Measurement properties of the OARSI core set of performance-based measures for hip osteoarthritis: a prospective cohort study on reliability,construct validity and responsiveness in 90 hip osteo­arthritis patients

Background and purpose — Improvement of physical function is one of the main treatment goals in severe hip osteoarthritis (OA) patients. The Osteoarthritis Research Society International (OARSI) has identified a core set of performance-based tests to assess the construct physical function: 30-s chair stand test (30-s CST), 4x10-meter fast-paced walk test (40 m FPWT), and a stair-climb test. Despite this recommendation, available evidence on the measurement properties is limited. We evaluated the reliability, validity, and responsiveness of these performance-based measures in patients with hip OA scheduled for total hip arthroplasty (THA).

Patients and methods — Baseline and 12-month follow-up measurements were prospectively obtained in 90 end-stage hip OA patients who underwent THA. As there is no gold standard for comparison, the hypothesis testing method was used for construct validity and responsiveness analysis. A test can be assumed valid if ≥75% of predefined hypotheses are confirmed. A subgroup (n = 30) underwent test–retest measurements for reliability analysis. The Oxford Hip Score, Hip injury and Osteoarthritis Outcome Score—Physical Function Short Form, pain during activity score, and muscle strength were used as comparator instruments.

Results — Test–retest reliability was appropriate; intraclass correlation coefficient values exceeded 0.70 for all 3 tests. None of the performance-based measures reached 75% hypothesis confirmation for the construct validity or responsiveness analysis.

Interpretation — The performance-based tests have good reliability in the assessment of physical function. Construct validity and responsiveness, using patient-reported measures and muscle strength as comparator instruments, could not be confirmed. Therefore, our findings do not justify their use for clinical practice.     

The prognostic significance of facial lymphoedema in HIV-seropositive subjects with Kaposi sarcoma

Background

Kaposi Sarcoma (KS) is a multifocal angioproliferative neoplasm characterized by inflammation, oedema, neoangiogenesis and spindle cell proliferation. The pathogenesis of human immunodeficiency virus (HIV)-associated KS (HIV-KS) is multifactorial. HHV-8 is an essential factor but not in itself sufficient to cause HIV-KS, the development of which is influenced by HIV, by increased production of cytokines and by growth factors. Whether HIV-KS is a true malignancy or a reactive hyperplastic inflammatory condition is debatable.

Results and Conclusion

Oedema of the face, legs and hands is a prominent feature of HIV-KS and is probably caused by lymphoedema related to the HIV-KS lesions. The cases of two HIV-seropositive subjects with KS-associated facial lymphoedema are reported. Extensive oral HIV-KS in association with facial oedema in the absence of anti-retroviral treatment appears to be an indication of a poor prognosis.     

慢性阻塞性肺疾病病情严重程度复合指数的设计与评价

背景和目的:COPD是一种因系统性效应的存在而使全身多个系统受累的多元性疾病,严重影响患者的生命质量,而且系统性效应与机体的健康状态之间还可以形成恶性循环.肺功能等单项指标(如FEV1)的检测不能全面反映COPD疾病本身对患者的影响.多项指标联合检测可以更加准确地反映COPD对机体各个方面的影响程度.已有的BODE指数和COPD预后指数因其自身设计的问题,在实际应用过程中存在一定局限性.本研究设计并评估了1个反映当前COPD病情严重程度的复合指数(DOSE指数),DOSE指数涉及的指标均具有重要的临床意义,在实际应用过程中不受病情严重程度和患者身体状况的限制,易于操作.     

肠毒素大肠杆菌攻毒小鼠模型的建立以及疫苗候选株保护效果的评价

目的:建立肠毒素大肠杆菌攻毒小鼠模型以及应用模型对疫苗候选株免疫效果进行评价．方法:通过鼻饲半数致死量(LD50)肠毒素大肠杆菌E44813,E44815和E11881A观察小鼠肺病理学变化、肺部细菌清除情况变化,建立肠毒素大肠杆菌鼻饲小鼠模型;应用鼻饲小鼠模型观察疫苗候选株FE1,FE3,FE6保护效果．结果:鼻饲LD50剂量肠毒素大肠杆菌小鼠的病理特征是肺组织存在大量的淋巴细胞、巨噬细胞、中性粒细胞和浆细胞,为多病灶支气管肺炎,肺部细菌清除缓慢,至第7天仍能检测到105数量级的细菌．应用疫苗候选株免疫后进行攻毒,小鼠没有发病和死亡,病理特征主要是淋巴细胞少量增多,肺部细菌清除迅速,至第7天已检测不到细菌,与对照有显著性差异(0 CFU／g vs 6．2×105,5．4×105,2．3×105 CFU／g,P<0．05)．结论:肠毒素大肠杆菌鼻饲小鼠模型能够为疫苗筛选和评价提供了有效途径,同时也证实了疫苗候选株FE1,FE3,FE6具有良好的免疫保护效果．     

依替膦酸二钠对卵巢切除妇女骨密度降低的预防作用

目的 探讨双膦酸盐对切除双侧卵巢的妇女骨密度减低的预防作用。方法 18例早期恶性肿瘤行双侧卵巢切除的患者使用骨吸收抑制剂依替膦酸二钠,400 mg/d×14d,每3个月间断用药一次,持续1年,并以20例因其它病因而实施去势手术的妇女作为对照,研究骨吸收抑制剂依替膦酸二钠对早期恶性肿瘤去势术后妇女骨量的保护作用。结果使用依替膦酸二钠1年时,患者的骨量虽然未能保持在术前水平,但可以显著减少骨量的丢失,与对照组相比差异有显著性(P<0.05),并且骨密度的变化与BALP呈负相关性(P<0.05)。投药1年时肿瘤患者无1例复发。结论依替膦酸二钠可以减少去势手术妇女的骨量丢失,对预防去势手术妇女的骨质疏松有积极的作用。     

Bone and collagen turnover during treatment with inhaled dry powder budesonide and beclomethasone dipropionate

OBJECTIVES--To assess bone and collagen turnover in asthmatic children treated with dry powder budesonide from the Turbuhaler and dry powder beclomethasone dipropionate from the Diskhaler in a dose of 800 micrograms/day. SUBJECTS--Thirteen prepubertal children with asthma. DESIGN--Open crossover study with two treatment periods and treatment free run-in and wash-out periods. All periods were of two weeks' duration. At day 14 in each period blood samples were taken for assessment of serum osteocalcin, the carboxyterminal propeptide of type I collagen (PICP), and the aminoterminal propeptide of type III collagen (PIIINP). At the same time urine was collected for assessment of creatinine corrected pyridinoline (uPYR/cr) and deoxypyridinoline (udPYR/cr) crosslinks. RESULTS--Osteocalcin concentrations were not influenced by any of the treatments. During budesonide treatment mean (SEM) PICP was reduced by 18% (8%) (p = 0.03), PIIINP by 24% (3%) (p = 0.0002), uPYR/cr by 16% (6%) (p = 0.03), and udPYR/cr by 21% (13%) (p = 0.12). During treatment with beclomethasone dipropionate mean (SEM) PICP was reduced by 20% (6%) (p = 0.01), PIIINP by 36% (3%) (p = 0.0002), uPYR/cr by 18% (4%) (p = 0.004), and udPYR by 13% (5%) (p = 0.02). The suppressive effect of beclomethasone dipropionate on PIIINP was more marked than that of budesonide (p = 0.001). CONCLUSION--Treatment with dry powder budesonide and beclomethasone dipropionate 800 micrograms/day is associated with suppression of bone and collagen turnover. The suppression seems to be more marked during treatment with beclomethasone dipropionate. Long term effects and effects of lower doses of budesonide and beclomethasone dipropionate on bone and collagen markers needs further study.