Subcutaneous metastasis--the first sign of hepatocellular carcinoma in chronic virus C hepatitis patient--Case report.

Hepatocellular carcinomas make up 90% of primary liver cancers. The association between the hepatic carcinoma and virus B and C infection has been already proven. Hepatocellular carcinoma develops, in most cases, on a background of cirrhosis and rarely in hepatitis. The case we have chosen to report distinguishes itself due to the unusual extra-hepatic metastatic location of a hepatocellular carcinoma in a patient with Chronic HCV hepatitis.

Possibilities to acylate 7-aminocephalosporanic acid to obtain some cephalosporins.

AIM: Acylation of 7-aminocephalosporanic acid with an adequate acyl chloride in order to obtain cefotaxime sodium salt. MATERIAL AND METHODS: Cefotaxime sodium salt was synthesized by acylating 7-amino cephalosporanic acid with 2-[2'-chloracetamidothiazole-4-yl]-2-(syn)-methoxy-imino acetic chloride in four steps. The melting point was determined, and IR spectral analysis and elemental analysis were performed to confirm cefotaxime structure. The quantitative determination was performed. RESULTS: The reaction conditions were established. The yield of the synthesis phases (73-80%) and actual yield (45-47%) were very good. The structure of the obtained cefotaxime sodium salt was confirmed by the IR spectral analysis and by elemental analysis (C, H, N). The melting point was 163 degrees C. The purity of the synthesized cefotaxime sodium salt was 98.9%. CONCLUSIONS: Cefotaxime sodium salt was synthesized by acylation of 7-aminocephalosporanic acid with 2-[2'-chloracetamidothiazole-4-yl]-2-(syn)-methoxy-imino acetic chloride, in aqueous solution, then transformed into sodium salt with sodium 2-ethylhexanoate. The method proved to be very good, yields were good, it is reproducible and simple, and does not involve high risks, so it is also safe.

[Research for the improvement of acylation conditions in antistaphylococcal penicillin synthesis]. / Cercetari privind îmbunatatirea conditiilor de acilare în cazul obtinerii penicilinelor antistafilococice.

AIM: The 6-aminopenicillanic acid acylation with certain acyl chlorides was performed in order to obtain antistaphylococcal penicillins with bigger crystals, easy to filtrate (shorter filtration time), much pure, and an increased output. MATERIAL AND METHODS: Oxacillin sodium salt was synthesized by acylating an aqueous solution of 6-aminopenicillanic acid sodium salt (NaHCO3 not in excess) with an ethylacetate solution of 5-phenyl-3-methyl-isoxazolyl-4-carboxilic acid chloride. The crystallization was performed with a 40.5% sodium 2-ethyl hexanoate izopropanolic solution. All tests (IR spectrum, iodometric titration, and microbiological dosage) were performed according to the Xth Romanian Pharmacopoeia standards. RESULTS: The amount of synthesized oxacillin was higher and the output of 88,21%. Oxacillin had a high chemical purity (98,72%), and a very good microbiological activity (95% of the standard activity). CONCLUSIONS: Oxacillin crystals were bigger, the filtration speed was increased, and process efficacy improved. The output of the process was also improved being higher than with classical acylation.

Clinical prediction of 5-year survival in systemic sclerosis: validation of a simple prognostic model in EUSTAR centres.

OBJECTIVE: Systemic sclerosis (SSc) is associated with a significant reduction in life expectancy. A simple prognostic model to predict 5-year survival in SSc was developed in 1999 in 280 patients, but it has not been validated in other patients. The predictions of a prognostic model are usually less accurate in other patients, especially from other centres or countries. A study was undertaken to validate the prognostic model to predict 5-year survival in SSc in other centres throughout Europe. METHODS: A European multicentre cohort of patients with SSc diagnosed before 2002 was established. Patients with SSc according to the preliminary American College of Rheumatology classification criteria were eligible for the study when they were followed for at least 5 years or shorter if they died. The primary outcome was 5-year survival after diagnosis of SSc. The predefined prognostic model uses the following baseline variables: age, gender, presence of urine protein, erythrocyte sedimentation rate (ESR) and carbon monoxide diffusing capacity (DLCO). RESULTS: Data were available for 1049 patients, 119 (11%) of whom died within 5 years after diagnosis. Of the patients, 85% were female, the mean (SD) age at diagnosis was 50 (14) years and 30% were classified as having diffuse cutaneous SSc. The prognostic model with age (OR 1.03), male gender (OR 1.93), urine protein (OR 2.29), elevated ESR (1.89) and low DLCO (OR 1.94) had an area under the receiver operating characteristic curve of 0.78. Death occurred in 12 (2.2%) of 509 patients with no risk factors, 45 (13%) of 349 patients with one risk factor, 55 (33%) of 168 patients with two risk factors and 7 (30%) of 23 patients with three risk factors. CONCLUSION: A simple prognostic model using three disease factors to predict 5-year survival at diagnosis in SSc showed reasonable performance upon validation in a European multicentre study.

Depletion of antigen-presenting cells by clodronate liposomes reverses the psoriatic skin phenotype in KC-Tie2 mice.

BACKGROUND: There is ongoing debate regarding the initiation of psoriatic plaque as primarily arising from an anomaly in epidermal keratinocytes (KCs) or from abnormalities in immunocytes that secondarily activate otherwise normal KCs. In mice engineered to overexpress the angiopoietin receptor Tie2 in KCs, skin spontaneously develops the characteristic clinical, histological and immune cell phenotypes of psoriasis which can be reversed with either transgene repression or ciclosporin administration, suggesting key roles for both KCs and T cells in mediating the skin disease in this murine model. OBJECTIVES: To determine if antigen-presenting cells (APCs) and macrophages alone are sufficient to sustain psoriasiform inflammation in the KC-Tie2 murine model of psoriasis. METHODS: Clodronate liposomes were intradermally injected into involved dorsal skin of KC-Tie2 or control animals once a week for 6weeks and acanthosis, angiogenesis, immune cell infiltration and cytokine production were quantitated using immunohistochemistry and interactive image analyses, enzyme-linked immunosorbent assay (ELISAs) and quantitative real-time polymerase chain reaction (qRT-PCR). RESULTS: Clodronate liposome injection eliminated CD11c+, F4/80+ and CD11b+ cells in the skin and returned CD8+ T-cell numbers to control mouse levels. APC depletion in KC-Tie2 mouse skin resulted in resolution of the acanthotic skin phenotype, decreased dermal angiogenesis, and a return to control mouse levels for interleukin (IL)-1α, IL-6, IL-23 and tumour necrosis factor (TNF)-α expression and modest reductions in interferon-γ and IL-17. CONCLUSIONS: These findings suggest a critical role for APCs and myeloid cell-derived IL-23 and TNF-α and underscore the importance of Th1 and Th17 T cells in maintaining the psoriasiform skin phenotype in the KC-Tie2 mouse model.

Development of a five-year mortality model in systemic sclerosis patients by different analytical approaches.

OBJECTIVES: Systemic sclerosis (SSc) is a multiorgan disease with high mortality rates. Several clinical features have been associated with poor survival in different populations of SSc patients, but no clear and reproducible prognostic model to assess individual survival prediction in scleroderma patients has ever been developed. METHODS: We used Cox regression and three data mining-based classifiers (Naïve Bayes Classifier [NBC], Random Forests [RND-F] and logistic regression [Log-Reg]) to develop a robust and reproducible 5-year prognostic model. All the models were built and internally validated by means of 5-fold cross-validation on a population of 558 Italian SSc patients. Their predictive ability and capability of generalisation was then tested on an independent population of 356 patients recruited from 5 external centres and finally compared to the predictions made by two SSc domain experts on the same population. RESULTS: The NBC outperformed the Cox-based classifier and the other data mining algorithms after internal cross-validation (area under receiving operator characteristic curve, AUROC: NBC=0.759; RND-F=0.736; Log-Reg=0.754 and Cox= 0.724). The NBC had also a remarkable and better trade-off between sensitivity and specificity (e.g. Balanced accuracy, BA) than the Cox-based classifier, when tested on an independent population of SSc patients (BA: NBC=0.769, Cox=0.622). The NBC was also superior to domain experts in predicting 5-year survival in this population (AUROC=0.829 vs. AUROC=0.788 and BA=0.769 vs. BA=0.67). CONCLUSIONS: We provide a model to make consistent 5-year prognostic predictions in SSc patients. Its internal validity, as well as capability of generalisation and reduced uncertainty compared to human experts support its use at bedside. Available at: http://www.nd.edu/~nchawla/survival.xls.

Disease activity as a risk factor for myocardial infarction in rheumatoid arthritis.

OBJECTIVE: Patients with rheumatoid arthritis (RA) are at greater risk of developing coronary heart disease than the general population. Systemic inflammation may contribute to this risk. This study investigated whether the level of disease activity is associated with the risk of developing myocardial infarction (MI) in patients with RA. METHODS: A case-control study was performed within a large prospective cohort of patients with RA. Cases were patients who developed their first MI after the diagnosis of RA, controls were patients with RA without MI. Cases and controls had similar RA disease duration. Traditional and disease-specific risk factors for MI were collected and a time-averaged disease activity score (DAS28) was calculated. The data were analysed using conditional logistic regression analysis. RESULTS: Cases of MI were significantly older, were more often male, with higher body mass index (BMI) and total cholesterol and lower high-density lipoprotein (HDL) serum levels than controls. Time-averaged disease activity was similar for cases and controls. The raw odds ratio for MI in patients with a "high" (>4.0) versus a "low" (

[Erythromycin ethylsuccinate obtaining possibilities]. / Posibilitati de obtinere a etil-succinatului de eritromicina.

UNLABELLED: In this study we tried to improve the erythromycin ethylsuccinate obtaining, having in view to separate the erythromycin ester by crystallization in water. MATERIAL AND METHODS: The erythromycin acylation and the erythromycin ethylsuccinate crystallization were realized, following the next steps: 1. the acylation of the erythromycin with a methylene chloride solution of monoethylsuccinyl chloride, at 25-28 degrees C for 3 hours in the presence of NaHCO3; 2. the transfer of the erythromycin ethylsuccinate from methylene chloride solution in acetone solution by distillation of mixture methylene chloride: acetone 1:1 at 25-28 degrees C; 3. erythromycin ethylsuccinate separation by crystallization in water at pH = 8-8.5 and 5 degrees C for 90 minutes. The quality control for the erythromycin ester was performed according to the Xth edition of Romanian Pharmacopoeia standards using national standard for erythromycin ethylsuccinate and national standard for erythromycin with an activity of 1: 937 U and 2.02% humidity. The Micrococcus luteus ATCC 9341 was used as a test microorganism and a thin layer cromatography was performed for qualitative control. RESULTS: 13.1 g of erythromycin ethylsuccinate were obtained with an output of the process of 82.02%. Using water for the separation of erythromycin ethylsuccinate the output of the process is greater (82.02%) than in case of using petroleum ether (74.14%) or hexane (80.25%). The thin layer cromatography revealed an Rf = 0.56 and the microbiological activity of the erythromycin ethylsuccinate was 98.7% compared with the standard. CONCLUSIONS: Using water instead of hexane or petroleum ether is gainful for the separation of erythromycin ethylsuccinate from the reaction medium. The obtained erythromycin ethylsuccinate corresponds to the Xth edition of Romanian Pharmacopoeia standards. So, the raw materials consumption is decreased, the costs are cut down, the obtained product purity is high and the output of the process is greater.

[Means of purification of cephalexin with a view to therapeutic use]. / Posibilitati de purificare a cefalexinei în scopul utilizarii terapeutice.

Cephalexin (CEX) is the generic word of chemical compound 7-(D-alpha-aminophenylacetamido)-3-methyl-3-cephem-4-carboxylic acid, which is part of first generation oral cephalosporins group. It is use as cephalexin monohydrochloride monohydrate (CEX.HCl.H2O) syrup or tablets for oral administration. For obtaining a compound with great solubility and osmotic pressure, which is ideal for pharmaceutical forms with controlled dosage, it is necessary to achieve the crystalline form of Cephalexin monohydrochloride monohydrate. The therapeutic use Cephalexin has an output over 95 %, so it is necessary to purify CEX depending on it's isoelectric pH (pKa), which is 4.2. A good purification took place at greater or less values of pH, then the isoelectric pH value of CEX. The purification of CEX at greater values of pH then isoelectric point, took place with a greater output (75-76%), and the obtaining Cephalexin is much pure (97-98%).

[CAD/CAM technology-elaboration of electronic model through optical impression in the fabrication of the dental prostheses by a computer assisted device]. / Tehnologia CAD/CAM--elaborarea modelului electronic prin amprentarea optica în cadrul technologiei de realizare a protezelor dentare asistate de computer.

In modern CAD/CAM technology of dental prosthetics, the "optical impression" taken by special video cameras deploying 3D-recording of the oral situation (Cerec 1, Cerec 2) initiates the computer-generated production of a digital model. The computer receives and renders the digital data obtained through "optical impression" i.e. data acquisition not as a "negative" of the oral situation but as a "positive" copy of it, namely as a digital model in a virtual environment which can be displayed on the screen and be further used in the fabrication of dental prostheses by means of a computer-assisted device (CAM or CIM).