Epidemiology of inflammatory bowel diseases in the elderly in the province of Liège

OBJECTIVE: Inflammatory bowel diseases (IBD) are heterogeneous diseases which affect preferentially young adults. The late onset could represent a particular form of expression of these diseases. The aim of our prospective study was to describe the incidence of IBD in patients older than 60 years as well as their clinical pattern in comparison with a population younger than 60.METHODS: A standardized questionnaire for each new case diagnosed in the province of Liège between 01/06/1993 and 31/05/1996 was completed.RESULTS: During the three years, 270 patients were enrolled. In group IBD > 60 years old, there were 60 new cases, including 23 cases with Crohn's disease (CD) (38%), 30 with ulcerative colitis (UC) (50%), and 7 with undetermined colitis (IC) (12%). The proportion of CD was significantly lower in the group IBD > 60 years old than in the group<60 (114 CD (54%), 81 UC (39%) and 15 IC (7%); P=0.04).The annual incidence tended to be higher for UC than for CD in group IBD > 60 (4.5 and 3.5 per 100,000, respectively) while it was the contrary in younger patients (3.4 and 4.8 per 100,000, respectively). There was no striking difference in the clinical features for both diseases in the two groups, except more frequent diarrhea, weight loss and extraintestinal symptoms in CD patients<60 years old.CONCLUSIONS: In the province of Liège, the incidence of IBD in people older than 60 years is high. IBD in the elderly is characterized by a lower proportion of CD than in the younger population. Clinical features tend to be the same whatever the age at diagnosis for each disease.     

The role of hypergastrinemia in the pathogenesis of intussusception in infants

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Endovascular interventions of the femoro-popliteal disease in the elderly

In the last few years the treatment of superficial femoral artery (SFA) occlusive disease has undergone greater changes in management including more aggressive endoluminal therapy, especially in the elderly patients who are at high risk for extra-vascular comorbidities from the surgical approach. While acute and chronic arterial limb ischemia is the conditions which the interventional cardiologists frequently encounter, the elderly population represents special problematic clinical and anatomical setting due to heavy calcification and poor distal run-off. Arterial thrombolysis, rheolytic thrombectomy, mechanical thrombectomy, laser angioplasty, cryoplasty, and new flexible long stents are some of the promising techniques to improve the technical and clinical outcomes in these elderly patients.     

β-Thalassemia Haplotypes in Romania in the Context of Genetic Mixing in the Mediterranean Area

The purpose of this meta-study was to investigate β-thalassemia (β-thal) mutations and their chromosomal background in order to highlight the origin and spread of thalassemia alleles in the European and Mediterranean areas. Screening of more than 100 new Romanian β-thal alleles was also conducted. The results suggest an ancient introduction of mutations at codon 39 (C?>?T) (HBB: c.118C?>?T) and IVS-I-6 (T?>?C) (HBB: c.92?+?6T?>?C) in Romania. A comparative study was performed based on restriction fragment length polymorphism (RFLP) haplotypes associated with β-thal mutations in Romania and in Mediterranean countries. Each common β-thal allele from different populations exhibits a high degree of haplotype similarity, a sign of a clear unicentric origin for the IVS-I-110 (G?>?A) (HBB: c.93-21G?>?A), IVS-I-6, IVS-II-745 (C?>?G) (HBB: c.316-106C?>?G) and codon 39 mutations (the 17a [+?????????+?+], 13c [???+?+???????+], 17c [?+???????????+] and 14a [??+?+???+?+?+?] ancestral RFLP background, respectively), followed by recurrent recombination events. This study also showed that geographic distances played a major role in shaping the spread of the predominant β-thal alleles, whereas no genetic boundaries were detected between broad groups of populations living in the Middle East, Europe and North Africa. The analyses revealed some discrepancies concerning Morocco and Serbia, which suggest some peculiar genetic flows. Marked variations in β^A were observed between Southeast Asia and the Mediterranean, whereas a relative genetic homogeneity was found around the Mediterranean Basin. This homogeneity is undoubtedly the result of the high level of specific historic human migrations that occurred in this area.     

Is there evidence in support of the use of intra-articular hyaluronate in treating rheumatoid arthritis of the knee? A meta-analysis of the published literature

Abstract

Intra-articular hyaluronate (HA) injections for treating rheumatoid knee are still debatable, and this meta-analysis aims to elucidate the effectiveness of HA injection for rheumatoid knee. The meta-analysis comprised randomized clinical trials (RCTs) that compared the efficacy of HA injections with that of a placebo. The articles were retrieved after systematic searches of databases, including MEDLINE, EMBASE, and Japana Centra Revuo Medicina. The outcomes were classified into four categories: evaluation of reduction in the intensity of pain, evaluation of reduction in the intensity of inflammation, overall evaluation of therapeutic efficacy, and evaluation of adverse effects. Effect sizes were calculated from the risk ratio (RR) of each of the above-mentioned outcome categories. Five RCTs (720 participants) were pooled for the meta-analysis. The pooled effect sizes were 1.64 (p = 0.01) for pain reduction, 1.61 (p = 0.001) for reduction in inflammation, and 1.50 (p = 0.004) for the overall evaluation of treatment effectiveness. No serious side-effects were reported, while minor adverse effects were reported in patients after HA treatment (RR 0.98, p = 0.32). The results indicated that intra-articular HA is an effective and safe alternative therapy for the rheumatoid knee.     

Is there evidence in support of the use of intra-articular hyaluronate in treating rheumatoid arthritis of the knee? A meta-analysis of the published literature

Intra-articular hyaluronate (HA) injections for treating rheumatoid knee are still debatable, and this meta-analysis aims to elucidate the effectiveness of HA injection for rheumatoid knee. The meta-analysis comprised randomized clinical trials (RCTs) that compared the efficacy of HA injections with that of a placebo. The articles were retrieved after systematic searches of databases, including MEDLINE, EMBASE, and Japana Centra Revuo Medicina. The outcomes were classified into four categories: evaluation of reduction in the intensity of pain, evaluation of reduction in the intensity of inflammation, overall evaluation of therapeutic efficacy, and evaluation of adverse effects. Effect sizes were calculated from the risk ratio (RR) of each of the above-mentioned outcome categories. Five RCTs (720 participants) were pooled for the meta-analysis. The pooled effect sizes were 1.64 (p = 0.01) for pain reduction, 1.61 (p = 0.001) for reduction in inflammation, and 1.50 (p = 0.004) for the overall evaluation of treatment effectiveness. No serious side-effects were reported, while minor adverse effects were reported in patients after HA treatment (RR 0.98, p = 0.32). The results indicated that intra-articular HA is an effective and safe alternative therapy for the rheumatoid knee.     

What is the role of radiotherapy in the treatment of mucosal melanoma of the head and neck?

Mucosal melanoma of the head and neck is a rare, poor prognosis tumour with a high tendency to recur locally and regionally after surgical resection. A number of centres have used radiotherapy to sterilize positive and close margins after non-radical surgery or to treat inoperable cases. The present article discusses the literature data to analyze the possible indications for radiotherapy in terms of patient selection and treatment strategy. In the majority of the available retrospective series, postoperative radiotherapy improves the local control of mucosal melanomas, but its effect on survival has not yet been sufficiently investigated. Radiobiological studies show a high heterogeneity in behaviour of irradiated melanoma cells and the clinical implications of this will be illustrated. In the future, a better understanding of the radiosensitivity of this rare tumour and the availability of new technical modalities might allow for a more profitable incorporation of radiotherapy into a multidisciplinary strategy.     

Proteomic analysis of hippocampus in the rat

Objective To analyze the protein expression in the rat hippocampus by the proteomic approach. Methods Proteins from hippocampal tissue homogenates of the rat were separated by two-dimensional gel electrophoresis (2-DE), and stained with colloidal Coomassie blue to produce a high-resolution map of the rat hippocampus proteome. Selected proteins from this map were digested with trypsin, and the resulting tryptic peptides were analyzed by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF-MS) The mass spectrometric data were used to identify the proteins through searches of the NCBI protein sequence database. Results 37 prominent proteins with various functional characteristics were identified. The identified brain protein classes covered metabolism enzymes, cytoskeleton proteins, heat shock proteins, antioxidant proteins,signalling proteins, proteasome-related proteins, neuron-specific proteins and glial-associated proteins. Furthermore,3 hypothetical proteins, unknown proteins so far only proposed from their nucleic acid structure, were identified.Conclusion This study provides the first unbiased characterization of proteins of the rat hippocampus and will be used for future studies of differential protein expression in rat models of neurological disorders.     

Multi-Modality Imaging in the Assessment of Cardiovascular Toxicity in the Cancer Patient

Cancer therapy can be associated with both cardiac and vascular toxicity. Advanced multi-modality imaging can be used to stratify patient risk, identify cardiovascular injury during and after therapy, and forecast recovery. Echocardiography continues to be the mainstay in the evaluation of cardiac toxicity. Particularly, echocardiography-based strain imaging is useful for risk stratification of patients at baseline, and detection of subclinical left ventricle (LV) dysfunction during therapy. Cardiac magnetic resonance (CMR) serves a complementary role in the patient with poor echocardiographic or equilibrium radionuclide angiographic image quality or in situations where a more accurate and precise LV ejection fraction measurement is needed to inform decisions regarding discontinuation of chemotherapy. New CMR techniques like T1 and T2 mapping and positron emission tomography (PET) imaging will help us better understand the structural, pathological, and metabolic myocardial changes associated with ventricular dysfunction or release of serum biomarkers. CMR may also be helpful in the evaluation of vascular complications of cancer therapy. Stress echocardiography, stress CMR, computed tomography, and PET are excellent imaging options in the evaluation of ischemia in patients receiving therapies that could potentially cause vasospasm or accelerated atherosclerosis.     

Role of the kallikrein–kinin system in the maturation of cardiovascular phenotype

Recent studies indicate that during early phases of life the kallikrein–kinin system (KKS) plays a role in kidney development. In the rat kidney, the spatial and temporal pattern of expression of the genes encoding for kallikrein or bradykinin (BK) B₂-receptors parallels postnatal nephrogenesis and blood flow redistribution from the inner to the outer renal cortex. Animal models with genetic dysfunction of the renal KKS show alterations in the functional maturation of the kidney, and ultimately develop salt-sensitive hypertension. Kininogen-deficient Brown Norway Katholiek rats have undetectable urinary kinin levels and show an exaggerated blood pressure sensitivity to chronic excess of salt or mineralocorticoids. Another rat model with genetic reduction in urinary kallikrein excretion is characterized by an altered pressure–natriuresis relationship, with this defect being corrected by infusion of purified rat tissue kallikrein. Knockout mice lacking the BK B₂-receptor gene show elevated blood pressure and heart rate under basal conditions and enhanced blood pressure sensitivity to salt. In rats, prenatal blockade of the BK B₂-receptor by icatibant leads to a cardiovascular phenotype similar to that of animals with genetic defects of the KKS. Delayed renal maturation is observed when high salt intake is associated with icatibant. Collectively, these findings indicate a relevant role of the KKS in the physiologic maturation of renal and cardiovascular phenotypes. Genetic or environmental factors, able to potentiate the activity of the renal KKS, could protect against the development of arterial hypertension.     

Analysis of the identification of Mycobacterium species in strians during the period 1987～1996 in Shanghai

目的对上海市1987年~1996年鉴定的5619株分支杆菌菌种鉴定结果进行分析,对其中非结核分支杆菌耐药性测定结果进行探讨?方法全部菌株的鉴定按1984年全国结核病细菌学检验规程进行?结果人型5465株(97.3%)?牛型22株(0.4%)?非结核分支杆菌132株(2.3%),其中偶发42株?胞内30株?龟型17株?瘰疬10株?堪萨斯9株?戈登9株?浅黄6株?草分支4株?不产色2株?金色2株?溃疡1株?非结核分支杆菌(MOTT)对PAS?INH?SM?RFP?EMB与KM的耐药率分别为72.4%?61.2%?49.0%?43.9%?31.6%和27.6%?对1~6种药物的耐药率分别为13.3%?21.4%?24.5%?16.3%?10.2%和6.1%?结论上海市肺结核患者感染菌种主要为人型结核分支杆菌(97.3%),而牛型(0.4%)和非结核分支杆菌(MOTT,2.3%)所占比重很小,明显低于全国水平?MOTT耐药率高应引起重视。