Calcaneus Bone Mineral Density Using Single X-ray Absorptiometry in Japanese Women

Calcaneus bone mineral density (BMD) of 738 Japanese women (605 healthy and 133 with osteoporosis) was measured using single X-ray absorptiometry (SXA). A reference range of calcaneus BMD values for healthy Japanese women was established and the usefulness of this method for screening and diagnosis of osteoporosis was evaluated. There was no significant age change of calcaneus BMD prior to menopause, though values decreased significantly thereafter. BMD loss ratio was 1.7%/year in the 10 years after menopause. The reference range of calcaneus BMD was 410 ± 43 mg/cm², calculated from the mean BMD value of subjects whose ages ranged from 25 to 50 years old. The fracture threshold for the spine was established as 294 mg/cm², which corresponded to −2.67 SD from the average BMD of the young healthy women, and the odds ratio for spine fracture in the subjects with BMD lower than this threshold was 3.52 [95% CI (confidence interval) 1.34–9.26]. The spine fracture group showed statistically lower calcaneus BMD than the nonfracture group when subjects with adjusted age and body size were analyzed. There were no significant differences in the ROC analysis for spine fracture between calcaneus BMD and spine BMD. Therefore, calcaneus BMD is not readily affected by degenerative change or soft tissue, and the annual decrement rate (1.7%/year) can be detected easily and with low precision error (0.8%). These indices may prove useful for the screening and diagnosis of osteoporosis. Received: 16 September 1998 / Accepted: 28 January 1999     

加减下瘀血汤对低密度及氧化型低密度脂蛋白诱导小鼠肾足细胞血管内皮生长因子分泌的干预作用

目的：观察脂质低密度（LDL）及氧化型低密度脂蛋白（OX-LDL）对体外培养小鼠足细胞分泌血管内皮生长因子（VEGF）的影响及加减下瘀血汤的保护作用.方法：观察不同浓度下LDL和OX-LDL对小鼠肾足细胞分泌VEGF的影响,再用不同浓度加减下瘀血汤含药血清进行干预,分别用RT-PCR及ELISA检测足细胞分泌VEGF的变化.结果：LDL和OX-LDL可使肾足细胞分泌VEGF明显增高,且有浓度依赖性.中药加减下瘀血汤含药血清的干预可以明显抑制脂质诱导肾足细胞VEGF的高表达.结论：LDL和OX-LDL可以通过促进足细胞分泌VEGF增加而加重脂质肾毒性,而中药加减下瘀血汤可能通过抑制脂质诱导足细胞分泌过多VEGF,从而保护足细胞的脂质损伤.     

Number of osteoporotic sites and fracture risk assessment: a cohort study from the Manitoba Bone Density Program.

Site-discordance in BMD assessment is common and significantly affects patient categorization. Greater number of osteoporotic sites correlates with lower T scores at each index site. This largely explains the positive association between number of osteoporotic sites and fracture risk. INTRODUCTION: Site-discordance in BMD is common when used to classify patients based on a cut-off T score of -2.5. It is unclear whether fracture risk assessment is improved by considering BMD information from multiple sites. Our objective was to assess the contribution of number of osteoporotic sites to overall fracture risk. MATERIALS AND METHODS: The study population was drawn from the regionally based clinical database of the Manitoba Bone Density Program that includes all clinical DXA test results for the Province of Manitoba, Canada. Analyses were limited to 16,505 women>or=50 years of age at the time of baseline DXA of the spine (L1-L4) and hip (three sites). During follow-up (3.2+/-1.5 years), longitudinal health service records showed 765 women with at least one osteoporotic fracture code (hip, forearm, spine, or humerus). RESULTS: Of 5012 women classified as osteoporotic by at least one site (T score -2.5 or lower), almost one half (2370; 47%) were abnormal at only a single site. Among the 1856 women with an osteoporotic total hip measurement, mean total hip T scores decreased as the number of additional osteoporotic sites increased (-2.58, no other osteoporotic sites; -2.69, one other site; -2.87, two other sites; -3.17, three other sites; Spearman r=-0.44, p<0.0001). Age-adjusted fracture risk from a Cox proportional hazards model increased as the number of osteoporotic sites increased (p<0.0001), but number of osteoporotic sites was no longer an independent predictor after total hip BMD was included as a covariate (p=0.19). Covariate adjustment for other sites of BMD measurement attenuated, but did not eliminate, the effect of number of osteoporotic sites. CONCLUSIONS: Site-discordance is common and significantly affects patient categorization when different skeletal sites are used for diagnosis. Greater number of osteoporotic sites correlates with lower T scores at each index site. This largely explains the positive association between number of osteoporotic sites and fracture risk.     

Histologic upgrading of prostate cancer occurs frequently over a short period of time: Single hospital experiences of radical prostatectomy

A total of 163 patients with localized prostate cancer underwent retropubic radical prostatectomy and pelvic lymphadenectomy at a single hospital from 1989 to 1998. We reviewed the patients in terms of their prognostic factors and survival. The patients without advanced diseases were diagnosed as having prostate carcinoma, using either biopsies or transurethral resection of the prostate. The carcinomas were categorized into localized prostate carcinomas (stage A, B or C) as a result of digital rectal examinations, computed tomography scans and bone scans. The patients were informed of the risk of surgery and, if they agreed to sign the consent form, underwent radical prostatectomy under general and epidural anesthesia usually 2 months after a positive biopsy. The surgical specimens were sent for pathology and were graded according to classifications of well-, moderately and poorly differentiated adenocarcinoma. The patients were usually discharged from the hospital 2-3 weeks postoperatively and had regular follow-up treatment. The mean age (+/- SD) was 68.75 (+/- 5.59) years and the mean follow-up period was 47.2 months. There was a significant difference (34.4%) in pathologic grades between biopsy and surgical specimen. In a quarter of the patients (approximately 26.4%) upgrading of the surgical report occurred despite neoadjuvant therapy. Three-year, 5-year and 7-year actuarial survival rates were 91.8%, 79.9% and 71.9%, respectively. Patients with organ-confined prostate cancer underwent radical prostatectomy and survived a fairly good period of time. Histologic upgrading was frequently observed within a short period of time (2 months).     

Transanal Endoscopic Microsurgery for Rectal Tumours Using a Single Incision Laparoscopic Port

Background : Transanal endoscopic microsurgery (TEM), first described by Buess enables a less aggressive approach of benign rectal lesions, or even early rectal cancer in a curative intent.

Materials and methods : The SILS Port, initially designed for laparoscopic surgery, was successfully used for 20 TEM procedures in 16 patients. Local resection was sufficient in 15 procedures (benign tumours or pT1) out of 20, whereas 5 TEM operations required additional surgery: 3 rectal resections (pT1Nx, pT1sm3Nx and pT2N1) and 1 TEM revision (1 patient refused the rectal resection (pT1Nx).

Postoperative complications following Dindo-Clavien were: grade II in 4 patients (pain: 2; fever: 1; bleeding: 1) and grade IIIb in 2 patients (bleeding). No long term faecal incontinence was noted.

Conclusion : TEM using the SILS Port is a safe and effective procedure for local resection of benign and certain malignant tumours. Using such a cheaper device, TEM procedure could be available in any operating theatre.     

Comparing GFR Estimating Equations Using Cystatin C and Creatinine in Elderly Individuals

Current guidelines recommend reporting eGFR using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations unless other equations are more accurate, and recommend the combination of creatinine and cystatin C (eGFRcr-cys) as more accurate than either eGFRcr or eGFRcys alone. However, preferred equations and filtration markers in elderly individuals are debated. In 805 adults enrolled in the community-based Age, Gene/Environment Susceptibility (AGES)-Reykjavik Study, we measured GFR (mGFR) using plasma clearance of iohexol, standardized creatinine and cystatin C, and eGFR using the CKD-EPI, Japanese, Berlin Initiative Study (BIS), and Caucasian and Asian pediatric and adult subjects (CAPA) equations. We evaluated equation performance using bias, precision, and two measures of accuracy. We first compared the Japanese, BIS, and CAPA equations with the CKD-EPI equations to determine the preferred equations, and then compared eGFRcr and eGFRcys with eGFRcr-cys using the preferred equations. Mean (SD) age was 80.3 (4.0) years. Median (25th, 75th) mGFR was 64 (52, 73) ml/min per 1.73 m², and the prevalence of decreased GFR was 39% (95% confidence interval, 35.8 to 42.5). Among 24 comparisons with the other equations, CKD-EPI equations performed better in 9, similar in 13, and worse in 2. Using the CKD-EPI equations, eGFRcr-cys performed better than eGFRcr in four metrics, better than eGFRcys in two metrics, and similar to eGFRcys in two metrics. In conclusion, neither the Japanese, BIS, nor CAPA equations were superior to the CKD-EPI equations in this cohort of community-dwelling elderly individuals. Using the CKD-EPI equations, eGFRcr-cys performed better than eGFRcr or eGFRcys.     

Safe and Effective One-Session Fractional Skin Resurfacing Using a Carbon Dioxide Laser Device in Super-Pulse Mode: A Clinical and Histologic Study

Carbon dioxide (CO₂) laser ablative fractional resurfacing produces skin damage, with removal of the epidermis and variable portions of the dermis as well as associated residual heating, resulting in new collagen formation and skin tightening. The nonresurfaced epidermis helps tissue to heal rapidly, with short-term postoperative erythema. The results for 40 patients (8 men and 32 women) after a single session of a fractional CO₂ resurfacing mode were studied. The treatments included resurfacing of the full face, periocular upper lip, and residual acne scars. The patients had skin prototypes 2 to 4 and wrinkle degrees 1 to 3. The histologic effects, efficacy, and treatment safety in various clinical conditions and for different phototypes are discussed. The CO₂ laser for fractional treatment is used in super-pulse mode. The beam is split by a lens into several microbeams, and super-pulse repetition is limited by the pulse width. The laser needs a power adaptation to meet the set fluence per microbeam. Laser pulsing can operate repeatedly on the same spot or be moved randomly over the skin, using several passes to achieve a desired residual thermal effect. Low, medium, and high settings are preprogrammed in the device, and they indicate the strength of resurfacing. A single treatment was given with the patient under topical anesthesia. However, the anesthesia was injected on areas of scar tissue. Medium settings (2 Hz, 30 W, 60 mJ) were used, and two passes were made for dark skins and degree 1 wrinkles. High settings (2 Hz, 60 W, 120 mJ) were used, and three passes were made for degree 3 wrinkles and scar tissue. Postoperatively, resurfaced areas were treated with an ointment of gentamycin, Retinol Palmitate, and DL-methionine (Novartis; Farmaceutics, S.A., Barcelona, Spain). Once epithelialization was achieved, antipigment and sun protection agents were recommended. Evaluations were performed 15 days and 2 months after treatment by both patients and clinicians. Treatment improved wrinkle aspect and scar condition, and no patient reported adverse effects or complications, irrespective of skin type, except for plaques of erythema in areas that received extra laser passes, which were not seen at the 2-month assessment. The results evaluated by clinicians were very much in correlation with those of patients. Immediately after treatment, vaporization was produced by stacked pulses, with clear ablation and collateral heat coagulation. An increased number of random pulses removed more epidermis, and with denser pulses per area, a thermal deposit was noted histologically. At 2 months, a thicker, multicelluar epidermis and an evident increase in collagen were observed. Fractional CO₂ laser permits a variety of resurfacing settings that obtain safe, effective skin rejuvenation and correct scar tissue in a single treatment.     

Long-term Parenteral Nutrition Using a Mixture of Fat, Amino Acids and Carbohydrates in a Single Three-Litre Bag

Long-term parenteral nutrition is today an established therapy, both in hospitals and at home. A variety of patients with chronic intestinal dysfunction, leading to malnutrition, are candidates for this treatment.
There are however several problems related to this therapy, some of which can be attributed to the infusion system. In Scandinavia most patients receiving parenteral nutrition are given separate bottles of aminoacids, fat-emulsions and carbohydrates. This method has several disadvantages. A new system which includes premixing of all nutrients in a single bag is discussed. Nutrients are mixed in three litre bags in the hospital pharmacy, under optimal conditions, and can be stored refrigerated for several days.     

Diffusion in Ni-Based Single Crystal Superalloys with Density Functional Theory and Kinetic Monte Carlo Method

In the paper, we focus on atom diffusion behavior in Ni-based superalloys, which have important applications in the aero-industry. Specifically, the expressions of the key physical parameter – transition rate (jump rate) in the diffusion can be given from the diffusion theory in solids and the kinetic Monte Carlo (KMC) method, respectively. The transition rate controls the diffusion process and is directly related to the energy of vacancy formation and the energy of migration of atom from density functional theory (DFT). Moreover, from the KMC calculations, the diffusion coefficients for Ni and Al atoms in the γ phase (Ni matrix) and the $γ^′$ phase (intermetallic compound Ni₃Al) of the superalloy have been obtained. We propose a strategy of time stepping to deal with the multi-time scale issues. In addition, the influence of temperature and Al concentration on diffusion in dilute alloys is also reported.     

Resolving Human Lactation Heterogeneity Using Single Milk-Derived Cells,a Resource at the Ready

Journal of Mammary Gland Biology and Neoplasia - Single cell RNA sequencing (scRNAseq) of human milk-derived cells (HMDCs) makes highly detailed analyses of the biology of human lactation possible....     

膨胀式椎弓根螺钉在腰椎疾患中的应用

目的探讨膨胀式椎弓根螺钉（expensive pedicle screw,EPS）在腰椎不稳症内固定治疗中的初步疗效。方法自2005年6月至2008年3月,在27例腰椎不稳症患者经椎弓根内固定手术治疗中采用EPS,其中男11例,女16例;年龄25～72岁,平均49．4岁。病程6个月～7年,平均29．4个月。患者应用EPS的合并指征依次是骨质疏松14例,对普通椎弓根螺钉固定翻修3例,术中改钉道重新植钉4例,腰骶椎锚定融合3例．增加额外的矫形力3例。采用JOA临床腰椎手术评分系统、椎体间骨性融合X线CookSD标准对疗效进行综合评定。同时观察内固定器械相关情况。结果术后1例椎间盘突出翻修病例合并脑脊液漏,经保守治疗。于术后23d切口延期愈合,未合并感染;其余患者切口均一期愈合。末见神经、脏器损伤等并发症发生。所有病例平均随访17．8个月（12～39个月）。27例患者所用EPS均完全膨胀,共81枚,每例用1～7枚不等,平均3．1枚。JOA改善率显效16例,有效7例,总有效率85．2％（23／27）,其中24例达融合X线标准,融合率88．9％。1例螺钉松动、拔出,融合失败,滑脱复发;1例因术后局部不适于术后3个月取除内固定;1例固定稳定但无融合X线证据。结论本研究表明,在合并有骨质疏松等骨质条件较差的情况下,对腰椎不稳症的内固定治疗采用EPS是有效的;EPS的应用拓宽了经椎弓根内固定技术的适用范围。     

Adult Porcine Islet Isolation Using a Ductal Preservation Method and Purification With a Density Gradient Composed of Histidine-Tryptophan-Ketoglutarate Solution and Iodixanol

Background

Given the fragility of adult porcine islets, reduction of shearing stress in islet purification using histidine-tryptophan-ketoglutarate (HTK) solution and iodixanol could be an effective strategy. We examined the effect of ductal preservation with HTK solution and an islet purification protocol that utilizes HTK solution and iodixanol in adult porcine islet isolation.

Methods

Islets were isolated with a modified Ricordi method using adult Prestige World Genetics (PWG) and Yucatan pigs. The discontinuous density gradient was composed of either HTK solution/iodixanol (n = 23, iodixanol group) or Hank's balanced salt solution (HBSS)/Ficoll (n = 17, Ficoll group). In the iodixanol group, ductal injection of HTK solution was performed before purification.

Results

In PWG pigs, significantly higher islet yield after purification (3480 ± 214.2 islet equivalent [IEQ]/g, P = .003) and higher recovery rate (85.45% ± 3.49%, P = .0043) were obtained from the HTK/iodixanol group as compared to the HBSS/Ficoll group (1905 ± 323.2 IEQ/g, and 67.22% ± 4.77%, respectively). Similar results were obtained in Yucatan pigs with greater body weight.

Conclusion

Ductal preservation and iodixanol-based islet purification using HTK solution improved the yield of adult porcine islet isolation compared to the conventional method using HBSS and Ficoll. The results of this study support the feasibility of an adult porcine islet isolation protocol using HTK solution and iodixanol, which have the favorable physical properties.     

Single Needle Venovenous Extracorporeal Membrane Oxygenation Using a Nonocclusive Roller Pump for Rescue in Infants and Children

Abstract: In 1993, J.Y. Chevalier described a single needle venovenous extracorporeal membrane oxygenation (ECMO) system using a nonocclusive roller pump and alternating clamps for pulmonary support in neonates. We modified this system to use it in older children as well and for additional indications. Introducing a double raceway and 2 different sizes of tubing sets and performing percutaneous approach, we treated 21 children (age 1 day to 49 months) using this system. Indications for treatment were hypoxia and hypoxic induced myocardial dysfunction resulting from pulmonary failure, sepsis, and congenital defects. Of the chiIdren treated for neonatal indications. 7/9 survived. For 2 children ECMO was terminated because of intraventricular hemorrhage (TVH). In the pediatric group 5/7 of the children could be weaned from ECMO, and 2 children died after more than 30 days on ECMO. Two of the children who had been almost completely weaned died later because of therapy withdrawal following a brain death diagnosis. In the cardiac group, 3/5 of the children survived. We conclude that the described system is an effective venovenous ECMO system that reduces invasivity and expenditure.