OBJECTIVE

To investigate effects of perirenal space blocking (PSB) on gastrointestinal function in patients with severe acute pancreatitis (SAP).

METHODS

Forty patients with SAP were randomly allocated to receive PSB or no PSB (NPSB). All the SAP patients received specialized medical therapy (SMT). Patients in the PSB group received PSB + SMT when hospitalized and after diagnosis, whereas patients in the NPSB group only received SMT. A modified gastrointestinal failure (GIF) scoring system was used to assess the gastrointestinal function in SAP patients after admission. Pain severity (visual analog scale, 0 to 100) was monitored every 24 h for 72 h.

RESULTS

Modified GIF score decreased in both groups during the 10-d study period. The median score decrease was initially significantly greater in the PSB group than in the NPSB group after PSB was performed. During the 72-h study period, pain intensity decreased in both groups. The median pain decrease was significantly greater in the PSB group than in the NPSB group at single time points. Patients in the PSB group had significantly lower incidences of hospital mortality, multiple organ dysfunction syndrome, systemic inflammatory response syndrome, and pancreatic infection, and stayed in the intensive care unit for a shorter duration. However, no difference in terms of operation incidence was found between the two groups.

CONCLUSIONS

PSB could ameliorate gastrointestinal dysfunction or failure during the early stage of SAP. Moreover, PSB administration could improve prognosis and decrease the mortality of SAP patients.

Opercular epithelia from seawater-adapted killifish (Fundulus heteroclitus) were dissected with the nerve intact, mounted in Ussing-style membrane chambers and bathed in symmetrical saline solutions. Nerve stimulation rapidly inhibited transepithelial current (a measure of Cl- secretion rate) by 27.3+/-3.3 % (N=22), and the effect could be sustained for more than 10 min using intermittent pulse trains at 10 Hz. The effect was blocked in a dose-dependent manner by yohimbine, but not by propranolol, atropine or tubocurarine, indicating mediation by <IMG src="/images/symbols/&agr ;.<em>gif</em>" WIDTH= "9" HEIGHT="12" ALIGN="BOTTOM" NATURALSIZEFLAG="3">2-adrenergic receptors. The effect was also present, but significantly diminished, in opercular membranes from animals that had been transferred to sea water for 48 h (18+/-8.6 % inhibition, N=14). The resting current and the effect were absent in membranes from freshwater-adapted animals. The addition of clonidine (1.0 micromol l-1 serosal side) started to inhibit Cl- current after 40-60 s; immediately before this, at 30 s, there was a significant rise (P<0.05, N=14) in tissue inositol 1,4,5, -trisphosphate (InsP3) level, but no change at later times, compared with LiCl-treated control membranes and measured by radiolabeled receptor assay. The results indicate that seawater-adapted killifish can decrease their Cl- secretion rate through the action of the sympathetic nervous system, a response appropriate for the entry of estuarine fish to fresh water, and that the effect is mediated by <IMG src="/images/symbols/&agr ;.<em>gif</em>" WIDTH="9" HEIGHT="12" ALIGN="BOTTOM" NATURALSIZEFLAG="3">2-adrenoceptors via InsP3. The results imply that euryhaline fish entering fresh water can undergo an autonomic reflex reduction in salt secretion that does not require a stress response.

The general synthesis of dantrolene analogues with various substituents on its phenyl ring has been developed via palladium-catalyzed cross-coupling reactions, the Stille or Suzuki reaction, as the key step. The effects of synthesized analogues have been evaluated by two kinds of Ca(2+) release modes from sarcoplasmic reticulum (SR) of mouse skeletal muscle fibers based on: (1) the measurement of twitch contraction caused by the physiological Ca(2+) release (PCR) of intact skeletal muscle and (2) the rate of Ca(2+)-induced Ca(2+) release (CICR) in saponin-treated skinned muscle fibers. Although dantrolene, a lead compound, inhibits both twitch contraction and CICR, some structurally modified analogues exhibit one or the other of these effects. The methoxy congener, GIF-0185, potently inhibits the twitch contraction without affecting the CICR, while GIF-0166 and GIF-0248, the ortho-nitro regioisomer and ortho, ortho-dinitro substituted analogues, respectively, doubly potentiate the CICR exclusively.

OBJECTIVE

To determine the value of serum chromogranin A (CgA), a marker of neuroendocrine differentiation, for monitoring prostate cancer: CgA levels were related to three other tumour markers, i.e. total prostate-specific antigen (tPSA), prostatic acid phosphatase (PAP), neurone-specific enolase (NSE), and to testosterone, to assess the importance of hormone withdrawal.

METHODS

Serum samples (218) were obtained from 118 patients with prostate cancer, including 111 patients with advanced prostate cancer: 103 presented to our centre for systemic radionuclide therapy of painful skeletal metastases. CgA concentrations were measured using a new immunoradiometric assay (IRMA: Cis Bio International, Gif sur Yvette, France) and a threshold of 70 ng/mL was determined after receiver operating characteristic curve analysis. Testosterone was also measured with an IRMA assay; tPSA, PAP and NSE were assayed using the time-resolved amplified cryptate emission.

RESULTS

Serum marker levels were high in 64% of the patients for CgA, 24% for NSE, 89% for tPSA and 81% for PAP. Patients resistant to endocrine treatments and with elevated tPSA (i.e. hormone-independent) showed increased CgA and NSE in 62% and 29%, respectively. Patients with hormone-dependent prostate cancer (i.e. with a normal tPSA level) had elevated CgA in 59% but no abnormal NSE. All patients of the latter group except one showed clinical progression of their disease. However, the mean (SD) concentrations of CgA in hormone-independent (146) or hormone-dependent (22) patients, at 185.3 (449.1) and 160.9 (293.9) ng/mL, respectively, were not statistically different (P=0.8, Mann-Whitney U-test). For 30 patients, blood samples were drawn and markers measured before and after systemic radionuclide therapy. There was a significant increase in the CgA and tPSA concentrations after treatment (P=0.0146 and 0.0025, respectively).

CONCLUSIONS

In association with tPSA, serum CgA appears to be a promising marker for monitoring patients with prostate cancer.

OBJECTIVE

The new developed ultrathin transnasal endoscope, the GIF-XP290N, makes possible a resolving power similar to the GIF-H260 at a distance of 3 mm. In this study, using the GIF-XP290N, we evaluated whether endoscopic diagnosis (discrimination between benign and malignant) of gastric lesions is possible using nonmagnified narrow-band imaging (NBI) endoscopy.

METHODS

The subjects were 255 consecutive patients who underwent screening of the gastrointestinal tract using new ultrathin transnasal endoscopy. Their average age was 65.2 ± 11.4 years. The male-female ratio was 2.5:1. All cases were examined using conventional white-light imaging (WLI) and nonmagnified NBI. When a depressed lesion was detected in the stomach, it was examined using WLI, then NBI close examination (at about 3 mm). We observed the mucosal structure of the lesion using close visualization with NBI. Concerning mucosal structural changes, we looked for a clear demarcation line between the lesion and the surrounding mucosa, and loss, irregularity, or nonuniformity of the lesion mucosal microsurface pattern.

RESULTS

A total of 52 depressed lesions were examined. The histological diagnosis was cancer for 8 lesions, and noncancer for 44 lesions. WLI examination yielded a sensitivity of 50.0% (4/8), specificity of 63.6% (28/44), and accuracy 61.5% (32/52). On the other hand, NBI close examination yielded a sensitivity of 87.5% (7/8), specificity of 93.2% (41/44), and accuracy of 92.3% (48/52), significantly higher.

CONCLUSIONS

NBI close examination using ultrathin transnasal endoscopy enables mucosal diagnosis even without magnification and was considered to be an effective technique for improving endoscopic diagnosis.

The role of the catecholamines noradrenaline, adrenaline and dopamine on metallothionein (MT) levels of specific areas of the rat brain has been studied. MT-I or MT-I + II levels were measured by radioimmunoassay using specific antibodies that cross-react only slightly with human MT-III (growth inhibitory factor, GIF). The inhibition of tyrosine hydroxylase with alpha-methyl-p-tyrosine (MPT), which depletes brain dopamine, noradrenaline, and adrenaline, increased MT levels in all brain areas studied (frontal cortex, cortex, medulla oblongata plus pons, midbrain, striatum, hippocampus, hypothalamus, and cerebellum) when considering the results of two separate experiments. The alpha- and beta-receptor blockers, phentolamine, and propranolol, alone or together, did not increase brain MT levels in any area of the brain, suggesting that the effect of MPT in vivo is related to inhibition of the synthesis of dopamine rather than of noradrenaline and adrenaline. Dopamine, noradrenaline, and serotonin increased MT-I levels in primary cultures of neurons, whereas decreased them in astrocyte-enriched primary cultures. Since MT-I levels are about ten times higher in astrocytes than in neurons, the increased brain MT levels induced by MPT may reflect the suppression of the normal inhibitory effect of dopamine on astrocyte MT levels. The increase in MT concentrations induced in most parts of the brain by immobilization stress was not prevented by MPT, phentolamine, or propranolol, suggesting that it was not mediated by the central monoamines.

Energy Filtered Transmission Electron Microscopy (EFTEM) has been used to study nucleic acids localization in unstained thin sections of virus-infected cells. For this purpose, phosphorus maps (P-maps) have been obtained by applying the N-windows Egerton model for background subtraction from data acquired by a non-dedicated TEM Jeol 1200EXII equipped with a post-column PEELS Gatan 666-9000 and a Gatan Image Filter (GIF-100). To prevent possible errors in the evaluation of elemental maps and thus incorrect nucleic acid localization, we have studied different regions of swine testis (ST) cells with similar local density containing either high concentration of nucleic acids (condensed chromatin and ribosomes) or a very low concentration (mitochondria). Special care was taken to optimize the sample preparation conditions to avoid as much as possible the traditional artifacts derived from this source. Selection of the best set of pre-edge images for background fitting was also considered in order to produce "true P-maps". A new software for interactive processing of images series has been applied to estimate this set. Multivariate Statistical Analysis was used as a filtering tool to separate the "useful information" present in the inelastic image series (characteristic signal) from the "non-useful information" (noise and acquisition artifacts). The reconstitution of the original image series preserving mainly the useful information allowed the computation of P-maps with improved signal-to-noise ratio (SNR). This methodology has been applied to study the RNA content of maturation intermediate coronavirus particles found inside infected cells.

Monoclonal antibody GIF-1 was found to neutralize human natural immune interferon (IFN-gamma), but not Escherichia coli-derived recombinant IFN-gamma. In addition, GIF-1 antibody failed to immunoprecipitate 125I-labeled recombinant IFN-gamma, whereas it precipitated natural IFN-gamma in a concentration-dependent manner. The lack of recognition of recombinant IFN-gamma by antibody GIF-1 may not be due to the absence of the oligosaccharide moiety in the molecules of recombinant IFN-gamma alone, because removal of carbohydrate from natural IFN-gamma by treatment with a mixture of glycosidases did not alter the selective binding of antibody, i.e., deglycosylated and untreated natural IFN-gamma were equally neutralized and immunoprecipitated by GIF-1 antibody. In addition, a minor monomeric component of natural IFN-gamma with the m.w. of 15,500, which apparently lacks carbohydrate, was also recognized by antibody GIF-1. These results suggest that the discriminative recognition of natural and recombinant IFN-gamma by monoclonal antibody GIF-1 may be due to a conformational difference at or near the active regions of natural and recombinant human IFN-gamma molecules.

BACKGROUND

Recent studies have documented good patient and graft outcomes and a low risk of acute rejection with steroid-avoidance immunosuppression in kidney-transplant recipients, but the risk of progressive graft fibrosis is not well studied.

METHODS

All adult primary kidney transplant or combined kidney and pancreas transplant recipients on steroid avoidance immunosuppression were eligible for study. All recipients received induction with antithymocyte globulin or basiliximab. Corticosteroids were stopped after day 4 post-transplantation. Patients were maintained with tacrolimus and mycophenolate mofetil. Protocol biopsies were done at reperfusion and at one, four, and 12 months after transplantation.

RESULTS

Eighty one-yr protocol biopsies with adequate specimens were obtained from 132 kidney or kidney-pancreas transplant recipients. Fifteen (19%) of the biopsies showed moderate to severe graft interstitial fibrosis (GIF) (Banff ci score>> or = 2). Recipients with GIF were older, had lower body mass index, greater human lymphocyte antigen (HLA) mismatch, older donors, serum creatinine>> or = 1.6 mg/dL at one month, a Banff ci score>> 0 on one-month biopsy, BK nephropathy, and interstitial cellular infiltrates on the one-yr biopsy. In the unadjusted logistic regression analysis, BK nephropathy, serum creatinine>> or =1.6 mg/dL at one month, recipient age, Banff ci score>> 0 on one-month biopsy, and donor age were the only variables associated with a higher risk of GIF on the one-year biopsy. In the multivariate logistic regression model adjusted for these variables, BK nephropathy, serum creatinine>> or = 1.6 mg/dL at one month after transplantation, and recipient age were independently associated with the risk of GIF on the one-year biopsy.

CONCLUSIONS

In this small study of primary kidney or combined kidney-pancreas transplant recipients on steroid-avoidance immunosuppression, we found that 19% had GIF on a one-year protocol biopsy. BK nephropathy, serum creatinine>> or = 1.6 mg/dL one month after transplantation, and recipient age correlated with an increased risk for GIF on the one-yr biopsy.

To show the effects of growth inhibitory factor (Cu4Zn3MT-III) involved in the scavenging of reactive oxygen species (ROS), a pulse radiolytic study was employed using N2O-saturated Cu4Zn3MT-III aqueous solutions. It was demonstrated that the oxidizing OH* radical efficiently reacted with Cu4Zn3MT-III by forming a thiyl radical RS* with a second-order constant of 1.46 x 10(11) mol l(-1) s(-1), which was determined by competition kinetics against KSCN. The thiyl radical RS* reacted rapidly and reversibly with a thiolate in Cu4Zn3MT-III to form radical anion RSSR*- with a constant of 1.65 x 10(9) mol lL(-1) s(-1) per thiolate, while the constant of the decay of this radical anion was 2.72 x 10(5) s(-1), and the equilibrium constant of the formation for RSSR*- was 6.08 x 10(3) mol(-1) l. These values were close to those of Cd5Zn2MT-II. The SOD activity of Cu4Zn3MT-III to quench O2(*-) was assayed by the riboflavine-methionine-nitrobluetetrazolium (NBT) method which catalyzed the dismutation of superoxide (O2(*-)) at pH 7.8 with an IC50 value of 1.50 x 10(-6) M for Cu4Zn3MT-III and 1.62 x 10(-6) M for Cd5Zn2MT-II. Additionally, the down-regulation of GIF may be a main factor in the decrease of the scavenging ability for the free OH* and O2(*-) radicals, which is possibly associated with the pathogenesis of neurodegenerative disease.

The A and J series of prostaglandins (PGs) accumulate in the nuclei to suppress the proliferation of cancer cells. Here we report that Delta7-PGA1 methyl ester, a synthetic anti-cancer PG, increased the level of mRNA for the cyclin-dependent kinase inhibitor p21 in human leukaemia HL-60 cells. The induction of p21 was associated with the accumulation of hypophosphorylated retinoblastoma protein (pRB) and the suppression of c-myc gene expression. Since the p53 gene is deleted in HL-60 cells, the anti-cancer PG is suggested to inhibit cancer cell growth by inducing p21 via a p53-independent pathway. Unlike HL-60 cells, cisplatin-resistant HL-60/R-CP cells were insensitive to Delta7-PGA1 methyl ester. While c-myc expression was transiently suppressed, neither G1 arrest nor hypophosphorylation of pRB was observed with the anti-cancer PG. Plasma membrane vesicles from HL-60/R-CP cells showed an enhanced level of GS-X pump (ATP-dependent glutathione S-conjugate export pump) activity towards the glutathione S-conjugate of Delta7-PGA1 methyl ester (Km 110 nM). GIF-0019 ¿N-carbomethoxy-S-[5-(4-benzoylphenyl)pentyl]glutathione dimethyl ester¿, a specific inhibitor of the GS-X pump, dose-dependently enhanced the cellular sensitivity of HL-60/R-CP cells to Delta7-PGA1 methyl ester and induced G1 arrest. The GS-X pump is suggested to play a pivotal role in modulating the biological action of the anti-cancer PG.

BACKGROUND

Oesophageal varices are common sequelae of cirrhosis, which when they bleed can be difficult to control. Oesophageal variceal band ligation, being the best modality for controlling variceal bleeding has not been common practice in West Africa, a region recognized to have a high prevalence of liver diseases. We present a case of band ligation of the varices of a patient that presented to our hospital with variceal haemorrhage, secondary to liver cirrhosis.

METHODS

We started by presenting a summary of the presentation of a 31 year old man at the Jos University Teaching Hospital and how we established the diagnosis of grade IV bleeding oesophageal varices. The subject had four bands applied to the oesophageal varices using a saeed six shooter oesophageal Multi-band ligator (North Carolina, USA) using a forward-viewing GIF P30 gastroscope (Tokyo, Japan) with the bands mounted on an Opti-vu barrel-shaped piece. He had a total of three sessions after which he was maintained on propranolol.

RESULTS

The last recheck endoscopy demonstrated obliterated varices after which he was maintained on propranolol.

CONCLUSIONS

We present a case of successful variceal band ligation of a cirrhotic with extensive oesophageal varices presenting in a resource-constraint medical setting.

BACKGROUND

The number of hip fractures, the most common complication of osteoporosis, has increased rapidly over the past decades. The goal of this study is to estimate the avoidable burden of certain modifiable risk factor of the condition using the Generalized Impact Fraction (GIF) model, which has been suggested and used by epidemiologists to overcome the drawbacks associated with the use of Attributable Fraction index. In addition to preventing a risk factor or the avoidable fraction of burden, this index can also calculate the change in the burden, when a risk factor is altered.

METHODS

International databases were searched through PubMed, CINAHLD, Embase using OVID and Google scholar. National resources were searched through IranDoc, IranMedex, SID and Journal sites. Other resources include abstract books and articles sent to the IOF congress. The following search strategy was used: ("Osteoporotic fracture" OR "Fragility Hip fracture" OR "Calcium" OR "vitamin D" OR "BMI" OR "lean body weight" OR "Physical activity" OR "exercise" OR "Smoke") AND ("prevalence" OR "incidence" OR "relative risk") and limited to "humans."

RESULTS

With regards to different scenarios already explained in modifying the studied risk factors, the greatest impact in reducing the prevalence of risk factors on osteoporotic hip fractures, was seen in low serum vitamin D levels, low physical activity and low intake of calcium and vitamin D, respectively. According to the fact that interventions for low serum vitamin D and low intake of calcium and vitamin D, are related to each other, it can be concluded that implementing interventions to change these two risk factors, in the easy, moderate and difficult scenarios, would result in approximately a 5%, 11% and 17% decrease in the burden of osteoporotic hip fractures, respectively. The addition of interventions addressing low physical activity in the easy, moderate and difficult scenarios, an 8%, 21% and 35% reduction in the burden of osteoporotic hip fractures would be reported, respectively.

CONCLUSIONS

Improving serum vitamin D levels, recommending the consumption of calcium and vitamin D supplementations and advocating physical activity are the most effective interventions to reduce the risk of osteoporotic hip fractures.

Structural characterization of enzymes that belong to microbial metabolic pathways is very important for structure-based drug design since some of these proteins may be present in the bacterial genome, but absent in humans. Thus, metabolic pathways became potential targets for drug design. The motivation of this work is the fact that Mycobacterium tuberculosis is the cause of the deaths of millions of people in the world, so that the structural characterization of protein targets to propose new drugs has become essential. DBMODELING is a relational database, created to highlight the importance of methods of molecular modeling applied to the Mycobacterium tuberculosis genome with the aim of proposing protein-ligand docking analysis. There are currently more than 300 models for proteins from Mycobacterium tuberculosis genome in the database. The database contains a detailed description of the reaction catalyzed by each enzyme and their atomic coordinates. Information about structures, a tool for animated gif image, a table with a specification of the metabolic pathway, modeled protein, inputs used in modeling, and analysis methods used in this project are available in the database for download. The search tool can be used for researchers to find specific pathways or enzymes.

The use of attenuated classical swine fever virus (CSFV) strains as live vaccines is no longer allowed for the control of classical swine fever in Europe, due to the inability to differentiate between infected and vaccinated animals (Differentiating Infected from Vaccinated Animals; DIVA), except as emergency vaccines or as bait vaccines for wild boars. Thus, the establishment of a DIVA vaccine(s) is of pivotal importance for the control of this infectious disease. In this study, recombinant versions of the live-attenuated vaccine strain CSFV Riems were generated by replacing parts of the E2 gene with the corresponding sequence of border disease virus strain Gifhorn. Three cDNA clones were constructed: pRiems-ABC-Gif, pRiems-A-Gif and pRiems-BC-Gif. Infectious particles were obtained from clones pRiems-ABC-Gif and pRiems-BC-Gif only, whereas transfected RNA from clone pRiems-A-Gif behaved like a replicon. Based on its ability to be differentiated in vitro from wild-type CSFV by mAbs, vRiems-ABC-Gif was assessed for immunogenicity and protection against challenge infection in pigs. Before challenge, no CSFV-specific anti-E2 antibodies could be detected with commercial E2-blocking ELISAs in vRiems-ABC-Gif-vaccinated animals, whereas vRiems-vaccinated pigs developed high titres of anti-E2 antibodies, confirming the marker properties of this vaccine candidate. After oral vaccination, only partial protection against challenge infection was observed in the vRiems-ABC-Gif vaccinees, whereas all intramuscularly vaccinated animals and all vRiems-vaccinated animals were fully protected. These experiments suggest that the strategy of exchanging specific antigenic epitopes among pestiviruses is a promising tool for the development of new CSFV marker vaccines.

OBJECTIVE A population-based genealogical resource with linked medical data was used to define the observed familial clustering of Chiari malformation Type I (CM-I). METHODS All patients with CM-I were identified from the 2 largest health care providers in Utah; those patients with linked genealogical data were used to test hypotheses regarding familial clustering. Relative risks (RRs) in first-, second-, and third-degree relatives were estimated using internal cohort-specific CM-I rates; the Genealogical Index of Familiality (GIF) test was used to test for an excess of relationships between all patients with CM-I compared with the expected distribution of relationships for matched control sets randomly selected from the resource. Pedigrees with significantly more patients with CM-I than expected (p < 0.05) based on internal rates were identified. RESULTS A total of 2871 patients with CM-I with at least 3 generations of genealogical data were identified. Significantly increased RRs were observed for first- and third-degree relatives (RR 4.54, p < 0.001, and RR 1.36, p < 0.001, respectively); the RR for second-degree relatives was elevated, but not significantly (RR 1.20, p = 0.13). Significant excess pairwise relatedness was observed among the patients with CM-I (p < 0.001), and borderline significant excess pairwise relatedness was observed when all relationships closer than first cousins were ignored (p = 0.051). Multiple extended high-risk CM-I pedigrees with closely and distantly related members were identified. CONCLUSIONS This population-based description of the familial clustering of 2871 patients with CM-I provided strong evidence for a genetic contribution to a predisposition to CM-I.

The biological function as well as gene expression of the MRP/GS-X pump is closely linked with cellular GSH metabolism. This article describes two important aspects, i.e., 1) a role of the MRP/GS-X pump in the modulation of cell cycle arrest induced by anticancer prostaglandins; 2) coordinated up-regulation of gamma-glutamylcysteine synthetase gamma-GCS) and MRP1 genes. The A and J series of prostaglandins (PGs) accumulate in the nuclei to suppress the proliferation of cancer cells. Delta(7)-Prostaglandin A(1) (Delta(7)-PGA(1)) methyl ester, a synthetic anticancer PG, increased the mRNA level of the cyclin-dependent kinase inhibitor p21(Sdi1/CIP1/WAF1) in human leukemia HL-60 cells. The induction of p21(Sdi1/CIP1/WAF1) was associated with the accumulation of hypophosphorylated retinoblastoma protein (pRB) and the suppression of c-myc gene expression. Unlike HL-60 cells, cisplatin-resistant HL-60/R-CP cells were insensitive to Delta(7)-PGA(1) methyl ester. While c-myc expression was transiently suppressed, neither G1 arrest nor hypophosphorylation of pRB was observed with the anticancer PG. Plasma membrane vesicles from HL-60/R-CP cells showed an enhanced level of GS-X pump activity toward the glutathione S-conjugate of Delta(7)-PGA(1) methyl ester. GIF-0019, a potent inhibitor of the GS-X pump, dose-dependently enhanced the cellular sensitivity of HL-60/R-CP cells to Delta(7)-PGA(1) methyl ester, resulting in G1 arrest. The GS-X pump is suggested to play a pivotal role in modulating the biological action of the anticancer PG. The expression of MRP1 and gamma-GCS genes can be coordinately up-regulated by cisplatin, 1-[5-(4-amino-2-methyl)pyrimidyl]methyl-3-(2-chloroethyl)-3-nitrosourea (ACNU), and heavy metals in human cancer cells. For the up-regulation of these genes, both transcriptional and posttranscriptional regulations are considered to be involved.

Gadolinium-based contrast agents (GBCAs), once believed to be safe for patients with renal disease, have been strongly associated with nephrogenic systemic fibrosis (NSF), a severe systemic fibrosing disorder that predominantly afflicts individuals with advanced renal dysfunction. We provide a historical perspective on the appearance and disappearance of NSF, including its initial recognition as a discrete clinical entity, its association with GBCA exposure, and the data supporting a causative relationship between GBCA exposure and NSF. On the basis of this body of evidence, we propose that the name gadolinium-induced fibrosis (GIF) more accurately reflects the totality of knowledge regarding this disease. Use of high-risk GBCAs, such as formulated gadodiamide, should be avoided in patients with renal disease. Restriction of GBCA use in this population has almost completely eradicated new cases of this debilitating condition. Emerging antifibrotic therapies may be useful for patients who suffer from GIF.

BACKGROUND

Gastrointestinal failure (GIF) has been postulated as the motor of multiple organ dysfunction syndrome (MODS) but is not commonly included among other organ failures in scoring systems identifying MODS.

METHODS

Relevant articles and published reviews were identified and analyzed through a PubMed search of English language literature on gastrointestinal problems.

CONCLUSIONS

Wide variability in terms and definitions was observed. Data on the incidence of GIF and its impact on mortality in critically ill patients are controversial. Very few objectively measurable variables of GI function are available. Most of the definitions of GIF are diagnosis-, but not function-based. Diagnosis-based approach to GIF differs significantly from the function-based assessment of other organ failures and has not justified itself over time.

CONCLUSIONS

There is no consensus on definition of GIF and different medical specialties have different approaches. Development of a proper definition of GIF is warranted.

As vision is required in almost all activities of daily living, visual impairment (VI) may be one of the major treatable factors for preventing activity limitations. We aimed to evaluate the attributable risk of VI associated with activity limitations and the extent to which limitations are avoidable with optimal optical correction of undercorrected refractive errors.

We analyzed 709 older adults from the Three-City-Alienor population-based study. VI was defined by presenting distance visual acuity in the better-seeing eye. Multivariate modified Poisson regressions were used to estimate the associations between vision, activity limitations, and social participation restrictions. Population attributable risk (PAR) and generalized impact fraction (GIF) were estimated. Bootstrapping was used to estimate 95% confidence intervals (CI).

After adjustment for potential confounders, VI was associated with each domain of activity limitations, except basic activities of daily living (ADL) limitations. These associations were found for even minimal levels of VI. PAR was estimated at 10.1% (95% CI: 5.2-10.6) for mobility limitations, at 26.0% (95% CI: 13.5-41.2) for instrumental ADL (IADL) limitations, and at 24.9% (95% CI: 10.5-47.1) for social participation restrictions. GIF for improvement of undercorrected refractive errors was 6.1% (95% CI: 3.8-8.5) for mobility limitations, 15.8% (95% CI: 11.5-20.1) for IADL limitations and 21.4% (95% CI: 13.8-28.5) for social participation restrictions.

About one-sixth of IADL limitations and one-fifth of social participation restrictions could be prevented by an optimal optical correction. These results underline the importance of eye examinations in older adults to prevent disability.

Against a background of a rapidly aging society, the number of patients with oral cancers in Japan is increasing yearly. The number of double-cancers with oral cancer as the first malignancy is also reportedly on the rise. Esophageal and gastric cancers are the most common second malignancies. At our institution, our policy is to proactively perform upper gastrointestinal (GI) fiberscopy (GIF) in patients with oral cancer. In anticipation of a probable further increase in the number of patients with double-cancers consisting of oral and GI tract malignancies, we retrospectively analyzed the occurrence of upper GI tract cancers in patients with oral squamous cell carcinoma (OSCC). The cohort consisted of 171 patients in whom OSCC had been diagnosed and who had undergone upper GIF between March 1996 and August 2008. Multivariate analysis was performed. Upper GIF identified 8 patients (7 men, 1 woman, totaling 4.7% of 171 patients) with double-cancer in the upper GI tract. One patient had a triple malignancy consisting of oral, esophageal and gastric cancers. Seven patients had esophageal cancer, while two had gastric cancer. An age of over 65 years was significantly higher in patients with double-cancers including esophageal cancer than in patients without esophageal cancer (OR=10.454, 95% CI=1.143-95.621). None of the other analyzed patient factors (sex, smoking habit, drinking habit, site of OSCC, TNM classification, staging results) showed a significant difference. These results indicate that, when treating elderly patients with oral cancers, physicians need to devise suitable treatment plans which take into account the possibility of upper GI tract cancer, particularly esophageal cancer, as a double-cancer.

BACKGROUND

Older adults in residential settings frequently suffer from functional decline, mental illness, and social isolation, which make them more vulnerable to spiritual distress. However, empirical evidence of the interrelationships between physiopsychosocial variables and spiritual well-being are still lacking, limiting the application of the biopsychosocial-spiritual model in institutional healthcare practice.

OBJECTIVE

To explain the mechanisms by which these variables are linked, this cross-sectional study tested a causal model of predictors of spiritual well-being among 377 institutionalized older adults with disability using a structural equation modeling approach.

METHODS

The primary variables in the hypothesized model were measured using the Barthel Index for functional ability, the Geriatric Depression Scale-short form for depression, the Personal Resources Questionnaire 85-Part 2 for perceived social support, and the Spiritual Well-Being Scale for spiritual well-being.

RESULTS

The model fit indices suggest that the hypothesized model had a reasonably adequate model fit (χ2 = 12.18, df = 6, p = .07, goodness-of-fitness index [GFI] = 0.99, adjusted GIF index [AGFI] = 0.93, nonnormed fit index [NFI] = 0.99, comparative fit index [CFI] = 0.99). In this study, perceived social support and depression directly affected spiritual well-being, and functional ability indirectly affected spiritual well-being via perceived social support or depression. In addition, functional ability influenced perceived social support directly, which in turn influenced depression and ultimately influenced spiritual well-being.

CONCLUSIONS

This study results confirm the effect of physiopsychosocial factors on institutionalized older adults' spiritual well-being. However, the presence and level of functional disability do not necessarily influence spiritual well-being in late life unless it is disruptive to social relationships and is thus bound to lead to low perceived social support and the onset of depression.

UNASSIGNED

The findings address the fact that the practice of spirituality is multidimensional and multileveled. Psychosocial interventions for institutionalized elders with disabilities should focus on increasing nurse-patient interaction and providing access to meaningful social activities to improve mental health and spiritual well-being.

With the use of the radioimmunoassay for growth hormone--releasing inhibiting factor (GIF), it was found that measurable amounts of GIF-like substance existed in the chorionic villi and decidua of pregnant women. The indirect immunofluorescent method revealed that the higher intensity of GIF-like immunofluorescence was presented in cytotrophoblasts rather than in syncytiotrophoblasts of the villi and in stromal cells of the decidua.