Effects of Beraprost Sodium on Subjective Symptoms in Diabetic Patients with Peripheral Arterial Disease

Background

This study evaluated the effects of Beraprost sodium (Berasil) on subjective leg symptoms in patients with peripheral arterial disease caused by diabetes mellitus.

Methods

Ninety-four diabetic patients with peripheral arterial disease were treated with Beraprost in a fixed-dose, prospective, multicenter, cohort study. Beraprost (40 µg) was administered orally 3 times daily (120 µg/day) for 12 weeks. We developed a new disease-specific symptom questionnaire, which evaluated the effect of peripheral arterial disease on leg discomfort in daily life and assessed therapeutic responses to treatment. Patients were asked for their subjective assessment of symptoms on a written questionnaire before treatment and after 12 weeks of therapy.

Results

There was significant improvement in all estimated subjective symptoms (burning, coldness, edema, exertional pain, stabbing, and paresthesias) in the lower extremities at 12 weeks (p < 0.001). There were 18 patients with neuropathy in whom significant improvement was noted for 6 subjective symptoms at 12 weeks (p < 0.05). Adverse events considered to be drug-related were observed in 4 patients (4.3%), all of which were mild and resolved with discontinuation of the medication.

Conclusions

Beraprost is effective as a treatment for improving various subjective symptoms in the lower extremities, such as burning, coldness, edema, exertional pain, stabbing, and paresthesias, in diabetic patients with peripheral arterial disease.     

Negative Effect of Rapidly Resorbing Properties of Bioactive Glass-Ceramics as Bone Graft Substitute in a Rabbit Lumbar Fusion Model

Background

Bioactive glass-ceramics have the ability to directly bind to bones and have been widely used as bone graft substitutes due to their high osteoconductivity and biocompatibility. CaO-SiO₂-P₂O₅-B₂O₃ glass-ceramics are known to have good osteoconductivity and are used as bone graft extenders.

Methods

This study aimed to evaluate the effects of the resorbing properties of glass-ceramics in bone fusion after producing and analyzing three types of CaO-SiO₂-P₂O₅-B₂O₃ glass-ceramics with high osteoconductivity that had enhanced resorption by having an increased B₂O₃ content. The three types of CaO-SiO₂-P₂O₅-B₂O₃ glass-ceramics with B₂O₃ contents of 8.0, 9.0, and 9.5 weight % were designated and grouped as P20B80, P10B90, and P5B95, respectively. Glass-ceramic types were tested for fusion rates and bone formation by employing the lumbar 5-6 intertransverse process fusion model in 51 New Zealand male rabbits. Bioactivity was assessed by soaking in simulated body fluid (SBF).

Results

In vitro study results showed sufficient hydroxycarbonate apatite layer formation occurred for P20B80 in1 day, for P10B90 in 3 days, and for P5B95 in 5 days after soaking in SBF. For the rabbit lumbar spine posterolateral fusion model, the autograft group recorded a 100% fusion rate with levels significantly higher than those of P20B80 (29.4%), P10B90 (0%), and P5B95 (14.3%), with high resorbing properties. Resorbing property differences among the three glass-ceramic groups were not significant. Histological results showed new bone formation confirming osteoconductivity in all three types of glass-ceramics. Radiomorphometric results also confirmed the resorbing properties of the three glass-ceramic types.

Conclusions

The high resorbing properties and osteoconductivity of porous glass-ceramics can be advantageous as no glass-ceramics remain in the body. However, their relatively fast rate of resorption in the body negatively affects their role as an osteoconductive scaffold as glass-ceramics are resorbed before bony fusion.     

A simple method to pass a pulmonary artery flotation catheter rapidly into the pulmonary artery in anaesthetized patients

Background. In some patients passage of a pulmonary artery flotationcatheter (PAFC) into the pulmonary artery may be difficult andtime consuming and the prolonged manipulation can cause ventriculararrhythmias. A simple clinical method used during general anaesthesiais presented to allow rapid passage of a PAFC into the pulmonaryartery. Methods. The operating table is positioned head up and slightlyright side down to position the pulmonary valve at the highestlevel possible. When the balloon catheter is in the right ventricularoutflow tract (indicated by premature ventricular contractions)the ventilator is paused in inspiration and the balloon cathetersimultaneously passed into the pulmonary artery. Results. The manoeuvre shortens the time necessary to pass thecatheter into the pulmonary artery and may reduce ventriculararrhythmias. Over 5 yr, 105 PAFCs were inserted with this methodwithout major complications. Conclusion. This method may reduce the risk of ventricular arrhythmias,and could be particularly useful in high-risk critically illpatients. Br J Anaesth 2003; 90: 794–6     

Fibronectin fragments active in chondrocytic chondrolysis can be chemically cross-linked to the alpha5 integrin receptor subunit

OBJECTIVE: To determine whether fibronectin fragments (Fn-f) known to enhance cartilage matrix degradation and to alter chondrocyte metabolism, bind on the chondrocyte cell surface close enough to the alpha(5)beta(1) fibronectin (Fn) receptor to be chemically cross-linked to it. DESIGN: Biotinylated Fn-fs were added to chondrocytes, followed by cross-linking with dithiobissulfosuccinimidyl propionate, and the resultant alpha(5) complexes trapped on to antialpha(5)-agarose. Adherent material was analysed by probing with avidin-HRP. In a more specific approach in which only proximal targets could be cross-linked, photoaffinity labeled Fn-fs or Fn were added to cells, the derivatives activated and the cross-linked material analysed. Interaction of biotinylated Fn-fs and Fn with insolubilized alpha(5)beta(1) receptor was also visualized and quantified. RESULTS: Biotinylated Fn-fs and Fn, but not a control of BSA, were cross-linked to alpha(5) protein in the presence of the propionate. Photoaffinity label Fn-f and Fn, but not BSA, were cross-linked to alpha(5) protein as well. Interaction was decreased by addition of an excess of unlabeled Fn-f or Fn. Fn-fs bound to alpha(5)beta(1)-agarose, although the affinity was 30-fold weaker and the stoichiometry 20-fold greater when the smallest Fn-f was compared to native Fn. CONCLUSIONS: These data are consistent with a role for the alpha(5) subunit in Fn-f activities and suggest that the Fn-fs bind proximal or directly to alpha(5) receptors. The weaker, higher stoichiometry interaction of Fn-fs with receptor suggests that fragmentation has allowed de novo interactions not possible in native Fn.     

Role of admission gas exchange measurement in predicting congenital diaphragmatic hernia survival in the era of gentle ventilation

Background/Purpose

Neonates with significant congenital diaphragmatic hernia (CDH) require cardiopulmonary support. Management has been characterized by progressive abandonment of hyperventilation. Ability to prognosticate outcomes using measures of ventilation and oxygenation with gentle ventilation remains unclear. We sought to determine whether assessment of gas exchange at the time of NICU admission is predictive of survival in this current era.

Methods

Neonates with CDH admitted to a Children’s Hospital from 1995 to 2006 were evaluated for demographics, blood gas (ABG) measurements and ventilator settings for the first 48 hours, and discharge outcome.

Results

One-hundred-and-nineteen CDH patients were admitted, 88 (74%) survived. Mean admission ABG pCO₂ was higher in infants who died compared to survivors (86 ± 48 versus 49 ± 20, p ≤ 0.001); positive predictive value (PPV) for mortality of pCO₂ ≥ 80 mmHg was 0.71. Mean first hour preductal oxygen saturation (preductalO₂Sat) was lower in infants who died compared to survivors (81 ± 17 versus 97 ± 5, p < 0.001); PPV for mortality of preductalO₂Sat < 85% was 0.82. Eleven patients met both pCO₂ and preductalO₂Sat criteria, and 10 (91%) died, PPV of 0.92. Within hours of admission, pCO₂ and preductalO₂Sat differences between survivors and nonsurvivors lost significance.

Conclusion

Admission pCO₂ and preductalO₂Sat may be useful in predicting survival in neonatal CDH. The differential in gas exchange between survivors and nonsurvivors loses significance with contemporary neonatal care.     

The treatment of mild endometriosis with laser laparoscopy: a two-step treatment analysis of patients whose primary therapy was successful.

OBJECTIVES: The most advantageous treatment for pelvic endometriosis that is not extensive has long been the subject of debate. In recent years, the ability to detect atypical presentations has allowed the gynecological surgeon to treat this entity more readily. The treatment in the past has been concerned with the singular treatment being applied at the time, not on the prior treatment effects on current therapy. The purpose of the current study was to see whether previous successful treatment modalities affected the success of subsequent laparoscopic laser fulguration treatment of endometriosis. METHODS: Patients who were previously treated for their endometriosis (minimal and mild) and had success in achieving pregnancy were treated for their disease after failing to become pregnant after delivery. They were treated with laparoscopic laser fulguration of the disease and the results were examined by chi-square (chi2) analysis. RESULTS: There appears to be no difference in current pregnancy rates in patients who were successfully treated in the original treatment for endometriosis, no matter which of the therapies had been used. CONCLUSION: If endometriosis is diagnosed at the time of laparoscopy and is easily amenable to treatment, it should be treated at the time of surgery regardless of prior treatment and results.     

Risk factors for prolonged ICU stay in patients following coronary artery bypass grafting with a long duration of cardiopulmonary bypass

Purpose Risk factors for prolonged stay in the intensive care unit (ICU) in patients following coronary artery bypass grafting (CABG) have been reported in many previous studies. However few have focused on circulatory and respiratory status as immediate postoperative risk factors. Therefore we examined immediate postoperative risk factors for prolonged ICU stay after CABG with a long duration of cardiopulmonary bypass (CPB).Methods We studied retrospectively 100 consecutive patients undergoing elective CABG with CPB. Patients were excluded from this study if the duration of aortic cross-clamping was less than 60min. Patients were divided into three groups according to the duration of the ICU stay. Patients in group A (n = 68) were discharged from the ICU on the next morning after surgery, those in group B (n = 19) stayed for 3 days, and group C (n = 13) stayed for more than 3 days. Perioperative variables were compared among the three groups and we demonstrated risk factors for prolonged (more than 3 days) ICU stay.Results There were significant differences in duration of CPB (157 ± 34 versus 184 ± 48 minutes, P < 0.05) and aortic cross-clamping (119 ± 32 versus 141 ± 40min) between groups A and B. On the other hand, there were significant differences in age (62.8 ± 7.8 versus 67.4 ± 6.2 years), mean pulmonary artery pressure (MPAP) (17 ± 2 versus 22 ± 3mmHg), and Pa_{O 2}/FI _{O 2} (PF ratio) (409 ± 94 versus 303 ± 108mmHg) on admission to the ICU between groups A and C. There were no significant differences in intraoperative fluid balance and duration of CPB. Multiple logistic regression analysis identified age (>65 years), MPAP (>21mmHg), and PF ratio (<300mmHg) as independent risk factors for more than a 3-day ICU stay.Conclusion Advanced age, increased MPAP, and decreased PF ratio on admission to the ICU were significant risk factors for a prolonged ICU stay of more than 3 days.