Volume and echostructure of the thyroid and ioduria in an urban population of adults in the southeastern Polish city of Rzeszów

The aim of this work was to determine the volume and echostructure of the thyroid and to examine urinary iodine excretion in an adult population of residents of Rzeszów, a city located in the Carpathian endemic region for goiter, after the introduction of mandatory iodine prophylaxis in 1997. 984 subjects, aged 19-60, were examined (540 females and 394 males). The mean level of urinary iodine in the examined population was 104.17 microg/l (+/- 85.22). Higher urinary iodine levels were seen in the group of males (p = 0.005) and in those who were taking medication containing iodine (p = 0.002). The mean volume of the thyroid in the examined group was 18.69 (+/- 10.01) ml and was larger in the group of males than females (p < 0.005). Nodular lesions were found in 17% of the examined thyroids and a statistically significant prevalence in the group of females (20.8%) over the group of males (11.4%) was found (p < 0.0005). The occurrence of nodules increased with age and was significantly higher in the 40-60 year age group than in the 19-25 years age group (p = 0.001). In single--and multi--factor analysis, a correlation was found between the occurrence of nodules and the female gender (r-2.04, 3.48; p < 0.005, < 0.0005) and the occurrence of nodules and the volume of the thyroid (r-1.1, 1.11; p < 0.005, < 0.0005). The occurrence of nodules did not correlate with ioduria (r-1, p = 0.8). Iodine prophylaxis was shown to be highly effective, although the examined region does not yet meet the criteria for the elimination of iodine deficiency as formulated by the ICCIDD.     

What is the role and significance of serum and stool biomarkers in the diagnosis of IBD?

Biomarkers hold promise for identifying high-risk individuals who may go on to develop IBD as well as prognosticate disease behavior. Stool markers have not been readily accepted but may be more sensitive and specific than our serum biomarkers for evaluating disease activity. Ultimately, genomic and proteomic approaches will be used to identify novel biomarkers in IBD.     

Chinese diet in the causation and prevention of cancer

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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.     

Implications of TNF-α in the pathogenesis and management of GVHD

Clinical graft-versus-host disease (GVHD) symptoms are the result of a complex set of interactions between cellular and soluble factors. One of the key soluble factors is the proinflammatory cytokine, TNF-α, which participates in the initiating events that culminate in GVHD as well as amplifies the disease process once established. The importance of TNF-α in this process has been supported by a series of clinical experiments demonstrating strong correlation between TNF receptor-1 levels and GVHD. TNF-α has both indirect effects, through activating and proliferation pathways of T cells, the main cellular effector of GVHD, and direct effects leading to apoptosis, on GVHD target tissues. Accordingly, TNF-α has been used as a therapeutic target in experimental GVHD prevention and treatment strategies with promising clinical results. TNF-α can be pharmacologically inhibited using soluble TNF receptors or monoclonal antibodies. The optimal dosing and duration of TNF inhibition to prevent or treat GVHD remains under investigation.     

Can the changes in dietary fat intake reduce the risk of onset and development of atherosclerosis and of ischemic cardiopathy in particular?

In this review we have collected data from epidemiologic studies and clinical trials published from 1968 to 1989 on the relationship between dietary fat and risk of coronary heart disease. Although the reported observational studies of diet and coronary heart disease provide general support for the classic diet-heart hypothesis, evidence of specific dietary lipids is weak. A positive association with saturated fat intake was seen in two prospective studies. A positive association with cholesterol intake was found in only two cohort studies, and an inverse relationship with polyunsaturated fat intake in only one. Clear evidence from dietary trials in the prevention of coronary heart disease has not been found. The analysis of trends in coronary heart disease and stroke mortality of developed countries has shown a discrepancy between fat intakes, cholesterol levels and mortality. The reduction in intake of certain foods "at high risk" such as meat, eggs, milk and cheese, as a preventive intervention, is based on weak scientific evidence. A strategy program has to emphasize the maintenance of ideal body weight by caloric control, an adequate level of physical activity, and the control of other risk factors such as hypertension, hypercholesterolemia, and diabetes.     

Analysis of the levels of endotoxin and β-d-glucan in the synovial fluid of hemodialysis patients

Abstract

We analyzed the levels of endotoxin and β-d-glucan, which possibly induce cytokine production, in the synovial fluid of patients on long-term hemodialysis and compared the results to those in patients with osteoarthritis and rheumatoid arthritis. We studied 42 knees in 42 hemodialysis patients, 21 in 21 osteoarthritis patients, and 26 in 26 rheumatoid arthritis patients. The mean ages were 60.7, 63.2, and 59.7 years, respectively. The duration of hemodialysis in the long-term hemodialysis group averaged 14.0 years. The concentrations of endotoxin and β-d-glucan in the synovial fluid of these three groups were measured. The concentration of endotoxin was the same in the three groups. However, the concentration of β-d-glucan was significantly higher in long-term hemodialysis patients. This finding suggests that β-d-glucan may have some relation to the pathogenesis of the synovitis which exists in the hydrarthrosis of long-term hemodialysis patients.     

Investigation of the differences between the Tibetan and Han populations in the hemoglobin–oxygen affinity of red blood cells and in the adaptation to high-altitude environments

Objective: High altitude is characterized by low oxygen pressure, resulting in multiple adaptive responses. Tibetans who have lived in the plateau for thousands of years have developed unique phenotypes, such as downregulation of the HIF pathway through EPAS1 and EGLN1 gene mutation. However, the changes of hemoglobin–oxygen affinity under hypoxia environment remain elusive.

Methods: A blood cell analyzer and a blood oxygen analyzer were used to conduct routine blood tests and measure the oxygen affinity P₅₀ in in the Han population that rapidly entered the plateau (for 3–7 days), the plateau-acclimatized Han population (residing for 30 days on the plateau), the plateau Han population (more than 10 years on the plateau), and the Tibetan population.

Results: The Han population that rapidly entered the plateau had increasing higher P₅₀ values, RBCs counts and hemoglobin (HGB) levels, while the acclimatized Han population, the plateau Han population and Tibetan all had significantly lower P₅₀ values. However, there were no significant differences in the RBCs counts and HGB levels between the plateau Han, Tibetan populations and the Han population of the plains.

Discussion: The adaptability of the Tibetan and plateau Han populations to the plateau was mainly due to the strong affinity of HGB for oxygen, which provided sufficient oxygen for tissues and organs.

Conclusions: The change of P₅₀ could be a feature of the adaptation to the plateau and to avoid altitude sickness, such as high-altitude polycythemia and dyspnea.     

On the Paragommus and the epidemiology of paragonimiasis in Fujian Province.

Up till now, 4 species of Paragonimus, namely P. westermani Kerbert, 1878, P,     

The Value of PAPP-A and MMP-9 in the Diagnosis and Outcome of ACS Patients

Objectives To investigate the value of pregnancy-associated plasma protein-A （ PAPP-A ） and matrix metallo proteinase-9 （MMP-9） in the diagnosis and outcomes evaluation of acute coronary syndrome （ACS） patient. Methods 100 ACS patients were divided into UAP group （ 64 cases ） and AMI group （ 36 cases）, and 50 healthy cases served as control group. The levels of PAPP-A, MMP-9, Hs-CRP, CK-MB and cTnI were obtained. The ACS patients with normal CK-MB and cTnI concentration were followed up. During 6 months, the total rates of major cardiovascular events （MACE） were recorded. Results Compared to control group, the PAPP-A, MMP-9, Hs-CRP, CK-MB, cTnI levels of ACS patients were significantly increased （ P 〈 0.01 ）, but the levels of PAPP-A, MMP-9 did not correlate well with CK-MB and cTnI. The ACS patients with normal CK-MB and cTnI concentration were followed up 6 months, the levels of PAPP-A, MMP-9 were significantly associated with the MACE （ P 〈 0.01 ）. Conclusions The levels of PAPP-A, MMP-9 of ACS patients were not associated with myocardial ischemic necrosis, but could serve as predictor of unstable atherosclerotic plaque, and as valuable index for prognosis monitoring in ACS patients.     

Current status of basic and clinical research studies in the field of gastroenterology in China

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New Developments in the Diagnosis and Treatment of Pancreatic Cancer

The prognosis of pancreatic cancer is poor. Less than 5% of patients diagnosed with pancreatic cancer survive more than 5 years. Generally, the advanced stage, the late diagnosis and the poor therapeutic options are assumed to be responsible for this poor prognosis. Nonetheless, in recent years our knowledge of the pathogenesis of pancreatic cancer has dramatically improved and will give rise to new therapeutic options based on molecular alterations, which contribute to pancreatic carcinogenesis. Furthermore, new diagnostic procedures offer a new perspective towards a better and earlier diagnostic management of these individuals affected with this malignancy.     

Morphological comparison of the pulmonary egg granuloma in unsensitized and sensitized mice and the effect of pyquiton on the pulmonary egg granuloma in sensitized mice.

150 female mice were divided into three groups. 1. Unsensitized group: 2,500-3, 000 fresh eggs of S. japonicum were injected into tail vein/mouse. 2. Sensitized group:10 days before the i.v. injection of schistosome eggs, the same number of eggs/mouse     

Inhibitory effect of dimeric β peptide on the recurrence and metastasis of hepatocellular carcinoma in vitro and in mice

AIM：To block the adhesion of tumor cells to the extracellular matrix, and prevent tumor metastasis and recurrence, the dimer of the β peptide （DLYYLMDLSYSMKG- GDLYYLMDLSYSMK, β2） was designed and synthesized and its anti-adhesion and anti-invasion effects on hepa- tocellular carcinoma cells were assessed. Additionally, its influence on the metastasis and recurrence of mouse hepatocellular carcinoma was measured.
METHODS：The anti-adhesion effect of β2 on the highly metastatic hepatocellular carcinoma cell line HCCLM6 cells and fibronectin （FN） was assayed by the MTT as- say. The inhibition of invasion of HCCLM6 cells by β2 was observed using a Transwell （modified Boyden chamber） and matrigel. Using the hepatocellular carcinoma metas- tasis model and LCI-D20 nude mice, the influence of β2 on the metastasis and recurrence of hepatocellular carci- noma after early resection was investigated.
RESULTS：HCCLM6 cells co-incubated with 100 mmol/L, 50 mmol/L, 20 mmol/L or 10 mmol/L β2 for 3 h showed an obvious decrease in adhesion to FN. The adhesion inhibition ratios were 11.8%, 21.7%, 29.6% and 48.7%, respectively. Additionally, HCCLM6 cells cultured with 100 mmol/L β2 had a dramatic decrease in cell invasion. β2 was also observed to inhibit the incisal edge recur- rence and the distant metastasis of nude mice hepato- cellular carcinoma after early resection （P 〈 0.05）.
CONCLUSION：The β2 peptide can specifically block the adhesion and invasion of HCCLM6 cells, and can inhibit HCC recurrence and metastasis of LCI-D20 model pos-thepatectomy in vivo. Thus, β2 should be further studied as a new anti-tumor drug.     

Do physician attitudes and practices limit use of EUS in the staging and the treatment of esophageal carcinoma?

BACKGROUND: Although EUS provides superior local staging of esophageal carcinoma when compared with other tests, EUS seems to be underused by physicians. We designed this prospective study to determine whether EUS is ordered in the evaluation of esophageal cancer and whether staging information obtained would change management. METHODS: A total of 114 physicians were mailed a questionnaire that surveyed which tests are used in evaluating patients with esophageal cancer, the order in which they are requested, and their estimated cost. Physicians were asked to estimate prognosis and to indicate which therapy would be used for each specific TNM cancer stage. RESULTS: Of 114 physicians, 71 (62.3%) physicians from 4 disciplines responded. Only 47.3% of physicians would use EUS in the patient workup for esophageal cancer. Physicians would only order EUS after first obtaining an endoscopy, then a barium swallow, and then a CT scan ( p < 0.0001). A significantly greater number of internists (78.9%, p = 0.055) would not order EUS, and 31.6% of internists would not use any staging data before referral to another physician for definitive management. Physicians were accurate in their assessment of the prognosis for each cancer stage and the cost of each test. There was no difference in the use of surgery between disciplines for stages O, I, IIA, and IV. However, significantly more surgeons than nonsurgeons would use surgery for stage IIB (100.0% vs. 71.3%, p = 0.019), with a trend toward greater use by surgeons for stage III (64.3% vs. 34.1%, p = 0.11). Except for significantly greater use of chemotherapy by surgeons and oncologists for stage IIA than internists and gastroenterologists (36.6% vs. 3.1%, p = 0.0006), there were no differences between subspecialties with use of chemotherapy for all other stages or use of radiation therapy for any stage. CONCLUSIONS: Clinicians have an adequate understanding of patient survival based on cancer stage and a reasonable appreciation of cost for diagnostic tests regarding esophageal carcinoma. Specific data on cancer staging does impact treatment choices and management decisions. EUS is grossly underused by clinicians for staging esophageal cancer. Although internists may serve as gatekeepers, they fail to order EUS, order EUS only after less accurate tests, or fail to use staging data in management (especially referral) decisions. The ultimate modality of treatment may be more related to the type of physician that the patient is referred to, instead of the specific cancer stage. Education of primary care clinicians may be needed before the full impact of EUS on patient care can be appreciated.