Influence of diet,vitamins and chemotherapeutic agents on gastrointestinal cancer

Abstract Dietary influences play a major role in the pathogenesis of most gastrointestinal malignancies. However, it has been difficult to define which dietary components will be most significant for any given individual. In this article we discuss the methodological challenges to research in this field as well as recent observations that have been made on the role of dietary factors in specific digestive tract neoplasms.     

A Decade of Clinical Trial Developments in Postmyocardial Infarction, Congestive Heart Failure, and Sustained Ventricular Tachyarrhythmia Patients: From CAST to AVID and Beyond

A Decade of Clinical Trials. Multiple trials using antiarrhythmic drugs, pharmacologic therapy, and implantable cardioverter defibrillators have been performed in an attempt to improve survival in patients: (1) postmyocardial infarction; (2) with congestive heart failure, with and without nonsustained ventricular tachycardia; and (3) with sustained ventricular tachycardia and those who have survived an out-of-hospital cardiac arrest. This article reviews some of the key findings and limitations of completed and ongoing trials. We also make recommendations for the current treatment of such patients based on the results of these trials.     

Evaluation of recombinant protein r140, a polypeptide segment of tegumental glycoprotein Sm25, as a defined antigen vaccine against Schistosoma mansoni

To investigate the role of tegumental glycoprotein Sm25 in protective immunity against schistosomiasis, codons 43-182 of its gene (GP22) were amplified by PCR and cloned in the pET 15b bacterial expression system. Recombinant protein r140 was inducibly expressed in the presence of rifampicin and purified by Ni-affinity chromatography. In different vaccination trials, Balb/c mice and Fischer rats repeatedly immunized with r140 in combination with one of several adjuvants (alum, cholera toxin or complexed into proteosomes) produced high titre anti-r140 responses. These antibodies detected an N-glycanase sensitive, 25 kDa antigen in a detergent solubilized worm fraction using Western immunoblotting. The choice of adjuvant affected the isotype distribution of the specific anti-r140 antibodies. Despite the presence of high antibody titres and isotypes which have been shown to correlate with protective immunity, protection against subsequent cercarial challenge was not observed. In addition, no appreciable effects on worm sex ratios or liver egg yields were detected in mice. Studies involving biotin labelling of membrane proteins in live worms showed that the majority of anti-r140 reactive molecules present in adult schistosomes are biotinylated after permeabilization of the parasite surface. Several possibilities to account for the lack of protective immunity are analysed .     

Reproducible Induction of "Atypical" Torsades de Pointes by Programmed Electrical Stimulation:

Sotalol-Induced Polymorphic VT. We present a patient with sotalol-induced polymorphic ventricular tachycardia that was seen only with programmed ventricular stimulation. Electrophysiologic studies performed prior to initiation of sotalol therapy revealed inducible monomorphic ventricular tachycardia. Possible underlying electrophysiologic mechanisms are discussed.     

The Characterization of Human Transmyocardial Impedance during Implantation of the Automatic Internal Cardioverter Defibrillator

We set out to determine in a prospective fashion the characteristics of energy delivery related to defibrillation in a population of patients receiving the AICD. Specifically, we examined the characteristics of the delivered current, transmyocardial voltage, and transmyocardial impedance. Secondly, we determined the relationship between the energy delivered, the impedance encountered and the defibrillation threshold. Since the AICD will deliver a succession of shocks if the initial shock does not cardiovert, the effects of consecutive shocks at different energy levels on the transmyocardial impedance were also assessed.     

Transtelephonic Monitoring and Transmission of Stored Arrhythmia Detection and Therapy Data From an Implantable Cardioverter Defibrillator

A new transtelephonic monitoring device designed for use with implantable Cardioverter defibrillators (ICDs) was evaluated. It is capable of interrogating ICDs and transmitting the following data via telephone: programmed parameters (e.g., ventricular tachycardia [VT] and ventricular fibrillation [VF] detection, therapies), number of VT and VF episodes, identification of successful therapies, the 20 cycle lengths preceding the last episode detected, the 10 cycle lengths after the last delivered therapy, battery voltage, and real-time transmission of the patient's rhythm. Eighteen patients (mean age 64 ± 17years; 15 males) were implanted with an ICD and epicardial lead system. The patients who did not live near the primary hospital were provided with this transmitter and instructed to transmit monthly and whenever presyncope, syncope, or a shock were experienced. Five hundred ten episodes of spontaneous arrhythmia (495 VT, 15 VF) were detected in 14 of 18 patients in a 24-month period and the success of each therapy (antitachycardia pacing, cardioversion 0.4-34 J, defibrillation 34 J) was analyzed. The number of therapies delivered and their success (%) in terminating the arrhythmia were: 380 ramp/86%, 116 burst/84%, 119 cardioversion/57%, and 15 defibrillations/ 100%. Sixty-three (42%) of the 152 transmissions indicated an arrhythmia. Twenty-five (16%) of the 152 were transmitted because of symptoms. Sixteen (9.7%) of 165 VT episodes could not be terminated by the full set of programmed VT therapies. Analysis of the pre- and post-episode intervals along with the patient's transmitted rhythm indicated that sinus tachycardia or atrial fibrillation were likely responsible for these episodes. The transmitted data included the real-time ECG, which provided acute rhythm status plus stored data from the ICDs memory identifying the chronic arrhythmias detected, the therapies delivered, and the number and type of successful and ineffective therapies. This information provided the clinical data to the primary physician in order to determine the effectiveness of the programmed detection and therapy parameters and in some cases recommend to the home physician modifications to the device parameters or medication adjustments for enhanced arrhythmia control. We conclude that telephone transmission of stored ICD data is feasible and useful for patient management. It may obviate the need for patients experiencing symptoms to return to a site capable of device interrogation.