CT findings of intussusception in adults

Intussusception is rare in adults, in contrast to its frequent occurrence in infants. The clinical presentation is variable, consisting mainly of abdominal pain that may be chronic, intermittent, or acute. The classic triad of nausea and vomiting, bloody diarrhea, and an abdominal mass typically present in children with intussusception does not usually appear in adults. This diagnosis is, therefore, rarely included in the differential diagnosis of adult patients with vague abdominal complaints. However, with increasing use of CT scanning in the evaluation of patients with abdominal pain, the diagnosis of intussusception can be readily suggested by the radiologist because of its virtually pathognomonic appearance on CT.     

Pre‐transplant phospholipase A2 receptor autoantibody concentration is associated with clinically significant recurrence of membranous nephropathy post‐kidney transplantation

Previous studies that have assessed the association of pre‐transplant antiphospholipase A2 receptor autoantibody (PLA2R‐Ab) concentration with a recurrence of membranous nephropathy (rMN) post‐kidney transplant have yielded variable results. We tested 16 consecutive transplant patients with a history of iMN for pre‐transplant PLA2R‐Ab. Enzyme‐linked immunosorbent assay titers (Euroimmun, NJ, USA) >14 RU/mL were considered positive. A receiver operating characteristic (ROC) analysis was performed after combining data from Quintana et al. (n = 21; Transplantation February 2015) to determine a PLA2R‐Ab concentration which could predict rMN. Six of 16 (37%) patients had biopsy‐proven rMN at a median of 3.2 yr post‐transplant. Of these, five of six (83%) had a positive PLA2R‐Ab pre‐transplant with a median of 82 RU/mL (range = 31–1500). The only patient who had rMN with negative PLA2R‐Ab was later diagnosed with B‐cell lymphoma. One hundred percent (n = 10) of patients with no evidence of rMN (median follow‐up = five yr) had negative pre‐transplant PLA2R‐Ab. In a combined ROC analysis (n = 37), a pre‐transplant PLA2R‐Ab > 29 RU/mL predicted rMN with a sensitivity of 85% and a specificity of 92%. Pre‐transplant PLA2R‐Ab could be a useful tool for the prediction of rMN. Patients with rMN in the absence of PLA2R‐Ab should be screened for occult malignancy and/or alternate antigens.     

Association of oestrogen receptor alpha gene polymorphism with the angiographic extent of coronary artery disease.

AIMS: To investigate the association between sequence variants in the promoter region of the oestrogen receptor-alpha (ER-alpha) gene and the angiographic severity of coronary artery disease (CAD). METHODS AND RESULTS: We studied 503 subjects undergoing coronary angiography (mean age 63+/-12 years, 72% men, 28% women). Coronary artery disease extent was assessed by the number of: (1) major coronary vessels with >50% narrowing (NMCV); (2) coronary vessels with any narrowing (NCV); (3) narrowed coronary segments (NCS). The number of thymine and adenine dinucleotide repeats [(TA)(n)], 1174 base-pairs upstream exon 1, was determined by PCR. The median number of (TA)(n)(18) was used to categorize subjects into long, short and mixed allele genotypes. Poisson regression was used to analyse the association between genotypes and CAD extent, with age category (age #10877;55 vs >55), sex, risk factors and age at onset of CAD as covariates. In young subjects, (TA)(n)length had a significant effect on NCS (P=0.047) and a borderline significant effect on NCV (P=0.066). Young subjects homozygous for long alleles had higher NCV and NCS compared to those homozygous for short alleles (NCV 3.7+/-2.4 vs 2.4+/-1.8, NCS 4.4+/-2.7 vs 3.1+/-2.3, respectively, P#10877;0.034). CONCLUSION: The (TA)(n)length in the ER-alpha gene promoter region is associated with the angiographic severity of CAD in young patients.     

NOD2/CARD15 genotype and phenotype differences between Ashkenazi and Sephardic Jews with Crohn's disease

OBJECTIVE: NOD2/CARD15 has been identified as a major susceptibility gene for Crohn's disease (CD). Three mutations, Arg702Trp, Gly908Arg, and Leu1007fsinsC, are associated with CD. The incidence and prevalence rate of inflammatory bowel diseases is two- to four-fold higher in Ashkenazi Jews as compared to non-Jewish Caucasians. The aim of this study was to determine the significance of the NOD2/CARD15 mutations in Jewish CD patients in Israel, and more specifically, to compare the significance of the mutations to the expression of CD in the Ashkenazi and Sephardic Jewish populations. METHODS: Allele frequencies of the mutations were determined in 180 Jewish CD patients, 73 ulcerative colitis patients, and 159 ethnically matched controls. Variants were detected using allele-specific PCR and restriction enzyme digestion assay. Demographic and phenotypic characterizations of the CD patients were determined. RESULTS: The carrier rate of the three mutations in the entire Jewish Israeli CD cohort is 41.1% versus 10.7% in controls (p < 0.0001). The Ashkenazi Jewish CD patients have an increased carrier rate compared to Sephardic Jews (47.4%vs 27.45%, p= 0.034). Association analyses in Ashkenazi Jews reveal odds ratios of 10.5, 9, and 4.8 for carriage of Gly908Arg, Arg702Trp, and Leu1007fsinsC mutations, respectively. Significantly higher rates of smoking, family history of inflammatory bowel diseases, and extraintestinal manifestations were found among the Sephardic CD patients. CONCLUSIONS: NOD2/CARD15 CD-associated mutations confer increased risk mainly to the Ashkenazi Jewish CD patients in Israel. This suggests that NOD2/CARD15 mutations could contribute to the higher incidence and prevalence rates of CD among Ashkenazi Jews.     

Mediterranean diet and functional indicators among older adults in non-Mediterranean and Mediterranean countries

Background/Objectives

The Mediterranean diet (MEDDIET) has been shown to be related to longevity. This study aimed to determine the association between adherence to MEDDIET and physical function of older adults in the United-States and Israel.

Methods

Data from the US National Health and Nutrition Survey (NHANES) 1999–2002 and from the Israeli National Health and Nutrition Survey (MABAT ZAHAV) 2005–2006 were used. Participants with nutritional and functional data were included. Adherence to the MEDDIET was assessed by a 9-unit score (MDS).

Results

Among 2791 NHANES and 1786 MABAT ZAHAV participants, mean age=71.2y and 74.9y, 20% and 27% had low MDS (0–2), 66% and 62% had a medium score (3–5), and 14% and 11% had a high score (6–9), respectively. Higher MDS was associated with higher education and better lifestyle behaviors. Cognitive and physical functions were significantly better in NHANES and MABAT ZAHAV among the highest MDS. In NHANES, MDS (high vs. low) was associated with faster walking speed after adjusting for confounders in a logistic regression model [Odds Ratio (OR)=0.71, P=0.034, Cl 95% 0.511–0.974]. When cognitive function was added, the association was attenuated (OR=0.75, P=0.093, Cl 95% 0.540–1.049). In MABAT ZAHAV, in a logistic regression model adjusted among other to cognitive function, MDS (high vs. low) was associated with fewer disabilities (OR=0.51, P=0.029, Cl 95% 0.276–0.934).

Conclusions

Adherence to the MEDDIET is associated with better health characteristics and better functioning. Further cohort and intervention studies may shed light on temporal and causal relationships between MEDDIET and these parameters.     

EGFR Mutation Testing Practice in Advanced Non-Small Cell Lung Cancer

Purpose

Testing tumor samples for the presence of a mutation in the epithelial growth factor receptor (EGFR) gene is recommended for advanced non-squamous non-small cell lung cancer (NSCLC) patients. We aimed to collect data about common practice among Medical Oncologists treating lung cancer patients, regarding EGFR mutation testing in advanced NSCLC patients.

Methods

An internet-based survey was conducted among members of the Israeli Society for Clinical Oncology and Radiotherapy involved in the treatment of lung cancer patients.

Results

24 Oncologists participated in the survey. The participants encompass the Oncologists treating most of the lung cancer patients in Israel. 79 % of them use EGFR testing routinely for all advanced NSCLC patients. Opinions were split regarding the preferable biopsy site for EGFR testing material. 60 % of participants recommend waiting for EGFR test results prior to initiation of first-line therapy.

Conclusions

EGFR testing is requested in Israel routinely by most treating Oncologists for all advanced NSCLC patients, regardless of histology. In most cases, systemic treatment is deferred until the results of this test are received.     

Improving the analysis of routine outcome measurement data: what a Bayesian approach can do for you

Since recent decades, clinicians offering interventions against mental problems must systematically collect data on how clients change over time. Since these data typically contain measurement error, statistical tests have been developed which should disentangle true changes from random error. These statistical tests can be subdivided into two types: classical tests and Bayesian tests. Over the past, there has been much confusion among analysts regarding the questions that are answered by each of these tests. In this paper we discuss each type of test in detail and explain which questions are, and which are not, answered by each of the types of tests. We then apply a test of each type on an empirical data set and compare the results. Copyright © 2015 John Wiley & Sons, Ltd     

Prostaglandin E<Subscript>2</Subscript> Suppresses NK Activity In Vivo and Promotes Postoperative Tumor Metastasis in Rats

Background: Prostaglandins (PGs) were shown in vitro to suppress several functions of cellular immunity. It is unclear, however, whether physiological levels of PGs can suppress cellular immunity in vivo and whether such suppression would compromise postoperative host resistance to metastasis.Methods: Fischer 344 rats were administered PGE₂ in doses (18 to 300 g/kg subcutaneously) that increased the serum levels approximately 2- to 4-fold. We then assessed the number and activity of circulating natural killer (NK) cells, as well as rats resistance to experimental metastasis of a syngeneic NK-sensitive tumor (MADB106). To study whether endogenously released PGs after surgery compromise these indices, we tested whether laparotomy adversely affects them and whether a cyclooxygenase-synthesis inhibitor, indomethacin (4 mg/kg), attenuates these effects.Results: PGE₂ dose-dependently suppressed NK activity per NK cell and dose-dependently increased 4- and 24-hour MADB106 lung tumor retention (LTR); 240 g/kg of PGE₂ quadrupled the number of lung metastases counted 3 weeks later. Selective depletion of NK cells abrogated the promotion of LTR by PGE₂. Surgery significantly suppressed NK activity and increased MADB106 LTR, and indomethacin halved these effects without affecting nonoperated rats.Conclusions:PGE₂ is a potent in vivo suppressor of NK activity, and its postoperative release may promote tumor recurrence.