Impact of telephone counseling on the quality of life of patients discharged after coronary artery bypass grafts

BackgroundThis study aimed to assess the impact of telephone counseling on quality of life in patients with coronary artery bypass graft.MethodsA quasi-experimental study was conducted with 71 discharged patients after coronary artery bypass graft surgery at Ekbatan Edcuational hospital in Hamadan, Iran, in 2014. The patients were randomly allocated into intervention (n = 36) and control group (n = 35). The intervention group received education and counseling about therapeutic plan via telephone after discharge. Patients in the control group received only routines. All patients completed the quality of life questionnaire before and after the intervention period of five weeks.ResultsThere was no significant difference between intervention and control group about quality of life before intervention (p = 0.696). However, there was significant and positive deference between the two groups in favor of the telephone counseling after the intervention (P = 0.01) and control group (P = 0.04). Quality of life in the intervention group was significantly better compared to control group (P = 0.01).ConclusionsTelephone counseling could be a cost-effective patient counseling plan for therapeutic adherence after coronary artery bypass surgery in order to improve the patients’ quality of life.Practice implicationsTelephone counseling is feasible to implement and well accepted for patient counseling for many diseases.     

Short-term response of metabolic hormones to coronary artery bypass surgery

PurposeTo explore the response pattern of plasma adipokine and ghrelin levels to coronary artery bypass graft (CABG) surgery in patients with (on-pump) and without (off-pump) cardiopulmonary bypass (CPB).Material/methodsSixteen consecutive patients (age: 62 ± 10 years, male: 10) with obstructive coronary artery disease (CAD) who underwent elective CABG surgery with CPB and intraoperative GIK infusion were selected for on-pump group and 19 CAD patients (age: 63 ± 10 years, male: 16) were included in the off-pump group. Blood samples were taken before, during and after surgery. Intraoperative samples were withdrawn simultaneously for peripheral vein and sinus coronarius (SC). Plasma adipokine concentrations were measured by ELISA, those of ghrelin by RIA kits.ResultsIn response to surgical intervention there was an early, transient fall in plasma levels of adiponectin (p < 0.0001) and resistin (p = 0.002) followed by an increase to approach their initial values. Plasma ghrelin also increased (p = 0.045), this increase, however, was confined to the period of GIK supported CPB. Plasma insulin (p = 0.003) and resistin (p = 0.009) was significantly higher in the peripheral vein than in SC. The perioperative hormone profile of patients without CPB (off-pump) proved to be comparable to that of on-pump patients in spite of the insulin administration and greater oxidative and inflammatory stress.ConclusionsAdipose tissue-derived factors appear to mediate the metabolic and vascular changes that occur in patients with CABG surgery. Epicardial adipose tissue is unlikely to have major contribution to the development of CAD as adipokines are not elevated in SC independent of the mode of intervention.     

Comparison of graft healing in anterior cruciate ligament reconstruction with and without a preserved remnant in rabbits

BackgroundThe remnant of the native anterior cruciate ligament (ACL) might contribute to the biological integration of the graft in ACL reconstruction. The aim of this study was to explore whether the preserved remnant enhanced graft healing in ACL reconstruction.MethodsForty New Zealand rabbits underwent bilateral anterior cruciate ligament reconstructions. One knee was treated with a 2-mm remnant preserved on the tibial side (remnant-preservation, RP group) while the contralateral knee underwent a complete removal of the remnants by cauterization (remnant-resection, RR group) in each animal. Gross observations combined with microangiography, histological evaluation, and uniaxial load testing were performed after 4, 8, and 12 weeks.ResultsThe vascular density on the graft surface was statistically higher in the RP group as compared to that of the RR group at 4 (P = 0.002) and 8 weeks (P = 0.020). Additionally, the accelerated intra-articular and intra-tunnel graft integration were histologically observed in the RP group. Histological scores in the RP group were statistically higher than the RR group at 4 weeks (P = 0.028 for the intra-articular healing and P = 0.046 for the intra-tunnel healing) and 8 weeks (P = 0.031 for the intra-articular healing and P = 0.014 for the intra-tunnel healing). The ultimate failure load (P = 0.017), yield load (P = 0.025), and stiffness (P = 0.004) were statistically higher in the RP group as compared to those of the RR group, with corresponding significant differences in the failure mode (P = 0.020) between the two groups at 8 weeks.ConclusionsThe preserved remnant enhanced ACL graft healing with improved biomechanical properties in the rabbit model.Level of evidenceLevel II.     

Randomized study of the effect of video education on heart failure healthcare utilization,symptoms, and self-care behaviors

ObjectiveAdherence to self-care behaviors improves heart failure (HF) morbidity and life quality. We examined short-term impact of video education (VE) in addition to standard education (SE) on HF healthcare utilization and self-care behavior adherence.MethodsOne hundred and twelve hospitalized patients were randomly assigned to SE (n = 53) or SE plus VE (n = 59). Differences between groups were analyzed in patients who underwent 3-month follow-up (39 SE and 37 VE patients). Mean age was 60 ± 14 years; mean HF length was 57 months.ResultsThree-month healthcare utilization was similar between groups but VE patients needed less extra diuretic dosing (P < 0.02), received more HF literature (P < 0.03), and had less healthcare team telephone communication (P < 0.04). VE patients had greater sign/symptom reduction (P < 0.04); especially related to edema (P < 0.01) and fatigue (P < 0.01) and initiated more actions for edema (P < 0.05) and dyspnea (with exercise or rest, both P < 0.01). Overall, VE patients had a higher mean self-care behavior score (P < 0.01), reflecting greater self-care adherence.ConclusionVideo education prompts self-care behavior adherence to control worsening signs/symptoms of volume overload. During 3-month follow-up, utilization of most healthcare resources was unchanged.Practice implicationsVE is a useful adjunct to in-person education.     

Early postoperative bleeding after isolated coronary bypasses: Changes over a period of 20 years – An observational study

ObjectivesThe objectives were to analyze the evolution of the postoperative bleeding after coronary artery bypass grafting and to determine which factors impacted on this evolution.MethodsThis is a single-center retrospective study including 4590 patients undergoing coronary bypass surgery between 1995 and 2017. The study period was divided into 3 same-sized periods. We analyzed the evolution of the bleeding according to: the chest volume bleeding over the first 24 hours, the severity and the rate of transfusion during the hospital stay. Intrahospital outcomes were compared between “minor” and “major” bleedings. The risk factors of major bleeding were analyzed by multiple logistic regression.ResultsThe chest volume decreased particularly during the first years of the study period. Major bleedings decreased over the periods (7.3%, 4.9% and 3.8% respectively, P < 0.0001), as did the rate of transfusion (26.4%, 23.5% and 19.6% respectively, P < 0.0001). Major bleedings were correlated with hospital mortality (8.2% versus 1.1%, P < 0.0001). The risk factors of major bleeding were the period 1 (1995 to 2003), a renal failure, a resternotomy, the EuroSCORE, the hematocrit prior to cardiopulmonary bypass and the duration of cardiopulmonary bypass.ConclusionsPostoperative bleeding decreased mainly in the 1990s. Progressive changes in bleeding prevention and blood recovery, surgical techniques, haemoglobin threshold for transfusion decision and practitioners’ experience have contributed to these results and must be continued to optimize the postoperative outcomes.     

Comparison the effect of lateral wedge insole and acupuncture in medial compartment knee osteoarthritis: A randomized controlled trial

BackgroundThere is lack of well-designed trials evaluating structural benefits of non-pharmacologic therapies in knee osteoarthritis (OA). In this parallel-group randomized controlled trial, we aim to compare the possible advantages of lateral wedge insole and acupuncture in patients with medial knee OA.MethodPatients with grade two or three of medial knee OA were randomly allocated to group one who received an in shoe lateral wedge and group two who underwent acupuncture. We assessed patients' pain, function and knee joint cartilage thickness before and after intervention. Paired t-test and independent samples t-test were used for in group and between group analyses. (Level of evidence: 2.)ResultsTwenty patients in each group were recruited in the study. Pain significantly decreased after therapy in both groups one and two (paired t test, P < 0.001, 95% CI: 1.62–3.25 and 1.58–3.20 respectively). Function improved in each group (paired t test, P = 0.001, 95% CI of 0.94–2.38 in group one and 0.97–2.43 in group two). A non-clinically statistically significant difference regarding the femoral and tibial cartilage thickness was obtained in both groups one (P = 0.005, CI: − 0.43–0.82 and P = 0.037, CI: − 0.44–0.80 respectively) and two (P = 0.025, CI: − 0.45–0.79 and P = 0.035, CI: − 0.29–0.96 respectively). Between groups analysis showed no significant difference regarding abovementioned measures.ConclusionBoth lateral wedge insole and acupuncture can be effective in the treatment of medial knee osteoarthritis without any superiority of one over the other.Iranian Registry of Clinical Trials: IRCT201201108235N1.URL: http://irct.ir/searchen.php     

Effects of couple based coping intervention on self-efficacy and quality of life in patients with resected lung cancer

ObjectiveWe aimed to assess the couple based coping intervention (CBCI) for self-efficacy and quality of life in patients with resected lung cancer, compared with individual coping intervention (ICI).MethodsFrom October to December 2015, 132 consecutive patients with resected lung cancer who were married/lived in a stable relationship were randomly assigned to the ICI group and the CBCI group.ResultsThe CBCI group had higher GSES compared with the ICI group at 2 month after operation, and at 6 month after operation (P < 0.05). The CBCI group had higher VT, SF, RE, and MH score of SF-36 compared with the ICI group at 2 month after operation, and at 6 month after operation (P < 0.05), but no significant differences were found in RP, PF, BP, and GH score of SF-36 compared between two groups (P > 0.05) in these 2 time points.ConclusionCouple based coping intervention is more effective than individual coping intervention for improving the self-efficacy and the quality of life in patients with resected lung cancer.Practice implicationsPractitioners might like to consider using couple based coping intervention strategy to improve self-efficacy and quality of life in patients with resected lung cancer.     

Efficacy and cost-effectiveness of a clinic-based counseling intervention tested in an ethnically diverse sample of pregnant smokers

ObjectiveRates of cigarette smoking are higher among women who receive obstetric care through publicly funded prenatal clinics. This study compared smoking outcomes for pregnant women (n = 105) who were randomized to receive either usual care (standard cessation advice from the health care provider) or an intervention conducted in the prenatal clinic consisting of 1.5 h of counseling plus telephone follow-up delivered by a masters prepared mental health counselor.MethodsSubjects were 105 low income, predominantly Hispanic, pregnant patients in an urban prenatal clinic. Smoking outcomes were assessed at end of pregnancy and 6 months post-partum.ResultsAt follow-up, 28.3% and 9.4% of participants in the experimental intervention and 9.6% and 3.8% of patients in usual care were abstinent at end of pregnancy (p = .015) and 6 months post-partum, respectively (p = .251). Cost of the intervention was $56 per patient and cost to produce a non-smoker at end of pregnancy was $299.ConclusionsThis model for intervention was cost-effective and was associated with significantly lower smoking rates at end of pregnancy.Practical implicationsIf these findings are replicated, prenatal clinics could offer the option for intensive smoking cessation treatment by training mental health counselors to deliver one extended smoking cessation counseling session.     

Effects of supervised whole body vibration exercise on fall risk factors,functional dependence and health-related quality of life in nursing home residents aged 80+

ObjectiveTo test the feasibility and effectiveness of whole-body vibration (WBV) therapy on fall risk, functional dependence and health-related quality of life in nursing home residents aged 80+ years.DesignTwenty-nine 80–95 years old volunteers, nursing home residents were randomized to an eight-week WBV intervention group) (n = 15) or control group (n = 14). Functional mobility was assessed using the timed up and go (TUG) test. Lower limb performance was evaluated using the 30-s Chair Sit to Stand (30-s CSTS) test. Postural stability was measured using a force platform. The Barthel Index was used to assess functional dependence and the EuroQol (EQ-5D) was used to evaluate Health-Related Quality of Life. All outcome measures were assessed at baseline and at a follow-up after 8 weeks.ResultsAt the 8-week follow up, TUG test (p < 0.001), 30-s CSTS number of times (p = 0.006), EQ-5Dmobility (p < 0.001), EQ-5DVAS (p < 0.014), EQ-5Dutility (p < 0.001) and Barthel index (p = 0.003) improved in the WBV intervention group when compared to the control group.ConclusionsAn 8-week WBV-based intervention in a nursing home setting is effective in reducing fall risk factors and quality of life in nursing home residents aged 80+.     

Effects of ABO incompatibility in allogeneic hematopoietic stem cell transplantation

IntroductionThe impact of ABO mismatch on outcomes following allo-HSCT remains controversial. In this study, our aim is to define the effect of ABO mismatch on post-transplant outcomes, engraftment kinetics and complications in a large cohort.Patients and methodsWe retrospectively identified 1000 patients who underwent allo-HSCT from either bone marrow or peripheral blood stem cells at our center between 1988 and 2016. P < 0.05 was considered statistically significant.ResultsFive hundred and ninety (59%) patient-donor pairs were ABO matched, 164 (16.4%) were ABO major mismatched (MM), 191 (19.1%) were ABO minor MM, and 55 (5.5%) were ABO bi-directionally MM. ABO matched pairs were more common in transplants from related donors (P < 0.001) and using bone marrow as a stem cell source (P < 0.001). In minor ABO MM transplantations, mild delayed hemolytic reaction occurred more frequently compared to major and bidirectional ABO MM transplantations (47% vs 35% and 18%, P < 0.001). Neutrophil engraftment was slightly delayed in ABO MM patient-donor pairs when compared ABO matched donor pairs according to median engraftment time in all group (167/410, 41% vs 204/590, 35%, P = 0.046). Pure red cell aplasia was diagnosed in 6 patients (1%). Higher risk of death was shown in ABO MM transplants compared to ABO matched transplants in overall survival (OS) analysis (HR:1.201, 95% CI:1.004–1.437, P = 0.045). The non-relapse mortality (P = 0.546) and cumulative incidences of acute graft versus host disease (aGVHD) and chronic (c) GVHD were comparable between ABO MM and ABO matched patient-donor pairs (for aGVHD, P = 0.235; for cGVHD, P = 0.137).ConclusionABO MM transplants were associated with decreased OS and slightly delayed neutrophil engraftment. NRM and the risk of GVHD were not related to ABO incompatibility.     

Impact of diabetes on mortality and complications after coronary artery by-pass graft operation in patients with left main coronary artery disease

PurposeLeft main disease (LMD) is a severe form of coronary artery disease (CAD). Fifty percent of patients with LMD treated conservatively die within 3–5 years of diagnosis. The aim of the study was to assess the influence of type 2 diabetes on early and late (2-year) prognosis and the risk of complications after coronary artery by-pass graft (CABG) surgery in patients with LMD.Material/methodsWe enrolled 257 patients diagnosed with LMD. 169 (67%) underwent CABG, 19 (8%) percutaneous coronary intervention (PCI) without left main stem protection. 30 (12%) patients had CABG previously. Patients treated with CABG were divided into two groups – with and without diabetes. There were 43 (25.4%) patients with diabetes and 126 (74.6%) without diabetes.ResultsWe observed more complications with wound healing (40.5% vs. 12.8%, p < 0.001) and sternal dehiscence (23.8% vs. 4.0%, p < 0.001) after CABG in patients with diabetes. There were no differences in 7-day, 30-day, 3-month and 1-year mortality. 2-Year mortality was also similar in both groups (11.6% vs. 11.1%, p = 0.928). Patients with diabetes were more frequently hospitalized due to other reasons than angina (39.5% vs. 20.6%, p = 0.014).ConclusionsPatients with diabetes and LMD had more often complications with wound healing and sternal dehiscence after CABG than patients without diabetes. Type 2 diabetes did not influence early and late mortality in patients with LMD treated with cardiac surgery, but the presence of diabetes was associated with more frequent hospitalizations.     

Computer navigation is a useful intra-operative tool for joint line measurement in total knee arthroplasty

BackgroundRestoration of the native joint line in total knee arthroplasty is important in restoring ligamentous balance and normal knee kinematics. Failure to achieve this could lead suboptimal outcomes. The purpose of this study was to analyze the clinical and functional outcome of patients who demonstrated joint line changes after computer-assisted (CAS) total knee arthroplasty (TKA).MethodsOne hundred sixty-eight patients (168 knees) underwent CAS TKA by two surgeons at a single institution with 2 years follow-up. The final change in joint line was calculated from the verified tibial resection and distal femoral cuts. Group A patients had joint line changes of less than 4 mm and Group B patients had joint line changes of more than 4 mm. Post-operative Oxford scores, Knee scores, Function scores and SF-36 scores were obtained at 6 months and 2 years post TKA.ResultsThere was significant linear correlation between joint line changes and Oxford scores (P = 0.0001), Function scores (P = 0.0001) and Knee scores (P = 0.0001) at 6 months and Oxford scores (P = 0.0001) alone at 2 years with increasing joint line changes having poorer outcome scores. Group A compared to Group B patients demonstrated better Oxford scores (P = 0.0001), Function scores (P = 0.0001), Knee scores (P = 0.0001) and total SF-36 scores (P = 0.003) at 6 months as well as better Oxford scores (P = 0.0001) and Knee scores (P = 0.014) at 2 years.ConclusionsCAS is a useful intra-operative tool for assessing the final joint line in TKA. Outliers in joint line changes of ≥ 4 mm are associated with poorer clinical outcome scores.Level of evidence: Prognostic Study, Level II-1.     

Mortality and risk factor analysis for Candida blood stream infection: A three-year retrospective study

BackgroundThe aim of this study was to evaluate the possible risk factors for mortality in adult patients with candidemia by investigating the causative agents, underlying conditions and predisposing factors.Material and methodsThe data including causative Candida species, predisposing factors, and underlying conditions of candidemia patients between the years 2015–2017 were collected and the impact of these factors on mortality was evaluated. Patients were divided into two groups as died (died patients within 30 days of the onset of candidemia) and survived and risk factors were evaluated for each group.ResultsWe found 163 adult candidemia cases during the study period. Overall 30-day mortality was 40.5%. Candida parapsilosis was the most frequent causative agent (49.1%). C. parapsilosis candidemia was more common in the survived group compared with the died group (n: 49 (61.3%) vs. n: 31 (38.8%), P = 0.888). Mortality rates were significantly higher in patients with dialysis (n: 27 (69.2%) vs. n: 12 (30.8%), P < 0.00) and concurrent bacteremia (n: 20 (57.1%) vs. n: 15 (42.9%), P = 0.024). Survival rates were significantly higher in patients with follow-up blood cultures (n: 75 (65.8%) vs. n: 39 (34.2%), P = 0.013). The most important source of candidemia was catheter (49.7%), and C. parapsilosis was the most common causative agent (58%). The catheter was removed in 96.3% of these patients and the mortality rate was 38.5%. All of the patients received antifungal therapy and there was no significant difference between the effects of antifungals on mortality (n: 65 (39.9%) vs. 98 (60.1%), P = 0.607).ConclusionsDialysis and concurrent bacteremia are strong predictors of mortality in 30 days within patients with candidemia, whereas follow-up blood cultures have a protective role with lower mortality rates. In our study, the most important source of candidemia was catheter, and C. parapsilosis was the most common causative agent. The catheter was removed in almost all patients and the mortality rate was almost one third among these patients.     

One-year outcome of an interactive internet-based physical activity intervention among university students

ObjectiveThe purpose of the present study was to evaluate whether improvement in physical activity of students following a 4-month intervention of a university course was maintained 8 months later.MethodsData on 77 students who responded to our scheduled inquiries completely through 1 year were analyzed. Participants of the intervention group (n = 49) using the internet-based physical activity program exhibited significant increases in energy expenditures measured by IPAQ compared with the no-treatment control group (n = 28) through 1 year.ResultsParticipants who did not engage in regular university sports activities (baseline: 450 ± 351 kcal day⁻¹; post: 587 ± 320 kcal day⁻¹; 8-month follow-up: 580 ± 394 kcal day⁻¹) only exhibited significant increases in energy expenditures compared with those of the control group (baseline: 498 ± 341 kcal day⁻¹; post: 414 ± 242 kcal day⁻¹; 8-month follow-up: 347 ± 275 kcal day⁻¹).ConclusionThese results suggested that an internet-based interactive intervention could become a helpful tool in promoting and maintaining physical activity in the long term.     

An asthma management system in a pediatric emergency department

IntroductionPediatric asthma exacerbations account for >1.8 million emergency department (ED) visits annually. Asthma guidelines are intended to guide time-dependent treatment decisions that improve clinical outcomes; however, guideline adherence is inadequate. We examined whether an automatic disease detection system increases clinicians’ use of paper-based guidelines and decreases time to a disposition decision.MethodsWe evaluated a computerized asthma detection system that triggered NHLBI-adopted, evidence-based practice to improve care in an urban, tertiary care pediatric ED in a 3-month (7/09–9/09) prospective, randomized controlled trial. A probabilistic system screened all ED patients for acute asthma. For intervention patients, the system generated the asthma protocol at triage for intervention patients to guide early treatment initiation, while clinicians followed standard processes for control patients. The primary outcome measures included time to patient disposition.ResultsThe system identified 1100 patients with asthma exacerbations, of which 704 had a final asthma diagnosis determined by a physician-established reference standard. The positive predictive value for the probabilistic system was 65%. The median time to disposition decision did not differ among the intervention (289 min; IQR = (184, 375)) and control group (288 min; IQR = (185, 375)) (p = 0.21). The hospital admission rate was unchanged between intervention (37%) and control groups (35%) (p = 0.545). ED length of stay did not differ among the intervention (331 min; IQR = (226, 581)) and control group (331 min; IQR = (222, 516)) (p = 0.568).ConclusionDespite a high level of support from the ED leadership and staff, a focused education effort, and implementation of an automated disease detection, the use of the paper-based asthma protocol remained low and time to patient disposition did not change.     

Effect of Foeniculum vulgare (fennel) vaginal cream on vaginal atrophy in postmenopausal women: A double-blind randomized placebo-controlled trial

ObjectiveVaginal atrophy is one of the main concerns of postmenopausal women. The aim of the present study was to investigate the effect of fennel vaginal cream on vaginal atrophy in postmenopausal women in Ahvaz, Iran.Materials and methodsThis double-blind randomized controlled trial was conducted on 60 postmenopausal women (45–65 years of age) in Ahvaz, Iran. The study participants were randomly divided into one of two groups, receiving either a placebo (n = 30) or fennel 5% vaginal cream (n = 30) administered as one application per day (5 g/day) for 8 weeks.Main outcomeThe vaginal pH and maturation vaginal index (MVI) were measured at baseline and 8 weeks after the intervention, while the vaginal atrophy symptoms was measured at baseline and at 2, 4, and 8 weeks after the intervention. The data were analyzed using the independent t-test, chi-square test, paired sample t-test, and the generalized estimating equation.ResultsThe number of superficial cells increased significantly in the fennel group after 8 weeks compared to the control group (76.1 ± 15.3 vs. 11.8 ± 8, p < 0.001). The number of intermediate and parabasal cells decreased significantly in the fennel group compared to the control group (p < 0.001). The vaginal pH decreased significantly at the 8-week follow-up in the fennel group compared to the control group (100% vs. 7.4%, p < 0.001). All women in the fennel group had an MVI of 65–100 at the 8-week follow-up, whereas almost half (40.7%) of the women in the control group had an MVI of 50–64 (p < 0.001).ConclusionAccording to results of this study, fennel is an effective means to manage the symptoms of vaginal atrophy in postmenopausal women and is devoid of side effects. Larger studies are necessary to confirm the positive impact of fennel for vaginal conditions occurring among postmenopausal women.     

Evaluation of a standardized patient education program for inpatient asthma rehabilitation: Impact on patient-reported health outcomes up to one year

ObjectivesTo modify and evaluate a patient education program for adult asthma patients in consideration of quality criteria for teaching.MethodsThis was a prospective single-center controlled trial in an inpatient rehabilitation center. The control group (n = 215) received the usual lecture-based education program, and the intervention group (n = 209) the modified patient education program. Data were assessed at admission, discharge, 6 and 12 months post discharge. The primary outcome was asthma control, the secondary outcomes were asthma knowledge, quality of life, and program acceptance. Analysis of change was performed by ANCOVA for each follow-up, adjusting for baseline values.ResultsStatistically significant increases in all health outcomes and in asthma control were maintained in both groups at 12 months: CG: +1.9 (95%-CI 1.3–2.6) IG: +1.6 (95%-CI 0.8–2.3). We observed no significant differences between the programs for asthma control and quality of life. Regarding practical asthma knowledge, after 12 months, a group*time interaction emerged with a small effect size (P = 0.06, η2 = 0.01).ConclusionThe modified program was not superior to traditional patient education concerning asthma control. It permanently increased self-management knowledge.Practical implicationsStructured and behavioral patient education fosters patient’s disease management ability. Possible ways of improving asthma control need to be explored.     

The prevalence of human endogenous retroviruses in cerebrospinal fluids from patients with sporadic Creutzfeldt–Jakob disease

BackgroundAbout 8% of human genome is constituted by retroviral sequences. Some of these have been classified as human endogenous retroviruses (HERVs), which have been implicated in both health and disease. Recently, indirect evidence for a possible role of retroviral elements in neurological diseases has been provided by several studies.ObjectivesIn the present study, we aimed to evaluate the relationship between HERVs and sporadic Creutzfeldt–Jakob disease (CJD), one of the human forms of prion diseases.Study designWe investigated the prevalence of HERV families by RT-PCR in cell-free cerebrospinal fluids (CSFs) samples from normal controls, patients with sporadic CJD and other neurological diseases (OND).ResultsThe incidence rate of some HERV families were significantly different in CSF samples from the group of sporadic CJD compared to samples from normal individuals; HERV-W (P = 0.001), T (P = 0.039), FRD (P < 0.001), L (P = 0.003) and ERV-9 (P < 0.001) and the incidence rate of HERV-W (P = 0.021) and HERV-L (P = 0.049) were significantly increased in CSF samples from the group of sporadic CJD compared to samples from OND group. Moreover, our results from combining frequencies of two HERV families indicated that the prevalence of many combination groups was significantly different between sporadic CJD and normal CSF samples and between two patients’ CSF samples. In addition, a large number of HERV sequences were newly identified in CSFs from normal and diseased individuals.ConclusionsOur study about distinct prevalence patterns of HERVs reflects that some HERVs families may be associated with the development of prion diseases, and considered as a candidate marker for the diagnosis of sporadic CJD.     

Tumor necrosis factor-alpha single nucleotide polymorphisms in juvenile systemic lupus erythematosus

BackgroundJuvenile systemic lupus erythematosus (JSLE) is a multi-system autoimmune disorder of unknown origin. Given the importance of the contribution of pro-inflammatory cytokines, including tumor necrosis factor-alpha (TNF-α), towards the pathogenesis of JSLE, this study was performed to assess TNFA gene polymorphisms in a case-control study.MethodsFifty nine patients with JSLE were enrolled in this study as case group and compared with healthy control subjects. The frequency of alleles, genotypes, and haplotypes of TNFA single-nucleotide polymorphisms (SNPs) at positions −308 and −238 were evaluated, using polymerase chain reaction with sequence-specific primers method.ResultsThe G allele at position −238 in TNFA promoter region was significantly more frequent in patients with JSLE than in the healthy controls (P value < 0.001), while the frequency of A allele at the same position was significantly lower than controls. Furthermore, a significant positive association for G/G genotype at the same position was detected in patients’ group compared with control subjects (P value < 0.001). The GA haplotype of TNFA (positions −308, −238) was significantly less frequent in case group than in controls (P value < 0.001), while GG was the most frequent haplotype for TNFA in the patient group, compared to controls (P value < 0.01).ConclusionsPro-inflammatory cytokine gene polymorphisms may influence susceptibility to JSLE. Particular TNFA gene variants are associated with JSLE and could be used as a genetic marker for susceptibility to JSLE.     

Biomechanics of single-tunnel double-bundle anterior cruciate ligament reconstruction using fixation with a unique expandable interference screw

BackgroundSingle-tunnel double-bundle (STDB) anterior cruciate ligament (ACL) reconstruction can restore biomechanical function and anatomic structure, but existing methods of graft fixation are not adequate. The aims of this study are to examine knee biomechanics after STDB reconstruction using a unique expandable interference screw for fixation.MethodsThe biomechanical parameters of six pairs of human cadaveric knee specimens were measured with the ACL intact, after ACL removal, and after STDB reconstruction using the interference screw or single-tunnel single-bundle (STSB) reconstruction. Anterior tibial translation under 134 N anterior tibial load in a neutral position as well as in 15° and 30° internal and external knee rotation and the internal tibial rotation angle under the rotatory load (5 N · m internal tibial rotation) were measured.ResultsAnterior tibial translations at each degree of knee flexion in the STDB group were significantly less than in the STSB group (all, P < 0.05). The internal rotation angles in the STSB group at five flexion angles were significantly higher than in the ACL intact group, whereas there were significantly less than those of the ACL absent group (P < 0.05). Under rotatory loads in the neutral position, the tibial internal rotation angles of the STDB group were significantly lower than in the STSB group at all flexion angles (all, P < 0.05).ConclusionsSTDB ACL reconstruction with the expandable interference screw provides better anteroposterior and rotational stability than STSB reconstruction.Clinical relevanceThe technique provides the advantages of double-bundle reconstruction using a single-tunnel technique.