Is emergent laparoscopic cholecystectomy for acute cholecystitis safe in a low volume resource poor setting?

Background: The outcomes of emergent laparoscopic cholecystectomy (LC) for acute cholecystitis have not been documented in the low-volume, resource-poor Caribbean setting.

Settings And Design: This study was carried out in a low-resource setting across three islands in the Anglophone Caribbean.

Methods And Materials: The records of all consecutive patients who had emergency LC for acute cholecystitis over 82 months were examined.

Frailty in people aging with human immunodeficiency virus (HIV) infection.

The increasing life spans of people infected with human immunodeficiency virus (HIV) reflect enormous treatment successes and present new challenges related to aging. Even with suppression of viral loads and immune reconstitution, HIV-positive individuals exhibit excess vulnerability to multiple health problems that are not AIDS-defining. With the accumulation of multiple health problems, it is likely that many people aging with treated HIV infection may be identified as frail.

Surrogate markers of visceral adipose tissue in treated HIV-infected patients: accuracy of waist circumference determination.

Objectives: The accuracy of the use of anthropometrics to quantify visceral adipose tissue (VAT) in treated HIV-infected patients is unknown. We evaluated the predictive accuracy of waist circumference (WC) with and without dual-energy X-ray absorptiometry (DXA)-derived trunk : limb fat ratio [fat mass ratio (FMR)] as surrogates for VAT determined using computerized axial tomography (CT-determined VAT).

Methods: We performed a retrospective cohort analysis of treated HIV-infected male patients followed at the Modena HIV Clinic.

Do multimedia based information services increase knowledge and satisfaction in head and neck cancer patients?

Objectives: To investigate the impact of a Multimode Comprehensive Tailored Information Package (MCTIP) on Head and Neck (H&N) cancer patients' knowledge and satisfaction.

Methods: A non-randomized controlled trial was conducted at two participating hospitals. One hospital delivered the MCTIP and the second hospital provided normal care.

Role of tyrosine phosphorylation in the muscarinic activation of the cystic fibrosis transmembrane conductance regulator (CFTR).

Cystic fibrosis transmembrane conductance regulator (CFTR) is a chloride (Cl(-)) channel, which plays an important role in physiological anion and fluid secretion, and is defective in several diseases. Although its activation by PKA and PKC has been studied extensively, its regulation by receptors is less well understood. To study signaling involved in CFTR activation, we measured whole-cell Cl(-) currents in BHK cells cotransfected with GPCRs and CFTR.

Prostate cancer and androgenic alopecia.

Prostate cancer is a burden on society. Its prevalence can reach up to 80% in males aged 70 years and older. Current screening programs based on prostate-specific antigen testing lead to overdiagnosis and overtreatment with uncertain benefits on survival.

Physical activity, body mass index and bone mineral density-associations in a prospective population-based cohort of women and men: the Canadian Multicentre Osteoporosis Study (CaMos).

Background: Physical activity (PA) is an important modifiable risk factor for both bone mineral density (BMD) and body mass index (BMI). However, BMI is itself strongly predictive of BMD. Our aim was to determine the association between PA and BMD, with consideration of BMI as a potential mediating factor.

Evaluating a complex intervention with a single outcome may not be a good idea: an example from a randomised trial of stroke case management.

Objectives: to estimate the extent to which a case-management intervention for persons newly discharged into the community following an acute stroke effected a change in stroke outcome in comparison with usual care.

Design: a re-analysis of stratified, balanced, randomised clinical trial.

Setting: five university-affiliated acute-care hospitals in Montreal, Quebec, Canada.

Bridging health technology assessment (HTA) and efficient health care decision making with multicriteria decision analysis (MCDA): applying the EVIDEM framework to medicines appraisal.

Background: Health care decision making is complex and requires efficient and explicit processes to ensure transparency and consistency of factors considered.

Objectives: To pilot an adaptable decision-making framework incorporating multicriteria decision analysis (MCDA) in health technology assessment (HTA) with a pan-Canadian group of policy and clinical decision makers and researchers appraising 10 medicines covering 6 therapeutic areas.

Methods: An appraisal group was convened and participants were asked to express their individual perspectives, independently of the medicines, by assigning weights to each criterion of the MCDA core model: disease severity, size of population, current practice and unmet needs, intervention outcomes (efficacy, safety, patient reported), type of health benefit, economics, and quality of evidence.

Treatment of multiple sclerosis with anti-CD20 antibodies.

The recently successful targeting of B cells in patients with multiple sclerosis (MS) using monoclonal antibodies (mAbs) targeting CD20 has established that it is no longer a question of whether B cells contribute, but how they contribute, to MS disease activity. Here, the focus will be to review results that have emerged over the last few years from clinical trials of different anti-CD20 mAbs in patients with MS. We will also consider the biological basis underlying the apparent therapeutic efficacy of B cell depletion in MS.

Allergen-induced asthma in C57Bl/6 mice: hyper-responsiveness, inflammation and remodelling.

The relationship among airway responsiveness, inflammation and remodelling in asthma is incompletely understood. To investigate potential mechanistic associations, allergen-induced asthma was studied in C57Bl/6 mice. Mice were sensitized and challenged with ovalbumin (OVA) using sub-acute (SA) or chronic (C) protocols.

Case management poststroke did not induce response shift: the value of residuals.

Objectives: To estimate the extent to which different methods of assessing response shift lead to different conclusions about its presence.

Study Design And Setting: A reanalysis of a randomized clinical trial involving 190 persons poststroke to evaluate the effectiveness of a case management intervention aimed at assisting persons with stroke to make the transition from acute care to home.

Results: Response shift was found to be nondifferential across groups and was therefore ruled out as an explanation for why the case management intervention showed no impact on patients' perceptions of their health.

Control of superoxide and nitric oxide formation during human sperm capacitation.

We studied the modulation of superoxide anion (O(2).(-)) and nitric oxide (NO.) generation during human sperm capacitation (changes needed for the acquisition of fertility).

Mechanical strain increases cytokine and chemokine production in bronchial fibroblasts from asthmatic patients.

Background: Mechanical strain and cytokine stimulation are two important mechanisms leading to airway remodeling in asthma. The effect of mechanical strain on cytokine secretion in airway fibroblasts is not known. The aim of this study was to determine whether bronchial and nasal fibroblasts differentially alter cytokine secretion in response to mechanical strain.

Reactive oxygen-induced reactive oxygen formation during human sperm capacitation.

Physiological processes are often activated by reactive oxygen species (ROS), such as the superoxide anion (O(2)(*)(-)) and nitric oxide (NO*) produced by cells. We studied the interactions between NO* and O(2)(*)(-), and their generators (NO* synthase, NOS, and a still elusive oxidase), in human spermatozoa during capacitation (transformations needed for acquisition of fertility). Albumin, fetal cord serum ultrafiltrate, and L-arginine triggered capacitation and ROS generation (NO* and O(2)(*)(-)) and superoxide dismutase (SOD) and NOS inhibitors prevented all these effects.

Th-17 cell-related cytokines' potential role in the pathogenesis of severe asthma.

Severe asthma represents a distinct, poorly-understood phenotype of asthma that has higher morbidity, mortality and a disproportionate need for health care support. Studies have indicated the presence of a specific inflammatory response in severe asthmatics, including the paucity of expression of classical Th-2 type cytokines. Following antigenic stimulation, naive CD4+ T cells proliferate and differentiate into various effector subsets such as Th-1 and Th-2 cells.

Bridging the gap: the effectiveness of teaming a stroke coordinator with patient's personal physician on the outcome of stroke.

Objectives: to test the hypothesis as to whether persons newly discharged into the community following an acute stroke and assigned a stroke case manager would experience, compared to usual post-hospital care, better health-related quality of life (HRQL), fewer emergency room visits and less non-elective hospitalisations.

Design: a stratified, balanced, evaluator-blinded, randomised clinical trial.

Setting: five university-affiliated acute-care hospitals in Montreal, Quebec, Canada.

Localized retinal ischemia as an ocular manifestation of primary antiphospholipid syndrome.

Case Report: Herein, a case of an unusual ocular presentation of primary antiphospholipid syndrome. The patient disclosed localized retinal ischemia due to branch retinal artery occlusion, confirmed by fluorescein angiography and manual perimetry.

Comments: The ocular manifestation led to the diagnosis and successful treatment of the systemic disease.

Differences in proteoglycan deposition in the airways of moderate and severe asthmatics.

Excess deposition of proteoglycans (PGs) has been described in the subepithelial layer of the asthmatic airway wall. However, less is known about deposition in the airway smooth muscle (ASM) layer, and whether the pattern of deposition is altered depending upon disease severity. Endobronchial biopsies were performed in patients with severe or moderate asthma (defined using American Thoracic Society criteria) and in control subjects.

Association between antiphospholipid antibodies and recurrent fetal loss in women without autoimmune disease: a metaanalysis.

Objective: To assess the strength of association between recurrent fetal loss (RFL) and presence of antiphospholipid antibodies (aPL) in women without autoimmune disease, and to examine whether magnitude of association varies according to type or titer of antibody and timing of fetal loss.

Methods: We searched Medline and Current Contents for articles published between 1975 and 2003 with terms denoting early (less than 13 weeks) and late (less than 24 weeks) RFL associated with various aPL. Published case-control, cohort, and cross-sectional studies rated moderate or strong were included in our metaanalysis.

Asbestos, smoking, and lung cancer: interaction and attribution.

Commentary on the paper by Reid (see page 509)

Differences in MAP kinase phosphorylation in response to mechanical strain in asthmatic fibroblasts.

Background: Mechanical strain alters protein expression. It results in phosphorylation of MAP kinases and up-regulation of extracellular matrix proteins. We investigated whether phosphorylation of MAP kinase family members was increased in response to mechanical strain in fibroblasts from asthmatic patients (AF) and normal controls (NF), and whether phosphorylation of these signaling molecules would be different in the two cell populations.