False negative orbital fine needle biopsy

Orbital fine needle aspiration biopsy is a useful diagnostic adjuvant. In this case, an FNAB showed lymphocytes. The surgeon felt that this diagnosis was possibly inaccurate, and therefore took out the tumor en bloc. This was a mucoepidermoid carcinoma involving the lacrimal gland that had been heavily infiltrated by lymphocytes.     

Shear stress influences the pluripotency of murine embryonic stem cells in stirred suspension bioreactors

Pluripotent embryonic stem cells (ESCs) have been used increasingly in research as primary material for various tissue‐engineering applications. Pluripotency, or the ability to give rise to all cells of the body, is an important characteristic of ESCs. Traditional methods use leukaemia inhibitory factor (LIF) to maintain murine embryonic stem cell (mESC) pluripotency in static and bioreactor cultures. When LIF is removed from mESCs in static cultures, pluripotency genes are downregulated and the cultures will spontaneously differentiate. Recently we have shown the maintenance of pluripotency gene expression of mESCs in stirred suspension bioreactors during differentiation experiments in the absence of LIF. This is undesired in a differentiation experiment, where the goal is downregulation of pluripotency gene expression and upregulation of gene expression characteristic to the differentiation. Thus, the objective of this study was to examine how effectively different levels of shear stress [100 rpm (6 dyne/cm²), 60 rpm (3 dyne/cm²)] maintained and influenced pluripotency in suspension bioreactors. The pluripotency markers Oct‐4, Nanog, Sox‐2 and Rex‐1 were assessed using gene expression profiles and flow‐cytometry analysis and showed that shear stress does maintain and influence the gene expression of certain pluripotency markers. Some significant differences between the two levels of shear stress were seen and the combination of shear stress and LIF was observed to synergistically increase the expression of certain pluripotency markers. Overall, this study provides a better understanding of the environmental conditions within suspension bioreactors and how these conditions affect the pluripotency of mESCs. Copyright © 2012 John Wiley & Sons, Ltd.     

Epstein-Barr virus genome load is increased by therapeutic vaccination in HIV-l carriers, and further enhanced in patients with a history of symptomatic primary infection

Objective

Epstein–Barr virus (EBV) infection is an established risk factor for B-cell lymphomas in Human Immunodeficiency virus (HIV)-1 infected patients. A disturbed EBV-host relationship is seen in patient groups with a high risk for EBV-associated lymphomas. We have analysed this relationship by measuring EBV-DNA in the blood of HIV-1 carriers.

Method

EBV-DNA load in B-cells was monitored by PCR in non- or insufficiently antiretroviral treated and rgp160-vaccinated HIV-patients.

Results

Both asymptomatic HIV-infected and AIDS-patients showed a 25–40-fold increase in the number of B cell associated EBV-DNA copies compared to healthy controls. Patients included in a vaccine trial with recombinant HIV gp160 showed a 5-fold increase of EBV load compared to non-immunised patients and a 50-fold increase compared to healthy controls. There was no difference whether they received vaccine or “placebo”. Vaccinated patients with a history of symptomatic primary HIV-1 infection (PHI) had a 280-fold increase in median EBV load compared to healthy controls, thus suggesting a synergistic effect between the vaccination and PHI, which hypothetically could affect lymphoma risk.

Conclusions

We recommend analysis of EBV-load and long term follow up of lymphoma risk in all therapeutic HIV-1 vaccination trials.     

Outcomes of liver-first strategy and classical strategy for synchronous colorectal liver metastases in Sweden

Background

Patients with synchronous colorectal liver metastases (sCRLM) are increasingly operated with liver resection before resection of the primary cancer. The aim of this study was to compare outcomes in patients following the liver-first strategy and the classical strategy (resection of the bowel first) using prospectively registered data from two nationwide registries.

Prevalence of carnitine depletion in critically ill patients with undernutrition.

The aim of this study was to evaluate to what extent secondary carnitine deficiency may exist based on the prevalence of subnormal carnitine status in patients with critical illness and abnormal nutritional state. Healthy control patients (n = 12) were investigated and compared with patients with possible secondary carnitine deficiency, ie, patients with overt severe protein-energy malnutrition (PEM, n = 28), postoperative long-term (greater than 14 days) parenteral glucose feeding (250 g glucose/d, n = 7), severe liver disease (n = 10), renal insufficiency (n = 7), and sustained septicemia with increased metabolic rate (n = 8). Nutritional status, energy expenditure, creatinine excretion, and blood biochemical tests were measured in relationship to free and total carnitine concentrations in plasma and skeletal muscle tissue, as well as urinary excretion of free and total carnitine. The overall mortality rate was 48% within 30 days of the investigation in study patients with the highest mortality in liver disease (90%). The hospitalization range was 14 to 129 days in study patients. Most study patients had lost weight (4% to 19%) and had abnormal body composition. Patients with liver disease, septicemia, renal insufficiency, and those on long-term glucose feeding had significantly higher than predicted metabolic rate (+25% +/- 3%), while patients with severe malnutrition had decreased metabolic rate compared with controls. Patients with liver disease had increased plasma concentrations of free (96 +/- 16 mumol/L) and total (144 +/- 27 mumol/L) carnitine compared with controls (45 +/- 3, 58 +/- 7 mumol/L, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)     

Medication management in older adults and interprofessional education: A needs assessment

ABSTRACT

Elderly, multi-morbid patients are at high risk for suffering adverse drug events. Safe medication management is a key process in preventing these adverse events, and requires interprofessional teamwork. We performed a needs assessment survey of graduating medical students and faculty to evaluate student training in medication management, in particular students’ preparedness in the three minimum geriatrics competencies pertaining to medication management, interprofessional educational opportunities, and optimal learning methods. Response rates were 45/105 (43%) for students and 38/93 (41%) for faculty. The majority of students felt that they did not receive sufficient training in medication management in older adults. Faculty either agreed with students or were unsure whether students received sufficient training. Neither students nor faculty felt that students were extremely prepared to carry out the three minimum geriatrics competencies at the time of medical school graduation. Students and faculty identified direct patient care experiences as the optimal learning method, and inappropriate medications as the highest priority topic. Students and faculty felt that students do not receive sufficient interprofessional educational opportunities. The results of this study are currently being used to create customized interprofessional educational experiences for medical students related to medication management in older adults.     

Comparative evaluation of synthetic anti-HER2 Affibody molecules site-specifically labelled with <Superscript>111</Superscript>In using N-terminal DOTA,NOTA and NODAGA chelators in mice bearing prostate cancer xenografts

Purpose  

In disseminated prostate cancer, expression of human epidermal growth factor receptor type 2 (HER2) is one of the pathways to androgen independence. Radionuclide molecular imaging of HER2 expression in disseminated prostate cancer might identify patients for HER2-targeted therapy. Affibody molecules are small (7 kDa) targeting proteins with high potential as tracers for radionuclide imaging. The goal of this study was to develop an optimal Affibody-based tracer for visualization of HER2 expression in prostate cancer.     

An experimental model for studies of zinc bioavailability from milk and infant formulas using extrinsic labeling

The ability to assess zinc bioavailability from various diets is essential as the zinc content on many foods can be low or marginal. We have investigated the absorption of zinc from human milk, cows' milk, cows' milk formula (whey-adjusted) and soy protein formula as these fluids can comprise the majority of an infant's diet. Radiozinc was added to the diets in tracer amounts. The extrinsic 65Zn was shown by ultracentrifugation, ultrafiltration, and gel filtration to add to milk fractions and individual binding compounds in a manner analogous to the distribution of native zinc, validating the use of extrinsically labeled milk diets. Labeled diets were fed by intubation to 16-day-old suckling rats. Animals were killed after 4 h and tissues removed and counted. Zinc bioavailability was 28% from human milk, 24% from whey-adjusted cows' milk formula, 15% from cows' milk, and 10% from soy formula. Intubation studies using adult rats showed that zinc absorption was lower from all the diets; however, it was still highest from human milk and cows' milk formula. These results show that the rat pup model may provide a rapid, inexpensive, and sensitive method to assay bioavailability of zinc from infant foods.     

A new simplified dietary history method for measuring intake of energy and macronutrients.

In this dietary history method, which preserves the characteristic features of the full dietary history, the principle of simplification is to group several food items into common codes. This enables us to complete both an interview and all nutrient calculations within 35-45 min. In this study we investigated whether the method could replace a 4-day food record for assessing individual intakes of energy and macronutrients. Dietary data were collected from 75 individuals (57 males and 18 females). Protein intake was validated by comparison with 24 h urinary nitrogen excretion (33 subjects), and energy intake was compared to weight maintenance energy intake from a later controlled diet study (19 subjects). When average intakes according to the two methods were compared, dietary history intakes were slightly higher than food record results (0-13%) except for alcohol. Comparison with urinary nitrogen excretion and energy intake data indicate that this is due to an overestimation by the dietary history method, rather than an underestimation by the food record. For individuals most of the correlations between the two methods were in the range 0.5-0.7, but alcohol correlation was down to 0.2. About 75% (53-93%) of the individuals at the extremes of the intake distribution were classified similarly by both methods. Although the ability of the dietary history to predict the individual food record results was unreliable the two methods agreed better when classifying individuals relative to certain cut-off points (sensitivity and specificity values of 0.7-0.9, relative to the food records).(ABSTRACT TRUNCATED AT 250 WORDS)