Percutaneous vertebroplasty in metastatic disease: transpedicular access and treatment of lysed pedicles--initial experience

For the treatment of lytic disease involving the pedicles of vertebrae in patients with metastatic disease, the authors performed percutaneous vertebroplasty by using an access route via the lysed pedicle. Fifty-one pedicles were treated in 32 consecutive patients. In all cases, a radiologically satisfactory filling of both the affected pedicle and the vertebral body was achieved. Clinically effective pain relief was obtained in 24 (75%) of 32 patients, and no clinical complications were observed.     

Pharmacodynamic equivalence of two flecainide acetate formulations in patients with paroxysmal atrial fibrillation by QRS analysis of ambulatory electrocardiogram

The pharmacodynamic equivalence of flecainide acetate immediate-release (IR) and controlled-release (CR) formulations was assessed from QRS duration in patients currently treated with the IR formulation. Patients were blindly assigned randomly to the IR (100 mg BID, n = 25) or to the CR group (200 mg OD, n = 23). Electrocardiographic parameters were measured at baseline and at week 8 from 24-h Holter monitoring. Mean (SD) normalized flecainide trough plasma concentration (measured 12 h after last intake) at week 8 was 381.3 ng/ml (104.8) with the IR and 381.4 ng/ml (123.8) with the CR formulation. Hodges-Lehmann estimate (95% CI) of the difference between IR and CR for change in QRS duration between baseline and week 8 was 1.6% (-0.1; 3.7), indicating that the formulations were pharmacodynamically equivalent. Median QRS values (102 vs 100.1 ms at baseline; 103.15 vs 99 ms at week 8) as well as first and third quartiles were very similar in both groups. The correlation between QRS duration and RR classes at baseline was highly significant (P < 0.0001). Correlation coefficient at week 8 was statistically significant for > 50% of the patients and was significant in a greater proportion of patients under the IR compared with the CR formulation. Circadian hourly variations of QRS duration as determined by harmonic analysis showed the occurrence of a peak of QRS widening following each intake of the IR, whereas this pattern was not observed with the CR formulation. The latter results are consistent with a greater occurrence of frequency-dependent QRS variations over the 24-h period with the IR compared with the CR formulation.     

Classification of human astrocytic gliomas on the basis of gene expression: a correlated group of genes with angiogenic activity emerges as a strong predictor of subtypes

The development of targeted treatment strategies adapted to individual patients requires identification of the different tumor classes according to their biology and prognosis. We focus here on the molecular aspects underlying these differences, in terms of sets of genes that control pathogenesis of the different subtypes of astrocytic glioma. By performing cDNA-array analysis of 53 patient biopsies, comprising low-grade astrocytoma, secondary glioblastoma (respective recurrent high-grade tumors), and newly diagnosed primary glioblastoma, we demonstrate that human gliomas can be differentiated according to their gene expression. We found that low-grade astrocytoma have the most specific and similar expression profiles, whereas primary glioblastoma exhibit much larger variation between tumors. Secondary glioblastoma display features of both other groups. We identified several sets of genes with relatively highly correlated expression within groups that: (a). can be associated with specific biological functions; and (b). effectively differentiate tumor class. One prominent gene cluster discriminating primary versus nonprimary glioblastoma comprises mostly genes involved in angiogenesis, including VEGF fms-related tyrosine kinase 1 but also IGFBP2, that has not yet been directly linked to angiogenesis. In situ hybridization demonstrating coexpression of IGFBP2 and VEGF in pseudopalisading cells surrounding tumor necrosis provided further evidence for a possible involvement of IGFBP2 in angiogenesis. The separating groups of genes were found by the unsupervised coupled two-way clustering method, and their classification power was validated by a supervised construction of a nearly perfect glioma classifier.     

Characteristics of the patients seen in 1999 by referral centres for sexually transmitted diseases in Ceará (Northeast Brazil)

Since 1995, in the State of Ceará, in Northeast Brazil, there is a public health project focusing on training and continuing education of health reference teams taking care of patients with sexually transmitted diseases (STD). An information system including a patient's form was worked out and established. The characteristics of the patients seen at consultation in 1999 are described. Ten units provided 1,478 filled forms. Women are more present than men (72% vs 28%). Multipartnership during the last three months is more frequent among males (52%) than among females (5%). Taking antibiotics prior to the first medical advice was frequent in the male population (17%). The main syndromes presented by women were vaginal discharge (81%) and genital warts (19%), whereas with men genital warts (47%) and urethral discharge (43%) were more frequent. The frequency of positive serology for syphilis and HIV among patients presenting an STD syndrome was 7.9% and 1.3%, respectively. It was higher among males (12% and 3%) than among females (7% and 1%). The way the referral facilities are used is different according to sex, the women corning more often spontaneously. The need for accurate etiologic data for each STD syndrome was identified. The analysis of the data resulting from these STD referral units allowed to produce relevant information whose follow-up will be of great interest for both health professionals and decision-makers.     

Differential effects of oral and transdermal postmenopausal estrogen replacement therapies on C-reactive protein

C-reactive protein (CRP) is one of the main independent predictors of cardiovascular events. Oral post-menopausal estrogen replacement therapy (ERT) increases CRP levels, but the effect of transdermal ERT is not well documented. CRP, interleukine-6 (IL-6) and tumor necrosis factor-alpha (TNF-alpha) levels were evaluated in a randomised study of 196 healthy postmenopausal women, who were allocated to receive continuous oral estradiol-1beta, (n=63) or transdermal estradiol-1beta, (n=68) both combined with micronised progesterone, or place-bo (n=65). Oral estrogen increased CRP levels compared with both placebo (p=0.010) and transdermal estrogen (p=0.004) at 6 months. There was no significant effect of transdermal estrogen on CRP levels compared with placebo (p=0.997). No significant difference was found in the median changes for IL-6 and TNF-alpha between the three treatment groups. In conclusion, transdermal estrogen has no significant effect on CRP levels at 6 months, but CRP concentrations increased significantly with oral estrogen although no changes in cytokine levels were detected. The clinical relevance of these effects remains to be determined.     

骨髓干细胞植入正常或慢性梗死心肌后短期内移植细胞的分布及可利用度

目的采用心肌内注射方法将骨髓间充质干细胞(BMSCs)植入到正常或慢性梗死心肌中后, 研究短期内植入细胞的分布和可利用度。方法采用选择性冠状动脉结扎方法建立大鼠慢性心肌梗死模型( n =9) 。1个月后, 采用心肌内注射方法将 111 铟 - 羟基喹啉 ( 111Indium- oxine, 111In) 同位素标记的自体 BMSCs (2×106/50μL)植入到慢性梗死心肌和正常对照心肌中( n =6) 。采用序列平面针孔闪烁扫描方法测定 BMSCs移植后 2 h、1 d、3 d、7 d 时的心肌 111In 的放射活性, 并计算植入细胞在心肌内的驻留率。于细胞移植术后第 7 天切取制备心脏横断面冷冻切片, 进行组织放射微成像(Micro- imaging)和组织病理学分析, 观察植入细胞在心肌内的分布情况。结果慢性心肌梗死(MI)组的心肌 111In 的放射活性在所有测定的时间点均显著高于正常对照组(P<0.01)。心肌放射强度实测值在经由各相应时间点 BMSCs细胞 111In 的自发泄漏率的体外标定值校正后, 计算得出植入的 BMSCs 细胞在慢性梗死心肌(MI 组)中的驻留率平均为 60%, 而在正常对照组心肌中细胞的驻留率只有 25%(P <0.01), 并在 7 d 的随访期中保持稳定。组织放射微成像和组织病理学分析都证实植入的 BMSCs 主要分布于由注射针头插入损伤或慢性心肌梗死所造成的纤维瘢痕组织中。结论心肌内细胞移植术后 7 d 内,被植入到慢性梗死心肌中的 BMSCs 细胞的可利用度高于被植入在正常心肌中的 BMSCs 细胞的可利用度。植入心肌内的 BMSCs 主要分布于由注射针头插入损伤和慢性心肌梗死导致的纤维瘢痕组织中。