Anticardiolipin antibodies in children on chronic haemodialysis

IgG and IgM anticardiolipin antibody (Ab) concentrations weredetermined in serum samples of 48 children with end-stage renaldisease (ESRD) on haemodialysis using ELISA technique in anattempt to analyse their possible role in the occurrence ofthrombosis of the vascular access. Ten normal healthy childrenwere studied as a control group. The positivity of anticardiolipinAb isotypes both IgM and IgG was high in children with ESRDon haemodialysis. Children with positive anticardiolipin Abhad significantly higher incidence of prior thrombosis of vascularaccess. Also, these antibodies should be considered as markersof high risk for fistula thrombosis.     

Flecainide excretion in human breast milk

Healthy human volunteers who intended not to breast feed were placed on a regimen of 100 mg oral flecainide every 12 hours for 5 1/2 days beginning 1 day after parturition. Milk and blood samples were collected during the dosing period and for 2 days after the last dose. Concentrations of flecainide in milk and plasma were assayed by HPLC. Apparent steady-state levels of flecainide in both milk and plasma were achieved in most cases by day 4 of the study. Highest daily average concentration of flecainide in milk ranged from 270 to 1529 ng/ml for the 11 subjects. Mean +/- SD milk to plasma flecainide ratios were 3.7 +/- 3.5, 3.2 +/- 2.3, 3.5 +/- 2.1, and 2.6 +/- 0.7 on study days 2, 3, 4, and 5, respectively. After the last dose of flecainide, peak milk levels of the drug occurred at 3 to 6 hours and then declined monoexponentially. The half-life for elimination of flecainide from milk was 14.7 +/- 3.5 hours and is very similar to the plasma elimination half-life of flecainide in healthy human subjects. The mean milk to plasma ratios for flecainide after the last dose were 2.3 +/- 1.0 and 2.9 +/- 1.1 at 24 and 48 hours after the dose, respectively. Based on the pharmacokinetics of flecainide in infants, the expected average steady-state plasma concentration of flecainide in a newborn infant consuming all of the milk production of its mother (approximately 700 ml/day) would not be expected to exceed about 62 ng/ml.(ABSTRACT TRUNCATED AT 250 WORDS)     

Aggressive primary thyroid non Hodgkin's lymphoma with pregnancy

We present here a multigravida patient who presented with a huge neck swelling, severe respiratory distress together with dysphagia and hoarseness of voice while she was pregnant +/- 30 weeks of gestation. She was diagnosed as an aggressive non-Hodgkin lymphoma of the thyroid gland. She was treated by 6 cycles of chemotherapy, with dramatic response after receiving the first cycle. She had 3 cycles of 4 chemotherapeutic agents before successful, elective and scheduled induction of labor at 36 weeks of gestation with favorable outcomes.     

Transendothelial migration enhances integrin-dependent human neutrophil chemokinesis

Transendothelial migration of neutrophils induces phenotypic changes that influence the interactions of neutrophils with extravascular tissue components. To assess the influence of transmigration on neutrophil chemokinetic motility, we used polyethylene glycol hydrogels covalently modified with specific peptide sequences relevant to extracellular matrix proteins. We evaluated fMLP-stimulated human neutrophil motility on peptides Arg-Gly-Asp-Ser (RGDS) and TMKIIPFNRTLIGG (P2), alone and in combination. RGDS is a bioactive sequence found in a number of proteins, and P2 is a membrane-activated complex-1 (Mac-1) ligand located in the gamma-chain of the fibrinogen protein. We evaluated, via video microscopy, cell motility by measuring cell displacement from origin and total accumulated distance traveled and then calculated average velocity. Results indicate that although adhesion and shape change were supported by hydrogels containing RGD alone, motility was not. Mac-1-dependent motility was supported on hydrogels containing P2 alone. Motility was enhanced through combined presentation of RGD and P2, engaging Mac-1, alpha(V)beta(3), and beta(1) integrins. Na?ve neutrophil motility on combined peptide substrates was dependent on Mac-1, and alpha(4)beta(1) while alpha(6)beta(1) contributed to speed and linear movement. Transmigrated neutrophil motility was dependent on alpha(v)beta(3) and alpha(5)beta(1), and alpha(4)beta(1), alpha(6)beta(1), and Mac-1 contributed to speed and linear motion. Together, the data demonstrate that efficient neutrophil migration, dependent on multi-integrin interaction, is enhanced after transendothelial migration.     

Erythropoietin in cancer patients with anemia

OBJECTIVE: The aim of this study is to evaluate the endogenous erythropoietin production in cancer patients with anemia. METHODS: Our prospective study interested 99 cancer patients with anemia from 17 to 80 years old, during the period going from March 2002 to December 2004, and 31 healthy individuals with anemia caused by iron deficiency. A blood sample was collected from each patient, as well as healthy individuals to measure serum erythropoietin, C reactive protein and ferritin. RESULTS: The increase of serum erythropoietin was significantly lower in patients than in healthy individuals (P < 0.05). 25.2% of our cancer patients have inflammatory anemia and 74.7% presented microcytic anemia associated with increase of serum ferririn and CRP. These values were significantly higher than in healthy individuals (p < 0.05). CONCLUSION: Anemia in cancer patients results from activation of inflammatory system, which inhibit erythropoietin production. Apart from etiologic treatments, anemia can be treated with recombinant human erythropoietin.     

Drug metabolism and clearance system in tumor cells of patients with multiple myeloma

Resistance to chemotherapy is a major limitation of cancer treatments with several molecular mechanisms involved, in particular altered local drug metabolism and detoxification process. The role of drug metabolism and clearance system has not been satisfactorily investigated in Multiple Myeloma (MM), a malignant plasma cell cancer for which a majority of patients escapes treatment. The expression of 350 genes encoding for uptake carriers, xenobiotic receptors, phase I and II Drug Metabolizing Enzymes (DMEs) and efflux transporters was interrogated in MM cells (MMCs) of newly-diagnosed patients in relation to their event free survival. MMCs of patients with a favourable outcome have an increased expression of genes coding for xenobiotic receptors (RXRα, LXR, CAR and FXR) and accordingly of their gene targets, influx transporters and phase I/II DMEs. On the contrary, MMCs of patients with unfavourable outcome displayed a global down regulation of genes coding for xenobiotic receptors and the downstream detoxification genes but had a high expression of genes coding for ARNT and Nrf2 pathways and ABC transporters. Altogether, these data suggests ARNT and Nrf2 pathways could be involved in MM primary resistance and that targeting RXRα, PXR, LXR and FXR through agonists could open new perspectives to alleviate or reverse MM drug resistance.     

Sagittal alignment and kinematics at instrumented and adjacent levels after total disc replacement in the cervical spine

Background

The purpose of the study was to report radiological outcomes after total disc replacement (TDR) in the cervical spine through a 24 months follow-up (FU) prospective study with a special focus on sagittal alignment and kinematics at instrumented and adjacent levels.

Materials and methods

Thirty-two patients, who sustained one-level TDR with a ball-and-socket arthroplasty (Discocerv^™ implant, Scient’x/Alphatec Spine, USA) were consecutively included in the study. Clinical (visual analogical scale and neck disability index) and radiological parameters were measured preoperatively and postoperatively at 3/6 months, 1-year and 2-year FU. Sagittal alignment, ranges of motion (ROM) and center of rotations (CORs) were analyzed using specific motion analysis software (Spineview^™, Paris, France). Patients CORs were compared with those of a control group of 39 normal and asymptomatic subjects.

Results

Both local and C3–C7 lordosis significantly increased postoperatively (+8° and +13° at 2 years, respectively). At instrumented level ROM in flexion–extension (FE) was measured to 10.2° preoperatively versus 7.5° at 1 year and 6.1° at 2 years. There were no differences in ROM at adjacent levels between pre and postoperative assessments. When compared with control group and preoperative measurements, we noted postoperative cranial shift of the COR at instrumented level for patients group. In contrast, there was no difference in CORs location at adjacent levels.

Conclusion

Through this prospective study, we observed that cervical lordosis consistently increased after TDR. In addition, although ball-and-socket arthroplasty did not fully restore native segmental kinematics with significant reduction of motion in FE and consistent cranial shift of the COR, no significant changes in terms of ROM and CORs were observed at adjacent levels.     

Determinants for the use of ambulation AIDS in a geriatric rehabilitation care unit: a retrospective study

ObjectivesThis study aimed at assessing the profile of ambulation aid users among patients admitted for geriatric rehabilitation care.DesignRetrospective chart review.SettingGeriatric Rehabilitation Department of the Hôpital Albert Chenevier, Créteil, France.ParticipantsThe sample comprised 206 records of patients aged 65 or older with no previous use of assistive device before admission and length of stay longer than 7 days.MeasurementsAmbulation levels were classified as independent ambulators (IA, reference category), ambulation aid users (AA), or nonambulatory patients (NA). we explored age, gender, purpose of initial admission, comorbidities, and past medical history as factors potentially associated with ambulation levels, using multinomial logistic regression.ResultsThe study population (mean age 84 years [6.1 standard deviation], 68.5 % women) comprised 110 IA (53.4% of the overall population), 72 AA (34.9%), and 24 NA (11.6%). Factors independently associated with AA use were the following: older age (odds ratio = 1.17; [95% confidence interval 1.09–1.25]), previous history of lower limb surgery (2.15; [1.0–4.73]), and admission for hip surgery (8.14; [2.60–25.53]). Factors independently associated with NA were the following: older age (1.12 [1.02–1.23]) and low Mini-Mental State Exam score (0.77 [0.70–0.85]). A borderline association was observed for visual impairment (3.36 [0.93–12.95]). Cardiac disease, respiratory disease, falls, and dementia were not associated with ambulation aid use.ConclusionsHistory of lower-limb surgery, particularly recent hip surgery, and old age are the primary predictive factors of ambulation aid use in a geriatric rehabilitation hospital.