Influence of gender on epithelial host defence peptide gene expression under non-infected and infected conditions: A basic medical research study.

Bacterial resistance against conventional antibiotics is increasing. This introduces challenges, for example, in the treatment of infected surgical wounds. Host defence peptides (HDP), which are endogenous peptide antibiotics, show broad-spectrum antimicrobial effectiveness. They protect the organism against pathological microorganisms. Synthetic HDP might supplement or even become alternatives to conventional antibiotics. Knowledge of their quantities under physiological and pathophysiological conditions is therefore required. The influence of gender on HDP expression is unknown. This study evaluates whether gender influences HDP expression in infected or healthy epithelium. Expression levels of HDP human beta-defensin (hBD)-1, -2 and -3 and psoriasin (S100A7) were analysed, by using real-time polymerase chain reaction, in samples of epithelium from infected surgical wounds (n = 20) and healthy epithelium (n = 14) from the neck in a basic medical research study (analytic observational design). The results demonstrated a significantly elevated expression of hBD-2, hBD-3 and psoriasin (P = 0.001 each) in infected epithelium compared with healthy epithelium. No difference in HDP expression levels was evident between samples from female and male patients, either within infected samples or within healthy epithelium samples. Thus, gender does not affect the cutaneous expression of the investigated HDP. This is fundamental knowledge for the study and potential use of HDP derivates as alternative antibiotic substances.

An Immunohistochemical Study on the Role of Oxidative and Nitrosative Stress in Irradiated Skin.

BACKGROUND/AIM: The effects of ionizing radiation through the generation of free radicals, reactive aldehydes, and other oxidative and nitrosative by-products account for skin injuries as side effects of radiation therapy (RT). This study aims to identify cellular pathways in oxidative and nitrosative stress in irradiated skin using well-established marker proteins in an immunohistochemical analysis. MATERIALS AND METHODS: Tissue specimens of 51 patients were obtained during operative access to the neck. Twenty patients (39.2%) received RT prior to the surgical intervention. Immunohistochemical analysis of stable degradation products of reactive oxygen and nitrogen species (RONS), 3-nitrotyrosine, 8-isoprostane, phosphorylated AKT (p-AKT), and phosphorylated extracellular signal-regulated kinase (p-ERK) was performed in specimens which were exposed to RT and those without a history of RT. RESULTS: Immunohistochemical staining showed a significantly increased expression of nitrotyrosine in superficial and basal epidermal regions of interest (ROI), p-AKT in all epidermal ROI, and p-ERK in all the investigated epidermal and dermal ROI, as well as in an overall analysis. No significance could be detected in immunostaining against isoprostane. DISCUSSION: This study summarizes the influence of RONS in RT. Moreover, a detailed histological analysis was able to identify epidermal ROI as a main starting point of RONS in irradiated skin. Even though the role of RONS in high-dose therapeutic radiation remains a subject for further research, these data underlines the crucial role of RONS in high-dose radiation.

Use of Complementary and Alternative Medicine (CAM) as Part of the Oncological Treatment: Survey about Patients' Attitude towards CAM in a University-Based Oncology Center in Germany.

INTRODUCTION: To understand if and which patients would be open-minded to Complementary and Alternative Medicine (CAM) use parallel to their oncological treatment. Moreover, we sought to determine which methods are most accepted and which are the primary motivators to use CAM. METHODS: We developed and anonymously conducted a questionnaire for patients in the oncology center (TU Munich). Questions focus on different CAM methods, previous experiences, and willingness to apply or use CAM when offered in a university-based setting. RESULTS: A total of 171 of 376 patients (37.4% women, 62.0% men, 0.6% unknown) participated. This corresponds to a return rate of 45%. Median age was 64 years (17-87 years). Of all participants, 15.2% used CAM during their oncological therapy; 32.7% have used it in the past. The majority (81.9%) was not using CAM during therapy; 55.5% have not used CAM in the past respectively. The analysis revealed a significant correlation between education and CAM use during therapy (r = 0.18; p = 0.02), and CAM use in the past (r = 0.17; p = 0.04). Of all patients using CAM during therapy, favored methods were food supplements (42.3%), vitamins/minerals (42.3%), massage (34.6%). Motivations are especially the reduction of side effect and stress, the positive effect of certain CAM-treatments on the immune system and tumor therapy. Results showed no difference between women and men. Most patients not having had any experience with CAM complain about the deficiency of information by their treating oncologist (31.4%) as well as missing treatment possibilities (54.3%). CONCLUSION: Since many patients believe in study results demonstrating the efficacy of CAM, it stresses our task to develop innovative study protocols to investigate the outcomes of certain CAM on symptom reduction or other endpoints. Thus, prospective trials and innovative evidence-based treatment concepts to include CAM into high-end oncology is what patients demand and what a modern oncology center should offer.

Low-dose preoperative chemoradiation therapy compared with surgery alone with or without postoperative radiotherapy in patients with head and neck carcinoma.

BACKGROUND: Several multimodal strategies have been developed to treat patients with squamous cell carcinoma of the oral cavity (OSCC), and many have shown survival benefits. The theoretical advantages of preoperative chemoradiotherapy are downstaging of the primary tumor, an increased resectability rate, and the elimination of micrometastases. We aimed to assess whether a short low-dose preoperative radiotherapy regimen with concurrent low-dose chemotherapy with cisplatin improves outcomes for patients with OSCC undergoing surgical treatment with curative intent. METHODS: A total of 407 patients received preoperative low-dose radiotherapy of 20 Gy given in 10 fractions with concurrent low-dose chemotherapy with cisplatin (12.5 mg/m(2)) as part of a pre-existing protocol. This was compared with 519 patients receiving surgery alone. Endpoints were overall survival, tumor response, and toxic effects. Analysis was controlled for tumor-related and demographic factors. RESULTS: After controlling for age, tumor stage, nodal stage, tumor grade, recurrence, and resection margin status, which were independent and dependent predictors of survival, preoperative radiotherapy was associated with improved survival [0.79; P = 0.002; 95% confidence interval (95% CI), 0.66-0.96], in patients receiving only preoperative radiation therapy or in combination with/without postoperative radiotherapy (1.31; P = 0.041; 95% CI, 1.01-1.70 with postoperative radiotherapy; 1.40; P = 0.039; 95% CI, 1.01-1.85 without postoperative radiotherapy). CONCLUSIONS: Low-dose preoperative radiotherapy combined with low-dose chemotherapy with cisplatin significantly improves overall survival for patients with resectable OSCC compared with surgery alone.

High resolution magnetic resonance imaging with an orbital coil as an alternative to computed tomography scan as the primary imaging modality of pediatric orbital fractures.

PURPOSE: The computed tomography (CT) scan is currently the gold standard in the imaging of orbital fractures. The weak points of this imaging modality, however, include restricted soft tissue depiction as well as the radiation. Both attributes are of particular importance in children because of the high rate of trapdoor fractures and the radiation to the lens. Although magnetic resonance imaging (MRI) is not associated with these drawbacks, it has not been established in the primary diagnosis of pediatric orbital fractures. The aim of our study was to establish the use of MRI with a special orbital coil for the primary diagnosis of pediatric orbital trauma. PATIENTS AND METHODS: In our retrospective study, 14 pediatric patients presented to our department with a blunt orbital trauma from 2003 to 2007. Twelve of 14 patients with orbital floor fractures required surgical reconstruction. Until 2004, imaging was carried out by plain x-rays and CT scan for a decision regarding the necessity of surgery. Since introducing the MRI microscopy orbital coil in 2004, CT scans have been replaced by MRI for the primary fracture diagnosis in 8 pediatric cases. Kappa statistics have been applied to assess inter- and intraobserver reliability for CT scans and MRI. This study shows our experiences using MRI in combination with conventional x-rays to determine the operative approach in 2 of the 8 pediatric cases suffering from blunt orbital trauma. RESULTS: The most common causes for pediatric orbital trauma in our collective were accidents. In 8 cases using MRI as the primary imaging modality, depiction of the fracture dislocation and differentiation of the adjacent fatty and muscle tissue was excellent and indication for surgery was distinct. MRI reached a high intra- and inter-rater agreement level (kappa=0.80). CONCLUSION: MRI combined with a microscopy orbital coil is a valuable alternative to the CT scan in the primary diagnosis of pediatric orbital fractures. Floor fractures, and particularly muscle incarceration, should be diagnosed by high resolution MRI combined with a microscopy coil instead of CT to avoid radiation to the lens and to obtain a better soft tissue depiction.

Electrical ear acupuncture reduces histamine-induced itch (alloknesis).

In order to assess an objective measure for the outcome of ear acupuncture, we evaluated the effect of electrical ear acupuncture on areas of histamine-induced alloknesis in 32 healthy volunteers. In a first assessment 5 min after histamine application on both volar forearms, 16 subjects received right ear and 16 left ear acupuncture. Immediately before and 5 min after acupuncture, alloknesis areas on both forearms were planimetrically evaluated. A second assessment was carried out 4 weeks later with the same patients. They underwent histamine application once more, but received no acupuncture. Alloknesis areas were then compared with reference to time, assessment and therapy side. Forearms relating to ipsilateral acupuncture showed significantly reduced or even no alloknesis areas after therapy. On the contralateral sides and during the "non-acupuncture" assessment 4 weeks later, alloknesis areas were significantly enlarged compared with sides ipsilateral to right and left ear acupuncture. Hence, results verify the effects of electrical ear acupuncture by objective measures.