Chronic cholecystitis in elderly patients. Correlation of the severity of inflammation with the number and size of the stones

BACKGROUND: [corrected] The present study focused on cholecystectomized elderly patients and aimed to investigate whether inflammation in the gallbladder wall was associated with the number and size of gallstones, as well as the patients' age. PATIENTS AND METHODS: The present study included 306 cholecystectomized patients aged over 65 years. From the specimens derived from cholecystectomy, the gallstone number, the largest gallstone diameter and gallbladder wall thickness were determined. According to the histopathological examination, chronic inflammation was subdivided into mild-moderate and severe. Univariable analysis and multivariable logistic regression followed. RESULTS: Mild-moderate inflammation characterized 63.4% of the cases and severe inflammation 366%. Solitary gallstones were found in 13.1% of the cases, while multiple gallstones were found in 86.9% of the cases. The largest gallstone diameter was less than 1 cm in the majority of cases (73.2%). The gallbladder wall thickness was associated with the degree of inflammation (p < 0.001, Chi-square). In the univariable analysis, inflammation was positively associated with the diameter of the largest gallstone (p = 0.032, Chi-square), but negatively associated with the number of gallstones (p < 0.001, Chi-square) and patients' age (p = 0.008, logistic regression). The number of gallstones was negatively associated with the diameter of gallstones and positively associated with the patients' age. The diameter of the largest gallstone was negatively associated with the patients' age. In the multivariable logistic regression, the effect of age (OR = 0.95, 95% CI: 0.91-0.99) and solitary gallstones (OR = 2.66, 95% CI: 1.02-6.93) on inflammation persisted, but that of the largest gallstone diameter vanished. CONCLUSION: The elderly population presented mainly with multiple and small gallstones. Solitary gallstones and younger age were the most important predictors for severe inflammation.     

The economic burden of atherothrombosis in Greece: results from the THESIS study

The aim of this study was to estimate the total annual cost of patients with or at risk for atherothrombosis in Greece. A multicentre, cost-of-illness study was conducted between January 2007 and December 2009. In the study, 800 patients with coronary artery disease, cerebrovascular disease, or peripheral artery disease (PAD) or multiple cardiovascular risk factors (MRF) were recruited. Direct and indirect cost data were assessed at patients’ enrolment in the study, and at 6 and 12 months of follow-up. The annual total cost was €6,017/patient. This cost ranged from €10,098/patient with PAD to €1,813/patient with MRF. The annual direct health-care cost was €5,056/patient. This cost escalates from €1,623/patient with MRF to €8,697/patient with PAD. The total annual expenditures related to atherothrombosis, in Greece, were estimated to be €7.5 billion at the national level. The findings of the current study indicate the high economic burden of atherothrombosis in Greece.     

Unsaturated dideoxy fluoro-ketopyranosyl nucleosides as new cytostatic agents: A convenient synthesis of 2,6-dideoxy-3-fluoro-4-keto-β-d-glucopyranosyl analogues of uracil, 5-fluorouracil, thymine, N-benzoyl cytosine and N-benzoyl adenine

The β-protected nucleosides of uracil (2a), 5-fluorouracil (2b), thymine (2c), N⁴-benzoyl cytosine (2d) and N⁶-benzoyl adenine (2e) were synthesized by condensation of the peracetylated 3-deoxy-3-fluoro-d-glucopyranose (1) with the corresponding silylated bases. The nucleosides were deacetylated and several subsequent protection and deprotection steps afforded the partially acetylated analogues 6a–e. Selective iodination followed by hydrogenation gave the acetylated dideoxy analogues of uracil (8a), 5-fluorouracil (8b), thymine (8c), N⁴-benzoyl cytosine (8d) and N⁶-benzoyl adenine (8e), respectively. Finally, direct oxidation of the free hydroxyl group at the 4′-position of 8a–e, and simultaneous elimination reaction of the β-acetoxyl group, afforded the desired unsaturated 2,6-dideoxy-3-fluoro-4-keto-β-d-glucopyranosyl derivatives 9a–e. The new analogues were evaluated for antiviral and cytostatic activity. Compounds 9a–e were not active against a broad panel of DNA and RNA viruses at subtoxic concentrations. However, they were markedly cytostatic against a variety of tumor cell lines. The compounds should be regarded as potential new lead compounds to be further investigated for anticancer therapy.     

Zinc ion dependent B-cell epitope, associated with primary Sjogren's syndrome, resides within the putative zinc finger domain of Ro60kD autoantigen: physical and immunologic properties

The Ro/La ribonucleoprotein (RNP) complex is composed of the proteins Ro60kD, Ro52kD, and La48kD that are in association with one small cytoplasmic RNA (YRNA). Specific protein-RNA and protein-protein interactions are thought to occur through the RNP and zinc-finger secondary structure elements of the Ro60kD protein. The aim of our study was to investigate the antigenic properties of the zinc finger domain of the Ro60KD autoantigen and its contribution to the formation of Ro/La RNP complex. It was found that the peptide VSLVCEKLCNEKLLKKARIHPFHILIA (Zif-1), which corresponds to the natural sequence of the zinc finger domain (301-327), and the peptide C(Acm)NEKLLKKARIC(Acm), analogous to the intermediate loop 310-319 (Zif-3) of the same domain of Ro60KD, are recognized by the majority of anti-Ro/SSA and anti-La/SSB positive sera (82.6% and 77.1%, respectively) in the absence of zinc ions. The same sera failed to react with Zif-1 peptide in the presence of Zn2+. In contrast, the addition of zinc ions was necessary for the binding of Zif-1 to recombinant Ro52KD as shown by direct binding experiments of the recombinant protein with synthetic peptides. Our data suggest the zinc finger domain of Ro60kD contains a B-cell epitope with high specificity for primary Sjogren's syndrome. Furthermore, depending on the presence of zinc ions, the zinc finger domain of the Ro60KD protein can exist in two different conformational states favoring either an interaction with the Ro52KD protein or binding with autoantibodies.     

Common surgical complications in degenerative spinal surgery

The rapid growth of spine degenerative surgery has led to unrelenting efforts to define and prevent possible complications, the incidence of which is probably higher than that reported and varies according to the region of the spine involved (cervical and thoracolumbar) and the severity of the surgery. Several issues are becoming progressively clearer, such as complication rates in primary versus revision spinal surgery, complications in the elderly, the contribution of minimally invasive surgery to the reduction of complication rate. In this paper the most common surgical complications in degenerative spinal surgery are outlined and discussed.