Predictive factors for successful sacral nerve stimulation in the treatment of faecal incontinence: results of trial stimulation in 200 patients

Aim Sacral nerve stimulation (SNS) has a place in the treatment algorithm for faecal incontinence (FI). However, after implantation, 15–30% of patients with FI fail to respond for unknown reasons. We investigated the effect of SNS on continence and quality of life (QOL) and tried to identify specific predictive factors of the success of permanent SNS in the treatment of FI. Method Two hundred consecutive patients (six men; median age = 60; range 16–81) underwent permanent implantation for FI. The severity of FI was evaluated by the Cleveland Clinic Score. Quality of life was evaluated by the French version of the American Society of Colon and Rectal Surgeons (ASCRS) quality of life questionnaire (FIQL). All patients underwent a preoperative evaluation. After permanent implantation, severity and QOL scores were reevaluated after six and 12 months and then once a year. Results The severity scores were significantly reduced during SNS (P = 0.001). QOL improved in all domains. At the 6‐month follow‐up, the clinical outcome of the permanent implant was not affected by age, gender, duration of symptoms, QOL, main causes of FI, anorectal manometry or endoanal ultrasound results. Only loose stool consistency (P = 0.01), persistent FI even though diarrhoea was controlled by medical treatment (P = 0.004), and low stimulation intensity (P = 0.02) were associated with improved short‐term outcomes. Multivariate analysis confirmed that loose stool consistency and low stimulation intensity were related to a favourable outcome. Conclusion Stool consistency and low stimulation intensity have been identified as predictive factors for the short‐term outcome of SNS.     

Relationship between human spermatozoa–hyaluronan‐binding assay,conventional semen parameters and fertilisation rates in intracytoplasmic spermatozoa injection

Selecting the best spermatozoa for intracytoplasmic spermatozoa injection (ICSI) has recently been a topic of great interest among embryologists. The study aimed to evaluate the relationship between the spermatozoa‐hyaluronan‐binding assay (HBA), routine semen analysis results and fertilisation rates as recorded during conventional ICSI therapy. Ninety‐one patients undergoing conventional ICSI treatment in the Medfem Fertility Clinic in Johannesburg (South Africa) were included in the study. A total of 797 oocytes were injected of which 457 oocytes fertilised (57.3%, range 0–100%). None of the semen parameters correlated with the fertilisation rates (Table 2). HBA scores, however, revealed a highly significant association (p ≤ 0.0001) with the fertilisation rates. The HBA scores also correlated significantly with the biochemical pregnancy values (Spearman r = 0.24, P = 0.02, 95% CI 0.039–0.43); however, the HBA scores did not correlate with the clinical pregnancy rates (Spearman r = 0.14, P = 0.16, 95% CI ?0.06 to 0.34). No correlation was recorded between HBA and the standard semen parameters. The study showed that HBA is significantly associated with fertilisation in conventional ICSI. The HBA scores were also significantly associated with the fertilisation rates and biochemical pregnancies.     

Enhanced glomerular expression of caldesmon in IgA nephropathy and its suppression by glucocorticoid-heparin therapy

Background: Activation and consequent phenotypic modulation of mesangial cells is considered to play a crucial role in the process of glomerular disease progression. Caldesmon, a calmodulin and actin-binding protein, is a molecular marker of the phenotypic change in smooth muscle cells. Subjects and Methods: We studied whether the expression of caldesmon in mesangial cells was enhanced in the process of IgA nephropathy and whether it would be a marker of mesangial activation indicating prognostic significance in specific disease states. We performed immunohistochemical staining with anti-caldesmon and &agr;-smooth-muscle actin (&agr;-SMA) antibodies in 32 biopsy specimens from IgA nephropathy patients and analysed them quantitatively with a computer-aided manipulator. Results: The glomerular expression of caldesmon was enhanced in IgA nephropathy patients. We compared caldesmon expression with composite histological scores (cell score and matrix score), clinical parameters and expressions of &agr;-SMA. There was a statistically significant correlation between the caldesmon score and the histological scores (cell score and matrix score, P<0.001, P<0.01 respectively). Patients showing a high intensity of caldesmon expression (defined as caldesmon score ⩾35; H-group) had significantly higher urinary protein excretion than those showing a low intensity of caldesmon expression (defined as caldesmon score <35; L-group) 1.2±1.2 g/24 h vs 0.41±0.53 g/24 h, P<0.05). Caldesmon and &agr;-SMA expression had a statistically significant correlation (P<0.0001). Next, 13 patients were treated with glucocorticoid-heparin for 4-8 weeks and re-biopsies were performed. After the therapy, the caldesmon and &agr; SMA scores were significantly lower than those before the therapy (P<0.01). Discussion: These results suggest that the expression of caldesmon in glomeruli is associated with the progression of IgA nephropathy, and that glucocorticoid-heparin therapy may reverse the phenotype of mesangial cells during the disease process of glomerulonephritis.     

Previous vertebral compression fractures add to the deterioration of the disability and quality of life after an acute compression fracture

Prevalent vertebral compression fracture(s) have been reported as having a negative impact on pain, disability, and quality of life. But no study has evaluated the effect of previous fracture on the course of acute compression fractures. The aim of the present study was to compare the natural course of the acute compression fracture in patients with (n = 51) and without (n = 56) previous vertebral compression fracture(s). The study is a retrospective analysis of a prospective cohort followed with postal questionnaires during a 12-month period after an acute fracture event. Eligible patients were those over 40 years of age, who were admitted to the emergency unit because of back pain and had an X-ray confirmed acute vertebral body fracture. A total of 107 patients were included in the study. The pain, disability (von Korff pain and disability scores), ADL (Hannover ADL score), and quality of life (QoL) (EQ-5D) were measured after 3 weeks, and 3, 6, and 12 months. The X-rays from the first visit to the emergency unit were evaluated. The difference of the scores between the groups with and without previous fracture was statistically significant (P < 0.05) at 3 weeks, 6 and 12 months for von Korff disability score, at all occasions for EQ-5D and at 3–12 months for Hannover ADL score, but only at 12 months for the von Korff pain intensity score. In both the groups all scores had improved in a statistically significant way at 3 months. The number of previous fractures was related to all the outcome scores in a statistically significant way (P < 0.05) except von Korff pain intensity score at 3 weeks and 3 months and von Korff disability score at 3 months. In conclusion, disability, ADL, and QoL scores, but not pain intensity score, were significantly worse in the patients with previous fracture from the fracture episode through the first 12 months. However, the improvements during the follow-up year seen in both groups were of a similar magnitude. The presence or absence of a previous fracture in an acutely fractured patient will influence the prognosis and thus possibly also the indications for treatments.     

Psychotropic Drug Use in a Cohort of Workers 4 Years After an Industrial Disaster in France

Two years after the 2001 Toulouse industrial disaster, a longitudinal study was set up to evaluate the impact of the disaster. The current substudy examines the medium‐term impact (5 years) the incident had on the mental health of 3,004 participants. As part of the monitoring, data relating to the psychotropic drug use of 2,494 participants were collected from administrative databases 4 years after the disaster. Use of psychotropics was higher among women for anxiolytics (10.4% for men and 15.0% for women), hypnotics (10.5% and 17.0%), and antidepressants (7.6% and 11.2%). Exposure to the disaster, especially proximity to the exposure, was significantly associated with the use of antidepressants in men, OR = 3.22, 95% CI[1.57, 6.61]. This was also the case for other exposure factors (saw dead or injury, injured, home damage, death or injury loved one, psychological disorders, exposure toxic fumes): range of OR 1.75 to 2.52 in men, 1.48 to 1.62 in women. In conclusion, this study highlights the medium‐term psychological impact of an industrial disaster on psychotropic drug use and the potential for using medical records data as a means for tracking postdisaster mental health.     

No effect of perianal application of topical anaesthetic on patient comfort during nonsedated flexible sigmoidoscopy: a randomized, placebo-controlled clinical trial

Aim A literature review revealed no data on the effects of topical anaesthetic on patient comfort during flexible sigmoidoscopy. We therefore aimed to evaluate this in a randomized manner. Method One hundred and forty‐six patients who underwent flexible sigmoidoscopy were randomly allocated to one of three groups. Vaseline (n = 49), 2% lidocaine gel (n = 51) or a cream of 2.5% lidocaine plus 2.5% prilocaine (n = 46) were applied to the patients 30 min before the procedure. Demographic data and haemodynamic monitoring during procedures were recorded. Pain was assessed by visual analogue scale (VAS) and anxiety levels by the State‐Trait Anxiety Inventory (STAI‐I and STA‐II). Results Median pre‐procedural STAI‐I scores were 45, 46 and 40.5 and median post‐procedural STAI‐I scores were 35, 34 and 33.5 for the vaseline, lidocaine, and lidocaine/prilocaine treatments, respectively. There was no statistical difference among the groups in terms of STAI‐I and II scores. However, post‐procedural STAI‐I scores were significantly lower than pre‐procedural values in each group (P < 0.001). There was no significant difference in VAS scores among the groups. In all groups there were statistically higher VAS scores during the procedure compared with the pre‐ and post‐procedural scores (P < 0.001). Conclusion Perianal application of topical anaesthetic does not influence patient comfort during sigmoidoscopy.     

Alexithymia in Holocaust Survivors with and Without PTSD

Alexithymia was measured in non-treatment seeking, community-dwelling Holocaust survivors using the Toronto Alexithymia Scale—Twenty Item Version (TAS-20). Scores of survivors with (n = 30) and without (n = 26) posttraumatic stress disorder (PTSD) were compared, and associations among alexithymia, severity of trauma, and severity of PTSD symptoms were determined. Survivors with PTSD had significantly higher scores on the TAS-20 compared to survivors without PTSD. TAS-20 scores were significantly associated with severity of PTSD symptoms, but not with severity of trauma. This study adds to our knowledge of the relationship between alexithymia and trauma by demonstrating that this characteristic is related to the presence of posttraumatic symptoms and not simply exposure to trauma.     

Mental Health Following Separation in a Disaster: The Role of Attachment

Short‐term separation from close family members during a disaster is a highly salient event for those involved. Yet, its subsequent impact on mental health has received little empirical attention. One relevant factor may be attachment style, which influences patterns of support‐seeking under threatening conditions. Individuals (N = 914) affected by the 2009 Victorian bushfires in southeastern Australia were assessed for disaster experiences, depression, posttraumatic stress disorder (PTSD) symptoms, and attachment style 3–4 years after the fires. Using multigroup structural equation modelling, individuals who reported separation from close family members during the bushfires (n = 471) were compared to those who reported no separation (n = 443). Cross‐sectional results indicated that separated individuals had higher levels of PTSD symptoms. Furthermore, attachment anxiety was more strongly positively associated with depression among separated (b = 0.62) versus not separated individuals (b = 0.32). Unexpectedly, among separated individuals, attachment avoidance had a statistically weaker association with depression (b = 0.17 vs. b = 0.35) and with PTSD symptoms (b = 0.06 vs. b = 0.22). These results suggest that attachment anxiety amplifies a negative reaction to separation; meanwhile, for avoidant individuals, separation in times of danger may facilitate defensive cognitive processes.     

25-Hydroxyvitamin D, parathyroid hormone, and functional recovery after hip fracture in elderly patients

There is increasing interest in the effects of vitamin D and parathyroid hormone (PTH) on extraskeletal tissues, including the muscle. These effects may explain impairment in functional ability found in vitamin D-deficient subjects. Our aim was to investigate the roles of vitamin D and PTH in affecting the ability to perform activities of daily living after hip fracture. We studied 456 of 521 hip-fracture patients admitted consecutively to a rehabilitation hospital. Functional outcome was assessed after acute inpatient rehabilitation by using the Barthel index score. The functional scores were significantly correlated with serum levels of 25-hydroxyvitamin D (ρ = 0.190; P < 0.001) and PTH (ρ = −0.164; P < 0.001) and the 25-hydroxyvitamin D/PTH ratio (ρ = 0.261; P < 0.001). At multiple regression, 25-hydroxyvitamin D and PTH levels were independently associated with Barthel index scores. The correlation between the 25-hydroxyvitamin D/PTH ratio and Barthel index scores was significantly stronger than the one between 25-hydroxyvitamin D and Barthel index scores (difference between the two correlation coefficients = 0.071; 95% CI = 0.009–0.133; P = 0.011). The significant association between the 25-hydroxyvitamin D/PTH ratio and the Barthel index scores persisted after adjustment for 12 prognostic factors (P = 0.012). On the whole, the panel of prognostic factors we studied predicted 50.1% of the variance of the functional score. Data shows that PTH and 25-hydroxyvitamin D were significantly associated with the ability to function after hip fracture and suggest that the two hormones act through independent mechanisms. The 25-hydroxyvitamin D/PTH ratio significantly contributed to a predictive model of functional outcome.     

Posttraumatic Stress Disorder 23 Years After the 1988 Spitak Earthquake in Armenia

This population‐based longitudinal study examined the rates and predictors of posttraumatic stress disorder (PTSD) among 725 differentially exposed survivors of the 1988 Spitak earthquake in Armenia, 23 years after the event. Participants had been previously evaluated in 1991. Evaluations included assessment of current PTSD (based on DSM‐5 criteria), and a variety of potential risk and protective factors. For the whole sample, the rate of PTSD attributed to the earthquake decreased from 48.7% in 1991 to 11.6% in 2012 (p < .001). A “dose of exposure” pattern persisted, and 15.7% of participants who were in Spitak (high exposure) and 6.6% of participants who were in Kirovagan (low exposure) during the earthquake met the criteria for PTSD (p = .003). Additionally, in 2012, another 9.9% of participants met PTSD criteria due to post‐earthquake traumas, which is a 5‐fold increase from pre‐ to postearthquake (p < . 001). Factors positively associated with PTSD included earthquake‐related job loss, exposure to post‐earthquake traumas, depression at baseline, and chronic illness since the earthquake. Factors inversely associated with PTSD included housing assistance within two years after the earthquake, support of family and/or friends, and to a lesser degree, higher education and high living standard. These variables accounted for 23.1% of the variance in current PTSD severity scores. These findings indicate that PTSD rates subside significantly after a catastrophic disaster, although earthquake‐related PTSD persists among a subgroup of exposed individuals. Predictors of PTSD identified in this study provide guidance for planning acute and longer‐term postdisaster public mental health recovery programs.     

The Children's Revised Impact of Event Scale: Dimensionality and Measurement Invariance in a Sample of Children and Adolescents Exposed to Wildfires

Natural disasters are potentially traumatic events due to their disruptive nature and high impact on social and physical environments, particularly for children and adolescents. The present study aimed to examine the psychometric properties of the Children's Revised Impact of Event Scale (CRIES‐13) in a sample of Portuguese children and adolescents exposed to a specific type of natural disaster (i.e., wildfire). The sample was recruited at six school units of the Central region of Portugal following wildfires in the summer of 2017 and included children and adolescents without a clinical diagnosis of a psychopathological condition associated with exposure to the traumatic event (i.e., nonclinical sample, n = 486) and those with a clinical diagnosis of a trauma‐ and/or stress‐related disorder (i.e., posttraumatic stress disorder [PTSD], adjustment disorder, separation anxiety disorder, or grief; clinical sample, n = 54). Confirmatory factor analyses indicated that a two‐factor model (i.e., Intrusion/Arousal and Avoidance) provided a better fit than a three‐factor model (i.e., Intrusion, Arousal, and Avoidance) and was found to be invariant across gender and age groups. The CRIES‐13 showed good reliability for all subscales, with Cronbach's αs > .79. Higher CRIES‐13 scores were associated with poorer health and well‐being and more internalizing and externalizing problems. The clinical sample presented with significantly higher CRIES‐13 scores than the nonclinical sample, η_p² = .13. These results contribute to the cross‐cultural validation of the CRIES‐13 and support its use as a reliable and valid measure for assessing posttraumatic symptoms in children and adolescents.     

Impact of a technological disaster on young children: A five‐year postdisaster multiinformant study

Children exposed to a technological disaster during an understudied part of the lifespan, preschool age and early middle childhood, were assessed in a 5‐year follow‐up regarding mental health problems, anxiety disorder symptoms, depressive symptoms, physical symptoms, and posttraumatic stress symptoms. Exposed children and their parents (n = 264) reported significantly more problems than controls (n = 515). The differences were greater for conduct problems (including hyperactivity) and physical symptoms, than for anxiety and depression. The long‐term effects of a technological disaster on children of pre‐school age at exposure appear to differ from those in children, who were victimized at a later age. This may reflect interference with completion of specific developmental tasks.     

Effect of the frequency of transcutaneous electrical nerve stimulation on analgesia during extracorporeal shock wave lithotripsy

In this prospective, randomised, sham controlled study, we set out to determine which transcutaneous electrical nerve stimulation (TENS) therapy modality (conventional vs acupuncture-like) is more effective as a supplementary analgesic regimen during extracorporeal shock wave lithotripsy (ESWL). Patients were prospectively randomised to one of three groups. In Group I (n=22), conventional TENS (impulse pattern: continuous at 80 Hz; intensity: 10–30 mA) was applied. In Group II (n=22) acupuncture-like TENS (impulse pattern: burst at 2 Hz; intensity: 15–50 mA) was applied. In Group III (n=22) (control group), stimulation was started at 1 mA and the intensity increased to no more than 10 mA until it produced a tickling sensation. Alfentanil was administered through a patient controlled analgesic device. Alfentanil consumption, hemodynamics and respiratory parameters, a 10-cm visual analogue pain scale, patient satisfaction, recovery and discharge times were evaluated. The consumption of alfentanil was significantly lower in Group I than in Groups II and III (P<0.0001). Pain scores were lower in Group I than in the other two groups (P<0.05). Patients in Group I were more satisfied with their analgesic medication than those in the other two groups (P<0.05). Both the time to an Aldrete score >8 and a modified post-anaesthetic discharge score >8 were significantly shorter in Group I (2.3±1.8, 49.1±14.6) than those of Groups II (4.6±2.2, 60.2±18.1) and III (4.9±2.8, 58.4±16.5) (P<0.0001 and P<0.05, respectively). We conclude that the use of conventional TENS is effective in decreasing the analgesic requirements and the incidence of alfentanil-related side effects during ESWL.     

Divergent Effects of Glucocorticoids on Cortical and Trabecular Compartment BMD in Childhood Nephrotic Syndrome

Glucocorticoid (GC) effects on skeletal development have not been established. The objective of this pQCT study was to assess volumetric BMD (vBMD) and cortical dimensions in childhood steroid‐sensitive nephrotic syndrome (SSNS), a disorder with minimal independent deleterious skeletal effects. Tibia pQCT was used to assess trabecular and cortical vBMD, cortical dimensions, and muscle area in 55 SSNS (age, 5–19 yr) and >650 control participants. Race‐, sex‐, and age‐, or tibia length‐specific Z‐scores were generated for pQCT outcomes. Bone biomarkers included bone‐specific alkaline phosphatase and urinary deoxypyridinoline. SSNS participants had lower height Z‐scores (p < 0.0001) compared with controls. In SSNS, Z‐scores for cortical area were greater (+0.37; 95% CI = 0.09, 0.66; p = 0.01), for cortical vBMD were greater (+1.17; 95% CI = 0.89, 1.45; p < 0.0001), and for trabecular vBMD were lower (?0.60; 95% CI, = ?0.89, ?0.31; p < 0.0001) compared with controls. Muscle area (+0.34; 95% CI = 0.08, 0.61; p = 0.01) and fat area (+0.56; 95% CI = 0.27, 0.84; p < 0.001) Z‐scores were greater in SSNS, and adjustment for muscle area eliminated the greater cortical area in SSNS. Bone formation and resorption biomarkers were significantly and inversely associated with cortical vBMD in SSNS and controls and were significantly lower in the 34 SSNS participants taking GCs at the time of the study compared with controls. In conclusion, GCs in SSNS were associated with significantly greater cortical vBMD and cortical area and lower trabecular vBMD, with evidence of low bone turnover. Lower bone biomarkers were associated with greater cortical vBMD. Studies are needed to determine the fracture implications of these varied effects.     

Impact of antiangiogenic treatment on the erectile function in patients with advanced renal cell carcinoma

We longitudinally assessed erectile function as well as the willingness to use pro-erectile treatment in a cohort on AAT for advanced RCC. Thirty-seven patients with advanced RCC completed the five-item version of the International Index of Erectile Function (IIEF-5) and other interview items before (T0) and 12 weeks into therapy (T12) with AAT. Patients were further asked if they were willing to use and pay out-of-pocket for on-demand treatment with phosphodiesterase-5-inhibitors (PDE-5i). Statistical analysis was performed using nonparametric hypothesis testing. The IIEF-5 score at T12 was significantly decreased compared with T0 (p < .001). Subjective patient satisfaction regarding their sexual lives was associated with higher IIEF-5 scores at both time points (p = .006 and p = .03, respectively). At T12, subjective sexual contentment showed a nonsignificant trend towards decline (p = .074). Patients who opted for medical treatment of ED showed significantly better IIEF-5 scores at both time points compared with the rest of the cohort (p < .001 and p = .005, respectively). In summary, AAT seems to have a negative effect on erectile function in RCC patients, however, the role of psychosocial issues warrants further elucidation. Affected patients may benefit from a proactive approach promoting medical treatment of erectile dysfunction during AAT.     

Severe depression and anxiety in women with overactive bladder

Aim

Depression and anxiety are prevalent psychiatric conditions and are associated with overactive bladder. The objective of this study was to determine prevalence and severity of anxiety and depression associated with overactive bladder (OAB) in women.

Methods

274 women with clinical diagnosis of OAB were recruited from 2012 to 2015. They were submitted to the International Consultation on Incontinence Questionnaire‐Overactive Bladder (ICIQ‐OAB), the Beck Depression Inventory (BDI), and the Beck Anxiety Inventory (BAI).

Results

Severe or moderate depression was present in 59.8% of women and severe or moderate anxiety was identified in 62.4%. Higher scores of depression and anxiety were associated with higher scores of ICIQ‐OAB (P = 0.0031 and 0.0049). Women with severe depression had higher nocturia score than those with mild depression (P = 0.0046). Also, women with severe depression had higher urgency incontinence score than those with minimal depression (P = 0.0261). Patients with severe anxiety had higher nocturia score than those with minimal anxiety (P = 0.0118) and women with moderate anxiety had higher urgency incontinence score than with minimal anxiety (P = 0.0300).

Conclusions

Moderate or severe depression and anxiety are prevalent in women with OAB. There is a correlation between intensity of OAB symptoms with depression and anxiety. Anxiety and depression levels are mainly related with urgency incontinence and nocturia.     

Bone density and structure in long-term survivors of pediatric allogeneic hematopoietic stem cell transplantation

Children requiring allogeneic hematopoietic stem cell transplantation (alloHSCT) have multiple risk factors for impaired bone accrual. The impact of alloHSCT on volumetric bone mineral density (vBMD) and cortical structure has not been addressed. Tibia peripheral quantitative computed tomography (pQCT) scans were obtained in 55 alloHSCT recipients, ages 5 to 26 years, a median of 7 (range, 3–16) years after alloHSCT. pQCT outcomes were converted to sex‐ and race‐ specific Z‐scores relative to age based on reference data in >700 concurrent healthy participants. Cortical section modulus (Zp; a summary measure of cortical bone structure and strength), and muscle and fat area Z‐scores were further adjusted for tibia length for age Z‐scores. AlloHSCT survivors had lower height Z‐scores (?1.21 ± 1.25 versus 0.23 ± 0.92; p < 0.001), versus reference participants; BMI Z‐scores did not differ. AlloHSCT survivors had lower trabecular vBMD (?1.05; 95% confidence interval [CI], ?1.33 to ?0.78; p < 0.001), cortical Zp (?0.63; 95% CI, ?0.91 to ?0.35; p < 0.001), and muscle (?1.01; 95% CI, ?1.30 to ?0.72; p < 0.001) Z‐scores and greater fat (0.82; 95% CI, 0.54–1.11; p < 0.001) Z‐scores, versus reference participants. Adjustment for muscle deficits eliminated Zp deficits in alloHSCT. Total body irradiation (TBI) was associated with lower trabecular vBMD (?1.30 ± 1.40 versus ?0.49 ± 0.88; p = 0.01) and muscle (?1.34 ± 1.42 versus ?0.34 ± 0.87; p < 0.01) Z‐scores. Growth hormone deficiency (GHD) was associated with lower Zp Z‐scores (?1.64 ± 2.47 versus ?0.28 ± 1.24; p = 0.05); however, muscle differences were not significant (?1.69 ± 1.84 versus ?0.78 ± 1.01; p = 0.09). History of graft versus host disease was not associated with pQCT outcomes. In summary, alloHSCT was associated with significant deficits in trabecular vBMD, cortical geometry, and muscle area years after transplantation. TBI and GHD were significant risk factors for musculoskeletal deficits. Future studies are needed to determine the metabolic and fracture implications of these deficits, and to identify therapies to improve bone accrual following alloHSCT during childhood. © 2012 American Society for Bone and Mineral Research.     

Genetic Risk Scores Implicated in Adult Bone Fragility Associate With Pediatric Bone Density

Using adult identified bone mineral density (BMD) loci, we calculated genetic risk scores (GRS) to determine if they were associated with changes in BMD during childhood. Longitudinal data from the Bone Mineral Density in Childhood Study were analyzed (N = 798, 54% female, all European ancestry). Participants had up to 6 annual dual energy X‐ray scans, from which areal BMD (aBMD) Z‐scores for the spine, total hip, and femoral neck were estimated, as well as total body less head bone mineral content (TBLH‐BMC) Z‐scores. Sixty‐three single‐nucleotide polymorphisms (SNPs) were genotyped, and the percentage of BMD‐lowering alleles carried was calculated (overall adult GRS). Subtype GRS that include SNPs associated with fracture risk, pediatric BMD, WNT signaling, RANK‐RANKL‐OPG, and mesenchymal stem cell differentiation were also calculated. Linear mixed effects models were used to test associations between each GRS and bone Z‐scores, and if any association differed by sex and/or chronological age. The overall adult, fracture, and WNT signaling GRS were associated with lower Z‐scores (eg, spine aBMD Z‐score: β_adult = –0.04, p = 3.4 × 10^?7; β_fracture = –0.02, p = 8.9 × 10^?6; β_WNT = –0.01, p = 3.9 × 10^?4). The overall adult GRS was more strongly associated with lower Z‐scores in females (p‐interaction ≤ 0.05 for all sites). The fracture GRS was more strongly associated with lower Z‐scores with increasing age (p‐interaction ≤ 0.05 for all sites). The WNT GRS associations remained consistent for both sexes and all ages (p‐interaction > 0.05 for all sites). The RANK‐RANKL‐OPG GRS was more strongly associated in females with increasing age (p‐interaction < 0.05 for all sites). The mesenchymal stem cell GRS was associated with lower total hip and femoral neck Z‐scores, in both boys and girls, across all ages. No associations were observed between the pediatric GRS and bone Z‐scores. In conclusion, adult identified BMD loci associated with BMD and BMC in the pediatric setting, especially in females and in loci involved in fracture risk and WNT signaling. © 2015 American Society for Bone and Mineral Research.     

Mild Hypothermia Improves Survival During Hemorrhagic Shock Without Affecting Bacterial Translocation

Background: Accidental hypothermia in patients with hemorrhagic shock (HS) is associated with increased mortality. However, experimental mild and moderate hypothermia has beneficial effects. The mechanisms for beneficial effects of hypothermia have not been completely understood. Therefore, the aim of this study was to investigate the effect of hypothermia on survival, bacterial translocation (BT), and remote pulmonary injury in a controlled HS model in rats. Methods: HS was achieved by blood withdrawal through femoral vein. Rats in the normothermia group (group I) were maintained at 37°C. Mild hypothermia group (group II) was observed at 32°C that was spontaneously induced by exposure to ambient temperature. Moderate hypothermia of 28°C was actively induced by external cooling in group III for 90 min. Survival and neurological deficit scores (NDS) were recorded at 24th hr. Mesenteric lymph nodes, liver and spleen samples were collected. Myeloperoxidase (MPO) and malondialdehyde (MDA) levels were measured in lung tissue. Results: Blood pressure significantly increased in hypothermia groups. Mild hypothermia significantly increased survival. No difference was found in BT rates in groups. Hypothermia was found to significantly decrease the NDS points in group III, compared to group I. There was no difference in lung tissue MPO levels among groups. Lung tissue MDA levels increased significantly in groups II and III. Conclusions: Mild hypothermia improved blood pressure, survival, and neurological outcome with a possible detrimental effect on pulmonary ROS production during HS in rats. These effects of hypothermia are not associated with BT.     

Postoperative Analgesic Effect of Locally Infiltrated Levobupivacaine in Fleur-de-Lys Abdominoplasty

Background This prospective double-blind study compared the analgesic properties of locally infiltrated levobupivacaine with those of ropivacaine in fleur-de-lys abdominoplasty. Methods A total of 46 patients subjected to fleur-de-lis abdominoplasty under general anesthesia were included. The patients were randomly assigned to receive local infiltration of the peri-incisional and dissected area with the following solutions: group A (placebo group, n = 15) received 100 ml of saline 0.9%, group B (n = 15) received 50 ml of ropivacaine 0.75% in 50 ml of saline 0.9%, and group C (n = 16) received 60 ml of levobupivacaine 0.25% in 40 ml of saline 0.9%. The anesthetic technique was standardized for all the groups. The patients were asked to assess their pain at rest on a visual analog scale (VAS) at 2 h, 4 h, and 24 h postoperatively. Data were analyzed by mixed analysis of variance (ANOVA), simple ANOVA, and repeated measures ANOVA, followed by Tukey’s test. Results Groups B and C did not differ significantly in their VAS scores at 2 h postoperatively, but group C experienced significantly less pain (p < 0.001) than either the control group or the B group at 4 h and 24 h postoperatively. Group B also registered significantly lower VAS scores (p < 0.001) than the placebo group at 4 h postoperatively. Conclusions It is concluded that for mini abdominoplasty, adequate analgesia is achieved for at least 4 h postoperatively by local tissue infiltration with either ropivacaine or levobupivacaine. However, in terms of intensity and duration of analgesia, levobupivacaine was found to be more effective than ropivacaine in reducing postoperative pain associated with mini abdominoplasty.