Predictive value of serum insulin-like growth factor-1 in hepatocellular carcinoma.

BACKGROUND: Hepatocellular carcinoma (HCC) is the commonest primary malignant cancer of the liver in the world. Insulin-like growth factor-1 (IGF-1) levels reflect hepatic function and are inversely correlated with the severity of background chronic liver disease. OBJECTIVE: This study evaluated whether basal serum IGF-1 levels can predict prognosis of HCC patients according to different risks of disease progression. MATERIALS AND METHODS: A total of 89 patients with hepatocellular carcinoma (HCC) were recruited in 3 groups: Group I, 30 HCC patients receiving sorafinib; Group II, 30 HCC patients with best supportive care; and Group III include 29 patients undergoing transcatheter arterial chemoembolization (TACE). All patients were investigated for serum levels of AST, ALP, Bb, Cr, BUN, AFP and IGF-I. RESULTS: Patients with disease control had significantly higher baseline IGF-1 levels 210 (185-232.5) ng/mL (p value<0.01) than did patients without disease control. Low basal IGF-1 levels were associated with advanced HCC, such as multiple tumors and advanced stage, and low IGF-1 levels predicted shorter TTP and overall survival in patients treated with TACE. CONCLUSIONS: The levels of serum IGF-1, expressed as continuous values, may be helpful for accurately assessing hepatic function and the prognostic stratification of patients with HCC.

Role of bacterial biofilms in idiopathic childhood epistaxis.

The objective of the study is to conduct a prospective trial investigating the possible role of bacterial biofilms in the pathogenesis of severe idiopathic childhood epistaxis. This study included 84 cases of severe idiopathic epistaxis, aged below 16 years, who were prepared for cautery under general anesthesia. A nasal swab was taken for bacterial culture and a nasal mucosal specimen (≤ 3 mm(2)) was taken from the suspected site of bleeding just prior to cautery and sent for bacterial identification by pathogen specific fluorescence in situ hybridization (FISH) and also for detection of bacterial biofilms by scanning electron microscope (SEM). Nasal mucosal specimens from 20 children of the same age prepared for reduction of fracture nasal bones and have no nasal problems were taken as a control group. Bacterial culture was positive in 27.3 % of patients and the most common organism was Staphylococcus aureus (19 %). By SEM, biofilm formation was detected in only six patients (7.1 %). Evaluation of nasal specimens with FISH was positive for pathogenic bacteria in 37 % of cases; the most common organism was S. aureus (22.6 % of cases). In the control group, no biofilm was detected by SEM and no pathogenic bacteria were cultured or detected by FISH. The difference between the two groups was statistically significant. Bacterial biofilm does not seem to play a major role in the pathogenesis of idiopathic epistaxis in children (only positive in 7.1 % of cases by SEM) although a low-grade chronic inflammation is not infrequently present (37 % of cases detected by FISH). FISH is more sensitive than bacterial culture in detecting bacterial infections. S. aureus was the most common pathogen detected by both techniques.

Role of adenoid biofilm in chronic otitis media with effusion in children.

To study the extent of surface adenoid biofilm and to evaluate its role in the pathogenesis of chronic otitis media with effusion (COME) in children. The study was carried out on 100 children between 3 and 14 years of age, who were divided into two groups. The first group (50 children) had otitis media with effusion associated with adenoid hypertrophy, whereas the second group (50 children) had adenoid hypertrophy without middle ear effusion. Adenoidectomy with ventilation tube insertion was done for group 1 cases, whereas, only Adenoidectomy was done for group 2 cases. Microbiological study, Scanning electron microscope and multiplex- PCR were done for suspected adenoid biofilms and specimens from middle ear effusion. Adenoids removed from children with COME had higher grade biofilm formation (74 %) than the second group (42 %). No correlation was found between adenoid size and biofilm formation. Culture of adenoid tissue in group 1 patients was positive in 52 % of cases compared to 96 % by PCR, while in group 2 culture of adenoid tissue was positive in 38 % compared to 48 % by PCR. Culture of middle ear fluid was positive in 32 % of cases only compared to 80 % by PCR. A positive correlation was found between results of bacterial biofilm visualized by SEM and bacteria detected and identified by PCR technique. On the other hand, no correlation was found between results of bacterial biofilm visualized by SEM and bacteria detected by culture. The size of the adenoid is not the main determinant factor in OME pathogenesis but the degree of bacterial colonization is much more important. Adenoids in COME may act as a reservoir of chronic infection rather than causing mechanical Eustachian obstruction. Higher grade biofilm formation was found in cases with middle ear effusion than those with adenoid hypertrophy only. These findings support the hypothesis that there would be an association between adenoidal biofilm formation and COME. This study focused on the value of PCR in detecting pathogens in the adenoid and middle ear specimens although the bacterial culture would be negative.