Transjugular intrahepatic portosystemic stent shunt: 11 years' experience at a regional referral centre

OBJECTIVES: Transjugular intrahepatic portosystemic stent shunt (TIPSS) is now widely used in the treatment of uncontrolled and recurrent variceal haemorrhage. This study reports the outcome and long-term follow-up of 125 patients who were referred to a single centre for TIPSS. METHODS: One hundred and twenty-five patients were referred to undergo TIPSS. All but 10 had variceal haemorrhage. The 10 patients referred with refractory ascites were excluded from the analysis. Our follow-up protocol was to assess shunt patency only if bleeding recurred or there was a clinical indication. The mean age was 51.5 years (range 18-87 years) and 64 patients (56%) were male. The commonest aetiology for chronic liver disease was alcohol (80%). At referral, 19 patients (16%) were Child-Pugh class A, 26 patients (23%) were Child-Pugh class B and 70 patients (61%) were Child-Pugh class C. The mean follow-up period was 20.4 months (range 0-95 months). RESULTS: TIPSS was successfully placed in 108 of 115 patients (94%). The thirty-day mortality was 30%. One-year and 2-year overall cumulative survival was 52% (survival ratio, 0.525; 95% confidence interval, 0.432-0.619) and 43% (survival ratio, 0.436; 95% confidence interval, 0.340-0.532), respectively. CONCLUSION: TIPSS is effective in the treatment of uncontrolled or recurrent variceal bleeding. In comparison with previously published studies, our study suggests no value in regular or routine shunt surveillance to reduce rebleeding episodes or mortality, but this needs to be further assessed in prospective randomized studies.     

The RAGE axis and endothelial dysfunction: maladaptive roles in the diabetic vasculature and beyond

Receptor for advanced glycation end product (RAGE) is a member of the immunoglobulin superfamily of cell surface molecules. The ligand-RAGE axis is emerging as a central mechanism linked to vascular injury and atherosclerosis in diabetes and in euglycemia. The repertoire of RAGE ligands, including advanced glycation end products, S100/calgranulins, high-mobility group box 1, amyloid-beta peptide, and Mac-1, transcends RAGE biology from specifically the science of diabetic complications to central aspects of the inflammatory response and oxidative stress. Experiments in cell culture and in vivo support the notion that interaction of RAGE ligands with RAGE activates key signal transduction pathways that modulate fundamental cellular properties, thereby leading to vascular and inflammatory cell perturbation. These considerations support the premise that the ligand-RAGE axis may be an important target for therapeutic intervention in cardiovascular disease and, fundamentally, in initiation and amplification of inflammatory responses.     

Taurine prevents fructose-diet induced collagen abnormalities in rat skin

OBJECTIVE: The aim of the study is to investigate the effect of taurine administration on the content and characteristics of skin collagen in high-fructose-fed rats. RESEARCH DESIGN AND METHODS: Adult male Wistar rats were divided into four groups of six each: a control group (CON) and a taurine-supplemented control group (CON+TAU), a high fructose diet-fed group (FRU), and a taurine supplemented fructose diet-fed group (FRU+TAU). After 30 days, collagen was isolated from the skin, and its physicochemical properties were studied. RESULTS: Fructose administration caused an accumulation of collagen and extensive cross-linking. This was evidenced by increases in glycation, fluorescence, and peroxidation in collagen samples. The physicochemical properties of collagen, like shrinkage temperature, aldehyde content, solubility pattern, and susceptibility to denaturing agents, were altered in the fructose-fed rats. The sodium dodecyl sulphate-polyacrylamide gel electrophoretic (SDS-PAGE) pattern of collagen from fructose-fed rats showed and elevated beta component of Type I collagen. Simultaneous administration of taurine alleviated these changes. CONCLUSION: The positive influence of taurine on both collagen content and its properties suggests a potential mechanism for the ability of taurine to delay diabetic complications.     

Prevalence of essential tremor in Singapore: a study on three races in an Asian country

To investigate the prevalence of Essential Tremor (ET) in Singapore and compare the rates between Singaporean Chinese, Malays, and Indians, a community-based survey among a disproportionate random sample of 15,000 individuals (9000 Chinese, 3000 Malays, 3000 Indians) aged 50 years and above was conducted. In phase 1, trained interviewers conducted a door-to-door survey using a screening questionnaire for Parkinson's disease. In phase 2, medical specialists examined participants who screened positive to evaluate for the presence of postural or kinetic tremor of the upper limbs, or head tremor. Participants with suspected ET had their diagnosis confirmed in phase 3 by a movement disorders specialist and fellow based on the latest core diagnostic criteria. Forty participants with classic ET were identified. The prevalence rate (PR) of ET was 2.37 per 1000 (95% CI: 1.65-3.32), age-adjusted to UICC world standard population. The PR was significantly higher in males (p=0.01) and increased significantly with age (p<0.001). Indians (PR=4.94 per 1000, 95% CI: 2.63-9.04) were 1.8 times more likely to have ET than Chinese (PR=2.77 per 1000, 95% CI: 1.78-4.17) (p=0.08). No Malays with ET were identified. The data suggest that the prevalence of ET increases with age, is higher in males and may be higher amongst Indians.     

Spectrophotometric analysis of raloxifene hydrochloride in pure and pharmaceutical formulations

Two simple and sensitive spectrophotometric methods (A and B) for the determination of raloxifene hydrochloride in bulk samples and pharmaceutical formulations are described. Method A is based on the oxidation of the drug with ferric chloride and coupling with potassium ferric cyanide. Method B is based on reduction of the drug with Fehling's reagent. Bluish green color formed in method A absorbs at 735 nm and brown color produced in method B absorbs at 430 nm.