Current Medicine News Results

What is this thing "fatigue" anyway?

J Appl Physiol. 2010 Feb; 108(2): 464-5
Light AR

Limitation of performance and the brain: simply more complex.

J Appl Physiol. 2010 Feb; 108(2): 463; author reply 469
Place N, Kayser B

Risk factors for recurrent urinary tract infections in a cohort of patients with primary vesicoureteral reflux.

Pediatr Infect Dis J. 2010 Feb; 29(2): 139-44
Dias CS, Silva JM, Diniz JS, Lima EM, Marciano RC, Lana LG, Trivelato AL, Lima MS, Simöes e Silva AC, Oliveira EA

BACKGROUND: Knowledge of risk of urinary tract infection (UTI) recurrence in vesicoureteral reflux (VUR) can help clinicians make therapeutic decisions. The aim of this retrospective cohort study was to identify risk factors associated with recurrent urinary tract infection in children with VUR. In addition, a risk score that might predict the chance of UTI recurrence was also proposed. METHODS: Between 1970 and 2007, 740 patients were diagnosed with VUR and were systematically followed up at a single tertiary Renal Unit. Recurrent UTI was defined as more than 1 episode during follow-up. A binary logistic regression model was applied to identify variables independently associated with recurrent UTIs. RESULTS: During follow-up, information was obtained on 58,856 person-months. Recurrent UTIs occurred in 120 (16.2%) patients. The overall incidence rate of UTI was 8.4 episodes per 1000 person-months (95% CI, 7.7, 9.2). After adjustment by multivariable analysis, 5 variables were independent predictors of recurrent UTI: UTI as clinical presentation, age < 6 months, female gender, dysfunctional elimination syndrome, and severe grade of reflux. The risk for recurrent UTI was classified as low in 24% of children, medium in 42%, and high in 34%. UTI incidence rates per 1000 person-months were 4.3 (95% CI, 3.2, 5.6), 7.9 (95% CI, 6.7, 9.1), and 11.3 (95% CI, 9.9, 12.8) for low-, medium-, and high-risk groups, respectively. CONCLUSION: The prediction model of recurrent UTI allows an early recognition of patients at risk for long-term morbidity and might contribute to the formulation of therapeutic strategies.

Other sources outside the muscle afferent feedback limit locomotor performance in the heat.

J Appl Physiol. 2010 Feb; 108(2): 462-3; author reply 469
Girard O, Racinais S

Unusual pattern of dislocation of the trapeziometacarpal joint with avulsion fracture of the trapezium: case report.

Hand Surg. 2009; 14(2-3): 149-52
Morizaki Y, Miura T

Dislocation of the trapeziometacarpal joint is a rare injury. We report an unusual pattern of dorsal dislocation of the trapeziometacarpal joint with an avulsion fracture of the dorsoradial tubercle of the trapezium. Simultaneous ligament rupture with an avulsion fracture of the thumb metacarpophalangeal joint was associated. The trapeziometacarpal joint was reduced and disrupted ligaments with avulsed fragments of both joints were surgically repaired.

Apparent visi deformity: periscaphoid perilunate dissociation - a case report.

Hand Surg. 2009; 14(2-3): 145-8
Tatebe M, Hirata H, Koh S, Shinohara T

We report a case of carpal instability complex, which presented apparent volar intercalated segmental instability (VISI) caused by acute injury. Proper diagnosis and treatment by ligament repair and Kirschner wire fixation yielded good clinical results.

Meta-analysis of capsule endoscopy in patients diagnosed or suspected with esophageal varices.

World J Gastroenterol. 2010 Feb 14; 16(6): 785-6
Ahn D, Guturu P

The PillCam ESO (Given Imaging, Israel) or esophageal capsule endoscopy (ECE) is a novel technique used in the diagnostic evaluation of esophagus. Many studies have been performed to compare the accuracy of ECE against the current gold standard esophago-gastro-duodenoscopy and a meta-analysis recently published by Lu et al suggests that ECE may have an acceptable sensitivity and specificity in detecting esophageal varices. We would like to discuss the importance and implication of publication bias in this meta-analysis.

A case of gouty arthritis following percutaneous radiofrequency ablation for hepatocellular carcinoma.

World J Gastroenterol. 2010 Feb 14; 16(6): 778-81
Choi DH, Lee HS

Percutaneous radiofrequency thermal ablation (RFA) is considered an effective technique for providing local control in the majority of Hepatocellular carcinoma (HCC) patients. Although RFA is generally well tolerated, recent studies have reported complications associated with RFA. We describe a case of acute gouty arthritis in a 71-year-old man with chronic renal failure who was treated with RFA for a HCC lesion and who had hepatitis B-associated cirrhosis and mild renal insufficiency. Regular surveillance of the patient detected a 3.5 cm HCC lesion. Because the patient had declined surgery, RFA was chosen for therapy. On the third post-procedural day, the laboratory results showed increases in his uric acid and potassium levels, which were compatible with a tumor lysis syndrome. On the 6th post-procedural day, the patient complained of new right knee pain. Subsequent joint aspiration revealed monosodium urate monohydrate crystals. We made the diagnosis of acute gouty arthritis arising from tumor lysis and liver infarction caused by HCC ablation, which was aggravated by acute renal insufficiency. After adequate hydration and administration of oral colchicines, the patient's right knee pain subsided and the uric acid serum level returned to normal. This is the first described case of acute gouty arthritis after RFA for a HCC lesion in a patient with underlying chronic renal insufficiency. To avoid hyperuricemia and an acute attack of gout after RFA therapy for HCC, early identification of patients at risk is warranted, such as those with a large tumor, rapid tumor growth, and renal insufficiency, and preventative measures should be considered.

Surgery for gastrointestinal malignant melanoma: Experience from surgical training center.

World J Gastroenterol. 2010 Feb 14; 16(6): 745-8
Akaraviputh T, Arunakul S, Lohsiriwat V, Iramaneerat C, Trakarnsanga A

AIM: To characterize clinical features, surgery, outcome, and survival of malignant melanoma (MM) of the gastrointestinal (GI) tract in a surgical training center in Bangkok, Thailand. METHODS: A retrospective review was performed for all patients with MM of the GI tract treated at our institution between 1997 and 2007. RESULTS: Fourteen patients had GI involvement either in a metastatic form or as a primary melanoma. Thirteen patients with sufficient data were reviewed. The median age of the patients was 66 years (range: 32-87 years). Ten patients were female and three were male. Seven patients had primary melanomas of the anal canal, stomach and the sigmoid colon (5, 1 and 1 cases, respectively). Seven patients underwent curative resections: three abdominoperineal resections, two wide local excisions, one total gastrectomy and one sigmoidectomy. Six patients had distant metastatic lesions at the time of diagnosis, which made curative resection an inappropriate choice. Patients who underwent curative resection exhibited a longer mean survival time (29.7 mo, range: 10-96 mo) than did patients in the palliative group (4.8 mo, P = 0.0006). CONCLUSION: GI MM had an unfavorable prognosis, except in patients who underwent curative resection (53.8% of cases), who had a mean survival of 29.7 mo.

How useful is rectal endosonography in the staging of rectal cancer?

World J Gastroenterol. 2010 Feb 14; 16(6): 691-7
Kav T, Bayraktar Y

It is essential in treating rectal cancer to have adequate preoperative imaging, as accurate staging can influence the management strategy, type of resection, and candidacy for neoadjuvant therapy. In the last twenty years, endorectal ultrasound (ERUS) has become the primary method for locoregional staging of rectal cancer. ERUS is the most accurate modality for assessing local depth of invasion of rectal carcinoma into the rectal wall layers (T stage). Lower accuracy for T2 tumors is commonly reported, which could lead to sonographic overstaging of T3 tumors following preoperative therapy. Unfortunately, ERUS is not as good for predicting nodal metastases as it is for tumor depth, which could be related to the unclear definition of nodal metastases. The use of multiple criteria might improve accuracy. Failure to evaluate nodal status could lead to inadequate surgical resection. ERUS can accurately distinguish early cancers from advanced ones, with a high detection rate of residual carcinoma in the rectal wall. ERUS is also useful for detection of local recurrence at the anastomosis site, which might require fine-needle aspiration of the tissue. Overstaging is more frequent than understaging, mostly due to inflammatory changes. Limitations of ERUS are operator and experience dependency, limited tolerance of patients, and limited range of depth of the transducer. The ERUS technique requires a learning curve for orientation and identification of images and planes. With sufficient time and effort, quality and accuracy of the ERUS procedure could be improved.

Experience of a single center with congenital hepatic fibrosis: A review of the literature.

World J Gastroenterol. 2010 Feb 14; 16(6): 683-90
Shorbagi A, Bayraktar Y

Congenital hepatic fibrosis (CHF) is an autosomal recessive inherited malformation defined pathologically by a variable degree of periportal fibrosis and irregularly shaped proliferating bile ducts. It is one of the fibropolycystic diseases, which also include Caroli disease, autosomal dominant polycystic kidney disease, and autosomal recessive polycystic kidney disease. Clinically it is characterized by hepatic fibrosis, portal hypertension, and renal cystic disease. CHF is known to occur in association with a range of both inherited and non-inherited disorders, with multiorgan involvement, as a result of ductal plate malformation. Because of the similarities in the clinical picture, it is necessary to differentiate CHF from idiopathic portal hypertension and early liver cirrhosis, for which a liver biopsy is essential. Radiological tests are important for recognizing involvement of other organ systems. With regards to our experience at Hacettepe University, a total of 26 patients have been diagnosed and followed-up between 1974 and 2009 with a diagnosis of CHF. Presentation with Caroli syndrome was the most common diagnosis, with all such patients presenting with symptoms of recurrent cholangitis and symptoms related to portal hypertension. Although portal fibrosis is known to contribute to the ensuing portal hypertension, it is our belief that portal vein cavernous transformation also plays an important role in its pathogenesis. In all patients with CHF portal vein morphology should be evaluated by all means since portal vein involvement results in more severe and complicated portal hypertension. Other associations include the Joubert and Bardet-Biedl syndromes.

Iron: An emerging factor in colorectal carcinogenesis.

World J Gastroenterol. 2010 Feb 14; 16(6): 663-72
Chua AC, Klopcic B, Lawrance IC, Olynyk JK, Trinder D

The carcinogenic potential of iron in colorectal cancer (CRC) is not fully understood. Iron is able to undergo reduction and oxidation, making it important in many physiological processes. This inherent redox property of iron, however, also renders it toxic when it is present in excess. Iron-mediated generation of reactive oxygen species via the Fenton reaction, if uncontrolled, may lead to cell damage as a result of lipid peroxidation and oxidative DNA and protein damage. This may promote carcinogenesis through increased genomic instability, chromosomal rearrangements as well as mutations of proto-oncogenes and tumour suppressor genes. Carcinogenesis is also affected by inflammation which is exacerbated by iron. Population studies indicate an association between high dietary iron intake and CRC risk. In this editorial, we examine the link between iron-induced oxidative stress and inflammation on the pathogenesis of CRC.

Simultaneous determination of four iridoid and secoiridoid glycosides and comparative analysis of Radix Gentianae Macrophyllae and their related substitutes by HPLC.

Phytochem Anal. 2010 Feb 5;
Cao XY, Wang ZZ

Introduction - Radix Gentianae Macrophyllae, a traditional Chinese medicine, has been frequently used to dispel rheumatism and ease pain. There are four species of Gentiana (G. macrophylla, G. straminea, G. dahurica and G. crassicaulis) recorded as herbal drugs in the Chinese Pharmacopoeia and two other Gentiana species (G. officinalis and G. siphonantha) are often used as substitutes. Currently, the LC fingerprint comparison among different species and evidence for the equivalent application of these herbs are lacking.Objective - To develop an HPLC method for the simultaneous determination of four iridoid and secoiridoid glycosides and a comparative study of six species of Gentiana.Methodology - HPLC analysis was performed on a C(18) column (Phenomenex, 150 x 4.6 mm, 5 microm particle size) with gradient elution using 0.4% aqueous phosphoric acid and methanol at 242 nm.Results - The proposed method was precise, accurate and sensitive enough for simultaneous quantitative evaluation of four iridoid and secoiridoid glycosides (loganic acid, swertiamarin, gentiopicroside and sweroside) in the six species of Gentiana. Contents of the four marker compounds varied from each other even among the samples from the same species and the LC chromatograms of the six species of Gentiana showed high similarities.Conslusion - The close similarity of LC chromatograms and chemical composition of the four genuine Gentiana species explain their popular usage as Radix Gentianae Macrophyllae in Chinese medicine. By comparing the four genuine Gentiana species, it is suggested that the two substitutes could be used as Radix Gentianae Macrophyllae to relieve the scarcity of resources. Copyright (c) 2010 John Wiley & Sons, Ltd.

2-D RP/RPLC method to separate components in Fructus schisandrae chinensis.

J Sep Sci. 2010 Feb 4;
Jin G, Dai Y, Feng J, Qin X, Xue X, Zhang F, Liang X

An off-line 2-D RP/RPLC method was developed to separate components in extracts of Fructus schisandrae chinensis, which is a traditional Chinese medicine. In this method, Click beta-CD stationary phase was proposed for constructing 2-D RP/RPLC system combined with C18 column. beta-CD column showed great potential to separate compounds in traditional Chinese medicines under RP mode. Collected fractions from Click beta-CD column used in first dimension were resolved into many additional components, indicating that the 2-D LC system based on Click beta-CD and C18 phases is orthogonal. The mobile phase was same on both columns. This 2-D LC method facilitates us not only to separate components that cannot be resolved by unidimensional chromatography, but also to achieve much more efficient detection of minor sample components.

Simultaneous qualitative and quantitative analysis of 28 components in Isodon rubescens by HPLC-ESI-MS/MS.

J Sep Sci. 2010 Feb 4;
Du Y, Liu P, Yuan Z, Jin Y, Zhang X, Sheng X, Shi X, Wang Q, Zhang L

A novel method, HPLC-MS/MS was developed to qualitatively identify and quantitatively determine the 28 components including 19 diterpenoids, 6 phenolic acids and 3 flavonoids in Isodon rubescens, an important traditional Chinese medicine. The separation was performed on a C(18) column with linear gradient elution with 0.1% aqueous formic acid/methanol containing 0.1% formic acid at a flow rate of 0.7 mL/min. The identification and quantification of those analytes were achieved on a hybrid quadrupole linear ion trap mass spectrometer. Multiple-reaction monitoring scanning was employed for quantification with switching electrospray ion source polarity between positive and negative modes in a single run. Full validation of the method was carried out (linearity, precision, accuracy, LOD and LOQ). The results indicated that the method was simple, rapid, specific and reliable. The proposed method was successfully applied for the qualitative and quantitative analysis of 28 chemical compositions in 21 batchs of natural and cultured I. rubescens samples from different sources which had great variation on the contents. The results demonstrated that the method was useful for standardization and differentiation of large numbers of similar samples.

Variability of pulse oximetry measurement over 1 year in children with sickle cell disease depends on initial oxygen saturation measurement.

Pediatr Blood Cancer. 2010 Feb 4;
Mullin JE, Cooper B, Seicean S, Strunk R, Rosen C, Redline S, Kemp J, Debaun MR

A prospective cohort of children with sickle cell disease (SCD) was evaluated to determine the variability of daytime pulse oximetry among three measurements over approximately 1 year. Fifty-eight participants were evaluated. Asymptomatic children with initial oxygen saturation 92% had a mean range of 1.9% (0-5.5%). These results suggest, changes in pulse oximetry measurement of approximately 5% may not be clinically significant in otherwise, healthy children with SCD with previous pulse oximetry

PTSD symptom increases in Iraq-deployed soldiers: Comparison with nondeployed soldiers and associations with baseline symptoms, deployment experiences, and postdeployment stress.

J Trauma Stress. 2010 Feb 4;
Vasterling JJ, Proctor SP, Friedman MJ, Hoge CW, Heeren T, King LA, King DW

This prospective study examined: (a) the effects of Iraq War deployment versus non-deployment on pre- to postdeployment change in PTSD symptoms and (b) among deployed soldiers, associations of deployment/postdeployment stress exposures and baseline PTSD symptoms with PTSD symptom change. Seven hundred seventy-four U.S. Army soldiers completed self-report measures of stress exposure and PTSD symptom severity before and after Iraq deployment and were compared with 309 soldiers who did not deploy. Deployed soldiers, compared with non-deployed soldiers, reported increased PTSD symptom severity from Time 1 to Time 2. After controlling for baseline symptoms, deployment-related stressors contributed to longitudinal increases in PTSD symptoms. Combat severity was more strongly associated with symptom increases among active duty soldiers with higher baseline PTSD symptoms.

Granulocyte colony stimulating factor in neonatal alloimmune neutropenia: A possible association with induced thrombocytopenia.

Pediatr Blood Cancer. 2010 Feb 4;
Wiedl C, Walter AW

Neonatal alloimmune neutropenia (NAIN) is a rare cause of congenital neutropenia seen in <1% of births. Significant morbidity, usually infections, may result from this disease. The pathophysiology of NAIN, mediated by maternal antibodies crossing the placenta to destroy fetal cells expressing paternal antigens, is similar to that of neonatal alloimmune thrombocytopenia, as well as Rh/ABO hemolytic disease of the newborn. The use of high-dose granulocyte colony stimulating factor in patients with NAIN may cause a reversible thrombocytopenia in some patients. Pediatr Blood Cancer (c) 2010 Wiley-Liss, Inc.

Radial shock waves effectively introduced NF-kappa B decoy into rat achilles tendon cells in vitro.

J Orthop Res. 2010 Feb 4;
Sugioka K, Nakagawa K, Murata R, Ochiai N, Sasho T, Arai M, Tsuruoka H, Ohtori S, Saisu T, Gemba T, Takahashi K

The purpose of this study was to test if radial shock waves could enhance the introduction of nuclear factor-kappa B (NF-kappaB) decoy oligodeoxynucleotides, which is reported to markedly inhibit NF-kappaB activation and suppress pro-inflammatory cytokine gene expression, using rat Achilles tendon cells. In the presence of NF-kappaB decoy labeled with or without fluorescein isothiocyanate (FITC) in culture media, radial shock waves were applied to the tendon cells in variable conditions and cultivated for 24 h. The transfection rate was assessed by counting FITC-positive cells, and IL-1-induced NF-kappaB activation in the cells was assessed. Radial shock waves significantly enhanced introduction of NF-kappaB decoy-FITC into the tendon cells. IL-1-induced NF-kappaB activation was significantly inhibited by pretreatment of the cells with NF-kappaB decoy combined with radial shock wave exposure. The present study demonstrated the effectiveness of radial shock waves on introduction of NF-kappaB decoy into tendon cells. Radial shock wave treatment combined with local NF-kappaB decoy administration could be a novel therapeutic strategy for chronic tendinopathy. (c) 2010 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res.

Radiation Resistance of Cancer Stem Cells - The 4R's of Radiobiology Revisited.

Stem Cells. 2010 Feb 4;
Pajonk F, Vlashi E, McBride WH

There is compelling evidence that many solid cancers are organized hierarchically and contain a small population of cancer stem cells (CSCs). It seems reasonable to suggest that cancer cure can only be achieved if this population is eliminated. Unfortunately, there is growing evidence that CSCs are inherently resistant to radiation, and perhaps other cancer therapies. In general, success or failure of standard clinical radiation treatment is determined by the 4 Rs of radiobiology: repair of DNA damage, redistribution of cells in the cell cycle, repopulation, and reoxygenation of hypoxic tumor areas. We relate recent findings on CSCs to these 4 phenomena and discuss possible consequences.