Synchronous and metachronous transitional cell carcinoma of the urinary tract: prevalence, incidence, and radiographic detection

Six hundred forty-five cases of transitional cell carcinoma (TCC) of the bladder, ureter, and/or kidney were reviewed retrospectively to determine the frequency of synchronous and metachronous lesions elsewhere in the urinary tract. Among 597 patients with TCC of the bladder, 23 (3.9%) developed an upper-tract lesion, after an average delay of 61 months. Metachronous upper-tract tumors developed in 13% of 38 patients with primary ureteral TCC and in 11% of 63 with renal TCC, after average delays of 28 and 22 months, respectively. Synchronous TCC was found in 2.3% of patients with bladder TCC, 39% of those with ureteral TCC, and 24% of those with renal TCC. Seventeen percent of the subsequent upper-tract lesions would have been demonstrated by intravenous or retrograde urography performed 1 year after the initial onset of primary bladder cancer, and 61% would have been demonstrated by studies performed within 2 years. Therefore, the authors recommend annual radiologic evaluation of the upper urinary tract for 2 years after initial diagnosis and treatment of an upper-tract or bladder TCC.     

Bacterial renal infection: role of CT

The imaging studies done on 62 patients hospitalized for acute renal infections were retrospectively reviewed. Thirty-six (58%) had one or more abscesses, 17 (27%) had focal or diffuse acute bacterial nephritis, five (8%) had pyonephrosis, and four (6%) had pyelonephritis. All had prolonged fever (greater than or equal to 72 hours) and leukocytosis. Among 25 patients examined with both ultrasound (US) and computed tomography (CT), US failed to depict three of five (60%) cases of acute bacterial nephritis and seven of 15 (47%) intrarenal and extrarenal abscesses. One renal abscess was misdiagnosed as a tumor at CT. US is not an adequate screening test for detecting lesions that may require invasive therapy. CT is more sensitive for the detection of acute renal inflammatory disease and for defining the extent of disease for planning of radiologic or surgical intervention.     

Low Molecular Weight CEA, Isolation and Characterization

A low molecular weight CEA-fraction (CEA_low) was purified from liver metastases of colorectal cancer. The following purification sequence was used: homogenization—PCA extraction—ion-exchange chromatography— Con A affinity chromatography—gel filtration on Sephadex G-200 (x2)—affinity chromatography on specific anti-CEA immunoadsorbent—gel filtration (G-200).
CEA_low was homogeneous on gel filtration in 6M guanidine-HCl and gave a single band on SDS-PAGE. CEA_low and CEA gave a reaction of identity in immunodiffusion with 7/9 monkey anti-CEA sera. 2/9 monkey anti-CEA sera showed a weak spur, with CEA spurring over CEA_low. CEA_low gave a reaction of partial identity with NCA and BGP-1 with unabsorbed rabbit and sheep anti-CEA sera. CEA_low consisted of a single polypeptide chain and had a molecular weight of 125,000 as compared to 175,000 ± 8,000 for CEA (SDS-PAGE). CEA and CEA_low contained the same sugars and aminoacids in approximately the same molar proportions. However the carbohydrate content of CEA_low was lower (30–40% as compared to 45–50% for CEA). The peptide relatedness (expressed in SΔQ-units) of CEA, CEA_low, NCA and BGP-I was compared. CEA_low was most closely related to CEA (SΔQ-values of 5–7) followed by NCA (SΔQ values of 12–17) and BGP-I (SΔQ-values of 35–40).
It is clear from these studies that CEA_low is closely related to CEA but contains less carbohydrate. Whether the polypeptide chain is shorter remains to be established.     

Human sperm cytosolic factor triggers Ca2+ oscillations and overcomes activation failure of mammalian oocytes

Among the possible mechanisms of oocyte activation after sperm penetration, it appears most likely that a protein released by the spermatozoon elicits a calcium elevation in the ooplasm. To further test this idea, cytosolic factors obtained from human spermatozoa by two different methods, freezing-thawing and sonication, were injected into mouse oocytes following which intracellular calcium release was measured. Of a total of 42 mouse oocytes, a pattern of calcium oscillations was observed in nine out of 16 oocytes injected with sonicated fraction, in all of eight oocytes with the frozen-thawed fraction and in none of 18 control oocytes. Injection of the frozen- thawed fraction also produced regular calcium oscillations in all of five in-vitro matured human oocytes. To assess the putative factor's ability to support fertilization, human oocytes that were not activated by prior intracytoplasmic injection of spermatozoa (ICSI) and round spermatids were reinjected with the frozen-thawed sperm fraction. Of 23 human oocytes which remained unfertilized after ICSI, 19 became activated after injection with sperm cytosolic factor; eight showed two pronuclei, three one pronucleus and eight showed three or more pronuclei. Of 11 oocytes unfertilized after prior round spermatid injection, two developed two pronuclei, four developed one pronucleus and two had three or more pronuclei. Cytogenetic analysis by fluorescence in-situ hybridization confirmed the existence of a male pronucleus in eight out of nine such zygotes displaying two or more pronuclei. Thus, human sperm extracts activated mouse and human oocytes after injection, as judged by calcium flux patterns in conjunction with male pronucleus formation.      

Interventions to improve employee health and well‐being within health care organizations: A systematic review

In response to an increasing body of evidence on the importance of employee health and well‐being (HWB) within health care, there has been a shift in focus from both policymakers and individual organizations toward improving health care employee HWB. However, there is something of a paucity of evidence regarding the impact and value of specific HWB interventions within a health care setting. The aim of this article was to systematically review the literature on this topic utilizing the EMBASE, Global Health, Health Management Information Consortium, MEDLINE, and PsycINFO databases. Forty‐four articles were identified and, due to a large degree of heterogeneity, were considered under different headings as to the type of intervention employed: namely, those evaluating changing ways of working, physical health promotion, complementary and alternative medicine, and stress management interventions, and those utilizing multimodal interventions. Our results consider both the efficacy and reliability of each intervention in turn and reflect on the importance of careful study design and measure selection when evaluating the impact of HWB interventions.     

Immunohistochemical expression of latent membrane protein 1 (LMP1) and p53 in nasopharyngeal carcinoma: Moroccan experience

Background

Nasopharyngeal carcinoma (NPC) is a malignant epithelial tumor intimately associated with Epstein-Barr virus (EBV). NPC is a characteristic tumor displaying epidemiological, genetic and regional distribution properties that makes it unique by its natural behavior.

Objectives

To assess the expression pattern of LMP1 and p53 proteins in the different histological types of NPC in a sample of the Moroccan population and to define any association between the expression of those proteins with the sex, the age and the histological types of NPC.

Methods

Archival formalin-fixed, paraffin-embedded NPC biopsies were evaluated in 23 Moroccan patients for the presence of LMP1 and p53 using immunohistochemistry (IHC).

Results

No LMP1 expression was observed whereas 8 of 23 cases (34. 7%) had detectable p53 protein in the nuclei of tumor cells. After statistical analysis according to the Fisher''s exact probability test, no significant association between p53 expression and histological type, age and sex distributions was demonstrated (p>0.05).

Conclusion

This study confirms that p53 overexpression is present in a subset of Moroccan NPC patients. Our results are consistent with those reported by other studies concerning the same NPC endemic risk area and provide original data concerning Morocco.     

Upper GI bleeding among neonates admitted to Mulago Hospital,Kampala, Uganda: a prospective cohort study

Background

The World Health Organization (WHO) reports estimate that 85% of newborn deaths are due to infections, prematurity and fetal distress. These conditions are risk factors for upper GI bleeding (UGIB) in sick neonates. UGIB is associated with poor neonatal outcomes such as prolonged hospitalisation and poor weight gain. The magnitude of UGIB and its contribution to neonatal morbidity has not been described in most low income countries.

Objective

To determine the occurrence and factors associated with UGIB among neonates admitted to the Special Care Unit (SCU) of Mulago Hospital.

Methods

This was a prospective single cohort study where neonates admitted within 24 hours of birth were consecutively enrolled and followed up for seven days. Gastric aspirates from the neonates were examined daily over a period of 7 days using Guaiac and Apt tests for evidence of UGIB. Data on occurrence of UGIB has been presented as proportions and Odds Ratios for associated factors.

Results

Out of 191 neonates, 44 (23 %) developed UGIB. Factors independently associated with UGIB included cyanosis in the neonate [OR 5.8; (95% CI; 1.8 – 19.1) p-value 0.004], neonatal seizures [OR 12.6; (95% CI 2.3 – 70.5); p-value 0.004] and birth asphyxia [OR 6.3; (95% CI 1.9 – 21.6); p-value 0.003].

Conclusions

In the first seven days of life, UGIB occurred in 1:4 neonates. Factors independently associated with UGIB included birth asphyxia, cyanosis in the neonate and neonatal seizures.