Impact of zinc supplementation in children with acute diarrhoea in Turkey.

OBJECTIVE: Zinc deficiency is prevalent in children in developing countries. Supplemental zinc provides therapeutic benefits in diarrhoea. Our aim was to evaluate the effect of daily zinc supplementation for 14 days on diarrhoea duration, severity, and morbidity in children. METHODS: In a randomised, open label non-placebo controlled trial, we assessed the efficacy of providing zinc sulfate to 6-60 month old children with acute diarrhoea for 2 weeks followed by 3 months of morbidity surveillance. Children were randomly assigned to zinc (n = 150) and control (n = 130) groups and received 15-30 mg elemental zinc daily. RESULTS: Supplemented children had significantly improved plasma zinc levels by day 14 of therapy. Zinc deficiency was observed in 2.6% of the treatment and 3.3% of the control group. The mean duration of diarrhoea after starting supplementation was 3.02+/-2 days in the zinc group and 3.67+/-3.2 days in the control group. There was no significant difference in diarrhoea duration by treatment group (p>0.05). The number of stools after starting supplementation was 5.8+/-3.7 and 5.1+/-3.9 on day 1, 2.9+/-1.6 and 3.0+/-2.2 on day 2, and 1.8+/-1.1 and 1.6+/-0.9 on day 3 in the zinc and control groups, respectively. There was no significant difference in diarrhoea severity by treatment group (p>0.05). No significant effect was found on the incidence and prevalence of diarrhoea in the zinc compared with the control group. CONCLUSION: Our data indicate that supplementing children with acute diarrhoea in Turkey with 3 RDA of elemental zinc for 14 days improved neither diarrhoea duration nor severity despite significant increments in plasma zinc.     

The use of the wide-awake local anesthesia no tourniquet technique in foot and ankle injuries

PurposeAlthough the wide-awake anesthesia no tourniquet (WALANT) technique has demonstrated high efficacy, safety, patient satisfaction, and cost-effectiveness in hand surgery, there are limited data on its use in foot and ankle surgery. This study aimed to evaluate the efficacy of the WALANT technique in selected foot and ankle injuries in terms of intra- and post-operative characteristics.Material and methodsPatients with foot and ankle injuries who underwent surgery with the WALANT technique were evaluated in this retrospective study. A total of 31 patients (22 male/9 female) with a mean age of 40 ± 16 years were evaluated for the type of injury, underlying comorbidities, American Society of Anesthesiologists Classification (ASA) score, intraoperative visual analog pain (VAS) and anxiety (VAS-A) scores, duration of operation, complications, need for intensive care and duration of hospitalization.ResultsThere were 15 patients with medial malleolus fracture, 5 with lateral malleolus fracture, 5 with Achilles tendon ruptures, 2 with proximal phalangeal fracture, and 1 with Lisfranc injury, medial malleolus + syndesmotic injury, deltoid ligament + syndesmotic injury and fifth metatarsal fracture. ASA I–II score was determined in 27 patients and ASA III score in 4. The mean operation time was 36.6 ± 7 min, and the mean length of hospital stay was 8.3 ± 6.1 h. The median VAS pain score was 1 (range, 0–4), the median VAS-A score was 1 (range, 0–3) and no patient needed further anesthetics during the operation. No patient needed intensive care unit stay and no complications were observed in any patient.ConclusionThe WALANT technique was seen to provide satisfactory anxiety and pain scores, acceptable complications, and a short length of hospital stay in patients with foot and ankle injuries. Simple foot and ankle injuries can be managed successfully with this technique through adequate hemostasis without a tourniquet.Level of evidence: Level III.     

白金胶囊对CUMS诱导的抑郁症大鼠模型行为学及脑内单胺类神经递质的影响

目的：观察白金胶囊对慢性不可预知温和应激（ CUMS）致抑郁症大鼠模型行为学及脑内单胺类神经递质的影响。方法采用慢性不可预知温和应激结合孤养的方法建立抑郁症大鼠模型,造模7周后,采用白金胶囊（12.6 g／kg、4.2 g／kg、1.4 g／kg）和盐酸氟西汀（3.5 mg／kg）连续灌胃4周进行治疗,给药期间继续实施应激方案,共计11周,另设正常对照组,常规饲养。监测糖水偏嗜度、以及动物在旷场中的水平运动、垂直运动等行为学指标;实验终点,采用高效液相-电化学法测定大鼠脑皮层、海马部位单胺类神经递质（5-HT、DA、NE及其代谢产物）的水平。结果与正常对照组比较,模型大鼠造模7周后,体重、糖水消耗百分比、旷场水平运动和垂直活动明显降低（ P＜0.05,P＜0.01）;与模型组比较,白金胶囊连续给药4周后,各剂量可显著增加糖水消耗百分比,旷场水平运动距离和垂直运动次数（ P＜0.05,P＜0.01）,改善抑郁动物行为学;可升高抑郁模型脑皮层中5-HT、DA以及NE的含量（ P＜0.05）。结论白金胶囊可改善CUMS致抑郁症大鼠模型的行为学异常,作用机制可能与增加脑皮层中单胺类神经递质含量有关。     

HLA-Identical Sibling Renal Transplantation: Influence of Donor and Recipient Gender Mismatch on Long-term Outcomes

BackgroundLong-term function of living-related kidney allograft depends on multiple variables. The aim of the present study was to assess the influence of donor and recipient gender mismatch on the short and long-term outcomes in human leukocyte antigen (HLA)-identical sibling renal transplants (SRTs) receiving induction therapy and different immunosuppressive regimens.Material and MethodsTwenty-nine recipients who were grafted from their HLA-identical siblings between 1994 and 2008 were divided into 2 groups (same and mismatched) according to gender of donor and recipient. The analyzed variables were age, gender, cholesterol, triglyceride, proteinuria, estimated glomerular filtration rate, weight, body mass index, and serum creatinine at 6, 12, 24, 36, 48, and 60 months, and median follow-up. Univariate and multivariate logistic regression models (when appropriate) were used to evaluate the effects of variables on allograft survival.ResultsThe number of male donors (P = .001) and recipient age (P = .019) was significantly higher in the same gender group than in mismatched gender group; there were no relationships between remainder analyzed parameters. Multivariate regression analysis revealed that after median follow-up period of 84 months (range, 60–232) the most important potential factors to significantly influence long-term outcomes were male donor (P = .002), recipient age (P < .001), and donor age (P = .021).ConclusionOur study demonstrated that male donor, and donor and recipient age affected long-term survival of HLA-identical SRTs, supported with antibody induction therapy and lifetime immunosuppression.     

军队医院开放式共享科研平台建设实践与展望

目的：探讨开放式共享科研平台建设的意义,交流军队医院开放式共享科研平台建设运行与管理的实践做法,促进新建科研平台的开放与共享。方法：分析科研平台建设的背景,研究开放式共享科研平台建设的原则、特色与管理要求。结果：开放式共享科研平台具有促进临床和科研相结合的作用。从实际出发、具有创新性、统筹兼顾及与促进科研人才队伍建设相结合是开放式共享科研平台的特色,平台的管理中要注意为本院和同行业医学科技人员提供技术服务和设备支持,做好信息化管理、及时掌握课题进展及学科动态,实行年度目标考核制度等。结论：开放式共享科研平台的建设为促进综合性医院学科发展、推进转化医学、促进医院高层次科研人才的培养提供了新途径。     

Up-regulation of TGM2 with ITGB1 and SDC4 is important in the development and metastasis of renal cell carcinoma

ObjectiveTissue transglutaminase (TGM2) up-regulation is involved in the progression and dissemination of carcinomas through β1 integrin (ITGB1) association. Given that TGM2 interaction with syndecan-4 (SDC4) on the cell surface is important in the activation of ITGB1 and integrin-mediated survival signaling, we investigated the roles of TGM2, ITGB1, and SDC4 in the development and metastasis of renal cell carcinoma (RCC).Material and methodsExpression levels of TGM2, ITGB1, and SDC4 mRNA were analyzed in primary tumor samples (n = 95) and their healthy counterparts in addition to control and RCC epithelial cell lines. TGM2 catalytic activity in 60 randomly selected patient samples was measured by enzyme-linked sorbent plate assay.ResultsTGM2 expression ratio showed a significant 2.9-fold decrease in 67 (70.5%) of the primary RCC tumors (P <0.0001) independent of clinical covariates, including tumor node metastasis (TNM) staging and histopathologic grading. For the remaining 28 (29.5%) tumors, a 1.95-fold increase was recorded in the TGM2 expression levels, which also showed a significant increase in ITGB1 and SDC4 expression levels in 82.6% of the overexpression cases (P <0.001). Up-regulation of TGM2 along with ITGB1 and SCD4 was associated with metastasis and a marked decrease in tumor necrosis. Consistently, RCC cell lines exhibited higher levels of TGM2 expression compared with the control epithelial cell line with a significant up-regulation of ITGB1 and SCD4 recorded for the metastatic lines.ConclusionsOur findings suggest that TGM2 up-regulation along with ITGB1 and SDC4 plays an important role in the development of RCC tumors and advanced RCC with metastasis.     

Head-to-head comparison of two different low-molecular-weight heparins in acute coronary syndrome: a single center experience

Low-molecular-weight heparins (LMWH) of different types have yielded different results when used in the setting of unstable angina (UA) or non Q-wave myocardial infarction (NQMI). We compared the safety and therapeutic efficacy of two different LMWHs, namely dalteparin (Dalt.) and enoxaparin (Enox.), in the acute phase (first 5 days) of UA or NQMI. One hundred and forty-two patients with UA/NQMI were randomly assigned to treatment with either Dalt. [120 IU/kg twice daily by subcutaneous (SC) injection] or Enox. [1 mg/kg twice daily by SC injection]. The occurrence of any one of death, myocardial infarction, or angina recurrence within 5 days of the first LMWH injection was the endpoint of the study. There were 69 patients in the Enox. group (53 males, 16 females, mean age: 60.3+/-11.9) and 73 patients in the Dalt. group (54 males, 19 females, mean age: 59.6 +/-10.3). The baseline characteristics of the patients in the two groups were similar. There were no deaths in either group. Myocardial infarction occurred in two patients in the Dalt. group (4%). Angina recurrence was seen in 11 patients in the Enox. group (16%) and in 11 patients in the Dalt. group (15%). Overall, any of the events that made up the endpoint occurred in 11 (16%) and 14 (19%) patients in the Enox. and Dalt. groups, respectively (P>0.05). The time to occurrence of the first event, however, was significantly longer in the Enox. group (82.3+/-33.2 versus 37.6+/-23.4 hours, P=0.007). Thrombocytopenia and allergic reactions were not detected in any patient. Major bleeding was seen in I patient in the Enox. group. Minor bleeding occurred in 17 (25%) and 21 (29%) patients in the Enox. and Dalt. groups, respectively (P>0.05). Enoxaparin and dalteparin were found to be equally safe and effective for the early management of UA/NQMI, but enoxaparin appeared to delay the occurrence of MI or angina recurrence as compared to dalteparin in this setting.     

Mutations of the HFE gene among Turkish hereditary hemochromatosis patients

Since the discovery of the HFE gene, C282Y and H63D mutations have been reported as significantly correlated with clinically manifested hereditary hemochromatosis (HH). As the other genes involved in iron metabolism have been described, non-HFE cases of HH have been identified. Since in the general Turkish population, the C282Y mutation is not found and the H63D mutation is of high frequency, we aimed to determine mutations in the HFE genes in our patients with HH. The HFE gene of the five patients with HH were sequenced. C282Y mutation was absent, and all HH patients were heterozygote for H63D mutation. No other mutation was found in HFE gene by sequencing. Although the higher allele frequency of the H63D mutation in Turkish HH patients than in the general population implies a role of the H63D mutation in iron overload, there is a strong possibility that Turkish HH patients have non-HFE hemochromatosis.