Elevation of plasma homocysteine levels associated with acute myocardial infarction

OBJECTIVE: To study the effect of acute myocardial infarction (AMI) on plasma homocystein (Hcy) levels, to determine the optimal time to measure this risk factor for coronary artery disease. DESIGN: A prospective case study. SETTING: The Division of Cardiac Sciences, Grey Nuns Hospital in Edmonton. PATIENTS: Sixty-two patients (40 men, 22 women) admitted to hospital with AMI. INTERVENTION: Measurement of Hcy levels within 48 to 72 hours of admission and at 6 weeks after discharge from the Coronary Care Unit. In a second group of 15 patients, the Hcy levels were measured on hospital days 1 and 3. MAIN OUTCOME MEASURE: Comparison of the Hcy levels measured at the time of AMI and after discharge. RESULTS: Mean (and standard error of the mean) Hcy level measured during the AMI (13.6 [0.98] micromol/L) was significantly higher (p < 0.05) than at 6 weeks (12.1 [1.01] micromol/L). Based on the 48- to 72-hour and 6-week determinations, 31 and 21 patients, respectively, had abnormal Hcy levels (greater than 12 micromol/L) (p < 0.001). In the separate group of 15 patients, the Hcy level measured on day 3 (9.7 [0.6] micromol/L) was noted to be significantly higher (p < 0.01) than on day 1 (7.7 [0.8] micromol/L). CONCLUSIONS: There is an elevation of Hcy during AMI that may be related to an increase in the acute-phase reactant proteins. Thus, Hcy measurement should be deferred for 6 weeks in order to determine the true baseline level.     

An 18-months' evaluation of self-etch and etch & rinse adhesive in non-carious cervical lesions

Objective. In this intra-individual comparison (an 18-months' randomized, controlled prospective study), we evaluated the clinical performance of one self-etch and one “etch & rinse” adhesive in non-carious cervical lesions. Methods. Twenty-five patients with at least two pairs of similar-sized non-carious cervical lesions participated. Seventy-eight restorations were placed; 39 with etch & rinse (Single-Bond) and 39 with self-etch (Adper Prompt). Both adhesives were combined with the microfilled resin composite Filtek-A110. The restorations were evaluated at baseline, 6, 12, and 18 months according to slightly modified USPHS criteria. Statistical differences between the adhesives was tested with McNemar's test and clinical degradation over time for each material with the Fisher exact test (α=0.05). Results. Thirty pairs were evaluated at 12 and 18 months. Two self-etch restorations were lost after 18 months. Nine Adper Prompt and four Single-Bond restorations scored bravo for marginal adaptation at 18 months (p<0.05). Nine Adper Prompt and three Single-Bond restorations scored bravo for marginal discoloration (p<0.05). Conclusions. Both adhesive systems showed acceptable clinical retention rates according to the ADA full acceptance criteria for enamel-bonding systems in class V non-carious lesions. The self-etch adhesive showed a faster progressive marginal degradation.     

Exophthalmometric values and their biometric correlates: The Kandy Eye Study

Background: To determine normal exophthalmometric values for a Sri Lankan population and investigate their demographic, physical, refractive and ocular biometric correlates. Methods: The Kandy Eye study was a population‐based, cross‐sectional study. By randomized cluster sampling, 1721 eligible participants, who were 40 years old and over were identified; 1375 participated. Exophthalmometry was performed with Hertel's exophthalmometer. Participants' demographics including age, gender and ethnicity were recorded. Height, weight, body mass index, non‐cycloplegic refraction and ocular biometry were measured with standardized methods. Summary statistical analysis was performed for exophthalmometric values and relationships with other factors were tested using Pearson product–moment correlation coefficient analysis, standard single and multiple linear regression analysis. Results: A total of 1341 subjects were included in the analysis. Exophthalmometric values for the population had a mean of 15.82 mm, standard deviation of 2.73 mm and range of 10.46–21.28 mm. Exophthalmometric values for men were significantly higher than women. There were no significant differences between the racial groups' exophthalmometric values (Sinhalese, Tamils, Moors). Exophthalmometric values were significantly correlated with age, gender, height, weight, body mass index, base and axial length but not to refractive spherical equivalents. Only gender, weight, base and axial length were independent predictors for exophthalmometric values after adjusting for confounders. Conclusion: In this Sri Lankan population, our study provided the first reported estimates of a normal exophthalmometric range and determined gender, weight, base and axial length as its correlates. Sri Lankans are the first population to demonstrate this relationship between weight and exophthalmometric values and also showed that refraction is not a cause for pseudo‐proptosis.     

Anti-tuberculosis drug inducd hepatitis - a Sri Lankan experience

OBJECTIVE: To assess the incidence of anti-tuberculosis (TB) drug induced hepatitis (AIH) in Sri Lankan patients, determine risk factors of AIH, and to address management options in AIH. DESIGN: A prospective study. SETTING: Chest Hospital, Welisara, Sri Lanka, from April 2001 to April 2002. PATIENTS: Seven hundred and eighty three patients with a confirmed diagnosis of TB and resident in the Colombo and Gampaha districts who presented to Chest Hospital, Welisara, Sri Lanka. METHODS: WHO recommended treatment was commenced in all cases. AIH was diagnosed when patients complained of decreased appetite with nausea or vomiting and elevated serum bilirubin (SB; >1.1 mg/dL) or elevated serum alanine transferase (ALT; > 3 times upper limit of normal). RESULTS: Of 783 enrolled patients, 74 (9.5%) developed AIH, the majority (58%) developing AIH within the first 2 weeks of the intensive phase of treatment. AIH was more common among patients over 60 years (p = 0.018), who developed pulmonary TB (p = 0.028), and in patients weighing 33-55 kg (p = 0.004). Age, weight and rifampicin overdosage were significant predictors of AIH. Of the 74 AIH patients, standard treatment was restarted in 60, treatment modified in six, two defaulted and six died. CONCLUSIONS: The incidence of AIH in Sri Lanka is 9.5% in treated patients. AIH was associated with age, low body weight and rifampicin overdosage.     

CK19表达及其在结肠癌淋巴结微转移诊断中的应用

目的：研究用免疫组化方法检测CK19及其在结肠癌淋巴结微转移诊断中的应用与临床病理意义。方法：取材于50例结肠癌病人肿瘤组织及癌周淋巴结255枚,同时进行HE染色组织学检查和抗角蛋白19抗体的免疫组化检测。结果：50例结肠癌组织中CK19表达均为阳性。255枚淋巴结用HE染色检查阳性者56枚(22．0％),皆同时表达CK19阳性;另20枚淋巴结HE染色阴性,而CK19表达阳性。50例中有12例淋巴结中发现微转移,其中6例常规组织学检查属淋巴结转移阴性而免疫组化染色诊断表现为转移阳性。占常规病理检查淋巴结转移阴性者的21．4％(6／28)。随着肿瘤分期增加,淋巴结CK19表达阳性率亦增加。CK19表达阳性者预后较阴性者为差。结论：CK19免疫组化法是检测结肠癌淋巴结微转移的敏感而便捷的方法,而检测结肠癌微转移有助于判断肿瘤进展程度与预后。特别对在筛选组织学检查淋巴结阴性但存在微转移的病人有实用价值。     

Nitrogen containing bisphosphonates induce apoptosis and inhibit the mevalonate pathway,impairing Ras membrane localization in prostate cancer cells

PURPOSE: Metastasis to bone is an important cause of morbidity in advanced prostate cancer. Despite the typically sclerotic nature of prostatic bone metastases osteolysis has a significant role in the pathogenesis of this disease. The nitrogen containing bisphosphonates (N-BPs), such as pamidronate and zoledronic acid, have greatly enhanced potency for inhibiting bone resorption and inducing apoptosis in osteoclasts. We investigated the effects of N-BPs on prostate cancer cells. MATERIALS AND METHODS: Cell viability was determined with an MTS (3-(4,5-dimethylthiazol-2-yl)-5-(3-carboxymeyhoxyphenyl)-2-(4-sulfophenyl)-2H-tetrazolium) dye reduction assay. Cell cycle analysis, DNA fragmentation and caspase 3 activity were assessed using flow cytometry. Ras, Bcl-2 and Bax were quantified by Western blotting. RESULTS: Pamidronate and zoledronic acid decreased cell viability in the 3 human cell lines DU145, PC3 and LNCaP. These effects were associated with changes in cell cycle distribution, induction of DNA fragmentation and a decrease in the Bcl-2-to-Bax ratio, which are features of apoptotic cell death. Pre-incubation with caspase inhibitors attenuated the effects of zoledronic acid and caspase 3 activity was demonstrated in treated DU145 cells. Zoledronic acid induced loss of cell viability in DU145 cells was prevented by co-treatment with farnesol, suggesting that N-BPs cause inhibition of the mevalonate pathway and Ras prenylation. A decrease in active, membrane bound Ras in zoledronic acid treated DU145 cells was shown by Western blot analysis. CONCLUSIONS: N-BPs induce apoptosis in prostate cancer via a caspase dependent mechanism. They have effects on protein prenylation via inhibition of the mevalonate pathway and impair membrane localization of Ras in prostate cancer cells.     

Quadrant通道下单侧后路腰椎椎体间融合术与传统开放手术治疗退行性腰椎疾病的初步比较分析

目的 比较分析采用Quadrant通道与传统开放单侧后路腰椎椎体间融合术治疗退行性腰椎疾病的临床效果及优缺点.方法 2008年1月～2011年6月,87例退行性腰椎疾病患者采用随机分组行单侧后路腰椎椎体间融合术,其中40例采用Quadrant通道微创手术治疗,47例采用传统开放手术治疗作为对照.比较两组手术时间、术中失血量及术后住院时间等,采用VAS疼痛评分、ODI功能障碍评分和改良MacNab分级进行疗效评定.结果 全部病例随访12～52个月,平均26.7个月.两组手术时间、出血量、术后住院时间等差异有统计学意义.两组术后VAS疼痛评分比较差异有统计学意义(P＜0.05) ;两组ODI功能障碍评分和改良MacNab分级评定差异无统计学意义.结论 Quadrant通道下单侧后路腰椎椎体间融合术治疗退行性腰椎疾病具有术中出血量少、创伤小、术后恢复快、疗效确切等优点,是临床上可行的实用的一种脊柱微创术式,与传统开放式手术比较疗效相近,为退行性腰椎疾病的外科治疗提供又一选择,但由于提供的操作空间有限,手术视野小,所以病例选择及手术操作熟练程度显得尤其重要.     

Different faces of non-autoimmune diabetes of infancy

The aim of this report is to describe four cases of non-autoimmune diabetes that presented in infancy. Three had transient neonatal diabetes mellitus (TNDM) with diabetic ketoacidosis at onset, followed by complete remission after several months of insulin treatment. While the fourth case was initially diagnosed as TNDM, she had renal, hepatic and pancreatic dysplasia. These cases illustrate that diabetes in infants can be difficult to diagnose and that patients with TNDM can have a recurrence of diabetes several years later.