Decreased interleukin-20 level in patients with systemic sclerosis: are they related with angiogenesis?

In this study, we aimed to evaluate the relation between angiogenesis indicators and T helper 17 cytokine group in patients with systemic sclerosis (SSc) which is a disease characterized by impaired angiogenesis and autoimmune response. In our study, patients with SSc are compared with patients with primary Raynaud’s phenomenon (RP) and healthy controls. Forty SSc patients, 18 primary RP cases, and 20 healthy controls were included in our study. The demographic and clinical features of patients with SSc were recorded. The serum levels of vascular endothelial growth factor (VEGF), vascular endothelial (VE)-cadherin, interleukin (IL)-20, IL-22, and IL-23 were assessed. In the SSc group, IL-20 level was significantly lower than in both primary RP group and controls (p values <0.001). VE-cadherin level in SSc was significantly higher than in primary RP (p?=?0.016). The IL-22 and IL-23 and VEGF levels of SSc, primary RP, and control groups were similar (p values >0.05). In SSc patients, IL-23 correlated negatively with VEGF (r?=??0.36, p?=?0.025) and positively with VE-cadherin (r?=?0.55, p?<?0.001). IL-20 levels in SSc patients correlated with disease duration (r?=?0.32, p?=?0.044). SSc patients with limited involvement had significantly higher VE-cadherin levels than SSc patients with diffuse involvement (p?=?0.044). We observed that IL-20 which is an IL-10 group angiogenesis indicator was observed to be suppressed in SSc, suggesting abnormal angiogenesis.     

Application of non-invasive mechanical ventilation in an asthmatic pregnant woman in respiratory failure: a case report

The use of non-invasive mechanical ventilation (NIV) during an asthma attack is controversial. We report a case of a 28-year-old female patient in her 16th week of pregnancy with community-acquired pneumonia who presented during an asthma attack, which led to hypoxic respiratory failure. She was successfully treated using NIV. This case is worth discussing as it includes two clinical conditions in which NIV is often considered contraindicated.KEY WORDS : Mechanical ventilation, pregnant, respiratory failure, severe asthma     

Is there a role for postimplant dosimetry after real-time dynamic permanent prostate brachytherapy?

PURPOSE: To evaluate the correlation of real-time dynamic prostate brachytherapy (RTDPB) dosimetry and traditional postimplant dosimetry for permanent prostate brachytherapy. METHODS AND MATERIALS: A total of 164 patients underwent RTDPB for clinically confined prostate cancer. Of these 164 patients, 45 were implanted with 103Pd and 119 with 125I. Additionally, 44 patients underwent combined external beam radiotherapy and brachytherapy and 120 patients underwent brachytherapy alone. The postimplant dosimetry with computed tomography was performed at 4 weeks and compared with the RTDPB dose plan using the intraclass correlation coefficient. The millicurie/gram of the prostate volume and the percentage of the minimal dose to 90% of the prostate relative to the prescribed implant dose (D90%) of the RTDPB patients was compared with 400 patients treated with a free-seed technique. RESULTS: The mean D90% achieved in the operating room and on the 3-week dose plan was 109% (range, 93-139%) and 105% (range, 88-140), respectively. The mean percentage of prostate volume receiving 100% of the prescribed minimal peripheral dose (V100) achieved in the operating room and on the 3-week dose plan was 93% (range, 78-98%) and 91% (range, 64-98%), respectively. The intraclass correlation coefficient for each calculated relationship was 0.586 for D90 (p<0.001), 1.19 for V100 (p=0.135), 0.692 for the urethral D90 (p<0.001), 0.602 for the maximal rectal dose (p<0.001), 0.546 for D90 with 125I (p<0.001), and 0.565 for D90 with 103Pd (p<0.001). A 12% decrease was noted in the millicurie/gram of the isotope, with a 2.5% increase in the D90 comparing RTDPB and the free-seed technique. CONCLUSION: The results of this study demonstrated a correlation between the dose assessment obtained intraoperatively and postoperatively at 3 weeks. With reliable dose data available in the operating room, our results question the need for routine postimplant dose studies. Furthermore, patients treated with RTDPB received less radioactivity per gram of the prostate with a corresponding small increase in the D90. Future analyses will assess variations in the inverse dose planning rules and the clinical correlation of patients undergoing RTDPB vs. older techniques for toxicity and biochemical outcomes.     

Successful treatment of Trichosporon mucoides infection with lipid complex amphotericin B and 5-fluorocytosine

Infections in immunocompromised children can stem from bacteria, fungi, viruses, or protozoa, but most importantly, from the host's endogenous bacterial flora. Disseminated infection caused by Trichosporon species is one of the emerging mycoses in neutropenic patients, particularly when they are treated for haematological malignancy with cytotoxic and immunosuppressive chemotherapy. We report a 15-year-old boy with acute lymphoblastic leukaemia, whose Trichosporon mucoides infection was successfully treated with lipid complex amphotericin B plus 5-fluorocytosine.     

Factors Influencing Treatment Compliance Among Turkish People at Risk for Stroke

Successful management of stroke risk factors depends on adequate knowledge and self-care. The purpose of this study was to examine the factors affecting treatment compliance among people with modifiable stroke risks. We evaluated modifiable risk factors of stroke, recognition of these factors by patients, and patients' compliance with treatment in a teaching hospital. Semi-structured questionnaires were completed using face-to-face interview techniques. A majority (58.3%) of patients were aware of their risk factors for stroke. Awareness of risk factors was statistically significant for the participants carrying risk factors such as heart disease and hyperlipidemia. Compliance of the participants with treatment was mainly affected by the recognition that their disease could be a risk factor for stroke. Awareness of the presence of multiple risk factors and nonsmoker status were positively associated with treatment compliance. Editors' Strategic Implications: The authors provide evidence that the recognition of risk factors and informative healthcare education may decrease the likelihood of and the recurrence of stroke. Future research should document efforts to inform high risk patients and measure their compliance with recommendations.     

In vitro studies of a degradable device for controlled-release of meloxicam

BACKGROUND: Plaque biofilm and associated host responses are the primary factors in the pathogenesis of periodontitis. Delivery of medications directly into the periodontal pockets to suppress or eradicate the pathogenic microbiota or modulate the inflammatory response has attracted significant interest to limit periodontal tissue destruction. The aim of the present study was twofold: (1) to describe the development of a biodegradable controlled-release device containing meloxicam as the therapeutic agent and (2) to evaluate the in vitro release of meloxicam from this device into different release media. METHODS: Films of cross-linked gelatin matrix containing meloxicam were prepared, hardened for various time periods and cut in a form to fit to the periodontal pocket anatomy. The release of active agents was studied separately in 10 ml distilled water, artificial saliva and pH 7.4 phosphate buffer at 37 degrees C. Apparatus Vibrax was used at 120 r.p.m. Determinations were carried out spectrophotometrically, and the release profiles were plotted as a function of time. The results were evaluated by the similarity test. RESULTS: The release rates of meloxicam from the hardened (1 h, 4 h, 8 h) formulations were slower than the unhardened formulation in all the three release media. Increasing the hardening time decreased the release rates. The overall release rates were similar in artificial saliva and pH 7.4 phosphate buffer, while it was lower in distilled water. CONCLUSIONS: As a conclusion, cross-linked gelatin matrix films may be considered as a suitable inert material for obtaining a prolonged local release of meloxicam as an adjunct to the mechanical periodontal treatment. As required, further in vitro and in vivo studies will be performed before starting clinical applications of this controlled-release formulation of the anti-inflammatory agent.     

Prognostic factors in early glottic carcinoma implications for treatment

AIM: In this study we aimed to determine the prognostic factors affecting local control (LC) in limited glottic carcinoma treated with definitive radiotherapy (RT). MATERIAL AND METHODS: Between June 1991 and December 2001, 114 patients with early squamous-cell carcinoma of the glottis were treated with definitive RT at our institution. Only four (3.5%) patients were women. The median age was 60 (27-79). Fifteen percent, 72% and 13% of the patients had Tis, T1 and T2 tumors, respectively. Forty-three (37.7%) patients had anterior commissure invasion. Prior to RT 35 (31%) patients had undergone vocal cord stripping and two (2%) cordectomy. A median dose of 66 Gy (50-70.2) was given over a median period of 46 days (20-60). Univariate and multivariate analyses were performed for LC. The prognostic parameters analyzed for LC were T classification, anterior commissure involvement, total RT dose, and overall treatment time. RESULTS: Five-year local and regional control rates were 84.2% and 97.7%. RTOG grade 3-4 late side effects were observed only in one (0.9%) patient. In 15 patients with local failure, salvage treatment consisted of partial laryngectomy in eight patients and total laryngectomy in five. One of the remaining two patients was medically inoperable, and the other refused salvage surgery. In one of the three patients with regional failure, salvage surgery was applied and the other two were given palliative chemotherapy because of unresectable disease. Following salvage treatments, the ultimate five-year LC rate was 96.9% and the five-year larynx preservation rate was 91.1%. Second primary cancer was diagnosed in 17 (14.9%) patients. Only one patient developed distant metastases and two patients died of laryngeal cancer. While T2 disease and anterior commissure involvement were found to be unfavorable prognostic factors significantly influencing LC in univariate analyses, only T2 disease remained independent in multivariate analysis. CONCLUSION: In patients with early glottic carcinoma, T classification proved to be the only independent prognostic factor affecting LC after primary radiotherapy according to the results of this study.     

False negative bone scintigraphy in a patient with primary breast cancer: a possible transient phenomenon of bisphosphonate (alendronate) treatment

Breast cancer is the most common cancer and the second leading cause of cancer deaths among women in developed countries. Bone is a frequent site of metastatic disease with a stage-dependent incidence. Most women with breast cancer are at risk of osteoporosis due to their age or their breast cancer treatment. Scintigraphy enables imaging of the entire skeleton with high sensitivity but limited specificity. The false positive rate varies from 1.6% to as high as 22%, while the false negative rate varies from 0.96% to 13%. We observed a 70-year-old woman with a diagnosis of breast cancer and a false negative bone scan despite extensive bone metastases. She was under alendronate treatment for osteoporosis at the time. The false negative finding might be due to a transient phenomenon of alendronate, a bisphosphonate cleared from the plasma by uptake into bone and by renal excretion. 99mTc-MDP is eliminated via the same pathways, and therefore competition may occur between the two substances. Another possible explanation for the false negative bone scan could be that bone metastases, indicating hematogenous tumor spread, are detected earlier by CT scan or MRI than by bone scan. Breast cancer patients under bisphosphonate treatment for osteoporosis must be carefully evaluated for bone metastasis during radionuclide studies with 99mTc-MDP.     

Strategies for improving the functionality of an affinity bioreactor

Heparin employed in extracorporeal blood circulation (ECBC) procedures (e.g. open heart operations) often leads to a high incidence of bleeding complications. Protamine employed in heparin neutralization, on the other hand, can cause severe adverse reactions. We previously developed an approach that could prevent both heparin- and protamine-induced toxic side effects concomitantly. This approach consisted of placing a hollow fiber-based bioreactor device containing immobilized protamine (termed a "protamine bioreactor") at the distal end of the ECBC procedure. This protamine bioreactor would remove heparin after heparin served its anticoagulant purpose in the ECBC device, thereby eliminating heparin-induced bleeding risks. In addition, this protamine bioreactor would prevent protamine from entering the patients, thereby aborting any protamine-induced toxic effects. Both in vitro and in vivo studies have successfully demonstrated the feasibility of this approach. Despite promises, early findings also revealed two shortcomings that must be overcome for the protamine bioreactor to be applied clinically. The first drawback was that the cyanate ester linkages, involved in conjugating protamine to the bioreactor device, were unstable and prone to hydrolysis, resulting in the leakage of a significant amount of protamine into circulation during application of the protamine bioreactor. The second deficiency was that the capacity of the protamine bioreactor in heparin removal was rather low, owing to the limited surface area of the hollow fibers for protamine immobilization and subsequently heparin adsorption. In this paper, we present novel strategies to overcome these two limitations. A new conjugation method based on the use of 4-(oxyacetyl)phenoxyacetic acid (OAPA) as the activating reagent was employed to yield stable linkages, via the abundant arginine residues of protamine, onto the hollow fibers. Results showed that while the amount of protamine immobilized on each gram of fibers was relatively comparable between the OAPA and the previous CNBr activation methods (7.45 mg/g versus 7.69 mg/g fibers), there was virtually no detectable leaching of immobilized protamine from the bioreactor by the OAPA method, comparing to 35% leaching of protamine by the previous CNBr method following 72 h of storage of the bioreactor in PBS buffer at 37 degrees C. To improve the capacity and functionality of the protamine bioreactor, two novel approaches were adopted. Long chain and high molecular weight poly-lysine was linked to the hollow fibers, prior to protamine coupling, to create multiple layers of immobilized protamine for subsequent heparin adsorption. In addition, a poly(ethylene glycol) (PEG) chain was inserted between protamine and the hollow fibers to yield a three-dimensional, free dynamic motion for immobilized protamine. Preliminary observations indicated that a four- to five-fold enhancement in heparin adsorption was attained by utilizing each of these new approaches. Aside from their current use, these new strategies can also be employed generically to improve the functionality of any affinity-type bioreactor. Indeed, efforts have been made recently in utilizing these approaches to develop a clinically usable GPIIb/IIIa bioreactor for the treatment of immune thrombocytopenic purpura (ITP)-an autoimmune disease.