Sarcopenia and Post-Operative Morbidity and Mortality in Patients with Gastric Cancer

PURPOSE: Surgical resection for gastric adenocarcinoma is associated with significant post-operative morbidity and mortality. The aim of this study was to assess the prognostic significance of sarcopenia in patients undergoing resection for gastric adenocarcinoma with respect to post-operative morbidity and survival. MATERIALS AND METHODS: A retrospective analysis was conducted on a cohort of consecutive patients who underwent surgical resection for gastric adenocarcinoma between 2008 and 2014. Patient demographics, radiological parameters, and pathological data were collected. OsiriX software (Pixmeo) was used to measure skeletal muscle area, which was normalized for height to calculate skeletal muscle index. RESULTS: A total of 56 patients (41 male, 15 female; mean age, 68.4 ± 11.9 years) met the inclusion criteria. Of these, 36% (20 of 56) of the patients were sarcopenic pre-operatively. Both sarcopenic and non-sarcopenic patient groups were equally matched with the exception of weight and body mass index (P=0.036 and 0.001, respectively). Sarcopenia was associated with a decreased overall survival (log-rank P=0.003) and was an adverse prognostic predictor of overall survival in multivariate analysis (hazard ratio, 10.915; P=0.001). Sarcopenia was a predictor of serious in-hospital complications in multivariate analysis (odds ratio, 3.508; P=0.042). CONCLUSIONS: In patients undergoing curative resection for gastric cancer, there was a statistically significant association between sarcopenia and both decreased overall survival and serious post-operative complications. The measurement and reporting of skeletal muscle index on pre-operative computed tomography should be considered.

Cytokeratin 18 as a non invasive marker in diagnosis of NASH and its usefulness in correlation with disease severity in Egyptian patients

A simple noninvasive test that accurately distinguishes NASH from NAFL as well as determines the disease severity is urgently needed. Recently, it was found that determination of Cytokeratin-18 [CK-18] fragments in the blood, predicts and correlates with histological NASH in which there is development of lobular inflammation, cell ballooning and fibrosis, supporting its usefulness in clinical practice To evaluate the role of CK-18 as a non invasive marker in diagnosis of NASH and its usefulness in correlation with disease severity in Egyptian patients. 90 subjects were divided into 3 groups: group I: including 30 patients with NASH, group II: including 30 patients with NAFL, and group III: including 30 healthy subjects as control. Diagnosis of NASH and its discrimination from NAFL was done by liver biopsy. CK-18 level in plasma was measured for all subjects using ELISA. CK-18 was significantly elevated in patients of group I in comparison to group II and III patients, with mean +/- SD: 460 +/- 279, 167 +/- 56 and 149 +/- 57, respectively, and/3 value: 0.001. The [ROC] curve diagnostic performance of CK18 in diagnosis of NASH shows: cutoff value of >240U/L, with sensitivity 76.7%, specificity 95.0%. Ck-18 was found to correlate with disease severity assessed by NAS scoring system with P value: 0.001. Measurement of CK18 in NASH is a useful screening, diagnostic and staging bio-marker

Role of cerebrospinal fluid il-8 as a marker for differentiation between acute bacterial and aseptic meningitis

No doubt, the distinguishing between bacterial and aseptic meningitis in the emergency department could help to limit unnecessary antibiotic use and hospital admissions. This study evaluated the role of cerebrospinal fluid IL-8 in differentiating acute bacterial meningitis [ABM] from aseptic meningitis [AM]. A total of 80 hospitalized patients with clinical presentations of suspected acute meningitis were subjected to estimation of IL-8 CSF concentrations. The results showed that CSF IL-8 levels were higher in acute bacterial meningitis than in aseptic ones [p <0.05]. The best cut-off value of CSF IL8 for early diagnosis of bacterial meningitis was 3.6ng/ml with a sensitivity of 82.5% and a specificity of 85.0%

Multiple molecular markers MAGE-1, MAGE-3 and AFP mRNAs expression nested PCR assay for sensitive and specific detection of circulating hepatoma cells: Enhanced detection of hepatocellular carcinoma

Hepatocellular Carcinoma is a multifactorial, multistep and complex process. Its prognosis is poor and early diagnosis and monitoring of metastasis of HCC is of utmost importance. Circulating alpha-fetoprotien mRNA has been proposed as a marker of HCC cells disseminated into the circulation but the specificity of this molecular marker and its correlation with the main HCC clinico-pathological parameters remain controversial. In recent years; several different multi-marker assays have been developed for the detection of hepatoma cells in the peripheral blood of patients with HCC. In this study 58 patients and 15 matched healthy volunteers were included; the patients were divided into three groups; group A: patients with primary HCC [n = 32], group B: patients with cirrhosis with no evidence of HCC [n = 12], group C: patients with metastatic cancer in liver [n = 14]. Group D: 15 healthy volunteers age and sex matched. The staging of HCC was carried out according to the Tumor/Node/Metastasis [TNM] classification. Peripheral blood samples were obtained from all subjects; MAGE-1 and MAGE-3 and AFP mRNAs were detected by nested RT-PCR. The positive rates of MAGE-1, MAGE-3 and AFP mRNAs were 18/32 [56.3%], 15/32 [46.9%] and 19/32 [59.4%] respectively in the primary HCC patients. In the cirrhotic group only 4/12 [33.3%]patients were positive for AFP mRNA, whereas in the metastatic group 5/14 [35.7%] and 4/14 [28.6%] were positive to MAGE-1 and MAGE-3 mRNAs respectively. MAGE-1 and MAGE-3 mRNAs were correlated with TNM clinical stages; tumor number and tumor size [p < 0.05]. Our results indicate that a multi-marker nested RT-PCR assay with cancer-specific markers such as MAGE-1 and MAGE-3 in combination with a hepatocyte-specific AFP marker may be a promising diagnostic tool for monitoring hepatocellular carcinoma patients. Nested PCR exhibits higher sensitivity, stronger specificity and lower false-positive occurrence as compared to single RT

Application of artificial neural networks for response surface modeling in HPLC method development

This paper discusses the usefulness of artificial neural networks [ANNs] for response surface modeling in HPLC method development. In this study, the combined effect of pH and mobile phase composition on the reversed-phase liquid chromatographic behavior of a mixture of salbuta-mol [SAL] and guaiphenesin [GUA], combination I, and a mixture of ascorbic acid [ASC], paracetamol [PAR] and guaiphenesin [GUA], combination II, was investigated. The results were compared with those produced using multiple regression [REG] analysis. To examine the respective predictive power of the regression model and the neural network model, experimental and predicted response factor values, mean of squares error [MSE], average error percentage [E[[r%], and coefficients of correlation [r] were compared. It was clear that the best networks were able to predict the experimental responses more accurately than the multiple regression analysis

Computed Tomography Assessment of Intestinal Gas Volumes in Functional Gastrointestinal Disorders

BACKGROUND/AIMS: Many patients with functional gastrointestinal disorders (FGIDs) rank sensations of bloating and distension among their most debilitating symptoms. Previous studies that have examined intestinal gas volume (IGV) in patients with FGIDs have employed a variety of invasive and imaging techniques. These studies are limited by small numbers and have shown conflicting results. The aim of our study was to estimate, using CT of the abdomen and pelvis (CTAP), IGV in patients attending FGID clinic and to compare IGV in patients with and without FGID. METHODS: All CTAP (n = 312) performed on patients (n = 207) attending a specialized FGID clinic over 10-year period were included in this study. Patients were classified into one of 3 groups according to the established clinical grading system, as organic gastrointestinal disorder (OGID, ie, patients with an organic non-functional disorder, n = 84), FGID (n = 36) or organic and functional gastrointestinal disorder (OFGID, ie, patients with an organic and a functional disorder, n = 87). Two independent readers blinded to the diagnostic group calculated IGV using threshold based 3D region growing with OsiriX. RESULTS: Median IGVs for the FGID, OGID, and OFGID groups were 197.6, 220.6 and 155.0 mL, respectively. Stepwise linear regression revealed age at study, gender, and calculated body mass index to predict the log IGV with an r2 of 0.116, and P < 0.001. There was a significant positive correlation between age and IGV in OGID (Spearman's = 0.253, P = 0.02) but this correlation was non-significant in the other groups. CONCLUSIONS: Although bloating is a classic symptom in FGID patients, IGV may not be increased compared with OGID and OFGID patients.

Complete Radiological Findings in Gallstone Ileus

No abstract available.

[Kikuchi-Fujimoto's disease]

The necrotizing histiocyte lymphadenitis is a disease of unknown cause. Clinicians should be aware of this uncommon disease in order to differentiate it from lymphoma, infectious adenitis, and collagenosis. A 24-year-old woman consulted for a right cervical mass which had developed rapidly with no associated symptom. Laboratory results were normal. The gangular biopsy confirmed the diagnosis of necrotizing hymphanditis. Necrotizing histiocyte lymphadenitis is generally observed in young women in their twenties. There has been no predominant ethnic backgrouns. Clinically, it is characterized by lymphadenitis of one or more lymph nodes, predominantly in the cervical region. The Laboratory tests are normal excepting for discrete signs of inflammation. Diagnosis anatomopathologic, the characteristic features include focal necrosis predominantly in the paracortical region with abundant karyorrhectic debris and atypical mononuclear cells around the necrotic zone [crescent-shaped histiocytes, plasmacytoid monocytes, and small lymphocytes and immunoblasts]. The clinical course is generally spontaneously favorable in six months. Relapse is uncommon. The clinicopathologic picture can be confused with a malignant blood disease particularly lymphoma. Evolution is benign and healing without treatment is the rule

Study of respiratory disorders in endoscopically negative and positive gastroesophageal reflux disease

The relation between respiratory disorders and reflux symptoms has been debated since the beginning of the last century and the interest in the question has increased during the last few decades. This study aims to investigate the relation between specified respiratory disorders and reflux symptoms and examine the correlation between respiratory disorders and endoscopic findings in patients with gastroesophageal reflux disease. This study included 515 patients evaluated for gastroesophageal reflux disease [GERD] by patient self-report symptom questionnaire; modified four grade Likert scale and endoscopic assessment using endoscopic Los Angeles Classification. All participants were asked about various respiratory symptoms experienced during the past six months and exposed to measuring body mass index [BMI], medical history, pulmonary physical examination, chest X-ray, respiratory function tests and available sleep studies. A total number of 515 patients were categorized according to endoscopic findings into two groups; [group 1] subjects with normal endoscopic studies [NERD] 118 [22.9%] patients and [group 2] subjects with abnormal endoscopic studies [ERD] 397 [77.1%]. The proportion of females was significantly higher in ERD group [80.1%] as compared with NERD group [62.7%] [P<0.02]. Duration of reflux symptoms found to be significantly prolonged in ERD group [P<0.03]. The cases of ERD group were more likely to be overweight [BMI>25] P<0.02. History of pulmonary symptoms preceding GERD symptoms was found in 15% of patients. There were 294 patients [57.1%] with different pulmonary manifestations. These manifestations were significantly higher among female group [P<0.01] and among obese, above 40 years old [P<0.001, 0.05 respectively]. Among all patients with respiratory manifestations the commonest disorders diagnosed were chronic pharyngitis [50.3%], chronic bronchitis [15.8%], bronchial asthma [12.6%] and recurrent pneumonia [3.3%]. Obstructive sleep apnea and recurrent hemoptysis were present in 2.7% and 1.5% of the studied patients respectively. There were three cases of chronic lung abscess. There was a significant difference between ERD and NERD groups in their relations to respiratory disorders [P<0.001]. There were statistically significant differences in FEV1,FVC and FEV1/FVD [P<0.02, P<0.05 and P<0.05] respectively in ERD group as compared with NERD group. The study confirms the strong link between gastroesophageal reflux symptoms and various respiratory disorders. Endoscopy of the upper digestive tract remains an important exam in the evaluation of GERD. Respiratory symptoms are more prevalent among erosive esophagitis patients with a positive correlation with degree of severity. These is direct relationship between the severity of airways obstruction as detected by FEV[1], and FEV1/FVC and GER symptoms

MR susceptibility sign of the middle cerebral artery in imaging of acute stroke

To evaluate the accuracy of echo-planar T2-weighted, compared to MRA and FLAIR in the detection of acute middle cerebral artery [MCA] thrombotic occlusion. 47 consecutive patients with acute stroke involving the MCA territory underwent MR imaging within 2 to 76 hours after clinical onset. MR examination included echo-planar T2-weighted-, FLAIR, diffusion-weighted-imaging [DWI] and MR-angiography [MRA]. The susceptibility sign on echoplanar T2-weighted images, which is indicative of acute thrombotic occlusion involving the MCA, was assessed and compared to findings on MRA and axial FLAIR in all patients and to CT in 23 patients. National Institutes of Health Stroke Scale [NIHSS] score, which is a clinical scale assessment, was used for evaluating the neurological status of patients. Fourty seven [47] patients [29 males; age range 11-86years [mean: 58.3 +/- 14.7 yrs] and 18 females; age range 35-83 years [mean: 59.4 +/- 12.7 yrs] with acute territorial MCA infarcts were included in this study. Out of these 47 patients, 10 had hyperacute MCA infarction [scanned 2-6 hours after ictus], 7 of those patients presented with very severe stroke [NIHSS score 21 or more] and 3 patients with severe stroke [NIHSS score 15-20]. Thirty seven [37] patients were studied within 76 hours from ictus [acute to early subacute]. Among this group and according to NIHSS score, 5 patients had mild to moderate stroke, 16 patients severe stroke; and 13 patients had very severe stroke. One patient who had very severe stroke with NIHSS score of 22, died. She had left MCA occlusion, presented 4 hours within onset of right hemiplegia and had a history of DM, HTN and COPD. Presence of the susceptibility sign on T2 WI proximal to the MCA bifurcation provides fast and accurate detection of acute proximal MCA thrombotic occlusion. It is considered a warning sign for rapid and efficient intervention for stroke treatment, including thrombolysis and can be used for follow up of thrombus evolution

Cardiopulmonary compromise during and after gastrointestinal endoscopy

Although gastrointestinal endoscopy is a safe procedure, it is occasionally associated with complications especially in elderly patients or those having heart disease. We studied some cardiopulmonary parameters during and after upper gastrointestinal endoscopy and colonoscopy in patients with and without heart disease in different age groups. Ninety hospitalized patients with age range [46-94 years]; all underwent endoscopy without premedications or conscious sedation. Patients were classified into three groups according to age and risk cardiac index. Electrocardiography with two leads [II, V5] was used; blood pressure and peripheral oxygen saturation [SpO2] were monitored throughout the procedure. Troponin t was evaluated before and 12 hours after the procedure. Relation between changes in cardiopulmonary parameters during and after endoscopy and cardiac function were analyzed. A significant fall was noted in SpO2 during the procedure in group II [92.12 +/- 3.4] and group III [91. 75 +/- 2.4] [P= 0.001] whereas in group I [95 .34 +/- 1.1] no significant fall in SpO2 was noted from the baseline [P=0.63]. A higher cardiac risk index was found in patients with oxygen desaturation than in patients without it [P<0.05]. Atrial and ventricular premature beats found to be significantly higher in old patients and those had underlying heart disease. There is significant increase in systolic blood pressure during insertion of endoscope in all groups with no statistical difference between groups [P=0.5]. ST changes were recorded in three patients with no significant ST level changes between patients with and without heart diseases. Silent ischemia was reported as elevated Troponin t in three patients. Duration of the procedure significantly correlated with oxygen desaturation. Transient cardiopulmonary changes are not uncommon during upper and lower gastrointestinal endoscopy. Patients with ischemic heart disease, chronic pulmonary disease, advanced age, and those undergoing prolonged therapeutic procedures must be considered as high risk patients for the development of cardiopulmonary complications during gastrointestinal endoscopy. Routine use of electronic monitoring with pulse oximetry, ECG recording and blood pressure are important for detecting potentially important abnormalities in high risk groups

Therapeutical and surgical management results of trigger finger at Aleppo University Hospital

This research contains studying of congenital trigger thumb and degenerative trigger finger at Aleppo University Hospital. We study the relationship between this disease and systemic diseases as diabetic mellitus and rheumatoid arthritis and how these diseases can affect on occurrence this disease and how they affect on the plan of treatment. The cases were treated by conservative therapy [physical treatment, steroids injection] or by surgical therapy. We followed up the cases for sex months at least. Then we take out the results and compared the results with other studies

con A purified hydatid glycoprotein fraction effectively diagnoses human hydatidosis

Diagnosis and quantification of Echinococcus granulosus in-fection in man and animal hosts are centralized to feasible con-trol this study included 93 serum sample, 25 sure positive hydatid cases confirmed surgically, 7 suspected cases diagnosed by indirect haemagglutination IHA and 41 cases other parasitic infection [15 S. mansoni, 8 fasciola, 7 Ascaris, 5 H. nana and 6 Ancylostoma] diagnosed by microscopic examination and were negative by ELISA and/or IHA for anti-hydatid antibody. Twen-ty negative serum samples served as healthy controls. Six types of hydatid fluid antigens [crude, host-free and Con-A purified] of human and camel origin were subjected to electrophoretic separ-ation [SDS-PAGE] and immunoblotting [EITB]. The anti-hydat-id IgG was detected in sera of the different groups for evalua-tion of sensitivity, specificity and diagnostic efficacy each type of antigens. Detection of circulating hydatid antigen [CAg] was performed using anti rabbit hyperimmune sera raised again-st Con-A purified either human or camel hydatid antigen. SDS-PGE revealed several bands ranging from 55-185- kDa with 10kD band shared by all antigens. The specific bands revealed by EITB for Con-A purified camel and human antigens were at 80, 110, 55, 110 kDa respectively. ELISA highest sensitivity [96.9%] was by using host-free Con-A purified glycoprotein fraction of human hydatied antigen. Highest specificity [98.4%] was reco-rded upon use of either Con-A purified camel or human antigen with 94.5% and 97.7 and diagnostic efficacy respectively. Detection of circulating antigen by polyclonal antibodies against Con-A purified human hydatid antigen revealed 91.8%specificity.

Early cerebral duplex, doppler D-dimer, and plasminogen activator inhibitor - 1 in high risk term neonates

Alterations in the cerebral blood flow in the neonate can be assessed by Duplex Doppler. Stressed neonates may be liable to cerebral thrombosis owing to disturbed procoagulant balance between reactive fibrinolysis and antifibrinolysis. This study assessed some plasma hemostatic markers in correlation with cerebral hemodynamics in a group of stressed FT neonates. To investigate possible relation of both measurements to the type of the offending risk factor and to the severity of neurologic presentation. In this study, plasma level of D-dimer, a marker of fibrin formation and reactive fibrinolysis, and plasminogen activator inhibitor-1 [PAI-1], a marker of anti-fibrinolysis were assessed in 62 FT neonates. Of these, 52 were perinatally distressed, having neurological manifestations in the immediate post-natal period and 10 were healthy FT neonates who served as control. Studied neonates were clinically assessed at birth by Apgar score, resuscitated as required, sampled for ABG and CRP, and subjected to full clinical evaluation. Stressed neonates were categoriesed according to the type of perinatal insult into: One risk factor group; namely perinatal asphyxia [group A] and intrapartum trauma [group B], Two risk factor group; comprising group C, that included the above two risks, groups D and E that included any of the above two risks with superadded early postnatal sepsis. They were eventually classified by neurological criteria according to early postnatal encephalopathy score [ES] into minimum ES and maximum ES groups. Re-sampling followed for ABG and laboratory investigations that included CBC, platelet count, PT, PTT, D-dimer and PAI-1 assay by enzyme linked immunosorbant assay [ELISA]. Within 24 hours of birth, middle cerebral artery blood flow velocity was assessed and resistive index [RI] was measured using Duplex Doppler sonography. The mean values of RI, plasma D dimer and PAI-1 were significantly higher than control in all stressed neonates and in each high risk group. Reduced cerebral blood flow in asphyxiated neonates was mainly aggravated by birth trauma. Traumatised neonates had significantly higher mean plasma D-dimer and PAI-1 as compared to neonates with perinatal asphyxia. Development of postnatal sepsis significantly raised plasma level of PAI-1 in asphyxiated neonates. RI was more predictive of severity of encephalopathy than either hemostatic markers. Cerebral ischemia was significantly associated with instrumental delivery, premature rupture of membranes [PROM] while no significant association existed with either fetal bradycardia, liquor stained meconium, emergency CS, degree of hypoxemia or hypocarbia. A significant positive correlation existed between values of RI and each of plasma levels of D-dimer and PAI-1 in all stressed neonates. Conclusions: On the first day of life, cerebral blood flow is reduced and some plasma prothrombotic markers are elevated in FT neonates subjected to trauma or asphyxia at birth. Cerebral ischemia in severely stressed FT neonates may pave the way to future cerebrovascular thrombosis. It follows that early screening by cerebral Duplex Doppler is crucial for high risk FT neonates especially following exposure to intrapartum trauma

Multidetector CT Urography in Imaging of the Urinary Tract in Patients with Hematuria

This review article comprehensively discusses multidetector CT urography protocols and their role in imaging of the urinary tract in patients with hematuria.

Techniques, Clinical Applications and Limitations of 3D Reconstruction in CT of the Abdomen

Enhanced z-axis coverage with thin overlapping slices in breath-hold acquisitions with multidetector CT (MDCT) has considerably enhanced the quality of multiplanar 3D reconstruction. This pictorial essay describes the improvements in 3D reconstruction and technical aspects of 3D reconstruction and rendering techniques available for abdominal imaging. Clinical applications of 3D imaging in abdomen including liver, pancreaticobiliary system, urinary and gastrointestinal tracts and imaging before and after transplantation are discussed. In addition, this article briefly discusses the disadvantages of thin-slice acquisitions including increasing numbers of transverse images, which must be reviewed by the radiologist.

Radiation exposure from Chest CT: Issues and Strategies

Concerns have been raised over alleged overuse of CT scanning and inappropriate selection of scanning methods, all of which expose patients to unnecessary radiation. Thus, it is important to identify clinical situations in which techniques with lower radiation dose such as plain radiography or no radiation such as MRI and occasionally ultrasonography can be chosen over CT scanning. This article proposes the arguments for radiation dose reduction in CT scanning of the chest and discusses recommended practices and studies that address means of reducing radiation exposure associated with CT scanning of the chest.

Correlation of Patient Weight and Cross-Sectional Dimensions with Subjective Image Quality at Standard Dose Abdominal CT

OBJECTIVE: We evaluated the association between patients' weight and abdominal cross-sectional dimensions and CT image quality. MATERIALS AND METHODS: We prospectively evaluated 39 cancer patients aged more than 65 years with multislice CT scan of abdomen. All patients underwent equilibrium phase contrast-enhanced abdominal CT with 4 slices (from top of the right kidney) obtained at standard tube current (240 280 mA). All other scanning parameters were held constant. Patients' weight was measured just prior to the study. Cross-sectional abdominal dimensions such as circumference, area, average anterior abdominal wall fat thickness and, anteroposterior and transverse diameters were measured in all patients. Two subspecialty radiologists reviewed randomized images for overall image quality of abdominal structures using 5-point scale. Non-parametric correlation analysis was performed to determine the association of image quality with patients' weight and cross-sectional abdominal dimensions. RESULTS: A statistically significant negative linear correlation of 0.46, 0.47, 0.47, 0.58, 0.56, 0.54, and 0.56 between patient weight, anterior abdominal fat thickness, anteroposterior and transverse diameter, circumference, cross-sectional area and image quality at standard scanning parameters was found (p< 0.01). CONCLUSION: There is a significant association between image quality, patients' weight and cross-sectional abdominal dimensions. Maximum transverse diameter of the abdomen has the strongest association with subjective image quality.

Splenic cytokine mRNA expression in mice intravenously injected ith schistosoma mansoni 26-kDa glutathione S-transferase or soluble egg antigen before infection with schistosoma mansoni cercariae

This work was designed to assess the changes in hepatic granuloma formation associated with hyporesponsiveness to schistosomal egg antigen [SEA] or S.mansoni-26GST[Sm-26GST]. Multiple small doses of SEA [10 micro g x 4] or Sm-26GST [I micro g x 4] were injected intravenously [i.v.] into C57B1/6 mice 7 days prior to cercarial exposure. Mice were sacrificed 6 and 8 weeks post-infection, hepatic granuloma diameter was evaluated and mRNA expression of splenic cytokines IFN- alpha, IL-2, IL-4, IL-10 and IL-12 was estimated using the semiquantitative reverse transcription-polymerase chain reaction [RT-PCR]. Compared to infected controls, both SEA and Sm-26GST-treated groups showed significant decrease in hepatic granuloma diameter 8 wks post infection [p.i.] associated with lowered level of IFN- alpha and IL-4 mRNA; while the levels of both IL-10 and IL-12 were higher than that of infected controls. The present data show that Sm-26GST has an antipathology effect similar to SEA if it is used by i.v. route. The predominant cytokine involved in this hyporesponsiveness is IL- 10 and to a lesser extent IL- 12