Omeprazole is More Effective than Famotidine for Preventing Acute Gastritis in Rats

Purpose Acute gastric mucosal lesions, which can develop within a few hours after polytrauma, shock, major operations, central nervous system lesions, or severe infection, cause about 33% of cases of gastrointestinal bleeding. We analyzed and compared the effectiveness of famotidine and omeprazole on acute gastric mucosal lesions.Methods Thirty male albino Wistar rats were given ketalar anesthesia after 12h fasting, then immobilized and exposed to stress according to Brodies protocol, without restricting their respiration. We divided the rats into three groups of ten according to whether they were given famotidine, omeprazole, or normal saline (control group). All rats were ulcer-indexed according to the diameter of their ulcers. The stomach contents were aspirated for acid output and pH analysis, and sent to the laboratory. The total number of mast cells was also counted.Results Omeprazole was more effective than famotidine in keeping gastric pH high and lowering the total gastric acid output. Lower ulcer indexes in acute gastric mucosal erosions and better protected mucosal integrity were found in the omeprazole-treated rats.Conclusion Omeprazole prevents acute gastric mucosal erosions in rats more effectively than famotidine.     

Interleukin-12 Administration Is More Effective for Preventing Metastasis than for Inhibiting Primary Established Tumors in a Murine Model of Spontaneous Hepatic Metastasis

Purpose. The effect of interleukin-12 (IL-12) on tumor growth at the primary site and its therapeutic efficacy against metastasis were examined using a model of spontaneous hepatic metastasis. Methods. IL-12 was peritumorally injected into RL♂F1 tumor-bearing BALB/c male mice at the different tumor stage. Results. Striking inhibition of hepatic metastasis in both athymic and euthymic mice was induced by the administration of IL-12 irrespective of the stage of tumor progression. In contrast, IL-12 failed to produce any antitumor effect in athymic mice which lack conventional T cells. These results suggest that the antitumor effect of IL-12 is mediated mainly by T cells, and that the antimetastatic effect is mediated mainly by natural killer (NK) and/or NKT cells. Next we examined the direct effect of IL-12 on these cells. IL-12-induced T-cell proliferation was remarkably augmented in the early stage, then decreased dramatically in the advanced stage, while IL-12-induced cytotoxic activity, mediated by NK and NKT cells, was not attenuated even in the advanced stage. This dissociation in IL-12 responsiveness appeared to be the reason for the remarkable antimetastatic effect but insufficient antitumor effect of IL-12 in the advanced stage. Conclusion. The findings of this study support the clinical use of IL-12 for immunotherapy against either occult or evident liver metastasis. Received: November 10, 2000 / Accepted: September 11, 2001     

Inelastic Leg Compression Is More Effective to Reduce Deep Venous Refluxes than Elastic Bandages

BACKGROUND: Deep venous refluxes play an important triggering role for the development of venous leg ulcers. Compression therapy is able to reduce these refluxes depending on pressure and the kind of material being used. OBJECTIVE: To compare the efficacy of compression bandages of varying pressure and material (elastic, long-stretch versus inelastic, short-stretch bandages, four-layer bandages). METHODS: Venous volume (VV) and venous filling index (VFI) as a quantitative parameter of venous reflux were measured using an airplethysmograph (APG) in a total of 21 patients presenting with venous leg ulcers and deep venous refluxes. Bandage pressure was measured in every experiment. The influence of elastic and inelastic bandages with increasing pressure and the changes in these parameters using different bandages with the same pressure were investigated. RESULTS: The initial median value of VFI without compression was 8.45 ml/sec. VV and VFI were significantly reduced by increasing external pressure, more strongly with inelastic than with elastic material. With a pressure of 25 mmHg inelastic bandages diminished VFI to a median of 3.25 ml/sec while the elastic material did not even approach this value with a pressure of 40 mmHg (4.25 ml/sec). Applying bandages of different material with the same pressure of 30 mmHg, the most intense reduction of VV and VFI was obtained by inelastic and by four-layer bandages. The effect on venous reflux was statistically significantly superior with inelastic compared to elastic material. CONCLUSION: Using the same bandage pressure, inelastic material is more effective at reducing deep venous refluxes than elastic bandages in patients with venous ulcers. Four-layer bandages show similar efficacy to inelastic bandages.     

In vitro comparison of Refobacin-Palacos R with Refobacin Bone Cement and Palacos R + G

Background?Refobacin Palacos R (RPR) is no longer produced and Palacos R + G (PRG) and Refobacin Bone Cement R (RBC) have been introduced to supersede it. We performed an in vitro study to ascertain whether the handling and mechanical properties of the more recent cement preparations are different to those of their predecessor.

Methods?The 3 cements were tested to ISO 5833 and German DIN 53435 standards. In addition, their gentamicin elution, shrinkage, viscosity, and handling characteristics were studied.

Results?All 3 cements had comparable mechanical properties exceeding the ISO 5833 and DIN 53435 standards. They eluted similar amounts of gentamicin and had comparable shrinkage. In the batches tested, RBC showed statistically significantly longer handling curves. Both PRG and RBC had statistically significantly lower viscosities as they cured compared to their predecessor.

Interpretation?Surgeons must be aware that both successor cements do not appear to have handling curves and viscoelastic properties identical to those of RPR.     

In vitro comparison of Refobacin-Palacos R with Refobacin Bone Cement and Palacos R + G

Background Refobacin Palacos R (RPR) is no longer produced and Palacos R + G (PRG) and Refobacin Bone Cement R (RBC) have been introduced to supersede it. We performed an in vitro study to ascertain whether the handling and mechanical properties of the more recent cement preparations are different to those of their predecessor.

Methods The 3 cements were tested to ISO 5833 and German DIN 53435 standards. In addition, their gentamicin elution, shrinkage, viscosity, and handling characteristics were studied.

Results All 3 cements had comparable mechanical properties exceeding the ISO 5833 and DIN 53435 standards. They eluted similar amounts of gentamicin and had comparable shrinkage. In the batches tested, RBC showed statistically significantly longer handling curves. Both PRG and RBC had statistically significantly lower viscosities as they cured compared to their predecessor.

Interpretation Surgeons must be aware that both successor cements do not appear to have handling curves and viscoelastic properties identical to those of RPR.     

Voriconazole Is Delivered From Antifungal-Loaded Bone Cement

Background

Local delivery of antifungals is an important modality in managing orthopaedic fungal infection. Voriconazole is a powder antifungal suitable for addition to bone cement that is released from bone cement but the mechanical properties of antimicrobial-loaded bone cement (ALBC) made with voriconazole are unknown.

Questions/Purposes

(1) Is voriconazole release dose-dependent? (2) Is released voriconazole active? (3) Is the loss of ALBC’s compressive strength caused by voriconazole dose- and elution-dependent?

Methods

Sixty standard test cylinders were fabricated with ALBC: 300 or 600 mg voriconazole per batch eluted for 30 days in deionized water. Voriconizole concentration in the eluate was measured using high-performance liquid chromatography. Cumulative-released voriconizole was calculated. Biologic activity was tested. Compressive strength was measured before and after elution. The effect of dose and time on release and compressive strength were analyzed using repeated-measure analysis of variance.

Results

Fifty-seven percent and 63% of the loaded voriconazole were released by Day 30 for the 300-mg and 600-mg formulations, respectively. The released voriconazole was active on bioassay. Compressive strength was reduced from 79 MPa to 53 MPa and 69 MPa to 31 MPa by 30 days for the 300-mg and 600-mg formulations, respectively.

Conclusions

Voriconazole release from ALBC increases with dose and is bioactive. Loss in compressive strength is greater after elution and with higher dose.

Clinical Relevance

Three hundred milligrams of voriconazole in ALBC would be expected to deliver meaningful amounts of active drug in vivo. The compressive strength of ALBC with 600 mg voriconazole is less than expected compared to commonly used antibacterials.     

Nasal Ventilation Is More Effective than Combined Oral-Nasal Ventilation during Induction of General Anesthesia in Adult Subjects

Background: The authors hypothesized that nasal mask ventilation may be more effective than combined oral-nasal mask ventilation during induction of general anesthesia. They tested this hypothesis by comparing the volume of carbon dioxide removed per breath with nasal versus combined oral-nasal mask ventilation in nonparalyzed, apneic, adult subjects during induction of general anesthesia.

Methods: Fifteen adult subjects receiving general anesthesia were ventilated first with a combined oral-nasal mask and then with only a nasal mask. The patient's head was maintained in a neutral position, without head extension or lower jaw thrust. Respiratory parameters were recorded simultaneously from both the nasal and oral masks regardless of ventilation approach.

Results: The volume of carbon dioxide removed per breath during nasal mask ventilation (median, 5.0 ml; interquartile range, 3.4-8.8 ml) was significantly larger than that during combined oral-nasal mask ventilation (median, 0.0 ml; interquartile range, 0.0-0.4 ml; P = 0.001); even the peak inspiratory airway pressure during nasal ventilation (16.7 +/- 2.7 cm H2O) was lower than that during combined oral-nasal ventilation (24.5 +/- 4.7 cm H2O; P = 0.002). The expiratory tidal volume during nasal ventilation (259.8 +/- 134.2 ml) was also larger than that during combined oral-nasal ventilation (98.9 +/- 103.4 ml; P = 0.003).     

Intravenous Lornoxicam Is More Effective than Paracetamol as a Supplemental Analgesic After Lower Abdominal Surgery: A Randomized Controlled Trial

Background

The aim of this prospective, randomized, double-blind study was to determine the more effective supplemental analgesic, paracetamol or lornoxicam, for postoperative pain relief after lower abdominal surgery.

Methods

Sixty patients scheduled for lower abdominal surgery under general anesthesia were randomly allocated to receive either isotonic saline (control group), intravenous paracetamol 1?g every 6?h (paracetamol group), or lornoxicam 16?mg then 8?mg after 12?h (lornoxicam group). Additionally pain was treated postoperatively with morphine patient-controlled analgesia. Postoperative pain scores measured by the verbal pain score (VPS), morphine consumption, and the incidence of side effects were measured at 1, 2, 4, 8, 12, and 24?h postoperatively.

Results

Morphine consumption at 12 and 24?h was significantly lower in the lornoxicam group (19.25?±?5.7?mg and 23.1?±?6.5?mg) than in the paracetamol group (23.4?±?6.6?mg and 28.6?±?7.6?mg). Both treatment groups had less morphine consumption than the control group (28.5?±?5?mg and 38.1?±?6.6?mg) at 12 and 24?h, respectively. Additionally, VPS was reduced in the paracetamol and the lornoxicam groups compared with the control group both at rest and on coughing. Further analysis revealed that VPS in the lornoxicam group was significantly lower than that in the paracetamol group only during coughing. Drug-related side effects were comparable in all groups.

Conclusions

Lornoxicam is superior to paracetamol for postoperative analgesia after lower abdominal surgery. However, paracetamol could be an alternative supplemental analgesic whenever an NSAID is unsuitable. Trial Registration: clinicaltrials.gov.identifier:NCT01564680.     

Alendronate Is Effective to Treat Bone Loss in Renal Transplantation Recipients

Bone loss is a common complication among renal transplant patients. Some studies have shown that alendronate may be effective to treat bone loss in these patients. In this study, we have reported our experience with administration of alendronate to treat bone loss in renal transplanted patients.

Methods

The 46 kidney transplant recipients with bone loss were randomly divided into 2 groups: group I was treated with calcium and calcitriol, and group II with calcium, calcitriol, and alendronate. We examined bone mineral density (BMD) and biochemical indicators of both groups. All patients received cyclosporine and prednisone treatment.

Results

There was no significant difference in age, body mass index, gender, immunosuppression, time since transplantation, 25(OH)D₃, or intact parathyroid hormone levels at study commencement. The BMD of the femoral neck was significantly increased (P < .05), and the serum type I collagen-cross-linked N telopeptide (NTx) dramatically (P < .05) decreased in posttransplantation group II recipients treated with calcium, calcitriol, and alendronate. There were also significant differences in BMD and serum NTx between recipients treated with versus without alendronate (P < .05).

Conclusion

At least in the short term, alendronate is a effective inhibitor for the treatment of bone loss in renal transplantation patients.     

Acidosis Inhibits Bone Formation by Osteoblasts In Vitro by Preventing Mineralization

The negative effect of acidosis on the skeleton has been known for almost a century. Bone mineral serves an important pathophysiologic role as a reserve of hydroxyl ions to buffer systemic protons if the kidneys and lungs are unable to maintain acid-base balance within narrow physiologic limits. Extracellular hydrogen ions are now thought to be the primary activation signal for osteoclastic bone resorption, and osteoclasts are very sensitive to small changes in pH within the pathophysiologic range. Herein, we investigated the effects of acidosis on osteoblast function by using mineralized bone nodule-forming primary osteoblast cultures. Osteoblasts harvested from neonatal rat calvariae were cultured up to 21 days in serum-containing medium, with ascorbate, beta-glycerophosphate and dexamethasone. pH was manipulated by addition of 5 to 30 mmol/L HCl and monitored by blood gas analyzer. Abundant, matrix-containing mineralized nodules formed in osteoblast cultures at pH 7.4, but acidification progressively reduced mineralization of bone nodules, with complete abolition at pH 6.9. Osteoblast proliferation and collagen synthesis, assessed by 3H-thymidine and 3H-proline incorporation, respectively, were unaffected by pH in the range 7.4 to 6.9; no effect of acidification on collagen ultrastructure and organization was evident. The apoptosis rate of osteoblasts, assessed by the enrichment of nucleosomes in cell lysates, was also unaffected by pH within this range. However, osteoblast alkaline phosphatase activity, which peaked strongly near pH 7.4, was reduced eight-fold at pH 6.9. Reducing pH to 6.9 also downregulated messenger ribonucleic acid (mRNA) for alkaline phosphatase, but upregulated mRNA for matrix Gla protein, an inhibitor of mineralization. The same pH reduction is associated with two-and four-fold increases in Ca2+ and PO4(3-) solubility for hydroxyapatite, respectively. Our results show that acidosis exerts a selective, inhibitory action on matrix mineralization that is reciprocal with the osteoclast activation response. Thus, in uncorrected acidosis, the deposition of alkaline mineral in bone by osteoblasts is reduced, and osteoclast resorptive activity is increased in order to maximize the availability of hydroxyl ions in solution to buffer protons.     

Intermittent Pneumatic Compression Is Effective in Preventing Symptomatic Pulmonary Embolism After Thoracic Surgery

Purpose. Postoperative pulmonary embolism (PE) remains a fatal complication even in thoracic surgery. We have used intermittent pneumatic compression for the prophylaxis of postoperative PE since 1998, and herein examined its effectiveness. Methods. Seven hundred and six patients, whose medical records showed use/no use of pneumatic compression for prophylaxis of PE, underwent general thoracic surgery in our department from December 1995 to December 2000. Their clinical records were reviewed, and variables were compared between patients who experienced clinically apparent PE and patients who did not have PE. Results. Three hundred and forty-four patients did not receive any prophylactic treatment, and 7 of these (2.0%) experienced postoperative PE. Three hundred and sixty-two patients received prophylactic pneumatic compression and none of these developed PE. There was a statistical correlation between the occurrence of PE and the application of pneumatic compression (²-test, P = 0.006). Six of the seven patients with PE were operated on in the right decubitus position, and the operative position and the prevalence of PE was also significantly correlated (²-test, P = 0.024). Other factors, such as age, sex, operative time, duration until patients became fully ambulatory, body mass index, and character of the disease, did not have significant correlation with the occurrence of PE. Conclusions. Pneumatic compression was found to effectively prevent postoperative PE. The right decubitus position is considered to be a risk factor for the development of postoperative PE in thoracic surgery.     

硅胶薄膜囊预防椎体后凸成形术中骨水泥渗漏的实验研究

目的探讨硅胶薄膜囊预防椎体后凸成形术中骨水泥渗漏的可能性和有效性。方法取6具甲醛固定的老年女性脊柱标本(T12～L5)制成36个单椎体,刮匙在椎体前3/4制成体积约为6ml单侧或双侧空腔,分别直接注入骨水泥和先置入壁厚100μm、200μm的硅胶薄膜囊后再注入骨水泥。结果壁厚100μm的硅胶薄膜囊包裹骨水泥可控制骨水泥在椎体内的分布,和直接注入骨水泥一样能较好地嵌入到周围骨小梁内,不形成界面。而壁厚200μm的硅胶囊虽能控制骨水泥在椎体内分布,但会在骨小梁间形成界面。结论球囊扩张椎体后凸成形术中置入壁厚100μm的硅胶薄膜囊包裹骨水泥可控制椎体内骨水泥分布,并能嵌入到骨小梁间隙,不形成界面,有效预防球囊扩张椎体后凸成形术并发症的出现。     

Bone Wax Is Effective in Reducing Blood Loss After Total Knee Arthroplasty

Background

Total knee arthroplasty (TKA) is associated with major blood loss and blood transfusion is often required. This study aimed to evaluate the efficacy of bone wax in reducing blood loss and transfusion rates after TKA.

Removed Antibiotic-Impregnated Cement Spacers in Two-Stage Revision Joint Arthroplasty Do Not Show Biofilm Formation In Vivo

Use of antibiotic-impregnated spacers is common in the two-stage approach to treatment of periprosthetic joint infection despite the lack of information regarding in vivo performance of these implants. Antibiotic elution levels likely often fall below the minimal inhibitory concentration need to inhibit bacterial growth, raising concern that the spacers themselves may provide a potential attachment site for biofilm formation. Advanced microscopy was used in this study to evaluate the surface characteristics of antibiotic-eluting spacers collected at the time of prosthesis reimplantation from 6 patients undergoing two-stage treatment for an infected total joint arthroplasty. Scanning electron microscopy and confocal scanning microscopy of the removed spacers revealed modest fibrous matrix formation and inflammatory cells with no biofilm or bacteria detected. This study supports the continued use of antibiotic spacers in the treatment of periprosthetic joint infection.     

PTH Treatment Increases Cortical Bone Mass More in Response to Compression than Tension in Mice

Parathyroid hormone (PTH) is an anabolic osteoporosis treatment that increases bone mass and reduces fracture risk. Clinically, the effects of PTH are site-specific, increasing bone mass more at the spine than the hip and not increasing bone mass at the radius. Differences in local loading environment between the spine, hip, and radius may help explain the variation in efficacy, as PTH and mechanical loading have been shown to synergistically increase bone mass. We hypothesized that differences in loading mode might further explain these variations. Owing to the curvature of the mouse tibia, cyclic compression of the hindlimb causes bending at the tibial midshaft, placing the anterior surface under tension and the posterior surface under compression. We investigated the combination of PTH treatment and tibial loading in an osteoblast-specific estrogen receptor-alpha knockout mouse model of low bone mass (pOC-ERαKO) and their littermate controls (LCs) and analyzed bone morphology in the tensile, compressive, and neutral regions of the tibial midshaft. We also hypothesized that pretreating wild-type C57Bl/6J (WT) mice with PTH prior to mechanical loading would enhance the synergistic anabolic effects. Compression was more anabolic than tension, and PTH enhanced the effect of loading, particularly under compression. PTH pretreatment maintained the synergistic anabolic effect for longer durations than concurrent treatment and loading alone. Together these data provide insights into more effective physical therapy and exercise regimens for patients receiving PTH treatment. © 2022 American Society for Bone and Mineral Research (ASBMR).     

Left Ventricular Hypertrophy Is More Prevalent in Type B than Type A Aortic Dissection

Objectives: Several factors determining differences between types A and B aortic dissection (AD) have been reported; however, little data exist examining their differences in left ventricular hypertrophy (LVH). We compared the prevalence of LVH in patients with types A and B AD.Methods: We retrospectively analyzed 334 patients with acute AD (227 type A; 107 type B). Concentric hypertrophy (CH; increased left ventricular mass index [LVMI] and relative wall thickness [RWT]) is one of four types of left ventricular (LV) geometry thought to be most associated with hypertension. We compared LVMI and the prevalence of CH in patients with types A or B AD. Multivariate logistic regression analyses of variables associated with type B AD were performed.Results: Comparing type A and B AD, LVMI (95 ± 26 vs.107 ± 28, p <0.001) and prevalence of CH (26% vs. 44%, p = 0.001) were higher in type B AD. In multivariate analysis, CH was an independent factor associated with type B AD (odds ratio: 2.62, confidence interval: 1.54–4.47, p <0.001).Conclusions: Our data suggested LVH was more prevalent in type B than in type A AD. Considering LVH usually results from hypertension, patients with type B AD may be more affected by hypertension than those with type A.