Dynamic exercise therapy in rheumatoid arthritis: a systematic review

The aim of this systematic review was to determine the effectiveness of dynamic exercise therapy in improving joint mobility, muscle strength, aerobic capacity and daily functioning in patients with rheumatoid arthritis (RA). In addition, possible unwanted effects such as an increase in pain, disease activity and radiological progression were studied. A computer-aided search of the MEDLINE, Embase and SCISEARCH databases was performed to identify controlled trials on the effect of exercise therapy. Randomized trials were selected on the effect of dynamic exercise therapy in RA patients with an exercise programme fulfilling the following criteria: (a) intensity level such that heart rates exceeded 60% of maximal heart rate during at least 20 min; (b) exercise frequency > or = 2 a week; and (c) duration of intervention > or = 6 weeks. Two blinded reviewers independently selected eligible studies, rated the methodological quality and extracted data. Six out of 30 identified controlled trials met the inclusion criteria. Four of the six included studies fulfilled > or = 7/10 methodological criteria. Because of heterogeneity in outcome measures, data could not be pooled. The results suggest that dynamic exercise therapy is effective in increasing aerobic capacity and muscle strength. No detrimental effects on disease activity and pain were observed. The effects of dynamic exercise therapy on functional ability and radiological progression are unclear. It is concluded that dynamic exercise therapy has a positive effect on physical capacity. Research on the long-term effect of dynamic exercise therapy on radiological progression and functional ability is needed.      

胰岛ε细胞的研究进展

胰腺由外分泌组织和内分泌组织2个部分所组成,两者在机体能量平衡和营养代谢调节中发挥重要的作用．胰岛是胰腺组织中重要的内分泌功能单位,胰岛的发育和分化过程涉及一个复杂而精细的分子调控网络体系,其中包括许多转录因子的参与．经典的胰岛内分泌细胞包括α细胞、β细胞、δ细胞及PP细胞,分别产生胰升糖素、胰岛素、生长抑素及胰多肽(PP),各种胰岛细胞之间的相互调节在维持血糖稳态中具有重要的意义．表达ghrelin 的ε细胞是一种新近发现和命名的胰岛细胞类型．现着重对胰岛ε细胞的发现过程、形态学特点及生物学作用进行介绍．     

Evaluation of the antioxidant activity of non-transformed and transformed pineapple: A comparative study

Pineapple has several beneficial properties including antioxidant activity. We investigated the antioxidant effect of different extracts of non-transformed (S) and transformed pineapple (with the magainin gene construct, [TS], for disease resistance). They were examined using 1,1-diphenyl-2-picryl hydrazyl (DPPH) radical scavenging, oxygen radical absorbance capacity (ORAC) and lipid peroxidation assays besides phenolic and flavonoid contents. HPLC analysis was carried out to identify the possible components responsible for the differences observed. The present study indicates that the ORAC values of extracts range from 9.5 to 26.4, similar to or higher than those for some fruits and vegetables. The HPLC analysis shows that the main compounds present are ascorbic acid, quercetin, flavone-3-ols, flavones, cinnamic acids. The TS core Et. extract exhibited slightly higher concentration of ascorbic acid and considerably higher concentration of flavon-3-ols. Our study, in general, indicates that the transformation event has caused only marginal difference in antioxidant activity. Moreover the TS samples showed more antioxidant activity in some aspects and also exhibit more flavonoid content. It appears that plant cell transformation has only caused minor and favourable changes in the overall chemical composition. Thus the TS pineapple variety may have potential applications in human health like its non-transformed counterpart.     

Treatment of cluster headache in pregnancy and lactation

Cluster headache is a rare disorder in women, but has a serious impact on the affected woman's life, especially on family planning. Women with cluster headache who are pregnant need special support, including the expertise of an experienced headache centre, an experienced gynaecologist and possibly a teratology information centre. The patient should be seen through all stages of the pregnancy. A detailed briefing about the risks and safety of various treatment options is mandatory. In general, both the number of medications and the dosage should be kept as low as possible. Preferred treatments include oxygen, subcutaneous or intranasal sumatriptan for acute pain and verapamil and prednisone/prednisolone as preventatives. If there is a compelling reason to treat the patient with another preventative, gabapentin is the drug of choice. While breastfeeding, oxygen, sumatriptan and lidocaine for acute pain and prednisone/prednisolone, verapamil, and lithium as preventatives are the drugs of choice. As the individual pharmacokinetics differ substantially, adverse drug effects should be considered if unexplained symptoms occur in the newborn.     

Patient satisfaction with doctor–patient interaction in a radiotherapy centre during the severe acute respiratory syndrome outbreak

An outpatient radiotherapy department assessed how precautions implemented during the severe acute respiratory syndrome (SARS) outbreak affected patient satisfaction with doctor–patient interaction and explored variables potentially influencing satisfaction. The information obtained would help prepare us for future infectious disease outbreaks. Outpatients seen during the outbreak completed a validated questionnaire assessing satisfaction with doctor–patient interaction. Additional items assessed included patients’ perception of SARS measures and patient demographics. Of 149 patients, 97% had heard of SARS, 92% believed SARS precautions necessary, and 54% believed contracting SARS was possible despite the precautions. Patients were satisfied with doctors wearing masks (97%), temperature checks (97%), and patients wearing masks (96%). Despite the high satisfaction levels with SARS precautions, 24% believed it had adversely affected doctor–patient interaction. With regards to doctor–patient interaction, 94% of patients were satisfied. Patients were most satisfied with the ‘information exchange’ domain (mean score 3.23 out of 4) compared to other domains (P < 0.0001, 100.00% confidence) and were less satisfied with the ‘empathy’ domain compared to other domains (P < 0.0001, 100.00% confidence). Patients were most satisfied with understanding their treatment plan (100%), doctor being honest (97%) and being understood (96%). Patients were least satisfied with information about caring for their illness (61%), that the visit could be better (59%), and the doctor showing more interest (58%). On multivariate analysis, patients who were less satisfied with SARS measures were significantly less satisfied with doctor–patient interaction (P = 0.0001). Dissatisfaction with SARS measures was associated with significant dissatisfaction for questions in all domains. Older age and non‐breast cancer patients were also less satisfied with doctor–patient interaction. Most (94%) of patients were satisfied with doctor–patient interaction, despite implementation of infectious disease prevention measures. However, patients who were dissatisfied with the SARS precautions had poorer satisfaction. In particular, physician empathy appeared to be most adversely affected. The results have relevance to any radiotherapy department preparing contingency plans in the event of infectious disease outbreaks.     

Differential modification by caffeine of oxygen-dependent and independent effects of gamma-irradiation on rat liver mitochondria

PURPOSE: Following the demonstration that caffeine effectively competes with oxygen for electrons and also scavenges hydroxyl radicals and singlet oxygen, the differential modification of oxygen-dependent and independent effects of gamma-radiation by caffeine in membranes was examined, using rat liver mitochondria as a model system. MATERIALS AND METHODS: Mitochondria were isolated from the livers of Wistar rats and exposed to gamma-radiation in the dose range of 45-600 Gy (dose rate 15 Gy/min) in the presence or absence of caffeine. To examine the 'oxygen effect', post-irradiation incubation was carried out in the presence of oxygen or nitrogen in buffers saturated with the respective gases. Membrane damage was examined as lipid peroxidation (assessed as formation of thiobarbituric acid-reactive substances (TBARS), lipid hydroperoxides (LOOH) and conjugated dienes (CD), protein oxidation, depletion of protein thiols, superoxide dismutase or glutathione. RESULTS: Lipid peroxidation increased as a function of radiation dose, from 45 to 600 Gv. Post-irradiation incubation of mitochondria under nitrogen decreased the response, while incubation under oxygen saturation enhanced it significantly. The presence of caffeine during radiation exposure inhibited lipid peroxidation significantly as a function of concentration, in the range of 5 microM to 4 mM. The inhibition was highest with 4 mM of caffeine. Under oxic conditions, inhibition at 1 mM was significantly more than under anoxia. Anoxia was either ineffective or marginally increased peroxidation in the presence of caffeine. A similar observation was obtained when membrane damage was assessed as protein oxidation. Radiation-induced depletion of protein thiols was greatly enhanced by oxygen saturation and this was completely prevented by caffeine. This compound also protected against the radiation-induced loss of the antioxidant glutathione and the enzyme superoxide dismutase. CONCLUSIONS: The results suggest that caffeine effectively protected membranes against the oxic component of damage but may not do so for the anoxic component.     

Endometrial adenosarcoma with adjuvant tamoxifen therapy for primary breast carcinoma

The first documented case of endometrial adenosarcoma associated with chronic tamoxifen usage is reported.     

门诊与住院患者口服抗凝剂治疗的安全性指征

1 引言 英国血液标准化委员会于1998年公布了第三版口服抗凝剂治疗指南,并于2006年修订.这些指南在安全性指征方面值得称道,但对开始口服抗凝剂治疗患者和已持续进行口服抗凝剂治疗的患者来说,安全性指征和危险性是相互伴随的.并非所有的安全性指征都要被医务工作者所采纳,而是为他们提供一种选择,可根据具体情况和需求选择最有用的指标.为了医疗服务的健康发展,这些安全性指征可以用来设立各种标准和规范,并进行相应的监督和审计.     

Mutations and impaired function of LKB1 in familial and non-familial Peutz-Jeghers syndrome and a sporadic testicular cancer

Germline mutations in LKB1 have been reported to underlie familial Peutz-Jeghers syndrome (PJS) with intestinal hamartomatous polyps and an elevated risk of various neoplasms. To investigate the prevalence of LKB1 germline mutations in PJS more generally, we studied samples from 33 unrelated PJS patients including eight non-familial sporadic patients, 20 familial patients and five patients with unknown family history. Nineteen germline mutations were identified, 12 (60%) in familial and four (50%) in sporadic cases. LKB1 mutations were not detected in 14 (42%) patients, indicating that the existence of additional minor PJS loci cannot be excluded. LKB1 is predicted to encode a serine/threonine kinase. To demonstrate the putative Lkb1 kinase function and to study the consequences of LKB1 mutations in PJS and sporadic tumors, we have analyzed the kinase activity of wild-type and mutant Lkb1 proteins. Interestingly, while most of the small deletions or missense mutations resulted in loss-of-function alleles, one missense mutation (G163D) previously identified in a sporadic testicular tumor demonstrated severely impaired but detectable kinase activity.