Conjoint bicondylar Hoffa fracture in an adult

Conjoint bicondylar Hoffa fracture is an extremely rare injury. Only one case has been reported previously in the pediatric age group. We describe this injury in a 17-year-old male who presented following a fall with direct impact on his semiflexed right knee. Plain radiographs were inadequate to define the exact pattern of injury. Computed tomographic (CT) scans demonstrated the coronal fracture involving both the femoral condyles which were joined by a bridge of intact bone. The patient was treated with open reduction and internal fixation using swashbuckler (modified anterior) approach. Union occurred within 3 months and at final followup (at 18 months) the patient had a good clinical outcome. The possible mechanism of injury is discussed.     

Experimental Evaluation of a New Single Wire Stainless Steel Fishscale Coronary Stent (Freedomª)

Recent randomized clinical trials revealed a significant reduction in angiographic restenosis rates when adjunctive stenting was performed after conventional coronary balloon angioplasty. Current approved coronary stents are however hampered by their rigidity, limiting their trackability in tortuous vessels and furthermore, needing high pressure deployment for optimal vessel apposition. New coronary stents are currently under development, using more biocompatible metal alloys and/or designs which better align to the vessel wall at moderate deployment pressures. We evaluated the safety, efficacy, angiographic and histological effect of a new stainless steel fishscale designed stent (Freedoma, Global Therapeutics, Co., USA) in a porcine coronary and peripheral artery model. Implantation in the right coronary artery was successful in all 20 pigs. Control angiograms at 6 weeks follow-up demonstrated patent vessels and morphologic evaluation showed only a mild fibromuscular neointimal response resulting in an area stenosis of 28.7 +/- 0.18% and a mean neointimal hyperplasia of 0.18 +/- 0.25 mm. Comparison with the Palmaz-Schatza coronary stent in a porcine peripheral artery model demonstrated similar quantitative angiographic and morphologic vessel analysis results. Also the morphometric data were comparable. Area stenosis: Palmaz-Schatz: 37 +/- 0.24%, Freedom: 21 +/- 0.14%, p = 0.07. Mean neointimal hyperplasia: Palmaz-Schatz: 0.33 +/- 0.24 mm, Freedom: 0.18 +/- 0.08 mm, p = 0.08. CONCLUSION: Freedom coronary stent implantation in a porcine model resulted in a high procedural success without subacute thrombotic occlusions, despite no further anticoagulation nor antiplatelet therapy. Six weeks histopathological and morphometric evaluation demonstrated only a mild fibromuscular neointimal hyperplasia.     

Cardiovascular Risk Stratification and Management in Pre-Diabetes

Prediabetes, covering individuals with impaired fasting glycemia, impaired glucose tolerance, or high-risk HbA_1c levels, is associated with a ～20 % increased risk of developing cardiovascular disease (CVD) compared with normoglycemic individuals. It is well-known that lifestyle or pharmacologic interventions can prevent diabetes in prediabetic people; however, the evidence is less clear regarding prevention of CVD. Most diabetes prevention trials have failed to show beneficial effects on CVD morbidity and mortality despite significant improvements of CVD risk factors in individuals with prediabetes. Another challenge is how to estimate CVD risk in prediabetic people. In general, prediction models for CVD do not take glucose levels or prediabetes status into account, thereby underestimating CVD risk in these high-risk individuals. More evidence within risk stratification and management of CVD risk in prediabetes is needed in order to recommend useful and effective strategies for early prevention of CVD.     

Microarray-based classification of diffuse large B-cell lymphoma

OBJECTIVE: Hierarchical clusterings of diffuse large B-cell lymphoma (DLBCL) based on gene expression signatures have previously been used to classify DLBCL into Germinal Center B-cell (GCB) and Activated B-cell (ABC) types. To examine if it was feasible to perform a cross-platform validation on the Affymetrix HG-U133A oligonucleotide arrays and improve the classification, we determined the expression profiles of pretreatment, diagnostic samples from 52 primary nodal DLBCL. METHODS AND RESULTS: First, three previously published gene lists were converted to the HG-U133A probe sets and used for hierarchical clustering. In this way, three subtypes, including the GCB type (n = 20), the ABC type (n = 25) and an intermediate group, Type-3 (n = 5), were distinguished. The CD10 and Bcl-6 expression as well as t(14;18) translocation were prevalent, but not exclusive to the GCB type. By contrast, MUM1 was only expressed in the ABC and in Type-3 samples. The 5-year survival was similar between the groups, but GCB patients showed a better initial response to CHOP or CHOP-like regimens than the remaining patients and tended to have less advanced disease and lower IPI scores. As a next step, an improved set of classifier genes was generated by analysis of 34 patients that were consistently classified as GCB or ABC in the above analyses. Seventy-eight genes were selected and demonstrated on two previously published data sets (Shipp et al. Nat Med 2002;8:68-74 and Houldsworth et al. Blood 2004;103:1862-1868) to exhibit a higher specificity than the original gene lists. CONCLUSION: We conclude that gene expression profiling with Affymetrix Genechips is efficient to distinguish between GCB and ABC types of DLBCL and that these are likely to represent separate biological entities. The Genechip platform is highly standardised and therefore useful for future prospective investigations to establish the value of gene expression profiling in the clinical management of DLBCL.     

Recombinant rat stem cell factor synergizes with recombinant human granulocyte colony-stimulating factor in vivo in mice to mobilize peripheral blood progenitor cells that have enhanced repopulating potential

Splenectomized mice treated for 7 days with pegylated recombinant rat stem cell factor (rrSCF-PEG) showed a dose-dependent increase in peripheral blood progenitor cells (PBPC) that have enhanced in vivo repopulating potential. A dose of rrSCF-PEG at 25 micrograms/kg/d for 7 days produced no significant increase in PBPC. However, when this dose of rrSCF-PEG was combined with an optimal dose of recombinant human granulocyte colony-stimulating factor (rhG-CSF; 200 micrograms/kg/d), a synergistic increase in PBPC was observed. Compared with treatment with rhG-CSF alone, the combination of rrSCF-PEG plus rhG-CSF resulted in a synergistic increase in peripheral white blood cells, in the incidence and absolute numbers of PBPC, and in the incidence and absolute numbers of circulating cells with in vivo repopulating potential. These data suggest that low doses of SCF, which would have minimal, if any, effects in vivo, can synergize with optimal doses of rhG-CSF to enhance the mobilization of PBPC stimulated by rhG-CSF alone.     

Intravascular Low Power Red Laser Light as an Adjunct to Coronary Stent Implantation Evaluated in a Porcine Coronary Model

BACKGROUND: It is believed that restenosis following coronary interventions is the result of endothelial denudation that leads to thrombus formation, vascular remodeling, and smooth muscle cell proliferation. We previously demonstrated that low power red laser light (LPRLL) irradiation enhances endothelial cell growth in vitro and in vivo and reduces restenosis in a small animal model. The present study investigated the effectiveness of intravascular LPRLL therapy in the reduction of restenosis following stenting in a porcine model. METHODS AND RESULTS: Stents were placed in the right coronary artery of domestic cross-bred pigs. After stent deployment, an additional inflation was performed with the laser-balloon. In group I (n = 18) no LPRLL was used; group II (n = 10) received LPRLL dosage of 10 mW for 1 minute; group III (n = 10) received LPRLL dosage of 34 mW for 1 minute. Quantitative coronary analysis of the stented vessel was performed before, immediately after stenting, and at 6 weeks. The pigs were sacrificed and histologic and planimetric analysis conducted. At 6 weeks, minimal luminal stent diameter was significantly narrower in the control group compared to the higher dose group (p < 0.05), late loss correlated inversely proportional to the dose used (r = 0.9; p < 0.03), these results were confirmed by morphometric analysis. Neointimal area was also significantly decreased in the higher dose group. CONCLUSIONS: Intravascular LPRLL contributes to reduction of angiographic restenosis and hyperplastic reaction in this animal model and seems to be dose dependent.     

Overweight children's response to an annual health dialogue with the school nurse

Borup IK, Holstein BE. International Journal of Nursing Practice 2010; 16 : 359–365
Overweight children's response to an annual health dialogue with the school nurse The objective of this study was to compare overweight and normal weight pupils' perceived outcome of the health dialogue with the school nurse. A random sample of schools in Denmark, where pupils age 11.6, 13.6 and 15.6 years old, answered a questionnaire (response rate 88%, n = 5205). The independent variable weight group was measured by self‐reported height and weight and calculated as body mass index. Perceived outcome of the dialogue was measured as: (i) reflected on the dialogue; (ii) discussed the content with parents; (iii) followed the advice of the nurse; and (iv) visited the nurse again. Overweight boys reflected (odds ratio (OR) = 1.73), discussed the dialogue with at least one parent (OR = 1.38), followed the nurse's advice (OR = 1.42) and visited the nurse again (OR = 2.68). There was a significant statistical link between age group and perceived outcome among the boys, but not girls. The 11‐year‐old overweight boys perceived more positive effects from the dialogue with the school nurse.