Transforming growth factor-beta1 gene expression in hepatocellular carcinoma: a preliminary report

The transforming growth factor [TGF]-beta signalling pathway plays a dual role in hepatocarcinogenesis. It has been recognised for its role as a tumour suppressor as well as a tumour promoter depending on the cellular context. The aim of this study was to investigate the clinical significance of serum TGF-beta1 level and TGF-beta1 messenger RNA [mRNA] in the peripheral blood of liver cirrhosis and hepatocellular carcinoma [HCC] patients as noninvasive biomarkers in diagnosing HCC. Twenty patients were allocated to each of the liver cirrhosis and HCC groups, in addition to 20 healthy volunteers. TGF-beta1 gene expression in peripheral blood was quantitated using real-time polymerase chain reaction [PCR], while serum TGF-beta1 was analysed using enzyme-linked immunosorbent assay [ELISA]. TGF-beta1 gene expression was significantly lower in HCC patients [median 0.401 [0.241-0.699] fold change] than in liver cirrhosis patients [median 0.595 [0.464-0.816]] [p = 0.042] and normal controls [median 1.00 [0.706-1.426] fold change] [p = 0.001]. TGF-beta1 gene expression showed significant positive correlation with serum TGF-beta1 [r = 0.272, p = 0.036] and significant negative correlation with alpha-fetoprotein [AFP] [r = ?0.528, p = 0.001]. Receiver operating characteristic [ROC] analysis was conducted for TGF-beta1 gene expression in comparison with AFP. The area under the curve for TGF-beta1 gene expression was 0.688 [95% CI = 0.517-0.858] [p = 0.042] and AFP was 0.869 [95% CI = 0.761-0.976] [p = 0.001]. The sensitivity and specificity of TGF-beta1 gene expression were 65% and 75%, respectively, at a cutoff value of 0.462 fold change. TGF-beta1 gene expression in the peripheral blood may be used as a molecular marker for the diagnosis of HCC. Additional studies on a large-scale population are necessary to gain greater insight into the impact of TGF-beta1 gene expression in the pathogenesis of HCC

Dropped Shoulder Syndrome: A Cause of Lower Cervical Radiculopathy

BACKGROUND AND PURPOSE: Cervical radiculopathy is a pathological process involving a nerve root of the cervical spine. The most common causes of radiculopathy are cervical disc herniation followed by cervical spondylosis. The aim of this study was to determine the effect of dropped shoulder as a cause of lower cervical radiculopathy. METHODS: In total, 132 patients, comprising 105 women (79.5%) and 27 men (20.5%; female : male ratio of 4 : 1) and a mean age of 36.7 years (range 18-58 years), were included in this study. All of the patients presented with shoulder pain, and were investigated by cervical X-ray, cervical magnetic resonance imaging, serum muscle enzymes, and electromyography (EMG)/nerve-conduction studies. RESULTS: Ninety six patients (72.7%) exhibited visually detectable dropped shoulder. The lateral view X-ray of the cervical region revealed eight or more vertebrae. In 119 patients (90.2%), the EMG revealed a mild-to-moderate or moderate denervation patterns in the abductor digiti minimi, first dorsal interosseous, and flexor carpi ulnaris muscles, while the abductor pollicis brevis, extensor carpi radialis, and triceps brachii were denervated in 102 patients (77.3%). All of the patients had lower cervical paraspinal muscles with a denervation pattern. CONCLUSIONS: Three criteria for diagnosing dropped shoulder syndrome have been suggested: pain with consistent anatomical distribution, X-ray abnormalities, and EMG abnormalities. Compression of the cervical roots by muscle spasm has been proposed as the cause of dropped shoulder syndrome; this possibility is discussed herein.

Partnership of the community in support of health for all

Health for all is a people-based approach to health which considers the community as its focus. Community partnership is an important principle of health for all. This paper describes the many aspects of community partnership and gives examples of community partnerships initiatives in the World Health Organization Eastern Mediterranean Region, such as the basic development needs approach. The main agenda of community partnership for health for all is discussed and some opportunities conductive to community partnership in the Region are outlined