High expression of anti-apoptotic protein Bcl-2 is a good prognostic factor in colorectal cancer: Result of a meta-analysis.

AIM: To systematically evaluate the prognostic-predictive capability of Bcl-2 in colorectal cancer (CRC). METHODS: A systematic literature search was conducted using PubMed, Web of Science and EMBASE databases. Any eligible study must meet the following criteria: (1) bcl-2 expression was evaluated in human CRC tissues by immunohistochemistry; (2) assessment of the relationships between bcl-2 expression and overall survival (OS), disease free survival (DFS), recurrent free survival (RFS) or clinic-pathological characteristics of CRC was included; (3) sufficient information was provided to estimate the hazard ratio (HR) or odds ratio and their 95% confidence intervals (CIs); and (4) the study was published in English. The impact of Bcl-2 expression on survival of CRC patients were evaluated through this meta-analysis. RESULTS: A total of 40 eligible articles involving 7658 patients were enrolled in our final analysis. We drew the conclusion that Bcl-2 high expression was significantly correlated with favorable OS (pooled HR = 0.69, 95%CI: 0.55-0.87, P = 0.002) and better DFS/RFS (pooled HR = 0.65, 95%CI: 0.50-0.85, P = 0.001). Additionally, the subgroup analysis suggested that Bcl-2 overexpression was significantly associated with prognosis (OS) especially in patients came from Europe and America but not Asian and patients who did not receive any adjuvant therapy before surgery. Finally, our present results indicated that expression of bcl-2 protein was associated with high differentiation grade and A/B Ducks' stage. CONCLUSION: Bcl-2 high expression was significantly correlated with favorable OS and better DFS/RFS. Hence, we propose that Bcl-2 may be a valuable prognostic-predictive marker in CRC.

Knowledge-based iterative model reconstruction technique in computed tomography of lumbar spine lowers radiation dose and improves tissue differentiation for patients with lower back pain.

PURPOSE: To evaluate the image quality and diagnostic confidence of reduced-dose computed tomography (CT) of the lumbar spine (L-spine) reconstructed with knowledge-based iterative model reconstruction (IMR). MATERIALS AND METHODS: Prospectively, group A consisted of 55 patients imaged with standard acquisition reconstructed with filtered back-projection. Group B consisted of 58 patients imaged with half tube current, reconstructed with hybrid iterative reconstruction (iDose(4)) in Group B1 and knowledge-based IMR in Group B2. Signal-to-noise ratio (SNR) of different regions, the contrast-to-noise ratio between the intervetebral disc (IVD) and dural sac (D-D CNR), and subjective image quality of different regions were compared. Higher strength IMR was also compared in spinal stenosis cases. RESULTS: The SNR of the psoas muscle and D-D CNR were significantly higher in the IMR group. Except for the facet joint, subjective image quality of other regions including IVD, intervertebral foramen (IVF), dural sac, peridural fat, ligmentum flavum, and overall diagnostic acceptability were best for the IMR group. Diagnostic confidence of narrowing IVF and IVD was good (kappa=0.58-0.85). Higher strength IMR delineated IVD better in spinal stenosis cases. CONCLUSION: Lower dose CT of L-spine reconstructed with IMR demonstrates better tissue differentiation than iDose(4) and standard dose CT with FBP.

Imaging quality and diagnostic reliability of low-dose computed tomography lumbar spine for evaluating patients with spinal disorders.

BACKGROUND CONTEXT: Computed tomography (CT) scans of the lumbar spine (CTLS) have demonstrated a higher level of accuracy than plain films and have been used to assess patients with spinal disorder when magnetic resonance imaging is not available. Nevertheless, radiation exposure remains a serious safety concern. Iterative reconstruction (IR) decreases the CT radiation dose for diagnostic imaging. However, the feasibility of using IR in CTLS is unclear. PURPOSE: To evaluate the imaging quality and diagnostic reliability of CTLS with IR. STUDY DESIGN: A prospective study. PATIENT SAMPLE: All patients from outpatient departments who suffered from spinal disorders and were referred for CTLS. OUTCOME MEASURES: In acquired CT images, the signal-to-noise ratio (SNR) of the dural sac (DS), intervertebral disc (IVD), psoas muscle (PM), and L5 vertebral body, the contrast-to-noise ratio between the DS and IVD (D-D CNR), and the subjective imaging qualities were compared across groups. Interobserver agreement was evaluated with kappa values. METHODS: Patients receiving low radiation CTLS were divided into three groups. A 150 mAs tube current with 120 kVp tube voltage was used with Group A and a 230 mAs tube current with 100 kVp tube voltage with Group B. Intended end radiation exposure was 50% less than that of the control group. Tube modulation was active for all groups. The images of the two low-radiation groups were reconstructed by IR; those of the control group by filtered back-projection (FBP). RESULTS: The SNRs of the DS, IVD, PM, BM, and D-D CNR of Group A were not inferior to those of the control group. All SNRs and D-D CNRs for Group B were inferior to those of the control group. Except for that of the facet joint, all subjective imaging ratings for anatomic regions were equivalent between Groups A and B. Interobserver agreement was highest for the control group (0.72-0.88), followed by Group A (0.69-0.83) and B (0.55-0.83). CONCLUSIONS: Fifty percent tube current reduction combined with IR provides equivalent diagnostic accuracy and improved patient safety when compared with conventional CTLS. Our results support its use as a screening tool. With the tube modulation technique, further adjustments in weighting IR and FBP algorithms based on body mass index become unnecessary.

Secondary metabolites and cytotoxic activities from the stem bark of Zanthoxylum nitidum.

A dihydrobenzo[c]phenanthridine alkaloid, epizanthocadinanine A (1), together with 27 known compounds, including eight benzo[c]phenanthridines, i.e., oxynitidine (2), oxyavicine (3), oxychelerythrine (4), dihydrochelerythrine (5), 6-acetonyldihydrochelerythrine (6), norchelerythrine (7), decarine (8), and arnottianamide (9); two 2-quinolones, i.e., flindersine (10) and 4-methoxy-1-methyl-2-quinolone (11); two furoquinolines, i.e., skimmianine (12) and gamma-fagarine (13); three aporphines, i.e., liriodenine (14), N-acetyldehydroanonaine (15), and N-acetylanonaine (16); six lignans, i.e., sesamin (17), episesamin (18), piperitol-3,3-dimethylallyl ether (19), xanthoxylol-3,3-dimethylallyl ether (20), savinin (21), and 2,3-bis(3,4-methylenedioxybenzyl)but-2-en-4-olide (22); three terpenoids, i.e., alpha-cadinol (23), anticopalol (24), and spathulenol (25); one coumarin, i.e., aesculetin dimethyl ether (26); and two steroids, i.e., beta-sitosterol (27) and beta-sitostenone (28) were isolated from the stem bark of Zanthoxylum nitidum. Their structures were elucidated on the basis of extensive 1D- and 2D-NMR as well as MS analyses. Moreover, the recently reported structures 2'-4' of rhoifolines B and A, and '8-methoxynorchelerythrine', resp., isolated as new compounds from Z. rhoifolium and Z. nitidum, resp., could be assigned the revised structures 2-4 by reinvestigation of the spectroscopic data. In addition, the cytotoxicity of the isolates was evaluated on the MCF-7, NCI-H460, and SF-268 cell lines. Among these isolates, liriodenine (14) was the most active compound against the MCF-7, NCI-H460, and SF-268 cell lines with IC(50) values of 2.19, 2.38, and 3.19 microg/ml, resp.

Dihydrobenzo[c]phenanthridine alkaloids from stem bark of Zanthoxylum nitidum.

Five novel alkaloids, zanthomuurolanine ( 1), epi-zanthomuurolanine ( 2), zanthocadinanines A ( 3) and B ( 4), and epi-zanthocadinanine B ( 5), composed of dihydrochelerythrine and a cadinane-type sesquiterpene linked by a methylene bridge, have been isolated from stem bark of Zanthoxylum nitidum. These structures were elucidated by spectroscopic techniques (UV, IR, MS, CD, 1H NMR, 13C NMR, DEPT, COSY, NOESY, HSQC, and HMBC analyses). Single-crystal X-ray diffraction studies confirmed the relative configurations of 1 and 4 and provided additional support for the structures of 2, 3, and 5.

Effect of oral conjugated equine estrogen combined with medroxyprogesterone acetate on plasma homocysteine levels in postmenopausal women.

Conjugated equine estrogen alone or combined with medroxyprogesterone acetate lowered homocysteine levels in postmenopausal women. Regardless of the dosage of progestin used, there was no impact on homocysteine metabolism after 3 years of therapy.

Choosing calcium channel blockers for pregnant women with paroxysmal supraventriclar tachycardia and preterm labor: a case report.

Preterm labor is a major clinical hazard causing both maternal and neonatal morbidity and mortality. Paroxysmal supraventricular tachycardia (PSVT) complicated by preterm labor is rare. Of the many drugs used to treat PSVT, only calcium channel blockers are tocolytics. Here, we present the case of a 29-year-old female admitted to our ward with previously diagnosed PSVT and preterm labor at 31 weeks' gestation of her fourth pregnancy. Calcium channel blockers were administered and her uterine contractions subsided. Afterwards, no side effects were noted and she suffered no further tachycardic attacks during her pregnancy. She successfully delivered a full-term baby and received subsequent regular follow-up at the outpatient clinic.

Cyclooxygenase-2 expression in the endometrium at the end of 2 years' continuous combined hormone replacement therapy.

OBJECTIVE: To evaluate the change of endometrial histology and the expression of cyclooxygenase-2 (Cox-2) in the endometrium after continuous combined hormone replacement therapy (HRT). METHODS: Forty-five postmenopausal women were recruited. All participants received 0.625 mg conjugated equine estrogen (CEE) and 2.5 mg medroxyprogesterone (MPA) daily for 2 years. Endometrial biopsy was performed twice, before medication (baseline) and after 2 years of HRT, respectively. Immunohistochemistry was used to detect the presence of Cox-2 expression. RESULTS: More atrophic and weak secretory features of endometrium were noted after the 2-year HRT. Endometrial hyperplasia and carcinoma were not found and immunohistochemistry results revealed that Cox-2 was not expressed in the endometrium. CONCLUSION: Cox-2, known to play an important role in the tumorigenesis of cancer, was not stained in endometrium tissue after hormonal induction and more endometrium atrophy was noted after the 2-year HRT. From the results, it is noted that continuous combined HRT may be a relatively safe and appropriate regimen for long-term use in postmenopausal women.

Chronic administration of atrial natriuretic peptide reduces testosterone production of testes in mice.

The purpose of the present study was to examine the effect of the long-term administration of human atrial natriuretic peptide (ANP) on testosterone production in male mice. Twenty-five mice received ANP (20 ng/hour/g body weight) for 7 days via mini-osmotic pump, and the other group (n = 25) received twice-daily intraperitoneal injections. After death, levels of follicle-stimulating hormone, luteinizing hormone (LH), and testosterone in plasma, pituitary gland, and testis were measured by radioimmunoassay. Five mice from each group were examined histologically. In the minipump group, pituitary and plasma levels were significantly higher than those in the control group (771.2 +/- 43.6 vs 644.8 +/- 24.9 ng/mg and 6.7 +/- 0.6 ng/mg vs 2.5 +/- 0.6 ng/mL, respectively). In the intraperitoneal group, plasma LH levels were significantly higher in the ANP-treated group than that in control mice (9.6 +/- 0.3 ng/mg vs 3.8 +/- 0.5 ng/mL), whereas pituitary levels did not differ significantly. In both studies, testicular and plasma testosterone levels were significantly lower than those in control mice (P <.02). Histological features of the testes in ANP-treated mice revealed structural disorganization and inhibition of spermatogenesis. We conclude that the chronic administration of ANP may result in reduced testosterone production due to testicular damage.

An unexpected quadruplet heterotopic pregnancy after bilateral salpingectomy and replacement of three embryos.

OBJECTIVE: To report a case of combined intrauterine and interstitial twin pregnancies after bilateral salpingectomy and IVF with replacement of three embryos. DESIGN: Case report. SETTING: University hospital. PATIENT(S): A 31-year-old woman known to have bilateral salpingectomy for ectopic pregnancies who underwent IVF. INTERVENTION(S): Laparotomy. MAIN OUTCOME MEASURE(S): Postoperation intrauterine monozygotic twins survival and birth. RESULT(S): After removing the interstitial monozygotic twin pregnancy, the patient had an uneventful postoperative course and delivered two healthy girls by cesarean section at 38 weeks' gestation. CONCLUSION(S): Heterotopic pregnancy can still occur in women treated by IVF after bilateral salpingectomy. The early sonography follow-up of IVF pregnancy would be of value because of the reported higher incidence of pathological pregnancies and especially monozygotic twinning.

Laparoscopically assisted vaginal hysterectomy versus total abdominal hysterectomy: a study of 100 cases on light-endorsed transvaginal section.

The objective of this study was to compare the results of a modified laparoscopically assisted vaginal hysterectomy (LAVH) procedure, using light-endorsed transvaginal section by two puncture trocars, with those of total abdominal hysterectomy (TAH) in a prospective, randomized, short-term study. A new, modified LAVH technique using Endo GIA stapler and two puncture trocars was established. For the laparoscopic phase, each adnexum was dissected, and the vesicouterine junction was identified clearly with the laparoscopic light from the vaginal side. Vaginal-phase surgery was performed as usual. Two hundred patients scheduled for abdominal hysterectomy were randomized to either LAVH (n = 100) or TAH (n = 100). Duration of hospitalization, time of surgery, dose of analgesics, and rates of complications were significantly lower in the LAVH group (p < 0.001). The average operating time was 77 +/- 30 min for LAVH and 102 +/- 18 min for TAH. The duration of hospitalization was 3.2 +/- 0.7 days for LAVH and 5.5 +/- 1.3 days for TAH. There were three complications in the LAVH group and 15 in the TAH group. Postoperative meperidine requirements (1.2 vs. 3.7 ampoules, 1 ampoule = 50 mg) were significantly fewer in the LAVH group. Regarding the training time, the mean operating time in the first 20 cases was 98 min, and in the last 20 cases it was 70.9 min. As compared with TAH and other modified LAVH procedures reported previously, the present technique is easy to learn and timesaving with fewer complications.

Multilobular cyst as endosalpingiosis of uterine serosa: a case report.

A case of endosalpingiosis presented as a multilobular cyst on sonography. The tentative clinical diagnosis was an ovarian tumor; however, laparotomy revealed a degenerative cyst of the uterine myoma with a stalk connecting to the uterus. Histopathologically, it showed characteristics of endosalpingiosis. To our knowledge, such a multilobular cyst of endosalpingiosis originating solely from the uterine serosa has not been reported.

[Applications of ultrasound in the treatment of the complications of breast augmentation with polyacrylamide hydrogel injection].

OBJECTIVE: To search for a simple and non-invasive method to assist the treatment of the complications of breast augmentation with polyacrylamide hydrogel injection. METHODS: High-frequency ultrasound was used to examine the breast and observe the distributions of the injected polyacrylamide hydrogel. The operation procedure was predetermined according to the ultrasound information. The ultrasound results were compared with what was seen during the operation. RESULTS: 40 patients (80 breasts) were examined. The ultrasound results were coincident with the outcomes of surgery. The results of postoperative follow-up were coincident with the predicted. CONCLUSION: Ultrasound is an accurate method for examining the augmented breast with polyacrylamide hydrogel injection. It is helpful in predetermining the operation procedure, predicting postoperative results.

Medical abortion with mifepristone and misoprostol: a clinical trial in Taiwanese women.

BACKGROUND AND PURPOSE: Medical abortion was not officially approved in Taiwan until the end of 2001. We investigated the efficacy of combination mifepristone and misoprostol therapy for medical abortion (which has now been approved) in early pregnant Taiwanese women and whether the attitudes of women who received this treatment affected the clinical outcome of medical abortion. METHODS: Eighty healthy women in early pregnancy (< 49 d of gestation) were enrolled into two studies of medical abortion using mifepristone and misoprostol regimens. The outcomes were evaluated based on complete expulsion of intrauterine contents, with or without surgical intervention. Study 1 used treatment with mifepristone (200 mg or 600 mg) and misoprostol (400 micrograms), and the decision to perform surgical intervention was made mainly on the basis of the patient's request. Study 2 used treatment with mifepristone (200 mg or 600 mg) and misoprostol (600 micrograms) where the decision to perform surgical intervention was made exclusively by the physician. Serum or urinary human chorionic gonadotropin (hCG) concentration was measured serially after abortion. RESULTS: In general, the success rate was 95% as judged by complete expulsion of intrauterine contents without surgical intervention. However, the success rate in Study 1 was only 62.5%. The mean duration of bleeding after abortion was 16.7 to 21.7 days. Serum or urinary hCG concentration remained positive in one woman (1.2%) studied during 43 to 60 days after abortion. CONCLUSION: A combination of mifepristone and misoprostol for medical abortion in Taiwanese women during early pregnancy can achieve a high success rate. Our study showed that a mifepristone dose of 200 mg and a misoprostol dose of 400 micrograms were most effective. Our results suggest that sufficient physician and patient communication regarding medical abortion affects the clinical outcome.

Leptin affects pregnancy outcome of in vitro fertilization and steroidogenesis of human granulosa cells.

PURPOSE: This study was to examine the serum leptin levels in the prediction of pregnancy outcomes in women receiving ovarian hyperstimulation. Effect of leptin on the steroidogenesis was evaluated for granulosa cell (GC) culture in vitro. METHOD: Serum levels of leptin and estradiol were measured on Day 2, the time of hCG administration and oocyte retrieval in 50 women undergoing long-course GnRH agonist ovarian hyperstimulation. The production of estrogen and progesterone in granulosa cell culture were detected after administration of leptin at the absence or presence of FSH 1 mIU. RESULTS: Leptin levels at the time of hCG injection were significantly lower in the pregnant women than in those without pregnancy. Estradiol concentrations were not correlated with leptin levels during the time of hCG injection and oocyte retrieval. High leptin concentration suppressed both basal estradiol and progesterone productions in GC. Leptin in high doses suppressed estradiol production, but did not alter progesterone production of GC in the presence of FSH. CONCLUSIONS: Serum leptin levels may be predictive of IVF pregnancy outcome with the effect on intraovarian progesterone/estradiol ratio during the follicular phase. Significantly low serum leptin levels were noted in the pregnant women than in the nonpregnant women.