Radiation Induced Oral Mucositis

Patients receiving radiotherapy or chemotherapy will receive some degree of oral mucositis The incidence of oral mucositis was especially high in patients: (i) With primary tumors in the oral cavity, oropharynx, or nasopharynx; (ii) who also received concomitant chemotherapy; (iii) who received a total dose over 5,000 cGy; and (iv) who were treated with altered fractionation radiation schedules. Radiation-induced oral mucositis affects the quality of life of the patients and the family concerned. The present day management of oral mucositis is mostly palliative and or supportive care. The newer guidelines are suggesting Palifermin, which is the first active mucositis drug as well as Amifostine, for radiation protection and cryotherapy. The current management should focus more on palliative measures, such as pain management, nutritional support, and maintenance, of good oral hygiene     

HDAC6 Deacetylates Ku70 and Regulates Ku70-Bax Binding in Neuroblastoma

Ku70 was first characterized as a nuclear factor that binds DNA double-strand breaks in nonhomolog end-joining DNA repair. However, recent studies have shown that Ku70 is also found in the cytoplasm and binds Bax, preventing Bax-induced cell death. We have shown that, in neuroblastoma cells, the binding between Ku70 and Bax depends on the acetylation status of Ku70, such that, when Ku70 is acetylated, Bax is released from Ku70, triggering cell death. Thus, to survive, in neuroblastoma cells, cytoplasmic Ku70 acetylation status is carefully regulated such that Ku70 is maintained in a deacetylated state, keeping Bax complexed with Ku70. We have shown that overexpression of CREB-binding protein (CBP), a known acetyltransferase that acetylates Ku70, releases Bax from Ku70, triggering apoptosis. Although we have shown that blocking deacetylase activity using non-type-specific inhibitors also triggers Ku70 acetylation and Bax-dependent cell death, the targets of these deacetylase inhibitors in neuroblastoma cells remain unknown. Here, we demonstrate that, in neuroblastoma cells, histone deacetylase 6 (HDAC6) binds Ku70 and Bax in the cytoplasm and that knocking down HDAC6 or using an HDAC6-specific inhibitor triggers Bax-dependent cell death. Our results show that HDAC6 regulates the interaction between Ku70 and Bax in neuroblastoma cells and may be a therapeutic target in this pediatric solid tumor.     

The Hong Kong Society of Rheumatology consensus recommendations for the management of gout

Clinical Rheumatology - Gout is one of the most common noncommunicable diseases in Hong Kong. Although effective treatment options are readily available, the management of gout in Hong Kong remains...     

Toll-like receptors: their roles in bacterial recognition and respiratory infections

Although respiratory infections cause significant morbidity and mortality throughout the world, the immunologic factors that mediate host susceptibility to these infections remain poorly understood. The lung contains a vast surface at the host-environment interface and acts as a crucial barrier to invading pathogens. The lung is equipped with specialized epithelial and hematopoietic cells, which express pattern recognition receptors that act as both sentinels and mediators of pulmonary innate immunity. Toll-like receptors (TLRs) mediate a particularly critical role in pathogen recognition and subsequent initiation of the host immune response. In this review, we will summarize current knowledge of TLRs and their bacterial ligands and explore their role in respiratory infections. Moreover, we will highlight recent advances in the role of TLRs in pulmonary infections from a human immunogenetics perspective.     

Determinants of renal functional outcome in lupus nephritis: a single centre retrospective study

Background: Lupus nephritis (LN) is a rare disease but is thestrongest predictor of poor outcome in patients with SystemicLupus Erythematosis (SLE). It is associated with significantmorbidity, with 10–20% of patients developing end stagerenal failure. As there is a paucity of randomized clinicaltrial data in LN, and no consistent literature regarding baselinefactors that predict renal outcome, we were prompted to analyseour centre's complete experience of managing LN. Methods: A retrospective analysis was undertaken of all patientspresenting to our renal centre with biopsy proven LN from 1979–2003.Patients were divided into two categories, those with stableor deteriorating renal function over time. Baseline parameterswere correlated with renal outcome. Results: Complete clinical records were available for 45 (40female) patients. Mean (SD) age of onset of SLE was 32 ±14 years, and mean age onset of LN was 36 ± 13 years.Patients were followed up for an average of 74 ± 56 months.Four patients (9%) had WHO Class II LN, 11 (24%) WHO Class IIIand there were 15 (33%) each in Class IV and V, respectivelyon renal biopsy. Five (11%) patients presented with acute renalfailure and all had proliferative changes on biopsy. The chiefarbiters of renal functional deterioration over follow up werelonger time to development of LN (P = 0.04), a high plateletcount and worse baseline renal function (both P = 0.05). Therewas a trend relating low haemoglobin or membranous histologyto poor renal outcome, and Class IV histology to better outcome. Conclusion: The study has identified that longer time to developmentof LN, high platelet count and poorer renal function at baselinesuggest a worse renal outcome in LN. The study was small butLN is a rare condition. A combination of factors is likely toinfluence renal outcome in LN and larger prospective trialsare required to ascertain consistent baseline prognostic markers.     

Surgical considerations for ‘intrinsic＇ brainstem gliomas： proposal of a modification in classification

BACKGROUND： Brainstem gliomas are highly heterogeneous tumors both in their clinical manifestation and in their pathology. Despite significant advances in the surgery for brainstem gliomas many aspects of this pathology are still unelear. OBJECTIVE： To evaluate the clinical, radiological and surgical outcome of 40 focal ＂intrinsic＂ brainstem gliomas and propose a surgical strategyoriented classification. MATERIALS AND METHODS： A total of 40 focal ‘intrinsie’ （＂expanding variety＂） tumors have been operated over a period of 8.5-years （January 1998-June 2007）. Our criteria included patients with （1） well-defined gadolinium enhancing tumor, （2） relatively long duration of symptoms （〉 six months） and （3） good neurological functional status and independent for all activities of davy living. The cutoff size of 2 cm was not rigidly adhered to. RESULTS： The ＂intrinsic＂ brainstem tumors were classified into three types： Expanding, diffuse infiltrative and pure ventral varieties.