Advances in proteomic techniques for biomarker discovery in COPD

Chronic obstructive pulmonary disease (COPD) is a disorder characterized by chronic inflammation of the lung with airflow obstruction and progressive deterioration of pulmonary function. The need to discover and validate biomarkers as prognostic tools of development and progression of the disease has received further support with the advent of proteomic techniques. Liquid chromatography-mass spectrometry (LC/MS) and gel electrophoresis-mass spectrometry (2-DE/MS) have been applied to investigate the proteome of a number of lung-origin samples, including sputum, bronchoalveolar lavage fluid, exhaled-breath condensate, cells and biopsies from COPD patients. In particular, 2-DE and MS are the main proteomic approaches with 2-DE presenting the major approach for quantitative proteomics. The molecules identified as potential biomarkers of COPD may represent a preliminary step for better comprehension of the mechanisms involved in the onset/progression of the disease.     

Proctalgia Fugax in Patients with the Irritable Bowel, Peptic Ulcer, or Inflammatory Bowel Disease

One hundred forty-eight patients with gastrointestinal disease, 50 patients with the irritable bowel syndrome (IBS) and 49 each with peptic ulcer and inflammatory bowel disease, were interviewed to determine if they had proctalgia fugax (PF) and if the symptom was associated with the IBS. One-third of the patients had PF. It occurred in 51% of females and 12% of males (p less than 0.001). When corrected for sex, PF was no more prevalent in IBS than in peptic ulcer or inflammatory bowel disease. Only two of six previously described IBS symptoms were more prevalent in the PF patients. Attacks occurred in the day in 94%, and one-third of sufferers related them to defecation. The pain was localized in the anus in 90%, occurred less than five times a year in 51%, and lasted less than 1 min in 57%. In most, activity was not interrupted by this pain and only 20% had ever reported it to a physician. PF is very common among patients with abdominal symptoms, but is not related to the IBS. Since it is infrequent, benign, and transient, PF is usually not mentioned to the physician.     

General genetic and acquired risk factors,and prevalence of peri‐implant diseases – Consensus report of working group 1

For decades, oral implants have been used successfully for the replacement of missing teeth. Nevertheless, peri‐implant diseases have become an increasingly important issue in daily practice. In this working group, the prevalence of peri‐implant mucositis and peri‐implantitis, as well as different general risk factors and their impact on the onset and progression of peri‐implant diseases, were discussed based on reviews reflecting the current state of evidence. The influence of smoking on the peri‐implant bone‐healing process and its association with peri‐implantitis has been explored in the current literature, demonstrating that smoking is an important risk indicator for the development of peri‐implantitis and implant loss. Compared with non‐smokers, smokers have a higher potential for pathological peri‐implant bone loss, which is also influenced by poor oral hygiene. Despite the fact that a growing number of genetic polymorphisms have been identified and related to periodontal diseases, there are still no genetic patterns that could act as adjuncts to clinical diagnostics in order to identify patients at higher risk of peri‐implant diseases. Long‐term medications, such as bisphosphonate therapy (> 3 years), may have an impact on implant loss. A higher incidence of implant failure was reported in patients using selective serotonin reuptake inhibitors in anti‐depression therapy. Alcoholism (defined as more than 5 units a day) has been associated with implant loss in retrospective and case–control studies, as well as in animal studies.     

Costs of neonatal care for low-birthweight babies in English hospitals

Aim:  To estimate mean costs of neonatal care for babies with birthweights ≤1800 g in a regional Level 3 unit and three Level 2 units providing short-term intensive care.
Method:  Babies ≤1800 g admitted to units in four hospitals in England over 15 months in 2001–2002 were audited until discharge. Unit costs (2005–2006 prices) were attributed to their resource items, including neonatal cot occupancy, pharmaceuticals, blood products and ambulance transfers. Bootstrapped mean costs were derived for the Level 3 unit and the Level 2 units combined.
Results:  The mean gestation period for 199 Level 3 babies was 29.5 weeks compared with 30.4 weeks for 192 Level 2 babies (p = 0.003). Mean costs excluding ambulance journeys were £17  861 per Level 3 baby and £12  344 per Level 2 baby. Level 3 babies <1000 g averaged £26  815, whereas Level 2 babies <1000 g were generally less costly than babies 1000–1499 g. Ambulances transported 76 Level 3 babies and 62 Level 2 babies; their adjusted mean costs were £18  495 and £12  881, respectively.
Conclusion:  By comprehensively costing resource components, the magnitude of total costs for low-birthweight babies has been revealed, thus demonstrating the importance of budgets for neonatal units being realistically determined by commissioners of neonatal services.     

Intraductal papillary-mucinous tumors: an entity which is infrequent and difficult to diagnose

BACKGROUND/AIMS: Intraductal papillary-mucinous tumor of the pancreas is currently considered to be a tumor which is an entity of its own, different from classic pancreatic ductal carcinoma. It is basically characterized by slow growth and low malignancy potential, as well as by the production of mucin. The aim of this study is to contribute to world literature some clarification of its natural history, clinical presentation, the most useful diagnostic tests, methods of detection of stromal invasion and handling of treatment. METHODOLOGY: Of 297 pancreatectomies undertaken at the "12 de Octubre" hospital between May 1985 and January 1998, only 1 case of Intraductal papillary-mucinous tumor was found. We have revised 127 cases published in 10 series over the last 10 years. We also contribute a review of our own case. RESULTS: These tumors, which are very infrequent, produce non-specific symptoms, with long latency periods from the first symptom up to stromal invasion. Endoscopic retrograde cholangiopancreatography showed alterations in 100% of cases where this was undertaken. Tumor-related mortality was zero amongst patients with non-invasive tumor who underwent surgery. None of the cases published presented upper gastrointestinal hemorrhage. This indicated the correct surgery and led us to our diagnosis. CONCLUSIONS: We confirm the low frequency and difficulty of diagnosis, the sensitivity of endoscopic retrograde cholangiopancreatography, the difficulty of early detection of stromal invasion, and the high survival rate in cases where resection is done before this occurs. Early diagnosis and treatment is therefore of utmost importance.     

Vitamin K status in cystic fibrosis

Appearance of PIVKA-II (protein induced by vitamin K absence-II) in serum is a biochemical sign of insufficient vitamin K-dependent carboxylation of prothrombin. Plasma concentrations of PIVKA-II and vitamin K1 were determined in 24 children with cystic fibrosis. Eight were supplemented with vitamin K1. The purpose of the study was to determine the occurrence of vitamin K deficiency in cystic fibrosis and to evaluate the effect of vitamin K supplementation. PIVKA-II was detectable in only one unsupplemented child. In this patient, the concentration of vitamin K1 was below the limit of detection of 60 ng/l. Vitamin K1 levels in the other unsupplemented children were normal (mean 476 ng/l = 1 mmol/l). The supplemented patients showed extremely high levels of vitamin K1 (mean 22445 ng/l = 50 nmol/l). In conclusion, vitamin K deficiency occurs infrequently in cystic fibrosis. Checking the coagulation system is advised, but routine vitamin K supplementation is not recommended. If additional vitamin K is needed, the starting dose should not exceed 1 mg daily.