Contributions of severe burn and disuse to bone structure and strength in rats

Burn and disuse results in metabolic and bone changes associated with substantial and sustained bone loss. Such loss can lead to an increased fracture incidence and osteopenia. We studied the independent effects of burn and disuse on bone morphology, composition and strength, and microstructure of the bone alterations 14 days after injury. Sprague–Dawley rats were randomized into four groups: Sham/Ambulatory (SA), Burn/Ambulatory (BA), Sham/Hindlimb Unloaded (SH) and Burn/Hindlimb Unloaded (BH). Burn groups received a 40% total body surface area full-thickness scald burn. Disuse by hindlimb unloading was initiated immediately following injury. Bone turnover was determined in plasma and urine. Femur biomechanical parameters were measured by three-point bending tests and bone microarchitecture was determined by micro-computed tomography (uCT). On day 14, a significant reduction in body mass was observed as a result of burn, disuse and a combination of both. In terms of bone health, disuse alone and in combination affected femur weight, length and bone mineral content. Bending failure energy, an index of femur strength, was significantly reduced in all groups and maximum bending stress was lower when burn and disuse were combined. Osteocalcin was reduced in BA compared to the other groups, indicating influence of burn. The reductions observed in femur weight, BMC, biomechanical parameters and indices of bone formation are primarily responses to the combination of burn and disuse. These results offer insight into bone degradation following severe injury and disuse.     

LASEK术中弃留角膜上皮瓣对高度近视疗效的影响

目的:对比研究LASEK术中弃留上皮瓣治疗高度近视的手术疗效。方法:回顾性分析高度近视患者58例115眼,根据手术方式分为,LASEK留瓣组30例59眼,LASEK弃瓣组28例56眼。观察两组患者术后疼痛感、裸眼视力、角膜haze、上皮愈合时间。结果:留瓣组和弃瓣组术后1d疼痛积分分别为1.64±0.64、1.57±0.57分,术后2d为0.83±0.49、0.84±0.56分,术后3d为0.36±0.48、0.34±0.47分;两组不同时间疼痛积分无差异(P>0.05)。留瓣组和弃瓣组术后1wk裸眼视力分别为0.15±0.06、0.12±0.05,术后1mo时为0.032±0.004、0.041±0.003,术后3mo时为0.018±0.004、0.022±0.005;两组不同时间裸眼视力无差异(P>0.05)。术后1、3mo,角膜haze 0.5~1级发生率差异均无统计学意义(P>0.05);角膜2级haze发生率差异均有统计学意义(P<0.05);留瓣组和弃瓣组上皮愈合时间分别为4.22±0.30、3.89±0.32d(P<0.05)。两组患者上皮延迟愈合数分别为0眼、6例10眼(P<0.05)。结论:留瓣与弃瓣术后裸眼视力恢复无明显差异,角膜刺激症状相似。弃瓣组上皮愈合较快,但弃瓣组角膜haze 2级发生率稍高,上皮延迟愈合和愈合不良较多。因此,对于高度近视行LASEK手术时建议留瓣。     

Leukocytapheresis for the treatment of active pouchitis: a pilot study

BACKGROUND: Pouchitis is a major long-term complication of ileal pouch-anal anastomosis for ulcerative colitis. The aim of this study is to investigate the efficacy of leukocytapheresis for the treatment of active pouchitis. METHODS: Eight patients with active pouchitis received leukocytapheresis weekly for 5 weeks in an open-label treatment protocol together with baseline therapy. RESULTS: Patients showed significant improvement in their pouchitis disease activity index scores, from 9.5 (range, 8-10) to 4.0 (range, 2-8) (P < 0.05). Six (75%) of the 8 treated patients achieved remission. No adverse events were observed. CONCLUSIONS: Leukocytapheresis therapy could be a new therapeutic strategy for patients with pouchitis after ileal pouch-anal anastomosis for ulcerative colitis. These encouraging results lead us to propose a randomized controlled trial.     

High expression and frequently humoral immune response of melanoma-associated antigen D4 in glioma

MAGE-D4 is a novel member of MAGE super-family. It has preliminarily been demonstrated that MAGE-D4 mRNA is not expressed in majority of normal tissues except for brain and ovary in which only trace amount of MAGE-D4 mRNA can be detected, but predominantly expressed in glioma. MAGE-D4 protein expression and its immunogenicity in glioma have not been elucidated well. This study was designed to analyze MAGE-D4 expression both at mRNA and protein level, characteristic of humoral immune response, and their relationships with glioma patients’ clinicopathological parameters. Recombinant MAGE-D4 protein and antiserum were generated. Quantitative RT-PCR analysis revealed that MAGE-D4 mRNA expression was overall up-regulated in 41 glioma specimens compared with that in 14 normal brain tissues. Immunohistochemistry analysis showed that 78% (21/27) glioma tissues expressed MAGE-D4 protein, which was predominantly located in the cytoplasm of tumor cells, but absent in any neuroglia cell of normal brain tissues. ELISA analysis demonstrated that humoral response against MAGE-D4 was detected in 17% (7/41) of glioma patients’ sera but not in 77 healthy donors. No apparent correlation was observed between the expression and immunogenicity of MAGE-D4 with clinicopathological parameters of glioma. In summary, these results indicate that MAGE-D4 is highly expressed in glioma and can develop specifically humoral response in glioma patients, which supports that it may be a promising biomarker for glioma diagnosis and immunotherapy.     

Genome-wide single nucleotide polymorphism array analysis reveals recurrent genomic alterations associated with histopathologic features in intrahepatic cholangiocarcinoma

Recent studies indicate that genomic alterations (GAs) are associated with many human malignancies. Genome-wide analysis of GAs involved in intrahepatic cholangiocarcinoma (ICC) and association with histopathologic features are limited. To help characterize this relatively rare neoplasm, we collected 32 frozen tissue samples of ICC to study GAs and molecular karyotypes by using single-nucleotide polymorphism array. Recurrent GAs occurring in at least 40% of the patients were further correlated with histopathologic features. Gain of 1q21.3-q23.1 and losses of 1p36.33-p35.3 and 3p26.3-p13 were significantly associated with larger tumor size more than 5 cm in diameter; and loss of 4q13.2-q35.2 with tumor multiplicity. Moreover, losses of 1p36.32-p35.3, 3p26.3-p22.2, 4q13.1-q21.23, 4q31.3-q34.3 and 4q34.3-35.2 were inclined to be associated with high histological grade. As to tumor vascular invasion, gain of 1q21.3-q23.1 and losses of 3p22.1-p12.3 and 4q13.2-q35.2 were significantly associated with tumor vascular invasion. Some regions were concurrently associated with multiple histopathologic characteristics, including loss of 4q13.2-q35.2 associated with larger tumor size, high histological grade and vascular invasion; losses of 1p36.33-p35.3 and 3p26.3-p22.2 with larger tumor size and high histological grade; and gain of 1q21.3-q23.1 with larger tumor size and vascular invasion. Our study indicates that complex chromosomal instability is characteristic of ICC. Detecting crucial GAs will enable risk stratification and development of personalized therapies.     

DOSE-RELATED EFFECTS OF RADIAL EXTRACORPOREAL SHOCK WAVE THERAPY FOR KNEE OSTEOARTHRITIS: A RANDOMIZED CONTROLLED TRIAL

ObjectiveTo assess the dose-related effects of radial extracorporeal shock wave therapy on pain alleviation in knee osteoarthritis.MethodsWith the use of a 2 × 2 factorial randomized controlled design, 89 patients diagnosed with knee osteoarthritis were assigned to 1 of 4 treatment groups, which varied in terms of shock intensity (0.12 mJ/mm², lower density, or 0.24 mJ/mm², higher density) and shock number (2,000 impulses or 4,000 impulses), or to a placebo control. Each group received 4 sessions of radial extracorporeal shock wave therapy, one week apart. The primary outcome was pain intensity measured on a visual analogue scale, and the secondary outcome was the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score. Assessments were performed at baseline, after each session, and at 4-week follow-up.ResultsTwo-way repeated-measures analysis of variance revealed a significant effect on the Pain score for intensity (p < 0.001), with no effect for number (p = 0.467) or the intensity–number interaction (p = 0.536). Similar results were obtained for the WOMAC scores, except for an association between number and WOMAC score (p = 0.036). At the 4-week follow-up, all treatment groups showed greater reductions in the Pain and WOMAC scores than the control group. In addition, scores decreased more at higher densities of shock intensity than at lower densities, while there was no significant difference between the 2,000- and 4,000-shock conditions.ConclusionModerate-intensity radial extracorporeal shock wave therapy was effective, and a higher density might be more efficacious in alleviating pain in knee osteoarthritis.LAY ABSTRACTExtracorporeal shock wave therapy may be a viable treatment for knee osteoarthritis with local pain and dysfunction; however, there are no standards on how to choose the treatment parameters to obtain the best outcome. This study compared 5 different levels of amount of treatment in 89 patients with knee osteoarthritis, and found that a medium intensity of therapy was effective. In addition, a higher intensity of extracorporeal shock wave therapy, rather than higher shock numbers, might result in a higher level of alleviation of symptoms in these patients.Key words: dose-response relationship, radial extracorporeal shock wave therapy, knee osteoarthritis

Knee osteoarthritis (KOA) is the most common degenerative joint lesion; it has a high prevalence and a negative impact on the quality of life of affected individuals (1). It has been reported in a case–control study carried out in North Staffordshire that 9.6% of men and 18% of women have symptomatic KOA at the age of 60 years and over (2). In addition, approximately 25% of the population older than 55 years reports at least one episode of knee pain each year in the United Kingdom.(3). The management of early- medium stage KOA is crucial; the main aims during this stage of conservative therapy for KOA are to relieve pain and enhance joint mobility (4, 5). Treatments for KOA include oral medication, exercise therapy, intra-articular drug injection, and physiotherapy. Among these treatments, radial extracorporeal shock wave therapy (rESWT) has recently attracted increasing attention (6). rESWT is widely used for pain relief and the treatment of musculoskeletal disorders, and has proven beneficial at specific stages of KOA (7).An extracorporeal shock wave is a transient sequence of acoustic pulses with a high peak pressure of 100 MPa, followed by a negative pressure of approximately 5–10 MPa, with an energy density between 0.003 and 0.89 mJ/mm² (8). Radial shock wave devices generate the maximum energy at the probe tip and then distribute it radially into the tissue, providing effective treatment (9). rESWT may be a more acceptable treatment for some patients because of its non-invasiveness, low complication rate, lack of required hospitalization and low cost compared with other approaches. However, rESWT has not met established efficacy standards, and the optimal dose is unknown. A meta-analysis indicated that the effects of rESWT are superior to those of a placebo and physical therapy for pain relief in KOA (10). Nevertheless, an RCT that applied a relatively small dose of radial extracorporeal shock waves did not demonstrate any statistically significant difference from a placebo treatment in terms of pain control in patients with severe KOA (11). Another systematic review identified that the positive energy flux density (EFD) should be as high as possible; however, the dose was based on the subjective feeling of the individual patient (12).It is important to quantify the amount of rESWT needed to reduce symptoms of KOA and establish the efficacy of rESWT. Thus, the primary aim of this prospective randomized placebo-controlled study was to test whether there was a dose-response relationship between the treatment doses and reduction in pain and dysfunction. The secondary aim was to examine whether the mean change in pain and function scores was greater for the active rESWT conditions than for the placebo control 4 weeks after the final treatment.     

Les besoins non couverts des personnes âgées en incapacités fonctionnelles à Bobo-Dioulasso (Burkina Faso)

BackgroundIn sub-Sahara Africa, the strong involvement of the family in multidimensional cares/supports of elderly is often presented like the family ensures almost everything to these people. Thus, few studies have focused on unmet needs of the elderly in their family or above. This study was conducted in Bobo-Dioulasso to identify those needs.MethodsThis is a longitudinal study including 58 people or 15 elderly and 43 caregivers from 15 families in Bobo-Dioulasso. In addition to regular observations of these families during 1 year, we conducted in-depth individual interview with each participant at the beginning and at the end of the study. The data were analyzed using QSR NVivo 8 software.ResultsA priori, respondents let believe that there is no unmet functional needs of the elderly in their family. However, the food, the first and main functional need of the elderly is not qualitatively satisfied by their family as well as other equipments or health needs. The quality of social cares/supports, biomedical cares and community supports are insufficient when these cares/supports are provided. The family demands many free or subsidized services to public or community structures then they are not currently available.DiscussionIn a context of widespread poverty, it is difficult for each actor of the social system of maintaining elderly in functional autonomy to provide services/supports of optimal quality. A synergy of action will reduce the unmet needs of the elderly in Bobo-Dioulasso.     

影响医患关系和谐的诸因素研究——全国十城市典型调查

针对全国十城市医患关系现状典型调查结果，本文从政府因素、医方因素、患方因素和其他因素等四方面视角对影响医患关系和谐的一些因素进行剖析和阐释。     

构建和谐医患关系的对策研究——全国十城市典型调查

针对全国十城市医患关系现状典型调查结果及影响医患关系和谐的因素分析研究，本文从政府责任、医疗保障、法律、医方、心理学、伦理学及医学教育等七个方面对构建和谐医患关系的对策进行多维的跨学科研究。