Same day/next day discharge of burn patients treated with skin grafts

In the past, many patients were admitted for a minimum of 72 h for split-thickness skin grafting (STSG). Several factors have caused us to discharge burn patients on the same day or within 24 h following STSG. We have reviewed outcomes of such patients to determine whether early discharge has an adverse effect on graft outcome and to determine patient acceptance of this new procedure. We retrospectively reviewed charts of patients consecutively treated at our hospital. Two hundred patients were identified. All patients were found to have successful grafts. From our results, we can conclude that patient discharge in less than 24 h following STSG does not predispose patients to poor graft take or other adverse outcomes.     

Enhancing islet engraftment with rosiglitazone

To study the role of a peroxisome proliferator-activated receptor agonist, rosiglitazone, on islet engraftment, streptozotocin-induced diabetic C57BL/6 mice were fed daily rosiglitazone (2.4 mg/kg) for 9 and 31 days starting 2 days before transplantation with 75 and 150 syngeneic islets, respectively. After receiving 75 islets and 9 days of rosiglitazone, half of the treated diabetic mice became normoglycemic at 4 weeks, while none were normoglycemic among those mice that did not receive treatment. After transplanting 150 islets and receiving 31 days of rosiglitazone, 80% of the treated diabetic mice became normoglycemic while the incidence was only 25% for the controls. The insulin content of the islet grafts in the rosiglitazone groups was 0.8 times (75-islet group) and 1.3 times (150-islet group) higher than that of control mice. The insulin content of pancreatic remnants did not differ significantly among all groups. An in vitro study revealed that the glucose-stimulated insulin secretion and insulin content of cultured islets was not different in the presence versus absence of 4.5 or 22.5 micromol/L rosiglitazone. In vitro study revealed that rosiglitazone inhibited the lipopolysaccharide-induced secretion of interleukin-1 beta and interferon-gamma from peritoneal exudate cells. In conclusion, our data suggest that short-term administration of rosiglitazone enhances islet engraftment.     

Effects of insulin sensitizers on islet transplantation

To solve the problems of islet engraftment, we investigated the effects of insulin sensitizers, metformin and rosiglitazone, on the in vitro and in vivo function of mouse islets. The in vitro study was done by culturing 30 isolated C57BL/6 mouse islets with glucose (100 or 300 mg/dL) or rosiglitazone (4.5 mumol/L) for 2, 4, 8, or 12 hours. The in vivo study was performed by syngeneically transplanting 150 C57BL/6 mouse islets under the kidney capsule of streptozotocin-diabetic mice. The metformin group was treated with 200 mg/kg/d in water and the control group was pair-fed the same volume of liquid diet. In the in vitro study, insulin release stimulated by 300 mg/dL glucose (n = 6) was the highest at all time points. That stimulated by rosiglitazone (n = 6) was greater than by 100 mg/dL glucose (n = 6) only at 8 hours. In the recipients treated with metformin (n = 17) and controls (n = 13), the blood glucose decreased and body weight increased gradually after transplantation. However, there was no significant difference between the two groups. Their tolerance to intraperitoneal glucose challenge at 2 and 4 weeks was also comparable. At 4 weeks, 12/17 (71%) in the metformin group and 8/13 (62%) in the control group achieved normoglycemia (P = .60). At 4 weeks, the insulin content of the graft was 8.35 +/- 3.42 mg in the metformin group and 5.28 +/- 4.28 mg in the control group (P = .59). Our data indicate that (1) rosiglitazone stimulated isolated islets to release insulin but was less effective than high levels of glucose; and (2) metformin treatment had no beneficial effect on islet recipients.     

Prevalence of depressive and anxiety disorders in an assisted reproductive technique clinic

BACKGROUND: Little is known about the prevalence of specific depressive and anxiety disorders in women before a new course of assisted reproductive technology treatment. Few studies have adopted the proper psychiatric diagnostic procedures. METHODS: All consecutive women visiting the assisted reproduction clinic of a university-affiliated medical centre, with the intention of starting a new assisted reproduction treatment course, were recruited. A psychiatrist made a diagnosis of psychiatric disorders using a structured interview, the Mini-International Neuropsychiatric Interview (MINI). RESULTS: Of a total of 112 participants, 40.2% had a psychiatric disorder. The most common diagnosis was generalized anxiety disorder (23.2%), followed by major depressive disorder (17.0%), and dysthymic disorder (9.8%). Participants with a psychiatric morbidity did not differ from those without in terms of age, education, income, or years of infertility. Women with a history of previous assisted reproduction treatment did not differ from those without in depression or anxiety. CONCLUSIONS: Depressive and anxiety disorders were highly prevalent among women who visited an assisted reproduction clinic for a new course of the treatment. Demographic features and a history of previous assisted reproduction treatment were not risk factors for these psychiatric morbidities in the assisted reproduction clinic.     

Helping a terminal cancer patient establish hope

Cancer patients who feel a sense of hopelessness concerning the prospects of long-term treatment success may defeat all efforts to stop their diseases. The authors present a case study of a breast cancer patient, a former nursing instructor, who suffered from passiveness, depression, resistance to communication, blunted affect, lack of participation in self-care, and refusal to eat--all resulting from a lack of treatment-related progress. One of the authors established a continuing and active care relationship with the patient. As part of her nursing care plan, she enacted encouraging social interactions, provided medical treatment information, assisted with self-care procedures, and attempted to maintain a constant level of psychological calm. Outcomes included an improved positive attitude toward treatment, enhanced self-control, active participation in self-care, and improved social interaction. The patient was also better able to adapt to her illness and to face an uncertain future.     

Parents' life events and substance use among German adolescent girls: testing a family mediation model

In this cross-sectional study, data from 202 German adolescent girls (ages 13-17 years) and their parents were utilized to test whether the relationship between parents' stressful life events and their daughter's substance use was mediated by higher levels of parents' depressive symptoms, lower quality of the relationship between the parents, and poor parenting behaviour. Structural equation modelling revealed that these family characteristics did not account for the link between parents' stressful life events and adolescent girl's substance use. Further research is needed to better understand the mechanisms that account for such linkages.     

Enhancement of vaccinia vaccine potency by linkage of tumor antigen gene to gene encoding calreticulin

Vaccinia vaccines have become important vectors for antigen-specific immunotherapy. Calreticulin has been shown to enhance MHC class I presentation of linked peptide/protein and may be useful for antigen-specific cancer treatment. An innovative vaccine administering antigen linked to calreticulin via a vaccinia vector may generate a potent antigen-specific antitumor response. We tested the efficacy of linking calreticulin (CRT) to model antigen human papilloma virus type 16 (HPV-16) E7 in the context of a vaccinia vaccine (Vac-CRT/E7). Intraperitoneal vaccination of C57BL/6 mice with Vac-CRT/E7 led to a dramatic increase in E7-specific IFN-gamma-secreting CD8+ T cells and a potent antitumor effect against E7-expressing tumors compared to immunization with Vac-E7 or Vac-CRT. When compared to other chimeric vaccinia vaccines employing various intracellular targeting strategies previously developed in our lab, Vac-CRT/E7 elicited the highest number of E7-specific CD8+ T cells. Thus, vaccination with vaccinia expressing CRT linked to a tumor antigen may represent an advantageous strategy for cancer immunotherapy.     

Expression of cytoplasmic-domain substituted epidermal growth factor receptor inhibits tumorigenicity of EGFR-overexpressed human glioblastoma multiforme

The accumulated results of recent clinical studies have indicated that aberrant epidermal growth factor receptor (EGFR) activation due to gene amplification and/or rearrangement contributes to increased malignancy and poor prognosis in many human cancers, especially in human glioblastoma multiforme (GBM). The elevated EGFR signaling in GBM has been correlated with shorter interval to relapse and lower survival rates, even in patients treated with surgery, radiation therapy, and/or chemotherapy. Therefore, the blockade of EGFR signaling in GBM may provide an ideal alternative therapeutic strategy. In this study, two EGFR-overexpressing human GBM cell lines (i.e., DBTRG and GBM 8901) were used as a model system. We demonstrated that expression of a human EGFR (EGFRt-EGFP) chimera protein in which the cytoplasmic domain is substituted by EGFP significantly reduced the EGF-induced endogenous EGFR autophosphorylation, EGF-induced downstream extra-cellular signal-regulated kinase (ERK) and Akt signaling, and the proportion of internalized receptors in EGF stimulated cells. Furthermore, these cells' anchorage-independent growth in vitro was decreased and their tumorigenicity in vivo abrogated or strongly suppressed. Our data suggest that EGFRt-EGFP abrogates tumor growth by disrupting receptor activation via competing for EGF-like ligands, forming non-activated heterodimers with endogenous EGFR, and inhibiting the EGFR endosomal signaling by substantially diminishing receptor internalization. This treatment modality (termed 'dominant-negative EGFR therapy') and its efficacy for gliomas or other tumors are under scrutiny.     

Excision of mature teratoma using culdotomy, with and without laparoscopy: a prospective randomised trial

Objective To compare the results of removing mature teratoma with laparoscopy or without laparoscopy.
Design A prospective, randomised trial.
Setting Medical centre.
Participants Seventy-nine women with mature teratomas identified using results of ultrasound examinations and biochemical markers.
Intervention Cystectomy with laparoscopic approach or without laparoscopic approach through a culdotomy.
Methods Patients were randomly assigned to have their cysts removed via vaginal cystectomy without laparoscopy (   n= 37, Group A  ) or laparoscopic cystectomy via culdotomy opening (   n= 42, Group B  ). Inclusion criteria were history of vaginal delivery, no previous abdominal surgery, no history of pelvic inflammatory disease, no medical illness, and no presenting symptoms. Eight women randomised to Group A withdrew before surgery. The laparoscopically resected tumours were each put into a cellulose bag, and tumours without laparoscopic-assistance were removed directly via the vagina.
Results Blood loss in Group A (  88±37 ml  ) was significantly more than that in Group B (  64±20 ml, P=0.000  ). The post-operative recovery times were 20 and 17 hours, respectively (  P=0.030  ). The rates of successful surgery were 58.6 and 97.6%, respectively (  P=0.002  ). The spillage rates were 44.8% and 19.0%, respectively (  P=0.006  ). There were no significant differences in tumour size, patient age, and operative time between groups.
Conclusion Cystectomy without assistance of laparoscopy could be applied to manage mature teratoma of the ovary; however, because of the difficulty of this technique, we had high percentages of tumour spillage and more blood loss during operation and a high percentage of patients who required conversion to laparotomy compared with laparoscopic cystectomy. We favoured laparoscopically assisted cystectomy to manage mature teratoma.     

Application of tumor markers CEA, TPA, and SCC-Ag in patients with low-risk FIGO stage IB and IIA squamous cell carcinoma of the uterine cervix

OBJECTIVE: The aim of this study was to determine the potential clinical utility of tumor markers carcinoembryonic antigen (CEA), tissue polypeptide antigen (TPA), and squamous cell carcinoma antigen (SCC-Ag) in patients with FIGO stage IB and IIA squamous cell carcinoma of the uterine cervix with low-risk clinicopathologic factors (negative lymph node metastasis, no lymphovascular space involvement, no bulky tumor size, no parametrial invasion, no deep stromal invasion, and well-differentiated cellular histology). METHODS: A retrospective study was performed on 558 patients with FIGO stage IB-IIA and pathology-proven invasive squamous cell carcinoma of the uterine cervix, treated at the Veterans General Hospital, Taipei, between December 1986 and November 1990. Serum specimens were drawn before operation. A total of 140 assessable patients were enrolled into the study (including 109 stage IB patients and 31 stage IIA patients; all patients had no clinicopathologic risk factors and had at least one tumor marker datum). Survival curves were constructed according to the Kaplan-Meier method and survival curves were compared using the log-rank test. RESULTS: In univariate analysis of survival, CEA, TPA, and SCC-Ag all have roles in the prediction of prognosis. In Cox proportional hazards model using CEA, TPA, and SCC-Ag as covariates, TPA demonstrated the most significant risk factor (P = 0.031). CONCLUSIONS: We concluded that preoperative evaluation of serum TPA might be of great value in the prediction of survival of patients without any clinicopathologic risk factors and this special group of patients should be paid much attention in the follow-up period. From this study, preoperative elevation of TPA defines a group of otherwise low-risk invasive cervical cancer patients who are at high risk for recurrence. Adjuvant therapy might be necessary for this special subset of patients. A prospective study with a larger sample should be conducted to prove this particular finding.