Neurovascular contact (NVC) with the root exit zone (REZ) of the ipsilateral facial nerve is associated with hemifacial spasm (HFS), but unresolved issues remain.
To 1) determine the frequency of ...symptomatic and nonsymptomatic NVC, 2) determine the features of NVC associated with HFS, and 3) correlate severity of HFS to these features.
Two independent, blinded, prospective assessments of high-resolution MR and MR angiography (MRA) images were performed on Chinese cases (HFS: n = 44; age-matched control subjects: n = 20).
Over 88% of 44 symptomatic sides in patients with HFS had NVC of the ipsilateral facial nerve. At least 80% of symptomatic sides involved NVC at the anterior aspect of the REZ REZ(ant.). Although NVC was observed in approximately half of nonsymptomatic sides, at least 70% of them were not at REZ(ant.). NVC at the cisternal and intracanalicular portions of the facial nerve were not associated with HFS. Half of our patients with HFS had bilateral NVC, but none had bilateral symptoms. Most of our MR/MRA images showed that the size and position of the arterial branches of the vertebrobasilar system were markedly asymmetric. Of patients with bilateral NVC, over 83% had asymmetric NVC sites. The anterior inferior cerebellar artery was the most common vessel involved in NVC, but was not significantly associated with HFS. Most of the NVC involved one vessel at one contact point with no indentation. The development of HFS was significantly associated with nerve indentation in NVC. The development and severity of HFS were not associated with multiple contact points in NVC. No significant interobserver variability existed between the blinded assessments.
MRI/MR angiography are accurate, fast, and safe in characterizing neurovascular contact (NVC) at the brainstem. The site of NVC and ipsilateral facial nerve indentation in NVC are significant determinants for the development of hemifacial spasm (HFS). The lack of bilateral NVC at the anterior aspect of the root exit zone of the facial nerve could explain in part the lack of bilateral symptoms. The development and severity of HFS are not associated with a specific blood vessel or multiple contact points in NVC.
Abstract only Background: Sex differences in the pathogenesis of hypertension exist. Whilst gut microbiota (GM) dysregulation is a novel risk factor of hypertension, studies using shotgun ...metagenomics sequencing and ambulatory 24-hour blood pressure (BP) monitoring to study the potential sex differences in the associations between the GM and BP are lacking. Methods: We recruited 241 asymptomatic Hong Kong Chinese (113 male, 128 female, mean age 54±6), who were not on anti-hypertensive agents, and studied their GM composition using shotgun sequencing. 24-hour ambulatory BP was recorded. GM-mediated short chain fatty acids (SCFAs) were quantified in stool and plasma by GC-MS. Statistical analysis was performed under covariate-adjusted models including age, sex, BMI, smoking, sodium-intake, fatty liver and menopause status. Results: Based on 24-hour BP, 36% (87 of 241) of the study population was hypertensive. Males had a higher mean BP than females (127±13/81±10mmHg vs. 117±12/71±8mmHg, p<0.001). GM β-diversity was significantly different in hypertensive vs. normotensive individuals, driven by females. A significant enrichment of Ruminococcus gnavus was observed in the hypertensive group whilst Oscillibacter sp. CAG:241 and Gemmiger formicilis was enriched in the normotensive group. These differences remained significant in females with no significant differential species found in males. Additionally, Dorea formicigenerans was negatively associated whilst Clostridium bolteae and Bacteroides ovatus were positively associated in female-specific hypertension. Repeated cross-validation machine-learning demonstrated microbial features were more predictive of hypertension in females than males, and the addition of microbial features to clinical features (age, BMI) improved the model’s prediction accuracy from 0.69 to 0.84 in females. Total plasma SCFAs and propionic acid were independent predictors of systolic and diastolic BP in females but not males. GM β-diversity was also significantly associated with total SCFAs and propionic acid levels. Conclusion: GM dysregulation appears to be more strongly associated with hypertension in females, which may be mediated through circulating plasma SCFAs.
Plasma endotoxin levels were investigated using a quantitative Limulus assay in patients with chronic liver diseases and correlated with the severity of liver diseases, the presence of esophageal ...varices, and hemodynamic parameters. The plasma endotoxin levels were significantly higher in chronic hepatitis patients with acute exacerbation (10.1 +/- 1.3 pg/ml, n = 13, p < 0.05) and patients with cirrhosis (7.0 +/- 0.7 pg/ml, n = 126, p < 0.05) than in healthy subjects (2.9 +/- 0.2 pg/ml, n = 45). Chronic hepatitis patients (n = 30) had plasma endotoxin levels which were similar to those in healthy subjects (4.6 +/- 0.5 vs. 2.9 +/- 0.2 pg/ml, p > 0.05) but lower than those in chronic hepatitis patients with acute exacerbation (4.6 +/- 0.5 vs. 10.1 +/- 1.3 pg/ml, p < 0.05). Endotoxemia (plasma endotoxin level > 5.7 pg/ml) was found in 27%, 85% and 41% of patients with chronic hepatitis, chronic hepatitis with acute exacerbation, and cirrhosis, respectively. In patients with cirrhosis, the plasma endotoxin levels progressively increased in relation to the severity of liver dysfunction (Pugh's class A/B/C = 4.9 +/- 0.5/7.9 +/- 1.4/10.2 +/- 2.0 pg/ml, p < 0.05). In contrast, plasma endotoxin levels were comparable between patients with cirrhosis with and without esophageal varices (p > 0.05). Chronic hepatitis patients with acute exacerbation (no collaterization) had much higher plasma endotoxin levels than those in patients with cirrhosis and large varices (p < 0.05), whereas compensated patients with cirrhosis and large esophageal varices had plasma endotoxin levels similar to those seen in chronic hepatitis patients (no collaterization) (p > 0.05).
Background: Nitric oxide synthase (NOS), particularly endothelial and inducible forms (e/i-NOS), are expressed in various cancers, including breast cancer. In mammary fibroepithelial lesions, NOS ...expression in stromal cells has been reported to be lower in fibroadenomas than in phyllodes tumours. Aims: To investigate NOS expression in phyllodes tumours of varying degrees of malignancy. Methods: One hundred and sixty seven mammary phyllodes tumours (97 benign, 47 borderline malignant, and 23 frankly malignant) were evaluated for e-NOS and i-NOS expression by immunohistochemistry. Correlations with previously reported expression of stromal vascular growth factor (VEGF) and microvessel density were also performed. Results: Stromal expression of e-NOS was absent, weak, moderate, and strong in 43%, 31%, 13%, and 13% of benign tumours; 17%, 26%, 13%, and 44% of borderline malignant tumours; and 17%, 35%, 13%, and 35% of frankly malignant tumours, respectively. Stromal expression of i-NOS was 77%, 18%, 4%, and 1% in benign tumours; 42%, 28%, 19%, and 11% in borderline malignant tumours; and 43%, 13%, 26%, and 18% in frankly malignant tumours, respectively. Stromal expression of both i-NOS and e-NOS was significantly different between the benign and malignant (borderline and frank) groups of phyllodes tumours (p<0.0001). Furthermore, the expression of i-NOS correlated with stromal VEGF expression and microvessel density. The expression of NOS in the epithelial cells was strong, and showed no differences between the different groups of tumours. Conclusions: Higher stromal expression of NOS in phyllodes tumours is associated with malignancy, suggesting a possible role in malignant progression, particularly metastasising potential.
Background Bismuth salts are not available worldwide. It remains unknown whether clarithromycin can replace bismuth salts as an adjuvant agent in the rescue regimens for Helicobacter pylori ...infection. We therefore designed the prospective study to compare the efficacies of two rescue therapies for H. pylori infection after standard triple therapies.
Patients and methods Ninety‐three patients who failed H. pylori eradication using proton pump inhibitor plus clarithromycin and amoxicillin were randomly assigned to undergo rescue therapy with esomeprazole, clarithromycin, tetracycline and metronidazole (ECTM group, n = 46) or esomeprazole, bismuth subcitrate, tetracycline and metronidazole (EBTM group, n = 47). Follow‐up endoscopy was performed at 8 weeks after the end of treatment to assess the treatment response.
Results Intention‐to‐treat analysis demonstrated both groups had similar eradication rates (ECTM 74% vs. EBTM 77%; P = 0·76) and drug compliance (ECTM 94% vs. EBTM 96%; P = 0·68). However, the frequency of adverse events in the ECTM group was higher than that in EBTM group (ECTM 57% vs. EBTM 36%, P = 0·05). In the EBTM group, eradication rate of metronidazole‐resistant strains was lower than that of metronidazole‐susceptible strains (67%8/12 vs. 100%9/9, P = 0·05). However, eradication rates were similar between metronidazole‐susceptible and metronidazole‐resistant strains in ECTM group (69%9/13 vs. 70%7/10, P = 1·00).
Conclusions The new ECTM second‐line therapy can achieve similar eradication rate as standard EBTM therapy. It may be very useful in countries where bismuth salts are not available.
Experimental targeting of the exocrine pancreatic ductal tree stimulates beta-cell rejuvenation thereby underscoring the importance of functional crosstalk between the exocrine and endocrine ...pancreas. We recently found that antibody directed against serpin B13, a protease inhibitor expressed in the ductal epithelium of the exocrine pancreas, increased the catalytic activity of it’s protease target, cathepsin L (CatL) and subsequently upregulated Reg-mediated cellular proliferation in the islets. However, the exact molecular events that link catL activity to upregulated Reg and islet cell proliferation remain unclear. As increased E-cadherin levels during islet formation mediate a decline in beta-cell proliferation, and Reg upregulation has been linked to activation of beta-catenin, we hypothesized that the functional crosstalk between pancreatic ductal epithelium and the islets may involve CatL-mediated activation of the E-cadherin/β-catenin pathway. In support of this we found that E-cadherin was downregulated with a concomitant increase in Reg1 in mice treated with serpin B13 monoclonal antibody (mAb). Likewise, exposure to recombinant CatL or ductal epithelium extract treated with serpin B13 mAb caused decreased E-cadherin expression in the pancreatic islets during in vitro culture. On the other hand, this expression was recovered with CatL inhibitor. Moreover, treatment of MIN-6 insulinoma cells with ductal epithelium extract and serpin B13 mAb stimulated intranuclear accumulation of β-catenin, while Reg gene expression in the islets was markedly reduced in the presence of the β-catenin chemical inhibitor, FH535. These data establish E-cadherin as a potential target of CatL in the regulation of islet cell proliferation by an immunological response to serpin B13, and implicate the E-cadherin/β-catenin pathway as an islet sensing mechanism of the signals that are generated in the pancreatic exocrine milieu.
Disclosure
C. Lo: None. T. Sheu: None. J. Czyzyk: None.
Quality of life (QOL) was evaluated in
162 patients having radical gastrectomy for cancer. The results showed that more than half of the patients had a good appetite; they consumed a normal diet and ...a normal volume of food. Approximately 60% of the patients had weight loss of more than 5 kg. Patients who underwent a total gastrectomy had poor tolerance of normal food and frequent eating and body weight loss versus those who had a subtotal gastrectomy. Patients who underwent Billroth II reconstruction after a distal subtotal gastrectomy lost more body weight than those with a Billroth I anastomosis. The extent of lymphadenectomy did not influence the QOL. Patients under 65 years of age had a better QOL. Nearly all patients had normal work and daily living activities. Some patients appeared to lack energy or had a period of anxiety or depression. These data indicate that radical gastrectomy can be performed with an acceptable QOL for a potentially curable gastric carcinoma.
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