<Superscript>1</Superscript>H MAS and <Superscript>1</Superscript>H → <Superscript>31</Superscript>P CP/MAS NMR Study of Human Bone Mineral

Chemical structure of human bone mineral was studied by solid-state nuclear magnetic resonance (NMR) with magic-angle spinning (MAS). Trabecular and cortical bone samples from adult subjects were compared with mineral standards: hydroxyapatite (HA), hydrated and calcined, carbonatoapatite of type B with 9 wt% of CO ₃ ^2– (CHA-B), brushite (BRU) and mixtures of HA with BRU. Proton spectra were acquired with excellent spectral resolution provided by ultra-high speed MAS at 40 kHz. 2D ¹H-³¹P NMR heteronuclear correlation was achieved by cross-polarization (CP) under fast MAS at 12 kHz. ³¹P NMR was applied with CP from protons under slow MAS at 1 kHz. Appearance of ³¹P rotational sidebands together with their CP kinetics were analyzed. It was suggested that the sidebands of CP spectra are particularly suitable for monitoring the state of apatite crystal surfaces. The bone samples appeared to be deficient in structural hydroxyl groups analogous to those in HA. We found no direct evidence that the HPO ₄ ^2– brushite-like ions are present in bone mineral. The latter problem is extensively discussed in the literature. The study proves there is a similarity between CHA-B and bone mineral expressed by their similar NMR behavior.     

The Polysoft<Superscript>®</Superscript> patch: prospective evaluation of feasibility,postoperative pain and recovery

Introduction

The Polysoft^® patch was conceived to associate the advantages of placement of the patch in the preperitoneal space (PPS) and easiness of the inguinal incision. The aim of this study was to evaluate prospectively the feasibility and postoperative outcome of this method.

Methods

Two hundred Polysoft repairs were performed in 191 consecutive patients with Nyhus types III and IV hernias. The anesthesia was spinal in 146 patients (76.4%), local in 36 (18.8%) and general in 9 (4.7%). The patch was placed in the PPS through the hernial orifice in the fascia in direct hernias and through the internal orifice in indirect ones. The technical points and postoperative course data were prospectively recorded and postoperative pain was assessed daily by visual analogue scale (VAS) in 25 patients.

Results

The method was achieved in all the cases. The type of the hernias was as follows: 59 direct, 129 indirect (including 28 pantaloon and 16 sliding), 3 inguino-femoral and 9 recurrent. The size of the patch used was medium in 152 cases (76%) and large in 48 (24%). The large patch was used more in pantaloon, sliding and inguino-femoral hernias. In direct hernias the patch was not split; in indirect hernias the patch was split (so the wings recreate a new internal orifice around the spermatic cord) in 79 cases (61.2%) and not split (with the cord parietalized) in 50 cases (38.8%). The length of operation, postoperative hospital stay, return to daily activity, to work and analgesics consumption were [median ± SD (extremes)]: 35 min ± 9.1 (20–60), 1 day ± 0.4 (0–5), 3 days ± 1.8 (0-8), 15 days ± 9.7 (1–30) and 3 days ± 2.3 (0–10), respectively. The median number of analgesics units was 8 ± 5.9 (0–32). The values of pain assessed daily by VAS (on 100) varied from 20.4 ± 19.7 (0–60) at day 0, 25.0 ± 24.5 (0–80) at day 1 to 7.5 ± 13.7 (0–50) at day 7; the mean value for the week was 16.7 ± 16.7 (0–57). There were 14 (7%) benign postoperative complications.

Conclusion

This study permitted the definition of some technical points and showed that the Polysoft patch can be used for all types of hernias with a weak posterior wall, including complex cases (big scrotal, pantaloon, sliding and recurrent), with a low risk of postoperative complications, a low level of postoperative pain and a short recovery time.

     

Gene expressions and mechanical functions of α<Subscript>1</Subscript>-adrenoceptor subtypes in mouse ureter

Purpose  

This study was performed to characterize the α₁-adrenoceptor subtypes in mouse ureters as regards gene expressions and contractile functions.     

The Lap-Band<Superscript>®</Superscript> System in a North American Population

Background: European and Australian results with laparoscopic adjustable gastric banding (LAGB) using the Lap-Band^? (Inamed Health, Santa Barbara, CA) have been impressive, with over 100,000 procedures completed at this writing. However, prior to U.S. FDA approval in June 2001, U.S. patients had to travel out of the U.S. for this procedure. This study reports on a series of U.S. patients who requested off-shore referral for LAGB placement. Methods: 105 U.S. patients were implanted with the Lap-Band System^? in Mexico by one surgeon in a private practice. 70% were implanted with the perigastric approach, while the final 30% were implanted using the pars flaccida approach. Routine postoperative visits, including band adjustments, were completed in a private U.S. clinic where medical staff performed frequent small adjustments as necessary to optimize results. Data were collected from concurrent and retrospective chart reviews and from telephone interviews. Summary statistics provided for baseline measures included mean ± standard deviation. Postoperative measures of weight loss included mean ± standard error. Results: Weight loss results were comparable to international results: 61% EWL at 12 months (n=50), 75% EWL at 24 months (n=37), 72% EWL at 36 months (n=24), and 60% EWL at 48 months (n=7). There were few major complications. Conclusion: Attention to patient management is essential to success, and this study found that appropriately-managed U.S. LAGB patients can be as successful as their international counterparts. Frequent follow-up delivered by a bariatric team with easy access to band adjustments is essential.     

The Effect of <Emphasis Type="SmallCaps">l</Emphasis>-arginine and Aprotinin on Intestinal Ischemia–reperfusion Injury

Background Intestinal ischemia/reperfusion (I/R) results in local mucosal injury, systemic injuries, and organ dysfunction. These injuries are characterized by altered microvascular and epithelial permeability and villous damage. Activation of neutrophils, platelets, and endothelial factors are known to be involved in this process. Cytokines such as TNF-α, IL-1, IL-6, and oxygen-derived free radicals are believed to be important pathogenic mediators. Capillary no-reflow is also known to play a role in I/R. The aim of our study was to examine the role of l-arginine, a known nitric oxide (NO) donor, and aprotinin, a protease inhibitor with multiple effects, on intestinal I/R. Methods Pigs weighing 20–25 kg were used. Ischemia was established by clamping the superior mesenteric artery (SMA) at its origin and was sustained for 2 hours. Duration of reperfusion was 2 hours. The animals were divided into four groups: group A, the control group, which was submitted to I/R injury only; group B, in which l-arginine was administered at a rate of 5 mg/kg/min during ischemia and continuing throughout reperfusion; group C, in which aprotinin was administered with an initial bolus dose of 20,000 U/kg during ischemia followed by a continuous dose at 50 U/hour throughout reperfusion; and group D in which both substances were administered. In all groups TNF-α, IL-1, and IL-6 levels were measured using ELISA at baseline, 2 hours of ischemia, and 1 hour and 2 hours of reperfusion. SMA blood flow was measured with a Doppler probe at baseline, 10 min, 1 hour, and 2 hours of reperfusion. Histological changes of the intestinal mucosa were examined and graded on a five-point scale in all groups. Results In the control group, levels of TNF-α, IL-1, and IL-6 were significantly increased during reperfusion (p < 0.05) compared to baseline. Administration of l-arginine and aprotinin led to suppression of the release of TNF-α, IL-1, and IL-6 during reperfusion in a statistically significant manner (all p < 0.05). A synergistic or additive effect of l-arginine and aprotinin was not observed. SMA blood flow in the control group was decreased (p > 0.05) during reperfusion compared to baseline. In animals treated with l-arginine and aprotinin, SMA blood flow during reperfusion was significantly increased (p < 0.05) compared to the control group. Histologic examination of the intestinal mucosa was characterized by flattening of the villi and necrosis in the control group. In the treated animals, less severe histological changes were noted. Conclusions Administration of l-arginine and aprotinin may lead to amelioration of intestinal I/R injury. We did not note a synergistic or additive effect of these two substances. These findings warrant further studies in clinical settings for future treatment efforts. This paper was presented as a poster at the 47th Annual Meeting of the Society for Surgery of the Alimentary Tract, Los Angeles, California, May 20–24, 2006.     

Involvement of α<Subscript>v</Subscript>β<Subscript>3</Subscript> integrins in osteoclast function

Integrins are heterodimeric adhesion receptors that mediate cell–matrix interaction. Osteoclast exhibits high expression of the α_vβ₃ integrin, which binds to a variety of extracellular matrix proteins including vitronectin, osteopontin, and bone sialoprotein. Arg-Gly-Asp (RGD)-containing peptides, RGD-mimetics, and blocking antibodies to α_vβ₃ integrin were shown to inhibit bone resorption in vitro and in vivo, suggesting that this integrin may play an important role in regulating osteoclast function. Several lines of evidence have demonstrated that a number of signaling molecules are involved in the α_vβ₃ integrin-dependent signaling pathway, including c-Src, Pyk2, c-Cbl, and p130^Cas. In this article, we review the history of “α_vβ₃ integrin and osteoclasts” and discuss the involvement of α_vβ₃ integrins in osteoclast function at tissue, cellular, and molecular levels. A better understanding of the role of α_vβ₃ integrin in osteoclastic bone resorption would provide opportunities for developing new therapeutics to treat human bone diseases, including rheumatoid arthritis, osteoporosis, and periodontal disease.     

Marital status and gender affect stage,tumor grade,treatment type and cancer specific mortality in T<Subscript>1–2</Subscript> N<Subscript>0</Subscript> M<Subscript>0</Subscript> renal cell carcinoma

Purpose

To examine the effect of marital status and gender on stage at diagnosis, tumor grade, treatment type and cancer specific mortality (CSM) in patients with localized renal cell carcinoma (RCC).

Methods

Within Surveillance, Epidemiology, and End Results registry (2001–2013), we identified 57,700 patients with T_1–2 N₀ M₀ RCC. Logistic regression and competing-risks regression models tested the effect of marital status and gender on stage, tumor grade, treatment type and cancer specific mortality (CSM).

Results

Of all patients, 8.8, 10.6 and 14.8% were, respectively, widowed, separated/divorced and never married. The three categories accounted for 3.9, 9.0 and 14.9% of males (35,641) and for 16.7, 13.1 and 14.7% of females (22,059). Widowed (OR 1.13, p = 0.04), separated/divorced (OR 1.16, p = 0.02) and never married status (OR 1.38, p < 0.001) predisposed to higher rate of no surgical treatment. Widowed (HR 1.32, p < 0.001) and separated/divorced (HR 1.32, p < 0.001) status predisposed to higher CSM. Male gender predisposed to higher T-stage (OR 1.12, p < 0.001), higher tumor grade (OR 1.35, p < 0.001), no surgical treatment (OR 1.23, p < 0.001) and higher CSM (1.13, p = 0.01). Interaction tests between gender and marital status failed to reach independent predictor status in all analyses.

Conclusions

Male patients are at higher risk of less favorable baseline characteristics. Additionally, male, widowed and separated/divorced patients exhibit worse cancer control outcomes after treatment for T_1–2 N₀ M₀ RCC. These observations indicate the need of more focused attention to those patients prior to, as well as after treatment for localized RCC.

     

The augmenter of liver regeneration protects the kidneys after orthotopic liver transplantation possibly by upregulating HIF-1α and O<Subscript>2</Subscript>-sensitive K<Superscript>+</Superscript> channels

Purpose  

The augmenter of liver regeneration (ALR) might promote better renal function after orthotopic liver transplantation (OLT). Using a rat allogeneic OLT model, we investigated if ALR can mediate renal protection and its potential mechanisms.     

<Emphasis Type="Italic">FABP2</Emphasis>, <Emphasis Type="Italic">LEPR223</Emphasis>, <Emphasis Type="Italic">LEP656</Emphasis>, and <Emphasis Type="Italic">FTO</Emphasis> Polymorphisms: Effect on Weight Loss 2 Years After Bariatric Surgery

Purpose

Differences in weight loss outcomes after bariatric surgery may be related to individual preoperative characteristics. The aim of this study was to evaluate the potential effect of fatty acid binding protein-2 (rs1799883), leptin receptor (LEP223, rs1137101 and LEP656, rs1805094), and fat mass and obesity-related (rs9939609) genotypes on weight loss 2 years after bariatric surgery in Brazilian patients.

Materials and Methods

Prospective observational study involving 105 patients (lost to follow-up, 25.7%). In the preoperative period, patients were clinically evaluated and a fasting blood sample for genetic analysis (by real-time DNA amplification technique) was collected. From the patient’s medical records, follow-up weight loss (3, 6, 12, 24 months) was obtained. Percentage of excess weight loss (%EWL) was examined by pairwise comparison across the polymorphisms.

Results

At baseline, the mean weight was 127.5 (23.3) kg and age 43.1 (10.9) years old. The %EWL was significant over time (p?<?0.01). Only the LEP223 genotype showed association (p?<?0.01). Up to 6 months after surgery, no differences were observed. At 12 months, a significant difference (p?=?0.03) between AA (n?=?19) and GG (n?=?34) groups was observed, with 76.5% EWL versus 52.0%, respectively. This difference remained at 24 months. Other genotypes did not present any significant association.

Conclusions

There is a different evolution of weight loss in carriers of the LEP223 after bariatric surgery. The AA genotype seems to be associated with a higher weight loss. However, this pattern was evident only at 12 months after surgery.

     

The utility of the perioperative autologous transfusion system <Emphasis Type="Italic">OrthoPAT</Emphasis><Superscript>®</Superscript> in total hip replacement surgery: a prospective study

Background  Total hip replacement (THR) is associated with a significant perioperative blood loss, and 30–50% of these patients receive allogeneic blood transfusion (ABT). We evaluated the clinical utility of washed shed blood (WSB) return to reduce ABT in THR patients. Study design and methods  Data from 108 consecutive THR patients were prospectively collected. WSB salvage and reinfusion (OrthoPAT) was intended for 60 (Reinfusion group), whereas the remaining 48 patients served as control group. Patients received ABT if haemoglobin <8 g/dl or clinical signs and symptoms of acute anemia. Results  WSB return was possible in 49 patients (205 ± 151 ml of erythrocyte/patient), without any clinically relevant incident. Return of WSB decreased both the ABT rate (48 vs. 15%, for control and reinfusion groups, respectively; P = 0.001) and the ABT index (371 ± 154 ml RBC vs. 53 ± 117 ml RBC, respectively; P = 0.001), without differences between cemented and uncemented THR. In addition, patients from reinfusion group showed a trend to lower postoperative infection rate (10 vs. 2%, respectively; P = 0.086). Conclusions  Perioperative salvage and return of WSB in THR seems to effectively reduce the requirements for ABT. However, for patients with preoperative Hb < 13 g/dl, some additional blood saving method should be associated to WSB return.