Novel effects of Helicobacter pylori CagA on key genes of gastric cancer signal transduction: a comparative transfection study.

Helicobacter pylori (H. pylori) infection is now recognized as a worldwide problem. Helicobacter pylori CagA is the first bacterial oncoprotein to be identified in relation to human cancer. Helicobacter pylori CagA is noted for structural diversity in its C-terminal region (contains EPIYA motifs), with which CagA interacts with numerous host cell proteins. Deregulation of host signaling by translocated bacterial proteins provides a new aspect of microbial-host cell interaction. The aim of this study is to compare the cellular effects of two different CagA EPIYA motifs on identified signaling pathways involve in gastric carcinogenesis. To investigate the effects of CagA protein carboxyl region variations on the transcription of genes involved in gastric epithelial carcinogenesis pathways, the eukaryotic vector carrying the cagA gene (ABC and ABCCC types) was transfected into gastric cancer cell line. The 42 identified key genes of signal transduction involved in gastric cancer were analyzed at the transcription level by real-time PCR. The results of real-time PCR provide us important clue that the ABCCC oncoprotein variant can change the fate of the cell completely different from ABC type. In fact, these result proposed that the ABCCC type can induce the intestinal metaplasia, IL-8, perturbation of Crk adaptor proteins, anti-apoptotic effect and carcinogenic effect more significantly than ABC type. These data support our hypothesis of a complex interaction of host cell and these two different H. pylori effector variants that determines host cellular fate.

H9N2 influenza A virus circulates in H5N1 endemically infected poultry population in Egypt.

We describe the identification and characterization of the H9N2 influenza subtype reported in Egyptian broiler and broiler breeder farms for the first time. Circulation of this subtype in a highly pathogenic H5N1 influenza virus endemic population provides an opportunity for genetic reassortment and emergence of novel viruses.

Refractory cardiac arrest due to inadvertent intravenous injection of 0.25% bupivacaine used for local infiltration anesthesia.

The cardiotoxic effect of bupivacaine is a well-known fact that can lead to asystole, and most of the time it is refractory to resuscitative measures. We describe the case of a three-year-old child operated for anorectal malformation (ARM) by abdominal approach. Apart from congenital anomalies, preoperative evaluation was unremarkable. General anesthesia and controlled ventilation were instituted through endotracheal tube (ET). She had an uneventful intraoperative period. Immediately after surgery when local infiltration block was given using 0.25% of bupivacaine (6 ml volume) around the abdominal incision for postoperative analgesia, the patient went into cardiac asystole. Cardiopulmonary resuscitation (CPR) was continued for 60 minutes but the patient could not be revived. At that time we had neither lipid emulsion nor the facility for cardiopulmonary bypass in our hospital setup.

Comparison of three supraglottic devices in anesthetised paralyzed children undergoing elective surgery.

CONTEXT: The newest variation of the i-gel supraglottic airway is a pediatric version. AIMS: This study was designed to investigate the usefulness of the size 2 i-gel compared with the ProSeal laryngeal mask airway (PLMA) and classic laryngeal mask airway (cLMA) of the same size in anesthetized, paralyzed children. SETTINGS AND DESIGN: A prospective, randomized, single-blinded study was conducted in a tertiary care teaching hospital. METHODS: Ninety ASA grade I-II patients undergoing lower abdominal, inguinal and orthopedic surgery were included in this prospective study. The patients were randomly assigned to the i-gel, PLMA and cLMA groups (30 patients in each group). Size 2 supraglottic airway was inserted according to the assigned group. We assessed ease of insertion, hemodynamic data, oropharyngeal sealing pressure and postoperative complications. RESULTS: There were no differences in the demographic and hemodynamic data among the three groups. The airway leak pressure of the i-gel group (27.1±2.6 cmH(2)O) was significantly higher than that of the PLMA group (22.73±1.2 cmH(2)O) and the cLMA group (23.63±2.3 cmH(2)O). The success rates for first attempt of insertion were similar among the three devices. There were no differences in the incidence of postoperative airway trauma, sore throat or hoarse cry in the three groups. CONCLUSIONS: Hemodynamic parameters, ease of insertion and postoperative complications were comparable among the i-gel, PLMA and cLMA groups, but airway sealing pressure was significantly higher in the i-gel group.

Comparison of Size 2.5 i-gel™ with Proseal LMA™ in Anaesthetised, Paralyzed Children Undergoing Elective Surgery.

BACKGROUND: The newest variation of i-gel is its pediatric version. This novel supraglottic airway device has the added advantage of a drain tube. In this study, we compared the effectiveness of size 2.5 i-gel with size 2.5 ProSeal LMA. AIMS: This study was designed to investigate the usefulness of the size 2.5 i-gel compared with the ProSeal laryngeal mask airway (PLMA) of the same size in anesthetized, paralyzed children. MATERIALS AND METHODS: Sixty ASA grade I - II patients undergoing elective surgery were included in this prospective study and were randomly assigned to the i-gel and PLMA groups (30 patients in each group). A size 2.5 supraglottic airway was inserted according to the assigned group. We assessed the ease of insertion, hemodynamic data, oropharyngeal sealing pressure, and postoperative complications. RESULTS: There were no differences in the demographic and hemodynamic data, success rates for the first attempt of insertion, or postoperative airway morbidity among the two groups. The airway leak pressure of the i-gel group (27.12 ± 1.69 cm H(2)O) was significantly higher than that of the PLMA group (22.75 ± 1.46 cm H(2)O). CONCLUSION: Hemodynamic parameters, ease of insertion and postoperative complications were comparable between the i-gel and PLMA, but the nairway sealing pressure was significantly higher in the i-gel group.

A prospective, randomized, Single-blinded, comparative study of Classic Laryngeal Mask Airway and ProSeal Laryngeal Mask Airway in pediatric patients.

CONTEXT: ProSeal Laryngeal Mask Airway (PLMA) is extensively being used in pediatric anesthesia. AIMS: To evaluate the efficacy of PLMA as compared to Classic Laryngeal Mask Airway (CLMA) for airway maintenance in pediatric patients. SETTINGS AND DESIGN: A prospective, randomized, Single-blinded study was conducted in a tertiary care teaching hospital. MATERIALS AND METHODS: Sixty ASA I and II children were included. Patients were randomized to either size 2 PLMA or size 2 CLMA groups. Parameters noted were time for insertion, number of attempts, airway sealing pressure, blood pressures (systolic, diastolic, and mean), pulse rate, end-tidal carbon dioxide (EtCO(2)), peripheral oxygen saturation (SpO(2)), and postoperative change in abdominal circumference, and airway trauma. STATISTICAL ANALYSIS USED: Parametric data were analyzed with the unpaired t-test and non-parametric data were analyzed with the chi-square (χ(2)) test. Unless otherwise stated, data are presented as mean (SD). Significance was taken as P < 0.05. RESULTS: There was no statistical difference between the two groups for the success rates at the first attempt of insertion, airway sealing pressure, hemodynamic responses, SpO(2), EtCO(2) and postoperative changes in abdominal circumference. Patients in the PLMA group had longer time of insertion and higher incidence of airway trauma. CONCLUSIONS: The PLMA and the CLMA were comparable for hemodynamic and ventilatory parameters and change in abdominal circumference; however, the time taken for insertion and airway trauma was more with PLMA.

[Dietary intake of non-dioxin-like polychlorinated biphenyls (PCB) in Bavaria, Germany. Results from the Integrated Exposure Assessment Survey (INES)]. / Nahrungsbedingte Zufuhr von nicht-dioxinähnlichen polychlorierten Biphenylen (PCB) in Bayern. Ergebnisse von INES (Integrated Exposure Assessment Survey).

Polychlorinated biphenyls (PCB) were widely used in numerous industrial and commercial applications in high quantities in the past. Based on their persistence in the environment, their tendency to accumulate in the organism and their specific health effects, PCBs have to be assessed as critical substances. Because the dietary intake was assumed to be the main intake route, the Integrated Exposure Assessment Survey (INES) aimed to measure the recent exposure to PCBs in Germany. The study consisted of 10 female and 10 male participants living in Munich and surroundings. The participants collected dietary duplicates of all food consumed and prepared as for consumption over 7 consecutive days. Altogether the 6 non-dioxin-like PCB congeners 28, 52, 101, 138, 153 and 180 ndl-PCB or, respectively, indicator PCB and furthermore the congener 118 were detected using a gas chromatographic method. Dietary intake was calculated using the amount of food eaten daily and the results from the duplicates. Using the sum of PCB 138, 153 and 180 multiplied by 4, the daily intake ranged from 4.0 to 24.1 ng/kg b.w. (median: 9.5 ng/kg b.w.). On the contrary, the daily intake was 2.9 to 20.6 ng/kg b.w. (median: 11.2 ng/kg b.w.) if the sum of the 6 indicator PCBs multiplied by factor 2 was used for quantification. No sex-related difference of the dietary intake was observable. Overall, it can be concluded that the dietary PCB intake has further decreased in the last years in Germany. At present, the toxicological database is not suitable to assess the risks coming solely from the non-dioxin-like PCBs because it is not possible to differentiate between non dioxin-like and dioxin-like effects in toxicological studies. Nevertheless, a further reduction of PCB exposure via food by searching for possible sources is needed.

A Study of the Use of Laryngeal Mask Airway (LMA) in Children and its Comparison with Endotracheal Intubation.

SUMMARY: Laryngeal mask airway (LMA) is increasingly being used in children as it is less invasive compared to endotracheal intubation and causes less discomfort in the postoperative period. However, some concerns remained about its safety during positive pressure ventilation in children. In a prospective randomized trial, 100 ASA I and II children weighing between 10-20 kg in the range of 2-10 years of age, scheduled for elective surgery were randomly allocated to one of the two groups of 50 patients each. The efficacy of LMA in children during positive pressure ventilation, its haemodynamic changes and postoperative complications were compared to endotracheal intubation. Insertion of LMA was easier in 94% patients while endotracheal intubation was done easily in 53% of patients only (p<0.05). The changes in haemodynamic parameters were significantly higher after endotracheal intubation as compared to LMA placement. Furthermore these changes persisted for longer duration after endotracheal intubation in comparison to LMA insertion (5 min vs 3 min). Incidence of postoperative complications i.e. bronchospasm, laryngospasm and soft tissue trauma was significantly higher (p<0.05) after endotracheal intubation as compared to LMA insertion. To conclude, the laryngeal mask airway is a suitable alternative to endotracheal intubation for positive pressure ventilation in children.

New insights into the mechanisms of the thermal Fenton reactions occurring using different iron(II)-complexes.

Although the Fenton reagent (a mixture of hydrogen peroxide and an iron(II) salt) has been known for more than a century, the manifold mechanisms occurring during the thermal Fenton reaction are still under discussion. Indeed, this discussion served as a powerful driving force for the steadily increasing insight into the field of inorganic radical and electron transfer chemistry. In this work, an experimental approach towards the elucidation of the first steps taking place in the reaction between several iron(II)-complexes and hydrogen peroxide (H2O2) in water at pH = 3.0 is presented. 2,4-xylidine (2,4-dimethylaniline) reacts differently with reactive intermediates via the addition or hydrogen abstraction by the hydroxyl radical (HO*) or electron transfer reactions to higher valent iron-species, such as a hydrated ferryl-complex (Fe(IV)). The chemical reactivity of the employed iron(II)-complexes with H2O2 differed strongly depending on their ground-state one-electron oxidation potentials. The results are interpreted in accordance with the paradigm originally developed by Goldstein et al. which is based on the evidence obtained from the Marcus theory that outer-sphere electron transfer reactions between metal complexes are not likely to occur because they are too slow. Therefore, most of the "Fenton-reagents" form transient metal complexes, which can be described as [LnFe-H2O2]m+. They form, depending on the reaction conditions, either the hydroxyl radical or higher-valent iron complex species.

Leishmania donovani invasion of the blood in a child with dermal leishmaniasis.

Cutaneous leishmaniasis is highly endemic in eastern Mediterranean countries. The causative organisms are Leishmania tropica or Leishmania major but, further west, variants of Leishmania infantum frequently cause cutaneous leishmaniasis. We report a young girl from Beirut with an acute cutaneous leishmaniasis in whom the causative organism was cultured from both the skin lesion and the blood in the absence of any signs or symptoms typical of systemic involvement. The parasite was found to have a zymodeme typical of organisms belonging to the L. donovani complex. With the negative past history and in the absence of anti-Leishmania antibodies in her serum, post-kala-azar dermal leishmaniasis is an unlikely possibility, especially in view of the rarity of the complication in this part of the world. The infection was probably acquired during a recent visit to Aleppo, where cutaneous leishmaniasis is hyperendemic as similar cases have not been reported in Beirut. This case indicates the need to consider L. infantum strains in addition to L. tropica in cutaneous disease in Aleppo. This case also demonstrates that L. infantum can spread by the haematogenous route, even in a child without evidence of the immunosuppression, which usually predisposes to such spread.

Crossed renal ectopia: clinical and radiological findings in 22 cases.

The clinical and radiological features of 22 patients with crossed ectopic kidneys are reported, including a case with unusual mobility of an unfused ectopic kidney. In some cases the anomaly was an incidental finding. However, complications were frequent and included seven hydronephrotic and three non-functioning kidneys, two of the latter were found to be obstructed by a calculus. Vesico-ureteral reflux was demonstrated in three of the five children in whom the examination was performed. Anomalous blood supply was present in all patients who underwent renal arteriography or surgery. Skeletal anomalies were present in 11 patients, one of whom had in addition coarctation of the aorta, and another atrial septal defect and anal atresia.

Constrictive pericarditis in familial Mediterranean fever.

Fibrosing peritonitis and constrictive pericarditis occurred in an 18-year-old patient who manifested the classic features of familial Mediterranean fever (FMF). Pericardial calcification had been present in chest X-rays taken when the patient was five years old. Intermittent intestinal obstruction and congestive heart failure were relieved by appropriate surgical intervention, but attacks of FMF subsided only after colchicine therapy. This is the first instance of nonuremic pericarditis in our experience with over 1,000 FMF patients. Critical analysis of the reported cases in which pericarditis was attributed to FMF strengthens our belief that the occurrence of pericarditis in a patient with FMF probably represents a fortuitous intercurrent disease.

Crossed renal ectopia: angiographic findings in six cases.

Angiographic findings in six patients with crossed renal ectopia are reported. Crossed fused ectopia was present in four cases, and the remaining two had single crossed ectopic kidneys. All kidneys, including the nonectopic ones, had an anomalous blood supply. No constant arterial pattern was discernible, and renal arteries were found to arise from the aorta both above and below the normal level as well as from the iliac arteries. It is suggested that angiography be undertaken in all cases when surgery is contemplated.

The value of tomography of the sterno-clavicular region.

Nine patients out of a series of 20 are presented illustrating some of the conditions which may affect the sterno-clavicular region (SCR). The value of tomography as a routine procedure in the study of the SCR is stressed, as in many cases the plain film studies fail to reveal clear-cut evidence of pathological changes. Establishing the exact aetiological nature of the lesion is not always possible by means of radiology alone. However, the radiological demonstration of disease in the SCR is invaluable as a guide to the further management of the patient.