Robotic gastrectomy is safe in geriatric patients with gastric cancer: a retrospective cohort study.

OBJECTIVE: The efficacy of robotic surgery in oncological operations has been demonstrated, but its applicability in the elderly population (≥70 years) is limited in studies. This study aims to investigate the feasibility, safety, and short-term outcomes of robotic surgery in gastric cancer surgery in geriatric patients. PATIENTS AND METHODS: Patients who underwent robotic surgery for gastric cancer between July 2021 and September 2023 were included in the study. Patients were divided into two groups: the elderly group (≥70 years) and the younger group (<70 years). Demographic data, clinical findings, perioperative outcomes, and pathology results were analyzed and compared between the two groups. RESULTS: 63 patients were included in our study. Group 1, the younger patients (<70 years), consisted of 44 patients, while Group 2, the older patients (>70 years), consisted of 19 patients. The male gender was dominant in both groups (70.5% vs. 78.9%, p=0.486). ASA 2 was the most common score in both groups (70.5% vs. 52.6%, p=0.261). Group 2 had lower hemoglobin (11.3 vs. 10.1, p=0.017) and albumin levels (39.9 vs. 37.6, p=0.049). The average operation times were similar in both groups (255 min vs. 242 min, p=0.457). The median postoperative hospital stay was 5 days in both groups. The distributions of postoperative complications according to the Clavien-Dindo classification were similar. Postoperative 30-day mortality was observed in one patient in Group 2. The 90-day hospital readmission rates were similar (11.3% vs. 10.6%, p=0.459). The average tumor diameters were similar (38 mm vs. 48 mm, p=0.165), as were the numbers of dissected lymph nodes (35 vs. 34, p=0.796). According to pathology results, T4a tumors were most common in Group 1 and T0 tumors in Group 2 (34.1% vs. 31.6%, p=0.149). The most common lymph node involvements were N0 in Group 1 and N1 in Group 2 (36.4% vs. 36.8%, p=0.515). CONCLUSIONS: Robotic surgery in gastric cancer is considered a safe and feasible method in the elderly population due to its successful early outcomes, suggesting its reliability and effectiveness.

Genotoxic and genoprotective effects of some antipsychotic drugs, methylphenidate and atomoxetine on human lymphocytes and HepG2 cells.

OBJECTIVE: Aripiprazole, risperidone, atomoxetine, and methylphenidate are drugs commonly prescribed for many psychiatric conditions and can be used alone or in combination in children and adolescents. This study aimed to investigate comparatively the possible genotoxic effects or genoprotective potentials of these drugs on human lymphocytes and HepG2 cells. MATERIALS AND METHODS: Cytotoxicity analysis was performed with the cell viability test on human lymphocytes and HepG2 cells, and half-maximal inhibitory concentration (IC50) values of the drugs were determined, and three different doses (» IC50, ½ IC50, and IC50) were applied for genetic analysis. For the determined doses, cells with and without DNA damage were examined by comet analysis. RESULTS: In lymphocytes, aripiprazole and risperidone increased DNA damage at moderate and maximum doses, whereas atomoxetine increased DNA damage only at the maximum dose. In HepG2 cells, risperidone reduced DNA damage at all doses, while atomoxetine increased DNA damage at all doses. On the other hand, in the DNA-damaged cells induced by hydrogen peroxide (H2O2), DNA damage decreased at all concentrations of all drugs in both lymphocytes and HepG2 cells. CONCLUSIONS: As a result, the genotoxicity of the drugs was found to be dose-dependent, and all drugs showed a genoprotective effect on DNA-damaged cells.

The relationship between microsatellite instability in colorectal adenocarcinoma and tumor budding and histopathological parameters.

OBJECTIVE: This study aims to investigate the correlation between the presence of microsatellite instability (MSI) and tumor budding, as well as their relationship with histopathological parameters in patients diagnosed with colorectal adenocarcinoma. PATIENTS AND METHODS: The study encompassed patients who underwent curative surgery to treat colorectal cancer. These patients were classified into groups based on their MSI status. The International Tumor Budding Consensus Conference (ITBCC) 2016 guidelines were utilized to identify tumor budding. Demographics, clinical data, tumor budding, and histopathological attributes were assessed across study groups. RESULTS: The study analyzed 268 patients, out of which 32 (11.9%) were identified as having MSI. Microsatellite Stable (MSS) patients were placed in Group 1, and those with MSI were classified into Group 2. The average age was lower in Group 2 compared to Group 1 (55.9 years vs. 61.4 years, p=0.034). Tumor localizations in the caecum (5.9% vs. 18%) and the ascending colon (11.9% vs. 25%) were more prevalent in Group 2 (p=0.019). The occurrence of tumor budding (75% vs. 62.5%, p=0.133) and the budding degree in those with tumor budding were comparable between the groups. Poorly differentiated tumors were more prevalent in Group 2 (5.5% vs. 25%, p=0.001). Additionally, the tumor diameter was larger in Group 2 (3.58 cm vs. 4.35 cm, p=0.007). CONCLUSIONS: MSI is a significant biomarker, possessing diagnostic, prognostic, and predictive value in colorectal cancer (CRC). Understanding the connection between MSI and tumor budding in CRC may provide clinicians with insights to enhance patient management.

Impact of radiologic variables on item responses of ODI, SRS22 and SF-36. in adult spinal deformity patients: differential item functioning (DIF) analysis results from a multi-center database.

PURPOSE: To determine if responses given to each question of the Scoliosis Research Society-22 (SRS22), Oswestry disability index (ODI) and Short Form-36 (SF-36) questionnaires are influenced by the radiological parameters. METHODS: Patients enrolled in a multi-centre prospectively collected adult spinal deformity database who had complete SRS22, ODI and SF-36 data at baseline and at one-year follow-up were analysed. The presence of a differential item function of each question within each score in relation to radiological parameters was analysed using a mixed Rasch model with the radiological threshold value(s) determined. RESULTS: Of those patients analysed (n = 1745; 1406 female, average age 51.0 ± 19.8 years), 944 were surgically and 801 were non-surgically treated. For the SRS22, questions (Q) 3, 5 and 18 were sensitive to almost all radiological parameters and the overall score was found sensitive to the Cobb angle. For the ODI, Q3, 6, 9 and 10 were not sensitive to any radiologic parameters whereas Q4 and 5 were sensitive to most. In contrast, only 3 of the SF-36 items were sensitive to radiological parameters. CONCLUSIONS: 78% of the SRS-22, 60% of the ODI and 8% of the questions in the SF-36 are sensitive to radiological parameters. Sagittal imbalance is independently associated with a poor overall outcome, but affects mental status and function more than pain and self-image. The assembly of questions responsive to radiological parameters may be useful in establishing a connection between changes in radiologic parameters and HRQL.

The therapeutic effect of Cilastatin on drug-induced nephrotoxicity: a new perspective.

OBJECTIVE: By creating nephrotoxicity models with cisplatin, vancomycin, and gentamicin in HK-2 (human renal proximal tubule cell) and HEK293T (human embryonic kidney epithelial cells) cell lines, we aimed to evaluate the effect of cilastatin on recovery of cell damage after toxicity had occurred. MATERIALS AND METHODS: In the first phase of the study, the doses of cisplatin, vancomycin, and gentamicin (50% inhibitive concentration; IC50) were determined. In the second phase, the effective dose of cilastatin against these drugs was determined, and IC50 doses of nephrotoxic agents were administered simultaneously. In the third phase of our study, to evaluate the possible therapeutic effect of cilastatin after toxicity had occurred, the analyses of cell viability, apoptosis, oxidative stress, expression of kidney injury molecule-1 (KIM-1), and neutrophil gelatinase-associated lipocalin (NGAL) were performed. RESULTS: In the second phase of the study, it was observed that cilastatin increased cell viability when treated simultaneously with a nephrotoxic agent. In the third phase, cilastatin provided a significant increase in cell viability. After treatment with each agent for 24 hours, we determined that adding cilastatin to the medium had an effect on the recovery of cell damage by increasing cell viability and reducing apoptosis and oxidative stress. The expression of KIM-1 and NGAL increased when nephrotoxicity occurred and decreased with the addition of cilastatin to the medium. CONCLUSIONS: The findings of the study suggest that cilastatin may have a healing effect after the development of nephrotoxicity.

Tunnel widening after single- versus double-bundle anterior cruciate ligament reconstruction: a randomized 8-year follow-up study.

OBJECTIVE: The purpose of this study was to compare the single-bundle (SB) and double-bundle (DB) surgical techniques for anterior cruciate ligament (ACL) reconstruction with regard to tunnel widening, isokinetic muscle strength, and clinical outcomes over an 8-year follow-up period. METHODS: This study included 31 patients with ACL injury who underwent ACL reconstruction via the SB (n = 16) or the DB (n = 15) technique. Isokinetic and concentric strength measurements of the quadriceps and hamstring muscles were conducted at postoperative 6 months and postoperative 8 years, and 3D-CT scans of the knee joints were performed on the 2nd, 3rd and 6th month, and the 8th year postoperatively. Clinical evaluations were performed at 8 years postoperatively with the International Knee Documentation Committee (IKDC), Tegner, and Lysholm knee scoring systems. RESULTS: There was marked widening of the parts of the femoral tunnel close to the knee joint in both the SD and the DB groups. There was no difference between the two groups in terms of clinical results and isometric muscle strength at postoperative 8 years; however, there was a significant difference between the preoperative and 6 months postoperative clinical and strength results in both group (P < 0.05). There was no difference between the groups in IKDC score, Lysholm score, Tegner activity scale, and anterior drawer test at postoperative 8 years. On evaluation of the anteromedial bundles alone, the DB group had greater widening than the SB group. CONCLUSION: In this study, we have found that the tunnels continue to enlarge after 6 months. However, that has no impact in patients comfort and that did not made any change in our daily routine. On the other hand, we found that the reconstruction of the double-band ligament technique is useless for non-professional athletes.

Using PVA and TPGS as combined emulsifier in nanoprecipitation method improves characteristics and anticancer activity of ibuprofen loaded PLGA nanoparticles.

In the preparation of nanoparticles (NPs) by the nanoprecipitation method, emulsifiers play a key role for NPs' characteristics. The present study aimed to investigate the combined emulsifier effect on ibuprofen loaded poly(lactic-co-glycolic acid) (PLGA) NPs' characteristics and anticancer activity. Ibuprofen loaded PLGA NPs were prepared by nanoprecipitation using different concentrations of PVA (poly(vinyl alcohol)) or PVA-TPGS (d-α-tocopherol polyethylene glycol 1000 succinate) combination as emulsifier. It was found that encapsulation efficiencies of NPs varied between 17.9 and 41.9 % and the highest encapsulation efficiency was obtained with 0.5% PVA + 0.1% TPGS (coded as PLGA PVA/TPGS NPs). PLGA PVA/TPGS NPs were characterized and compared with PLGA PVA NPs, which was obtained by 0.5% PVA alone. Polydispersity index of PLGA PVA/TPGS and PLGA PVA NPs were found to be 0.08 and 0.15, respectively. Incorporation of TPGS with PVA slightly decreased the initial ibuprofen release. Transmission electron microscopy analyses demonstrated a nearly uniform particle size distribution and spherical particle shape of the PLGA PVA/TPGS NPs. Additionally, PLGA PVA/TPGS NPs were significantly more cytotoxic than PLGA PVA NPs on the MCF-7 (human breast adenocarcinoma cells) and Caco-2 (human epithelial colorectal adenocarcinoma) cells (p<0.05). Also PLGA PVA/TPGS NPs were not cytotoxic on normal cells (L929, mouse healthy fibroblast cells) (p>0.05). In conclusion, these results indicated that using a combination of TPGS and PVA as an emulsifier in nanoprecipitation could be a promising approach for preparing ibuprofen loaded PLGA NPs because of their improved characteristics and anticancer activity.

The role of reactive oxygen species in the antibacterial photodynamic treatment: photoinactivation vs proliferation.

UNLABELLED: Low-level light/low concentration of reactive oxygen species (ROS) may trigger some biochemical pathways that lead to cell proliferation. Thus, there is a risk of stimulation of bacterial cell proliferation during photodynamic therapy (PDT). In this study, PDT with different doses of 809-nm laser and indocyanine green (ICG) was investigated in vitro for safe bactericidal application. The combined effect of laser doses with ICG concentrations were examined on Pseudomonas aeruginosa in vitro. Data showed that low energy dose and ICG concentration caused bacterial cell proliferation. When these parameters were increased high enough, photoinactivation of the bacteria was achieved. Energy dose and photosensitizer concentration ranges at which proliferation, cell death or neither observed were determined. Furthermore, l-histidine was used as a scavenger of ROS to block the mechanism of biostimulation and cell killing. It inhibited proliferation when laser dose and ICG concentrations were low. It also inhibited cell killing when dose and concentration were high. Data showed that mechanisms of proliferation and cell killing depend on the amount of ROS and antibacterial photodynamic treatment have serious biostimulative risk. Effective range might need to be determined before any therapeutic usage. The risk seems to exist specifically at lower energy doses and photosensitizer concentrations. SIGNIFICANCE AND IMPACT OF THE STUDY: The main purpose in antibacterial photodynamic therapy (PDT) is to kill the micro-organisms that cannot be destroyed by conventional methods. Low-level light and/or low concentration of reactive oxygen species may trigger some biochemical pathways that lead to cell proliferation. Thus, there is a risk of bacterial cell proliferation during PDT. In this study we report that PDT with ICG application can induce biostimulation when laser dose and photosensitizer concentration are not optimized properly. Therefore, optimum dosimetry in PDT possesses great importance in the treatment of wounds infected by antibiotic-resistant bacteria.

Primary mucinous carcinoma of the vulva with signet ring cells deriving from the cloaca.

Vulvar neoplasias are rarely encountered lesions at female genital tract, regardless if they are primary or metastatic. Presence of signet ring cells in a tumour at female genito-urinary tract is highly suggestive of a metastatic lesion particularly from a gastrointestinal tumour. Here the authors present a case of vulvar carcinoma with signet ring cells with an undetermined primary site possibly originating from embryonic cloaca.

A CASE OF CONFINED PLACENTAL MOSAICISM WITH TRISOMY 15 ASSOCIATED WITH TURNER SYNDROME.

We here present a rare case of a Turner syndrome with mosaic trisomy 15 identified on chorionic villous sampling (CVS). Although there are several reports in the literature indicating confined placental mosaicism (CPM), counseling parents of a fetus with trisomy 15 mosaicism at CVS remains difficult because of the phenotypic variability. To illuminate that condition an amniocentesis or cord blood study should be offered in conjunction with genetic counseling.

The efficacy and safety of capecitabine plus bevacizumab combination as first-line treatment in elderly metastatic colorectal cancer patients.

AIM: The optimal treatment in older persons with metastatic colorectal cancer (mCRC) is complicated by a lack of general agreement. The aim of this study was to evaluate the activity of bevacizumab plus capecitabine combination in elderly mCRC patients who were not suitable for chemotherapy with irinotecan and oxaliplatin-containing regimens. MATERIALS AND METHODS: Seventy years and older patients with metastatic colorectal carcinoma were included in this retrospective study. Bevacizumab was administered at a dose of 7.5 mg/kg on day 1 as an intravenous (IV) infusion over 30-90 min every 21 days, and capecitabine was prescribed at 1000 mg/m(2) twice daily on days 1-14 of the same 21-day schedule. RESULTS: Eighty-two consecutive patients (47 men, 35 women) were included in the study. The mean age was 75.5 (SD 3.9, range 70-87). Half of the patients were older than 75 years. There were 55 patients (67.1 %) with a good Eastern Cooperative Oncology Group (ECOG) performance status (PS: 0-1) and the remaining 27 patients (32.9 %) had a poor ECOG performance status (PS: 2). With a median follow-up period of 18.5 months, the median progression-free survival (PFS) was 10 months (95 % CI, 7.8-12.1) and the median OS was 25 months (95 % CI, 18.6-31.3). The main toxicities recorded were non-hematological. Thirty-one patients (37 %) experienced grade 3/4 adverse events, the most common being hand-foot syndrome (9.8 %). No fatal toxicity resulting from this regimen was recorded. CONCLUSIONS: Considering the toxicity profile and survival outcomes, the combination regimen of capecitabine and bevacizumab is a potentially feasible treatment option in elderly mCRC patients.

Management of a Benign Phyllodes Tumor in a 13-Year-Old Girl with Trans-position of the Nipple Areola Complex and Breast Reconstruction.

Phyllodes tumor is a rare primary tumor of the breast. In children and adolescents, it is even rarer with only 20 cases, treatment of which vary in the literature. Herein we report the case of a 13-year-old female patient with a giant benign phyllodes tumor eroding the bottom of the breast skin and causing nipple retraction. We performed breast conservative surgery by mobilizing the areola, using skin flaps and inserting an implant. Breast malignancy, including phyllodes tumor (PT), is very rare in adolescents. PT, previously called cystosarcoma phylloides, consists of leaf-like fronds, from which the tumor gets its name (1, 2). Although PT is most often seen in the fourth decade of life, almost 20 cases have been reported in the adolescent period, most of which are benign. The histologic types are benign, borderline, and malignant, depending on the mitotic rate of the tumor (3, 4).

Prognostic significance of ADAM17 expression in patients with gastric cancer who underwent curative gastrectomy.

BACKGROUNDS: A disintegrin and metalloproteinase (ADAM) 17 has been indicated to be an indispensable regulator of cellular events from proliferation to migration. Although prognostic importance of ADAM17 expression has been investigated in several tumours, its clinical utility as a useful prognostic molecular marker remains unclear in gastric cancer. In the current study, we evaluated the expression of ADAM17 and its prognostic significance in gastric cancer patients after curative gastrectomy. METHODS: The prognostic significance of ADAM17 expression was analysed immunohistochemically in 156 patients with gastric cancer who had undergone curative gastrectomy, and the relationship between its expression and clinicopathological factors was also evaluated. RESULTS: High ADAM17 expression was detected in 79 patients (51 %), whereas low expression was found in 77 cases (49 %). There was significant correlation between gender, histology, lymph node metastasis, vascular invasion, the presence of recurrence and high ADAM17 expression. Recurrence in patients with high ADAM17 expression was significantly higher than that for patients with low ADAM17 expression (p = 0.032). The median disease-free survival (DFS) time for patients with tumours with high ADAM17 expression was worse than that of patients with tumours with low ADAM17 expression (16.6 vs. 44.2 months, p = 0.004). In addition, patients with low ADAM17 expression had a higher median overall survival (OS) (49.6 vs. 26.9 months, p = 0.019) compared to those with high ADAM17 expression. Multivariate analysis indicated that the rate of ADAM17 expression was an independent prognostic factor for DFS, in addition to the already known important clinicopathological prognostic indicator. But the prognostic importance of ADAM17 expression could not be proved by multivariate analysis for OS. CONCLUSIONS: The potential value of ADAM17 expression as a useful molecular marker in gastric cancer progression should be evaluated comprehensively; it may predict recurrence and poor prognosis in patients with gastric cancer after curative resection.

Comparison of second-line treatment outcomes between sensitive and refractory small cell lung cancer patients: a retrospective analysis.

PURPOSE: Small cell lung cancer (SCLC) has a high relapse rate despite being very chemosensitive. The efficacy of second-line treatment is dismal. Our aim was to evaluate the outcome of second-line treatment. METHODS: We retrospectively assessed data of 120 SCLC patients who failed first-line treatment and received second-line treatment at three medical oncology centers. RESULTS: Median age of group was 58. 82 % had an ECOG PS of 0-1 at the time of relapse. 39 % were at limited stage (LS) at the time of diagnosis. Patients who progressed more than 3 months after first-line therapy were categorized as having platinum-sensitive disease (PSD) (64 %). The number of patients who received platin-based combination treatment was 33 (27 %). The median OS time starting from the initiation of second-line treatment was 7 months. Multivariate analysis identified PS (p = 0.006), extent of disease at diagnosis (0.014) and PSD (0.001) as the independent prognostic factors for survival. Subgroup analyses of the patients with PSD indicated platin rechallenge yields higher progression-free survival, overall survival and overall response rate. CONCLUSION: Patients with good ECOG PS,who have PSD or initially presenting with LS, have a good prognosis and in patients with PSD, platinum-based therapy would be more appropriate.

To study the correlation between carrier status of nasal Staphylococcus aureus in patients on haemodialysis with hepatitis C, hepatitis B and their sociodemographic features / Estudiar la correlación entre el portador del Estafilococo dorado nasal en pacientes de hemodiálisis con hepatitis C, hepatitis B y sus características sociodemográficas

AIM: To study the correlation of nasal Staphylococcus aureus carrier status in patients on haemodialysis, infected by hepatitis C virus (HCV), hepatitis B virus (HBV), and their sociodemographic features. SUBJECTS AND METHODS: A survey, including patients ' sociodemographic features, was applied to patients by physicians in face to face interviews. Medical records regarding their serologic data were recorded from haemodialysis centres. Nasal swab samples of 2 cm depth from both nostrils of patients were obtained for nasal culture. Samples were inoculated in 5% sheep blood agar and incubated in an incubator at a temperature of 37ºCfor 24 hours. The results were studied by the same microbiologist. RESULTS: A total of 185 patients were enrolled in the study. According to culture results, 14.1% of patients (n = 26) had methicillin sensitive Staphylococcus aureus (MSSA) and 1.1% (n = 2) had methicillin resistant Staphylococcus aureus (MRSA). Status of viral hepatitis was 3.8% (n = 8), 10.8% (n = 20) for HBV and HCV, respectively. Forty per cent (n = 8) of patients with HBV (+) had MSSA carrier status. Statistically significant positive correlation between MSSA and HCV carrier was detected (r = 0.325, p = 0.001) but not between HBV carrier and MSSA (p = 0.255). CONCLUSION: In the present study, significant positivity was detected between MSSA carrier status and HCV in patients on haemodialysis and who have lived together with < 2 family members at home. Particularly, statistically significant correlation between HCV (+) and MSSA carrier was observed.

OBJETIVO: Estudiar la correlación entre el portador del Estafilococo dorado (Staphylococcus aureus) nasal en pacientes de hemodiálisis infectados por el virus de la hepatitis C (VHC), el virus de la hepatitis B (VHB), y sus características sociodemográficas. SUJETOS Y MÉTODOS: Una encuesta que incluía características sociodemográficas de los pacientes fue aplicada a pacientes por médicos en entrevistas cara a cara. Historias clínicas contentivas de sus datos serológicos, fueron registradas a partir de los centros de hemodiálisis. Muestras defrotis nasales de 2 cm de profundidad de ambas fosas nasales, fueron obtenidas para un cultivo nasal. Se inocularon muestras en agar de sangre de oveja al 5%, e incubadas en una incubadora a una temperatura de 37ºC por 24 horas. Los resultados fueron examinados por el mismo microbiólogo. RESULTADOS: Un total de 185 pacientes fueron enrolados en el estudio. Según los resultados del cultivo, 14.1% pacientes (n = 26) tenían estafilococo dorado sensible a la meticilina (MSSA) y 1.1% (n = 2) tenían estafilococo dorado resistente a la meticilina (MRSA). El estatus de las hepatitis virales fue 3.8% (n = 8), y 10.8% (n = 20) para HVB y HVC respectivamente. Cuarentapor ciento (n = 8) de los pacientes con HVB (+) eran portadores del MSSA. Estadísticamente, se detectó una correlación positiva significativa (r = 0.325, p = 0.001), entre MSSA y el portador de VHC, no así entre el portador del VHByMSSA (p = 0.255). CONCLUSIÓN: En el estudio presente, se detectó una positividad significativa entre el estatus de; portador de MSSA y los pacientes de VHC en hemodiálisis, que vivían junto con [= dos o menos de dos] miembros de la familia en casa. En particular, se observó una correlación estadísticamente significativa entre HCV (+) y el portador MSSA.

Prevalence of aspirin-exacerbated respiratory disease in patients with asthma in Turkey: a cross-sectional survey.

BACKGROUND: There are no country-based data focused on aspirin (ASA)-exacerbated respiratory disease (AERD) in Turkey. OBJECTIVE: To assess the prevalence of AERD in adult patients with asthma. METHODS: A structured questionnaire was administered via face-to-face interview by a specialist in pulmonology/allergy at seven centres across Turkey. RESULTS: A total of 1344 asthma patients (F/M: 1081/263: 80.5%/19.5%, mean age: 45.7 ± 14.2 years) were enrolled. Atopy rate was 47%. Prevalence of allergic rhinitis, chronic rhinosinusitis/rhinitis, and nasal polyposis (NP) were 49%, 69% and 20%, respectively. Of 270 patients with NP, 171 (63.3%) reported previous nasal polypectomy and 40 (25%) had a history of more than three nasal polypectomies. Aspirin hypersensitivity was diagnosed in 180 (13.6%) asthmatic patients, with a reliable history in 145 (80.5%), and oral ASA provocation test in 35 (19.5%) patients. Clinical presentations of ASA hypersensitivity were respiratory in 76% (n=137), respiratory/cutaneous in 15% (n=27), and systemic in 9% (n=16) of the patients. Multivariate analysis indicated that a family history of ASA hypersensitivity (p: 0.001, OR: 3.746, 95% CI: 1.769-7.929), history of chronic rhinosinusitis/rhinitis (p: 0.025, OR: 1.713, 95% CI: 1.069-2.746) and presence of NP (p<0.001, OR: 7.036, 95% CI: 4.831-10.247) were independent predictors for AERD. CONCLUSION: This cross-sectional survey showed that AERD is highly prevalent among adult asthmatics and its prevalence seems to be affected by family history of ASA hypersensitivity, history of rhinosinusitis and presence of NP.

Obstructive sleep apnoea, glucose tolerance and liver steatosis in obese women.

In this study of obstructive sleep apnoea (OSA), glucose tolerance and liver steatosis in females from an obesity unit, 45 patients (mean age 46.8 years, mean body mass index 39.4 kg/m(2), all non-diabetic and alcohol abstainers) underwent nocturnal polysomnography, a 2 h oral glucose tolerance test and abdominal ultrasonography. OSA, defined as an apnoea-hypopnoea index (AHI) of > or = 10 events/h, was present in 20 patients (44%). Impaired glucose tolerance (IGT) was found in eight patients (40%) with OSA and three patients (12%) without OSA; there was a positive linear relationship between AHI and post-load glucose levels. On multivariate logistic regression analysis, IGT was predicted by OSA independently of age, waist circumference, systolic blood pressure and current smoking. Liver steatosis was present in 37 women (82.2%), of whom six had grade III steatosis. Of the variables tested, IGT was the only predictor of grade III steatosis. In conclusion, OSA is an independent predictor of IGT which, in turn, is associated with severe liver steatosis in an obesity unit-based sample of women.

Improved purification of Piscirickettsia salmonis using Percoll gradients.

Viable preparations of intact Piscirickettsia salmonis, purified from host cell material, are necessary for studying characteristics associated with this bacterium. However, purification of the organism is difficult due to its obligate intracellular nature. A simple and effective method for isolating whole P. salmonis, which is quick and easy to perform, but still maintains the viability and antigenicity of the bacterium is described. P. salmonis was purified by differential pelleting and density gradient centrifugation using 30%, 40%, or 50% (v/v) Percoll gradients. Following fractionation, a band with a density of 1.056-1.080 was found to be composed entirely of rickettsiae, confirmed by fluorescent antibody technique (IFAT). Purity of the P. salmonis from different stages of the purification process was assessed by light and transmission electron microscopy, and the viability of yields determined from a plaque assay and a tissue culture infective dose (TCID(50) ml(-1)). P. salmonis recovered from the 30% Percoll gradient appeared to retain their intracellular structure better than P. salmonis obtained from the 40% and 50% Percoll gradients, and appeared to have a greater viability. Differences were seen between P. salmonis-infected CHSE-214 cells and purified P. salmonis when compared by SDS-PAGE and Western blotting, and less host cell contamination was present in preparations obtained from the 30% Percoll gradient. Finally ten different P. salmonis isolates obtained from three different geographical locations and four different fish species, were purified using the 30% Percoll gradient. When the morphology of these was compared by transmission electron microscopy (TEM), they appeared similar in size and appearance, although isolate R980769 was highly pleomorphic and isolate R-29 was larger than the other isolates examined.