage are limited. The purpose of our study was to evaluate the clinical outcomes and safety of EUS-guided drainage of pancreatic collections after failure of percutaneous drainage.

METHODS

This retrospective study was conducted in a single, tertiary university center from August 2013 to January 2020. Indication was pancreatic collection after acute pancreatitis with PFC requiring EUS-guided drainage after failure of percutaneous drainage.

RESULTS

Twenty-two patients with PFC after acute pancreatitis were included (mean age 64.1 ± 11.3 years) of which 4/22 (18.2%) had pancreatic pseudocyst and 18/22 (81.8%) presented with a walled-off necrosis. Seventy-six interventions were performed among the 22 patients. Lumen-Apposing Metal Stent (LAMS) were used in 5/22 (22.7%) and double pigtail plastic stents in 17/22 (77.3%) of interventions with a median number intervention of 3 per patient (range 1 to 7). Technical success rate was 98.7% (75/76) with an overall clinical success of 81.8% (18/22). Procedure related adverse events rate was 9.1% (2/22) including one bleeding and one pancreatic fistula. Two non-procedure related deaths were observed.

CONCLUSION

EUS-guided pancreatic collection drainage is clinically effective and safe after clinical/technical failure of radiological percutaneous management.

Boron-incorporated biocomposite coatings on 316L and NiTi alloys: Enhanced structural, antibacterial activity, and cell viability performances

Boron doped (5 %, 10%, and 15 wt.%) Hydroxyapatite (B-HA) biocomposites were syntesized and coated on 316L SS and NiTi (Ni-45Ti) metallic substrates by using the electrophoretic deposition process (EPD). The morphological and structural characterization of the coatings was executed using scanning electron microscopy (SEM) and X-ray diffraction devices (XRD). Antibacterial tests were conducted using Escherichia coli ( E. coli, JM103) and Staphylococcus aureus ( S. aureus, ATCC29293) microorganisms. The mitochondrial activity assay (MTT)-[3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide] was used to examine cell viability and cytotoxicity in Saos-2 osteoblast cells. HA and boron peaks, as well as B-TCP and metallic components, were detected in XRD examinations. Porous morphologies were generated on the surface with boron doped B-HA coatings, as revealed by SEM views. Antibacterial activity studies revealed that both metallic coating groups, notably with boron doping, demonstrated antibacterial activity against gram-negative E. coli and gram-positive S. aureus. The antibacterial activity of the 316L group was shown to be better than that of the NiTi group in comparisonal testing. The syntesized boron-doped biocomposite coatings did not have any detrimental effects on living cells, according to cell viability studies. The cell viability rate was found to be greater in NiTi coatings than in 316 SS coatings, and the impact was amplified by the addition of boron.

Fabrication of porous-Ti6Al4V alloy by using hot pressing technique and Mg space holder for hard-tissue biomedical applications

Porous-Ti6Al4V (P-Ti6Al4V) alloys were produced using the hot pressing and spacer methods for hard tissue biomedical applications and in particular, the effects of porosity on the mechanical and morphological properties of the structures were investigated. P-Ti6Al4V structures having the homogeneously distributed porosities at 41.08, 52.37 and 64.10% were fabricated by adding 40, 50 and 60% spherical magnesium (Mg) powder with 350 μm particle sizes in average as spacers and evaporating magnesium via the atmosphere-controlled sintering. The obtained porous structures were characterized by SEM, XRD and EDS. Furthermore, the strength and elastic modulus were evaluated by performing compression tests. Elastic modulus and densities were found to be 40-171 MPa, 2-5 GPa and 1.59-2.61, respectively and these values have been shown to decrease with an increase in porosity. The achieved density and mechanical property values, in particular, elastic modulus are close to human bone and within acceptable ranges for with biomedical application purposes. In addition, it was also found out from the analysis of produced P-Ti6Al4V that macropores were responsible for mechanical anisotropy contributed to formation of homogeneous and inter-connected open pores.

Systematic Analysis of the Impact of Diagnostic Delay on Bowel Damage in Paediatric Versus Adult Onset Crohn's Disease

BACKGROUND AND AIMS

Length of diagnostic delay is associated with bowel strictures and intestinal surgery in adult patients with Crohn's disease [CD]. Here we assessed whether diagnostic delay similarly impacts on the natural history of paediatric CD patients.

METHODS

Data from the Swiss IBD Cohort Study were analysed. Frequency of CD-related complications [bowel stenosis, perianal fistula, internal fistula, any fistula, resection surgery, fistula/abscess surgery, any complication] at diagnosis and in the long term [up to 30 years after CD diagnosis] was compared between paediatric patients [diagnosed <18 years] and adult patients [diagnosed ≥18 years] using multivariate Cox proportional hazard regression modelling.

RESULTS

From 2006 to 2016, 387 paediatric and 1163 adult CD patients were included. Median [interquartile range: IQR] diagnostic delay was 3 [1-9] for the paediatric and 6 [1-24] months for the adult group, respectively. Adult onset CD patients presented at diagnosis more frequently with bowel stenosis [p <0.001] and bowel surgery [p <0.001] compared with paediatric CD patients. In the long term, length of diagnostic delay was significantly associated with bowel stenosis [p = 0.001], internal fistula [p = 0.038], and any complication [p = 0.024] in the adult onset CD population. No significant association between length of diagnostic delay and CD-related outcomes in the long term was observed in the paediatric population.

CONCLUSIONS

Adult CD patients have longer diagnostic delay compared with paediatric CD patients and present at diagnosis more often with bowel stenosis and surgery. Length of diagnostic delay was found to be predictive for CD-related complications only in the adult but not in the paediatric CD population.

[Functional gastrointestinal disorders: update on the Rome IV criteria]

Functional gastrointestinal disorders are highly prevalent worldwide and may have an important impact on the quality of life of affected patients. In addition, they are associated with a major socio-economic impact. In 2016 the Rome IV criteria were published that provided an update of the 2006 published Rome III criteria for functional gastrointestinal disorders. This article provides an overview of the current classification of functional gastrointestinal disorders and highlights the most important changes incorporated into the Rome IV criteria.

[Endoscopic ultrasound - guided biliary and pancreatic drainage: an update]

Endosonography is an effective diagnostic procedure for intraluminal, parietal and extradigestive pathologies with superior resolution compared to other imaging modalities. The evolution of this technique permits targeted biopsies and offers new therapeutic approaches, initially for the drainage of abdominal collections, and now also for the drainage of bile ducts and the pancreas. These procedures offer a wide range of minimal invasive curative or palliative therapeutic options. The safety profile of these procedures is good and equivalent to a percutaneous approach. They provide a greater comfort and are associated with lower overall cost.

Angiotensin Converting Enzyme Inhibitor-related Angioedema: A Case of an Unexpected Death

Angioedema is an asymmetric non-pitting oedema on face, lips, tongue and mucous membranes; any delay in diagnosis and treatment can be fatal. Treatment with lisinopril as an angiotensin converting enzyme (ACE) inhibitor, can be a reason of angioedema. Here we report a case who developed oral-facial edema four years after using lisinopril/hydrochlorothiazide. Laryngeal oedema is a main cause of death in angioedema. The treatment of choice in angioedema including fresh frozen plasma, C1 inhibitor concentrations and BRK-2 antagonists (bradykinin B2 receptor antagonists) were used. In this case; a 77 years old female patient suffering from hypertension was considered. This patient was suffering two days from swelling on her face and neck. Non- allergic angioedema was distinguished in five major forms; acquired (AAO), hereditary (HAE), renin-angiotensin-aldosterone system (RAAS) blocker-dependent, pseudoallergic angioedema (PAS) and an idiopathic angioedema (IAO). She was admitted to our clinic with the diagnosis of hereditary angioedema. Patient had skin edema and life threatening laryngeal edema. In emergency department treatment was started using intravenous methylprednisolone, diphenydramine as well as inhaled and subcutaneous epinephrine simultaneously. Despite the initial treatment, the patient died due to the insufficient respiration and cardiac arrest. The patient has no history of kidney disease.

VACTERL association with a rare vertebral anomaly (butterfly vertebra) in a case of monochorionic twin

The VATER/VACTERL association is typically defined by the presence of at least three of the following congenital malformations: vertebral anomalies, anal atresia, cardiac malformations, tracheo-esophageal fistula, renal anomalies, and limb abnormalities (13). We report a rare case of a monochorionic twin gestation in which one of the infants had VACTERL association. Antenatal ultrasound showed bilateral renal dysplasia and cardiac anomaly (ASD) in twin A. Twin A was noted to have the following anomalies: a single umbilical artery, limb anomaly (right hand preaxial polydactyly), vertebral anomalies (T9 and T11 butterfly vertebras, bilateral renal agenesis, bladder agenesis, anal and urethral atresia. A normal-sized stomach and normal amount of amniotic fluid were observed during the prenatal period with no other anomalies. Twin B (male) was healthy and no cardiac, renal, or congenital anomalies were demonstrated on ultrasound and physical examination. Infant A was also diagnosed as having VACTERL association because he had five of the core anomalies (V, A, C, R, L) of VACTERL association. Butterfly vertebra is an uncommon congenital spinal anomaly. To the best of our knowledge, our patient is the second case VACTERL association with butterfly vertebra in the literature.

Impaired TRAIL-dependent cytotoxicity of CD1c-positive dendritic cells in chronic hepatitis C virus infection

Dendritic cells (DCs) play a central role in antiviral immunity. Conflicting data on DC function have been reported for hepatitis C virus (HCV) infection. In addition to antigen presentation and cytokine secretion, a subset of human DCs displays direct cytotoxic activity. It has been suggested that measles virus and human immunodeficiency virus (HIV) may enhance cytotoxicity of DCs potentially leading to apoptosis of activated T cells and subsequent down-regulation of antiviral immune responses. We demonstrate that CD1c-positive myeloid DCs, but not BDCA-4-positive plasmacytoid DCs, are able to kill different target cells mainly via tumour necrosis factor-related apoptosis-inducing ligand. The ability of CD1c+ DCs to lyze target cells was found to be completely impaired in patients with chronic hepatitis C (10 chronic HCV patients vs 10 healthy controls; P < 0.001) but not in patients with primary biliary cirrhosis. Successful antiviral therapy of chronic hepatitis C rescued the cytotoxicity of DCs. Myeloid DCs of HCV patients and healthy controls had a similar phenotype and endocytotic activity, however, the frequency of mDCs in the peripheral blood was lower (P = 0.004) and the allostimulatory function was weaker (P < 0.001) in chronic hepatitis C. Thus, in contrast to HIV and measles virus studies on monocyte-derived DCs, freshly isolated myeloid DCs of patients with hepatitis C do not show an increased but a completely abolished cytotoxic activity. The impaired DC cytotoxicity could represent a novel mechanism for the increased prevalence of autoimmunity in HCV infection.

Advanced stage of cervical carcinoma undiagnosed during antenatal period in term pregnancy and concomitant metastasis on episiotomy scar during delivery: a case report and review of the literature

The objective of this study is to review the implantation of malignant cells of cervical cancer in an episiotomy site. This is the second case of cervical cancer with concomitant episiotomy metastasis in the literature. The treatment consisted of radiochemotherapy. There was no confirmed recurrent disease after 1 year of follow-up in our reported case. In conclusion, pregnancy appears to be a chance for cervical cancer screening as a part of prenatal care. If cervical cancer is diagnosed in a woman after vaginal delivery, she must be examined carefully including the episiotomy site.

Induction of hepatitis C virus (HCV)-specific T cells by needle stick injury in the absence of HCV-viraemia

BACKGROUND

The risk of hepatitis C virus (HCV) infection after occupational exposure is low with seroconversion rates between 0 and 5%. However, factors associated with natural resistance against HCV after needle stick injury are poorly defined. HCV-specific T-cell responses have been described in cross-sectional studies of exposed HCV-seronegative individuals.

MATERIALS AND METHODS

In this study, we prospectively followed 10 healthcare professionals who experienced an injury with an HCV-contaminated needle. Blood samples were taken on the day or the day after the event and at different time points during follow-up for up to 32 months. HCV-specific T-cell responses were investigated directly ex vivo and in T-cell lines.

RESULTS

None of the individuals became positive for HCV-RNA in serum tested with the highly sensitive transcription-mediated amplification (TMA)-assay or in peripheral blood mononuclear cells (PBMC). All of them remained anti-HCV negative throughout follow-up. At the time of injury, HCV-specific CD4+ T-cell responses were already detectable in two individuals and became detectable thereafter in three additional persons. Transient HCV-specific CD8+ T-cell responses developed in two HLA-A2 positive patients, which became negative until the most recent follow-up after 5 and 17 months, respectively.

CONCLUSION

We demonstrate the development of HCV-specific T cells in HCV-exposed individuals after needle stick injury indicating subinfectious exposure to HCV. T-cell immunity against HCV may contribute to the low prevalence of HCV in medical healthcare professionals in Western countries.

Cytotoxic CD4 T cells in viral hepatitis

CD4+ T cells are thought to contribute to antiviral immune responses by secretion of cytokines thereby providing help to CD8+ T and B cells. However, perforin-positive cytotoxic CD4+ T cells have been described in human immunodeficiency virus-positive patients suggesting a role not only of CD8+ but also of CD4+ T cells for killing virus-infected cells. We investigated 76 patients with viral hepatitis [15 hepatitis B virus (HBV), 22 HBV/hepatitis D virus and 17 hepatitis C virus (HCV)] for cytotoxic CD4+ T cells. The frequency of perforin-positive CD4+ T cells in viral hepatitis was highly variable ranging from < 1% to more than 25%. Perforin-positive CD4+ T cells displayed the phenotype of terminally differentiated effector cells (CD28-, CD27-). The highest frequencies of CD4+ cytotoxic T lymphocytes (CTLs) were found in patients with delta hepatitis (P = 0.04 vs HBV and HCV patients), and the presence of CD4+ CTLs was associated with elevated aspartate aminotransferase levels (P = 0.01) and decreased platelet counts (P = 0.03). Perforin-positive CD4+ T cells decreased in two individuals during spontaneous clearance of acute hepatitis C. Significant associations were found between the frequency of perforin-expressing CD4+ cells and age (P = 0.04), perforin-positive CD8+ cells (P < 0.001) and perforin-positive CD4-/CD8- lymphoid cells (P = 0.002). Differentiated CD27- effector CD4+ CTLs can be detected in patients with viral hepatitis. In particular in patients with more advanced liver disease, the accumulation of perforin-positive T cells with age could be one correlate for the more severe course of viral hepatitis in elderly individuals.

Molecular epidemiology of hepatitis B, C and D viruses in Turkish patients

Different genotypes of the hepatitis viruses may influence the clinical outcome of the disease. The distribution of genotypes may vary according to geographical regions. The aim of this study was to evaluate hepatitis B virus (HBV), hepatitis C virus (HCV) and hepatitis D virus (HDV) genotypes in Turkish patients with chronic hepatitis in a large cohort of patients. Genotyping was performed in 41, 59 and 365 patients with chronic hepatitis B, D and C, respectively, and 36 hemodialysis patients with chronic hepatitis C. Genotypes were determined by direct sequencing in hepatitis B and by polymerase chain reaction-restriction fragment length polymorphism in hepatitis C and D patients. In addition, HBV subtyping by multiplex PCR and subtype specific ELISA were performed in 83 and 71 HBsAg (+) blood donors, respectively. All hepatitis B (100%) and hepatitis D (100%) patients had genotype D and type I, respectively. HBsAg subtyping by two methods yielded that 99% of the patients were subtype ayw. S gene amino acid sequence in the 41 patients included for HBV genotyping revealed the ayw2 subtype. Genotype distribution of 365 patients with chronic C hepatitis were as follows: 306 (84%) patients genotype 1b, 43 (11%) patients genotype 1a, 10 (3%) patients genotype 2, 3 (1%) patients genotype 3, 3 (1%) patients genotype 4. Among 36 patients receiving hemodialysis, 28 (78%) patients had genotype 1b and 8 (22%) patients had genotype 1a. The study indicates that Turkish patients with chronic viral hepatitis show very little genotypic heterogeneity. Subtype ayw and the genotype D of HBV DNA, and the type I of HDV RNA represent almost 100% of related infections. The genotype 1b of HCV RNA was found to be significantly dominant in Turkish patients.

YSDD: a novel mutation in HBV DNA polymerase confers clinical resistance to lamivudine

The emergence of drug-resistant virus in hepatitis B virus (HBV) patients treated with lamivudine is well documented. In this study, we determined the mutations occurring in the tyrosine-methionine-aspartate-aspartate (YMDD) amino acid motif of the HBV DNA polymerase gene, as well as upstream and downstream of this region, in patients with breakthrough virus during lamivudine therapy. Thirty-one Turkish patients (20 patients HBeAg positive, 11 patients HBeAg negative and anti-HBe positive) with chronic HBV infection who completed at least 104 weeks of lamivudine treatment were investigated. All patients received lamivudine, (150 mg/day), for 104 weeks, with or without 4 months of interferon (IFN) combination. HBV-specific sequences were amplified by polymerase chain reaction (PCR) from sera of patients with breakthrough virus, and the PCR products were directly analysed by sequencing. Breakthrough virus was detected in seven of the 31 patients (22.6%) between 9 and 18 months of therapy. Of the seven patients, six were HBeAg positive at baseline, and four had a double mutation consisting of rtM204V and rtL180M, while two had an rtM204I change. In one patient, two base substitutions at rt204 (ATG --> AGT; T to G and G to T) lead to a methionine to serine change (YMDD --> YSDD). This novel DNA pol mutation was detected at month 18 of lamivudine treatment. In addition, this new variant had the rtL180M mutation and a 12 base pair deletion in the pre-S1 region between nucleotides 43-54. The YSDD mutation was still present 6 months after lamivudine discontinuation. In vitro transfection studies also confirmed that the YSDD strain is resistant to lamivudine. In conclusion, the results indicate that, in addition to a Met --> Val and Met --> Ile change in YMDD, a Met --> Ser change at rt204 (YMDD --> YSDD) associated with the rtL180M change can also emerge during lamivudine treatment, which confers lamivudine resistance in vivo and in vitro, leading to virological breakthrough and ALT increases.

A nitrate-selective electrode based on tris(2,2',2"-salicylideneimino)triethylamine

A new nitrate-selective liquid-membrane electrode based on the tris(2,2',2"-salicylideneimino)triethylamine-iron(III) complex has been developed. This electrode exhibits a linear Nernstian response over the range 10(-1)-10(-4) M of nitrate, with a slope of 54.3 +/- 0.9 mV per p[NO3]. The effects of the pH and the liquid-membrane composition were also investigated. The lifetime of the electrode is at least one month. The selectivity coefficients for ten monovalent ions were calculated. The preparation procedure of the electrode is very easy and inexpensive. Moreover, the proposed electrode was applied for the determination of nitrate in fertilizers.

Circulating IL-2 and IL-10 in chronic active hepatitis C with respect to the response to IFN treatment

BACKGROUND

The importance of circulating immunoregulatory cytokines in response to IFN treatment and the change of in vivo production of these cytokines during interferon (IFN) treatment are not well known. We aimed to determine whether pretreatment serum levels of IL-2 and IL-10 are predictive of the response to IFN treatment and to investigate if treatment response or nonresponse has any effect on the circulating levels of these cytokines.

PATIENTS AND METHODS

37 patients (18 responders and 19 non-responders) with chronic hepatitis C virus (HCV) infection who received IFN-alpha2b for 6 months were studied. Responders were defined by complete alanine aminotransferase (ALT) normalization and loss of HCV RNA as detected by bDNA assay while patients who had elevated ALT levels and positive HCV RNA after 6 months were considered as nonresponders.

RESULTS

Genotype distribution, ALT and HCV RNA levels were similar in responders and nonresponders. A significant number of patients with chronic hepatitis C (20/37 = 54%) had elevated IL-2 levels while IL-10 levels were not different from controls. No difference in baseline cytokine levels was observed between responders and non-responders. In the posttreatment serum samples some patients lost their detectable IL-2 or IL-10; some patients developed detectable cytokine levels after treatment irrespective of the treatment response.

CONCLUSION

These results suggest that active liver injury in chronic hepatitis C is associated with increased circulating Th1 cytokine IL-2 but not with Th2 cytokine IL-10 and that circulating levels of these cytokines do not predict the response to IFN treatment. There is no constant and regular change in circulating levels of these cytokines under IFN treatment with respect to treatment response.

Influence of viral load and alanine aminotransferase on viral genetic heterogeneity in patients with chronic hepatitis C virus infection

BACKGROUND/AIM

Hepatitis C virus (HCV) populations in vivo consist of genetically different heterogeneous mixtures defined as 'quasispecies', which vary in the hypervariable region 1 (HVR1) mostly. To further address the role of quasispecies diversity in hepatitis C infection, this study aimed to evaluate the influence of ALT, viral load and genotypes on quasispecies heterogeneity in patients with HCV infection.

METHODS

Thirty-six chronic hepatitis C patients with high levels of alanine aminotransferase (ALT) were studied. None of them received any antiviral therapy. HCV RNA serum levels, genotype and genetic heterogeneity were determined by branched-chain DNA assay, restriction fragment length patterns and RT-PCR single-strand conformational polymorphism analysis of HVR1, respectively.

RESULTS

Twenty-eight patients had genotype 1b (28/36; 78%), 6 patients had genotype 1a (6/36; 17%), 1 patient was 2a (1/36; 3%) and genotype could not be determined in 1 patient. The patients were categorized into two groups according to the number of bands representing the dominant strains in the circulation: group A with 2 bands having 1 strain (14/36 patients; 39%) and group B with more than 2 bands indicating more than 1 strain (22/36 patients; 61%). The serum viremia and ALT levels for these groups were 11 +/- 8.8 and 5.3 +/- 4.6 mEq/ml (p < 0.05), and 79 +/- 20, and 127 +/- 80 IU/l (p < 0.05), respectively.

CONCLUSION

The results of this study suggest that hepatitis C patients having 1 dominant strain in the circulation may show a relatively weaker immune response resulting in lower ALT and higher viremia levels, whereas patients with high degrees of virus quasispecies diversity have higher ALT levels and a more active immune response causing the selection of new genome variants and depressing viral replication partly.

Polymorphism of precore region of hepatitis B virus DNA among patients with chronic HBV infection in Turkey

The prevalence of mutations in the precore and core promoter regions of hepatitis B virus DNA and the association with the hepatitis B e antigen-negative phenotype vary in different geographical areas. It is rather high especially in the Far East and Mediterranean countries. The mutations occurring in the precore and the minimal essential region of the core promoter of HBV-DNA were analyzed in the sera of 81 patients (HBeAg-positive, 47 patients; HBeAg-negative, 34 patients) with chronic hepatitis B virus infection by direct sequencing of amplified polymerase chain reaction products. All patients had thymine at nucleotide 1858. Seven of 47 HBeAg-positive patients (15%) and 29 of 34 HBeAg-negative patients (85%) had precore stop codon mutations (G to A change at nucleotide 1896). No nucleotide change was found in the minimal essential region of HBV core promoter in any patient studied. In conclusion, the hepatitis B e antigen-negative phenotype in Turkish patients with chronic hepatitis B is associated with mutations in the precore but not in the minimal essential region of the core promoter. These results representing a part of the eastern Mediterranean support the studies conducted for the other populations of the region.

Comparison of Tc-99m EC and Tc-99m DTPA captopril scintigraphy to diagnose renal artery stenosis

PURPOSE

Although, captopril scintigraphy is a well established method to detect renovascular hypertension, the optimal radiopharmaceutical for this test remains to be determined. Recently, Tc-99m ethylenedicysteine (Tc-99m EC) appeared as an alternative agent for captopril scintigraphy. The aim of this study was to compare the diagnostic accuracy of Tc-99m EC with Tc-99m DTPA, which is a well-established renal radiopharmaceutical for the captopril test.

METHODS

Nineteen hypertensive patients who had various degrees of renal artery stenosis on angiography were included in the study. All patients had baseline and captopril Tc-99m EC and Tc-99m DTPA scintigraphy within a 1-week period. The results were compared with angiography and in eight patients with changes in blood pressure after revascularization. The images were interpreted without knowledge of the angiography and revascularization data as low, intermediate, or high probability for hemodynamically significant renal artery stenosis, which was defined as an area of stenosis exceeding 50%.

RESULTS

Tc-99m EC and Tc-99m DTPA study results were in agreement in 16 of the 19 patients. In two patients with branch artery stenosis, Tc-99m EC was definitely superior to Tc-99m DTPA and correctly identified the probability of stenosis on scintigraphy. On kidney analysis, Tc-99m EC had a slightly greater diagnostic sensitivity compared with Tc-99m DTPA (79% vs. 68%; P > 0.05 by the chi-squared test) but equal specificity (93% for both agents). Both Tc-99m EC and Tc-99m DTPA showed the same accuracy in predicting the outcome after revascularization in all but one patient with branch artery stenosis, in whom Tc-99m EC accurately predicted a successful outcome of the intervention but Tc-99m DTPA did not. Tc-99m EC had better renal uptake in patients with decreased renal function and provided more dramatic evidence of renogram changes after captopril intervention, which resulted in more confident interpretation.

CONCLUSIONS

There is no significant difference between Tc-99m EC and Tc-99m DTPA captopril scintigraphy for detecting renal artery stenosis. However, because of the better imaging characteristics and more confident interpretation provided by the dramatic changes in the degree of renogram abnormality after captopril intervention, Tc-99m EC captopril scintigraphy should be used, particularly in patients with decreased renal function or branch artery stenosis.

Diagnostic efficacy of the preoperative lymphoscintigraphy, Ga-67 scintigraphy and computed tomography for detection of lymph node metastasis in cases with ovarian or endometrial carcinoma

BACKGROUND

To investigate the diagnostic efficacy of preoperative lymphoscintigraphy (LS), Ga-67 scintigraphy (GS) and computed tomography (CT) for detection of lymph node metastasis in patients with endometrial or ovarian carcinoma.

METHODS

The results of preoperative LS, GS and CT used to detect lymph node metastasis were compared to the postoperative histopathological results of lymph node dissection materials of a total of 37 patients, including 16 patients with endometrial and 21 patients with ovarian carcinomas. The diagnostic efficacy of these methods for detecting lymph node metastasis were calculated.

RESULTS

When the results of all of the patients were taken into account, the preoperative LS, GS and CT were found to have sensitivities of 50%, 20% and 40% and specificities of 51.8%, 96.3%, and 92.6%, respectively, for detection of pelvic lymph node metastasis. The same methods had sensitivities of 27.3%, 27.3% and 72.7% and specificities of 88.5%, 88.5%, 84.6%, respectively, for detecting para-aortic lymph node metastasis in all patients.

CONCLUSION

These data suggested that although LS, GS and CT had relatively high specificity, low sensitivity of these imaging methods precluded their routine preoperative use for diagnosis of lymph node metastasis of ovarian or endometrial carcinoma.

Evidence for the presence of muscarinic M2 and M4 receptors in guinea-pig gallbladder smooth muscle

1. The affinities of 10 selective muscarinic receptor antagonists against [3H]-quinuclidinyl benzilate (QNB) binding were determined to characterize the muscarinic receptors present in guinea-pig gallbladder smooth muscle. The highest correlation was obtained for the comparison between the pKi values for the gallbladder smooth muscle and M2 sites. Pirenzepine revealed two binding sites with affinities indicating the presence of muscarinic M2 receptors in abundance and a minor population of an additional site(s). 2. Carbachol produced gallbladder contractions, stimulated phosphoinositide (PI) hydrolysis and inhibited cAMP formation concentration-dependently with pD2 values of 6.12 +/- 0.11, 5.18 +/- 0.33 and 7.19 +/- 0.15, respectively. 3. Pirenzepine, 4-DAMP, HHSiD, pF-HHSiD, AF-DX 116, methoctramine, AQ-RA 741, guanylpirenzepine and AF-DX 384 showed competitive antagonism against carbachol-induced gallbladder contractions. There was no correlation between the pA2 values for the gallbladder and pKi values for the M2 sites, whereas significant correlations were found for the M1, M3 and M4 sites, the best correlation being between the pA2 values for the gallbladder and M4 subtypes. 4. Finally, the presence of both m2 and m4 receptor proteins were demonstrated by Western blot analysis. It is concluded that guinea-pig gallbladder smooth muscle has both muscarinic M2 and M4 receptors, which are coupled to adenylate cyclase inhibition and PI hydrolysis. 5. Although it seems likely that M2 receptors do not play a primary role in carbachol-induced guinea-pig gallbladder contraction, the characterization of the muscarinic subtypes which mediate these contractile responses needs further evidence.

Role of paraventricular and dorsomedial nuclei of the hypothalamus and central nucleus of the amygdala on muscimol-induced cardiovascular responses

Gamma-aminobutyric acid (GABA) plays an important role in the central control of cardiovascular functions. Previous evidence indicates that a tonically active GABAergic system exists in forebrain structures. The purpose of this study was to examine the role of the unilateral lesion of the central nucleus of amygdala, paraventricular or dorsomedial nuclei of the hypothalamus on muscimol-induced cardiovascular responses. Electrolytic ablation of nuclei was made by a monopolar isolated electrode under a stereotaxic instrument, 3-5 days before the experiments. Effects of intracerebroventricular injections of muscimol were investigated in intact, lesioned and sham-lesioned rats. On the day of the experiments, blood pressure and heart rate recordings were carried out in male Sprague-Dawley conscious rats. Muscimol produced decreases in arterial blood pressure and heart rate. The hypotensive effect of muscimol was completely inhibited in rats with dorsomedial nucleus lesions, whereas the bradycardic effect was partially prevented. The results indicate that the dorsomedial nucleus of the hypothalamus plays an important role on muscimol-induced blood pressure and heart rate responses.

Role of the AV3V region in the pressor responses induced by amygdala stimulation

The role of the anteroventral third ventricle (AV3V) region in the pressor responses to carbachol injected into the lateral cerebral ventricle (i.c.v.), the electrical stimulation of and carbachol-induced stimulation of, the central nucleus of the amygdala were investigated in conscious, unrestrained Sprague-Dawley rats. I.c.v. and intra-amygdalar carbachol caused a significant rise in blood pressure of 22.9 +/- 2.8 and 16.8 +/- 2.2 mmHg, respectively. Electrical stimulation (1 ms, 80 Hz, 50-300 microA, for 30 s) of the central nucleus of amygdala also produced intensity-dependent pressor effects. Electrolytic lesion of the AV3V region abolished the pressor responses induced by carbachol and by electrical amygdala stimulation. The heart rate changes were also significantly inhibited in the AV3V-lesioned rats. These results indicate that the integrity of the AV3V region is essential for the central cholinergic cardiovascular changes induced by central amygdaloid nucleus stimulation.

Carbachol-induced pressor responses and muscarinic M1 receptors in the central nucleus of amygdala in conscious rats

The type of muscarinic receptor in the central nucleus of the amygdala that mediates the carbachol-evoked pressor responses was investigated in conscious unrestraint Sprague-Dawley rats. Carbachol (100 ng) injected into the lateral cerebral ventricle caused a significant rise in blood pressure of 31.8+/-4.5 mmHg and a decrease in heart rate of 80.0+/-12.2 beats/min. Pirenzepine (10-75 nmol) injected into the central nucleus of the amygdala inhibited carbachol-induced pressor responses dose-dependently. The bradycardic response to carbachol was also inhibited by pirenzepine, but no dose-dependency was observed. Injection of pirenzepine into the basolateral amygdala at a dose (50 nmol) that inhibited carbachol-induced changes in mean arterial pressure and heart rate when injected into the central nucleus of the amygdala failed to exert any inhibition. Methoctramine at a dose of 50 nmol injected into both the central nucleus of the amygdala and the basolateral amygdala did not cause any significant alteration in the responses. These results indicate that muscarinic M1 receptors in the central nucleus of the amygdala are involved in cardiovascular regulation mediated by central cholinergic pathways.

Modulation of the pressor response elicited by carbachol and electrical stimulation of the amygdala by muscarinic antagonists in conscious rats

1. The nature of the muscarinic receptor involved in mediating cardiovascular changes caused by unilateral microinjection of carbachol (5 nmol) into, and electrical stimulation (200-300 microA) of, the amygdaloid complex was investigated in conscious, unrestrained female Sprague-Dawley rats. 2. Unilateral microinjection of carbachol (5 nmol; n = 6) and electrical stimulation (200-300 microA, 80 Hz, 30 s; n = 4) caused a significant rise in blood pressure of 21 +/- 4 mmHg and 25 +/- 5 mmHg, respectively. These changes were associated with no overall effect on heart rate. The effects of electrical stimulation were found to be repeatable. 3. Pretreatment i.c.v. with pirenzepine (5-20 mmol; n = 6-7 for each dose), dose-dependently inhibited the rise in blood pressure induced by carbachol, whereas AF-DX 116 (100 nmol; n = 6) failed to have any effect on the carbachol-induced pressure response. Neither antagonist alone had any effect on resting baseline variables. 4. Unilateral microinjections of atropine sulphate (1-100 nmol; n = 4-6 for each dose), pirenzepine (0.03-10 nmol; n = 4 for each dose) or AF-DX 116 (10-60 nmol; n = 4-5 for each dose), into the amygdala, dose-dependently inhibited the rise in blood pressure caused by electrical stimulation (200-300 microA). The ID50 values were 1.05, 0.23 and 39.5 nmol, respectively. Although pirenzepine seemed to be more potent than atropine, this difference was not significant. 5. It is concluded that the rise in blood pressure elicited by unilateral microinjection of carbachol into, or electrical stimulation of, the amygdaloid complex is mediated by M1-muscarinic receptors.

Numerical and experimental stress analysis of a polymeric composite hip joint prosthesis

A comparative stress analysis of a polymeric composite hip joint replacement was performed. A prototype short carbon-fiber reinforced PEEK (CF/PEEK) prosthesis was manufactured by injection molding. Finite element (FE) analysis was conducted on intact femurs and femurs fitted with the CF/ PEEK and the titanium prostheses under various loading conditions. FE models were validated by experimental strain gauge measurements by using synthetic femurs. There was a good agreement between the two methods except in the hoop strain of the femur in the calcar region because of the assumption of the isotropic material properties. The stem stresses were lower for the CF/PEEK prosthesis than for the titanium prosthesis. The maximum stress was in the spigot of the CF/PEEK prosthesis, but in the middle third of the stem of the titanium prosthesis. Stress generated in the cement was almost equal for both prostheses although more load was transferred, via cement, to the femur with the CF/ PEEK prosthesis because the load transfer took place over a larger area. An out-of-plane component of the joint load causes higher prosthesis and cement stresses.

The role of amygdala and hypothalamus in GABAA antagonist bicuculline-induced cardiovascular responses in conscious rats

gamma-Aminobutyric acid (GABA) is known to play an important role in the central control of cardiovascular functions. GABAergic agonists and antagonists elicit blood pressure and heart rate changes when injected into the brain. It was demonstrated here that bicuculline methiodide (BMI), a GABAA antagonist, caused dose-dependent increases in both blood pressure and heart rate in conscious rats when injected intracerebroventricularly. The roles of the central nucleus of the amygdala (CeA), the paraventricular nucleus (PVN) and the dorsomedial nucleus (DMH) of the hypothalamus in BMI-induced blood pressure and heart rate changes were investigated in this study. The pressor effect of BMI was significantly attenuated by the electrolytic ablation of DMH and PVN, whereas it was only slightly, but insignificantly reduced by CeA lesions. The microinjection of BMI into the DMH and the PVN elicited significant pressor and tachycardic responses whereas only a slight increase was observed in rats injected BMI into the CeA. The BMI-induced increases in both blood pressure and heart rate were more prominent when given into the DMH. These results indicate that the DMH plays an important role in GABAergic control of cardiovascular functions. The PVN and CeA seem to have a minor part in this respect.

Antinociceptive effect of D-aspartic acid in mice

The effects of D- and L-aspartic acids on the nociceptive tail flick reflex in mice were investigated. D-Aspartic acid (115-230 mg/kg, IP) was found to increase tail flick latency significantly. Naloxone (0.1 mg/kg) abolished the analgesic effect of D-aspartic acid (115 mg/kg). Morphine and D-aspartic acid, when combined at their nonanalgesic doses, led to significant analgesia. It may be concluded that the opioid system is involved in the antinociceptive effect of D-aspartic acid. Both morphine and D-aspartic acid were previously reported to inhibit L-aspartic acid production via blockade of L-asparaginase. L-Aspartic acid, which was ineffective alone, significantly inhibited the antinociceptive effects of both D-aspartic acid and morphine.

An estimation of fatigue life for a carbon fibre/poly ether ether ketone hip joint prosthesis

A fracture mechanics approach was applied to estimate the life of a prosthesis injection moulded from short carbon fibre reinforced poly ether ether ketone. Flexural modulus and strength, fracture toughness, fatigue endurance limit, fatigue crack growth rate and threshold stress intensity factor were determined. The dimensions of the test pieces were selected to yield fibre orientation and fibre length distributions similar to those obtained in the prosthesis. Stress levels generated in the prosthesis under different activities were estimated by conducting three-dimensional finite element analysis. It was shown by a fracture mechanics approach that a fatigue failure due to the propagation of an embedded elliptical slit, under these stresses, would be unlikely for a crack length smaller than 1.85 mm. However, the cement would fail under the same conditions, irrespective of the type of the prosthesis employed.

Oxytocin-induced contractions of the rabbit corpus cavernosum

The contractile effect of oxytocin on isolated rabbit corpus cavernosum strips was investigated. Concentration-response curves to oxytocin and phenylephrine were obtained. Oxytocin repetitively induced concentration-dependent contractions in the corpus cavernosum strips. The maximal contractile response to oxytocin was in amplitude 39.4 +/- 9.1% of that to phenylephrine. The slopes of the concentration-response curves, the amplitude of the maximal contractile effects, and the pD2 values of oxytocin obtained in endothelium-denuded strips were not significantly different from those of intact preparations. The results of this study demonstrated that oxytocin contracts the rabbit corpus cavernosum, but the endothelium does not contribute to this effect. Since oxytocin is less efficacious than phenylephrine, it seems unlikely that this hormone can serve as an alternative in the treatment of prolonged penile erections.

Reversal of hemorrhagic shock in rats by oxotremorine: the role of muscarinic and nicotinic receptors, and AV3V region

In an experimental model of hemorrhagic shock resulting in the death of almost all rats within 20-30 min, centrally active cholinomimetic drugs are reported to induce a prompt, sustained and dose-dependent improvement in blood pressure and survival rate claimed to be due to nicotinic, but not muscarinic actions. In the present study, cholinergic receptor agonist, oxotremorine (50 micrograms/kg, i.v.) increased mean arterial pressure (from 22 +/- 1 to 123 +/- 3 mm Hg) and 60 min-survival rate (from 0% to 92%) in rats bled to hypovolemic shock. Atropine (2 mg/kg, i.v.) pretreatment inhibited the pressor effect of oxotremorine significantly, but did not modify its effect on survival rate. On the other hand, pretreatment with mecamylamine (50 micrograms, i.c.v.) almost abolished the reduction in mortality rate, but inhibited the pressor effect of oxotremorine, partially. These results indicate that oxotremorine-induced pressor response and decrease in mortality in rats with severe hemorrhagic shock are primarily mediated via central muscarinic and nicotinic receptors, respectively. AV3V region was previously reported to be involved in pressor and natriuretic effects of i.c.v. carbachol in normotensive rats. In the present study, the electrolytic lesions of AV3V region significantly inhibited oxotremorine-induced increases in both blood pressure and survival rate in rats subjected to hemorrhagic shock. These findings indicate that AV3V region plays a major role in cholinergic cardiovascular control in hypotensive animals as well as normotensives.