The role of hypergastrinemia in the pathogenesis of intussusception in infants

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Value of selective chemoembolization in treatment of hepatic metastases in colorectal carcinoma

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Pharmacoeconomic analysis of Metoject(®) in the treatment of rheumatoid arthritis in Spain

ObjectivesThe aim of this study was to compare the clinical and economic consequences of using subcutaneous methotrexate (Metoject^®) with respect to oral methotrexate in the management of rheumatoid arthritis (RA) in Spain.MethodsA cost-effectiveness analysis was performed to compare early treatment of RA using a Markov model. The model allowed us to estimate long term efficacy of RA treatment based on data from the literature and expert opinion, and to combine this data with costs of managing RA in Spain. The perspective of the study was from the National Health System point of view, using a time horizon of 5 years and patient lifetime. All costs were expressed in 2009 euros and a 3% discount rate was applied.ResultsThe cost (only pharmacologic costs) per quality-adjusted life year (QALY) gained with Metoject^® went from 25,173 to 35,807 € at 5 years and from 19,056 to 25,351 € for patient lifetime. When direct costs in RA treatment were considered, it was observed that cost-effectiveness at 5 years went from 29,682 to 42,175 €/QALY gained, and for patient lifetime from 22,514 to 29,848 €/ QALY gained.ConclusionsAdditional costs of Metoject^® with respect to oral methotrexate would be offset by their improved effectiveness, expressed in QALY, showing that Metoject^® could be a cost-effective treatment option for RA in the Spanish Health System assuming a spanish threshold.     

Advances in clinical research of hepatocellular carcinoma in China

Ｂａｓｅｄｏｎｔｈｅｓｕｒｖｅｙｉｎ１９９０／１９９２，ｈｅｐａｔｏｃｅｌｕｌａｒｃａｒｃｉｎｏｍａ（ＨＣＣ）ｈａｓｂｅｃｏｍｅｔｈｅｓｅｃｏｎｄｃａｎｃｅｒｋｉｌｅｒｉｎＣｈｉｎａ，ｔｈｅｍｏｒｔａｌｉｔｙｒａｔｅｗａｓ２０３７／１０００００［１...     

Prevalence of Raynaud’s Phenomenon in General Practice in the East of Spain

Our aim was to establish the prevalence of Raynaud’s phenomenon in a general practice in the east of Spain and compare our results with those of other studies performed in geographical areas with similar climatic characteristics. Two hundred and seventy-six subjects visiting their general practitioner for whatever reason were randomly selected from a particular area of the city of Valencia. Each was interviewed by their GP following the guidelines of a structured questionnaire to establish whether they had Raynaud’s phenomenon or not. There were 205 women and 71 men. The mean age was 54.43, with a standard deviation of 18.22. Raynaud’s phenomenon was present in nine subjects, two men and seven women, with a prevalence of 2.8% and 3.4%, respectively. Of the nine positives (mean age 60.56 years, standard deviation 16.38), two were diagnosed with hypertension and two with migraine. None of them usually took Raynaud’s phenomenon-related drugs or performed physical exercise. No patient had a family history of Raynaud’s phenomenon or had already been diagnosed with it. All the positive males were affected only by the pallor stage. This study shows lower prevalences than those of other studies performed in different geographical areas with similar climatic conditions. Received: 22 November 1999 / Accepted: 6 September 2000     

Assessment of resin perfusion in hepatic failure in vitro and in vivo

AIM:To observe the adsorbent effect of resin on endotoxin,cytokine,bilirubin in plasma of patients with hepatic failureand to determine the resin perfusion as an artificial liversupport system in the treatment of hepatic failure.METHODS:One thousand milliliters of discarded plasmawas collected from each of 6 severe hepatitis patients treatedwith plasma exchange.The plasma was passed through aresin perfusion equipment for 1-2 h via extracorporealcirculation,and then absorbent indicators of transaminase,bilirubin,blood ammonia,endotoxin and cytokines wereexamined.In the meantime,study of in vivo resin plasmaperfusion was performed on 7 severe hepatitis patients tocompare the changes of endotoxin and cytokines in bloodbefore and after perfusion.RESULTS:The levels of total bilirubin,endotoxin,interleukin1β and TNF-α in plasma were significantly decreased afterin vitro resin plasma perfusion.The levels of interleukin 1β,TNF-α and endotoxin in blood were also evidently declinedafter in vivo resin plasma perfusion.Nevertheless,no obviouschanges in IL-6,creatinine (Cr) and urea nitrogen (UN),bloodammonia and electrolytes were found both in vitroand in vivo.CONCLUSION:Bilirubin,endotoxin and cytokines in plasmaof patients with hepatic failure can be effectively adsorbedby resin in vitro.Most cytokines and endotoxin in plasma canalso be effectively removed by resin in vivo.It demonstratesthat resin perfusion may have good treatment efficacy onhepatic failure and can be expected to slow down theprogression of hepatic failure.     

Role of intestinal barrier in pathogenesis of pigment gallstone in a guinea pig model

BACKGROUND: The function of the intestinal barrier has drawn more and more attention from researchers in recent years for its important role in many diseases such as burns, wounds, and pancreatitis. In our experimental studies on pigment gallstone, we found potential relationships between the function of the intestinal barrier and pigment gallstone formation. This study was undertaken to investigate the possible action and mechanism of the function of the intestinal barrier in the pathogenesis of pigment gallstone. METHODS: Eighty guinea pigs were divided into a normal group (CON), a pigment gallstone group (PS) and an intestinal mucosa protection group (GLN). Normal forage, pigment gallstone-forming forage and pigment gallstoneforming forage with supplemental intestinal mucosa protector (glutamine) were given to each group. In the gallstone-forming rate, morphology of intestinal mucosa, intestinal permeability, serum endotoxin and biliaryβ-glucuronidase were assessed after 8 weeks. RESULTS: The rate of gallstone-formation was 73.9% in the PS group. Damage of intestinal mucosa, endotoxemia (from 77±43×106 EU/L to 1367±525×l06 EU/L, P<0.01) and increased activity of biliaryβ-glucuronidase (endogenousβ-glucuromdase from 122.1±39.5 to 209.8±47.5 Fishman Unit, P<0.01, and exogenous p-glucuronidase from 573.5±476.9 to 2206.6±983.9 Fishman Unit, P<0.01) were observed in the PS group compared with the CON group. The rate gallstone-formation decreased significantly to 44.4% and the other indices except P-glucuronidase were lower in the GLN group than in the PS group. CONCLUSIONS: The function of the intestinal barrier is correlated with pigment gallstone formation. Dysfunction of the intestinal barrier function may promote pigment gallstone formation through bacterial translocation, endotoxemia, and biliaryβ-glucuronidase.     

Fumagillin treatment of hepatocellular carcinoma in rats： An in vivo study of antiangiogenesis

AIM: To investigate the effect and possible mechanisms of antiangiogenesis therapy for HCC in rats. METHODS: Adult male LEW/SsN rats were divided into 3 groups, 25 animals each. Group A was the control group. Groups B and C were given diethylnitrosamine, 5 mg/kg/d. In addition, group C rats received an intraperitoneal injection of fumagillin, 30 mg/(kg·d). Five animals in each group were killed at 6th, 12th, 18th, 20th and 24th wk to evaluate the development of HCC and metastasis. Weight of the rats, liver tumors, and number of organs involved by HCC were measured at each stage. We compared methionine aminopeptidase-2 (MetAP-2) mRNA, Bcl-2 mRNA, telomerase mRNA, and telomerase activity at 24th wk in the liver tissue of group A rats and tumor tissue of HCC from group B and C rats. RESULTS: No HCC developed in group A, but tumors were present in group B and C rats by the 18th wk. At wk 20 and 24, the median liver weight in group B was 0.64 g (range: 0.58-0.70 g) and 0.79 g (range: 0.70-0.90 g) (P= 0.04), and that in group C was 0.37 g (range: 0.35-0.42 g) and 0.39 g (range: 0.35-0.47 g) (P= 0.67). The liver weight in group C rats was significantly lower than that in group B rats (P= 0.009). At the same time, the median metastasis score (number of organ systems involved) was 3 (range2-3) in group B, and 1 (range 1-2) in group C, a significant difference between the groups (P= 0.007, 0.004). The levels of MetAP-2 mRNA were significantly higher in groups B and C than in group A (P = 0.025), and significantly higher in group C than in group B (P= 0.047). The level of Bcl-2 mRNA was significantly higher in group B than in group A (P=0.024), but lower in group C than in group B, although not significantly (P = 0.072). Telomerase mRNA was significantly higher in group B than in group A (P = 0.025), but significantly lower in group C than in group B (P= 0.016). The same inter-group relationship was also true for telomerase activity (P= 0.025 and 0.046). CONCLUSION: Fumagillin effectively inhibits both liver tumor growth and metastasis in rats in vivo. A possible mechanism is fumagillin-induced inhibition of MetAP-2, which plays an essential role in endothelial cell proliferation. Inhibition of MetAP-2 also results in inhibition of Bcl-2 and telomerase activity.     

Role of Ribomunyl® in the Prevention of Recurrent Respiratory Tract Infections in Adults

Recurrent respiratory tract infections (RRTIs) in adults are the result of an imbalance between lung defense mechanisms, and bacterial burden. Antibacterial treatments can temporarily restore the equilibrium between host and bacterial load, but do not prevent recurrence of infection. An alternative approach to prevent recurrence of infection is treatment with an immunostimulant, which provides immune protection against repeated bacterial and viral infection. All immunostimulant products are bacterial in origin: lysates (first generation immunostimulants), or bacterial extracts, like bacterial ribosomes, or membrane proteoglycans. This review highlights the current state of knowledge regarding the use of immunostimulants in adults with RRTIs, taking the ribosomal immunostimulant Ribomunyl((R)) as an example. Many studies are available on the mechanism of action and clinical efficacy in prevention of RRTIs in adults treated with Ribomunyl((R)). The effect of this immunostimulant on anti-infectious responses is explained by a stimulation of both nonspecific (innate) and specific (adaptive) immunity. In order to obtain a global overview of the therapeutic efficacy of Ribomunyl((R)) the most pertinent trials were selected from the literature based on adequate patient numbers and good methodology. Results of double-blind placebo-controlled trials using Ribomunyl((R)) for the treatment of different upper or lower RRTIs have demonstrated a statistically significant reduction in the number of infectious episodes and as a consequence, a decrease in antibacterial consumption, after 3 and 6 months of treatment. The tolerance profile of Ribomunyl((R)) was good in all studies. Economic evaluations suggest that savings can be made in healthcare expenditure, in patients with recurrent episodes of infection. It is concluded that Ribomunyl((R)) is effective in preventing and reducing upper and lower respiratory tract infections in adults. The product may also have an impact on reducing the development of bacterial resistance, as a result of fewer courses of antibacterials required to treat patients with RRTIs.     

Potential involvement of leptin in carcinogenesis of hepatocellular carcinoma

AIM:To investigate the potential involvement of leptin incarcinogenesis of hepatocellular carcinoma(HCC)and toelucidate the etiology,carcinogenesis and progress of HCC.METHODS:Expressions of Ob gene product,leptin and itsreceptor,Ob-R were investigated in 36 cases of HCC specimensand corresponding adjacent non-tumorous liver tissues withimmunohistochemical staining.The effect of leptin onproliferation of Chang liver cell line and liver cancer cell lineSMMC-7721 was studied with cell proliferation assay(MTT),RESULTS:Leptin expression was detected in 36 cases ofadjacent non-tumorous liver tissues(36/36,100%)withmoderate( )to strong( )intensity;and in 72.22%(26/36)of HCC with weaker( )intensity(P<0.05).Thirtyof 36(83.33%)cases of adjacent non-tumorous livertissues were positive for Ob-R,with moderate( )tostrong( )intensity.In HCC,11/36(30.56%)cases werepositive,with weak( )intensity(P<0.05).In cellproliferation assay,leptin inhibited the proliferation of Changliver cells.The cell survival rate was 10-13% lower thanthat of the untreated cells(P>0.05).Leptin had little effecton the proliferation of liver cancer cells(P>0.05).CONCLUSION:High level expression and decreased orabsent expression of leptin and its receptor in adjacentnon-tumorous liver cells and HCC cells,inhibitory effect ofleptin on the proliferation of normal Chang liver cells andno effect of leptin on proliferation of liver cancer cells,may provide new insights into the carcinogenesis andprogression of human HCC.It could be assumed that leptinacting as an inhibitor and/or promoter,is involved in theprocess of carcinogenesis and progress of human HCC.     

Transthoracic esophagectomy of adenocarcinoma in Barrett’s esophagus in Japanese patients: analysis of localization of lymph node metastases in 19 cases

Background  

The incidence of esophageal adenocarcinoma is only 1%–2% in Japan. For this reason, many aspects of this disease have not been clarified, such as its generation, progress, and the potential of malignancy. It is necessary to investigate the strategy for treating this disease.     

Evaluation of the Effect of Support-Training System of Peer Group on Promotion of Self-Care in β-Thalassemia Major Patients in Southern Iran

Abstract

β-Thalassemia (β-thal) is a chronic illness and its complications make the patient less compliant with the treatment protocol. This study aimed to evaluate the effect of a support-training system of peer group on promotion of self-care in β-thal major (β-TM) patients. In this semi-experimental study, 112 β-TM were randomly selected and assigned to the study and control groups. Seven β-TM patients, who were physically, mentally and socially normal, were selected and trained as the peer group. Eight training sessions over 4 months were done by the peer group. The questionnaire with 50 questions was scored using the Likert scale, always with 1 point, sometimes 0.5 point and never 0 points. In the study group, before intervention, the mean score of the patients was 29.84?±?6.16, which, after intervention, increased significantly to 37.14?±?4.35, p?<?0.001. In the control group, the overall mean self-care patients’ score decreased significantly, from 29.76?±?7.18 to 29.48?±?7.02. No significant difference was observed between pre and post intervention in the control group in all aspects of self-care (daily activities, fitness and wellness, nourishment, stress relief, job and home environment, time management, expression and creativity, support, items supporting self-care, self-care of the sickness), but it was significant in the study group. The results revealed the positive impact of peer group in promoting self-care of β-TM patients in the study group compared to the control group, which may be used as a frontline educational model in these patients.     

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.     

Role of conventional therapies in the era of biological treatment in Crohn’s disease

Outstanding progress regarding the pathophysiology of Crohn’s disease (CD) has led to the development of innovative therapeutic concepts. Numerous controlled trials have been performed in CD. This review concentrates on the results of randomized,placebo-controlled trials,and meta-analyses when available,that provide the highest degree of evidence. Current guidelines on the management of CD recommend a step-up approach to treatment involving the addition of more powerful therapies as the severity of disease ...     

Prevalence of syphilis seropositivity in antenatal clinic clients in a teaching hospital in South–South region of Nigeria

ObjectiveTo assess the seroprevalence of syphilis among women receiving antenatal care in University of Uyo Teaching Hospital (UUTH), Uyo, Akwa Ibom State, Nigeria.MethodsBetween July 2009 to March 2010, blood samples of 415 consenting clients submitted for prevention of mother to child transmission (PMTCT) HIV screening programme were screened for syphilis antibodies using the Immunochromatographic ACON Ultra Rapid Syphilis Test Strip (ACON laboratory Inc. USA). Any positive result was repeated with another test strip (Diaspot Ultra Rapid Syphilis Test Strip, Diaspot Inc. USA).ResultsOf the 415 samples, 9 (2.2%) were syphilis seropositive and 14 (3.4%) were HIV positive. Assessment of risk factors for syphilis revealed an observed trend with increasing parity though statistically not significant (P=0.268). More than half of the syphilis positive clients believed their spouses were promiscuous.ConclusionsThere is still a substantial carriage of syphilis among antenatal clinic attendees in UUTH, Uyo. The need for routine screening is imperative. Point of care testing should conveniently be incorporated into the PMTCT programme.