Bacteroides fragilis vertebral osteomyelitis: case report and a review of the literature

BACKGROUND: To review the presentation of Bacteroides fragilis (B fragilis) spondylodiscitis. METHODS: Two investigators independently searched the published English, Spanish and French languages literature through September 2005 using MEDLINE (1966-2005). We included all reported cases of vertebral osteomyelitis or spondylodiscitis caused by B fragilis, not related to sacral decubitus ulcers, in adults (age 16 yr and above). A third author independently reviewed all articles and extracted data for accuracy. The final pool of eligible publications included 11 articles, publication dates ranging from 1978 to 2005. Eight were written in English, two in Spanish, and one in French. RESULTS: The age of the patients in this series ranged from 17 to 74 years, with a mean age of 55 years. Male to female ratio was 6:1. Lumbar involvement was reported in nine cases, thoracic involvement in two patients and sacral involvement in one patient. B fragilis was recovered by blood culture in four patients and by tissue culture in eight patients. Metronidazole was the most common antibiotic used for treatment (eight patients), either as monotherapy or in combination with other antibiotics. CONCLUSIONS: B fragilis is a rare causative agent of spondylodiscitis, but it should be considered in patients with spondylodiscitis who have contiguous intraabdominal or pelvic infections or who had recent gastrointestinal procedures that may have led to B fragilis bacteremia.     

TNF-alpha and CXCL-10 correlation with insulin resistance in patients with chronic hepatitis C virus infection

There are increasing reports of association between HCV infection and type-2 diabetes mellitus. Although the mechanism by which this association remains uncertain, development of insulin resistance may explain this association. We investigated the association of TNF-alpha and CXCL-10 with insulin resistance in HCV infected patients. Forty-four non-diabetic chronic hepatitis C patients and twenty healthy individuals were included. Fasting blood was used for glucose and insulin measurements. Diagnosis of insulin resistance (IR) was based on a mathematical means by the homeostasis model assessment score-insulin resistance index (HOMA-IR). Serum insulin, TNF-alpha and CXCL-10 levels were measured by enzyme linked immunosorbent assay (ELISA). Quantitative measurement of hepatitis C virus was performed by a standardized real time PCR assay. The HCV patients demonstrated a significant increase in serum TNF-alpha, CXCL-10, and HOMA-IR values as compared to normal controls. HOMA-IR level positively correlated with hepatitis C viral load, TNF-alpha and CXCL-10. It is concluded that, TNF-alpha, CXCL-10 correlate with IR and may play a role in the development of type-2 diabetes mellitus in chronic hepatitis C infected patients.     

Identifying the subproteome of kinetically stable proteins via diagonal 2D SDS/PAGE

Most proteins are in equilibrium with partially and globally unfolded conformations. In contrast, kinetically stable proteins (KSPs) are trapped by an energy barrier in a specific state, unable to transiently sample other conformations. Among many potential roles, it appears that kinetic stability (KS) is a feature used by nature to allow proteins to maintain activity under harsh conditions and to preserve the structure of proteins that are prone to misfolding. The biological and pathological significance of KS remains poorly understood because of the lack of simple experimental methods to identify this property and its infrequent occurrence in proteins. Based on our previous correlation between KS and a protein's resistance to the denaturing detergent SDS, we show here the application of a diagonal 2D (D2D) SDS/PAGE assay to identify KSPs in complex mixtures. We applied this method to the lysate of Escherichia coli and upon proteomics analysis have identified 50 nonredundant proteins that were SDS-resistant (i.e., kinetically stable). Structural and functional analyses of a subset (44) of these proteins with known 3D structure revealed some potential structural and functional biases toward and against KS. This simple D2D SDS/PAGE assay will allow the widespread investigation of KS, including the proteomics-level identification of KSPs in different systems, potentially leading to a better understanding of the biological and pathological significance of this intriguing property of proteins.     

胸腔镜内乳淋巴结清扫:一种针对乳腺癌内乳淋巴结的分期技术(英文)

Objective  

The aim of our study was to investigate the feasibility and safety of thoracoscopic internal mammary lymphadenectomy as a method to refine and thereby improve nodal staging in breast cancer.     

Laparoscopic hysterectomy in the treatment of endometrial cancer: NCI experience

BackgroundThe standard treatment for women with endometrial cancer is total abdominal hysterectomy and pelvic lymphadenectomy for surgical staging. Total laparoscopic radical hysterectomy (TLH) is an alternative approach providing surgical and patient related advantages to laparoscopy.MethodsTwenty female patients with early stage endometrial cancer were operated upon by TLH and pelvic lymphadenectomy, aiming to assess the safety and efficacy of TLH.ResultsThe mean operative time was 296.8 min conversion to laparotomy was done in one patient due to bleeding from the uterine vessels. The mean blood loss was 517.5 cc. The uterus was removed transvaginally in 18 patients (90%) and via a small Pfannenstiel incision in two patients (10%). The mean number of pelvic lymph nodes retrieval was 21.2. Postoperative bleeding occurred in one patient (5%) which necessitated exploration. One patient (5%) suffered a pulmonary embolism. Four patients (20%) developed pyrexia, and one patient (5%) suffered from a chest infection. One patient (5%) had wound infection. The mean hospital stay was 4.5 days (range 3–10).ConclusionTLH with pelvic lymphadenectomy is a safe and effective approach in the treatment of early endometrial carcinoma.     

Immunoadjuvant capacity of flagellin and mannosamine-coated poly(anhydride) nanoparticles in oral vaccination

Bioadhesive poly(anhydride) nanoparticles coated with mannose (M-NP) or Salmonella Enteritidis derived flagellin (F-NP) were designed to be applied in oral vaccination strategies using ovalbumin (OVA) as antigen model. Nanoparticles formulations (OVA-M-NP, OVA-F-NP and control OVA-NP) were characterized and evaluated in BALB/c mice. OVA-M-NP and OVA-F-NP displayed a size of about 300–400 nm and were efficiently coated with the respective ligand, Systemic and mucosal immune responses reported after S.C. and oral administration, indicated that a single dose of OVA-M-NP and OVA-F-NP, elicited higher and balanced systemic specific antibody responses [IgG1 (Th2-response) and IgG2a (Th1-response)] compared to non-coated ones. In addition, oral immunization using OVA-M-NP or OVAF-NP was able to elicit a higher levels of intestinal secretory IgA compared to S.C. In summary, oral immunization by bioadhesive mannosylated or flagellin nanoparticles demonstrated strong long lasting systemic and mucosal immune responses than the respective non-conjugated vectors.     

In vivo and in vitro adjuvant activities of the B subunit of Type IIb heat-labile enterotoxin (LT-IIb-B5) from Escherichia coli

The pentameric B subunit of the Escherichia coli LT-IIb enterotoxin (LT-IIb-B₅) activates TLR2 signaling in macrophages. Herein we demonstrate that LT-IIb-B₅, in contrast to a TLR2-nonbinding point mutant, induces functional activation of bone marrow-derived dendritic cells and stimulates CD4⁺ T cell proliferation, activities which suggested that LT-IIb-B₅ might function as an adjuvant in vivo. Indeed, in an intranasal mouse immunization model, LT-IIb-B₅ augmented specific mucosal and serum antibody responses to a co-administered immunogen, at levels which were almost comparable to those induced by intact LT-IIb holotoxin, a potent but toxic adjuvant. Therefore, LT-IIb-B₅ displays useful adjuvant properties which, combined with lack of enterotoxicity and relative stability against degradation, may find application in mucosal vaccines.     

Induction Docetaxel and Cisplatin Followed by Weekly Docetaxel and Cisplatin with Concurrent Radiotherapy in Locally Advanced Stage III Non Small Cell Lung Cancer (LA-NSCLC)-A Phase II Study

Purpose: The objective of this phase II study was to document the activity and to evaluate the toxicity of docetaxel and cisplatin as induction chemotherapy followed by concurrent docetaxel and cisplatin with thoracic radiation in locally advanced stage III non small cell lung cancer. Patients and Methods: Twenty-seven patients with stage III locally advanced non-small cell lung cancer received induction chemotherapy with two cycles of docetaxel 75mg/m2 and cisplatin 75mg/m2 D1 every 3 weeks. Patients without disease progress after induction chemotherapy were assigned to concurrent chemoradiotherapy 20mg/m2 docetaxel&25mg/m2 cisplatin administrated on day 1 every week for 6 weeks along with concurrent radiotherapy at a dose of 60Gy in 30 fractions (2 Gy/fraction and 5 fractions per week). The primary endpoint was to determine the overall response rate (ORR), the secondary endpoint was to evaluate time to progression (TTP) and safety profile. Results: After induction chemotherapy, the overall response rate (ORR) was 44.4%, 23 patients without disease progress were assigned to concurrent treatment with an overall response rate of 65%. Median survival time was 17 months, time to progression was 11.5 months and the one-year survival was 58%. Neutropenia was the most common toxicity during induction therapy (26% expressed grade 3-4) whereas esophagitis was the most common toxicity during concurrent phase (17.3% expressed grade 3-4); toxicities were manageable. Conclusion: Induction chemotherapy by docetaxel and cisplatin followed by weekly docetaxel and cisplatin with concurrent thoracic radiation therapy is feasible and tolerable. These results warrant further large randomized studies to document and confirm the effectiveness of this regimen. Key Words: Lung cancer , Docetaxel , Cisplatin , Concurrent chemoradiotherapy.