Showing papers in "Medical Science Monitor in 2004"

Pesticides and oxidative stress: a review.

Abstract: The purpose of this paper is to provide a brief review of the current state of our knowledge regarding pesticides and oxidative stress. To this end, we performed a search of the literature using Medline/Index Medicus, EMBASE/Excerpta Medica, and Chemical Abstracts; most of the relevant citations were studied and summarized. In order to better understand the nature of oxidative stress, the principles of free radical production and the body's normal defense system are discussed. The pesticides are categorized and discussed according to their ability to produce lipid peroxidation or alter body antioxidant status. It is concluded that stimulation of free radical production, induction of lipid peroxidation, and disturbance of the total antioxidant capability of the body are mechanisms of toxicity in most pesticides, including organophosphates, bipyridyl herbicides and organochlorines.

PTEN regulatory functions in tumor suppression and cell biology.

Abstract: PTEN is a dual-specificity phosphatase with both protein phosphatase and lipid phosphatase activity. PTEN is the first phosphatase identified as a tumor suppressor. Not since the discovery of p53 has a tumor suppressor generated such interest. Initial studies performed on cancer cell lines suggested that PTEN may be responsible for almost all types of cancer, both solid tumors and hematological malignancies. Biallelic deletion of PTEN has been associated with advanced stage tumors or metastatic disease. PTEN has been shown to play a pivotal role in apoptosis, cell cycle arrest, and possibly cell migration. Emerging data suggest that this may be an oversimplification of PTEN's role, and that PTEN may be haploinsufficient for tumor progression and may play important roles in other cellular functions such as angiogenesis and MAP kinase signaling.

Low-dose balsalazide plus a high-potency probiotic preparation is more effective than balsalazide alone or mesalazine in the treatment of acute mild-to-moderate ulcerative colitis.

Abstract: BACKGROUND Balsalazide is well tolerated and effective in treating acute ulcerative colitis. VSL#3 is a probiotic cocktail proven to be effective in preventing flare-ups of chronic pouchitis. We compared the efficacy and safety of low-dose balsalazide (2.25 g/day) plus 3 g/day VLS#3 (group A) with medium-dose balsalazide alone (group B) and with mesalazine (group C) in the treatment of mild-to-moderate active ulcerative colitis. MATERIAL/METHODS Ninety patients (30 per group) were randomly enrolled, with a treatment duration of 8 weeks. Efficacy was assessed by symptoms assessment, endoscopic appearance, and histological evaluation. RESULTS Balsalazide/VSL#3 was significantly superior to balsalazide alone and to mesalazine in obtaining remission: 24 patients of group A were in remission [per-protocol: 85.71% (C.I.95%: 62-96), on intention-to-treat: 80% (C.I.95%: 59-91)], while 21 group B [per-protocol: 80.77% (C.I. 95%: 51-82), on intention-to-treat: 77% (C.I.95%: 43-81)] and 16 group C patients [per-protocol: 72.73% (C.I. 95%: 30-75), on intention-to-treat: 53.33% (C.I.95%: 42-62)] were in remission (p<0.02). Balsalazide with or without VSL#3 was better tolerated than mesalazine: two group C patients were withdrawn from the study because of severe side-effects; 1 group A (3.33%), 3 group B (10%) and 4 group C (13.33%) patients experienced slight side-effects. The balsalazide/VSL#3 combination was faster in obtaining remission than balsalazide alone or mesalazine (4, 7.5, and 13 days in groups A, B and C, respectively) and also better in improving all parameters evaluated. CONCLUSIONS Balsalazide/VSL#3 may be a very good choice in the treatment of active mild-to-moderate active ulcerative colitis instead of balsalazide alone or mesalazine.

Transcription factors having impact on vascular endothelial growth factor (VEGF) gene expression in angiogenesis

Abstract: This article discusses the role of transcription factors in vascular endothelial growth factor (VEGF) gene expression. Angiogenesis is a complex and multilevel process of new capillary formation on the basis of already existing blood vessels. Physiologically, it is a very strictly regulated process, which results in a balance between stimulatory (angiogenic) and inhibitory (angiostatic) factors to control the correct development of blood vessels. There are many very well characterized angiogenic and angiostatic factors that can modulate VEGF expression. Some of them (e.g. HIF-1, AP-1, and Sp-1) are transcription factors, proteins that bind to the VEGF promoter to initiate and activate the transcription of a gene directly. Others, like nitric oxide or cytokines, are agents that stimulate the transcription factors through different cellular signaling pathways. There are also oncogenes (V-SRC, bcl-2) and tumor suppressor genes (VHL), the mutations of which lead indirectly to increased transcription of the VEGF gene.

Habenular and interpeduncularis nuclei: shared components in multiple-function networks.

Abstract: This paper reviews habenula (Hb) and interpeduncularis nucleus (IPN) literature from the perspective that the axial anatomy of Hb-IPN could be shared by numerous brain circuits that subserve diverse functions. The first section summarizes the major anatomical connections, showing that the axis is strategically positioned between key rostral structures and brainstem areas. Little is known about these connections as they relate to the heterogeneous Hb-IPN sub-nuclei. Insufficient understanding exists about ascending pathways in the fasiculus retroflexus, possible pineal gland connections with the Hb, serotonergic inputs, whether given pathways are excitatory or inhibitory, and interactions of neurotransmitter systems. Next reviewed are studies that implicate the Hb-IPN axis in a variety of brain functions and behaviors. These include nociception, learning and memory, motor activity, sexual and maternal behavior, stress, affective states (anxiety, depression, and reward phenomena), sleep, and eating and drinking behavior. I propose that these multiple functions arise because the Hb-IPN is a shared-component axis in the multiple circuits that subserve these different elements of behavior. More research is needed to test the possibility that the Hb-IPN provides a way for the brain to share circuitry, to explore the significance of the anatomical convergence of inputs to the lateral Hb, to map the circuitry of the subnuclei in Hb and IPN, to explore the interactions of the multiple neurotransmitter systems involved, to conduct studies in simpler animals, and to design experiments that will elucidate system properties of circuits that share the Hb-IPN axis.

Irritable bowel syndrome: a model of the brain-gut interactions

Abstract: Brain-gut interactions are increasingly recognized as underlying pathomechanisms of functional gastrointestinal disorders. Bi-directional communication between the central nervous system (CNS) and the enteric nervous system (ENS) occurs both in health and disease. Various CNS- and gut-directed stressors stimulate the brain-gut axis. Processes modulating responsiveness to stressors along the brain-gut axis involve neural pathways, the immunological, and endocrinological mechanisms. Disturbances at every level of neural control of the gastrointestinal tract can affect modulation of gastrointestinal motility, secretion, immune functions as well as perception and emotional response to visceral events. ENS function, central processing, and autonomic regulation play an important role in the brain-gut dialogue. Stress and emotions may trigger neuroimmune and neuroendocrine reactions via the brain-gut axis. Various non-site specific neurotransmitters influence gastrointestinal, endocrine and immune function, as well as human behavior and emotional state, depending on their location. The physiology of the digestive tract, the subjective experience of symptom, health behavior, and treatment outcome are strongly affected by psychosocial factors. Recently, a biopsychosocial model of IBS containing physiological, emotional, cognitive and behavioral components has been proposed. Rapid progress in neurogastroenterology, using new brain imaging techniques, should bring better understanding of the brain-gut axis and open new therapeutic perspectives.

Depression and physical health among family caregivers of geriatric patients with cancer--a longitudinal view.

Abstract: Background: We investigated, in a sample of 491 cancer patient/caregiver dyads, the impact of caregiving on caregivers' mental and physical health over a period of one year (four assessments). Our model postulates that patient and caregiver characteristics impact caregiver experiences, and all of these in turn affect the mental and physical health of the caregiver. Material/methods: Random-effects regression methods were employed to investigate how patient and caregiver characteristics affect caregiver experiences, and how these same patient and caregiver characteristics affect caregiver physical and psychological health, and are mediated by caregiver experiences. Results: Caregivers' personal perceptions of the caregiving experience (impact on schedule, social functioning, abandonment) played a central role as determinants of caregiver outcomes (depression and physical health). The contextual elements that came to the foreground as either direct or indirect determinants of caregiver outcomes were the patient characteristics symptoms, depression, treatment, comorbidity and cancer site, and the caregiver characteristics education, esteem derived from caregiving, and living arrangement. Conclusions: Our findings suggest that physicians, oncologists and other health care providers involved in the care of cancer patients should be cognizant of the demands put on caregivers. Periodic assessments and dialogue with the caregiver about their experiences, needs and concerns in combination with a review of the patient's illness trajectory may be necessary to insure that caregivers are able to provide quality care to their patients and not succumb to the burdens of caregiving.

Pathogenesis, diagnosis, treatment, and outcome aspects of cerebral tuberculosis

Abstract: Cerebral tuberculosis or tuberculosis of the brain manifests predominantly as tuberculous meningitis followed by tuberculoma, tuberculous abscess, and other concomitant forms such as cerebral miliary tuberculosis, tuberculous encephalopathy, tuberculous encephalitis, and tuberculous arteritis. Different forms of cerebral tuberculosis are mainly caused by Mycobacterium tuberculosis and also by non-tuberculous mycobacteria such as M. avium-intracellulare in human immunodeficiency virus-infected persons. Cerebral tuberculosis is diagnosed based on clinical features, cerebrospinal fluid studies combined with radiological images. Early diagnosis, prompt institution of anti-tubercular treatment, and the clinical stage at which the patient presents are important and deciding factors for final outcome. The present review highlights the pathogenesis, recent strides made in diagnosis, including sensitive and specific molecular diagnostic (immunologic and polymerase chain reaction) tests, treatment, and outcome aspects of cerebral tuberculosis.

Topical honey application vs. acyclovir for the treatment of recurrent herpes simplex lesions

Abstract: Background The objective of this research was to investigate the effect of the topical application of honey on recurrent attacks of herpes lesions, labial and genital, as compared to acyclovir cream. Material/methods Sixteen adult patients with a history of recurrent attacks of herpetic lesions, 8 labial and 8 genital, were treated by topical application of honey for one attack and acyclovir cream for another attack. Results For labial herpes, the mean duration of attacks and pain, occurrence of crusting, and mean healing time with honey treatment were 35%, 39%, 28% and 43% better, respectively, than with acyclovir treatment. For genital herpes, the mean duration of attacks and pain, occurrence of crusting, and mean healing time with honey treatment were 53%, 50%, 49% and 59% better, respectively, than with acyclovir. Two cases of labial herpes and one case of genital herpes remitted completely with the use of honey. The lesions crusted in 3 patients with labial herpes and in 4 patients with genital herpes. With acyclovir treatment, none of the attacks remitted, and all the lesions, labial and genital, developed crust. No side effects were observed with repeated applications of honey, whereas 3 patients developed local itching with acyclovir. Conclusions Topical honey application is safe and effective in the management of the signs and symptoms of recurrent lesions from labial and genital herpes.

Multidrug resistance P-glycoprotein: crucial significance in drug disposition and interaction.

Abstract: This article reviews recent advances in our understanding of the structure, drug interaction mechanism, and substrate molecular requirements of P-glycoprotein (P-gp) and its emerging crucial role in drug disposition and the modulation of drug interaction. In view of its wide localization in normal tissues, the broad variety of structurally and functionally unrelated substrates of P-gp, and its ATP-dependent outward-oriented transport, P-gp actively participates in intestinal secretion, blood-tissue barriers, and biliary and renal excretions for many exogenous substrates, and also performs a protective role to prevent entry of xenobiotics. Moreover, the importance of P-gp-mediated drug interactions in clinical practice can hardly be underestimated, since it may result in severe side effects, such as digitalis drug interaction. Polymorphism or single nucleotide polymorphism (SNP) associated with P-gp may exert a significant effect on the pharmacokinetic behavior of its substrates, a fact which has major clinical implications and suggests careful dose adjustment for individual treatment. Moreover, dietary components and pharmaceutical excipients may modulate P-gp activity, and as a result affect in vivo drug disposition and therapeutic efficacy; examples include grapefruit juice, Pluronic P85, PEG 300, etc. In summary, it should be emphasized that P-gp is an integral component in the process of drug discovery, development strategy,

Effect of massage on blood flow and muscle fatigue following isometric lumbar exercise.

Abstract: Summary Background: This study attempted to investigate the influence of massage on the skin and the intramuscular circulatory changes associated with localized muscle fatigue. Material/Methods: Twenty-nine healthy male subjects participated in two experimental sessions (massage and rest conditions). Subjects lay prone on the table and were instructed to extend their trunks until the inferior portion of their rib cage no longer rested on the table. Subjects held this position for 90 seconds (Load I). Subjects then either received massage on the lumbar region or rested for 5 minutes, then repeated the same load (Load II). Skin blood flow (SBF), muscle blood volume (MBV), skin temperature (ST), and subjects’ subjective feelings of fatigue were evaluated using Visual Analogue Scale (VAS). Results: An increase of MBV between pre- and post-load II periods was higher after massage than after rest (p<0.05). An increase of SBF at pre- and post-load II was observed only under massage condition. An increase of SBF between post-load I and pre-load II periods was higher after massage than after rest (p<0.05). An increase of ST between post-load I and post-load II periods was greater after massage than after rest (p<0.05). The VAS score was lower with massage than with rest in the post-treatment period (p<0.01). Conclusions: A significant difference was observed between massage and rest condition on VAS for muscle fatigue. Lumbar massage administration also appeared to have some effect on increasing skin temperature and enhancement of blood flow in local regions.

Reviewing the mechanism of action of thiopurine drugs: towards a new paradigm in clinical practice.

Abstract: The precise mechanism of action of thiopurine drugs remains unclear despite more than 40 years of use. Recent knowledge in the field of apoptosis and a better insight into, as well as a rapid increase in their use in several important areas of clinical medicine justify this appraisal. This is a review of the recent advances in the knowledge of their mechanism of action and is primarily intended to help clinicians understand the pharmacological properties of these drugs adequately and to find ways to improve their use in clinical practice. The parent compound is azathioprine (AZA), which is rapidly reduced in the presence of glutathione to 6-mercaptopurine (6-MP) and then metabolized into active metabolites with immune-modifier activity. Recent observations and new data indicate that AZA/6-MP could be considered as a "two-in-one" drug, providing a source of 6-thioguanine nucleotides (6-TGNs) and methylated metabolites, and that both compounds could contribute to its antiproliferative effects. This review will also focus on mechanisms that may help to explain a number of recent observations showing that myelotoxicity may occur in patients with high TPMT level or low 6-TGN rate. Our final proposal suggests that the immunosuppressive effects of these drugs are due to a balanced combination of antimetabolic and pro-apoptotic actions.

The exposure to cadmium, lead and mercury from smoking and its impact on renal integrity.

Abstract: Background Human beings are exposed to cadmium (Cd), lead (Pb) and mercury (Hg) from cigarette smoking. Whether this exposure is associated with nephrotoxicity is unknown. Material/methods A total of 68 adult males were included in this study. The studied population was grouped into those who are smokers (n=35) and those who had never smoked (n=33). Cd, Pb and Hg were determined in the blood, urine, hair and nails to assess the extent of exposure to these metals. Urinary excretion of b2-microglobulin (b2M), N-acetyl-b-D-glucosaminidase (NAG), g-glutamyltransferase (g-GT) and alkaline phosphatase (ALP) were determined as markers of tubular damage. Albuminuria was determined as a marker of glomerular damage. Serum levels of creatinine, b2M, and blood urea nitrogen (BUN) were determined to assess glomerular filtration. Results The Cd level in blood and Pb levels in blood and hair were significantly higher in the smokers than non-smokers. Blood levels of Cd and Pb correlated significantly with the smoking index (an indicator for the degree of smoking) in the smokers group. The studied markers of kidney damage neither elevated among the smokers nor correlated with the exposure indices of these metals. Conclusions Smokers are exposed to Cd and Pb. This exposure is not high enough to produce nephrotoxicity. However, it may incite signs of nephrotoxicity in the presence of risk factors for kidney diseases.

Can a Mediterranean diet moderate the development and clinical progression of coronary heart disease? A systematic review

Abstract: Background It has been suggested that adherence to a Mediterranean diet reduces all causes of mortality, especially death rates due to coronary heart disease. In this review we summarize the findings of observational studies that evaluated the effect of the Mediterranean dietary pattern in the primary and secondary prevention of coronary heart disease. Material/methods We retrieved published results from prospective and case-control studies which evaluated the association between adherence to a Mediterranean diet and the occurrence of coronary heart disease outcomes. Results The benefits from the Mediterranean diet were significant in all studies. The reduction in the risk of coronary heart disease varied from 8% to 45%, depending on the increment used by the investigators in the presentation of their results. Conclusions The systematically reviewed studies reveal a cardio-protective effect of the Mediterranean diet and point to this dietary pattern as highly appropriate for public health objectives.

Music alters constitutively expressed opiate and cytokine processes in listeners.

Abstract: BACKGROUND Listening to music as a means of inducing a sense of calm and relaxation has been known for some time. Although these effects are robust, little research has been conducted into exploring the underlying neurochemical changes, which must occur to provide an individual with these objective sensations. MATERIAL/METHODS In the current report we utilize an AB design to explore observed differences in blood plasma signaling molecules in pre- and post music listening groups when compared with controls. We focus chiefly on cytokines, as well as peripheral blood mononuclear cells and polymorphonuclear cells. We utilized reverse transcription followed by real-time polymerase chain reactions to determine relative mRNA expression for the mu opiate receptor gene. Using high pressure liquid chromatography coupled to electrochemical detection as well as nano electrospray ionization double quadrupole orthogonal acceleration time of flight-mass spectrometry we determined opiate alkaloid levels. RESULTS Our findings are two-fold: with regard to mu opiate receptor expression, mononuclear cells showed a statistically significant increase in subjects in the music group compared to the control. Plasma morphine levels were found to be non-significantly lower in subjects after listening to music when compared to control subjects whereas morphine 6 glucuronide levels increased slightly, suggesting morphine's conversion to morphine 6 glucuronide. IL- 6 levels were significantly lower as well whereas IL-1b, IL-10 and cortisol values were unchanged. CONCLUSIONS Taken together, it appears that music-listeners exhibit plasma signal molecule changes consistent with the physiological changes associated with the reported actions of music, i.e, lower blood pressure.

Molecular mechanisms and clinical applications of ginseng root for cardiovascular disease

Abstract: Ginseng root is used extensively in traditional Chinese medicine for its alleged tonic effect and possible curative and restorative properties. There are increasing evidences in the literature on the potential role of ginseng in treating cardiovascular diseases. We herein examine the history of ginseng usage and review the current literature on a myriad pharmacological function of ginseng on the cardiovascular system. From the published studies involving cell cultures and animal models, ginseng is shown to have potential benefits on the cardiovascular system through diverse mechanisms, including antioxidant, modifying vasomotor function, reducing platelet adhesion, influencing ion channels, altering autonomic neurotransmitters release, improving lipid profiles, and involving in glucose metabolism and glycemic control. In addition, the relevant clinical trials regarding the effects of ginseng on the cardiovascular disease are summarized, particularly in managing hypertension and improving cardiovascular function. Finally, the controversies in the literature and the possible adverse interactions between ginseng and other drugs are discussed. This review underscores the potential benefit effects of ginseng on cardiovascular diseases, highlights the gaps in our current research, and emphasizes the necessity for more rigorous systemic investigation.

A comparative evaluation of the effects of MMR immunization and mercury doses from thimerosal-containing childhood vaccines on the population prevalence of autism.

Abstract: Background The purpose of the study was to evaluate the effects of MMR immunization and mercury from thimerosal-containing childhood vaccines on the prevalence of autism. Material/methods Evaluations of the Biological Surveillance Summaries of the Centers for Disease Control and Prevention (CDC), the U.S. Department of Education datasets, and the CDC's yearly live birth estimates were undertaken Results It was determined that there was a close correlation between mercury doses from thimerosal--containing childhood vaccines and the prevalence of autism from the late 1980s through the mid-1990s. In contrast, there was a potential correlation between the number of primary pediatric measles-containing vaccines administered and the prevalence of autism during the 1980s. In addition, it was found that there were statistically significant odds ratios for the development of autism following increasing doses of mercury from thimerosal-containing vaccines (birth cohorts: 1985 and 1990-1995) in comparison to a baseline measurement (birth cohort: 1984). The contribution of thimerosal from childhood vaccines (>50% effect) was greater than MMR vaccine on the prevalence of autism observed in this study. Conclusions The results of this study agree with a number of previously published studies. These studies have shown that there is biological plausibility and epidemiological evidence showing a direct relationship between increasing doses of mercury from thimerosal-containing vaccines and neurodevelopmental disorders, and measles-containing vaccines and serious neurological disorders. It is recommended that thimerosal be removed from all vaccines, and additional research be undertaken to produce a MMR vaccine with an improved safety profile.

Induced abortion and traumatic stress: a preliminary comparison of American and Russian women

Abstract: Background Individual and situational risk factors associated with negative postabortion psychological sequelae have been identified, but the degree of posttraumatic stress reactions and the effects of culture are largely unknown. Material/methods Retrospective data were collected using the Institute for Pregnancy Loss Questionnaire (IPLQ) and the Traumatic Stress Institute's (TSI) Belief Scale administered at health care facilities to 548 women (331 Russian and 217 American) who had experienced one or more abortions, but no other pregnancy losses. Results Overall, the findings here indicated that American women were more negatively influenced by their abortion experiences than Russian women. While 65% of American women and 13.1% of Russian women experienced multiple symptoms of increased arousal, re-experiencing and avoidance associated with posttraumatic stress disorder (PTSD), 14.3% of American and 0.9% of Russian women met the full diagnostic criteria for PTSD. Russian women had significantly higher scores on the TSI Belief Scale than American women, indicating more disruption of cognitive schemas. In this sample, American women were considerably more likely to have experienced childhood and adult traumatic experiences than Russian women. Predictors of positive and negative outcomes associated with abortion differed across the two cultures. Conclusions Posttraumatic stress reactions were found to be associated with abortion. Consistent with previous research, the data here suggest abortion can increase stress and decrease coping abilities, particularly for those women who have a history of adverse childhood events and prior traumata. Study limitations preclude drawing definitive conclusions, but the findings do suggest additional cross-cultural research is warranted.

Effect of Lactobacillus casei supplementation on the effectiveness and tolerability of a new second-line 10-day quadruple therapy after failure of a first attempt to cure Helicobacter pylori infection.

Abstract: BACKGROUND Probiotics have never been used as second-line treatment in patients resistant to a first course of anti-H. pylori treatment. MATERIAL/METHODS 70 consecutive patients with persistent H. pylori infection were enrolled and treated with ranitidine bismuth citrate (RBC) 400 mg b.d, esomeprazole or pantoprazole 40 mg/day, amoxycillin 1 g t.d, tinidazole 500 mg b.d. with (group A) or witlhout (group B) supplementation with 750 mg daily containing 16 billion bacteria Lactobacillus casei subsp. casei DG. Esomeprazole or pantoprazole 40 mg/day was administered for a further 4 weeks in cases of active peptic ulcer or severe gastritis detected at endoscopy. In these cases endoscopy was repeated one month after conclusion of therapy. The remaining patients were checked by 13C-urea breath test. RESULTS Sixty-six patients completed the study, 34 in group A and 32 in group B. One group A patient (2.85%) was excluded for protocol violation and one group B patient (2.85%) was lost to follow-up. 33/34 group A patients were H. pylori-negative [per-protocol: 97.05%, on intention-to-treat: 94.28%]. 5/34 patients (14.7%) showed side-effects, but all of them completed the treatment. In group B, two patients (5.71%) showed severe side-effects and were withdrawn from the study. 30/32 patients were H. pylori-negative [per-protocol: 93.75%, on intention-to-treat: 85.71% (p = n.s.)]. 11/32 patients (34.37%) showed side-effects, but all of them completed the study (p < 0.05). CONCLUSIONS This 10-day quadruple therapy obtains a high eradication rate, but probiotic supplementation reduces side-effects and permits a slight improvement in eradicating H. pylori.

The effect of long-term antiepileptic treatment on serum cholesterol (TC, HDL, LDL) and triglyceride levels in adult epileptic patients on monotherapy.

Abstract: BACKGROUND: Antiepileptic drugs influence, among others, cholesterol and lipoprotein serum levels. MATERIAL/ METHODS: Serum cholesterol (TC, HDL-c, and LDL-c) and triglyceride (TG) levels were measured in 103 epileptic patients receiving chronic antiepileptic monotherapy and in 103 age- and sex-matched controls. RESULTS: Compared with controls, patients on carbamazepine showed significant higher TC, HDL-c, and LDL-c and non significantly higher TG values. Patients on phenobarbital showed no statistically significant differences in TC, HDL-c, LDL-c and TG values. Patients on phenytoin showed significantly higher LDL-c values and non-significant differences in TC, HDL-c and TG values. Patients on valproate showed significantly lower TC, LDL-c and TG values and non-significant differences in HDL-c values. Changes in serum lipid profiles did not correlate with drug plasma levels. CONCLUSIONS: Our results suggest a need for monitoring serum TC, HDL-c, LDL-c and TG levels and, perhaps, prescribing a low-cholesterol diet in patients receiving carbamazepine and phenytoin, but not phenobarbital.

Resistin levels in patients with obstructive sleep apnoea syndrome--the link to subclinical inflammation?

Abstract: BACKGROUND The role of resistin, a "new" white adipose tissue hormone, still needs to be established. Its linkage to insulin sensitivity and body mass was controversial in previous studies. MATERIAL/METHODS Twenty obese patients (BMI: 32.1+/-6.9 kg/m2 ) with obstructive sleep apnoea syndrome (OSAS) (Apnoea-Hypopnoea Index: 48.6+/-19.1, underwent measurements of resistin, interleukin-6 (IL-6), intracellular adhesion molecule-1 (ICAM-1), CRP and the insulin sensitivity index (ISI) by hyperinsulinaemic euglycaemic clamp before, 2 days and 2 months after onset of CPAP treatment. RESULTS Resistin remained unchanged during CPAP-therapy and was negatively correlated to ISI (r=-0.359; p=0.006), the latter was significantly improved by CPAP (p<0.001). In a correlation matrix, IL-6 and ICAM-1 were significantly (p=0.001) correlated to resistin (p=0.614 and 0.427). Changes of inflammatory markers under CPAP treatment were related to AHI, as well as resistin changes. CONCLUSIONS In agreement with previous investigations, we could only demonstrate a weak linkage between ISI and resistin. However, at least in obese patients with OSAS, there is a close relation to subclinical inflammation (IL-6) and endothelial activation (ICAM-1).

The brain-gut axis in irritable bowel syndrome – clinical aspects

Abstract: Irritable bowel syndrome (IBS) is the most common chronic gastrointestinal (GI) disorder, affecting about 20% of the world's population. Chronic abdominal pain or discomfort relieved by defecation and associated with altered bowel habits are the mainstay in diagnosis. The pathophysiology of IBS remains unknown. This biopsychosocial disorder involves dysregulation of the nervous system, altered intestinal motility, and increased visceral sensitivity. All of these result from dysregulation of the bidirectional communication between the gut with its enteric nervous system and the brain (the brain-gut axis), modulated by various psychosocial and environmental factors (e.g. infection, inflammation). Numerous neurotransmitters are found in the brain and gut that regulate GI activities, including 5-hydroxytryptamine (5-HT, serotonin) and its 5-HT3 and 5-HT4 receptors. The current approach to IBS patients is based on a positive diagnosis of the symptom complex, exclusion of underlying organic disease, and institution of a therapeutic trial. Traditional symptomatic treatment has included antidiarrheals, laxatives and bulking agents/fiber, low-dose tricyclic antidepressants, antispasmodics for pain, and "alternative" therapies (e.g. psychotherapy, hypnotherapy). The scientific evidence supporting this therapy is limited. Novel approaches include visceral analgesics and serotonin agonists and antagonists. In patients with severe diarrhea, 5-HT3 receptor antagonists (e.g. alosetron) and selective M3-type anticholinergics are indicated, in constipation 5-HT4 agonists (e.g. tegaserod), and in pain alfa2-adrenergics (e.g. clonidine), cholecystokinin antagonists, kappa-opioid agonists (e.g. fedotozine), and neurokinin antagonists; some of these agents are still being investigated. Understanding the brain-gut axis is crucial in the development of effective therapies for IBS.

Commonalities in the central nervous system’s involvement with complementary medical therapies: limbic morphinergic processes

Abstract: Background Currently, complementary and alternative medicine (CAM) are experiencing growing popularity, especially in former industrialized countries. However, most of the underlying physiological and molecular mechanisms as well as participating biological structures are still speculative. Specific and non-specific effects may play a role in CAM. Moreover, trust, belief, and expectation may be of importance, pointing towards common central nervous system (CNS) pathways involved in CAM. Material/methods Four CAM approaches (acupuncture, meditation, music therapy, and massage therapy) were examined with regard to the CNS activity pattern involved. CNS commonalities between different approaches were investigated. Results Frontal/prefrontal and limbic brain structures play a role in CAM. Particularly, left-anterior regions of the brain and reward or motivation circuitry constituents are involved, indicating positive affect and emotion-related memory processing--accompanied by endocrinologic and autonomic functions--as crucial components of CAM effects. Thus, trust and belief in a therapist or positive therapy expectations seem to be important. However, besides common non-specific or subjective effects, specific (objective) physiological components also exist. Conclusions Non-specific CNS commonalities are involved in various CAM therapies. Different therapeutic approaches physiologically overlap in the brain. However, molecular correspondents of the detected CNS analogies still have to be specified. In particular, fast acting autoregulatory signaling molecules presumably play a role. These may also be involved in the placebo response.

Protective effects of green tea catechins on cerebral ischemic damage.

Abstract: BACKGROUND: Green tea catechins possess potent antioxidative properties, and the preventive effects against various oxidative diseases have been reported. The purpose of this study is to examine preventive and protective effects of green tea catechins on various deteriorative processes following stroke. MATERIAL/METHODS: Male Wistar rats were given ad libitum water with or without 0.25 and 0.5% tea catechin extract for 5 days prior to the operation and during the experiment. Right middle cerebral artery was occluded for 2 h, then reperfused for 22 h. Brain slices were stained with triphenyltetrazolim chloride to assess infarct area. Concentrations of plasma EGCg, and serum NOx were analyzed by HPLC. Detection of iNOS expression, neutrophil infiltration and peroxynitrite formation in the penumbra was performed by immunostain. Neurologic deficit was scored by posture reflex. RESULTS: Tea catechins dose-dependently reduced the brain infarct area and volume. Infarct volume was inversely correlated with plasma EGCg concentration. Dark staining for iNOS, neutrophils and peroxynitrite were observed in vessel wall of small arteries in control ischemic hemisphere, while in catechins (0.5%)-treated rats iNOS was detected slightly, and staining for neutrophils and peroxynitrite was not seen. Catechin ingestion blocked a 3-fold increase in serum NOx concentration in the jugular vein, and also reduced by 35% a 2-fold increase of plasma lipid peroxide level seen in control rats after reperfusion. Neurologic deficits were significantly alleviated by 0.5% catechin ingestion. CONCLUSIONS: Daily intake of green tea catechins efficiently protects the penumbra from irreversible damage due to cerebral ischemia, and consequent neurologic deficits.

Prognostic value of heart rate variability after acute myocardial infarction.

Abstract: Background Prognosis after acute myocardial infarction (AMI) may be influenced by autonomic dysfunction that can be evaluated by assessment of heart rate variability (HRV). Its predictive value resulted from studies performed prior to large scale use of reperfusion therapy. We assessed the prognostic value of HRV parameters 1 year after AMI in patients treated conventionally or by a reperfusion method in the first 12 hours from onset. Material/methods We included 463 consecutive patients with AMI (312 M, 151 F) 60.6+/-13.0 years old. 211 were treated by thrombolysis or primary PTCA, the other 251 patients receiving conventional therapy. Time-domain (SDNN, rMSSD) and frequency-domain (LF, HF, total power) HRV parameters were calculated from 24-hour Holter ECG recordings 10-20 days after AMI. The primary endpoint was one-year total mortality and sudden cardiac death. Results The incidence of cardiac death was 14.7%, while that of sudden death was 4.8%. Both were higher in patients treated conventionally. Patients treated by reperfusion had higher HRV parameters reflecting both vagal and sympathetic activity (SDNN, total spectral power) as well as those expressing only vagal output (rMSSD, HF power) than conventionally treated subjects. The variables independently correlating with 1-year survival were SDNN 2, non-sustained ventricular tachycardia, and left ventricular ejection fraction Conclusions HRV parameters have prognostic value independent from left ventricular ejection fraction and spontaneous ventricular arrhythmias one year after AMI. Reduction of mortality risk by reperfusion therapy does not decrease the prognostic utility of HRV after AMI.

Yogurt feeding inhibits promotion and progression of experimental colorectal cancer.

Abstract: Background In BALB/c mice, a yogurt diet given before and after the carcinogen 1, 2 dymethylhydrazine (DMH) inhibited colon cancer. This paper studied at which stage of tumor development (initiation, promotion or progression) yogurt exerts its antitumor activity. Material/methods Six experimental groups were used: 1) non-treatment control; 2) DMH control; 3) yogurt-DMH-yogurt: yogurt administered before and after DMH. 4) yogurt-DMH: yogurt given only 10 days before DMH; 5) DMH-yogurt: yogurt given cyclically after DMH; and 6) yogurt control. The groups DMH-yogurt and yogurt-DMH were compared histologically and TNFalpha, INFgamma, IL-10 and IL-4 cytokines, CD4+/CD25+ T cells, and apoptotic cells were determined in large intestine biopsies. TNFalpha and INFgamma were also determined in cells isolated from large intestine nodules and from Peyer's patches. Results The DMH-yogurt group did not develop tumor. The yogurt-DMH group showed only tumor delay; TNFalpha, INFgamma and IL-10 increasing in this group in all the periods assayed. These results agree with those already reported for DMH control and yogurt-DMH-yogurt. There was no correlation between the high levels of IL-10 and CD4+/CD25+ T regulatory population. IL-4 and apoptotic cells increased in the yogurt-DMH group only in the first months. In the DMH-yogurt group, cellular apoptosis increased during the whole treatment. Yogurt feeding induced TNFalpha and INFgamma increases in cells isolated from large intestine nodules. These cytokines also increased in cells from Peyer's patches of the yogurt control group. Conclusions These results show that yogurt inhibited tumor progression and promotion by modulating the immune response and stimulating cellular apoptosis.

Access to electronic health records in primary care-a survey of patients' views.

Abstract: BACKGROUND The NHS is moving towards electronic access to health records for patients from 2004 and needs to involve patients in the development process. The aim of the study was to explore the views of a large sample of patients about online access to EPRs and health information in primary care. Areas covered included: accuracy rights of access; security; confidentiality and smart cards. MATERIAL/METHODS The questionnaire was sent to 1050 patients selected at random from the practice list after stratification for age and sex. RESULTS 66% of patients aged over 20 years old responded. Patients know they have the right to see their records although few have done so. Overall they feel the advantages of electronic health records outweigh the disadvantages. They have concerns about security, confidentiality, understanding their records, their accuracy and completeness. The patients recognised the potential benefits to their healthcare and relationships with health professionals. There was a majority view that parents / guardians and carers should have access to their dependants' records. CONCLUSIONS Patients need to be confident that access is limited to those who have the right to see the records. The majority were confident they would understand their records and about half were familiar with computer use. However these are major issues for older patients who will require assistance in order to benefit from accessing their EPRs. It is essential that patient involvement takes place at every stage of the development of EPRs and that their views are taken into account.

Laparoscopic repair of "sportsman's hernia" in soccer players as treatment of chronic inguinal pain.

Abstract: Background To evaluate the clinical course of soccer players affected by chronic groin pain, who were referred for laparoscopic inguinal exploration. Material/methods Thirty-five professional soccer players affected by chronic groin pain and referred for laparoscopic inguinal exploration were included in this prospective, non-randomized study. Prior to surgery, patients were assessed by history, clinical examination, pelvic X-ray, bone scanning with Technetium and ultrasound of the inguinal region. The pre-peritoneal space was visualized with a laparoscope under general anesthesia. A bilateral polypropylene mesh was attached pre-peritoneally. Recorded data included demographics, history, symptoms, surgical findings and postoperative recovery. Results All patients were male. The mean age was 24.3 years. Six patients (17.1%) complained of pain affecting their normal life. A true indirect type I hernia was identified in 4 patients (11.4%). In 28 patients (80%), a wide internal ring and peritoneal dimple were found during the procedure. No clear pathology was found in three patients (8.6%). Thirty-four patients (97.1%) returned to their normal activities after surgery. Conclusions Laparoscopic inguinal exploration and repair of "sportsman's hernias" in soccer players was associated with rapid recovery and fast return to full training and activity.

Early effects of smoking on the voice: a multidimensional study.

Abstract: BACKGROUND The purpose of this study was to evaluate the effect of tobacco on the voice in a relatively early stage of the cigarette-smoking habit (<10 years). MATERIAL/METHODS A multi-parameter acoustic analysis tool, the Multi-Dimensional Voice Program (MDVP), was used to obtain a set of 27 parameters from sustained vowel phonations of 134 non-dysphonic young adults (aged 20-29) of both genders, including smokers and non-smokers. RESULTS Some voice parameters were significantly altered in young smokers when compared with young non-smokers, probably as a consequence of histological changes caused by tobacco. Main differences were observed in Frequency Perturbation parameters (jitter, sPPQ) for both genders, in Fundamental Frequency parameters (Fo, Fhi, Flo) mainly in women, and in tremor parameters (ATRI, FTRI) in men. The number of cigarettes smoked per day was related to the Fundamental Frequency values in women and FTRI in men. A discriminant analysis correctly classified 70-75% of the subjects in each gender group as smokers and non-smokers. CONCLUSIONS A combination of voice parameters seems to suggest a possible neurological effect of nicotine--or some other chemical component of tobacco--on the voice.

Laparoscopic detection of sentinel lymph nodes using blue dye in women with cervical and endometrial cancer.

Abstract: Background One of the cornerstones of gynecologic cancer surgery is the assessment and removal of the regional lymph nodes (LNs). Vital blue dye was used to shown the feasibility and accuracy of laparoscopic intraoperative lymphatic mapping of the sentinel lymph nodes (SNs) in patients with cervical and endometrial cancer (EC). Material/methods Thirty-two women were submitted to laparoscopic staging of cervical and endometrial cancer. Patent blue dye (BPD) was intraoperatively injected into the cervix in 6 cases with stage I and one case with stage II cervical cancer. In 25 cases of stage I EC, the BPD was intraoperatively injected into the cervix and uterine fundus. After the BPD procedure, the patients underwent pelvic lymphadenectomy or para-aortic lymph node dissection and either laparoscopically assisted vaginal hysterectomy (26 patients) or laparoscopic radical hysterectomy (5 patients). Results Laparoscopically assisted surgical staging was successfully performed in all cases. SN detection was successful in 100% of 7 women with cervical cancer. In one patient with advanced cervical cancer the metastatic SN was found. A deposition of dye into at least one lymph node was found in 21 out of 25 cases (84%) in women with EC. Uptake of the BPD was observed in a total of 53 (14.4%) of 367 LNs. Histological analysis of two LNs of the 53 were positive for metastases, whereas the remaining 51 were negative. Conclusions With the use of laparoscopy, accurate detection using blue dye on sentinel lymph nodes in uterine cancer is feasible technique.