Glucosamine and chondroitin for osteoarthritis?

The current body of evidence currently supports modest efficacy for glucosamine and chondroitin in the treatment of OA symptoms. The products are safe and could play a valuable role in the management of this disorder. Nevertheless, further independent studies are needed to confirm these findings and to determine the clinical applicability of these compounds. Physicians need to become involved in these treatment decisions but are confused by wide variability in the formulation and purity of the numerous preparations available to consumers. The notion that glucosamine and chondroitin might have disease-modifying effects in OA is highly appealing and supported by preliminary data. Research is needed to confirm these findings and to evaluate the impact of glucosamine and chondroitin on all aspects of OA progression.     

Advanced Imaging for Barrett’s Esophagus and Early Neoplasia: Surface and Subsurface Imaging for Diagnosis and Management

Purpose of Review

Esophageal adenocarcinoma bears one of the fastest rising incidence of any cancers and generally arises in the setting of gastroesophageal reflux and Barrett’s esophagus. However, early detection of neoplasia can be challenging since most patients are asymptomatic until they progress to more advanced and less curable stages, and early dysplastic lesions can be small, multifocal, and difficult to detect. Clearly, new imaging tools are needed in light of sampling error associated with random biopsies, the current standard of practice.

Recent Findings

Advances in endoscopic imaging including virtual chromoendoscopy, confocal laser endomicroscopy, and subsurface imaging with optical coherence tomography have ushered in a new era for detecting subtle neoplastic lesions. Moreover, in light of esophagus-sparing treatments for neoplastic lesions, such tools are likely to guide ablation and follow-up management.

Summary

While there is no ideal single imaging modality to facilitate improved detection, staging, ablation, and follow-up of patients with dysplastic Barrett’s esophagus, new advances in available technology, the potential for multimodal imaging, and the use of computer-aided diagnosis and biomarkers all hold great promise for improving detection and treatment.

     

Supplemental Vitamins and Minerals for CVD Prevention and Treatment

The authors identified individual randomized controlled trials from previous meta-analyses and additional searches, and then performed meta-analyses on cardiovascular disease outcomes and all-cause mortality. The authors assessed publications from 2012, both before and including the U.S. Preventive Service Task Force review. Their systematic reviews and meta-analyses showed generally moderate- or low-quality evidence for preventive benefits (folic acid for total cardiovascular disease, folic acid and B-vitamins for stroke), no effect (multivitamins, vitamins C, D, β-carotene, calcium, and selenium), or increased risk (antioxidant mixtures and niacin [with a statin] for all-cause mortality). Conclusive evidence for the benefit of any supplement across all dietary backgrounds (including deficiency and sufficiency) was not demonstrated; therefore, any benefits seen must be balanced against possible risks.     

American Society for Bone and Mineral Research

 【网址】 http://www.asbmr.org
【类型】 专业机构 

美国骨矿研究学会（American Society for Bone and Mineral Research，ASBMR）创建于1977年，是骨矿研究领域首个专、科学的医学学 会，旨在鼓励临床和科研学者参与到骨骼和矿物质代谢的研究中，促进骨矿研究的发展，加快将基础研究成果转化为临床实践应用。该学会成员包括基础研究学者、骨矿物质代谢及相关领域临床研究者，同时还包括医生和其他健康医疗从业人员。目前全球会员人数约4000 名，覆盖研究领域有生物力学、细胞生物学、分子生物学、口腔医学、发育生物学、内分泌学、流行病学、内科学、新陈代谢、分子遗传学 、肾脏学、妇产科学、骨科学、病理学、药理学、生理学、风湿病学以及其他基础或临床领域。
学会通过举办科学年会、创办杂志（Journal of Bone and Mineral Research）和原始读物、与政府机构和有关学会交流来鼓励并推动此领 域研究的不断扩大。
该学会主页提供了大量的信息资源，主要栏目如下：
（1）会议（Meetings）：主要包括年会和专题会议，以年会信息为主，提供已经举办过的年会报告下载、即将举行的以及将来举行的年会 信息等，具体信息包括大会注册、发言内容、专家介绍、各论坛时间安排等。
（2）出版物（Publications）：提供官方期刊和骨矿研究领域入门读物的相关介绍、编辑精选以及电子版链接，其中入门读物提供书籍每 章内容的幻灯片下载；另外该栏目下还有学会的电子新闻（eNews）专栏，主要为用户时时传达该领域内的重大事件、会议信息、会员福利 以及其他重要信息。“In The Field”子栏目还为用户提供本领域内发表的最新研究论文及相关链接。
（3）教育（Education）：包括骨骼基础课程、在线研讨会、网络广播、基本读物幻灯和教育资源5个子栏目，骨骼基础课程介绍骨的结构 、功能、生长、重塑、骨细胞等基础知识；在线研讨会提供每期会议的时间、频道和往期的内容；网络广播为用户提供往届年会和专题会议 的录像和幻灯下载，用户可在线观看会议的实况录像。
（4）基金资助（Grants）：提供该学会资助的基金项目的详细介绍，具体资助的国家，以及资助项目的相关网站链接。此外，网站的宣传中心提供了骨矿研究相关的最新消息、其他学会的网站链接和合作信息；同时职业规划中心还提供了工作岗位、职业规划 建议等大量的就业信息。     

Hepatitis B-lamivudine for all and forever?

This retrospective study was designed to evaluate the safety and efficacy of long-term lamivudine therapy in Korean patients with chronic hepatitis B virus (HBV) with or without cirrhosis. Study patients were men and women who had received lamivudine 100 mg/day p.o. for 52 wk for treatment of biopsy-proven chronic HBV; 11/29 patients had cirrhosis. Patient eligibility requirements included having a diagnosis of chronic HBV, being positive for HBV by polymerase chain reaction, at least 18 yr of age, and positive for HBsAg, and having abnormally elevated ALT levels. Patients were evaluated for changes in HBV DNA and ALT concentrations, rates at which HBeAg was converted to negative, development of lamivudine resistance, and differences in the drug's effectiveness between patients with and without cirrhosis. Responses of serum HBV DNA and ALT were categorized into three groups according to degree of response to lamivudine treatment: continuous, unstable, and no response.
Twenty-nine patients were evaluated in this retrospective analysis. Therapy with lamivudine suppressed serum HBV DNA to undetectable levels in 97% of patients within 12 wk and remained undetectable in 83% of patients after 52 wk. Differences in responses of HBV DNA and ALT to lamivudine therapy in HBeAg-positive and -negative patients and in the development of drug resistance between patients with and without cirrhosis were negligible. Pretreatment HBV DNA and ALT levels had no effect on the efficacy of lamivudine (   p = 0.9116  ).
No serious adverse events were reported.     

Etiology and risk factors for oesophageal adenocarcinoma: possibilities for chemoprophylaxis?

The rapid increase in the incidence of oesophageal adenocarcinoma, particularly among white males, seems to be a true increase occurring in many parts of the industrialised world during the last few decades. Some main risk factors have been established: i.e. Barrett's oesophagus, gastrooesophageal reflux, high body mass, male sex, tobacco smoking, and high dietary intake of fruit and vegetables. Several other potential risk factors have been studied for which the evidence is less clear, including medications that relax the lower oesophageal sphincter or diets high in fat or low in nutrients from plant foods. Other factors have been found to be possibly inversely linked with the risk of oesophageal adenocarcinoma, including infection with Helicobacter pylori and anti-inflammatory drugs (such as aspirin and other non-steroidal anti-inflammatory drugs, including cyclo-oxygenase inhibitors). The methodological problem of 'confounding by indication' makes it difficult to interpret the results of anti-inflammatory drugs, and currently such medication cannot be recommended for the prevention of oesophageal adenocarcinoma. Similarly, since there is no strong evidence of a preventive effect of medical or surgical antireflux therapy with regard to risk of oesophageal adenocarcinoma, such therapy cannot be recommended in the prevention of this cancer. Although some of the known risk factors might contribute to the increasing incidence of oesophageal adenocarcinoma, the explanation that can entirely explain this striking trend remains to be identified. Oesophageal adenocarcinoma is a highly deadly cancer, but the overall prognosis and the prognosis after oesophageal cancer surgery has improved during recent years.     

What works? Interventions for maternal and child undernutrition and survival

We reviewed interventions that affect maternal and child undernutrition and nutrition-related outcomes. These interventions included promotion of breastfeeding; strategies to promote complementary feeding, with or without provision of food supplements; micronutrient interventions; general supportive strategies to improve family and community nutrition; and reduction of disease burden (promotion of handwashing and strategies to reduce the burden of malaria in pregnancy). We showed that although strategies for breastfeeding promotion have a large effect on survival, their effect on stunting is small. In populations with sufficient food, education about complementary feeding increased height-for-age Z score by 0.25 (95% CI 0.01-0.49), whereas provision of food supplements (with or without education) in populations with insufficient food increased the height-for-age Z score by 0.41 (0.05-0.76). Management of severe acute malnutrition according to WHO guidelines reduced the case-fatality rate by 55% (risk ratio 0.45, 0.32-0.62), and recent studies suggest that newer commodities, such as ready-to-use therapeutic foods, can be used to manage severe acute malnutrition in community settings. Effective micronutrient interventions for pregnant women included supplementation with iron folate (which increased haemoglobin at term by 12 g/L, 2.93-21.07) and micronutrients (which reduced the risk of low birthweight at term by 16% (relative risk 0.84, 0.74-0.95). Recommended micronutrient interventions for children included strategies for supplementation of vitamin A (in the neonatal period and late infancy), preventive zinc supplements, iron supplements for children in areas where malaria is not endemic, and universal promotion of iodised salt. We used a cohort model to assess the potential effect of these interventions on mothers and children in the 36 countries that have 90% of children with stunted linear growth. The model showed that existing interventions that were designed to improve nutrition and prevent related disease could reduce stunting at 36 months by 36%; mortality between birth and 36 months by about 25%; and disability-adjusted life-years associated with stunting, severe wasting, intrauterine growth restriction, and micronutrient deficiencies by about 25%. To eliminate stunting in the longer term, these interventions should be supplemented by improvements in the underlying determinants of undernutrition, such as poverty, poor education, disease burden, and lack of women's empowerment.     

Liver transplantation for intrahepatic and perihilar cholangiocarcinoma: Current and future

Cholangiocarcinomas are categorized as intrahepatic cholangio- carcinoma (iCCA), perihilar cholangiocarcinoma (pCCA), and dis- tal cholangiocarcinoma (dCCA) [1] . iCCA and pCCA are the second most common primary hepatobiliary malignant neoplasms [ 1 , 2 ]. Most patients with iCCA and pCCA have asymptomatic clinical course, highly aggressive nature and dismal prognosis [3] . Com- plete surgical resection offers the best possibility of long-term sur- vival but only a minority of patients are amenable to R0 resec- tion [4] . Tumor involvement of segmental bilateral intrahepatic bile duct, inadequate remnant liver volume or hepatic functional reserve due to underlying chronic liver disease, are key factors limiting the resectability of iCCA and pCCA. Liver transplantation (LT) provides an option for patients with unresectable iCCA and pCCA [4] .     

Asserted and neglected issues linking evidence-based and Chinese medicines for cardiac rehabilitation

High blood pressure is among the most prevalent chronic disease in adults that impacts on the quality of life of patients, which are often subjected to physical rehabilitation. Chinese medicine intervention in patients with hypertension presents promising albeit inconclu-sive results, mostly due to methodological issues. This paper discusses asserted and neglected issues linking evidence-based and Chinese medicines as related to systemic arterial hypertension, as well as their impact on the physical rehabilitation of those patients. On the one hand, natural history of hypertension, pulse palpa-tion, and herbal therapy are among the asserted issues because of the scientific evidence collected about them, either in favor or against its integration to the current medical practice. On the other hand, anatomical varia-tions of vessels and comparative physiology are among the most commonly neglected issues because previous researches on integrative medicine ignored the pos-sible effects of these issues as related to the study's outcome. The asserted issues highlighted in this paperstimulate the increasing use of Chinese medicine for health care and the continuity of research on integra-tive medicine in the cardiovascular field for rehabilita-tion. The neglected issues poses additional challenges that must not be overlooked in future research on this topic so that the integration of both traditional and cur-rent knowledge may be of benefit to the population with cardiovascular disease.     

Surgical treatment for hepatocellular carcinoma and secondary hypersplenism

BACKGROUND: Hepatocellular carcinoma (HCC) is a common disease with high mortality and serious effect on the life quality of patients. Operation is still the most effective treatment. Currently, in China, patients with HCC are often complicated by hepatitis B related liver cirrhosis and secondary hypersplenism. This study was undertaken to evaluate the effect and indications of synchronous hepatectomy and splenectomy for HCC patients with hypersplenism. METHODS: The clinical records and treating processes of 24 patients with HCC and hypersplenism during the period of January 1991 to July 2004 were analyzed retrospectively. RESULTS: Sixteen patients underwent hepatectomy and splenectomy, including extensive devascularizasion around the cardia (9 patients). Seven patients were treated with microwave ablation and splenectomy plus extensive esophagogastric devascularization. One patient underwent hepatectomy combined with microwave ablation and splenectomy plus extensive esophagogastric devascularization. There were no deaths during the operation. During the first week after operation, the symptoms of hypersplenism disappeared and the platelet (Plt) and white blood cell (WBC) counts were significantly elevated (Plt: 247×109/L vs. 45.9×109/L, WBC: 13.0×109/L vs.3.3×109/L,P<0.01). CONCLUSIONS: Synchronous splenectomy can increase the safety of hepatectomy in selected patients with HCC and secondary hypersplenism by reducing bleeding complications. Splenectomy enhances patients' immunity against tumor in a long period as well.