Nucleolar organizer regions in gastric carcinoma and its precursor stages

A silver technique for nucleolar organizer regions (AgNOR) was applied to sections from 156 gastric biopsies and gastrectomy specimens. These included normal controls, normal gastric mucosa from carcinoma-bearing stomachs, intestinal metaplasia types I and III, dysplasia and carcinoma. AgNOR counts gradually increased from normal, through intestinal metaplasia, to carcinoma. This finding supports the chronic atrophic gastritis-intestinal metaplasia-dysplasia-carcinoma sequence concept for gastric carcinogenesis. Normal gastric mucosa was different from all lesions, including normal mucosa from carcinoma-bearing stomachs. Significantly higher AgNOR counts were observed in tumours compared to all other lesions except dysplasia. Dysplasia differed from intestinal metaplasia type I but not from type III. Eighty-five per cent of metaplasia cases overlapped with carcinoma and 19% with normal controls. The spread of AgNOR values in intestinal metaplasia reinforces the concept that this lesion is a heterogeneous entity reflecting a dynamic and continuous process. The AgNOR technique may contribute to the assessment of the stage of evolution of 'borderline' lesions.     

Major Adverse Cardiac Events at Long-Term Follow-Up in Patients Treated With Single versus Multiple Stents during Single-Vessel Percutaneous Coronary Intervention

Background: Although insertion of multiple stents into a single coronary vessel during single-vessel percutaneous coronary intervention (PCI) is common, there are no data on long-term occurrence of major adverse cardiac events (MACE) in patients treated with multiple stents versus a single stent.
Methods: The incidence of MACE (death, myocardial infarction, or target vessel revascularization) during long-term follow-up was investigated in 634 patients who underwent single-vessel PCI. Of the 634 patients, 319 (50%) had a single stent, and 315 (50%) had multiple stents inserted. Stepwise Cox regression analyses were performed to identify significant independent prognostic factors for MACE.
Results: At 47-month follow-up, MACE occurred in 61 of 319 patients (19%) who had a single stent versus in 57 of 315 patients (18%) who had multiple stents (P not significant). Significant independent predictors of MACE were use of vein grafts (hazard ratio = 1.94; 95% CI, 1.24–3.03; P = 0.0038) and use of drug-eluting stents (hazard ratio = 0.49; 95% CI, 0.34–0.72; P = 0.0002).
Conclusions: At long-term follow-up of single-vessel PCI, the incidence of MACE was similar in patients with multiple or single stents inserted even after controlling for the length of stents.     

The effect of a target controlled infusion of propofol on predictability of recovery from anesthesia in children

Background: Emergence following termination of a general anesthetic depends on the effect site concentration (C_e) of the drug declining to an awakening value (C_e‐awake). C_e‐awake has been described in adults, but is unknown in children. Objectives: To determine C_e‐awake in children following a target‐controlled infusion (TCI) of propofol and to assess a C_e‐driven TCI system’s ability to predict times to emergence from anesthesia. Methods: Subjects undergoing elective surgery, aged 3 months to <10 years were recruited into three age‐stratified groups. A target C_e of 3–4 μg·ml^?1 was selected for induction and subsequently titrated to patient response and surgical stimulus. Preoperative acetaminophen, a remifentanil infusion and regional anesthesia were permitted for supplemental analgesia. State Entropy (SE) was monitored from induction to emergence. Emergence was defined as the time of first purposeful spontaneous movement (PSM). Time zero was defined as the end of propofol infusion. Based on a pilot study, a C_e‐awake of 1.9 μg·ml^?1 was chosen as the wake‐up threshold used by the software to predict emergence times. Results: Data was collected for 90 of 104 recruited patients. PSM occurred at a mean (sd ) C_e of 2.0 (0.5) μg·ml^?1 and an SE of 79 (11). There were no differences between age groups. A wide variation in emergence time was observed, with a mean (sd ) of 16.9 (7) min, and a trend to more rapid emergence in older subjects. Conclusion: A predicted C_e‐awake of 2.0 μg·ml^?1 in children aged 3 months to <10 years was identified with the selected model. For expert users of propofol in children, during shorter surgical procedures, TCI predicted emergence times do not offer significant clinical advantages.