Clinical equivalence of intranasal estradiol and oral estrogens for postmenopausal symptoms.

OBJECTIVES: The aim was to demonstrate the equivalent efficacy of intranasal estradiol (Aerodiol Servier, Istanbul, Turkey) 300 mg/day relative to a standard oral estradiol therapy of 2 mg/day and to assess the therapeutic value of the potential benefits of Aerodiol. METHODS: Two hundred and one postmenopausal women with severe menopausal symptoms were recruited to the trial. Women received either intranasal Aerodiol 300 microg/day (one spray delivery of 150 microg per nostril) or an oral estradiol 2 mg for 24 weeks. Severity of symptoms were compared based on the Kupperman index (KI) at the end of 24 weeks. RESULTS: The KI score decreased markedly in both groups between W0 and W24. At W24, the two treatments were shown to be statistically equivalent (P<0.001). The incidence of adverse events was very similar in both groups; those related to treatment were of mild or moderate intensity in 95% of cases for the nasal group and 90% for the oral group. CONCLUSIONS: In conclusion, pulsed estrogen therapy using Aerodiol is safe, easily used and highly efficient in alleviating postmenopausal symptoms with a dose of 300 microg. The dose of 300 microg in one administration per day offers the optimal therapy whilst being easily adaptable to each patient's clinical response.     

Conversion of atrial fibrillation to sinus rhythm during treatment with intravenous esmolol or diltiazem: a prospective, randomized comparison

Prior studies have suggested that intravenous diltiazem reduces the probability of spontaneous conversion of atrial fibrillation (AF) to sinus rhythm in the electrophysiology laboratory and in patients with postoperative AF. Whether diltiazem exerts the same effect in patients presenting to the emergency department (ED) with spontaneous AF is unclear. Fifty patients presenting to the ED with new-onset or paroxysmal AF and a rapid ventricular rate (>100 beats per minute) were randomly assigned to receive intravenous diltiazem or esmolol during the first 24 hours of presentation. Conversion to sinus rhythm occurred in 10 patients (42%) in the diltiazem group compared with 10 patients (39%) in the esmolol group (P = 1.0). Diltiazem does not decrease the likelihood of spontaneous conversion of AF to sinus rhythm in the ED setting.     

Characteristics of rapid rhythms recorded within pulmonary veins during atrial fibrillation

Rapid rhythms often arise in the pulmonary veins during atrial fibrillation (AF). The activation patterns within pulmonary veins during these rapid rhythms are not well described. In 39 patients with paroxysmal AF, ostial recordings were obtained during AF in 110 pulmonary veins with a decapolar distal ring catheter. Pulmonary vein tachycardia (PVT) was defined as a pulmonary vein (PV) rhythm that had a cycle length shorter than at the adjacent left atrium. During AF, PVT was recorded in 93% of PV's, usually in the form of intermittent bursts that had a mean duration of 1,325 +/- 647 ms and mean cycle length of 125 +/- 20 ms. The mean cycle length of continuous PVT's (141 +/- 25) was longer than the mean cycle length of intermittent bursts of PVT (P < 0.05). The intermittent PVT's were associated with a shorter left atrial cycle length than were the continuous PVT's. In 90% of PVTs, complex activation patterns attributable to simultaneous recordings from two or more overlapping fascicles were present at a segment of the pulmonary vein ostium, and the mean cycle length of these recordings was 80 +/- 32 ms. PVT during AF is much more often intermittent than continuous. The relationship between PVT cycle length and left atrial cycle length suggests that PVT's influence the left atrium during AF. PVT must be distinguished from recordings within PV's that have a short cycle length as a result of simultaneous recordings from two or more overlapping fascicles.     

Increased oxidative protection by high active vitamin E content and partial radiation crosslinking of UHMWPE

Vitamin E stabilization successfully improved long‐term oxidation resistance of wear‐resistant ultra‐high‐molecular‐weight polyethylene (UHMWPE) used for joint implants. Stabilization can be achieved by blending an antioxidant into the UHMWPE resin powder before consolidation and irradiation. Balancing the wear resistance and vitamin E content in the blend is the current challenge with this approach, because vitamin E hinders crosslinking of UHMWPE during irradiation, which decreases wear resistance. The vitamin E concentration in the blend is generally limited to less than 0.3 wt%. Wear‐ and oxidation‐resistant UHMWPE has been obtained previously by consolidating blends of pre‐irradiated UHMWPE powders (XPE) into an unmodified polyethylene matrix (PE), where the improvement in wear rate depended on the radiation dose and fraction of XPE. We hypothesized that increasing the vitamin E content in the unirradiated matrix would not compromise wear and would further improve the oxidative stability of XPE/PE blends. Pin‐on‐disk wear testing showed that the XPE/PE blends containing 0.1–1.0 wt% vitamin E in the matrix had comparable wear rates. We used an aggressive accelerated aging test in the presence of the pro‐oxidant squalene and oxidation induction time (OIT) test and found that higher amounts of vitamin E resulted in stronger oxidation resistance for XPE/PE blends. The mechanical strength and toughness of the blends were not affected by changing the vitamin E content in the matrix. Stabilizing UHMWPE with higher vitamin E content may extend the service life of UHMWPE implants. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:1860–1867, 2018.

     

成人牙周炎继发错畸形正畸治疗的效果评价

目的在严格选择适应证的前提下,探讨成人牙周炎继发错牙合畸形患者正畸治疗的效果。方法分析19例成人牙周炎继发错牙合畸形患者的矫治过程,并对矫治效果进行评价。结果总成功率达到84.21%。结论在正确选择适应证、严格控制牙周状况、注意牙周炎矫治特点的情况下,成人牙周炎继发错牙合畸形的正畸治疗可以取得良好效果。     

Comparison of silver sulfadiazine 1%, mupirocin 2%, and fusidic acid 2% for topical antibacterial effect in methicillin-resistant staphylococci-infected,full-skin thickness rat burn wounds

Silver sulfadiazine 1%, mupirocin 2%, and fusidic acid 2% were compared to assess the antibacterial effect of a once-daily application on experimental rat 15% full-skin thickness burn wounds seeded 24 hours earlier with a 10 standard strain of methicillin-resistant staphylococci. The quantitative counts of seeded organism in burn eschar and subjacent muscle were determined at postburn day 7, beside the cultures of blood and lung biopsies. All tested topical agents were equally effective against methicillin-resistant in reducing local burn wound bacterial count and preventing systemic infection.     

The altered autonomic nervous system activity in iron deficiency anemia

Autonomic function is impaired in anemic patients with various etiologies such as vitamin B12 deficiency, sickle cell trait, and thalassemia major. However, there are insufficient data about autonomic functions in patients with iron deficiency anemia, the leading cause for anemia in the general population. In the present study we aimed to investigate the autonomic status in iron deficiency anemia by analyzing the heart rate variability (HRV). Age- and gender-matched 43 patients with iron deficiency anemia and 39 healthy subjects were undertaken into 24-hr Holter monitoring for assessing the HRV. We used serum levels of iron, iron binding capacity, C-reactive protein, vitamin B12, and folate to exclude other causes of anemia. While age, gender, vitamin B12 and folate levels were not different between the groups, HRV values were lower in patients with iron deficiency anemia compared to control group, which reflects parasympathetic withdrawal. Blood hemorheological factors such as decreased viscosity and/or altered red cell deformability may be responsible for this decreased parasympathetic activity. However, these components do not display remarkable contribution in iron deficiency anemia. Therefore, we speculated a probable link between anemia and the accentuated sympathetic activity that may be triggered by hypoxia sensed through carotid bodies. Despite lacking adequate convincing evidence concerning exact mechanism of carotid body activation, it is assumed as due either to hypoxia-related mitochondrial respiratory chain inhibition or potassium channel suppression that leads to intracellular calcium accumulation. In conclusion, the present study demonstrates an altered autonomic balance in patients with true iron deficiency anemia.