A proposal for a method of reporting cervico-uterine smears

A method for reporting Papsmears is proposed. Paperwork is limited to choosing a few codes on a working list prepared according to the Bethesda system and the ADICAP coding system. The method is easy to use. It reduces the work load of time for cytologists and secretaries. It allows harmonization and structurization of the look and the filling of reports for Papsmears. It may be easily adapted for vaginal smears. It leads to a report complete and adapted to the Bethesda system. It gives the possibility of adding comments and additional codes. It avoids most mistakes about ?bligatory codes. It makes easier to perform statistical evaluation and to initiate a quality control program.     

Intra-and Extrahepatic Leukocytes and Cytokine mRNA Expression During Liver Regeneration After Partial Hepatectomy in Rats

We investigated intra- and extrahepaticleukocytes during liver regeneration after a 70% partialhepatectomy in the rats using flow cytometry and RT-PCRfor cytokine mRNA expression. Our study indicated that LFA-1⁺⁺⁺ CD3⁺ cell,NK3.2.3⁺⁺ T cells, and CD5⁺ Bcells, which are activated in autoimmune diseases andmalignancy in humans and mice, were activated in theearly phase of liver regeneration in the liver and the blood after partial hepatectomyin the rats. On measuring cytokine mRNA expression byRT-PCR, only IFN- mRNA was detected in the normalrat liver. IFN- mRNA expression clearly decreased in the liver on day 1 after partial hepatectomyand increased thereafter. IL-2 and IL-4 mRNA were notdetected in the liver regardless of hepatectomy. Everycytokine was detected in normal spleen and increased in the early phase after partial hepatectomy.These were also detected in normal thymus; however, IL-2and IFN- mRNA expressions decreased and IL-4 mRNAexpression increased slightly in the early phase after partial hepatectomy. Thus, the immunesystem dramatically changed both in the liver andelsewhere in the early phase of liver regeneration afterpartial hepatectomy.     

Regional citrate anticoagulation in continuous venovenous haemodiafiltration using commercial solutions.

BACKGROUND: Treatment with trisodium citrate provides an effective means of regional anticoagulation during continuous renal replacement therapy (CRRT). We evaluated the efficacy, safety and cost of a regional citrate anticoagulation protocol using commercial solutions in 17 critically ill patients treated with continuous venovenous haemodiafiltration (CVVHDF). We performed a total of 22 sessions. METHODS: We delivered an A.C.D-A(541(R)) solution containing 112.9 mmol/l disodium citrate (3.22%) at a median rate of 260 (190-280) ml/h via the pre-filter port of a COBE PRISMA with an AN-69 dialyser, while adjusting the rate to maintain post-filtered ionized calcium (iCa(2+)) between 0.25 and 0.4 mmol/l. Plasma iCa(2+) was maintained at >1.1 mmol/l by infusion of calcium chloride at a median rate of 1.70 (1.36-2.27) mmol/h. The dialysate was easily modified according to the acid-base status of each patient. Both replacement and dialysate solutions were delivered at 1200 ml/h. Each session was scheduled for 48 h and biological parameters were assessed every 6 h. RESULTS: The mean dialyser survival was 39 +/- 11 h (median 41.5 h; range 13-48 h). We observed dialyser clotting in four cases (18%). There were no bleeding events or modifications of coagulation parameters. The citrate solution, replacement solution and dialysate were obtained as commercial products. Both the replacement and dialysate solutions contained calcium. The extra cost of this technique was 25 euro;/day as compared to anticoagulation with heparin. CONCLUSIONS: We designed an efficient method of regional citrate anticoagulation for CVVHDF by using commercial solutions. The monitoring of patients was as intensive as during heparin anticoagulation for CRRT. Because of the higher cost of this method, it should be proposed only for patients with high bleeding risk.     

Conserved balance of hepatocyte nuclear DNA content in mononuclear and binuclear hepatocyte populations during the course of chronic viral hepatitis

AIM: To analyze the percentages of hepatocytes with increased nuclear DNA content, i.e., tetraploid (4n) and octoploid (8n) nuclei, and then compared mononuclear and binuclear hepatocyte populations: METHODS: The percentages of mononuclear diploid (2n), 4n, and 8n hepatocytes and those of binuclear 2×2n, 2×4n, and 2×8n hepatocytes were determined with a method that can simultaneously measure hepatocyte nuclear DNA content and binuclearity in 62 patients with chronic hepatitis B or C. The percentage of 4n and 8n hepatocytes in the mononuclear hepatocyte population was compared with the percentage of 2×4n and 2×8n hepatocytes in the binuclear hepatocyte population. RESULTS: The percentages of 4n and 8n hepatocytes in mononuclear hepatocytes and 2×4n and 2×8n hepatocytes in binuclear hepatocytes were similar, regardless of the activity or fibrosis grade of chronic hepatitis and regardless of the infecting virus. CONCLUSION: The distribution of nuclear DNA content within mononuclear and binuclear hepatocyte populations was conserved during the course of chronic viral hepatitis.     

Punicic Acid Triggers Ferroptotic Cell Death in Carcinoma Cells

Plant-derived conjugated linolenic acids (CLnA) have been widely studied for their preventive and therapeutic properties against diverse diseases such as cancer. In particular, punicic acid (PunA), a conjugated linolenic acid isomer (C18:3 c9t11c13) present at up to 83% in pomegranate seed oil, has been shown to exert anti-cancer effects, although the mechanism behind its cytotoxicity remains unclear. Ferroptosis, a cell death triggered by an overwhelming accumulation of lipid peroxides, has recently arisen as a potential mechanism underlying CLnA cytotoxicity. In the present study, we show that PunA is highly cytotoxic to HCT-116 colorectal and FaDu hypopharyngeal carcinoma cells grown either in monolayers or as three-dimensional spheroids. Moreover, our data indicate that PunA triggers ferroptosis in carcinoma cells. It induces significant lipid peroxidation and its effects are prevented by the addition of ferroptosis inhibitors. A combination with docosahexaenoic acid (DHA), a known polyunsaturated fatty acid with anticancer properties, synergistically increases PunA cytotoxicity. Our findings highlight the potential of using PunA as a ferroptosis-sensitizing phytochemical for the prevention and treatment of cancer.     

Hypertension and dementia

Hypertension is one of the principal risk factors for cerebrovascular diseases. Several epidemiologic studies have also indicated a positive correlation between cognitive decline or dementia and blood pressure level. Indeed, the results of most longitudinal studies show that cognitive functioning is often inversely proportional to blood pressure values measured 15 or 20 years previously. Cerebral infarcts, lacunae, and white matter changes are implicated in the pathogenesis of vascular dementia, but may also favor the development of Alzheimer’s disease. Microcirculation disorders and endothelial dysfunctions are also advanced to explain the deterioration in cognitive functions in hypertensive subjects. Data from recent therapeutic trials open the way to the prevention of dementia (vascular or Alzheimer’s type) by antihypertensive treatments and must be confirmed by other studies.     

Augmentation of Cheek Bone Contour Using Malar Osteotomy

Patients with a narrow face have often a defect in expansion of the maxillary–malar complex. A malar osteotomy, separating the malar–zygomatic complex from the orbit and the maxilla, allows an anterolateral cheek projection when performing an external rotation. This technique changes facial contour and improves facial aesthetics. During the past 5 years, 18 malar osteotomies have been performed; the external rotation was stabilized with interposed coral graft in six patients and with interposed bone graft fixed by a miniplate or with a stainless steel wire in 12 patients. Simultaneously septoplasty was performed in five patients, rhinoplasty in 13 patients, and genioplasty in two patients. Six patients had a face and neck lift, one patient had a forehead lift, and one patient had onlay iliac crest bone graft to treat atrophic maxillary alveolar ridges prior to implant placement. Stability was defined after 1 year follow-up. The increase in projection was correlated to the size of the graft. At least 5 mm were necessary to have cheek modification. Mucous inflammation, maxillary sinusitis, and relapse were observed with the use of interposed coral graft, but no complications were observed with bone graft. Malar osteotomy is a simple and safe procedure; it allows an anterolateral cheek projection and seems to be effective for treating transverse midface deficiency. Presented at the XVI^th congress of ISAPS, Istanbul, Turkey, 26–29 May 2002     

Genetic analysis of Italian patients with congenital tufting enteropathy

Background

Congenital tufting enteropathy (CTE), an inherited autosomal recessive rare disease, is a severe diarrhea of infancy which is clinically characterized by absence of inflammation and presence of intestinal villous atrophy. Mutations in the EpCAM gene were identified to cause CTE. Recent cases of syndromic tufting enteropathy harboring the SPINT2 (19q13.2) mutation were described.

Methods

Four CTE Italian patients were clinically and immunohistochemically characterized. Direct DNA sequencing of EpCAM and SPINT2 genes was performed.

Results

All patients were of Italian origin. Three different mutations were detected (p.Asp219Metfs*15, Tyr186Phefs*6 and p.Ile146Asn) in the EpCAM gene; one of them is novel (p.Ile146Asn). Two patients (P1 and P2) showed compound heterozygosity revealing two mutations in separate alleles. A third patient (P3) was heterozygous for only one novel EpCAM missense mutation (p.Ile146Asn). In a syndromic patient (P4), no deleterious EpCAM mutation was found. Additional SPINT2 mutational analysis was performed. P4 showed a homozygous SPINT2 mutation (p.Y163C). No SPINT2 mutation was found in P3. CLDN7 was also evaluated as a candidate gene by mutational screening in P3 but no mutation was identified.

Conclusion

This study presented a molecular characterization of CTE Italian patients, and identified three mutations in the EpCAM gene and one in the SPINT2 gene. One of EpCAM mutations was novel, therefore increasing the mutational spectrum of allelic variants of the EpCAM gene. Molecular analysis of the SPINT2 gene also allowed us to identify a SPINT2 substitution mutation (c.488A>G) recently found to be associated with syndromic CTE subjects.

     

Pharmacotherapy for the treatment of aggressive behavior in general adult psychiatry: A systematic review

OBJECTIVE: To systematically review the evidence for pharmacologic management of outwardly directed aggressive behavior in general adult psychiatry. DATA SOURCES: Literature searches in PubMed, EMBASE, PsycINFO, and Cochrane libraries from 1966 through March 2005 were used to identify relevant studies. The keywords aggression, violence, anger, and hostility combined with drug therapy, psychotropic drugs, adrenergic beta-antagonists, anticonvulsants, anti-depressants, antipsychotic agents, benzodiazepines, and lithium were searched. Furthermore, the retrieved publications were searched for additional references. STUDY SELECTION: All randomized controlled trials addressing pharmacotherapy for aggression or aggression-related symptoms were included, except studies addressing the "emergency situation" and studies conducted in specialized psychiatric or non-psychiatric settings. DATA EXTRACTION: Evidence synthesis was performed using the "best-evidence principle." Two authors independently adjudicated methodological quality and generalizability to daily clinical practice. DATA SYNTHESIS: Thirty-five randomized controlled trials met the inclusion criteria and were evaluated. On the basis of a best-evidence synthesis model, weak evidence for antiaggressive effects of antipsychotics, anti-depressants, anticonvulsants, and beta-adrenergic-blocking drugs was found. Atypical antipsychotics appeared superior to typical antipsychotics. The use of various outcome measures and insufficient data reporting in the individual studies hampered the quantitative assessment of efficacy across studies. Further limitations of the available randomized controlled trials included small sample sizes, short study duration, and poor generalizability to daily clinical practice setting. CONCLUSIONS: Whereas pharmacotherapy is frequently applied in aggressive patients, only weak evidence of efficacy of various drug classes was found. Consensus about the use of aggression measurement scales in clinical trials is necessary for future research. Furthermore, large-scale trials with more naturalistic designs, as opposed to classical randomized controlled trials with strict inclusion and exclusion criteria, may be advisable in order to obtain results that are more generalizable to daily clinical practice.