Human bocavirus as the cause of a life-threatening infection

Human bocavirus is a recently described respiratory pathogen. A case of a life-threatening human bocavirus infection of a previously healthy pediatric patient is described. An initial clinical presentation of acute bronchiolitis developed into an extremely severe course of disease characterized by pneumothorax, pneumomediastinum, and acute respiratory failure with pronounced air-leak syndrome.     

Collateral sprouting of sensory axons after end-to-side nerve coaptation--a longitudinal study in the rat

The end-to-side nerve coaptation is able to induce collateral sprouting of axons from the donor nerve and to provide functional reinnervation of the target tissue. Sensory axon sprouting and its effects on the donor nerve up to 9 months after the end-to-side nerve coaptation were studied in the rat. Peroneal, tibial and saphenous nerves were transected and ligated, and the distal stump of the transected peroneal nerve was sutured to the side of the uninjured sural nerve. The average skin area of the residual sensitivity to pinch due to the axons sprouting through the recipient peroneal nerve did not change statistically significantly between 4 and 9 months after surgery. Axon counting, measurements of compound action potentials and retrograde neuron labeling indicate that the sprouting of the myelinated sensory axons and unmyelinated axons through the recipient nerve was largely completed by 2 months and 4 months after the end-to-side nerve coaptation, respectively, and remained stable thereafter for at least 9 months. A decrease in the amplitude and area of the CAP of myelinated fibers, observed in the donor nerve up to 4 months after surgery, was probably due to mild degeneration of nerve fibers and a tendency of the diameter of myelinated axons to decline. However, no significant changes in functional, electrophysiological or morphological properties of the donor nerve could be observed at the end of the observational period, indicating that end-to-side nerve coaptation has no detrimental effect on the donor nerve on a long-term scale.     

Prognostic significance of non-muscle-invasive bladder tumor history in patients with upper urinary tract urothelial carcinoma

ObjectiveTo evaluate the prognostic factors for survival and disease recurrence in patients treated surgically for upper tract urothelial carcinoma (UTUC), focusing especially on the impact of history of non-muscle-invasive bladder cancer.Patients and methodsA single-center series of 221 consecutive patients who were treated surgically for UTUC between January 1999 and December 2010 was evaluated. Patients who had a history of bladder tumor at a higher stage than the upper tract disease, preoperative chemotherapy, or previous contralateral UTUC were excluded. None of the patients included in this study had distant metastasis at diagnosis of UTUC. In total, 183 patients (mean age 66 years, range 36–88) were then available for evaluation. Tumor multifocality was defined as the synchronous presence of 2 or more pathologically confirmed tumors in any upper urinary tract location (renal pelvis or ureter). All patients were treated with either open radical nephroureterectomy (RNU) or open conservative surgery. Recurrence-free probabilities and cancer-specific survival were estimated using the Kaplan-Meier method and Cox regression analyses.ResultsFifty-one patients (28%) had previous carcinoma not invading bladder muscle. Previous history of non-muscle-invasive bladder cancer was significantly associated with tumor multifocality (P < 0.001), concomitant bladder cancer (P < 0.001), higher tumor stage (P = 0.020), and lymphovascular invasion (P = 0.026). Using univariate analyses, history of non-muscle-invasive bladder cancer was significantly associated with an increased risk of both any recurrence (HR = 2.17; P = 0.003) and bladder-only recurrence (HR = 3.17; P = 0.001). Previous carcinoma not invading bladder muscle (HR = 2.58; P = 0.042) was an independent predictor of bladder-only recurrence. Overall 5-year disease recurrence-free (any recurrence and bladder-only recurrence) survival rates were 66.7% and 77%, respectively. Previous history of non-muscle-invasive bladder cancer was not associated with cancer-specific survival. Our results are subject to the inherent biases associated with high-volume tertiary care centers.ConclusionsPatients with previous history of non-muscle-invasive bladder cancer had a higher risk of having multifocal and UTUC with higher tumor stages (pT3 or greater). History of bladder tumor was an independent predictor of bladder cancer recurrence but had no effect on non-bladder recurrence, and cancer-specific survival in patients who underwent surgical treatment of UTUC.     

Periodontal inflammatory burden correlates with C-reactive protein serum level

Abstract Objective. The aim of study was to present a new method for evaluation of the periodontal inflammatory burden, to apply the method to the adult population and to correlate it with serum levels of C-reactive protein (CRP). Materials and methods. On 515 extracted teeth was measured the neck circumferences (NC). The average values of the NC were obtained for 16 male and 16 female individual tooth types. In the clinical part of this study 238 dentate subjects were included. The subgingival area, inflamed area and periodontal wound size were calculated from NC, probing depth and BOP. The sum of the inflamed and ulcerated subgingival areas of all teeth represented the total periodontal inflammatory burden of an individual. Serum levels of CRP were measured by immunochemical method. Results. The average subgingival area in 238 subjects was calculated to be 13.11 ± 6.35 cm(2) and inflammatory burden area 9.25 ± 5.57 cm(2). The periodontal bleeding wound (p < 0.05) was significantly larger in men. The increased serum levels of CRP correlated with periodontal inflammatory burden (p < 0.05). Conclusions. This new method quantifies the inflammatory burden caused by periodontal disease. The size of the inflammatory burden is correlated with increased serum levels of CRP.     

The impact of tumor size on outcomes in patients with upper urinary tract urothelial carcinoma

Purpose

To investigate the association between tumor size and clinicopathologic factors and outcomes of upper urinary tract urothelial carcinoma (UTUC) in patients treated surgically for UTUC.

Methods

A single-center series of 235 consecutive patients who were treated surgically for UTUC between January 1999 and December 2011 was evaluated. Patients with a history of muscle-invasive urothelial carcinoma of the urinary bladder, those who received neoadjuvant therapies, and those with previous contralateral UTUC were excluded. Bladder-only recurrence, any recurrence, and cancer-specific mortality after surgery were analyzed. Recurrence-free probabilities and cancer-specific survival (CSS) were estimated using the Kaplan–Meier method and Cox regression analyses.

Results

Tumor size was significantly associated with age of the patient (P = 0.001), tumor location (P < 0.0001), tumor multifocality (P = 0.005), higher tumor stage (P < 0.0001), higher tumor grade (P = 0.038), lymphovascular invasion (P = 0.002), and mode of operation (P = 0.001). Tumor size was not associated with bladder-only recurrence (HR 0.91; 95 % CI 0.46–1.80; P = 0.79). The Kaplan–Meier method showed that tumor size >3 cm was significantly associated with worse CSS (P = 0.006, log rank). The 5-year CSS for patients with tumor size ≤3 cm was 70.1 % and for patients with tumor size >3 cm was 56.1 %. Tumor size was not associated with cancer-specific survival in multivariable analysis (HR 1.53; 95 % CI 0.89–2.61; P = 0.12).

Conclusions

Tumor size >3 cm was associated with a lower 5-year CSS at Kaplan–Meier analysis, but was not an independent predictor of CSS, bladder-only recurrence, and any recurrence-free survival at multivariable analysis.     

A CYP17A1 gene polymorphism in association with multiple uterine leimyomas; a meta-analysis

Objective: The mutant genotype GG of the CYP17A1 gene polymorphism has been linked to higher levels of serum estradiol and thus might be associated with steroid-hormone dependent tumors. We decided to assess an association of CYP17A1 polymorphism with uterine leiomyomas (ULM) and multiple ULM by conducting a meta-analysis and subgroup analysis. Methods: We searched the HuGE Navigator and PubMed databases using the terms "leiomyoma" and "CYP17A1" for articles published by October 1, 2010. Our article in press was added. The selection criteria were (i) cases having ULM, (ii) controls showing no ULM from the same ethnic group, (iii) cases and controls not overlapping. The subgroup analysis included cases having multiple ULM, predisposing black women mostly present with multiple ULM. Pooled risk ratio was calculated using χ ^{2} statistic. Results: Five papers fulfilled the selection criteria for meta-analysis and two papers for the subgroup analysis. The meta-analysis revealed no association of CYP17A1 polymorphism with all ULM. A high pooled risk ratio for multiple ULM was associated with the presence of mutant genotype GG (RR 3.25). Conclusion: CYP17A1 polymorphism may be associated with multiple ULM but not with all ULM. The future research might enable us to predict the course of the disease.