Impact of metabolic syndrome on the survival of Chinese patients with resectable esophageal squamous cell carcinoma.

Metabolic syndrome (MetS) is associated with the risk of esophageal squamous cell carcinoma (ESCC). However, the impact of MetS on survival has not been evaluated. A retrospective review was performed on 596 consecutive Chinese patients with esophageal squamous cell carcinoma who received surgery between January 2005 and October 2007. The clinical data and pretreatment information related to MetS were reviewed. The impact of MetS on overall survival (OS) was estimated by Kaplan-Meier and Cox proportional hazards analyses. MetS was a significant and independent predictor for better survival in patients with resectable ESCC. The 3-year OS and 5-year OS for patients with and without MetS were 75.0% versus 57.8% and 65.1% versus 44.6%, respectively (P = 0.005 in the univariate analysis, P = 0.010 in multivariate analysis). However, there was no apparent influence of any single component of MetS on OS. The other independent prognostic factors identified in the univariate analysis included the following: gender, smoking status, alcohol use, the extent of radical surgical resection, T and N stage, and tumor differentiation. The results of the multivariate analysis included the extent of radical surgery resection, T and N stage, and tumor differentiation. MetS was also associated with greater tumor cell differentiation (P = 0.036). There was no association found between MetS status and postoperative complications. MetS is an independent prognostic factor for OS in patients with ESCC and is associated with better tumor cell differentiation.

Pitfalls of CT for deep neck abscess imaging assessment: a retrospective review of 162 cases.

OBJECTIVES: To investigate the diagnostic value of contrast-enhanced computed tomography (CT) for the prediction of deep neck abscesses in different deep neck spaces and to evaluate the false-positive results. METHOD: We retrospectively analysed the clinical charts, CT examinations, surgical findings, bacteriology, pathological examinations and complications of hospitalised patients with a diagnosis of deep neck abscess from 2004 to 2010. The positive predictive values (PPV) for the prediction of abscesses by CT scan in different deep neck spaces were calculated individually on the basis of surgical findings. RESULTS: A total of 162 patients were included in this study. All patients received both intravenous antibiotics and surgical drainage. The parapharyngeal space was the most commonly involved space. The overall PPV for the prediction of deep neck abscess with contrast-enhanced CT was 79.6%. The PPV was 91.3% when more than one deep neck space was involved but only 50.0% in patients with isolated retropharyngeal abscesses. In the false-positive group, cellulitis was the most common final result, followed by cystic degeneration of cervical metastases. Five specimens taken intra-operatively revealed malignancy and four of these were not infected. CONCLUSIONS: There are some limitations affecting the differentiation of abscesses and cellulitis, particularly in the retropharyngeal space. A central necrotic cervical metastatic lymph node may sometimes also mimic a simple pyogenic deep neck abscess on both clinical pictures and CT images. Routine biopsy of the tissue must be performed during surgical drainage.

Assembly of a robust, thermally stable porous cobalt(II) nicotinate framework based on a dicobalt carboxylate unit.

A series of robust, thermally stable open-framework cobalt nicotinate compounds, Co(2)(H(2)O)[C(6)H(4)O(2)N](4).0.5CH(3)CH(2)OH.0.5H(2)O (1), Co(2)(H(2)O)[C(6)H(4)O(2)N](4) (2), and Co(2)(H(2)O)[C(6)H(4)O(2)N](4).C(6)H(5)CH(2)OH (3), based on rigid dimetallic carboxylate clusters as the basic building unit have been prepared. Single-crystal X-ray crystallographic analyses of 1 and 3 reveal the host framework possessing an effective channel area with the dimensions of 10.8 x 4.5 A. These channels can accommodate guest molecules of various sizes and shapes such as ethanol, water, and benzyl alcohol. Thermogravimetric analysis shows a two-step weight loss corresponding to the loss of guest molecules followed by the loss of coordinated water. The host framework is thermally stable up to 295 degrees C. The cobalt nicotinate host remains intact, even upon the removal of the guest to form compound 2 as revealed by single-crystal X-ray diffraction analysis. Crystal data for 1: Co(2)(H(2)O)[C(6)H(4)O(2)N)](4).0.5CH(3)CH(2)OH.0.5H(2)O, fw = 656.33, triclinic, space group P(-)1, a = 10.5407(2) A, b = 11.8266(3) A, c = 14.1122(2) A, alpha = 106.878(4) degrees, beta = 102.411(2) degrees, gamma = 111.011(3) degrees, V = 1467.9(5) A(3), Z = 2. Crystal data for 2: Co(2)(H(2)O)[C(6)H(4)O(2)N](4), fw = 624.28, triclinic, space group P(-)1, a = 10.507(3) A, b = 11.824(2) A, c = 14.113(3) A, alpha = 107.06(2) degrees, beta = 102.39(2) degrees, gamma = 111.105(16) degrees, V = 1459.5(6) A(3), Z = 2. Crystal data for 3: Co(2)(H(2)O)[C(6)H(4)O(2)N](4).C(6)H(5)CH(2)OH, fw = 732.42, triclinic, space group P(-)1, a = 10.6671(6) A, b = 12.0063(7) A, c = 14.0658(8) A, alpha = 106.7180(10) degrees, beta = 102.2790(10) degrees, gamma = 111.1900(10) degrees, V = 1504.1(6) A(3), Z = 2. The magnetic exchange coupling between the dicobalt centers for compounds 1 and 3 are analyzed on the basis of both the Curie-Weiss expression and a binuclear magnetic model. The negative values of the magnetic exchange coupling constant indicate the antiferromagnetic nature within the cobalt dimer.

Synthesis and biological evaluation of purine-containing butenolides.

6-Chloropurine derivatives of gamma-(Z)-ethylidene-2,3-dimethoxybutenolide 3a, gamma-(Z)-ethylidene-2-methoxy-3-(4-nitro)benzyloxybutenolide 3b, gamma-(Z)-ethylidene-2-(4-nitro)benzyloxy-3-methoxybutenolide 3c, gamma-(Z)-ethylidene-2,3-di(4-nitro)benzyloxybutenolide 3d, and dimethylphosphono-gamma-(Z)-ethylidene-2,3-dimethoxybutenolide 11 as well as the adenine derivative of gamma-(Z)-ethylidene-2,3-dimethoxybutenolide 6 were synthesized. The key steps in the high-yield synthesis of 6 involved hydration/dehydration of the C(4)=C(5) in the precursor 3a. In the presence of NH4OH at elevated temperature, 3a underwent a reverse Michael-type addition with water to produce hydrate 5. At 37 degrees C, 6 was also hydrated in the presence of S-adenosyl-L-homocysteine hydrolase to afford 5. Butenolide 6 exhibited an inhibitory property toward the enzyme. Such type II (enzyme-mediated addition of water across C(4)=C(5)) mechanism is the first example of "enzyme-substrate intermediate" inactivation of S-adenosyl-L-homocysteine hydrolase. In contrast with type I mechanism-based inactivation, reduction of enzyme-bound NADP(+) to NADPH was not observed. Upon treatment with HCl, stereoselective dehydration of 5 occurred to give the target molecule 6. At ambident temperature, 3a was hydrated in the presence of NH4OH or pig liver esterase to produce 6-chloropurine derivative 4. An unambiguous proof of the structures of 3-5 was obtained by X-ray crystallographic analysis. For the synthesis of phosphonate derivative 11, the key step involved chlorination of phosphonate 9 by use of CF3SO2Cl and 1,8-diazabicyclo[5.4.0]undec-7-ene in CH2Cl2. 6-Chloropurine-containing butenolide 3d, 6-chloropurine derivative of 4-hydroxybutenolide 4, and adenine-containing 4-hydroxybutenolide 5 did not show anticancer and antiviral activities. 6-Chloropurine-containing ethylidene-2,3-dialkoxybutenolides 3a-c and phosphonate 11, however, exhibited inhibitory activity against murine leukemias (L1210 and P388), breast carcinoma (MCF7), and human T-lymphoblasts (Molt4/C8 and CEM/0) cell lines. They were also notably active toward thymidine kinase-deficient varicella-zoster virus (TK(-)VZV). Adenine-containing ethylidene-2,3-dimethoxybutenolide 6 exhibited marked selectivity in cytostatic activity against the murine leukemia (P388) cell line.

Primary tumour volume delineation in nasopharyngeal carcinoma and correlation with 1997 AJCC tumour stage classification.

OBJECTIVE: To investigate the variability in primary tumour volume in nasopharyngeal carcinoma and compare it with the tumour staging of the 1997 American Joint Committee on Cancer. DESIGN: Prospective study. SETTING: Tertiary care centre. METHOD: A series of 33 newly diagnosed patients who were treated with high-dose radiotherapy participated in the study. MAIN OUTCOME MEASURES: Using computed tomographic scans, primary tumour volumes were measured using the summation-of-areas technique, and the variability in tumour volume was determined. The Mann-Whitney test was used for statistical analysis. RESULTS: A large variation in primary tumour volume was observed, especially in advanced-stage cases. CONCLUSIONS: Nasopharyngeal carcinoma shows considerable variability in primary tumour volume. Incorporation of primary tumour volume may lead to further refinement of the 1997 tumour staging system.

Novel transformations of gamma-silyl nitro compounds.

Introduction of a gamma-silyl group into nitro compounds of dihydrobenzofuran, dihydrobenzo[b]thiophene, and dihydrofuran allowed new transformations to take place in the presence of a Lewis acid to give the corresponding alpha,beta-unsaturated oximes or multisubstituted dihydrofurans, respectively, in good to excellent yields.[reaction: see text]

Deep neck infections in diabetic patients.

PURPOSE: Deep neck infections may be lethal if life-threatening complications occur, especially in immunocompromised hosts such as diabetic patients. This study was undertaken to better define the clinical features and prognosis of deep neck infections in the diabetic patients with special emphasis on the use of empirical antibiotics and the role and timing of surgical management. PATIENTS AND METHODS: A retrospective analysis of 105 consecutive patients treated at a single institution during a 9-year period was conducted. Of these, 30 patients also presented with diabetes mellitus. RESULTS: Compared with the nondiabetic patients, the unique features of deep neck infections in diabetic patients were as follows: (1) older age, (2) tendency of unclear infection source, (3) tendency to involve multiple spaces, (4) required more aggressive surgical intervention, (5) prolonged hospitalization, and (6) higher complication rate. The differences were statistically significant (P< .05). There were no significant differences in the complete blood count/ differential count positive findings and fever between the 2 groups (P> .05). Bacterial cultures showed that Klebsilla pneumoniae was the most common causative pathogen in diabetic patients. CONCLUSIONS: In deep neck infection patients with diabetes mellitus, the clinical course is more severe and there is a poorer prognosis. Thus, in treating them, we should keep close observation, appropriately control the diabetes, detect the life-threatening complications early, perform aggressive surgical treatment if fluctuation or complication occurs, and take into account the preponderance of K pneumoniae when administering the empirical antibiotics.

Effects of radiotherapy for nasopharyngeal carcinoma on the paranasal sinuses: study based on computed tomography scanning.

OBJECTIVE: The purpose of this study was to determine if radiotherapy for nasopharyngeal carcinoma causes mucosal disease of the paranasal sinuses. DESIGN: This study was a retrospective study. SETTING: This study was conducted at a tertiary care centre. METHOD: A series of 69 newly diagnosed patients, without pre-existing sinus disease, who were treated with high-dose radiotherapy participated. MAIN OUTCOME MEASURES: The prevalence, severity, and time course of mucosal abnormalities were analyzed, as judged by consecutive computed tomographies (CTs). RESULTS: The CT study revealed that 58.8% of the postirradiation scans had mucosal disease of the sinuses. The maxillary sinus had the highest prevalence (42.3%) without statistical significance (p = .10). The difference by McNemar test for two follow-up scans was not significant (p = .48) and by Kappa test was significant (p = .04). The relationship between the prevalence and the time course post radiotherapy revealed that it remained a high prevalence until after the 4-year follow-up scans. CONCLUSIONS: The results of this study confirm that chronic sinus disease is a common late complication of radiotherapy and it persists for years. Thus, aggressive treatment is indicated.

Noninvasive evaluation of blunt abdominal trauma: prospective study using diagnostic algorithms to minimize nontherapeutic laparotomy.

A prospective study was performed to investigate the feasibility and benefit of evaluating blunt abdominal trauma (BAT) without diagnostic peritoneal lavage (DPL) or other invasive methods. Diagnostic algorithms were designed by using ultrasonography (US) as a screening method. For unstable patients, a free fluid >/= 2 mm thickness on US images over any one of the intraperitoneal spaces (bilateral subphrenic, Morrison, and Douglas pouch) was used as an indicator for laparotomy. For stable patients, any intraabdominal free fluid detected by US was used as an indicator for further investigations. Computed tomography served as a principal complementary method. To further clarify the clinical results, the rate of nontherapeutic laparotomy (NTL) was compared with that from a previous 5-year review done before this study. During studying period of 1 year, 170 patients were consecutively enrolled. There was no delayed diagnosis, and 66 patients were found to have BAT; 17 patients were initial unstable, among whom 15 had free fluid shown by US and 13 patients had confirmed BAT. Eight of the unstable patients with free fluid on US were saved from NTL, of whom six had retroperitoneal hematoma. There was no NTL in unstable patients. Twenty-two patients underwent laparotomy. Two laparotomies done for a suspicion of bowel injury turned out to be NTL. The rate of NTL in the present study was significant lower than that in a previous review (9.1% vs. 32.2%, p = 0.025). Hence following well designed algorithms, noninvasive evaluation of BAT can proceed with safety, and NTL is minimized.

Predisposing factors of life-threatening deep neck infection: logistic regression analysis of 214 cases.

OBJECTIVE: In the era of antibiotics, most deep neck infections can be cured by conservative treatment, but some still result in life-threatening complications. In this study, we discuss whether or not there are predisposing factors of complicated deep neck infection. DESIGN: A retrospective chart review of patients presenting between 1988 and 1996 was conducted. METHOD: Among 214 deep neck infection patients, 18 cases resulted in lethal complications. We used the "dummy" variable with logistic regression as the statistical analysis method. RESULTS: Patients with an underlying disease, neck swelling, and delay time had a positive correlation that was statistically significance (p < .05). Patients who were older, male, with complete blood count/differential count-positive finding and fever had positive correlation, but this was not statistically significant (p > .05). CONCLUSION: Although complicated deep neck infection is a rapidly progressive disease with a high mortality, we can not thoroughly predict the prognosis or avoid it happening completely. But, if we can detect and pay more attention to the high-risk group of patients with use of aggressive therapy, the incidence of complicated deep neck infection may be reduced.

Early repair of traumatic ventricular septal defect and mitral valve regurgitation.

Traumatic ventricular septal defect with valvular injury is an uncommon blunt trauma. It may develop either immediately or be delayed, but it should be corrected electively. With hemodynamic instability and cardiopulmonary deterioration, however, early repair is necessary as a lifesaving procedure. Two-dimensional echocardiography and Doppler color flow mapping are very important for rapid detection in patients who are critically injured. This is a case report of the successful repair of ventricular septal defect and posterior leaflet disruption of mitral valve right after blunt trauma.

A phosphorylated conformational state of the (Ca2+-Mg2+)-ATPase of fast skeletal muscle sarcoplasmic reticulum can mediate rapid Ca2+ release.

A rapid Ca2+ release from Ca2+-loaded sarcoplasmic reticulum vesicles from fast skeletal muscle can be induced under conditions which permit the formation of a stable phosphorylated intermediate of the (Ca2+-Mg2+)-ATPase. Such a state can be achieved experimentally by phosphorylating the ATPase in the absence of Mg2+ ions, which otherwise would stimulate the dephosphorylation step(s). Also, quercetine stimulates the rapid release of Ca2+ if used in the concentration range which does not produce inhibition of phosphoenzyme formation, but which inhibits phosphoenzyme dephosphorylation. The rapid efflux of Ca2+ ions proceeds as long as the low affinity Ca2+-binding sites facing the lumen of the vesicles are saturated and as long as Ca2+ is removed from the catalytic sites facing the cytosol. A molecular mechanism of the phosphoenzyme-mediated Ca2+ release is proposed. This mechanism is based on a rapid shuttling of the ATPase molecules between an ADP-sensitive and an ADP-insensitive phosphorylated state.