Prevalence and impact on FEV(1) decline of chronic methicillin-resistant Staphylococcus aureus (MRSA) colonization in patients with cystic fibrosis. A single-center, case control study of 165 patients

BackgroundRisk factors for methicillin-resistant Staphylococcus aureus (MRSA) in Cystic Fibrosis (CF) and the impact on CF disease progression are still under debate.The objectives of this study were to determine clinical variables associated with MRSA colonization and examine impact on FEV₁ evolution in CF patients.MethodsA retrospective case–control study using the University Hospital of Brussels CF clinic patient registry from 2002 to 2010, comparing clinical variables and decline of FEV₁ of MRSA positive patients with age and sex matched controls, chronically colonized with S. aureus.ResultsThirty of the 165 CF patients, chronically colonized with S. aureus, had cultures positive for MRSA (18.2%). Excluding patients under 4 years, the prevalence became 15.2% (23/151). Chronic colonization (i.e., three or more consecutive positive cultures) was found in 19/151 (12.6%).The MRSA positive group showed a higher proportion of patients with genotype F508del, less pancreas sufficient patients, more bronchiectasis and more frequent hospitalization.The FEV₁ recorded one year prior to, and at the moment of MRSA acquisition, was lower but not significantly different from that obtained in controls (72.9% ± 26.6 vs 84.3 ± 21.8 and 68.2% ± 27.1 vs 81.4% ± 24.3 respectively, p > 0.1). However, FEV₁ decline over 2- and 6-year periods, were significantly greater in the chronic MRSA group than in the controls (− 5% ± 5.5 vs −2.5 ± 2.3 over 2 years (p = 0.043) and − 1.8% ± 4.6 vs −1.0% ± 1.9 over a 6-year period (p = 0.026)).ConclusionIn our center the prevalence of MRSA in CF patients, chronically colonized with S. aureus and over the age of 4 years, was 15.2% (12.6% chronic infection). MRSA colonization was shown to be associated with a genotype F508del, presence of bronchiectasis and hospitalization. Our spirometric data also show that a MRSA episode entails an FEV₁ decline that is almost double that predicted for CF patients who can remain unaffected by MRSA.     

Vitamin D inadequacy in French osteoporotic and osteopenic women

ObjectiveStudies have shown that low serum vitamin D levels are associated with secondary hyperparathyroidism, which decreases bone strength and increases fracture risk, most notably after 50 years of age. The objective of this study was to evaluate the vitamin D status of postmenopausal women in France.MethodsWe conducted a cross-sectional observational study of 1292 menopausal women with osteoporosis or osteopenia. The age range was 52–94 years. Serum 25-OH-vitamin D was assayed in each patient. Based on data in the literature, we used four 25-OH-D cutoffs to define vitamin D deficiency: 30, 50, 75, and 80 nmol/L (<12, <20, <30, and <32 ng/ml).ResultsMean serum 25-OH-D was 51.5 ± 26.1 nmol/L (about 20.6 ± 10.4 ng/ml). In the 343 (26.5%) patients taking supplemental vitamin D with or without supplemental calcium, the mean serum 25-OH-D level was significantly higher than in the other patients (65.0 ± 26.0 ng/ml vs. 46.6 ± 18.6 ng/ml; P < 0.001). In the subgroup not taking vitamin D supplements, the prevalence of vitamin D deficiency was 27.3%, 54.1%, 89.9%, and 93.2% with the 30, 50, 75, and 80 nmol/L cutoffs, respectively. The mean 25-OH-D level varied across seasons (P < 0.001), with the highest value being obtained in summer (53.4 ± 18.7 nmol/L; about 21.3 ± 7.5 ng/ml).ConclusionVitamin D deficiency is common among postmenopausal women with osteoporosis or osteopenia in France.     

Anti-inflammatory effects of DX-890, a human neutrophil elastase inhibitor

BackgroundNeutrophil elastase (NE)-mediated inflammation contributes to lung damage in cystic fibrosis (CF). We investigated if DX-890, a small-protein NE inhibitor, could reduce neutrophil trans-epithelial migration and reduce activity released from neutrophils and NE-induced cytokine expression in airway epithelial cells.MethodsActivated blood neutrophils (CF and healthy) treated ± DX-890 were assayed for NE activity. Transmigration of calcein-labeled neutrophils was studied using a 16HBE14o⁻ epithelial monolayer. IL-8 release from primary nasal epithelial monolayers (CF and healthy) was measured after treatment ± DX-890 and NE or CF sputum.ResultsDX-890 reduced NE activity from neutrophils (CF and healthy) and reduced neutrophil transmigration. DX-890 pre-treatment reduced IL-8 release from epithelial cells of healthy or CF subjects after stimulation with NE and CF sputum sol. All improvements with DX-890 were statistically significant (p < 0.05).ConclusionsDX-890 reduces NE-mediated transmigration and inflammation. NE inhibition could be useful in managing neutrophilic airway inflammation in CF.     

Assessment of hand trabecular bone texture with high resolution direct digital radiograph in rheumatoid arthritis: a case control study

ObjectivesRheumatoid arthritis is characterized by an early inflammatory related periarticular osteopenia. A new high resolution direct digital X-ray device has been recently developed to provide bone texture analysis which is designed to assess changes in trabecular bone architecture. For the first time, we have evaluated trabecular bone texture impairment in rheumatoid arthritis patients compared to healthy controls.MethodsIn this cross-sectional study, the reproducibility was assessed by three separate digital X-rays of the right hand, with repositioning in 14 late rheumatoid arthritis patients and 14 healthy subjects. Then, trabecular bone texture of the MCP2 and MCP3 from patients enrolled in a prospective cohort of 78 rheumatoid arthritis patients was compared with that of 50 healthy subjects, using three texture parameters: Hmean, co-occurrence and run-length.ResultsThe coefficients of variation of the high resolution direct digital X-ray measurements ranged from 0.5 to 1.8%. Only the Hmean parameter was significantly decreased in rheumatoid arthritis patients compared to healthy subjects at MCP2 (0.637 ± 0.040 vs 0.654 ± 0.032, P < 0.05) and at MCP3 (0.646 ± 0.044 vs 0.665 ± 0.037, P < 0.05). This reduction was significantly correlated to disease activity.ConclusionsThis study demonstrated both the good reproducibility of the high resolution digital X-ray measurements and the trabecular bone texture impairment at MCP joints in rheumatoid arthritis patients. In addition to provide a high resolution hand radiograph, this technique may represent an interesting tool to easily quantify periarticular osteopenia with a low radiation dose.     

Percutaneous radiofrequency sacral rhizotomy in the treatment of neurogenic detrusor overactivity in spinal cord injured patients

IntroductionTo evaluate the effects of percutaneous radiofrequency sacral rhizotomy in spinal cord injured (SCI) patients on urodynamic parameters (maximum cystometric capacity – MCC and detrusor pressure at maximum cystometric capacity - PdetMCC).Material and MethodsThis prospective study assessed eight patients with SCI (four men and four women) with a mean age of 31.3 years (22 to 41). Mean interval period between spinal cord lesion and rhizotomy was 53.5 months (20 to 96). All patients underwent an anesthetic block of the 3rd sacral root bilaterally using 0.5% bupivacaine under fluoroscopic control. Those who responded with an increase on bladder capacity were selected to undergo the percutaneous radiofrequency sacral rhizotomy. All patients underwent urodynamic evaluation at 6 and 12 months following the procedure. MCC and P_detMCC were recorded.ResultsAll patients presented a significant improvement on MCC after 12 months. The mean vesical volume increased from 100.2 ± 57.1 to 282.9 ± 133.4 ml (p<0.05). The P_detMCC reduced from 82.4 ± 31.7 to 69.9 ± 28.7 cmH₂O (p = 0.2). Three patients with autonomic dysreflexia had complete relief of symptoms after the procedure. At 12 months, recurrence of detrusor hyperactivity was observed in all patients. One patient presented abolishment of reflex erections after the procedure. No major complications related to the rhizotomy were noted.ConclusionsPercutaneous radiofrequency sacral rhizotomy is a minimally invasive technique with low morbidity able to increase MCC. There is a trend towards the reduction of the P_detMCC in SCI patients at 12 months, although statistical significance was not reached.     

Onset of labor epidural analgesia with ropivacaine and a varying dose of fentanyl: a randomized controlled trial

BackgroundThis study was conducted to investigate the onset of labor epidural analgesia using 0.17% ropivacaine with a varying dose of fentanyl. We hypothesized that the onset of analgesia would be shortened in proportion to an increase in fentanyl dose.MethodsWomen requesting labor epidural analgesia were enrolled in this randomized controlled clinical trial. Each woman was randomly assigned to receive fentanyl 0, 50, 75, or 100 μg with 0.17% ropivacaine 12 mL. The onset and duration of analgesia, the incidence of side effects and patient satisfaction were measured.ResultsData from 102 women were analyzed. The onset of analgesia (mean ± SD) was shortened with an increasing dose of fentanyl (14.3 ± 5.4, 14.2 ± 6.5, 12.1 ± 5.1, and 8.7 ± 3.8 min with fentanyl 0, 50, 75, or 100 μg, respectively, P = 0.001). The duration of analgesia was prolonged with an increasing dose of fentanyl (87.4 ± 20.8, 112.3 ± 19.5, 140.8 ± 18.8, and 143.6 ± 18.6 min with fentanyl 0, 50, 75, or 100 μg, respectively, P < 0.001). The incidence of pruritus increased with an increasing dose of fentanyl (P = 0.027) but there were no differences for other maternal side effects. There was a significant difference in satisfaction score among groups (P = 0.009).ConclusionThe addition of increasing doses of fentanyl to 0.17% ropivacaine contributed to shortened onset as well as prolonged duration of labor epidural analgesia and improved patient satisfaction.     

Feasibility of using pedometers to measure daily step counts in cystic fibrosis and an assessment of its responsiveness to changes in health state

BackgroundEvaluation of physical activity is integral to the assessment of daily physical function and a potential objective outcome measure for clinical trials. We evaluated the feasibility of using pedometers to measure physical activity in adolescents and adults with cystic fibrosis (CF) and assessed the responsiveness of its measurement to changes in health state.MethodsParticipants were recruited through two CF clinics in Seattle, WA. Subjects were instructed to use their pedometer for at least one ill and two well periods (each lasting 7 days). Step rate was calculated as steps per hour of use. Daily symptoms were also recorded using the CF Respiratory Symptom Diary (CFRSD). Generalized estimating equation linear regression was used to compare mean step rate between health states and by self-reported symptom category.ResultsWe enrolled 30 CF patients with a mean (± SD) age of 22 (± 7) years and a mean forced expiratory volume in 1 s (FEV₁) of 57% (± 25%) predicted. The mean period step rate increased from 397 (95% CI 324–497) steps/hour when ill to 534 (95% CI 413–654) steps/hour when well (p = 0.015). Pedometer-recorded step rate also correlated with self-reported physical activity items on the CFRSD.ConclusionStep rate measured with a pedometer correlates significantly with changes in health status and self-reported activity, and could be used as an outcome measure in CF.     

Mean platelet volume (MPV) as an inflammatory marker in ankylosing spondylitis and rheumatoid arthritis

AimsThe aim of this retrospective study was to investigate the correlation between MPV and the clinical disease activity indices of rheumatoid arthritis and ankylosing spondylitis.MethodsThe study consisted of 32 active RA patients (males/females: 7/25, mean age: 49 ± 13) and 30 active AS patients (males/females: 15/15, mean age: 36 ± 12) along with 26 osteoarthritis (OA) patients (males/females: 4/22, mean age: 52 ± 8) and 29 age-matched healthy subjects (males/females: 5/24, mean age: 41 ± 7) as control groups for RA and AS, respectively.ResultsMPV was significantly lower in both AS patients and RA patients with active disease as compared to controls (RA vs OA p < 0.001, AS vs healthy subjects p < 0.001). After treatment MPV values significantly increased in AS and RA (p < 0.001 for all). However, MPV values remained somewhat lower in RA patients than OA patients (p = 0.019). There was a negative correlation between MPV values and BASDAI scores in AS patients after two months of treatment (r = ?0.507; p = 0.004).ConclusionOur results suggest that assessment of MPV may provide additional information about inflammation in AS and RA.     

No differences of carotid intima-media thickness between young patients with ankylosing spondylitis and healthy controls

ObjectiveAccelerated atherosclerosis in inflammatory rheumatic diseases such as ankylosing spondylitis (AS) stands out among the leading causes of morbidity and mortality. We assessed the correlation between subclinical carotid atherosclerosis and its related clinical parameters in AS patients.MethodsTwenty-eight patients (23 males, 5 females) with AS and 27 sex- and age-matched controls were consecutively recruited to this study. We estimated the carotid intima–media thickness (IMT) and parameters related to arterial elastic properties, including the distensibility coefficient (DC), stiffness index (β), and incremental elastic modulus (E_inc) using high-resolution ultrasonography. Serum levels of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and monocyte chemoattractant protein-1 (MCP-1) were measured using enzyme-linked immunosorbent assay (ELISA).ResultsCarotid IMT values and arterial elastic parameters in AS patients showed no statistical significance compared to those of controls (0.57 ± 0.07 vs 0.55 ± 0.05, p = 0.387 for IMT, 28.45 ± 9.23 vs 31.93 ± 9.52, p = 0.175 for DC, 2.32 ± 0.18 vs 2.29 ± 0.15, p = 0.559 for stiffness index (β), and 0.14 ± 0.05 vs 0.12 ± 0.03, p = 0.116 for E_inc). The serum level of IL-6 in AS patients was significantly different compared with controls (p = 0.001), but not in serum levels of TNF-α and MCP-1 (p = 0.162, p = 0.087, respectively). Carotid IMT and all arterial elastic parameters calculated in this study were not found to be associated with serum levels of TNF-α, IL-6, and MCP-1.ConclusionThis cross-sectional study showed that carotid IMT and parameters related with arterial elastic properties in young AS patients without clinically evident cardiovascular risk factors were not different from those of sex- and age-matched healthy controls. Serum levels of TNF-α, IL-6, and MCP-1 did not reflect the degree of carotid subclinical atherosclerosis. However, these findings should be confirmed further in a larger population.     

Haemodynamics in obese pregnant women

BackgroundObesity in pregnant women is a serious health issue. Invasive monitoring devices are rarely used in pregnancy due to their risks; however, assessment of cardiac function is often required in these women. Transthoracic echocardiography offers advantages but may be technically difficult to perform. Our aim was to determine the feasibility of transthoracic echocardiography and to quantify left ventricular function and structure using transthoracic echocardiography in obese pregnant women.MethodFifteen obese but otherwise healthy pregnant women (body mass index >30 kg/m²), were compared with 40 healthy non-obese pregnant women. Echocardiography was performed according to American Society of Echocardiography recommendations.ResultsTest completion with key haemodynamic data were obtained in 100% of women. Gestational age (Mean ± SD) was similar between groups (36 ± 5 weeks). Compared with non-obese pregnant women, obese pregnant women had elevated mean arterial pressure (88 ± 6 vs. 81 ± 8 mmHg, P = 0.003), increased left ventricular mass (162.8 ± 35.4 vs. 130.8 ± 21.0 g, P = 0.008) but similar cardiac output (4417 ± 890 vs. 4109 ± 595 mL/min, P = 0.230) and diastolic changes (mitral valve E/se′ > 8 in 33% vs. 15% of patients, P = 0.26). Septal tissue Doppler indices in obese pregnant women were s′ 9.1 ± 1.9 cm/s, e′ 11.6 ± 2.6 cm/s, a′ 8.1 ± 2.7 cm/s. Tei index was reduced in both groups (0.49 ± 0.12 vs. 0.42 ± 0.09, P = 0.05).ConclusionsTransthoracic echocardiography was used to delineate haemodynamics in obese pregnant women. Mean arterial blood pressure and left ventricular mass were increased in obese pregnant woman. The incidence of diastolic impairment and reduced myocardial performance were similar between groups.     

Clinical evidence that V456A is a Cystic Fibrosis causing mutation in South Asians

BackgroundCystic Fibrosis (CF) genotypes in South Asians are variable with a decreased incidence of Delta F508 and an increased incidence of novel mutations. The objective of this study is to provide clinical evidence that V456A, a novel mutation in South Asian Cystic Fibrosis patients, can cause significant lung disease.MethodsWe extracted clinical data from a retrospective chart review of 2 CF patients of South Asian descent.ResultsPatient 1, a 10 year and 11 month old Pakistani female at her initial clinic visit, required multiple hospitalizations for bronchiectasis and pulmonary infections. She was pancreatic sufficient but had slow weight gain. Genetic testing revealed that she is homozygous for the CFTR V456A mutation. Patient 2, an Indian female diagnosed with CF on newborn screening, is compound heterozygous for V456A/R709X. She had slow weight gain with BMI ranging from 12.9 to 13.4 kg/m² from 3 to 5 years of age and was 14.2 kg/m² at 6 years of age. At 6 years of age, pulmonary function tests revealed mild lung disease with FVC of 71%, FEV₁ of 75%, FEF_25–75 of 119%, and FEV₁/FVC of 86% predicted. Sputum cultures were intermittently positive for Staphylococcus aureus and Haemophilus influenza.ConclusionsWe provide evidence that V456A can cause significant pulmonary disease in South Asian Cystic Fibrosis patients.     

Sleep quality and depression–anxiety in mothers of children with two chronic respiratory diseases: Asthma and cystic fibrosis

BackgroundSleep quality and psychological well being of parents are expected to be influenced by the child's health and disease status. The aim of this study was to compare sleep quality and depression–anxiety parameters in mothers of children with cystic fibrosis (CF) asthma and healthy controls.MethodsThe study included mothers of 62 children with asthma, 21 children with CF and 35 healthy children. All mothers filled in the Pittsburgh Sleep Quality Index (PSQI) questionnaire and hospital anxiety depression scale (HADS).ResultsComparison of the three groups with Kruskall Wallis analysis demonstrated that subjective sleep, sleep efficiency and total PSQI scores were significantly different between the groups (p = 0.02, p = 0.01 and p = 0.04 respectively). Comparisons of the groups in pairs with Mann Whitney U test with Bonferroni correction revealed that subjective sleep quality scores in mothers of children with asthma were significantly higher than the ones in the control group (1.0 ± 0.9 vs 0.6 ± 0.7, p = 0.015). The other PSQI scores as well as the anxiety and depression scores were higher in CF and asthma groups when compared to the control group but did not reach statistical significance. Anxiety and depression scores were significantly correlated with PSQI total score in CF (rho = 0.54 and 0.49 respectively) and asthma groups (rho = 0.45 and 0.60 respectively) but not in the control group.ConclusionIn conclusion, presence of a chronic respiratory disease in a child may be associated with disturbed sleep quality and increased depression and anxiety in mothers.     

Inflammatory and growth factor response to continuous and intermittent exercise in youth with cystic fibrosis

BackgroundChildren with cystic fibrosis (CF) tend to suffer from chronic systemic inflammation and may have impaired growth associated with muscle catabolism. Therefore, investigating which type of exercise can elicit an anabolic response with minimal inflammation is of clinical value.MethodsTwelve children with CF (mean ± SD; age: 14.7 ± 2.3 years, predicted FEV₁: 90.0 ± 21.6%) and biological age-matched controls (age: 13.9 ± 2.1 years) completed moderate-intensity, continuous exercise (MICE) and high-intensity, intermittent exercise (HIIE) on separate days. During each exercise, blood was drawn at various time points and analyzed for immune cells, inflammatory cytokines, and growth mediators.ResultsAt rest, children with CF had higher concentrations of neutrophils and IL-6 compared with controls. In children with CF, HIIE did not affect immune cell subsets or cytokines: TNF-α, IL-6, and tumor necrosis factor-like weak inducer of apoptosis (TWEAK). All immune cell subsets and IL-6 increased significantly with MICE in both groups. Growth hormone (GH) increased with both types of exercise, with a greater change from rest during MICE.ConclusionsHIIE was a sufficient stimulus to increase GH in children with CF, without affecting systemic inflammation.     

Prevalence of cystic fibrosis pathogens in the oropharynx of healthy children and implications for cystic fibrosis care

ObjectiveTo describe the prevalence of the CF pathogens Pseudomonas aeruginosa, Staphylococcus aureus and Haemophilus influenzae in OP cultures from healthy children.MethodsOropharyngeal (OP) swabs were collected from 100 healthy children ≤ 18 years of age undergoing a clinically indicated procedure.ResultsP. aeruginosa was isolated from the OP swab of one participant, S. aureus from 48 participants (including 4 methicillin-resistant) and H. influenzae from 47 participants. Cultures from 75 participants grew one or more of these organisms (55 grew one, 19 grew 2 and one grew 3 organisms).ConclusionP. aeruginosa is rarely recovered from the oropharynx of healthy children ≤ 18 years of age, while recovery of S. aureus and H. influenzae is common. It is important to understand what the “normal” prevalence of CF pathogens is in the oropharynx in order to aid interpretation of OP cultures in CF patients.     

Quality of food intake after bariatric surgery: vertical gastrectomy versus gastric bypass

IntroductionThe different bariatric surgical techniques have an influence on food tolerance and the presence of vomiting. There have been few studies on the impact of these techniques on the quality of food intake.Patients and methodA prospective and comparative study was performed on a consecutive patient cohort operated on due to morbid obesity between May 2008 and November 2010. The quality of the diet was evaluated before and at 3, 6, 12 and 24 months postoperatively, using the questionnaire described by Suter et al.ResultsOne hundred and five patients (64 vertical gastrectomy [VG] and 41 gastric bypass [GB]) completed the questionnaire before the surgery, and 87 at 3 months, 79 at 6 months, 53 at 12 months, and 18 at 24 months after surgery. The overall score of the questionnaire before surgery was 23.5 ± 2.6, with a significant difference at 3 months (20.4 ± 3.8, P<.001), at 6 months (21.3 ± 4.6, P<.001) and at 12 months (22.4 ± 3.3, P<.044), and with no difference at 24 months (23.2 ± 2.5, P<.622), after surgery. On comparing food intake of VG versus GB, the scores were similar before surgery (23.8 ± 2.4 vs 23.0 ± 2.8, P<.125) as well as in the post-surgical follow up at 3 months (20.5 ± 3,9 vs 20.2 ± 3.7, P<.599), 6 months (21.1 ± 5.3 vs 21.7 ± 3.4, P<.243), 12 months (22.3 ± 3.3 vs 22.7 ± 3.4, P<.140) and 24 months (22.9 ± 3.0 vs 23.6 ± 2.2, P = 1.00).ConclusionsThe worsening of the quality of food intake is common in the first months after bariatric surgery, gradually improving and with no differences being seen between VG and GB.     

Ancestral haplotype 8.1 and lung disease severity in European cystic fibrosis patients

BackgroundThe clinical course of cystic fibrosis (CF) lung disease varies between patients bearing identical CFTR mutations. This suggests that additional genetic modifiers may contribute to the pulmonary phenotype. The highly conserved ancestral haplotype 8.1 (8.1AH), carried by up to one quarter of Caucasians, comprises linked gene polymorphisms on chromosome 6 that play a key role in the inflammatory response: LTA + 252A/G; TNF −308G/A, HSP70-2 + 1267A/G and RAGE −429T/C. As inflammation is a key component inducing CF lung damage, we investigated whether the 8.1AH represents a lung function modifier in CF.MethodsWe analyzed the lung function of 404 European CF patients from France (n = 230), Germany (n = 95) and UK (n = 79). FEV₁ differences between 8.1AH carriers and non-carriers were calculated in each country and pooled using a random effects model.ResultsThe frequency of 8.1AH carriers was similar between French (22%), German (29%) and UK (27%) patients. We found that 8.1AH carriers had significantly lower FEV₁, adjusted for age classes and countries (P < 0.04, mean FEV₁ difference − 6.4% CI95% [− 12.4%, − 0.5%]). No difference was observed with respect to BMI Z-scores and chronic colonization with P. aeruginosa.ConclusionsThese findings support the concept that 8.1AH is an important genetic modifier of lung disease in CF. To conclude, multiple linked genes outside the CF locus might explain some of the variability in lung phenotype.     

Detection and molecular staging of bladder cancer using real-time RT-PCR for gelatinases (MMP-2, MMP-9) and TIMP-2 in peripheral blood

IntroductionMolecular staging of bladder cancer based on the detection of mRNA of urothelial specific genes in circulating cancer cells has been inconclusive. We analyze whether real-time RT-PCR evaluation of gelatinases (MMP-9, MMP-2) and TIMP-2 in peripheral blood to diagnose and characterize patients with bladder neoplasm.Material and methodTotal RNA is extracted from circulating blood cells in 42 individuals (11 healthy controls, 31 patients with bladder cancer of different stages) and real-time RT-PCR performed using specific primers for MMP-9, MMP-2, TIMP-2 and ribosomal 18S. The quantification values of mRNA are described as relative to 18S mRNA (ΔΔCt method) and the results are blindly compared with data obtained from histological diagnosis and clinical staging.ResultsNormalized levels of MMP-9 and MMP-2 mRNA are higher in patients with cancer than controls (1.82 ± 0.6-fold and 2.7 ± 0.6-fold, respectively; P < .05). Patients with metastatic disease also have increased MMP-9, MMP-2 and TIMP-2 mRNA levels (9.6 ± 0,20-fold, 5.22 ± 0.26-fold and 1,97 ± 0,22-fold, respectively; P < .05). MMP-9 and MMP-2 are also associated with advanced clinical stage and grade (P < .05). A ratio between variables that increases the ability to segregate patients with Ta, T1, T2-4M0 and T2-4M1 tumours is proposed.ConclusionsBoth non-invasive bladder tumor recognition and molecular staging of the disease is possible using real-time RT-PCR-based detection of gelatinases and TIMP-2 in peripheral blood. The ability to distinguish metastatic disease is higher for MMP-9 but MMP-2 discriminates better levels of tumour invasion. Further investigation in this field could yield promising results regarding molecular evaluation of bladder neoplasia.     

Measurement of intra-abdominal pressure in term pregnancy: a pilot study

BackgroundThis study was conducted to assess the feasibility of measuring intra-abdominal pressure in term parturients under spinal anesthesia.MethodsIntra-abdominal pressure was measured in 20 term parturients after spinal anesthesia for elective caesarean section. Pressure was measured in the supine and 10° left lateral tilt positions with a constant reference point throughout.ResultsIntra-abdominal pressure measurement was feasible and safe to perform. Pressure was significantly lower in the left lateral tilt position than supine (10.9 mmHg ± 4.67 vs. 8.9 mmHg ± 4.87, P = 0.0004). The range of intra-abdominal pressure in pregnancy was wide, from 2 to 20 mmHg, with >25% of patients resting with pressures above 12 mmHg in both positions.ConclusionsUnder spinal anesthesia, intra-abdominal pressure in >25% of healthy term parturients was > 12 mmHg, which has conventionally been defined as intra-abdominal hypertension. The intra-abdominal pressure in term pregnancy should be performed in the left lateral tilt position to avoid falsely elevated pressure measurements.     

Multiple antibiotic-resistant Pseudomonas aeruginosa and lung function decline in patients with cystic fibrosis

BackgroundThe goal of this study was to determine the association of multiple antibiotic-resistant Pseudomonas aeruginosa (MARPA) acquisition with lung function decline in patients with cystic fibrosis (CF).MethodsUsing data from Epidemiologic Study of Cystic Fibrosis (ESCF), we identified patients with spirometry data and MARPA, defined as PA (1) resistant to gentamicin and either tobramycin or amikacin, and (2) resistant to ≥ 1 antipseudomonal beta lactam. MARPA had to be detected in a respiratory culture after ≥ 2 years of PA-positive but MARPA-negative respiratory cultures. Multivariable piecewise linear regression was performed to model the annual rate of decline in forced expiratory volume in 1 second (FEV₁) % predicted 2 calendar years before and after the index year of MARPA detection, adjusting for patient characteristics and CF therapies.ResultsIn total, 4349 patients with chronic PA and adequate PFT data were identified; 1111 subsequently developed MARPA, while 3238 patients were PA positive but MARPA negative. Compared with patients who did not acquire MARPA, MARPA-positive patients had lower FEV₁ and received more oral (p < 0.013) and inhaled (p < 0.001) antibiotic therapy. Mean FEV₁ decline did not change significantly after MARPA detection (− 2.22% predicted/year before detection and − 2.43 after, p = 0.45). There was no relationship between persistent infection or FEV₁ quartile and FEV₁ decline.ConclusionsNewly detected MARPA was not associated with a significant change in the rate of FEV₁ decline. These results suggest that MARPA is more likely to be a marker of more severe disease and more intensive therapy, and less likely to be contributing independently to more rapid lung function decline.     

Temocillin in cystic fibrosis: A retrospective pilot study

BackgroundTemocillin is currently used in the treatment of acute pulmonary exacerbations caused by Burkholderia cepacia complex and multi-resistant Pseudomonas aeruginosa in cystic fibrosis (CF) patients despite little published clinical data. This study assessed if intravenous (IV) antibiotic therapy including temocillin was equivalent to standard combination therapy for an acute exacerbation.MethodsA retrospective, pilot cross-over study. Adult patients attending two CF centres between 1997 and 2006 who had received a course of IV antibiotics including temocillin (TIV) and a further IV course (within ± 1 year) which did not include temocillin (NTIV) were included. Outcome measures at the start and end of each IV course were recorded (FEV₁%, FVC%).ResultsTwenty six patients had received temocillin. Baseline values of FEV₁% predicted were comparable for both groups (TIV: 37(18%), NTIV: 39(20%)). FEV₁% increased by 7.12(11.67)% after TIV (p < 0.01) and 6.65(7.62)% after NTIV (p < 0.01). There was no significant difference between the IV courses in mean %change in lung function TIV versus NTIV (FEV₁ 0.46% [95%CI: − 4.55 to 5.48%]).ConclusionThese data suggest equivalence in the lung function outcome of IV antibiotic therapy includingtemocillin versus standard IV antibiotic therapy.