Atrial fibrillation

The first 150 words of the full text of this article appear below. Key points

• Atrial fibrillation (AF) is the commonest cardiacarrhythmia; its incidence increases with age.
• Diabetes mellitus,hypertension and ventricular hypertrophy are commonly associatedwith non-valvular atrial fibrillation.
• Primary aims of managementof AF are conversion to sinus rhythm, maintenance of sinus rhythmand prevention of thromboembolic complications.
• In elderlypatients who are asymptomatic, adequate rate control of AF appearsto offer the same benefits as rhythm control.
• Chronic AF carriesa high risk of ischaemic stroke from thromboembolism; all patientsat risk must receive adequate anticoagulation.
• Anticoagulationshould be continued in patients with risk factors despite successfulconversion to sinus rhythm.

  Atrial fibrillation (AF) is the commonest cardiac arrhythmia.The incidence increases with age and affects 5% of UK populationabove the age of 65 yr and 10% above 75 yr.^{1 2} In the UnitedStates, AF accounts for more than 35% of all admissions forcardiac arrhythmias.³ Men are . . . [Full Text of this Article]

Breast reconstruction with the denervated latissimus dorsi musculocutaneous flap

ObjectiveTo analyze clinical implications of the thoracodorsal nerve division in the latissimus dorsi musculocutaneous flap breast reconstruction.Patients and methodsProspective cohort study was conducted on 29 patients. Breast reconstruction with latissimus dorsi musculocutaneous flap was performed unilaterally in 20 patients or bilaterally in 9 women (38 breasts). Thoracodorsal nerve was divided during reconstruction of 20 breasts (group 1) and was preserved for 18 breasts (group 2). Height, width, projection, area of the covering skin and volume of the reconstructed and healthy breasts were measured on the 3D images of the anterior chest wall, taken 6 weeks and 6 months postoperatively with the Di3D 3D camera. Data regarding tissue consistency, painfulness and animation of the reconstructed breast, symmetry of both breasts and overall satisfaction after the surgery were collected at 6 months.ResultsThe reconstructed and healthy breasts decreased in volume in group 1 (?45.85 cm³ ± 48.41 cm³, p = 0.0004; ?29.13 cm³ ± 14.98 cm³, p = 0.0009) and in group 2 (?31.5 cm³ ± 25.35 cm³, p = 0.0001; ?15.4 cm³ ± 21.96 cm³, p = 0.0537). There were no differences in decrease in volume between groups 1 and 2 (p > 0.05).Respondents in group 1 in comparison to group 2 showed similar satisfaction of the tissue consistency of the reconstructed breast (p > 0.05) and the level of symmetry between both breasts (p > 0.05), gave lower scores for painfulness (p < 0.0001), animation (p < 0.0001) and higher scores for the overall satisfaction about the reconstructed breast (p = 0.0001).ConclusionWe suggest that division of the thoracodorsal nerve during latissimus dorsi musculocutaneous flap breast reconstruction is a useful undertaking to minimize unnatural animation of the reconstructed breast.     

Heterogeneity of gastrointestinal hormones

The molecular heterogeneity of gastrointestinal hormones is reviewed. The phenomenon of heterogeneity is characteristic of all secreted proteins, including macromolecules like albumin and immunoglobulins, as well as protein and polypeptide hormones. Heterogeneity reflects basal mechanisms involved in ribosomal biosynthesis, posttranslational cleavage and modification, as well as degradation in peripheral tissue of biologically important substances. Thus far, all gastrointestinal hormones have displayed heterogeneity. The degree of heterogeneity reported has varied for the individual gut hormones. The most extensively studied hormones, such as gastrin and insulin, have displayed a high degree of heterogeneity, and similar heterogeneity will probably emerge for the remaining hormones when they have been studied in greater detail. Based on the extent of molecular difference, a distinction between macro- and microheterogeneity is proposed. Macroheterogeneity indicates a difference in molecular size of several (two or more) amino acids, while microheterogeneity indicates modifications of single amino acid residues. Molecular heterogeneity has implications regarding extraction, measurement, and evaluation of the action of the individual gut hormones. Thus, extraction may require several different procedures in order to identify all the molecular forms of a hormone. Measurement in blood and other biological fluids requires careful evaluation of the specificity of the assays towards the different molecular forms of a hormone in order to evaluate its physiological role. Consequently, understanding of the significance of gut hormones in gastrointestinal disease requires further clarification of their heterogeneous nature.

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Résumé L'article est consacré à l'hétérogénéité moléculaire des hormones gastro-intestinales. L'hétérogénéité est caractéristique de toutes les protéines sécrétées, y compris les macromolécules comme l'albumine, les immunoglobulines, les protéines et les hormones polypeptidiques. L'hétérogénéité résulte des mécanismes de biosynthèse dans les ribosomes, de scisson et d'altération après transfert et de dégradation de toutes les substances biologiquement importantes au niveau des tissus périphériques. Toutes les hormones gastro-intestinales qui ont été découvertes à ce jour sont hétérogènes. Le degré d'hétérogénéité varie d'une hormone à l'autre. Les hormones les mieux étudiées, telles que la gastrine et l'insuline, se sont révélées très hétérogènes. Il est vraisemblable que, pour les autres hormones, une hétérogénéité similaire apparaîtra quand elles seront mieux étudiées. En nous basant sur l'étendue des différences moléculaires, nous proposons une distinction entre macro- et microhétérogénéité. La macrohétérogénéité indique une différence de taille des molécules de plusieurs acides aminés (2 ou plus). La microhétérogénéité indique des modifications d'un seul résidu aminoacide. L'hétérogénéité moléculaire est importante pour l'extraction, le dosage et la mesure de l'action des hormones digestives. Ainsi, plusieurs procédés différents peuvent être nécessaires pour l'extraction, pour pouvoir identifier toutes les formes moléculaires de l'hormone. Le dosage dans le sang et dans les liquides biologiques doit bien préciser la spécificité de la méthode pour les diverses formes moléculaires d'une hormone, pour pouvoir évaluer son rôle physiologique. Il faudra donc préciser et clarifier encore la nature hétérogène des hormones gastro-intestinales, pour mieux connaître leur rôle dans les maladies du tube digestif.

     

The role of mast cells in non-ablative laser resurfacing with 1,320 nm neodymium:yttrium–aluminium–garnet laser

The aim of this study was to investigate the role of mast cells in mechanisms of collagen remodelling induced by non-ablative laser treatment. The dorsal skin of Kunming (KM) mice was exposed to 1,320 nm neodymium–yttrium–aluminium garnet (Nd:YAG) laser weekly for four consecutive weeks. Biopsies were taken 1 h after irradiation and 1 day, 7 days, 14 days, 30 days and 60 days after the first treatment. Skin samples were studied for mast cells, fibroblasts, and type I and III collagen, by toluidine blue, haematoxylin–eosin (HE) and immunohistochemical staining, respectively. The total number of mast cells in the skin of experimental group was significantly greater than that in the control at 1 h, 1 day, 21 days and 60 days after the first treatment (P < 0.05, respectively). At any of the time points studied, the number of degranulated mast cells in the experimental group was significantly higher than in the control (P < 0.01, P < 0.01, P < 0.05, P < 0.01, P < 0.05, P < 0.05, respectively).The number of fibroblasts in the experimental group exhibited a significant increase in comparison with those in control skin at days 7, 21, 30 and 60 after irradiation (P < 0.05, P < 0.01, P < 0.01, P < 0.05, respectively). The amount of type I collagen was significantly higher than in the control from day 21 to day 60 (P < 0.05, P < 0.01, P < 0.01, respectively), and type III collagen showed a marked increase between day 7 and day 60, compared with the control (P < 0.01, P < 0.05, P < 0.01, P < 0.01, respectively). There was a significant positive correlation between the number of fibroblasts and granulated mast cells (r = 0.549, P < 0.01). The amount of type I and III collagen also showed significant positive correlations with the number of degranulated mast cells (r = 0.555, P < 0.01 and r = 0.579, P < 0.01, respectively). The results suggested that dermal mast cells might be involved in the inflammatory response, fibroblast proliferation and collagen remodelling induced by non-ablative laser treatment.     

De l'intérêt à synthéser par plaque vissée bon nombre de fractures de la diaphyse humérale

Résumé Analyse de 246 synthèses de la diaphyse humérale par plaque vissée pour fractures récentes, pratiquées en 22 ans, dans le même service hospitalo-universitaire. Plaidoyer en faveur de cette façon de synthéser les diaphyses humérales, non seulement dans les indications classiques (fractures récentes «compliquées» ou «associées à d'autres lésions»), mais aussi dans bon nombre de fractures «isolées non compliquées»; Cet élargissement des indications à des fractures qu'il n'était pas courant de synthéser s'est, au fil des ans, progressivement substitué — pas complètement, mais presque — à l'habituel traitement orthopédique, en raison de l'absence d'immobilisation du membre supérieur synthésé, qui permet sa ré-utilisation pratiquement immédiate ... comme s'il ne s'était rien passé à son niveau, et de la fiabilité de ces synthèses, attestée par l'étude précise et détaillée de leurs résultats.

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Primary plating of fractures of the shaft of the humerus

Summary The authors have reviewed 246 fresh fractures of the shaft of the humerus treated by primary plating over a period of 22 years. It has been customary to treat the majority of fractures of the shaft of the humerus by conservative means, with use of open reduction and fixation by a plate for complicated fractures with associated injuries, or in cases of nonunion. Over the period of review the authors have gradually increasing their use of primary plating as opposed to the traditional methods. They feel that the reliability of union, together with the early mobilisation and return of the arm to normal function, favours the use of this method. Their opinion is based on a careful analysis of their results.

     

Complications of blood transfusion

The first 150 words of the full text of this article appear below. Key points

• Complications of blood transfusion are rare but canbe life-threatening.
• Since 2005, it has been a legal requirementthat all serious adverse reactions attributable to the safetyor quality of blood are reported.
• Most reported complicationsare because of transfusion of mismatched blood products andare avoidable through clinical vigilance.
• Massive blood transfusionsresult in abnormalities of coagulation status, serum biochemistry,acid–base balance and temperature homeostasis.
• Transfusion-relatedacute lung injury is the most common cause of major morbidityand death after transfusion.

  The serious hazards of transfusion (SHOT) scheme has collecteddata on significant adverse events resulting from transfusionof blood components from volunteer organizations since 1996.However, after the implementation of the European Union Directiveon Blood Safety and Quality in 2005, it is now a requirementthat all ‘Blood Establishments and Hospital Blood Banksreport to the Secretary of State for Health all serious adversereactions . . . [Full Text of this Article]

Stereoselective in vitro degradation pattern of mivacurium in human plasma

Background. Mivacurium is a mixture of three isomers, two ofwhich are rapidly broken down in vivo by plasma cholinesterases.This study investigates the stereospecificity of mivacuriumin vitro degradation to determine if it accounts for its invivo behaviour. Methods. The in vitro rate of degradation of each isomer ofmivacurium and the in vitro rate of formation of their primary(monoesters and alcohols) and secondary (alcohols) metaboliteswere examined using human plasma from six healthy volunteers.The in vitro rate of degradation of the monoester metaboliteswas also assessed. All these determinations were made usinga stereospecific high-performance liquid chromatography assay. Results. The in vitro rate of disappearance of the two activeisomers of mivacurium was very rapid, with mean values for thetrans trans and cis trans isomers of 0.803 and 0.921 min^–1respectively. These values are twofold faster than publishedin vivo data. The in vitro rate of disappearance was much slowerfor the cis cis isomer, with a mean value of 0.0106 min^–1.The cis trans isomer was converted exclusively to cis monoesterand trans alcohol, while only metabolites in the trans and cisconfiguration were found for the trans trans and cis cis isomersrespectively. Mean in vitro rates of disappearance for the transand cis monoester were 0.00750 and 0.000633 min^–1respectively. Conclusions. The in vitro rates of hydrolysis of the activeisomers of mivacurium confirm that plasma cholinesterases playa major role in their in vivo degradation, but that in vivoelimination is slowed by extravascular distribution. Mivacuriumhydrolysis is stereoselective, the ester group in the transconfiguration being more accessible to enzymatic attack. Thisstereoselective pattern, along with the relatively slow breakdownof the cis cis isomer, sheds light on the in vivo dispositionof the cis alcohol metabolite. Br J Anaesth 2002; 89: 832–8     

Penicillin therapy as an adjunct to genitourinary surgery: Report of eleven cases

Penicillin is a powerful antibiotic which is of great value as an adjunct to surgical intervention on the genitourinary organs. It does not supplant operation for drainage or removal of encapsulated infection.Penicillin sensitive organisms present in infections of the genitourinary organs and surgical wounds are Gram-positive and Gram-negative cocci and diplococci, Gram-positive bacilli and certain strains of Gram-negative bacilli. Inadequate present day culture methods frequently fail to reveal offending anaerobes. Mixed infections are benefited by rapid destruction of susceptible organisms.Prophylactic use of penicillin materially aids in the prevention and control of infection. In cases of perinephritic abscess, kidney cortical abscess and infected renal cyst, it prevents dissemination of infection. In the aged prostatic, who does not tolerate sulfatherapy, it is an ideal antibacterial agent.Therapeutic use of penicillin readily controls acute infection; 300,000 to 500,000 units usually suffice. In chronic mixed infections response is slower, and two to three million units are usually necessary to afford relief.Systemic administration of penicillin combined with local application in wounds favors prompt healing and smooth convalescence.Eleven cases¹ are reported in which penicillin was used as an adjunct to genito-urinary surgery. Eight were poor surgical risks and presented overwhelming mixed urinary infection. Penicillin therapy, instituted prophylactically in six and therapeutically in five, controlled infection and hastened return to health in all. In this group of cases it has surpassed any other form of chemotherapeusis formerly employed.

Comparative efficacy and safety of drug treatment for premature ejaculation: A systemic review and Bayesian network meta-analysis

To assess the comparative efficacy and safety of drug treatments for premature ejaculation. A systemic review and Bayesian network meta-analysis were executed on randomised controlled trials of drug interventions for premature ejaculation. Intravaginal ejaculation latency time and related adverse effects were outcome measures. A total of 44 RCTs with 11,008 patients were included in our NMA. In therapy <8 weeks, the ranking of drug efficacy was topical creams >selective serotonin reuptake inhibitor (SSRI)+ phosphodiesterase 5 inhibitor (PDE5i) > PDE5i > sertraline > clomipramine > paroxetine > dapoxetine 60 milligram (mg) > dapoxetine 30 mg > fluoxetine>citalopram > duloxetine>placebo. In therapy ≥ 8 weeks, the ranking of drug efficacy was SSRI + PDE5i > topical creams > paroxetine > tramadol > PDE5i > fluoxetine > dapoxetine 60 mg > dapoxetine 30 mg > clomipramine>citalopram > placebo. For total adverse events, clomipramine, dapoxetine 30 mg, dapoxetine 60 mg, paroxetine, PDE5i, SSRI + PDE5i and tramadol had a higher risk than placebo. In conclusion, in ≥8 weeks of therapy, the drug combination of SSRI + PDE5i was the most effective PE therapy. In <8 weeks of therapy, the efficacy of local anaesthetics was best. All drug treatments were ranked better than placebo. In general, drugs with better effects had more obvious side effects.     

Sperm parameters quality and reproductive effects of methanolic extract of Alchornea cordifolia leaves on senescent male rats

The effect of the methanolic extract of Alchornea cordifolia leaves on the fertility of senescent male rats was assessed in this study. 40 rats received daily distilled water, testosterone, 200 and 400 mg/kg of extract of Alchornea cordifolia. The reproductive organs weight, the gonadotropins, testosterone and cholesterol level, the sperm parameters, histology of the testes and epididymis were assessed. The weight of testes and prostate (400 mg/kg) significantly increased (p < 0.05) as well as the level of FHS (p < 0.001), LH and testosterone (p < 0.01) at a dose of 400 mg/kg, respectively, while the cholesterol decreased at a dose of 200 mg/kg (p < 0.05) and 400 mg/kg (p < 0.01) respectively. The testes and epididymis were full of spermatozoa particularly at a dose of 400 mg/kg. The sperm count and morphology significantly increased at both doses of 200 mg/kg (p < 0.01; p < 0.001) and 400 mg/kg (p < 0.001; p < 0.01) respectively. The sperm motion (PROG, VAP, VSL, VCL) (p < 0.001), (ALH, BCF) (p < 0.05) increased at a dose of 200 mg/kg and decreased at a dose of 400 mg/ kg. The overall results provide the strong evidence of the fertility potential of the methanolic extract of Alchornea cordifolia leaves in senescent male rats.     

Pilot Postoperative Ileus Study of Escin in Cancer Patients After Colorectal Surgery

Background  Postoperative ileus, a common complication in patients after abdominal surgery, brings no benefit to the recovery of postoperative patients, and treatment targeted at restoring gastrointestinal motility may shorten the hospital stay. Studies have shown that escin accelerates gastrointestinal transit in mice and improves gastrointestinal motility in patients after abdominal surgery. A pilot study of escin’s effect on the recovery of gastrointestinal motility was conducted in colorectal cancer patients in anticipation of a multiple-center randomized controlled trial. Methods  A total of 72 postoperative colorectal cancer patients were randomly assigned to four parallel groups on the basis of sealed envelopes—escin 5 mg group (E5 mg), escin 15 mg group (E15 mg), escin 25 mg group (E25 mg), and placebo group—with 18 patients in each group. Escin or placebo was diluted in 500 ml 5% dextrose injection, which was given once daily through the subclavian vein. The first injection took place 6 h after completion of the surgery. The treatment continued for 7 days or stopped at the time of the patient’s first bowel movement. Time to recovery of passage of gas (TRPG), time to recovery of gastrointestinal sounds (TRGS), and time to recovery of bowel movements (TRBM) were recorded to evaluate the efficacy of escin. Results  The TRPGs of the three escin treatment groups were 76.78 + 28.81 h (E5 mg), 72.06 + 14.65 h (E15 mg), and 65.50 + 26.70 h (E25 mg), respectively, with differences of 6.03 ± 7.64 h (p = 0.436; E5 mg), 10.75 ± 4.92 h (p = 0.036; E15 mg), and 17.31 ± 7.20 h (p = 0.022; E25 mg) compared with the placebo group. The TRGSs of the three escin treatment groups were 45.28 ± 26.15 h (E5 mg), 41.22 ± 16.98 h (E15 mg), and 40.33 ± 14.09 h (E25 mg), respectively, with differences of 4.33 ± 7.12 h (p = 0.547; E5 mg), 8.39 ± 5.36 h (p = 0.127; E15 mg), and 9.28 ± 4.87 h (p = 0.065; E25 mg) compared with the placebo group. The TRBMs of the three escin treatment groups were 89.25 ± 23.77 h (E5 mg), 84.83 ± 27.91 h (E15 mg), and 84.44 ± 19.74 h (E25 mg), respectively, with differences of 19.03 ± 10.13 h (p = 0.069; E5 mg), 23.44 ± 10.70 h (p = 0.035; E15 mg), and 23.83 ± 9.63 h (p = 0.019; E25 mg) compared with the placebo group. Conclusion  The results of this pilot Postoperative Ileus Study of Escin (PISE) showed that escin can shorten the time to recovery of gastrointestinal motility in cancer patients after colorectal surgery.     

Anaesthesia and adrenocortical disease

The first 150 words of the full text of this article appear below. Key points Adrenocortical disease results in disturbances ofbody water volume and electrolyte concentrations; intra-cellularelectrolyte defects may be severe. Preoperative assessmentis of crucial importance in identifying the endocrine diseaseprocess and the severity of its effects. Preoperative preparationinvolves correction of volume deficit and electrolyte disturbances,and replacement of deficient hormones. Cardiovascular disturbanceand instability are particularly common and invasive cardiovascularmonitoring should be considered. Postoperative mineralocorticoidand glucocorticoid supplementation should be considered in Addison'sdisease and in steroid-induced hypoadrenalism.  

Mechanical properties and morphologic features of intrinsic foot muscles and plantar fascia in individuals with hallux valgus

BackgroundThe aim of the present study was to investigate the morphologic features and mechanical properties of plantar fascia (PF), flexor hallucis brevis (FHB), flexor digitorum brevis (FDB), and abductor hallucis (AbH) muscles in individuals with halluks valgus (HV) and to compare the results with individuals without HV.MethodsA total of 30 participants (27 female, 3 male) between the ages of 19–58 years with HV deformity and 30 individuals without HV (27 female, 3 male) between the ages of 20–58 years were included in the study. AbH, PF, FHB, and FDB thickness, cross-sectional area and stiffness were measured with an ultrasonography device. For stiffness measurements, Shear Wave Velocity (SWV) of the assessed soft tissues was calculated using a customized software program.ResultsMean and standard deviation of SWV of PF, AbH, FHB, FDB, and thickness of PF, AbH, FHB, FDB, and cross-sectional area of AbH, FHB, FDB in individuals with HV were 7.6 ± 1.0 m/sec, 2.8 ± 0.3 m/sec, 2.6 ± 0.4 m/sec, and 3.4 ± 0.2 m/sec, 3.3 ± 0.5 mm, 11.4 ± 2.2 mm, 16.5 ± 1.9 mm, 8.9 ± 1.8 mm, 2.4 ± 0.5 cm², 2.7 ± 0.5 cm², 1.9 ± 0.6 cm², respectively. Mean and standard deviation of SWV of PF, AbH, FHB, FDB and thickness of PF, AbH, FHB, FDB, and cross-sectional area of AbH, FHB, FDB in controls groups were 7.6 ± 1.2 m/sec, 2.3 ± 0.3 m/sec, 2.3 ± 0.4 m/sec, and 3.4 ± 0.4 m/sec, 3.3 ± 0.5 mm, 9.7 ± 2.1 mm, 14.5 ± 1.4 mm, 9.7 ± 1.2 mm, 2.1 ± 0.3 cm², 2.3 ± 0.4 cm², 2.1 ± 0.4 cm², respectively. Individuals with HV had lower AbH and FHB thickness, cross-sectional area and SWV, however FDB thickness and cross-sectional area were higher in individuals with HV compared to that of individuals without HV (p < 0.05). PF thickness (p = 0.273), SWV of PF (p = 0.979) and FDB (p = 0.295) were similar in both groups.ConclusionOur results suggest that individuals with HV had lower AbH and FHB stiffness, however PF and FDB stiffness were similar in HV and control group. In addition, AbH and FHB thickness and cross-sectional area were lower in individuals with HV; however, FDB thickness and cross-sectional area were higher in individuals with HV compared to that of individuals without HV.Level of EvidenceLevel III, Diagnostic Study.     

Effects of phytate and pyrophosphate on brushite and hydroxyapatite crystallization

This is a comparative study of the effects of phytate and pyrophosphate and other polyphosphates on the crystallization of hydroxyapatite and brushite, the most frequent calcium phosphates involved in calcium oxalate urolithiasis. Brushite and hydroxyapatite crystal formation was studied in synthetic urine, through kinetic-turbidimetric measurements that allowed evaluation of the inhibitory effects on crystallization of insoluble salts. The effectiveness in preventing brushite crystallization decreases in the sequence phytate > polyphosphate > EDTPO > etidronate > pyrophosphate > triphosphate > medronate; whereas the order of effectiveness in preventing hydroxyapatite crystallization was EDTPO > etidronate=pyrophosphate > triphosphate > medronate > polyphosphate > phytate. Phytate, a natural inhibitor in urine, most effectively blocked brushite precipitation (1.21·10⁻⁵ M prevented crystallization during time periods of at least 1 h), and pyrophosphate was the natural inhibitor that most effectively blocked hydroxyapatite precipitation (2.87·10⁻⁶ M prevented crystallization during time periods of at least 1 h). This demonstrates that low excretion of these substances would pose a risk of renal lithiasis. Received: 15 July 1999 / Accepted: 28 October 1999     

Evaluation of certain constituents of antioxidant defense in youth treated in the past for steroid-sensitive idiopathic nephrotic syndrome

Disorders of lipid metabolism and antioxidant defense capacity reported during idiopathic nephrotic syndrome (INS) exacerbations are known. The aim of this study was to evaluate constituents of antioxidant defense [total antioxidant potential: ferric-reducing antioxidant power (FRAP), paraoxonase-1 (PON-1), tocopherols, ascorbic acid] in patients formerly treated for INS. The studied group consisted of 30 patients (20 males and 10 females) treated 4–15 years ago for INS. The control group consisted of 30 healthy teenagers. There were no statistically significant differences in PON-1 activity (156.4 ± 97.1 vs 137.7 ± 80.2 U/l), α-tocopherol levels (23.9 ± 7.3 vs 22.4 ± 3.2 μmol/l) and sum of β- and γ-tocopherols (2.1 ± 1.0 vs 2.3 ± 0.6 μmol/l), and in FRAP (484.9 ± 87.2 vs 452.8 ± 76.9 μmol/l) between groups. In the study group, a significantly lower concentration of ascorbic acid (53.0 ± 20.8 vs 69.4 ± 16 μmol/l; p < 0.002), decreased values of α-tocopherol/cholesterol (4.9 ± 0.7 vs 5.5 ± 1.2; p = 0.03), and total tocopherol/cholesterol (5.3 ± 0.8 vs 6.1 ± 1.4; p = 0.016) ratios were observed. A positive correlation between tocopherol/total cholesterol (TCh) (r = 0.41; p < 0.05) and α-tocopherol/TCh (r = 0.50; p < 0.001) ratios and INS relapse frequency was reported. The relationship between the study parameters and group of variables (relapse frequency, duration of the last remission, age, gender) was tested using the multiple linear regression analysis. The results of this study suggest that the nonenzymatic antioxidant defense in young persons formerly treated for INS is weaker than in their healthy counterparts.     

Enclouage centro-médullaire par voie haute des fractures récentes de la diaphyse humérale

Résumé Les auteurs ont revu 57 fractures récentes de la diaphyse humérale traitées par enclouage centro-médullaire sans alésage par voie haute.Après avoir décrit le principe de leur méthode, ils précisent leur technique opératoire: voie d'abord delto pectorale avec résection du ligament acromio coracoïdien et enfouissement du clou sous la coiffe des rotateurs.Ils analysent ensuite leurs résultats; la consolidation per primam a été obtenue 53 fois sur 57 dans un délai moyen de 52 jours; 45 blessés, soit 79%, ont obtenu un bon ou très bon résultat.Ils énumèrent ensuite les avantages et les inconvénients de leur méthode par rapport aux autres modes de traitement des fractures récentes de la diaphyse humérale; traitement orthopédique, traitement chirurgical; ostéosynthèse par plaque vissée, enclouage avec alésage et embrochage fasciculé.Ils pensent que cette méthode de traitement peut être étendue aux fractures métastatiques et aux pseudarthroses de la diaphyse humérale.Ils dégagent ensuite leurs indications thérapeutiques.

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Closed intramedullary nailing of fractures of the shaft of the humerus

Summary Fifty seven fractures of the shaft of the humerus were treated by closed intramedullary nailing without reaming of the proximal part of the bone.Fifty three of the fifty seven fractures healed promptly with an average time to union of 52 days. The technique of operation is described and the authors compare the results of their management with other methods of treatment.The indications for the use of closed nailing are discussed and its role in the treatment of pathological fractures and ununited fractures indicated.

     

Assessing the Use of p16 Promoter Gene Methylation in Serum for Detection of Bladder Cancer

Objective: This study was undertaken to investigate whether hypermethylation in p16^INK4a gene promoter could serve as plasma biomarker of bladder cancer.Methods and Patients: We examined the p16^INK4a status using methylation-specific PCR in 86 cancer patients and 49 controls (31 healthy people and 18 patients with benign urological diseases).Results: The p16^INK4a methylation was found in 22% of the serum samples and in 26% of the bladder cancer biopsies; one of them with carcinoma in situ. The presence of hypermethylated p16^INK4a in serum seems to be a product from tumour cells because a strong statistical association was found between both matched DNA signals (p<0.0001). Using the control group, the presence of methylated p16^INK4a in the serum of individuals with suspicion of bladder cancer was found to be associated with the tumour presence (p=0.0009). Aberrant p16^INK4a methylation was also observed in one non-cancer patient, which is undergoing further assessment.Conclusions: According with our results, methylation of p16^INK4a promoter may be involved in the bladder cancer genesis and the presence of p16^INK4a methylated in serum of these patients could be useful in the cancer diagnosis with values of sensitivity, specificity and positive predictive value of 0.226, 0.950 and 0.98, respectively. These figures support the use of methylated p16^INK4a as a new class of tumour marker in bladder cancer.     

Surgical site infections after post-bariatric abdominoplasty and flank liposuction: a case-control study focusing on the quantity of tissue removed

We evaluated whether the quantity of fat removed during abdominoplasty and liposuction correlated with the occurrence of surgical site infection (SSI). We selected patients of similar age, sex, smoking status, obesity, and post-bariatric weight loss, retrospectively, and classified them into groups according to the development of SSI. The total amount of fat removed and aspirated was compared. The size of the flap removed from the abdomen and the amount of fat aspirated with liposuction differed significantly between the SSI and no-SSI groups (1.6 ± 0.2 vs. 0.6 ± 0.3 kg and 2 ± 0.2 vs. 0.9 ± 0.3 l, respectively; p < 0.001). The four SSI patients with the most fat removed (1.4 ± 0.2 kg) or aspirated (2 ± 0.1 l kg) had the deepest infections. SSI was strongly correlated with the size of flap resection (ρ = 0.80; p < 0.001) and liposuction (ρ = 0.72; p < 0.001). The quantity of fat removed or aspirated can influence the occurrence of SSI. If confirmed, these data could be used to better stratify patients according to their risk.     

Urinary ?2-microglobulin in very preterm neonates with chorioamnionitis

It is important to identify premature infants with prenatal inflammation as it contributes to short- and long-term complications. Our object was to study how prenatal inflammation affects the urinary β₂-microglobulin (β₂-MG) level. Preterm neonates were divided based on the presence of chorioamnionitis (CAM) into the CAM (n = 100) and non-CAM groups (n = 117). These were further subdivided into five groups each: 30 preterm neonates of 23–26; 42 neonates of 27–28; 54 neonates of 29–30; 51 neonates of 31–32; and 40 neonates of 33–34 weeks’ gestation. The urinary β₂-MG level within 48 h of birth was significantly higher in the CAM group than in the non-CAM group among the neonates of 23–26 weeks’ gestation (18.3 ± 6.9 vs 10.0 ± 5.6 × 10⁴ μg/gCr, p = 0.0018) and the neonates of 27–28 weeks’ gestation (16.2 ± 10.8 vs 8.8 ± 3.3 × 10⁴ μg/gCr, p = 0.0101). However, there was no difference in urinary β₂-MG level between the CAM and the non-CAM group among the neonates ≥ 29 weeks ’gestation. Moreover, the elevated urinary β₂-MG level in the neonates ≤ 28 weeks ’ gestation with CAM had disappeared by 1 week after birth. The reasons for the increase in urinary β₂-MG level within 48 h of birth in very preterm neonates (≤ 28 weeks’ gestation) with CAM are believed to be not only prematurity, but also prenatal inflammation. It is suggested that the urinary β₂-MG level during the early postnatal period can identify prenatal inflammation.     

Effects of chronic kidney disease on perioperative and 180-day complication rates after total shoulder arthroplasty

BackgroundChronic kidney disease (CKD) is associated with increased risk of complications in total hip arthroplasty and total knee arthroplasty. Despite this known association, there are little data regarding the effect of outcomes in patients undergoing total shoulder arthroplasty (TSA). The purpose of this study is to identify the effects of CKD on patient outcomes after TSA.MethodsThe National Readmissions Database was queried from 2010 to 2017 to identify all primary TSA patients (n = 62,455). CKD was identified using International Classification of Diseases, Ninth Revision and International Classification of Diseases, Tenth Revision codes. Chi-squared analysis and multivariate regression were used to analyze differences in outcomes and the impact of CKD stage.ResultsCKD patients had higher rates of 180-day readmissions, 180-day mortality, acute renal failure (ARF), transfusions, urinary tract infections (UTI), acute respiratory distress syndrome (ARDS), pneumonia, and gastrointestinal (GI) complications. Stage 3 CKD (odds ratio [OR] = 1.378; P = .002), stage 4 CKD (OR = 1.805; P = .027), and unspecified CKD stage (OR = 1.787; P < .001) were at increased odds of 180-day readmission. Stage 4 CKD (OR = 10.647; P = .034) was associated with increased odds of 180-day mortality. Stage 2 CKD had increased odds of GI complications (OR = 8.365; P = .004). Both stage 3 CKD (OR = 1.463; P = .038) and stage 4 CKD (OR = 2.465; P = .033) had increased odds of UTI. Stage 5 CKD (OR = 36.143; P < .001) had increased odds of ARDS. Stage 2 CKD had increased odds of thrombosis (OR = 7.869; P = .007). Stage 2 (OR = 4.826; P < .001), stage 3 (OR = 5.724; P < .001), stage 4 (OR = 11.162; P < .001), stage 5 (OR = 31.328; P < .001), and unspecified CKD stage (OR = 4.801; P < .001) were associated with increased odds of ARF. Stage 2 CKD (OR = 12.809; P = .014), stage 3 (OR = 7.351; P = .001), and stage 4 (OR = 39.684; P < .001) were associated with increased odds of transfusions.ConclusionCKD is associated with increased risk of complications, including postoperative ARF, transfusions, UTI, ARDS, pneumonia, and GI complications. Patients with CKD also have increased 180-day readmission rates and 180-day mortality rates. Increasing stage of CKD is associated with increasing odds of 180-day readmission, postoperative ARF, and transfusions. Surgeons should consider these increased risks in the decision-making process during preoperative evaluation. These complications would likely increase cost, which raises the need for further evaluation and stratification of risk in patients who use bundled payment systems.Level of evidenceLevel III; Case-Control Study