Volume 3, Issue 1

Type 2 diabetes has become a major public health challenge worldwide. It is now widely accepted that genetic components affect the development of type 2 diabetes, in concert with environmental factors such as lifestyle and diet. Traditional linkage mapping, positional cloning, and candidate gene-based association studies have identified a few genetic variants in genes such as TCF7L2, PPARG, and KCNJ11 that are reproducibly related to the risk of type 2 diabetes. To date, about ten genome-wide association (GWA) studies have been published. These studies discovered new susceptibility genes for type 2 diabetes and provide novel insight into the diabetes etiology. In addition, data especially from lifestyle intervention trials display promising evidence that the genetic variants may interact with changes of dietary habit and physical activity in predisposing to type 2 diabetes. The gene-lifestyle interactions merit extensive exploration in large, prospective studies. The findings from these areas will substantially improve the prediction and prevention of type 2 diabetes.

Coffee is a complex mixture of potentially active chemicals. It contains significant amounts of phenolic polymers, chlorogenic acid and also caffeine. Agricultural factors, roasting, blending, and brewing determine coffee’s chemical composition. Recent epidemiological studies suggest that habitual coffee consumption may help to prevent some chronic diseases including type 2 diabetes. Despite reports from the clinical trials of the effect of caffeine on decreasing insulin sensitivity, long-term prospective studies revealed that coffee may improve fasting glucose, glucose tolerance and insulin sensitivity as well. In the most recent publication habitual coffee drinkers have a lower total and cardiovascular mortality rate among diabetic subjects.

It Peripheral blood progenitor enriched CD34+ cells (PBPC) are rather often used as stem cell background in cancer patients following high dose therapy. Keeping in mind that precursor dendritic cells (DCs) originate from haematopoietic progenitor cells, purified CD34+ cells might also serve as starting cells for ex-vivo production of DC. The aim of the present study is to develop a clinical grade procedure for ex-vivo production of DC derived from enriched CD34+ cells. Various concentrations of CD34+ cells were grown in gas-permeable Teflon bags with different serum-free and serum-containing media supplemented with GM-CSF, IL-4, TNF-a, SCF, Flt-3L and INF-a. Serum-free CellGroSCGM medium for 7 days followed by CellGroDC medium in 7 days gave equal results as serum-containing medium. Following incubation, the cultured cells containing immature DCs were concentrated and transfected with tumour mRNA from human prostate cancer cell lines employing a highly efficient electroporation procedure. Thawed transfected DCs were able to elicit primary T-cell responses in vitro against antigens encoded by the prostate cancer mRNA as shown by ELISPOT assay using mock-transfected DCs as control. The results of our study show that frozen enriched CD34+ cells can be an alternative and efficient source for production of DCs for therapeutic purpose.

There is a high risk of relapse after resection of gastric cancer. We studied the prognostic significance of the deleted colorectal cancer (DCC) gene and thymidylate synthase (TS) protein expression after resection of gastric cancer. Protein expression in the primary tumor of 146 patients with serosal and/or lymph node involvement was studied immunohistochemically by using anti-DCC and anti-TS monoclonal antibodies. DCC expression was found in 69.9%, while low TS staining intensity (0+,1+) and focal staining (<25% of tumor cells stained) were found in 44.6% and 33.8%, respectively. Overall survival (OS) was significantly longer in patients with DCC (p=0.014) negative tumors. TS expression was not an independent prognostic factor. Lack of DCC expression was associated with significantly longer cause-specific survival (CSS) (p=0.040) after curative resection. In conclusion, DCC expression is an independent prognostic factor in patients undergoing resection of gastric cancer while TS expression was not associated with the prognosis in our study.

Colonization with Helicobacter pylori (HP) may have major clinical consequences and HP virulence factors are associated with more severe gastroduodenal pathologies. In this study, prevalence of HP in patients with Non-Ulcer Dyspepsia (NUD) was determined by rapid urease test and culture and correlations of histopathologic changes with bacterial virulence factors and serologic profiles were investigated. Gastric biopsies from sixty-nine patients admitted to Haydarpasa Training Hospital Department of Gastroenterology were evaluated for rapid urease, HP isolation and examined histopathologically. PCR was employed for HP confirmation and detection of HP cagA, cagE and virB11 genes. For each patient, IgG and IgA antibodies and anti-cagA antibodies were also determined by ELISA tests. HP was isolated and confirmed by PCR in 74% (51/69) of the patients. Anti-HP IgG and IgA were detected in 96% (49/51) and 53% (27/51), respectively. Anti-cagA were present in 51% (26/51). cagA, cagE and virB11 were positive in 56.8% (29/51), 60.7% (31/51) and 58.8% (30/51) of the patients, respectively. Statistically significant correlation was observed between cagA PCR and inflammation/activity scores. Detection of cagA by molecular assays can be an alternative test that can be employed for individual patient assessment.

A The acetylcholinesterase inhibitors galantamine and tacrine are used to treat Alzheimer’s disease. However, these compounds also affect the gastrointestinal (GI) tract. Here, we compared and analyzed both the effects of galantamine-and tacrine on the evacuatory kinetics of the GI tract in rats. Rats were untreated (n=15) or treated with galantamine (one daily dose of 1 mg/kg per os for 21 days; n=17) or tacrine (one daily dose of 0.5 mg/kg per os for 21 days; n=13) and evacuatory kinetics were assessed using radiological methods. Galantamine initially slowed and then accelerated evacuation, which is characteristic of the majority of cholinesterase inhibitors and is a result of the endogenous acetylcholine accumulated in the GI tissues. In the tacrine-treated rats the contrast medium was kept in the stomach and cecum and its evacuation time was reliably increased. These results indicate that when administered for 20 days, galantamine and tacrine have different effects on motor and evacuatory function in the GI tract of rats, because at certain levels of the tract the tacrine-action is dominated by specific non-cholinergic and non-anticholinesterase mechanisms.

It has been observed that a distinct blood pressure (BP) response to prolonged and forced hyperventilation in adult patients with essential hypertension is associated with significant changes in plasma catecholamine and β-endorphin levels. This paper investigated whether hemodynamic and neuro-endocrine responses to hyperventilation in elderly patients with essential hypertension (n = 39, mean age 81 ± 3 years) differ from those in elderly patients with secondary hypertension (isolated systolic hypertension, bilateral chronic nephropathy, nephroangiosclerosis, diabetic nephropathy and hyperparathyroidism) (n = 39, mean age 80 ± 1 years). Plasma β-endorphin levels were normal in patients with essential hypertension and increased in patients with secondary hypertension. Plasma norepinephrine levels were normal in both populations. Hyperventilation decreased BP and norepinephrine levels and increased β-endorphin levels in essential hypertensive patients, whereas it did not significantly change BP or neuro-hormonal levels in secondary hypertensive patients. Hierarchical cluster analysis based on BP response to hyperventilation disclosed a sub-group of essential hypertensive patients with the highest basal levels of norepinephrine and the lowest β-endorphin levels, in whom the BP decrease following hyperventilation was correlated with the decrease in norepinephrine and increase in β-endorphin levels. This suggests that b-endorphin may be involved in modulating sympatho-adrenergic activity in elderly patients with essential hypertension.

The aim of study was to analyze heart rate variability (HRV) after different cardiac valve surgery procedures and the prognostic values of these findings. This study included 101 consecutive patients who underwent surgical implantation for an artificial valve. The mean age of the patients was 62 ± 10 years. An aortic valve was implanted in 65 patients. A mitral valve was implanted in 36 patients. HRV was analyzed from 24 hours Holter electrocardiographic (ECG) records. The time from the operation to the recording of Holter ECG and measuring HRV was 3.8 ± 1.4 months. After discharged from stationary cardiac rehabilitation, all involved patients were contacted to provide data on their health in the follow-up period (33 ± 21 months). A total of 46 patients with an implanted artificial valve had decreased overall HRV or standard deviation of all normal R-R intervals (SDNN) < 93 ms. Patients with an implanted artificial mitral valve had a shorter RR interval (817 ± 122 vs. 863 ± 122ms, p=0.03) and lower values of total power (1166 ± 1888 vs. 2802 ± 3601 ms2, p<0.001) compared to patients with an implanted artificial aortic valve. The results of study show that several months after cardiac surgery, almost half of the patients with an implanted artificial valve have decreased HRV. However, postoperative decreased HRV in those patients have no importance in long-term prediction of mortality rate.

Human chorionic gonadotropin (HCG) is used parenterally for treatment of threatened abortions and repeated spontaneous abortion in pregnant women. No controlled epidemiological studies of preterm birth and low birthweight newborns in pregnant women with HCG treatment have been published while the results of animal investigations were controversial. The data of 97 pregnant women with HCG treatment in the second and third months of pregnancy due to threatened abortion and/or previous spontaneous abortion(s) was compared with the data of other 38,054 pregnant women in the population-based large data set of the Hungarian Case-Control Surveillance of Congenital Abnormalities. There was no difference in mean gestational age at delivery and birth weight, in addition the rate of preterm birth and low birthweight newborns. Parenteral HCG treatment in the early pregnancy due to threatened abortion did not associate with a higher risk for preterm births or low birthweight newborns. However, a higher occurrence of gestational diabetes was found in pregnant women with HCG treatment and there was a slight male excess among newborn infants (p=0.06).

Invasive procedures, such as the lumbar puncture, can cause anxiety and pain in children undergoing treatment for acute lymphoblastic leukemia (ALL). We investigated the safety and efficacy of two different protocols for pain relief in 20 children with ALL undergoing lumbar puncture. Protocol A was composed of an association between propofol and alfentanil. Protocol B consisted in the combination of propofol and ketamine. Vital and behavioural parameters, sedation and pain scores were recorded at different times during and after the procedure. All patients showed a satisfactory sedation and analgesia. We found a statistically significant difference of vital parameters between protocol A and protocol B, while there were no significative differences between sedation scores and the other parameters evaluated. Patients in protocol A showed a higher incidence of major side effects, such as respiratory depression. Our results show that both protocols are effective to obtain a good sedation and analgesia in children with ALL undergoing lumbar puncture, but the association between propofol and ketamine appears more safe due to the lower incidence of side effects.

The purpose of the present study was to demonstrate the epidemiological characteristics of colorectal cancers (CRCs) diagnosed in Lower Silesia between 1984 and 2003. Data from the Lower Silesian Cancer Registry on the incidence of CRC in the Lower Silesian province were subjected to analysis. The age adjusted incidence of CRC in both genders increased markedly. A higher relative increase of incidence was recorded for colon cancer. The age-specific incidence of either colon or rectal cancer increased markedly with age in both genders. No constant time-trend toward the earlier diagnosis of CRC was noted in the period studied. Although the number of CRC surgeries performed at the Regional Comprehensive Cancer Center in Wroclaw has increased over time, most of the cases that were diagnosed were treated outside that reference center. If an intensive increase in new case numbers, demonstrated in both the locations by 2003, is not moderated, the incidence of colorectal malignancies in Lower Silesia would become one of the highest in Europe.

Core decompression by exact drilling into ischemic lesions of the femoral condyle stays a challenging procedure, particularly in obese patients. The precision of fluoroscopically-based drilling compared to conventional drilling was evaluated in an in-vitro model for obesity. 40 sawbones were prepared mimicking osteonecrosis in obese patients. 20 sawbones were drilled by guidance of an intraoperative navigation system VectorVision® (BrainLAB, Munich, Germany); the other 20 sawbones were conventionally drilled by fluoroscopic control only. Regarding the distance to the desired mid-point of the lesion, a statistically significant difference with 0.55 mm in the navigated group and 1.19 mm in the control group could be stated (p<0.001). Significant differences were further found for the number of drilling corrections (p<0.001) and radiation time needed (p<0.001). Even in difficult circumstances as in obese patients, the drilling guided by the VectorVision®-navigation system shows high precision with simultaneous enormous reduction of radiation time.

The aim of the present study was to establish the relationship between tobacco use and periodontal health in an adult sample in India. A cross-sectional population-based study was conducted in a province of southern India. A total of 805 subjects between the ages of 30 and 69 years were interviewed, and clinical examinations were made by three cooperating dentists. The examiners recorded oral mucosal findings, gingivitis, and the Community Periodontal Index of Treatment Needs index using a WHO-621 Trinity probe. Among the 805 participants, 72% were males and 28% were females. Among regular smokers, 98% were males and 2% were females. In the studied population, 64.6% visited the dentist only when they had some dental problems. Oral mucosal findings were present more in of the regular smokers and chewing tobacco users than in the non-consumers. The maximum findings from six sextants indicate that non-consumers exhibited higher rates of healthy periodontium and bleeding on probing but lower rates of pockets than tobacco consumers. The present analysis shows that tobacco use exerts a strong and chronic effect on periodontium and oral mucosa and reduces bleeding on probing.

This paper draws attention to the rapid increase in the number of published articles in medicine devoted to issues of empowerment. While our main aim is to identify populations to which empowerment has been applied, we have also offered a brief overview of the literature. A Medline search was used to identify all articles relating to empowerment published between 1980 and 2005. A total of 4496 articles were identified, but after the deletion of articles with non-human applications (n=409) and those published in languages other than English (n=145), a total of 3942 were reviewed. Based on this review, we present a taxonomy of the literature, based on the primary foci, including patients (n=1742, 44%), providers (n=1162, 29%), and society (n=1038, 27%). Over the study period, we document a rapid increase in the numbers of articles devoted to all three categories, but a significant increase in the proportion of papers devoted to patient empowerment (P < 0.0001). We conclude by juxtaposing some recent European health care policy reforms that have had mixed consequences for the empowerment of patients and argue for a more scientific approach to the study of empowerment.

Anomalous origin of the right coronary artery from the contralateral aortic sinus is a rare but potentially fatal congenital abnormality. We analyzed 8.066 consecutive coronary angiograms and found 4 cases demonstrating this anomaly. In 2 cases the right coronary artery was without significant atherosclerotic lesions and coursed between the aorta and pulmonary trunk. In the 2 other cases the right coronary artery was significantly stenosed. In the last case, diagnosis was based on angiographic and dual-source computed tomographic examinations. Dual-source computed tomography showed precisely the origin and course of the right coronary artery between the ascending aorta and pulmonary artery. Moreover, stenoses of the anomalous coronary artery were depicted. Subsequent coronary interventions required modification of the Amplatz left guiding catheter, which enabled a sufficient support even for coronary artery stenting. Both methods seem to be complementary in the diagnostic and therapeutic process of this coronary anomaly.

The authors presented the birth course, in a primiparous woman with complicated, refractory, high shoulder dystocia, of a macrosomic term-born malformed child (4400/54) with complete occipital meningoencephalomyelocele and microcephaly. After head delivery, high shoulder dystocia occurred that could not be resolved with neither the McRoberts or Resnik maneuver nor with the Woods and Barnum maneuvers, despite recurred tries. Only on third attempt with the Barnum maneuver was the posterior arm released with hand traction, followed by the whole body of the macrosomic baby. The child was transferred to the Neurosurgery department where operative correction was performed, and after the intervention the child died because of respiratory insufficiency. Due to the strict parental decision on pregnancy continuation and prohibition of any obstetric interventions during delivery, unborn child and parturient, as well as the obstetric team, were put into high professional, forensic and ethical risk.

Fulminant cases of Wegener’s granulomatosis (WG) with severe lung and kidney dysfunction may resemble pneumonia with sepsis and multiorgan dysfunction. Increased serum levels of antineutrophyl citoplasmic autoantibodies (c-ANCA) and proteinase 3 antibodies (PR3) confirm the correct diagnosis and are essential to start early immunosupressive treatment to improve the outcome. With the emphasis on diagnostic dilemmas, we present a 61-year old patient with fulminant WG, resembling pneumonia with sepsis and multiorgan dysfunction. After antibiotics and supportive measures increased serum levels of c-ANCA and PR3 confirmed the suspicion of WG and adequate immunosupressive treatment improved the patient’s condition. We concluded that it is important to include vasculitis in the differential diagnosis of unexplained multiorgan dysfunction, because only early adequate immunosuppressive therapy in combination with other resuscitation measures improves survival.