The effectiveness of low laser therapy in subacromial impingement syndrome: a randomized placebo controlled double-blind prospective study

OBJECTIVES:

Conflicting results were reported about the effectiveness of Low level laser therapy on musculoskeletal disorders. The aim of this study was to investigate the effectiveness of 850‐nm gallium arsenide aluminum (Ga‐As‐Al) laser therapy on pain, range of motion and disability in subacromial impingement syndrome.

METHODS:

A total of 52 patients (33 females and 19 males with a mean age of 53.59±11.34 years) with subacromial impingement syndrome were included. The patients were randomly assigned into two groups. Group I (n = 30, laser group) received laser therapy (5 joule/cm² at each point over maximum 5‐6 painful points for 1 minute). Group II (n = 22, placebo laser group) received placebo laser therapy. Initially cold pack (10 minutes) was applied to all of the patients. Also patients were given an exercise program including range of motion, stretching and progressive resistive exercises. The therapy program was applied 5 times a week for 14 sessions. Pain severity was assessed by using visual analogue scale. Range of motion was measured by goniometer. Disability was evaluated by using Shoulder Pain and Disability Index.

RESULTS:

In group I, statistically significant improvements in pain severity, range of motion except internal and external rotation and SPADI scores were observed compared to baseline scores after the therapy (p<0.05). In Group II, all parameters except range of motion of external rotation were improved (p<0.05). However, no significant differences were recorded between the groups (p>0.05).

CONCLUSIONS:

The Low level laser therapy seems to have no superiority over placebo laser therapy in reducing pain severity, range of motion and functional disability.     

The influence of various anesthesia techniques on postoperative recovery and discharge criteria among geriatric patients

OBJECTIVE:

We aim to compare selective spinal anesthesia and general anesthesia with regard to postoperative recovery and fast‐track eligibility in day surgeries.

MATERIALS AND METHOD:

Sixty geriatric outpatient cases, with ASA II‐III physical status and requiring short‐duration transurethral intervention, were enrolled in the study. The cases were split into 2 groups: as general anesthesia (Group GA) and selective spinal anesthesia (Group SSA). Group GA (n = 30) received propofol 2 mg kg^‐1 (until loss of eyelash reflex), remifentanil induction 0.5‐1 µg kg^‐1, and laryngeal mask. Maintenance was achieved by 4‐6% desflurane in 60% N₂O and 40% O₂ along with remifentanil infusion at 0.05 µg /kg^‐1 /min^‐1. Drugs were discontinued after the withdrawal of the ureteroscope, and extubation was carried out with 100% O₂. Group SSA (n = 30) received 0.5% spinal anesthesia via L4‐5 space by 0.5% hyperbaric bupivacaine 5 mg. Anesthesia preparation time, time to surgical anesthesia level, postoperative fast‐tracking, and time to White‐Song recovery score of 12, were noted. In the operating room, we evaluated hemodynamics, nausea/vomiting, surgeon and patient satisfaction with anesthesia, perioperative midazolam‐fentanyl administration, postoperative pain, and discharge time.

RESULTS:

Anesthesia preparation time, length of surgery, anesthesia‐related time in the operating room, time to sit, and time to walk were significantly low in Group GA (p<0.05), whereas time to fast‐track eligibility, length of stay in the PACU, discharge time, and other parameters were similar in both of the groups.

CONCLUSION:

While anesthesia preparation time, length of surgery, start time of surgery, time to sit, and time to walk were shorter in the General Anesthesia group, time to fast‐track eligibility, phase 1 recovery time, and discharge time were similar among patients subjected to selective spinal anesthesia.     

Outcome of children hospitalized with community-acquired pneumonia treated with aqueous penicillin G

OBJECTIVE:

To describe the evolution and outcome of children hospitalized with community‐acquired pneumonia receiving penicillin .

METHODS:

A search was carried out for all hospitalized community‐acquired pneumonia cases in a 37‐month period. Inclusion criteria comprised age ≥2 months, intravenous penicillin G use at 200,000 IU/kg/day for ≥48 h and chest x‐ray results. Confounders leading to exclusion included underlying debilitating or chronic pulmonary illnesses, nosocomial pneumonia or transference to another hospital. Pneumonia was confirmed if a pulmonary infiltrate or pleural effusion was described by an independent radiologist blind to the clinical information. Data on admission and evolution were entered on a standardized form.

RESULTS:

Of 154 studied cases, 123 (80%) and 40 (26%) had pulmonary infiltrate or pleural effusion, respectively. Penicilli was substituted by other antibiotics in 28 (18%) patients, in whom the sole significant decrease was in the frequency of tachypnea from the first to the second day of treatment (86% vs. 50%, p = 0.008). Among patients treated exclusively with penicillin G, fever (46% vs. 26%, p = 0.002), tachypnea (74% vs. 59%, p = 0.003), chest indrawing (29% vs. 13%, p<0.001) and nasal flaring (10% vs. 1.6%, p = 0.001) frequencies significantly decreased from admission to the first day of treatment. Patients treated with other antimicrobial agents stayed longer in the hospital than those treated solely with penicillin G (16±6 vs. 8±4 days, p<0.001, mean difference (95% confidence interval) 8 (6–10)). None of the studied patients died.

CONCLUSION:

Penicillin G successfully treated 82% (126/154) of the study group and improvement was marked on the first day of treatment.     

Longitudinal study of Cystatin C in healthy term newborns

OBJECTIVE:

The purpose of this study was to determine the levels of Cystatin C in healthy term newborns in the first month of life.

INTRODUCTION:

Cystatin C may be a suitable marker for determining the glomerular filtration rate because it is not affected by maternal renal function.

METHODS:

Cohort study. Inclusion: term newborns with appropriate weight; mother without renal failure or drugs that could affect fetal glomerular filtration rate. Exclusion: malformations; hypertension or any condition that could affect glomerular filtration rate. Cystatin C (mg/L) and creatinine (mg/dl) were determined in the mother (Mo) and in the newborn at birth (Day‐0), 3^rd (Day‐3), 7^th(Day‐7) and 28^th(Day‐28) days. Statistics: one way ANOVA and Pearson''s correlation tests. Sample size of 20 subjects for α  =  5% and a power test  =  80% (p<0.05).

RESULTS:

Data from 21 newborns were obtained (mean ± standard deviation): MoCystatin C = 1.00±0.20; Day‐0 Cystatin C 1.70±0.26; Day‐3 Cystatin C = 1.51±0.20; Day‐7 Cystatin C = 1.54±0.10; Day‐28 Cystatin C = 1.51±0.10.MoCystatin C was smaller than Day‐0 Cystatin C (p<0.001), while MoCreatinine was not different from Day‐0 Creatinine. Cystatin C only decreased from Day‐0 to Day‐3 (p = 0.004) but newborns Creatinine decreased along the time. Correlations were obtained between MoCystatin C and MoCreatinine (p = 0.012), as well as Day‐3 (p = 0.047) and Day‐28 (p = 0.022) Cystatin C and Creatinine values.

CONCLUSION:

Neonatal Cystatin C values were not affected by MoCystatin C and became stable from the 3^rd day of life.     

Histomorphometric changes in the perirenal adipocytes of adrenalectomized rats treated with dexamethasone

INTRODUCTION:

Prolonged steroid treatment administered to any patient can cause visceral obesity, which is associated with metabolic disease and Cushing''s syndrome. Glucocorticoids have a profound negative effect on adipose tissue mass, giving rise to obesity, which in turn is regulated by the 11β-hydroxysteroid dehydrogenase type 1 enzyme. Adrenalectomized rats treated with dexamethasone exhibited an increase in visceral fat deposition but not in body weight.

OBJECTIVES:

The main aim of this study was to determine the effect of dexamethasone on the histomorphometric characteristics of perirenal adipocytes of adrenalectomized, dexamethasone-treated rats (ADR+Dexa) and the association of dexamethasone treatment with the expression and activity of 11β-hydroxysteroid dehydrogenase type 1 (11β- hydroxysteroid dehydrogenase type 1).

METHODS:

A total of 20 male Sprague Dawley rats were divided into 3 groups: a baseline control group (n = 6), a sham-operated group (n = 7) and an adrenalectomized group (n = 7). The adrenalectomized group was given intramuscular dexamethasone (ADR+Dexa) 2 weeks post adrenalectomy, and the rats from the sham-operated group were administered intramuscular vehicle (olive oil).

RESULTS:

Treatment with 120 µg/kg intramuscular dexamethasone for 8 weeks resulted in a significant decrease in the diameter of the perirenal adipocytes (p<0.05) and a significant increase in the number of perirenal adipocytes (p<0.05). There was minimal weight gain but pronounced fat deposition in the dexamethasone-treated rats. These changes in the perirenal adipocytes were associated with high expression and dehydrogenase activity of 11β-hydroxysteroid dehydrogenase type 1.

CONCLUSIONS:

In conclusion, dexamethasone increased the deposition of perirenal fat by hyperplasia, which causes increases in the expression and dehydrogenase activity of 11β-hydroxysteroid dehydrogenase type 1 in adrenalectomized rats.     

Depression and conservative surgery for breast cancer

BACKGROUND:

Depression is prevalent among women and associated with reduced quality of life, and therefore it is important to determine its incidence in adult women, especially in those with breast cancer.

OBJECTIVE:

To determine the occurrence of depression in women who underwent conservative surgery for breast cancer with or without breast reconstruction.

METHODS:

Seventy‐five women aged between 18 and 65 years were enrolled. Patients had undergone conservative surgery for breast cancer with immediate breast reconstruction (n = 25) or without breast reconstruction (n = 25) at least one year before the study. The control group consisted of 25 women without cancer, but of similar age and educational level distribution as the other two groups. The Beck Depression Inventory was used to measure depression. The collected data were assessed using analysis of variance and the χ² test.

RESULTS:

There were no significant differences between groups in age (p = 0.72) or educational level (p = 0.20). A smaller number of patients had undergone the menopause (p = 0.02) in the control group than in other groups. There were no significant differences in occurrence of depression between groups (χ² = 9.97; p = 0.126).

CONCLUSION:

Conservative surgery for breast cancer did not affect the occurrence of depression in women, regardless of whether breast reconstruction was performed.     

Trends in ischemic heart disease and stroke death ratios in brazilian women and men

OBJECTIVE:

Cardiovascular diseases are the main cause of death in women and men in Brazil, but the trends for the death ratios for ischemic heart disease and stroke in women and men remain unknown.

METHOD:

In this study, the trends for the death ratios among women and men who were over 30 years of age were analyzed from 1980 to 2005. Data were collected for both the Brazilian population and the metropolitan area of São Paulo. Estimates of the population size and data for mortality were then obtained from the Brazilian Institute of Geography and Statistics and the Ministry of Health. The risk for death was adjusted using a direct method.

RESULTS:

Death rates due to cardiovascular disease, ischemic heart disease, and stroke have declined in both Brazil and the metropolitan region of São Paulo. A linear regression analysis revealed a similar trend for ischemic heart disease and demonstrated a male/female ratio of 1.653 ± 0.001 (r = 0.228; p = 0.262) in Brazil and 1.763 ± 0.008 (r = 0.863; p<0.001) in São Paulo. Comparisons between the slopes of the linear regressions showed an increased ischemic heart disease ratio in men/women in São Paulo in comparison to those in Brazil (p<0.0001). The linear regression showed an increasing trend for the male/female stroke ratio of 1.252 ± 0.004 (r = 0.776; p<0.0001) in Brazil and 1.331 ± 0.006 (r = 0.580; p = 0.002) in São Paulo. Comparisons between the regressions for the stroke ratio were similar for men/women in São Paulo compared to Brazil (p = 0.244).

CONCLUSION:

We observed an increased trend in the ratio for ischemic heart disease death in men compared to women. Improvements in the control of risk factors and treatments for both men and women are mandatory to reduce the number of ischemic heart disease‐related deaths in Brazil.     

Does videothoracoscopy improve clinical outcomes when implemented as part of a pleural empyema treatment algorithm?

OBJECTIVE:

We aimed to evaluate whether the inclusion of videothoracoscopy in a pleural empyema treatment algorithm would change the clinical outcome of such patients.

METHODS:

This study performed quality-improvement research. We conducted a retrospective review of patients who underwent pleural decortication for pleural empyema at our institution from 2002 to 2008. With the old algorithm (January 2002 to September 2005), open decortication was the procedure of choice, and videothoracoscopy was only performed in certain sporadic mid-stage cases. With the new algorithm (October 2005 to December 2008), videothoracoscopy became the first-line treatment option, whereas open decortication was only performed in patients with a thick pleural peel (>2 cm) observed by chest scan. The patients were divided into an old algorithm (n = 93) and new algorithm (n = 113) group and compared. The main outcome variables assessed included treatment failure (pleural space reintervention or death up to 60 days after medical discharge) and the occurrence of complications.

RESULTS:

Videothoracoscopy and open decortication were performed in 13 and 80 patients from the old algorithm group and in 81 and 32 patients from the new algorithm group, respectively (p<0.01). The patients in the new algorithm group were older (41±1 vs. 46.3±16.7 years, p = 0.014) and had higher Charlson Comorbidity Index scores [0(0-3) vs. 2(0-4), p = 0.032]. The occurrence of treatment failure was similar in both groups (19.35% vs. 24.77%, p = 0.35), although the complication rate was lower in the new algorithm group (48.3% vs. 33.6%, p = 0.04).

CONCLUSIONS:

The wider use of videothoracoscopy in pleural empyema treatment was associated with fewer complications and unaltered rates of mortality and reoperation even though more severely ill patients were subjected to videothoracoscopic surgery.     

Fumarate hydratase enzyme activity in lymphoblastoid cells and fibroblasts of individuals in families with hereditary leiomyomatosis and renal cell cancer

Background

Hereditary leiomyomatosis and renal cell cancer (HLRCC) is the autosomal dominant heritable syndrome with predisposition to development of renal cell carcinoma and smooth muscle tumours of the skin and uterus.

Objective

To measure the fumarate hydratase (FH) enzyme activity in lymphoblastoid cell lines and fibroblast cell lines of individuals with HLRCC and other familial renal cancer syndromes.

Methods

FH enzyme activity was determined in the whole cell, cytosolic, and mitochondrial fractions in 50 lymphoblastoid and 16 fibroblast cell lines including cell lines from individuals with HLRCC with 16 different mutations.

Results

Lymphoblastoid cell lines (n = 20) and fibroblast cell lines (n = 11) from individuals with HLRCC had lower FH enzyme activity than cells from normal controls (p<0.05). The enzyme activity in lymphoblastoid cell lines from three individuals with mutations in R190 was not significantly different from individuals with other missense mutations. The cytosolic and mitochondrial FH activity of cell lines from individuals with HLRCC was reduced compared with those from control cell lines (p<0.05). There was no significant difference in enzyme activity between control cell lines (n = 4) and cell lines from affected individuals with other hereditary renal cancer syndromes (n = 22).

Conclusions

FH enzyme activity testing provides a useful diagnostic method for confirmation of clinical diagnosis and screening of at‐risk family members.     

Influence of preoperative serum N-terminal pro-brain type natriuretic peptide on the postoperative outcome and survival rates of coronary artery bypass patients

BACKGROUND:

The N-terminal fragment of pro-brain type natriuretic peptide (NT-proBNP) is an established biomarker for cardiac failure.

OBJECTIVE:

To determine the influence of preoperative serum NT-proBNP on postoperative outcome and mid-term survival in patients undergoing coronary artery bypass grafting (CABG).

METHODS:

In 819 patients undergoing isolated CABG surgery preoperative serum NT-proBNP levels were measured. NT-proBNP was correlated with various postoperative outcome parameters and survival rate after a median follow-up time of 18 (0.5–44) months. Risk factors of mortality were identified using χ², Mann–Whitney test, and Cox regression.

RESULTS:

NT-proBNP levels >430 ng/ml and >502 ng/ml predicted hospital and overall mortality (p<0.05), with an incidence of 1.6% and 4%, respectively. Kaplan–Meier analysis revealed decreased survival rates in patients with NT-proBNP >502 ng/ml (p = 0.001). Age, preoperative serum creatinine, diabetes, chronic obstructive pulmonary disease, low left ventricular ejection fraction and BNP levels >502 ng/ml were isolated as risk factors for overall mortality. Multivariate Cox regression analysis, including the known factors influencing NT-proBNP levels, identified NT-proBNP as an independent risk factor for mortality (OR = 3.079 (CI = 1.149-8.247), p = 0.025). Preoperative NT-proBNP levels >502 ng/ml were associated with increased ventilation time (p = 0.005), longer intensive care unit stay (p = 0.001), higher incidence of postoperative hemofiltration (p = 0.001), use of intra-aortic balloon pump (p<0.001), and postoperative atrial fibrillation (p = 0.031)

CONCLUSION:

Preoperative NT-proBNP levels >502 ng/ml predict mid-term mortality after isolated CABG and are associated with significantly higher hospital mortality and perioperative complications.     

Correlation between central corneal thickness and intraocular pressure peak and fluctuation during the water drinking test in glaucoma patients

OBJECTIVE:

To investigate the correlation between central corneal thickness and outflow facility assessed by intraocular pressure peak and fluctuation during the water drinking test.

METHODS:

Fifty‐five newly diagnosed primary open‐angle glaucoma patients submitted to central corneal thickness measurements and water drinking test were enrolled in this retrospective study.;. Patients were divided into three groups according to their central corneal thickness. Pearson''s Correlation test was performed in the groups with lower and higher pachymetric values.

RESULTS:

The mean age was 65,65 ± 28,28 years; 63,63% were female and 52,72% were caucasian. The mean central corneal thickness was 544,32 ± 36,86 µm, and the mean baseline intraocular pressure was 23,36 ± 6,26 mmHg. During the water drinking test, the mean intraocular pressure peak and mean intraocular pressure fluctuation were 30,43 ± 8,13 mmHg and 31,46 ± 18,46%, respectively. No relevant correlation was detected between the central corneal thickness and the intraocular pressure peak (r² = 0,021) or between the central corneal thickness and the intraocular pressure fluctuation (r² = 0,011). Group 1 presented a mean central corneal thickness of 505,81 ± 13,86 µm, and Group 3 was 583,55 ± 27,87 µm (p = 0,001). The mean intraocular pressure peak was 31,05 ± 9,05 mmHg and 27,83 ± 4,92 mmHg in Group 1 and in Group 3, respectively (p = 0,193). The difference of intraocular pressure fluctuation was not statistically significant between Group 1 (mean 28,47 ± 16,25%) and Group 3 (mean 33,27 ± 21,27%) (p = 0,43).

CONCLUSION:

In our case series, no correlation was found between central corneal thickness and water drinking test results.     

Connexin 50 gene on human chromosome 1q21 is associated with schizophrenia in matched case control and family-based studies

Background

The gap junction subunit connexin permits direct intercellular exchange of ions and molecules including glutamate, and plays an important role in the central nervous system. The connexin 40 (Cx40) and connexin 50 (Cx50) genes are located on chromosome 1q21.1, a region strongly linked with schizophrenia. These lines of evidence suggest that Cx40 and Cx50 may play a role in schizophrenia.

Methods

Using an allele‐specific PCR assay, four polymorphisms each were genotyped for Cx40 and Cx50 in 190 Caucasian patients with schizophrenia and 190 controls matched for sex, age and ethnicity. Following up, Cx50 rs989192 and rs4950495 were investigated in 99 Canadian and 163 Portuguese trios and nuclear families with schizophrenia probands. Hardy–Weinberg equilibrium and linkage disequilibrium (LD) block identification was carried out with HaploView, and association analysis for alleles and haplotypes with a permutation test of 10 000 simulations was carried out using the UNPHASED software program.

Results

Distributions of genotype frequencies of all markers were in Hardy–Weinberg equilibrium in Caucasian patients, controls and families. One rs989192‐rs4950495 LD block was found in patients but not in controls. We found a significant association between the Cx50 rs989192‐rs4950495 haplotype and schizophreniay (χ² = 29.55, p<0.01). The A‐C haplotype had a higher frequency in patients (χ² = 7.153, p<0.01). Family studies also showed that the A‐C haplotype was transmitted more often to patients with schizophrenia (χ² = 8.43, p<0.01). No association of Cx40 with schizophrenia was found for allele, genotype or haplotype analyses.

Conclusions

Our matched case–control and family study indicate that Cx50, but not Cx40, may play a role in the genetic susceptibility to schizophrenia.     

Relationship between depression and apolipoproteins A and B: a case-control study

OBJECTIVE:

To investigate the relation between major depressive disorder and metabolic risk factors of coronary heart disease.

INTRODUCTION:

Little evidence is available indicating a relationship between major depressive disorder and metabolic risk factors of coronary heart disease such as lipoprotein and apolipoprotein.

METHODS:

This case–control study included 153 patients with major depressive disorder who fulfilled the criteria of the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM‐IV), and 147 healthy individuals. All participants completed a demographic questionnaire and Hamilton rating scale for depression. Anthropometric characteristics were recorded. Blood samples were taken and total cholesterol, high‐ and low‐density lipoproteins and apolipoproteins A and B were measured. To analyze the data, t‐test, χ² test, Pearson correlation test and linear regression were applied.

RESULTS:

Depression was a negative predictor of apolipoprotein A (β = −0.328, p<0.01) and positive predictor of apolipoprotein B (β = 0.290, p<0.05). Apolipoprotein A was inversely predicted by total cholesterol (β = −0.269, p<0.05) and positively predicted by high‐density lipoprotein (β = 0.401, p<0.01). Also, low‐density lipoprotein was a predictor of apolipoprotein B (β = 0.340, p<0.01). The severity of depression was correlated with the increment in serum apolipoprotein B levels and the decrement in serum apolipoprotein A level.

CONCLUSION:

In view of the relationship between apolipoproteins A and B and depression, it would seem that screening of these metabolic risk factors besides psychological interventions is necessary in depressed patients.     

The effects of volatile induction and maintenance of anesthesia and selective spinal anesthesia on QT interval, QT dispersion, and arrhythmia incidence

OBJECTIVE:

The effects of sevoflurane general anesthesia and bupivacaine selective spinal anesthesia on QT dispersion (QTd) and corrected QT (QTc) interval were investigated.

METHODS AND MATERIALS:

This prospective, randomized, double-blind study was conducted between July and September 2009 in the Urology and General Surgery operating rooms. Forty ASA I–II patients undergoing noncardiac surgery were randomized into two groups: Group R (n = 20) and Group V (n = 20). In Group R, 5 mg bupivacaine was administered into the spinal space. Anesthesia induction in Group V was established with sevoflurane + 0.1 mg/kg vecuronium using the maximum vital capacity technique. Anesthesia was maintained with 2–3% sevoflurane + 50% N₂O/O₂ inhalation. All patients were tested with a 24-hour Holter ECG device. QT, QTc, and QTd intervals were measured using 12-lead ECG records at 1 and 3 minutes during preinduction, postinduction, postincision and postextubation periods. Mean arterial pressure (MAP), heart rate and ECG records were measured simultaneously.

RESULTS:

None of the patients displayed arrhythmia. There was no significant difference between the groups with regard to QTd values (p>0.05). However, QTc was longer in Group V than in Group R after the induction of anesthesia at 3 minutes, after the intubation at 1 and 3 minutes, and after the incision at 1 and 3 minutes. MAP and heart rate were generally higher in Group V (p<0.05).

CONCLUSION:

Although Volatile Induction and Maintenance of Anesthesia (VIMA) with sevoflurane might prolong the QTc interval and did not result in arrhythmia, selective spinal anesthesia with bupivacaine was not associated with alterations in the QT interval or arrhythmia.     

Natural coagulation inhibitors and active protein c resistance in preeclampsia

INTRODUCTION:

The etiology of preeclampsia is not fully established. A few studies have shown a relationship between natural coagulation inhibitors and preeclampsia.

OBJECTIVES:

The purpose of this study was to investigate the status of natural coagulation inhibitors and active protein C resistance (APC‐R) in preeclampsia.

PATIENTS AND METHODS:

We studied 70 women with preeclampsia recruited consecutively and 70 healthy pregnant and 70 nonpregnant women as controls. Plasma protein C (PC), free protein S (fPS), antithrombin III (ATIII) and APC‐R were evaluated.

RESULTS:

ATIII values were found to be significantly lower in preeclamptic patients than in the control groups (p< 0.001). Nevertheless, there was no significant difference between the healthy pregnant and nonpregnant women groups (p = 0.141). The fPS values of the preeclamptic and healthy pregnant groups were lower than that of the nonpregnant group (p< 0.001), and the fPS value of the preeclamptic pregnant women was lower than that of healthy pregnant women (p<0.001). The PC value of the preeclamptic pregnant women was lower than that of the control groups (p< 0.001). The PC value of the healthy pregnant women was lower than that of the nonpregnant women (p< 0.001). The mean APC activity values were lower in the preeclamptic patients than that of the control groups (p< 0.001, p< 0.001). The APC‐R positivity rates of the preeclamptic groups were higher than that of the control groups (p<0.001).

CONCLUSIONS:

This study demonstrated that ATIII, fPS, PC values and APC resistance were lower and APC‐R positivity was higher in preeclamptic women than in normal pregnant and nonpregnant women.     

Polymorphisms in the xylosyltransferase genes cause higher serum XT-I activity in patients with pseudoxanthoma elasticum (PXE) and are involved in a severe disease course

Background

Pseudoxanthoma elasticum (PXE) is a heritable connective tissue disorder caused by mutations in the ABCC6 gene. Fragmentation of elastic fibres and deposition of proteoglycans result in a highly variable clinical picture. The altered proteoglycan metabolism suggests that enzymes from this pathway function as genetic co‐factors in the severity of PXE. Therefore, we propose the XYLT genes encoding xylosyltransferase I (XT‐I) as the chain‐initiating enzyme in the biosynthesis of proteoglycans and the highly homologous XT‐II as potential candidate genes.

Methods

We screened all XYLT exons in 65 German PXE patients using denaturing high performance liquid chromatography and analysed the influence of the variations on clinical characteristics.

Results

We identified 22 variations in the XYLT genes. The missense variation p.A115S (XT‐I) is associated with higher serum XT activity (p = 0.005). The amino acid substitution p.T801R (XT‐II; c.2402C>G) occurs with significantly higher frequency in patients under 30 years of age at diagnosis (43% v 26%; p = 0.04); all PXE patients with this variation suffer from skin lesions compared to only 75% of the wild type patients (p = 0.002). c.166G>A, c.1569C>T, and c.2402C>G in the XYLT‐II gene were found to be more frequent in patients with higher organ involvement (p = 0.04, p = 0.01, and p = 0.02, respectively).

Conclusions

Here we show for the first time that variations in the XYLT‐II gene are genetic co‐factors in the severity of PXE. Furthermore, the higher XT activity in patients with the exchange p.A115S (XT‐I) indicates that this polymorphism is a potential marker for increased remodelling of the extracellular matrix.     

Repercussions of training and detraining by water-based exercise on functional fitness and quality of life: a short-term follow-up in healthy older women

OBJECTIVE:

To evaluate the effects of short‐term exercise detraining on the functional fitness of older women after a 12‐week water‐based exercise (WE) program.

METHODS:

Healthy older women (trained (TR) group) were submitted to 12 weeks WE (three 45 min sessions per week) followed by a 6‐week detraining period. A group of aged‐matched women without any exercise training (UN group) were evaluated during the same period. The aerobic power, measured by VO₂max and 800 meters performance, and the neuromuscular fitness and quality of life were evaluated. All assessments were made at baseline, after 12 weeks of training and after 4 and 6 weeks of detraining.

RESULTS:

No changes were found for the UN group during the follow‐up study, but WE induced significant improvement in aerobic capacity, neuromuscular fitness and quality of life score. However, the upper and lower body strength, agility, flexibility, and body balance returned to UN levels (p>0.05) after 6 weeks of detraining.

CONCLUSIONS:

The results confirmed that 12 weeks of WE improves the functional fitness parameters and quality of life of older women. However, after a short detraining period of 4–6 weeks, the neuromuscular parameters and the quality of life score returns to baseline or untrained subject levels.     

An analysis of 214 cases of rib fractures

INTRODUCTION:

Rib fractures are the most common type of injury associated with trauma to the thorax. In this study, we investigated whether morbidity and mortality rates increased in correlation with the number of fractured ribs.

MATERIALS AND METHODS:

Data from 214 patients with rib fractures who applied or were referred to our clinic between January 2007 and December 2008 were retrospectively evaluated. The patients were allocated into three groups according to the number of fractures: 1) patients with an isolated rib fracture (RF1) (n = 50, 23.4%), 2) patients with two rib fractures (RF2) (n = 53, 24.8%), and 3) patients with more than two rib fractures (RF3) (n = 111, 51.9%). The patients were evaluated and compared according to the number of rib fractures, mean age, associated chest injuries (hemothorax, pneumothorax, and/or pulmonary contusion), and co-existing injuries to other systems.

FINDINGS:

The mean age of the patients was 51.5 years. The distribution of associated chest injuries was 30% in group RF1, 24.6% in group RF2, and 75.6% in group RF3 (p<0.05). Co-existing injuries to other systems were 24% in group RF1, 23.2% in group RF2, and 52.6% in group RF3 (p<0.05). Two patients (4%) in group RF1, 2 patients (3.8%) in group RF2, and 5 patients (4.5%) in group RF3 (total n = 9; 4.2%) died.

CONCLUSION:

Patients with any number of rib fractures should be carefully screened for co-existing injuries in other body systems and hospitalized to receive proper treatment.     

Recombinant factor VIIa is associated with an improved 24-hour survival without an improvement in inpatient survival in massively transfused civilian trauma patients

OBJECTIVE:

To determine whether recombinant factor VIIa (rFVIIa) is associated with increased survival and/or thromboembolic complications.

INTRODUCTION:

Uncontrollable hemorrhage is the main cause of early mortality in trauma. rFVIIa has been suggested for the management of refractory hemorrhage. However, there is conflicting evidence about the survival benefit of rFVIIa in trauma. Furthermore, recent reports have raised concerns about increased thromboembolic events with rFVIIa use.

METHODS:

Consecutive massively transfused (≥ 8 units of red blood cells within 12 h) trauma patients were studied. Data on demographics, injury severity scores, baseline laboratory values and use of rFVIIa were collected. Rate of transfusion in the first 6 h was used as surrogate for bleeding. Study outcomes included 24‐hour and in‐hospital survival, and thromboembolic events. A multivariable logistic regression analysis was used to determine the impact of rFVIIa on 24‐hour and in‐hospital survival.

RESULTS:

Three‐hundred and twenty‐eight patients were massively transfused. Of these, 72 patients received rFVIIa. As expected, patients administered rFVIIa had a greater degree of shock than the non‐rFVIIa group. Using logistic regression to adjust for predictors of death in the regression analysis, rFVIIa was a significant predictor of 24‐hour survival (odds ratio (OR) =  2.65; confidence interval 1.26–5.59; p = 0.01) but not of in‐hospital survival (OR = 1.63; confidence interval 0.79–3.37; p = 0.19). No differences were seen in clinically relevant thromboembolic events.

CONCLUSIONS:

Despite being associated with improved 24‐hour survival, rFVIIa is not associated with a late survival to discharge in massively transfused civilian trauma patients.