Exposure to CB-153 and p,p’-DDE and bone mineral density and bone metabolism markers in middle-aged and elderly men and women

The incidence of osteoporotic fractures is rising in western societies, partly due to unknown reasons. Persistent organochlorine compounds (POC) have in animal studies impaired the normal bone metabolism and resulted in increased bone fragility, which might have health implications for POC-exposed human populations. The aim of the present study was to assess whether a high dietary intake of POC through fatty fish from the Baltic may result in decreased bone mineral density (BMD) or disturbances in biochemical markers of bone metabolism. From a study base of fishermen and fishermens wives from the Swedish east coast who are considerably more POC-exposed than the general Swedish population, 196 men (median age 59 years) and 184 women (median age 62 years) participated in an examination of their forearm BMD, using dual energy x-ray absorptiometry (DXA). Further, POC exposure was assessed by analysis of lipid-adjusted serum levels of 2,2,4,4,5,5-hexachlorobiphenyl (CB-153) and 1,1-dichloro-2,2-bis(p-chlorophenyl)-ethylene (p,p-DDE). Cadmium in urine (U-Cd) was also analyzed. Biochemical markers in serum of osteoblastic (osteocalcin) and osteoclastic (CrossLaps) functions were measured. Adjustment for potential confounders was made by employing multiple regression analyses. Univariate analyses showed significant negative associations between CB-153 concentrations and BMD, but after adjustment for age and body mass index, these associations did not remain. None of the POC exposure variables were associated with CrossLaps or osteocalcin. There were no significant associations between U-Cd and BMD or any of the biochemical biomarkers. In conclusion, the results did not provide any support for the hypothesis that the current exposure levels to POC constitute a hazard for impaired bone metabolism in the general Swedish population.     

HIV and tuberculosis – science and implementation to turn the tide and reduce deaths

Introduction

Every year, HIV-associated tuberculosis (TB) deprives 350,000 mainly young people of productive and healthy lives. People die because TB is not diagnosed and treated in those with known HIV infection and HIV infection is not diagnosed in those with TB. Even in those in whom both HIV and TB are diagnosed and treated, this often happens far too late. These deficiencies can be addressed through the application of new scientific evidence and diagnostic tools.

Discussion

A strategy of starting antiretroviral therapy (ART) early in the course of HIV infection has the potential to considerably reduce both individual and community burden of TB and needs urgent evaluation for efficacy, feasibility and broader social and economic impact. Isoniazid preventive therapy can reduce the risk of TB and, if given strategically in addition to ART, provides synergistic benefit. Intensified TB screening as part of the “Three I''s” strategy should be conducted at every clinic, home or community-based attendance using a symptoms-based algorithm, and new diagnostic tools should increasingly be used to confirm or refute TB diagnoses. Until such time when more sensitive and specific TB diagnostic assays are widely available, bolder approaches such as empirical anti-TB treatment need to be considered and evaluated. Patients with suspected or diagnosed TB must be screened for HIV and given cotrimoxazole preventive therapy and ART if HIV-positive. Three large randomized trials provide conclusive evidence that ART initiated within two to four weeks of start of anti-TB treatment saves lives, particularly in those with severe immunosuppression. The key to ensuring that these collaborative activities are delivered is the co-location and integration of TB and HIV services within the health system and the community.

Conclusions

Progress towards reducing HIV-associated TB deaths can be achieved through attention to simple and deliverable actions on the ground. John Donne, Meditation XVII, Devotions upon Emergent Occasions: … any mans death diminishes me because I am involved in Mankinde; And therefore never send to know for whom the bell tolls; it tolls for thee ….     

Hip and pelvic fractures and sciatic nerve injury

Objective:To investigate te influence of hip and pelvic fracture,especially acetanbular fracture complicated by sciatic nerve injury on clinical features and prognosis of sciatic nerve injury.Methods:From January 1987 to January 2000,17 patients(14 male and 3 female) who had hip and pelvic fractures complicated by sciatic nerve injury were treated with operative reduction and internal fixation and followed up from 10 months to 5 years.The average age was 38 years(ranging 23-56 years).The left extremities were involved in 11 patients and the right in 6.Twelve patients underwent primary exploration and neurolysis and 5 patients underwent secondary operation.Results:Preperativelys,8 patients were treated with large doses of oral narcotics to control their severe sciatic pain.Three of the 8 patients underwent patient-controlled analgesia and epidural analgesin.After operation,excellent and good rates of reduction and functional recovery of sciatic nerve were 94.1% and 88% respectively.Four patients still had sciatic pain and 2 patients failed to recover.Sciatic nerve function improved within 3-6 months after surgery in 11 patients.Conclusions:Hip and pelivic fractures can result in sciatic nerve injury,especially common peroneal nerve injury and prognosis is poor.Open reduction and internal fixation combined with nerve exploration and neurolysis should be used as early as possible for severe sciatic pain.     

Post-transplant cyclophosphamide and bortezomib inhibit dendritic cell maturation and function and alter their IκB and NFκB

Impairing dendritic cell (DC) function to prevent graft versus host disease (GvHD) is an appealing concept. DC antigen presentation is NF-κB pathway-dependent and bortezomib might therefore play a role in preventing alloreactivity. We obtained DC from the blood of patients enrolled in a phase I study using post-transplant cyclophosphamide and bortezomib for prevention of GvHD. Control samples were obtained from patients receiving standard GvHD prevention regimen. Pre-treatment samples were also collected from enrolled patients. DC isolated on days + 1, + 4, and + 7 showed progressive decrease in the expression of maturation markers in comparison to control. In a DC–CD4 + mixed lymphocyte reaction (MLR) where DC isolated from the recipient blood before graft infusion were the stimulator cells, T cell proliferation measured by bromodeoxyuridine (BrdU) integration was decreased in samples obtained on days + 14 and + 21 in comparison to control group. Finally, measured by real-time PCR, the expression of IκB progressively increased while the expression of NF-κB decreased in DC on days + 1, + 4, and + 7, in comparison to pre-treatment paired controls. We conclude that our data further justify exploring the role of bortezomib in GvHD prevention and propose a novel mechanism of action of bortezomib in DC.     

Expression and significance of estrogen receptor α and β in prostate cancer and peri-cancer tissue

Objective To investigate the expression of estrogen receptor (ER) α and β in human prostate cancer (PC), peri-cancer tissue and benign prostatic hyperplasia (BPH) tissue, and to discuss the role of estrogen receptor in prostate cancer. Methods The expression of ERα and ERβ in PC (n=28), peri-cancer tissue (n=28) and BPH (n=29) were detected by immunohistochemistry with En vision method. The ERα and ERβ expression were compared among different tissues by chisquare. The relationship between ER expression and related clinicopathologic features was statistically analyzed by spearman rank collection. Results ERα was localized dominantly in the stromal cell of PC. There were significant differences of the expression of ERα in PC, peri-cancer tissue and BPH tissue (epithelial cell 0%, 14%, 24%, P＜0. 05; stromal cell 57%, 68%, 31%,P＜0. 05). ERβ was localized in both epithelial and stromal cell of PC. There were significant differences of the expression of ERβ in PC, peri-cancer tissue and BPH tissue (epithelial cell 39%, 64%, 29%, P＜0.01; stromal cell 50%, 75%, 79%, P＜0.05). There was a significant difference of the expression of ERβ in different Gleason scores of PC tissue. Conclusions ERα is localized in the stromal cell of PC tissue.ERβ is localized in both epithelial and stromal cell of PC tissue. The ERβ might be related to the tumor differentiation of PC.     

Expression and significance of estrogen receptor α and β in prostate cancer and peri-cancer tissue

Objective To investigate the expression of estrogen receptor (ER) α and β in human prostate cancer (PC), peri-cancer tissue and benign prostatic hyperplasia (BPH) tissue, and to discuss the role of estrogen receptor in prostate cancer. Methods The expression of ERα and ERβ in PC (n=28), peri-cancer tissue (n=28) and BPH (n=29) were detected by immunohistochemistry with En vision method. The ERα and ERβ expression were compared among different tissues by chisquare. The relationship between ER expression and related clinicopathologic features was statistically analyzed by spearman rank collection. Results ERα was localized dominantly in the stromal cell of PC. There were significant differences of the expression of ERα in PC, peri-cancer tissue and BPH tissue (epithelial cell 0%, 14%, 24%, P＜0. 05; stromal cell 57%, 68%, 31%,P＜0. 05). ERβ was localized in both epithelial and stromal cell of PC. There were significant differences of the expression of ERβ in PC, peri-cancer tissue and BPH tissue (epithelial cell 39%, 64%, 29%, P＜0.01; stromal cell 50%, 75%, 79%, P＜0.05). There was a significant difference of the expression of ERβ in different Gleason scores of PC tissue. Conclusions ERα is localized in the stromal cell of PC tissue.ERβ is localized in both epithelial and stromal cell of PC tissue. The ERβ might be related to the tumor differentiation of PC.     

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Microsurgery and music: Parallel ideas and philosophy?

Can a philosophic analogy be drawn between music, a major formal area and discipline of the fine arts, and microsurgery, a branch of applied medical science and research? Is an interdisciplinary view of value? Should we look for links beyond the stated boundaries of each of these areas? These are questions that fascinate physicians who, apart from their professional scientific activity, are also involved in making music a way to enrich their lives. In this paper a medical researcher, physician, and composer gives words to his thoughts about the parallel ideas and philosophies of these two disciplines. © 2007 Wiley‐Liss, Inc. Microsurgery, 2007.     

“Half and half” woven and knitted Dacron grafts in the aortoiliac and aortofemoral positions: Seven and one-half years follow-up

One-hundred fifty-eight patients received specially manufactured aortoiliac or aortofemoral bifurcated grafts with one limb woven, the other knitted from Dacron. During an observation period ranging from 1,567 to 2,555 days (average 2,130 days) no statistically significant difference was found in either platelet adherence (30 patients studied) or in clinical patency. According to the results of the study, the type of graft (woven or knitted) did not seem to influence either platelet adherence or patency rate in the aortoiliac or aortofemoral positions.     

PTSD and traumatic brain injury: folklore and fact?

A number of controversies and debates have arisen over the years surrounding the dual diagnosis of post-traumatic stress disorder (PTSD) and traumatic brain injury (TBI). Many of these have centred around the around the degree of protection provided by TBI against developing the disorder. The following is brief review of the literature in this area to help resolve some of these issues and to address a number of specific challenges which arise when working with this patient group.     

Nutrition and fluid management in palliative medicine: do food and drink keep body and soul together?

Induction, implementation and continuation of an invasive nutrition or fluid administration in patients with advanced, life-limiting illnesses is an often controversial but also very emotionally discussed topic. This article summarizes the current state of knowledge based mainly on the European Society for Clinical Nutrition and Metabolism (ESPEN) guidelines and is intended as a simple guide for clinical practice. In the early phase of disease the induction of an invasive food and fluid administration may be indicated in order to prevent undernutrition and cachexia, to enhance compliance with anti-tumor treatment, to control some adverse effects of anti-tumor therapy and to improve the quality of life. If oral or enteral feeding is possible this should be preferred. Patients in the final stage of a disease rarely suffer from hunger or thirst. In this phase of the disease other things, such as monitoring of patients and relatives play a much more important role.     

Vitamin D and estrogen receptor-α genotype and indices of bone mass and bone turnover in Danish girls

Peak bone mass is a major determinant of osteoporosis risk in later life. It is under strong genetic control; however, little is known about the identity of the genes involved. In the present study, we investigated the relationship between polymorphisms in the genes encoding the vitamin D receptor (VDR) (FokI, TaqI) and estrogen receptor-α (ERα) (PvuII, XbaI), and bone mineral density (BMD), bone mineral content (BMC), and markers of bone turnover in 224 Danish girls aged 11–12 years. BMD and BMC were measured by dual-energy X-ray absorptiometry. Serum osteocalcin, 25(OH)D, and parathyroid hormone (PTH) were measured by ELISA assays and urinary pyridinium cross-links by HPLC. Physical activity, dietary calcium, and Tanner stage were assessed by questionnaire. In general, there were no significant differences in anthropometrical variables, physical activity, dietary calcium, serum 25(OH)D, or PTH among genotype groups. BMD or BMC of lumbar spine or whole body (adjusted for body and bone size and pubertal status) were not associated with VDR or ERα genotypes or the combination of these genotypes. This lack of association remained even after adjustment for dietary and environmental factors. VDR genotypes had no effect on bone turnover markers. XX and PP ERα genotypes were associated (P < 0.05) with reduced levels of urinary pyridinium cross-links, whereas serum osteocalcin was similar among genotypes. These findings suggest that the rate of bone resorption was influenced by ERα genotypes, even though these biochemical differences were not evident in bone mass indices.     

Spinal cord injury of cervical vertibrae and early diagnosis and treatment

Objective:To sum up clinical data and CT and MRI examination in 22 patients with spinal cord injury of cervical vertebrae.Methods:CT and MRI examination of the 22 patients with spinal cord injury of cervical vertebrae revealed that 16 patients had spinal comprssion caused by fracture dislocation and protrusion of intervertebral disc,5 suffered from intramedullary hemorrhage and 1 had complete spinal cord injury.A combined modality therapy of intramedullary and extramedullary decompression for spinal cord,skull traction and avoiding reinjury to spinal cord were used. Results:According to Frankel Classification,before operation 3 cases were classified as A degree,2 as B degree,5as C degree,8 as D degree and 4 as Edegree;after operation 2 were classified as A degree,1 as B degree,6 as C degree,6 as D degree and 7 as E degree.Conclusions:Early diagnosis and timely treatmetn,clear mechanism and degree of injury and early selection of effective treatment are very important in raising the rate of curing spinal cord injury.