BACKGROUND & AIMS: Our aim was to compare the effects of intake of diets supplemented with different dietary fibers, namely cellulose, methylcellulose or Plantago ovata husks,(insoluble, soluble non-fermentable, and soluble fermentable fiber, respectively), on the abnormalities clustered in the metabolic syndrome. METHODS: Adult obese Zucker rats were distributed in four groups which were fed respectively a standard, a cellulose-supplemented, a methylcellulose-supplemented or a P. ovata husks-supplemented diet, for ten weeks. RESULTS: Increased body weight, hyperlipidemia, hyperinsulinemia and hyperleptinemia, increased TNF-alpha and reduced adiponectin secretion by adipose tissue found in obese Zucker rats were significantly improved in obese rats fed the P. ovata husks-supplemented diet, together with a lower hepatic lipid content which parallels activation of the signaling pathway of AMP-protein kinase in the liver. The methylcellulose-supplemented diet reduced body weight, hyperlipidemia, circulating free fatty acids concentration and ameliorated adipose tissue secretion of adiponectin and TNF-alpha. Feeding with the cellulose-supplemented diet only reduced free fatty acids circulating levels. CONCLUSIONS: The soluble dietary fibers essayed are more beneficial than insoluble fiber in the treatment of metabolic syndrome, being the soluble and fermentable the more efficient to improve metabolic alterations. Fermentation products of P. ovata husks must play an important role in such effects.

Cu, Pb, and Hg concentrations were determined in surface sediment samples collected at three sites in San Jorge Bay, northern Chile. This study aims to evaluate differences in their spatial distribution and temporal variability. The highest metal concentrations were found at the site "Puerto", where minerals (Cu and Pb) have been loaded for more than 60 years. On the other hand, Hg does not pose a contamination problem in this bay. Cu and Pb concentrations showed significant variations from 1 year to another. These variations seem to be a consequence of the combination of several factors, including changes in the loading and/or storage of minerals in San Jorge Bay, the dredging of bottom sediments (especially at Puerto), and seasonal changes in physical-chemical properties of the water column that modify the exchange of metals at the sediment-water interface. Differences in the contamination factor and geoaccumulation index suggest that pre-industrial concentrations measured in marine sediments of this geographical zone, were better than geological values (average shale, continental crust average) for evaluating the degree of contamination in this coastal system. Based on these last two indexes, San Jorge Bay has a serious problem of Cu and Pb pollution at the three sampling locations. However, only Cu exceeds the national maximum values used to evaluate ecological risk and the health of marine environments. It is suggested that Chilean environmental legislation for marine sediment quality-presently under technical discussion-is not an efficient tool for protecting the marine ecosystem.

Damage following ischemia and reperfusion (I/R) is common in the intestine and can be caused during abdominal surgery, in several disease states and following intestinal transplantation. Most studies have concentrated on damage to the mucosa, although published evidence also points to effects on neurons. Moreover, alterations of neuronally controlled functions of the intestine persist after I/R. The present study was designed to investigate the time course of damage to neurons and the selectivity of the effect of I/R damage for specific types of enteric neurons. A branch of the superior mesenteric artery supplying the distal ileum of anesthetised guinea pigs was occluded for 1 h and the animals were allowed to recover for 2 h to 4 weeks before tissue was taken for the immunohistochemical localization of markers of specific neuron types in tissues from sham and I/R animals. The dendrites of neurons with nitric oxide synthase (NOS) immunoreactivity, which are inhibitory motor neurons and interneurons, were distorted and swollen by 24 h after I/R and remained enlarged up to 28 days. The total neuron profile areas (cell body plus dendrites) increased by 25%, but the sizes of cell bodies did not change significantly. Neurons of type II morphology (intrinsic primary afferent neurons), revealed by NeuN immunoreactivity, were transiently reduced in cell size, at 24 h and 7 days. These neurons also showed signs of minor cell surface blebbing. Calretinin neurons, many of which are excitatory motor neurons, were unaffected. Thus, this study revealed a selective damage to NOS neurons that was observed at 24 h and persisted up to 4 weeks, without a significant change in the relative numbers of NOS neurons.

Triggering receptor expressed on myeloid cells-like (TREM-like) transcript-1 (TLT-1), a type 1 single Ig domain orphan receptor specific to platelet and megakaryocyte alpha-granules, relocates to the platelet surface upon platelet stimulation. We found here that patients diagnosed with sepsis, in contrast to healthy individuals, had substantial levels of soluble TLT-1 (sTLT-1) in their plasma that correlated with the presence of disseminated intravascular coagulation. sTLT-1 bound to fibrinogen and augmented platelet aggregation in vitro. Furthermore, the cytoplasmic domain of TLT-1 could also bind ezrin/radixin/moesin family proteins, suggesting its ability to link fibrinogen to the platelet cytoskeleton. Accordingly, platelets of Treml1-/- mice failed to aggregate efficiently, extending tail-bleeding times. Lipopolysaccharide-treated Treml1-/- mice developed higher plasma levels of TNF and D-dimers than wild-type mice and were more likely to succumb during challenge. Finally, Treml1-/- mice were predisposed to hemorrhage associated with localized inflammatory lesions. Taken together, our findings suggest that TLT-1 plays a protective role during inflammation by dampening the inflammatory response and facilitating platelet aggregation at sites of vascular injury. Therefore, therapeutic modulation of TLT-1-mediated effects may provide clinical benefit to patients with hypercoagulatory conditions, including those associated with inflammation.

Objective: To evaluate the outcomes of published studies involving lingual nerve (LN) and inferior alveolar nerve (IAN) microsurgery and reviewing differences in sensory recovery and timing to repair for both groups. Method and Materials: A total of 29 patient charts referred to the principal investigator were reviewed (15 IAN and 14 LN). Age, gender, mechanism of injury, and time from injury to surgical repair were assessed. Two-point discrimination and tactile detection threshold (via von Frey monofilaments) were the utilized measured variables because both are quantifiable and repeatable data points. Results: There was a predominance of female patients (10 IAN, 12 LN), and the mean age of the patients in the IAN group (37.40 +/- 9.61 years) was significantly higher than in the LN group (28.86 +/- 7.99 years). The time from injury to microsurgery was longer in the LN group (234.10 +/- 166.13 days) than the IAN group (137.80 +/- 83.80 days). Four patients from the IAN group and 7 from the LN group were operated on more than 6 months after the injury. Of the 15 patients who underwent IAN microsurgery, 1 patient had no change in either von Frey or 2-point discrimination results after the procedure, and 2 patients had no changes in only von Frey results. For the 14 patients undergoing LN repair, 1 patient demonstrated no change in the 2-point discrimination test and 1 patient had a reduced postoperative von Frey result compared to the preoperative measurement. Conclusion: Patients undergoing LN and IAN microsurgery benefit from trigeminal nerve microsurgery. No statistically significant differences overall were observed when comparing the outcomes of LN and IAN microsurgery. Patients undergoing trigeminal nerve microsurgery for LN and IAN injuries 6 months after injury derived less sensory recovery; however, significant improvement was still observed, warranting consideration for microsurgery in those patients who might present later for initial surgical consultation.(Quintessence Int 2009;40:295-301).

ABSTRACT: BACKGROUND: A current paradigm in the treatment of cervical cancer with radiation therapy is that intracavitary brachytherapy is an essential component of radical treatment. This is a matched retrospective comparison of the results of treatment in patients treated with external beam chemoradiation (EBRT-CT) and radical hysterectomy versus those treated with identical chemoradiation followed by brachytherapy. METHODS: In this non-randomized comparison EBRT-CT protocol was the same in both groups of 40 patients. In the standard treated patients, EBRT-CT was followed by one or two intracavitary Cesium (low-dose rate) applications within 2 weeks of finishing external radiation to reach a point A dose of at least 85Gy. In the surgically treated patients, radical hysterectomy with bilateral pelvic lymph node dissection and para-aortic lymph node sampling were performed within 7 weeks after EBRT-CT. Response, toxicity and survival were evaluated. RESULTS: A total of 80 patients were analyzed. The patients receiving EBRT-CT and surgery were matched with the standard treated cases. There were no differences in the clinicopathological characteristics between groups or in the delivery of EBRT-CT. The pattern of acute and late toxicity differed. Standard treated patients had more chronic proctitis while the surgically treated had acute complications of surgery and hydronephrosis. At a maximum follow-up of 60 months, median follow-up 26 (2-31) and 22 (3-27) months for the surgery and standard therapy respectively, eight patients per group have recurred and died. The progression free and overall survival are the same in both groups. CONCLUSIONS: The results of this study suggest that radical hysterectomy can be used after EBRT-CT without compromising survival in FIGO stage IB2-IIB cervical cancer patients in settings were brachytherapy is not available. A randomized study is needed to uncover the value of surgery after EBRT-CT.

BACKGROUND:: Image-guided small catheter tube thoracostomy (SCTT) is not currently used as a first-line procedure in the management of patients with chest trauma. We adopted a practice recommendation to use SCTT as a less invasive alternative in the treatment of chest injuries. We reviewed our trauma registry to evaluate our change in practice and the effectiveness of SCTT. METHODS:: Retrospective review of all tube thoracostomies (TT) performed in patients with chest injury at a level I trauma center from September 2002 through March 2006. Data collected included age, sex, indications and timing for TT, use of antibiotics, length of stay, complications, and outcomes. Large catheter tube thoracostomy (LCTT) not performed in the operating room or trauma room and all SCTT were deemed nonemergent. RESULTS:: There were 565 TT performed in 359 patients. Emergent TT was performed in 252 (70%) and nonemergent TT in 157 (44%) patients, of which 63 (40%) received LCTT and 107 (68%) received SCTT. Although SCTT was performed later after injury than nonemergent LCTT (5.5 days vs. 2.3 days, p < 0.001), average duration of SCTT was shorter (5.5 days vs. 7 days, p < 0.05). Rates of hemothoraces were similarly low for SCTT versus nonemergent LCTT (6.1% vs. 4.2%, p = NS) and rates of residual/recurrent pneumothoraces were not significantly different (8% vs. 14%, p = NS). The rate of occurrence of fibrothorax, however, was significantly lower for SCTT compared with nonemergent LCTT (0% vs. 4.2%, p < 0.05). In patients receiving a single nonemergent TT, SCTT was performed in 55 (61%) and LCTT in 35 (39%). A comparison of these groups revealed that SCTT was performed in older patients (p < 0.05), and was associated with a lower Injury Severity Score (p < 0.05) and shorter length of stay (p = 0.05). SCTT was increasingly used in younger and more seriously injured patients as our experience grew. CONCLUSION:: SCTT is effective in managing chest trauma. It is comparable with LCTT in stable trauma patients. This study supports adopting image-guided small catheter techniques in the management of chest trauma in stable patients.

Background and objective: Stable asthma is characterized by the production of Th2 cytokines, although Th1 cytokines may play a key role in aspects such as airway hyper-responsiveness. This study explored cytokine profiles associated with asthma exacerbation. Methods: Intracellular T-cell cytokine production was measured in 16 children with acute severe asthma (emergency department), after convalescence (6 weeks, n = 13), with stable disease (after 6 months, n = 7) and in 14 age-matched hospital controls. Flow cytometry was used to identify CD4+ and CD8+ cells and to quantify intracellular T-cell production of the cytokines interferon (IFN)-gamma, IL-4 and IL-13. Cytokine production was compared using analysis of variance and random-effects generalized linear models and associations were examined using Pearson's correlation. Results: Cytokine production was evident in CD4+ and CD8+ cells, and compared with asthmatic children, non-asthmatics had a higher percentage of IFN-gamma+CD4+ cells (P = 0.01). The percentage of CD8+IFN-gamma+ cells was increased in the convalescent phase compared with acute (P = 0.009) and stable asthma (P = 0.004). IL-4+ cells were not significantly altered. IL-13 levels were higher in acute disease than in stable asthma (P = 0.009 in CD4+ cells) and IFN-gamma/IL-13 ratios indicated a Th2 profile during exacerbation (P = 0.005 in CD4+ cells). Conclusions: IL-13, rather than IL-4, may play a pro-inflammatory role during acute severe asthma, whereas IFN-gamma responses were associated with recovery from acute severe asthma. These results suggest that altered T-cell cytokine profiles may contribute to the pathogenesis of and recovery from asthma exacerbations.

CXCL10 production is a critical step in limiting mycobacterial infection. Although induction of this chemokine by mycobacteria in epithelial cells has been reported, it is still unclear how CXCL10 is regulated in Mycobacterium bovis BCG-infected epithelial cells. In this study, we demonstrate that phosphatidylinoditol 3-kinase (PI3K)/Akt and the nuclear factor kB (NF-kB) signaling pathways play an important role in CXCL10 expression at the protein and mRNA level in A549 cells. We demonstrate that treatment of A549 cells with LY294002 and wortmannin, two PI3K inhibitors, inhibited M. bovis BCG-induced CXCL10 expression. In addition, treatment of A549 cells with an Akt inhibitor significantly blocked M. bovis BCG-induced CXCL10 production. Moreover, our data show that treatment of epithelial cells with CAPE, BAY 11-7082, and PDTC three selective inhibitors of NF-kB, significantly reduced the effect of M. bovis BCG on induced CXCL10 mRNA expression (74%, 69% and 83% inhibition by 8muM CAPE, 10muM BAY 11-7082 and 3muM PDTC as assessed by real-time PCR, respectively). In accordance with the gene induction, the production of CXCL10 was also significantly reduced by these inhibitors. Finally, the inhibition of PI3K affect NF-kB activation in M. bovis BCG-infected cells, indicating that PI3K activity is required for the M. bovis BCG-induced activation of NF-kB. The functional association between PI3K/Akt and NF-kB demonstrates another mechanism in the regulation of M. bovis BCG-induced CXCL10 in A549 cells.